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DOHNS revision MCQ: General ENT 1

Answers & discussion


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The recurrent laryngeal nerve supplies all intrinsic muscles of the larynx.
FALSE
The cricothyroid muscle is innervated by the external branch of the superior
laryngeal nerve; it allows voice projection

The inferior parathyroid glands arise from the fourth branchial arch.
FALSE
The inferior parathyroids arise from the third arch and the superior glands from the
fourth and they swap over during development
A favourite examination question

The marginal mandibular nerve innervates the depressor angulae oris.
TRUE
This is the muscle that pulls the corner of the mouth out and down when you say
show me your teeth

The blood supply to the entire anterior nasal septum is derived from the external carotid
artery.
FALSE
The anterior and posterior ethmoid arteries are derived from the ophthalmic and
therefore internal carotid supply

Which one of the following is not used in tonsillectomy?
MORRISS RETRACTOR
An attempt to mirror the name this bit of kit station in the OSCE; make sure you
know the names and shapes of equipment used in common ENT operations
including: rigid scopes of all sorts; equipment for tonsillectomy; equipment for
septoplasty and equipment for basic ear operations eg grommets
Morriss retractor is a large single-bladed retractor for abdominal operations

Nasal packing is first line treatment for epistaxis.
FALSE
Manual pressure (aka the Hippocratic method) is first line; do not put a pack in if
you can help it

Necrotising otitis externa is usually associated with diabetes mellitus and young age.
FALSE
Diabetes mellitus, old age and male sex are the classical risk factors

The median time of grommet extrusion is about:
12 MONTHS

Oral amoxicillin is superior to topical gentamicin for the treatment of a discharging ear.
FALSE

10. Nasal regurgitation is a recognised complication of:

ADENOTONSILLECTOMY
This describes regurgitation of food and drink up past the soft palate into the nose,
on swallowing. It can really worry patients and their parents but it resolves within a
few weeks as the musculature adapts

11. Secondary post-tonsillectomy haemorrhage occurs in about 4% of patients.
TRUE
See the National Prospective Tonsillectomy Audit:
http://www.rcseng.ac.uk/publications/docs/national_prospective.html

12. Frontal sparing is not a feature of lower motor neurone facial palsy.
TRUE
It is a feature of upper motor neurone facial palsy, commonly caused by a stroke
Learn the House-Brackmann grading of facial palsy easy marks

13. Chandlers class II denotes orbital cellulitis without periosteal abscess.
TRUE
Learn Chandlers classification of peri/orbital cellulitis easy marks

14. The cricopharyngeus is about 20cm from the upper incisors.
FALSE
15cm in an adult

15. Cigarette smoke is a recognised risk factor for the development of nasopharyngeal
carcinoma.
FALSE
Both tobacco and alcohol intake isnt clearly implicated in nasopharyngeal
carcinogenesis and they do not seem to increase the risk of developing cancer in
the same way as in the mouth, larynx and pharynx
Exposure to hardwood dust and formaldehyde are possible risk factors
Epstein-Barr virus is implicated in carcinogenesis in conjunction with certain
ethnicities (eg southern Chinese and south-east Asian)
A diet high in fermented vegetables and salted fish is implicated
A favourite exam question

16. The triad of otorrhoea, severe deep otalgia and ipsilateral lateral rectus palsy is known as:
GRADENIGOS SYNDROME
Lemierres syndrome is the association of an internal jugular venous
thrombophlebitis with a deep neck space infection or peritonsillar abscess;
Fusobacterium necrophorum is commonly involved
Citellis abscess is a digastric fossa abscess secondary to a mastoid abscess
Kernigs sign denotes neck pain on passive meningeal stretch
Bezolds abscess is a sternomastoid sheath abscess secondary to a mastoid abscess

17. Adolescent boys are most at risk of developing juvenile nasopharyngeal angiofibroma.
TRUE

18. Globus pharyngeus can be safely diagnosed when a patient gives a history of acid reflux.
FALSE
While globus may have an association with laryngopharyngeal reflux (ie further up
than gastro-oeosphageal reflux), it is a diagnosis of exclusion

19. The European Position Paper On Rhinosinusitis (EPOS) 2012 recommends the use of topical
corticosteroids for acute rhinosinusitis (ARS).
TRUE
Familiarise yourself with the short form of:
http://rhinologyjournal.com/supplement_23.pdf

20. Which diagnosis fits best with the symptoms of trismus, aphagia, severe sore throat and
hoarseness?
LUDWIGS ANGINA
This is a deep neck space infection of the floor of the mouth, usually arising from a
dental abscess
Like all deep neck space infections, it can cause inflammation of the supraglottic and
glottic tissues (hence hoarseness); it is an airway emergency

Severe sore throat with aphagia fits all diagnoses

Add in trismus and you narrow the differential to peritonsillar abscess and Ludwigs
Add in hoarseness and Ludwigs fits best
Andrew Lau
Editor, entsho.com