EMRCS 2021

Head & Neck Surgery

MRCS I.V.
Head & NeckSurgery
1/1/2021
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Head and neck surgery

N. Question Ans.
A 34 year old lady presents with a long standing offensive discharge from
the ear and on examination is noted to have a reduction in her hearing of
40 decibels compared to the opposite side. What is the most likely cause?
A. Otosclerosis
1 C
B. Acute otitis media
C. Cholesteatoma
D. Long standing perforation of the pars tensa
E. Otitis externa
A dentist treating a woman with rheumatoid arthritis for recurrent
episodes of dental sepsis notices that both parotid and submandibular
glands are symmetrically enlarged. What is the most likely diagnosis?
A. Sjogren's syndrome
2 A
B. Mikulicz's syndrome
C. Alcoholism
D. Liver cirrhosis
E. Metastatic cancer
A 29 year old man has had a sore throat for the past 5 days. Over the past
24 hours he has noticed increasingly severe throbbing pain in the region
of his right tonsil. He is pyrexial and on examination he is noted to have a
swelling of this area. What is the most likely cause?
3 A. Tonsillar cancer C
B. Lymphoma
C. Quinsy
D. Glandular fever
E. Common cold
A 42 year old singer is admitted for a thyroidectomy. Post operatively she
is only able to make a gargling noise. Her voice sounds breathy. What is
the most likely explanation?
A. Bilateral inferior laryngeal nerve injury
4 B
B. Unilateral inferior laryngeal nerve injury
C. Unilateral superior laryngeal nerve injury
D. Bilateral superior laryngeal nerve injury
E. Lacunar infarct
5 A 53 year old man presents with a mass lesion slightly inferior to the C

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tragus of his right ear. An FNA and USS are performed and a 2cm
pleomorphic adenoma is diagnosed. What is the most appropriate course
of action?
A. USS guided core biopsy
B. Radical parotidectomy
C. Superficial parotidectomy
D. Discharge
E. MRI scanning of the region
A child is brought to casualty complaining of a headache and a sensation
of pressure between the eyes. On examination, she is febrile with a
smooth swelling overlying the superomedial aspect of the right eye. The
eye is uncomfortable and there is a purulent discharge from the inner
canthus. What is the most likely cause?
6 B
A. Maxillary sinusitis
B. Ethmoidal sinusitis
C. Nasal polyps
D. Ethmoid sinus cancer
E. Maxillary sinus cancer
An 8 year old boy presents with a lump in his neck. On examination, he is
found to have a lump in the midline of the neck immediately below the
hyoid which moves on tongue protrusion. What is the most likely
diagnosis?
7 A. Benign lymphadenopathy C
B. Malignant lymphadenopathy
C. Thyroglossal cyst
D. Branchial cyst
E. Dermoid cyst
An 18 year old boy presents with pancreatitis. He has bilateral painful
parotid enlargement. What is the most likely underlying cause?
A. Sialectasis
8 B. Bacterial parotitis C
C. Viral parotitis
D. Mucoepidermoid carcinoma
E. Sjogren's syndrome
A 14 year old boy presents with enlarged tonsils that meet in the midline.
9 Oropharyngeal examination confirms this finding and you also notice D
petechial haemorrhages affecting the oropharynx. On systemic

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examination he is noted to have splenomegaly. What is the most likely

cause?
A. Oral candidiasis
B. Infection with Streptococcus pyogenes
C. Infection with Rickettsia rickettsii
D. Infection with Epstein Barr virus
E. Infection with Staphylococcus aureus
A 70 year old lady presents with a painless neck lump. There is a mass
noted beneath the sternocleidomastoid muscle. There is a long history and
somewhat unkindly her husband remarked on her rather noticeable
halitosis. What is the most likely explanation?
10 A. Branchial cyst C
B. Branchial fistula
C. Pharyngeal pouch
D. Thyroglossal cyst
E. Dental caries
A 21 year old man presents with a unilateral facial nerve palsy after being
hit on the head. On examination, he has a right sided facial nerve palsy
and a watery discharge from his nose. What is the most likely cause?
A. Pleomorphic adenoma
11 D
B. Cerebrovascular accident
C. Occipital bone fracture
D. Petrous temporal fracture
E. Sarcoidosis
A 4 year old is brought to the general practitioner by her mother. She has
been distressed with ear pain for the past 14 hours. She is constantly
touching and pulling at her ear. Whilst she is sat in the waiting room her
mother notices a discharge of foul smelling fluid from the ear, following
which the pain resolves. What is the most likely cause?
12 A
A. Acute otitis media
B. Otitis externa
C. Cholesteatoma
D. Mastoiditis
E. Otosclerosis
A 40 year old woman presents as an emergency with a painful mass
13 underneath her right mandible. The mass has appeared over the previous B
week with the pain worsening as the lump has increased in size. On

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examination, there is a 4cm mass underneath her mandible, there is no

associated lymphadenopathy. What is the most likely diagnosis?
A. Submandibular gland cancer
B. Submandibular gland calculus
C. Carotid body tumour
D. Papilloma of Whartons duct
E. Carotid body aneurysm
A 46-year-old woman is referred to endocrine surgery for a possible
thyroidectomy. She has a tender neck swelling. Blood results are as
follows:

TS
<0.1 mU/l
H

188
T4
nmol/l

Hb 14.2 g/dl

377 *
Plt
10^9/l
14 D
W 6.4 *
BC 10^9/l

ES
65 mm/hr
R

Technetium thyroid scan shows decreased uptake globally

What is the most likely diagnosis?

A. Sick thyroid syndrome
B. Acute bacterial thyroiditis
C. Hashimoto's thyroiditis
D. Subacute thyroiditis

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E. Toxic multinodular goitre

Which of the following statements relating to branchial cysts is untrue?
A. The greater auricular nerve may be divided during excision
B. They typically occur in young adults
15 C
C. They move upwards on swallowing
D. They are rare over the age of 40 years
E. They are usually located in the anterior triangle of the neck
A 30 year old lady is found to have a thyroglossal cyst that has been
recently infected and the patient requests treatment. What is the most
appropriate course of action?
A. Surgical treatment with resection of cyst, associated track, central
16 portion of the hyoid and wedge of tongue muscle behind the hyoid A
B. Excision of the cyst alone with ligation of the track
C. Laying open of the track and excision of the cyst
D. Phenolisation of the cyst
E. Marsupialisation of the cyst
A 22 year old female attends clinic after noticing a painless neck lump.
On examination she is noted to have bilateral thyroid masses and
multicentric nodes near the base of the thyroid. Her corrected Ca is 2.18.
What is the most likely diagnosis?
A. Sporadic medullary carcinoma of the thyroid
17 B
B. Medullary carcinoma of the thyroid associated with multiple
endocrine neoplasia
C. Follicular thyroid carcinoma
D. Anaplastic thyroid carcinoma
E. Toxic nodular goitre
A 45 year old man presents with a facial swelling. On examination, he has
a swelling that lies inferolaterally to the nose. When the area is palpated,
it feels like the underlying bone is cracking. What is the most likely
diagnosis?
18 A. Maxillary sinus cancer B
B. Ameloblastoma
C. Nasal polyps
D. Maxillary sinusitis
E. Mucocele
A 42 year old singer is admitted for a thyroidectomy. Post operatively the
19 D
patient develops stridor and has difficulty speaking. What is the most

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likely underlying cause?

A. Bilateral superior laryngeal nerve injury
B. Unilateral recurrent laryngeal nerve injury
C. Unilateral superior laryngeal nerve injury
D. Bilateral recurrent laryngeal nerve injury
E. Hypoglossal nerve injury
A 50 year old women presents with a diffuse swelling in the region of her
right parotid together with facial pain. On examination, she has a right
sided facial nerve palsy. What is the most likely underlying cause?
A. Pleomorphic adenoma
20 B
B. Adenoid cystic carcinoma
C. Warthins tumour
D. Lymphoma
E. Sarcoid
A 10 year old girl presents with epistaxis. From which of the following
regions is the bleeding most likely to originate?
A. Posterior nasal space
21 B. Alar rim C
C. Kiesselbach's plexus
D. Cribriform plate
E. None of the above
A 56 year old man presents with a painless swelling in the upper part of
the anterior triangle of his neck. On examination a mass lesion involving
the sub mandibular gland is identified. On CT scanning this is shown to
be a solid lesion. There is no regional lymphadenopathy. Two fine needle
aspirates have failed to be diagnostic. Which of the following is the most
appropriate management option?
22 A
A. Sub mandibular gland excision
B. Incisional biopsy of the mass
C. Manage conservatively and repeat the CT scan in 6 months
D. Sub mandibular gland excision and radical neck dissection
E. Diagnostic excision of the superficial lobe of the submandibular
gland
A 36-year-old woman who presented with a goitre is diagnosed with
autoimmune thyroiditis. Which one of the following types of thyroid
23 B
cancer is she predisposed to developing?
A. Anaplastic

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B. Lymphoma
C. Medullary
D. Follicular
E. None of the above
A 50 year old lady presents with symptoms of a dry mouth that has been
present for the past few months. She also has a sensation of grittiness in
her eyes. On examination, she has a diffuse swelling of her parotid gland.
There is no evidence of facial nerve palsy. What is the likely underlying
diagnosis?
24 B
A. Sarcoid
B. Sjogrens syndrome
C. Adenoid cystic carcinoma
D. Pleomorphic adenoma
E. Lymphoma
An elderly diabetic male presents with a severe deep seated otalgia and a
facial nerve palsy, he has completed a course of amoxycillin with no
benefit. What is the most likely diagnosis?
A. Malignant otitis externa
25 A
B. Otosclerosis
C. Acoustic neuroma
D. Meniers disease
E. Viral illness
A 25 year old lady presents with a swelling located at the anterior border
of the sternocleidomastoid muscle. The swelling is intermittent and on
examination it is soft and fluctuant. What is the most likely diagnosis?
A. Thyroglossal cyst
26 B
B. Branchial cyst
C. Carotid body tumour
D. Infection with Bartonella
E. Dental abscess
A 4 year old child presents with a 4-5 day history of feeling generally
unwell and also of having a sore throat. On examination, there is marked
cervical lymphadenopathy, the oropharynx is covered with a thick grey
27 membrane which bleeds following attempted removal. What is the most C
likely diagnosis?
A. Acute streptococcal pharyngitis
B. Infection with Epstein Barr virus

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C. Diptheria
D. Ludwigs angina
E. Ingestion of caustic soda
A 43 year old lady presents with symptoms of chronic ear discharge and a
right sided facial nerve palsy. On examination, she has foul smelling fluid
draining from her right ear and a complete right sided facial nerve palsy.
What is the most likely cause?
28 A. Adenoid cystic carcinoma B
B. Cholesteatoma
C. Acute otitis media
D. Chronic sinusitis
E. Cerebrovascular accident
A 40 year old professional singer is admitted for a right thyroid
lobectomy. Post operatively, she is unable to sing high notes. Which of
the following muscles is likely to demonstrate impaired function?
A. Thyroarytenoid
29 C
B. Posterior cricoarytenoid
C. Cricothyroid
D. Thyrohyoid
E. Lateral cricoarytenoid
Which of the following does not cause parotid enlargement?
A. Liver cirrhosis
B. Myxoedema
30 C
C. Amiodarone
D. Tuberculosis
E. Sjogrens syndrome
At which of the following time frames is secondary haemorrhage most
likely to occur following tonsillectomy?
A. Between 5 and 10 days after surgery
31 B. During the first 6 hours after surgery A
C. Between 6 and 12 hours after surgery
D. Upon resumption of normal feeding
E. Between 2 and 3 days post operatively
A 4 year old child is brought to the clinic by his father. They are
concerned because the child has been noted to have a small epithelial
32 C
defect anterior to the left ear and is has been noted to discharge foul
smelling material for the past 2 days. What is the most likely explanation?

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A. Otitis externa
B. Otitis media
C. Pre auricular sinus
D. Cholesteatoma
E. Long standing pars flaccida perforation
A 56 year old man presents with symptoms of nasal pain, anosmia and
rhinorrhea. He has been well until recently and has worked as a wood
carver for many years. What is the most likely diagnosis?
A. Ethmoid sinus cancer
33 A
B. Ameloblastoma
C. Maxillary sinus cancer
D. Fibrous dysplasia
E. Haemangiopericytoma
A 32 year old lady is referred to the clinic with recurrent infections and
abscesses in the neck. On examination, she has a midline defect with an
overlying scab, which moves upwards on tongue protrusion. What is the
most likely diagnosis?
34 A. Branchial cyst C
B. Branchial fistula
C. Thyroglossal cyst
D. Sebaceous cyst
E. Dermoid cyst
A 8 year old boy with recurrent attacks of otitis media is suspected of
developing a glue ear. If his sound conduction is tested, which of the
following is most consistent with a unilateral middle ear effusion?
A. Negative Rinne's test on the ipsilateral side
35 A
B. Positive Rinne's test on the ipsilateral side
C. Positive Webers and Rinnes tests on the ipsilateral side
D. Positive Rinne's test on the contralateral side
E. Negative Webers test only on the contralateral side
A 10 year old child presents with enlarged tonsils that meet in the
midline. Oropharyngeal examination confirms this finding and you also
notice peticheal haemorrhages affecting the oropharynx. On systemic
36 examination he is noted to have splenomegaly. What is the most likely B
cause?
A. Lymphoma
B. Acute Epstein Barr virus infection

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C. Diptheria
D. Streptococcal throat infection
E. Quinsy
37 A 22 month old child is brought to the clinic by her mother who is B
concerned that she has developed a swelling in her neck. On
examination; she has a soft lesion located in the posterior triangle that
transilluminates. What is the most likely cause?
A. Lymphoma
B. Cystic hygroma
C. Rhabdomyosarcoma
D. Branchial cyst
E. Dermoid
38 An 8 year old boy presented with a painless swelling on the A
superotemporal aspect of his orbit. It was smooth on examination,
produced no visual disturbances. Following excision it was found to be
lined by squamous epithelium and hair follicles. Which of the following
lesions most closely matches these findings?
A. Dermoid cyst
B. Desmoid tumour
C. Lipoma
D. Sebaceous cyst
E. Schwannoma
39 A 3 year old boy is brought to the clinic by his mother who has noticed a D
mass in his neck. On examination; he has a smooth mass located on the
lateral aspect of his anterior triangle, near to the angle of the mandible.
On ultrasound; it has a fluid filled, anechoic, appearance. What is the
most likely cause?
A. Cystic hygroma
B. Dermoid cyst
C. Thyroglossal cyst
D. Branchial cyst
E. Lymphoma
40 A 22 year old is found to have bilateral acoustic neuromas. Which of the B
disorders listed below is most likely to be present?
A. Neurofibromatosis Type I
B. Neurofibromatosis Type II
C. MEN I
D. MEN II
E. Gardner's syndrome
41 A 4 year old boy is brought to the clinic by his mother who has noticed a A

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small lesion at the external angle of his eye. On examination there is a

small cystic structure which has obviously been recently infected. On
removal of the scab, there is hair visible within the lesion. What is the
most likely diagnosis?
A. Dermoid cyst
B. Desmoid cyst
C. Sebaceous cyst
D. Epidermoid cyst
E. Keratoacanthoma
42 A 10 year old boy who has learning difficulties, is reported as having a A
difference in size between his two legs. What is the underlying disorder?
A. Neurofibromatosis Type I
B. Neurofibromatosis Type II
C. Kartagener's syndrome
D. Multiple endocrine neoplasia type II
E. Multiple endocrine neoplasia type I

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