Islamabad medical & Dental College
(4th year MBBS Examination)
(MCQ’S PAPER 1)
Date: ____________________________ Subject: ENT
Max Marks: Times Allowed: minutes
Q 1: A 40 year old diabetic patient is complaining of severe itching for 10 days. He also has
conductive hearing loss. Examination with Otoscope showed black-headed Hyphae. The most
likely diagnosis is
a. Foreign body in ear
b. Aspergillus Niger
c. Aspergillus fumigatus
d. Candida infection
e. Mucormycosis
Q2: Tympanometry showed decrease compliance, Audiometry showed mixed hearing loss with
Carhart’s notch seen on
a. In bone conduction
b. In air conduction
c. In Bone conduction at 1000Hz
d. In Bone conduction at 2000Hz
e. Air conduction at 2000 Hz
Q3: A 25 years' male presented red swollen pinna, tender to touch.
What is the treatment?
a. Analgesic and ciprofloxacin
b. Co-amoxiclave is drug of choice
c. Analgesic and Co-amoxiclave
d. Analgesic and I&D
e. Third generation cephalosporin’s and I&D
Q4: A 30 years' male got ear trauma, Post traumatic profound hearing loss occurs in
a) Longitudinal fractures of temporal bone
b) Le forte type III fracture
c) Rupture of tympanic membrane
d) Transverse fracture of temporal bone
e) Fracture squamous temporal bone.
Q5: A 35 years' male presented with combination of fluctuating SNHL, roaring tinnitus-, episodic
vertigo and fullness of the ear is most likely to be associated.
a) Otosclerosis
b) Chronic SOM
c) Meniere's Disease
d) Acoustic Neuroma
e) Perilymph fistula
Q6: Severe headache, vomiting, dysphasia & visual field defects in a patient with Cholesteatoma
indicate:
a. Cerebellar Abscess
b. Otogenic facial paralysis
c. Mastoid abscess
d. Temporal lobe abscess
e. Meningitis
Q7: A 20 years' male presented with high grade fever, headache, and bilateral nasal obstruction
for 2 days. Diagnosis is
a) Bilateral Ethmoidal polyps.
b) Bilateral inferior turbinate hypertrophy
c) Acute sinusitis
d) Atrophic sinusitis
e) Allergic Rhinitis
Q8: A 10 years' boy presented recurrent small bleed. Bleed was anterior. Which of the following
arteries is not involved?
a) [Link] artery
b) Greater palatine artery
c) Post. Ethmoidal artery
d) Sup. Labial artery
e) Sphenopalatine artery
Q9: A 20 years' male under gone surgery for septal deflection. SMR done.
. Which is the most common complication of this procedure?
a) Septal perforation
b) Toxic shock syndrome
c) Septal hematoma
d) Saddle deformity
e) CSF rhinorrhea
Q10: A 25 years' male presented with crusting and epistaxis after SMR.
Diagnosis is ?
a) Synachae
b) Large perforation
c) Carcinoma
d) Small perforation
e) Atrophic rhinitis
Q11: A patient suffered from right sided hearing loss after having bath. He is also
complaining of aural fullness. Otoscopic examination shows external auditory
canal full of brownish material. What is the best treatment?
a) Syringing
b) Dry mopping
c) Soda glycerin drops followed by syringing
d) Soda glycine drops followed by suctioning
e) suction
Q12: A 40 year old patient is complaining of severe earache for 2 days. He also has
conductive hearing loss. Examination with Otoscope was painful showed
swollen external auditory meatus. Commonest organism responsible for it is?
a. Staph aureus
b. Beta hemolytic streptococcus
c. Candida
d pseudomonas
. Pseudomonas e. Haemophilus influenza
Q13: During middle ear surgery, medial wall of middle ear was examined.
It includes all except
a. Oval window
b. Processus cochleariformis
c. Round window
d. Pyramid
e. First genu of facial nerve
Q15: Myringotomy with grommet insertion is the ideal surgical treatment for
a. Acute otitis media
b. Serous otitis media
c. Adhesive otitis media
d. Retracted tympanic membrane
e. Cholesteatoma
Q17: A 35 years' male presented with fever, epistaxis, hematuria, ESR was120. Granulations were
seen on nasal septum. Most common diagnosis is
a. Tuberculosis
b. Wegner's granuloma
c. Midline lethal granuloma
d. Leprosy
e. Syphilis
Q18: A 11Years' old boy presented with recurrent epistaxis. Most common cause of epistaxis is
a. Tuberculosis
b. Hypertension
c. Idiopathic
d. Trauma
e. Malignancy
Q20: A 60 years' male presented with repeated epistaxis from Right nasal cavity for last 7 years.
Mass was in Right nasal cavity. CT scan showed mass filling maxillary sinus. Most probable
diagnosis is
a) Transitional cell papilloma
b) Malignant growth of maxillary sinus
c) Angiofibroma
d) Nasopharyngeal carcinomas
e) Mucormycosis
Q23: Audiogram showed hearing loss both in AC and BC with no air bone gap. Following are the
causes except
a. Ototoxic drugs
b. Torch Infections
c. Noise
d. Otosclerosis
e. Meniere’s disease
Q24: Earliest nerve to be involved in a patient with unilateral SNHL, Tinnitus and Mass at CP angle
on MRI:
a. Vth nerve
b. Vl th nerve
c. X1 nerve
d. X11 nerve
e. IXth nerve
Q25: On CT scan of PNS, the uncinate process of ethmoid bone articulates with:
a) Superior turbinate
b) Middle turbinate
c) Inferior turbinate
d) Ethmoid bone
e) Palatine bone
Q27: A child of 8 years' presented with nasal trauma, pain and bilateral nasal blockage.
Patient has a low grade fever. What is the probable Diagnosis ?
a) Septal hematoma
b) Fracture nasal bones
c) Septal abscess
d) Blood clots
e) Septal perforation
Q28: A 35 years' male presented with vertigo lasts for few seconds by putting head
on pillo, while Tunning Fork tests are normal. The Diagnosis is?
a) Meniere's disease
b) Acoustic Neuroma
c) Benign paroxysmal positional vertigo
d) Labyrinthitis
e) Vestibular neuronitis
Q29: Diagnosis in above case is made by:
a) Fistula test
b) Romberg test
c) Caloric test
d) Hall pike’s maneuver
e) Epley's maneuver
Q33: A 40 years' male comes to Emergency Room with severe respiratory distress . Immediately
the best & easiest way to restore airway is
a) Airway placement
b)Emergency Tracheostomy
c) Endotracheal intubation
d) Laryngotomy
e) Elective tracheostomy
Q34: On IDL examination, Unilateral vocal cord is immobile. The most common cause of unilateral
vocal cord paralysis is
a) Thyroid surgery
b) Thoracic surgery
c) Stroke
d) Idiopathic
e) Tuberculosis
Q35: A 25 years' patient presented with permanent hoarseness of voice, two nodular swellings
seen on both vocal cords. Which of the following is true?
a) They are often seen in men
b) They are mostly bilateral
c) They are mostly treated surgically
d) They are rarely associated with vocal abuse
e) CO2 LASER is rarely helpful
Q36: A 25 years old women with a turbulent married life is brought to emergency with 3 hours
history of inability to speak. She is otherwise conscious. IDL shows normal-appearing vocal cords
that fail to adduct on attempted phonation. Her cough is normal. Choose the most likely pathology
from the following?
a) Bilateral abductor palsy
b) Vocal cords nodules
c) Myasthenia gravis
d) Functional aphonia
e) Fixation of cricoarytenoid joint
Q37: After Thyroid surgery, patient presented with hoarseness of voice, respiratory distress on
exertion. IDL examination will be
a) Bilateral vocal cord paralysis with vocal cords near the midline
b) Bilateral vocal cord paralysis with vocal cord away from the midline in cadaveric position
c) Unilateral cord is in lateral position
d) Loss of tension in one cord
e) one cord was normal, other close to midline and immobile
Q38: In a patient tracheostomy was planned, will help the patient in all except
a) Bilateral vocal cord paralysis with vocal cords near the midline
b) Bilateral vocal cord paralysis with vocal cords away from the midline in cadaveric position
c) Laryngomalacia
d) Left Unilateral vocal cord paralysis
e) Acute epiglottitis
Q39: In 35 years' patient Voice is good with severe dyspnea
a) Bilateral recurrent nerve paralysis
b) Bilateral superior laryngeal nerve paralysis
c) unilateral recurrent nerve paralysis
d) unilateral vagus nerve paralysis
e) Bilateral Vagus nerve paralysis
Q40: In 35 years' patient, slight dysphonia without dyspnea
a) Bilateral recurrent nerve paralysis
b) Unilateral superior laryngeal nerve paralysis
c) unilateral recurrent nerve paralysis
d) unilateral vagus nerve paralysis
e) Bilateral Vagus nerve paralysis
Q41: A 25 years' hawker presented with hoarseness of voice, All are caused by voice abuse except
a) Vocal nodules
b) Reinke's Edema
c) Vocal cord polyp
d) Papilloma larynx
e) Chronic hypertrophic laryngitis
Q42: Internal branch of superior laryngeal nerve pierce
a) Cricothyroid membrane
b) Thyrohyoid membrane
c) Cricovocal membrane
d) Aryepiglottic membrane (Fold)
e) Quadrangular membrane
Q43: Examination of larynx by palpation includes
a) Indirect laryngoscopy (IDL)
b) Fibre-optic laryngoscopy
c) Laryngeal crepitus
d) Direct laryngoscopy
e) Laryngopharyngoscopy
Q44: Commonest indication for Myringotomy is
a) Myringitis bullosa
b) Serous otitis media
c) Middle ear defect
d) Mastoiditis
e) Otosclerosis
Q45: Flat Tympanogram is a feature of
a) Ossicular discontinuity
b) Serous otitis media
c) Perforation of eardrum
d) Otosclerosis
e) CSOM
Q46: Treatment of choice in deafness associated with Attico antral perforation is
a) Simple mastoidectomy
b) Modified radical mastoidectomy
c) Watch and wait
d) Instillation of antibiotic drops
e) Myringoplasty
Q47: In a classic case of Meniere’s disease which one of the following statements is TRUE?
a) Carhart’s Notch is a characteristic feature in pure tone audiogram
b) Schwartz’s sign is usually present in the Tympanic membrane
c) Low frequency sensory neural deafness is often seen in pure tone audiogram
d) Decompression of Fallopian Canal is the treatment of choice.
e) Antibiotics and steroids play an important role in the recovery.
Q48: The normal length of external auditory meatus is
a) 7mm
b) 10mm
c) 24mm
d) 36mm
e) 46mm
Q49: The commonest extra cranial complication following mastoidectomy includes
a) Facial nerve palsy
b) Dislocation of incus
c) Post-operative hematoma
d) Cochlear injury
e) Trigeminal nerve injury
Q50: A 3years old child presents with fever and (Rt) earache from last 48 Hrs, which is not
relieving with medications. On otoscopic examination, there is congested tympanic membrane
with slight bulge with” cart wheel appearance”. What is the treatment of choice in this patient?
a) Myringotomy with broad spectrum antibiotics
b) Myringotomy with grommet with antibiotics
c) Only antibiotics and analgesics
d) Wait and observe the patient.
e) Self-limited. No treatment required.
Q51: Common cause of Eustachian tube disease is due to
a) Adenoids
b) Sinusitis
c) Otitis media
d) Pharyngitis
e) Tonsillitis
Q52: A patient of CSOM with Cholesteatoma present with acute onset of vertigo treatment is
a) Immediate exploration
b) Antibiotics + Steroids
c) Labyrinthine sedatives + Bed Rest
d) Labyrinthine sedatives only
e) Conservative treatment / No surgical intervention required
Q53: Bell’s palsy not responding to steroid what will be the further line of management?
a) Increase the dose of steroid
b) Vasodilators and ACTH
c) Surgical decompression
d) Electrical nerve stimulation
e) Facial physiotherapy
Q54: Condition where a pulsatile tumour is found in external auditory meatus which bleeds to
touch is
a) Cholesteatoma
b) Polyp
c) Glomus tumour
d) Malignancy middle ear
e) Acoustic neuroma
Q55: All of the following are Ototoxic drugs except
a) Kanamycin
b) Streptomycin
c) Gentamicin
d) Ampicillin
e) Metronidazole
Q56: Hypoesthesia of the posterior aspect of the external auditory canal may be an early sign of
a) Trigeminal neuralgia
b) Facial paralysis
c) Lateral sinus thrombosis
d) Multiple sclerosis
e) Acoustic neuroma
Q57: A 20 years old girl presented to ENT OPD with odynophagia and trismus for the last 2 days.
One examination, floor of mouth is swollen & tongue seems to pushed upward & backward .she
has Hx of tooth extraction some days ago. The probable diagnose is
a) Retropharyngeal abscess
b) Parapharyngeal abscess
c) Ludwig’s angina
d) Parotid abbess
e) Dental abscess
Q58: A 65 years old male presented to ENT OPD with dysphagia to solids from last 2 months
.patient is malnourished and gives Hx of gurgling sound is produced on swallowing . He also
complains of undigested food and regurgitation at night. Which investigation will you carry out to
confirm diagnosis?
a) MRI
b) CT Scan
c) Barium swallow
d) Blood CP
e) X ray lateral neck soft tissue
Q59: “Rat ail “’ appearance is the diagnostic feature of
a) Hiatus hernia
b) Pre-vertebral space abscess
c) Achalasia Cardia
d) Plummer Vinson syndrome
e) Pharyngeal pouch
Q60: A 20 years old male patient presents with history of left ear blockage and reduced hearing
from some weeks. On examination, brownish material was found in the external auditory canal.
The best solution for softening the wax is
a) Gentacin ear drops
b) Normal saline
c) Warm oil
d) Liquid paraffin
e) 5 % soda glycerin
Q61: A patient comes to ENT OPD with severe pain in right ear and hearing loss from 2dayst. On
exam, blood and air bubbles were seen behind tympanic membrane. Tympanic membrane was
intact. He also has history of travelling by air. The Probable diagnosis is
a) ASOM
b) CSOM
c) Secretory OM
d) Barotrauma
e) Ossicular Chain disruption
Q62: The most common tumor of external auditory canal following long standing blood stained
mucopurulant discharge with severe earache is
a) Squamous cell carcinoma
b) Basal cell adenoma
c) Adenocarcinoma
d) Malignant otitis externa
e) Malignant melanoma
Q63: Most common cause of facial nerve paralysis is?
a) Bell’s palsy
b) Cholesteatoma
c) Mastoidectomy
d) Parotid surgery
e) Herpes zoster otitis
Q64: Slow growing tumor involving the facial nerve is
a) Warthin tumour
b) Lipoma
c) Oncocytoma
d) Mucoepidermoid carcinoma
e) Pleomorphic adenoma
Q65: Tip of tongue drains into
a) Sub mandibular node
b) Deep cervical nodes
c) Jugulodiagestric nodes
d) Superficial cervical node
e) Sub mental lymph node
Q66: Chances of Post cricoid CA in patients of Plummer Vinson syndrome IS
a) 30%
b) 10%
c) 80%
d) 90%
e) 25%
Q67: A 6 years old child brought to ENT OPD for the evaluation of hearing problem. There is
suspicion of Otitis media with effusion. What is the best investigation to confirm the diagnosis?
a) Pure tone audiometry
b) Tympanometry
c) Tuning fork tests
d) Speech audiometry
e) Brain stem evoked response audiometry
Q68: A young female patient came to ENT OPD with complaints of ringing of ears from last some
months . she also gave history of CSOM for which using gentamycin ear drops. Most probable
cause is
a) BPPV
b) Ototoxicity
c) Salicylates level
d) Complication of Cholesteatoma
e) Fracture petrous temporal bone
Q69: A28 years male patient gives history of chronic suppurative otitis media from last 3 years.
What can be the Most common complication if untreated?
a) Meningitis
b) Extra Dural abscess
c) Petrositis
d) Acute Mastoiditis
e) Facial paralysis
Q70: Best treatment for Atticoantral type CSOM is
a) Cortical mastoidectomy
b) Canal wall down procedure
c) Atticotomy
d) Myringotomy
e) Tympanoplasty
Q71: A Patient presented with mucoid, odorless, profuse ear discharge from last 1 year. What
otoscopic findings are expected in this case?
a) Attic perforation
b) Retraction pockets
c) Marginal perforation
d) Congested tympanic membrane
e) Central perforation
Q72: Cortical mastoidectomy is also called
a) Canal wall up mastoidectomy
b) Atticotomy
c) Canal will down mastoidectomy
d) Modified radical mastoidectomy
e) Tympanoplasty
Q73: A 23 years old patient presented in ENT OPD with complaint of pulsatile tinnitus. Otoscopy
shows “Rising sun” appearance. What is the most likely diagnosis?
a) Otosclerosis
b) Vestibular schwanoma
c) Glomus Tumour
d) Acute SOM
e) Meniere’s disease
Q74: Which of the following is a cause of sensorineural hearing loss?
a) Presbycusis.
b) Tympanosclerosis.
c) Otosclerosis.
d) Longitudinal fracture of the temporal bone.
e) Cholesteatoma.
Q 75: A child aged 3 years presented with severe sensorineural deafness, he was
prescribed hearing aids but showed no improvement. What is the next line of
management?
a) Myringotomy
b) Stapedectomy
c) Cochlear implant.
d) Conservative. No treatment required
e) Mastoidectomy.
Q 76: A 50 years old diabetic male patient has developed severer itching in his ears. On
Otoscopy, there is debris with black specks in external auditory canal. The treatment
of choice in this case is:-
a) Otosporin ear drops.
b) Gentamicin ear drops.
c) Salicylic acid in spirit drops.
d) Repeated suction toilet with antifungal drops.
e) Oral anti-fungal drugs.
Q 77: Adenoidectomy is indicated in all of the following conditions except:
a) Otitis media with effusion.
b) Nasal obstruction due to adenoidal hyperplasia.
c) Allergic rhinitis in children.
d) Recurrent otitis media in children.
e) Sleep apnea syndrome.
Q78: A 2 years old baby has put a plastic bead in his ear. On Otoscopy, it is present in
deeper portion of meatus and totally occluding the meatus. The best way to remove this
bead is:
a) Remove it with foreign body hook.
b) Remove it with crocodile forceps.
c) Remove it with suction.
d) Remove it with ear syringing.
e) Remove it under general anesthesia using microscope
Q 79: Which statement is CORRECT regarding Juvenile Angiofibroma:
a) Patients have often had repeated episodes of epistaxis.
b) It is a tumour of young girls with a mean age of 14 at presentation.
c) Bone erosion of the greater wing of the sphenoid does not occur.
d) Cervical lymphadenopathy is present.
e) External beam radiotherapy is first line treatment.
Q 80: All are causes of congenital STRIDOR except:
a) Acute epiglottitis.
b) Laryngeal web.
c) Subglottic stenosis.
d) Laryngomalacia.
e) Vascular anomaly.
Q 81: Absolute indication of tonsillectomy is:
a) Chronic tonsillitis.
b) Diphtheria carrier.
c) Obstructive sleep apnea .
d) Glossopharyngeal neurectomy.
e) Rheumatic fever.
Q 82: Which of the following is not a complication of acute tonsillitis?
a) Peritonsillar abscess.
b) Bezold’s abscess.
c) Acute rheumatism.
d) Acute nephritis.
e) Acute infection of middle ear cleft
Q 83: Trismus accompanying Quinsy is due to spasm of which muscle?
a) Masseter.
b) Pharyngeal constrictors.
c) Medial pterygoid.
d) Temporalis.
e) Palatopharyngeus
Q 84: Indication of tracheostomy:
a) In all cases of acute laryngitis.
b) In any intubated patient within 3 days.
c) Unilateral Choanal atresia.
d) Bilateral vocal cord paralysis.
e) If there is suspicion of Laryngomalacia
Q 85: The little’s area is supplied by :
a. Superior labial artery, anterior Ethmoidal artery, greater palatine artery and
spheno-ethmoidal artery.
b. Superior labial artery, posterior Ethmoidal artery, greater palatine artery
and spheno-ethmoidal artery.
c. Superior labial artery, anterior Ethmoidal artery, lesser palatine artery and
spheno-ethmoidal artery.
d. Inferior labial artery, anterior Ethmoidal artery, greater palatine artery and
spheno-ethmoidal artery.
e. None of the above.
Q 86: Inflammation of the external nose:
a. Furunolosis is due to streptococcus infection.
b. Furunculosis cannot be complicated by cavernous sinus thrombosis.
c. Usually painless.
d. Needs many investigations for diagnosis.
e. Infections should be treated with broad spectrum antibiotics.
Q 87: All of the following are causes of bilateral nasal obstruction except:
a. Adenoids.
b. Allergic rhinitis.
c. Antro-choanal polyp.
d. Ethmoidal polyp.
e. Atrophic rhinitis.
Q 88: All of the following are complications of sinusitis except:
a. Cavernous sinus thrombosis.
b. Orbital cellulitis
c. Toxic shock syndrome.
d. Glomerulonephritis.
e. Pott's puffy tumor.
Q 89: The diagnostic test of Allergic Rhinitis is
a) Blood CP / ESR
b) Serum Ig E
c) Skin prick test
d) Nasal provocation test
e) RAST
Q 90: A complication of common cold:
a. Otitis externa.
b. Quinsy.
c. Facial palsy.
d. Maxillary sinusitis.
e. Inverted papilloma.
Q 91: A 5 year old patient is scheduled for tonsillectomy. On the day of surgery he had
runny nose, temperature 37.5°C and dry cough. Which of the following should be the most
appropriate decision for surgery?
a) Surgery should be cancelled for one week treatment of paracetamol,
b) Can proceed for surgery if chest is clear and there is no history of asthma
c) Should get X-ray chest before proceeding for surgery
d) Cancel surgery for 3 weeks and patient to be put on antibiotics
e) No treatment required. Do surgery. As it is viral infection.
Q 92: Lymphatic drainage of palatine Tonsil is
a) Jugulodiagestric
b) Prelaryngeal
c) Jugulo-omohyoid
d) Sub mental
e) Para tracheal
Q 93: Commonest causative organism leading to Acute Laryngo-tracheo-bronchitis is
a) Staphylococcus aureus
b) Streptococcus
c) Para influenza
d) Corynebacterium diphtheria
e) H –Influenza
Q 94: A boy 9 years of age presents with a mass in the midline of neck just
below the hyoid bone noted 6 months back. It moves with protrusion of
tongue. The most probable diagnosis is:
a) Cystic Hygroma.
b) Thyroglossal duct cyst
c) Haemangioma.
d) Branchial cleft cyst.
e) Dermoid cyst.
Q 95: Nasal perforation in bony part is caused by
a) Syphilis
b) Atrophic rhinitis
c) Systemic lupus erythematosis
d) Tuberculosis
e) Wagner granulomatosis
Q 96: The most common bacteria leading to Acute Rhino -sinusitis is
a) Streptococcus pneumonia
b) Haemophilus influenza
c) Moraxella catarrhalis
d) Staphylococcus specie
e) E- coli
Q 97: Which of the PNS is most commonly involved in malignancy?
a) Maxillary
b) Ethmoid
c) Frontal
d) Sphenoid
e) All of the above
Q 98: Cartilaginous part of Eustachian tube is
a) 1/3
b) 2/3
c) 1/2
d) 3/4
e) None of the above
