Last 5 Year PYQs in ENT for INI-CET

Q1. What is the probable diagnosis for a person who has facial swelling and orbital edema on the left side of their face after a minor trauma involving a piece of wood 20 days ago? The CT scan showed no abnormalities in the sinuses but revealed subcutaneous nodules. Microscopic examination of tissue sections showed positivity for PAS stain and Grocott's methenamine silver stain.

1. Phycomycosis
2. Midline lethal granuloma
3. Foreign body granuloma
4. IgG4 granuloma

Ans. 1) Phycomycosis

• Phycomycosis, also known as mucormycosis, is a fungal infection caused by Mucorales fungi.
• It typically affects immunocompromised individuals and can manifest as rhinocerebral, pulmonary, gastrointestinal, or cutaneous infection.
• The clinical presentation described in the question, with facial swelling, orbital edema, and subcutaneous nodules, along with the histological findings of PAS-positive and Grocott’s methenamine silver-positive staining, is suggestive of phycomycosis.

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Q2. Which of the following is not considered a major diagnostic criterion for allergic fungal sinusitis?

1. Elevated Serum IgA level
2. Presence of Allergic Mucin
3. Characteristic CT findings :Double Density
4. Positive KOH stain

Ans. 1) Elevated Serum IgE level

• Increased levels of immunoglobulin E in the blood indicate an allergic response to fungal antigens, not IgA level
• Allergic Fungal Rhino Sinusitis (AFRS) is a non-invasive form of fungal sinusitis. The diagnosis is based on the Bent and Kuhn criteria, which include:
  • Elevated serum IgE level: increased levels of immunoglobulin E in the blood, indicating an allergic response to fungal antigens.
  • Positive KOH stain: identification of fungal hyphae in nasal secretions using potassium hydroxide (KOH) staining.
  • Presence of Allergic Mucin: characteristic mucin containing eosinophils, Charcot-Leyden crystals, and fungal hyphae, indicative of an allergic reaction to fungi.
  • Nasal Polyposis: Growth of benign inflammatory tissue (polyps) within the nasal cavity or sinuses, often associated with chronic inflammation.
  • Double Density: Radiological finding of two distinct densities within the sinuses, representing allergic mucin and fungal debris.​

Q3. A 65-year-old patient presents with right-sided nasal obstruction and occasional blood-stained nasal discharge. His CT and endoscopy findings are shown in the below image. What could be the underlying cause?​

1. Inverted papilloma
2. Carcinoma maxilla
3. Esthesioneuroblastoma
4. Nasopharyngeal angiofibroma

Ans. 1) Inverted papilloma

• The image shows inverted papilloma causing erosion or remodeling of adjacent bony structures, such as the nasal septum or the walls of the sinuses.
• Inverted papilloma is a benign sinonasal tumor that arises from the lining of the nasal cavity or paranasal sinuses.
• It often presents with unilateral nasal obstruction, recurrent nosebleeds, and the potential for locally aggressive behavior.

Q4. A young man presented with hearing loss and tinnitus. Histology image is shown below. What is the diagnosis?

1. Neurofibroma
2. Schwannoma
3. Leiomyoma
4. Rhabdomyoma

Ans. 2) Schwannoma

Schwannoma, also known as neurilemmomas, are benign nerve sheath tumors that arise from Schwann cells, which are the cells responsible for producing the myelin sheath that covers peripheral nerves. Histologically, the following findings are characteristic of Schwannoma, which can be seen in the image:

• Antoni A areas: These areas are composed of tightly packed spindle-shaped cells with elongated nuclei. The cells are arranged in palisades or whorls, forming Verocay bodies. The cells in Antoni A areas exhibit nuclear hyperchromasia (increased staining intensity) and cellular cohesion.
• Antoni B areas: These areas are less cellular and show a looser arrangement of cells with a myxoid or microcystic appearance. The cells in Antoni B areas may have more irregular nuclei and a less distinct cytoplasmic organization compared to Antoni A areas.

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Q5. Which of the following devices can be used in a patient with bilateral external auditory atresia?

1. 1
2. 2
3. 3
4. 4

​Ans. 1) 1 

• In a patient with bilateral external auditory atresia we use hearing devices.
• The first image shows such a device known as BAHA.
• BAHA stands for Bone Anchored Hearing Aid.
• It is a type of hearing aid that utilizes bone conduction to improve hearing in individuals with certain types of hearing loss.
• The BAHA system consists of three main components: a titanium implant, an external abutment, and a sound processor.

Q6. Choose the best description for the structure marked in the CT given below.​

1. Agger nasi cell
2. Pneumatised superior turbinate
3. Onodi cell
4. Haller cell

Ans. 2) Pneumatised superior turbinate

• Pneumatization of the superior turbinate refers to the presence of an air cell within the superior turbinate

​​Q7. A CT scan of a patient with laryngeal carcinoma is shown below. What is the staging?​

1. T1N0M0
2. T4N1M0
3. T2N1M0
4. T3N0M0​

 Ans. 2) T4N1M0

• The TNM staging of this patient with laryngeal carcinoma is T4N1M0 since there is an invasion of the tumor into the cricoid and thyroid cartilage, and there is an extension of the tumor into adjacent soft tissues of the neck, which includes the strap muscles, thyroid, and deep extrinsic muscles of the tongue.
• There is single, ipsilateral lymph node involvement measuring less than 3 cm in size with no distant metastasis.

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Q8. Arrange the following in the sequence of auditory pathway:

1. Cochlear nucleus
2. Spiral ganglion
3. Superior olivary nucleus
4. Inferior colliculus
5. Medial geniculate body

1. 1-2-3-4-5
2. 5-4-3-2-1
3. 2-1-3-4-5
4. 3-4-5-1-2

Ans. 3) 2-1-3-4-5

2: Spiral ganglion: The auditory pathway starts with the spiral ganglion (which contains cell bodies of auditory nerve fibers). In response to sound, the cochlear hair cells generate impulses that are transmitted along these auditory fibers.

1: Cochlear nucleus: These fibers enter the brainstem and synapse with the cochlear nucleus.

3: Superior olivary nucleus: Some fibers cross to the opposite side and enter the superior olivary complex.

4: Inferior colliculus: The fibers ascend and enter the inferior colliculus (midbrain).

5: Medial geniculate body: Signals are relayed to the medial geniculate body (thalamus). Fibers then relay to the auditory cortex (Brodmann’s area 41) (superior temporal gyrus).

Q9. A male patient presents to the OPD with a saddle nose deformity. He gives a history of cough, on-and-off fever, and hemoptysis. On examination, septal perforation is present with pale granuloma. His chest X-ray showed multiple cavitary lesions, and the biopsy showed granuloma, multinucleated giant cells, and caseous necrosis. What is the probable cause?

1. Wegener’s granulomatosis
2. Tuberculosis
3. Syphilis
4. Sarcoidosis

Ans. 2) Tuberculosis

• Nasal tuberculosis can occur secondary to pulmonary tuberculosis.
• Commonly involves the anterior end of the inferior turbinate and the anterior part of the nasal septum.
• Chronic inflammation can destroy the nasal septum, resulting in a deformity called saddle nose deformity.
• It is diagnosed by biopsy, which shows caseating granulomas, Langhans multinucleated giant cells, and necrotic debris.

Q10. A 35-year-old female presents with nasal obstruction and post-nasal drip. She has a history of FESS following failed conservative management 5 years ago. Post-surgical notes mentioned that uncinectomy and maxillary ostium dilation were done during the previous FESS. DNE currently shows patent ostia and mucosal edema of the maxillary sinus lining. What is the next best step in management?

1. Repeat surgery
2. Macrolides for 4 months
3. Steroid irrigation and antihistamine
4. Biological therapy

Ans. 3) Steroid irrigation and antihistamines

• The given case scenario presents the patient affected with nasal obstruction and post-nasal drip, which points towards an episode of acute rhinosinusitis.
• Hence, it requires antihistamines and steroid irrigation.
• Steroid irrigation reduces mucosal edema and the above-mentioned symptoms, like nasal obstruction.
• Antihistamines help in controlling allergic symptoms and mucosal edema.

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Q11. ​Of the following tests, which is not used for testing olfaction?

1. Smell diskettes
2. Arnold stick test
3. UPSIT
4. CC-SIT

Ans. 2) Arnold stick test

• Arnold cough reflex is an involuntary cough due to the stimulation of the external ear.
• It is mediated by the auricular branch of the vagus nerve (Arnold’s nerve).
• Insertion of a cotton bud or touching the external ear activates the nerve and evokes a forceful cough. Hence the name ‘Arnold Stick'. It is not used to assess olfaction.

Q12. A South Indian male farmer presents to the ENT OPD with complaints of reddish mass coming out from the nose and histopathology image as given below. What is the likely diagnosis?​

1. Rhinosporidiosis
2. Rhinoscleroma
3. Rhinophyma
4. Nasal polyp

Ans. 1) Rhinosporidiosis

• Rhinosporidiosis is a chronic fungal infection caused by the organism Rhinosporidium seeberi. It primarily affects the mucous membranes of the nose and occasionally other sites like the eye, skin, and genitals.
• Rhinosporidiosis is commonly seen in South India.
• The clinical presentation of rhinosporidiosis often includes the presence of reddish or pinkish masses or polyps in the nasal cavity.
• Histopathology shows sporangium with sporangiospores.
• These masses can vary in size and may bleed when touched or traumatized. The given image showing a mass protruding from the nose is suggestive of this characteristic presentation.

Q13. ​Which of the following symptoms is a 27-year-old female patient presenting with thyroid swelling is unlikely due to compression of adjacent structures?

1. Hoarseness of voice due to recurrent laryngeal nerve compression
2. Dysphagia due to oesophagus compression.
3. Superior vena cava syndrome
4. None of the above

Ans. 3) Superior vena cava syndrome

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Q14. Identify the accurate sequence of the Auditory pathway.

1. Eight nerve → cochlear nuclei → superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex
2. Eight nerve →Cochlear nuclei → lateral lemniscus → superior olivary nucleus → inferior colliculus → medial geniculate body → auditory cortex
3. Eight nerve →Superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex → Cochlear nuclei
4. Eight nerve →Superior olivary nucleus → inferior colliculus → medial geniculate body → auditory cortex → Cochlear nuclei → lateral lemniscus

Ans. 1) 

• The correct auditory pathway sequence is option (a):
• Eight nerve → cochlear nuclei → superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex

Q15. A 64-year-old female patient is brought to the ENT OPD with difficulties in comprehension. On examination, her fluency is found to be intact with poor comprehension and repetition. Her Pure tone audiometry and ABR is normal. What is the likely diagnosis in this patient?

1. Malingering
2. Auditory cortex lesion
3. Broca's aphasia
4. Wernicke’s aphasia

Ans. 4) Wernicke’s aphasia

• The likely diagnosis in this patient is Wernicke’s aphasia.
• Wernicke's aphasia is a condition where language comprehension is impaired, but speech may still have a normal rate, rhythm, and grammar. The most common cause of this type of aphasia is an ischemic stroke that affects the posterior temporal lobe of the dominant hemisphere.
• Pure tone audiometry and auditory brainstem response (ABR) tests are normal in this patient, indicating that there is no hearing loss or problem with the transmission of sound signals from the ear to the brain.

Q16. What is the likely diagnosis of the image given below?​

1. Ranula
2. Pleomorphic adenoma
3. Ludwig angina
4. Dermoid cyst

Ans. 1)  Ranula

• A ranula is a type of mucocele that occurs when a salivary gland duct, typically the sublingual gland duct, becomes blocked or damaged, leading to the accumulation of saliva in a cystic structure. This results in a painless, translucent or bluish swelling in the floor of the mouth as shown in the image​

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Q17.  A 30-year-old woman presents with an upper respiratory tract infection and orbital pain. What is the likely diagnosis?

1. Orbital cellulitis
2. Sinusitis
3. Both A and B
4. Periosteal abscess

Ans. 1) Orbital cellulitis

• The given CT is confirmatory of orbital cellulitis as there is proptosis visible on the CT and the patient is also having orbital pain.

Q18. ​A patient presents to the OPD with complaints of bilateral hearing loss with worse right ear hearing loss. On examination, the doctor diagnoses Otosclerosis and recommends stapedectomy as a final resort to the problem. What would be the findings of Tuning fork tests based on which Doctor recommends Stapedectomy?

1. Renne’s Test - positive; Weber’s Test - lateralized to left ear
2. Renne’s Test - positive; Weber’s Test - lateralized to right ear
3. Renne’s Test - negative; Weber’s Test - lateralized to left ear
4. Renne’s Test - negative; Weber’s Test - lateralized to right ear

Ans. 4) Renne’s Test - negative; Weber’s Test - lateralized to right ear:

The patient is experiencing bilateral hearing loss, worse in the right ear due to bilateral otosclerosis. In patients with otosclerosis, there is a conductive type of hearing loss hence Rinne will be negative. Weber will be lateralized to the diseased side, meaning towards the right ear.

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