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Arab Board ENT Final Clinical & Oral study materials
Arab Board ENT Final Clinical & Oral study resources

Arab Board ENT Final Clinical & Oral practice questions

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Question 1Otology and Neuro-otology

A 45-year-old man has a unilateral pulsatile tinnitus synchronous with his heartbeat, and otoscopy shows a reddish-blue retrotympanic mass. What is the most appropriate first-line imaging investigation?

  1. High-resolution CT of the temporal bone
  2. MRI with gadolinium of the brain
  3. Carotid Doppler ultrasonography
  4. CT angiography of the temporal bone Correct answer.

Explanation

A pulsatile synchronous tinnitus with a retrotympanic mass suggests a vascular lesion, most often a glomus tympanicum or jugulare. CT angiography (or a dedicated vascular protocol) is the preferred first study because it defines the relationship to the carotid artery and jugular bulb before any intervention.

Question 2Otology and Neuro-otology

Which of the following is the most common cause of a conductive hearing loss in a child with an intact tympanic membrane and a type B tympanogram?

  1. Tympanic membrane perforation
  2. Otitis media with effusion Correct answer.
  3. Otosclerosis
  4. Cholesteatoma

Explanation

A type B tympanogram indicates absent middle ear compliance, and in children the commonest cause is middle ear effusion. Otosclerosis is rare in children and gives a type As tympanogram.

Question 3Otology and Neuro-otology

A patient presents with sudden sensorineural hearing loss in the left ear of 3 days' duration. Which of the following is the single most important initial management step?

  1. Intravenous antibiotics
  2. Immediate MRI with gadolinium
  3. Tympanostomy tube insertion
  4. High-dose oral corticosteroids Correct answer.

Explanation

Sudden sensorineural hearing loss is treated as an otologic emergency, and high-dose corticosteroids (oral or intratympanic) are the mainstay of initial therapy. MRI is arranged but does not precede corticosteroid initiation.

Question 4Otology and Neuro-otology

A 30-year-old woman has a 2-year history of episodic vertigo lasting hours, fluctuating hearing loss, tinnitus, and aural fullness in the right ear. Which diagnosis best fits this presentation?

  1. Vestibular neuritis
  2. Benign paroxysmal positional vertigo
  3. Ménière disease Correct answer.
  4. Vestibular schwannoma

Explanation

The tetrad of episodic vertigo lasting minutes to hours, fluctuating sensorineural hearing loss, tinnitus, and aural fullness is the classic presentation of Ménière disease. The episodes are typically recurrent over months to years.

Question 5Otology and Neuro-otology

Which physical examination finding is most characteristic of a peripheral (labyrinthine) cause of vertigo?

  1. Nystagmus that increases with fixation
  2. Unidirectional horizontal nystagmus suppressed by visual fixation Correct answer.
  3. Vertical down-beating nystagmus on primary gaze
  4. Direction-changing nystagmus on lateral gaze

Explanation

Peripheral vestibular nystagmus is typically horizontal with a torsional component, beats in one direction, and is suppressed by visual fixation. Central lesions show direction-changing or vertical nystagmus that is not suppressed by fixation.

Question 6Otology and Neuro-otology

A 60-year-old man has a tympanic membrane perforation with a chronically discharging ear and a soft-tissue mass in the epitympanum on examination. Which of the following is the most appropriate next step?

  1. Topical antibiotic drops and review in 6 weeks
  2. Mastoid exploration without imaging
  3. CT of the temporal bone Correct answer.
  4. Audiometry alone

Explanation

A soft-tissue mass in the epitympanum with chronic discharge raises suspicion of cholesteatoma with possible erosion of the ossicles or tegmen. CT of the temporal bone defines the extent of disease and bony erosion before surgery.

Question 7Otology and Neuro-otology

Which of the following is the most appropriate first-line treatment for benign paroxysmal positional vertigo of the posterior canal?

  1. Vestibular sedatives for 6 weeks
  2. Betahistine
  3. Epley canalith repositioning maneuver Correct answer.
  4. Intratympanic gentamicin

Explanation

Posterior canal BPPV is treated with canalith repositioning, of which the Epley maneuver is the standard. It is effective in the majority of patients and avoids the side effects of medication.

Question 8Otology and Neuro-otology

A patient has a positive Rinne test in the right ear and a negative Rinne test in the left ear with lateralization of the Weber test to the left. What does this indicate?

  1. Left sensorineural hearing loss
  2. Left conductive hearing loss Correct answer.
  3. Bilateral normal hearing
  4. Right sensorineural hearing loss

Explanation

A negative Rinne (bone conduction greater than air conduction) with lateralization of Weber to the same ear indicates a conductive loss in that ear. The right ear shows a normal positive Rinne.

Question 9Otology and Neuro-otology

Which of the following is the most common cause of facial nerve palsy following middle ear surgery?

  1. Viral reactivation
  2. Direct surgical transection
  3. Ischaemic neuropraxia from oedema Correct answer.
  4. Thermal injury from drilling

Explanation

Most postoperative facial palsies are due to neuropraxia from oedema and inflammation rather than transection. Immediate complete palsy suggests direct injury, whereas delayed palsy suggests oedema.

Question 10Otology and Neuro-otology

A 55-year-old presents with a unilateral, slowly progressive sensorineural hearing loss and reduced speech discrimination. MRI shows an enhancing mass in the internal auditory canal. What is the most likely diagnosis?

  1. Cholesteatoma of the petrous apex
  2. Glomus jugulare
  3. Meningioma of the cerebellopontine angle
  4. Vestibular schwannoma Correct answer.

Explanation

An enhancing mass within the internal auditory canal causing asymmetric progressive sensorineural hearing loss is most often a vestibular schwannoma. It arises from the vestibular division of the eighth cranial nerve.

Question 11Otology and Neuro-otology

Which of the following best describes the pathophysiology of otosclerosis?

  1. Autoimmune destruction of the stria vascularis
  2. Viral inflammation of the spiral ganglion
  3. Endolymphatic hydrops
  4. Abnormal bone remodelling at the oval window Correct answer.

Explanation

Otosclerosis is characterized by abnormal remodelling of the otic capsule bone, leading to fixation of the stapes footplate at the oval window and a conductive hearing loss. It is often familial and bilateral.

Question 12Otology and Neuro-otology

A patient with a long-standing tympanic membrane perforation and chronic otorrhoea develops vertigo and nystagmus. Which complication should be suspected?

  1. Bezold abscess
  2. Serous labyrinthitis
  3. Facial nerve palsy
  4. Labyrinthine fistula Correct answer.

Explanation

Vertigo and nystagmus in a patient with chronic suppurative otitis media and cholesteatoma suggest erosion of the lateral semicircular canal with a labyrinthine fistula. This is a surgical emergency requiring urgent imaging and repair.

Question 13Otology and Neuro-otology

Which of the following is the most appropriate treatment for a patient with acute mastoiditis and a subperiosteal abscess?

  1. Tympanostomy tube alone
  2. Observation with repeat imaging
  3. Intravenous antibiotics and urgent cortical mastoidectomy Correct answer.
  4. Oral antibiotics alone

Explanation

Acute mastoiditis with a subperiosteal abscess requires intravenous antibiotics and surgical drainage, usually a cortical mastoidectomy with myringotomy. Antibiotics alone are insufficient once an abscess has formed.

Question 14Otology and Neuro-otology

Which of the following is the most sensitive test for detecting a perilymph fistula?

  1. Fistula test with pneumatic otoscopy Correct answer.
  2. MRI of the temporal bone
  3. Electronystagmography
  4. Pure-tone audiometry

Explanation

The fistula test, performed by applying positive pressure with pneumatic otoscopy and observing for induced nystagmus or vertigo, is the classic bedside test for a perilymph fistula. A positive result supports the diagnosis but a negative test does not exclude it.

Question 15Otology and Neuro-otology

A 70-year-old presents with a 3-month history of progressive right-sided hearing loss and a right facial nerve palsy. What is the most appropriate next investigation?

  1. CT of the temporal bone without contrast
  2. Tympanometry
  3. Pure-tone audiometry
  4. MRI with gadolinium of the internal auditory meatus Correct answer.

Explanation

Progressive unilateral sensorineural hearing loss with facial palsy suggests a retrocochlear lesion, and gadolinium-enhanced MRI is the investigation of choice.

Question 16Otology and Neuro-otology

Which of the following is the most appropriate initial treatment for a patient with Ménière disease who has frequent disabling attacks despite dietary salt restriction?

  1. Vestibular nerve section
  2. Betahistine and a diuretic Correct answer.
  3. Endolymphatic sac decompression
  4. Intratympanic gentamicin

Explanation

After dietary measures, medical therapy with betahistine and a diuretic is the standard next step. Destructive and surgical options are reserved for medically refractory disease.

Question 17Otology and Neuro-otology

A patient has a conductive hearing loss with a normal tympanic membrane, a normal type A tympanogram, and a Carhart notch on audiometry. What is the most likely diagnosis?

  1. Presbycusis
  2. Otosclerosis Correct answer.
  3. Tympanosclerosis
  4. Ossicular discontinuity

Explanation

A Carhart notch (an apparent bone conduction loss at 2 kHz) with a normal tympanic membrane and type A tympanogram is characteristic of otosclerosis. Ossicular discontinuity usually follows trauma or chronic ear disease.

Question 18Otology and Neuro-otology

Which of the following is the most appropriate treatment for a patient with a small traumatic tympanic membrane perforation and no infection?

  1. Topical antibiotic drops
  2. Immediate surgical repair
  3. Paper patch myringoplasty
  4. Observation with avoidance of water entry Correct answer.

Explanation

Most small traumatic perforations heal spontaneously within weeks, so observation and keeping the ear dry are appropriate. Surgery is reserved for perforations that fail to heal after several months.

Question 19Otology and Neuro-otology

A patient with a history of chronic ear disease develops a facial nerve palsy with a swollen, tender mastoid. What is the most likely underlying pathology?

  1. Bell palsy
  2. Acoustic neuroma
  3. Ramsay Hunt syndrome
  4. Cholesteatoma eroding the fallopian canal Correct answer.

Explanation

Facial palsy in the setting of chronic suppurative otitis media or cholesteatoma suggests erosion of the bony fallopian canal by disease. Urgent imaging and surgical decompression are usually required.

Question 20Otology and Neuro-otology

Which of the following is the most appropriate treatment for a patient with a large central tympanic membrane perforation and a dry ear?

  1. Topical antibiotic drops
  2. Mastoidectomy
  3. Myringoplasty Correct answer.
  4. Tympanostomy tube

Explanation

A dry, chronic central perforation with good hearing is best managed by myringoplasty to close the defect and prevent recurrent infection. The ear must be dry before surgery.

Question 21Otology and Neuro-otology

A patient presents with vertigo, hearing loss, and vesicular rash in the external auditory canal. Which diagnosis is most likely?

  1. Ménière disease
  2. Ramsay Hunt syndrome Correct answer.
  3. Vestibular neuritis
  4. Acoustic neuroma

Explanation

Vesicular rash in the ear canal with facial palsy, vertigo, and hearing loss is characteristic of Ramsay Hunt syndrome due to varicella-zoster reactivation in the geniculate ganglion.

Question 22Otology and Neuro-otology

Which of the following is the most appropriate first-line investigation for a patient with suspected acoustic neuroma and normal pure-tone audiometry?

  1. CT of the temporal bone
  2. Auditory brainstem response
  3. MRI with gadolinium of the internal auditory canal Correct answer.
  4. Electronystagmography

Explanation

Gadolinium-enhanced MRI is the gold standard for detecting vestibular schwannoma, including small intracanalicular tumors, and is indicated even when audiometry is normal if clinical suspicion persists.

Question 23Otology and Neuro-otology

A patient with a history of a skull base fracture presents with a conductive hearing loss and a hemotympanum. What is the most likely cause?

  1. Facial nerve transection
  2. Perilymph fistula
  3. Ossicular chain disruption Correct answer.
  4. Labyrinthine concussion

Explanation

Head trauma with a conductive hearing loss and hemotympanum most often reflects ossicular chain disruption, particularly incudostapedial dislocation.

Question 24Otology and Neuro-otology

Which of the following is the most appropriate treatment for a patient with a discharging mastoid cavity after canal wall down mastoidectomy?

  1. Radiotherapy
  2. Regular aural toilet and topical antibiotic drops Correct answer.
  3. Revision surgery in all cases
  4. Systemic antifungals

Explanation

A discharging mastoid cavity is usually managed with regular aural toilet, topical antibiotic drops, and cavity care. Revision surgery is reserved for persistent disease or an inadequate cavity.

Question 25Otology and Neuro-otology

Which of the following is the most common cause of a sensorineural hearing loss in a patient with a history of meningitis?

  1. Eustachian tube dysfunction
  2. Tympanic membrane perforation
  3. Labyrinthitis ossificans Correct answer.
  4. Ossicular fixation

Explanation

Bacterial meningitis can spread to the labyrinth and cause labyrinthitis ossificans, leading to permanent sensorineural hearing loss and complicating later cochlear implantation.

Question 26Otology and Neuro-otology

A 45-year-old woman presents with episodic vertigo, fluctuating left-sided hearing loss, tinnitus, and a sensation of aural fullness. Audiometry shows a low-frequency sensorineural hearing loss in the left ear. What is the most likely diagnosis?

  1. Ménière disease Correct answer.
  2. Benign paroxysmal positional vertigo
  3. Vestibular schwannoma
  4. Vestibular migraine

Explanation

The combination of recurrent vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness is the classic tetrad of Ménière disease, which is caused by endolymphatic hydrops. The low-frequency sensorineural loss further supports this diagnosis.

Question 27Otology and Neuro-otology

A 30-year-old man presents with a sudden onset of severe right-sided hearing loss and tinnitus that woke him from sleep 2 days ago. He has no vertigo. Otoscopy is normal. What is the most appropriate initial management?

  1. Hyperbaric oxygen therapy alone
  2. Observation with repeat audiogram in 3 months
  3. High-dose oral corticosteroids Correct answer.
  4. Intratympanic gentamicin

Explanation

Sudden sensorineural hearing loss is an otologic emergency and is treated with high-dose systemic corticosteroids as soon as possible, typically within 2 weeks of onset. Intratympanic steroids may be added if systemic therapy is contraindicated or fails.

Question 28Otology and Neuro-otology

A 25-year-old man presents with a conductive hearing loss and a retracted tympanic membrane. Audiometry shows a maximal conductive loss at 2000 Hz with a Carhart notch. What is the most likely diagnosis?

  1. Ossicular discontinuity
  2. Tympanosclerosis
  3. Middle ear effusion
  4. Otosclerosis Correct answer.

Explanation

A Carhart notch, a dip in bone conduction at 2000 Hz, is a classic audiometric sign of otosclerosis, which causes progressive conductive hearing loss due to stapes fixation. The notch disappears after successful stapes surgery.

Question 29Otology and Neuro-otology

A 60-year-old woman presents with a 6-month history of progressive right-sided hearing loss and mild imbalance. MRI with gadolinium shows a 2-cm enhancing mass in the right cerebellopontine angle. What is the most appropriate initial management?

  1. Chemotherapy with bevacizumab
  2. Observation with serial MRI Correct answer.
  3. Surgical resection via translabyrinthine approach
  4. Stereotactic radiosurgery

Explanation

Vestibular schwannomas are benign, slow-growing tumors; small to medium-sized tumors without brainstem compression can be managed with observation and serial imaging, especially in older patients. Treatment is indicated for tumor growth or worsening symptoms.

Question 30Otology and Neuro-otology

A 45-year-old woman presents with a 3-day history of severe right-sided otalgia, facial weakness, and a vesicular rash in the external auditory canal and concha. What is the most likely diagnosis?

  1. Malignant otitis externa
  2. Bell's palsy
  3. Acute otitis media with facial palsy
  4. Ramsay Hunt syndrome Correct answer.

Explanation

Ramsay Hunt syndrome is caused by varicella-zoster virus reactivation in the geniculate ganglion, producing facial palsy, otalgia, and vesicles in the ear canal or auricle. It is treated with antivirals and corticosteroids.

Question 31Otology and Neuro-otology

A 35-year-old man presents with a conductive hearing loss after being slapped on the right ear. Otoscopy shows a small perforation in the pars tensa with fresh blood. What is the most appropriate initial management?

  1. Keep the ear dry and review in 4-6 weeks Correct answer.
  2. Topical antibiotic drops
  3. Oral corticosteroids
  4. Immediate myringoplasty

Explanation

Most traumatic tympanic membrane perforations heal spontaneously within 4-6 weeks. Initial management is conservative, keeping the ear dry and avoiding instrumentation; antibiotics are reserved for infection.

Question 32Otology and Neuro-otology

A 70-year-old diabetic man presents with severe, deep otalgia and purulent discharge from the right ear for 3 weeks. Examination shows granulation tissue in the floor of the external canal and a normal tympanic membrane. What is the most appropriate first-line investigation?

  1. CT scan of the temporal bone Correct answer.
  2. MRI of the brain
  3. Pure tone audiometry
  4. Tympanocentesis

Explanation

Malignant (necrotizing) otitis externa is suspected in elderly diabetic patients with severe otalgia, purulent discharge, and granulation tissue. CT of the temporal bone is the initial imaging study to assess bone erosion and disease extent.

Question 33Otology and Neuro-otology

A 50-year-old man presents with episodic vertigo triggered by rolling over in bed. The Dix-Hallpike test reproduces vertigo with a geotropic torsional nystagmus that fatigues. What is the most likely diagnosis?

  1. Vestibular neuritis
  2. Posterior canal benign paroxysmal positional vertigo Correct answer.
  3. Horizontal canal benign paroxysmal positional vertigo
  4. Ménière disease

Explanation

The Dix-Hallpike maneuver tests the posterior semicircular canal; a positive result with geotropic torsional nystagmus that fatigues is diagnostic of posterior canal BPPV. Horizontal canal BPPV is diagnosed with the supine roll test.

Question 34Otology and Neuro-otology

A 28-year-old woman presents with recurrent vertigo and left-sided hearing loss. She has a history of recurrent meningitis in childhood. Otoscopy shows a normal tympanic membrane, but pneumo-otoscopy reveals a positive fistula test. What is the most likely diagnosis?

  1. Perilymph fistula Correct answer.
  2. Vestibular neuritis
  3. Acoustic neuroma
  4. Ménière disease

Explanation

A perilymph fistula can present with vertigo and hearing loss, often after trauma or barotrauma, and may be associated with a positive fistula test (nystagmus induced by pressure). The history of recurrent meningitis suggests a possible congenital inner ear malformation with a fistula.

Question 35Otology and Neuro-otology

A 65-year-old man presents with a 1-year history of progressive right-sided hearing loss. Audiometry shows a right-sided sensorineural hearing loss with poor speech discrimination. MRI reveals a 1.5-cm mass in the right internal auditory canal. What is the most likely diagnosis?

  1. Epidermoid cyst
  2. Vestibular schwannoma Correct answer.
  3. Meningioma
  4. Glomus tumor

Explanation

Vestibular schwannoma is the most common tumor of the cerebellopontine angle and internal auditory canal, typically causing unilateral sensorineural hearing loss and tinnitus. Speech discrimination is often disproportionately poor.

Question 36Otology and Neuro-otology

A 40-year-old woman presents with a 6-month history of progressive right-sided facial weakness. Examination shows a complete right facial palsy. She also reports a 3-month history of right-sided hearing loss. What is the most appropriate next step?

  1. CT scan of the temporal bone
  2. Trial of oral corticosteroids
  3. Electromyography of the facial nerve
  4. MRI of the internal auditory canals with gadolinium Correct answer.

Explanation

Progressive facial palsy over weeks to months is suspicious for a neoplasm, such as a facial nerve schwannoma or a parotid malignancy, and warrants MRI with gadolinium to evaluate the facial nerve along its course. The associated hearing loss further suggests a lesion in the cerebellopontine angle or internal auditory canal.

Question 37Otology and Neuro-otology

A 55-year-old man presents with a 2-year history of progressive hearing loss and tinnitus in the left ear. He has no vertigo. Audiometry shows a left-sided sensorineural hearing loss. MRI shows a 3-cm mass in the left cerebellopontine angle with brainstem compression. What is the most appropriate management?

  1. Stereotactic radiosurgery
  2. Chemotherapy
  3. Surgical resection Correct answer.
  4. Observation with serial MRI

Explanation

Large vestibular schwannomas causing brainstem compression are best treated with surgical resection to relieve compression and prevent neurological deterioration. Observation and radiosurgery are options for smaller tumors.

Question 38Otology and Neuro-otology

A 30-year-old man presents with acute vertigo, nausea, and vomiting for 2 days. He has no hearing loss or tinnitus. Examination shows spontaneous horizontal nystagmus that beats to the left, and a positive head impulse test to the right. What is the most likely diagnosis?

  1. Right vestibular neuritis Correct answer.
  2. Ménière disease
  3. Left vestibular neuritis
  4. Posterior canal BPPV

Explanation

Vestibular neuritis causes acute, prolonged vertigo without hearing loss. The head impulse test is positive on the affected side, and the fast phase of nystagmus beats away from the affected side; thus a positive right head impulse test with left-beating nystagmus indicates right vestibular neuritis.

Question 39Otology and Neuro-otology

A 65-year-old woman presents with a 1-year history of progressive hearing loss and tinnitus in the right ear. She also reports occasional imbalance. Otoscopy is normal. Audiometry shows a right-sided sensorineural hearing loss. What is the most appropriate first-line investigation?

  1. Electronystagmography
  2. Pure tone audiometry
  3. MRI of the internal auditory canals with gadolinium Correct answer.
  4. CT scan of the temporal bone

Explanation

Asymmetric progressive sensorineural hearing loss in an adult raises suspicion of a retrocochlear lesion such as vestibular schwannoma, and MRI with gadolinium is the gold standard for diagnosis. It can detect small tumors within the internal auditory canal.

Question 40Otology and Neuro-otology

A 45-year-old man presents with a 6-month history of progressive right-sided hearing loss and intermittent pulsatile tinnitus. Otoscopy shows a reddish-blue mass behind the intact tympanic membrane. Audiometry shows a conductive hearing loss. What is the most likely diagnosis?

  1. Cholesteatoma
  2. Vestibular schwannoma
  3. Otosclerosis
  4. Glomus tympanicum Correct answer.

Explanation

Glomus tympanicum is a vascular tumor of the middle ear that presents with pulsatile tinnitus, conductive hearing loss, and a reddish-blue retrotympanic mass. It is the most common tumor of the middle ear.

Question 41Rhinology and Anterior Skull Base

A 45-year-old man has a biopsy-proven inverted papilloma arising from the lateral nasal wall. Which single feature most strongly mandates planning for an endoscopic medial maxillectomy rather than a limited local excision?

  1. Attachment to the maxillary sinus medial wall with extension into the sinus Correct answer.
  2. A septal deviation toward the affected side
  3. A positive skin-prick test for house dust mite
  4. Presence of unilateral nasal obstruction and bloody discharge

Explanation

Inverted papilloma arises from the sinus or lateral nasal wall mucosa, and the site of attachment determines the surgical approach. A tumour attached within the maxillary sinus requires removal of the involved wall with adequate margins, typically an endoscopic medial maxillectomy. Symptoms and incidental findings such as allergy or septal deviation do not dictate extent of resection.

Question 42Rhinology and Anterior Skull Base

Which artery is the principal vessel divided during a sphenopalatine artery ligation for refractory posterior epistaxis?

  1. Superior labial artery
  2. Sphenopalatine artery Correct answer.
  3. Anterior ethmoidal artery
  4. Facial artery

Explanation

Posterior epistaxis most commonly arises from branches of the sphenopalatine artery in the posterior nasal cavity and Woodruff's plexus. Ligation of this vessel at the sphenopalatine foramen is the standard endoscopic procedure. The anterior ethmoidal artery supplies a more superior territory and the facial artery supplies the anterior septum.

Question 43Rhinology and Anterior Skull Base

A patient with allergic rhinitis reports persistent symptoms despite a nasal steroid spray and antihistamine. Skin testing confirms sensitisation to grass pollen. Which adjunctive measure has the strongest evidence for reducing symptom burden in this setting?

  1. Long-term oral decongestant
  2. Topical nasal vasoconstrictor spray
  3. Allergen-specific immunotherapy Correct answer.
  4. Intranasal saline irrigation alone

Explanation

Allergen immunotherapy is the only disease-modifying treatment for allergic rhinitis and is indicated when pharmacotherapy is inadequate despite correct use. Saline irrigation is adjunctive and does not modify the immune response. Decongestants and vasoconstrictors provide short-term relief but risk rhinitis medicamentosa.

Question 44Rhinology and Anterior Skull Base

Which finding on CT best distinguishes an antrochoanal polyp from a simple maxillary sinus retention cyst?

  1. A soft-tissue mass expanding through the accessory ostium into the nasal cavity Correct answer.
  2. A fluid level within the sinus
  3. Thickening of the maxillary sinus mucosa
  4. Complete opacification of the maxillary sinus

Explanation

An antrochoanal polyp arises in the maxillary sinus and passes through the ostium into the middle meatus and choana, producing a characteristic dumbbell-shaped soft-tissue opacity. A retention cyst is confined to the sinus and does not extend into the nasal cavity. Mucosal thickening and fluid levels are nonspecific.

Question 45Rhinology and Anterior Skull Base

Which structure must be identified and preserved to avoid injury during endoscopic transsphenoidal pituitary surgery when opening the sphenoid sinus?

  1. The internal carotid artery promontory and optic nerve canal Correct answer.
  2. The cribriform plate
  3. The lacrimal sac
  4. The inferior turbinate

Explanation

Within the sphenoid sinus the carotid promontory and optic nerve canal are at risk and must be identified on imaging and endoscopically before opening the sella. The cribriform plate lies anteriorly and superiorly and is outside the sphenoid sinus. The lacrimal sac and inferior turbinate are anterior structures unrelated to sellar access.

Question 46Rhinology and Anterior Skull Base

A 30-year-old woman has a 6-week history of unilateral foul-smelling nasal discharge, facial pain and a blocked nostril. Endoscopy shows a purulent discharge in the middle meatus and a decayed upper molar. What is the most likely diagnosis?

  1. Allergic fungal rhinosinusitis
  2. Inverting papilloma
  3. Odontogenic maxillary sinusitis Correct answer.
  4. Granulomatosis with polyangiitis

Explanation

Unilateral foul-smelling discharge with a diseased maxillary molar points to odontogenic sinusitis, in which oral flora enter the sinus through the tooth root. Treatment requires dental management together with sinus drainage. Allergic fungal sinusitis is usually bilateral with polyposis and allergic mucin, while tumour and vasculitis have different features.

Question 47Rhinology and Anterior Skull Base

Which statement best describes the primary goal of endoscopic dacryocystorhinostomy?

  1. To create a fistula between the lacrimal sac and the nasal cavity Correct answer.
  2. To stent the nasolacrimal duct permanently
  3. To remove the lacrimal gland
  4. To excise the inferior turbinate

Explanation

Endoscopic DCR bypasses an obstructed nasolacrimal duct by fashioning an opening between the lacrimal sac and the lateral nasal wall. The lacrimal gland and turbinate are not the target. Stenting may be used temporarily but is not the aim of the procedure.

Question 48Rhinology and Anterior Skull Base

A patient develops a cerebrospinal fluid leak after endoscopic sinus surgery. Which initial management step is most appropriate once the leak is recognised?

  1. Commencing oral antibiotics and discharge home
  2. Bed rest with head elevation and endoscopic localisation of the defect Correct answer.
  3. Immediate lumbar drain insertion without nasal assessment
  4. Packing the nasal cavity with a non-absorbable nasal tampon

Explanation

Initial management of a postoperative CSF leak involves conservative measures such as head elevation and avoidance of straining while the defect is localised endoscopically. Small leaks may then be repaired with a mucosal or fascial graft. Lumbar drains and formal repair are considered after assessment, and blind packing or discharge is inappropriate.

Question 49Rhinology and Anterior Skull Base

Which of the following is the most common site of origin of juvenile nasopharyngeal angiofibroma?

  1. The sphenopalatine foramen region Correct answer.
  2. The inferior turbinate
  3. The nasal septum
  4. The frontal sinus

Explanation

Juvenile nasopharyngeal angiofibroma arises near the sphenopalatine foramen and posterior nasal cavity and extends into the nasopharynx and pterygopalatine fossa. It is a highly vascular tumour seen in adolescent males. The septum, turbinates and frontal sinus are not typical sites.

Question 50Rhinology and Anterior Skull Base

A 55-year-old man has unilateral blood-stained nasal discharge, facial numbness and a friable mass in the middle meatus. Which investigation is most important before planning biopsy?

  1. Tympanometry
  2. Plain sinus radiograph
  3. Nasal allergen testing
  4. Contrast-enhanced CT or MRI of the sinuses and skull base Correct answer.

Explanation

Unilateral bleeding with facial numbness suggests a sinonasal malignancy with possible perineural spread, so cross-sectional imaging with contrast is needed to define extent and skull-base involvement. Plain films lack sensitivity. Allergy testing and tympanometry do not address the oncological question.