NEET-PG 2015 — ENT
24 Previous Year Questions with Answers & Explanations
All of the following are features of a nasal foreign body except:
Chemical labyrinthectomy by transtympanic route is done in Meniere's disease using which drug?
Which of the following is a cause of objective tinnitus?
Otosclerosis affects which bone?
Which perforation of the tympanic membrane is most commonly seen with tubotympanic CSOM?
Most common cause of otitis externa is
Which of the following tests is used to differentiate between cochlear and retrocochlear hearing loss?
Hitselberger's sign is seen in?
Which of the following statements about vasomotor rhinitis is NOT true?
Which of the following statements about malignant otitis externa is true?
NEET-PG 2015 - ENT NEET-PG Practice Questions and MCQs
Question 1: All of the following are features of a nasal foreign body except:
- A. Epistaxis
- B. Nasal obstruction
- C. Nasal polyps (Correct Answer)
- D. Foul smelling discharge
Explanation: ***Nasal polyps*** - While chronic inflammation can lead to nasal polyps, they are **not a direct or acute feature** of a nasal foreign body. - Nasal foreign bodies typically present with more immediate and obstructive symptoms rather than polyp formation. *Epistaxis* - A nasal foreign body can **irritate and traumatize the delicate nasal mucosa**, leading to bleeding. - This is a common symptom, especially if the foreign body is sharp or has been in place for some time. *Nasal obstruction* - The presence of any object in the nasal cavity will inevitably cause some degree of **physical blockage of airflow**. - This is one of the most common presenting symptoms, particularly in children. *Foul smelling discharge* - If a foreign body remains in the nasal cavity for an extended period, it can lead to **stasis of secretions and secondary bacterial infection**. - This infection often results in a **purulent, unilateral, and foul-smelling discharge**.
Question 2: Chemical labyrinthectomy by transtympanic route is done in Meniere's disease using which drug?
- A. Amikacin
- B. Amoxycillin
- C. Cyclosporine
- D. Gentamicin (Correct Answer)
Explanation: ***Gentamicin*** - **Gentamicin** is an **aminoglycoside antibiotic** that is commonly used for chemical labyrinthectomy due to its **ototoxic** properties, particularly its selective toxicity to **vestibular hair cells** at lower doses. - When administered transtympanically, it achieves high concentrations in the **inner ear fluid**, effectively ablating the vestibular function and reducing severe vertigo in **Meniere's disease**. *Amikacin* - **Amikacin** is also an **aminoglycoside antibiotic** with ototoxic potential, but it is typically reserved for severe bacterial infections and is not the primary drug of choice for **chemical labyrinthectomy** in Meniere's disease. - While it can cause hearing loss, **gentamicin** has a more established and preferential effect on the **vestibular system** at therapeutic doses for Meniere's. *Amoxycillin* - **Amoxycillin** is a common **beta-lactam antibiotic** used for bacterial infections, and it does not possess **ototoxic** properties that would make it suitable for chemical labyrinthectomy. - It is primarily known for its antibacterial action and has no role in the management of vertigo in **Meniere's disease** via transtympanic administration. *Cyclosporine* - **Cyclosporine** is an **immunosuppressant drug** used to prevent organ rejection and treat autoimmune conditions; it does not have properties for chemical ablation of the labyrinth. - While some autoimmune components are sometimes considered in Meniere's disease, cyclosporine is not used for **transtympanic chemical labyrinthectomy**.
Question 3: Which of the following is a cause of objective tinnitus?
- A. Impacted Wax
- B. Carotid artery aneurysm (Correct Answer)
- C. Meniere's disease
- D. Ototoxic drugs
Explanation: ***Carotid artery aneurysm*** - An **aneurysm** of the **carotid artery** can cause pulsatile tinnitus that is audible to others (objective) due to turbulent blood flow. - The sounds originate from vascular structures within or near the ear, making them detectable by a clinician. *Impacted Wax* - **Impacted cerumen** is a common cause of **subjective tinnitus**, where the sound is heard only by the patient. - It can muffle external sounds and alter the perception of internal body sounds, but it does not produce a sound audible to others. *Meniere's disease* - **Meniere's disease** is characterized by **subjective tinnitus**, along with vertigo, hearing loss, and aural fullness. - The tinnitus in Meniere's is typically a low-pitched roaring or buzzing sound, audible only to the affected individual. *Ototoxic drugs* - **Ototoxic drugs** (e.g., aspirin, aminoglycosides) commonly induce **subjective tinnitus** as a side effect. - These medications primarily damage inner ear structures, leading to perceived sounds that are not externally measurable.
Question 4: Otosclerosis affects which bone?
- A. Stapes (Correct Answer)
- B. Incus
- C. Malleus
- D. Cochlea
Explanation: ***Stapes*** - **Otosclerosis** is a condition characterized by abnormal bone growth in the middle ear, specifically around the **stapes footplate**. - This abnormal growth fixates the stapes, preventing it from vibrating properly and leading to **conductive hearing loss**. - **Fenestral otosclerosis** (most common type) directly affects the oval window and stapes footplate. *Incus* - The **incus** is the middle ossicle in the chain, between the malleus and the stapes. - While it can be affected by other middle ear pathologies, otosclerosis primarily targets the **stapes**. *Malleus* - The **malleus** is the outermost ossicle, attached to the eardrum. - Its involvement in otosclerosis is rare and indirect, as the primary site of disease is the **stapes**. *Cochlea* - **Cochlear (retrofenestral) otosclerosis** can occur but is less common and typically causes **sensorineural hearing loss**. - The classic presentation of otosclerosis involves **stapedial fixation** causing conductive hearing loss, not primary cochlear involvement.
Question 5: Which perforation of the tympanic membrane is most commonly seen with tubotympanic CSOM?
- A. Central (Correct Answer)
- B. Anterosuperior
- C. Posterosuperior
- D. Posteroinferior
Explanation: ***Central*** - A **central perforation** of the tympanic membrane is the most common type seen in **tubotympanic chronic suppurative otitis media (CSOM)**. - This type of perforation involves the **pars tensa** of the tympanic membrane, leaving an intact annulus. *Anterosuperior* - While perforations can occur anywhere, an **anterosuperior perforation** is not the hallmark of tubotympanic CSOM. - This location does not specifically correlate with the characteristic inflammatory patterns seen in tubotympanic disease. *Posterosuperior* - A **posterosuperior perforation** is more often associated with **atticoantral CSOM** due to **cholesteatoma formation**. - **Cholesteatoma** typically begins in the pars flaccida or posterosuperior pars tensa, which is different from tubotympanic CSOM. *Posteroinferior* - A **posteroinferior perforation** is not the most typical presentation for tubotympanic CSOM. - This location does not specifically differentiate it from other forms of otitis media or reflect the primary pathology of tubotympanic disease.
Question 6: Most common cause of otitis externa is
- A. Fungal infection
- B. Bacterial infection (Correct Answer)
- C. Seborrheic disease
- D. Herpes Zoster
Explanation: ***Bacterial infection*** - The most common pathogens causing **otitis externa** are bacteria, primarily **Pseudomonas aeruginosa** and **Staphylococcus aureus**. - This condition, often called "swimmer's ear," is favored by moisture in the ear canal, which creates a conducive environment for bacterial growth. *Fungal infection* - While fungal infections (otomycosis) can cause otitis externa, they are **less common** than bacterial causes. - Fungi like *Aspergillus* and *Candida* are typically involved, often in immunocompromised individuals or after prolonged antibiotic use. *Seborrheic disease* - **Seborrheic dermatitis** can affect the ear canal and surrounding skin, leading to flaking, itching, and inflammation. - However, it is a primary skin condition and does not directly cause infectious otitis externa, although it can predispose to secondary infections. *Herpes Zoster* - **Herpes zoster oticus** (Ramsay Hunt syndrome) is a viral infection affecting the facial nerve, causing a painful rash, facial paralysis, and hearing loss. - It is a specific viral etiology with distinct neurological symptoms and is not a common cause of general otitis externa.
Question 7: Which of the following tests is used to differentiate between cochlear and retrocochlear hearing loss?
- A. Recruitment
- B. Threshold tone decay test
- C. Evoked response audiometry (Correct Answer)
- D. SISI test
Explanation: **Evoked response audiometry** - **Evoked response audiometry (ERA)**, specifically **Auditory Brainstem Response (ABR)** or **Brainstem Evoked Response Audiometry (BERA)**, is the gold standard for differentiating between cochlear and retrocochlear hearing loss. - ABR measures electrical activity from the auditory nerve and brainstem in response to sound, allowing for differentiation between **cochlear pathology** (normal ABR latencies with hearing loss) and **retrocochlear pathology** (prolonged interpeak latencies, absent waves, or abnormal waveform morphology suggestive of auditory nerve or brainstem lesion). - Classic findings in retrocochlear lesions include prolonged I-V interpeak latency or absent Wave V. *SISI test* - The **Short Increment Sensitivity Index (SISI) test** assesses the ability to detect small (1 dB) increments in sound intensity superimposed on a continuous tone. - A **high SISI score (>70%)** indicates **cochlear dysfunction** due to recruitment phenomenon, while a **low score (<20%)** may suggest retrocochlear pathology. - However, it does not directly differentiate between cochlear and retrocochlear lesions with the same specificity and sensitivity as ABR. *Threshold tone decay test* - The **Tone Decay Test (TDT)** measures the ability to sustain the perception of a continuous pure tone presented at or near threshold level. - **Significant tone decay (>30 dB in 60 seconds)** suggests **retrocochlear pathology** due to auditory nerve fatigue, making it useful for screening. - While helpful, it is less precise, sensitive, and specific than ABR for definitive differentiation and may have false positives. *Recruitment* - **Recruitment** is an abnormal growth in the perception of loudness, where a small increase in sound intensity leads to a disproportionately large increase in perceived loudness. - It is a classic sign of **cochlear hearing loss**, particularly associated with outer hair cell damage (sensory hearing loss). - Its presence confirms cochlear pathology but its absence does not confirm retrocochlear lesions, making it less reliable as a differentiating test compared to ABR.
Question 8: Hitselberger's sign is seen in?
- A. Glomus Tumour
- B. Nasal angiofibroma
- C. Acute suppurative otitis media
- D. Acoustic neuroma (Correct Answer)
Explanation: ***Acoustic neuroma*** - Hitselberger's sign is an area of **hypoesthesia** or **anesthesia** in the **posterosuperior portion of the external auditory canal**. - Acoustic neuromas (vestibular schwannomas) arise from the **vestibular portion of CN VIII** in the internal auditory canal. - This sign results from involvement of the **sensory fibers of the nervus intermedius** (sensory branch associated with the facial nerve) due to close anatomical proximity in the cerebellopontine angle. - This symptom, also known as the **"ear canal sign,"** is relatively specific for acoustic neuroma. *Glomus Tumour* - Glomus tumors are **highly vascular benign tumors** of the **middle ear** that present with **pulsatile tinnitus** and conductive hearing loss. - While they can affect cranial nerves, Hitselberger's sign is not a characteristic presentation. *Nasal angiofibroma* - Nasal angiofibromas are **benign, highly vascular tumors** found in the **nasopharynx**, primarily affecting adolescent males. - They typically present with **epistaxis** and **nasal obstruction** and do not cause Hitselberger's sign. *Acute suppurative otitis media* - Acute suppurative otitis media is an **infection of the middle ear** causing earache, fever, and hearing loss. - It does not involve the cerebellopontine angle or sensory innervation of the external auditory canal in a way that would lead to Hitselberger's sign.
Question 9: Which of the following statements about vasomotor rhinitis is NOT true?
- A. It is due to parasympathetic overactivity
- B. Resistant cases may need cryotherapy
- C. It may lead to hypertrophic rhinitis
- D. It is caused by an allergic reaction (Correct Answer)
Explanation: ***It is caused by an allergic reaction.*** - Vasomotor rhinitis, also known as nonallergic rhinitis, is characterized by symptoms similar to allergic rhinitis but is **not mediated by an allergic reaction** or an IgE-mast cell response. - Its etiology is related to the **dysregulation of the autonomic nervous system**, specifically an imbalance in the vascular tone of nasal blood vessels, rather than an allergic trigger. *It is due to parasympathetic overactivity* - **Parasympathetic overactivity** is a recognized underlying mechanism in vasomotor rhinitis, leading to increased vascular permeability and glandular secretion. - This overactivity results in symptoms such as **nasal congestion**, rhinorrhea, and sneezing, mimicking allergic rhinitis without an identifiable allergen. *Resistant cases may need cryotherapy* - For severe and **medically refractory cases** of vasomotor rhinitis, **cryotherapy** (specifically cryoablation of the posterior nasal nerve) can be a treatment option. - This procedure targets the nerves responsible for parasympathetic outflow to the nasal mucosa, thereby reducing symptoms like rhinorrhea and congestion. *It may lead to hypertrophic rhinitis* - Chronic inflammation and vascular engorgement associated with long-standing vasomotor rhinitis can lead to **mucosal hypertrophy**, particularly of the inferior turbinates. - This condition, known as **hypertrophic rhinitis**, can exacerbate nasal obstruction and may require surgical intervention to improve airflow.
Question 10: Which of the following statements about malignant otitis externa is true?
- A. Not painful
- B. Common in diabetics and old age (Correct Answer)
- C. Caused by streptococcus
- D. Responds to topical antibiotics alone
Explanation: ***Common in diabetics and old age*** - **Malignant otitis externa** is an aggressive infection primarily affecting the external auditory canal and surrounding structures. - It most commonly occurs in **immunocompromised individuals**, especially **elderly diabetics**, due to impaired immune response and microvascular complications. *Not painful* - Malignant otitis externa is characterized by **severe, unrelenting otalgia (ear pain)** that often worsens at night and is disproportionate to the clinical findings. - The pain is due to the **inflammatory and destructive process** involving cartilage, bone, and nerves. *Caused by streptococcus* - The most common causative organism for malignant otitis externa is **Pseudomonas aeruginosa** (>90% of cases), not Streptococcus. - **Streptococcus species** are more commonly associated with acute otitis media or common skin infections. *Responds to topical antibiotics alone* - Malignant otitis externa requires **prolonged systemic antibiotic therapy** (typically 4-6 weeks of intravenous or oral fluoroquinolones like ciprofloxacin). - Topical antibiotics alone are **insufficient** due to the invasive nature of the infection, which extends beyond the external canal to involve bone and soft tissues.