NEET-PG 2021 - ENT PYQs Practice Questions

Q: A woman visits the ENT outpatient department with complaints of nasal obstruction. On examination, greenish-black crusts were found in the nasal cavity covering the turbinates and septum, and she also had complete anosmia (lack of sense of smell). What other sign is most likely to be found on examination in this case?

Roomy nasal cavity. ***Roomy nasal cavity*** - The presence of **greenish-black crusts**, **anosmia**, and **nasal obstruction** in the context of chronic atrophy of the nasal mucosa strongly suggests **atrophic rhinitis**. - **Atrophic rhinitis** (also known as ozena) is characterized by progressive atrophy of the nasal mucosa, turbinates, and underlying bone, leading to an abnormally **wide and roomy nasal cavity**. *Hypertrophied inferior turbinate* - **Hypertrophied turbinates** typically result in nasal obstruction but would present with a narrow, rather than a roomy, nasal cavity. - There would also be no greenish-black crusts or complete anosmia with simple turbinate hypertrophy. *Polyp* - **Nasal polyps** are typically pale, glistening, grape-like masses that cause nasal obstruction and hyposmia but do not cause greenish-black crusts or a roomy nasal cavity. - They usually result from chronic inflammation and are often associated with conditions like allergic rhinitis or asthma. *Foreign Body* - A **nasal foreign body** would cause unilateral nasal obstruction and often a foul-smelling, purulent discharge, but not typically greenish-black crusts or a roomy nasal cavity. - It would also not explain the complete anosmia unless it severely obstructed both nasal passages for an extended period, which is less likely than atrophic rhinitis. [Practice more ENT PYQs on OnCourse]

Q: A child who underwent a tonsillectomy started bleeding while lying in the ward post-operatively. Which of the following is the most appropriate management step?

Take to OT, remove the clot & re-ligation. ***Take to OT, remove the clot & re-ligation*** - **Post-tonsillectomy bleeding** is a surgical emergency requiring immediate intervention to prevent airway compromise and significant blood loss. - The most definitive management involves returning to the **operating theatre** for direct visualization, removal of any obstructing clots, and **re-ligation** of the bleeding vessel. *Conservative management* - **Conservative management** is generally insufficient for significant post-tonsillectomy bleeding, as it does not address the source of hemorrhage and can lead to severe complications. - While minor oozing might be observed, active bleeding often indicates a larger vessel injury that requires **surgical hemostasis**. *Take to OT & pressure packing* - While **pressure packing** can temporarily slow bleeding, it is not a definitive long-term solution as it does not directly identify and treat the bleeding vessel. - Furthermore, pharyngeal packing in a child carries a risk of **airway obstruction** and aspiration, making it less suitable than direct re-ligation. *Cautery* - **Cautery** is a method of hemostasis, but it is typically performed in the operating theatre under direct vision, often after clot removal. - It is not a stand-alone initial management step in the ward for active bleeding without proper surgical assessment and preparation. [Practice more ENT PYQs on OnCourse]

Q: A patient with a history of chronic ear infection now presents with manifestations, including headache and vomiting. A CT brain image is shown. What is the most probable diagnosis?

Temporal lobe Abscess. ***Temporal lobe Abscess*** - The CT scan shows a **ring-enhancing lesion** with significant surrounding edema, which is characteristic of a **brain abscess**. - Given the history of a **chronic ear infection**, the temporal lobe is a common site for bacterial spread from the mastoid air cells or middle ear. *Meningitis* - Meningitis involves inflammation of the **meninges** and typically presents with diffuse changes on imaging, such as sulcal effacement or leptomeningeal enhancement, rather than a focal, encapsulated lesion. - While it can cause headache and vomiting, the CT image does not show findings typical of meningitis. *Extradural Abscess* - An extradural (or epidural) abscess is located **between the dura mater and the skull bone**. - It would typically appear as a collection outside the brain parenchyma, potentially causing mass effect but distinct from an intraparenchymal lesion seen in the image. *Cerebral Abscess* - The image does show a **cerebral abscess**, but this option is less specific than "Temporal lobe abscess." - The question asks for the **most probable diagnosis**, and combining the imaging findings with the patient's history of ear infection points to a specific location within the cerebrum. [Practice more ENT PYQs on OnCourse]

Q: A patient presents with ear discharge. The CT image is shown below. Based on the clinical presentation and imaging, what is the most likely diagnosis?

Temporal lobe abscess. ***Temporal lobe abscess*** - The CT scan shows a **ring-enhancing lesion** in the **temporal lobe**, which is characteristic of a brain abscess. - **Ear discharge** (otorrhea), particularly from otitis media, is a common predisposing factor for temporal lobe abscesses due to the proximity of the middle ear and mastoid to the temporal lobe. - Otogenic brain abscesses account for a significant proportion of intracranial complications from ear infections, with the temporal lobe being the most common location. *Extradural abscess* - An **extradural abscess** would typically be located between the dura mater and the skull, often presenting as a **lenticular or biconvex collection** displacing the dura and brain, not within the brain parenchyma as seen here. - While ear infections can lead to extradural abscesses, the imaging clearly shows an intraparenchymal lesion. *Cerebellar abscess* - A **cerebellar abscess** would be located in the cerebellum (posterior fossa), which is a different anatomical location from the lesion seen in the image (which is in the supratentorial compartment, consistent with the temporal lobe). - Although ear infections can also lead to cerebellar abscesses, the lesion's position on the CT scan does not correspond to the cerebellum. *Meningitis* - **Meningitis** is an inflammation of the meninges and typically manifests on CT as **leptomeningeal enhancement**, particularly in the sulci and basal cisterns, rather than a discrete, encapsulated mass lesion like an abscess. - While ear discharge can be associated with meningitis, the imaging findings strongly point to an abscess, not diffuse meningeal inflammation. [Practice more ENT PYQs on OnCourse]

Question 1

A woman visits the ENT outpatient department with complaints of nasal obstruction. On examination, greenish-black crusts were found in the nasal cavity covering the turbinates and septum, and she also had complete anosmia (lack of sense of smell). What other sign is most likely to be found on examination in this case?

Accepted Answer

Roomy nasal cavity

Answer

Hypertrophied inferior turbinate

Answer

Polyp

Answer

Foreign Body

Question 2

A child who underwent a tonsillectomy started bleeding while lying in the ward post-operatively. Which of the following is the most appropriate management step?

Accepted Answer

Take to OT, remove the clot & re-ligation

Answer

Conservative management

Answer

Take to OT & pressure packing

Answer

Cautery

Question 3

A patient with a history of chronic ear infection now presents with manifestations, including headache and vomiting. A CT brain image is shown. What is the most probable diagnosis?

Accepted Answer

Temporal lobe Abscess

Answer

Meningitis

Answer

Extradural Abscess

Answer

Cerebral Abscess

Question 4

A patient presents with ear discharge. The CT image is shown below. Based on the clinical presentation and imaging, what is the most likely diagnosis?

Accepted Answer

Temporal lobe abscess

Answer

Extradural abscess

Answer

Cerebellar abscess

Answer

Meningitis

NEET-PG 2021 — ENT