NEET-PG 2025 — ENT

Q: A 72-year-old female smoker presents with a long history of hoarseness and difficulty swallowing. Laryngoscopy and biopsy confirm a large, advanced squamous cell carcinoma that involves both vocal cords and extends into the subglottic region and the thyroid cartilage. The tumor is not amenable to radiation therapy alone. Based on the extent and location of the tumor, which of the following surgical procedures is most appropriate to ensure complete tumor removal with adequate margins and control the disease?

Total laryngectomy. ***Total laryngectomy*** - This procedure is the standard of care for **advanced laryngeal carcinoma (T3/T4a)** when there is extensive involvement, including the **thyroid cartilage invasion** and extension into the **subglottic region**. - Given the tumor's size, bilateral cord involvement, and lack of response to primary radiation, total laryngectomy is required to achieve complete tumor removal with **negative surgical margins**. *Partial laryngectomy* - This technique is generally restricted to **early-stage tumors (T1 or T2)** confined to one part of the larynx without substantial cartilage or subglottic spread. - Attempting a partial resection on a large, bilateral tumor with **cartilage invasion** would result in positive margins and an unacceptable risk of local recurrence. *Emergency tracheostomy* - This is a procedure performed solely to relieve **acute airway obstruction**, which may occur in advanced laryngeal cancer, but it is not a curative treatment for the malignancy itself. - It addresses the symptom (airway compromise) but fails to remove the **squamous cell carcinoma** that is threatening the patient's life. *Submental tracheostomy* - A tracheostomy is an airway management procedure, not a definitive oncologic surgery for removing a large laryngeal tumor. - A standard tracheostomy (for airway placement) is sometimes needed, but placing it specifically in the **submental region** is not the standard location for a permanent tracheostoma following curative total laryngectomy. [Practice more ENT PYQs on OnCourse]

Q: A 12-year-old male with a history of recurrent epistaxis presents with nasal obstruction for the past 1 year. On examination the presence of nasal mass and investigation shows bowing of the posterior wall of maxillary sinus. What is the probable diagnosis?

Nasopharyngeal angiofibroma. ***Nasopharyngeal angiofibroma*** - This diagnosis is strongly suggested by the classic triad of **adolescent male** (12 years old), **recurrent epistaxis**, and **nasal obstruction** - the typical presentation of this benign but locally aggressive tumor. - The **Holman-Miller sign** (bowing of the posterior wall of maxillary sinus) is pathognomonic for nasopharyngeal angiofibroma, indicating aggressive expansion and bony remodeling. *Rhinosporidiosis* - This condition presents as **friable, strawberry-like polyps** that may bleed, but doesn't cause the severe, recurrent epistaxis seen in this case. - It does not cause aggressive **bony remodeling** or the characteristic Holman-Miller sign seen on imaging. *Antrochoanal polyp* - While it can cause **unilateral nasal obstruction**, it rarely presents with severe, recurrent **epistaxis** as the predominant feature. - This benign polyp does not cause the aggressive **bony expansion** and Holman-Miller sign characteristic of angiofibroma. *Rhinoscleroma* - This chronic granulomatous infection caused by **Klebsiella rhinoscleromatis** typically presents with firm, sclerotic lesions and **crusting**. - It rarely causes the prominent, recurrent **epistaxis** or the destructive bony changes (Holman-Miller sign) seen in this patient. [Practice more ENT PYQs on OnCourse]

Q: A 30-year-old male presents to the clinic with a history of recurrent ear infections and a recent "popping" sensation in his left ear. Otoscopic examination of the left ear reveals a central perforation of the tympanic membrane. The pure tone audiometry (PTA) results show the following: Right Ear: Air conduction and bone conduction thresholds are within normal limits. Left Ear: A significant air-bone gap is present, with bone conduction thresholds within the normal range. Based on these findings, what is the most likely diagnosis regarding the type of hearing loss?

Left conductive hearing loss. ***Left conductive hearing loss*** - A conductive hearing loss is defined on PTA by the presence of a significant **air-bone gap** (AC threshold worse than BC threshold) with **normal bone conduction** thresholds. - The otoscopic finding of a **central perforation of the tympanic membrane** indicates a pathology in the middle ear/conducting mechanism, which is the classical cause of a conductive loss. *Left sensorineural hearing loss* - This type of loss occurs when both **air conduction** and **bone conduction** thresholds are equally reduced (no air-bone gap) and are outside the normal limits. - It indicates a problem with the **cochlea** or the **auditory nerve**, which contradicts the normal bone conduction found in the left ear. *Right conductive hearing loss* - The PTA results for the right ear showed **air and bone conduction thresholds** within normal limits, confirming **normal hearing** in the right ear. - Therefore, a hearing loss of any type in the right ear is ruled out by the objective audiometric data. *Right sensorineural hearing loss* - This would require both air and bone conduction thresholds in the right ear to be significantly elevated (impaired), which is inconsistent with the **normal audiometry findings** reported for the right ear. [Practice more ENT PYQs on OnCourse]

Q: A patient presents to the emergency department with significant nasal trauma after a fall. Examination reveals a deviated nasal pyramid and palpation confirms crepitus and mobility of the nasal bones. A lateral nasal bone X-ray confirms a displaced nasal bone fracture. Which of the following instruments is specifically designed for the closed reduction of a displaced nasal bone fracture?

Walsham forceps. ***Walsham forceps*** - The **Walsham forceps** is specifically designed for the **closed reduction** of displaced nasal bone fractures, utilizing an internal blade and an external padded blade for controlled lifting and manipulation. - They allow the surgeon to gain purchase on the fractured segments to safely elevate **depressed nasal bones** and restore the nasal pyramid's shape. *Tilley's forceps* - **Tilley's nasal dressing forceps** are primarily used for general purposes, such as removing foreign bodies, packing the nose, or removing **small polyps** from the nasal cavity. - They lack the necessary structure, leverage, and specialized curve required to successfully engage and **reduce** a bony nasal fracture. *Luc's forceps* - **Luc's forceps** are generally used for applying **anterior nasal packing** or removing dressings, serving primarily as a dressing forceps. - Although used in the nose, they do not have the specialized geometry needed to grasp and elevate the bony cartilage for **fracture reduction**. *Bayonet forceps* - **Bayonet forceps** are commonly used in microscopic or endoscopic procedures (e.g., ear or fine nasal surgery) because their offset handle prevents the surgeon's hand from obstructing the line of sight. - They are used for fine grasping, packing, or dissection, but are entirely unsuitable for the heavy task of **reducing** a **displaced nasal bone fracture**. [Practice more ENT PYQs on OnCourse]

Q: A patient presents to the clinic with a history of chronic ear drainage and hearing loss for several months. Otoscopic examination reveals a central perforation of the tympanic membrane. Pure tone audiometry confirms a conductive hearing loss. Based on these findings, what is the most appropriate next step in the definitive management of this patient's condition?

Myringoplasty. ***Myringoplasty*** - This procedure involves the surgical repair of the **tympanic membrane (TM)** perforation (a central perforation in this case) and is the definitive treatment for chronic otitis media, tubotympanic type (safe CSOM). - Repairing the TM perforation eliminates the source of chronic drainage and optimally helps in resolving the **conductive hearing loss** by restoring the vibrating surface. *Modified radical mastoidectomy* - This procedure is primarily reserved for **unsafe chronic otitis media** (Atticoantral disease), typically involving **cholesteatoma** or extensive irreversible mucosal disease in the mastoid. - Since the patient has a **central perforation** (safe type) without mention of retraction pockets or cholesteatoma, this extensive surgery is overmanagement and not indicated. *Exploratory tympanostomy* - This term generally refers to making an incision in the TM (myringotomy) or placing a **ventilation tube (grommet)**, typically done for otitis media with effusion (serous otitis media). - It does not address the underlying **chronic irreversible perforation** of the TM causing the current symptoms; surgical repair is required. *Immediate commencement of broad-spectrum oral antibiotics* - Antibiotics are useful for managing acute exacerbations of CSOM (controlling active discharge or infection) but are not the **definitive treatment** for the underlying structural pathology (chronic perforation). - They cannot **repair the tympanic membrane** or permanently restore hearing; the structural defect requires surgical intervention (myringoplasty). [Practice more ENT PYQs on OnCourse]

6 Previous Year Questions with Answers & Explanations

Questions

A 72-year-old female smoker presents with a long history of hoarseness and difficulty swallowing. Laryngoscopy and biopsy confirm a large, advanced squamous cell carcinoma that involves both vocal cords and extends into the subglottic region and the thyroid cartilage. The tumor is not amenable to radiation therapy alone. Based on the extent and location of the tumor, which of the following surgical procedures is most appropriate to ensure complete tumor removal with adequate margins and control the disease?

A 12-year-old male with a history of recurrent epistaxis presents with nasal obstruction for the past 1 year. On examination the presence of nasal mass and investigation shows bowing of the posterior wall of maxillary sinus. What is the probable diagnosis?

A 30-year-old male presents to the clinic with a history of recurrent ear infections and a recent "popping" sensation in his left ear. Otoscopic examination of the left ear reveals a central perforation of the tympanic membrane. The pure tone audiometry (PTA) results show the following: Right Ear: Air conduction and bone conduction thresholds are within normal limits. Left Ear: A significant air-bone gap is present, with bone conduction thresholds within the normal range. Based on these findings, what is the most likely diagnosis regarding the type of hearing loss?

A patient presents to the emergency department with significant nasal trauma after a fall. Examination reveals a deviated nasal pyramid and palpation confirms crepitus and mobility of the nasal bones. A lateral nasal bone X-ray confirms a displaced nasal bone fracture. Which of the following instruments is specifically designed for the closed reduction of a displaced nasal bone fracture?

A patient presents to the clinic with a history of chronic ear drainage and hearing loss for several months. Otoscopic examination reveals a central perforation of the tympanic membrane. Pure tone audiometry confirms a conductive hearing loss. Based on these findings, what is the most appropriate next step in the definitive management of this patient's condition?

A 40-year-old patient presents with recurrent and severe nosebleeds from the anterior nasal septum. The bleeding has been refractory to nasal packing and chemical cautery. A decision is made to proceed with surgical ligation to control the bleeding. Which of the following arteries is the primary target for ligation in the management of this patient's anterior epistaxis?

NEET-PG 2025 - ENT NEET-PG Practice Questions and MCQs

Question 1: A 72-year-old female smoker presents with a long history of hoarseness and difficulty swallowing. Laryngoscopy and biopsy confirm a large, advanced squamous cell carcinoma that involves both vocal cords and extends into the subglottic region and the thyroid cartilage. The tumor is not amenable to radiation therapy alone. Based on the extent and location of the tumor, which of the following surgical procedures is most appropriate to ensure complete tumor removal with adequate margins and control the disease?

A. Emergency tracheostomy
B. Submental tracheostomy
C. Partial laryngectomy
D. Total laryngectomy (Correct Answer)

Explanation: ***Total laryngectomy*** - This procedure is the standard of care for **advanced laryngeal carcinoma (T3/T4a)** when there is extensive involvement, including the **thyroid cartilage invasion** and extension into the **subglottic region**. - Given the tumor's size, bilateral cord involvement, and lack of response to primary radiation, total laryngectomy is required to achieve complete tumor removal with **negative surgical margins**. *Partial laryngectomy* - This technique is generally restricted to **early-stage tumors (T1 or T2)** confined to one part of the larynx without substantial cartilage or subglottic spread. - Attempting a partial resection on a large, bilateral tumor with **cartilage invasion** would result in positive margins and an unacceptable risk of local recurrence. *Emergency tracheostomy* - This is a procedure performed solely to relieve **acute airway obstruction**, which may occur in advanced laryngeal cancer, but it is not a curative treatment for the malignancy itself. - It addresses the symptom (airway compromise) but fails to remove the **squamous cell carcinoma** that is threatening the patient's life. *Submental tracheostomy* - A tracheostomy is an airway management procedure, not a definitive oncologic surgery for removing a large laryngeal tumor. - A standard tracheostomy (for airway placement) is sometimes needed, but placing it specifically in the **submental region** is not the standard location for a permanent tracheostoma following curative total laryngectomy.

Question 2: A 12-year-old male with a history of recurrent epistaxis presents with nasal obstruction for the past 1 year. On examination the presence of nasal mass and investigation shows bowing of the posterior wall of maxillary sinus. What is the probable diagnosis?

A. Nasopharyngeal angiofibroma (Correct Answer)
B. Rhinosporidiosis
C. Antrochoanal polyp
D. Rhinoscleroma

Explanation: ***Nasopharyngeal angiofibroma*** - This diagnosis is strongly suggested by the classic triad of **adolescent male** (12 years old), **recurrent epistaxis**, and **nasal obstruction** - the typical presentation of this benign but locally aggressive tumor. - The **Holman-Miller sign** (bowing of the posterior wall of maxillary sinus) is pathognomonic for nasopharyngeal angiofibroma, indicating aggressive expansion and bony remodeling. *Rhinosporidiosis* - This condition presents as **friable, strawberry-like polyps** that may bleed, but doesn't cause the severe, recurrent epistaxis seen in this case. - It does not cause aggressive **bony remodeling** or the characteristic Holman-Miller sign seen on imaging. *Antrochoanal polyp* - While it can cause **unilateral nasal obstruction**, it rarely presents with severe, recurrent **epistaxis** as the predominant feature. - This benign polyp does not cause the aggressive **bony expansion** and Holman-Miller sign characteristic of angiofibroma. *Rhinoscleroma* - This chronic granulomatous infection caused by **Klebsiella rhinoscleromatis** typically presents with firm, sclerotic lesions and **crusting**. - It rarely causes the prominent, recurrent **epistaxis** or the destructive bony changes (Holman-Miller sign) seen in this patient.

Question 3: A 30-year-old male presents to the clinic with a history of recurrent ear infections and a recent "popping" sensation in his left ear. Otoscopic examination of the left ear reveals a central perforation of the tympanic membrane. The pure tone audiometry (PTA) results show the following: Right Ear: Air conduction and bone conduction thresholds are within normal limits. Left Ear: A significant air-bone gap is present, with bone conduction thresholds within the normal range. Based on these findings, what is the most likely diagnosis regarding the type of hearing loss?

A. Left conductive hearing loss (Correct Answer)
B. Right sensorineural hearing loss
C. Left sensorineural hearing loss
D. Right conductive hearing loss

Explanation: ***Left conductive hearing loss*** - A conductive hearing loss is defined on PTA by the presence of a significant **air-bone gap** (AC threshold worse than BC threshold) with **normal bone conduction** thresholds. - The otoscopic finding of a **central perforation of the tympanic membrane** indicates a pathology in the middle ear/conducting mechanism, which is the classical cause of a conductive loss. *Left sensorineural hearing loss* - This type of loss occurs when both **air conduction** and **bone conduction** thresholds are equally reduced (no air-bone gap) and are outside the normal limits. - It indicates a problem with the **cochlea** or the **auditory nerve**, which contradicts the normal bone conduction found in the left ear. *Right conductive hearing loss* - The PTA results for the right ear showed **air and bone conduction thresholds** within normal limits, confirming **normal hearing** in the right ear. - Therefore, a hearing loss of any type in the right ear is ruled out by the objective audiometric data. *Right sensorineural hearing loss* - This would require both air and bone conduction thresholds in the right ear to be significantly elevated (impaired), which is inconsistent with the **normal audiometry findings** reported for the right ear.

Question 4: A patient presents to the emergency department with significant nasal trauma after a fall. Examination reveals a deviated nasal pyramid and palpation confirms crepitus and mobility of the nasal bones. A lateral nasal bone X-ray confirms a displaced nasal bone fracture. Which of the following instruments is specifically designed for the closed reduction of a displaced nasal bone fracture?

A. Luc's forceps
B. Bayonet forceps
C. Walsham forceps (Correct Answer)
D. Tilley's forceps

Explanation: ***Walsham forceps*** - The **Walsham forceps** is specifically designed for the **closed reduction** of displaced nasal bone fractures, utilizing an internal blade and an external padded blade for controlled lifting and manipulation. - They allow the surgeon to gain purchase on the fractured segments to safely elevate **depressed nasal bones** and restore the nasal pyramid's shape. *Tilley's forceps* - **Tilley's nasal dressing forceps** are primarily used for general purposes, such as removing foreign bodies, packing the nose, or removing **small polyps** from the nasal cavity. - They lack the necessary structure, leverage, and specialized curve required to successfully engage and **reduce** a bony nasal fracture. *Luc's forceps* - **Luc's forceps** are generally used for applying **anterior nasal packing** or removing dressings, serving primarily as a dressing forceps. - Although used in the nose, they do not have the specialized geometry needed to grasp and elevate the bony cartilage for **fracture reduction**. *Bayonet forceps* - **Bayonet forceps** are commonly used in microscopic or endoscopic procedures (e.g., ear or fine nasal surgery) because their offset handle prevents the surgeon's hand from obstructing the line of sight. - They are used for fine grasping, packing, or dissection, but are entirely unsuitable for the heavy task of **reducing** a **displaced nasal bone fracture**.

Question 5: A patient presents to the clinic with a history of chronic ear drainage and hearing loss for several months. Otoscopic examination reveals a central perforation of the tympanic membrane. Pure tone audiometry confirms a conductive hearing loss. Based on these findings, what is the most appropriate next step in the definitive management of this patient's condition?

A. Immediate commencement of broad-spectrum oral antibiotics
B. Myringoplasty (Correct Answer)
C. Modified radical mastoidectomy
D. Exploratory tympanostomy

Explanation: ***Myringoplasty*** - This procedure involves the surgical repair of the **tympanic membrane (TM)** perforation (a central perforation in this case) and is the definitive treatment for chronic otitis media, tubotympanic type (safe CSOM). - Repairing the TM perforation eliminates the source of chronic drainage and optimally helps in resolving the **conductive hearing loss** by restoring the vibrating surface. *Modified radical mastoidectomy* - This procedure is primarily reserved for **unsafe chronic otitis media** (Atticoantral disease), typically involving **cholesteatoma** or extensive irreversible mucosal disease in the mastoid. - Since the patient has a **central perforation** (safe type) without mention of retraction pockets or cholesteatoma, this extensive surgery is overmanagement and not indicated. *Exploratory tympanostomy* - This term generally refers to making an incision in the TM (myringotomy) or placing a **ventilation tube (grommet)**, typically done for otitis media with effusion (serous otitis media). - It does not address the underlying **chronic irreversible perforation** of the TM causing the current symptoms; surgical repair is required. *Immediate commencement of broad-spectrum oral antibiotics* - Antibiotics are useful for managing acute exacerbations of CSOM (controlling active discharge or infection) but are not the **definitive treatment** for the underlying structural pathology (chronic perforation). - They cannot **repair the tympanic membrane** or permanently restore hearing; the structural defect requires surgical intervention (myringoplasty).

Question 6: A 40-year-old patient presents with recurrent and severe nosebleeds from the anterior nasal septum. The bleeding has been refractory to nasal packing and chemical cautery. A decision is made to proceed with surgical ligation to control the bleeding. Which of the following arteries is the primary target for ligation in the management of this patient's anterior epistaxis?

A. Internal maxillary artery
B. Sphenopalatine artery (Correct Answer)
C. Anterior ethmoidal artery
D. Facial artery

Explanation: ***Sphenopalatine artery*** - The **Sphenopalatine artery** (terminal branch of the internal maxillary artery) is the **dominant blood supply** to the nasal cavity, including the anterior nasal septum via its **septal branches**. - It is the **major contributor** to **Kiesselbach's plexus** (Little's area), which is located in the anteroinferior nasal septum and is the source of 90% of anterior epistaxis. - **Endoscopic sphenopalatine artery ligation (ESPAL)** is the **first-line surgical intervention** for refractory anterior epistaxis that has failed conservative management (packing, cautery). - This procedure has high success rates (85-95%) and is now the gold standard for surgical management of severe anterior and posterior epistaxis. *Anterior ethmoidal artery* - Branch of the **ophthalmic artery** (internal carotid system) that supplies the **superior anterior** nasal cavity and anterior ethmoid cells. - It contributes **minimally** to Kiesselbach's plexus; its main territory is the **roof and upper anterior nasal cavity**. - Anterior ethmoidal artery ligation (via external or endoscopic approach) is indicated for **superior anterior** or **roof bleeding**, NOT typical anteroinferior septal bleeding. *Facial artery* - The **superior labial artery** (branch of facial artery) contributes to the inferior aspect of Kiesselbach's plexus but is a **minor contributor**. - Facial artery ligation is **ineffective** for controlling severe nasal bleeding as it is too distal and doesn't address the main vascular supply. *Internal maxillary artery* - Parent vessel of the sphenopalatine artery; ligation is performed when **sphenopalatine artery ligation is technically difficult or has failed**. - Historically performed via **transantral (Caldwell-Luc) approach**, now rarely needed due to success of endoscopic sphenopalatine artery ligation. - Reserved for severe refractory cases or when endoscopic access is not feasible.