Islamabad medical & Dental College

(4th year MBBS Examination)

(MCQ’S PAPER)

Date: 18th Sep, 2018 Subject: ENT

Max Marks:70 Times Allowed: 70

minutes

Q 1: A 40 year old diabetic patient is complaining of severe itching for 10

days. He also has conductive hearing loss. Examination with Otoscope showed
black-headed Hyphae. The most likely diagnosis is

a) Foreign body in ear

b) Aspergillus Niger
c) Aspergillus fumigatus
d) Candida infection
e) Mucormycosis

Q2: Tympanometry showed decrease compliance, Audiometry showed mixed

hearing loss with Carhart’s notch seen on

a. In bone conduction
b. In air conduction
c. In Bone conduction at 1000Hz
d. In Bone conduction at 2000Hz
e. Air conduction at 2000 Hz

Q3: A 25 years' male presented red swollen pinna, tender to touch. What is
the treatment?

a. Analgesic and ciprofloxacin

b. Co-amoxiclave is drug of choice
c. Analgesic and Co-amoxiclave
d. Analgesic and I&D
e. Third generation cephalosporin’s and I&D

Q4: Severe headache, vomiting, dysphasia & visual field defects in a

patient with Cholesteatoma indicates:

a. Cerebellar Abscess
b. Otogenic facial paralysis
c. Mastoid abscess
d. Temporal lobe abscess
e. Meningitis
Q5: A 20 years' male presented with high grade fever, headache, and
bilateral nasal obstruction for 2 days. Diagnosis is

a) Bilateral Ethmoidal polyps.

b) Bilateral inferior turbinate hypertrophy
c) Acute sinusitis
d) Atrophic sinusitis
e) Allergic Rhinitis

Q6: A 20 years' male under gone surgery for septal deflection. SMR done.
Which is the most common complication of this procedure?

a) Septal perforation
b) Toxic shock syndrome
c) Septal hematoma
d) Saddle deformity
e) CSF rhinorrhea

Q7: A patient suffered from right sided hearing loss after taking a bath.
He is also complaining of aural fullness. Otoscopic examination shows
external auditory canal full of brownish material. What is the best
treatment?

a) Syringing
b) Dry mopping
c) Soda glycerin drops followed by syringing
d) Soda glycine drops followed by suctioning
e) Removal with Jobson probe

Q8: A 40 years old patient is complaining of severe earache for 2 days. He

also has conductive hearing loss. Examination with Otoscope was painful
showed swollen external auditory meatus. Commonest organism responsible for
it is?

a. Staph aureus
b. Beta hemolytic streptococcus
c. Candida
d. Pseudomonas
e. Haemophilus influenza
Q9: During middle ear surgery, medial wall of middle ear was examined. It
includes all except

a. Oval window
b. Processus cochleariformis
c. Round window
 d. Pyramid
e. First genu of facial nerve

Q10: Myringotomy with grommet insertion is the ideal surgical treatment for

a. Acute otitis media

b. Serous otitis media
c. Adhesive otitis media
d. Retracted tympanic membrane
e. Cholesteatoma

Q11: A 35 years' male presented with fever, epistaxis, hematuria, ESR

was120. Granulations were seen on nasal septum. Most common diagnosis is

a. Tuberculosis
b. Wegner's granuloma
c. Midline lethal granuloma
d. Leprosy
e. Syphilis

Q12: A 60 years' male presented with repeated epistaxis from Right nasal
cavity for last 7 years. Mass was in Right nasal cavity. CT scan showed
mass filling maxillary sinus. Most probable diagnosis is

a) Transitional cell papilloma

b) Malignant growth of maxillary sinus
c) Angiofibroma
d) Nasopharyngeal carcinomas
e) Mucormycosis

Q13: Audiogram showed hearing loss both in AC and BC with no air bone gap.
Following are the causes except

a. Ototoxic drugs
b. Torch Infections
c. Noise
d. Otosclerosis
e. Meniere’s disease

Q14: Earliest nerve to be involved in a patient with unilateral SNHL,

Tinnitus and Mass at CP angle on MRI:

a. Vth nerve
b. Vl th nerve
c. X1 nerve
d. X11 nerve
 e. IXth nerve

Q15: A child of 8 years' presented with nasal trauma, pain and bilateral
nasal blockage. Patient has a low grade fever. What is the probable
Diagnosis?

a) Septal hematoma
b) Fracture nasal bones
c) Septal abscess
d) Blood clots
e) Septal perforation

Q16: A 35 years' male presented with vertigo lasts for few seconds by
putting head on pillow, while Tunning Fork tests are normal. The
therapeutic test is?

a) Valsalva manoeuvre
b) Epley’s manoeuvre
c) Glycerol test
d) Hallpike manoeuvre
e) Vestibular neuronitis

Q17: What is the most common site for Leukoplakia in the oral cavity?

a) Lips
b) Buccal mucosa
c) Floor of the mouth
d) Hard palate
e) Lateral border of Tongue

Q18: A 40 years' male comes to Emergency Room with severe respiratory

distress . Immediately the best & easiest way to restore airway is

a) Airway placement
b) Emergency Tracheostomy
c) Endotracheal intubation
d) Laryngotomy
e) Elective tracheostomy

Q19: A 25 years old women with a turbulent married life is brought to

emergency with 3 hours history of inability to speak. She is otherwise
conscious. IDL shows normal-appearing vocal cords that fail to adduct on
attempted phonation. Her cough is normal. Choose the most likely pathology
from the following?

a) Bilateral abductor palsy

 b) Vocal cords nodules
c) Myasthenia gravis
d) Functional aphonia
e) Fixation of cricoarytenoid joint

Q20: After carcinoma Thyroid surgery, severe respiratory distress developed

after extubation. What has happened to the patient?

a) Bilateral vocal cord paralysis with vocal cords near the midline
b) Bilateral vocal cord paralysis with vocal cord away from the midline
in cadaveric position
c) Unilateral cord is in lateral position
d) Loss of tension in one cord
e) one cord was normal, other close to midline and immobile

Q21: In a patient tracheostomy was planned, will help the patient in all
except

a) Bilateral vocal cord paralysis with vocal cords near the midline
b) Bilateral vocal cord paralysis with vocal cords away from the midline
in cadaveric position
c) Laryngomalacia
d) Left Unilateral vocal cord paralysis
e) Acute epiglottitis

Q22: A 25 years' hawker presented with hoarseness of voice, All are caused
by voice abuse except

a) Vocal nodules
b) Reinke’s Edema
c) Vocal cord polyp
d) Papilloma larynx
e) Chronic hypertrophic laryngitis

Q23: Internal branch of superior laryngeal nerve pierce

a) Crico-thyroid membrane
b) Thyro-hyoid membrane
c) Cricovocal membrane
d) Aryepiglottic membrane (Fold)
e) Quadrangular membrane

Q24: Absolute indication of tonsillectomy is

a) Recurrent sore throat attacks

b) Quinsy
 c) Tonsillar hypertrophy
d) Diphtheria carrier
e) Suspicion of malignancy

Q25: Treatment of choice in deafness associated with Attico antral

perforation is

a) Simple mastoidectomy
b) Modified radical mastoidectomy
c) Watch and wait
d) Instillation of antibiotic drops
e) Myringoplasty

Q26: In a classic case of Meniere’s disease which one of the following

statements is TRUE?

a) Carhart’s Notch is a characteristic feature in pure tone audiogram

b) Schwartz’s sign is usually present in the Tympanic membrane
c) Low frequency sensory neural deafness is often seen in pure tone
audiogram
d) Decompression of Fallopian Canal is the treatment of choice.
e) Antibiotics and steroids play an important role in the recovery.

Q27: The commonest extra cranial complication following mastoidectomy

includes

a) Facial nerve palsy

b) Dislocation of incus
c) Post-operative hematoma
d) Cochlear injury
e) Trigeminal nerve injury

Q28: A 3years old child presents with fever and (Rt) earache from last 48
Hrs, which is not relieving with medications. On otoscopic examination,
there is congested tympanic membrane with slight bulge with” cart wheel
appearance”. What is the treatment of choice in this patient?

a) Myringotomy with broad spectrum antibiotics

b) Myringotomy with grommet & broad spectrum antibiotics
c) Only antibiotics and analgesics
d) Wait and observe the patient.
e) Self-limited. No treatment required.

Q29: Common cause of Eustachian tube disease is due to

 a) Adenoids
b) Sinusitis
c) Otitis media
d) Pharyngitis
e) Tonsillitis

Q30: A patient of CSOM with Cholesteatoma present with acute onset of

vertigo treatment is

a) Immediate exploration
b) Antibiotics + Steroids
c) Labyrinthine sedatives + Bed Rest
d) Labyrinthine sedatives only
e) Conservative treatment / No surgical intervention required

Q31: Bell’s palsy not responding to steroid what will be the further line
of management?

a) Increase the dose of steroid

b) Vasodilators and ACTH
c) Surgical decompression
d) Electrical nerve stimulation
e) Facial physiotherapy

Q32: Condition where a pulsatile tumour is found in external auditory

meatus which bleeds to touch is

a) Cholesteatoma
b) Polyp
c) Malignancy middle ear
d) Glomus tumour
e) Acoustic neuroma
Q33: A 65 years female presents in ER with cruciating pain in right ear
from last night. She is known diabetic patient. She has facial weakness on
same side also. On otoscopic examination, there is granulations on osteo-
cartilagenous part while Tympanic Membrane in intact. What is your probable
diagnosis?
a) Diffused otitis externa
b) Otomycosis
c) Malignant otitis externa
d) CSOM atticoantral disease
e) Otitis externa haemorrghica
Q34: A 20 years old girl presented to ENT OPD with odynophagia and trismus
for the last 2 days. One examination, floor of mouth is swollen & tongue
seems to pushed upward & backward .she has Hx of tooth extraction some days
ago. The probable diagnose is

a) Retropharyngeal abscess
b) Parapharyngeal abscess
c) Parotid abbess
d) Ludwig’s angina
e) Dental abscess

Q35: A 65 years old male presented to ENT OPD with dysphagia to solids
from last 2 months .patient is malnourished and gives Hx of gurgling sound
is produced on swallowing . He also complains of undigested food and
regurgitation at night. Which investigation will you carry out to confirm
diagnosis?

a) MRI
b) CT Scan
c) Barium swallow
d) Blood CP
e) X ray lateral neck soft tissue

Q36: A patient comes to ENT OPD with severe pain in right ear and hearing
loss from 2days. On exam, blood and air bubbles were seen behind tympanic
membrane. Tympanic membrane was intact. He also has history of travelling
by air. The Probable diagnosis is

a) ASOM
b) Barotrauma
c) Secretory OM
d) CSOM
e) Ossicular Chain disruption

Q37: The most common tumor of external auditory canal following long
standing blood stained mucopurulant discharge with severe earache is

a) Squamous cell carcinoma

b) Basal cell adenoma
c) Adenocarcinoma
d) Malignant otitis externa
e) Malignant melanoma

Q38: Most common cause of facial nerve paralysis is?

a) Mastoidectomy
b) Bell’s palsy
c) Cholesteatoma
 d) Parotid surgery
e) Herpes zoster otitis
Q39: Slow growing tumor involving the Facial nerve is

a) Warthin’s tumour
b) Adenoid cystic carcinoma
c) Oncocytoma
d) Mucoepidermoid carcinoma
e) Pleomorphic adenoma

Q40: Tip of tongue drains into

a) Sub mandibular node

b) Deep cervical nodes
c) Jugulodiagestric nodes
d) Superficial cervical node
e) Sub mental & Jugulo-omohyoid lymph node

Q41: Chances of Post- cricoid CA in patients of Plummer Vinson syndrome is

a) 30%
b) 10%
c) 80%
d) 90%
e) 25%

Q42: A 6 years old child brought to ENT OPD for the evaluation of hearing
problem. There is suspicion of Otitis media with effusion. What is the
best investigation to confirm the diagnosis?

a) Pure tone audiometry

b) Tympanometry
c) Tuning fork tests
d) Speech audiometry
e) Brain stem evoked response audiometry

Q43: A young female patient came to ENT OPD with complaints of ringing of
ears from last some months . she also gave history of CSOM for which
using gentamycin ear drops. Most probable cause is

a) BPPV
b) Salicylates level
c) Ototoxicity
d) Complication of Cholesteatoma
e) Fracture petrous temporal bone

Q44: Best treatment for Atticoantral type CSOM is

 a) Cortical mastoidectomy
b) Canal wall down procedure
c) Atticotomy
d) Myringotomy
e) Tympanoplasty

Q45: A Patient presented with mucoid, odorless, profuse ear discharge from
last 1 year. What otoscopic findings are expected in this case?

a) Attic perforation
b) Retraction pockets
c) Marginal perforation
d) Congested tympanic membrane
e) Central perforation

Q46: Cortical mastoidectomy is also called

a) Canal wall up mastoidectomy

b) Atticotomy
c) Canal will down mastoidectomy
d) Modified radical mastoidectomy
e) Tympanoplasty

Q47: A 23 years old patient presented in ENT OPD with complaint of

pulsatile tinnitus. Otoscopy shows “Rising sun” appearance. What is the
most likely diagnosis?

a) Otosclerosis
b) Vestibular schwanoma
c) Glomus Tumour
d) Acute SOM
e) Meniere’s disease

Q48: A child aged 3 years presented with severe sensorineural deafness, he

was prescribed hearing aids but showed no improvement. What is the
next line of management?
a) Myringotomy
b) Stapedectomy
c) Cochlear implant.
d) Conservative. No treatment required
e) Mastoidectomy.
Q49: A 50 years old diabetic male patient has developed severer itching in
his ears. On Otoscopy, there is debris with black specks in external
auditory canal. The treatment of choice in this case is:-
a) Otosporin ear drops.
b) Gentamicin ear drops.
c) Salicylic acid in spirit drops.
d) Repeated suction toilet with antifungal drops.
e) Oral anti-fungal drugs.

Q50: Adenoidectomy is indicated in all of the following conditions except:

a) Otitis media with effusion.
b) Nasal obstruction due to adenoidal hyperplasia.
c) Allergic rhinitis in children.
d) Recurrent otitis media in children.
e) Sleep apnea syndrome.
Q51: A 4 years old baby has put a plastic bead in his ear. On Otoscopy, it
is present in deeper portion of meatus and totally occluding the meatus.
The best way to remove this bead is:
a) Remove it with foreign body hook.
b) Remove it with crocodile forceps.
c) Remove it with suction.
d) Remove it with ear syringing.
e) Remove it under general anesthesia using microscope
Q52: Which statement is CORRECT regarding Juvenile Angiofibroma:
a) Patients have often repeated episodes of epistaxis.
b) It is a tumour of young girls with a mean age of 14 at presentation.
c) Bone erosion of the greater wing of the sphenoid does not occur.
d) Cervical lymphadenopathy is present.
e) External beam radiotherapy is first line treatment.

Q53: All are causes of congenital STRIDOR except:

a) Acute epiglottitis.
b) Laryngeal web.
c) Subglottic haemangioma
d) Laryngomalacia.
e) Vocal cord paralysis

Q54: Which of the following is NOT a complication of acute tonsillitis?

a) Peritonsillar abscess.
b) Bezold’s abscess.
c) Acute rheumatism.
d) Acute nephritis.
 e) Acute infection of middle ear cleft

Q55: Trismus accompanying Quinsy is due to spasm of which muscle?

a) Masseter.
b) Lateral pterygoid.
c) Medial pterygoid.
d) Temporalis.
e) Palatopharyngeus

Q56: Indication of tracheostomy:

a) In all cases of acute laryngitis.
b) In any intubated patient within 3 days.
c) Unilateral Choanal atresia.
d) Bilateral vocal cord paralysis.
e) If there is suspicion of Laryngomalacia

Q57: The little’s area is supplied by :

a) Superior labial artery, anterior Ethmoidal artery, greater palatine
artery and spheno-ethmoidal artery.
b) Superior labial artery, posterior Ethmoidal artery, greater palatine
artery and spheno-ethmoidal artery.
c) Superior labial artery, anterior Ethmoidal artery, lesser palatine
artery and spheno-ethmoidal artery.
d) Inferior labial artery, anterior Ethmoidal artery, greater palatine
artery and spheno-ethmoidal artery.
e) None of the above.

Q58: All of the following are complications of sinusitis except:

a) Cavernous sinus thrombosis.
b) Orbital cellulitis
c) Toxic shock syndrome.
d) Glomerulonephritis
e) Pott's puffy tumor.

Q 59: The diagnostic test of Allergic Rhinitis is

a) Blood CP / ESR
b) Serum Ig E
c) Skin prick test
d) Nasal provocation test
e) RAST
Q60: A 5 years old patient is scheduled for tonsillectomy. On the day of
surgery he had runny nose, temperature 37.5°C and dry cough. Which of the
following should be the most appropriate decision for surgery?
a) Surgery should be cancelled for one week treatment of paracetamol,
b) Can proceed for surgery if chest is clear and there is no history of
asthma
c) Should get X-ray chest before proceeding for surgery
d) Cancel surgery for 2weeks and patient to be put on antibiotics
e) No treatment required. Do surgery. As it is viral infection.

Q61: Commonest causative organism leading to Acute Laryngo-tracheo-

bronchitis is
a) Staphylococcus aureus
b) Streptococcus
c) Para influenza
d) Corynebacterium diphtheria
e) H –Influenza

Q62: A girl 12 years of age presents with a mass in the midline of neck
just below the hyoid bone noted 6 months back. It moves with protrusion of
tongue. The most probable diagnosis is:
a) Cystic Hygroma.
b) Thyroglossal duct cyst
c) Haemangioma.
d) Branchial cleft cyst.
e) Dermoid cyst.
Q63: Nasal perforation in bony part is caused by

a) Syphilis
b) Atrophic rhinitis
c) Systemic lupus erythematosis
d) Tuberculosis
e) Wagner granulomatosis

Q64: A 4 years old male child is suffering from low grade fever and sore
throat. On examination, he has toxic look, has membrane adherent to tonsils
and adjoining pharynx which is difficult to remove. His pulse is fast and
thready. Multiple lymph nodes in neck are also enlarged. What is the one
most probable clinical diagnosis?

a) Acute follicular tonsillitis

b) Pharyngeal diphtheria
c) Ludwig’s angina
 d) Infectious mononucleosis
e) Peritonsillar abscess

Q65: A 30 Years old male (bus conductor) presented in ENT OPD with
hoarsness of voice. On IDL, there is unilateral pedunculated mass was seen
an anterior 1/3 and posterior 2/3 junction. What is the most probable
diagnosis?
a) vocal Nodule
b) Juvenile papillomatosis
c) Vocal polyp
d) Laryngeal carcinoma
e) Reinke’s edema

Q66: On Flexible Nasolaryngoscopy, the epiglottis is omega shaped is

found in which pathological condition?
a) Adenoids
b) Laryngomalacia
c) Vocal cord paralysis
d) Vocal polyp
e) Acute epiglottitis

Q 67: A 25 years' patient presented with permanent hoarseness of voice, two

nodular swellings seen on both vocal cords. Which of the following is true?

a) They are often followed by upper respiratory infection.

b) The cause is usually bacterial.
c) Micro laryngeal surgery is the treatment of choice.
d) They are rarely associated with vocal abuse.
e) Radiotherapy is usually helpful.

Q 68: A 25 years old male complains of nasal obstructions and right sided
tenderness of cheek from seven days after common cold. On examination,
there was mucopurulant discharge in right nostril and postnasal drip. What
is the most probable diagnosis?
a) Wegener granulomatosis
b) Nasal foreign body
c) Acute maxillary sinusitis
d) Allergic fungal sinusitis
e) Rhinolith
Q 69: A 30 years old lady had flu which was followed by severe otalgia and
tinnitus. One day later she had blood stained discharge from ears and on
Otoscopy had reddish vesicles on ear drum. She is suffering from:
 a) Malignant otitis externa
b) Otitis externa hemorrhagica
c) Ramsay-Hunt syndrome
d) Hemotympanum
e) Acute otitis media
Q 70: A six months old baby has stridor which gets worsen on crying and
improves on lying in prone position .He is suffering from?
a) Laryngeal web
b) Subglottic stenosis
c) Laryngomalacia
d) Congenital paralysis of vocal cord
e) Vocal cord polyp

---------------------------------------------------------------------------

Islamabad medical & Dental College

(4th year MBBS Examination)
(SEQ’S PAPER)

Date: 18th Sep, 2018 Subject: ENT

Max Marks:30 Times Allowed: 30 minutes

Q 1: A 45 year’s male presents with complaint of fluctuating hearing loss,

roaring tinnitus, episodic vertigo and fullness of the right ear from last some
months. On Otoscopy, bilateral tympanic membranes are intact. Other ENT
examination is unremarkable.

a) What is the probable diagnosis?

1
b) What are the DDx?
2
c) What is the confirmatory test for diagnosis?
1
d) How you will investigate this case?
2
e) What are the treatment options?
4

Q2: A 5 years old boy presents in emergency room with respiratory distress and
odynophagia from last night. He has low grade fever and thready pulse. Patient
looks ill and toxic. He has Hx of upper respiratory tract infection from last some
days. On throat examination, there is greyish dirty membrane adherent to both
tonsils with bleeds on removal. He has massive bilateral cervical lymphadenopathy
also.

a) What is the most probable diagnosis?

1
b) What is the causative organism?
1
c) What are the DDx?
2
d) How you will treat this case?
4
e) What are the complications if untreated?
2

Q3: A 45 years old male presents with nasal obstruction from last some months
for which he has done multiple nasal surgeries in the past. On anterior
rhinoscopy, he has multiple pedunculated glistening, grapes like mass filling the
both nasal cavities which is insensitive to touch and don’t have tendency to
bleed.

a) What is the probable diagnosis?

1
b) What are the DDx?
2
c) What is the pathophysiology of this disease?
2
d) How you will investigate this case?
2
e) What are the treatment options?
3

-----------------------------------------------------------------