Otolaryngology Basics Practice Questions

Q: Identify the instrument used in ENT surgery.

Eve's Tonsillar snare. ***Eve's Tonsillar snare*** - A specialized **wire loop instrument** designed specifically for **tonsillectomy procedures**, featuring a adjustable wire snare that can be tightened around the tonsillar tissue. - Has a distinctive **long handle** with a **trigger mechanism** that allows controlled tightening of the wire loop to safely remove tonsils by cutting through tissue while minimizing bleeding. *Luc Nasal forceps* - Primarily used for **nasal procedures** and **septoplasty**, not for tonsillar surgery, with curved tips designed for grasping nasal structures. - Features **delicate, curved jaws** specifically designed for **intranasal work** rather than the robust cutting mechanism needed for tonsillectomy. *Denis Browne Tonsil Holding forceps* - Used to **grasp and stabilize** the tonsil during surgery but **cannot perform the actual removal** - it's an accessory instrument rather than the primary cutting tool. - Functions as a **tissue holder** to provide traction and visualization during tonsillectomy, but requires additional instruments like the tonsillar snare for actual excision. *St Clair Thompson curette* - A **scraping instrument** with a sharp, spoon-shaped end used for **adenoidectomy** and removal of adenoid tissue from the nasopharynx. - Designed for **curettage procedures** in the **posterior nasal space**, not suitable for the precise cutting and removal required in tonsillectomy.

Q: A patient with Pancoast's tumour develops loss of voice after radiation. What is the most likely cause?

Involvement of the recurrent laryngeal nerve. ### Explanation **Correct Option: B. Involvement of the recurrent laryngeal nerve** **The Medical Concept:** A Pancoast tumor (Superior Sulcus Tumor) is a bronchogenic carcinoma located at the apex of the lung. The **Left Recurrent Laryngeal Nerve (RLN)** has a long intrathoracic course, looping under the arch of the aorta. In the context of apical lung tumors, the nerve is frequently involved either by direct tumor infiltration or by the development of **post-radiation fibrosis**. Radiation therapy induces scarring and fibrotic changes in the mediastinum and apex, which can compress or entrap the RLN, leading to vocal cord paralysis and subsequent hoarseness or loss of voice. **Analysis of Incorrect Options:** * **A. Vocal cord infiltration:** Pancoast tumors are located at the lung apex. Direct infiltration of the vocal cords is anatomically impossible as they are located superiorly in the larynx. * **C. Direct irradiation to vocal cords:** Radiation for a Pancoast tumor is targeted at the lung apex and superior mediastinum. The larynx is typically outside the primary radiation field for this pathology. * **D. Radiation stenosis of the larynx:** While radiation to the neck (e.g., for laryngeal cancer) can cause stenosis, it is not a complication of treating a lung apex tumor. **NEET-PG High-Yield Pearls:** * **Anatomy:** The **Left RLN** is more commonly involved in thoracic pathologies (aortic aneurysm, lung cancer) due to its lower loop around the aorta. The **Right RLN** loops around the subclavian artery. * **Pancoast Syndrome:** Classically presents with Horner’s syndrome (miosis, ptosis, anhidrosis) due to involvement of the sympathetic chain (stellate ganglion) and pain in the C8-T2 distribution. * **Ortner’s Syndrome:** Hoarseness caused by Left RLN compression due to a dilated left atrium (mitral stenosis).

Q: Tracheostomy is indicated in all of the following conditions except:

Uncomplicated bronchial asthma. **Explanation:** Tracheostomy is a surgical procedure that creates an opening in the anterior wall of the trachea to bypass an upper airway obstruction, provide long-term ventilation, or facilitate tracheobronchial toilet. **Why Option D is the correct answer:** In **uncomplicated bronchial asthma**, the pathology lies in the **lower airways** (reversible bronchoconstriction of the bronchi and bronchioles). Since the obstruction is distal to the trachea, a tracheostomy—which bypasses the upper airway—will not relieve the bronchospasm. Management involves medical therapy (bronchodilators, steroids) or mechanical ventilation via endotracheal intubation if respiratory failure occurs. **Analysis of Incorrect Options:** * **A. Tracheal Stenosis:** Narrowing of the trachea often requires a tracheostomy to bypass the stenotic segment and maintain a patent airway. * **B. Bilateral Vocal Cord Palsy:** In the abductor variety (e.g., post-thyroidectomy), the vocal cords remain in the midline, causing acute inspiratory stridor. A tracheostomy is life-saving here. * **C. Foreign Body in the Larynx:** An impacted foreign body can cause complete upper airway obstruction. If it cannot be removed via laryngoscopy immediately, an emergency tracheostomy or cricothyroidotomy is indicated. **High-Yield Clinical Pearls for NEET-PG:** * **Level of Tracheostomy:** Usually performed at the level of the **2nd, 3rd, or 4th tracheal rings**. * **Emergency Procedure:** In a "cannot intubate, cannot ventilate" scenario, **Cricothyroidotomy** is the fastest emergency procedure, followed by a formal tracheostomy later. * **Most Common Indication:** Currently, the most common indication is **prolonged intubation** (to prevent subglottic stenosis). * **Post-Op Complication:** The most common immediate complication is **hemorrhage**; the most common late complication is **tracheal stenosis**.

Question 1

A 52-year-old woman presents with bilateral hearing loss noticed over the past 3 years. She denies tinnitus or vertigo. Otoscopic examination is normal bilaterally with intact, healthy tympanic membranes. Tympanometry shows bilateral type As (shallow) curves. The audiogram is shown in Image 1. She is medically fit for surgery but strongly wishes to avoid an operation at this time. Which of the following is the most appropriate next step in management?

Accepted Answer

D. Prescription of bilateral hearing aids as the preferred nonoperative intervention

Answer

A. Staged stapedectomy beginning with the worse-hearing ear

Answer

B. Bilateral myringotomy with grommet insertion

Answer

C. Sodium fluoride therapy and annual audiological monitoring

Question 2

A 32-year-old woman presents with progressive bilateral hearing loss over 3 years, worse during pregnancy. She reports a family history of hearing impairment. Otoscopy reveals normal tympanic membranes bilaterally. Tympanometry shows As (shallow) curves. Her audiogram is shown (Image 1). Which of the following best explains the bone conduction dip seen on this audiogram?

Accepted Answer

A. Mechanical stiffness of the ossicular chain altering the inertial component of bone conduction

Answer

B. Sensorineural degeneration of outer hair cells in the basal turn of the cochlea

Answer

C. Endolymphatic hydrops causing distortion of the basilar membrane at that frequency

Answer

D. Disruption of the ossiculotympanic component of bone conduction due to tympanic membrane perforation

Question 3

Identify the instrument used in ENT surgery.

Accepted Answer

Eve's Tonsillar snare

Answer

Luc Nasal forceps

Answer

Denis Browne Tonsil Holding forceps

Answer

St Clair Thompson curette

Question 4

A patient with Pancoast's tumour develops loss of voice after radiation. What is the most likely cause?

Accepted Answer

Involvement of the recurrent laryngeal nerve

Answer

Vocal cord infiltration with secondary effects

Answer

Direct irradiation to vocal cords

Answer

Radiation stenosis of the larynx

Question 5

Tracheostomy is indicated in all of the following conditions except:

Accepted Answer

Uncomplicated bronchial asthma

Answer

Tracheal stenosis

Answer

Bilateral vocal cord palsy

Answer

Foreign body in the larynx

Otolaryngology Basics — MCQs

Otolaryngology Basics — MCQs

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