CME for Family Physicians ENT

1. A 14 years old boy presents to your clinic with a small dimple just in front of the left ear since birth. The dimple was sore and discharging 3 months ago and is well these days. The father asks you to remove this dimple. What would be your approach

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

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

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

!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

0. (ase same as above. 3ow would you manage this patient

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

(lo'acillin (lo'acillin 4 5etronida6ole Amo'icillin #oratidine 4 Amo'acillin #oratidine 4 topical antibiotics

-reauricular sinus .urgery with facial nerve monitoring /. A 01 years old man presents with / days history of pain and swelling of the left ear. 2n e'amination the auricle is inflamed and ear lobe is normal. What is the most likely diagnosis

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

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

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

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

1. (ase same as above. 3ow would you manage this patient

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

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

Topical antibiotics (lo'acillin (lo'acillin 4 Topical antibiotics (autry $iopsy

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

(lo'acillin (lo'acillin 4 5etronida6ole Amo'icillin #oratidine 4 Amo'acillin #oratidine 4 topical antibiotics

8. Which one is not a contraindication to the ear syringing

!A" 2nly hearing ear !$" 3istory of Tympanic 5embrane

perforation

4. A /4 years old man resents with pain and swelling of the left ear since / days.
-1-

!(" -revious ear surgery !*" +ecent ear trauma !)" 3istory of otitis e'terna

CME for Family Physicians ENT

9. A 3/ years man was hit on his left ear during a street fight. 3e presents to your clinic with swelling of e'ternal ear. 3e does not want to hospital because of fear of police. 2n e'amination the both sides of the left auricle are swollen: red and tender. 3ow would you manage this case

!*" Antibiotic drops and refer to

),T

!)" =mmediately refer to ),T

1/. 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. What is the most likely cause of ear pain

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

pinna

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

!(" (lo'acillin and e'cision of the

swelling !*" *iclofenac and (lo'acillin and pressure bandage !)" *iclofenac: (lo'acillin: aspiration and pressure dressing 1;. (ase same as above. What is the most likely diagnosis

to tonsillectomy !(" )ustachian tube dysfunction !*" =t is a complication of anesthesia !)" +eferred pain 13. A 1 years old boy presents with fever and pain in right ear since / days. 2n e'amination the child is febrile: irritable and the tympanic membrane is red: bulging. What is the most likely diagnosis

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

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

11. A /0 years old man comes to your clinic and tells you that one of fast friend put a small object in his ear during play. <ou e'amined his ear and found a small bead attached to the superior aspect of the ear canal. 3ow would you manage this patient

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

perforation !(" .erous otitis media !*" ,ormal ear !)" Acute on chronic otitis media 14. 3ow would you manage this patient

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

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

!A" -aracetamol !$" -aracetamol and Amo'icillin !(" -aracetamol: Amo'icillin and
Antibiotic ear drops

!*" -aracetamol: Amo'icillin and

grommet insertion !)" +efer to ),T

-2-

CME for Family Physicians ENT

10. (ase same as above. Which organism is the most common cause of this condition

Which clinical sign would be useful to further reinforce your diagnosis

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

.treptococcus pneumoniae 3aemophilus influen6ae .trep pyogenes 5ora'ella catarrhalis .taphylococcus

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

3earing test +ennie test Weber test Tragus sign ,one of the above

17. A 0 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. 3ow would you manage this patient

19. (ase same as above. 3ow would you manage this patient

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

4 Topical Antibiotics !*" 2ral antibiotics 4 Topical antibiotics !)" =ncision and oral antibiotics /;. A 3/ years old shopkeeper presents to your clinic with 3 days history of rhinorhea: fever and cough. 3e is taking treatment from an ),T surgeon who has advised surgery after / weeks. 3is 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

!*" ($(: ).+: %&ray nasopharyn' !)" >ollow up in your clinic

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

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

+esponse Audiometry" !*" #imited (T scan of the ear !)" (aloric test
18.

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

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

A /1 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;/; >. 3er preauricular lymph node is palpable. 2n e'amination the ear looks like this?

/1. 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. <ou also noticed the following features. What is the most likely diagnosis
-3-

facial

CME for Family Physicians ENT

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

$ells palsy .arcoidosis *iabetic mononeuropathy +amsay 3unt .yndrome 2tomycosis

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

AirchowEs lymph node Tuberulosis -ancoastEs tumor Tumor of left lobe of thyroid .arcoidosis

/0. (ase same as above. //. (ase same as above. 3ow would you manage this patient 3ow would you investigate this patient as a family physician

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

.teroids Acyclovir Antibiotics Aitamin $ 1/ ,one of the above

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

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

/3. A 7 years old girl presents with / days history of fever: difficulty in swallowing: drowsiness. 2n e'amination there is a grayish white layer in the throat and the neck is swollen. 3er pulse is 13;B minute and e'tremities are cold. 3ow would you manage this patient

/7. A 9 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" +efer to ),T 2-* !$" +efer to =(C !(" =A line: )rythromycin for /4
hours and then decide

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

!*" Amo'icillin and steroids !)" )rythromycin and removal of

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

.wallowing =ndirect laryngoscopy -rotruding tongue $lowing out air against closed mouth !)" Trans illumination /1. A 40 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" !$" !(" !*"

-4-

.cleroderma 2ral (andida infection 5ucosal atrophy .ub mucous fibrosis

CME for Family Physicians ENT

!)" #eukoplakia

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

3/. A 19 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" !$" !(" !*"

-apilloma +hinitis medicamentosa .eptal haematoma Cnilateral choanal atresia

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

*iphtheria -eritonsillar abscess #udwigEs angina )piglottitis >oreign body in the throat

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.

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

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

-apilloma +hinitis medicamentosa .eptal haematoma Cnilateral choanal atresia

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

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

34. A 18 year old has noticed right sided nasal obstruction associated with a bloody discharge that has developed over the last month.

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

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

Adenoidal 3ypertrophy Allergic rhinitis (arcinoma >oreign body

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

then refer !(" =nsert oral airway and then refer !*" =A steroids and antibiotics and then refer !)" ,one of the above 31. A 3 year old with unilateral foul&smelling bloody discharge.

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

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

Adenoidal 3ypertrophy Allergic rhinitis (arcinoma >oreign body

37. A 40 year old man is referred to you by his dentist: 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" !$" !(" !*"

Adenoidal 3ypertrophy Allergic rhinitis (arcinoma >oreign body

-5-

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

#ichen planus $asal cell carcinoma Angular stomatitis Clcerative stomatitis

CME for Family Physicians ENT

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

!$" 3ypothyroidism !(" #aryngeal (arcinoma !*" 2esophageal reflu'

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

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

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

38. A 00 year old man presents with bleeding gums. 2n e'amination there is a line of inflammation at the border of the gum: the intradental papillae are swollen: and he has halitosis.

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

2veruse .inusitis Airal laryngitis Aocal cord nodules

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

Apthous Clcer #eukoplakia 5ucocoele @ingivitis 2ral candidiasis

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

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

2veruse .inusitis Airal laryngitis Aocal cord nodules

39. A 71 year old man with (2-* has recently had an infective e'cerbation. 3e complains of an unpleasant taste in his mouth: and e'amination reveals white deposits adhering to the mucous membranes.

44. A 19 year old woman with a pulsatile mass in the anterior triangle. What is the most likely diagnosis

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

Apthous Clcer #eukoplakia 5ucocaele @ingivitis 2ral candiasis

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

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

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

4;. A 71 year old smoker has noticed a gradual change in voice over the last / months.

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

>unctional -aralysis 3ypothyroidism #aryngeal (arcinoma 2esophageal reflu'

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

+eactive #ymphadenitis .arcoidosis .ebaceous cyst Thyroglossal cyst

41. A 08 year old woman feels 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 ahs gained weight. What is the most appropriate diagnosis

47. A 3/ year old with diffuse smooth midline swelling that moves on swallowing. What is most likely diagnosis

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

@oitre #aryngocoele #ymphoma -haryngeal pouch

!A" >unctional -aralysis

-6-

CME for Family Physicians ENT

41. A 9 year old boy returns from his summer holiday with a painful ear which is keeping him awake all night. 3e is unable to tolerate e'amination of the affected side.

01. 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. 3ow would you interpret the findings

!A" =nfective otitis media !$" 2titis e'terna !(" Temporomandibular joint
dysfunction !*" Tonsillitis 48. A 3; year old man presents with a / G day history of malaise: fever: bad oral smell: painful swallowing and bilateral ear ache. )'amination of the ears is normal.

!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 0/. 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. 3ow would you interpret these findings

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

!*" Tonsillitis !)" -eritonsillar abscess

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

!A" $ilateral sensory loss !$" $ilateral conduction defect !(" $ilateral sensory 4 conduction
defect

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

03. 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. What is the most likely diagnosis

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

helicis e'terna !(" 5astoiditis !*" $arotrauma 0;. A 10 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. 3ow 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

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

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

04. (ase same as above. 3ow would you manage this case

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

-7-

CME for Family Physicians ENT

!(" Treat for /4 hrs and then refer !*" =nvestigate and refer !)" Treat him yourself
00. Which antibiotic would you like to prescribe to him

09. Which single investigation would you order to confirm your diagnosis

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

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

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

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

07. Which symptomatic treatment would you like to prescribe

7;. A 04 years old man presents with right ear pain and discharge since 3 days. There is no fever. 3is past medical history is unremarkable. 3ow would you manage this patient

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

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

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

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

+efer immediately. .tart treatment and refer Treat him yourself =f he doesnEt respond in 1 week then refer !)" =nvestigate and confirm your diagnosis and then decide 71. A 40 years old woman presents with episodic history of di66iness: earache and progressive sensorineural deafness. What is the most likely diagnosis

!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

08. A 7 year old girl presents to you with bilateral ear discharge. 3e mother tells you that she speaks in nasal tone. 3er weight is 17 D@. What symptoms would you further e'plore in the history to find the cause of ear discharge

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

$enign -ositional vertigo 2tosclerosis 5ennierEs disease $ 1/ deficiency Acoustic neuroma

7/. A 04 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. 3ow would manage this patient

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

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

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

-8-

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

CME for Family Physicians ENT

!)" .tart tricyclic antidepressant

73. A 38 year old female comes to your office a 1 year history of episodic di66iness: ringing in both ears: a feeling of fullness: 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 di66iness: the patient says that Ithe world is spinning around. 2n physical e'amination: the patient has hori6ontal nystagmus. The slow phase of the nystagmus is to the left: and the rapid phase is to. the +ight Audiagrams reveal bilateral sensorineural hearing loss in the low freFuencies. What is the most likely diagnosis in this patient

What is the most likely diagnosis in this patient

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

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

77. What is the best treatment for the patient described in case above

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

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

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

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

71. 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. 3e describes sensation of Ithe world spinning aroundI him. The episodes usually last for 1;&10 seconds. What is the most likely diagnosis in this patient

74. The treatment of this disorder includes which .of the fallowingK

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

*ecrease caffeine intake *ecrease alcohol intake Cse a thia6ide diuretic Cse of ant emetic far nausea and vomiting !)" All of the Above !>" ,one of the above 70. A /3&year&old female comes to your office with a 1 month history of di66iness. .he Ifeels di66yI when she: 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;B9; mm 3g sitting md decreases to 9;B11; mm 3g when she stands. There is no ata'ia: no nystagmus: and no other symptoms.
-9-

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

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

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

!A" Avoidance of alcohol and

caffeine

!$" *imenhydrinate !(" A thia6ide diuretic !*" +eassurance and simple

e'ercises !)" )dolymphatic surgery 79. A 39&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 loss: no tinnitus: and

CME for Family Physicians ENT

no sensation of aural fullness. The patient has just recovered from an upper&respiratory tract infection. . . 2n e'amination: nystagmus is present. The slow phase of the nystagmus is toward the left: 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" !$" !(" !*" !)"

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

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

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

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

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

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

1;. What is the treatment of choice for the patient described in case above

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

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

11. 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'amination: 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

14. A. 31&year&old female comes to your office for assessment o hearing 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 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 10. A 43&year&old male comes to your office for assessment of hearing loss. 3e has had hearing difficulties for the 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" !$" !(" !*" !)"

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

1/. What is the most common cause of sensorineural hearing loss in the adult population
- 10 -

!A" A

right&sided hearing loss

conductive

CME for Family Physicians ENT

!$" A left&sided conductive hearing

loss

!(" A

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

sensorineural sensorineural

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

17. A 4/&year&old woman comes to 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. 3er 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" !$" !(" !*"

5a'illary sinusitis )thmoidal sinusitis >rontal sinusitis 5andibular sinusitis e. Anterior sinusitis

!A" The most common causes are

allergic and viral

!$" +hinovirus. =s the most

common among of viral causes !(" Airal often is accompanied by fever: malaise: and systemic symptoms !*" A and b only : !)" A: b: and c are true 11. Acute bacterial sinusitis is caused most common=y by which of the following organisms

8;. 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'amination: the child has nasal congestion and a hyperemic throat. The left tympanic membrane is normal: and the right tympanic membrane is bulging and red. There appears to be fluid behind it: The lungs are clear. The childJs temperature is 39.0O (. 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 81. An 8&month&old male is brought to your clinic. 3e has had an upper&respiratory tract infection but has no signs of acute ear infection such as irritability: poor sleeping: pulling at his ears: or fever. 2n e'amination: 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" !$" !(" !*" !)"

.trep. -rieumonae 3aemophilus influen6ae 5ora'ella catarhalis .. pyogenes .taphylococcus aureus

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

!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"
- 11 -

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

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

CME for Family Physicians ENT

8/. A 1&month&old child is brought to your clinic by his mother 3e has had an upper&respiratory tract infection for the past 3 days. 2n e'amination: there is erythema of the left tympanic membrane with opacification. There are no other signs or symptoms. What is the most likely diagnosis in this patient

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

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

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

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

87. A 1 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" +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 81. Which of the following statements regarding treatment of the condition described in acute otitis media

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 infections: all of which have been treated with antibiotics. What is the most likely diagnosis in this patient

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

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

!A" )arache and fever should be

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 88. 3ow is recurrent otitis media defined

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

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

group A streptococci: 3aemophilus influen6ae .. pneumonae: 3. influen6ae: .taphylococcus aureus ..pneumonae: 3. influen6ae: 5ora'ella 3. influen6ae: .. pneumonae: group A streptococci 3. influen6ae: .. pneumonae: 5. catarrBwlis

!A" Three or more episodes of

A25 that occur 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. What is the drug of first choice for the condition acute ottitis media

!A" -enicillin
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CME for Family Physicians ENT

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 89. Which of the following statements regarding recurrent otitis media is true

!A" =nfants and young children are !$" !(" !*" !)"
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" +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 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 9;. Which of the following intracranial complications may occur with otitis media

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

!A" A child who presents with

Acute otitis media and com& plains of tinnitus: vertigo: 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 child: who is already taking antibiotics

!$" !("

!*" !)"

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

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

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

94. A 19 years old college student presents to your clinic with one day history of 1;1; > fever and malaise. 3is college e'aminations are coming up ne't week. 3is past history is unremarkable. 2n e'amination his throat is mildly hyperemic. What could be the best management is this case

!A" -aracetamol 4
chlorpheneramine 4 @argles

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

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

!$" -aracetamol 4 Amo'icillin 4

@argles. !(" -aracetamol 4 chlorpheneramine 4 Amo'cillin !*" -aracetamol 4 chlorpheneramine 4 Amo'cillin 4 @argles !)" -aracetamol 4 gargles.
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9/. Which of the following is false about Acute 2titis 5edia

CME for Family Physicians ENT

90.

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

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

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

99. procedure 5ecli6ine !Antivert" *ia6epam #ow&salt diet 3ydrochlorothia6ide

!A" #ymphadenopathy is
associated with allergic rhinitis.

!$" Aasomotor rhinitis is seasonal:

not perennial.

!(" 2ccupational rhinitis can be

allergic or nonallergic. !*" Allergic rhinitis is only seasonal. 97. =n addition to .taphylococcus aureus: which one of the following is the ne't most common pathogen isolated from ears with chronic suppurative otitis media

A 4; years old man comes with tinnitus in both ear .3is hearing is normal .)ar e'amination is also normal Which one of the following may lead to tinnitus without hearing loss

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

91.

.treptococcus pneumoniae. 3aemophilus influen6ae. 5ora'ella catarrhalis. -seudomonas aeruginosa. .erratia marcescens.

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

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

A 0;&year&old patient complains of hearing loss. 3e denies noise e'posure at work but says that he has a hard time hearing the television unless he turns up the volume. 3e denies any discharge from the ears: vertigo or fever: 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

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

!A" (onductive deficit. !$" .ensorineural deficit of the right

ear.

!(" 5i'ed deficit. !*" Temporal threshold shift.

98. A // years old man presents with vertigo on turning his face to right . 3e does not have hearing problem: ear complaint: or headache his general and systemic e'ams are normal. 3alpick maneurer elicits nystaginus on + lateral ga6e. Which one of the following
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!A" Acoustic neuroma

CME for Family Physicians ENT

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

1;/.

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

P8. 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.

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