ENT

1.A25y earoldpat ienthaspr esent

edtoOPDwi t
hfoulsmelldi
schargefr
om ri
ghtear,anddecr
eased
hear
inglevelforthel ast7y ear
s.Onotoscopi
cexaminat
ionCholest
eotomaisseenintheatt
icregi
on
aspearlwhitemat eri
als.CTscanshowshy podent
eopacit
yinther i
ghtmastoi
dantrum,Whatisthe
mostli
kelydiagnosi sinthi
scase?

AAcuteSupporat
iveOt
it
isMedi
a
BChroni
cSupporati
veOti
ti
sMedia
COtoscl
erosi
s
DSecret
oryoti
ti
smedia
ETympanoscler
osis

2.A15y ear
sol dpatienthaspr esentedtoaconsul t
antcli
nicforcompl ai
ningofr i
ghteardischarge,
swell
ingandpai nforlast20day s.Theconsul
tantnoti
cesaswel l
ingandlabeleditasanextracranial
complicat
ionofchoronicsupportiveoti
ti
smediaalongthester
ocleidomast
oidmuscl e.CTScanshows
erosi
onoft heboneatsi nudur
alangle.Whati
sthemostl i
kel
ydiagnosisi
nthiscase?

ABezoldsAbscess
BCit
il
eabscess
CLucsabscesses
DMastoidabscesses
EZygomati
cabscesses

3.A12y earsoldpati
enthaspr esent
edtoEmergencyRoom complai
ningofFever&rigorsfort
hel
ast4
days.Hei salsoadi agnosedcaseofcholesteat
omaleftear.Theconsult
antadv isedaMagneti
c
ResonanceVenographyt oshow venousf
low andPTAshowsmi xedhear
ingloss.Whati st
hemost
l
ikel
ycli
nical
diagnosi
sinthiscase?

AAcutemast oidit
is
BAcutepy ogenicmeningi
ti
s
CCerebell
arabscess
DLateral
sinust hr
ombosis
EOti
tichydrocephalus

4.An11y earsoldboywasbr oughttoemer gencyr

oom byhismot hercomplainingofuni lat
eralsore
thr
oat,headacheanddiffi
cult
yinmouthopeningfort
helast7days.Onexaminationapal pableswell
ing
i
snot i
cedatl evel
-2behindangleoft hejaw andonoralcavi
tyexaminat
ion,swel li
nghasext ension
poster
iortotheposter
iorpil
l
arofthetonsi
lonsameside.Whatisthemostli
kelydi agnosi
sint hi
scase?

AUnil
ateraltonsil
li
ti
s
BPeritonsil
larabscesses
CParaphar yngealabscesses
ERetrophary ngealabscesses
DPleomor phicadenoma

5.A55y earoldmanwasbr oughttotheemergencyroom compl ainingofhoar senessofv oicefort helast

7mont hsthatisprogr
essiveandnowhav i
ngdi f
fi
cultyinbreathingf orthelastthreeday s.Hei sgiving
hi
stor
yofCar cinomaLar ynxforwhichhereceiv
edr adiat
ion.Flexiblelaryngoscopyshowsf ixedv ocal
cor
dswi thulcerat
edgr owthandCTScanshowshet erogeneousl yenhanci nglesioninv ol
vingv ocal
cor
dsandt hyroi
dcarti
l
age.Whati sthemostappropriat
eT- st
agecl assifi
cationforthispati
ent?
A TO
B T1
C T2
D T3
E T4b

6.A45y earol
dmanhasbr oughttotheemer gencyroom compl ai
ningofhoarsenessofvoi
ceforthel
ast
14mont hsthati
sprogressiv
eandnowhav ingdif
ficul
tyinbreathingf
orthelasttwodays.Heisgiv
ing
hist
oryofCar ci
nomaLar ynxforwhichher ecei
vedr adiat
ion.Thepatienthasdev el
opeddecrease
satur
ati
onforwhichi
nterventi
onisneeded.Whatist hebestairwaymanagementopt i
oninthi
scase?

AEndoTr acheal
Intubati
on
BTracheostomybet weenri
ngt
woandt
hreeoft
rachea
CLowTr acheost
omy
DPercutaneousTracheostomy
EHighTracheostomy

7.A 60 y earol d man has pr esent

ed to speci
ali
stoutpati
entcomplaini
ng ofpainfulswallowi
ng,
hoarsenessofv oiceand
sometimer egurgi
tat
ionoff oodforthelast8mont hs.Examinat
ionoft
heneckandi ndi
rectlar
yngoscopyare
unr
emar kable.HisHbl eveli
s9. 8g/ dl
,Totall
eucocytecount15000mcl .Repeat
edWat ersolubleBari
um
swall
owshowsaconst antfi
ll
ingonthesideoftheneck.Whatisthemostl
ikel
ydiagnosi
sinthiscase?

ALaryngocel
e
BOesopheagealcarci
noma
CPharyngealpouch
DPir
if
orm sinuscarci
noma
EPostcricoi
dcarci
noma

8.A5y earol
dpatientisbr
oughtt
oconsul tantcli
nicbyhisparent
scomplai
ningofpai
ninhi
sri
ghtearof
suddenonsetofthreehour
sduration.Otoscopyshowsr edcongest
edTympanicmembranewit
hbulge
i
nt hecent
reandt hepati
enti
sf ebril
etoo.Whati sthemostl i
kel
yrout
eofspreadofinf
ect
ionint
his
case?

ADir
ectspreadfr
om externalear
BHaematogenousspread
CInf
ecti
onoftheParaNasal Si
nusi
s
DPatul
ousEustachi
anTube
EShort
erandwiderEustachianTub

9.A55y earsoldpati
enthaspr esentedtooutpat
ientdepartmentcompl ai
ningofchangeinvoi
ceforthe
l
ast3mont hsthatispersi
stentandpr ogr
essiv
ei nnature.HerFlexi
bleEndoscopyshowsafungati
ng.
ul
cer
ativelesi
oninvol
vingant er
ioronethi
rdoft herightv ocalcor
d,butbothv ocalcor
dsar
emobi le.
Whati
st hemostlikel
ydiagnosisinthi
scase?

AAryt
enoidgranuloma
BCordpapil
loma
CSquamouscel lcar
cinoma
DVocalcordnodule
EVocalcordpolyp

10.
A19year
sol
dpati
entwasdi
agnosedasacaseofGradi
nigosyndr
omedueChronicSupporat
iveOti
ti
s
medi
a7daysago.Onexami
nati
on,thepostaur
alar
eaistenderwit
hscant
yfoulsmell
ingdischar
ge
 f
rom thelef
tear.Puretoneaudi
omet
ryshowsmi
xedhear
ingl
oss.Whati
sthemostl
i
kel
ycause
r
esponsi
blefort
hiscondi
ti
on?

AAcutemastoidabscess
BAcutepetr
osit
is
CChroni
cotit
ismedia.
DLucusabscesses
ESecret
oryoti
ti
smedia

11.
A 24yearoldpat
ienthashi storyoffoulsmelldi
schargefr
om rightearforthelast7years.On
exami
nati
onhehasatticdefectandgranul
ati
onti
ssue.Fort
helast7days,hehasdevel
opedatri
adof
eardi
schar
ge,r
etr
o-orbit
alpainand6t hnervepar
alysi
s.Audi
ometryshowedprofoundhear
ingloss.
Whati
sthemostli
kelycauseinthispati
ent
?

ACav ernoussinusthr
ombosi
s
BLateralsinusthr
ombosi
s
CLaby r
inthit
is
DMast oidit
is
EPetrositi
s

12.
A17- year-
oldpati
enthaspresentedtooutpat
ientcomplai
ningofr i
ghtpainforthelast3day s.On
otoscopicexaminat
ionthetympanicmembranei sr
edcongested.Thepati
entrecei
vedoralanti
biot
ics
andnasal spray
sbutnotrel
i
vedMostef f
ect
ivetreat
mentopti
oninthispat
ientt
oav oi
dcompl i
cat
ionis

AInt
ravenousVenousAntibi
oti
cs
BNasal t
opical
steroi
ds
CMy r
ingotomywi t
hgrommetinser
ti
on
DTympanocent esi
sinant
eri
orsuperi
orquadrant
ETympanocentesisinant
eri
ori
nferi
orquadrant

13.
A40- y
ear-
oldmanhaspr esentedtooutpati
entcompl ai
ningofhoar
senessofv oi
cefort helast15
mont hspersistentandpr ogressi
ve.Neckexami nati
oni snormalandindi
rectlar
yngoscopyshows
ulceratedgr
owt honl ef
tvocalcordanter
ioronethirdwi t
hnormalmovements.Hi
sf l
exi
bleendoscopy
showssamef i
ndingsonlywhitepatchonrightcord.Whati st
hemostli
kel
yTSt ageofthediseasein
thiscase?

A St
age1
B St
age1a
C St
age1b
D St
age2a
E St
age2b

14.
A9y earol
dpat ienthaspresentedtooutpat
ientdepar
tmentcompl
ainingofnasalobst
ruct
ionand
decreasedheari
ngl ev
elinhisbot hear
s.Examinati
onshowshigharchedpalat
eanddulltymapani
c
membr anewithlossoflandmarks.XRaynasophary
nxshowsenlar
geAdenoids.Whati
sthemostli
kel
y
typeofhear
inglossinthiscase?

AConductiv
ehearingloss
BMixedhearingl
oss
CProfoundheari
ngloss
DSensoryNeuralHearingloss
ESuddenSensoryNeur alHeari
ngl
oss
 15. A45y earoldmanhaspr esent
edt ooutpati
entdepart
mentcomplainingofhoarsenessofvoi
ceforthe
l
ast18mont hsthatispersistentandprogressiv
e.Hei sfar
merbyprofession.Hi
sneckexami nati
onisnormal
andi ndir
ectlaryngoscopyshowsul ceratedgrowt honr i
ghtvocalcor danteri
ormi dpor t
ionwithnormal
mov ements.Hisflexi
bleendoscopyshowssamef indi
ngs,t
hepati
enti
sst agedasT1aNOMO.Hi st
opathol
ogy
reportshowsSquamousCel lCarci
noma.Af t
ercounseli
ngfortr
eat
ment ,heisrel
uctanttogoforRadiot
herapy
.
Whati sthemostl i
kelynexttreat
mentopt i
onint hi
scase?

AChemot herapy
DSubepi t
helialCordect
omy
BCordectomy
ETot
al Laryngectomy
CParti
allar
y ngectomy

16.A9y ear
soldboyhaspresentedtoconsul
tantout
pati
entcomplai
ningofbil
ater
aldecr
easedhear
ing
l
evel
f
orthe l
ast2 months.Otoscopyshows dulltympanic membrane and Tympanometr
yr eveal
stype B
t
ympanogram.Whati
sthemostli
kel
ydiagnosi
sint
hisincase?

AAcutesuppur ati
veotit
ismedia
BChronicotit
ismedi a
CRetractedtympanicmembr ane
DSecretoryoti
tismedia
ETympanoscl erosi
s

17.
A 40-
year-ol
dhy per
tensi
vemanpr esentedtoemer gencydepartmentwi t
hhistor
yofsuddenonset
sever
eepistaxi
s.Afterpr
operhist
ory,examinationandinvesti
gat
ionanteri
ornasalpacki
ngwasdone
butunsuccessf
ul.Youarecall
edforvesselli
gationundergener
alanest
hesiathr
oughendoscope.What
ist
hemostappr opri
atevesselt
obel i
gatedthroughendoscopetostopbleedi
ng?

AAnteri
orethmoidalart
ery
BPoster
iorethmoidalar
tery
CSeptalbr
anchofspheno-pal at
inearter
y
DSeptalbr
anchofgr eat
erpalati
neartery
ESeptalbr
anchofsuper i
orlabi
alart
ery

18.
A16y earoldboyhaspr esentedtoEmer gencyRoom withsuddenonsetofheadacheandv omit
ing.He
hasal sohistor
yoff oulsmel lr
ighteardischargefort
helast6years.Onexaminati
on,ther
eisscant y
dischargeandgr anulat
iontissueintheat ti
cregionofri
ghtearanddiff
icul
tyi
nclosingtheri
ghtey e.
Whati sthemostl i
kelyExtr
acr ani
alcompl i
cati
onofChroni
cSupporati
veOtit
isMediai
nthiscase?

ABrainabscess
BEpidur
al abscess
CFacialnerveparal
ysi
s
EOti
tishydrocephal
us

19.
A50y earol
dmal epati
entiscomingtospeci
ali
stout
pati
entcompl ai
ningofdif
fi
cul
tyinswal
lowingfor
li
quidsandsolids,r
egurgi
tat
ionoffoodandoccasi
onall
ychestpainforthelast2year
s.Hehashi st
ory
ofhospi t
ali
zat
ionforchestinfect
ion9mont hsback.Examinati
onoft henecki sunremar
kableand
indir
ectlar
yngoscopyshowspool i
ngofsali
va.Lowmolecul
arwei ghtbari
um swall
owshowscl assi
cal
birdbeakappearance.Whatisthemosteff
ecti
vetr
eatmentforthi
sdisease?
ABotul
inum t
oxininj
ection
BCardi
omy ot
omywi t
hparti
alfundopli
cat
ion
CCardi
omy ot
omywi t
hcompl et
ef undopl
i
cati
on
DOesophagealdil
atati
on
EOesophegectomy

20.
A51y earol
dshopkeeperpresent
edtotheConsult
antCliniccomplainingofhoarsenessofv oi
cefort
he
fast06mont hspersi
stentandprogr
essi
ve.Flexi
blelaryngoscopyshowsr ightfixedv ocalcor
dwi t
h
ulceratedgrowthandCTScanshowshet er
ogeneouslyenhanci ngl
esi oninvolv
ingv ocalcordwithno
extensiontothyr
oidcar
til
age.Whati
stheappropri
atestagingclassi
ficati
onforthispatient?

A T1NoMa
B T2NoMa
C T3NoMo
D T4NoMa
E T11NoMa

21.
A45y earoldmalepati
enti
spresent
edt oot
olar
yngol
ogyspeci
ali
stcl
i
niccomplaini
ngofhoar senessof
voicef orthelast3months.HeI schr
onicsmokerandwasusi ngmedicinesforheartbur n.Fl
exi
ble
lar
y ngoscopyshowsgr ayi
shwhitepatchesonanteri
ortwothir
dofbot hmobilev ocalcords.Under
dir
ectl ar
yngoscopy,t
heplaquescoul
dnotbeeasi l
yexci
sed.Whatisthemostl i
kel
ydi agnosisi
nt hi
s
case?

AContactulcers
BHyperkeratosis
CLeukoplakia
DSquamouscel lcar
cinoma
EVerr
icouscar ci
noma

22.
A17y earol
dgir
lwasbroughttotheemergencyroom compl
aini
ngofdiff
icul
tyinbr eat
hingforthel
ast
twoday s.Sheal
sogiveshist
oryofdent
almani pul
ati
on.Onexaminat
ion,thetonguei sprotr
udedwith
reducedmov ements.Whichoneoft hef ol
lowingisthemostl i
kel
yor gani
sm r esponsibl
eforthis
conditi
on?

AHaemophi l
iusi
nfl
uenza
BPseudomonasaer ugi
nosa
CStaphyl
ococusaureus
DStrept
ococcuspneumonae
ESt
reptococcusvri
dans

23.
A48y earoldhighschoolt eacherhaspresentedtooutpati
entcomplai
ningofhoar
senessofv oicef or
the l
ast16 mont hsper sistentand progressi
ve.Neckexami nati
on i
sunremarkable,and Flexible
lar
yngoscopyshowsul ceratedgrowthonr ightvocalcor
danterioronethi
rdwit
hnormalmov ement s.
Thispati
enti
sSt ageasTiaNOMO, accordi
ngt oAJCC.Whatisthemostappropr
iat
etreatmentoption?

DCordectomysegment al
Subepi
thel
i
alCor
dect
omy
BChemor adiotheraphy
ETot
al Laryngectomy
CRadiother
aphy

24.
A12y earol
dboyhascomet oOutpati
entcli
niccompl
aini
ngofdischar
gefrom hisri
ghtearfort
helast
2days.Onexami nati
onthety
mpanicmembr anehascentralper
forat
ionwit
hr edcongestedmucosa
andmucoiddischarge.Whi
choneoft hefol
lowingi
sthemostl i
kelycausat
iveorgani
sm responsi
ble
 upont
her
epor
tofcul
tur
eandsensi
ti
vi
tyt
est
?

AH.infl
uenzae
BPneumococcus
CPseudomonasAurgenosa
DStaphyl
ococcus
ESt
reptococcus

25.
A7y earol
dgi r
lwasbroughtt
otoutpat
ientbyherparent
scomplai
ningofbi l
ateraldecr
easedhear
ing
andnasalobstr
uct
ionforthel
ast3mont hs.Onotoscopy
,shehasbilat
eraldulltympani
cmembr anes
wit
hlossoflandmarksandisamouthbreather
.Tympanometr
yrevealstypeBgr aph.Whatisthemost
eff
ecti
veTreat
mentofchoicei
nthi
scase?

AAdenoTonsil
l
ectomy
BAdenodect
omywi thGromet t
sinserti
on.
CConserv
ati
vetreatmentwithanalgesics
DConserv
ati
vetreatmentwithantibi
oti
cs
EMyri
ngotomywi t
hv ent
il
ati
on,tubeinsert
ion

26.
A5y earoldboyi sscheduledfordiagnost
icbr
onchoscopy.Cli
nicalexami
nati
onandXRaychestar e
normal.Dur
ingrigidbronchoscopy,apieceofpeanutwasr emoved.Intherecov
eryroom t
hepatient
wasnotmai nt
aining02sat urat
ion,wi
thhyperr
esonantchestonper cussi
on.Whatisthenextst
epi n
thetr
eatmentofthispati
ent?

AEndotracheali
ntubat
ion
BChestintubati
on
CReBr onchoscopy
DTracheostomy
EVenti
latorsupport

27.A40y earol
dladyiscomingtospecial
i
stcli
niccomplaini
ngofdiff
icul
tyi
nswallowi
ngforthelast2
year
s.Shehashistor
yoftotalt
hyr
oidectomyfordi
fferent
iat
edthyroi
dcarci
noma3y earsback.Her
Bari
um swal
lowisnormalandfl
exi
bleendoscopyshowsr i
ghtvocalcordpar
aly
sis.Whati
st hemost
l
ikel
ycause
ofdysphagi
ainthi
scase?

A Decreasedpharyngealgradientpressureanddecr easedglott
isclosur
e
B Decreasedpharyngealgradientpressureandincreasedglotti
sclosure
C Incr
easedpharyngealgradientpressureandincreasedglotti
sclosure
D Incr
easedpharyngealgradientpressureanddecr easedglott
isclosure
E Superi
orconstr
ictormuscleandcr i
cothyr
oidmuscl edysfuncti
on

28.
A 20y earoldboypr esent
edt otheConsultantCl
ini
ccompl ai
ningofsorethr
oatanddi f
fi
cul
tyin
swallowing f
ort helast06 mont hsassoci
ated wi
thf everbodyachesand pains.Thepati
entis
appearinginprofessi
onalexaminati
on.Onexaminat
ionoft heor
alcavi
tymobi
lemucosalsurf
acesof
thetonguehav ingwhitereddi
shspot s,mul
ti
pleandtendertotouch.Whati
sthemostl i
kel
ycli
nical
diagnosisi
nthiscase?

AApthusulcers
BEryt
hroplaki
a
CLeukoplakia
DSubmucosal fi
brosi
s
ESquamouscel
lcar
cinoma

29.
A 15y earsol
dboywasbr oughttoemergencyr oom byhispar ent
scompl ai
ningofsorethr
oat,
headacheanddif
fi
cult
yinopeningmout
hforthelastthr
eedays.Hisbothtonsi
lsarecover
edbywhit
e
fol
li
clesandt
heleftt
onsi
li
senlargedmedi
all
yanteri
ortothepost
eri
orpill
arwit
hdev i
ati
onoft
heuvul
a
totheopposi
tesi
de.Whatisthemostpr
obabledi
agnosis?

AAcutefol
li
culartonsi
ll
it
is
BInf
ecti
ousmononucl eosis
CMembr anoustonsil
li
ti
s
DPerit
onsil
larabscesses
EParapharyngealabscesses

30.
A9y ear
soldboypresent
edtoconsult
antclini
cforpaininthethroat
,fever
,andsev
erebodyachesfor
thelast4days.Onexaminat
ion,t
heoropharynxiscongestedwithwhiti
shlayer
sandredspot
s,neckis
alsoswollenandt
ender.Whatist
heinvest
igati
onofchoiceinthi
spatient?

AASOTitre
BCompleteBloodPict
ure
CCult
ureandSensit
ivi
ty
DPaulBunnelTest
ERapi
dAnt i
gentest

31.
A16y earol
dgir
lpresentedtotheConsult
antClini
ccomplai
ningofswelli
nginthefloorofmouthfor
thelast06monthsthatisprogr
essi
ve.Theswell
ingisbl
uishi
ncol or
,soft
,nott
enderonleftsi
deoft
he
frenul
um andonventr
alofthetongue.Whatist
hemostlikel
yclini
caldi
agnosi
sinthi
scase?

ADermoi dcyst
BGranuloma
CPapil
loma
DRanula
ESubmandi bul
arductst
one

32.
A25y earol
dboypr esent
edt oemer gencyroom complai
ningofburni
ngsensationint
het hr
oatand
dif
ficul
tyinchewingf oodf orthelast06mont hsassociat
edwi t
hf ev
erbodyachesandpai ns.The
patienti
saddict
edt oPan( Betelquid)andsmoki ng.Onexaminati
onoftheoralcavi
tymobil
emucosal
surfacesoft
het onguehav i
ngwhi t
er eddishspot
s, mul
ti
pleandtendert
otouch.Whichofthefol
lowi
ng
isthemostli
kelydiagnosisinthiscase?

AApthusulcers
BErythr
oplaki
a
CLeukoplakia
DLichenpl
anus
ESubmucosal fi
brosi
s

33.
A45y earol
dmanpr esentedtooutpat
ientcompl ai
ningofhoarsenessofv oi
cef ort helast12mont hs
thatisandpr ogressi
ve.Neckexami nati
onshowssi ngl
ei psi
l
aterally
mphnodel esst han6cm,and
indi
rectlar
yngoscopyshowsul cerat
edgrowt hont heanter
ioronet hi
rdoftherightv ocalcordanterior
onet hi
rdwithnormalmov ements.Hisfl
exibleendoscopyshowssamef indi
ngs.Whati sthemostlikely
TNM St ageofthediseaseinthi
scaseaccor dingt
oAGCC( Americanjoi
ntcommi tteef orcancer
)?

A T1N1Mo
B T1N10Mo
C T1N20M1
D T1N10M2
E T₁N20M2

34.
A9y ear
soldboywasbr oughttoemergencyroom byhi
smot hercomplai
ningofsor
ethroat
,headache
andseverebodyachesandpai ns.Hi
sbothtonsil
sarecoveredbywhi t
efoll
icl
esandonexami nat
ion
enl
argedlevel
-2necknodesonbot hsi
des.Whichofthefol
lowingisthemostl i
kel
yorgani
smswhi ch
cancauseforval
vularheartdi
seaseinfut
ure?

AGroupbhaemol yt
icstr
ept
ococci
BH-
infl
uenzae
CSt
aphy l
ococusaureus
DSt
reptococcusvir
idi
ns
ESt
reptococuspyogenes

35.
A16y earsoldgi
rlpresent
edtoconsult
antoutpati
entcli
nicwit
hcompl ai
ntsoffev
er,for
eignbody
sensat
ioni
nthethroatandchangeinvoicefor12hours.Onexaminat
ion,t
hepati
entisanxi
ouswith
sweati
ng.Whati
sthemostappropri
atet
reatmenti
nthiscase?

ACricot
hy rodoctomy
BIVAntibiotics
CMaskoxy genation
DTracheost omy
EVentil
atorsuppor t

36.
A49y earoldmanpr esentedtooutpati
entcomplainingofnon-heali
ngul
ceronri
ghtmiddleofthe
tongueforthelast7mont hsthati
sprogressi
ve.Neckexaminat
ionshowsonemobilenecknodeless
than3cm i ngreat
erdiameter.Whatist hemostl ikel
yinv
esti
gationinthi
scasetoestabli
shthe
diagnosi
s?

ACT-scanor alcavi
ty
BI
ncisional
bi opsyundergeneral
anest
hesi
a
CInci
sionalbiopsyundersurf
aceanest
hesi
a
DMRI
EUltr
asoundbmodet ongue

37.
A7y earsoldboywasbr oughttoemer gencyroom byhi
smot hercomplai
ningofsoret
hroat,
headache
anddiff
icult
yinbreathi
ng.Hisbothtonsil
sarecoveredbygrey,whi
temembr ane;r
edspotsont hesof
t
palat
eandper i
orbit
aledemaar enoted.Theneckhasenlargedtenderl
y mphnodesonbot hsides.Hi
s
lymphocyte/WBCratioi
shigherthan0.35.Whatisthemostli
kelydi
agnosis?

AAcutemembr anoustonsi
ll
it
is
BAcutefol
li
cul
artonsi
ll
it
is
CCandidi
asi
s
DDipht
heri
a
EI
nfecti
ousmononucleosis

38.
A42y earoldmanpr esentedt otheout pat
ientdepar
tmentcompl aini
ngofdiffi
cult
yinbreathi
ngand
swallowinghert
helast10day sthatisprogressi
ve.Or
alexaminati
onshowsswel li
ngi nt
heorophary
ns
onr i
ghtsideandthewelloriented.Xrayneckl at
eralv
iewinextensionshowsincreasedshadowofthe
retr
ophar ynxwi
ththecorrespondingv er
tebrae.Whatist
hemostappr opr
iat
etreatmenti
nthiscase?B
Inci
sionanddrai
naget hr
oughcer vicali
ncisi
on
AAnti-
Tubercul
arTherapy
CW Anti
bioti
cs
DPeroralInci
sionanddrai
nage
ETracheostomy

39.
A17-year-
oldboywasl i
stedfortonsi
l
lectomyforrepeatedsor
ethroat.Onexaminati
on,t
het onsiland
enl
argedsizeasgr ade-4.Duringsurgi
calint
erventi
on,bothtonsil
swer edissect
edwhi l
eenl arged
adenoidswerel
eftandnushav ed.Whatisthemostlikel
yabsol
utecontrai
ndi
cati
onforadenoi
dsur ger
y
inthi
scase?

AAberrantphar
yngealar
tery
BBifi
duv ul
a
CNasophar y
ngeali
nsuff
ici
ency
DSinusit
is
ESuspectedAngiof
ibr
oma

40.
A47y earol
dmanwasbr oughttotheemergencyroom compl ai
ningofhoarsenessofvoicefort helast
12mont hspersist
entandprogressi
veandnowdi ff
icul
tyinbreathingforthel
asttwoday s.Hei sgiving
hist
oryofCarcinomaLar ynxforwhichhereceiv
edr adiat
ion.Fl
exiblelar
yngoscopyshowsf ixedv ocal
cordswithulceratedgrowthandCTScanshowshet erogeneouslyenhancinglesi
oninv ol
vingv ocal
cordaandthyroi
dcar t
il
agespari
ngpharyngealmucosa.Whati smostmanagementopt i
oni nthiscase?

AChemot herapy
BNeoadj unctradiot
her
apy
CPart
ialLaryngectomy
DPal
li
at i
vecare
ETot
al Laryngectomy

41.
Your ecei
vedaconsult
ati
oncallofa2y earoldpati
entwhoi sinsever
er espi
rator
ydistr
essforthelast
2day s.Hei snotmaintai
ningsatur
ati
on.Onexami nat
ion,thepati
enti sininspi
rator
ydistr
esswi th
int
ercostalr
ecessi
onandX-Rayshowsst eeplesignSaturat
ionisdecreasingandt hepati
entdevel
ops
peri
pheralcyanosi
s.Whati
st hemostsuit
ablemanagementopt ioni
nthiscase?

ABronchoscopy
BCricot
hyrodoct
omy
CEndotrachealI
ntubat
ion
DMaskoxy genati
onwithhel
i
um
ETracheostomy

42.
A15y earsoldboypresentedtoemergencyroom spi
tt
ingrepeat
edbloodst ai
nedsalivafr
om theoral
cav
ity
.Hehashi stor
yoftonsil
l
ectomy9day sback.Onexaminati
onrighttonsi
lfessahasclotwit
hme
whi
teslough.Thepati
entishaemodynamical
lyst
able,
butpaleandtri
est ovomit
; sat
urat
ionis96%and
Hb9g/dlwithrai
sedTLCcount.Whatisthemostappropri
atenextst
epi nmanagement ?

ABloodtransfusions
BCryst
aloidsinfusions
CIVAntibi
otics
DLigat
ionofbl oodv esselundergener
alanesthesi
a
EPacki
ngoft hetonsilbedwithAdrenal
inesocked

43.
An8-year-ol
dmalepat
ientisbr
oughtbyhi
smot herwi
thcompl aintsofsorethr
oatandfev
erf orwhich
hereceivedtr
eat
mentfrom aGener
alPhy
sici
an.However
,hissy mpt omshaveworsenedaf
terrecei
ving
theprescri
bedmedi
cati
ons.Heisnowunabletoswall
owf orthel ast2days.Onexaminat
ion,hisboth
 tonsi
lsarecover
edbywhi
temembraneandneckhaspal
pabl
enecknodesatlev
el2.HisComplet
e
BloodPict
ureshowsLy
mphocy
tosi
s.Whati
sthemostli
kel
ydrugr
esponsi
blef
orexacer
bat
ionofhi
s
symptoms?

AAmaxicill
i
n
BBrufen
CCefacl
or
DCefadroxi
l
ECl
arthromy ci
ne

44.
Your ecei
vedaconsul t
ati
oncal
lofa02- day-ol
dinf
antfr
om Nur ser
yofchil
dheal t
hdepar tmentstat
ing
thatthebahasdi ff
icul
tyinbr
eathingwhileawake.Accordi
ngtot hemother,thefeedingandsleepof
thebabyi sadequateOnexami nation,t
hebabyi snotcyanosedandishav ingmi l
dchestr ecessi
on,
Flexi
blelar
yngoscopyshowsshor taryepi
glott
icf
oldsWhatisthemostl i
kelycli
nicaldiagnosi
sinthis
case?

AChoanalatresi
a
BEpi
glott
it
is
CLary
ngomal aci
a
DLary
ngotracheobr
onchi
ti
s
EVocalcordWeb

45.
A4y earsoldchildwasbroughttooutpati
entofconsult
antcl
i
nicbyhisnasalobstr
uction,decr
eased
hear
inglev
elandf oulsmellfr
om ri
ghtnostr
ilf
orthelast7days.Onexaminat
ion,t
hereismucopusi n
ther
ightnostri
l
,postnasaldripanddullt
ympanicmembr aneWhatparent
swi thcomplaintofsnori
ng
themostli
kelydiagnosi
sinthi
scase?

AAdenoi ds
BForeignbodynose
CMaxillarysinusi
t
DOti
tismedi awi t
heff
usi
on
ESeptal abscesses

46.
A diagnosedcaseofchroni
cot i
ti
smediahaspr esent
edtoEmergencyRoom complai
ningofpost
actualweigforthe7days.Otoscopi
cexaminat
ionshowschol
east
eatomainat
ticregi
onofleftear
.
Pur eToneAudiomet
rynosAirBoneGipof10db,andCTScanshowsopaci
tyint
heantrum Mostli
kel
y
treatmenti
nthi
scase

ACort
icalmastidectomy
BConservat
iveManagement
CModifi
edRadi calMast
idect
omy
DMastoidexplorat
ion
ERadi
calMast i
dectomy

47.
Ami ddl
e-agedmanv isi
tedENTCl i
nicf
orarouti
neoralcavi
tyexami
nati
onfort
hecomplai
ntsofforei
gn
bodysensationinthethroat.Onexaminat
ion,hehasr i
ght-
sidedt
onsi
ll
arenl
argementTheatt
ending
surgeoncounsell
edthepatientf
orearl
ysur
gicali
nter
venti
onWhatat hemostl
ikel
yabsol
utei
ndicati
on
forearl
ytonsil
surger
yinthiscase?

AAcutetonsil
li
ti
s
BChronictonsi
ll
it
s
CMalignancy
DSleepapnea
EPentonsil
l
arabscesses

48.
A5y earoldchil
dwasbr oughttotheemer gencyr oom byhermotherwit
hcompl ai
ntsofdiff
icul
tyi
n
breat
hingandisunabl
etospeakf orthelast2hour s.Themothertol
dthatt
hekidwaspl ay
ingwithtoy
s
Onexami nat
iont
hechildisinrespi
rator
ydi str
ess,andiscyanosedandexhausted.HerX-Raychesti
s
normal.Whatist
hemostlikel
ydiagnosisint hi
scase?

AAcuteEpiglot
ti
ti
s
BAcuteTracheobronchi
ti
s
CForeignbodyTracheobronchi
alt
ree
DLaryngit
is
ELar
y ngomalaci
a

49.
A 15y earsoldgi r
lwasscheduledfort onsil
l
ect omyforrepeatedsorethroat.Onexaminati
on,t
he
tonsil
sareenl ar
gedi nsi
zewit
hbi l
ateralnecknodes.Dur i
ngsur ger
y,thelefttonsi
lhasableedi
ng
vesselthatbl
eedsr epeat
edl
yanda2ndy earresi
dentisunabl
et ocontr
olitHehascal l
edforhel
pof
seniorconsul
tantWhatisthemostl
ikelyvessel t
hatneedsl
igati
oninthi
scase?

AAscendingPharyngealart
erybranch
BBranchoffacial
arter
y
CDescendingPharyngealart
erybranch
DLi
ngual ar
terybr
anch
EParatonsi
ll
arvei
n

50.
A50y earoldmanwast othebr
oughttotheemer gencyroom complai
ningofdi
ffi
cult
yinbr
eathingfor
thel astthreedays.Heisuncontrol
leddiabet
ic,thatandalsogivi
nghi st
orydentalmani
pulati
onby
Dent i
st.Onexami nat
iont
hetongueisprot
rudedwi thsubli
ngualswell
i
ngWhatist hemostappropri
ate
cli
nicaldiagnosi
s?

ALudwighsAngina
BParaphary
ngeal abscesses.
CRetr
opharyngeal abscesses
DSubmandibularductst one
ESubmandibularabscesses

51.
An18y earol
dboypr esent
stoEmer gencydepart
mentwithhi
stor
yofsever
eheadachewhichheclai
ms
tobethewor stofhi
slif
e.Headacheisassoci
atedwit
hvomi t
ingandneckpai
n.Pat
ienti
sgivi
nghist
ory
ofnasalobst r
ucti
onandpost -
nasaldrip.Onexaminati
on,ther
eismucopusi nhothnostri
ls.What
speci
fi
cinvesti
gati
onyouwouldliketoorderi
mmediatel
y?

ACSFanalysi
s
BCTBrain&PNSwithcontr
ast
CCTBr ai
nwit
houtcont
rast
DMRIBr ai
n
EPetscan

52.
A39y earoldl
adypresentedtotheEmer gencyroom wi
thpr
ofuseepistaxi
sfor4hours.Hehassimil
ar
epi
sodes inthe past.Anteri
ornasalpacki ng was done i
n emer gency r
oom butbl eedi
ng was
uncont
roll
ed.Al
lbaselineinv
estigat
ionswer enormal
.Theconsul
tantdecidedtocontrolt
hebleedi
ng
 underGener
alAnesthesi
a.Whati
sthemostl
i
kel
yvesselt
hatneedt
obecl
i
ppedwi
thFunct
ional
Endoscopei
nthi
scase?

AAnt eri
orEt himidal
Spenopalatinear ter
y
Greaterpalatinear t
ery
Septalart
ery
CPost eri
orEt himidal

53.
Ami ddl
eageladypr esent
edtooutpat
ient
sdepartmentwithcomplaint
sofnasalobstr
ucti
on,headache
andpostnasaldischargefort
helast9months.Clini
calexaminat
ion,showsunil
ater
alpol
yp,mucopus
andmuci n,CTscanshowsdoubl edensit
yopacityinthenose,Maxi l
l
aryandEthmoidregionpushing
theorbi
tonsämesi de.Whatisthemostappropr
iatetr
eatmentoptioninthi
scase?

AEndoscopi
csinussurger
y
BEndoscopi
csinussurger
ypl
ust
opi
cal
nasalst
eroids.
CEndoscopi
csinussurger
ypl
ust
opi
calandor
alsteroi
ds
DIVAmphoteraci
neB
ETopi
calnasalst
eroi
ds

54.
A20- year-
oldpatientpr
esentedtoENTout pati
entwiththecompl ai
ntofeardischar
geforthelast6
years.Thedischargeisrel
ievedbytopi
calandsystemicanti
biot
ics,andaggrav
atedbywaterentr
y.On
cli
nicalexaminat
ion,heisdiagnosedwit
hCholesteat
omar i
ghtearWhati sthemostli
kel
ypreoper
ati
ve
investi
gati
ontohel pi
nmanagementpl an?

ACTscanwit
hIVcontrast
BCTScanaxi
alandcoronalcut
s
CCTscanSagi
tt
alview
DMRIWithI
Vcontrast
EPETScan

55.
Ami ddl
e-agedladypresentedtooutpati
entdepart
mentwi thcomplaint
sofnasalobstr
ucti
on,headache
andpostnasaldi schar
gef ort
helast9mont hs.Cli
nicalexaminati
onshowsunilat
eralpol
yp,mucopus
andmuci n.CTscanshowsdoubl e-densi
tyopacit
yint henose,maxi l
l
aryandethmoidregionpushing
theorbi
tont hesamesi de.Whati
sthemostl ikel
ydiagnosisi
nthiscase?

AAntr
ochoanal polyp
BAl
ler
gicfungalsinusi
ti
s
CEt
himoidalpolypi
DI
nvert
idpapil
loma
EMaxil
lar
ysinusiti
s

56.
A27y earol
dpati
entiscompl ainingofnasalobstr
ucti
onfort helast7monthst hatispersist
entand
progressi
veandsassociatedwi thheadache.Hehasnohi storyofanynasalsurgery.Onexami nati
on,
thereismucopusinbothnostr
ils,wi t
hpostnasal
dri
pwithmul t
ipl
elargewhi
tegraysenselessswel l
i
ngs
inthenose.CTScanwi thoutcont rastshowsheter
ogeneouslyopaciti
esi
nnoseandsi nuses.Whati s
themostappropri
atetr
eatment?

AAnti
biot
icsfi
rstli
ne
BFESS
CInt
ranasalpolypect
omy
DTopi
calandor
al st
eroi
ds
ETopi
cal
Xy l
ometazoli
ne

57.
A4y earol
dpat i
entcomest oconsult
antcli
nicwithcomplaint
sofmout hbr eat
hing,snor
ingduri
ng
sleepanddecreasedheari
nglev
elinbothear
sf ort
helast15day s.XRaynasopharynxshowsenl
arged
adenoid.Whatisthenextmostl
ikel
yinv
esti
gati
ontohelpindiagnosis?

ABERA( Brai
nStem EvokedResponseBAudi
omet
ry)
BOtoacousti
cemi ssi
ons
CPureToneAudi ometry
DPureToneAudi ometryandTympanomet
ry
ETympanomet r
y