FMGE 2019 - ENT PYQs Practice Questions

Q: Most prominent and largest air cell of ethmoidal sinus?

Bulla ethmoidalis. ***Bulla ethmoidalis*** - The **bulla ethmoidalis** is universally present and is consistently described as the **largest and most prominent** of the anterior ethmoid air cells. - It forms an anatomical landmark that is consistently superior and posterior to the **hiatus semilunaris**. *Onodi cell* - The **Onodi cell** is a posterior ethmoid air cell that pneumatizes laterally and superiorly into the sphenoid bone, in close proximity to the optic nerve. - While clinically significant due to its relationship with the optic nerve, it is not the largest or most prominent ethmoidal air cell. *Haller cell* - A **Haller cell** is an infraorbital ethmoid cell located along the floor of the orbit, extending into the maxillary sinus. - These cells can contribute to **ostial obstruction** of the maxillary sinus but are typically small compared to the bulla ethmoidalis. *Agger nasi cell* - The **agger nasi cell** is the most anterior ethmoid air cell, located in the lacrimal bone anterior to the frontal recess. - It is often one of the first ethmoid cells to pneumatize but is generally small and not considered the most prominent. [Practice more ENT PYQs on OnCourse]

Q: A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?

Topical corticosteroids. ***Topical corticosteroids*** - **Topical corticosteroids** are the **first-line medical management** for **nasal polyps**, helping to reduce inflammation and shrink polyp size. - They work by reducing local inflammation and edema, improving nasal airway patency and breathing. - **Important note**: The presence of **bleeding on aspiration** suggests a **vascular lesion** (such as juvenile nasopharyngeal angiofibroma in young males), which would require **imaging (CT/MRI) before any intervention** and **no biopsy** due to hemorrhage risk. However, if these are inflammatory polyps, topical steroids remain the initial medical management. *Antihistaminic* - **Antihistamines** are not first-line treatment for nasal polyps, as polyps are primarily an **eosinophilic inflammatory condition** rather than a simple IgE-mediated allergic reaction. - While antihistamines may help with associated allergic rhinitis symptoms, they do **not shrink polyps** or address the underlying inflammatory pathology. *Septoplasty* - **Septoplasty** is a surgical procedure to correct a **deviated nasal septum**, not for treating nasal polyps. - This would not address the bilateral polyps causing difficulty in breathing. *I and D* - **Incision and drainage (I&D)** is performed for abscesses or pus collections, which is not the presentation here. - Nasal polyps are benign inflammatory masses, not infectious collections requiring drainage. [Practice more ENT PYQs on OnCourse]

Q: All the following are true about Meniere's disease except?

Destroying the cochlea is mandatory. ***Destroying the cochlea is mandatory*** - While various interventions, including **destructive procedures**, exist for Meniere's disease in severe cases refractory to medical therapy (e.g., labyrinthectomy, vestibular neurectomy), it is **not mandatory** for diagnosis or initial management. - Initial management typically involves **conservative medical treatment** to control symptoms, such as **diuretics**, low-salt diet, and symptomatic relief during attacks. *Low frequency hearing loss* - Meniere's disease typically presents with **fluctuating sensorineural hearing loss**, predominantly affecting **low frequencies** in the early stages. - This characteristic hearing loss is often associated with aural fullness and tinnitus. *Increase in endolymph* - The underlying pathology of Meniere's disease is believed to be **endolymphatic hydrops**, which is an **excessive accumulation of endolymph** in the inner ear. - This increased pressure within the endolymphatic system distorts the membranous labyrinth, leading to the classic symptoms. *Idiopathic* - Meniere's disease is generally considered **idiopathic**, meaning its specific cause is unknown. - While various theories exist regarding its etiology (e.g., viral infections, autoimmune disorders, vascular compromise), a definitive cause has not been identified. [Practice more ENT PYQs on OnCourse]

Q: Frontal headache is due to inflammation of which sinus?

Frontal. ***Frontal*** - Inflammation of the **frontal sinuses** typically causes pain and pressure over the forehead, known as a **frontal headache**. - The pain is often worse in the morning, when bending over, or with changes in **barometric pressure**. *Sphenoid* - **Sphenoid sinusitis** usually causes a headache behind the eyes, at the **vertex of the head**, or in the occipital region. - It is less common than other forms of sinusitis and often presents with more diffuse, deep-seated pain. *Ethmoidal* - **Ethmoidal sinusitis** typically results in pain and pressure between the eyes or over the **bridge of the nose**. - It can also cause eye pain and is sometimes mistaken for a **tension headache**. *Maxillary* - **Maxillary sinusitis** commonly causes pain and pressure in the cheeks, under the eyes, and in the upper teeth, often exacerbated by **chewing or biting**. - This pain can radiate to the temples or ears, but it typically does not manifest as a **frontal headache**. [Practice more ENT PYQs on OnCourse]

Question 1

Most prominent and largest air cell of ethmoidal sinus?

Accepted Answer

Bulla ethmoidalis

Answer

Onodi cell

Answer

Haller cell

Answer

Agger nasi cell

Question 2

A 6-year-old boy came to the hospital with complaints of sore throat and difficulty in swallowing. His left tonsil was pushed medially and had swelling over the left side upper part of neck. What will be the diagnosis?

Accepted Answer

Peritonsillar abscess

Answer

Ludwig's angina

Answer

Retropharyngeal abscess

Answer

Parapharyngeal abscess

Question 3

A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?

Accepted Answer

Topical corticosteroids

Answer

Septoplasty

Answer

I and D

Answer

Antihistaminic

Question 4

All the following are true about Meniere's disease except?

Accepted Answer

Destroying the cochlea is mandatory

Answer

Low frequency hearing loss

Answer

Increase in endolymph

Answer

Idiopathic

Question 5

Frontal headache is due to inflammation of which sinus?

Accepted Answer

Frontal

Answer

Sphenoid

Answer

Ethmoidal

Answer

Maxillary

Question 6

What is the most common presentation of nasopharyngeal carcinoma?

Accepted Answer

Neck lymph node

Answer

Loss of smell

Answer

Blockage of nose

Answer

Blood tinged discharge

Question 7

What is the most common cause of deafness in a patient with Nasopharyngeal Carcinoma:

Accepted Answer

Fluid accumulation in the middle ear due to eustachian tube obstruction

Answer

Middle ear Infection

Answer

Metastasis to Temporal Bone

Answer

Infiltration of Tumour into middle ear

FMGE 2019 — ENT