FMGE 2025 - ENT Practice Questions

Q: The image below shows a lateral view of the face with a highlighted region in front of the ear. Which type of abscess is most likely indicated in this area?

Luc's abscess. ***Luc's abscess*** - This is a **subperiosteal abscess** located in the **preauricular region**, on the external surface of the squamous part of the temporal bone, which corresponds to the highlighted area. - It is a rare complication of **acute otitis media** or **mastoiditis**, occurring when infection spreads through the tympanosquamous suture. *Citelli’s abscess* - This abscess is located at the **tip of the mastoid process** and extends into the **digastric triangle** of the neck, which is posterior and inferior to the area shown. - It is formed when pus from mastoiditis tracks along the posterior belly of the **digastric muscle**. *Bezold's abscess* - This is a **deep neck abscess** that forms when infection erodes through the medial aspect of the mastoid tip and spreads inferiorly into the neck. - The swelling is located deep to the **sternocleidomastoid muscle**, far from the preauricular location shown in the image. *Zygomatic abscess* - This abscess forms over the **zygomatic process** of the temporal bone, which is located superior and anterior to the external auditory canal. - It results from the spread of infection from mastoid air cells into the **root of the zygoma**, a location slightly more superior than what is highlighted.

Q: A patient presents with enophthalmos and periorbital ecchymosis after being hit by a ball. What is the most likely diagnosis?

Orbital blowout fracture. ***Orbital blowout fracture*** - The clinical presentation of **periorbital ecchymosis** (bruising around the eye) and **enophthalmos** (posterior displacement of the eyeball) following blunt trauma from an object like a ball is classic for an orbital blowout fracture. - This injury often involves the thin orbital floor, leading to herniation of orbital contents into the maxillary sinus and potential entrapment of the **inferior rectus muscle**, which can cause **diplopia** (double vision) on upward gaze. *Zygomatic fracture* - A zygomatic (cheekbone) fracture typically causes facial flattening, a palpable **step-off deformity** along the orbital rim, and numbness over the cheek due to **infraorbital nerve** injury. - While it can be associated with an orbital floor fracture, isolated **enophthalmos** is not its primary presenting sign; facial asymmetry is more prominent. *Nasal bone fracture* - This is the most common facial fracture and presents with localized pain, swelling, deformity of the nasal bridge, and **epistaxis** (nosebleed). - **Enophthalmos** is not a feature of an isolated nasal bone fracture, although periorbital ecchymosis can be present. *Le Fort I fracture* - This is a horizontal fracture of the maxilla, resulting in a **"floating palate"** where the entire upper dental arch is mobile. - It is characterized by **dental malocclusion** and does not typically cause the isolated orbital signs of **enophthalmos** seen in this case.

Q: A patient presents with a history of fall and is found to have bleeding from the ear on examination. What is the investigation of choice?

CT Temporal bone. ***CT Temporal bone***- This is the **investigation of choice** for suspected **temporal bone fractures**, which are strongly suggested by **otorrhagia** (bleeding from the ear) following trauma.- CT provides superior resolution for visualizing the intricate bony anatomy of the temporal bone, allowing for the precise identification of fracture line extension (e.g., *longitudinal* or *transverse*) and related complications like **ossicular chain integrity** or **hemotympanum**.*CBC*- Complete Blood Count (CBC) is part of the initial trauma workup to assess general systemic status (e.g., potential **blood loss** or baseline hemoglobin), but it is not a diagnostic tool for identifying the source of bleeding (the anatomical injury).- It provides no structural information necessary to localize the injury or determine the presence of a **skull fracture**.*MRI Brain*- **MRI** is optimized for visualizing **soft tissue injury** (e.g., brain contusions, nerve damage) and is poor for detailing acute bony fractures, especially the fine structures of the temporal bone.- It may be used if profound neurological deficits or specific **intracranial injury** (e.g., vascular dissection or brain parenchymal damage) are suspected, but not as the primary diagnostic imaging for bony trauma.*X-ray Skull*- **Plain X-rays** lack the sensitivity and detail required to reliably capture the subtle, complex fractures of the **temporal bone** or skull base.- This method is largely superseded by **CT scans** for trauma evaluation due to high rates of **false negatives** regarding skull base injuries.

Q: A 60-year-old man complains of gradual hearing loss over several years. He reports difficulty hearing conversations, especially in noisy environments, and has trouble perceiving high-pitched sounds. There are no episodes of vertigo, tinnitus, or ear fullness. What is the most likely diagnosis?

Presbycusis. ***Correct: Presbycusis*** - It is the most common cause of **gradual, bilateral sensorineural hearing loss** in the elderly, characterized by a protracted course over several years. - The defining feature is difficulty hearing **high-pitched sounds** (loss of high-frequency hearing) and **poor speech discrimination** in noisy environments, consistent with the clinical picture. - This is age-related cochlear degeneration, typically beginning after age 50-60. *Incorrect: Meniere's disease* - This condition is defined by the classic triad of **episodic vertigo**, **fluctuating (usually low-frequency) sensorineural hearing loss**, and **tinnitus** with aural fullness, none of which are present. - The hearing loss is typically episodic and unilateral, contrasting with the patient's chronic, gradual deterioration. *Incorrect: Otosclerosis* - This disorder causes **conductive hearing loss** (or mixed loss) due to abnormal bone growth around the **stapes footplate**, often presenting earlier in life (20s–30s). - Unlike the gradual, high-frequency loss seen here, otosclerosis causes reduced sound transmission to the inner ear, typically improving speech perception in noise (**paracusis Willisii**). *Incorrect: Acoustic neuroma* - Although it causes sensorineural hearing loss, it is typically **unilateral** and often asymmetrical, frequently accompanied by **unilateral tinnitus** and imbalance. - This diagnosis is less likely in a patient with **bilateral**, gradual hearing loss without unilateral symptoms or specific cranial nerve involvement.

Q: A diabetic male presents with facial pain and blackish discoloration in the nose. The CT image shows bone erosion and sinus involvement. What is the most likely diagnosis?

Rhino-orbital-cerebral mucormycosis. ***Rhino-orbital-cerebral mucormycosis*** - This diagnosis is strongly suggested by the clinical triad of an **immunocompromised state (diabetes)**, the presence of a **black necrotic eschar** in the nose, and imaging evidence of **bone erosion**. - Mucormycosis is an **angioinvasive** fungal infection that causes tissue infarction and necrosis, leading to the characteristic black discoloration and rapid spread through tissues. *Acute bacterial sinusitis* - While it causes facial pain and sinus inflammation, it typically presents with purulent discharge and does not cause a **black necrotic eschar**. - **Bone erosion** is a very rare complication and not a characteristic feature, unlike in invasive fungal disease. *Allergic fungal sinusitis* - This is a **non-invasive** hypersensitivity reaction to fungi and does not cause tissue destruction, necrosis, or bone erosion. - It is characterized by the presence of thick **allergic mucin** containing eosinophils and fungal hyphae within the sinuses, often in atopic individuals. *Nasal polyposis* - This condition involves benign mucosal growths that cause chronic nasal obstruction and anosmia, not acute facial pain or tissue necrosis. - Nasal polyps may remodel bone over time due to pressure, but they do not cause the rapid and destructive **bone erosion** seen in this invasive process.

Q: A tympanometry graph is shown below. An arrow indicates a shallow peak at pressure = 0 daPa. What is the most likely diagnosis based on the tympanometry result shown?

Type As. ***Type As*** - This tympanogram shows a peak pressure within the normal range (around 0 daPa) but with significantly reduced static compliance (a shallow or stiff peak), which is characteristic of a Type As curve. - This finding indicates a stiff middle ear system and is commonly associated with conditions like **otosclerosis**, **tympanosclerosis**, or **ossicular fixation**. *Type A* - A Type A tympanogram represents a **normal** middle ear system, characterized by a sharp peak at normal pressure (around 0 daPa) and normal static compliance (0.3-1.6 mmho). - The graph shown has abnormally **low compliance**, distinguishing it from a normal Type A curve. *Type B* - A Type B tympanogram is a **flat line** with no discernible peak, indicating very poor compliance of the tympanic membrane across all pressures. - This pattern is typically seen with **fluid in the middle ear** (otitis media with effusion) or a tympanic membrane perforation, which is inconsistent with the peaked curve shown. *Type Ad* - A Type Ad tympanogram shows a peak at normal pressure but with **abnormally high compliance** (a deep or hypermobile peak). - This suggests a flaccid tympanic membrane or a discontinuity in the ossicular chain (**ossicular disarticulation**), which is the opposite of the low compliance seen in the provided image.

Q: A 5-year-old child is brought to the outpatient department by his mother with irritability, poor school performance, and a history of recurrent ear infections. Otoscopic examination shows a dull, retracted tympanic membrane with fluid behind it. There is no blood clot present in the ear. What is the most likely diagnosis?

Otitis media with effusion. ***Otitis media with effusion***- This condition is characterized by the presence of **non-purulent fluid (effusion)** in the middle ear space without signs or symptoms of acute infection (such as fever or severe pain).- The otoscopic findings of a **dull, retracted tympanic membrane** with fluid behind it, coupled with symptoms suggesting chronic hearing loss (**poor school performance** and irritability), are classic for OME, or "**glue ear**." *Acute otitis media*- AOM is generally associated with the acute onset of **otalgia** (ear pain) and often fever, along with a key otoscopic finding of a **bulging**, erythematous, and immobile **tympanic membrane**.- The absence of acute inflammatory signs and the description of a retracted, rather than bulging, TM distinguishes this chronic finding from an acute infection. *Otitis externa*- This condition involves inflammation and infection of the **external auditory canal**; the middle ear and the fluid described are not typically affected.- Key clinical findings involve tenderness upon manipulation of the **tragus** or **pinna**, often with swelling and exudate limited to the ear canal. *Cholesteatoma*- Cholesteatoma is a destructive process involving a collection of **squamous epithelium** (a “pearly mass”) that usually causes **foul-smelling chronic otorrhea** due to bone erosion.- While chronic retraction of the TM can lead to its formation, the primary finding here is simply **effusion (fluid)**, not the characteristic highly destructive epidermal mass.

Q: Which of the following subunits is associated with inspiratory stridor?

Supraglottic. ***Supraglottic*** - Obstruction or narrowing in the supraglottic region (above the true vocal cords), such as in **epiglottitis** or **laryngomalacia**, collapses inward during inspiration. - This physiological collapse under negative inspiratory pressure creates characteristic high-pitched airflow limitation known as **inspiratory stridor**. *Glottic* - Lesions affecting the true vocal cords (e.g., bilateral **vocal cord paralysis** or severe webbing) typically cause a relatively fixed obstruction. - Fixed obstruction at the vocal cord level generally results in a **biphasic stridor** (heard equally during both inspiration and expiration). *Subglottic* - Obstruction occurring below the vocal cords at the level of the cricoid cartilage (e.g., **croup** or **subglottic stenosis**). - Since the subglottic area is less compliant than the supraglottic area, it commonly causes a coarse, barking sound and often presents as **biphasic stridor**. *Trachea* - Lower tracheal obstruction may produce a **monophonic wheeze** or sounds related more to expiratory airflow limitation. - High or mid-tracheal lesions, especially if fixed, typically generate a relatively loud **biphasic stridor** rather than purely inspiratory stridor.

Question 1

The image below shows a lateral view of the face with a highlighted region in front of the ear. Which type of abscess is most likely indicated in this area?

Accepted Answer

Luc's abscess

Answer

Zygomatic abscess

Answer

Bezold's abscess

Answer

Citelli’s abscess

Question 2

A patient presents with enophthalmos and periorbital ecchymosis after being hit by a ball. What is the most likely diagnosis?

Accepted Answer

Orbital blowout fracture

Answer

Le Fort I fracture

Answer

Zygomatic fracture

Answer

Nasal bone fracture

Question 3

A patient presents with a history of fall and is found to have bleeding from the ear on examination. What is the investigation of choice?

Accepted Answer

CT Temporal bone

Answer

X-ray Skull

Answer

MRI Brain

Answer

CBC

Question 4

A 60-year-old man complains of gradual hearing loss over several years. He reports difficulty hearing conversations, especially in noisy environments, and has trouble perceiving high-pitched sounds. There are no episodes of vertigo, tinnitus, or ear fullness. What is the most likely diagnosis?

Accepted Answer

Presbycusis

Answer

Meniere’s disease

Answer

Otosclerosis

Answer

Acoustic neuroma

Question 5

A diabetic male presents with facial pain and blackish discoloration in the nose. The CT image shows bone erosion and sinus involvement. What is the most likely diagnosis?

Accepted Answer

Rhino-orbital-cerebral mucormycosis

Answer

Acute bacterial sinusitis

Answer

Allergic fungal sinusitis

Answer

Nasal polyposis

Question 6

A tympanometry graph is shown below. An arrow indicates a shallow peak at pressure = 0 daPa. What is the most likely diagnosis based on the tympanometry result shown?

Accepted Answer

Type As

Answer

Type A

Answer

Type B

Answer

Type Ad

Question 7

A 5-year-old child is brought to the outpatient department by his mother with irritability, poor school performance, and a history of recurrent ear infections. Otoscopic examination shows a dull, retracted tympanic membrane with fluid behind it. There is no blood clot present in the ear. What is the most likely diagnosis?

Accepted Answer

Otitis media with effusion

Answer

Acute otitis media

Answer

Otitis externa

Answer

Cholesteatoma

Question 8

Which of the following subunits is associated with inspiratory stridor?

Accepted Answer

Supraglottic

Answer

Glottic

Answer

Trachea

Answer

Subglottic

FMGE 2025 — ENT