INI-CET 2026 - ENT PYQs Practice Questions

Q: A patient develops acute-onset severe unilateral hearing loss with no identifiable cause. Audiometry confirms sensorineural hearing loss. Which of the following pharmacological regimens is considered the first-line treatment for this condition?

Oral prednisolone (systemic corticosteroids). ***Oral prednisolone (systemic corticosteroids)*** - Systemic corticosteroids are the **first-line standard of care** for idiopathic sudden sensorineural hearing loss (SSNHL), typically initiated as soon as possible after diagnosis. - The goal is to reduce **inner ear inflammation** and edema, which is thought to be a primary pathophysiological mechanism for the condition. *Intratympanic steroid injections* - These are typically reserved as a **salvage therapy** for patients who fail to respond to initial systemic corticosteroid treatment. - While effective, they are generally not used as a first-line monotherapy due to the invasive nature and the proven efficacy of oral regimens. *Topical steroid ear drops* - These are ineffective for treating inner ear pathology because they are **unable to cross the tympanic membrane** into the middle and inner ear. - Topical therapy is primarily indicated for **otitis externa** and is irrelevant for sensorineural hearing loss conditions. *Gentamicin combined with systemic steroids* - Gentamicin is an **ototoxic aminoglycoside** that is toxic to the hair cells of the cochlea, which would potentially worsen, not treat, hearing loss. - This combination is contraindicated in the treatment of SSNHL and is actually used in a completely different context, such as chemical labyrinthectomy for Meniere's disease to ablate vestibular function. [Practice more ENT PYQs on OnCourse]

Q: A patient is evaluated for a rare orofacial syndrome. The classical diagnostic triad of this condition is being reviewed. Which of the following is NOT a component of the Melkersson- Rosenthal syndrome triad?

Proptosis (forward displacement of the eyeball). ***Proptosis (forward displacement of the eyeball)*** - Proptosis is **not a component** of the classic Melkersson-Rosenthal syndrome (MRS) triad. - Orbital involvement is generally not associated with this condition, making this the correct choice as the exception. *Lower motor neuron facial palsy* - This condition is a key component of the MRS triad, often manifesting as **recurrent, unilateral or bilateral facial paralysis**. - The paralysis is usually transient and may result in residual weakness as the disease progresses. *Orofacial granulomatous oedema* - Also known as **granulomatous cheilitis**, this presents as chronic, recurrent swelling of the lips and face. - This edema is a hallmark feature of MRS and corresponds to the granulomatous inflammation seen on histology. *Fissured (scrotal) tongue* - This is the third component of the classic triad, described as a **deeply furrowed tongue** (lingua plicata). - While it is a recognized part of the syndrome, it is frequently the least common of the three features and may be seen in healthy individuals as well. [Practice more ENT PYQs on OnCourse]

Q: A female patient presents with recurrent epistaxis and a unilateral nasal cavity mass. CT scan reveals localised bony erosion. Among the following differential diagnoses, which is the LEAST likely cause of these findings?

Antrochoanal polyp. ***Antrochoanal polyp*** - These are benign **inflammatory lesions** arising from the maxillary sinus and extending into the nasal cavity, typically presenting with symptoms of obstruction rather than epistaxis. - They do not cause **bony erosion**; rather, they can cause **bony remodeling** or widening of the ostium due to chronic pressure, making them the least likely cause of aggressive bony destruction. *Inverted papilloma with malignant transformation* - These are locally aggressive, **neoplastic tumors** that frequently cause significant **bony destruction** and remodeling of the nasal cavity and sinuses. - They are well-known to have high rates of recurrence and potential for malignant transformation into **squamous cell carcinoma**, which correlates with the patient's presentation. *Olfactory esthesioneuroblastoma* - This is a rare **neuroectodermal malignancy** arising from the olfactory epithelium in the superior nasal cavity, inherently capable of aggressive involvement. - It commonly presents with nasal obstruction, **epistaxis**, and, upon imaging, frequently demonstrates extension into the skull base with associated **bony erosion**. *Juvenile nasopharyngeal angiofibroma* - Although predominantly found in young males, this is a highly vascular tumor that presents with **profuse, recurrent epistaxis** and a nasal mass. - It is classically known for specific radiological findings including the widening of the **pterygopalatine fossa** and significant **bony erosions** in the surrounding regions. [Practice more ENT PYQs on OnCourse]

Q: An elderly immunocompromised patient presents with blood-stained nasal discharge and a black necrotic eschar covering the right nasal cavity, hard palate, and nasal turbinates. Histopathology reveals broad aseptate hyphae. Which organism is the most common causative agent of this life-threatening condition?

Rhizopus species. ***Rhizopus species*** - This organism is the most frequent cause of **rhinocerebral mucormycosis**, an aggressive fungal infection that rapidly invades tissues, producing the classic **black necrotic eschar** on the nasal mucosa and palate. - Histopathology characteristically shows **broad, aseptate hyphae** with right-angle branching, distinguishing it from other common fungal pathogens. *Candida albicans* - While an opportunistic pathogen, this fungi typically causes **thrush** or systemic candidiasis rather than invasive, angioinvasive tissue destruction leading to necrosis. - Histopathology reveals **yeast cells** and **pseudohyphae**, which are morphologically distinct from the structures seen in mucormycosis. *Cryptococcus neoformans* - This yeast is primarily associated with **meningitis** and pulmonary infections in immunocompromised hosts, especially those with advanced HIV/AIDS. - It presents as an **encapsulated yeast** on special stains like India ink or mucicarmine, not as broad hyphae. *Aspergillus fumigatus* - Known to cause invasive aspergillosis, particularly in lungs, but typically presents with **septate hyphae** showing **acute-angle (45 degree) branching**. - While it can invade the sinuses, the specific clinical picture of a black eschar on the hard palate is pathognomonic for mucormycosis (Zygomycosis). [Practice more ENT PYQs on OnCourse]

Question 1

A patient develops acute-onset severe unilateral hearing loss with no identifiable cause.
Audiometry confirms sensorineural hearing loss. Which of the following pharmacological regimens
is considered the first-line treatment for this condition?

Accepted Answer

Oral prednisolone (systemic corticosteroids)

Answer

Intratympanic steroid injections

Answer

Topical steroid ear drops

Answer

Gentamicin combined with systemic steroids

Question 2

A patient is evaluated for a rare orofacial syndrome. The classical diagnostic triad of this
condition is being reviewed. Which of the following is NOT a component of the Melkersson-
Rosenthal syndrome triad?

Accepted Answer

Proptosis (forward displacement of the eyeball)

Answer

Lower motor neuron facial palsy

Answer

Orofacial granulomatous oedema

Answer

Fissured (scrotal) tongue

Question 3

A female patient presents with recurrent epistaxis and a unilateral nasal cavity mass. CT scan
reveals localised bony erosion. Among the following differential diagnoses, which is the LEAST
likely cause of these findings?

Accepted Answer

Antrochoanal polyp

Answer

Inverted papilloma with malignant transformation

Answer

Olfactory esthesioneuroblastoma

Answer

Juvenile nasopharyngeal angiofibroma

Question 4

An elderly immunocompromised patient presents with blood-stained nasal discharge and a
black necrotic eschar covering the right nasal cavity, hard palate, and nasal turbinates.
Histopathology reveals broad aseptate hyphae. Which organism is the most common causative
agent of this life-threatening condition?

Accepted Answer

Rhizopus species

Answer

Candida albicans

Answer

Cryptococcus neoformans

Answer

Aspergillus fumigatus

INI-CET 2026 — ENT