ENT 1 PDF - Previous Year Questions

Made with Xodo PDF Reader and Editor Index Anatomy of External, Middle and Internal Ear - Page 1 Physiology of Hearing. - Page 23 Assessment of Hearing - Page 28 Vestibular System (Physiology, Assessment & Disease of Vestibular System) - Page 43 Diseases of External Ear & Eustachian Tube - Page 62 Acute Suppurative Otitis Media - Page 77 Chronic Suppurative Otitis Media,Cholesteatoma - Page 90 Complication of ASOM and CSOM - Page 102 Otosclerosis - Page 112 Facial Nerve and Acoustic Neuroma - Page 119 Meniere’s Disease - Page 130 Glomus Tumor - Page 138 Hearing Rehabilitation, Otalgia and Tinnitus - Page 145 Previous Year Questions (Ear) - Page 150 Anatomy of Nose and Paranasal Sinuses - Page 214 Septal Disease and Disease of External Nose - Page 233 Acute Chronic Rhinitis,CSF Rhinorrhea - Page 249 Granulomatous Lesions of the Nose - Page 261 Congenital Anomalies of the Nose - Page 273 Nasal Polyps - Page 279 Epistaxis - Page 285 Facial Trauma - Page 292 Sinusitis and its Complications - Page 300 Tumors of Nose and Paranasal Sinuses (Including Malignancies) - Page 310 Previous Year Questions (Nose and Paranasal Sinuses) - Page 319 Anatomy of Pharynx and Pharyngeal Spaces - Page 386 Adenoids and Tonsils - Page 397 Juvenile Nasopharyngeal Angiofibroma - Page 412 Diseases of Pharynx (Ludwig's Angina,Abscess) - Page 419 Previous Year Questions (Pharynx) - Page 428 Anatomy of Larynx - Page 467 Inflammatory Conditions of the Larynx (Including Benign Inflammatory lesions) - Page 472 Voice Pathologies - Page 479 Congenital Lesions of Larynx and Stridor - Page 484 Laryngeal Paralysis - Page 491 Laryngeal Carcinoma - Page 498 Made with Xodo PDF Reader and Editor Index Previous Year Questions (Larynx) - Page 502 Instruments - Page 532 Made with Xodo PDF Reader and Editor Anatomy of External, Middle and Internal Ear 1. Which part of the temporal bone is elongated and projects at the base of the temporal bone? A. Squamous B. Tympanic C. Styloid D. Petromastoid E. Zygomatic ---------------------------------------- 2. Which nerve supplies the lateral surface of the tympanic membrane and can cause a cough reflex when stimulated? A. Lesser Occipital Nerve B. Auriculotemporal Nerve C. Greater Auricular Nerve D. Arnold's Nerve ---------------------------------------- 3. Which nerve supplies the roof and the anterior wall of the external auditory canal? A. Lesser occipital nerve B. Greater auricular nerve C. Auriculotemporal nerve D. Vagus nerve ---------------------------------------- 4. What is the effective vibrating area of the tympanic membrane? A. 90 mm² B. 45 mm² C. 10 mm² D. 20 mm² ---------------------------------------- 5. How is the side of the tympanic membrane identified based on the cone of light? A. 3 o'clock to 6 o'clock - Right B. 6 o'clock to 9 o'clock - Right C. 9 o'clock to 12 o'clock - Right D. 12 o'clock to 3 o'clock – Left ---------------------------------------- 6. What type of perforation involves all the quadrants of the pars tensa but leaves the annulus intact? A. Central perforation 1 Made with Xodo PDF Reader and Editor B. Attic perforation C. Large perforation D. Subtotal perforation ---------------------------------------- 7. What is the length of the external auditory canal, and how is it divided into cartilaginous and bony parts? A. 24mm; 1/3 cartilaginous, 2/3 bony B. 24mm; 1/3 bony, 2/3 cartilaginous C. 16mm; equal parts cartilaginous and bony D. 16mm; 1/3 cartilaginous, 2/3 bony ---------------------------------------- 8. The communication present between the underlying parotid gland and the cartilaginous part of the external auditory canal is called: A. Parotid Canal B. Foramen of Huschke C. Fissure of Santorini D. Parotid Duct ---------------------------------------- 9. What is the narrowest portion of the external auditory canal, and where is it located? A. Fissure of Santorini; 6mm lateral to the tympanic membrane: B. Isthmus; 6mm lateral to the tympanic membrane C. Foramen of Huschke; 4mm lateral to the tympanic membrane D. Isthmus; 4 mm lateral to the tympanic membrane ---------------------------------------- 10. Mark the incorrect statement regarding the external ear in an adult: A. Cavum concha is the biggest depression in the external ear B. The purpose of the Lempert endaural incision is to prevent cartilaginous necrosis C. External auditory canal is straightened for visualization of the tympanic membrane by pulling it downwards and outwards. D. Tympanic membrane is placed to the EAC at an angle of 45 degrees. E. Annulus is absent in pars flaccida ---------------------------------------- 11. In the upper portion of the tympanic membrane, which layer is absent? A. Epithelial layer B. Endothelial layer C. Fibrous layer Page 2 2 Made with Xodo PDF Reader and Editor D. None of the above ---------------------------------------- 12. Identify the marked structure: A. Crux of helix B. Triangular fossa C. Incisura terminalis D. Cymba concha ---------------------------------------- 13. Which part of the middle ear is known as the attic? A. Protympanum B. Mesotympanum C. Hypotympanum D. Epitympanum ---------------------------------------- 14. What is the correct order of structures in the ventilation pathway of the middle ear cleft? A. Eustachian tube → Nasopharynx → Aditus → Antrum → Mastoid air cells B. Nasopharynx → Eustachian tube →Aditus → Antrum → Mastoid air cells C. Aditus → Nasopharynx → Eustachian tube → Mastoid air cells → Antrum D. Antrum → Eustachian tube → Nasopharynx → Mastoid air cells → Aditus ---------------------------------------- 15. At what level does the anteroposterior dimension of the middle ear become 6mm? A. Epitympanum B. Mesotympanum C. Hypotympanum D. Protympanum ---------------------------------------- 16. Match the following structures with the respective walls that they correspond to: 1 Pyramid A Medial wall 2 Canal for tensor tympani B Lateral wall 3 Scutum C Anterior wall 4 Promontory D Posterior wall Page 3 3 Made with Xodo PDF Reader and Editor 1 Pyramid A Medial wall 2 Canal for tensor tympani B Lateral wall 3 Scutum C Anterior wall 4 Promontory D Posterior wall A. 1-C, 2-B, 3-D, 4-A B. 1-B, 2-C, 3-D, 4-A C. 1-D, 2-C, 3-B, 4-A D. 1-C, 2-D, 3-B, 4-A ---------------------------------------- 17. What is the landmark for the 1st geniculate ganglion of the facial nerve in the middle ear? A. Oval window B. Cochleariform process C. Promontory D. Pyramid ---------------------------------------- 18. Which structure marks the boundary between the superficial and deep cells of the mastoid bone? A. Tegmen tympani B. MacEwen triangle C. Korner's septum D. Supra mastoid crest ---------------------------------------- 19. What is the landmark for the endolymphatic duct in the inner ear? A. Donaldson's line B. Helicotrema C. Bill's bars D. Oval window ---------------------------------------- 20. What is the most common site for residual cholesteatoma in the middle ear? A. Facial recess B. Fallopian canal C. Mastoid antrum D. Sinus tympani ---------------------------------------- 21. What is the fluid flow sequence of endolymph in the inner ear? A. Cochlear duct → Utricle → Vestibular aqueduct → Saccule → SSC Page 4 4 Made with Xodo PDF Reader and Editor B. Utricle → Saccule → Cochlear duct → Endolymphatic duct → Endolymphatic sac C. Cochlear duct → Utricle → Saccule → Endolymphatic sac → Endolymphatic duct D. Cochlear duct → Saccule → Vestibular aqueduct → Utricle → SSC ---------------------------------------- 22. Which nerve supplies the tensor tympani muscle? A. Cranial nerve VII B. Cranial nerve IX C. Cranial nerve V D. Cranial nerve X ---------------------------------------- 23. A 45-year-old patient presents with a history of chronic ear infections and hearing loss. Otoscopic examination reveals a cholesteatoma involving the mastoid region. The surgeon decides to perform a mastoidectomy and during the surgical procedure, the surgeon carefully identifies a specific landmark to prevent injury to the cranial fossa. What is this special landmark? (or) In a mastoidectomy for cholesteatoma removal, what specific landmark does the surgeon carefully identify to prevent injury to the cranial fossa in a patient with chronic ear infections and hearing loss? A. Jugular tubercle B. Supra mastoid crest C. Mastoid foramen D. Scutum ---------------------------------------- 24. The medial wall of the middle ear has impressions formed by: A. Oval window and round window B. Tensor tympani muscle and internal carotid artery C. Cochleariform process D. Basal turn of the cochlea and lateral semicircular canal ---------------------------------------- 25. What is the fluid communication between scala tympani and the subarachnoid space called? A. Vestibular aqueduct B. Endolymphatic duct C. Aqueduct of cochlea D. Aqueduct of vestibule ---------------------------------------- 26. When does intrauterine hearing start during gestation? A. 12 weeks B. 16 weeks Page 5 5 Made with Xodo PDF Reader and Editor C. 20 weeks D. 24 weeks ---------------------------------------- 27. Which surgical procedure involves accessing the middle ear through the supra-pyramidal recess? A. Anterior tympanotomy B. Tympanoplasty C. Posterior tympanotomy D. Mastoidectomy ---------------------------------------- 28. Match the structures with their corresponding functions: A Cochlea 1 Responsible for hearing. B Utricle 2 Detects angular or rotatory motion. C Saccule 3 Central chamber with bony recesses. D Crista ampularis 4 Neurosensory epithelium for hearing and balance. E Semi-circular canals 5 Maintains balance in vertical, horizontal, and oblique axes. A Cochlea 1 Responsible for hearing. B Utricle 2 Detects angular or rotatory motion. C Saccule 3 Central chamber with bony recesses. D Crista ampularis 4 Neurosensory epithelium for hearing and balance. E Semi-circular canals 5 Maintains balance in vertical, horizontal, and oblique axes. A. A-2, B-5, C-4, D-1, E-3 B. A-3, B-2, C-1, D-4, E-5 C. A-1, B-3, C-4, D-2, E-5 D. A-1, B-3, C-5, D-4,E-2 ---------------------------------------- 29. How is the elliptical recess connected to the opening of the Semi-circular Canal duct? A. Anteriorly B. Posteriorly C. Superiorly D. Inferiorly ---------------------------------------- 30. Mark the correct statement regarding hair cells: A. Type 2 cells are single cells B. Type 1 cells secrete inhibitory neurotransmitters C. Type 3 cells are outer hair cells D. Type 1 cells are afferent ---------------------------------------- 31. Which nerve is located in the antero-superior quadrant of the internal auditory canal? Page 6 6 Made with Xodo PDF Reader and Editor A. Facial nerve B. Cochlear nerve C. Superior vestibular nerve D. Inferior vestibular nerve ---------------------------------------- 32. Match the following parts of the ear with the respective embryonic origin: 1 Superstructure of stapes A Otic capsule 2 Footplate of stapes B 1st and 2nd arch 3 Pinna C 1st arch 4 Malleus D 2nd arch 1 Superstructure ofstapes A Otic capsule 2 Footplate of stapes B 1stand 2ndarch 3 Pinna C 1starch 4 Malleus D 2ndarch A. 1-B, 2-C, 3-D, 4-A B. 1-D, 2-A, 3-C, 4-B C. 1-A, 2-D, 3-B, 4-C D. 1-D, 2-A, 3-B, 4-C ---------------------------------------- 33. Where is the organ of Corti located, and what is its function? A. In the scala vestibuli; responsible for balance B. In the scala tympani; responsible for hearing C. In the scala media; responsible for hearing D. In the scala vestibuli; responsible for hearing ---------------------------------------- Correct Answers Question Correct Answer Question 1 3 Question 2 4 Question 3 3 Question 4 2 Question 5 1 Question 6 4 Question 7 1 Question 8 3 Question 9 2 Question 10 3 Page 7 7 Made with Xodo PDF Reader and Editor Question 11 3 Question 12 4 Question 13 4 Question 14 2 Question 15 3 Question 16 3 Question 17 2 Question 18 3 Question 19 1 Question 20 4 Question 21 4 Question 22 3 Question 23 2 Question 24 4 Question 25 3 Question 26 3 Question 27 3 Question 28 3 Question 29 2 Question 30 4 Question 31 1 Question 32 4 Question 33 3 Solution for Question 1: Correct Option C - Styloid: The styloid process is an elongated projection that projects at the base of the temporal bone. It is part of the temporal bone and serves as an attachment point for several muscles and ligaments, including the stylohyoid ligament and muscles involved in tongue movement. Incorrect Options: Option A - Squamous: The squamous part of the temporal bone is one of its largest parts and lies at th e upper end of temporal bone. Option B - Tympanic: The tympanic part is located between the styloid and zygomatic parts, containing the middle ear. It is not an elongated projection. Option D - Petromastoid: The petromastoid part is present on the lateral surface, and it includes the ma stoid part and the petrous part. It is not an elongated projection. Page 8 8 Made with Xodo PDF Reader and Editor Option E - Zygomatic: The zygomatic process of the temporal bone projects anteriorly from the squam ous part and not from the base of the temporal bone. Solution for Question 2: Correct Option D - Arnold's Nerve: Arnold's nerve, aka Alderman's nerve the auricular branch of the vagus nerve (cranial nerve X), supplies the lateral surface of the tympanic membrane. Stimulation of Arnold's nerve during any procedure, such as removing ear wax, may cause a cough reflex. This reflex occurs because Arnold's nerve (part of the vagus nerve), which innervates the larynx, causes a cough response when stimulated. Incorrect Options: Option A - Lesser Occipital Nerve: The lesser occipital nerve does not supply the tympanic membrane. It is primarily involved in the sensory innervation of the skin over the posterior part of the scalp. Option B - Auriculotemporal Nerve: The auriculotemporal nerve supplies the lateral surface of the tymp anic membrane but it is not responsible for cough reflex. Option C - Greater Auricular Nerve: The greater auricular nerve mainly supplies the lower portion of the pinna. It does not cause a cough reflex. Solution for Question 3: Correct Option C - Auriculotemporal nerve: The auriculotemporal nerve is a branch of the mandibular nerve (V3), which is part of the trigeminal nerve. This nerve supplies the roof and the anterior wall of the external auditory canal. Incorrect Options: Option A - Lesser occipital nerve: The lesser occipital nerve primarily supplies the skin of the posterior aspect of the auricle (pinna) and the scalp behind the auricle. Option B - Greater auricular nerve: The greater auricular nerve supplies the major portion of the pinna ( mainly, the lower portion). Option D - Vagus nerve: The auricular branch of the vagus nerve supplies the posterior wall and floor o f the external auditory canal. Solution for Question 4: Correct Option B - 45 mm²: The effective vibrating area of the tympanic membrane is the peripheral portion because the central portion is where the handle of the malleus bone rests, preventing vibrations. The total surface area of the tympanic membrane is 90 mm², but the effective vibrating area is only half of that, which is 45 mm². Incorrect Options: Page 9 9 Made with Xodo PDF Reader and Editor Option A - 90 mm²: This represents the total surface area of the tympanic membrane, not the effective vibrating area, i.e. 45 mm². Option C - 10 mm²: The effective vibrating area of the tympanic membrane is 45 mm². Option D - 20 mm²: The effective vibrating area of the tympanic membrane is 45 mm². Solution for Question 5: Correct Option A- 3 o'clock to 6 o'clock - Right: The cone of light is a triangular reflection of light that is visible on the tympanic membrane when illuminated. The orientation of the cone of light helps in identifying the side of the tympanic membrane. If the cone of light is present in the 3 o'clock to 6 o'clock position, it indicates the right tympanic membrane. Incorrect Options: Option B - 6 o'clock to 9 o'clock - Right: The cone of light in this position would indicate the left tympanic membrane, not the right. Option C - 9 o'clock to 12 o'clock -Right: The cone of light does not appear in this position. Option D - 12 o'clock to 3 o'clock – Left: The cone of light in this position would indicate the right tympanic membrane, not the left. Solution for Question 6: Correct Option D - Subtotal perforation: A subtotal perforation is a type of tympanic membrane perforation that involves all four quadrants of the pars tensa but leaves the annulus intact. Perforations are different from total perforations, where the entire tympanic membrane, including the annulus, is disrupted. Incorrect Options: Option A - Central perforation: This term refers to any perforation in the pars tensa. Option B - Attic perforation: Attic perforation specifically involves the pars flaccida, which is the upper p ortion of the tympanic membrane. Option C - Large central perforation: Large central perforation involves more than one quadrant. Solution for Question 7: Correct Option A - 24mm; 1/3 cartilaginous, 2/3 bony: The external auditory canal has a total length of 24mm. It is divided into two parts: The cartilaginous part, which accounts for 1/3rd(8mm) of the external auditory canal, is the lateral section. The bony part, which accounts for the remaining 2/3rd(16mm) portion of the external auditory canal, is the medial Page 10 10 Made with Xodo PDF Reader and Editor section. The cartilaginous part, which accounts for 1/3rd(8mm) of the external auditory canal, is the lateral section. The bony part, which accounts for the remaining 2/3rd(16mm) portion of the external auditory canal, is the medial section. Incorrect Options: Option B - 24mm; 1/3 bony, 2/3 cartilaginous: The length of the external auditory canal is 24mm and the lateral 1/3rd is the cartilaginous part and the medial 2/3rd is the bony part. Option C - 16mm; equal parts cartilaginous and bony: The length of the external auditory canal is 24mm and the lateral 1/3rd is the cartilaginous part and the medial 2/3rd is the bony part. Option D - 16mm; 1/3 cartilaginous, 2/3 bony: The length of the external auditory canal is 24mm and the lateral 1/3rd is the cartilaginous part and the medial 2/3rd is the bony part. Solution for Question 8: Correct Option C - Fissure of Santorini: The Fissure of Santorini is the communication present between the underlying parotid gland and the cartilaginous part of the external auditory canal. This anatomical structure can allow infections to pass back and forth between the external ear and the parotid gland. Incorrect Options: Option A - Parotid Canal: There is no structure called parotid canal. Option B - Foramen of Huschke: The Foramen of Huschke is an opening that can be present in the bo ny part of the external auditory canal, not in the cartilaginous part. Option D - Parotid Duct: The Parotid Duct (Stensen's Duct) is a separate structure responsible for draining saliva from the parotid gland into the oral cavity. Solution for Question 9: Correct Option B - Isthmus; 6mm lateral to the tympanic membrane: The narrowest portion of the external auditory canal is the isthmus, located 6mm lateral to the tympanic membrane. This area is prone to wax impaction and foreign body lodgment. Incorrect Options: Option A - Fissure of Santorini; 6mm lateral to the tympanic membrane: Fissure of Santorini is not the narrowest portion of the external auditory canal; it is a communication between the canal and the parotid gland. Page 11 11 Made with Xodo PDF Reader and Editor Option C - Foramen of Huschke; 4mm lateral to the tympanic membrane: Foramen of Huschke is not the narrowest portion of the external auditory canal; it is a communication between the canal and the parotid gland. Option D - Isthmus; 4 mm lateral to the tympanic membrane: Isthmus is located 6mm lateral to the tympanic membrane, not 4mm lateral. Solution for Question 10: Correct Option C - External auditory canal is straightened for visualization of the tympanic membrane b y pulling it downwards and outwards: The EAC is S-shaped, so it is necessary to straighten the canal before visualizing it. To do so, the pinna is stretched upwards, backward, and outwards in adult patients and in children, the pinna is stretched downwards and backward because the bony portion of the external auditory canal has not been fully developed. Incorrect Options: Option A - Cavum concha is the biggest depression in the external ear: Cavum concha is the biggest depression in the external ear and it is surrounded by the anti-tragus, tragus, and anti-helix. Option B - The purpose of the Lempert endaural incision is to prevent cartilaginous necrosis: The incisura terminalis is the site of incision in an endaural surgery and this incision is known as Lempert endaural incision. In case of postoperative infection, the lack of cartilage prevents the chances of underlying cartilage necrosis. Option D - Tympanic membrane is placed at an angle of 45 degrees: The tympanic membrane is a partition/curtain between the external ear and the middle ear. It is obliquely placed to the canal at an angle of 45 degrees to the floor of the canal. It is an oval-shaped structure, so it has a longer vertical axis and a shorter horizontal axis. Option E - Annulus is absent in pars flaccida: Annulus is absent in pars flaccida and present only in pars tensa. It provides tensile strength. Solution for Question 11: Correct Option C - Fibrous layer: The upper portion of the tympanic membrane, i.e. pars flaccida, is devoid of fibrous layer therefore it is loose and lax. Incorrect Options: Option A - Epithelial layer: Pars flaccida consists of an outer epithelial layer. Option B - Endothelial layer: Pars flaccida consists of an inner endothelial layer. Option D - None of the above: The tympanic membrane has only 3 layers. The pars flaccida is devoid of fibrous layer whereas the pars tensa has all 3 layers Page 12 12 Made with Xodo PDF Reader and Editor Solution for Question 12: Correct Option D - Cymba concha: The part marked as ‘A’ in the given picture is cymba concha. The cymba concha is a part of the pinna and refers to the concave, shallow depression located just above the ear canal opening. Incorrect Options: Option A - Crux of helix: The crux of helix is situated just below the marked structure A which is the cymba concha. Option B - Triangular fossa: The triangular fossa is a depression located between the antihelix and the helix of the ear. It is situated above the structure marked A in the image. Option C - Incisura terminalis: The incisura terminalis is a groove that separates the tragus from the ant itragus on the ear. It is not the structure identified in the image. Solution for Question 13: Correct Option D - Epitympanum The epitympanum is the part of the middle ear that is known as the attic. It is the uppermost portion of the middle ear and is located above the tympanic membrane. Incorrect Options: Option A - Protympanum: The protympanum is not known as the attic. It is the part of the middle ear an teriorly that has the opening of the Eustachian tube. Option B - Mesotympanum: The mesotympanum is a part of the middle ear but is not known as the atti c. It lies against the pars tensa of the tympanic membrane. Option C - Hypotympanum: The hypotympanum is not known as the attic. It is the part of the middle ea r that lies below the level of the annulus. Solution for Question 14: Correct Option B - Nasopharynx → Eustachian tube → Aditus → Antrum → Mastoid air cells: The correct order of structures in the ventilation pathway of the middle ear cleft is as follows: Nasopharynx: Air enters the pathway from the nasopharynx. ↓ Eustachian tube: The air travels through the Eustachian tube connecting the nasopharynx to the middl e ear. Aditus: There is communication between the attic tympanum and the antrum through the aditus. Antrum: The air passes through the antrum, which is the largest mastoid air cell Page 13 13 Made with Xodo PDF Reader and Editor Mastoid air cells: The air finally reaches the mastoid air cells. Incorrect Options: Option A - Eustachian tube → Nasopharynx → Aditus → Antrum → Mastoid air cells: This sequence is incorrect as it reverses the order of the structures in the ventilation pathway. Option C - Aditus → Nasopharynx → Eustachian tube → Mastoid air cells → Antrum: This sequence is incorrect as it places the aditus before the Eustachian tube, disrupting the correct order. Option D - Antrum → Eustachian tube → Nasopharynx → Mastoid air cells → Aditus: This sequence is incorrect as it reverses the order and misplaces the antrum in relation to the Eustachian tube. Solution for Question 15: Correct Option C - Hypotympanum: The anteroposterior dimension of the middle ear becomes 6mm at the level of the hypotympanum. Incorrect Options: Option A - Epitympanum: The epitympanum is the part of the middle ear lying against the pars flaccida and here the anteroposterior dimension becomes 4mm. Option B - Mesotympanum: The mesotympanum is the part of the middle ear that lies against the pars tensa where the anteroposterior dimension becomes 2mm. Option D - Protympanum: The protympanum is the anterior part of the middle ear that has the opening of the Eustachian tube. Solution for Question 16: Correct Option C - 1-D, 2-C, 3-B, 4-A: 1 Pyramid D Posterior wall 2 Canal for tensor tympani C Anterior wall 3 Page 14 14 Made with Xodo PDF Reader and Editor Scutum B Lateral wall 4 Promontory A Medial wall Solution for Question 17: Correct Option B - Cochleariform process: In the middle ear, the landmark for the 1st geniculate ganglion of the facial nerve is the cochleariform process. The facial nerve enters the middle ear and takes its first turn, known as the 1st geniculate ganglion, at the cochleariform process. Incorrect Options: Option A - Oval window: The oval window is not associated with the geniculate ganglion of the facial nerve. Option C - Promontory: The promontory is not related to the 1st geniculate ganglion of the facial nerve. Option D - Pyramid: The pyramid is a projection on the posterior wall of the middle ear and is associate d with the 2nd genu of the facial nerve, not the 1st geniculate ganglion. Solution for Question 18: Correct Option C - Korner's septum: Korner's septum is a structure that marks the boundary between the superficial and deep cells of the mastoid bone. When the squamous cells (superficial) and the petrous cells (deep) fuse, they form a petrosquamous suture, and if the suture persists, it is referred to as Korner's septum. Incorrect Options: Option A - Tegmen Tympani: The tegmen tympani is a thin plate of bone that forms the roof of the mid dle ear. It separates the middle ear from the middle cranial fossa. Option B - MacEwen Triangle: MacEwen triangle is an important landmark used for identifying the mast oid antrum during mastoidectomy. It is marked by the supra mastoid crest, an imaginary line from the p osterior wall of the external auditory canal, and a tangential line connecting the first two lines. Option D - Supra Mastoid Crest: The supra mastoid crest is a superior landmark used to identify the tegmen antri during mastoidectomy. Page 15 15 Made with Xodo PDF Reader and Editor Solution for Question 19: Correct Option A - Donaldson's line: Donaldson's line is an imaginary line that passes from the lateral semicircular canal and bisects the posterior semicircular canal. It serves as a landmark for the endolymphatic duct in the inner ear. Incorrect Options: Option B - Helicotrema: The helicotrema is the communication point between the scala vestibuli and scala tympani at the apex of the cochlea. Option C - Bill's bars: Bill's bars are vertical crests of bone found in the cross-sections of the internal auditory canal. Option D - Oval window: The oval window is a membrane-covered opening between the middle ear and the vestibule of the inner ear. Solution for Question 20: Correct Option D - Sinus tympani: Sinus tympani is the most common site for residual cholesteatoma in the middle ear. The sinus tympani is a hidden space in the middle ear which makes it a challenging area to completely remove cholesteatoma during surgery. Due to its location and difficulty in visualization, residual cholesteatoma may be more likely to occur in the sinus tympani. Incorrect Options: Option A - Facial recess: The facial recess is not a common site for residual cholesteatoma. It is a spac e used in surgical approaches to the middle ear, especially in procedures like posterior tympanotomy. Option B - Fallopian canal: The fallopian canal is the bony canal through which the facial nerve passes. The fallopian canal is not a common site for residual cholesteatoma. Option C - Mastoid antrum: Mastoid atrum is the largest mastoid air cell, but it is not the most common site for residual cholesteatoma. Solution for Question 21: Correct Option D - Cochlear duct → Saccule → Vestibular aqueduct → Utricle → SSC: The correct sequence of fluid flow of endolymph in the inner ear is as follows: Cochlear duct → Saccule → Vestibular aqueduct → Utricle → SSC ducts Page 16 16 Made with Xodo PDF Reader and Editor This sequence ensures the proper circulation of endolymph within the membranous labyrinth, contributi ng to the functions of hearing and balance. Solution for Question 22: Correct Option C - Cranial nerve V: The tensor tympani muscle, which is one of the two intratympanic muscles in the middle ear, is supplied by the mandibular branch of the trigeminal nerve (Cranial nerve V). Incorrect Options: Option A - Cranial nerve VII: Facial nerve - The facial nerve does not supply the tensor tympani muscle. Option B - Cranial nerve IX: Glossopharyngeal nerve - The glossopharyngeal nerve does not supply the tensor tympani muscle. Option D - Cranial nerve X: Vagus nerve - The vagus nerve is not associated with the supply of the tensor tympani muscle. Solution for Question 23: Correct Option B - Supra mastoid crest: It is a true line/ridge present on the mastoid bone In mastoidectomy, the supra mastoid crest which is a part of the MacEwen triangle, is a critical landmark. Identifying this triangle is essential for avoiding injury to the tegmen antri and, subsequently, the middle cranial fossa. This precaution is particularly relevant in cases involving cholesteatoma removal. Incorrect Options: Option A - Jugular tubercle: The jugular tubercle is not a landmark to prevent injury to the cranial fossa. It is associated with the jugular foramen and the passage of the internal jugular vein. Option C - Mastoid foramen: The mastoid foramen is not a landmark to prevent injury to the cranial fossa. Option D - Scutum: The scutum is a part of the lateral wall of the middle ear and is not directly related to the cranial fossa. Solution for Question 24: Correct Option D - Basal turn of the cochlea and lateral semicircular canal: The medial wall of the middle ear has impressions formed by the basal turn of the cochlea and the lateral semicircular canal. These structures create distinct impressions on the medial wall, known as the promontory (formed by the basal turn of the cochlea) and the subiculum (formed by the lateral semicircular canal). Page 17 17 Made with Xodo PDF Reader and Editor Incorrect Options: Option A - Oval window and round window: The oval window and round window are not impressions on the medial wall; instead, they are openings in the middle ear related to sound transmission. Option B - Tensor tympani muscle and internal carotid artery: The tensor tympani muscle and internal carotid artery are located in the anterior wall of the middle ear, not the medial wall. Option C - Cochleariform process: The cochleariform process on the medial wall is a projection and not an impression. Solution for Question 25: Correct Option C - Aqueduct of cochlea: The fluid communication between the scala tympani and the subarachnoid space is called the Aqueduct of Cochlea. Incorrect Options: Option A - Vestibular Aqueduct: It is a bony covering over the endolymphatic duct and not a fluid commmunication. Option B - Endolymphatic duct: It is contains endolymph which is the fluid inside the membranous labyrinth. Option D - Aqueduct of Vestibule: It is not the fluid communication between the scala tympani and the subarachnoid space. Solution for Question 26: Correct Option C - 20 weeks: Intrauterine hearing begins during gestation, and by approximately 20 weeks, the fetal auditory system is developed enough for the fetus to start perceiving sounds. At this stage, the cochlea is structurally mature, allowing the fetus to detect and respond to auditory stimuli from the external environment. Incorrect Options: Option A - 12 weeks: At 12 weeks, cochlea is not sufficiently developed for the perception of sounds. Option B - 16 weeks: At 16 weeks, cochlea is not sufficiently developed for the perception of sounds. Option D - 24 weeks: By 24 weeks, intrauterine hearing has already begun, and the fetus is capable of perceiving sounds. Page 18 18 Made with Xodo PDF Reader and Editor Solution for Question 27: Correct Option C - Posterior Tympanotomy: In surgical procedures involving the middle ear, accessing it through the supra-pyramidal recess is associated with a posterior tympanotomy. This approach allows surgical access to the middle ear from the mastoid region, specifically through the supra-pyramidal recess. It is a technique commonly used in certain ear surgeries, including cochlear implantation. Incorrect Options: Option A - Anterior Tympanotomy: An anterior tympanotomy is not associated with the supra-pyramidal recess. Option B - Tympanoplasty: Tympanoplasty is not associated with the supra-pyramidal recess. Option D - Mastoidectomy: Mastoidectomy is not associated with the supra-pyramidal recess. Solution for Question 28: Correct Option D - A- 1, B- 3, C-4, D-2, E- 5: A Cochlea 1 Responsible for hearing. B Utricle 3 Neurosensory epithelium for hearing and balance.. D Crista ampularis 2 Detects angular or rotatory motion. E Semi-circular canals 4 Maintains balance in vertical, horizontal, and oblique axes. Page 19 19 Made with Xodo PDF Reader and Editor Solution for Question 29: Correct Option B - Posteriorly: The Elliptical recess is connected to the opening of the Semi-circular Canal (SSC) duct posteriorly. Incorrect Options: Option A - Anteriorly: The Elliptical recess is connected to the opening of the SSC duct posteriorly, not anteriorly. Option C - Superiorly: The Elliptical recess is connected to the opening of the SSC duct posteriorly, not superiorly. Option D - Inferiorly: The Elliptical recess is connected to the opening of the SSC duct posteriorly, not inferiorly. Solution for Question 30: Correct Option D - Type 1 cells are afferent: Type 1 hair cells are afferent nerve fibers that transmit auditory impulses. Afferent nerve fibers carry signals toward the central nervous system. Incorrect Options: Option A - Type 2 cells are single cells: Type 2 cells are multiple cells and are efferent nerve fibers that secrete an inhibitory neurotransmitter. Option B - Type 1 cells secrete inhibitory neurotransmitters: Type 1 cells secrete excitatory neurotransmitters, not inhibitory neurotransmitters. Option C - Type 3 cells are outer hair cells: There are no Type 3 hair cells. The typical classification involves Type 1 and Type 2 cells. Solution for Question 31: Correct Option A - Facial nerve: In the antero-superior quadrant of the internal auditory canal, the facial nerve is located. The internal auditory canal is a bony canal in the petrous part of the temporal bone. Incorrect Options: Option B - Cochlear nerve: The cochlear nerve is typically located in the antero-inferior quadrant of the internal auditory canal. Option C - Superior vestibular nerve: The superior vestibular nerve is in the postero-superior quadrant of the internal auditory canal. Option D - Inferior vestibular nerve: Page 20 20 Made with Xodo PDF Reader and Editor The inferior vestibular nerve is situated in the postero-inferior quadrant of the internal auditory canal. Solution for Question 32: Correct Option D - 1-D, 2-A, 3-B, 4-C: 1 Superstructure of stapes D 2nd arch 2 Footplate of stapes A Otic capsule 3 Pinna B 1st and 2nd arch 4 Malleus C 1st arch Solution for Question 33: Correct Option C - In the scala media; responsible for hearing: The organ of Corti is located in the scala media (cochlear duct) within the cochlea of the inner ear. It rests on the basilar membrane, which separates the scala media from the scala tympani. The organ of Corti is a crucial structure for the process of hearing. Incorrect Options: Option A - In the scala vestibuli; responsible for balance: The scala vestibuli is a fluid-filled chamber in the cochlea, and it does not contain the organ of Corti. Additionally, the organ of Corti is primarily involved in hearing, not balance. Option B - In the scala tympani; responsible for hearing: The scala tympani is in the cochlea, but the organ of Corti is not located here. Page 21 21 Made with Xodo PDF Reader and Editor Option D - In the scala vestibuli; responsible for hearing: The scala vestibuli does not contain the organ of Corti. It is present in the scala media. Page 22 22 Made with Xodo PDF Reader and Editor Physiology of Hearing. 1. What is the primary function of the external and middle ear in the physiology of hearing? A. Amplification of sound B. Transduction of sound C. Transmission of electrical impulses D. Conversion of mechanical energy ---------------------------------------- 2. Which ratio describes the effective transformation of sound energy from the tympanic membrane to the footplate of stapes? A. Lever ratio B. Areal ratio C. Total transformation ratio D. Phase difference ratio ---------------------------------------- 3. Which part of the cochlea is responsible for recognizing high-frequency sounds? A. Basal turn B. Apical turn C. Both apical and basal turns D. Helicotrema ---------------------------------------- 4. What percentage of sound energy goes to the inner ear through the impedance-matching mechanism? A. 1% B. 5% C. 0.1% D. 10% ---------------------------------------- 5. What is phase difference, and why is it important in sound transmission? A. Difference in frequency; enhances hearing B. Difference in amplitude; improves pitch perception C. Difference in time; effective vibration of the basilar membrane D. Difference in wavelength; reduces interference ---------------------------------------- 6. What structure does sound impulses travel through when going from the cochlear nucleus to the superior olivary complex? A. Tectorial membrane 23 Made with Xodo PDF Reader and Editor B. Basilar membrane C. Oval window D. Trapezoid body ---------------------------------------- 7. What part of the brain does the final perception of sound occur in? A. Brodmann area 41 B. Brodmann area 42 C. Medial geniculate body D. Inferior colliculus ---------------------------------------- 8. What is the primary function of the cochlear receptor in the auditory pathway? A. Recognizing pitch B. Conduction of electrical impulses C. Impedance matching D. Amplification of sound waves ---------------------------------------- Correct Answers Question Correct Answer Question 1 1 Question 2 2 Question 3 1 Question 4 3 Question 5 3 Question 6 4 Question 7 2 Question 8 1 Solution for Question 1: Correct Option A - Amplification of sound: The primary function of the external and middle ear is to amplify sound waves. The external ear collects sound waves and directs them into the ear canal, where they reach the middle ear. In the middle ear, the sound waves cause the tympanic membrane (eardrum) to vibrate, and these vibrations are then transmitted to the three small bones (ossicles) in the middle ear—malleus, incus, and stapes. The primary function of the external and middle ear is to amplify sound waves. The external ear collect s sound waves and directs them into the ear canal, where they reach the middle ear. In the middle ear, the sound waves cause the tympanic membrane (eardrum) to vibrate, and these vibrations are then tr Page 2 24 Made with Xodo PDF Reader and Editor ansmitted to the three small bones (ossicles) in the middle ear—malleus, incus, and stapes. Incorrect Options: Option B - Transduction of sound: This process occurs in the inner ear, specifically in the cochlea. The cochlea contains hair cells that convert mechanical vibrations (sound) into electrical signals that can be interpreted by the brain. Option C - Transmission of electrical impulses: This is not the primary function of the external and midd le ear. Transmission of electrical impulses occurs in the auditory nerve and higher auditory pathways af ter the transduction of sound in the inner ear. Option D - Conversion of mechanical energy: The conversion of mechanical energy into electrical ener gy is done in the inner ear and the process is known as transduction. Solution for Question 2: Correct Option B - Areal ratio: The areal ratio is the effective transformation of sound energy from the tympanic membrane to the footplate of the stapes in the middle ear. This ratio is essential for optimizing the transfer of sound waves from the air-filled middle ear to the fluid-filled inner ear. Incorrect Options: Option A - Lever ratio: This ratio describes the mechanical advantage gained by the ossicles (malleus, incus, and stapes) in transmitting sound from the eardrum to the oval window. Option C - Total transformation ratio: It is not used to describe the effective transformation of sound en ergy from the tympanic membrane to the footplate of stapes. Option D - Phase difference ratio: Phase difference refers to the time delay between different components of a sound wave. Solution for Question 3: Correct Option A - Basal turn: The basal turn of the cochlea is responsible for recognizing high-frequency sounds. Incorrect Options: Option B - Apical turn: The apical turn is responsible for recognizing low-frequency sounds. Option C - Both apical and basal turns: Only the basal turn is responsible for recognizing high-frequenc y sounds, not the apical turn. Option D - Helicotrema: It is a structure that connects scala vestibuli and scala tympani. Page 3 25 Made with Xodo PDF Reader and Editor Solution for Question 4: Correct Option C - 0.1%: The impedance-matching mechanism is responsible for overcoming the resistance offered by the fluid in the inner ear (perilymph and endolymph). Only a small percentage of sound energy, specifically 0.1%, goes to the inner ear. Solution for Question 5: Correct Option C - Difference in time; effective vibration of the basilar membrane: The phase difference occurs due to time delay which creates a phase shift that is necessary for the basilar membrane's effective vibration, leading to the stimulation of hair cells. Incorrect Options: Option A, B & D - The phase difference is not related to differences in frequency, amplitude and wavelength. Solution for Question 6: Correct Option D - Trapezoid body: When sound travels from the cochlear nucleus to the superior olivary complex, it travels by a body called a Trapezoid body. Incorrect Options: Option A, B & C - They are not the structures through which sound travels from the cochlear nucleus t o the superior olivary complex. Solution for Question 7: Correct Option B - Area 42: The final perception of sound occurs in the auditory cortex, specifically in Area 42. This region is responsible for recognizing and interpreting auditory stimuli, contributing to the conscious experience of sound. Incorrect Options: Option A - Area 41: Area 41, also known as the primary auditory complex, is involved in the initial proc essing of auditory signals, not the final perception of sound. Option C - Medial Geniculate Body: The medial geniculate body is not the site of the final perception of sound. Option D - Inferior Colliculus: The inferior colliculus is not the site for the final perception of sound. Page 4 26 Made with Xodo PDF Reader and Editor Solution for Question 8: Correct Option A - Recognizing pitch: The primary function of the cochlear receptor in the auditory pathway is to recognize the pitch of the sound and transduction Incorrect Options: Option B - Conduction of electrical impulses: The cochlear receptor's primary function is transduction a nd pitch recognition, not the conduction of electrical impulses. Option C - Impedance matching: Impedance matching is a function of the middle ear, not the cochlear receptor. Option D - Amplification of sound waves: The cochlear receptor's primary function is transduction and p itch recognition, not the amplification of sound. Page 5 27 Made with Xodo PDF Reader and Editor Assessment of Hearing 1. A 45-year-old patient presents to the clinic with complaints of hearing difficulty in the right ear. On examination, a small central perforation is seen in the tympanic membrane. What will be the status of Rinne’s test in the right ear? (or) In a patient with hearing difficulty in the right ear and a small central tympanic membrane perforation, what is seen on performing Rinne test? A. Positive B. Negative C. False positive D. Indeterminate ---------------------------------------- 2. A 32-year-old patient presents to the clinic with complaints of hearing difficulty in the left ear. Rinne test is performed and shows: Rinne test negative for 256 Hz Rinne test negative for 512 Hz Rinne test positive for 1024 Hz These findings suggest an air-bone gap how many decibels? (or) What is the air-bone gap in decibels based on Rinne test negative for 256 Hz, 512 Hz, and positive for1024 Hz? A. 25 dB B. 35 dB C. 55 dB D. 60 dB ---------------------------------------- 3. Match the following: 1 A Weber’s test 2 B Bing’s test 3 C Gelles test 4 D Rinne test 1 A Weber’s test 28 Made with Xodo PDF Reader and Editor 2 B Bing’s test 3 C Gelles test 4 D Rinne test A. 1-A, 2-D, 3-C, 4-B B. 1-D, 2-A, 3-C, 4-B C. 1-D, 2-A, 3-B, 4-C D. 1-D, 2-B, 3-A, 4-C ---------------------------------------- 4. If a patient demonstrates a Weber positive result on the right side, and a Rinne positive result in both ears, what type of hearing loss is likely present? A. Right conductive hearing loss B. Left conductive hearing loss C. Left sensory neural hearing loss Page 2 29 Made with Xodo PDF Reader and Editor D. Right sensory neural hearing loss ---------------------------------------- 5. Match the following pathologies with appropriate investigations: 1 Acoustic neuroma A Otoacoustic emissions 2 Menier’s disease B BERA 3 Hearing loss in neonates C Recruitment 4 Presbycusis D Electrocochleography 1 Acoustic neuroma A Otoacoustic emissions 2 Menier’s disease B BERA 3 Hearing loss in neonates C Recruitment 4 Presbycusis D Electrocochleography A. 1-D, 2-A, 3-B, 4-C B. 1-B, 2-A, 3-C, 4-D C. 1-B, 2-D, 3-A, 4-C D. 1-D, 2-B, 3-A, 4-C ---------------------------------------- 6. A 45-year-old patient with a history of recurrent middle ear infections now presents with gradually worsening hearing loss in the right ear. Otoscopic examination reveals chalky white plaques on the tympanic membrane. Rinne’s test is negative in the right ear. What is the type of graph that is likely to be seen on the impedance audiometry of this patient? (or) What type of graph is seen on impedance audiometry in a middle-aged patient with recurrent middle ear infections, gradually worsening hearing loss, chalky white plaques on the tympanic membrane, and a negative Rinne’s test in the right ear? A. B-type B. C-type C. AS-type D. AD-type ---------------------------------------- 7. A 65-year-old male presents with complaints of gradual hearing loss over the past few years. His medical history includes hypertension and type 2 diabetes. During the pure-tone audiometry, the following findings can be seen: What is the most likely type of hearing loss? (or) What is the type of hearing loss in an old male presenting with complaints of hearing loss over the past few years and having a medical history of hypertension and type 2 diabetes showing the following findings on pure tone audiometry? Page 3 30 Made with Xodo PDF Reader and Editor A. Conductive hearing loss B. Sensorineural hearing loss C. Mixed hearing loss D. Normal hearing ---------------------------------------- 8. A 35-year-old female presents with complaints of progressive hearing loss in her left ear. Upon examination, a normal tympanic membrane is seen. Weber test shows lateralization of sound to the affected ear, and the Rinne test demonstrates bone conduction greater than air conduction on the left side. What frequency range is most often affected in this condition? (or) What frequency range is most often affected in a patient with progressive hearing loss, normal tympanic membrane, Weber test shows lateralization of sound to the affected ear, and the Rinne test demonstrates bone conduction greater than air conduction on the left side? A. 250 Hz B. 4000 Hz C. 1000 Hz D. 2000 Hz ---------------------------------------- 9. What is the most likely location of the pathology seen in a patient that shows the following findings on PTA? A. Cochlear pathology Page 4 31 Made with Xodo PDF Reader and Editor B. Ossicular chain C. Tympanic membrane D. Eustachian tube ---------------------------------------- 10. A patient undergoes a stapedial reflex test, and the results show bilateral loss of the reflex. What condition is most likely responsible for this outcome? A. Cochlear pathology B. 8th nerve pathology C. 7th nerve pathology D. Ossicular discontinuity ---------------------------------------- 11. Mark the correct statement: A. Retro cochlear lesions show recruitment B. Threshold tone decay is above 25 dB in cochlear lesions C. SISI score is above 70% in cochlear lesions D. Normal interval between I and V wave is seen on BERA in retro cochlear lesion ---------------------------------------- 12. Match the following graphs with their corresponding conditions: 1 A Presbycusis 2 B Meniere’s disease 3 C Otosclerosis 4 D NIHL 1 A Presbycusis 2 B Meniere’s disease Page 5 32 Made with Xodo PDF Reader and Editor 3 C Otosclerosis 4 D NIHL A. 1- C, 2-D, 3-A, 4-B B. 1-A, 2- D, 3-B, 4-A C. 1-D, 2-C, 3-B, 4-A D. 1-D, 2-C, 3-A, 4-B ---------------------------------------- 13. What does a Speech Discrimination Score below 50% indicate? A. Normal hearing B. Retro cochlear pathology C. Cochlear pathology D. Tympanic membrane pathology ---------------------------------------- 14. In impedance audiometry, high compliance and normal middle ear pressure are indicative of which condition? A. Ossicular discontinuity B. Ossicular fixation C. Eustachian tube dysfunction D. Otosclerosis ---------------------------------------- Page 6 33 Made with Xodo PDF Reader and Editor Correct Answers Question Correct Answer Question 1 2 Question 2 2 Question 3 3 Question 4 3 Question 5 3 Question 6 3 Question 7 2 Question 8 4 Question 9 4 Question 10 2 Question 11 3 Question 12 4 Question 13 2 Question 14 1 Solution for Question 1: Correct Option B- Negative: In Rinne's test, a negative result indicates that air conduction is less effective than bone conduction. A small central perforation in the right ear disrupts the normal transmission of sound waves through the middle ear. This results in bone conduction being greater than air conduction, resulting in a negative Rinne test. Incorrect Options: Option A- Positive: A positive Rinne's test occurs when air conduction is more effective than bone cond uction. It is seen in sensorineural hearing loss and in normal ear. Option C- False Positive: In this case of small central perforation, the Rinne test is negative, not false p ositive. Option D- Indeterminate: In this case of small central perforation, the Rinne test is negative, not indeter minate. Solution for Question 2: Correct Answer- B-35 dB: A Rinne test negative for 256 Hz and 512 Hz but positive for 1024 Hz is suggestive of an air-bone gap of 30 to 45 dB. Page 7 34 Made with Xodo PDF Reader and Editor Incorrect Options: Option A, C & D - They are not suggestive with findings of Rinne test negative for 256 Hz and 512 Hz a nd positive for 1024 Hz. Solution for Question 3: Correct Option C- 1-D, 2-A, 3-B, 4-C: 1 D Rinne test 2 Page 8 35 Made with Xodo PDF Reader and Editor A Weber test 3 B Bing’s test 4 C Gelles test Solution for Question 4: Page 9 36 Made with Xodo PDF Reader and Editor Correct Option C- Left sensory neural hearing loss: The findings suggest that the sound is perceived by the patient more on the right side (Weber positive on the right) and the air conduction is better in both ears (Rinne positive in both) so conductive hearing loss is ruled out and in sensorineural hearing loss, the lateralization of sound is towards the normal ear so the patient is most likely suffering from left sensory neural hearing loss. Incorrect Options: Option A- Right Conductive Hearing Loss: Rinne’s test is negative for conductive hearing loss but as Rinne’s test is positive in both ears, so right conductive hearing loss is less likely. Option B- Left Conductive Hearing Loss: Rinne’s test is negative for conductive hearing loss but as Rinne’s test is positive in both ears, so left conductive hearing loss is less likely. Option D- Right Sensory Neural Hearing Loss: Weber test positive on the right side and a Rinne positive result in both ears indicate sensory neural hearing loss on the left side, not the right side. Solution for Question 5: Correct Option C- 1-B, 2-D, 3-A, 4-C: 1 Acoustic neuroma B BERA 2 Menier’s disease D Electrocochleography 3 Hearing loss in neonates A Otoacoustic emissions 4 Presbycusis C Recruitment Page 10 37 Made with Xodo PDF Reader and Editor Solution for Question 6: Correct Option C- AS-type: In a patient with recurrent middle ear infections, gradually worsening hearing loss, chalky white plaques on the tympanic membrane, and a negative Rinne's test in the right ear points toward the diagnosis of tympanosclerosis which shows AS-type graph on impedance audiometry. Incorrect Options: Option A, B & D - These graphs are not seen in the case of tympanosclerosis. Solution for Question 7: Correct Option B- Sensorineural hearing loss: The patient’s history and a downward-sloping graph on pure tone audiometry and the clinical findings are highly suggestive of Presbycusis, which is a sensorineural type of hearing loss. Incorrect Options: Option A- Conductive hearing loss: The downward-sloping graph on PTA and the clinical findings sugg est a diagnosis of Presbycusis, which is a sensory-neural type of hearing loss, not conductive hearing loss. Option C- Mixed hearing loss: The downward-sloping graph on PTA and the clinical findings suggest a diagnosis of Presbycusis, which is a sensory-neural type of hearing loss, not a mixed hearing loss. Option D- Normal hearing: The patient's complaint of gradual hearing loss and the findings on pure-ton e audiometry do not support normal hearing. Solution for Question 8: Correct Option D-2000 Hz: The clinical presentation described is highly suggestive of Otosclerosis. It is characteristic of a dip in bone conduction threshold at around 2000 Hz, specifically demonstrating a Carhart's notch. Incorrect Options: Option A- 250 Hz: This frequency is not affected in the case of otosclerosis. Option B- 4000 Hz: A dip at 4000 Hz is associated with noise-induced hearing loss, not otosclerosis. It' s referred to as a Boiler's notch. Option C- 1000 Hz: This frequency is not affected in the case of otosclerosis. Solution for Question 9: Correct Option D- Eustachian tube: The C-type curve on a pure-tone audiogram is typically seen in eustachian tube dysfunction. Page 11 38 Made with Xodo PDF Reader and Editor Incorrect Options: Option A- Cochlear pathology: Cochlear pathology does not show a C-type curve on a pure-tone audiogram. Option B- Ossicular chain: Ossicular chain discontinuity shows AD type curve, not C type curve. Option C- Tympanic membrane: Tympanic membrane abnormalities like tympanosclerosis shows AS t ype curve, not C type. Solution for Question 10: Correct Option B- 8th nerve pathology: The stapedial reflex involves the contraction of the stapedius muscle in response to loud sounds. Bilateral loss of the stapedial reflex is associated with 8th nerve pathology or cochlear pathology. Incorrect Options: Option A- Cochlear pathology: Bilateral loss of stapedial reflex is not seen in cochlear pathology. Option C- 7th nerve pathology: Bilateral loss of stapedial reflex is not seen in cochlear pathology, inste ad unilateral loss of stapedial reflex is seen. Option D- Ossicular discontinuity: Bilateral loss of stapedial reflex is not seen in ossicular discontinuity. Solution for Question 11: Correct Option C- SISI score is above 70% in cochlear lesions: SISI (Short Increment Sensitivity Index) is a test used in audiology to evaluate auditory processing, and a score above 70% is indicative of cochlear lesions. In cochlear lesions, the auditory nerve fibers are affected, leading to decreased sensitivity to small changes in intensity, which is reflected in the elevated SISI score. Incorrect Options: Option A-Retro cochlear lesions show recruitment: Retrocochlear lesions does not exhibit recruitment. Option B-Threshold tone decay is above 25 dB in cochlear lesion: Threshold tone decay is less than 25 dB in cochlear lesions Option D- Normal interval between I and V wave is seen on BERA in retro cochlear lesion: In retrocochlear lesions, wave V is delayed or absent on BERA (Brainstem Auditory Evoked Response). Solution for Question 12: Correct Answer D- 1-D, 2-C, 3-A, 4-B: 1 Page 12 39 Made with Xodo PDF Reader and Editor D NIHL 2 C Otosclerosis 3 Page 13 40 Made with Xodo PDF Reader and Editor A Presbycusis 4 B Meniere’s disease Solution for Question 13: Correct Option B- Retro cochlear pathology: A Speech Discrimination Score (SDS) below 50% indicates poor ability to understand phonetically balanced words, suggesting a retro cochlear pathology. Page 14 41 Made with Xodo PDF Reader and Editor Incorrect Options: Option A- Normal hearing: A Speech Discrimination Score below 50% is inconsistent with normal hearing. Option C- Cochlear pathology: A Speech Discrimination Score below 50% is less likely to indicate cochlear pathology. Option D- Tympanic membrane pathology: A Speech Discrimination Score below 50% is not suggestive of Tympanic membrane pathology. Solution for Question 14: Correct Option A- Ossicular discontinuity: In ossicular discontinuity, which refers to a disruption in the continuity of the ossicular chain in the middle ear, there is typically high compliance (increased movement) of the tympanic membrane in response to sound stimuli during impedance audiometry. The middle ear pressure remains normal. Incorrect Options: Option B- Ossicular fixation: Ossicular fixation involves the abnormal fixation of one or more ossicles in the middle ear. This condition is associated with reduced compliance in impedance audiometry due to limited movement of the ossicles. Option C- Eustachian tube dysfunction: Eustachian tube dysfunction can lead to negative middle ear pr essure, causing reduced compliance in impedance audiometry. Option D- Otosclerosis: Otosclerosis can result in decreased compliance in impedance audiometry due to reduced mobility of the ossicles. Page 15 42 Made with Xodo PDF Reader and Editor Vestibular System (Physiology, Assessment & Disease of Vestibular System) 1. Mark the incorrect statement: A. The to and fro movement of the eye is assessed through the nystagmus test. B. The communication between the middle ear and inner ear is tested through the fistula test. C. The Dix Hallpike Maneuver checks the position effect on vertigo. D. The normalcy of the vestibular system is checked by conducting clinical tests. ---------------------------------------- 2. In cases of hypoactive labyrinth lesions, what is the expected effect on eye movement? A. The eye drifts toward the hypoactive side B. The eye remains in its midline position without any drift C. The eye drifts away from the hypoactive side D. The eye exhibits random movements ---------------------------------------- 3. In hyperactive labyrinth lesions, what is the direction of nystagmus? A. Towards the hyperactive side B. Away from the hyperactive side C. Random direction D. Towards the opposite side ---------------------------------------- 4. What is a distinguishing feature of the direction of nystagmus in central and peripheral cases? A. Nystagmus direction in central cases is fixed, towards the undermost ear. B. Direction of nystagmus in central cases keeps changing. C. Both central and peripheral nystagmus exhibit fixed directions towards the undermost ear. D. Peripheral nystagmus changes direction frequently. ---------------------------------------- 5. Which of the following is least likely to induce nystagmus? A. Change of position B. Change of illumination C. Change of temperature D. Change of pressure ---------------------------------------- 6. A 58-year-old patient presents with complaints of vertigo, particularly triggered by changes in head position. A test is performed to diagnose the condition, what is the angle at which the patient's head should hang in the supine position? 43 Made with Xodo PDF Reader and Editor (or) What is the angle at which the patient's head should hang in the supine position to diagnose the cause of vertigo? A. 45 degrees B. 90 degrees C. 30 degrees D. 60 degrees ---------------------------------------- 7. During the Dix Hallpike Test, in which semicircular canal is the otolith most likely to be displaced causing nystagmus? A. Anterior semicircular canal B. Lateral semicircular canal C. Posterior semicircular canal D. Horizontal semicircular canal ---------------------------------------- 8. During the caloric test, if the patient experiences nystagmus when warm water is irrigated into the right ear, what would be the expected direction of the nystagmus? A. Nystagmus towards the left side B. Nystagmus towards the right side C. Random direction of nystagmus D. Absence of nystagmus ---------------------------------------- 9. Which semicircular canal is primarily stimulated during the caloric test? A. Anterior semicircular canal B. Lateral semicircular canal C. Posterior semicircular canal D. Medial semicircular canal ---------------------------------------- 10. A 45-year-old patient presents with complaints of dizziness and vertigo. Upon examination, the following can be seen: Which method is most suitable to assess labyrinthine function in this patient? (or) Which method is most suitable to assess labyrinthine function in a patient with a perforated tympanic membrane? Page 2 44 Made with Xodo PDF Reader and Editor A. Caloric test B. Fitzgerald-Hallpike test C. Barany's Rotational Chair test D. Dunda's Grant Tube test ---------------------------------------- 11. A patient with anotia undergoes a vestibular assessment. Which test would be most appropriate for evaluating angular motion and inducing nystagmus in this case? (or) How is vestibular function assessed in individuals with anotia? A. Dix Hallpike Test B. Head Impulse Test C. Barany's Rotational Chair Test D. Romberg Test ---------------------------------------- 12. Match the following conditions with their expected response in the Fistula test: 1 Congenital syphilis A Positive 2 Normal B False Negative 3 Cholesteatoma C Negative 4 Round window rupture D False Positive 1 Congenital syphilis A Positive 2 Normal B False Negative 3 Cholesteatoma C Negative 4 Round window rupture D False Positive A. 1-A, 2-C, 3-B, 4-D B. 1-D, 2-C, 3-B, 4-A C. 1-C, 2-B, 3-D, 4-A D. 1-D, 2-B, 3-C, 4-A ---------------------------------------- 13. A 45-year-old patient visits the neurology clinic complaining of dizziness and unsteadiness. During the head impulse test, the patient is asked to focus on the examiner's nose. The examiner suddenly tilts the patient's head to the left, and the patient's eyes drift in the same direction but quickly return to the Page 3 45 Made with Xodo PDF Reader and Editor examiner's nose. What does this response indicate? (or) During the head impulse test, a 45-year-old patient's eyes drift to the left but quickly return to the examiner's nose when the head is tilted left. What does this response indicate? A. Normal response B. Positive response C. Inconclusive response D. Negative response ---------------------------------------- 14. Which part of the vestibular system is specifically stimulated in Cervical Vestibular Evoked Myogenic Potential test? A. Utricle B. Lateral semi-circular canal C. Superior vestibular nerve D. Inferior vestibular nerve ---------------------------------------- 15. A patient is asked to stand with eyes closed, and the examiner observes for swaying from side to side. Which clinical test is being performed? A. Unterberger Test B. Gait Test C. Head Impulse Test D. Romberg sign ---------------------------------------- 16. All of the following are central vestibular disorders, except: A. PICA syndrome B. Epilepsy C. Acoustic neuroma D. Vertebrobasilar insufficiency ---------------------------------------- 17. Perilymph fistula can occur due to a defect in all of the following structures except: A. Oval window B. Round window C. Semi-circular canal D. Internal acoustic meatus ---------------------------------------- 18. What is the most common cause of perilymph fistula? Page 4 46 Made with Xodo PDF Reader and Editor A. Chronic otitis media B. Barotrauma C. Acute suppurative otitis media D. Congenital abnormalities ---------------------------------------- 19. Basilar migraine is characterized by: A. Vertigo and ataxia B. Severe headache with no aura C. Gradual hearing loss D. Motor dysfunction and vertigo ---------------------------------------- 20. Which disorder leads to poor blood flow in the brain's posterior region? A. Meniere's Disease B. Vestibular Neuronitis C. Vertebrobasilar insufficiency D. Perilymph Fistula ---------------------------------------- 21. What is the mechanism of action in the Epley's maneuver? A. Stimulation of the vestibular nerve B. Repositioning displaced otoliths C. Activation of the cochlear nerve D. Enhancement of hearing ---------------------------------------- 22. A 55-year-old patient presents with sudden-onset vertigo, accompanied by sensorineural hearing loss (SNHL) and tinnitus. All of the following are true about this condition, except: A. It is caused due to endolymphatic hypertension B. Involvement of organ of corti leads to vertigo C. It is associated with vagal symptoms D. Vertigo lasts for few minutes to hours ---------------------------------------- 23. A 45-year-old patient presents to the clinic with a sudden onset of vertigo, nausea, and vomiting. There is no associated hearing loss or tinnitus. The caloric test reveals canal paresis and directional preponderance. What is the most appropriate initial treatment for this condition? (or) What is the initial recommended treatment for a 45-year-old patient with sudden-onset vertigo, nausea, and vomiting, along with canal paresis and directional preponderance on the caloric test? A. Epley’s maneuver Page 5 47 Made with Xodo PDF Reader and Editor B. Corticosteroids C. Bed rest and labyrinthine sedatives D. Surgical intervention ---------------------------------------- 24. Mark the correct statement: A. Vestibular neuritis is characterized by intermittent vertigo. B. Labyrinthitis is associated with hearing loss and tinnitus. C. Meniere's disease does not show features of aural fullness. D. Peri-lymphatic Fistula (PF) commonly occurs after a viral infection. ---------------------------------------- 25. What is the neurosensory epithelium that covers the Saccule and the Utricle? A. Cristae B. Cupula C. Macula D. Ampulla ---------------------------------------- 26. Which nerve provides the innervation for the posterior semi-circular canal? A. Superior Vestibular Nerve B. Cochlear nerve C. Facial nerve D. Inferior Vestibular Nerve ---------------------------------------- 27. What is the correct sequence of pathway in the vestibular system? A. Inferior and Superior Vestibular Nerve → Scarpa's Ganglion → Vestibular Nuclei → Median Longitudinal Fascicle → Cerebellum B. Inferior and Superior Vestibular Nerve → Scarpa's ganglion → Median Longitudinal Fascicle → Vestibular Nuclei → Cerebellum C. Superior Vestibular Nerve → Scarpa's ganglion → Inferior Vestibular nerve→ Spinal Cord → Median Longitudinal Fascicle D. Superior Vestibular Nerve → Inferior Vestibular nerve → Vestibular Nuclei → Scarpa’s ganglion →Median Longitudinal Fascicle → Cerebellum ---------------------------------------- 28. What is the primary function of Cristae? A. Linear movement B. Horizontal movement C. Angular movement D. Gravity Page 6 48 Made with Xodo PDF Reader and Editor ---------------------------------------- 29. Where is Scarpa’s ganglion located? A. Vestibular chamber B. External auditory canal C. Jugular foramen D. Internal auditory meatus ---------------------------------------- 30. What physiological response is triggered by the stimulation of the Median Longitudinal Fascicle? A. Vestibular spinal Reflex B. Vestibular ocular Reflex C. Vestibular cerebellar reflex D. Vestibular cochlear reflex ---------------------------------------- Correct Answers Question Correct Answer Question 1 4 Question 2 3 Question 3 1 Question 4 2 Question 5 2 Question 6 3 Question 7 3 Question 8 2 Question 9 2 Question 10 4 Question 11 3 Question 12 2 Question 13 2 Question 14 4 Question 15 4 Question 16 3 Question 17 4 Question 18 2 Question 19 1 Page 7 49 Made with Xodo PDF Reader and Editor Question 20 3 Question 21 2 Question 22 2 Question 23 3 Question 24 2 Question 25 3 Question 26 4 Question 27 1 Question 28 3 Question 29 4 Question 30 2 Solution for Question 1: Correct Option D- The normalcy of the vestibular system is checked by conducting clinical tests: The normalcy of the vestibular system is checked by conducting laboratory tests, not clinical tests. Incorrect Options: Option A- The to and fro movement of the eye is assessed through the nystagmus test: The nystagmus test is indeed used to assess the to and fro movement of the eyes. Option B- The communication between the middle ear and inner ear is tested through the fistula test: T he fistula test is used to assess communication between the middle ear and inner ear. Option C- The Dix Hallpike Maneuver checks the position effect on vertigo: The Dix Hallpike Maneuver is used to diagnose benign paroxysmal positional vertigo (BPPV). Solution for Question 2: Correct Option C- The eye drifts away from the hypoactive side: If there is a right-sided hypoactive labyrinth, it will not be able to push the eye to the left side effectively. If the left one is normal, it can push the eye towards the right side. By this rule, the eye should drift toward the hypoactive side, but it does not happen because the brain interferes and compensates. The brain compensates by pushing the eyeball to the opposite side in a very fast way drifting the eye toward the opposite side. Hypoactive lesions will cause nystagmus towards the opposite side. Incorrect Options: Option A- The eye drifts toward the hypoactive side: The compensatory mechanism causes the eye to drift away from the hypoactive side. Option B- The eye remains in its midline position without any drift: The compensatory mechanism leads to a fast drift of the eye away from the hypoactive side. Option D- The eye exhibits random movements: Page 8 50 Made with Xodo PDF Reader and Editor The compensatory mechanism causes a specific drift away from the hypoactive side, resulting in nystagmus. Solution for Question 3: Correct Option A- Toward the hyperactive side: In hyperactive lesions, the nystagmus occurs toward the hyperactive side, as the more powerful side pushes the eyeball with extra intensity in that direction. Incorrect Options: Option B- Away from the hyperactive side: Nystagmus is generally induced toward the hyperactive side due to the stronger forces exerted by that side. Option C- Random direction: Nystagmus in hyperactive labyrinth lesions is not random. It has a specific direction, typically toward the hyperactive side. Option D- Toward the opposite side: Nystagmus in hyperactive lesions does not occur toward the opposite side. Solution for Question 4: Correct Option B- Direction of nystagmus in central cases keeps changing: Central nystagmus exhibits variability in its direction, and it is not fixed towards a specific ear. This dynamic nature is often a characteristic feature of central nervous system involvement. Incorrect Options: Option A- Nystagmus direction in central cases is fixed, towards the undermost ear: Central nystagmus is not fixed towards the undermost ear; its direction can vary. Option C-Both central and peripheral nystagmus exhibit fixed directions towards the undermost ear: While peripheral nystagmus may exhibit a fixed direction towards the undermost ear, central nystagmus does not follow this pattern. Option D- Peripheral nystagmus changes direction frequently: Peripheral nystagmus typically has a fixed direction towards the undermost ear, and it does not change frequently. Solution for Question 5: Correct Option B- Change of illumination: Page 9 51 Made with Xodo PDF Reader and Editor Change of illumination is least likely to induce nystagmus. Illumination changes are not typically used to trigger nystagmus in clinical assessments. Incorrect Options: Option A- Change of position: Altering the position of the head or body is a common method to induce nystagmus during clinical tests, such as the Dix Hallpike maneuver. Option C- Change of temperature: Variations in temperature, such as the caloric test involving warm or cold water irrigation of the ear canal, can induce nystagmus. Option D- Change of pressure: Changes in pressure, as seen in tests like the fistula test, can also indu ce nystagmus by affecting the vestibular system Solution for Question 6: Correct Option C- 30 degrees: The given clinical presentation raises a suspicion of BPPV and the test performed to confirm the diagnosis is Dix Hallpike Test.The angle at which the patient's head should hang in the supine position for the Dix Hallpike Test is 30 degrees. Incorrect Options: Option A- 45 degrees: This angle is associated with the initial rotation of the head in the Dix Hallpike T est, not the angle at which the head hangs in the supine position. Option B- 90 degrees: This is not the correct angle for the Dix Hallpike Test; it is too steep. The angle i s 30 degrees for the head to hang in the supine position. Option D- 60 degrees: This angle is not used in the Dix Hallpike Test for the supine position; the correc t angle is 30 degrees. Solution for Question 7: Correct Option C- Posterior semicircular canal: The Dix Hallpike Test is primarily used to diagnose benign paroxysmal positional vertigo (BPPV), where otolith displacement, typically involving small calcium carbonate crystals, occurs. The posterior semicircular canal is more likely to be affected due to its gravity-dependent position. Incorrect Options: Option A- Anterior Semicircular Canal: The anterior semicircular canal is not typically involved in the Di x Hallpike Test. Option B- Lateral Semicircular Canal: The lateral semicircular canal is not typically involved in the Dix Hallpike Test. Option D- Horizontal Semicircular Canal: The horizontal semicircular canal is not typically involved in th e Dix Hallpike Test. Page 10 52 Made with Xodo PDF Reader and Editor Solution for Question 8: Correct Option B- Nystagmus towards the right: When warm water is irrigated into the right ear, it causes an increase in temperature resulting in nystagmus towards the right (same side of irrigation) as a response to the temperature gradient. Incorrect Options: Option A- Nystagmus towards the left: The direction of nystagmus is same to the side of irrigation, not t he oppositee side. Option C- Random direction of nystagmus: The direction of nystagmus is same as the side of irrigation, not random. Option D- Absence of nystagmus: Nystagmus is expected in response to the temperature changes duri ng the caloric test in normal individuals. The absence of nystagmus is seen if labyrinth is not functional, and is a dead labyrinth. Solution for Question 9: Correct Option B- Lateral semicircular canal: In the caloric test, the lateral semicircular canal is primarily stimulated. Warm or cold water irrigation into the ear affects the temperature of the lateral semicircular canal, leading to a temperature-induced convection current. This stimulates the cupula within the lateral semicircular canal, resulting in nystagmus as a response. Incorrect Options: Option A- Anterior Semicircular Canal: The anterior semicircular canal is not directly stimulated during t he caloric test. Option C- Posterior Semicircular Canal: The posterior semicircular canal is not directly stimulated durin g the caloric test. Option D- Medial Semicircular Canal: There are only 3 semi-circular canals- anterior, posterior, and lateral. There is no medial semi-circular canal. Solution for Question 10: Correct Option D - Dunda's Grant Tube test: In this scenario, where the patient presents with a perforation of the tympanic membrane, the assessment of the vestibular system using traditional caloric testing with water may not be feasible due to the risk of complications. This test involves using air instead of water for vestibular stimulation, ensuring a safe assessment of labyrinthine function in the presence of tympanic membrane perforation. Incorrect Options: Option A- Caloric Test: The assessment of the vestibular system using traditional caloric testing with w ater may not be feasible due to the risk of complications, so it is not the most suitable method. Option B- Fitzgerald-Hallpike Test: When cold water plus warm water is used for the caloric test. It is n ot the most suitable method due to risk of perforation. Page 11 53 Made with Xodo PDF Reader and Editor Option C- Barany's Rotational Chair Test: This test is preferred for patient who has a congenital absence of the pinna Solution for Question 11: Correct Options C- Barany's Rotational Chair Test: In cases of anotia or the congenital absence of the pinna, Barany's Rotational Chair Test is employed to assess the vestibular system. Rotatory movements on the chair stimulate the crista responsible for recognizing angular motion, activating the vestibular pathway and inducing nystagmus. VR glasses connected to a monitor help in recording and assessing the nystagmus. Incorrect Options: Option A- Dix Hallpike Test: It is not the preferred choice for evaluating angular motion in cases of con genital pinna absence. Option B- Head Impulse Test: The Head Impulse Test is not the preferred choice for evaluating angular motion in cases of congenital pinna absence. Option D- Romberg Test: The Romberg Test assesses balance and proprioception. It is not the preferr ed choice for evaluating angular motion in cases of congenital pinna absence. Solution for Question 12: Correct Option B- 1-D, 2-C, 3-B, 4-A: 1 Congenital syphilis D False positive 2 Normal C Negative 3 Cholesteatoma B False negative 4 Round window rupture A Positive Page 12 54 Made with Xodo PDF Reader and Editor Solution for Question 13: Correct Option B- Positive response: In a normal response, the patient's eyes should remain fixed on the examiner's nose despite the sudden head tilt. A positive response includes a catch-up saccade, where the eyes drift in the direction of the head tilt and then return to the examiner's nose. Incorrect Options: Option A- Normal response: In a normal response during the head impulse test, the patient's eyes sho uld remain fixed on the examiner's nose without drifting in the direction of the head tilt. Option C- Inconclusive response: The given response is indicative of an abnormal response. It is not in conclusive. Option D- Peripheral vestibular dysfunction: This is an incorrect choice because it essentially describes the correct interpretation. The described response indicates an abnormal head impulse test, suggestin g peripheral vestibular dysfunction. Solution for Question 14: Correct Option D- Inferior vestibular nerve: Cervical Vestibular Evoked Myogenic Potential involves stimulation of the inferior vestibular nerve, leading to impulses carried via the saccules and resulting in the contraction of the sternocleidomastoid muscle. Incorrect Options: Option A- Utricle: The utricle is not specifically stimulated in the Cervical Vestibular Evoked Myogenic Potential (C-VEMP) test. The C-VEMP test primarily involves the stimulation of the inferior vestibular nerve. B- Lateral semi-circular canal: The lateral semi-circular canal is not directly stimulated during the C-VEMP test. C- Superior vestibular nerve: The C-VEMP test does not primarily stimulate the superior vestibular nerve. It is specifically designed to assess the function of the inferior vestibular nerve. Solution for Question 15: Correct Option D- Romberg sign: The Romberg sign is a clinical test used to assess a patient's ability to maintain balance and posture with eyes closed. The test is particularly useful for evaluating cerebellar pathway coordination. In a normal response, the patient should be able to maintain balance, but if there is swaying from side to side or loss of balance, it may indicate impairment. Page 13 55 Made with Xodo PDF Reader and Editor Incorrect Options: Option A- Unterberger Test: The Unterberger Test involves having the patient needs to stretch his hands and march in place with eyes closed. Option B- Gait Test: The Gait Test assesses a patient's ability to walk in a straight line with one foot placed directly in front of the other. Option C- Head Impulse Test: The Head Impulse Test is used to assess the vestibulo-ocular reflex by having the patient focus on a target while the examiner makes rapid head movements. Solution for Question 16: Correct Option C - Acoustic neuroma: Acoustic neuroma is a peripheral vestibular disorder. It is a benign tumor arising from the Schwann cells of the vestibulocochlear nerve (cranial nerve VIII) in the internal auditory canal. Incorrect Options: Option A - PICA syndrome: PICA (Posterior Inferior Cerebellar Artery) syndrome is a central vestibular disorder. Option B - Epilepsy: Epilepsy is a central vestibular disorder Option D - Vertebrobasilar insufficiency: Vertebrobasilar insufficiency is a central vestibular disorder. Solution for Question 17: Correct Option D - Internal acoustic meatus: Perilymph fistula refers to an abnormal communication between the middle ear and the fluid-filled inner ear (perilymphatic space). This can occur due to a defect in the oval window, round window, or semi-circular canal, allowing leakage of perilymph. The internal acoustic meatus is not involved in perilymph fistula formation. Incorrect Options: Option A - Oval window: The oval window is one of the potential sites for perilymph fistula. Option B - Round window: The round window is another potential site for perilymph fistula. Option C - Semi-circula

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