FCORL(SA) Final

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Final Examination for the Fellowship of the

College of Otorhinolaryngologists of South Africa

26 February 2018

Paper 1 (3 hours)
All questions to be answered. Each question to be answered in a separate book (or books if more than one is required
for the one answer)

1 a) Discuss the symptoms, diagnosis and classification of posterior laryngeal clefts in infants.
(10)
b) Discuss acute epiglottitis in a 6-year-old. Include in your discussion: symptoms, signs,
pathology and treatment. (15)
c) What anatomical and physiological features of trisomy 21 (Down syndrome) present
special problems in ENT and what clinical problems do they cause for the patient? (15)
d) Write short notes on nasal gliomas, including embryology, characteristics and
presentation. (10)
[50]

2 a) Describe the classical MRI (magnetic resonance imaging) features of the following
tumours of the petrous apex (apex of the petrous temporal bone) and cerebello-pontine
angle (CPA)
i) Vestibular nerve schwannoma (“acoustic neuroma”). (5)
ii) Cholesterol granuloma. (5)
iii) Meningioma. (5)
iv) Epidermoid cyst. (5)
b) Eustachian tube dysfunction is believed to play a role in most middle ear conditions
i) Discuss briefly the clinical assessment of Eustachian tube function. (6)
ii) List the items on the ETDQ7 (Eustachian tube dysfunction) Questionnaire. (7)
c) In benign paroxysmal positional vertigo (BPPV)
i) Describe the classical features of the Dix-Hallpike test in posterior semicircular
canal (SCC) BPPV. (5)
ii) What is the difference between cupulolithiasis and canalothisiasis, is this important,
and if so why? (4)
iii) How would you recognise the unusual situations of horizontal and superior SCC
BPPV? (4)
iv) How would you treat these? (4)
[50]

PTO/Page 2 Question 3…
 -2-

3 a) A patient has a mass located in the submandibular triangle

i) How do you distinguish between a submandibular gland mass and submandibular
lymphadenopathy? (5)
ii) You need to proceed to submandibular gland excision
a) Describe in point format all the issues to discuss when taking consent, and
b) Detail the surgical steps. (20)
b) A patient presents with a clinically T1b squamous cell cancer centred at the anterior
commissure of the larynx. Discuss the investigations and management options. (25)
[50]
 FCORL(SA) Final

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Final Examination for the Fellowship of the

College of Otorhinolaryngologists of South Africa

27 February 2018

Paper 2 (3 hours)
All questions to be answered. Each question to be answered in a separate book (or books if more than one is required
for the one answer)

1 a) Write short notes on acute suppurative sialoadenitis (parotitis). (15)

b) Angio-oedema can be caused by various drugs. List three examples of this and the
mechanism of action. (6)
c) Write short notes on Plummer–Vinson / Patterson-Brown-Kelly Syndrome. (7)
d) With respect to facial pain and headaches: write short notes on the following 2 conditions
i) Trigeminal neuralgia. (11)
ii) Temporal arteritis. (11)
[50]

2 a) The following are 3 implantable solutions for hearing loss

 Osseo-integrated devices
 Active middle ear implants
 Cochlear implants

For each describe briefly

i) How the devices work. (12)
ii) The pathway of sound. (12)
iii) Candidacy (indications, contra-indications, patient selection). (13)
b) Ménière’s disease
i) Define the difference between Ménière’s disease and Ménière’s syndrome. (3)
ii) What is the current understanding of the pathophysiology of Ménière’s disease, and
what evidence is there for it? (5)
iii) Define the Hitselberger sign and its clinical relevance. (5)
[50]

3 a) With regards to an adenoidectomy: stipulate in point form the

i) Indications for
ii) Contra-indications to, and
iii) Complications of doing an adenoidectomy. (20)
b) Classify and describe fractures of the nasal bones. (10)
c) Briefly discuss the following conditions in point form (definition, aetiology, presentation,
and treatment)
i) Rhinophyma. (8)
ii) Relapsing polychondritis. (12)
[50]
 FCORL(SA) Final

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Final Examination for the Fellowship of the

College of Otorhinolaryngologists of South Africa

28 February 2018

Paper 3 ORL and Head & Neck Surgery (3 hours)

All questions to be answered. Each question to be answered in a separate book (or books if more than one is required
for the one answer)

1 a) Describe in point form the technique of sphenopalatine artery ligation AND mention in
point form anatomical factors that may cause difficulty with access and how you would
address these difficulties. (20)
b) Discuss briefly in point form common reasons why an endoscopic DCR could fail.
(10 points, with 2 marks for each = 20)
c) About (Wegener’s) Granulomatosis with Polyangitis: discuss in point form the useful
special investigations, their possible findings and the implication of these findings. (10)
[50]

2 a) You are called on a Friday night to attend to a 20-year-old man who was stabbed an hour
previously, just anterior to the mastoid process. He has a complete facial nerve paralysis,
but is otherwise completely stable. You are the only surgical specialist in town that
weekend
i) If you decided to explore the facial nerve, how would you locate the facial nerve?
(10)
ii) List the various surgical options/techniques available to restore facial movement,
with short comments on each as appropriate. (15)
b) Describe the anatomy of the spinal accessory nerve, and the surgical techniques used to
locate it in the neck (10)
c) A 40-year-old patient had a pleomorphic adenoma excised from the parotid gland 15
years ago, and now presents with a 1cm mass in the parotid bed and a 1cm hard cervical
node in Level 2a of the neck. Discuss the management of the patient. (15)
[50]