1. Your co-intern consulted for right sided recurrent otorrhea and decreased hearing for 3 years.

Otoscopy shows 70% tympanic membane perforation with minimal to moderate amount of mucoid
discharge. Otoscopy on the left is normal. Your best treatment option at this point is?
a) Aural toilette and oral Co-Amoxiclav
b) Aural toilette and topical Ofloxacin
c) Oral Co-Amoxiclav and topical Ofloxacin
d) Topical Garamycin + Betamethasone

2. The following are located in Level 2 EXCEPT

a) Carotid bifurcation
b) Upper jugulodigastric nodes
c) Middle jugular nodes
d) Posterior belly of digastric

3. Your cousin has a hard neck mass. You suspect malignancy. The best procedure to confirm your
suspicion is by
a) CT scan of the neck
b) Ultrasound of the mass
c) FNAB of the mass
d) Endoscopy

4. Nasopharyngeal carcinoma is treated with:

a) Surgery
b) Surgery and radiotherapy
c) Radiotherapy
d) Chemotherapy and radiotherapy

5. Function of the false vocal cords:

a) Resonance of the voice
b) Attenuator of the voice
c) Sealing of the airway
d) Non-functional remnant

6. The following contribute to the resonance of the voice EXCEPT:

a) Sinuses
b) Pharynx
c) Nasal Cavity
d) Tongue

7. Patient who underwent thyroidectomy and complains of hoarseness is best examined by:
a) Indirect laryngoscopy
b) Electromyography
c) T3 T4 TSH
d) Computerized Speech Lab
8. Patient with a subglottic lesion will initially present with
a) Dysphagia
b) Dysphonia
c) Dyspnea
 d) Dysarthria

9. Transcutaneous emergency airway access is best achieved by:

a) Puncturing the space just above the cricoid
b) Puncturing the thyroid cartilage
c) Puncturing the space just above the thyroid cartilage
d) Puncturing just above the 3rd tracheal ring

10. Patient with the least voice range probably has injury to
a) Inferior laryngeal nerve
b) Superior laryngeal nerve
c) Internal branch of the recurrent laryngeal nerve
d) External branch of the recurrent laryngeal nerve

11. A patient with Bell’s Palsy is most likely to have problems in which phase of swallowing ( analysis )
a) Oral preparatory phase
b) Oral transport phase
c) Pharyngeal phase
d) Esophageal phase

12. A 21 year old male is on his 3rd day of oral antibiotics for acute tonsillopharyngitis. He experiences
an increase in fever, pain on swallowing, & voice becomes muffled. PE shows left tonsil to be
pushed downward & forward with deviation of uvula to the right. Your impression is
(comprehension )
a) Peritonsillar abscess
b) Retropharyngeal abscess
c) Ludwig’s angina
d) Vincent’s angina

13. A 15 year old girl arrives at the clinic because of frequent sneezing with watery nasal discharge.
Her mother says that her ENT diagnosed her to have intermittent allergic rhinitis. How often would
you think her symptoms occur?
a) Her symptoms last more than 4 weeks
b) Her symptoms occur >4 times a week
c) Her symptoms only last <4 times a week
d) Triggered by changes in temperature

14. A 30 year old man complains of nasal obstruction and sneezing, triggered by changes in
temperature and strong odors. What is the most likely diagnosis?
a) Non-specific rhinitis
b) Intermittent allergic rhinitis
c) Persistent allergic rhinitis
d) Vasomotor rhinitis

15. Most common pathogen for acute bacterial rhinitis includes

a) Coronavirus and adenovirus
b) E. coli and beta-hemolytic Strep
c) H. influenzae and Strep. Pneumonia
 d) Staph. Aureus and M. catarrhalis

16. Rhinitis medicamentosa can be brought about by which of the following medications
a) Oxymetazoline
b) Phenylpropanolamine
c) Desloratadine
d) Mometasone

17. A 27 year old woman who is 6 months pregnant consult because of persistent nasal obstruction.
What is the best management for this condition?
a) Topical antihistamines
b) Topical decongestants
c) Oral steroids
d) Saline nasal douche and reassurance that it will resolve after pregnancy or when near term

18. Complication of untreated septal abscess?

a) Saddle nose deformity
b) Nasal valve collapse
c) Septal spur
d) Septal deviation

19. The parasympathetic stimulation of the nasal mucosa leads to which effect?
a) Vasodilation
b) Vasoconstriction
c) Secretion inhibition
d) Sneezing

20. While eating at Jollibee, 31 year old patient was witnessed to have choking episodes with violent
coughing while eating in the canteen, after a while she became more stable with no difficulty of
breathing. What should you advise
a) Heimlich Maneuver
b) Barium esophagogram
c) Diagnostic and Therapeutic Bronchoscopy
d) No need for consultation

21. A 23 year old football player got hit in the face while playing, he was brought your clinic for
evaluation. On physical examination, you noted decreased sensation in the cheek area, you would
suspect fracture in the area of the…
a) Zygomatic arch
b) Nasal bone
c) Anterior maxillary wall
d) Pterygomaxillary Buttress

22. Patients with viral rhinitis are predisposed to develop epistaxis because:
a) Inflammatory reaction in the nasal mucosa
b) Mechanical trauma to the nasal mucosa
c) Derangement in bleeding parameters
d) Increased risk of developing vascular anomalies
23. A patient with Nasopharyngeal carcinoma may present with diplopia because of
a) Direct Invasion of the orbital tissues
b) Direct invasion of Cranial nerve 6
c) Direct invasion of the pterygoid area
d) Direct invasion of the medial rectus

24. Which of the following patients would most likely have Juvenile Nasopharyngeal Angiofibroma
a) A 45 year old male with epistaxis associated with a lateral neck mass and hearing loss
b) A 14 year old male with recurrent profuse epistaxis and nasal obstruction
c) A 15 year old female with epistaxis and recurrent sneezing with purulent nasal discharge
d) A 50 year old male with profuse epistaxis and uncontrolled hypertension

25. Epistaxis is more common among children who are fond of picking their nose because
a) The vessel walls in the nasal mucosa are naturally fragile compared to other blood vessels
b) The submucosal layer is very thin and blood vessels are superficially located
c) The presence of a physiologic mucosal shedding causes exposure of the rich blood vessels
d) The clotting and hemostatic functions are immature in children

26. In the control of epistaxis, anterior nasal packing is applied. Overzealous application should be
avoided because of the possibility of
a) Pressure necrosis
b) Airway obstruction
c) Nasal fracture
d) Septal hematoma

27. A 6 year old child was noted by her mother since 2 weeks to be less participative during meal time
conversations and to be sitting nearer the TV when watching. She consults you and you note
bilateral serous fluid behind the tympanic membranes with note of few bubbles on the left. Which
structure is most likely involved in the pathogenesis of the condition?
a) Tympanic Membrane
b) Maxillary Sinuses
c) Eustachian Tube
d) Palatine Tonsils

28. In a newborn with congenital hearing loss, one of the biggest factors to consider in the timing of
further evaluation and management is:
a) Speech development
b) Hemoglobin levels
c) Weight for height
d) Motor skills

29. Herpes zoster oticus usually presents with clustered vesicles around the meatus and concha, facial
palsy and sensorineural hearing loss. It typically affects the following cranial nerves:
a) V and VI
b) VI and VII
c) VII and VIII
d) VIII and IX
30. Your roommate wakes you up at 4am complaining of severe rotatory vertigo and nausea. You
suspect BPPV and assure him for it will probably be better in:
a) 1 minute
b) 1 hour
c) 1 day
d) 1 week

31. (refer to #30) To confirm your diagnosis, you do the following maneuver:
a) Epley
b) Semont
c) Valsalva
d) Dix-Hallpike

32. (Refer to #30) Best treatment for this case includes:

a) Complete bed rest
b) Antihistamine therapy
c) IV steroid infusion
d) Particle repositioning

33. The most rigid part of the airway from the epiglottis to the 3 rd tracheal ring
a) Supraglottis
b) Glottis
c) Cricoid
d) 3rd tracheal ring

34. The larynx can be evaluated by using the following EXCEPT

a) Tongue depressor
b) Listening to the voice
c) Laryngeal mirror
d) Stroboscope

35. Overuse of voice will commonly result in:

a) Metaplasia of the lamina propia of the vocal cords
b) Granulomatous formation in the lamina propia of the vocal cords
c) Hypertrophy of the lamina propia of the vocal cords
d) Hyalinization of the lamina propia of the vocal cords

36. Treatment of choice for vocal cord nodules

a) Vocal cord stripping
b) Laser excision of nodules
c) Voice therapy
d) Biopsy

37. True of vocal cord cysts EXCEPT:

a) Usually bilateral
b) Usually filled with mucous
c) Usually surgical
 d) Usually associated with poor hydration

38. Most common malignancy of the larynx

a) Adenoma
b) Sarcoma
c) Carcinoma
d) Hemangioma

39. Racemic epinephrine is used in the treatment of Laryngotraceobronchitis because of its

a) Alpha adrenergic mediated vasoconstriction
b) Alpha adrenergic mediated vasodilation
c) Alpha adrenergic mediated bronchoconstriction
d) Alpha adrenergic mediated bronchodilation

40. Steeple sign is a radiologic finding seen as a result of

a) Swelling of the epiglottis
b) Foreign body with a check-valve mechanism
c) Airway collapse during inhalation
d) Airway narrowing due to inflammation

41. A 65 year old man with presbycusis would have:

a) A Weber’s test which lateralizes to the worse hearing ear
b) Difficulty in understanding certain words when spoken to
c) A history of recurrent spinning sensation
d) Nystagmus to the same ear upon doing cold calorics exam

42. A 20 year old patient with otalgia claims to have had 2-3 episodes of ear infection in the past 5
years. Upon doing otoscopy, you note that both tympanic membranes are intact but hyperemic
and congested. What is the most probable diagnosis?
a) Chronic Otitis Media, active
b) Chronic Otitis Media, inactive
c) Acute Otitis Media
d) Acute Otitis Externa

43. A 20 year old with Otitis Media with Effusion will probably show the following on hearing test:
a) Conductive hearing loss
b) Sensorineural hearing loss
c) Mixed hearing loss
d) Within normal hearing range

44. A 40 year old with BPPV will probably show the following on hearing test:
a) Conductive hearing loss
b) Sensorineural hearing loss
c) Mixed hearing loss
d) Within normal hearing range

45. The following is at higher risk for developing Otitis Media:

a) 2 year old with cleft lip
 b) 5 year old with speech delay
c) 15 year old competitive swimmer
d) 20 year old with allergic rhinitis

46. An intern goes to the College of Medicine Penthouse and stands right behind the glass walls and
looks at Sta. Ignaciana street from above. He suddenly feels dizzy. What is wrong?
a) Impairment of visual sensation
b) Conflicting visual and proprioceptive sensations
c) Bilateral vestibular impairment
d) Metabolic disorder causing impaired central processing

47. Given abnormal tympanic membrane findings on the left ear, what do you expect from doing a
Tuning Fork Test?
a) Non-lateralizing Weber’s
b) Weber’s lateralizing to the left
c) Positive Rinne (AC>BC) on the left
d) Negative Rinne (BC>AC) on the right

48. While doing your routine physical examination, you note the presence of a 90% tympanic
membrane perforation but the ossicles seem intact. Upon proceeding with audiometry, you expect
the following results:
a) Abnormal air conduction
b) Abnormal bone conduction
c) Abnormal air and bone conduction
d) Profound hearing loss

49. Tragal tenderness in otitis externa occurs because of:

a) Referred pain from the auditory canal
b) Irritation of the perichondrium
c) Increased sensitivity of the periosteum
d) Dermal irritation from the discharge

50. Passive information transfer in sound conduction may be impeded when a patient has:
a) Acute otitis media
b) Chronic otitis media
c) Presbycussis
d) Acoustic neuroma

51. Tinnitus may be present in any of the following conditions EXCEPT:

a) Presbycussis
b) Noise induced hearing loss
c) Impacted cerumen
d) Basal cell carcinoma, auricle

52. A 40/M who was diagnosed to have tonsillar squamous cell carcinoma after undergoing
tonsillectomy is now presently undergoing chemotherapy. He is complaining of decreased hearing
on both ears. What could be causing this problem?
a) Toxic damage to cochlear hair cells
 b) Ascending infection to the middle ear
c) Metastasis involving the auditory system
d) Functional obstruction of the Eustachian tube

53. A 35/M with history of unilateral decreased hearing and findings of perforated tympanic
membrane with moderate amount of mucoid discharge would be best managed by:
a) Oral antibiotics and oral antihistamines
b) Oral and aural antibiotics at the same time
c) Aural toilette and aural antibiotics
d) Oral antibiotics only

54. A 65/F with history of unilateral decreased hearing and findings of serous fluid and bubbles behind
an intact tympanic membrane would necessitate most:
a) Culture study of the middle ear fluid
b) Thorough evaluation of the nasopharynx
c) Hearing test and subsequent hearing aid
d) Evaluation for possible Diabetes Mellitus

55. A 20/M with history of recent swimming suddenly complains of right-sided otalgia. Initially, you
note tragal tenderness. What other findings would you likely find on otoscopy?
a) Furuncle in the external auditory canal
b) Swollen external auditory canal skin
c) Bulging tympanic membrane
d) Perforated tympanic membrane

56. A 3 week old infant is brought to the clinic for weak cry. Mom says she doesn’t have difficulty
breathing but seems to choke when feeding. The most likely diagnosis is
a) Laryngomalacia
b) Vocal Cord Paralysis
c) Anterior glottic web
d) Posterior glottic web

57. Which of the following statements about laryngomalacia is true

a) Laryngomalacia manifests within the first year of life
b) Laryngomalacia can persist until 18 months
c) Laryngomalacia is commonly seen in premature babies
d) Laryngomalacia is managed by laser epiglottopexy

58. Stridor, hoarseness, barking cough with low to moderate grade fever are characteristic
presentations of patient’s with
a) Epiglottitis
b) Laryngomalacia
c) Laryngotracheobronchitis
d) Tracheomalacia
59. Which of the following is the primary function of the larynx?
a) Phonation
b) Speech
c) Cough
 d) Airway protection

60. Earliest symptom of a patient with laryngeal carcinoma arising from the supraglottic area is:
a) Hoarseness
b) Sorethroat
c) Dyspnea
d) Stridor

61. Drug of choice for laryngopharyngeal reflux is :

a) H2 blocker
b) Antacids
c) Proton pump inhibitors
d) Aluminum hydroxide

62. Immediate treatment of patients with bilateral vocal fold paralysis is:
a) Arytenoidectomy
b) Vocal fold medialization surgery
c) Tracheotomy
d) Cordectomy

63. Does NOT exit into middle meatus

a) Anterior ethmoids
b) Bulla ethmoidalis
c) Frontal sinus
d) Nasolacrimal duct

64. The paranasal sinuses are

a) Gel layer filled
b) Sol layer filled
c) Mucous filled
d) Airfilled

65. The best treatment for allergic rhinitis

a) Eliminate allergic irritants
b) Antihistamine
c) Sympathomimetics
d) Steroids
66. Nasopharyngeal cancer most commonly metastasizes to
a) Upper jugulodigastric nodes
b) Level I
c) Level V
d) Level III

67. Which of the following is an etiology of croup

a) Mycoplasma
b) Parainfluenza
c) Moraxella
d) Hemophilus
68. Treatment of choice for lymphoma
a) surgery
b) radiotherapy
c) chemotherapy
d) all of the above

69. A lateral neck mass in a 6o year old patient is most likely

a) Primary neck carcinoma
b) Primary neck adenocarcinoma
c) Metastatic carcinoma
d) Metastatic adenocarcinoma

70. Most common malignancy in the head and neck

a) Melanoma
b) Squamous cell carcinoma
c) Basal cell carcinoma
d) Adenocarcinoma

71. The sensory innervation of the larynx is the:

a) Trigeminal nerve
b) Internal branch of the superior laryngeal nerve
c) External branch of the superior laryngeal nerve
d) Recurrent laryngeal nerve

72. A newborn male was delivered by normal spontaneous delivery and was noted to have stridor.
Which of the following condition is he most likely to have?
a) Bilateral vocal fold paralysis
b) Laryngeal web
c) Laryngomalacia
d) Laryngocele

73. After thyroidectomy, a patient experienced vocal fatigue and inability to reach high pitch. Which of
the following could have been affected:
a) External branch of the recurrent laryngeal nerve
b) External branch of the superior laryngeal nerve
c) Internal branch of the recurrent laryngeal nerve
d) Internal branch of the superior laryngeal nerve

74. Unilateral vocal fold paralysis will have which of the following:
a) Airway obstruction with good voice
b) Airway obstruction with hoarseness
c) Hoarseness with good airway
d) Good voice with good airway

75. Injury to this nerve will result in an inability to initiate the pharyngeal phase of swallowing
a) Lingual nerve
b) CN IX
 c) Inferior Maxillary Nerve
d) CN IV

76. Nerve in the neck that is most commonly injured in neck surgery causing limitation in elevating the
shoulder:
a) Glossopharyngeal nerve
b) Spinal Accessory nerve
c) Trapezius nerve
d) Sternocleidomastyoid nerve

77. Most common cranial nerve affected in nasopharyngeal cancer

a) I
b) II
c) VI
d) VII

78. Most important concern in the emergency room when confronted with maxillo-facial fractures:
a) Immobilize the neck
b) Secure the airway
c) Establish a fluid line
d) Ascertain that brain injury is stable

79. Benign locally aggressive nasal tumor which can transform to a squamous cell carcinoma
a) osteoma
b) inverted papilloma
c) chordoma
d) rhynophyma

80. The most common fracture pattern seen among the facial bones
a) Tripod fracture
b) Nasal Bone fractures
c) Body of the mandible
d) Longitudinal temporal bone fracture

81. Vertical Buttresses include

a) Nasomaxillary Buttress, Zygomaticofrontal Buttress, Pterygomaxillary Buttress
b) Nasofrontal Buttress, Zygomaticomaxillary Buttress, Pterygomaxillary Buttress
c) Nasomaxillary Buttress, Zygomaticomaxillary Buttress, Pterygozygomatic Buttress
d) Nasomaxillary Buttress, Zygomaticomaxillary Buttress, Pterygomaxillary Buttress

82. Components of Complex Orbito-zygomatic fractures

a) Zygomatic arch, Orbital rim, Frontozygomatic process, zygomaticomaxillary buttress
b) Zygomatic arch, Orbital rim, Frontomaxillary process, zygomaticomaxillary buttress
c) Zygomatic arch, Orbital floor, Frontozygomatic process, zygomaticomaxillary buttress
d) Zygomatic arch, Orbital rim, Frontozygomatic process, maxillary alveolus

83. The sphenopalative artery is a branch of the:

a) facial artery
 b) palatine artery
c) pharyngeal artery
d) maxillary artery

84. Fungal infection in the nose which is found in immunocompromised patients

a) aspergillosis
b) mucormycosis
c) rhinosporidosis
d) acanthosis

85. The most common causative organism of acute viral rhinitis is rhinoviruses and
a) coronaviruses
b) retroviruses
c) adenoviruses
d) influenza viruses

86. Most common site of epistaxis in a 5 year old girl:

a) Poolittles area
b) Kiesselbach’s plexus
c) Middle turbinate
d) Inferior turbinate

87. In normal otoscopy, the malleus handle points ___(1)___ and the cone of light is found ___(2)___
a) Anteriorly(1), posteriorly(2)
b) Posteriorly(1), anteriorly(2)
c) both anteriorly
d) both posteriorly

88. What is the most common complication of otitis media?

a) Facial nerve paralysis
b) Sensorineural hearing loss
c) Meningitis
d) Mastoiditis

89. The facial nerve exits the temporal bone to the face thru the
a) digastric ridge
b) foramen lacerum
c) stylomastoid foramen
d) foramen magnum

90. Which of the following otoscopic findings would most probably indicate a cholesteatoma?
a) Total tympanic membrane perforation with dry middle ear mucosa
b) Pinpoint tympanic membrane perforation with pulsatile mucoid discharge
c) Calcium deposits at the postero-inferior quadrant of the tympanic membrane
d) Retraction pocket at the attic

91. The best imaging modality for a chronic otitis media is

a) Schüller radiography
 b) Stenvers radiography
c) CT scan
d) MRI

92. The following may be causes of impaired middle ear ventilation EXCEPT:
a) diffuse otitis externa
b) cleft palate
c) acute sinusitis
d) nasoangiofibroma

93. Adenoiditis is a cause of middle ear problems mainly because:

a) it causes mechanical obstruction of the Eustachian tube
b) it causes deficient opening of the Eustachian tube due to inflammation of the tensor veli palatini
c) it acts as a reservoir for pathogenic microorganisms
d) it causes a rapid decrease in middle ear pressure due to mucosal swelling

94. A person in the following situation is at risk of developing barotrauma in the middle ear:
a) Mountain climbing in Mt. Apo
b) Snorkeling in Anilao
c) Sniffing flowers in a Tagaytay garden
d) Riding a descending plane from Bohol

95. A 25 year old with Acute Otitis Media will benefit best by treatment with:
a) Co-amoxiclav 625 mg BID
b) Ofloxacin 500 mg BID
c) Polymyxin + Neomycin Otic 3 drops TID
d) Ciprofloxacin Otic 3 drops TID

96. Initial evaluation of a 3 year old child with speech delay should include:
a) Endoscopic examination
b) Speech evaluation
c) Hearing test
d) Radiologic imaging

97. Which of the following statement is true regarding the maxillary sinus
a) The maxillary sinus is not present at birth.
b) The pterygopalataine fossa located lateral to the maxillary sinus
c) The close relation of the roots of maxillary 1 st molar to the maxillary sinus floor may lead to
formation of an oroantral fistula.
d) The lamina papyracea separates the floor of the orbit from the maxillary sinus

98. The olfactory epithelium extends inferiorly to which of the following structure?
a) Superior turbinate
b) Middle turbinate
c) Vomer
d) Waldeyer’s ring
99. A 13 year old boy arrives at your clinic complaining of nasal obstruction and epistaxis after he was
hit on the nose during a basketball game. What is the next best step in managing this patient?
a) Prescribe decongestants and send the patient home.
b) Immediately correct the nasal bone fracture by closed reduction.
c) Examine the nasal septum for septal hematoma
d) Apply ice cold compress over the nasal bridge.

100. A 55 year old male complains of unilateral nasal obstruction of 2 months duration. Occasionally, he
notes of mild to moderate epistaxis. He has no prior history of frequent nasal congestion. On
examination, a fleshy mass is noted on the obstructed nasal cavity. Which of following should be
done next to evaluate the extent of the lesion?
a) CT scan of the paranasal sinus
b) Culture and sensitivity of the nasal discharge
c) Xray of the paranasal sinus
d) Nasal endoscopy with biopsy