Otolaryngology ENT, Head & Neck surgery

Questions 1-6 pertain to the following clinical scenario

A 35-year-old male complains of right ear deafness and nasal congestion with associated intermittent
blood stained nasal discharge. One physical examination of the neck a firm, fixed level II cervical lymph
node is present. Otoscopy is reveals fluid behind an intact tympanic membrane. Rinne testing is positive
on the right and Weber lateralizes to the right ear.

1. The most probable diagnosis is…

a. Nasopharyngeal Angiofibroma
b. Non-Hodgkin’s lymphoma
c. Squamous cell Carcinoma of the External Ear
d. Mucoepidermoid Carcinoma
e. Nasopharyngeal carcinoma

2. Which of the following risk factors is most strongly associated with the pathogenesis of this condition?

a. Cigarette smoking
b. Obesity
c. Viral infection
d. Excessive Alcohol intake
e. Cantonese style salted fish

3. Which of the following investigations is best to determine the extent of spread of his disease?

a. Flexible nasopharyngoscopy
b. Computed tomography of the head and neck
c. Magnetic resonance Imaging
d. Positron Emission Tomography
e. Post Nasal Space X-ray

4. The treatment modality that is likely to be the most effective is

a. Radical neck dissection

b. Immunotherapy
c. Chemo-radiotherapy
d. Hormonal therapy
e. Cryosurgery

5. A pure tone audiogram along with impedance tympanometry is requested. Which of the following is
most consistent with his condition?
a. Conductive hearing loss – type A tympanogram
b. Sensorineural hearing loss – type B tympanogram
c. Conductive hearing loss – type C tympanogram
d. Sensorineural hearing loss – type Ad tympanogram
e. Conductive hearing loss –type AS tympanogram
 Otolaryngology ENT, Head & Neck surgery

6. The best treatment option to address his hearing issue is

a. Tympanocentesis
b. Tympanoplasty
c. Adenoidectomy
d. Antibiotics
e. Grommet insertion

Section II: Otology & Audiology

7.