EN1.1-2 | ENT Foundations — Practice Quiz

Correct. The cochlea contains the organ of Corti, where inner hair cells transduce the mechanical vibration of the basilar membrane into action potentials that travel via the cochlear nerve (CN VIII) to the auditory cortex.

The cochlea (scala media, organ of Corti) converts mechanical vibration to electrical signals via hair cells. The semicircular canals and otolith organs handle balance. The Eustachian tube equalises pressure.

Balance and equilibrium are functions of the vestibular portion of the inner ear (semicircular canals + utricle + saccule). Pressure equalisation is the Eustachian tube's role. Conduction of sound to the tympanic membrane is an external ear function.

Correct. In right conductive hearing loss: Rinne test on the right is negative (bone conduction > air conduction, because the middle ear mechanism is bypassed). Weber test lateralises to the right (the affected ear), because bone conduction is relatively enhanced when environmental noise is masked by the conductive block.

Rinne NEGATIVE (bone > air) = conductive loss. Weber lateralises TO the affected ear in conductive loss (the impaired ear perceives bone conduction better in a quieter acoustic environment). Never invert these relationships.

Rinne positive means air > bone, indicating normal hearing or sensorineural loss — not conductive loss. Weber lateralises to the BETTER ear in sensorineural loss and to the AFFECTED ear in conductive loss. The key rule: conductive loss → Weber to the affected side.

Correct. Kiesselbach's plexus (Little's area) is supplied by four anastomosing vessels: the sphenopalatine artery, the greater palatine artery, the anterior ethmoidal artery, and the superior labial artery. This rich anastomosis between internal and external carotid territories makes the anterior septum highly vascular and prone to bleeding.

Little's area (Kiesselbach's plexus) receives anastomotic supply from: anterior ethmoidal (ICA branch via ophthalmic), sphenopalatine (ECA via internal maxillary), greater palatine (ECA), and superior labial (ECA via facial). This dual ICA-ECA supply makes it a high-risk site.

Posterior epistaxis arises from the sphenopalatine or Woodruff's nasopharyngeal plexus in the posterior nasal cavity — these are NOT sites of Kiesselbach's plexus. The anterior ethmoidal alone is insufficient; the plexus requires all four named vessels. ICA branches alone do not constitute the full plexus.

Correct. Otosclerosis is an autosomal dominant condition of the otic capsule — predominantly affecting young women — where new spongy bone forms, fixing the stapes footplate and causing conductive hearing loss. Early active otospongiosis is visible as a flamingo-pink blush (Schwartze sign) through the intact tympanic membrane due to increased vascularity of the active focus near the promontory.

Otosclerosis: hereditary (autosomal dominant, incomplete penetrance), predominantly in young females, bilateral progressive conductive hearing loss, normal tympanic membrane with Schwartze sign (flamingo-pink blush due to active otospongiosis in the promontory). CSOM has a perforation; Meniere's is sensorineural.

CSOM presents with a tympanic membrane perforation — this patient has an intact TM. A bluish TM discolouration suggests a glomus tumour or haemotympanum, not otosclerosis. Meniere's disease is sensorineural hearing loss with tinnitus and vertigo — the TM is normal and there is no fluid level. Schwartze sign is the pathognomonic otoscopic finding in active otosclerosis.

Correct. The 'unsafe' or atticoantral type of CSOM is defined by the presence of cholesteatoma arising from a marginal or attic perforation. Cholesteatoma erodes bone through collagenase and enzymes, risking lateral sinus thrombosis, meningitis, brain abscess, and facial nerve palsy — hence 'unsafe'. This mandates surgical clearance (mastoidectomy).

CSOM safe (tubotympanic/mucosal): central perforation, no cholesteatoma, rarely serious complications. CSOM unsafe (atticoantral/squamosal): attic/marginal perforation + cholesteatoma, bone erosion, intracranial complications — requires surgery (mastoidectomy). This distinction drives the management decision.

Foul-smelling scanty discharge is characteristic of the unsafe type but is a consequence of cholesteatoma — the defining feature is the cholesteatoma itself plus the type of perforation (attic/marginal). A central perforation with profuse discharge is the SAFE type (tubotympanic). Bilateral involvement and conductive loss are not the distinguishing criterion.

Correct. The adenoid (pharyngeal tonsil) is located on the posterior wall of the nasopharynx. Hypertrophy obstructs the posterior choanae, producing bilateral nasal obstruction, mouth breathing, hyponasal voice, and snoring. In children, adenoid hypertrophy is physiological until age 8-12 but becomes pathological when obstructive. Nasopharyngoscopy is the definitive investigation.

Adenoid hypertrophy (pharyngeal tonsil) presents in children with bilateral nasal obstruction, mouth breathing, hyponasal voice, snoring, and sleep-disordered breathing. The adenoid sits on the roof/posterior wall of the nasopharynx — part of Waldeyer's ring. Obstruction of the choanae produces nasal symptoms; Eustachian tube obstruction causes otitis media.

Palatine tonsils are in the oropharynx and, when enlarged, cause dysphagia, throat discomfort, and voice change — not primarily nasal obstruction. The lingual tonsil at the tongue base rarely causes the nasal symptoms described. The tubal tonsil is small and not a cause of significant nasal obstruction. The clinical picture points specifically to adenoid hypertrophy.

Correct. Meniere's disease is characterised by endolymphatic hydrops causing a triad: episodic prolonged vertigo (20 minutes to hours), fluctuating low-frequency sensorineural hearing loss, and tinnitus with or without aural fullness. BPPV involves displaced otoconia causing brief (seconds) positional vertigo provoked by head movement, a positive Dix-Hallpike test, and completely normal hearing and audiometry.

Meniere's disease: endolymphatic hydrops → triad of episodic vertigo (lasting 20 min–24 hours) + sensorineural hearing loss (low-frequency, fluctuating) + tinnitus (± aural fullness). BPPV: displaced otoconia in posterior semicircular canal → brief (<60 sec) positional vertigo, positive Dix-Hallpike, normal hearing. They are easily confused but have distinct mechanisms.

Brief positional vertigo is BPPV, not Meniere's. Meniere's causes SNHL, not conductive hearing loss. The two conditions have entirely different audiometric profiles — BPPV has a normal audiogram. Conflating their features leads to management errors (Epley manoeuvre is curative for BPPV, not for Meniere's).

Correct. Juvenile nasopharyngeal angiofibroma (JNA) is an extremely vascular benign fibromatous tumour occurring almost exclusively in adolescent males. The classic presentation is recurrent severe epistaxis and nasal obstruction. Biopsy is absolutely contraindicated — it can trigger life-threatening haemorrhage. Diagnosis is made on contrast CT (showing the vascular mass with extension patterns) and angiography. Treatment involves preoperative embolisation followed by surgical excision.

Juvenile Nasopharyngeal Angiofibroma (JNA): adolescent males, extremely vascular benign tumour, recurrent epistaxis + nasal obstruction. DO NOT BIOPSY — catastrophic haemorrhage. Diagnose on contrast CT/MRI (sunburst pattern) + angiography. Treatment: preoperative embolisation + surgical excision.

Biopsy is absolutely contraindicated in JNA — this is one of the classic 'must-not-biopsy' lesions in ENT. Intranasal steroids are for nasal polyps (inflammatory), not for a vascular tumour. BIPP packing may temporise bleeding but is not definitive treatment for a mass lesion.

Correct. The Eustachian tube has three primary functions: equalising air pressure between the middle ear and atmosphere (via opening during swallowing and yawning, mediated by tensor veli palatini), draining middle ear secretions into the nasopharynx, and protecting the middle ear from nasopharyngeal pressure fluctuations. Eustachian tube dysfunction leads to negative middle ear pressure, retraction of the tympanic membrane, and ultimately middle ear effusion.

Eustachian tube: three functions — (1) pressure equalisation (opens during swallowing/yawning via tensor veli palatini); (2) drainage of middle ear secretions toward nasopharynx; (3) protection from nasopharyngeal sound pressure. Dysfunction → negative middle ear pressure → effusion (glue ear / secretory otitis media).

Mastoid air cells communicate with the middle ear (not drain to the nose). Sound conduction from the tympanic membrane to the inner ear is the function of the ossicular chain (malleus, incus, stapes). Olfaction is a nasal/olfactory nerve function — completely unrelated to the Eustachian tube.

Correct. Glottic (true vocal cord) carcinoma is the most common laryngeal cancer. Because the vocal cords are exquisitely sensitive to any mass effect, even a small lesion produces hoarseness early, leading to early presentation and diagnosis. The glottis has sparse lymphatics, which limits nodal spread — contributing to a better prognosis compared to supraglottic carcinoma, which has rich lymphatics and presents late with cervical node enlargement.

Glottic carcinoma: most common laryngeal cancer; presents EARLY with hoarseness (cords are voice-critical); good prognosis due to poor lymphatic drainage of the glottis. Supraglottic: rich lymphatics → late presentation with nodal metastasis, poor prognosis. Hoarseness >3 weeks in a smoker = mandatory laryngoscopy.

It is supraglottic carcinoma — not glottic — that presents late with nodal metastasis as a first sign, due to rich supraglottic lymphatics and the absence of hoarseness until late involvement of the cords. Persistent hoarseness in a smoker for more than 3 weeks is a red flag that mandates laryngoscopy to exclude malignancy.