FMGE 2025 - ENT PYQs Practice Questions

Q: A 45-year-old male was admitted with respiratory distress. CT showed a nasal polyp with fluid collection in the sinus. Drainage of which of the following is obstructed?

Maxillary sinus. ***Maxillary sinus*** - The coronal CT scan clearly shows opacification (fluid collection) in the right **maxillary sinus**, the large air-filled space located inferior to the orbit and lateral to the nasal cavity. - Nasal polyps commonly arise in the **middle meatus**, which is the primary drainage site for the maxillary sinus via the **maxillary ostium**. Obstruction here leads to fluid retention and sinusitis. *Ethmoidal sinus* - The **ethmoidal sinuses** are a complex of small air cells located between the orbits. While some mild mucosal thickening may be present, they are not the site of the large, complete fluid collection seen in the image. - These sinuses also drain into the **middle meatus** (anterior and middle ethmoidal cells) and **superior meatus** (posterior ethmoidal cells), but the primary pathology shown is not within the ethmoid air cells themselves. *Sphenoidal sinus* - The **sphenoidal sinus** is located more posteriorly within the sphenoid bone, behind the ethmoid sinuses, and is not the sinus shown to be opacified in this anterior coronal view. - It drains into the **sphenoethmoidal recess**, a location superior and posterior to the superior turbinate, anatomically distinct from the area affected by the polyp. *Frontal sinus* - The **frontal sinuses** are situated superior to the orbits within the frontal bone. The image shows these sinuses are well-aerated and free of significant fluid. - Drainage of the frontal sinus occurs via the **frontonasal duct** into the **middle meatus**. Obstruction would cause fluid buildup superior to the eye, which is not seen here. [Practice more ENT PYQs on OnCourse]

Q: A 49-year-old female from Nagaland presented with right-sided hearing loss and tinnitus. On examination, dull tympanic membrane with lymph nodes in the posterior triangle of the neck was seen. Which of the following is the management for the condition?

Radiotherapy. ***Correct: Radiotherapy*** - This clinical presentation is **classic for nasopharyngeal carcinoma (NPC)**: middle-aged patient from **Nagaland** (endemic region for NPC in Northeast India), unilateral serous otitis media (dull TM, hearing loss, tinnitus from Eustachian tube obstruction), and **posterior triangle lymphadenopathy** (most characteristic feature) - **NPC is highly radiosensitive** and radiotherapy is the primary treatment modality for all stages - Concurrent chemoradiotherapy is the standard for locally advanced disease - The geographic origin (Nagaland) is a critical clue as NPC has high incidence in Northeast India, Southeast Asia, and Southern China (associated with EBV infection and dietary factors) *Incorrect: Grommet insertion + Steroids* - Treats only the **secondary middle ear effusion**, not the underlying malignancy - Would delay definitive diagnosis and treatment of NPC - May temporarily relieve hearing symptoms but doesn't address the cancer *Incorrect: Steroids* - No role in the treatment of nasopharyngeal carcinoma - May mask symptoms and delay diagnosis - Does not address the underlying malignancy or lymphadenopathy *Incorrect: Grommet insertion* - Only addresses the **symptomatic serous otitis media**, not the primary pathology - The presence of posterior triangle lymph nodes makes malignancy the priority - Any adult with unilateral serous otitis media + cervical lymphadenopathy requires nasopharyngoscopy and biopsy to rule out NPC before symptomatic treatment [Practice more ENT PYQs on OnCourse]

Q: A patient presents to the OPD with hearing loss. On examination: - Rinne test - Positive in the left ear and negative in the right ear - Weber's test - lateralization towards the left - Bone conduction test - Reduced in the right ear and similar in the left ear. Interpret the findings.

Sensorineural hearing loss in right ear. ***Sensorineural hearing loss in right ear***- The **Weber test** lateralizes toward the **left ear**, which acts as the better ear. In cases of **unilateral sensorineural hearing loss (SNHL)**, sound lateralizes to the *unaffected* ear.- The **Bone Conduction (BC)** hearing is explicitly reported as **reduced in the right ear**, which is the definitive finding for damage to the **cochlea** or **auditory nerve** (SNHL).*Sensorineural hearing loss in left ear*- If SNHL was present in the left ear, the **Weber test** would lateralize to the *right ear* (the better ear), contradicting the finding of lateralization to the left.- The Rinne test is **positive** in the left ear (AC > BC), and BC is similar to normal, confirming that the left ear is functioning normally or has only mild SNHL.*Conductive hearing loss in left ear*- A **positive Rinne test** in the left ear (AC > BC) essentially rules out significant **conductive hearing loss (CHL)** in that ear, as CHL results in a negative Rinne test (BC > AC).- While Weber lateralization to the left is consistent with CHL in the left ear, the simultaneous positive Rinne test and normal BC assessment contradict this diagnosis.*Conductive hearing loss in right ear.*- Although the **Rinne test is negative** in the right ear (BC > AC), suggesting CHL, the **Weber test lateralizes to the left**; Weber lateralizes to the *affected* ear only in CHL.- Furthermore, **Bone Conduction is reduced** in the right ear, which is inconsistent with simple CHL, where BC is expected to be normal (or elevated due to masking). [Practice more ENT PYQs on OnCourse]

Q: Identify the treatment option with the image given below:

Type 3 tympanoplasty. ***Type 3 tympanoplasty*** - This procedure, also known as **myringostapediopexy**, involves placing a graft directly onto the head of the stapes, as depicted in the image. - It is indicated when both the **malleus** and **incus** are eroded or absent, but the stapes is intact and mobile, allowing for sound transmission directly to the stapes. *Type 1 Tympanoplasty* - This is a simple repair of a tympanic membrane perforation, also called **myringoplasty**, where the graft is placed to close the hole. - This procedure is only suitable when the **ossicular chain** is completely intact and mobile, which is not the case shown. *Type 2 tympanoplasty* - This is performed when the **malleus** is eroded, and the graft is placed onto the **incus** or the remaining part of the malleus. - The image shows that the incus is also absent, as the graft is placed directly on the stapes, making this option incorrect. *Type 4 tympanoplasty* - This procedure is indicated when only the **stapes footplate** remains and is mobile; the graft is placed directly on the footplate. - This creates a very shallow middle ear space, essentially shielding only the round window and Eustachian tube opening, a more extensive reconstruction than shown. [Practice more ENT PYQs on OnCourse]

Q: A patient presented to the OPD with complaints of greenish black matter in the nose with foul-smelling discharge. What is the diagnosis?

Atrophic rhinitis. ***Atrophic rhinitis***- This condition is characterized by progressive atrophy of the nasal mucosa and underlying turbinate bones, leading to excessively wide nasal cavities.- The presence of large, dry, **greenish-black crusts** that produce a very offensive, sickening smell (**ozena**) is the classic defining feature, matching the patient's presentation.*Allergic rhinitis*- This condition presents with symptoms like watery rhinorrhea, sneezing, nasal itching, and **conjunctivitis**, often triggered by specific allergens.- It is an inflammatory condition and does not result in the mucosal atrophy or the formation of large, fetid, **greenish-black crusts** (ozena).*Rhinitis caseosa*- This rare form is characterized by the accumulation of a firm, malodorous, **cheese-like** (caseous) material that acts as a foreign body within the nasal cavity, differentiating it from the general crusting of atrophic rhinitis.- While it causes a very foul smell, the material retrieved is typically described as caseous or putty-like, not the widespread greenish-black crusts typical of ozena.*Rhinitis sicca*- This condition involves localized **dryness** and minor crusting, often restricted to the anterior nasal septum, typically seen in dry climates or specific occupations.- It is characterized by persistent dryness and discomfort but generally lacks the severe **mucosal atrophy** or the intense, offensive odor (**ozena**) associated with generalized greenish-black crusts found in atrophic rhinitis. [Practice more ENT PYQs on OnCourse]

Question 1

A 45-year-old male was admitted with respiratory distress. CT showed a nasal polyp with fluid collection in the sinus. Drainage of which of the following is obstructed?

Accepted Answer

Maxillary sinus

Answer

Ethmoidal sinus

Answer

Frontal sinus

Answer

Sphenoidal sinus

Question 2

A 49-year-old female from Nagaland presented with right-sided hearing loss and tinnitus. On examination, dull tympanic membrane with lymph nodes in the posterior triangle of the neck was seen. Which of the following is the management for the condition?

Accepted Answer

Radiotherapy

Answer

Grommet insertion + Steroids

Answer

Steroids

Answer

Grommet insertion

Question 3

A patient presents to the OPD with hearing loss. On examination: - Rinne test - Positive in the left ear and negative in the right ear - Weber's test - lateralization towards the left - Bone conduction test - Reduced in the right ear and similar in the left ear. Interpret the findings.

Accepted Answer

Sensorineural hearing loss in right ear

Answer

Conductive hearing loss in left ear

Answer

Conductive hearing loss in right ear

Answer

Sensorineural hearing loss in left ear

Question 4

Identify the treatment option with the image given below:

Accepted Answer

Type 3 tympanoplasty

Answer

Type 2 tympanoplasty

Answer

Type 4 tympanoplasty

Answer

Type 1 tympanoplasty

Question 5

A patient presented to the OPD with complaints of greenish black matter in the nose with foul-smelling discharge. What is the diagnosis?

Accepted Answer

Atrophic rhinitis

Answer

Rhinitis caseosa

Answer

Allergic rhinitis

Answer

Rhinitis sicca

Question 6

Which of the following conditions is associated with Holman-Miller sign in the CT image given below?

Accepted Answer

Juvenile nasopharyngeal angiofibroma

Answer

Nasal polyp

Answer

Rhinosporidiosis

Answer

Maxillary sinusitis

Question 7

A patient with CSOM presented to the OPD with seizures. On examination, homonymous hemianopia was present. Identify the condition based on the CT scan given below.

Accepted Answer

Temporal abscess

Answer

Meningitis

Answer

Cerebellar abscess

Answer

Extradural abscess

Question 8

Which of the following is shown in the image below (circled)?

Accepted Answer

Osteomeatal complex

Answer

Nasal valve

Answer

Columella

Answer

Crest of maxilla

Question 9

A patient presents with a fish bone stuck in the pyriform sinus. During the removal procedure, there is accidental nerve injury. Which nerve is most likely to be damaged?

Accepted Answer

Internal branch of the superior laryngeal nerve

Answer

Recurrent laryngeal nerve

Answer

Glossopharyngeal nerve

Answer

External branch of the superior laryngeal nerve

Question 10

Human papillomavirus (HPV) infection is most strongly associated with which of the following head and neck cancers?

Accepted Answer

Oropharyngeal carcinoma

Answer

Laryngeal carcinoma

Answer

Hypopharyngeal carcinoma

Answer

Nasopharyngeal carcinoma

FMGE 2025 — ENT