NEET-PG ENT Previous Year Questions (2017–2026)

Correct answer: B. Vessels lack a muscle coat.

Juvenile nasopharyngeal angiofibroma is a fibrovascular tumour in which the vessels are irregular, thin-walled channels lined only by endothelium and lacking a complete smooth-muscle media. Because these vessels cannot contract when cut, biopsy produces torrential bleeding, so diagnosis relies on contrast imaging and angiography rather than tissue sampling.

Incorrect Options:

• A. Erodes internal carotid artery: advanced tumour may reach the skull base, but routine biopsy bleeding is from its own defective vessels, not carotid erosion. Angiography of the internal carotid artery.
• C. Releases a fibrinolytic factor: the tumour does not secrete a fibrinolysin; bleeding is structural, not a clotting defect. Fibrin strands enmeshing red cells (a fibrinolysin would dissolve these).
• D. Tumour lacks a capsule: the angiofibroma is indeed unencapsulated, but absence of a capsule does not by itself cause bleeding. A well-circumscribed encapsulated tumour, shown for contrast.

High-Yield Facts:

• Classic patient: adolescent male with recurrent epistaxis and nasal obstruction.
• Holman-Miller sign (anterior bowing of the posterior maxillary wall) on imaging.
• Diagnosis by contrast imaging and angiography; biopsy is contraindicated.
• Treatment: pre-operative embolisation then surgical excision.

Correct answer: B. Non-organic (functional/malingering) hearing loss.

Hearing thresholds that are inconsistent and non-reproducible (large shifts on retest, no shadow curve) in the presence of normal objective tests (otoacoustic emissions, acoustic reflexes) and a positive Stenger test indicate a non-organic loss. The objective measures confirm the cochlea and auditory pathway are working, so the claimed loss is functional or feigned.

Incorrect Options:

• A. Presbycusis: a real, reproducible bilateral high-frequency sensorineural loss of ageing.
  Presbycusis: consistent high-frequency SNHL.
• C. Noise-induced hearing loss: shows a reproducible 4000 Hz notch, not fluctuating thresholds.
  NIHL: characteristic 4 kHz notch.
• D. Otosclerosis: a conductive loss with an air-bone gap and Carhart notch, with consistent, reproducible thresholds.
  Otosclerosis: reproducible conductive loss, treated by stapedectomy.

High-Yield Facts:

• Suspect non-organic loss when thresholds are inconsistent or contradicted by objective tests.
• Objective tests (OAE, acoustic reflexes, brainstem-evoked response) bypass voluntary responses.
• A positive Stenger test unmasks a feigned unilateral or asymmetric loss.
• Carhart notch (2 kHz bone-conduction dip) is a feature of otosclerosis, which disappears after stapedectomy.

Correct answer: B. Gadolinium-enhanced MRI of the cerebellopontine (CP) angle.

Unilateral tinnitus with progressive sensorineural hearing loss and a positive Hitzelberger sign (numbness of the posterior external auditory canal wall from involvement of the sensory fibres of the facial nerve) is the classic picture of a vestibular schwannoma (acoustic neuroma) at the CP angle. Gadolinium-enhanced MRI is the investigation of choice: it resolves even intracanalicular tumours a few millimetres across and shows the enhancing lesion filling the internal auditory canal and extending into the cistern (the classic ice-cream cone appearance).

Contrast MRI: a small enhancing schwannoma (outlined) at the right internal auditory canal / CP angle.

Incorrect Options:

• Brainstem evoked audiometry (BERA): only a screening test - a normal trace does not exclude a small tumour, so it cannot confirm the diagnosis. Auditory evoked-potential waveform (SP/AP peaks against latency) - a screening electrophysiology test.
• HRCT of the temporal bone: excellent for bony detail and cholesteatoma but poor for a small soft-tissue tumour in the canal. Axial HRCT temporal bone (bone window) - shows osseous anatomy, not the soft-tissue tumour.
• Tympanometry: assesses middle-ear compliance; normal here because the lesion is retrocochlear. Tympanogram (admittance vs pressure) - a middle-ear test, unaffected by a retrocochlear tumour.

High-Yield Facts:

• Vestibular schwannoma arises from Schwann cells of the vestibular division of cranial nerve VIII, usually within the internal auditory canal.
• Gadolinium is essential - non-contrast MRI can miss tiny intracanalicular tumours.
• Bilateral vestibular schwannomas are pathognomonic of neurofibromatosis type 2.
• Early facial-canal sensory loss (Hitzelberger sign) precedes overt facial weakness.