NEET-PG 2013 - ENT Practice Questions

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: 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: Which of the following statements about tubercular otitis media is false?

Causes painful ear discharge. ***Causes painful ear discharge*** - **Pain** is typically an **absent or minimal symptom** in tubercular otitis media, even with significant ear discharge. - The discharge is usually **thin, watery, and non-purulent**, reflecting the indolent nature of the infection. *Spreads through the eustachian tube* - Tubercular otitis media can spread via the **eustachian tube** from the nasopharynx, especially in cases of active pulmonary or pharyngeal tuberculosis. - This is a common route for infectious agents to reach the middle ear. *Usually affects only one ear* - Tubercular otitis media predominantly presents as a **unilateral infection**. - While bilateral involvement can occur, it is less common than unilateral presentation. *May cause multiple perforations* - Tubercular otitis media is notorious for causing **multiple, small perforations** in the tympanic membrane. - This feature, often described as a "sieve-like" drum, is a characteristic diagnostic clue for the condition.

Q: What is the treatment of choice for atticoantral type of chronic suppurative otitis media (CSOM)?

Modified radical mastoidectomy. ***Modified radical mastoidectomy*** - The **atticoantral type of CSOM** is characterized by active **cholesteatoma**, which requires surgical removal to prevent further bone erosion and complications. - A **modified radical mastoidectomy** is the treatment of choice as it removes the cholesteatoma and diseased mastoid air cells while aiming to preserve residual hearing. *Antibiotics* - While topical or systemic antibiotics may be used to control acute infections or discharge in CSOM, they do not eradicate **cholesteatoma**. - **Cholesteatoma** is an epidermoid cyst that requires surgical excision, as antibiotics alone cannot resolve it. *Tympanoplasty* - **Tympanoplasty** is primarily performed to reconstruct the tympanic membrane (eardrum) and/or the ossicular chain to restore hearing. - It is typically indicated for the **tubotympanic type of CSOM** (safe type) without cholesteatoma, not for the atticoantral type which involves cholesteatoma. *None of the options* - This option is incorrect because **modified radical mastoidectomy** is a well-established and necessary treatment for the atticoantral type of CSOM involving cholesteatoma.

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: Which of the following statements about Grisel syndrome is false?

A neurosurgeon is never needed.. ***A neurosurgeon is never needed.*** - This statement is false because severe cases of **Grisel syndrome** may require surgical intervention, necessitating consultation with a **neurosurgeon**. - Surgical management, such as **cervical fusion**, may be indicated in cases of irreducible subluxation or neurological compromise. *It can occur after adenoidectomy.* - This statement is true; **Grisel syndrome** is a rare complication that may occur following **adenoidectomy** or other head and neck surgeries. - The postulated mechanism involves inflammation spreading from the pharynx to the alar and transverse ligaments, leading to **atlantoaxial subluxation**. *It involves inflammation of cervical spine ligaments.* - This statement is true; **Grisel syndrome** is characterized by non-traumatic **atlantoaxial subluxation** resulting from inflammatory laxity of the cervical ligaments. - Specifically, the **transverse and alar ligaments** become inflamed and weakened, leading to instability between the atlas (C1) and axis (C2). *Conservative treatment is the first-line approach in most cases.* - This statement is true; initial management of **Grisel syndrome** typically involves conservative measures such as **neck immobilization**, pain control, and muscle relaxants. - Early diagnosis and conservative treatment are crucial to prevent progression and potential neurological complications.

Q: Posterosuperior retraction pocket if allowed to progress will lead to?

Primary cholesteatoma. ***Primary cholesteatoma*** - A posterosuperior retraction pocket is a common precursor to the development of a **primary cholesteatoma**. - This pocket, formed by **negative pressure** in the middle ear, accumulates **desquamated keratin** and can erode surrounding bone. *SNHL* - While a cholesteatoma can ultimately cause **sensorineural hearing loss (SNHL)** due to extensive bone erosion affecting the inner ear, it is a later complication, not the direct outcome of the initial retraction pocket itself. - **SNHL** is more commonly associated with conditions directly damaging the **cochlea or auditory nerve**. *Secondary cholesteatoma* - A **secondary cholesteatoma** typically arises from a perforation in the tympanic membrane where skin migrates into the middle ear, not from an intact retraction pocket. - This condition is also known as a **'migratory'** or **'acquired'** cholesteatoma. *Tympanosclerosis* - **Tympanosclerosis** involves the formation of **hyalinized collagen and calcium deposits** within the tympanic membrane or middle ear mucosa, resulting from chronic inflammation or previous trauma. - It is a **fibrotic healing response** and does not directly result from a retraction pocket, although both can be sequelae of chronic otitis media.

Q: In which condition do symptoms improve with crying?

Choanal atresia. ***Choanal atresia*** - In **bilateral choanal atresia**, a newborn is unable to breathe through the nose due to a bony or membranous obstruction. Symptoms like **cyanosis** worsen with feeding and improve with crying because crying involves **mouth breathing**, which bypasses the nasal obstruction. - This condition is a **medical emergency** as newborns are obligate nasal breathers, and immediate intervention (e.g., oral airway, surgical repair) is often required. *Tetralogy of Fallot* - This congenital heart defect can lead to **cyanotic spells** (hypercyanotic or "tet" spells), which are characterized by increased cyanosis, tachypnea, and irritability. These spells are often precipitated by activities that increase right-to-left shunting, and **crying can worsen them** rather than improve them due to increased systemic oxygen demand and vascular resistance. - Management often involves positioning (knee-chest) and medications to reduce pulmonary vascular resistance or increase systemic vascular resistance, to alleviate shunting. *Bronchial asthma* - **Crying is a common trigger for asthma attacks** in children, as it can induce bronchoconstriction due to hyperventilation and airway irritation. Symptoms typically worsen with crying, leading to **wheezing, coughing, and shortness of breath**. - Asthma is characterized by **reversible airway obstruction** and airway hyperresponsiveness, and its symptoms do not improve with crying. *None of the options* - This option is incorrect because **choanal atresia** is a condition where symptoms (specifically cyanosis) do improve with crying due to the switch from nasal to mouth breathing.

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.

Question 1

Endolymphatic sac decompression is done in?

Accepted Answer

Definitive treatment for intractable vertigo in Meniere's disease

Answer

Management of endolymphatic hydrops in early-stage Meniere's disease

Answer

Prophylactic treatment in recurrent vertigo syndromes

Answer

Primary surgical approach for cochlear disorders

Question 2

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 3

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 4

Which of the following statements about tubercular otitis media is false?

Accepted Answer

Causes painful ear discharge

Answer

Spreads through the eustachian tube

Answer

Usually affects only one ear

Answer

May cause multiple perforations

Question 5

What is the treatment of choice for atticoantral type of chronic suppurative otitis media (CSOM)?

Accepted Answer

Modified radical mastoidectomy

Answer

Tympanoplasty

Answer

None of the options

Answer

Antibiotics

Question 6

In which condition is the Schwartze sign observed?

Accepted Answer

Otosclerosis

Answer

Glomus Jugulare

Answer

Acoustic neuroma

Answer

Meniere's disease

Question 7

Which of the following statements about Grisel syndrome is false?

Accepted Answer

A neurosurgeon is never needed.

Answer

It can occur after adenoidectomy.

Answer

It involves inflammation of cervical spine ligaments.

Answer

Conservative treatment is the first-line approach in most cases.

Question 8

Posterosuperior retraction pocket if allowed to progress will lead to?

Accepted Answer

Primary cholesteatoma

Answer

SNHL

Answer

Secondary cholesteatoma

Answer

Tympanosclerosis

Question 9

In which condition do symptoms improve with crying?

Accepted Answer

Choanal atresia

Answer

Tetralogy of Fallot

Answer

Bronchial asthma

Answer

None of the options

Question 10

During functional endoscopic sinus surgery the position of the patient is

Accepted Answer

Reverse Trendelenburg

Answer

Lateral

Answer

Lithotomy

Answer

Trendelenburg

NEET-PG 2013 — ENT