Category: Quiz

Eustachian Tube

Eustachian Tube

Q. 1

True regarding the development of ear:

 A

Eustachian tube opens at the level of interior turbinate

 B

Pinna develops from the cleft of Ist arch

 C

Growth of the inner- ear completed by 4th month

 D

All

Q. 1

True regarding the development of ear:

 A

Eustachian tube opens at the level of interior turbinate

 B

Pinna develops from the cleft of Ist arch

 C

Growth of the inner- ear completed by 4th month

 D

All

Ans. D

Explanation:

A i.e. Eustachian tube opens at the level of inferior turbinate; B i.e. Pinna develops from the cleft of arch; C i.e. Growth of inner ear completed by 4th month

Eustachian tube connects tympanic cavity with nasopharynx. It is about 36cm long in adults and runs downwards, forwards & medially at an angle of 45° with horizontal from bony tympanic end to slit like pharyngeal end. Tympanic end is in the anterior wall of middle ear, just above the level of floor. While nasopharyngeal end is situated in the lateral wall about 1 -1.25 cm behind the posterior end of inferiro turbinateQ


Q. 2

Eustachian tube opens into middle ear cavity at:

 A

Anterior wall

 B

Medial wall

 C

Lateral wall

 D

Posterior wall

Q. 2

Eustachian tube opens into middle ear cavity at:

 A

Anterior wall

 B

Medial wall

 C

Lateral wall

 D

Posterior wall

Ans. A

Explanation:

 

The tympanic end of the eustachian tube is bony and is situated in the anterior wall of middle ear.

The pharyngeal end of the tube is slit like and is situated in the lateral wall of the nasopharynx, 1-1.25 cm behind the posterior end of inferior tubinate.



Q. 3

The length of Eustachian tube is:

 A

16 mm

 B

24mm

 C

36 mm

 D

40 mm

Q. 3

The length of Eustachian tube is:

 A

16 mm

 B

24mm

 C

36 mm

 D

40 mm

Ans. C

Explanation:

Q. 4

True about Eustachian tube are:

 A

24mm in length

 B

Outer 1/3rds is cartilaginous

 C

Inner 2/3rds is bony

 D

Inner 2/3rds is cartilaginous

Q. 4

True about Eustachian tube are:

 A

24mm in length

 B

Outer 1/3rds is cartilaginous

 C

Inner 2/3rds is bony

 D

Inner 2/3rds is cartilaginous

Ans. D

Explanation:

Q. 5

True about Eustachian tube is/are:

 A

Size is 3.75 cm

 B

Cartilagenous 1/3 and 2/3rd bony

 C

Opens during swallowing

 D

a and c

Q. 5

True about Eustachian tube is/are:

 A

Size is 3.75 cm

 B

Cartilagenous 1/3 and 2/3rd bony

 C

Opens during swallowing

 D

a and c

Ans. D

Explanation:

 

  • The Eustachian tube/auditory tube in the adult is 36 mm in length. (Range 32-38 mm) From its tympanic end, it runs downward forward and medially joining an angle of 45° with horizontal.
  • In infants, the tube is shorter, wider and is more horizontal.
  • It has two parts -a pharyngeal cartilaginous part which forms 2/3rd (24 mm) of its length (i.e. inner or medial part) and a tympanic bony part which forms remaining 1/3rd (outer or lateral part -12 mm). This is just reverse of external auditory canal



Q. 6

Which of the following causes opening of Eustachian tube?

 A

Salpingophayngeus

 B

Levator veli palatine

 C

Tensor veli palatini

 D

None of the abvoe

Q. 6

Which of the following causes opening of Eustachian tube?

 A

Salpingophayngeus

 B

Levator veli palatine

 C

Tensor veli palatini

 D

None of the abvoe

Ans. B

Explanation:

 

Eustachian tube serves to ventilate the middle ear and exchange nasopharyngeal air in the middle ear.

In children, ET is rela­tively narrow. It is prone to obstruction when mucosa swell in response to infection or allergic challenge and it results in middle ear effusion


Q. 7

True about Eustachian tube:

 A

Length is 36mm in adults and 1.6 to 3 mm in children

 B

Higher elastin content in adults

 C

Ventilatory function of ear better developed in infants

 D

More horizontal in adults

Q. 7

True about Eustachian tube:

 A

Length is 36mm in adults and 1.6 to 3 mm in children

 B

Higher elastin content in adults

 C

Ventilatory function of ear better developed in infants

 D

More horizontal in adults

Ans. B

Explanation:

Q. 8

Eustachian tube develops from:

 A

2nd and 3rd pharyngeal pouch

 B

1st pharyngeal pouch

 C

2nd pharyngeal pouch

 D

b and c

Q. 8

Eustachian tube develops from:

 A

2nd and 3rd pharyngeal pouch

 B

1st pharyngeal pouch

 C

2nd pharyngeal pouch

 D

b and c

Ans. D

Explanation:

 

  • The Eustachian tube, tympanic cavity, attic, antrum and mastoid develops from endoderm of tubotympanic recess which arises from the first and partly from the second pharyngeal pouch. 
  • From 2″d pharyngeal pouch –> develops tonsil
  • From 3rd pharyngeal pouch –> develops thymus and inferior parathyoid
  • From 4th pharyngeal pouth –> Part of thyroid and superior parathyroid gland

Q. 9

True regarding development of the ear:

 A

Eustachian tube develops from 1st cleft

 B

Eustachian tube opens behind the level of inferior turbinate

 C

Pinna develops from 1st pouch

 D

All

Q. 9

True regarding development of the ear:

 A

Eustachian tube develops from 1st cleft

 B

Eustachian tube opens behind the level of inferior turbinate

 C

Pinna develops from 1st pouch

 D

All

Ans. B

Explanation:

Q. 10

All are tests to check eustachian tube patency except: 

 A

Valsalva manuvere

 B

Fistula’s test

 C

Frenzel’s manuvere

 D

Tonybee’s manuvere

Q. 10

All are tests to check eustachian tube patency except: 

 A

Valsalva manuvere

 B

Fistula’s test

 C

Frenzel’s manuvere

 D

Tonybee’s manuvere

Ans. B

Explanation:

Q. 11

Eustachian tube gets blocked if pressure difference is more than:

 A

15 mm Hg

 B

30 mm Hg

 C

50 mm Hg

 D

90 mm Hg

Q. 11

Eustachian tube gets blocked if pressure difference is more than:

 A

15 mm Hg

 B

30 mm Hg

 C

50 mm Hg

 D

90 mm Hg

Ans. D

Explanation:

Q. 12

Muscle which helps to open Eustachian tube while sneezing:

March 2005, September 2010

 A

Tensor veli palatini

 B

Levator veli palatini

 C

None of the.above

 D

Both A and B

Q. 12

Muscle which helps to open Eustachian tube while sneezing:

March 2005, September 2010

 A

Tensor veli palatini

 B

Levator veli palatini

 C

None of the.above

 D

Both A and B

Ans. D

Explanation:

Ans. D: Both A and B

Pharyngotympanic (Auditory) tube is 4 cm long, consists of two parts:

  • Bony part forms posterior and lateral one third of the tube (12 cm long)
  • Cartilaginous part forms the anterior and medial two third (25 cm long)
  • Connects the middle ear with the nasopharynx
  • Equalizes pressure on both sides of the tympanic membrane
  • Usually closed to prevent entrance of particles from the nose
  • Muscles that open auditory tube while swallowing, yawning and sneezing are levator veli palatini and tensor veli palatini

Q. 13

Length of the cartilaginous part of “Eustachian tube”

 A

15 mm

 B

20 mm

 C

25 mm

 D

30 mm

Q. 13

Length of the cartilaginous part of “Eustachian tube”

 A

15 mm

 B

20 mm

 C

25 mm

 D

30 mm

Ans. C

Explanation:

  • The external auditory meatus is 4 cm long and conducts sound waves from the auricle to the tympanic membrane. The framework of the anterior and medial two-thirds of the meatus is elastic cartilage (measures 25 mm in length), and the posterior and lateral one third is bony, formed by the tympanic plate (measures 12 mm in length). The sensory nerve supply of the lining skin is derived from the auriculotemporal nerve and the auricular branch of the vagus nerve.
  • The lymph drainage is to the superficial parotid, mastoid, and superficial cervical lymph nodes.

Q. 14

Length of Eustachian tube‑

 A

12 mm

 B

24mm

 C

36mm

 D

48mm

Q. 14

Length of Eustachian tube‑

 A

12 mm

 B

24mm

 C

36mm

 D

48mm

Ans. C

Explanation:

 

  • Length of Eustachian tube is 36 mm. (reached by the age of 7 years)
  • Lateral third (i.e. 12 mm) is bony.
  • Medial 2/3 (i.e. 24 mm) is fibrocartilaginous.

Q. 15

Not a test for Eustachian tube patency ‑

 A

Tympanometry

 B

Toynbee

 C

Valsalva

 D

Frenzel maneuver

Q. 15

Not a test for Eustachian tube patency ‑

 A

Tympanometry

 B

Toynbee

 C

Valsalva

 D

Frenzel maneuver

Ans. A

Explanation:

Ans. is ‘a’ i.e., Tympanometry

Tests for Eustachian tubepatency

  • Valsalva test
  • Methylene blue test
  • Sonotubometry
  • Politzer test 
  • Toynbee test
  • Frenzel maneuver
  • Catheterization
  • Inflation – Deflation test

Q. 16

Ostmann fat pad is related to ‑

 A

Ear lobule

 B

Buccal mucosa

 C

Eustachian tube

 D

Tip of nose

Q. 16

Ostmann fat pad is related to ‑

 A

Ear lobule

 B

Buccal mucosa

 C

Eustachian tube

 D

Tip of nose

Ans. C

Explanation:

Ans. is ‘c’ i.e., Eustachian tube

There are small fat bodies located infermedial to Eustachian tube. These are called Ostmann fat pads.

They are important in normal closure of eustachian tube and preventing transmission of nasopharyngeal pressure to middle ear.

These fat pads are absent in Patulous tube syndrome.


Q. 17

Eustachian tube patency seen by ‑

 A

Valsalva

 B

Methylene blue test

 C

Tonybee test

 D

All the above

Q. 17

Eustachian tube patency seen by ‑

 A

Valsalva

 B

Methylene blue test

 C

Tonybee test

 D

All the above

Ans. D

Explanation:

Ans. is d i.e., All the above

Tests for Eustachian tube patency

  • Valsalva test
  • Methylene blue test 
  • Sonotubometry
  • Politzer test
  • Toynbee test 
  • Frenzel maneuver
  • Catheterization
  • Inflation – Deflation test


External ear

EXTERNAL EAR

Q. 1

Ear pinna develops from ____________

 A

Ectoderm

 B

Endoderm

 C

Mesoderm

 D

All 

Q. 1

Ear pinna develops from ____________

 A

Ectoderm

 B

Endoderm

 C

Mesoderm

 D

All 

Ans. A

Explanation:

 Ans:A.)Ectoderm

  • First branchial cleft is the precursor of external auditory canal.
  • Around the sixth week of embryonic life, a series of six tubercles appear around the first branchial cleft

 

  • Branchial clefts are ectodermal in origin.

Q. 2

Which of the following is formed at birth?

 A

Mastoid process

 B

Pinna

 C

Otic capsule

 D

Secondary areola

Q. 2

Which of the following is formed at birth?

 A

Mastoid process

 B

Pinna

 C

Otic capsule

 D

Secondary areola

Ans. B

Explanation:

Q. 3

The presence of white fibrocartilage is a feature of all of the following, EXCEPT:

 A

Acetabular labrum

 B

Intervertebral disc

 C

Meniscus

 D

Pinna

Q. 3

The presence of white fibrocartilage is a feature of all of the following, EXCEPT:

 A

Acetabular labrum

 B

Intervertebral disc

 C

Meniscus

 D

Pinna

Ans. D

Explanation:

Pinna is composed of a thin plate of yellow elastic cartilage, covered with integument

It is connected to the surrounding parts by ligaments and muscles; and to the commencement of the external acoustic meatus by fibrous tissue.


Q. 4

Fibrocartilage is present in all, EXCEPT:

 A

Pinna

 B

Symphysis pubis

 C

Intervertebral disc

 D

Menisci of knee joint

Q. 4

Fibrocartilage is present in all, EXCEPT:

 A

Pinna

 B

Symphysis pubis

 C

Intervertebral disc

 D

Menisci of knee joint

Ans. A

Explanation:

Fibrocartilage is a white opaque structure due to dense collage fibres (type I and II).

When a fibrous tissue is subjected to pressure it is replaced by fibrocartilage.

It is seen in joints, symphysis, intervertebral discs, menisci and labra (shoulder joint and hip joint).

Pinna is a type of elastic cartilage. Elastic cartilages are seen at sites concerned with production or reception of sounds eg external acoustic meatus (lateral part), auditory tube and epiglottis.


Q. 5

True regarding the development of ear:

 A

Eustachian tube opens at the level of interior turbinate

 B

Pinna develops from the cleft of Ist arch

 C

Growth of the inner- ear completed by 4th month

 D

All

Q. 5

True regarding the development of ear:

 A

Eustachian tube opens at the level of interior turbinate

 B

Pinna develops from the cleft of Ist arch

 C

Growth of the inner- ear completed by 4th month

 D

All

Ans. D

Explanation:

A i.e. Eustachian tube opens at the level of inferior turbinate; B i.e. Pinna develops from the cleft of arch; C i.e. Growth of inner ear completed by 4th month

Eustachian tube connects tympanic cavity with nasopharynx. It is about 36cm long in adults and runs downwards, forwards & medially at an angle of 45° with horizontal from bony tympanic end to slit like pharyngeal end. Tympanic end is in the anterior wall of middle ear, just above the level of floor. While nasopharyngeal end is situated in the lateral wall about 1 -1.25 cm behind the posterior end of inferiro turbinateQ


Q. 6

Sensory nerve supply of pinna is :

 A

Mandibular nerve

 B

Maxillary nerve

 C

Facial nerve

 D

Abducent nerve

Q. 6

Sensory nerve supply of pinna is :

 A

Mandibular nerve

 B

Maxillary nerve

 C

Facial nerve

 D

Abducent nerve

Ans. A

Explanation:

Auriculotemporal nerve, a branch of mandibular nerve (V3)(2 supplies the external acoustic meatus, external surface of auricle above this, skin of temporal region and TM joint.


Q. 7

Major part of the skin of pinna is supplied by:

 A

Aurculo temporal nerve

 B

Auricular branch of the vagus

 C

Posterior auricular nerve

 D

Great auricular nerve

Q. 7

Major part of the skin of pinna is supplied by:

 A

Aurculo temporal nerve

 B

Auricular branch of the vagus

 C

Posterior auricular nerve

 D

Great auricular nerve

Ans. D

Explanation:

D i.e. Great auricular


Q. 8

Which of the following does not give sensory supply to the pinna:

 A

Auricotemporal Nerve

 B

Great Auricular Nerve

 C

Lesser Occipital Nerve

 D

Tympanic branch of Glossopharyngeal Nerve

Q. 8

Which of the following does not give sensory supply to the pinna:

 A

Auricotemporal Nerve

 B

Great Auricular Nerve

 C

Lesser Occipital Nerve

 D

Tympanic branch of Glossopharyngeal Nerve

Ans. D

Explanation:

Tympanic branch of glossopharyngeal (IX) nerve or Jacobson’s nerve supplies the medial (inner) surface of tympanic membrane. It does not supply pinnaQ.

Main nerves supplying the skin of auricle (pinna) are great auricular nerve (c2, CP and auriculo temporal nerve (V3)(2 with a small contribution from lesser occipital nerve, (C2), auricular branch of vagus (X) nerve or Arnold’s nerve and facial nerve.

The great auricular supplies the whole of the cranial (medial /back) surface of auricle (C2, with a little overlap from the lesser occipital at the top) and the posterior part of lateral (front) surface (helix, anthelix, and lobule).

The auriculo temporal nerve (br. of CNV3) supplies the upper part of lateral surface , skin of auricle anterior to external acoustic meatus, tragus, crus & adjacent part of helix and most of meatal skin.

Auricular branch of vagus (Arnold’s nerve) supplies skin on the concavity of concha & posterior part of eminentia , posterior wall & floor of meatus and adjoining tympanic membrane.


Q. 9

Skin over pinna is fixed:

 A

Firmly on both sides

 B

Loosely on medial side

 C

Loosely on lateral side

 D

Loosely on both side

Q. 9

Skin over pinna is fixed:

 A

Firmly on both sides

 B

Loosely on medial side

 C

Loosely on lateral side

 D

Loosely on both side

Ans. B

Explanation:

Skin over the pinna is closely adherent to the perichondrium on the lateral surface while it is loosely attached on the medial surface.


Q. 10

Pinna develops from:

 A

1st pharyngeal arch

 B

1st and 3rd pharyngeal arch

 C

1st and 2nd pharyngeal arch

 D

2nd pharyngeal arch

Q. 10

Pinna develops from:

 A

1st pharyngeal arch

 B

1st and 3rd pharyngeal arch

 C

1st and 2nd pharyngeal arch

 D

2nd pharyngeal arch

Ans. C

Explanation:


Mastoidectomy

Mastoidectomy

Q. 1 A 30 year old male is having Attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following will be the operation of choice?
 A Intact canal wall mastoidectomy
 B Simple mastoidectomy with Tympanoplasty 
 C Canal wall down mastoidectomy
 D Mastoidectomy with cavity obliteration
Q. 1 A 30 year old male is having Attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following will be the operation of choice?
 A Intact canal wall mastoidectomy
 B Simple mastoidectomy with Tympanoplasty 
 C Canal wall down mastoidectomy
 D Mastoidectomy with cavity obliteration
Ans. C

Explanation:

(CWD) Canal wall down is usually done is cases of Attic cholesteotoma with complications. The indications for a canal wall down procedure would be a large cholesteatonma involving the mastoid cavity, or a patient with chronic otitis media who has already failed a canal wall up procedure. There is a category of canal wall down procedures based on intracranial complications of chronic ottitis media, due to cholesteamoma, For etample brain  abscess or  meningitis from ear  disease  or even a sigmoid sinus thrombosis from ear disease these would merit a canal wall down procedure


Q. 2

Iatrogenic traumatic facial nerve palsy is most commonly caused du­ring:

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Q. 2

Iatrogenic traumatic facial nerve palsy is most commonly caused du­ring:

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Ans. C

Explanation:

Q. 3

Schwartz operation is:

 A

Cortical mastoidectomy

 B

Radical mastoidectomy

 C

Modified radical mastoidectomy

 D

Myringotomy

Q. 3

Schwartz operation is:

 A

Cortical mastoidectomy

 B

Radical mastoidectomy

 C

Modified radical mastoidectomy

 D

Myringotomy

Ans. A

Explanation:

Q. 4

Radical mastoidectomy is done for:

 A

ASOM

 B

CSOM

 C

Attico antro cholesteatoma

 D

Acute mastoiditis

Q. 4

Radical mastoidectomy is done for:

 A

ASOM

 B

CSOM

 C

Attico antro cholesteatoma

 D

Acute mastoiditis

Ans. C

Explanation:

Q. 5

A 30 year old male is having attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following would be the operation of choice?

 A

Intact canal wall mastoidectomy

 B

Canal wall down mastoidectomy

 C

Mastoidectomy with cavity obliteration

 D

Simple mastoidectomy with Tympanoplasty

Q. 5

A 30 year old male is having attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following would be the operation of choice?

 A

Intact canal wall mastoidectomy

 B

Canal wall down mastoidectomy

 C

Mastoidectomy with cavity obliteration

 D

Simple mastoidectomy with Tympanoplasty

Ans. B

Explanation:

Canal wall down mastoidectomy is done in cases of attic cholesteatoma. In this procedure mastoid cavity is left open into the external auditory canal.

Since the patient in the question is suffering from attic cholesteatoma and secondary complications canal wall down mastoidectomy would be the treatment of choice.

Other indications of this procedure includes extensive chronic otits media, formation of a new attic retraction pocket with disease following a previously performed canal wall up procedure, lateral semicircular canal fistula in the only hearing ear.


Q. 6

Which of the following is an indication for cortical mastoidectomy?

 A

CSOM

 B

CSOM with brain abscess

 C

Coalescent mastoiditis

 D

Perforation of pars flascida

Q. 6

Which of the following is an indication for cortical mastoidectomy?

 A

CSOM

 B

CSOM with brain abscess

 C

Coalescent mastoiditis

 D

Perforation of pars flascida

Ans. C

Explanation:

Q. 7

Which of the following surgery is known as Schwartz operation?

 A

Cortical mastoidectomy

 B

Radical mastoidectomy

 C

Modified radical mastoidectomy

 D

Myringotomy

Q. 7

Which of the following surgery is known as Schwartz operation?

 A

Cortical mastoidectomy

 B

Radical mastoidectomy

 C

Modified radical mastoidectomy

 D

Myringotomy

Ans. A

Explanation:

Cortical mastoidectomy, known as simple or complete mastoidectomy or Schwartz operation, is complete exenteration of all accessible mastoid air cells and converting them into single cavity. Posterior meatal wall is left intact. Middle ear structures are not disturbed.

 
Indications:
1. Acute coalescent mastoiditis
2. Incompletely resolved acute otitis media with reservoir sign
3. Masked mastoiditis
4. As an initial step to perform,
  • Endolymphatic sac surgery
  • Decompression facial nerve
  • Translabyrinthine or retrolabyrinthine procedures for acoustic neuroma

Q. 8

All of the following are removed during modified radical mastoidectomy in a patient with cholesteatoma, EXCEPT:

 A

Incus and head of malleus removed

 B

Lateral attic wall removed

 C

Cochlea removed

 D

Posterior meatal wall removed

Q. 8

All of the following are removed during modified radical mastoidectomy in a patient with cholesteatoma, EXCEPT:

 A

Incus and head of malleus removed

 B

Lateral attic wall removed

 C

Cochlea removed

 D

Posterior meatal wall removed

Ans. C

Explanation:

Q. 9

What is the indication for radical mastoidectomy in an middle aged female?

 A

ASOM

 B

CSOM

 C

Cholesteatoma invading eustachian tube

 D

Acute mastoiditis

Q. 9

What is the indication for radical mastoidectomy in an middle aged female?

 A

ASOM

 B

CSOM

 C

Cholesteatoma invading eustachian tube

 D

Acute mastoiditis

Ans. C

Explanation:

Indications for radical mastoidectomy:
  • When all cholesteatoma cannot be safely removed, e.g., that invading eustachian tube, round window niche, perilabyrinthine or hypotympanic cells.
  • If previous attempts to eradicate chronic inflammatory disease or cholesteatoma have failed.
  • As an approach to petrous apex
  • Removal of glomus tumor
  • Carcinoma middle ear

Q. 10

Which of the following is the treatment of choice for atticoantral variety of chronic suppurative otitis media?

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation lube

Q. 10

Which of the following is the treatment of choice for atticoantral variety of chronic suppurative otitis media?

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation lube

Ans. A

Explanation:

Atticoantral type of CSOM involves the attic of the tympanic membrane and is often associated with cholesteatoma formation.

In this type, a retraction pocket develops in the pars flaccida and a cholesteatoma develops if the squamous epithelium cannot migrate out of this pocket.

It is associated with a number of complications and the surgery is the primary modality of treatment.

Surgical procedures indicated in this condition are atticotomy, mastoidectomy or combined approach tympanoplasty.

 
Tubotympanic type of CSOM involves the anteroinferior part of the middle ear cleft and is associated with a permanent central perforation. It is not associated with serious complications and it is called safe or benign CSOM.
 

Q. 11

Iatrogenic traumatic facial nerve palsy is MOST commonly produced during which of the following surgical procedure?

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Q. 11

Iatrogenic traumatic facial nerve palsy is MOST commonly produced during which of the following surgical procedure?

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Ans. C

Explanation:

 
Iatrogenic facial nerve trauma most often occurs during mastoidectomy. When injury occur to more than 50% of the neural diameter either primary reanastomosis or reconstruction using a nerve graft is done. 
 
Complications of mastoidectomy includes:
  • Infection
  • Labrynthitis ossificans
  • Mucosalization of the middle ear
  • Facial nerve injury
  • CSF leak
  • Encephalocele

Q. 12

The treatment of choice for atticoantral variety of chronic suppurative otitis media is:

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation tube

Q. 12

The treatment of choice for atticoantral variety of chronic suppurative otitis media is:

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation tube

Ans. A

Explanation:

Q. 13

Treatment of choice for Perforation in pars flaccida of the tympanic membrane with cholesteatoma is: 

 A

Myringoplasty

 B

 Modified Radical Mastoidectomy [MRM]

 C

Antibiotics

 D

Radical mastoidectomy

Q. 13

Treatment of choice for Perforation in pars flaccida of the tympanic membrane with cholesteatoma is: 

 A

Myringoplasty

 B

 Modified Radical Mastoidectomy [MRM]

 C

Antibiotics

 D

Radical mastoidectomy

Ans. B

Explanation:

Q. 14

Treatment of cholesteatoma with facial paresis in child is:

 A

Antibiotics to dry ear and then mastoidectomy

 B

Immediate mastoidectomy

 C

Observation

 D

Only antibiotic ear drops

Q. 14

Treatment of cholesteatoma with facial paresis in child is:

 A

Antibiotics to dry ear and then mastoidectomy

 B

Immediate mastoidectomy

 C

Observation

 D

Only antibiotic ear drops

Ans. B

Explanation:

Q. 15

Schwartz operation is also called as:

 A

Cortical mastoidectomy

 B

Radial mastoidectomy

 C

Fenestration operation

 D

All

Q. 15

Schwartz operation is also called as:

 A

Cortical mastoidectomy

 B

Radial mastoidectomy

 C

Fenestration operation

 D

All

Ans. A

Explanation:

Q. 16

Simple mastoidectomy is done in:

 A

Acute mastoiditis

 B

Cholesteatoma

 C

Coalescent mastoiditis

 D

Localized chronic otitis media

Q. 16

Simple mastoidectomy is done in:

 A

Acute mastoiditis

 B

Cholesteatoma

 C

Coalescent mastoiditis

 D

Localized chronic otitis media

Ans. C

Explanation:

Q. 17

Cortical mastoidectomy in indicated in:

 A

Cholesteatoma without complication

 B

Coalescent mastoiditis

 C

CSOM with brain abscess

 D

perforation in Pars flaccida

Q. 17

Cortical mastoidectomy in indicated in:

 A

Cholesteatoma without complication

 B

Coalescent mastoiditis

 C

CSOM with brain abscess

 D

perforation in Pars flaccida

Ans. B

Explanation:

 

Schwartz operation is another name for cortical/sample mastoidectomy


Q. 18

Radical mastoidectomy is done for:

 A

ASOM

 B

CSOM

 C

Atticoantral cholesteotoma

 D

Acute mastoiditis

Q. 18

Radical mastoidectomy is done for:

 A

ASOM

 B

CSOM

 C

Atticoantral cholesteotoma

 D

Acute mastoiditis

Ans. C

Explanation:

Q. 19

All of of the following steps are done in radical mastoidectomy except:

 A

Lowering of facial ridge

 B

Removal of middle ear mucosa and muscles

 C

Removal of all ossicles of eustachiean tube plate

 D

Maintainance of patency of eustachian tube

Q. 19

All of of the following steps are done in radical mastoidectomy except:

 A

Lowering of facial ridge

 B

Removal of middle ear mucosa and muscles

 C

Removal of all ossicles of eustachiean tube plate

 D

Maintainance of patency of eustachian tube

Ans. D

Explanation:

Q. 20

Radical mastoidectomy includes all except: 

 A

Closure of the auditory tube

 B

Ossicles removed

 C

Cochlea removed

 D

Exteriorisation of mastoid

Q. 20

Radical mastoidectomy includes all except: 

 A

Closure of the auditory tube

 B

Ossicles removed

 C

Cochlea removed

 D

Exteriorisation of mastoid

Ans. C

Explanation:

Q. 21

Modified radical mastoidectomy is indicated in all except:

 A

Safe SCOM

 B

Unsafe CSOM with atticoantral disease

 C

Coalescent mastoiditis

 D

Limited mastoid pathology

Q. 21

Modified radical mastoidectomy is indicated in all except:

 A

Safe SCOM

 B

Unsafe CSOM with atticoantral disease

 C

Coalescent mastoiditis

 D

Limited mastoid pathology

Ans. C

Explanation:

Q. 22

A -30-yead old male is having Attic cholesteatoma of left ear with lateral sinus thromboplebitis. Which of the following will be the operation of choice?

 A

Intact canal will be the operation of choice

 B

Simple mastoidectomy with Tympanoplasty

 C

Canal wall down mastoidectomy

 D

Mastodidectomy with cavity obliteration

Q. 22

A -30-yead old male is having Attic cholesteatoma of left ear with lateral sinus thromboplebitis. Which of the following will be the operation of choice?

 A

Intact canal will be the operation of choice

 B

Simple mastoidectomy with Tympanoplasty

 C

Canal wall down mastoidectomy

 D

Mastodidectomy with cavity obliteration

Ans. C

Explanation:

In Attic cholesteatoma, if it invades eustachian tube or perilabyrynthine tissue, then manage­ment is Radial Mastoidectomy. 


Q. 23

Communication between middle ear and Eustachian tube is obliterated in which surgery?

 A

Tympanoplasty

 B

Schwartz operation

 C

Modified radical mastoidectomy

 D

Radical mastoidectomy

Q. 23

Communication between middle ear and Eustachian tube is obliterated in which surgery?

 A

Tympanoplasty

 B

Schwartz operation

 C

Modified radical mastoidectomy

 D

Radical mastoidectomy

Ans. D

Explanation:

 

In radical mastoidectomy, the opening of Eustachian tube is closed by curetting its mucosa and plugging the opening with tensor tympani muscle or cartilage.


Q. 24

latrogenic traumatic facial nerve palsy is most commonly caused during:

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Q. 24

latrogenic traumatic facial nerve palsy is most commonly caused during:

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Ans. C

Explanation:

 

Other Operations where Facial Nerve may be Damaged

–         Stapedectomy

–         Removal of acoustic neuroma



Q. 25

Treatment of middle ear malignancy includes:

 A

Excision of petrous part of temporal bone

 B

Subcortical excision

 C

Modified radical mastoidectomy

 D

a and c

Q. 25

Treatment of middle ear malignancy includes:

 A

Excision of petrous part of temporal bone

 B

Subcortical excision

 C

Modified radical mastoidectomy

 D

a and c

Ans. D

Explanation:

 

Most common malignant tumor of middle ear and mastoid is squamous cell carcinoma.

Clinical Features

  • It affects age group 40-60 years
  • Slightly more common in females
  • Most important predisposing cause is long standing CSOM
  • Patient may present with chronic foul smelling blood stained discharge
  • Pain is severe and comes at night.
  • Facial palsy may be seen
  • 0/E – Friable, hemorrhagic granulation or polyp are present.
  • Diagnosis – made only on biopsy CT and angiography are done to see the extent of disease.

Metastasis occurs to cervical lymph nodes later.

Treatment of carcinoma of middle ear is combination of surgery followed by radiotherapy.

Surgery consists of radical mastoidectomy / subtotal or total petrosectomy depending on the extent of tumor.



Q. 26

Attico antral disease is treated by ‑

 A

Modified radical mastoidectomy

 B

Antibiotics

 C

Grommet insertion

 D

Synringing

Q. 26

Attico antral disease is treated by ‑

 A

Modified radical mastoidectomy

 B

Antibiotics

 C

Grommet insertion

 D

Synringing

Ans. A

Explanation:

Ans. is ‘a’ i.e., Modified radical mastoidectomy

Treatment of atticoantral disease

Since cholesteatoma is going to expand and destroy bone and mucous membrane, it has to be removed. Therefore, surgery is the mainstay of treatment. Primary aim is removal of disease by mastoidectomy to make ear safe followed by reconstruction of hearing at a later stage. Modified radical mastoidectomy is the surgery of choice.

Two types of surgical procedures (mastoidectomy) are done to deal with cholesteatoma.

1) Canal wall down procedures

  • These leave the mastoid cavity open into the external auditory canal so that the diseased area is fully exteriorized.
  • The commonly used procedures for atticoantral disease are atticotomy, modified radical mastoidectomy and rarely radical mastoidectomy.
  • Modified radical mastoidectomy is the procedure of choice.

2) Canal wall up procedures (cortical mastoidectomy)

  • Here disease is removed by combined approach through the meatus and mastoid but retaining the posterior bony meatus wall, thereby avoiding an open mastoid cavity.
  • For reconstruction of hearing mechanism myringoplasty or tympanoplasty can be done at the time of primary surgery or as a second stage procedure.

Q. 27

Treatment of middle ear papilloma is ‑

 A

Myringotomy and simple excision

 B

Myringectomy and simple excision

 C

Tympanomastoidectomy

 D

Local infiltration with podophyllin

Q. 27

Treatment of middle ear papilloma is ‑

 A

Myringotomy and simple excision

 B

Myringectomy and simple excision

 C

Tympanomastoidectomy

 D

Local infiltration with podophyllin

Ans. C

Explanation:

Ans. is ‘c’ i.e., Tympanomastoidectomy

Middle ear pappilomas

The middle ear papillomas are rare presentations and medical literature is mainly limited to case reports or case series.

These include aggressive pappilary tumors, schneiderian type of pappilomas and inverted pappilomas.

They are associated with hearing difficulty and vertigo and may be associated with Von Hippel Lindau syndrome.

They tend to be slowly growing, locally aggressive non metastasizing neoplasms

The approach for treatment of such pathology is usually radical and tympanomastoidectomy is considered the treatment of choice. This gives the best chance of cure.


Q. 28

A 12 year old presents with fever, unilateral post auricular pain, mastoid bulging displacing the pinna forward and outwards with loss of bony trabeculae. This patient has history of chronic persistent pus discharge from same ear. Treatment of choice is‑

 A

Antibiotics only

 B

Incision and drainage

 C

Antibiotics, incision and drainage

 D

Mastoidectomy with incision, drainage and antibiotics

Q. 28

A 12 year old presents with fever, unilateral post auricular pain, mastoid bulging displacing the pinna forward and outwards with loss of bony trabeculae. This patient has history of chronic persistent pus discharge from same ear. Treatment of choice is‑

 A

Antibiotics only

 B

Incision and drainage

 C

Antibiotics, incision and drainage

 D

Mastoidectomy with incision, drainage and antibiotics

Ans. D

Explanation:

 

The patient is presenting with features of postauricular subperiosteal abscess. Treatment for this is antibiotics along with drainage of abscess and cortical mastoidectomy.

This patient has developed this abscess as a complication of CSOM (History of chronic ear discharge) for which he requires meastoidectomy.



Cochlear Implant

Cochlear Implant

Q. 1

Regarding cochlear implant, which of the following is true:

 A

Not contraindicated in cochlear malformation

 B

Contraindicated in < 5 yrs

 C

Indicated in mild to moderate hearing loss

 D

Implanted through oval window

Q. 1

Regarding cochlear implant, which of the following is true:

 A

Not contraindicated in cochlear malformation

 B

Contraindicated in < 5 yrs

 C

Indicated in mild to moderate hearing loss

 D

Implanted through oval window

Ans. A

Explanation:

Not contraindicated in cochlear malformation [Ref. Dhingra ENT 5/e p138-141; Current Diagnosis and Treatment in Otolaryngology 2/e chap. 70]

  • Cochlear malformation is a surgical challenge but not a contraindication for cochlear implantation. Specially designed electrodes are available to facilitate implantation – Current Diagnosis and Treatment in Otolaryngology
  • Cochlear ossification is also no bar for implant
  • Cochlear implant is an artificial means that allows the transmission of acoustic information through the central auditory pathway via direct electric stimulation of auditory nerve fibers.
  • General criteria for cochler implant candidacy
  • B/L severe to profound sensorineural hearing loss. (Option ‘c’ is false)
  • Little or no benefit from hearing aids.
  • No medical contraindication for surgery.
  • Cochlea & auditory nerve should be present
  • Realistic expectation
  • Good family and social support
  • Adequate cognitive. function to be able to use the disease.
  • Candidates are defined as pre-lingual or post-lingual depending on whether they were deafened before or after the acquisition of speech & language.
  • In children with pre-lingual deafness (at birth or in early child hood) implantation at an early age ensures better results and children can be implanted at 12 months of age. (Option `b’ is false)Post lingual patients with shorter duration of deafness have better outcome.
  • In cochlear implant surgery the electrode array is placed within the scala tympani of the cochlea. There are two techniques to approach cochlea.

– The facial recess approach in which cochleostomy is performed antero-inferior to the round window membrane (option `d’ is false)

The pericanal technique in which cochleostomy is performed either by endaural or post-aural approach for e.g. Veria and suprameatal recess approach.


Q. 2 Use of nitrous oxide is contraindicated in all of the following surgeries except ?
 A

Cochlear implant

 B

Microlaryngeal surgery

 C

Vitreoretinal surgery

 D

Exentration operation

Q. 2 Use of nitrous oxide is contraindicated in all of the following surgeries except ?
 A

Cochlear implant

 B

Microlaryngeal surgery

 C

Vitreoretinal surgery

 D

Exentration operation

Ans. D

Explanation:

Exentration operation [Ref: Journal of Anaesthesia volume 97(5) Nov 2002]

  • One major problem with N20 is that it will exchange with N2 in any air containing cavity in the body.

Moreover, because of their differential blood : gas partition coefficients, nitrous oxide will enter the cavity faster than nitrogen escapes, thereby increasing the volume and/or pressure in the cavity.

  • Examples of air collections that can be expanded by nitrous oxide are :

– Pneumothorax

– Air embolus

– Obstructed middle ear

– Obstructed loop of bowel

– lntracranial air

– A pulmonary (bleep)

  • Nitrous oxide should be avoided in these clinical settings: Now lets move on to the options

Nitrous oxide in vitreoretinal surgery

  • The use of nitrous oxide anaesthesia in patients with an intraocular gas bubble is potentially sight threatening.
  • Patients who have vitreoretinal surgery often have a gas bubble deliberately left within the eyes as it helps keep the retina attached while adhesions develop.
  • Filtered room air, Sulfur hexqfluoride and perfluoropropane are the most commonly used gases.
  • By varying the concentration volume and type of gas used, bubbles can be produced that will last upto 70 days before being completely absorbed.
  • If nitrous oxide is administered during this time the bubble will rapidly expand with the risk of retinal and optic nerve ischemia.

Nitrous oxide and middle ear surgeries

  • Middle ear cavity is connected to eustachian tube.
  • When nitrous oxide is inhaled in large quantities N20 replaces the N2 in the middle air cavity thereby increasing the pressure in the cavity.
  • After discontinuation of N20 the gas is rapidly reabsorbed from the cavity thus creating negative pressure in the cavity this may cause: ?

– Serous otitis media

– Disarticulation of stapes

– Impaired hearing

  • N20 anaesthesia is hazadrous to hearing iu patients who have previously undergone reconstructive middle ear surgery.

Microlaryngeal surgery

  • CO2and (Nd : YAG) lasers are frequently used for microsurgery on the upper airway and trachea.
  • Lasers can ignite materials used in anaesthesia. The CO2 laser can penetrate an endotracheal tube
  • and ignite a fire. Nitrous oxide supports combustion just like 02 and and may ignite fire.

Q. 3

In Cochlear implants, the electrodes are most commonly placed at:

 A

Oval window

 B

Round window

 C

Horizontal semicircular canal

 D

Cochlea

Q. 3

In Cochlear implants, the electrodes are most commonly placed at:

 A

Oval window

 B

Round window

 C

Horizontal semicircular canal

 D

Cochlea

Ans. D

Explanation:

The cochlear implant electrodes are placed in the scala tympani of the cochlea.

The electrode thus stimulates the cochlear nerve which is a part of the vestibulo-cochlear nerve (CN VIII).


Q. 4

A 6 year old boy with congenital hearing loss approached an ENT surgeon for cochlear implantation. TRUE regarding cochlear implants is:

 A

Contraindicated in children less than 5 years of age

 B

Implanted in mild-to-moderate deafness

 C

Malformed cochlea is not a contraindication

 D

Inserted through oval window

Q. 4

A 6 year old boy with congenital hearing loss approached an ENT surgeon for cochlear implantation. TRUE regarding cochlear implants is:

 A

Contraindicated in children less than 5 years of age

 B

Implanted in mild-to-moderate deafness

 C

Malformed cochlea is not a contraindication

 D

Inserted through oval window

Ans. C

Explanation:

Congenital malformations of the cochlea are not contraindications to cochlear implantation.

Contraindications for Cochlear Implants:

1. Deafness caused by lesions of the acoustic nerve or the central auditory pathway

2. Active middle ear infections

3. Cochlear ossification that prevents electrode insertion

4. Tympanic membrane perforation

 

Appropriate age for cochlear implantation is between 2-17 years. Bilateral severe-to-profound sensorineural hearing loss is the main criteria for implantation. The electrode is inserted through the round window into the scala tympani of the cochlea.


Q. 5

A child with congenital hearing loss is brought for cochlear implantation. For the implantation, the following structure should be intact:

 A

Outer hair cell

 B

Inner hair cell

 C

Spiral ganglion cell

 D

Auditory nerve

Q. 5

A child with congenital hearing loss is brought for cochlear implantation. For the implantation, the following structure should be intact:

 A

Outer hair cell

 B

Inner hair cell

 C

Spiral ganglion cell

 D

Auditory nerve

Ans. D

Explanation:

Cochlear implants are neural prostheses that convert sound energy to electrical signals and can be used to stimulate the auditory division of the eighth nerve directly.

Successful cochlear implantation requires an intact and functional auditory processing pathway, from spiral ganglion cells to the auditory cortex. 


Q. 6

A child aged 3 yrs, presented with severe sensorineural deafness, was prescribed hearing aids, but showed no improvement. What is the next line of management?

 A

Fenestration surgery

 B

Stapes mobilisation

 C

Cochlear implant

 D

Conservative

Q. 6

A child aged 3 yrs, presented with severe sensorineural deafness, was prescribed hearing aids, but showed no improvement. What is the next line of management?

 A

Fenestration surgery

 B

Stapes mobilisation

 C

Cochlear implant

 D

Conservative

Ans. C

Explanation:

Cochlear implants are neural prostheses that convert sound energy to electrical signals and can be used to stimulate the auditory division of the eighth nerve directly.

Bilateral cochlear implants are increasingly common and serve to enhance sound localization and improve understanding of speech in background noise.


Q. 7

Use of nitrous oxide is contraindicated in all of the following surgeries except:

 A

Cochlear implant

 B

Microlaryngeal surgery

 C

Vitrioretinal surgery

 D

Exentration operation

Q. 7

Use of nitrous oxide is contraindicated in all of the following surgeries except:

 A

Cochlear implant

 B

Microlaryngeal surgery

 C

Vitrioretinal surgery

 D

Exentration operation

Ans. D

Explanation:

D.i.e. Excentration operation 

Diffusion hypoxia is seen during recovery phase after discontinuation of prolonged N20 anesthesia. It can be prevented by continuing 100% 02 inhalation for a few minutes after discontinuing N20Q. Second gas effect occurs in initial part of induction of N20 anesthesia. N20 also shows bone marrow suppressionQ.

Excentration is enucleation + wide dissection of periorbital tissue. In it there is no closed space formation so N20 can be used. In microlaryngeal lesser surgery, N20 is contraindicated d/t risk of airway fireQ


Q. 8

All are true about facial recess except:

 A

Supra pyramical recess

 B

Medially it is bounded by chorda tympani and laterally by facial nerve

 C

Important in cochlear implant

 D

Middle ear can be approached through it

Q. 8

All are true about facial recess except:

 A

Supra pyramical recess

 B

Medially it is bounded by chorda tympani and laterally by facial nerve

 C

Important in cochlear implant

 D

Middle ear can be approached through it

Ans. B

Explanation:

 



Q. 9

Where is electrode kept in cochlear implant?

 A

Round window

 B

Oval window

 C

Scala vestibuli

 D

Scala tympani

Q. 9

Where is electrode kept in cochlear implant?

 A

Round window

 B

Oval window

 C

Scala vestibuli

 D

Scala tympani

Ans. D

Explanation:

Q. 10

A child aged 3 years, presented with severe sensorineural deafness, was prescribed hearing aids, but showed no improvement. What is the next line of management:

 A

Fenestration surgery

 B

Stapes mobilisation

 C

Cochlear implant

 D

Conservative

Q. 10

A child aged 3 years, presented with severe sensorineural deafness, was prescribed hearing aids, but showed no improvement. What is the next line of management:

 A

Fenestration surgery

 B

Stapes mobilisation

 C

Cochlear implant

 D

Conservative

Ans. C

Explanation:

Q. 11

10-year-old boy is having sensorineural deafness, not benefited by hearing aids. Next best management is:

 A

Cochlear implant

 B

Stapes fixation

 C

Stapedectomy

 D

Fenestration

Q. 11

10-year-old boy is having sensorineural deafness, not benefited by hearing aids. Next best management is:

 A

Cochlear implant

 B

Stapes fixation

 C

Stapedectomy

 D

Fenestration

Ans. A

Explanation:

Q. 12

In cochlear implants, electrodes are most commonly placed at:

 A

Oval window

 B

Round window

 C

Horizontal semicircular canal

 D

Cochlea

Q. 12

In cochlear implants, electrodes are most commonly placed at:

 A

Oval window

 B

Round window

 C

Horizontal semicircular canal

 D

Cochlea

Ans. B

Explanation:

Q. 13

Cochlear implant is done in:

 A

Scala vestibuli

 B

Scala tympani

 C

Cochlear duct

 D

Endolymphatic duct

Q. 13

Cochlear implant is done in:

 A

Scala vestibuli

 B

Scala tympani

 C

Cochlear duct

 D

Endolymphatic duct

Ans. B

Explanation:

 

MIC Surgical approach for placing cochlea implant = Facial Recess approach (Posterior tympanotomy) which involves doing a cortical I mastoidectomy. From the middle ear the electrodes are then introduced into the scala tympani through the round window. Recently Veria technique (Non-Mastoidectomy technique) is gaining popularity for cochlear implantation. It uses transcanal approach.

Advantage of Vera technique

  • Simple
  • Less chances of injuring facial nerve
  • Suitable in young children where mastoid has not developed fully.



Q. 14

Which of the following statement regarding cochlear implant is true:

 A

Cochlear malformation is not a CI to its use

 B

Contraindicated in children < 5 yrs of age

 C

Indicated in mild-moderate hearing loss

 D

Approached through oval window

Q. 14

Which of the following statement regarding cochlear implant is true:

 A

Cochlear malformation is not a CI to its use

 B

Contraindicated in children < 5 yrs of age

 C

Indicated in mild-moderate hearing loss

 D

Approached through oval window

Ans. A

Explanation:

 

 

 



Q. 15

Cochlear implant is done if the following is intact: 

 A

Outer hair cell

 B

Inner hair cell

 C

Spiral ganglion cell

 D

Auditory nerve

Q. 15

Cochlear implant is done if the following is intact: 

 A

Outer hair cell

 B

Inner hair cell

 C

Spiral ganglion cell

 D

Auditory nerve

Ans. D

Explanation:

 

They are indicated for patients of profound binaural SNHL (with non functional cochlear hair cells) who have intact auditory nerve functions and show little or no benefit from hearing aids.


Q. 16

All are true about cochlear implant except: 

 A

Minimum age is 1 year

 B

PTA of 70 dB or more

 C

Switch on is done after 3 weeks

 D

MRI has no role in pre op assessment

Q. 16

All are true about cochlear implant except: 

 A

Minimum age is 1 year

 B

PTA of 70 dB or more

 C

Switch on is done after 3 weeks

 D

MRI has no role in pre op assessment

Ans. D

Explanation:

 

Pre op investigation done before an implant is placed

  • Complete audiological evaluation
  • HRCT

Q. 17

Which of the following part of cochlear implant is im­planted during surgery?

 A

Receiver stimulator

 B

Transmitting coil

 C

Microphone

 D

Speech processor

Q. 17

Which of the following part of cochlear implant is im­planted during surgery?

 A

Receiver stimulator

 B

Transmitting coil

 C

Microphone

 D

Speech processor

Ans. A

Explanation:

Q. 18

What is placed during surgery for cochlear implant?

 A

Microphone

 B

Speech processor

 C

Transmitting coil

 D

Receiver stimulator

Q. 18

What is placed during surgery for cochlear implant?

 A

Microphone

 B

Speech processor

 C

Transmitting coil

 D

Receiver stimulator

Ans. D

Explanation:

 

 Microphone, Speech-processor and Transmitter are the part of external component of cochlear implant, which remain outside the body. Receiver/Stimulator (Implanted under the skin) and Electrode array (implanted in the scala tympani of the cochlea) are the part of internal component of cochlear implant, which are fitted inside the body.




Nystagmus

Nystagmus

Q. 1 In which nystagmus occurs when the patient looks straight:
 A Latent
 B Deviational
 C Optokinetic
 D Central
Q. 1 In which nystagmus occurs when the patient looks straight:
 A Latent
 B Deviational
 C Optokinetic
 D Central
Ans. C

Explanation:

Optokinetic


Q. 2

. A 45 year male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:

 A

Korsakoff’s psychosis

 B

Wernicke encephalopathy.

 C

De Clerambault syndrome

 D

Delirium tremens

Q. 2

. A 45 year male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:

 A

Korsakoff’s psychosis

 B

Wernicke encephalopathy.

 C

De Clerambault syndrome

 D

Delirium tremens

Ans. B

Explanation:

B i.e. Wernicke encephalopathy


Q. 3

Down beat nystagmus could be due to:

 A

Cerebellar lesion

 B

Arnold-Chiari malformation

 C

Optic neuritis

 D

a and b

Q. 3

Down beat nystagmus could be due to:

 A

Cerebellar lesion

 B

Arnold-Chiari malformation

 C

Optic neuritis

 D

a and b

Ans. D

Explanation:

A i.e. Cerebellar lesion; B i.e. Arnold Chiari malformation

  • Down beat nystagmus (in primary position of gaze the fast component is downward) occurs from lesions near craniocervical junction (in posterior fossa near foramen magnum) e.g. Chiari malformation Q, basilar invagination. It has also been reported in cerebellar or brainstem stroke Q, lithium or anticonvulsant intoxication, alcoholism, and multiple sclerosis.
  • Upbeat nystagmus is associated with damage to pontine tegmentum from stroke, demylination or tumor.
  • Vestibular nystagmus results from dysfunction of labyrinth (Meniere’s disease), vestibular nerve or vestibular nucleus in brainstem.
  • Gaze evoked nystagmus is induced by drugs (sedatives, anticonvulsants, alcohol); muscle paresis; myasthenia gravis; dent disease; and cerebello-pontine angle, brainstem & cerebellar lesions.

Q. 4

A patient has a right homonymous hemian-opia with saccadic pursuit movements and defective optokinetic nystagmus. The lesion is most likely to be in the

 A

Frontal lobe

 B

Occipital lobe

 C

Parietal lobe

 D

Temporal lobe

Q. 4

A patient has a right homonymous hemian-opia with saccadic pursuit movements and defective optokinetic nystagmus. The lesion is most likely to be in the

 A

Frontal lobe

 B

Occipital lobe

 C

Parietal lobe

 D

Temporal lobe

Ans. C

Explanation:

C i.e. Parietal lobe

Optokinetic Nystagmus: If a white drum with vertical black stripes is rotated in front of the eyes, the patient follows the stripe till it disappears & then switches back suddenly to pick up a new stripe.

  • This reflex is abnormal in patients with congenital nystagmus. One may observe a paradoxical reversal of the optokinetic nystagmus response.
  • Patients with horizontal nystagmus with unilateral hemispheric lesions, especially parietal or parietal-occipital lesions, show impaired optokinetic nystagmus when the drum is rotated toward the side of the lesion.
  • The OKN drum may be used as an estimate of visual acuity. The striped drum is equivalent to a vision of counting fingers when held at a distance of 3-5 feet from the patient. The further the drum is from the patient, the better the visual acuity must be to respond normally to the moving drum.

Q. 5

Site of lesion in unilateral past pointing nystagmus is:

 A

Posterior semicircular canal

 B

Superior semicircular canal

 C

Flocculonodular node

 D

Cerebellar hemisphere

Q. 5

Site of lesion in unilateral past pointing nystagmus is:

 A

Posterior semicircular canal

 B

Superior semicircular canal

 C

Flocculonodular node

 D

Cerebellar hemisphere

Ans. D

Explanation:

Q. 6

In Fitzgerald Hallpike differential caloric test, cold-water irrigation at 30 degrees centigrade in the left ear in a normal person will include:

 A

Nystagmus to the right side

 B

Nystagmus to the left side

 C

Direction changing nystagmus

 D

Positional nystagmus

Q. 6

In Fitzgerald Hallpike differential caloric test, cold-water irrigation at 30 degrees centigrade in the left ear in a normal person will include:

 A

Nystagmus to the right side

 B

Nystagmus to the left side

 C

Direction changing nystagmus

 D

Positional nystagmus

Ans. A

Explanation:

Q. 7

Which of the following is not true of caloric test?

 A

Induction of nystagmus by thermal stimulation

 B

Normally, cold water induces nystatmus to opposite side and warm water to same side

 C

In canal paresis, the test is inconclusive

 D

None

Q. 7

Which of the following is not true of caloric test?

 A

Induction of nystagmus by thermal stimulation

 B

Normally, cold water induces nystatmus to opposite side and warm water to same side

 C

In canal paresis, the test is inconclusive

 D

None

Ans. C

Explanation:

 

 

  • Nystagmus can be induced both by cold as well as thermal stimulation
  • Cold stimulation causes nystagmus towards opposite side while thermal stimulation causes Nystagmus towards same side. (COWS)
  • In canal paresis either there is a reduced or absent response (causes of U/L canal paresis are-U/L vestibular Schwannoma or vestibular neuritis).
  • B/L absence of caloric nystagmus is seen in case of amminoglycoside ototoxicity or postmeningitis



Q. 8

Spontaneous vertical nystagmus is seen in the lesion of:

 A

Midbrain

 B

Labyrinth

 C

Vestibule

 D

Cochlea

Q. 8

Spontaneous vertical nystagmus is seen in the lesion of:

 A

Midbrain

 B

Labyrinth

 C

Vestibule

 D

Cochlea

Ans. A

Explanation:

Q. 9

True about central nystagmus:

 A

Horizontal

 B

Direction fixed

 C

Direction changes

 D

a and c

Q. 9

True about central nystagmus:

 A

Horizontal

 B

Direction fixed

 C

Direction changes

 D

a and c

Ans. D

Explanation:

 

  • Nystagmus is rhythmic oscillatory movement of eye and has two components slow and fast.
  • It can be of vestibular or ocular in origin
  • Vestibular nystagmus is called peripheral when it is due to lesion of labyrinth or VIllth nerve and central, when lesion is in the central neural pathways (Vestibular nuclei, brainstem and cerebellum)

 

Form

Direction of nystagmus° Latency

Duration

On visual fixation Accompanying symptoms Fafiguability

Example

Torsional with horizontal or vertical component Direction fixed

2-20 seconds

Less than 1 minute

Nystagmus disappears

Tinnitus, vertigo

Fatiguable

BPPV, labyrinthitis, Meniere’s disease labyrinthine fistula

Purely horizontal or vertical (No torsional component) Direction changing°

No latency

More than 1 minute Does not disappear None

Non fatiguable

Vertebrobasilar insufficiency, tumours



Q. 10

Nystagmus is associated with all EXCEPT:

 A

Cerebellar disease

 B

Vestibular disease

 C

Cochlear disease

 D

Arnold Chiari Malformation

Q. 10

Nystagmus is associated with all EXCEPT:

 A

Cerebellar disease

 B

Vestibular disease

 C

Cochlear disease

 D

Arnold Chiari Malformation

Ans. C

Explanation:

Cochlear problems is associated with hearing loss and not nystagmus.

Rest all are associated with nystagmus.


Q. 11

Spontaneous pure vertical nystagmus is seen in the lesion of:

 A

Medulla

 B

Labyrinth

 C

Middle ear

 D

Cochlea

Q. 11

Spontaneous pure vertical nystagmus is seen in the lesion of:

 A

Medulla

 B

Labyrinth

 C

Middle ear

 D

Cochlea

Ans. A

Explanation:

Q. 12

Destruction of right labyrinth causes nystagmus to:

 A

Right side

 B

Left side

 C

Pendular nystagmus

 D

No nystagmus

Q. 12

Destruction of right labyrinth causes nystagmus to:

 A

Right side

 B

Left side

 C

Pendular nystagmus

 D

No nystagmus

Ans. B

Explanation:

 

  • In destructive lesions eg. trauma to labyrinth, the nystagmus is towards the opposite side.
  • In irritative lesions eg. serous labyrinthitis, fistula of labyrinth, the nystagmus is towards ipsilateral side.

Q. 13

True about central nystagmus is:

 A

Duration not limited

 B

Direction fixed

 C

Latency present

 D

Suppressed by visual fixation

Q. 13

True about central nystagmus is:

 A

Duration not limited

 B

Direction fixed

 C

Latency present

 D

Suppressed by visual fixation

Ans. A

Explanation:

Q. 14

True about peripheral nystagmus is:

 A

Duration not limited

 B

Direction fixed

 C

No latency

 D

Vertigo not present

Q. 14

True about peripheral nystagmus is:

 A

Duration not limited

 B

Direction fixed

 C

No latency

 D

Vertigo not present

Ans. B

Explanation:

Q. 15

Stimulation of posterior semicircular canal produces

 A

Horizontal nystagmus 

 B

Pure vertical nystagmus 

 C

Pendular nystagmus

 D

Torsional vertical nystagmus

Q. 15

Stimulation of posterior semicircular canal produces

 A

Horizontal nystagmus 

 B

Pure vertical nystagmus 

 C

Pendular nystagmus

 D

Torsional vertical nystagmus

Ans. D

Explanation:

 

 

  • Superior semicircular canal lesion leads to torsional vertical upbeat nystagmus
  • Posterior semicircular canal lesion leads to torsional vertical downbeat nystagmus
  • Only vertical or horizontal nystagmus without torsion or only torsional without vertical and horizontal nystagmus is seen in central causes of nystagmus.

 

  • Medullary lesions lead to pure torsional nystagmus
  • Pure vertical nystagmus is seen in medullary lesion or vertebrobasilar insufficiency.
  • Pure horizontal nystagmus is seen in cerebral lesions.

Q. 16

In caloric test left jerk nystagmus occurs when:

 A

Cold water is poured in right ear

 B

Hot water is poured in right ear

 C

Cold water is poured in left ear

 D

All of the above

Q. 16

In caloric test left jerk nystagmus occurs when:

 A

Cold water is poured in right ear

 B

Hot water is poured in right ear

 C

Cold water is poured in left ear

 D

All of the above

Ans. A

Explanation:

Ans. Cold water is poured in right ear


Q. 17

In unilateral past pointing nystagmus the site of lesion is:

 A

Cerebellar hemisphere

 B

Lateral semicircular canal

 C

Flocculo-nodular lobe

 D

Superior semicircular canal

Q. 17

In unilateral past pointing nystagmus the site of lesion is:

 A

Cerebellar hemisphere

 B

Lateral semicircular canal

 C

Flocculo-nodular lobe

 D

Superior semicircular canal

Ans. A

Explanation:

Ans. Cerebellar hemisphere


Q. 18

Miners nystagmus is of which type:

 A

Lateral

 B

Vertical

 C

Rotatory

 D

Can be of any type

Q. 18

Miners nystagmus is of which type:

 A

Lateral

 B

Vertical

 C

Rotatory

 D

Can be of any type

Ans. C

Explanation:

Ans. Rotatory


Q. 19

Down beat nystagmus could be due to:

 A

Cerebellar lesion

 B

Arnold-Chiari malformation

 C

All of the above

 D

None of the above

Q. 19

Down beat nystagmus could be due to:

 A

Cerebellar lesion

 B

Arnold-Chiari malformation

 C

All of the above

 D

None of the above

Ans. C

Explanation:

Ans. All of the above


Q. 20

A patient has a right homonymous hemianopia with saccadic pursuit movements and defective optokinetic nystagmus. The lesion is most likely to be in the :

 A

Frontial lobe

 B

Occipital lobe

 C

Parietal lobe

 D

Temporal lobe

Q. 20

A patient has a right homonymous hemianopia with saccadic pursuit movements and defective optokinetic nystagmus. The lesion is most likely to be in the :

 A

Frontial lobe

 B

Occipital lobe

 C

Parietal lobe

 D

Temporal lobe

Ans. C

Explanation:

Ans. Parietal lobe


Q. 21

Brainstem dead are all, except:         

JIPMER 08

 A

Weaned off from ventilator, no respiration for 15 sec

 B

Absent pupillary response

 C

Absent nystagmus

 D

Absent corneal reflex

Q. 21

Brainstem dead are all, except:         

JIPMER 08

 A

Weaned off from ventilator, no respiration for 15 sec

 B

Absent pupillary response

 C

Absent nystagmus

 D

Absent corneal reflex

Ans. A

Explanation:

Ans.Weaned off from ventilator, no respiration for 15 sec


Q. 22

Illuminated frenzel glasses are used in detecting‑

 A

Nystagmus

 B

Heterophoria

 C

Esotropia

 D

Astigmatism

Q. 22

Illuminated frenzel glasses are used in detecting‑

 A

Nystagmus

 B

Heterophoria

 C

Esotropia

 D

Astigmatism

Ans. A

Explanation:

Ans. is ‘a’ i.e., Nystagmus

Illuminated frenzel galsses (+20 lenses) are useful for abolishing fixation and thus revealing peripheral vestibular nystagmus.



Pharynx

PHARYNX

Q. 1

Which of the following statement regarding the sensory nerve supply of pharyngeal mucous membrane is TRUE?

 A

Nasopharynx is supplied by the maxillary nerve

 B

Glossopharyngeal nerve innervates the oral pharynx

 C

Laryngeal pharynx is supplied by the internal laryngeal branch of vagus nerve

 D

All of the above

Q. 1

Which of the following statement regarding the sensory nerve supply of pharyngeal mucous membrane is TRUE?

 A

Nasopharynx is supplied by the maxillary nerve

 B

Glossopharyngeal nerve innervates the oral pharynx

 C

Laryngeal pharynx is supplied by the internal laryngeal branch of vagus nerve

 D

All of the above

Ans. D

Explanation:

Nerves providing sensory innervation of the nasopharynx are :
Maxillary nerve innervates nasopharynx, glossopharyngeal nerve innervates the oral pharynx and laryngeal pharynx is supplied by the internal laryngeal branch of vagus nerve.
 

Q. 2

Airway noise originating in the nose, nasopharynx and oropharynx is known as:

 A

Stridor

 B

Stertor

 C

Both of the above

 D

None of the above

Q. 2

Airway noise originating in the nose, nasopharynx and oropharynx is known as:

 A

Stridor

 B

Stertor

 C

Both of the above

 D

None of the above

Ans. B

Explanation:

Stridor is a harsh noise produced by turbulent airflow through a partially obstructed airway. It may be inspiratory, expiratory, or both (biphasic).

The term stertor is used to describe airway noise originating in the nose, nasopharynx, and oropharynx; therefore, stridor is generally of laryngeal or tracheal origin.


Q. 3

When a large bolus of food is swallowed, the hyoid bone moves anteriorly to open the pharynx. The muscle responsible for this action is innervated by which of the following nerves?

 A

C1 (ansa cervicalis)

 B

CN IX

 C

Pharyngeal plexus

 D

CN V3

Q. 3

When a large bolus of food is swallowed, the hyoid bone moves anteriorly to open the pharynx. The muscle responsible for this action is innervated by which of the following nerves?

 A

C1 (ansa cervicalis)

 B

CN IX

 C

Pharyngeal plexus

 D

CN V3

Ans. A

Explanation:

The muscle that moves the hyoid anteriorly to open the pharynx is the geniohyoid. This muscle is innervated by the ansa cervicalis branch of C1. The ansa cervicalis also innervates the thyrohyoid and the intra hyoids.

Note:

  • Cranial nerve IX innervates the stylopharyngeus.
  • The pharyngeal plexus innervates the palatoglossus, palatopharyngeus, and cricopharyngeus.
  • Cranial nerve V-3 innervates most of the muscles of mastication.

Q. 4

Referred otalgia from base of tongue or oropharynx is carried by nerve?

 A

Cranial nerve V

 B

Cranial nerve VII

 C

Cranial nerve IX

 D

Cranial nerve X

Q. 4

Referred otalgia from base of tongue or oropharynx is carried by nerve?

 A

Cranial nerve V

 B

Cranial nerve VII

 C

Cranial nerve IX

 D

Cranial nerve X

Ans. C

Explanation:

The Jacobson nerve, tympanic branch of glossopharyngeal nerve (cranial nerve IX) directly innervates the ear but also has pharyngeal, lingual, and tonsillar branches to supply the posterior one-third portion of the tongue, tonsillar fossa, pharynx, eustachian tube, and parapharyngeal and retropharyngeal spaces. So any pathology involving those areas can lead to referred otalgia.

Must know:
Referred Otalgia: the source of the pain does not reside within the ear but, rather it originates from a source distant from the ear hence it is called as “referred otalgia”. Any pathology residing within the sensory net of cranial nerves V, VII, IX, and X and upper cervical nerves C2 and C3 can potentially cause referred otalgia.


Q. 5

All muscles of the pharynx are supplied by pharyngeal plexus, EXCEPT?

 A

Inferior constrictors

 B

Salpingopharyngeus

 C

Stylopharyngeus

 D

None of the above

Q. 5

All muscles of the pharynx are supplied by pharyngeal plexus, EXCEPT?

 A

Inferior constrictors

 B

Salpingopharyngeus

 C

Stylopharyngeus

 D

None of the above

Ans. C

Explanation:

With the exception of stylopharyngeus, which is supplied by the glossopharyngeal nerve, the muscles are supplied by the cranial part of the accessory nerve via the pharyngeal plexus.

 


Q. 6

The pharyngeal diverticulum is a protustion of mucosa between-

 A

The two parts of inferior constrictor muslce of the pharynx

 B

The two parts of middle constrictor muslce of the pharynx

 C

The two parts of the superior constrictor muscle of the pharynx

 D

Cricopharyngeal and posterior part o suprahyoid membrane

Q. 6

The pharyngeal diverticulum is a protustion of mucosa between-

 A

The two parts of inferior constrictor muslce of the pharynx

 B

The two parts of middle constrictor muslce of the pharynx

 C

The two parts of the superior constrictor muscle of the pharynx

 D

Cricopharyngeal and posterior part o suprahyoid membrane

Ans. A

Explanation:

Ans. is ‘a’ i.e., The two parts of inferior constrictor muscle of the pharynx 


Q. 7

Killian’s dehiscence is seen in:

 A

Oropharynx

 B

Nasophrynx

 C

Cricopharynx

 D

Vocal cords

Q. 7

Killian’s dehiscence is seen in:

 A

Oropharynx

 B

Nasophrynx

 C

Cricopharynx

 D

Vocal cords

Ans. C

Explanation:

 

Killian’s Dehiscence 

  • It is an area of weakness between the two parts of inferior constrictor muscle—sub thyropharyngeus and cricopharyngeus
  • A pulsion diverticulum of pharyngeal mucosa can emerge posteriorly through the Killian’s dehiscence called as Zenker’s diverticulum or pharyngeal pouch. This pouch is posterior.
  • Since it is an area of weakness it is one of the sites of esophageal perforation during instrumentation and scopy—hence also called ‘Gateway of Tears’.
  • A true diverticulum has all the layers of a tubular structure but zenker’s diverticulum is a false diverticulum as h. does not have any muscular layer.

 

  • Killian-Janieson’s space – It lies between cricopharyngeus and circular fibres of the esophagus.
  • Lamier Hackemann’s space – It lies between circular and longitudinal fibers of esophagus.

Q. 8

True regarding nasopharynx are all except:

 A

Fossa of rosenmuller corresponds to the internal carotid artery

 B

Lateral wall has pharyngeal opening of Eustachian

 C

Passavant’s muscle is formed by Stylopharyngeus

 D

Also called as epipharynx

Q. 8

True regarding nasopharynx are all except:

 A

Fossa of rosenmuller corresponds to the internal carotid artery

 B

Lateral wall has pharyngeal opening of Eustachian

 C

Passavant’s muscle is formed by Stylopharyngeus

 D

Also called as epipharynx

Ans. C

Explanation:

Q. 9

True regarding opening of auditory tube in nasopharynx is:     

 A

Posterior to inferior nasal concha

 B

Posterior to middle nasal concha

 C

Superior to inferior nasal concha

 D

Inferior to inferior nasal concha

Q. 9

True regarding opening of auditory tube in nasopharynx is:     

 A

Posterior to inferior nasal concha

 B

Posterior to middle nasal concha

 C

Superior to inferior nasal concha

 D

Inferior to inferior nasal concha

Ans. A

Explanation:

The lateral wall of nasopharynx has pharyngeal opening of the auditory tube, at the level of the inferior nasal concha and 1.2 cm behind it


Q. 10

True about pharyngeal diverticula are all excep

 A

Results due to neuromuscular incoordination

 B

Lies in the anterior wall of pharynx

 C

They are normal in pig

 D

Food may get accumulated

Q. 10

True about pharyngeal diverticula are all excep

 A

Results due to neuromuscular incoordination

 B

Lies in the anterior wall of pharynx

 C

They are normal in pig

 D

Food may get accumulated

Ans. B

Explanation:

  • Killians dehiscence is a weak part in the posterior wall of the pharynx which lies at the level of vocal folds or upper border of the cricoid lamina and is limited inferiorly by the thick cricopharyngeal sphincter.
  • Pharyngeal diverticula results due to outpouching of the dehiscence
  • Two parts of the inferior constrictor has different nerve supplies, propulsive thyropharyngeus by the pharyngeal plexus and the sphincter cricopharyngeus by the recurrent laryngeal nerve so there is possibility of neuromuscular incoordination. If cricopharyngeus fails to relax and the thyropharyngeus contracts bolus of food may be pushed backwards and tends to produce a diverticulum

Q. 11

False regarding the foreign body of oropharynx is ‑

 A

Impacted foreign bodies most often lodge in the soft tissue at the base of tongue

 B

Food particles are the most common oropharyngeal foreign bodies in children

 C

Clinical hypopharyngeal foreign bodies are amenable to clinical examination

 D

Endoscopy and MDCT are used in the diagnosis

Q. 11

False regarding the foreign body of oropharynx is ‑

 A

Impacted foreign bodies most often lodge in the soft tissue at the base of tongue

 B

Food particles are the most common oropharyngeal foreign bodies in children

 C

Clinical hypopharyngeal foreign bodies are amenable to clinical examination

 D

Endoscopy and MDCT are used in the diagnosis

Ans. B

Explanation:

Ans. is ‘b’ i.e., Food particles are the most common oropharyngeal foreign bodies in children

Oropharyngeal foreign bodies

  • Most ingested foreign bodies do not impact in the oropharynx
  • Sharp foreign bodies like fish and chicken bones most commonly impact in the soft tissues at the base of the tongue.
  • Hypopharyngeal foreign bodies can be detected by good physical examination.
  • Endoscopy and MDCT are used in the diagnosis of foreign bodies of cervical esophagus.
  • Coins are the most common impacted oropharyngeal foreign bodies encountered in children followed by food particles.

Q. 12

Pyriform fossa is situated in ‑

 A

Oropharynx

 B

Hypopharynx

 C

Nasopharynx

 D

None of the above

Q. 12

Pyriform fossa is situated in ‑

 A

Oropharynx

 B

Hypopharynx

 C

Nasopharynx

 D

None of the above

Ans. B

Explanation:

Ans. is ‘b’ i.e., Hypopharynx

Pyriform fossa is a part of laryngopharynx (hypopharynx)


Q. 13

All muscles of pharynx are supplied by pharyngeal plexus except –

 A

Palatopharyngngeus

 B

Stylopharyngeus

 C

Salpingopharyngeus

 D

Superior constrictor

Q. 13

All muscles of pharynx are supplied by pharyngeal plexus except –

 A

Palatopharyngngeus

 B

Stylopharyngeus

 C

Salpingopharyngeus

 D

Superior constrictor

Ans. B

Explanation:

All muscles of pharynx are supplied by cranial accessory through branches of vagus via pharyngeal plexus except stylopharyngeus which is supplied by glossopharyngeal.

The inferior constrictor receives an additional supply from the external and recurrent laryngeal nerves.


Q. 14

Lower border of pharynx is at the level of (Extent of pharynx is upto) ‑

 A

C2

 B

C3

 C

C4

 D

C6

Q. 14

Lower border of pharynx is at the level of (Extent of pharynx is upto) ‑

 A

C2

 B

C3

 C

C4

 D

C6

Ans. D

Explanation:

Ans. is ‘d’ i.e., C6

Pharynx is a musculomembranous tube that extands from the base of skull to the level of the sixth cervical vertebra, where it is continuous with esophagus. Pharynx is subdivided into :‑

I) Nasopharynx :- Part of the pharynx above the soft palate, i.e. from the base of skull to the soft palate‑

2) Oropharynx :- Extends from the soft palate superiorly to the level of hyoid inferiorly.

3)  Hypopharynx :- The hypopharynx includes that portion of the pharynx below the level of the hyoid.


Q. 15

Keratinizing squamous cell carcinoma of nasopharynx is ‑

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Q. 15

Keratinizing squamous cell carcinoma of nasopharynx is ‑

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Ans. A

Explanation:

Ans. is ‘a’ i.e., Type I


Q. 16

In which part of the pharynx the procedure shown in the picture below is being performed ? 

 A

Nasopharynx.

 B

Oropharynx.

 C

Pharynx.

 D

None of the above.

Q. 16

In which part of the pharynx the procedure shown in the picture below is being performed ? 

 A

Nasopharynx.

 B

Oropharynx.

 C

Pharynx.

 D

None of the above.

Ans. A

Explanation:

Ans:A.)Nasopharynx.

The procedure shown in the picture above represents Posterior Rhinoscopy test.

Different methods of examining the Nasopharynx 

i. Posterior Rhinoscopy

ii. Nasopharyngoscopy.

iii. Examination under anaesthesia after palatal retraction.

iv. Digital palpation.

v. Radiological examination.

Posterior Rhinoscopy:

It is method of examination of the Nasopharynx.

Structures seen on posterior rhinoscopy:
– Both choanae

– Posterior end of nasal septum

– Opening of Eustachian

– Posterior end of superior/tube middle and inferior turbinates

– Fossa of Rosenmuller

– Torus Tubarius

– Adenoids

– Roof and posterior wall and nasopharynx.


Q. 17

Nasopharynx is lined by which epithelium ‑

 A

Stratified squamous nonkerationized

 B

Stratified squamous keratinized

 C

Ciliated columnar

 D

Cuboidal

Q. 17

Nasopharynx is lined by which epithelium ‑

 A

Stratified squamous nonkerationized

 B

Stratified squamous keratinized

 C

Ciliated columnar

 D

Cuboidal

Ans. C

Explanation:

Ans. is ‘c’ i.e., Ciliated columnar


Q. 18

Lymphatic drainage of orpharynx is mainly through‑

 A

Superficial cervical lymph nodes

 B

Submandibular nodes

 C

Jugulodigastric node

 D

Jugulo-omohyoid nodes

Q. 18

Lymphatic drainage of orpharynx is mainly through‑

 A

Superficial cervical lymph nodes

 B

Submandibular nodes

 C

Jugulodigastric node

 D

Jugulo-omohyoid nodes

Ans. C

Explanation:

Ans. is ‘c’ i.e., Jugulodigastric nodes

  • Deep cervical lymph nodes are divided into two groups :- (i) jugulodigastric, and (ii) jugulo-omohyoid.
  • Lymphatics from oropharynx drain into jugulodigastric nodes.

Lymphatic drainage of pharynx

  • Lymphatic drainage of pharynx may be :‑

1. Nasopharynx

  • Nasopharynx drains into upper deep cervical nodes either directly or indirectly through retropharyngeal or parapharyngeal nodes.
  • Nasopharynx also drains into spinal accessory chain of nodes in the posterior triangle of the neck.

2. Oropharynx

  • Lymphatics from the oropharynx drain into upper jugular particularly the jugulodigastric (tonsillar) nodes.
  • The soft palate, lateral and posterior pharyngeal walls and the base of tongue also drain into retropharyngeal and parapharyngeal nodes and from there to the jugulodigastric and posterior cervical group.

3. Hyphopharynx

  • Pyriform sinus drains into upper jugular chain & then to deep cervical group of lymph nodes.
  • Postcricoid region drains into parapharyngeal and paratracheal group of lymph nodes.
  • Posterior pharyngeal wall drains into parapharyngeal lymph nodes and finally to deep cervical lymph nodes.


Vertigo

Vertigo

Q. 1 Clinical features of a vertebrobasilar transient ischemic attack include all the following except:
 A ‘Drop’ attacks
 B Aphasia
 C Diplopia & vertigo
 D Ataxia
Q. 1 Clinical features of a vertebrobasilar transient ischemic attack include all the following except:
 A ‘Drop’ attacks
 B Aphasia
 C Diplopia & vertigo
 D Ataxia
Ans. B

Explanation:

Aphasia

A vertebrobasilar transient ischemic attack is characterized by the sudden onset of one or the more of the following symptoms and signs .Paresis (1,2 or 4/limbs), drop attacks, numbness of involved limbs and face, impaired vision (Diplopia or Bilateral visual field defects) vertigo, nausea, dysarthria and ataxia. Aphasia is a feature of Carotid artery transient ischemic attack.


Q. 2

Epley’s test is used for__________

 A

Benign paroxysmal vertigo

 B

Basilar migraine

 C

Orthostatic hypotension

 D

Thoracic outlet syndrome

Q. 2

Epley’s test is used for__________

 A

Benign paroxysmal vertigo

 B

Basilar migraine

 C

Orthostatic hypotension

 D

Thoracic outlet syndrome

Ans. A

Explanation:

 

Benign paroxysmal positional vertigo (BPPV):

  • It is characterised by vertigo when the head is placed in a certain critical position. There is no hearing loss or other neurologic symptoms.
  • Disease is caused by a disorder of posterior semicircular canal though many patients have history of head trauma and ear infection
  • It has been demonstrated that otoconial debris, consisting of crystals of calcium carbonate, is released from the degenerating macula of the utricle and floats freely in the endolymph
  • The condition can be treated by performing Epley’s manoeuvre. The principle of this manoeuvre is to reposition the otoconial debris from the posterior semicircular canal back into the utricle.
  • The manoeuvre consists of five positions.
  1. Position 1; With the head turned 45°, the patient is made to lie down in head-hanging position (DixHallpike manoeuvre). It will cause vertigo and nystagmus. Wait till vertigo and nystagmus subside.
  2. Position 2. Head is now turned so that affected ear is up.
  3. Position 3. The whole body and head are now rotated away from the affected ear to a la teral recumbent position in a face-down position.
  4. Position 4. Patient is now brought to a Sitting posiition with head st ill turned to the unaffected side by 45°
  5. Position 5. The head is now turned forward and chin brought down 20°.

Q. 3

An adolescent female has headache which is intermittent in episode in associated with tinnitus, vertigo and hearing loss. There is history of similar complains in her mother. Most likely diagnosis 

 A

Basilar migraine

 B

Cervical spondylosis

 C

Temporal arteritis

 D

Vestibular neuronitis

Q. 3

An adolescent female has headache which is intermittent in episode in associated with tinnitus, vertigo and hearing loss. There is history of similar complains in her mother. Most likely diagnosis 

 A

Basilar migraine

 B

Cervical spondylosis

 C

Temporal arteritis

 D

Vestibular neuronitis

Ans. A

Explanation:

Basilar migraine [Ref: CMDT 09 p. 849]

  • It is a case of Basilar migraine
  • Since it was believed to have originated in the basilar artery it was earlier called basilar artery migraine, but the absence of consistent evidence for basilar artery involvement lead to renaming as Basilar migraine only.
  • Basilar migraine is characterized by aura comprising of a bewildering variety of signs and symptoms of the visual cortex and brain stem.

– Basilar migraine mimicks ischemic strokes of the brainstem and the posterior cortical regions.

  • The aura which lasts for 10-45 minutes usually begin with typical migrainous disturbance of vision and is characterized by : ?

– Visual symptoms in both the temporal and nasal, fields.

– Dysorthria

– Vertigo

– Tinnitus

– Decreased hearing

– Double vision

– Ataxia

– B/L paresthesia

B/L paresis

– Decreased level of consciousness

  • After the aura is over a severe throbbing occipital headache supervenes.

Q. 4

A clinical condition seen in a 24 year old male is characterised by a facial palsy and is often associated with facial pain and the appearance of vesicles on the canal and pinna. Vertigo and sensor neural hearing loss (VIIIth nerve) accompanying it is suggestive of:

 A

Downs Syndrome

 B

Bells Palsy

 C

Pendred Syndrome

 D

Ramsay Hunt Syndrome

Q. 4

A clinical condition seen in a 24 year old male is characterised by a facial palsy and is often associated with facial pain and the appearance of vesicles on the canal and pinna. Vertigo and sensor neural hearing loss (VIIIth nerve) accompanying it is suggestive of:

 A

Downs Syndrome

 B

Bells Palsy

 C

Pendred Syndrome

 D

Ramsay Hunt Syndrome

Ans. D

Explanation:

Q. 5

All are TRUE about the clinical features of polycythemia rubra vera, EXCEPT:

 A

Hepatomegaly is the initial presenting sign

 B

Aquagenic pruritus present

 C

Vertigo, tinnitus, headache and visual disturbances are due to hyperviscosity

 D

Systolic hypertension is a feature of increased red cell mass

Q. 5

All are TRUE about the clinical features of polycythemia rubra vera, EXCEPT:

 A

Hepatomegaly is the initial presenting sign

 B

Aquagenic pruritus present

 C

Vertigo, tinnitus, headache and visual disturbances are due to hyperviscosity

 D

Systolic hypertension is a feature of increased red cell mass

Ans. A

Explanation:

Polycythemia rubra vera clinical features:
  • Splenomegaly may be the initial presenting sign 
  • Aquagenic pruritus
  • Hyperviscosity leads to vertigo, tinnitus, headache, visual disturbances, and transient ischemic attacks (TIAs). 
  • Systolic hypertension is due to red cell mass elevation. 
  • Venous or arterial thrombosis may be the presenting manifestation of PV. 
  • Erythromelalgia, is a complication of the thrombocytosis
  • Hyperuricemia with secondary gout, uric acid stones, and symptoms due to hypermetabolism can also complicate the disorder.
Ref: Harrison, E-18, P-899

Q. 6

A young girl presents with repeated episodes of throbbing occipital headache associated with ataxia and vertigo. The family history is positive for similar headaches in her mother. Most likely diagnosis is:

 A

Vestibular Neuronitis

 B

Basilar migraine

 C

Cluster headache

 D

Tension headache

Q. 6

A young girl presents with repeated episodes of throbbing occipital headache associated with ataxia and vertigo. The family history is positive for similar headaches in her mother. Most likely diagnosis is:

 A

Vestibular Neuronitis

 B

Basilar migraine

 C

Cluster headache

 D

Tension headache

Ans. B

Explanation:

It mainly occurs in young females and children, frequently in context with a family history of other forms of migraine.

It clinically manifests with bilateral visual symptoms associated with vertigo, ataxia, tinnitus.

Weakness and peripheral dysaesthesias and sometimes other brainstem and occipital lobe symptoms.

This is followed by severe, throbbing, posterior bilateral headache.

Ref: Benign childhood partial seizures and related epileptic syndromes — Chrysostomos P. Panayiotopoulos, Page 304


Q. 7

A fifty-year-old man presents to his practitioner complaining that he often feels as if the room is spinning when he gets up from a recumbent position or turns his head. He has not lost consciousness and has had no chest pain. He has no cardiac history and a recent treadmill test showed no abnormalities. On examination, the sensation can be produced by rapidly turning the head. It can be reproduced many times, but it eventually ceases. Nystagmus is elicited. Hearing is normal. Which of the following is the most likely diagnosis?

 A

Benign paroxysmal positional vertigo

 B

Brain stem tumor

 C

Meniere’s disease

 D

Syncope

Q. 7

A fifty-year-old man presents to his practitioner complaining that he often feels as if the room is spinning when he gets up from a recumbent position or turns his head. He has not lost consciousness and has had no chest pain. He has no cardiac history and a recent treadmill test showed no abnormalities. On examination, the sensation can be produced by rapidly turning the head. It can be reproduced many times, but it eventually ceases. Nystagmus is elicited. Hearing is normal. Which of the following is the most likely diagnosis?

 A

Benign paroxysmal positional vertigo

 B

Brain stem tumor

 C

Meniere’s disease

 D

Syncope

Ans. A

Explanation:

Benign paroxysmal positional vertigo (BPPV) is vertigo that is precipitated by head position. It can be precipitated by trauma, but often no precipitating factor is identified. It generally abates after weeks to months. On exam, patients display nystagmus and the symptoms can be reproduced by head movement. In addition, the symptoms show latency, fatigability and habituation.

Brain stem tumor and vertebrobasilar TIA are causes of central causes of vertigo, but would often be associated with other neurologic findings.
 
Meniere disease displays the classic triad of unilateral tinnitus, unilateral deafness, and paroxysmal vertigo. Since the patient has normal hearing, this is unlikely to be Meniere syndrome, although hearing loss may not manifest until later stages of the disease.
 
Syncope is defined as transient loss of consciousness of cardiovascular origin. Thus since the patient has a lack of other cardiovascular symptoms and has not lost consciousness, this is not syncope.

Q. 8

Epley’s test is used for which of the following conditions?

 A

Benign paroxysmal positional vertigo

 B

Basilar migraine

 C

Orthostatic hypotension

 D

Thoracic outlet syndrome

Q. 8

Epley’s test is used for which of the following conditions?

 A

Benign paroxysmal positional vertigo

 B

Basilar migraine

 C

Orthostatic hypotension

 D

Thoracic outlet syndrome

Ans. A

Explanation:

Benign paroxysmal positional vertigo (BPPV) is characterised by vertigo when the head is placed in a certain critical position.

There is no hearing loss or other neurologic symptoms. Disease is caused by a disorder of posterior semicircular canal.

The condition can be treated by performing Epley’s manoeuvre.

The principle of this manoeuvre is to reposition the otoconial debris from the posterior semicircular canal back into the utricle.


Q. 9

A fifty-year-old man presents to his practitioner complaining that he often feels as if the room is spinning when he gets up from a recumbent position or turns his head. He has not lost consciousness and has had no chest pain. He has no cardiac history and a recent treadmill test showed no abnormalities. On examination, the sensation can be produced by rapidly turning the head. It can be reproduced many times, but it eventually ceases. Nystagmus is elicited. Hearing is normal. Which of the following is the most likely diagnosis?

 A

Benign paroxysmal positional vertigo

 B

Brain stem tumor

 C

Meniere’s disease

 D

Syncope

Q. 9

A fifty-year-old man presents to his practitioner complaining that he often feels as if the room is spinning when he gets up from a recumbent position or turns his head. He has not lost consciousness and has had no chest pain. He has no cardiac history and a recent treadmill test showed no abnormalities. On examination, the sensation can be produced by rapidly turning the head. It can be reproduced many times, but it eventually ceases. Nystagmus is elicited. Hearing is normal. Which of the following is the most likely diagnosis?

 A

Benign paroxysmal positional vertigo

 B

Brain stem tumor

 C

Meniere’s disease

 D

Syncope

Ans. A

Explanation:

Benign paroxysmal positional vertigo (BPPV) is vertigo that is precipitated by head position. It can be precipitated by trauma, but often no precipitating factor is identified. It generally abates after weeks to months. On exam, patients display nystagmus and the symptoms can be reproduced by head movement. In addition, the symptoms show latency, fatigability and habituation.

Brain stem tumor and vertebrobasilar TIA are causes of central causes of vertigo, but would often be associated with other neurologic findings.
 
Meniere disease displays the classic triad of unilateral tinnitus, unilateral deafness, and paroxysmal vertigo. Since the patient has normal hearing, this is unlikely to be Meniere syndrome, although hearing loss may not manifest until later stages of the disease.
 
Syncope is defined as transient loss of consciousness of cardiovascular origin. Thus since the patient has a lack of other cardiovascular symptoms and has not lost consciousness, this is not syncope.

Q. 10

Triad of tinnitus, progressive deafness and vertigo along with facial weakness is seen in which of the following conditions?

 A

Meniere’s disease

 B

Lermoyez syndrome

 C

Acoustic neuroma

 D

Otosclerosis

Q. 10

Triad of tinnitus, progressive deafness and vertigo along with facial weakness is seen in which of the following conditions?

 A

Meniere’s disease

 B

Lermoyez syndrome

 C

Acoustic neuroma

 D

Otosclerosis

Ans. C

Explanation:

Acoustic neuroma arise from the nerve sheath cells of the acoustic nerve in the region of the internal auditory meatus. The symptoms of this condition includes progressive unilateral sensorineural deafness, tinnitus and vertigo. At the cerebellopontine angle it puts pressure on  ipsilateral cranial nerves and can produce facial palsy and trigeminal nerve involvement.
 
Causes of vertigo in different diseases:
  • Vertigo precipitated by the movement of head in a specific direction: Benign positional vertigo.
  • Intermittent brief vertigo with occasional drop attacks, ataxia, visual loss, double vision and confusion:  Vertebrobasilar insufficiency.
  • Episodic recurrent vertigo, with auditory symptoms, headache, photophobia and aura: Migraine.
  • Vertigo with facial weakness and loss  of taste sensation: Ramsay hunt syndrome.
  • Triad of episodic vertigo, tinnitus and progressive deafness: Meniere’s disease.


Q. 11

A patient on total parenteral nutrition for 20 days presents with weakness, vertigo and convulsions. Diagnosis is:

 A

Hypomagnesemia

 B

Hyperammonemia

 C

Hypercalcemia

 D

Hyperkalemia

Q. 11

A patient on total parenteral nutrition for 20 days presents with weakness, vertigo and convulsions. Diagnosis is:

 A

Hypomagnesemia

 B

Hyperammonemia

 C

Hypercalcemia

 D

Hyperkalemia

Ans. A

Explanation:

Ans. is ‘a’ i.e., Hypomagnesemia

All the above given metabolic abnormalities except hyperammonemia is seen in TPN, however the symptoms mentioned match with those of hypomagnesemia.


Q. 12

Post traumatic vertigo is due to:

 A

Perilymphatic fistula

 B

Vestibular neuritis

 C

Secondary endolymphatic hydrops

 D

a and c

Q. 12

Post traumatic vertigo is due to:

 A

Perilymphatic fistula

 B

Vestibular neuritis

 C

Secondary endolymphatic hydrops

 D

a and c

Ans. D

Explanation:

Q. 13

Postitional vertigo is:

 A

Lateral

 B

Superior

 C

Inferior

 D

Posterior

Q. 13

Postitional vertigo is:

 A

Lateral

 B

Superior

 C

Inferior

 D

Posterior

Ans. D

Explanation:

Q. 14

What is the treatment for Benign Positional vertigo?

 A

Vestibular exercises

 B

Vestibular sedatives

 C

Anthistamines

 D

Diuretics

Q. 14

What is the treatment for Benign Positional vertigo?

 A

Vestibular exercises

 B

Vestibular sedatives

 C

Anthistamines

 D

Diuretics

Ans. A

Explanation:

Q. 15

Vertigo is defined as:

 A

Subjective sense of imbalance

 B

Objective sense of imbalance

 C

Both of the above

 D

Round movement

Q. 15

Vertigo is defined as:

 A

Subjective sense of imbalance

 B

Objective sense of imbalance

 C

Both of the above

 D

Round movement

Ans. A

Explanation:

Q. 16

Positional vertigo is due to stimulation of:

 A

Lateral semicircular canal

 B

Superior semicircular canal

 C

Inferior semicircular canal

 D

Posterior semicircular canal

Q. 16

Positional vertigo is due to stimulation of:

 A

Lateral semicircular canal

 B

Superior semicircular canal

 C

Inferior semicircular canal

 D

Posterior semicircular canal

Ans. D

Explanation:

Q. 17

Epleys maneuver is done in:

 A

Positional vertigo

 B

Otosclerosis

 C

ASOM

 D

CSOM

Q. 17

Epleys maneuver is done in:

 A

Positional vertigo

 B

Otosclerosis

 C

ASOM

 D

CSOM

Ans. A

Explanation:

Ans. is a i.e. Positional vertigo 

Benign paroxysmal positional vertigo (BPPV) is characterised by vertigo when the head is placed in a certain critical postion, and can be treated by Epley’s maneuver.

The principle of this maneuver is to reposition the otoconial debris from the posterior semicircular canal back into the utricle. After maneuver is complete, patient should maintain an upright posture for 48 hour. Eighty per cent of the patients will be cured by a single maneuver.


Q. 18

A young girl presents with repeated episodes of throbbing occipital headache associated with ataxia and vertigo. The family history is positive for similar headaches in her mother. Most likely diagnosis is:

 A

Vestibular Neuronitis

 B

Basilar migraine

 C

Cluster headache

 D

Tension headache

Q. 18

A young girl presents with repeated episodes of throbbing occipital headache associated with ataxia and vertigo. The family history is positive for similar headaches in her mother. Most likely diagnosis is:

 A

Vestibular Neuronitis

 B

Basilar migraine

 C

Cluster headache

 D

Tension headache

Ans. B

Explanation:

Answer. is B (Basilar migraine)

Repeated episodes of throbbing occipital headache in association with ataxia and vertigo in a young female with a positive family history of headache suggest a diagnosis of basilar migraine.

Dizziness, vertigo and ataxia heralding an intense throbbing (occipital) headache are typical features of basilar type migraine

Diagnosis of Basilar Migraine is suggested by age, female gender, positive family history and attacks of headache with vertiginous aura provoked by usual migraine triggers

Basilar Type Migraine (subtype of migraine with aura)

  • Basilar type migraine describes recurrent attacks of migraine with aura in which symptoms suggest a brainstem origin (including vertigo & ataxia)
  • The onset of Basilar type migraine is typically before 30 years of age and peaks during adolescence
  • There is a distinct female preponderance with girls more frequently affected than boys in a ratio of 3:1 (majority of sufferers are girls )
  • Family history of migraine is frequent
  • Unlike other types of migraine headache may be occipital in origin
Reference:

‘Vertigo & Disequilibrium: A practical guide to diagnosis and management’ by Weber (Thieme); ‘Handbook of Headache (Lippincott- Williams)’ 2nd/214

Practical Neurology’ by Biller 3rd/15


Q. 19

All of the following are true for Vogt-Koyanagi­Harada syndrome except:

 A

More common in Japanese people, who are usually positive for HLA-B27

 B

Ocular features are; Chronic granulomatous anterior uveitis, posterior uveitis and exudative retinal detachment

 C

Cutaneous lesions are alopecia, poliosis and vitiligo

 D

Neurological lesions include, meningism, encephalopathy, tinnitis, vertigo and deafness

Q. 19

All of the following are true for Vogt-Koyanagi­Harada syndrome except:

 A

More common in Japanese people, who are usually positive for HLA-B27

 B

Ocular features are; Chronic granulomatous anterior uveitis, posterior uveitis and exudative retinal detachment

 C

Cutaneous lesions are alopecia, poliosis and vitiligo

 D

Neurological lesions include, meningism, encephalopathy, tinnitis, vertigo and deafness

Ans. A

Explanation:

Ans. More common in Japanese people, who are usually positive for HLA-B27


Q. 20

Which of ‘.he following defines vertigo:

September 2011

 A

Ringing of ears

 B

Subjective sense of imbalance

 C

Sense of pressure in the ear

 D

Infection of the inner ear

Q. 20

Which of ‘.he following defines vertigo:

September 2011

 A

Ringing of ears

 B

Subjective sense of imbalance

 C

Sense of pressure in the ear

 D

Infection of the inner ear

Ans. B

Explanation:

Ans. B: Subjective sense of imbalance

In vertigo, patient gets a feeling of rotation of himself or of his environment.

Vertigo (“a whirling or spinning movement”)

  • It is a type of dizziness, where there is a feeling of motion when one is stationary.
  • The symptoms are due to a dysfunction of the vestibular system in the inner ear.
  • It is often associated with nausea and vomiting as well as difficulties standing or walking.
  • The most common causes are benign paroxysmal positional vertigo, concussion and vestibular migraine while less common causes include Meniere’s disease and vestibular neuritis.
  • Excessive consumption of ethanol (alcoholic beverages) can also cause notorious symptoms of vertigo.
  • A number of conditions that involve the central nervous system may lead to vertigo including: migraine headaches, lateral medullary syndrome, multiple sclerosis
  • Vertigo is a sensation of spinning while stationary.
  • Repetitive spinning, as in familiar childhood games, can induce short-lived vertigo by disrupting the inertia of the fluid in the vestibular system

Vertigo is classified into either peripheral or central depending on the location of the dysfunction of the vestibular pathway

Peripheral:

Vertigo caused by problems with the inner ear or vestibular system is called “peripheral”, “otologic” or “vestibular”.

– The most common cause is benign paroxysmal positional vertigo (BPPV) but other causes include Meniere’s disease, superior canal dehiscence syndrome, labyrinthitis and visual vertigo.

– Any cause of inflammation such as common cold, influenza, and bacterial infections may cause transient vertigo if they involve the inner ear, as may chemical insults (e.g., aminoglycosides) or physical trauma (e.g., skull fractures).

– Motion sickness is sometimes classified as a cause of peripheral vertigo.

Central:

If vertigo arises from the balance centers of the brain, it is usually milder, and has accompanying neurologic deficits, such as slurred speech, double vision or pathologic nystagmus.

– Brain pathology can cause a sensation of disequilibrium which is an off-balance sensation.


Q. 21

Antiemetic Phenothiazine with labrynthine suppressant activityused for vertigo is ‑

 A

Prochlorperazine

 B

Cinnarazine

 C

Hyoscine

 D

Promethazine

Q. 21

Antiemetic Phenothiazine with labrynthine suppressant activityused for vertigo is ‑

 A

Prochlorperazine

 B

Cinnarazine

 C

Hyoscine

 D

Promethazine

Ans. A

Explanation:

Ans. is ‘A’ i.e., Prochlorperazine

Labyrinthine suppressants used in vertigo

They suppress end organ receptors or inhibit central cholinergic pathways in vestibular nuclei.

These are :‑

  1. Antihistaminics (with anticholinergic action) – cinnarizine, cyclizine, dimenhydrinate, diphenhydramine, promethazine.
  2. Anticholinergics- atropine, hyoscine.
  3. Antiemetic phenothiazines-prochlorperazine, thiethylperazine.

Q. 22

If a patient gets an attack of vertigo/dizziness by loud noise, he is having ‑

 A

Tullio phenomenon

 B

Dysplacusis

 C

Hyperacusis

 D

Paracusis

Q. 22

If a patient gets an attack of vertigo/dizziness by loud noise, he is having ‑

 A

Tullio phenomenon

 B

Dysplacusis

 C

Hyperacusis

 D

Paracusis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Tullio phenomenon

Hyperacusis refers to sensation of discomfort or pain on exposure to normal sounds. It is seen in injury to nerve to stapedius and in case of congenital syphilis (Hennebert sign).

Displacusis is a condition where same tone is heard as notes of different pitch in either ear.

Paracusis willisii is a condition where patient hears a sound better in presence of background noise. It is seen in otosclerosis.

Tullio phenomenon is a condition where the subject gets attack of vertigo/dizziness by loud sounds.lt is seen in labyrinthine fistula and after fenestration surgery.



Palate

PALATE

Q. 1

The sensory supply of the palate is through all of the following, EXCEPT?

 A

Facial nerve

 B

Hypoglossal nerve

 C

Glossopharyngeal nerve

 D

Maxillary division of trigeminal nerve

Q. 1

The sensory supply of the palate is through all of the following, EXCEPT?

 A

Facial nerve

 B

Hypoglossal nerve

 C

Glossopharyngeal nerve

 D

Maxillary division of trigeminal nerve

Ans. B

Explanation:

The muscles of the soft palate are the tensor veli palatini, the levator veli palatini, the palatoglossus, the palatopharyngeus, and the musculus uvulae.

  • The greater and lesser palatine nerves from the maxillary division of the trigeminal nerve enter the palate through the greater and lesser palatine foramina.
  • The nasopalatine nerve a branch of the maxillary nerve, enters the front of the hard palate through the incisive foramen.
  • The glossopharyngeal nerve also supplies the soft palate.
  • Facial nerve supplies submandibular and sublingual salivary parasympathetic glands, lacrimal gland, and glands of nose and palate.

Q. 2

Which of the following statement about the nerve supply of palate is NOT TRUE?

 A

Pharyngeal plexus supply muscles of soft palate

 B

Tensor veli palatini is supplied by mandibular nerve

 C

Anterior branch of pterygopalatine ganglion supplies soft palate

 D

Middle and posterior lesser palatine nerves supply soft palate and tonsil

Q. 2

Which of the following statement about the nerve supply of palate is NOT TRUE?

 A

Pharyngeal plexus supply muscles of soft palate

 B

Tensor veli palatini is supplied by mandibular nerve

 C

Anterior branch of pterygopalatine ganglion supplies soft palate

 D

Middle and posterior lesser palatine nerves supply soft palate and tonsil

Ans. C

Explanation:

“Greater or anterior palatine branches of pterygopalatine ganglion supplies hard palate and lateral wall of the nose while the lesser or middle and posterior palatine nerve supply the soft palate and tonsils”.

  • All the muscles of the soft palate except tensor veli palatini are supplied by pharyngeal plexus (fibers of the plexus are derived from the cranial part of the accessory nerve through the vagus nerve)
  • Tensor veli palatini is supplied by mandibular nerve.

Q. 3

All of the following muscles of tongue are supplied by hypoglossal nerve, EXCEPT?

 A

Palatoglossus

 B

Genioglossus

 C

Geniohyoid

 D

None of the above

Q. 3

All of the following muscles of tongue are supplied by hypoglossal nerve, EXCEPT?

 A

Palatoglossus

 B

Genioglossus

 C

Geniohyoid

 D

None of the above

Ans. A

Explanation:

The muscles of the tongue, with the exception of palatoglossus, are supplied by the hypoglossal nerve. Palatoglossus is supplied via the pharyngeal plexus.


Q. 4

All muscles of the palate are supplied by pharyngeal plexus, EXCEPT?

 A

Tensor veli palatine

 B

Palatoglossus

 C

Palatopharyngeus

 D

None of the above

Q. 4

All muscles of the palate are supplied by pharyngeal plexus, EXCEPT?

 A

Tensor veli palatine

 B

Palatoglossus

 C

Palatopharyngeus

 D

None of the above

Ans. A

Explanation:

With the exception of tensor veli palatini, which is supplied by the motor branch of the mandibular division of the trigeminal through the nerve to medial pterygoid, the muscles are supplied by the cranial part of the accessory nerve via the pharyngeal plexus.


Q. 5

Cranial part of accessory nerve supplies all palatal muscles, EXCEPT?

 A

Palatoglossus

 B

Palato pharyngeus

 C

Tensor veli palatini

 D

Tensor veli tympani

Q. 5

Cranial part of accessory nerve supplies all palatal muscles, EXCEPT?

 A

Palatoglossus

 B

Palato pharyngeus

 C

Tensor veli palatini

 D

Tensor veli tympani

Ans. C

Explanation:

The cranial root of the accessory nerve is smaller than the spinal root. It exits the skull through the jugular foramen and unites for a short distance with the spinal root. Its fibers innervate the pharyngeal and palatal muscles, except tensor veli palatini. 


Q. 6

Primary and secondary palates are divided by

 A

Greater palatine foramen

 B

Canine teeth

 C

Alveolar arch

 D

Incisive foramen

Q. 6

Primary and secondary palates are divided by

 A

Greater palatine foramen

 B

Canine teeth

 C

Alveolar arch

 D

Incisive foramen

Ans. D

Explanation:

D. i.e. Incisive foramen

The incisive foramen is dividing landmark between the primary & secondary palateQ; and anterior & posterior cleft deformities


Q. 7

Sensory fibres from the taste buds in the bard and soft palate travel along:

 A

Trigeminal nerve

 B

Facial nerve

 C

Glossopharynegeal nerve

 D

Vagus nerve

Q. 7

Sensory fibres from the taste buds in the bard and soft palate travel along:

 A

Trigeminal nerve

 B

Facial nerve

 C

Glossopharynegeal nerve

 D

Vagus nerve

Ans. B

Explanation:

B i.e. Facial nerve


Q. 8

Muscle which helps to open Eustachian tube while sneezing:

March 2005, September 2010

 A

Tensor veli palatini

 B

Levator veli palatini

 C

None of the.above

 D

Both A and B

Q. 8

Muscle which helps to open Eustachian tube while sneezing:

March 2005, September 2010

 A

Tensor veli palatini

 B

Levator veli palatini

 C

None of the.above

 D

Both A and B

Ans. D

Explanation:

Ans. D: Both A and B

Pharyngotympanic (Auditory) tube is 4 cm long, consists of two parts:

  • Bony part forms posterior and lateral one third of the tube (12 cm long)
  • Cartilaginous part forms the anterior and medial two third (25 cm long)
  • Connects the middle ear with the nasopharynx
  • Equalizes pressure on both sides of the tympanic membrane
  • Usually closed to prevent entrance of particles from the nose
  • Muscles that open auditory tube while swallowing, yawning and sneezing are levator veli palatini and tensor veli palatini

Q. 9

Tongue muscle which is not developed from occipital myotome ‑

 A

Styloglossus

 B

Hyoglossus

 C

Genioglossus

 D

Palatoglossus

Q. 9

Tongue muscle which is not developed from occipital myotome ‑

 A

Styloglossus

 B

Hyoglossus

 C

Genioglossus

 D

Palatoglossus

Ans. D

Explanation:

DEVELOPMENT OF THE TONGUE :‑

I. Epithelium

a)       Ant 2/3 — lingual swellings of 1st arch and tuberculum impar

b)     Post 1/3 — large dorsal part of hypobranchial eminence, Le. 3rd arch

c)       Posterior most part — small dorsal part of the hypobranchial eminence, i.e. 4th arch

II. Muscles

From occipital myotomes except palatoglossus which is derived from the 6th arch.


Q. 10

Passavant ridge ‑

 A

Superior constrictor and palatopharyngeus

 B

Inferior constrictor and palatopharyngeus

 C

Superior constrictor and palatoglossus

 D

Inferior constrictor and palatoglossus

Q. 10

Passavant ridge ‑

 A

Superior constrictor and palatopharyngeus

 B

Inferior constrictor and palatopharyngeus

 C

Superior constrictor and palatoglossus

 D

Inferior constrictor and palatoglossus

Ans. A

Explanation:

 

Passavant ridge

  • Near the superior margin of pharynx, a few fibres of superior constrictor blend with a band of muscle fibres belonging to the palatopharyngeus muscle.
  • These fused fibres form a band or ring around the posterior wall and sidewalls of the nasopharyngeal isthumus.
  • When the soft palate is elevated this muscle band appears as a ridge is known as passavant’s ridge.


Foramens of skull

FORAMENS OF SKULL

Q. 1

Structure passing through Foramen Ovale is?

 A

Maxillary artery

 B

Mandibular nerve

 C

Middle meningeal artery

 D

Spinal accessory nerve

Q. 1

Structure passing through Foramen Ovale is?

 A

Maxillary artery

 B

Mandibular nerve

 C

Middle meningeal artery

 D

Spinal accessory nerve

Ans. B

Explanation:

Mandibular nerve


Q. 2

Structure passing through foramen Rotundum?

 A

Maxillary artery

 B

Maxillary nerve

 C

Middle meningeal artery

 D

Spinal accessory nerve

Q. 2

Structure passing through foramen Rotundum?

 A

Maxillary artery

 B

Maxillary nerve

 C

Middle meningeal artery

 D

Spinal accessory nerve

Ans. B

Explanation:

Maxillary nerve


Q. 3 Superior orbital fissure is formed by :
 A Greater wing of sphenoid and lesser wing of sphenoid.
 B Greater wing of sphenoid and palatine process of maxilla.
 C Lesser wing of sphenoid and palatine process of maxilla.
 D Greater wing and lesser wing of sphenoid and body of sphenoid.
Q. 3 Superior orbital fissure is formed by :
 A Greater wing of sphenoid and lesser wing of sphenoid.
 B Greater wing of sphenoid and palatine process of maxilla.
 C Lesser wing of sphenoid and palatine process of maxilla.
 D Greater wing and lesser wing of sphenoid and body of sphenoid.
Ans. A

Explanation: Superior orbital fissure is a slit like opening between the lesser and greater wing of the sphenoid. It transmits the lacrimal, frontal, trochlear, oculomotor, nasociliary and abducens nerve together with superior ophthalmic vein.

Foramen rotundum: It is situated behind the medial end of superior orbital fissure. It perforates the greater wing of sphenoid and transmits the maxillary nerve from the trigeminal ganglion to the pterygopalatine fossa.

Foramen ovale: It lies posterolateral to the foramen rotundum. It perforates the greater wing of sphenoid and transmits the large sensory root and small motor root of the mandibular nerve to the infratemporal fossa.

Ref: Tsai L.M., Kamenetzky S.A. (2010). Chapter 37. The Eye & Ocular Adnexa. In G.M. Doherty (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.


Q. 4

Foramen spinosum transmits the following?

 A

Meningeal branch of the mandibular nerve, middle meningeal artery

 B

Emissary veins from the cavernous sinus

 C

Both A and B

 D

None of the above

Q. 4

Foramen spinosum transmits the following?

 A

Meningeal branch of the mandibular nerve, middle meningeal artery

 B

Emissary veins from the cavernous sinus

 C

Both A and B

 D

None of the above

Ans. A

Explanation:

Foramen spinosum is a opening in middle cranial fossa situated immediately in front of the angular spine, posterolateral to foramen ovale. It transmits the middle meningeal artery and vein, and  surrounding the artery. 
 
The various foramens in middle cranial fossa are;
  • Foramen ovale
  • Foramen lacerum
  • Foramen spinosum
  • Foramen rotundum
  • Superior orbital fissure
 

Foramens in middle cranial fossa

Location

Content

Foramen ovale

Posteriolateral to the foramen rotumdum

Accessory meningeal artery

Mandibular nerve (V3)

Lesser petrosal nerve (occasionally)

accessory meningeal vein

Foramen spinosum

Posteriolateral to the foramen ovale

Middle meningeal artery and vein

Meningeal branch of the mandibular nerve (V3)

Sympathetic plexus

Foramen lacerum

Lies superiomedially to the foramen spinosum

Internal carotid artery,

Artery of pterygoid canal

Nerve of pterygoid canal

Superior orbital fissure

Slit like opening between the lesser and greater wings of the sphenoid

Oculomotor nerve (III)

Trochlear nerve (IV)

Lacrimal, frontal and nasociliary branches of Ophthalmic nerve (V1)

Abducent nerve (VI)

Orbital branch of middle meningeal artery

Recurrent branch of lacrimal artery

Superior orbital vein

Superior ophthalmic vein

Foramen rotundum

Below and behind the medial end of the superior orbital fissure

Maxillary nerve (V2)

 

Q. 5

Which of the following opening in the base of the skull transmits the third branch of trigeminal nerve?

 A

Foramen ovale

 B

Foramen lacerum

 C

Foramen magnum

 D

Foramen spinosum

Q. 5

Which of the following opening in the base of the skull transmits the third branch of trigeminal nerve?

 A

Foramen ovale

 B

Foramen lacerum

 C

Foramen magnum

 D

Foramen spinosum

Ans. A

Explanation:

Foramen ovale is an opening at the base of the lateral pterygoid plate. It transmits the third branch of the trigeminal nerve, the accessory meningeal artery, and occasionally the superficial petrosal nerve.
 
  • Foramen lacerum transmits the internal carotid artery.
  • Foramen magnum transmits the medulla and its membranes, the spinal accessory nerves, the vertebral arteries, and the anterior and posterior spinal arteries.

Q. 6

Which of the following cranial nerve travels through the jugular foramen in the base of the skull?

 A

3rd branch of trigeminal nerve

 B

Abducens nerve

 C

Facial nerve

 D

Glossopharyngeal nerve

Q. 6

Which of the following cranial nerve travels through the jugular foramen in the base of the skull?

 A

3rd branch of trigeminal nerve

 B

Abducens nerve

 C

Facial nerve

 D

Glossopharyngeal nerve

Ans. D

Explanation:

Glossopharyngeal nerve travel through the middle compartment of the jugular foramen. Jugular foramen is formed by the petrous portion of the temporal and occipital bones. It is divided into 3 compartments. The intermediate compartment contains the glossopharyngeal, vagus, and spinal accessory nerves. The anterior compartment contains the inferior petrosal sinus and the posterior compartment contains the sigmoid sinus and meningeal branches from the occipital and ascending pharyngeal arteries.

Q. 7

Middle meningeal artery courses along which of the following opening in the base of the skull?

 A

Foramen ovale

 B

Foramen lacerum

 C

Foramen spinosum

 D

Foramen rotundum

Q. 7

Middle meningeal artery courses along which of the following opening in the base of the skull?

 A

Foramen ovale

 B

Foramen lacerum

 C

Foramen spinosum

 D

Foramen rotundum

Ans. C

Explanation:

Middle meningeal artery and vein travels through foramen spinosum. 
 
Structures passing through openings in the skull base are:

 

Foramen

Structures

Cribriform plate of ethmoid

Olfactory nerves

Optic foramen

Optic nerve, ophthalmic artery, meninges

Superior orbital fissure

Oculomotor, trochlear, and abducens nerves; ophthalmic division of trigeminal nerve; superior ophthalmic vein

Foramen rotundum

Maxillary division of trigeminal nerve, small artery and vein

Foramen ovale

Mandibular division of trigeminal nerve, vein

Foramen lacerum

Internal carotid artery, sympathetic plexus

Foramen spinosum

Middle meningeal artery and vein

Internal acoustic meatus

Facial and vestibulocochlear nerves, internal auditory artery

Jugular foramen

Glossopharyngeal, vagus, and spinal accessory nerves; sigmoid sinus

Hypoglossal canal

Hypoglossal nerve

Foramen magnum

Medulla and meninges, spinal accessory nerve, vertebral arteries, anterior and posterior spinal arteries


Q. 8

Which of the following structure is passing through foramen rotundum?

 A

Maxillary artery

 B

Maxillary nerve

 C

Middle meningeal artery

 D

Spinal accessory nerve

Q. 8

Which of the following structure is passing through foramen rotundum?

 A

Maxillary artery

 B

Maxillary nerve

 C

Middle meningeal artery

 D

Spinal accessory nerve

Ans. B

Explanation:

Foramen rotundum located posterior to the medial end of the superior orbital fissure. The foramen rotundum transmits the maxillary nerve (CN V-2) en route to the pterygopalatine fossa. CN V-2 supplies the skin, teeth, and mucosa associated with the maxillary bone.

Q. 9

True about relation of epiploic foramen is :

 A

Portal vein posteriorly

 B

IVC inferiorly

 C

Hepatic art superiorly

 D

Bile duct anteriorly

Q. 9

True about relation of epiploic foramen is :

 A

Portal vein posteriorly

 B

IVC inferiorly

 C

Hepatic art superiorly

 D

Bile duct anteriorly

Ans. D

Explanation:

D. i.e. Bile duct anteriorly 


Q. 10

Primary and secondary palates are divided by

 A

Greater palatine foramen

 B

Canine teeth

 C

Alveolar arch

 D

Incisive foramen

Q. 10

Primary and secondary palates are divided by

 A

Greater palatine foramen

 B

Canine teeth

 C

Alveolar arch

 D

Incisive foramen

Ans. D

Explanation:

D. i.e. Incisive foramen

The incisive foramen is dividing landmark between the primary & secondary palateQ; and anterior & posterior cleft deformities


Q. 11

Mandibular nerve passes through following foramen:

 A

F. ovale

 B

F. rotundum

 C

F. spinosum

 D

F. lacerum

Q. 11

Mandibular nerve passes through following foramen:

 A

F. ovale

 B

F. rotundum

 C

F. spinosum

 D

F. lacerum

Ans. A

Explanation:

A i.e. Foramen ovale 

–     Vidian nerve and artery pass through pterygoid canalQ.

Foramen spinosum pass MEN i.e. Middle meningeal artery, Emissary vein & Nervous spinosus (meningeal br. of mandibular nerve).

–    Foramen ovale pass MALE i.e. Mandibular nerveQ, Accessory meningeal artery, Lesser petrosal nerve and Emissary vein.


Q. 12

All of the following nerves pass through Jugular foramen except:

 A

9th

 B

10th

 C

11th

 D

12th

Q. 12

All of the following nerves pass through Jugular foramen except:

 A

9th

 B

10th

 C

11th

 D

12th

Ans. D

Explanation:

D i.e. 12th nerve 


Q. 13

Structures passing through superior orbital fissure:

 A

Cranial nerve VI

 B

Cranial nerve I

 C

Cranial nerve II

 D

Ophthalmic nerve

Q. 13

Structures passing through superior orbital fissure:

 A

Cranial nerve VI

 B

Cranial nerve I

 C

Cranial nerve II

 D

Ophthalmic nerve

Ans. A

Explanation:

A i.e. Cranial nerve VI


Q. 14

Structures passing through superior orbital fissure:

 A

Oculomotor nerve

 B

Trochlear nerve

 C

Lacrimal nerve

 D

All

Q. 14

Structures passing through superior orbital fissure:

 A

Oculomotor nerve

 B

Trochlear nerve

 C

Lacrimal nerve

 D

All

Ans. D

Explanation:

A. i.e. Oculomotor nerve; B i.e. Trochlear nerve; C i.e. Lacrimal nerve


Q. 15

Structure passing through the foramen manum are

 A

Spinal cord

 B

Vertebral artery

 C

Internal jugular vein

 D

All

Q. 15

Structure passing through the foramen manum are

 A

Spinal cord

 B

Vertebral artery

 C

Internal jugular vein

 D

All

Ans. B

Explanation:

B i.e. Vertebral artery 


Q. 16

Structures passing through foramen magnum include all

 A

Spinal accessory nerve

 B

Spinal cord

 C

Vertebral artery

 D

Vertebral venous plexus 

Q. 16

Structures passing through foramen magnum include all

 A

Spinal accessory nerve

 B

Spinal cord

 C

Vertebral artery

 D

Vertebral venous plexus 

Ans. B

Explanation:

B. i.e. Spinal cord 

Lower part of medulla oblongata (not the spinal cord)Q passes through posterior part of foramen magnum, and vertebral arteries are transmitted through the subarachnoid space in foramen magnum.Q


Q. 17

True about foramen of Morgagni:

 A

It is femoral canal

 B

It is a diaphragmatic opening

 C

Superior epigastric vessels passes through it

 D

B and C

Q. 17

True about foramen of Morgagni:

 A

It is femoral canal

 B

It is a diaphragmatic opening

 C

Superior epigastric vessels passes through it

 D

B and C

Ans. D

Explanation:

B i.e. It is an opening through diaphragm C i.e. Superior epigastric vessels passes through it. 


Q. 18

Which of the following regarding mandibular nerve is correct-           

 A

Branch of facial nerve

 B

Purely motor

 C

Passes through foramen ovale

 D

Related to sphenopalatine ganglion

Q. 18

Which of the following regarding mandibular nerve is correct-           

 A

Branch of facial nerve

 B

Purely motor

 C

Passes through foramen ovale

 D

Related to sphenopalatine ganglion

Ans. C

Explanation:

C i.e. Passes through foramen ovale


Q. 19

Hernia through foramen of Bochdalek true is –

 A

Congeniatal hernia

 B

Is asymptomatic

 C

Seen especially in males

 D

Least common

Q. 19

Hernia through foramen of Bochdalek true is –

 A

Congeniatal hernia

 B

Is asymptomatic

 C

Seen especially in males

 D

Least common

Ans. A

Explanation:

Answer is ‘a’ i.e. Congenital hernia 


Q. 20

Trochlear and abducent nerve pass through

 A

Optic canal

 B

Superior orbital fissure

 C

Inferior orbital fissure

 D

Infraorbital foramen

Q. 20

Trochlear and abducent nerve pass through

 A

Optic canal

 B

Superior orbital fissure

 C

Inferior orbital fissure

 D

Infraorbital foramen

Ans. B

Explanation:

Optic nerve runs backwards and medially, and passes through the optic canal to enter the middle cranial fossa

  • Inferior orbital fissure transmits maxillary nerve, the zygomatic nerve etc.
  • Infraorbital foramen transmits the infraorbital nerve and vessels

Q. 21

 Structures Passing Through The Foramen Marked in the Diagram are all EXCEPT?

Foramen Magnum

 A

Spinal accessory nerve

 B

Spinal cord

 C

Vertebral artery

 D

Vertebral venous plexus

Q. 21

 Structures Passing Through The Foramen Marked in the Diagram are all EXCEPT?

Foramen Magnum

 A

Spinal accessory nerve

 B

Spinal cord

 C

Vertebral artery

 D

Vertebral venous plexus

Ans. B

Explanation:

The Structure Marked is Foramen Magnum 

Lower part of medulla oblongata (not the spinal cord) passes through posterior part of foramen magnum, and vertebralarteries are transmitted through the subarachnoid space in foramen magnum


Q. 22

Identify the Foramen marked in the Picture

Mental Foramen

 A

Incisive Foramen

 B

Mental Foramen

 C

Greater Palatine foramina

 D

Lesser Palatine foramina

Q. 22

Identify the Foramen marked in the Picture

Mental Foramen

 A

Incisive Foramen

 B

Mental Foramen

 C

Greater Palatine foramina

 D

Lesser Palatine foramina

Ans. B

Explanation:

Mental Foramen is marked in the Diagram.

It transmits Mental Nerves and Vessels .


Q. 23

Optic canal is a part of ‑

 A

Lesser wing of sphenoid

 B

Greater wing of sphenoid

 C

Ethmoid

 D

Pterygoid

Q. 23

Optic canal is a part of ‑

 A

Lesser wing of sphenoid

 B

Greater wing of sphenoid

 C

Ethmoid

 D

Pterygoid

Ans. A

Explanation:

Ans. is ‘a’ i.e., Lesser wing of sphenoid

The optic nerve leaves the orbit is the optic canal to enter the cranial vault.

The optic canal is the most posterior landmark of the orbit. It measures 10 mm in length.

The thin piece of bone separating the optic canal from the superior orbital fissure is the optic strut.

The optic strut and optic canal are a part of the lesser wing of sphenoid bone.


Q. 24

Mandibular nerve passes through ‑

 A

Formanen rotundum

 B

Foramen lacerum

 C

Stylomastoid foramen

 D

Foramen ovale

Q. 24

Mandibular nerve passes through ‑

 A

Formanen rotundum

 B

Foramen lacerum

 C

Stylomastoid foramen

 D

Foramen ovale

Ans. D

Explanation:

Foramen ovale


Q. 25

All are true about boundries of epiploic foramen except –

 A

Anterior : portal vein & hepatic artery

 B

Posterior : IVC

 C

Inferior : liver

 D

Inferior : duodenum

Q. 25

All are true about boundries of epiploic foramen except –

 A

Anterior : portal vein & hepatic artery

 B

Posterior : IVC

 C

Inferior : liver

 D

Inferior : duodenum

Ans. C

Explanation:

Epiploic foramen (foramen of winslow or aditus to lesser sac) is a slit-like opening through which lesser sac communicates with greater sac. It is situated at the level of T12 vertebra. Its boundries are :-

  • Anterior :- Right free margin of lesser omentum (contains portal vein, hepatic artery proper and bile duct).
  • Posterior :- IVC, right suprarenal gland and T12 vertebra.
  • Superior :- Caudate lobe of liver.
  • Inferior :- 1st part of duodenum and horizontal part of hepatic artery.

Q. 26

Which of the following is wrong regarding oph­thalmic artery ‑

 A

Present in dura along with optic nerve

 B

Supplies anterior ethmoidal sinus

 C

Artery to retina is end artery

 D

Leaves orbit through inferior orbital fissure

Q. 26

Which of the following is wrong regarding oph­thalmic artery ‑

 A

Present in dura along with optic nerve

 B

Supplies anterior ethmoidal sinus

 C

Artery to retina is end artery

 D

Leaves orbit through inferior orbital fissure

Ans. D

Explanation:

OPHTHALMIC ARTERY

Origin

The ophthalmic artery is a branch of the cerebral part of the internal carotid artery, given off medial to the anterior clinoid process close to the optic canal.

Course and relations

  1. The artery enters the orbit through the optic canal, lying inferolateral to the optic nerve. Both the artery and nerve lie in a common dural sheath.
  2. In the orbit, the artery pierces the dura mater, ascends over the lateral side of the optic nerve, and crosses above the nerve from lateral to medial side along with the nasociliary nerve. It then runs forwards along the medial wall of the orbit between the superior oblique and the medial rectus muscles, and parallel to the nasociliary nerve.
  3. It terminates near the medial angle of the eye by dividing into the supratrochlear and dorsal nasal branches. Branches

Ophthalmic artery gives following branches :

1. Central artery of retina.

2. Lacrimal artery :-

It gives following branches :

i)  Lateral palpebral branch.

ii) Zygomaticotemporal

iii) Zygomaticofacial

iv) Recurrent meningeal

3. Meningeal

4. Ciliary

5. Anterior ethmoidal

6. Posterior ethmoidal

7. Medial palpebral

8. Supratrochlear

9. Supraorbital

10. Dorsal nasal

Ophthalmic artery is the first and most important branch. It is an end artery.


Q. 27

True about vertebral artery ‑

 A

A branch of thyrocervical trunk

 B

Enters skull through foramen magnum

 C

Unite to form posterior cerebral artery

 D

A small artery

Q. 27

True about vertebral artery ‑

 A

A branch of thyrocervical trunk

 B

Enters skull through foramen magnum

 C

Unite to form posterior cerebral artery

 D

A small artery

Ans. B

Explanation:

Ans. is ‘b’ i.e., Enters skull through foramen magnum

Vertebral artery

  • It is the largest branch of subclavian artery.
  • Vertebral artery traverses through vertebral triangle, foramina transversaria of upper six cervical vertebrae, suboccipital triangle, posterior atlanto-occipital membrane, vertebral canal, pierce duramater and arachnoid (Subarachnoid) and passes through foramen magnum to enter posterior cranial fossa. It gives following branches:-
  1. Cervical branches :- Spinal branches, muscular branches (to suboccipital muscle).
  2. Cranial branches :- Posterior inferior cerebellar artery, medullary artery, meningeal branches, anterior spinal artery, posterior spinal artery and both vertebral arteries unite to form basilar artery.

Q. 28

Boundries of foramen of Winslow is formed by all except ‑

 A

IVC

 B

Liver

 C

2nd part of duodenum

 D

Suprarenal gland

Q. 28

Boundries of foramen of Winslow is formed by all except ‑

 A

IVC

 B

Liver

 C

2nd part of duodenum

 D

Suprarenal gland

Ans. C

Explanation:

Ans. is ‘c’ i.e., 2nd part of duodenum


Q. 29

Which of the following is incorrectly matched ‑

 A

Foramen rotundum – Maxillary nerve

 B

Foramen ovale – Mandibular nerve

 C

Foramen spinesum – Middle meningeal artery

 D

Jugular foramen – External jugular vein

Q. 29

Which of the following is incorrectly matched ‑

 A

Foramen rotundum – Maxillary nerve

 B

Foramen ovale – Mandibular nerve

 C

Foramen spinesum – Middle meningeal artery

 D

Jugular foramen – External jugular vein

Ans. D

Explanation:

Ans. is ‘d’ i.e., Jugular foramen – External jugular vein

Jugular foramen transmits internal jugular vein (not external jugular vein).


Q. 30

Superior orbital fissure syndrome – following nerves are affected ‑

 A

C.N. 1, 2, 4, 6

 B

C.N. 2, 3, 4, 6

 C

C.N. 3, 4, 5, 6

 D

C.N. 1, 2, 3, 4, 5

Q. 30

Superior orbital fissure syndrome – following nerves are affected ‑

 A

C.N. 1, 2, 4, 6

 B

C.N. 2, 3, 4, 6

 C

C.N. 3, 4, 5, 6

 D

C.N. 1, 2, 3, 4, 5

Ans. C

Explanation:

Ans. is ‘c’ i.e., C.N. 3, 4, 5, 6

The superior orbital fissure is a cleft between the lesser and greater wing of sphenoid.The structures passed through superior orbital fissure are 3rd, 4th, 6th nerve, ophthalmic division of 5th nerve, superior & inferior division of ophthalmic vein and sympathetic fibres.


Q. 31

Structures Passing Through The Foramen Marked in the Diagram are all EXCEPT?

 A

Spinal accessory nerve

 B

Spinal cord

 C

Vertebral artery

 D

Vertebral venous plexus

Q. 31

Structures Passing Through The Foramen Marked in the Diagram are all EXCEPT?

 A

Spinal accessory nerve

 B

Spinal cord

 C

Vertebral artery

 D

Vertebral venous plexus

Ans. B

Explanation:

The Structure Marked is Foramen Magnum 

Lower part of medulla oblongata (not the spinal cord) passes through posterior part of foramen magnum, and vertebralarteries are transmitted through the subarachnoid space in foramen magnum


Q. 32

This arrow showing Foramen Spinosum,,Contents are ??

 A

Vertebral venous plexus

 B

Vertebral artery

 C

Middle meningeal artery

 D

Maxillary nerve

Q. 32

This arrow showing Foramen Spinosum,,Contents are ??

 A

Vertebral venous plexus

 B

Vertebral artery

 C

Middle meningeal artery

 D

Maxillary nerve

Ans. C

Explanation:

The lateral segments of the middle fossa are deeper than its middle portion; they support the temporal lobes of the brain and show depressions that mark the convolutions of the brain. These segments are traversed by furrows for the anterior and posterior branches of the middle meningeal vessels, which pass through the foramen spinosum.


Q. 33

The canal marked by an arrow, is a part of??

 A

Lesser wing of sphenoid

 B

Greater wing of sphenoid

 C

Ethmoid

 D

Pterygoid

Q. 33

The canal marked by an arrow, is a part of??

 A

Lesser wing of sphenoid

 B

Greater wing of sphenoid

 C

Ethmoid

 D

Pterygoid

Ans. A

Explanation:

Ans. is ”A i.e., Lesser wing of sphenoid

The optic nerve leaves the orbit is the optic canal to enter the cranial vault.

The optic canal is the most posterior landmark of the orbit. It measures 10 mm in length.

The thin piece of bone separating the optic canal from the superior orbital fissure is the optic strut.

The optic strut and optic canal are a part of the lesser wing of sphenoid bone


Q. 34

Contents of jugular foramen are??

 A

Glossopharyngeal nerve

 B

vagus nerve

 C

Accessory nerve

 D

All the above

Q. 34

Contents of jugular foramen are??

 A

Glossopharyngeal nerve

 B

vagus nerve

 C

Accessory nerve

 D

All the above

Ans. D

Explanation:

The glossopharyngeal nerve, the vagus nerve and the accessory nerve, so cranial nerves IX, X and XI pass through the jugular foramen. That’s four structures to remember. You’ve got cranial nerves IX, X and XI and you’ve got the internal jugularvein.


Q. 35

Structure passing through both greater and lesser sciatic foramen is ‑

 A

Pudendal nerve

 B

Sciatic nerve

 C

Superior gluteal nerve 

 D

Inferior gluteal nerve

Q. 35

Structure passing through both greater and lesser sciatic foramen is ‑

 A

Pudendal nerve

 B

Sciatic nerve

 C

Superior gluteal nerve 

 D

Inferior gluteal nerve

Ans. A

Explanation:

Ans. is ‘a’ i.e., Pudendal nerve

Three structures pass through both greater and lesser sciatic foramen :-

  • Pudendal nerve
  • Internal pudendal vessels
  • Nerve to obturator internus

Structure passing throught greater sciatic foramen

  1.  Piriformis fills the foramen almost completely
  2. Structures passing above the piriformis
  • Superior gluteal nerve
  • Superior gluteal vessels
  • Structures passing below the piriformis
  • Inferior gluteal nerve
  • Inferior gluteal vessel.
  • Sciatic nerve
  • Posterior cutaneous nerve of thigh
  • Nerve to quadratus femoris
  • Pudendal nerve
  • Internal pudendal vessels
  • Nerve to obturator internus

Note : Last three structures also enter the lesser sciatic foramen.

  • Structures passing through lesser sciatic foramen
  • Pudendal nerve
  • Internal pudendal vessels
  • Nerve to obturator internus

Q. 36

All pass through jugular foramen except 

 A

Emissary vein

 B

Vagus nerve

 C

Mandibular nerve

 D

Internal jugular vein

Q. 36

All pass through jugular foramen except 

 A

Emissary vein

 B

Vagus nerve

 C

Mandibular nerve

 D

Internal jugular vein

Ans. C

Explanation:

Ans. is ‘c’ i.e., Mandibular nerve


Q. 37

Foramen ovale transmits all except 

 A

Emissary vein

 B

Mandibular nerve

 C

Lesser petrosal nerve

 D

Middle meningeal artery

Q. 37

Foramen ovale transmits all except 

 A

Emissary vein

 B

Mandibular nerve

 C

Lesser petrosal nerve

 D

Middle meningeal artery

Ans. D

Explanation:

Ans. is ‘d’ i.e., Middle meningeal artery 

Foramen ovate transmits (mnemonic – MALE) :-

  1. Mandibular nerve
  2. Accessory meningeal artery
  3. Lesser petrosal nerve
  4. Emissory vein


Lateral nasal wall

LATERAL NASAL WALL

Q. 1

All open into hiatus semilunaris except

 A

Posterior ethmoid sinus

 B

Anterior ethmoid sinus

 C

Frontal sinus

 D

Maxillary sinus

Q. 1

All open into hiatus semilunaris except

 A

Posterior ethmoid sinus

 B

Anterior ethmoid sinus

 C

Frontal sinus

 D

Maxillary sinus

Ans. A

Explanation:

Q. 2

Paranasal sinuses communicate with the nose through its openings. Following group of ethmoidal sinuses drain into superior meatus:

 A

Anterior

 B

Middle

 C

Posterior

 D

Middle + Posterior

Q. 2

Paranasal sinuses communicate with the nose through its openings. Following group of ethmoidal sinuses drain into superior meatus:

 A

Anterior

 B

Middle

 C

Posterior

 D

Middle + Posterior

Ans. C

Explanation:

The frontal sinus drains into the anterior part of the hiatus semilunaris via the infundibulum. 

The maxillary sinus also drains into the hiatus semilunaris, as do the anterior and middle ethmoidal sinuses. 

The posterior ethmoidal sinuses drain into the superior meatus. 

The sphenoid sinus drains into the space above the superior concha called the sphenoethmoidal recess.


Q. 3

All of the following structures open into the middle meatus, EXCEPT:

 A

Ant. ethmoidal sinus

 B

Post. ethmoidal sinus

 C

Frontonasal duct

 D

Maxillary sinus

Q. 3

All of the following structures open into the middle meatus, EXCEPT:

 A

Ant. ethmoidal sinus

 B

Post. ethmoidal sinus

 C

Frontonasal duct

 D

Maxillary sinus

Ans. B

Explanation:

Posterior ethmoid sinus opens into superior meatus. 
  • Anterior ethmoid cells are divided into frontal recess cells, which open into the frontal recess of the middle meatus, infundibular cells which open into the ethmoid infundibulum and and bullae or middle ethmoid cells which open into the middle meatus.
  • Maxillary sinus drain into the middle meatus of nasal cavity.  The frontal sinus opens into the infundibulum of middle meatus through frontonasal duct.
  • Sphenoid sinus opens into the sphenoethmoidal recess above and behind the superior nasal concha. 

Q. 4

The maxillary sinus opens into middle meatus at the level of:

 A

Hiatus semilunaris

 B

Bulla ethmoidalis

 C

Infundibulum

 D

None of the above

Q. 4

The maxillary sinus opens into middle meatus at the level of:

 A

Hiatus semilunaris

 B

Bulla ethmoidalis

 C

Infundibulum

 D

None of the above

Ans. A

Explanation:

The maxillary sinus is the largest of the paranasal sinuses and is located in the maxilla, lateral to the nasal cavity and inferior to the orbit.

The maxillary sinus opens into the posterior aspect of the hiatus semilunaris in the middle meatus.

The infraorbital nerve (CN V-2) primarily innervates the maxillary sinus.

 

 


Q. 5

Paired bones are:

 A

Inferior Concha

 B

Frontal bone

 C

Nasal bone

 D

A & C

Q. 5

Paired bones are:

 A

Inferior Concha

 B

Frontal bone

 C

Nasal bone

 D

A & C

Ans. D

Explanation:

A i.e. Inferior concha; C i.e. Nasal bone 

Inferior nasal concha & nasal bones are paired bones; whereas vomer, frontal and ethmoid are unpaired bones.


Q. 6

Frontonasal duct opens into:

 A

Inferior meatus

 B

Middle meatus

 C

Superior meatus

 D

Inferior turbinate

Q. 6

Frontonasal duct opens into:

 A

Inferior meatus

 B

Middle meatus

 C

Superior meatus

 D

Inferior turbinate

Ans. B

Explanation:

Q. 7

Frontal sinus drain into:

 A

Superior meatus

 B

Inferior meatus

 C

Middle meatus

 D

Ethmoid recess

Q. 7

Frontal sinus drain into:

 A

Superior meatus

 B

Inferior meatus

 C

Middle meatus

 D

Ethmoid recess

Ans. C

Explanation:

Q. 8

Hiatus semilunaris is present in:

 A

Superior meatus

 B

Middle meatus

 C

Inferior meatus

 D

Spenoethmoidal recess

Q. 8

Hiatus semilunaris is present in:

 A

Superior meatus

 B

Middle meatus

 C

Inferior meatus

 D

Spenoethmoidal recess

Ans. B

Explanation:

Q. 9

Bulla ethmoidalis is seen in:

 A

Superior meatus

 B

Inferior meatus

 C

Middle meatus

 D

Sphenoethmoidal recess

Q. 9

Bulla ethmoidalis is seen in:

 A

Superior meatus

 B

Inferior meatus

 C

Middle meatus

 D

Sphenoethmoidal recess

Ans. C

Explanation:

 

Middle meatus lies between the middle and inferior turbinates and is important because of the presence of osteomeatal complex in this area.


Q. 10

Sphenoidal sinus opens into:

 A

Inferior meatus

 B

Middle meatus

 C

Superior meatus

 D

Sphenoethmoidal recess

Q. 10

Sphenoidal sinus opens into:

 A

Inferior meatus

 B

Middle meatus

 C

Superior meatus

 D

Sphenoethmoidal recess

Ans. D

Explanation:

 

Sphenoethmoid recess is situated above the superior turbinate and receives opening of sphenoidal sinus.


Q. 11

Nasolacrimal duct opens into:

 A

Superior meatus

 B

Middle meatus

 C

Inferior meatus

 D

Sphenopalatine recess

Q. 11

Nasolacrimal duct opens into:

 A

Superior meatus

 B

Middle meatus

 C

Inferior meatus

 D

Sphenopalatine recess

Ans. C

Explanation:

Ans. is c i.e Inferior meatus

  • Nasolacrimal duct opens into inferior meatus below the level of inferior turbinate
  • Nasolacrimal duct is guarded at its temporal end by a mucosal valve k/a Hasner’s valve
  • Frontonasal duct opens into middle meatus.



Q. 12

Inferior turbinate is a:

 A

Part of maxilla

 B

Part of sphenoid

 C

Separate bone

 D

Part of ethmoid

Q. 12

Inferior turbinate is a:

 A

Part of maxilla

 B

Part of sphenoid

 C

Separate bone

 D

Part of ethmoid

Ans. C

Explanation:

Q. 13

Which of the following is known as fourth turbinate?

 A

Superior turbinate

 B

Aggernasi

 C

Supreme turbinate

 D

Bulous turbinate

Q. 13

Which of the following is known as fourth turbinate?

 A

Superior turbinate

 B

Aggernasi

 C

Supreme turbinate

 D

Bulous turbinate

Ans. C

Explanation:

Q. 14

Turbinate that articulates with ethmoid is:

 A

Superior

 B

Middle

 C

Inferior

 D

All of the above

Q. 14

Turbinate that articulates with ethmoid is:

 A

Superior

 B

Middle

 C

Inferior

 D

All of the above

Ans. C

Explanation:

 

Middle turbinate and superior turbinate are a part of the ethmoidal bone whereas inferior turbinate is an independant bone which articulates with the ethmoid bone, completing the medial wall of nasolacrimal duct.


Q. 15

All open into hiatus semilunaris except:

 A

Posterior ethmoid sinus 

 B

Anterior ethmoid sinus

 C

Frontal sinus

 D

Maxillary sinus

Q. 15

All open into hiatus semilunaris except:

 A

Posterior ethmoid sinus 

 B

Anterior ethmoid sinus

 C

Frontal sinus

 D

Maxillary sinus

Ans. B

Explanation:

Q. 16

True about sphenoid sinus:

 A

Lined by stratified squamous epithelium

 B

Duct open in middle meatus

 C

Open in sphenoethmoid recess

 D

Present at birth

Q. 16

True about sphenoid sinus:

 A

Lined by stratified squamous epithelium

 B

Duct open in middle meatus

 C

Open in sphenoethmoid recess

 D

Present at birth

Ans. C

Explanation:

 

  • All paranasal sinuses are lined by respiratory epithelium (i.e. ciliated pseudo stratified columnar epithelium) 

Sphenoid sinus: 

  • It is not present at birth
  • It occupies the body of sphenoid
  • Ostrum of sphenoid sinus is situated in the upper part of anterior wall and drains into spheno ethmoidal recess.
  • On x ray: Sphenoid sinus is visible by 4 years of age.



Q. 17

Sinus opening in middle meatus is:     

September 2011

 A

Posterior ethmoid sinus

 B

Sphenoid sinus

 C

Frontal sinus

 D

Nasolacrimal duct

Q. 17

Sinus opening in middle meatus is:     

September 2011

 A

Posterior ethmoid sinus

 B

Sphenoid sinus

 C

Frontal sinus

 D

Nasolacrimal duct

Ans. C

Explanation:

Ans. C: Frontal Sinus

Frontal sinus opens into the middle meatus of the nose at the anterior end of hiatus semilunaris

Middle Meatus

  • It is a nasal opening or canal situated between the middle and inferior conchae, and extends from the anterior to the posterior end of the latter.
  • On it is a curved fissure, the hiatus semilunaris and limited below by the edge of the uncinate process of the ethmoid and above by an elevation named the bulla ethmoidalis; the middle ethmoidal cells are contained within this bulla and open on or near to it.
  • Through the hiatus semilunaris the meatus communicates with a curved passage termed the infundibulum, which communicates in front with the anterior ethmoidal cells and in rather more than fifty percent of skulls is continued upward as the frontonasal duct into the frontal air-sinus; when this continuity fails, the frontonasal duct opens directly into the anterior part of the meatus.
  • Below the bulla ethmoidalis and hidden by the uncinate process of the ethmoid is the opening of the maxillary sinus (ostium maxillare); an accessory opening is frequently present above the posterior part of the inferior nasal concha.



Q. 18

Posterior ethmoid sinus opens in which meatus‑

 A

Superior

 B

Middle

 C

Inferior

 D

Spenoethmoidal recess

Q. 18

Posterior ethmoid sinus opens in which meatus‑

 A

Superior

 B

Middle

 C

Inferior

 D

Spenoethmoidal recess

Ans. A

Explanation:

Ans. is ‘a’ i.e., Superior


Q. 19

Maxillary sinus drains into ‑

 A

Inferior meatus

 B

Middle meatus

 C

Superior meatus

 D

Sphenoethmoidal recess

Q. 19

Maxillary sinus drains into ‑

 A

Inferior meatus

 B

Middle meatus

 C

Superior meatus

 D

Sphenoethmoidal recess

Ans. B

Explanation:

 Middle meatus


Q. 20

Nasolacrimal duct opens in which part of internal nose ?

 A

Superior meatus

 B

Inferior meatus

 C

Middle meatus

 D

Spenoethmoidal recess

Q. 20

Nasolacrimal duct opens in which part of internal nose ?

 A

Superior meatus

 B

Inferior meatus

 C

Middle meatus

 D

Spenoethmoidal recess

Ans. B

Explanation:

Ans. is ‘b’ i.e., Inferior meatus


Q. 21

Middle turbinate is a ‑

 A

Separate bone

 B

Part of ethmoid

 C

Part of sphenoid

 D

Part of zygomatic

Q. 21

Middle turbinate is a ‑

 A

Separate bone

 B

Part of ethmoid

 C

Part of sphenoid

 D

Part of zygomatic

Ans. B

Explanation:

There are three turbinates in the lateral wall of nose : superior, middle and inferior.

The inferior turbinate is a separate bone, while rest of the turbinates are a part of ethmoidal bone.

Below and lateral to each turbinate is the corresponding meatus.

Inferior turbinate is longest one.


Q. 22

Largest turbinate in nose is ‑

 A

Superior

 B

Middle

 C

Inferior

 D

All are same

Q. 22

Largest turbinate in nose is ‑

 A

Superior

 B

Middle

 C

Inferior

 D

All are same

Ans. C

Explanation:

Ans. is ‘c’ i.e., Inferior 

  • The nasal conchae or turbinates are curved bony projections directed downwards and medially.
  1. The inferior concha is the largest and is an independent bone.
  2. The middle concha is also a projection from the medial surface of ethmoiod.
  3. The superior concha is the smallest and also arises from the medial surface of the ethmoid. 
  • The meatuses of the nose are passages beneath the overhanging conchae.


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