INI-CET 2025 — ENT
5 Previous Year Questions with Answers & Explanations
Which of the following statements regarding Juvenile Nasopharyngeal Angiofibroma (JNA) is NOT typically correct or recommended?
Choose the most appropriate candidates for cochlear implants: 1. Ototoxicity 2. Congenital hearing loss 3. Ossicular fixation 4. Otosclerosis
A 50-year-old female complains of an episode of acute vertigo with vomiting and unsteadiness and light-headedness, which was triggered by changing her head position in the morning. She denied hearing loss, recent viral illness, medication use, head injury, or trauma. Choose the most appropriate diagnosis:
Which of the following is incorrect regarding Juvenile Nasopharyngeal Angiofibroma (JNA)?
A 35-year-old man presents to the emergency department with a complaint of food stuck in his throat. On examination, a bone is seen in the left piriform recess. Which of the following is most likely to be impaired?
INI-CET 2025 - ENT INI-CET Practice Questions and MCQs
Question 1: Which of the following statements regarding Juvenile Nasopharyngeal Angiofibroma (JNA) is NOT typically correct or recommended?
- A. Recurrent epistaxis
- B. Unilateral nasal obstruction
- C. Exclusively to adolescent boys
- D. Biopsy under anesthesia to diagnose (Correct Answer)
Explanation: ### **Explanation: Juvenile Nasopharyngeal Angiofibroma (JNA)** **Juvenile Nasopharyngeal Angiofibroma (JNA)** is a benign but locally aggressive, highly vascular tumor. Understanding its management is crucial for NEET-PG/INI-CET. #### **Why "Biopsy" is the Correct Answer (The Incorrect Practice)** * **Contraindication:** A biopsy is **strictly contraindicated** in suspected cases of JNA. Because the tumor is composed of thin-walled blood vessels lacking a muscular coat (*tunica media*), it cannot constrict when injured. * **Risk:** Performing a biopsy can trigger **profuse, life-threatening hemorrhage** that is difficult to control. * **Diagnosis:** Diagnosis is primarily **clinical and radiological**. Contrast-enhanced CT (CECT) or MRI showing the characteristic "Holman-Miller Sign" is sufficient to proceed to surgery without a tissue diagnosis. #### **Analysis of Other Options** * **A & B (Recurrent Epistaxis & Unilateral Nasal Obstruction):** These are the **classic clinical dyad** of JNA. Epistaxis is typically spontaneous, painless, and recurrent. Obstruction is initially unilateral but can become bilateral as the tumor grows. * **C (Exclusively to Adolescent Boys):** JNA is a **testosterone-dependent** tumor. It occurs almost exclusively in males, typically between **10–20 years of age**. If a similar mass is found in a female, a chromosomal analysis or alternative diagnosis should be considered. --- ### **High-Yield Clinical Pearls for INI-CET** * **Origin:** Most commonly arises from the superior border of the **sphenopalatine foramen**. * **Holman-Miller Sign (Antral Sign):** Forward bowing of the posterior wall of the maxillary sinus seen on CT. * **Frog Face Deformity:** Occurs due to the widening of the nasal bridge and proptosis in advanced stages. * **Investigation of Choice:** **CECT** (to assess bone involvement) or **MRI** (to assess intracranial extension). * **Gold Standard Treatment:** Surgical excision (usually via endoscopic or open approaches). **Pre-operative embolization** (24–48 hours prior) is done to reduce intraoperative blood loss. * **Classification:** Fisch or Radkowski classifications are commonly used to stage the tumor.
Question 2: Choose the most appropriate candidates for cochlear implants: 1. Ototoxicity 2. Congenital hearing loss 3. Ossicular fixation 4. Otosclerosis
- A. 3 and 4
- B. 1 and 2 (Correct Answer)
- C. 2 and 3
- D. 1 and 4
Explanation: ### Explanation The core principle of a **Cochlear Implant (CI)** is to bypass a non-functional or damaged cochlea (specifically the hair cells) and directly stimulate the **Auditory Nerve**. Therefore, the ideal candidate must have **Severe to Profound Sensorineural Hearing Loss (SNHL)** with a functioning auditory nerve. #### Why 1 and 2 are Correct: * **Ototoxicity (1):** Drugs like aminoglycosides or cisplatin cause permanent damage to the **outer and inner hair cells** of the cochlea, resulting in bilateral SNHL. Since the auditory nerve remains intact, these patients are excellent candidates for CI. * **Congenital Hearing Loss (2):** Children born with bilateral profound SNHL (Pre-lingual) are the primary target for CI. Early implantation (ideally before age 2) is crucial for the development of speech and language due to **neural plasticity**. #### Why 3 and 4 are Incorrect: * **Ossicular Fixation (3) & Otosclerosis (4):** These conditions primarily cause **Conductive Hearing Loss (CHL)** because the pathology lies in the middle ear (mechanical conduction). * **Otosclerosis** is typically managed with a **Stapedectomy** or hearing aids. * *Note:* While "Far-advanced Otosclerosis" can lead to SNHL, it is not the primary or most common indication compared to the options provided. --- ### High-Yield Clinical Pearls for INI-CET: * **Site of Action:** CI bypasses the **Organ of Corti** to stimulate the **Spiral Ganglion** of the auditory nerve. * **Prerequisite:** A visible **Auditory Nerve** on MRI (Internal Auditory Canal) is mandatory before surgery. * **Contraindications:** * **Michel Aplasia** (Complete absence of inner ear structures). * **Aplasia of the Auditory Nerve**. * Active middle ear infections. * **Mondini Dysplasia:** This is a partial aplasia of the cochlea (1.5 turns instead of 2.5); these patients **can** still receive a CI.
Question 3: A 50-year-old female complains of an episode of acute vertigo with vomiting and unsteadiness and light-headedness, which was triggered by changing her head position in the morning. She denied hearing loss, recent viral illness, medication use, head injury, or trauma. Choose the most appropriate diagnosis:
- A. Vestibular neuritis
- B. BPPV (Correct Answer)
- C. Acoustic neuroma
- D. Meniere disease
Explanation: ### **Explanation: Benign Paroxysmal Positional Vertigo (BPPV)** The clinical presentation of **recurrent, brief episodes of vertigo triggered by head movements** (like rolling over in bed or getting up in the morning) without associated hearing loss is classic for **BPPV**. #### **Why BPPV is the Correct Answer** * **Mechanism:** It is caused by **canalolithiasis** (displaced otoconia, usually from the utricle into the **posterior semicircular canal**). * **Key Features:** Vertigo is **positional**, lasts for **seconds to minutes**, and is associated with autonomic symptoms like nausea/vomiting. * **Absence of "Red Flags":** The lack of hearing loss, tinnitus, or recent viral prodrome helps differentiate it from other vestibular disorders. #### **Why Other Options are Incorrect** * **Vestibular Neuritis:** Presents as a **prolonged, single episode** of severe vertigo (lasting days) often following a **viral upper respiratory infection**. It is not transiently triggered by head movement. * **Acoustic Neuroma:** A slow-growing tumor of the CN VIII. It typically presents with **progressive unilateral sensorineural hearing loss (SNHL)** and tinnitus rather than acute positional vertigo. * **Meniere Disease:** Characterized by a triad of **episodic vertigo (lasting 20 mins to hours)**, fluctuating SNHL, and **tinnitus/aural fullness**. #### **High-Yield Clinical Pearls for INI-CET** * **Gold Standard Diagnosis:** **Dix-Hallpike Maneuver** (look for geotropic, rotatory nystagmus with latency and fatigability). * **Treatment of Choice:** **Epley Maneuver** (Canalith Repositioning Procedure). * **Most Common Canal Involved:** **Posterior Semicircular Canal** (90% of cases). * **Nystagmus Characteristics:** In BPPV, the nystagmus is **paroxysmal** (starts after a few seconds) and **fatigable** (decreases with repeated testing).
Question 4: Which of the following is incorrect regarding Juvenile Nasopharyngeal Angiofibroma (JNA)?
- A. Biopsy is contraindicated
- B. Epistaxis is the most common presenting symptom
- C. Unilateral cervical lymph nodes are a common feature (Correct Answer)
- D. Only seen in young boys
Explanation: ### **Explanation: Juvenile Nasopharyngeal Angiofibroma (JNA)** **Juvenile Nasopharyngeal Angiofibroma (JNA)** is a benign but locally aggressive, highly vascular tumor. #### **Why Option C is Incorrect (The Correct Answer)** * **JNA is a benign tumor:** By definition, benign tumors do not metastasize. Therefore, **cervical lymphadenopathy is NOT a feature** of JNA. * If a young male presents with a nasopharyngeal mass and cervical lymphadenopathy, the clinician should suspect **Nasopharyngeal Carcinoma (NPC)** or Lymphoma instead. #### **Analysis of Other Options** * **A. Biopsy is contraindicated:** Because the tumor is composed of thin-walled blood vessels lacking a muscular coat (*tunica media*), it is prone to **profuse, life-threatening hemorrhage**. Diagnosis is made clinically and via imaging (CT/MRI); biopsy is strictly avoided unless done in an operating room under extreme caution. * **B. Epistaxis is the most common symptom:** The classic presentation is a triad of **painless, progressive nasal obstruction**, **recurrent profuse epistaxis**, and a mass in the nasopharynx. * **D. Only seen in young boys:** JNA is an **androgen-dependent** tumor seen almost exclusively in adolescent males (typically ages 10–20). If seen in a female, genetic testing (karyotyping) is often recommended. --- ### **High-Yield Clinical Pearls for NEET-PG/INI-CET** * **Origin:** Most commonly from the superior border of the **sphenopalatine foramen**. * **Holman-Miller Sign (Antral Sign):** A pathognomonic radiological finding on CT showing **anterior bowing of the posterior wall of the maxillary sinus**. * **Frog-Face Deformity:** Occurs due to the widening of the nasal bridge and proptosis in advanced stages. * **Investigation of Choice:** **Contrast-Enhanced CT (CECT)** to assess bony involvement; **Angiography** is done to identify the feeding vessel (usually the **Internal Maxillary Artery**) and for preoperative embolization. * **Treatment:** Surgical excision (e.g., Transpalatal, Maxillary swing, or Endoscopic approach) preceded by **preoperative embolization** to reduce blood loss.
Question 5: A 35-year-old man presents to the emergency department with a complaint of food stuck in his throat. On examination, a bone is seen in the left piriform recess. Which of the following is most likely to be impaired?
- A. Cough reflex
- B. Salivation
- C. Gag reflex (Correct Answer)
- D. Mastication
Explanation: ***Gag reflex*** - The **piriform recess (piriform fossa)** is located within the **hypopharynx**, lateral to the laryngeal opening, and is part of the pharyngeal space where the gag reflex is mediated. - A foreign body (bone) lodged in the piriform recess would **directly stimulate and affect** the **gag reflex** by irritating the pharyngeal mucosa innervated by the **glossopharyngeal nerve (CN IX)** (afferent limb) and **vagus nerve (CN X)** (efferent limb). - The **superior laryngeal nerve** (internal branch), which supplies sensation to the piriform fossa, contributes to triggering the gag reflex when this area is stimulated by a foreign body. - This makes the gag reflex the **most directly affected reflex** in this clinical scenario, as the foreign body is in direct contact with the pharyngeal structures that mediate this protective reflex. *Incorrect: Cough reflex* - The cough reflex is primarily mediated by sensory innervation from the **vagus nerve (CN X)** to the **larynx below the vocal cords, trachea, and bronchi**. - While the piriform recess is adjacent to the laryngeal inlet, a foreign body lodged here typically causes dysphagia and affects the gag reflex rather than primarily impairing the cough reflex. - The cough reflex would be more affected if the foreign body were aspirated into the larynx or trachea. *Incorrect: Mastication* - Mastication (chewing) is controlled by the **trigeminal nerve (CN V)**, which innervates the muscles of mastication (masseter, temporalis, pterygoids). - These structures are located in the oral cavity and are anatomically distant from the piriform recess. - A foreign body in the hypopharynx causes **dysphagia** (difficulty swallowing) and **odynophagia** (painful swallowing), not difficulty with chewing. *Incorrect: Salivation* - Salivation is controlled by parasympathetic innervation via the **facial nerve (CN VII)** (submandibular and sublingual glands) and **glossopharyngeal nerve (CN IX)** (parotid gland). - While pain or discomfort from a foreign body might reflexively affect salivation, this is an indirect effect and not the primary reflex associated with the piriform recess. - The neurological pathways controlling salivary secretion are not directly impaired by a foreign body in the pharynx.