FMGE 2026 - ENT PYQs Practice Questions

Q: A 35-year-old patient presents with hearing loss. Clinical examination reveals a Rinne test where Air Conduction is greater than Bone Conduction in both ears. The Weber test lateralizes to the left ear. What is the most likely diagnosis?

Sensorineural hearing loss in the right ear. ***Sensorineural hearing loss in the right ear*** - A **positive Rinne test** (AC > BC) in both ears indicates that the inner ear function is compromised, suggesting **sensorineural hearing loss** (SNHL) rather than conductive pathology. - In SNHL, the **Weber test lateralizes to the better hearing ear** (the side without the pathology), meaning the left ear is the better hearing ear, confirming SNHL in the right ear. *Conductive hearing loss in the left ear* - In **conductive hearing loss**, the Rinne test would be negative (BC > AC) on the affected side, which contradicts the finding of AC > BC in both ears. - Furthermore, a conductive deficit would cause the **Weber test to lateralize to the affected side** (left), but the Rinne test results do not support a conductive etiology. *Conductive hearing loss in the right ear* - If the right ear had **conductive hearing loss**, the Rinne test would show BC > AC in that ear, failing to match the clinical finding of a positive Rinne. - The **Weber test lateralizing to the left ear** indicates the left ear is either normal or has better conduction, ruling out right-sided conductive pathology. *Sensorineural hearing loss in the left ear* - If the SNHL were in the left ear, the **Weber test** would typically lateralize to the right ear (the healthy side). - Since the Weber test lateralizes to the left, this implies the left ear is actually the one with better sensory function, making right-sided SNHL the correct diagnosis. [Practice more ENT PYQs on OnCourse]

Q: A factory worker presents with bilateral hearing difficulty. Audiometry is as shown in the image. This pattern is characteristic of:

Noise-induced hearing loss. ***Noise-induced hearing loss*** - Audiometry typically reveals a **classic 'notch' at 4000 Hz** (4 kHz), which is the hallmark diagnostic finding for occupational exposure to loud noise. - This condition results from damage to the **outer hair cells in the organ of Corti**, primarily in the basal turn of the cochlea, leading to high-frequency hearing loss. *Presbycusis* - Characterized by **bilateral symmetric progressive high-frequency sensorineural hearing loss** that typically begins above 2000 Hz, unlike the specific 4 kHz notch. - This is primarily due to **age-related degeneration** of the cochlea and neural pathways, not occupational trauma. *Meniere’s disease* - Often presents with **low-frequency sensorineural hearing loss**, which is the inverse of the high-frequency loss seen in noise trauma. - Associated with a **triad of symptoms**: episodic vertigo, fluctuating hearing loss, and aural fullness. *Sudden sensorineural hearing loss* - Defined as a rapid reduction in hearing (usually >30 dB in at least three contiguous frequencies) occurring within **72 hours**. - It is generally **unilateral** and idiopathic, whereas noise-induced hearing loss is typically bilateral and chronic. [Practice more ENT PYQs on OnCourse]

Q: A patient presents with chronic sinusitis, nasal crusting, and saddle nose deformity. What is the most likely diagnosis?

Granulomatosis with polyangiitis. ***Granulomatosis with polyangiitis*** - Classically presents with the triad of **upper airway involvement** (chronic sinusitis, **nasal crusting**, **saddle nose deformity**), **lower airway involvement** (lung nodules/cavitation), and **glomerulonephritis**. - Laboratory workup typically reveals **antineutrophil cytoplasmic antibodies (ANCA)**, specifically **PR3-ANCA** (c-ANCA) positivity. *Allergic rhinitis* - Presents with sneezing, rhinorrhea, and **nasal congestion** often triggered by specific **allergens** like pollen or dust. - Does not cause destructive lesions like **saddle nose** or systemic vasculitis manifestations. *Nasal polyposis* - Characterized by soft, gelatinous, **non-tender growths** on the nasal mucosa, often associated with asthma or **aspirin sensitivity**. - It does not cause the severe mucosal ulceration, crusting, or the cartilaginous inflammatory destruction seen in **saddle nose deformity**. *Rhinoscleroma* - A rare chronic granulomatous disease caused by **Klebsiella rhinoscleromatis**, typically seen in endemic regions. - Primarily presents with a painless, slowly progressive **nasal mass** or [Practice more ENT PYQs on OnCourse]

Q: The ideal age for surgical correction of the condition shown in the image is:

6 years and above. ***6 years and above*** - Surgical correction (otoplasty) for **prominent ears (bat ears)** is ideally performed after the age of 6, as the ear reaches approximately **85-90% of its adult size** by this age. - Operating at or after this age allows for adequate structural development and ensures the child has better psychological readiness to cope with the procedure and postoperative care. *At birth* - Surgical intervention is not indicated at birth because maternal hormones like **estrogen** have a circulating effect that allows for **nonsurgical ear molding** (splinting) during the first few weeks of life. - If nonsurgical correction fails or is not attempted, surgery is then deferred until the ear cartilage matures. *1 year and above* - While the ear grows significantly during this period, operating this early is generally avoided due to the higher risk of **anesthesia complications** in infants. - Furthermore, the **cartilage is too soft and thin**, making it difficult to maintain the new shape after correction. *Anytime after adolescence* - There is no clinical mandate to wait until after adolescence; surgery can be safely performed anytime from age 6 through adulthood. - Waiting until after adolescence is often counterproductive, as the child may already have suffered years of **psychological distress** or teasing regarding their appearance. [Practice more ENT PYQs on OnCourse]

Q: A 12-year-old child presents with a midline neck swelling that moves upward with deglutition. She undergoes surgical removal, and postoperatively, she cannot raise her voice. What is the most likely nerve injury?

Unilateral superior laryngeal nerve palsy. ***Unilateral superior laryngeal nerve palsy*** - The **external branch of the superior laryngeal nerve** (SLN) supplies the **cricothyroid muscle**, which is responsible for tensioning the vocal cords to produce high-pitched sounds. - Injury to this nerve during the excision of a **thyroglossal duct cyst** or thyroid surgery leads to difficulty in producing high-pitched tones and **vocal fatigue**. *Bilateral recurrent laryngeal nerve palsy* - Bilateral injury to the **recurrent laryngeal nerve** (RLN) typically results in **stridor** and **respiratory distress** due to the vocal cords remaining adducted in the paramedian position. - The primary deficit is airway compromise rather than a selective loss of vocal pitch. *Hypoglossal nerve injury* - The **hypoglossal nerve** (CN XII) innervates the muscles of the tongue, and its injury results in **tongue deviation** toward the side of the lesion and potential **dysarthria**. - It is located superiorly to the cricothyroid area and is not typically injured during the surgical excision of a midline thyroglossal duct cyst. *Vagus nerve injury* - Injury to the **vagus nerve** (CN X) higher up in its course would present with a broad array of symptoms, including **palatal paralysis** and **absent gag reflex**. - This injury is highly unlikely during a localized neck surgery for a thyroglossal duct cyst. [Practice more ENT PYQs on OnCourse]

Question 1

A 35-year-old patient presents with hearing loss. Clinical examination reveals a Rinne test where Air Conduction is greater than Bone Conduction in both ears. The Weber test lateralizes to the left ear. What is the most likely diagnosis?

Accepted Answer

Sensorineural hearing loss in the right ear

Answer

Conductive hearing loss in the left ear

Answer

Conductive hearing loss in the right ear

Answer

Sensorineural hearing loss in the left ear

Question 2

A factory worker presents with bilateral hearing difficulty. Audiometry is as shown in the image. This pattern is characteristic of:

Accepted Answer

Noise-induced hearing loss

Answer

Presbycusis

Answer

Meniere’s disease

Answer

Sudden sensorineural hearing loss

Question 3

A patient presents with chronic sinusitis, nasal crusting, and saddle nose deformity. What is the most likely diagnosis?

Accepted Answer

Granulomatosis with polyangiitis

Answer

Allergic rhinitis

Answer

Nasal polyposis

Answer

Rhinoscleroma

Question 4

The ideal age for surgical correction of the condition shown in the image is:

Accepted Answer

6 years and above

Answer

At birth

Answer

1 year and above

Answer

Anytime after adolescence

Question 5

A 12-year-old child presents with a midline neck swelling that moves upward with deglutition. She undergoes surgical removal, and postoperatively, she cannot raise her voice. What is the most likely nerve injury?

Accepted Answer

Unilateral superior laryngeal nerve palsy

Answer

Bilateral recurrent laryngeal nerve palsy

Answer

Hypoglossal nerve injury

Answer

Vagus nerve injury

Question 6

A patient presents with difficulty swallowing and regurgitation of undigested food with foul- smelling breath. The lateral neck X-ray is as shown. The diverticulum occurs due to herniation between which muscles?

Accepted Answer

Cricopharyngeus and Thyropharyngeus

Answer

Cricopharyngeus and Sternocleidomastoid

Answer

Thyropharyngeus and Inferior constrictor

Answer

Inferior constrictor and Sternocleidomastoid

Question 7

A chronic smoker presents with a low -pitched, husky voice. Indirect laryngoscopy reveals findings as shown in the image. What is the most likely diagnosis?

Accepted Answer

Reinke’s edema

Answer

Vocal cord polyp

Answer

Bilateral vocal cord cyst

Answer

Laryngeal papillomatosis

Question 8

A child presents with a history of accidental coin ingestion. The X -ray is as shown in the image. The coin is most likely lodged in which site?

Accepted Answer

Esophagus

Answer

Larynx

Answer

Trachea

Answer

Hypopharynx

Question 9

A 58-year-old man, chronic smoker, presents with progressive hoarseness of voice and throat discomfort for 4 months. Laryngoscopy reveals a laryngeal growth, and neck examination shows a single ipsilateral, mobile cervical lymph node. Biopsy confirms squamous cell carcinoma of the larynx. What is the most appropriate treatment?

Accepted Answer

Chemoradiotherapy

Answer

Radiotherapy alone

Answer

Partial laryngectomy

Answer

Total laryngectomy

Question 10

A patient presents with an ulcer on the posterior pharyngeal wall, as shown in the image. This lesion most likely originates from which structure?

Accepted Answer

Pharyngeal mucosa

Answer

Minor salivary glands

Answer

Subepithelial region

Answer

Lymphoid tissue

FMGE 2026 — ENT