Part one

1.Caloric test has

a) Slow component only
b) fast component only
c) Slow + Fast components
d) fast components occasionally

2.Carhart’s notch is characteristically seen at

a)1000hz
b)2000hz
c)4000hz
d)6000hz

3.Gradenigo’s syndrome does not consist of

a) abducent nerve palsy
b) Retro orbital pain
c) aural discharge
d) Palatal palsy

4.In Acoustic neuroma the following is not seen

a) Auditory defect
b) Sensory aphasia
c) Motor aphasia
d) Changes in audiometry

5.Myringotomy is done on the …quadrant of the tympanic membrane

a) Postero inferior
b) Postero superior
c) antero inferior
d) antero superior

6.In unsafe CSOM with cholesteatoma and sensorineural deafness treatment choice
a) simple mastoidectomy
b) modified radical mastoidectomy
c)radical mastoidectomy
d) tympanoplasty

7.Organ of corti is situated in

a) scala media
b) ScalaTympanum
c) Scala Vestibule
d) Saccule

8.Endolymphatic hydrops is associated with

a) Otosclerosis
b) CSOM
c) wax impacted ear
d) presbycusis

9.Positive Rinnetest is seen in

a) Otosclerosis
b) csom
c) wax impacted ear
d) Presbycusis
10.Pulsatile otorrhea seen in
a) Glomus tumour
b) CSF otorrhea
c) ASOM
d) fistula

11.Commonest cause of deafness in childhood is

a) ASOM
b) CSOM
c) deaf-mutism
d) foreign body

12.Otosclerosis is associated with all except

a) conductive deafness
b) common in males
c) Mostly affects stapes
d) Run in families

13.Common cause of facial palsy is

a) Bell’s palsy
b) Mastoid surgery
c) Guillian Barre syndrome
d) Injury to facial nerve

14.The land mark on the lateral surface of temporal bone which acts as a guide to surgeryto the antrum is
the
a) trauman’s triangle
b) temporal line
c) suprameatal spine of Henle
d) notch of Rivinus
e) None of the above

15.Destruction of right labyrinth causes nystagmus to

a) right side
b) Left side
c) rotatory nystagmus
D) No nystagmus

16.The secretomotor nerve fibres of sphenopalatine ganglion supply the

a) Lacrimal gland
b) Parotid gland
c) submandibular gland
d) sublingual gland

17.In conductive deafness Weber test is lateralized to:

a) deaf ear
b) normal ear
c) Both ears
d) Any of the above

18.Hyposthesia of the posterior aspect of the external auditory canal may be an early sign of
a) Trigeminal neuralgia
b) costens syndrome
c) Lateral sinus thrombosis
d) Multiple sclerosis
e) acoustic neuroma

19.Pulsatile tinnitus in ear is due to

a) Malignant otitis media
b) osteoma
c) mastoid reservoir
d) glomus jugulare tumour

20.Impairment of hearing due to noise starts at

a)1000Hz
b)2000Hz
c)3000Hz
d)4000 Hz

21.Management of otogenic cerebral abscess is

a) radical mastoidectomy
b) drainage of abscess followed by mastoidectomy
c) conservative treatment with antibiotics
d) drainage of abscess only

22.Absolute bone conduction test (ABC) is shortened in

a) conductive deafness
b) perceptive deafness
c) both a&b
d) none of the above

23.All of the following are the features of cholesteatoma except

a) filled with keratinized stratified squamous epithelium
b) Deafness
c) erodes bone
d) lymphatic permeation

24.In majority of the cases with otosclerosis the tympanic membrane is

a) normal
b) flamingo pink
C) blue
d) yellow

25.The syndrome of sensorineural hearing loss together with hereditary nephritis is

a) alports syndrome
b) fabry’s syndrome
C) Nail patella syndrome
d) Edward syndrome

26.Ototoxic drugs are all except

a) Kanamycin
b) streptomycin
c) gentamicin
d) ampicillin

27.A patient hears better in Noise the diagnosis is

a) Hyperacusis
b) Hypoacusis
c) presbycusis
d) paracusis
28.Dryness of eyes is caused by injury to facial nerve at
a) chorda tympani
b) cerebellopontine angle
c) tympanic canal
d) geniculate ganglion

29.The aost mobile part at the tympanic membrane

a) central
b) peripheral
c) both
d) none of the above

30.The commonest site of otogenic brain abscess occurring due to CSOM is

a) frontal lobe
b) parietal lobe
c) temporo petrosal lobe
d) occipital lobe

31.In blast injury most common organ affected

a) eardrum
b) stomach
c) lungs
d) all of the above

32. Condition where a pulsatile tumour is found in external auditory meatus which bleeds to touch
a) cholesteatoma
b) polyp
c) glomus tumour
d) malignancy middle ear

33. Organ of cortt is arranged along the inner edge of

a) Reissners membrane
b) Basilar membrane
c) stria vascularis
d) none of the above

34.Cochlear implant used in

a) sensory neural deafness
b) conductive deafness
c) Mixed
d) None

35.Tone decay test is done to find out

a) Otosclerosis
b) Cochlear lesions
c) Retrocochlear lesions
d) Menier’s disease

36.Which of the following statement regarding eustachian tube dysfunction is wrong?

a) Un Distorted light image on the anterior quadrant of tympanic membrane
b) No movement of the tympanic membrane on Seagul’s method
c) Malleus is easily visible
d) Lusterless tympanic membrane

37.Bell’s palsy not responding to steroid what will be the further line of management?
a) Increase the dose of steroid
b) Vasodilators and ACTH
c) surgical decompression
d) electrical nerve stimulation

38. The facial nerve

a) Is motor to the tensor tympani muscle
b) In the internal auditory canal lies inferior to the cochlear nerve
c) Is the nerve in the internal auditory meatus to the most frequently affected by a neuroma
d) Medial wall of the middle ear

39.Otosclerosis occurs in the

a) Lateral wall of the middle ear
b) Roof of the middle ear
c) Floor of the middle ear
d) Medial wall of the ear

40.Acute suppurative otitis media is treated using

a) erythromycin
b) penicillin
c) streptomycin
d) chloramphenicol

41.Before attempting tympanoplasty operation the surgeon must look for

a) Disruption of ossicular chain
b) no infection in the sinuses
c) the ear has been dry
d) cochlear reserve

42.A patient of CSOM with cholesteatoma present with acute onset of vertigo treatment is
a) Immediate exploration
b) antibiotics steroids
c) Labyrinthine sedatives
d) Labyrinthine sedatives only

43. Monoaural diplacusis is present in a lesion of

a) acoustic nerve
b) pontine glioma
c) cochlea
d) efferent auditory neurons

44.Blue drum is seen in

a) tympanosclerosis
b) secretory otitis media
c) otosclerosis
d) myringitis bullosa

45.Nerve supply of tympanic membrane is

a) auriculo temporal
b) auricular branch of vagus
c) lesser occipital
d) greater occipital

46.Appreciation of sound occurs in

a) organ of corti
b) Basilar membranae m
c) cochlear nuclei
d) transverse temporal gyrus

47.Meniers disease is associated with

a) cochlear deafness
b) conductive deafness
c) retrocochlear deafness
d) mixed

48.Acoustic neuroma commonly affects the cranial nerve

a) 5th
b) 6th ‘
c) 7tb
d) 8th

49.Common cause of eustachian tube disease is due to

a) adenoids
b) sinusitis
c) otitis media
d) pharyngitis

50. A 3year old child presents with fever and earache on examination there is congested tympanic
membranae with slight bulge . the treatment of choice is
a) myringotomy with penicillin
b) myringotomy with grommet
c) only antibiotics
d) wait and watch

51. A 14-year-old boy presented with high fever, neck stiffness, severe
headache, and a positive Kernig’s sign. His
mother indicated that he had had a lot of ear problems, but none
recently. The tympanic membrane appeared dull but without
erythema and moved sluggishly. A computed tomography scan
showed a normal brain, an opacified middle ear, and an opacified
mastoid that was smaller than the normally aerated opposite
mastoid. Lumbar puncture
was positive for meningitis, and he was placed on culturespecific
intravenous antibiotics and exhibited a good clinical
response over the next few days. On day 6, his temperature
spiked to 103°F, and he was drowsy. The most important step
now is to

A. repeat the lumbar puncture.

B. perform tympanocentesis.
C. obtain an enhanced magnetic resonance imaging (MRI)
scan.
D. obtain additional history of recent ear problems.
E. schedule immediate exploratory mastoidectomy.
53. A 39-year-old man is seen with a chronically draining
left ear and has a positive fistula test in that ear. A
computed tomography scan suggests possible erosion of
the lateral semicircular canal. Against which of the
following pairs
of microorganisms should antibiotic therapy be directed?

A. Streptococcus pneumoniae and Mycoplasma pneumoniae

B. Pseudomonas aeruginosa and Mycoplasma pneumoniae
C. Haemophilus influenzae and Bacteroides fragilis
D. Haemophilus influenzae and Streptococcus pneumoniae
E. Pseudomonas aeruginosa and Bacteroides fragilis

54. A 50-year-old man presents with a right-sided 30 dB conductive hearing

loss without other symptoms. Physical
examination shows a large, uninfected attic erosion with
keratinized epithelial debris filling the defect. A fistula test is
negative, although the patient subjectively is slightly dizzy with
negative pressure. A computed tomography scan shows an
aerated middle ear, erosion of the
scutum, and opacification of the upper two-thirds of the mastoid.
Which of the following is most likely to be found at surgery

A. erosion of the tegmen mastoideum

B. erosion of the tympanic segment of the fallopian canal C.
lateral sinus thrombosis
D. serous labyrinthitis
E. epidural abscess
55. Choose the correct answer:
a. Ear washing is not contraindicated in traumatic perforation of the drum.
b. Pathological perforation of the drum occurs at any site while traumatic ones
occurs in pars tensa only.
c. In ear washing, the sterile nozzle of the syringe is directed to the drum
directly.
d. Ear washing is indicated in the presence of fistula between the middle & inner
ear.

56. Pain on mastication is present in:

a. Acute mastoiditis.
b. Otosclerosis.
c. Furunculosis of the external ear.
d. Allergic otitis externa.

57. Sagging of the postero-superior wall of the EAC occurs in:

a. Acute mastoiditis.
b. Furunculosis of the external ear.
c. Otitis media.
d. Petrositis.
6. The causative agent in otomycosis is:
a. Aspergillus nigers & / or Candida albicans.
b. Streptococci.
c. Staphylococci.
d. E.coli
e. B. pyocyaneus.

58. Ramsy-Hunt syndrome is:

a. Herpes-zoster affection of the geniculate ganglion of the facial nerve.
b. Dysphagia in middle aged female.
c. Dysphagia in old male.
d. Sensory-neural deafness in newly born.

59. Stapedectomy is one line for treatment of:

a. Otosclerosis.
b. Otomycosis.
c. Otitic barotrauma.
d. Secretory otitis media.
60. The most common cause of deafness in children:
a. Acute otitis media.
b. Secretory otitis media.
c. Chronic otitis media.
d. Cholesteatoma.

61.What is faulse In traumatic ossicular disruption:

a. The audiogram shows 55 dB loss.
b. Separation of the icudo-stapedial joint is the commonest lesion.
c. There is bulging drum.
d. C.T scan is indicated.

62. Crescentic hairline is an otoscopic finding in:

a. Otomycosis.
b. Otosclerosis.
c. Secretory otitis media.
d. Acute otitis media.

63. Reservoir is a characteristic sign in:

a. Acute mastoid abscess.
b. Acute otitis media.
c. Chronic otitis media.
d. Secretory otitis media.

64. Gradеnigo syndrome occurs in:

a. Acute mastoid abscess.
b. Acute petrositis.
c. Chronic otitis media.
d. Secretory otitis media.

65. Griesinger's sign is:

a. Edema & tenderness over the posterior border of the mastoid process.
b. Unilateral pulsating otorrhoea.
c. Vertigo & nystagmus on increasing the pressure of the EAC.
d. Tenderness on the tip of mastoid bone.

66. Fever in lateral sinus thrombosis is:

a. Intermittent.
b. Remittent.
c. Low grade.
d. High grade.

67. Tobey-Ayer's test is a characteristic sign in:

a. Brain abscess.
b. Lateral sinus thrombosis.
c. Extradural abscess.
d. Meningitis.
e. Cavernous sinus thrombosis.

68. Pain in acute tonsillitis is referred to the ear through:

a. The 5th nerve.
b. The 9th nerve.
c. The 10th nerve.
d. 2nd & 3rd cervical nerve.

69. Pain in acute sinusitis is referred to the ear through:

a. The 5th nerve.
b. The 9th nerve.
c. The 10th nerve.
d. 2nd & 3rd cervical nerve.

70. Pain in tempro-mandibular joint is referred to the ear through:

a. The 5th nerve.
b. The 9th nerve.
c. The 10th nerve.
d. 2nd & 3rd cervical nerve.

71. Pain in cancer larynx is referred to the ear through:

a. The 5th nerve.
b. The 9th nerve.
c. The 10th nerve.
d. 2nd & 3rd cervical nerve.

72. Pain in salivary calculi is referred to the ear through:

a. The 5th nerve.
b. The 9th nerve.
c. The 10th nerve.
d. 2nd & 3rd cervical nerve.

73. The fluids presents in secretory otitis media is:

a. Mucopurulent.
b. Serosanguinous.
c. Exudates.
d. Transudates.
e. Mixture of exudates & transudates.

74. The discharge in case of cholesteatoma is:

a. Copious purulent.
b. Copious offensive.
c. Scanty offensive.
d. Thick scanty creamy.

75. Watery discharge from the ear occurs in all of the following EXCEPT:
a. Cerebro-spinal otorrhoea.
b. Parotid fistula.
c. Acute otitis media.
d. Endolymphatic sac surgery.

76. In Rinne's test:

a. In perceptive deafness: air conduction is better than bone conduction.
b. In conductive deafness: air conduction is better than bone conduction.
c. In conductive deafness: bone conduction is equal to air conduction.
d. In perceptive deafness: bone conduction is better than air conduction.

77. In Weber's test:

a. In conductive deafness: sound is heard equally in the both ears.
b. In conductive deafness: sound is heard better in the healthy ear.
c. In perceptive deafness: sound is heard better in the healthy ear.
d. In perceptive deafness: sound is heard better in the diseased ear.

78. Schwabach's test is:

a. Comparison between air & bone conduction of the same ear.
b. Comparison of bone conduction of both ears at the same time.
c. Comparison of duration of bone conduction of the patient & the examiner.
79. The following is true about pure tone audiometry EXCEPT:
a. It gives the amount of the hearing loss in dB.
b. It gives the type of deafness.
c. It gives the possible cause of deafness.
d. It helps in hearing aid selection.
e. It measures the sound emitted from the cochlea.

80. In lesion of facial nerve at vertical part"below the nerve of stapedius"

there is:
a. Loss of taste.
b. Impairment of salivation.
c. Impairment of lacrimation.
d. Hyperacusis

81. Bell's palsy is LMNL at the level of:

a. Geniculate ganglion.
b. Internal facial auditory meatus.
c. Stylomastoid foramen.
d. Cerebellopontine angle.

82. The early symptom of Bell's palsy is:

a. Dropping of angle of the affected side.
b. Obliteration of the angle of the mouth.
c. Pain of acute onset behind the ear.
d. Inability to close the eye.

83. All are correct about Meniere's disease EXCEPT:

a. It is an endolymphatic hydrops.
b. Males are more affected than females.
c. The type of deafness is conductive.
d. Decompression of the labyrinth is indicated if the vertiginous attack is
crippling.

84. The aim of radical mastoidectomy is:

a. To give safe ear.
b. To preserve hearing.
c. Reconstruct the ossicles.
d. Reconstruct the tympanic membrane.

85. The aim of modified radical mastoidectomy is:

a. To give safe ear & to preserve hearing.
b. Reconstruct the ossicles.
c. Reconstruct the tympanic membrane.

86. The pain in acute suppurative otitis media in the suppurative stage is:
a. Dull aching.
b. Throbbing.
c. Boring.
d. Burning
87. The pain in acute suppurative otitis media in the catarrhal stage is:
a. Dull aching.
b. Throbbing.
c. Boring.
d. Burning.

88. The pain in acute suppurative otitis media is more severe at:
a. Night.
b. Morning.
c. Mid-day.
d. All the day.

89. McEwen's triangle is the surface landmark of:

a. The tympanic part of the facial nerve.
b. Mastoid antrum.
c. Dome of the lateral semicircular canal.
d. Icudo-stapedial joint.

90. The middle ear magnifies the sound:

a. 20 times.
b. 22 times.
c. 200 times.
d. 21 times.

91. The test of hearing in infants is:

a. Rinne test.
b. Weber test.
c. Pure tone audiometry.
d. ABR "Auditory Brain stem Response".

92. The following are the manifestations of temporal lobe abscess EXCEPT:
a. Hemi paresis.
b. Aphasia.
c. Convulsive fits.
d. Vertigo.

93. The earliest manifestation of cavernous sinus thrombosis is:

a. Fever.
b. Ptosis.
c. Proptosis.
d. Ophthalmoplegia.

94. In traumatic rupture of the drum, all are true EXCEPT:

a. The main treatment is conservative.
b. Local ear drops are highly indicated.
c. It heals spontaneously within 3 months.
d. It may be caused by longitudinal fracture of the temporal bone.

95. The pathology in case of Bell's palsy is:

a. Facial nerve tumor.
b. Cut in the tympanic segment in the facial nerve.
c. Edema of the facial nerve inside its bony canal.
d. Hemorrhage in the facial nerve nucleus.

96. The most accurate diagnostic test to detect degeneration of the facial nerve:
a. Nerve excitability test.
b. Electromyography.
c. Electroneurography.
d. Stapedial reflex.

97. Cholesteatoma is:

a. Benign middle ear tumor.
b. Skin in a wrong place.
c. Specific middle ear granuloma.
d. Non of the above.
65. Bezold's abscess is a swelling:
a. Behind the ear.
b. Below the ear in the neck.
c. Above the ear.
d. In front of the ear.

98. Inability to raise the eye brow & close the same eye with deviation of the
angle of the mouth to the opposite side is:
a. UMNL 7th cranial nerve palsy.
b. UMNL 5th cranial nerve palsy.
c. LMNL 5th cranial nerve palsy.
d. LMNL 7th cranial nerve palsy.

99. Unilateral hearing loss with pulsating tinnitus is suggestive of:

a. Otosclerosis.
b. Extradural abscess complicating CSOM.
c. Glomus tumor.
d. Acoustic neuroma.

100. The intracranial complications of cholesteatoma are all of the following

EXCEPT:
a. Extradural abscess.
b. Lateral sinus thrombosis.
c. Petrositis.
d. Meningitis.

101. The most common vertigo is:

a. Acoustic neuroma.
b. Ototoxicity.
c. Meniere's disease.
d. Benign paroxysmal positional vertigo.

102. The commonest organism in malignant otitis externa:

a. Streptococci.
b. Pneumococci.
c. Pseudomonas aeroginosa.
d. Moraxella catarrhalis.
103. The medial wall of the middle ear shows the following EXCEPT:
a. The oval window.
b. The promontory.
c. The pyramid.
d. The lateral semicircular canal.

104. The triad of ear discharge, retro-orbital pain % 6th nerve paralysis is due to:
a. Mastoiditis.
b. Labyrinthitis.
c. Apical petrositis.
d. Lateral sinus thrombosis.

105. In case of Meniere's disease with mild SNHL is treated by all the following
EXCEPT:
a. Medical treatment.
b. Labyrinthectomy.
c. Endolymphatic sac decompression.
d. Vestibular nerve section.

106. Fluctuant SNHL usually occurs in:

a. Presbyacusis.
b. Meniere's disease.
c. Otosclerosis.
d. All of the above.

107. Nystagmus & vertigo induced by pressure on the tragus is a sign of:
a. Fistula complicating cholesteatoma.
b. Benign paroxysmal vertigo.
c. Vestibular neuritis.
d. Cholesteatoma only.

108. Insertion of Grommet tube is indicated in:

a. Acute suppurative otitis media.
b. Secretory otitis media resistant to medical treatment.
c. Chronic otitis media.

109. Fever & rigor developing in a case of cholesteatoma is suggestive of:

a. Cerebellar abscess.
b. Acute mastoiditis.
c. Lateral sinus thrombosis.
d. Labyrinthitis.

110. Vertigo is a case of cholesteatoma is a suggestive of:

a. Temporal lobe abscess.
b. Acute petrositis.
c. Lateral sinus thrombosis.
d. Labyrinthine fistula.

111. Equilibrium during angular "rotational" movement is the function of:

a. The utricle.
b. The saccule.
c. The cochlea.
d. The semicircular canal.

112. The earliest symptom in a case with cholesteatoma that indicates intracranial
complication is:
a. Persistent headache.
b. Facial palsy.
c. SNHL.
d. Squint

113. Slowly progressive conductive deafness in middle aged female with normal
drum & Eustachian tube function is most probably due to:
a. Otitis media with effusion.
b. Otosclerosis.
c. Malingering.
d. Tympanosclerosis.

114. Adhesive otitis media is a complication of:

a. Cholesteatoma.
b. Otitis media with effusion.
c. Both of them.
d. Non of them.

115. Following ear surgery, LMNL facial palsy with intact taste sensation of the
anterior 2/3 of the tongue indicates injury at the level of:
a. The parotid gland.
b. The internal auditory canal.
c. The stylomastoid foramen.
d. The tympanic segment.

116. Anesthesia of the face may be caused by:

a. Facial paralysis.
b. Occulomotor paralysis.
c. Trigeminal paralysis.
d. All of the above.

117. A false +ve fistula test is due to:

a. Labyrinthine fistula with dead ear.
b. Cholesteatoma bridging an inner ear fistula.
c. Hyper mobile footplate of the stapes.
d. All of the above.

118. The concept that the facial nerve supplies the auricle is related to:
a. Ramsy-Hunt syndrome.
b. Jugular foramen syndrome.
c. Horner's syndrome.
d. Bell's palsy.

119. The most common cause of otitis media with effusion is:
a. Inadequate treatment of acute otitis media.
b. Nasopharyngeal neoplasm.
c. Allergy.
d. Otitic barotraumas.

120. Complete LMNL facial paralysis due to acoustic neuroma may be associated
by all the following EXCEPT:
a. Loss of lacrimation of the ipsilateral eye.
b. Loss of taste of the anterior 2/3 of the tongue.
c. Loss of stapedial reflex.
d. Hyperacusis.

121. A patient with uncomplicated CSOM has:

a. Ear discharge & headache.
b. Ear discharge & dizziness.
c. Ear discharge & hearing impairment.
d. Ear discharge & fever.

122. The ostium of the maxillary sinus opens in:

a. Floor of the sinus.
b. Roof of the sinus.
c. Medial wall of the sinus.
d. Between the medial wall & floor of the orbit.

123. The inferior meatus receives the opening of:

a. The maxillary sinus.
b. The anterior ethmoidal sinus.
c. The posterior ethmoidal sinus.
d. Nasolacrimal duct.
124. The middle meatus contains:
a. The ostia of the maxillary, anterior ethmoidal & frontal sinuses.
b. The ostia of the posterior ethmoidal sinuses.
c. The nasolacrimal duct.
d. The sphenoid sinus.

125. Mikulicz cell is a characteristic histological finding in:

a. Rhinoscleroma.
b. Rhinosporodosis.
c. Aspergillosis.
d. Sarcoidosis.

126. Russell bodies is a characteristic histological finding in:

a. Rhinoscleroma.
b. Rhinosporodosis.
c. Aspergillosis.
d. Sarcoidosis.

1277. Perforation of bony part of the nasal septum occurs in:

a. Sarcoidosis.
b. Rhinoscleroma.
c. Tuberculosis.
d. Syphilis.

128. Keim test is positive in:

a. Sarcoidosis.
b. Rhinoscleroma.
c. Tuberculosis.
d. Syphilis.

129. Spontaneous recovery is usual in:

a. Rhinosporodosis.
b. Sarcoidosis.
c. Tuberculosis.
d. Syphilis.

130. The causative agent of rhinoscleroma is:

a. Sporozoon.
b. Low virulent T.B bacillus.
c. Treponema Ballidum.
d. Gram –ve short capsulated diplobacillus.

131. Sarcoidosis is:

a. Chronic sub-epithelial inflammatory granuloma of upper respiratory tract.
b. Non caseating granuloma with histological picture similar to T.B.
c. Fungal infection of nasal mucosa.
d. Infection with sporozoon.

132. The causative agent of lupus vulgaris is:

a. Sporozoon.
b. Low virulent T.B bacillus.
c. Treponema Ballidum.
d. Gram –ve short capsulated diplobacillus

133. Apple-jelly nodules of the nasal mucosa is a clinical finding in:

a. Saroidosis.
b. Rhinoscleroma.
c. Lupus vulgaris.
d. Tuberculosis.

134. Nasal furunculosis is due to:

a. Staphylococcal infection of a pilosebaceous gland.
b. T.B infection of nasal mucosa.
c. Fungal infection of nasal skin.
d. H.influenza infection of the nose.

135. The mechanism of nasal allergy is:

a. Type 1 hypersensitivity reaction.
b. Type 2 hypersensitivity reaction.
c. Type 3 hypersensitivity reaction.
d. Type 4 hypersensitivity reaction.

136. Which of the following statements is true?

A. Hearing loss from ototoxic drugs is frequently
reversible because the regeneration of cochlear hair cells
has been demonstrated in humans.
B. Renal failure is a risk factor that may increase the probability of
hearing loss in patients receiving aminoglycoside antibiotics but not
furosemide.
C. There is no relationship between the blood level of
salicylates and the severity of tinnitus experienced by
patients.
D. Brain irradiation does not alter the severity of cisplatininduced hearing
loss.
E. Although carboplatin is less nephrotoxic than cisplatin, it can
cause hearing loss.

137. A 50-year-old white woman has been prescribed a highdose aspirin

regimen to control her rheumatoid arthritis
stiffness and pain. She comes to your office complaining of
tinnitus and stomach upset. If you advise the patient to take the
same dose of aspirin with meals, what effect will this have?
A. It will decrease the rate of absorption of aspirin from the
stomach and may reduce the tinnitus severity.
B. It will increase the rate of absorption of aspirin from the
stomach and may increase the risk of hearing loss.
C. It will accelerate the rate of elimination of aspirin from the
gastrointestinal tract and may reduce the tinnitus severity.
D. It will enhance the rate of elimination of aspirin by the
kidneys and thereby reduce the tinnitus severity.
E. It will accelerate the rate of metabolism of aspirin by the liver
and thereby reduce the severity of tinnitus.

138. In which pair are both antineoplastic agents ototoxic?

A. kanamycin and cisplatin
B. cyclophosphamide and methotrexate
C. 5-fluorouracil and cisplatin
D. doxorubicin and vincristine
E. cisplatin and carboplatin

139. A 68-year-old African American woman presents to you with a

painful, solitary 8 cm neck mass after having had
a composite resection followed by radiation therapy. You discuss the
possibility of treatment for the neck mass with cisplatin-epinephrine
gel injection into the tumor. The advantages of this mode of treatment
over systemic cisplatin chemotherapy include all of the following
except
A. other options for treatment remain possible. B.
reduced risk of ototoxicity.
C. less invasive treatment.
D. higher probability of complete remission. E.
decreased risk of nephrotoxicity.

140. A 55-year-old Native American veteran with a stage IV

squamous cell carcinoma of the hypopharynx is receiving multiple
courses of chemotherapy with cisplatin. During
the course of treatment, he presents with a gram-negative kidney
infection, and his serum creatinine level is 4.0. You consider gentamicin
therapy but are concerned about possible drug interactions between
gentamicin and cisplatin.
Which of the following statements is not correct?
A. Gentamicin may increase the risk of ototoxicity when given in
combination with cisplatin.
B. The kidney infection may reduce the rate of elimination of
gentamicin, increasing the risk of ototoxicity.
C. Gentamicin may reduce the antitumor efficacy of cisplatin. D.
Cisplatin will probably not reduce the antibacterial
effect of gentamicin.
E. The antitumor effect of cisplatin is not likely to be altered
by gentamicin.

141. The allergic nasal polyp is:

a. Soft & mobile.
b. Rigid & non mobile.
c. Reddish in color.
d. Grayish in color

142. All the following lines of treatment could be applied in rhinoscleroma

except:
a. Rifampicin.
b. Cytotoxic drugs.
c. Surgery to canalize the stenosed canal.
d. Laser surgery.

143. Unilateral polypoidal mass arising from the lateral wall of the nose in 55
years old man is most probably:
a. Inverted papilloma.
b. Rhinoscleroma.
c. Allergic nasal polyp.
d. Antrochoanal polyp.

144. Anterior ethmoid presents bulge in the middle meatus called:

a. Bulla ethmoidalis.
b. Concha bullosa.
c. Lamina papyracea.
d. Haitaus semilunaris.

145. The most common site of origin of allergic nasal polpi is:
a. Maxillary sinus.
b. Ethmoidal sinus.
c. Frontal sinus.
d. Sphenoid sinus.

146. CSF rhinorrea is characterized by all of the following EXCEPT:

a. Clear color.
b. Sediment formation after standing in a test tube.
c. Containing glucose.
d. Accelerated flow rate with straining.

147. All are true about the treatment of CSF rhinorrhea EXCEPT:
a. Antibiotics to avoid infection.
b. Nasal drops.
c. Treatment of the cause.
d. Cleaning & sterilization of the skin of the nasal vestibule
30. Perforation of the cartilaginous part of the nasal septum may be due to
Except:
a. Lupus.
b. Leprosy.
c. T.B.
d. Syphilis.

148. Perforation of the bony part of the nasal septum may be due to:
a. Lupus.
b. Leprosy.
c. T.B.
d. Syphilis.

149. Radiological finding of sinusitis include all of the following EXCEPT:

a. Bone destruction.
b. Opacity of the affected sinus.
c. Fluid level.
d. Mucosal thickening.

150. Unilateral chronic maxillary sinusitis is usually of:

a. Nasal origin.
b. Dental origin.
c. Orbital origin.
d. All of the above.

151. The main presenting symptom of ethmoidal nasal polyp are all of the
following EXCEPT:
a. Attack of severe epistaxis.
b. Persistant nasal obstruction.
c. Rhinorrhea.
d. All of the above.

152. Unilateral nasal obstruction in newly born infant may be due to:
a. Antrochoanal polyp.
b. Allergic nasal polyp.
c. Choanal atresia.
d. Non of the above.

153. Unilateral mucopurulent & purulent nasal discharge may be due to:
a. Unilateral sinusitis.
b. FB in the nose.
c. Non of them.
d. All of them.

154. The most common site of nasal bleeding is:

a. Little's area.
b. Mac ewing triangle.
c. Pyriform fossa.
d. Sphenoethmoidal recess.

155. Resistant epistaxis from below the middle turbinate requires ligation of:
a. The anterior ethmoidal artery.
b. The sphenopalatine artery.
c. The maxillary artery.
d. The internal jugular vein.

156. Little's area is the site of anastomosis of the following arteries EXCEPT:
a. Anterior ethmoidal artery.
b. Sphenopalatine artery.
c. Greater palatine artery.
d. Ascending pharyngeal artery

157. Nasopharyngeal carcinoma cause Horner's syndrome as a result of

infiltration of:
a. 3rd cranial nerve.
b. 5th cranial nerve.
c. 7th cranial nerve.
d. Cervical sympathetic chain.

158. Periodic headache is a characteristic symptoms in:

a. Frontal sinusitis.
b. Ethmoidal sinusitis.
c. Maxillary sinusitis.
d. All of the above.

159. The commonest cause of nasal polypi is:

a. Infective.
b. Malignant.
c. Secondary to malignancy.
d. Allergic.

160. The commonest cause of CSF rhinorrhea is:

a. Congenital.
b. Traumatic.
c. Infective.
d. Neoplastic.

161. The commonest complication of sinusitis is:

a. Meningitis.
b. Orbital.
c. Extradural abscess.
d. Brain abscess.

162. Alternating nasal obstruction is mainly:

a. Allergic.
b. Infective.
c. Neoplastic.
d. Non of them.

163 Cyclic asphyxia is the presenting symptom is:

a. Bilateral choanal atresia.
b. Adenoids.
c. Acute laryngitis.
d. Nasal allergy.

164. The main manifestation of antrochoanal polyp is:

a. Proptosis.
b. Unilateral nasal obstruction.
c. Headache.
d. Sneezing.

165. The commonest cause of epistaxis in 50 years old man is:

a. Hypertension.
b. Angiofibroma.
c. Allergic nasal polypi.
d. Antrochoanal polyp.

166. Non symptomatic deviated nasal septum needs:

a. Septoplasty.
b. No treatment.
c. Sub-mucperichondrial resection.
d. Cauterization.

167. Chronic sinusitis has:

a. Low grade fever.
b. Intermittent fever.
c. Remittent fever.
d. No fever.

168. The point of tenderness in acute frontal sinusitis is:

a. The inner canthus.
b. The supra-orbital margin.
c. The infra-orbital margin.
d. Non of them.

168. The point of tenderness in acute ethmoidal sinusitis is:

a. The inner canthus.
b. The supra-orbital margin.
c. The infra-orbital margin.
d. Non of them.

169. The point of tenderness in acute maxillary sinusitis is:

a. The inner canthus.
b. The supra-orbital margin.
c. The infra-orbital margin.
d. Non of them.

170. Unilateral nasal discharge and unilateral nasal obstruction in 13 years old
boy is most probably diagnostic of:
a. Choanal atresia.
b. Adenoids.
c. Nasopharyngeal carcinoma.
d. Non of them.
171. In frontal sinusitis, the discharge is in:
a. The anterior part of the middle meatus.
b. The posterior part of the middle meatus.
c. All over the middle meatus.
d. The inferior meatus.

172. In ethmoidal sinusitis, the discharge is in:

a. The anterior part of the middle meatus.
b. The posterior part of the middle meatus.
c. All over the middle meatus.
d. The inferior meatus.

173. In maxillary sinusitis, the discharge is in:

a. The anterior part of the middle meatus.
b. The posterior part of the middle meatus.

c. All over the middle meatus.

d. The inferior meatus.

173. Mucoid fluid in the maxillary sinus indicates:

a. Suppurative inflammation with irreversible mucosal damage.
b. Suppurative inflammation with reversible pathology.
c. Allergic sinusitis.
d. Catarrhal inflammation.

174. Mucopurulent fluid in the maxillary sinus indicates:

a. Suppurative inflammation with irreversible mucosal damage.
b. Suppurative inflammation with reversible pathology.
c. Allergic sinusitis.
d. Catarrhal inflammation.

175. Purulent fluid in the maxillary sinus indicates:

a. Suppurative inflammation with irreversible mucosal damage.
b. Suppurative inflammation with reversible pathology.
c. Allergic sinusitis.
d. Catarrhal inflammation.

176. A patient with human immunodeficiency virus with a CD4

count of less than 200 cells/mm3 presents with a polyp of the
middle ear and discharge. These findings are most likely
attributable to an infection that would respond

best to which treatment?

A. isoniazid
B. rifampin
C. trimethoprim-sulfamethoxazole
D. amphotericin B
E. fluconazole

176. A 30-year-old man from India presents with symptoms of

epistaxis and nasal obstruction. Physical examination discloses a
friable, painless, polypoid growth at the nasal vestibule. The
treatment for the most likely cause of these findings includes
A. penicillin and diphtheria antitoxin.
B. ciprofloxacin and surgical débridement.
C. dapsone.
D. an antitubercular combination regimen.
E. surgical removal only with no medical treatment.

177. What is the most frequent site of involvement when leprosy

affects the upper respiratory tract?
A. larynx
B.
hypopharynx
C. nose
D. middle ear
E. salivary
glands

178. Two weeks after a mandibular tooth extraction, a 33-yearold woman

develops a mildly tender induration of the
neck and mandibular area. The lesion slowly progresses to
a board-like consistency with a draining fistula. A pathognomonic finding in
this condition is
A. “sulfur
granules.”
B. Mikulicz’s cells.
C. “foamy histiocytes.”
D. Charcot-Leyden crystals.
E. fungus ball.

179. A 50-year-old insulin-dependent diabetic patient presents with

unilateral purulent rhinorrhea and proptosis. Physical examination shows
ulceration and necrosis of the lateral
nasal wall. Appropriate treatment of the most likely diagnosis includes
A. surgical débridement and amphotericin
B. B. dapsone.
C. surgical débridement and itraconazole.
D. amphotericin B only.
E. surgical débridement only.

180. A 40-year-old man, in otherwise good health, presents with

unilateral painless otorrhea. Otologic examination shows a near-total
perforation of the tympanic membrane with granulation tissue in the
middle ear. Additionally, the patient has partial facial weakness.
Which is the most likely diagnosis?
A.aspergills
B. leprosy
C.tuberculosis
D.histoplasmoE
.cryptococcosis

181. A 30-year-old recent immigrant from Central America presents with long-
standing nasal obstruction, purulent rhinorrhea,
and crusting. Physical examination demonstrates
blue-red rubbery granulomas of the nasal mucosa, as well as
broadening of the nasal dorsum. Some parts of the nasal airway
appear fibrotic. The most likely diagnosis is
A.
mucormycosis.
B. tuberculosis.
C.
rhinosporidiosis.
D. histoplasmosis.
E. rhinoscleroma.

182. A 70-year-old man complains of soreness in the left vestibule over

the last 3 to 4 months that has failed to respond to a variety of topical
preparations. A small ulcerated area is noted on the inner vestibule skin
from which a biopsy is taken. The histology report suggests chronic
inflammation, a few basaloid cells, and areas of necrosis. As a
consequence, one should
A. reassure him that there is nothing seriously wrong.
B. arrange a computed tomography scan.
C. perform a second biopsy.
D. refer him to a dermatologist.
E. place him on long-term oral antibiotics.

183. A woman of 30 years develops significant collapse of the nasal

bridge after a septoplasty. She had felt generally
unwell and had developed some crusting and spotting of blood
from the nose. Endoscopic examination reveals a generally
friable mucosa throughout the nose that bleeds easily and is
associated with generalized crusting. The next step is to
A. offer her reconstructive surgery.
B. perform a computed tomography (CT) scan.
C. take a biopsy of the nasal mucosa.
D. obtain blood tests.
E. perform a bone scan.

184. A 20-year-old man complains of left-sided nasal obstruction that began

spontaneously 2 years ago. There have
been no other nasal symptoms, and otolaryngologic examination, including
rigid endoscopy, is entirely normal, as
was a computed tomography (CT) scan of the sinuses. Medical
therapy in the form of intranasal corticosteroids has proved
ineffective, and the patient insists that nasal surgery be
performed. Which investigation would best clarify the situation?
A. nasal inspiratory peak flow
B. anterior active rhinomanometry
C. olfactory thresholds
D. magnetic resonance imaging
E. saccharin test of mucociliary clearance

185. A high fever, conjunctivitis, polymorphous erythematous rash,

erythema and edema of the extremities, cervical lymphadenopathy, and
necrotic pharyngitis in a child
under 5 years suggest which of the following conditions? A.
erythema multiforme major
B. erythema multiforme minor
C. Reiter’s syndrome
D. Kawasaki’s disease
E. systemic lupus erythematosus

186. Adult supraglottitis (epiglottitis) differs from pediatric

supraglottitis in all of the following ways except
A. in adults, the infectious agent is less likely Haemophilus and more
likely group A streptococcus.
B. in adults, the clinical course is usually less severe.
C. in adults who present with drooling, endotracheal intubation is
frequently necessary.
D. in adults, progression to epiglottic abscess is more
common.
E. in adults, conservative measures include oxygenation,
humidification, hydration, corticosteroids, and intravenous
antibiotics.

187. Isolated laryngeal candidiasis is usually secondary to

A. prolonged antimicrobial use.
B. systemic corticosteroid use.
C. inhaled corticosteroid use.
D. insulin-dependent diabetes.
E. infection with human immunodeficiency virus.

188. The initial management for a child with suspected supraglottitis is

A. referral to radiology for a soft tissue lateral radiograph of the
neck.
B. fiberoptic laryngoscopy to confirm the diagnosis.
C. consultation with pediatric infectious disease for
antimicrobial recommendations.
D. supervised transport to the operating room to secure the
airway.
E. admission to the pediatric intensive care unit for observation and
intravenous antibiotics.

190. The cause of secondary hemorrhage is:

a. Wound sepsis.
b. Unprepared patient.
c. Injury of the pharyngeal muscle.
d. Rising of blood pressure with slipping ligature.

191. The cause of reactionary hemorrhage is:

a. Wound sepsis.
b. Unprepared patient.
c. Injury of the pharyngeal muscle.
d. Rising of blood pressure with slipping ligature.

192. The cause of primary hemorrhage is:

a. Wound sepsis.
b. Unprepared patient.
c. Injury of the pharyngeal muscle.
d. Rising of blood pressure with slipping ligature.

194. Fever in diphtheria is:

a. High grade fever.
b. Low grade fever.
c. Remittent fever.
d. Intermittent fever.
5. the pulse in diphtheria is:
a. Weak rapid pulse.
b. Full bounding pulse.
c. Synchronous with the temperature.
d. Non synchronous with the temperature.

195. In a case of 5 years old boy with a membranous faucial lesion , temp 38° &
pulse 180/min, the most probable diagnosis is:
a. Infectious mononucleosis.
b. Acute follicular tonsillitis.
c. Diphtheria.
d. Agranulocytosis.

196. The causative agent of vincent`s agent:

a. Boreli vencenti.
b. Candida albicans.
c. Barr-epestin virus.
d. Streptococci.

197. The causative agent of infectious mononucleosis:

a. Boreli vencenti.
b. Candida albicans.
c. Barr-epestin virus.
d. Streptococci.

197. The causative agent of thrush stomatitis is:

a. Boreli vencenti.
b. Candida albicans.
c. Barr-epestin virus.
d. Streptococci.

198. Paul-bunnell test is diagnostic for:

a. Diphtheria.
b. Acute follicular tonsillitis.
c. Infectious mononucleosis.
d. Thrush stomatitis.

199. Leucoplakia of the oral & pharyngeal mucosa is:

a. Malignant condition.
b. Precancerous condition.
c. Inflammatory condition.
d. Toxic condition.

200. The following antibiotic is contraindicated in infectious mononucleosis :

a. Ampicillin.
b. Erythromycin.
c. Cephalosporin.
d. Non of the above.

201. Adenoid hypertrophy may lead to all of the following EXCEPT:

a. Adenoid face.
b. Otitis media with effusion.
c. Sensory neural deafness.
d. Night mares.

202. Chronic retropharyngeal abscess is treated by:

a. External drainage posterior to sternomastoid.
b. External drainage anterior to sternomastoid.
c. Internal drainage via longitudinal incision.
d. Non of the above.

203. Acute retropharyngeal abscess is treated by:

a. External drainage posterior to sternomastoid.
b. External drainage anterior to sternomastoid.
c. Internal drainage via longitudinal incision.
d. Non of the above.
204. Chronic retropharyngeal abscess is caused by:
a. TB of bodies of the cervical vertebrae.
b. Suppuration of the retropharyngeal gland.
c. Diphtheria bacilli.
D
22. Acute retropharyngeal abscess is caused by:
a. TB of bodies of the cervical vertebrae.
b. Suppuration of the retropharyngeal gland.
c. Diphtheria bacilli.
d. Non of the above.

205. Frog face appearance, is a clinical manifestation of:

a. Ludwig's angina.
b. Juvenile nasopharyngeal angiofibroma.
c. Retropharyngeal abscess.
d. Non of the above.

206. the possible cause of death in case of juvenile nasopharyngeal angiofibroma

is:
a. Recurrent infection.
b. Sever epistaxis.
c. Upper respiratory tract obstruction.
d. Non of the above.

207. What theoretical plane from the medial canthus of the eye to the angle of the mandible divides the
facial skeleton
into two parts?
A. Ohngren’s line
B. Frankford’s line
C. Kennedy’s line
D. Osguthorpe’s line
E. arcuate line

208. Poor prognostic factors among nasal and paranasal sinus malignancies include all of the following
except
A. histologic subtype.
B. lymph node involvement.
C. skull base involvement.
D. stage.
E. perineural invasion.

209. Resectability of tumors and extent of surgery are defined by

A. computed tomography (CT).
B. magnetic resonance imaging (MRI).
C. surgical exploration.
D. transdural extension.
E. all of the above.

210. Incisional components of the midfacial degloving exposure include

A. marginal rim incisions.
B. transcartilaginous lower lateral cartilage incisions.
C. intercartilaginous (between the upper and lower lateral cartilages) incisions.
D. hemitransfixion incision.
E. external columellar incision.

211. Complications associated with craniofacial resection include

A. anosmia.
B. dacryocystitis.
C. meningitis.
D. pneumocephalus.
E. all of the above.

212. A high fever, conjunctivitis, polymorphous erythematous rash, erythema and edema of the
extremities, cervical lymphadenopathy, and necrotic pharyngitis in a child
under 5 years suggest which of the following conditions? A. erythema multiforme major
B. erythema multiforme minor C. Reiter’s syndrome
D. Kawasaki’s disease
E. systemic lupus erythematosus

213. All except one of the following signs are oral manifestations of leukemia:
A. gingival hypertrophy
B. atrophic smooth erythematous tongue
C. necrotic ulcers of the mucous membranes
D. pallor of the mucous membranes
E. petechiae of the mucous membranes

214. All except one of the following are oral manifestations of human immunodeficiency virus (HIV)
infections:
A. angular cheilitis
B. hairy leukoplakia
C. diffuse parotitis
D. Kaposi’s sarcoma
E. Wickham’s striae

215. Which fascial space is the most frequently involved with serious infections and is the most frequent
route of spread of infection from one region to another?
A. prevertebral
B. retropharyngeal
C. lateral pharyngeal
D. submandibular
E. visceral

216.Which of the following radiologic studies is the most valuable for evaluating deep neck infections?
A. contrast-enhanced computed tomography (CT)
B. contrast-enhanced magnetic resonance imaging
C. contrast-enhanced MRI with magnetic resonance angiography
D. ultrasonography
E. lateral neck radiography

217. If a malignancy is suspected in a child with an enlarged cervical lymph node, which of the following
is preferred to establish a diagnosis?
A. endoscopy with biopsy of likely primary sites
B. excisional biopsy
C. incisional biopsy
D. needle biopsy
E. punch biopsy

218. Which of the following is not an odontogenic tumor?

A. ameloblastoma
B. cementoblastoma
C. myxoma
D. odontoma
E. osteoma
219. Adenoidectomy may help improve all of the following conditions except
A. recurrent otitis media.
B. otitis media with effusion.
C. upper airway obstruction.
D. sinusitis.
E. velopharyngeal insufficiency.

220. Which of the following is the least common complication of adenotonsillectomy?

A. torticollis
B. nasopharyngeal stenosis
C. hypernasal speech
D. dehydration
E. bleeding

221. Which study is the most definitive test for the diagnosis of sleep apnea?
A. multiple sleep latency test
B. nocturnal oximetry
C. measurement of esophageal pressure during sleep
D. polysomnography
E. sleep sonography

222. Which of the following characteristics of stridor is true with laryngomalacia?

A. It is usually biphasic.
B. It is inspiratory only.
C. It is expiratory only.
D. It is usually not present.
E. None of the above.

223. The diagnosis of laryngomalacia can best be made

A. with radiographs of the neck.
B. with fluoroscopy.
C. with flexible laryngoscopy.
D. with rigid laryngoscopy and tracheoscopy.
E. by symptoms and signs alone.

224. If an infant has immediate airway distress on delivery, which is least likely to be the cause?
A. laryngeal atresia
B. laryngeal webs
C. laryngomalacia
D. saccular cyst
E. subglottic stenosis

225. Symptoms of laryngeal webs include

A. vocal dysfunction.
B. airway obstruction.
C. biphasic stridor.
D. reflux.
E. all of the above.

226. Saccular cysts are best diagnosed with

A. lateral neck radiography.
B. fluoroscopy.
C. barium swallow.
D. computed tomography of the neck.
E. direct laryngoscopy.

227. Laryngoceles
A. are symptomatic only when filled with air or fluid.
B. are easily diagnosed with lateral radiographs.
C. are symptomatically consistent.
D. are easily diagnosed with direct laryngoscopy.
E. cannot be diagnosed except at autopsy.

228. The most common manifestation of a laryngeal cleft is

A. aspiration and cyanosis.
B. asphyxia.
C. increased mucus production.
D. airway distress.
E. recurrent pneumonia.

229. Bilateral vocal cord paralysis may result from

A. compression of the vagus nerves in their course through the foramen magnum.
B. traction of the cervical rootlets of the vagus nerves.
C. brainstem dysgenesis.
D. all of the above.
E. none of the above.

230. Acquired subglottic stenosis is

A. associated with endotracheal intubation most frequently.
B. more common in neonates because they do not tolerate intubation well.
C. associated with a loose-fitting tube with a large air leak.
D. not associated with endotracheal intubation.
E. not affected by systemic factors.

231. Congenital subglottic stenosis A. always requires repair.

B. can be treated only with a tracheostomy.
C. can be observed expectantly if the symptoms are minimal.
D. requires a staged reconstruction with rib cartilage.
E. can be treated with dilatation if the stenosis is mature.

232. Which of the following mechanisms describes the most common biomechanics of laryngeal trauma?
A. laryngeal fracture, resulting in hemoptysis and asphyxiation
B. striking the laryngeal skeleton against the vertebral
column, resulting in a crush injury
C. laryngeal edema release by sudden acceleration and deceleration of soft tissue, inciting the
inflammatory cascade
D. penetrating injury, resulting in neck crepitance, pneumothorax, and pneumomediastinum
E. hematoma formation with loss of the airway

233. The radiographic evaluation of laryngeal injury plays an important role in the evaluation and
management of laryngeal fracture. Which statement about the radiographic evaluation of laryngeal injury
is most appropriate?
A. Emergency barium swallow is indicated for patients complaining of dysphagia and odynophagia to
rule out a tracheoesophageal fistula.
B. A computed tomographic (CT) scan should be obtained in all patients with suspected laryngeal trauma.
C. A lateral soft tissue film and chest radiograph at the bedside should be obtained to evaluate for
pneumothorax and viscus penetration.
D. Magnetic resonance imaging scan of the larynx should be done to rule out a hematoma.
E. A CT scan is obtained when the airway has been stabilized with a tracheostomy.

234. Surgical exploration of the larynx is indicated when A. there is a minimally displaced fracture of the
thyroid cartilage.
B. the laryngeal fracture is associated with laryngealedema.
C. there has been arytenoid cartilage avulsion.
D. there is limited mobility of one vocal fold.
E. there is evidence of cricothyroid muscle involvement.

235. The principles of cartilage fracture repair are especially complicated in the larynx owing to
A. the poor blood supply of partially avulsed laryngeal cartilage.
B. the fragments being difficult to stabilize.
C. lacerations in the airway, resulting in infection.
D. secondary healing, resulting in granulation tissue formation and cicatrix.
E. all of the above.

236. All of the following likely require a laryngeal stent except

A. telescoped cricoid cartilage fracture.
B. comminuted thyroid cartilage fracture.
C. disruption of the anterior commissure.
D. mucosal lacerations that require grafting.
E. all of the above.

237. Proper workup and management of a patient with vocal fold hematoma and mild supraglottic edema
on flexible laryngoscopy include all of the following except
A. elevation of the head of the bed.
B. open exploration.
C. voice rest.
D. humidified air.
E. Computed tomography (CT) scan of the larynx.

238. A 29-year-old man presents to the emergency department after striking the anterior part of his neck
against a fence
post while riding a motorcycle at 20 miles per hour. He is alert and oriented, with normal and stable vital
signs other than mild tachypnea. He has severe dysphonia, mildhemoptysis, and subcutaneous crepitus.
The best approach to the management of his airway is
A. fiberoptic endotracheal intubation.
B. cricothyrotomy under local anesthesia.
C. tracheostomy under local anesthesia.
D. direct laryngoscopy and intubation.
E. rigid bronchoscopy with a ventilating scope followed by tracheostomy.

239. Best results are obtained in open reduction and internal fixation of laryngeal fractures if
A. the procedure is performed 7 to 10 days after the injury to allow the edema to subside.
B. a stent is used to buttress the fixation.
C. all mucosal lacerations are closed.
D. any unstable cartilage is removed.
E. wires are used to fixate the reduced fracture sites instead of miniplates.

240. In general, the problem of late glottic insufficiency after laryngeal trauma may be addressed by all of
the following except
A. medialization laryngoplasty.
B. reconstruction with laryngeal stenting and grafting.
C. fat injection.
D. speech rehabilitation
E. supraglottic laryngectomy.

Supraglottic laryngectomy would be an appropriate choice if

the problem is laryngeal stenosis and not laryngeal insufficiency. The major cause of delayed laryngeal
chondronecrosis following full-course radiotherapy is
A. mucosal edema secondary to venous congestion.
B. infection secondary to poor ciliary function.
C. irreversible microvascular injury owing to intimal hyperplasia.
D. lymphatic outflow congestion.
E. mucosal dryness secondary to damage to mucousglands.

241. Laryngopharyngeal reflux differs from gastroesophageal reflux disease in all of the following ways
except
A. patients with laryngopharyngeal reflux frequently experience daytime reflux.
B. patients with laryngopharyngeal reflux typically experience upright reflux.
C. patients with laryngopharyngeal reflux frequently suffer from heartburn.
D. patients with laryngopharyngeal reflux often suffer from globus and chronic cough.
E. patients with laryngopharyngeal reflux often suffer from hoarseness.

242. The most common laryngeal inflammatory disorder in children is

A. laryngopharyngeal reflux.
B. herpes simplex laryngitis.
C. vocal misuse and abuse.
D. viral laryngotracheitis.
E. acute supraglottitis.

243. The initial management for a child with suspected supraglottitis is

A. referral to radiology for a soft tissue lateral radiograph of the neck.
B. fiberoptic laryngoscopy to confirm the diagnosis.
C. consultation with pediatric infectious disease for antimicrobial recommendations.
D. supervised transport to the operating room to secure the airway.
E. admission to the pediatric intensive care unit for observation and intravenous antibiotics

244. Adult supraglottitis (epiglottitis) differs from pediatric supraglottitis in all of the following ways
except
A. in adults, the infectious agent is less likely Haemophilus and more likely group A streptococcus.
B. in adults, the clinical course is usually less severe.
C. in adults who present with drooling, endotracheal intubation is frequently necessary.
D. in adults, progression to epiglottic abscess is more common.
E. in adults, conservative measures include oxygenation, humidification, hydration, corticosteroids, and
intravenous antibiotics.

245. Isolated laryngeal candidiasis is usually secondary to

A. prolonged antimicrobial use.
B. systemic corticosteroid use.
C. inhaled corticosteroid use.
D. insulin-dependent diabetes.
E. infection with human immunodeficiency virus.

246. Which of the following may result in secondary muscle tension dysphonia?
A. Bogart-Bacall syndrome
B. psychogenic dysphonia
C. cheerleading
D. presbylaryngis
E. teaching

247. Which of the following is not an indication to remove a vocal process granuloma?
A. When there is concern for underlying laryngea carcinoma.
B. When the lesion has progressed to a fibroepithelial polyp.
C. When the lesion has been present for more than 6 weeks.
D. When there is concern for airway obstruction.
E. When a professional voice user is severely dysphonic.

248. Pseudosulcus vocalis refers to

A. an adhesion of the vocal fold epithelium to the underlying vocal ligament.
B. a vocal fold scar.
C. subglottic edema that is a manifestation of laryngopharyngeal reflux.
D. a type of vocal fold pseudocyst.
E. an area of localized Reinke’s edema.

249. Treatment for laryngeal diphtheria includes all of the following except
A. securing the airway with a tracheostomy tube if necessary.
B. securing the airway with an endotracheal tube if necessary.
C. fluid resuscitation and supportive care.
D. antimicrobial therapy with penicillin or erythromycin.
E. administration of diphtheria antitoxin.

250. Which of the following statements is not true about laryngeal tuberculosis?
A. It is one of the most common granulomatous diseases of the larynx.
B. It is usually associated with advanced pulmonary disease.
C. Its prevalence has been rising since the emergence of HIV.
D. The clinical presentation is often similar to that of a neoplastic process.
E. One-quarter of patients with laryngeal tuberculosis present with airway obstruction.

251. in a patient presenting with severe throbbing pain in the nasal vestibule
a- the likely diagnosis is vestibulitis .
b- squeezing pus from the swelling is recommended.
c- the causative organism is streptococcus hemolyticus .
d- checking the blood sugar in recurrent cases is recommended

252. The causative organism in influenza is

a- Haemophilus influenza
b- influenza virus type A, B, C
c- Rhinovirus
d- none of the above.

253. The most frequent cause of nasal allergy is

a- synthetic materials
b- smoke
c- insecticides
d- house dust mites.

254. The primary treatment of acute maxillary sinusitis is

a- Puncture and lavage of the sinus.
b- Inferior meatal antrostomy
c- Medical treatment.
d- Functional endoscopic sinus surgery.

255. The following statements are correct concerning lupus vulgaris except
a- It is caused by attenuated tubercle bacilli.
b- reddish ulcerating nodules at the mucocutaneous junction are seen.
c- perforation of the hard palate is characteristic sign.
d- perforation of cartilagenous part of the septum may occur.

256. The organism involved in the pathogenesis of atrophic rhinitis is

a- klebsiella rhinoscleromatis .
b- klebsiella ozynae .
c- non of the above .
d- all of the above

257. In atrophic rhinitis the following signs are seen except

a- reddish non ulcerating firm nodules at the muco-cutaneous junction.
 b- roomy nose.
c- greenish offensive crusts.
d- pale and atrophic mucosa

258. In a teenager presented with unilateral nasal obstruction with single pale grayish glistening soft
pedunculated mass. The most likely diagnosis is:
a- nasopharyngeal angiofibroma .
b- inverted papilloma .
c- antrochoanal polyp.
d- non of the above.

259. Syphilis of the nose may cause

a- bony septal perforation.
b- palatal perforation.
c- saddle nose deformity.
d- all of the above.

260. The criteria of early congenital syphilis are

a- Persistent rhinorrhoea, vestibulitis with fissuring of the upper lip.
b- Notching of the upper central incisors with keratitis.
c- Peforation of the nasal septum.
d- Non of the above.

261. Uncontrolled diabetic patient was diagnosed as having acute sinusitis. His general condition
deteriorated rapidly. Nasal examination revealed blackish crusts, the most likely diagnosis is
a- mycetoma.
b- acute fulminating fungal sinusitis.
c- allergic fungal sinusitis.
d- chronic indolent fungal sinusitis

262. A patient presented with bilateral nasal obstruction after nasal trauma. The patient temperature is 38.
There is throbbing nasal pain. Your diagnosis is
a- nasal frunculosis .
b- septal hematoma.
c- septal abscess.
d- 4- non of the above

263. 25 years old patient with fever, mucopurulent nasal discharge and pain over the cheeks is
suffering from
a. Frontal sinusitis.
b.Acute maxillary sinusitis.
c. Ethmoidal sinusitis.
d.Chronic maxillary sinusitis

264. An atopic 35 years old patient presented with unilateral nasal obstruction. Examination
revealed unilateral multiple nasal polypi and CT scan revealed unilateral sinus opacity with
hyperdense spots . what is your diagnosis?
a- allergic nasal polypi
b- acute fulminating fungal sinusitis.
c- allergic fungal sinusitis
d- chronic indolent fungal sinusitis.

265. -40 years old male presented with left nasal obstruction and fleshy reddish nasal mass.
There is a history of recurrence after previous surgery 2 years ago

a- the likely diagnosis is nasopharyngeal angiofibroma

b- inverted papilloma is suspected.
 c- allergic nasal polypi is a possible diagnosis
d- none of the above.

266. Juvenile nasopharyngeal angiofibroma is characterized by the following except:

a. Affects teenagers
b. Causes nasal obstructions
c. Very vascular tumor
d. Affects only females

267. The commonest benign tumor of the paranasal sinuses is

a. inverted papilloma
b. osteoma
c-nasopharyngeal angiofibroma
d- non of the above

268. All of the following are tumors of the nose except

a. Inverted papilloma.
b. Bleeding polyp of the septum.
c. Pott’s puffy tumour.
d. Osteoma.

269. In a 45 years old female patient presenting with pulsating tinnitus and red mass behind
the drum, all of the following are true except :
a- glomus tumour is a possible diagnosis
b-more assessment is needed by CT scan or MRI
c- MRI angiography confirm the diagnosis
d-biopsy is essential to verify the pathological nature

270. Cacosmia means

a. Complete loss of smell
b. Diminution of the sense of smell
c. Smelling bad odor due to the presence of noxious substance in the nose.
d. Smelling of non existing odor.

271. Parosmia means

a- smelling of bad odor due to the presence of noxious substance in the patient nose.
b- smelling of non existing odor .
c- complete loss of the sense of smell.
d- -diminution of the sense of smell

272. Cerebrospinal rhinorrhea is characterized by all of the following except

a- watery and salty.
b- does not stiffen handkerchief.
c- increase on straining.
d- Bilateral.

273. The following are causes of unilateral offensive nasal discharge except
a- nasal malignancy.
b- nasal foreign body.
c- nasal allergy.
d- allergic fungal sinusitis

274. 3 years old male child with recurrent epistaxis, subcutaneous hematoma and swollen
joints after minor trauma is probably suffering from
a. thrombocytopenic purpura .
b.hemophilia.
 c. Leukemia.
d.rheumatic fever

275. Keisselbach’s plexus accounts for the following percentage of epistaxis

a- 50%.
b- 60%.
c- 70%.
d- 80%.
e- 90% ki

276. Bilateral nasal obstruction in a 40 years old patient can be caused by

a- posterior choanal atresia.
b- bilateral nasal polypi.
c- nasopharyngeal angiofibroma..
d- foreign body.

277. In a patient presenting with right watery clear nasal discharge that increases with
straining, the following statements are correct except.
a- cerebrospinal rhinorrhoea is suspected.
b- CT scan with intrathecal dye injection is necessary.
c- biochemical analysis of the nasal discharge should be done.
d- nasal drops and packing are helpful to the patient.
e- patient should avoid nose blowing and leaning

278. 19 years old female presented with anosmia and crusty nose. Her mother described bad
odor of her daughter’s nose. The most likely diagnosis is
a. rhinoscleroma
b.foreign body in the nose
c. chronic sinusitis.
d.atrophic rhinitis

279. Which of the following is wrong concerning submucous resection septal operation
a. it is contraindicated before the age of 18.
b. it can be done under local anaesthesia.
c. the incidence of septal perforation is less than septoplasty operation.
d. the incidence of septal hematoma is more common than septoplasty operation.

280. A middle aged female with gradually progressive dysphagia, koilonychia, hypochromic
anaemia and glazed tongue is suffering from
a. Plummer Vinson syndrome.
b. hypopharyngeal carcinoma.
c. oesophageal carcinoma.
d. achalasia
281. Functional Endoscopic sinus surgery is the operation of choice in all of the following
except
a- mucocele of the paranasal sinus.
b- Twisted nose.
c- Chronic sinusitis.
d- Nasal polyposis.

282. The value of functional endoscopic sinus surgery is to

a- Restore the function of the nose and sinuses
b- Avoid external scar
c- Preserve sinus drainage through the natural ostium.
d- All

283. The commonest cause of nasal septal perforation is

 a- Tuberculosis
b- Syphilis
c- Septal operations
d- Congenital

284. The nasopharynx takes its sensory nerve supply from

a. trigeminal nerve
b.glossopharyngeal nerve
c. vagus nerve
d.non of the above

285. The oropharynx takes its sensory nerve supply from

a- trigeminal nerve
b- glossopharyngeal nerve
c- vagus nerve
d- non of the above

286. The hypopharynx takes its sensory nerve supply from

a- trigeminal nerve
b- glossopharyngeal nerve
c- vagus nerve
d- none of the above
287. The part of the pharynx that lies in front of the 3rd to 6th cervical vertebra is a- oropharynx
b- nasopharynx
c- hypopharynx
d- the whole pharynx.
288. The voluntary stage of swallowing is
a- the oral phase
b- the pharyngeal phase
c- the esophageal phase
d- both 1 and 2
289. The posterior pillar of the tonsil is formed by
a- Palatoglossus muscle.
b- Palatopharyngeus muscle
c- Tensor palate muscle
d- Styloglossus muscle.

290. Infreior constrictor musle of the pharynx take origin from

a- Hyoid bone
b- Mandible
c- Maxilla
d- Thyroid and cricoid cartilage

291. The second stage of swallowing is completed by

a- Elevation of the soft palate
b- Retroflexing epiglottis
c- Closure of the laryngeal aperture
d- Cricopharyngeal sphincter relaxation

292. A middle aged female with gradually progressive dysphagia, koilonychia, hypochromic
anaemia and glazed tongue is suffering from
a. Plummer Vinson syndrome.
b. hypopharyngeal carcinoma.
 c. oesophageal carcinoma.
d. achalasia
293. The most common cause for pharyngeal and oral ulceration is
a- Behcet disease.
b- aphthous ulcers.
c- tuberculous ulcers.
d- syphilitic ulcer
294. The earliest and commonest complication of diphtheria is
a- heart failure
b- palatal paralysis.
c- laryngeal obstruction.
d- acute nephritis

295. The earliest and Commonest neurological complication of Diphtheria is

a- paralysis of occular muscles.
b- paralysis of the diaphragm
c- palatal paralysis.
d- laryngeal paralysis

296. Which of the following is not true concerning active immunization against diphtheria
a- it is compulsory and given at the age of 2,4 and 6 month.
b- it is given to contacts of diphtheretic patients.
c- it is given to diphtheria patients.
d- booster doses are given at the age of 18 months and 5 years

297. In diphtheria, the antitoxic serum is given

a- To neutralize the circulating antitoxin.
b- To neutralize the fixed antitoxin
c- to kill the diphtheria bacilli.
d- all of the above

298. True pharyngeal membrane occurs in

a- vincent angina
b- diphtheria.
c- infectious mononucleasis .
d- acute membranous tonsilitis

299. Rapid onset of sore throat , fever , anorrhexia and malaise suggest
a- allergic rhinitis.
b- Influenza.
c- Vasomotor rhinitis.
d- All
300. patient suffering from severe sore throat and generalized lymphadenopathy received
ampicilline injection by his family doctor and then he developed rubella like skin rashes. You
should consider doing
a- Blood picture
b- Abdominal ultrasound
c- Monospot test
d- All of the above are true
e- Continue giving ampicilline.