ENT mcqs

CME for Family Physicians ENT

1. A 14 years old boy boy pres resents 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 day days. The The fath father er asks 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

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

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 • •

(ellul (el luliti itis s -erichondritis 2titis e'terna -erichondral hematoma kin allergy

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

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

7. A 70 year years s old pres presen ents ts to your clinic with a small painless wound on the right ear since 1 month. What is the most likely diagnosis

-reauricular sinus urgery with facial nerve monitoring /. 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.

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

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

What is the most likely diagnosis

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

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

(ellulitis -erichond -eri chondriti ritis s 2titis e'terna -erichondral hematoma kin allergy

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

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

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

Topical antibiotics (lo'acillin (lo'acillin  Topical antibiotics (autry $iop $i opsy sy

8. Whic Which h one one is not a cont contra rain indi dica cati tion on to the ear syringing 

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

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

4. A /4 year years s old old man man rese resent nts s with with pain pain and swelling of the left ear since / days. -1-


!*" Antibiotic drops and refer to 9. A 3/ ye years ma man was was hit hit on his his left left ear ear duri during ng a street street fight. fight. e presents 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 1/. 1/. A /4 year years s old old woma woman n comp compla lain ins s of right earache / days after Tonsillectomy. Tonsillectomy. he is on oral antibiotics. 2n e'amination hearing is normal and the Tympanic Tympanic membrane membranes s are normal normal bilaterally.

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

What is the most likely cause of ear pain

ow would you manage this case

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

!A" *iclofenac !$" *iclofenac and aspiration of the

tonsillectomy !(" )ustachian tube dysfunction !*" =t is a complication of anesthesia !)" +eferr +ef erred ed pain pai n

pinna !(" (lo'acillin and e'cision of the swelling !*" *iclofenac and (lo'acillin and pressure bandage !)" *iclofenac: *iclofenac: (lo'acillin: (lo'acillin: aspiration and pressure dressing

13. A  years old boy pres resents with with feve feverr and and pain in right ear since / days. 2n e'amination e'amination the child is febril febrile: e: irrita irritable ble and and the the tymp tympan anic ic memb membra rane ne is red: red: bulging.

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

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

to

(ellulitis -erichondritis 2titis e'terna -erichond -eri chondral ral hematoma hema toma -erichondral edema


11. A /0 years old man man come comes s to your your clin clinic ic and tells you that one of fast friend put a small object in his ear during play.
!A" Acute otitis otitis media !$" 2titis media with small perforation !(" erous otitis media !*" ,ormal ear !)" Acute on chronic otitis otitis media 14. ow would you you manage this this patient patient

!A" -aracetamol !$" -aracetamo -arac etamoll and Amo'icillin Amo'icil lin !(" -aracetamol: -aracetamol: Amo'icillin and

!A" #eave it as such !$" -ut -ut local local anest anesthe hetic tic drops drops in

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

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

-2-


10. (ase same same as above. above. Which Which organ organism ism is the the most most commo common n cause of this condition

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

Which clinical sign would be useful to further reinforce your diagnosis

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

treptoc tre ptococcus occus pneumoniae pneum oniae aemophilus influen6ae trep pyogenes 5ora'ella catarrhalis taphylococcus

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

17. A 0 years ears old girl presents with heav heavin ines ess s of righ rightt year since 1 month. The The chil child d is othe otherr 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 !(" Topi Topica call ster steroi oids ds

!*" !)"



Topi Topica call

Antibiotics Antibiotics !*" 2ral ral antib tibiotic tics  Top Topica ical antibiotics !)" =ncision and oral antibiotics /;. A 3/ years old shopkeeper pres presen ents ts to your your clinic with 3 days history of rhin rhinor orhe hea: a: feve feverr and cough. e is taki taking ng trea treatm tmen entt from from an ),T ),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 !$" !("

earing test +ennie test Weber test Tragu Tr agus s sign s ign ,one of the above

insertion +efer for audiometry 1; days of oral antibiotics and then reassess ($(: )+: %&ray nasopharyn' >ollow >oll ow up in your yo ur clinic cl inic

1. (ase same same as above. above. What is the most accurate diagnostic test for this condition

!A" Tympanometry !$" Audiometry Audiometry !(" $)+A !$rainstem )voke

!A" @o ahead with surgery as !$" !("

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

!*" !)"

/ years old housewife presents with pain in left ear since 0 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?

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

18. A

/1. /1. 5r. 5r. mit mith h come comes s to your clinic with pain in right ear since / days. 2n e'amination there are are few few vesi vesicl cles es on the e'ternal ear canal and Tympanic membrane.

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

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

$ells palsy arcoidosis *iabetic mononeuropathy +amsay +ams ay unt yndrome yndr ome 2tomycosis

irchowEs irc howEs lymph node Tuberulosis -ancoastEs tumor Tumor of left lobe of thyroid arcoidosis

/0. (ase same same as above. above. //. (ase same same as above. above. ow would you manage this patient

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

ow would you investigate this patient as a family physician

teroids Acyclovir Antibiotics Antibiotics itamin $ 1/ ,one of the above

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

/3. /3. A 7 years ears old old girl girl presents with / days history of feve fever: r: diff diffic icul ulty ty in swallowing: drowsiness. 2n e'amination ther there e is a gray grayis ish h whit white e lay layer in the the throat and the neck is swollen. er pulse is 13;B minute and e'tremities are cold.

!)"

anesthesia in your clinic >,A of the lump ($(: )+: electrolytes (hest %&ray: ultrasound abdomen $one marrow biopsy

/7. A 9 years ears old girl presents with a small swelling in the neck since birth. =t is pain painles less s and and is not not growing in si6e. Which single clinical sign would be most useful in this case

ow would you manage this patient

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

wallowing =ndirect laryngoscopy -rotrudi -rot ruding ng tongue t ongue $lowing out air against closed mouth !)" Trans illumination

!A" +efer to ),T 2-* !$" +efer +ef er to t o =(C =( C !(" = line: )rythromycin for /4 hours and then decide !*" Amo'icillin and and steroids steroids !)" )rythromycin and removal of the membrane

/. A 40 years old chron chronic ic $eat $eatle le nut nut eater eater presen presents ts with with difficulty in opening his his mout mouth h sinc since e 7 months. The oral mucosa is thick thick and white white all over

/4. /4. A 40 years years old old woman presents to your clinic with with a painl painless ess lump on the left side of her neck since / months. he he has has lost lost 4 D@ during this period. The lump lump is hard hard:: immob immobile ile:: painl painless ess and irregular.


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


-4-

cleroderma 2ral (andida infection 5ucosal atrophy ub mucous m ucous fibrosis fibr osis


3/. 3/. A 19 year year old old rugb rugby y play player er who who has has been hit on the nose and is now complaining of bilateral nasal obstr obstruct uctio ion. n. 2n e'ami e'amina natio tion n there there is bright red midline swelling visible from both nostrils.

!)" #eukoplakia

/8. A 9 years old boy presents presents to your your clinic clinic with fever: throat pain: drooling and restlessn restlessness. ess. There There is an audible husky inspiratory sound. What is the most likely

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

!A" !$" !(" !*" diagnosis

33. A 43 year old is sufferin suffering g from chronic chronic nasal nasal obstruct obstruction ion and discharg discharge. e. he has used over the counter nasal sprays for months and feels that the problem is worsening.

*iphtheria -eritonsillar -eritonsillar abscess #udwigEs angina )piglotti )pigl ottitis tis >oreign body in the throat

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

/9. (ase same same as above. above. What clinical error would you like to avoid in this case

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

-apilloma +hinitis +hini tis medicamen medi camentosa tosa eptal haematoma Cnilateral choanal atresia

34. 34. A 8 year year old has notice noticed d right right sided sided nasa nasall obst obstru ruct ctio ion n asso associ ciat ated ed with with a bloo bloody dy discha discharge rge that that has has devel develop oped ed over the last month.

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

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

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

Adenoidal Adenoidal ypertrophy ypertrophy Allergic rhinitis rhinitis (arcin (ar cinoma oma >oreign body

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

!A" +efer immediat imme diately ely !$" -ass a nasogastric tube and

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

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

Adenoidal Adenoidal ypertrophy ypertrophy Allergic rhinitis rhinitis (arcinoma >oreign body

37. A 40 year old man is referred referred to you you by his his dent dentis ist: t: who who noti notice ced d a pale pale grey grey opaFue opaFue areas interspe interspersed rsed with a few red red infl inflam amed ed patc patche hes s on his his tong tongue ue while scraping the tobacco stains of his teeth

31. A 3 year old with with unilateral foul&smelling foul&smelling bloody discharge.

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

-apilloma +hinitis medicamentosa eptal epta l haematoma haemat oma Cnilateral choanal atresia

Adenoidal Adenoidal ypertrophy ypertrophy Allergic rhinitis rhinitis (arcinoma >oreig >or eign n body bo dy

!A" !$" !(" !*" -5-

#ichen planus $asal cell carcinoma Angular stomatitis stomatitis Clcerative stomatitis


!$" ypothyroi ypot hyroidism dism !(" #aryngeal (arcinoma !*" 2esophageal reflu'

3. 3. An elderl elderly y man with with ill&fi ill&fitti tting ng dentu dentures res complains of painful inflamed cracks at the corners of his mouth

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

4/. A 38 year old opera opera singer is concerned concerned that the timbre of her voice is changing. What is the most likely diagnosis

#ichen planus $asal cell carcinoma Angular stomatitis stomatitis Clcerative stomatitis @ingiv @in giviti itis s

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

38. A 00 year old man prese resen nts with bleeding gums. 2n e'amination there is a line of inflammation at the border of the gum: gum: the intrad intraden ental tal papil papillae lae are swollen: and he has halitosis.

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

43. 43. A 3/ year year old old lect lectur urer er has a 1 week week history of low grade fever: bodyaches: runny nose and malaise associated associated with hoarseness.

Apthous Clcer #eukoplakia 5ucocoele @ingivitis 2ral candidiasi candi diasis s

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

39. 39. A 7 year year old old man man with with (2-* (2-* has has recently recently had an infectiv infective e e'cerba e'cerbation tion.. e complains of an unpleasant taste in his mouth mouth:: and and e'ami e'amina natio tion n revea reveals ls white deposits adhering to the mucous membranes.

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

2veruse inusitis iral ira l laryngi la ryngitis tis ocal cord nodules

44. 44. A 9 year year old woman woman with a pulsa pulsatil tile e mass in the anterior triangle. What is the most likely diagnosis

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

Apthous Clcer #eukoplakia 5ucocaele @ingivitis 2ral candiasis

$ranchial cyst (arotid (aro tid body bo dy aneurysm ane urysm (ervical rib (ystic hygroma

40. 40. A 10 year year old with a midlin midline e lump lump that that moves on on protruding protruding the the tongue. tongue. What is most likely diagnosis

4;. 4;. A 71 year year old old smok smoker er has has noti notice ced d a gradual change in voice over the last / months.

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

2veruse inusitis iral laryngitis ocal cord nodules nodul es

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

>unctional -aralysis ypothyroidism #aryngeal #aryn geal (arci ( arcinoma noma 2esophageal reflu'

+eactive #ymphadenitis arcoidosis ebaceous cyst Thyroglossal cyst

47. A 3/ year old with ith diffu iffuse se smo smooth midline swelling that moves on swallowing. What is most likely diagnosis

41. 41. A 08 year year old old woma woman n feel feels s that that her voice is much more croaky that it used to be: and has been gradually tired for the last 7 months. he feels depressed and and ahs ahs gain gained ed weig weight ht.. What What is the the most appropriate diagnosis

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

!A" >unctional -aralysis -6-

@oit @oitre re #aryngocoele #ymphoma -haryngeal pouch


4. A 9 year ear old boy retu return rns s from rom his summer holiday with a painful ear which is keeping him awake all night. e is unab unable le to tolera tolerate te e'ami e'amina natio tion n of the affected side.

01. A // years stud tudent prese resen nts with ith reduced hearing in right ear. he had a high grade fever in the last month. 2n e'amination air conduction is more than bone bone cond conduc ucti tion on in both both ears ears and and Weber is locali6ed to left ear.

!A" =nfective otitis media !$" 2titis 2tit is e'terna e'ter na !(" 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 enso ry loss los s in right ri ght ear $oth sensory sensory plus conducti conduction on loss in left ear !>" ame as above

dysfunction !*" Tonsillitis 48. 48. A 3; year old man presen presents ts with with a / G day history of malaise: fever: bad oral smell: smell: painful painful swallow swallowing ing and bilatera bilaterall ear ear ache. ache. )'ami )'amina natio tion n of the the ears ears is normal.

0/. 0/. A mothe motherr bring brings s her her 11 years 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.

!A" =nfective otitis media !$" 2titis e'terna !(" Temporomandibular joint dysfunction !*" Tonsi Ton silli llitis tis !)" -eritonsillar -eritonsillar abscess

ow would you interpret these findings

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

49. A  year old boy present presents s with a 1; day histor history y of malai malaise: se: low low grade grade pyre' pyre'ia ia and a painful discharging ear. )'amination reveals tenderness behind the ear: but you are unable to visuali6e his tympanic membrane.

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

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

03. 03. A mothe motherr bring brings s her her 3 years years old child child son with complaints of fever and right ear discharge rge since 1 day. The disc discha harg rge e is yello ellow w and and puru purule lent nt.. 2n e'amination the e'ternal canal is full of pus.

helicis e'terna !(" 5astoi 5as toidit ditis is !*" $arotrauma 0;. A 10 year old old boy complains complains of reduced reduced hearing in left ear since two months. 2n e'amina e'amination tion bone bone conduct conduction ion is more than than air air cond conduc ucti tion on in left left ear ear and and Weber is locali6ed to left side.

What is the most likely diagnosis

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

ow would you interpret these findings

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

(onductio (ondu ction n loss in left le ft ear (onduction loss in right ear ensory loss in left ear ensory loss in right ear $oth sensory sensory plus plus conduct conduction ion loss in left ear

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

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

!A" +efer !$" tart treatment and refer -7-


!(" Treat for /4 hrs and then refer !*" =nvestigate and refer !)" Treat him yourself

09. 09. Which Which single single inves investig tigati ation on would would you you order to confirm your diagnosis

00. 00. Whic Which h anti antibi biot otic ic woul would d you you like like to prescribe to him

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

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

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

7;. A 04 years old man present presents s with right ear ear pain pain and and disch discharg arge e since since 3 days. days. Ther There e is no feve fever. r. is is past past medi medica call history is unremarkable.

07. Which symptomatic symptomatic treatment treatment would you you like to prescribe

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

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

ow would you manage this patient

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

+efer immediately. tart tar t treatment treat ment and refer r efer Treat him yourself =f he doesnEt respond in 1 week then refer !)" =nvest =nvestig igate ate and and confir confirm m your your diagnosis and then decide

0. What is the most likely likely outcome outcome of this child assuring he doesnEt have any other medical problem

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

71. 71. A 40 year years s old old woma woman n pres presen ents ts with with episodi episodic c history history of di66ines di66iness: s: earache earache and progressive sensorineural deafness.

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


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

08. 08. A 7 year old girl prese presents nts to you with bilateral ear discharge. e mother tells you that she speaks in nasal tone. er weight is 17 D@.

$enign -ositional vertigo 2tosclerosis 5ennierEs 5enni erEs disease dise ase $ 1/ deficiency Acoustic neuroma neuroma

7/. A 04 years old man man pres resents with ith sens sensor orin ineu eura rall deaf deafne ness ss of righ rightt ear ear since 3 months. There is no ear ache or ear discharge. The tympanic membranes are normal.

What What symp sympto toms ms would ould you furt furthe herr e'plore in the history to find the cause of ear discharge

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

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

ow would manage this patient

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

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

-8-

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


What is the most likely diagnosis in this patient

!)" tart tricyclic antidepressant antidepressant 73. 73. A 38 year year old old fema female le comes comes to your your offi office ce a 1 year year hist histor ory y of epis episod odic ic di66iness: ringing in both ears: a feeling of full fullne ness ss:: and and hear hearin ing g loss loss.. The The sympt symptoms oms came came an every every 1&/ 1&/ weeks weeks and .usually last far 1/ hours. ,ausea and vomiting are present. When asked to descr describe ibe the di66in di66ines ess: s: the patie patient nt says that Ithe world is spinning around.

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

77. 77. What What is the the best best trea treatm tmen entt for for the the patient described in case above

2n phys physica icall e'ami e'amina natio tion: n: the the patie patient nt has has hori6 hori6on ontal tal nysta nystagmu gmus. s. The slow slow phase of the nystagmus is to the left: and and the the rapi rapid d phas phase e is to. to. the the +igh +ightt Audiagrams Audiagrams reveal bilateral senso sensorin rineu eural ral heari hearing ng loss loss in the low freFuencies.

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

An antiseptic antiseptic )ducation and reassurance A thia6ide thia6ide diuretic A change change in the antidepres antidepressant sant $ and a nd d

7. A. 3;&year&old 3;&year&old male comes to your your office for for asse assess ssme ment nt of di66 di66in ines ess. s.II The The di66 di66in ines ess s occu occurs rs when hen he roll rolls s over over from the lying position to either the left side side or the the righ rightt side side.. =t also also occu occurs rs when when he is lookin looking g up. up. e descr describe ibes s sensation sensation of Ithe world spinning aroundI him. The episodes usually last for 1;&10 seconds.


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

estibular neuronitis ,cute labyrinthitis $enign positional vertigo 2rthostat 2rth ostatic ic hypotension hypotens ion 5eniereJs disease

esubular esubular neuritis Acute labyrinthitis labyrinthitis $enign pasitianal vcrtigo. Arthastatic hypatensian hypatensian 5eniereJs 5enie reJs disease disea se


74. The treatmen treatmentt of this disorder disorder includes includes which .of the fallowingK

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

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

*ecrease caffeine intake *ecrease alcohol intake Cse a thia6ide diuretic Cse of ant emetic far nausea and vomiting !)" All of the Above Above !>" ,one of the above

estibular estibular neuronitis. neuronitis . Acute labyrinthitis labyrinthitis -ositional -osit ional vertigo vert igo 2rthostatic hypotension 5eniereJs disease

78. What is the treatmen treatmentt of choice for the patient described in case above

70. A /3&year&o /3&year&old ld female female comes comes to your your office with a 1 month history of di66iness. he Ifeels di66yI when she: stands up !as if she is going to faint". The The sens sensat atio ion n disa disapp ppea ears rs with within in a minu minute te.. he he has has a hist histor ory y of majo majorr depression and she is taking *o'epin.

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

The patientJs blood pressure is 14;B9; mm g sitting md decreas decreases es to 9;B1; 9;B1; mm g when she stands. There is no ata' ata'ia ia:: no nyst nystag agmu mus: s: and and no othe otherr symptoms.

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

79. 79. A 39&y 39&yea ear& r&ol old d fema female le come comes s to your your office with a 4&day history of Iunrelenting di66iness.I The di66iness is associated with with nause nausea a and and vomit vomiting ing.. There There has has been no hearing loss: no tinnitus: and -9-


no sens sensat atio ion n of aura aurall full fullne ness ss.. The The pati patien entt has has just just reco recove vere red d from from an upper&respiratory tract infection. . . 2n e'amination: nystagmus is present. The slow phas phase e of the nystag nystagmu mus s is toward the left: and the rapid phase of the nystagmus is toward the right. There is a significant ata'ia present.

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

3. 3. What What is the the most most comm common on caus cause e of conduct conductive ive hearing hearing loss in adults adults who have have norm normal al&a &app ppea eari ring ng tymp tympan anic ic membranes


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

estibula est ibularr neuronitis neuroni tis Acute labyrinthitis labyrinthitis $enign positional vertigo 2rthostatic hypotension 5eniereJs disease

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

;. What is the treatmen treatmentt of choice choice for the patient described in case above

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

of

alcohol

5eniereJs disease (hronic otitis media -resbycusis 2toscler 2tos clerosis osis 5astoiditis

4. 4. A. 3&ye 3&year& ar&ol old d femal female e comes comes to your your office office for for asses assessme sment nt o heari hearing ng loss. loss. he has had problems intermittently for the past 1/ months. 2n e'amination: the Weber tuning fork test laterali6es to the right ear: and the +inne tuning fork test is negative in the right right ear ear !bone !bone cond conduct uction ion is greate greaterr than air conduction L$(MA("". . This suggests which one of the following hearing losses

and

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

1. 1. A /7&y /7&yea ear& r&ol old d fema female le come comes s to your your offi office ce with with a 7&da 7&day y hist histor ory y of seve severe re di66in di66ines ess s associ associate ated d with with ata'i ata'ia a and and right right sided sided heari hearing ng loss. loss. he he had had an upper&respiratory tract infection 1 week ago. ago. At tha that time time her her righ rightt ear ear felt felt plugged. 2n e'amination: e'amination: there is fluid behind the righ rightt eard eardru rum. m. The There is hori hori6o 6ont ntal al nys nystag tagmus mus prese resen nt with ith the the slow slow compo compone nent nt to the the right right and and the Fuick Fuick component to the left. Ata'ia is present.

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

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

0. A 43&year&old 43&year&old male comes to your your office for assessment of hearing loss. e has had had heari hearing ng diffi difficu culti lties es for for the past past 4 years. 2n e'amination: 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" !$" !(" !*" !)"

5eniereJs disease (hronic otitis media -resby -re sbycus cusis is 2tosclerosis 5astoiditis

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

/. /. What What is the the most most comm common on caus cause e of sensorineural hearing loss in the adult population

!A" A

right&sided hearing loss

- 10 -

conductive conductive


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

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

sensorineural sensorineural sensorineural sensorineural

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

7. 7. A 4/&y 4/&yea ear& r&ol old d woma woman n come comes s to your your office complaining of severe facial pain in the region of her right ma'illa: fever: and a purulent discharge from her right nose: all of which started after a recent upper&respiratory infection. er er temp temper erat atur ure e is 1;1 1;1 >. Ther There e is tenderness tenderness over the right ma'illary sinus and and a green greenish ish disch discharg arge e in her her right right nares nares.. The rest of her her e'ami e'amina natio tion n is normal. Whic Which h of the the foll follow owin ing g stat statem emen ents ts concerning this patient is !are" true

8;. A mother mother comes to your office office with her /4&m /4&mon onth th&o &old ld daug daught hter er.. The The chil child d deve develop loped ed an uppe upper&r r&resp espira irator tory y tract tract infec infectio tion n appro appro'im 'imat ately ely 1 week week ago. ago. Two days ago the child began complaining of pain in the right ear. 2n e'ami e'amina natio tion: n: the the child child has has nasal nasal congestion and a hyperemic throat. The left tympanic membrane is normal: and the right tympanic membrane is bulging and and red. red. The There appe appear ars s to be flui fluid d behi behind nd it: it: The The lung lungs s are are clea clear. r. The The childJs temperature is 39.0O (. What is the most likely diagnosis in this child

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

allergic and viral +hinovirus. +hinovirus. =s the most common among of viral causes iral often is accompanied by fever: malaise: and systemic symptoms A and b only only : A: b: and c are true

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

Acute otitis otitis media !A25" !A25" 2titis media without effusion (hronic otitis media !(25" 2tit 2titis is medi media. a. With With effu effusi sion on !25)" !)" ,one of the above

. Acute Acute bacterial bacterial sinusiti sinusitis s is caused most comm common on=y =y by whic which h of the the foll follow owin ing g organisms

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

81. An 8&month&o 8&month&old ld male is brought brought to your clinic. e has had an upper&respiratory tract infection but has no signs of acute ear ear infect infectio ion n such such as irrita irritabi bilit lity: y: poor poor sleeping: pulling at his ears: or fever. 2n e'am e'amina inatio tion: n: the the tympa tympani nic c mem& mem& brane is dull and bulging but not red. The rest of the the e'am e'amina inatio tion n is benig benign n besides a mild clear rhinorrhea. What is the most likely diagnosis in this child

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

8. 8. What What is the the antib antibac acter terial ial drug drug of first first choice choice for for modet modetat ate e to severe severe acute acute bacterial sinusitus

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

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

5a'illary sinusitis )thmoidal sinusitis >rontal >ron tal sinusit si nusitis is 5andibular sinusitis e. Anterior sinusitis

14 day course" (otr (otrim imo' o'a6 a6ol ole e !1;N !1;N 14 day day course" cefuro'iine !1;&14day course" ciproflo'acin !1;day course" )rythromycin !1;&day course" - 11 -

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


8/. A &month&old &month&old child child is brought brought to your clin clinic ic by his his moth mother er e has has had had an upper&re upper&respir spirator atory y tract tract infectio infection n for the past 3 days. 2n e'amina e'amination tion:: there there is erythem erythema a of the left tympanic membrane with opacification. There are no other signs or symptoms.

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

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


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

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

!A" +ennie and weber !$" -erfo -erform rm a myrin myringo gotom tomy y and and suck suck out out all all the the flui fluid d that 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 child is brought brought to your office with a discharge from the left ear that that has has been been pres presen entt for for the the last last / weeks. The The chi child has a histo story of freFuent ear infections: infections: all of which have been treated with antibiotics. What is the most likely diagnosis in this patient

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

8. 8. Whic Which h of the the foll follow owin ing g state tateme ment nts s regard regarding ing treat treatmen mentt of the the condi conditio tion n described in acute otitis media

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

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

84. Wha What are the thre three e most most commo mmon bacteria rial organisms in order of freFuen freFuency cy that that are responsible responsible for the Acute 2titis 2titis 5edia 5edia

!*"

!A" treptococcus pneumolliae: !$" !(" !*" !)"

Amo'icillin )rythromycin (efaclor Amo'icillin&cavulanic Amo'icillin&cavulanic acid acid

group A streptococci: aemophilus influen6ae . pneumonae: . influen6ae: taphylococcus aureus .pneumonae: . influen6ae: 5ora'ella . influen6ae: . pneumonae: group A streptococci . influen6ae: . pneumonae: 5. catarrBwlis

!)"

treated with aspirin Topical decongestants are useful in improving eustachian tube dysfunction )ar drops do not provide significant 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 statements are are true

88. ow is recurrent recurrent otitis media defined defined

!A" Three or more episodes of A25 that occur within within 7 months within a year !$" >our or more episodes of A25 that occur within 7 months: or five episodes that occur within a year. !(" >ive or more epfaMdes of aom that occur within 7 months or

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

!A" -enicillin - 12 -


si' episodes that occur within a year !*" i' or more episodes of A*5 that occur within 7 months: or eight episodes within a year !)" 1; or more episodes of A25 that occur within 7 months: or three or more episodes that occur within a year

!A" =nfants and young children are !$" !(" !*"

89. 89. Whic Which h of the the foll follow owin ing g stat statem emen ents ts regarding recurrent otitis media is true

!)"

!A" +ecurrent A25 usually occur !$"

!("

!*" !)"

in 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 does not have have a major role to play in the management of recurrent A*5 Antibiotic prophyla' prophyla'is is should be be given for at least 7 months to a year

93. 93. Tymp Tympim imoc ocen ente tesi sis s with with aspi aspira rati tion on of midd middle le ear ear flui fluid d shou should ld not not be considered in which patients e'ceptK

!A" A child who who presents presents with

!$" !("

!*"

9;. 9;. Whic Which h of the the foll follow owin ing g intr intrac acra rani nial al comp compli lica cati tion ons s may may occu occurr with otit otitis is media

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

!)"

Acute otitis otitis media and and com& plains of tinnitus: vertigo: and hearing loss A child who who develops develops a suppurative intra cranial complication of 2titis 5edia An patient patient who is immunologically impaired and does not improve with antibiotic treatment A child who who has e'treme e'treme ear pain and appears ill. A child: who who is already already taking antibiotics

94. A 19 years old college college student presents presents to your your clini clinic c with with one one day day histor history y of ; 1;1 > fever and malaise. is college e'aminations are coming up ne't week. is past history is unremarkable. 2n e'am e'amin inat atio ion n his his thro throat at is mild mildly ly hype hypere remi mic. c. What What coul could d be the the best best management is this case

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

91. Which of the following following is NOT a possible e'tr e'trac acra rani nial al comp compli lica cati tion on of otit otitis is media

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

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 9;H of children will have an episode of aom by age 3 years =ncidence of aom peaks between 7 to 13 months of age

!A" -aracetamol  !$"

5astoiditis (holesteatoma #abyrinthitis >acial paralysis 2tic hydrocephalus

!(" !*"

9/. 9/. Whic Which h of the the foll follow owin ing g is fals false e abou aboutt Acute 2titis 2titis 5edia 5edia

!)" - 13 -

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


90.

treatmen treatments ts would would be most most appropr appropriate iate for this patient who has benign paro'ysmal

Which one of the foll follow owin ing g stateme temen nts abou aboutt the the diff differ eren enti tial al diag diagno nosi sis s of rhin rhinit itis is is correct

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

!A" #ymphadenopathy is associated with allergic rhinitis. !$" asomotor asomotor rhinitis is seasonal: seasonal: not perennial. !(" 2ccupational rhinitis can be allergic or nonallergic. nonallergic. !*" Allergic rhinitis rhinitis is only seasonal. 97. 97.

=n addit additio ion n to taph taphyl yloc ococ occu cus s aure aureus us:: which one of the following is the ne't most common common pathoge pathogen n isolated isolated from ears ears with with chro chroni nic c supp suppur urat ativ ive e otit otitis is media

!A" !$" !(" !*" !)" 9.

99. 99.

)'ternal ear infection. (erumen impaction. 5iddle ear fluid. >urosamide 2tosclerosis.

1;;. Which one of the following recommen recommendati dations ons about about antibio antibiotics tics for the the prev preven enti tion on of cold cold symp sympto toms ms is CORRECT

A 0;&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. volume. e denies denies any discharge discharge from the ears: vertigo or fever: but he has had some intermittent ringing of the right ear. A Weber test reveals latera laterali6 li6at ation ion to the left. left. A +inne +inne test test shows better air conduction than bone conduction bilaterally. What is the most appropriate diagnosis

!A" Antibiotics Antibiotics are recommended recommended for patients with purulent nasal disch discharg arge e after after three three to five five days. !$" Antibiotics Antibiotics are recommended recommended to prevent pneumonia. !(" Antibiotics Antibiotics are not recommended for patients with a suspected cold. !*" Antibiotics Antibiotics are recommended 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. 98.

A 4; year years s old man man come comes s with with tinn tinnit itus us in both ear .is hearing is normal .)ar e'amination e'amination is also normal Which one of the the foll follow owin ing g may may lead lead to tinn tinnit itus us without hearing loss

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

treptococcus pneumoniae. aemophilus influen6ae. 5ora'ella catarrhalis. catarrhalis. -seudomonas -seud omonas aeruginos aeru ginosa a. erratia marcescens.

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

1;1. 1;1. A 48 year year old man complai complains ns of hearing hearing loss: tinnitus in the right ear: and vertigo for the past 7 months. =n addition: he has has facia faciall pain pain and and weak weaknes ness s of his his facial muscles. 2n physical e'amina e'amination tion:: he has a facial facial palsy palsy on the right side. Which of the following is the most likely diagnosis

A // years old man presents with vertigo on turning his face to right . e does does not not have have heari hearing ng proble problem: m: ear ear complaint: or headache his general and syste systemic mic e'am e'ams s are norma normal. l. alpi alpick ck maneurer elicits nystaginus on + lateral ga6e. 6e. Whi Which one of the foll follo owing

!A" Acoustic neuroma neuroma - 14 -


!$" !(" !*" !)" 1;/.

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

P8. Which one of the following is not a cause cause of conducti conductive ve hearing hearing loss that that may lead to tinnitus ? !A" )'ternal ear infection. !$" (erumen impaction. !(" 5iddle ear fluid. !*" #oop diuretic medications. !)" 2tosclerosis.

- 15 -

ENT mcqs

Recommend Documents