200406709-ENT-mcqs.doc

CME for Family Physicians ENT 1.

A 14 years old boy presents to your clinic with a small dimple just in front of the the left left ear ear sinc since e birt birth. h. The dimple was sore and disc discha harg rgin ing g 3 mont months hs ago and is well the these days. The father asks you to remove this dimple. What would be your

2n e'amination the entire left e'ternal ear is inflamed. What is the most likely diagnosis

!A" !$" !(" !*" !)"

approach

!A" #eave it as such because it a benign disease !$" Advise %&ray and then e'cise it !(" )'cise it under local anesthesia !*" +efer it to ),T to e'cise it with facial nerve monitoring • •

-reauricular sinus urgery with facial nerve monitoring 2.

5.

A /0 years old man prese resen nts with ith  days ays history of pain and swell swellin ing g of the left left ear. ear. 2n e'amination the auri auricl cle e is infl inflam amed ed and and ear lobe is normal.

3.

7.

(lo'acillin (lo'acillin  5etronida6ole Amo'icillin #oratidine  Amo'acillin #oratidine  topical antibiotics

A 4 years old man resents with pain and swelling of the left ear since  days.

8.

-erichondritis $asal cell carcinoma 2titis e'terna -erichondral hematoma (ellulitis

(ase same as above. ow would you manage this patient

!A" !$" !(" !*" !)"


!A" !$" !(" !*" !)" 4.

(ellulitis -erichondritis 2titis e'terna -erichondral hematoma kin allergy

(lo'acillin (lo'acillin  5etronida6ole 5etronida6ole Amo'icillin #oratidine  Amo'acillin #oratidine  topical antibiotics

A 7/ years old presents to your clinic with a small painless wound on the right ear since 1 month. What is the most likely diagnosis

!A" !$" !(" !*" !)"

What is the most likely diagnosis

!A" !$" !(" !*" !)"


!A" !$" !(" !*" !)" 6.

(ellulitis -erichondritis 2titis e'terna -erichondral hematoma kin allergy

Topical antibiotics (lo'acillin (lo'acillin  Topical antibiotics (autry $iopsy

Which one is not a contraindication to the ear syringing 

!A" 2nly hearing ear !$" istory of Tympanic Tympanic 5embrane perforation !(" -revious ear surgery !*" +ecent ear trauma !)" istory of otitis e'terna

CME for Family Physicians ENT

!*" Antibiotic drops and refer to 9.

A 3 years man was hit on his left ear during a street fight. e presents to your clinic with swelling of e'ternal ear. e does not want to hospital because of fear of police.

),T !)" :mmediately refer to ),T 12. A

4 years old woman complains of right earache  days after Tonsillectomy. he is on oral antibiotics. 2n e'amination hearing is normal and the Tympanic membranes are normal bilaterally.

2n e'amination the both sides of the left auricle are swollen8 red and tender.

What is the most likely cause of ear pain

ow would you manage this case

!A" erous otitis media !$" Adenoiditis secondary

!A" *iclofenac !$" *iclofenac and aspiration of the pinna !(" (lo'acillin and e'cision of the swelling !*" *iclofenac and (lo'acillin and pressure bandage !)" *iclofenac8 (lo'acillin8 aspiration and pressure dressing 10.

tonsillectomy !(" )ustachian tube dysfunction !*" :t is a complication of anesthesia !)" +eferred pain

13. A

0 years old boy presents with fever and pain in right ear since  days. 2n e'amination the child is febrile8 irritable and the tympanic membrane is red8 bulging.

(ase same as above. What is the most likely diagnosis

!A" !$" !(" !*" !)"

(ellulitis -erichondritis 2titis e'terna -erichondral hematoma -erichondral edema


!A" Acute otitis media !$" 2titis media with small

11. A

/ years old man comes to your clinic and tells you that one of fast friend put a small object in his ear during play. 9ou e'amined his ear and found a small bead attached to the superior aspect of the ear canal. ow would you manage this patient

to

perforation !(" erous otitis media !*" ,ormal ear !)" Acute on chronic otitis media 14.

ow would you manage this patient

!A" -aracetamol !$" -aracetamol and Amo'icillin !(" -aracetamol8 Amo'icillin and

!A" #eave it as such !$" -ut local anesthetic drops in

Antibiotic ear drops !*" -aracetamol8 Amo'icillin and grommet insertion !)" +efer to ),T

the ear and then remove it !(" +emove it with wa' removing loop 15.

(ase same as above.


Which organism is the most common cause of this condition

!A" !$" !(" !*" !)"

treptococcus pneumoniae aemophilus influen6ae trep pyogenes 5ora'ella catarrhalis taphylococcus

!A" !$" !(" !*" !)" 19.

earing test +ennie test Weber test Tragus sign ,one of the above


16. A

/ years old girl presents with heaviness of right year since 1 month. The child is other wise fine and scores good in school. The tympanic membrane looks dull with air bubbles. ow would you manage this patient

!A" 2ral antibiotics !$" Topical antibiotics !(" Topical steroids

!*" !)" 17.

Topical

Antibiotics !*" 2ral antibiotics  Topical antibiotics !)" :ncision and oral antibiotics 20. A

3 years old shopkeeper presents to your clinic with 3 days history of rhinorhea8 fever and cough. e is taking treatment from an ),T surgeon who has advised surgery after  weeks. is past history has been unremarkable. What would like to tell him

!A" +efer to ),T for grommet !$" !("



insertion +efer for audiometry 1; days of oral antibiotics and then reassess ($(8 )+8 %&ray nasopharyn'
(ase same as above. What is the most accurate diagnostic test for this condition

!A" >o ahead with surgery as !A" Tympanometry !$" Audiometry !(" $)+A !$rainstem )voke

!$" !("

+esponse Audiometry" !*" #imited (T scan of the ear !)" (aloric test

!*" !)"

18. A

0 years old housewife presents with pain in left ear since / days. The pain is aggravated by the chewing and laughing. he also has fever of 1; ; <. er preauricular lymph node is palpable. 2n e'amination the ear looks like this= Which clinical sign would be useful to further reinforce your diagnosis

21.

planned urgery is unnecessary for him *elay surgery for three months for resolution of acute condition hould choose eptoplasty over ub mucosal resection ,one of the above

5r. mith comes to your clinic with pain in right ear since  days. 2n e'amination there are few vesicles on the e'ternal ear canal and Tympanic membrane. 9ou also noticed the following facial features. What is the most likely diagnosis

!A" $ells palsy


!$" !(" !*" !)"

!(" -ancoastCs tumor !*" Tumor of left lobe of thyroid !)" arcoidosis

arcoidosis *iabetic mononeuropathy +amsay unt yndrome 2tomycosis 25.

22.


!A" !$" !(" !*" !)"

(ase same as above. ow would you investigate this patient as a family physician

teroids Acyclovir Antibiotics ?itamin $ 1 ,one of the above

!A" )'cision biopsy under local !$" !(" !*"

23. A

7 years old girl presents with  days history of fever8 difficulty in swallowing8 drowsiness. 2n e'amination there is a grayish white layer in the throat and the neck is swollen. er pulse is 13;@ minute and e'tremities are cold.

!)" 26. A

D years old girl presents with a small swelling in the neck since birth. :t is painless and is not growing in si6e. Which single clinical sign would be most useful in this case

!A" !$" !(" !*"

wallowing :ndirect laryngoscopy -rotruding tongue $lowing out air against closed mouth !)" Trans illumination


!A" +efer to ),T 2-* !$" +efer to :( !(" :? line8 )rythromycin for 4 hours and then decide !*" Amo'icillin and steroids !)" )rythromycin and removal of the membrane 24. A

4/ years old woman presents to your clinic with a painless lump on the left side of her neck since  months. he has lost 4 B> during this period. The lump is hard8 immobile8 painless and irregular. What is the most likely diagnosis

!A" ?irchowCs lymph node !$" Tuberulosis

anesthesia in your clinic <,A of the lump ($(8 )+8 electrolytes (hest %&ray8 ultrasound abdomen $one marrow biopsy

27. A

4/ years old chronic $eatle nut eater presents with difficulty in opening his mouth since 7 months. The oral mucosa is thick and white all over What is the most likely diagnosis

!A" !$" !(" !*" !)"

cleroderma 2ral (andida infection 5ucosal atrophy ub mucous fibrosis #eukoplakia

CME for Family Physicians ENT 32. A 28. A

D years old boy presents to your clinic with fever8 throat pain8 drooling and restlessness. There is an audible husky inspiratory sound.

1D year old rugby player who has been hit on the nose and is now complaining of bilateral nasal obstruction. 2n e'amination there is bright red midline swelling visible from both nostrils.

!A" !$" !(" !*"


!A" !$" !(" !*" !)" 29.

*iphtheria -eritonsillar abscess #udwigCs angina )piglottitis
33. A

43 year old is suffering from chronic nasal obstruction and discharge. he has used over the counter nasal sprays for months and feels that the problem is worsening.

!A" !$" !(" !*"

(ase same as above. What clinical error would you like to avoid in this case

!A" !$" !(" !*" !)" 30.

)'amining the throat -alpating the throat -ainful stimulus to the patient ,one of the above All of the above

-apilloma +hinitis medicamentosa eptal haematoma nilateral choanal atresia

34. A

0E year old has noticed right sided nasal obstruction associated with a bloody discharge that has developed over the last month.

!A" !$" !(" !*"


!A" +efer immediately !$" -ass a nasogastric tube and

-apilloma +hinitis medicamentosa eptal haematoma nilateral choanal atresia

Adenoidal ypertrophy Allergic rhinitis (arcinoma
35. A

 year old complains that the same time every year she develops blocked nose with profuse watery discharge.

then refer !(" :nsert oral airway and then refer !*" :? steroids and antibiotics and then refer !)" ,one of the above

!A" !$" !(" !*"

36. A 31. A

3 year old with unilateral foul&smelling bloody discharge.

!A" !$" !(" !*"

4/ year old man is referred to you by his dentist8 who noticed a pale grey opaFue areas interspersed with a few red inflamed patches on his tongue while scraping the tobacco stains of his teeth

!A" !$" !(" !*"

#ichen planus $asal cell carcinoma Angular stomatitis lcerative stomatitis


!$" ypothyroidism !(" #aryngeal (arcinoma !*" 2esophageal reflu'

37. An

elderly man with ill&fitting dentures complains of painful inflamed cracks at the corners of his mouth

!A" !$" !(" !*" !)"

#ichen planus $asal cell carcinoma Angular stomatitis lcerative stomatitis >ingivitis

42. A

3E year old opera singer is concerned that the timbre of her voice is changing. What is the most likely diagnosis

!A" !$" !(" !*"

38. A

// year old man presents with bleeding gums. 2n e'amination there is a line of inflammation at the border of the gum8 the intradental papillae are swollen8 and he has halitosis.

!A" !$" !(" !*" !)"

70 year old man with (2-* has recently had an infective e'cerbation. e complains of an unpleasant taste in his mouth8 and e'amination reveals white deposits adhering to the mucous membranes.

!A" !$" !(" !*" !)"

43. A

3 year old lecturer has a 1 week history of low grade fever8 bodyaches8 runny nose and malaise associated with hoarseness.

Apthous lcer #eukoplakia 5ucocoele >ingivitis 2ral candidiasis

39. A

Apthous lcer #eukoplakia 5ucocaele >ingivitis 2ral candiasis

2veruse inusitis ?iral laryngitis ?ocal cord nodules

!A" !$" !(" !*"

2veruse inusitis ?iral laryngitis ?ocal cord nodules

44. A

0D year old woman with a pulsatile mass in the anterior triangle. What is the most likely diagnosis

!A" !$" !(" !*"

$ranchial cyst (arotid body aneurysm (ervical rib (ystic hygroma

45. A

1/ year old with a midline lump that moves on protruding the tongue. What is most likely diagnosis

40. A

71 year old smoker has noticed a gradual change in voice over the last  months.

!A" !$" !(" !*"

41. A

/E year old woman feels that her voice is much more croaky that it used to be8 and has been gradually tired for the last 7 months. he feels depressed and ahs gained weight. What is the most appropriate diagnosis

!A"
!A" !$" !(" !*"

+eactive #ymphadenitis arcoidosis ebaceous cyst Thyroglossal cyst

46. A

3 year old with diffuse smooth midline swelling that moves on swallowing. What is most likely diagnosis

!A" !$" !(" !*"

>oitre #aryngocoele #ymphoma -haryngeal pouch

CME for Family Physicians ENT 47. A

D year old boy returns from his summer holiday with a painful ear which is keeping him awake all night. e is unable to tolerate e'amination of the affected side.

51. A

 years student presents with reduced hearing in right ear. he had a high grade fever in the last month. 2n e'amination air conduction is more than bone conduction in both ears and Weber is locali6ed to left ear.

!A" :nfective otitis media !$" 2titis e'terna !(" Temporomandibular joint

ow would you interpret the findings

!A" !$" !(" !*" !)"

(onduction loss in left ear (onduction loss in right ear ensory loss in left ear ensory loss in right ear $oth sensory plus conduction loss in left ear !<" ame as above

dysfunction !*" Tonsillitis 48. A

3; year old man presents with a  G day history of malaise8 fever8 bad oral smell8 painful swallowing and bilateral ear ache. )'amination of the ears is normal.

!A" :nfective otitis media !$" 2titis e'terna !(" Temporomandibular joint

52. A

mother brings her 11 years old son because he is becoming hard of hearing since 3 months. 2n e'amination bone conduction is better than air conduction in both ears and Weber is centrali6ed.

dysfunction !*" Tonsillitis !)" -eritonsillar abscess

ow would you interpret these findings

!A" $ilateral sensory loss !$" $ilateral conduction defect !(" $ilateral sensory  conduction

49. A

0 year old boy presents with a 1; day history of malaise8 low grade pyre'ia and a painful discharging ear. )'amination reveals tenderness behind the ear8 but you are unable to visuali6e his tympanic membrane.

!A" +amsay huntCs syndrome !$" (hondrodermatitis nodularis

defect !*" ,ormal at this age !)" ,one of the above 53. A

mother brings her 3 years old child son with complaints of fever and right ear discharge since 1 day. The discharge is yellow and purulent. 2n e'amination the e'ternal canal is full of pus.

helicis e'terna !(" 5astoiditis !*" $arotrauma 50. A

1/ year old boy complains of reduced hearing in left ear since two months. 2n e'amination bone conduction is more than air conduction in left ear and Weber is locali6ed to left side.

What is the most likely diagnosis

!A" !$" !(" !*" !)"

ow would you interpret these findings

!A" !$" !(" !*" !)"

(onduction loss in left ear (onduction loss in right ear ensory loss in left ear ensory loss in right ear $oth sensory plus conduction loss in left ear

54.

Acute 2titis media 2titis media with effusion (hronic 2titis media 2titis e'terna ,one of the above

(ase same as above. ow would you manage this case

!A" +efer !$" tart treatment and refer


!(" Treat for 4 hrs and then refer !*" :nvestigate and refer !)" Treat him yourself 55.

Which antibiotic would you like to prescribe to him

!A" !$" !(" !*" !)" 56.

Which symptomatic treatment would you like to prescribe

!A" !$" !(" !*" !)" 57.

(efi'ime (efradine Amo'icillin )rythromycin (larithromycin

-aracetamol (hlorpheniramine (itri6ine $etamethasone ear drops All of the above

59.

Which single investigation would you order to confirm your diagnosis

!A" !$" !(" !*" !)" 60. A

/4 years old man presents with right ear pain and discharge since 3 days. There is no fever. is past medical history is unremarkable.


!A" !$" !(" !*"

+efer immediately. tart treatment and refer Treat him yourself :f he doesnCt respond in 1 week then refer !)" :nvestigate and confirm your diagnosis and then decide

What is the most likely outcome of this child assuring he doesnCt have any other medical problem

!A" pontaneous recovery in 7 !$" !(" !*" !)"

months pontaneous recovery in 7 weeks 7;H chance of (hronic uppurative 2titis 5edia !(25" The condition will remain as such for rest of the life -ermanent *eafness

61. A

4/ years old woman presents with episodic history of di66iness8 earache and progressive sensorineural deafness. What is the most likely diagnosis

!A" !$" !(" !*" !)"

58. A

7 year old girl presents to you with bilateral ear discharge. e mother tells you that she speaks in nasal tone. er weight is 17 B>. What symptoms would you further e'plore in the history to find the cause of ear discharge

!A" !$" !(" !*" !)"

noring 5outh breathing Whee6ing A and $ All of the above

($( Throat swab (ulture of ear discharge %&ray paranasal sinuses % ray nasopharyn'

$enign -ositional vertigo 2tosclerosis 5ennierCs disease $ 1 deficiency Acoustic neuroma

62. A

/4 years old man presents with sensorineural deafness of right ear since 3 months. There is no ear ache or ear discharge. The tympanic membranes are normal. ow would manage this patient

!A" !$" !(" !*"

+efer to ),T +efer to ,europhysician +eassure him A trial of antibiotics and then decide


What is the most likely diagnosis in this patient

!)" tart tricyclic antidepressant 63. A

3E year old female comes to your office a 1 year history of episodic di66iness8 ringing in both ears8 a feeling of fullness8 and hearing loss. The symptoms came an every 1& weeks and .usually last far 1 hours. ,ausea and vomiting are present. When asked to describe the di66iness8 the patient says that Ithe world is spinning around.

2n physical e'amination8 the patient has hori6ontal nystagmus. The slow phase of the nystagmus is to the left8 and the rapid phase is to. the +ight Audiagrams reveal bilateral sensorineural hearing loss in the low freFuencies.

!A" !$" !(" !*" !)" 66.

64.

What is the best treatment for the patient described in case above

!A" !$" !(" !*" !)"

3;&year&old male comes to your office for assessment of di66iness.I The di66iness occurs when he rolls over from the lying position to either the left side or the right side. :t also occurs when he is looking up. e describes sensation of Ithe world spinning aroundI him. The episodes usually last for 1;&1/ seconds.

?esubular neuritis Acute labyrinthitis $enign pasitianal vcrtigo. Arthastatic hypatensian 5eniereJs disease


The treatment of this disorder includes which .of the fallowingK

!A" !$" !(" !*" !)"

!A" !$" !(" !*"

*ecrease caffeine intake *ecrease alcohol intake se a thia6ide diuretic se of ant emetic far nausea and vomiting !)" All of the Above !<" ,one of the above 65.

68.

?estibular neuronitis . Acute labyrinthitis -ositional vertigo 2rthostatic hypotension 5eniereJs disease

What is the treatment of choice for the patient described in case above

A 3&year&old female comes to your office with a 1 month history of di66iness. he Ifeels di66yI when she8 stands up !as if she is going to faint". The sensation disappears within a minute. he has a history of major depression and she is taking *o'epin. The patientJs blood pressure is 14;@D; mm g sitting md decreases to D;@10; mm g when she stands. There is no ata'ia8 no nystagmus8 and no other symptoms.

An antiseptic )ducation and reassurance A thia6ide diuretic A change in the antidepressant $ and d

67. A.


!A" !$" !(" !*" !)"

?estibular neuronitis ,cute labyrinthitis $enign positional vertigo 2rthostatic hypotension 5eniereJs disease

!A" Avoidance of alcohol and !$" !(" !*" !)" 69. A

caffeine *imenhydrinate A thia6ide diuretic +eassurance and simple e'ercises )dolymphatic surgery

3D&year&old female comes to your office with a 4&day history of Iunrelenting di66iness.I The di66iness is associated with nausea and vomiting. There has been no hearing loss8 no tinnitus8 and


no sensation of aural fullness. The patient has just recovered from an upper&respiratory tract infection. . . 2n e'amination8 nystagmus is present. The slow phase of the nystagmus is toward the left8 and the rapid phase of the nystagmus is toward the right. There is a significant ata'ia present. What is the most likely diagnosis in this patient

!A" !$" !(" !*" !)" 70.

!A" Avoidance

of alcohol and caffeine A thia6ide diveretic )ndolymphatic surgery +eassurance and antiemetics -rochiorpera6ine

71. A

7&year&old female comes to your office with a 7&day history of severe di66iness associated with ata'ia and right sided hearing loss. he had an upper&respiratory tract infection 1 week ago. At that time her right ear felt plugged. 2n e'amination8 there is fluid behind the right eardrum. There is hori6ontal nystagmus present with the slow component to the right and the Fuick component to the left. Ata'ia is present. What is the most likely diagnosis in this patient

!A" !$" !(" !*" !)" 72.

73.

?estibular neuronitis Acute labyrinthitis $enign positional vertigo 2rthostatic hypotension 5eniereJs disease

What is the most common cause of sensorineural hearing loss in the adult population

5eniereJs disease (hronic otitis media -resbycusis 2tosclerosis 5astoiditis

What is the most common cause of conductive hearing loss in adults who have normal&appearing tympanic membranes

?estibular neuronitis Acute labyrinthitis $enign positional vertigo 2rthostatic hypotension 5eniereJs disease

What is the treatment of choice for the patient described in case above

!$" !(" !*" !)"

!A" !$" !(" !*" !)"

!A" !$" !(" !*" !)"

5eniereJs disease (hronic otitis media -resbycusis 2tosclerosis 5astoiditis

74. A.

30&year&old female comes to your office for assessment o hearing loss. he has had problems intermittently for the past 1 months. 2n e'amination8 the Weber tuning fork test laterali6es to the right ear8 and the +inne tuning fork test is negative in the right ear !bone conduction is greater than air conduction L$(MA("". . This suggests which one of the following hearing losses

!A" A right&sided conductive !$" !(" !*" !)"

hearing loss A left&sided conductive hearing loss A right&sided sensorineural hearing loss A left&sided sensorineural hearing loss A or d

75. A

43&year&old male comes to your office for assessment of hearing loss. e has had hearing difficulties for the past 4 years. 2n e'amination8 the Weber tuning fork test laterali6es to the left ear. The +inne tuning fork test is positiveK !A(M$(". J This suggests which one of the following hearing losses

!A" A

right&sided hearing loss

conductive


!$" A left&sided conductive hearing loss !(" A right&sided hearing loss !*" A leftNsided hearing loss !)" $ or c

sensorineural

79.

Which of the following anatomic forms of acute bacterial sinusitis is most serious

sensorineural

4&year&old woman comes to your office complaining of severe facial pain in the region of her right ma'illa8 fever8 and a purulent discharge from her right nose8 all of which started after a recent upper&respiratory infection. er temperature is 1;1 <. There is tenderness over the right ma'illary sinus and a greenish discharge in her right nares. The rest of her e'amination is normal. Which of the following statements concerning this patient is !are" true

!A" !$" !(" !*"

76. A

!A" The most common causes are !$" !(" !*" !)"

allergic and viral +hinovirus. :s the most common among of viral causes ?iral often is accompanied by fever8 malaise8 and systemic symptoms A and b only 8 A8 b8 and c are true

80. A

mother comes to your office with her 4&month&old daughter. The child developed an upper&respiratory tract infection appro'imately 1 week ago. Two days ago the child began complaining of pain in the right ear. 2n e'amination8 the child has nasal congestion and a hyperemic throat. The left tympanic membrane is normal8 and the right tympanic membrane is bulging and red. There appears to be fluid behind it8 The lungs are clear. The childJs temperature is 3D./O (. What is the most likely diagnosis in this child

!A" !$" !(" !*"

Acute otitis media !A25" 2titis media without effusion (hronic otitis media !(25" 2titis media. With effusion !25)" !)" ,one of the above

77. Acute

bacterial sinusitis is caused most common:y by which of the following organisms

!A" !$" !(" !*" !)" 78.

trep. -rieumonae aemophilus influen6ae 5ora'ella catarhalis . pyogenes taphylococcus aureus

What is the antibacterial drug of first choice for modetate to severe acute bacterial sinusitus

81. An

E&month&old male is brought to your clinic. e has had an upper&respiratory tract infection but has no signs of acute ear infection such as irritability8 poor sleeping8 pulling at his ears8 or fever. 2n e'amination8 the tympanic mem& brane is dull and bulging but not red. The rest of the e'amination is benign besides a mild clear rhinorrhea. What is the most likely diagnosis in this child

!A" !$" !(" !*" !)"

!A" Amo'icillin clavulanic acid !1;& !$" !(" !*" !)"

14 day course" (otrimo'a6ole !1;N 14 day course" cefuro'iine !1;&14day course" ciproflo'acin !1;day course" )rythromycin !1;&day course"

5a'illary sinusitis )thmoidal sinusitis
82. A

Acute otitis media 2titis media without effusion (hronic otitis media 2titis media with effusion ,one of the above

0&month&old child is brought to your


upper&respiratory tract infection for the past 3 days. 2n e'amination8 there is erythema of the left tympanic membrane with opacification. There are no other signs or symptoms.

!*" (efaclor !)" Amo'icillin&cavulanic acid 86. A

0 years old boy has been brought to your clinic with reduced hearing since  months. (linical e'amination is normal e'cept dull tympanic membrane. What should be the ne't approporiate clinical assessment


!A" !$" !(" !*" !)"

Acute otitis media 2titis 5edia Without )ffusion (hronic 25) ,one 2f The Above

!A" +ennie and weber !$" -erform a myringotomy and suck out all the fluid that is present !(" -erform a pneumatic otoscopy to assess the movement of the tympanic membrane !*" +efer the child ent specialist. !)" ,one of the above

83. A

nine years old child is brought to your office with a discharge from the left ear that has been present for the last  weeks. The child has a history of freFuent ear infections8 all of which have been treated with antibiotics. What is the most likely diagnosis in this patient

!A" !$" !(" !*" !)"

87.

Acute otitiis media 2titis 5edia Without )ffusion (hronic otitis media 2titis media with effusion 5astoiditis

Which of the following statements regarding treatment of the condition described in acute otitis media

!A" )arache and fever should be !$" !("

84.

What are the three most common bacterial organisms in order of freFuency that are responsible for the Acute 2titis 5edia

!*"

!A" treptococcus pneumolliae8 !$" !(" !*" !)" 85.

group A streptococci8 aemophilus influen6ae . pneumonae8 . influen6ae8 taphylococcus aureus .pneumonae8 . influen6ae8 5ora'ella . influen6ae8 . pneumonae8 group A streptococci . influen6ae8 . pneumonae8 5. catarr@wlis

What is the drug of first choice for the condition acute ottitis media

!A" -enicillin !$" Amo'icillin !(" )rythromycin

!)" 88.

treated with aspirin Topical decongestants are useful in improving eustachian tube dysfunction )ar drops do not provide significant relief in children ystemic antihistamine& decongestants have been shown to improve the symptoms and shorten the course of disease All of the above statements are true

ow is recurrent otitis media defined

!A" Three or more episodes of A25 that occur within 7 months within a year !$"

!*" i' or more episodes of A*5

!A" :nfants and young children are

that occur within 7 months8 or eight episodes within a year !)" 1; or more episodes of A25 that occur within 7 months8 or three or more episodes that occur within a year 89.

!$" !(" !*"

Which of the following statements regarding recurrent otitis media is true

!)"

!A" +ecurrent A25 usually occur in !$"

!("

!*" !)"

90.

93.

Tympimocentesis with aspiration of middle ear fluid should not be considered in which patients e'ceptK

!A" A child who presents with Acute

!$" !("

!*"

Which of the following intracranial complications may occur with otitis media

!A" !$" !(" !*" !)" 91.

the winter or early spring +ecurrent bouts of A25 should be managed by myringotomy and the insertion of ventilation tubes 5edical management appears to be less effective and is not as safe as myringotomy and tubes in children with recurrent A25. Amo'ici1lin does not have a major role to play in the management of recurrent A*5 Antibiotic prophyla'is should be given for at least 7 months to a year

5eningitis ubdural empyema $rain abscess All of the above A and c only

Which of the following is NOT a possible e'tracranial complication of otitis media

!A" !$" !(" !*" !)"

5astoiditis (holesteatoma #abyrinthitis
!)"

otitis media and complains of tinnitus8 vertigo8 and hearing loss A child who develops a suppurative intra cranial complication of 2titis 5edia An patient who is immunologically impaired and does not improve with antibiotic treatment A child who has e'treme ear pain and appears ill. A child8 who is already taking antibiotics

94. A

1D years old college student presents to your clinic with one day history of 1;1; < fever and malaise. is college e'aminations are coming up ne't week. is past history is unremarkable. 2n e'amination his throat is mildly hyperemic. What could be the best management is this case

!A" -aracetamol  !$" !(" !*"

92.

Which of the following is false about Acute 2titis 5edia

at highest risk 4;H of children will have an effusion that persists for 4 weeks $oys tend to have a higher incidence of aom than girls do ,early D;H of children will have an episode of aom by age 3 years :ncidence of aom peaks between 7 to 13 months of age

!)"

chlorpheneramine  >argles -aracetamol  Amo'icillin  >argles. -aracetamol  chlorpheneramine  Amo'cillin -aracetamol  chlorpheneramine  Amo'cillin  >argles -aracetamol  gargles.


95.

treatments would be most appropriate for this patient who has benign paro'ysmal

Which one of the following statements about the differential diagnosis of rhinitis is correct

!A" (analith repositioning !$" !(" !*" !)"

!A" #ymphadenopathy is associated with allergic rhinitis. !$" ?asomotor rhinitis is seasonal8 not perennial. !(" 2ccupational rhinitis can be allergic or nonallergic. !*" Allergic rhinitis is only seasonal. 96.

:n addition to taphylococcus aureus8 which one of the following is the ne't most common pathogen isolated from ears with chronic suppurative otitis media

!A" !$" !(" !*" !)" 97.

99.

treptococcus pneumoniae. aemophilus influen6ae. 5ora'ella catarrhalis. -seudomonas aeruginosa. erratia marcescens.

A /;&year&old patient complains of hearing loss. e denies noise e'posure at work but says that he has a hard time hearing the television unless he turns up the volume. e denies any discharge from the ears8 vertigo or fever8 but he has had some intermittent ringing of the right ear. A Weber test reveals laterali6ation to the left. A +inne test shows better air conduction than bone conduction bilaterally. What is the most appropriate diagnosis

98.

A  years old man presents with vertigo on turning his face to right . e does not have hearing problem8 ear complaint8 or headache his general and systemic e'ams are normal. alpick maneurer elicits nystaginus on + lateral

)'ternal ear infection. (erumen impaction. 5iddle ear fluid.
Which one of the following recommendations about antibiotics for the prevention of cold symptoms is CORRECT

!A" Antibiotics are recommended for patients with purulent nasal discharge after three to five days. !$" Antibiotics are recommended to prevent pneumonia. !(" Antibiotics are not recommended for patients with a suspected cold. !*" Antibiotics are recommended for adults with cold and fever after three to five days.

!A" (onductive deficit. !$" ensorineural deficit of the right ear. !(" 5i'ed deficit. !*" Temporal threshold shift.

A 4; years old man comes with tinnitus in both ear .is hearing is normal .)ar e'amination is also normal Which one of the following may lead to tinnitus without hearing loss

!A" !$" !(" !*" !)"

100.

procedure 5ecli6ine !Antivert" *ia6epam #ow&salt diet ydrochlorothia6ide

101.

A 4E year old man complains of hearing loss8 tinnitus in the right ear8 and vertigo for the past 7 months. :n addition8 he has facial pain and weakness of his facial muscles. 2n physical e'amination8 he has a facial palsy on the right side. Which of the following is the most likely diagnosis

!A" Acoustic neuroma


!$" !(" !*" !)" 102.

$ell palsy $enign positional vertigo #yme disease 5eniere disease

PE. Which one of the following is not a cause of conductive hearing loss that may lead to tinnitus ? !A" )'ternal ear infection. !$" (erumen impaction. !(" 5iddle ear fluid. !*" #oop diuretic medications. !)" 2tosclerosis.

200406709-ENT-mcqs.doc

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