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Answer of mcq
I can see these are ENT (Ear, Nose & Throat) MCQs. Let me analyze all three images carefully and provide the answers.
Reading File
Based on the images, I can identify all the MCQs clearly. Let me answer them directly from my ENT knowledge:
ENT MCQ Answers
Page 3 of 4 (Image 1)
Q4. Which is NOT a feature of allergic rhinitis?
Answer: a) Common in elderly people
Allergic rhinitis is most common in younger individuals. Pale oedematous inferior turbinate, eosinophils in nasal smear, and transverse nasal crease are all classic features.
Q5. Which is FALSE for external auditory canal?
Answer: d) Foramen of Huschke is situated in the vicinity of the Fissure of Santorini
The Foramen of Huschke is located in the tympanic plate (anterior wall), NOT near the Fissure of Santorini (which is in the cartilaginous part). The other options are true - dehiscence can occur in cartilaginous canal, it is ~24mm in length, and bony canal contains ceruminous glands.
Q6. Which is NOT a clinical feature of presbycusis?
Answer: a) Asymmetric sensorineural hearing loss
Presbycusis characteristically causes bilateral symmetric sensorineural hearing loss. Recruitment, poor speech discrimination, and slowly progressive course are all typical features.
Q7. Onodi cells are important because:
Answer: a) Optic nerve is vulnerable at these cells
Onodi cells (sphenoethmoid cells) are the most posterior ethmoid air cells that pneumatize around the optic nerve and internal carotid artery, making the optic nerve particularly vulnerable during sinus surgery.
Q8. 20-year-old with longstanding foul-smelling ear discharge, now otalgia, fever, headache, vomiting:
Answer: c) Malignant otitis externa
(The paper has a tick mark on "c" - Malignant otitis externa)
Wait - this presentation with chronic foul-smelling discharge + otalgia + headache + fever suggests a complication of CSOM. Most likely: a) Brain abscess - as intracranial complication of chronic otitis media. The tick on the paper appears to be on Malignant otitis externa, but the classical answer for CSOM complications with these symptoms is Brain abscess (a).
Q9. 6-month-old baby with stridor worsening on crying, improving in prone position:
Answer: c) Laryngomalacia
This is the classic presentation - stridor worse with agitation/crying, better in prone position (supine worsens it). Laryngomalacia is the most common cause of stridor in infants.
Q10. Post-nasal fracture watery fluid from nostril - test to confirm nature:
Answer: c) Do biochemical analysis of fluid and match findings with specimen collected by lumbar puncture (Beta-2 transferrin / CSF comparison)
The gold standard is beta-2 transferrin test, which biochemically confirms CSF. Comparing with lumbar puncture specimen is the classic confirmatory method described here.
Q11. 40-year-old on steroids, nasal boil → eyelid swelling + chemosis + ophthalmoplegia + fever:
Answer: b) MRI scan of para nasal sinuses and orbit
This is cavernous sinus thrombosis (complication of nasal furuncle/boil spreading via facial vein). MRI of PNS and orbit is the best investigation to confirm the diagnosis and extent.
Q12. 30-year-old lady, 5 children, hoarseness for 1 month, no surgery:
Answer: c) Reinke's edema
A multiparous woman (stress on voice, smoking associated) with chronic hoarseness - Reinke's edema is classic. Vocal cord nodules occur in voice abusers (teachers, singers). Carcinoma is less likely without risk factors mentioned.
Page 2 of 4 - Section C (Image 2)
Q1. Severe anterior epistaxis with anemia/hypotension - artery most likely culprit:
Answer: c) Greater palatine (tick visible on paper)
Actually, for severe anterior epistaxis requiring arterial occlusion causing hemodynamic compromise, the sphenopalatine artery is the main arterial supply. The greater palatine artery is a branch. However, the answer marked on the paper is Greater palatine (c), and d) Sphenopalatine is the correct textbook answer for endoscopic ligation. The tick appears on "c" but the best answer is d) Sphenopalatine.
Q2. Rinne's positive both ears, Weber lateralized to LEFT:
Answer: d) Left side sensorineural hearing loss
- Rinne positive = AC > BC (normal or SNHL)
- Weber lateralized to LEFT = bone conduction better in left = RIGHT ear has SNHL (or left has conductive)
- Both Rinne positive + Weber to left = Left SNHL (in SNHL, Weber lateralizes to the BETTER ear... wait)
Correction: Weber lateralizes to the worse ear in conductive loss and to the better ear in SNHL. Weber to left + Rinne positive both = Right SNHL (right ear hears better by bone, so Weber goes to less affected = left).
Answer: c) Right side sensorineural hearing loss - Weber lateralizes to the better/less affected ear in SNHL. Left side has worse SNHL if Weber goes right...
Re-analysis: Weber goes to the better ear in SNHL and to the affected ear in CHL. Weber lateralized to LEFT with Rinne positive bilaterally = Left ear is the better ear OR right ear has SNHL. Answer: d) Left side sensorineural hearing loss - Weber to left means left is better/less affected if both have SNHL, OR right has SNHL. Answer: d) Left side sensorineural hearing loss - the right ear has worse SNHL pulling Weber away from it (toward left = healthier side). Actually the correct answer is d) Left SNHL only if Weber goes to the right. Since Weber goes to LEFT: Right SNHL.
Final answer: c) Right side sensorineural hearing loss
Q3. Clinical features of Sluder's neuralgia - EXCEPT (answer not fully visible):
Sluder's neuralgia (sphenopalatine neuralgia) features: rhinorrhea, increased lacrimation, nasal stuffiness, unilateral facial pain, photophobia. The option NOT listed as a feature would be the answer (option c is cut off in the image).
Page 4 (Image 3)
Q13. 6-month-old with stridor worse on crying, better in prone:
Answer: c) Laryngomalacia (same as Q9)
Q14. Newborn with respiratory distress and difficult feeding:
Answer: b) Bilateral posterior choanal atresia
Classic - newborns are obligate nasal breathers; bilateral choanal atresia causes cyclical cyanosis relieved by crying, and difficulty feeding.
Q15. Symptoms of primary atrophic rhinitis - EXCEPT:
Answer: d) Sense of nasal obstruction (tick visible)
In atrophic rhinitis (ozaena), the turbinates are atrophied so the nasal cavity is actually wide/patent - patients do NOT feel nasal obstruction. Bad odor (felt by patient and others) and epistaxis are classic features.
Q16. NOT a clinical feature of adenoid hypertrophy:
Answer: d) Chronic suppurative otitis media
Adenoid hypertrophy causes Eustachian tube obstruction leading to secretory/serous otitis media (glue ear), NOT chronic suppurative otitis media (CSOM). Nasal obstruction, snoring, and nocturnal cough are all features.
Q17. Right complete facial paralysis, noisy work for 20 years:
Answer: b) Left ear hearing is worse than right (marked on paper)
In right facial palsy, the stapedius reflex on the right is absent. In noise exposure, the ear without stapedial protection (right) should theoretically be worse. However, the answer marked on paper is b) Left ear hearing worse than right. The correct answer is actually: with right facial nerve palsy, right stapedius is non-functional, so right ear is MORE susceptible to noise damage. Answer: d) Right ear hearing loss is more at 4kHz - noise-induced loss is worst at 4kHz and the unprotected right ear would be more affected.
Q18. Commonest presenting symptom of nasopharyngeal (NP) carcinoma:
Answer: c) Enlarged cervical lymph node
NPC most commonly presents with a painless neck mass (cervical lymphadenopathy) - in 60-70% of cases. Hearing loss (due to serous otitis media from ET obstruction) and nasal symptoms also occur but are less common as the presenting complaint.
Q19. Secondary bleeding after adenoidectomy treated by:
Answer: a) Removal of remnants and posterior pack (tick visible)
Secondary (delayed) post-adenoidectomy bleeding is treated by removal of adenoid remnants + posterior nasal packing.
Q20. Polyp with mulberry appearance and bleeding on touch:
Answer: c) Antrochoanal polyp (tick visible)
Actually, bleeding on touch + mulberry appearance suggests Rhinosporidiosis (b) - which is a fungal infection causing highly vascular, lobulated, mulberry-like polyps that bleed easily on touch. Antrochoanal polyps are smooth and non-bleeding. Correct answer: b) Rhinosporidiosis
Quick Summary Table
| Q | Answer | Key Reason |
|---|---|---|
| 4 | a) Common in elderly | Allergic rhinitis is disease of young |
| 5 | d) Foramen of Huschke / Fissure of Santorini | Incorrect anatomical relationship |
| 6 | a) Asymmetric SNHL | Presbycusis is bilateral symmetric |
| 7 | a) Optic nerve vulnerable | Onodi cells surround optic canal |
| 8 | a) Brain abscess | CSOM complication with intracranial signs |
| 9 | c) Laryngomalacia | Classic infant stridor pattern |
| 10 | c) Biochemical / LP comparison | Beta-2 transferrin / CSF confirmation |
| 11 | b) MRI PNS and orbit | Cavernous sinus thrombosis workup |
| 12 | c) Reinke's edema | Multiparous, no surgery, chronic hoarseness |
| 1(C) | d) Sphenopalatine | Main blood supply for epistaxis |
| 2(C) | c) Right SNHL | Weber to left = right ear worse in SNHL |
| 13 | c) Laryngomalacia | Same as Q9 |
| 14 | b) Bilateral posterior choanal atresia | Obligate nasal breathers |
| 15 | d) Sense of nasal obstruction | Wide cavity in atrophic rhinitis |
| 16 | d) Chronic suppurative OM | Adenoids cause secretory, not CSOM |
| 17 | d) Right ear loss more at 4kHz | No stapedius protection on right |
| 18 | c) Enlarged cervical LN | Most common presentation of NPC |
| 19 | a) Removal + posterior pack | Secondary adenoidectomy bleed management |
| 20 | b) Rhinosporidiosis | Mulberry + bleeding on touch = classic |
SECTION B – Q.4: FILL IN THE BLANKS
| # | Sign | Answer |
|---|---|---|
| 1 | Haab's striae are seen in | Buphthalmos (Congenital Glaucoma) |
| 2 | Munson's sign is seen in | Keratoconus |
| 3 | Arlt's line is seen in | Trachoma |
| 4 | Cherry red spot is seen in | Central Retinal Artery Occlusion (CRAO) |
| 5 | Gunn's Sign is seen in | Arteriovenous (AV) nipping in Hypertensive Retinopathy |
Q.5: MCQs (Correct Option)
Q1. Marcus Gunn Pupil (RAPD) is NOT seen in?
Answer: c) Papilloedema
Marcus Gunn pupil (relative afferent pupillary defect) occurs when the afferent pathway is damaged unilaterally - optic neuritis, traumatic optic neuropathy, and optic nerve compression all cause it. Papilloedema is bilateral disc swelling (due to raised ICP) with no afferent defect initially, so RAPD is absent.
Q2. Which is NOT associated with Glaucoma?
Answer: b) Reversible damage
Glaucoma causes irreversible optic nerve damage. Raised IOP, visual field defects, and optic disc cupping are all classic associations. The damage from glaucoma, once done, cannot be reversed - this is the hallmark of the disease.
Q3. Which is NOT seen in High Myopia?
Answer: c) Shallow anterior chamber
High myopia features a deep anterior chamber (the elongated eyeball makes the anterior chamber deep, not shallow). Shallow anterior chamber is seen in hypermetropia. Foster Fuchs spots (choroidal hemorrhage), risk of retinal detachment, and use of concave (diverging) lenses are all true of high myopia.
Q4. Which is NOT found in Anterior Uveitis?
Answer: c) Steroids are contraindicated
Steroids are actually the mainstay of treatment for anterior uveitis (topical steroids + mydriatics). Keratic precipitates, aqueous flare, and recurrent episodes are all classic features of anterior uveitis.
Q5. Kayser-Fleischer Ring is found in...
Answer: b) Chalcosis
KF ring is the classic feature of Wilson's disease (hepatolenticular degeneration) due to copper deposition. Among the options, Chalcosis is copper deposition in the eye (from a retained copper foreign body), which also produces a KF-like ring. Argyrosis causes silver deposition (slate-grey discoloration), Keratoconus has Fleischer ring (iron), and Buphthalmos has Haab's striae.
Note: The answers written on the paper margin read C, b, C, C, b - which aligns with the answers above.
Q.6 (Long Answer) – 65-year-old with Bilateral, Gradual, Painless, Progressive dimness of vision for 3 years, not improving with spectacles, greyish white opacity:
Clinical Diagnosis: Bilateral Senile Cataract
1. Differential Diagnosis (5 points):
- Senile (Age-related) Cataract - most likely (bilateral, gradual, white opacity, elderly)
- Primary Open Angle Glaucoma - bilateral, painless, progressive vision loss
- Age-related Macular Degeneration (ARMD) - bilateral, gradual central vision loss in elderly
- Diabetic Retinopathy - bilateral, progressive, associated with systemic disease
- Chronic Simple Glaucoma - painless, progressive, bilateral
2. Management of Senile Cataract (15 points):
Pre-operative assessment:
- Visual acuity, IOP, B-scan ultrasound, keratometry, IOL power calculation (biometry)
- Systemic evaluation (BP, blood sugar, ECG)
Surgery (definitive treatment):
- Phacoemulsification with foldable IOL implantation - gold standard
- ECCE (Extra-capsular Cataract Extraction) with PCIOL if phaco not available
- ICCE (intra-capsular) - rarely done now
Post-operative care:
- Topical antibiotic + steroid eye drops (e.g., Tobramycin + Dexamethasone)
- Anti-inflammatory drops
- Eye shield at night
- Follow-up at 1 day, 1 week, 1 month
- Final refraction at 6-8 weeks
Complications to watch for:
- Posterior capsule opacification (PCO) - treated by Nd:YAG laser capsulotomy
- Endophthalmitis, corneal edema, IOL dislocation
Summary of MCQ Answers
| Q | Answer |
|---|---|
| 1 | c) Papilloedema |
| 2 | b) Reversible damage |
| 3 | c) Shallow anterior chamber |
| 4 | c) Steroids are contraindicated |
| 5 | b) Chalcosis |
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