HEAD AND NECK INSERVICE EXAMINATIONS

(November 27, 2022)

Kindly fill-up your answer sheets properly including your YEAR LEVEL opposite your name. DO
NOT forget to put your resident number and shade the corresponding numbers. Kindly shade
well, all your answers using PENCIL. Answers shaded with ballpen/ pentel pen would not be
checked. God bless.

1. What do you call the first sign of the future face, which is a surface depression situated
just below the developing brain? (page 5, Embryology and Congenital lesions of the Midface, Som
& Curtin’s Head and Neck Imaging, 5th edition)
A. Stomodeum
B. Ectoderm
C. Prechordal Mesoderm
D. Paraxial Mesoderm

2. The following are subclassifications for frontoethmoidal cephaloceles, except for? (page
47, Embryology and Congenital lesions of the Midface, Som & Curtin’s Head and Neck Imaging,
5th edition)
A. Nasofrontal
B. Nasoethmoidal
C. Nasoorbital
D. Nasomaxillary

3. The pterygopalatine fossa communicates with the following areas, except? (page 131,
Embryology, Anatomy, Physiology and Imaging of the Sinonasal Cavities, Som & Curtin’s Head
and Neck Imaging, 5th edition)
A. Nasal fossa via the sphenopalatine foramen
B. Mouth via the greater and lesser pterygopalatine canals
C. Orbit via the inferior orbital fissure
D. Infratemporal fossa via the foramen rotundum

4. This paranasal sinus is present and aerated at birth, the first one to fully develop and is
composed of about 3 to 18 cells per complex? ((page 119, Embryology, Anatomy, Physiology and
Imaging of the Sinonasal Cavities, Som & Curtin’s Head and Neck Imaging, 5th edition)
A. Ethmoid
B. Maxillary
C. Sphenoid
D. Frontal
5. Kiesselbach’s plexus, which is the source of 90% of the cases of epistaxis, are supplied by
the branches of the following arteries, except for? (page 116, Embryology, Anatomy, Physiology
and Imaging of the Sinonasal Cavities, Som & Curtin’s Head and Neck Imaging, 5th edition)
A. Facial
B. Sphenopalatine
C. Greater Palatine
D. Superior Labial

6. True about Mucoceles? (pages 205-207, Inflammatory Diseases of the Sinonasalcavities,

Som & Curtin’s Head and Neck Imaging, 5th edition)
A. On CT, it appears as an airless, expanded cavity filled with mucoid density of 10 to 25 HU.
B. On MRI, it exhibits varying signals in both T1 and T2 weighted sequences due to varying
protein content
C. Two thirds of cases occur within the frontal sinus
D. All of the above

7. What is the T-staging of a Maxillary Sinus Carcinoma if there is already invasion of the
pterygoid fossa and ethmoid sinuses? (pages 262-263, Tumors and Tumor-like Conditions of the
Sinonasal cavities, Som & Curtin’s Head and Neck Imaging, 5th edition)
A. T2
B. T3
C. T4a
D. T4b

8. Which is true about Fibrous Dysplasia of the craniofacial bones? (page 345, Tumors and
Tumor-like Conditions of the Sinonasal cavities, Som & Curtin’s Head and Neck Imaging, 5th
edition)
A. The majority of the cases are limited polyostotic form
B. In the monostotic form of FD, the facial bones commonly affected are the zygoma and
nasal bones
C. McCune-Albright syndrome consists of the polyostotic form of FD, along with pigmented
skin macules and sexual precocity.
D. Malignant transformation of bone with FD is very common

9. They are the most common jaw cyst and arise in erupted, infected carious teeth as
sequelae to periapical granulomas. (page 374, Tumors and Tumor-like Conditions of the Sinonasal
cavities, Som & Curtin’s Head and Neck Imaging, 5th edition)
A. Fissural cyst
B. Radicular Cyst
C. Follicular Cyst
D. Odontogenic Keratocyst
10. Most common CT finding in a patient with failed FESS. P.428
A. mucosal disease
B. bony spurs
C. deviated septum
D. septal perforation

11. Is an external ethmoidectomy approach used primarily for disease in the ethmoid sinuses
and supraorbital ethmoid cells. P. 441
A. Reidel’s procedure
B. Lynch’s procedure
C. Osteoplastic Flap Procedure
D. None of the Above

12. Patients with recurrent inflammatory disease, tumors, and complex fractures are candidates
for this cosmetically nondeforming procedure, generally performed with sinus cavity
obliteration.
A. Reidel’s procedure
B. Lynch’s procedure
C. Osteoplastic Flap Procedure
D. None of the Above

13. Pyramidal-shaped high central midface fracture (Le Fort II) is typically caused by a strong,
broad blow over the central facial region. P. 500
a. Le Fort I
b. Le Fort II
c. Le Fort III
d. None of the Above

14. Centrolateral midfacial fractures are characterized by separation of the entire facial skeleton
from the skull base. P. 501
A. Le Fort I
B. Le Fort II
C. Le Fort III
D. None of the Above

15. At 3.5 weeks of the embryological development of the eye, the following develops. P. 533
A. The optic vesicles appear set at 180 degrees to each other.
B. The lens vesicles separate from the overlying ectoderm; the choroidal fissures appear in
the optic cups and stalks; the vitreous appears.
C. The retina is differentiated into neural and pigment layers; the lens thickens; the eyes
rotate to 160 degrees.
D. The choroidal fissures close; the lens cavities are obliterated; the lids begin to form; axons
enter the optic stalks.
16. At 5 weeks of the embryological development of the eye, the following develops. P. 533
A. The optic vesicles appear set at 180 degrees to each other.
B. The lens vesicles separate from the overlying ectoderm; the choroidal fissures appear in
the optic cups and stalks; the vitreous appears.
C. The retina is differentiated into neural and pigment layers; the lens thickens; the eyes
rotate to 160 degrees.
D. The choroidal fissures close; the lens cavities are obliterated; the lids begin to form; axons
enter the optic stalks.

17. This is the term used to refer to an end-stage calcified shrunken globe. (Page 604)
A. Microphthalmia
B. Cryptophthalmos
C. Buphthalmos
D. Phthisis bulbi

18. This is the most common primary malignant orbital tumor in children. (Page 607)
A. Retinoblastoma
B. Rhabdomyosarcoma
C. Optic nerve glioma
D. Neurilemoma

19. There are three anatomic narrowing in the nasolacrimal drainage system which must not be
mistaken for strictures or obstructions in dacryocystography. Which one of these is not part of
these physiologic narrowing? (Page 779)
A. At the junction of the common canaliculus and lacrimal sac
B. At the junction of the distal lacrimal sac and nasolacrimal duct
C. At the junction of the superior/inferior ampulla and horizontal canaliculi
D. At the distal valve of Hasner

20. Most common site of obstruction of the nasolacrimal drainage system: (Page 782)
A. Neck of the lacrimal sac
B. Valve of Rosenmüller
C. Vertical canaliculi
D. Horizontal canaliculi

21. The normal diameter of the optic nerve on axial and coronal scans: (Page 867)
A. 2-3 mm and 3-4 mm
B. 3-5 mm and 4-6 mm
C. 4-5 mm and 5-6 mm
D. None of the above
22. The embryo itself will develop from what layer of the embryo disc? (Page 927)
A. Epiblast
B. Hypoblast
C. Endoblast
D. None of the above.

23. If the areas of the central skull base, cavernous sinuses, and sphenoid sinus are to be
evaluated, a suggested protocol includes: (Page 945)
A. T1-weighted sequences with and without Gadolinium
B. T2-weighted scans
C. A only
D. A and B

24. Which cranial nerve is one of the most often involved in perineural tumor spread from head
and neck cancer? (Page 867)
A. Olfactory nerve
B. Oculomotor nerve
C. Facial nerve
D. Vestibulocochlear nerve

25. On MR imaging, findings suggestive of perineural tumor spread include the following except?
(Page 880)
A. Excessive enhancement of a cranial nerve branch
B. Increased T2 signal delineating the spread of disease
C. Widening/excessive enhancement within the PPF, Meckel’s cave, or the cavernous sinus
D. Loss of the normal T1-hyperintense fat in the PPF

26. The labyrinth reaches its mature anatomic configuration by approximately what time wherein
the membranous labyrinth is completely developed? (Page 1059)
A. 6 months of fetal age
B. 1 month postpartum
C. 1 year old
D. During birth

27. What is the order of the formation of the sensory end organs in the labyrinth? (Page 1059)
A. Cochlea > utricle and saccule > semicircular ducts
B. Semicircular ducts > utricle and saccule > cochlea
C. Cochlea > semicircular ducts > utricle and saccule
D. Utricle and saccule > semicircular ducts > cochlea
28. Which of the following is INCORRECT regarding the temporal bone? (Page 1097)
A. The temporal bone develops from three separate precursors.
B. The pars branchialis radiates from the first and second branchial arches, the first branchial
groove, and the adjacent mesenchyme.
C. The pars otica develops from the auditory vesicle and the adjacent mesenchyme.
D. The development of the external ear and the middle ear is independent of the
development of the inner ear.

29. A classification system developed by Weerda et al. divides the deformities into first, second,
and third degrees. Which deformity is the most pronounced and is defined as either absence of
normal auricular structure (anotia)? (Page 1001)
A. First
B. Second
C. Third
D. Fourth

Match the fracture with its proper description. (Page 1169)

30. Longitudinal fracture
31. Transverse fracture

A. PARALLEL to the long axis of the petrous bone

B. PERPENDICULAR to the long axis of the petrous bone

32. Post-traumatic vertigo implies damage to the following structures EXCEPT: (Page 1178)
A. Utricle
B. Semicircular ducts
C. Vestibular nuclei
D. All of the above

33. A CT scan of a 12-year-old boy with history of 1 week ear pain shows air fluid levels in the
left mastoid air cells with a small areas of bone erosion of the tip of the mastoid. There is marked
fat stranding posterior to the left ear. The findings are suggestive of
A. Acute subperiosteal abscess
B. acute mastoiditis bezolds abscess
C. Coalescent mastoiditis
D. Acute Otomastoiditis `SOM 5TH 1118

34. A soft tissue mass identified at the petrous apex of the temporal bone on CT scan. The.
An earlier MRI scan showed the lesion having increased signal on T1 and T2WI. The petrous bone
showed erosion. The most likely diagnosis is
A. Cholesteatoma
B. Chocolate cyst
C. Schwannoma
D. Paraganglioma SOM 5TH 1200
35. A 70-year-old elderly diabetic patient complaining of right ear pain showed extensive soft
tissue swelling in the right temporal region. This is accompanied by right facial nerve paralysis.
CT study showed swelling of the soft tissue amount the ear and soft tissue thickening in lining of
the external auditory canal. The best diagnosis is
A. Necrotizing external otitis
B. External canal cholesteatoma
C. Keratosis obturans
D. Osteomyelitis. SOM 5TH 1183

36. CT scan of a patient with temporal bone thickening on x-ray shows ground glass changes
in the left temporal bone. The findings extend to the otic capsule which reveal demineralization.
The more likely diagnosis is
A. Hyperparathyroidism
B. Fibrous dysplasia
C. Paget’s’ disease
D. Hyperostosis SOM 5TH 1243

37. A non-contrast MRI discloses a CP angle mass whose signal characteristic is similar to gray
matter on T1 weighted and T2 weighted images. The lesion is most likely
A. Epidermoid
B. schwannoma
C. meningioma
D. metastasis SOM 5TH 1288

38. MRI is indicated in which clinical situation

A. Presence of an intratympanic mass.
B. Non-pulsatile tinnitus
C. Paget’ disease
D. Carotid bifurcation stenosis.

39. Intracanalicular masses of the temporal bone can be differentiated from CP angle lesion
by
A. Location
B. Poor Contrast enhancement
C. Calcification
D. Symptomatic presentation SOM 5TH 1318

40. The lesion which can appear nearly identical to an intracanalicular schwannoma on
contrast MRI is?
A. Focal neuritis
B. Meningioma
C. Amyloid neuropathy
D. Melanoma SOM 5TH 1319
41. Which of the following tumor of the mandible is NOT OF DENTAL ORIGIN?
A. Cemento-osseous dysplasia
B. Odontogenic Myxoma
C. Ameloblastoma
D. Primary intraosseous squamous cell carcinoma SOM 5TH 1503

42. Of adult organ/structure which is directly contributed by one of the branchial clefts
A. Tensor tympani
B. Tonsillar fossa
C. Skin of anterior triangle
D. External auditory canal epithelium SOM 5TH 2133

43. An acute lacunar stroke of a patient was identified at the pontomedullary region. The
patient complained of not being able to swallow food properly. On fluoroscopic guided
esophagram, what stage of swallowing will most likely show poor coordinated movement?
A. Oral preparatory stage
B. Oral transport stage
C. Pharyngeal stage
D. Esophageal stage SOM 5TH 2089

44. Which of the neck triangles is the sternocleidomastoid muscle not used a landmark
boundary?
A. Occipital triangle
B. Subclavian triangle
C. Muscular triangle
D. Submandibular triangle SOM 5TH 2141-2142

45. Which imaging feature of meningioma suggest an aggressive type of tumor?

A. Marked homogeneous enhancement
B. Absence of a dural tail
C. Areas with punctate calcifications
D. Appearance of non-enhancing cystic foci SOM 5th 1288

46. A 35 male brought with a history of head trauma is send for CT due to hearing loss. A
hairline fracture of the temporal bone is identified running perpendicular to the long axis of the
petrous. The most likely area of injury that needs inspection is
A. Genicular ganglion
B. Facial hiatus
C. Labyrinthine segment
D. Internal auditory canal SOM 5th 1174
47. For patient a with congenital hearing disability, the evaluation should focus on which
disease entity
A. Cochleosaccular Dysplasia
B. Mondini’s dysplasia
C. Michel’s dysplasia
D. Alexander’s deafness SOM 5th 1111

48. When a fracture is parallel to the petrous bone, the structure of the temporal bone that
is NOT OFTEN INJURED is the
A. Ossicular chain
B. Tegmen tympani
C. Otic capsule
D. Anterior genu of the facial nerve canal SOM 5th. 1169

49. True of pleomorphic adenoma p2188

A. 90% are located in the superficial lobe of parotid gland
B. Malignant transformation is common
C. Small tumors are prone to cystic and hemorrhagic degeneration
D. Ultrasound is the imaging of choice in detecting tumor recurrence

50. Metastatic lymphadenopathies to the neck are true except: p2192

A. Well-differentiated thyroid carcinomas have a very high rate of neck metastases
B. Metastases from melanoma are superficial in location such as in the parotid gland, or
posterior triangle
C. Metastases frequently originate from squamous cell carcinomas of the mucosa of the upper
aerodigestive tract
D. On ultrasound, every slightly enlarged node should not be regarded as suspicious.

51. True of Sibson’s fascia p2209

A. Serves as a plane of separation between the lower neck and thorax.
B. Covers the dome of the pleura
C. Attaches to the medial surface of the first rib
D. All of the above

52. What are the contents of the carotid sheath? P2232

A. Internal carotid artery, internal jugular vein, cranial nerves IX and X; level II, III, IV lymph
nodes and fat
B. Internal carotid artery, internal jugular vein, cranial nerves IX and X; level II and III lymph
nodes and fat
C. Internal carotid artery, internal jugular vein, common carotid artery, cranial nerves IX, X, XI,
and XII; level II, III, IV lymph nodes and fat
D. Internal carotid artery, internal jugular vein, cranial nerves IX, X, and XI; level II, III, IV lymph
nodes and fat
53. Lymph nodes are considered if they exceed these measurements, except: p 2353
A. MLD of jugulogdigastric and submandibular nodes >15 mm
B. MLD of retropharyngeal node <8mm
C. MAD jugulodigastric nodes >11 mm
D.MAD in level II are >9 to 10 mm

54. Which of the following is true in imaging extranodal tumor spread p2363
A. enhancement, thickening and irregularity of the nodal rim
B. tumor extension to internal carotid and common carotid artery
C. infiltration of the adjacent planes
D. All of the above

55. On imaging, this pathology occurs in the suprahyoid neck, midline and lie immediately
adjacent to the hyoid bone p2254
A. Thyroglossal cyst
B. Ranula
C. Branchial cleft cyst
D. Cystic hygroma

56.True of cystic hygroma EXCEPT p 2265

A. most common form of lymphangioma
B. 80% occur in neck within posterior triangle
C. 10% may extend into the mediastinum
D. typically multiloculated cystic masses in the posterior triangle of the neck in a child or young
adult

57. Which among the following syndromes is capillary hemangiomas commonly associated
with? P2274
A. Osler-Weber-Rendu
B. Louis-Barr
C. Wyburn-Mason
D. All of the above

58. Which among the pathologies are most common in the masticator space? P 2429
A. Infection from recent tooth extraction
B. Tumor
C. Severe gingivitis
D. Osteomyelitis of the mandible

59. True about Stensen’s duct, except: p2453

A. It is about 7 cm long and courses over the masseter muscle only
B. Courses medially to pierce buccinator muscle
C. Caliber of the duct is uniform in size
D. Opening is opposite the second upper molar tooth
60. What syndrome comprises the triad of orofacial swelling, facial nerve palsy and lingual
plicata? P 2462
A. Usher syndrome
B. Melkersson-Rosenthal syndrome
C. Gillian Barre syndrome
D. None of the above

61. What muscle limits any direct anterior extension of the thyroid gland? p.2588
A. Sternohyoid
B.Thyrohyoid
C. Sternothyroid
D. Omohyoid

62. The upper or superior parathyroid gland arises from which of the following? p.2629
A. 2nd branchial pouch
B. 3RD branchial pouch
C. 4th branchial pouch
D. 5th branchial pouch

63. True of basal cell carcinoma, except. p.2662

A. Most common type of skin cancer
B. Common with dark-skinned people
C. Common in males
D. Common to develop into melanoma

64. The second most common site where melanoma is seen. p.2664
A. neck
B. face
C. ear
D. scalp

65. True about TMJ except: page 1547

A. Like most of the joints in the body, articulating surfaces of the TMJ have cartilaginous
coverings.
B. TMJ disk is a biconcave fibrous structure located between the mandibular conde and the
temporal bone component of the joint.
C. In a sagittal section, the normal disk is biconcave, with the anterior and posterior bands
represent the anterior and posterior thicker parts of the disk.
D. A joint capsule surrounds the joint
66. True about TMJ disk displacement: page 1549
A. Most common type is posterior displacement.
B. Posterior displacement is frequently seen in combination with medial disk displacement.
C. The combination of posterior and lateral or medial displacement is called rotational
displacement.
D. Anterior displacement is rare.

67. Which is the most common and most well-established plain film technique for examination
of TMJ: page 1552
A. Transorbital projection
B. Transmaxillary projection
C. Transcranial projection
D. Transphenoidal projection

68. Congenital anomalies that cause decrease in size of the short side of the mandibular condyle
except: page 1609
A. Hemifacial microsomia
B. Goldenhar's Syndrome
C. Nager- Reynier Syndrome
D. Beckwith-Wiedemann Syndrome

69. Which is the correct match for the stage of internal derangement and its imaging findings?
page 1553
A. Early stage- slight forward displacement; slight thickening of the posterior edge or beginning
of anatomic deformity of disk
B. Intermediate stage- abnormal tomograms, early to moderate degenerative remodeling.
C. Intermediate-late stage- anterior displacement, abnormal tomograms, degenerative arthritic
changes
D. Late stage- anterior displacement, perforation with simultaneous filling of the upper and lower
compartments, filling defects

70. Which is an arthrographic sign of disk displacement in a single contrast lower compartment
arthrography? page 1557
A. Enlargement of the anterior recess of the lower joint space.
B. Posterior band at 12 o'clock position relative to the mandibular condyle.
C. Small anterior recess of the lower joint space.
D. Passage of contrast from the lower to upper joint space

71. CT finding of a normal TMJ except: page 1561

A. Inability to see the disk inferior to the tubercle.
B. Presence of lateral pterygoid fat pad.
C. Inability to see the disk anterior to the condyle.
D. Presence of high attenuation lesion anterior to the condyle
72. Which is the most common neoplastic lesion affecting the TMJ? Page 1588
A. Synovial chondromatosis
B. Pigmented Villonodular Synovitis
C. Osteochondroma
D. Chondrosarcoma

73. Common arthritides that affect TMJ except: page 1598

A. Rheumatoid arthritis
B Ankylosing spondylitis
C. Gout
D. Psoriatic arthritis

74. True of normal imaging features of adenoid except: page 1823

A. Presence of thin line of enhancement probably indicates submucosal veins.
B. Adenoids are abnormal if asymmetrically lobular or thickened.
C. Occasional small calcifications can be seen within the adenoids on CT.
D. On T2W images, adenoids are homogeneously hyperintense relative to muscles.

75. Which is the most common congenital abnormality of the nasal cavity? page 1831
A. Nasal cavity stenosis
B. Pyriform aperture stenosis
C. Turbinate hypertrophy
D. Choanal atresia

76. Where is the level of obstruction in nasolacrimal duct cysts? Page 1833
A. Hasner's valve
B. Inferior turbinate
C. Nasolacrimal ostium
D. None of the above

77. True of Relapsing Polychondritis except: page 2063

A. Most commonly involved are larynx and upper trachea
B. Usual appearance is tracheal narrowing
C. Involvement of the posterior membrane of the trachea
D. On dynamic imaging, there is airway collapse

78. True of Tracheopathia Osteochondroplastica: page 2066

A. Tends to occur in patients who are older than 50 years of age.
B. Located mainly in the posterior membranous portion of the tracheal wall.
C. Sparing of the anterolateral tracheal wall
D. Mostly involve the superior 1/3 of the trachea
79. Most common primary malignancy of the trachea: page 2070
A. Adenoid cystic carcinoma
B. Carcinoid tumor
C. Squamous cell carcinoma
D. Chondrosarcoma

80. True of Carcinoid tumors: page 2073

A. Predominantly extraluminal mass
B. Avascular
C. Central in location
D. Carcinoids have high fluorodeoxyglucose uptake making PET imaging highly sensitive

CONTRIBUTORS:

MAKATI MEDICAL CENTER – Maria Bida Olivia S. Tamayo, MD

DE LA SALLE UNIVERSITY MEDICAL CENTER – Aisha Marie M. Sanico, MD (Team leader)
UNIVERSITY OF STO. TOMAS HOSPITAL – Mirasol Quitlong-Pahutan, MD
DAVAO DOCTOR’S HOSPITAL – Anatole D.J. Garcia, MD
CHINESE GENERAL HOSPITAL AND MEDICAL CENTER – Charina M. Vitug-Villegas, MD