E.N.

T-Otorhinolaryngology

Instructions: Read each question carefully and then select the single best answer
Part I: Otology/Ear

1) A 21-year-old swimmer presents with severe ear pain, discharge and itching in his left ear for 2 days.
On physical exam pain is elicited when tragal pressure. The auditory meatus is oedematous and
erythematous with yellowish debris. What is the next best step in the management of this patient?
a. Apply topical ciprofloxacin ear drops
b. Prescribe NSAIDs
c. Irrigating or suctioning of the ear canal
d. Request CT scan of the temporal bone
e. Request an audiogram

2) A 42-year-old patient with HIV and diabetes complains of marked otalgia and otorrhea for 2 weeks.
Hemi-facial weakness is present. Otoscopy reveals purulent discharge and granulation tissue on the
floor of the external auditory canal at the osseocartilaginous junction. Which of the following
statements is likely to be most accurate?
a. The granulation tissue noted in the ear should be biopsied to rule out a possible malignancy
b. Streptococcus pneumoniae is the most likely organism implicated in this disease
c. A perforation in the pars flaccida is characteristic of this condition
d. Her condition is most likely caused by reactivated varicella zoster virus
e. Oral amoxicillin is considered the treatment of choice

3) A 52-year-old woman presents with “really bad dizziness in the mornings” that occurs whenever she
changes head position. She goes on to explain that the episodes last less than 1 minute and is
accompanied by nausea but no vomiting. Which of the following statements is correct?
a. Her clinical presentation is most suggestive of Meniere’s disease
b. A negative dix-hall-pike test rules out BPPV as a possible cause of her symptoms
c. A canalith is most likely present in the superior semicircular duct
d. The Epley manouvre has been shown to provide symptomatic relief in the majority of patients with
this condition
e. A vestibular schwannoma is the most likely diagnosis and a CT or MRI is indicated

4) You are the Senior House officer assigned to a busy ENT/audiology clinic at the Kingston Public
hospital. You are charged with the responsibility for assisting with the management of different
patients; many with a complaint of hearing loss or related otologic pathology. You should recall
that…
a. Pure tone audiometry is a suitable test for a neonate suspected of having congenital deafness
b. A negative Rinne test is typically associated with Noise induced hearing loss & Presbycusis
c. Otoacoustic emissions testing and Brainstem electrical response audiometry are both subjective
tests of hearing
d. A 256-kHz tuning fork is ideal when performing tuning fork test
e. In a patient with purely sensorineural hearing loss sound will lateralize to the unaffected ear on
Weber testing
 Part II: Nose & Paranasal Sinuses

5) A 15-year-old female is brought to the emergency department in Montego Bay with bleeding from
the left nostril. She reports that prior to this she was at a party with friends. On inspection, she has
perioral hyperpigmentation. Rhinoscopy shows bleeding arising from the anterior inferior nasal
septum. Her vital signs show a BP 157/90 and Pulse of 100 bpm. She is asked to start nasal
compression however this fails to terminate the bleeding. Which of the following statements is the
best course of action at this time?
a. The patient should be asked to sit up, compress the nasal bones and tilt the head backwards
b. Silver nitrate cautery should be attempted if a discrete bleeding point is seen at Little’s area
c. A Foley catheter should be inserted immediately and both nasal cavities packed with ribbon
gauze soaked in antiseptic cream
d. internal carotid artery ligation may be necessary if she continues to have severe epistaxis
e. urgent transfusion with platelets and whole blood

6) Which of the following would be the initial step in determining the cause of nasal bleeding in the
above patient?
a. An intranasal biopsy should be considered as Juvenile nasopharyngeal angiofibroma is very likely
to be the cause of bleeding in this teenager
b. CT facial bones & paranasal sinuses is necessary to rule out a septal haematoma
c. Perioral hyperpigmentation is pathognomonic of Osler-Weber-Rendu Syndrome and no further
history or investigations is required
d. CBC, PT, PTT, INR should be ordered immediately to rule out a bleeding disorder
e. The emergency physician should ascertain information regarding the patients drug history

7) A 14-year-old male presents to the Otolaryngology clinic with a complaint of unilateral nasal
obstruction, anosmia and rhinorrhea. Anteriorly a nasal mass is noted. The mass can also be seen
hanging down from the nasopharynx when the patient opens the mouth. There is no cervical
lymphadenopathy. Computed tomography shows a mass arising from the maxillary antrum with
widening of the maxillary ostium and no associated bony destruction. What is the most likely
diagnosis?
a. Killian (Antrochoanal) polyp
b. Earl stage Nasopharyngeal carcinoma
c. Juvenile nasopharyngeal angiofibroma
d. Squamous cell carcinoma of the maxilla
e. Inverted papilloma

8) The patient above is scheduled for functional endoscopic sinus surgery (F.E.S.S) to remove the lesion
described above. The E.N.T surgeon should keep in mind that…
a. The Uncinate process is located posterior medial to the nasolacrimal duct but anterior to the
hiatus semilunaris
b. The frontal, anterior ethmoidal & maxillary sinuses open into the inferior meatus
c. The posterior ethmoidal sinus and sphenoidal sinuses all drain into the middle meatus
d. Vitreous haemorrhage is the most common complication associated with this procedure
e. The Nasal cavity receives most of its blood supply from the first part of the maxillary artery

2
 Part III: Throat

9) A 49-year old chronic smoker and alcoholic presents to the otorhinolaryngology clinic with a 6-month
history of hoarseness and weight loss. Fibre optic endoscopy is performed and biopsies are taken.
Results from clinical examination & radiologic imaging of the head and neck is consistent with an
AJCC 7th edition TNM stage of T1b N0, M0.

The most accurate conclusion regarding that can be drawn from this case scenario is
a. A 95% probability exist that histology will show features of an “Adenocarcinoma” of the head
and neck
b. This patient has most likely undergone malignant transformation of a recurrent respiratory
papilloma
c. direct laryngoscopy is likely to show a lesion on both vocal cords with reduced mobility
d. Fixation of one or both true vocal cords is consistent with this patient’s tumour stage
e. A hemi-laryngectomy is the most appropriate modality of treatment for this patient

10) A 33-year-old woman is sent to the ENT clinic by her GP after the physician noted a 2cm lump in the
anterior neck. The lump moves on swallowing and is firm. She also complains of hoarseness for 5
days along with dysphagia. She has a positive family history of cancers in the family but she is not
sure exactly what types. Her TSH level is within normal limits. Fine needle aspiration is “suspicious
for malignancy” but the pathologist is unable to definitively give a diagnoses.

Which of the following statements is correct?

a. If a malignancy is confirmed, it is most likely to be well differentiated and multi-centric
b. The patient’s age and gender indicate a poor prognosis
c. A partial lobectomy is the surgical procedure of choice
d. Elevated Thyroglobulin levels in this patient would be specific for papillary carcinoma
e. The presence of a Pituitary adenoma and elevated parathyroid hormone levels in this patient
would be characteristic of MEN 2B syndrome