SECTION A
1. A 30 year old woman with a family history of hearing loss on her mother’s side develops a hearing problem during pregnancy. The hearing loss is bilateral slowly progressive with bilateral tinnitus that bothers her at night. Pure tone audiometry shows a conductive hearing loss with an apparent bone conduction hearing loss at 2 KHz.
Which of the following is NOT associated with this patient’s most likely diagnosis?
a. Carharts notch
b. Type C tympanogram c. Shwartze’s sign
d. A negative Rinne Test e. Paracusis Willis
2. Which of the following statements is correct regarding the anatomy of the ear;
a. Stapes footplate covers the round window
b. Endolymph is produced by the endolymphatic sac c. The external auditory canal is 36 mm in length
d. Sensory supply of the middle ear is via the glossopharyngeal nerve e. The Pinna supplied by auricular branches of the lingual artery 3. A 38 year old male presents with decreased hearing in the right ear for 2
years. On testing with a 512 Hz tuning fork, the Rinnes test (without masking) is negative on the right ear and positive on the left ear. With the weber test the sound is perceived louder in the left ear. The patient most likely has
a. Right conductive hearing loss b. Right sensorineural hearing loss c. Left sensorineural hearing loss d. Left conductive hearing loss e. Mixed hearing loss
4. A 40-year-old woman presents with a history of vertigo. She describes these spells as lasting for 20 minutes to a few hours sometimes associated with nausea and vomiting. You suspect Meniere’s disease. Which of the following additional findings is not associated with this condition
a. pulsatile tinnitus
b. sensorineural deafness c. fluctuating hearing loss
d. increased endolymphatic pressure e. aural fullness
5. All of the following statements are CORRECT regarding vestibular schwanommas EXCEPT;
a. Gadolinium contrast MRI of the base of skull is the gold standard investigation
b. Sensorineural hearing loss is the most common presenting symptom c. The most common location is the cerebellar peduncle
d. Tinnitus is a common presenting complaint e. Facial paralysis may occur post operatively
6. Which of the following is true regarding malignant otitis externa a. Associated with high mitotic figures
b. Staphylococcus aureus is the most commonly isolated pathogen (95%) c. More common in patients with diabetes insipidus and swimmers
d. Infection spreads outside the auditory canal via fissures of Santorini e. Amoxicillin is the treatment of choice for complete eradication of
infection
A 60 year old woman presents to the clinic with a right pre-auricular mass of 9 months duration. Initially the patient palpated a tender 1cm X 0.5 cm mass which progressively enlarged to its present size. On physical examination there is 5 X 4 X 4 cm tender, stony hard, nodular mass on the right pre-auricular area. The
overlying skin is not indurated. No cervical lymphadenopathy was noted.
7. Which additional finding in the above patient, would most support a parotid malignancy
a. Enlargement of the Deep lobe of the parotid b. Severe burning Pain in the pre-auricular region c. Increased fluctuance of the mass
d. Lagohthalmos and facial asymmetry e. Slow to moderate rate of growth
8. A superficial parotidectomy is attempted but with great difficulty and unfortunately all facial nerve branches could not be preserved. The most reliable landmark to identify the main trunk of the facial nerve is
a. Tympanomastoid suture b. Tragal cartilaginous pointer c. Mastoid tip
d. The styloid process e. Zygomatic process
9. The mass is resected and sent for histopathological examination. The result came back as; Adenoid cystic carcinoma of the parotid. Which of the following statements is most accurate regarding this condition
c. Perineural invasion with skip lesions is characteristic d. Most common malignancy of the parotid gland
e. Least common malignancy of the submandibular gland
10.2-months post-surgery the patient returns complaining of increased sweating and flushing to the right cheek especially when eating. Which of the following statements is incorrect regarding her diagnosis?
a. Due to Aberrant cross –innervation of post-ganglionic parasympathetic fibres for parotid to post ganglionic fibres supplying sweat glands of the skin
b. Topical antiperspirants may help to reduce symptoms c. Jacobson’s neurectomy is a possible treatment option
d. Botox injections have no role in the treatment of this condition e. Minor Starch’s iodine test may help to diagnose this condition
11.Which of the following statements is CORRECT regarding the anatomy of the nose?
a. Sphenopalatine artery is a branch of the internal carotid artery b. The nasolacrimal duct opens into the middle meatus
c. The internal carotid plexus carries post ganglionic axons to in the nose causing sympathetic vasoconstriction
d. The uncinate process is part of the horizontal process of the maxilla e. The sphenoid sinus drains into the superior meatus
12.Which of the following statements is INCORRECT;
a. A septal haematoma should be drained immediately to prevent ischemic necrosis of the septal cartilage
b. the most effective medical treatment for nasal polyps is topical glucocorticoids
c. Prolonged usage of oxymetazoline may cause rebound nasal congestion
d. Aspirin may improve nasal congestion in patients with asthma and nasal polyps
e. Antihistamines have not been shown to be effective in the treatment of acute sinusitis
An 18- year-old male is referred to otolaryngology clinic with a history of unilateral nasal obstruction. He also has a history of recurrent nose bleeds, hearing loss and anosmia. There is no family history of epistaxis. Radiologic imaging shows a highly vascularized submucosal mass arising from the lateral nasal wall extending to the nasopharynx. Oral examination shows no abnormalities and there are no cervical lymph nodes. A biopsy of the lesion is attempted in the clinic however the patient develops profuse epistaxis requiring operative intervention.
13.Which of the following is the most likely diagnosis? a. Nasopharyngeal Carcinoma
b. Juvenile Nasopharyngeal angiofibroma c. Osler-Weber-Rendu Syndrome
d. Pyogenic granuloma e. Antrochoanal polyp
14.Identify which malignancy of the paranasal sinuses is MOST associated with woodwork dust exposure
a. Adenocarcinoma
b. Squamous Cell carcinoma c. Olfactory neuroblastoma d. Adenoid Cystic Carcinoma e. Mucoepidermoid carcinoma
A 14 year old male presents with bilateral cervical lymphadenopathy, conductive hearing loss and nasal congestion. Nasopharyngoscopy reveals a mass in the fossa of rosenmuller.
15.Which of the following is true about his condition?
a. The most common nerve involved is cranial nerve X
b. Early disease is primarily treated with surgery and adjuvant chemotherapy
c. Patients of South African descent are at higher risk of developing this malignancy
d. Associated with early ingestion of Cantonese style salted fish
e. Epstein Barr viral DNA and LMP1 is seen only detected in a minority of cases
16.Which of the following would be associated with a favorable prognosis in this patient
a. Metastases to level V (supraclavicular) lymph nodes b. Tumour size less than 2cm
c. Keratinizing squamous cell carcinoma (WHO type I) on histology d. Computed tomography showing Intracranial extension
17.Which of the following statements is TRUE regarding paediatric tonsillectomy?
a. Intraoperative bleeding is mainly from the superficial temporal artery b. Postoperative referred earache is mediated via the trigeminal nerve c. Urgent tonsillectomy is indicated in patients with a single episode of
Peritonsillar abscess
d. Tonsillectomy is contraindicated in patients with febrile convulsions e. Upper aero-digestive obstruction is an absolute indication
18.A 50 year old man presents with a mass of lymph nodes in the upper cervical region. Complete physical examination of the upper aero-digestive tract did not reveal any primary tumour. He is a smoker and also drinks two to three times per week. Your next diagnostic step should be
a. Incisional biopsy of the node b. Excision of cervical nodes c. Fine needle aspiration cytology
d. Observation for appearance of any primary e. CT scan neck
19.Which of the following is MOST accurate regarding Laryngeal anatomy a. The posterior cricoarytenoid muscles are the only abductors of the
true vocal cords
b. Sensory supply above the true vocal cords is via the recurrent laryngeal nerves
c. The cricothyroid muscle relaxes the vocal cords via the internal branch of the superior laryngeal nerve
d. The vocal cords are lined by keratinized stratified squamous epithelium e. Injury to recurrent laryngeal nerve would denervate the cricothyroid
muscles
20.A 66-year-old farmer presents to the clinic with persistent hoarseness and dysphagia of 3 months duration. He is a chronic smoker and drinks alcohol daily. Indirect laryngoscopy shows no lesions in the larynx but the left vocal cord appears fixed in the para-median position. All of the following options are possible differentials EXCEPT
a. Vagal nerve schwannoma
b. Anaplastic Carcinoma of the thyroid c. Dissecting Aneurysm of the Aortic arch d. Inferior sulcus Bronchogenic carcinoma e. Advanced Oesophageal Carcinoma
21.Regarding carcinoma of the Larynx which of the following statements is CORRECT;
a. Most common histologic type is adenocarcinoma
b. hoarseness is an early symptom of supra-glottic carcinoma c. glottic carcinomas have the best prognosis
d. lymph node metastases occurs very early in glottic carcinomas e. patients with subglottic laryngeal carcinoma usually present early 22.The BEST treatment option for squamous cell carcinoma with spread to the
thyroid cartilage. Stage T4NoMo is a. Laser surgery
b. Chemoradiation
c. Total laryngectomy and radiotherapy d. Hemilaryngectomy and radiotherapy e. Neck dissection
23.All of the following structures are commonly removed in a radical neck dissection EXCEPT;
a. Sternocleidomastoid b. Internal jugular vein c. Vagus nerve
d. Level I, II, III, IV, V lymph nodes e. Spinal Accessory nerve
You are called by the nurse in recovery room see a 46-year old patient who is confused and agitated post total thyroidectomy. Her RR is 24 breaths per minute, pulse rate 130, blood pressure is 180/70 and her temperature is 104 ◦C. She has lid retraction and a fine tremor. Her chvostek sign is negative. The neck is flat and the dressing appears clean. Both vocal cords were mobile post op.
24.The most likely cause of this patient’s clinical presentation is a. Low serum calcium levels
b. Postoperative bleeding
c. Recurrent laryngeal nerve injury d. Thyrotoxic storm
25.Which of the following statements is CORRECT regarding thyroid gland anatomy?
a. It contains numerous parafollicular cells which secrete T3 and T4 b. the superior thyroid artery is a branch of the first part the subclavian
artery
c. The inferior thyroid artery is a branch of the external carotid artery d. Isthmus lies anterior to the 2nd to 4th tracheal rings
e. moves with swallowing because its attachment to the hyoid bone
A 55-year-old male presents to the clinic with a palpable anterior neck mass that moves on swallowing. The mass is 5cm x 5cm, hard in consistency and confined to the left neck.
26.Which if the following is the single most useful initial investigation? a. Thyroid stimulation Hormone
b. Fine Needle biopsy c. Ultrasound
d. CT scan of the neck e. Core needle biopsy
27.The patient is found to have medullary thyroid carcinoma. Which of the following is FALSE?
a. Calcitonin levels can be used to monitor recurrence b. Somatic RET mutation is a poor prognostic factor
c. Associated with Multiple Endocrine Neoplasia type 2a and 2b d. Congo Red staining of stromal amyloid is characteristic e. Hemithryoidectomy is the treatment of choice
28.Typical features of Horner’s syndrome include all the following EXCEPT; a. Dilated pupils
b. Partial Ptosis
c. Pseudoenophthalmos d. Anhydrosis
29.Which statement is incorrect regarding facial bone fractures;
a. Diplopia is secondary to inferior rectus muscle entrapment in blowout fractures of the orbit
b. Naso-ethmoidal injuries may present with CSF rhinorrhea
c. A tripod fracture occurs through the maxilla, zygomatic and nasal bones sparing the inferior orbital rim
d. Waters view on Xray will show the majority of facial bone fractures e. A lefort type II fracture is detected clinically with movement of the
nose on tugging the hard palate
30.A 36-year-old high school coach presents with persistent hoarseness of 3 months duration. His past medical history is significant for mild GERD, and allergic rhinitis. His past surgical history includes excision of a thyro-glossal duct cyst when he was 6 years old. He used to smoke occasionally but quit last year since he started this new job. Indirect laryngoscopy shows a single nodule between the junction of the anterior 1/3 and posterior 2/3rds on the right vocal cord.
Which of the following is the most likely cause of his symptoms? a. Acute laryngitis
b. Recurrent laryngeal papillomatosis c. Reinkes oedema
d. Singers nodule e. hypothyroidism
Section B
Theme: Congenital Hearing Loss
A. Pendred SyndromeB. Treacher Collins syndrome C. Waardenburg Syndrome D. Alport Syndrome
E. Usher syndrome
1) An autosomal recessive condition in which children are born with bilateral sensorineural hearing loss and develop abnormalities in thyroxine synthesis resulting in goiters in adolescence
2) Autosomal dominant disorder associated with sensorineural hearing loss, heterochromia iridis and white lock of hair.
3) A rare autosomal recessive disease associated with hearing loss with retinitis pigmentosa
Theme: Diagnosis and Investigation of Dysphagia
A. Barium swallowB. Computed tomography of the chest C. 24-hour lower oesophageal pH D. Rigid oesophagoscopy
E. Oesophageal Manometry
4) A 67-year-old man presents with dysphagia and a night cough – symptoms he has suffered for 6 months. He has recently been admitted to hospital with a chest infection. On examination, there is a soft swelling in the anterior triangle of the neck that gurgles on palpation. The Best initial investigation is?
5) A 37-year-old woman presents with dysphagia that is equally apparent with solids and liquids. She also complains of regurgitation of food, which usually occurs on lying flat. She otherwise feels well, but admits to losing 5 kg in weight over the past 3 months. A chest X-ray shows an air–fluid level behind the heart, a double right heart border and absence of the gastric air bubble. What is the “gold standard” test to diagnose her condition?