1. Weber ferguson approach is used for?

a) Mastoidectomy

b) Maxillectomy

c) Myringoplasty

d) Mandibulectomy

Correct Answer - B
Ans. B. Maxillectomy
WEBER FERGUSON APPROACH:
This approach involves an extension of the lateral rhinotomy incision
that includes the splitting of upperlip.
Indications: Exenteration of maxilla for total or subtotal maxillectomy
(splitting the upper lip releases the facial flap for adequate lateral
retraction and adds transoral exposure of palate and teeth)
2. Afollowing
patient with ear complaints showed positive Hennebert sign. Which of the
condition shows positive Hennebert sign?

a) Meniere's disease

b) Acoustic neuroma

c) Neuronitis

d) Glossopharyngeal neuralgia

Correct Answer - A
The presence of a fistula is suspected if nystagmus occurs or if the patient perceives
movement of a visual target that is fixed after applying positive pressure to the outer ear
canal.
A positive test result (ie, Hennebert sign) suggests either a perilymph fistula or
Meniere's disease.
3. The maxillary sinus opens into middle meatus at the level of:
a) Hiatus semilunaris

b) Bulla ethmoidalis

c) Infundibulum

d) None of the above

Correct Answer - A
The maxillary sinus is the largest of the paranasal sinuses and is located in the maxilla,
lateral to the nasal cavity and inferior to the orbit.
The maxillary sinus opens into the posterior aspect of the hiatus semilunaris in the middle
meatus.
The infraorbital nerve (CN V-2) primarily innervates the maxillary sinus.
4. Gradenigo's syndrome involves all of the
following cranial nerves, EXCEPT:
a) IV

b) V

c) VI

d) VII

Correct Answer - A
Ans. A. IV
Gradenigo’s syndrome is characterized by facial pain, particularly in
the first division of the trigeminal nerve and diplopia due to sixth
cranial nerve palsy. It is associated with disease at the apex of the
petrous temporal bone where the abducens nerve is closely related
to the trigeminal nerve. Facial nerve palsy and deafness (VIII nerve
palsy) is also considered to be a part of this syndrome.
Causes includes:
Inflammation (petrositis, possibly spreading from a local infection
such as otitis or mastoiditis)
Tumors ( cholesteatoma, chordoma, meningioma, nasopharyngeal
carcinoma, metastatic disease)
Skull base fracture
5. Ceruminous glands present in the ear are:
a) Modified eccrine glands

b) Modified apocrine glands

c) Mucous gland

d) Modified holocrine glands

Correct Answer - B
Ans. is. B. Modified apocrine glands
6. Mac Ewan's triangle is the landmark for:
a) Maxillary sinus

b) Mastoid antrum

c) Frontal sinus

d) None

Correct Answer - B
Ans. is. B. Mastoid antrum
7. External auditory canal is formed by:
a) 1s branchial groove
t

b) 1st visceral pouch

c) 2nd branchial groove

d) 2nd visceral pouch

Correct Answer - A
Ans. is. A. 1st branchial groove
8. Hyperacusis is defined as:
a) Hearing of only loud sound

b) Normal sounds heard as loud and painful

c) Completely deaf

d) Ability to hear in noisy surroundings

Correct Answer - B

Sensation of discomfort or pain on exposure to normal sounds. Seen

in injury to nerve to stapedius and in case of congenital syphilis
(Hennebert sign)
9. In electrocochleography:
a) It measures middle ear latency

b) Outer hair cells are mainly responsible for cochlear mi​‐

crophonics and summation potential

c) Summation potential is a compound of synchronus audi​tory

nerve potential

d) Total AP represents endocochlear receptor potential to an

external auditory stimulus

Correct Answer - B
Ans. is. B. Outer hair cells are mainly responsible for cochlear
mi​crophonics and summation potential
10. True statement about malignant otitis
externa is:
a) Not painful

b) Common in diabetics and old age

c) Caused by streptococcus

d) All of the above

Correct Answer - B
Ans. is. B. Common in diabetics and old age
11. Ossicle M/C involved in CSOM:
a) Stapes

b) Long process of incus

c) Head of malleus

d) Handle of malleus

Correct Answer - B
Ans. is. B. Long process of incus
12. Most common nerve to be damaged in
CSOM is
a) III

b) VII

c) IV

d) VI

Correct Answer - B

Facial nerve is the M/C nerve to be damaged in CSOM.

13. Simple mastoidectomy is done in:
a) Acute mastoiditis

b) Cholesteatoma

c) Coalescent mastoiditis

d) Localized chronic otitis media

Correct Answer - C
Ans. is. C. Coalescent mastoiditis
14. Radical mastoidectomy is done for:
a) ASOM

b) CSOM

c) Atticoantral cholesteotoma

d) Acute mastoiditis

Correct Answer - C
Ans. is. C. Atticoantral cholesteotoma
15. Light house sign in seen in ASOM in
which stage?
a) Stage of suppuration

b) Stage of hyperaemia

c) Stage of resolution

d) Stage of pre-suppuration

Correct Answer - A

In the stage of supperation of ASOM, pus formation occurs,

hence in this stage pulsatile otorrhea or light house sign in
seen.
16. In otosclerosis, the tympanogram is:
a) Low compliance

b) High compliance

c) Normal compliance

d) None of the above

Correct Answer - A

In otosclerosis - As type curve is seen which is a low compliance

curve.
17. Which fracture of the petrous bone will
cause facial nerve palsy:
a) Longitudinal fractures

b) Transverse fractures

c) Mastoid

d) Facial nerve injury is always complete

Correct Answer - B
Ans. is. B. Transverse fractures
18. FISCH classification is used for:
a) Juvenile nasopharyngeal angiofibroma

b) Nasopharyngeal ca

c) Vestibular schwannoma

d) Glomus tumour

Correct Answer - D
A classification system (A-D) describing glomus tumors based on
anatomic location and size, with larger lettering representing more
extensive tumors.
19. True about rhinophyma:
a) Premalignant

b) Common in alcoholics

c) Acne rosacea

d) Fungal etiology

Correct Answer - C

Rhinophyma is a slow-growing benign tumor which occurs due to

hypertrophy of the sebaceous glands° of the tip of the nose.
Seen in long standing cases of acne rosacea.
Mostly affects men past middle age.
Presents as a pink, lobulated mass over the nose.
Treatment
Paring down the bulk of the tumor with a sharp knife, or carbon
dioxide laser or scalpel (dermabraions), and the area is allowed to
re-epithelize.
Sometimes tumor is completely excised and the raw area is covered
with skin graft.
20. What is a Rhinolith:
a) Foreign body in nose

b) Stone in nose

c) Deposition of calcium around foreign body in nose

d) Misnomer

Correct Answer - C
Rhinoliths are calcareous masses which result due to deposition of
salts-like calcium and magnesium carbonates and phosphates
around the nucleus of a foreign body.
21. Posterior epistaxis occurs from:
a) Woodruffs plexus

b) Kiesselbach's plexus

c) Atherosclerosis

d) Littles area

Correct Answer - A
22. Caldwell view is done for
a) Sphenoid sinus

b) Maxillary sinus

c) Ethmoid sinus

d) Frontal sinus

Correct Answer - D

Caldwell view is the occipito frontal view. The frontal sinuses are
seen clearly in this view.
23. Regarding ranula all are true except:
a) Retention cyst

b) Arises from submandibular gland

c) Translucent

d) Plunging may be a feature

Correct Answer - B
24. Regarding adenoids true is/are:
a) There is failure to thrive

b) Mouth breathing is seen

c) CT scan should be done to assess size

d) a and b

Correct Answer - D
High arched palate and mouth breathing are features of
hypertrophied adenoids which leads to adenoid facies
In adenoids as a consequence of recurrent nasal obstruction and
URTI, child develops failure to thrive
Size of adenoids may well be assessed using lateral radiograph of
nasopharynx, and CT scan is not necessary
Adenoids, also known as nasopharyngeal tonsils, are subepithelial
collection of lymphoid tissue at the junction of roof and posterior wall
of nasopharynx.
25. Trismus in parapharyngeal abscess is due
to spasm of:
a) Masseter muscle

b) Medial pterygoid

c) Lateral pterygoid

d) Temporalis

Correct Answer - B
Styloid process divides the pharynx into anterior and posterior
compartment.
Trismus occurs in infection of anterior compartment whereas
torticollis (due to spasm of paravertebral muscles) occurs in the
infection of posterior compartment.
26. Inlet of larynx is formed by:
a) Ventricular fold

b) Aryepiglottic fold

c) Glossoepiglottic fold

d) Vocal cord

Correct Answer - B
The laryngeal inlet (laryngeal aditus, laryngeal aperture) is the
opening that connects the pharynx and the larynx. Its borders are
formed by: the free curved edge of the epiglottis, anteriorly.
the arytenoid cartilages, the corniculate cartilages, and the
interarytenoid fold, posteriorly.
27. All the following are true about Laryngeal
carcinoma except:
a) More common in females

b) Common in patients over 40 years of age

c) After laryngectomy, esophageal voice can be used

d) b and c

Correct Answer - A
Cancer Larynx
Most common histological type of laryngeal Ca - Squamous cell
carcinoma (seen in 90% cases)
It is more common in males.
Male: Female ratio is 4: 1
Most common age = 60-70 years.
28. Select correct statements about Ca
larynx:
a) Glottic Ca is the most common

b) Supraglottic ca has best prognosis

c) Lymphatic spread is the most common in subglottic Ca

d) All

Correct Answer - A
Ans. is. A. Glottic Ca is the most common
29. The commonest site of aspiration of a
foreign body in the supine position is into
the:
a) Right upper lobe apical

b) Right lower lobe apical

c) Left basal

d) Right medial

Correct Answer - B
In supine position and with the patient on back superior
segment of RLL is the most dependent segment.
30. Cauliflower ear seen in:
a) Hematoma of the auricle

b) Carcinoma of the auricle

c) Fungal infection of the auricle

d) Congenital deformity

Correct Answer - A
Cauliflower ear (boxer's ear, wrestler's ear) is an acquired deformity
of the outer ear.
In this injury, the ear can shrivel up and fold in on itself and appear
pale, giving it a cauliflower-like appearance, hence the term
cauliflower ear.
Wrestlers, boxers and martial artists in particular are susceptible to
this type of injury. When the ear is struck and a blood clot develops
under the skin, or the skin is sheared from the cartilage, the
connection of the skin to the cartilage is disrupted.
31. All of the following arteries contributes to
Little's area EXCEPT:
a) Anterior Ethmoidal artery

b) Posterior Ethmoidal artery

c) Sphenopalatine artery

d) Greater palatine artery

Correct Answer - B

Kiesselbach's plexus
It lies in Kiesselbach's area/ Kiesselbach's triangle/ Little's area
It is a region in the anteroinferior part of the nasal septum where four
arteries anastomose to form a vascular plexus of that name. The
arteries are:
- Anterior Ethmoidal artery (from the Ophthalmic artery)
- Sphenopalatine artery (terminal branch of the Maxillary artery)
- Greater palatine artery (from the Maxillary artery)
Septal branch of the superior labial artery (from the Facial artery)
Although the Posterior Ethmoidal artery also supplies the septum of
the nose, it does not contribute to the plexus.
32. Multiple perforation of tympanic
membrane characteristic of ?
a) Tubercular Otitis Media

b) Syphilitic Otitis Media

c) Pseudomonas infection

d) Fungal Otitis Media

Correct Answer - A
Ans. is 'a' i.e., Tubercular otitis media
Tubercular otitis media
Tuberculosis of middle ear is a comparatively rare entity usually
seen in association with or secondary to pulmonarytuberculosis,
infection reaches the middle ear through eustachian tube.
The rare modes of infection are through hematogenous spread from
tubercular focus in lung, tonsils, cervical lymph nodes; or due to
ingestion of infected cow's milk.
It usually affects children and young adults.
Clinical features
Generally, tuberculosis of middle ear is unilateral.
It is characterized by painless otorrhoea which fails to respond to the
usual antimicrobial treatment. There is painless watery otorrhea.
Single or multiple perforation of tympanic membrane. There may be
multiple perforations in the early stages, but they coalesce into a
large tympanic membrane perforation accompanied by a pale
granulation tissue.
Periauricular fistulae, lymphadenopathy and facial palsy are
infrequent findings.
Late complications include facial paralysis, labyrinthitis, postauricular
fistulae, subperiosteal abscess, petrous apicitis and intracranial
extension of infection.
33. Another name for oral thrush is ?
a) Candidiasis

b) Herpangina

c) Vincent's infection

d) Hand foot and mouth disease

Correct Answer - A
Ans. is 'a' i.e., Candidiasis
Oral thrush
Also called: oral candidiasis
It is the fungal infection of the oral cavity. It is caused by candida
albicans.
It manifests as greyish white patches on the oral mucosa and
tongue.\When wiped off it leaves an erythematous mucosa.
This is more common in infants and children. Adults suffering fro
diabetes, malignancy, taking broad spectrum oral antibiotics,
radiation, cytotoxic drugs or steroids can also be affected.
It is treated by topical application of nystatin or clotrimazole.
Chronic Hypertrophic Candidiasis (Candidial Leukoplakia)
Appears as a white patch in the oral cavity which cannot be wiped
off.
It mostly affects the anterior buccal mucosa just behind the angle of
mouth.
It is treated by excision of the lesion.
34. Which of the following is not true about
inverted papilloma ?
a) It is always unilateral

b) It is more common in males

c) 10-15 % of the cases may be associated with squamous cell

carcinoma

d) It is also called Ringertz tumor

Correct Answer - D
Ans. is 'd' i.e., It is also called Ringertz tumor
Inverted Papilloma (Transitional cell papilloma / Schneiderion
papilloma)
Inverted papilloma is a benign neoplasm occurs mostly between 40-
70 years with male preponderance (5 : 1). o It arises from the lateral
wall of nose and is always unilateral. Rarely, it may arise from nasal
septum. o Features of inverted papilloma are :-
It shows finger like epithelial invasions into the underlying stroma of
the epithelium rather than on surface so called inverted papilloma.
It is usually unilateral and is a locally aggressive tumour.
Patients complain of nasal obstruction, rhinorrhea & unilateral
epistaxis.
In 10-15% cases there may be associated squamous cell
carcinoma.
Treatment is adequate local excision. If it arises in maxillary sinus,
then a radical antrostomy is carried out.If it arises in the ethmoidal
sinus, an external ethmoidectomy is done. If it arises from nose,
treatment is wide surgical excision by lateral rhinotomy.
Has a tendency to recur even after removal.
35. Positive head impulse test is suggestive
of ?
a) Injury to vestibular nuclei

b) Injury to peripheral vestibular nerve

c) Lesion in the brain stem

d) Injury to Occulomotor nerve

Correct Answer - B
Ans. is `b' i.e., Injury to peripheral vestibular nerve
Head Impulse Test
It is also called head thrust test.
It is test for the diagnosis of injury to vestibular nerve which forms
the peripheral vestibular pathway.
Clinician asks the patient to fix his gaze on a target and then perform
passive horizontal and vertical head impulses and observes the
patient's eyes.
Observation of a refixation saccade after the head impulse indicates
decreased decreasedvestibulo ocular reflex secondary to peripheral
vestibular lesions (vestibular nerve involvement).
36. Conducting hearing loss with intact
tympanic membrane ?
a) Presbycausis

b) Meniere's disease

c) Glue ear

d) Acoustic neuroma

Correct Answer - C
Ans. is 'c' i.e., Glue ear
Among the given options, only glue ear (serous otitis media) is a
cause of conductive deafness.
37. Not a cause of objective tinnitus ?
a) Palatal myoclonus

b) Glomus tumor

c) Carotid artery aneurysm

d) Presbyacusis

Correct Answer - D
Ans. is 'd' i.e., Presbyacusis
Tinnitus
Tinnitus is ringing sound or noise in the ear.
The characteristic feature is that the origin of this sound is within the
patient.
38. Length of external auditory meatus is ?
a) 12mm

b) 16mm

c) 20mm

d) 24mm

Correct Answer - D
Ans. is 'd' i.e., 24 mm
External auditory canal (External acoustic meatus)
External auditory canal is a 'S' shaped canal with length of 24-
25 mm and it is divided into two parts :?
1) Cartilagenous part
It forms outer/lateral 1/3 (8mm) of the external auditory canal. It has
two fissures / deficiencies in the anterior part called fissure of
santorini through which parotid or superficial mastoid infection can
appear in the canal and vice versa. Skin covering it is thick and has
ceruminous glands (modified apocrine sweat glands), pilosebaceous
glands and hair. Since hair is confined to cartilaginous part,
furuncles are seen only in the outer third of the canal.
2) Bony part
It forms inner/medial 2/3 (16 mm) of external auditory canal. Skin
lining the bony part is thin and is devoid of hair and ceruminous
glands. Isthmus is the narrowest portion of bony canal and is 5 mm
lateral to tympanic membrane. Foreign bodies get lodged in isthmus
are difficult to remove as it is the narrowest part. `Foramen of
Huschke' is a deficiency present in antero-inferior part of bony canal
in children upto 4 years of age, permitting infection to and from
parotid.
39. Which of the following is false regarding
frontal sinusitis ?
a) Pain shows periodicity

b) Most common sinus involved in infants and children

c) Pain is referred to as office headache

d) Tenderness is present just above the medial canthus of eye

Correct Answer - B
Ans. is 'b' i.e., Most common sinus involved in infants and children
Most common sinus involved in infant and children is Ethmoid sinus.
Clinical features of acute sinusitis
Most common presenting patient's compliant is persistent nasal
discharge which can be of any quality (thin, thick, clear, or purulent).
Nasal discharge from a sinus infection can be blood - tinged from
excessive nose blowing and irritation. The clinical symptoms of
acute sinusitis have been classified into major and minor.
40. Mini tracheostomy is performed through ?
a) Cricothyroid membrane

b) 2nd and 3rd tracheal rings

c) Any of the above

d) None of the above

Correct Answer - A
Ans. is 'a' i.e., Cricothyroid membrane
Cricothyrotomy or Laryngtomy or Minitracheostomy
It is the procedure to open the airway through the cricothyroid
membrane.
Patient's head and neck are extended, lower border of throid
cartilage and cricoid ring is identified. Skin in this area is incised
vertically and then cricothyroid membrane is opened with a
transverse incision.
It is an emergency procedure to buy time for the patient to be shifted
to the operation theatre.
 41. Which of the following is included in the
Levenson criteria for congenital
cholesteatoma ?
a) White mass medial to normal tympanic membrane

b) Atticoantral perforation of the tympanic membrane

c) Definite history of otorrhoea

d) History of prior otologic procedures

Correct Answer - A
Ans. is 'a' i.e., White mass medial to normal tympanic
membrane
Levenson criteria for congenital cholesteatoma
1. White mass medial to normal TM.
2. Normal pars flaccida and tensa.
3. No history of otorrhea or perforations.
4. No prior otologic procedures.
5. Prior bouts of otitis media no ground for exclusions.
42. Which of the following is false regarding
Frey's syndrome?
a) It is also called gustatory sweating

b) It is caused by injury to auriculotemporal nerve

c) It occurs immediately after the parotid surgery

d) It is caused by aberrant regeneration of post

Correct Answer - C
Ans. is 'c' i.e., It occurs immediately after the parotid surgery
Frey's syndrome (gustatory sweating)
Gustatory sweating or Frey's syndrome involves post-parotidectomy
facial sweating and skin flushing while eating.
The symptoms usually occur several months or even years after
parotid surgery.
The likely pathophysiology is aberrant regeneration of postganglionic
secretomotor parasympathetic nerve fibres (originating from the otic
ganglion) misdirected through several axonal sheaths of post-
ganglionic sympathetic fibres feeding the sweat glands. These
sympathetic fibres are to the sweat glands of the skin in the
dissected field.
The frey's syndrome is likely due to injury to auriculotemporal nerve
with faulty regeneration, therefore Frey's syndrome is also known as
Auriculotemporal syndrome.
A variant of Frey's syndrome in which there is gustatory facial
flushing but not sweating, occurs following facial paralysis due to
faulty regeneration following injury to the facial nerve. So, Frey's
syndrome is not limited to parotid surgery with injury to
auriculotemporal nerve.
43. Most common cause of trigeminal
neuralgia ?
a) Infection

b) Trauma

c) Vascular compression

d) Iatrogenic

Correct Answer - C
Ans. is 'c' i.e., Vascular compression
Trigeminal neuralgia (tic douloureux) is characterized by intermittent,
shooting pain in the face.
It is due to involvement of trigeminal nerve.
95% of causes of trigeminal neuralgia are due to pressure on
trigeminal nerve close to where it enters the brain stem, past the
Gasserian ganglion. In most cases, this pressure seems to be
caused by an artery or vein compressing trigeminal nerve.
Other causes are tumor, cysts, AV malformation and multiple
sclerosis.
Most commonly used drugs for treatment of trigeminal neuralgia are
carbamazepine, gabapentin and valproate.
44. Patient with thin painless otorrhoea,
multiple perforations of the tympanic
membrane and failure to respond to
antimicrobial treatment. What is the most
probable causative organism ?
a) Mycobacterium tuberculosis

b) Staphylococcus aureus

c) Candida albicans

d) Aspegillusfumigatus

Correct Answer - A
Ans. is 'a' i.e., Mycobacterium tuberculosis
Thin painless otorrhoea, multiple perforations of the tympanic
membrane and failure to respond to antimicrobial treatment are the
features of tubercular otitis media and it is caused by Mycobacterium
tuberculosis.
45. Synkinesis is a sequel of ?
a) Facial nerve paralysis

b) Trigeminal nerve paralysis

c) Superficial temporal nerve paralysis

d) Greater Petrosal nerve paralysis

Correct Answer - A
Ans. is 'a' i.e., Facial nerve paralysis
Clinical features of Bell's palsy
Acute onset, ipsilateral facial paralysis.
Facial paralysis is usually preceded by pain behind the ear.
Patient is unable to close his eyes.
Bells phenomenon, i.e. on attempting to close the eye, eyeball turns
up and out.
Face becomes asymmetrical and saliva dribbles from angle of
mouth.
Ipsilateral loss of taste sensation, salivation and lacrimation.
Intolerance to high pitched or loud sound (hyperacusis).
Most patients (80%) recover within few weeks to months.
Synkinesis and crocodile tear are sequelae of Bell's palsy :-
Synkinesis or facial synkinesis is a common sequelae to Bell's palsy.
This is due to cross innervation of nerve fibres during recovery.
When the patient wishes to close the eye, corner of mouth also
twiches and vice versa.
Crocodile tear (gustatory lacrimation) is due to faulty regeneration of
parasympathetic fibres which now supply lacrimal gland instead of
the salivary glands.
46. Sago grain appearance is seen in ?
a) Healed myringitis bullosa

b) Otomycosis

c) Malignant otitis externa

d) Keratosis obturans

Correct Answer - A
Ans. is 'a' i.e., Healed myringitis bullosa
Otitis externa haemorrhagica
This condition is also known as Bullous myringitis or myringitis
bullosa.
This condition is extremely painful and has sudden onset.
It is thought to be due to mycoplasma pneumoniae or viral infection,
usually influenza'.
There may be a mild conductive deafness and a mildly discharging
car.
The appearance of haemorrhagic bullae on the tympanic membrane
and in the deep meatus is characteristic. The bullae are filled with
serosanguinous fluid and blood.
On healing, bullae look like Sago-grain.
Therefore "Sago-grain" appearance of tympanic membrane is seen
in healed myringitis bullosa.
 47. Following is the preferred treatment of
Serous Otitis Media -
a) Grommet surgery

b) Oral Amoxicillin for 5 - 10 days

c) Modified radical mastoidectomy

d) Bed rest, antipyretics and adequate fluid intake

Correct Answer - A
Ans. is 'a' i.e., Grommet surgery
Treatment of otitis media
Following two treatments have been described : ?
1) Watchful waiting
Watchful waiting is the active monitoring of the condition and hearing
in anticipation of spontaneous resolution. Guidlines aimed at both
primary care and specialist otolaryngologist broadly agree that a
watch​ful waiting period for about three months is the initial
management of children with serous otitis media. Therefore, unless
there are also signs of an infection, most health care providers will
not treat SOM at first Instead, they will recheck the problem in 2-3
months. This should be coupled with reassurance that doing nothing
is as likely as doing something to result in resolution of the SOM and
the associated symptoms.
2) Surgery
Surgical intervention is recommended when watchful waiting and
monitoring of hearing has confirmed failure of resolution of SOM.
Following surgical intervention are used commonly : -
i. Myringotomy and aspiration offluid : -An incision is made in tympanic
membrane and fluid aspirated with suction.
ii. Grommet (ventilation tube) surgery : - If myringotomy and aspiration
 combined with medical measures has not helped and fluid recurs, a
grommet is inserted to provide continued aeration of middle ear.
This is the most common surgical intervention for SOM. Most
prefered site of grommet insertion is antero-inferior through
circumferential or radial incision.
iii. Surgical treatment of causative factor : - Adenoidectomy,
tonsillectomy etc.
Medical measures are controversial and involve : ?
1. Decongestants
2. Antiallergic measures
3. Antibiotics
4. Middle ear aeration :- Valsalva maneuver, Politzerisation or
eustachian tube catheterization, Chewing gum.
48. When a patient says Ah the right uvula
presses the palate which of the following
nerve is damaged ?
a) Rght X CN

b) Right XII CN

c) Left X CN

d) Right XII CN

Correct Answer - C
Ans. is 'c' i.e., Left X CN
Assessment of the movement of soft palate - Both IX and X CNs are
tested:
The glossopharyngeal nerve (IX CN) is a mixed nerve with motor,
sensory and some parasympathetic activity. It carries sensory input
from the palate and pharynx and the taste from the posterior third of
the tongue. It provides afferent limb of the gag reflex.
The vagus (X CN) is also a mixed nerve with motor, sensory and
parasympathetic activity. It provides the motor supply to the pharynx,
soft palate and larynx and provides the efferent limb to the gag
reflex.
Normally on oral examination thesoft palate is symmetrical with the
uvula dangling in the centre and dividing the soft palate.
When the patient is asked to say AAAh! The soft palate should
elevate symmetrically and the uvula should remain centric. If there is
unilateral weakness of the soft palate the uvula is pulled away from
the weakened side.
Now in the question given when the patient says aaah the right
uvula presses the palate i. e. the right side soft palate pulls the uvula
away from the weak left side. The weakness of the left soft palate
away from the weak left side. The weakness of the left soft palate
can be because of the weakness of the left IX or X cranial nerves.
49. Lumpy feeling in throat relieved on taking
food is attributed to ?
a) Globus pharyngeus

b) Pharyngeal pouch

c) Diverticular disease

d) Esophageal atresia

Correct Answer - A
Ans. is 'a' i.e., Globus Pharyngeus
Globus Pharyngeus
Symptom where in a patient describes something stuck in throat or a
sensation of lump or tightness in throat which is relieved by taking
food or talking.
50. Glomus jugulare commonly arises from ?
a) Hypotympanum

b) Mesotympanum

c) Epitympanum

d) Prussaks space

Correct Answer - A
Ans. is 'a' i.e., Hypotympanum
There are two types of glomus tumors:-
i) Glomus jugulare
These glomus tumors arise from the dome of the internal jugular
vein in the hypotympanum and jugular foramen. In jugular foramen
they can invade IX to XII cranial nerves.
ii) Glomus tympanicum
They arise from the promontory of the middle ear along the course
of the tympanic branch of the IXth cranial nerve.
51. Gradenigo syndrome is characterized by
all except ?
a) Diplopia

b) Retro-orbital pain

c) Persistent ear discharge

d) Vertigo

Correct Answer - D
Ans. is d i.e., Vertigo
Infection of mastoid and middle ear may be complicated by the
spread of infection within the temporal bone into petrous apex.
Petrositis is an extension of infection from middle ear and mastoid to
the petrous part of the temporal bone.
Gradenigo's syndrome is the classical presentation and
consists of a triad of : -
External rectus palsy (VIth nerve/abducent nerve palsy) causing
diplopia.
Deep seated orbital or retroorbital pain (Vth nerve involvement).
Persistent ear discharge due to ipsilateral acute or chronic otitis
media.
Associated symptoms of otitis media are also present e.g.,
conductive deafness. Other symptoms are fever, head​ache,
vomiting, and sometimes neck rigidity. Some patient may get facial
paralysis and recurrent vertigo due to involvement of facial and
statoacoustic nerves.
52. Attico antral disease is treated by ?
a) Modified radical mastoidectomy

b) Antibiotics

c) Grommet insertion

d) Synringing

Correct Answer - A
Ans. is 'a' i.e., Modified radical mastoidectomy
Treatment of atticoantral disease
Since cholesteatoma is going to expand and destroy bone and
mucous membrane, it has to be removed. Therefore, surgery is the
mainstay of treatment. Primary aim is removal of disease by
mastoidectomy to make ear safe followed by reconstruction of
hearing at a later stage. Modified radical mastoidectomy is the
surgery of choice.
Two types of surgical procedures (mastoidectomy) are done to deal
with cholesteatoma.
1) Canal wall down procedures
These leave the mastoid cavity open into the external auditory canal
so that the diseased area is fully exteriorized.
The commonly used procedures for atticoantral disease are
atticotomy, modified radical mastoidectomy and rarely radical
mastoidectomy.
Modified radical mastoidectomy is the procedure of choice.
2) Canal wall up procedures (cortical mastoidectomy)
Here disease is removed by combined approach through the meatus
and mastoid but retaining the posterior bony meatus wall, thereby
avoiding an open mastoid cavity.
For reconstruction of hearing mechanism myringoplasty or
tympanoplasty can be done at the time of primary surgery or as a
second stage procedure.
53. Samters triad is seen in patients with ?
a) Asthma

b) Chronic pancreatitis

c) Crohn's disease

d) Liver cell carcinoma

Correct Answer - A
Ans. is 'a' i.e., Asthma
Samter's triad
Samter's triad is a medical condition consisting of asthma, aspirin
sensitivity, and nasal/ethmoidal polyposis. It occurs in middle age
(twenties and thirties are the most common onset times) and may
not include any allergies.
Most commonly, the first symptom is rhinitis.
The disorder typically progeses to asthma, then polyposis, with
aspirin sensitivity coming last.
The aspirin reaction can be severe, including an asthma attack,
anaphylaxis, and urticaria in some cases. Patients typically react to
other NSAIDS such as ibuprofen, although paracetamol is generally
considered safe.
Anosmia (lack of smell) is also typical, as the inflammation reaches
the olfactory receptors in the nose.
54. Strawberry tongue is seen in ?
a) Streptococcal scarlet fever

b) Kawasaki disease

c) Both of the above

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Both of the above
Strawberry tongue
It is also called raspberry tongue
It basically refers to glossitis, which manifests with hyperplastic
(enlarged) fungiform papillae, giving the appearance of a strawberry.
White strawberry tongue is where there is a white coating on the
tongue through which the hyperplastic fungiform papillae protrude.
Red strawberry tongue is where the white coating is lost and a dark
red, erythematous surface is revealed, interspaced with the
hyperplastic fungiform papillae.
White strawberry tongue is seen in early scarlet fever (a systemic
infection of group A hemolytic streptococci).
Red strawberry tongue occurs later, after 4-5 days.
Other conditions in which strawberry tongue is seen are: Kawasaki
disease, toxic shock syndrome, and vitamin B 12 deficiency.
55. All are true for gradenigo's syndrome
except ?
a) Associated with intermittent ear discharge

b) Associated with conductive hearing loss

c) Causes diplopia

d) Leads to retro orbital pain

Correct Answer - A
Ans. is 'a' i.e., Associated with intermittent ear discharge
Gradenigo's syndrome, also called Gradenigo-Lannois
syndrome, is a complication of otitis media and mastoiditis involving
the apex of the petrous temporal bone.
Symptoms
Components of the syndrome include:
retroorbital pain due to pain in the area supplied by the ophthalmic
branch of the trigeminal nerve (fifth cranial nerve),
abducens nerve palsy (sixth cranial nerve)
otitis media
Other symptoms can include photophobia,
excessive lacrimation, fever, and reduced corneal sensitivity. The
syndrome is classically caused by the spread of an infection into the
petrous apex of the temporal bone.
56. Treatment of middle ear papilloma is ?
a) Myringotomy and simple excision

b) Myringectomy and simple excision

c) Tympanomastoidectomy

d) Local infiltration with podophyllin

Correct Answer - C
Ans. is 'c' i.e., Tympanomastoidectomy
Middle ear pappilomas
The middle ear papillomas are rare presentations and medical
literature is mainly limited to case reports or case series.
These include aggressive pappilary tumors, schneiderian type of
pappilomas and inverted pappilomas.
They are associated with hearing difficulty and vertigo and may be
associated with Von Hippel Lindau syndrome.
They tend to be slowly growing, locally aggressive non
metastasizing neoplasms
The approach for treatment of such pathology is usually radical and
tympanomastoidectomy is considered the treatment of choice. This
gives the best chance of cure.
57. Best time for hearing assessment in an
infant ?
a) 1st month of life

b) 3-6 months

c) 6-9 months

d) 9-12 months

Correct Answer - A
Ans. is 'a' i.e., 1st month of life
The American Academy of Pediatrics (AAP), Joint Committee on
Infant hearing (2007), has recommended that all newborn infants be
screened for hearing impairment either as neonate or before 1
month of age and that those infants who fail newborn screening
have an audiologic examination to varify hearing loss before age of
3 months.
58. Darwin tubercle is seen in ?
a) Tragus

b) Helix

c) Antihelix

d) Lobule

Correct Answer - B
Ans. is 'b' i.e., Helix
Darwin's tubercle (or auricular tubercle) is a congenital earcondition
which often presents as a thickening on the helix at the junction of
the upper and middle thirds.
The feature is present in approximately 10.4% of the population.This
acuminate nodule represents the point of the mammalian ear.
59. Trotter triad not included is ?
a) Conductive deafness

b) Temporoparietal neuralgia

c) Palatal paralysis

d) Seizures

Correct Answer - D
Ans. is 'd' i.e., Seizures
Trotter's triad
Trotter's triad occurs in nasopharyngeal carcinoma
It includes :-
i) Conductive deafness (due to Eustachian tube blockage)
ii) Temporo - parietal neuralgia (due to involvement of ipsilateral Vth
cranial nerve)
iii) Palatal paralysis (due to involvement of Xth cranial nerve)
60. Following protein is not found in organ of
corti ?
a) Myosin

b) Microtubule associated protein 2

c) Microtubule associated protein 4

d) Fodrin

Correct Answer - C
Ans. is 'c' i.e., Microtubule associated protein 4
Proteins present in cochlea
Actin-binding and microtubule-associated proteins regulate
microfilament and microtubule number, length, organization and
location in cells.
In freeze-dried preparations of the guinea pig cochlea, both actin
and tubulin are found in the sensory and supporting cells of the
organ of Corti.
Fodrin (brain spectrin) co-localized with actin in the cuticular plates
of both inner and outer hair cells and along the lateral wall of the
outer hair cells.
Alpha-actinin co-localized with actin in the cuticular plates of the hair
cells and in the head and foot plates of the supporting cells. It was
also found in the junctional regions between hair cells and
supporting cells. o Profilin co-localized with actin in the cuticular
plates of the sensory hair cells.
Myosin was detected only in the cuticular plates of the outer hair
cells and in the supporting cells in the region facing endolymph.
Gelsolin was found in the region of the nerve fibers.
Tubulin is found in microtubules in all cells of the organ of Corti.
In supporting cells, microtubules are bundled together with actin
microfilaments and tropomyosin, as well as being present as
individual microtubules arranged in networks.
An intensely stained network of microtubules is found in both outer
and inner sensory hair cells.
The microtubules in the outer hair cells appear to course throughout
the entire length of the cells, and based on their staining with
antibodies to the tyrosinated form of tubulin they appear to be more
dynamic structures than the microtubules in the supporting cells.
The microtubule-associated protein MAP-2 is present only in outer
hair cells within the organ of Corti and co-localizes with tubulin in
these cells. No other MAPs (1,3,4,5) are present.
Tau is found in the nerve fibers below both inner and outer hair cells
and in the osseous spiral lamina.
61. Following is true about laryngomalacia
except ?
a) Omega shaped epiglottis

b) Reassuarance of the patient is the treatment of choice

c) Condition is first noticed in the first few weeks of life

d) Expiratory stridor

Correct Answer - D
Ans. is 'd' i.e., Expiratory stridor
Laryngomalacia
It is the most common congenital abnormality of the larynx.
Laryngomalacia is the most frequent cause of stridor or noisy
breathing in infants. It occurs as a result of a floppy portion of the
larynx (in supraglottic larynx) that has not yet developed the strength
to provide rigid support to the airway. During inspiration negative
pressure is created through larynx, which results in a collapse of
these structures into the airway and a narrower breathing passage.
Partial obstruction is the source of the noise with breathing (stridor),
and sometimes cyanosis.
The hallmark sign includes intermittent stridor mostly in inspiration. It
is usually more prominent when the infant is lying on his/her back
(supine position, crying, feeding, excited or has a cold. Stridor gets
relieved on placing the patient in prone position. This is usually first
noticed in the first few weeks of life.
It may worsen over the first few months and become louder. This is
because as the baby grows, inspiratory force is greater, which
causes greater collapse of the laryngeal structures into the airway.
This is usually worst at 3-6 months and then gradually improves as
the rigidity of the cartilage improves.
Most children are symptom free by 1 to 2 years.
Sometimes, cyanosis may occur.
Direct laryngoscopy shows :-
Omega shaped epiglottis, i.e. elongated and curled on itself.
Floopy, tall, foreshortened and thin aryepiglottic folds.
Prominent arytenoids.
In most patients laryngomalacia is a self limiting condition.
Treatment of laryngomalacia is reassurance to the parents and early
antibiotic therapy for upper respiratory tract infections.
62. Following are the laboratory tests for the
diagnosis of vestibular dysfunction
except ?
a) Electronystagmography

b) Optokinetic test

c) Galvanic test

d) Gelle's test

Correct Answer - D
Ans. is 'd' i.e., Gelle's test
Vestibular system
The vestibular system contributes to balance and to the sense of
spatial orientation.
It is a sensory system that provides the leading contribution about
movement and sense of balance.
It includes the labyrinth (semicircular canals and otolith : utricle &
sacules) of the inner ear and is situated in the vestibulum in the
inner ear.
The symptoms of vestibular dysfunction are vertigo, dizziness and
Unbalance.
63. In a patient with CSOM, labrynthine fistula
most commnonly involves ?
a) Superior SCC

b) Lateral SCC

c) Posterior SCC

d) Utricle

Correct Answer - B
Ans. is 'b' i.e., Lateral SCC
Labrynthine fistula is almost exclusively reported in association with
chronic otitis media and cholesteatoma.
The most commonly affected canal is lateral (horizontal) semicircular
canal, but involvement of the posterior and superior canals as well
as other regions of labyrinth have been reported.
The incidence of labrynthine fistula in chronic otitis media is
approximately 10%.
64. Horizontal acceleration with forward
movement in the sagittal plane is detected
by ?
a) Macula of Utricle

b) Macula of Saccule

c) Lateral semicircular canal

d) Posterior semicircular canal

Correct Answer - A
Ans. is 'a' i.e., Macula of utricle
65. Patient presents with mouth breathing,
recurrent serous otitis media and adenoid
facies. What is the best line of
management ?
a) Adenoidectomy

b) Tonsillectomy

c) Antibiotics

d) Supportive therapy

Correct Answer - A
Ans. is 'a' i.e., Adenoidectomy
The triad of nasal and aural symptoms with adenoid facies points to
the diagnosis of enlarged adenoids.
For the treatment of enlarged adenoids when symptoms are not
marked breathing excercise, decongenstant nasal drops and
antihistaminics are used and when symptoms are marked,
adenoidectomy is done.
We have a patient with marked and recurrent symptoms thus
adenoidectomy is the treatment of choice.
66. Which of the following organisms is
known to cause Atrophic rhinitis ?
a) Klebsiella ozaena

b) Klebsiella pneumonia

c) Streptococcus pneumonia

d) Streptococcus foetidis

Correct Answer - A
Ans. is 'a' i.e., Klebsiella ozaena
Atrophic rhinitis (Ozaena)
Atrophic rhinitis is a chronic inflammation of nose characterized by
atrophy of nasal mucosa, including the glands, turbinate bones and
the nerve elements. Atrophic rhinitis may be primary or secondary :
?
1) Primary atrophic rhinitis
The primary pathology is inflammation and atrophy of the nose.
Generally, atrophic rhinitis refers to primary atrophic rhinitis.
Causes are : -
i) Hereditary
ii) Endocrinal pathology - Starts at puberty. Stops after menopause
iii) Racial factors - Seen more in Whites and Yellow races
iv) Nutritional deficiency - Deficiency of vitamin A, D, E and iron may
be responsible for it.
v) Infective - Klebsiella ozanae, Diphtheriods, P. vulgaris, E.coli,
Staphylococci, Streptococci.
vi) Autoimmune process - Causing destruction of nasal,
neurovascular and glandular elements may be the cause.
2) Secondary atrophic rhinitis
Specific infections, such as syphilis, lupus, leprosy, and
rhinoscleroma, may cause destruction of the nasal structures
leading to atrophic changes. Can also results from long standing
purulent sinusitis , radiotherapy of nose, excessive surgical removal
of the turbinate and as complication of DNS on the root side of nose.
67. Potato tumor due to ?
a) Hypotrophy of sebaceous glands of nose

b) Hypertrophy of sebaceous glands of nose

c) Hypotrophy of sweat glands of nose

d) Hpertrophy of sweat glands of nose

Correct Answer - B
Ans. is 'b' i.e., Hypertrophy of sebaceous glands of nose
Rhinophyma (Potato tumor)
Rhinophyma is large, bulb-shaped, red-colored (ruddy) nose. It is a
slow growing benign tumor due to hypertrophy of the sebaceous
glands. The cause of rhinophyma is unknown, though it is thought to
be a severe form of acne roscea. Rhinophyma was once thought to
be caused by heavy alcohol consumption, but this is not the case.
Rhinophyma occurs equally in those who do not drink at all and
those who drink large quantities of alcohol. It mostly affects men
past middle age. Red/pink colour of the tumor is due to engorgment
of superficial vessels.
Treatment
Surgery to reshape the nose is the best known treatment for
rhinophyma. Surgery may be done with a laser (carbon dioxide
laser), scalpel (sharp knife) or a rotating brush (dermabrasion) and
the area is allowed to re-epithelialize. Sometimes, tumour is
completely excised and the raw area is skin-grafted.
68. Rhinitis most common bacterial cause ?
a) Haemophilus influenza

b) Streptococcus haemolyticus

c) Pasturellamultocida

d) Cornybacterium diphtheria

Correct Answer - A
Ans. is 'a' i.e., Haemophilus influenza
Acute bacterial rhinitis is most commonly seen among children, but
adult may develop the condition after nasal trauma, viral upper
respiratory tract infection, or surgery.
The clinical presentation of acute bacterial rhinitis may be identical
to that of common cold.
Most common causative organisms include S. pneumoniae, H.
influenzae and Moraxella Catarrhalis.
Note: Overall, most common cause of infective rhinitis is viral
infection (viral rhinitis).
 69. Surgical markings for finding the facial
nerve is are?
a) Tympano - mastoid suture

b) Tragal pointer

c) Posterior belly of digastric

d) All the above

Correct Answer - A
Ans. is 'a' i.e., Tympano-mastoid suture
Surgical landmarks to identify main trunk of the facial nerve are
as follows:
i. Tympanomastoid suture line - it is located between the mastoid and
the tympanic bones. The main facial trunk lies 6 -8 mm distal to the
end of the suture.
ii. Tragal pointer - the main nerve trunk lies 1.0 to 1.5 cm deep and
slightly anterior and inferior to the tip of the external ear canal
cartilage.
iii. Posterior belly of digastric -the main nerve trunk lies 1 cm deep to
the medial attachment of the posterior belly of digastric muscle to
the digastric groove (mastoid notch) of the mastoid bone.
iv. Mastoid bone - main nerve trunk is identified inside the mastoid
bone by mastoidectomy.
70.
Central part of cholesteatoma contains ?
a) Keratin debris

b) Keratinized squamous epithelium

c) Coulmnar epithelium

d) Fibroblasts

Correct Answer - A
Ans. is 'a' i.e., Keratin debris
Cholesteatoma
Destructive or expanding growth in the middle ear or mastoid
process
The term cholesteatoma is a misnomer, because it neither contains
cholesterol crystals nor is it a tumor to merit the suffix `oma'.
Cholesteatoma has the property to destroy bone. It may cause
destruction of ear ossicles, erosion of bony labyrinth, canal of facial
nerve, sinus plate or tegmen tympani and thus cause several
complications. Bone destruction by cholesteatoma has been
attributed to various proteolytic enzymes liberated by osteoclasts
and mononuclear inflammatory cells, seen in association with
cholesteatoma.
Cholesteatoma consists of two parts : ?
i) Matrix : - Made up of keratinizing squamous epithelium.
ii) Keratin debris (central white mass) : - Produced by the matrix.
Therefore, cholesteatoma also referred to as epidermosisor
keratoma.
 71. Which of the following is not a cause of
oropharyngeal carcinoma?
a) Occupational exposue to hydrochloric acid

b) Smoking

c) Human Papilloma Virus infection

d) Occupational exposure to isopropyl oil

Correct Answer - A
Ans. is 'a' i.e., Occupational exposure to hydrochloric acid
Etiology of oropharyngeal carcinoma
i. Tobacco in any form - cigarette smoking or chewing
ii. Heavy alcohol abuse
iii. Beetle nut chewing
iv. Plummer vinson syndrome, cirrhosis
v. Syphilis
vi. Trauma
vii. Dental irritation
viii. Poor oral hygiene
ix. Occupational exposure to isopropyl alcohol, sulphuric acid and
nickel
x. HPV infection
72. False regarding the foreign body of
oropharynx is ?
a) Impacted foreign bodies most often lodge in the soft tissue at
the base of tongue

b) Food particles are the most common oropharyngeal foreign

bodies in children

c) Clinical hypopharyngeal foreign bodies are amenable to clinical

examination

d) Endoscopy and MDCT are used in the diagnosis

Correct Answer - B
Ans. is 'b' i.e., Food particles are the most common
oropharyngeal foreign bodies in children
Oropharyngeal foreign bodies
Most ingested foreign bodies do not impact in the oropharynx
Sharp foreign bodies like fish and chicken bones most commonly
impact in the soft tissues at the base of the tongue.
Hypopharyngeal foreign bodies can be detected by good physical
examination.
Endoscopy and MDCT are used in the diagnosis of foreign bodies of
cervical esophagus.
Coins are the most common impacted oropharyngeal foreign bodies
encountered in children followed by food particles.
73. Not a test for Eustachian tube patency ?
a) Tympanometry

b) Toynbee

c) Valsalva

d) Frenzel maneuver

Correct Answer - A
Ans. is 'a' i.e., Tympanometry
Tests for Eustachian tubepatency
Valsalva test
Methylene blue test
Sonotubometry
Politzer test
Toynbee test
Frenzel maneuver
Catheterization
Inflation - Deflation test
74. Tympanoplasty deals with reconstruction
of -
a) Tympanic membrane

b) Ossicular chain

c) Both a and b

d) None of the above

Correct Answer - C
Ans. is 'c' i.e., Both a and b
Tympanoplasty is the surgical operation performed for
reconstruction of tympanic membrane and/or middle ear ossicles.
Myringoplasty is the reconstruction of tympanic membrane.
Ossiculoplasty is the reconstruction of ossicular chain.
Tympanoplasty = Myringoplasty ± ossiculoplasty
75. Most common organism cultured in CSOM
is ?
a) Staphylococcus aureus

b) Staphylococcus epidermidis

c) Streptococcus pneumonia

d) Pseudomonas aeruginosa

Correct Answer - D
Ans. is 'd' i.e., Pseudomonas aeruginosa
Microbiology of CSOM
Pus culture in both types of aerobic and anaerobic CSOM may show
multiple organisms.
Most commonly isolated organisms are gram negative bacilli, i.e.,
Pseudomonas, proteus, E.coli.
These organisms are not commonly found in the respiratory tract,
while commonly found in the skin of external ear.
76. Fowl smelling nasal discharge is seen in
all except?
a) Nasal Myiasis

b) Choanal atresia

c) Foreign body in nose

d) Rhinolith

Correct Answer - B
Ans. is `b' i.e., Choanal atresia
Diseases with fowl smelling nasal discharge are:
Nasal myiasis
Foreign body in nose
Rhinolith
In choanal atresia there is presence of nasal discharge without air
bubbles.
77. Rhinoscleroma occurs due to ?
a) Autoimmune cause

b) Inflammatory cause

c) Klebsiella rhinoscleromatis infection

d) Mycotic infection

Correct Answer - C
Ans. is 'c' i.e., Klebsiellarhinoscleromatis infection
Rhinoscleroma
The causative organism is Klebsiellarhinosclerontatisor Frisch
bacillus, which can be cultured from the biopsy material.
The disease is endemic in several parts of world.
In India, it is seen more often in northern than in the southern parts.
Biopsy shows infiltration of submucosa with plasma cells,
lymphocytes, eosinophils, Mikulicz cells & Russell bodies.
The latter two are diagnostic features of the disease.
The disease starts in the nose & extends to nasopharynx,
oropharynx, larynx, trachea & bronchi.
Mode of infection is unknown.
Both sexes of any age may be affected.
78. Cauliflower ear is due to ?
a) Hematoma

b) Carcinoma

c) Fungal infection

d) Herpes

Correct Answer - A
Ans. is 'a' i.e., Hematoma
Hematoma of the auricle
It is the collection of blood between the auricular cartilage and its
perichondrium.
It usually occurs due to blunt trauma and often seen in boxers,
wrestlers and rugby players, therefore it is also called Boxer's ear.
Extravasated blood may clot and then organise, resulting in typical
deformity called, Cauliflower ear. If hae​matoma gets infected, severe
perichondritis may set in.
79. Fowl smelling ear discharge with
presence of pale granulation tissue in ear
in an adolescent boy is suggestive of ?
a) Cholesteatoma

b) Exostosis

c) Otomycosis

d) Malignant otitis externa

Correct Answer - A
Ans. is 'a' i.e., Cholesteatoma
Fowl smelling ear discharge with presence of granulation tissue in
earin adolescent boy is suggestive chronic suppurativeotits media of
the unsafe type (atticoantral disease). Such patients have underlying
cholesteatoma along with evidence of bone destruction.
Clinical features of cholesteatoma/atticoantral CSOM
Otorrhoea :- Scanty, foul smelling discharge due to bone
destruction.
Hearing loss :- Initially conductive due to destruction of ossicles.
Later sensorineural element may be added, which results in mixed
hearing loss.
Bleeding :- May occur from granulation or the polyp when cleaning
the ear.
Tympanic membrane show posterior marginal or attic perforation.
Also granulation tissue and polyps may be present in ear.
80. Complication of trauma to danger area of
face ?
a) Cavernous sinus infection

b) Meningitis

c) Visual loss

d) Loss of memory

Correct Answer - A
Ans. is 'a' i,e., Cavernous sinus infection
The area of upper lip and the lower part of nose is the danger area
of face. It is due to that this area is the common site of infection.
This area is drained by facial vein which communicates with the
cavernous sinus through the superior ophthalmic vein and pterygoid
venous plexus through the emissary vein.
In case of any infection of this area it may spread to the cavernous
sinus causing infection and/or thrombosis.
 81. Presence of delta sign on contrast
enhanced CT SCAN suggests presence of
?
a) Lateral Sinus thrombophlebitis

b) Cholesteatoma

c) Cerebellar abscess

d) Mastoiditis

Correct Answer - A
Ans. is 'a' i.e., Lateral Sinus thrombophlebitis
LATERAL SINUS THROMBOPHLEBITIS (SIGMOID SINUS
THROMBOSIS)
Lateral or sigmoid sinus thrombophlebitis arises from inflammation in
the adjacent mastoid. It may occur as a complication of : ?
i. Acute coalescent mastoiditis
ii. CSOM and cholesteatoma
Clinical features
Hectic Picket-Fence type of fever with rigor.
Headache, Progressive anemia and emaciation.
Griesinger's sign : - odema over the posterior part of mastoid due to
thrombosis of mastoid emissary veins.
Papilloedema
Tobey-Ayer test :- Compression of vein on the thrombosed side
produces no effect while compression of vein on healthy side
produces rapid rise in CSF pressure which will be equal to bilateral
compression of jugular veins.
Crowe-Beck test :- Pressure on jugular vein of healthy side produces
engorgement of retinal veins. Pressure on affected side does not
produce such change.
Tenderness along jugular vein
Imaging studies
Contrast-enhanced CT scan can show sinus thrombosis by typical
delta-sign. It is a triangular area with rim enhancement, and central
low density area is seen in posterior cranial fossa on axial cuts.
Delta-sign may also be seen on contrast enhanced MRI.
82. Ostmann fat pad is related to ?
a) Ear lobule

b) Buccal mucosa

c) Eustachian tube

d) Tip of nose

Correct Answer - C
Ans. is 'c' i.e., Eustachian tube
There are small fat bodies located infermedial to Eustachian tube.
These are called Ostmann fat pads.
They are important in normal closure of eustachian tube and
preventing transmission of nasopharyngeal pressure to middle ear.
These fat pads are absent in Patulous tube syndrome.
 83. Which of the following structures is not at
immediate risk of erosion by
cholesteatoma ?
a) Long process of incus

b) Fallopian canal containing facial nerve

c) Horizontal/ lateral semicircular canal

d) Base plate of stapes

Correct Answer - D
Ans. is 'd' i.e., Base plate of stapes
Cholesteatoma has the property to destroy the bone by virtue of the
enzymes released by it.
Structures immediately at the risk of erosion are : -
i. Long process of incus.
ii. Fallopian canal containing facial nerve.
iii. Horizontal / lateral semicircular canal
84. When the patient fails to understand
normal speech, but can understand
shouted or amplified speech the hearing
loss, is termed ?
a) Mild hearing loss

b) Moderate hearing loss

c) Severe hearing loss

d) Profound hearing loss

Correct Answer - C
Ans. is 'c' i.e., Severe hearing loss
Severe hearing loss
What is severe hearing loss? On average, the most quiet sounds
heard by people with their better ear are between 70 and 95 dB.
People who suffer from severe hearing loss will benefit from
powerful hearing aids, but often they rely heavily on lip-reading even
when they are using hearing aids. Some also use sign language.
85. Most common site for carcinoma pharynx
in females suffering from plummer vinson
syndrome is
a) Post cricoid region

b) Posterior wall

c) Lateral wall

d) Pyriformis fossa

Correct Answer - A
Ans. is 'a' i.e., Post cricoid
Plummer-Vinson syndrome
Plummer-Vinson syndrome, also known as Brown-Kelly-Paterson
syndrome or sederopenic dysphagia, seen in middle aged
edentulous women.
The plummer Vinsion Paterson Brown Kelly Syndrome is
characterized by : -
Dysphagia
Chronic iron deficiency anemia
Atrophic oral mucosa and glossitis
Brittle, spoon-shaped fingernails (Koilonychia)
The cause of dysphagia is usually a cervical esophageal web, but
abnormal pharyngeal and esophageal motility may play a role.
The syndrome characterstically occurs in middle aged edentulous
(without teeth) women.
It is a premalignant lesion. Approximately 10% of patient develop
squamous cell Ca of esophagus, oral cavity or the hypopharynx.
As iron-deficiency anemia is a common finding, it is also known as
sideropenic dysphagia.
Carcinoma develops in post-cricoid region.
86. Pyriform fossa is situated in ?
a) Oropharynx

b) Hypopharynx

c) Nasopharynx

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Hypopharynx
Pyriform fossa is a part of laryngopharynx (hypopharynx)
87. Incisura terminalis is between ?
a) Tragus and crux of helix

b) Ear lobule and antihelix

c) Antihelix and external auditory meatus

d) Tragus and ear lobule

Correct Answer - A
Ans. is 'a' i.e., Tragus and crux of helix
Incisura ternzinalis is the area between the tragus and crus of helix
 88. Graft for myringoplasty
a) Temporalis fascia

b) Iliacus fascia

c) Coles fascia

d) I hotibial band

Correct Answer - A
Ans. is 'a' i.e., Temporalis fascia
Graft material used for myringoplasty are :
i. Temporalis fascia (most common)
ii. Tragal cartilage
iii. Perichondrium from the tragus
iv. Vein
 89. Which of the following is not a derivative
of the middle ear cleft ?
a) Semicircular canal

b) Mastoid air cell

c) Tympanic cavity

d) Eustachian tube

Correct Answer - A
Ans. is 'a' i.e., Semicircular canal
The middle - ear cleft in the temporal bone includes :?
i. Eustachian tube
ii. The middle ear (tympanic cavity)
iii. Aditus which leads posteriorly to the mastoid antrum and air cells.
90.
Exostosis due to repetitive exposure to cold
water is common in which part of the
temporal bone?
a) Squamous part

b) Tympanic part

c) Ptreous part

d) Mastoid part

Correct Answer - B
Ans. is 'b' i.e., Tympanic part
Surfer's ear
It is the common name for an exostosis or abnormal bone growth
within the external auditory canal.
Surfer's ear is not the same as swimmer's ear, although infection
can result as a side effect.
Irritation from cold wind and water exposure causes the bone
surrounding the ear canal to develop lumps of new bony growth
which constrict the ear canal. The condition is so named due to its
prevalence among cold water surfers. Cold water surfers experience
surfer's ear at about six times the rate of warm water surfers.
Common site for surfer's ear is external auditory canal. Tympanic
part of the temporal bone is a U shaped curved bony plate that
forms most of the part of the external auditory canal. Thus exostosis
is common in the tympanic part of the temporal bone.
Note: Parts of temporal bone are: squamous, tympanic, styloid,
petrous, and mastoid.
91. Ohgren's line passes from ?
a) Medial canthus to angle of mandible

b) Lateral canthus to angle of mandible

c) Medial canthus to mastoid process

d) Lateral canthus to mastoid process

Correct Answer - A
Ans. is 'a' i.e., Medial canthus to angle of mandible
92. Passavant ridge ?
a) Superior constrictor and palatopharyngeus

b) Inferior constrictor and palatopharyngeus

c) Superior constrictor and palatoglossus

d) Inferior constrictor and palatoglossus

Correct Answer - A
Passavant ridge
Near the superior margin of pharynx, a few fibres of superior
constrictor blend with a band of muscle fibres belonging to the
palatopharyngeus muscle.
These fused fibres form a band or ring around the posterior wall and
sidewalls of the nasopharyngeal isthumus.
When the soft palate is elevated this muscle band appears as a
ridge is known as passavant's ridge.
93. Rhinolith can cause
a) Nasal obstruction

b) Epistaxis

c) Epiphora

d) All of the above

Correct Answer - D
A rhinolith is a calculus present in the nasal cavity.
The word is derived from the roots rhino- and -lith, literally meaning
"nose stone".
A rhinolith usually forms around the nucleus of a small exogenous
foreign body, blood clot or secretion by slow deposition of calcium
and magnesium salts.
Over a period of time, they grow into large irregular masses that fill
the nasal cavity.
They may cause pressure necrosis of the nasal septum or
lateral wall of nose leading to nasal obstruction, epistaxis,
headache, sinusitis and epiphora.
94. All of the following are true about
malignant otitis externa except:
a) ESR is used for follow up after treatment

b) Granulation tissues are seen on superior wall of the external

auditory canal

c) Severe hearing loss is the chief presenting complaint

d) Pseudomonas is the most common cause

Correct Answer - C
Ans. c. Severe hearing loss is the chief presenting complaint
Severe hearing loss is not the chief presenting complaint malignant
otitis externa.
Malignant Otitis Externa:
Characterized by granulation tissue in external auditory canal at the
junction of bone and cartilage.
MC organismz Pseudomonas aeruginosa
ESR is raised, used for follow up of treatment
95. All are true about Rhinoscleroma, except
?
a) Mikulicz cells

b) Caused by fungus

c) More common in Northern area

d) Woody nose

Correct Answer - B
Ans. is 'b' i.e., Caused by fungus
Rhinoscleroma is caused by a bacterium.
Rhinoscleroma
The causative organism is Klebsiella rhinoscleromatis or Frisch
bacillus, which can be cultured from the biopsy material.
The disease is endemic in several parts of world.
In India, it is seen more often in northern than in the southern parts.
Biopsy shows infiltration of submucosa with plasma cells,
lymphocytes, eosinophils, Mikulicz cells & Russell bodies.
The latter two are diagnostic features of the disease.
The disease starts in the nose & extends to nasopharynx,
oropharynx, larynx, trachea & bronchi.
Mode of infection is unknown.
Both sexes of any age may be affected.
Clinical features of rhinoscleroma
The disease runs through the following stages :?
a. Atrophic stage : It resembles atrophic rhinitis and is
characterised by foul smelling purulent nasal discharge and crusting.
b. Granulomatous stage : Granulomatous nodules form in nasal
mucosa. There is also subdermal infiltration of lower part of external
nose and upper lip giving a 'woody' feel. Nodules are painless and
non-ulcerative.
c. Cicatricial stage : This causes stenosis of nares, distortion of
upper lip, adhesions in the nose, nasopharynx and oropharynx.
There may be subglottic stenosis with respiratory distress.
Biopsy of rhinoscleroma shows infiltration of submucosa with plasma
cells, lymphocytes, eosinophils, Mikulicz cells and Russell bodies.
The latter two are the diagnostic features of the disease.
Treatment
Both streptomycin & tetracycline are given together for minimum of
4-6 wks. Steroid can be combined to reduce fibrosis. Surgical
treatment may be required to establish the airway and correct nasal
deformity
96. Associated with objective tinnitus?
a) Meiners disease

b) Acoustic neuroma

c) Ear wax

d) Glomus tumor

Correct Answer - D
Ans. is `d' i.e., Glomus tumor
Tinnitus
Tinnitus is ringing sound or noise in the ear.
The characteristic feature is that the origin of this sound is within the
patient.
Two types of tinnitus have been described : ?
a. Subjective
I. Otologic II . Non-otologic
Impacted wax Disease of CNS
Fluid in the middle ear Anaemia
Acute and chronic otitis media Arteriosclerosis
Abnormally patent eustachian tube Hypertension
Meniere's disease Hypotension
Otosclerosis Hypoglycaemia
97. Which drug is to be given in a truck driver
for rhinitis ?
a) Cetrezine

b) Hydroxyzine

c) Promethazine

d) Buclizine

Correct Answer - A
Ans. is 'a' i.e., Cetrezine
 98. Schwartze sign seen in?
a) Glomus Jugulare

b) Otosclerosis

c) Meniere's diseases

d) Acoustic neuroma

Correct Answer - B
Ans. is 'b' i.e., Otosclerosis
Symptoms of otosclerosis
Hearing loss :- Bilateral conductive deafness which is painless and
progressive with insidious onset. In cochlear otosclerosis
sensorineural hearing loss also occur along with conductive
deafness.
Paracusis willissii :- An otosclerotic patient hears better in noisy than
quiet surroundings.
Tinnitus :- More common in cochlear otosclerosis.
Speech :- Monotonous, well modulated soft speech.
Vertigo :- is uncommon.
Signs in otosclerosis
Tympanic membrane is quite normal and mobile.
In 10% of cases flamingo - pink blush is seen through the tympanic
membrane called as Schwartze sign.
Various tests show conductive hearing loss.
Tuning fork tests in otosclerosis
As otosclerotic patients have conductive deafness, the tuning fork
tests results will be as follows :?
1. Rinnes :- Negative
2. Webers :- Lateralized to the ear with greater conductive loss.
3. Absolute bone conduction (ABC) :- Normal (can be decreased in
 cochlear otosclerosis).
4. Gelles test :- No change in the hearing through bone conduction
when air pressure of ear canal is increased by Siegle's speculum.
Audiometry in otosclerosis
Audiometry is one of the important tools in evaluation of a patient of
otosclerosis.Various audiometric tests are :?
1. Pure tone audiometry
1. Shows loss of air conduction, more for lower frequencies with
characteristic rising pattern. Bone conduction is normal. However in
some cases, there is a dip in bone conduction curve which is
maximum at 2000 Hz (2 KHz) and is called the Carhart's notch.
2. Impedance audiometry
Impedance audiometry shows :-
Tympanometry
Patient with early disease may show type A tympanogram (because
middle ear areation is not affected) Progressive stapes fixation
results in classical As type tympanogram.
Acoustic (stapedial reflex)
It is one of the earliest sign of otosclerosis and preceedes the
development of airbone gap. In early stage, diphasic on-off pattern is
seen in which there is a brief increase in compliance at the onset
and at the termination of stimulus occurs. This is pathognomonic of
otosclerosis. In later stage the reflex is absent.
99. Galle's test is used for ?
a) Otosclerosis

b) Juvenile angiofibroma

c) Nasal polyp

d) None

Correct Answer - A
Ans. is 'a' i.e., Otosclerosis
Gelle's test
It is a bone conduction test and examines the effect of increased air
pressure in ear canal on hearing.
Increased air pressure in ear canal (by Siegle's speculum) pushes
the tympanic membrane and ossicles inwards which raises the
intralabyrinthine pressure and causes immobility of basilar
membrane and decreased hearing.
However, if ear ossicles are already fixed or disconnected, the
pressure cannot be transfered to inner ear
No change in hearing in this situation.
Base of vibrating tuning fork is placed on mastoid process and air
pressure in ear canal increased (by Siegle's speculum).
Interpretation are : -
Positive Gelle's (decreased hearing on increased pressure)→
Normal or sensorineural hearing loss. h)
Negative Gelle's (No effect of pressure change in hearing) →
Disconnected or fixed ossicular chain.
100. Macula is stimulated by ?
a) Gravity

b) Head position change

c) Linear acceleration

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
Vestibular apparatus (Peripheral part of vestibular system)
The vestibular apparatus within the inner ear detects head motion
and position and transduces this information to a neural signal. The
vestibular apparatus has following parts :-
101. Paranasal sinuses present at birth ?
a) Frontal and maxillary

b) Ethmoid and maxillary

c) Frontal and ethmoid

d) Sphenoid and ethmoid

Correct Answer - B
Ans. is 'b' i.e., Ethmoid and maxillary
Maxillary sinus → 4 Develop at birth; completely develop at 9
years
Ethmoidal sinus → Develop at birth; completely develop at late
puberty
Frontal sinus → Develop at 2 year; completely develop at
late adolescence
Spenoid sinus → Develop at 3-5 years; completely develop at
12-15 years
102. Most common bone affected by
otosclerosis
a) External auditory canal

b) Bony labyrinth

c) Mastoid process

d) None

Correct Answer - B
Ans. is 'b' i.e., Bony labyrinth
Otosclerosis is a primary disease of the bony labyrinth.
There is abnormal bone growth that causes hearing loss.
There is altered bone remodeling.
Normally, the typical human otic capsule remodeling rate is
extremely low.
In otosclerosis, normal inhibition of bone remodeling is lost resulting
in foci of bone remodeling.
When remodeled bone bridges the stapediovestibular joint, it fixates
the joint and impedes sound transmission manifested as conductive
hearing loss.
The most common site of disease is promontory in the region of the
anterior margin of oval window, and in advanced cases the stapes
become ankylosed in position by a mass of new spongy bone.
Other sites, which may be involved, are round window area,
stapedial footplate, internal auditory canal, and semicircular canal.
103. Best view for nasal bone ?
a) Lateral

b) Towne's

c) Cald-well

d) Submentovertical

Correct Answer - A
Ans. is 'a' i.e., Lateral
104. Lomard's test is used to diagnosis ?
a) Conductive hearing loss

b) Sensorineural hearing loss

c) Mixed hearing loss

d) Non-organic hearing loss

Correct Answer - D
Ans. is 'd' i.e., Non-organic hearing loss
 105. True about serous otitis media are all
except ?
a) Also called glue ear

b) Affect school going children

c) Type C tympanogram

d) Fluid in middle ear

Correct Answer - C
Ans. is `c' i.e., Type C tympanogram
Serous otitis media
Serous otitis media (SOM) has many synonyms : Serous otitis
media, otitis media with effusion, glue ear, non-suppurative otitis
media, mucoid otitis media, silent otitis media. SOM is an insidious
condition in which there is thick or sticky non-purulent fluid behind
the eardrum in the middle ear, but there is no ear infection, i.e.,
effusion of middle ear without infection. Fluid in the middle ear is
sterile. SOM occurs most commonly in school going children and
SOM is the commonest cause of childhood hearing loss.
Etiopathogenesis
1. Eustachian tube dysfunction
Eustachian tube dysfunction, coupled with recurrent upper
respiratory tract infection is the most important factor in the
development of SOM. Normally eustachian tube helps to drain fluids
to prevent them from building up in the ear. In Eustachian tube
dysfunction, it is unable to drain the fluid. Following can cause
Eustachian tube block :-
1. Respiratory tract infection :- Adenoid, rhinitis, tonsillitis, sinusitis.
2. Allergies
3. Benign and malignant tumor of nasopharynx.
2. Unresolved otitis media
Inadequate antibiotic therapy in acute suppurative otitis media may
inactivate infection but fails to resolve it completely. Low grade
infection lingers on and acts as stimulus for mucosa to secrete more
fluid.
Clinical features
Unlike children with an ear infection (ASOM), children with SOM do
not act sick. o The only presenting symptom may be hearing loss
with fullness in ear.
Otoscopic finding of SOM
Air bubbles on the surface of ear drum
Fluid behind the eardrum.
Dullness of the eardrum when a light is used, with loss of light reflex.
o Eardrum may appear yellow, grey or bluish in colour.
Retracted eardrum with decreased mobility
Tympanometry shows type B tympanogram.
 106. Cause of myringosclerosis ?
a) Genetic

b) Grommet insertion

c) Otosclerosis

d) None

Correct Answer - B
Ans. is 'b' i.e., Grommet insertion
Tvmpanosclerosis
Tympanosclerosis is a condition in which there is calcification of
tissue in the eardrum (tympanic membrane) and middle ear.
Tympanosclerosis may be classified as : -
1. Myringosclerosis : - Involving only the tympanic membrane.
2. Intratympanic tympanosclerosis : - Involving other middle ear sites :
ossicular chain or, rarely, the mastoid cavity.
Exact etiology of tympanosclerosis is not known. It may be an
abnormal healing process and most commonly occurs in cases of
serous otitis media as a complication of ventilation tube (gourmet)
insertion.
Characteristic chalky white patches are seen on inspection of the
eardrum. It is worth noting that cholesteatoma may look similar but
the whiteness appears behind, rather than in/on the tympanum.
Otherwise tympanosclerosis is asymptomatic. Conductive hearing
loss may occur in some cases.
107. Delta-sign is seen in ?
a) Petrositis

b) Acute mastoiditis

c) Sigmoid sinus thrombosis

d) Glomus tumor

Correct Answer - C
Ans. is 'c' i.e., Sigmoid sinus thrombosis
Contrast-enhanced CT scan can show sinus thrombosis by typical
delta-sign. It is a triangular area with rim enhancement, and central
low density area is seen in posterior cranial fossa on axial cuts.
Delta-sign may also be seen on contrast enhanced M RI.
108. Trismus is seen in commonly ?
a) Ludwig angina

b) Quinsy

c) Retropharyngeal abscess

d) Parapharyngeal abscess

Correct Answer - B
Ans. is 'b' i.e., Quinsy
Trismus is inability to open-mouth.
Normal opening of mouth ranges between 25-50mm.
Any value less than this is known as trismus (roughly the opening
should permit a minimum of three fingers when inserted sideways).
Causes of quinsy are :?
A. Common causes
Infection around impacted third molor
Quinsy (peritonsillar abscess)
Submucous fibrosis
TM joint dysfunction
B. Less common causes
Ludwings angina
Parotid gland infection and tumors
Malignant otitis externa or furncle in external auditory canal.
Parapharyngeal and retropharyngeal abscess
Carcinoma mandible
Tetanus
Radiation therapy
Carcinoma check
Malignant hyperthermia
Coming to the question
Trismus can occur in all the given options.
However, it is most common and most characteristic of quinsy
(among the given options).
109. SNHL is seen in all except?
a) Nail patella syndrome�

b) Distal RTA

c) Batter syndrome

d) Alport syndrome

e) None

Correct Answer - E
Ans. is 'e' i.e.None
All the given options are causes of sensorineural hearing loss.
Treacher collin
syndrome
Congenital causes of
Alport's
SNHL
syndrome
Usher's syndrome
Pendred
Hurler's syndrome
syndrome Michel's aplasia
Klippel feil syndrome
Crouzon's Mondini's anomaly
Type 1 (distal) Renal
disease Schibe's and
tubular acidosis
Bartter syndrome Alexander's anomalies
Jervell & lange Neilson
Leopard LThl's anomaly
syndrome
syndrome Michel's aplasia
Biotinase deficiency
Refsum Nail - patella syndrome
Albinism
syndrome Alstrom syndrome
MELAS
Waardenburg Brachio - oto - renal
Trisomy 13, 15, 21
syndrome (BOR) syndrome
Fabry disease Cockayne's syndrome
110. Red line in pure tone audiometry is for -
a) Bone conduction

b) Air conduction

c) Right ear

d) Left ear

Correct Answer - C
Ans. is 'c' i.e., Right ear
 111. Transverse fracture of maxilla is ?
a) Le Fort-1

b) Le Fort-2

c) Le Fort-3

d) Cranifacial disruction

Correct Answer - A
Ans. is 'a' i.e., Le Fort-1
It is classified into 3 types : ?
1. Le Fort I (transverse) fracture runs above and parallel to the plate. It
crosses lower part of nasal septum, maxillary antra and the
pterygoid plates.
2. Le Fort II (pyramidal) fracture passes through the root of nose,
lacrimal bone, floor of orbit, upper part of maxillary sinus and
pterygoid plates. This fracture has some features common with the
zygomatic fractures.
3. Le Fort III (craniofacial dysfunction). There is complete separation of
facial bones from the cranial bones. The fracture line passes through
root of nose, ethmofrontal junction, superior orbital fissure, lateral
wall of orbit, frontozygomatic and temporozygomatic sutures and the
upper part of pterygoid plates.
112. Which of the following laryngeal
cartilage is hyaline?
a) Epiglottis

b) Comiculate

c) Cricoid

d) Cuneiform

Correct Answer - C
Ans. is 'c' i.e., Cricoid
Hyaline cartilages Elastic cartilages (do not ossify)
Thyroid cartilage Epioglottis
Cricoid cartilage Corniculate
Basal part of arytenoid cartilage Cuneiform
Processes of arytenoid
113. All of the following cranial nerves are
involved in Acoustic neuroma, except ?
a) Vagus

b) Glossopharyngeal

c) Oculomotor

d) Facial

Correct Answer - C
Ans. is 'c' i.e., Oculomotor
Clinical features of acoustic neuroma
The clinical features depend on the extent of tumor and involved
structure :?
When tumor is still confined to the internal auditory canal
Cochleovestibular symptoms are the earliest symptoms of acoustic
neuroma when tumour is still confined to internal auditory canal. The
commonest presenting symptoms are unilateral deafness or tinnitus,
or a combination of both. Hearing loss is retrocochlear sensorineural
type. There is marked difficulty in understanding speech, out of
proportion to the pure tone hearing loss, a characteristic feature of
acoustic neuroma. Vestibular symptoms are imbalance or
unsteadiness. True vertigo is very rare.
When tumor extends beyond IAC and involves other structures
Vhcranial nerve :- It is the earliest nerve to be involved. There is
reduced corneal sensitivity and loss of corneal reflex which is the
earliest sign of acoustic neuroma. Numbness or paraesthesia of face
may occur. Involvement of Vth nerve indicates that tumor is roughly
2.5 cm in diameter and occupies the CP angle.
VIP nerve :- Sensory fibres of facial nerve are involved. There is
hypoesthesia of posterior meatal wall (Hitzelberg's sign), loss of
taste, and loss of lacrimation on Schirmer's test. Motor fibres are
more resistant.
IXth and A' nerves :- Dysphagia and hoarseness due to palatal,
pharyngeal and laryngeal paralysis.
Brainstem :- Ataxia, weakness, numbness of arms & legs,
exaggerated tendon reflexes.
Cerebellum :- Ataxia, Dysdiadochokinesia, Nystagmus.
Due to raised ICT :- Headache, neusea, vomiting, diplopia due to VI'
nerve involvement, and papilloedema.
114. Wave I in brain-stem response
audiometry arises from?
a) Cochlear nerve

b) Superior olivary complex

c) Lateral lemniscus

d) Inferior colliculus

Correct Answer - A
Ans. is 'a' i.e., Cochlear nerve
Brain Stem Response Audiometry (BERA)
It is a non-invasive procedure which objectively helps to find the
integrity of central auditory pathway through the VIII nerve, pons and
mid brain. It is accurate to within 10 or 15 dB of the psychoacoustic
thereshold. It is the most reliable audiological method of
differentiating between cochlear and Retrocochlear hearing losses. It
is an objective test and can be done under sedation.
It is used both as a screening test and as a definative hearing
assessment test in children. Best test to detect deafness in infants
(reliably recorded even from premature infants of 30 weeks
gestational age) and mentally retarded or malingering subjects. It is
also used for Identification of the site of lesion in Retrocochlear
pathologies and to diagnose brainstem pathology e.g. multiple
sclerosis or pontine tumor.
Waves of BERA
In a normal person, 7 waves are produced in first 10 miliseconds.
The first, third and fifth waves are most stable and are used in
measurements. Site of origin of waves are :-
Wave I Distal part of Eighth nerve
Wave II Proximal, part of Eighth cranial nerve
Wave III Cochlear nucleus
Wave IV Superior olivary complex
Wave V Lateral leminiscus
Wave VI & VII Inferior colliculus
115. Site of glomus jugulare?
a) Epitympanum

b) Hypotympanum

c) Mesotympanum

d) Internal ear

Correct Answer - B
Ans. is 'b' i.e., Hypotympanum
Glomus tumor
Glomus tumor is the most common benign tumor of middle ear.
It arises from the glomus bodies, therefore named Glomus tumor.
It is well recognised that glomus tumors arise from paraganglions,
which are normally occuring structures usually found in close
association with sympathetic ganglions along the aorta and its main
branches.
The chief cells (paraganglionic cells) of the paraganglions are of
neural crest origin and are components of the diffuse
neuroendocrine system (DNES).
These paraganglionic cells are derived from embryonic
neuroepithelium (neural crest).
Glomus tumors are also referred to as chemodectomas or
nonchromaffin paragangliomas.
There are two types of glomus tumors :-
Glomus jugulare
These glomus tumors arise from the dome of the internal jugular
vein in the hypotympanum and jugular foramen. In jugular foramen
they can invade IX to XII cranial nerves.
Glomus tympanicum
They arise from the promontory of the middle ear along the course
of the tympanic branch of the IXth cranial nerve.
Although rare, glomus tumors are the most common tumor of the
middle ear and are second to acoustic neuroma (vestibular
schwannoma) as the most common tumor of the temporal bone.
It is more common in females with female to male ratio of 3-6 : 1.
Glomus jugulare tumors have also been noted to be more common
on the left side, especially in females. o Most tumors occur in patient
40-60 years.
Multicentric tumors are found in 3-10% of sporadic cases and in 25-
50% of familial cases.
116. Frey's syndrome is caused by ?
a) Post traumatic nerve fibres of facial nerve with parasympathetic
of auriculotemporal nerve

b) Greater auricular with auriculotemporal nerve

c) Facial nerve with greater auricular nerve

d) None

Correct Answer - A
Ans. is 'a' i.e., Post traumatic nerve fibres of facial nerve with
parasympathetic of auriculotemporal nerve
Frey's syndrome (gustatory sweating)
Gustatory sweating or Frey's syndrome involves post-parotidectomy
facial sweating and skin flushing while eating.
The symptoms usually occur several months or even years after
parotid surgery.
The likely pathophysiology is aberrant regeneration of postganglionic
secretomotor parasympathetic nerve fibres (originating from the otic
ganglion) misdirected through several axonal sheaths of post-
ganglionic sympathetic fibres feeding the sweat glands. These
sympathetic fibres are to the sweat glands of the skin in the
dissected field.
The frey's syndrome is likely due to injury to auriculotemporal nerve
with faulty regeneration, therefore Frey's syndrome is also known as
Auriculotemporal syndrome.
A variant of Frey's syndrome in which there is gustatory facial
flushing but not sweating, occurs following facial paralysis due to
faulty regeneration following injury to the facial nerve. So, Frey's
syndrome is not limited to parotid surgery with injury to
auriculotemporal nerve.
117. Killions incision is used for?
a) Septoplasty

b) SMR

c) Proof puncture

d) Modified radical mastoidectomy

Correct Answer - A
Ans. is 'a' i.e., Septoplasty
Technique of septoplasty
1. Infiltrate the septum with 1% lignocaine with adrenaline
1:100,000.
2. In cases of deviated septum, make a slightly curvilinear incision,
2-3 mm above the caudal end of septal cartilage on the concave
side (Killian's incision). In case of caudal dislocation, a transfixion or
hemitrans fixion (Freer's) incision is made.
3. Raise mucoperichondrial/mucoperiosteal flap on one side only.
4. Separate septal cartilage from the vomer and ethmoid plate and
raise mucoperiosteal flap on the opposite side of septum.
5. Remove maxillary crest to realign the septal cartilage.
6. Correct the bony septum by removing the deformed parts.
Deformed septal cartilage is corrected by various methods, such as :
Scoring on the concave side
Cross-hatching or morselizing
Shaving
Wedge excision
Further manipulations like realignment of nasal spine, separation of
septal cartilage from upper lateral cartilages, implantation of
cartilage strip in the columella or the dorsum of nose may be
required.
7. Trans-septal sutures are put to coapt mucoperichondrial flaps.
7. Trans-septal sutures are put to coapt mucoperichondrial flaps.
8. Nasal pack.
118. Turban epiglottis is seen in ?
a) TB

b) Leprosy

c) Laryngeal papilloma

d) Epiglottitis

Correct Answer - A
Ans. is 'a' i.e., TB
Tubercular larvn_gitis
Tubercular laryngitis is almost always secondary to pulmonary
lesions, mostly affecting males in middle age (20-40 years). Disease
affects the posterior third of larynx more commonly than anterior
part.The parts affected in descending order of frequency are :- i)
Interarytenoid fold, ii) Ventricular band, iii) Vocal cords, iv) Epiglottis
Clinical features
Weakness of voice with periods of aphonia earliest symptoms. o
Hoarsness, cough, dysphagia (odynophagia)
Referred otalgia
Laryngeal examination in TB laryngitis
Hyperaemia of the vocal cord in its whole extent or confined to
posterior part with impairment of adduction is the first sign.
Swelling in the interarytenoid region giving a mammilated
appearance.
Ulceration of vocal cord giving mouse-nibbled appearance.
Superficial ragged ulceration on the arytenoids and interarytenoid
region.
Granulation tissue in interarytenoid region or vocal process of
arytenoid.
Pseudoedema of the epiglottis "turban epiglottis".
Swelling of ventricular bands and aryepiglottic folds.
Marked pallor of surrounding mucosa.
119.
Most common part of larynx involved in TB ?
a) Anterior

b) Posterior

c) Middle

d) Anywhere

Correct Answer - B
Ans. is 'b' i.e., Posterior
Essential otolaryngology 2"d/e p. 1139]
Disease affects the posterior third of larynx more commonly than
anterior part.
The parts affected in descending order of frequency are :- i)
Interarytenoid fold, ii) Ventricular band, iii) Vocal cords, iv) Epiglottis.
120. Most common cause of ASOM is?
a) Meningococci

b) Pneumococci

c) H influenzae

d) Moraxella

Correct Answer - B
Ans. is 'b' i.e., Pneumococci
ASOM is an acute inflammation of middle ear cleft caused by
pyogenic organism.
It is worth noting that ASOM is the infection of middle ear cleft, i.e.,
middle ear (tympanic cavity), Eustachian tube, Attic, Aditus, antrum
and mastoid air cells.
ASOM is especially common in infants and children.
Most of the time ASOM usually follows respiratory tract infections
(i.e., acute tonsillitis, common cold or influenza) and the infection
travel up by the eustachian tube to the middle ear.
The most common causative organism is streptococcus
pneumoniae. Other common organisms are H. influenzae and
Moraxella catarrhalis. Less common causative organisms are
streptococcus pyogenes, staphylococcus aureus and E.coli.
121. Defective function of which of the
following causes hyperacusis ?
a) VIII nerve

b) 7th nerve

c) Stapedius muscles

d) Any of the above

Correct Answer - D
Ans. is 'd' i.e., Any of the above
Hyperacusis
Hyperacusis is hearing normal voice as louder.
The protective mechanisms a normal ear employs to minimize the
harmful effects of loud noise are malfunctioning in hyperacusis.
So, noise may seem too loud even with hearing protection.
There is some speculation that the efferent portion of the auditory
nerve is selectively damaged while the hair cells that allow us to
hear pure tones in an audiometric evaluation remains intact.
Some have said it involves direct malfunction of facial nerve; as a
result, the stapedius muscle is unable to dampen sound.
122. Paranasal polyp CT view?
a) Corona!

b) Axial

c) Sagital

d) 3D

Correct Answer - A
Ans. is 'a' i.e., Coronal
Both coronal and axial view are used, but coronal views are best to
study paranasal sinus polyps.
 123. Vallecula sign is seen in ?
a) TB laryngitis

b) Vocal nodule

c) Inverted papilloma

d) Acute epiglottitis

Correct Answer - D
Ans. is 'd' i.e., Acute epiglottitis
There are two important radiological signs in acute epiglottitis :?
1. Thumb sign
2. Vollecula sign
124. Most common cause of otomycosis ?
a) Histoplasma

b) Rhinosporidium

c) Aspergillus

d) Actinomyces

Correct Answer - C
Ans. is 'c' i.e., Aspergillus
Otomycosis
Otomycosis, also called acute fungal otitis externa, describes a
fungal or yeast infection of the external auditory meatus.
Saprophytic fungi potentially residing in the ear canal include
Aspergillus, Candida albicans, Phycomycetes, Rhizopus,
Actinomyces, and Penicillium.
Under certain conditions of increased heat, humidity, glucose
concentration (diabetes), immunosuppression, or overuse of
systemic or topical antibiotics and steroids, these saprophytic fungi
can become pathogenic.
Aspergillus niger accounts for 90% of otomycosis infections.
Other common organisms are candida albicans (2"a most common)
and Aspergillus fumigatus.
Less common organisms are Phycomycetes, Rhizopus,
Actinomyces and Penicillium
125. Facial nerve palsy can be caused by ?
a) Cholesteatoma

b) Multiple sclerosis

c) Mastoidectomy

d) All of the above

Correct Answer - D
Ans. is 'd'' i.e., All of the above
Causes of facial paralysis
Central :- Brain abscess, pontine glioma, Polio, multiple sclerosis
Intracranial part (cerebellopontine angle) :- Acoustic neuroma,
meningioma, congenital cholesteatoma, metastatic carcinoma,
meningitis
Intratemporal part :-
Idiopathic :- Bell's palsy, Melkersson's syndrome
Infections :- ASOM, CSOM, Herpes zoster oticus, malignant otitis
externa
Trauma :- Surgical (mastoidectomy, stapedectomy), accidental
(fractures of temporal bone)
Neoplasms :- Malignancies of external and middle ear, glomus
jugular, facial nerve neuroma, metastasis (from breast, lung etc).
Extracranial part :- Malignancies or surgery or injury to parotid gland
Systemic diseases :- Diabetes, hypothyroidism, uremia, PAN,
Sarcoidosis (Heerfordt's syndrome), leprosy, leukaemia,
demyelinating disease
126. Predisposing factor for Nasal myiasis ?
a) Allergic rhinitis

b) Vasomotor rhinitis

c) Atrophic rhinitis

d) Rhinitis medicomentosa

Correct Answer - C
Ans. is 'c' i.e., Atrophic rhinitis
Nasal myiasis (Maggots in nose)
It results from the presence of ova of flies particularly chrysomia
species in the nose which produce ulceration and destruction of
nasal structure. Mostly seen in atrophic rhinitis when the mucosa
becomes insensitive to flies laying eggs inside.
Clinical features
Initial symptoms (3-4 days maggots) :- Intense irritation, sneezing,
headache, blood stained disharge, lacrimation. o Later :- Maggots
may crawl out of nose and there is foul smell.
Complications
Destruction of nose, sinuses, soft tissues of face, palate and eyeball.
Fistulae in nose and palate.
Death occurs due to meningitis.
Treatment
Chloroform water or vapor must be instilled in order to anaesthetize
or kill the maggots and so release their grip from the skin.
127.
Glomus tumor invading the vertical part of
carotid canal. It is ?
a) Type B

b) Type CI

c) Type C2

d) Type C3

Correct Answer - C
Ans. is `c' i.e., Type C2
128. Unilateral sensorineural hearing loss
may occur in?
a) Coronavirus

b) Mumps

c) Pertussis

d) Rotavirus

Correct Answer - B
Ans. is 'b' i.e., Mumps
Infections of labyrinth Acquired causes Systemic disorders
Trauma to labyrinth or of SNHL (DM, Hypothyroidism,
VIII nerve (Head Presbycusis Renal disorders)
injury, surgery etc) Meniere's disease Multiple sclerosis
Noise induced hearing Acoustic neuroma Smoking & Alcoholism
loss Sudden hearing
Ototoxic drugs loss
 129. Fracture of which of the following bone
causes leakage of cerebrospinal fluid
through ear ?
a) Mastoid process

b) Petrous temporal

c) Ethmoid plate

d) Cribriform plate

Correct Answer - B
Ans. is `b' i.e., Petrous temporal
CSF otorrhea
CSF otorrhea, i.e., leakage of cerebrospinal fluid through ear
structure, is a rare but potentially life threatening situation that
requires rapid intervention.
The underlying etiology of spinal fluid leak through temporal bone is
a violation of the bony and meningeal barriers that separate the
subarachoid space from the middle ear and mastoid.
This means that a defect must exist not only in the bone, but also in
the dura matter.
Causes of CSF otorrhea are : ?
1. Congenital:- Defect in otic capsule.
2. Acquired:- More common than congenital and cause are : -
1. Surgery:- Post-operative leakage is the most common cause of CSF
otorrhea. Surgical causes are acoustic neuroma removal, skull base
surgeries and sometimes mastoid surgery.
2. Trauma:- Fracture of petrous part of temporal can lead to CSF
otorrhea.
3. Infection
3. Spontaneous:- It is without an obvious antecedent pathology.
There may be some defect in the temporal bone.
130. Which of the following is a pneumatic
bone ?
a) Parietal bone

b) Occipital bone

c) Mastoid process

d) None

Correct Answer - C
Ans. is 'c' i.e., Mastoid process
Pneumatic bones are one which contain large air spaces lined by
epithelium. Examples: maxilla, sphenoid, ethmoid, etc. They make
the skull light in weight, help in resonance of voice, and act as air
conditioning chambers for the inspired air.
A bone that is hollow or contains many air cells called as penumatic
bone.
Examples are mastoid process of temporal bone, maxilla, ethmoid,
sphlenoid and frontal bone. Very simple to remember last 4 as all
four paransal sinuses are pneumatic bones.
131. Mulberry nasal mucosa is seen in ?
a) Lupus vulgaris

b) Vasomotor rhinitis

c) Atrophic rhinitis

d) None

Correct Answer - B
Ans. is 'b' i.e., Vasomotor rhinitis
Vasomotor is a nonallergic condition that involves a constant runny
nose, sneezing and nasal congestion, i.e., the nose is stuffy or runny
for reasons other than allergies and infections. The exact etiology is
unknown, but triggers include emotions, odors, poor air quality, spicy
foods, and medication side effects. Pathogenesis include : -
Parasympathetic overactivity
Hyperactive nasal mucosa to several non-specific stimuli especially
in women of 20-40 years.
Symptoms of vasomotor rhinitis include excessive clear rhinorrhoea,
nasal obstruction/congestion, irritation, paroxysmal sneezing and
post-nasal drip. Nasal mucosa is hypertrophied & congested; and
mucosa of turbinates may give mulberry like appearance and is pale
to dusky red in colour.
Complications of vasomotor rhinitis include hypertrophic rhinitis &
sinusitis, and nasal polyp.
Mulberry nasal mucosa is also seen in chronic hypertrophic rhinitis
132. All are seen in Samters triad except?
a) Asthma

b) Nasal polyp

c) Bacterial infection

d) Aspirin sensitivity

Correct Answer - C
Ans. is 'c' i.e., Bacterial infection
Samter's triad
Samter's triad is a medical condition consisting of asthma, aspirin
sensitivity, and nasaL'ethmoidal polyposis. It occurs in middle age
(twenties and thirties are the most common onset times) and may
not include any allergies. o Most commonly, the first symptom is
rhinitis.
The disorder typically progeses to asthma, then polyposis, with
aspirin sensitivity coming last.
The aspirin reaction can be severe, including an asthma attack,
anaphylaxis, and urticaria in some cases. Patients typically react to
other NSAIDS such as ibuprofen, although paracetamol is generally
considered safe.
Anosmia (lack of smell) is also typical, as the inflammation reaches
the olfactory receptors in the nose.
133. Objective test in adenoids
a) Posterior rhinoscopy

b) Anterior rhinoscopy

c) Manual palpation

d) All of the above

Correct Answer - A
Ans. is 'a' i.e., Posterior rhinoscopy
134. Most common sinus to be involved in
acute sinusitis?
a) Ethmoid

b) Maxillary

c) Sphenoid

d) Frontal

Correct Answer - B
Ans. is 'b' i.e., Maxillary
Most common sinus affected by
Maxillary
sinusitis overall
Most common sinus affected in
Maxillary
adult
Most common sinus affected in
Ethmoid
children
Least common sinus affected Sphenoid
Sinuses involved in order of Maxillary > Frontal > Ethmoid >
frequency Sphenoid
135. Queckensted test is done for ?
a) Glomus tumor

b) CSF rhinorrhea

c) Otosclerosis

d) Acoustic neuroma

Correct Answer - B
Ans. is 'b' i.e., CSF rhinorrhea
Detection of CSF Leak
1. Biochemical tests
Concentrations of Glucose are higher in CSF than in nasal
discharge. Glucose value > 30-40 mg% and protein value < 100 mg
% (max 200 mg %) support a diagnosis of CSF leak.
Presence of I3,transferrin is the most definitive test for detection of
CSF and I32transferrin assay is the test of choice when a
confirmatory test is needed, because of high sensitivity as well as
specificity.
I3-trace protein (prostaglandin D synthase) is also used, however it
is nonspecific as it is also present in human testes, heart and
seroma.
2. Basic clinical tests
Tissue test (Handker chief test) : - Unlike nasal mucous, CSF does
not cause a tissue to stiffen.
Filter paper test : - Sample of nasal discharge on a filter paper
exhibits a light CSF border and a dark central area of blood, i.e.,
double ring sign or halo sign.
Queckensted test : - Compression of the jugular vein leas to
increased CSF leak due to increase in ICP.
Rhinoscopy : - Visualization of CSF leak from paranasal sinus.
3. CSF tracers
Intrathecal fluorescein dye adminstration, radionuclide
cisternography, CT cisternography.
136. Bilateral recurrent laryngeal nerve palsy
is seen in all except ?
a) Thyroid carcinoma

b) Lymphadenopathy

c) Thyroid surgery

d) Aortic aneurysm

Correct Answer - D
Ans. is 'd' i.e., Aortic aneurysm
137. Most common cause of singer's nodule
is ?
a) Infection

b) Allergy

c) Vocal abuse

d) None

Correct Answer - C
Ans. is 'c' i.e., Vocal abuse
Vocal nodule (singer's or screamer's nodule)
Vocal nodule are benign noneoplastic growth on free edge of both
the vocal cords at the junction of anterior 1/ 3 with posterior 2/3.
This area is particularly vulnerable to trauma as this is the area of
maximum vibration of the cord.
The major cause is voice abuse, therefore it is most commonly seen
in singers, actors, teachers, and howkers.
Hoarseness is the most common symptom. Vocal fatigue and pain in
neck on prolonged phonation are other symptoms.
Treatment
Early cases of vocal nodules can be treated conservatively by
educating the patient in proper use of voice. Many nodules
especially in children, disappear with this treatment.
Surgery is required for large nodules or long standing nodules in
adults. Microscopic (micorlaryngoscopic) excision is the treatment of
choice.
138. Mucoperichondrial flap in septoplasty is
made on?
a) Alar cartilage

b) Septal cartilage

c) Maxillary spine

d) Sphenoid spine

Correct Answer - B
Ans. is 'b' i.e., Septal cartilage
Steps in septoplasty
A unilateral incision is made in the mucoperichodrial flap at the lower
border of septal cartilage on the left side in right handed persons.
The mucoperichondrial flap is elevated on one side making an
anterior tunnel.
Another incision is made in the mucoperiosteum over the nasal
spine on the same side, elevating the mucoperiosteum from nasal
spine on both sides thus making two more tunnels called inferior
tunnels. Two tunnels are joined by sharp dissection.
Septal cartilage is then separated from vomero-ethmoid bones
posteriorly and nasal spine inferiorly.
Maxillary crest is removed to realign septal cartilage.
Bony septal deformity is corrected by removing deformed part.
Deformed septal cartilage is corrected.
Trans-septal sutures are put to coapt mucoperichondrial flaps.
Nasal pack is put.
Thus (coming to question)
Mucoperichondrial flap (and tunnel) are made on septal cartilage.
Mucoperiosteal flap (and tunnels) are made on nasal spine.
139. All are major symptoms of sinusitis
except ?
a) Nasal bluckage

b) Facial congertion

c) Nasal congestion

d) Halitosis

Correct Answer - D
Ans. is 'd' i.e., Halitosis
The clinical symptoms of acute sinusitis have been classified into
major and minor
Major Minor
Facial pain or pressure Headache
Purulent nasal Cough
discharge Fatigue
Fever Halitosis
Nasal congestion Dental pain
Nasal obstruction Ear pain or
Hyposmia or Anosmia pressure
Facial congestion or
fullness
140. Laryngitis sicca is associated with ?
a) Rhinosporidium

b) M. leprae

c) Klebsiella azaenae

d) Klebsiella rhinoscleromatosis

Correct Answer - C
Ans. is 'c' i.e., Klebsiella azaenae
Laryngitis sicca (Atrophic laryngitis or laryngitis atrophica)
It is a rare entity characterized by atrophic changes in the respiratory
mucosa with loss of the mucus - producing glands.
It is usually associated with atrophic rhinitis and pharyngitis caused
by klebsiella ozaenae.
The most common sites involved in larynx are the false cords
(vestibular folds), the posterior region and the subglottic region.
More common in women.
Clinical features
Irritable cough and hoarseness
Excessive crusts formation which are sometimes bloodstained
(hemorrhagic) with foul odour. Crusts are the most important
diagnostic feature.
Treatment
Elimination of causative factors and humidification.
Laryngeal sprays with glucose in glycerine or oil of pine helps in
crust removal. Expectorants containing ammonium chloride or
iodides also help to loosen the crust.
Microlaryngoscopic removal of crust in laryngitis sicca is the new
modality of treatment.
141. Ossicles of middle ear are responsible
for which of the following ?
a) Amplification of sound intensity

b) Reduction of sound intensity

c) Protecting the inner ear

d) Reduction of impedance to sound transmission

Correct Answer - D
Ans. is 'd' i.e., Reduction of impedance to sound transmission
The ear canal (auditory canal) acts as a resonator, i.e. it resonates
(amplifies frequencies) between 2000 and 5000 (average 3000)
cycles per second and therefore most energy will be transmitted to
the cochlea in these frequencies.
However, if this sound energy hits the inner ear fluid directly most of
the energy would be reflected, resulting in hearing loss (as all the
sound wave is reflected and nothing is a transmitted as electrical
impulse).
Therefore, there is a need for a transformer mechanism, a need that
is fullfilled by middle ear → middle ear converts sound of greater
amplitude but lesser force to that of lesser amplitude but greater
force.
This function of the middle ear is called impedence matching
mechanism or the transformer action.
142. Which structure prevents spread of
infection form middle ear to brain ?
a) Tegmen tympani

b) Cribriform plate

c) Fundus tympani

d) Petrous apex

Correct Answer - A
Ans. is 'a' i.e., Tegmen tympani
Tegmen tympani (forming the roof of middle ear cavity) separates
the tympanic cavity from middle cranial fossa.
143. In otosclerosis, which is most affected?
a) Oval window

b) Round window

c) Foot plate of stapes

d) Utricle

Correct Answer - A
Ans. is 'a' i.e., Oval window
The most common site of disease is promontory in the region of the
anterior margin of oval window, and in advanced cases the stapes
become ankylosed in position by a mass of new spongy bone.
Why is it so ?
This area is involved most commonly because in this area is located
the fissula ante fenestram, a vestigial structure which frequently
contains cartilaginous remnants and which is particularly prone to
otosclerotic changes.
Most common type of otosclerosis → Stapedial
otosclerosis
Most common site of otosclerosis → Fissula ante
fenestram (i.e, just in front of oval window)
Most common site for Stapedial otosclerosis → Fissula ante
fenestram (i.e, just in front of oval window)
Most common site for cochlear otosclerosis → Round window
144. True regarding laryngeal TB is?
a) Commonly involves anterior 2/3 rd of vocal cord

b) Mouse-nibbled vocal cord

c) More common in males

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Mouse-nibbled vocal cord
145. Most common cause of acute tonsilitis ?
a) Streptococcus pneumoniae

b) H. Influenza

c) 13- hemolytic streptococci

d) Staphylococcus aureus

Correct Answer - C
Ans. is 'c' i.e., 13- hemolytic streptococci
Tonsils frequently serve as the site of acute infection, which causes
acute tonsillitis.
Tonsillitis is particularly common in children, especially in school
going age group. However, it can occur in adult also.
Virus initiates an acute tonsillitis attack and predisposes to bacterial
infection.
8-hemolytic streptococcus is the most common organism causing
acute tonsillitis.
Other bacteria causing acute tonsillitis are staphylococcus,
hemophilus and pneumococcus.
146. Treatment of choice for nasopharyngeal
carcinoma is ?
a) Surgery

b) Radiotherapy

c) Surgery & radiotherapy

d) Chemotherapy

Correct Answer - B
Ans. is 'b' i.e., Radiotherapy
Treatment of nasopharyngeal carcinoma
Irradiation is treatment of choice (external radiotherapy).
Radical neck dissection is required for persistent nodes when
primary has been controlled and in post radiation cervical
metastasis.
Systemic chemotherapy is used as palliation for distant metastases
or radiation failure.
For advanced stages (stage III & IV), the cure rate can be doubled
when chemotherapy is combined with radiotherapy.
147. Cone of light focuses on which quadrant
of tympanic membrane?
a) Anteroinferior

b) Posteroinferior

c) Anterosuperior

d) Posterosuperior

Correct Answer - A
Ans. is 'a' i.e., Anteroinferior
Cone of light
Seen in anteroinferior quadrant of the tympanic membrane is
actually the reflection of the light projected into the ear canal to
examine it.
This part reflects it because it is the only part of tympanic membrane
that is approximately at right angles to the meatus.
This difference in different part of the tympanic membrane is due to
the handle of malleus which pulls the tympanic membrane and
causes it to tent inside.
Thus, the handle of malleus causes tenting and because of tenting
the antero-inferior quardrant is at right angles to the meatus and
thus reflects the light (leading to cone light).
148. Hearing loss of 65dB, what is the grade
of deafness?
a) Mild

b) Moderate

c) Severe

d) Moderately severe

Correct Answer - D
Ans. is 'd' i.e., Moderately severe
149. Vestibular function is assessed by ?
a) Fistula test

b) Hallpike manaeuver

c) Caloric test

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
150. Blue ear drum is seen in ?
a) Serous otitis media

b) CSOM

c) Perforation

d) None

Correct Answer - A
Ans. is 'a' i.e., Serous otitis media
Any accumulation of fluid behind tympanic membrane causes
structural changes in tympanic membrane causing it to appear blue,
be it pus, blood or serous fluid.
The most common cause of fluid accumulation in middle ear
is serous otitis media or glue ear (most common cause) and
haemotympanum.
Other causes of blue tympanic membrane are glomus tumor,
hemangioma of middle ear, and cholesterol granuloma.
 151. Peritonsillar abscess is caused most
commonly by ?
a) Streptococcus pneumoniae

b) Staphylococcus aureus

c) Beta hemolytic streptococcus

d) H. influenzae

Correct Answer - C
Ans. is 'c' i.e., Beta hemolytic streptococcus
Peritonsillar abscess (Ouinsy)
Quinsy consists of suppuration outside the capsule in the area
around the capsule. There is collection of pus between the capsule
of tonsil and the superior constrictor muscle, i.e. in the peritonsillar
area.
Peritonsillar abscess is a complication of tonsillitis and is most
commonly caused by group A beta - hemolytic streptococcus.
Clinical features of Quinsy
Clinical features are divided into :?
General : They are due to septicaemia and resemble any acute
infection.
1. They include fever (up to 104°F), chills and rigors, general malaise,
body aches, headache, nausea and constipation.
2. Local :
3. Severe pain in throat. Usually unilateral.
4. Odynophagia. It is so marked that the patient cannot even swallow
his own saliva which dribbles from the angle of his mouth. Patient is
usually dehydrated.
5. Muffled and thick speech, often called "Hot potato voice".
6. Foul breath due to sepsis in the oral cavity and poor hygiene.
7. Ipsilateral earache. This is referred pain via CN IX which supplies
both the tonsil and the ear.
8. Trismus due to spasm of pterygoid muscles which are in close
proximity to the superior constrictor.
Examination findings
1. The tonsil, pillars and soft palate on the involved side are congested
and swollen. Tonsil itself may not appear enlarged as it gets buried
in the oedematous pillars.
2. Uvula is swollen and oedematous and pushed to the opposite side.
3. Bulging of the soft palate and anterior pillar above the tonsil.
4. Mucopus may be seen covering the tonsillar region.
5. Cervical lymphadenopathy is commonly seen. This involves
jugulodigastric lymph nodes.
6. Torticollis : Patient keeps the neck tilted to the side of abscess.
Treatment of peritonsillar abscess
IV fluids
Antibiotics : High dose penicllin. (iv benzipenicillin) is the DOC. In
patients allergic to penicillin erythromycin is the DOC.
Incision and drainage per orally, if the abscess does not resolve
depite high dose of iv antibiotics
Tonsillectomy is done 6 weeks following an attack of quinsy (interval
tonsillectomy).
152. Strawberry oppearance is seen in ?
a) Lupus vulgarsis

b) Rhinoscleroma

c) Rhinosporidiosis

d) Angiofibroma

Correct Answer - C
Ans. is 'c' i.e., Rhinosporidiosis
Rhinosporidiosis
Rhinosporidiosis is a chronic granulomatous infection of the mucous
membrane that usually manifests as vascular friable polyps that
arise from the nasal mucosa. The etiological agent is
Rhinosporidium seeberi. Rhinosporidium seeberi is an aquatic
bacterum (not a fungus). Infection usually results from a local
traumatic inoculation with the organism. It is seen in India, Pakistan
and Sri Lanka. In India, most of the cases are seen in Southern
states. Infection of the nose and nasopharynx is observed in 70% of
persons with rhinosporidiosis; infection of palpebral conjunctiva or
associated structures (including lacrimal apparatus) is observed in
15% of cases. Other structures of the mouth and upper airway may
be sites of disease. Disease of the skin, ear, genitals and rectum
has also been described. Rhinosporidiosis is an infection that
typically limited to the mucosal epithelium. The disease progress
with local replication of R seeberi and associated hyperplastic
growth of host tissue and a localized immune response.
Clinical features of Rhinosporidiosis
Rhinosporidiosis presents as soft leafy polypoidal mass (soft polyp),
which is pink to purple in colour studded with white dots, i.e.
strawberry appearance. This appearance results from sporangia,
which is visible as grey or yellow spots in the vascular polypoid
masses. Because the polyps are vascular and friable, they bleed
easily upon manipulation.
Treatment
The treatment of choice is surgical excision. Complete excision of
mass is done with diathermy knife and cauterization of base.
Dapsone is being tried for treating rhinosporidiosis but with limited
success.
 153. True about central nystagmus ?
a) Changing direction

b) Not suppressed by optic fixation

c) Horizontal or vertical

d) All of the above

Correct Answer - D
Ans. is 'd' i.e., All of the above
Nystagmus
Nystagmus is rhythmic oscillatory movement of eye.
Nystagmus has following characteristics :?
1. Rapid,
2. Involuntary,
3. Repetitive
Nystagmus may be :?
1. Side to side (horizontal nystagmus)
2. Up and down (verticle nystagmus)
3. Rotary
Vestibular nystagmus has two components, i.e. a slow and a fast.
The direction of nystagmus is indicated by the direction of fast
component.
Vestibular nystagmus may be :?
1. Peripheral :- due to lesion of labyrinth or VIII nerve.
2. Central :- due to lesion of vestibular nuclei, brainstem or cerebellum.
i. Peripheral nystagmus
Diminshes or suppresses with gaze fixation (optic fixation)
Enhances in darkness or by use of Frenzel glasses
Unidirectional fast component
Direction is typically horzonto - rotary, not purely horizontal or rotary
and not vertical
Direction is fixed towards undermost ear
Present in one head position
ii. Central nystagmus
Not suppressed by optic fixation
Fast component can be unidirectional or bidirectional
Can be horizontal, vertical or rotary
Direction is changing
Present in multiple head positions
154. Potato tumor is
a) Rhinosporidiosis

b) Hypertrophied sebaceous gland

c) Nosopharyngeal angiofibroma

d) Tubercular infection

Correct Answer - B
Ans. is 'b' i.e., Hypertrophied sebaceous gland
Rhinophyma (Potato tumor)
Rhinophyma is a benign tumor of tip of nose due to hypertrophy of
sebaceous gland.
It is caused by granulomatous infiltration and occurs as a
complication of long standing acne rosacea.
Alcoholism is mistakenly attributed as a cause of this disease, but
heavy alcohol consumption does aggravate the condition.
The usual presentation is due to cosmetic appearance or
obstruction.
Treatment of choice is debulking of tumor by carban dioxide laser.
 155. Early tonsillectomy is not done in?
a) Thyroid storm

b) Suspected malignancy

c) Peritonsillar abscess

d) Rheumatic fever

Correct Answer - A
Ans. is 'a' i.e., Thyroid storm
Uncotrolled systemic hypertension is a contraindication for
tonsillectomy.
In thyroid storm there is dangerously high BP.
Contraindications of tonsillectomy
1. Haemoglobin level less than 10 g%.
2. Presence of acute infection in upper respiratory tract, even acute
tonsillitis. Bleeding is more in the presence of acute infection.
3. Children under 3 years of age. They are poor surgical risks.
4. Overt or submucous cleft palate.
5. Bleeding disorders, e.g. leukaemia, purpura, aplastic anaemia,
haemophilia.
6. At the time of epidemic of polio.
7. Uncontrolled systemic disease, e.g. diabetes, cardiac disease,
hypertension or asthma.
8. Tonsillectomy is avoided during the period of menses.
156. Most common cause of retropharyngeal
abscess in adults?
a) TB

b) Tooth extraction

c) Tonsillitis

d) Lymphadenitis

Correct Answer - A
Ans. is 'a' i.e., TB
Abscess in infants (acute retropharyngeal abscess)
Most commonly it results from retropharyngeal lymphadenitis due to
an upper respiratory tract infection.
Treatment is incision and drainage.
Abscess in adults (chronic retropharyngeal abscess)
If an adult or an older child has a retropharyngeal infection it is likely
to be due to a tuberculous infection of the cervical spine (caries of
cervical spine). Sometime it may be secondary to tuberculous
infection of retropharyngeal lymph nodes.
Treatment includes incision and drainage of abscess along with full
course of antitubercular treatment.
157. Otosclerosis affects which bone?
a) Stapes

b) Incus

c) Malleus

d) None

Correct Answer - A
Ans. is 'a' i.e., Stapes
Types of otosclerosis
Following types of otosclerosis have been described :-
1. Fenesteral or stapedial otosclerosis
It is the most common type (80-90%) The lesion starts just in front of
the oval window in an area called fissula ante fenestram" and
causes stapes footplate fixation and conductive hearing loss.
Hearing loss is purely mechanical.
2. Cochlear otosclerosis (Retrofenestral otosclerosis)
When present, it is almost always associated with stapedial
(fenestral) otosclerosis. It involves region of round window or other
areas in the otic capsule. It causes mixed or sensorineural hearing
loss which is believed to be toxic due to diffusion of cytotoxic
enzymes into the fluid of the membranous labyrinth (In contrast to
stapedial otosclerosis, where the deafness is purely mechanical and
is conductive). Tinnitus is more common in cochlear otosclerosis.
3. Histologic otosclerosis
This type of otosclerosis remains asymptomatic and causes neither
conductive nor sensorineural hearing loss.
158. Endolymphatic sac decompression is
done in?
a) Menieres disease

b) Otosclerosis

c) Otitis media

d) Vestibular schwannoma

Correct Answer - A
Ans. is 'a' i.e., Menieres disease
Treatment of Meniere's disease
Most treatments are for symptoms believed to be caused by excess
endolymphatic fluid. Treatment of Meniere's disease is of two types
:?
A) Medical management
B) Surgical management
Medical management:
Treatment of Meniere's disease begins first with medical
management.
Medical treatment controls the condition in over two third of patients.
Medical management includes :?
1. Antihistamine labyrinthine sedatives (vestibular sedatives)
Many cases can be controlled by vestibular sedatives like
prochlorperazine, promethazine, dimenhydramine, and cinnarzine.
2. Anxiolytic and tranquillizers
Many patients are anxious, therefore they may be helped by
anxiolytic and tranquillizers like diazepam.
3. Vasodilators
Betahistine hydrochloride appears to be the most useful recent
addition to the medical armamentarium and is routinely prescribed
for most patients. It increases labyrinthine blood flow by releasing
histamine.
Other vasodilators employed include nicotinic acid, thymoxamine,
inhaled carbogen (5% CO2 with 95% 02), and histamine drip.
Vasodilators increase vascularity of endolymphatic sac and its
duct and thereby increases reabsorption of endolymphatic fluid.
4. Diuretics (furosemide)
Diuretics with fluid and salt restriction can help to control recurrent
attacks if not controlled by vestibular sedatives or vasodilators.
5. Other drugs
Propantheline bromide, phenobarbitone and hyoscine are effective
alternatives.
Surgical management
Surgical therapy for meneire's disease is reserved for medical
treatment failures and is otherwise controversial. Surgical
procedures can be divided into two main categories
Destructive surgical procedures
Nondestructive surgical procedures
Destructive surgical procedures : rationale is to control vertigo.
Endolymphatic hydrops causes fluid pressure accumulation within
the inner ear, which causes temporary malfunction and misfiring of
the vestibular nerve. These abnormal signals cause vertigo.
Destruction of the inner ear and / or the vestibular nerve prevents
these abnormal signals. The procedures performed are :
Labyrinthectomy
Intermittent low pressure pulse therapy (Meniett device therapy)
Conservative surgical procedures : are used in cases where vertigo
is disabling but hearing is still useful & needs to be preserved. They
are :
Decompression of endolymphatic sac
Endolymphatic shunt operation
Sacculotomy (Fick's operation & Cody's tack procedure)
Vestibular neuronectomy
Ultrasonic destruction of vestibular labyrinth to preserve cochlear
function.
Stellate ganglion block or cervical sympathectomy
I ntratympanic gentamycin
Vestibular nerve section
 159. In type-4 thyroplasty, vocal cord is ?
a) Medially displaced

b) Laterally displaced

c) Lengthened

d) Shortened

Correct Answer - C
Ans. is 'c' i.e., Lengthened
Thyroplasty
Isshiki divided thyroplasty procedures into 4 categories to produce
functional alteration of vocal cords : -
1. Type I : Medial displacement of vocal cord (done by injection of gel
foam/Teflon paste)
2. Type 2 : Lateral displacement of cord (done to improve the airway).
3. Type 3 : Shortening (relax) the cord, to lower the pitch (gender
transformation from female to male).
4. Type 4 : Lengthening (tightening) the cord, to elevate the pitch
(gender transformation from male to female), for example as a
treatment of androphonia.
160. Fenestration operation is which type of
tympanoplasty?
a) Type-2

b) Type-3

c) Type-4

d) Type-5

Correct Answer - D
Ans. is 'd' i.e., Type-5
Types of tympanoplasty
Wullstein classified tympanoplasty into five types :?
Type I: → Defect is perforation of tympanic membrane which is
repaired with a graft. It is also called myringoplasty.
Type II: → Defect is perforation of tympanic membrane with
erosion of malleus. Graft is placed on the incus or remnant of
malleus.
Type III: → Malleus and incus are absent. Graft is placed directly
on the stapes head. It is also called myringostapediopexy or
columella tympanoplasty.
Type IV: → Only the footplate of stapes is present. It is exposed
to the external ear, and graft is placed between the oval and round
windows. A narrow middle ear (cavum minor) is thus created, to
have an air pocket around the round window. A mucosa-lined space
extends from the eustachian tube to the round window. Sound
waves in this case act directly on the footplate while the round
window has been shielded.
Type V: → Stapes footplate is fixed but round window is
functioning. In such cases, another window is created on horizontal
semicircular canal and covered with a graft. Also called fenestration
operation.
161. Bullous myringitis is caused by?
a) Pseudomonas

b) Mycoplasma

c) Pneumococcus

d) Candida

Correct Answer - B
Ans. is 'b' i.e., Mycoplasma
Otitis externa haemorrhagica
This condition is also known as Bullous myringitis or myringitis
bullosa.
This condition is extremely painful and has sudden onset.
It is thought to be due to mycoplasma pneumoniae or viral
infection, usually influenza
There may be a mild conductive deafness and a mildly discharging
ear.
The appearance of haemorrhagic bullae on the tympanic membrane
and in the deep meatus is characteristic.
The bullae are filled with serosanguinous fluid and blood.
On healing, bullae look like Sago-grain.
Therefore "Sago-grain" appearance of tympanic membrane is seen
in healed myringitis bullosa.
162. All are absolute indications of
tonsillectomy except
a) Suspicious malignancy

b) Peritonsillar abscess

c) Chronic tonsillits

d) Tonsils causing obstructive sleep apnea

Correct Answer - C
Ans. is 'c' i.e., Chronic tonsillits
Tonsillectomy
Tonsillectomy, as the name suggests, is the surgical procedure to
remove the tonsils.
Often, tonsillectomy is done at the same time as adenoidectomy.
Indications
Indications are divided into :?
A. Absolute
1. Recurrent infections of throat. This is the most common
indication.Recurrent infections are further defined as :
Seven or more episodes in one year, or
Five episodes per year for 2 years, or
Three episodes per year for 3 years, or
Two weeks or more of lost school or work in one year.
2. Peritonsillar abscess.
In children. tonsillectomy is done 4-6 weeks after abscess has been
treated. In adults, second attack of peritonsillar abscess forms the
absolute indication.
3. Tonsillitis causing febrile seizures.
4. Hypertrophy of tonsils causing
Airway obstruction (sleep apnoea)
 Difficulty in deglutition
Interference with speech.
5. Suspicion of malignancy.
A unilaterally enlarged tonsil may be a lymphoma in children and an
epidermoid carcinoma in adults. An excisional biopsy is done.
B. Relative
1. Diphtheria carriers, who do not respond to antibiotics
2. Streptococcal carriers, who may be the source of infection to others.
3. Chronic tonsillitis with bad taste or halitosis which is unresponsive to
medical treatment.
4. Recurrent streptococcal tonsillitis in a patient with valvular heart
disease.
C. As a part of Another Operation
1. Palatopharyngoplaty which is done for sleep apnoea syndrome.
2. Glossopharyngeal neurectomy. Tonsil is removed first and then IX
nerve is severed in the bed of tonsil.
3. Removal of styloid process.
163. Retraction of tympanic membrane
touching promontory. What is sade's
grade?
a) 1

b) 2

c) 3

d) 4

Correct Answer - C
Ans. is 'c' i.e., 3
Atelectic grades of pars tensa
Sade classification::
Grade 1 = slight retraction of TM over the annulus
Grade 2 = the TM touches the long process of the incus
Grade 3 = the TM touches the promontory
Grade 4 = the TM is adherent to the promontory
 164. Posterosuperior retraction pocket if
allowed to progress will lead to?
a) SNHL

b) Secondary cholesteatoma

c) Tympanosclerosi

d) Primary cholesteatoma

Correct Answer - D
Ans. is'd' i.e., Primary cholesteatoma
Retraction pockets are more common in the postero-superior portion
of pars-tensa of ear-drum (tympanic membrane).
Two reasons have been attributed to this features :-
1. This area is more vascular, hence could be subjected to intense
inflammatory reaction.
2. Middle fibrous layer in this area is incomplete, lackin circular fibers.
Long term effects ofprogressive retraction may be :-
1. Fixation of atrophic sigment to bony wall of middle ear cavity.
2. Erosion of ossicles, most commonly long process of incus.
3. Formation of cholesteatoma (primary acquired cholesteatoma).
4. "A posterior superior retraction pocket, if allowed to progress, leads
to primary acquired choleastoma".
Acquired cholesteatoma
In majority of cases cholesteatoma is acquired. Acquired
cholesteatoma may be either primary acquired or secondary
acquired :?
A. Primary acquired cholesteatoma
There is no history of previous otitis media or a pre-existing
perforation.
Theories for its genesis are : -
1. Retraction pocket (wittmaack's theory) : - It is the most accepted
theory. There is invagination of pars flaccida in the form of retraction
pocket due to negative pressure in middle ear as a result of
Eustachian tube dysfunction. There is in growth (migration) of
squamous epithelium from the outer layer of tympanic membrane
(outer layer of TM is lined by squamous epithelium) through this
retraction pocket. Infection supervenes on the impacted squamous
epithelium/keratin.
2. Basal cell hyperplasia (Ruedi's theory) : - There is proliferation of the
basal layer of pars flaccida induced by subclinical childhood
infections. These proliferating basal cells lay down keratinizing
squamous epithelium.
3. Squamous metaplasia (Sade's theory) : - Pavement epithelium of
attic undergoes metaplasia and transforms into squamous
epithelium due to subclinical infections.
B. Secondary acquired cholesteatoma
There is pre-existing perforation in pars tensa.
Theories on its genesis include : -
1. Epithelial invasion (Habermann's theory) : - The epithelium from the
meatus or outer drum surface grows into the middle ear through a
pre-existing perforation especially of the marginal type where part of
annulus tympanicus has already been destroyed.
2. Metaplasia : - Middle ear mucosa undergoes metaplasia due to
repeated infections of middle ear through the pre-existing
perforation.
165. Treatment of choice for atticoantral type
of CSOM?
a) Antiboiotics

b) Tympanoplasty

c) Modified radical mastoidectomy

d) None

Correct Answer - C
Ans. is'c' i.e., Modified radical mastoidectomy
Treatment of atticoantral disease
Since cholesteatoma is going to expand and destroy bone and
mucous membrane, it has to be removed.
Therefore, surgery is the mainstay of treatment.
Primary aim is removal of disease by mastoidectomy to make ear
safe followed by reconstruction of hearing at a later stage.
Modified radical mastoidectomy is the surgery of choice.
Two types of surgical procedures (mastoidectomy) are done to deal
with cholesteatoma:-
1. Canal wall down procedures
These leave the mastoid cavity open into the external auditory canal
so that the diseased area is fully exteriorized.
The commonly used procedures for atticoantral disease are
atticotomy, modified radical mastoidectomy and rarely radical
mastoidectomy.
Modified radical mastoidectomy is the procedure of choice.
2. Canal wall up procedures (cortical mastoidectomy)
Here disease is removed by combined approach through the meatus
and mastoid but retaining the posterior bony meatus wall, thereby
avoiding an open mastoid cavity.
For reconstruction of hearing mechanism myringoplasty or
tympanoplasty can be done at the time of primary surgery or as a
second stage procedure.
166. Retraction of tympanic membrane
touching the promontory. It is called ?
a) Mild retraction

b) Severe retraction

c) Atelectasis

d) Adhesive otitis

Correct Answer - C
Ans. is 'c' i.e., Atelectasis
Tympanic membrane retraction
The retracted segment of eardrum is often known
as a retraction pocket.
The terms "atelectasis" or sometimes "adhesive otitis media" can
be used to describe retraction of a large area of the pars tensa.
167. All are true about Rinne's test except ?
a) Positive in normal ear

b) Positive in sensorineural hearing loss

c) Minimum 15-20 dB air bone gap is required in conductive

deafness

d) Bone conduction is better in sensorineural hearing loss

Correct Answer - D
Ans. is'd' i.e., Bone conduction is better in sensorineural hearing loss
Rinne's Test
The Rinne test is a tuning fork test that compares hearing by air
conduction and bone conduction. The Rinne test is based on the
idea that hearing mechanism is normally more efficient by air
conduction (AC) than it is by bone conduction (BC), i.e., AC > BC in
normal persons. For this reason, a tuning fork will sound louder and
longer by air conduction than by bone conduction. However, this air
conduction advantage is lost when there is a conductive hearing loss
in which case the tuning fork sounds louder by bone conduction than
by air-conduction.
Method
Administering the Rinne test involves asking the patient to indicate
whether a vibrating tuning fork sounds louder when its base is held
against mastoid process (bone conduction) or when its prongs are
held near the pinna, facing the opening of ear canal (air conduction).
After striking the fork, the clinician alternates it between these two
positions so that the patient can make a judgement about which one
is louder.
Interpretation of Rinne's test
The outcome of the Rinne test is traditionally called "positive" if the
 fork is louder by air conduction and this finding implies that the ear is
normal or has sensorineural hearing loss. The results are called
"negative" if the bone-conduction is louder than air-conduction,
which is interpreted as revealing the presence of conductive
deafness i.e., lesions of either external ear, tympanic membrane,
middle ear or ear ossicles..
In conductive deafness Rinne's test will be negative if the conductive
hearing loss is greater than 15-20 dB (minimum air bone gap 15-
20 dB). That means, at least 15-20 dB of conductive hear loss is
required to show bone conduction better than air conduction, i.e.,
Negative Rinne's test. A negative Rinne test for 256, 512 and 1024
Hz indicates a minimum air-bone gap (ABG) of 15, 30, 45 dB
respectively. Therefore, AB gap can be made if tuning forks of 256,
512 and 1024 Hz are used : -
1. A Rinne test equal or negative for 256 Hz but positive for 512 Hz
indicates air-bone gap of 20-30 dB.
2. A Rinne test negative for 256 and 512 Hz but positive for 1024 Hz
indicates air-bone gap of 30-45 dB.
3. A Rinne negative for all the three tuning forks of 256, 512, and 1024
Hz, indicates air-bone gap of 45​60 dB.
Rationale of positive test
Positive test (AC > BC) is seen in :?
1. Normal person
It has already been explained that air conduction is better than bone
conduction, thus Rinne test is positive in normal person.
2. Sensori-neural hearing
In sensorineural hearing loss, the defect is in cochlea or VIII nerve or
its central connection. There is no defect in conductive apparatus of
ear (air conduction) or in mastoid bone (bone conduction). As air
conduction is better than bone conduction, Rinne test will be
positive (because both air conductive apparatus and bone
conductive apparatus are normal and the pathology is distal to
them).
Negative test (BC >AC) is seen in : ?
1. Conductive deafness
As the conductive apparatus is defective, bone conduction becomes
better than air conduction (BC > AC).
2. Severe unilateral sensorineural hearing loss
Here the Rinne test is false negative (not true negative) as it is
interpreted by the patient that BC > AC, but actually it is not. In
reality this response is from the opposite ear because of transcranial
transmission of sound during bone conduction testing. This can be
prevented by masking the non-test ear with Barany's box while
testing the bone conduction. Weber test will help for such situation.
 168. Stimulation of horizontal semicircular
canal causes nystagmus in which
directions ?
a) Vertical

b) Horizontal

c) Rotary

d) Any of the three

Correct Answer - B
Ans. is 'b' i.e., Horizontal
The cupulae of the semicircular canals are stimulated by movement
of endolymphatic fluid and each canal causes the nystagmus in its
own plane :-
1. Stimulation of horizontal SCC → 4 Horizontal nystagmus.
2. Stimulation of superior SCC → 4 Rotary nystagmus.
3. Stimulation of vertical SCC → Vertical nystagmus
 169. Bilateral past-pointing is due to defect in
?
a) Brainstem

b) Cerebellum

c) Vestibular system

d) Basal ganglia

Correct Answer - C
Ans. is 'c' i.e., Vestibular system
Past-pointing is the deviation of the extremities caused by either
cerebellar hemisphere or vestibular disease.
Testing is usually done with arms. The traditional method is to have
the patient extend the arm and place his extended finger on the
examiner's index finger; then with the eye closed raise the arm
directly overhead; than bring it back down precisely onto the
examiner's finger.
If vestibular or cerebellar lesion is there, past pointing (deviation of
limb) will be present.
The two types (cerebellar and vestibular) past pointing have different
patterns :-
1. With vestibular in:balance, the normal labyrinth will push the limb
toward the abnormal side and the patient will miss the target. The
past pointing will always be to the same side of target and will occur
with either limb.
2. With a cerebellar hemispheric lesion, the ipsilateral limbs will have
ataxia and incoordination; past pointing occurs only with the involved
arm and may be to the side of lesion or erratically to either side of
the target.
So,
Bilateral past-pointing → Vestibular system defect.
Unilateral past-pointing → Cerebellar hemisphere defect.
170. Major contribution in the formation of
nasal septum is by all except ?
a) Septal cartilage

b) Vomer

c) Ethmoid

d) Nasal bone

Correct Answer - D
Ans. is 'd' i.e., Nasal bone
The medial wall, or nasal septum, is formed (from anteiror to
posterior) by :
(1) the septal cartilage (destroyed in a dried skull)
(2) the perpendicular plate of the ethmoid bone, and
(3) the vomer . It is usually deviated to one side.
The vomer contributes to the inferior portion of the nasal septum;
the perpendicular plate of the ethmoid bone contributes to the
superior portion.
171. All are true about conductive deafness
except ?
a) Rinne's test is negative

b) Absolute bone conduction is normal

c) Weber is lateralized to poorer ear

d) There is decay in threshold tone

Correct Answer - D
Ans. is 'd' i.e., There is decay in threshold tone
172. Ethmoidal polyp is ?
a) Due to infection

b) Single

c) Recurrent

d) Occurs in children

Correct Answer - C
Ans. is 'c' i.e., Recurrent
173. Most common cause of oroantral fistula
?
a) TB

b) Penetrating injury

c) Tooth extraction

d) latrogenic

Correct Answer - C
Ans. is 'c' i.e., Tooth extraction
Oroantral fistula
It is communication between the antrum and oral cavity.
Etiology
Dental extraction :- Most important cause and maxillary first molar
accounts for 50% of oral-antral fistulas caused by extractions.
Maxillary second and third molar extractions account for other 50%.
Infection :- TB, syphilis, leprosy of maxillary bone.
Malignant neoplasm :- Causes erosion of antrum.
Fracture or penetrating injuries of maxilla.
Midline granuloma (a form of lymphoma)
Failure of sublabial incision to heal after Caldwell - Luc operation.
Clinical features
Regurgitation of food
Discharge (often foul smelling)
Inability to built positive or negative pressure in mouth.
174. Killian dehiscence is in ?
a) Superior constrictor

b) Inferior constrictor

c) Middle constrictor

d) None

Correct Answer - B
Ans. is 'b' i.e., Inferior constrictor
Inferior constrictor muscle has two parts :- (i) Thyropharyngeous with
oblique fibres, and (ii) Cricopharyngeous with transverse fibres.
Between these two parts of inferior constrictor exists a potential gap
called Killan's dehiscence. It is also called the gateway to tear as
perforation can occur at this site during esophagoscopy. It is also the
site for herniation of pharyngeal mucosa in case of pharyngeal
pouch.
175. Saddle nose is ?
a) Depressed nose

b) Crooked nose

c) Deviated nose

d) C-shaped

Correct Answer - A
Ans. is 'a' i.e., Depressed nose
Saddle nose (Depressed nose)
Nasal dorsum is depressed (sagging of the bridge of nose).
Depressed nasal dorsum may involve either bony, cartilaginous or
both bony and cartilaginous components. Most common etiology :
Nasal trauma
Causes are hematoma, excessive surgical removal, trauma, syphilis,
abscess, Leprosy, and tuberculosis.
Crooked or deviated nose
Crooked nose is the external deviation of nose due to deviation of
the dorsal border of septal cartilage, forming a `C' or 'S' shaped
curve.
In crooked nose, the midline dorsum is curved in 'C' or 'S' shaped
manner from the frontonasal angle to the tip of nose.
In a deviated nose, the midline is straight but deviated to one side,
midline is not curved as in crooked nose.
176. Tonsillar fossa is bounded anteriorly by
?
a) Pharyngobasilar fascia

b) Palatopharyngeal fold

c) Buccopharyngeal fascia

d) Palatoglossal fold

Correct Answer - D
Ans. is 'd' i.e., Palatoglossal fold
Palatine tonsils are masses of lymphoid tissue that can be seen on
the left and right sides at the back of the throat.
There are two palatine tonsils, and each palatine tonsil (right or left)
lies in the tonsilar sinus (tonsilar fossa) on the lateral wall of
oropharynx.
Tonsillar fossa bounded by the palatoglossal fold in front and the
palatopharyngeal fold behind.
Tonsils are lined by non - keratinized stratified squamous epithelium.
Medial surface of each tonsil has 15-20 crypts, the largest of which
is called Intratonsillar cleft or crypta magna (which represents
persistence of the ventral portion of the second pharyngeal pouch).
Tonsillar bed is formed from within - outwards by :-
Li Pharyngobasilar fascia
Superior constrictor (above) and palatopharyngeus muscle
Styloglossus (below)
Buccopharyngeal fascia
177. Passavants ridge is formed by ?
a) Palatoglossus

b) Superior constrictor

c) Salpingopharyngeus

d) Palatopharyngeus

Correct Answer - D
Ans. is 'd' i.e., Palatopharyngeus
Pharynx has two group of muscles :?
* Intrinsic muscles :- Stylopharyngeous, salpingopharyngeous,
palatopharyngeous.
* Extrinsic muscles :- Superior constrictor, middle constrictor, inferior
constrictor.
- All muscles of pharynx are supplied by cranial accessory through
branches of vagus via pharyngeal plexus except stylopharyngeus
which is supplied by glossopharyngeal.
- Inferior constrictor muscle has two parts :- (i) Thyropharyngeous
with oblique fibres, and (ii) Cricophatyngeous with transverse fibres.
- Between these two parts of inferior constrictor exists a potential
gap called Killan's dehiscence. It is also called the gateway to tear
as perforation can occur at this site during esophagoscopy. It is also
the site for herniation of pharyngeal mucosa in case of pharyngeal
pouch.
- Upper fibers of palatopharyngeus constitute the Passavant's
muscle which on contraction raises a ridge called Passavant's ridge
on posterior wall of nasopharynx.
178. Hot potato voice is characteristic of ?
a) Nasopharyngeal carcinoma

b) Glottic carcinoma

c) Subglottic carcinoma

d) Supraglottic carcinoma

Correct Answer - D
Ans. is 'd' i.e., Supraglottic carcinoma
Clinical features of supraglottic carcinoma
Pain on swallowing is the most frequent initial symptom -- Devita
7th/e p. 698
Mass in neck may be the first sign.
Hoarsness is a late symptom.
Pain may be referred to ear by vagus nerve and auricular nerve of
arnold.
Late symptoms include foul breath, dysphagia and aspiration.
Large tumors can cause "hot potato voice/muffled voice".
Hemoptysis, sore throat, shorteness of breath, stridor, otalgia and
aspiration pneumonia may also occur.
179. All are early complications of
tracheostomy except?
a) Hemorrhage

b) Pneumothorax

c) Injury to esophagus

d) Tracheal stenosis

Correct Answer - D
Ans. is 'd' i.e., Tracheal stenosis
Complications of Late (with prolonged
tracheostomy use of tube for weeks
Intermediate (first few or months)
Immediate (at
hours or days) Hemorrhage, due to
the time of
Bleeding (reactionary or erosion of major vessel
operation)
secondary) Laryngeal stenosis
Hemorrhage
Displacement of tube Tracheal stenosis
Apnea
Blocking of tube Tracheo-esophageal
Pneumothorax
Subcutaneous emphysema fistula
Injury to RLN
Tracheitis and Problem of
Aspiration of
tracheobronchitis decannulation
blood
Atelectasis and lung Persistent
Injury to
abscess tracheocutaneous
esophagus
Local wound infection and fistula
granulations Problem of
tracheostomy scar
180. Nasopharynx is lined by which
epithelium ?
a) Stratified squamous nonkerationized

b) Stratified squamous keratinized

c) Ciliated columnar

d) Cuboidal

Correct Answer - C
Ans. is 'c' i.e., Ciliated columnar
The two main types of epithelia lining the nasopharynx are stratified
squamous (comprising approximately 60%
of nasopharyngeal epithelium) and pseudostratified columnar
respiratory epithelium containing ciliated cells, goblet cells and
basal cells.
181. Vidian neurectomy is done for ?
a) Allergic rhinitis

b) Atrophic rhinitis

c) Vasomotor rhinitis

d) Chronic hypertrophic rhinitis

Correct Answer - C
Ans. is 'c' i.e., Vasomotor rhinitis
Vasomotor rhinitis
Vasomotor is a nonallergic condition that involves a constant runny
nose, sneezing and nasal congestion, i.e., the nose is stuffy or runny
for reasons other than allergies and infections. The exact etiology is
unknown, but triggers include emotions, odors, poor air quality, spicy
foods, and medication side effects. Pathogenesis include:-
Parasympathetic overactivity
Hyperactive nasal mucosa to several non-specific stimuli especially
in women of 20-40 years.
Symptoms of vasomotor rhinitis include excessive clear rhinorrhoea,
nasal obstruction/congestion, irritation, paroxysmal sneezing and
post-nasal drip. Nasal mucosa is hypertrophied & congested; and
mucosa of turbinates may give mulberry like appearance and is pale
to dusky red in colour.
Complications of vasomotor rhinitis include hypertrophic rhinitis &
sinusitis, and nasal polyp.
Treatment
Treatment of vasomotor rhinitis includes : -
1. Conservative treatment
Avoidance of physical factors which provoke symptoms.
Antihistaminics and oral or nasal decongestants.
Topical or systemic steroids
2. Surgical treatment
Nasal obstruction can be relieved by measures which reduce the
size of hypertrophied nasal turbinate : -Cryosurgery, submucosal
diathermy, Linear cauterization, partial or total turbinectomy,
submucosal
resection of turbinate.
Excessive rhinorrhoea in vasomotor Rhinitis not corrected by
medical therapy and bothersome to the patient, is relieved by
sectioning the parasympathetic secretomotor fibres to nose i.e.,
vidian neurectomy.
182. Lymphatic drainage of orpharynx is
mainly through?
a) Superficial cervical lymph nodes

b) Submandibular nodes

c) Jugulodigastric node

d) Jugulo-omohyoid nodes

Correct Answer - C
Ans. is 'c' i.e., Jugulodigastric nodes
Deep cervical lymph nodes are divided into two groups :- (i)
jugulodigastric, and (ii) jugulo-omohyoid.
Lymphatics from oropharynx drain into jugulodigastric nodes.
L mphatic drainage of pharynx
y

Lymphatic drainage of pharynx may be :?

1. Nasopharynx
Nasopharynx drains into upper deep cervical nodes either directly or
indirectly through retropharyngeal or parapharyngeal nodes.
Nasopharynx also drains into spinal accessory chain of nodes in the
posterior triangle of the neck.
2. Oropharynx
Lymphatics from the oropharynx drain into upper jugular particularly
the jugulodigastric (tonsillar) nodes.
The soft palate, lateral and posterior pharyngeal walls and the base
of tongue also drain into retropharyngeal and parapharyngeal nodes
and from there to the jugulodigastric and posterior cervical group.
3. Hyphopharynx
Pyriform sinus drains into upper jugular chain & then to deep
cervical group of lymph nodes.
Postcricoid region drains into parapharyngeal and paratracheal
group of lymph nodes.
Posterior pharyngeal wall drains into parapharyngeal lymph nodes
and finally to deep cervical lymph nodes.
183. All are true about otitic barotrauma
except ?
a) Conductive deafness

b) Retracted tympanic membrane

c) Catheterization can be used

d) Occurs during sudden ascent in aircraft

Correct Answer - D
Ans. is 'd' i.e., Occurs during sudden ascent in aircraft
Otitic Barotrauma
This condition is seen when the ambient pressure is rising, e.g. in
scuba diving (underwater diving), descending in an aircraft, or
compression in pressure chamber.
It occurs due to pressure differences between the inside and outside
of the eardrum.
Clinical features
Ear discomfort or pain, hearing loss, and tinnitus are common
Vertigo is uncommon
Otoscopy findings are :-
Congested and retracted tympanic membrane
Blood may extravasate into middle ear producing haemotympanum
On examination there is conductive deafness.
Pathogenesis of otitic barotrauma
The middle ear pressure is normally maintained at a level similar to
that of the atmosphere by the function of Eustachian tube which
allows passage of air from middle ear to pharynx. Sudden or
dramatic changes of external pressure may defeat this mechanism
and cause injury to middle ear. When atmospheric pressure is
higher than that of middle ear by critical level of 90 mm Hg,
eustachian tube gets locked as the soft tissues of pharyngeal end of
the tube are forced into the lumen by high atmospheric pressure.
This results in sudden negative pressure in the middle ear which
causes retraction of tympanic membrane, hyperemia, transudation
with hemorrhage and development of
Aero-otitis media (barotrauma)
At pressure difference >100 to 500 mm Hg, tympanic membrane can
rupture → when the pressure difference is more than 100 mg Hg,
tympanic membrane can rupture.
Treatment of otitic Barotrauma
Routine self treatment of pain associated with changing pressure in
air craft includes chewing gum, attempting to yawn & swallow,
blowing against closed nostrils, and using decongestant nasal
sprays. The aim is to restore middle ear areation.
Catheterization or politzerization can also be used. If the
eustachian tube will not open with other treatments, surgery may be
necessory. Myringotomy and aspiration of fluid is the surgical
procedure used.
184. Tear drop sign is seen in ?
a) Fracture zygomatic arch

b) Fracture maxilla

c) Fracture mandible

d) Blow out fracture

Correct Answer - D
Ans. is 'd' i.e., Blow out fracture
Fractures of the floor of the orbit
Zygomatic fracture and Le fort II maxillary fractures are always
accompanied by fractures of orbital floor.
Isolated fractures of orbital floor, when a large blunt object strikes
the globe, are called "blow out fractures".
Clinical features
Ecchymosis of lid, conjunctiva and sclera.
Endophthalmos with inferior displacement of the eye-ball. This
becomes apparent when oedema subsides.
Diplopia, which may be due to displacement of the eyeball or
entrapment of inferior rectus and inferior oblique muscles.
Hypoaesthesi a or anaesthesia of cheek and upper lip, if infraorbital
nerve is involved.
Diagnosis
J Water's view show a convex opacity bulging into the antrum from
above, i.e., Tear drop opacity.
CT scan is diagnostic.
185.
Inverted papilloma of nose arise from ?

a) Nasal septum

b) Roof of the nose

c) Tip of the nose

d) Lateral wall of the nose

Correct Answer - D
Ans. is 'd' i.e., Lateral wall of the nose
Inverted Papilloma (Transitional cell papilloma/Schneiderion
papilloma)
Inverted papilloma is a benign neoplasm occurs mostly between 40-
70 years with male preponderance (5 : 1).
It arises from the lateral wall of nose and is always unilateral.
Rarely, it may arise from nasal septum.
Features of inverted papilloma are : -
It shows finger like epithelial invasions into the underlying stroma of
the epithelium rather than on surface so called inverted papilloma.
It is usually unilateral and is a locally aggressive tumour.
Patients complain of nasal obstruction, rhinorrhea & unilateral
epistaxis.
In 10-15% cases there may be associated squamous cell
carcinoma.
Treatment is adequate local excision. If it arises in maxillary sinus,
then a radical antrostomy is carried out. If it arises in the ethmoidal
sinus, an external ethmoidectomy is done. If it arises from nose,
treatment is wide surgical excision by lateral rhinotomy.
Has a tendency to recur even after removal.
 186. True about external nose ?
a) Upper 2/3 is bony

b) Lower 1/3 is cartilaginous

c) Single lateral cartilage

d) Two nasal bones

Correct Answer - D
Ans. is'd' i.e., Two nasal bones
External nose has an osteocartilaginous framework of which upper
one - third is bony and lower two-third is cartilaginous.
1. Bony part :- Consists of two nasal bones.
2. Cartilagenous part :- Consists of two upper lateral cartilages, two
lower lateral cartilages, two or more lessar alar (or sesmoid)
cartilages and a septal cartilage. So, there are 3 paired and 1
unpaired cartilages.
187. Indication of BAHA (Bone-anclored
hearing aid)
a) Bilateral hearing loss

b) Sensorineural hearing loss

c) Congenital canal atresia

d) All of the above

Correct Answer - C
Ans. is 'c' i.e., Congenital canal atresia
Indications for BAHA
When air-conduction (AC) hearing aid connot be used;
Canal atresia, congenital or acquired, not amenable to treatment.
Chronic ear discharge, not amenable to treatment.
Excessive feedback and discomfort from air-conduction hearing aid.
Conductive or mixed hearing loss, e.g. otoscierosis and
tympanosclerosis where surgery is contraindicated.
Single-sided hearing loss.
188. Muller's manoeuver is used ?
a) To findout opening of mouth

b) To remove laryngeal foreign body

c) To find degree of obstruction in sleep disordered breathing

d) To remove foreign body from ear

Correct Answer - C
Ans. is 'c' i.e., To find degree of obstruction in sleep disordered
breathing
Muller's manoeuvre
Used to find the level and degree of obstruction in sleep-
disordered breathing.
It is performed while using flexible nasopharyngoscope.
First the examiner sees the upper airways at rest and then during
the time when patient makes maximal inspiratory effort with nose
and mouth closed.
Base of tongue, lateral pharyngeal wall and palate are examined for
collapsibility and then rated form 0 (minimal collapse) to 4+
(complete collapse).
189. Rosen's incision is used for ?
a) Septoplasty

b) SMR

c) Stapedectomy

d) Tonsillectomy

Correct Answer - C
Ans. is 'c' i.e., Stapedectomy
Rosen's incision is the most commonly used for stapedectomy
through endomeatal or transcanal approach. Also know
Lempert's incision is used for endural approach.
Wilde's incision is used for postaural approach.
190. Submandibular nodes are classified as ?
a) Level IA neck nodes

b) Level IB neck nodes

c) Level II neck nodes

d) Level III neck nodes

Correct Answer - B
Ans. is 'b' i.e., Level 1B neck nodes
Division of neck nodes according to levels
Level I Submental (IA) Submandibular (IB)
Level II Upper jugular
Level III Mid jugular
Level IV Lower jugular
Level V Posterior triangle group (Spinal accessory and
transverse cervical chains)
Level VI Prelaryngeal Pretracheal Paratracheal
Level VII Nodes of upper mediastinum
191. Hyponasal voice is seen in all except ?
a) Adenoids

b) Nasal polyp

c) Cleft palate

d) Habitual

Correct Answer - C
Ans. is 'c' i.e., Cleft palate
Cause of hyponasality and hypernasality
Hyponasality Hypernasality
Common cold Velopharyngeal insufficiency
Nasal allergy Congenitally short soft palate
Nasal polyp Submucous palate
Nasal growth Large nasopharynx
Adenoids Cleft of soft palate
Nasopharyngeal mass Paralysis of soft palate
Familial speech pattern Post-adenoidectomy
Habitual Oronasal fistula Familial speech pattern
Habitual speech pattern
192. Schatzki's Ring is present at ?
a) Upper end of trachea

b) Lower end of trachea

c) Upper end of esophagus

d) Lower end of esophagus

Correct Answer - D
Ans. is 'd' i.e., Lower end of esophagus
Schatzki's ring
It occurs at the junction of squamous and columnar epithelium at the
lower end of oesophagus and has also been called lower
oesophageal ring.
Usually seen in patients above 50 years of age.
Cause is unknown.
Symptomatic patients complain of intermittent dysphagia and some
may even present with bolus obstruction.
It may be associated with hiatus hernia.
Treatment is oesophageal dilatation.
193. "Rising sun" appearance is seen in -
a) ASOM

b) CSOM

c) Glomus tumor

d) Acoustic neuroma

Correct Answer - C
Ans. is 'c' i.e., Glomus tumor
Clinical features of glomus tumor
The earliest symptoms of glomus tumour is pulsatile tinnitus
(earliest) and hearing loss. Hearing loss is conductive and slowly
progressive. These are followed by blood stained otorrhoea and
earache.
Before the tympanic membrane (eardrum) is perforated a red
swelling is seen to arise from the floor of middle ear, i.e. "Rising
sun" appearance. This results in a red reflex through the intact
tympanic membrane.
Sometimes, eardrum may be bluish and bulging. o Pulsation sign
(Brown sign) is positive, i.e. when ear canal pressure is raised with
Siegle's speculum, tumor pulsates vigorously and then blanches;
reverse happens with release of pressure.
Aquino sign is positive, i.e. blanching of mass with manual
compression of ipsilateral carotid artery.
When the tumour perforates the eardrum a polypus will be seen in
the meatus and this will bleed profusely if touched.
Cranial nerve palsies is a late feature appearing several years after
aural symptoms. IXth to XIV' cranial nerves may be paralysed. This
can cause dysphagia and hoarseness, and weakness of trapezius
and sternocleidomastoid muscles, unilateral paralysis of soft palate,
pharynx and vocal cord.
Ausculation with stethoscope over the mastoid may reveal audible
systolic bruit.
Some glomus tumours secrete catecholamines and produce
symptoms like tachycardia, arrhythmias, sweating, flushing and
headache etc.
Facial palsy may be caused by glomus tympanicum type of glomus
tumor.
Audiometry shows conductive deafness, However if inner ear is
invaded, mixed conductive and sensorineural hearing loss is seen.
194. Cart-wheel appearance of tympanic
membrane in ASOM is due to ?
a) Perforation of tymparic membrane

b) Edema of tympanic membrane

c) Congested blood vessels along malleus

d) Granulation tissue on tympanic membrane

Correct Answer - C
Ans. is 'c' i.e., Congested blood vessels along malleus
Stages of ASOM
ASOM runs through the following stages and therefore presentation
depends upon the stage :
1. Stage of tubal occlusion (Eustachian tube obstruction)
Edema and hyperaemia of nasopharyngeal end of Eustachion tube
blocks the tube, leading to absorption of air and negative
intratympanic pressure.
There is feeling of discomfort and mild hearing loss (conductive) with
pink retracted tympanic membrane.
2. Stage of presuppuration (Early infection)
There is collection of inflammatory exudate behind the tympanic
membrane.
There is marked Throbbing earache, hearing loss, tinnitus and fever.
Tympanic membrane is congested. Leash of blood vessels
appear along the handle of malleus and at the periphery of
tympanic membrane imparting it a Cart-wheel appearance.
3. Stage of suppuration (suppurative stage)
There is collection of frank pus in the middle ear.
Patient has excruciating earache, hearing loss, and constitutional
symptoms like high grade fever.
Tympanic membrane is red and bulging with loss of landmarks.
4. Stage of resolution (Resolution stage)
The tympanic membrane ruptures with release of pus and
subsidence of symptoms.
Earache is relieved, fever comes down and child feels better.
 195. In noice induced hearing loss,
audiogram shows a typical notch at
a) 1000 Hz

b) 2000 Hz

c) 3000 Hz

d) 4000 Hz

Correct Answer - D
Ans. is 'd' i.e., 4000 Hz
Noise induced hearing loss
Exposure to loud noise can lead to permanent hearing threshold
shifts.
This may happen immediately with extreme exposure (nearby
explosion or gunfire), but more commonly occurs slowly over time
with repeated exposure to industrial or environmental noise.
Patients will often have a typical 4-KHz (4000 Hz) notch (dip at
4000 Hz) in their audiogram called acoustic dip.
Auditory effects of noice are :?
1. Auditory fatigue :- at 90 d B and 4000 Hz.
2. Hearing loss
3. Temporary :- At 4000 - 6000 Hz
4. Permanent :- Repeated prolonged exposure to 100 d B or single
exposure to 160 d B.
196. In sensorineural hearing loss, weber's
test is lateralized to
a) Normal ear

b) Defective ear

c) Not lateralized

d) May alternate

Correct Answer - A
Ans. A. Weber test is lateralized to the unaffected or normal ear.
PURPOSE: Determination of a conductive vs.
a sensorineural hearing loss.
Strike tuning fork and place base in the center of the forehead or
the top of the head
Ask if the tone is louder in the left ear, the right ear or equally loud in
both ears due to the sound localization process,
In a patient with a unilateral conductive hearing loss, the sound
will be louder in the affected ear (airborne sounds mask bone
conduction in the normal ear; conductive loss prevents masking in
affected ear sound is perceived to be louder in affected ear)
In a patient with unilateral sensorineural hearing loss, the sound
is louder in the normal ear (no signal is transduced by the cochlea
on the affected side, therefore the sound is louder on the normal
side and is perceived to be coming from that side
In a normal person or a person with symmetrical hearing loss, it is
equally loud in both ears.
In other words, a normal patient, the Weber tuning fork sound is
heard equally loudly in both ears, with no one ear hearing the
sound louder than the other (lateralization). In a patient with
hearing loss, the Weber tuning fork sound is heard louder in
one ear (lateralization) than the other.
197. Which of the following is responsible for
localization of sound ?
a) Cochlear nerve

b) Cochlea

c) Superior olivary nucleus

d) Cochlear nuclei

Correct Answer - C
Ans. is 'c' i.e., Superior olivary nucleus
Localization of sound in space
A human can distinguish sounds originating from sources separated
by as little as 1 degree. Binaural receptive fields (which is a feature
of most auditory neurons above the level of cochlear nuclei)
contribute to sound localization. In other words, relay nuclei in the
brain stem (especially the superior olivary nuclei complex)
mediate localization of sound. The auditory system uses following
clues to judge the origin of sound :?
Time lag between the entry of sound in two ears :- For example, if
the sound originates from the right side of a person, it reaches the
right ear earlier than the left ear. This time lag is more important for
relatively low -frequency sounds (below 3000 Hz).
Difference in intensities between the sound in the two ears :- It is
important for sounds of higher frequencies (>3000 Hz).
Sounds coming from directly in front of the individual and the back of
the individual cannot be differentiated by the above two
mechanisms. Here shape of pinna plays a role, it changes the
quality of the sound depending on the direction from which sound
comes.
 198. Endolymph resembles ?
a) CSF

b) ICF

c) ECF

d) Plasma

Correct Answer - B
Ans. is 'b' i.e., ICF
Endolymph → Resembles intracellular fluid, rich in I+ ions.
Perilymph (ectolymph) → Resembles ECF, rich in Na' ions.
Perilymph communicates with CSF through cochlear acqueduct
therefore has characteristics similar to CSF.
Fluid in the inner ear
There are two main fluids in the inner ear : ?
1. Perilymph
2. Endolymph
Perilymph
It resembles ECF and is rich in Na+ ions. It fills the space between
bony and the membranous labyrinth, i.e., Scala vestibuli and scala
tympani.
It communicates with CSF through the aqueduct of Cochlea which
opens into the scala tympani near the round window. Therefore It
closely resembles CSF.
It is formed by : -
1. It is a fi iterate of blood serum and is formed by capillaries of the
spiral ligament.
2. It is a direct continuation of CSF and reaches the labyrinth via
aqueduct of cochlea.
Endolymph
It fills the entire membranous labyrinth including scala media
(cochlear duct).
It resembles intracellular fluid, being rich in K" ions.
It is secreted by the secretory cells of the stria vascularis of the
cochlea and by the dark cells (present in the utricle and near the
ampullated ends of semicircular ducts).
199. All are intracranial complications of otitis
media except?
a) Lateral sinus thrombophlebitis

b) Facial nerve palsy

c) Brain abscess

d) Hydrocephalus

Correct Answer - B
Ans. is 'b' i.e., Facial nerve palsy
Intracranial Complications from Otitis Media
Intracranial complications occur after the infectious (or inflammatory)
process proceeds beyond the temporal bone "requiring immediate
and precise therapeutic intervention."
Most common intracranial complications include meningitis, followed
by brain abscess and lateral sinus thrombosis, subdural
empyema, epidural abscess, and otic hydrocephalus.
200. Most commonly used tuning fork in ear
examination?
a) 128 Hz

b) 256 Hz

c) 512 Hz

d) 1024 Hz

Correct Answer - C
Ans. is 'c' i.e., 512 Hz
Commonly used tuning fork has a frequency of 512 Hz.
Forks of other frequencies, e.g. 256 and 1024 Hz should also be
available.
201.
 Modified radical neck dissection includes
which level of cervical lymph nodes?
a) I-Ill

b) I-IV

c) I-V

d) I-Vil

Correct Answer - C
Ans. is 'c' i.e., I-V
Radical neck dissection
During radical neck dissection, following are removed.
a. Lymph nodes of submental, submandibular, upper, middle and lower
jugular, and lateral (posterior) triangle regions, i.e. Level I to V along
with its fibrofatty tissue.
b. Sternomastoid muscle.
c. Internal jugular vein.
d. Spinal accessory nerve.
e. Submandibular salivary gland.
f. Tail of the parotid.
g. Omohyoid muscle.
Following structures are saved -
Carotid artery
Brachial plexus, phrenic nerve, vagus nerve, cervical sympathetic
chain, marginal mandibular branch of facial, lingual and hypoglosal
nerve.
Modified neck dissection
It is similar to radical neck dissection but with preservation of one or
more following structures -
1. Spinal accessory nerve
2. Internal jugular vein
3. Sternocleidomastoid muscle
Thus, both radical neck dissection and modified radical neck
dissection remove level Ito V neck nodes.
Different levels of neck nodes heve been explained in previous
sessions.
 202. All are seen in treacher collin syndrome
except
a) Conductive deafness

b) Cleft palate

c) Mandibular hypoplasia

d) Choanal atresia

Correct Answer - D
Ans. is 'd' i.e., Choanal atresia
Treacher collins syndrome
It is rare condition that presents several craniofacial deformities of
different levels.
This is a congenital malformation involving the first and second
branchial arches.
The disorder is characterized by abnormalities of the auricular pinna,
hypoplasia of facial bones, antimongoloid slanting palpebral fissures
with coloboma of the lower eyelids and cleft palate.
Important clinical findings are :-
1. Antimongoloid palpebral fissures
2. Malformed malleus and incus (normal stapes)
3. Coloboma of lower lid
4. Conductive deafness
5. Hypoplasia of mandible (micrognathia) and molar bones
6. Cleft palate
7. Malformed pinna and meatal atresia
It is the most common benign neoplasm of nasopharynx.
It is a highly vascular tumor and blood supply of the tumor most
commonly arises from the internal maxillary artery.
Juvenile nasopharyngeal angiofibroma (JNA) occurs almost
exclusively in males.
Female with Juvenile nasopharyngeal angiofibroma (JNA) should
undergo genetic testing.
Onset is most commonly in the second decades, the range is 7-19
years.
The exact cause is unknown. As the tumour is predominantly seen
in adolescent males in the second decade of life, it is thought to be
testosterone dependent.
The most common site is posterior part of nasal cavity close to the
margin of sphenopalatine foramen.
The tumor starts adjacent to the sphenopalatine foramen.
Large tumors are frequently bilobed or dumbbel shaped, with one
portion of tumor filling the nasopharynx and the other portion
extending to the pterygopalatine fossa.
Clinical features
Symptoms depend on spread of tumour to nasal cavity, paranasal
sinuses, pterygomaxillary fossa, infratemporal fossa, cheek, orbits
(through inferior orbital fissure), cranial cavity (most common site is
middle cranial fossa).
Nasal obstruction (80-90%) is the most common symptom,
especially in the initial stages. This results in denasal speech,
hyposmia, broadening of nasal bridge.
pontaneous profuse & recurrent epistaxis is the second most
common symptom
Otalgia, conductive hearing loss, serous otitis media, due to
eustachian tube obstruction.
Pink or purplish mass obstructing one or both chonae in
nasopharynx.
Tumour in the orbit causes : proptosis; and frog-face deformity;
diplopia and diminshed vision.
Tumour in infratemporal fossa can cause trismus and bulge of
parotid.
II, III, IV, V, VI cranial nerve can be involved.
Splaying of nasal bones.
Swelling of cheek and fullness of face.
Diagnosis and treatment
Contrast CT is the investigation of choice.
Biopsy should be avoided as it can cause severe bleeding.
Surgical excision is the treatment of choice.
203. True about penderd's syndrome ?
a) Blindness

b) Conductive deafness

c) Sensorineural deafness

d) All of the above

Correct Answer - C
Ans. is 'c' i.e., Sensorineural deafness
Important features of Pendered syndrome:
Congenital disorder
Mutation in gene SLC 26 A4. Which codes for a protein called
pendrin (helps in transport of ions across membrane).
Impaired activity of Pendrin is seen in inner ear and thyroid gland.
Bilateral sensorineural hearing loss.
Goiter.
Sometimes hypothyroidism.
Occasionally vestibular dysfunction.
No specific treatment.
204. Endoscopic sinus surgery prerequisite?
a) MRI of paranasal sinus

b) CT of PNS

c) Mucocilliary clearing testing

d) Acoustic tests

Correct Answer - B
Ans. is 'b' i.e., CT of PNS
Endoscopic surgery of inflammatory diseases of paranasal sinuses
(sinusitis or polyp) requires a very detailed preoperative knowledge
of the individual anatomical conditions and pathological changes.
CT scan are used best to visualize sinus areas.
CT scan provides excellent definition of paranasal sinuses and
is a prerequisite for endoscopic surgery.
"CT scan limited study coronal cuts in bone window is prerequisite
for endscopic sinus surgery"----Mohan Bansal
205. X-ray findings in chronic otitis media ?
a) Honeycombing of mastoid

b) Sclerosis with cavity in mastoid

c) Clear-cut distinct bony partition between cells

d) None of the above

Correct Answer - B
Ans. is 'b' i.e., Sclerosis with cavity in mastoid
206. What is not true about use of intranasal
steroids in nasal polyposis?
a) Reduce recurrence

b) Reduce obstruction

c) Effective in eosinophilically predominant polyp only

d) May cause epistaxis

Correct Answer - C
Ans. is 'c' i.e., Effective in eosinophilically predominant polyp only
Intranasal steroids have been used extensively as first-line
management of nasal polyposis with few side effects
Usually, patients with small polyps and limited involvement on CT
scan are good candidates for topical therapy alone.
Intranasal steroids reduce nasal obstruction, polyp size, drainage
and polyp recurrence.
The effect of steroids seems to be nonspecific, improving symptoms
in both eosinophilically and non​eosinophilically dominated
polyps.
Nasal bleeding is the most common adverse event and can
usually be minimized by directing the medication away from nasal
septum.
 207. Referred ear pain may travel through all
except?
a) Trigeminal nerve

b) Glossopharyngeal nerve

c) Abducens nerve

d) Vagus nerve

Correct Answer - C
Ans. is 'c' i.e., Abducens nerve
Referred otalgia
As ear receives nerve supply from Vth (auriculotemporal branch),
IXth (tympanic branch) and Xth (auricular branch) cranial nerves;
and from C2 (lesser occipital) and C2 and C3 (greater auricular), pain
may be referred from these remote areas:
1. Via Vth cranial nerve
1. Dental : - Caries tooth, apical abscess, impacted molar,
malocclusion.
2. Oral cavity : - Benign or malignant ulcerative lesions of oral cavity or
tongue.
3. Temporomandibular joint disorders : - Bruxism, osteoarthritis,
recurrent dislocation, ill-fitting denture.
4. Sphenopalatine neuralgia
Vi intensity will hear it. Therefore, if identical vibrating tuning forks
are held at equal distances from both ears they are heard in both
ears. However, if one tuning fork is moved closer to one ear the
person hears only that fork although the other fork is still vibrating
sufficiently for him to hear. In stenger test, two vibrating tuning forks
are held equidistant from either ear. If the patient is claiming
 deafness in his left ear he will clain to hear only the fork on his right
side. The fork on the left side is moved closer. If the patient is
feigning deafness he will perceive only the tuning fork on the left
side and will claim not to hear anything. If the patient has a genuine
hearing loss on the left he will still hear the tuning fork on the right
side.
2. Teal test
This can be used when the patient admits to hearing bone
conduction in his 'deaf' ear. The examiner stands behind the patient
and applies a tuning fork to the mastoid process of his 'deaf' ear.
The patient admits to
a IXth cranial nerve
1. Oropharynx : - Acute tonsillitis, peritonsillar abscess, tonsillectomy.
Benign or malignant ulcers of soft palate, tonsil and its pillars.
2. Base of tongue : - Tuberculosis or malignancy
3. Elongated styloid process.
3.Via Xth cranial cerve :
Malignancy or ulcerative lesion of vallecula, epiglottis, larynx or
laryngopharynx, oesophagus.
4. Via C2 and C3 spinal nerves :
Cervical spondylosis, injuries of cervical spine, caries spine.
208. Acute retropharyngeal abscess, not true
?
a) Due to lymphadenitis

b) Common in adults

c) Swelling on one side of midline

d) Incision & drainage

Correct Answer - B
Ans. is 'b' i.e., Common in adults
Retropharyngeal abscess
Retropharyngeal space lies behind the pharynx, i.e. between
buccopharyngeal fascia covering pharyngeal constrictor muscles
(anteriorly) and prevertebral fascia covering the prevertebral
muscles (posteriorly).
So, retropharyngeal space lies behind the pharyngeal constrictor
muscles and anterior to prevertebral fascia covering the prevertebral
muscles.
Abscess in this space may present differently depending upon the
age :?
Abscess in infants (acute Retropharyngeal abscess)
It is commonly seen in infants and children below 3 years of
age. Most commonly it results from retropharyngeal
lymphadenitis due to an upper respiratory tract infection. The
presention is acute, i.e. child has high temperature and sore throat.
There is smooth swelling (bulge) in posterior pharyngeal wall
on one side of the midline. There is dysphagia, difficulty in
breathing, stridor, croupy cough and torticollis. Swelling can be
palpable per orally on the posterior pharyngeal wall. Treatment is
incision and drainage.
Abscess in adults (chronic retropharyngeal abscess)
If an adult or an older child has a retropharyngeal infection it is likely
to be due to a tuberculous infection of the cervical spine (caries of
cervical spine). Sometime it may be secondary to tuberculous
infection of retropharyngeal lymph nodes. It is of slow onset and
gives rise to pharyngeal discomfort, rather than pain. There is
fluctuant swelling in posterior pharyngeal wall, centrally in the
midline (if it is secondary to caries of cervical spine) or on one side
of midline (if it is secondary to tuberculosis of retropharyngeal
nodes). Treatment includes incision and drainage of abscess
along with full course of antitubercular treatment.
209. Proof puncture is done through ?
a) Superior meatus

b) Middle meatus

c) Inferior meatus

d) Sphenoethmoidal recess

Correct Answer - C
Ans. is 'c' i.e., Inferior meatus
Proof functure (Antral puncture)
This procedure involves puncturing the medial wall of maxillary sinus
in the region of inferior meatus and irrigating the sinus.
Indications
1. Chronic and subacute maxillary sinusitis with dual purpose of :
Confirming the diagnosis and
Washing out the pus
2. To collect the specimen of the antral contents for culture and
sensitivity, or cytological examination to exclude early malignancy.
Contraindications
Children less than 12 years of age.
Acute maxillary sinusitis as it may lead to osteomyelitis
Fracture of maxilla as fluid may pass through fracture line.
Diabetes hearing it. The examiner then says that he is going to
repeat the test, but puts a non-vibrating fork on the mastoid while at
the same time bringing a vibrating fork close to the auricle. If the
patient is malingering, he will hear the tuning fork through air
conduction, but think that it is being heard through the bone. If he is
really deaf he will not hear the fork.
3. Lomard's test
This depends upon the fact that to the normal man the sound of his
own voice is necessary for the proper regulation of its tone and
loudness. The Barany noise apparatus is adjusted to the patient's
sound ear and its machinery started in order to accustom him to its
grating noise. He is given a book, and told to read aloud in his
normal voice and not to stop reading when the instrument is set in
action. As soon as the noise begins, a man whose opposite ear is
profoundly deaf will at once raise his voice and, if his deafness is
absolute, may literally shout. The malingerer, on the other hand,
claiming a one-sided deafness which is not real will continue to read
in an even tone or in a tone only slightly elevated.
4. Acoustic reflex (stapedial reflex threshold)
If stapedial reflex is present, it rules out NOHL because stapedial
reflex is not in voluntary control.
5. Electric response audiometry (ERA) or cortical evoked response
audiometry
It is very useful in NOHL and can establish hearing acuity of the
person to within 5-10 dB of actual thresholds.
6. Other tests
Gault test, Erhard's test, delayed speech feedback.
210. Inspiratory stridor is found in what kind
of lesions:
a) Supraglottic

b) Subglottic

c) Tracheal

d) Bronchus

Correct Answer - A
Answer A. Supraglottic
Generally, an inspiratory stridor suggests airway obstruction above
the glottis.
While an expiratory stridor is indicative of obstruction in the lower
trachea.
A biphasic stridor suggests a glottic or subglottic lesion.
211. The most common site of the branchial
cyst is:
a) Posterior border of sternocleidomastoid

b) Anterior border of sternocleidomastoid

c) Digastric muscle

d) Omohyoid muscle

Correct Answer - B
Answer. B. Anterior border of sternocleidomastoid
A branchial cleft cyst (BCC) commonly presents as a solitary,
painless mass in the neck of a child or young adult.
They are most commonly located along the anterior border and the
upper third of the sternocleidomastoid muscle in the anterior triangle
of the neck.
212. Lower limit of retropharyngeal space is
at ?
a) C 7

b) Bifurcation of trachea

c) 4th esophageal constriction

d) None

Correct Answer - B
Ans. is'b'i.e., Bifurcation of trachea
Retropharyngeal space is divided into two lateral spaces (space of
gillette) by a fibrous band.
Retropharyngeal space is limited above by the base of skull and
below where the alar fascia fuses with buccopharyngeal fascia at the
level of T4 and carina (bifurcation of trachea).
213. Retroauricular incision is also known
as?
a) Rosen's incision

b) Lempert's -I incision

c) Lempert's-II incision

d) Wilde's incision

Correct Answer - D
Ans. is'd'i.e., Wilde's incision
[Ref: Dhingra Sth/e p. 410]
Wilde's incision is used for postaural (retroauricular) approach.
Lempert's incision is used for endaural approach.
Rosen's incision is used for stapedectomy through endomeatal or
transcanal approach,
214. Electrode of cochlear implant is placed
at ?
a) Horizontal semicircular canal

b) Scala media

c) Scala tympani

d) Scala vestibuli

Correct Answer - C
Ans. is 'c' i.e., Scala tympani
[Ref Essentials otolaryngology 2d/e p. 82]
Cochlear implants
Internal component : -
lt contains receiver/stimulator which is implanted under the skin and
electrode which is implanted in the scala tympani of the cochlea a
cochleostomy opening in the basal turn of cochlea.
It may also be placed at other locations like promontory or round
window but these sites has poorer performance.
215. Threshold of hearing in a young normal
adult is ?
a) 0 dB

b) 10 dB

c) 20 dB

d) 30 dB

Correct Answer - A
Ans. is'a'i.e.,0 dB
[Rd Dhingra 4n/e p. 21]
Audiometric zero
Threshold of hearing, i.e. The faintest intensity which a normal
healthy person can hear will vary from person to person.
The International Standards Organisation (ISO) adopted a standard
for this, which is represented as the zero level on the audiometer (0
dB).
According to ISO, audiometric zero is the mean value of minimal
audible intensity in a group of normally hearing healthy young adults.
216. Nasopharyngeal carcinoma seen in
which occupation?
a) Asbestos industry

b) Cement industry

c) Wood workers

d) Chimney workers

Correct Answer - C
Ans. is 'c' i.e., Wood workers
Ref Dhingra 4h/e p. 235; Nasopharyngeal carcinoma By Andrew
Van Hasselt,
Alan G. Gibb 2d/e p. 4
Wood dusts exposure is a risk factor of nasopharyngeal carcinoma
and
Adenocarcinoma of PNS.
Formaldehyde exposure is a risk factor of Nasopharyngeal
carcinoma.
217. Investigation of choice for
nasopharyngeal angiofibroma?
a) X-ray

b) MRI

c) Plane-CT

d) CT- contrast

Correct Answer - D
Ans. is'd'i.e., CT contrast
Ref: Dhingra Sth/e p. 262
CT scan of head with contrast enhancement is the investigation of
choice for JNA.
218. True about tubercular otitis media are all
except?
a) Spreads through eustachian tube

b) Causes painless ear discharge

c) May cause multiple perforations

d) Usually affects both ears

e) None

Correct Answer - D
Answer- D. Usually affects both ears
Tuberculosis of middle ear is a comparatively rare entity usually
seen in association with or secondary to pulmonary tuberculosis,
infection reaches the middle ear through eustachian tube.
Clinical features
Generally, tuberculosis of middle ear is unilateral.
It is characterized by painless otorrhoea which fails to respond to the
usual antimicrobial treatment. There is painless watery otorrhea.
Single or multiple perforation of tympanic membrane.
219. Feature of Granulomatosis with
polyangiitis:
a) Nasal polyp

b) Perforated Nasal septum

c) Persistant sinus

d) Crusting of nasal mucosa

e) Collapse of nasal bridge

Correct Answer - B:C:D

Answer- (B) Perforated Nasal septum (C) Persistant sinus
(D) Crusting of nasal mucosa
Granulomatosis with polyangiitis (Wegener) is a distinct
clinicopathologic entity characterized by granulomatous vasculitis of
the upper and lower respiratory tracts together with
glomerulonephritis.
Disseminated vasculitis involving both small arteries and veins may
occur.
Nasal findings include crusting granulations, septal perforation & a
saddle nose
Destruction of the septum with a characteristic implosion of the nasal
bridge.
220. Tensor tympani is attached at ?
a) Malleus

b) Incus

c) Stapes

d) Tympanic membrane

Correct Answer - A
Ans. is 'a' i.e., Malleus [Ref Gray's Anatomy 38th le p. 485]
Tympanic cavity has two muscles :
221. Vesicles on external ear are seen in
a) Otitis externa

b) Malignant otitis externa

c) Herpes zoster

d) Clear cell carcinoma

Correct Answer - C
Ans. is 'c' i.e., Herpes zoster [Ref Head and Neck Surgical
Pathology p. 53]
Ramsay Hunt syndrome
It is lower motor neuron type of facial palsy due to Varicella (herpes)
zoster. Pain is often a prominent feature and vesicles are
seen in the ipsilateral ear, on the hard palate and/or on anterior two
third of tongue. It may involve other cranial nerves-V,
VIII, IX and X and cervical branches (C2, C3 & C4) that have
anastomotic communications with facial nerve. This results
in features like :
Anaesthesia of face
Giddiness
Hearing impairment along with VII nerve palsy.
222. First line treatment for mild retraction
pocket in the ear is
a) Observation

b) Antibiotics

c) Tympanostomy tube

d) Surgical excision

Correct Answer - B
Ans. is 'b' i.e., Antibiotics [Ref Conquering Otitis media by
Charles Bluestone p. 95]
Retraction pocket
It must be treated by an otolaryngologist.
1) Antibiotics
A mild retraction pocket that is present in a fluid - filled middle ear
can first be treated with antibiotics.
2) Tympanostomy
If antibiotics does not work, a tympanostomy tube is usually
inserted, and in most cases, the eardrum will return to normal.
If the retraction pocket is very deep, a tube should be inserted,
bypassing the antibiotic treatment.
3) Surgical excision
If the retraction pocket still does not go away, the deformed eardrum
should be operated on to prevent a cholesteatoma from developing.
Once a cholesteatoma develops, surgery is the only way to remove
it.
223. Cristae are seen in?
a) Utricle

b) Saccule

c) Semicircular canal

d) Otolith membrane

Correct Answer - C
Ans. is 'c' i.e., Semicircular canal [Ref Dhingra Sth/e p. 16]
Vestibular apparatus
The vestibular apparatus within the inner ear detects head motion
and position and transduces this information to a neural signal.
224. Function of saccule is?
a) Linear acceleration

b) Angular acceleration

c) Senses position of head

d) Rotational movement

Correct Answer - A:C

Ans. is 'a' i.e.,Linear acceleration & 'c' i.e.,Senses position of
head
225. Earliest age for doing BERA is?
a) In utero - before birth

b) At birth

c) 3 months

d) 6 months

Correct Answer - B
Ans. is 'b' i.e., At birth [Ref Logan Turner 10thle p. 254; PL
Dhingra 4th/e p. 28]
"Worldwide screening is largely performed in newborn nursery with
the first screening test performed from birth until 10 days of age"
226. Most common malignancy of middle ear
is
a) Glomus tumor

b) Squamous cell carcinoma

c) Adenocarcinoma

d) Sarcoma

Correct Answer - B
Ans. is 'b' i.e.,Squamous cell carcinoma [Ref Textbook of ENT
by Rakesh Shrivastav 2"/e p. 67]
Squamous cell carcinoma is the most common malignant tumor of
the middle ear.
Other forms of malignancy like adenocarcinoma and sarcoma are
rare.
227. Most common benign tumor of ear canal
is
a) Osteomas

b) Sebaceous adenoma

c) Papilloma

d) Ceruminoma

Correct Answer - A
Ans. is 'a' i.e., Osteomas [Ref Dhingra 6thle p. 107; Bansal ENT
p. 160; Encyclopedia of Imaging, Baert p. 1318]
Osteomas/ exostoses → most common benign tumors of the
external auditory canal.
Squamous cell carcinomas → Most common malignant tumors of
the external auditory canal.
228. Diplacusis is
a) Hearing sound with diminished intensity

b) Hearing sounds of two different tones

c) Hearing extremely loud sound

d) Perceiving light on production of sound

Correct Answer - B
Ans. is 'b' i.e.,Hearing sounds of two different tones [Ref Tuli
lst/e p. 114]
Monaural diplacusis :- In monaural diplacusis, a listener hears two
tones when a single tone is presented to a single ear, i.e. one ear
hears two different tones when presented one.
Binaural diplacusis :- In binaural diplacusis, a listener hears two
different tones in right & left ear when a single tone is presented to
both ears.
Both monoaural and binaural diplacusis are caused by
inhomogenities in the cochlea that also give rise to spontaneous
otoacoustic emissions.
229. Which semicircular canal is most
commonly involved in BPPV?
a) Horizontal

b) Posterior

c) Superior

d) All of the above

Correct Answer - B
Ans. is 'b' i.e., Posterior [Ref Dhingra Sth/e p. 51]
BPPV is thought to be caused by displacement of otoconia (mineral
crystals) from the vestibule of inner ear into the semicircular canals.
The posterior semicircular canal is most commonly involved, though
superior and horizontal canals canal can also be affected.
Otoconia or ear rocks are small crystals of calcium carbonate
derived structure in the utricle which migrate into semicircular canals
and cause BPPV. While saccules also contains otoconia, they are
not able to migrate into the semicircular canals.
230. Most common ossicle affected due to
trauma -
a) Malleus

b) Incus

c) Stapes

d) All affected similarly

Correct Answer - B
Ans. is 'b' i.e, Incus [Ref Hearing : Practical Guide by Tysome p.
96]
"Significant head injury or direct trauma to the middle ear can result
in subluxation of one or more of the ossicles, the incus being the
most commonly affected
 231. Singapore ear is
a) Hypertrophy of sweat glands

b) Hypertrophy of sebaceous glands

c) Otitis externa

d) Excoriation of external ear skin

Correct Answer - C
Ans. is 'c' i.e, Otitis externa [Ref Clinical ENT 5th/e p. 223]
Excessive moisture is an important predisposing factor for otitis
externa as excessive moisture elevates the pH and removes
protective cerumen. Therefore, humidity and hot climate predispose
to otitis externa. Hence otitis externa is also known as :-
1. Singapore ear (where climate is hot and humid)
2. Swimmer's ear
3. Telephonist's ear (telephonists who require inserts in their ear have
excessive moisture due to sweating).
232. A diabetic patient presents with foul
smelling ear discharge, fever and severe
pain in the ear. On examination there is
thick yellow coloured discharge from the
ear and granulation tissue in the canal.
Which of the following is the appropriate
management for this patient?
a) Surgical debridement

b) Antibiotic therapy

c) Cryotherapy

d) Laser removal of granulation tissue

Correct Answer - B
Ans. is 'b' i.e., Antibiotic therapy [Ref Dhingra 6th/e p. 52]
The patient described in the question most likely has malignant otitis
externa.
So the treatment of choice is anti - pseudomonal antibiotics.
Extensive surgical debridement once an important part of the
treatment is now rarely needed
 233. Topodiagnosis of facial nerve has all the
tests except
a) Schirmer test

b) Bing test

c) Taste test

d) Salivary flow test

Correct Answer - B
Ans. is 'b' i.e., Bing test [Ref Dhingra 6th/e p. 98]
The following tests are useful in finding the site of lesion in paralysis
of lower motor neuron.
1. Schirmer test : It compares lacrimation of the two sides. A strip of
filter paper is hooked in the lower fornix of each eye and the amount
of wetting of strip measured. Decreased lacrimation indicates lesion
proximal to the geniculate gan- glion as the secretomotor fibres to
lacrimal gland leave at the geniculate ganglion via greater superficial
petrosal nerve.
2. Stapedial reflex : Stapedial reflex is lost in lesions above the nerve
to stapedius. It is tested by tympanometry.
3. Taste test : It can be measured by a drop of salt or sugar solution
placed on one side of the protruded tongue, or by electrogustometry.
Impairment of taste indicates lesion above the chorda tympani.
4. Submandibular salivary flow test : It also measures func- tion of
chorda tympani. Polythene tubes are passed into both Wharton
ducts and drops of saliva counted during one minute period.
Decreased salivation shows injury above the chorda.
 234. Which of the following is the function of
tensor tympani muscle?
a) Dampen very loud sound

b) Tenses tympanic membrane

c) Tenses pharyngotympanic tube

d) Prevent noise trauma to the inner ear

Correct Answer - B
Ans. is 'b' i.e., Tenses tympanic membrane [Ref Dhingra 6"/e p.
8]
Normal opening of the eustachian tube equalizes atmospheric
pressure in the middle ear; closing of the Eustachian tube protects
the middle ear from unwanted pressure fluctuations and loud
sounds.
The muscles of the eustachian tube system help to open and close
the tube, thus allowing it to perform its function.
The muscles are :?
1. Tensor veli palatini (tensor palatini) :- Contraction of this muscle
during swallowing, yawning and sneezing opens the tube. Defective
function of this muscle in cleft palate results in eustachian tube
dysfunction.
2. Tensor tympani :- Tensonises the tympanic membrane.
3. Levator veli palatini :- Sometimes, it also helps to open the tube,
however it is usually considered as a velopharyngeal valve muscle
only.
4. Salpingopharyngeus :- Its functional significance is questionable.
235. Pink reflex through intact tympanic
membrane in active otosclerosis is
known as
a) Schwabach's sign

b) Schwartz sign

c) Lyre's sign

d) Chvostek's sign

Correct Answer - B
Ans. is 'b' i.e., Schwartz sign [Ref Dhingra 5th/e p. 98; Current
otolaryngology 2nd/e p. 674]
A reddish hue / Flammingo pink may be seen on the
promontory and oval window niche owing to the prominent
vascularity associated with an otospongiotic focus. This is k/a
Schwartz sign.
Schwartz sign is a pink reflex, seen through intact tympanic
membrane, in the area of oval window. It indicates active
otosclerosis usually during pregnancy.
Lyre's sign is splaying apart of internal and external carotid arteries
on angiogram in cases of carotid body tumour of the neck.
Chvostek's sign seen in hypocalcaemia as after total thyroidectomy
where parathyroids have also been removed. Tapping over the
distribution of facial nerve produces a twitch.
236. SADE classification classifies
a) Retraction of tympanic membrane

b) Extension of Glomus tumor

c) Mortality after heart disease during pregnancy

d) Extent of CSF rhinorrhea

Correct Answer - A
Ans. is 'a' i.e., Retraction of tympanic membrane [Ref Basic
Clinical Radiobiology 5th/e p. 942]
Sade's classification of retraction of the pars tensa of the tympanic
membrane defined two types of retraction and classified each on an
ordinal scale :?
1. Atelectasis, defined as diffuse 'retraction of the tympanic
membrane towards the promontorium'.
2. Retraction pocket, defined as focal 'retraction of the pars tensa
towards or into the attic'
237. A 10 year old child presents with non
foul purulent smelling discharge, which
is painless. Patient reports that he is able
to hear better in the presence of
discharge than when the ear is dry. The
most probable diagnosis is
a) CSOM

b) Serous otitis media

c) Cholesteatoma

d) Mastoiditis

Correct Answer - A
Ans. is 'a' i.e., CSOM [Ref Dhingra 6th /e p. 68]
Clinical features of CSOM
Profuse mucopurulant discharge which is not foul smelling, i.e., non
foul smelling discharge .
Hearing loss (conductive type). If sensorineural component also
occurs (i.e., mixed type), it arouses the suspician of toxic deafness.
Sometimes, patient reports a paradoxical effect, i.e., hears better in
the presence of discharge than when the ear is dry. This is due to
round window shielding effect produced by discharge which helps to
maintain phase differential.
There is no pain, if it occurs it is due to associated otitis externa not
due to otitis media.
Since the infected area is open at both ends, discharge does not
accumulate in the middle ear cavity.
Ossicular chain is mostly uninvolved, if involved only long process of
incus is involved.
 238. Treatment of central safe perforation of
tympanic membrane includes all except
a) Aural toilet

b) Ear drops

c) Avulsion of aural polyp

d) Myringoplasty

Correct Answer - C
Ans. is 'c' i.e., Avulsion of aural polyp [Ref Dhingra 6th le p. 72]
An aural polyp should never be avulsed as it may be arising from the
stapes, facial nerve or horizontal canal and thus lead to facial
paralysis or labyrinthitis.
Treatment
The aim is to control infection and eliminate ear discharge and at a
later stage to correct the hearing loss by surgical means.
1. Aural toilet : Remove all discharge and debris from the ear. It can be
done by dry mopping with absorbent cotton buds, suction clearance
under microscope or irrigation (not forceful syringing) with sterile
normal saline. Ear must be dried after irrigation.
2. Ear drops : Antibiotic ear drops containing neomycin, polymyxin,
chloromycetin or gentamicin are used. They are combined with
steroids, which have local antiinflammatory effect.
3. Systemic antibiotics : They are useful in acute exacerbation of
chronically infected ear, otherwise role of systemic antibiotics in the
treatment of CSOM is limited.
4. Precautions : Patients are instructed to keep water out of the ear
during bathing, swimming and hair wash. Rubber inserts can be
used. Hard nose blowing can also push the infection from
nasopharynx to middle ear and should be avoided.
5. Treatment of contributory causes : Attention should be paid to treat
concomitantly infected tonsils, adenoids, maxillary antrum and nasal
allergy.
6. Surgical treatment : Aural polyp or granulations, if present, should be
removed before local treatment with antibiotics. It will facilitate ear
toilet and permit ear drops to be used effectively.
7. Reconstructive surgery: Once ear is dry, myringoplasty with or
without ossicular reconstruction can be done to restore hearing.
Closure of perforation will also check repeated infection from the
external canal.
239. Agger nasi is
a) Mucosal flap covering the nasolacrimal duct

b) Opening of the sinuses

c) Depression in front of middle turbinate

d) Elevation anterior to middle turbinate

Correct Answer - D
Ans. is 'd' i.e., Elevation anterior to middle turbinate [Ref
Dhingra 5thie p. 150; Tuli 1"/e p. 135]
Atrium is a shallow depression in front of the middle turbinate. Agger
nasi is an elevation just anterior to the attachement of middle
turbinate.
240. Quadrungular septum is seen in which of
the following?
a) Larynx

b) Nose

c) Cranium

d) Palate

Correct Answer - B
Ans. is 'b' i.e., Nose [Ref Dhingra 5th/e p. 150]
"Cartilage of the septum, also known as the quandragular cartilage
because it is roughly quadrilateral in shape - separates the nostrils".
241. Nasal vestibule is
a) Lateral part of nasal cavity

b) Antero - inferior part of nasal cavity

c) Supero - medial part of nose

d) Posterior aperture of nose

Correct Answer - B
Ans. is 'b' i.e., Antero - inferior part of nasal cavity[Ref
Otolaryngology Basic Science & Clinical Review by Van De
Water p. 462]
Internal nose has following parts :
Nasal cavity proper:- Internal nose is divided into right and left nasal
cavities by nasal septum. Each nasal cavity communicates with the
exterior through naris or nostrils and with nasopharynx through
posterior nasal aperture or posterior nares or choana.
Vestibule of nose :- Anterior and inferior part of the nasal cavity is
lined by skin and is called vestibule of nose. It contains sebaceous
glands, hair follicles and the hair called vibrissae.
242. Which of the following terms is used to
describe the most prominent point of
nasal tip?
a) Pronasale

b) Alare

c) Nasion

d) Columella apex

Correct Answer - A
Ans. is 'a' i.e., Pronasale [Ref Handbook of anthropometry:
Physical measures of human form in health and diseases, by
Victor R. Preedy, p. 922]
Pronasale : Most prominent point on the nasal tip.
Alare : The point where the nasal blade (Ala nasi) extends the
farthest out.
Columella apex : The most anterior or the highest point on the
columella crest at the apex of the nostril.
Nasion : The point in the midline of both the anatomic nose and the
nasoanterioral suture
243. Epistaxis after ligating external carotid
artery is due to which vessel?
a) Anterior ethmoidal artery

b) Superior labial artery

c) Sphenopalatine artery

d) Greater palatine artery

Correct Answer - A
Ans. is 'a' i.e., Anterior ethmoidal artery [Ref Dhingra 5thie p.
190]
Since external carotid artery is ligated, the bleeding comes from
branches of the internal carotid artery.
Anterior ethmoidal artery, a branch of ophthalmic artery, which is a
branch of internal carotid artery, is a constituent of the blood supply
of the Little's area of the nasal septum.
Blood supply of nasal septum
i) Internal carotid system
Anterior ethmoidal artery
Branches of ophthalmic artery
Posterior ethmoidal artery
ii) External Carotid System
Sphenopalatine artery (branch of maxillary artery) gives
nasopalatine and posterior medial nasal branches.
Septal branch of greater palatine artery (Br. of maxillary artery).
Septal branch of superior labial artery (Br. of facial artery)
244. Killian's polyp is a/an
a) Antrochoanal polyp

b) Ethmoidal polyp

c) Frontal polyp

d) Maxillary polyp

Correct Answer - A
Ans. is 'a' i.e., Antrochoanal polyp [Ref Dhingra 5th/e p. 186;
Essential otolaryngology 2"1/e p. 660]
Nasal polyps are of two types :?
Antrochoanal :- This is usually solitary and arises from maxillary
sinus and grows backward in the nose towards the choana (in
contrast to ethmoidal polyps which tend to grow forward). The
Antrochoanal polyp was first described by Gustain killians, therefore
the name given to it was killian's polyp.
Ethmoidal :- These are multiple, bilateral and arise from etmoidal
sinuses and tend to protrude forwards.
245. Which of the following is the
predisposing factor for ethmoidal
carcinoma
a) Smoking

b) Alcohol

c) Chronic infection

d) All of the above

Correct Answer - A
Ans. is 'a' i.e., Smoking [Ref Diseases of ENT by Bansal p. 363]
Risk factors for squamous cell carcinoma of the paranasal
sinuses :-
Smoking , Mustard gas, Nickel and chromium plating industry,
Isopropyl oil
Leather industry , Wood dust exposure (adenocarcinoma of
ethmoid), Polycyclic volatile hydrocarbons
246. Most common sinus predisposed to
malignancy which of the following?
a) Ethmoid

b) Maxillary

c) Frontal

d) Sphenoid

Correct Answer - B
Ans. is 'b' i.e., Maxillary [Ref Dhingra 5thie p. 219]
The majority of paranasal sinus malignancies (50-80%) originate
within the maxillary sinus antrum.
Sinuses and various conditions in which sinuses are affected in
descending order of frequency
247. Most common benign tumor of paranasal
sinuses?
a) Papilloma

b) Osteoma

c) Warts

d) Fibroma

Correct Answer - B
Ans. is 'b' i.e., Osteoma [Ref Logan Turner 8`h/e p. 89]
Osteoma of the frontal sinus - Most common benign tumour arising
in the nasal sinuses.
The osteoma arises from the floor of the frontal sinus near the
midline.
248. Treatment of nasal bone fracture
includes all except
a) Hematoma drainage

b) Topical vasoconstrictor

c) Closed reduction

d) Immediate rhinoplasty

Correct Answer - D
Ans. is 'd' i.e., Immediate rhinoplasty [Ref Scott Brown 7th/e p.
1612]
Treatment of nasal injuries
After ensuring patency of airway, adequate ventilation and overall
stability of patient, attention to the nasal injuries should be given.
Standard therapy is to perform closed reduction or open reducation
between 3 and 7 days, and upto 2 weeks. This is because :
Most of the patients (-70-80%) do not require any active treatment,
as many do not have a nasal fracture and those that do, the fracture
is not displaced. Soft tissue swelling can produce the misleading
appearance of a deformity which disapears as the swelling subsides.
Such patients require only reassurance & topical vasoconstrictors to
alleviate congestion and obstructive symptoms. A re-examination
should be carried out after 5 days, if there is uncertainity about the
need for reduction.
A large number of patients will have a preexisting nasal deformity
caused by a previous incident. Patients that fall in this category are
advised to consider a formal rhinoplasty when everything has settled
down some months later.
Immediate surgical intervention in acute phase is indicated : ?
Severe deformity:- Septal hematoma causing nasal obstruction
249. All of the following are true about
parapharyngeal abscess except?
a) Mastoid process divides the space into anterior and posterior

b) Also known as pharyngomaxillary space infection

c) Tonsil is pushed medially

d) Occurs after tooth extraction

Correct Answer - A
Ans. is 'a' i.e., Mastoid process divides the space into anterior
and posterior [Ref Dhingra V/e p. 281]
Styloid process and the muscles attached to it divide the
parapharyngeal space into anterior and posterior compartments, not
mastoid process.
250. Lining epithelium of vocal cord is
a) Stratified squamous epithelium

b) Non stratified squamous epithelium

c) Ciliated columnar epithelium

d) Non ciliated columnar epithelium

Correct Answer - A
Ans. is 'a' i.e., Stratified squamous epithelium [Ref Dhingra Vie
p. 300]
Vocal cords along with the upper part of the vestibule is the only part
of laryngeal mucous membrane which is lined by epithelium of
stratified squamous type. Elsewhere in the larynx epithelium of the
mucous membrane is ciliated columnar type.
251. Which of the following sites of Ca larynx
has the best prognosis?
a) Glottic

b) Supraglottis

c) Subgottis

d) All have poor prognosis

Correct Answer - A
Ans. is 'a' i.e.,Glottic [Ref Dhingra 5th/e p. 326]
Laryngeal carcinoma:-
Cancer Prognosis
Glottis Good
SupraglottisPoor
Subglottis Worst
252. Laser used in tracheal neoplasm is
a) Argon

b) KTP - 532

c) CO2

d) Nd - YAG

Correct Answer - C
Ans. is 'c' i.e., CO2 [Ref Dhingra 5th/e p. 315]
Four types of laser are generally used in ENT surgery :
Argon
KTP - 532 (Potassium titanyl phosphate);
Nd : YAG (Neodyminum - yttrium aluminium garnet);
CO2
The carbon dioxide (CO) laser is the most common laser used for
tracheal neoplasm.
253. Most common site of distant metastasis
from Ca larynx
a) Lymph nodes

b) Lung

c) Brain

d) Bone

Correct Answer - B
Ans. is 'b' i.e., Lung [Ref Clinical Otorhinolaryngology
yd /el). 931]
Distant metastasis is seen much less frequently. The most
commonly affected sites for distant metastases are lungs (66%);
bone (22%), liver (10%), mediastinum and bone marrow.
254. A patient presents with Ca larynx
involving left false cord, left arytenoid
and left aryepiglottic fold with bilateral
mobile true cords. The treatment of
choice in this patient is which of the
following?
a) Vertical hemilarygectomy

b) Horizontal partial hemilaryngectomy

c) Total laryngectomy

d) Radiotherapy followed by chemotherapy

Correct Answer - B
Ans. is 'b' i.e., Horizontal partial hemilaryngectomy [Ref Dhingra
4th/e p. 284]
Involvement of unilateral false cord, aryepiglottic folds and
arytenoids with mobile cord suggests supraglottic cancer in T2 stage
(more than one subsites of supraglottis are involved).
 255. In recurrent laryngeal nerve palsy which
muscle keeps vocal cord in median
position?
a) Posterior cricoarytenoid

b) Cricothyroid

c) Vocalis

d) All of the above

Correct Answer - B
Ans. is 'b' i.e., Cricothyroid [Ref Dhingra 5th/e p. 300]
Recurrent laryngeal nerve paralysis
Recurrent laryngeal nerve supplies : ?
1. All intrinsic muscles of the larynx except cricothyroid.
2. Sensory supply to larynx below vocal cords.
So, paralysis of recurrent laryngeal nerve causes : ?
1. Paralysis of all intrinsic muscles including all adductors (except for
cricothyroid) and all abductors.
2. Anaesthesia below the level of vocal cord.
Though, there is paralysis of both adductors (except cricothyroid)
and abductors, the manifestations are mainly due to paralysis of
abductors.
256.
Food particles mostly get obstructed in which
part of esophagus -
a) Cricopharyngeal sphincter

b) Crossing of arch of aorta

c) Cardiac end

d) None of the above

Correct Answer - A
Ans. is 'a' i.e, Cricopharyngeal sphincter [Ref: Dhingra 6thie p.
349]
By far the commonest site is at or just below the cricopharyngeal
sphincter. Flat objects like coins are held up at the sphincter while
others are held in the upper oesophagus just below the sphincter
due to poor peristalsis.
257. True regarding traction diverticuli of
esophagus is all except
a) Does not empty completely

b) Triangular appearance

c) Contains all layers

d) Maintains elastic recoil

Correct Answer - A
Ans. is 'a' i.e., Does not empty completely [Ref The Esophagus
by Richter p. 143]
Pulsion Diverticula
False diverticula
Traction Diverticula Ususally only mucosal
True diverticula outpouchings Distal
Type
Lined by all layers esophagus
Layers
Mid esophagus Associated with
Location
Scarring from TB or dysmotility
Associated
histoplasmosis involving perihilar Rounded
Shape
or subcarinal lymph nodes outpouchings
Emptying
Triangular or tented Do not empty
Tends to empty contents completely
Epiphrenic diverticula,
Zenker's diverticula
258. Sluder's neuralgia is also called as
a) Anterior ethmoidal syndrome

b) Posterior ethmoidal syndrome

c) Trotter syndrome

d) Lermoyez syndrome

Correct Answer - A
Ans. is 'a' i.e., Anterior ethmoidal syndrome [Ref Dhingra 6th/e
p. 450]
Sluder's neuralgia
It is also called anterior ethmoidal syndrome.
It is said to originate from the middle turbinate pressing on the nasal
septum.
It is characterized by pain around the bridge of the nose radiating
into forehead.
Treatment Anatomical correction relieves the pain.
259. Most common tumor of oropharynx is
a) Squamous cell carcinoma

b) Adenocarcinoma

c) Melanoma

d) Salivary gland tumors

Correct Answer - A
Ans. is 'a' i.e., Squamous cell carcinoma [Ref Abeloff's Clinical
Oncology 6" le p. 1059]
90 – 95% of tumors in the oropharynx are squamous cell
carcinomas, whereas others are minor salivary gland tumors,
melanomas.
The most common manifesting symptoms are a nontender neck
mass, dysphagia, otalgia, or a "hot potato" voice.
260. Investigation of choice for diagnosing
submandibular gland duct stones is
a) Ultrasound

b) X-ray of floor of mouth

c) Sialography

d) Sialoendoscopy

Correct Answer - A
Ans. is 'a' i.e., Ultrasound [Ref Churchill's pocket book of
surgery p. 133] Investigations for salivary gland stones
Ultrasound is the investigation of choice – as it permits assessment
of the gland, duct system and calculus which usually has an acoustic
shadow.
'Floor of mouth' radiographic view for submandibular calculi in
Wharton's duct where ultrasound findings are equivocal or
unavailable.
If no stone is seen, consider sialography.
Sialoendoscopy is increasingly used in the diagnosis and treatment
of salivary gland outflow obstructive conditions.
 261. Deafness in a case of Paget's disease is
due to
a) Retraction pockets

b) Otitis

c) Eight nerve involvement

d) Endolymphatic hydrops

Correct Answer - C
Ans. is 'c' i.e., Eight nerve involvement [Refer Neurology
consult 5"/e p. 866]
Cranial nerve compression is the usual cause of deafness.
Complications of Paget's disease
Following complications can occur in Paget's disease : -
1. Fracture : Are common in weight bearing bones
2. Cranial nerve compression :- May cause impaired vision, facial
palsy, trigeminal neuralgia or deafness.
3. Otosclerosis : - Another cause of deafness in Paget's disease.
4. Spinal canal stenosis and nerve root compression
5. High output cardiac failure
6. Osteoarthritis : of Hip and knee
7. Rarely osteosarcoma
262. Membrane incised during
hemilaryngectomy is
a) Thyrohyoid

b) Cricothyroid

c) Aryepiglottic

d) Infralaryngeal

Correct Answer - B
Ans. is 'b' i.e., Cricothyroid [Ref Dhingra ele p. 310]
Indications and containdications
Ideal for bulky lesions of the membranous true vocal cord
Normal or slightly impaired vocal cord mobility
No involvement of the supraglottis
263. Callaural fistula is an abnormality of ?
a) 1" branchial arch

b) Pt branchial cleft

c) 2nd branchial arch

d) 2nd branchial cleft

Correct Answer - B
Ans. is 'b' i.e., Pt branchial cleft
Collaural fistula is a 1" branchial cleft anomaly which arises from
failure of fusion of the ventral part of the Pt cleft.
Its upper part opens into floor of external auditary canal.
Its lower part opens in the neck between angle of mandible and
sternocleidomastoid muscle.
264. Acute suppurative otits media in children
is most commonly caused by ?
a) St. pneumoniae

b) S. epidermidis

c) S. aureus

d) Pseudomonas

Correct Answer - A
Ans. is 'a' i.e., St. pneumonia [Ref Dhingra 5thle p. 54]
ASOM is especially common in infants and children. Most of the time
ASOM usually follows respiratory tract infections (i.e., acute
tonsillitis, common cold or influenza) and the infection travel up by
the eustachian tube to the middle ear.
The most common causative organism is streptococcus pneumoniae
 265. Young's operation is done for
a) Allergic rhinitis

b) Atropic rhinitis

c) Vasomotor rhinitis

d) Idiopathic rhinitis

Correct Answer - B
Ans. is 'b' i.e., Atrophic rhinitis [Ref Dhingra 5th/e p. 171;
Essential otolaryngology 2"d/e p. 523]
Surgical treatment of Atrophic rhinitis
1. Young's operation
2. Modified Young's operation
3. Narrowing of the nasal cavity by (Lautenslagers operation)
4. Lautenslagers operation
266.
All of the following are are a part of medial
wall of the middle ear except?
a) Promontory

b) Fenestra vestibule

c) Pyramid

d) Subiculum

Correct Answer - C
Ans. is 'c' i.e.,Pyramid [Ref Dhingra Save p. 6]
Medial or inner or labyrinthic wall (paries labyrinthica) of middle
ear
It is formed by labyrinth and separates the middle ear cavity from
internal ear. It has following features :- A bulge called as
promontory formed by basal turn of cochlea.
Fenestra vestibuli (oval window) lies posterosuperior (behind and
above) to the promontory and opens into scala vestibuli.
It is occupied by foot plate of stapes fixed by annular ligament.
Its, size on average is 3.25 mm long & 1.75 mm wide.
Fenestra cochleae (round window) lies posteroinferior to the
promontory and opens into scala tympani of cochlea. It is closed by
secondary tympanic membrane. The round window is closest to
ampulla of posterior semicircular canal. Round window is a
triangular opening. Its diameter is between 1.8 to 2.3 mm.
267. What is the intensity in decibel of normal
conversation in humans?
a) 30dB

b) 60dB

c) 90dB

d) 150dB

Correct Answer - B
Ans. is 'b' i.e., 60dB [Ref Dhingra 5thle p. 23]
Intensity is the strength of sound which determines its loudness. It is
usually measured in decibels (dB).
Following are intensities when a person is at a distance of one meter
from sound source.
Whisper 30 dB
Normal conversation60 dB
Shout 90 dB
Discomfort of ear 120 dB
Pain in ear 130 dB
 268. What is the role of Sodium Fluoride in
otosclerosis?
a) It restores the electrolyte equilibrium

b) It hastens recovery of the Overstimulated Cochlea

c) It quickens the maturity of the active focus and reduces

osteoclastic resorption

d) It repolarizes the cochlear cells

Correct Answer - C
Ans. is 'c' i.e., It quickens the maturity of the active focus and
reduces osteoclastic resorption
[Ref Current Diagnosis and treatment in Otolaryngology 2nd/e
p. 678; Otosclerosis and Stapedectomy: Diagnosis,
Management, and Complication by Glasscock (7hieme) 1st
(2004) p. 61, 62]
Mechanism of action of Sodium fluoride in otosclerosis
1. Reduces osteoclastic bone resorption and increases osteoblastic
bone formation : These actions reduce bone remodelling in actively
expanding osteolytic lesions and promote recalcification.
2. Inhibits proteolytic enzymes that are cytotoxic to the cochlea :
Inhibition of proteolyic enzymes that are cytotoxic to the cochlea is
believed to prevent sensorineural deafness.
269. Chemical labyrinthectomy by
transtympanic route is done in Meniere's
disease using which drug?
a) Amikacin

b) Gentamicin

c) Amoxycillin

d) Cyclosporine

Correct Answer - B
Ans. is 'b' i.e., Gentamicin [Ref Levine SC, Haberkamp TJ.
Labyrinthectomy to correct vertigo
Operative techniques in otolaryngology - Head & neck surgery.
2001. 12:141-143.]
Chemical labyrinthectomy in meneires disease is done using
Gentamicin locally.
270. Which of the following tests is not used
to differentiate between cochlear and
retrocochlear hearing loss?
a) SISI TEST

b) Evoked response audiometry

c) Threshold tone decay test

d) Recruitment

Correct Answer - C
Ans. is 'c' i.e., Threshold tone decay test [Ref Dhingra 5th/e p.
31; zr/e p. 28]
271. Where is the auditory cortex located
inside the brain?
a) Superior temporal gyrus

b) Inferior temporal gyrus

c) Area 3,1,2

d) Cingulate gyrus

Correct Answer - A
Ans. is 'a' i.e., Superior temporal gyrus [Ref Pickles,
James 0. (2012). An Introduction to the Physiology of Hearing (4th
ed.). Bingley, UK: Emerald Group Publishing Limited, pp. 215-217.]
Primary Auditory Cortex is located bilaterally, roughly at the upper
sides of the temporal lobes - in humans on the superior temporal
plane, within the lateral fissure and comprising parts of Heschl's
gyrus and the superior temporal gyrus, including planum polare and
planum temporale (roughly Brodmann areas 41, 42, and partially
22).
272. When does the rudimentary cochlea
develop in the fetus?
a) First week

b) 4th to 8th week

c) 8th to 12th week

d) 16 to 20th week

Correct Answer - B
Ans. is 'b' i.e., 4th to 8th week [Ref Chap 172-Teview of medical
embryology-Ben Pasky]
Development of Inner ear
After implantation, around the second to third week the developing
embryo consists of three layers: endoderm, mesoderm
andectoderm.
The first part of the ear to develop is the inner ear,which begins to
form from the ectoderm around the 22nd day of the embryo's
development. Specifically, the inner ear derives from two thickenings
called otic placodes on either side of the head. Each otic placode
recedes below the ectoderm, forms an otic pit and then an otic
vesicle. This entire mass will eventually become surrounded by
mesenchyme to form the bony labyrinth.
Around the 33'd day of development, the vesicles begin to
differentiate. Closer to the back of the embryo, they form what will
become the utricle and semicircular canals. Closer to the front of the
embryo, the vesicles differentiate into a rudimentary saccule, which
will eventually become the saccule and cochlea.
Part of the saccule will eventually give rise and connect to the
cochlear duct. This duct appears approximately during the sixth
week and connects to the saccule through the ductus reuniens.
273. The main muscle affected in congenital
muscular torticollis is?
a) Sternocleidomastoid

b) Trapezius

c) Scalenus Anticus

d) Omohyoid

Correct Answer - A
Ans. is 'a' i.e., Sternocleidomastoid
[Ref: Cooperman, Daniel R. (1997). Karmel-Ross, Karen, ed. "The
Differential Diag​nosis of Torticollis in Children". Physical &
Occupational Therapy in Pediatrics. 17 (2): 1-11]
The cause of congenital muscular torticollis is unclear. Birth trauma
or intrauterine malposition is considered to be the cause of damage
to the sternocleidomastoid muscle in the neck. Other alterations to
the muscle tissue arise from repetitive microtrauma within the womb
or a sudden change in the calcium concentration in the body which
causes a prolonged period of muscle contraction.
274. Miracle fruit is used to change the taste
from?
a) Sour to Bitter

b) Sour to Sweet

c) Bitter to sweet

d) Salty to sweet

Correct Answer - B
Ans. is 'b' i.e., Sour to Sweet [Ref Peter Hanelt, ed.
(2001).Mansfeld's encyclopedia of agricultural and horticultural
crops 2. Springer. p. 1660. ISBN 3-540-41017-1.]
Miracle Fruit contains a glycoprotein called miraculin, which binds to
the tongue's taste buds when the fruit is consumed.
Miraculin acts as a sweetness inducer when it comes in contact with
acids, causing sour foods to taste sweet, temporarily.
275. All of the following are complications of
maxillary sinus lavage and insufflation
except?
a) Air embolism

b) Orbital injury

c) Epistaxis

d) Facial nerve injury

Correct Answer - D
Ans. is 'd' i.e., Facial nerve injury [Ref Schlemmer KD, Naidoo
SK. Complicated sinusitis in a developing country, a
retrospective review. Int J Pediatr Otorhinolaryngol. 2013 May
17]
Complication of Maxillary sinus lavage and insufflation
Complications of nonendoscopic drainage procedures can be minor
or severe.
The most common complication is failure to enter the sinus because
of improper positioning of the trocar, incomplete penetration of the
sinus mucosa, or the presence of a hypoplastic antrum.
Epistaxis may occur because of laceration of the nasal mucosa or
preexisting coagulopathies necessitating packing.
Severe complications include orbital injury, air embolism, and death
secondary to injection of air into the sinus.
276. All of the following are removed in
vertical hemilaryngectomy except?
a) Half Glottis

b) Half Supraglottis

c) Half tongue

d) Half Subglottis

Correct Answer - C
Ans. is 'c' i.e., Half tongue [Ref Dhingra 4th/e p. 284;
http://128.255.52.245/oto/Beta/database/contents]
Vertical hemilaryngectomy means excision of one half of the larynx
on one side, i.e., vertical half is removed which include vertical half
of supraglottis, glottis and subglottis.
Horizontal hemilaryngectomy is the excision of supraglottis only,
also known as supraglottic laryngectomy.
277.
 Submucosal resection is the treatment of
choice of?
a) DNS in adults

b) DNS in children

c) Sluder's Neuralgia

d) Nasal polyp

Correct Answer - A
Ans. is 'a' i.e., DNS in adults [Ref Dhingra 5th /e p. 423]
Submucous resection (SMR) is a surgical procedure to correct the
deformity of nasal septum.
The principle of this procedure is to remove deviated cartilage and
bone from beneath the mucosal lining of nasal septum, leaving a
corrected septum largely composed of scar tissue.
Submucous resection is not advocated in children upto 17 years of
age as it may interfere with development of the facial bones.
278. Which perforation of the tympanic
membrane is most commonly seen with
tubotympanic CSOM?
a) Central

b) Anterosuperior

c) Posterosuperior

d) Posteroinferior

Correct Answer - A
Ans. is 'a' i.e., Central [Ref Dhingra 5thle p. 77; Pediatric
otolaryngology 2"/e p. 478] Tubotympanic CSOM
It is also known as safe ear as it does not cause any serious
complications
Infection is is limited to antero-inferior part of middle ear cleft
(eustachain tube & mesotympanum) and is associated with central
perforation in pars tensa of tympanic membrane.
279. Caldwell Luc Surgery has its approach to
the maxillary antrum through ?
a) Gingivolabial sulcus

b) Inferior orbital rim

c) Nasal septum

d) Cribriform plate

Correct Answer - A
Ans. is 'a' i.e.,Gingivolabial sulcus [Ref Dhingra 5thIe p. 422]
280. In Caldwell Luc operation, the approach
is through the?
a) Sublabial Approach leading to opening of mandibular antrum

b) Through the sphenopalatine recess

c) Opening of maxillary antrum through gingivolabial approach

d) Superior meatus

Correct Answer - C
Ans. is 'c' i.e., Opening of maxillary antrum through
gingivolabial approach [Ref Dhingra Stile p. 422]
Caldwell-Luc operation is a process of opening the maxillary antrum
through canine fossa by sublabial approach and dealing with the
pathology inside the antrum.In this surgery, antrum is reached
through a incision in gingivolabial sulcus (from lateral incisor to
2"d molar) and then opening of antrum in this area.
281. All of the following are indications for
tracheostomy except ?
a) Coma after head injury

b) Maxillofacial injury

c) Bilateral abductor palsy

d) Superior laryngeal nerve palsy

Correct Answer - D
Ans. is 'd' i.e., Superior laryngeal nerve palsy [Ref Ajay
Yadav zithie p. 215; Dhingra 5thie p. 337]
Tracheostomy
A tracheostomy is a surgical procedure to create an opening through
the neck into the anterior wall of trachea.
A tube is usually placed through this opening to provide an airway
and to remove secretions from the lungs. The tube is
called tracheostomy tube.
282. Most common cause of otitis externa is?
a) Fungal infection

b) Bacterial infection

c) Seborrheic disease

d) Herpes Zoster

Correct Answer - B
Ans. is 'b' i.e., Bacterial infection [Ref Clinical ENT 5th/e p. 223]
Most common cause of otitis externa is bacterial infection.
Two most common causative bacteria are staphylococcus aureus
and pseudomonas
283. Which is the narrowest portion of the
esophagus?
a) At the cricopharyngeal sphincter

b) At the crossing of the left main bronchus

c) At the level of the aortic arch

d) At the diagphragmatic aperture

Correct Answer - A
Ans. is 'a' i.e., At the cricopharyngeal sphincter
[Gray H. Chapter 35: Mediastinum. Standring S, ed. Gray's
Anatomy: The Anatomical Basis of Clinical Practice. 40`Ve New
York, NY: Churchill Livingstone Elsevier; 2008. 939-57.]
Cricopharyngeal sphincter is the narrowest portion of esophagus
284. Which of the following is not a
premalignant condition oral cancer?
a) Leukoplakia

b) Erythroplakia

c) Oral submucous fibrosis

d) Systemic Sclerosis

Correct Answer - D
Ans. is 'd' i.e., Systemic Sclerosis [ Ref Devita 7"Ve p. 982;
Bailey & love 25`Ve p. 735]
Lesions with increased risk of malignancy in oral cancer
Premalignant condition :- Leukoplakia, Erythroplakia, Speckled
erythroplakia, chronic hyperplastic candidiasis.
Conditions increasing risk :- Oral submucous fibrosis, syphilitic
glossitis, sideropenic dysphagia (Peterson Kelly syndrome).
Risk is doubtful : - Oral lichen planus, DLE, Dyskeratosis congenita.
285. Which of the following is a cause of
objective tinnitus?
a) Impacted Wax

b) Carotid artery aneurysm

c) Meniere's disease

d) Ototoxic drugs

Correct Answer - B
Ans. is 'b' i.e., Carotid artery aneurysm [Refi Dhingra Sth/e p.
145; Scott Brown's 7th/e Vol-3 p. 4029-4030;Tuli p. 125-126]
286. Which of the following cancers do not
present with cervical lymphnode
involvement?
a) Glottic Cancer

b) Subglottic Cancer

c) Papillary thyroid cancer

d) Oral cancer

Correct Answer - A
Ans. is 'a' i.e., Glottic Cancer [Ref Dhingra 5th le p. 327; 41' p.
283]
True vocal cords are devoid of lymphatic, hence less chance of
cervical nodal metastasis
287. Pulsatile tinnitus is a feature of ?
a) Glomus tumour

b) acoustic neuroma

c) malignant otits externa

d) meneire's disease

Correct Answer - A
Ans. is 'a' i.e., Glomus tumour [Ref Logan Turner 10th/e p. 214]
The earliest symptoms of glomus tumour is pulsatile tinnitus
(earliest) and hearing loss. Hearing loss is conductive and slowly
progressive. These are followed by blood stained otorrhoea and
earache.
288. Histelberger's sign is seen in?
a) Acoustic neurom

b) Glomus Tumour

c) Nasal angiofibroma

d) Acute suppurative otitis media

Correct Answer - A
Ans. is 'a' i.e., Acoustic neurom [Ref Acta Otorhinolaryngol
Belg. 1987;41(1):40-8.The Hitselberger sign as a perception
phenomenon. Benz B, Baumgarten D.]
Hitselberger's sign
In Acoustic neuroma - loss of sensation in the postero-superior part
of external auditory meatus supplied by Arnold's nerve (branch of
Vagus nerve to ear).
289. All of the following are true about
Spasmoidic Dysphonia except ?
a) It may be of adductor or abductor type

b) Abductor type is characterized by Whispering quality of voice

c) Adductor type is characterized by Breathlessness

d) It is focal Laryngeal dystonia

Correct Answer - C
Ans. is 'c' i.e., Adductor type is characterized by
Breathlessness
[RefiSulica L (December 2004). "Contemporary man​agement of
spasmodic dysphonia". Current Opinion in Otolaryngology &
Head and Neck Surgery. 12 (6)]
290. Ethmoidal infundibulum lies between ?
a) Bulla ethmoidalis and uncinate process of ethmoid

b) Middle and inferior turbinate

c) Hiatus semilunaris and Inferior meatus

d) Wing of sphenoid and maxillary antrum

Correct Answer - A
Ans. is 'a' i.e., Bulla ethmoidalis and uncinate process of
ethmoid
The hiatus semilunaris is bounded inferiorly by the sharp concave
margin of the uncinate process of the ethmoid bone, and leads into a
curved channel, the infundibulum, bounded above by the bulla
ethmoidalis and below by the lateral surface of the uncinate process
of the ethmoid.
291. What lies between the middle and
inferior turbinate?
a) Middle meatus

b) Superior meatus

c) Hiatus semmilunaris

d) Inferior meatus

Correct Answer - A
Ans. is 'a' i.e., Middle meatus [Ref Scott Brown 7'Ve vol 2 p.
1329]
Superior meatus → * Below superior turbinate (between superior
and middle turbinates)
Middle meatus → Below middle turbinate (between middle and
inferior turbinates)
Inferior meatus → Below inferior turbinate.
 292. All of the following are extrinsic
laryngeal membranes except?
a) Quadrangular membrane

b) Hyoepiglottic ligament

c) Cricotracheal membrane

d) Thyrohyoid membrane

Correct Answer - A
Ans. is 'a' i.e., Quadrangular membrane
[Ref Merati AL, Bielamowicz SA. Textbook of Laryngology. San
Diego: Plural Publishing Inc 2006.]
Quadrangular membrane
1. Aryepiglottic ligament (superior border of membrane)
2. Vestibular ligament (Inferior border of membrane
293.
The narrowest part of the nasal cavity is ?
a) Internal nasal valve

b) Antrochoanal region

c) 1st nasal turbinate

d) Region of inferior concha

Correct Answer - A
Ans. is 'a' i.e., Internal nasal valve [Ref Jafek BW. Anatomy and
physiology of the nose. Jafek BW, Stark AK, eds. ENT Secrets.
Philadelphia, Pa: Hanley & Belfus; 1996. 77-83.]
The internal nasal valve involves the area bounded by upper lateral
cartilage, septum, nasal floor, and anterior head of the inferior
turbinate. This makes up the narrowest portion of the nasal airway
294. Anterior tonsillar pillar is formed by?
a) Palatopharyngeal fold

b) Palatoglossal fold

c) Pterygopalatine arch

d) Valleculae

Correct Answer - B
Ans. is 'b' i.e., Palatoglossal fold
Anterior tonsillar pillar- Palatoglossal fold
Posterior tonsillar pillar- Palatopharyngeal fold
295. One of the following is true regarding
Zenker diverticulum ?
a) It is a pulsion diverticulum

b) It projects anteriorly

c) Commonly seen in young males

d) It is between superior and middle constrictor

Correct Answer - A
Ans. is 'A' i.e., It is a pulsion diverticulum
Hypopharyngeal diverticulum or Zenker's diverticulum or
pharyngeal pouch
It is a pulsion diverticulum where pharyngeal mucosa herniates
through the Killian's dehiscence, a weak area between two parts of
the inferior constrictor.
It is the most common esophageal diverticulum.
The diverticula arise posteriorly in the midline of neck. The mouth of
the diverticula is in the midline but projects laterally (usually left
laterally )
Zenker's diverticula are rarely seen below 30 yrs of age, most
patients are over 50.
296.
Narrowest part of the nasal cavity is ?
a) Vestibule

b) Choanae

c) Inferior turbinate

d) Middle turbinate

Correct Answer - C
Ans. is 'c' i.e., Inferior turbinate [Ref Heidari Z, Mahmoudzadeh-
Sagheb H, Khammar T, Khammar M (May 2009).
"Anthropometric measurements of the external nose in 18-25-
year-old Sistani and Baluch aborigine women in the southeast
of Iran". Folia Morphol. (Warsz) 68 (2): 88-92]
The internal nasal valve comprises the area bounded by the upper
lateral-cartilage, the septum, the nasal floor, and the anterior head of
the inferior turbinate. In the narrow (leptorrhine) nose, this is the
narrowest portion of the nasal airway.
 297. Saddle nose deformity is seen in?
a) Primary Syphilis

b) Secondary syphilis

c) Tertiary syphilis

d) Lupus Vulgaris

Correct Answer - C
Ans. is 'c' i.e., Tertiary syphilis [Ref Dhingra 5th/e p. 184]
Syphilis of nose occurs as :-
1. Primary :- Rare and manifests as primary chancre of the vestibule.
2. Secondary :- Rarely recognized and manifests as simple rhinitis,
crusting and fissuring.
3. Tertiary :- This is the stage in which nose is involved most
commonly. There is formation of gumma followed by bony
perforation of nasal septum. Bridge of the nose collapses causing a
saddle deformity. Atrophic rhinitis may occur as a complication.
298. All of the following are true about
vasomotor rhinitis except ?
a) It is allergic

b) It is due to parasympathetic overactivity

c) Resistant cases may need cryotherapy

d) It may lead to hypertrophic rhinitis

Correct Answer - A
Ans. is 'a' It is allergic [Ref Scott's Brown 7thie p. 2122]
Vasomotor rhinitis
Vasomotor rhinitis is a nonallergic condition that involves a constant
runny nose, sneezing and nasal congestion, i.e., the nose is stuffy or
runny for reasons other than allergies and infections. The exact
etiology is unknown, but triggers include emotions, odors, poor air
quality, spicy foods, and medication side effects.
299. All of the following are true about
vasomotor rhinitis except?
a) It is a nonallergic condition

b) it is due to parasympathetic overactivity

c) It may cause paroxysmal episodes of sneezing

d) It is an infective condition

Correct Answer - D
Ans. is 'd' i.e., It is an infective condition [Ref Dhingra 5th/e p.
170]
300. In evaluation of a case of immotile nasal
cilia, which of the following
investigations should prove useful?
a) Rhinogram

b) Xray nasal and paranasal sinuses

c) Sweat sodium levels

d) Nitric oxide test

Correct Answer - D
Ans. is 'd' i.e., Nitric oxide test [Ref Leigh MW, Pittman JE,
Carson JL, Ferkol TW, Dell SD, Davis SD. Clinical and genetic
aspects of primary ciliary dyskinesia/Kartagener syndrome.
Genet Med. 2009 Jul. 11(7):473-87]
Screening tests for immotile cilia syndrome
Nitric oxide : Measuring exhaled nasal nitric oxide, which is mostly
reduced in primary ciliary dyskinesia, is a good screening test for
immotile-cilia syndrome with a good negative predictive value.
Studies have demonstrated a relationship between nasal nitric oxide
levels, nasal oxide synthase mRNA expression, and ciliary beat
frequency. There is also a significant inverse correlation between the
degree of aplasia and/or hypoplasia of the paranasal sinus and
nasal nitric oxide values in primary ciliary dyskinesia patients.
301. All of the following are features of
ethmoidal polyp except ?
a) Common in adults

b) Commonly Singular

c) Commonly bilateral

d) Is usually allergic

Correct Answer - B
Ans. is `b' i.e., Commonly Singular [Ref Dhingra 5thle p. 187; Tuli
1"/e p. 173]
Antrochoanal polyp grows backward (posteriorly), therefore, it may
not be visible on anterior rhinoscopy, while posterior rhinoscopy
shows smooth, greyish white, spherical mass in choana.
On the other hand, ethmoidal polyps grow anteriorly. Therefore, they
are best seen on anterior rhinoscopy and may not be seen on
posterior rhinoscopy.
302. All of the following are features of
enlarged adenoids except?
a) Otitis media

b) Nasal obstruction

c) Failure to thrive of child

d) Esophagitis

Correct Answer - D
Ans. is 'd' i.e., Esophagitis [Ref Dhingra Vie p. 254]
Clinical features of enlarged adenoids
Enlarged and infected adenoids may cause nasal, aural (ear),
and general symptoms.
1) Nasal symptoms
Nasal obstruction is the commonest symptom. This result in mouth
breathing. As the respiration and feeding cannot take place
simultaneously, child fails to thrive.
Other symptoms are nasal discharge (wet bubbly nose), sinusitis,
epistaxis and toneless voice with loss of nasal quality (Rhinololia
clausa).
2) Aural symptoms
Tubal obstruction
Otitis media :- Recurrent acute otitis media, CSOM, serous otitis
media
3) General symptoms
Adenoidfacies: Elong at edface with dullex pression,open
mouth,prominent & crow dedup per teeth, hit chedup perlip, pinched
in appearance of nose and high arched palate. Pulmonary
hypertension, aprosexia (lack of concentration).
 303. All of the following are treatments of
multiple bilateral ethmoidal polyps
except?
a) Functional endoscopic sinus surgery

b) Intranasal ethmoidectomy

c) Extranasal ethmoidectomy

d) Caldwll Luc Surgery

Correct Answer - D
Ans. is 'd' i.e., Caldwil Luc Surgery [Ref Scott Brown, Vol-IL
p.1701; Dhingra 5`"/e p. 188, 430]
Surgical treatment of ethmoidal polyps :
1. Functional endoscopic sinus surgery (FESS) : Surgery of choice
when available.
2. Polypectomy : When there are one or two pedunculated polyps.
3. Intranasal ethmoidectomy : Indicated when polyps are multiple and
sessile.
4. Extranasal ethmoidectomy : This is indicated when polyps recur
after intranasal procedures.
5. Transantral ethmoidectomy : Indicated when infection and polypoidal
changes are also seen in the maxillary antrum. In this case antrum is
opened by caldwell-Luc approach and the ethmoidal air cells
approached through the medial wall of the antrum.
304. What is the treatment of choice for
ethmoidal polyps?
a) Functional Endoscopic sinus surgery with polypectomy

b) Intranasal ethmoidectomy

c) Extranasl ethmoidectomy

d) Transantral ethmoidectomy

Correct Answer - A
Ans. is 'a' i.e.,Functional Endoscopic sinus surgery with
polypectomy [Ref See above explanation]
305. What is the type of epithelium of the
adenoid?
a) Pseudostratified ciliated columnar epithelium

b) Non keratinized squamous epithelium

c) Cuboidal epithelium

d) Columnar epithelium with goblet cells

Correct Answer - A
Ans. is 'a' i.e., Pseudostratified ciliated columnar epithelium
[Ref Wiatrak BJ, Woolley AL. Pharyngitis and adenoton​sillar
disease. Cummings CW, Fredrickson JM , Harker LA, Crause
CJ, Schuller DE, Richardson MA. Otolaryngology Head and
Neck Surgery. ..V/e. London: Mosby; 1998. 188-215.]
The adenoid is covered by a pseudostratified ciliated columnar
epithelium that is plicated to form numerous surface folds The
nasopharyngeal epithelium lines a series of mucosal folds, around
which the lymphoid parenchyma is organized into follicles and is
subdivided into 4 lobes by connective tissue septa Seromucous
glands lie within the connective tissue, and their ducts extend
through the parenchyma and reach the nasopharyngeal surface.
306. The artery which leads to bleeding in
Woodruff's area is?
a) Anterior ethmoidal artery

b) Sphenopalatine artery

c) Greater palatine artery

d) Superior labial artery

Correct Answer - B
Ans. is 'b' i.e., Sphenopalatine artery [Ref Scott Brown 7h/e Vol-
2p. 1597; Dhingra 5th/e p. 190]
Woodruff's area : ?
It is situated under the posterior end of inferior turbinate.
Sphenopalatine artery anastomoses with posterior pharyngeal artery
here. Posterior epistaxis occurs in this area.
 307. Intrathecal fluorescein with endoscopic
visualization is useful in diagnosis of?
a) Deviated nasal septum

b) Multiple ethmoidal polyps

c) Rhinitis Medicamentosa

d) CSF Rhinorrhoea

Correct Answer - D
Ans. is 'd' i.e., CSF Rhinorrhoea [ Ref: Logan Turner 10(h/e p.
28, Dhingra 5th/e p. 179]
Detection of site of CSF leak in CSF Rhinorrhoea
1. HRCT : - HRCT with or without godolinium is the most helpful study
for identifying the site of leak, i.e., investigation of choice.
2. MRI : - MRI with heavy T2 weighted image may highlight CSF
sufficiently to show the leak.
3. CT cisternography : - CT scan after injection of contrast dye is
effective in patients with an active leak.
4. Radioisotope cisternography : - Radioisotope injected intrathecally
and measured.
5. Fluorescin dye : - Intrathecal fluorescin with endoscopic
visualization.
308. All of the following are features of a
nasal foreign body except?
a) Foul smelling discharge

b) Epistaxis

c) Nasal obstruction

d) Septal perforation

Correct Answer - D
Ans. is 'd' i.e., Septal perforation [Ref Dhingra SaVe p. 176;
Logan Turner 10'h/e p. 63]
Foreign body in nose
A nasal foreign body is anything that gets stuck inside the nose.
Inanimate foreign body (object) is more common than animate
foreign body. Common objects found in noses include food material
(peas, beans, nuts), tissue paper, beads, toys and rocks. Animate
foreign bodies are worms, larvae or maggots. Most cases of foreign
bodies in the nose and nasal cavity are not serious and occur in
toddlers and children from 1-8 years. Because children develop the
ability to pick up objects at about the age of 9 months, this problem
is much less common before 9 months of age.
309. ETHMOIDAL BULLAE are seen in?
a) Posterior ethmoidal air cells

b) Middle ethmoid air cells

c) Superior ethmoidal air cells

d) Inferior ethmoidal air cells

Correct Answer - B
Ans. is 'b' i.e., Middle ethmoid air cells [Ref: Logan Turner 10th
le p. 379; Dhingra 5th/e p. 153, 154]
310. All of the following are features of a
nasal foreign body except?
a) Vestibulitis

b) Epistaxis

c) Nasal obstruction

d) Deviated septum

Correct Answer - D
Ans. is 'd' i.e., Deviated septum [Ref Dhingra 5thie p. 176; Logan
Turner 10`"/e p. 63]
311.
All of the following are causes of perforation
of cartilaginous part of nasal septum except?
a) Tuberculosis

b) Leprosy

c) Lupus

d) Syphilis

Correct Answer - D
Ans. is 'd' i.e., Syphilis [Ref Dhingra 5th/e p. 166; Scott-Brown's
Otolaryngology 7th/e Vol-2 chapter-124 p. 1583]
A nasal septal perforation is a through-and-through defect in any
portion of the cartilaginous or bony septum with no overlying
mucoperichondrium or mucoperiosteum on either side.
Perforation of bony part :- Syphilis
Perforation of cartilaginous part :- TB, leprosy, lupus.
312. All of the following are true about nasal
myiasis except?
a) Common in vasomotor rhinitis

b) Intense nasal irritation present

c) Meningitis may occur in severe disease

d) Chloroform water is one of the modes of treatment

Correct Answer - A
Ans. is 'a' i.e., Common in vasomotor rhinitis [Ref Dhingra 5th/e
p. 178]
313. Water’s view is used to obtain diagnostic
information of:
a) Maxillary sinus

b) Ethmoidal sinuses

c) Frontal sinus

d) Sphenoid sinus

Correct Answer - A
ANSWER: A. Maxillary sinus
Waters' view (also known as the Occipitomental view) is a
radiographic view, where an X-ray beam is angled at 45° to the
orbitomeatal line.
The rays pass from behind the head and are perpendicular to the
radiographic plate.
It is commonly used to get a better view of the maxillary sinuses.
314. Tracheostomy indication is:
a) Vocal cord replacement

b) Pharynx replacement

c) Tracheomalacia

d) Foreign body obstructing airway

Correct Answer - D
Answer- D. Foreign body obstructing airway
Indications of tracheostomy:
Upper respiratory tract obstruction; Laryngeal, supralaryngeal ,and
tracheal causes.( Causes of stridor )
Lower respiratory tract obstruction: (Secretory obstruction, Wet lung
syndrome).
315. Caldwell’s view is used for:
a) Maxillary sinus

b) Frontal sinus

c) Ethmoidal sinus

d) All of the above

Correct Answer - B
Answer- B. Frontal sinus
Caldwell's view (or Occipitofrontal view) is a radiographic view of
skull, where X-ray plate is angled at 20° to orbitomeatal line.
The rays pass from behind the head and are perpendicular to
radiographic plate.
It is commonly used to get better view of frontal sinuses.
316. Where will be the placement location for
Auditory Brainstem Implant?
a) Scala tympani

b) Recess of 4th ventricle

c) IAC

d) back of ear

Correct Answer - B
Answer: B - Recess of 4th ventricle.
The implant is usually placed in the lateral recess of the fourth
ventricle at the time of tumor resection to stimulate the
cochlear nucleus
Auditory Brainstem Implant (ABI):
Tumor resection surgery in NF patients result in cochlear nerve
damage or loss of function of nerve resulting in deafness.
ABI are useful in restoring auditory perception to deaf patients with
neurofibromatosis type 2 (NF2)
Also used in treatment of congenitally deaf children with cochlear
malformations or cochlear nerve deficiencies.
Placement location: Lateral recess of 4th ventricle
317. All of the following are features of
Tubotympanic CSOM except ?
a) Profuse discharge

b) Hearing loss

c) Extreme pain

d) Sometimes paradoxical improvement in hearing is seen

Correct Answer - C
Ans. is 'c' i.e., Extreme pain [Ref Dhingra 5th/e p. 77; Pediatric
otolaryngology 2"/e p. 478]
Clinical features of tubotympanic CSOM
Profuse mucopurulent discharge which is not foul smelling, i.e., non-
foul smelling discharge
Hearing loss (conductive type). If sensorineural component also
occurs (i.e., mixed type), it arouses the suspicion of toxic deafness.
Sometimes, patient reports a paradoxical effect, i.e., hears better in
the presence of discharge than when the ear isdry. This is due to
round window shielding effect produced by discharge which helps to
maintain phase differential.
There is no pain, if it occurs it is due to associated otitis externa not
due to otitis media.
Since the infected area is open at both ends, discharge does not
accumulate in the middle ear cavity
Ossicular chain is mostly uninvolved, if involved only long process of
incus is involved.
318. Features of Usher's Syndrome include all
except ?
a) Night Blindness

b) Visual Impairment

c) Multiple Neurofibromas

d) Hearing deficit

Correct Answer - C
Ans. is 'c' i.e., Multiple Neurofibromas [Ref Mets MB, Young NM,
Pass A, Lasky JB (2000). "Early diagnosis of Usher syndrome in
children". Transactions of the American Ophthalmological
Society. 98: 237-45.]
Usher syndrome
Usher syndrome is a relatively rare genetic disorder caused by a
mutation in any one of at least 11 genes resulting in a combination
of hearing loss and visual impairment, and is a leading cause of
deafblindness. Usher syndrome is incurable at present.
Other names for Usher syndrome include Hallgren syndrome,
Usher-Hallgren syndrome, retinitis pigmentosa dysacusis syndrome,
and dystrophia retinae dysacusis syndrome.
This syndrome is characterized by hearing loss and a gradual visual
impairment. The hearing loss is caused by a defective inner ear,
whereas the vision loss results from retinitis pigmentosa (RP), a
degeneration of the retinal cells.Usually, the rod cells of the retina
are affected first, leading to early night blindness and the gradual
loss of peripheral vision. In other cases, early degeneration of the
cone cells in the macula occurs, leading to a loss of central acuity. In
some cases, the foveal vision is spared, leading to "doughnut
vision"; central and peripheral vision are intact, but an annulus exists
around the central region in which vision is impaired.
319. 65 year old person with hearing loss with
normal speech discrimination is
suffering from?
a) Noise induced hearing loss

b) Presbycusis

c) Ototoxic drug

d) NOHL

Correct Answer - B
Ans. is 'B' i.e., Presbycusis
Information in this question are :- (i) Old age (65 years), (ii) Hearing
loss, and (iii) Preserved speech discrimnation.
Diagnosis is Presbycusis.
Presbycusis
Presbycusis refers to sensorineural hearing loss in elderly
individuals
Characteristically, presbycusis involves bilateral high
frequency hearing loss associated with difficulty in speech
discrimination and central auditory processing information.
Four pathological types of presbycusis have been identified :-
Sensory presbycusis There is epithelial atrophy with loss of sensory
hair cells and supporting cells in the organ of corti. This
process starts in the basal turn of cochlea and slowly progress
towards the apex. Higher frequencies are affected but speech
discrimination is preserved.
Neural presbycusis :- There is atrophy of nerve cells in the cochlea
and central neural pathways. Atrophy occurs throughout the
cochlea, with the basilar region only slightly more predisposed than
the remainder of the cochlea. Therefore, no precipitous drop in
threshold on audiometry is observed. Speech discrimination is poor.
Metabolic (strial) presbycusis ;;- There is atrophy of stria vascularis.
Atrophy results in hearing loss represented by flat audiogram, but
speech discrimination is preserved.
Mechanical (cochlear conductive) presbycusis :- There is thickening
and secondary stiffening of the basilar membrane of the cochlea.
The thickening is more severe in the basal turn of cochlea where the
basilar membrane is narrow. This correlates with a gradually sloping
high frequency sensorineural hearing loss. Speech discrimination is
average.
320. Stimulation of the external auditory canal
leads to cough due to which nerve
a) Auricular branch Vagus

b) Greater auricular nerve

c) Auriculotemporal nerve

d) Facial Nerve

Correct Answer - A
Ans: A. Auricular branch Vagus nerve.
>Auricular branch of Vagus (Arnold's nerve) and Facial nerve
continues inwards to supply the posterior wall and floor of the EAC.
> The cough response caused while stimulating the ear canal is
mediated by the vagus which also supplies the larynx.
(Re/. Shambaugh, 6th ed., page 45)
321.
widening of the cartilaginous part of the extra
auditory canal called.
a) Otoplasty

b) Myringoplasty

c) Tympanoplasty

d) Meatoplasty

Correct Answer - D
Ans. (d) Meatoplasty.
Meatoplasty is an operative technique to widen the lateral
cartilaginous part of the external auditory canal.
Otoplasty- is a procedure to change the shape, position or size of
the ears.
Myringoplasty-closure of the perforation of pars tensa of the
tympanic membrane
Tympanoplasty- surgical technique to repair a defect in the
tympanic membrane with the placement of a graft, either medial or
lateral to the tympanic membrane annulus
ref:https://vula.uct.ac.za/access/content/group/ba5fb1bd-be95-
48e5-81be-586fbaeba29d/Meatoplasty.pdf
322. Tubercular Otitis media is characterized
by all except
a) Painful otorrhea

b) Multiple perforations

c) Pale granulations

d) Foul-smelling ear discharge

Correct Answer - A
Ans. A. Painful otorrhea.
>Tuberculosis of middle ear is a comparatively rare entity usually
seen in association with or secondary to pulmonary tuberculosis, the
infection reaches the middle ear through the eustachian tube
>It is characterized by painless otorrhoea which fails to respond to
the usual antimicrobial treatment
>patient with evidence of tubercle infection elsewhere followed by
multiple tympanic membrane perforations, abundant granulation
tissue, and bone necrosis, preauricular lymph node enlargement
https://www.ncbi.nlm.nih.gov/pubmed/21522113
323. Partial and full closure done in
a) Atrophic rhinitis

b) Allergic rhinitis

c) Vasomotor rhinitis

d) Occupational rhinitis

Correct Answer - A
Ans. A. Atrophic rhinitis
ATROPHIC RHINITIS
>It is a form of chronic rhinitis associated with atrophy of
nasal mucosa, mucous glands, nerves, and vessels.
>It can be primary or secondary.
>The surgical options aim to reduce the size of the roomy
cavities to prevent the exposure to drying effects of air
and crusts formation and thus help regeneration of nasal mucosa.
Full closure - Young's operation
Partial closure - Modified young's operation.
(Ref. Cummings,6th ed., 695)
324. Occipitomental view of PNS X-ray called
as
a) Caldwell view

b) Water view

c) Town view

d) Pine view

Correct Answer - B
Answer:b. Water view
Occipitomental view of PNS X-ray called as Water view