FCORL(SA) Final

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Final Examination for the Fellowship of the

College of Otorhinolaryngologists of South Africa

24 July 2017

Paper 1 (3 hours)

All questions to be answered. Each question to be answered in a separate book (or books if more than one is required
for the one answer)

1 a) Discuss the value of imaging in chronic otitis media and the use of Diffusion Weighted
MRI. (15)
b) List the cell type and description in the Kuhn classification of cells of the frontal recess
and frontal sinus. (15)
c) Describe the Draf endonasal frontal sinus procedures. (10)
d) Discuss the use of stents and balloon dilatation in sinus surgery. (10)
[50]

2 Write short notes on the key clinical features on history and examination you would try to elicit
to make the diagnosis of the following conditions
a) Necrotising otitis externa. (7)
b) Wegener’s granulomatosis. (8)
c) Allergic rhinitis. (16)
d) Temporomandibular joint dysfunction. (12)
e) Orbital cellulitis. (7)
[50]

3 Write short notes on what are currently considered to be possible aetiologic/associated

contributors to the following conditions, pointing to evidence for the purported cause
a) Otosclerosis. (12)
b) Nasal polyposis. (8)
c) Nasopharyngeal carcinoma. (10)
d) “Idiopathic” sudden sensorineural hearing loss. (5)
e) Anosmia. (15)
[50]

4 Classifications, staging and grading systems can be useful in aiding clinical management.
Describe briefly
a) The following classifications
i) The Keros Classification of depth of the olfactory fossa. (5)
ii) The Myer-Cotton classification of subglottic stenosis. (4)
iii) The WHO classification of the histological subtypes of nasopharyngeal carcinoma.
(6)

PTO/Page 2 Question 4b)…

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b) The following staging systems

i) The Tos staging of pars flaccida retraction. (6)
ii) The TNM staging of carcinoma of the oral cavity. (8)
iii) The TNM staging of lymph node metastasis. (8)
c) The following Grading systems
i) Grading system for croup. (7)
ii) Brodsky grading scale for tonsillar obstruction. (6)
[50]
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FCORL(SA) Final

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Final Examination for the Fellowship of the

College of Otorhinolaryngologists of South Africa

25 July 2017

Paper 2 (3 hours)
All questions to be answered. Each question to be answered in a separate book (or books if more than one is required
for the one answer)

1 a) Define SSNHL and discuss the causes. (10)

b) Discuss the clinical assessment and investigation of a patient with SSNHL. (10)
c) Describe how a patient with a temporal bone fracture might present. (10)
d) List the autoimmune causes of hearing loss. (10)
e) Briefly discuss site of lesion testing in the auditory system. (10)
[50]

2 a) What is Frey’s syndrome, what is it caused by and what is the incidence depending
on different surgical techniques? (10)
b) How can Frey’s syndrome possibly be prevented and what are the sequela of these
preventative measures? (10)
c) How would you treat someone with Frey’s syndrome? (10)
d) List indications/specific reasons for doing the following procedures and briefly discuss
possible sequelae or complications and how to avoid them
i) Small (type 1) middle meatal antrostomy. (5)
ii) Large (type 2 and 3) middle meatal antrostomy. (5)
iii) Maxillary antrum washout. (5)
iv) Caldwell-Luc approach to the maxillary sinus. (5)
[50]

3 A 30-year-old male presents with facial pain over the frontal sinuses and CT-sinuses show
normally aerated sinuses and some mucosal contact points
a) What is your opinion regarding mucosal contact points as a cause for facial pain and
when would you consider operating on such a patient? (10)
b) How would you manage this patient? (10)
c) Discuss why you would or would not do a CT before a septoplasty. (10)
d) Should intranasal splints be used after septal surgery? Discuss benefits and risks. (10)
e) A small incidental 5x5mm osteoma is seen within the right ethmoid sinus of a patient
who had a CT scan for headaches. The rest of the paranasal sinuses are normal. How
would you manage this patient? (10)
[50]

PTO/Page 2 Question 4…
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4 a) Give the different classifications for Glomus tumours. (10)

b) List the complications of tracheostomy. (10)
c) List the congenital abnormalities of the nose, pharynx, larynx and trachea that cause
airway obstruction. (30)
[50]
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FCORL(SA) Final

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Final Examination for the Fellowship of the

College of Otorhinolaryngologists of South Africa

26 July 2017

Paper 3 ORL and Head & Neck Surgery (3 hours)

All questions to be answered. Each question to be answered in a separate book (or books if more than one is required
for the one answer)

1 a) List the causes and investigations of asymmetrical sensorineural hearing loss in an adult.
(10)
b) Discuss management options for a vestibular schwannoma under the following headings
i) Non surgical options. (10)
ii) Surgical approaches. (10)
c) Tinnitus in an adult female: Briefly discuss (20)
i) Defination.
ii) Classification.
iii) Diagnostic evaluation.
iv) Treatment.
[50]

2 a) Discuss the general differences between an inflammatory nasal polyp and an inverted
papilloma with respect to the following
i) General features and histopathology. (10)
ii) Treatment. (10)
iii) Follow-up and longterm management. (10)
b) Discuss how you would do a submandibular gland excision and the anatomical structures
encountered during the procedure. (10)
c) Describe the presentation and spread of nasopharyngeal carcinoma. (10)
[50]

3 a) List 5 different petrous apex lesions and their CT and MRI diagnostic features. (20)
b) Discuss the classification of blunt temporal bone trauma and the presenting symptoms
and signs associated with them. (10)
c) Discuss 4 theories for the pathogenesis of acquired cholesteatoma. (20)
[50]

PTO/Page 2 Question 4…
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4 a) Discuss the following complications associated with total laryngectomy and the
predisposing factors (not management).
i) Fistula. (10)
ii) Stomal recurrence and stenosis. (10)
iii) Medical Complication. (5)
iv) Oesophageal. (5)
v) Endocrinology. (5)
b) What is the vasomotor rhinitis? Discuss features of vasomotor rhinitis. (5)
c) Discuss the autonomic nervous system control of the nasal cavity. (10)
[50]