LY M P H N O T E S

ENT MEDICINE MCQs

Table of Contents
Ear · 2
Nose · 27
Throat · 44
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EAR

MCQ:
1. Which drum perforation can cause more hearing loss?

a) Antero-inferior perforation at the position of cone of light

b) Superior perforation in the pars flaccid
c) central perforation in the pars tensa
d) Posterior perforation opposite the oval & round window
2. Congenital aural(meatal) atresia occurs as aresult of:
a) Defect in development of the first branchial arch
b) Defect in development of the second branchial arch
c) Defect in development of the first & second
d) Defect in development of the third branchial arch branchial arch
3. Facial paralysis in Ramsay – Hunt syndrome is due to affection of:
a) Gasserian ganglion
b) spiral ganglion
c) Geniculate ganglion
d) Vestibular ganglion
4. All the following are correct for TTT of diffuse OE except:
a) Local removal of discharge by suction
b) Ear drops with antibiotic & corticosteroids
c) Surgical TTT by drainage of abscess
d) Antibiotic & analgesic in severe cases

5. The first nerve to be paralyzed in malignant OE is:

a) Trigeminal
b) Facial
c) Glossopharyngeal
d) Vagus

6. Ceruminous glands present in the ear are :

a) Modified eccrine glands

b) Modified apocrine glands
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c) Mucous glands
d) Modified holocrine glands
7. The difference between ASOM & acute mastoiditis is:
a) Collection of pus within mastoid air cells
b) Destruction of bony walls between mastoid air cells in mastoiditis
c) Rupture of the TM
d) Inflammation of the mucosa of the mastoid air cells
8. Which of the following is not the site for paraganglioma:
a) carotid bifurcation
b) Jugular bulb
c) Promontory in ME
d) Geniculate ganglion

9. Otitic barotraumas can't occur in a patient with:

a) Otosclerosis
b) CSOM
c) meniere's disease
d) Secretory OM

10.Bell's palsy has bad prognosis in the following conditions except:

a) young age
b) Diabetic & hypertensive patients
c) Severe post-auricular pain
d) Old age

11.Iatrogenic traumatic facial nerve palsy is most commonly caused

during:

a) Myringoplasty
b) Stapedectomy
c) Mastoidectomy
d) Ossiculoplasty

12.The concept that the facial nerve supplies the auricleis related to:

a) Ramsay-Hunt syndrome
b) Jugular foramen syndrome
c) Horner's syndrome

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d) Bell's palsy

13.Watery discharge from the ear occurs in all of the following

except:

a) CSF otorrhea
b) Parotid fistula
c) AOM
d) Endolymphatic sac surgery

14.The site where the electrode of cochlear implant is inserted:

a) Round window
b) Oval window
c) Horizontal SCC
d) Endolymphatic sac

15.Hearing aid isn't used for the following diseases:

a) Cochlear otosclerosis
b) Adhesive OM
c) Secretory OM
d) Presbycusis

16.Which of the following patients is in need for ear surgery before

the others:

a) A patient with cholesteatoma

b) A patient with AOM & mastoiditis
c) A patient with Secretory OM with marked diminution of hearing
d) A patient with bilateral otosclerosis with marked diminution of hearing
17. A 4-year-old child presented by his mother complaining of lack of
attention, mouth breathing &hyponasality
a) Secretory OM
b) Adenoid is suspected
c) both 1 and 2
d) None of the above

18.+ve kernig's sign means:

a) reflex flexion of the knees when the neck is flexed

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b) inability to extend the knee completely when his hip is flexed on the abdomen
c) Inability to do rapid alternating movements
d) None of the above
19.A child with retracted drum & conductive deafness after
inadequate ttt of ASOM is sufferingfrom:
a) chronic tubotympanic otitis media
b) Chronic atticoantral OM
c) Otitis media with effusion
d) None of the above

20.Throbbing & severe earache is present in the following stage of

AOM

a) Stage of salpingitis
b) Stage of catarrhal OM
c) stage of suppurative otitis media
d) Stage of TM perforation

21.The first line of TTT in a child who develops LMN facial paralysis
after AOM is:

a) antibiotics and corticosteroids

b) Decompression of facial nerve
c) Exploration of facial nerve
d) Myringotomy

22.Which of the following statements is wrong concerning

myringotomy operation:

a) It is indicated in ASOM with bulging drum

b) Secretory OM after failure of medical TTT
c) it’s better done in the postero-superior quadrant
d) Residual perforation of the TM is one of its complications

23.The commonest cause of SNHL in children:

a) post-meningitic
b) Congenital cholesteatoma
c) Secretory OM
d) Cochlear otosclerosis

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24.The following are manifestations of meniere's disease except:

a) Vertigo
b) post reservoir sign
c) SNHL
d) Tinnitus

25.The causative organism in ear furuncles is:

a) Proteus
b) Pseudomonas
c) staph. Aureus
d) E.coli

26.In, otosclerosis,the following is correct except:

a) usually affects both ears

b) Shows more progress during pregnancy
c) Shows type As curve on tympanometry
d) tympanoplasty is the operation of choice

27.Traumatic perforation of TM is characterized by:

a) irregular edges of the perforation

b) Purulent discharge
c) Attic perforation
d) Congested ME mucosa

28.The primary goal of surgery for cholesteatoma is:

a) hearing improvement
b) Reconstruction of the ossicular chain
c) removal of all the disease
d) Reconstruction of the TM

29.TTT of a small dry traumatic rupture of TM is:

a) antibiotic ear drops

b) Myringoplasty
c) ear pack
d) protection Of ear against water

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30.Gradinigo's syndrome is characterized by the following EXCEPT

a) profuse ear discharge

b) Facial pain
c) facial nerve paralysis
d) Diplopia

31.Most common cause of Bilateral CHL in children is:

a) Otosclerosis
b) secretory otitis media
c) Congenital cholesteatoma
d) adhesive OM

32.Otoacoustic emission arise from:

a) Inner hair cells

b) Outer hair cells
c) Both inner & outer hair cells
d) Supporting cells of the inner ear
33.When the hearing thresholds for air and bone conduction pure
tone are equal with anaverage hearing threshold of 45 dB, this
indicates:
a) Mixed hearing loss
b) SNHL
c) CHL
d) Central hearing loss

34.Which of the following is NOT a high-risk factor for hearing loss

in new born:

a) low birth weight

b) Family history of hearing loss
c) Siblings with upper respiratory infection
d) Neonatal jaundice

35.A 35 years old female complaining of tinnitus with bilateral

moderate conductive hearing loss and type As tympanogram, the
most probable etiology is:

a) Acoustic neuroma

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b) Otosclerosis
c) CSOM
d) Meniere's disease

36. As regards tympanometry, all the following statements are true

Except:

a) It measures the function of the ET

b) Compares the pressure of the ME to the atmospheric pressure
c) Can be used to confirm endolymph hydrops
d) Assesses the mobility of the tympanic membrane

36.Management of a child with severe to profound hearing loss may

involve:

a) Hearing aid
b) Cochlear implant
c) Speech & language therapy
d) All of the above

37.Gradenigo’s syndrome include the following Except:

a) Trigeminal nerve affection

b) Abducent nerve affection
c) Facial nerve affection
d) Otorrhea
38.A patient with Meniere's disease has failed all medical treatment
but stillretains a serviceable hearing. All the following
treatments can beconsidered except:
a) Endolymphatic sac decompression
b) Intratympanic injection of streptomycin
c) vestibular neurectomy
d) Labyrinthectomy

39.All the following can predispose to otitis media with effusion

except:

a) Cleft palate
b) Angiofibroma
c) Lingual tonsil hypertrophy
d) Nasopharyngeal tonsil hypertrophy

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40.The facial nerve supplies all the following muscles except:

a) Stapedius
b) Anterior belly of digastric
c) Orbicularis oris
d) buccinator
41.A 20-year-old male presents with left Bell's
palsy,onexamination,whatcould be the manifestations:
a) Rt UMNL facial nerve paralysis
b) Rt LMNL facial nerve paralysis
c) Lt UMNL facial nerve paralysis
d) Lt LMNL facial nerve paralysis
42.Fluctuant SNHL,vertigo,tinnitus may be the presenting symptoms
of allthe following except:
a) Meniere's disease
b) Otosclerosis
c) Syphilis
d) Peri lymphatic fistula

43.Radical mastoidectomy entails removal of all of the following

except:

a) Stapedius muscle
b) Mastoid air cells
c) Facial ridge
d) Incus bone

44.Treatment of secretory otitis media includes all the following

except:

a) Corticosteroids
b) Myringoplasty
c) Antibiotics
d) Myringotomy
45.A patient with chronic suppurative otitis media developed fever
whatcould be the reason?
a) he developed labyrinthitis
b) he developed Petrositis
c) he developed Lateral sinus thrombosis

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d) he developed facial nerve paralysis

46.In case glomus,jugular tumor of the middle ear, which of the
followingis the diagnostic procedure?
a) Biopsy
b) MRI brain
c) CT scan of petrous
d) carotid angiography

47.Lesion of the facial nerve at the geniculate ganglion, may present

with:

a) Preserved stapedial reflex

b) Lost lacrimation
c) UMNL facial paralysis
d) Lost taste sensation

48.In conditions with Eustachian dysfunction:

a) The cone of light is disturbed

b) The drum is seen bulging
c) There are hemorrhagic blebs on the drum surface
d) The drum is always perforated

49.Lateral sinus thrombophlebitis:

a) Occurs mainly as a result of acute otitis media

b) Is the commonest intracranial complication
c) Presents usually with pyrexia
d) can be confused with malaria

50.Otosclerosis:

a) Is mainly caused by a viral agent

b) Males are more affected than females
c) Is the result of ankyloses of the stapes footplate
d) Treatment is always medical

51.Bullous myringitis is characterized by:

a) recurrent fever
b) Absence of pain

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c) SNHL
d) Sero-sanguinous discharge

52.A positive fistula sign can be elicited in the following conditions

except:

a) Otosclerosis
b) Syphilis
c) Cholesteatoma
d) Labyrinthine trauma

53.Congenital hearing loss is:

a) Present from birth and is caused by a genetic defect or disturbance during

fetal development
b) Only due to genetic abnormalities
c) Only conductive in nature
d) Always accompanied by ear deformities

54.Unusual bleeding after removal of an aural polyp suggests:

a) Tuberculosis
b) Cholesteatoma
c) Carcinoma
d) Exostosis

EAR MCQ 2015

1. The following have an ototoxic effect except:

a) gentamicin
b) streptomycin
c) amoxicillin
d) quinine

2. Which of the following statements is wrong concerning

myringotomy operation?

a) it is indicated in acute suppurative otitis media with bulging drum.

b) it is indicated in secretory otitis media after failure of medical treatment

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c) it is better done in the poster-superior quadrant of the tympanic membrane.

d) residual perforation of the tympanic membrane is one of its complications.

3. Uncontrolled diabetes in on elderly patient may predispose to:

a) cholesteatoma
b) malignant otitis externa
c) Meniere’s disease
d) vestibular neuritis

4. malignancy is suspected in enlarged lymph node if it has the

following except:

a) hard
b) painful
c) progressive
d) fixed

EAR MCQ 2016

1. A 30-year-old female patient presented by bilateral gradual
hearing loss more in the right ear, her older sister had the same
problem, on examination a healthy intact tympanic membrane
was seen, Rinne test was negative on the right ear & positive on
the left, Weber test was lateralized to the right, the most probable
diagnosis:

a) Otosclerosis
b) Ototoxicity
c) Presbycusis
d) Early middle ear diffusion
e) Glomus tympanicum

2. The following fibers are present in the facial nerve Except:

a) Secreto-motor fibers to the lacrimal gland through GSPN

b) Secreto-motor fibers to the submandibular gland through the chorda tympani
c) Taste sensation fibers to the anterior third of the tongue through the chorda
tympani
d) Motor fibers to the stapedius muscle
e) Motor fibers to the tensor tympani muscle (→ mandibular nerve)

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3. A 35-year-old male presented by right ear discharge for 5 years,

the discharge is intermittent and profuse in nature, on
examination the right external canal was seen full of muco-
purulent discharge, suction revealed a central kidney shaped
perforation in the ear drum, if this condition is left un-treated
the most probable consequence will be:

a) repeated attacks of muco-purulent attacks

b) progressive hearing loss up to complete deafness
c) right sided facial paralysis
d) spread of infection to the intra-cranial cavity
e) septicemia secondary to a septic focus in the ear

4. A 6-year-old boy was brought by his parents for progressive right

ear pain of 2 days’ duration, this is associated with fever & runny
nose, on examination the External canal was healthy, however
the right tympanic membrane was obviously reddish,
management of this condition may include all the following
Except:

a) systemic antibiotics
b) local and systemic pain control
c) cold fomentations and anti-pyretics
d) CT scan petrous bones to stand on the extent of the disease
e) myringotomy if not responsive to medical treatment

5. Otitis media with effusion in children should be initially treated

by:

a) medical treatment in the form of systemic steroids for several weeks

b) medical treatment in the form of systemic steroids only for 48 hours
c) adenoidectomy & myringotomy
d) adenoidectomy & placement of a ventilation tube
e) long-term penicillin till the age of 15 years

6. Lateral sinus thrombophlebitis:

a) Occurs mainly as a result of acute otitis media.

b) It's the commonest intracranial complication.
c) Presents usually with pyrexia.
d) Can be confused with malaria.

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7. Otosclerosis:

a) Is mainly caused by a viral agent.

b) Males are more affected than females.
c) Is the result of ankyloses of the stapes footplate.
d) Treatment is always medical.

8. Bullous myrilgitis is characterized by:

a) Recurrent fever.
b) Absence of pain.
c) Sensorineural hearing loss.
d) Serosanguinous discharge.

9. A positive fistula sign can be elicited in the following conditions,

except:

a) Otosclerosis.
b) Syphilis.
c) Cholesteatoma.
d) Labyrinthine trauma.

10.Congenital hearing loss is:

a) Present from birth and is caused by a genetic defect or disturbance during

fatal development.
b) Only due to genetic abnormalities.
c) Only conductive in nature.
d) Always accompanied by ear deformities.

11.Before his final exam, a 22-year-old student presented to the

otologist complaining of hearing loss in his Lt. ear about 2
months ago. He had history of repeated upper respiratory tract
infections. He also heard some noises in his Lt. ear, especially by
night, but no vertigo was noticed. He felt itching in both ears &
sometimes attacks of pain. He denied any history of trauma, but
he remembered that he fell down when he was climbing the stairs
2 months ago. Examinations revealed bilateral intact tympanic
membranes. Rinne test was negative on the left side, positive on
the right side. Weber test was lateralized to the left side.
Siegalization showed no restricted mobility in both drums. Nasal

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examination showed mild congestion. The otologist asked for

some investigations to help him in diagnosis.

1. This student has:

a) Lt. CHL.
b) Rt. CHL.
c) Lt. SNHL.
d) Rt. SNHL.
2. What's the appropriate investigation that the otologist had asked to prove
his diagnosis?
a) Otoacoustic emission.
b) Auditory brain response (ABR).
c) Electrocochleography.
d) PTA & tympanometry.
3. What could be the most logical reason for hearing loss?
a) The student is malingering to skip the exam.
b) Secretory otitis media.
c) Large osteoma in external auditory canal.
d) Fracture in his ear ossicles.
4. How can we manage such a case?
a) Grommets tube insertion.
b) Removal of osteoma.
c) Tympanoplasty.
d) Partial ossiculoplasty replacement prosthesis (PORP).
5. If Rinne test was positive bilaterally & Weber test was lateralized to the
right side, what could he have?
a) Lt. SNHL.
b) Lt. CHL.
c) Rt. CHL.
d) Rt. SNHL.

12.The caloric vestibular test can evaluate the function of:

a) the lateral semicircular canal

b) the superior semicircular canal
c) the posterior semicircular canal
d) all of the above
e) none of the above
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13.All the following are neoplasms that may lead to facial nerve
paralysis Except:

a) adenocarcinoma of the carotid gland

b) glomus jugular tumor
c) malignant otitis externa
d) facial nerve schwannoma

14.Left conductive hearing loss, a retracted tympanic membrane in

50 years old requires:

a) nasopharyngoscopy and biopsy

b) myringotomy and T-tube insertion
c) both of the above
d) none of the above

15.The function of stapedius muscle is to contract to:

a) transmit all the energy of sounds properly to the inner ear

b) increase sensitivity of the inner ear to high frequency sound
c) limit transmission of high frequency sounds to the inner ear
d) prevent dislocation of incudostapedial joint

16.Schirmer’s test evaluate the following branch of facial nerve in

case of paralysis:

a) chorda tympani nerve

b) deep petrosal nerve
c) greater superficial petrosal nerve
d) lesser superficial petrosal nerve

17.The end-organ responsible for the sensation of hearing is the:

a) organ of Corti
b) crista ampularis
c) utricle
d) saccule

18.The commonest cause for impaction of ear wax is:

a) narrow external auditory canal

b) tenacious ear wax

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c) self-cleaning of the ear by the patient

d) osteoma of the external auditory canal

19.Earache accompanying acute tonsillitis is referred along the:

a) vagus nerve
b) glossopharyngeal nerve
c) trigeminal nerve
d) facial nerve

20.Degree of hearing loss in tubotympanic otitis media with a

central perforation depends on:

a) ossicular dislocation
b) size of perforation
c) exposure of the round window
d) all of the above
e) none of the above

21.A lumbar puncture is valuable in case of otogenic meningitis for

the following except:

a) bacteriological diagnosis of the causative organism

b) drainage of the infected CSF
c) relieve the symptoms of increased intracranial tension
d) injection of a dye in the CSF space to help in radiological diagnosis of the
condition

22.The following is true about the corda tympani Except:

a) it crosses through the middle ear cavity

b) it carries taste sensation from the palate
c) it’s a branch from the mastoid portion of facial nerve
d) it joins the lingual nerve

23.The following are possible complications of myringotomy Except:

a) dislocation of incudo-stapedial joint

b) facial nerve injury
c) injury of incudo-malleolar joint
d) injury of jugular bulb

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24.Delayed language development is caused by the following Except:

a) sensorineural deafness
b) brain damage
c) child autism
d) visual disturbance

25.The value of myringotomy in acute suppurative otitis media is:

a) drain the middle ear

b) avoid complications
c) promote better healing of the drum membrane
d) all of the above
e) none of the above

26.Type C tympanogram is an indication of:

a) stapes fixation
b) Eustachian tube dysfunction
c) fluid in the middle ear
d) auditory ossicle disruption

27.Of the following the most important in the management of Bell’s

palsy is:

a) care of the eye

b) corticosteroids
c) facial nerve decompression
d) psychotherapy

28.The following antibiotics may be used in acute suppurative otitis

media Except:

a) aminoglycosides
b) penicillin
c) cephalosporin
d) quinolones

29.During the sport of diving otitic barotrauma occurs during:

a) two hours after diving is over

b) after diving is over immediately

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c) ascent
d) descent

30.The expected otoscopic finding in case of acute suppurative otitis

media with high fever and throbbing earache is a:

a) retracted tympanic membrane

b) congested tympanic membrane
c) bulging tympanic membrane
d) normal tympanic membrane

31.In case of lower motor neuron paralysis following ear surgery

with intact taste sensation of the anterior two thirds of the
tongues this indicates that the level of the trauma is at:

a) the internal auditory canal

b) the tympanic potion of the facial nerve
c) the stapes
d) the stylomastoid foramen

32.Neuropraxia of the facial nerve means:

a) physiological block of neural transmission

b) degeneration of the axons
c) loss of nerve continuity
d) de-vascularization of the nerve

33.A 35 years old man has right offensive otorrhea, otoscopically

there is marginal perforation with a pulsating discharge, the
most probable pathology is:

a) Acute suppurative otitis media

b) cholesteatoma with labyrinthine fistula
c) cholesteatoma with an intracranial complication
d) chronic tubotympanic otitis media

34.The following is true about suppurative labyrinthitis Except:

a) it may be a complication of otitis media or meningitis

b) it symptomatizes by vertigo and sensorineural hearing loss
c) It may be viral in nature
d) it treated by antibiotics that cross the blood brain barrier
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35.The nerve supply of tympanic membrane is:

a) glossopharyngeal nerve
b) trigeminal nerve
c) vagus nerve
d) all of the above
e) none of the above

36.The following tests are for hearing except:

a) Rinne tuning fork test

b) pure tune audiometry
c) electronystagmography
d) speech discrimination test

37.Adult male patient suffering from ear pain that increases on

mastication:

a) acute otitis media

b) acute otitis externa
c) eczematous external otitis
d) soft wax in the external canal

38.The pathology behind Bell’s palsy is:

a) a cut in the facial nerve

b) a tumor in the facial nerve
c) edema in the facial nerve
d) hemorrhage in the facial nerve

39.Irregular attacks of fever and rigors with marked anemia in a

chronic suppurativeotitis media with cholesteatoma is suggestive
of:

a) suppurative meningitis
b) temporal lobe abscess
c) lateral sinus thrombophlebitis
d) subdural empyema

40.Left sided body weakness and incoordination of movement in a

patient withbilateral chronic suppurative otitis media with
cholesteatoma is:
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a) right temporal lobe abscess

b) right cerebellar abscess
c) left temporal lobe abscess
d) left cerebellar abscess

41.The perforation in tubotympanic otitis is commonly central

kidney shapedbecause:

a) blood supply is from the periphery and along the handle of malleus
b) the tympanic membrane is normally kidney shaped
c) the handle of malleus indents the perforation in the center of tympanic
membrane
d) the pars tensa is kidney shaped and located inferiorly

42.A watery fluid that drains from the ear and increase by straining
is:

a) otitis media
b) serous external otitis
c) post-traumatic CSF otorrhea
d) bleeding from glomus jugular tumor

43.lateralized Weber tuning fork to one side may occur in:

a) persons with normal hearing

b) acoustic neuroma
c) bilateral impacted wax
d) presbyacusis

44.Unilateral sensory neural hearing loss and tinnitus is suspicious

of:

a) otitis media with effusion

b) cholesteatoma
c) acoustic neuroma
d) otosclerosis

45.The corda tympani receive taste sensation from:

a) posterior two thirds of the tongue

b) anterior one third of the tongue

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c) anterior two thirds of the tongue

d) posterior one third of the tongue

46.The tympanic membrane is:

a) angled at 35 degrees with the floor of the external auditory canal

b) made up of two parts (pars flaccida and pars tensa)
c) both of the above
d) none of the above

47.Hematoma Auris may be complicated by:

a) facial nerve paralysis

b) bleeding from the ear
c) perichondritis
d) acute mastoiditis

48.To examine the tympanic membrane the auricle is pulled:

a) downwards, backwards and outwards

b) upwards, forwards and outwards
c) upwards, backwards and outwards
d) downwards, forwards and outwards

49.vVertigo during ear wash is due to:

a) too hot water

b) rupture of the tympanic membrane
c) vagal stimulation
d) associated otitis media

50.The management of a diabetic necrotizing otitis externa depends

on:

a) local gentle debridement of any necrotic tissue in the external ear

b) strict control of diabetes
c) antibiotics of large doses
d) all of the above
e) none of the above

51.The treatment of otomycosis is best carried out in the following

order:
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a) antifungal drops, alcohol salicylic acid drops, cleaning of the ear, drying of the
ear
b) cleaning of the ear, drying of the ear, alcohol salicylic acid drops, antifungal
drops
c) drying of the ear, cleaning the ear, antifungal drops, alcohol salicylic acid
drops
d) antifungal drops, cleaning of the ear, alcohol salicylic acid drops, drying the
ear

52.The earliest diagnostic otoscopic finding in pediatric acute otitis

media is:

a) bulging tympanic membrane

b) loss of luster of the tympanic membrane
c) throbbing pain
d) retracted tympanic membrane

53.The following are diagnostic for mastoiditis except:

a) sagging of the postero-superior external auditory canal wall

b) continuous discharge
c) obliteration of the retro auricular sulcus
d) tender tipoff mastoid

54.Gradengo’s triad of Petrositis is:

a) a serous otorrhea, hemi facial spasm, divergent squint

b) convergent paralytic squint, orbital pain, purulent otorrhea
c) bilateral convergent squint, face pain, purulent otorrhea
d) medial convergent paralytic squint, face edema, continuous purulent otorrhea

55.An aural polyp with facial paralysis, sensorineural hearing loss,

hoarseness ofvoice, some dysphagia and dysarthria is suspicious:

a) cholesteatoma
b) acute otitis media
c) Glomus jugular tumor
d) acoustic neuroma

56.The patient with otosclerosis may present with the following

symptoms except:

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a) sensorineural hearing loss

b) conductive hearing loss
c) vertigo
d) earache

57.A mother brings her 2-year-old child to the emergency room as

he placed asmall green bean in his right ear and you found it
deep in the bony externalauditory canal, what is the best way to
remove it?

a) removal by ear wash using warm water (37 C) in the outpatient clinic
b) removal under general anesthesia through the external canal by crocodile
c) removal using crocodile forceps in the out-clinic patient
d) removal under general anesthesia by ear wash using warm (36) water

58.The first presentation of congenital cholesteatoma usually is:

a) persistent unilateral otitis media with effusion attic

b) very offensive scanty discharge with a small perforation
c) profuse offensive discharge with large attic perforation
d) intact tympanic membrane with reddish mass behind it

59.The diagnostic sign of acute mastoiditis is:

a) hyperemic tympanic membrane

b) conductive hearing loss
c) sagging of the postero-superior canal
d) presence of aural polyp

60.All are branches of facial nerve except:

a) nerve to stapedius muscle

b) chorda tympani
c) deep petrosal nerve
d) nerve to posterior belly of digastric

61.Itching in the external auditory canal can be caused by all of the

followingexcept:

a) eczematous otitis externa

b) Otomycosis

LYM PH N O T E S
25| EAR

c) ear wax
d) tympanosclerosis

62.All of the following can lead to facial paralysis except:

a) herpes zoster oticus

b) cholesteatoma
c) diffuse external otitis
d) necrotizing otitis externa

63.Persistent discharge after rupture of the tympanic membrane in

case of acuteotitis media may be due to:

a) insufficient drainage of pus

b) accompanying mastoiditis
c) inadequate treatment
d) all of the above
e) none of the above

64.The lateral semicircular canal detects:

a) upwards body movement

b) downwards body movement
c) vertical angular movement
d) horizontal angular movement

65.The caloric vestibular test can evaluate the function of:

a) the lateral semicircular canal

b) the superior semicircular canal
c) the posterior semicircular canal
d) all of the above
e) none of the above
66. Not supplied by facial nerve:
a) Stapedius muscle
b) Buccinator muscle
c) Levatorpalpebraesuperioris muscle
d) Posterior belly of diagastric
67.All the following is correct about the treatment of otomycosis
except:

LYM PH N O T E S
 EAR |26

a) Removal of fungal mass by suction

b) Bed rest
c) Removal of fungal mass by forceps
d) Topical antifungal drugs as nystatin,clotrimazole& gentian violet

68.An approach to the ME & mastoid:

a) End aural
b) Retro labyrinthine
c) Middle cranial fossa
d) Suboccipital

69. The first line of ttt in a child who develops LMN facial paralysis
after AOM is:

a) Antibiotics & corticosteroids

b) Decompresssion of facial nerve
c) Exploration of facial nerve
d) Myringotomy

LYM PH N O T E S
27| NOSE

NOSE

MCQ:
1. The ostium of maxillary sinus opens into:
a) Floor of the sinus
b) Roof of the sinus
c) Medial wall of the sinus
d) Between the medial wall & the floor of the orbit

2. During inspiration, the main current of airflow in a normal

nasal cavity is through:
a) Middle part of the cavity in middle meatus in a parabolic curve
b) Lower part of the cavity in the inferior meatus in a parabolic curve
c) Superior part of the cavity in the superior meatus
d) Through olfactory area

3. Which of the following is the most important surgical

landmark during nasal surgery:
a) Inferior turbinate
b) Middle turbinate
c) Superior turbinate
d) Hiatus semilunaris

4. The most diagnostic investigation in choanal atresia is:

a) X-ray
b) CT coronal view
c) CT axial view
d) MRI

5. Surgical emphysema that may happen in fracture nose is

increased by:
a) Blowing of the nose
b) Nasal drops
c) Coughing

LYM PH N O T E S
 NOSE |28

d) Straining

6. Anterior nasal packing after reduction of nasal fracture is to:

a) Stop epistaxis
b) Internal support of nasal bone
c) Prevent nasal infection
d) reduce the pain

7. Foreign body in the nose should be removed urgently to aboid:

a) Infection as rhinitis & sinusitis
b) Rhinolith
c) FB inhalation
d) Persistent nasal obstruction

8. To identify the source of leakage of CSF rhinorrhoea intra-

operatively, we use:
a) IV Flourescine
b) Intrathecal Flourescine
c) Intranasal Flourescine
d) Intrathecal metrizamide

9. Apple jelly nodule of the nose is caused by:

a) Rhinoscleroma
b) Syphilis
c) Lupus
d) Leprosy

10. Allergic fungal sinusitis is characterized by the following

except:
a) Caused by Asperigellus
b) Causes nasal polyps which is more commonly unilateral
c) Seen as heterogenous opacity with calcification & bone expansion in CT
d) Fatal & treated with Amphotericin B

11. Scleroma can affect the following sites except:

a) Larynx
b) Nose

LYM PH N O T E S
29| NOSE

c) Bronchi
d) Lacrimal system

12. Deviated nasal septum may cause the following except:

a) Nasal obstruction
b) Epistaxis
c) Anosmia
d) Headache

13. Septal abscess may cause the following except:

a) perforation of the bony septum
b) Cavernous sinus thrombosis
c) Supratip depression
d) Bilateral nasal obstruction

14. The commonest sinus to be inflamed is:

a) Maxillary
b) Anterior ethmoid
c) Frontal
d) Sphenoid

15. In control of epistaxis, posterior nasal pack is used in the

following except:
a) Post-adenoidectomy bleeding
b) Bleeding from the sphenopalatine artery
c) Bleeding from Little's area
d) Bleeding after excision of an angiofibroma

16. Who of the following is less liable to complain of migraine:

a) Doctor
b) Obssesive person
c) Intellectual worker
d) heavy manual worker

17. Headache in sinusitis is due to:

a) Tension headache
b) Vacuum headache

LYM PH N O T E S
 NOSE |30

c) Toxic headache
d) All the above

18. The function of muciciliary system of the nose is:

a) Warming of air
b) Lubrication
c) Assist in olfaction
d) Continous clearance of the mucous blanket

19.The most common malignant tumor of the nasal cavity?

a) Inverted papilloma (transitional cell papilloma)

b) Squamous cell carcinoma

c) Adenocarcinoma

d) Osteosarcoma

20.Cacosmia may be due to:

a) Fracture base of skull

b) Oroantral fistula

c) Brain tumor

d) Rhinoscleroma

21.Congenital posterior choanal atresia is usually due to:

a) Persistence of bucco pharyngeal membrane

b) Persistence of bucco nasal membrane
c) Non recanalization of oronasal membrane
d) Non recanalization of pharyngeal pouch

22.The following tetrad of symptoms indicates the diagnosis of

acute and chronic sinusitis?

a) Nasal discharge – nasal itching – sneezing – headache

b) Nasal obstruction – nasal itching – sneezing – high fever
c) Nasal obstruction – nasal discharge – smell disorders – facial pain
d) Nasal obstruction – runny nose – eye symptoms – mild fever

LYM PH N O T E S
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23.The olfactory mucosa is located at the:

a) Lower part of nasal septum

b) Roof of the nose
c) Inferior meatus
d) Middle meatus

24.Nasal polypi can be a result of one of the following diseases

except:

a) Allergic rhinitis
b) Vasomotor rhinitis
c) Fungal sinusitis
d) Inverting papilloma

25.Unilateral sanguinous nasal discharge can be found in all of

the following except:

a) Inverting papilloma
b) FB lodgment
c) Ethamoidal mucocele
d) Nasal malignant tumor

26.The commonest cause of recurrent acute sinusitis affecting

the frontal maxillary & ethamoids on the same side is:

a) Dental infection
b) Ostio meatal complex abnormalities as concha ( bullose ) & concha
paradoxica
c) Low general immunity as AIDs & diabetes mellitus
d) Malignancy

27.Fracture nasal bone accompanied by orbital emphysema is

indication of:

a) Cribriform plate fracture

b) Ethmoid paranasal sinus fracture
c) Septal fracture
d) Scleral injury

28.A 50-year-old male with a right offensive sanguineous nasal

discharge who developed an upper neck firm nontender
LYM PH N O T E S
 NOSE |32

swelling has:

a) Right acute maxillary sinusitis

b) Right chronic maxillary sinusitis
c) Right ethmoid carcinoma
d) Right nasal FB

29.Following a common cold with excessive blowing of the nose a

red tender hot swelling appeared in the right nasal vestibule.
The diagnosis is:

a) Vestibulitis
b) Furuncle
c) Sinusitis
d) Squamous papilloma

30.A rhinolith is caused by:

a) Hypercalcemia
b) Nasal FB
c) Acute rhinitis
d) Malignancy of the nose

31.A 30 year old male patient with bilateral nasal obstruction ,

broaded nose , mild epistaxis and mild laryngeal stridor is a
case of:

a) Allergic nasal polypi

b) Nasal malignancy
c) Scleroma
d) Common cold

32.An x-ray chest showing a (non a erated) right lung with narrow
inter costal spaces elevated cupula of the diaphragm & shift of
mediastinum to the right is:

a) Right compression collapse due to FB inhalation by the left main bronchus

b) Right absorption collapse due to FB inhalation by the right main bronchus
c) Both of the above
d) None of the above

33.The first measure to be carried in case of severe epistaxis.

LYM PH N O T E S
33| NOSE

a) Anterior nasal pack

b) Posterior nasal pack
c) Arterial ligation
d) Antishock measures

34.Unilateral offensive discharge in five-year-old commonly

caused by

a) neglected foreign body

b) scleroma
c) atrophic rhinitis
d) malignancy

35.All of the following will lead to nasal regurgitation during

swallowing except

a) complete cleft palate

b) palate paralysis
c) during the immediate postoperative period after tonsillectomy and
adenoidectomy
d) spasm of the pharyngeusms

36.A patient with a left nasal furuncle that develops fever rigors
and conjunctival edema has the following complication

a) lateral sinus thrombcphlebitis

b) cavernous sinus thrombosis
c) meningitis
d) facial cellulitis

37.The following paranasal sinuses opening in the middle

meatus except

a) the frontal sinus

b) the sphenoid sinus
c) the maxillary sinus
d) the anterior ethmoid air cells

38.The histopathological picture of rhinoscleroma includes all

the following except

a) mikulicz cells and russel bodies

LYM PH N O T E S
 NOSE |34

b) fibroblasts
c) neutrophils
d) endorteritisoblitrans

39.All are lines of management of severe epistaxis except

a) interventional radiographic embolization of bleeding vessels

b) chemical (silver nitrate) cauterization of the bleeding vessels
c) combined anterior and posterior nasal pack
d) nasal endoscopic control of bleeding vessel by vascular clip

40.Perennial nasal allergy means

a) allergy caused by pollens

b) allergy that is resistant to treatment
c) allergy that present all year round
d) allergy that affect more than one organ

41.A standard lateral x-ray is required after a fracture of a nose

a) of medico, legal importance

b) for assessment of the degree of the nasal deviation
c) to determine the CSF rhinorrhea
d) to determine the fracture line for surgical purpose

42.Unilateral sanguineous offensive discharge enlarged tender

upper deep cervical lymph node and loosing of the upper
premolar teeth on the same side require

a) examination of the nose and paranasal sinuses by the nasal sinuscope

b) ct scan paranasal sinus & neck
c) biopsy of abnormal tissue in the nasal cavity or paranasal sinuses
d) all of the above
e) none of the above

43.Eye examination in case of cavernous sinus thrombosis show

all the following except

a) edema of upper eyelid

b) external and internalophthalomplegia
c) downward and lateral proptosis

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35| NOSE

d) chemosis of the conjunctiva

44.Nasal allergy is type

a) type 1 hypersensitivity
b) type2 hypersensitivity
c) type 3 hypersensitivity
d) type4 hypersensitivity

45.To prevent the recurrence of allergic nasal polypi the

following treatment should be followed

a) nasal polypectomy followed by medical ttt

b) functional endoscopic sinus surgery followed by medical ttt
c) medical ttt, functional endoscopic sinus surgery then continuous of ttt
d) nasal polypectomy only

46.The early diagnosis of the hypovolemic shock due to epistaxis

depend on

a) hypotension
b) weak rapid pulse
c) cold sweaty hands and feet
d) irritable patient

47.Antrochonal polyp is characterized by

a) arise from the maxillary sinus widens the middle meatus and extend into the
nasopharynx
b) arises from the maxillary ethmoid sinuses and extend to the nasopharynx
c) arises from the maxillary sinuses and widens the middle meatus and fill the
ethmoid sinuses
d) arises from the ethmoid sinus and extend to fill the maxillary sinus

48.Proptosis in a17 years old with acute ethmoiditis is an

indication of a :

a) mucocele
b) subperiosteal orbital abscess
c) frontal lobe abscess
d) frontal sinusitis

LYM PH N O T E S
 NOSE |36

49.Cacosima means

a) altered smell sensation

b) decreased smell sensation
c) a true sense of an offensive odor
d) a false sense of an offensive odor

50.A surgery in a case of bilateral congenital choanal atresia

suffering from airway obstruction is carried out

a) immedatly after establishing diagnosis

b) four weeks after birth
c) all of the above
d) none of the above

51.A nasal polyp is

a) a sessile mass
b) a pedunculated mass
c) all of the above
d) none of the above

52.Bilateral nasal obstruction cause all of the following except

a) dysphagia
b) mouth breathing
c) sleep apnea
d) rhinolalia clausa

53.Unusual bleeding after removal of an aural polyp suggests:

a) Tuberculosis.
b) Cholesteatoma.
c) Carcinoma.
d) Exostosis.

54.The most effective medical treatment of nasal polyp is:

a) Topical decongestant nasal drops.

b) Antihistaminics.
c) Steroids.
d) Anti-inflammatory.

LYM PH N O T E S
37| NOSE

55.The artery responsible for bleeding from Little's area maybe

all of the following, except:

a) Anterior ethmoid.
b) Posterior ethmoid.
c) Sphenopalatine.
d) Greater palatine.

56.Common cold is most often caused by:

a) Influenza virus.
b) Rhinovirus.
c) Adenovirus.
d) Respiratory syncytial virus.

57.Pott's puffy tumor is related to:

a) Infected cell in middle turbinate.

b) Tuberculosis sinusitis.
c) Pyogenic infection of frontal sinus.
d) Cavernous sinus thrombosis.

58.Paranasal sinus osteoma commonly involves:

a) Frontal sinus.
b) Maxillary sinus.
c) Ethmoid sinus.
d) Sphenoid sinus.

59.The root of the nasal cavity is formed of:

a) The fovea ethmoidalis.

b) The superior turbinate.
c) The lamina papyracea.
d) The cribriform plate.

60.Inverted papilloma presents with:

a) Nasal itching.
b) Bilateral watery nasal discharge.

LYM PH N O T E S
 NOSE |38

c) Unilateral nasal mass.

d) Post nasal drip.

61.The most common general cause of epistaxis is:

a) Hypertension.
b) Idiopathic.
c) Septal deviation.
d) Mediastinal tumor.
62. A teenager male with recurrent severe left epistaxis , pallor &
conductive deafness of the left ear , you should suspect:
a) Antro-choanal polyp
b) Inverted papilloma
c) Nasopharyngeal angiofibroma
d) Septal hemangioma
63. Trotter’s triad consists of all the following except:
a) Unilateral CHL
b) Ipsilateral earache & facial pain
c) Ipsilateral proptosis
d) Ipsilateral immobilization of soft palate
64. A 4 years old child presented by his mother complaining of
lack of attention, mouth breathing & hyponasality:
a) Secretory otitis media is suspected
b) Adenoid is suspected
c) Both 1 & 2
d) None of the above
65. The most common cause of oro antral fistula is:
a) Acute sinusitis
b) Car accident
c) Dental extraction of upper second premolar tooth
d) Radical antrum operation
66. Unilateral clear watery nasal discharge reducing fehling’s
solution is suggestive of:
a) CSF Rhinorrhea
b) Allergic rhinitis
c) Viral rhinitis
d) Nasal diphtheria
67. The most common complication associated with acute
LYM PH N O T E S
39| NOSE

ethmoid sinusitis in children is:

a) Orbital cellulitis
b) Osteomyelitis frontal bone
c) Subdural abscess
d) Cavernous sinus thrombosis
68. Bilateral choanal atresia in neonates is best treated by:
a) Transnasal puncture
b) Inserting an oral airway
c) Transpalatal repair
d) Transnasal by endoscope
69. All of the following is true about cerebrospinal fluid
rhinorrhea except:
a) Clear fluid drips from the nose
b) Initial treatment is to pack the nose
c) Fluid contains glucose
d) Fluid has a salty taste

70.A 22-year-old female banker came to the otolaryngology clinic

complaining of chronic nasal obstruction. Her condition
started since she was 10 years old, but it was intermittent
obstruction that was aggravated by attacks of influenza. Now
she is a mouth breather with severe night snoring which
annoys her husband. She used to put nasal decongestant
drops in her nose. Since that time, she has frequent
mucopurulent nasal discharge with post nasal discharge. 1
year ago, she noticed sense of hearing loss in her left ear &
sometimes ear bubbling & obstruction. She has recurrent
attacks of acute pharyngitis & chronic refractory cough. There
was no history of medical illness or previous operation. When
she sought medical advice, medical treatment was prescribed
for her & some investigations for her nasal & ear condition.

What do you think about the possible diagnosis?

a) Nasopharyngeal angiofibroma.
b) Nasopharyngeal tonsil.
c) Deviated nasal septum.
d) None of the above.
Why she has snoring?
a) Because she has complete nasal obstruction.
LYM PH N O T E S
 NOSE |40

b) Because she put nasal decongestant drops.

c) Because she has partial airway obstruction.
d) Because it's her costume.
How can you explain the bubbling sensation & obstruction of her left ear?
a) It's due to impacted wax.
b) It might follow recurrent acute otitis media.
c) She is malingering.
d) The pharyngotympanic tube might be partially obstructed.
What is the possible cause of recurrent pharyngitis in this case?
a) Drinking cold drinks.
b) Gastric reflux.
c) Post nasal drip.
d) Dental infections.
What could be the possible medical treatment that she has received?
a) Anti-reflux drugs & diet modification.
b) Antibiotics & mucolytics.
c) Anti-tuberculous drugs.
d) Antiviral therapy.
What is the investigation of choice for her nasal condition?
a) Nasal biopsy.
b) X-ray sinus view.
c) Nasal challenge test.
d) CT paranasal sinus.
What is the investigation of choice for her ear condition?
a) ABR.
b) PTA & tympanogram.
c) Electrocochleography.
d) Rinne test.
If angiofibroma is suspected, what is the investigation of choice?
a) Biopsy.
b) CT paranasal sinus.
c) Angiography.
d) None of the above.
If it is angiofibroma, what is the best management?
a) Just follow up every 6 months.
b) Deep radiotherapy.
LYM PH N O T E S
41| NOSE

c) Embolization & surgical removal.

d) Medical treatment until it shrinks spontaneously.
If it is deviated septum, what is the treatment?
a) Refracture & fixation.
b) Submucous resection.
c) Medications & decongestants.
d) Partial maxilloectomy.

71.A 43-year-old female presented to the outpatient clinic with

right hearing loss & pulsatile tinnitus. On examination, she
had an intact right blue tympanic membrane. She was given
medical treatment for secretory otitis media, but there was no
improvement. 5 months later, she returned with the same
symptoms, plus hoarseness & dysphagia.

This condition –most probably- is:

a) Congenital.
b) Inflammatory.
c) Neoplastic.
d) Miscellaneous.
Other symptoms maybe all of the following, except:
a) Dysarthria.
b) Ophthalmoplegia.
c) Drooling of saliva.
d) Projectile vomiting.
Examination may show all of the following, except:
a) Shoulder drop.
b) Deviation of angle of the mouth to the right side.
c) Deviation of the tongue to the right side.
d) Right Rinne negative.
Investigations for such case are all of the following, except:
a) CT.
b) MRI.
c) Angiography.
d) Biopsy.
The treatment of such case is:
a) Medical.

LYM PH N O T E S
 NOSE |42

b) Surgical.
c) Radiotherapy.
d) Embolization.

72. Inverted papilloma of the nose

a) Is a locally malignant tumor
b) Arises from the nasal septum in most cases
c) Is best diagnosed by carotid angiography
d) Should be treated by wide surgical resection to avoid recurrence
e) Surgery should be followed by radiation therapy to avoid recurrence

73. A 3 year old boy was brought to you by his parents for Rt sided
offensive nasal discharge for 2 weeks duration. They tried
several courses of antibiotics & anti-allergic medications with
no success. The most propable diagnosis is:

a) Unilateral choanal atresia

b) Neglected FB
c) Deviated nasal septum
d) Angiofibroma
e) Rhinoscleroma

74.A 20 year old male presented to the ER 30 min. after sustaining

a blow to his face. Bleeding was noted from the nose. His nose
was found to be deviated to the Lt side. There was no obvious
facial edema or eccymosis.X-ray showed fractured nasal bone.
Reduction of this fracture should be performed:

a) Immediately
b) After 24 H
c) After 48 h
d) After 1 week
e) After 3 months

75. A 10 year old girl presented to the ER with swollen Lt eyelid.

Her condition started 1 week earlier by fever, nasal discharge
& facial pain. This progressed to pain around the Lt eye &
LYM PH N O T E S
43| NOSE

edema of both eye lids. The most informative investigation in

her case is:

a) Culture & sensitivity of her nasal discharge

b) Measurement of serum IgE levels
c) Complete blood picture
d) Ocular ultrasonagraphy
e) CT scan of the nose & paranasal sinuses

LYM PH N O T E S
 THROAT |44

THROAT

MCQS
1. The vallecula is:

a)Part of tongue base

b)Lower pole of the palatine tonsil
c) Part of pyriform fossa
d) Part of soft palate above the uvula

2. The specific LNs of the palatine tonsil are:

a)Submandibular
b)Jugulodiagastric
c)Occipital
d)Supraclavicular

3. Enlarged adenoid may cause the following except:

a)Deafness
b)Epistaxis
c)Sleep apnea
d)Nocturnal enuresis

4. The routinely used investigation for diagnosis of adenoid

hypertrophy is:

a) CT on nasopharynx
b)MRI on nasopharynx
c)X-ray on nasopharynx with contrast
d)Plain X-ray on nasopharynx

5. Complications of acute tonsillitis may include the following

except:

a)Rheumatic fever
b)Glomerulonephritis
c)Ludwig's angina
d) Parapharyngeal abscess

LYM PH N O T E S
45| THROAT

6. The commonest cause of death in diphtheria is:

a)HF due to toxic myocarditis

b)RF due to respiratory paralysis
c)Airway obstruction by the pseudomembrane
d)Bronchopneumonia by inhaled pseudomembranous

7. The pulse in diphtheria

a)Weak rapid pulse

b)Full bounding pulse
c)Synchronous with the temperature
d)Non-synchronous with the temperature

8. TTT of infectious mononucleosis includes the following except:

a)Complete bed rest

b)Ampicillin antibiotic
c)Analgesic antipyretic as pracaetamol
d)Antiseptic moth gargle

9. Holman-miller sign which is bowing of the posterior wall of

maxillary sinus on radiography is seen in:

a)nasopharyngeal carcinoma
b)Nasopharyngealangiofibroma
c)Antrochoanal polyp
d)Inverted papilloma

10.The highest incidence of lymphatic spread is present in the

following tumor:

a)Nasopharyngeal carcinoma
b)Oropharyngeal carcinoma
c)Hypopharyngeal carcinoma
d)Laryngeal carcinoma

11.The most important item in ttt of post-tosillectomy 2ry

hemorrhage is:

a)Sedative
b)Antibiotic
c)Ligation
d)Diathermy

LYM PH N O T E S
 THROAT |46

12.In operation of rheumatic patient for tonsillectomy, Aspirin

should be discontinued for:

a)3 days
b)5 days
c)7 days
d)10 days

13.A 5-year-old child with adenoid & tonsillar hypertrophy causing

sleep apnea, the ttt is:

a)Adenotonsillectomy in one sitting starting by adenoidectomy

b) Adenotonsillectomy in one sitting starting by tonsillectomy
c) adenoidectomy in one sitting followed by tonsillectomy in another sitting after
3
months
d) tonsillectomy in one sitting followed by adenoidectomy in another sitting after
3
months

14.During tonsillectomy, the neck should be:

a)Extended
b)Flexed
c)Semi flexed
d)Tilted to one side

15.During adenoidectomy, the neck should be flexed to avoid:

a)Injury of the ET
b) Injury of thepevertebral muscles
c) Injury of the palate
d)Dental injury

16.The dysphagia in Plummer-Vinson syndrome is to:

a)Solids then to fluids

b)Fluids then to solids
c)Fluid & solids at the same time
d)Fluids & never progress to solids

17.The dysphagia in cardiac achalasia is to:

a)Solids then to fluids

LYM PH N O T E S
47| THROAT

b)Fluids then to solids

c) Fluid & solids at the same time
d)Fluids only

18.Dysphagia may be due to all the following except:

a)Aneurysm of the aorta

b)Enlarged Lt atrium
c) Mediastinal tumor
d)Enlarged Rt lobe of the liver

19.The commonest site of swallowed coin is:

a)Pyriform fossa
b)Above the cricopharyngeus
c)Below the cricopharyngeus
d)At the cardia

20.Unilateral nasal regurgitation of food & fluid is due to:

a)Paralysis of the palate

b) Cleft palate
c)Oroantral fistula
d)Midline hard apalte perforation by syphilis

21.the commonest site for palatal fistula after cleft palate repair:

a)The hard palate

b) The soft palate
c)The junction between hard & soft palate
d)The junction between the primary & secondary palate

22.The most important function of the larynx is:

a) Phonation
b)Fixation of the chest
c)Protection of lungs
d)Resonance of voice

23.All are elevators of larynx except:

a)Diagastric
b)Thyrohyoid
c)Sternohyoid

LYM PH N O T E S
 THROAT |48

d)Stylohyoid

24.The crico-thyroid membrane is the external extension of:

a)Quadrangular ligament
b)Conus elasticus
c)Crico-tracheal ligament
d)Thyro-hyoid membrane

25.The ventricle of the larynx is part of:

a)Supraglottis
b)Glottis
c)Subglottic
d)Paraglottis

26.The space between the vocal folds &the vestibular folds is

called;

a)Paraglottic space
b)Pre-epiglottic space
c) Vestibule
d)Ventricle

27.All the following are correct about laryngomalacia except:

a)It is due to congenital weak flaccid larynx

b)Child looks healthy
c)It affects the vocal cords
d)Inspiratory stridor may start soon after birth

28.Voice abuse may cause the following except:

a)Laryngeal nodules
b)Laryngeal polyp
c)Hypertrophic laryngitis
d)leukoplakia

29.Scleroma is commonly affecting the following sites except:

a)Epiglottis
b)Subglottis
c)Nasopharynx
d)lacrimal sac

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30.The commonest presenting features of laryngoscleroma are:

a)VC paralysis & chocking

b)Stridor & hoarseness
c)Pain & night sweating
d) Metastatic LNs

31.A case of cancer larynx with involvement of anterior

commissure &Rt vocal cord, developed perichondritis of
thyroid cartilage.Which of the following statements is true for
management of this case:

a) He should be given radical radiotherapy as this can cure early tumors

b) He should be treated with combination of chemotherapy &radiotherapy
c)He should first receive radiotherapy & if residual tumor is present, he should
undergo
laryngectomy
d)He should first undergo laryngectomy & then post-operative radiotherapy

32.The commonest cause of unilateral VC paralysis;

a)Thyroidectomy
b)Bronchogenic carcinoma
c)Nasopharyngeal carcinoma
d)Idiopathic

33.A localized nodule of squamous cell carcinoma in the VC is best

treated by

a)Crysurgery
b)Surgical excision
c) Radiotherapy
d)Chemotherapy

34.Which of the following statements is not true for contact ulcer:

a)The commonest site is the junction of anterior 1/3 rd& middle 1/3 rd of VC &
GERD is the causative factor
b)Can be caused by intubation injury
c)The vocal process is the site & is caused / aggravated by acid reflux
d)Can by caused by adductor dysphonia

35.Respiratory dead space in adults is;

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a)50 ml
b)100ml
c)150 ml
d)250 ml

36.Dyspnea, crepitation & expectoration of large amount of frothy

stained sputum after tracheostomy is suspected of:

a)Pneumothorax
b)Acute pulmonary edema
c)Mediastinal emphysema
d)None of them

37.A tracheostomised patient, with portex tracheostomy tube, in

the ward, developed complete blockadge of the tube. Which of
the following is the best next step in the management?

a)Immediate removal of the tracheostomy tube

b)Suction of tube with sodium bicarbonate
c) Suction of the tube with saline
d)Jet ventilation

38.In emergency tracheostomy, the following structures are

damaged except:

a)Isthmus of the thyroid

b)Iferio thyroid vein
c)Inferior thyroid artery
d)Thyroideaima artery

39.A fire breaks out during laser VC surgery.Which of the following

measures should not be done:

a)Pouring sterile water

b)100% oxygen after discontinuing anaesthetic gases
c) TTT with steroids & antibiotics
d)Removal of burning endotracheal tube

40.this type of thyroid tumor may be multicentric:

a) Papillary
b)Follicular
c)Medullary

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d) Anaplastic

41. Sensory nerve supply above level of the vocal folds

a) Glossopharyngeal
b) Superior laryngeal
c) Recurrent laryngeal
d) Pharyngeal branch of vagus

42.Laryngeal crepitus is seen in:

a) Normal person
b) Fracture of thyroid cartilage
c) Post cricoid carcinoma
d) Prevertebral abscess

43. In child with epiglottis the first thing to do:

a) x-ray lateral view to establish the diagnosis

b) perform laryngoscopy
c) start antibiotic treatment
d) secure the airway by intubation

44.Hoarseness of voice is the earliest symptom of carcinoma of:

a) Glottis
b) Sub-glottis
c) Supra-glottis
d) All of the above

45.Regarding glottis laryngeal carcinoma:

a) Glottis tumors metastasize early from extensive cartilage

b) Hoarseness is the most common presenting feature
c) A fixed vocal cord is dicates a T2 tumor
d) Radiotherapy is contraindicated in the tumor

46.In Quinsy, tonsillectomy is done:

a) Immediately
b) Within week
c) After 3 weeks

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d) Not indicated as the condition is treated by incision & drainage

47. In congenital laryngeal web, the patient may present with:

a) Nasal obstruction
b) Stridor
c) Crying of unknown reason
d) Cough and expectoration

48.Chronic abuse of voice may result in:

a) Cancer larynx
b) Laryngoscleroma
c) Vocal cord nodule
d) Laryngeal papillomatosis

49.A fibroma is treated by:

a) Radiotherapy
b) Surgery
c) Chemotherapy
d) Embolization

50.Adenoid hypertrophy:

a) Is related to lower respiratory tract infection

b) May present with unilateral nasal obstruction
c) May present with deafness
d) May present with cervical LN enlargement

51.Angiofibroma:

a) Never occurs in females

b) The most common age of presentation is 25 years' old
c) May present with lymph node metastasis
d) Is treated by radiotherapy

52.Achalasia of the cardia:

a) Is defined as dilatation of lower 1/3 of the esophagus

b) May be due to Plummer Vinson syndrome
c) Dysphagia is more to solids

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d) May be treated surgically

53.Fistula is always congenital if it's due to:

a) Persistence of thyroglossal cyst

b) Remnant of 2nd branchial arch
c) Failure of fusion of the 6 tubercles of the1st and 2nd
d) Persistence of the Bucco-nasal membrane

54.All of the followings are true about deep neck space infection
EXCEPT:

a) it is considered as an emergency.
b) securing the airway is not important.
c)it usually has late presentation.
d) usually occurs in immune deficient patients.

55. The usual cause of secondary hemorrhage after tonsillectomy

is:

a) slipped ligature.
b)infection of the surgical field.
c) incomplete removal of the tonsil.
d) patient has bleeding tendency.

56.Peri-tonsillar abscess (Quinsy) is characterized by:

a) Deviation of uvula to the same side, dry mouth & low grade fever.
b)Deviation of uvula to the opposite side, trismus & drooling of saliva.
c) Bilateral throat pain, edema over soft palate & dry mouth.
d)Bilateral throbbing throat pain, trismus & drooling of saliva.

57.A 40-year-old female patient presented with rapidly progressive

dysphagia with change of voice, nasal regurgitation of food,
vertigo & right sided body weakness.

What is the most important investigation required:

a) X-ray Barium swallow.

b) MRI of the brain.
c) CT scan of the neck.
d) Flexible esophagoscopy.

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58.Odynophagia is defined as:

a) difficulty in swallowing of fluids.

b)pain during swallowing of solids.
c) nasal regurgitation during swallowing.
d) choking during swallowing of semisolids.

59.Foreign body inhalation should be suspected in:

a) Positive history of choking & cyanosis.

b) Resistant to treatment chest infection.
c) Unilateral diminished air entry.
d) All of the above.
e) None of the above.

60.The lines of treatment in a child with croup are:

a) Antibiotics,mucolytics& anti-histamines.
b) Rest of voice, tracheo-bronchoscopy.
c) Endotracheal intubation & mechanical ventilation.
d) Steroids, steam inhalation & endotracheal intubation.

61.the silent areas of head & neck tumors are all of the following
except:

a) Pyriform fossa.
b) Glottic larynx.
c) Nasopharyngeal fossa of Rosen Muller.
d) Palatine tonsil.

62.In recurrent respiratory papillomatosis, all of the following are

true Except:

a) Occurs commonly in children.

b) Has vital etiology.
c) Affects only the glottic area.
d) Best treated by laser surgery.

63.Polysomnography is:

a) An investigation to detect the type, severity & effects of sleep apnea.

b) A technique by which sleep apnea is treated conservatively.

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c) A method of treatment for sleep apnea to avoid complications.

d) A training protocol for sleep apnea patients to improve their breathing during
sleep.

64.The best way to detect the possibility of bleeding tendency prior

to tonsillectomy is:

a) Accurate history.
b) laboratory investigation.
c) Throat swabs.
d) ESR.

65.The following are causes of respiratory stridor Except:

a) acute epiglottitis.
b) Glottic carcinoma.
c) bronchial asthma.
d) recurrent laryngeal papillomas.

66.The most dangerous microorganism causing acute follicular

tonsillitis is:

a) Staphylococcus aureus.
b) Alpha hemolytic Streptococcus.
c) Klebsiella.
d) Beta hemolytic streptoccus.

67. Obstructive emphysema in a lung or one of its lobes due to

foreign body inhalation occurs because of:

a) Air lack phenomenon.

b) Shunting of blood.
c) Check valve effect.
d) All of the above.
e) None of the above.

68. An intermittent, sometimes continuous feeling of foreign body

stuck in the throat that can be dislodged despite swallowing
and occasional sore throat in a patient with neurosis is:

a) velopharyngeal valve insufficiency.

b) Globus hystericus.

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c) Chronic hyperplastic pharyngitis.

d) Pharyngeal bursitis.

69. Adenoidectomy is avoided in a patient with cleft palate for fear

of:

a) Velopharyngeal valve incompetence.

b) Eustacian tube injury.
c) Tempromandibular joint dislocation.
d) Loosening of teeth.

70. Trismus in case of quinsy is due to:

a) Tempromandibular joint involvement.

b) Limited palatal movements.
c) Spasm of the medial pterygoid muscle.
d) Cervical lymphadenitis.

71. Laryngeal stridor, fever 38.3 c, cough in a one – year old of ten
hours’ duration is due to:

a) Atrophic laryngitis.
b) Laryngeoscleroma.
c) Laryngeal diphtheria.
d) Acute laryngotracheobronchitis.

72.A middle-aged female with gradually progressive dysphagia,

koilonychia, chronic anemia with glazed tongue is suffering
from:

a) Plummer Vinson syndrome

b) hypopharyngeal carcinoma
c) esophageal carcinoma
d) achalasia

73.Trotter’s triad consists of all the following except:

a) unilateral conductive hearing loss

b) ipsilateral earache and facial pain
c) ipsilateral proptosis
d) ipsilateral immobilization of soft palate

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74.In diphtheria, the anti-toxic serum is given:

a) to neutralize the circulating exotoxin

b) to neutralize the fixed toxin
c) to kill the diphtheria bacilli
d) all of the above

75.Nasopharyngeal carcinoma can cause paralysis of following

nerves except:

a) vagus nerve
b) facial nerve
c) glossopharyngeal nerve
d) the abducent nerve

76.Polysomnography is a method of investigation of case with:

a) Sinusitis
b) Sleep apnea syndrome
c) Acute rhinitis
d) Nasal allergy

77.The commonest cause of obstructive sleep apnea in adults:

a) Allergic rhinitis
b) Allergic nasal polypi
c) Marked obesity
d) Elongated uvula

78.All of the following is correct about leukoplakia of larynx

except:

a) it’s caused by excessive smoking

b) it never turns malignant
c) it causes gradual hoarseness of voice
d) it is white in color

79. a 20-year-old man with fever and increasing sore throat with drippling
of saliva and trismus for only 2 days, on examination the right tonsil is
pushed medially and forwards, no response to antibiotics. Rapid relief
can be obtained by:

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a) Short course of radiotherapy

b) Assurance and rest
c) Anti-diphtheric serum
d) Incision and drainage

80.tonsillectomy is absolutely contraindicated in:

a) Chronic tonsillitis
b) Quinsy
c) Hemophilia
d) Below 5 years

81. A 3 years old boy complained of sudden acute respiratory distress, with
spasmodic cough, cyanosis, and acting accessory respiratory muscles.
Most probably due to:

a) Acute follicular tonsillitis

b) Foreign body inhalation
c) Adenoid hypertrophy
d) Vocal cord nodule

82.The commonest presentation of laryngoscleroma is:

a) Vocal cord paralysis

b) Stridor and hoarseness
c) Pain and night sweating
d) Metastatic lymph node

83.Quinsy is due to:

a) Blood disease
b) Pharyngoscleroma
c) Retropharyngeal suppuration
d) Peritonsillar suppuration

84.Achalasia of the cardia is characterized by the following except:

a) Dysphagia is more marked for solids than fluids

b) Dysphagia is more marked for fluids than solids
c) Treated by cardiotomy
d) Regurgitation of undigested food

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85.Stridor is a characteristic feature of the following diseases

except:

a) Laryngeal diphtheria
b) Angioneurotic edema
c) Adenoid hypertrophy
d) Bilateral abductor vocal cord paralysis

86.Surgical emphysema after tracheostomy is treated by:

a) Taking more stitches of the wound

b) Cold compresses
c) Widening of the wound by removal of some stitches
d) Antihistaminic intake

87.The most common laryngeal site of involvement in

laryngoscleroma is:

a) True vocal cords

b) Epiglottis
c) Subglottis
d) Arytenoids

88.The most important function of larynx is:

a) Vocal production
b) Protection during swallowing
c) Cough production
d) Increasing subglottic pressure

89.The most common presenting sign or symptom of

nasopharyngeal cancer is:

a) nasal obstruction
b) nasal bleeding
c) neck mass
d) facial pain

90.All of the following about nasopharyngeal angiofibroma is true

EXCEPT:

a) Occurs exclusively in males

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b) Epistaxis and nasal obstruction are common

c) Radiotherapy is the treatment of choice
d) Arises from nasopalatine foramen

91.An apnea is defined as cessation of breathing for:

a)10 sec.
b) 12 sec.
c) 15 sec.
d) 18 sec.

92.An infant is noticed to have stridor and hoarse cry, all of the
following diagnosis are possible except:

a) Laryngeal web
b) Laryngeal paralysis
c) Congenital laryngeal cyst
d) Laryngomalacia

93.Plummer Vinson syndrome is characterized by all of the

following EXCEPT:

a) koilonychia
b) dysphagia
c) glossitis
d) hematemesis

94.In which of the following locations there is collection of pus in

quinsy:

a) Parapharyngeal space
b) Retropharyngeal space
c) Peritonsillar space
d) Within the tonsil

95.Quinsy means collection of pus in:

a) Parapharyngeal space
b) Retropharyngeal space
c) Peritonsillar space
d) Crypta magna

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96.Rhinolaliaaperta (hypernasality) is caused by the following

except:

a) Cleft palate
b) Rhinoscleroma
c) Palatal paralysis
d) Fistula of palate

97.Hot potato voice is caused by the following except:

a) Supraglottic carcinoma
b) Epiglottitis
c) Glottis carcinoma
d) Tonsillar hypertrophy

98.A 7-year-old boy presented to ER with stridor, he had

hoarseness of voice for a year. On examination, his temp. was
37oC, nasal and oral examination showed no evidence of
disease, laryngeal examination showed warty growths affecting
both vocal cords reducing the respiratory shrink, the most
likely diagnosis is:

a) juvenile onset recurrent respiratory papillomatosis

b) laryngeal nodule
c) laryngomalacia
d) chronic laryngitis secondary to GERD

99.laryngeal squamous cell carcinoma is characterized by the

following EXCEPT:

a) Smoking is a predisposing factor in carcinogenesis

b) It seldom arises from the subglottic area
c) Invasion of laryngeal cartilage is staged as T4 disease
d) The commonest site of nodal metastasis is the upper deep cervical lymph
nodes (level II)
e) It commonly sends distal metastasis to the lung, bone, brain, and liver.

100. A 6-year old presented to the ER in stridor, examination of the

larynx showed swollen epiglottis blocking the laryngeal inlet,
the most common organism in such a case is:

a) Beta hemolytic streptococci

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b) Penicillinase producing staphylococcus

c) Pseudomonas aeruginosa
d) Hemophilus influenza
e) Epstein Barr virus

101. The following benign lesions in the larynx can be

precancerous:

a) Leukoplakia
b) Reink’s edema
c) Laryngeal nodule
d) Laryngoscleroma
e) Juvenile onset recurrent respiratory papillomatosis

102. A 20-year-old male presented to the emergency room

complaining of severe throbbing pain in the right side of his
throat, his pain started 2 days ago, and rapidly progressed and
become throbbing nature, on examination his temp. was 38, he
couldn’t open his mouth properly during oral examination the
palate was found to be swollen and tonsil was pushed medially
and downwards, his upper deep cervical nodes was enlarged
and tender, the initial line of treatment is:

a) Intravenous broad spectrum antibiotics

b) Incision and drainage under local anesthesia
c) CT scan to diagnose the extension of the disease
d) Intravenous fluids to avoid dehydration
e) Tracheostomy to avoid any airway compromise

103. A 60-year-old male, chronic heavy smoker presented with hoarseness

of voice for several months’ duration, not responsive to medical
treatment, laryngeal examination showed a fungating mass arising
from the right vocal cord which was found fixed, CT scan in such case is
indicated in order to determine:

a) The exact site of the tumor

b) The exact size of the tumor
c) Extension of the tumor to the hypopharynx
d) Extension of the tumor to the tongue base
e) Extension of the tumor to the cartilage and/or intralaryngeal spaces

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104. The following spaces can be the site of abscess formation in the area
of the head and neck except:

a) The peritonsillar space

b) The paraglottic space
c) The parapharyngeal space
d) The retropharyngeal space
e) The submandibular space

105. A 5-year-old boy presented to the emergency room with bleeding from
the mouth, he underwent tonsillectomy one week ago, his surgery went
uneventful and he was discharged home at the same day in a suitable
condition, six days later he started to spit few blood drops, the bleeding
gradually progressed, his Hb on admission was 11.5 management of
such case should be:

a) Surgical intervention in the form of ligation of the bleeder

b) Admission to the hospital, observation and IV antibiotics
c) Immediate tracheostomy to save his airway
d) Immediate blood transfusion to replace his blood loss
e) Angiography and embolization of the bleeding vessels

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106. A 12-year-old girl presented with high fever, sore throat, inability to
swallow and Rt. ear pain, on examination her temp. was 39oC, oral
examination showed large inflamed tonsils with whitish spots, the
upper deep cervical nodes were felt tender and enlarged, management
of her condition includes all of the following EXCEPT:

a) Bed rest for 48 hrs.

b) Amoxicillin-clavulanic acid for one week
c) Warm semi-sold diet
d) Throat swab
e) Analgesic antipyretic medication

107. The following are indications of tracheostomy EXCEPT:

a) Expected prolonged intubation in the ICU

b) Before resection of large oro-mandibular cancer
c) Extensive leukoplakia affecting both vocal cords
d) Bilateral vocal cord paralysis after total thyroidectomy
e) Advanced supraglottic laryngeal cancer obstructing the laryngeal inlet

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