AIIMS/ NEET-PG 2017: ENT MCQs 171-180

Q-171. Stapes footplate covers
a) Round window
b) Oval window
c) Inferior sinus tympani
d) Pyramid

Answer: Oval window
The oval window, an opening between scala vestibuli and the middle ear, lies at the end of the cochlea nearest the middle ear, the basal end.
The oval window is covered by the footplate at the stapes in the middle ear.
The round window, a membrane-covered opening between the scala tympani and the middle ear also lies at the basal end of the cochlea.
Because fluid of the inner ear in non-compressible, inward movement of the stapes footplate is allowed because of the yielding of the thin membrane which covers the round window.
This is essential to the transmission process, since it provides elastic relief for the fluid of the inner ear, thus permitting movement of the stapes and the structures of the inner ear.

Q-172. The etiology of anterior ethmoidal neuralgia is:
a) Inferior turbinate pressing on the nasal septum
b) Middle turbinate pressing on the nasal septum
c) Superior turbinate pressing on the nasal septum
d) Causing obstruction of sphenoid opening

Answer: Middle turbinate pressing on the nasal septum
Anterior ethmoidal neuralgia is said to originate from middle turbinate pressing on the nasal septum.
Anterior Ethmoidal Nerve Syndrome results from irritation of the terminal branches of the Anterior Ethmoidal Nerve.
The referred pain arising from this nerve are chiefly of the sinus type but may also take the form of headache, sometimes of a migrainous character.
Ephedrine applied to the anterior ethmoid fissure and/or the middle turbinate body has met with considerable success in the cure of the pain and headache of this origin. Anatomical correction relieves the pain.

Q-173. The treatment of choice for stage 1 cancer larynx is:
a) Radical Surgery
b) Chemotherapy
c) Radiotherapy
d) Surgery followed by radiotherapy.

Answer: Radiotherapy
Stage I and II laryngeal cancers:
Either radiation alone (without surgery) or partial laryngectomy can be used in most people.
Voice results tend to be better with radiation therapy than with partial laryngectomy, and the complication rate tends to be lower for radiation treatment.
Radiation is the primary nonsurgical treatment for early-stage glottic tumors (i.e., T1, T2).
A close correlation between the vascularization of tumors and their radio-curability is revealed. In poorly vascularized tumors the local regression and 5-year survival are significantly lower than those in richly vascularized tumors.
Radio-sensitivity of laryngeal tumor-Ca glottis 991 %)> Supra-glottic ca (84 %)> Sub-glottic ca (66%)
Stage III and IV laryngeal cancers often require treatment with some combination of surgery, radiation, and/or chemotherapy.

Q-174. All the following signs could result from infection within the right cavernous sinus except
a) Constricted pupil in response to light
b) Engorgement of the retinal veins upon ophthalmoscopic examination
c) Ptosis of the right eyelid
d) Right ophthalmoplegia

Answer: Constricted pupil in response to light
Headache is the most common presentation symptom and usually precedes fevers, peri-orbital edema, and cranial nerve signs.
Peri-orbital edema may be the earliest physical finding.
Chemosis results from occlusion of the ophthalmic veins
Cranial nerve palsy:
Lateral gaze palsy (isolated cranial nerve VI) is usually seen first since CN VI lies freely within the sinus in contrast to CN III and IV, which lie within the lateral walls of the sinus.
Ptosis, mydriasis (dilated pupil), and eye muscle weakness from cranial nerve III dysfunction
Manifestations of increased retro-bulbar pressure follow:
Signs of increased intraocular pressure (IOP) may be observed:
Pupillary responses are sluggish.
Decreased visual acuity is common owing to increased IOP and traction on the optic nerve and central retinal artery.

Q-175. Iatrogenic traumatic facial nerve palsy is most commonly caused during
a) Myringoplasty
b) Stapedectomy
c) Mastoidectomy
d) Ossiculoplasty

Answer: Mastoidectomy
Idiopathic facial paralysis (Bell palsy) is the most common type. It is often thought to be due to virally induced inflammation of the nerve that results in functional compromise, swelling, and vascular compromise.
Traumatic facial paralysis (from blunt and penetrating trauma or intra-operative iatrogenic injury) is the next most common type.
All ear operations run the risk of facial nerve damage, particularly if nerve is exposed. Mastoidectomy had a high risk because a sharp cutting rotating burr is used in close proximity to nerve.

Q-176. In complete bilateral palsy of recurrent laryngeal nerves, there is:
a) Complete loss of speech with stridor and dyspnea
b) Complete loss of speech but no difficulty in breathing
c) Preservation of speech with severe stridor and dyspnea
d) Preservation of speech and no difficulty in breathing

Answer: Preservation of speech with severe stridor and dyspnea
Etiology: Neuritis and thyroidectomy
As both cords lie in median or para-median position, the airway is inadequate causing dyspnea and stridor but voice is good.
Lateralization of cord

Q-177. Which of the following would be the most appropriate treatment for rehabilitation of a patient, who has bilateral profound deafness following surgery for bilateral acoustic schwannoma?
a) Bilateral high powered digital hearing aid
b) Bilateral cochlear implants
c) Unilateral cochlear implant
d) Brain stem implant

Answer: Brain stem implant
Auditory brainstem implant (ABI) has been the only auditory rehabilitation option in patients with bilateral profound deafness and previous B/L schwannoma resection.
Recently cochlear implants have emerged as a reasonable therapeutic option in selected cases.
Initially patients should undergo schwannoma resection with preservation of the cochlear nerve as the main goal. Subsequently CI is done in a standard fashion through a cochleostomy or directly through the round window.
Cochlear nerve function is not always preserved in spite of anatomic preservation of the cochlear nerve.

Q-177. Which of the following is not the site for paragangliomas?
a) Carotid bifurcation
b) Jugular foramen
c) Promontory in middle ear
d) Geniculate ganglion

Answer: Geniculate ganglion
Paragangliomas may develop anywhere there are sympathetic nerve cells, and this usually means along any of the major arteries in the body.
Paragangliomas can be found in the skull region, neck, chest cavity, abdomen, pelvis, and bladder.
Far and away, the most common site is within the abdomen where approximately 85-90% are located. Most abdominal paragangliomas are found in front of or to the side of the vertebral column near the aorta or kidney.
In contrast, the most common location for a parasympathetic paraganglioma is in the neck.
They are divided according to location:
Carotid body tumour: located at the carotid body, and splaying the carotid bifurcation
Most common paraganglioma of the head and neck
Glomus tympanicum tumour: Arise from the glomus tympanicum confined to the middle ear overlying the cochlear promontory arises from the inferior tympanic branch of glosso-pharyngeal nerve (CN IX) (or Jacobson’s nerve)
Glomus jugulo-tympanicum tumour: Arising from the glomus jugulo-tympanicum extending between the cochlear promontory and jugular foramen arising from Arnold’s nerve, the mastoid branch of the vagus nerve (CN X)
Glomus jugulare tumour: Arising from the glomus jugulare confined to the jugular foramen extending into the middle ear glomus vagale tumour arising from the glomus vagale associated with vagus nerve (CN X)

Q-178. “Gold standard” surgical procedure for prevention of aspiration is:
a) Thyroplasty
b) Tracheostomy
c) Tracheal division and permanent tracheostome
d) Feeding gasgtrostomy/ jejunostomy

Answer: Tracheostomy
Adjuvantive surgical procedures:
Traditional management of chronic aspiration→ tracheostomy + enteral feeding
Crico-pharyngeal Myotomy & Laryngeal Suspension
Definitive Procedures:
All definitive procedures require a tracheostoma
Endo-laryngeal Stents
Laryngeal Diversion and Laryngo-tracheal separation
Glottic/Supra-glottic Closure
Sub-perichondrial cricoidectomy
Laryngectomy: Total narrow field laryngectomy  gold standard in terms of definitive treatment
Trend of be replaced by sub-perichondrial cricoidectomy

Q-179. Which of the following statements is not true for contact ulcer?
a) The commonest site is the junction of anterior 1/3rd and middle 1/3rd of vocal cord and gastro-esophageal reflux is the causative factor
b) Can be caused by intubation injury
c) The vocal process is the site and is caused/aggravated by acid reflux
d) Can be caused by adductor dysphonia

Answer: The commonest site is the junction of anterior 1/3rd and middle 1/3rd of vocal cord and gastro-esophageal reflux is the causative factor
Contact ulcers are benign lesions usually located on the medial aspect of the vocal process of the arytenoid cartilage.
Contact granulomas may occur unilaterally or bilaterally.
The lesion most commonly is identified in men.
Voice abuse
Intubation or
Gastro-esophageal reflux
Varying degrees of hoarseness and a low-pitched, pressed voice quality, Cough, Throat clearing, Pain-especially on pressed phonation or with cough or throat clearing and A rough foreign body sensation

Q-180. All of the following cause a gray-white membrane on the tonsils, except:
a) Infectious mononucleosis
b) Ludwig’s angina
c) Streptococcal tonsillitis
d) Diphtheria

Answer: Ludwig’s angina
White Patch on Tonsil: Differential Diagnosis
Membranous tonsillitis, Diphtheria, Vincent’s angina, Infectious mononucleosis, Agranulocytosis, Leukemia, Aphthous ulcers, Malignancy tonsil, Traumatic ulcer
Ludwig’s angina:
Ludwig’s angina is characterized as a rapidly progressive gangrenous cellulitis of the soft tissues of the neck and floor of the mouth.
With progressive swelling of the soft tissues and elevation and posterior displacement of the tongue, the most life-threatening complication of Ludwig’s angina is airway obstruction.
In Ludwig’s angina, the submandibular space is the primary site of infection.
The majority of cases of Ludwig’s angina are odontogenic in etiology, primarily resulting from infections of the second and third molars.