ENT Examination 2017 (GROUP 5 ROTATION 1)

SBA
1. A 7 years old boy presents with a right preauricular sinus which has been
infected before. You will advise him to
a. Take antibiotics whenever it gets infected
b. Get it excised under local anaesthesia
c. Get it excised under general anaesthesia
d. Get it excised after next infected episode.

2. Ali consults you for a painful discharging ear for 2 days. Examination of auditory
canal reveals pus and whitish material with black spots over it. Treatment will
include ear toilet, analgesics and
a. Antibiotic drops
b. Antifungal drops
c. Steroid drops
d. Antiseptic drops

3. Acute suppurative otitis media in children, the most common causative organism
is
a. Streptococcus pneumoniae
b. Moraxella catarrhalis
c. Candida albicans
d. Staphylococcus aureus

4. Serena, 25 years old complains of foul smelling scanty left ear discharges for
years. She is now giddy and vomiting. Her gait is unsteady and there is
horizontal LEFT beating nystagmus. She has
a. Sinusitis
b. Meningitis
c. Labyrinthitis
d. Encephalitis

5. A 45 years old present with sudden hearing loss in his RIGHT ear. Rinne’s test is
positive in LEFT ear and negative in RIGHT ear. Waber test lateralizes to his
LEFT ear. He should be investigated for
a. Acute otitis media
b. Vestibuloneuronitis
c. Meniere’s disease
d. Acoustic neuroma
6. The most critical period for acquisition of speech is
a. Birth to 3 years
b. 3 to 5 years
c. 5 to 7 years
d. Above 7 years

7. Nasal vestibular furuncle is a potential fatal condition because it can result in

a. Facial cellulitis
b. Nasal obstruction
c. Cavernous sinus thrombosis
d. Orbital abscess

8. A 1 year old child present with a single polyp in her left nasal fossa. It is
important in exclude the following
a. Allergic polyp
b. Antrochoanal polyp
c. Meningoencephalocele
d. Inverted papilloma

9. Which of the following sinus is most prone for infection?

a. Frontal
b. Maxillary
c. Ethmoid
d. Sphenoid

10. Maniam, 25 years, complains of right nasal obstruction and thick post-nasal drip
for eight months. He also has sore throat off and on. Examination reveals a
severely deviated nasal septum to the right and pus in the right middle meatus. A
CT scan confirms right pansinusitis. Under antibiotic cover, treatment will involve
a. Right antral washout
b. Septoplasty and right Caldwel Luc
c. Septoplasty and right FESS
d. Septoplasty and right antral washout
11. Mr. Lee 40 years old presents with a blocked left ear. Otoscopy confirms left
secretory otitis media. There are two other signs and symptoms. He must be
investigate for?
a. Chronic nasopharyngitis
b. Chronic sinusitis
c. Allergic rhinitis
d. Nasopharyngeal carcinoma

12. Mr. Brown smoker and consumes alcohol for the last 40 years. He presents with
a chronic non-healing ulcer on the lateral border of his tongue. What is the next
step in his management
a. Dental referral to rule out a sharp tooth
b. Biopsy edge of ulcer
c. Antibiotics cream to ulcer
d. Steroid cream to ulcer

13. A mother brings her 2 years old child to consult with you for poor speech. You
notice his pronunciation is bad. He also has tongue tie. Treatment will be release
of tongue tie and
a. Wait for improvement in speech
b. Regular speech therapy
c. Audiometry and hearing aids
d. Enroll in kindergarten

14. The most common salivary gland tumour is

a. Warthin’s tumour
b. Lymphangioma
c. adenocytoma
d. Pleonorphic adenoma

15. Unilateral recurrent laryngeal nerve paralysis results in

a. The ipsilateral vocal cord lying in paramedian position
b. All the ipsilateral muscles of the larynx being paralysed
c. Aspiration of liquids is a major problem
d. Ipsilateral vocal cord lying in lateral position
16. A six-month old baby develops stridor on crying. The stridor disappears during
sleep especially if the baby is in prone position. The baby most likely has
a. Laryngomalacia
b. Laryngeal web
c. Subglottic stenosis
d. Tracheal stenosis

17. Foreign body in the oesophagus is removed by

a. Heimlich manoeuvre
b. Flexible fibre-optic gastroscope
c. Rigid oesophagoscope
d. Trans-cervical approach

18. A patient complains of fixed sticking in his throat for 3 months. He also has a
non-tender, firm lymph node (3x3) in the right mid-anterior triangle of his neck.
CT scan of neck and sinuses is normal apart from the lymph node. The next step
in management is
a. Needle biopsy of nodes
b. Excision biopsy of node
c. Panendoscopy
d. Irradiation of node

19. A 4 years old girl presents with sore throat and fever for 2 days. Her tonsils are
hyperaemic, enlarged and filld with pus. Her leucocyte count is over 100,000 per
cu.mm. She has
a. Acute tonsillitis
b. Acute leukaemia
c. Infectious mononucleosis
d. Vincent’s angina

20. A patient present with Right peritonsillar abscess. He has had a similar attack
before. Treatment is
a. Parental antibiotics and antiseptic gargles for six weeks
b. Incision and drainage with antibiotics for six weeks
c. Transcervical drainage with antibiotics for six weeks
d. Incision and drainage with tonsillectomy after six weeks
21. A 60 years old diabetic presents
with………………………………………………………………………………..
auditory canal and facial nerve palsy. The most likely causative organism is
a. Psedomonous aeruginosa
b. Staphylococcus aureus
c. Streptococcus pyogenes
d. Hemophillus influenzae

22. A 3 years old child present to her family physicians with hard impacted earwax
bilaterally and hearing loss. The best way to treat her is to administer ……… ear
drops for a week and
a. Suck it out
b. Remove under general anaesthesia
c. Flush it out with warm water
d. Flush it out with cold water.

23. Fresh traumatic perforations of the tympanic membrane should be

a. Kept dry and monitored for spontaneous healing
b. Treated with prophylactic oral antibiotic and await healing
c. Treated with topical antibiotics and await healing
d. Surgically grafted as soon as possible to prevent infection

24. A child evelops sudden earache in the right ear with fever. Rinne’s test is
negative in right ear and positive in left ear. Waber lateralizes to the right ear.
This child should be treated with antibiotics
a. Antihistamines, analgesics and nasal decongestants
b. Antihistamines and analgesics
c. Antihistamines, analgesics and ear toilet
d. Antihistamines, analgesics and myringitomy

25. Mr. Lim, a 50 years old diabetic present with

a. Bell’s palsy
b. Choleastoma of middle ear
c. Otitis media with effusion
d. Herpes zoster oticus
26. Median rhomboid glosatis
a. Is a fungal infection
b. Is a bacterial infection
c. Is a developmental anomaly
d. Is premalignant

27. A four year old child presents with a blocked running nose and bilateral otitis
media for 2 months. He is also mouth breathing. He should be investigated for
a. Tonsillar hypertrophy
b. Adenoid hypertrophy
c. Chronic nasopharyngitis
d. Chronic pharyngitis
28. Ali has mild nasal obstruction that alternates to be opposite side every 3 to 4
hours and a left septal spur. Ali should be advised
a. This is normal nasal cycle and left alone
b. To undergo a septoplasty
c. To undergo bilateral inferior turbinectomy
d. To undergo cautery of turbinates

29. A child with unilateral foul, blood stained nasal discharge should be investigated
for
a. Unilateral sinusitis
b. Nasal polyps
c. Nasal septal deviation
d. Foreign body

30. Sabrina has a high fever, severe body aches and nasal discharges with frank
epistaxis. She also has a rash over her chest blanches on pressure. Her platelet
count is grossly low. She has
a. Viral rhinitis
b. Influenza
c. Dengue fever
d. Acute leukaemia
31. A young man sustains blunt injury over his nasal bridge. He presents with severe
oedema and tenderness over his nose and surrounding soft tissue. There is also
crepitus over the area
a. An x-ray should be done and fracture corrected immediately
b. Reviewed after 3 weeks and fracture corrected if indicated
c. Reviewed after 1 week and fracture corrected
d. Reviewed after 1 week and fracture with deformity corrected

32. Herpangina
a. Is caused by herpes …. Virus
b. There are multiple
c. Seen mainly in adults
d. Ulcers persists for a few months

33. In Acute Epiglotitis the following are true EXCEPT

a. It is commonly caused by Staph. Aureus
b. Seen mainly in children
c. Stridor is present
d. Thumb sign is seen on lateral neck X-rays

34. Gold standard for diagnosis of obstructive sleep apneoa is

a. Body mass index
b. Computed tomography
c. Polysomnography
d. Distance between anterior tonsillar pillars

35. Mr. Lim complains of chronic left nasal obstruction and occasional foul, blood
stained nasal discharge. Nasal endoscopy reveals an irregular, brownish, stone
like mass deep in his nasal fossa which is radio-opaque on X-ray. It is a
a. Nasal osteoma
b. Rhinolith
c. Bony septal spur
d. Calcified turbinate
DIGITAL OSCE

1. Exhibit 1 (OME)
a. Name 3 possible causes of this condition
b. What will the tuning fork tests show
i. Rinne (Rt. And Lt)
ii. Waber
c. Interpret the tuning fork finding

2. Exhibit 2 (right facial nerve palsy)

a. What is you diagnosis?
b. List 2 infective conditions of the ear that can cause this (excluding
Bell’s palsy)
c. How would you treat Bell’s palsy

3. Exhibit 3 (nasal obstruction)

a. Give 2 differential diagnosis that may present this way
b. List the medical treatment of one condition in your differential diagnosis
c. If medical treatment fails name the surgical procedure indicated

4. Exhibit 4 (infected Preauricular sinus swelling)

a. What is the diagnosis
b. How will you treat this condition
c. After 3 days the swelling is fluctuant. How will you treat it now
d. What advice will you give Mr. Ahmet once he improves from this acute
phase

5. Exhibit 5 (sinusitis based on CT scan)

a. What is you diagnosis
b. How will you treat
c. Will you examine the oral cavity and why
d. Give 2 complications of this condition
 Ophthalmology Examination 2017 (GROUP 5 ROTATION 1)

SBA
1. The position of the eye ball in a patient with total III nerve palsy
a. Down & in
b. Up & in
c. Down & out
d. Up & out

2. Third cranial nerve innervates all of the following except

a. Superior oblique muscle
b. Levator palpebrae muscle
c. Inferior oblique muscle
d. Medial rectus muscle

3. The first line treatment in chemical injury is

a. Admission if severe
b. Topical antibiotics
c. Topical cycloplegia
d. Neutralization of pH by irrigation
e. Oral analgesia

4. Following are the features of orbital floor fracture

a. Diplopia on upgaze and downgaze
b. Damage to supra-orbital nerve
c. Haemoptysis
d. Numbness of lateral canthus
e. Haziness of ethmoidal sinus on x-ray

5. A patient present with red eye, decreased visual acuity, raised Intraocular
pressure & shallow anterior chamber. The likely diagnosis is
a. Cataract
b. Open angle glaucoma
c. Retinal detachment
d. Hyphema
e. Acute angle closure glaucoma
6. Treatment options in POAG may include all except
a. Pilocarpine
b. Beta blockers
c. Prostaglandin analgues
d. Carbonic anhydrase inhibitors
e. Atropine

7. According to WHO a person is blind when

a. Vision in better eye is less than 2/60 and/or visual field is less than 30
degree in better eye
b. Vision in better eye is less than 3/60 and/or visual field is less than 30
degree in better eye
c. Vision in better eye is less than 3/60 and/or visual field is less than 20
degree in better eye
d. Vision in better eye is less than 3/60 and/or visual field is less than 60
degree in better eye
e. Vision in better eye is less than 5/60 and/or visual field is less than 30
degree in better eye

8. A young boy presented to the emergency with watering and photophobia in the
right eye. Which test is appropriate?
a. Schirmer test
b. Tear breakup time
c. Rose Bengal staining
d. Applanation tonometry
e. Flouroscine staining

9. A patient sustained blunt trauma to the eye with tennis ball and develops
hyphema, which is
a. Pus in anterior chamber
b. Foreign body in anterior chamber
c. Uveal tissue
d. Blood in anterior chamber
e. Cells in anterior chamber
10. Calculation of IOL power is called
a. Biometry
b. Pachymetry
c. Tonometry
d. Keratometry
e. Ophthalmoscopy

11. Timolol maleate is anti0glaucona medication belonging to which group of drugs

a. Beta blocker
b. Carbonic anhydrase inhibitor
c. Antibiotic
d. Alpha blocker
e. Calcium channel blocker

12. Aphakia can be corrected by following

a. Spectacles
b. Contact lense
c. Anterior chamber IOL
d. Posterior chamber IOL
e. All of above

13. Retinoscopy is done for

a. Examination retina
b. Examination optic nerve
c. Refractive power of eye
d. Axial length of eye
e. To find out the power of IOL

14. A patient presented with photophobia and watering in the left eye. On
examination with fluorescein staining revealed dendritic ulcer which is caused by
a. Staphylococci
b. Fungal
c. Herpes simplex virus
d. Herpes zoster virus
e. Mycobacterium
15. Exophthalmos associated with thyroid opthalmopathy have the following clinical
signs except
a. Proptosis
b. Ptosis
c. Lid retraction
d. Conjunctival chemosis
e. Extraocular muscle thickening

16. A patient with presented with sudden painless loss of vision but there was no
view of the fundus. Which of the investigations is helpful to see the retina
a. Keratometry
b. Pachymetry
c. B-scan
d. A-scan
e. Indirect ophthalmoscopy

17. Myopia is a condition which is

a. Farsightedness
b. Corrected with concave lens
c. Corrected with convex lens
d. Image formed behind the retina
e. Eye ball is large

18. In diabetic retinopathy, new vessel formation is due to following pathology

a. Retinal hemorrhage
b. Vitreous hemorrhage
c. Retinal oedema
d. Retinal ischemia
e. Retinal breaks

19. Pathognomic clinical signs of proliferative diabetic retinopathy is

a. Micro aneurysms
b. Hard exudates
c. Deep retinal hamorrhages
d. Neovascularization of retina
e. Vitreous hemorrhage
20. The commonest cause of painless lid swelling is
a. Stye
b. Cyst of moll
c. Cyst of zeis
d. Internal hordeolum
e. Chalazion
DIGITAL OSCE

1. Station 1
This 75 years old man presented with hand movement vision in the eye shown.
He noticed his on vision has been gradually deteriorating over the last 4-5 years.

a. What type of cataract do you see

b. What are the methods of cataract extraction
c. List 4 complications that can occur from cataract surgeries.

2. Station 2
A 25 years old man presented to you with history of allegedly being assaulted.
He has been punched in the eye and now complains of diplopia especially on
looking down.

a. What does the CT scan show

b. Is any positive intervention necessary in this case? If yes why
c. What can be done for this patient his diplopia persists
3. Station 3
This 68 years old diabetic presented with a painful swelling of the left eye 2 days
after an insect bite on his left upper eyelid. The lids could not be sufficiently
separated to allow adequate ocular examination

a. What is the diagnosis

b. What is the possible fatal complication
c. What is the management if this case

4. Station 4
This is the eye of a patient with acute congestive primary angle-closure
glaucoma with an intraocular pressure of 65 mmHg

a. What signs and symptoms will this patient be presenting

b. What is the immediate treatment
c. What is the definitive treatment for this condition
5. Station 5
Observe the following picture of an opthalmological instrument

a. Name the instrument

b. What tests would you use it for in you clinical practice
c. Name 3 examples of instruments that are used for the same reason

6. Station 6
This picture is of a 40 years old female

a. Name the signs that you observe

b. What symptoms would you expect from this patient
c. Name 3 blinding complications from thyroid eye disease
7. Station 7
This man was hit in the eye with a shuttlecock an hour ago

a. What is your diagnosis

b. What other anterior segment injuries may be present
c. What is your management

8. Station 8

a. What is your diagnosis

b. What may be the complications you see
c. How would you treat this child
Forensic Examination 2017 (GROUP 5 ROTATION 1)
MTF
1. The inquest report includes:
a. Description of wounds
b. Sections of Malaysian penal code dealing with the crime
c. Appearance and surrounding of the body
d. The type of weapon which inflicted injuries
e. The amount of fee to appear in court

2. Regarding superimposition:
a. It is a technique used by criminals to conceal sex
b. It is a technique used by police to catch criminals
c. It is a technique in identifying a deceased person through X-ray of the
skull on to a photo of the face of the person
d. It is a technique to identify the cause of death
e. It is a technique to identify a person by study of hair

3. Regarding stillbirth
a. Child born after 28 weeks of pregnancy
b. Show signs of rigor mortis
c. Floatation test shows whole lung sink in water
d. Positive Spalding sign
e. Sign of mummification

4. Regarding estimation of post-mortem interval

a. To know when the crime was committed
b. It facilitates the police for their inquiries
c. It enables to determine the cause of death
d. It enables to check on suspect’s statement
e. It helps to identify the suspect

5. The following are the features of stab wounds

a. Wound tailing
b. Shape of the wound indicates the type of weapon used
c. Wound margins are jagged
d. Surrounding tissues show bruising
e. There is gaping of the wounds
6. Consent for sexual intercourse is NOT valid in the following cases
a. Woman is sixteen years or above
b. Consent is obtained by impersonation of the husband
c. Drunken woman
d. Woman is below sixteen years
e. Woman is sixteen years and married

7. Match the following

a. Cunnilingus……..anal intercourse
b. Voyeurism………peeping Tom
c. Masochism…….intercourse with lower animals
d. Tribadism……….male homosexuality
e. Fetichism………..objects for sexual gratification

8. Regarding the exit bullet wound

a. It is bigger that the bullet size
b. Edges are inverted
c. Grease collar is present
d. Lead ring is absent
e. Fat may protrude out

9. The following features are seen in deaths due to strangulation by ligatures

a. The ligature mark is transverse, completely encircling the neck
b. Ecchymoses and abrasions are common around the ligature mark
c. Fracture of thyroid cartilage is less common
d. Saliva often runs out of mouth
e. The neck is not stretched

10. Cadaveric spasm occurs after death

a. 1-2 hours
b. 2-4 hours
c. 4-6 hours
d. Immediately
e. 6-8 hours
11. The following features are seen in the lungs of a man died due to fresh water
drowning
a. Ballooned and heavy
b. Pale pink in color
c. Shape is retained and do not collapse
d. Crepitus is heard during sectioning
e. Soft and jelly-like consistency

12. Regarding Battered-child syndrome

a. Non-accidental physical injuries on a child produced by unknown person
b. There is always delay between the injury and medical attention
c. The victims are usually less than 3-years of age
d. These victims often have a history of family disharmony
e. They can present with skull fracture

13. The Coroner

a. Has the power to charge contempt of court
b. Gives the verdict in court
c. Is a magistrate by profession
d. Is an appointee of the police
e. Issues a subpoena

14. Self-inflicted wounds are

a. Mostly incised wounds
b. Commonly seen on eyes
c. Made to charge an enemy with assault or attempted murder
d. Done by women to bring a charge of rape against an individual
e. Produced by another person with consent

15. Regarding color of bruise

a. At first- red
b. Few hours to 3 days- blue
c. 4th day- black to brown
d. 7-12 days- green
e. 2 weeks- yellow
SBA
1. Lower end of the femur can help to determine the
a. Age
b. Sex
c. Height
d. Weight
e. Stature
2. Brainstem death is produced by
a. Concussion of the brain
b. Cerebral hypoxia
c. Meningitis
d. Diabetic encephalopathy
e. Brain tumour

3. Meconium consists of
a. Saliva and mucus
b. Feces and mucus
c. Feces matter
d. Bile and mucus
e. Bile pigments

4. Incest is sexual intercourse with

a. Aunt
b. Step-mother
c. Step-sister
d. Mother
e. All the above

5. The conclusive proof of death due to burns is

a. Heat rupture
b. Pugilistic attitude
c. Petrol smell over the body
d. Carbon/soot particles in the air passages
e. Early rigor mortis
DIGITAL OSCE

1. Exhibit 1
Photograph of a deceased man recovered from locked room

a. Identify the TWO important changes seen

b. What is the approximate time since death
c. What is the pathophysiologic basis for the above changes

2. Exhibit 2
Picture of an injured left hand

a. Describe the injury

b. State the TYPE of injury

3. Exhibit 3
Picture shown 22- years old female who was seen on the rooftop

a. Explain this type of behavior

b. Mention TWO underlying causes for the above behavior
c. Mention ONE similar behavior pattern
4. Exhibit 4
Postmortem specimen

a. Identify the organ

b. Briefly describe the finding in the organ
c. Mention ONE cause of this injury
d. Mention ONE complication of the above condition which could have lead
to death of the individual.

5. Exhibit 5
Picture of lesions found on the buttock of a child

a. Describe the lesions

b. What are the causes of the lesions