END of Year Exam – 29 JUN 2013

ENT

1. Which of the following anesthetic agent should be avoided if local anesthesia with
epinephrine is to be used during surgery:
A. Halothane
B. Isoflurane
C. Ethrane
D. Furane
E. Nitrous oxide

2. Which is the initial treatment for chyle leak diagnosed 3 days after neck
dissection:
A. Apply dressing on the side of the neck
B. Proceed with neck exploration and possible ligation
C. Proceed with trans-mediastinal ligation for thoracic duct
D. Maintain drain and begin medium chain triglyceride tube feed
E. Remove drains and start patient on a low salt diet

3. An immune-compromised patient develops rhinosinusitis while in the hospital.

What diagnosis should you consider:
A. Fluminant malignant neoplasm
B. Fungal infection
C. Maxillary osteitis
D. Acute viral rhino sinusitis
E. An inverting papilloma undergoing malignant transformation.

4. The most common nasal manifestations of HIV are:

A. Nasal obstruction
B. Watery nasal discharge
C. Anosmia
D. Burning nose

5. Which one of the following options is considered an indirect method to rise of

the skin paddle when raising a muscuocutaneous flap:
A. The cutaneous compartment should be narrow-based
B. Avoid proximal skin paddle
C. Avoid distal skin paddle
D. Use local epinephrine immediately after raising the falp
6. A 5-years old child presents with sever sore throat, fever and red ulceration in
soft palate without cough. Rapid antigen detection test for streptcoccus was
negative. The next management step should be:
A. sends a throat swab for culture and sensitivity and start empirical antibiotics
B. Repeat the rapid antigen detection test after 24 hours
C. No treatment and send child back to school
D. Admit to hospital, establish airway by intubation and start IV …
E. Symptomatic treatment.

7. Healing and closing does NOT occur in a postoperative fistula following major
head and neck Squemous cell carcinoma, the first concern should be:
A. Nutritional depletion
B. Recurrent cancer
C. Electrolyte imbalance
D. Wound infection
E. Necroticed tissue

8. Which of the following tumor should routinely receive neck dissection:

A. Polymorphous low grade adenocarcinoma.
B. Adenoid cystic carcinoma
C. Acinic cell carcinoma
D. Lymphoma

9. Normal size adenoid expected to cause upper airway obstruction in:

A. Usher's syndrome
B. Fanconi Anemia
C. Crouzon's disease
D. Xeroderma pigmentosum
E. Prolonged use of corticosteroids

10. The most common cause of arthritis of the cricoarytenoid joint is:
A. Rheumatoid arthritis
B. Ankylosing spondylitis
C. Gout
D. Systemic lupus erythematosis
E. Chron's disease

11. Ethacrynic acid is a known ototoxic drug which used for the management
which one of the following condition:
A. Sizure disorder
B. Hypertension
C. Thyrotoxicosis
D. Leukemia

12. After the endoscopic resection of 2x2.5 cm superficial mass lesion of the
posterior pharyngeal wall. It is advisable to take which one of the following steps:
A. To leave the defect to by secondary intention
B. To close the defect with a split thickness graft
C. To close the defect with a full thickness graft
D. To close the defect with a mucosal graft
E. To close the defect with a mucosal flap

13. A patient is seen with recurrent aphthous stomatitis, genital ulceration, iritis
and limb erythema :
A. Behcet's disease
B. Herpitoform ulcers
C. Oral Chron's disease
D. Gaitz cartin syndrome

14. Which of the following condition is known to be associated with mutation of

the tumor suppressor p53 gene:
A. Squamous Cell Carcinoma + Anaplastic
B.
C. Xeroderma pigmentosum
D. Ewing's sarcoma
E. Medullary thyroid carcinoma

15. Most common deep neck space

A. Pretonsillar abscess
B. Retropharyngeal abscess
C. Carotid sheath
D. Masticator abscess
E. Submandibular abscess

16. Psamomma's body seen in:

A. Ewing sarcoma
B. Lymphoma
C. Follicular carcinoma of thyroid
D. Papillary Carcinoma (also has Orphan Annie, intranuclear Pseudoinclusions)

17. Complete absence of labyrinth seen in:

A. Mondini aplasia
B. Mickel Aplasia
C. Schible
D. Shebenham

18. Maxillary bone fracture can lead to injury of which nerve:

A. Sphenoplalatine
B. Antrior ethmoid
C. Infraorbital
D. Infratrochlear

19. Tracheostomy in HIV patients:

A. More stomal infection
B. Needs more staff in OT
C. No difference

20. Test for Gaint cell Artritis;

A. Alpha 1 antitrypsin.
B. ANC
C. ESR
D. RF

21. Group of neck lymph node which is below hyoid, superior to clavicle and deep
to sternocleidomastoid muscle:
A. Level II
B. Level III
C. Level IV
D. Level V
E. Level VI

22. Palpable left supraclavicular lymph node with normal head and neck
examination, patient should be investigated for:
A. Brain malignancy
B. Lung malignancy
C. GI malignancy
D. Pituitary tumor

23. Most common organism of Community Acquired Pneumonia:

A. Streptococcus virdian
B. Streptococcus pneumonia
C. Group A beta-hemolytic streptococcus
D. Staphylococcus aureus
24. Child with group A Beta Hemolytic Streptococcus Pneumonia when he can
return to school after:
A. After 24 hours
B. 1 week
C. 2 weeks
D. 1 month

25. Second primary of laryngeal carcinoma:

A. Bronchial
B. Esophageal
C. Bladder
D. Brain
E. Nasopharyngeal

26. Summation potential originated from:

A. Inner hair cell
B. Cochlear nucleus
C. Auditory nerve
D. Outer Hair Cells

27. Mass in floor of mouth, Medline, CT showed extension to mandible with no

lymph node or metastasis:
A. T1N0M0
B. T2N0M0
C. T3N0M0
D. T4N0M0
E. T3N0M1

28. Oral cavity carcinoma with parotid lymph nodes. The treatment of choice:
A. Palliative.
B. Radiotherapy.
C. Surgery + Radiotherapy.
D. Surgery

29. HIV with white patch, slightly raised, lateral part of the tongue:
A. Lukoplakia
B. Hairy lukoplakia
C. Erythroplakia

30. Patient with penetrating trauma behind angle of mandible with hematoma.
Your next step:
A. Arterigraphy.
B. Exploration.
C. Arterigraphy then Exploration.
D. Arterigraphy then Exploration if Arterial injury suspected

31. For a 70 kg man, what is the maximum dose of 2% lidocaine:

A. 10 ml
B. 15 ml
C. 20ml

32. Which of the following is NOT used for DVT prophylaxis:

A. Enoxiparin
B. Stocking
C. Clopidogril
D. Warfarine

33. Intraural attenuation for bone conduction:

A. 0 dB
B. 10 dB
C. 20 dB
D. 30 dB
E. 40 dB

34. Pt underwent Orbital compression post op he develop hematoma. Immediate

action is:
A. Steroid
B. Manitol
C. Lateral canthotomy
D. Open wound

35. During Parotidectomy, you injured main trunk of facial nerve. Which muscle
will be affected:
A. Stylopharyngus
B. Anterior belly of diagastric muscle
C. Buccinator muscle
D. Masseter muscle
E. Omohyoid muscle

36. 80 yrs old female with facial palsy for 2 yrs have pooling of saliva. What is
appropriate treatment:
A. Fascia lata sling
B. Greater auricular nerve cable grafting
C. Tomporalis muscles sling
D.Hypoglossal nerve grafting

37. Adult with an obstructive sleep apnea syndrome. What you will advise him:
A. CPAP
B. Uvulopalatoplasty

38. Congenital cholesteatoma complication:

A. Meningitis
B. Perilymph fistula
C. SNHL
D. Ossicular discontinuity

39. FNAC is less useful test as it gives high negative result in which of the following:
A. Parotid lesion
B. Branchial cyst
C. Lymph node
D. Thyroid nodule

40. Fracture to jugular foreman which structure is least likely to be injured:

A. Vagus nerve
B. Spinal accessory nerve
C. Hypoglossal nerve
D. Glossalpharngeal nerve
E. ICA

41. 1st branchial arch cyst presents:

A. Parotid abscess
B. Larynx abscess
C. Submandibular abscess
D. Parapharyngeal abscess

42. Fall from 5 m height with suspected fracture of temporal bone, your 1st
concern is:
A. Hearing loss
B. Vertigo
C. Otorrhea
D. Spine fracture.
43. Regarding repair of malformed auricle, EAC atresia, otoplasty, which of the
following statement is true?
A. Auricle develop only from mandibular arch
B. Auricle develop from second arch only
C. Skin excision alone is enough to correct the prominent ear deformity
D. Skin excision alone not enough to correct the prominent ear deformity
E. Should be done immediately after birth

44. After FESS, which of the following symptoms less likely to improve:
A. Nasal Discharge
B. Nasal congestion
C. Headache
D. Fatigue

45. 28 years old male who came after football game with dysphonia. Respiration is
not compromise. Laryngoscopy revealed heamatoma in both vocal cords. Both
cords are mobile. Your next step:
A. Voice rest & observe
B. Laryngoscope and evacuation of heamatoma
C. IV antibiotic
D. Intubation

46. Sudden unilateral complete loss of vestibular function without hearing loss
suggests:
A. Mennier’s
B. Vestibular Neuritis
C. Streptomycin Toxicity
D. BPPV

47. Commonest cause of vocal cord paralysis in children:

A. Epilepsy
B. Birth asphyxia

48. Perichondritis seen in :

A.DM
B.Gout
C.Rheumatoid arthritis
D.Hyperthyroid
49. Characteristic of GERD:
A. Granular pharyngeal wall
B. Tonsilar hypertrophy
C. interarytenoid erythematic (Patchyderma)
D. Vocal cord thick

50. Post Esophagoscopy for F.B patient suspect esophageal perforation, developed
marked emphysema. Not on respiratory distress. What next step:
A. Esophagoscopy with flexible esophagoscopy
B. Esophogascopy with rigid esophagoscopy
C. XR Chest
D. Observation
E. Tracheotomy

51. Age of child to produce multi-word sentence:

A. 12 months
B. 18 months
C. 24 months
D. 36 months
E. 48 months

52. Recurrent croup in a child u should check:

A. Immunodeficiency
B. Subglottis stenosis
C. Bacterial

53. Cleft palate will have difficulty in pronouncing:

A. Vowels
B. Consonant

54. 27 year old man with 6 month cystic swelling in parotid what is next step in
management:
A. HIV test
B. Parotidictomy
C. Observe

55. Patient had motor accident and a clothesline injury to the neck , Came to the
ANE with mild distress, surgical emphysema and B/L VC palsy, best to secure
airway:
A. Cricothyrotomy.
B. Oral endotracheal intubation.
C. Nasal endotracheal Intubation.
D. Tracheostomy.
E. Observation.

56. Which is not pre-malignant lesion:

A. Leukoplakia
B. Moderate Dysplasia
C. Erythroplakia
D. Atinic keratosis
E. Submucou Fibrosis

57. H Zone important in face, because;

A. Common site of cuetaneous malignancies
B. Danger for dermal infections
D. Risk f metastasis
E. Esthetic important

58. Lateral pharyngeal abscess most caused by:

A. soft palate infection.
B. Dermatologic infection.
C. Ear infection.
D. Tonsiller infectuon.
E. Laryngeal infection.

59. Endoscopic sinus surgery done in cystic fibrosis aiming mainly for:
A. Improve Headache.
B. Open sinuses by removing polyps and widen ostium for dysfunctioning sinuses.
C. Improve lungs situation.
D. Deacreae nasal discharge.
E. Retain function of cilia

60. Hyperacousis common in:

A. Menier.'s disease
B. Cochlear otosclerosis.
C. Bell's palsy.
D. Ototoxicity.
E. Acoustic neuroma
61. Patient with Headache, right eye pushed inferiorly and laterally with proptosis.
Nasal endoscopic showed congested middle meatus with purulent discharge. Your
next step will be: (Infected mucocele – Pyocele)
A. IV Antibiotic
B. One week IV dexamethazone
C. CT Scan sinus & orbit then proceed for ethmoidectomy
D. CT Scan and observe.

62. Nasopharyngeal Ca has poorest prognosis if has: (High stag, poor prognosis)
A. Single unilateral lymph node 3 cm in size in Level IV. (N1)
B. Single unilateral 3 cm supraclavicular lymph node. (N1)
C. Bilateral Level III lymph nodes (N2)
D. Fixed lymph node. (No *N* based on 7th edition)
E. Single lymph node more than 6 cm in size

63. Supraglotis most involved in which inflammatory condition:

A. Sarcoidosis. (Limited to Supraglottis and Glottis - Cumming)
B. Tuberculosis
C. Leprosy
D. Wegner Granulomatosis (Subglottis- cumming)
E. Amylodosis

64. Adult with Epiglotitis, you suspect need IV antibiotic and Intubation if:
A. Temperature more than 101 F
B. Severe pain
C. Few days history
D. Rapid onset of symptoms
E. Dysphagia

65. Angioedema is mediated by which of the following:

A. IgA
B. IgG
C. IgM
D. IgE (Mast cell, Histamine mediated – BUT Type III Hypersensitivity)
E. Complement

66. Child after head trauma has epistaxis stopped spontaneously, now clear nasal
discharge on/off slightly mixed with blood. CT Head showed frontal sinus
opacification and undisplaced anterior table fracture of frontal sinus. Your next
step management:
A. Endoscopic repair of frontal sinus
B. Bicoronal approach to repair
C. Take sample for transferring (Undisplaced fracture, no treatment- cumming, CSF is suspected, Send for B 2 and
observe for 7-10 days for spontaneous recovery)
D. Iv Antibiotic for one week.
E. Observation.

67. Posterior nasal packing for patient with epistaxis. Which of the following is
correct:
A. Should not be used with anterior packing
B. Should monitor CO2 and arrhythmia (Due to naso-pulmonary reflux –Ballenger)
C. Can cause hypocapnea

68. Patient came to your clinic unable to move his right eye laterally and his right
side of the face is expressionless. Where is the suspected pathology:
A. Ventrolateral of pons
B. Posterolateral of pons
C. Midbrain

69. Most common cause of brain abscess:

A. Hematogenous
B. Lymphatic.
C. Sinusitis.
D. Ear infection. (3rd common cause)
E. Nasopharyngeal Infection.

70. A 2 years old child with conductive hearing loss, brity bones with history of
limbs fractures. On examination he is having blue sclera. Your most likely
diagnosis:
A. Osteoporosis.
B. Crohn's disease.
C. Rheumatoid arthritis.
D. Osteogenesis Imperfecta. (Van der Hoeve syndrome)

71. A young female having history of relapsing and resolving attacks of dysphagia
with decrease vision, change is voice and limb weakness. The most likely diagnosis:
A. Myasthenia Gravis.
B. Parkinson's disease.
C. Multiple Sclerosis.
D. Lateral medullary syndrome.
72. Regarding follicular thyroid malignancy:
A. Always need post-op radiotherapy
B. Does not metastasis to level IV
C. Rarely involve level I
D. Excision of neck node metastasis is enough to control the neck

73. The best study to localize Parathyroid lesion in Hyperparathyroidism:

A. CT Scan and MRI of the neck
B. Transesopgageal scan
C. Cistamebi scan
D. US and Cistamebi scan

74. Child came with bluish mass in his oral cavity. He is unable to swallow.
A. Turn blue when child cry.
B. Most resolve spontaneously.
C. Need FNAC.
D. Need Sclerotherapy.

75. Regarding blood transfusion:

A. Always transfuse RBC if Hemoglobin below 70.
B. Use as volume expenditure.
C. Does not involve patient if indicated.
D. Depend on Clinical parameters.

76. Patient with headache, decrease vision, fever, proptosis and B/L Orbital
ecchymosis is indicated of:
A. Stroke.
B. Cavernous Sinus Thrombosis.
C. Frontal Mucocele.
D. Meningitis.

77. Child came with nasal block with hx of meningitis. Examination revealed cystic
mass in nasal cavity which is expanding when you are pressing on neck veins. Your
likely diagnosis:
A. Encephalocel
B. Dermoid
C. Glioma
D. Heamangioma

78. Patient with Rheumatic Heart disease had Tonsillectomy, tonsillectomy will:
A. It will stop aggregation of the disease.
B. Tonsiller Hypertrophy is indication for Tonsillectomy.
C. It will improve the disease.

79. Cystic swelling Left side of Floor of mouth, painfule, causing speech &
swallowing problems, most likely:
A- Ranula.
B- Mucou retension cyst.
C- Mainor salivary gland tumor.
D- Lymph node metastasis.
E- Submandibular duct Ca.

80. In patient with malignant lesion of sinonasal pathology, best investigation to

evaluate orbital and intra-cranial extension:
A. CT scan
B. Nuclear scan
C. MRI
D. Endoscopy
E. Plain XR

81. Sale man with recurrent with granuloma of vocal process of VC, had H/O past
excision, next investigation directed toward:
A. H/O trauma
B. Detalied h/o Reflux Esophagitis
C. Wegner Granulomatosis
D. Chronic Rhinosinusitis
E. Check zink level

82. Child patient post Cochlear implantation, through his future can not:
A. Singing
B. Flighing
C. Runing
D. Diving Scuba
E. Playing Basket Ball

83. Patient post tympanostomy tubes placement. He will c/o chronic otorrhea if:
A. Has mucoid discharge from middle ear intra-Op
B. Adenoidectomy performed same time.
C. Long standing OME.
D. Blue Glue.
E. Cholestetoma.

84. Patient with nystagmus. Electronystagmography test is used to test pathway

between:
A. Cornea and retina
B. Cornea and optic nerve
C. Retina and VIII cranial nerve
D. Labyrinth and optic nucleus

85. The second most common route for hospital acquired pneumonia after air
aerosol is:
A. Heamatogenous
B. Sepsis
C. Medical instrumentation
D. Bacteremia

86. Patient with hereditary telangectesia has:

A. High platelets count
B. Prolong bleeding time
C. Decrease factor VIII assay
D. Normal bleeding study

87. Regarding Clival chondroma:

A. Commonly involving hypoglossal nerve
B. Always occur in head and neck
C. Involve renal system
D. Commonly metastasized to level VI

88. Patient operated for Parotid duct injury, most common facial branch to be
injured:
A- Temporal.
B Zygomatic.
C- Buccal.
D- Mandibular.
E- Cervical.

89. P with pain in the Lt inframandibular region , more on eating , whats the most
likely diagnosis:
A-Sailolithiasis

90. Regarding salivary glands:

A-60% of saliva is secreted by parotid gland
B- 20% of saliva from minor salivary glands
C- unestimated saliva is the amount of saliva produced by minor salivary glands
D- Unestimated saliva defined as less than 0.5 ml ( ... )

91. In management of acute post-operative hypercalcemia. Your first line

management:
A. Correct extracellular fluid depletion.
B. Hemodialysis.
C. IV calcitonin.
D. Frusemide.
E. Thyroxine.