All are major symptoms of sinusitis except?
What is the characteristic feature of ethmoidal polyps?
Which of the following statements about acute retropharyngeal abscess is true?
Which part of the larynx is most commonly involved in tuberculosis (TB)?
Laryngitis sicca is associated with ?
Hot potato voice is characteristic of ?
All are absolute indications of tonsillectomy except which of the following?
Early tonsillectomy is not done in?
Which of the following statements about laryngeal tuberculosis (TB) is true?
During functional endoscopic sinus surgery the position of the patient is
NEET-PG 2013 - ENT NEET-PG Practice Questions and MCQs
Question 21: All are major symptoms of sinusitis except?
- A. Nasal blockage
- B. Facial congestion
- C. Halitosis (Correct Answer)
- D. Anosmia
Explanation: ***Halitosis*** - While **halitosis** (bad breath) can be a symptom associated with sinusitis due to post-nasal drip and bacterial overgrowth, it is generally considered a **minor symptom** or a secondary effect rather than one of the primary, defining features. - Major symptoms focus on those directly caused by inflammation and obstruction of the sinuses. *Nasal blockage* - **Nasal blockage** or congestion is a cardinal symptom of sinusitis, resulting from inflammation and swelling of the nasal and sinus mucosa. - It often leads to difficulty breathing through the nose and contributes to a feeling of fullness. *Facial congestion* - **Facial congestion** or pressure is a key symptom of sinusitis, caused by the buildup of fluid and inflammation within the sinus cavities. - This symptom can manifest as pain or pressure around the eyes, cheeks, and forehead. *Anosmia* - **Anosmia**, or the loss of smell, is a significant symptom of sinusitis, particularly chronic sinusitis. - It occurs due to the inflammation and obstruction of the nasal passages, preventing odorants from reaching the olfactory receptors.
Question 22: What is the characteristic feature of ethmoidal polyps?
- A. Usually multiple
- B. Typically recurrent (Correct Answer)
- C. Can occur in children
- D. Can be associated with infections
Explanation: ***Typically recurrent*** - Ethmoidal polyps, especially those associated with **chronic rhinosinusitis** with nasal polyps, have a high tendency to **recur** even after surgical removal. - This recurrence is due to the underlying inflammatory process in the ethmoid sinuses and represents their most characteristic clinical feature. - Recurrence rates can reach **20-30%** even after functional endoscopic sinus surgery (FESS). *Usually multiple* - While ethmoidal polyps are often **multiple**, this is a common descriptive feature rather than their most characteristic pathological tendency. - Their multiplicity contributes to nasal obstruction and other symptoms but does not distinguish them as uniquely as their recurrence rate. *Can occur in children* - Though less common than in adults, **ethmoidal polyps can occur in children**, particularly in association with conditions like cystic fibrosis or primary ciliary dyskinesia. - However, nasal polyps in children are **rare** and should prompt investigation for underlying systemic conditions. *Can be associated with infections* - While chronic rhinosinusitis with polyps can be complicated by **bacterial infections**, the polyps themselves are primarily an inflammatory response, not directly caused by infections in most cases of ethmoidal polyps. - Their primary association is with chronic inflammation and not solely with acute or chronic infections.
Question 23: Which of the following statements about acute retropharyngeal abscess is true?
- A. Treatment often involves incision and drainage.
- B. Acute retropharyngeal abscess is common in adults.
- C. Swelling typically occurs unilaterally.
- D. Acute retropharyngeal abscess is often due to lymphadenitis. (Correct Answer)
Explanation: ***Acute retropharyngeal abscess is often due to lymphadenitis.*** - The **retropharyngeal lymph nodes** (nodes of Rouviere) are prominent in children and drain the nasopharynx, oropharynx, and paranasal sinuses. Infection in these areas can lead to **suppurative lymphadenitis**, which can then progress to an abscess. - **Lymphadenitis** following an upper respiratory tract infection is the **most common etiology** in children, who represent the majority of cases. This is a characteristic pathophysiological mechanism specific to retropharyngeal abscesses. - While other causes exist (trauma, foreign bodies, odontogenic infections in adults), this statement best captures the typical presentation and etiology. *Acute retropharyngeal abscess is common in adults.* - **Retropharyngeal abscesses** are far more common in **children**, especially those under 6 years of age, due to the presence of prominent retropharyngeal lymph nodes that typically atrophy by age 5-6. - In adults, retropharyngeal abscesses are rarer and usually result from trauma, foreign bodies, or odontogenic infections rather than lymphadenitis. *Swelling typically occurs unilaterally.* - The **retropharyngeal space** is a **midline structure**, and infection typically causes **bilateral** or central swelling. - **Edema and inflammation** affect the entire space, leading to generalized posterior pharyngeal wall bulging rather than true unilateral presentation. - While some asymmetry may be visible, describing the swelling as "typically unilateral" is inaccurate. *Treatment often involves incision and drainage.* - While this statement is technically true for **mature abscesses**, it is **incomplete** as a characterizing statement about retropharyngeal abscesses. - Treatment depends on stage: **early phlegmon or cellulitis** may respond to **intravenous antibiotics alone**, while a **mature abscess** requires both **I&D and antibiotics**. - The statement lacks the important context that **antibiotics are the cornerstone** of treatment, with surgical drainage reserved for established abscesses. - This is a treatment modality rather than a defining characteristic of the condition, making it a less complete answer than the etiology-based statement.
Question 24: Which part of the larynx is most commonly involved in tuberculosis (TB)?
- A. Anterior
- B. Posterior (Correct Answer)
- C. Middle
- D. Anywhere
Explanation: ***Posterior*** - The **posterior larynx**, specifically the **arytenoids** and **interarytenoid area**, is the most common site for tuberculosis involvement. - This region is susceptible due to its rich **lymphatic supply** and direct exposure to infected secretions from the lungs. *Anterior* - While TB can affect any part of the larynx, the **anterior laryngeal structures** are less frequently the primary site of involvement. - The vocal cords, which are in the anterior-middle aspect, are less commonly affected initially compared to the posterior structures. *Middle* - The middle part of the larynx, including the **vocal cords**, is not the predominant site for initial tuberculous lesions. - Involvement here often occurs as the disease progresses from more commonly affected areas. *Anywhere* - Although TB can theoretically affect any part of the larynx, it demonstrates a strong predilection for the **posterior laryngeal region**. - Stating "anywhere" does not accurately reflect the statistically significant preference for specific anatomical sites.
Question 25: Laryngitis sicca is associated with ?
- A. Rhinosporidium
- B. M. leprae
- C. Klebsiella ozaenae
- D. Klebsiella rhinoscleromatosis (Correct Answer)
Explanation: ***Klebsiella rhinoscleromatis*** - **Laryngitis sicca** is characterized by extreme dryness and crusting of the laryngeal mucosa, which is a known manifestation of complications due to **Rhinoscleroma**. - **Rhinoscleroma** is a chronic granulomatous disease caused by *Klebsiella rhinoscleromatis* (formerly *K. rhinoscleromatosis*), primarily affecting the upper respiratory tract including the larynx. *Rhinosporidium* - **Rhinosporidium seeberi** is an aquatic protistan parasite that causes **rhinosporidiosis**, characterized by friable, polypoidal lesions, often in the nose, but typically not laryngitis sicca. - The lesions caused by Rhinosporidium are usually vascular and bleeding, rather than dry and crusting. *M. leprae* - **Mycobacterium leprae** is the causative agent of **leprosy**, a chronic infectious disease primarily affecting the skin, peripheral nerves, upper respiratory tract mucosa, eyes, and testes. - While *M. leprae* can affect the larynx, it typically causes **granulomatous infiltration** and nodule formation leading to hoarseness and stridor, not specifically laryngitis sicca. *Klebsiella ozaenae* - *Klebsiella ozaenae* is associated with **ozena**, a form of chronic atrophic rhinitis characterized by a foul odor, crusting, and atrophy of nasal mucosa. - While it causes dryness and crusting, its primary manifestation is in the **nasal cavity**, and it is not directly linked to laryngitis sicca in the context tested here.
Question 26: Hot potato voice is characteristic of ?
- A. Nasopharyngeal carcinoma
- B. Glottic carcinoma
- C. Subglottic carcinoma
- D. Supraglottic carcinoma (Correct Answer)
Explanation: ***Supraglottic carcinoma*** - Among the given options, **supraglottic carcinoma** is the best answer, as it can produce a **"hot potato" voice** (also known as a "muffled" or "potato-in-the-mouth" voice) due to tumor bulk in the supraglottic region. - The tumor interferes with normal resonance and articulation of speech by reducing the pharyngeal space and impairing the mobility of the **epiglottis** and aryepiglottic folds. - **Clinical note:** Hot potato voice is **classically** associated with **acute supraglottic inflammatory conditions** such as **peritonsillar abscess (quinsy)**, **acute epiglottitis**, and **retropharyngeal abscess** rather than malignancies. However, any mass lesion in the supraglottic region that causes pharyngeal space reduction can theoretically produce this voice quality. *Nasopharyngeal carcinoma* - **Nasopharyngeal carcinoma** is located in the **nasopharynx** (above the soft palate) and typically presents with **nasal obstruction**, epistaxis, **conductive hearing loss** (Eustachian tube involvement), and cranial nerve palsies. - It does not affect the supraglottic larynx or oropharynx in a way that would produce the characteristic "hot potato" voice. *Glottic carcinoma* - **Glottic carcinoma** primarily affects the **true vocal cords**, leading to early symptoms of **progressive hoarseness** or dysphonia due to impaired vocal cord vibration. - While it affects voice quality significantly, it produces a **hoarse or breathy voice**, not the muffled "hot potato" quality associated with supraglottic space-occupying lesions. *Subglottic carcinoma* - **Subglottic carcinoma** is located **below the true vocal cords** and is the rarest laryngeal malignancy, often presenting late with **stridor** and **dyspnea** due to airway narrowing. - Voice changes occur late and are related to **airway obstruction** or superior extension to the vocal cords, not the characteristic muffled sound of a "hot potato" voice.
Question 27: All are absolute indications of tonsillectomy except which of the following?
- A. Peritonsillar abscess
- B. Tonsils causing obstructive sleep apnea
- C. Chronic tonsillitis (Correct Answer)
- D. Suspicious malignancy
Explanation: ***Chronic tonsillitis*** - **Chronic tonsillitis** is a **relative indication** for tonsillectomy, not an **absolute indication**. - It becomes an indication based on frequency criteria (e.g., Paradise criteria: ≥7 episodes in 1 year, ≥5 episodes per year for 2 years, or ≥3 episodes per year for 3 years). - Absolute indications involve conditions requiring urgent surgical intervention. *Suspicious malignancy* - Suspected **malignancy** is an **absolute indication** for tonsillectomy to obtain tissue for histopathological diagnosis. - Early diagnosis and treatment of tonsillar malignancy is critical for patient outcomes. *Peritonsillar abscess* - **Peritonsillar abscess** (quinsy) is typically managed with needle aspiration or incision & drainage plus antibiotics, NOT immediate tonsillectomy. - Acute tonsillectomy during active infection ("hot tonsillectomy") is generally **contraindicated** due to increased bleeding risk and surgical complications. - **Recurrent peritonsillar abscess** may warrant **interval tonsillectomy** (4-6 weeks after resolution) as a **relative indication**, not an absolute one. *Tonsils causing obstructive sleep apnea* - **Obstructive sleep apnea (OSA)** caused by tonsillar hypertrophy is an **absolute indication** for tonsillectomy, particularly in children. - Untreated OSA can lead to serious complications including failure to thrive, cor pulmonale, developmental delays, and neurocognitive problems.
Question 28: Early tonsillectomy is not done in?
- A. Peritonsillar abscess
- B. Thyroid storm (Correct Answer)
- C. Rheumatic fever
- D. Suspected malignancy
Explanation: ***Thyroid storm*** - **Thyroid storm** is a life-threatening medical emergency caused by exaggerated hyperthyroidism, requiring immediate medical stabilization to control hormone levels and systemic effects. - Early tonsillectomy is **contraindicated** in this scenario because it would add significant surgical stress and anesthetic risks to an already critically unstable patient. *Peritonsillar abscess* - A **quinsy tonsillectomy** (abscess tonsillectomy) is often performed acutely, especially if drainage is difficult or if it's the first episode, to resolve the abscess and remove the infected tissue. - This procedure can be done in the acute phase of a peritonsillar abscess to relieve symptoms and reduce the risk of recurrence. *Rheumatic fever* - Patients with recurrent **acute tonsillitis** who are at risk of developing **rheumatic fever** are strong candidates for tonsillectomy to prevent further streptococcal infections and subsequent autoimmune complications. - Tonsillectomy is considered a prophylactic intervention in cases of recurrent strep throat leading to rheumatic fever. *Suspected malignancy* - If tonsillar asymmetry or other signs raise suspicion of **tonsillar malignancy**, prompt tonsillectomy is often performed for **diagnostic biopsy** and initial tumor removal. - Early surgical intervention is crucial for diagnosing and staging potential tonsil cancer, which can guide subsequent treatment.
Question 29: Which of the following statements about laryngeal tuberculosis (TB) is true?
- A. It commonly involves the posterior 1/3 of the vocal cord.
- B. It is more common in females.
- C. It is a common form of tuberculosis.
- D. It presents with a mouse-nibbled appearance of the vocal cord. (Correct Answer)
Explanation: ***It presents with a mouse-nibbled appearance of the vocal cord.*** - The appearance of a **mouse-nibbled vocal cord** is a classic and pathognomonic description of the irregular, ulcerated, and often edematous lesions seen in laryngeal tuberculosis. - This characteristic finding is due to the granulomatous inflammation and tissue destruction caused by *Mycobacterium tuberculosis* in the larynx. *It commonly involves the posterior 1/3 of the vocal cord.* - Laryngeal tuberculosis typically affects the **anterior two-thirds of the vocal cord**, rather than the posterior third, and often involves the arytenoids and epiglottis. - The involvement pattern can be variable, but posterior involvement is less common than mid-cord or anterior involvement. *It is more common in females.* - Laryngeal tuberculosis is generally **more common in males** than in females, with a male-to-female ratio often reported to be around 2-3:1. - This higher prevalence in males may be attributed to a combination of factors including occupational exposure and lifestyle choices. *It is a common form of tuberculosis.* - Laryngeal tuberculosis is considered a **rare form of extrapulmonary TB**, accounting for a small percentage of all TB cases. - Pulmonary tuberculosis is much more common, and laryngeal involvement is often secondary to active pulmonary disease, occurring via direct spread of infected sputum.
Question 30: During functional endoscopic sinus surgery the position of the patient is
- A. Lateral
- B. Lithotomy
- C. Reverse Trendelenburg (Correct Answer)
- D. Trendelenburg
Explanation: ***Reverse Trendelenburg*** - This position helps to reduce **venous congestion** in the surgical field, which is crucial for maintaining clear visibility during **functional endoscopic sinus surgery (FESS)**. - It minimizes **bleeding** by allowing gravity to drain blood away from the head and neck, improving surgical precision and safety. *Trendelenburg* - This position involves tilting the patient with the head lower than the feet, which would increase **venous pressure** in the head and neck. - Increased venous congestion would lead to significant **bleeding**, severely impairing visibility during FESS. *Lateral* - The lateral position is generally used for procedures involving the **side of the body**, such as kidney surgery or lung procedures. - It does not provide the optimal ergonomic access or venous drainage benefits required for **endoscopic sinus surgery**. *Lithotomy* - The lithotomy position is characterized by the patient lying on their back with hips and knees flexed and supported, primarily used for **pelvic or perineal procedures**. - This position is entirely inappropriate for **head and neck surgery** as it does not allow proper access to the sinus area.