1.Weberfergusonapproachisusedfor? a)Mastoidectomy b)Maxillectomy c)Myringoplasty d)Mandibulectomy CorrectAnswer-BAns.B.MaxillectomyWEBERFERGUSONAPPROACH:Thisapproachinvolvesanextensionofthelateralrhinotomyincisionthatincludesthesplittingofupperlip.Indications:Exenterationofmaxillafortotalorsubtotalmaxillectomy(splittingtheupperlipreleasesthefacialflapforadequatelateralretractionandaddstransoralexposureofpalateandteeth)
2.ApatientwithearcomplaintsshowedpositiveHennebertsign.Whichofthe followingconditionshowspositiveHennebertsign? a)Meniere'sdisease b)Acousticneuroma c)Neuronitis d)Glossopharyngealneuralgia CorrectAnswer-AThepresenceofafistulaissuspectedifnystagmusoccursorifthepatientperceivesmovementofavisualtargetthatisfixedafterapplyingpositivepressuretotheouterearcanal.Apositivetestresult(ie,Hennebertsign)suggestseitheraperilymphfistulaorMeniere'sdisease.
3.Themaxillarysinusopensintomiddlemeatusatthelevelof: a)Hiatussemilunaris b)Bullaethmoidalis c)Infundibulum d)Noneoftheabove CorrectAnswer-AThemaxillarysinusisthelargestoftheparanasalsinusesandislocatedinthemaxilla,lateraltothenasalcavityandinferiortotheorbit.Themaxillarysinusopensintotheposterioraspectofthehiatussemilunarisinthemiddlemeatus.Theinfraorbitalnerve(CNV-2)primarilyinnervatesthemaxillarysinus.
4.Gradenigo'ssyndromeinvolvesallofthe followingcranialnerves,EXCEPT: a)IV b)V c)VI d)VII CorrectAnswer-AAns.A.IVGradenigo'ssyndromeischaracterizedbyfacialpain,particularlyinthefirstdivisionofthetrigeminalnerveanddiplopiaduetosixthcranialnervepalsy.Itisassociatedwithdiseaseattheapexofthepetroustemporalbonewheretheabducensnerveiscloselyrelatedtothetrigeminalnerve.Facialnervepalsyanddeafness(VIIInervepalsy)isalsoconsideredtobeapartofthissyndrome.Causesincludes:Inflammation(petrositis,possiblyspreadingfromalocalinfectionsuchasotitisormastoiditis)Tumors(cholesteatoma,chordoma,meningioma,nasopharyngealcarcinoma,metastaticdisease)Skullbasefracture
5.Ceruminousglandspresentintheearare: a)Modifiedeccrineglands b)Modifiedapocrineglands c)Mucousgland d)Modifiedholocrineglands CorrectAnswer-BAns.is.B.Modifiedapocrineglands
6.MacEwan'striangleisthelandmarkfor: a)Maxillarysinus b)Mastoidantrum c)Frontalsinus d)None CorrectAnswer-BAns.is.B.Mastoidantrum
7.Externalauditorycanalisformedby: a)1stbranchialgroove b)1stvisceralpouch c)2ndbranchialgroove d)2ndvisceralpouch CorrectAnswer-AAns.is.A.1stbranchialgroove
8.Hyperacusisisdefinedas: a)Hearingofonlyloudsound b)Normalsoundsheardasloudandpainful c)Completelydeaf d)Abilitytohearinnoisysurroundings CorrectAnswer-BSensationofdiscomfortorpainonexposuretonormalsounds.Seenininjurytonervetostapediusandincaseofcongenitalsyphilis(Hennebertsign)
9.Inelectrocochleography: a)Itmeasuresmiddleearlatency b)Outerhaircellsaremainlyresponsibleforcochlearmi crophonicsandsummationpotential c)Summationpotentialisacompoundofsynchronusauditory nervepotential d)TotalAPrepresentsendocochlearreceptorpotentialtoan externalauditorystimulus CorrectAnswer-BAns.is.B.Outerhaircellsaremainlyresponsibleforcochlearmicrophonicsandsummationpotential
10.Truestatementaboutmalignantotitis externais: a)Notpainful b)Commonindiabeticsandoldage c)Causedbystreptococcus d)Alloftheabove CorrectAnswer-BAns.is.B.Commonindiabeticsandoldage
11.OssicleM/CinvolvedinCSOM: a)Stapes b)Longprocessofincus c)Headofmalleus d)Handleofmalleus CorrectAnswer-BAns.is.B.Longprocessofincus
12.Mostcommonnervetobedamagedin CSOMis a)III b)VII c)IV d)VI CorrectAnswer-BFacialnerveistheM/CnervetobedamagedinCSOM.
13.Simplemastoidectomyisdonein: a)Acutemastoiditis b)Cholesteatoma c)Coalescentmastoiditis d)Localizedchronicotitismedia CorrectAnswer-CAns.is.C.Coalescentmastoiditis
14.Radicalmastoidectomyisdonefor: a)ASOM b)CSOM c)Atticoantralcholesteotoma d)Acutemastoiditis CorrectAnswer-CAns.is.C.Atticoantralcholesteotoma
15.LighthousesigninseeninASOMin whichstage? a)Stageofsuppuration b)Stageofhyperaemia c)Stageofresolution d)Stageofpre-suppuration CorrectAnswer-AInthestageofsupperationofASOM,pusformationoccurs,henceinthisstagepulsatileotorrheaorlighthousesigninseen.
16.Inotosclerosis,thetympanogramis: a)Lowcompliance b)Highcompliance c)Normalcompliance d)Noneoftheabove CorrectAnswer-AInotosclerosis-Astypecurveisseenwhichisalowcompliancecurve.
17.Whichfractureofthepetrousbonewill causefacialnervepalsy: a)Longitudinalfractures b)Transversefractures c)Mastoid d)Facialnerveinjuryisalwayscomplete CorrectAnswer-BAns.is.B.Transversefractures
18.FISCHclassificationisusedfor: a)Juvenilenasopharyngealangiofibroma b)Nasopharyngealca c)Vestibularschwannoma d)Glomustumour CorrectAnswer-DAclassificationsystem(A-D)describingglomustumorsbasedonanatomiclocationandsize,withlargerletteringrepresentingmoreextensivetumors.
19.Trueaboutrhinophyma: a)Premalignant b)Commoninalcoholics c)Acnerosacea d)Fungaletiology CorrectAnswer-CRhinophymaisaslow-growingbenigntumorwhichoccursduetohypertrophyofthesebaceousglands?ofthetipofthenose.Seeninlongstandingcasesofacnerosacea.Mostlyaffectsmenpastmiddleage.Presentsasapink,lobulatedmassoverthenose.TreatmentParingdownthebulkofthetumorwithasharpknife,orcarbondioxidelaserorscalpel(dermabraions),andtheareaisallowedtore-epithelize.Sometimestumoriscompletelyexcisedandtherawareaiscoveredwithskingraft.
20.WhatisaRhinolith: a)Foreignbodyinnose b)Stoneinnose c)Depositionofcalciumaroundforeignbodyinnose d)Misnomer CorrectAnswer-CRhinolithsarecalcareousmasseswhichresultduetodepositionofsalts-likecalciumandmagnesiumcarbonatesandphosphatesaroundthenucleusofaforeignbody.
21.Posteriorepistaxisoccursfrom: a)Woodruffsplexus b)Kiesselbach'splexus c)Atherosclerosis d)Littlesarea CorrectAnswer-A
22.Caldwellviewisdonefor a)Sphenoidsinus b)Maxillarysinus c)Ethmoidsinus d)Frontalsinus CorrectAnswer-DCaldwellviewistheoccipitofrontalview.Thefrontalsinusesareseenclearlyinthisview.
23.Regardingranulaallaretrueexcept: a)Retentioncyst b)Arisesfromsubmandibulargland c)Translucent d)Plungingmaybeafeature CorrectAnswer-B
24.Regardingadenoidstrueis/are: a)Thereisfailuretothrive b)Mouthbreathingisseen c)CTscanshouldbedonetoassesssize d)aandb CorrectAnswer-DHigharchedpalateandmouthbreathingarefeaturesofhypertrophiedadenoidswhichleadstoadenoidfaciesInadenoidsasaconsequenceofrecurrentnasalobstructionandURTI,childdevelopsfailuretothriveSizeofadenoidsmaywellbeassessedusinglateralradiographofnasopharynx,andCTscanisnotnecessaryAdenoids,alsoknownasnasopharyngealtonsils,aresubepithelialcollectionoflymphoidtissueatthejunctionofroofandposteriorwallofnasopharynx.
25.Trismusinparapharyngealabscessisdue tospasmof: a)Massetermuscle b)Medialpterygoid c)Lateralpterygoid d)Temporalis CorrectAnswer-BStyloidprocessdividesthepharynxintoanteriorandposteriorcompartment.Trismusoccursininfectionofanteriorcompartmentwhereastorticollis(duetospasmofparavertebralmuscles)occursintheinfectionofposteriorcompartment.
26.Inletoflarynxisformedby: a)Ventricularfold b)Aryepiglotticfold c)Glossoepiglotticfold d)Vocalcord CorrectAnswer-BThelaryngealinlet(laryngealaditus,laryngealaperture)istheopeningthatconnectsthepharynxandthelarynx.Itsbordersareformedby:thefreecurvededgeoftheepiglottis,anteriorly.thearytenoidcartilages,thecorniculatecartilages,andtheinterarytenoidfold,posteriorly.
27.AllthefollowingaretrueaboutLaryngeal carcinomaexcept: a)Morecommoninfemales b)Commoninpatientsover40yearsofage c)Afterlaryngectomy,esophagealvoicecanbeused d)bandc CorrectAnswer-ACancerLarynxMostcommonhistologicaltypeoflaryngealCa-Squamouscellcarcinoma(seenin90%cases)Itismorecommoninmales.Male:Femaleratiois4:1Mostcommonage=60-70years.
28.SelectcorrectstatementsaboutCa larynx: a)GlotticCaisthemostcommon b)Supraglotticcahasbestprognosis c)LymphaticspreadisthemostcommoninsubglotticCa d)All CorrectAnswer-AAns.is.A.GlotticCaisthemostcommon
29.Thecommonestsiteofaspirationofa foreignbodyinthesupinepositionisintothe: a)Rightupperlobeapical b)Rightlowerlobeapical c)Leftbasal d)Rightmedial CorrectAnswer-BInsupinepositionandwiththepatientonbacksuperiorsegmentofRLListhemostdependentsegment.
30.Cauliflowerearseenin: a)Hematomaoftheauricle b)Carcinomaoftheauricle c)Fungalinfectionoftheauricle d)Congenitaldeformity CorrectAnswer-ACauliflowerear(boxer'sear,wrestler'sear)isanacquireddeformityoftheouterear.Inthisinjury,theearcanshrivelupandfoldinonitselfandappearpale,givingitacauliflower-likeappearance,hencethetermcauliflowerear.Wrestlers,boxersandmartialartistsinparticulararesusceptibletothistypeofinjury.Whentheearisstruckandabloodclotdevelopsundertheskin,ortheskinisshearedfromthecartilage,theconnectionoftheskintothecartilageisdisrupted.
31.Allofthefollowingarteriescontributesto Little'sareaEXCEPT: a)AnteriorEthmoidalartery b)PosteriorEthmoidalartery c)Sphenopalatineartery d)Greaterpalatineartery CorrectAnswer-BKiesselbach'splexusItliesinKiesselbach'sarea/Kiesselbach'striangle/Little'sareaItisaregionintheanteroinferiorpartofthenasalseptumwherefourarteriesanastomosetoformavascularplexusofthatname.Thearteriesare:-AnteriorEthmoidalartery(fromtheOphthalmicartery)-Sphenopalatineartery(terminalbranchoftheMaxillaryartery)-Greaterpalatineartery(fromtheMaxillaryartery)Septalbranchofthesuperiorlabialartery(fromtheFacialartery)AlthoughthePosteriorEthmoidalarteryalsosuppliestheseptumofthenose,itdoesnotcontributetotheplexus.
32.Multipleperforationoftympanic membranecharacteristicof? a)TubercularOtitisMedia b)SyphiliticOtitisMedia c)Pseudomonasinfection d)FungalOtitisMedia CorrectAnswer-AAns.is'a'i.e.,TubercularotitismediaTubercularotitismediaTuberculosisofmiddleearisacomparativelyrareentityusuallyseeninassociationwithorsecondarytopulmonarytuberculosis,infectionreachesthemiddleearthrougheustachiantube.Theraremodesofinfectionarethroughhematogenousspreadfromtubercularfocusinlung,tonsils,cervicallymphnodes;orduetoingestionofinfectedcow'smilk.Itusuallyaffectschildrenandyoungadults.ClinicalfeaturesGenerally,tuberculosisofmiddleearisunilateral.Itischaracterizedbypainlessotorrhoeawhichfailstorespondtotheusualantimicrobialtreatment.Thereispainlesswateryotorrhea.Singleormultipleperforationoftympanicmembrane.Theremaybemultipleperforationsintheearlystages,buttheycoalesceintoalargetympanicmembraneperforationaccompaniedbyapalegranulationtissue.Periauricularfistulae,lymphadenopathyandfacialpalsyareinfrequentfindings.Latecomplicationsincludefacialparalysis,labyrinthitis,postauricularfistulae,subperiostealabscess,petrousapicitisandintracranial
extensionofinfection.
33.Anothernamefororalthrushis? a)Candidiasis b)Herpangina c)Vincent'sinfection d)Handfootandmouthdisease CorrectAnswer-AAns.is'a'i.e.,CandidiasisOralthrushAlsocalled:oralcandidiasisItisthefungalinfectionoftheoralcavity.Itiscausedbycandidaalbicans.Itmanifestsasgreyishwhitepatchesontheoralmucosaandtongue.\Whenwipedoffitleavesanerythematousmucosa.Thisismorecommonininfantsandchildren.Adultssufferingfrodiabetes,malignancy,takingbroadspectrumoralantibiotics,radiation,cytotoxicdrugsorsteroidscanalsobeaffected.Itistreatedbytopicalapplicationofnystatinorclotrimazole.ChronicHypertrophicCandidiasis(CandidialLeukoplakia)Appearsasawhitepatchintheoralcavitywhichcannotbewipedoff.Itmostlyaffectstheanteriorbuccalmucosajustbehindtheangleofmouth.Itistreatedbyexcisionofthelesion.
34.Whichofthefollowingisnottrueabout invertedpapilloma? a)Itisalwaysunilateral b)Itismorecommoninmales c)10-15%ofthecasesmaybeassociatedwithsquamouscell carcinoma d)ItisalsocalledRingertztumor CorrectAnswer-DAns.is'd'i.e.,ItisalsocalledRingertztumorInvertedPapilloma(Transitionalcellpapilloma/Schneiderionpapilloma)Invertedpapillomaisabenignneoplasmoccursmostlybetween40-70yearswithmalepreponderance(5:1).oItarisesfromthelateralwallofnoseandisalwaysunilateral.Rarely,itmayarisefromnasalseptum.oFeaturesofinvertedpapillomaare:-Itshowsfingerlikeepithelialinvasionsintotheunderlyingstromaoftheepitheliumratherthanonsurfacesocalledinvertedpapilloma.Itisusuallyunilateralandisalocallyaggressivetumour.Patientscomplainofnasalobstruction,rhinorrhea&unilateralepistaxis.In10-15%casestheremaybeassociatedsquamouscellcarcinoma.Treatmentisadequatelocalexcision.Ifitarisesinmaxillarysinus,thenaradicalantrostomyiscarriedout.Ifitarisesintheethmoidalsinus,anexternalethmoidectomyisdone.Ifitarisesfromnose,treatmentiswidesurgicalexcisionbylateralrhinotomy.Hasatendencytorecurevenafterremoval.
35.Positiveheadimpulsetestissuggestive of? a)Injurytovestibularnuclei b)Injurytoperipheralvestibularnerve c)Lesioninthebrainstem d)InjurytoOcculomotornerve CorrectAnswer-BAns.is`b'i.e.,InjurytoperipheralvestibularnerveHeadImpulseTestItisalsocalledheadthrusttest.Itistestforthediagnosisofinjurytovestibularnervewhichformstheperipheralvestibularpathway.Clinicianasksthepatienttofixhisgazeonatargetandthenperformpassivehorizontalandverticalheadimpulsesandobservesthepatient'seyes.Observationofarefixationsaccadeaftertheheadimpulseindicatesdecreaseddecreasedvestibuloocularreflexsecondarytoperipheralvestibularlesions(vestibularnerveinvolvement).
36.Conductinghearinglosswithintact tympanicmembrane? a)Presbycausis b)Meniere'sdisease c)Glueear d)Acousticneuroma CorrectAnswer-CAns.is'c'i.e.,GlueearAmongthegivenoptions,onlyglueear(serousotitismedia)isacauseofconductivedeafness.
37.Notacauseofobjectivetinnitus? a)Palatalmyoclonus b)Glomustumor c)Carotidarteryaneurysm d)Presbyacusis CorrectAnswer-DAns.is'd'i.e.,PresbyacusisTinnitusTinnitusisringingsoundornoiseintheear.Thecharacteristicfeatureisthattheoriginofthissoundiswithinthepatient.
38.Lengthofexternalauditorymeatusis? a)12mm b)16mm c)20mm d)24mm CorrectAnswer-DAns.is'd'i.e.,24mmExternalauditorycanal(Externalacousticmeatus)Externalauditorycanalisa'S'shapedcanalwithlengthof24-25mmanditisdividedintotwoparts:?1)CartilagenouspartItformsouter/lateral1/3(8mm)oftheexternalauditorycanal.Ithastwofissures/deficienciesintheanteriorpartcalledfissureofsantorinithroughwhichparotidorsuperficialmastoidinfectioncanappearinthecanalandviceversa.Skincoveringitisthickandhasceruminousglands(modifiedapocrinesweatglands),pilosebaceousglandsandhair.Sincehairisconfinedtocartilaginouspart,furunclesareseenonlyintheouterthirdofthecanal.2)BonypartItformsinner/medial2/3(16mm)ofexternalauditorycanal.Skinliningthebonypartisthinandisdevoidofhairandceruminousglands.Isthmusisthenarrowestportionofbonycanalandis5mmlateraltotympanicmembrane.Foreignbodiesgetlodgedinisthmusaredifficulttoremoveasitisthenarrowestpart.`ForamenofHuschke'isadeficiencypresentinantero-inferiorpartofbonycanalinchildrenupto4yearsofage,permittinginfectiontoandfromparotid.
39.Whichofthefollowingisfalseregarding frontalsinusitis? a)Painshowsperiodicity b)Mostcommonsinusinvolvedininfantsandchildren c)Painisreferredtoasofficeheadache d)Tendernessispresentjustabovethemedialcanthusofeye CorrectAnswer-BAns.is'b'i.e.,MostcommonsinusinvolvedininfantsandchildrenMostcommonsinusinvolvedininfantandchildrenisEthmoidsinus.ClinicalfeaturesofacutesinusitisMostcommonpresentingpatient'scompliantispersistentnasaldischargewhichcanbeofanyquality(thin,thick,clear,orpurulent).Nasaldischargefromasinusinfectioncanbeblood-tingedfromexcessivenoseblowingandirritation.Theclinicalsymptomsofacutesinusitishavebeenclassifiedintomajorandminor.
40.Minitracheostomyisperformedthrough? a)Cricothyroidmembrane b)2ndand3rdtrachealrings c)Anyoftheabove d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,CricothyroidmembraneCricothyrotomyorLaryngtomyorMinitracheostomyItistheproceduretoopentheairwaythroughthecricothyroidmembrane.Patient'sheadandneckareextended,lowerborderofthroidcartilageandcricoidringisidentified.Skininthisareaisincisedverticallyandthencricothyroidmembraneisopenedwithatransverseincision.Itisanemergencyproceduretobuytimeforthepatienttobeshiftedtotheoperationtheatre.
41.Whichofthefollowingisincludedinthe Levensoncriteriaforcongenitalcholesteatoma? a)Whitemassmedialtonormaltympanicmembrane b)Atticoantralperforationofthetympanicmembrane c)Definitehistoryofotorrhoea d)Historyofpriorotologicprocedures CorrectAnswer-AAns.is'a'i.e.,WhitemassmedialtonormaltympanicmembraneLevensoncriteriaforcongenitalcholesteatoma 1. WhitemassmedialtonormalTM.2. Normalparsflaccidaandtensa.3. Nohistoryofotorrheaorperforations.4. Nopriorotologicprocedures.5. Priorboutsofotitismedianogroundforexclusions.
42.Whichofthefollowingisfalseregarding Frey'ssyndrome? a)Itisalsocalledgustatorysweating b)Itiscausedbyinjurytoauriculotemporalnerve c)Itoccursimmediatelyaftertheparotidsurgery d)Itiscausedbyaberrantregenerationofpost CorrectAnswer-CAns.is'c'i.e.,ItoccursimmediatelyaftertheparotidsurgeryFrey'ssyndrome(gustatorysweating)GustatorysweatingorFrey'ssyndromeinvolvespost-parotidectomyfacialsweatingandskinflushingwhileeating.Thesymptomsusuallyoccurseveralmonthsorevenyearsafterparotidsurgery.Thelikelypathophysiologyisaberrantregenerationofpostganglionicsecretomotorparasympatheticnervefibres(originatingfromtheoticganglion)misdirectedthroughseveralaxonalsheathsofpost-ganglionicsympatheticfibresfeedingthesweatglands.Thesesympatheticfibresaretothesweatglandsoftheskininthedissectedfield.Thefrey'ssyndromeislikelyduetoinjurytoauriculotemporalnervewithfaultyregeneration,thereforeFrey'ssyndromeisalsoknownasAuriculotemporalsyndrome.AvariantofFrey'ssyndromeinwhichthereisgustatoryfacialflushingbutnotsweating,occursfollowingfacialparalysisduetofaultyregenerationfollowinginjurytothefacialnerve.So,Frey'ssyndromeisnotlimitedtoparotidsurgerywithinjurytoauriculotemporalnerve.
43.Mostcommoncauseoftrigeminal neuralgia? a)Infection b)Trauma c)Vascularcompression d)Iatrogenic CorrectAnswer-CAns.is'c'i.e.,VascularcompressionTrigeminalneuralgia(ticdouloureux)ischaracterizedbyintermittent,shootingpainintheface.Itisduetoinvolvementoftrigeminalnerve.95%ofcausesoftrigeminalneuralgiaareduetopressureontrigeminalnerveclosetowhereitentersthebrainstem,pasttheGasserianganglion.Inmostcases,thispressureseemstobecausedbyanarteryorveincompressingtrigeminalnerve.Othercausesaretumor,cysts,AVmalformationandmultiplesclerosis.Mostcommonlyuseddrugsfortreatmentoftrigeminalneuralgiaarecarbamazepine,gabapentinandvalproate.
44.Patientwiththinpainlessotorrhoea, multipleperforationsofthetympanicmembraneandfailuretorespondtoantimicrobialtreatment.Whatisthemostprobablecausativeorganism? a)Mycobacteriumtuberculosis b)Staphylococcusaureus c)Candidaalbicans d)Aspegillusfumigatus CorrectAnswer-AAns.is'a'i.e.,MycobacteriumtuberculosisThinpainlessotorrhoea,multipleperforationsofthetympanicmembraneandfailuretorespondtoantimicrobialtreatmentarethefeaturesoftubercularotitismediaanditiscausedbyMycobacteriumtuberculosis.
45.Synkinesisisasequelof? a)Facialnerveparalysis b)Trigeminalnerveparalysis c)Superficialtemporalnerveparalysis d)GreaterPetrosalnerveparalysis CorrectAnswer-AAns.is'a'i.e.,FacialnerveparalysisClinicalfeaturesofBell'spalsyAcuteonset,ipsilateralfacialparalysis.Facialparalysisisusuallyprecededbypainbehindtheear.Patientisunabletoclosehiseyes.Bellsphenomenon,i.e.onattemptingtoclosetheeye,eyeballturnsupandout.Facebecomesasymmetricalandsalivadribblesfromangleofmouth.Ipsilaterallossoftastesensation,salivationandlacrimation.Intolerancetohighpitchedorloudsound(hyperacusis).Mostpatients(80%)recoverwithinfewweekstomonths.SynkinesisandcrocodileteararesequelaeofBell'spalsy:-SynkinesisorfacialsynkinesisisacommonsequelaetoBell'spalsy.Thisisduetocrossinnervationofnervefibresduringrecovery.Whenthepatientwishestoclosetheeye,cornerofmouthalsotwichesandviceversa.Crocodiletear(gustatorylacrimation)isduetofaultyregenerationofparasympatheticfibreswhichnowsupplylacrimalglandinsteadofthesalivaryglands.
46.Sagograinappearanceisseenin? a)Healedmyringitisbullosa b)Otomycosis c)Malignantotitisexterna d)Keratosisobturans CorrectAnswer-AAns.is'a'i.e.,HealedmyringitisbullosaOtitisexternahaemorrhagicaThisconditionisalsoknownasBullousmyringitisormyringitisbullosa.Thisconditionisextremelypainfulandhassuddenonset.Itisthoughttobeduetomycoplasmapneumoniaeorviralinfection,usuallyinfluenza'.Theremaybeamildconductivedeafnessandamildlydischargingcar.Theappearanceofhaemorrhagicbullaeonthetympanicmembraneandinthedeepmeatusischaracteristic.Thebullaearefilledwithserosanguinousfluidandblood.Onhealing,bullaelooklikeSago-grain.Therefore"Sago-grain"appearanceoftympanicmembraneisseeninhealedmyringitisbullosa.
47.Followingisthepreferredtreatmentof SerousOtitisMedia- a)Grommetsurgery b)OralAmoxicillinfor5-10days c)Modifiedradicalmastoidectomy d)Bedrest,antipyreticsandadequatefluidintake CorrectAnswer-AAns.is'a'i.e.,GrommetsurgeryTreatmentofotitismediaFollowingtwotreatmentshavebeendescribed:?1)WatchfulwaitingWatchfulwaitingistheactivemonitoringoftheconditionandhearinginanticipationofspontaneousresolution.Guidlinesaimedatbothprimarycareandspecialistotolaryngologistbroadlyagreethatawatchfulwaitingperiodforaboutthreemonthsistheinitialmanagementofchildrenwithserousotitismedia.Therefore,unlesstherearealsosignsofaninfection,mosthealthcareproviderswillnottreatSOMatfirstInstead,theywillrechecktheproblemin2-3months.ThisshouldbecoupledwithreassurancethatdoingnothingisaslikelyasdoingsomethingtoresultinresolutionoftheSOMandtheassociatedsymptoms.2)SurgerySurgicalinterventionisrecommendedwhenwatchfulwaitingandmonitoringofhearinghasconfirmedfailureofresolutionofSOM.Followingsurgicalinterventionareusedcommonly:- i. Myringotomyandaspirationoffluid:-Anincisionismadeintympanic membraneandfluidaspiratedwithsuction. ii. Grommet(ventilationtube)surgery:-Ifmyringotomyandaspiration
combinedwithmedicalmeasureshasnothelpedandfluidrecurs,agrommetisinsertedtoprovidecontinuedaerationofmiddleear.ThisisthemostcommonsurgicalinterventionforSOM.Mostpreferedsiteofgrommetinsertionisantero-inferiorthroughcircumferentialorradialincision. iii. Surgicaltreatmentofcausativefactor:-Adenoidectomy, tonsillectomyetc.Medicalmeasuresarecontroversialandinvolve:? 1. Decongestants2. Antiallergicmeasures3. Antibiotics4. Middleearaeration:-Valsalvamaneuver,Politzerisationor eustachiantubecatheterization,Chewinggum.
48.WhenapatientsaysAhtherightuvula pressesthepalatewhichofthefollowingnerveisdamaged? a)RghtXCN b)RightXIICN c)LeftXCN d)RightXIICN CorrectAnswer-CAns.is'c'i.e.,LeftXCNAssessmentofthemovementofsoftpalate-BothIXandXCNsaretested:Theglossopharyngealnerve(IXCN)isamixednervewithmotor,sensoryandsomeparasympatheticactivity.Itcarriessensoryinputfromthepalateandpharynxandthetastefromtheposteriorthirdofthetongue.Itprovidesafferentlimbofthegagreflex.Thevagus(XCN)isalsoamixednervewithmotor,sensoryandparasympatheticactivity.Itprovidesthemotorsupplytothepharynx,softpalateandlarynxandprovidestheefferentlimbtothegagreflex.Normallyonoralexaminationthesoftpalateissymmetricalwiththeuvuladanglinginthecentreanddividingthesoftpalate.WhenthepatientisaskedtosayAAAh!Thesoftpalateshouldelevatesymmetricallyandtheuvulashouldremaincentric.Ifthereisunilateralweaknessofthesoftpalatetheuvulaispulledawayfromtheweakenedside.Nowinthequestiongivenwhenthepatientsaysaaahtherightuvulapressesthepalatei.e.therightsidesoftpalatepullstheuvulaawayfromtheweakleftside.Theweaknessoftheleftsoftpalate
awayfromtheweakleftside.TheweaknessoftheleftsoftpalatecanbebecauseoftheweaknessoftheleftIXorXcranialnerves.
49.Lumpyfeelinginthroatrelievedontaking foodisattributedto? a)Globuspharyngeus b)Pharyngealpouch c)Diverticulardisease d)Esophagealatresia CorrectAnswer-AAns.is'a'i.e.,GlobusPharyngeusGlobusPharyngeusSymptomwhereinapatientdescribessomethingstuckinthroatorasensationoflumportightnessinthroatwhichisrelievedbytakingfoodortalking.
50.Glomusjugularecommonlyarisesfrom? a)Hypotympanum b)Mesotympanum c)Epitympanum d)Prussaksspace CorrectAnswer-AAns.is'a'i.e.,HypotympanumTherearetwotypesofglomustumors:-i)GlomusjugulareTheseglomustumorsarisefromthedomeoftheinternaljugularveininthehypotympanumandjugularforamen.InjugularforamentheycaninvadeIXtoXIIcranialnerves.ii)GlomustympanicumTheyarisefromthepromontoryofthemiddleearalongthecourseofthetympanicbranchoftheIXthcranialnerve.
51.Gradenigosyndromeischaracterizedby allexcept? a)Diplopia b)Retro-orbitalpain c)Persistenteardischarge d)Vertigo CorrectAnswer-DAns.isdi.e.,VertigoInfectionofmastoidandmiddleearmaybecomplicatedbythespreadofinfectionwithinthetemporalboneintopetrousapex.Petrositisisanextensionofinfectionfrommiddleearandmastoidtothepetrouspartofthetemporalbone.Gradenigo'ssyndromeistheclassicalpresentationandconsistsofatriadof:-Externalrectuspalsy(VIthnerve/abducentnervepalsy)causingdiplopia.Deepseatedorbitalorretroorbitalpain(Vthnerveinvolvement).Persistenteardischargeduetoipsilateralacuteorchronicotitismedia.Associatedsymptomsofotitismediaarealsopresente.g.,conductivedeafness.Othersymptomsarefever,headache,vomiting,andsometimesneckrigidity.Somepatientmaygetfacialparalysisandrecurrentvertigoduetoinvolvementoffacialandstatoacousticnerves.
52.Atticoantraldiseaseistreatedby? a)Modifiedradicalmastoidectomy b)Antibiotics c)Grommetinsertion d)Synringing CorrectAnswer-AAns.is'a'i.e.,ModifiedradicalmastoidectomyTreatmentofatticoantraldiseaseSincecholesteatomaisgoingtoexpandanddestroyboneandmucousmembrane,ithastoberemoved.Therefore,surgeryisthemainstayoftreatment.Primaryaimisremovalofdiseasebymastoidectomytomakeearsafefollowedbyreconstructionofhearingatalaterstage.Modifiedradicalmastoidectomyisthesurgeryofchoice.Twotypesofsurgicalprocedures(mastoidectomy)aredonetodealwithcholesteatoma.1)CanalwalldownproceduresTheseleavethemastoidcavityopenintotheexternalauditorycanalsothatthediseasedareaisfullyexteriorized.Thecommonlyusedproceduresforatticoantraldiseaseareatticotomy,modifiedradicalmastoidectomyandrarelyradicalmastoidectomy.Modifiedradicalmastoidectomyistheprocedureofchoice.2)Canalwallupprocedures(corticalmastoidectomy)Herediseaseisremovedbycombinedapproachthroughthemeatusandmastoidbutretainingtheposteriorbonymeatuswall,therebyavoidinganopenmastoidcavity.Forreconstructionofhearingmechanismmyringoplastyor
tympanoplastycanbedoneatthetimeofprimarysurgeryorasasecondstageprocedure.
53.Samterstriadisseeninpatientswith? a)Asthma b)Chronicpancreatitis c)Crohn'sdisease d)Livercellcarcinoma CorrectAnswer-AAns.is'a'i.e.,AsthmaSamter'striadSamter'striadisamedicalconditionconsistingofasthma,aspirinsensitivity,andnasal/ethmoidalpolyposis.Itoccursinmiddleage(twentiesandthirtiesarethemostcommononsettimes)andmaynotincludeanyallergies.Mostcommonly,thefirstsymptomisrhinitis.Thedisordertypicallyprogesestoasthma,thenpolyposis,withaspirinsensitivitycominglast.Theaspirinreactioncanbesevere,includinganasthmaattack,anaphylaxis,andurticariainsomecases.PatientstypicallyreacttootherNSAIDSsuchasibuprofen,althoughparacetamolisgenerallyconsideredsafe.Anosmia(lackofsmell)isalsotypical,astheinflammationreachestheolfactoryreceptorsinthenose.
54.Strawberrytongueisseenin? a)Streptococcalscarletfever b)Kawasakidisease c)Bothoftheabove d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,BothoftheaboveStrawberrytongueItisalsocalledraspberrytongueItbasicallyreferstoglossitis,whichmanifestswithhyperplastic(enlarged)fungiformpapillae,givingtheappearanceofastrawberry.Whitestrawberrytongueiswherethereisawhitecoatingonthetonguethroughwhichthehyperplasticfungiformpapillaeprotrude.Redstrawberrytongueiswherethewhitecoatingislostandadarkred,erythematoussurfaceisrevealed,interspacedwiththehyperplasticfungiformpapillae.Whitestrawberrytongueisseeninearlyscarletfever(asystemicinfectionofgroupAhemolyticstreptococci).Redstrawberrytongueoccurslater,after4-5days.Otherconditionsinwhichstrawberrytongueisseenare:Kawasakidisease,toxicshocksyndrome,andvitaminB12deficiency.
55.Allaretrueforgradenigo'ssyndrome except? a)Associatedwithintermittenteardischarge b)Associatedwithconductivehearingloss c)Causesdiplopia d)Leadstoretroorbitalpain CorrectAnswer-AAns.is'a'i.e.,AssociatedwithintermittenteardischargeGradenigo'ssyndrome,alsocalledGradenigo-Lannoissyndrome,isacomplicationofotitismediaandmastoiditisinvolvingtheapexofthepetroustemporalbone.
SymptomsComponentsofthesyndromeinclude:retroorbitalpainduetopainintheareasuppliedbytheophthalmicbranchofthetrigeminalnerve(fifthcranialnerve),abducensnervepalsy(sixthcranialnerve)otitismediaOthersymptomscanincludephotophobia,excessivelacrimation,fever,andreducedcornealsensitivity.Thesyndromeisclassicallycausedbythespreadofaninfectionintothepetrousapexofthetemporalbone.
56.Treatmentofmiddleearpapillomais? a)Myringotomyandsimpleexcision b)Myringectomyandsimpleexcision c)Tympanomastoidectomy d)Localinfiltrationwithpodophyllin CorrectAnswer-CAns.is'c'i.e.,TympanomastoidectomyMiddleearpappilomasThemiddleearpapillomasarerarepresentationsandmedicalliteratureismainlylimitedtocasereportsorcaseseries.Theseincludeaggressivepappilarytumors,schneideriantypeofpappilomasandinvertedpappilomas.TheyareassociatedwithhearingdifficultyandvertigoandmaybeassociatedwithVonHippelLindausyndrome.Theytendtobeslowlygrowing,locallyaggressivenonmetastasizingneoplasmsTheapproachfortreatmentofsuchpathologyisusuallyradicalandtympanomastoidectomyisconsideredthetreatmentofchoice.Thisgivesthebestchanceofcure.
57.Besttimeforhearingassessmentinan infant? a)1stmonthoflife b)3-6months c)6-9months d)9-12months CorrectAnswer-AAns.is'a'i.e.,1stmonthoflifeTheAmericanAcademyofPediatrics(AAP),JointCommitteeonInfanthearing(2007),hasrecommendedthatallnewborninfantsbescreenedforhearingimpairmenteitherasneonateorbefore1monthofageandthatthoseinfantswhofailnewbornscreeninghaveanaudiologicexaminationtovarifyhearinglossbeforeageof3months.
58.Darwintubercleisseenin? a)Tragus b)Helix c)Antihelix d)Lobule CorrectAnswer-BAns.is'b'i.e.,HelixDarwin'stubercle(orauriculartubercle)isacongenitalearconditionwhichoftenpresentsasathickeningonthehelixatthejunctionoftheupperandmiddlethirds.Thefeatureispresentinapproximately10.4%ofthepopulation.Thisacuminatenodulerepresentsthepointofthemammalianear.
59.Trottertriadnotincludedis? a)Conductivedeafness b)Temporoparietalneuralgia c)Palatalparalysis d)Seizures CorrectAnswer-DAns.is'd'i.e.,SeizuresTrotter'striadTrotter'striadoccursinnasopharyngealcarcinomaItincludes:-i)Conductivedeafness(duetoEustachiantubeblockage)ii)Temporo-parietalneuralgia(duetoinvolvementofipsilateralVthcranialnerve)iii)Palatalparalysis(duetoinvolvementofXthcranialnerve)
60.Followingproteinisnotfoundinorganof corti? a)Myosin b)Microtubuleassociatedprotein2 c)Microtubuleassociatedprotein4 d)Fodrin CorrectAnswer-CAns.is'c'i.e.,Microtubuleassociatedprotein4ProteinspresentincochleaActin-bindingandmicrotubule-associatedproteinsregulatemicrofilamentandmicrotubulenumber,length,organizationandlocationincells.Infreeze-driedpreparationsoftheguineapigcochlea,bothactinandtubulinarefoundinthesensoryandsupportingcellsoftheorganofCorti.Fodrin(brainspectrin)co-localizedwithactininthecuticularplatesofbothinnerandouterhaircellsandalongthelateralwalloftheouterhaircells.Alpha-actininco-localizedwithactininthecuticularplatesofthehaircellsandintheheadandfootplatesofthesupportingcells.Itwasalsofoundinthejunctionalregionsbetweenhaircellsandsupportingcells.oProfilinco-localizedwithactininthecuticularplatesofthesensoryhaircells.Myosinwasdetectedonlyinthecuticularplatesoftheouterhaircellsandinthesupportingcellsintheregionfacingendolymph.Gelsolinwasfoundintheregionofthenervefibers.TubulinisfoundinmicrotubulesinallcellsoftheorganofCorti.Insupportingcells,microtubulesarebundledtogetherwithactin
microfilamentsandtropomyosin,aswellasbeingpresentasindividualmicrotubulesarrangedinnetworks.Anintenselystainednetworkofmicrotubulesisfoundinbothouterandinnersensoryhaircells.Themicrotubulesintheouterhaircellsappeartocoursethroughouttheentirelengthofthecells,andbasedontheirstainingwithantibodiestothetyrosinatedformoftubulintheyappeartobemoredynamicstructuresthanthemicrotubulesinthesupportingcells.Themicrotubule-associatedproteinMAP-2ispresentonlyinouterhaircellswithintheorganofCortiandco-localizeswithtubulininthesecells.NootherMAPs(1,3,4,5)arepresent.Tauisfoundinthenervefibersbelowbothinnerandouterhaircellsandintheosseousspirallamina.
61.Followingistrueaboutlaryngomalacia except? a)Omegashapedepiglottis b)Reassuaranceofthepatientisthetreatmentofchoice c)Conditionisfirstnoticedinthefirstfewweeksoflife d)Expiratorystridor CorrectAnswer-DAns.is'd'i.e.,ExpiratorystridorLaryngomalaciaItisthemostcommoncongenitalabnormalityofthelarynx.Laryngomalaciaisthemostfrequentcauseofstridorornoisybreathingininfants.Itoccursasaresultofafloppyportionofthelarynx(insupraglotticlarynx)thathasnotyetdevelopedthestrengthtoproviderigidsupporttotheairway.Duringinspirationnegativepressureiscreatedthroughlarynx,whichresultsinacollapseofthesestructuresintotheairwayandanarrowerbreathingpassage.Partialobstructionisthesourceofthenoisewithbreathing(stridor),andsometimescyanosis.Thehallmarksignincludesintermittentstridormostlyininspiration.Itisusuallymoreprominentwhentheinfantislyingonhis/herback(supineposition,crying,feeding,excitedorhasacold.Stridorgetsrelievedonplacingthepatientinproneposition.Thisisusuallyfirstnoticedinthefirstfewweeksoflife.Itmayworsenoverthefirstfewmonthsandbecomelouder.Thisisbecauseasthebabygrows,inspiratoryforceisgreater,whichcausesgreatercollapseofthelaryngealstructuresintotheairway.Thisisusuallyworstat3-6monthsandthengraduallyimprovesastherigidityofthecartilageimproves.
Mostchildrenaresymptomfreeby1to2years.Sometimes,cyanosismayoccur.Directlaryngoscopyshows:-Omegashapedepiglottis,i.e.elongatedandcurledonitself.Floopy,tall,foreshortenedandthinaryepiglotticfolds.Prominentarytenoids.Inmostpatientslaryngomalaciaisaselflimitingcondition.Treatmentoflaryngomalaciaisreassurancetotheparentsandearlyantibiotictherapyforupperrespiratorytractinfections.
62.Followingarethelaboratorytestsforthe diagnosisofvestibulardysfunctionexcept? a)Electronystagmography b)Optokinetictest c)Galvanictest d)Gelle'stest CorrectAnswer-DAns.is'd'i.e.,Gelle'stestVestibularsystemThevestibularsystemcontributestobalanceandtothesenseofspatialorientation.Itisasensorysystemthatprovidestheleadingcontributionaboutmovementandsenseofbalance.Itincludesthelabyrinth(semicircularcanalsandotolith:utricle&sacules)oftheinnerearandissituatedinthevestibulumintheinnerear.Thesymptomsofvestibulardysfunctionarevertigo,dizzinessandUnbalance.
63.InapatientwithCSOM,labrynthinefistula mostcommnonlyinvolves? a)SuperiorSCC b)LateralSCC c)PosteriorSCC d)Utricle CorrectAnswer-BAns.is'b'i.e.,LateralSCCLabrynthinefistulaisalmostexclusivelyreportedinassociationwithchronicotitismediaandcholesteatoma.Themostcommonlyaffectedcanalislateral(horizontal)semicircularcanal,butinvolvementoftheposteriorandsuperiorcanalsaswellasotherregionsoflabyrinthhavebeenreported.Theincidenceoflabrynthinefistulainchronicotitismediaisapproximately10%.
64.Horizontalaccelerationwithforward movementinthesagittalplaneisdetectedby? a)MaculaofUtricle b)MaculaofSaccule c)Lateralsemicircularcanal d)Posteriorsemicircularcanal CorrectAnswer-AAns.is'a'i.e.,Maculaofutricle
65.Patientpresentswithmouthbreathing, recurrentserousotitismediaandadenoidfacies.Whatisthebestlineofmanagement? a)Adenoidectomy b)Tonsillectomy c)Antibiotics d)Supportivetherapy CorrectAnswer-AAns.is'a'i.e.,AdenoidectomyThetriadofnasalandauralsymptomswithadenoidfaciespointstothediagnosisofenlargedadenoids.Forthetreatmentofenlargedadenoidswhensymptomsarenotmarkedbreathingexcercise,decongenstantnasaldropsandantihistaminicsareusedandwhensymptomsaremarked,adenoidectomyisdone.Wehaveapatientwithmarkedandrecurrentsymptomsthusadenoidectomyisthetreatmentofchoice.
66.Whichofthefollowingorganismsis knowntocauseAtrophicrhinitis? a)Klebsiellaozaena b)Klebsiellapneumonia c)Streptococcuspneumonia d)Streptococcusfoetidis CorrectAnswer-AAns.is'a'i.e.,KlebsiellaozaenaAtrophicrhinitis(Ozaena)Atrophicrhinitisisachronicinflammationofnosecharacterizedbyatrophyofnasalmucosa,includingtheglands,turbinatebonesandthenerveelements.Atrophicrhinitismaybeprimaryorsecondary:?1)PrimaryatrophicrhinitisTheprimarypathologyisinflammationandatrophyofthenose.Generally,atrophicrhinitisreferstoprimaryatrophicrhinitis.Causesare:-i)Hereditaryii)Endocrinalpathology-Startsatpuberty.Stopsaftermenopauseiii)Racialfactors-SeenmoreinWhitesandYellowracesiv)Nutritionaldeficiency-DeficiencyofvitaminA,D,Eandironmayberesponsibleforit.v)Infective-Klebsiellaozanae,Diphtheriods,P.vulgaris,E.coli,Staphylococci,Streptococci.vi)Autoimmuneprocess-Causingdestructionofnasal,neurovascularandglandularelementsmaybethecause.2)SecondaryatrophicrhinitisSpecificinfections,suchassyphilis,lupus,leprosy,and
rhinoscleroma,maycausedestructionofthenasalstructuresleadingtoatrophicchanges.Canalsoresultsfromlongstandingpurulentsinusitis,radiotherapyofnose,excessivesurgicalremovaloftheturbinateandascomplicationofDNSontherootsideofnose.
67.Potatotumordueto? a)Hypotrophyofsebaceousglandsofnose b)Hypertrophyofsebaceousglandsofnose c)Hypotrophyofsweatglandsofnose d)Hpertrophyofsweatglandsofnose CorrectAnswer-BAns.is'b'i.e.,HypertrophyofsebaceousglandsofnoseRhinophyma(Potatotumor)Rhinophymaislarge,bulb-shaped,red-colored(ruddy)nose.Itisaslowgrowingbenigntumorduetohypertrophyofthesebaceousglands.Thecauseofrhinophymaisunknown,thoughitisthoughttobeasevereformofacneroscea.Rhinophymawasoncethoughttobecausedbyheavyalcoholconsumption,butthisisnotthecase.Rhinophymaoccursequallyinthosewhodonotdrinkatallandthosewhodrinklargequantitiesofalcohol.Itmostlyaffectsmenpastmiddleage.Red/pinkcolourofthetumorisduetoengorgmentofsuperficialvessels.TreatmentSurgerytoreshapethenoseisthebestknowntreatmentforrhinophyma.Surgerymaybedonewithalaser(carbondioxidelaser),scalpel(sharpknife)orarotatingbrush(dermabrasion)andtheareaisallowedtore-epithelialize.Sometimes,tumouriscompletelyexcisedandtherawareaisskin-grafted.
68.Rhinitismostcommonbacterialcause? a)Haemophilusinfluenza b)Streptococcushaemolyticus c)Pasturellamultocida d)Cornybacteriumdiphtheria CorrectAnswer-AAns.is'a'i.e.,HaemophilusinfluenzaAcutebacterialrhinitisismostcommonlyseenamongchildren,butadultmaydeveloptheconditionafternasaltrauma,viralupperrespiratorytractinfection,orsurgery.Theclinicalpresentationofacutebacterialrhinitismaybeidenticaltothatofcommoncold.MostcommoncausativeorganismsincludeS.pneumoniae,H.influenzaeandMoraxellaCatarrhalis.Note:Overall,mostcommoncauseofinfectiverhinitisisviralinfection(viralrhinitis).
69.Surgicalmarkingsforfindingthefacial nerveisare? a)Tympano-mastoidsuture b)Tragalpointer c)Posteriorbellyofdigastric d)Alltheabove CorrectAnswer-AAns.is'a'i.e.,Tympano-mastoidsutureSurgicallandmarkstoidentifymaintrunkofthefacialnerveareasfollows: i. Tympanomastoidsutureline-itislocatedbetweenthemastoidand thetympanicbones.Themainfacialtrunklies6-8mmdistaltotheendofthesuture. ii. Tragalpointer-themainnervetrunklies1.0to1.5cmdeepand slightlyanteriorandinferiortothetipoftheexternalearcanalcartilage. iii. Posteriorbellyofdigastric-themainnervetrunklies1cmdeepto themedialattachmentoftheposteriorbellyofdigastricmuscletothedigastricgroove(mastoidnotch)ofthemastoidbone. iv. Mastoidbone-mainnervetrunkisidentifiedinsidethemastoid bonebymastoidectomy.
70.
Centralpartofcholesteatomacontains? a)Keratindebris b)Keratinizedsquamousepithelium c)Coulmnarepithelium d)Fibroblasts CorrectAnswer-AAns.is'a'i.e.,KeratindebrisCholesteatomaDestructiveorexpandinggrowthinthemiddleearormastoidprocessThetermcholesteatomaisamisnomer,becauseitneithercontainscholesterolcrystalsnorisitatumortomeritthesuffix`oma'.Cholesteatomahasthepropertytodestroybone.Itmaycausedestructionofearossicles,erosionofbonylabyrinth,canaloffacialnerve,sinusplateortegmentympaniandthuscauseseveralcomplications.Bonedestructionbycholesteatomahasbeenattributedtovariousproteolyticenzymesliberatedbyosteoclastsandmononuclearinflammatorycells,seeninassociationwithcholesteatoma.Cholesteatomaconsistsoftwoparts:?i)Matrix:-Madeupofkeratinizingsquamousepithelium.ii)Keratindebris(centralwhitemass):-Producedbythematrix.Therefore,cholesteatomaalsoreferredtoasepidermosisorkeratoma.
71.Whichofthefollowingisnotacauseof oropharyngealcarcinoma? a)Occupationalexposuetohydrochloricacid b)Smoking c)HumanPapillomaVirusinfection d)Occupationalexposuretoisopropyloil CorrectAnswer-AAns.is'a'i.e.,OccupationalexposuretohydrochloricacidEtiologyoforopharyngealcarcinoma i. Tobaccoinanyform-cigarettesmokingorchewing ii. Heavyalcoholabuse iii. Beetlenutchewing iv. Plummervinsonsyndrome,cirrhosis v. Syphilis vi. Trauma vii. Dentalirritation viii. Poororalhygiene ix. Occupationalexposuretoisopropylalcohol,sulphuricacidand nickel x. HPVinfection
72.Falseregardingtheforeignbodyof oropharynxis? a)Impactedforeignbodiesmostoftenlodgeinthesofttissueat thebaseoftongue b)Foodparticlesarethemostcommonoropharyngealforeign bodiesinchildren c)Clinicalhypopharyngealforeignbodiesareamenabletoclinical examination d)EndoscopyandMDCTareusedinthediagnosis CorrectAnswer-BAns.is'b'i.e.,FoodparticlesarethemostcommonoropharyngealforeignbodiesinchildrenOropharyngealforeignbodiesMostingestedforeignbodiesdonotimpactintheoropharynxSharpforeignbodieslikefishandchickenbonesmostcommonlyimpactinthesofttissuesatthebaseofthetongue.Hypopharyngealforeignbodiescanbedetectedbygoodphysicalexamination.EndoscopyandMDCTareusedinthediagnosisofforeignbodiesofcervicalesophagus.Coinsarethemostcommonimpactedoropharyngealforeignbodiesencounteredinchildrenfollowedbyfoodparticles.
73.NotatestforEustachiantubepatency? a)Tympanometry b)Toynbee c)Valsalva d)Frenzelmaneuver CorrectAnswer-AAns.is'a'i.e.,TympanometryTestsforEustachiantubepatencyValsalvatestMethylenebluetestSonotubometryPolitzertestToynbeetestFrenzelmaneuverCatheterizationInflation-Deflationtest
74.Tympanoplastydealswithreconstruction of- a)Tympanicmembrane b)Ossicularchain c)Bothaandb d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,BothaandbTympanoplastyisthesurgicaloperationperformedforreconstructionoftympanicmembraneand/ormiddleearossicles.Myringoplastyisthereconstructionoftympanicmembrane.Ossiculoplastyisthereconstructionofossicularchain.Tympanoplasty=Myringoplasty?ossiculoplasty
75.MostcommonorganismculturedinCSOM is? a)Staphylococcusaureus b)Staphylococcusepidermidis c)Streptococcuspneumonia d)Pseudomonasaeruginosa CorrectAnswer-DAns.is'd'i.e.,PseudomonasaeruginosaMicrobiologyofCSOMPuscultureinbothtypesofaerobicandanaerobicCSOMmayshowmultipleorganisms.Mostcommonlyisolatedorganismsaregramnegativebacilli,i.e.,Pseudomonas,proteus,E.coli.Theseorganismsarenotcommonlyfoundintherespiratorytract,whilecommonlyfoundintheskinofexternalear.
76.Fowlsmellingnasaldischargeisseenin allexcept? a)NasalMyiasis b)Choanalatresia c)Foreignbodyinnose d)Rhinolith CorrectAnswer-BAns.is`b'i.e.,ChoanalatresiaDiseaseswithfowlsmellingnasaldischargeare:NasalmyiasisForeignbodyinnoseRhinolithInchoanalatresiathereispresenceofnasaldischargewithoutairbubbles.
77.Rhinoscleromaoccursdueto? a)Autoimmunecause b)Inflammatorycause c)Klebsiellarhinoscleromatisinfection d)Mycoticinfection CorrectAnswer-CAns.is'c'i.e.,KlebsiellarhinoscleromatisinfectionRhinoscleromaThecausativeorganismisKlebsiellarhinosclerontatisorFrischbacillus,whichcanbeculturedfromthebiopsymaterial.Thediseaseisendemicinseveralpartsofworld.InIndia,itisseenmoreofteninnorthernthaninthesouthernparts.Biopsyshowsinfiltrationofsubmucosawithplasmacells,lymphocytes,eosinophils,Mikuliczcells&Russellbodies.Thelattertwoarediagnosticfeaturesofthedisease.Thediseasestartsinthenose&extendstonasopharynx,oropharynx,larynx,trachea&bronchi.Modeofinfectionisunknown.Bothsexesofanyagemaybeaffected.
78.Cauliflowerearisdueto? a)Hematoma b)Carcinoma c)Fungalinfection d)Herpes CorrectAnswer-AAns.is'a'i.e.,HematomaHematomaoftheauricleItisthecollectionofbloodbetweentheauricularcartilageanditsperichondrium.Itusuallyoccursduetoblunttraumaandoftenseeninboxers,wrestlersandrugbyplayers,thereforeitisalsocalledBoxer'sear.Extravasatedbloodmayclotandthenorganise,resultingintypicaldeformitycalled,Cauliflowerear.Ifhaematomagetsinfected,severeperichondritismaysetin.
79.Fowlsmellingeardischargewith presenceofpalegranulationtissueinearinanadolescentboyissuggestiveof? a)Cholesteatoma b)Exostosis c)Otomycosis d)Malignantotitisexterna CorrectAnswer-AAns.is'a'i.e.,CholesteatomaFowlsmellingeardischargewithpresenceofgranulationtissueinearinadolescentboyissuggestivechronicsuppurativeotitsmediaoftheunsafetype(atticoantraldisease).Suchpatientshaveunderlyingcholesteatomaalongwithevidenceofbonedestruction.Clinicalfeaturesofcholesteatoma/atticoantralCSOMOtorrhoea:-Scanty,foulsmellingdischargeduetobonedestruction.Hearingloss:-Initiallyconductiveduetodestructionofossicles.Latersensorineuralelementmaybeadded,whichresultsinmixedhearingloss.Bleeding:-Mayoccurfromgranulationorthepolypwhencleaningtheear.Tympanicmembraneshowposteriormarginaloratticperforation.Alsogranulationtissueandpolypsmaybepresentinear.
80.Complicationoftraumatodangerareaof face? a)Cavernoussinusinfection b)Meningitis c)Visualloss d)Lossofmemory CorrectAnswer-AAns.is'a'i,e.,CavernoussinusinfectionTheareaofupperlipandthelowerpartofnoseisthedangerareaofface.Itisduetothatthisareaisthecommonsiteofinfection.Thisareaisdrainedbyfacialveinwhichcommunicateswiththecavernoussinusthroughthesuperiorophthalmicveinandpterygoidvenousplexusthroughtheemissaryvein.Incaseofanyinfectionofthisareaitmayspreadtothecavernoussinuscausinginfectionand/orthrombosis.
81.Presenceofdeltasignoncontrast enhancedCTSCANsuggestspresenceof? a)LateralSinusthrombophlebitis b)Cholesteatoma c)Cerebellarabscess d)Mastoiditis CorrectAnswer-AAns.is'a'i.e.,LateralSinusthrombophlebitisLATERALSINUSTHROMBOPHLEBITIS(SIGMOIDSINUSTHROMBOSIS)Lateralorsigmoidsinusthrombophlebitisarisesfrominflammationintheadjacentmastoid.Itmayoccurasacomplicationof:? i. Acutecoalescentmastoiditis ii. CSOMandcholesteatoma ClinicalfeaturesHecticPicket-Fencetypeoffeverwithrigor.Headache,Progressiveanemiaandemaciation.Griesinger'ssign:-odemaovertheposteriorpartofmastoidduetothrombosisofmastoidemissaryveins.PapilloedemaTobey-Ayertest:-CompressionofveinonthethrombosedsideproducesnoeffectwhilecompressionofveinonhealthysideproducesrapidriseinCSFpressurewhichwillbeequaltobilateralcompressionofjugularveins.Crowe-Becktest:-Pressureonjugularveinofhealthysideproducesengorgementofretinalveins.Pressureonaffectedsidedoesnot
producesuchchange.TendernessalongjugularveinImagingstudiesContrast-enhancedCTscancanshowsinusthrombosisbytypicaldelta-sign.Itisatriangularareawithrimenhancement,andcentrallowdensityareaisseeninposteriorcranialfossaonaxialcuts.Delta-signmayalsobeseenoncontrastenhancedMRI.
82.Ostmannfatpadisrelatedto? a)Earlobule b)Buccalmucosa c)Eustachiantube d)Tipofnose CorrectAnswer-CAns.is'c'i.e.,EustachiantubeTherearesmallfatbodieslocatedinfermedialtoEustachiantube.ThesearecalledOstmannfatpads.Theyareimportantinnormalclosureofeustachiantubeandpreventingtransmissionofnasopharyngealpressuretomiddleear.ThesefatpadsareabsentinPatuloustubesyndrome.
83.Whichofthefollowingstructuresisnotat immediateriskoferosionbycholesteatoma? a)Longprocessofincus b)Fallopiancanalcontainingfacialnerve c)Horizontal/lateralsemicircularcanal d)Baseplateofstapes CorrectAnswer-DAns.is'd'i.e.,BaseplateofstapesCholesteatomahasthepropertytodestroythebonebyvirtueoftheenzymesreleasedbyit.Structuresimmediatelyattheriskoferosionare:- i. Longprocessofincus. ii. Fallopiancanalcontainingfacialnerve. iii. Horizontal/lateralsemicircularcanal
84.Whenthepatientfailstounderstand normalspeech,butcanunderstandshoutedoramplifiedspeechthehearingloss,istermed? a)Mildhearingloss b)Moderatehearingloss c)Severehearingloss d)Profoundhearingloss CorrectAnswer-CAns.is'c'i.e.,SeverehearinglossSeverehearinglossWhatisseverehearingloss?Onaverage,themostquietsoundsheardbypeoplewiththeirbettereararebetween70and95dB.Peoplewhosufferfromseverehearinglosswillbenefitfrompowerfulhearingaids,butoftentheyrelyheavilyonlip-readingevenwhentheyareusinghearingaids.Somealsousesignlanguage.
85.Mostcommonsiteforcarcinomapharynx infemalessufferingfromplummervinsonsyndromeis a)Postcricoidregion b)Posteriorwall c)Lateralwall d)Pyriformisfossa CorrectAnswer-AAns.is'a'i.e.,PostcricoidPlummer-VinsonsyndromePlummer-Vinsonsyndrome,alsoknownasBrown-Kelly-Patersonsyndromeorsederopenicdysphagia,seeninmiddleagededentulouswomen.TheplummerVinsionPatersonBrownKellySyndromeischaracterizedby:-DysphagiaChronicirondeficiencyanemiaAtrophicoralmucosaandglossitisBrittle,spoon-shapedfingernails(Koilonychia)Thecauseofdysphagiaisusuallyacervicalesophagealweb,butabnormalpharyngealandesophagealmotilitymayplayarole.Thesyndromecharactersticallyoccursinmiddleagededentulous(withoutteeth)women.Itisapremalignantlesion.Approximately10%ofpatientdevelopsquamouscellCaofesophagus,oralcavityorthehypopharynx.Asiron-deficiencyanemiaisacommonfinding,itisalsoknownassideropenicdysphagia.
Carcinomadevelopsinpost-cricoidregion.
86.Pyriformfossaissituatedin? a)Oropharynx b)Hypopharynx c)Nasopharynx d)Noneoftheabove CorrectAnswer-BAns.is'b'i.e.,HypopharynxPyriformfossaisapartoflaryngopharynx(hypopharynx)
87.Incisuraterminalisisbetween? a)Tragusandcruxofhelix b)Earlobuleandantihelix c)Antihelixandexternalauditorymeatus d)Tragusandearlobule CorrectAnswer-AAns.is'a'i.e.,TragusandcruxofhelixIncisuraternzinalisistheareabetweenthetragusandcrusofhelix
88.Graftformyringoplasty a)Temporalisfascia b)Iliacusfascia c)Colesfascia d)Ihotibialband CorrectAnswer-AAns.is'a'i.e.,TemporalisfasciaGraftmaterialusedformyringoplastyare: i. Temporalisfascia(mostcommon) ii. Tragalcartilage iii. Perichondriumfromthetragus iv. Vein
89.Whichofthefollowingisnotaderivative ofthemiddleearcleft? a)Semicircularcanal b)Mastoidaircell c)Tympaniccavity d)Eustachiantube CorrectAnswer-AAns.is'a'i.e.,SemicircularcanalThemiddle-earcleftinthetemporalboneincludes:? i. Eustachiantube ii. Themiddleear(tympaniccavity) iii. Adituswhichleadsposteriorlytothemastoidantrumandaircells.
90.
Exostosisduetorepetitiveexposuretocoldwateriscommoninwhichpartofthetemporalbone? a)Squamouspart b)Tympanicpart c)Ptreouspart d)Mastoidpart CorrectAnswer-BAns.is'b'i.e.,TympanicpartSurfer'searItisthecommonnameforanexostosisorabnormalbonegrowthwithintheexternalauditorycanal.Surfer'searisnotthesameasswimmer'sear,althoughinfectioncanresultasasideeffect.Irritationfromcoldwindandwaterexposurecausesthebonesurroundingtheearcanaltodeveloplumpsofnewbonygrowthwhichconstricttheearcanal.Theconditionissonamedduetoitsprevalenceamongcoldwatersurfers.Coldwatersurfersexperiencesurfer'searataboutsixtimestherateofwarmwatersurfers.Commonsiteforsurfer'searisexternalauditorycanal.TympanicpartofthetemporalboneisaUshapedcurvedbonyplatethatformsmostofthepartoftheexternalauditorycanal.Thusexostosisiscommoninthetympanicpartofthetemporalbone.Note:Partsoftemporalboneare:squamous,tympanic,styloid,petrous,andmastoid.
91.Ohgren'slinepassesfrom? a)Medialcanthustoangleofmandible b)Lateralcanthustoangleofmandible c)Medialcanthustomastoidprocess d)Lateralcanthustomastoidprocess CorrectAnswer-AAns.is'a'i.e.,Medialcanthustoangleofmandible
92.Passavantridge? a)Superiorconstrictorandpalatopharyngeus b)Inferiorconstrictorandpalatopharyngeus c)Superiorconstrictorandpalatoglossus d)Inferiorconstrictorandpalatoglossus CorrectAnswer-APassavantridgeNearthesuperiormarginofpharynx,afewfibresofsuperiorconstrictorblendwithabandofmusclefibresbelongingtothepalatopharyngeusmuscle.Thesefusedfibresformabandorringaroundtheposteriorwallandsidewallsofthenasopharyngealisthumus.Whenthesoftpalateiselevatedthismusclebandappearsasaridgeisknownaspassavant'sridge.
93.Rhinolithcancause a)Nasalobstruction b)Epistaxis c)Epiphora d)Alloftheabove CorrectAnswer-DArhinolithisacalculuspresentinthenasalcavity.Thewordisderivedfromtherootsrhino-and-lith,literallymeaning"nosestone".Arhinolithusuallyformsaroundthenucleusofasmallexogenousforeignbody,bloodclotorsecretionbyslowdepositionofcalciumandmagnesiumsalts.Overaperiodoftime,theygrowintolargeirregularmassesthatfillthenasalcavity.Theymaycausepressurenecrosisofthenasalseptumorlateralwallofnoseleadingtonasalobstruction,epistaxis,headache,sinusitisandepiphora.
94.Allofthefollowingaretrueabout malignantotitisexternaexcept: a)ESRisusedforfollowupaftertreatment b)Granulationtissuesareseenonsuperiorwalloftheexternal auditorycanal c)Severehearinglossisthechiefpresentingcomplaint d)Pseudomonasisthemostcommoncause CorrectAnswer-CAns.c.SeverehearinglossisthechiefpresentingcomplaintSeverehearinglossisnotthechiefpresentingcomplaintmalignantotitisexterna.MalignantOtitisExterna:Characterizedbygranulationtissueinexternalauditorycanalatthejunctionofboneandcartilage.MCorganismzPseudomonasaeruginosaESRisraised,usedforfollowupoftreatment
95.AllaretrueaboutRhinoscleroma,except ? a)Mikuliczcells b)Causedbyfungus c)MorecommoninNorthernarea d)Woodynose CorrectAnswer-BAns.is'b'i.e.,CausedbyfungusRhinoscleromaiscausedbyabacterium.RhinoscleromaThecausativeorganismisKlebsiellarhinoscleromatisorFrischbacillus,whichcanbeculturedfromthebiopsymaterial.Thediseaseisendemicinseveralpartsofworld.InIndia,itisseenmoreofteninnorthernthaninthesouthernparts.Biopsyshowsinfiltrationofsubmucosawithplasmacells,lymphocytes,eosinophils,Mikuliczcells&Russellbodies.Thelattertwoarediagnosticfeaturesofthedisease.Thediseasestartsinthenose&extendstonasopharynx,oropharynx,larynx,trachea&bronchi.Modeofinfectionisunknown.Bothsexesofanyagemaybeaffected.ClinicalfeaturesofrhinoscleromaThediseaserunsthroughthefollowingstages:?a.Atrophicstage:Itresemblesatrophicrhinitisandischaracterisedbyfoulsmellingpurulentnasaldischargeandcrusting.b.Granulomatousstage:Granulomatousnodulesforminnasalmucosa.Thereisalsosubdermalinfiltrationoflowerpartofexternalnoseandupperlipgivinga'woody'feel.Nodulesarepainlessand
non-ulcerative.c.Cicatricialstage:Thiscausesstenosisofnares,distortionofupperlip,adhesionsinthenose,nasopharynxandoropharynx.Theremaybesubglotticstenosiswithrespiratorydistress.Biopsyofrhinoscleromashowsinfiltrationofsubmucosawithplasmacells,lymphocytes,eosinophils,MikuliczcellsandRussellbodies.Thelattertwoarethediagnosticfeaturesofthedisease.TreatmentBothstreptomycin&tetracyclinearegiventogetherforminimumof4-6wks.Steroidcanbecombinedtoreducefibrosis.Surgicaltreatmentmayberequiredtoestablishtheairwayandcorrectnasaldeformity
96.Associatedwithobjectivetinnitus? a)Meinersdisease b)Acousticneuroma c)Earwax d)Glomustumor CorrectAnswer-DAns.is`d'i.e.,GlomustumorTinnitusTinnitusisringingsoundornoiseintheear.Thecharacteristicfeatureisthattheoriginofthissoundiswithinthepatient.Twotypesoftinnitushavebeendescribed:?a.SubjectiveI.OtologicII.Non-otologicImpactedwaxDiseaseofCNSFluidinthemiddleearAnaemiaAcuteandchronicotitismediaArteriosclerosisAbnormallypatenteustachiantubeHypertensionMeniere'sdiseaseHypotensionOtosclerosisHypoglycaemia
97.Whichdrugistobegiveninatruckdriver forrhinitis? a)Cetrezine b)Hydroxyzine c)Promethazine d)Buclizine CorrectAnswer-AAns.is'a'i.e.,Cetrezine
98.Schwartzesignseenin? a)GlomusJugulare b)Otosclerosis c)Meniere'sdiseases d)Acousticneuroma CorrectAnswer-BAns.is'b'i.e.,OtosclerosisSymptomsofotosclerosisHearingloss:-Bilateralconductivedeafnesswhichispainlessandprogressivewithinsidiousonset.Incochlearotosclerosissensorineuralhearinglossalsooccuralongwithconductivedeafness.Paracusiswillissii:-Anotoscleroticpatienthearsbetterinnoisythanquietsurroundings.Tinnitus:-Morecommonincochlearotosclerosis.Speech:-Monotonous,wellmodulatedsoftspeech.Vertigo:-isuncommon.SignsinotosclerosisTympanicmembraneisquitenormalandmobile.In10%ofcasesflamingo-pinkblushisseenthroughthetympanicmembranecalledasSchwartzesign.Varioustestsshowconductivehearingloss.TuningforktestsinotosclerosisAsotoscleroticpatientshaveconductivedeafness,thetuningforktestsresultswillbeasfollows:? 1. Rinnes:-Negative2. Webers:-Lateralizedtotheearwithgreaterconductiveloss.3. Absoluteboneconduction(ABC):-Normal(canbedecreasedin
cochlearotosclerosis). 4. Gellestest:-Nochangeinthehearingthroughboneconduction whenairpressureofearcanalisincreasedbySiegle'sspeculum.AudiometryinotosclerosisAudiometryisoneoftheimportanttoolsinevaluationofapatientofotosclerosis.Variousaudiometrictestsare:?1.Puretoneaudiometry 1. Showslossofairconduction,moreforlowerfrequencieswith characteristicrisingpattern.Boneconductionisnormal.Howeverinsomecases,thereisadipinboneconductioncurvewhichismaximumat2000Hz(2KHz)andiscalledtheCarhart'snotch.2.ImpedanceaudiometryImpedanceaudiometryshows:-TympanometryPatientwithearlydiseasemayshowtypeAtympanogram(becausemiddleearareationisnotaffected)ProgressivestapesfixationresultsinclassicalAstypetympanogram.Acoustic(stapedialreflex)Itisoneoftheearliestsignofotosclerosisandpreceedesthedevelopmentofairbonegap.Inearlystage,diphasicon-offpatternisseeninwhichthereisabriefincreaseincomplianceattheonsetandattheterminationofstimulusoccurs.Thisispathognomonicofotosclerosis.Inlaterstagethereflexisabsent.
99.Galle'stestisusedfor? a)Otosclerosis b)Juvenileangiofibroma c)Nasalpolyp d)None CorrectAnswer-AAns.is'a'i.e.,OtosclerosisGelle'stestItisaboneconductiontestandexaminestheeffectofincreasedairpressureinearcanalonhearing.Increasedairpressureinearcanal(bySiegle'sspeculum)pushesthetympanicmembraneandossiclesinwardswhichraisestheintralabyrinthinepressureandcausesimmobilityofbasilarmembraneanddecreasedhearing.However,ifearossiclesarealreadyfixedordisconnected,thepressurecannotbetransferedtoinnerearNochangeinhearinginthissituation.Baseofvibratingtuningforkisplacedonmastoidprocessandairpressureinearcanalincreased(bySiegle'sspeculum).Interpretationare:-PositiveGelle's(decreasedhearingonincreasedpressure)Normalorsensorineuralhearingloss.h)NegativeGelle's(Noeffectofpressurechangeinhearing)Disconnectedorfixedossicularchain.
100.Maculaisstimulatedby? a)Gravity b)Headpositionchange c)Linearacceleration d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveVestibularapparatus(Peripheralpartofvestibularsystem)Thevestibularapparatuswithintheinnereardetectsheadmotionandpositionandtransducesthisinformationtoaneuralsignal.Thevestibularapparatushasfollowingparts:-
101.Paranasalsinusespresentatbirth? a)Frontalandmaxillary b)Ethmoidandmaxillary c)Frontalandethmoid d)Sphenoidandethmoid CorrectAnswer-BAns.is'b'i.e.,EthmoidandmaxillaryMaxillarysinus4Developatbirth;completelydevelopat9yearsEthmoidalsinusDevelopatbirth;completelydevelopatlatepubertyFrontalsinusDevelopat2year;completelydevelopatlateadolescenceSpenoidsinusDevelopat3-5years;completelydevelopat12-15years
102.Mostcommonboneaffectedby otosclerosis a)Externalauditorycanal b)Bonylabyrinth c)Mastoidprocess d)None CorrectAnswer-BAns.is'b'i.e.,BonylabyrinthOtosclerosisisaprimarydiseaseofthebonylabyrinth.Thereisabnormalbonegrowththatcauseshearingloss.Thereisalteredboneremodeling.Normally,thetypicalhumanoticcapsuleremodelingrateisextremelylow.Inotosclerosis,normalinhibitionofboneremodelingislostresultinginfociofboneremodeling.Whenremodeledbonebridgesthestapediovestibularjoint,itfixatesthejointandimpedessoundtransmissionmanifestedasconductivehearingloss.Themostcommonsiteofdiseaseispromontoryintheregionoftheanteriormarginofovalwindow,andinadvancedcasesthestapesbecomeankylosedinpositionbyamassofnewspongybone.Othersites,whichmaybeinvolved,areroundwindowarea,stapedialfootplate,internalauditorycanal,andsemicircularcanal.
103.Bestviewfornasalbone? a)Lateral b)Towne's c)Cald-well d)Submentovertical CorrectAnswer-AAns.is'a'i.e.,Lateral
104.Lomard'stestisusedtodiagnosis? a)Conductivehearingloss b)Sensorineuralhearingloss c)Mixedhearingloss d)Non-organichearingloss CorrectAnswer-DAns.is'd'i.e.,Non-organichearingloss
105.Trueaboutserousotitismediaareall except? a)Alsocalledglueear b)Affectschoolgoingchildren c)TypeCtympanogram d)Fluidinmiddleear CorrectAnswer-CAns.is`c'i.e.,TypeCtympanogramSerousotitismediaSerousotitismedia(SOM)hasmanysynonyms:Serousotitismedia,otitismediawitheffusion,glueear,non-suppurativeotitismedia,mucoidotitismedia,silentotitismedia.SOMisaninsidiousconditioninwhichthereisthickorstickynon-purulentfluidbehindtheeardruminthemiddleear,butthereisnoearinfection,i.e.,effusionofmiddleearwithoutinfection.Fluidinthemiddleearissterile.SOMoccursmostcommonlyinschoolgoingchildrenandSOMisthecommonestcauseofchildhoodhearingloss.Etiopathogenesis1.EustachiantubedysfunctionEustachiantubedysfunction,coupledwithrecurrentupperrespiratorytractinfectionisthemostimportantfactorinthedevelopmentofSOM.Normallyeustachiantubehelpstodrainfluidstopreventthemfrombuildingupintheear.InEustachiantubedysfunction,itisunabletodrainthefluid.FollowingcancauseEustachiantubeblock:- 1. Respiratorytractinfection:-Adenoid,rhinitis,tonsillitis,sinusitis.2. Allergies3. Benignandmalignanttumorofnasopharynx.
2.UnresolvedotitismediaInadequateantibiotictherapyinacutesuppurativeotitismediamayinactivateinfectionbutfailstoresolveitcompletely.Lowgradeinfectionlingersonandactsasstimulusformucosatosecretemorefluid.ClinicalfeaturesUnlikechildrenwithanearinfection(ASOM),childrenwithSOMdonotactsick.oTheonlypresentingsymptommaybehearinglosswithfullnessinear.OtoscopicfindingofSOMAirbubblesonthesurfaceofeardrumFluidbehindtheeardrum.Dullnessoftheeardrumwhenalightisused,withlossoflightreflex.oEardrummayappearyellow,greyorbluishincolour.RetractedeardrumwithdecreasedmobilityTympanometryshowstypeBtympanogram.
106.Causeofmyringosclerosis? a)Genetic b)Grommetinsertion c)Otosclerosis d)None CorrectAnswer-BAns.is'b'i.e.,GrommetinsertionTvmpanosclerosisTympanosclerosisisaconditioninwhichthereiscalcificationoftissueintheeardrum(tympanicmembrane)andmiddleear.Tympanosclerosismaybeclassifiedas:- 1. Myringosclerosis:-Involvingonlythetympanicmembrane.2. Intratympanictympanosclerosis:-Involvingothermiddleearsites: ossicularchainor,rarely,themastoidcavity.Exactetiologyoftympanosclerosisisnotknown.Itmaybeanabnormalhealingprocessandmostcommonlyoccursincasesofserousotitismediaasacomplicationofventilationtube(gourmet)insertion.Characteristicchalkywhitepatchesareseenoninspectionoftheeardrum.Itisworthnotingthatcholesteatomamaylooksimilarbutthewhitenessappearsbehind,ratherthanin/onthetympanum.Otherwisetympanosclerosisisasymptomatic.Conductivehearinglossmayoccurinsomecases.
107.Delta-signisseenin? a)Petrositis b)Acutemastoiditis c)Sigmoidsinusthrombosis d)Glomustumor CorrectAnswer-CAns.is'c'i.e.,SigmoidsinusthrombosisContrast-enhancedCTscancanshowsinusthrombosisbytypicaldelta-sign.Itisatriangularareawithrimenhancement,andcentrallowdensityareaisseeninposteriorcranialfossaonaxialcuts.Delta-signmayalsobeseenoncontrastenhancedMRI.
108.Trismusisseenincommonly? a)Ludwigangina b)Quinsy c)Retropharyngealabscess d)Parapharyngealabscess CorrectAnswer-BAns.is'b'i.e.,QuinsyTrismusisinabilitytoopen-mouth.Normalopeningofmouthrangesbetween25-50mm.Anyvaluelessthanthisisknownastrismus(roughlytheopeningshouldpermitaminimumofthreefingerswheninsertedsideways).Causesofquinsyare:?A.CommoncausesInfectionaroundimpactedthirdmolorQuinsy(peritonsillarabscess)SubmucousfibrosisTMjointdysfunctionB.LesscommoncausesLudwingsanginaParotidglandinfectionandtumorsMalignantotitisexternaorfurncleinexternalauditorycanal.ParapharyngealandretropharyngealabscessCarcinomamandibleTetanusRadiationtherapyCarcinomacheckMalignanthyperthermiaComingtothequestion
Trismuscanoccurinallthegivenoptions.However,itismostcommonandmostcharacteristicofquinsy(amongthegivenoptions).
109.SNHLisseeninallexcept? a)Nailpatellasyndrome b)DistalRTA c)Battersyndrome d)Alportsyndrome e)None CorrectAnswer-EAns.is'e'i.e.NoneAllthegivenoptionsarecausesofsensorineuralhearingloss. Treachercollinsyndrome Congenitalcausesof Alport's SNHL syndrome Usher'ssyndrome Pendred Hurler'ssyndrome syndrome Michel'saplasia Klippelfeilsyndrome Crouzon's Mondini'sanomaly Type1(distal)Renal disease Schibe'sand tubularacidosis Barttersyndrome Alexander'sanomalies Jervell&langeNeilson Leopard LThl'sanomaly syndrome syndrome Michel'saplasia Biotinasedeficiency Refsum Nail-patellasyndrome Albinism syndrome Alstromsyndrome MELAS Waardenburg Brachio-oto-renal Trisomy13,15,21 syndrome (BOR)syndrome Fabrydisease Cockayne'ssyndrome
110.Redlineinpuretoneaudiometryisfor- a)Boneconduction b)Airconduction c)Rightear d)Leftear CorrectAnswer-CAns.is'c'i.e.,Rightear
111.Transversefractureofmaxillais? a)LeFort-1 b)LeFort-2 c)LeFort-3 d)Cranifacialdisruction CorrectAnswer-AAns.is'a'i.e.,LeFort-1Itisclassifiedinto3types:? 1. LeFortI(transverse)fracturerunsaboveandparalleltotheplate.It crosseslowerpartofnasalseptum,maxillaryantraandthepterygoidplates. 2. LeFortII(pyramidal)fracturepassesthroughtherootofnose, lacrimalbone,flooroforbit,upperpartofmaxillarysinusandpterygoidplates.Thisfracturehassomefeaturescommonwiththezygomaticfractures. 3. LeFortIII(craniofacialdysfunction).Thereiscompleteseparationof facialbonesfromthecranialbones.Thefracturelinepassesthroughrootofnose,ethmofrontaljunction,superiororbitalfissure,lateralwalloforbit,frontozygomaticandtemporozygomaticsuturesandtheupperpartofpterygoidplates.
112.Whichofthefollowinglaryngeal cartilageishyaline? a)Epiglottis b)Comiculate c)Cricoid d)Cuneiform CorrectAnswer-CAns.is'c'i.e.,Cricoid Hyalinecartilages Elasticcartilages(donotossify) Thyroidcartilage Epioglottis Cricoidcartilage Corniculate Basalpartofarytenoidcartilage CuneiformProcessesofarytenoid
113.Allofthefollowingcranialnervesare involvedinAcousticneuroma,except? a)Vagus b)Glossopharyngeal c)Oculomotor d)Facial CorrectAnswer-CAns.is'c'i.e.,OculomotorClinicalfeaturesofacousticneuromaTheclinicalfeaturesdependontheextentoftumorandinvolvedstructure:?WhentumorisstillconfinedtotheinternalauditorycanalCochleovestibularsymptomsaretheearliestsymptomsofacousticneuromawhentumourisstillconfinedtointernalauditorycanal.Thecommonestpresentingsymptomsareunilateraldeafnessortinnitus,oracombinationofboth.Hearinglossisretrocochlearsensorineuraltype.Thereismarkeddifficultyinunderstandingspeech,outofproportiontothepuretonehearingloss,acharacteristicfeatureofacousticneuroma.Vestibularsymptomsareimbalanceorunsteadiness.Truevertigoisveryrare.WhentumorextendsbeyondIACandinvolvesotherstructuresVhcranialnerve:-Itistheearliestnervetobeinvolved.Thereisreducedcornealsensitivityandlossofcornealreflexwhichistheearliestsignofacousticneuroma.Numbnessorparaesthesiaoffacemayoccur.InvolvementofVthnerveindicatesthattumorisroughly2.5cmindiameterandoccupiestheCPangle.VIPnerve:-Sensoryfibresoffacialnerveareinvolved.Thereishypoesthesiaofposteriormeatalwall(Hitzelberg'ssign),lossof
taste,andlossoflacrimationonSchirmer'stest.Motorfibresaremoreresistant.IXthandA'nerves:-Dysphagiaandhoarsenessduetopalatal,pharyngealandlaryngealparalysis.Brainstem:-Ataxia,weakness,numbnessofarms&legs,exaggeratedtendonreflexes.Cerebellum:-Ataxia,Dysdiadochokinesia,Nystagmus.DuetoraisedICT:-Headache,neusea,vomiting,diplopiaduetoVI'nerveinvolvement,andpapilloedema.
114.WaveIinbrain-stemresponse audiometryarisesfrom? a)Cochlearnerve b)Superiorolivarycomplex c)Laterallemniscus d)Inferiorcolliculus CorrectAnswer-AAns.is'a'i.e.,CochlearnerveBrainStemResponseAudiometry(BERA)Itisanon-invasiveprocedurewhichobjectivelyhelpstofindtheintegrityofcentralauditorypathwaythroughtheVIIInerve,ponsandmidbrain.Itisaccuratetowithin10or15dBofthepsychoacousticthereshold.ItisthemostreliableaudiologicalmethodofdifferentiatingbetweencochlearandRetrocochlearhearinglosses.Itisanobjectivetestandcanbedoneundersedation.Itisusedbothasascreeningtestandasadefinativehearingassessmenttestinchildren.Besttesttodetectdeafnessininfants(reliablyrecordedevenfromprematureinfantsof30weeksgestationalage)andmentallyretardedormalingeringsubjects.ItisalsousedforIdentificationofthesiteoflesioninRetrocochlearpathologiesandtodiagnosebrainstempathologye.g.multiplesclerosisorpontinetumor.WavesofBERAInanormalperson,7wavesareproducedinfirst10miliseconds.Thefirst,thirdandfifthwavesaremoststableandareusedinmeasurements.Siteoforiginofwavesare:-WaveIDistalpartofEighthnerveWaveIIProximal,partofEighthcranialnerve
WaveIIICochlearnucleusWaveIVSuperiorolivarycomplexWaveVLateralleminiscusWaveVI&VIIInferiorcolliculus
115.Siteofglomusjugulare? a)Epitympanum b)Hypotympanum c)Mesotympanum d)Internalear CorrectAnswer-BAns.is'b'i.e.,HypotympanumGlomustumorGlomustumoristhemostcommonbenigntumorofmiddleear.Itarisesfromtheglomusbodies,thereforenamedGlomustumor.Itiswellrecognisedthatglomustumorsarisefromparaganglions,whicharenormallyoccuringstructuresusuallyfoundincloseassociationwithsympatheticganglionsalongtheaortaanditsmainbranches.Thechiefcells(paraganglioniccells)oftheparaganglionsareofneuralcrestoriginandarecomponentsofthediffuseneuroendocrinesystem(DNES).Theseparaganglioniccellsarederivedfromembryonicneuroepithelium(neuralcrest).Glomustumorsarealsoreferredtoaschemodectomasornonchromaffinparagangliomas.Therearetwotypesofglomustumors:-GlomusjugulareTheseglomustumorsarisefromthedomeoftheinternaljugularveininthehypotympanumandjugularforamen.InjugularforamentheycaninvadeIXtoXIIcranialnerves.GlomustympanicumTheyarisefromthepromontoryofthemiddleearalongthecourse
ofthetympanicbranchoftheIXthcranialnerve.Althoughrare,glomustumorsarethemostcommontumorofthemiddleearandaresecondtoacousticneuroma(vestibularschwannoma)asthemostcommontumorofthetemporalbone.Itismorecommoninfemaleswithfemaletomaleratioof3-6:1.Glomusjugularetumorshavealsobeennotedtobemorecommonontheleftside,especiallyinfemales.oMosttumorsoccurinpatient40-60years.Multicentrictumorsarefoundin3-10%ofsporadiccasesandin25-50%offamilialcases.
116.Frey'ssyndromeiscausedby? a)Posttraumaticnervefibresoffacialnervewithparasympathetic ofauriculotemporalnerve b)Greaterauricularwithauriculotemporalnerve c)Facialnervewithgreaterauricularnerve d)None CorrectAnswer-AAns.is'a'i.e.,PosttraumaticnervefibresoffacialnervewithparasympatheticofauriculotemporalnerveFrey'ssyndrome(gustatorysweating)GustatorysweatingorFrey'ssyndromeinvolvespost-parotidectomyfacialsweatingandskinflushingwhileeating.Thesymptomsusuallyoccurseveralmonthsorevenyearsafterparotidsurgery.Thelikelypathophysiologyisaberrantregenerationofpostganglionicsecretomotorparasympatheticnervefibres(originatingfromtheoticganglion)misdirectedthroughseveralaxonalsheathsofpost-ganglionicsympatheticfibresfeedingthesweatglands.Thesesympatheticfibresaretothesweatglandsoftheskininthedissectedfield.Thefrey'ssyndromeislikelyduetoinjurytoauriculotemporalnervewithfaultyregeneration,thereforeFrey'ssyndromeisalsoknownasAuriculotemporalsyndrome.AvariantofFrey'ssyndromeinwhichthereisgustatoryfacialflushingbutnotsweating,occursfollowingfacialparalysisduetofaultyregenerationfollowinginjurytothefacialnerve.So,Frey'ssyndromeisnotlimitedtoparotidsurgerywithinjurytoauriculotemporalnerve.
117.Killionsincisionisusedfor? a)Septoplasty b)SMR c)Proofpuncture d)Modifiedradicalmastoidectomy CorrectAnswer-AAns.is'a'i.e.,SeptoplastyTechniqueofseptoplasty1.Infiltratetheseptumwith1%lignocainewithadrenaline1:100,000.2.Incasesofdeviatedseptum,makeaslightlycurvilinearincision,2-3mmabovethecaudalendofseptalcartilageontheconcaveside(Killian'sincision).Incaseofcaudaldislocation,atransfixionorhemitransfixion(Freer's)incisionismade.3.Raisemucoperichondrial/mucoperiostealflapononesideonly.4.Separateseptalcartilagefromthevomerandethmoidplateandraisemucoperiostealflapontheoppositesideofseptum.5.Removemaxillarycresttorealigntheseptalcartilage.6.Correctthebonyseptumbyremovingthedeformedparts.Deformedseptalcartilageiscorrectedbyvariousmethods,suchas:ScoringontheconcavesideCross-hatchingormorselizingShavingWedgeexcisionFurthermanipulationslikerealignmentofnasalspine,separationofseptalcartilagefromupperlateralcartilages,implantationofcartilagestripinthecolumellaorthedorsumofnosemayberequired.7.Trans-septalsuturesareputtocoaptmucoperichondrialflaps.
7.Trans-septalsuturesareputtocoaptmucoperichondrialflaps.8.Nasalpack.
118.Turbanepiglottisisseenin? a)TB b)Leprosy c)Laryngealpapilloma d)Epiglottitis CorrectAnswer-AAns.is'a'i.e.,TBTubercularlarvn_gitisTubercularlaryngitisisalmostalwayssecondarytopulmonarylesions,mostlyaffectingmalesinmiddleage(20-40years).Diseaseaffectstheposteriorthirdoflarynxmorecommonlythananteriorpart.Thepartsaffectedindescendingorderoffrequencyare:-i)Interarytenoidfold,ii)Ventricularband,iii)Vocalcords,iv)EpiglottisClinicalfeaturesWeaknessofvoicewithperiodsofaphoniaearliestsymptoms.oHoarsness,cough,dysphagia(odynophagia)ReferredotalgiaLaryngealexaminationinTBlaryngitisHyperaemiaofthevocalcordinitswholeextentorconfinedtoposteriorpartwithimpairmentofadductionisthefirstsign.Swellingintheinterarytenoidregiongivingamammilatedappearance.Ulcerationofvocalcordgivingmouse-nibbledappearance.Superficialraggedulcerationonthearytenoidsandinterarytenoidregion.Granulationtissueininterarytenoidregionorvocalprocessofarytenoid.Pseudoedemaoftheepiglottis"turbanepiglottis".
Swellingofventricularbandsandaryepiglotticfolds.Markedpallorofsurroundingmucosa.
119.
MostcommonpartoflarynxinvolvedinTB? a)Anterior b)Posterior c)Middle d)Anywhere CorrectAnswer-BAns.is'b'i.e.,PosteriorEssentialotolaryngology2"d/ep.1139]Diseaseaffectstheposteriorthirdoflarynxmorecommonlythananteriorpart.Thepartsaffectedindescendingorderoffrequencyare:-i)Interarytenoidfold,ii)Ventricularband,iii)Vocalcords,iv)Epiglottis.
120.MostcommoncauseofASOMis? a)Meningococci b)Pneumococci c)Hinfluenzae d)Moraxella CorrectAnswer-BAns.is'b'i.e.,PneumococciASOMisanacuteinflammationofmiddleearcleftcausedbypyogenicorganism.ItisworthnotingthatASOMistheinfectionofmiddleearcleft,i.e.,middleear(tympaniccavity),Eustachiantube,Attic,Aditus,antrumandmastoidaircells.ASOMisespeciallycommonininfantsandchildren.MostofthetimeASOMusuallyfollowsrespiratorytractinfections(i.e.,acutetonsillitis,commoncoldorinfluenza)andtheinfectiontravelupbytheeustachiantubetothemiddleear.Themostcommoncausativeorganismisstreptococcuspneumoniae.OthercommonorganismsareH.influenzaeandMoraxellacatarrhalis.Lesscommoncausativeorganismsarestreptococcuspyogenes,staphylococcusaureusandE.coli.
121.Defectivefunctionofwhichofthe followingcauseshyperacusis? a)VIIInerve b)7thnerve c)Stapediusmuscles d)Anyoftheabove CorrectAnswer-DAns.is'd'i.e.,AnyoftheaboveHyperacusisHyperacusisishearingnormalvoiceaslouder.Theprotectivemechanismsanormalearemploystominimizetheharmfuleffectsofloudnoisearemalfunctioninginhyperacusis.So,noisemayseemtooloudevenwithhearingprotection.Thereissomespeculationthattheefferentportionoftheauditorynerveisselectivelydamagedwhilethehaircellsthatallowustohearpuretonesinanaudiometricevaluationremainsintact.Somehavesaiditinvolvesdirectmalfunctionoffacialnerve;asaresult,thestapediusmuscleisunabletodampensound.
122.ParanasalpolypCTview? a)Corona! b)Axial c)Sagital d)3D CorrectAnswer-AAns.is'a'i.e.,CoronalBothcoronalandaxialviewareused,butcoronalviewsarebesttostudyparanasalsinuspolyps.
123.Valleculasignisseenin? a)TBlaryngitis b)Vocalnodule c)Invertedpapilloma d)Acuteepiglottitis CorrectAnswer-DAns.is'd'i.e.,AcuteepiglottitisTherearetwoimportantradiologicalsignsinacuteepiglottitis:? 1. Thumbsign2. Volleculasign
124.Mostcommoncauseofotomycosis? a)Histoplasma b)Rhinosporidium c)Aspergillus d)Actinomyces CorrectAnswer-CAns.is'c'i.e.,AspergillusOtomycosisOtomycosis,alsocalledacutefungalotitisexterna,describesafungaloryeastinfectionoftheexternalauditorymeatus.SaprophyticfungipotentiallyresidingintheearcanalincludeAspergillus,Candidaalbicans,Phycomycetes,Rhizopus,Actinomyces,andPenicillium.Undercertainconditionsofincreasedheat,humidity,glucoseconcentration(diabetes),immunosuppression,oroveruseofsystemicortopicalantibioticsandsteroids,thesesaprophyticfungicanbecomepathogenic.Aspergillusnigeraccountsfor90%ofotomycosisinfections.Othercommonorganismsarecandidaalbicans(2"amostcommon)andAspergillusfumigatus.LesscommonorganismsarePhycomycetes,Rhizopus,ActinomycesandPenicillium
125.Facialnervepalsycanbecausedby? a)Cholesteatoma b)Multiplesclerosis c)Mastoidectomy d)Alloftheabove CorrectAnswer-DAns.is'd''i.e.,AlloftheaboveCausesoffacialparalysisCentral:-Brainabscess,pontineglioma,Polio,multiplesclerosisIntracranialpart(cerebellopontineangle):-Acousticneuroma,meningioma,congenitalcholesteatoma,metastaticcarcinoma,meningitisIntratemporalpart:-Idiopathic:-Bell'spalsy,Melkersson'ssyndromeInfections:-ASOM,CSOM,Herpeszosteroticus,malignantotitisexternaTrauma:-Surgical(mastoidectomy,stapedectomy),accidental(fracturesoftemporalbone)Neoplasms:-Malignanciesofexternalandmiddleear,glomusjugular,facialnerveneuroma,metastasis(frombreast,lungetc).Extracranialpart:-MalignanciesorsurgeryorinjurytoparotidglandSystemicdiseases:-Diabetes,hypothyroidism,uremia,PAN,Sarcoidosis(Heerfordt'ssyndrome),leprosy,leukaemia,demyelinatingdisease
126.PredisposingfactorforNasalmyiasis? a)Allergicrhinitis b)Vasomotorrhinitis c)Atrophicrhinitis d)Rhinitismedicomentosa CorrectAnswer-CAns.is'c'i.e.,AtrophicrhinitisNasalmyiasis(Maggotsinnose)Itresultsfromthepresenceofovaoffliesparticularlychrysomiaspeciesinthenosewhichproduceulcerationanddestructionofnasalstructure.Mostlyseeninatrophicrhinitiswhenthemucosabecomesinsensitivetoflieslayingeggsinside.ClinicalfeaturesInitialsymptoms(3-4daysmaggots):-Intenseirritation,sneezing,headache,bloodstaineddisharge,lacrimation.oLater:-Maggotsmaycrawloutofnoseandthereisfoulsmell.ComplicationsDestructionofnose,sinuses,softtissuesofface,palateandeyeball.Fistulaeinnoseandpalate.Deathoccursduetomeningitis.TreatmentChloroformwaterorvapormustbeinstilledinordertoanaesthetizeorkillthemaggotsandsoreleasetheirgripfromtheskin.
127.
Glomustumorinvadingtheverticalpartofcarotidcanal.Itis? a)TypeB b)TypeCI c)TypeC2 d)TypeC3 CorrectAnswer-CAns.is`c'i.e.,TypeC2
128.Unilateralsensorineuralhearingloss mayoccurin? a)Coronavirus b)Mumps c)Pertussis d)Rotavirus CorrectAnswer-BAns.is'b'i.e.,Mumps Infectionsoflabyrinth Acquiredcauses SystemicdisordersTraumatolabyrinthor ofSNHL (DM,Hypothyroidism, VIIInerve(Head Presbycusis Renaldisorders) injury,surgeryetc) Meniere'sdisease Multiplesclerosis Noiseinducedhearing Acousticneuroma Smoking&Alcoholismloss Suddenhearing Ototoxicdrugs loss
129. Fractureofwhichofthefollowingbone causesleakageofcerebrospinalfluid throughear? a)Mastoidprocess b)Petroustemporal c)Ethmoidplate d)Cribriformplate CorrectAnswer-BAns.is`b'i.e.,PetroustemporalCSFotorrheaCSFotorrhea,i.e.,leakageofcerebrospinalfluidthroughearstructure,isararebutpotentiallylifethreateningsituationthatrequiresrapidintervention.Theunderlyingetiologyofspinalfluidleakthroughtemporalboneisaviolationofthebonyandmeningealbarriersthatseparatethesubarachoidspacefromthemiddleearandmastoid.Thismeansthatadefectmustexistnotonlyinthebone,butalsointheduramatter.CausesofCSFotorrheaare:?1.Congenital:-Defectinoticcapsule.2.Acquired:-Morecommonthancongenitalandcauseare:- 1. Surgery:-Post-operativeleakageisthemostcommoncauseofCSF otorrhea.Surgicalcausesareacousticneuromaremoval,skullbasesurgeriesandsometimesmastoidsurgery. 2. Trauma:-FractureofpetrouspartoftemporalcanleadtoCSF otorrhea. 3. Infection
3.Spontaneous:-Itiswithoutanobviousantecedentpathology.Theremaybesomedefectinthetemporalbone.
130.Whichofthefollowingisapneumatic bone? a)Parietalbone b)Occipitalbone c)Mastoidprocess d)None CorrectAnswer-CAns.is'c'i.e.,MastoidprocessPneumaticbonesareonewhichcontainlargeairspaceslinedbyepithelium.Examples:maxilla,sphenoid,ethmoid,etc.Theymaketheskulllightinweight,helpinresonanceofvoice,andactasairconditioningchambersfortheinspiredair.Abonethatisholloworcontainsmanyaircellscalledaspenumaticbone.Examplesaremastoidprocessoftemporalbone,maxilla,ethmoid,sphlenoidandfrontalbone.Verysimpletorememberlast4asallfourparansalsinusesarepneumaticbones.
131.Mulberrynasalmucosaisseenin? a)Lupusvulgaris b)Vasomotorrhinitis c)Atrophicrhinitis d)None CorrectAnswer-BAns.is'b'i.e.,VasomotorrhinitisVasomotorisanonallergicconditionthatinvolvesaconstantrunnynose,sneezingandnasalcongestion,i.e.,thenoseisstuffyorrunnyforreasonsotherthanallergiesandinfections.Theexactetiologyisunknown,buttriggersincludeemotions,odors,poorairquality,spicyfoods,andmedicationsideeffects.Pathogenesisinclude:-ParasympatheticoveractivityHyperactivenasalmucosatoseveralnon-specificstimuliespeciallyinwomenof20-40years.Symptomsofvasomotorrhinitisincludeexcessiveclearrhinorrhoea,nasalobstruction/congestion,irritation,paroxysmalsneezingandpost-nasaldrip.Nasalmucosaishypertrophied&congested;andmucosaofturbinatesmaygivemulberrylikeappearanceandispaletoduskyredincolour.Complicationsofvasomotorrhinitisincludehypertrophicrhinitis&sinusitis,andnasalpolyp.Mulberrynasalmucosaisalsoseeninchronichypertrophicrhinitis
132.AllareseeninSamterstriadexcept? a)Asthma b)Nasalpolyp c)Bacterialinfection d)Aspirinsensitivity CorrectAnswer-CAns.is'c'i.e.,BacterialinfectionSamter'striadSamter'striadisamedicalconditionconsistingofasthma,aspirinsensitivity,andnasaL'ethmoidalpolyposis.Itoccursinmiddleage(twentiesandthirtiesarethemostcommononsettimes)andmaynotincludeanyallergies.oMostcommonly,thefirstsymptomisrhinitis.Thedisordertypicallyprogesestoasthma,thenpolyposis,withaspirinsensitivitycominglast.Theaspirinreactioncanbesevere,includinganasthmaattack,anaphylaxis,andurticariainsomecases.PatientstypicallyreacttootherNSAIDSsuchasibuprofen,althoughparacetamolisgenerallyconsideredsafe.Anosmia(lackofsmell)isalsotypical,astheinflammationreachestheolfactoryreceptorsinthenose.
133.Objectivetestinadenoids a)Posteriorrhinoscopy b)Anteriorrhinoscopy c)Manualpalpation d)Alloftheabove CorrectAnswer-AAns.is'a'i.e.,Posteriorrhinoscopy
134.Mostcommonsinustobeinvolvedin acutesinusitis? a)Ethmoid b)Maxillary c)Sphenoid d)Frontal CorrectAnswer-BAns.is'b'i.e.,Maxillary Mostcommonsinusaffectedby Maxillary sinusitisoverallMostcommonsinusaffectedin Maxillary adultMostcommonsinusaffectedin Ethmoid childrenLeastcommonsinusaffected Sphenoid Sinusesinvolvedinorderof Maxillary>Frontal>Ethmoid> frequency Sphenoid
135.Queckenstedtestisdonefor? a)Glomustumor b)CSFrhinorrhea c)Otosclerosis d)Acousticneuroma CorrectAnswer-BAns.is'b'i.e.,CSFrhinorrheaDetectionofCSFLeak1.BiochemicaltestsConcentrationsofGlucosearehigherinCSFthaninnasaldischarge.Glucosevalue>30-40mg%andproteinvalue<100mg%(max200mg%)supportadiagnosisofCSFleak.PresenceofI3,transferrinisthemostdefinitivetestfordetectionofCSFandI32transferrinassayisthetestofchoicewhenaconfirmatorytestisneeded,becauseofhighsensitivityaswellasspecificity.I3-traceprotein(prostaglandinDsynthase)isalsoused,howeveritisnonspecificasitisalsopresentinhumantestes,heartandseroma.2.BasicclinicaltestsTissuetest(Handkerchieftest):-Unlikenasalmucous,CSFdoesnotcauseatissuetostiffen.Filterpapertest:-SampleofnasaldischargeonafilterpaperexhibitsalightCSFborderandadarkcentralareaofblood,i.e.,doubleringsignorhalosign.Queckenstedtest:-CompressionofthejugularveinleastoincreasedCSFleakduetoincreaseinICP.Rhinoscopy:-VisualizationofCSFleakfromparanasalsinus.
3.CSFtracersIntrathecalfluoresceindyeadminstration,radionuclidecisternography,CTcisternography.
136.Bilateralrecurrentlaryngealnervepalsy isseeninallexcept? a)Thyroidcarcinoma b)Lymphadenopathy c)Thyroidsurgery d)Aorticaneurysm CorrectAnswer-DAns.is'd'i.e.,Aorticaneurysm
137.Mostcommoncauseofsinger'snodule is? a)Infection b)Allergy c)Vocalabuse d)None CorrectAnswer-CAns.is'c'i.e.,VocalabuseVocalnodule(singer'sorscreamer'snodule)Vocalnodulearebenignnoneoplasticgrowthonfreeedgeofboththevocalcordsatthejunctionofanterior1/3withposterior2/3.Thisareaisparticularlyvulnerabletotraumaasthisistheareaofmaximumvibrationofthecord.Themajorcauseisvoiceabuse,thereforeitismostcommonlyseeninsingers,actors,teachers,andhowkers.Hoarsenessisthemostcommonsymptom.Vocalfatigueandpaininneckonprolongedphonationareothersymptoms.TreatmentEarlycasesofvocalnodulescanbetreatedconservativelybyeducatingthepatientinproperuseofvoice.Manynodulesespeciallyinchildren,disappearwiththistreatment.Surgeryisrequiredforlargenodulesorlongstandingnodulesinadults.Microscopic(micorlaryngoscopic)excisionisthetreatmentofchoice.
138.Mucoperichondrialflapinseptoplastyis madeon? a)Alarcartilage b)Septalcartilage c)Maxillaryspine d)Sphenoidspine CorrectAnswer-BAns.is'b'i.e.,SeptalcartilageStepsinseptoplastyAunilateralincisionismadeinthemucoperichodrialflapatthelowerborderofseptalcartilageontheleftsideinrighthandedpersons.Themucoperichondrialflapiselevatedononesidemakingananteriortunnel.Anotherincisionismadeinthemucoperiosteumoverthenasalspineonthesameside,elevatingthemucoperiosteumfromnasalspineonbothsidesthusmakingtwomoretunnelscalledinferiortunnels.Twotunnelsarejoinedbysharpdissection.Septalcartilageisthenseparatedfromvomero-ethmoidbonesposteriorlyandnasalspineinferiorly.Maxillarycrestisremovedtorealignseptalcartilage.Bonyseptaldeformityiscorrectedbyremovingdeformedpart.Deformedseptalcartilageiscorrected.Trans-septalsuturesareputtocoaptmucoperichondrialflaps.Nasalpackisput.Thus(comingtoquestion)Mucoperichondrialflap(andtunnel)aremadeonseptalcartilage.Mucoperiostealflap(andtunnels)aremadeonnasalspine.
139.Allaremajorsymptomsofsinusitis except? a)Nasalbluckage b)Facialcongertion c)Nasalcongestion d)Halitosis CorrectAnswer-DAns.is'd'i.e.,HalitosisTheclinicalsymptomsofacutesinusitishavebeenclassifiedintomajorandminor Major Minor Facialpainorpressure HeadachePurulentnasal Cough discharge Fatigue Fever Halitosis Nasalcongestion Dentalpain Nasalobstruction Earpainor HyposmiaorAnosmia pressureFacialcongestionorfullness
140.Laryngitissiccaisassociatedwith? a)Rhinosporidium b)M.leprae c)Klebsiellaazaenae d)Klebsiellarhinoscleromatosis CorrectAnswer-CAns.is'c'i.e.,KlebsiellaazaenaeLaryngitissicca(Atrophiclaryngitisorlaryngitisatrophica)Itisarareentitycharacterizedbyatrophicchangesintherespiratorymucosawithlossofthemucus-producingglands.Itisusuallyassociatedwithatrophicrhinitisandpharyngitiscausedbyklebsiellaozaenae.Themostcommonsitesinvolvedinlarynxarethefalsecords(vestibularfolds),theposteriorregionandthesubglotticregion.Morecommoninwomen.ClinicalfeaturesIrritablecoughandhoarsenessExcessivecrustsformationwhicharesometimesbloodstained(hemorrhagic)withfoulodour.Crustsarethemostimportantdiagnosticfeature.TreatmentEliminationofcausativefactorsandhumidification.Laryngealsprayswithglucoseinglycerineoroilofpinehelpsincrustremoval.Expectorantscontainingammoniumchlorideoriodidesalsohelptoloosenthecrust.Microlaryngoscopicremovalofcrustinlaryngitissiccaisthenewmodalityoftreatment.
141.Ossiclesofmiddleearareresponsible forwhichofthefollowing? a)Amplificationofsoundintensity b)Reductionofsoundintensity c)Protectingtheinnerear d)Reductionofimpedancetosoundtransmission CorrectAnswer-DAns.is'd'i.e.,ReductionofimpedancetosoundtransmissionTheearcanal(auditorycanal)actsasaresonator,i.e.itresonates(amplifiesfrequencies)between2000and5000(average3000)cyclespersecondandthereforemostenergywillbetransmittedtothecochleainthesefrequencies.However,ifthissoundenergyhitstheinnerearfluiddirectlymostoftheenergywouldbereflected,resultinginhearingloss(asallthesoundwaveisreflectedandnothingisatransmittedaselectricalimpulse).Therefore,thereisaneedforatransformermechanism,aneedthatisfullfilledbymiddleearmiddleearconvertssoundofgreateramplitudebutlesserforcetothatoflesseramplitudebutgreaterforce.Thisfunctionofthemiddleeariscalledimpedencematchingmechanismorthetransformeraction.
142.Whichstructurepreventsspreadof infectionformmiddleeartobrain? a)Tegmentympani b)Cribriformplate c)Fundustympani d)Petrousapex CorrectAnswer-AAns.is'a'i.e.,TegmentympaniTegmentympani(formingtheroofofmiddleearcavity)separatesthetympaniccavityfrommiddlecranialfossa.
143.Inotosclerosis,whichismostaffected? a)Ovalwindow b)Roundwindow c)Footplateofstapes d)Utricle CorrectAnswer-AAns.is'a'i.e.,OvalwindowThemostcommonsiteofdiseaseispromontoryintheregionoftheanteriormarginofovalwindow,andinadvancedcasesthestapesbecomeankylosedinpositionbyamassofnewspongybone.Whyisitso?Thisareaisinvolvedmostcommonlybecauseinthisareaislocatedthefissulaantefenestram,avestigialstructurewhichfrequentlycontainscartilaginousremnantsandwhichisparticularlypronetootoscleroticchanges.MostcommontypeofotosclerosisStapedialotosclerosisMostcommonsiteofotosclerosisFissulaantefenestram(i.e,justinfrontofovalwindow)MostcommonsiteforStapedialotosclerosisFissulaantefenestram(i.e,justinfrontofovalwindow)MostcommonsiteforcochlearotosclerosisRoundwindow
144.TrueregardinglaryngealTBis? a)Commonlyinvolvesanterior2/3rdofvocalcord b)Mouse-nibbledvocalcord c)Morecommoninmales d)Noneoftheabove CorrectAnswer-BAns.is'b'i.e.,Mouse-nibbledvocalcord
145.Mostcommoncauseofacutetonsilitis? a)Streptococcuspneumoniae b)H.Influenza c)13-hemolyticstreptococci d)Staphylococcusaureus CorrectAnswer-CAns.is'c'i.e.,13-hemolyticstreptococciTonsilsfrequentlyserveasthesiteofacuteinfection,whichcausesacutetonsillitis.Tonsillitisisparticularlycommoninchildren,especiallyinschoolgoingagegroup.However,itcanoccurinadultalso.Virusinitiatesanacutetonsillitisattackandpredisposestobacterialinfection.8-hemolyticstreptococcusisthemostcommonorganismcausingacutetonsillitis.Otherbacteriacausingacutetonsillitisarestaphylococcus,hemophilusandpneumococcus.
146.Treatmentofchoicefornasopharyngeal carcinomais? a)Surgery b)Radiotherapy c)Surgery&radiotherapy d)Chemotherapy CorrectAnswer-BAns.is'b'i.e.,RadiotherapyTreatmentofnasopharyngealcarcinomaIrradiationistreatmentofchoice(externalradiotherapy).Radicalneckdissectionisrequiredforpersistentnodeswhenprimaryhasbeencontrolledandinpostradiationcervicalmetastasis.Systemicchemotherapyisusedaspalliationfordistantmetastasesorradiationfailure.Foradvancedstages(stageIII&IV),thecureratecanbedoubledwhenchemotherapyiscombinedwithradiotherapy.
147.Coneoflightfocusesonwhichquadrant oftympanicmembrane? a)Anteroinferior b)Posteroinferior c)Anterosuperior d)Posterosuperior CorrectAnswer-AAns.is'a'i.e.,AnteroinferiorConeoflightSeeninanteroinferiorquadrantofthetympanicmembraneisactuallythereflectionofthelightprojectedintotheearcanaltoexamineit.Thispartreflectsitbecauseitistheonlypartoftympanicmembranethatisapproximatelyatrightanglestothemeatus.Thisdifferenceindifferentpartofthetympanicmembraneisduetothehandleofmalleuswhichpullsthetympanicmembraneandcausesittotentinside.Thus,thehandleofmalleuscausestentingandbecauseoftentingtheantero-inferiorquardrantisatrightanglestothemeatusandthusreflectsthelight(leadingtoconelight).
148.Hearinglossof65dB,whatisthegrade ofdeafness? a)Mild b)Moderate c)Severe d)Moderatelysevere CorrectAnswer-DAns.is'd'i.e.,Moderatelysevere
149.Vestibularfunctionisassessedby? a)Fistulatest b)Hallpikemanaeuver c)Calorictest d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,Alloftheabove
150.Blueeardrumisseenin? a)Serousotitismedia b)CSOM c)Perforation d)None CorrectAnswer-AAns.is'a'i.e.,SerousotitismediaAnyaccumulationoffluidbehindtympanicmembranecausesstructuralchangesintympanicmembranecausingittoappearblue,beitpus,bloodorserousfluid.Themostcommoncauseoffluidaccumulationinmiddleearisserousotitismediaorglueear(mostcommoncause)andhaemotympanum.Othercausesofbluetympanicmembraneareglomustumor,hemangiomaofmiddleear,andcholesterolgranuloma.
151.Peritonsillarabscessiscausedmost commonlyby? a)Streptococcuspneumoniae b)Staphylococcusaureus c)Betahemolyticstreptococcus d)H.influenzae CorrectAnswer-CAns.is'c'i.e.,BetahemolyticstreptococcusPeritonsillarabscess(Ouinsy)Quinsyconsistsofsuppurationoutsidethecapsuleintheareaaroundthecapsule.Thereiscollectionofpusbetweenthecapsuleoftonsilandthesuperiorconstrictormuscle,i.e.intheperitonsillararea.PeritonsillarabscessisacomplicationoftonsillitisandismostcommonlycausedbygroupAbeta-hemolyticstreptococcus.ClinicalfeaturesofQuinsyClinicalfeaturesaredividedinto:?General:Theyareduetosepticaemiaandresembleanyacuteinfection. 1. Theyincludefever(upto104?F),chillsandrigors,generalmalaise, bodyaches,headache,nauseaandconstipation. 2. Local:3. Severepaininthroat.Usuallyunilateral.4. Odynophagia.Itissomarkedthatthepatientcannotevenswallow hisownsalivawhichdribblesfromtheangleofhismouth.Patientisusuallydehydrated. 5. Muffledandthickspeech,oftencalled"Hotpotatovoice".6. Foulbreathduetosepsisintheoralcavityandpoorhygiene.
7. Ipsilateralearache.ThisisreferredpainviaCNIXwhichsupplies boththetonsilandtheear. 8. Trismusduetospasmofpterygoidmuscleswhichareinclose proximitytothesuperiorconstrictor.Examinationfindings 1. Thetonsil,pillarsandsoftpalateontheinvolvedsidearecongested andswollen.Tonsilitselfmaynotappearenlargedasitgetsburiedintheoedematouspillars. 2. Uvulaisswollenandoedematousandpushedtotheoppositeside.3. Bulgingofthesoftpalateandanteriorpillarabovethetonsil.4. Mucopusmaybeseencoveringthetonsillarregion.5. Cervicallymphadenopathyiscommonlyseen.Thisinvolves jugulodigastriclymphnodes. 6. Torticollis:Patientkeepsthenecktiltedtothesideofabscess. TreatmentofperitonsillarabscessIVfluidsAntibiotics:Highdosepenicllin.(ivbenzipenicillin)istheDOC.InpatientsallergictopenicillinerythromycinistheDOC.Incisionanddrainageperorally,iftheabscessdoesnotresolvedepitehighdoseofivantibioticsTonsillectomyisdone6weeksfollowinganattackofquinsy(intervaltonsillectomy).
152.Strawberryoppearanceisseenin? a)Lupusvulgarsis b)Rhinoscleroma c)Rhinosporidiosis d)Angiofibroma CorrectAnswer-CAns.is'c'i.e.,RhinosporidiosisRhinosporidiosisRhinosporidiosisisachronicgranulomatousinfectionofthemucousmembranethatusuallymanifestsasvascularfriablepolypsthatarisefromthenasalmucosa.TheetiologicalagentisRhinosporidiumseeberi.Rhinosporidiumseeberiisanaquaticbacterum(notafungus).Infectionusuallyresultsfromalocaltraumaticinoculationwiththeorganism.ItisseeninIndia,PakistanandSriLanka.InIndia,mostofthecasesareseeninSouthernstates.Infectionofthenoseandnasopharynxisobservedin70%ofpersonswithrhinosporidiosis;infectionofpalpebralconjunctivaorassociatedstructures(includinglacrimalapparatus)isobservedin15%ofcases.Otherstructuresofthemouthandupperairwaymaybesitesofdisease.Diseaseoftheskin,ear,genitalsandrectumhasalsobeendescribed.Rhinosporidiosisisaninfectionthattypicallylimitedtothemucosalepithelium.ThediseaseprogresswithlocalreplicationofRseeberiandassociatedhyperplasticgrowthofhosttissueandalocalizedimmuneresponse.ClinicalfeaturesofRhinosporidiosisRhinosporidiosispresentsassoftleafypolypoidalmass(softpolyp),whichispinktopurpleincolourstuddedwithwhitedots,i.e.strawberryappearance.Thisappearanceresultsfromsporangia,
whichisvisibleasgreyoryellowspotsinthevascularpolypoidmasses.Becausethepolypsarevascularandfriable,theybleedeasilyuponmanipulation.TreatmentThetreatmentofchoiceissurgicalexcision.Completeexcisionofmassisdonewithdiathermyknifeandcauterizationofbase.Dapsoneisbeingtriedfortreatingrhinosporidiosisbutwithlimitedsuccess.
153.Trueaboutcentralnystagmus? a)Changingdirection b)Notsuppressedbyopticfixation c)Horizontalorvertical d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveNystagmusNystagmusisrhythmicoscillatorymovementofeye.Nystagmushasfollowingcharacteristics:? 1. Rapid,2. Involuntary,3. Repetitive Nystagmusmaybe:? 1. Sidetoside(horizontalnystagmus)2. Upanddown(verticlenystagmus)3. Rotary Vestibularnystagmushastwocomponents,i.e.aslowandafast.Thedirectionofnystagmusisindicatedbythedirectionoffastcomponent.Vestibularnystagmusmaybe:? 1. Peripheral:-duetolesionoflabyrinthorVIIInerve.2. Central:-duetolesionofvestibularnuclei,brainstemorcerebellum. i.PeripheralnystagmusDiminshesorsuppresseswithgazefixation(opticfixation)EnhancesindarknessorbyuseofFrenzelglassesUnidirectionalfastcomponentDirectionistypicallyhorzonto-rotary,notpurelyhorizontalorrotary
andnotverticalDirectionisfixedtowardsundermostearPresentinoneheadpositionii.CentralnystagmusNotsuppressedbyopticfixationFastcomponentcanbeunidirectionalorbidirectionalCanbehorizontal,verticalorrotaryDirectionischangingPresentinmultipleheadpositions
154.Potatotumoris a)Rhinosporidiosis b)Hypertrophiedsebaceousgland c)Nosopharyngealangiofibroma d)Tubercularinfection CorrectAnswer-BAns.is'b'i.e.,HypertrophiedsebaceousglandRhinophyma(Potatotumor)Rhinophymaisabenigntumoroftipofnoseduetohypertrophyofsebaceousgland.Itiscausedbygranulomatousinfiltrationandoccursasacomplicationoflongstandingacnerosacea.Alcoholismismistakenlyattributedasacauseofthisdisease,butheavyalcoholconsumptiondoesaggravatethecondition.Theusualpresentationisduetocosmeticappearanceorobstruction.Treatmentofchoiceisdebulkingoftumorbycarbandioxidelaser.
155.Earlytonsillectomyisnotdonein? a)Thyroidstorm b)Suspectedmalignancy c)Peritonsillarabscess d)Rheumaticfever CorrectAnswer-AAns.is'a'i.e.,ThyroidstormUncotrolledsystemichypertensionisacontraindicationfortonsillectomy.InthyroidstormthereisdangerouslyhighBP.Contraindicationsoftonsillectomy 1. Haemoglobinlevellessthan10g%.2. Presenceofacuteinfectioninupperrespiratorytract,evenacute tonsillitis.Bleedingismoreinthepresenceofacuteinfection. 3. Childrenunder3yearsofage.Theyarepoorsurgicalrisks.4. Overtorsubmucouscleftpalate.5. Bleedingdisorders,e.g.leukaemia,purpura,aplasticanaemia, haemophilia. 6. Atthetimeofepidemicofpolio.7. Uncontrolledsystemicdisease,e.g.diabetes,cardiacdisease, hypertensionorasthma. 8. Tonsillectomyisavoidedduringtheperiodofmenses.
156.Mostcommoncauseofretropharyngeal abscessinadults? a)TB b)Toothextraction c)Tonsillitis d)Lymphadenitis CorrectAnswer-AAns.is'a'i.e.,TBAbscessininfants(acuteretropharyngealabscess)Mostcommonlyitresultsfromretropharyngeallymphadenitisduetoanupperrespiratorytractinfection.Treatmentisincisionanddrainage.Abscessinadults(chronicretropharyngealabscess)Ifanadultoranolderchildhasaretropharyngealinfectionitislikelytobeduetoatuberculousinfectionofthecervicalspine(cariesofcervicalspine).Sometimeitmaybesecondarytotuberculousinfectionofretropharyngeallymphnodes.Treatmentincludesincisionanddrainageofabscessalongwithfullcourseofantituberculartreatment.
157.Otosclerosisaffectswhichbone? a)Stapes b)Incus c)Malleus d)None CorrectAnswer-AAns.is'a'i.e.,StapesTypesofotosclerosisFollowingtypesofotosclerosishavebeendescribed:-1.FenesteralorstapedialotosclerosisItisthemostcommontype(80-90%)Thelesionstartsjustinfrontoftheovalwindowinanareacalledfissulaantefenestram"andcausesstapesfootplatefixationandconductivehearingloss.Hearinglossispurelymechanical.2.Cochlearotosclerosis(Retrofenestralotosclerosis)Whenpresent,itisalmostalwaysassociatedwithstapedial(fenestral)otosclerosis.Itinvolvesregionofroundwindoworotherareasintheoticcapsule.Itcausesmixedorsensorineuralhearinglosswhichisbelievedtobetoxicduetodiffusionofcytotoxicenzymesintothefluidofthemembranouslabyrinth(Incontrasttostapedialotosclerosis,wherethedeafnessispurelymechanicalandisconductive).Tinnitusismorecommonincochlearotosclerosis.3.HistologicotosclerosisThistypeofotosclerosisremainsasymptomaticandcausesneitherconductivenorsensorineuralhearingloss.
158.Endolymphaticsacdecompressionis donein? a)Menieresdisease b)Otosclerosis c)Otitismedia d)Vestibularschwannoma CorrectAnswer-AAns.is'a'i.e.,MenieresdiseaseTreatmentofMeniere'sdiseaseMosttreatmentsareforsymptomsbelievedtobecausedbyexcessendolymphaticfluid.TreatmentofMeniere'sdiseaseisoftwotypes:?A)MedicalmanagementB)SurgicalmanagementMedicalmanagement:TreatmentofMeniere'sdiseasebeginsfirstwithmedicalmanagement.Medicaltreatmentcontrolstheconditioninovertwothirdofpatients.Medicalmanagementincludes:?1.Antihistaminelabyrinthinesedatives(vestibularsedatives)Manycasescanbecontrolledbyvestibularsedativeslikeprochlorperazine,promethazine,dimenhydramine,andcinnarzine.2.AnxiolyticandtranquillizersManypatientsareanxious,thereforetheymaybehelpedbyanxiolyticandtranquillizerslikediazepam.3.VasodilatorsBetahistinehydrochlorideappearstobethemostusefulrecentadditiontothemedicalarmamentariumandisroutinelyprescribed
formostpatients.Itincreaseslabyrinthinebloodflowbyreleasinghistamine.Othervasodilatorsemployedincludenicotinicacid,thymoxamine,inhaledcarbogen(5%CO2with95%02),andhistaminedrip.Vasodilatorsincreasevascularityofendolymphaticsacanditsductandtherebyincreasesreabsorptionofendolymphaticfluid.4.Diuretics(furosemide)Diureticswithfluidandsaltrestrictioncanhelptocontrolrecurrentattacksifnotcontrolledbyvestibularsedativesorvasodilators.5.OtherdrugsPropanthelinebromide,phenobarbitoneandhyoscineareeffectivealternatives.SurgicalmanagementSurgicaltherapyformeneire'sdiseaseisreservedformedicaltreatmentfailuresandisotherwisecontroversial.SurgicalprocedurescanbedividedintotwomaincategoriesDestructivesurgicalproceduresNondestructivesurgicalproceduresDestructivesurgicalprocedures:rationaleistocontrolvertigo.Endolymphatichydropscausesfluidpressureaccumulationwithintheinnerear,whichcausestemporarymalfunctionandmisfiringofthevestibularnerve.Theseabnormalsignalscausevertigo.Destructionoftheinnerearand/orthevestibularnervepreventstheseabnormalsignals.Theproceduresperformedare:LabyrinthectomyIntermittentlowpressurepulsetherapy(Meniettdevicetherapy)Conservativesurgicalprocedures:areusedincaseswherevertigoisdisablingbuthearingisstilluseful&needstobepreserved.Theyare:DecompressionofendolymphaticsacEndolymphaticshuntoperationSacculotomy(Fick'soperation&Cody'stackprocedure)VestibularneuronectomyUltrasonicdestructionofvestibularlabyrinthtopreservecochlearfunction.StellateganglionblockorcervicalsympathectomyIntratympanicgentamycin
Vestibularnervesection
159.Intype-4thyroplasty,vocalcordis? a)Mediallydisplaced b)Laterallydisplaced c)Lengthened d)Shortened CorrectAnswer-CAns.is'c'i.e.,LengthenedThyroplastyIsshikidividedthyroplastyproceduresinto4categoriestoproducefunctionalalterationofvocalcords:- 1. TypeI:Medialdisplacementofvocalcord(donebyinjectionofgel foam/Teflonpaste) 2. Type2:Lateraldisplacementofcord(donetoimprovetheairway).3. Type3:Shortening(relax)thecord,tolowerthepitch(gender transformationfromfemaletomale). 4. Type4:Lengthening(tightening)thecord,toelevatethepitch (gendertransformationfrommaletofemale),forexampleasatreatmentofandrophonia.
160.Fenestrationoperationiswhichtypeof tympanoplasty? a)Type-2 b)Type-3 c)Type-4 d)Type-5 CorrectAnswer-DAns.is'd'i.e.,Type-5TypesoftympanoplastyWullsteinclassifiedtympanoplastyintofivetypes:?TypeI:Defectisperforationoftympanicmembranewhichisrepairedwithagraft.Itisalsocalledmyringoplasty.TypeII:Defectisperforationoftympanicmembranewitherosionofmalleus.Graftisplacedontheincusorremnantofmalleus.TypeIII:Malleusandincusareabsent.Graftisplaceddirectlyonthestapeshead.Itisalsocalledmyringostapediopexyorcolumellatympanoplasty.TypeIV:Onlythefootplateofstapesispresent.Itisexposedtotheexternalear,andgraftisplacedbetweentheovalandroundwindows.Anarrowmiddleear(cavumminor)isthuscreated,tohaveanairpocketaroundtheroundwindow.Amucosa-linedspaceextendsfromtheeustachiantubetotheroundwindow.Soundwavesinthiscaseactdirectlyonthefootplatewhiletheroundwindowhasbeenshielded.TypeV:Stapesfootplateisfixedbutroundwindowisfunctioning.Insuchcases,anotherwindowiscreatedonhorizontalsemicircularcanalandcoveredwithagraft.Alsocalledfenestration
operation.
161.Bullousmyringitisiscausedby? a)Pseudomonas b)Mycoplasma c)Pneumococcus d)Candida CorrectAnswer-BAns.is'b'i.e.,MycoplasmaOtitisexternahaemorrhagicaThisconditionisalsoknownasBullousmyringitisormyringitisbullosa.Thisconditionisextremelypainfulandhassuddenonset.Itisthoughttobeduetomycoplasmapneumoniaeorviralinfection,usuallyinfluenzaTheremaybeamildconductivedeafnessandamildlydischargingear.Theappearanceofhaemorrhagicbullaeonthetympanicmembraneandinthedeepmeatusischaracteristic.Thebullaearefilledwithserosanguinousfluidandblood.Onhealing,bullaelooklikeSago-grain.Therefore"Sago-grain"appearanceoftympanicmembraneisseeninhealedmyringitisbullosa.
162.Allareabsoluteindicationsof tonsillectomyexcept a)Suspiciousmalignancy b)Peritonsillarabscess c)Chronictonsillits d)Tonsilscausingobstructivesleepapnea CorrectAnswer-CAns.is'c'i.e.,ChronictonsillitsTonsillectomyTonsillectomy,asthenamesuggests,isthesurgicalproceduretoremovethetonsils.Often,tonsillectomyisdoneatthesametimeasadenoidectomy.IndicationsIndicationsaredividedinto:?A.Absolute1.Recurrentinfectionsofthroat.Thisisthemostcommonindication.Recurrentinfectionsarefurtherdefinedas:Sevenormoreepisodesinoneyear,orFiveepisodesperyearfor2years,orThreeepisodesperyearfor3years,orTwoweeksormoreoflostschoolorworkinoneyear.2.Peritonsillarabscess.Inchildren.tonsillectomyisdone4-6weeksafterabscesshasbeentreated.Inadults,secondattackofperitonsillarabscessformstheabsoluteindication.3.Tonsillitiscausingfebrileseizures.4.HypertrophyoftonsilscausingAirwayobstruction(sleepapnoea)
DifficultyindeglutitionInterferencewithspeech.5.Suspicionofmalignancy.Aunilaterallyenlargedtonsilmaybealymphomainchildrenandanepidermoidcarcinomainadults.Anexcisionalbiopsyisdone.B.Relative 1. Diphtheriacarriers,whodonotrespondtoantibiotics2. Streptococcalcarriers,whomaybethesourceofinfectiontoothers.3. Chronictonsillitiswithbadtasteorhalitosiswhichisunresponsiveto medicaltreatment. 4. Recurrentstreptococcaltonsillitisinapatientwithvalvularheart disease.C.AsapartofAnotherOperation 1. Palatopharyngoplatywhichisdoneforsleepapnoeasyndrome.2. Glossopharyngealneurectomy.TonsilisremovedfirstandthenIX nerveisseveredinthebedoftonsil. 3. Removalofstyloidprocess.
163.Retractionoftympanicmembrane touchingpromontory.Whatissade'sgrade? a)1 b)2 c)3 d)4 CorrectAnswer-CAns.is'c'i.e.,3AtelecticgradesofparstensaSadeclassification::Grade1=slightretractionofTMovertheannulusGrade2=theTMtouchesthelongprocessoftheincusGrade3=theTMtouchesthepromontoryGrade4=theTMisadherenttothepromontory
164.Posterosuperiorretractionpocketif allowedtoprogresswillleadto? a)SNHL b)Secondarycholesteatoma c)Tympanosclerosi d)Primarycholesteatoma CorrectAnswer-DAns.is'd'i.e.,PrimarycholesteatomaRetractionpocketsaremorecommoninthepostero-superiorportionofpars-tensaofear-drum(tympanicmembrane).Tworeasonshavebeenattributedtothisfeatures:- 1. Thisareaismorevascular,hencecouldbesubjectedtointense inflammatoryreaction. 2. Middlefibrouslayerinthisareaisincomplete,lackincircularfibers. Longtermeffectsofprogressiveretractionmaybe:- 1. Fixationofatrophicsigmenttobonywallofmiddleearcavity.2. Erosionofossicles,mostcommonlylongprocessofincus.3. Formationofcholesteatoma(primaryacquiredcholesteatoma).4. "Aposteriorsuperiorretractionpocket,ifallowedtoprogress,leads toprimaryacquiredcholeastoma".AcquiredcholesteatomaInmajorityofcasescholesteatomaisacquired.Acquiredcholesteatomamaybeeitherprimaryacquiredorsecondaryacquired:?A.PrimaryacquiredcholesteatomaThereisnohistoryofpreviousotitismediaorapre-existingperforation.Theoriesforitsgenesisare:-
1. Retractionpocket(wittmaack'stheory):-Itisthemostaccepted theory.ThereisinvaginationofparsflaccidaintheformofretractionpocketduetonegativepressureinmiddleearasaresultofEustachiantubedysfunction.Thereisingrowth(migration)ofsquamousepitheliumfromtheouterlayeroftympanicmembrane(outerlayerofTMislinedbysquamousepithelium)throughthisretractionpocket.Infectionsupervenesontheimpactedsquamousepithelium/keratin. 2. Basalcellhyperplasia(Ruedi'stheory):-Thereisproliferationofthe basallayerofparsflaccidainducedbysubclinicalchildhoodinfections.Theseproliferatingbasalcellslaydownkeratinizingsquamousepithelium. 3. Squamousmetaplasia(Sade'stheory):-Pavementepitheliumof atticundergoesmetaplasiaandtransformsintosquamousepitheliumduetosubclinicalinfections.B.SecondaryacquiredcholesteatomaThereispre-existingperforationinparstensa.Theoriesonitsgenesisinclude:- 1. Epithelialinvasion(Habermann'stheory):-Theepitheliumfromthe meatusorouterdrumsurfacegrowsintothemiddleearthroughapre-existingperforationespeciallyofthemarginaltypewherepartofannulustympanicushasalreadybeendestroyed. 2. Metaplasia:-Middleearmucosaundergoesmetaplasiadueto repeatedinfectionsofmiddleearthroughthepre-existingperforation.
165.Treatmentofchoiceforatticoantraltype ofCSOM? a)Antiboiotics b)Tympanoplasty c)Modifiedradicalmastoidectomy d)None CorrectAnswer-CAns.is'c'i.e.,ModifiedradicalmastoidectomyTreatmentofatticoantraldiseaseSincecholesteatomaisgoingtoexpandanddestroyboneandmucousmembrane,ithastoberemoved.Therefore,surgeryisthemainstayoftreatment.Primaryaimisremovalofdiseasebymastoidectomytomakeearsafefollowedbyreconstructionofhearingatalaterstage.Modifiedradicalmastoidectomyisthesurgeryofchoice.Twotypesofsurgicalprocedures(mastoidectomy)aredonetodealwithcholesteatoma:-1.CanalwalldownproceduresTheseleavethemastoidcavityopenintotheexternalauditorycanalsothatthediseasedareaisfullyexteriorized.Thecommonlyusedproceduresforatticoantraldiseaseareatticotomy,modifiedradicalmastoidectomyandrarelyradicalmastoidectomy.Modifiedradicalmastoidectomyistheprocedureofchoice.2.Canalwallupprocedures(corticalmastoidectomy)Herediseaseisremovedbycombinedapproachthroughthemeatusandmastoidbutretainingtheposteriorbonymeatuswall,therebyavoidinganopenmastoidcavity.
Forreconstructionofhearingmechanismmyringoplastyortympanoplastycanbedoneatthetimeofprimarysurgeryorasasecondstageprocedure.
166.Retractionoftympanicmembrane touchingthepromontory.Itiscalled? a)Mildretraction b)Severeretraction c)Atelectasis d)Adhesiveotitis CorrectAnswer-CAns.is'c'i.e.,AtelectasisTympanicmembraneretractionTheretractedsegmentofeardrumisoftenknownasaretractionpocket.Theterms"atelectasis"orsometimes"adhesiveotitismedia"canbeusedtodescriberetractionofalargeareaoftheparstensa.
167.AllaretrueaboutRinne'stestexcept? a)Positiveinnormalear b)Positiveinsensorineuralhearingloss c)Minimum15-20dBairbonegapisrequiredinconductive deafness d)Boneconductionisbetterinsensorineuralhearingloss CorrectAnswer-DAns.is'd'i.e.,BoneconductionisbetterinsensorineuralhearinglossRinne'sTestTheRinnetestisatuningforktestthatcompareshearingbyairconductionandboneconduction.TheRinnetestisbasedontheideathathearingmechanismisnormallymoreefficientbyairconduction(AC)thanitisbyboneconduction(BC),i.e.,AC>BCinnormalpersons.Forthisreason,atuningforkwillsoundlouderandlongerbyairconductionthanbyboneconduction.However,thisairconductionadvantageislostwhenthereisaconductivehearinglossinwhichcasethetuningforksoundslouderbyboneconductionthanbyair-conduction.MethodAdministeringtheRinnetestinvolvesaskingthepatienttoindicatewhetheravibratingtuningforksoundslouderwhenitsbaseisheldagainstmastoidprocess(boneconduction)orwhenitsprongsareheldnearthepinna,facingtheopeningofearcanal(airconduction).Afterstrikingthefork,theclinicianalternatesitbetweenthesetwopositionssothatthepatientcanmakeajudgementaboutwhichoneislouder.InterpretationofRinne'stestTheoutcomeoftheRinnetestistraditionallycalled"positive"ifthe
forkislouderbyairconductionandthisfindingimpliesthattheearisnormalorhassensorineuralhearingloss.Theresultsarecalled"negative"ifthebone-conductionislouderthanair-conduction,whichisinterpretedasrevealingthepresenceofconductivedeafnessi.e.,lesionsofeitherexternalear,tympanicmembrane,middleearorearossicles..InconductivedeafnessRinne'stestwillbenegativeiftheconductivehearinglossisgreaterthan15-20dB(minimumairbonegap15-20dB).Thatmeans,atleast15-20dBofconductivehearlossisrequiredtoshowboneconductionbetterthanairconduction,i.e.,NegativeRinne'stest.AnegativeRinnetestfor256,512and1024Hzindicatesaminimumair-bonegap(ABG)of15,30,45dBrespectively.Therefore,ABgapcanbemadeiftuningforksof256,512and1024Hzareused:- 1. ARinnetestequalornegativefor256Hzbutpositivefor512Hz indicatesair-bonegapof20-30dB. 2. ARinnetestnegativefor256and512Hzbutpositivefor1024Hz indicatesair-bonegapof30-45dB. 3. ARinnenegativeforallthethreetuningforksof256,512,and1024 Hz,indicatesair-bonegapof4560dB.RationaleofpositivetestPositivetest(AC>BC)isseenin:?1.NormalpersonIthasalreadybeenexplainedthatairconductionisbetterthanboneconduction,thusRinnetestispositiveinnormalperson.2.Sensori-neuralhearingInsensorineuralhearingloss,thedefectisincochleaorVIIInerveoritscentralconnection.Thereisnodefectinconductiveapparatusofear(airconduction)orinmastoidbone(boneconduction).Asairconductionisbetterthanboneconduction,Rinnetestwillbepositive(becausebothairconductiveapparatusandboneconductiveapparatusarenormalandthepathologyisdistaltothem).Negativetest(BC>AC)isseenin:?1.ConductivedeafnessAstheconductiveapparatusisdefective,boneconductionbecomesbetterthanairconduction(BC>AC).
2.SevereunilateralsensorineuralhearinglossHeretheRinnetestisfalsenegative(nottruenegative)asitisinterpretedbythepatientthatBC>AC,butactuallyitisnot.Inrealitythisresponseisfromtheoppositeearbecauseoftranscranialtransmissionofsoundduringboneconductiontesting.Thiscanbepreventedbymaskingthenon-testearwithBarany'sboxwhiletestingtheboneconduction.Webertestwillhelpforsuchsituation.
168.Stimulationofhorizontalsemicircular canalcausesnystagmusinwhichdirections? a)Vertical b)Horizontal c)Rotary d)Anyofthethree CorrectAnswer-BAns.is'b'i.e.,HorizontalThecupulaeofthesemicircularcanalsarestimulatedbymovementofendolymphaticfluidandeachcanalcausesthenystagmusinitsownplane:- 1. StimulationofhorizontalSCC4Horizontalnystagmus.2. StimulationofsuperiorSCC4Rotarynystagmus.3. StimulationofverticalSCCVerticalnystagmus
169.Bilateralpast-pointingisduetodefectin ? a)Brainstem b)Cerebellum c)Vestibularsystem d)Basalganglia CorrectAnswer-CAns.is'c'i.e.,VestibularsystemPast-pointingisthedeviationoftheextremitiescausedbyeithercerebellarhemisphereorvestibulardisease.Testingisusuallydonewitharms.Thetraditionalmethodistohavethepatientextendthearmandplacehisextendedfingerontheexaminer'sindexfinger;thenwiththeeyeclosedraisethearmdirectlyoverhead;thanbringitbackdownpreciselyontotheexaminer'sfinger.Ifvestibularorcerebellarlesionisthere,pastpointing(deviationoflimb)willbepresent.Thetwotypes(cerebellarandvestibular)pastpointinghavedifferentpatterns:- 1. Withvestibularin:balance,thenormallabyrinthwillpushthelimb towardtheabnormalsideandthepatientwillmissthetarget.Thepastpointingwillalwaysbetothesamesideoftargetandwilloccurwitheitherlimb. 2. Withacerebellarhemisphericlesion,theipsilaterallimbswillhave ataxiaandincoordination;pastpointingoccursonlywiththeinvolvedarmandmaybetothesideoflesionorerraticallytoeithersideofthetarget.So,
Bilateralpast-pointingVestibularsystemdefect.Unilateralpast-pointingCerebellarhemispheredefect.
170.Majorcontributionintheformationof nasalseptumisbyallexcept? a)Septalcartilage b)Vomer c)Ethmoid d)Nasalbone CorrectAnswer-DAns.is'd'i.e.,NasalboneThemedialwall,ornasalseptum,isformed(fromanteirortoposterior)by:(1)theseptalcartilage(destroyedinadriedskull)(2)theperpendicularplateoftheethmoidbone,and(3)thevomer.Itisusuallydeviatedtooneside.Thevomercontributestotheinferiorportionofthenasalseptum;theperpendicularplateoftheethmoidbonecontributestothesuperiorportion.
171.Allaretrueaboutconductivedeafness except? a)Rinne'stestisnegative b)Absoluteboneconductionisnormal c)Weberislateralizedtopoorerear d)Thereisdecayinthresholdtone CorrectAnswer-DAns.is'd'i.e.,Thereisdecayinthresholdtone
172.Ethmoidalpolypis? a)Duetoinfection b)Single c)Recurrent d)Occursinchildren CorrectAnswer-CAns.is'c'i.e.,Recurrent
173.Mostcommoncauseoforoantralfistula ? a)TB b)Penetratinginjury c)Toothextraction d)latrogenic CorrectAnswer-CAns.is'c'i.e.,ToothextractionOroantralfistulaItiscommunicationbetweentheantrumandoralcavity.EtiologyDentalextraction:-Mostimportantcauseandmaxillaryfirstmolaraccountsfor50%oforal-antralfistulascausedbyextractions.Maxillarysecondandthirdmolarextractionsaccountforother50%.Infection:-TB,syphilis,leprosyofmaxillarybone.Malignantneoplasm:-Causeserosionofantrum.Fractureorpenetratinginjuriesofmaxilla.Midlinegranuloma(aformoflymphoma)FailureofsublabialincisiontohealafterCaldwell-Lucoperation.ClinicalfeaturesRegurgitationoffoodDischarge(oftenfoulsmelling)Inabilitytobuiltpositiveornegativepressureinmouth.
174.Killiandehiscenceisin? a)Superiorconstrictor b)Inferiorconstrictor c)Middleconstrictor d)None CorrectAnswer-BAns.is'b'i.e.,InferiorconstrictorInferiorconstrictormusclehastwoparts:-(i)Thyropharyngeouswithobliquefibres,and(ii)Cricopharyngeouswithtransversefibres.BetweenthesetwopartsofinferiorconstrictorexistsapotentialgapcalledKillan'sdehiscence.Itisalsocalledthegatewaytotearasperforationcanoccuratthissiteduringesophagoscopy.Itisalsothesiteforherniationofpharyngealmucosaincaseofpharyngealpouch.
175.Saddlenoseis? a)Depressednose b)Crookednose c)Deviatednose d)C-shaped CorrectAnswer-AAns.is'a'i.e.,DepressednoseSaddlenose(Depressednose)Nasaldorsumisdepressed(saggingofthebridgeofnose).Depressednasaldorsummayinvolveeitherbony,cartilaginousorbothbonyandcartilaginouscomponents.Mostcommonetiology:NasaltraumaCausesarehematoma,excessivesurgicalremoval,trauma,syphilis,abscess,Leprosy,andtuberculosis.CrookedordeviatednoseCrookednoseistheexternaldeviationofnoseduetodeviationofthedorsalborderofseptalcartilage,forminga`C'or'S'shapedcurve.Incrookednose,themidlinedorsumiscurvedin'C'or'S'shapedmannerfromthefrontonasalangletothetipofnose.Inadeviatednose,themidlineisstraightbutdeviatedtooneside,midlineisnotcurvedasincrookednose.
176.Tonsillarfossaisboundedanteriorlyby ? a)Pharyngobasilarfascia b)Palatopharyngealfold c)Buccopharyngealfascia d)Palatoglossalfold CorrectAnswer-DAns.is'd'i.e.,PalatoglossalfoldPalatinetonsilsaremassesoflymphoidtissuethatcanbeseenontheleftandrightsidesatthebackofthethroat.Therearetwopalatinetonsils,andeachpalatinetonsil(rightorleft)liesinthetonsilarsinus(tonsilarfossa)onthelateralwalloforopharynx.Tonsillarfossaboundedbythepalatoglossalfoldinfrontandthepalatopharyngealfoldbehind.Tonsilsarelinedbynon-keratinizedstratifiedsquamousepithelium.Medialsurfaceofeachtonsilhas15-20crypts,thelargestofwhichiscalledIntratonsillarcleftorcryptamagna(whichrepresentspersistenceoftheventralportionofthesecondpharyngealpouch).Tonsillarbedisformedfromwithin-outwardsby:-LiPharyngobasilarfasciaSuperiorconstrictor(above)andpalatopharyngeusmuscleStyloglossus(below)Buccopharyngealfascia
177.Passavantsridgeisformedby? a)Palatoglossus b)Superiorconstrictor c)Salpingopharyngeus d)Palatopharyngeus CorrectAnswer-DAns.is'd'i.e.,PalatopharyngeusPharynxhastwogroupofmuscles:?*Intrinsicmuscles:-Stylopharyngeous,salpingopharyngeous,palatopharyngeous.*Extrinsicmuscles:-Superiorconstrictor,middleconstrictor,inferiorconstrictor.-Allmusclesofpharynxaresuppliedbycranialaccessorythroughbranchesofvagusviapharyngealplexusexceptstylopharyngeuswhichissuppliedbyglossopharyngeal.-Inferiorconstrictormusclehastwoparts:-(i)Thyropharyngeouswithobliquefibres,and(ii)Cricophatyngeouswithtransversefibres.-BetweenthesetwopartsofinferiorconstrictorexistsapotentialgapcalledKillan'sdehiscence.Itisalsocalledthegatewaytotearasperforationcanoccuratthissiteduringesophagoscopy.Itisalsothesiteforherniationofpharyngealmucosaincaseofpharyngealpouch.-UpperfibersofpalatopharyngeusconstitutethePassavant'smusclewhichoncontractionraisesaridgecalledPassavant'sridgeonposteriorwallofnasopharynx.
178.Hotpotatovoiceischaracteristicof? a)Nasopharyngealcarcinoma b)Glotticcarcinoma c)Subglotticcarcinoma d)Supraglotticcarcinoma CorrectAnswer-DAns.is'd'i.e.,SupraglotticcarcinomaClinicalfeaturesofsupraglotticcarcinomaPainonswallowingisthemostfrequentinitialsymptom--Devita7th/ep.698Massinneckmaybethefirstsign.Hoarsnessisalatesymptom.Painmaybereferredtoearbyvagusnerveandauricularnerveofarnold.Latesymptomsincludefoulbreath,dysphagiaandaspiration.Largetumorscancause"hotpotatovoice/muffledvoice".Hemoptysis,sorethroat,shortenessofbreath,stridor,otalgiaandaspirationpneumoniamayalsooccur.
179.Allareearlycomplicationsof tracheostomyexcept? a)Hemorrhage b)Pneumothorax c)Injurytoesophagus d)Trachealstenosis CorrectAnswer-DAns.is'd'i.e.,Trachealstenosis Complicationsof Late(withprolonged tracheostomy useoftubeforweeks Intermediate(firstfew ormonths) Immediate(at hoursordays) Hemorrhage,dueto thetimeof Bleeding(reactionaryor erosionofmajorvessel operation) secondary) Laryngealstenosis Hemorrhage Displacementoftube Trachealstenosis Apnea Blockingoftube Tracheo-esophageal Pneumothorax Subcutaneousemphysema fistula InjurytoRLN Tracheitisand Problemof Aspirationof tracheobronchitis decannulation blood Atelectasisandlung Persistent Injuryto abscess tracheocutaneous esophagus Localwoundinfectionand fistulagranulations Problemoftracheostomyscar
180.Nasopharynxislinedbywhich epithelium? a)Stratifiedsquamousnonkerationized b)Stratifiedsquamouskeratinized c)Ciliatedcolumnar d)Cuboidal CorrectAnswer-CAns.is'c'i.e.,CiliatedcolumnarThetwomaintypesofepithelialiningthenasopharynxarestratifiedsquamous(comprisingapproximately60%ofnasopharyngealepithelium)andpseudostratifiedcolumnarrespiratoryepitheliumcontainingciliatedcells,gobletcellsandbasalcells.
181.Vidianneurectomyisdonefor? a)Allergicrhinitis b)Atrophicrhinitis c)Vasomotorrhinitis d)Chronichypertrophicrhinitis CorrectAnswer-CAns.is'c'i.e.,VasomotorrhinitisVasomotorrhinitisVasomotorisanonallergicconditionthatinvolvesaconstantrunnynose,sneezingandnasalcongestion,i.e.,thenoseisstuffyorrunnyforreasonsotherthanallergiesandinfections.Theexactetiologyisunknown,buttriggersincludeemotions,odors,poorairquality,spicyfoods,andmedicationsideeffects.Pathogenesisinclude:-ParasympatheticoveractivityHyperactivenasalmucosatoseveralnon-specificstimuliespeciallyinwomenof20-40years.Symptomsofvasomotorrhinitisincludeexcessiveclearrhinorrhoea,nasalobstruction/congestion,irritation,paroxysmalsneezingandpost-nasaldrip.Nasalmucosaishypertrophied&congested;andmucosaofturbinatesmaygivemulberrylikeappearanceandispaletoduskyredincolour.Complicationsofvasomotorrhinitisincludehypertrophicrhinitis&sinusitis,andnasalpolyp.TreatmentTreatmentofvasomotorrhinitisincludes:-1.ConservativetreatmentAvoidanceofphysicalfactorswhichprovokesymptoms.Antihistaminicsandoralornasaldecongestants.
Topicalorsystemicsteroids2.SurgicaltreatmentNasalobstructioncanberelievedbymeasureswhichreducethesizeofhypertrophiednasalturbinate:-Cryosurgery,submucosaldiathermy,Linearcauterization,partialortotalturbinectomy,submucosalresectionofturbinate.ExcessiverhinorrhoeainvasomotorRhinitisnotcorrectedbymedicaltherapyandbothersometothepatient,isrelievedbysectioningtheparasympatheticsecretomotorfibrestonosei.e.,vidianneurectomy.
182.Lymphaticdrainageoforpharynxis mainlythrough? a)Superficialcervicallymphnodes b)Submandibularnodes c)Jugulodigastricnode d)Jugulo-omohyoidnodes CorrectAnswer-CAns.is'c'i.e.,JugulodigastricnodesDeepcervicallymphnodesaredividedintotwogroups:-(i)jugulodigastric,and(ii)jugulo-omohyoid.Lymphaticsfromoropharynxdrainintojugulodigastricnodes.LymphaticdrainageofpharynxLymphaticdrainageofpharynxmaybe:?1.NasopharynxNasopharynxdrainsintoupperdeepcervicalnodeseitherdirectlyorindirectlythroughretropharyngealorparapharyngealnodes.Nasopharynxalsodrainsintospinalaccessorychainofnodesintheposteriortriangleoftheneck.2.OropharynxLymphaticsfromtheoropharynxdrainintoupperjugularparticularlythejugulodigastric(tonsillar)nodes.Thesoftpalate,lateralandposteriorpharyngealwallsandthebaseoftonguealsodrainintoretropharyngealandparapharyngealnodesandfromtheretothejugulodigastricandposteriorcervicalgroup.3.HyphopharynxPyriformsinusdrainsintoupperjugularchain&thentodeepcervicalgroupoflymphnodes.Postcricoidregiondrainsintoparapharyngealandparatracheal
groupoflymphnodes.Posteriorpharyngealwalldrainsintoparapharyngeallymphnodesandfinallytodeepcervicallymphnodes.
183.Allaretrueaboutotiticbarotrauma except? a)Conductivedeafness b)Retractedtympanicmembrane c)Catheterizationcanbeused d)Occursduringsuddenascentinaircraft CorrectAnswer-DAns.is'd'i.e.,OccursduringsuddenascentinaircraftOtiticBarotraumaThisconditionisseenwhentheambientpressureisrising,e.g.inscubadiving(underwaterdiving),descendinginanaircraft,orcompressioninpressurechamber.Itoccursduetopressuredifferencesbetweentheinsideandoutsideoftheeardrum.ClinicalfeaturesEardiscomfortorpain,hearingloss,andtinnitusarecommonVertigoisuncommonOtoscopyfindingsare:-CongestedandretractedtympanicmembraneBloodmayextravasateintomiddleearproducinghaemotympanumOnexaminationthereisconductivedeafness.PathogenesisofotiticbarotraumaThemiddleearpressureisnormallymaintainedatalevelsimilartothatoftheatmospherebythefunctionofEustachiantubewhichallowspassageofairfrommiddleeartopharynx.Suddenordramaticchangesofexternalpressuremaydefeatthismechanismandcauseinjurytomiddleear.Whenatmosphericpressureishigherthanthatofmiddleearbycriticallevelof90mmHg,
eustachiantubegetslockedasthesofttissuesofpharyngealendofthetubeareforcedintothelumenbyhighatmosphericpressure.Thisresultsinsuddennegativepressureinthemiddleearwhichcausesretractionoftympanicmembrane,hyperemia,transudationwithhemorrhageanddevelopmentofAero-otitismedia(barotrauma)Atpressuredifference>100to500mmHg,tympanicmembranecanrupturewhenthepressuredifferenceismorethan100mgHg,tympanicmembranecanrupture.TreatmentofotiticBarotraumaRoutineselftreatmentofpainassociatedwithchangingpressureinaircraftincludeschewinggum,attemptingtoyawn&swallow,blowingagainstclosednostrils,andusingdecongestantnasalsprays.Theaimistorestoremiddleearareation.Catheterizationorpolitzerizationcanalsobeused.Iftheeustachiantubewillnotopenwithothertreatments,surgerymaybenecessory.Myringotomyandaspirationoffluidisthesurgicalprocedureused.
184.Teardropsignisseenin? a)Fracturezygomaticarch b)Fracturemaxilla c)Fracturemandible d)Blowoutfracture CorrectAnswer-DAns.is'd'i.e.,BlowoutfractureFracturesoftheflooroftheorbitZygomaticfractureandLefortIImaxillaryfracturesarealwaysaccompaniedbyfracturesoforbitalfloor.Isolatedfracturesoforbitalfloor,whenalargebluntobjectstrikestheglobe,arecalled"blowoutfractures".ClinicalfeaturesEcchymosisoflid,conjunctivaandsclera.Endophthalmoswithinferiordisplacementoftheeye-ball.Thisbecomesapparentwhenoedemasubsides.Diplopia,whichmaybeduetodisplacementoftheeyeballorentrapmentofinferiorrectusandinferiorobliquemuscles.Hypoaesthesiaoranaesthesiaofcheekandupperlip,ifinfraorbitalnerveisinvolved.DiagnosisJWater'sviewshowaconvexopacitybulgingintotheantrumfromabove,i.e.,Teardropopacity.CTscanisdiagnostic.
185. Invertedpapillomaofnosearisefrom? a)Nasalseptum b)Roofofthenose c)Tipofthenose d)Lateralwallofthenose CorrectAnswer-DAns.is'd'i.e.,LateralwallofthenoseInvertedPapilloma(Transitionalcellpapilloma/Schneiderionpapilloma)Invertedpapillomaisabenignneoplasmoccursmostlybetween40-70yearswithmalepreponderance(5:1).Itarisesfromthelateralwallofnoseandisalwaysunilateral.Rarely,itmayarisefromnasalseptum.Featuresofinvertedpapillomaare:-Itshowsfingerlikeepithelialinvasionsintotheunderlyingstromaoftheepitheliumratherthanonsurfacesocalledinvertedpapilloma.Itisusuallyunilateralandisalocallyaggressivetumour.Patientscomplainofnasalobstruction,rhinorrhea&unilateralepistaxis.In10-15%casestheremaybeassociatedsquamouscellcarcinoma.Treatmentisadequatelocalexcision.Ifitarisesinmaxillarysinus,thenaradicalantrostomyiscarriedout.Ifitarisesintheethmoidalsinus,anexternalethmoidectomyisdone.Ifitarisesfromnose,
treatmentiswidesurgicalexcisionbylateralrhinotomy.Hasatendencytorecurevenafterremoval.
186.Trueaboutexternalnose? a)Upper2/3isbony b)Lower1/3iscartilaginous c)Singlelateralcartilage d)Twonasalbones CorrectAnswer-DAns.is'd'i.e.,TwonasalbonesExternalnosehasanosteocartilaginousframeworkofwhichupperone-thirdisbonyandlowertwo-thirdiscartilaginous. 1. Bonypart:-Consistsoftwonasalbones.2. Cartilagenouspart:-Consistsoftwoupperlateralcartilages,two lowerlateralcartilages,twoormorelessaralar(orsesmoid)cartilagesandaseptalcartilage.So,thereare3pairedand1unpairedcartilages.
187.IndicationofBAHA(Bone-anclored hearingaid) a)Bilateralhearingloss b)Sensorineuralhearingloss c)Congenitalcanalatresia d)Alloftheabove CorrectAnswer-CAns.is'c'i.e.,CongenitalcanalatresiaIndicationsforBAHAWhenair-conduction(AC)hearingaidconnotbeused;Canalatresia,congenitaloracquired,notamenabletotreatment.Chroniceardischarge,notamenabletotreatment.Excessivefeedbackanddiscomfortfromair-conductionhearingaid.Conductiveormixedhearingloss,e.g.otoscierosisandtympanosclerosiswheresurgeryiscontraindicated.Single-sidedhearingloss.
188.Muller'smanoeuverisused? a)Tofindoutopeningofmouth b)Toremovelaryngealforeignbody c)Tofinddegreeofobstructioninsleepdisorderedbreathing d)Toremoveforeignbodyfromear CorrectAnswer-CAns.is'c'i.e.,TofinddegreeofobstructioninsleepdisorderedbreathingMuller'smanoeuvreUsedtofindthelevelanddegreeofobstructioninsleep-disorderedbreathing.Itisperformedwhileusingflexiblenasopharyngoscope.Firsttheexaminerseestheupperairwaysatrestandthenduringthetimewhenpatientmakesmaximalinspiratoryeffortwithnoseandmouthclosed.Baseoftongue,lateralpharyngealwallandpalateareexaminedforcollapsibilityandthenratedform0(minimalcollapse)to4+(completecollapse).
189.Rosen'sincisionisusedfor? a)Septoplasty b)SMR c)Stapedectomy d)Tonsillectomy CorrectAnswer-CAns.is'c'i.e.,StapedectomyRosen'sincisionisthemostcommonlyusedforstapedectomythroughendomeatalortranscanalapproach.AlsoknowLempert'sincisionisusedforenduralapproach.Wilde'sincisionisusedforpostauralapproach.
190.Submandibularnodesareclassifiedas? a)LevelIAnecknodes b)LevelIBnecknodes c)LevelIInecknodes d)LevelIIInecknodes CorrectAnswer-BAns.is'b'i.e.,Level1BnecknodesDivisionofnecknodesaccordingtolevelsLevelISubmental(IA)Submandibular(IB)LevelIIUpperjugularLevelIIIMidjugularLevelIVLowerjugularLevelVPosteriortrianglegroup(Spinalaccessoryandtransversecervicalchains)LevelVIPrelaryngealPretrachealParatrachealLevelVIINodesofuppermediastinum
191.Hyponasalvoiceisseeninallexcept? a)Adenoids b)Nasalpolyp c)Cleftpalate d)Habitual CorrectAnswer-CAns.is'c'i.e.,CleftpalateCauseofhyponasalityandhypernasalityHyponasalityHypernasalityCommoncoldVelopharyngealinsufficiencyNasalallergyCongenitallyshortsoftpalateNasalpolypSubmucouspalateNasalgrowthLargenasopharynxAdenoidsCleftofsoftpalateNasopharyngealmassParalysisofsoftpalateFamilialspeechpatternPost-adenoidectomyHabitualOronasalfistulaFamilialspeechpatternHabitualspeechpattern
192.Schatzki'sRingispresentat? a)Upperendoftrachea b)Lowerendoftrachea c)Upperendofesophagus d)Lowerendofesophagus CorrectAnswer-DAns.is'd'i.e.,LowerendofesophagusSchatzki'sringItoccursatthejunctionofsquamousandcolumnarepitheliumatthelowerendofoesophagusandhasalsobeencalledloweroesophagealring.Usuallyseeninpatientsabove50yearsofage.Causeisunknown.Symptomaticpatientscomplainofintermittentdysphagiaandsomemayevenpresentwithbolusobstruction.Itmaybeassociatedwithhiatushernia.Treatmentisoesophagealdilatation.
193."Risingsun"appearanceisseenin- a)ASOM b)CSOM c)Glomustumor d)Acousticneuroma CorrectAnswer-CAns.is'c'i.e.,GlomustumorClinicalfeaturesofglomustumorTheearliestsymptomsofglomustumourispulsatiletinnitus(earliest)andhearingloss.Hearinglossisconductiveandslowlyprogressive.Thesearefollowedbybloodstainedotorrhoeaandearache.Beforethetympanicmembrane(eardrum)isperforatedaredswellingisseentoarisefromthefloorofmiddleear,i.e."Risingsun"appearance.Thisresultsinaredreflexthroughtheintacttympanicmembrane.Sometimes,eardrummaybebluishandbulging.oPulsationsign(Brownsign)ispositive,i.e.whenearcanalpressureisraisedwithSiegle'sspeculum,tumorpulsatesvigorouslyandthenblanches;reversehappenswithreleaseofpressure.Aquinosignispositive,i.e.blanchingofmasswithmanualcompressionofipsilateralcarotidartery.Whenthetumourperforatestheeardrumapolypuswillbeseeninthemeatusandthiswillbleedprofuselyiftouched.Cranialnervepalsiesisalatefeatureappearingseveralyearsafterauralsymptoms.IXthtoXIV'cranialnervesmaybeparalysed.Thiscancausedysphagiaandhoarseness,andweaknessoftrapeziusandsternocleidomastoidmuscles,unilateralparalysisofsoftpalate,
pharynxandvocalcord.Ausculationwithstethoscopeoverthemastoidmayrevealaudiblesystolicbruit.Someglomustumourssecretecatecholaminesandproducesymptomsliketachycardia,arrhythmias,sweating,flushingandheadacheetc.Facialpalsymaybecausedbyglomustympanicumtypeofglomustumor.Audiometryshowsconductivedeafness,Howeverifinnerearisinvaded,mixedconductiveandsensorineuralhearinglossisseen.
194.Cart-wheelappearanceoftympanic membraneinASOMisdueto? a)Perforationoftymparicmembrane b)Edemaoftympanicmembrane c)Congestedbloodvesselsalongmalleus d)Granulationtissueontympanicmembrane CorrectAnswer-CAns.is'c'i.e.,CongestedbloodvesselsalongmalleusStagesofASOMASOMrunsthroughthefollowingstagesandthereforepresentationdependsuponthestage:1.Stageoftubalocclusion(Eustachiantubeobstruction)EdemaandhyperaemiaofnasopharyngealendofEustachiontubeblocksthetube,leadingtoabsorptionofairandnegativeintratympanicpressure.Thereisfeelingofdiscomfortandmildhearingloss(conductive)withpinkretractedtympanicmembrane.2.Stageofpresuppuration(Earlyinfection)Thereiscollectionofinflammatoryexudatebehindthetympanicmembrane.ThereismarkedThrobbingearache,hearingloss,tinnitusandfever.Tympanicmembraneiscongested.LeashofbloodvesselsappearalongthehandleofmalleusandattheperipheryoftympanicmembraneimpartingitaCart-wheelappearance.3.Stageofsuppuration(suppurativestage)Thereiscollectionoffrankpusinthemiddleear.Patienthasexcruciatingearache,hearingloss,andconstitutionalsymptomslikehighgradefever.
Tympanicmembraneisredandbulgingwithlossoflandmarks.4.Stageofresolution(Resolutionstage)Thetympanicmembraneruptureswithreleaseofpusandsubsidenceofsymptoms.Earacheisrelieved,fevercomesdownandchildfeelsbetter.
195.Innoiceinducedhearingloss, audiogramshowsatypicalnotchat a)1000Hz b)2000Hz c)3000Hz d)4000Hz CorrectAnswer-DAns.is'd'i.e.,4000HzNoiseinducedhearinglossExposuretoloudnoisecanleadtopermanenthearingthresholdshifts.Thismayhappenimmediatelywithextremeexposure(nearbyexplosionorgunfire),butmorecommonlyoccursslowlyovertimewithrepeatedexposuretoindustrialorenvironmentalnoise.Patientswilloftenhaveatypical4-KHz(4000Hz)notch(dipat4000Hz)intheiraudiogramcalledacousticdip.Auditoryeffectsofnoiceare:? 1. Auditoryfatigue:-at90dBand4000Hz.2. Hearingloss3. Temporary:-At4000-6000Hz4. Permanent:-Repeatedprolongedexposureto100dBorsingle exposureto160dB.
196.Insensorineuralhearingloss,weber's testislateralizedto a)Normalear b)Defectiveear c)Notlateralized d)Mayalternate CorrectAnswer-AAns.A.Webertestislateralizedtotheunaffectedornormalear.PURPOSE:Determinationofaconductivevs.asensorineuralhearingloss.StriketuningforkandplacebaseinthecenteroftheforeheadorthetopoftheheadAskifthetoneislouderintheleftear,therightearorequallyloudinbothearsduetothesoundlocalizationprocess,Inapatientwithaunilateralconductivehearingloss,thesoundwillbelouderintheaffectedear(airbornesoundsmaskboneconductioninthenormalear;conductivelosspreventsmaskinginaffectedearsoundisperceivedtobelouderinaffectedear)Inapatientwithunilateralsensorineuralhearingloss,thesoundislouderinthenormalear(nosignalistransducedbythecochleaontheaffectedside,thereforethesoundislouderonthenormalsideandisperceivedtobecomingfromthatsideInanormalpersonorapersonwithsymmetricalhearingloss,itisequallyloudinbothears.Inotherwords,anormalpatient,theWebertuningforksoundisheardequallyloudlyinbothears,withnooneearhearingthesoundlouderthantheother(lateralization).Inapatientwithhearingloss,theWebertuningforksoundisheardlouderin
oneear(lateralization)thantheother.
197.Whichofthefollowingisresponsiblefor localizationofsound? a)Cochlearnerve b)Cochlea c)Superiorolivarynucleus d)Cochlearnuclei CorrectAnswer-CAns.is'c'i.e.,SuperiorolivarynucleusLocalizationofsoundinspaceAhumancandistinguishsoundsoriginatingfromsourcesseparatedbyaslittleas1degree.Binauralreceptivefields(whichisafeatureofmostauditoryneuronsabovethelevelofcochlearnuclei)contributetosoundlocalization.Inotherwords,relaynucleiinthebrainstem(especiallythesuperiorolivarynucleicomplex)mediatelocalizationofsound.Theauditorysystemusesfollowingcluestojudgetheoriginofsound:?Timelagbetweentheentryofsoundintwoears:-Forexample,ifthesoundoriginatesfromtherightsideofaperson,itreachestherightearearlierthantheleftear.Thistimelagismoreimportantforrelativelylow-frequencysounds(below3000Hz).Differenceinintensitiesbetweenthesoundinthetwoears:-Itisimportantforsoundsofhigherfrequencies(>3000Hz).Soundscomingfromdirectlyinfrontoftheindividualandthebackoftheindividualcannotbedifferentiatedbytheabovetwomechanisms.Hereshapeofpinnaplaysarole,itchangesthequalityofthesounddependingonthedirectionfromwhichsoundcomes.
198.Endolymphresembles? a)CSF b)ICF c)ECF d)Plasma CorrectAnswer-BAns.is'b'i.e.,ICFEndolymphResemblesintracellularfluid,richinI+ions.Perilymph(ectolymph)ResemblesECF,richinNa'ions.PerilymphcommunicateswithCSFthroughcochlearacqueductthereforehascharacteristicssimilartoCSF.FluidintheinnerearTherearetwomainfluidsintheinnerear:? 1. Perilymph2. Endolymph PerilymphItresemblesECFandisrichinNa+ions.Itfillsthespacebetweenbonyandthemembranouslabyrinth,i.e.,Scalavestibuliandscalatympani.ItcommunicateswithCSFthroughtheaqueductofCochleawhichopensintothescalatympanineartheroundwindow.ThereforeItcloselyresemblesCSF.Itisformedby:- 1. Itisafiiterateofbloodserumandisformedbycapillariesofthe spiralligament. 2. ItisadirectcontinuationofCSFandreachesthelabyrinthvia aqueductofcochlea.Endolymph
Itfillstheentiremembranouslabyrinthincludingscalamedia(cochlearduct).Itresemblesintracellularfluid,beingrichinK"ions.Itissecretedbythesecretorycellsofthestriavascularisofthecochleaandbythedarkcells(presentintheutricleandneartheampullatedendsofsemicircularducts).
199.Allareintracranialcomplicationsofotitis mediaexcept? a)Lateralsinusthrombophlebitis b)Facialnervepalsy c)Brainabscess d)Hydrocephalus CorrectAnswer-BAns.is'b'i.e.,Facialnervepalsy
IntracranialComplicationsfromOtitisMediaIntracranialcomplicationsoccuraftertheinfectious(orinflammatory)processproceedsbeyondthetemporalbone"requiringimmediateandprecisetherapeuticintervention."Mostcommonintracranialcomplicationsincludemeningitis,followedbybrainabscessandlateralsinusthrombosis,subduralempyema,epiduralabscess,andotichydrocephalus.
200.Mostcommonlyusedtuningforkinear examination? a)128Hz b)256Hz c)512Hz d)1024Hz CorrectAnswer-CAns.is'c'i.e.,512HzCommonlyusedtuningforkhasafrequencyof512Hz.Forksofotherfrequencies,e.g.256and1024Hzshouldalsobeavailable.
201.
Modifiedradicalneckdissectionincludeswhichlevelofcervicallymphnodes? a)I-Ill b)I-IV c)I-V d)I-Vil CorrectAnswer-CAns.is'c'i.e.,I-VRadicalneckdissectionDuringradicalneckdissection,followingareremoved. a. Lymphnodesofsubmental,submandibular,upper,middleandlower jugular,andlateral(posterior)triangleregions,i.e.LevelItoValongwithitsfibrofattytissue. b. Sternomastoidmuscle. c. Internaljugularvein. d. Spinalaccessorynerve.e. Submandibularsalivarygland. f. Tailoftheparotid. g. Omohyoidmuscle. Followingstructuresaresaved-CarotidarteryBrachialplexus,phrenicnerve,vagusnerve,cervicalsympatheticchain,marginalmandibularbranchoffacial,lingualandhypoglosalnerve.ModifiedneckdissectionItissimilartoradicalneckdissectionbutwithpreservationofoneormorefollowingstructures- 1. Spinalaccessorynerve
2. Internaljugularvein3. Sternocleidomastoidmuscle Thus,bothradicalneckdissectionandmodifiedradicalneckdissectionremovelevelItoVnecknodes.Differentlevelsofnecknodeshevebeenexplainedinprevioussessions.
202.Allareseenintreachercollinsyndrome except a)Conductivedeafness b)Cleftpalate c)Mandibularhypoplasia d)Choanalatresia CorrectAnswer-DAns.is'd'i.e.,ChoanalatresiaTreachercollinssyndromeItisrareconditionthatpresentsseveralcraniofacialdeformitiesofdifferentlevels.Thisisacongenitalmalformationinvolvingthefirstandsecondbranchialarches.Thedisorderischaracterizedbyabnormalitiesoftheauricularpinna,hypoplasiaoffacialbones,antimongoloidslantingpalpebralfissureswithcolobomaofthelowereyelidsandcleftpalate.Importantclinicalfindingsare:- 1. Antimongoloidpalpebralfissures2. Malformedmalleusandincus(normalstapes)3. Colobomaoflowerlid4. Conductivedeafness5. Hypoplasiaofmandible(micrognathia)andmolarbones6. Cleftpalate7. Malformedpinnaandmeatalatresia Itisthemostcommonbenignneoplasmofnasopharynx.Itisahighlyvasculartumorandbloodsupplyofthetumormostcommonlyarisesfromtheinternalmaxillaryartery.Juvenilenasopharyngealangiofibroma(JNA)occursalmost
exclusivelyinmales.FemalewithJuvenilenasopharyngealangiofibroma(JNA)shouldundergogenetictesting.Onsetismostcommonlyintheseconddecades,therangeis7-19years.Theexactcauseisunknown.Asthetumourispredominantlyseeninadolescentmalesintheseconddecadeoflife,itisthoughttobetestosteronedependent.Themostcommonsiteisposteriorpartofnasalcavityclosetothemarginofsphenopalatineforamen.Thetumorstartsadjacenttothesphenopalatineforamen.Largetumorsarefrequentlybilobedordumbbelshaped,withoneportionoftumorfillingthenasopharynxandtheotherportionextendingtothepterygopalatinefossa.ClinicalfeaturesSymptomsdependonspreadoftumourtonasalcavity,paranasalsinuses,pterygomaxillaryfossa,infratemporalfossa,cheek,orbits(throughinferiororbitalfissure),cranialcavity(mostcommonsiteismiddlecranialfossa).Nasalobstruction(80-90%)isthemostcommonsymptom,especiallyintheinitialstages.Thisresultsindenasalspeech,hyposmia,broadeningofnasalbridge.pontaneousprofuse&recurrentepistaxisisthesecondmostcommonsymptomOtalgia,conductivehearingloss,serousotitismedia,duetoeustachiantubeobstruction.Pinkorpurplishmassobstructingoneorbothchonaeinnasopharynx.Tumourintheorbitcauses:proptosis;andfrog-facedeformity;diplopiaanddiminshedvision.Tumourininfratemporalfossacancausetrismusandbulgeofparotid.II,III,IV,V,VIcranialnervecanbeinvolved.Splayingofnasalbones.Swellingofcheekandfullnessofface.DiagnosisandtreatmentContrastCTistheinvestigationofchoice.
Biopsyshouldbeavoidedasitcancauseseverebleeding.Surgicalexcisionisthetreatmentofchoice.
203.Trueaboutpenderd'ssyndrome? a)Blindness b)Conductivedeafness c)Sensorineuraldeafness d)Alloftheabove CorrectAnswer-CAns.is'c'i.e.,SensorineuraldeafnessImportantfeaturesofPenderedsyndrome:CongenitaldisorderMutationingeneSLC26A4.Whichcodesforaproteincalledpendrin(helpsintransportofionsacrossmembrane).ImpairedactivityofPendrinisseenininnerearandthyroidgland.Bilateralsensorineuralhearingloss.Goiter.Sometimeshypothyroidism.Occasionallyvestibulardysfunction.Nospecifictreatment.
204.Endoscopicsinussurgeryprerequisite? a)MRIofparanasalsinus b)CTofPNS c)Mucocilliaryclearingtesting d)Acoustictests CorrectAnswer-BAns.is'b'i.e.,CTofPNSEndoscopicsurgeryofinflammatorydiseasesofparanasalsinuses(sinusitisorpolyp)requiresaverydetailedpreoperativeknowledgeoftheindividualanatomicalconditionsandpathologicalchanges.CTscanareusedbesttovisualizesinusareas.CTscanprovidesexcellentdefinitionofparanasalsinusesandisaprerequisiteforendoscopicsurgery."CTscanlimitedstudycoronalcutsinbonewindowisprerequisiteforendscopicsinussurgery"----MohanBansal
205.X-rayfindingsinchronicotitismedia? a)Honeycombingofmastoid b)Sclerosiswithcavityinmastoid c)Clear-cutdistinctbonypartitionbetweencells d)Noneoftheabove CorrectAnswer-BAns.is'b'i.e.,Sclerosiswithcavityinmastoid
206.Whatisnottrueaboutuseofintranasal steroidsinnasalpolyposis? a)Reducerecurrence b)Reduceobstruction c)Effectiveineosinophilicallypredominantpolyponly d)Maycauseepistaxis CorrectAnswer-CAns.is'c'i.e.,EffectiveineosinophilicallypredominantpolyponlyIntranasalsteroidshavebeenusedextensivelyasfirst-linemanagementofnasalpolyposiswithfewsideeffectsUsually,patientswithsmallpolypsandlimitedinvolvementonCTscanaregoodcandidatesfortopicaltherapyalone.Intranasalsteroidsreducenasalobstruction,polypsize,drainageandpolyprecurrence.Theeffectofsteroidsseemstobenonspecific,improvingsymptomsinbotheosinophilicallyandnoneosinophilicallydominatedpolyps.Nasalbleedingisthemostcommonadverseeventandcanusuallybeminimizedbydirectingthemedicationawayfromnasalseptum.
207.Referredearpainmaytravelthroughall except? a)Trigeminalnerve b)Glossopharyngealnerve c)Abducensnerve d)Vagusnerve CorrectAnswer-CAns.is'c'i.e.,AbducensnerveReferredotalgiaAsearreceivesnervesupplyfromVth(auriculotemporalbranch),IXth(tympanicbranch)andXth(auricularbranch)cranialnerves;andfromC2(lesseroccipital)andC2andC3(greaterauricular),painmaybereferredfromtheseremoteareas:1.ViaVthcranialnerve 1. Dental:-Cariestooth,apicalabscess,impactedmolar, malocclusion. 2. Oralcavity:-Benignormalignantulcerativelesionsoforalcavityor tongue. 3. Temporomandibularjointdisorders:-Bruxism,osteoarthritis, recurrentdislocation,ill-fittingdenture. 4. Sphenopalatineneuralgia Viintensitywillhearit.Therefore,ifidenticalvibratingtuningforksareheldatequaldistancesfrombothearstheyareheardinbothears.However,ifonetuningforkismovedclosertooneearthepersonhearsonlythatforkalthoughtheotherforkisstillvibratingsufficientlyforhimtohear.Instengertest,twovibratingtuningforksareheldequidistantfromeitherear.Ifthepatientisclaiming
deafnessinhisleftearhewillclaintohearonlytheforkonhisrightside.Theforkontheleftsideismovedcloser.Ifthepatientisfeigningdeafnesshewillperceiveonlythetuningforkontheleftsideandwillclaimnottohearanything.Ifthepatienthasagenuinehearinglossonthelefthewillstillhearthetuningforkontherightside.2.TealtestThiscanbeusedwhenthepatientadmitstohearingboneconductioninhis'deaf'ear.Theexaminerstandsbehindthepatientandappliesatuningforktothemastoidprocessofhis'deaf'ear.ThepatientadmitstoaIXthcranialnerve 1. Oropharynx:-Acutetonsillitis,peritonsillarabscess,tonsillectomy. Benignormalignantulcersofsoftpalate,tonsilanditspillars. 2. Baseoftongue:-Tuberculosisormalignancy3. Elongatedstyloidprocess. 3.ViaXthcranialcerve:Malignancyorulcerativelesionofvallecula,epiglottis,larynxorlaryngopharynx,oesophagus.4.ViaC2andC3spinalnerves:Cervicalspondylosis,injuriesofcervicalspine,cariesspine.
208.Acuteretropharyngealabscess,nottrue ? a)Duetolymphadenitis b)Commoninadults c)Swellingononesideofmidline d)Incision&drainage CorrectAnswer-BAns.is'b'i.e.,CommoninadultsRetropharyngealabscessRetropharyngealspaceliesbehindthepharynx,i.e.betweenbuccopharyngealfasciacoveringpharyngealconstrictormuscles(anteriorly)andprevertebralfasciacoveringtheprevertebralmuscles(posteriorly).So,retropharyngealspaceliesbehindthepharyngealconstrictormusclesandanteriortoprevertebralfasciacoveringtheprevertebralmuscles.Abscessinthisspacemaypresentdifferentlydependingupontheage:?Abscessininfants(acuteRetropharyngealabscess)Itiscommonlyseenininfantsandchildrenbelow3yearsofage.Mostcommonlyitresultsfromretropharyngeallymphadenitisduetoanupperrespiratorytractinfection.Thepresentionisacute,i.e.childhashightemperatureandsorethroat.Thereissmoothswelling(bulge)inposteriorpharyngealwallononesideofthemidline.Thereisdysphagia,difficultyinbreathing,stridor,croupycoughandtorticollis.Swellingcanbepalpableperorallyontheposteriorpharyngealwall.Treatmentisincisionanddrainage.
Abscessinadults(chronicretropharyngealabscess)Ifanadultoranolderchildhasaretropharyngealinfectionitislikelytobeduetoatuberculousinfectionofthecervicalspine(cariesofcervicalspine).Sometimeitmaybesecondarytotuberculousinfectionofretropharyngeallymphnodes.Itisofslowonsetandgivesrisetopharyngealdiscomfort,ratherthanpain.Thereisfluctuantswellinginposteriorpharyngealwall,centrallyinthemidline(ifitissecondarytocariesofcervicalspine)orononesideofmidline(ifitissecondarytotuberculosisofretropharyngealnodes).Treatmentincludesincisionanddrainageofabscessalongwithfullcourseofantituberculartreatment.
209.Proofpunctureisdonethrough? a)Superiormeatus b)Middlemeatus c)Inferiormeatus d)Sphenoethmoidalrecess CorrectAnswer-CAns.is'c'i.e.,InferiormeatusProoffuncture(Antralpuncture)Thisprocedureinvolvespuncturingthemedialwallofmaxillarysinusintheregionofinferiormeatusandirrigatingthesinus.Indications1.Chronicandsubacutemaxillarysinusitiswithdualpurposeof:ConfirmingthediagnosisandWashingoutthepus2.Tocollectthespecimenoftheantralcontentsforcultureandsensitivity,orcytologicalexaminationtoexcludeearlymalignancy.ContraindicationsChildrenlessthan12yearsofage.AcutemaxillarysinusitisasitmayleadtoosteomyelitisFractureofmaxillaasfluidmaypassthroughfractureline.Diabeteshearingit.Theexaminerthensaysthatheisgoingtorepeatthetest,butputsanon-vibratingforkonthemastoidwhileatthesametimebringingavibratingforkclosetotheauricle.Ifthepatientismalingering,hewillhearthetuningforkthroughairconduction,butthinkthatitisbeingheardthroughthebone.Ifheisreallydeafhewillnothearthefork.3.Lomard'stestThisdependsuponthefactthattothenormalmanthesoundofhis
ownvoiceisnecessaryfortheproperregulationofitstoneandloudness.TheBaranynoiseapparatusisadjustedtothepatient'ssoundearanditsmachinerystartedinordertoaccustomhimtoitsgratingnoise.Heisgivenabook,andtoldtoreadaloudinhisnormalvoiceandnottostopreadingwhentheinstrumentissetinaction.Assoonasthenoisebegins,amanwhoseoppositeearisprofoundlydeafwillatonceraisehisvoiceand,ifhisdeafnessisabsolute,mayliterallyshout.Themalingerer,ontheotherhand,claimingaone-sideddeafnesswhichisnotrealwillcontinuetoreadinaneventoneorinatoneonlyslightlyelevated.4.Acousticreflex(stapedialreflexthreshold)Ifstapedialreflexispresent,itrulesoutNOHLbecausestapedialreflexisnotinvoluntarycontrol.5.Electricresponseaudiometry(ERA)orcorticalevokedresponseaudiometryItisveryusefulinNOHLandcanestablishhearingacuityofthepersontowithin5-10dBofactualthresholds.6.OthertestsGaulttest,Erhard'stest,delayedspeechfeedback.
210.Inspiratorystridorisfoundinwhatkind oflesions: a)Supraglottic b)Subglottic c)Tracheal d)Bronchus CorrectAnswer-AAnswerA.SupraglotticGenerally,aninspiratorystridorsuggestsairwayobstructionabovetheglottis.Whileanexpiratorystridorisindicativeofobstructioninthelowertrachea.Abiphasicstridorsuggestsaglotticorsubglotticlesion.
211.Themostcommonsiteofthebranchial cystis: a)Posteriorborderofsternocleidomastoid b)Anteriorborderofsternocleidomastoid c)Digastricmuscle d)Omohyoidmuscle CorrectAnswer-BAnswer.B.AnteriorborderofsternocleidomastoidAbranchialcleftcyst(BCC)commonlypresentsasasolitary,painlessmassintheneckofachildoryoungadult.Theyaremostcommonlylocatedalongtheanteriorborderandtheupperthirdofthesternocleidomastoidmuscleintheanteriortriangleoftheneck.
212.Lowerlimitofretropharyngealspaceis at? a)C7 b)Bifurcationoftrachea c)4thesophagealconstriction d)None CorrectAnswer-BAns.is'b'i.e.,BifurcationoftracheaRetropharyngealspaceisdividedintotwolateralspaces(spaceofgillette)byafibrousband.RetropharyngealspaceislimitedabovebythebaseofskullandbelowwherethealarfasciafuseswithbuccopharyngealfasciaatthelevelofT4andcarina(bifurcationoftrachea).
213.Retroauricularincisionisalsoknown as? a)Rosen'sincision b)Lempert's-Iincision c)Lempert's-IIincision d)Wilde'sincision CorrectAnswer-DAns.is'd'i.e.,Wilde'sincision[Ref:DhingraSth/ep.410]Wilde'sincisionisusedforpostaural(retroauricular)approach.Lempert'sincisionisusedforendauralapproach.Rosen'sincisionisusedforstapedectomythroughendomeatalortranscanalapproach,
214.Electrodeofcochlearimplantisplaced at? a)Horizontalsemicircularcanal b)Scalamedia c)Scalatympani d)Scalavestibuli CorrectAnswer-CAns.is'c'i.e.,Scalatympani[RefEssentialsotolaryngology2d/ep.82]CochlearimplantsInternalcomponent:-ltcontainsreceiver/stimulatorwhichisimplantedundertheskinandelectrodewhichisimplantedinthescalatympaniofthecochleaacochleostomyopeninginthebasalturnofcochlea.Itmayalsobeplacedatotherlocationslikepromontoryorroundwindowbutthesesiteshaspoorerperformance.
215.Thresholdofhearinginayoungnormal adultis? a)0dB b)10dB c)20dB d)30dB CorrectAnswer-AAns.is'a'i.e.,0dB[RdDhingra4n/ep.21]AudiometriczeroThresholdofhearing,i.e.Thefaintestintensitywhichanormalhealthypersoncanhearwillvaryfrompersontoperson.TheInternationalStandardsOrganisation(ISO)adoptedastandardforthis,whichisrepresentedasthezerolevelontheaudiometer(0dB).AccordingtoISO,audiometriczeroisthemeanvalueofminimalaudibleintensityinagroupofnormallyhearinghealthyyoungadults.
216.Nasopharyngealcarcinomaseenin whichoccupation? a)Asbestosindustry b)Cementindustry c)Woodworkers d)Chimneyworkers CorrectAnswer-CAns.is'c'i.e.,WoodworkersRefDhingra4h/ep.235;NasopharyngealcarcinomaByAndrewVanHasselt,AlanG.Gibb2d/ep.4WooddustsexposureisariskfactorofnasopharyngealcarcinomaandAdenocarcinomaofPNS.FormaldehydeexposureisariskfactorofNasopharyngealcarcinoma.
217.Investigationofchoicefor nasopharyngealangiofibroma? a)X-ray b)MRI c)Plane-CT d)CT-contrast CorrectAnswer-DAns.is'd'i.e.,CTcontrastRef:DhingraSth/ep.262CTscanofheadwithcontrastenhancementistheinvestigationofchoiceforJNA.
218.Trueabouttubercularotitismediaareall except? a)Spreadsthrougheustachiantube b)Causespainlesseardischarge c)Maycausemultipleperforations d)Usuallyaffectsbothears e)None CorrectAnswer-DAnswer-D.UsuallyaffectsbothearsTuberculosisofmiddleearisacomparativelyrareentityusuallyseeninassociationwithorsecondarytopulmonarytuberculosis,infectionreachesthemiddleearthrougheustachiantube.ClinicalfeaturesGenerally,tuberculosisofmiddleearisunilateral.Itischaracterizedbypainlessotorrhoeawhichfailstorespondtotheusualantimicrobialtreatment.Thereispainlesswateryotorrhea.Singleormultipleperforationoftympanicmembrane.
219.FeatureofGranulomatosiswith polyangiitis: a)Nasalpolyp b)PerforatedNasalseptum c)Persistantsinus d)Crustingofnasalmucosa e)Collapseofnasalbridge CorrectAnswer-B:C:DAnswer-(B)PerforatedNasalseptum(C)Persistantsinus(D)CrustingofnasalmucosaGranulomatosiswithpolyangiitis(Wegener)isadistinctclinicopathologicentitycharacterizedbygranulomatousvasculitisoftheupperandlowerrespiratorytractstogetherwithglomerulonephritis.Disseminatedvasculitisinvolvingbothsmallarteriesandveinsmayoccur.Nasalfindingsincludecrustinggranulations,septalperforation&asaddlenoseDestructionoftheseptumwithacharacteristicimplosionofthenasalbridge.
220.Tensortympaniisattachedat? a)Malleus b)Incus c)Stapes d)Tympanicmembrane CorrectAnswer-AAns.is'a'i.e.,Malleus[RefGray'sAnatomy38thlep.485]Tympaniccavityhastwomuscles:
221.Vesiclesonexternalearareseenin a)Otitisexterna b)Malignantotitisexterna c)Herpeszoster d)Clearcellcarcinoma CorrectAnswer-CAns.is'c'i.e.,Herpeszoster[RefHeadandNeckSurgicalPathologyp.53]RamsayHuntsyndromeItislowermotorneurontypeoffacialpalsyduetoVaricella(herpes)zoster.Painisoftenaprominentfeatureandvesiclesareseenintheipsilateralear,onthehardpalateand/oronanteriortwothirdoftongue.Itmayinvolveothercranialnerves-V,VIII,IXandXandcervicalbranches(C2,C3&C4)thathaveanastomoticcommunicationswithfacialnerve.Thisresultsinfeatureslike:AnaesthesiaoffaceGiddinessHearingimpairmentalongwithVIInervepalsy.
222.Firstlinetreatmentformildretraction pocketintheearis a)Observation b)Antibiotics c)Tympanostomytube d)Surgicalexcision CorrectAnswer-BAns.is'b'i.e.,Antibiotics[RefConqueringOtitismediabyCharlesBluestonep.95]RetractionpocketItmustbetreatedbyanotolaryngologist.1)AntibioticsAmildretractionpocketthatispresentinafluid-filledmiddleearcanfirstbetreatedwithantibiotics.2)TympanostomyIfantibioticsdoesnotwork,atympanostomytubeisusuallyinserted,andinmostcases,theeardrumwillreturntonormal.Iftheretractionpocketisverydeep,atubeshouldbeinserted,bypassingtheantibiotictreatment.3)SurgicalexcisionIftheretractionpocketstilldoesnotgoaway,thedeformedeardrumshouldbeoperatedontopreventacholesteatomafromdeveloping.Onceacholesteatomadevelops,surgeryistheonlywaytoremoveit.
223.Cristaeareseenin? a)Utricle b)Saccule c)Semicircularcanal d)Otolithmembrane CorrectAnswer-CAns.is'c'i.e.,Semicircularcanal[RefDhingraSth/ep.16]VestibularapparatusThevestibularapparatuswithintheinnereardetectsheadmotionandpositionandtransducesthisinformationtoaneuralsignal.
224.Functionofsacculeis? a)Linearacceleration b)Angularacceleration c)Sensespositionofhead d)Rotationalmovement CorrectAnswer-A:CAns.is'a'i.e.,Linearacceleration&'c'i.e.,Sensespositionofhead
225.EarliestagefordoingBERAis? a)Inutero-beforebirth b)Atbirth c)3months d)6months CorrectAnswer-BAns.is'b'i.e.,Atbirth[RefLoganTurner10thlep.254;PLDhingra4th/ep.28]"Worldwidescreeningislargelyperformedinnewbornnurserywiththefirstscreeningtestperformedfrombirthuntil10daysofage"
226.Mostcommonmalignancyofmiddleear is a)Glomustumor b)Squamouscellcarcinoma c)Adenocarcinoma d)Sarcoma CorrectAnswer-BAns.is'b'i.e.,Squamouscellcarcinoma[RefTextbookofENTbyRakeshShrivastav2"/ep.67]Squamouscellcarcinomaisthemostcommonmalignanttumorofthemiddleear.Otherformsofmalignancylikeadenocarcinomaandsarcomaarerare.
227.Mostcommonbenigntumorofearcanal is a)Osteomas b)Sebaceousadenoma c)Papilloma d)Ceruminoma CorrectAnswer-AAns.is'a'i.e.,Osteomas[RefDhingra6thlep.107;BansalENTp.160;EncyclopediaofImaging,Baertp.1318]Osteomas/exostosesmostcommonbenigntumorsoftheexternalauditorycanal.SquamouscellcarcinomasMostcommonmalignanttumorsoftheexternalauditorycanal.
228.Diplacusisis a)Hearingsoundwithdiminishedintensity b)Hearingsoundsoftwodifferenttones c)Hearingextremelyloudsound d)Perceivinglightonproductionofsound CorrectAnswer-BAns.is'b'i.e.,Hearingsoundsoftwodifferenttones[RefTulilst/ep.114]Monauraldiplacusis:-Inmonauraldiplacusis,alistenerhearstwotoneswhenasingletoneispresentedtoasingleear,i.e.oneearhearstwodifferenttoneswhenpresentedone.Binauraldiplacusis:-Inbinauraldiplacusis,alistenerhearstwodifferenttonesinright&leftearwhenasingletoneispresentedtobothears.Bothmonoauralandbinauraldiplacusisarecausedbyinhomogenitiesinthecochleathatalsogiverisetospontaneousotoacousticemissions.
229.Whichsemicircularcanalismost commonlyinvolvedinBPPV? a)Horizontal b)Posterior c)Superior d)Alloftheabove CorrectAnswer-BAns.is'b'i.e.,Posterior[RefDhingraSth/ep.51]BPPVisthoughttobecausedbydisplacementofotoconia(mineralcrystals)fromthevestibuleofinnerearintothesemicircularcanals.Theposteriorsemicircularcanalismostcommonlyinvolved,thoughsuperiorandhorizontalcanalscanalcanalsobeaffected.OtoconiaorearrocksaresmallcrystalsofcalciumcarbonatederivedstructureintheutriclewhichmigrateintosemicircularcanalsandcauseBPPV.Whilesacculesalsocontainsotoconia,theyarenotabletomigrateintothesemicircularcanals.
230.Mostcommonossicleaffecteddueto trauma- a)Malleus b)Incus c)Stapes d)Allaffectedsimilarly CorrectAnswer-BAns.is'b'i.e,Incus[RefHearing:PracticalGuidebyTysomep.96]"Significantheadinjuryordirecttraumatothemiddleearcanresultinsubluxationofoneormoreoftheossicles,theincusbeingthemostcommonlyaffected
231.Singaporeearis a)Hypertrophyofsweatglands b)Hypertrophyofsebaceousglands c)Otitisexterna d)Excoriationofexternalearskin CorrectAnswer-CAns.is'c'i.e,Otitisexterna[RefClinicalENT5th/ep.223]ExcessivemoistureisanimportantpredisposingfactorforotitisexternaasexcessivemoistureelevatesthepHandremovesprotectivecerumen.Therefore,humidityandhotclimatepredisposetootitisexterna.Henceotitisexternaisalsoknownas:- 1. Singaporeear(whereclimateishotandhumid)2. Swimmer'sear3. Telephonist'sear(telephonistswhorequireinsertsintheirearhave excessivemoistureduetosweating).
232.Adiabeticpatientpresentswithfoul smellingeardischarge,feverandseverepainintheear.Onexaminationthereisthickyellowcoloureddischargefromtheearandgranulationtissueinthecanal.Whichofthefollowingistheappropriatemanagementforthispatient? a)Surgicaldebridement b)Antibiotictherapy c)Cryotherapy d)Laserremovalofgranulationtissue CorrectAnswer-BAns.is'b'i.e.,Antibiotictherapy[RefDhingra6th/ep.52]Thepatientdescribedinthequestionmostlikelyhasmalignantotitisexterna.Sothetreatmentofchoiceisanti-pseudomonalantibiotics.Extensivesurgicaldebridementonceanimportantpartofthetreatmentisnowrarelyneeded
233.Topodiagnosisoffacialnervehasallthe testsexcept a)Schirmertest b)Bingtest c)Tastetest d)Salivaryflowtest CorrectAnswer-BAns.is'b'i.e.,Bingtest[RefDhingra6th/ep.98]Thefollowingtestsareusefulinfindingthesiteoflesioninparalysisoflowermotorneuron. 1. Schirmertest:Itcompareslacrimationofthetwosides.Astripof filterpaperishookedinthelowerfornixofeacheyeandtheamountofwettingofstripmeasured.Decreasedlacrimationindicateslesionproximaltothegeniculategan-glionasthesecretomotorfibrestolacrimalglandleaveatthegeniculateganglionviagreatersuperficialpetrosalnerve. 2. Stapedialreflex:Stapedialreflexislostinlesionsabovethenerve tostapedius.Itistestedbytympanometry. 3. Tastetest:Itcanbemeasuredbyadropofsaltorsugarsolution placedononesideoftheprotrudedtongue,orbyelectrogustometry.Impairmentoftasteindicateslesionabovethechordatympani. 4. Submandibularsalivaryflowtest:Italsomeasuresfunc-tionof chordatympani.PolythenetubesarepassedintobothWhartonductsanddropsofsalivacountedduringoneminuteperiod.Decreasedsalivationshowsinjuryabovethechorda.
234.Whichofthefollowingisthefunctionof tensortympanimuscle? a)Dampenveryloudsound b)Tensestympanicmembrane c)Tensespharyngotympanictube d)Preventnoisetraumatotheinnerear CorrectAnswer-BAns.is'b'i.e.,Tensestympanicmembrane[RefDhingra6"/ep.8]Normalopeningoftheeustachiantubeequalizesatmosphericpressureinthemiddleear;closingoftheEustachiantubeprotectsthemiddleearfromunwantedpressurefluctuationsandloudsounds.Themusclesoftheeustachiantubesystemhelptoopenandclosethetube,thusallowingittoperformitsfunction.Themusclesare:? 1. Tensorvelipalatini(tensorpalatini):-Contractionofthismuscle duringswallowing,yawningandsneezingopensthetube.Defectivefunctionofthismuscleincleftpalateresultsineustachiantubedysfunction. 2. Tensortympani:-Tensonisesthetympanicmembrane.3. Levatorvelipalatini:-Sometimes,italsohelpstoopenthetube, howeveritisusuallyconsideredasavelopharyngealvalvemuscleonly. 4. Salpingopharyngeus:-Itsfunctionalsignificanceisquestionable.
235.Pinkreflexthroughintacttympanic membraneinactiveotosclerosisisknownas a)Schwabach'ssign b)Schwartzsign c)Lyre'ssign d)Chvostek'ssign CorrectAnswer-BAns.is'b'i.e.,Schwartzsign[RefDhingra5th/ep.98;Currentotolaryngology2nd/ep.674]Areddishhue/Flammingopinkmaybeseenonthepromontoryandovalwindownicheowingtotheprominentvascularityassociatedwithanotospongioticfocus.Thisisk/aSchwartzsign.Schwartzsignisapinkreflex,seenthroughintacttympanicmembrane,intheareaofovalwindow.Itindicatesactiveotosclerosisusuallyduringpregnancy.Lyre'ssignissplayingapartofinternalandexternalcarotidarteriesonangiogramincasesofcarotidbodytumouroftheneck.Chvostek'ssignseeninhypocalcaemiaasaftertotalthyroidectomywhereparathyroidshavealsobeenremoved.Tappingoverthedistributionoffacialnerveproducesatwitch.
236.SADEclassificationclassifies a)Retractionoftympanicmembrane b)ExtensionofGlomustumor c)Mortalityafterheartdiseaseduringpregnancy d)ExtentofCSFrhinorrhea CorrectAnswer-AAns.is'a'i.e.,Retractionoftympanicmembrane[RefBasicClinicalRadiobiology5th/ep.942]Sade'sclassificationofretractionoftheparstensaofthetympanicmembranedefinedtwotypesofretractionandclassifiedeachonanordinalscale:?1.Atelectasis,definedasdiffuse'retractionofthetympanicmembranetowardsthepromontorium'.2.Retractionpocket,definedasfocal'retractionoftheparstensatowardsorintotheattic'
237.A10yearoldchildpresentswithnon foulpurulentsmellingdischarge,whichispainless.Patientreportsthatheisabletohearbetterinthepresenceofdischargethanwhentheearisdry.Themostprobablediagnosisis a)CSOM b)Serousotitismedia c)Cholesteatoma d)Mastoiditis CorrectAnswer-AAns.is'a'i.e.,CSOM[RefDhingra6th/ep.68]ClinicalfeaturesofCSOMProfusemucopurulantdischargewhichisnotfoulsmelling,i.e.,nonfoulsmellingdischarge.Hearingloss(conductivetype).Ifsensorineuralcomponentalsooccurs(i.e.,mixedtype),itarousesthesuspicianoftoxicdeafness.Sometimes,patientreportsaparadoxicaleffect,i.e.,hearsbetterinthepresenceofdischargethanwhentheearisdry.Thisisduetoroundwindowshieldingeffectproducedbydischargewhichhelpstomaintainphasedifferential.Thereisnopain,ifitoccursitisduetoassociatedotitisexternanotduetootitismedia.Sincetheinfectedareaisopenatbothends,dischargedoesnotaccumulateinthemiddleearcavity.Ossicularchainismostlyuninvolved,ifinvolvedonlylongprocessof
incusisinvolved.
238.Treatmentofcentralsafeperforationof tympanicmembraneincludesallexcept a)Auraltoilet b)Eardrops c)Avulsionofauralpolyp d)Myringoplasty CorrectAnswer-CAns.is'c'i.e.,Avulsionofauralpolyp[RefDhingra6thlep.72]Anauralpolypshouldneverbeavulsedasitmaybearisingfromthestapes,facialnerveorhorizontalcanalandthusleadtofacialparalysisorlabyrinthitis.TreatmentTheaimistocontrolinfectionandeliminateeardischargeandatalaterstagetocorrectthehearinglossbysurgicalmeans. 1. Auraltoilet:Removealldischargeanddebrisfromtheear.Itcanbe donebydrymoppingwithabsorbentcottonbuds,suctionclearanceundermicroscopeorirrigation(notforcefulsyringing)withsterilenormalsaline.Earmustbedriedafterirrigation. 2. Eardrops:Antibioticeardropscontainingneomycin,polymyxin, chloromycetinorgentamicinareused.Theyarecombinedwithsteroids,whichhavelocalantiinflammatoryeffect. 3. Systemicantibiotics:Theyareusefulinacuteexacerbationof chronicallyinfectedear,otherwiseroleofsystemicantibioticsinthetreatmentofCSOMislimited. 4. Precautions:Patientsareinstructedtokeepwateroutoftheear duringbathing,swimmingandhairwash.Rubberinsertscanbeused.Hardnoseblowingcanalsopushtheinfectionfromnasopharynxtomiddleearandshouldbeavoided.
5. Treatmentofcontributorycauses:Attentionshouldbepaidtotreat concomitantlyinfectedtonsils,adenoids,maxillaryantrumandnasalallergy. 6. Surgicaltreatment:Auralpolyporgranulations,ifpresent,shouldbe removedbeforelocaltreatmentwithantibiotics.Itwillfacilitateeartoiletandpermiteardropstobeusedeffectively. 7. Reconstructivesurgery:Onceearisdry,myringoplastywithor withoutossicularreconstructioncanbedonetorestorehearing.Closureofperforationwillalsocheckrepeatedinfectionfromtheexternalcanal.
239.Aggernasiis a)Mucosalflapcoveringthenasolacrimalduct b)Openingofthesinuses c)Depressioninfrontofmiddleturbinate d)Elevationanteriortomiddleturbinate CorrectAnswer-DAns.is'd'i.e.,Elevationanteriortomiddleturbinate[RefDhingra5thiep.150;Tuli1"/ep.135]Atriumisashallowdepressioninfrontofthemiddleturbinate.Aggernasiisanelevationjustanteriortotheattachementofmiddleturbinate.
240.Quadrungularseptumisseeninwhichof thefollowing? a)Larynx b)Nose c)Cranium d)Palate CorrectAnswer-BAns.is'b'i.e.,Nose[RefDhingra5th/ep.150]"Cartilageoftheseptum,alsoknownasthequandragularcartilagebecauseitisroughlyquadrilateralinshape-separatesthenostrils".
241.Nasalvestibuleis a)Lateralpartofnasalcavity b)Antero-inferiorpartofnasalcavity c)Supero-medialpartofnose d)Posteriorapertureofnose CorrectAnswer-BAns.is'b'i.e.,Antero-inferiorpartofnasalcavity[RefOtolaryngologyBasicScience&ClinicalReviewbyVanDeWaterp.462]Internalnosehasfollowingparts:Nasalcavityproper:-Internalnoseisdividedintorightandleftnasalcavitiesbynasalseptum.Eachnasalcavitycommunicateswiththeexteriorthroughnarisornostrilsandwithnasopharynxthroughposteriornasalapertureorposteriornaresorchoana.Vestibuleofnose:-Anteriorandinferiorpartofthenasalcavityislinedbyskinandiscalledvestibuleofnose.Itcontainssebaceousglands,hairfolliclesandthehaircalledvibrissae.
242.Whichofthefollowingtermsisusedto describethemostprominentpointofnasaltip? a)Pronasale b)Alare c)Nasion d)Columellaapex CorrectAnswer-AAns.is'a'i.e.,Pronasale[RefHandbookofanthropometry:Physicalmeasuresofhumanforminhealthanddiseases,byVictorR.Preedy,p.922]Pronasale:Mostprominentpointonthenasaltip.Alare:Thepointwherethenasalblade(Alanasi)extendsthefarthestout.Columellaapex:Themostanteriororthehighestpointonthecolumellacrestattheapexofthenostril.Nasion:Thepointinthemidlineofboththeanatomicnoseandthenasoanterioralsuture
243.Epistaxisafterligatingexternalcarotid arteryisduetowhichvessel? a)Anteriorethmoidalartery b)Superiorlabialartery c)Sphenopalatineartery d)Greaterpalatineartery CorrectAnswer-AAns.is'a'i.e.,Anteriorethmoidalartery[RefDhingra5thiep.190]Sinceexternalcarotidarteryisligated,thebleedingcomesfrombranchesoftheinternalcarotidartery.Anteriorethmoidalartery,abranchofophthalmicartery,whichisabranchofinternalcarotidartery,isaconstituentofthebloodsupplyoftheLittle'sareaofthenasalseptum.Bloodsupplyofnasalseptumi)InternalcarotidsystemAnteriorethmoidalarteryBranchesofophthalmicarteryPosteriorethmoidalarteryii)ExternalCarotidSystemSphenopalatineartery(branchofmaxillaryartery)givesnasopalatineandposteriormedialnasalbranches.Septalbranchofgreaterpalatineartery(Br.ofmaxillaryartery).Septalbranchofsuperiorlabialartery(Br.offacialartery)
244.Killian'spolypisa/an a)Antrochoanalpolyp b)Ethmoidalpolyp c)Frontalpolyp d)Maxillarypolyp CorrectAnswer-AAns.is'a'i.e.,Antrochoanalpolyp[RefDhingra5th/ep.186;Essentialotolaryngology2"1/ep.660]Nasalpolypsareoftwotypes:?Antrochoanal:-Thisisusuallysolitaryandarisesfrommaxillarysinusandgrowsbackwardinthenosetowardsthechoana(incontrasttoethmoidalpolypswhichtendtogrowforward).TheAntrochoanalpolypwasfirstdescribedbyGustainkillians,thereforethenamegiventoitwaskillian'spolyp.Ethmoidal:-Thesearemultiple,bilateralandarisefrometmoidalsinusesandtendtoprotrudeforwards.
245.Whichofthefollowingisthe predisposingfactorforethmoidalcarcinoma a)Smoking b)Alcohol c)Chronicinfection d)Alloftheabove CorrectAnswer-AAns.is'a'i.e.,Smoking[RefDiseasesofENTbyBansalp.363]Riskfactorsforsquamouscellcarcinomaoftheparanasalsinuses:-Smoking,Mustardgas,Nickelandchromiumplatingindustry,IsopropyloilLeatherindustry,Wooddustexposure(adenocarcinomaofethmoid),Polycyclicvolatilehydrocarbons
246.Mostcommonsinuspredisposedto malignancywhichofthefollowing? a)Ethmoid b)Maxillary c)Frontal d)Sphenoid CorrectAnswer-BAns.is'b'i.e.,Maxillary[RefDhingra5thiep.219]Themajorityofparanasalsinusmalignancies(50-80%)originatewithinthemaxillarysinusantrum.Sinusesandvariousconditionsinwhichsinusesareaffectedindescendingorderoffrequency
247.Mostcommonbenigntumorofparanasal sinuses? a)Papilloma b)Osteoma c)Warts d)Fibroma CorrectAnswer-BAns.is'b'i.e.,Osteoma[RefLoganTurner8`h/ep.89]Osteomaofthefrontalsinus-Mostcommonbenigntumourarisinginthenasalsinuses.Theosteomaarisesfromthefloorofthefrontalsinusnearthemidline.
248.Treatmentofnasalbonefracture includesallexcept a)Hematomadrainage b)Topicalvasoconstrictor c)Closedreduction d)Immediaterhinoplasty CorrectAnswer-DAns.is'd'i.e.,Immediaterhinoplasty[RefScottBrown7th/ep.1612]TreatmentofnasalinjuriesAfterensuringpatencyofairway,adequateventilationandoverallstabilityofpatient,attentiontothenasalinjuriesshouldbegiven.Standardtherapyistoperformclosedreductionoropenreducationbetween3and7days,andupto2weeks.Thisisbecause:Mostofthepatients(-70-80%)donotrequireanyactivetreatment,asmanydonothaveanasalfractureandthosethatdo,thefractureisnotdisplaced.Softtissueswellingcanproducethemisleadingappearanceofadeformitywhichdisapearsastheswellingsubsides.Suchpatientsrequireonlyreassurance&topicalvasoconstrictorstoalleviatecongestionandobstructivesymptoms.Are-examinationshouldbecarriedoutafter5days,ifthereisuncertainityabouttheneedforreduction.Alargenumberofpatientswillhaveapreexistingnasaldeformitycausedbyapreviousincident.Patientsthatfallinthiscategoryareadvisedtoconsideraformalrhinoplastywheneverythinghassettleddownsomemonthslater.Immediatesurgicalinterventioninacutephaseisindicated:?Severedeformity:-Septalhematomacausingnasalobstruction
249.Allofthefollowingaretrueabout parapharyngealabscessexcept? a)Mastoidprocessdividesthespaceintoanteriorandposterior b)Alsoknownaspharyngomaxillaryspaceinfection c)Tonsilispushedmedially d)Occursaftertoothextraction CorrectAnswer-AAns.is'a'i.e.,Mastoidprocessdividesthespaceintoanteriorandposterior[RefDhingraV/ep.281]Styloidprocessandthemusclesattachedtoitdividetheparapharyngealspaceintoanteriorandposteriorcompartments,notmastoidprocess.
250.Liningepitheliumofvocalcordis a)Stratifiedsquamousepithelium b)Nonstratifiedsquamousepithelium c)Ciliatedcolumnarepithelium d)Nonciliatedcolumnarepithelium CorrectAnswer-AAns.is'a'i.e.,Stratifiedsquamousepithelium[RefDhingraViep.300]Vocalcordsalongwiththeupperpartofthevestibuleistheonlypartoflaryngealmucousmembranewhichislinedbyepitheliumofstratifiedsquamoustype.Elsewhereinthelarynxepitheliumofthemucousmembraneisciliatedcolumnartype.
251.WhichofthefollowingsitesofCalarynx hasthebestprognosis? a)Glottic b)Supraglottis c)Subgottis d)Allhavepoorprognosis CorrectAnswer-AAns.is'a'i.e.,Glottic[RefDhingra5th/ep.326]Laryngealcarcinoma:- Cancer Prognosis Glottis Good Supraglottis PoorSubglottis Worst
252.Laserusedintrachealneoplasmis a)Argon b)KTP-532 c)CO2 d)Nd-YAG CorrectAnswer-CAns.is'c'i.e.,CO2[RefDhingra5th/ep.315]FourtypesoflaseraregenerallyusedinENTsurgery:ArgonKTP-532(Potassiumtitanylphosphate);Nd:YAG(Neodyminum-yttriumaluminiumgarnet);CO2Thecarbondioxide(CO)laseristhemostcommonlaserusedfortrachealneoplasm.
253.Mostcommonsiteofdistantmetastasis fromCalarynx a)Lymphnodes b)Lung c)Brain d)Bone CorrectAnswer-BAns.is'b'i.e.,Lung[RefClinicalOtorhinolaryngologyyd/el).931]Distantmetastasisisseenmuchlessfrequently.Themostcommonlyaffectedsitesfordistantmetastasesarelungs(66%);bone(22%),liver(10%),mediastinumandbonemarrow.
254.ApatientpresentswithCalarynx involvingleftfalsecord,leftarytenoidandleftaryepiglotticfoldwithbilateralmobiletruecords.Thetreatmentofchoiceinthispatientiswhichofthefollowing? a)Verticalhemilarygectomy b)Horizontalpartialhemilaryngectomy c)Totallaryngectomy d)Radiotherapyfollowedbychemotherapy CorrectAnswer-BAns.is'b'i.e.,Horizontalpartialhemilaryngectomy[RefDhingra4th/ep.284]Involvementofunilateralfalsecord,aryepiglotticfoldsandarytenoidswithmobilecordsuggestssupraglotticcancerinT2stage(morethanonesubsitesofsupraglottisareinvolved).
255.Inrecurrentlaryngealnervepalsywhich musclekeepsvocalcordinmedianposition? a)Posteriorcricoarytenoid b)Cricothyroid c)Vocalis d)Alloftheabove CorrectAnswer-BAns.is'b'i.e.,Cricothyroid[RefDhingra5th/ep.300]RecurrentlaryngealnerveparalysisRecurrentlaryngealnervesupplies:? 1. Allintrinsicmusclesofthelarynxexceptcricothyroid.2. Sensorysupplytolarynxbelowvocalcords. So,paralysisofrecurrentlaryngealnervecauses:? 1. Paralysisofallintrinsicmusclesincludingalladductors(exceptfor cricothyroid)andallabductors. 2. Anaesthesiabelowthelevelofvocalcord. Though,thereisparalysisofbothadductors(exceptcricothyroid)andabductors,themanifestationsaremainlyduetoparalysisofabductors.
256.
Foodparticlesmostlygetobstructedinwhichpartofesophagus- a)Cricopharyngealsphincter b)Crossingofarchofaorta c)Cardiacend d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e,Cricopharyngealsphincter[Ref:Dhingra6thiep.349]Byfarthecommonestsiteisatorjustbelowthecricopharyngealsphincter.Flatobjectslikecoinsareheldupatthesphincterwhileothersareheldintheupperoesophagusjustbelowthesphincterduetopoorperistalsis.
257.Trueregardingtractiondiverticuliof esophagusisallexcept a)Doesnotemptycompletely b)Triangularappearance c)Containsalllayers d)Maintainselasticrecoil CorrectAnswer-AAns.is'a'i.e.,Doesnotemptycompletely[RefTheEsophagusbyRichterp.143] PulsionDiverticulaFalsediverticula TractionDiverticula Ususallyonlymucosal Truediverticula outpouchingsDistal Type Linedbyalllayers esophagus Layers Midesophagus Associatedwith Location ScarringfromTBor dysmotility Associated histoplasmosisinvolvingperihilar Rounded Shape orsubcarinallymphnodes outpouchings Emptying Triangularortented Donotempty Tendstoemptycontents completelyEpiphrenicdiverticula,Zenker'sdiverticula
258.Sluder'sneuralgiaisalsocalledas a)Anteriorethmoidalsyndrome b)Posteriorethmoidalsyndrome c)Trottersyndrome d)Lermoyezsyndrome CorrectAnswer-AAns.is'a'i.e.,Anteriorethmoidalsyndrome[RefDhingra6th/ep.450]Sluder'sneuralgiaItisalsocalledanteriorethmoidalsyndrome.Itissaidtooriginatefromthemiddleturbinatepressingonthenasalseptum.Itischaracterizedbypainaroundthebridgeofthenoseradiatingintoforehead.TreatmentAnatomicalcorrectionrelievesthepain.
259.Mostcommontumoroforopharynxis a)Squamouscellcarcinoma b)Adenocarcinoma c)Melanoma d)Salivaryglandtumors CorrectAnswer-AAns.is'a'i.e.,Squamouscellcarcinoma[RefAbeloff'sClinicalOncology6"lep.1059]90?95%oftumorsintheoropharynxaresquamouscellcarcinomas,whereasothersareminorsalivaryglandtumors,melanomas.Themostcommonmanifestingsymptomsareanontenderneckmass,dysphagia,otalgia,ora"hotpotato"voice.
260.Investigationofchoicefordiagnosing submandibularglandductstonesis a)Ultrasound b)X-rayoffloorofmouth c)Sialography d)Sialoendoscopy CorrectAnswer-AAns.is'a'i.e.,Ultrasound[RefChurchill'spocketbookofsurgeryp.133]InvestigationsforsalivaryglandstonesUltrasoundistheinvestigationofchoice?asitpermitsassessmentofthegland,ductsystemandcalculuswhichusuallyhasanacousticshadow.'Floorofmouth'radiographicviewforsubmandibularcalculiinWharton'sductwhereultrasoundfindingsareequivocalorunavailable.Ifnostoneisseen,considersialography.Sialoendoscopyisincreasinglyusedinthediagnosisandtreatmentofsalivaryglandoutflowobstructiveconditions.
261.DeafnessinacaseofPaget'sdiseaseis dueto a)Retractionpockets b)Otitis c)Eightnerveinvolvement d)Endolymphatichydrops CorrectAnswer-CAns.is'c'i.e.,Eightnerveinvolvement[ReferNeurologyconsult5"/ep.866]Cranialnervecompressionistheusualcauseofdeafness.ComplicationsofPaget'sdiseaseFollowingcomplicationscanoccurinPaget'sdisease:- 1. Fracture:Arecommoninweightbearingbones2. Cranialnervecompression:-Maycauseimpairedvision,facial palsy,trigeminalneuralgiaordeafness. 3. Otosclerosis:-AnothercauseofdeafnessinPaget'sdisease.4. Spinalcanalstenosisandnerverootcompression5. Highoutputcardiacfailure6. Osteoarthritis:ofHipandknee7. Rarelyosteosarcoma
262.Membraneincisedduring hemilaryngectomyis a)Thyrohyoid b)Cricothyroid c)Aryepiglottic d)Infralaryngeal CorrectAnswer-BAns.is'b'i.e.,Cricothyroid[RefDhingraelep.310]IndicationsandcontaindicationsIdealforbulkylesionsofthemembranoustruevocalcordNormalorslightlyimpairedvocalcordmobilityNoinvolvementofthesupraglottis
263.Callauralfistulaisanabnormalityof? a)1"branchialarch b)Ptbranchialcleft c)2ndbranchialarch d)2ndbranchialcleft CorrectAnswer-BAns.is'b'i.e.,PtbranchialcleftCollauralfistulaisa1"branchialcleftanomalywhicharisesfromfailureoffusionoftheventralpartofthePtcleft.Itsupperpartopensintofloorofexternalauditarycanal.Itslowerpartopensintheneckbetweenangleofmandibleandsternocleidomastoidmuscle.
264.Acutesuppurativeotitsmediainchildren ismostcommonlycausedby? a)St.pneumoniae b)S.epidermidis c)S.aureus d)Pseudomonas CorrectAnswer-AAns.is'a'i.e.,St.pneumonia[RefDhingra5thlep.54]ASOMisespeciallycommonininfantsandchildren.MostofthetimeASOMusuallyfollowsrespiratorytractinfections(i.e.,acutetonsillitis,commoncoldorinfluenza)andtheinfectiontravelupbytheeustachiantubetothemiddleear.Themostcommoncausativeorganismisstreptococcuspneumoniae
265.Young'soperationisdonefor a)Allergicrhinitis b)Atropicrhinitis c)Vasomotorrhinitis d)Idiopathicrhinitis CorrectAnswer-BAns.is'b'i.e.,Atrophicrhinitis[RefDhingra5th/ep.171;Essentialotolaryngology2"d/ep.523]SurgicaltreatmentofAtrophicrhinitis 1. Young'soperation2. ModifiedYoung'soperation3. Narrowingofthenasalcavityby(Lautenslagersoperation)4. Lautenslagersoperation
266.
Allofthefollowingareareapartofmedialwallofthemiddleearexcept? a)Promontory b)Fenestravestibule c)Pyramid d)Subiculum CorrectAnswer-CAns.is'c'i.e.,Pyramid[RefDhingra avep.6] S Medialorinnerorlabyrinthicwall(parieslabyrinthica)ofmiddleearItisformedbylabyrinthandseparatesthemiddleearcavityfrominternalear.Ithasfollowingfeatures:-Abulgecalledaspromontoryformedbybasalturnofcochlea.Fenestravestibuli(ovalwindow)liesposterosuperior(behindandabove)tothepromontoryandopensintoscalavestibuli.Itisoccupiedbyfootplateofstapesfixedbyannularligament.Its,sizeonaverageis3.25mmlong&1.75mmwide.Fenestracochleae(roundwindow)liesposteroinferiortothepromontoryandopensintoscalatympaniofcochlea.Itisclosedbysecondarytympanicmembrane.Theroundwindowisclosesttoampullaofposteriorsemicircularcanal.Roundwindowisatriangularopening.Itsdiameterisbetween1.8to2.3mm.
267.Whatistheintensityindecibelofnormal conversationinhumans? a)30dB b)60dB c)90dB d)150dB CorrectAnswer-BAns.is'b'i.e.,60dB[RefDhingra5thlep.23]Intensityisthestrengthofsoundwhichdeterminesitsloudness.Itisusuallymeasuredindecibels(dB).Followingareintensitieswhenapersonisatadistanceofonemeterfromsoundsource. Whisper 30dB Normalconversation 60dBShout 90dB Discomfortofear 120dB Paininear 130dB
268.WhatistheroleofSodiumFluoridein otosclerosis? a)Itrestorestheelectrolyteequilibrium b)IthastensrecoveryoftheOverstimulatedCochlea c)Itquickensthematurityoftheactivefocusandreduces osteoclasticresorption d)Itrepolarizesthecochlearcells CorrectAnswer-CAns.is'c'i.e.,Itquickensthematurityoftheactivefocusandreducesosteoclasticresorption[RefCurrentDiagnosisandtreatmentinOtolaryngology2nd/ep.678;OtosclerosisandStapedectomy:Diagnosis,Management,andComplicationbyGlasscock(7hieme)1st(2004)p.61,62]MechanismofactionofSodiumfluorideinotosclerosis 1. Reducesosteoclasticboneresorptionandincreasesosteoblastic boneformation:Theseactionsreduceboneremodellinginactivelyexpandingosteolyticlesionsandpromoterecalcification. 2. Inhibitsproteolyticenzymesthatarecytotoxictothecochlea: Inhibitionofproteolyicenzymesthatarecytotoxictothecochleaisbelievedtopreventsensorineuraldeafness.
269.Chemicallabyrinthectomyby transtympanicrouteisdoneinMeniere'sdiseaseusingwhichdrug? a)Amikacin b)Gentamicin c)Amoxycillin d)Cyclosporine CorrectAnswer-BAns.is'b'i.e.,Gentamicin[RefLevineSC,HaberkampTJ.LabyrinthectomytocorrectvertigoOperativetechniquesinotolaryngology-Head&necksurgery.2001.12:141-143.]ChemicallabyrinthectomyinmeneiresdiseaseisdoneusingGentamicinlocally.
270.Whichofthefollowingtestsisnotused todifferentiatebetweencochlearandretrocochlearhearingloss? a)SISITEST b)Evokedresponseaudiometry c)Thresholdtonedecaytest d)Recruitment CorrectAnswer-CAns.is'c'i.e.,Thresholdtonedecaytest[RefDhingra5th/ep.31;zr/ep.28]
271.Whereistheauditorycortexlocated insidethebrain? a)Superiortemporalgyrus b)Inferiortemporalgyrus c)Area3,1,2 d)Cingulategyrus CorrectAnswer-AAns.is'a'i.e.,Superiortemporalgyrus[RefPickles,James0.(2012).AnIntroductiontothePhysiologyofHearing(4thed.).Bingley,UK:EmeraldGroupPublishingLimited,pp.215-217.]PrimaryAuditoryCortexislocatedbilaterally,roughlyattheuppersidesofthetemporallobes-inhumansonthesuperiortemporalplane,withinthelateralfissureandcomprisingpartsofHeschl'sgyrusandthesuperiortemporalgyrus,includingplanumpolareandplanumtemporale(roughlyBrodmannareas41,42,andpartially22).
272.Whendoestherudimentarycochlea developinthefetus? a)Firstweek b)4thto8thweek c)8thto12thweek d)16to20thweek CorrectAnswer-BAns.is'b'i.e.,4thto8thweek[RefChap172-Teviewofmedicalembryology-BenPasky]DevelopmentofInnerearAfterimplantation,aroundthesecondtothirdweekthedevelopingembryoconsistsofthreelayers:endoderm,mesodermandectoderm.Thefirstpartoftheeartodevelopistheinnerear,whichbeginstoformfromtheectodermaroundthe22nddayoftheembryo'sdevelopment.Specifically,theinnerearderivesfromtwothickeningscalledoticplacodesoneithersideofthehead.Eachoticplacoderecedesbelowtheectoderm,formsanoticpitandthenanoticvesicle.Thisentiremasswilleventuallybecomesurroundedbymesenchymetoformthebonylabyrinth.Aroundthe33'ddayofdevelopment,thevesiclesbegintodifferentiate.Closertothebackoftheembryo,theyformwhatwillbecometheutricleandsemicircularcanals.Closertothefrontoftheembryo,thevesiclesdifferentiateintoarudimentarysaccule,whichwilleventuallybecomethesacculeandcochlea.Partofthesacculewilleventuallygiveriseandconnecttothecochlearduct.Thisductappearsapproximatelyduringthesixth
weekandconnectstothesacculethroughtheductusreuniens.
273.Themainmuscleaffectedincongenital musculartorticollisis? a)Sternocleidomastoid b)Trapezius c)ScalenusAnticus d)Omohyoid CorrectAnswer-AAns.is'a'i.e.,Sternocleidomastoid[Ref:Cooperman,DanielR.(1997).Karmel-Ross,Karen,ed."TheDifferentialDiagnosisofTorticollisinChildren".Physical&OccupationalTherapyinPediatrics.17(2):1-11]Thecauseofcongenitalmusculartorticollisisunclear.Birthtraumaorintrauterinemalpositionisconsideredtobethecauseofdamagetothesternocleidomastoidmuscleintheneck.Otheralterationstothemuscletissuearisefromrepetitivemicrotraumawithinthewomborasuddenchangeinthecalciumconcentrationinthebodywhichcausesaprolongedperiodofmusclecontraction.
274.Miraclefruitisusedtochangethetaste from? a)SourtoBitter b)SourtoSweet c)Bittertosweet d)Saltytosweet CorrectAnswer-BAns.is'b'i.e.,SourtoSweet[RefPeterHanelt,ed.(2001).Mansfeld'sencyclopediaofagriculturalandhorticulturalcrops2.Springer.p.1660.ISBN3-540-41017-1.]MiracleFruitcontainsaglycoproteincalledmiraculin,whichbindstothetongue'stastebudswhenthefruitisconsumed.Miraculinactsasasweetnessinducerwhenitcomesincontactwithacids,causingsourfoodstotastesweet,temporarily.
275.Allofthefollowingarecomplicationsof maxillarysinuslavageandinsufflationexcept? a)Airembolism b)Orbitalinjury c)Epistaxis d)Facialnerveinjury CorrectAnswer-DAns.is'd'i.e.,Facialnerveinjury[RefSchlemmerKD,NaidooSK.Complicatedsinusitisinadevelopingcountry,aretrospectivereview.IntJPediatrOtorhinolaryngol.2013May17]ComplicationofMaxillarysinuslavageandinsufflationComplicationsofnonendoscopicdrainageprocedurescanbeminororsevere.Themostcommoncomplicationisfailuretoenterthesinusbecauseofimproperpositioningofthetrocar,incompletepenetrationofthesinusmucosa,orthepresenceofahypoplasticantrum.Epistaxismayoccurbecauseoflacerationofthenasalmucosaorpreexistingcoagulopathiesnecessitatingpacking.Severecomplicationsincludeorbitalinjury,airembolism,anddeathsecondarytoinjectionofairintothesinus.
276.Allofthefollowingareremovedin verticalhemilaryngectomyexcept? a)HalfGlottis b)HalfSupraglottis c)Halftongue d)HalfSubglottis CorrectAnswer-CAns.is'c'i.e.,Halftongue[RefDhingra4th/ep.284;http://128.255.52.245/oto/Beta/database/contents]Verticalhemilaryngectomymeansexcisionofonehalfofthelarynxononeside,i.e.,verticalhalfisremovedwhichincludeverticalhalfofsupraglottis,glottisandsubglottis.Horizontalhemilaryngectomyistheexcisionofsupraglottisonly,alsoknownassupraglotticlaryngectomy.
277.
Submucosalresectionisthetreatmentof choiceof? a)DNSinadults b)DNSinchildren c)Sluder'sNeuralgia d)Nasalpolyp CorrectAnswer-AAns.is'a'i.e.,DNSinadults[RefDhingra5th/ep.423]Submucousresection(SMR)isasurgicalproceduretocorrectthedeformityofnasalseptum.Theprincipleofthisprocedureistoremovedeviatedcartilageandbonefrombeneaththemucosalliningofnasalseptum,leavingacorrectedseptumlargelycomposedofscartissue.Submucousresectionisnotadvocatedinchildrenupto17yearsofageasitmayinterferewithdevelopmentofthefacialbones.
278.Whichperforationofthetympanic membraneismostcommonlyseenwithtubotympanicCSOM? a)Central b)Anterosuperior c)Posterosuperior d)Posteroinferior CorrectAnswer-AAns.is'a'i.e.,Central[RefDhingra5thlep.77;Pediatricotolaryngology2"/ep.478]TubotympanicCSOMItisalsoknownassafeearasitdoesnotcauseanyseriouscomplicationsInfectionisislimitedtoantero-inferiorpartofmiddleearcleft(eustachaintube&mesotympanum)andisassociatedwithcentralperforationinparstensaoftympanicmembrane.
279.CaldwellLucSurgeryhasitsapproachto themaxillaryantrumthrough? a)Gingivolabialsulcus b)Inferiororbitalrim c)Nasalseptum d)Cribriformplate CorrectAnswer-AAns.is'a'i.e.,Gingivolabialsulcus[RefDhingra5thIep.422]
280.InCaldwellLucoperation,theapproach isthroughthe? a)SublabialApproachleadingtoopeningofmandibularantrum b)Throughthesphenopalatinerecess c)Openingofmaxillaryantrumthroughgingivolabialapproach d)Superiormeatus CorrectAnswer-CAns.is'c'i.e.,Openingofmaxillaryantrumthroughgingivolabialapproach[RefDhingraStilep.422]Caldwell-Lucoperationisaprocessofopeningthemaxillaryantrumthroughcaninefossabysublabialapproachanddealingwiththepathologyinsidetheantrum.Inthissurgery,antrumisreachedthroughaincisioningingivolabialsulcus(fromlateralincisorto2"dmolar)andthenopeningofantruminthisarea.
281.Allofthefollowingareindicationsfor tracheostomyexcept? a)Comaafterheadinjury b)Maxillofacialinjury c)Bilateralabductorpalsy d)Superiorlaryngealnervepalsy CorrectAnswer-DAns.is'd'i.e.,Superiorlaryngealnervepalsy[RefAjayYadavzithiep.215;Dhingra5thiep.337]TracheostomyAtracheostomyisasurgicalproceduretocreateanopeningthroughtheneckintotheanteriorwalloftrachea.Atubeisusuallyplacedthroughthisopeningtoprovideanairwayandtoremovesecretionsfromthelungs.Thetubeiscalledtracheostomytube.
282.Mostcommoncauseofotitisexternais? a)Fungalinfection b)Bacterialinfection c)Seborrheicdisease d)HerpesZoster CorrectAnswer-BAns.is'b'i.e.,Bacterialinfection[RefClinicalENT5th/ep.223]Mostcommoncauseofotitisexternaisbacterialinfection.Twomostcommoncausativebacteriaarestaphylococcusaureusandpseudomonas
283.Whichisthenarrowestportionofthe esophagus? a)Atthecricopharyngealsphincter b)Atthecrossingoftheleftmainbronchus c)Attheleveloftheaorticarch d)Atthediagphragmaticaperture CorrectAnswer-AAns.is'a'i.e.,Atthecricopharyngealsphincter[GrayH.Chapter35:Mediastinum.StandringS,ed.Gray'sAnatomy:TheAnatomicalBasisofClinicalPractice.40`VeNewYork,NY:ChurchillLivingstoneElsevier;2008.939-57.]Cricopharyngealsphincteristhenarrowestportionofesophagus
284.Whichofthefollowingisnota premalignantconditionoralcancer? a)Leukoplakia b)Erythroplakia c)Oralsubmucousfibrosis d)SystemicSclerosis CorrectAnswer-DAns.is'd'i.e.,SystemicSclerosis[RefDevita7"Vep.982;Bailey&love25`Vep.735]LesionswithincreasedriskofmalignancyinoralcancerPremalignantcondition:-Leukoplakia,Erythroplakia,Specklederythroplakia,chronichyperplasticcandidiasis.Conditionsincreasingrisk:-Oralsubmucousfibrosis,syphiliticglossitis,sideropenicdysphagia(PetersonKellysyndrome).Riskisdoubtful:-Orallichenplanus,DLE,Dyskeratosiscongenita.
285.Whichofthefollowingisacauseof objectivetinnitus? a)ImpactedWax b)Carotidarteryaneurysm c)Meniere'sdisease d)Ototoxicdrugs CorrectAnswer-BAns.is'b'i.e.,Carotidarteryaneurysm[RefiDhingraSth/ep.145;ScottBrown's7th/eVol-3p.4029-4030;Tulip.125-126]
286.Whichofthefollowingcancersdonot presentwithcervicallymphnodeinvolvement? a)GlotticCancer b)SubglotticCancer c)Papillarythyroidcancer d)Oralcancer CorrectAnswer-AAns.is'a'i.e.,GlotticCancer[RefDhingra5thlep.327;41'p.283]Truevocalcordsaredevoidoflymphatic,hencelesschanceofcervicalnodalmetastasis
287.Pulsatiletinnitusisafeatureof? a)Glomustumour b)acousticneuroma c)malignantotitsexterna d)meneire'sdisease CorrectAnswer-AAns.is'a'i.e.,Glomustumour[RefLoganTurner10th/ep.214]Theearliestsymptomsofglomustumourispulsatiletinnitus(earliest)andhearingloss.Hearinglossisconductiveandslowlyprogressive.Thesearefollowedbybloodstainedotorrhoeaandearache.
288.Histelberger'ssignisseenin? a)Acousticneurom b)GlomusTumour c)Nasalangiofibroma d)Acutesuppurativeotitismedia CorrectAnswer-AAns.is'a'i.e.,Acousticneurom[RefActaOtorhinolaryngolBelg.1987;41(1):40-8.TheHitselbergersignasaperceptionphenomenon.BenzB,BaumgartenD.]Hitselberger'ssignInAcousticneuroma-lossofsensationinthepostero-superiorpartofexternalauditorymeatussuppliedbyArnold'snerve(branchofVagusnervetoear).
289.Allofthefollowingaretrueabout SpasmoidicDysphoniaexcept? a)Itmaybeofadductororabductortype b)AbductortypeischaracterizedbyWhisperingqualityofvoice c)AdductortypeischaracterizedbyBreathlessness d)ItisfocalLaryngealdystonia CorrectAnswer-CAns.is'c'i.e.,AdductortypeischaracterizedbyBreathlessness[RefiSulicaL(December2004)."Contemporarymanagementofspasmodicdysphonia".CurrentOpinioninOtolaryngology&HeadandNeckSurgery.12(6)]
290.Ethmoidalinfundibulumliesbetween? a)Bullaethmoidalisanduncinateprocessofethmoid b)Middleandinferiorturbinate c)HiatussemilunarisandInferiormeatus d)Wingofsphenoidandmaxillaryantrum CorrectAnswer-AAns.is'a'i.e.,BullaethmoidalisanduncinateprocessofethmoidThehiatussemilunarisisboundedinferiorlybythesharpconcavemarginoftheuncinateprocessoftheethmoidbone,andleadsintoacurvedchannel,theinfundibulum,boundedabovebythebullaethmoidalisandbelowbythelateralsurfaceoftheuncinateprocessoftheethmoid.
291.Whatliesbetweenthemiddleand inferiorturbinate? a)Middlemeatus b)Superiormeatus c)Hiatussemmilunaris d)Inferiormeatus CorrectAnswer-AAns.is'a'i.e.,Middlemeatus[RefScottBrown7'Vevol2p.1329]Superiormeatus*Belowsuperiorturbinate(betweensuperiorandmiddleturbinates)MiddlemeatusBelowmiddleturbinate(betweenmiddleandinferiorturbinates)InferiormeatusBelowinferiorturbinate.
292.Allofthefollowingareextrinsic laryngealmembranesexcept? a)Quadrangularmembrane b)Hyoepiglotticligament c)Cricotrachealmembrane d)Thyrohyoidmembrane CorrectAnswer-AAns.is'a'i.e.,Quadrangularmembrane[RefMeratiAL,BielamowiczSA.TextbookofLaryngology.SanDiego:PluralPublishingInc2006.]Quadrangularmembrane 1. Aryepiglotticligament(superiorborderofmembrane)2. Vestibularligament(Inferiorborderofmembrane
293.
Thenarrowestpartofthenasalcavityis? a)Internalnasalvalve b)Antrochoanalregion c)1stnasalturbinate d)Regionofinferiorconcha CorrectAnswer-AAns.is'a'i.e.,Internalnasalvalve[RefJafekBW.Anatomyandphysiologyofthenose.JafekBW,StarkAK,eds.ENTSecrets.Philadelphia,Pa:Hanley&Belfus;1996.77-83.]Theinternalnasalvalveinvolvestheareaboundedbyupperlateralcartilage,septum,nasalfloor,andanteriorheadoftheinferiorturbinate.Thismakesupthenarrowestportionofthenasalairway
294.Anteriortonsillarpillarisformedby? a)Palatopharyngealfold b)Palatoglossalfold c)Pterygopalatinearch d)Valleculae CorrectAnswer-BAns.is'b'i.e.,PalatoglossalfoldAnteriortonsillarpillar-PalatoglossalfoldPosteriortonsillarpillar-Palatopharyngealfold
295.Oneofthefollowingistrueregarding Zenkerdiverticulum? a)Itisapulsiondiverticulum b)Itprojectsanteriorly c)Commonlyseeninyoungmales d)Itisbetweensuperiorandmiddleconstrictor CorrectAnswer-AAns.is'A'i.e.,ItisapulsiondiverticulumHypopharyngealdiverticulumorZenker'sdiverticulumorpharyngealpouchItisapulsiondiverticulumwherepharyngealmucosaherniatesthroughtheKillian'sdehiscence,aweakareabetweentwopartsoftheinferiorconstrictor.Itisthemostcommonesophagealdiverticulum.Thediverticulaariseposteriorlyinthemidlineofneck.Themouthofthediverticulaisinthemidlinebutprojectslaterally(usuallyleftlaterally)Zenker'sdiverticulaarerarelyseenbelow30yrsofage,mostpatientsareover50.
296.
Narrowestpartofthenasalcavityis? a)Vestibule b)Choanae c)Inferiorturbinate d)Middleturbinate CorrectAnswer-CAns.is'c'i.e.,Inferiorturbinate[RefHeidariZ,Mahmoudzadeh-SaghebH,KhammarT,KhammarM(May2009)."Anthropometricmeasurementsoftheexternalnosein18-25-year-oldSistaniandBaluchaboriginewomeninthesoutheastofIran".FoliaMorphol.(Warsz)68(2):88-92]Theinternalnasalvalvecomprisestheareaboundedbytheupperlateral-cartilage,theseptum,thenasalfloor,andtheanteriorheadoftheinferiorturbinate.Inthenarrow(leptorrhine)nose,thisisthenarrowestportionofthenasalairway.
297.Saddlenosedeformityisseenin? a)PrimarySyphilis b)Secondarysyphilis c)Tertiarysyphilis d)LupusVulgaris CorrectAnswer-CAns.is'c'i.e.,Tertiarysyphilis[RefDhingra5th/ep.184]Syphilisofnoseoccursas:- 1. Primary:-Rareandmanifestsasprimarychancreofthevestibule.2. Secondary:-Rarelyrecognizedandmanifestsassimplerhinitis, crustingandfissuring. 3. Tertiary:-Thisisthestageinwhichnoseisinvolvedmost commonly.Thereisformationofgummafollowedbybonyperforationofnasalseptum.Bridgeofthenosecollapsescausingasaddledeformity.Atrophicrhinitismayoccurasacomplication.
298.Allofthefollowingaretrueabout vasomotorrhinitisexcept? a)Itisallergic b)Itisduetoparasympatheticoveractivity c)Resistantcasesmayneedcryotherapy d)Itmayleadtohypertrophicrhinitis CorrectAnswer-AAns.is'a'Itisallergic[RefScott'sBrown7thiep.2122]VasomotorrhinitisVasomotorrhinitisisanonallergicconditionthatinvolvesaconstantrunnynose,sneezingandnasalcongestion,i.e.,thenoseisstuffyorrunnyforreasonsotherthanallergiesandinfections.Theexactetiologyisunknown,buttriggersincludeemotions,odors,poorairquality,spicyfoods,andmedicationsideeffects.
299.Allofthefollowingaretrueabout vasomotorrhinitisexcept? a)Itisanonallergiccondition b)itisduetoparasympatheticoveractivity c)Itmaycauseparoxysmalepisodesofsneezing d)Itisaninfectivecondition CorrectAnswer-DAns.is'd'i.e.,Itisaninfectivecondition[RefDhingra5th/ep.170]
300.Inevaluationofacaseofimmotilenasal cilia,whichofthefollowinginvestigationsshouldproveuseful? a)Rhinogram b)Xraynasalandparanasalsinuses c)Sweatsodiumlevels d)Nitricoxidetest CorrectAnswer-DAns.is'd'i.e.,Nitricoxidetest[RefLeighMW,PittmanJE,CarsonJL,FerkolTW,DellSD,DavisSD.Clinicalandgeneticaspectsofprimaryciliarydyskinesia/Kartagenersyndrome.GenetMed.2009Jul.11(7):473-87]ScreeningtestsforimmotileciliasyndromeNitricoxide:Measuringexhalednasalnitricoxide,whichismostlyreducedinprimaryciliarydyskinesia,isagoodscreeningtestforimmotile-ciliasyndromewithagoodnegativepredictivevalue.Studieshavedemonstratedarelationshipbetweennasalnitricoxidelevels,nasaloxidesynthasemRNAexpression,andciliarybeatfrequency.Thereisalsoasignificantinversecorrelationbetweenthedegreeofaplasiaand/orhypoplasiaoftheparanasalsinusandnasalnitricoxidevaluesinprimaryciliarydyskinesiapatients.
301.Allofthefollowingarefeaturesof ethmoidalpolypexcept? a)Commoninadults b)CommonlySingular c)Commonlybilateral d)Isusuallyallergic CorrectAnswer-BAns.is`b'i.e.,CommonlySingular[RefDhingra5thlep.187;Tuli1"/ep.173]Antrochoanalpolypgrowsbackward(posteriorly),therefore,itmaynotbevisibleonanteriorrhinoscopy,whileposteriorrhinoscopyshowssmooth,greyishwhite,sphericalmassinchoana.Ontheotherhand,ethmoidalpolypsgrowanteriorly.Therefore,theyarebestseenonanteriorrhinoscopyandmaynotbeseenonposteriorrhinoscopy.
302.Allofthefollowingarefeaturesof enlargedadenoidsexcept? a)Otitismedia b)Nasalobstruction c)Failuretothriveofchild d)Esophagitis CorrectAnswer-DAns.is'd'i.e.,Esophagitis[RefDhingraViep.254]ClinicalfeaturesofenlargedadenoidsEnlargedandinfectedadenoidsmaycausenasal,aural(ear),andgeneralsymptoms.1)NasalsymptomsNasalobstructionisthecommonestsymptom.Thisresultinmouthbreathing.Astherespirationandfeedingcannottakeplacesimultaneously,childfailstothrive.Othersymptomsarenasaldischarge(wetbubblynose),sinusitis,epistaxisandtonelessvoicewithlossofnasalquality(Rhinololiaclausa).2)AuralsymptomsTubalobstructionOtitismedia:-Recurrentacuteotitismedia,CSOM,serousotitismedia3)GeneralsymptomsAdenoidfacies:Elongatedfacewithdullexpression,openmouth,prominent&crowdedupperteeth,hitchedupperlip,pinchedinappearanceofnoseandhigharchedpalate.Pulmonaryhypertension,aprosexia(lackofconcentration).
303.Allofthefollowingaretreatmentsof multiplebilateralethmoidalpolypsexcept? a)Functionalendoscopicsinussurgery b)Intranasalethmoidectomy c)Extranasalethmoidectomy d)CaldwllLucSurgery CorrectAnswer-DAns.is'd'i.e.,CaldwilLucSurgery[RefScottBrown,Vol-ILp.1701;Dhingra5`"/ep.188,430]Surgicaltreatmentofethmoidalpolyps: 1. Functionalendoscopicsinussurgery(FESS):Surgeryofchoice whenavailable. 2. Polypectomy:Whenthereareoneortwopedunculatedpolyps.3. Intranasalethmoidectomy:Indicatedwhenpolypsaremultipleand sessile. 4. Extranasalethmoidectomy:Thisisindicatedwhenpolypsrecur afterintranasalprocedures. 5. Transantralethmoidectomy:Indicatedwheninfectionandpolypoidal changesarealsoseeninthemaxillaryantrum.Inthiscaseantrumisopenedbycaldwell-Lucapproachandtheethmoidalaircellsapproachedthroughthemedialwalloftheantrum.
304.Whatisthetreatmentofchoicefor ethmoidalpolyps? a)FunctionalEndoscopicsinussurgerywithpolypectomy b)Intranasalethmoidectomy c)Extranaslethmoidectomy d)Transantralethmoidectomy CorrectAnswer-AAns.is'a'i.e.,FunctionalEndoscopicsinussurgerywithpolypectomy[RefSeeaboveexplanation]
305.Whatisthetypeofepitheliumofthe adenoid? a)Pseudostratifiedciliatedcolumnarepithelium b)Nonkeratinizedsquamousepithelium c)Cuboidalepithelium d)Columnarepitheliumwithgobletcells CorrectAnswer-AAns.is'a'i.e.,Pseudostratifiedciliatedcolumnarepithelium[RefWiatrakBJ,WoolleyAL.Pharyngitisandadenotonsillardisease.CummingsCW,FredricksonJM,HarkerLA,CrauseCJ,SchullerDE,RichardsonMA.OtolaryngologyHeadandNeckSurgery...V/e.London:Mosby;1998.188-215.]TheadenoidiscoveredbyapseudostratifiedciliatedcolumnarepitheliumthatisplicatedtoformnumeroussurfacefoldsThenasopharyngealepitheliumlinesaseriesofmucosalfolds,aroundwhichthelymphoidparenchymaisorganizedintofolliclesandissubdividedinto4lobesbyconnectivetissueseptaSeromucousglandsliewithintheconnectivetissue,andtheirductsextendthroughtheparenchymaandreachthenasopharyngealsurface.
306. Thearterywhichleadstobleedingin Woodruff'sareais? a)Anteriorethmoidalartery b)Sphenopalatineartery c)Greaterpalatineartery d)Superiorlabialartery CorrectAnswer-BAns.is'b'i.e.,Sphenopalatineartery[RefScottBrown7h/eVol-2p.1597;Dhingra5th/ep.190]Woodruff'sarea:?Itissituatedundertheposteriorendofinferiorturbinate.Sphenopalatinearteryanastomoseswithposteriorpharyngealarteryhere.Posteriorepistaxisoccursinthisarea.
307.Intrathecalfluoresceinwithendoscopic visualizationisusefulindiagnosisof? a)Deviatednasalseptum b)Multipleethmoidalpolyps c)RhinitisMedicamentosa d)CSFRhinorrhoea CorrectAnswer-DAns.is'd'i.e.,CSFRhinorrhoea[Ref:LoganTurner10(h/ep.28,Dhingra5th/ep.179]DetectionofsiteofCSFleakinCSFRhinorrhoea 1. HRCT:-HRCTwithorwithoutgodoliniumisthemosthelpfulstudy foridentifyingthesiteofleak,i.e.,investigationofchoice. 2. MRI:-MRIwithheavyT2weightedimagemayhighlightCSF sufficientlytoshowtheleak. 3. CTcisternography:-CTscanafterinjectionofcontrastdyeis effectiveinpatientswithanactiveleak. 4. Radioisotopecisternography:-Radioisotopeinjectedintrathecally andmeasured. 5. Fluorescindye:-Intrathecalfluorescinwithendoscopic visualization.
308.Allofthefollowingarefeaturesofa nasalforeignbodyexcept? a)Foulsmellingdischarge b)Epistaxis c)Nasalobstruction d)Septalperforation CorrectAnswer-DAns.is'd'i.e.,Septalperforation[RefDhingraSaVep.176;LoganTurner10'h/ep.63]ForeignbodyinnoseAnasalforeignbodyisanythingthatgetsstuckinsidethenose.Inanimateforeignbody(object)ismorecommonthananimateforeignbody.Commonobjectsfoundinnosesincludefoodmaterial(peas,beans,nuts),tissuepaper,beads,toysandrocks.Animateforeignbodiesareworms,larvaeormaggots.Mostcasesofforeignbodiesinthenoseandnasalcavityarenotseriousandoccurintoddlersandchildrenfrom1-8years.Becausechildrendeveloptheabilitytopickupobjectsatabouttheageof9months,thisproblemismuchlesscommonbefore9monthsofage.
309.ETHMOIDALBULLAEareseenin? a)Posteriorethmoidalaircells b)Middleethmoidaircells c)Superiorethmoidalaircells d)Inferiorethmoidalaircells CorrectAnswer-BAns.is'b'i.e.,Middleethmoidaircells[Ref:LoganTurner10thlep.379;Dhingra5th/ep.153,154]
310.Allofthefollowingarefeaturesofa nasalforeignbodyexcept? a)Vestibulitis b)Epistaxis c)Nasalobstruction d)Deviatedseptum CorrectAnswer-DAns.is'd'i.e.,Deviatedseptum[RefDhingra5thiep.176;LoganTurner10`"/ep.63]
311.
Allofthefollowingarecausesofperforationofcartilaginouspartofnasalseptumexcept? a)Tuberculosis b)Leprosy c)Lupus d)Syphilis CorrectAnswer-DAns.is'd'i.e.,Syphilis[RefDhingra5th/ep.166;Scott-Brown'sOtolaryngology7th/eVol-2chapter-124p.1583]Anasalseptalperforationisathrough-and-throughdefectinanyportionofthecartilaginousorbonyseptumwithnooverlyingmucoperichondriumormucoperiosteumoneitherside.Perforationofbonypart:-SyphilisPerforationofcartilaginouspart:-TB,leprosy,lupus.
312.Allofthefollowingaretrueaboutnasal myiasisexcept? a)Commoninvasomotorrhinitis b)Intensenasalirritationpresent c)Meningitismayoccurinseveredisease d)Chloroformwaterisoneofthemodesoftreatment CorrectAnswer-AAns.is'a'i.e.,Commoninvasomotorrhinitis[RefDhingra5th/ep.178]
313.Water'sviewisusedtoobtaindiagnostic informationof: a)Maxillarysinus b)Ethmoidalsinuses c)Frontalsinus d)Sphenoidsinus CorrectAnswer-AANSWER:A.MaxillarysinusWaters'view(alsoknownastheOccipitomentalview)isaradiographicview,whereanX-raybeamisangledat45?totheorbitomeatalline.Therayspassfrombehindtheheadandareperpendiculartotheradiographicplate.Itiscommonlyusedtogetabetterviewofthemaxillarysinuses.
314.Tracheostomyindicationis: a)Vocalcordreplacement b)Pharynxreplacement c)Tracheomalacia d)Foreignbodyobstructingairway CorrectAnswer-DAnswer-D.ForeignbodyobstructingairwayIndicationsoftracheostomy:Upperrespiratorytractobstruction;Laryngeal,supralaryngeal,andtrachealcauses.(Causesofstridor)Lowerrespiratorytractobstruction:(Secretoryobstruction,Wetlungsyndrome).
315.Caldwell'sviewisusedfor: a)Maxillarysinus b)Frontalsinus c)Ethmoidalsinus d)Alloftheabove CorrectAnswer-BAnswer-B.FrontalsinusCaldwell'sview(orOccipitofrontalview)isaradiographicviewofskull,whereX-rayplateisangledat20?toorbitomeatalline.Therayspassfrombehindtheheadandareperpendiculartoradiographicplate.Itiscommonlyusedtogetbetterviewoffrontalsinuses.
316.Wherewillbetheplacementlocationfor AuditoryBrainstemImplant? a)Scalatympani b)Recessof4thventricle c)IAC d)backofear CorrectAnswer-BAnswer:B-Recessof4thventricle.TheimplantisusuallyplacedinthelateralrecessofthefourthventricleatthetimeoftumorresectiontostimulatethecochlearnucleusAuditoryBrainstemImplant(ABI):TumorresectionsurgeryinNFpatientsresultincochlearnervedamageorlossoffunctionofnerveresultingindeafness.ABIareusefulinrestoringauditoryperceptiontodeafpatientswithneurofibromatosistype2(NF2)Alsousedintreatmentofcongenitallydeafchildrenwithcochlearmalformationsorcochlearnervedeficiencies.Placementlocation:Lateralrecessof4thventricle
317.Allofthefollowingarefeaturesof TubotympanicCSOMexcept? a)Profusedischarge b)Hearingloss c)Extremepain d)Sometimesparadoxicalimprovementinhearingisseen CorrectAnswer-CAns.is'c'i.e.,Extremepain[RefDhingra5th/ep.77;Pediatricotolaryngology2"/ep.478]ClinicalfeaturesoftubotympanicCSOMProfusemucopurulentdischargewhichisnotfoulsmelling,i.e.,non-foulsmellingdischargeHearingloss(conductivetype).Ifsensorineuralcomponentalsooccurs(i.e.,mixedtype),itarousesthesuspicionoftoxicdeafness.Sometimes,patientreportsaparadoxicaleffect,i.e.,hearsbetterinthepresenceofdischargethanwhentheearisdry.Thisisduetoroundwindowshieldingeffectproducedbydischargewhichhelpstomaintainphasedifferential.Thereisnopain,ifitoccursitisduetoassociatedotitisexternanotduetootitismedia.Sincetheinfectedareaisopenatbothends,dischargedoesnotaccumulateinthemiddleearcavityOssicularchainismostlyuninvolved,ifinvolvedonlylongprocessofincusisinvolved.
318.FeaturesofUsher'sSyndromeincludeall except? a)NightBlindness b)VisualImpairment c)MultipleNeurofibromas d)Hearingdeficit CorrectAnswer-CAns.is'c'i.e.,MultipleNeurofibromas[RefMetsMB,YoungNM,PassA,LaskyJB(2000)."EarlydiagnosisofUshersyndromeinchildren".TransactionsoftheAmericanOphthalmologicalSociety.98:237-45.]UshersyndromeUshersyndromeisarelativelyraregeneticdisordercausedbyamutationinanyoneofatleast11genesresultinginacombinationofhearinglossandvisualimpairment,andisaleadingcauseofdeafblindness.Ushersyndromeisincurableatpresent.OthernamesforUshersyndromeincludeHallgrensyndrome,Usher-Hallgrensyndrome,retinitispigmentosadysacusissyndrome,anddystrophiaretinaedysacusissyndrome.Thissyndromeischaracterizedbyhearinglossandagradualvisualimpairment.Thehearinglossiscausedbyadefectiveinnerear,whereasthevisionlossresultsfromretinitispigmentosa(RP),adegenerationoftheretinalcells.Usually,therodcellsoftheretinaareaffectedfirst,leadingtoearlynightblindnessandthegraduallossofperipheralvision.Inothercases,earlydegenerationoftheconecellsinthemaculaoccurs,leadingtoalossofcentralacuity.Insomecases,thefovealvisionisspared,leadingto"doughnutvision";centralandperipheralvisionareintact,butanannulusexists
aroundthecentralregioninwhichvisionisimpaired.
319.65yearoldpersonwithhearinglosswith normalspeechdiscriminationissufferingfrom? a)Noiseinducedhearingloss b)Presbycusis c)Ototoxicdrug d)NOHL CorrectAnswer-BAns.is'B'i.e.,PresbycusisInformationinthisquestionare:-(i)Oldage(65years),(ii)Hearingloss,and(iii)Preservedspeechdiscrimnation.DiagnosisisPresbycusis.PresbycusisPresbycusisreferstosensorineuralhearinglossinelderlyindividualsCharacteristically,presbycusisinvolvesbilateralhighfrequencyhearinglossassociatedwithdifficultyinspeechdiscriminationandcentralauditoryprocessinginformation.Fourpathologicaltypesofpresbycusishavebeenidentified:-SensorypresbycusisThereisepithelialatrophywithlossofsensoryhaircellsandsupportingcellsintheorganofcorti.Thisprocessstartsinthebasalturnofcochleaandslowlyprogresstowardstheapex.Higherfrequenciesareaffectedbutspeechdiscriminationispreserved.Neuralpresbycusis:-Thereisatrophyofnervecellsinthecochleaandcentralneuralpathways.Atrophyoccursthroughoutthecochlea,withthebasilarregiononlyslightlymorepredisposedthan
theremainderofthecochlea.Therefore,noprecipitousdropinthresholdonaudiometryisobserved.Speechdiscriminationispoor.Metabolic(strial)presbycusis;;-Thereisatrophyofstriavascularis.Atrophyresultsinhearinglossrepresentedbyflataudiogram,butspeechdiscriminationispreserved.Mechanical(cochlearconductive)presbycusis:-Thereisthickeningandsecondarystiffeningofthebasilarmembraneofthecochlea.Thethickeningismoresevereinthebasalturnofcochleawherethebasilarmembraneisnarrow.Thiscorrelateswithagraduallyslopinghighfrequencysensorineuralhearingloss.Speechdiscriminationisaverage.
320.Stimulationoftheexternalauditorycanal leadstocoughduetowhichnerve a)AuricularbranchVagus b)Greaterauricularnerve c)Auriculotemporalnerve d)FacialNerve CorrectAnswer-AAns:A.AuricularbranchVagusnerve.>AuricularbranchofVagus(Arnold'snerve)andFacialnervecontinuesinwardstosupplytheposteriorwallandflooroftheEAC.>Thecoughresponsecausedwhilestimulatingtheearcanalismediatedbythevaguswhichalsosuppliesthelarynx.(Re/.Shambaugh,6thed.,page45)
321.
wideningofthecartilaginouspartoftheextraauditorycanalcalled. a)Otoplasty b)Myringoplasty c)Tympanoplasty d)Meatoplasty CorrectAnswer-DAns.(d)Meatoplasty.Meatoplastyisanoperativetechniquetowidenthelateralcartilaginouspartoftheexternalauditorycanal.Otoplasty-isaproceduretochangetheshape,positionorsizeoftheears.Myringoplasty-closureoftheperforationofparstensaofthetympanicmembraneTympanoplasty-surgicaltechniquetorepairadefectinthetympanicmembranewiththeplacementofagraft,eithermedialorlateraltothetympanicmembraneannulusref:https://vula.uct.ac.za/access/content/group/ba5fb1bd-be95-48e5-81be-586fbaeba29d/Meatoplasty.pdf
322.TubercularOtitismediaischaracterized byallexcept a)Painfulotorrhea b)Multipleperforations c)Palegranulations d)Foul-smellingeardischarge CorrectAnswer-AAns.A.Painfulotorrhea.>Tuberculosisofmiddleearisacomparativelyrareentityusuallyseeninassociationwithorsecondarytopulmonarytuberculosis,theinfectionreachesthemiddleearthroughtheeustachiantube>Itischaracterizedbypainlessotorrhoeawhichfailstorespondtotheusualantimicrobialtreatment>patientwithevidenceoftubercleinfectionelsewherefollowedbymultipletympanicmembraneperforations,abundantgranulationtissue,andbonenecrosis,preauricularlymphnodeenlargementhttps://www.ncbi.nlm.nih.gov/pubmed/21522113
323.Partialandfullclosuredonein a)Atrophicrhinitis b)Allergicrhinitis c)Vasomotorrhinitis d)Occupationalrhinitis CorrectAnswer-AAns.A.AtrophicrhinitisATROPHICRHINITIS>Itisaformofchronicrhinitisassociatedwithatrophyofnasalmucosa,mucousglands,nerves,andvessels.>Itcanbeprimaryorsecondary.>Thesurgicaloptionsaimtoreducethesizeoftheroomycavitiestopreventtheexposuretodryingeffectsofairandcrustsformationandthushelpregenerationofnasalmucosa.Fullclosure-Young'soperationPartialclosure-Modifiedyoung'soperation.(Ref.Cummings,6thed.,695)
324.OccipitomentalviewofPNSX-raycalled as a)Caldwellview b)Waterview c)Townview d)Pineview CorrectAnswer-BAnswer:b.WaterviewOccipitomentalviewofPNSX-raycalledasWaterview
2.ApatientwithearcomplaintsshowedpositiveHennebertsign.Whichofthe followingconditionshowspositiveHennebertsign? a)Meniere'sdisease b)Acousticneuroma c)Neuronitis d)Glossopharyngealneuralgia CorrectAnswer-AThepresenceofafistulaissuspectedifnystagmusoccursorifthepatientperceivesmovementofavisualtargetthatisfixedafterapplyingpositivepressuretotheouterearcanal.Apositivetestresult(ie,Hennebertsign)suggestseitheraperilymphfistulaorMeniere'sdisease.
3.Themaxillarysinusopensintomiddlemeatusatthelevelof: a)Hiatussemilunaris b)Bullaethmoidalis c)Infundibulum d)Noneoftheabove CorrectAnswer-AThemaxillarysinusisthelargestoftheparanasalsinusesandislocatedinthemaxilla,lateraltothenasalcavityandinferiortotheorbit.Themaxillarysinusopensintotheposterioraspectofthehiatussemilunarisinthemiddlemeatus.Theinfraorbitalnerve(CNV-2)primarilyinnervatesthemaxillarysinus.
4.Gradenigo'ssyndromeinvolvesallofthe followingcranialnerves,EXCEPT: a)IV b)V c)VI d)VII CorrectAnswer-AAns.A.IVGradenigo'ssyndromeischaracterizedbyfacialpain,particularlyinthefirstdivisionofthetrigeminalnerveanddiplopiaduetosixthcranialnervepalsy.Itisassociatedwithdiseaseattheapexofthepetroustemporalbonewheretheabducensnerveiscloselyrelatedtothetrigeminalnerve.Facialnervepalsyanddeafness(VIIInervepalsy)isalsoconsideredtobeapartofthissyndrome.Causesincludes:Inflammation(petrositis,possiblyspreadingfromalocalinfectionsuchasotitisormastoiditis)Tumors(cholesteatoma,chordoma,meningioma,nasopharyngealcarcinoma,metastaticdisease)Skullbasefracture
5.Ceruminousglandspresentintheearare: a)Modifiedeccrineglands b)Modifiedapocrineglands c)Mucousgland d)Modifiedholocrineglands CorrectAnswer-BAns.is.B.Modifiedapocrineglands
6.MacEwan'striangleisthelandmarkfor: a)Maxillarysinus b)Mastoidantrum c)Frontalsinus d)None CorrectAnswer-BAns.is.B.Mastoidantrum
7.Externalauditorycanalisformedby: a)1stbranchialgroove b)1stvisceralpouch c)2ndbranchialgroove d)2ndvisceralpouch CorrectAnswer-AAns.is.A.1stbranchialgroove
8.Hyperacusisisdefinedas: a)Hearingofonlyloudsound b)Normalsoundsheardasloudandpainful c)Completelydeaf d)Abilitytohearinnoisysurroundings CorrectAnswer-BSensationofdiscomfortorpainonexposuretonormalsounds.Seenininjurytonervetostapediusandincaseofcongenitalsyphilis(Hennebertsign)
9.Inelectrocochleography: a)Itmeasuresmiddleearlatency b)Outerhaircellsaremainlyresponsibleforcochlearmi crophonicsandsummationpotential c)Summationpotentialisacompoundofsynchronusauditory nervepotential d)TotalAPrepresentsendocochlearreceptorpotentialtoan externalauditorystimulus CorrectAnswer-BAns.is.B.Outerhaircellsaremainlyresponsibleforcochlearmicrophonicsandsummationpotential
10.Truestatementaboutmalignantotitis externais: a)Notpainful b)Commonindiabeticsandoldage c)Causedbystreptococcus d)Alloftheabove CorrectAnswer-BAns.is.B.Commonindiabeticsandoldage
11.OssicleM/CinvolvedinCSOM: a)Stapes b)Longprocessofincus c)Headofmalleus d)Handleofmalleus CorrectAnswer-BAns.is.B.Longprocessofincus
12.Mostcommonnervetobedamagedin CSOMis a)III b)VII c)IV d)VI CorrectAnswer-BFacialnerveistheM/CnervetobedamagedinCSOM.
13.Simplemastoidectomyisdonein: a)Acutemastoiditis b)Cholesteatoma c)Coalescentmastoiditis d)Localizedchronicotitismedia CorrectAnswer-CAns.is.C.Coalescentmastoiditis
14.Radicalmastoidectomyisdonefor: a)ASOM b)CSOM c)Atticoantralcholesteotoma d)Acutemastoiditis CorrectAnswer-CAns.is.C.Atticoantralcholesteotoma
15.LighthousesigninseeninASOMin whichstage? a)Stageofsuppuration b)Stageofhyperaemia c)Stageofresolution d)Stageofpre-suppuration CorrectAnswer-AInthestageofsupperationofASOM,pusformationoccurs,henceinthisstagepulsatileotorrheaorlighthousesigninseen.
16.Inotosclerosis,thetympanogramis: a)Lowcompliance b)Highcompliance c)Normalcompliance d)Noneoftheabove CorrectAnswer-AInotosclerosis-Astypecurveisseenwhichisalowcompliancecurve.
17.Whichfractureofthepetrousbonewill causefacialnervepalsy: a)Longitudinalfractures b)Transversefractures c)Mastoid d)Facialnerveinjuryisalwayscomplete CorrectAnswer-BAns.is.B.Transversefractures
18.FISCHclassificationisusedfor: a)Juvenilenasopharyngealangiofibroma b)Nasopharyngealca c)Vestibularschwannoma d)Glomustumour CorrectAnswer-DAclassificationsystem(A-D)describingglomustumorsbasedonanatomiclocationandsize,withlargerletteringrepresentingmoreextensivetumors.
19.Trueaboutrhinophyma: a)Premalignant b)Commoninalcoholics c)Acnerosacea d)Fungaletiology CorrectAnswer-CRhinophymaisaslow-growingbenigntumorwhichoccursduetohypertrophyofthesebaceousglands?ofthetipofthenose.Seeninlongstandingcasesofacnerosacea.Mostlyaffectsmenpastmiddleage.Presentsasapink,lobulatedmassoverthenose.TreatmentParingdownthebulkofthetumorwithasharpknife,orcarbondioxidelaserorscalpel(dermabraions),andtheareaisallowedtore-epithelize.Sometimestumoriscompletelyexcisedandtherawareaiscoveredwithskingraft.
20.WhatisaRhinolith: a)Foreignbodyinnose b)Stoneinnose c)Depositionofcalciumaroundforeignbodyinnose d)Misnomer CorrectAnswer-CRhinolithsarecalcareousmasseswhichresultduetodepositionofsalts-likecalciumandmagnesiumcarbonatesandphosphatesaroundthenucleusofaforeignbody.
21.Posteriorepistaxisoccursfrom: a)Woodruffsplexus b)Kiesselbach'splexus c)Atherosclerosis d)Littlesarea CorrectAnswer-A
22.Caldwellviewisdonefor a)Sphenoidsinus b)Maxillarysinus c)Ethmoidsinus d)Frontalsinus CorrectAnswer-DCaldwellviewistheoccipitofrontalview.Thefrontalsinusesareseenclearlyinthisview.
23.Regardingranulaallaretrueexcept: a)Retentioncyst b)Arisesfromsubmandibulargland c)Translucent d)Plungingmaybeafeature CorrectAnswer-B
24.Regardingadenoidstrueis/are: a)Thereisfailuretothrive b)Mouthbreathingisseen c)CTscanshouldbedonetoassesssize d)aandb CorrectAnswer-DHigharchedpalateandmouthbreathingarefeaturesofhypertrophiedadenoidswhichleadstoadenoidfaciesInadenoidsasaconsequenceofrecurrentnasalobstructionandURTI,childdevelopsfailuretothriveSizeofadenoidsmaywellbeassessedusinglateralradiographofnasopharynx,andCTscanisnotnecessaryAdenoids,alsoknownasnasopharyngealtonsils,aresubepithelialcollectionoflymphoidtissueatthejunctionofroofandposteriorwallofnasopharynx.
25.Trismusinparapharyngealabscessisdue tospasmof: a)Massetermuscle b)Medialpterygoid c)Lateralpterygoid d)Temporalis CorrectAnswer-BStyloidprocessdividesthepharynxintoanteriorandposteriorcompartment.Trismusoccursininfectionofanteriorcompartmentwhereastorticollis(duetospasmofparavertebralmuscles)occursintheinfectionofposteriorcompartment.
26.Inletoflarynxisformedby: a)Ventricularfold b)Aryepiglotticfold c)Glossoepiglotticfold d)Vocalcord CorrectAnswer-BThelaryngealinlet(laryngealaditus,laryngealaperture)istheopeningthatconnectsthepharynxandthelarynx.Itsbordersareformedby:thefreecurvededgeoftheepiglottis,anteriorly.thearytenoidcartilages,thecorniculatecartilages,andtheinterarytenoidfold,posteriorly.
27.AllthefollowingaretrueaboutLaryngeal carcinomaexcept: a)Morecommoninfemales b)Commoninpatientsover40yearsofage c)Afterlaryngectomy,esophagealvoicecanbeused d)bandc CorrectAnswer-ACancerLarynxMostcommonhistologicaltypeoflaryngealCa-Squamouscellcarcinoma(seenin90%cases)Itismorecommoninmales.Male:Femaleratiois4:1Mostcommonage=60-70years.
28.SelectcorrectstatementsaboutCa larynx: a)GlotticCaisthemostcommon b)Supraglotticcahasbestprognosis c)LymphaticspreadisthemostcommoninsubglotticCa d)All CorrectAnswer-AAns.is.A.GlotticCaisthemostcommon
29.Thecommonestsiteofaspirationofa foreignbodyinthesupinepositionisintothe: a)Rightupperlobeapical b)Rightlowerlobeapical c)Leftbasal d)Rightmedial CorrectAnswer-BInsupinepositionandwiththepatientonbacksuperiorsegmentofRLListhemostdependentsegment.
30.Cauliflowerearseenin: a)Hematomaoftheauricle b)Carcinomaoftheauricle c)Fungalinfectionoftheauricle d)Congenitaldeformity CorrectAnswer-ACauliflowerear(boxer'sear,wrestler'sear)isanacquireddeformityoftheouterear.Inthisinjury,theearcanshrivelupandfoldinonitselfandappearpale,givingitacauliflower-likeappearance,hencethetermcauliflowerear.Wrestlers,boxersandmartialartistsinparticulararesusceptibletothistypeofinjury.Whentheearisstruckandabloodclotdevelopsundertheskin,ortheskinisshearedfromthecartilage,theconnectionoftheskintothecartilageisdisrupted.
31.Allofthefollowingarteriescontributesto Little'sareaEXCEPT: a)AnteriorEthmoidalartery b)PosteriorEthmoidalartery c)Sphenopalatineartery d)Greaterpalatineartery CorrectAnswer-BKiesselbach'splexusItliesinKiesselbach'sarea/Kiesselbach'striangle/Little'sareaItisaregionintheanteroinferiorpartofthenasalseptumwherefourarteriesanastomosetoformavascularplexusofthatname.Thearteriesare:-AnteriorEthmoidalartery(fromtheOphthalmicartery)-Sphenopalatineartery(terminalbranchoftheMaxillaryartery)-Greaterpalatineartery(fromtheMaxillaryartery)Septalbranchofthesuperiorlabialartery(fromtheFacialartery)AlthoughthePosteriorEthmoidalarteryalsosuppliestheseptumofthenose,itdoesnotcontributetotheplexus.
32.Multipleperforationoftympanic membranecharacteristicof? a)TubercularOtitisMedia b)SyphiliticOtitisMedia c)Pseudomonasinfection d)FungalOtitisMedia CorrectAnswer-AAns.is'a'i.e.,TubercularotitismediaTubercularotitismediaTuberculosisofmiddleearisacomparativelyrareentityusuallyseeninassociationwithorsecondarytopulmonarytuberculosis,infectionreachesthemiddleearthrougheustachiantube.Theraremodesofinfectionarethroughhematogenousspreadfromtubercularfocusinlung,tonsils,cervicallymphnodes;orduetoingestionofinfectedcow'smilk.Itusuallyaffectschildrenandyoungadults.ClinicalfeaturesGenerally,tuberculosisofmiddleearisunilateral.Itischaracterizedbypainlessotorrhoeawhichfailstorespondtotheusualantimicrobialtreatment.Thereispainlesswateryotorrhea.Singleormultipleperforationoftympanicmembrane.Theremaybemultipleperforationsintheearlystages,buttheycoalesceintoalargetympanicmembraneperforationaccompaniedbyapalegranulationtissue.Periauricularfistulae,lymphadenopathyandfacialpalsyareinfrequentfindings.Latecomplicationsincludefacialparalysis,labyrinthitis,postauricularfistulae,subperiostealabscess,petrousapicitisandintracranial
extensionofinfection.
33.Anothernamefororalthrushis? a)Candidiasis b)Herpangina c)Vincent'sinfection d)Handfootandmouthdisease CorrectAnswer-AAns.is'a'i.e.,CandidiasisOralthrushAlsocalled:oralcandidiasisItisthefungalinfectionoftheoralcavity.Itiscausedbycandidaalbicans.Itmanifestsasgreyishwhitepatchesontheoralmucosaandtongue.\Whenwipedoffitleavesanerythematousmucosa.Thisismorecommonininfantsandchildren.Adultssufferingfrodiabetes,malignancy,takingbroadspectrumoralantibiotics,radiation,cytotoxicdrugsorsteroidscanalsobeaffected.Itistreatedbytopicalapplicationofnystatinorclotrimazole.ChronicHypertrophicCandidiasis(CandidialLeukoplakia)Appearsasawhitepatchintheoralcavitywhichcannotbewipedoff.Itmostlyaffectstheanteriorbuccalmucosajustbehindtheangleofmouth.Itistreatedbyexcisionofthelesion.
34.Whichofthefollowingisnottrueabout invertedpapilloma? a)Itisalwaysunilateral b)Itismorecommoninmales c)10-15%ofthecasesmaybeassociatedwithsquamouscell carcinoma d)ItisalsocalledRingertztumor CorrectAnswer-DAns.is'd'i.e.,ItisalsocalledRingertztumorInvertedPapilloma(Transitionalcellpapilloma/Schneiderionpapilloma)Invertedpapillomaisabenignneoplasmoccursmostlybetween40-70yearswithmalepreponderance(5:1).oItarisesfromthelateralwallofnoseandisalwaysunilateral.Rarely,itmayarisefromnasalseptum.oFeaturesofinvertedpapillomaare:-Itshowsfingerlikeepithelialinvasionsintotheunderlyingstromaoftheepitheliumratherthanonsurfacesocalledinvertedpapilloma.Itisusuallyunilateralandisalocallyaggressivetumour.Patientscomplainofnasalobstruction,rhinorrhea&unilateralepistaxis.In10-15%casestheremaybeassociatedsquamouscellcarcinoma.Treatmentisadequatelocalexcision.Ifitarisesinmaxillarysinus,thenaradicalantrostomyiscarriedout.Ifitarisesintheethmoidalsinus,anexternalethmoidectomyisdone.Ifitarisesfromnose,treatmentiswidesurgicalexcisionbylateralrhinotomy.Hasatendencytorecurevenafterremoval.
35.Positiveheadimpulsetestissuggestive of? a)Injurytovestibularnuclei b)Injurytoperipheralvestibularnerve c)Lesioninthebrainstem d)InjurytoOcculomotornerve CorrectAnswer-BAns.is`b'i.e.,InjurytoperipheralvestibularnerveHeadImpulseTestItisalsocalledheadthrusttest.Itistestforthediagnosisofinjurytovestibularnervewhichformstheperipheralvestibularpathway.Clinicianasksthepatienttofixhisgazeonatargetandthenperformpassivehorizontalandverticalheadimpulsesandobservesthepatient'seyes.Observationofarefixationsaccadeaftertheheadimpulseindicatesdecreaseddecreasedvestibuloocularreflexsecondarytoperipheralvestibularlesions(vestibularnerveinvolvement).
36.Conductinghearinglosswithintact tympanicmembrane? a)Presbycausis b)Meniere'sdisease c)Glueear d)Acousticneuroma CorrectAnswer-CAns.is'c'i.e.,GlueearAmongthegivenoptions,onlyglueear(serousotitismedia)isacauseofconductivedeafness.
37.Notacauseofobjectivetinnitus? a)Palatalmyoclonus b)Glomustumor c)Carotidarteryaneurysm d)Presbyacusis CorrectAnswer-DAns.is'd'i.e.,PresbyacusisTinnitusTinnitusisringingsoundornoiseintheear.Thecharacteristicfeatureisthattheoriginofthissoundiswithinthepatient.
38.Lengthofexternalauditorymeatusis? a)12mm b)16mm c)20mm d)24mm CorrectAnswer-DAns.is'd'i.e.,24mmExternalauditorycanal(Externalacousticmeatus)Externalauditorycanalisa'S'shapedcanalwithlengthof24-25mmanditisdividedintotwoparts:?1)CartilagenouspartItformsouter/lateral1/3(8mm)oftheexternalauditorycanal.Ithastwofissures/deficienciesintheanteriorpartcalledfissureofsantorinithroughwhichparotidorsuperficialmastoidinfectioncanappearinthecanalandviceversa.Skincoveringitisthickandhasceruminousglands(modifiedapocrinesweatglands),pilosebaceousglandsandhair.Sincehairisconfinedtocartilaginouspart,furunclesareseenonlyintheouterthirdofthecanal.2)BonypartItformsinner/medial2/3(16mm)ofexternalauditorycanal.Skinliningthebonypartisthinandisdevoidofhairandceruminousglands.Isthmusisthenarrowestportionofbonycanalandis5mmlateraltotympanicmembrane.Foreignbodiesgetlodgedinisthmusaredifficulttoremoveasitisthenarrowestpart.`ForamenofHuschke'isadeficiencypresentinantero-inferiorpartofbonycanalinchildrenupto4yearsofage,permittinginfectiontoandfromparotid.
39.Whichofthefollowingisfalseregarding frontalsinusitis? a)Painshowsperiodicity b)Mostcommonsinusinvolvedininfantsandchildren c)Painisreferredtoasofficeheadache d)Tendernessispresentjustabovethemedialcanthusofeye CorrectAnswer-BAns.is'b'i.e.,MostcommonsinusinvolvedininfantsandchildrenMostcommonsinusinvolvedininfantandchildrenisEthmoidsinus.ClinicalfeaturesofacutesinusitisMostcommonpresentingpatient'scompliantispersistentnasaldischargewhichcanbeofanyquality(thin,thick,clear,orpurulent).Nasaldischargefromasinusinfectioncanbeblood-tingedfromexcessivenoseblowingandirritation.Theclinicalsymptomsofacutesinusitishavebeenclassifiedintomajorandminor.
40.Minitracheostomyisperformedthrough? a)Cricothyroidmembrane b)2ndand3rdtrachealrings c)Anyoftheabove d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,CricothyroidmembraneCricothyrotomyorLaryngtomyorMinitracheostomyItistheproceduretoopentheairwaythroughthecricothyroidmembrane.Patient'sheadandneckareextended,lowerborderofthroidcartilageandcricoidringisidentified.Skininthisareaisincisedverticallyandthencricothyroidmembraneisopenedwithatransverseincision.Itisanemergencyproceduretobuytimeforthepatienttobeshiftedtotheoperationtheatre.
41.Whichofthefollowingisincludedinthe Levensoncriteriaforcongenitalcholesteatoma? a)Whitemassmedialtonormaltympanicmembrane b)Atticoantralperforationofthetympanicmembrane c)Definitehistoryofotorrhoea d)Historyofpriorotologicprocedures CorrectAnswer-AAns.is'a'i.e.,WhitemassmedialtonormaltympanicmembraneLevensoncriteriaforcongenitalcholesteatoma 1. WhitemassmedialtonormalTM.2. Normalparsflaccidaandtensa.3. Nohistoryofotorrheaorperforations.4. Nopriorotologicprocedures.5. Priorboutsofotitismedianogroundforexclusions.
42.Whichofthefollowingisfalseregarding Frey'ssyndrome? a)Itisalsocalledgustatorysweating b)Itiscausedbyinjurytoauriculotemporalnerve c)Itoccursimmediatelyaftertheparotidsurgery d)Itiscausedbyaberrantregenerationofpost CorrectAnswer-CAns.is'c'i.e.,ItoccursimmediatelyaftertheparotidsurgeryFrey'ssyndrome(gustatorysweating)GustatorysweatingorFrey'ssyndromeinvolvespost-parotidectomyfacialsweatingandskinflushingwhileeating.Thesymptomsusuallyoccurseveralmonthsorevenyearsafterparotidsurgery.Thelikelypathophysiologyisaberrantregenerationofpostganglionicsecretomotorparasympatheticnervefibres(originatingfromtheoticganglion)misdirectedthroughseveralaxonalsheathsofpost-ganglionicsympatheticfibresfeedingthesweatglands.Thesesympatheticfibresaretothesweatglandsoftheskininthedissectedfield.Thefrey'ssyndromeislikelyduetoinjurytoauriculotemporalnervewithfaultyregeneration,thereforeFrey'ssyndromeisalsoknownasAuriculotemporalsyndrome.AvariantofFrey'ssyndromeinwhichthereisgustatoryfacialflushingbutnotsweating,occursfollowingfacialparalysisduetofaultyregenerationfollowinginjurytothefacialnerve.So,Frey'ssyndromeisnotlimitedtoparotidsurgerywithinjurytoauriculotemporalnerve.
43.Mostcommoncauseoftrigeminal neuralgia? a)Infection b)Trauma c)Vascularcompression d)Iatrogenic CorrectAnswer-CAns.is'c'i.e.,VascularcompressionTrigeminalneuralgia(ticdouloureux)ischaracterizedbyintermittent,shootingpainintheface.Itisduetoinvolvementoftrigeminalnerve.95%ofcausesoftrigeminalneuralgiaareduetopressureontrigeminalnerveclosetowhereitentersthebrainstem,pasttheGasserianganglion.Inmostcases,thispressureseemstobecausedbyanarteryorveincompressingtrigeminalnerve.Othercausesaretumor,cysts,AVmalformationandmultiplesclerosis.Mostcommonlyuseddrugsfortreatmentoftrigeminalneuralgiaarecarbamazepine,gabapentinandvalproate.
44.Patientwiththinpainlessotorrhoea, multipleperforationsofthetympanicmembraneandfailuretorespondtoantimicrobialtreatment.Whatisthemostprobablecausativeorganism? a)Mycobacteriumtuberculosis b)Staphylococcusaureus c)Candidaalbicans d)Aspegillusfumigatus CorrectAnswer-AAns.is'a'i.e.,MycobacteriumtuberculosisThinpainlessotorrhoea,multipleperforationsofthetympanicmembraneandfailuretorespondtoantimicrobialtreatmentarethefeaturesoftubercularotitismediaanditiscausedbyMycobacteriumtuberculosis.
45.Synkinesisisasequelof? a)Facialnerveparalysis b)Trigeminalnerveparalysis c)Superficialtemporalnerveparalysis d)GreaterPetrosalnerveparalysis CorrectAnswer-AAns.is'a'i.e.,FacialnerveparalysisClinicalfeaturesofBell'spalsyAcuteonset,ipsilateralfacialparalysis.Facialparalysisisusuallyprecededbypainbehindtheear.Patientisunabletoclosehiseyes.Bellsphenomenon,i.e.onattemptingtoclosetheeye,eyeballturnsupandout.Facebecomesasymmetricalandsalivadribblesfromangleofmouth.Ipsilaterallossoftastesensation,salivationandlacrimation.Intolerancetohighpitchedorloudsound(hyperacusis).Mostpatients(80%)recoverwithinfewweekstomonths.SynkinesisandcrocodileteararesequelaeofBell'spalsy:-SynkinesisorfacialsynkinesisisacommonsequelaetoBell'spalsy.Thisisduetocrossinnervationofnervefibresduringrecovery.Whenthepatientwishestoclosetheeye,cornerofmouthalsotwichesandviceversa.Crocodiletear(gustatorylacrimation)isduetofaultyregenerationofparasympatheticfibreswhichnowsupplylacrimalglandinsteadofthesalivaryglands.
46.Sagograinappearanceisseenin? a)Healedmyringitisbullosa b)Otomycosis c)Malignantotitisexterna d)Keratosisobturans CorrectAnswer-AAns.is'a'i.e.,HealedmyringitisbullosaOtitisexternahaemorrhagicaThisconditionisalsoknownasBullousmyringitisormyringitisbullosa.Thisconditionisextremelypainfulandhassuddenonset.Itisthoughttobeduetomycoplasmapneumoniaeorviralinfection,usuallyinfluenza'.Theremaybeamildconductivedeafnessandamildlydischargingcar.Theappearanceofhaemorrhagicbullaeonthetympanicmembraneandinthedeepmeatusischaracteristic.Thebullaearefilledwithserosanguinousfluidandblood.Onhealing,bullaelooklikeSago-grain.Therefore"Sago-grain"appearanceoftympanicmembraneisseeninhealedmyringitisbullosa.
47.Followingisthepreferredtreatmentof SerousOtitisMedia- a)Grommetsurgery b)OralAmoxicillinfor5-10days c)Modifiedradicalmastoidectomy d)Bedrest,antipyreticsandadequatefluidintake CorrectAnswer-AAns.is'a'i.e.,GrommetsurgeryTreatmentofotitismediaFollowingtwotreatmentshavebeendescribed:?1)WatchfulwaitingWatchfulwaitingistheactivemonitoringoftheconditionandhearinginanticipationofspontaneousresolution.Guidlinesaimedatbothprimarycareandspecialistotolaryngologistbroadlyagreethatawatchfulwaitingperiodforaboutthreemonthsistheinitialmanagementofchildrenwithserousotitismedia.Therefore,unlesstherearealsosignsofaninfection,mosthealthcareproviderswillnottreatSOMatfirstInstead,theywillrechecktheproblemin2-3months.ThisshouldbecoupledwithreassurancethatdoingnothingisaslikelyasdoingsomethingtoresultinresolutionoftheSOMandtheassociatedsymptoms.2)SurgerySurgicalinterventionisrecommendedwhenwatchfulwaitingandmonitoringofhearinghasconfirmedfailureofresolutionofSOM.Followingsurgicalinterventionareusedcommonly:- i. Myringotomyandaspirationoffluid:-Anincisionismadeintympanic membraneandfluidaspiratedwithsuction. ii. Grommet(ventilationtube)surgery:-Ifmyringotomyandaspiration
combinedwithmedicalmeasureshasnothelpedandfluidrecurs,agrommetisinsertedtoprovidecontinuedaerationofmiddleear.ThisisthemostcommonsurgicalinterventionforSOM.Mostpreferedsiteofgrommetinsertionisantero-inferiorthroughcircumferentialorradialincision. iii. Surgicaltreatmentofcausativefactor:-Adenoidectomy, tonsillectomyetc.Medicalmeasuresarecontroversialandinvolve:? 1. Decongestants2. Antiallergicmeasures3. Antibiotics4. Middleearaeration:-Valsalvamaneuver,Politzerisationor eustachiantubecatheterization,Chewinggum.
48.WhenapatientsaysAhtherightuvula pressesthepalatewhichofthefollowingnerveisdamaged? a)RghtXCN b)RightXIICN c)LeftXCN d)RightXIICN CorrectAnswer-CAns.is'c'i.e.,LeftXCNAssessmentofthemovementofsoftpalate-BothIXandXCNsaretested:Theglossopharyngealnerve(IXCN)isamixednervewithmotor,sensoryandsomeparasympatheticactivity.Itcarriessensoryinputfromthepalateandpharynxandthetastefromtheposteriorthirdofthetongue.Itprovidesafferentlimbofthegagreflex.Thevagus(XCN)isalsoamixednervewithmotor,sensoryandparasympatheticactivity.Itprovidesthemotorsupplytothepharynx,softpalateandlarynxandprovidestheefferentlimbtothegagreflex.Normallyonoralexaminationthesoftpalateissymmetricalwiththeuvuladanglinginthecentreanddividingthesoftpalate.WhenthepatientisaskedtosayAAAh!Thesoftpalateshouldelevatesymmetricallyandtheuvulashouldremaincentric.Ifthereisunilateralweaknessofthesoftpalatetheuvulaispulledawayfromtheweakenedside.Nowinthequestiongivenwhenthepatientsaysaaahtherightuvulapressesthepalatei.e.therightsidesoftpalatepullstheuvulaawayfromtheweakleftside.Theweaknessoftheleftsoftpalate
awayfromtheweakleftside.TheweaknessoftheleftsoftpalatecanbebecauseoftheweaknessoftheleftIXorXcranialnerves.
49.Lumpyfeelinginthroatrelievedontaking foodisattributedto? a)Globuspharyngeus b)Pharyngealpouch c)Diverticulardisease d)Esophagealatresia CorrectAnswer-AAns.is'a'i.e.,GlobusPharyngeusGlobusPharyngeusSymptomwhereinapatientdescribessomethingstuckinthroatorasensationoflumportightnessinthroatwhichisrelievedbytakingfoodortalking.
50.Glomusjugularecommonlyarisesfrom? a)Hypotympanum b)Mesotympanum c)Epitympanum d)Prussaksspace CorrectAnswer-AAns.is'a'i.e.,HypotympanumTherearetwotypesofglomustumors:-i)GlomusjugulareTheseglomustumorsarisefromthedomeoftheinternaljugularveininthehypotympanumandjugularforamen.InjugularforamentheycaninvadeIXtoXIIcranialnerves.ii)GlomustympanicumTheyarisefromthepromontoryofthemiddleearalongthecourseofthetympanicbranchoftheIXthcranialnerve.
51.Gradenigosyndromeischaracterizedby allexcept? a)Diplopia b)Retro-orbitalpain c)Persistenteardischarge d)Vertigo CorrectAnswer-DAns.isdi.e.,VertigoInfectionofmastoidandmiddleearmaybecomplicatedbythespreadofinfectionwithinthetemporalboneintopetrousapex.Petrositisisanextensionofinfectionfrommiddleearandmastoidtothepetrouspartofthetemporalbone.Gradenigo'ssyndromeistheclassicalpresentationandconsistsofatriadof:-Externalrectuspalsy(VIthnerve/abducentnervepalsy)causingdiplopia.Deepseatedorbitalorretroorbitalpain(Vthnerveinvolvement).Persistenteardischargeduetoipsilateralacuteorchronicotitismedia.Associatedsymptomsofotitismediaarealsopresente.g.,conductivedeafness.Othersymptomsarefever,headache,vomiting,andsometimesneckrigidity.Somepatientmaygetfacialparalysisandrecurrentvertigoduetoinvolvementoffacialandstatoacousticnerves.
52.Atticoantraldiseaseistreatedby? a)Modifiedradicalmastoidectomy b)Antibiotics c)Grommetinsertion d)Synringing CorrectAnswer-AAns.is'a'i.e.,ModifiedradicalmastoidectomyTreatmentofatticoantraldiseaseSincecholesteatomaisgoingtoexpandanddestroyboneandmucousmembrane,ithastoberemoved.Therefore,surgeryisthemainstayoftreatment.Primaryaimisremovalofdiseasebymastoidectomytomakeearsafefollowedbyreconstructionofhearingatalaterstage.Modifiedradicalmastoidectomyisthesurgeryofchoice.Twotypesofsurgicalprocedures(mastoidectomy)aredonetodealwithcholesteatoma.1)CanalwalldownproceduresTheseleavethemastoidcavityopenintotheexternalauditorycanalsothatthediseasedareaisfullyexteriorized.Thecommonlyusedproceduresforatticoantraldiseaseareatticotomy,modifiedradicalmastoidectomyandrarelyradicalmastoidectomy.Modifiedradicalmastoidectomyistheprocedureofchoice.2)Canalwallupprocedures(corticalmastoidectomy)Herediseaseisremovedbycombinedapproachthroughthemeatusandmastoidbutretainingtheposteriorbonymeatuswall,therebyavoidinganopenmastoidcavity.Forreconstructionofhearingmechanismmyringoplastyor
tympanoplastycanbedoneatthetimeofprimarysurgeryorasasecondstageprocedure.
53.Samterstriadisseeninpatientswith? a)Asthma b)Chronicpancreatitis c)Crohn'sdisease d)Livercellcarcinoma CorrectAnswer-AAns.is'a'i.e.,AsthmaSamter'striadSamter'striadisamedicalconditionconsistingofasthma,aspirinsensitivity,andnasal/ethmoidalpolyposis.Itoccursinmiddleage(twentiesandthirtiesarethemostcommononsettimes)andmaynotincludeanyallergies.Mostcommonly,thefirstsymptomisrhinitis.Thedisordertypicallyprogesestoasthma,thenpolyposis,withaspirinsensitivitycominglast.Theaspirinreactioncanbesevere,includinganasthmaattack,anaphylaxis,andurticariainsomecases.PatientstypicallyreacttootherNSAIDSsuchasibuprofen,althoughparacetamolisgenerallyconsideredsafe.Anosmia(lackofsmell)isalsotypical,astheinflammationreachestheolfactoryreceptorsinthenose.
54.Strawberrytongueisseenin? a)Streptococcalscarletfever b)Kawasakidisease c)Bothoftheabove d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,BothoftheaboveStrawberrytongueItisalsocalledraspberrytongueItbasicallyreferstoglossitis,whichmanifestswithhyperplastic(enlarged)fungiformpapillae,givingtheappearanceofastrawberry.Whitestrawberrytongueiswherethereisawhitecoatingonthetonguethroughwhichthehyperplasticfungiformpapillaeprotrude.Redstrawberrytongueiswherethewhitecoatingislostandadarkred,erythematoussurfaceisrevealed,interspacedwiththehyperplasticfungiformpapillae.Whitestrawberrytongueisseeninearlyscarletfever(asystemicinfectionofgroupAhemolyticstreptococci).Redstrawberrytongueoccurslater,after4-5days.Otherconditionsinwhichstrawberrytongueisseenare:Kawasakidisease,toxicshocksyndrome,andvitaminB12deficiency.
55.Allaretrueforgradenigo'ssyndrome except? a)Associatedwithintermittenteardischarge b)Associatedwithconductivehearingloss c)Causesdiplopia d)Leadstoretroorbitalpain CorrectAnswer-AAns.is'a'i.e.,AssociatedwithintermittenteardischargeGradenigo'ssyndrome,alsocalledGradenigo-Lannoissyndrome,isacomplicationofotitismediaandmastoiditisinvolvingtheapexofthepetroustemporalbone.
SymptomsComponentsofthesyndromeinclude:retroorbitalpainduetopainintheareasuppliedbytheophthalmicbranchofthetrigeminalnerve(fifthcranialnerve),abducensnervepalsy(sixthcranialnerve)otitismediaOthersymptomscanincludephotophobia,excessivelacrimation,fever,andreducedcornealsensitivity.Thesyndromeisclassicallycausedbythespreadofaninfectionintothepetrousapexofthetemporalbone.
56.Treatmentofmiddleearpapillomais? a)Myringotomyandsimpleexcision b)Myringectomyandsimpleexcision c)Tympanomastoidectomy d)Localinfiltrationwithpodophyllin CorrectAnswer-CAns.is'c'i.e.,TympanomastoidectomyMiddleearpappilomasThemiddleearpapillomasarerarepresentationsandmedicalliteratureismainlylimitedtocasereportsorcaseseries.Theseincludeaggressivepappilarytumors,schneideriantypeofpappilomasandinvertedpappilomas.TheyareassociatedwithhearingdifficultyandvertigoandmaybeassociatedwithVonHippelLindausyndrome.Theytendtobeslowlygrowing,locallyaggressivenonmetastasizingneoplasmsTheapproachfortreatmentofsuchpathologyisusuallyradicalandtympanomastoidectomyisconsideredthetreatmentofchoice.Thisgivesthebestchanceofcure.
57.Besttimeforhearingassessmentinan infant? a)1stmonthoflife b)3-6months c)6-9months d)9-12months CorrectAnswer-AAns.is'a'i.e.,1stmonthoflifeTheAmericanAcademyofPediatrics(AAP),JointCommitteeonInfanthearing(2007),hasrecommendedthatallnewborninfantsbescreenedforhearingimpairmenteitherasneonateorbefore1monthofageandthatthoseinfantswhofailnewbornscreeninghaveanaudiologicexaminationtovarifyhearinglossbeforeageof3months.
58.Darwintubercleisseenin? a)Tragus b)Helix c)Antihelix d)Lobule CorrectAnswer-BAns.is'b'i.e.,HelixDarwin'stubercle(orauriculartubercle)isacongenitalearconditionwhichoftenpresentsasathickeningonthehelixatthejunctionoftheupperandmiddlethirds.Thefeatureispresentinapproximately10.4%ofthepopulation.Thisacuminatenodulerepresentsthepointofthemammalianear.
59.Trottertriadnotincludedis? a)Conductivedeafness b)Temporoparietalneuralgia c)Palatalparalysis d)Seizures CorrectAnswer-DAns.is'd'i.e.,SeizuresTrotter'striadTrotter'striadoccursinnasopharyngealcarcinomaItincludes:-i)Conductivedeafness(duetoEustachiantubeblockage)ii)Temporo-parietalneuralgia(duetoinvolvementofipsilateralVthcranialnerve)iii)Palatalparalysis(duetoinvolvementofXthcranialnerve)
60.Followingproteinisnotfoundinorganof corti? a)Myosin b)Microtubuleassociatedprotein2 c)Microtubuleassociatedprotein4 d)Fodrin CorrectAnswer-CAns.is'c'i.e.,Microtubuleassociatedprotein4ProteinspresentincochleaActin-bindingandmicrotubule-associatedproteinsregulatemicrofilamentandmicrotubulenumber,length,organizationandlocationincells.Infreeze-driedpreparationsoftheguineapigcochlea,bothactinandtubulinarefoundinthesensoryandsupportingcellsoftheorganofCorti.Fodrin(brainspectrin)co-localizedwithactininthecuticularplatesofbothinnerandouterhaircellsandalongthelateralwalloftheouterhaircells.Alpha-actininco-localizedwithactininthecuticularplatesofthehaircellsandintheheadandfootplatesofthesupportingcells.Itwasalsofoundinthejunctionalregionsbetweenhaircellsandsupportingcells.oProfilinco-localizedwithactininthecuticularplatesofthesensoryhaircells.Myosinwasdetectedonlyinthecuticularplatesoftheouterhaircellsandinthesupportingcellsintheregionfacingendolymph.Gelsolinwasfoundintheregionofthenervefibers.TubulinisfoundinmicrotubulesinallcellsoftheorganofCorti.Insupportingcells,microtubulesarebundledtogetherwithactin
microfilamentsandtropomyosin,aswellasbeingpresentasindividualmicrotubulesarrangedinnetworks.Anintenselystainednetworkofmicrotubulesisfoundinbothouterandinnersensoryhaircells.Themicrotubulesintheouterhaircellsappeartocoursethroughouttheentirelengthofthecells,andbasedontheirstainingwithantibodiestothetyrosinatedformoftubulintheyappeartobemoredynamicstructuresthanthemicrotubulesinthesupportingcells.Themicrotubule-associatedproteinMAP-2ispresentonlyinouterhaircellswithintheorganofCortiandco-localizeswithtubulininthesecells.NootherMAPs(1,3,4,5)arepresent.Tauisfoundinthenervefibersbelowbothinnerandouterhaircellsandintheosseousspirallamina.
61.Followingistrueaboutlaryngomalacia except? a)Omegashapedepiglottis b)Reassuaranceofthepatientisthetreatmentofchoice c)Conditionisfirstnoticedinthefirstfewweeksoflife d)Expiratorystridor CorrectAnswer-DAns.is'd'i.e.,ExpiratorystridorLaryngomalaciaItisthemostcommoncongenitalabnormalityofthelarynx.Laryngomalaciaisthemostfrequentcauseofstridorornoisybreathingininfants.Itoccursasaresultofafloppyportionofthelarynx(insupraglotticlarynx)thathasnotyetdevelopedthestrengthtoproviderigidsupporttotheairway.Duringinspirationnegativepressureiscreatedthroughlarynx,whichresultsinacollapseofthesestructuresintotheairwayandanarrowerbreathingpassage.Partialobstructionisthesourceofthenoisewithbreathing(stridor),andsometimescyanosis.Thehallmarksignincludesintermittentstridormostlyininspiration.Itisusuallymoreprominentwhentheinfantislyingonhis/herback(supineposition,crying,feeding,excitedorhasacold.Stridorgetsrelievedonplacingthepatientinproneposition.Thisisusuallyfirstnoticedinthefirstfewweeksoflife.Itmayworsenoverthefirstfewmonthsandbecomelouder.Thisisbecauseasthebabygrows,inspiratoryforceisgreater,whichcausesgreatercollapseofthelaryngealstructuresintotheairway.Thisisusuallyworstat3-6monthsandthengraduallyimprovesastherigidityofthecartilageimproves.
Mostchildrenaresymptomfreeby1to2years.Sometimes,cyanosismayoccur.Directlaryngoscopyshows:-Omegashapedepiglottis,i.e.elongatedandcurledonitself.Floopy,tall,foreshortenedandthinaryepiglotticfolds.Prominentarytenoids.Inmostpatientslaryngomalaciaisaselflimitingcondition.Treatmentoflaryngomalaciaisreassurancetotheparentsandearlyantibiotictherapyforupperrespiratorytractinfections.
62.Followingarethelaboratorytestsforthe diagnosisofvestibulardysfunctionexcept? a)Electronystagmography b)Optokinetictest c)Galvanictest d)Gelle'stest CorrectAnswer-DAns.is'd'i.e.,Gelle'stestVestibularsystemThevestibularsystemcontributestobalanceandtothesenseofspatialorientation.Itisasensorysystemthatprovidestheleadingcontributionaboutmovementandsenseofbalance.Itincludesthelabyrinth(semicircularcanalsandotolith:utricle&sacules)oftheinnerearandissituatedinthevestibulumintheinnerear.Thesymptomsofvestibulardysfunctionarevertigo,dizzinessandUnbalance.
63.InapatientwithCSOM,labrynthinefistula mostcommnonlyinvolves? a)SuperiorSCC b)LateralSCC c)PosteriorSCC d)Utricle CorrectAnswer-BAns.is'b'i.e.,LateralSCCLabrynthinefistulaisalmostexclusivelyreportedinassociationwithchronicotitismediaandcholesteatoma.Themostcommonlyaffectedcanalislateral(horizontal)semicircularcanal,butinvolvementoftheposteriorandsuperiorcanalsaswellasotherregionsoflabyrinthhavebeenreported.Theincidenceoflabrynthinefistulainchronicotitismediaisapproximately10%.
64.Horizontalaccelerationwithforward movementinthesagittalplaneisdetectedby? a)MaculaofUtricle b)MaculaofSaccule c)Lateralsemicircularcanal d)Posteriorsemicircularcanal CorrectAnswer-AAns.is'a'i.e.,Maculaofutricle
65.Patientpresentswithmouthbreathing, recurrentserousotitismediaandadenoidfacies.Whatisthebestlineofmanagement? a)Adenoidectomy b)Tonsillectomy c)Antibiotics d)Supportivetherapy CorrectAnswer-AAns.is'a'i.e.,AdenoidectomyThetriadofnasalandauralsymptomswithadenoidfaciespointstothediagnosisofenlargedadenoids.Forthetreatmentofenlargedadenoidswhensymptomsarenotmarkedbreathingexcercise,decongenstantnasaldropsandantihistaminicsareusedandwhensymptomsaremarked,adenoidectomyisdone.Wehaveapatientwithmarkedandrecurrentsymptomsthusadenoidectomyisthetreatmentofchoice.
66.Whichofthefollowingorganismsis knowntocauseAtrophicrhinitis? a)Klebsiellaozaena b)Klebsiellapneumonia c)Streptococcuspneumonia d)Streptococcusfoetidis CorrectAnswer-AAns.is'a'i.e.,KlebsiellaozaenaAtrophicrhinitis(Ozaena)Atrophicrhinitisisachronicinflammationofnosecharacterizedbyatrophyofnasalmucosa,includingtheglands,turbinatebonesandthenerveelements.Atrophicrhinitismaybeprimaryorsecondary:?1)PrimaryatrophicrhinitisTheprimarypathologyisinflammationandatrophyofthenose.Generally,atrophicrhinitisreferstoprimaryatrophicrhinitis.Causesare:-i)Hereditaryii)Endocrinalpathology-Startsatpuberty.Stopsaftermenopauseiii)Racialfactors-SeenmoreinWhitesandYellowracesiv)Nutritionaldeficiency-DeficiencyofvitaminA,D,Eandironmayberesponsibleforit.v)Infective-Klebsiellaozanae,Diphtheriods,P.vulgaris,E.coli,Staphylococci,Streptococci.vi)Autoimmuneprocess-Causingdestructionofnasal,neurovascularandglandularelementsmaybethecause.2)SecondaryatrophicrhinitisSpecificinfections,suchassyphilis,lupus,leprosy,and
rhinoscleroma,maycausedestructionofthenasalstructuresleadingtoatrophicchanges.Canalsoresultsfromlongstandingpurulentsinusitis,radiotherapyofnose,excessivesurgicalremovaloftheturbinateandascomplicationofDNSontherootsideofnose.
67.Potatotumordueto? a)Hypotrophyofsebaceousglandsofnose b)Hypertrophyofsebaceousglandsofnose c)Hypotrophyofsweatglandsofnose d)Hpertrophyofsweatglandsofnose CorrectAnswer-BAns.is'b'i.e.,HypertrophyofsebaceousglandsofnoseRhinophyma(Potatotumor)Rhinophymaislarge,bulb-shaped,red-colored(ruddy)nose.Itisaslowgrowingbenigntumorduetohypertrophyofthesebaceousglands.Thecauseofrhinophymaisunknown,thoughitisthoughttobeasevereformofacneroscea.Rhinophymawasoncethoughttobecausedbyheavyalcoholconsumption,butthisisnotthecase.Rhinophymaoccursequallyinthosewhodonotdrinkatallandthosewhodrinklargequantitiesofalcohol.Itmostlyaffectsmenpastmiddleage.Red/pinkcolourofthetumorisduetoengorgmentofsuperficialvessels.TreatmentSurgerytoreshapethenoseisthebestknowntreatmentforrhinophyma.Surgerymaybedonewithalaser(carbondioxidelaser),scalpel(sharpknife)orarotatingbrush(dermabrasion)andtheareaisallowedtore-epithelialize.Sometimes,tumouriscompletelyexcisedandtherawareaisskin-grafted.
68.Rhinitismostcommonbacterialcause? a)Haemophilusinfluenza b)Streptococcushaemolyticus c)Pasturellamultocida d)Cornybacteriumdiphtheria CorrectAnswer-AAns.is'a'i.e.,HaemophilusinfluenzaAcutebacterialrhinitisismostcommonlyseenamongchildren,butadultmaydeveloptheconditionafternasaltrauma,viralupperrespiratorytractinfection,orsurgery.Theclinicalpresentationofacutebacterialrhinitismaybeidenticaltothatofcommoncold.MostcommoncausativeorganismsincludeS.pneumoniae,H.influenzaeandMoraxellaCatarrhalis.Note:Overall,mostcommoncauseofinfectiverhinitisisviralinfection(viralrhinitis).
69.Surgicalmarkingsforfindingthefacial nerveisare? a)Tympano-mastoidsuture b)Tragalpointer c)Posteriorbellyofdigastric d)Alltheabove CorrectAnswer-AAns.is'a'i.e.,Tympano-mastoidsutureSurgicallandmarkstoidentifymaintrunkofthefacialnerveareasfollows: i. Tympanomastoidsutureline-itislocatedbetweenthemastoidand thetympanicbones.Themainfacialtrunklies6-8mmdistaltotheendofthesuture. ii. Tragalpointer-themainnervetrunklies1.0to1.5cmdeepand slightlyanteriorandinferiortothetipoftheexternalearcanalcartilage. iii. Posteriorbellyofdigastric-themainnervetrunklies1cmdeepto themedialattachmentoftheposteriorbellyofdigastricmuscletothedigastricgroove(mastoidnotch)ofthemastoidbone. iv. Mastoidbone-mainnervetrunkisidentifiedinsidethemastoid bonebymastoidectomy.
70.
Centralpartofcholesteatomacontains? a)Keratindebris b)Keratinizedsquamousepithelium c)Coulmnarepithelium d)Fibroblasts CorrectAnswer-AAns.is'a'i.e.,KeratindebrisCholesteatomaDestructiveorexpandinggrowthinthemiddleearormastoidprocessThetermcholesteatomaisamisnomer,becauseitneithercontainscholesterolcrystalsnorisitatumortomeritthesuffix`oma'.Cholesteatomahasthepropertytodestroybone.Itmaycausedestructionofearossicles,erosionofbonylabyrinth,canaloffacialnerve,sinusplateortegmentympaniandthuscauseseveralcomplications.Bonedestructionbycholesteatomahasbeenattributedtovariousproteolyticenzymesliberatedbyosteoclastsandmononuclearinflammatorycells,seeninassociationwithcholesteatoma.Cholesteatomaconsistsoftwoparts:?i)Matrix:-Madeupofkeratinizingsquamousepithelium.ii)Keratindebris(centralwhitemass):-Producedbythematrix.Therefore,cholesteatomaalsoreferredtoasepidermosisorkeratoma.
71.Whichofthefollowingisnotacauseof oropharyngealcarcinoma? a)Occupationalexposuetohydrochloricacid b)Smoking c)HumanPapillomaVirusinfection d)Occupationalexposuretoisopropyloil CorrectAnswer-AAns.is'a'i.e.,OccupationalexposuretohydrochloricacidEtiologyoforopharyngealcarcinoma i. Tobaccoinanyform-cigarettesmokingorchewing ii. Heavyalcoholabuse iii. Beetlenutchewing iv. Plummervinsonsyndrome,cirrhosis v. Syphilis vi. Trauma vii. Dentalirritation viii. Poororalhygiene ix. Occupationalexposuretoisopropylalcohol,sulphuricacidand nickel x. HPVinfection
72.Falseregardingtheforeignbodyof oropharynxis? a)Impactedforeignbodiesmostoftenlodgeinthesofttissueat thebaseoftongue b)Foodparticlesarethemostcommonoropharyngealforeign bodiesinchildren c)Clinicalhypopharyngealforeignbodiesareamenabletoclinical examination d)EndoscopyandMDCTareusedinthediagnosis CorrectAnswer-BAns.is'b'i.e.,FoodparticlesarethemostcommonoropharyngealforeignbodiesinchildrenOropharyngealforeignbodiesMostingestedforeignbodiesdonotimpactintheoropharynxSharpforeignbodieslikefishandchickenbonesmostcommonlyimpactinthesofttissuesatthebaseofthetongue.Hypopharyngealforeignbodiescanbedetectedbygoodphysicalexamination.EndoscopyandMDCTareusedinthediagnosisofforeignbodiesofcervicalesophagus.Coinsarethemostcommonimpactedoropharyngealforeignbodiesencounteredinchildrenfollowedbyfoodparticles.
73.NotatestforEustachiantubepatency? a)Tympanometry b)Toynbee c)Valsalva d)Frenzelmaneuver CorrectAnswer-AAns.is'a'i.e.,TympanometryTestsforEustachiantubepatencyValsalvatestMethylenebluetestSonotubometryPolitzertestToynbeetestFrenzelmaneuverCatheterizationInflation-Deflationtest
74.Tympanoplastydealswithreconstruction of- a)Tympanicmembrane b)Ossicularchain c)Bothaandb d)Noneoftheabove CorrectAnswer-CAns.is'c'i.e.,BothaandbTympanoplastyisthesurgicaloperationperformedforreconstructionoftympanicmembraneand/ormiddleearossicles.Myringoplastyisthereconstructionoftympanicmembrane.Ossiculoplastyisthereconstructionofossicularchain.Tympanoplasty=Myringoplasty?ossiculoplasty
75.MostcommonorganismculturedinCSOM is? a)Staphylococcusaureus b)Staphylococcusepidermidis c)Streptococcuspneumonia d)Pseudomonasaeruginosa CorrectAnswer-DAns.is'd'i.e.,PseudomonasaeruginosaMicrobiologyofCSOMPuscultureinbothtypesofaerobicandanaerobicCSOMmayshowmultipleorganisms.Mostcommonlyisolatedorganismsaregramnegativebacilli,i.e.,Pseudomonas,proteus,E.coli.Theseorganismsarenotcommonlyfoundintherespiratorytract,whilecommonlyfoundintheskinofexternalear.
76.Fowlsmellingnasaldischargeisseenin allexcept? a)NasalMyiasis b)Choanalatresia c)Foreignbodyinnose d)Rhinolith CorrectAnswer-BAns.is`b'i.e.,ChoanalatresiaDiseaseswithfowlsmellingnasaldischargeare:NasalmyiasisForeignbodyinnoseRhinolithInchoanalatresiathereispresenceofnasaldischargewithoutairbubbles.
77.Rhinoscleromaoccursdueto? a)Autoimmunecause b)Inflammatorycause c)Klebsiellarhinoscleromatisinfection d)Mycoticinfection CorrectAnswer-CAns.is'c'i.e.,KlebsiellarhinoscleromatisinfectionRhinoscleromaThecausativeorganismisKlebsiellarhinosclerontatisorFrischbacillus,whichcanbeculturedfromthebiopsymaterial.Thediseaseisendemicinseveralpartsofworld.InIndia,itisseenmoreofteninnorthernthaninthesouthernparts.Biopsyshowsinfiltrationofsubmucosawithplasmacells,lymphocytes,eosinophils,Mikuliczcells&Russellbodies.Thelattertwoarediagnosticfeaturesofthedisease.Thediseasestartsinthenose&extendstonasopharynx,oropharynx,larynx,trachea&bronchi.Modeofinfectionisunknown.Bothsexesofanyagemaybeaffected.
78.Cauliflowerearisdueto? a)Hematoma b)Carcinoma c)Fungalinfection d)Herpes CorrectAnswer-AAns.is'a'i.e.,HematomaHematomaoftheauricleItisthecollectionofbloodbetweentheauricularcartilageanditsperichondrium.Itusuallyoccursduetoblunttraumaandoftenseeninboxers,wrestlersandrugbyplayers,thereforeitisalsocalledBoxer'sear.Extravasatedbloodmayclotandthenorganise,resultingintypicaldeformitycalled,Cauliflowerear.Ifhaematomagetsinfected,severeperichondritismaysetin.
79.Fowlsmellingeardischargewith presenceofpalegranulationtissueinearinanadolescentboyissuggestiveof? a)Cholesteatoma b)Exostosis c)Otomycosis d)Malignantotitisexterna CorrectAnswer-AAns.is'a'i.e.,CholesteatomaFowlsmellingeardischargewithpresenceofgranulationtissueinearinadolescentboyissuggestivechronicsuppurativeotitsmediaoftheunsafetype(atticoantraldisease).Suchpatientshaveunderlyingcholesteatomaalongwithevidenceofbonedestruction.Clinicalfeaturesofcholesteatoma/atticoantralCSOMOtorrhoea:-Scanty,foulsmellingdischargeduetobonedestruction.Hearingloss:-Initiallyconductiveduetodestructionofossicles.Latersensorineuralelementmaybeadded,whichresultsinmixedhearingloss.Bleeding:-Mayoccurfromgranulationorthepolypwhencleaningtheear.Tympanicmembraneshowposteriormarginaloratticperforation.Alsogranulationtissueandpolypsmaybepresentinear.
80.Complicationoftraumatodangerareaof face? a)Cavernoussinusinfection b)Meningitis c)Visualloss d)Lossofmemory CorrectAnswer-AAns.is'a'i,e.,CavernoussinusinfectionTheareaofupperlipandthelowerpartofnoseisthedangerareaofface.Itisduetothatthisareaisthecommonsiteofinfection.Thisareaisdrainedbyfacialveinwhichcommunicateswiththecavernoussinusthroughthesuperiorophthalmicveinandpterygoidvenousplexusthroughtheemissaryvein.Incaseofanyinfectionofthisareaitmayspreadtothecavernoussinuscausinginfectionand/orthrombosis.
81.Presenceofdeltasignoncontrast enhancedCTSCANsuggestspresenceof? a)LateralSinusthrombophlebitis b)Cholesteatoma c)Cerebellarabscess d)Mastoiditis CorrectAnswer-AAns.is'a'i.e.,LateralSinusthrombophlebitisLATERALSINUSTHROMBOPHLEBITIS(SIGMOIDSINUSTHROMBOSIS)Lateralorsigmoidsinusthrombophlebitisarisesfrominflammationintheadjacentmastoid.Itmayoccurasacomplicationof:? i. Acutecoalescentmastoiditis ii. CSOMandcholesteatoma ClinicalfeaturesHecticPicket-Fencetypeoffeverwithrigor.Headache,Progressiveanemiaandemaciation.Griesinger'ssign:-odemaovertheposteriorpartofmastoidduetothrombosisofmastoidemissaryveins.PapilloedemaTobey-Ayertest:-CompressionofveinonthethrombosedsideproducesnoeffectwhilecompressionofveinonhealthysideproducesrapidriseinCSFpressurewhichwillbeequaltobilateralcompressionofjugularveins.Crowe-Becktest:-Pressureonjugularveinofhealthysideproducesengorgementofretinalveins.Pressureonaffectedsidedoesnot
producesuchchange.TendernessalongjugularveinImagingstudiesContrast-enhancedCTscancanshowsinusthrombosisbytypicaldelta-sign.Itisatriangularareawithrimenhancement,andcentrallowdensityareaisseeninposteriorcranialfossaonaxialcuts.Delta-signmayalsobeseenoncontrastenhancedMRI.
82.Ostmannfatpadisrelatedto? a)Earlobule b)Buccalmucosa c)Eustachiantube d)Tipofnose CorrectAnswer-CAns.is'c'i.e.,EustachiantubeTherearesmallfatbodieslocatedinfermedialtoEustachiantube.ThesearecalledOstmannfatpads.Theyareimportantinnormalclosureofeustachiantubeandpreventingtransmissionofnasopharyngealpressuretomiddleear.ThesefatpadsareabsentinPatuloustubesyndrome.
83.Whichofthefollowingstructuresisnotat immediateriskoferosionbycholesteatoma? a)Longprocessofincus b)Fallopiancanalcontainingfacialnerve c)Horizontal/lateralsemicircularcanal d)Baseplateofstapes CorrectAnswer-DAns.is'd'i.e.,BaseplateofstapesCholesteatomahasthepropertytodestroythebonebyvirtueoftheenzymesreleasedbyit.Structuresimmediatelyattheriskoferosionare:- i. Longprocessofincus. ii. Fallopiancanalcontainingfacialnerve. iii. Horizontal/lateralsemicircularcanal
84.Whenthepatientfailstounderstand normalspeech,butcanunderstandshoutedoramplifiedspeechthehearingloss,istermed? a)Mildhearingloss b)Moderatehearingloss c)Severehearingloss d)Profoundhearingloss CorrectAnswer-CAns.is'c'i.e.,SeverehearinglossSeverehearinglossWhatisseverehearingloss?Onaverage,themostquietsoundsheardbypeoplewiththeirbettereararebetween70and95dB.Peoplewhosufferfromseverehearinglosswillbenefitfrompowerfulhearingaids,butoftentheyrelyheavilyonlip-readingevenwhentheyareusinghearingaids.Somealsousesignlanguage.
85.Mostcommonsiteforcarcinomapharynx infemalessufferingfromplummervinsonsyndromeis a)Postcricoidregion b)Posteriorwall c)Lateralwall d)Pyriformisfossa CorrectAnswer-AAns.is'a'i.e.,PostcricoidPlummer-VinsonsyndromePlummer-Vinsonsyndrome,alsoknownasBrown-Kelly-Patersonsyndromeorsederopenicdysphagia,seeninmiddleagededentulouswomen.TheplummerVinsionPatersonBrownKellySyndromeischaracterizedby:-DysphagiaChronicirondeficiencyanemiaAtrophicoralmucosaandglossitisBrittle,spoon-shapedfingernails(Koilonychia)Thecauseofdysphagiaisusuallyacervicalesophagealweb,butabnormalpharyngealandesophagealmotilitymayplayarole.Thesyndromecharactersticallyoccursinmiddleagededentulous(withoutteeth)women.Itisapremalignantlesion.Approximately10%ofpatientdevelopsquamouscellCaofesophagus,oralcavityorthehypopharynx.Asiron-deficiencyanemiaisacommonfinding,itisalsoknownassideropenicdysphagia.
Carcinomadevelopsinpost-cricoidregion.
86.Pyriformfossaissituatedin? a)Oropharynx b)Hypopharynx c)Nasopharynx d)Noneoftheabove CorrectAnswer-BAns.is'b'i.e.,HypopharynxPyriformfossaisapartoflaryngopharynx(hypopharynx)
87.Incisuraterminalisisbetween? a)Tragusandcruxofhelix b)Earlobuleandantihelix c)Antihelixandexternalauditorymeatus d)Tragusandearlobule CorrectAnswer-AAns.is'a'i.e.,TragusandcruxofhelixIncisuraternzinalisistheareabetweenthetragusandcrusofhelix
88.Graftformyringoplasty a)Temporalisfascia b)Iliacusfascia c)Colesfascia d)Ihotibialband CorrectAnswer-AAns.is'a'i.e.,TemporalisfasciaGraftmaterialusedformyringoplastyare: i. Temporalisfascia(mostcommon) ii. Tragalcartilage iii. Perichondriumfromthetragus iv. Vein
89.Whichofthefollowingisnotaderivative ofthemiddleearcleft? a)Semicircularcanal b)Mastoidaircell c)Tympaniccavity d)Eustachiantube CorrectAnswer-AAns.is'a'i.e.,SemicircularcanalThemiddle-earcleftinthetemporalboneincludes:? i. Eustachiantube ii. Themiddleear(tympaniccavity) iii. Adituswhichleadsposteriorlytothemastoidantrumandaircells.
90.
Exostosisduetorepetitiveexposuretocoldwateriscommoninwhichpartofthetemporalbone? a)Squamouspart b)Tympanicpart c)Ptreouspart d)Mastoidpart CorrectAnswer-BAns.is'b'i.e.,TympanicpartSurfer'searItisthecommonnameforanexostosisorabnormalbonegrowthwithintheexternalauditorycanal.Surfer'searisnotthesameasswimmer'sear,althoughinfectioncanresultasasideeffect.Irritationfromcoldwindandwaterexposurecausesthebonesurroundingtheearcanaltodeveloplumpsofnewbonygrowthwhichconstricttheearcanal.Theconditionissonamedduetoitsprevalenceamongcoldwatersurfers.Coldwatersurfersexperiencesurfer'searataboutsixtimestherateofwarmwatersurfers.Commonsiteforsurfer'searisexternalauditorycanal.TympanicpartofthetemporalboneisaUshapedcurvedbonyplatethatformsmostofthepartoftheexternalauditorycanal.Thusexostosisiscommoninthetympanicpartofthetemporalbone.Note:Partsoftemporalboneare:squamous,tympanic,styloid,petrous,andmastoid.
91.Ohgren'slinepassesfrom? a)Medialcanthustoangleofmandible b)Lateralcanthustoangleofmandible c)Medialcanthustomastoidprocess d)Lateralcanthustomastoidprocess CorrectAnswer-AAns.is'a'i.e.,Medialcanthustoangleofmandible
92.Passavantridge? a)Superiorconstrictorandpalatopharyngeus b)Inferiorconstrictorandpalatopharyngeus c)Superiorconstrictorandpalatoglossus d)Inferiorconstrictorandpalatoglossus CorrectAnswer-APassavantridgeNearthesuperiormarginofpharynx,afewfibresofsuperiorconstrictorblendwithabandofmusclefibresbelongingtothepalatopharyngeusmuscle.Thesefusedfibresformabandorringaroundtheposteriorwallandsidewallsofthenasopharyngealisthumus.Whenthesoftpalateiselevatedthismusclebandappearsasaridgeisknownaspassavant'sridge.
93.Rhinolithcancause a)Nasalobstruction b)Epistaxis c)Epiphora d)Alloftheabove CorrectAnswer-DArhinolithisacalculuspresentinthenasalcavity.Thewordisderivedfromtherootsrhino-and-lith,literallymeaning"nosestone".Arhinolithusuallyformsaroundthenucleusofasmallexogenousforeignbody,bloodclotorsecretionbyslowdepositionofcalciumandmagnesiumsalts.Overaperiodoftime,theygrowintolargeirregularmassesthatfillthenasalcavity.Theymaycausepressurenecrosisofthenasalseptumorlateralwallofnoseleadingtonasalobstruction,epistaxis,headache,sinusitisandepiphora.
94.Allofthefollowingaretrueabout malignantotitisexternaexcept: a)ESRisusedforfollowupaftertreatment b)Granulationtissuesareseenonsuperiorwalloftheexternal auditorycanal c)Severehearinglossisthechiefpresentingcomplaint d)Pseudomonasisthemostcommoncause CorrectAnswer-CAns.c.SeverehearinglossisthechiefpresentingcomplaintSeverehearinglossisnotthechiefpresentingcomplaintmalignantotitisexterna.MalignantOtitisExterna:Characterizedbygranulationtissueinexternalauditorycanalatthejunctionofboneandcartilage.MCorganismzPseudomonasaeruginosaESRisraised,usedforfollowupoftreatment
95.AllaretrueaboutRhinoscleroma,except ? a)Mikuliczcells b)Causedbyfungus c)MorecommoninNorthernarea d)Woodynose CorrectAnswer-BAns.is'b'i.e.,CausedbyfungusRhinoscleromaiscausedbyabacterium.RhinoscleromaThecausativeorganismisKlebsiellarhinoscleromatisorFrischbacillus,whichcanbeculturedfromthebiopsymaterial.Thediseaseisendemicinseveralpartsofworld.InIndia,itisseenmoreofteninnorthernthaninthesouthernparts.Biopsyshowsinfiltrationofsubmucosawithplasmacells,lymphocytes,eosinophils,Mikuliczcells&Russellbodies.Thelattertwoarediagnosticfeaturesofthedisease.Thediseasestartsinthenose&extendstonasopharynx,oropharynx,larynx,trachea&bronchi.Modeofinfectionisunknown.Bothsexesofanyagemaybeaffected.ClinicalfeaturesofrhinoscleromaThediseaserunsthroughthefollowingstages:?a.Atrophicstage:Itresemblesatrophicrhinitisandischaracterisedbyfoulsmellingpurulentnasaldischargeandcrusting.b.Granulomatousstage:Granulomatousnodulesforminnasalmucosa.Thereisalsosubdermalinfiltrationoflowerpartofexternalnoseandupperlipgivinga'woody'feel.Nodulesarepainlessand
non-ulcerative.c.Cicatricialstage:Thiscausesstenosisofnares,distortionofupperlip,adhesionsinthenose,nasopharynxandoropharynx.Theremaybesubglotticstenosiswithrespiratorydistress.Biopsyofrhinoscleromashowsinfiltrationofsubmucosawithplasmacells,lymphocytes,eosinophils,MikuliczcellsandRussellbodies.Thelattertwoarethediagnosticfeaturesofthedisease.TreatmentBothstreptomycin&tetracyclinearegiventogetherforminimumof4-6wks.Steroidcanbecombinedtoreducefibrosis.Surgicaltreatmentmayberequiredtoestablishtheairwayandcorrectnasaldeformity
96.Associatedwithobjectivetinnitus? a)Meinersdisease b)Acousticneuroma c)Earwax d)Glomustumor CorrectAnswer-DAns.is`d'i.e.,GlomustumorTinnitusTinnitusisringingsoundornoiseintheear.Thecharacteristicfeatureisthattheoriginofthissoundiswithinthepatient.Twotypesoftinnitushavebeendescribed:?a.SubjectiveI.OtologicII.Non-otologicImpactedwaxDiseaseofCNSFluidinthemiddleearAnaemiaAcuteandchronicotitismediaArteriosclerosisAbnormallypatenteustachiantubeHypertensionMeniere'sdiseaseHypotensionOtosclerosisHypoglycaemia
97.Whichdrugistobegiveninatruckdriver forrhinitis? a)Cetrezine b)Hydroxyzine c)Promethazine d)Buclizine CorrectAnswer-AAns.is'a'i.e.,Cetrezine
98.Schwartzesignseenin? a)GlomusJugulare b)Otosclerosis c)Meniere'sdiseases d)Acousticneuroma CorrectAnswer-BAns.is'b'i.e.,OtosclerosisSymptomsofotosclerosisHearingloss:-Bilateralconductivedeafnesswhichispainlessandprogressivewithinsidiousonset.Incochlearotosclerosissensorineuralhearinglossalsooccuralongwithconductivedeafness.Paracusiswillissii:-Anotoscleroticpatienthearsbetterinnoisythanquietsurroundings.Tinnitus:-Morecommonincochlearotosclerosis.Speech:-Monotonous,wellmodulatedsoftspeech.Vertigo:-isuncommon.SignsinotosclerosisTympanicmembraneisquitenormalandmobile.In10%ofcasesflamingo-pinkblushisseenthroughthetympanicmembranecalledasSchwartzesign.Varioustestsshowconductivehearingloss.TuningforktestsinotosclerosisAsotoscleroticpatientshaveconductivedeafness,thetuningforktestsresultswillbeasfollows:? 1. Rinnes:-Negative2. Webers:-Lateralizedtotheearwithgreaterconductiveloss.3. Absoluteboneconduction(ABC):-Normal(canbedecreasedin
cochlearotosclerosis). 4. Gellestest:-Nochangeinthehearingthroughboneconduction whenairpressureofearcanalisincreasedbySiegle'sspeculum.AudiometryinotosclerosisAudiometryisoneoftheimportanttoolsinevaluationofapatientofotosclerosis.Variousaudiometrictestsare:?1.Puretoneaudiometry 1. Showslossofairconduction,moreforlowerfrequencieswith characteristicrisingpattern.Boneconductionisnormal.Howeverinsomecases,thereisadipinboneconductioncurvewhichismaximumat2000Hz(2KHz)andiscalledtheCarhart'snotch.2.ImpedanceaudiometryImpedanceaudiometryshows:-TympanometryPatientwithearlydiseasemayshowtypeAtympanogram(becausemiddleearareationisnotaffected)ProgressivestapesfixationresultsinclassicalAstypetympanogram.Acoustic(stapedialreflex)Itisoneoftheearliestsignofotosclerosisandpreceedesthedevelopmentofairbonegap.Inearlystage,diphasicon-offpatternisseeninwhichthereisabriefincreaseincomplianceattheonsetandattheterminationofstimulusoccurs.Thisispathognomonicofotosclerosis.Inlaterstagethereflexisabsent.
99.Galle'stestisusedfor? a)Otosclerosis b)Juvenileangiofibroma c)Nasalpolyp d)None CorrectAnswer-AAns.is'a'i.e.,OtosclerosisGelle'stestItisaboneconductiontestandexaminestheeffectofincreasedairpressureinearcanalonhearing.Increasedairpressureinearcanal(bySiegle'sspeculum)pushesthetympanicmembraneandossiclesinwardswhichraisestheintralabyrinthinepressureandcausesimmobilityofbasilarmembraneanddecreasedhearing.However,ifearossiclesarealreadyfixedordisconnected,thepressurecannotbetransferedtoinnerearNochangeinhearinginthissituation.Baseofvibratingtuningforkisplacedonmastoidprocessandairpressureinearcanalincreased(bySiegle'sspeculum).Interpretationare:-PositiveGelle's(decreasedhearingonincreasedpressure)Normalorsensorineuralhearingloss.h)NegativeGelle's(Noeffectofpressurechangeinhearing)Disconnectedorfixedossicularchain.
100.Maculaisstimulatedby? a)Gravity b)Headpositionchange c)Linearacceleration d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveVestibularapparatus(Peripheralpartofvestibularsystem)Thevestibularapparatuswithintheinnereardetectsheadmotionandpositionandtransducesthisinformationtoaneuralsignal.Thevestibularapparatushasfollowingparts:-
101.Paranasalsinusespresentatbirth? a)Frontalandmaxillary b)Ethmoidandmaxillary c)Frontalandethmoid d)Sphenoidandethmoid CorrectAnswer-BAns.is'b'i.e.,EthmoidandmaxillaryMaxillarysinus4Developatbirth;completelydevelopat9yearsEthmoidalsinusDevelopatbirth;completelydevelopatlatepubertyFrontalsinusDevelopat2year;completelydevelopatlateadolescenceSpenoidsinusDevelopat3-5years;completelydevelopat12-15years
102.Mostcommonboneaffectedby otosclerosis a)Externalauditorycanal b)Bonylabyrinth c)Mastoidprocess d)None CorrectAnswer-BAns.is'b'i.e.,BonylabyrinthOtosclerosisisaprimarydiseaseofthebonylabyrinth.Thereisabnormalbonegrowththatcauseshearingloss.Thereisalteredboneremodeling.Normally,thetypicalhumanoticcapsuleremodelingrateisextremelylow.Inotosclerosis,normalinhibitionofboneremodelingislostresultinginfociofboneremodeling.Whenremodeledbonebridgesthestapediovestibularjoint,itfixatesthejointandimpedessoundtransmissionmanifestedasconductivehearingloss.Themostcommonsiteofdiseaseispromontoryintheregionoftheanteriormarginofovalwindow,andinadvancedcasesthestapesbecomeankylosedinpositionbyamassofnewspongybone.Othersites,whichmaybeinvolved,areroundwindowarea,stapedialfootplate,internalauditorycanal,andsemicircularcanal.
103.Bestviewfornasalbone? a)Lateral b)Towne's c)Cald-well d)Submentovertical CorrectAnswer-AAns.is'a'i.e.,Lateral
104.Lomard'stestisusedtodiagnosis? a)Conductivehearingloss b)Sensorineuralhearingloss c)Mixedhearingloss d)Non-organichearingloss CorrectAnswer-DAns.is'd'i.e.,Non-organichearingloss
105.Trueaboutserousotitismediaareall except? a)Alsocalledglueear b)Affectschoolgoingchildren c)TypeCtympanogram d)Fluidinmiddleear CorrectAnswer-CAns.is`c'i.e.,TypeCtympanogramSerousotitismediaSerousotitismedia(SOM)hasmanysynonyms:Serousotitismedia,otitismediawitheffusion,glueear,non-suppurativeotitismedia,mucoidotitismedia,silentotitismedia.SOMisaninsidiousconditioninwhichthereisthickorstickynon-purulentfluidbehindtheeardruminthemiddleear,butthereisnoearinfection,i.e.,effusionofmiddleearwithoutinfection.Fluidinthemiddleearissterile.SOMoccursmostcommonlyinschoolgoingchildrenandSOMisthecommonestcauseofchildhoodhearingloss.Etiopathogenesis1.EustachiantubedysfunctionEustachiantubedysfunction,coupledwithrecurrentupperrespiratorytractinfectionisthemostimportantfactorinthedevelopmentofSOM.Normallyeustachiantubehelpstodrainfluidstopreventthemfrombuildingupintheear.InEustachiantubedysfunction,itisunabletodrainthefluid.FollowingcancauseEustachiantubeblock:- 1. Respiratorytractinfection:-Adenoid,rhinitis,tonsillitis,sinusitis.2. Allergies3. Benignandmalignanttumorofnasopharynx.
2.UnresolvedotitismediaInadequateantibiotictherapyinacutesuppurativeotitismediamayinactivateinfectionbutfailstoresolveitcompletely.Lowgradeinfectionlingersonandactsasstimulusformucosatosecretemorefluid.ClinicalfeaturesUnlikechildrenwithanearinfection(ASOM),childrenwithSOMdonotactsick.oTheonlypresentingsymptommaybehearinglosswithfullnessinear.OtoscopicfindingofSOMAirbubblesonthesurfaceofeardrumFluidbehindtheeardrum.Dullnessoftheeardrumwhenalightisused,withlossoflightreflex.oEardrummayappearyellow,greyorbluishincolour.RetractedeardrumwithdecreasedmobilityTympanometryshowstypeBtympanogram.
106.Causeofmyringosclerosis? a)Genetic b)Grommetinsertion c)Otosclerosis d)None CorrectAnswer-BAns.is'b'i.e.,GrommetinsertionTvmpanosclerosisTympanosclerosisisaconditioninwhichthereiscalcificationoftissueintheeardrum(tympanicmembrane)andmiddleear.Tympanosclerosismaybeclassifiedas:- 1. Myringosclerosis:-Involvingonlythetympanicmembrane.2. Intratympanictympanosclerosis:-Involvingothermiddleearsites: ossicularchainor,rarely,themastoidcavity.Exactetiologyoftympanosclerosisisnotknown.Itmaybeanabnormalhealingprocessandmostcommonlyoccursincasesofserousotitismediaasacomplicationofventilationtube(gourmet)insertion.Characteristicchalkywhitepatchesareseenoninspectionoftheeardrum.Itisworthnotingthatcholesteatomamaylooksimilarbutthewhitenessappearsbehind,ratherthanin/onthetympanum.Otherwisetympanosclerosisisasymptomatic.Conductivehearinglossmayoccurinsomecases.
107.Delta-signisseenin? a)Petrositis b)Acutemastoiditis c)Sigmoidsinusthrombosis d)Glomustumor CorrectAnswer-CAns.is'c'i.e.,SigmoidsinusthrombosisContrast-enhancedCTscancanshowsinusthrombosisbytypicaldelta-sign.Itisatriangularareawithrimenhancement,andcentrallowdensityareaisseeninposteriorcranialfossaonaxialcuts.Delta-signmayalsobeseenoncontrastenhancedMRI.
108.Trismusisseenincommonly? a)Ludwigangina b)Quinsy c)Retropharyngealabscess d)Parapharyngealabscess CorrectAnswer-BAns.is'b'i.e.,QuinsyTrismusisinabilitytoopen-mouth.Normalopeningofmouthrangesbetween25-50mm.Anyvaluelessthanthisisknownastrismus(roughlytheopeningshouldpermitaminimumofthreefingerswheninsertedsideways).Causesofquinsyare:?A.CommoncausesInfectionaroundimpactedthirdmolorQuinsy(peritonsillarabscess)SubmucousfibrosisTMjointdysfunctionB.LesscommoncausesLudwingsanginaParotidglandinfectionandtumorsMalignantotitisexternaorfurncleinexternalauditorycanal.ParapharyngealandretropharyngealabscessCarcinomamandibleTetanusRadiationtherapyCarcinomacheckMalignanthyperthermiaComingtothequestion
Trismuscanoccurinallthegivenoptions.However,itismostcommonandmostcharacteristicofquinsy(amongthegivenoptions).
109.SNHLisseeninallexcept? a)Nailpatellasyndrome b)DistalRTA c)Battersyndrome d)Alportsyndrome e)None CorrectAnswer-EAns.is'e'i.e.NoneAllthegivenoptionsarecausesofsensorineuralhearingloss. Treachercollinsyndrome Congenitalcausesof Alport's SNHL syndrome Usher'ssyndrome Pendred Hurler'ssyndrome syndrome Michel'saplasia Klippelfeilsyndrome Crouzon's Mondini'sanomaly Type1(distal)Renal disease Schibe'sand tubularacidosis Barttersyndrome Alexander'sanomalies Jervell&langeNeilson Leopard LThl'sanomaly syndrome syndrome Michel'saplasia Biotinasedeficiency Refsum Nail-patellasyndrome Albinism syndrome Alstromsyndrome MELAS Waardenburg Brachio-oto-renal Trisomy13,15,21 syndrome (BOR)syndrome Fabrydisease Cockayne'ssyndrome
110.Redlineinpuretoneaudiometryisfor- a)Boneconduction b)Airconduction c)Rightear d)Leftear CorrectAnswer-CAns.is'c'i.e.,Rightear
111.Transversefractureofmaxillais? a)LeFort-1 b)LeFort-2 c)LeFort-3 d)Cranifacialdisruction CorrectAnswer-AAns.is'a'i.e.,LeFort-1Itisclassifiedinto3types:? 1. LeFortI(transverse)fracturerunsaboveandparalleltotheplate.It crosseslowerpartofnasalseptum,maxillaryantraandthepterygoidplates. 2. LeFortII(pyramidal)fracturepassesthroughtherootofnose, lacrimalbone,flooroforbit,upperpartofmaxillarysinusandpterygoidplates.Thisfracturehassomefeaturescommonwiththezygomaticfractures. 3. LeFortIII(craniofacialdysfunction).Thereiscompleteseparationof facialbonesfromthecranialbones.Thefracturelinepassesthroughrootofnose,ethmofrontaljunction,superiororbitalfissure,lateralwalloforbit,frontozygomaticandtemporozygomaticsuturesandtheupperpartofpterygoidplates.
112.Whichofthefollowinglaryngeal cartilageishyaline? a)Epiglottis b)Comiculate c)Cricoid d)Cuneiform CorrectAnswer-CAns.is'c'i.e.,Cricoid Hyalinecartilages Elasticcartilages(donotossify) Thyroidcartilage Epioglottis Cricoidcartilage Corniculate Basalpartofarytenoidcartilage CuneiformProcessesofarytenoid
113.Allofthefollowingcranialnervesare involvedinAcousticneuroma,except? a)Vagus b)Glossopharyngeal c)Oculomotor d)Facial CorrectAnswer-CAns.is'c'i.e.,OculomotorClinicalfeaturesofacousticneuromaTheclinicalfeaturesdependontheextentoftumorandinvolvedstructure:?WhentumorisstillconfinedtotheinternalauditorycanalCochleovestibularsymptomsaretheearliestsymptomsofacousticneuromawhentumourisstillconfinedtointernalauditorycanal.Thecommonestpresentingsymptomsareunilateraldeafnessortinnitus,oracombinationofboth.Hearinglossisretrocochlearsensorineuraltype.Thereismarkeddifficultyinunderstandingspeech,outofproportiontothepuretonehearingloss,acharacteristicfeatureofacousticneuroma.Vestibularsymptomsareimbalanceorunsteadiness.Truevertigoisveryrare.WhentumorextendsbeyondIACandinvolvesotherstructuresVhcranialnerve:-Itistheearliestnervetobeinvolved.Thereisreducedcornealsensitivityandlossofcornealreflexwhichistheearliestsignofacousticneuroma.Numbnessorparaesthesiaoffacemayoccur.InvolvementofVthnerveindicatesthattumorisroughly2.5cmindiameterandoccupiestheCPangle.VIPnerve:-Sensoryfibresoffacialnerveareinvolved.Thereishypoesthesiaofposteriormeatalwall(Hitzelberg'ssign),lossof
taste,andlossoflacrimationonSchirmer'stest.Motorfibresaremoreresistant.IXthandA'nerves:-Dysphagiaandhoarsenessduetopalatal,pharyngealandlaryngealparalysis.Brainstem:-Ataxia,weakness,numbnessofarms&legs,exaggeratedtendonreflexes.Cerebellum:-Ataxia,Dysdiadochokinesia,Nystagmus.DuetoraisedICT:-Headache,neusea,vomiting,diplopiaduetoVI'nerveinvolvement,andpapilloedema.
114.WaveIinbrain-stemresponse audiometryarisesfrom? a)Cochlearnerve b)Superiorolivarycomplex c)Laterallemniscus d)Inferiorcolliculus CorrectAnswer-AAns.is'a'i.e.,CochlearnerveBrainStemResponseAudiometry(BERA)Itisanon-invasiveprocedurewhichobjectivelyhelpstofindtheintegrityofcentralauditorypathwaythroughtheVIIInerve,ponsandmidbrain.Itisaccuratetowithin10or15dBofthepsychoacousticthereshold.ItisthemostreliableaudiologicalmethodofdifferentiatingbetweencochlearandRetrocochlearhearinglosses.Itisanobjectivetestandcanbedoneundersedation.Itisusedbothasascreeningtestandasadefinativehearingassessmenttestinchildren.Besttesttodetectdeafnessininfants(reliablyrecordedevenfromprematureinfantsof30weeksgestationalage)andmentallyretardedormalingeringsubjects.ItisalsousedforIdentificationofthesiteoflesioninRetrocochlearpathologiesandtodiagnosebrainstempathologye.g.multiplesclerosisorpontinetumor.WavesofBERAInanormalperson,7wavesareproducedinfirst10miliseconds.Thefirst,thirdandfifthwavesaremoststableandareusedinmeasurements.Siteoforiginofwavesare:-WaveIDistalpartofEighthnerveWaveIIProximal,partofEighthcranialnerve
WaveIIICochlearnucleusWaveIVSuperiorolivarycomplexWaveVLateralleminiscusWaveVI&VIIInferiorcolliculus
115.Siteofglomusjugulare? a)Epitympanum b)Hypotympanum c)Mesotympanum d)Internalear CorrectAnswer-BAns.is'b'i.e.,HypotympanumGlomustumorGlomustumoristhemostcommonbenigntumorofmiddleear.Itarisesfromtheglomusbodies,thereforenamedGlomustumor.Itiswellrecognisedthatglomustumorsarisefromparaganglions,whicharenormallyoccuringstructuresusuallyfoundincloseassociationwithsympatheticganglionsalongtheaortaanditsmainbranches.Thechiefcells(paraganglioniccells)oftheparaganglionsareofneuralcrestoriginandarecomponentsofthediffuseneuroendocrinesystem(DNES).Theseparaganglioniccellsarederivedfromembryonicneuroepithelium(neuralcrest).Glomustumorsarealsoreferredtoaschemodectomasornonchromaffinparagangliomas.Therearetwotypesofglomustumors:-GlomusjugulareTheseglomustumorsarisefromthedomeoftheinternaljugularveininthehypotympanumandjugularforamen.InjugularforamentheycaninvadeIXtoXIIcranialnerves.GlomustympanicumTheyarisefromthepromontoryofthemiddleearalongthecourse
ofthetympanicbranchoftheIXthcranialnerve.Althoughrare,glomustumorsarethemostcommontumorofthemiddleearandaresecondtoacousticneuroma(vestibularschwannoma)asthemostcommontumorofthetemporalbone.Itismorecommoninfemaleswithfemaletomaleratioof3-6:1.Glomusjugularetumorshavealsobeennotedtobemorecommonontheleftside,especiallyinfemales.oMosttumorsoccurinpatient40-60years.Multicentrictumorsarefoundin3-10%ofsporadiccasesandin25-50%offamilialcases.
116.Frey'ssyndromeiscausedby? a)Posttraumaticnervefibresoffacialnervewithparasympathetic ofauriculotemporalnerve b)Greaterauricularwithauriculotemporalnerve c)Facialnervewithgreaterauricularnerve d)None CorrectAnswer-AAns.is'a'i.e.,PosttraumaticnervefibresoffacialnervewithparasympatheticofauriculotemporalnerveFrey'ssyndrome(gustatorysweating)GustatorysweatingorFrey'ssyndromeinvolvespost-parotidectomyfacialsweatingandskinflushingwhileeating.Thesymptomsusuallyoccurseveralmonthsorevenyearsafterparotidsurgery.Thelikelypathophysiologyisaberrantregenerationofpostganglionicsecretomotorparasympatheticnervefibres(originatingfromtheoticganglion)misdirectedthroughseveralaxonalsheathsofpost-ganglionicsympatheticfibresfeedingthesweatglands.Thesesympatheticfibresaretothesweatglandsoftheskininthedissectedfield.Thefrey'ssyndromeislikelyduetoinjurytoauriculotemporalnervewithfaultyregeneration,thereforeFrey'ssyndromeisalsoknownasAuriculotemporalsyndrome.AvariantofFrey'ssyndromeinwhichthereisgustatoryfacialflushingbutnotsweating,occursfollowingfacialparalysisduetofaultyregenerationfollowinginjurytothefacialnerve.So,Frey'ssyndromeisnotlimitedtoparotidsurgerywithinjurytoauriculotemporalnerve.
117.Killionsincisionisusedfor? a)Septoplasty b)SMR c)Proofpuncture d)Modifiedradicalmastoidectomy CorrectAnswer-AAns.is'a'i.e.,SeptoplastyTechniqueofseptoplasty1.Infiltratetheseptumwith1%lignocainewithadrenaline1:100,000.2.Incasesofdeviatedseptum,makeaslightlycurvilinearincision,2-3mmabovethecaudalendofseptalcartilageontheconcaveside(Killian'sincision).Incaseofcaudaldislocation,atransfixionorhemitransfixion(Freer's)incisionismade.3.Raisemucoperichondrial/mucoperiostealflapononesideonly.4.Separateseptalcartilagefromthevomerandethmoidplateandraisemucoperiostealflapontheoppositesideofseptum.5.Removemaxillarycresttorealigntheseptalcartilage.6.Correctthebonyseptumbyremovingthedeformedparts.Deformedseptalcartilageiscorrectedbyvariousmethods,suchas:ScoringontheconcavesideCross-hatchingormorselizingShavingWedgeexcisionFurthermanipulationslikerealignmentofnasalspine,separationofseptalcartilagefromupperlateralcartilages,implantationofcartilagestripinthecolumellaorthedorsumofnosemayberequired.7.Trans-septalsuturesareputtocoaptmucoperichondrialflaps.
7.Trans-septalsuturesareputtocoaptmucoperichondrialflaps.8.Nasalpack.
118.Turbanepiglottisisseenin? a)TB b)Leprosy c)Laryngealpapilloma d)Epiglottitis CorrectAnswer-AAns.is'a'i.e.,TBTubercularlarvn_gitisTubercularlaryngitisisalmostalwayssecondarytopulmonarylesions,mostlyaffectingmalesinmiddleage(20-40years).Diseaseaffectstheposteriorthirdoflarynxmorecommonlythananteriorpart.Thepartsaffectedindescendingorderoffrequencyare:-i)Interarytenoidfold,ii)Ventricularband,iii)Vocalcords,iv)EpiglottisClinicalfeaturesWeaknessofvoicewithperiodsofaphoniaearliestsymptoms.oHoarsness,cough,dysphagia(odynophagia)ReferredotalgiaLaryngealexaminationinTBlaryngitisHyperaemiaofthevocalcordinitswholeextentorconfinedtoposteriorpartwithimpairmentofadductionisthefirstsign.Swellingintheinterarytenoidregiongivingamammilatedappearance.Ulcerationofvocalcordgivingmouse-nibbledappearance.Superficialraggedulcerationonthearytenoidsandinterarytenoidregion.Granulationtissueininterarytenoidregionorvocalprocessofarytenoid.Pseudoedemaoftheepiglottis"turbanepiglottis".
Swellingofventricularbandsandaryepiglotticfolds.Markedpallorofsurroundingmucosa.
119.
MostcommonpartoflarynxinvolvedinTB? a)Anterior b)Posterior c)Middle d)Anywhere CorrectAnswer-BAns.is'b'i.e.,PosteriorEssentialotolaryngology2"d/ep.1139]Diseaseaffectstheposteriorthirdoflarynxmorecommonlythananteriorpart.Thepartsaffectedindescendingorderoffrequencyare:-i)Interarytenoidfold,ii)Ventricularband,iii)Vocalcords,iv)Epiglottis.
120.MostcommoncauseofASOMis? a)Meningococci b)Pneumococci c)Hinfluenzae d)Moraxella CorrectAnswer-BAns.is'b'i.e.,PneumococciASOMisanacuteinflammationofmiddleearcleftcausedbypyogenicorganism.ItisworthnotingthatASOMistheinfectionofmiddleearcleft,i.e.,middleear(tympaniccavity),Eustachiantube,Attic,Aditus,antrumandmastoidaircells.ASOMisespeciallycommonininfantsandchildren.MostofthetimeASOMusuallyfollowsrespiratorytractinfections(i.e.,acutetonsillitis,commoncoldorinfluenza)andtheinfectiontravelupbytheeustachiantubetothemiddleear.Themostcommoncausativeorganismisstreptococcuspneumoniae.OthercommonorganismsareH.influenzaeandMoraxellacatarrhalis.Lesscommoncausativeorganismsarestreptococcuspyogenes,staphylococcusaureusandE.coli.
121.Defectivefunctionofwhichofthe followingcauseshyperacusis? a)VIIInerve b)7thnerve c)Stapediusmuscles d)Anyoftheabove CorrectAnswer-DAns.is'd'i.e.,AnyoftheaboveHyperacusisHyperacusisishearingnormalvoiceaslouder.Theprotectivemechanismsanormalearemploystominimizetheharmfuleffectsofloudnoisearemalfunctioninginhyperacusis.So,noisemayseemtooloudevenwithhearingprotection.Thereissomespeculationthattheefferentportionoftheauditorynerveisselectivelydamagedwhilethehaircellsthatallowustohearpuretonesinanaudiometricevaluationremainsintact.Somehavesaiditinvolvesdirectmalfunctionoffacialnerve;asaresult,thestapediusmuscleisunabletodampensound.
122.ParanasalpolypCTview? a)Corona! b)Axial c)Sagital d)3D CorrectAnswer-AAns.is'a'i.e.,CoronalBothcoronalandaxialviewareused,butcoronalviewsarebesttostudyparanasalsinuspolyps.
123.Valleculasignisseenin? a)TBlaryngitis b)Vocalnodule c)Invertedpapilloma d)Acuteepiglottitis CorrectAnswer-DAns.is'd'i.e.,AcuteepiglottitisTherearetwoimportantradiologicalsignsinacuteepiglottitis:? 1. Thumbsign2. Volleculasign
124.Mostcommoncauseofotomycosis? a)Histoplasma b)Rhinosporidium c)Aspergillus d)Actinomyces CorrectAnswer-CAns.is'c'i.e.,AspergillusOtomycosisOtomycosis,alsocalledacutefungalotitisexterna,describesafungaloryeastinfectionoftheexternalauditorymeatus.SaprophyticfungipotentiallyresidingintheearcanalincludeAspergillus,Candidaalbicans,Phycomycetes,Rhizopus,Actinomyces,andPenicillium.Undercertainconditionsofincreasedheat,humidity,glucoseconcentration(diabetes),immunosuppression,oroveruseofsystemicortopicalantibioticsandsteroids,thesesaprophyticfungicanbecomepathogenic.Aspergillusnigeraccountsfor90%ofotomycosisinfections.Othercommonorganismsarecandidaalbicans(2"amostcommon)andAspergillusfumigatus.LesscommonorganismsarePhycomycetes,Rhizopus,ActinomycesandPenicillium
125.Facialnervepalsycanbecausedby? a)Cholesteatoma b)Multiplesclerosis c)Mastoidectomy d)Alloftheabove CorrectAnswer-DAns.is'd''i.e.,AlloftheaboveCausesoffacialparalysisCentral:-Brainabscess,pontineglioma,Polio,multiplesclerosisIntracranialpart(cerebellopontineangle):-Acousticneuroma,meningioma,congenitalcholesteatoma,metastaticcarcinoma,meningitisIntratemporalpart:-Idiopathic:-Bell'spalsy,Melkersson'ssyndromeInfections:-ASOM,CSOM,Herpeszosteroticus,malignantotitisexternaTrauma:-Surgical(mastoidectomy,stapedectomy),accidental(fracturesoftemporalbone)Neoplasms:-Malignanciesofexternalandmiddleear,glomusjugular,facialnerveneuroma,metastasis(frombreast,lungetc).Extracranialpart:-MalignanciesorsurgeryorinjurytoparotidglandSystemicdiseases:-Diabetes,hypothyroidism,uremia,PAN,Sarcoidosis(Heerfordt'ssyndrome),leprosy,leukaemia,demyelinatingdisease
126.PredisposingfactorforNasalmyiasis? a)Allergicrhinitis b)Vasomotorrhinitis c)Atrophicrhinitis d)Rhinitismedicomentosa CorrectAnswer-CAns.is'c'i.e.,AtrophicrhinitisNasalmyiasis(Maggotsinnose)Itresultsfromthepresenceofovaoffliesparticularlychrysomiaspeciesinthenosewhichproduceulcerationanddestructionofnasalstructure.Mostlyseeninatrophicrhinitiswhenthemucosabecomesinsensitivetoflieslayingeggsinside.ClinicalfeaturesInitialsymptoms(3-4daysmaggots):-Intenseirritation,sneezing,headache,bloodstaineddisharge,lacrimation.oLater:-Maggotsmaycrawloutofnoseandthereisfoulsmell.ComplicationsDestructionofnose,sinuses,softtissuesofface,palateandeyeball.Fistulaeinnoseandpalate.Deathoccursduetomeningitis.TreatmentChloroformwaterorvapormustbeinstilledinordertoanaesthetizeorkillthemaggotsandsoreleasetheirgripfromtheskin.
127.
Glomustumorinvadingtheverticalpartofcarotidcanal.Itis? a)TypeB b)TypeCI c)TypeC2 d)TypeC3 CorrectAnswer-CAns.is`c'i.e.,TypeC2
128.Unilateralsensorineuralhearingloss mayoccurin? a)Coronavirus b)Mumps c)Pertussis d)Rotavirus CorrectAnswer-BAns.is'b'i.e.,Mumps Infectionsoflabyrinth Acquiredcauses SystemicdisordersTraumatolabyrinthor ofSNHL (DM,Hypothyroidism, VIIInerve(Head Presbycusis Renaldisorders) injury,surgeryetc) Meniere'sdisease Multiplesclerosis Noiseinducedhearing Acousticneuroma Smoking&Alcoholismloss Suddenhearing Ototoxicdrugs loss
129. Fractureofwhichofthefollowingbone causesleakageofcerebrospinalfluid throughear? a)Mastoidprocess b)Petroustemporal c)Ethmoidplate d)Cribriformplate CorrectAnswer-BAns.is`b'i.e.,PetroustemporalCSFotorrheaCSFotorrhea,i.e.,leakageofcerebrospinalfluidthroughearstructure,isararebutpotentiallylifethreateningsituationthatrequiresrapidintervention.Theunderlyingetiologyofspinalfluidleakthroughtemporalboneisaviolationofthebonyandmeningealbarriersthatseparatethesubarachoidspacefromthemiddleearandmastoid.Thismeansthatadefectmustexistnotonlyinthebone,butalsointheduramatter.CausesofCSFotorrheaare:?1.Congenital:-Defectinoticcapsule.2.Acquired:-Morecommonthancongenitalandcauseare:- 1. Surgery:-Post-operativeleakageisthemostcommoncauseofCSF otorrhea.Surgicalcausesareacousticneuromaremoval,skullbasesurgeriesandsometimesmastoidsurgery. 2. Trauma:-FractureofpetrouspartoftemporalcanleadtoCSF otorrhea. 3. Infection
3.Spontaneous:-Itiswithoutanobviousantecedentpathology.Theremaybesomedefectinthetemporalbone.
130.Whichofthefollowingisapneumatic bone? a)Parietalbone b)Occipitalbone c)Mastoidprocess d)None CorrectAnswer-CAns.is'c'i.e.,MastoidprocessPneumaticbonesareonewhichcontainlargeairspaceslinedbyepithelium.Examples:maxilla,sphenoid,ethmoid,etc.Theymaketheskulllightinweight,helpinresonanceofvoice,andactasairconditioningchambersfortheinspiredair.Abonethatisholloworcontainsmanyaircellscalledaspenumaticbone.Examplesaremastoidprocessoftemporalbone,maxilla,ethmoid,sphlenoidandfrontalbone.Verysimpletorememberlast4asallfourparansalsinusesarepneumaticbones.
131.Mulberrynasalmucosaisseenin? a)Lupusvulgaris b)Vasomotorrhinitis c)Atrophicrhinitis d)None CorrectAnswer-BAns.is'b'i.e.,VasomotorrhinitisVasomotorisanonallergicconditionthatinvolvesaconstantrunnynose,sneezingandnasalcongestion,i.e.,thenoseisstuffyorrunnyforreasonsotherthanallergiesandinfections.Theexactetiologyisunknown,buttriggersincludeemotions,odors,poorairquality,spicyfoods,andmedicationsideeffects.Pathogenesisinclude:-ParasympatheticoveractivityHyperactivenasalmucosatoseveralnon-specificstimuliespeciallyinwomenof20-40years.Symptomsofvasomotorrhinitisincludeexcessiveclearrhinorrhoea,nasalobstruction/congestion,irritation,paroxysmalsneezingandpost-nasaldrip.Nasalmucosaishypertrophied&congested;andmucosaofturbinatesmaygivemulberrylikeappearanceandispaletoduskyredincolour.Complicationsofvasomotorrhinitisincludehypertrophicrhinitis&sinusitis,andnasalpolyp.Mulberrynasalmucosaisalsoseeninchronichypertrophicrhinitis
132.AllareseeninSamterstriadexcept? a)Asthma b)Nasalpolyp c)Bacterialinfection d)Aspirinsensitivity CorrectAnswer-CAns.is'c'i.e.,BacterialinfectionSamter'striadSamter'striadisamedicalconditionconsistingofasthma,aspirinsensitivity,andnasaL'ethmoidalpolyposis.Itoccursinmiddleage(twentiesandthirtiesarethemostcommononsettimes)andmaynotincludeanyallergies.oMostcommonly,thefirstsymptomisrhinitis.Thedisordertypicallyprogesestoasthma,thenpolyposis,withaspirinsensitivitycominglast.Theaspirinreactioncanbesevere,includinganasthmaattack,anaphylaxis,andurticariainsomecases.PatientstypicallyreacttootherNSAIDSsuchasibuprofen,althoughparacetamolisgenerallyconsideredsafe.Anosmia(lackofsmell)isalsotypical,astheinflammationreachestheolfactoryreceptorsinthenose.
133.Objectivetestinadenoids a)Posteriorrhinoscopy b)Anteriorrhinoscopy c)Manualpalpation d)Alloftheabove CorrectAnswer-AAns.is'a'i.e.,Posteriorrhinoscopy
134.Mostcommonsinustobeinvolvedin acutesinusitis? a)Ethmoid b)Maxillary c)Sphenoid d)Frontal CorrectAnswer-BAns.is'b'i.e.,Maxillary Mostcommonsinusaffectedby Maxillary sinusitisoverallMostcommonsinusaffectedin Maxillary adultMostcommonsinusaffectedin Ethmoid childrenLeastcommonsinusaffected Sphenoid Sinusesinvolvedinorderof Maxillary>Frontal>Ethmoid> frequency Sphenoid
135.Queckenstedtestisdonefor? a)Glomustumor b)CSFrhinorrhea c)Otosclerosis d)Acousticneuroma CorrectAnswer-BAns.is'b'i.e.,CSFrhinorrheaDetectionofCSFLeak1.BiochemicaltestsConcentrationsofGlucosearehigherinCSFthaninnasaldischarge.Glucosevalue>30-40mg%andproteinvalue<100mg%(max200mg%)supportadiagnosisofCSFleak.PresenceofI3,transferrinisthemostdefinitivetestfordetectionofCSFandI32transferrinassayisthetestofchoicewhenaconfirmatorytestisneeded,becauseofhighsensitivityaswellasspecificity.I3-traceprotein(prostaglandinDsynthase)isalsoused,howeveritisnonspecificasitisalsopresentinhumantestes,heartandseroma.2.BasicclinicaltestsTissuetest(Handkerchieftest):-Unlikenasalmucous,CSFdoesnotcauseatissuetostiffen.Filterpapertest:-SampleofnasaldischargeonafilterpaperexhibitsalightCSFborderandadarkcentralareaofblood,i.e.,doubleringsignorhalosign.Queckenstedtest:-CompressionofthejugularveinleastoincreasedCSFleakduetoincreaseinICP.Rhinoscopy:-VisualizationofCSFleakfromparanasalsinus.
3.CSFtracersIntrathecalfluoresceindyeadminstration,radionuclidecisternography,CTcisternography.
136.Bilateralrecurrentlaryngealnervepalsy isseeninallexcept? a)Thyroidcarcinoma b)Lymphadenopathy c)Thyroidsurgery d)Aorticaneurysm CorrectAnswer-DAns.is'd'i.e.,Aorticaneurysm
137.Mostcommoncauseofsinger'snodule is? a)Infection b)Allergy c)Vocalabuse d)None CorrectAnswer-CAns.is'c'i.e.,VocalabuseVocalnodule(singer'sorscreamer'snodule)Vocalnodulearebenignnoneoplasticgrowthonfreeedgeofboththevocalcordsatthejunctionofanterior1/3withposterior2/3.Thisareaisparticularlyvulnerabletotraumaasthisistheareaofmaximumvibrationofthecord.Themajorcauseisvoiceabuse,thereforeitismostcommonlyseeninsingers,actors,teachers,andhowkers.Hoarsenessisthemostcommonsymptom.Vocalfatigueandpaininneckonprolongedphonationareothersymptoms.TreatmentEarlycasesofvocalnodulescanbetreatedconservativelybyeducatingthepatientinproperuseofvoice.Manynodulesespeciallyinchildren,disappearwiththistreatment.Surgeryisrequiredforlargenodulesorlongstandingnodulesinadults.Microscopic(micorlaryngoscopic)excisionisthetreatmentofchoice.
138.Mucoperichondrialflapinseptoplastyis madeon? a)Alarcartilage b)Septalcartilage c)Maxillaryspine d)Sphenoidspine CorrectAnswer-BAns.is'b'i.e.,SeptalcartilageStepsinseptoplastyAunilateralincisionismadeinthemucoperichodrialflapatthelowerborderofseptalcartilageontheleftsideinrighthandedpersons.Themucoperichondrialflapiselevatedononesidemakingananteriortunnel.Anotherincisionismadeinthemucoperiosteumoverthenasalspineonthesameside,elevatingthemucoperiosteumfromnasalspineonbothsidesthusmakingtwomoretunnelscalledinferiortunnels.Twotunnelsarejoinedbysharpdissection.Septalcartilageisthenseparatedfromvomero-ethmoidbonesposteriorlyandnasalspineinferiorly.Maxillarycrestisremovedtorealignseptalcartilage.Bonyseptaldeformityiscorrectedbyremovingdeformedpart.Deformedseptalcartilageiscorrected.Trans-septalsuturesareputtocoaptmucoperichondrialflaps.Nasalpackisput.Thus(comingtoquestion)Mucoperichondrialflap(andtunnel)aremadeonseptalcartilage.Mucoperiostealflap(andtunnels)aremadeonnasalspine.
139.Allaremajorsymptomsofsinusitis except? a)Nasalbluckage b)Facialcongertion c)Nasalcongestion d)Halitosis CorrectAnswer-DAns.is'd'i.e.,HalitosisTheclinicalsymptomsofacutesinusitishavebeenclassifiedintomajorandminor Major Minor Facialpainorpressure HeadachePurulentnasal Cough discharge Fatigue Fever Halitosis Nasalcongestion Dentalpain Nasalobstruction Earpainor HyposmiaorAnosmia pressureFacialcongestionorfullness
140.Laryngitissiccaisassociatedwith? a)Rhinosporidium b)M.leprae c)Klebsiellaazaenae d)Klebsiellarhinoscleromatosis CorrectAnswer-CAns.is'c'i.e.,KlebsiellaazaenaeLaryngitissicca(Atrophiclaryngitisorlaryngitisatrophica)Itisarareentitycharacterizedbyatrophicchangesintherespiratorymucosawithlossofthemucus-producingglands.Itisusuallyassociatedwithatrophicrhinitisandpharyngitiscausedbyklebsiellaozaenae.Themostcommonsitesinvolvedinlarynxarethefalsecords(vestibularfolds),theposteriorregionandthesubglotticregion.Morecommoninwomen.ClinicalfeaturesIrritablecoughandhoarsenessExcessivecrustsformationwhicharesometimesbloodstained(hemorrhagic)withfoulodour.Crustsarethemostimportantdiagnosticfeature.TreatmentEliminationofcausativefactorsandhumidification.Laryngealsprayswithglucoseinglycerineoroilofpinehelpsincrustremoval.Expectorantscontainingammoniumchlorideoriodidesalsohelptoloosenthecrust.Microlaryngoscopicremovalofcrustinlaryngitissiccaisthenewmodalityoftreatment.
141.Ossiclesofmiddleearareresponsible forwhichofthefollowing? a)Amplificationofsoundintensity b)Reductionofsoundintensity c)Protectingtheinnerear d)Reductionofimpedancetosoundtransmission CorrectAnswer-DAns.is'd'i.e.,ReductionofimpedancetosoundtransmissionTheearcanal(auditorycanal)actsasaresonator,i.e.itresonates(amplifiesfrequencies)between2000and5000(average3000)cyclespersecondandthereforemostenergywillbetransmittedtothecochleainthesefrequencies.However,ifthissoundenergyhitstheinnerearfluiddirectlymostoftheenergywouldbereflected,resultinginhearingloss(asallthesoundwaveisreflectedandnothingisatransmittedaselectricalimpulse).Therefore,thereisaneedforatransformermechanism,aneedthatisfullfilledbymiddleearmiddleearconvertssoundofgreateramplitudebutlesserforcetothatoflesseramplitudebutgreaterforce.Thisfunctionofthemiddleeariscalledimpedencematchingmechanismorthetransformeraction.
142.Whichstructurepreventsspreadof infectionformmiddleeartobrain? a)Tegmentympani b)Cribriformplate c)Fundustympani d)Petrousapex CorrectAnswer-AAns.is'a'i.e.,TegmentympaniTegmentympani(formingtheroofofmiddleearcavity)separatesthetympaniccavityfrommiddlecranialfossa.
143.Inotosclerosis,whichismostaffected? a)Ovalwindow b)Roundwindow c)Footplateofstapes d)Utricle CorrectAnswer-AAns.is'a'i.e.,OvalwindowThemostcommonsiteofdiseaseispromontoryintheregionoftheanteriormarginofovalwindow,andinadvancedcasesthestapesbecomeankylosedinpositionbyamassofnewspongybone.Whyisitso?Thisareaisinvolvedmostcommonlybecauseinthisareaislocatedthefissulaantefenestram,avestigialstructurewhichfrequentlycontainscartilaginousremnantsandwhichisparticularlypronetootoscleroticchanges.MostcommontypeofotosclerosisStapedialotosclerosisMostcommonsiteofotosclerosisFissulaantefenestram(i.e,justinfrontofovalwindow)MostcommonsiteforStapedialotosclerosisFissulaantefenestram(i.e,justinfrontofovalwindow)MostcommonsiteforcochlearotosclerosisRoundwindow
144.TrueregardinglaryngealTBis? a)Commonlyinvolvesanterior2/3rdofvocalcord b)Mouse-nibbledvocalcord c)Morecommoninmales d)Noneoftheabove CorrectAnswer-BAns.is'b'i.e.,Mouse-nibbledvocalcord
145.Mostcommoncauseofacutetonsilitis? a)Streptococcuspneumoniae b)H.Influenza c)13-hemolyticstreptococci d)Staphylococcusaureus CorrectAnswer-CAns.is'c'i.e.,13-hemolyticstreptococciTonsilsfrequentlyserveasthesiteofacuteinfection,whichcausesacutetonsillitis.Tonsillitisisparticularlycommoninchildren,especiallyinschoolgoingagegroup.However,itcanoccurinadultalso.Virusinitiatesanacutetonsillitisattackandpredisposestobacterialinfection.8-hemolyticstreptococcusisthemostcommonorganismcausingacutetonsillitis.Otherbacteriacausingacutetonsillitisarestaphylococcus,hemophilusandpneumococcus.
146.Treatmentofchoicefornasopharyngeal carcinomais? a)Surgery b)Radiotherapy c)Surgery&radiotherapy d)Chemotherapy CorrectAnswer-BAns.is'b'i.e.,RadiotherapyTreatmentofnasopharyngealcarcinomaIrradiationistreatmentofchoice(externalradiotherapy).Radicalneckdissectionisrequiredforpersistentnodeswhenprimaryhasbeencontrolledandinpostradiationcervicalmetastasis.Systemicchemotherapyisusedaspalliationfordistantmetastasesorradiationfailure.Foradvancedstages(stageIII&IV),thecureratecanbedoubledwhenchemotherapyiscombinedwithradiotherapy.
147.Coneoflightfocusesonwhichquadrant oftympanicmembrane? a)Anteroinferior b)Posteroinferior c)Anterosuperior d)Posterosuperior CorrectAnswer-AAns.is'a'i.e.,AnteroinferiorConeoflightSeeninanteroinferiorquadrantofthetympanicmembraneisactuallythereflectionofthelightprojectedintotheearcanaltoexamineit.Thispartreflectsitbecauseitistheonlypartoftympanicmembranethatisapproximatelyatrightanglestothemeatus.Thisdifferenceindifferentpartofthetympanicmembraneisduetothehandleofmalleuswhichpullsthetympanicmembraneandcausesittotentinside.Thus,thehandleofmalleuscausestentingandbecauseoftentingtheantero-inferiorquardrantisatrightanglestothemeatusandthusreflectsthelight(leadingtoconelight).
148.Hearinglossof65dB,whatisthegrade ofdeafness? a)Mild b)Moderate c)Severe d)Moderatelysevere CorrectAnswer-DAns.is'd'i.e.,Moderatelysevere
149.Vestibularfunctionisassessedby? a)Fistulatest b)Hallpikemanaeuver c)Calorictest d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,Alloftheabove
150.Blueeardrumisseenin? a)Serousotitismedia b)CSOM c)Perforation d)None CorrectAnswer-AAns.is'a'i.e.,SerousotitismediaAnyaccumulationoffluidbehindtympanicmembranecausesstructuralchangesintympanicmembranecausingittoappearblue,beitpus,bloodorserousfluid.Themostcommoncauseoffluidaccumulationinmiddleearisserousotitismediaorglueear(mostcommoncause)andhaemotympanum.Othercausesofbluetympanicmembraneareglomustumor,hemangiomaofmiddleear,andcholesterolgranuloma.
151.Peritonsillarabscessiscausedmost commonlyby? a)Streptococcuspneumoniae b)Staphylococcusaureus c)Betahemolyticstreptococcus d)H.influenzae CorrectAnswer-CAns.is'c'i.e.,BetahemolyticstreptococcusPeritonsillarabscess(Ouinsy)Quinsyconsistsofsuppurationoutsidethecapsuleintheareaaroundthecapsule.Thereiscollectionofpusbetweenthecapsuleoftonsilandthesuperiorconstrictormuscle,i.e.intheperitonsillararea.PeritonsillarabscessisacomplicationoftonsillitisandismostcommonlycausedbygroupAbeta-hemolyticstreptococcus.ClinicalfeaturesofQuinsyClinicalfeaturesaredividedinto:?General:Theyareduetosepticaemiaandresembleanyacuteinfection. 1. Theyincludefever(upto104?F),chillsandrigors,generalmalaise, bodyaches,headache,nauseaandconstipation. 2. Local:3. Severepaininthroat.Usuallyunilateral.4. Odynophagia.Itissomarkedthatthepatientcannotevenswallow hisownsalivawhichdribblesfromtheangleofhismouth.Patientisusuallydehydrated. 5. Muffledandthickspeech,oftencalled"Hotpotatovoice".6. Foulbreathduetosepsisintheoralcavityandpoorhygiene.
7. Ipsilateralearache.ThisisreferredpainviaCNIXwhichsupplies boththetonsilandtheear. 8. Trismusduetospasmofpterygoidmuscleswhichareinclose proximitytothesuperiorconstrictor.Examinationfindings 1. Thetonsil,pillarsandsoftpalateontheinvolvedsidearecongested andswollen.Tonsilitselfmaynotappearenlargedasitgetsburiedintheoedematouspillars. 2. Uvulaisswollenandoedematousandpushedtotheoppositeside.3. Bulgingofthesoftpalateandanteriorpillarabovethetonsil.4. Mucopusmaybeseencoveringthetonsillarregion.5. Cervicallymphadenopathyiscommonlyseen.Thisinvolves jugulodigastriclymphnodes. 6. Torticollis:Patientkeepsthenecktiltedtothesideofabscess. TreatmentofperitonsillarabscessIVfluidsAntibiotics:Highdosepenicllin.(ivbenzipenicillin)istheDOC.InpatientsallergictopenicillinerythromycinistheDOC.Incisionanddrainageperorally,iftheabscessdoesnotresolvedepitehighdoseofivantibioticsTonsillectomyisdone6weeksfollowinganattackofquinsy(intervaltonsillectomy).
152.Strawberryoppearanceisseenin? a)Lupusvulgarsis b)Rhinoscleroma c)Rhinosporidiosis d)Angiofibroma CorrectAnswer-CAns.is'c'i.e.,RhinosporidiosisRhinosporidiosisRhinosporidiosisisachronicgranulomatousinfectionofthemucousmembranethatusuallymanifestsasvascularfriablepolypsthatarisefromthenasalmucosa.TheetiologicalagentisRhinosporidiumseeberi.Rhinosporidiumseeberiisanaquaticbacterum(notafungus).Infectionusuallyresultsfromalocaltraumaticinoculationwiththeorganism.ItisseeninIndia,PakistanandSriLanka.InIndia,mostofthecasesareseeninSouthernstates.Infectionofthenoseandnasopharynxisobservedin70%ofpersonswithrhinosporidiosis;infectionofpalpebralconjunctivaorassociatedstructures(includinglacrimalapparatus)isobservedin15%ofcases.Otherstructuresofthemouthandupperairwaymaybesitesofdisease.Diseaseoftheskin,ear,genitalsandrectumhasalsobeendescribed.Rhinosporidiosisisaninfectionthattypicallylimitedtothemucosalepithelium.ThediseaseprogresswithlocalreplicationofRseeberiandassociatedhyperplasticgrowthofhosttissueandalocalizedimmuneresponse.ClinicalfeaturesofRhinosporidiosisRhinosporidiosispresentsassoftleafypolypoidalmass(softpolyp),whichispinktopurpleincolourstuddedwithwhitedots,i.e.strawberryappearance.Thisappearanceresultsfromsporangia,
whichisvisibleasgreyoryellowspotsinthevascularpolypoidmasses.Becausethepolypsarevascularandfriable,theybleedeasilyuponmanipulation.TreatmentThetreatmentofchoiceissurgicalexcision.Completeexcisionofmassisdonewithdiathermyknifeandcauterizationofbase.Dapsoneisbeingtriedfortreatingrhinosporidiosisbutwithlimitedsuccess.
153.Trueaboutcentralnystagmus? a)Changingdirection b)Notsuppressedbyopticfixation c)Horizontalorvertical d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveNystagmusNystagmusisrhythmicoscillatorymovementofeye.Nystagmushasfollowingcharacteristics:? 1. Rapid,2. Involuntary,3. Repetitive Nystagmusmaybe:? 1. Sidetoside(horizontalnystagmus)2. Upanddown(verticlenystagmus)3. Rotary Vestibularnystagmushastwocomponents,i.e.aslowandafast.Thedirectionofnystagmusisindicatedbythedirectionoffastcomponent.Vestibularnystagmusmaybe:? 1. Peripheral:-duetolesionoflabyrinthorVIIInerve.2. Central:-duetolesionofvestibularnuclei,brainstemorcerebellum. i.PeripheralnystagmusDiminshesorsuppresseswithgazefixation(opticfixation)EnhancesindarknessorbyuseofFrenzelglassesUnidirectionalfastcomponentDirectionistypicallyhorzonto-rotary,notpurelyhorizontalorrotary
andnotverticalDirectionisfixedtowardsundermostearPresentinoneheadpositionii.CentralnystagmusNotsuppressedbyopticfixationFastcomponentcanbeunidirectionalorbidirectionalCanbehorizontal,verticalorrotaryDirectionischangingPresentinmultipleheadpositions
154.Potatotumoris a)Rhinosporidiosis b)Hypertrophiedsebaceousgland c)Nosopharyngealangiofibroma d)Tubercularinfection CorrectAnswer-BAns.is'b'i.e.,HypertrophiedsebaceousglandRhinophyma(Potatotumor)Rhinophymaisabenigntumoroftipofnoseduetohypertrophyofsebaceousgland.Itiscausedbygranulomatousinfiltrationandoccursasacomplicationoflongstandingacnerosacea.Alcoholismismistakenlyattributedasacauseofthisdisease,butheavyalcoholconsumptiondoesaggravatethecondition.Theusualpresentationisduetocosmeticappearanceorobstruction.Treatmentofchoiceisdebulkingoftumorbycarbandioxidelaser.
155.Earlytonsillectomyisnotdonein? a)Thyroidstorm b)Suspectedmalignancy c)Peritonsillarabscess d)Rheumaticfever CorrectAnswer-AAns.is'a'i.e.,ThyroidstormUncotrolledsystemichypertensionisacontraindicationfortonsillectomy.InthyroidstormthereisdangerouslyhighBP.Contraindicationsoftonsillectomy 1. Haemoglobinlevellessthan10g%.2. Presenceofacuteinfectioninupperrespiratorytract,evenacute tonsillitis.Bleedingismoreinthepresenceofacuteinfection. 3. Childrenunder3yearsofage.Theyarepoorsurgicalrisks.4. Overtorsubmucouscleftpalate.5. Bleedingdisorders,e.g.leukaemia,purpura,aplasticanaemia, haemophilia. 6. Atthetimeofepidemicofpolio.7. Uncontrolledsystemicdisease,e.g.diabetes,cardiacdisease, hypertensionorasthma. 8. Tonsillectomyisavoidedduringtheperiodofmenses.
156.Mostcommoncauseofretropharyngeal abscessinadults? a)TB b)Toothextraction c)Tonsillitis d)Lymphadenitis CorrectAnswer-AAns.is'a'i.e.,TBAbscessininfants(acuteretropharyngealabscess)Mostcommonlyitresultsfromretropharyngeallymphadenitisduetoanupperrespiratorytractinfection.Treatmentisincisionanddrainage.Abscessinadults(chronicretropharyngealabscess)Ifanadultoranolderchildhasaretropharyngealinfectionitislikelytobeduetoatuberculousinfectionofthecervicalspine(cariesofcervicalspine).Sometimeitmaybesecondarytotuberculousinfectionofretropharyngeallymphnodes.Treatmentincludesincisionanddrainageofabscessalongwithfullcourseofantituberculartreatment.
157.Otosclerosisaffectswhichbone? a)Stapes b)Incus c)Malleus d)None CorrectAnswer-AAns.is'a'i.e.,StapesTypesofotosclerosisFollowingtypesofotosclerosishavebeendescribed:-1.FenesteralorstapedialotosclerosisItisthemostcommontype(80-90%)Thelesionstartsjustinfrontoftheovalwindowinanareacalledfissulaantefenestram"andcausesstapesfootplatefixationandconductivehearingloss.Hearinglossispurelymechanical.2.Cochlearotosclerosis(Retrofenestralotosclerosis)Whenpresent,itisalmostalwaysassociatedwithstapedial(fenestral)otosclerosis.Itinvolvesregionofroundwindoworotherareasintheoticcapsule.Itcausesmixedorsensorineuralhearinglosswhichisbelievedtobetoxicduetodiffusionofcytotoxicenzymesintothefluidofthemembranouslabyrinth(Incontrasttostapedialotosclerosis,wherethedeafnessispurelymechanicalandisconductive).Tinnitusismorecommonincochlearotosclerosis.3.HistologicotosclerosisThistypeofotosclerosisremainsasymptomaticandcausesneitherconductivenorsensorineuralhearingloss.
158.Endolymphaticsacdecompressionis donein? a)Menieresdisease b)Otosclerosis c)Otitismedia d)Vestibularschwannoma CorrectAnswer-AAns.is'a'i.e.,MenieresdiseaseTreatmentofMeniere'sdiseaseMosttreatmentsareforsymptomsbelievedtobecausedbyexcessendolymphaticfluid.TreatmentofMeniere'sdiseaseisoftwotypes:?A)MedicalmanagementB)SurgicalmanagementMedicalmanagement:TreatmentofMeniere'sdiseasebeginsfirstwithmedicalmanagement.Medicaltreatmentcontrolstheconditioninovertwothirdofpatients.Medicalmanagementincludes:?1.Antihistaminelabyrinthinesedatives(vestibularsedatives)Manycasescanbecontrolledbyvestibularsedativeslikeprochlorperazine,promethazine,dimenhydramine,andcinnarzine.2.AnxiolyticandtranquillizersManypatientsareanxious,thereforetheymaybehelpedbyanxiolyticandtranquillizerslikediazepam.3.VasodilatorsBetahistinehydrochlorideappearstobethemostusefulrecentadditiontothemedicalarmamentariumandisroutinelyprescribed
formostpatients.Itincreaseslabyrinthinebloodflowbyreleasinghistamine.Othervasodilatorsemployedincludenicotinicacid,thymoxamine,inhaledcarbogen(5%CO2with95%02),andhistaminedrip.Vasodilatorsincreasevascularityofendolymphaticsacanditsductandtherebyincreasesreabsorptionofendolymphaticfluid.4.Diuretics(furosemide)Diureticswithfluidandsaltrestrictioncanhelptocontrolrecurrentattacksifnotcontrolledbyvestibularsedativesorvasodilators.5.OtherdrugsPropanthelinebromide,phenobarbitoneandhyoscineareeffectivealternatives.SurgicalmanagementSurgicaltherapyformeneire'sdiseaseisreservedformedicaltreatmentfailuresandisotherwisecontroversial.SurgicalprocedurescanbedividedintotwomaincategoriesDestructivesurgicalproceduresNondestructivesurgicalproceduresDestructivesurgicalprocedures:rationaleistocontrolvertigo.Endolymphatichydropscausesfluidpressureaccumulationwithintheinnerear,whichcausestemporarymalfunctionandmisfiringofthevestibularnerve.Theseabnormalsignalscausevertigo.Destructionoftheinnerearand/orthevestibularnervepreventstheseabnormalsignals.Theproceduresperformedare:LabyrinthectomyIntermittentlowpressurepulsetherapy(Meniettdevicetherapy)Conservativesurgicalprocedures:areusedincaseswherevertigoisdisablingbuthearingisstilluseful&needstobepreserved.Theyare:DecompressionofendolymphaticsacEndolymphaticshuntoperationSacculotomy(Fick'soperation&Cody'stackprocedure)VestibularneuronectomyUltrasonicdestructionofvestibularlabyrinthtopreservecochlearfunction.StellateganglionblockorcervicalsympathectomyIntratympanicgentamycin
Vestibularnervesection
159.Intype-4thyroplasty,vocalcordis? a)Mediallydisplaced b)Laterallydisplaced c)Lengthened d)Shortened CorrectAnswer-CAns.is'c'i.e.,LengthenedThyroplastyIsshikidividedthyroplastyproceduresinto4categoriestoproducefunctionalalterationofvocalcords:- 1. TypeI:Medialdisplacementofvocalcord(donebyinjectionofgel foam/Teflonpaste) 2. Type2:Lateraldisplacementofcord(donetoimprovetheairway).3. Type3:Shortening(relax)thecord,tolowerthepitch(gender transformationfromfemaletomale). 4. Type4:Lengthening(tightening)thecord,toelevatethepitch (gendertransformationfrommaletofemale),forexampleasatreatmentofandrophonia.
160.Fenestrationoperationiswhichtypeof tympanoplasty? a)Type-2 b)Type-3 c)Type-4 d)Type-5 CorrectAnswer-DAns.is'd'i.e.,Type-5TypesoftympanoplastyWullsteinclassifiedtympanoplastyintofivetypes:?TypeI:Defectisperforationoftympanicmembranewhichisrepairedwithagraft.Itisalsocalledmyringoplasty.TypeII:Defectisperforationoftympanicmembranewitherosionofmalleus.Graftisplacedontheincusorremnantofmalleus.TypeIII:Malleusandincusareabsent.Graftisplaceddirectlyonthestapeshead.Itisalsocalledmyringostapediopexyorcolumellatympanoplasty.TypeIV:Onlythefootplateofstapesispresent.Itisexposedtotheexternalear,andgraftisplacedbetweentheovalandroundwindows.Anarrowmiddleear(cavumminor)isthuscreated,tohaveanairpocketaroundtheroundwindow.Amucosa-linedspaceextendsfromtheeustachiantubetotheroundwindow.Soundwavesinthiscaseactdirectlyonthefootplatewhiletheroundwindowhasbeenshielded.TypeV:Stapesfootplateisfixedbutroundwindowisfunctioning.Insuchcases,anotherwindowiscreatedonhorizontalsemicircularcanalandcoveredwithagraft.Alsocalledfenestration
operation.
161.Bullousmyringitisiscausedby? a)Pseudomonas b)Mycoplasma c)Pneumococcus d)Candida CorrectAnswer-BAns.is'b'i.e.,MycoplasmaOtitisexternahaemorrhagicaThisconditionisalsoknownasBullousmyringitisormyringitisbullosa.Thisconditionisextremelypainfulandhassuddenonset.Itisthoughttobeduetomycoplasmapneumoniaeorviralinfection,usuallyinfluenzaTheremaybeamildconductivedeafnessandamildlydischargingear.Theappearanceofhaemorrhagicbullaeonthetympanicmembraneandinthedeepmeatusischaracteristic.Thebullaearefilledwithserosanguinousfluidandblood.Onhealing,bullaelooklikeSago-grain.Therefore"Sago-grain"appearanceoftympanicmembraneisseeninhealedmyringitisbullosa.
162.Allareabsoluteindicationsof tonsillectomyexcept a)Suspiciousmalignancy b)Peritonsillarabscess c)Chronictonsillits d)Tonsilscausingobstructivesleepapnea CorrectAnswer-CAns.is'c'i.e.,ChronictonsillitsTonsillectomyTonsillectomy,asthenamesuggests,isthesurgicalproceduretoremovethetonsils.Often,tonsillectomyisdoneatthesametimeasadenoidectomy.IndicationsIndicationsaredividedinto:?A.Absolute1.Recurrentinfectionsofthroat.Thisisthemostcommonindication.Recurrentinfectionsarefurtherdefinedas:Sevenormoreepisodesinoneyear,orFiveepisodesperyearfor2years,orThreeepisodesperyearfor3years,orTwoweeksormoreoflostschoolorworkinoneyear.2.Peritonsillarabscess.Inchildren.tonsillectomyisdone4-6weeksafterabscesshasbeentreated.Inadults,secondattackofperitonsillarabscessformstheabsoluteindication.3.Tonsillitiscausingfebrileseizures.4.HypertrophyoftonsilscausingAirwayobstruction(sleepapnoea)
DifficultyindeglutitionInterferencewithspeech.5.Suspicionofmalignancy.Aunilaterallyenlargedtonsilmaybealymphomainchildrenandanepidermoidcarcinomainadults.Anexcisionalbiopsyisdone.B.Relative 1. Diphtheriacarriers,whodonotrespondtoantibiotics2. Streptococcalcarriers,whomaybethesourceofinfectiontoothers.3. Chronictonsillitiswithbadtasteorhalitosiswhichisunresponsiveto medicaltreatment. 4. Recurrentstreptococcaltonsillitisinapatientwithvalvularheart disease.C.AsapartofAnotherOperation 1. Palatopharyngoplatywhichisdoneforsleepapnoeasyndrome.2. Glossopharyngealneurectomy.TonsilisremovedfirstandthenIX nerveisseveredinthebedoftonsil. 3. Removalofstyloidprocess.
163.Retractionoftympanicmembrane touchingpromontory.Whatissade'sgrade? a)1 b)2 c)3 d)4 CorrectAnswer-CAns.is'c'i.e.,3AtelecticgradesofparstensaSadeclassification::Grade1=slightretractionofTMovertheannulusGrade2=theTMtouchesthelongprocessoftheincusGrade3=theTMtouchesthepromontoryGrade4=theTMisadherenttothepromontory
164.Posterosuperiorretractionpocketif allowedtoprogresswillleadto? a)SNHL b)Secondarycholesteatoma c)Tympanosclerosi d)Primarycholesteatoma CorrectAnswer-DAns.is'd'i.e.,PrimarycholesteatomaRetractionpocketsaremorecommoninthepostero-superiorportionofpars-tensaofear-drum(tympanicmembrane).Tworeasonshavebeenattributedtothisfeatures:- 1. Thisareaismorevascular,hencecouldbesubjectedtointense inflammatoryreaction. 2. Middlefibrouslayerinthisareaisincomplete,lackincircularfibers. Longtermeffectsofprogressiveretractionmaybe:- 1. Fixationofatrophicsigmenttobonywallofmiddleearcavity.2. Erosionofossicles,mostcommonlylongprocessofincus.3. Formationofcholesteatoma(primaryacquiredcholesteatoma).4. "Aposteriorsuperiorretractionpocket,ifallowedtoprogress,leads toprimaryacquiredcholeastoma".AcquiredcholesteatomaInmajorityofcasescholesteatomaisacquired.Acquiredcholesteatomamaybeeitherprimaryacquiredorsecondaryacquired:?A.PrimaryacquiredcholesteatomaThereisnohistoryofpreviousotitismediaorapre-existingperforation.Theoriesforitsgenesisare:-
1. Retractionpocket(wittmaack'stheory):-Itisthemostaccepted theory.ThereisinvaginationofparsflaccidaintheformofretractionpocketduetonegativepressureinmiddleearasaresultofEustachiantubedysfunction.Thereisingrowth(migration)ofsquamousepitheliumfromtheouterlayeroftympanicmembrane(outerlayerofTMislinedbysquamousepithelium)throughthisretractionpocket.Infectionsupervenesontheimpactedsquamousepithelium/keratin. 2. Basalcellhyperplasia(Ruedi'stheory):-Thereisproliferationofthe basallayerofparsflaccidainducedbysubclinicalchildhoodinfections.Theseproliferatingbasalcellslaydownkeratinizingsquamousepithelium. 3. Squamousmetaplasia(Sade'stheory):-Pavementepitheliumof atticundergoesmetaplasiaandtransformsintosquamousepitheliumduetosubclinicalinfections.B.SecondaryacquiredcholesteatomaThereispre-existingperforationinparstensa.Theoriesonitsgenesisinclude:- 1. Epithelialinvasion(Habermann'stheory):-Theepitheliumfromthe meatusorouterdrumsurfacegrowsintothemiddleearthroughapre-existingperforationespeciallyofthemarginaltypewherepartofannulustympanicushasalreadybeendestroyed. 2. Metaplasia:-Middleearmucosaundergoesmetaplasiadueto repeatedinfectionsofmiddleearthroughthepre-existingperforation.
165.Treatmentofchoiceforatticoantraltype ofCSOM? a)Antiboiotics b)Tympanoplasty c)Modifiedradicalmastoidectomy d)None CorrectAnswer-CAns.is'c'i.e.,ModifiedradicalmastoidectomyTreatmentofatticoantraldiseaseSincecholesteatomaisgoingtoexpandanddestroyboneandmucousmembrane,ithastoberemoved.Therefore,surgeryisthemainstayoftreatment.Primaryaimisremovalofdiseasebymastoidectomytomakeearsafefollowedbyreconstructionofhearingatalaterstage.Modifiedradicalmastoidectomyisthesurgeryofchoice.Twotypesofsurgicalprocedures(mastoidectomy)aredonetodealwithcholesteatoma:-1.CanalwalldownproceduresTheseleavethemastoidcavityopenintotheexternalauditorycanalsothatthediseasedareaisfullyexteriorized.Thecommonlyusedproceduresforatticoantraldiseaseareatticotomy,modifiedradicalmastoidectomyandrarelyradicalmastoidectomy.Modifiedradicalmastoidectomyistheprocedureofchoice.2.Canalwallupprocedures(corticalmastoidectomy)Herediseaseisremovedbycombinedapproachthroughthemeatusandmastoidbutretainingtheposteriorbonymeatuswall,therebyavoidinganopenmastoidcavity.
Forreconstructionofhearingmechanismmyringoplastyortympanoplastycanbedoneatthetimeofprimarysurgeryorasasecondstageprocedure.
166.Retractionoftympanicmembrane touchingthepromontory.Itiscalled? a)Mildretraction b)Severeretraction c)Atelectasis d)Adhesiveotitis CorrectAnswer-CAns.is'c'i.e.,AtelectasisTympanicmembraneretractionTheretractedsegmentofeardrumisoftenknownasaretractionpocket.Theterms"atelectasis"orsometimes"adhesiveotitismedia"canbeusedtodescriberetractionofalargeareaoftheparstensa.
167.AllaretrueaboutRinne'stestexcept? a)Positiveinnormalear b)Positiveinsensorineuralhearingloss c)Minimum15-20dBairbonegapisrequiredinconductive deafness d)Boneconductionisbetterinsensorineuralhearingloss CorrectAnswer-DAns.is'd'i.e.,BoneconductionisbetterinsensorineuralhearinglossRinne'sTestTheRinnetestisatuningforktestthatcompareshearingbyairconductionandboneconduction.TheRinnetestisbasedontheideathathearingmechanismisnormallymoreefficientbyairconduction(AC)thanitisbyboneconduction(BC),i.e.,AC>BCinnormalpersons.Forthisreason,atuningforkwillsoundlouderandlongerbyairconductionthanbyboneconduction.However,thisairconductionadvantageislostwhenthereisaconductivehearinglossinwhichcasethetuningforksoundslouderbyboneconductionthanbyair-conduction.MethodAdministeringtheRinnetestinvolvesaskingthepatienttoindicatewhetheravibratingtuningforksoundslouderwhenitsbaseisheldagainstmastoidprocess(boneconduction)orwhenitsprongsareheldnearthepinna,facingtheopeningofearcanal(airconduction).Afterstrikingthefork,theclinicianalternatesitbetweenthesetwopositionssothatthepatientcanmakeajudgementaboutwhichoneislouder.InterpretationofRinne'stestTheoutcomeoftheRinnetestistraditionallycalled"positive"ifthe
forkislouderbyairconductionandthisfindingimpliesthattheearisnormalorhassensorineuralhearingloss.Theresultsarecalled"negative"ifthebone-conductionislouderthanair-conduction,whichisinterpretedasrevealingthepresenceofconductivedeafnessi.e.,lesionsofeitherexternalear,tympanicmembrane,middleearorearossicles..InconductivedeafnessRinne'stestwillbenegativeiftheconductivehearinglossisgreaterthan15-20dB(minimumairbonegap15-20dB).Thatmeans,atleast15-20dBofconductivehearlossisrequiredtoshowboneconductionbetterthanairconduction,i.e.,NegativeRinne'stest.AnegativeRinnetestfor256,512and1024Hzindicatesaminimumair-bonegap(ABG)of15,30,45dBrespectively.Therefore,ABgapcanbemadeiftuningforksof256,512and1024Hzareused:- 1. ARinnetestequalornegativefor256Hzbutpositivefor512Hz indicatesair-bonegapof20-30dB. 2. ARinnetestnegativefor256and512Hzbutpositivefor1024Hz indicatesair-bonegapof30-45dB. 3. ARinnenegativeforallthethreetuningforksof256,512,and1024 Hz,indicatesair-bonegapof4560dB.RationaleofpositivetestPositivetest(AC>BC)isseenin:?1.NormalpersonIthasalreadybeenexplainedthatairconductionisbetterthanboneconduction,thusRinnetestispositiveinnormalperson.2.Sensori-neuralhearingInsensorineuralhearingloss,thedefectisincochleaorVIIInerveoritscentralconnection.Thereisnodefectinconductiveapparatusofear(airconduction)orinmastoidbone(boneconduction).Asairconductionisbetterthanboneconduction,Rinnetestwillbepositive(becausebothairconductiveapparatusandboneconductiveapparatusarenormalandthepathologyisdistaltothem).Negativetest(BC>AC)isseenin:?1.ConductivedeafnessAstheconductiveapparatusisdefective,boneconductionbecomesbetterthanairconduction(BC>AC).
2.SevereunilateralsensorineuralhearinglossHeretheRinnetestisfalsenegative(nottruenegative)asitisinterpretedbythepatientthatBC>AC,butactuallyitisnot.Inrealitythisresponseisfromtheoppositeearbecauseoftranscranialtransmissionofsoundduringboneconductiontesting.Thiscanbepreventedbymaskingthenon-testearwithBarany'sboxwhiletestingtheboneconduction.Webertestwillhelpforsuchsituation.
168.Stimulationofhorizontalsemicircular canalcausesnystagmusinwhichdirections? a)Vertical b)Horizontal c)Rotary d)Anyofthethree CorrectAnswer-BAns.is'b'i.e.,HorizontalThecupulaeofthesemicircularcanalsarestimulatedbymovementofendolymphaticfluidandeachcanalcausesthenystagmusinitsownplane:- 1. StimulationofhorizontalSCC4Horizontalnystagmus.2. StimulationofsuperiorSCC4Rotarynystagmus.3. StimulationofverticalSCCVerticalnystagmus
169.Bilateralpast-pointingisduetodefectin ? a)Brainstem b)Cerebellum c)Vestibularsystem d)Basalganglia CorrectAnswer-CAns.is'c'i.e.,VestibularsystemPast-pointingisthedeviationoftheextremitiescausedbyeithercerebellarhemisphereorvestibulardisease.Testingisusuallydonewitharms.Thetraditionalmethodistohavethepatientextendthearmandplacehisextendedfingerontheexaminer'sindexfinger;thenwiththeeyeclosedraisethearmdirectlyoverhead;thanbringitbackdownpreciselyontotheexaminer'sfinger.Ifvestibularorcerebellarlesionisthere,pastpointing(deviationoflimb)willbepresent.Thetwotypes(cerebellarandvestibular)pastpointinghavedifferentpatterns:- 1. Withvestibularin:balance,thenormallabyrinthwillpushthelimb towardtheabnormalsideandthepatientwillmissthetarget.Thepastpointingwillalwaysbetothesamesideoftargetandwilloccurwitheitherlimb. 2. Withacerebellarhemisphericlesion,theipsilaterallimbswillhave ataxiaandincoordination;pastpointingoccursonlywiththeinvolvedarmandmaybetothesideoflesionorerraticallytoeithersideofthetarget.So,
Bilateralpast-pointingVestibularsystemdefect.Unilateralpast-pointingCerebellarhemispheredefect.
170.Majorcontributionintheformationof nasalseptumisbyallexcept? a)Septalcartilage b)Vomer c)Ethmoid d)Nasalbone CorrectAnswer-DAns.is'd'i.e.,NasalboneThemedialwall,ornasalseptum,isformed(fromanteirortoposterior)by:(1)theseptalcartilage(destroyedinadriedskull)(2)theperpendicularplateoftheethmoidbone,and(3)thevomer.Itisusuallydeviatedtooneside.Thevomercontributestotheinferiorportionofthenasalseptum;theperpendicularplateoftheethmoidbonecontributestothesuperiorportion.
171.Allaretrueaboutconductivedeafness except? a)Rinne'stestisnegative b)Absoluteboneconductionisnormal c)Weberislateralizedtopoorerear d)Thereisdecayinthresholdtone CorrectAnswer-DAns.is'd'i.e.,Thereisdecayinthresholdtone
172.Ethmoidalpolypis? a)Duetoinfection b)Single c)Recurrent d)Occursinchildren CorrectAnswer-CAns.is'c'i.e.,Recurrent
173.Mostcommoncauseoforoantralfistula ? a)TB b)Penetratinginjury c)Toothextraction d)latrogenic CorrectAnswer-CAns.is'c'i.e.,ToothextractionOroantralfistulaItiscommunicationbetweentheantrumandoralcavity.EtiologyDentalextraction:-Mostimportantcauseandmaxillaryfirstmolaraccountsfor50%oforal-antralfistulascausedbyextractions.Maxillarysecondandthirdmolarextractionsaccountforother50%.Infection:-TB,syphilis,leprosyofmaxillarybone.Malignantneoplasm:-Causeserosionofantrum.Fractureorpenetratinginjuriesofmaxilla.Midlinegranuloma(aformoflymphoma)FailureofsublabialincisiontohealafterCaldwell-Lucoperation.ClinicalfeaturesRegurgitationoffoodDischarge(oftenfoulsmelling)Inabilitytobuiltpositiveornegativepressureinmouth.
174.Killiandehiscenceisin? a)Superiorconstrictor b)Inferiorconstrictor c)Middleconstrictor d)None CorrectAnswer-BAns.is'b'i.e.,InferiorconstrictorInferiorconstrictormusclehastwoparts:-(i)Thyropharyngeouswithobliquefibres,and(ii)Cricopharyngeouswithtransversefibres.BetweenthesetwopartsofinferiorconstrictorexistsapotentialgapcalledKillan'sdehiscence.Itisalsocalledthegatewaytotearasperforationcanoccuratthissiteduringesophagoscopy.Itisalsothesiteforherniationofpharyngealmucosaincaseofpharyngealpouch.
175.Saddlenoseis? a)Depressednose b)Crookednose c)Deviatednose d)C-shaped CorrectAnswer-AAns.is'a'i.e.,DepressednoseSaddlenose(Depressednose)Nasaldorsumisdepressed(saggingofthebridgeofnose).Depressednasaldorsummayinvolveeitherbony,cartilaginousorbothbonyandcartilaginouscomponents.Mostcommonetiology:NasaltraumaCausesarehematoma,excessivesurgicalremoval,trauma,syphilis,abscess,Leprosy,andtuberculosis.CrookedordeviatednoseCrookednoseistheexternaldeviationofnoseduetodeviationofthedorsalborderofseptalcartilage,forminga`C'or'S'shapedcurve.Incrookednose,themidlinedorsumiscurvedin'C'or'S'shapedmannerfromthefrontonasalangletothetipofnose.Inadeviatednose,themidlineisstraightbutdeviatedtooneside,midlineisnotcurvedasincrookednose.
176.Tonsillarfossaisboundedanteriorlyby ? a)Pharyngobasilarfascia b)Palatopharyngealfold c)Buccopharyngealfascia d)Palatoglossalfold CorrectAnswer-DAns.is'd'i.e.,PalatoglossalfoldPalatinetonsilsaremassesoflymphoidtissuethatcanbeseenontheleftandrightsidesatthebackofthethroat.Therearetwopalatinetonsils,andeachpalatinetonsil(rightorleft)liesinthetonsilarsinus(tonsilarfossa)onthelateralwalloforopharynx.Tonsillarfossaboundedbythepalatoglossalfoldinfrontandthepalatopharyngealfoldbehind.Tonsilsarelinedbynon-keratinizedstratifiedsquamousepithelium.Medialsurfaceofeachtonsilhas15-20crypts,thelargestofwhichiscalledIntratonsillarcleftorcryptamagna(whichrepresentspersistenceoftheventralportionofthesecondpharyngealpouch).Tonsillarbedisformedfromwithin-outwardsby:-LiPharyngobasilarfasciaSuperiorconstrictor(above)andpalatopharyngeusmuscleStyloglossus(below)Buccopharyngealfascia
177.Passavantsridgeisformedby? a)Palatoglossus b)Superiorconstrictor c)Salpingopharyngeus d)Palatopharyngeus CorrectAnswer-DAns.is'd'i.e.,PalatopharyngeusPharynxhastwogroupofmuscles:?*Intrinsicmuscles:-Stylopharyngeous,salpingopharyngeous,palatopharyngeous.*Extrinsicmuscles:-Superiorconstrictor,middleconstrictor,inferiorconstrictor.-Allmusclesofpharynxaresuppliedbycranialaccessorythroughbranchesofvagusviapharyngealplexusexceptstylopharyngeuswhichissuppliedbyglossopharyngeal.-Inferiorconstrictormusclehastwoparts:-(i)Thyropharyngeouswithobliquefibres,and(ii)Cricophatyngeouswithtransversefibres.-BetweenthesetwopartsofinferiorconstrictorexistsapotentialgapcalledKillan'sdehiscence.Itisalsocalledthegatewaytotearasperforationcanoccuratthissiteduringesophagoscopy.Itisalsothesiteforherniationofpharyngealmucosaincaseofpharyngealpouch.-UpperfibersofpalatopharyngeusconstitutethePassavant'smusclewhichoncontractionraisesaridgecalledPassavant'sridgeonposteriorwallofnasopharynx.
178.Hotpotatovoiceischaracteristicof? a)Nasopharyngealcarcinoma b)Glotticcarcinoma c)Subglotticcarcinoma d)Supraglotticcarcinoma CorrectAnswer-DAns.is'd'i.e.,SupraglotticcarcinomaClinicalfeaturesofsupraglotticcarcinomaPainonswallowingisthemostfrequentinitialsymptom--Devita7th/ep.698Massinneckmaybethefirstsign.Hoarsnessisalatesymptom.Painmaybereferredtoearbyvagusnerveandauricularnerveofarnold.Latesymptomsincludefoulbreath,dysphagiaandaspiration.Largetumorscancause"hotpotatovoice/muffledvoice".Hemoptysis,sorethroat,shortenessofbreath,stridor,otalgiaandaspirationpneumoniamayalsooccur.
179.Allareearlycomplicationsof tracheostomyexcept? a)Hemorrhage b)Pneumothorax c)Injurytoesophagus d)Trachealstenosis CorrectAnswer-DAns.is'd'i.e.,Trachealstenosis Complicationsof Late(withprolonged tracheostomy useoftubeforweeks Intermediate(firstfew ormonths) Immediate(at hoursordays) Hemorrhage,dueto thetimeof Bleeding(reactionaryor erosionofmajorvessel operation) secondary) Laryngealstenosis Hemorrhage Displacementoftube Trachealstenosis Apnea Blockingoftube Tracheo-esophageal Pneumothorax Subcutaneousemphysema fistula InjurytoRLN Tracheitisand Problemof Aspirationof tracheobronchitis decannulation blood Atelectasisandlung Persistent Injuryto abscess tracheocutaneous esophagus Localwoundinfectionand fistulagranulations Problemoftracheostomyscar
180.Nasopharynxislinedbywhich epithelium? a)Stratifiedsquamousnonkerationized b)Stratifiedsquamouskeratinized c)Ciliatedcolumnar d)Cuboidal CorrectAnswer-CAns.is'c'i.e.,CiliatedcolumnarThetwomaintypesofepithelialiningthenasopharynxarestratifiedsquamous(comprisingapproximately60%ofnasopharyngealepithelium)andpseudostratifiedcolumnarrespiratoryepitheliumcontainingciliatedcells,gobletcellsandbasalcells.
181.Vidianneurectomyisdonefor? a)Allergicrhinitis b)Atrophicrhinitis c)Vasomotorrhinitis d)Chronichypertrophicrhinitis CorrectAnswer-CAns.is'c'i.e.,VasomotorrhinitisVasomotorrhinitisVasomotorisanonallergicconditionthatinvolvesaconstantrunnynose,sneezingandnasalcongestion,i.e.,thenoseisstuffyorrunnyforreasonsotherthanallergiesandinfections.Theexactetiologyisunknown,buttriggersincludeemotions,odors,poorairquality,spicyfoods,andmedicationsideeffects.Pathogenesisinclude:-ParasympatheticoveractivityHyperactivenasalmucosatoseveralnon-specificstimuliespeciallyinwomenof20-40years.Symptomsofvasomotorrhinitisincludeexcessiveclearrhinorrhoea,nasalobstruction/congestion,irritation,paroxysmalsneezingandpost-nasaldrip.Nasalmucosaishypertrophied&congested;andmucosaofturbinatesmaygivemulberrylikeappearanceandispaletoduskyredincolour.Complicationsofvasomotorrhinitisincludehypertrophicrhinitis&sinusitis,andnasalpolyp.TreatmentTreatmentofvasomotorrhinitisincludes:-1.ConservativetreatmentAvoidanceofphysicalfactorswhichprovokesymptoms.Antihistaminicsandoralornasaldecongestants.
Topicalorsystemicsteroids2.SurgicaltreatmentNasalobstructioncanberelievedbymeasureswhichreducethesizeofhypertrophiednasalturbinate:-Cryosurgery,submucosaldiathermy,Linearcauterization,partialortotalturbinectomy,submucosalresectionofturbinate.ExcessiverhinorrhoeainvasomotorRhinitisnotcorrectedbymedicaltherapyandbothersometothepatient,isrelievedbysectioningtheparasympatheticsecretomotorfibrestonosei.e.,vidianneurectomy.
182.Lymphaticdrainageoforpharynxis mainlythrough? a)Superficialcervicallymphnodes b)Submandibularnodes c)Jugulodigastricnode d)Jugulo-omohyoidnodes CorrectAnswer-CAns.is'c'i.e.,JugulodigastricnodesDeepcervicallymphnodesaredividedintotwogroups:-(i)jugulodigastric,and(ii)jugulo-omohyoid.Lymphaticsfromoropharynxdrainintojugulodigastricnodes.LymphaticdrainageofpharynxLymphaticdrainageofpharynxmaybe:?1.NasopharynxNasopharynxdrainsintoupperdeepcervicalnodeseitherdirectlyorindirectlythroughretropharyngealorparapharyngealnodes.Nasopharynxalsodrainsintospinalaccessorychainofnodesintheposteriortriangleoftheneck.2.OropharynxLymphaticsfromtheoropharynxdrainintoupperjugularparticularlythejugulodigastric(tonsillar)nodes.Thesoftpalate,lateralandposteriorpharyngealwallsandthebaseoftonguealsodrainintoretropharyngealandparapharyngealnodesandfromtheretothejugulodigastricandposteriorcervicalgroup.3.HyphopharynxPyriformsinusdrainsintoupperjugularchain&thentodeepcervicalgroupoflymphnodes.Postcricoidregiondrainsintoparapharyngealandparatracheal
groupoflymphnodes.Posteriorpharyngealwalldrainsintoparapharyngeallymphnodesandfinallytodeepcervicallymphnodes.
183.Allaretrueaboutotiticbarotrauma except? a)Conductivedeafness b)Retractedtympanicmembrane c)Catheterizationcanbeused d)Occursduringsuddenascentinaircraft CorrectAnswer-DAns.is'd'i.e.,OccursduringsuddenascentinaircraftOtiticBarotraumaThisconditionisseenwhentheambientpressureisrising,e.g.inscubadiving(underwaterdiving),descendinginanaircraft,orcompressioninpressurechamber.Itoccursduetopressuredifferencesbetweentheinsideandoutsideoftheeardrum.ClinicalfeaturesEardiscomfortorpain,hearingloss,andtinnitusarecommonVertigoisuncommonOtoscopyfindingsare:-CongestedandretractedtympanicmembraneBloodmayextravasateintomiddleearproducinghaemotympanumOnexaminationthereisconductivedeafness.PathogenesisofotiticbarotraumaThemiddleearpressureisnormallymaintainedatalevelsimilartothatoftheatmospherebythefunctionofEustachiantubewhichallowspassageofairfrommiddleeartopharynx.Suddenordramaticchangesofexternalpressuremaydefeatthismechanismandcauseinjurytomiddleear.Whenatmosphericpressureishigherthanthatofmiddleearbycriticallevelof90mmHg,
eustachiantubegetslockedasthesofttissuesofpharyngealendofthetubeareforcedintothelumenbyhighatmosphericpressure.Thisresultsinsuddennegativepressureinthemiddleearwhichcausesretractionoftympanicmembrane,hyperemia,transudationwithhemorrhageanddevelopmentofAero-otitismedia(barotrauma)Atpressuredifference>100to500mmHg,tympanicmembranecanrupturewhenthepressuredifferenceismorethan100mgHg,tympanicmembranecanrupture.TreatmentofotiticBarotraumaRoutineselftreatmentofpainassociatedwithchangingpressureinaircraftincludeschewinggum,attemptingtoyawn&swallow,blowingagainstclosednostrils,andusingdecongestantnasalsprays.Theaimistorestoremiddleearareation.Catheterizationorpolitzerizationcanalsobeused.Iftheeustachiantubewillnotopenwithothertreatments,surgerymaybenecessory.Myringotomyandaspirationoffluidisthesurgicalprocedureused.
184.Teardropsignisseenin? a)Fracturezygomaticarch b)Fracturemaxilla c)Fracturemandible d)Blowoutfracture CorrectAnswer-DAns.is'd'i.e.,BlowoutfractureFracturesoftheflooroftheorbitZygomaticfractureandLefortIImaxillaryfracturesarealwaysaccompaniedbyfracturesoforbitalfloor.Isolatedfracturesoforbitalfloor,whenalargebluntobjectstrikestheglobe,arecalled"blowoutfractures".ClinicalfeaturesEcchymosisoflid,conjunctivaandsclera.Endophthalmoswithinferiordisplacementoftheeye-ball.Thisbecomesapparentwhenoedemasubsides.Diplopia,whichmaybeduetodisplacementoftheeyeballorentrapmentofinferiorrectusandinferiorobliquemuscles.Hypoaesthesiaoranaesthesiaofcheekandupperlip,ifinfraorbitalnerveisinvolved.DiagnosisJWater'sviewshowaconvexopacitybulgingintotheantrumfromabove,i.e.,Teardropopacity.CTscanisdiagnostic.
185. Invertedpapillomaofnosearisefrom? a)Nasalseptum b)Roofofthenose c)Tipofthenose d)Lateralwallofthenose CorrectAnswer-DAns.is'd'i.e.,LateralwallofthenoseInvertedPapilloma(Transitionalcellpapilloma/Schneiderionpapilloma)Invertedpapillomaisabenignneoplasmoccursmostlybetween40-70yearswithmalepreponderance(5:1).Itarisesfromthelateralwallofnoseandisalwaysunilateral.Rarely,itmayarisefromnasalseptum.Featuresofinvertedpapillomaare:-Itshowsfingerlikeepithelialinvasionsintotheunderlyingstromaoftheepitheliumratherthanonsurfacesocalledinvertedpapilloma.Itisusuallyunilateralandisalocallyaggressivetumour.Patientscomplainofnasalobstruction,rhinorrhea&unilateralepistaxis.In10-15%casestheremaybeassociatedsquamouscellcarcinoma.Treatmentisadequatelocalexcision.Ifitarisesinmaxillarysinus,thenaradicalantrostomyiscarriedout.Ifitarisesintheethmoidalsinus,anexternalethmoidectomyisdone.Ifitarisesfromnose,
treatmentiswidesurgicalexcisionbylateralrhinotomy.Hasatendencytorecurevenafterremoval.
186.Trueaboutexternalnose? a)Upper2/3isbony b)Lower1/3iscartilaginous c)Singlelateralcartilage d)Twonasalbones CorrectAnswer-DAns.is'd'i.e.,TwonasalbonesExternalnosehasanosteocartilaginousframeworkofwhichupperone-thirdisbonyandlowertwo-thirdiscartilaginous. 1. Bonypart:-Consistsoftwonasalbones.2. Cartilagenouspart:-Consistsoftwoupperlateralcartilages,two lowerlateralcartilages,twoormorelessaralar(orsesmoid)cartilagesandaseptalcartilage.So,thereare3pairedand1unpairedcartilages.
187.IndicationofBAHA(Bone-anclored hearingaid) a)Bilateralhearingloss b)Sensorineuralhearingloss c)Congenitalcanalatresia d)Alloftheabove CorrectAnswer-CAns.is'c'i.e.,CongenitalcanalatresiaIndicationsforBAHAWhenair-conduction(AC)hearingaidconnotbeused;Canalatresia,congenitaloracquired,notamenabletotreatment.Chroniceardischarge,notamenabletotreatment.Excessivefeedbackanddiscomfortfromair-conductionhearingaid.Conductiveormixedhearingloss,e.g.otoscierosisandtympanosclerosiswheresurgeryiscontraindicated.Single-sidedhearingloss.
188.Muller'smanoeuverisused? a)Tofindoutopeningofmouth b)Toremovelaryngealforeignbody c)Tofinddegreeofobstructioninsleepdisorderedbreathing d)Toremoveforeignbodyfromear CorrectAnswer-CAns.is'c'i.e.,TofinddegreeofobstructioninsleepdisorderedbreathingMuller'smanoeuvreUsedtofindthelevelanddegreeofobstructioninsleep-disorderedbreathing.Itisperformedwhileusingflexiblenasopharyngoscope.Firsttheexaminerseestheupperairwaysatrestandthenduringthetimewhenpatientmakesmaximalinspiratoryeffortwithnoseandmouthclosed.Baseoftongue,lateralpharyngealwallandpalateareexaminedforcollapsibilityandthenratedform0(minimalcollapse)to4+(completecollapse).
189.Rosen'sincisionisusedfor? a)Septoplasty b)SMR c)Stapedectomy d)Tonsillectomy CorrectAnswer-CAns.is'c'i.e.,StapedectomyRosen'sincisionisthemostcommonlyusedforstapedectomythroughendomeatalortranscanalapproach.AlsoknowLempert'sincisionisusedforenduralapproach.Wilde'sincisionisusedforpostauralapproach.
190.Submandibularnodesareclassifiedas? a)LevelIAnecknodes b)LevelIBnecknodes c)LevelIInecknodes d)LevelIIInecknodes CorrectAnswer-BAns.is'b'i.e.,Level1BnecknodesDivisionofnecknodesaccordingtolevelsLevelISubmental(IA)Submandibular(IB)LevelIIUpperjugularLevelIIIMidjugularLevelIVLowerjugularLevelVPosteriortrianglegroup(Spinalaccessoryandtransversecervicalchains)LevelVIPrelaryngealPretrachealParatrachealLevelVIINodesofuppermediastinum
191.Hyponasalvoiceisseeninallexcept? a)Adenoids b)Nasalpolyp c)Cleftpalate d)Habitual CorrectAnswer-CAns.is'c'i.e.,CleftpalateCauseofhyponasalityandhypernasalityHyponasalityHypernasalityCommoncoldVelopharyngealinsufficiencyNasalallergyCongenitallyshortsoftpalateNasalpolypSubmucouspalateNasalgrowthLargenasopharynxAdenoidsCleftofsoftpalateNasopharyngealmassParalysisofsoftpalateFamilialspeechpatternPost-adenoidectomyHabitualOronasalfistulaFamilialspeechpatternHabitualspeechpattern
192.Schatzki'sRingispresentat? a)Upperendoftrachea b)Lowerendoftrachea c)Upperendofesophagus d)Lowerendofesophagus CorrectAnswer-DAns.is'd'i.e.,LowerendofesophagusSchatzki'sringItoccursatthejunctionofsquamousandcolumnarepitheliumatthelowerendofoesophagusandhasalsobeencalledloweroesophagealring.Usuallyseeninpatientsabove50yearsofage.Causeisunknown.Symptomaticpatientscomplainofintermittentdysphagiaandsomemayevenpresentwithbolusobstruction.Itmaybeassociatedwithhiatushernia.Treatmentisoesophagealdilatation.
193."Risingsun"appearanceisseenin- a)ASOM b)CSOM c)Glomustumor d)Acousticneuroma CorrectAnswer-CAns.is'c'i.e.,GlomustumorClinicalfeaturesofglomustumorTheearliestsymptomsofglomustumourispulsatiletinnitus(earliest)andhearingloss.Hearinglossisconductiveandslowlyprogressive.Thesearefollowedbybloodstainedotorrhoeaandearache.Beforethetympanicmembrane(eardrum)isperforatedaredswellingisseentoarisefromthefloorofmiddleear,i.e."Risingsun"appearance.Thisresultsinaredreflexthroughtheintacttympanicmembrane.Sometimes,eardrummaybebluishandbulging.oPulsationsign(Brownsign)ispositive,i.e.whenearcanalpressureisraisedwithSiegle'sspeculum,tumorpulsatesvigorouslyandthenblanches;reversehappenswithreleaseofpressure.Aquinosignispositive,i.e.blanchingofmasswithmanualcompressionofipsilateralcarotidartery.Whenthetumourperforatestheeardrumapolypuswillbeseeninthemeatusandthiswillbleedprofuselyiftouched.Cranialnervepalsiesisalatefeatureappearingseveralyearsafterauralsymptoms.IXthtoXIV'cranialnervesmaybeparalysed.Thiscancausedysphagiaandhoarseness,andweaknessoftrapeziusandsternocleidomastoidmuscles,unilateralparalysisofsoftpalate,
pharynxandvocalcord.Ausculationwithstethoscopeoverthemastoidmayrevealaudiblesystolicbruit.Someglomustumourssecretecatecholaminesandproducesymptomsliketachycardia,arrhythmias,sweating,flushingandheadacheetc.Facialpalsymaybecausedbyglomustympanicumtypeofglomustumor.Audiometryshowsconductivedeafness,Howeverifinnerearisinvaded,mixedconductiveandsensorineuralhearinglossisseen.
194.Cart-wheelappearanceoftympanic membraneinASOMisdueto? a)Perforationoftymparicmembrane b)Edemaoftympanicmembrane c)Congestedbloodvesselsalongmalleus d)Granulationtissueontympanicmembrane CorrectAnswer-CAns.is'c'i.e.,CongestedbloodvesselsalongmalleusStagesofASOMASOMrunsthroughthefollowingstagesandthereforepresentationdependsuponthestage:1.Stageoftubalocclusion(Eustachiantubeobstruction)EdemaandhyperaemiaofnasopharyngealendofEustachiontubeblocksthetube,leadingtoabsorptionofairandnegativeintratympanicpressure.Thereisfeelingofdiscomfortandmildhearingloss(conductive)withpinkretractedtympanicmembrane.2.Stageofpresuppuration(Earlyinfection)Thereiscollectionofinflammatoryexudatebehindthetympanicmembrane.ThereismarkedThrobbingearache,hearingloss,tinnitusandfever.Tympanicmembraneiscongested.LeashofbloodvesselsappearalongthehandleofmalleusandattheperipheryoftympanicmembraneimpartingitaCart-wheelappearance.3.Stageofsuppuration(suppurativestage)Thereiscollectionoffrankpusinthemiddleear.Patienthasexcruciatingearache,hearingloss,andconstitutionalsymptomslikehighgradefever.
Tympanicmembraneisredandbulgingwithlossoflandmarks.4.Stageofresolution(Resolutionstage)Thetympanicmembraneruptureswithreleaseofpusandsubsidenceofsymptoms.Earacheisrelieved,fevercomesdownandchildfeelsbetter.
195.Innoiceinducedhearingloss, audiogramshowsatypicalnotchat a)1000Hz b)2000Hz c)3000Hz d)4000Hz CorrectAnswer-DAns.is'd'i.e.,4000HzNoiseinducedhearinglossExposuretoloudnoisecanleadtopermanenthearingthresholdshifts.Thismayhappenimmediatelywithextremeexposure(nearbyexplosionorgunfire),butmorecommonlyoccursslowlyovertimewithrepeatedexposuretoindustrialorenvironmentalnoise.Patientswilloftenhaveatypical4-KHz(4000Hz)notch(dipat4000Hz)intheiraudiogramcalledacousticdip.Auditoryeffectsofnoiceare:? 1. Auditoryfatigue:-at90dBand4000Hz.2. Hearingloss3. Temporary:-At4000-6000Hz4. Permanent:-Repeatedprolongedexposureto100dBorsingle exposureto160dB.
196.Insensorineuralhearingloss,weber's testislateralizedto a)Normalear b)Defectiveear c)Notlateralized d)Mayalternate CorrectAnswer-AAns.A.Webertestislateralizedtotheunaffectedornormalear.PURPOSE:Determinationofaconductivevs.asensorineuralhearingloss.StriketuningforkandplacebaseinthecenteroftheforeheadorthetopoftheheadAskifthetoneislouderintheleftear,therightearorequallyloudinbothearsduetothesoundlocalizationprocess,Inapatientwithaunilateralconductivehearingloss,thesoundwillbelouderintheaffectedear(airbornesoundsmaskboneconductioninthenormalear;conductivelosspreventsmaskinginaffectedearsoundisperceivedtobelouderinaffectedear)Inapatientwithunilateralsensorineuralhearingloss,thesoundislouderinthenormalear(nosignalistransducedbythecochleaontheaffectedside,thereforethesoundislouderonthenormalsideandisperceivedtobecomingfromthatsideInanormalpersonorapersonwithsymmetricalhearingloss,itisequallyloudinbothears.Inotherwords,anormalpatient,theWebertuningforksoundisheardequallyloudlyinbothears,withnooneearhearingthesoundlouderthantheother(lateralization).Inapatientwithhearingloss,theWebertuningforksoundisheardlouderin
oneear(lateralization)thantheother.
197.Whichofthefollowingisresponsiblefor localizationofsound? a)Cochlearnerve b)Cochlea c)Superiorolivarynucleus d)Cochlearnuclei CorrectAnswer-CAns.is'c'i.e.,SuperiorolivarynucleusLocalizationofsoundinspaceAhumancandistinguishsoundsoriginatingfromsourcesseparatedbyaslittleas1degree.Binauralreceptivefields(whichisafeatureofmostauditoryneuronsabovethelevelofcochlearnuclei)contributetosoundlocalization.Inotherwords,relaynucleiinthebrainstem(especiallythesuperiorolivarynucleicomplex)mediatelocalizationofsound.Theauditorysystemusesfollowingcluestojudgetheoriginofsound:?Timelagbetweentheentryofsoundintwoears:-Forexample,ifthesoundoriginatesfromtherightsideofaperson,itreachestherightearearlierthantheleftear.Thistimelagismoreimportantforrelativelylow-frequencysounds(below3000Hz).Differenceinintensitiesbetweenthesoundinthetwoears:-Itisimportantforsoundsofhigherfrequencies(>3000Hz).Soundscomingfromdirectlyinfrontoftheindividualandthebackoftheindividualcannotbedifferentiatedbytheabovetwomechanisms.Hereshapeofpinnaplaysarole,itchangesthequalityofthesounddependingonthedirectionfromwhichsoundcomes.
198.Endolymphresembles? a)CSF b)ICF c)ECF d)Plasma CorrectAnswer-BAns.is'b'i.e.,ICFEndolymphResemblesintracellularfluid,richinI+ions.Perilymph(ectolymph)ResemblesECF,richinNa'ions.PerilymphcommunicateswithCSFthroughcochlearacqueductthereforehascharacteristicssimilartoCSF.FluidintheinnerearTherearetwomainfluidsintheinnerear:? 1. Perilymph2. Endolymph PerilymphItresemblesECFandisrichinNa+ions.Itfillsthespacebetweenbonyandthemembranouslabyrinth,i.e.,Scalavestibuliandscalatympani.ItcommunicateswithCSFthroughtheaqueductofCochleawhichopensintothescalatympanineartheroundwindow.ThereforeItcloselyresemblesCSF.Itisformedby:- 1. Itisafiiterateofbloodserumandisformedbycapillariesofthe spiralligament. 2. ItisadirectcontinuationofCSFandreachesthelabyrinthvia aqueductofcochlea.Endolymph
Itfillstheentiremembranouslabyrinthincludingscalamedia(cochlearduct).Itresemblesintracellularfluid,beingrichinK"ions.Itissecretedbythesecretorycellsofthestriavascularisofthecochleaandbythedarkcells(presentintheutricleandneartheampullatedendsofsemicircularducts).
199.Allareintracranialcomplicationsofotitis mediaexcept? a)Lateralsinusthrombophlebitis b)Facialnervepalsy c)Brainabscess d)Hydrocephalus CorrectAnswer-BAns.is'b'i.e.,Facialnervepalsy
IntracranialComplicationsfromOtitisMediaIntracranialcomplicationsoccuraftertheinfectious(orinflammatory)processproceedsbeyondthetemporalbone"requiringimmediateandprecisetherapeuticintervention."Mostcommonintracranialcomplicationsincludemeningitis,followedbybrainabscessandlateralsinusthrombosis,subduralempyema,epiduralabscess,andotichydrocephalus.
200.Mostcommonlyusedtuningforkinear examination? a)128Hz b)256Hz c)512Hz d)1024Hz CorrectAnswer-CAns.is'c'i.e.,512HzCommonlyusedtuningforkhasafrequencyof512Hz.Forksofotherfrequencies,e.g.256and1024Hzshouldalsobeavailable.
201.
Modifiedradicalneckdissectionincludeswhichlevelofcervicallymphnodes? a)I-Ill b)I-IV c)I-V d)I-Vil CorrectAnswer-CAns.is'c'i.e.,I-VRadicalneckdissectionDuringradicalneckdissection,followingareremoved. a. Lymphnodesofsubmental,submandibular,upper,middleandlower jugular,andlateral(posterior)triangleregions,i.e.LevelItoValongwithitsfibrofattytissue. b. Sternomastoidmuscle. c. Internaljugularvein. d. Spinalaccessorynerve.e. Submandibularsalivarygland. f. Tailoftheparotid. g. Omohyoidmuscle. Followingstructuresaresaved-CarotidarteryBrachialplexus,phrenicnerve,vagusnerve,cervicalsympatheticchain,marginalmandibularbranchoffacial,lingualandhypoglosalnerve.ModifiedneckdissectionItissimilartoradicalneckdissectionbutwithpreservationofoneormorefollowingstructures- 1. Spinalaccessorynerve
2. Internaljugularvein3. Sternocleidomastoidmuscle Thus,bothradicalneckdissectionandmodifiedradicalneckdissectionremovelevelItoVnecknodes.Differentlevelsofnecknodeshevebeenexplainedinprevioussessions.
202.Allareseenintreachercollinsyndrome except a)Conductivedeafness b)Cleftpalate c)Mandibularhypoplasia d)Choanalatresia CorrectAnswer-DAns.is'd'i.e.,ChoanalatresiaTreachercollinssyndromeItisrareconditionthatpresentsseveralcraniofacialdeformitiesofdifferentlevels.Thisisacongenitalmalformationinvolvingthefirstandsecondbranchialarches.Thedisorderischaracterizedbyabnormalitiesoftheauricularpinna,hypoplasiaoffacialbones,antimongoloidslantingpalpebralfissureswithcolobomaofthelowereyelidsandcleftpalate.Importantclinicalfindingsare:- 1. Antimongoloidpalpebralfissures2. Malformedmalleusandincus(normalstapes)3. Colobomaoflowerlid4. Conductivedeafness5. Hypoplasiaofmandible(micrognathia)andmolarbones6. Cleftpalate7. Malformedpinnaandmeatalatresia Itisthemostcommonbenignneoplasmofnasopharynx.Itisahighlyvasculartumorandbloodsupplyofthetumormostcommonlyarisesfromtheinternalmaxillaryartery.Juvenilenasopharyngealangiofibroma(JNA)occursalmost
exclusivelyinmales.FemalewithJuvenilenasopharyngealangiofibroma(JNA)shouldundergogenetictesting.Onsetismostcommonlyintheseconddecades,therangeis7-19years.Theexactcauseisunknown.Asthetumourispredominantlyseeninadolescentmalesintheseconddecadeoflife,itisthoughttobetestosteronedependent.Themostcommonsiteisposteriorpartofnasalcavityclosetothemarginofsphenopalatineforamen.Thetumorstartsadjacenttothesphenopalatineforamen.Largetumorsarefrequentlybilobedordumbbelshaped,withoneportionoftumorfillingthenasopharynxandtheotherportionextendingtothepterygopalatinefossa.ClinicalfeaturesSymptomsdependonspreadoftumourtonasalcavity,paranasalsinuses,pterygomaxillaryfossa,infratemporalfossa,cheek,orbits(throughinferiororbitalfissure),cranialcavity(mostcommonsiteismiddlecranialfossa).Nasalobstruction(80-90%)isthemostcommonsymptom,especiallyintheinitialstages.Thisresultsindenasalspeech,hyposmia,broadeningofnasalbridge.pontaneousprofuse&recurrentepistaxisisthesecondmostcommonsymptomOtalgia,conductivehearingloss,serousotitismedia,duetoeustachiantubeobstruction.Pinkorpurplishmassobstructingoneorbothchonaeinnasopharynx.Tumourintheorbitcauses:proptosis;andfrog-facedeformity;diplopiaanddiminshedvision.Tumourininfratemporalfossacancausetrismusandbulgeofparotid.II,III,IV,V,VIcranialnervecanbeinvolved.Splayingofnasalbones.Swellingofcheekandfullnessofface.DiagnosisandtreatmentContrastCTistheinvestigationofchoice.
Biopsyshouldbeavoidedasitcancauseseverebleeding.Surgicalexcisionisthetreatmentofchoice.
203.Trueaboutpenderd'ssyndrome? a)Blindness b)Conductivedeafness c)Sensorineuraldeafness d)Alloftheabove CorrectAnswer-CAns.is'c'i.e.,SensorineuraldeafnessImportantfeaturesofPenderedsyndrome:CongenitaldisorderMutationingeneSLC26A4.Whichcodesforaproteincalledpendrin(helpsintransportofionsacrossmembrane).ImpairedactivityofPendrinisseenininnerearandthyroidgland.Bilateralsensorineuralhearingloss.Goiter.Sometimeshypothyroidism.Occasionallyvestibulardysfunction.Nospecifictreatment.
204.Endoscopicsinussurgeryprerequisite? a)MRIofparanasalsinus b)CTofPNS c)Mucocilliaryclearingtesting d)Acoustictests CorrectAnswer-BAns.is'b'i.e.,CTofPNSEndoscopicsurgeryofinflammatorydiseasesofparanasalsinuses(sinusitisorpolyp)requiresaverydetailedpreoperativeknowledgeoftheindividualanatomicalconditionsandpathologicalchanges.CTscanareusedbesttovisualizesinusareas.CTscanprovidesexcellentdefinitionofparanasalsinusesandisaprerequisiteforendoscopicsurgery."CTscanlimitedstudycoronalcutsinbonewindowisprerequisiteforendscopicsinussurgery"----MohanBansal
205.X-rayfindingsinchronicotitismedia? a)Honeycombingofmastoid b)Sclerosiswithcavityinmastoid c)Clear-cutdistinctbonypartitionbetweencells d)Noneoftheabove CorrectAnswer-BAns.is'b'i.e.,Sclerosiswithcavityinmastoid
206.Whatisnottrueaboutuseofintranasal steroidsinnasalpolyposis? a)Reducerecurrence b)Reduceobstruction c)Effectiveineosinophilicallypredominantpolyponly d)Maycauseepistaxis CorrectAnswer-CAns.is'c'i.e.,EffectiveineosinophilicallypredominantpolyponlyIntranasalsteroidshavebeenusedextensivelyasfirst-linemanagementofnasalpolyposiswithfewsideeffectsUsually,patientswithsmallpolypsandlimitedinvolvementonCTscanaregoodcandidatesfortopicaltherapyalone.Intranasalsteroidsreducenasalobstruction,polypsize,drainageandpolyprecurrence.Theeffectofsteroidsseemstobenonspecific,improvingsymptomsinbotheosinophilicallyandnoneosinophilicallydominatedpolyps.Nasalbleedingisthemostcommonadverseeventandcanusuallybeminimizedbydirectingthemedicationawayfromnasalseptum.
207.Referredearpainmaytravelthroughall except? a)Trigeminalnerve b)Glossopharyngealnerve c)Abducensnerve d)Vagusnerve CorrectAnswer-CAns.is'c'i.e.,AbducensnerveReferredotalgiaAsearreceivesnervesupplyfromVth(auriculotemporalbranch),IXth(tympanicbranch)andXth(auricularbranch)cranialnerves;andfromC2(lesseroccipital)andC2andC3(greaterauricular),painmaybereferredfromtheseremoteareas:1.ViaVthcranialnerve 1. Dental:-Cariestooth,apicalabscess,impactedmolar, malocclusion. 2. Oralcavity:-Benignormalignantulcerativelesionsoforalcavityor tongue. 3. Temporomandibularjointdisorders:-Bruxism,osteoarthritis, recurrentdislocation,ill-fittingdenture. 4. Sphenopalatineneuralgia Viintensitywillhearit.Therefore,ifidenticalvibratingtuningforksareheldatequaldistancesfrombothearstheyareheardinbothears.However,ifonetuningforkismovedclosertooneearthepersonhearsonlythatforkalthoughtheotherforkisstillvibratingsufficientlyforhimtohear.Instengertest,twovibratingtuningforksareheldequidistantfromeitherear.Ifthepatientisclaiming
deafnessinhisleftearhewillclaintohearonlytheforkonhisrightside.Theforkontheleftsideismovedcloser.Ifthepatientisfeigningdeafnesshewillperceiveonlythetuningforkontheleftsideandwillclaimnottohearanything.Ifthepatienthasagenuinehearinglossonthelefthewillstillhearthetuningforkontherightside.2.TealtestThiscanbeusedwhenthepatientadmitstohearingboneconductioninhis'deaf'ear.Theexaminerstandsbehindthepatientandappliesatuningforktothemastoidprocessofhis'deaf'ear.ThepatientadmitstoaIXthcranialnerve 1. Oropharynx:-Acutetonsillitis,peritonsillarabscess,tonsillectomy. Benignormalignantulcersofsoftpalate,tonsilanditspillars. 2. Baseoftongue:-Tuberculosisormalignancy3. Elongatedstyloidprocess. 3.ViaXthcranialcerve:Malignancyorulcerativelesionofvallecula,epiglottis,larynxorlaryngopharynx,oesophagus.4.ViaC2andC3spinalnerves:Cervicalspondylosis,injuriesofcervicalspine,cariesspine.
208.Acuteretropharyngealabscess,nottrue ? a)Duetolymphadenitis b)Commoninadults c)Swellingononesideofmidline d)Incision&drainage CorrectAnswer-BAns.is'b'i.e.,CommoninadultsRetropharyngealabscessRetropharyngealspaceliesbehindthepharynx,i.e.betweenbuccopharyngealfasciacoveringpharyngealconstrictormuscles(anteriorly)andprevertebralfasciacoveringtheprevertebralmuscles(posteriorly).So,retropharyngealspaceliesbehindthepharyngealconstrictormusclesandanteriortoprevertebralfasciacoveringtheprevertebralmuscles.Abscessinthisspacemaypresentdifferentlydependingupontheage:?Abscessininfants(acuteRetropharyngealabscess)Itiscommonlyseenininfantsandchildrenbelow3yearsofage.Mostcommonlyitresultsfromretropharyngeallymphadenitisduetoanupperrespiratorytractinfection.Thepresentionisacute,i.e.childhashightemperatureandsorethroat.Thereissmoothswelling(bulge)inposteriorpharyngealwallononesideofthemidline.Thereisdysphagia,difficultyinbreathing,stridor,croupycoughandtorticollis.Swellingcanbepalpableperorallyontheposteriorpharyngealwall.Treatmentisincisionanddrainage.
Abscessinadults(chronicretropharyngealabscess)Ifanadultoranolderchildhasaretropharyngealinfectionitislikelytobeduetoatuberculousinfectionofthecervicalspine(cariesofcervicalspine).Sometimeitmaybesecondarytotuberculousinfectionofretropharyngeallymphnodes.Itisofslowonsetandgivesrisetopharyngealdiscomfort,ratherthanpain.Thereisfluctuantswellinginposteriorpharyngealwall,centrallyinthemidline(ifitissecondarytocariesofcervicalspine)orononesideofmidline(ifitissecondarytotuberculosisofretropharyngealnodes).Treatmentincludesincisionanddrainageofabscessalongwithfullcourseofantituberculartreatment.
209.Proofpunctureisdonethrough? a)Superiormeatus b)Middlemeatus c)Inferiormeatus d)Sphenoethmoidalrecess CorrectAnswer-CAns.is'c'i.e.,InferiormeatusProoffuncture(Antralpuncture)Thisprocedureinvolvespuncturingthemedialwallofmaxillarysinusintheregionofinferiormeatusandirrigatingthesinus.Indications1.Chronicandsubacutemaxillarysinusitiswithdualpurposeof:ConfirmingthediagnosisandWashingoutthepus2.Tocollectthespecimenoftheantralcontentsforcultureandsensitivity,orcytologicalexaminationtoexcludeearlymalignancy.ContraindicationsChildrenlessthan12yearsofage.AcutemaxillarysinusitisasitmayleadtoosteomyelitisFractureofmaxillaasfluidmaypassthroughfractureline.Diabeteshearingit.Theexaminerthensaysthatheisgoingtorepeatthetest,butputsanon-vibratingforkonthemastoidwhileatthesametimebringingavibratingforkclosetotheauricle.Ifthepatientismalingering,hewillhearthetuningforkthroughairconduction,butthinkthatitisbeingheardthroughthebone.Ifheisreallydeafhewillnothearthefork.3.Lomard'stestThisdependsuponthefactthattothenormalmanthesoundofhis
ownvoiceisnecessaryfortheproperregulationofitstoneandloudness.TheBaranynoiseapparatusisadjustedtothepatient'ssoundearanditsmachinerystartedinordertoaccustomhimtoitsgratingnoise.Heisgivenabook,andtoldtoreadaloudinhisnormalvoiceandnottostopreadingwhentheinstrumentissetinaction.Assoonasthenoisebegins,amanwhoseoppositeearisprofoundlydeafwillatonceraisehisvoiceand,ifhisdeafnessisabsolute,mayliterallyshout.Themalingerer,ontheotherhand,claimingaone-sideddeafnesswhichisnotrealwillcontinuetoreadinaneventoneorinatoneonlyslightlyelevated.4.Acousticreflex(stapedialreflexthreshold)Ifstapedialreflexispresent,itrulesoutNOHLbecausestapedialreflexisnotinvoluntarycontrol.5.Electricresponseaudiometry(ERA)orcorticalevokedresponseaudiometryItisveryusefulinNOHLandcanestablishhearingacuityofthepersontowithin5-10dBofactualthresholds.6.OthertestsGaulttest,Erhard'stest,delayedspeechfeedback.
210.Inspiratorystridorisfoundinwhatkind oflesions: a)Supraglottic b)Subglottic c)Tracheal d)Bronchus CorrectAnswer-AAnswerA.SupraglotticGenerally,aninspiratorystridorsuggestsairwayobstructionabovetheglottis.Whileanexpiratorystridorisindicativeofobstructioninthelowertrachea.Abiphasicstridorsuggestsaglotticorsubglotticlesion.
211.Themostcommonsiteofthebranchial cystis: a)Posteriorborderofsternocleidomastoid b)Anteriorborderofsternocleidomastoid c)Digastricmuscle d)Omohyoidmuscle CorrectAnswer-BAnswer.B.AnteriorborderofsternocleidomastoidAbranchialcleftcyst(BCC)commonlypresentsasasolitary,painlessmassintheneckofachildoryoungadult.Theyaremostcommonlylocatedalongtheanteriorborderandtheupperthirdofthesternocleidomastoidmuscleintheanteriortriangleoftheneck.
212.Lowerlimitofretropharyngealspaceis at? a)C7 b)Bifurcationoftrachea c)4thesophagealconstriction d)None CorrectAnswer-BAns.is'b'i.e.,BifurcationoftracheaRetropharyngealspaceisdividedintotwolateralspaces(spaceofgillette)byafibrousband.RetropharyngealspaceislimitedabovebythebaseofskullandbelowwherethealarfasciafuseswithbuccopharyngealfasciaatthelevelofT4andcarina(bifurcationoftrachea).
213.Retroauricularincisionisalsoknown as? a)Rosen'sincision b)Lempert's-Iincision c)Lempert's-IIincision d)Wilde'sincision CorrectAnswer-DAns.is'd'i.e.,Wilde'sincision[Ref:DhingraSth/ep.410]Wilde'sincisionisusedforpostaural(retroauricular)approach.Lempert'sincisionisusedforendauralapproach.Rosen'sincisionisusedforstapedectomythroughendomeatalortranscanalapproach,
214.Electrodeofcochlearimplantisplaced at? a)Horizontalsemicircularcanal b)Scalamedia c)Scalatympani d)Scalavestibuli CorrectAnswer-CAns.is'c'i.e.,Scalatympani[RefEssentialsotolaryngology2d/ep.82]CochlearimplantsInternalcomponent:-ltcontainsreceiver/stimulatorwhichisimplantedundertheskinandelectrodewhichisimplantedinthescalatympaniofthecochleaacochleostomyopeninginthebasalturnofcochlea.Itmayalsobeplacedatotherlocationslikepromontoryorroundwindowbutthesesiteshaspoorerperformance.
215.Thresholdofhearinginayoungnormal adultis? a)0dB b)10dB c)20dB d)30dB CorrectAnswer-AAns.is'a'i.e.,0dB[RdDhingra4n/ep.21]AudiometriczeroThresholdofhearing,i.e.Thefaintestintensitywhichanormalhealthypersoncanhearwillvaryfrompersontoperson.TheInternationalStandardsOrganisation(ISO)adoptedastandardforthis,whichisrepresentedasthezerolevelontheaudiometer(0dB).AccordingtoISO,audiometriczeroisthemeanvalueofminimalaudibleintensityinagroupofnormallyhearinghealthyyoungadults.
216.Nasopharyngealcarcinomaseenin whichoccupation? a)Asbestosindustry b)Cementindustry c)Woodworkers d)Chimneyworkers CorrectAnswer-CAns.is'c'i.e.,WoodworkersRefDhingra4h/ep.235;NasopharyngealcarcinomaByAndrewVanHasselt,AlanG.Gibb2d/ep.4WooddustsexposureisariskfactorofnasopharyngealcarcinomaandAdenocarcinomaofPNS.FormaldehydeexposureisariskfactorofNasopharyngealcarcinoma.
217.Investigationofchoicefor nasopharyngealangiofibroma? a)X-ray b)MRI c)Plane-CT d)CT-contrast CorrectAnswer-DAns.is'd'i.e.,CTcontrastRef:DhingraSth/ep.262CTscanofheadwithcontrastenhancementistheinvestigationofchoiceforJNA.
218.Trueabouttubercularotitismediaareall except? a)Spreadsthrougheustachiantube b)Causespainlesseardischarge c)Maycausemultipleperforations d)Usuallyaffectsbothears e)None CorrectAnswer-DAnswer-D.UsuallyaffectsbothearsTuberculosisofmiddleearisacomparativelyrareentityusuallyseeninassociationwithorsecondarytopulmonarytuberculosis,infectionreachesthemiddleearthrougheustachiantube.ClinicalfeaturesGenerally,tuberculosisofmiddleearisunilateral.Itischaracterizedbypainlessotorrhoeawhichfailstorespondtotheusualantimicrobialtreatment.Thereispainlesswateryotorrhea.Singleormultipleperforationoftympanicmembrane.
219.FeatureofGranulomatosiswith polyangiitis: a)Nasalpolyp b)PerforatedNasalseptum c)Persistantsinus d)Crustingofnasalmucosa e)Collapseofnasalbridge CorrectAnswer-B:C:DAnswer-(B)PerforatedNasalseptum(C)Persistantsinus(D)CrustingofnasalmucosaGranulomatosiswithpolyangiitis(Wegener)isadistinctclinicopathologicentitycharacterizedbygranulomatousvasculitisoftheupperandlowerrespiratorytractstogetherwithglomerulonephritis.Disseminatedvasculitisinvolvingbothsmallarteriesandveinsmayoccur.Nasalfindingsincludecrustinggranulations,septalperforation&asaddlenoseDestructionoftheseptumwithacharacteristicimplosionofthenasalbridge.
220.Tensortympaniisattachedat? a)Malleus b)Incus c)Stapes d)Tympanicmembrane CorrectAnswer-AAns.is'a'i.e.,Malleus[RefGray'sAnatomy38thlep.485]Tympaniccavityhastwomuscles:
221.Vesiclesonexternalearareseenin a)Otitisexterna b)Malignantotitisexterna c)Herpeszoster d)Clearcellcarcinoma CorrectAnswer-CAns.is'c'i.e.,Herpeszoster[RefHeadandNeckSurgicalPathologyp.53]RamsayHuntsyndromeItislowermotorneurontypeoffacialpalsyduetoVaricella(herpes)zoster.Painisoftenaprominentfeatureandvesiclesareseenintheipsilateralear,onthehardpalateand/oronanteriortwothirdoftongue.Itmayinvolveothercranialnerves-V,VIII,IXandXandcervicalbranches(C2,C3&C4)thathaveanastomoticcommunicationswithfacialnerve.Thisresultsinfeatureslike:AnaesthesiaoffaceGiddinessHearingimpairmentalongwithVIInervepalsy.
222.Firstlinetreatmentformildretraction pocketintheearis a)Observation b)Antibiotics c)Tympanostomytube d)Surgicalexcision CorrectAnswer-BAns.is'b'i.e.,Antibiotics[RefConqueringOtitismediabyCharlesBluestonep.95]RetractionpocketItmustbetreatedbyanotolaryngologist.1)AntibioticsAmildretractionpocketthatispresentinafluid-filledmiddleearcanfirstbetreatedwithantibiotics.2)TympanostomyIfantibioticsdoesnotwork,atympanostomytubeisusuallyinserted,andinmostcases,theeardrumwillreturntonormal.Iftheretractionpocketisverydeep,atubeshouldbeinserted,bypassingtheantibiotictreatment.3)SurgicalexcisionIftheretractionpocketstilldoesnotgoaway,thedeformedeardrumshouldbeoperatedontopreventacholesteatomafromdeveloping.Onceacholesteatomadevelops,surgeryistheonlywaytoremoveit.
223.Cristaeareseenin? a)Utricle b)Saccule c)Semicircularcanal d)Otolithmembrane CorrectAnswer-CAns.is'c'i.e.,Semicircularcanal[RefDhingraSth/ep.16]VestibularapparatusThevestibularapparatuswithintheinnereardetectsheadmotionandpositionandtransducesthisinformationtoaneuralsignal.
224.Functionofsacculeis? a)Linearacceleration b)Angularacceleration c)Sensespositionofhead d)Rotationalmovement CorrectAnswer-A:CAns.is'a'i.e.,Linearacceleration&'c'i.e.,Sensespositionofhead
225.EarliestagefordoingBERAis? a)Inutero-beforebirth b)Atbirth c)3months d)6months CorrectAnswer-BAns.is'b'i.e.,Atbirth[RefLoganTurner10thlep.254;PLDhingra4th/ep.28]"Worldwidescreeningislargelyperformedinnewbornnurserywiththefirstscreeningtestperformedfrombirthuntil10daysofage"
226.Mostcommonmalignancyofmiddleear is a)Glomustumor b)Squamouscellcarcinoma c)Adenocarcinoma d)Sarcoma CorrectAnswer-BAns.is'b'i.e.,Squamouscellcarcinoma[RefTextbookofENTbyRakeshShrivastav2"/ep.67]Squamouscellcarcinomaisthemostcommonmalignanttumorofthemiddleear.Otherformsofmalignancylikeadenocarcinomaandsarcomaarerare.
227.Mostcommonbenigntumorofearcanal is a)Osteomas b)Sebaceousadenoma c)Papilloma d)Ceruminoma CorrectAnswer-AAns.is'a'i.e.,Osteomas[RefDhingra6thlep.107;BansalENTp.160;EncyclopediaofImaging,Baertp.1318]Osteomas/exostosesmostcommonbenigntumorsoftheexternalauditorycanal.SquamouscellcarcinomasMostcommonmalignanttumorsoftheexternalauditorycanal.
228.Diplacusisis a)Hearingsoundwithdiminishedintensity b)Hearingsoundsoftwodifferenttones c)Hearingextremelyloudsound d)Perceivinglightonproductionofsound CorrectAnswer-BAns.is'b'i.e.,Hearingsoundsoftwodifferenttones[RefTulilst/ep.114]Monauraldiplacusis:-Inmonauraldiplacusis,alistenerhearstwotoneswhenasingletoneispresentedtoasingleear,i.e.oneearhearstwodifferenttoneswhenpresentedone.Binauraldiplacusis:-Inbinauraldiplacusis,alistenerhearstwodifferenttonesinright&leftearwhenasingletoneispresentedtobothears.Bothmonoauralandbinauraldiplacusisarecausedbyinhomogenitiesinthecochleathatalsogiverisetospontaneousotoacousticemissions.
229.Whichsemicircularcanalismost commonlyinvolvedinBPPV? a)Horizontal b)Posterior c)Superior d)Alloftheabove CorrectAnswer-BAns.is'b'i.e.,Posterior[RefDhingraSth/ep.51]BPPVisthoughttobecausedbydisplacementofotoconia(mineralcrystals)fromthevestibuleofinnerearintothesemicircularcanals.Theposteriorsemicircularcanalismostcommonlyinvolved,thoughsuperiorandhorizontalcanalscanalcanalsobeaffected.OtoconiaorearrocksaresmallcrystalsofcalciumcarbonatederivedstructureintheutriclewhichmigrateintosemicircularcanalsandcauseBPPV.Whilesacculesalsocontainsotoconia,theyarenotabletomigrateintothesemicircularcanals.
230.Mostcommonossicleaffecteddueto trauma- a)Malleus b)Incus c)Stapes d)Allaffectedsimilarly CorrectAnswer-BAns.is'b'i.e,Incus[RefHearing:PracticalGuidebyTysomep.96]"Significantheadinjuryordirecttraumatothemiddleearcanresultinsubluxationofoneormoreoftheossicles,theincusbeingthemostcommonlyaffected
231.Singaporeearis a)Hypertrophyofsweatglands b)Hypertrophyofsebaceousglands c)Otitisexterna d)Excoriationofexternalearskin CorrectAnswer-CAns.is'c'i.e,Otitisexterna[RefClinicalENT5th/ep.223]ExcessivemoistureisanimportantpredisposingfactorforotitisexternaasexcessivemoistureelevatesthepHandremovesprotectivecerumen.Therefore,humidityandhotclimatepredisposetootitisexterna.Henceotitisexternaisalsoknownas:- 1. Singaporeear(whereclimateishotandhumid)2. Swimmer'sear3. Telephonist'sear(telephonistswhorequireinsertsintheirearhave excessivemoistureduetosweating).
232.Adiabeticpatientpresentswithfoul smellingeardischarge,feverandseverepainintheear.Onexaminationthereisthickyellowcoloureddischargefromtheearandgranulationtissueinthecanal.Whichofthefollowingistheappropriatemanagementforthispatient? a)Surgicaldebridement b)Antibiotictherapy c)Cryotherapy d)Laserremovalofgranulationtissue CorrectAnswer-BAns.is'b'i.e.,Antibiotictherapy[RefDhingra6th/ep.52]Thepatientdescribedinthequestionmostlikelyhasmalignantotitisexterna.Sothetreatmentofchoiceisanti-pseudomonalantibiotics.Extensivesurgicaldebridementonceanimportantpartofthetreatmentisnowrarelyneeded
233.Topodiagnosisoffacialnervehasallthe testsexcept a)Schirmertest b)Bingtest c)Tastetest d)Salivaryflowtest CorrectAnswer-BAns.is'b'i.e.,Bingtest[RefDhingra6th/ep.98]Thefollowingtestsareusefulinfindingthesiteoflesioninparalysisoflowermotorneuron. 1. Schirmertest:Itcompareslacrimationofthetwosides.Astripof filterpaperishookedinthelowerfornixofeacheyeandtheamountofwettingofstripmeasured.Decreasedlacrimationindicateslesionproximaltothegeniculategan-glionasthesecretomotorfibrestolacrimalglandleaveatthegeniculateganglionviagreatersuperficialpetrosalnerve. 2. Stapedialreflex:Stapedialreflexislostinlesionsabovethenerve tostapedius.Itistestedbytympanometry. 3. Tastetest:Itcanbemeasuredbyadropofsaltorsugarsolution placedononesideoftheprotrudedtongue,orbyelectrogustometry.Impairmentoftasteindicateslesionabovethechordatympani. 4. Submandibularsalivaryflowtest:Italsomeasuresfunc-tionof chordatympani.PolythenetubesarepassedintobothWhartonductsanddropsofsalivacountedduringoneminuteperiod.Decreasedsalivationshowsinjuryabovethechorda.
234.Whichofthefollowingisthefunctionof tensortympanimuscle? a)Dampenveryloudsound b)Tensestympanicmembrane c)Tensespharyngotympanictube d)Preventnoisetraumatotheinnerear CorrectAnswer-BAns.is'b'i.e.,Tensestympanicmembrane[RefDhingra6"/ep.8]Normalopeningoftheeustachiantubeequalizesatmosphericpressureinthemiddleear;closingoftheEustachiantubeprotectsthemiddleearfromunwantedpressurefluctuationsandloudsounds.Themusclesoftheeustachiantubesystemhelptoopenandclosethetube,thusallowingittoperformitsfunction.Themusclesare:? 1. Tensorvelipalatini(tensorpalatini):-Contractionofthismuscle duringswallowing,yawningandsneezingopensthetube.Defectivefunctionofthismuscleincleftpalateresultsineustachiantubedysfunction. 2. Tensortympani:-Tensonisesthetympanicmembrane.3. Levatorvelipalatini:-Sometimes,italsohelpstoopenthetube, howeveritisusuallyconsideredasavelopharyngealvalvemuscleonly. 4. Salpingopharyngeus:-Itsfunctionalsignificanceisquestionable.
235.Pinkreflexthroughintacttympanic membraneinactiveotosclerosisisknownas a)Schwabach'ssign b)Schwartzsign c)Lyre'ssign d)Chvostek'ssign CorrectAnswer-BAns.is'b'i.e.,Schwartzsign[RefDhingra5th/ep.98;Currentotolaryngology2nd/ep.674]Areddishhue/Flammingopinkmaybeseenonthepromontoryandovalwindownicheowingtotheprominentvascularityassociatedwithanotospongioticfocus.Thisisk/aSchwartzsign.Schwartzsignisapinkreflex,seenthroughintacttympanicmembrane,intheareaofovalwindow.Itindicatesactiveotosclerosisusuallyduringpregnancy.Lyre'ssignissplayingapartofinternalandexternalcarotidarteriesonangiogramincasesofcarotidbodytumouroftheneck.Chvostek'ssignseeninhypocalcaemiaasaftertotalthyroidectomywhereparathyroidshavealsobeenremoved.Tappingoverthedistributionoffacialnerveproducesatwitch.
236.SADEclassificationclassifies a)Retractionoftympanicmembrane b)ExtensionofGlomustumor c)Mortalityafterheartdiseaseduringpregnancy d)ExtentofCSFrhinorrhea CorrectAnswer-AAns.is'a'i.e.,Retractionoftympanicmembrane[RefBasicClinicalRadiobiology5th/ep.942]Sade'sclassificationofretractionoftheparstensaofthetympanicmembranedefinedtwotypesofretractionandclassifiedeachonanordinalscale:?1.Atelectasis,definedasdiffuse'retractionofthetympanicmembranetowardsthepromontorium'.2.Retractionpocket,definedasfocal'retractionoftheparstensatowardsorintotheattic'
237.A10yearoldchildpresentswithnon foulpurulentsmellingdischarge,whichispainless.Patientreportsthatheisabletohearbetterinthepresenceofdischargethanwhentheearisdry.Themostprobablediagnosisis a)CSOM b)Serousotitismedia c)Cholesteatoma d)Mastoiditis CorrectAnswer-AAns.is'a'i.e.,CSOM[RefDhingra6th/ep.68]ClinicalfeaturesofCSOMProfusemucopurulantdischargewhichisnotfoulsmelling,i.e.,nonfoulsmellingdischarge.Hearingloss(conductivetype).Ifsensorineuralcomponentalsooccurs(i.e.,mixedtype),itarousesthesuspicianoftoxicdeafness.Sometimes,patientreportsaparadoxicaleffect,i.e.,hearsbetterinthepresenceofdischargethanwhentheearisdry.Thisisduetoroundwindowshieldingeffectproducedbydischargewhichhelpstomaintainphasedifferential.Thereisnopain,ifitoccursitisduetoassociatedotitisexternanotduetootitismedia.Sincetheinfectedareaisopenatbothends,dischargedoesnotaccumulateinthemiddleearcavity.Ossicularchainismostlyuninvolved,ifinvolvedonlylongprocessof
incusisinvolved.
238.Treatmentofcentralsafeperforationof tympanicmembraneincludesallexcept a)Auraltoilet b)Eardrops c)Avulsionofauralpolyp d)Myringoplasty CorrectAnswer-CAns.is'c'i.e.,Avulsionofauralpolyp[RefDhingra6thlep.72]Anauralpolypshouldneverbeavulsedasitmaybearisingfromthestapes,facialnerveorhorizontalcanalandthusleadtofacialparalysisorlabyrinthitis.TreatmentTheaimistocontrolinfectionandeliminateeardischargeandatalaterstagetocorrectthehearinglossbysurgicalmeans. 1. Auraltoilet:Removealldischargeanddebrisfromtheear.Itcanbe donebydrymoppingwithabsorbentcottonbuds,suctionclearanceundermicroscopeorirrigation(notforcefulsyringing)withsterilenormalsaline.Earmustbedriedafterirrigation. 2. Eardrops:Antibioticeardropscontainingneomycin,polymyxin, chloromycetinorgentamicinareused.Theyarecombinedwithsteroids,whichhavelocalantiinflammatoryeffect. 3. Systemicantibiotics:Theyareusefulinacuteexacerbationof chronicallyinfectedear,otherwiseroleofsystemicantibioticsinthetreatmentofCSOMislimited. 4. Precautions:Patientsareinstructedtokeepwateroutoftheear duringbathing,swimmingandhairwash.Rubberinsertscanbeused.Hardnoseblowingcanalsopushtheinfectionfromnasopharynxtomiddleearandshouldbeavoided.
5. Treatmentofcontributorycauses:Attentionshouldbepaidtotreat concomitantlyinfectedtonsils,adenoids,maxillaryantrumandnasalallergy. 6. Surgicaltreatment:Auralpolyporgranulations,ifpresent,shouldbe removedbeforelocaltreatmentwithantibiotics.Itwillfacilitateeartoiletandpermiteardropstobeusedeffectively. 7. Reconstructivesurgery:Onceearisdry,myringoplastywithor withoutossicularreconstructioncanbedonetorestorehearing.Closureofperforationwillalsocheckrepeatedinfectionfromtheexternalcanal.
239.Aggernasiis a)Mucosalflapcoveringthenasolacrimalduct b)Openingofthesinuses c)Depressioninfrontofmiddleturbinate d)Elevationanteriortomiddleturbinate CorrectAnswer-DAns.is'd'i.e.,Elevationanteriortomiddleturbinate[RefDhingra5thiep.150;Tuli1"/ep.135]Atriumisashallowdepressioninfrontofthemiddleturbinate.Aggernasiisanelevationjustanteriortotheattachementofmiddleturbinate.
240.Quadrungularseptumisseeninwhichof thefollowing? a)Larynx b)Nose c)Cranium d)Palate CorrectAnswer-BAns.is'b'i.e.,Nose[RefDhingra5th/ep.150]"Cartilageoftheseptum,alsoknownasthequandragularcartilagebecauseitisroughlyquadrilateralinshape-separatesthenostrils".
241.Nasalvestibuleis a)Lateralpartofnasalcavity b)Antero-inferiorpartofnasalcavity c)Supero-medialpartofnose d)Posteriorapertureofnose CorrectAnswer-BAns.is'b'i.e.,Antero-inferiorpartofnasalcavity[RefOtolaryngologyBasicScience&ClinicalReviewbyVanDeWaterp.462]Internalnosehasfollowingparts:Nasalcavityproper:-Internalnoseisdividedintorightandleftnasalcavitiesbynasalseptum.Eachnasalcavitycommunicateswiththeexteriorthroughnarisornostrilsandwithnasopharynxthroughposteriornasalapertureorposteriornaresorchoana.Vestibuleofnose:-Anteriorandinferiorpartofthenasalcavityislinedbyskinandiscalledvestibuleofnose.Itcontainssebaceousglands,hairfolliclesandthehaircalledvibrissae.
242.Whichofthefollowingtermsisusedto describethemostprominentpointofnasaltip? a)Pronasale b)Alare c)Nasion d)Columellaapex CorrectAnswer-AAns.is'a'i.e.,Pronasale[RefHandbookofanthropometry:Physicalmeasuresofhumanforminhealthanddiseases,byVictorR.Preedy,p.922]Pronasale:Mostprominentpointonthenasaltip.Alare:Thepointwherethenasalblade(Alanasi)extendsthefarthestout.Columellaapex:Themostanteriororthehighestpointonthecolumellacrestattheapexofthenostril.Nasion:Thepointinthemidlineofboththeanatomicnoseandthenasoanterioralsuture
243.Epistaxisafterligatingexternalcarotid arteryisduetowhichvessel? a)Anteriorethmoidalartery b)Superiorlabialartery c)Sphenopalatineartery d)Greaterpalatineartery CorrectAnswer-AAns.is'a'i.e.,Anteriorethmoidalartery[RefDhingra5thiep.190]Sinceexternalcarotidarteryisligated,thebleedingcomesfrombranchesoftheinternalcarotidartery.Anteriorethmoidalartery,abranchofophthalmicartery,whichisabranchofinternalcarotidartery,isaconstituentofthebloodsupplyoftheLittle'sareaofthenasalseptum.Bloodsupplyofnasalseptumi)InternalcarotidsystemAnteriorethmoidalarteryBranchesofophthalmicarteryPosteriorethmoidalarteryii)ExternalCarotidSystemSphenopalatineartery(branchofmaxillaryartery)givesnasopalatineandposteriormedialnasalbranches.Septalbranchofgreaterpalatineartery(Br.ofmaxillaryartery).Septalbranchofsuperiorlabialartery(Br.offacialartery)
244.Killian'spolypisa/an a)Antrochoanalpolyp b)Ethmoidalpolyp c)Frontalpolyp d)Maxillarypolyp CorrectAnswer-AAns.is'a'i.e.,Antrochoanalpolyp[RefDhingra5th/ep.186;Essentialotolaryngology2"1/ep.660]Nasalpolypsareoftwotypes:?Antrochoanal:-Thisisusuallysolitaryandarisesfrommaxillarysinusandgrowsbackwardinthenosetowardsthechoana(incontrasttoethmoidalpolypswhichtendtogrowforward).TheAntrochoanalpolypwasfirstdescribedbyGustainkillians,thereforethenamegiventoitwaskillian'spolyp.Ethmoidal:-Thesearemultiple,bilateralandarisefrometmoidalsinusesandtendtoprotrudeforwards.
245.Whichofthefollowingisthe predisposingfactorforethmoidalcarcinoma a)Smoking b)Alcohol c)Chronicinfection d)Alloftheabove CorrectAnswer-AAns.is'a'i.e.,Smoking[RefDiseasesofENTbyBansalp.363]Riskfactorsforsquamouscellcarcinomaoftheparanasalsinuses:-Smoking,Mustardgas,Nickelandchromiumplatingindustry,IsopropyloilLeatherindustry,Wooddustexposure(adenocarcinomaofethmoid),Polycyclicvolatilehydrocarbons
246.Mostcommonsinuspredisposedto malignancywhichofthefollowing? a)Ethmoid b)Maxillary c)Frontal d)Sphenoid CorrectAnswer-BAns.is'b'i.e.,Maxillary[RefDhingra5thiep.219]Themajorityofparanasalsinusmalignancies(50-80%)originatewithinthemaxillarysinusantrum.Sinusesandvariousconditionsinwhichsinusesareaffectedindescendingorderoffrequency
247.Mostcommonbenigntumorofparanasal sinuses? a)Papilloma b)Osteoma c)Warts d)Fibroma CorrectAnswer-BAns.is'b'i.e.,Osteoma[RefLoganTurner8`h/ep.89]Osteomaofthefrontalsinus-Mostcommonbenigntumourarisinginthenasalsinuses.Theosteomaarisesfromthefloorofthefrontalsinusnearthemidline.
248.Treatmentofnasalbonefracture includesallexcept a)Hematomadrainage b)Topicalvasoconstrictor c)Closedreduction d)Immediaterhinoplasty CorrectAnswer-DAns.is'd'i.e.,Immediaterhinoplasty[RefScottBrown7th/ep.1612]TreatmentofnasalinjuriesAfterensuringpatencyofairway,adequateventilationandoverallstabilityofpatient,attentiontothenasalinjuriesshouldbegiven.Standardtherapyistoperformclosedreductionoropenreducationbetween3and7days,andupto2weeks.Thisisbecause:Mostofthepatients(-70-80%)donotrequireanyactivetreatment,asmanydonothaveanasalfractureandthosethatdo,thefractureisnotdisplaced.Softtissueswellingcanproducethemisleadingappearanceofadeformitywhichdisapearsastheswellingsubsides.Suchpatientsrequireonlyreassurance&topicalvasoconstrictorstoalleviatecongestionandobstructivesymptoms.Are-examinationshouldbecarriedoutafter5days,ifthereisuncertainityabouttheneedforreduction.Alargenumberofpatientswillhaveapreexistingnasaldeformitycausedbyapreviousincident.Patientsthatfallinthiscategoryareadvisedtoconsideraformalrhinoplastywheneverythinghassettleddownsomemonthslater.Immediatesurgicalinterventioninacutephaseisindicated:?Severedeformity:-Septalhematomacausingnasalobstruction
249.Allofthefollowingaretrueabout parapharyngealabscessexcept? a)Mastoidprocessdividesthespaceintoanteriorandposterior b)Alsoknownaspharyngomaxillaryspaceinfection c)Tonsilispushedmedially d)Occursaftertoothextraction CorrectAnswer-AAns.is'a'i.e.,Mastoidprocessdividesthespaceintoanteriorandposterior[RefDhingraV/ep.281]Styloidprocessandthemusclesattachedtoitdividetheparapharyngealspaceintoanteriorandposteriorcompartments,notmastoidprocess.
250.Liningepitheliumofvocalcordis a)Stratifiedsquamousepithelium b)Nonstratifiedsquamousepithelium c)Ciliatedcolumnarepithelium d)Nonciliatedcolumnarepithelium CorrectAnswer-AAns.is'a'i.e.,Stratifiedsquamousepithelium[RefDhingraViep.300]Vocalcordsalongwiththeupperpartofthevestibuleistheonlypartoflaryngealmucousmembranewhichislinedbyepitheliumofstratifiedsquamoustype.Elsewhereinthelarynxepitheliumofthemucousmembraneisciliatedcolumnartype.
251.WhichofthefollowingsitesofCalarynx hasthebestprognosis? a)Glottic b)Supraglottis c)Subgottis d)Allhavepoorprognosis CorrectAnswer-AAns.is'a'i.e.,Glottic[RefDhingra5th/ep.326]Laryngealcarcinoma:- Cancer Prognosis Glottis Good Supraglottis PoorSubglottis Worst
252.Laserusedintrachealneoplasmis a)Argon b)KTP-532 c)CO2 d)Nd-YAG CorrectAnswer-CAns.is'c'i.e.,CO2[RefDhingra5th/ep.315]FourtypesoflaseraregenerallyusedinENTsurgery:ArgonKTP-532(Potassiumtitanylphosphate);Nd:YAG(Neodyminum-yttriumaluminiumgarnet);CO2Thecarbondioxide(CO)laseristhemostcommonlaserusedfortrachealneoplasm.
253.Mostcommonsiteofdistantmetastasis fromCalarynx a)Lymphnodes b)Lung c)Brain d)Bone CorrectAnswer-BAns.is'b'i.e.,Lung[RefClinicalOtorhinolaryngologyyd/el).931]Distantmetastasisisseenmuchlessfrequently.Themostcommonlyaffectedsitesfordistantmetastasesarelungs(66%);bone(22%),liver(10%),mediastinumandbonemarrow.
254.ApatientpresentswithCalarynx involvingleftfalsecord,leftarytenoidandleftaryepiglotticfoldwithbilateralmobiletruecords.Thetreatmentofchoiceinthispatientiswhichofthefollowing? a)Verticalhemilarygectomy b)Horizontalpartialhemilaryngectomy c)Totallaryngectomy d)Radiotherapyfollowedbychemotherapy CorrectAnswer-BAns.is'b'i.e.,Horizontalpartialhemilaryngectomy[RefDhingra4th/ep.284]Involvementofunilateralfalsecord,aryepiglotticfoldsandarytenoidswithmobilecordsuggestssupraglotticcancerinT2stage(morethanonesubsitesofsupraglottisareinvolved).
255.Inrecurrentlaryngealnervepalsywhich musclekeepsvocalcordinmedianposition? a)Posteriorcricoarytenoid b)Cricothyroid c)Vocalis d)Alloftheabove CorrectAnswer-BAns.is'b'i.e.,Cricothyroid[RefDhingra5th/ep.300]RecurrentlaryngealnerveparalysisRecurrentlaryngealnervesupplies:? 1. Allintrinsicmusclesofthelarynxexceptcricothyroid.2. Sensorysupplytolarynxbelowvocalcords. So,paralysisofrecurrentlaryngealnervecauses:? 1. Paralysisofallintrinsicmusclesincludingalladductors(exceptfor cricothyroid)andallabductors. 2. Anaesthesiabelowthelevelofvocalcord. Though,thereisparalysisofbothadductors(exceptcricothyroid)andabductors,themanifestationsaremainlyduetoparalysisofabductors.
256.
Foodparticlesmostlygetobstructedinwhichpartofesophagus- a)Cricopharyngealsphincter b)Crossingofarchofaorta c)Cardiacend d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e,Cricopharyngealsphincter[Ref:Dhingra6thiep.349]Byfarthecommonestsiteisatorjustbelowthecricopharyngealsphincter.Flatobjectslikecoinsareheldupatthesphincterwhileothersareheldintheupperoesophagusjustbelowthesphincterduetopoorperistalsis.
257.Trueregardingtractiondiverticuliof esophagusisallexcept a)Doesnotemptycompletely b)Triangularappearance c)Containsalllayers d)Maintainselasticrecoil CorrectAnswer-AAns.is'a'i.e.,Doesnotemptycompletely[RefTheEsophagusbyRichterp.143] PulsionDiverticulaFalsediverticula TractionDiverticula Ususallyonlymucosal Truediverticula outpouchingsDistal Type Linedbyalllayers esophagus Layers Midesophagus Associatedwith Location ScarringfromTBor dysmotility Associated histoplasmosisinvolvingperihilar Rounded Shape orsubcarinallymphnodes outpouchings Emptying Triangularortented Donotempty Tendstoemptycontents completelyEpiphrenicdiverticula,Zenker'sdiverticula
258.Sluder'sneuralgiaisalsocalledas a)Anteriorethmoidalsyndrome b)Posteriorethmoidalsyndrome c)Trottersyndrome d)Lermoyezsyndrome CorrectAnswer-AAns.is'a'i.e.,Anteriorethmoidalsyndrome[RefDhingra6th/ep.450]Sluder'sneuralgiaItisalsocalledanteriorethmoidalsyndrome.Itissaidtooriginatefromthemiddleturbinatepressingonthenasalseptum.Itischaracterizedbypainaroundthebridgeofthenoseradiatingintoforehead.TreatmentAnatomicalcorrectionrelievesthepain.
259.Mostcommontumoroforopharynxis a)Squamouscellcarcinoma b)Adenocarcinoma c)Melanoma d)Salivaryglandtumors CorrectAnswer-AAns.is'a'i.e.,Squamouscellcarcinoma[RefAbeloff'sClinicalOncology6"lep.1059]90?95%oftumorsintheoropharynxaresquamouscellcarcinomas,whereasothersareminorsalivaryglandtumors,melanomas.Themostcommonmanifestingsymptomsareanontenderneckmass,dysphagia,otalgia,ora"hotpotato"voice.
260.Investigationofchoicefordiagnosing submandibularglandductstonesis a)Ultrasound b)X-rayoffloorofmouth c)Sialography d)Sialoendoscopy CorrectAnswer-AAns.is'a'i.e.,Ultrasound[RefChurchill'spocketbookofsurgeryp.133]InvestigationsforsalivaryglandstonesUltrasoundistheinvestigationofchoice?asitpermitsassessmentofthegland,ductsystemandcalculuswhichusuallyhasanacousticshadow.'Floorofmouth'radiographicviewforsubmandibularcalculiinWharton'sductwhereultrasoundfindingsareequivocalorunavailable.Ifnostoneisseen,considersialography.Sialoendoscopyisincreasinglyusedinthediagnosisandtreatmentofsalivaryglandoutflowobstructiveconditions.
261.DeafnessinacaseofPaget'sdiseaseis dueto a)Retractionpockets b)Otitis c)Eightnerveinvolvement d)Endolymphatichydrops CorrectAnswer-CAns.is'c'i.e.,Eightnerveinvolvement[ReferNeurologyconsult5"/ep.866]Cranialnervecompressionistheusualcauseofdeafness.ComplicationsofPaget'sdiseaseFollowingcomplicationscanoccurinPaget'sdisease:- 1. Fracture:Arecommoninweightbearingbones2. Cranialnervecompression:-Maycauseimpairedvision,facial palsy,trigeminalneuralgiaordeafness. 3. Otosclerosis:-AnothercauseofdeafnessinPaget'sdisease.4. Spinalcanalstenosisandnerverootcompression5. Highoutputcardiacfailure6. Osteoarthritis:ofHipandknee7. Rarelyosteosarcoma
262.Membraneincisedduring hemilaryngectomyis a)Thyrohyoid b)Cricothyroid c)Aryepiglottic d)Infralaryngeal CorrectAnswer-BAns.is'b'i.e.,Cricothyroid[RefDhingraelep.310]IndicationsandcontaindicationsIdealforbulkylesionsofthemembranoustruevocalcordNormalorslightlyimpairedvocalcordmobilityNoinvolvementofthesupraglottis
263.Callauralfistulaisanabnormalityof? a)1"branchialarch b)Ptbranchialcleft c)2ndbranchialarch d)2ndbranchialcleft CorrectAnswer-BAns.is'b'i.e.,PtbranchialcleftCollauralfistulaisa1"branchialcleftanomalywhicharisesfromfailureoffusionoftheventralpartofthePtcleft.Itsupperpartopensintofloorofexternalauditarycanal.Itslowerpartopensintheneckbetweenangleofmandibleandsternocleidomastoidmuscle.
264.Acutesuppurativeotitsmediainchildren ismostcommonlycausedby? a)St.pneumoniae b)S.epidermidis c)S.aureus d)Pseudomonas CorrectAnswer-AAns.is'a'i.e.,St.pneumonia[RefDhingra5thlep.54]ASOMisespeciallycommonininfantsandchildren.MostofthetimeASOMusuallyfollowsrespiratorytractinfections(i.e.,acutetonsillitis,commoncoldorinfluenza)andtheinfectiontravelupbytheeustachiantubetothemiddleear.Themostcommoncausativeorganismisstreptococcuspneumoniae
265.Young'soperationisdonefor a)Allergicrhinitis b)Atropicrhinitis c)Vasomotorrhinitis d)Idiopathicrhinitis CorrectAnswer-BAns.is'b'i.e.,Atrophicrhinitis[RefDhingra5th/ep.171;Essentialotolaryngology2"d/ep.523]SurgicaltreatmentofAtrophicrhinitis 1. Young'soperation2. ModifiedYoung'soperation3. Narrowingofthenasalcavityby(Lautenslagersoperation)4. Lautenslagersoperation
266.
Allofthefollowingareareapartofmedialwallofthemiddleearexcept? a)Promontory b)Fenestravestibule c)Pyramid d)Subiculum CorrectAnswer-CAns.is'c'i.e.,Pyramid[RefDhingra avep.6] S Medialorinnerorlabyrinthicwall(parieslabyrinthica)ofmiddleearItisformedbylabyrinthandseparatesthemiddleearcavityfrominternalear.Ithasfollowingfeatures:-Abulgecalledaspromontoryformedbybasalturnofcochlea.Fenestravestibuli(ovalwindow)liesposterosuperior(behindandabove)tothepromontoryandopensintoscalavestibuli.Itisoccupiedbyfootplateofstapesfixedbyannularligament.Its,sizeonaverageis3.25mmlong&1.75mmwide.Fenestracochleae(roundwindow)liesposteroinferiortothepromontoryandopensintoscalatympaniofcochlea.Itisclosedbysecondarytympanicmembrane.Theroundwindowisclosesttoampullaofposteriorsemicircularcanal.Roundwindowisatriangularopening.Itsdiameterisbetween1.8to2.3mm.
267.Whatistheintensityindecibelofnormal conversationinhumans? a)30dB b)60dB c)90dB d)150dB CorrectAnswer-BAns.is'b'i.e.,60dB[RefDhingra5thlep.23]Intensityisthestrengthofsoundwhichdeterminesitsloudness.Itisusuallymeasuredindecibels(dB).Followingareintensitieswhenapersonisatadistanceofonemeterfromsoundsource. Whisper 30dB Normalconversation 60dBShout 90dB Discomfortofear 120dB Paininear 130dB
268.WhatistheroleofSodiumFluoridein otosclerosis? a)Itrestorestheelectrolyteequilibrium b)IthastensrecoveryoftheOverstimulatedCochlea c)Itquickensthematurityoftheactivefocusandreduces osteoclasticresorption d)Itrepolarizesthecochlearcells CorrectAnswer-CAns.is'c'i.e.,Itquickensthematurityoftheactivefocusandreducesosteoclasticresorption[RefCurrentDiagnosisandtreatmentinOtolaryngology2nd/ep.678;OtosclerosisandStapedectomy:Diagnosis,Management,andComplicationbyGlasscock(7hieme)1st(2004)p.61,62]MechanismofactionofSodiumfluorideinotosclerosis 1. Reducesosteoclasticboneresorptionandincreasesosteoblastic boneformation:Theseactionsreduceboneremodellinginactivelyexpandingosteolyticlesionsandpromoterecalcification. 2. Inhibitsproteolyticenzymesthatarecytotoxictothecochlea: Inhibitionofproteolyicenzymesthatarecytotoxictothecochleaisbelievedtopreventsensorineuraldeafness.
269.Chemicallabyrinthectomyby transtympanicrouteisdoneinMeniere'sdiseaseusingwhichdrug? a)Amikacin b)Gentamicin c)Amoxycillin d)Cyclosporine CorrectAnswer-BAns.is'b'i.e.,Gentamicin[RefLevineSC,HaberkampTJ.LabyrinthectomytocorrectvertigoOperativetechniquesinotolaryngology-Head&necksurgery.2001.12:141-143.]ChemicallabyrinthectomyinmeneiresdiseaseisdoneusingGentamicinlocally.
270.Whichofthefollowingtestsisnotused todifferentiatebetweencochlearandretrocochlearhearingloss? a)SISITEST b)Evokedresponseaudiometry c)Thresholdtonedecaytest d)Recruitment CorrectAnswer-CAns.is'c'i.e.,Thresholdtonedecaytest[RefDhingra5th/ep.31;zr/ep.28]
271.Whereistheauditorycortexlocated insidethebrain? a)Superiortemporalgyrus b)Inferiortemporalgyrus c)Area3,1,2 d)Cingulategyrus CorrectAnswer-AAns.is'a'i.e.,Superiortemporalgyrus[RefPickles,James0.(2012).AnIntroductiontothePhysiologyofHearing(4thed.).Bingley,UK:EmeraldGroupPublishingLimited,pp.215-217.]PrimaryAuditoryCortexislocatedbilaterally,roughlyattheuppersidesofthetemporallobes-inhumansonthesuperiortemporalplane,withinthelateralfissureandcomprisingpartsofHeschl'sgyrusandthesuperiortemporalgyrus,includingplanumpolareandplanumtemporale(roughlyBrodmannareas41,42,andpartially22).
272.Whendoestherudimentarycochlea developinthefetus? a)Firstweek b)4thto8thweek c)8thto12thweek d)16to20thweek CorrectAnswer-BAns.is'b'i.e.,4thto8thweek[RefChap172-Teviewofmedicalembryology-BenPasky]DevelopmentofInnerearAfterimplantation,aroundthesecondtothirdweekthedevelopingembryoconsistsofthreelayers:endoderm,mesodermandectoderm.Thefirstpartoftheeartodevelopistheinnerear,whichbeginstoformfromtheectodermaroundthe22nddayoftheembryo'sdevelopment.Specifically,theinnerearderivesfromtwothickeningscalledoticplacodesoneithersideofthehead.Eachoticplacoderecedesbelowtheectoderm,formsanoticpitandthenanoticvesicle.Thisentiremasswilleventuallybecomesurroundedbymesenchymetoformthebonylabyrinth.Aroundthe33'ddayofdevelopment,thevesiclesbegintodifferentiate.Closertothebackoftheembryo,theyformwhatwillbecometheutricleandsemicircularcanals.Closertothefrontoftheembryo,thevesiclesdifferentiateintoarudimentarysaccule,whichwilleventuallybecomethesacculeandcochlea.Partofthesacculewilleventuallygiveriseandconnecttothecochlearduct.Thisductappearsapproximatelyduringthesixth
weekandconnectstothesacculethroughtheductusreuniens.
273.Themainmuscleaffectedincongenital musculartorticollisis? a)Sternocleidomastoid b)Trapezius c)ScalenusAnticus d)Omohyoid CorrectAnswer-AAns.is'a'i.e.,Sternocleidomastoid[Ref:Cooperman,DanielR.(1997).Karmel-Ross,Karen,ed."TheDifferentialDiagnosisofTorticollisinChildren".Physical&OccupationalTherapyinPediatrics.17(2):1-11]Thecauseofcongenitalmusculartorticollisisunclear.Birthtraumaorintrauterinemalpositionisconsideredtobethecauseofdamagetothesternocleidomastoidmuscleintheneck.Otheralterationstothemuscletissuearisefromrepetitivemicrotraumawithinthewomborasuddenchangeinthecalciumconcentrationinthebodywhichcausesaprolongedperiodofmusclecontraction.
274.Miraclefruitisusedtochangethetaste from? a)SourtoBitter b)SourtoSweet c)Bittertosweet d)Saltytosweet CorrectAnswer-BAns.is'b'i.e.,SourtoSweet[RefPeterHanelt,ed.(2001).Mansfeld'sencyclopediaofagriculturalandhorticulturalcrops2.Springer.p.1660.ISBN3-540-41017-1.]MiracleFruitcontainsaglycoproteincalledmiraculin,whichbindstothetongue'stastebudswhenthefruitisconsumed.Miraculinactsasasweetnessinducerwhenitcomesincontactwithacids,causingsourfoodstotastesweet,temporarily.
275.Allofthefollowingarecomplicationsof maxillarysinuslavageandinsufflationexcept? a)Airembolism b)Orbitalinjury c)Epistaxis d)Facialnerveinjury CorrectAnswer-DAns.is'd'i.e.,Facialnerveinjury[RefSchlemmerKD,NaidooSK.Complicatedsinusitisinadevelopingcountry,aretrospectivereview.IntJPediatrOtorhinolaryngol.2013May17]ComplicationofMaxillarysinuslavageandinsufflationComplicationsofnonendoscopicdrainageprocedurescanbeminororsevere.Themostcommoncomplicationisfailuretoenterthesinusbecauseofimproperpositioningofthetrocar,incompletepenetrationofthesinusmucosa,orthepresenceofahypoplasticantrum.Epistaxismayoccurbecauseoflacerationofthenasalmucosaorpreexistingcoagulopathiesnecessitatingpacking.Severecomplicationsincludeorbitalinjury,airembolism,anddeathsecondarytoinjectionofairintothesinus.
276.Allofthefollowingareremovedin verticalhemilaryngectomyexcept? a)HalfGlottis b)HalfSupraglottis c)Halftongue d)HalfSubglottis CorrectAnswer-CAns.is'c'i.e.,Halftongue[RefDhingra4th/ep.284;http://128.255.52.245/oto/Beta/database/contents]Verticalhemilaryngectomymeansexcisionofonehalfofthelarynxononeside,i.e.,verticalhalfisremovedwhichincludeverticalhalfofsupraglottis,glottisandsubglottis.Horizontalhemilaryngectomyistheexcisionofsupraglottisonly,alsoknownassupraglotticlaryngectomy.
277.
Submucosalresectionisthetreatmentof choiceof? a)DNSinadults b)DNSinchildren c)Sluder'sNeuralgia d)Nasalpolyp CorrectAnswer-AAns.is'a'i.e.,DNSinadults[RefDhingra5th/ep.423]Submucousresection(SMR)isasurgicalproceduretocorrectthedeformityofnasalseptum.Theprincipleofthisprocedureistoremovedeviatedcartilageandbonefrombeneaththemucosalliningofnasalseptum,leavingacorrectedseptumlargelycomposedofscartissue.Submucousresectionisnotadvocatedinchildrenupto17yearsofageasitmayinterferewithdevelopmentofthefacialbones.
278.Whichperforationofthetympanic membraneismostcommonlyseenwithtubotympanicCSOM? a)Central b)Anterosuperior c)Posterosuperior d)Posteroinferior CorrectAnswer-AAns.is'a'i.e.,Central[RefDhingra5thlep.77;Pediatricotolaryngology2"/ep.478]TubotympanicCSOMItisalsoknownassafeearasitdoesnotcauseanyseriouscomplicationsInfectionisislimitedtoantero-inferiorpartofmiddleearcleft(eustachaintube&mesotympanum)andisassociatedwithcentralperforationinparstensaoftympanicmembrane.
279.CaldwellLucSurgeryhasitsapproachto themaxillaryantrumthrough? a)Gingivolabialsulcus b)Inferiororbitalrim c)Nasalseptum d)Cribriformplate CorrectAnswer-AAns.is'a'i.e.,Gingivolabialsulcus[RefDhingra5thIep.422]
280.InCaldwellLucoperation,theapproach isthroughthe? a)SublabialApproachleadingtoopeningofmandibularantrum b)Throughthesphenopalatinerecess c)Openingofmaxillaryantrumthroughgingivolabialapproach d)Superiormeatus CorrectAnswer-CAns.is'c'i.e.,Openingofmaxillaryantrumthroughgingivolabialapproach[RefDhingraStilep.422]Caldwell-Lucoperationisaprocessofopeningthemaxillaryantrumthroughcaninefossabysublabialapproachanddealingwiththepathologyinsidetheantrum.Inthissurgery,antrumisreachedthroughaincisioningingivolabialsulcus(fromlateralincisorto2"dmolar)andthenopeningofantruminthisarea.
281.Allofthefollowingareindicationsfor tracheostomyexcept? a)Comaafterheadinjury b)Maxillofacialinjury c)Bilateralabductorpalsy d)Superiorlaryngealnervepalsy CorrectAnswer-DAns.is'd'i.e.,Superiorlaryngealnervepalsy[RefAjayYadavzithiep.215;Dhingra5thiep.337]TracheostomyAtracheostomyisasurgicalproceduretocreateanopeningthroughtheneckintotheanteriorwalloftrachea.Atubeisusuallyplacedthroughthisopeningtoprovideanairwayandtoremovesecretionsfromthelungs.Thetubeiscalledtracheostomytube.
282.Mostcommoncauseofotitisexternais? a)Fungalinfection b)Bacterialinfection c)Seborrheicdisease d)HerpesZoster CorrectAnswer-BAns.is'b'i.e.,Bacterialinfection[RefClinicalENT5th/ep.223]Mostcommoncauseofotitisexternaisbacterialinfection.Twomostcommoncausativebacteriaarestaphylococcusaureusandpseudomonas
283.Whichisthenarrowestportionofthe esophagus? a)Atthecricopharyngealsphincter b)Atthecrossingoftheleftmainbronchus c)Attheleveloftheaorticarch d)Atthediagphragmaticaperture CorrectAnswer-AAns.is'a'i.e.,Atthecricopharyngealsphincter[GrayH.Chapter35:Mediastinum.StandringS,ed.Gray'sAnatomy:TheAnatomicalBasisofClinicalPractice.40`VeNewYork,NY:ChurchillLivingstoneElsevier;2008.939-57.]Cricopharyngealsphincteristhenarrowestportionofesophagus
284.Whichofthefollowingisnota premalignantconditionoralcancer? a)Leukoplakia b)Erythroplakia c)Oralsubmucousfibrosis d)SystemicSclerosis CorrectAnswer-DAns.is'd'i.e.,SystemicSclerosis[RefDevita7"Vep.982;Bailey&love25`Vep.735]LesionswithincreasedriskofmalignancyinoralcancerPremalignantcondition:-Leukoplakia,Erythroplakia,Specklederythroplakia,chronichyperplasticcandidiasis.Conditionsincreasingrisk:-Oralsubmucousfibrosis,syphiliticglossitis,sideropenicdysphagia(PetersonKellysyndrome).Riskisdoubtful:-Orallichenplanus,DLE,Dyskeratosiscongenita.
285.Whichofthefollowingisacauseof objectivetinnitus? a)ImpactedWax b)Carotidarteryaneurysm c)Meniere'sdisease d)Ototoxicdrugs CorrectAnswer-BAns.is'b'i.e.,Carotidarteryaneurysm[RefiDhingraSth/ep.145;ScottBrown's7th/eVol-3p.4029-4030;Tulip.125-126]
286.Whichofthefollowingcancersdonot presentwithcervicallymphnodeinvolvement? a)GlotticCancer b)SubglotticCancer c)Papillarythyroidcancer d)Oralcancer CorrectAnswer-AAns.is'a'i.e.,GlotticCancer[RefDhingra5thlep.327;41'p.283]Truevocalcordsaredevoidoflymphatic,hencelesschanceofcervicalnodalmetastasis
287.Pulsatiletinnitusisafeatureof? a)Glomustumour b)acousticneuroma c)malignantotitsexterna d)meneire'sdisease CorrectAnswer-AAns.is'a'i.e.,Glomustumour[RefLoganTurner10th/ep.214]Theearliestsymptomsofglomustumourispulsatiletinnitus(earliest)andhearingloss.Hearinglossisconductiveandslowlyprogressive.Thesearefollowedbybloodstainedotorrhoeaandearache.
288.Histelberger'ssignisseenin? a)Acousticneurom b)GlomusTumour c)Nasalangiofibroma d)Acutesuppurativeotitismedia CorrectAnswer-AAns.is'a'i.e.,Acousticneurom[RefActaOtorhinolaryngolBelg.1987;41(1):40-8.TheHitselbergersignasaperceptionphenomenon.BenzB,BaumgartenD.]Hitselberger'ssignInAcousticneuroma-lossofsensationinthepostero-superiorpartofexternalauditorymeatussuppliedbyArnold'snerve(branchofVagusnervetoear).
289.Allofthefollowingaretrueabout SpasmoidicDysphoniaexcept? a)Itmaybeofadductororabductortype b)AbductortypeischaracterizedbyWhisperingqualityofvoice c)AdductortypeischaracterizedbyBreathlessness d)ItisfocalLaryngealdystonia CorrectAnswer-CAns.is'c'i.e.,AdductortypeischaracterizedbyBreathlessness[RefiSulicaL(December2004)."Contemporarymanagementofspasmodicdysphonia".CurrentOpinioninOtolaryngology&HeadandNeckSurgery.12(6)]
290.Ethmoidalinfundibulumliesbetween? a)Bullaethmoidalisanduncinateprocessofethmoid b)Middleandinferiorturbinate c)HiatussemilunarisandInferiormeatus d)Wingofsphenoidandmaxillaryantrum CorrectAnswer-AAns.is'a'i.e.,BullaethmoidalisanduncinateprocessofethmoidThehiatussemilunarisisboundedinferiorlybythesharpconcavemarginoftheuncinateprocessoftheethmoidbone,andleadsintoacurvedchannel,theinfundibulum,boundedabovebythebullaethmoidalisandbelowbythelateralsurfaceoftheuncinateprocessoftheethmoid.
291.Whatliesbetweenthemiddleand inferiorturbinate? a)Middlemeatus b)Superiormeatus c)Hiatussemmilunaris d)Inferiormeatus CorrectAnswer-AAns.is'a'i.e.,Middlemeatus[RefScottBrown7'Vevol2p.1329]Superiormeatus*Belowsuperiorturbinate(betweensuperiorandmiddleturbinates)MiddlemeatusBelowmiddleturbinate(betweenmiddleandinferiorturbinates)InferiormeatusBelowinferiorturbinate.
292.Allofthefollowingareextrinsic laryngealmembranesexcept? a)Quadrangularmembrane b)Hyoepiglotticligament c)Cricotrachealmembrane d)Thyrohyoidmembrane CorrectAnswer-AAns.is'a'i.e.,Quadrangularmembrane[RefMeratiAL,BielamowiczSA.TextbookofLaryngology.SanDiego:PluralPublishingInc2006.]Quadrangularmembrane 1. Aryepiglotticligament(superiorborderofmembrane)2. Vestibularligament(Inferiorborderofmembrane
293.
Thenarrowestpartofthenasalcavityis? a)Internalnasalvalve b)Antrochoanalregion c)1stnasalturbinate d)Regionofinferiorconcha CorrectAnswer-AAns.is'a'i.e.,Internalnasalvalve[RefJafekBW.Anatomyandphysiologyofthenose.JafekBW,StarkAK,eds.ENTSecrets.Philadelphia,Pa:Hanley&Belfus;1996.77-83.]Theinternalnasalvalveinvolvestheareaboundedbyupperlateralcartilage,septum,nasalfloor,andanteriorheadoftheinferiorturbinate.Thismakesupthenarrowestportionofthenasalairway
294.Anteriortonsillarpillarisformedby? a)Palatopharyngealfold b)Palatoglossalfold c)Pterygopalatinearch d)Valleculae CorrectAnswer-BAns.is'b'i.e.,PalatoglossalfoldAnteriortonsillarpillar-PalatoglossalfoldPosteriortonsillarpillar-Palatopharyngealfold
295.Oneofthefollowingistrueregarding Zenkerdiverticulum? a)Itisapulsiondiverticulum b)Itprojectsanteriorly c)Commonlyseeninyoungmales d)Itisbetweensuperiorandmiddleconstrictor CorrectAnswer-AAns.is'A'i.e.,ItisapulsiondiverticulumHypopharyngealdiverticulumorZenker'sdiverticulumorpharyngealpouchItisapulsiondiverticulumwherepharyngealmucosaherniatesthroughtheKillian'sdehiscence,aweakareabetweentwopartsoftheinferiorconstrictor.Itisthemostcommonesophagealdiverticulum.Thediverticulaariseposteriorlyinthemidlineofneck.Themouthofthediverticulaisinthemidlinebutprojectslaterally(usuallyleftlaterally)Zenker'sdiverticulaarerarelyseenbelow30yrsofage,mostpatientsareover50.
296.
Narrowestpartofthenasalcavityis? a)Vestibule b)Choanae c)Inferiorturbinate d)Middleturbinate CorrectAnswer-CAns.is'c'i.e.,Inferiorturbinate[RefHeidariZ,Mahmoudzadeh-SaghebH,KhammarT,KhammarM(May2009)."Anthropometricmeasurementsoftheexternalnosein18-25-year-oldSistaniandBaluchaboriginewomeninthesoutheastofIran".FoliaMorphol.(Warsz)68(2):88-92]Theinternalnasalvalvecomprisestheareaboundedbytheupperlateral-cartilage,theseptum,thenasalfloor,andtheanteriorheadoftheinferiorturbinate.Inthenarrow(leptorrhine)nose,thisisthenarrowestportionofthenasalairway.
297.Saddlenosedeformityisseenin? a)PrimarySyphilis b)Secondarysyphilis c)Tertiarysyphilis d)LupusVulgaris CorrectAnswer-CAns.is'c'i.e.,Tertiarysyphilis[RefDhingra5th/ep.184]Syphilisofnoseoccursas:- 1. Primary:-Rareandmanifestsasprimarychancreofthevestibule.2. Secondary:-Rarelyrecognizedandmanifestsassimplerhinitis, crustingandfissuring. 3. Tertiary:-Thisisthestageinwhichnoseisinvolvedmost commonly.Thereisformationofgummafollowedbybonyperforationofnasalseptum.Bridgeofthenosecollapsescausingasaddledeformity.Atrophicrhinitismayoccurasacomplication.
298.Allofthefollowingaretrueabout vasomotorrhinitisexcept? a)Itisallergic b)Itisduetoparasympatheticoveractivity c)Resistantcasesmayneedcryotherapy d)Itmayleadtohypertrophicrhinitis CorrectAnswer-AAns.is'a'Itisallergic[RefScott'sBrown7thiep.2122]VasomotorrhinitisVasomotorrhinitisisanonallergicconditionthatinvolvesaconstantrunnynose,sneezingandnasalcongestion,i.e.,thenoseisstuffyorrunnyforreasonsotherthanallergiesandinfections.Theexactetiologyisunknown,buttriggersincludeemotions,odors,poorairquality,spicyfoods,andmedicationsideeffects.
299.Allofthefollowingaretrueabout vasomotorrhinitisexcept? a)Itisanonallergiccondition b)itisduetoparasympatheticoveractivity c)Itmaycauseparoxysmalepisodesofsneezing d)Itisaninfectivecondition CorrectAnswer-DAns.is'd'i.e.,Itisaninfectivecondition[RefDhingra5th/ep.170]
300.Inevaluationofacaseofimmotilenasal cilia,whichofthefollowinginvestigationsshouldproveuseful? a)Rhinogram b)Xraynasalandparanasalsinuses c)Sweatsodiumlevels d)Nitricoxidetest CorrectAnswer-DAns.is'd'i.e.,Nitricoxidetest[RefLeighMW,PittmanJE,CarsonJL,FerkolTW,DellSD,DavisSD.Clinicalandgeneticaspectsofprimaryciliarydyskinesia/Kartagenersyndrome.GenetMed.2009Jul.11(7):473-87]ScreeningtestsforimmotileciliasyndromeNitricoxide:Measuringexhalednasalnitricoxide,whichismostlyreducedinprimaryciliarydyskinesia,isagoodscreeningtestforimmotile-ciliasyndromewithagoodnegativepredictivevalue.Studieshavedemonstratedarelationshipbetweennasalnitricoxidelevels,nasaloxidesynthasemRNAexpression,andciliarybeatfrequency.Thereisalsoasignificantinversecorrelationbetweenthedegreeofaplasiaand/orhypoplasiaoftheparanasalsinusandnasalnitricoxidevaluesinprimaryciliarydyskinesiapatients.
301.Allofthefollowingarefeaturesof ethmoidalpolypexcept? a)Commoninadults b)CommonlySingular c)Commonlybilateral d)Isusuallyallergic CorrectAnswer-BAns.is`b'i.e.,CommonlySingular[RefDhingra5thlep.187;Tuli1"/ep.173]Antrochoanalpolypgrowsbackward(posteriorly),therefore,itmaynotbevisibleonanteriorrhinoscopy,whileposteriorrhinoscopyshowssmooth,greyishwhite,sphericalmassinchoana.Ontheotherhand,ethmoidalpolypsgrowanteriorly.Therefore,theyarebestseenonanteriorrhinoscopyandmaynotbeseenonposteriorrhinoscopy.
302.Allofthefollowingarefeaturesof enlargedadenoidsexcept? a)Otitismedia b)Nasalobstruction c)Failuretothriveofchild d)Esophagitis CorrectAnswer-DAns.is'd'i.e.,Esophagitis[RefDhingraViep.254]ClinicalfeaturesofenlargedadenoidsEnlargedandinfectedadenoidsmaycausenasal,aural(ear),andgeneralsymptoms.1)NasalsymptomsNasalobstructionisthecommonestsymptom.Thisresultinmouthbreathing.Astherespirationandfeedingcannottakeplacesimultaneously,childfailstothrive.Othersymptomsarenasaldischarge(wetbubblynose),sinusitis,epistaxisandtonelessvoicewithlossofnasalquality(Rhinololiaclausa).2)AuralsymptomsTubalobstructionOtitismedia:-Recurrentacuteotitismedia,CSOM,serousotitismedia3)GeneralsymptomsAdenoidfacies:Elongatedfacewithdullexpression,openmouth,prominent&crowdedupperteeth,hitchedupperlip,pinchedinappearanceofnoseandhigharchedpalate.Pulmonaryhypertension,aprosexia(lackofconcentration).
303.Allofthefollowingaretreatmentsof multiplebilateralethmoidalpolypsexcept? a)Functionalendoscopicsinussurgery b)Intranasalethmoidectomy c)Extranasalethmoidectomy d)CaldwllLucSurgery CorrectAnswer-DAns.is'd'i.e.,CaldwilLucSurgery[RefScottBrown,Vol-ILp.1701;Dhingra5`"/ep.188,430]Surgicaltreatmentofethmoidalpolyps: 1. Functionalendoscopicsinussurgery(FESS):Surgeryofchoice whenavailable. 2. Polypectomy:Whenthereareoneortwopedunculatedpolyps.3. Intranasalethmoidectomy:Indicatedwhenpolypsaremultipleand sessile. 4. Extranasalethmoidectomy:Thisisindicatedwhenpolypsrecur afterintranasalprocedures. 5. Transantralethmoidectomy:Indicatedwheninfectionandpolypoidal changesarealsoseeninthemaxillaryantrum.Inthiscaseantrumisopenedbycaldwell-Lucapproachandtheethmoidalaircellsapproachedthroughthemedialwalloftheantrum.
304.Whatisthetreatmentofchoicefor ethmoidalpolyps? a)FunctionalEndoscopicsinussurgerywithpolypectomy b)Intranasalethmoidectomy c)Extranaslethmoidectomy d)Transantralethmoidectomy CorrectAnswer-AAns.is'a'i.e.,FunctionalEndoscopicsinussurgerywithpolypectomy[RefSeeaboveexplanation]
305.Whatisthetypeofepitheliumofthe adenoid? a)Pseudostratifiedciliatedcolumnarepithelium b)Nonkeratinizedsquamousepithelium c)Cuboidalepithelium d)Columnarepitheliumwithgobletcells CorrectAnswer-AAns.is'a'i.e.,Pseudostratifiedciliatedcolumnarepithelium[RefWiatrakBJ,WoolleyAL.Pharyngitisandadenotonsillardisease.CummingsCW,FredricksonJM,HarkerLA,CrauseCJ,SchullerDE,RichardsonMA.OtolaryngologyHeadandNeckSurgery...V/e.London:Mosby;1998.188-215.]TheadenoidiscoveredbyapseudostratifiedciliatedcolumnarepitheliumthatisplicatedtoformnumeroussurfacefoldsThenasopharyngealepitheliumlinesaseriesofmucosalfolds,aroundwhichthelymphoidparenchymaisorganizedintofolliclesandissubdividedinto4lobesbyconnectivetissueseptaSeromucousglandsliewithintheconnectivetissue,andtheirductsextendthroughtheparenchymaandreachthenasopharyngealsurface.
306. Thearterywhichleadstobleedingin Woodruff'sareais? a)Anteriorethmoidalartery b)Sphenopalatineartery c)Greaterpalatineartery d)Superiorlabialartery CorrectAnswer-BAns.is'b'i.e.,Sphenopalatineartery[RefScottBrown7h/eVol-2p.1597;Dhingra5th/ep.190]Woodruff'sarea:?Itissituatedundertheposteriorendofinferiorturbinate.Sphenopalatinearteryanastomoseswithposteriorpharyngealarteryhere.Posteriorepistaxisoccursinthisarea.
307.Intrathecalfluoresceinwithendoscopic visualizationisusefulindiagnosisof? a)Deviatednasalseptum b)Multipleethmoidalpolyps c)RhinitisMedicamentosa d)CSFRhinorrhoea CorrectAnswer-DAns.is'd'i.e.,CSFRhinorrhoea[Ref:LoganTurner10(h/ep.28,Dhingra5th/ep.179]DetectionofsiteofCSFleakinCSFRhinorrhoea 1. HRCT:-HRCTwithorwithoutgodoliniumisthemosthelpfulstudy foridentifyingthesiteofleak,i.e.,investigationofchoice. 2. MRI:-MRIwithheavyT2weightedimagemayhighlightCSF sufficientlytoshowtheleak. 3. CTcisternography:-CTscanafterinjectionofcontrastdyeis effectiveinpatientswithanactiveleak. 4. Radioisotopecisternography:-Radioisotopeinjectedintrathecally andmeasured. 5. Fluorescindye:-Intrathecalfluorescinwithendoscopic visualization.
308.Allofthefollowingarefeaturesofa nasalforeignbodyexcept? a)Foulsmellingdischarge b)Epistaxis c)Nasalobstruction d)Septalperforation CorrectAnswer-DAns.is'd'i.e.,Septalperforation[RefDhingraSaVep.176;LoganTurner10'h/ep.63]ForeignbodyinnoseAnasalforeignbodyisanythingthatgetsstuckinsidethenose.Inanimateforeignbody(object)ismorecommonthananimateforeignbody.Commonobjectsfoundinnosesincludefoodmaterial(peas,beans,nuts),tissuepaper,beads,toysandrocks.Animateforeignbodiesareworms,larvaeormaggots.Mostcasesofforeignbodiesinthenoseandnasalcavityarenotseriousandoccurintoddlersandchildrenfrom1-8years.Becausechildrendeveloptheabilitytopickupobjectsatabouttheageof9months,thisproblemismuchlesscommonbefore9monthsofage.
309.ETHMOIDALBULLAEareseenin? a)Posteriorethmoidalaircells b)Middleethmoidaircells c)Superiorethmoidalaircells d)Inferiorethmoidalaircells CorrectAnswer-BAns.is'b'i.e.,Middleethmoidaircells[Ref:LoganTurner10thlep.379;Dhingra5th/ep.153,154]
310.Allofthefollowingarefeaturesofa nasalforeignbodyexcept? a)Vestibulitis b)Epistaxis c)Nasalobstruction d)Deviatedseptum CorrectAnswer-DAns.is'd'i.e.,Deviatedseptum[RefDhingra5thiep.176;LoganTurner10`"/ep.63]
311.
Allofthefollowingarecausesofperforationofcartilaginouspartofnasalseptumexcept? a)Tuberculosis b)Leprosy c)Lupus d)Syphilis CorrectAnswer-DAns.is'd'i.e.,Syphilis[RefDhingra5th/ep.166;Scott-Brown'sOtolaryngology7th/eVol-2chapter-124p.1583]Anasalseptalperforationisathrough-and-throughdefectinanyportionofthecartilaginousorbonyseptumwithnooverlyingmucoperichondriumormucoperiosteumoneitherside.Perforationofbonypart:-SyphilisPerforationofcartilaginouspart:-TB,leprosy,lupus.
312.Allofthefollowingaretrueaboutnasal myiasisexcept? a)Commoninvasomotorrhinitis b)Intensenasalirritationpresent c)Meningitismayoccurinseveredisease d)Chloroformwaterisoneofthemodesoftreatment CorrectAnswer-AAns.is'a'i.e.,Commoninvasomotorrhinitis[RefDhingra5th/ep.178]
313.Water'sviewisusedtoobtaindiagnostic informationof: a)Maxillarysinus b)Ethmoidalsinuses c)Frontalsinus d)Sphenoidsinus CorrectAnswer-AANSWER:A.MaxillarysinusWaters'view(alsoknownastheOccipitomentalview)isaradiographicview,whereanX-raybeamisangledat45?totheorbitomeatalline.Therayspassfrombehindtheheadandareperpendiculartotheradiographicplate.Itiscommonlyusedtogetabetterviewofthemaxillarysinuses.
314.Tracheostomyindicationis: a)Vocalcordreplacement b)Pharynxreplacement c)Tracheomalacia d)Foreignbodyobstructingairway CorrectAnswer-DAnswer-D.ForeignbodyobstructingairwayIndicationsoftracheostomy:Upperrespiratorytractobstruction;Laryngeal,supralaryngeal,andtrachealcauses.(Causesofstridor)Lowerrespiratorytractobstruction:(Secretoryobstruction,Wetlungsyndrome).
315.Caldwell'sviewisusedfor: a)Maxillarysinus b)Frontalsinus c)Ethmoidalsinus d)Alloftheabove CorrectAnswer-BAnswer-B.FrontalsinusCaldwell'sview(orOccipitofrontalview)isaradiographicviewofskull,whereX-rayplateisangledat20?toorbitomeatalline.Therayspassfrombehindtheheadandareperpendiculartoradiographicplate.Itiscommonlyusedtogetbetterviewoffrontalsinuses.
316.Wherewillbetheplacementlocationfor AuditoryBrainstemImplant? a)Scalatympani b)Recessof4thventricle c)IAC d)backofear CorrectAnswer-BAnswer:B-Recessof4thventricle.TheimplantisusuallyplacedinthelateralrecessofthefourthventricleatthetimeoftumorresectiontostimulatethecochlearnucleusAuditoryBrainstemImplant(ABI):TumorresectionsurgeryinNFpatientsresultincochlearnervedamageorlossoffunctionofnerveresultingindeafness.ABIareusefulinrestoringauditoryperceptiontodeafpatientswithneurofibromatosistype2(NF2)Alsousedintreatmentofcongenitallydeafchildrenwithcochlearmalformationsorcochlearnervedeficiencies.Placementlocation:Lateralrecessof4thventricle
317.Allofthefollowingarefeaturesof TubotympanicCSOMexcept? a)Profusedischarge b)Hearingloss c)Extremepain d)Sometimesparadoxicalimprovementinhearingisseen CorrectAnswer-CAns.is'c'i.e.,Extremepain[RefDhingra5th/ep.77;Pediatricotolaryngology2"/ep.478]ClinicalfeaturesoftubotympanicCSOMProfusemucopurulentdischargewhichisnotfoulsmelling,i.e.,non-foulsmellingdischargeHearingloss(conductivetype).Ifsensorineuralcomponentalsooccurs(i.e.,mixedtype),itarousesthesuspicionoftoxicdeafness.Sometimes,patientreportsaparadoxicaleffect,i.e.,hearsbetterinthepresenceofdischargethanwhentheearisdry.Thisisduetoroundwindowshieldingeffectproducedbydischargewhichhelpstomaintainphasedifferential.Thereisnopain,ifitoccursitisduetoassociatedotitisexternanotduetootitismedia.Sincetheinfectedareaisopenatbothends,dischargedoesnotaccumulateinthemiddleearcavityOssicularchainismostlyuninvolved,ifinvolvedonlylongprocessofincusisinvolved.
318.FeaturesofUsher'sSyndromeincludeall except? a)NightBlindness b)VisualImpairment c)MultipleNeurofibromas d)Hearingdeficit CorrectAnswer-CAns.is'c'i.e.,MultipleNeurofibromas[RefMetsMB,YoungNM,PassA,LaskyJB(2000)."EarlydiagnosisofUshersyndromeinchildren".TransactionsoftheAmericanOphthalmologicalSociety.98:237-45.]UshersyndromeUshersyndromeisarelativelyraregeneticdisordercausedbyamutationinanyoneofatleast11genesresultinginacombinationofhearinglossandvisualimpairment,andisaleadingcauseofdeafblindness.Ushersyndromeisincurableatpresent.OthernamesforUshersyndromeincludeHallgrensyndrome,Usher-Hallgrensyndrome,retinitispigmentosadysacusissyndrome,anddystrophiaretinaedysacusissyndrome.Thissyndromeischaracterizedbyhearinglossandagradualvisualimpairment.Thehearinglossiscausedbyadefectiveinnerear,whereasthevisionlossresultsfromretinitispigmentosa(RP),adegenerationoftheretinalcells.Usually,therodcellsoftheretinaareaffectedfirst,leadingtoearlynightblindnessandthegraduallossofperipheralvision.Inothercases,earlydegenerationoftheconecellsinthemaculaoccurs,leadingtoalossofcentralacuity.Insomecases,thefovealvisionisspared,leadingto"doughnutvision";centralandperipheralvisionareintact,butanannulusexists
aroundthecentralregioninwhichvisionisimpaired.
319.65yearoldpersonwithhearinglosswith normalspeechdiscriminationissufferingfrom? a)Noiseinducedhearingloss b)Presbycusis c)Ototoxicdrug d)NOHL CorrectAnswer-BAns.is'B'i.e.,PresbycusisInformationinthisquestionare:-(i)Oldage(65years),(ii)Hearingloss,and(iii)Preservedspeechdiscrimnation.DiagnosisisPresbycusis.PresbycusisPresbycusisreferstosensorineuralhearinglossinelderlyindividualsCharacteristically,presbycusisinvolvesbilateralhighfrequencyhearinglossassociatedwithdifficultyinspeechdiscriminationandcentralauditoryprocessinginformation.Fourpathologicaltypesofpresbycusishavebeenidentified:-SensorypresbycusisThereisepithelialatrophywithlossofsensoryhaircellsandsupportingcellsintheorganofcorti.Thisprocessstartsinthebasalturnofcochleaandslowlyprogresstowardstheapex.Higherfrequenciesareaffectedbutspeechdiscriminationispreserved.Neuralpresbycusis:-Thereisatrophyofnervecellsinthecochleaandcentralneuralpathways.Atrophyoccursthroughoutthecochlea,withthebasilarregiononlyslightlymorepredisposedthan
theremainderofthecochlea.Therefore,noprecipitousdropinthresholdonaudiometryisobserved.Speechdiscriminationispoor.Metabolic(strial)presbycusis;;-Thereisatrophyofstriavascularis.Atrophyresultsinhearinglossrepresentedbyflataudiogram,butspeechdiscriminationispreserved.Mechanical(cochlearconductive)presbycusis:-Thereisthickeningandsecondarystiffeningofthebasilarmembraneofthecochlea.Thethickeningismoresevereinthebasalturnofcochleawherethebasilarmembraneisnarrow.Thiscorrelateswithagraduallyslopinghighfrequencysensorineuralhearingloss.Speechdiscriminationisaverage.
320.Stimulationoftheexternalauditorycanal leadstocoughduetowhichnerve a)AuricularbranchVagus b)Greaterauricularnerve c)Auriculotemporalnerve d)FacialNerve CorrectAnswer-AAns:A.AuricularbranchVagusnerve.>AuricularbranchofVagus(Arnold'snerve)andFacialnervecontinuesinwardstosupplytheposteriorwallandflooroftheEAC.>Thecoughresponsecausedwhilestimulatingtheearcanalismediatedbythevaguswhichalsosuppliesthelarynx.(Re/.Shambaugh,6thed.,page45)
321.
wideningofthecartilaginouspartoftheextraauditorycanalcalled. a)Otoplasty b)Myringoplasty c)Tympanoplasty d)Meatoplasty CorrectAnswer-DAns.(d)Meatoplasty.Meatoplastyisanoperativetechniquetowidenthelateralcartilaginouspartoftheexternalauditorycanal.Otoplasty-isaproceduretochangetheshape,positionorsizeoftheears.Myringoplasty-closureoftheperforationofparstensaofthetympanicmembraneTympanoplasty-surgicaltechniquetorepairadefectinthetympanicmembranewiththeplacementofagraft,eithermedialorlateraltothetympanicmembraneannulusref:https://vula.uct.ac.za/access/content/group/ba5fb1bd-be95-48e5-81be-586fbaeba29d/Meatoplasty.pdf
322.TubercularOtitismediaischaracterized byallexcept a)Painfulotorrhea b)Multipleperforations c)Palegranulations d)Foul-smellingeardischarge CorrectAnswer-AAns.A.Painfulotorrhea.>Tuberculosisofmiddleearisacomparativelyrareentityusuallyseeninassociationwithorsecondarytopulmonarytuberculosis,theinfectionreachesthemiddleearthroughtheeustachiantube>Itischaracterizedbypainlessotorrhoeawhichfailstorespondtotheusualantimicrobialtreatment>patientwithevidenceoftubercleinfectionelsewherefollowedbymultipletympanicmembraneperforations,abundantgranulationtissue,andbonenecrosis,preauricularlymphnodeenlargementhttps://www.ncbi.nlm.nih.gov/pubmed/21522113
323.Partialandfullclosuredonein a)Atrophicrhinitis b)Allergicrhinitis c)Vasomotorrhinitis d)Occupationalrhinitis CorrectAnswer-AAns.A.AtrophicrhinitisATROPHICRHINITIS>Itisaformofchronicrhinitisassociatedwithatrophyofnasalmucosa,mucousglands,nerves,andvessels.>Itcanbeprimaryorsecondary.>Thesurgicaloptionsaimtoreducethesizeoftheroomycavitiestopreventtheexposuretodryingeffectsofairandcrustsformationandthushelpregenerationofnasalmucosa.Fullclosure-Young'soperationPartialclosure-Modifiedyoung'soperation.(Ref.Cummings,6thed.,695)
324.OccipitomentalviewofPNSX-raycalled as a)Caldwellview b)Waterview c)Townview d)Pineview CorrectAnswer-BAnswer:b.WaterviewOccipitomentalviewofPNSX-raycalledasWaterview