NEET-PG 2015 - ENT Practice Questions

Q: What is the treatment of choice for Deviated Nasal Septum (DNS) in adults?

Septoplasty. ***Septoplasty*** - **Septoplasty** is the surgical procedure of choice to correct a deviated nasal septum by **realigning the cartilage and bone** in the septum. - It is performed to improve nasal airflow and address symptoms like **nasal obstruction** or recurrent sinusitis. *Medical management with decongestants* - **Decongestants** provide temporary relief from nasal congestion but do not correct the underlying **anatomical deviation** of the septum. - Prolonged use of decongestants can lead to **rhinitis medicamentosa**, a rebound congestion. *Observation* - **Observation** is not an appropriate long-term solution for symptomatic DNS as the **anatomical deviation** will persist and symptoms are unlikely to improve spontaneously. - Patients with significant symptoms impacting their quality of life require active intervention rather than just monitoring. *Turbinoplasty* - **Turbinoplasty** is a procedure to reduce the size of the **turbinates**, which are bony structures in the nasal cavity that can contribute to nasal obstruction. - While it can be performed concurrently with septoplasty, it does not correct the **deviated septum itself**.

Q: Chemical labyrinthectomy by transtympanic route is done in Meniere's disease using which drug?

Gentamicin. ***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**.

Q: The narrowest part of the nasal cavity is?

Internal nasal valve. ***Internal nasal valve*** - The **internal nasal valve** is considered the narrowest and most restrictive part of the **nasal airway**. - It is formed by the caudal border of the **upper lateral cartilage**, septum, and the head of the inferior turbinate. *Antrochoanal region* - The **antrochoanal region** is the posterior opening of the nasal cavity into the nasopharynx. - While it can be narrowed by polyps or mucosal swelling, it is not anatomically the **narrowest fixed point** of the nasal cavity. *1st nasal turbinate* - The **inferior turbinate** (often referred to as the 1st turbinate) can contribute to nasal resistance, especially when enlarged. - However, the turbinate itself is a structure that can vary in size and degree of congestion, but the **internal nasal valve** represents a consistently narrower anatomical choke point. *External nasal valve* - The **external nasal valve** is formed by the ala, columella, and nostril rim, and represents the entrance to the nasal cavity. - While it is a critical area for airflow, it is typically wider than the **internal nasal valve**.

Q: Which of the following is not a feature of ethmoidal polyp?

Commonly found as a single polyp. ***Commonly found as a single polyp*** - **Ethmoidal polyps** are typically **multiple** and bilateral, originating from the ethmoid sinuses. - They rarely present as a single, isolated polyp, which is more characteristic of antrochoanal polyps. - This is the key distinguishing feature that makes this statement INCORRECT. *Common in adults* - **Ethmoidal polyps** are indeed **more prevalent in adults** than in children. - Peak incidence occurs between 30-50 years of age. - Their incidence tends to increase with age, often associated with chronic rhinosinusitis. *Commonly bilateral* - **Ethmoidal polyps** almost invariably present as **bilateral polyps**, involving both sides of the nasal cavity. - This bilateral nature is a key differentiating feature from antrochoanal polyps, which are typically unilateral. - Bilateral presentation is one of the hallmark characteristics of ethmoidal polyps. *Associated with chronic rhinosinusitis* - **Ethmoidal polyps** are strongly associated with **chronic rhinosinusitis with nasal polyposis (CRSwNP)**. - They arise from chronic mucosal inflammation of the ethmoid sinuses. - Often associated with conditions like aspirin-exacerbated respiratory disease (AERD/Samter's triad) and non-allergic eosinophilic inflammation.

Q: Which of the following is not typically associated with enlarged adenoids?

Esophagitis. ***Esophagitis*** - **Enlarged adenoids** are localized to the **nasopharynx** and do not directly impact the esophagus, making esophagitis an unlikely direct complication. - While chronic mouth breathing from enlarged adenoids can lead to **dry mouth**, it is not a direct cause of esophageal inflammation. *Otitis media* - Enlarged adenoids can obstruct the **eustachian tubes**, which connect the middle ear to the nasopharynx, predisposing to **recurrent acute otitis media** or **otitis media with effusion**. - This obstruction impairs middle ear ventilation and drainage, facilitating bacterial growth and inflammation. *Nasal obstruction* - Enlarged adenoids directly block the **nasopharyngeal airway**, leading to chronic **nasal obstruction** and obligate mouth breathing. - This can cause symptoms like snoring, sleep-disordered breathing, and a characteristic "adenoid facies." *Failure to thrive of child* - **Severe nasal obstruction** from enlarged adenoids can disrupt feeding, particularly in infants, as they must breathe through their mouths while attempting to feed. - This compromised feeding, along with **sleep apnea**, increases energy expenditure and can collectively contribute to **failure to thrive**.

Q: Most common cause of otitis externa is

Bacterial infection. ***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.

Q: All of the following are features of Tubotympanic CSOM except which of the following?

Extreme pain. ***Extreme pain*** - **Extreme pain** is NOT a characteristic feature of **tubotympanic CSOM**. This type is typically associated with a history of **painless otorrhea**. - Tubotympanic CSOM is considered the "safe" type with inflammation limited to the mucosa without bone erosion. - The presence of severe pain should raise suspicion for complications or the **atticoantral (unsafe) type** of CSOM. *Profuse discharge* - **Profuse, mucoid** or **mucopurulent discharge** is a hallmark feature of tubotympanic CSOM. - This discharge results from chronic inflammation of the **middle ear mucoperiosteum** through a central perforation in the **pars tensa**. - The discharge is typically non-foul smelling (unlike atticoantral CSOM). *Hearing loss* - **Conductive hearing loss** is a universal feature of tubotympanic CSOM. - Results from **tympanic membrane perforation**, middle ear effusion, and potential ossicular discontinuity. - The degree of hearing loss correlates with the size and location of the perforation. *Facial nerve paralysis* - Facial nerve paralysis is **NOT a typical feature** of tubotympanic (safe) CSOM. - This complication is characteristically associated with **atticoantral (unsafe) CSOM** with cholesteatoma causing bone erosion. - While theoretically possible in very advanced neglected tubotympanic disease, it would indicate transformation to unsafe disease or secondary complications. - **Note:** Some sources may list this as a rare complication, but it is not a characteristic feature distinguishing tubotympanic CSOM, making this option potentially ambiguous in an "EXCEPT" question format.

Q: Which of the following is not a complication of maxillary sinus lavage and insufflation?

Facial nerve injury. ***Facial nerve injury*** - The **facial nerve (CN VII)** passes through the parotid gland and temporal bone, far from the maxillary sinus. - There is no anatomical proximity or procedural mechanism during maxillary sinus lavage and insufflation that would put the facial nerve at risk of injury. *Air embolism* - **Insufflation of air** into the maxillary sinus, especially under pressure, can lead to air entering the bloodstream if a blood vessel is inadvertently punctured. - This can result in a serious and potentially fatal **air embolism**, particularly if the air reaches the cerebral circulation. *Orbital injury* - The **medial wall of the maxillary sinus** is in close proximity to the orbit, separated by thin bone. - During lavage, excessive force or incorrect angulation of instruments can perforate this thin bone, leading to **orbital complications** such as periorbital hematoma or injury to orbital contents. *Epistaxis* - During the procedure, the **mucosa of the nasal cavity** or the sinus itself can be traumatized by the instruments used for lavage. - This local trauma to the rich blood supply of these areas can easily cause **nasal bleeding (epistaxis)**.

Q: What is the treatment of choice for ethmoidal polyps?

Functional Endoscopic sinus surgery with polypectomy. ***Functional Endoscopic sinus surgery with polypectomy*** - This is the **gold standard treatment** for ethmoidal polyps, as it allows for **direct visualization** and complete removal of polyps while preserving healthy mucosa. - It also enables restoration of normal sinus ventilation and drainage, which helps prevent recurrence. *Intranasal ethmoidectomy* - This is an **older technique** that is performed blindly and carries a higher risk of complications, such as **orbital or intracranial injury**, compared to endoscopic approaches. - It often results in incomplete polyp removal, leading to a higher rate of recurrence. *Transantral ethmoidectomy* - This approach, also known as the **Caldwell-Luc procedure**, is primarily used for diseases of the **maxillary sinus** and is not the preferred method for isolated ethmoidal polyps. - It is a more invasive external approach with risks including facial swelling, pain, and damage to dental nerves. *Extranasal ethmoidectomy* - This is a more invasive **external approach** involving an incision on the face and is generally reserved for extensive or complicated cases, such as **tumors or severe trauma**, not for routine polyp removal. - It carries risks of visible scarring and longer recovery times, making it less favorable than endoscopic techniques.

Question 1

What does the term 'Total Communication' refer to in the context of deaf education?

Accepted Answer

Using all available communication methods to educate a deaf child.

Answer

Utilizing various communication methods for advertising purposes.

Answer

Employing multiple communication methods for educational purposes in schools.

Answer

Engaging various communication methods for community involvement.

Question 2

What is the treatment of choice for Deviated Nasal Septum (DNS) in adults?

Accepted Answer

Septoplasty

Answer

Medical management with decongestants

Answer

Observation

Answer

Turbinoplasty

Question 3

Chemical labyrinthectomy by transtympanic route is done in Meniere's disease using which drug?

Accepted Answer

Gentamicin

Answer

Amikacin

Answer

Amoxycillin

Answer

Cyclosporine

Question 4

The narrowest part of the nasal cavity is?

Accepted Answer

Internal nasal valve

Answer

Antrochoanal region

Answer

1st nasal turbinate

Answer

External nasal valve

Question 5

Which of the following is not a feature of ethmoidal polyp?

Accepted Answer

Commonly found as a single polyp

Answer

Common in adults

Answer

Commonly bilateral

Answer

Associated with chronic rhinosinusitis

Question 6

Which of the following is not typically associated with enlarged adenoids?

Accepted Answer

Esophagitis

Answer

Otitis media

Answer

Nasal obstruction

Answer

Failure to thrive of child

Question 7

Most common cause of otitis externa is

Accepted Answer

Bacterial infection

Answer

Fungal infection

Answer

Seborrheic disease

Answer

Herpes Zoster

Question 8

All of the following are features of Tubotympanic CSOM except which of the following?

Accepted Answer

Extreme pain

Answer

Profuse discharge

Answer

Hearing loss

Answer

Facial nerve paralysis

Question 9

Which of the following is not a complication of maxillary sinus lavage and insufflation?

Accepted Answer

Facial nerve injury

Answer

Orbital injury

Answer

Epistaxis

Answer

Air embolism

Question 10

What is the treatment of choice for ethmoidal polyps?

Accepted Answer

Functional Endoscopic sinus surgery with polypectomy

Answer

Intranasal ethmoidectomy

Answer

Transantral ethmoidectomy

Answer

Extranasal ethmoidectomy

NEET-PG 2015 — ENT