INICET ENT Previous Year Questions (2018–2026)

The correct answer is Proptosis.

Melkersson-Rosenthal syndrome is a rare neuro-mucocutaneous granulomatous disorder with a classic triad of recurrent orofacial (lip) edema, recurrent peripheral facial nerve palsy, and a fissured tongue (lingua plicata). Proptosis (forward protrusion of the eyeball) is not a feature - it points instead to orbital or thyroid disease. The complete triad is actually seen in only a minority of patients.

So orofacial edema, recurrent facial paralysis and fissured tongue are the three components, and proptosis is the odd one out.

Incorrect Options:

• Orofacial edema: recurrent non-tender lip and facial swelling, a core feature.
• Fissured tongue: lingua plicata, the third component of the triad.
• Recurrent facial paralysis: recurrent peripheral facial nerve palsy, a core feature.

High-Yield Facts:

• MRS triad: orofacial edema, recurrent facial palsy, fissured tongue.
• Fissured tongue = lingua plicata.
• The complete triad is uncommon (often incomplete).
• Proptosis is not part of MRS.

Figure: A fissured tongue (lingua plicata) - one of the three components of the Melkersson-Rosenthal triad.

The correct answer is Oral prednisolone.

SSNHL is defined as a sensorineural loss of at least 30 dB over 3 consecutive frequencies within 72 hours. The mainstay and most effective initial treatment is systemic corticosteroids - high-dose oral prednisolone (about 1 mg/kg/day), started as early as possible. Intratympanic steroid injection is reserved as salvage therapy when systemic steroids fail or are contraindicated.

The other regimens are not standard. Aspirin and gentamicin have no role - gentamicin is in fact ototoxic - so adding them is wrong.

Incorrect Options:

• Intratympanic steroid injection: used as salvage or second-line, not the most effective first regimen.
• Steroid plus high dose aspirin: aspirin has no proven benefit and is ototoxic in high doses.
• Gentamicin plus steroid: gentamicin is ototoxic and has no role in SSNHL.

High-Yield Facts:

• SSNHL = at least 30 dB SNHL over 3 consecutive frequencies within 72 hours.
• First-line and most effective = systemic (oral) corticosteroids, about 1 mg/kg.
• Intratympanic steroids = salvage therapy.
• Start steroids early for the best recovery.

The correct answer is Fatiguability.

Central nystagmus (from a brainstem or cerebellar lesion) is non-fatiguable, has no latency, is persistent (lasts more than a couple of minutes), can change direction with gaze or position, and is not suppressed by visual fixation. Fatiguability is the odd one out - it is a feature of peripheral nystagmus, not central.

Peripheral (for example BPPV) nystagmus shows latency, fatigues on repetition, is short-lived, is unidirectional, and is suppressed by fixation - the mirror image of the central pattern.

Incorrect Options:

• No latency: a true central feature - the nystagmus begins immediately.
• Lasts for more than 2 mins: central nystagmus is persistent, not transient.
• Direction changes in different positions: direction-changing nystagmus indicates a central cause.

High-Yield Facts:

• Central nystagmus: no latency, non-fatiguable, persistent, direction-changing, not suppressed by fixation.
• Peripheral nystagmus: latency, fatiguable, transient, unidirectional, suppressed by fixation.
• Fatiguability is a peripheral, not central, feature.
• Pure vertical or torsional nystagmus suggests a central lesion.

Figure: Nystagmus. Central nystagmus is non-fatiguable, persistent and direction-changing - unlike fatiguable peripheral nystagmus.