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OMSB ENT (OEENT) study materials
OMSB ENT (OEENT) study resources

OMSB ENT (OEENT) practice questions

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Question 1Otolaryngology (ENT)

A 45-year-old man presents with a painless, gradually enlarging neck mass in the upper deep cervical region. Fine-needle aspiration suggests squamous cell carcinoma. Which diagnostic step should be prioritised next?

  1. Reassurance and observation with repeat ultrasound in six months
  2. Complete head and neck examination with panendoscopy and biopsy of any mucosal lesion Correct answer.
  3. Empirical antibiotic therapy for two weeks and reassessment
  4. Immediate excisional biopsy of the neck mass under general anaesthesia

Explanation

A metastatic squamous cell carcinoma in a neck node is most often from an occult mucosal primary in the upper aerodigestive tract. The correct next step is a thorough mucosal examination, including flexible endoscopy and directed biopsies of the nasopharynx, tonsils, and base of tongue. This identifies the primary before any neck surgery is planned.

Question 2Otolaryngology (ENT)

Which nerve is most at risk of injury during ligation of the inferior thyroid artery close to the thyroid gland?

  1. External branch of the superior laryngeal nerve
  2. Hypoglossal nerve
  3. Recurrent laryngeal nerve Correct answer.
  4. Glossopharyngeal nerve

Explanation

The recurrent laryngeal nerve runs in the tracheo-oesophageal groove and passes close to the inferior thyroid artery before entering the larynx. Its relationship to the artery is variable, but it is the nerve classically injured during ligation of that vessel. Injury causes vocal cord paresis and hoarseness.

Question 3Otolaryngology (ENT)

A 3-year-old child has a barking cough, inspiratory stridor, and a low-grade fever for two days. Which diagnosis is most likely?

  1. Foreign body aspiration
  2. Viral croup Correct answer.
  3. Epiglottitis
  4. Bacterial tracheitis

Explanation

Viral croup (laryngotracheobronchitis) typically presents with a barking cough, hoarse voice, inspiratory stridor, and a preceding coryzal illness. It is most common between 6 months and 3 years of age. The subglottic narrowing produces the characteristic symptoms.

Question 4Otolaryngology (ENT)

A patient with a long-standing perforation of the tympanic membrane is advised to keep the ear dry. What is the main reason for this advice?

  1. To prevent recurrent middle ear infection through the perforation Correct answer.
  2. To improve the conductive hearing loss
  3. To prevent ossicular chain fixation
  4. To reduce tinnitus

Explanation

A perforated tympanic membrane allows water and pathogens to enter the middle ear directly, increasing the risk of recurrent otitis media and chronic suppurative otitis media. Keeping the ear dry reduces this contamination. Hearing loss and tinnitus are not corrected by water avoidance.

Question 5Otolaryngology (ENT)

Which of the following best describes the Rinne test in a patient with a moderate conductive hearing loss in the left ear?

  1. Air conduction is greater than bone conduction in both ears
  2. Bone conduction is equally perceived in both ears
  3. Bone conduction is greater than air conduction in the left ear Correct answer.
  4. Air conduction is greater than bone conduction in the left ear

Explanation

In conductive hearing loss, bone conduction is preserved while air conduction is impaired, so bone conduction exceeds air conduction on the affected side. This is a negative Rinne. A positive Rinne indicates normal or sensorineural hearing.

Question 6Otolaryngology (ENT)

A 60-year-old woman has a unilateral blood-stained nasal discharge and a fleshy mass in the nasal cavity. Which investigation is most appropriate to obtain a tissue diagnosis?

  1. Endoscopic-guided biopsy of the nasal mass Correct answer.
  2. CT scan of the paranasal sinuses
  3. Serum IgE measurement
  4. Allergy skin prick testing

Explanation

A unilateral fleshy nasal mass with bloody discharge raises concern for a sinonasal neoplasm, and histological diagnosis requires tissue sampling. Endoscopic-guided biopsy allows direct visualisation and targeted sampling. Imaging is useful for staging but does not provide histology.

Question 7Otolaryngology (ENT)

A patient reports episodes of vertigo lasting 20 minutes to several hours, associated with fluctuating low-frequency hearing loss and tinnitus. Which diagnosis is most consistent with this presentation?

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

Explanation

Ménière disease is characterised by the tetrad of episodic vertigo lasting 20 minutes to hours, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. The fluctuating low-frequency hearing loss is a hallmark. Symptoms typically recur over years.

Question 8Otolaryngology (ENT)

A 25-year-old man has recurrent epistaxis from a visible vessel on the anterior nasal septum. What is the most appropriate initial management?

  1. Ligation of the external carotid artery
  2. Embolisation of the internal maxillary artery
  3. Posterior nasal packing under general anaesthesia
  4. Chemical cautery or electrocautery of the bleeding point Correct answer.

Explanation

Anterior epistaxis commonly arises from Little's area on the anterior septum, where a visible vessel can be identified. Chemical or electrocautery of the point is effective and minimally invasive. More invasive measures are reserved for refractory or posterior bleeding.

Question 9Otolaryngology (ENT)

A 4-year-old child has recurrent otitis media with effusion and a persistent middle ear effusion for four months. Which factor most strongly predisposes to this condition?

  1. Chronic tonsillitis
  2. Enlarged adenoids Correct answer.
  3. Dental caries
  4. Deviated nasal septum

Explanation

Adenoidal hypertrophy obstructs the Eustachian tube orifice and impairs middle ear ventilation, predisposing to otitis media with effusion in children. Adenoidectomy is often considered when effusion persists. Tonsillitis, septal deviation, and dental caries are not primary predisposing factors.

Question 10Otolaryngology (ENT)

A 50-year-old smoker presents with a persistent hoarse voice for six weeks. Which is the most appropriate initial investigation?

  1. Barium swallow
  2. Flexible fibreoptic laryngoscopy Correct answer.
  3. Thyroid function tests
  4. Neck ultrasound

Explanation

Persistent hoarseness beyond three weeks in a smoker requires direct visualisation of the larynx to exclude malignancy. Flexible fibreoptic laryngoscopy allows assessment of vocal cord mobility and identification of lesions. Biopsy follows if a lesion is seen.

Question 11Otolaryngology (ENT)

Which of the following statements about the blood supply of the nasal septum is correct?

  1. The entire septum is supplied by the facial artery alone
  2. The sphenopalatine artery supplies only the posterior septum
  3. Little's area is supplied by Kiesselbach's plexus including branches of the sphenopalatine artery Correct answer.
  4. The anterior ethmoidal artery is the main supply to the septum

Explanation

Kiesselbach's plexus is located in Little's area on the anterior septum and is formed by branches of the anterior ethmoidal, greater palatine, sphenopalatine, and superior labial arteries. The sphenopalatine artery contributes to this plexus. This is the commonest site of anterior epistaxis.

Question 12Otolaryngology (ENT)

A patient with a known cholesteatoma is most likely to present with which combination of findings?

  1. Attic crusting with foul-smelling discharge and conductive hearing loss Correct answer.
  2. Episodic vertigo with normal otoscopy
  3. Bilateral sensorineural hearing loss with tinnitus
  4. Serous effusion with a normal tympanic membrane

Explanation

Cholesteatoma typically presents with a retraction pocket or attic crusting, persistent foul-smelling otorrhoea, and conductive hearing loss due to ossicular erosion. The keratinising squamous epithelium erodes bone. Early recognition is important to prevent complications.

Question 13Otolaryngology (ENT)

A 35-year-old woman has a unilateral painless parotid swelling that is soft and mobile. Fine-needle aspiration shows a benign pleomorphic adenoma. What is the recommended treatment?

  1. Total parotidectomy with facial nerve sacrifice
  2. Superficial parotidectomy with facial nerve preservation Correct answer.
  3. Observation with annual ultrasound
  4. Radiotherapy to the parotid

Explanation

Pleomorphic adenoma is a benign parotid tumour with a tendency to recur if incompletely excised and a small risk of malignant transformation. Superficial parotidectomy with preservation of the facial nerve is the standard treatment. Enucleation alone increases recurrence.

Question 14Otolaryngology (ENT)

Which of the following is the most common cause of unilateral nasal obstruction with a pale, polypoid mass in an adult with asthma?

  1. Nasal polyposis Correct answer.
  2. Rhinosporidiosis
  3. Inverted papilloma
  4. Antrochoanal polyp

Explanation

Nasal polyposis is a common cause of bilateral or unilateral nasal obstruction with pale, oedematous polypoid masses, and is strongly associated with asthma and aspirin sensitivity. Polyps arise from inflamed mucosa and are usually bilateral.

Question 15Otolaryngology (ENT)

A patient presents with sudden unilateral sensorineural hearing loss. What is the most appropriate initial management?

  1. High-dose oral corticosteroids started promptly Correct answer.
  2. Tympanostomy tube insertion
  3. Vestibular sedatives alone
  4. Reassurance and review in six months

Explanation

Idiopathic sudden sensorineural hearing loss is treated with prompt high-dose corticosteroids, which improve the chance of hearing recovery. Treatment should begin as soon as possible after onset. Intratympanic steroids may be added if oral therapy is insufficient.

Question 16Otolaryngology (ENT)

A child has a unilateral foul-smelling nasal discharge and obstruction for several weeks. Which diagnosis should be considered?

  1. Adenoid hypertrophy
  2. Nasal foreign body Correct answer.
  3. Choanal atresia
  4. Allergic rhinitis

Explanation

Unilateral purulent, foul-smelling nasal discharge in a child is a classic presentation of a retained nasal foreign body. The object causes local inflammation and secondary infection. Removal resolves the symptoms.

Question 17Otolaryngology (ENT)

A 55-year-old man has a fixed, hard level II neck node with an unknown primary after negative panendoscopy and imaging. Which management approach is most appropriate?

  1. Simple excision of the node alone
  2. Observation with repeat imaging in six months
  3. Neck dissection followed by radiotherapy to the neck and potential mucosal sites Correct answer.
  4. Antibiotic treatment for six weeks

Explanation

Carcinoma of unknown primary in the neck with negative workup is managed with neck dissection and radiotherapy to the neck and at-risk mucosal sites. This addresses both the nodal disease and the occult primary. Observation or simple excision is inadequate.

Question 18Otolaryngology (ENT)

Which structure passes through the foramen ovale and is at risk during procedures on the skull base?

  1. Facial nerve
  2. Maxillary division of the trigeminal nerve
  3. Optic nerve
  4. Mandibular division of the trigeminal nerve Correct answer.

Explanation

The mandibular division of the trigeminal nerve (V3) exits the skull through the foramen ovale. It is relevant in skull base surgery and in procedures such as percutaneous trigeminal rhizotomy. Injury causes loss of sensation in the lower face and weakness of the muscles of mastication.

Question 19Otolaryngology (ENT)

A 70-year-old man has a rapidly enlarging, painful submandibular mass with overlying skin erythema. What is the most likely diagnosis?

  1. Pleomorphic adenoma
  2. Submandibular abscess Correct answer.
  3. Lymphoma
  4. Submandibular duct stone

Explanation

A rapidly enlarging, painful submandibular mass with overlying erythema suggests an abscess, often arising from sialadenitis or an obstructed duct. Urgent drainage and antibiotics are required. Imaging may be needed to assess the extent.

Question 20Otolaryngology (ENT)

Which of the following best describes the pathophysiology of obstructive sleep apnoea in an adult with obesity?

  1. Excessive daytime hyperventilation
  2. Collapse of the pharyngeal airway during sleep due to reduced muscle tone and excess tissue Correct answer.
  3. Central failure of respiratory drive during sleep
  4. Reduced lung compliance causing hypoxaemia only during exercise

Explanation

Obstructive sleep apnoea results from repeated collapse of the pharyngeal airway during sleep, driven by reduced dilator muscle tone and increased peripharyngeal soft tissue from obesity. This causes apnoeas, oxygen desaturation, and arousal. It is distinct from central apnoea.

Question 21Otolaryngology (ENT)

A 40-year-old woman has a unilateral vocal cord paralysis of unknown cause. Which imaging study is most appropriate to investigate the cause?

  1. CT scan from skull base to upper mediastinum Correct answer.
  2. Thyroid ultrasound alone
  3. MRI of the brain only
  4. Barium swallow

Explanation

Unilateral vocal cord paralysis may result from lesions along the recurrent laryngeal nerve, including skull base, neck, thyroid, and mediastinal pathology. CT imaging from skull base to upper mediastinum evaluates the entire course of the nerve. This helps identify tumours or lymphadenopathy.

Question 22Otolaryngology (ENT)

A patient with a suspected perilymphatic fistula after head trauma reports episodic vertigo and fluctuating hearing loss. Which finding would most support this diagnosis?

  1. Positive Rinne test bilaterally
  2. Profound sensorineural hearing loss with a flat tympanogram
  3. Vertigo and nystagmus provoked by pressure changes in the external auditory canal Correct answer.
  4. Bilateral high-frequency hearing loss

Explanation

A perilymphatic fistula allows abnormal communication between the inner ear and middle ear, producing vertigo and nystagmus provoked by pressure changes such as the fistula test. Hearing may fluctuate. The condition often follows head trauma or barotrauma.

Question 23Otolaryngology (ENT)

Which of the following is a recognised risk factor for laryngeal carcinoma?

  1. Chronic gastro-oesophageal reflux
  2. Cigarette smoking Correct answer.
  3. Regular voice rest
  4. Adenoidectomy

Explanation

Cigarette smoking is the strongest established risk factor for laryngeal squamous cell carcinoma, with alcohol acting synergistically. Smoking cessation reduces risk. Other factors include alcohol consumption and laryngeal papillomatosis.

Question 24Otolaryngology (ENT)

A 2-year-old child has noisy breathing that is worse on inspiration and improves when crying. Which diagnosis is most likely?

  1. Vocal cord paralysis
  2. Subglottic stenosis
  3. Laryngomalacia Correct answer.
  4. Tracheomalacia

Explanation

Laryngomalacia is the commonest cause of stridor in infants, with inspiratory stridor that is often positional and worse when supine or crying. It results from floppy supraglottic structures that prolapse during inspiration. Symptoms usually resolve by 12 to 18 months.

Question 25Otolaryngology (ENT)

A patient has a suspected cerebrospinal fluid rhinorrhoea after endoscopic sinus surgery. Which test is most useful to confirm the diagnosis?

  1. Serum electrolytes
  2. Plain radiograph of the sinuses
  3. Nasal swab culture
  4. Beta-2 transferrin assay of the nasal fluid Correct answer.

Explanation

Beta-2 transferrin is highly specific for cerebrospinal fluid and confirms CSF rhinorrhoea when detected in nasal secretions. It helps distinguish CSF from other nasal fluids. Imaging may then localise the leak.

Question 26Otolaryngology (ENT)

A 45-year-old man has a 3 cm firm, mobile mass in the left parotid tail. Fine-needle aspiration is reported as a benign pleomorphic adenoma. Which management plan is most appropriate?

  1. Superficial parotidectomy with a cuff of normal tissue Correct answer.
  2. Enucleation of the tumour through a small incision
  3. Radical parotidectomy with facial nerve sacrifice
  4. Observation with annual ultrasound for five years

Explanation

Pleomorphic adenoma is a benign but locally recurrent tumour with a pseudocapsule that is often incomplete, so enucleation leads to recurrence. Superficial parotidectomy with a margin of normal parotid tissue is the standard treatment and preserves the facial nerve. Observation is inappropriate because of progressive growth and malignant transformation over time.

Question 27Otolaryngology (ENT)

Which nerve is most commonly injured during ligation of the inferior thyroid artery in thyroid surgery, causing hoarseness?

  1. Internal branch of the superior laryngeal nerve
  2. Recurrent laryngeal nerve Correct answer.
  3. Glossopharyngeal nerve
  4. Hypoglossal nerve

Explanation

The recurrent laryngeal nerve runs in the tracheo-oesophageal groove close to the inferior thyroid artery and supplies all intrinsic laryngeal muscles except the cricothyroid. Injury produces vocal cord paresis and hoarseness. The internal branch of the superior laryngeal nerve is sensory and lies higher, near the superior thyroid vessels.

Question 28Otolaryngology (ENT)

A 30-year-old man presents with a painless, fluctuant midline neck swelling that moves upward when he protrudes his tongue. What is the most likely diagnosis?

  1. Thyroglossal duct cyst Correct answer.
  2. Branchial cleft cyst
  3. Sublingual ranula
  4. Lymphangioma

Explanation

A thyroglossal duct cyst arises from remnants of the thyroglossal tract and classically moves upward on tongue protrusion because of its attachment to the hyoid bone and tongue base. It presents as a midline neck mass in children and young adults. Treatment is Sistrunk procedure to remove the cyst, mid-portion of the hyoid and tract.

Question 29Otolaryngology (ENT)

A 28-year-old woman reports episodic vertigo, aural fullness, tinnitus and fluctuating hearing loss in the left ear. Audiometry shows a low-frequency sensorineural loss. Which finding on examination is most consistent with this diagnosis?

  1. Purulent middle ear effusion with a bulging drum
  2. Profound unilateral sensorineural loss with absent reflexes
  3. Horizontal nystagmus during an acute attack Correct answer.
  4. Positive Dix-Hallpike manoeuvre with torsional nystagmus

Explanation

The presentation is Meniere disease, in which acute attacks can be accompanied by spontaneous horizontal nystagmus. The Dix-Hallpike test is used to diagnose benign paroxysmal positional vertigo, which causes brief positional vertigo rather than prolonged episodes with hearing loss. Profound loss with absent reflexes suggests a retrocochlear lesion such as vestibular schwannoma.

Question 30Otolaryngology (ENT)

Which of the following is the most appropriate first-line treatment for a patient with acute bacterial rhinosinusitis who has severe symptoms but no signs of orbital or intracranial spread?

  1. Intravenous amphotericin B
  2. Topical nasal decongestant for four weeks
  3. Amoxicillin-clavulanate with saline irrigation and analgesia Correct answer.
  4. Immediate endoscopic sinus surgery

Explanation

For acute bacterial rhinosinusitis, especially with severe symptoms, amoxicillin-clavulanate is recommended because it covers Streptococcus pneumoniae and Haemophilus influenzae, including beta-lactamase producers. Adjunctive saline irrigation and analgesia help symptom control. Surgery is reserved for complications or failure of medical therapy.

Question 31Otolaryngology (ENT)

A 55-year-old man has a hoarse voice and a large exophytic glottic mass. Biopsy shows squamous cell carcinoma. Which factor most strongly predicts the likelihood of cervical nodal metastasis in glottic carcinoma?

  1. Degree of airway obstruction at presentation
  2. Presence of vocal cord leukoplakia
  3. Patient's smoking history in pack-years
  4. T stage and involvement of the anterior commissure Correct answer.

Explanation

The glottis has sparse lymphatic drainage, so early glottic cancers rarely metastasise. Nodal risk rises with advancing T stage and with involvement of the anterior commissure, which has lymphatics that cross to the contralateral neck. Smoking history is aetiologically important but does not directly predict nodal spread.

Question 32Otolaryngology (ENT)

A 6-year-old child has a unilateral, foul-smelling, blood-stained nasal discharge and nasal obstruction. What is the most appropriate next step in management?

  1. Rigid nasal endoscopy to look for a foreign body Correct answer.
  2. Reassurance and review in six weeks
  3. Oral antibiotics for sinusitis
  4. Immediate anterior nasal packing

Explanation

Unilateral foul-smelling nasal discharge in a child should raise suspicion of a retained nasal foreign body, which can cause local inflammation and bleeding. Rigid or flexible nasal endoscopy allows direct visualisation and removal. Antibiotics alone do not address the underlying foreign body.

Question 33Otolaryngology (ENT)

Which of the following best describes the anatomical course of the recurrent laryngeal nerve on the right side?

  1. It passes through the foramen ovale
  2. It loops around the right subclavian artery Correct answer.
  3. It loops around the aortic arch
  4. It descends anterior to the common carotid artery

Explanation

The right recurrent laryngeal nerve branches from the vagus and loops around the right subclavian artery before ascending in the tracheo-oesophageal groove. The left nerve loops around the aortic arch distal to the ligamentum arteriosum. This asymmetry explains why a right-sided thoracic lesion can cause right vocal cord palsy.

Question 34Otolaryngology (ENT)

A 40-year-old woman has a 2 cm firm, painless thyroid nodule. Fine-needle aspiration is reported as follicular neoplasm. What is the most appropriate next step?

  1. Observation with annual ultrasound
  2. Radioactive iodine ablation
  3. Repeat fine-needle aspiration in six months
  4. Diagnostic hemithyroidectomy for histology Correct answer.

Explanation

Cytology cannot distinguish a follicular adenoma from a follicular carcinoma because the diagnosis depends on capsular or vascular invasion on histology. Diagnostic hemithyroidectomy provides the surgical specimen needed to make this distinction. Repeat cytology or observation would delay diagnosis of a possible malignancy.

Question 35Otolaryngology (ENT)

A 65-year-old man has a slowly enlarging, painless parotid mass with facial nerve weakness. What does the facial weakness most strongly suggest?

  1. Sialolithiasis of the parotid duct
  2. Malignant infiltration of the nerve Correct answer.
  3. A Warthin tumour
  4. A benign pleomorphic adenoma

Explanation

Facial nerve palsy with a parotid mass is a red flag for malignancy, because benign tumours typically displace rather than invade the nerve. Malignant tumours such as mucoepidermoid carcinoma or adenoid cystic carcinoma can cause perineural invasion. The presence of palsy changes staging and surgical planning.

Question 36Otolaryngology (ENT)

A 3-year-old child has a smooth, greyish-white mass at the anterior nasal septum, and the mother reports recurrent epistaxis. What is the most likely diagnosis?

  1. Nasal septal haemangioma Correct answer.
  2. Antrochoanal polyp
  3. Juvenile nasopharyngeal angiofibroma
  4. Rhinosporidiosis

Explanation

A nasal septal haemangioma is a benign vascular lesion that can present in childhood as a smooth mass on the anterior septum with recurrent epistaxis. Juvenile nasopharyngeal angiofibroma occurs almost exclusively in adolescent males and arises in the nasopharynx. Antrochoanal polyps arise from the maxillary sinus and extend posteriorly.

Question 37Otolaryngology (ENT)

A patient has a unilateral, profuse, watery nasal discharge that increases with chewing and is associated with unilateral facial pain. Which diagnosis should be considered?

  1. Cerebrospinal fluid rhinorrhoea Correct answer.
  2. Gustatory rhinitis
  3. Vasomotor rhinitis
  4. Choanal atresia

Explanation

Profuse watery rhinorrhoea that is unilateral and worse on leaning forward or with Valsalva can indicate a cerebrospinal fluid leak, especially after trauma or surgery. The fluid should be tested for beta-2 transferrin. Vasomotor and gustatory rhinitis are usually bilateral and not associated with a clear unilateral leak.

Question 38Otolaryngology (ENT)

Which of the following is the most appropriate initial treatment for a patient with acute mastoiditis without intracranial complications?

  1. Oral antibiotics alone as an outpatient
  2. Topical antibiotic ear drops
  3. Mastoidectomy as the first step
  4. Intravenous antibiotics with myringotomy Correct answer.

Explanation

Acute mastoiditis is treated with intravenous antibiotics and drainage of the middle ear by myringotomy, which allows culture and decompression. Cortical mastoidectomy is reserved for failure to improve, abscess formation or intracranial complications. Topical drops do not penetrate to the mastoid.

Question 39Otolaryngology (ENT)

A 50-year-old woman has a unilateral, firm, painless submandibular swelling. Which investigation is most appropriate to characterise the mass?

  1. Ultrasound-guided fine-needle aspiration Correct answer.
  2. Observation for six months
  3. Open biopsy before imaging
  4. Sialography with contrast

Explanation

Ultrasound-guided fine-needle aspiration is the preferred first investigation for a submandibular mass because it is minimally invasive and provides cytology. Imaging with ultrasound or CT helps define the extent. Open biopsy is avoided because it can seed tumour and complicate later definitive surgery.

Question 40Otolaryngology (ENT)

A 70-year-old man has a rapidly enlarging, painful, erythematous submandibular swelling with fever and trismus. What is the most important immediate concern?

  1. Airway compromise from deep neck space infection Correct answer.
  2. Chronic submandibular sialadenitis
  3. Malignant transformation of a pleomorphic adenoma
  4. Sialolithiasis causing duct obstruction

Explanation

A rapidly spreading submandibular infection with trismus and fever suggests a deep neck space infection such as Ludwig angina, which threatens the airway. The priority is airway assessment and protection, followed by antibiotics and surgical drainage. Malignancy and chronic sialadenitis do not present with this acute toxic picture.

Question 41Otolaryngology (ENT)

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

  1. Middle ear cleft
  2. Sphenopalatine foramen region Correct answer.
  3. Anterior nasal septum
  4. Subglottic larynx

Explanation

Juvenile nasopharyngeal angiofibroma arises near the sphenopalatine foramen and can extend into the nasal cavity, pterygopalatine fossa and nasopharynx. It occurs almost exclusively in adolescent males and presents with recurrent epistaxis and nasal obstruction. The anterior septum, middle ear and subglottis are not typical sites.

Question 42Otolaryngology (ENT)

A patient with a suspected peritonsillar abscess has trismus and a displaced uvula. What is the most appropriate management?

  1. Immediate tonsillectomy under general anaesthesia
  2. Needle aspiration or incision and drainage with antibiotics Correct answer.
  3. Oral penicillin alone as an outpatient
  4. Observation with analgesia

Explanation

Peritonsillar abscess is treated by drainage, either needle aspiration or incision and drainage, together with antibiotics and analgesia. Immediate tonsillectomy is generally reserved for recurrent abscesses or failure of drainage. Oral antibiotics alone are inadequate for a collection.

Question 43Otolaryngology (ENT)

Which of the following is the most appropriate first-line treatment for a patient with allergic rhinitis whose symptoms are not controlled by allergen avoidance?

  1. Systemic corticosteroids for six weeks
  2. Intranasal corticosteroid spray Correct answer.
  3. Topical antibiotic nasal ointment
  4. Long-term oral decongestants

Explanation

Intranasal corticosteroids are the most effective first-line pharmacotherapy for moderate to severe allergic rhinitis. They reduce mucosal inflammation and nasal obstruction with few systemic effects. Oral decongestants are adjunctive and prolonged use is avoided.

Question 44Otolaryngology (ENT)

A 35-year-old man has a sudden onset of severe vertigo, nausea and vomiting with no hearing loss, and he cannot walk. Examination shows spontaneous horizontal nystagmus. Which diagnosis is most likely?

  1. Meniere disease
  2. Vestibular neuritis Correct answer.
  3. Benign paroxysmal positional vertigo
  4. Acoustic neuroma

Explanation

Vestibular neuritis causes acute prolonged vertigo with nausea and spontaneous nystagmus but spares hearing, because it affects the vestibular nerve rather than the cochlea. BPPV causes brief positional vertigo, and Meniere disease includes fluctuating hearing loss. Acoustic neuroma causes progressive unilateral hearing loss and imbalance rather than acute severe vertigo.

Question 45Otolaryngology (ENT)

A 2-year-old child has a barking cough, inspiratory stridor and hoarse voice after a few days of coryza. What is the most likely diagnosis?

  1. Epiglottitis
  2. Foreign body aspiration
  3. Bacterial tracheitis
  4. Croup Correct answer.

Explanation

Croup, or acute laryngotracheobronchitis, typically follows a viral upper respiratory infection and causes a barking cough, hoarseness and inspiratory stridor. Epiglottitis presents with high fever, drooling and a muffled voice rather than a barking cough. Foreign body aspiration usually causes sudden onset without preceding coryza.

Question 46Otolaryngology (ENT)

A 60-year-old woman has a unilateral blood-stained nasal discharge and a fleshy mass in the nasal cavity. Which investigation is most appropriate to establish the diagnosis?

  1. Nasal swab for bacterial culture
  2. Endoscopic biopsy of the mass Correct answer.
  3. Plain radiograph of the paranasal sinuses
  4. Serum IgE and eosinophil count

Explanation

A unilateral fleshy nasal mass with blood-stained discharge in an adult requires tissue diagnosis to exclude malignancy such as inverted papilloma or squamous cell carcinoma. Endoscopic biopsy provides histology and is the definitive investigation. Imaging and blood tests support staging but do not establish the diagnosis.

Question 47Otolaryngology (ENT)

Which of the following best explains why the left recurrent laryngeal nerve is at greater risk from mediastinal disease than the right?

  1. It is a branch of the glossopharyngeal nerve
  2. It supplies the cricothyroid muscle
  3. It has a longer intrathoracic course around the aortic arch Correct answer.
  4. It passes through the carotid sheath

Explanation

The left recurrent laryngeal nerve loops around the aortic arch and has a longer intrathoracic course, placing it at risk from mediastinal lymphadenopathy, aortic aneurysm and lung cancer. The right nerve loops around the subclavian artery and has a shorter thoracic course. Both are branches of the vagus and supply most intrinsic laryngeal muscles.

Question 48Otolaryngology (ENT)

A 45-year-old woman has a unilateral vocal cord paralysis of unknown cause. Which imaging study is most appropriate to identify a possible extralaryngeal cause?

  1. CT scan of the neck and chest Correct answer.
  2. Barium swallow
  3. Thyroid ultrasound only
  4. MRI of the brain

Explanation

Unilateral vocal cord paralysis can result from lesions along the vagus or recurrent laryngeal nerve anywhere from the skull base to the mediastinum. CT of the neck and chest evaluates the entire course, including the thyroid, oesophagus, lung apex and mediastinum. Brain MRI and barium swallow are not first-line for this purpose.

Question 49Otolaryngology (ENT)

Which of the following is the most important advantage of endoscopic sinus surgery over external approaches for chronic rhinosinusitis with polyps?

  1. It eliminates the need for CT imaging
  2. It guarantees cure of the underlying inflammatory disease
  3. It restores sinus ventilation and drainage while preserving normal mucosa Correct answer.
  4. It avoids the need for postoperative medical therapy

Explanation

Endoscopic sinus surgery opens the ostiomeatal complex and removes obstructing disease while preserving normal mucosa, restoring ventilation and drainage. It is an adjunct to medical therapy rather than a cure, and CT imaging is still required for surgical planning. Postoperative topical steroids are often needed.

Question 50Otolaryngology (ENT)

Which of the following best describes the pathophysiology of obstructive sleep apnoea in an obese adult?

  1. Collapse of the pharyngeal airway during sleep due to reduced muscle tone and increased tissue bulk Correct answer.
  2. Central failure of respiratory drive during sleep
  3. Fixed laryngeal stenosis causing obstruction in wakefulness
  4. Reduced chest wall compliance from kyphoscoliosis

Explanation

In obstructive sleep apnoea, pharyngeal dilator muscles relax during sleep and excess peripharyngeal fat narrows the airway, leading to recurrent collapse and apnoeas. Central sleep apnoea results from absent respiratory drive rather than airway obstruction. Fixed laryngeal stenosis causes stridor while awake, not typical sleep apnoea.