NEET-PG 2013 - ENT Practice Questions

Q: During functional endoscopic sinus surgery the position of the patient is

Reverse Trendelenburg. ***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.

Q: Electrode of cochlear implant is placed in:

Scala tympani. ***Scala tympani*** - The electrode array of a **cochlear implant** is carefully inserted into the **scala tympani** of the cochlea. - This placement allows the electrodes to directly stimulate the **spiral ganglion neurons**, bypassing damaged hair cells and transmitting electrical signals to the auditory nerve. *Horizontal semicircular canal* - The **horizontal semicircular canal** is part of the **vestibular system**, responsible for sensing angular head movements, not hearing. - Placing an electrode here would cause **vestibular dysfunction** and would not restore hearing. *Scala media* - The **scala media** (cochlear duct) contains the **organ of Corti** and **endolymph**, which has a high potassium concentration. - Inserting an electrode here would damage the delicate structures essential for natural sound transduction and could lead to electric potential imbalances. *Scala vestibuli* - The **scala vestibuli** is filled with **perilymph** and receives sound vibrations from the stapes. - While it's adjacent to the scala tympani, the **scala tympani** offers a safer and more direct path for optimal electrode insertion with less trauma to the sensory structures.

Q: What is a specific indication for the use of a Bone-Anchored Hearing Aid (BAHA)?

Congenital canal atresia. ***Congenital canal atresia*** - **Congenital canal atresia** represents a classic, specific indication for BAHA because the ear canal is congenitally absent or severely stenosed, making conventional hearing aids impossible to fit or ineffective. - BAHA bypasses the absent ear canal entirely by transmitting sound vibrations directly to the **cochlea through bone conduction**, providing an ideal solution for this anatomical abnormality. *Bilateral conductive hearing loss* - While BAHA can be used for conductive hearing loss, **conventional hearing aids** are typically the first-line treatment when ear canals are intact and functional. - Bilateral cases often benefit from traditional amplification devices or **surgical correction** of the underlying conductive pathology before considering BAHA. *Unilateral sensorineural hearing loss* - BAHA is commonly used for **single-sided deafness (SSD)** to route sound from the deaf ear to the hearing ear via bone conduction using the **CROS principle**. - However, this indication is less specific than congenital canal atresia, as other treatment options like **conventional CROS hearing aids** may also be considered. *Conductive hearing loss due to other causes* - This option is too **broad and non-specific** as it encompasses many different etiologies of conductive hearing loss. - Many other causes of conductive hearing loss have **alternative treatments** such as surgical repair, conventional hearing aids, or medical management, making BAHA a secondary consideration.

Q: What is the preferred method for removing a foreign body from the lung in children?

Rigid bronchoscopy. ***Rigid bronchoscopy*** - **Rigid bronchoscopy** is the preferred method for removing foreign bodies from the lung in children due to its ability to provide better air control, magnified viewing, and larger working channels for robust grasping tools. - It allows for complete ventilation control and isolation of the airway, which is crucial in children where airway obstruction can rapidly lead to respiratory compromise. *Chest x-ray* - A **chest x-ray** is a diagnostic tool used to identify the presence and location of a foreign body, but it is not a method for removal. - Many foreign bodies, especially non-radiopaque ones like food, may not be visible on an x-ray, making it unreliable for definitive diagnosis of presence or absence. *Flexible endoscopy* - While **flexible bronchoscopy** can be used for foreign body removal in some adults or specific situations, it is generally less effective and carries higher risks in children, especially for larger or lodged objects. - Its smaller working channels and less stable airway control make it less suitable for urgent and complete removal in the pediatric population. *Direct laryngoscopy* - **Direct laryngoscopy** is used to visualize the larynx and vocal cords, primarily to remove foreign bodies from the upper airway or intubate, but not typically for removal of foreign bodies lodged deep within the main bronchi or lungs. - It does not offer direct access or visualization of the lower bronchial tree where most aspirated foreign bodies in children tend to lodge.

Q: Site of glomus jugulare tumor?

Hypotympanum. ***Hypotympanum*** - **Glomus jugulare tumor** is a paraganglioma arising from the **paraganglia** (chemoreceptor cells) located in the **adventitia of the jugular bulb** in the **jugular foramen**. - This anatomical location places the tumor in the **hypotympanum** (inferior compartment of the middle ear cavity), which lies directly above the jugular bulb [1]. - These tumors typically present with **pulsatile tinnitus**, **hearing loss**, and a **reddish-blue mass** behind the tympanic membrane (rising sun sign). - The hypotympanum extends from the floor of the middle ear to the level of the inferior margin of the tympanic membrane [1]. *Epitympanum* - The **epitympanum** (attic) is the **superior compartment** of the middle ear, located above the tympanic membrane [1]. - It contains the head of the **malleus** and body of the **incus** [1]. - **Glomus tympanicum tumors** (arising from paraganglia along the tympanic plexus on the promontory) may present here, but glomus jugulare tumors originate inferiorly in the hypotympanum. *Mesotympanum* - The **mesotympanum** is the **middle compartment** of the middle ear, at the level of the tympanic membrane. - It contains the **manubrium of malleus** and **long process of incus**. - While glomus jugulare tumors may extend into this region as they grow, their primary site of origin is the hypotympanum. *Internal ear* - The **internal ear** (inner ear) is located medial to the middle ear and contains the **cochlea**, **vestibule**, and **semicircular canals** [1]. - Advanced glomus jugulare tumors may erode into the inner ear causing **sensorineural hearing loss** and **vertigo**, but this is not their site of origin.

Q: In otosclerosis, which structure is primarily affected?

Foot plate of stapes. ***Foot plate of stapes*** - Otosclerosis is a disease of the **temporal bone** that causes abnormal bone growth, primarily affecting the footplate of the stapes. - This abnormal bone growth leads to the **fixation of the stapes** in the oval window, impairing sound conduction and causing **conductive hearing loss**. *Oval window* - While the oval window is the location where the stapes articulates, otosclerosis specifically affects the **footplate of the stapes**, causing it to become fixed within the oval window. - The oval window itself is a structure of the inner ear, but the primary pathology involves the **stapes bone**. *Round window* - The round window plays a role in relieving pressure in the **cochlea** by bulging outwards when the oval window bulges inwards. - It is **not directly affected** by the abnormal bone growth characteristic of otosclerosis. *Utricle* - The utricle is a part of the **vestibular system** in the inner ear, responsible for sensing linear acceleration and head tilt. - It is **not involved** in the pathogenesis of otosclerosis, which is primarily a conductive hearing loss disorder.

Q: What are the X-ray findings associated with chronic otitis media?

Sclerosis with cavity in mastoid. ***Sclerosis with cavity in mastoid*** - Chronic otitis media leads to **long-standing inflammation** and **destruction** of the mastoid air cells, resulting in dense, **sclerotic bone** with cavity formation due to bone erosion. - This is the **characteristic X-ray finding** in chronic otitis media, indicating osseous remodeling and bone destruction from persistent infection. - The sclerosis represents reactive bone formation, while cavities form from **coalescence** of destroyed air cells. *Honeycombing of mastoid* - Honeycombing describes a **normal, well-pneumatized mastoid** with numerous small, distinct air cells visible on X-ray. - This appearance indicates a healthy mastoid bone with good aeration and is **inconsistent** with chronic inflammation. - Chronic otitis media causes bone remodeling and sclerosis, **not** preserved pneumatization. *Clear-cut distinct bony partition between cells* - This describes **normal mastoid anatomy** where air cells are well-defined and separated by thin, intact bony septa. - In chronic otitis media, these septa are typically **eroded or thickened** by inflammation, leading to loss of distinctness. - The inflammatory process causes destruction and sclerosis, **not** preservation of normal architecture. *Increased pneumatization of mastoid cells* - Increased pneumatization indicates **excessive air cell development**, which is opposite to the changes seen in chronic infection. - Chronic otitis media causes **destruction and sclerosis** of air cells, not increased pneumatization. - This would be seen in normal developmental variants, not chronic inflammatory disease.

Q: What condition is characterized by a bluish appearance of the tympanic membrane?

Otitis media with effusion. ***Otitis media with effusion (with hemotympanum)*** - A bluish appearance of the tympanic membrane is characteristically seen when there is **blood in the middle ear space (hemotympanum)**, which can occur in **otitis media with effusion containing hemorrhagic fluid**. - The blue discoloration results from **blood or hemorrhagic effusion** behind the intact tympanic membrane, which imparts a blue or purple hue when visualized through the translucent drum. - This can occur with **traumatic hemotympanum** (basal skull fracture, temporal bone trauma), **hemorrhagic OME**, or in patients with **bleeding disorders**. - Classic causes of blue tympanic membrane include middle ear hemorrhage associated with effusion. *Chronic suppurative otitis media* - CSOM typically involves persistent **purulent (pus-filled) discharge** and often a **perforation of the tympanic membrane**. - The tympanic membrane in CSOM is usually **inflamed, thickened, or perforated**, with active mucopurulent drainage rather than a bluish tinge. - The blue discoloration specifically indicates **blood in the middle ear**, not purulent infection. *Normal tympanic membrane* - A normal tympanic membrane is **pearly gray, translucent**, and mobile, with a visible cone of light and normal middle ear landmarks. - It does not exhibit bluish discoloration, which specifically indicates **underlying hemorrhage or hemorrhagic fluid** in the middle ear space. *Tympanic membrane perforation* - A perforation is a **visible hole or defect in the eardrum**, often with evidence of drainage. - While perforations can occur with various middle ear pathologies, a **blue/purple discoloration of an intact drum** specifically indicates **hemotympanum** (blood behind the membrane), not a perforation itself.

Q: In which condition is the Schwartze sign observed?

Otosclerosis. ***Otosclerosis*** - The **Schwartze sign** is a reddish blush seen through the tympanic membrane, indicative of increased vascularity over the promontory. - It is a classic clinical finding in **active otosclerosis**, distinguishing it from inactive forms. *Glomus Jugulare* - This is a highly **vascular tumor** of the middle ear and mastoid, often presenting with pulsating tinnitus and hearing loss. - While vascularity is present, it manifests as a **reddish-blue mass behind the tympanic membrane**, not the diffuse blush characteristic of Schwartze sign. *Meniere's disease* - Characterized by episodes of **vertigo, fluctuating hearing loss, tinnitus**, and aural fullness due to endolymphatic hydrops. - It does not present with any specific otoscopic findings like the Schwartze sign. *Acoustic neuroma* - This is a **benign tumor of the vestibulocochlear nerve (CN VIII)**, typically causing progressive unilateral sensorineural hearing loss, tinnitus, and balance issues. - It does not produce any visible changes on otoscopy and therefore lacks the Schwartze sign.

Q: All are intracranial complications of otitis media except which of the following?

Facial nerve palsy. ***Facial nerve palsy*** - This is an **extracranial complication** of otitis media affecting the **facial nerve within the temporal bone**, not an intracranial structure. - The facial nerve (CN VII) runs through the **fallopian canal** in the temporal bone and can be affected by inflammation from adjacent mastoid or middle ear infection. - Classified as a **temporal bone complication** rather than an intracranial complication. *Lateral sinus thrombophlebitis* - This is a true **intracranial complication** involving thrombosis of the **sigmoid and lateral venous sinuses** within the cranial cavity. - Results from direct extension of infection through the **mastoid tegmen** or via septic thrombophlebitis. - Presents with features of sepsis, headache, and papilledema. *Brain abscess* - A severe **intracranial complication** representing focal suppurative infection within the **brain parenchyma** (commonly temporal lobe or cerebellum). - Occurs through direct extension via bony erosion, retrograde thrombophlebitis, or hematogenous spread. - Requires urgent neurosurgical intervention. *Hydrocephalus* - An **intracranial complication** that can occur secondary to **otogenic meningitis** or **lateral sinus thrombosis**. - Results from impaired CSF absorption or obstruction of CSF pathways. - More common in pediatric otitis media with CNS complications.

Question 1

During functional endoscopic sinus surgery the position of the patient is

Accepted Answer

Reverse Trendelenburg

Answer

Lateral

Answer

Lithotomy

Answer

Trendelenburg

Question 2

Electrode of cochlear implant is placed in:

Accepted Answer

Scala tympani

Answer

Horizontal semicircular canal

Answer

Scala media

Answer

Scala vestibuli

Question 3

What is a specific indication for the use of a Bone-Anchored Hearing Aid (BAHA)?

Accepted Answer

Congenital canal atresia

Answer

Bilateral conductive hearing loss

Answer

Unilateral sensorineural hearing loss

Answer

Conductive hearing loss due to other causes

Question 4

What is the preferred method for removing a foreign body from the lung in children?

Accepted Answer

Rigid bronchoscopy

Answer

Chest x-ray

Answer

Flexible endoscopy

Answer

Direct laryngoscopy

Question 5

Site of glomus jugulare tumor?

Accepted Answer

Hypotympanum

Answer

Epitympanum

Answer

Mesotympanum

Answer

Internal ear

Question 6

In otosclerosis, which structure is primarily affected?

Accepted Answer

Foot plate of stapes

Answer

Round window

Answer

Utricle

Answer

Oval window

Question 7

What are the X-ray findings associated with chronic otitis media?

Accepted Answer

Sclerosis with cavity in mastoid

Answer

Honeycombing of mastoid

Answer

Clear-cut distinct bony partition between cells

Answer

Increased pneumatization of mastoid cells

Question 8

What condition is characterized by a bluish appearance of the tympanic membrane?

Accepted Answer

Otitis media with effusion

Answer

Chronic suppurative otitis media

Answer

Normal tympanic membrane

Answer

Tympanic membrane perforation

Question 9

In which condition is the Schwartze sign observed?

Accepted Answer

Otosclerosis

Answer

Glomus Jugulare

Answer

Acoustic neuroma

Answer

Meniere's disease

Question 10

All are intracranial complications of otitis media except which of the following?

Accepted Answer

Facial nerve palsy

Answer

Brain abscess

Answer

Hydrocephalus

Answer

Lateral sinus thrombophlebitis

NEET-PG 2013 — ENT