Cognitive Questions - ENT

CSOM with ear discharge scenario:

1) A 70-year-old male patient seeks medical attention for a sudden worsening of ear discharge
which is copious, mucopurulent, nonfoul smelling, and not blood-stained. He complained of ear
discharge on and off for many years but had not sought treatment until now. Otoscopy reveals a
central perforation with crusting and persistent discharge.

A) What is the diagnosis?

B) What are the types of the above-mentioned Diagnosis?

C) What is the most common organism?

D) What are the types of perforation in pars tensa?

CSOM without ear discharge scenario:

2) A 45-year-old patient came with complaints of right ear reduced hearing and right ear
discharge for the past 1 year. H/o ear discharge present on and off and aggravated while taking a
head bath. No history of ear discharge at present. Otoscopy reveals a central perforation present
in the anteroinferior quadrant of the tympanic membrane.

A) What is the diagnosis?

B) What are the clinical features of the above diagnosis?

C) What is the type of hearing loss in the above diagnosis?

D) What is the surgical treatment?

CSOM with conductive hearing loss:

3) A 55-year-old male came with complaints of right ear hearing loss for 1 year. History of right
ear pain and discharge on and off for 2 years. Otoscopy reveals a central perforation in the
posteroinferior quadrant of the tympanic membrane.

A) What is the type of hearing impairment in the above condition?

B) What are the types of hearing loss?

C) What is round window shielding effect?

D) Which is the first ear ossicle to get involved in CSOM?

CSOM with foul-smelling discharge:

4) A 45-year-old female patient presents with a history of recurrent ear infections with foul-
smelling and blood-stained ear discharge from the right ear. The patient has been experiencing
this issue for several years, with a progressively worsening fishy odor. Examination reveals a
marginal perforation and granulation tissue with purulent ear discharge.

A) What is the diagnosis?

B) Name any 4 complications of the above condition.

C) What is cholesteatoma?

D) What is the surgical procedure done for the above condition?

Otosclerosis

5. A 28-year-old female came with c/o hard of hearing left ear for 2 years, complaints of tinnitus
for 2 years, on local examination bilateral ear tympanic membrane intact, on siegelisation TM
mobile. On tuning fork test Left ear Rinnes test was negative and Webers lateralized to left, PTA
with impedance done, left ear shows 40 dbhl and showing dip at 2khz in bone conduction. On
tympanogram shows As type curve.

A) What is the likely diagnosis?

B) What is 2khz dip known as?

C) What is Schwartze sign?
D) What is the surgical treatment for the above diagnosis?

Meniere’s disease

6. A45-year-old male came with complaints of right ear fluctuating aural fullness, episodic
vertigo, hard of hearing and tinnitus. on local examination bilateral ear Tympanic membrane was
intact, and pure tone audiometry was done and showed sensorineural hearing loss. On glycerol
test hearing improvement was seen.

A) What is the probable diagnosis?

B) What is lermoyez syndrome?
C) What is tulio’s phenomenon?
D) What is chemical labyrinthectomy?

Ototoxicity

7. A 62 year old male was diagnosed with a urinary tract infection and based on culture and
sensitivity; the patient was started on Amikacin. Patient had elevated blood urea and creatinine
values. Patient developed hard of hearing and tinnitus. On local examination bilateral ear
tympanic membrane intact.

A) What is the likely diagnosis?

B) Which type of hair cells does it affect?
C) Name any 5 drugs that can produce this condition.
D) How will you treat the patient?

Noise-induced hearing loss

8. A 31year old male working in a machinery industry for 3 years came with complaints of hard
of hearing for 6 months, on examination Bilateral ear tympanic membrane was intact. On tuning
fork test bilateral ear Rinne positive, Webers lateralised to right, absolute bone conduction
reduced on both ears (left>right).

A) What is likely diagnosis?

B) What is the safe limit of exposure?
C)At what frequency dip is seen in PTA with impedance?
D) What are the preventive methods?

LMN Facial palsy

9. 28 year male came with complaints of deviation of angle of mouth towards left side overnight,
inability to close right eyelid. History of exposure to cold air+. on examination tm was intact,
tuning fork test was normal.

A) What is the likely diagnosis?

B) What are the other features of this condition?
C) List any 4 other causes of this condition?
D) What is medical/surgical management of facial nerve pasy?

ASOM

10. A 4 year old kid with history of recurrent upper respiratory tract infection came with c/o ear
pain and ear block for past 3 days.

A) What is the probable diagnosis?

B) What are the stages of this disease?

C) What is the characteristic appearance of tympanic membrane in this disease?

D) What is the treatment?

DNS

11. A 20 year old male came with complaints of right sided nasal obstruction for past 8 months
which was not relieved on medications. No history of allergic symptoms or nasal bleeding.

Anterior rhinoscopy showed deviation of nasal septum to right.

A) List the etiology for the probable diagnosis?

B) What are the types of deviation?

C) What are the surgeries on septum?

D) List any 3 complications of the surgeries.

Chronic sinusitis
12. A 35 year old female came with c/o facial heaviness for past 1 year associated with post
nasal drip. CT PNS was done which showed features of mucosal thickening in bilateral frontal
and maxillary sinuses.

A) What is the probable diagnosis?

B) What are the investigations to be done for diagnosis?

C) Name the surgeries for sinusitis.

D) List any 4 complications of sinusitis.

Allergic rhinitis

13. A 45-year-old female came with c/o recurrent sneezing and watering of eyes on exposure to
dust. she also complaints of itching in nose and nasal stuffiness.

A) What could be the probable diagnosis?

B) What is the characteristic nasal and ocular sign?

C) Which antibody is involved?

D) What is skin prick test?

Atrophic rhinitis

14. A 55-year-old male with a history of recurrent URTI came with c/o foul-smelling discharge
for the past 3 weeks. On examination the nasal cavity was roomy with pale mucosa and the
turbinates were atrophied.

A) What is the probable diagnosis?

B) What are the symptoms of this disease?

C) Methods of nasal douching?

D) Name of the surgery done for this disease

Vocal cord nodule

15. A 30 year old female teacher came with complaints of hoarseness of voice for 2 months.
Patient has no throat pain or difficulty swallowing, No breathlessness / cough, No h/o loss of
weight or appetite.

A) What is the the likely diagnosis?

B) What occupations are commonly involved in this disease?
C) What is the etiopathogenisis and types of the disease?
D) How will you manage this condition?

Unilateral vocal cord paralysis

16. A 45 year old male , presents with a history of hoarseness of voice which has gradually
worsened over the past six months. History of cough on taking liquids+. Patient gives no history
of breathlessness or noisy breathing. No recent history of upper respiratory tract infections.
Laryngoscopy indicates paralysis of left vocal cord.

A) Which is the nerve involved in this scenario?

B) What is the position of vocal cord in unilateral vocal cord paralysis?
C) What are the causes for unilateral vocal cord paralysis?
D) How will you manage this patient?

Stridor & tracheostomy

17. A 65-year-old male who is a long-term smoker and alcoholic presented to the emergency
with acute shortness of breath and noisy, high-pitched breathing sounds over the past 24 hours.
Patient has been on home oxygen therapy for the past year. Pulse oximetry reveals oxygen
saturation levels below 85% despite high-flow oxygen supplementation.

A) What is the noisy breathing known as?

B) What is the first line management for this patient?
C) Name three indications for tracheostomy.
D) Name the types of tracheostomy

Acute tonsillitis

18. A 7-year-old male came with c/o difficulty and painful swallowing for the past 3 days for
solids more than liquids, h/o fever x 2 days, No h/o similar complaints in the past, on
examination child is febrile and dull, on local examination of the oral cavity, bilateral grade 3
tonsillar hypertrophy present, congestion present, posterior pharyngeal wall minimally congested,
no palpable neck nodes.
A) What is the likely diagnosis

B) What are the types?

C) What is d/d for membranous tonsillitis?

D) How do you manage the patient with above diagnosis?

Chronic tonsillitis

19. A 12-year-old female came with c/o difficulty in swallowing for the past 2 years, for solids
more than liquids, h/o halitosis, h/o cough, h/o snoring, and no h/o fever, on examination patient
is conscious, alert, and afebrile, on local examination bilateral grade 3 tonsillar hypertrophy,
minimal congestion present, posterior pharyngeal wall normal, b/l level iia lymph nodes palpable,
non tender.

A) What is the likely diagnosis of above condition?

B) What is Erwin moore’s sign?

C) What are the types of surgical treatment for the same?

D) Which lymph nodes are enlarged?

Quinsy (Peritonsillar abscess)

20. A 24 year old male came with c/o unilateral throat pain with dribbling of saliva from the
angle of mouth, h/o high grade fever, h/o body ache, h/o hot potato voice, h/o right side ear pain,
h/o trismus, on examination, patient is febrile, dull and dehydrated, on local examination-right
tonsillar enlargement noted, pillars and soft palate congested, uvula swollen and pushed to left
side, right II a lymphnodes papable on neck

A) What is likely diagnosis?

B) What is the most common causative organism?

C) What are the complications of chronic tonsillitis?

D) How do you treat this condition?

Post op tonsillectomy

21. A 7-year-old with recurrent sore throat attacks was diagnosed with chronic tonsillitis and was
planned for surgical management for the respective condition

A. What is the name, the position of the surgery?

B. List any 3 techniques of surgeries?

C. List the intraoperative complications?

D. What is reactionary haemorrhage?

Foreign body Esophagus.

22. A 4-year-old kid accidently swallowed one rupee coin. His mother got alarmed as the
incidence occurred in her presence. Immediately parent took the child to the casualty.

A) What is the common site of foreign body lodgment in the esophagus?

B) Which investigations will you advise for confirming the diagnosis?

C) List any 3 complications of Oesophageal foreign body.
D) List any 3 advantages of flexible Oesophagoscopy?

Foreign body Bronchus

23. A 5 year kid accidently inhaled a piece of peanut and started coughing and difficulty in
breathing. She was talking, laughing and playful while taking her food. Her parents got alarmed
and took her to casualty.

A) Where do you think the foreign body could be?

B) Which investigations will you advise for confirming the diagnosis?
C) What are the methods to remove tracheobronchial foreign body?
D) What is Heimlich maneuver?

Plummer Vinson syndrome

24. A 36-year-old female presented with difficulty in swallowing since 6 months duration. The
patient gave history of easy fatiguability and physically looks emaciated, severely dehydrated,
pale and lethargic.

A) What is the probable diagnosis? what is the other name?

 B) What are the clinical features?
C) What are the investigations will you advise for confirming the diagnosis?
D) What is the procedure that needs to be done to relieve dysphagia?

Epistaxis
25. A 24 year old female came with complaints of right nasal cavity bleed on and off, resolves
spontaneously, since 4 months. No h/o trauma/ digital trauma.

A) What is kiesselbachs plexus?

B) What are the local causes for epistaxis?
C) What is trotters method?
D) What is tespal?

Juvenile Nasopharyngeal Angiofibroma

26. A 20-year-old male came with complaints of torrential bleeding from right nasal cavity since
5 months. after history and clinical examination, diagnostic nasal endoscopy was performed,
showing a vascular mass in the nasopharynx that bleeds on touch.

A) What is the probable diagnosis?

B) What are the clinical features?
C) What is Holman- Miller sign?
D) What is the investigation of choice?

Nasopharyngeal carcinoma

27. A 45-year-old male came with complaints of bilateral nasal obstruction for 4 months. history
of weight loss history of loss of appetite. after a thorough history and clinical examination, DNE
was performed, showing an ulcerative lesion in the nasopharynx.

A) What could be the probable diagnosis?

B) Which virus is commonly associated with the condition?
C) What is trotter’s triad?
D) List the ophthalmoneurologic features?

Nasal polyps
28. A 33-year-old male came with complaints of bilateral nasal obstruction since 1 year. history
of paroxysmal sneezing on and off associated with watery nasal discharge. On anterior
rhinoscopy- bilateral nasal cavity shows pale grey polypoidal lesions which does not bleed on
touch.

A) What are two types of nasal polyp?

B) List any 3 differences between them
C) List the causes of bilateral nasal obstruction.
D) Triad of kartagener syndrome