FMGE 2026 - ENT Practice Questions

Q: A patient presents with a swelling in the floor of the mouth, as shown in the image. The swelling is painless and gradually increasing in size. What is the most likely diagnosis?

Ranula. ***Ranula*** - A ranula is a **mucus extravasation phenomenon** involving the **sublingual gland**, typically presenting as a painless, blue, translucent swelling in the floor of the mouth. - It specifically refers to this pathology occurring in the **sublingual space**, distinguishing it from mucoceles found elsewhere in the oral cavity. *Ludwig’s angina* - This is a rapidly progressive **bacterial infection** (cellulitis) of the submandibular space, presenting with **pain**, **fever**, and **airway compromise**, unlike the painless swelling described. - Clinical features include a **woody induration** of the neck and **elevated tongue**, appearing as a medical emergency, not a chronic, simple swelling. *Mucocele* - A mucocele is a general term for a lesion caused by **trauma** or obstruction of minor salivary gland ducts, occurring most commonly on the **lower lip**. - While pathologically similar to a ranula (mucus extravasation), the term **ranula** is specifically reserved for extravasation phenomenon involving the **sublingual gland** in the floor of the mouth. *Dermoid cyst* - A dermoid cyst is a **developmental, midline** lesion typically containing **keratin** and adnexal structures, often feeling doughy or fluctuant on palpation. - Unlike the translucent blue appearance of a ranula, dermoid cysts usually match the color of the surrounding **mucosa** and are slow-growing, congenital-like lesions.

Q: A 40 year old presented with bilateral hearing loss. Audiogram shows a dip at 2000 Hz. What is the most appropriate investigation?

Impedance audiometry. ### ***Impedance audiometry*** - In a patient with **otosclerosis**, the characteristic **Carhart's notch** (a dip at 2000 Hz on bone conduction audiometry) is a hallmark finding due to stapes fixation. - **Impedance audiometry** (specifically **tympanometry**) will demonstrate a **Type As tympanogram**, indicating reduced compliance of the tympanic membrane due to increased stiffness of the ossicular chain. ### *BERA* - **Brainstem Evoked Response Audiometry** (BERA) is primarily used for **retro-cochlear pathology** like **vestibular schwannomas** or in pediatric audiology screening. - While it can assess hearing thresholds, it is not the standard next diagnostic step for evaluating **conductive hearing loss** caused by stapes fixation. ### *Otoacoustic emissions* - **Otoacoustic emissions** (OAEs) are used to assess **outer hair cell function** in the cochlea, largely for neonatal hearing screening. - They do not provide diagnostic utility for middle ear pathologies like otosclerosis, as the sound energy cannot effectively enter or exit the middle ear. ### *Pure tone audiometry* - While **pure tone audiometry** is essential for establishing the diagnosis and identifying the **Carhart's notch**, it has already been performed in this scenario. - The clinical question asks for the *most appropriate investigation* to confirm the specific pathology (middle ear conduction system stiffness) implied by the audiogram findings.

Q: What is the treatment of choice for Rhinoscleroma?

Long term antibiotics with surgical debulking. ***Long term antibiotics with surgical debulking*** - Rhinoscleroma is a chronic granulomatous infection caused by **Klebsiella rhinoscleromatis**, requiring prolonged treatment, often with **tetracyclines**, **fluoroquinolones**, or **trimethoprim-sulfamethoxazole**, typically for months to prevent recurrence. - **Surgical debulking** is essential for cases with airway obstruction or heavy fibrotic tissue (

Question 1

A patient presents with a swelling in the floor of the mouth, as shown in the image. The swelling is painless and gradually increasing in size. What is the most likely diagnosis?

Accepted Answer

Ranula

Answer

Ludwig’s angina

Answer

Mucocele

Answer

Dermoid cyst

Question 2

A 40 year old presented with bilateral hearing loss. Audiogram shows a dip at 2000 Hz. What is the most appropriate investigation?

Accepted Answer

Impedance audiometry

Answer

BERA

Answer

Otoacoustic emissions

Answer

Pure tone audiometry

Question 3

What is the treatment of choice for Rhinoscleroma?

Accepted Answer

Long term antibiotics with surgical debulking

Answer

Corticosteroids with antihistamines

Answer

Radiotherapy

Answer

Short course oral antibiotics with nasal decongestants

FMGE 2026 — ENT