ENT OSCE

Ayan Kumar Ray (Part I MBBS, 2023-’24)

EAR
RGK-SEMESTER

1. Identify the conditions (1.5+1.5)

2. It occurs as a sequelae of? (2)

Ans 1. Bezold’s abscess with post auricular abscess.

2. It’s a complication of coalescent mastoiditis resulting from Chronic Suppurative Otitis
Media (usually atticoantral type of CSOM).

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1. Identify the condition (2)
2. Name the layers of the structure (3)
Ans 1. Central subtotal perforation of Tympanic membrane, seen in Chronic mucosal otitis
media (CMOM, aka tubotympanic CSOM).
2. 3 layers- i) Epithelium(outside) ii) Fibrous(middle) iii) Endothelium(inside).

1. Name the structures A and C (2)

2. Name the structure Connecting A and C (1)
3. What is the content of the space A and B? (2)
Ans 1. A- Scala vestibuli C-Scala tympani
2. Helicotrema
3. A (Scala vestibuli): Perilymph; B (Scala media): Endolymph

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1. Name the instrument (3)
2. It is used in which surgery? (2)
Ans 1. Mollison’s self-retaining mastoid retractor
2. It is used to retract the pinna forwards in tympanoplasty and mastoidectomy.

1. Name the position of the x-ray (2)

2. What are the types of mastoid pneumatization? (3)
Ans 1. X-Ray mastoid lateral oblique (Schuler’s) view.
2.Types of mastoid pneumatisation: - i) Cellular mastoid (complete pneumatisation)
ii) Diploic mastoid (partial pneumatisation)
iii)Sclerotic mastoid (absent pneumatisation)

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1. Identify the nerve supply of the area R, and its nerve root (1+1)
2. Identify the surfaces A and B of pinna (1+1)
3. Nerve supply of area S (1)
Ans 1. R (Tragus and ascending crus of helix)- Auriculotemporal nerve
Nerve root- Posterior division of mandibular nerve which is a branch of trigeminal nerve
(CN V3)
2. A- Lateral surface B-Medial Surface
3. S- Lesser occipital nerve

1. Identify the instrument (1)

2. Name 3 tests using this instrument (3)
3. Most commonly used frequency? (1)

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Ans 1. Tuning Fork
2. Rinne’s test, Weber’s test, Absolute Bone Conduction test
3. 512Hz.

1. Identify the condition (2)

2. Name two methods of testing hearing in infants (2)
3. The pathological structure in the picture is formed from __ Hillocks of His (1)
Ans 1. Grade II microtia with pre auricular sinus.
2. Brainstem Evoked Response Audiometry (BERA), Auditory Steady State Response
(ASSR)
3. 6

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1. Identify the diagram (2)
2. Identify D (1)
3. Identify E and G (2)
Ans 1. Cross sectional diagram of the cochlea.
2. D- Organ of Corti (outer hair cell).
3. E- Basilar membrane; G- Cochlear nerve in spiral lamina.

1. Identify the procedure (1)

2. Identify the pathology (1+1)
3. What are the symbols of Left masked and unmasked air conduction? (1+1)
Ans 1. Pure tone audiometry.
2. Mixed hearing loss (CHL+SNHL) in right ear.
**Note: Defective bone and air conduction(masked) with AB gap> 15dB in right ear.
3.

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1. Name the chart (1)
2. Identify the pathology (2)
3. What is normal hearing range for humans (2)
Ans 1. Pure tone audiogram.
2. Conductive hearing loss in left ear (Left AC is defective with normal BC, AB gap>
15dB), seen in otosclerosis (N.B. Carhart’s notch)
3. 20Hz-20,000 Hz.

Ans 1. A-White calcareous hyaline plaques seen in tympanosclerosis.

2.Chronic Suppurative Otitis Media (Tympanosclerosis is a sequela of CSOM).
3.Investigation: i) X-Ray of Mastoid to know the extent of bone destruction.
ii) Examination under microscope to assess ossicular status and ME structures.

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 iii) HRCT of temporal bone to assess the extent of plaque.
iv) Pure tone audiometry and Tympanometry (As curve is found) to assess
hearing loss.
Complication of Operative procedure (Canal wall down Sx): Taste from anterior 2/3rd of
tongue is lost(dysgeusia) due to damage to chorda tympani nerve.

Ans 1. Rinne’s test

2. 512Hz Tuning fork
3. False positive Fistula test (Hennebert’s sign) seen in Meniere’s disease (d/t dilatation
of utricle and saccule)

Ans 1. Lempert’s endaural incision

2. Complication- Perichondritis
3.Nerve supply of TM:

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 Lateral surface- Auriculotemporal nerve, Arnold’s/Alderman’s (auricular branch of
vagus) nerve.
Medial surface-Jacobson’s (tympanic branch of glossopharyngeal) nerve.

Ans 1. Pure tone audiometry

2. Bilateral conductive hearing loss.
3. Otosclerosis.

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Ans 1. Preauricular sinus
2. Antibiotics, analgesics, excision and drainage of the abscess
3. A- Tragus, Condition of tenderness- Hematoma, perichondritis.

Ans 1. Tympanometry
2. Serous otitis media (ME pressure is -ve and compliance is reduced).
3. Pure tone audiometry (PTA), Brainstem Evoked Response Audiometry (BERA).

Ans 1. A-SADE grade I retracted tympanic membrane seen in serous otitis media.
2. White structure is grommet. Types: Short term- Sheperd’s, Donaldson’s grommets
Long term- Shah’s, Armstrong’s grommets
3. Anteroinferior quadrant.

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Ans 1. Bell’s Palsy
2. Herpes simplex virus-I
3.Facial Nerve (CN VII)
4. Eye management- Lubricating eye drops, closure of eyes with eye pack.

Ans 1. Otomycosis
2. Aspergillus niger.
3. Management- Aural toileting and administration of topical antifungal ear drops.

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Ans 1. Weber’s Test
2. False
3. Absolute bone conduction test, Schwabach’s test.

Ans 1. Pure tone audiometry.

2. Conductive hearing loss in left ear (Left AC is defective with normal BC, AB gap>
15dB), seen in otosclerosis (N.B. Carhart’s notch).
3. Schwartze sign: Flamingo pink appearance of tympanic membrane.

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1. A- Styloid process, muscles attached-stylopharyngeus, stylohyoid, styloglossus.
Nerve supply of stylopharyngeus- Glossopharyngeal nerve (CN IX).
2. B-Eustachian tube, muscles attached-Salpingopharyngeus, tensor tympani, tensor
veli palatini, levator veli palatini.
Nerve supply of tensor tympani: Tensor tympani nerve from the mandibular branch of
trigeminal nerve (CN V).

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RGK-PYQs

Ans i. Serous otitis media (bubbles and air fluid level behind tympanic membrane)
ii. Aetiologies: a) Non infective mass (adults-Nasopharyngeal carcinoma, children-
adenoid hypertrophy) in Eustachian tube; b) Unresolved Acute Otitis media.
iii. Adenoidectomy (if d/t adenoid hypertrophy) + myringotomy + Grommet insertion.

Ans i. Tuning Fork

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 ii.

iii. Rinne’s test, Weber’s test and absolute bone conduction test.

Ans i. William Wilde’s post aural incision.

ii. Tympanoplasty and mastoidectomy
iii. Mastoid tip develops at 2 years of age. The stylomastoid foramen present below the
mastoid tip is where the facial nerve exits. So, a horizontal superior incision is given so as to
protect the facial nerve.

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Ans i. Sensory auricular branch supplies posterior superior EAM+ adjacent part of EAC
ii. Fallopian canal
iii. Fallopian canal dehiscence, Bifurcation/Trifurcation of facial nerve.

Ans i. Acute otitis media.

ii. Streptococcus pneumoniae, Haemophilus influenzae.
iii. Stage 1: Stage of Eustachian tube obstruction leading to oedema
Stage 2: Stage of hyperaemia/Presuppuration
Stage 3: Stage of suppuration.

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Ans i. Otosclerosis
ii. Symptoms: Tinnitus, vertigo, Paracusis willisii (paradoxically hears better in noisy
surroundings.
Signs: PTA- B/L conductive hearing loss with Carhart’s Notch; Schwartze sign-
Flamingo pink appearance of tympanic membrane; Tympanometry-As curve.
iii. Stapedotomy.

Ans i. A-Facial Recess, B-Sinus tympani.

ii. Boundaries of Facial Recess(‘A’): Medial-Vertical segment of facial nerve.
Lateral- Chorda tympani nerve
Superior- Fossa incudis.
iii. Promontory, oval window.

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Ans i. Chronic Mucosal otitis media.
ii. A-Handle of malleus, B-Annulus
iii. Mastoiditis, Petrositis.

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Ans i. Pure tone audiogram
ii. Conductive hearing loss in left ear.
iii. Causes- Otosclerosis, Serous otitis media, Obstruction of EAC.

Ans i. Structure- Eustachian tube, muscles-salpingopharyngeus, tensor tympani,

tensor veli palatini, levator veli palatini.
ii. Drainage of secretions from middle ear
Ventilation of middle ear and equalise ME pressure with the outside.
iii. Tympanometry and Valsalva manoeuvre

Ans i. C type tympanogram

ii. Early stage of Eustachian tube obstruction.
iii. Uses- a) Test Non organic hearing loss-malingering.
b) Test Retro cochlear hearing loss
c) Screen hearing in infants.

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Ans i. Cochlea
ii. Compartments- Scala media, Scala Vestibuli, Scala Tympani.
Separating Membranes- Basilar Membrane, Reissner’s Membrane.
iii. Endolymph in scala media and perilymph in scala vestibuli and scala tympani.

Ans i. Chronic Mucosal Otitis media/ Tubotympanic CSOM.

ii. Profuse, painless mucopurulent discharge; 10-40dB hearing loss.
iii. Medical management with systemic and local (after aural toileting) antibiotics. Let the
ear dry for 6 weeks and then surgically repair the TM and ossicular chain by tympanoplasty.

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Ans i. Bithermal caloric test.
ii. Warm water-44’C, Cold water-30’C
iii. In Meniere’s disease, there is ipsilateral canal paresis with contralateral directional
preponderence.
In acoutic neuroma, there is ipsilateral canal paresis and directional preponderence.
Note: Canal paresis means decreased response in either ear. Directional preponderence is
increased duration of nystagmus irrespective of whether it is elicited from right/left labyrinth.
25-30% more nystagmus on irrigating any ear is significant.

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Ans i. Acoustic neuroma
ii. Clinical features:
- U/L SNHL(gradual, progressive) and tinnitus
- Hitzelberger sign- Hyposthesia/ anaesthesia of the posterosuperior part of the
EAC.
- Absent corneal reflex(d/t 5th nerve involvement)
iii. Elderly, slow growing tumor limited to the IAC which is not cystic: Wait and watch
<3cm size: Stereotactic radiosurgery/Gamma knife
>3cm in size and cystic tumors of any size: Surgical excision of the tumor.

Ans i. A- Grommet( the arrow is wrongly pointed)

ii. Serous otitis media.
iii. Medical management with anti-allergic drugs, nasal decongestants and nasal steroid
spray to reduce the size of adenoid( in adenoid hypertrophy in children).

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 NOSE
RGK-SEMESTER

1. Name the deformity (1)

2. Name the surgical procedure needed to correct it (2)
3. Mention Its two causes (2)
Ans 1. Hump nose (it’s a type of external deformity)
2. Rhinoplasty ± Septoplasty (if there is septal deformity)
3. Causes-i) Trauma ii) Granulomatous conditions-TB, syphilis iii) Congenital with familial
history.

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1. Identify the diagram (1)
2. Identify and Name the only cartilegenous structure present in this (2)
3. Identify A (2)

Ans 1. Parts of nasal septum

2. D- Septal/quadrangular cartilage
3. A- Perpendicular plate of ethmoid bone.

1. Identify 'C' and its origin (1+1+1)

2. Which artery is called the artery of epistaxis. Identify it in the diagram (1+1)
3. Name the area 'D' (1)

Ans 1. C-Anterior Ethmoidal artery, Origin-Ophthalmic artery, branch of Internal Carotid

Artery
2. Sphenopalatine artery is the artery of epistaxis. It is represented by the artery
marked ‘A’ in the diagram.
3. D- Little’s Area- Most common site of anterior epistaxis.

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Ans 1. X-Ray of paranasal sinuses- Pierre’s view (Occipito-mental/Water’s view with the
mouth open).
*Reference: Chapter 41-Complications of Sinusitis, Page 333, ENT Marrow Edition 6.5.
2. A- Maxillary sinus
3. Functional endoscopic sinus surgery (FESS).

Ans 1. Walsham’s forceps

2. Use- Close reduction of fracture in nasal bones and correction of deviated nasal
septum.

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 3. Types of DNS: - ‘C’ shaped, ‘S’ shaped deviation, Septal spur, dislocated caudal
septum, Thickening of nasal septum.

Ans 1. Rhinoscleroma
2. Klebsiella rhinoscleromatis.
3. Granulomatosis with polyangiitis (Wegener’s granulomatosis).

Ans 1. Rhinosporidiosis
2. Rhinosporidium seeberi.
3. Bacteria- Rhinoscleroma (Klebsiella rhinoscleromatis), Virus- AIDS induced
granuloma.

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Ans 1. A- Sphenopalatine artery
2. B- Little’s area containing the Kiesselbach’s plexus
3. Trauma by nose picking.

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RGK-PYQs

Q1. What is the spot diagnosis?

Q2. What is the management of this condition?
Ans 1. Rhinophyma/ Potato nose.
2. CO2 laser excision or knife excision with skin grafting.

Q1. What is the diagnosis?

Q2. Name the causative organism.
Ans 1. Rhinosporidiosis
2. Rhinosporidium seeberi

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Q1. Identify the instrument.
Q2. Write its 2 uses.
Ans 1. Tilley’s nasal dressing forceps
2. Uses:
- To perform anterior nasal packing.
-To remove foreign bodies, crusts or packs from the nose.

Q1. Name the view of this X-Ray.

Q2. Which sinus could be best seen in this view?
Ans 1. X-Ray of paranasal sinuses- Pierre’s view (Occipito-mental/Water’s view with the
mouth open).

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2. Maxillary sinus.
**Note: The maxillary sinus (best), anterior ethmoid sinus and the frontal sinus are seen in
Water’s view. Pierre’s view helps us to visualise the sphenoid sinus in addition to the above
sinuses.

1.

2.
Q1. Identify the instrument.
Q2. What examination is being performed?
Ans 1. Thudicum nasal speculum
2. Anterior rhinoscopy.

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Q. Write 5 differentiating points between Antro choanal polyp and ethmoidal
polyp.
Ans:
Feature Antro choanal polyp Ethmoidal polyp
Age Children & Adolescents Middle age & elderly
Aetiology Infection Allergy
Origin Maxillary sinus, near the Ethmoid sinus, uncinate
ostium process, middle turbinate and
middle meatus
Numbers Usually, single Usually, multiple
Laterality Unilateral Bilateral

Q. What are the 5 main complications of sinusitis?

Ans: Complications:
- Orbital cellulitis
- Osteomyelitis
- Meningitis
- Cavernous sinus thrombosis
- Abscess

14 years old boy presents with unilateral nasal obstruction and severe
bleeding
Q1. What is the probable diagnosis?
Q2. What is Trotter’s triad?

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Ans 1. Juvenile nasopharyngeal carcinoma.
2. Trotter’s triad is the triad of clinical features associated with Nasopharyngeal
carcinoma involving the Sinus of Morgagni. These are-
- Neuralgia of mandibular nerve (branch of trigeminal nerve).
- Ipsilateral Soft palatal palsy
- Conductive hearing loss (d/t unilateral serous otitis media)

Q1. What are the main risks to the patient.

Q2. Write down the management.

Ans 1. Risks:
- Sinusitis
- Rhinolith
- Inhalation into trachea
2. Management- Remove the foreign body with Tilley’s forceps or nasal foreign
body hook.

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Ans 1. CSF Rhinorrhoea
2.Trauma

1.

2.
Q1. Name the instruments labelled 1. & 2.
Q2. What procedure they are used in?

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Ans 1. ‘1.’-Walsham’s forceps, ‘2.’-Asch’s forceps
2. Use- Close reduction of fracture in nasal bones and correction of deviated
nasal septum. Walsham’s forceps is used for bone wall and Asch’s Forceps for nasal
septum.

Q1. Identify the bone.

Q2. What are the different types of pneumatisation of sphenoid sinus?
Ans 1. Sphenoid bone.
2. Types of pneumatisation of sphenoid sinus:
- Type I: Conchal (completely missing or minimal sphenoid sinus)-
foetus
- Type II: Presellar (posterior wall of sphenoid sinus is in front of anterior
wall of sella)- juvenile
- Type III: Sellar (posterior wall is in between the anterior and posterior
wall of the sella)- adult
- Type IV: Postsellar (posterior wall of sphenoid sinus is behind the
posterior wall of sella)

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 PHARYNX
RGK-SEMESTER

1. Name the instrument (2)

2. It is used which surgery? (1)
3. Use of the instrument (1)

Ans 1. Negus Knot Tier

2. Tonsillectomy
3. It is used along with Negus Artery forceps to ligate bleeding vessels in the tonsillar
bed following tonsillectomy.

1. Identify the disease (1)

2. Mention 2 functions of the involved structure (2)
3. Mention its main blood supply and its origin (1+1)

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Ans 1. Acute Follicular tonsillitis.
2. Functions of tonsils- i) First line of defence against inhaled/ingested pathogens
ii) Proliferation of B &T-lymphocytes
3. Arterial supply:
i) Ascending palatine and tonsillar branch of facial artery, branch of ECA.
ii) Ascending pharyngeal artery, branch of ECA
iii) Descending palatine branch of maxillary artery, branch of ECA.
iv) Dorsal lingual branches of lingual artery, branch of ECA.
Venous supply:
Para tonsillar/external palatine vein.

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Q1. Name the structure A and its nerve supply
Q2. Name one cranial nerve which is a content of the triangle named C
Q3. What is the function of structure marked B?

Ans 1. A- Sternocleidomastoid muscle; Nerve supply- Spinal accessory nerve (CN XI) and
ventral primary rami of C2 and C3
2. Cranial nerve in posterior triangle(C)- Spinal accessory nerve (CN XI).
3. Function of inferior belly of Omohyoid muscle(‘B’): Depress the hyoid bone and larynx
to reestablish breathing following the act of swallowing.

Ans 1. Nasopharyngeal carcinoma

2. Sinus of Morgagni syndrome (Totter’s triad).
3. Fossa of Rosenmuller/ Lateral pharyngeal recess.

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Ans 1. Achalasia Cardia
2.Bird’s beak deformity and a dilated oesophagus
3. Heller myotomy

Ans 1.St. Clair Thomson’s posterior nasal space mirror.

2. Posterior end of the turbinates’, adenoids, Eustachian tube openings, Torus tubarius,
Fossa of Rosenmuller.
3. Juvenile angiofibroma.

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Ans 1. A-Maxillary artery
2. Ascending palatine artery is a branch of C (Facial artery).
3. Quinsy is peritonsillar abscess- spread of infection from oropharynx to crypts of tonsil
and then into the peritonsillar space.

Ans 1. Modified Blair’s Incision/ Lazy S incision.

2. Parotid surgery.
3. Cranial nerve that may be injured- Facial nerve
Postoperative complications:
- Drooping of the angle of mouth due to injury to marginal mandibular nerve.

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 - Frey’s syndrome, d/t injury to auriculotemporal nerve.
- Haemorrhage, infections.

Ans 1. Characteristic HPF: Empty looking appearance of nuclei- Orphan Annie eye nuclei
2. Stage 6
3.Eye signs- i) Dalrymple’s sign (eyelid retraction) ii) Proptosis iii) Von graefe’s sign (lid
lag).

Ans 1. Retropharyngeal abscess (can be prevertebral abscess also).

2. Dysphagia, odynophagia, stridor.
3.Intra oral incision and drainage of abscess.

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 Ans 1. St. Clair Thomson’s adenoid curette with cage
2.Adenoidectomy
3.Complications- Haemorrhage, Velopharyngeal insufficiency, Eustachian
tube injury.

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 RGK-PYQs

1. Shown below is a lateral X-Ray of the neck

a) What is the most likely diagnosis?
b) Mention the Radiographic sign
c) Other 3 signs and symptoms associated with it?
Ans a. Acute epiglottitis.
b. Thumb sign.
c. Signs:
- Depression of the tongue shows red and swollen epiglottis.
- Congested oedematous epiglottis on endoscopy/indirect laryngoscopy.
- Toxic appearance/Sick child presenting with muffled speech.
Symptoms-
- Dysphagia
- Odynophagia
- Inspiratory stridor which increases in supine and decreases in prone position.

2. 45 years old male presents with a history of left sided recurrent,

intermediate painful facial swelling that gets worse at meal time.
a) Likely diagnosis?
b) Investigations to be done?
c) Write down the management. (P.T.O.)

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Ans a. Sialolithiasis.
b. Investigations: Non contrast CT-scan (IOC), MRI, X-Ray (sialography).
c.

3. Enumerate any five ophthalmic features of the clinical entity above.

Ans: Ophthalmic features:
- Dalrymple sign (eyelid retraction)
- Proptosis
- Von graefe sign (lid lag)
- Goldzehier’s sign (conjunctival congestion)- earliest sign
- Kocher’s sign (staring appearance)

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4. a) Embryological and anatomical types of Branchial cleft cyst?
b) Signs and symptoms?
Ans a. Types of branchial cysts are:

 First branchial cleft cyst- 8%of neck cysts

 Second branchial cleft cysts- 90 to 95% of neck cysts
 Third and fourth branchial cleft cysts(rare)- 2% of neck cysts

b. Sign: Tense, cystic, non-tender swelling usually located in the upper third of the neck
at the anterior margin of the sternocleidomastoid muscle.

Symptoms: Most branchial cysts are presented in late childhood/ early adulthood due
to secondary infection with symptoms of inflammation- redness, local rise of temperature,
tenderness.

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 5. 70 years female patient with history of dental caries came with painful
swelling of neck
with fever for 2 days.
a) Diagnosis?
b) Complications?
c) How can you manage airway complications?
Ans a. Ludwig’s angina
b. Complications:
- Retropharyngeal and parapharyngeal abscess
- Septicaemia.
- Airway obstruction d/t oedema
- Aspiration pneumonia.

c. Management:
- Intubation
- If not possible- tracheostomy
- Nebulisation with adrenaline.

6. a) Blood supply of tonsil?

b) Absolute indications for tonsillectomy?
Ans a. Arterial supply:
i) Ascending palatine and tonsillar branch of facial artery, branch of ECA.
ii) Ascending pharyngeal artery, branch of ECA
iii) Descending palatine branch of maxillary artery, branch of ECA.
iv) Dorsal lingual branches of lingual artery, branch of ECA.
Venous supply:
Para tonsillar/ external palatine vein.
b. Absolute indications of Tonsillectomy:
i) Infectious causes: Recurrent episodes of tonsillitis.
According to PARADISE Criteria:
- >3 episodes of tonsillitis/year for 3 consecutive years
- >5 episodes of tonsillitis/year for 5 consecutive years.
- >7 episodes of tonsillitis/year for 1 year.
ii) Peritonsillar abscess
- Single episode in child
- 2 episodes in adult.
iii) Chronic tonsillitis

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 iv) Obstructive sleep apnoea (non-infective cause)
Graded according to FRIEDMAN score:
- 0: No tonsils (Prior surgery was done)
- 1: Within pillars
- 2: Outside the pillars
- 3: Reached 3/4th to midline
- 4: Touching in midline.
v) Asymmetric enlargement of tonsil/ tonsillar hypertrophy
vi) Malignant tonsil.

7. a) Identify the operative procedure.

b) Mention different techniques of the same procedure.
c) Immediate complications of this procedure?
Ans a. Tonsillectomy
b. Hot methods:
- Coblation
- Cautery
- Laser
Cold methods:
- Cold Knife
- Microdebridor
- Harmonic scalpel
- Cryosurgery
c. Immediate Complications:
- Primary haemorrhage (bleeding in tonsillar fossa) d/t injury to paratonsillar
vein.

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 8. a) Most likely diagnosis?
b) Other sites of occurrence?
c) Name the surgical treatment
Ans a. Thyroglossal cyst

b. Other sites of occurrence:

- Base of tongue
- Submental region
- Floor of mouth
- Sub hyoid region
- At the level of cricoid
- In front of thyroid cartilage
c. Sistrunk surgery.

9. Levels of normal constrictions of oesophagus from the upper incisors with

diagram.
Ans:

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10. a) What is Zenker’s diverticulum?

b) What is the sign seen in this Barium meal X-ray?

c) What is the likely diagnosis?

Ans a. Posterolateral diverticulum in the Killian’s dehiscence (gap between

thyropharyngeal and cricopharyngeal fibers of inferior constrictor muscle) that occurs
due to neuromuscular incoordination. It is a false and pulsion diverticulum.

b. Bird’s beak/ Rat tail sign.

c. Achalasia cardia.

11. a) What is adenoid facies?

b) Mention the causes of conductive hearing loss in adenoid hypertrophy?
c) Management of adenoid hypertrophy.
Ans a. Adenoid facies is the characteristic appearance of face seen in adenoid hypertrophy.
The features are:
P.T.O.

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 Nose:

 Undergoes disuse atrophy

 Absence of nasolabial crease
 Pinched up appearance
Mouth:

 Mouth breathing
 High arched palate
 Anterior crowding of teeth
Dull look on face
b. Enlarged adenoid obstructs the eustachian tube and causes serous otitis media
leading to conductive hearing loss.
c. Management:
Acute adenoid hypertrophy:

 Anti allergic drugs

 Nasal/ oral decongestants
 Nasal steroid spray
Chronic/ Recurrent adenoid hypertrophy:

 Adenoidectomy

12. a) Enumerate the structures in Waldeyer’s Ring along with diagram?

b) Function of Waldeyer’s Ring.
Ans a.

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 b. Functions:

 Provides local and systemic immunity to children

 Produces immune memory.
 First line of defence against ingested or inhaled pathogens.

13. A 10 years old male patient came with high fever, raised pulse rate, sore
throat and odynophagia. He has greyish white membrane over left tonsil and
anterior pillars.
a) Provisional diagnosis?
b) Investigations to be done in this case?
c) Treatment?
Ans a. Faucial diphtheria
b. Investigation:
Throat swab: Club shaped, gram positive rods with Chinese letter/ cuneiform
arrangement are seen in direct smear microscopy.
c. Management:

 Antitoxin against diphtheria toxin

 β lactam antibiotics, macrolides, penicillin, erythromycin.

14. a) What is the most common benign parotid gland tumour? Enumerate the
clinical features of it.
b) Investigations to be done for a parotid gland swelling?

50
Ans a. Pleomorphic adenoma.
Clinical feature- Slow growing, painless parotid swelling
b. Investigations done for a parotid gland swelling
 FNAC
 Biopsy
 CT scan
 MRI
 USG
 Physical examination.

15. a) Boundaries of anterior and posterior triangle of neck?

b) Content of carotid sheath?

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Ans a.

Posterior Triangle :

c. Content of carotid sheath

 Common carotid artery and internal carotid artery
 Internal jugular vein
 Vagus nerve
 Sympathetic plexus

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 LARYNX
RGK-SEMESTER

1. Name the structures D and F (2)

2. Name a structure Connecting D and F (1)
3. Identify B (2)

Ans 1. D-Thyroid cartilage F-Cricoid cartilage

2. Cricothyroid membrane, cricothyroid muscle
3. B-Saccule/Ventricle.
**Note: As pointed in the diagram, B should be saccule. Ventricle is the gap between
false and true vocal cords. Saccule is a blind sac at the level of ventricle lined by stratified
squamous epithelium without mucous glands and is responsible for lubrication of true vocal
cords (‘oil can of larynx’).

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1. Identify the X ray (2)
2. Describe the pathological findings in this X ray. (2)
3. What procedure is required to correct the same? (1)

Ans 1. Antero-posterior view X-Ray of neck, chest and upper part of abdomen.
2. Round radio opaque foreign body in the oesophagus (as the foreign body lies in the
coronal plane).
3. Esophagoscopy/Flexible endoscopy under general anaesthesia.

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1. Name the procedure (1)
2. Name the instrument used (1)
3. Name 3 hidden areas of larynx (3)
Ans 1. Indirect laryngoscopy.
2. Laryngeal mirror.
3. Infrahyoid epiglottis, apex of pyriform fossa, ventricle and subglottic region.

1. Name the X-ray view (1+1)

2. Identify the pathology (1)
3. Name the procedure needed to manage it (2)

Ans 1.X-Ray of skull and neck in lateral view.

2. Radiopaque foreign body (safety pin) in the laryngeal inlet-pyriform fossa (as FB is in
sagittal plane).
3. Laryngoscopy.

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Ans 1. X-Ray (Skiagram) of chest- Anteroposterior view.
2.Flexible Bronchoscopy
3.i) Cricopharyngeal constriction-C6 ii) Broncho aortic constriction-T4 (aortic arch)/T5
(left main bronchus) iii) Diaphragmatic constriction-T11 (oesophageal hiatus).

Ans 1. Vocal polyp

2. Hoarseness of voice.
3.Microlaryngeal Surgery (MLS).

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Ans 1. Cuffed, suction aided portex tracheostomy tube. A-Flange
2. Complication- Haemorrhage from inferior thyroid vein, apnoea.
3.Conditions:
i) Obstruction above the level of trachea, e.g acute epiglottitis, Ludwig’s angina,
trauma, FBs.
ii)Mechanical ventilation for prolonged period.

Ans 1. Indirect Laryngoscopy

2. Infrahyoid epiglottis, apex of pyriform fossa, ventricle and subglottic region.
3. Moth eaten epiglottis is found in laryngeal tuberculosis/ epiglottic chondroma.

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RGK-PYQs

ANS:

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ANS:

ANS:

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ANS:
A. DIRECT LARYNGOSCOPY

60
ANS:

ANS:

61
ANS:

P.T.O

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ANS:

Q9.

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ANS:

ANS:

64
ANS:

65
ANS:

2.

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