(‫ اﻹﺟﺎﺑﺎت ﺗﻢ اﺧﺘﯿﺎرھﺎ ﻛﻤﺎ وردت ﻓﻲ اﻟﻤﺮﺟﻊ ﺗﻤﺎﻣﺎ )ﻓﻲ اﻟﺠﺰء اﻷول واﻟﻤﻠﺤﻖ‬:‫ﻣﻼﺣﻈﮫ‬

‫ ﻓﺆاد ﺷﻤﺴﺎن‬.‫د‬ ‫ﻣﻊ دﻋﺎﺋﻲ ﻟﻠﺠﻤﯿﻊ ﺑﺎﻟﺘﻮﻓﯿﻖ‬

Baily Bayron otolaryngology, H & N surgery; 2nd Edition ‫ُﻣﻠﺤﻖ‬

Degenerative & idiopathic disease

The most common form of fibrous dysplasia is

monostotic fibrous dysplasia

polyostotic fibrous dysplasia
Albright’s syndrome
fibrous dysplasia of the skull

Which of the following statements is true of recurrent parotid swelling?

Autoimmune parotitis is often painful.

Autoimmune parotitis is characterized by damage to the large ducts of the parotid.
Rheumatoid arthritis is the most commonly associated connective tissue disease with secondary
Sj ِ◌gren’s syndrome.
Sialadenitis is associated with diffuse sialectasis on the sialogram.

Which of the following describes the histological characteristics of Wegener’s granulomatosis?

vasculitis, granulomas, and polymorphonuclear infiltrate

vasculitis, no granulomas, and atypical polymorphic infiltrate
monomorphic infiltrate
vasculitis, granulomas, and eosinophils

Which of the following is the most common form of amyloidosis?

primary systemic
secondary systemic
localized
myeloma associated

Relapsing polychondritis is associated with which of the following sequelae?

laryngeal collapse, thyroiditis

heart failure, cauliflower ear deformity
laryngeal collapse, saddle nose deformity
saddle nose deformity, heart failure

Lymphomatoid granulomatosis

is thought to be a B-cell lymphoma

is synonymous with polymorphic reticulosis
has multiple granulomas on histologic sectioning
 is best treated with sulfa drugs
Dr. Fouad Shamsan
Hashimoto’s thyroiditis is best treated with Otolaryngology

total thyroidectomy
thyroid hormone replacement
radioactive iodine
radiation therapy

Which of the following is a form of subacute thyroiditis?

Riedel’s thyroiditis
Hashimoto’s thyroiditis
goiterous thyroiditis
“postpartum” thyroiditis

Connective tissue diseases

A 45-year-old woman with mixed connective tissue disease and an erythrocyte sedimentation rate of 75 mm per
hour most likely has an elevated level of which of the following autoantibodies?

anti-Ro
anti-U1-RNP
c-ANCA
anti-RA33
anti-Jo-1

A pathologist reviewing specimens from a functional endoscopic sinus surgery case would find which one of the
following in a patient with active Wegener’s granulomatosis?

high lymphoid infiltration index

pseudoepitheliomatous hyperplasia
perivascular cuffing
vasculitis with fibrinoid necrosis
caseating granuloma

A 40-year-old woman has a 3-month history of neck weakness and dysphagia. Skeletal muscle enzymes are
elevated, and myopathic changes are seen on electromyography. Definitive diagnosis is confirmed with

parotid biopsy
SS-A and SS-B antibody levels
antinative DNA antibody levels
muscle biopsy
urinalysis

A 52-year-old woman is evaluated for multiple system complaints, and an otolaryngology-head and neck surgery
consultation is requested to evaluate the patient for connective tissue disease. The manifestation least likely to be
associated with these diseases is

arthritis
 oral ulcers
dysphagia
hearing loss
alopecia

A 58-year-old businessman develops severe throat pain, hoarseness, and odynophagia while at work. A review of
systems reveals recent morning joint stiffness. Which of the following is the examining physician most likely to
find?

xerostomia
esophageal dysmotility
oral ulcers
arytenoid dysfunction
butterfly rash

A patient with xerostomia is undergoing an evaluation to determine the cause of and best therapeutic approach to
the problem. Systemic disease and medications have been ruled out as possible etiologies. The patient should now
undergo which of the following tests?

esophageal motility
salivary gland biopsy
skin and muscle biopsy
small joint x-rays
c-ANCA autoantibody

A 32-year-old housewife and mother of four children seeks help for progressive dysphagia. A review of systems
reveals that her skin has lost its smooth texture and she has lost 12 pounds in the past 2 months. The working
diagnosis in this case is

hypothyroidism
maternal stress syndrome
Behçet’s disease
systemic sclerosis
hypovitaminosis

A 24-year-oldmale college student who has had no previous problem with acne experiences the sudden onset of
pain and erythema over the left upper lateral cartilage of his nose. This disappears in 10 days after being treated
with amoxicillin but returns within 6 weeks. Which of the following is the best diagnosis?

relapsing polychondritis
acne vulgaris
posttraumatic chondritis
dermatomyositis
rosacea

A 61-year-old man presents with unilateral diffuse headaches. His physical examination and imaging tests fail to
reveal the cause of his headaches. Although aspirin and ibuprofen relieve his symptoms temporarily, they fail to
alleviate the problem completely. This patient should have a
 carotid angiogram
spinal tap
paranasal sinus coronal CT scan
temporal artery biopsy
serum protein electrophoresis

A 52-year-old optometrist has been treated unsuccessfully for chronic rhinorrhea and cough for 6 months. He had
been on steroid therapy, after which endoscopic sinus surgery was performed. He had a bout of pneumonia that
cleared with antibiotic therapy. He had glomerulonephritis 3 years ago. He continues to have nasal crusting and
thickened sinus mucosa. This patient should undergo which of the following?

serum ANA and erythrocyte sedimentation rate

therapeutic trial of oral corticosteroids
24-hour urine protein analysis
bronchoscopy and bronchial washings
sinus mucosal biopsies

Granulomatous diseases of head & neck

What is the most common presentation of sarcoidosis?

lymphadenopathy
facial paralysis
airway obstruction
characteristic chest x-ray
parotid swelling

The most frequent otologic finding of histiocytosis X is

granulation tissue
otorrhea
deafness
swelling over the mastoid
otitis media

Lobular capillary hemangiomata (pyogenic granuloma) are most frequently seen in or on the

lip
nasal cavity
tongue
gingiva
oropharynx

Necrotizing sialometaplasia may be histologically differentiated from carcinoma by demonstration in the former of

absence of mitotic figures

lack of invasion of the basement membrane
preservation of lobular architecture
 myoepithelial cell hyperplasia
necrotizing granulomas

The most common laryngeal site of involvement in sarcoidosis is the

anterior commissure
true vocal cords
supraglottis
subglottis
ventricle

The treatment of choice for idiopathic midline destructive disease is

radiation therapy
prednisone
surgical excision
methotrexate
cyclophosphamide

Of biopsy-proven granulomatous inflammation of a cervical lymph node in a child, the most common cause is

Mycobacterium tuberculosis
nontuberculous mycobacteria
cat-scratch disease
Staphylococcus aureus
anaerobes

The most common laryngeal site of involvement in tuberculosis is the

true vocal cords

epiglottis
subglottis
arytenoids
false vocal cords

The most common presenting symptom/sign of the phycomycoses is

rhinorrhea
epistaxis
black, necrotic eschar of the mucous membranes
facial pain
cranial nerve palsy

Microscopic examination of Aspergillus fumigatus will reveal

nonseptate bifurcating hyphae

septate bifurcating hyphae
nonseptate nonbifurcating hyphae
 septate nonbifurcating hyphae
absence of hyphae

The decision of when to operate on a patient with sinusitis is based on the

patient history
physical examination
coronal CT scan
A and C
A, B, and C

Lymphocytes are not as effective in older people because the

number of lymphocytes is greatly reduced

function of helper and cytotoxic T-cell activity declines
thymus gland enlarges
volume of IgG and antibodies becomes excessive
paradoxical increase in T- and B-cell response blocks the immune mechanism

The risk of tracheal stenosis following intubation for more than 10 days is approximately

2%
6%
14%
23%
36%

Typical migraine usually is treated effectively by which combination of therapies?

abortive agents, analgesics, and preventives

analgesics, antihistamines, and sleep medications
muscle relaxants, exercise, and biofeedback
psychotherapy, oral splints, and oxygen inhalation
reassurance, exercise, and daily nonsteroidal antiinflammatory drugs

Subdural hematoma, brain tumor, and meningitis are likely to have all of the following in association with
headache except

stiff neck
papilledema
fever
visual aura
vomiting

Typical for migraine headache are all of the following features except

onset in the fifth decade

 throbbing quality
duration of days
photophobia
positive family history

The hiatus semilunaris of the lateral nasal wall is

the ostium of the maxillary sinus

a ridge formed by the uncinate process
a longitudinal depression located between the uncinate process and the ethmoid bulla
anterior (caudal) to the infundibulum
none of the above

Sympathetic and parasympathetic autonomic fibers distributed to the nose

pass through the sphenopalatine ganglion

synapse in the sphenopalatine ganglion
pass through the vidian nerve
all of the above
both A and C

Which of the following substances produce vasodilation of the nasal vasculature?

substance P
noradrenaline
vasoactive intestinal polypeptide
neuropeptide Y
both A and C

A 33-year-old woman notes perennial symptoms of nasal congestion, sneezing, and rhinorrhea. Skin and RAST
tests for potential allergens are negative. Thirty percent of the cells on her smear are eosinophils. The most likely
diagnosis is

vasomotor rhinitis
fungal rhinosinusitis
allergic rhinitis due to an allergen not detected by RAST or skin testing
eosinophilic nonallergic rhinitis
septal deviation

Which of the statements about fungal rhinosinusitis is true?

Invasive fungal rhinosinusitis can occur in apparently healthy individuals.

A form of allergic rhinosinusitis analogous to bronchopulmonary aspergillosis has been described.
Fungal elements form nasal smears and pathologic material can easily be overlooked without special stains.
both B and C
A, B, and C

Potential complications of nasal polyposis include

 cranial neuropathies
anosmia
osteitis
proptosis
all of the above

Factors which decrease nasal resistance include

cold air
supine posture
prostaglandin E2
exercise
C and D

Increased numbers of nasal eosinophils may be seen in nasal smears in patients with

vasomotor rhinitis
aspirin sensitivity
viral infections
rhinitis medicamentosa
A and C

The most common complication of total inferior turbinectomy is

bleeding
failure to relieve nasal destruction
infection
atrophic rhinitis
none of the above

Which preparation affords the greatest protection from the allergic event when used just before exposure?

cromolyn
astemizole
phenylpropanolamine
beclomethasone
flunisolide

Which is the initial drug of choice for treating an anaphylactic reaction?

ammonia
epinephrine
dexamethasone
diphenhydramine
cimetidine
If indicated for a patient with allergic rhinosinusitis and polyposis, immunotherapy is best started

after surgery, if polyps recur

after nasal steroids, if no response
before surgery, for therapeutic effect and to decrease chances of recurrence
after surgery, if polyps recur and patient refuses reoperation
before surgery, because of the 75% chance of cure without surgery

Skin test results are not affected by which factor?

recent allergen exposure

patient age
time of day of testing
antihistamines
corticosteroids

Vasomotor rhinitis is best managed with the intermittent use of

oxymetazoline
flunisolide
beclomethasone
ipratropium bromide
cromolyn sodium

Oil of wintergreen produces a “cold” sensation in the nose via the

olfactory nerve
trigeminal nerve
sympathetic efferents
parasympathetic efferents
greater palatine nerve

The diagnosis of unilateral choanal atresia is

incompatible with life

often missed until adulthood
suggested by unilateral purulent rhinorrhea
an indication for immediate surgery
part of the TORCH syndrome

The most common mucosal disease that produces nasal obstruction is

allergic rhinitis
acute bacterial sinusitis
vasomotor rhinitis
viral rhinitis
rhinitis medicamentosa
Rhinitis medicamentosa is due to the abuse of intranasal

oxymetazoline HCl
cocaine HCl
ephedrine
beclomethasone dipropionate
ipratropium bromide

Rhinoscleroma is

endemic in Sri Lanka

caused by a gram-positive organism
treated effectively with tetracycline
characterized by Mikulicz’s cells that are cuboidal cells consistent with metaplasia of the respiratory
epithelium
a precancerous lesion

All of the following statements regarding midface embryology are true except

The medial nasal process contributes to the columella, philtrum, and upper lip.
Congenital defects are rare in areas of intense developmental activity.
Gelatinous remnants of the notochord produce a Tornwaldt’s cyst.
The prenasal space lies between the nasal bones anteriorly and the cartilage of the developing nose
posteriorly.
The fonticulus frontalis is the space between the frontal bones where dura mater may project to produce a
congenital neurogenic tumor.

A 3-year-old boy with a mucopurulent nasal discharge for 2 weeks, exacerbation of reactive airway disease, and
periorbital edema for the past 5 days is most likely to have acute suppurative sinusitis involving which sinus?

frontal
maxillary
ethmoid
sphenoid
none; children younger than 5 years do not have sinusitis

Which of the following is most likely to help in making a diagnosis of acute ethmoid sinusitis?

percussion over the nose, medial to the medial canthus

transillumination
funduscopic examination
fiberoptic nasal endoscopy
ultrasonography

A 36-year-old and otherwise healthy woman presents with persistent signs and symptoms of acute maxillary
sinusitis despite a 10-day course of amoxicillin. The next most appropriate antibiotic course is

erythromycin
 cephalexin
trimethoprim/sulfamethoxazole
amoxicillin and erythromycin
amoxicillin/clavulanic acid

A 49-year-old man hospitalized after a bone marrow transplant presents with facial and retroorbital pain,
mucopurulent discharge, and, in the last 12 hours, altered mental status. CT scan reveals pansinusitis and what
appears to be an epidural abscess in the area of the right frontal sinus. He has been treated for Staphylococcus
aureus bacteremia for the past 10 days with IV nafcillin. In addition to surgical intervention, which of the
following antibiotics should be used perioperatively?

vancomycin and oxacillin

metronidazole, ampicillin, and ceftazidime
ampicillin, cefotaxime, and fluconazole
piperacillin/tazobactam and ciprofloxacin
vancomycin and imipenem

Which of the following is not typical of pediatric sinusitis symptoms?

mucopurulent discharge lasting more than 7 days

malodorous breath
cough worse at night
low-grade fever
maxillary toothache

A 36-year-old woman with a history of recurrent sinusitis presents with acute maxillary sinusitis despite a 14-day
course of amoxicillin and clavulanic acid. She seroconverted HIV positive 2 years ago but has not had any signs or
symptoms of AIDS. Which of the following pathogens is most likely responsible for her symptoms?

Moraxella catarrhalis
Pseudomonas aeruginosa
Haemophilus influenzae
Peptostreptococcus
Streptococcus pneumoniae

A 29-year-old salesman from Hong Kong presents for consultation with a CT scan showing right maxillary sinus
opacification. He has been on amoxicillin/clavulanic acid for the past 6 weeks, and a repeat CT scan shows no
change. He is in good health and denies history of atopy or nasal obstruction. A nasal endoscopy is unremarkable.
The most likely cause of this finding is

allergic fungal sinusitis

chronic sinusitis
mucous retention cyst
ciliary dyskinesia
tumor

In general, the distance from the anterior lacrimal crest to the anterior ethmoid artery is
 4 mm
8 mm
12 mm Dr. Fouad Shamsan
18 mm
Otolaryngology
24 mm
Acute suppurative frontal sinusitis occurs most commonly as a

de novo process
complication of acute maxillary sinusitis
result of hematogenous dissemination
complication of ethmoid sinusitis

Which of the following statements is false?

The concha type of sphenoid pneumatization results in the sinus being filled entirely by cancellous bone.
The perisellar type of sphenoid pneumatization is present in approximately one of ten patients.
Sphenoid sinuses are typically symmetric.
A posterior ethmoid sinus may extend into the body of the sphenoid bone and largely replace the sphenoid
sinus.
The sellar type of sphenoid pneumatization is the most favorable for transsphenoidal hypophysectomy.

Which of the following statements is true?

The nerves found within the cavernous sinus include the oculomotor, trochlear, abducens, and optic
branches of the trigeminal nerve.
The bony covering of the internal carotid artery and optic nerve may be thin, but it is always present during
their course next to the sphenoid sinus.
In the cavernous sinus, the trochlear nerve travels in close association with the carotid artery, whereas the
other cranial nerves are more lateral.
The internal carotid artery typically indents the posteroinferior surface of the lateral sphenoid sinus
wall.
The optic nerve typically indents the anteroinferior surface of the lateral sphenoid sinus wall.

The anterior wall of the sphenoid sinus is approximately how many centimeters posterior and at which angle from
the anterior nasal spine?

5 cm, 45 degrees
7 cm, 30 degrees
7 cm, 45 degrees
9 cm, 30 degrees
9 cm, 45 degrees

The first step in treatment of a developing retrobulbar hemorrhage as the result of endoscopic sinus surgery is

packing the nasal cavity to prevent further bleeding

ophthalmic consultation
reexploration of the ethmoid cavity to identify and control the site of hemorrhage
lateral canthotomy
mannitol
Which structure divides the anterior and posterior orbital chambers?

canthus
cornea
lens
septum
tarsus

The eye can sustain chronic increased retroorbital pressures for how long before blindness occurs?

30 minutes
90 minutes
180 minutes
360 minutes
480 minutes

A patient develops proptosis, mydriasis, ecchymosis, and chemosis during ethmoidectomy. Your first decision is
to

give steroids
order a CT scan
perform lateral canthotomy
perform medial decompression
start orbital massage

The sphenoid ostia in the average adult lie what distance from the nasal opening (nasal spine)?

4 cm
5 cm
6 cm
7 cm
8 cm

The most common complication associated with functional endoscopic sinus surgery is

hemorrhage
cheek numbness
orbital hematoma
orbital emphysema
synechia

The most common complication associated with traditional intranasal sinus surgery is

asthma attacks
hemorrhage
CSF leak
orbital emphysema
synechia

The most likely source of bleeding in a 25-year-old man with severe epistaxis 6 weeks after sustaining an ethmoid
and zygomatic fracture and ipsilateral blindness from a motor vehicle accident is the
 anterior ethmoid artery
maxillary artery
sphenopalatine artery
internal carotid artery
posterior nasal artery

The most likely environmental conditions leading to an episode of epistaxis in an otherwise healthy 65-year-old
man are

hot and dry

cold and humid
cold and dry
hot and humid
temperate and dry

The following arterial branches contribute to Little’s area with the exception of the

septal branch of the facial artery

anterior ethmoid artery
greater palatine artery
posterior nasal artery
sphenopalatine artery

A 1-month history of consistent unilateral nasal bleeding and chronic purulent drainage in an otherwise healthy 5-
year-old most likely represents a

nasopharyngeal tumor
juvenile angiofibroma
septal deviation with maxillary sinusitis
foreign body
polyps

Hereditary hemorrhagic telangiectasia, also known as Osler-Weber-Rendu disease, is characterized by all of the
following traits except

autosomal dominant
mucocutaneous telangiectasias
vessel walls without smooth muscle
decreased angiogenesis resulting in vascular dilation
arteriovenous fistulae

von Willebrand disease and hereditary hemorrhagic telangiectasia are similar except for

autosomal dominant inheritance

mucocutaneous hemorrhage
excessive bleeding during or after surgery
epistaxis being the most common presenting symptom
bleeding times serving as a useful screening test
Calcification may occur in which of the following?

sialolithiasis
Sjogren’s syndrome
hemangioma
 pleomorphic adenom
All of the above
None of the above

The most common inflammatory disorder affecting the salivary glands is

Staphylococcus aureus
mumps
benign lymphoepithelial lesion
Sjogren’s syndrome

Acute suppurative sialadenitis most commonly follows

head and neck operations

pulmonary operations
gastrointestinal operations
urologic operations

A key etiologic event in chronic sialadenitis is

penetrating trauma
immunosuppression
salivary stasis
upper respiratory infection

Granulomatous diseases of the salivary glands include all but which one of the following?

sarcoidosis
tuberculosis
animal scratch disease
Sjogren’s syndrome

So ِ◌gren’s disease is

an acute inflammatory disease

an autoimmune disease
a viral disease
a chronic inflammatory disease

The percentage of cases of Sj ِ◌gren’s syndrome involving women is

60%
70%
80%
90%

The percentage of calculi that occur in the parotid gland is

10%
20%
30%
40%
The first branchial cleft anomaly type 2 contains

ectoderm
ectoderm and mesoderm
mesoderm
ectoderm and endoderm

he etiology of necrotizing sialometaplasia is

viral
rickettsial
bacterial
unknown

The pharyngeal phase of swallowing includes

palate elevation
larynx elevation
pharyngeal constrictor contraction
relaxation of the cricopharyngeus
all of the above

Symptoms of food holding up in the neck area may be seen with

hiatal hernia with spasm

Zenker’s diverticulum
esophageal cancer
achalasia
all of the above

Vocal fold paralysis may be associated with

pain
fever
stridor
weight loss
food hold-up

Dysphagia due to neurologic dysfunction is

primarily manifested by dysphagia for solids

primarily manifested by dysphagia for liquids
accompanied by gastroesophageal reflux
accompanied by esophageal spasm
accompanied by heartburn

Which of the following nerves would not need to be anesthetized for endoscopy under local anesthesia?

recurrent laryngeal nerve

superior laryngeal nerve
hypoglossal nerve
glossopharyngeal nerve
trigeminal nerve
Which of the following statements is false concerning the herpes simplex virus (HSV)?

HSV is a DNA virus.

Approximately 90% of the population manifests the full clinical picture of herpetic gingivostomatitis.
The lesions usually heal in 1 to 2 weeks without scarring.
The virus may migrate along the periaxonal sheath to the trigeminal ganglion.
The vast majority of the population have antibodies to HSV.

Which of the following does not belong to the group of lesions categorized as desquamative gingivitis?

candidiasis
cicatricial pemphigoid
pemphigus vulgaris
dermatitis herpetiformis
lichen planus

Choose the incorrect statement about candidiasis.

Median rhomboid glossitis is thought to be a variant of candidiasis.

Local and systemic factors may predispose on to candidal infections.
Pseudomembranous candidiasis (thrush) is the most common form of candidiasis.
Candidal infections are more commonly found in neonatal, elderly, and immunocompromised patients.
Angular cheilitis is rarely associated with candidiasis.

Which of the following statements concerning recurrent aphthous ulcers is false?

Major aphthous ulcers often heal with scarring.

Multiple etiologies including immunology have been implicated.
Minor aphthous ulcers often heal with scarring.
The incidence of recurrent aphthous ulcers may have a range as high as 10% to 20% of the general
population.
The herpetiform variety is not related to HSV.

Which of the following statements about AIDS is false?

Candidiasis is a harbinger of the full-blown syndrome in an HSV-positive patient.

Herpes simplex infections present for longer than 1 month in the HIV-positive patient meet the criteria for
AIDS.
Hairy leukoplakia is seen only in the HIV-positive population.
The incidence of non-Hodgkin’s leukemia is greater in AIDS patients.
Gingivitis, periodontitis, and acute necrotizing gingivitis are more prevalent in the HIV-positive population
than in the HIV-negative population.

The carotid sheath is made of

the superficial cervical fascia

the superficial layer of the deep investing fascia
the middle layer of the deep investing fascia
the deep layer of the deep investing fascia
all the deep investing fascial layers

The structure that does not prevent spread of infection in the sublingual space is the
 mandible
mylohyoid muscle
hyoid bone
median lingual fascia
genioglossus muscle

The submandibular space is commonly infected by spread of infection from

mandibular second and third molars

maxillary second and third molars
mandibular bicuspid teeth
mandibular incisor teeth
the sublingual gland

Ludwig’s angina refers to infectious involvement of

bilateral submandibular space

bilateral sublingual space
bilateral submental space
all of the above
none of the above

Infection of the masticator space tends to involve

the temporalis muscle

all the masticatory muscles
the masseter muscle
the external pterygoid muscle
the internal pterygoid muscle

Complications of a parapharyngeal space infection include (select all answers that are correct)

Horner’s syndrome
hoarseness and/or aspiration
tongue paresis
sternocleidomastoid or trapezius weakness
decreased pharyngeal sensation
All of the above
None of the above
Laryngitis-associated airway compromise is more common in children because

antibiotics are less effective

organisms are more virulent
steroids are less effective
the airway is smaller
the immune system is immature

The most significant medical advance regarding acute supraglottitis in children is

development of more effective antibiotics

development of jet ventilation
 development of a Haemophilus influenzae vaccine
development of more effective corticosteroids
advances in anesthetic techniques

Of the following, which is the most common inflammatory condition of the larynx in adults?

tuberculosis
laryngopharyngeal reflux
blastomycosis
acute supraglottitis
rhinoscleroma

External laryngocele is least likely to

be congenital
communicate with the laryngeal ventricle
produce swelling in the neck during Valsalva’s maneuver
be seen on CT scan
herniate through the cricothyroid membrane

During vibration, modulation of the airstream occurs through

release of glottal puffs

rapid opening and closing of the vocal fold
a tissue mucosal wave
a pressure wave

In the body-cover theory of vocal fold vibration, the stiffness of the vocal fold is controlled by

inhibition of posterior cricoarytenoid neuromuscular contraction

the lateral cricoarytenoid muscle
the cricothyroid muscle
the thyroarytenoid and cricothyroid muscles

he most important characteristic(s) of normal phonatory posture are

adequate closure and symmetric stiffness

proper medial adductive compression and normal subglottic pressure
contraction of the lateral cricoarytenoid and interarytenoid muscles with modulation of the airstream
the normal antagonistic pull of the cricothyroid muscle on the thyroarytenoid muscle

Which one of the following statements is correct?

The infant larynx is approximately one-half the size of the adult larynx.
The superior border of the infant larynx is located at the first cervical vertebra.
One mm of edema within the infant larynx will create a glottic space narrowed by more than 25%.
A neonate with a subglottic diameter of 4 mm has subglottic stenosis.

Which condition is most likely to result in clinical aspiration?

posterior cricoarytenoid paralysis

bilateral recurrent laryngeal nerve injury (upper motor neuron)
pharyngeal phase dysfunction
 bilateral recurrent laryngeal nerve injury (lower motor neuron)

Which is the earliest sign of respiratory failure?

cyanosis
biphasic stridor
tachypnea
substernal retractions

The most common morbidity resulting from alkaline ingestion is from

acid-base abnormalities
delayed reepithelialization and resulting fibrosis
glottic and subglottic stenosis following alkaline mucosal injury
reflux esophagitis/laryngitis
tracheoesophageal fistula formation

The most commonly found esophageal foreign body in children is

a fish bone
meat
a toy
a coin
a meat bone

Antibiotics used to treat chronic sinusitis should

treat the beta-lactamase-producing bacteria

be given IV only
be given for 7 to 10 days
not be considered for children because of increasingly resistant bacteria

Chronic tonsillar infection and persistent hyperplasia are characterized by all of the following except

chronic cryptitis
infection with Haemophilus influenzae
increased core-bacterial concentration
increased helper T lymphocytes
increased suppressor T lymphocytes

Bacteria commonly associated with adenotonsillar disease include all of the following except

H. influenzae
Streptococcus pyogenes
Escherichia coli
Streptococcus pneumonia
Moraxella catarrhalis

Which of the following is true with regard to the adenoid epithelium?

It consists of three types of surface cells.

It is similar in composition to the tonsils.
Its only function is antigen processing.
 It is primarily transitional when chronically infected.
It has no role in mucociliary clearance.

n the germinal center of the lymphoid follicle all of the following may occur except

immunoglobulin production
expansion of memory clones
migration of B cells to postcapillary venules
antigen processing
delayed cellular hypersensitivity

The most common presenting sign of Hodgkin’s disease is

an oropharyngeal mass
a nasopharyngeal mass
a laryngeal mass
a cervical mass
an abdominal mass

The most common presenting sign of nasopharyngeal carcinoma is

an oropharyngeal mass
a nasopharyngeal mass
a laryngeal mass
a cervical mass
an abdominal mass

The definition of otitis media is inflammation of the middle ear

caused by allergy
caused by bacteria
caused by immune complexes
without reference to etiology or pathogenesis
caused by eustachian tube dysfunction

The most commonly identified pathogen associated with acute otitis media is

Staphylococcus aureus
Haemophilus influenzae, type B
Streptococcus pneumoniae
Klebsiella pneumoniae
Moraxella catarrhalis

Anatomically, two-thirds of all head and neck cancers are found in the

oral cavity
larynx
oral cavity and larynx
oral cavity and hypopharynx
larynx and hypopharynx

The severely malnourished head and neck cancer patient with metabolic derangements is a risk for
 impaired wound healing
poor ambulation and cough
muscle wasting
immunosuppression
all of the above

The most common premalignant lesion of the head and neck skin is

keratoacanthoma
seborrheic keratosis
Bowen’s disease
actinic keratosis
erythroplasia of Queyrat

The most critical factor for the aggressiveness of a cutaneous squamous cell cancer is

history of sun exposure

history of previous skin irradiation
history of arsenic ingestion
history of previous squamous cell cancer
size and depth of tumor
The most common masses of the sinonasal tract in children are

sarcomas
carcinomas
lymphomas
gliomas
inflammatory polyps
Dr. Fouad Shamsan
The most common salivary gland neoplasm in children is
Otolaryngology
mucoepidermoid carcinoma
lymphangioma
hemangioma
Warthin’s tumor
adenocarcinoma

The most common malignant submandibular tumor is

carcinoma exmixed adenoma

mucoepidermoid carcinoma
squamous cell carcinoma
adenoid cystic carcinoma
adenocarcinoma

The branch of the facial nerve at highest risk for injury during parotidectomy is the

frontal
zygomatic
buccal
marginal mandibular
cervical
Of the following complications of parotidectomy, the most common is

salivary fistula
seroma
infection
hematoma
flap necrosis

The most common source of malignant tumor metastatic to the parotid gland and parotid lymph nodes is the

stomach
colon
lungs
prostate
ovaries

All of the following nerves are involved in the sensory or motor function of the lip except the

marginal mandibular branch of cranial nerve VII

buccal branch of cranial nerve VII
inferior alveolar nerve
superior alveolar nerve
infraorbital nerve

The incisive foramina house the

greater palatine vessels and nerves

sphenopalatine nerve
palatine nerves and nasopalatine arteries
anterior and posterior superior alveolar nerves
lesser palatine nerve

The following are contents of the parapharyngeal space, except

fat
lymph nodes
carotid artery
V3
cranial nerve X

The most common type of malignancy of the palatine tonsils is

non-Hodgkin’s lymphoma
Hodgkin’s lymphoma
squamous cell carcinoma
mucoepidermoid carcinoma
lymphoepithelioma

The most common presenting symptom for oropharyngeal cancer patients is

pain
neck mass
hearing loss
 hemoptysis
foreign-body sensation

Which cranial nerves are implicated as the cause of referred otalgia in patients with oropharyngeal cancers?

ninth and fifth

tenth and fifth
ninth and eleventh
tenth and eleventh
ninth and tenth

A posterior hypopharyngeal carcinoma extending into the postcricoid area most likely will metastasize to the

node of Rouvière
jugulodigastric nodes
retropharyngeal nodes
paratracheal nodes
accessory nodes

The most common site within the hypopharynx for cancer to develop is the

posterior wall
aryepiglottic fold
postcricoid area
pyriform fossa
vallecula

Which of the following is the most important factor in the development of cervical esophageal cancer?

alcohol use
Barrett’s esophagus
reflux
tylosis
Plummer-Vinson eye disease

The glottic closure reflex responds to all of the following except

touch
emotion
chemical stimuli
thermal stimuli

Which of the following anesthetic agents would likely have the greatest effect on the auditory brainstem response?

isoflurane
fentanyl
ketamine
nitrous oxide
etomidate

Which of the following anesthetic agents would likely have the greatest effect on intraoperative facial EMG
recordings?
 halothane
narcotics
ketamine
nitrous oxide
neuromuscular-blocking agents

Within the temporal bone, the facial nerve is conveniently divided into which of the following segment(s)?

tympanic segment
internal genu
intracisternal segment
labyrinthine segment
B and C
A and D
The primary protective barrier of the external auditory canal is formed by the

tragus and antitragus

acidic lipid bilayer of cerumen and desquamated epithelium
hair-bearing skin and the sebaceous and apocrine glands forming the apopilosebaceous unit
cerumen and a complicated system of self-cleaning glands lining the external auditory canal
gentle S-shaped curve of the external auditory canal

Sensation to the auricle and external auditory canal is supplied by

branches of cranial nerves V, VII, VIII, IX, X and the cervical plexus (C2-3)
branches of cranial nerves V, VII, VIII, IX, X and the cervical plexus (C3, 4, 5)
branches of cranial nerves V, IX, X and the cervical plexus (C3, 4, 5)
branches of cranial nerves V, VII, IX, X and the cervical plexus (C3, 4, 5)
branches of cranial nerves V, VII, IX, X and the cervical plexus (C2-3) ??

The usual pathogens responsible for acute otitis externa are

Pseudomonas aeruginosa and staphylococci

P. aeruginosa, Proteus mirabilis, staphylococci, streptococci, and other gram-negative bacilli
P. aeruginosa, P. mirabilis, staphylococci, streptococci, and other gram-negative bacilli
P. aeruginosa, P. mirabilis, facultative anaerobes, and other gram-negative bacilli
P. aeruginosa, P. mirabilis, staphylococci, facultative aerobes, and other gram-negative bacilli

The causative agent of necrotizing otitis externa is almost always

a gram-positive organism, usually a Streptococcus species

two gram-positive organisms, usually a Staphylococcus and Streptococcus species
a mixed infection with P. aeruginosa as the predominant isolate
a gram-negative organism, usually a Pseudomonas species
a mixed infection with Pseudomonas mallei as the predominant isolate

The metabolic requirements for the growth of fungus in the external ear include

a warm and dark environment in a relatively immunocompromised host

a warm, dark, and moist environment in any host
a moist environment in a diabetic host
a warm and dark environment in any host
moisture alone in the external canal of an HIV-positive patient
Glomus temporale tumors (paragangliomas)

are usually confined to their site of origin until they become symptomatic
are rapidly growing tumors with a short interval between onset of symptoms and definitive diagnosis
have metachronous or synchronous tumors present in more than 35% of cases
can easily spread beyond the confines of the temporal bone before detection

The most common site of origin of middle ear cholesteatoma is the

anterior epitympanum
anterior mesotympanum
posterior mesotympanum
posterior epitympanum
central mesotympanum

The floor of Prussak’s space is defined by the

lateral process of the malleus and associated mucosal folds

head of the malleus and body of the incus
mallear fold
tegmen tympani
inferior mallear fold and ligament

The most common site of ossicular damage in middle ear cholesteatoma is the

head of the malleus

long process of the incus
stapes capitulum
stapes crura
body of the incus

The most common site of facial nerve paralysis secondary to cholesteatoma is the

horizontal segment
geniculate ganglion
vertical segment
second genu
stylomastoid foramen

In infants, a postauricular incision should be placed more posteriorly because

the mastoid antrum is more posteriorly and superiorly located

the facial nerve may be closer to the mastoid
the sigmoid sinus in an infant is at the surface of the skull and could be cut
an incision close to the postauricular groove may distort the contour of the auricle in young children
a more posterior incision gives a better view of the facial recess

The temporal line of the squamous part of the temporal bone

roughly corresponds to the floor of the middle cranial fossa

is the posterior insertion of the auriculotemporal muscle
must be left intact during tympanomastoid surgery
 must never be left intact during tympanomastoid surgery
is the upper extent of Trautmann’s triangle

A suture line is present in the posterior wall of the ear canal. It is the

petrosquamous suture line

subarcuate suture line
temporoparietal suture line
K ِ◌rner’s septum
tympanomastoid suture line

Korner’s septum

divides the epitympanum into an anterior and posterior region

may divide the mastoid air cells into a medial and lateral region
may divide the petrous apex into an anterior and posterior region
bifurcates the endolymphatic sac
is the principal landmark for the “vascular strip” within the ear canal

When approached through the mastoid, the facial recess is entered between the

facial nerve and the tympanic annulus

facial nerve and the fallopian canal
facial nerve and the chorda tympani nerve
facial nerve and the sigmoid sinus
chorda tympani nerve and the tympani annulus

The endolymphatic sac can usually be found

immediately superior to “Donaldson’s line” (a line through the length of the lateral semicircular canal)
between the inferior part of the posterior semicircular canal and the sigmoid sinus
posterior to the posterior semicircular canal
in the dura overlying the sigmoid sinus
in the dura of the middle cranial fossa

The anterior petrous apex is pneumatized in what percentage of cases?

3%
9%
18%
36%
54%

The most common anomaly of the facial nerve is

prolapse against the stapes

dehiscence above the geniculate ganglion
bifurcation of the mastoid segment
duplication of the labyrinthine segment
dehiscence of the tympanic segment

In which intratemporal region is the extrinsic blood supply to the facial nerve most vulnerable to ischemia?
 labyrinthine
geniculate ganglion
tympanic segment
mastoid segment
stylomastoid foramen

The hallmark finding in Ramsay-Hunt syndrome is

sensorineural hearing loss

nystagmus (with vertigo)
facial paralysis
otitis externa
vesicles

A 3-year-old girl presents with fever, otalgia, and a right facial palsy. Otoscopic examination reveals an
erythematous, bulging right tympanic membrane. You recommend

oral amoxicillin
transmastoid decompression
complete mastoidectomy and drain
myringotomy and appropriate antibiotics
amoxicillin and facial nerve tests

Hearing loss from tertiary syphilis is

bilateral and slowly progressive

bilateral and rapidly progressive
asymmetric and fluctuating
unilateral and total
bilateral and fluctuating

The facial paralysis in Lyme disease

slowly develops over several months

fluctuates in severity
with treatment resolves over 6 to 8 months
even with treatment is associated with permanent loss of function
is usually associated with hearing loss

The organism that most commonly is associated with virus-induced congenital deafness is

the rubella virus

the rubeola virus
cytomegalovirus
mumps virus

Which of the following data are least helpful in the diagnosis of congenital cytomegalovirus infection?

maternal history
radiographic documentation of intracerebral calcium deposits in the infant
documentation of “owl eye” bodies in the urinary sediment in the first week of life
identification of anticytomegalovirus immunoglobulin M (IgM) in infant serum
All of the following viruses can reactivate from a latent state except

cytomegalovirus
rubella
varicella zoster
Epstein-Barr virus

All of the following are significant factors in establishing the diagnosis of congenital rubella infection except

hearing loss associated with cataracts and cardiac defects

documentation of rubella virus in throat cultures
maternal history of a rash-associated illness during pregnancy
isolation of rubella virus from amniotic fluid

Which of the following is not true for mumps parotitis- associated sensorineural hearing loss?

unilateral presentation
onset at the end of the first week of parotitis
extensive vestibular involvement
accompaniment by orchitis and meningoencephalitis

Which audiometric test is most specific and sensitive in the diagnostic evaluation of a vestibular schwannoma?

electronystagmography
auditory brainstem response testing
acoustic reflex testing
electrocochleography
pure tone audiometric testing and speech discrimination scoring

Hitselberger’s sign occurs as a result of pressure from the vestibular schwannoma on which division of which
nerve?

motor division of the facial nerve

sensory division of the facial nerve
sensory division of the trigeminal nerve
sensory division of the glossopharyngeal nerve
motor division of the vagus nerve

A tumor originating on which nerve is most likely to spread into the inner ear?

facial nerve
trigeminal nerve
inferior vestibular nerve
superior vestibular nerve
cochlear nerve

The facial nerve occupies which position within the internal auditory canal?

anterosuperior
anteroinferior
posterosuperior
posteroinferior
singular canal
After viral infections of the inner ear, histopathologic findings include

fibrosis of the scala media

rupture of Reissner’s membrane
vacuolization of the stria vascularis
atrophy of the tectorial membrane
intact organ of Corti

High-frequency sudden sensory hearing loss with associated vertigo carries a poor prognosis for hearing recovery.
What is the best explanation for the associated vertigo?

severe damage throughout the inner ear

proximity of the vestibule to the basal turn of the cochlea
mixing of perilymph and endolymph
rupture of Reissner’s membrane
endolymphatic hydrops

In the vascular theory of sudden hearing loss, the pathophysiology in the cochlea is

reduced oxygen tension in the stria vascularis

venous obstruction leading to endolymphatic hydrops
acidosis caused by rising Pco2 levels in hair cells
vacuolization of hair cells
loss of hair cells

The inner ear has been shown to be immunoresponsive by

antigen challenge results in local antibody production

plasma cells accumulating within the inner ear
serum antibody crossing the blood labyrinth barrier
all of the above

The cerumen glands located in the external auditory canal

are the same as sebaceous glands

increase in number with age, which may lead to an increase in cerumen impactions
are present in the medial portion of the canal
atrophy with age, which may lead to drier cerumen
are not present in the elderly

Changes seen in the vestibular system of the elderly include

a decrease in the number of vestibular neurons

degeneration of otoconia within the saccule and utricle
a decrease in the caliber of peripheral myelinated nerve fibers
degeneration of connections in the central vestibular pathways
all of the above

Sudden loss of function of the right labyrinth causes all of the following signs and symptoms except

vertigo
nystagmus, fast component to right
 nystagmus, fast component to left
bradycardia and sweating

The facial nerve nucleus, the origin of the facial nerve, is located in the

cerebellar pontine angle

pons
medulla
internal auditory canal
first genu in the temporal pons

The marginal mandibular branch of the facial nerve courses in the

subcutaneous layer of fat that lies above the platysma muscle

parotid gland and lies below the angle of the mandible to perforate the platysma muscle before enervating
the depressors of the lip
fascia of the submandibular gland deep to the platysma muscle
subcutaneous aponeurotic system after it exits the anterior border of the parotid gland

The temporal branch of the facial nerve

becomes superficial in the region of the junction of the hair-bearing and non-hair-bearing skin
commences 1.5 cm below the external auditory canal
innervates the frontalis muscle from above
is protected by dissecting deep to the temporalis fascia when performing a coronal forehead lift

Adipose tissue derives its blood supply

from descending branches of the subdermal plexus

from ascending fascial arteries
primarily from ascending fascial arteries when the fat is more than 1 cm thick
primarily from ascending fascial arteries when the fat is less than 1 cm thick
through interseptal capillaries

Cervicofacial fat differs from fat elsewhere in that

it is primarily brown fat, whereas most other body fat is white fat
fat volume is relatively stable
it is unaffected by anabolic and catabolic hormones
its volume and distribution are solely determined by genetic factors
changes in volume and distribution brought about with liposurgical procedures are transient and
homeostatic, and mechanisms will restore this fat to its presurgical volume and morphology

Dr. Fouad Shamsan

Otolaryngology