NEET-PG 2013 - ENT Practice Questions

Q: Early tonsillectomy is not done in?

Thyroid storm. ***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.

Q: What is the investigation of choice for nasopharyngeal angiofibroma?

Contrast-enhanced CT. ***Contrast-enhanced CT*** - A **contrast-enhanced CT** scan is the investigation of choice for **nasopharyngeal angiofibroma** due to its ability to clearly delineate the extent of the tumor, its vascularity, and its bony involvement. - The contrast highlights the **highly vascular nature** of the angiofibroma, which is crucial for surgical planning and embolization. *X-ray* - **X-rays** provide limited detail of soft tissue structures and mass lesions in the complex anatomy of the nasopharynx. - They are generally not sensitive enough to characterize a tumor like **angiofibroma** or determine its exact extent. *Plain CT* - A **plain CT** (non-contrast CT) can show soft tissue masses and bony erosion but lacks the ability to assess the **vascularity** of the tumor. - Without contrast, it's difficult to differentiate the tumor from surrounding tissues or identify its blood supply, which is critical for **angiofibroma** management. *MRI* - While **MRI** offers excellent soft tissue contrast and is valuable for assessing intracranial extension or perineural spread, **contrast-enhanced CT** is generally preferred as the primary imaging modality for angiofibroma. - **CT with contrast** is superior for demonstrating **bony erosion** and the characteristic **vascularity** of this tumor.

Q: Posterior epistaxis occurs from:

Woodruff's plexus. ***Woodruff's plexus*** - **Woodruff's plexus** is a collection of large, often friable veins located on the **posterior aspect of the lateral wall of the nasal cavity**, making it the most common anatomical site for **posterior epistaxis**. - Bleeding from this plexus is typically more severe and difficult to control than anterior epistaxis due to the larger vessel size and posterior location. - Located in the **posterolateral nasal cavity** near the posterior end of the inferior turbinate. *Kiesselbach's plexus* - **Kiesselbach's plexus** (also known as Little's area) is located on the **anterior nasal septum** and is the most common site for **anterior epistaxis**. - This is an anastomotic network of vessels from multiple arterial sources in the anterior nasal cavity. - Bleeding from this plexus is usually less severe and often responds to local pressure or cauterization. *Sphenopalatine artery* - The **sphenopalatine artery** is the terminal branch of the maxillary artery and is the primary arterial supply to the posterior nasal cavity. - While it supplies the area where posterior epistaxis occurs, the venous **Woodruff's plexus** is the specific anatomical structure most commonly associated with posterior epistaxis. - The sphenopalatine artery may require ligation or embolization in severe posterior epistaxis cases. *Little's area* - **Little's area** is another name for **Kiesselbach's plexus** and is located on the **anterior nasal septum**, primarily responsible for anterior epistaxis. - This area is highly vascularized by anastomoses of the anterior ethmoidal, sphenopalatine, greater palatine, superior labial, and septal branches of arteries. - Prone to bleeding from minor trauma, digital manipulation, or mucosal dryness.

Q: What condition is associated with Lemierre's syndrome?

Thrombophlebitis of IJV. ***Thrombophlebitis of IJV*** - **Lemierre's syndrome** is classically defined as **septic thrombophlebitis of the internal jugular vein (IJV)** following an oropharyngeal infection [1]. - The infection, most commonly caused by *Fusobacterium necrophorum*, spreads from the pharynx to the parapharyngeal space, leading to IJV inflammation and thrombosis [1]. *Carotid sinus aneurysm* - A **carotid sinus aneurysm** is an abnormal focal dilation of the carotid sinus, often associated with atherosclerosis or connective tissue disorders. - It is not directly linked to the pathogenesis or complications of **Lemierre's syndrome**. *Traumatic occlusion of IJV* - **Traumatic occlusion of the IJV** results from direct injury to the neck, leading to vessel compression or damage. - While it affects the IJV, it does not involve the septic thrombophlebitis or preceding oropharyngeal infection characteristic of **Lemierre's syndrome**. *Any of the above* - This option is incorrect because **Lemierre's syndrome** is specifically associated with **septic thrombophlebitis of the IJV**, not with other unrelated vascular conditions affecting the neck.

Q: Most common cause of retropharyngeal abscess in adults?

Lymphadenitis. ***Lymphadenitis*** - **Lymphadenitis** in the retropharyngeal space, often secondary to an upper respiratory tract infection, is the most common cause of retropharyngeal abscesses in adults. - The infection spreads from inflamed lymph nodes to form a **purulent collection** in the potential space behind the pharynx. *TB* - **Tuberculosis (TB)** can cause retropharyngeal abscesses, particularly in immunocompromised individuals or endemic areas, but it is less common than pyogenic infections [1]. - TB abscesses tend to be more **chronic** and may be associated with vertebral involvement (Pott's disease) [1]. *Tooth extraction* - While dental infections, including complications from **tooth extraction**, can lead to deep neck space infections, they are not the most common cause of retropharyngeal abscess specifically. - Infections from teeth more often spread to the **submandibular** or **parapharyngeal spaces**. *Tonsillitis* - **Tonsillitis** is a common cause of pharyngeal inflammation and can lead to peritonsillar abscesses, which are distinct from retropharyngeal abscesses. - While severe tonsillitis can occasionally spread to the retropharyngeal space, it is primarily local and less common than direct lymphatic seeding.

Q: Which objective test is most effective for examining adenoids?

Posterior rhinoscopy. ***Posterior rhinoscopy*** - This method allows for **direct visualization of the nasopharynx** where the adenoids are located, using a post-nasal mirror or flexible endoscope. - It provides an **objective assessment** of adenoid size, extent, and any associated obstruction by direct observation. - Among the clinical examination methods listed, this is the most effective for **visualizing adenoid tissue** and assessing hypertrophy. - In modern practice, flexible nasopharyngoscopy has largely replaced mirror examination, but posterior rhinoscopy remains the principle of direct nasopharyngeal visualization. *Anterior rhinoscopy* - This technique examines the **anterior nasal cavity**, nasal septum, and inferior turbinates. - It **cannot visualize the nasopharynx** where adenoids are located due to anatomical limitations. - Useful for anterior nasal pathology but inadequate for adenoid assessment. *Manual palpation* - This is a **subjective, not objective** method that relies on examiner's tactile sensation. - Highly uncomfortable for children, causing gagging and distress. - Carries risks of trauma, bleeding, and infection. - Does not provide measurable or reproducible data, hence not considered an objective test. - Largely abandoned in modern practice due to these limitations. *None of the options* - Incorrect because **posterior rhinoscopy is a recognized objective clinical examination** for adenoids. - It allows direct visualization which can be documented and is superior to subjective methods like palpation. - While radiological methods (lateral neck X-ray) also provide objective data, among the examination techniques listed, posterior rhinoscopy is the correct answer.

Q: Which of the following statements about Grisel syndrome is false?

A neurosurgeon is never needed.. ***A neurosurgeon is never needed.*** - This statement is false because severe cases of **Grisel syndrome** may require surgical intervention, necessitating consultation with a **neurosurgeon**. - Surgical management, such as **cervical fusion**, may be indicated in cases of irreducible subluxation or neurological compromise. *It can occur after adenoidectomy.* - This statement is true; **Grisel syndrome** is a rare complication that may occur following **adenoidectomy** or other head and neck surgeries. - The postulated mechanism involves inflammation spreading from the pharynx to the alar and transverse ligaments, leading to **atlantoaxial subluxation**. *It involves inflammation of cervical spine ligaments.* - This statement is true; **Grisel syndrome** is characterized by non-traumatic **atlantoaxial subluxation** resulting from inflammatory laxity of the cervical ligaments. - Specifically, the **transverse and alar ligaments** become inflamed and weakened, leading to instability between the atlas (C1) and axis (C2). *Conservative treatment is the first-line approach in most cases.* - This statement is true; initial management of **Grisel syndrome** typically involves conservative measures such as **neck immobilization**, pain control, and muscle relaxants. - Early diagnosis and conservative treatment are crucial to prevent progression and potential neurological complications.

Q: All are absolute indications of tonsillectomy except which of the following?

Chronic tonsillitis. ***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.

Q: What is the treatment of choice for atticoantral type of chronic suppurative otitis media (CSOM)?

Modified radical mastoidectomy. ***Modified radical mastoidectomy*** - The **atticoantral type of CSOM** is characterized by active **cholesteatoma**, which requires surgical removal to prevent further bone erosion and complications. - A **modified radical mastoidectomy** is the treatment of choice as it removes the cholesteatoma and diseased mastoid air cells while aiming to preserve residual hearing. *Antibiotics* - While topical or systemic antibiotics may be used to control acute infections or discharge in CSOM, they do not eradicate **cholesteatoma**. - **Cholesteatoma** is an epidermoid cyst that requires surgical excision, as antibiotics alone cannot resolve it. *Tympanoplasty* - **Tympanoplasty** is primarily performed to reconstruct the tympanic membrane (eardrum) and/or the ossicular chain to restore hearing. - It is typically indicated for the **tubotympanic type of CSOM** (safe type) without cholesteatoma, not for the atticoantral type which involves cholesteatoma. *None of the options* - This option is incorrect because **modified radical mastoidectomy** is a well-established and necessary treatment for the atticoantral type of CSOM involving cholesteatoma.

Question 1

Early tonsillectomy is not done in?

Accepted Answer

Thyroid storm

Answer

Peritonsillar abscess

Answer

Rheumatic fever

Answer

Suspected malignancy

Question 2

Which of the following statements about acute retropharyngeal abscess is true?

Accepted Answer

Acute retropharyngeal abscess is often due to lymphadenitis.

Answer

Treatment often involves incision and drainage.

Answer

Acute retropharyngeal abscess is common in adults.

Answer

Swelling typically occurs unilaterally.

Question 3

What is the investigation of choice for nasopharyngeal angiofibroma?

Accepted Answer

Contrast-enhanced CT

Answer

Plain CT

Answer

X-ray

Answer

MRI

Question 4

Posterior epistaxis occurs from:

Accepted Answer

Woodruff's plexus

Answer

Kiesselbach's plexus

Answer

Sphenopalatine artery

Answer

Little's area

Question 5

What condition is associated with Lemierre's syndrome?

Accepted Answer

Thrombophlebitis of IJV

Answer

Carotid sinus aneurysm

Answer

Traumatic occlusion of IJV

Answer

Any of the above

Question 6

Most common cause of retropharyngeal abscess in adults?

Accepted Answer

Lymphadenitis

Answer

Tonsillitis

Answer

Tooth extraction

Answer

TB

Question 7

Which objective test is most effective for examining adenoids?

Accepted Answer

Posterior rhinoscopy

Answer

Anterior rhinoscopy

Answer

Manual palpation

Answer

None of the options

Question 8

Which of the following statements about Grisel syndrome is false?

Accepted Answer

A neurosurgeon is never needed.

Answer

It can occur after adenoidectomy.

Answer

It involves inflammation of cervical spine ligaments.

Answer

Conservative treatment is the first-line approach in most cases.

Question 9

All are absolute indications of tonsillectomy except which of the following?

Accepted Answer

Chronic tonsillitis

Answer

Peritonsillar abscess

Answer

Tonsils causing obstructive sleep apnea

Answer

Suspicious malignancy

Question 10

What is the treatment of choice for atticoantral type of chronic suppurative otitis media (CSOM)?

Accepted Answer

Modified radical mastoidectomy

Answer

Tympanoplasty

Answer

None of the options

Answer

Antibiotics

NEET-PG 2013 — ENT