FMGE ENT questions from past papers

1. Q1. An adult has a unilateral middle-ear effusion that has not settled over three months, together with a firm upper cervical lymph node. Which investigation should be arranged first?

   • A. Pure tone audiometry
   • B. Myringotomy with grommet insertion
   • C. Plain sinus radiograph
   • D. Nasopharyngeal endoscopy with biopsy

   Answer: D. Nasopharyngeal endoscopy with biopsy

1. Q1. A patient with post-traumatic hearing loss undergoes HRCT of the temporal bone. Which structure cannot be resolved, and why?

   • A. The malleus, because the tympanic membrane obscures it
   • B. The vestibular aqueduct, because it contains air
   • C. The internal auditory canal, because it lies outside the field
   • D. The organ of Corti, because it is soft tissue below the resolution of CT

   Answer: D. The organ of Corti, because it is soft tissue below the resolution of CT

2. Q2. A universal newborn hearing screening programme needs a first-line test that is quick, needs no sedation and requires no response from the baby. Which test is used?

   • A. Pure tone audiometry
   • B. Speech audiometry
   • C. Otoacoustic emissions
   • D. Rinne and Weber tuning fork tests

   Answer: C. Otoacoustic emissions

1. Q1. A vascular middle-ear tumour arises from paraganglionic tissue travelling with the tympanic branch of the glossopharyngeal nerve. Which tumour is this, and what is its characteristic otoscopic sign?

   • A. Cholesteatoma, with a pearly white mass and a marginal perforation
   • B. Glomus tympanicum, with a red retrotympanic mass that blanches on positive pressure
   • C. Facial nerve schwannoma, with a pale mass and facial weakness
   • D. Cholesterol granuloma, with a blue tympanic membrane

   Answer: B. Glomus tympanicum, with a red retrotympanic mass that blanches on positive pressure

2. Q2. A teenage boy has recurrent profuse epistaxis and progressive nasal obstruction, with a vascular mass at the sphenopalatine foramen. Why is biopsy avoided, and what is the treatment?

   • A. Biopsy risks seeding malignancy; treatment is radiotherapy alone
   • B. Biopsy is painless but non-diagnostic; treatment is observation
   • C. Biopsy risks torrential haemorrhage; treatment is embolisation followed by surgical excision
   • D. Biopsy risks a CSF leak; treatment is chemotherapy

   Answer: C. Biopsy risks torrential haemorrhage; treatment is embolisation followed by surgical excision

1. Q1. A 60-year-old man has painless cervical lymphadenopathy, a unilateral middle-ear effusion and reduced mobility of the soft palate. What links these three findings?

   • A. A nasopharyngeal tumour obstructing the Eustachian tube and invading locally
   • B. Chronic suppurative otitis media with extension
   • C. A parapharyngeal abscess
   • D. Tuberculous cervical lymphadenitis

   Answer: A. A nasopharyngeal tumour obstructing the Eustachian tube and invading locally

2. Q2. A toddler has a harsh seal-like cough with inspiratory stridor that worsens on crying. At what level does the obstruction lie, and what does the steeple sign on a neck radiograph represent?

   • A. Supraglottic, the sign showing a swollen epiglottis
   • B. Tracheal, the sign showing an intraluminal foreign body
   • C. Subglottic, the sign showing symmetrical subglottic narrowing
   • D. Bronchial, the sign showing distal hyperinflation

   Answer: C. Subglottic, the sign showing symmetrical subglottic narrowing

1. Q1. An unimmunised 6-year-old has fever, sore throat, a grey membrane over the tonsils that bleeds when peeled, and marked cervical swelling. Which organism, and what causes the systemic complications?

   • A. Epstein-Barr virus, through lymphoproliferation
   • B. Corynebacterium diphtheriae, through an exotoxin inhibiting elongation factor 2
   • C. Streptococcus pyogenes, through superantigen release
   • D. Candida albicans, through mucosal invasion

   Answer: B. Corynebacterium diphtheriae, through an exotoxin inhibiting elongation factor 2

2. Q2. A patient with a dead ear from labyrinthitis is tested with a tuning fork on the affected side. Bone conduction appears better than air conduction. Why is this result misleading?

   • A. It is a true negative Rinne, confirming conductive loss
   • B. It is a false negative Rinne, because the sound is being heard by the opposite functioning cochlea through the skull
   • C. It is a false positive Rinne, from tuning fork placement error
   • D. It is a true positive Rinne, confirming normal hearing

   Answer: B. It is a false negative Rinne, because the sound is being heard by the opposite functioning cochlea through the skull

1. Q1. Which property of brainstem evoked response audiometry makes it suitable for testing an uncooperative or sedated patient?

   • A. It is subjective and needs the patient to signal
   • B. It is invasive, requiring a transtympanic electrode
   • C. It measures middle-ear compliance only
   • D. It is objective, requiring no voluntary response, and estimates sensorineural threshold

   Answer: D. It is objective, requiring no voluntary response, and estimates sensorineural threshold

2. Q2. A woman has nasal obstruction despite an abnormally roomy nasal cavity, anosmia, and foul greenish crusts, with atrophic turbinates. What is the condition, and which surgical option narrows the airway?

   • A. Atrophic rhinitis, treated with Young's operation to close the nostril
   • B. Deviated nasal septum, treated with septoplasty
   • C. Vasomotor rhinitis, treated with vidian neurectomy
   • D. Nasal polyposis, treated with polypectomy

   Answer: A. Atrophic rhinitis, treated with Young's operation to close the nostril

1. Q1. A young man has a displaced nasal bone fracture with obvious deformity and marked swelling. When should reduction be performed, and why?

   • A. Within the first 12 hours, before any swelling develops
   • B. At 5 to 10 days, once swelling settles but before the bones unite
   • C. At 3 weeks, once callus is forming
   • D. At 6 weeks, as a formal rhinoplasty

   Answer: B. At 5 to 10 days, once swelling settles but before the bones unite

1. Q1. Two days after a head injury a woman has clear watery discharge from one nostril that increases on leaning forward. What is the diagnosis, and which bedside feature supports it?

   • A. Allergic rhinitis, supported by sneezing
   • B. Post-traumatic vasomotor rhinitis, supported by nasal blockage
   • C. CSF rhinorrhoea, supported by a target or halo sign on filter paper
   • D. Haemosinus, supported by blood-stained discharge

   Answer: C. CSF rhinorrhoea, supported by a target or halo sign on filter paper

2. Q2. Which laboratory test most specifically confirms that nasal fluid is cerebrospinal fluid?

   • A. Beta-2 transferrin assay, since this isoform is essentially unique to CSF
   • B. Glucose oxidase strip testing
   • C. Protein estimation
   • D. Culture and sensitivity

   Answer: A. Beta-2 transferrin assay, since this isoform is essentially unique to CSF

1. Q1. In an infant, which part of the airway is narrowest, and what practical consequence follows for intubation?

   • A. The supraglottis, so a smaller blade is used
   • B. The glottis, so a cuffed tube is essential
   • C. The subglottis at the cricoid ring, so an oversized tube risks post-extubation stridor
   • D. The epiglottis, so it must be lifted directly

   Answer: C. The subglottis at the cricoid ring, so an oversized tube risks post-extubation stridor

2. Q2. Juvenile nasopharyngeal angiofibroma occurs almost exclusively in adolescent males. From which site does it arise, and what does that explain about spread?

   • A. The nasal septum, so it stays midline
   • B. The maxillary antrum, so it presents with facial swelling
   • C. The nasopharyngeal roof, so it obstructs both choanae equally
   • D. The sphenopalatine foramen, from where it extends into the pterygopalatine fossa and skull base

   Answer: D. The sphenopalatine foramen, from where it extends into the pterygopalatine fossa and skull base

1. Q1. A child has a persistent middle-ear effusion with conductive hearing loss and no infection. What is the mainstay of treatment?

   • A. Radical mastoidectomy
   • B. Myringotomy with grommet insertion to ventilate the middle ear
   • C. Temporal bone resection
   • D. Tonsillectomy alone

   Answer: B. Myringotomy with grommet insertion to ventilate the middle ear

2. Q2. A patient has fever and a neck swelling, and the tonsil is displaced medially with trismus, but the uvula is not deviated. Where is the collection?

   • A. Peritonsillar (quinsy)
   • B. Retropharyngeal space
   • C. Parapharyngeal space
   • D. Submandibular space

   Answer: C. Parapharyngeal space

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.