Otorhinolaryngology

MCQs & EMQs

Volume I: The Ear

[COMPANY NAME] [Company address]

Questions 1 & 2 pertain to the anatomical structures of the ear (shown in figure 1-1)

1. Which of the following statements is correct?

a. The area labeled (18.) articulates with the Round window

b. The area labeled (6.) is supplied by auricular branch of the vagus nerve
c. The area labeled (4.) contains the sensory organs of balance
d. The area labeled (11.) is the external carotid artery
e. The area labeled (8) transmits auditory impulses to the cochlear nucleus

2. Which of the following statements is FALSE?

a. 2
b. 7 exits the skull base at the stylomastoid foramen to supply the muscles of facial expression
c. 5 receives sensory innervation from the facial nerve
b. 22 receives sensory innervation from branches of the vagus, trigeminal, facial and glossopharyngeal nerve
c. 11 is an anterior relation of the tympanic cavity/ middle ear

3. The picture below (figure 1-2) shows the lateral wall of the tympanic cavity. Which of the following statements is
CORRECT?

a. The structure labeled A. supplies taste to the posterior 1/3rd of the tongue
b. The structure labeled B is the promontory of the cochlea
c. The structure labeled C. is the stapedius muscle
d. The structure labeled D. supplies blood to the middle ear
e. The structure labeled E. gives motor innervation to the stylohyoid muscle
Questions 3 & 4. Relate to the picture below (figure 1-3.). It shows a cross section of the cochlea viewed with a microscope

4. Which of the following statements is TRUE?

a. The areas labeled A. & C. contain perilymph

b. Area B. has a similar composition to plasma
c. Area D. contains receptors that detect balance
d. Area E is the tectorial membrane
e. Area E. is the vestibular membrane

5. Which of the following statements is false?

a. The area labeled C. is known as the tympanic duct

b. The area labeled B. is the cochlear duct
c. The area labeled A. is the vestibular duct
d. The area labeled D is the Crista ampularis
e. The area labeled E separates the scala tympani from
the scala media

6. The drawing above (fig 1-4) depicts a dissected temporal bone (viewed from above). Which of the following
statements is NOT correct?

a. The structure labeled (1.) carries parasympathetic preganglionic fibers that supplies the lacrimal gland
b. The structure labeled (2) represents the geniculate ganglion
c. The structure labeled (3.) supplies general sensation (Pain, temperature & proprioception) to the tongue
d. The structure labeled (4.) represents the lesser petrosal nerve
e. The structure labeled (5.) supplies motor innervation to the muscles of mastication
The picture below (figure 1-5) shows structures that might be
encountered during mastoid surgery

7. Which of the following landmarks is NOT correct?

a. U represents the tympanic portion of the facial nerve

b. V represents the sigmoid sinus
c. X represents the posterior semicircular canal
d. Y represents the horizontal semicircular canal
e. Z represents the Superior semicircular canal

8. The picture above (figure 1-6) shows the contents and structures related to the middle ear. Identify the correct
statement

a. Item 3 is attached to the short process of the incus

b. Item 7 is supplied by the mandibular division of the trigeminal nerve
c. Item 4 carries preganglionic parasympathetic fibres that supply the parotid gland
d. Item 8 is the pyramidal eminence
e. Items 5 & 6 are derived from the 2nd pharyngeal arch

9. Figure 1-7 shows the lateral wall of the middle ear cavity
Identify the CORRECT statement

a. A & B is connected by a fibrous ball & socket joint

b. H is derived from the 1st pharyngeal arch
c. C is an area known as the epitympanum
d. I receives motor innervation from the Corda Tympani
e. F is lined by squamous epithelium on its medial surface
Theme: Applied anatomy of the Ear

10. Identify the incorrect statement concerning the anatomy of the Auricle.

a. Herpes zoster infections involving the facial nerve may result in vesicles or blisters erupting on the pinna
b. A cauliflower ear results from an untreated hematoma between the perichondrium & adherent skin of the pinna
c. The pinna should be pulled posteriorly and superiorly when performing otoscopy on a child
d. Fistulae & accessory auricles result from failure of fusion of the 6 hillocks derived from the 1st pharyngeal arch
e. The Cymba conchae is the anatomical landmark for the mastoid antrum

11. Which of the following statements is incorrect regarding the anatomy of the External auditory canal?

a. The skin of the external auditory canal is firmly adherent to the perichondrium laterally and to the periosteum
medially
b. The skin of the boney part of the external auditory canal is thinner, more adherent and sensitive
c. The inner 1/3 is boney and outer 2/3rd is cartilaginous
d. The external auditory canal is 24-15 mm long in the adult
e. The cartilaginous portion has more hair and ceruminous glands than the osseous portion

12. Which of the following is not likely to be seen on otoscopy of a normal right ear?

a. Cone of light appears on the left

b. Lateral process of the malleus appears on the right
c. The incus is to the left of the handle of the malleus
d. Pars flaccida is related superiorly to the handle of the malleus
e. Pars tensa is related inferior to the anterior and posterior folds

13. Which of the following is correct regarding the tympanic membrane?

a. It consists of only two layers derived from ectoderm and mesoderm

b. It has a well-defined light reflex due to its convex shape
c. It is divided into two parts; the large lower part, the pars flaccida and the smaller, upper part, the pars tensa
d. It is a lateral relation to the Corda tympani
e. Its inner surface innervated by the auricular branch of the vagus nerve

14. Which of the following is correct regarding the adult eustachian tube?

a. It measures approximately 48 mm in length

b. It is opened by the contraction of the tensor tympani muscle
c. The boney part of the tube is 12 mm in length and its cartilaginous part is 36 mm
d. It has a boney lateral 1/3rd and a cartilaginous medial 2/3rd
e. It opens into the lateral wall of the oropharynx
15. Which of the following structures do not pass through the internal auditory meatus?

a. The labyrinthine artery

b. The nervus intermedius
c. The facial nerve
d. The vestibulocochlear nerve
e. The chorda tympani

16. The sensory end organ of the cochlea is

a. The utricle
b. The saccule
c. The Organ of Corti
d. The macula
e. The Crista ampularis

17. The tensor veli palatini and tensor tympani muscles are innervated by

a. The vagus nerve

b. The glossopharyngeal nerve
c. The maxillary division of the trigeminal
d. The mandibular division of the trigeminal
e. The spinal root of the Accessory nerve

18. Which of the following is not contained in the membranous labyrinth?

a. Tectorial membrane
b. Endolymph
c. outer Hair cells
d. Macula
e. Perilymph

19. McEwens triangle is the surgical landmark for the

a. Sigmoid sinus
b. Mastoid antrum
c. Tympanic part of the facial nerve
d. Lateral semicircular canal
e. Incu-stapedial joint

20. Regarding the tympanic cavity

a. The middle ear contains the ossicular chain (malleus, incus & stapes) along with the stapedius and tensor tympani
b. Its medial wall is related to the facial nerve, the round & oval windows, the lateral semicircular canal & cochlea
c. Its posterior wall is related to the internal carotid artery, eustachian tube
d. Its superior wall is the tegmen, middle cranial fossa, dura, temporal lobe of the brain
e. Its inferior wall is the related to the jugular bulb & tympanic branch of the glossopharyngeal nerve
21. The eustachian tube
a. Connects the middle ear cleft to the oropharynx
b. Is longer in children than in adults
c. Is more horizontal in children than in adults
d. Is softer & more collapsible in adults than in children
e. Is approximately 24 mm long in the adult

22. The facial nerve

a. Supplies secretomotor innervation to the parotid gland
b. Supplies motor innervation to the risorius muscle
c. Supplies sensation to the skin of the face
d. Exits the skull through the sternomastoid foramen
e. Supplies sensation to the posterior 1/3rd of the tongue

23. The Corda tympani

a. Supplies the stapedius muscle

b. Gives off the greater petrosal nerve at the genu
c. Joins the auriculotemporal nerve to supply the parotid gland
d. Joins the lingual nerve to supply special sensation to the tongue
e. Is a branch of the mandibular nerve

24. The glossopharyngeal nerve

a. Exits the skull through the foramen magnum

b. Supplies sensory innervation to the middle ear cavity
c. Supplies motor innervation to the tensor tympani muscle
d. Gives a branch that passes through the mastoid canaliculus
e. Has fibres that eventually give rise to the greater petrosal nerve

25. A 58-year old woman has a paralysis on the right side of her face. She has difficulty in chewing and perceives sounds as
annoyingly loud. Physical examination reveals a loss of taste on the anterior 2/3rds of her tongue. The hyperacusis in
this case results from involvement of which of the following:

a. Auditory nerve
b. Nerve to stapedius
c. Lesser petrosal nerve
d. Chorda tympani nerve
e. Greater petrosal nerve

Theme: Examination of the Ear

26. Which of the following techniques would make adequate visualization of the tympanic membrane more difficult?

a. Removing any wax or debris by syringing or instrumentation

b. Using a small speculum
c. Varying the angle of the speculum
d. Pulling the pinna gently backwards and upwards to straighten the external meatus
e. Using the largest speculum that can easily be inserted
27. A mother presents to the ENT clinic with her 3-year-old son. She expresses her concerns about a small blind pit noted
anterior to the root of the helix. The child appears to have no symptoms, responds to his name and speaks appropriate
words for his age. She explains that her daughter (his sister) also has the same condition and she recently required
surgery to the ear. The mother is now worried that it may cause her son may develop an infection and require surgery.
Your next step in management should be

a. Request a Pure-tone audiogram

b. Request a CT scan
c. Prophylactic Surgical excision
d. Prescribe Oral antibiotics
e. Reassurance

Theme: Physiology of hearing

28. Regarding the ear & hearing, which of the following statements is FALSE?

a. Sound is a waveform of mechanical energy that travels fastest through solids > liquids >air
b. The threshold for normal hearing is 30-50 decibels
c. Conversation typically occurs at about 2-4 kHz
d. Range of human hearing is 20-20,000 Hz
e. The pinna funnels sound to the external auditory canal

29. Regarding the conductive apparatus of the ear, all the following statements are correct, EXCEPT

a. The external auditory canal amplifies sound in the frequency range 3-4 kHz
b. The tympanic membrane and ossicular chain are responsible for impedance matching
c. The lever system of the malleus & incus increases the pressure of the stapes footplate on the round window
d. The ratio of the functional area of the tympanic membrane to that of the footplate of the stapes is 13:1
e. The relative lengths of the handle of the malleus to that of the long process of the incus is 1.3 to 1.0

30. Regarding the inner ear, which of the following statements is MOST CORRECT?

a. Sound intensity is predominantly detected by the rate of production of action potentials in the auditory nerve
b. The stria vascularis produces perilymph, which contains a higher concentration of potassium to sodium ions
c. High frequency sounds mainly stimulate movement of the basilar membrane at the apex of the cochlea
d. Low frequency sounds stimulate vibration of the basilar membrane close to the basal turn of the cochlea
e. Sensitive receptor hair cells lie in the Organ of Corti, which sits on Reissners membrane

31. Which of the following statements about the physiology of hearing is INCORRECT?

a. The ear is most sensitive to frequencies between 1KHz and 3KHz

b. There are approximately 15000 hair cells in the cochlea
c. The eustachian tube is responsible for equalizing the pressure between the inner ear & external auditory canal
d. The cochlear duct contains endolymph, which is rich in potassium cations and is similar in composition to CSF
e. When stimulated by sound vibrations inner hair cells release glutamate into auditory nerve fibres
32. Which of the following most accurately describes the pathway of electrical impulses from the hair cells in the organ of
Corti to the auditory cortex?

a. cochlear nervecochlear nucleussuperior olivelateral lemniscusInferior colliculusmedial geniculate Body

b. auditory nervecochlear nucleiinferior olivemedial lemniscussuperior colliculuslateral geniculate body
c. eighth nervevestibular nucleuslateral olive, posterior lemniscuslateral colliculushippocampus
d. acoustic nerveacoustic nucleusmedial oliveanterior lemniscusmedial colliculusPrecentral gyrus
e. vestibular nervevestibular nucleimedial lemniscusventroposterior nucleusinternal capsule

33. Regarding the hair cells of the ear which of the following statements is FALSE?

a. The inner hair cells provide most of the auditory input to the brain via CN 8
b. Each consist of one large kinocilium and 50-150 stereocilia
c. The body of the hair cell is bathed in perilymph
d. The tip of the stereocilium is bathed in perilymph
e. Mechanical deformation towards the kinocilium causes K+ channels to open

Theme: Hearing loss

34. Regarding sensorineural hearing loss(SNHL), which of the following statements is not true?

a. The incidence of hearing loss 2o to meningitis has declined because of increasing HIB vaccination rates
b. Presbycusis is progressive, unilateral asymmetrical hearing loss, usually at lower frequencies, occurring with age
c. Ototoxic drugs include; aminoglycosides, loop diuretics and cytotoxic agents e.g. cisplatin
d. Viral infections such as measles, mumps and herpes zoster are all associated with S.N.H.L
e. Noise induced hearing loss is the 2nd most common cause of SNHL & its incidence is increasing in young adults

35. Which of the following statements is TRUE?

a. Common causes of conductive hearing loss in children include; TORCH infection, perinatal hypoxia & kernicterus
b. unilateral otitis media with effusion in the elderly may suggest a post nasal space tumour
c. ossicular chain discontinuity is not a known complication of cholesteatoma
d. otosclerosis, is caused by abnormal bone growth resulting in fixation of the malleolar handle to the oval window
e. syringing a patient with wax impaction may result in a syncopal episode due to abducens nerve stimulation

Sensorineural Hearing Loss In childhood

36. As it relates to Sensorineural hearing loss in childhood

a. 25%-30% is thought to be of genetic origin

b. 50% is thought to be due to environmental factors
c. Majority Is autosomal recessive
d. Majority is autosomal dominant
e. Is most commonly caused by Otitis media with effusion
37. Which of the following causes of Sensorineural Hearing loss in childhood, is correctly matched?

a. Pendred syndrome hypothyroidism, goiter, enlarged endolymphatic sac

b. Usher Syndrome glomerulonephritis, anterior lenticonus, X-Linked recessive
c. Alport syndrome white forelock, heterochromia, hirschsprungs disease
d. Waardenburg syndrome cleft palate, retrognathia, hypertelorism
e. Treacher-Collins syndrome retinitis pigmentosa, autosomal recessive

38. Which of the following is most likely to be a feature of Jervell & Lange-Neilson syndrome?

39. You are called to review a newborn with dysmorphic features (shown below). Findings include; a high prominent
forehead, proptosis, a depressed nasal bridge, a short nose, and low-set ears. His hands show fusion of the ring and
little finger.

The most likely diagnosis is

a. Alport syndrome
b. Apert syndrome
c. Goldenhar syndrome
d. Down Syndrome (Trisomy 21)
e. Crouzon syndrome
Theme: Conductive Hearing loss

A 35-year old woman presents with gradual onset of bilateral hearing loss & tinnitus for (2) years. She recalls that her
hearing started to decline while she was pregnant. Sometimes it improves with background noise. Her father and aunts also
have a history of deafness. On otoscopy a faint pink tinge is seen through the tympanic membrane in the region of the
cochlear promontory. Tuning fork test show a conductive hearing loss.

40. What is the most likely diagnosis?

a. Glomus Tympanicum
b. Tympanosclerosis
c. Otospongiosis
d. Cholesteatoma
e. Myringosclerosis

41. Which of the following statements best describes this condition?

a. It is an inherited disorder that causes ankylosis of the stapes foot plate to the margins of the round window
b. It is caused by the accumulation of keratin debris in the middle ear cleft due to a retraction pocket
c. It is a genetically mediated, metabolic bone disease, of uncertain aetiology that affects the otic capsule & ossicles
d. It is caused by hyalinization & subsequent calcification of sub-epithelial tissue of the tympanic membrane
e. It is a disorder of bone remodeling that results in a dislocation of the stapes footplate from the oval window

42. A pure-tone audiogram is requested & the results are displayed here
What prominent feature is displayed on this audiogram?

a. Phelps sign
b. Schwartz Peak
c. Carharts notch at 2KHz
d. Noise induced notch
e. Tullio Phenomenon

43. Impedance tympanometry is most likely to show which type of tracing:

44. The treatment of choice is

a. Sodium fluoride therapy

b. Stapedotomy
c. Stapedectomy
d. Cochlear implant
e. Bisphosphonate therapy
45. Complications of surgery may include any of the following, EXCEPT?

a. Perilymph fistula
b. Dysphonia
c. Dysgeusia
d. Complete deafness
e. Subluxation of the stapes footplate

46. Which of the following statements is likely to be correct, regarding this disorder?

a. Autosomal recessive with complete penetrance

b. Women, with this condition, tend to seek treatment more often than the males
c. More Common in Caucasians than Asians or blacks
d. Associated with Paracusis Willissii and Schwartz sign (red-blue hue)
e. Rarely In the late stages it may cause a sensorineural hearing loss

Theme: Sensorineural Hearing loss

47. Which of the following is not a cause of congenital deafness?

a. Toxoplasmosis
b. Cytomegalovirus
c. Maternal Rubella
d. Mumps
e. Syphilis

48. Which of the following medications is LEAST likely to be ototoxic

a. Dexamethasone
b. Aspirin
c. Cisplatin
d. Furosemide
e. Quinine

Theme: Sudden sensorineural Hearing loss

49. Which of the following is NOT a cause of sudden sensorineural hearing loss?

a. Viral Labyrinthitis
b. Cogans syndrome
c. Systemic Lupus erythematosus
d. Presbycusis
e. Vascular occlusion of labyrinthine artery

50. Commonly proposed methods used to treat sudden sensorineural hearing loss include all the following, EXCEPT?

a. Intratympanic glucocorticoids
b. Hyperbaric oxygen
c. Inhaled carbon dioxide
d. Low molecular weight dextran
e. Trans-tympanic aminoglycoside injection
Theme: Ear discharge

A 15-year-old boy attends a routine E.N.T outpatient appointment. He complains of hearing loss in his left ear and describes
malodorous discharge for 6 months. On examination you note a perforation and crust formation at the pars flaccida. (as
shown below)

51. What is the most likely diagnosis?

a. Chronic suppurative otitis media attico-antral type

b. Chronic suppurative otitis media tubotympanic type
c. Chronic serous otitis media
d. Chronic localized otitis externa
e. Cholesterol granuloma of the middle ear

52. The most common postulated mechanism for the genesis of this condition is

a. presence of congenital cells rest.

b. invagination of pars flaccida: (wittaacks theory)
c. basal cell hyperplasia: (Ruedis theory)
d. migration of squamous epithelium: (Habermanns theory)
e. squamous metaplasia: (Sades theory)

53. The most effective treatment option is

a. Topical ear drops
b. Aural suctioning
c. Systemic antibiotics
d. Combined approach Tympanoplasty
e. Modified radical mastoidectomy

54. If left untreated this disease could result any of the following complications EXCEPT
a. Facial nerve palsy
b. Lateral rectus palsy
c. Anosmia
d. Sigmoid sinus thrombosis
e. Meningitis

55. Tuning fork testing will most likely show

a. Bone conduction better than air conduction in the unaffected ear, weber lateralizes to the unaffected ear
b. Air conduction better than bone conduction in the affected ear, weber lateralizes to the affected ear
c. Bone conduction better than air conduction in the unaffected ear, weber lateralizes to the affected ear
d. Air conduction better than bone conduction in the affected ear, weber lateralizes to the unaffected ear
e. Bone conduction equal to air conduction in both ears, weber remains central
Audiologist Testing

56. Which of the following statements about tuning fork test is CORRECT?
a. Rinne negative means Air conduction is better than bone conduction(BC)
b. In a patient with a false negative Rinne test, sound lateralizes to the good ear
c. A false negative Rinne Test indicates severe or profound conductive hearing loss
d. Weber testing will lateralize to the left the ear in a patient with a negative Rinne test in the right ear
e. absolute bone conduction test compares the patients BC with the doctors BC to identify conductive hearing loss

57. With regards to audiologic testing, which of the following statements is INCORRECT?

a. Pure tone audiometry is more suitable than behavioural audiometry in children ages 2-4 years
b. Impedance audiometry may be used to elucidate middle ear pressure, compliance & acoustic reflexes
c. Patients with negative ear pressures will have a type C tympanogram
d. Patients with middle ear effusions usually have type B tympanograms
e. Otoacoustic emissions test & Auditory Brain stem response are objective tools used in neonatal hearing screening

58. A negative Rinne test is most likely to associated with

a. Vestibular schwannoma
b. Menieres disease
c. Presbycusis
d. Otosclerosis
e. Noise induced hearing loss

59. Rinne & weber test is performed in a 20-year-old male. Rinne test lateralizes to the left ear. Rinne testing is negative in
the left ear. Rinne test is positive in the right ear
a. Left sensorineural hearing loss
b. Left conductive hearing loss
c. Right sensorineural hearing loss
d. Right conductive hearing loss
e. Mixed hearing loss

60. Objective audiologic testing includes all the following, EXCEPT

a. Otoacoustic emissions
b. Electrocochleography
c. Auditory brainstem response
d. Pure tone audiometry
e. Impedance tympanometry

61. A patient is seen in the ENT clinic for review of an investigation your
consultant previously ordered. The result is most likely in keeping with a
diagnosis of

a. Presbycusis
b. Otosclerosis
c. Acoustic neuroma
d. Menieres disease
e. Noise induced hearing loss
62. You perform tuning fork test in a patient and obtain the following results

a. A right sensorineural hearing loss

b. A right conductive hearing loss
c. A left sensorineural hearing loss
d. A left conductive hearing loss
e. A false positive Rinne Test

63. The audiogram below is most typical of

a. Menieres disease
b. Otosclerosis
c. Noise induced hearing loss
d. Presbycusis
e. Ototoxic medications

64. Which of the following hearing test would be most appropriate for the
evaluation of a neonate?

a. Pure tone audiometry

b. Tuning fork test
c. Speech audiometry
d. Otoacoustic emissions
e. Behavioral audiometry

Vertigo & the physiology of balance

65. Which of the following statements is true?

a. Angular acceleration is detected by vestibular receptors in the utricle and saccule

b. Linear acceleration and tilt is detected by receptors in the semicircular canals
c. The cerebellum has a mainly excitatory effect on vestibular nuclear activity
d. The medial longitudinal fasciculus connects the vestibular and visual systems
e. Vertigo is defined as a sensation of feeling faint, dizzy or imbalanced

66. The diagnosis of vertigo depends mostly on

a. History
b. Physical examination
c. CT imaging
d. Audiogram findings
e. Presence or absence of nystagmus
67. A 30-year old conscious woman is brought to the ER following an accident. The caloric test was performed by irrigating
the left ear with cold water and then with warm water. The physician concluded that the vestibulo-ocular reflex was
present since he observed which eye movements?

a. Cold water induced the fast phase of nystagmus to the right side
b. Cold water induced the fast phase of nystagmus to the left side
c. Warm water induced the fast phase of nystagmus to the right side
d. No nystagmus was induced by cold water
e. No nystagmus was induced by the warm water

68. Peripheral Vertigo has all the following features EXCEPT

a. Vertical Nystagmus
b. Vertigo that worsens with head movement
c. A caloric response that decreases on the side of the lesion
d. Horizontal nystagmus
e. Rotational nystagmus

Theme: Causes of Vertigo

A 54-year-old retired teacher, presents to clinic complaining about "really bad dizziness." She says that when she first sat up
in bed this morning, she suddenly felt very unstable and as if her body was spinning in space. She was overcome by nausea
but did not vomit, and then the episode passed after approximately 30 seconds. She had a similar episode when she was
cooking in the kitchen. She has not had an episode like this before. She denies hearing loss, tinnitus, aural fullness, fever, or
headache.

69. Your next most appropriate step should be?

a. Dix-Hall-Pike test
b. Epley maneuver
c. Computed Tomography
d. Prescribe promethazine
e. MRI of the head

70. Positional rotatory nystagmus is noted on physical examination. What is the most likely diagnosis?

a. Acoustic Neuroma
b. Menieres disease
c. Benign Paroxysmal Positional Vertigo
d. Labyrinthitis
e. Vestibular Neuritis

71. The most commonly used treatment option for this condition is

a. Singular neurectomy
b. Canalith repositioning
c. Intratympanic gentamicin
d. Oral Prochlorperazine
e. Labyrinthectomy
72. Her condition is most likely due to

a. Idiopathic endolymphatic hydrops

b. Cerebellopontine angle mass
c. Viral or bacterial infection
d. Calcium deposits in the lateral semicircular canal
e. Calcium deposits within the posterior semicircular canal

Theme: Causes of Vertigo

A 35-year-old woman comes to the physician because of two 12-hour episodes of dizziness over the past 3 months.
During episodes, she experiences the acute onset of rotatory vertigo and imbalance, decreased hearing, tinnitus, a sense of
fullness of the right ear, and vomiting. Examination shows normal appearing tympanic membranes and mild hearing loss of
the right ear.

73. What is the most likely diagnosis?

a. Benign positional vertigo

b. Vestibular schwannoma
c. Vestibular insufficiency
d. Viral labyrinthitis
e. Menieres disease

74. Audiogram will most likely show

a. High frequency hearing loss

b. Low frequency hearing loss
c. Carharts notch
d. Conductive hearing loss
e. Noise induced notch

75. This patient should be advised to

a. Engage in balance intensive activities

b. Start cigarette smoking
c. Decrease sodium intake
d. Increase dietary intake of caffeine
e. Lose weight

76. Medications used to treat this condition include all the following, EXCEPT

a. Meclizine
b. Trans-tympanic Glucocorticoids
c. IM or IV Diazepam
d. Cisplatin
e. Trans-tympanic aminoglycosides
77. Which surgical procedure is not used to treat this condition?

a. Vestibular nerve resection

b. Endolymphatic shunt
c. Endolymphatic sac decompression
d. Stapedectomy
e. Labyrinthectomy

78. Which of the following investigations has no role in the evaluation of this patient?

a. Vestibular evoked myographic potential (VEMP)

b. Electrocochleography
c. Pure tone Audiometry
d. Endolymph aspiration
e. Electronystagmography

Theme: Hearing loss & Vertigo

A 36-year-old man presents with a 3-week history of imbalance, right-sided hearing loss, and tinnitus. He reports having an
upper respiratory infection 1 week before the onset of his symptoms. His symptoms began with a severe episode of room-
spinning vertigo with associated nausea and vomiting that lasted all day. The next day he noticed right, high-pitched tinnitus
and was unable to use the telephone in his right ear. He now reports constant imbalance and slight vertigo with quick head
turns to the right.

79. What is the most likely diagnoses?

a. Menieres disease
b. Viral Labyrinthitis
c. Vestibular Neuritis
d. Meningitis
e. Benign Paroxysmal Positional Vertigo

80. This patient should be advised to do all of the following, EXCEPT?

a. Avoid driving
b. Avoid working at heights
c. Avoid using tools and operating machinery
d. Avoid drinking plenty of water
e. Avoid Loud noises

81. Which treatment option is LEAST LIKELY to be required

a. Benzodiazepine
b. Steroids
c. Antiemetics
d. Bed Rest
e. Antibiotics
82. Unfortunately, his symptoms continue to persist for months which of the following management options should be
considered?

a. Vestibular neurectomy
b. Labyrinthectomy
c. Canalith repositioning procedure
d. Vestibular rehabilitation therapy
e. Endolymphatic sac decompression

Theme: Hearing Loss

A female patient presents with a history of progressively decreased hearing in her left ear over the past few years. She
noticed the hearing deficit when trying to use the phone with the left ear. She has recently complained of intermittent
dizziness, tinnitus in the left ear, and vague left-sided headaches

83. Tuning fork testing is most likely to show

a. Air conduction better than bone conduction in both ears, weber remains central
b. Air conduction better than bone conduction in both ears, weber lateralizing to the right ear
c. Bone conduction better than air conduction in both ears, weber remains central
d. Air conduction better than bone conduction in both ears, weber lateralizing to the left ear
e. Bone conduction better than air conduction in both ears, weber lateralizes to the right ear

84. The definitive diagnostic test required is?

a. MRI without contrast

b. Computed tomography of the brain
c. Auditory Brainstem response
d. Positron emission tomography
e. gadolinium-enhanced MRI

Appropriate radiologic imaging is ordered. The results (shown below) reveal a tumour at the cerebellopontine angle with an
ice-cream cone appearance.
85. What is the most likely diagnosis?

a. Meningioma
b. epidermoid
c. ependymoma
d. congenital cholesteatoma
e. Schwannoma

86. The lesion seen above most likely arose from

a. Superior vestibular nerve

b. Inferior vestibular nerve
c. Cochlear nerve
d. Facial nerve
e. Meninges

87. Which of the following modalities is not a recognized modality of treatment for this condition?

a. Stereotactic radiosurgery (e.g. gamma knife, X-knife)

b. Neoadjuvant Chemotherapy followed by surgical resection
c. Resection via a Retro-sigmoid approach
d. Resection via a middle cranial fossa approach
e. Resection via trans-labyrinthine approach

88. Surgical resection should be considered instead of serial observation, if

a. she was elderly with serious comorbidities

b. the tumour was small (< 0.5cm) and her hearing was unaffected
c. She refused treatment despite understanding the benefits
d. the tumour was on the side of the only hearing ear or seeing eye
e. the surgeon is experienced, and the patient accepted the risks

89. This condition is sometimes associated with a positive

a. Aquinos sign
b. Bryce sign
c. Hitzelbergers sign
d. Furstenburg sign
e. Hollman Miller sign

90. If left untreated, this condition could result in any of the following complications, EXCEPT

a. Loss of corneal sensation

b. Raised intracranial pressure
c. Brainstem displacement
d. Tympanic membrane immobility
e. Taste disturbance
91. Had this patient presented with bilateral lesions, you be wise to suspect

a. Multiple endocrine neoplasia type 2a

b. Multiple endocrine Neoplasia type 2B
c. Neurofibromatosis type 1
d. MISME syndrome (NF type 2)
e. Von Hipple-Lindau syndrome

Theme: Hearing Loss

A 3-year-old girl with history of recurrent acute otitis media, refractory to antibiotics, is brought to the ENT clinic. She has
been noted to have a mild conductive hearing loss and flat tympanograms on audiometric assessment. A serous effusion
is present bilaterally on otoscopic exam.

92. Her condition is most likely due to

a. Adenoidal hypertrophy
b. Eustachian tube dysfunction
c. Nasopharyngeal carcinoma
d. Immunodeficiency
e. Juvenile angiofibroma

Theme: Hearing Loss

Your 82-year old patient is in very good overall health. He does have, however, some deficits in hearing. He cannot hear the
full range of sounds that a young person can normally hear. You explain to him that this loss of hearing is common with
aging.
93. The hearing loss he is experiencing is most likely?

a. The result of damage to hair cells that respond maximally to low frequency sounds
b. The result of damage to hair cells that respond maximally to mid frequency sounds
c. The result of damage to hair cells at base of basilar membrane
d. The result of damage to hair cells at apex of basilar membrane
e. The result of damage to hair cells located in the cupula

94. Audiogram is likely to show

a. Bilateral down sloping sensorineural hearing loss

b. Unilateral up sloping sensorineural hearing loss
c. Unilateral down sloping sensorineural hearing loss
d. Bilateral up sloping sensorineural hearing loss
e. Bilateral conductive hearing loss

95. The next best step in management is to recommend

a. Myringotomy & Grommet insertion

b. Stapedectomy
c. Sodium fluoride therapy
d. Hearing aid
e. Cochlear transplant
Theme: Tinnitus

A 55-year-old woman presents with a unilateral conductive hearing loss and pulsatile tinnitus in the right ear. Otoscopy
reveals a reddish-blue appearance to the tympanic membrane

96. What is the most likely diagnosis?

a. paraganglioma
b. haemotympanum
c. Otosclerosis
d. Capillary Haemangioma
e. aberrant internal carotid artery

97. blanching of the tympanic membrane occurs with pneumatic pressure. This clinical sign is referred to as

a. Phelps sign
b. Schwartz sign
c. Sunset sign
d. browns sign
e. Citellis Sign

98. This lesion is most commonly located in the

a. Epitympanum
b. Mesotympanum
c. Hypotympanum
d. Mastoid air cells
e. Internal auditory meatus

99. Which modality is LEAST LIKELY to be used in the treatment of this condition?

a. Pre-operative embolization
b. Immunotherapy
c. Surgical resection
d. Gamma Knife
e. Radiotherapy
100. The patient refuses treatment. She eventually returns 6 months later with hoarseness, dysphagia and shoulder
weakness. This is best explained by

a. Infiltration of the recurrent laryngeal nerve

b. Tumour involvement at the jugular foramen
c. Invasion through the foramen lacerum
d. Compression of oesophageal lumen
e. Metastatic spread to the Vocal cords

Theme: Otalgia

A 65-year old male is referred to the otolaryngology clinic. He complains of deep, boring ear pain, scant ear discharge and
facial weakness. He is known to have hypertension & diabetes mellitus but has been non-compliant with his medication.
Recently he started swimming to lose weight. Five days ago, he was seen by his GP who diagnosed him with an outer ear
infection & prescribed acetic acid drops.

101. On physical examination, the patient is most likely to have any the following clinical findings EXCEPT?

a. Conductive hearing loss due to canal wall oedema, an aural polyp or otitis media with effusion
b. Impaired gag reflex, deviation of the tongue or facial pain
c. Granulation tissue at the osseocartilaginous junction of the eustachian tube
d. Marked tenderness on palpation of the mastoid tip or ascending ramus of the mandible
e. Trismus and tenderness over the temporomandibular joint

102. Which single factor is most likely contributing towards his condition?

a. Swimming
b. Hypertension
c. Age (elderly)
d. Gender (male)
e. Immunosuppression

103. An ear swab is taken for culture & sensitivity. Which of the following statements is false, regarding the most likely
organism to be isolated?

a. It is responsible for 95% of the cases involving progressive necrotizing infection of the external auditory canal
b. It is a gram-negative rod that produces exotoxins which cause tissue necrosis at the advancing edge of the
infection
c. It produces substances that encapsulate the infection (biofilm) from host defenses and systemic antibiotics
d. It is a gram-positive coccus that is typically arranged in grape-like clusters on microscopy
e. It may also cause infections in burn victims, cystic fibrosis patients & hot-tub folliculitis in immunocompetent
individuals

104. What is the most likely diagnosis and pathogen?

a. Malignant otitis media Staphylococcus aureus

b. Localized otitis externa Proteus Mirabilis
c. Necrotizing otitis externa Pseudomonas Aeruginosa
d. Osteomyelitis of the temporal bone Aspergillus fumigates
e. Diffuse otitis externa Klebsiella Pneumoniae
105. The mainstay of treatment is

a. Intravenous aminoglycoside therapy

b. Amoxicillin with clavulanic acid (augment) & metronidazole (flagyl)
c. Surgical debridement with a cortical mastoidectomy
d. Intravenous ceftazidime & oral Fluoroquinolone therapy
e. Antiretroviral medication

106. Which of the following adjuncts to treatment is not recommended?

a. Packing the ear canal with cotton soaked in warm 0.9% normal saline
b. Daily suction toilet of the external auditory canal
c. Analgesics with non-steroidal anti-inflammatory agents or opioids
d. Fluoroquinolone ear drops (e.g. ciprofloxacin)
e. Biopsy of granulation tissue to rule out a malignancy and check for fungi

107. Which of the following investigations is typically used to monitor the patients response to therapy?

a. leukocyte/white blood cell count

b. serial ear swabs
c. glucose profile
d. Computed tomography of the temporal bone
e. Erythrocyte sedimentation rate

108. The infection typically affects the cranial nerves as they exit their various foramina. Which of the following is most
accurate?

a. The hypoglossal nerve is most frequently affected as it exits the jugular foramen
b. The vagus nerve is typically affected as it leaves the anterior condylar canal
c. The facial nerve is most frequently affected in an abscess cavity close to the stylomastoid foramen
d. The trigeminal nerve is most frequently affected as it enters the internal acoustic meatus
e. The abducens (6th) nerve is usually affected as it passes through the mastoid process of the temporal bone

Theme: Outer ear infections

A 21-year-old swimmer comes to the clinic because of pain, moist discharge and itching in his left ear. He is known to have a
history of seborrheic dermatitis. The symptoms began two days ago and have worsened. He denies any hearing loss,
tinnitus, or vertigo. Pain is elicited when the left auricle is pulled superiorly and when the left tragus is pressed inward. The
left ear canal is edematous and erythematous, and the considerable yellowish debris present in the canal obstructs
visualization of the tympanic membrane.

109. What is the next most important treatment modality?

a. Systemic antibiotics
b. Application of topical gentamicin with dropper
c. aural toileting by suctioning
d. syringing the ear canal
e. Inserting a wick with glycerin & ichthammol
Theme: External Ear Infections

A young woman complains to you about having right sided ear pain. O/E: the is localized hyperemia and a small furuncle is
seen in the external auditory meatus. The tympanic membrane is unaffected

110. Which of the following statements is likely to be false?

a. The most likely causative organism is staphylococcus aureus

b. The Furuncle is most likely to be located on the inferior aspect of the medial 2/3rd of the canal
c. Incision and drainage is usually not necessary to treat these patients
d. NSAIDs along with oral antibiotics such as amoxicillin is usually all that is required
e. Topical antibiotic ointment may also be used

Theme: Ear infections

A 60-year male, with a known diagnosis of HIV, presents with otalgia and tinnitus. On examination there appears to be
vesicles in the left external auditory canal and pinna. On inspection there is marked facial paralysis.
111. What would be the most appropriate treatment?

a. Prednisone & acyclovir

b. Intravenous Ciprofloxacin
c. Prednisone & ganciclovir
d. Gentamicin ear drops
e. Facial nerve decompression

112. The most likely etiologic agent is

a. Herpes simplex virus

b. Epstein Bar Virus
c. Human Immunodeficiency virus
d. Human Lymphotropic Virus type II
e. Herpes zoster virus

113. hat is the most likely diagnosis?

a. Herpes zoster Oticus

b. Bells Palsy
c. Malignant otitis externa
d. Ramsay Hunt syndrome
e. Post herpetic neuralgia

114. The main pathophysiologic mechanism of this condition is

a. Activation of infection in Scarpas ganglion

b. Spread of infection through the Fissures of Santorini
c. Reactivation of infection in the geniculate ganglion
d. Binding to the CD4+ GP 120 surface molecule
e. Reactivation of infection in the otic ganglion
Theme: Middle Ear Infections

An 18-month-old toddler presents with 1 week of rhinorrhoea, cough, and congestion. Her parents report she is irritable,
sleeping restlessly, and not eating well. Overnight she developed a fever. She attends day care and both parents smoke. On
examination signs are found consistent with a viral respiratory infection including rhinorrhea and congestion. The toddler
appears irritable and apprehensive and has a fever. Otoscopy is shown below

115. Which clinical finding is MOST suggestive of the suspected diagnosis?

a. An erythematous tympanic membrane

b. A bulging, immobile tympanic membrane
c. Loss of identifiable landmarks, such as the handle of the malleus
d. Perforation of the tympanic membrane
e. Absent Cone of light

116. Which of the following pathogens is NOT implicated in the pathogenesis of her disease?

a. Streptococcus pneumoniae
b. Haemophilus influenzae
c. Respiratory syncytial virus
d. Moraxella Catarrhalis
e. Norwalk virus

117. Complications of this disease include all the following EXCEPT

a. Ludwigs angina
b. Gradenigos syndrome
c. Bezolds Abscess
d. Citellis abscess
e. Facial nerve paresis

118. The most common intracranial complication of this condition is

a. Temporal lobe abscess

b. Subdural abscess
c. Meningitis
d. Acute Mastoiditis
e. Extradural abscess

119. Which one of the following is the drug of choice for initial treatment of this condition?

a. Ciprofloxacin
b. Amoxicillin
c. Erythromycin
d. Azithromycin
e. Cefaclor
120. Which of the following environmental factors may increase the incidence of this condition?

a. Putting an infant to bed with a bottle

b. Cigarette smoke
c. Dust
d. Molds
e. All of the above

121. Which of the following is the most prevalent complication of this disease?

a. Fluctuating or persistent hearing loss

b. Perforation of the tympanic membrane
c. Development of cholesteatomas
d. Chronic infection of the middle ear
e. None of the above

Theme: Otalgia

A 4-year-old boy is brought to the emergency department with otalgia and discharge from the left ear. His
temperature is 39 C. On examination, the left ear appears to be pushed forward, outwards and downwards (as shown
below)

122. This condition is best treated with

a. Oral amoxicillin
b. A Watch and wait approach for 48 hours
c. IV antibiotics +/- Cortical mastoidectomy
d. Aminoglycoside ear drops
e. Combine approach tympanoplasty

123. The following are organisms is most commonly isolated in this condition.

a. Streptococcus pyogenes
b. Streptococcus pneumoniae
c. Staphylococcus aureus
d. Moraxella catarrhalis
e. Streptococcus viridans

Theme: Hearing aids

124. Which of the following hearing aids would be most appropriate in an elderly man suffering from bilateral
otitis externa with bilateral sensorineural hearing loss?

a. Bone anchored hearing aid

b. Cochlear implant
c. Auditory brain stem implant
d. In the canal hearing aid
e. Behind the ear hearing aid
125. A 34-year-old woman presents with bilateral mild to moderate sensorineural hearing loss. She feels
embarrassed about using a readily visible hearing aid at work. You should recommend a

a. Cochlear implant
b. Ventilation tube
c. Bone anchored hearing aid
d. In-the-canal hearing aid
e. Auditory Brainstem implant

126. A 25-year-old male with neurofibromatosis type 2 is to receive a hearing aid post resection of bilateral
vestibular schwannomas. Which of the following would be most appropriate?

a. Cochlear implant
b. CROS- hearing aid
c. Bone anchored hearing aid
d. In-the-canal hearing aid
e. Auditory Brainstem implant
Extended matching Questions

A. Acoustic Neuroma
B. Presbycusis
C. Otitis externa
D. Ototoxic drugs
E. Menieres disease
F. Otosclerosis
G. Bells Palsy
H. Acute Otitis Media
I. Mastoiditis
J. Labyrinthitis
K. Cholesteatoma
L. Citellis Abscess
M. Ramsay hunt syndrome

1. A 35-year-old man presents with a 2-day history of rapid-onset severe ear pain and fullness. The patient complains of
otorrhea and mild decreased hearing. He reports that his symptoms started after swimming. No fever is reported. On
physical exam the external ear canal is diffusely swollen and erythematous. He has tenderness of the tragus and pain
with movement of the auricle. The tympanic membrane was partially visualized due to the swelling. The concha and
the pinna look normal. Neck exam fails to reveal any lymphadenopathy

2. A 52-year old man reported feeling unsteady while walking. History taking revealed that this balance problem
developed after a hearing loss associated with the left ear. The patient's muscles of facial expression on the left
exhibited marked weakness. In addition, the patient's corneal reflex was absent on the left side.

3. A 6- year- old child presents with severe otalgia and a discharging left ear. On examination he is distressed with a
pyrexia and tenderness over the mastoid. CT shows a subperiosteal collection spreading through the medial aspect of
the mastoid into the digastric fossa.

4. A 42-year -old woman who over the last 4 years has had 3 attacks of vertigo lsting a few hours, each time preceded by
aural fullness and tinnitus in the left ear

5. A 37-year-old man presents with hearing loss and a painful intermittent purulent discharge from his right ear. He also
reports intermittent dizziness, and tinnitus in the right ear. On otoscopy, he has an attic crust on his right tympanic
membrane. Examination with an otomicroscope and microsuctioning reveals keratin in an attic retraction pocket. An
audiogram demonstrates a conductive hearing loss on the right side