Ent Mcqs For Part I Exam: Prepared By: Dr. Fouad Shamsan

ENT MCQs for Part I Exam
Prepared by: Dr. Fouad Shamsan

1- Surgical Anatomy of Head & Neck
A neoplastic process is found on CT examination to involve the area of the jugular foramen. Which anatomic
structure would not be affected?
hypoglossal nerve
internal jugular vein ‫ ﻓؤاد ﻣﺣﺳن ﻋﻠﻲ ﺷﻣﺳﺎن‬.‫د‬
vagus nerve
spinal accessory nerve ‫اﺧﺗﺻﺎص أﻧف وأذن وﺣﻧﺟرة‬
cervical sympathetic
The phrenic nerve can beidentified by its location superficial to the anterior scalene muscle. It may also be identified
by its location deep to the
digastric muscle
omohyoid muscle
transverse cervical artery
dorsal scapular artery
internal jugular vein
After a radical neck dissection, a patient is noted to have ptosis of the ipsilateral upper eyelid. This finding is due to
inadvertent dissection deep to the
internal jugular vein

common carotid artery
brachial plexus
omohyoid muscle
vagus nerve
he draining ostia for the anterior sinuses (frontal, maxillary, anterior ethmoids) and the draining ostia for the
posterior sinuses (posterior ethmoids, sphenoid) are separated from one another by
uncinate process
ethmoid bulla
inferior turbinate
middle turbinate
superior turbinate
A colleague calls you to the operating room to inspect a wound after a laryngectomy. He believes he has cut the
hypoglossal nerve! The nerve in question is approximately the same size as the hypoglossal nerve, runs in the same
direction as the hypoglossalnerve, but lies medial to the carotid artery. Which nerve has your associate cut?
hypoglossal
ansa cervicalis
cervical sympathetics
inferior laryngeal
superior laryngeal
After oral removal of a submandibular duct stone, the patient complains of numbness to the ipsilateral anterior
tongue. Which structure has been damaged?
lingual nerve
hypoglossal nerve
submandibular ganglion
Wharton’s duct
Stensen’s duct
Which pair of muscles provides convenient and safe landmarks for proceeding to and fro from the anterior to
posterior aspects of the neck?
omohyoid and sternohyoid

sternomastoid and trapezius
omohyoid and digastric
digastric and sternohyoid
sternohyoid and thyrohyoid
The ophthalmic artery accompanies the optic nerve through the optic canal. The ophthalmic vein exits the orbital
cone through which bony aperture?
optic canal
infraorbital canal
superior orbital fissure
inferior orbital fissure
ethmoidal foramen
The boundaries of the preepiglottic space are the epiglottis, aryepiglottic folds, and
median glossoepiglottic ligament, thyroid cartilage, thyrohyoid membrane

lateral glossoepiglottic ligaments, thyroid cartilage, thyrohyoid membrane
median glossoepiglottic ligament, cricoid cartilage, thyrohyoid membrane
lateral glossoepiglottic ligaments, cricoid cartilage, cricothyroid membrane
median glossoepiglottic ligament, hyoid bone, thyrohyoid membrane
The most reliable landmark for the identification of the extracranial main trunk of the facial nerve is the
styloid process
auditory canal
mastoid process
tympanomastoid suture
stylomastoid suture
2- Genetics
Which of the following disorders is due to an expanded number of trinucleotide repeats?
neurofibromatosis, type 1
cleft lip/palate
Friedreich’s ataxia
ataxia telangiectasia
Alport’s syndrome
For which type of inheritance would you typically use homozygosity mapping?
autosomal recessive
autosomal dominant
X-linked
maternal/mitochondrial
One characteristic of genomic imprinting is that it
simultaneously alters several closely linked genes

depends on trinucleotide repeat sequences
establishes a mutation in a population
involves modification of DNA by methylation
occurs only during spermatogenesis
Mutations within a single gene locus appear to account for all cases of
Alport’s syndrome
Pendred’s syndrome
prelingual isolated deafness
Usher’s syndrome
Waardenburg’s syndrome
Match Kallman syndrome with one of its other phenotypic features.
anosmia
congenital cataract
conotruncal heart defect
hypothyroidism
immotile cilia
nephritis
polyembolokoilamania
retinitis pigmentosum
Match Smith-Magenis syndrome with one of its other phenotypic features.
anosmia
congenital cataract
hypothyroidism
immotile cilia
nephritis
Match Usher’s syndrome with one of its other phenotypic features.
anosmia
congenital cataract
hypothyroidism
immotile cilia
nephritis
Match Pendred’s syndrome with one of its other phenotypic features.
anosmia
congenital cataract
hypothyroidism
immotile cilia
nephritis
Match Velocardiofacial syndrome with one of its other phenotypic features.
anosmia
congenital cataract
hypothyroidism
immotile cilia
nephritis
Match Alport’s syndrome with one of its other phenotypic features.
anosmia
congenital cataract
hypothyroidism
immotile cilia
nephritis
Genetic counseling for a disorder generally includes all of the following except
all options currently available for prenatal diagnosis and gene therapy
course of action most people would choose given the circumstances
natural history of the disorder
risk of recurrence in future offspring and other family members
role of both heredity and environment in the disorder
A patient with medullary thyroid carcinoma is found to have a pheochromocytoma, and genetic analysis reveals an
RET protooncogene germline mutation. No other physical or biochemical abnormalities are identified. The most
likely diagnosis is
familial medullary thyroid carcinoma

sporadic medullary thyroid carcinoma
multiple endocrine neoplasia I
multiple endocrine neoplasia IIB
multiple endocrine neoplasia IIA
TP53 (p53) acts as a tumor-suppressor gene through its activity in

arresting cell replication in Gl
accelerating the cell cycle
suppressing the activity of an oncogene
blocking cell division in S
interacting with DNA to regulate transcription of other genes
3- Advances in Molecular Biology
It is believed that Bcl-2 expression
determines the level of Bax expression

is exclusive to squamous cell carcinoma of the head and neck
is induced by radiotherapy
regulates apoptosis
is regulated by apoptosis
Apoptosis is
an abnormally high rate of tumor cell proliferation

exclusive to cancer-related pathologies
biologically programmed cell death
a byproduct of laser surgery
enhanced by Bcl-2 expression
What is the generally accepted cure rate for early squamous cell carcinoma of the larynx?
90%
80%
70%
60%
50%
Squamous cell carcinoma is
age-dependent
sex-dependent
exclusive to patients who smoke
all of the above
none of the above
Which of the following is true?
Bcl-2 underexpression is an indicator of squamous cell carcinoma patients who will have poor prognoses.
Bcl-2 underexpression is correlated to a decrease in apoptosis.
Bcl-2 overexpression is exclusive to squamous cell carcinoma.
Bcl-2 overexpression is correlated to an increase in apoptosis.
Bcl-2 overexpression is an indicator of prognosis in patients with early-stage squamous cell cancer of
the larynx.
4- The Principle of Pharmacology & Medical Therapy
The best example of the importance of establishing a specific diagnosis before prescribing therapy is
ampicillin given to a woman on oral contraceptives

cromolyn for nasal allergy
antibiotic choice for acute sinusitis
use of a mixture of corticosteroid and cromolyn nasal sprays for rhinitis
terfenadine therapy in an asthmatic
To treat a beta-lactamase-producing organism, the most cost-effective drug in the list below is
cefixime
cefaclor
amoxicillin-clavulanate
amoxicillin
penicillin V potassium
What percentage of Investigational New Drug Applications eventually result in an FDA-approved new drug?
12%
20%
37%
42%
50%
Which of the following does not present the potential for arrhythmias when administered with terfenadine or
astemizole?
erythromycin
ketoconazole
grapefruit juice
clarithromycin
cromolyn
Which combination is unlikely to result in adverse consequences?
allergy injection and propranolol

ampicillin and birth control pills
terfenadine and pseudoephedrine
erythromycin and theophylline
astemizole and itraconazole
The “teratogenic period” in humans is the
first 30 days of gestation

last 70 days of gestation
second and third trimesters of pregnancy
entire pregnancy
6 weeks after the first missed period
In treating sinusitis during pregnancy, which decongestant is most appropriate?
pseudoephedrine
phenylephrine
phenylpropanolamine
oxymetazoline
chlorpheniramine
A drug that shows teratogenicity in animals and has not been used in human studies is classified as
FDA category A
FDA category B
FDA category C
FDA category D
FDA category E
Which of the antibiotics listed below should be avoided in treating a pregnant patient at term?
amoxicillin
erythromycin
tetracycline
clindamycin
sulfamethoxazole
In the drug development process, the usual order is
animal testing, human safety testing, human effectiveness testing, determination of adverse effects
determination of adverse effects, animal testing, human effectiveness testing, human safety testing
human safety testing, human effectiveness testing, determination of adverse effects, confirmation in animal
tests
animal testing, determination of adverse effects, human safety testing, human effectiveness testing
animal testing, human effectiveness testing, human safety testing, determination of adverse effects
5-Microbiology, Infections & Antibiotic therapy
Which of the following complications of antimicrobial therapy are true statements?
Aminoglycoside antibiotics can be ototoxic in patients receiving ordinary therapeutic doses.

Either erythromycin or ciprofloxacin can elevate theophylline levels (and can cause side effects) when given
to asthmatic patients taking theophylline.
Antibiotic-induced enterocolitis can be caused by antibiotics other than clindamycin and can be treated orally
with either vancomycin or metronidazole.
Either tetracyclines or sulfonamides can cause frequent rashes and can stain teeth in children.
Cephalosporins are contraindicated in patients with prior penicillin-anaphylaxis reactions. They are also
contraindicated after penicillin-rash reactions.
A, B, and C
D and E
Streptococcus pneumoniae, a common pathogen causing acute otitis media and acute sinusitis, is
ordinarily sensitive to penicillin

ordinarily sensitive to first- and second-generation cephalosporins
sometimes resistant to cefixime (oral third-generation cephalosporin)
ordinarily resistant to clarithromycin
ordinarily resistant to third-generation cephalosporins and chloramphenicol
A, B, and C
D and E
Haemophilus influenzae, a common pathogen causing acute otitis media and acute sinusitis, is
always sensitive to amoxicillin

resistant to amoxicillin in 20% of cases
resistant to amoxicillin in 80% of cases
generally resistant to first-generation cephalosporins
generally resistant to second- and third-generation cephalosporins
A, C, and E
B and D
Moraxella (Branhamella) catarrhalis, a common pathogen causing acute otitis media and acute sinusitis, is generally
sensitive to
amoxicillin
cefuroxime
cefixime
erythromycin plus sulfonamide
A, C, and E
B, C, D, and E
Pseudomonas aeruginosa, a common infection in hospitalized patients and in contaminated wounds, is treatable with
ticarcillin-clavulanate
gentamicin
chloramphenicol
ciprofloxacin
B, C, and E
A and D
Staphylococcus aureus, a common pathogen of skin infections, is usually treatable with
penicillin or amoxicillin
nafcillin, dicloxacillin, or cephalexin
clindamycin
sulfonamides
A, B, and C
B, C, and E
Methicillin-resistant S. aureus (about 10% of S. aureus strains) is
treatable with cephalexin

treatable with amoxicillin-clavulanate
treatable with vancomycin
usually treatable with ciprofloxacin
usually treatable with clindamycin
A and B
C, D, and E
Anaerobic bacteria such as Bacteroides fragilis are treatable with
aminoglycosides (e.g., gentamicin)

erythromycin
ciprofloxacin
clindamycin
metronidazole
A and B
A, B, and D
D and E
6- Trends in Diagnostic Pathology
In general, cancers are thought to be the result of
a clonal selection of cells that acquire multiple genetic changes

progressive mutations of stem cells from preexisting malignant cells
progressive nongenetic mutations within normal cells
progressive accumulation of suppressor gene transformations
prolonged exposure of cells to blood cell alterations
p53
has a role in normal cell progression and not in neoplastic development

is one of the most frequently studied genes associated with cancer
has a short half-life when in the mutated form
abnormal forms may be found in up to 99% of tumors
is not considered to be a checkpoint in cellular DNA repair under normal conditions
p53
prevents cells with damaged DNA from passing through the cell cycle
mutations have been found in the majority of cancers of the head and neck
mutations are the result of interactions with other unidentified oncogenes
mutations produce normal cells with stable phenotypes
mutations are not considered to be a part of the progression of normal to malignant cells
p53
is always detectable by immunohistochemical methods

shows no change in staining intensity from one tumor to the next
aneuploid tumors of the head and neck are always strongly positive by immunohistochemistry
may act synergistically with other suppressor genes and indicate poor survival
is augmented by H-ras in head and neck cancer
Oncogenes
are not found in benign tissues of the head and neck

are considered to be an absolute requirement for neoplastic transformation
may be detected in normal tissues adjacent to carcinomas in head and neck cancer
in combination with measurements of angiogenesis, may allow for the separation of highly aggressive tumors
from low-grade tumors
are not considered a part of the transition from benign to malignant
Human papillomavirus (HPV) infections
may be present in up to 95% of head and neck lesions

may coexist with p53 in high-grade dysplastic lesion of the head and neck
have subtypes that have been shown to be present in invasive carcinomas only
do not represent a known etiologic agent associated with malignant transformation
are not found in dysplastic lesions from tobacco users
Molecular methods in diagnostic pathology
have no proven utility

are most often superior to standard methods for tumor detection
are used in conjunction with standard methods to ascribe prognosis
are methods designed to show the morphological appearances of tumors
are ways to look at the genetic transformations that occur in normal tissues only
Microsatellite instability
is a way to document loss of heterozygosity in neoplastic tissues

is a way to look at tandem repeats of 100 base pairs or more in neoplastic tissues
is always dependent on amplification of the DNA to be detected
cannot be used to detect contamination of cell cultures
has no role in forensic identification
Microsatellite instability
may be used to document precursor stages of tumor progression

has no utility in detecting premalignant changes in tissues adjacent to tumors
has not shown the presence of chromosomal abnormalities in head and neck cancers
has not shown that loss of heterozygosity at more than one loci is associated with poor prognosis
has been used to show that loss of heterozygosity is most often associated with cancers arising in minor
salivary glands
Fluorescence in situ hybridization
is used to document oncogene involvement in head and neck tumors

is used only to detect specific DNA sequences in human tumors
is used to detect specific DNA and RNA sequences in individual cells
has shown that increased numbers of chromosomes in normal cells are always associated with genetic
stability
can detect HPV in glandular cells of the parotid gland
7- Allergy & Immunology

After contact with antigen, lymphocytes
become activated
proliferate (clonal expansion)
differentiate (initiate RNA and protein synthesis)
degranulate
Pluripotential stem cells give rise to precursors in the following lines
lymphoid
epithelial
erythroid
myeloid
Antigen-presenting cells include (Except ??)
phagocytic cells
macrophages
lymphocytes
dendritic cells
For proper helper T-cell activation, the following are needed
immunoglobulins
antigen
MHC binding
growth factor (interleukin 1)
A positive delayed-hypersensitivity skin test with tuberculin means that
the subject has had prior contact with the TB bacillus

the subject possesses functional antigen-presenting cells
the subject has an adequate number of delayed-hypersensitivity cells
the subject’s macrophages are not functional
A molecule of IgG is composed of
two heavy  chains

two light  or  chains
disulfide bonds
J chains
Secretory IgA is
formed by two four-chain units of immunoglobulin

attached to a J chain and a secretory component
denatured inside the epithelial cells
the primary defense mechanism against local mucosal infections
Antibody(ies)
combine with antigen by virtue of their V regions

can initiate complement fixation by characteristics in their C regions
isotypes are defined by the light chain
can adhere to antigen (opsonization) and improve phagocytosis
The following immunoglobulins can fix complement (except ??)
IgD
IgM
IgG3
IgG1
Biological activity of complement is manifested as
opsonization
cell activation
stimulation of immunoglobulin synthesis
foreign-cell lysis
Phagocytic cells
exhibit chemotaxis
include polymorphonuclear leukocytes and monocytes
exhibit a respiratory burst after particle ingestion
die after the respiratory burst
In the experimental model of allergic rhinitis,
histamine is released in both the early and late phase

PGD2 and tryptase increase in the late phase
an influx of basophils occurs during the late phase
less antigen is required to induce a clinical response during rechallenge with antigen
High levels of total IgE
may be predictive of an allergic diathesis

can be seen in parasitic infestations
depend both on the genetic make-up and on environmental factors
have a protective effect against environmental antigens
Mast cells can be triggered to release mediators by
cromolyn sodium
anti-IgE
codeine
anaphylatoxins C3a and C5a
The pathophysiology of allergic rhinitis cannot be explained completely by a type I reaction because
the duration of the early reaction to antigen is measured in minutes, whereas clinical disease is more
prolonged
biopsies of nasal mucosa during the early reaction show only cellular infiltration
systemic steroids, useful in refractory cases of allergic rhinitis, do not inhibit the early reaction
changes in reactivity to nonspecific irritants occur during seasonal exposure, but not during the early
response
Which molecules assist with transendothelial migration of immune cells into areas of inflammation?
MHC
immunoglobulins
adhesion molecules
interleukin 2
Which compounds destroy foreign organisms produced by T cells?
perforins and granzymes

immunoglobulins
prostaglandins
major basic proteins
8- Development of Ear
Which part of the ear begins to appear first?
auricle
external ear canal
ossicles
inner ear
auditory nerve
The facial nerve is the nerve of which branchial arch?
first
second
third
fourth
sixth
The need to hear in air resulted in which evolutionary development, apparent in reptilian and amphibian ears?
development of hair cells

appearance of an independent cochlear nerve
development of a middle ear apparatus
division of the inner ear into vestibular and auditory compartments
development of the three ossicle design
The auricle develops from
6 hillocks on the first branchial arch

6 hillocks on the second branchial arch
6 hillocks on the first branchial arch and 6 hillocks on the second
Which of the following is adult size at birth?
cochlea
endolymphatic sac
incus
tympanic membrane
pinna
Which of the following abnormalities occurs with the greatest frequency?
dehiscence of the fallopian canal

external auditory canal stenosis
cochleosaccular dysplasia
Michel’s deformity
microtia
The sensory epithelia of the inner ear are derived from
neural crest mesenchyme

otocyst mesoderm
otocyst ectoderm
cephalic mesoderm
neural endoderm
When does the cochlear duct first achieve its full 2 1/2 turns?
8 weeks
10 weeks
12 weeks
16 weeks
20 weeks
Neural crest cells contribute to
Reissner’s membrane
basilar membrane
stria vascularis
annular ligament of the stapes
vestibular surface of the stapes footplate
The otic capsule develops from how many ossification centers?
one
three
seven
11
14
Where does the facial nerve lie in the fundus of the internal auditory meatus?
anterosuperior
posterosuperior
posteroinferior
inferior
anteroinferior
9- Comparative & Developmental Anatomy of Laryngeal Position
Advantages of a high (intranarially placed) larynx in mammals may include all of the following except
ability to breathe and swallow simultaneously

ability to smell and eat simultaneously
ability to echolocate and swallow simultaneously
increased ability for oral-tidal respiration
protection of the airway from inundation by liquid or semisolid food
The epiglottis is
derived from the first branchial arch

derived from the second branchial arch
derived from the third branchial arch
derived from the fourth through sixth branchial arches
unique to mammals, and thus not derived from the branchial arches
All of the following developments occur in the human fetus during the late second trimester except
The laryngotracheal groove becomes visible as a median, ventral diverticulum in the pharyngeal floor.
The epiglottis and soft palate are found to overlap for the first time.
The larynx remains intranarial during fetal swallowing movements.
The skull base undergoes remodeling of its shape.
Pulmonary glandular epithelium matures and produces surfactant.
The following statements concerning the human newborn upper respiratory tract are true except
The larynx is positioned high in the neck, corresponding to the level of basiocciput/C1-4.
The newborn human can produce the same range of speech sounds as an adult human.
The subglottic cavity of the larynx extends both backward and downward, unlike the adult condition, in
which the cavity is oriented almost entirely vertically.
The epiglottis overlaps the soft palate.
The high laryngeal position results in newborns being essentially, if not obligate, nose-breathers.
The larynx (from tip of epiglottis to lower border of cricoid) in an adult human corresponds to the level of
presphenoidal synchondrosis to sphenooccipital synchondrosis

basiocciput/C1-4
C2-5
C3/C4-7
C6/C7-T2
A low laryngeal position gives adult humans the ability for
simultaneous respiration and deglutition

simultaneous olfaction and deglutition
simultaneous vocalization and deglutition
greater pharyngeal modification of sounds produced at the vocal folds than that possible for other
mammals
obligate nasal breathing
All of the following statements concerning the adult human pharynx are true except
The lowered position of the larynx allows for an expanded supralaryngeal pharynx.
The posterior portion of the tongue forms the upper anterior wall of the pharynx.
The supralaryngeal pharynx serves as a resonating chamber for modifying the fundamental frequencies of
speech sounds.
The laryngeal aditus is located within the nasopharynx.
The enlarged oropharynx is commonly shared by the respiratory and digestive pathways.
All of the following are anatomical reasons why choking may occur with facility in an adult human except
The low position of the larynx allows a crossover between the respiratory and digestive pathways, thus
allowing a bolus of food to lodge easily in the laryngeal aditus.
The vestigial epiglottis may become lodged in the laryngeal aditus, thus blocking inspiration.
The expanded oropharynx allows a large bolus of food to be passed over the larynx during a swallow, rather
than around it via the piriform sinuses, as occurs in most other mammals.
The loss of a “two-tube” system for air and food may result in vomitus being aspirated into the larynx and
trachea.
The crossing of human breathing and swallowing pathways allows for more frequent incoordination of these
activities than is usually found in mammals with largely separate tracts.
The following statements concerning the epiglottis are true except
The epiglottis is already present in the human fetus by week 15 of development.

In newborn humans, the connection between the soft palate and the epiglottis is usually constant, but may be
interrupted during crying or swallowing of a dense bolus.
In children older than 3 years, the epiglottis can no longer approximate the soft palate, even during maximal
elevation.
In adult humans, the epiglottis has become a largely vestigial structure.
Patients who have had full or partial epiglottectomies exhibit difficulty in swallowing.
The following statements concerning comparative laryngeal anatomy are true except
Most mammals depend primarily on altering the shape of the oral cavity and lips to modify laryngeal sounds, whereas
adult humans can also use the greatly expanded supralaryngeal portion of the pharynx.
Nonhuman primates and human newborn infants exhibit mostly separate respiratory and digestive routes and the ability
to breathe and swallow almost simultaneously.
Many mammals can duplicate the full range of human speech sounds due to the evolution of accessory
apparatus such as laryngeal sacs.
Major aspects of the laryngeal skeleton, including cartilages homologous to those found in humans, exist in most
mammalian species, although they are often considerably modified to accommodate individual requirements.
Although the larynx is located high in the neck in most mammals, its exact position and the extent of its placement in
the nasopharynx can vary among species.
10- Anesthesiology
Which of the following potent halogenated anesthetic agents produces the least degree of bronchoirritation during an
inhalational induction?
nitrous oxide
enflurane
isoflurane
sevoflurane
none of the above
Which of the following potent halogenated anesthetic agents produces the least degree of depression of the
respiratory response to hypercarbia?
nitrous oxide
enflurane
isoflurane
halothane
none of the above
Which of the following local anesthetics produces an increase in circulating plasma catecholamine levels as a result
of inhibition of norepinephrine reuptake into adrenergic nerve terminals?
lidocaine
bupivacaine
cocaine
tetracaine
none of the above
Which of the following muscle relaxants may produce profound bradycardia from vagal stimulation when
administered to infants or children?
succinylcholine
d-tubocurarine
pancuronium
atracurium
none of the above
Which of the following intravenous anesthetic induction agents produces the most rapid awakening from general
anesthesia for brief outpatient procedures?
etomidate
ketamine
thiopental
propofol
none of the above
Which of the following drugs is a specific benzodiazepine antagonist?
diazepam
flumazenil
lorazepam
midazolam
none of the above
Which of the following drugs has only narcotic antagonist activity?
buprenorphine
nalbuphine
naloxone
butorphanol
none of the above
Noninvasive monitoring of hemoglobin saturation is essential for the safe performance of many
otorhinolaryngologic procedures. Which of the following accurately describes the monitoring modality of pulse
oximetry?
It may not detect a downward trend in hemoglobin saturation until the Pao2 is less than 150 mm Hg.
The injection of methylene blue may falsely lower the displayed hemoglobin saturation.
Patient movement may produce a signal that cannot be interpreted.
Peripheral vasoconstriction may inhibit detection of pulsatile flow by the oximeter.
all of the above
The measurement of carbon dioxide in expired gas is a useful monitoring modality in which of the following clinical
situations?
the detection of an endobronchial intubation

the detection of an esophageal intubation
the monitoring of a patient receiving induced hypotension to decrease surgical blood loss during a
tympanomastoidectomy
in assessing the adequacy of oxygenation
none of the above
In which of the following chronic disease states or dysmorphic syndromes may one expect to find impairment of
function of the temporomandibular, cricoarytenoid, and atlantooccipital joints?
Treacher-Collins syndrome
rheumatoid arthritis
Pierre Robin syndrome
Goldenhar’s syndrome
all of the above
Which of the following life-threatening abnormalities may also be present in the patient with external trauma to the
face or neck?
clinically inapparent dislocation of the cricoid cartilage
clinically inapparent dislocation of the larynx
an expanding intracranial mass lesion
an unstable cervical spine
all of the above
11- Dynamics of Wound Healing
A 33-year-old man is involved in a rollover motor vehicle accident and suffers a large avulsion injury of his right
neck skin. Because the wound is contaminated, it is left open for 72 hours, at which time granulation tissue appears.
It is then closed with a split-thickness skin graft. This is an example of which type of wound repair?
reepithelialization
primary healing
secondary healing
delayed primary healing
granulation
Although collagen production occurs during all four phases of wound healing, most activity occurs during the
coagulation phase
inflammatory phase
fibroplasia phase
remodeling phase
contraction phase
A professional football player suffers a long, clean laceration to the left leg. He undergoes primary closure, and
several months later has a well-healed scar. He wishes to know how strong that tissue is compared to normal skin.
He should be told that under the best circumstances it will be
20% as strong as normal skin

just as strong as normal skin
Several weeks after a simple incision, with unimpaired wound healing, a scar begins to mature. By this time, an
equilibrium is achieved between
epidermal growth factor and transforming growth factor-beta activity

collagen production and collagen lysis
macrophages and polymorphonuclear leukocytes
imbibition and inosculation
elastin and myofibroblasts
Cytokines (growth factors) are active in the wound healing process. These cytokines may exert their activity through
endocrine, autocrine, or paracrine effects, and there may be multiple actions for each cytokine. The cytokine that
exerts its effects primarily in an endocrine fashion is
epidermal growth factor
growth hormone
platelet-derived growth factor
fibroblast growth factor
transforming growth factor
An emaciated 75-year-old woman with recurrent alveolar ridge cancer is scheduled to undergo a composite
resection. She is a steroid-dependent asthmatic, smokes cigarettes, and has a history of cerebrovascular disease. The
factor leastlikely to contribute to the potential wound breakdown and fistula is
cerebrovascular disease
age
poor nutrition
tobacco use/hypoxia
steroid use
Promising techniques for the manipulation of wound healing include all the following except application of
fetal wound healing

cytokines, such as transforming growth factor-beta and platelet-derived growth factor
ultrasound treatment
ultraviolet radiation
hot cautery
A 61-year-old man with a high-grade mucoepidermoid carcinoma of the parotid gland undergoes parotidectomy with sacrifice
of the marginal mandibular branch of the facial nerve, 3 cm proximal to the target muscle. This branch is immediately grafted
with branches of the greater auricular nerve. The patient wishes to know when he can expect the return of function of this facial
nerve branch. He should be told that the nerve will regenerate at a rate of
precisely 1 mm per day, and he should therefore expect to see the return of function as early as 30 days after surgery
precisely 5 mm per day, and he should therefore expect to see the return of function as early as 2 months after surgery
precisely 10 mm per day, and he should therefore expect see the return of function as early as 6 months after surgery
approximately 1 mm per day, and he should therefore expect to see the return of function as early as 6 months
after surgery
approximately 10 mm per day, and he should therefore expect to see the return of function as early as 2 years after
surgery
Mandibular fractures typically undergo healing bycreation ofscar tissue (callus) followed by calcification of the
callus. Primary bone healing, with spontaneous regeneration in the absence of scar tissue, may occur. This requires
several conditions, the most important of which include
anatomic reduction, rigid fixation, and adequate vascularity

anatomic reduction, intermaxillary fixation, and adequate vascularity
adequate nutrition, rigid fixation, and adequate vascularity
anatomic reduction, external fixation, and adequate nutrition
anatomic reduction, rigid fixation, and topical cytokines
A 68-year-old farmer undergoes a floor of mouth resection for a T2,N0 squamous cell carcinoma. It is reconstructed
with a split-thickness skin graft, and a bolster is sewn into place. He wonders why this is necessary, and you tell him
that immobilization is necessary to ensure the survival of the skin graft. This is particularly important during the first
phase of skin graft survival, when the graft depends on diffusion of nutrients from the recipient bed. This process is
known as
epithelialization
inosculation
imbibition
proliferation
neovascularization
12- Manifestation Of AIDS
After initial exposure and infection with HIV, how many years will it take for 50% of patients to develop AIDS?
1
2
4
7
10
The enzyme reverse transcriptase is essential to the AIDS virus. Which of the following statements best describes
this enzyme?
It is produced by the host cell.

It produces messenger RNA from viral DNA.
It produces double-stranded DNA from single-stranded DNA.
It produces DNA from the viral RNA template.
It incorporates the viral RNA into the host cell genome.
The primary immune defect caused by HIV is
a complement defect
a defect of the cell-mediated immune system
primary agammaglobulinemia
combined cellular and humoral immune defects
loss of neutrophil killer activity
A 21-year-old man with HIV disease has not developed AIDS yet and has a CD4+ cell count of 800. He develops
acute otitis media. What is the most likely organism responsible for this infection?
Streptococcus pneumoniae
Pneumocystis carinii
Mycobacterium avium-intracellulare
Pseudomonas aeruginosa
Staphylococcus aureus
A young HIV-infected man presents with a whitish, nontender vertically corrugated lesion along the anterior lateral
border of the tongue. This condition is probably caused by
Candida
herpesvirus
squamous cell carcinoma
primary HIV infection
Epstein-Barr virus
The risk of developing HIV infection following a percutaneous exposure from a known HIV-positive source
individual is approximately
1 in 10
1 in 50
1 in 300
1 in 1,000
1 in 10,000
In addition to Kaposi’s sarcoma, the other malignancy most commonly seen in association with AIDS is
squamous cell carcinoma

Hodgkin’s disease
non-Hodgkin’s lymphoma
nasopharyngeal carcinoma
hairy leukoplakia
In which of the following situations should postexposure zidovudine prophylaxis be recommended?
Several drops of bloody sputum contact the back of a health care worker’s hand. It is immediately cleaned
off. The skin is intact.
A grateful HIV-infected patient French kisses a health care worker.
A surgeon has beenperforming surgery on an HIV-infected patient. At the conclusion of surgery he
discovers a hole in his glove and realizes that the patient’s blood has been in contact with his intact skin for an
indeterminate length of time.
An otolaryngologist is performing an indirect laryngoscopy on a known HIV-infected patient. The patient
gags and spits into the physician’s unprotected eye.
Immediately after performing a fine-needle aspiration of a neck node on a known HIV-infected patient,
the physician inadvertently impales the needle into his own thigh and injects the aspirate material into his
quadriceps muscle.
The most common dermatologic disease associated with HIV disease is
molluscum contagiosum
psoriasis
cutaneous cryptococcus
seborrheic dermatitis
acne rosacea
A nasopharyngeal mass in an HIV-infected patient is most likely
lymphoid hypertrophy
Kaposi’s sarcoma
non-Hodgkin’s lymphoma
antrochoanal polyps from chronic sinusitis
13- Fluids & electrolytes in Surgical Patients
The percentage of body weight composed of water is
15% to 20%
20% to 30%
30% to 50%
50% to 70%
70% to 85%
Lactated Ringer’s injection contains ions in addition to sodium and chloride, including
calcium
magnesium
potassium
A and C only
A, B, and C
A patient involved in a motor vehicle accident has sustained multiple injuries including facial trauma. His vital signs
are pulse of 125, blood pressure of 110/95, and respirations of 22. Initial management includes
establishing IV access with large-bore catheters

administering uncross-matched, O-negative blood to treat hemorrhagic shock
obtaining facial films to rule out fractures
rapidly administering isotonic crystalloid solution
A and D only
Some of the complications of colloid therapy are
pulmonary edema
anaphylactic shock
transfusion reactions
A and C only
A, B, and C
Urine output is a sensitive indicator of volume status, and in adults it should be
0.5 to 1.5 ml/kg/hr

1.5 to 3.0 ml/kg/hr
3.0 to 4.0 ml/kg/hr
greater than 4.0 ml/kg/hr
The first step in determining the cause of hyponatremia and initiating treatment is measuring
urinary sodium
BUN and creatinine
plasma osmolality
serum potassium
Symptoms of sodium imbalance predominantly involve the
central nervous system

cardiac conduction system
peripheral neuromuscular system
gastrointestinal system
genitourinary system
Dysrhythmias caused by hypokalemia include
shorted P-R interval

peaked T waves
U waves
A and C only
A, B, and C
Care should be taken in rapidly administering IV calcium to antagonize hyperkalemia in patients who are taking
thiazide diuretics
phenobarbital
insulin
amitriptyline
digoxin
Agents useful in the treatment of hypocalcemia include
IV calcium gluconate or calcium chloride

vitamin D
oral calcium carbonate, calcium citrate, or calcium glubionate
A and C only
all of the above
14- Ophthalmology
Visual acuity of 20/40 using a Snellen chart from 20 feet indicates which of the following?
50% deterioration of vision

a 40-cm letter can be seen at 20 feet
a 20-cm letter can be seen at 40 feet
can see at 20 feet what a normal-sighted person can see at 40 feet
The Marcus-Gunn pupillary response likely indicates a lesion at which of the following structures?
cornea
pupil
peripheral retina
optic nerve
The difference between an ocular “tropia” and a “phoria” is that the
phoria is observed when vision is interrupted

tropia is usually traumatic in origin
phoria is always acquired
tropia is always congenital
The upper limit of normal for intraocular pressure tested with a Schi‫؟‬tz tonometer is
14 mm Hg
18 mm Hg
22 mm Hg
26 mm Hg
Which of the following is the most common cause of diplopia?
orbital blowout fracture
diabetes mellitus
occipital cortex tumor
“Bacterial conjunctivitis,” which worsens with neomycin topical antibiotic ophthalmic drops, is usually due to which
of the following?
allergic reaction
viral infection
resistant organism
poor patient compliance
A possible complication of anterior chamber blood (hyphema) after blunt trauma to the eye might be which of the
following?
fixed, dilated pupil

corneal opacification
cataract formation
increased intraocular pressure
A peaked pupil in an injured eye may most likely indicate which of the following?
globe penetration
congenital abnormality
neuromuscular damage
dislocated lens
The main key to the initial treatment of chemical burns to the eye is
neutralization
lubrication
irrigation
tarsorrhaphy
Optic atrophy is frequently described as which of the following in appearance?
cherry red spot

Tylenol capsule
commotio retinae
aspirin disc
15- Preoperative Management Issues
The best transfusion replacement product for a previously healthy patient who has experienced significant blood loss
during surgery and falling hemoglobin is
fresh frozen plasma

packed red blood cells
whole blood
cryoprecipitate
fibrinogen
Which of the following is a major risk factor for thromboembolic disease?
pneumonia
chronic obstructive pulmonary disease
congestive heart failure
hemophilia A
inherited deficiency of antithrombin II
A 45-year-old man is scheduled for a routine septoplasty under local anesthesia. He is an adult-onset diabetic who
normally takes 20 units of NPH (neutral protamine Hagedorn) insulin every morning. Which of the following is the
best way to manage his diabetes during his surgery?
No adjustment is needed to the patient’s usual schedule.

Start an IV with 10% dextrose to provide additional glucose.
Give half the usual dose of NPH insulin, then give regular insulin during surgery dependent on his blood
glucose levels.
Schedule surgery early in the morning, give 10 units of regular insulin at the start of surgery, and monitor
blood glucose levels during surgery.
Start a constant regular insulin infusion and monitor blood glucose levels.
A 35-year-old woman with a history of galactorrhea undergoes a transsphenoidal removal of her pituitary adenoma.
During the postoperative period, she complains of excessive thirst and is noted to have a large volume of dilute urine
and hyperosmolarity of the serum. Her most likely diagnosis is
previously undiagnosed diabetes mellitus

syndrome of inappropriate ADH secretion
diabetes insipidus
adrenal insufficiency
acute renal failure
The most appropriate pharmacologic agent to manage significant hypertension postoperatively in a patient with
advanced renal or hepatic disease is
nitroprusside
labetalol
esmolol
nitroglycerin
nicardipine
The most likely cause of postoperative hypotension is
pain
sepsis
pulmonary emboli
inadequate fluid replacement or hemorrhage
congestive heart failure
A previously healthy 23-year-old man is involved in a serious motorcycle accident with multiple extremity and
facial fractures. He now has become septic. His pulmonary examinationshows that he has severe hypoxemia, diffuse
bilateral pulmonary infiltrates on his chest x-ray, and normal pulmonary artery wedge pressure. The most likely
diagnosis is
pneumonia
pulmonary emboli
diffuse atelectasis
pulmonary edema
adult respiratory distress syndrome
In a patient with chronic renal failure, which of the following medications can be used safely during anesthesia?
halothane
methoxyflurane
gallamine
pancuronium
tubocurarine
A 60-year-old man who is an alcoholic undergoes a laryngectomy. Three days after his surgery, he becomes more
restless and irritable, is disoriented, and has urinary incontinence. The most likely cause of his change in mental
status is
schizophrenia
Alzheimer’s disease
stroke
pulmonary insufficiency
delirium
In a patient receiving morphine for postoperative analgesia, which of the following medications has been shown to
potentiate the pain relief?
naloxone
diazepam
nonsteroidal antiinflammatory drugs such as ketorolac tromethamine
meperidine in addition to the morphine
oxygen
16- Radiology
For imaging of the paranasal sinuses, which of the following imaging modalities requires hyperextension of the neck
and may be contraindicated in acute traumatic injuries or severe degenerative spinal conditions?
coronal (frontal) conventional tomography

direct coronal CT imaging
coronal CT reformations
coronal MRI
frontal viewradionuclide scan
Which of the following statements are true?
MRI has greater contrast resolution than CT.

MRI shows cortical bone detail better than CT does.
MRI has greater spatial resolution than CT does.
MRI is more susceptible to metallic density artifact than CT is.
Metallic foreign bodies may be more of a contraindication to MRI than to CT.
A and D
B, C, and E
Which of the following modalities does not use ionizing radiation?
plain films
conventional tomography
CT
MRI
ultrasound, including Doppler scanning
angiography
radionuclide scans
Which of the following statements are true?
Conventional images may be sufficient to diagnose acute mastoiditis.

MRI is superior to CT in diagnosis of acoustic neuroma.
CT (bone window settings) is superior to MRI in assessing destructive changes of temporal bone.
Fractures of the temporal bone are best assessed by high-resolution CT.
Contrast-enhanced MRI studies (gadolinium) demonstrate inner ear neuronitis (vestibular, cochlear)
undetected by CT or unenhanced MRI studies.
All of the above
None of the above
Which of the following statements are true regarding sinus tumors?
Tumor extension into the adjacent soft tissues (retromaxillary, orbital, cerebral) is better detected by
enhanced than unenhanced CT.
Tumor invasion into the skull base or cerebral tissues is better assessed by MRI than by CT.
Enhancement (CT or MRI) may be useful to differentiate tumors from obstructive secretions.
MRI may be more sensitive in differentiating inflammatory masses from neoplastic masses than CT.
Degrees of tumor enhancement or vascularity may be assessed by CT or MRI and suggest more specific
diagnoses.
All of the above
None of the above
Which statements about sinus lesions are true?
The osteomeatal complex is better assessed by axial than coronal CT.

CT and/or MRI findings of sinus tumors tend to be tissue specific.
Most sinus tumors are imaged by CT and MRI, primarily to demonstrate extent of disease.
The presence of an opacified sinus or obstructed secretion hinders evaluation of sinus wall bony pathology
on CT.
Which of the following are true in assessment of neck masses?
CT tends to be more useful for inflammatory masses than MRI.

CT detects calcification within or associated with lesions better than MRI.
CT better detects vascular invasion or flow than MRI.
CT is better than ultrasound in differentiating solid from cystic lesions.
A and B
C and D
Which statements about neck masses are true?
MRI more easily demonstrates the relationship of pharyngeal or neck masses to the skull base than CT does.
Lymph node involvement may be assessed more easily by CT than by MRI.
Coronal or sagittal imaging of the tongue base or floor of the mouth may be more advantageous by MRI than
by CT to show extent of mass lesions.
MRI better defines lesions in the prevertebral or retropharyngeal tissue spaces than CT does.
All of the above
None of the above
Which of the following statements are true for larynx or upper airway lesions?
Conventional tomography is associated with more motion artifact, but otherwise demonstrates tumor extent
(extralaryngeal) equal to that by CT.
A single lateral film remains the fastest and most efficient radiologic imaging modality to diagnose epiglottitis,
presuming the patient’s airway is secure.
Xeroradiography has fallen into disrepute because of its increased radiation exposure.
CT and MRI are similar in their capabilities to demonstrate coronal plane images of the larynx and tumor extension in
the superior-inferior axis.
CT or sialography may be more useful than MRI to demonstrate parotid duct dilation and/or calcification.
A and D
B, C, & E
Which of the following statements are true for larynx or upper airway lesions?
Conventional tomography is associated with more motion artifact, but otherwise demonstrates tumor extent
(extralaryngeal) equal to that by CT.
A single lateral film remains the fastest and most efficient radiologic imaging modality to diagnose epiglottitis,
presuming the patient’s airway is secure.
Xeroradiography has fallen into disrepute because of its increased radiation exposure.
CT and MRI are similar in their capabilities to demonstrate coronal plane images of the larynx and tumor extension in
the superior-inferior axis.
CT or sialography may be more useful than MRI to demonstrate parotid duct dilation and/or calcification.
A and D
B, C, & E
17- Endocrinology
Which action affecting thyroid-stimulating hormone secretion is false?
stimulation by somatostatin
stimulation by somatomedin
stimulation by growth hormone
inhibition by thyroid hormone
inhibition by thyrotropin-releasing hormone
Pituitary somatotropic cells secrete
adrenocorticotropic hormone
growth hormone
prolactin
somatostatin
somatomedin
Secretion of growth hormone is directly affected by
somatostatin
somatomedin
somatocrinin
A and B
A and C
Vasopressin is released in response to
low intracellular osmolality

high intracellular osmolality
low extracellular osmolality
high intravascular volume
stimulation of cranial nerves IX and X
The blood supply to the parathyroid glands is usually from the
inferior thyroid artery

superior thyroid artery
inferior and superior thyroid arteries
external carotid artery
vertebral artery
Symptoms of tetany are characteristic of low levels of calcium and
aluminum
magnesium
potassium
phosphorus
zinc
Which of the following is used in the treatment of diabetes insipidus?
desmopressin
furosemide
methimazole
propylthiouracil
phenoxybenzamine
What is the best single test to detect early hypothyroidism?
total T4
resin T3 uptake
ultrasensitive thyroid-stimulating hormone assay
free T4 index
99mTc pertechnetate
Which statement is false regarding thyroxine?
It is converted to the more metabolically active form by deionization.

It is rapidly cleared from the circulation.
It is preferentially bound to thyroid-binding globulin in the circulation.
It is the form in which thyroid hormone is stored in the thyroid gland.
It is converted to inactive reverse T3 during stress or illness.
The most common type of apudoma is
islet cell tumor

medullary carcinoma
pheochromocytoma
carcinoid tumor
paraganglioma
18- Olfactory Function & order
In the process of diagnosing patients with olfactory disorders, different electrophysiologic measures can be used.
Which of the following statements is false?
Recordings from the epithelium (electroolfactograms) may be helpful to assess the degree of peripheral
damage.
The stimulus-related EEG clearly differentiates between anosmic and hyposmic patients.
Evoked potentials after electrical stimulation of the olfactory epithelium could prove helpful in testing the
integrity of the fila olfactoria.
Olfactory event-related potentials are used to identify malingering patients.
In cooperating patients, the contingent negative variation may be useful to identify dysosmia.
To record olfactory event-related potentials
stimuli should be puffed into the nostril to resemble natural sniffing

stimulants should excite the trigeminal nerve to produce the strongest possible sensation
stimuli should be applied in a constantly flowing stream of warm and humidified air
the interstimulus interval should be shorter than 1 second
an adequate duration of the chemical stimuli is necessary
Why are viruses able to enter the CNS via the nose?
The bipolar receptor cells project directly from the nasal cavity intothe brain without an intervening
synapse.
Olfactory bulbs are located on the ventral surface of each frontal lobe.
The medial olfactory tract provides a direct conduit.
There are three meatuses in the lateral wall of the nasal cavity.
Virion size permits penetration through the cribiform fenestrations.
Which of the following events could result in olfactory sensorineural damage?
excessive use of topical nasal decongestants

purulent nasal secretions in sinusitis
chronic exposure to noxious stimuli
sheared olfactory fila due to coup-contrecoup movement of the brain relative to the skull
nasal polyposis
Why is olfactory function of interest in the study of dementia-related diseases?
Patients with Alzheimer’s disease or Parkinson’s disease are unable todistinguish between odorants.
Enhanced olfactory ability in patients with dementia-related diseases helps to maintain their quality of life.
Medications for dementia-related diseases may reduce olfactory function of patients.
Patients with progressive supranuclear palsy have complete anosmia.
Olfactory dysfunction may be the first sign of Alzheimer’s disease and Parkinson’s disease.
Which statement is true of most patients with chemosensory dysfunction?
Most patients are not aware of a loss of olfactory or gustatory acuity.

Patients’ primary complaint is loss of olfactory function.
Olfactory and gustatory loss contribute equally to chemosensory dysfunction.
Patients complain of taste and smell loss but diagnosis reflects only olfactory dysfunction.
Most patients with chemosensory dysfunction have reduced ability to taste.
Which of the following methods is likely to be most reliable in assessing olfactory function?
patient responses to an extensive physical history questionnaire

psychophysical testing with a variety of encapsulated odorants
patient responses to presentation of stimuli from common odorous items
rigid nasal endoscopy
assessment of gustatory function with a series of chemical tests
Under what circumstances would MRI be a better choice of technique to determine olfactory loss than CT?
in paranasal sinus disease

in assessment of olfactory bulb degeneration post head trauma
in evaluation of viral-related anosmia
to confirm agenesis of the olfactory bulbs in Kallman’s syndrome
both B and D
In which of the following groups of patients would Reye’s memory test be useful?
those with olfactory deficit due to head trauma

patients suspected of having dementia-related diseases
patients suspected of malingering
individuals with allergic rhinitis
patients complaining of gustatory dysfunction without olfactory loss
What is the cause of most cases of olfactory dysfunction?
damage to the olfactory epithelium

structural damage due to physical trauma
malingering
a decreased number of olfactory receptor cells
a decreased number of gustatory receptor cells
19- Nasal Function & Evaluation
The following are major physiological functions of the nasal airway except:
Filtration of particulate and gaseous irritants

Regulation of respiratory airflow
Cooling of expiratory air
Warming and humidification of inspiratory air.
The rate and direction of mucociliary flow in the nasal airway is:
Posteriorly at a rate of 100 mm per minute

Anteriorly at a rate of 100 mm per minute
Posteriorly at a rate of 15 mm per minute
Anteriorly at a rate of 15 mm per minute
The major flow of resistance of segment to the nasal airway is:
The middle turbinate

The posterior choana
The nasal valve
The nasal vestibule
What portion of the inferior turbinate has the greatest influence on nasal airway resistance:
Midportion
Posterior portion
Anterior tip
Lateral surface
Inspiratory airway collapse is a result of:
The negative pressure generated as a air passes beneath the inferior turbinate.
The abrupt deviation of the nasal airflow at the nasopharynx
The negative pressure developed at the nasal valve as a result of airway narrowing.
The negative pressure developed at the naris
The level of nasal resistance at which most subjects experience subjective nasal obstruction is:
1.0 cm of water per liter per second

3.0 cm of water per liter per second
30 cm of water per liter per second
100 cm of water per liter per second
Which of these is not a clinical type of nasal obstruction:
Mucosal
Fixed structural obstruction
Dynamic collapse
Temperature related congestion
Which of the following is not a characteristic of mucosal obstruction:
Usually bilateral
Reversible by topical decongestion
Usually asymmetrical
Independence of nasal airflow
‫ ﻓؤاد ﻣﺣﺳن ﻋﻠﻲ ﺷﻣﺳﺎن‬.‫د‬
20- Sinus Anatomy & Functions
‫اﺧﺗﺻﺎص أﻧف وأذن وﺣﻧﺟرة‬
The ethmoturbinals give rise to all of the following except the
uncinate process
bulla ethmoidalis
superior turbinate
middle turbinate
inferior turbinate
The first of the paranasal sinuses to begin development in the human is the
anterior ethmoid
posterior ethmoid
perpendicular plate
maxillary
sphenoid
The thicker, more lateral portion of the ethmoid roof is referred to as the
lateral lamella
cribriform plate
perpendicular plate
fovea ethmoidalis
agger
The opening of the nasolacrimal duct is located in the
supreme meatus
superior meatus
middle meatus
inferior meatus
hiatus semilunaris
A unique feature of the venous supply to the ethmoidal sinuses is
intracranial pathways
presence of values
dual sinus drainage
cavernous sinus drainage
small venulae
The primary blood supply to the lateral nasal wall is provided by the
ophthalmic artery
greater palatine artery
sphenopalatine artery
anterior ethmoid artery
posterior ethmoid artery
The nasal mucous blanket may contain all of the following except
lysozyme
lactoferrin
IgA
IgG
IgE
Mucosal inflammation within the maxillary and frontal sinuses is most commonly due to
primary ciliary abnormalities

an excessively labile pH environment
a primary immunoglobulin deficiency
ethmoid infundibulum mucosal contact
relative humidity greater than 50%
The sphenoid sinus may contain prominent anatomic indentations including all of the following except
vidian nerve
optic nerve
frontal branch of V
maxillary branch of V
carotid artery
The mucosa of the paranasal sinuses is composed of all of the following except
ciliated pseudostratified columnar epithelium

nonciliated pseudostratified columnar epithelium
secretory glands
goblet cells
basement membrane
21- Endoscopic Sinus Surgery
A coronal CT image of the paranasal sinuses reveals unilateral pansinusitis with heterogeneous densities within the
lumen of the sinuses. This patient is has had multiple intranasal polypectomies and is atopic. The otolaryngologist
should be concerned about possible
Sampter’s triad (aspirin sensitivity, nasal polyposis, and asthma)

adenocarcinoma
Kartagener’s syndrome
extracranial meningioma
extramucosal (allergic) fungal sinusitis
A patient presents with exophthalmus secondary to thyroidopathy and undergoes endoscopic orbital decompression.
This approach may be limited in its effectiveness
at the orbital apex

at the anterior medial orbital wall
at the posterior orbital floor
because of an associated increase in risk of vision loss
at the anterior orbital floor and lateral to the infraorbital nerve
During a sphenoethmoidectomy, the skull base is usually identified posteriorly
because the skull base is situated more inferiorly there and is therefore easier to identify
because the posterior ethmoidal artery is less likely to be injured than is the anterior ethmoidal neurovascular
bundle
because the cribriform plate is very fragile
because the skull base is typically thinnest and most easily injured in the anterior ethmoidal sinuses
so that the sphenoid sinus may be safely entered
During an endoscopic sphenoethmoidectomy, injury to the optic nerve is most likely to occur
in the superior aspect of the posterior ethmoidal sinuses

in a sphenoethmoid cell (Onodi cell)
along the lateral wall of the sphenoid sinus
adjacent to the vertical segment of the ground lamella
while removing an intersinus septum within the sphenoid sinus
Functional endoscopic sinus surgery is not indicated for
extramucosal fungal sinusitis

massive nasal polyposis
chronic pansinusitis
disease limited to the ostiomeatal complex
The cavernous portion of the carotid canal may have a “clinical” bony dehiscence in approximately what percentage
of patients?
2%
5%
12%
22%
35%
The most common complication of endoscopic sinus surgery is
synechia
complete failure of the procedure
transient and/or permanent changes in vision
epiphora
hemorrhage requiring blood transfusion
Some doctors believe that endoscopic sinus surgery performed under local anesthesia with sedation is safest because
surgeon-patient communication is possible

there may be improved visualization as a result of decreased blood loss
the surgeon may be alerted by the patient when pain-sensitive areas along the base of the skull and medial
orbital wall are reached
if an orbital hematoma arises, the surgeon can perform vision checks to assess the status and severity of the
injury
all of the above
22- Anatomy & Physiology of Salivary Glands
A child with cerebral palsy undergoes bilateral chorda tympani section and tympanic neurectomy to treat sialorrhea.
Nine months postoperatively his drooling returns. The drooling is due to secretion from the
submandibular gland
parotid gland
sublingual gland
minor salivary glands
sublingual and submandibular glands
A patient undergoes superficial parotidectomy for a benign mixed tumor. Gustatory sweating is noticed 3 months
postoperatively. This is due to
stimulation of the sweat glands by released acetylcholine

stimulation of the sweat glands by released norepinephrine
stimulation of the sweat glands by the greater auricular nerve
disruption of the parasympathetic inhibitory effect on the sweat glands
stimulation of the sweat glands by aberrant facial nerve fibers
The stimulatory effect of the autonomic nervous system on salivary gland acinar cells results in
passive diffusion of K+ into the cells

passive diffusion of Cl- into the cells
hyperpolarization due to the influx of Cl- and the efflux of Na+
depolarization due to the release of K+
hyperpolarization due to the influx of Cl- and the efflux of K+
The minor salivary glands develop in the sixth to eighth week of embryonic life from
oral endoderm and nasopharyngeal endoderm

oral ectoderm and nasopharyngeal ectoderm
oral ectoderm and nasopharyngeal endoderm
oral endoderm and nasopharyngeal ectoderm
none of the above
Xerostomia in the elderly is believed to be due to

the effects of medication and systemic disease
salivary gland degeneration
subacute sialoadenitis
changes in acinar cell ultrastructure
chronic glandular dehydration
The salivary glands that contribute the largest fraction of saliva when stimulated by the autonomic nervous system
are the
parotid glands
submandibular glands
sublingual glands
all glands produce saliva in equivalent amounts when stimulated
The salivary glands that contribute the largest fraction of saliva when unstimulated by the autonomic nervous system
are the
parotid glands
submandibular glands
sublingual glands
if unstimulated, the glands do not produce saliva
The secretory process
is a passive ultrafiltration process

produces saliva that is hypertonic to saliva
involves two independent processes: primary secretion and ductal secretion
involves cell synthesis and active transport
produces saliva that is isotonic to saliva
Which factor appears to be most important in the maintenance of oral hygiene?
secretory IgA
salivary lysozyme
salivary peroxidase
salivary autolysins
salivary flow rate
Atropine is a potent antisialagogue because it
prevents acetylcholine uptake at the preganglionic neuron

prevents synthesis of acetylcholine in the preganglionic neuron
competes with acetylcholine for receptor sites
stimulates the breakdown of acetylcholine at the synapse
stimulates the breakdown of acetylcholine at the receptor site
23- Upper Digestive Tract Anatomy & Physiology
The upper esophageal sphincter is a
muscular valve
musculoskeletal valve
cartilaginous valve
Which stage of swallow is physiologically most critical?
oral preparation
oral phase
pharyngeal phase
esophageal phase
The following sequence of events controls the opening of the upper esophageal sphincter
thyrohyoid contraction followed by cricopharyngeal relaxation

cricopharyngeal relaxation
cricopharyngeal relaxation followed by pharyngeal bolus pressure
cricopharyngeal relaxation followed by hyolaryngeal anterior movement and bolus pressure
Airway closure during swallow progresses as follows
inferiorly to superiorly
superiorly to inferiorly
false vocal folds followed by true folds and epiglottis
epiglottis followed by true focal folds and false vocal folds
Voluntary control can be exerted over the following neuromuscular components of the oropharyngeal swallow
velopharyngeal closure and pharyngeal peristalsis

pharyngeal peristalsis, laryngeal elevation, and laryngeal closure
closure of the airway at the vocal folds, arytenoids to epiglottic base, and laryngeal elevation
pharyngeal peristalsis, laryngeal elevation, and vocal fold closure
As bolus volume increases, the following changes occur in the oropharyngeal swallow
airway closure and cricopharyngeal opening durations decrease

airway closure and cricopharyngeal opening durations increase
velopharyngeal closure and lingual movement increase in duration
airway closure begins sooner in relation to cricopharyngeal opening
Dysfunction of the pharyngeal pressure generators results in
residue in the valleculae

residue in one pyriform sinus
residue in both pyriform sinuses
all of the above
Pressure generators in the pharynx include
the pharyngeal walls and soft palate

the oral tongue and tongue base
the pharyngeal walls and tongue base
the tongue base and soft palate
24- Upper Airway Anatomy & Function
The muscle which is most important in maintaining patency of the pharyngeal airway is the
cricothyroid muscle
genioglossus muscle
palatoglossus muscle
posterior digastric muscle
superior pharyngeal constrictor
The intrinsic laryngeal muscle that opens the glottis is the
thyrohyoid muscle
cricothyroid muscle
interarytenoid muscle
lateral cricoarytenoid muscle
posterior cricoarytenoid muscle
Laryngospasm, in response to mechanical stimulation of the larynx, is most likely to occur under which of the
following conditions?
hypoxia
deep sleep
hypercarbia
light anesthesia
strenuous exercise
Mechanical stimulation of the larynx results in
bronchodilation
tachycardia
hypertension
Valsalva maneuver
diaphoresis
Which of the following is a requirement for normal phonation?
normal lamina propria

normal vital capacity
divergent glottal tract
tight glottal closure
25- Taste
The sensation of chocolate is
taste
smell ???
flavor
a composite sensation
all of the above
If a patient has an elevated taste threshold for NaCl, which of the following statements is correct?
The patient will be unable to taste strong NaCl in the real world.
The patient will be unable to taste any strong tastes in the real world.
The patient will taste strong NaCl to be even more intense than normal.
The patient will taste all strong tastes to be even more intense than normal.
No predictions can be made about strong NaCl.
The taste system is remarkably robust for several reasons. Which of the following does not contribute to the
robustness of the taste system?
Taste receptor cells regenerate from basal cells.

Taste localization is very poor.
Damage to the chorda tympani releases inhibition on the central structures receiving input from the
glossopharyngeal nerve.
Taste projects ipsilaterally.
Taste sensations seem to arise from areas with no receptors.
Taste loss is not associated with
viruses
radiation therapy
sinus disease
head trauma
Lyme disease
Conditioned food aversions
are formed primarily to the taste of foods

are formed primarily to the smell of foods
are impossible to extinguish
occur in patients who experience hives from eating foods to which they are allergic
result from pathologies in which the patient experiences pain from swallowing
Most taste buds are located in the fungiform, foliate, and circumvallate papillae. Which of these other areas is the
most likely to have taste buds?
filiform papillae
undersurface of the tongue
soft palate
inner surface of the lip
inner surface of the cheek
Which of these stimuli has a taste?
fat
protein
starch
hydrogen ion
vitamin E
People who cannot taste 6-N-propylthiouracil (PROP)
carry two recessive genes for the taste-blindness trait

perceive KCl to be intensely bitter
carry one recessive and one dominant gene for the taste-blindness trait
are unable to taste lithium salts
have a tendency to develop thyroid problems
Which of these statements about sweetness is false?
All sweet molecules bind to a common sweet receptor.

Diabetes affects the glucose receptor but not the fructose receptor.
PROP tasters perceive sucrose to be sweeter than those who do not taste PROP.
PROP tasters perceive saccharin to be sweeter than those who do not taste PROP.
Individuals who perceive sucrose to be intensely sweet are likely to perceive caffeine to be unusually bitter.
Textbooks often show a map of the tongue showing where each quality is perceived. Which of these statements is
correct?
Sweetness is perceived on the tip of the tongue.

Bitterness is perceived on the edges of the tongue.
Saltiness is perceived on the back of the tongue.
Sourness is perceived on the extreme rear portion of the tongue.
There is no tongue map.
26- TMJ Disorders
Pain is
a noxious sensation only

a response to organic disease only
an unpleasant emotional and sensory experience
always expressed in organic terms
C and D
The temporomandibular joint is primarily innervated by the
temporomandibular nerve
auriculotemporal nerve
mandibular nerve
masseteric nerve
The dura is innervated by the trigeminal nerve.
true
false
Statement 1: The temporomandibular joint is lined with fibrocartilage.Statement 2: All synovial joints are lined with
fibrocartilage.
Statement 1 is true.
Statement 2 is true.
Both statements are true.
Neither statement is true.
Chronic muscle pain is usually
due to spasm
due to internal derangement
exacerbated by palpation of the auditory meatus
diffuse
The dislocated temporomandibular disk is most frequently
anterolateral
posterolateral
anteromedial
posteromedial
Temporomandibular joint surgery is performed to
reduce pain
restore normal function
restore normal maximum opening
eliminate joint noise
prevent remodeling
all of the above
Mandibular condyle reconstruction is most often accomplished by
total joint implant

condylar implant only
ramus osteotomy
nonvascularized rib graft
vascularized rib graft
Arthroscopic surgery is best indicated for
reducing disk displacements

nonreducing disk displacements
degenerative joint disease
B and C
all of the above
Typically, temporomandibular disk surgery should be followed by
intermaxillary fixation
repositioning splint therapy
physical therapy and home exercise
intraarticular corticosteroid injections
none of the above
27- Esophageal disorder
The narrowest point in the entire gastrointestinal tract is the
cricopharyngeus
aortic arch
lower esophageal sphincter
pylorus
rectum
An important anatomic difference between the esophagus and the remainder of the abdominal-pelvic portion of the
gastrointestinal tract is the absence of
striated muscle
muscularis mucosae
stratified squamous epithelium
serosal lining
variable lymphatic drainage
The most important factor in the pathogenesis of gastroesophageal reflux disease is
esophageal clearance
potency of refluxed material
incompetence of the lower esophageal sphincter
gastric emptying
gastric volume
A 42-year-old obese white man is referred to your office for evaluation of hoarseness. Your evaluation leads you to
believe that the patient’s voice complaints are secondary to reflux. The patient has a history of severe esophagitis
that has recurred after previous medical regimens for reflux. Remission of this patient’s reflux will be maintained
best with which medical therapy?
antacids
antacids and H2-receptor antagonists
H2-receptor antagonists and promotility agents
proton pump inhibitors
promotility agents
Normal persons should have a reflux time of less than ________ during a 24-hour period.
10 minutes
20 minutes
1 hour
2 hours
3 hours
Surgery is recommended in the treatment of esophageal spasm when there is
severe, recurrent chest pain

disabling dysphagia
secondary pulsion diverticula
all of the above
none of the above
A small, asymptomatic Zenker’s diverticulum requires
endoscopic excision
packing
cricopharyngeal myotomy
no intervention
the Dohlman procedure
The recommended treatment for low-grade Barrett’s esophagus is
intensive antireflux therapy

intensive antireflux therapy with follow-up endoscopic examinations
resection
resection with follow-up endoscopic examinations
chromoscopy
One differentiating factor between achalasia and scleroderma is
esophageal dilatation
lower esophageal sphincter tone
dysphagia
esophagitis
none of the above
Lymph node metastases occur in 50% of patients with squamous cell carcinoma of the esophagus with infiltration of
the
epithelium
lamina propria
muscularis mucosa
mucosal layer
submucosal layer
28- Thyroid diseases & Surgery

The lymphatic drainage of the thyroid gland goes to the
1. superior deep cervical nodes
2. inferior deep cervical nodes
3. paratracheal nodes
4. superior pretracheal nodes
1, 2
2, 3
1, 3, 4
2, 3, 4
1, 2, 3, 4
The active cellular hormone produced by the thyroid is
triiodothyronine
thyroglobulin
tetraiodothyronine
thyroid-stimulating hormone
thyroxine-binding globulin
Which of the following factors influence the life expectancy of a patient with papillary carcinoma?
1. sex
2. age
3. palpable lymph node disease
4. distant metastases
5. prominent follicular pattern
1, 2, 4
2, 4
2, 3, 4
2, 3, 4, 5
1, 2, 3, 4, 5
The degree of angioinvasion is important in determining the aggressiveness of
papillary carcinoma
follicular carcinoma
hurtle cell carcinoma
medullary carcinoma
anaplastic carcinoma
Patients with medullary carcinoma typically have
unilateral disease: sporadic variety

bilateral disease: sporadic variety
unilateral disease: MEN IIA
unilateral disease: MEN IIB
bilateral disease: MEN IIA or B
Which of the following therapeutic modalities is not indicated for the treatment of medullary thyroid carcinoma?
radiation therapy
chemotherapy
131I
surgery
When a patient tests positive for the RET protooncogene analysis, the likelihood that he will develop medullary
thyroid carcinoma is
50%
70%
80%
90%
greater than 90%
What is the prevalence of thyroid carcinoma by type, ranked from highest to lowest prevalence?
papillary, follicular, medullary, anaplastic

follicular, papillary, medullary, anaplastic
papillary, follicular, anaplastic, medullary
follicular, papillary, anaplastic, medullary
papillary, anaplastic, follicular, medullary
Elective neck dissection is appropriate for certain patients with which type of thyroid carcinoma?
1. papillary
2. follicular
3. medullary
4. anaplastic
1 only
1, 3
3 only
3, 4
1, 4
The complication most often encountered by hyperthyroid patients after thyroid ablation with 131I is
thyroid neoplasm
thyroid crisis
hypoparathyroidism
hypothyroidism
leukemia
In the surgical treatment of hyperthyroid patients, an iodine preparation is often given preoperatively to
render the patient euthyroid

decrease the chance of postoperative thyroid storm
decrease the amount of colloid produced in the gland
shrink the gland
decrease vascularity
The following agents may be used for the preoperative management of hyperthyroidism
1. propylthiouracil alone
2. iodine preparation alone
3. lithium alone
4. beta-blocker alone
1, 4
1, 2, 4
2, 4
1, 3, 4
all of the above
29- Deep Neck Space Infections
In adults, what is the most common cause of deep neck space infections?
odontogenic sources
foreign bodies
spread of superficial infections
surgical wound infections
congenital deformities
The superior and inferior extent of the danger space is
from the base of the skull to T-2

from the base of the skull to T-1
from the base of the skull to the diaphragm
from T-2 to the diaphragm
none of the above
The clinical presentation of deep neck space infections does not include which of the following?
fever and pain

localized maculopapular rash
localized swelling
ptosis and contraction of the ipsilateral pupil
dysphagia and odynophagia
What is the proper management of descending necrotizing mediastinitis?
antibiotics and observation

cervical drainage and observation
cervical drainage and antibiotics
thoracotomy alone
thoracotomy and antibiotics
Pharyngomaxillary space infections may result from
tonsillitis
middle ear infections
spread from the retropharyngeal space
salivary gland infections
all of the above
Radiographic findings characteristic of retropharyngeal abscesses include all but which of the following?
reversal of the normal cervical contour

air in the prevertebral soft tissues
tuberculous erosion of the cervical vertebra
posterior pharyngeal soft tissue thicker than 7 mm at the sixth cervical vertebra
fluid collection in the retropharyngeal space
Which of the following is true of Ludwig’s angina?
It involves only the sublingual space.

It results in anterior protrusion of the tongue.
It is characterized by boardlike firmness of the floor of the mouth.
It rarely causes airway compromise.
It necessitates identification and drainage of the abscess cavity.
Which of the following is a characteristic sign or symptom of a peritonsillar abscess?
trismus
deviation of the uvula
bulging of the posterolateral soft tissue
drooling
all of the above
A 21-year-old patient with a history of recurrent tonsillitis is diagnosed with a peritonsillar abscess. Which of the
following is not appropriate therapy?
needle aspiration and interval tonsillectomy

incision, drainage, and interval tonsillectomy
quinsy tonsillectomy
incision and drainage and prophylactic antibiotics
Lemierre’s syndrome is caused by which of the following?
thrombosis of the carotid artery

thrombosis of the internal jugular vein
spread of infection into the mediastinum
rupture of the carotid artery
metastatic lung abscess
30- Pediatric Otolaryngology
The origin of the subspecialty of pediatric otolaryngology can be attributed to all of the following except
the establishment of freestanding children’s hospitals and pediatric wards in general hospitals
pathophysiologic and technologic advances in pediatric intensive care
the development of endoscopes and other instrumentation applicable to the pediatric airway
the increasing incidence of acute infectious diseases in the pediatric population
parallel subspecialization in other pediatric medical fields
All of the following are histopathologically benign lesions that can demonstrate clinically malignant behavior due to
local tissue destruction or aerodigestive tract obstruction except
papilloma
angiofibroma
lymphoma
lymphangioma
hemangioma
Which of the following pediatric otolaryngology problems has been associated with a high level of familial stress
and suspected child abuse in some cases?
juvenile respiratory papillomatosis

subglottic hemangioma
foreign body aspiration
laryngotracheal stenosis
vocal cord paralysis
All the following procedures are examples of the expansion concept of treating laryngotracheal stenosis except
anterior costal cartilage grafting

anterior laryngotracheofissure
posterior cricoidectomy with or without lateral cricoid cuts
tracheal resection and reanastomosis
anterior castellation procedure
The development of the Haemophilus influenzae B-conjugated vaccines for administration to infants as young as 2
months of age will have potential influence on the incidence of all the following except
acute otitis media

meningitis
postmeningitis sensorineural hearing loss
suppurative intracranial complications of acute otitis media
supraglottitis
Predisposition to chronic sinusitis in the pediatric population includes all of the following disorders except
cystic fibrosis
nasopharyngeal angiofibroma
hypogammaglobulinemia
allergic aspergillosis
The child with multiple sensory impairments is best exemplified by
Mobius’ syndrome
Treacher-Collins syndrome
Pierre Robin syndrome
Stickler syndrome
Down syndrome
Which of the following pairs of syndromes and congenital malformations is incorrect?
CHARGE syndrome and choanal atresia

Pierre Robin syndrome and retrognathia
Goldenhar’s syndrome and microtia
Stickler syndrome and micrognathia
Treacher-Collins syndrome and laryngeal cleft
All the following structures have greater physiologic significance in childhood than adulthood except
frontal sinus
retropharyngeal lymph node
subglottic larynx
eustachian tube
pharyngeal tonsil
Tympanomastoidectomy surgery before completion of postnatal mastoid growth increases the risk of which of the
following otologic complications?
conductive hearing loss

sensorineural hearing loss
vestibular dysfunction
facial nerve paralysis
CNS infection
31- Congenital Neck Masses & Cysts
All of the following present as lateral neck masses except
second branchial cyst

lymphangioma
external laryngocele
thyroglossal duct cyst
The most common branchial anomaly is a derivative of which arch?
first
second
third
fourth
Which is true about congenital hemangiomas of the head and neck?
Involution occurs spontaneously in 50% of them.

Sclerosing agents are recommended for conservative therapy.
They are the most common head and neck neoplasms in childhood.
Recurrence rates are typically less than 5% after excision of intramuscular hemangiomas.
Sacrifice of normal neural structures is planned in excision of
cystic hygroma
hemangiomas
A and B
none of the above
Which of the following elevates with tongue protrusion?

dermoid
thymic cyst
hemangioma
Which of the following almost always presents symptomatically at birth?
lymphangioma
hemangioma
cervical teratomas
Which of the following is the most common pediatric neoplasm of the head and neck?
lymphangioma
hemangioma
cervical teratoma
All of the following are correct about the pathway of second branchial cysts except that they
pass anterior to the sternomastoid muscle

pass deep to the external carotid artery
pass superficial to the internal carotid artery
enter the pharynx at the thyrohyoid membrane or the pyriform sinus
32- Congenital Anomalies Of Nose
Characteristics of an intranasal glioma include all of the following except
firm mass
unilateral nasal obstruction
usually present at birth
a probe cannot be passed medial to the mass
A nasal mass in a 1-year-old child is least likely to be a
dermoid
nasal polyp
glioma
encephalocele
Which of the following is suggestive of intracranial involvement of a dermoid on a CT scan?
bifid nasal septum

patent foramen cecum
broad nasal vault
soft tissue mass on the nasal dorsum
A glioma can present with any of the following except
spontaneous CSF rhinorrhea

meningitis
glabellar mass
intranasal mass that expands with crying or straining
A young child presents with a pit on the dorsum of the nose in the midline through which cheesy material
occasionally extrudes. The probability that this sinus tract extends deep to the nasal bones is
10%
45%
60%
100%
The preoperative evaluation of a nasal glioma should include all of the following except
CT scan
MRI scan ????
genetics consultation
neurosurgery consultation
The reasons to excise a dermoid cyst entirely are to prevent

progressive deformity
infection
recurrence
all of the above
Gliomas have been found in all of the following locations except
nose
palate
nasopharynx
upper lip
Nasal dermoids are most commonly
isolated cysts
shallow sinus tracts from the nasal dorsum, ending superficially
a sinus tract extending under the nasal bones and ending in a cyst in the septum
a firm mass on the lateral aspect of the nose
Dermoid cysts are characterized histologically by
contents derived from all three cell layers

skin, hair follicles, and sweat and sebaceous glands
glial cells in a connective tissue matrix
epithelium only
33- Cleft lip & Palate : The primary Deformity
The ratio of men to women with cleft lip, with or without cleft palate, is
1:3
1:2
2:1
3:1
4:1
The ratio of men to women with cleft palate alone is
1:3
1:2
2:1
3:1
4:1
Although the frequency varies by racial or ethnic group, the frequency of occurrence of cleft lip, with or without
cleft palate, in term newborns is
1 in 400
1 in 1,000
1 in 2,000
1 in 3,000
1 in 8,000
Although the frequency varies by racial or ethnic group, the frequency of occurrence of cleft palate alone in term
newborns is
1 in 400
1 in 1,000
1 in 2,000
1 in 3,000
1 in 8,000
During a performance of a rotation-advancement method to repair a cleft lip, which maneuver increases the length of
the rotation flap?
extending the circumalar incision

trimming the C-flap
creation of a back cut
primary nasal tip repair
vermilion Z-plasty
The first priority in the management of a newborn with a cleft palate is to
call the Cleft Palate Registry

provide genetic counseling
plot a growth curve
establish adequate feeding
schedule palatoplasty
The incidence of cleft lip, with or without cleft palate, is highest in
American Indians
whites
Asians
blacks
Hispanics
During embryologic development, the occurrence of a cleft lip results from
failure of fusion of the maxillary and nasal swellings

failure to maintain an epithelial bridge secondary to lack of mesodermal proliferation
failure of fusion of the palatal shelves
lack of tissue development posterior to the incisive foramen
lack of nasal septum development
34- Congenital Anomalies of the Aero digestive Tract
In a newborn infant with Pierre Robin syndrome, the larynx is usually
more anterior than usual

more posterior than usual
not altered
softer than usual
neurologically impaired
A newborn infant with high-pitched inspiratory stridor is most likely to have a lesion in the
subglottic space
trachea
nasopharynx
oropharynx
supraglottis
A 3-week-old infant presents with circumoral pallor and occasional cyanosis. In addition to a thorough evaluation of
the upper airway, the consultant should obtain
an echocardiogram
an MRI of the larynx
a CT scan of the mediastinum
a neurology consultation
a complete blood count
A newborn full-term girl is noted to have severe cyanosis and marked inspiratory stridor with retractions that clear
with crying. A presumptive diagnosis of bilateral choanal atresia is made. The next step should be
endoscopic correction
immediate intubation
CT scan of the nasal cavity
fiberoptic endoscopy
insertion of an oral airway
A 3-week-old boy develops the gradual onset of biphasic stridor made worse by agitation or crying. Radiologic
evaluation suggests the possibility of a subglottic hemangioma. The most useful treatment for this lesion would be
inhalational steroids
racemic epinephrine
CO2 laser removal
Nd:YAG laser removal
local steroid injection
A 6-week-old boy develops the gradual onset of high-pitched inspiratory stridor. A flexible fiberoptic laryngoscopy
reveals the classic characteristics of laryngomalacia. The consultant should
reassure the parents

insert a tracheotomy
perform an epiglottoplasty
search the aerodigestive system for more pathology ???
examine the child in 4 weeks
A newborn girl presents with severe respiratory distress and inspiratory stridor. Diagnostic evaluation reveals
bilateral vocal cord paralysis. The consultant should obtain
an echocardiogram
an ultrasound of the rental system
an imaging study of the CNS
an MRI of the mediastinal structures
a thyroid scan
A newborn infant presents with aphonia noted shortly after birth. The most likely site of the pathology in this infant
is
nasopharynx
oropharynx
supraglottis
glottis
subglottis
Anterior cricoid decompression (cricoid split) may be most useful in which one of the following conditions?
subglottic hemangioma
congenital subglottic stenosis
tracheoesophageal fistula
arytenoid dislocation
posterior laryngeal cleft
An 8-week-old boy presents with a history of recurrent apnea, expiratory stridor, and possible “wheezing.”A flexible
fiberoptic bronchoscopy reveals significant collapse of the anterior tracheal wall approximately 1 cm above the
carina. A presumptive diagnosis of tracheomalacia is made. At this point the consultant should
obtain an MRI scan to evaluate the vascular structures of the upper mediastinum
reassure the parents and reevaluate the patient in 2 months
place a tracheotomy to stent the airway
resect the diseased segment and anastomose the trachea end to end
augment the anterior tracheal wall with costal cartilage
The parents of a 2-week-old boy consult you because the infant has a weak cry and occasionally chokes during
feeding. A flexible fiberoptic laryngoscopy reveals a left vocal cord paralysis. You should then recommend
arytenoidectomy
nerve-muscle reinnervation procedure
chest x-ray
tracheotomy
a return visit in 2 months
A 6-week-old boy presents with increasing respiratory distress and difficulty with feeding. Careful examination of
the head and neck reveals a large cystic lesion involving the floor of the mouth and right neck. Endoscopic
evaluation reveals impingement on the supraglottic structures by extrinsic compression. The otolaryngologist should
treat the patient with high-dose intramuscular steroids

perform immediate radical surgery to decompress the airway
excise all visible tumors with the CO 2 laser
secure the airway and wait
utilize high-dose IV steroids plus antibiotics
35- Anatomy & Physiology Of Eustachian Tube
The only muscle that actively opens the eustachian tube is the
levator veli palatini

tensor veli palatini
salpingopharyngeus
lateral pterygoid
medial pterygoid
Developmentally, an infant’s eustachian tubes differ from an adult’s in that the infant’s tubes are
longer
shorter
less compliant
stiffer
more efficient
The cartilage of the eustachian tube is
lateral and inferior to the lumen

lateral to the lumen
medial and inferior to the lumen
medial to the lumen
crook-shaped
In an adult the eustachian tube is
osseous in the posterior one-third and cartilaginous in the anterior two-thirds

osseous in the posterior half and cartilaginous in the anterior half
osseous in the posterior two-thirds and cartilaginous in the anterior one-third
osseous throughout
cartilaginous throughout
The tensor veli palatini muscle is innervated by the
mandibular division of the trigeminal nerve

maxillary division of the trigeminal nerve
glossopharyngeal nerve
vagus nerve
hypoglossal nerve
Compared to atmospheric air, the physiologic gas composition in the middle ear is
higher in oxygen and lower in carbon dioxide

higher in oxygen and higher in carbon dioxide
lower in oxygen and higher in carbon dioxide
lower in oxygen and lower in carbon dioxide
approximately the same
Reflux of liquid from the nasopharynx into the middle ear is enhanced when the
tympanic membrane is not intact

tympanic membrane is intact
eustachian tube lumen is too narrow
length of the eustachian tube is longer as opposed to shorter
the eustachian tube is closed
In relation to normal eustachian tube function, the tensor tympani most likely
opens the tube during swallowing

opens the tube during loud sounds
opens the tube during yawning
closes the tube
is not involved
In older children of 7 to 12 years of age who are apparently otologically healthy, eustachian tube ventilatory function
is
similar to adults’, but better than young children’s

similar to adults’, but better than adolescents’
better than adults’
worse than young children’s
worse than adults’
Assessment of middle ear pressure in otologically healthy children, compared to a similar population of adults,
frequently shows
higher positive pressure

lower positive pressure
similar values
higher negative pressure
lower negative pressures in excess of -600 mm H2O
36- Gene Therapy

Which of the following is a feature of retroviral-mediated gene transfer?
infects replicating cells

episomal location
short-term gene transfer
precise gene integration
production of viral packaging proteins
Which of the following is a feature of adenovirus-mediated gene transfer?
infects only replicating cells

high infectivity ???
RNA virus
stable gene integration into target cell genome
no expression of viral proteins
Which of the following is a feature of adeno-associated virus-mediated gene transfer?
episomal location
random integration
infects quiescent cells
no risk of insertional mutagenesis
RNA virus
Gene therapy using the HSV-tk gene is characterized by which of the following?
nontransduced cell death

activation of inherent cellular mechanisms leading to cell death
cell death secondary to phosphate depletion
viral lysis of infected cells leading to viral replication
HSV infection of the patient
Which of the following is thought to lead to invasive carcinoma?
mutation of a single tumor suppressor gene

methylation of the p53 tumor suppressor gene only
a series of molecular events involving both oncogenes and tumor suppressor genes
mutation of the p16 tumor suppressor gene alone
HSV infection
What possible conclusions can be made from the initial phase I clinical trials of adenovirus-mediated transfer of
p53?
efficacy in the treatment of microscopic disease

significant, predictable tumor regression
increased survival
no significant vector-related toxicity
decreased incidence of metastasis
Studies of the p53 tumor-suppressor gene indicate a role for this gene product as
a reversible cell cycle checkpoint regulator

a ganciclovir kinase
an upregulator of MHC class I proteins
an activator of tumor-infiltrating lymphocytes
an inhibitor of microtubule formation
Transfection of the p16 gene has been shown to
depend on rapid cell replication

enhance tumor immunogenicity
upregulate p53 protein expression
depend on endogenous p16 status
lead to cell cycle arrest
Adenoviral transfer of the CFTR gene to cystic fibrosis patients may result in which of the following?
long-term integration of the CFTR gene into airway epithelium

significant vector-related toxicity
transduction of nondividing mucosa
one-dose therapy to decrease mucus viscosity
decreased transmission of the cystic fibrosis disease to offspring
Production of a nonreplicating virus to mediate gene transfer is dependent on which of the following?
target cell resistance to viral lysis

episomal incorporation of transfected genes
administration of ganciclovir
modification of a packaging cell line to produce viral proteins
incorporation of a tumor-suppressor gene
37- Principle of chemotherapy in treating H & N cancer
Which of the following is the main goal of a phase I drug trial?
determine the efficacy of the drug in any cancer

determine the efficacy of the drug in a specific cancer
determine toxicity and dose in animals
determine efficacy in animal tumors
determine toxicity and dose in humans
Drugs with a major role in head and neck cancer include all of the following except
methotrexate
etoposide
5-fluorouracil
paclitaxel
cisplatin
Which of the following statements is true of the combination of cisplatin and 5-fluorouracil infusion?
It commonly causes congestive heart failure or pulmonary fibrosis.

It results in 30% complete responses as neoadjuvant chemotherapy.
It cures 10% of patients with metastatic squamous cell head and neck cancer.
It results in vastly improved survival over methotrexate as a single agent.
It is not useful in head and neck cancer.
The major organ-specific toxicity of cisplatin is
cardiac
renal
hepatic
pulmonary
hemorrhagic cystitis
Which of the following statements is true about neoadjuvant chemotherapy for head and neck cancer?
It results in improved survival in the majority of randomized studies.

It is associated with low response rates.
It results in lower rates of metastatic disease in randomized studies.
It should be considered standard for care for all head and neck cancers.
It has no role in larynx cancer.
Which of the following statements is true of the Veterans Administration larynx cancer trial?
The 2-year overall survival in both groups was equal at 38%.

The chemotherapy agents used were bleomycin, methotrexate, and vincristine.
Late local failures were a common problem.
Thirty-nine percent of chemotherapy patients were alive with their larynx in place after 33 months.
The results apply to stage I patients.
Drugs which have been shown to be beneficial radiosensitizers in randomized trials include
5-fluorouracil, bleomycin, and methotrexate

cisplatin, etoposide, and doxorubicin
cisplatin, irinotecan, and paclitaxel
vinorelbine, ifosfamide, and 5-fluorouracil
doxorubicin, bleomycin, and etoposide
Which of the following statements is true about concomitant chemotherapy and radiotherapy for head and neck
cancer?
Two metaanalyses have demonstrated a benefit.

Two metaanalyses have shown no statistically significant benefit.
They have no role in nasopharyngeal cancer.
The synergistic action minimizes the side effects.
Methotrexate remains the chemosensitizer of choice.
Which of the following drugs cause pulmonary toxicity?
cisplatin
5-fluorouracil
paclitaxel
bleomycin
hydroxyurea
The treatment of neutropenic fever requires
immediate culturing and initiation of antibiotics

culturing and home oral antibiotics if not septic
no need for hospitalization if fever can be suppressed by acetaminophen
continuation of antibiotic until afebrile
granulocyte colony-stimulating factor for all patients
38- Principle of radiation oncology
In order to control a tumor with radiation therapy, the treatment must
kill all cancer cells

eradicate only the cancer cells capable of unlimited division
lyse or rupture the cancer cells’ membranes
destroy the tumor’s supporting stroma
make the cancer cells hypoxic
Which of the following doses of radiation therapy produces more biological injury?
4,000 cGy in 10 fractions over 2 weeks

If 400 cGy will reduce a tumor’s cell population from 1 million to 100,000 cells, how much radiation is required to
reduce a population from 1,000 cells to 100 cells?
4 cGy
40 cGy
400 cGy
4,000 cGy
40,000 cGy
Which of the following are reasons for fractionating a course of radiation therapy?
Reoxygenation occurs, leading to increased sensitivity of the cancer.

Fractionation allows more opportunity for radioresistant cells to redistribute between dose fractions.
Tumor cell proliferation is suppressed because of division delay.
A and B
A and C
Which of the following clinical descriptions of head and neck cancers is most likely to respond well to a course of
radiation therapy?
exophytic
infiltrative
ulcerative
friable
irregular
A dose of 5,000 cGy in 5 weeks controls subclinical disease in what percentage of patients?
45% to 50%
60%
70%
80%
90% to 95%
After completion of radiation therapy for a head and neck cancer, a positive biopsy is not very reliable for
determining residual disease for at least
4 weeks
6 weeks
8 weeks
10 weeks
12 weeks
In general, which is more effective?
surgery for salvaging radiation therapy failures

radiation therapy for salvaging surgical failures
chemotherapy for salvaging radiation therapy failures
chemotherapy for salvaging surgical failures
radiation therapy for salvaging chemotherapy failures
Which of the following are arguments for preoperative radiation therapy?
Nonresectable lesions may be made resectable.

The dose that can be given safely preoperatively is greater than that which can be given safely
postoperatively.
The viability of the tumor cells that may be disseminated by surgical manipulation is diminished, thereby
reducing the risk of distant metastasis.
A and B
A and C
The arguments in favor of postoperative radiation therapy are as follows
The treatment portals are usually smaller than those that would be used if the treatment were given
preoperatively.
The anatomic extent of the tumor can be determined by the surgery, making it easier to define the treatment
portals.
Surgical resection is easier and healing is better in unirradiated tissues.
It allows surgery to be performed earlier, thereby diminishing the risk of dissemination.
A greater dose of radiation can be given postoperatively than preoperatively.
A and D
B, C, and E
Which of the following is true about regression rates?
Regression rates are related to the cycling time of the tumor cells.
Regression rate is inversely proportional to rate of tumor proliferation.
Partially regressed tumors should be biopsied immediately after completion of radiation.
Cell loss following radiation is predominately due to lysis of nondividing cells.
39- Tumors Biology, Immunology of H & N cancer
Initiation during malignant transformation involves
the expression of tumor-specific antigens on the cell membrane of malignant cells

alterations of the cellular DNA by a carcinogenic agent
production of intracellular proteins unique to the malignant cells
clonal expansion of malignant cells
Elevated titers of antibody directed against EBV membrane antigen have been associated with
recurrent tumor
metastatic disease
improved survival
decreased survival
Recognition of tumor-associated antigen by helper T lymphocytes is dependent on all of the following except
activation of helper T cells by IL-1

antigen presentation by class I MHC molecules
antigen presentation by class II MHC molecules
macrophage recognition of the tumor antigen
An antibody-dependent cellular cytotoxic response against head and neck cancer is dependent on
effector cells that express Fc receptors

complement binding to IgG
IgA coating of the target tumor
prior activation of the effector cells by interleukins
IL-2 stimulation of peripheral-blood lymphocytes results in all of the following except

cytotoxic effector cells with enhanced tumor cell killing
lysis of fresh and cultured tumor cells
progression of micrometastasis when administered in vivo
production of interferon gamma from lymphocytes
Passive immunotherapy is best represented by which of the following treatments?
IV administration of interferon gamma

administration of IL-2-stimulated tumor-infiltrating lymphocytes
tumor-cell vaccine immunization
perilesional injection of IL-2
The antitumor effects of interferon gamma include
in vitro cytolysis, macrophage activation, and enhanced MHC expression

in vitro cytolysis, in vivo cytostasis, and suppression of cytotoxic T lymphocytes
enhanced antigen presentation by macrophages, improved in vivo survival of the host, and enhanced killing
of natural cell tumor
suppression of lymphokine-activated killer cell generation by IL-2, B lymphocyte stimulation, and inhibition
of cell proliferation
Inhibition of IL-1-induced immune responses may be mediated by
interferon gamma
circulating immune complexes
prostaglandins
IL-2
40- Parathyroid Diseases & Surgery
The incidence of renal stones in hyperparathyroidism is
0% to 10%
10% to 20%
20% to 30%
30% to 40%
more than 50%
The active form of calcium in the blood that is readily used is
protein-bound calcium
ionized calcium
calcium phosphate
calcium bicarbonate
Release of parathormone (PTH) causes all of the following except

increased osteoclastic activity
increased resorption of calcium in the kidney
increased absorption of calcium from the gastrointestinal tract
stimulation of renal-1 hydroxylase
increased stimulation of calcitonin
Benign familial hypocalciuria hypercalcemia is a syndrome characterized by
autosomal dominant inheritance

fewer complications than patients with hyperparathyroidism
possibly normal PTH levels
lack of need for surgery
all of the above
During surgery for hyperparathyroidism, an enlarged gland weighing 2.0 g is found in the posterior mediastinum.
This gland most likely originated from
the foregut
the first branchial pouch
the third branchial pouch
the fourth branchial pouch
none of the above
In MEN IIB, all of the following are true statements except

medullary carcinoma is commonly seen
pheochromocytoma can be bilateral ‫اﺧﺗﺻﺎص أﻧف وأذن وﺣﻧﺟرة‬
patients will have hyperparathyroidism
on oral examination, mucosal neuromas are seen
marfanoid habitus can be present
The best test to order when trying to differentiate hypercalcemia of hyperparathyroidism from hypercalcemia of
malignancy is
the IRMA-PTH level

the C-terminal PTH level
the carcinoembryonic antigen level
the urinary excretion of cyclic adenosine monophosphatase
none of the above
During surgery for hyperparathyroidism, the surgeon finds a morbidly enlarged gland and a smaller gland on the left
side. Biopsy from the enlarged gland is “consistent with an adenoma.”The smaller gland weighs 80 mg. The next
step is to
do no further surgery at this time

explore the mediastinum for another enlarged gland
explore the right side
do a total parathyroidectomy with autotransplantation of one gland to a muscle bed
none of the above
Parathyroid carcinoma is characterized by all of the following except
at surgery there is a dense fibrous reaction around the tumor

radiation therapy is used as primary treatment
regional and distant metastases occurs in 30% of cases
radical neck dissection is not done routinely
this carcinoma is rarely seen
Chvostek’s sign is a grimacing of the face when the skin overlying the main trunk of the facial nerve is tapped. This
is seen in
hypocalcemia
hypomagnesemia
hypokalemia
only A and B
all of the above
41- Base of Skull
The carotid artery enters the base of the skull just
anterior to the glenoid fossa and posterior to the cartilaginous eustachian tube
medial to the glenoid fossa and anterior to the cartilaginous eustachian tube
anterior to the glenoid fossa and posterior to the bony eustachian tube
medial to the glenoid fossa and posterior to the styloid spine
medial to the glenoid fossa and posterior to the spine of the sphenoid
Indicate the correct order of the layers of scalp.
skin, subcutaneous tissue, loose connective tissue, galea, pericranium

skin, subcutaneous tissue, loose connective tissue, pericranium, galea
skin, subcutaneous tissue, galea, loose connective tissue, pericranium
skin, subcutaneous tissue, galea, pericranium, loose connective tissue
skin, subcutaneous tissue, pericranium, loose connective tissue, galea
All of the following structures can be found within the superior orbital fissure except the
oculomotor nerve
ophthalmic nerve
ophthalmic artery
abducens nerve
trochlear nerve
The cavernous sinus contains which of the following structures?
carotid artery, ophthalmic nerve, maxillary nerve, oculomotor nerve, trochlear nerve
carotid artery, ophthalmic nerve, oculomotor nerve, trochlear nerve, abducens nerve
carotid nerve, ophthalmic nerve, maxillary nerve, mandibular nerve, oculomotor nerve, abducens nerve
trochlear nerve, ophthalmic nerve, maxillary nerve, oculomotor nerve, abducens nerve, carotid artery
oculomotor nerve, abducens nerve, maxillary nerve, mandibular nerve, carotid artery, trochlear nerve
Unilateral resection of the condylar head usually
decreases the ability of the ipsilateral lateral pterygoid to open the mouth
decreases the ability of the ipsilateral lateral pterygoid to close the mouth
results in long-term malocclusion
results in greater long-term morbidity in terms of oromandibular function as compared to TMJ dissection and
condylar retraction
is not necessary for exposure of the cavernous carotid artery when employing the infratemporal fossa
technique
Meningitis from spontaneous or posttraumatic cerebrospinal fluid fistula and from the extension of paranasal sinus
infections is most commonly due to pneumococcus. Postoperative meningitis is most commonly secondary to
Escherichia coli
anaerobes
Streptococcus
Enterococcus and Staphylococcus
Haemophilus and Meningococcus
Meningitis from spontaneous or posttraumatic cerebrospinal fluid fistula and from the extension of paranasal sinus
infections is most commonly due to pneumococcus. Postoperative meningitis is most commonly secondary to
Escherichia coli
anaerobes
Streptococcus
Enterococcus and Staphylococcus
Haemophilus and Meningococcus
42- Genetic of Hearing Loss

Genetic factors play an important etiologic role in childhood hearing impairment. Which statement best summarizes what is
known about the prevalence of genetic hearing loss in children?
Approximately 40% of childhood hearing loss is attributable to genetic causes, with sex-linked disorders
being the most common type of genetic hearing impairments.
Approximately 50% of childhood hearing loss is attributable to genetic causes, with approximately 90% of
these disorders being inherited in an autosomal-dominant fashion.
these disorders being inherited in an autosomal-recessive fashion.
Approximately 50% of childhood hearing loss is attributable to genetic causes, with approximately
80% of these disorders being inherited in an autosomal-recessive fashion.
these disorders being inherited in an autosomal-dominant fashion.
Which description best defines the term malformation, which refers to a type of individual alteration of form or
structure?
a nonrandom occurrence of an anomaly, not known to be a polytopic field defect, sequence, or syndrome, in
two or more individuals
a defect in the morphology of an organ or region of the body resulting from an intrinsically abnormal
developmental process
abnormal cellular organization within connective tissue elements of the body, which results in surface
contour deformities of major organs
a defect caused by mechanical factors, from within or outside the developing organism, which causes a part
of the body to assume an abnormal position, shape, or form
a defect that results from the influence of an extrinsic factor on an inherently normal developmental process
Alleles are commonly designated as dominant or recessive. Which statement best describes the characteristics of an
autosomal-recessive allele?
An autosomal-recessive allele is expressed only if it is located on the X chromosome, because the Y

chromosome would have no corresponding allele.
An autosomal-recessive allele is transmitted to all of the sons and none of the daughters of an affected
mother.
An autosomal-recessive allele is phenotypically expressed when present in the heterozygous state.
An autosomal-recessive allele is phenotypically expressed when present in the homozygous state.
An autosomal-recessive allele is phenotypically expressed when present in either the homozygous or
heterozygous state.
Which statement best characterizes a sex-linked pattern of inheritance?
A mother who is heterozygous for a sex-linked recessive gene will transmit it to all of her daughters and
none of her sons, but the daughters will seldom manifest the trait.
The sons who inherit their mother’s sex-linked recessive gene will manifest the disorder only if they inherit
an identical gene from their father.
The daughters of a father who has a sex-linked disorder will never inherit the gene because it is located on
the Y chromosome.
It is common to see families in which the father, the paternal grandfather, and the grandson all suffer from
the sex-linked disorder.
A recessive X-linked gene may be expressed in an affected man because no comparable allele is present
on the Y chromosome.
A dominant gene may demonstrate a lack of penetrance, which could have implications for genetic counseling.
Which summary best describes issues to be considered in such cases?
Not all individuals who are heterozygous for a dominant gene with decreased penetrance will manifest
the disorder.
Restriction fragment-length polymorphisms cannot be used in linkage studies involving dominant genes with
decreased penetrance.
If different family members have different manifestations of the dominant gene, it may be described as
demonstrating decreased penetrance in that family.
Most sex-linked genes will demonstrate decreased penetrance when present in the heterozygous state.
If a dominant gene is present in the homozygous state, it will demonstrate decreased penetrance in women
but not in men
Which clinical findings would be most helpful in determining whether a patient has Usher syndrome type I (USHI)
or type II (USHII)?
Unilateral hearing loss and normal vestibular function are uniformly present in USHII.
Congenital deafness and blindness are characteristic of USHI, whereas delayed-onset hearing and vision
deficits are seen with USHII.
Bilateral profound hearing impairment and markedly decreased or absent vestibular function are uniformly
present in USHII.
Normal vestibular function is characteristic of USHII, but profound bilateral hearing loss is seen with
USHI.
The onset of both the vestibular abnormalities and retinitis pigmentosa is generally delayed until the second
decade in patients with USHI.
Waardenburg’s syndrome is often characterized by variable expressivity. Which clinical observation drawn from
studies of Waardenburg’s syndrome patients is attributable to this phenomenon?
Although all patients with Waardenburg’s syndrome are profoundly deaf, not all affected individuals will
manifest a white forelock.
Waardenburg’s syndrome is subcategorized into two clinical types based on the presence or absence of a
white forelock in affected individuals.
The white forelock is present in approximately 80% of cases, but the sensorineural hearing loss is seen only
20% of the time.
Individuals with type I Waardenburg’s syndrome have unilateral sensorineural hearing loss, whereas the
impairment in type II cases is always bilateral.
Unilateral or bilateral sensorineural hearing loss can affect individuals with Waardenburg’s syndrome
whether or not they have dystopia canthorum.
In patients with neurofibromatosis type II (NFII), which clinical observation is most likely to be true?
Bilateral acoustic neuromas are more commonly found than café-au-lait spots.
Cutaneous neurofibromas are always seen if an acoustic neuroma is present.
Whereas only 50% of NFII patients are likely to have an acoustic neuroma, an optic glioma is present in
nearly 90% of patients.
NF2 is inherited in an autosomal-recessive fashion, but the gene has a higher penetrance in men than in
women.
Shortened wave I-V latency measurements are usually present bilaterally in auditory brainstem response
results obtained from patients with NFII.
The family history of a child with Alport’s syndrome is most likely to contain which element?
history of sudden infant death in at least one first-degree relative

history of heart conduction defects and ear pits in male relatives
history of a progressive hearing loss, which began in the second decade of life
history of a relative on the father’s side of the family who underwent liver transplantation
history of gradual loss of peripheral vision in relatives on both sides of the family
What would be the most accurate advice to give parents whose first child, a son, was born with profound deafness of
an unexplained origin?
Their child most likely has a dominantly inherited disorder with decreased penetrance.
All future children will have a 50% chance of being deaf.
If their second child has normal hearing, then the likelihood of their having any more deaf children
would decrease.
The risk that their deaf child’s offspring will also be deaf is approximately 75%, if he marries a deaf woman.
If the hearing loss is caused by a fully penetrant dominant gene, each future son will have a 25% chance of
being deaf.
43- Pediatric audiology
The Joint Committee on Infant Hearing’s high-risk indicators for hearing loss are intended for what population?
neonatal intensive care unit graduates

newborns and infants through 1 year of age
newborns, infants, and children through 3 years of age
premature infants
infants with a family history of hearing loss
Which of the following statements is true of behavioral audiologic assessment in infants and young children?
Behavioral testing attempts to yield ear- and frequency-specific information.

Behavioral testing is unreliable in children younger than 1 year of age.
Behavioral testing is limited to sound field.
Behavioral testing is unnecessary when auditory brainstem response testing is available.
Behavioral testing is unnecessary when otoacoustic emission testing is available.
When is behavioral audiologic assessment the first method of choice?
when the child can talk

when the child is developmentally at or older than 5 months of age
when the child turns 3 years of age
after auditory brainstem response testing has been performed
when newborns exhibit one or more risk indicators for hearing loss
Which of the following components should always be included in a pediatric audiologic assessment?
case history and behavioral observations

otoscopic examination and immittance audiometry
auditory brainstem response testing
A and B
all of the above
What audiologic testing technique is best suited for a child younger than 5 months of age?
behavioral observation audiometry

visual reinforcement audiometry
conditioned play audiometry
immittance audiometry
auditory brainstem response
What information is obtained from a threshold auditory brainstem response test?
an estimate of hearing for each ear

an estimate of hearing in the 250- to 8,000-Hz frequency range
an estimate of hearing in the 500- to 6,000-Hz frequency range
an estimate of hearing in the 1,000- to 4,000-Hz frequency range
an estimate of hearing at 500, 1,000, and 2,000 Hz
Which of the following statements describes the impact of pediatric hearing loss?
Hearing loss is most significant in the early years (e.g., 0 to 3 years of age).
Hearing loss impacts educational performance and social development.
Hearing loss in children has the same impact as hearing loss in adults.
A and B
B and C
Which of the following factors influences the output levels of hearing aids in the pediatric population?
size of the ear canal

size of the pinna
nature of the hearing loss
speech and language skills
style of the hearing aid
Which statement describes a central auditory processing disorder (CAPD)?
A CAPD is the same as an attention-deficit disorder.

A CAPD is a language-processing problem.
A CAPD is an auditory-based deficit.
A CAPD is diagnosed based on academic performance.
A CAPD involves a hearing sensitivity loss.
Which tests would be appropriate choices as part of a test battery for a 3-year-old multihandicapped child who is
functioning at a developmental age of 1 year?
otoacoustic emissions and auditory brainstem response

behavioral observation audiometry and immittance
visual reinforcement audiometry and immittance
A and B
A and C
44- Anatomy & Physiology of Hearing
The compound action potential is generated by the
inner ear cells

outer ear cells
stria vascularis
eighth nerve
spiral ganglion cells
Two-tone rate suppression is most likely secondary to the activity of
inner ear cells

outer ear cells
stria vascularis
round window
cochlear mechanics
Two-tone rate suppression is not affected by hearing loss caused by
metabolic presbycusis
noise exposure
cytomegalovirus
streptomycin
syphilis
Noise-induced hearing loss occurs first and most prominently at the 4-kHz region owing to the resonant frequency of
the
pinna
cochlea
external canal
tympanic membrane
ossicular chain
The shape of the tympanic membrane, the ratio of vibratory area ofthe tympanic membrane to the vibratory area of
the stapes, and the mechanical advantage of the ossicular chain result in a pressure gain of
0 to 5 dB
6 to 11 dB
12 to 17 dB
18 to 23 dB
24 to 29 dB
The endocochlear potential is produced by the
basilar membrane
inner ear cells
outer ear cells
reticular lamina
stria vascularis
The cochlear microphonic is dependent on the following cells
inner ear
outer ear
outer sulcus
marginal
supporting
What percentage of neurons in the eighth nerve (type I, radial fibers) innervate the inner hair cells?
10%
30%
50%
70%
90%
In auditory-evoked potential testing, wave II originates from the
cochlear nucleus
superior olivary complex
inferior colliculus
medial geniculate body
auditory cortex
The mechanism for the sharply tuned peak in the mechanical traveling wave in the cochlea primarily involves the
activity of which cells?
inner ear
outer ear
Hensen’s
Deiter’s
Claudius’s
45- Vestibular Function & anatomy
Maximal sensitivity to motion for the vestibular end organs occurs along an axis oriented in what manner?
perpendicular to both the plane of the canal and the plane of the otolith organ
parallel to both the plane of the canal and the plane of the otolith organ
perpendicular to the plane of the canal and parallel to the plane of the otolith organ
parallel to the plane of the canal and perpendicular to the plane of the otolith organ
The left posterior canal is synergistically paired with the
left horizontal canal

right horizontal canal
left anterior canal
right anterior canal
right posterior canal
Neural signals from the vestibular system travel in a coordinate system that corresponds to
the cardinal body axes
the axis of rotation of the eyes
axes which correspond to major neck muscle movements
the most sensitive axes of the semicircular canals
the plains of the sensors of specific force
The stereocilia of a vestibular hair cell are deflected first toward the kinocilium, then away, and finally, parallel to
the long axis of the kinocilium. What is the effect on the resting firing rate with each of these movements?
increase, decrease, no change

increase, decrease, decrease
increase, decrease, increase
decrease, increase, no change
decrease, increase, increase
Measurement of semicircular canal afferent responses to oscillation at a constant frequency shows maximal gain at
which frequency?
0 Hz
0.01 Hz
0.1 Hz
1 Hz
3 Hz
Orientation of hair cell polarization vectors in the otolith organs are
toward the striola in both utricle and saccule

away from the striola in both utricle and saccule
toward the striola in the utricle and away from the striola in the saccule
away from the striola in the utricle and toward the striola in the saccule
The resting discharge rate of the paired utricles respond in a similar manner to which set of motion stimuli?
acceleration from a stoplight and neck flexion

head tilt to the left and lateral acceleration to the right
head tilt to the left and lateral acceleration to the left
ascent in an elevator and neck flexion
ascent in an elevator and neck extension
46- Assessment of Peripheral & Central Auditory Function
The major classifications of hearing loss identifiable from pure tone air- and bone-conduction testing are
conductive and sensorineural

hair cell and eighth nerve
peripheral and central
middle ear and inner ear
In the presence of a unilateral conductive hearing loss, the Weber test lateralizes to
neither ear
the ear with the conductive loss
the ear with no conductive loss
Air-conduction pure-tone results provide a definitive measure of the magnitude of the hearing loss attributable to the
central auditory system

total auditory system
middle ear
cochlea and eighth nerve
Tympanometry provides diagnostic information about the function of the
stapedius muscle
tympanic membrane and middle ear
cochlea
brainstem
The acoustic reflex is typically
present in lesions of the eighth nerve

absent in lesions of the middle ear
absent in lesions of the cochlea
absent bilaterally with hearing loss
Monosyllabic speech recognition materials are usually used to
measure the sensitivity for speech

distinguish between different types of middle ear disorders
determine the patient’s ability to recognize words at suprathreshold levels
verify the pure-tone threshold levels average from the frequencies of 0.5, 1.0, and 2.0 kHz
When a patient exhibits an absent auditory-evoked brainstem response and absent acoustic reflex, it is usually
indicative of
a middle ear disorder

a cochlear disorder
an eighth nerve disorder
Patients with central auditory lesions usually have
little or no hearing loss

moderate hearing loss
absence of the otoacoustic emission
elevated speech reception thresholds
47- Congenital Aural Atresia

The most significant difference between major and minor malformations of the ear involves the
status of the stapes

status of the external auditory canal
status of the cochlea
frequency of facial nerve abnormalities
degree of mastoid development
The optimal test for evaluating hearing in a 6-year-old with unilateral aural atresia is
behavioral audiometry
impedance audiometry
air conduction, abortus-Bang-ring test
bone conduction, abortus-Bang-ring test
electrocochleography
The appropriate management of a 4-year-old patient with severe microtia and unilateral aural atresia (speech
reception threshold = 50 dB) is
a bone-conduction hearing aid

an air-conduction hearing aid
a contralateral routing of signal hearing aid
atresia repair pending CT findings
plastic surgery referral
The appropriate management of a 1-year-old patient with severe microtia and bilateral aural atresia (speech
awareness = 50 dB) is
a bone-conduction hearing aid

an air-conduction hearing aid
a CT to determine cochlear development
reevaluation with bone conduction abortus-Bang-ring test in 6 months
plastic surgery referral
Cholesteatoma is most likely in a patient who has
isolated atresia of the ear canal and a normal-size middle ear

isolated atresia of the ear canal and severe hypoplasia of the middle ear
syndromic atresia (e.g., Treacher-Collins syndrome) of the ear canal
severe canal stenosis and is younger than age 3
severe canal stenosis and is older than age 6
Which of the following conditions would indicate a poor result if surgery for unilateral aural atresia were
undertaken?
CT showing middle ear space of atretic ear reduced by 33%

CT showing poor definition of the facial nerve
CT showing poor definition of the ossicular chain
the presence of severe microtia
paralysis of the lower lip ipsilateral to the atretic ear
In the anterior surgical approach for aural atresia, which of the following is true?
The incostapedial joint is separated before removal of the atretic bone.

The middle ear is initially entered in the hypotympanum.
The bone of the temporomandibular joint must be removed.
Exposure of mastoid air cells is limited.
Anterior transposition of the mastoid segment of the facial nerve may be necessary.
Care must be exercised in drilling the posterior inferior aspect of the new bony canal in cases of aural atresia because
of the potential for
injury to the facial nerve

injury to the posterior semicircular canal
injury to the corti tympani nerve
sensorineural hearing loss from contact with the short process of the incus
excessive opening into the mastoid air cells
Anticipated findings in cases of aural atresia include all of the following except
fusion of the malleus and incus

fixation of the incus
normal mobility of the stapes
displacement of the facial nerve
contraction of the middle ear space
The most common anomaly of the facial nerve in cases of aural atresia is
a bifid nerve
an inferiorly displaced tympanic segment
a dehiscent mastoid segment
an anteriorly displaced mastoid segment
absent fibers to the orbicularis oris muscle
In carefully selected cases of aural atresia, a hearing level of 20 to 30 dB can be achieved in approximately what
percentage of patients?
less than 10%

20% to 30%
40% to 60%
70% to 80%
more than 80%
The most common complication after surgery for aural atresia is
facial paralysis
sensorineural hearing loss
vertigo
canal stenosis
poor take of the skin graft
48- Ototoxicity
A 63-year-old woman recently began aspirin therapy for rheumatoid arthritis. She presents with hearing loss and
tinnitus. After discontinuing the aspirin, she can expect
not to regain hearing

complete return of hearing over a period of months
progression of hearing damage, followed by vertigo
complete recovery of baseline hearing within 2 to 3 days
partial recovery of hearing
Vancomycin ototoxicity
results in bilateral high frequency hearing loss

results in severe vertigo
is primarily limited to an enhancing effect of aminoglycoside ototoxicity
has not been reported
manifests as severe outer hair cell loss
Loop diuretics, such as furosemide and ethacrynic acid
cause direct injury to the stria vascularis

do not cause damage to the cochlea when used alone
are safe to use in conjunction with aminoglycosides
primarily result in vertiginous symptoms
interfere with sodium transport within the cochlea
Ototoxicity resulting from topical preparations
in general, is considered negligible when compared to the risk of inner ear damage resulting from
infection
has not been clearly demonstrated in animal models
has been shown with use of quinolones, such as ofloxacin
has been clearly demonstrated in humans with randomized, controlled trials
has not been reported in humans
Cisplatin-induced ototoxicity
is seen histopathologically mainly as an inner hair cell loss

manifests primarily as outer hair cell loss in the basal turn of the cochlea
presents clinically as severe vertigo
presents clinically mainly as a middle-frequency hearing loss
can be minimized with the use of mannitol and prehydration
Reactive oxygen species and depletion of glutathione has been associated with exposure to
salicylates
aminoglycosides
loop diuretics
cisplatin
vancomycin
High-frequency audiometry
can replace conventional audiometry for monitoring of ototoxicity

is a sensitive method for early detection of ototoxicity
is most effective when used as an adjunct to auditory brainstem response
is recommended for all patients exposed to ototoxins
is not recommended for elderly individuals
Auditory damage from aminoglycosides present 2 to 3 weeks after discontinuing the medication is likely to
worsen
resolve within 2 months
gradually improve over a period of years
remain as a permanent deficit
resolve before vestibular deficits
A flat sensorineural hearing loss involving the speech frequencies is reported but rarely seen with the use of
aminoglycosides
erythromycin
cisplatin
salicylates
loop diuretics
Evidence of hair cell regeneration
has not been demonstrated in mammals

has been most clearly demonstrated in avian species
has corresponded with functional recovery
is lacking in the literature
has correlated with recovery of otoacoustic emissions
49- Congenital Auricular Malformation
Which of the following statements is true?
The vertical axis of the auricle should be inclined posteriorly 20 degrees.

The vertical height of the auricle should be 1.5 times the distance between the lateral orbital rim and the root
of the helix at the level of the brow.
The angle of protrusion for a normal ear should be between 30 and 40 degrees.
The midportion of the ear is thought to be level with the brow.
The lobule is two finger widths above the inferior orbital rim.
The intrinsic muscles of the ear include all of the following except the
major and minor helices

tragicus
antitragicus
transverse and oblique
intertragicus
Which of the following statements correctly describes the motor innervation of the auricle?
The temporal branch supplies the anterior and the superior auricularis.
The temporal branch supplies the intertragicus.
The posterior auricular branch supplies the anterior auricularis.
The superficial temporal supplies the oblique muscle.
The lesser occipital supplies the inferior auricularis.
The sensory innervation of the auricle includes all of the following except
the greater auricular nerve, C2 and C3

the lesser occipital nerve
the auriculotemporal nerve
the lesser auricular nerve, C4 and C5
Arnold’s nerve
The six hillocks give rise to all of these visible structures on an adult ear except for the
tragus
conchal bowl
antihelix and the antitragus
superior crus
helix
The preoperative evaluation of a protruding auricle should take into account all of the following except
thickness
flexibility
anatomy
position
color
50- Eponyms in Otolaryngology
The nerve transected to relieve the symptoms of Frey’s syndrome is
Arnold’s nerve
Jacobson’s nerve
vidian nerve
facial nerve
The characteristics of Alport’s syndrome include
hypoplastic mandible and conductive hearing loss

sensorineural hearing loss and goiter
keratoconjunctivitis and sensorineural hearing loss
sensorineural hearing loss and glomerulonephritis
A patient presents with malaise and a dark line that follows the margin of the gingiva. Careful questioning elicits a
history of exposure to
arsenic-containing insecticides
lead-based paints
overuse of fluoride dental treatments
chewing tobacco
The typical history of a child with Pierre Robin’s syndrome includes
tracheostomy-dependence until death in late childhood

tracheostomy-dependence, but a normal lifespan
eventual weaning from a tracheostomy, but lifelong problems with deglutition
relatively normal oral function of both airway and swallowing by late childhood
Persons with Plummer-Vinson syndrome are more likely to be
women with an increased likelihood of postcricoid cancer

men with an increased likelihood of esophageal cancer
women with an increased likelihood of oral cancer
either gender with an increased likelihood of benign esophageal stricture
The most serious type of inner ear dysplasia is
Michel’s dysplasia
Alexander’s dysplasia
Mondini’s dysplasia
Scheibe’s dysplasia
Winkler’s disease (chondrodermatitis nodularis chronica helicis) is most commonly treated with
steroids
excision
antibiotics
no treatment is necessary
Fordyce’s spots are
a normal variant and are seen in adults as well as children

seen prior to measles
seen in the newborn and spontaneously resolve
premalignant lesion
In Mikulicz’s disease, salivary glands show an infiltrate consisting of
eosinophils
macrophages
histiocytes
lymphocytes
A patient with Peutz-Jeghers syndrome may present to an otolaryngologist because of
hoarseness secondary to vocal cords polyps

hearing loss
sudden appearance of pigmented patches around the mouth
dysphagia
A patient is diagnosed by an otolaryngologist as having Peutz-Jeghers syndrome. The patient should also be seen by
a
nephrologist
hematologist
rheumatologist
gastroenterologist
A Tornwaldt’s cyst may be seen in the
mastoid
floor of mouth
posterior nasopharynx
neck

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ENT MCQs for Part I Exam

Prepared by: Dr. Fouad Shamsan

internal jugular vein

omohyoid and sternohyoid

median glossoepiglottic ligament, thyroid cartilage, thyrohyoid membrane

Which of the following disorders is due to an expanded number of trinucleotide repeats?

One characteristic of genomic imprinting is that it

simultaneously alters several closely linked genes

Match Kallman syndrome with one of its other phenotypic features.

Match Smith-Magenis syndrome with one of its other phenotypic features.

Match Usher’s syndrome with one of its other phenotypic features.

Match Velocardiofacial syndrome with one of its other phenotypic features.

Match Alport’s syndrome with one of its other phenotypic features.

familial medullary thyroid carcinoma

TP53 (p53) acts as a tumor-suppressor gene through its activity in

3- Advances in Molecular Biology

It is believed that Bcl-2 expression

determines the level of Bax expression

an abnormally high rate of tumor cell proliferation

Squamous cell carcinoma is

Which of the following is true?

ampicillin given to a woman on oral contraceptives

Which combination is unlikely to result in adverse consequences?

allergy injection and propranolol

The “teratogenic period” in humans is the

first 30 days of gestation

In the drug development process, the usual order is

5-Microbiology, Infections & Antibiotic therapy

Which of the following complications of antimicrobial therapy are true statements?

Aminoglycoside antibiotics can be ototoxic in patients receiving ordinary therapeutic doses.

ordinarily sensitive to penicillin

always sensitive to amoxicillin

Staphylococcus aureus, a common pathogen of skin infections, is usually treatable with

Methicillin-resistant S. aureus (about 10% of S. aureus strains) is

treatable with cephalexin

Anaerobic bacteria such as Bacteroides fragilis are treatable with

aminoglycosides (e.g., gentamicin)

6- Trends in Diagnostic Pathology

In general, cancers are thought to be the result of

a clonal selection of cells that acquire multiple genetic changes

has a role in normal cell progression and not in neoplastic development

is always detectable by immunohistochemical methods

are not found in benign tissues of the head and neck

Human papillomavirus (HPV) infections

may be present in up to 95% of head and neck lesions

Molecular methods in diagnostic pathology

have no proven utility

is a way to document loss of heterozygosity in neoplastic tissues

may be used to document precursor stages of tumor progression

Fluorescence in situ hybridization

is used to document oncogene involvement in head and neck tumors

7- Allergy & Immunology

Pluripotential stem cells give rise to precursors in the following lines

Antigen-presenting cells include (Except ??)

For proper helper T-cell activation, the following are needed

A positive delayed-hypersensitivity skin test with tuberculin means that

the subject has had prior contact with the TB bacillus