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CME for Family Physicians ENT 1. A 14 years old boy presents to your clinic with a small dimple just in front of the left ear since birth. The dimple was sore and discharging 3 months ago and is well these days. The father asks you to remove this dimple. On examination the entire left external ear is inflamed. What is the most likely diagnosis? (A) (B) (C) (D) (E) What would be your approach? (A) Leave it as such 5. Case same as above. How would you manage this patient? because it a benign disease (B) Advise X-ray and then excise it (C) Excise it under local anesthesia (D) Refer it to ENT to excise it with facial nerve monitoring Cellulitis Perichondritis Otitis externa Perichondral hematoma Skin allergy (A) (B) (C) (D) (E) Cloxacillin Cloxacillin + Metronidazole Amoxicillin Loratidine + Amoxacillin Loratidine + topical antibiotics 6. A 65 years old presents to your clinic with a small painless wound on the right ear since 1 month. What is the most likely diagnosis? Preauricular sinus Surgery with facial nerve monitoring 2. A 57 years old man presents with 2 days history of pain and swelling of the left ear. On examination the auricle is inflamed and ear lobe is normal. (A) (B) (C) (D) (E) Perichondritis Basal cell carcinoma Otitis externa Perichondral hematoma Cellulitis What is the most likely diagnosis? (A) (B) (C) (D) (E) 7. Case same as above. How would you manage this patient? Cellulitis Perichondritis Otitis externa Perichondral hematoma Skin allergy (A) (B) (C) (D) (E) 3. Case same as above. How would you manage this patient? (A) (B) (C) (D) (E) Topical antibiotics Cloxacillin Cloxacillin + Topical antibiotics Cautry Biopsy 8. Which one is not a contraindication to the ear syringing ? Cloxacillin Cloxacillin + Metronidazole Amoxicillin Loratidine + Amoxacillin Loratidine + topical antibiotics (A) Only hearing ear (B) History of Tympanic Membrane perforation (C) Previous ear surgery (D) Recent ear trauma (E) History of otitis externa 4. A 24 years old man resents with pain and swelling of the left ear since 2 days. -1- CME for Family Physicians ENT 9. A 32 years man was hit on his left ear during a street fight. He presents to your clinic with swelling of external ear. He does not want to hospital because of fear of police. 12. A 24 years old woman complains of right earache 2 days after Tonsillectomy. She is on oral antibiotics. On examination hearing is normal and the Tympanic membranes are normal bilaterally. What is the most likely cause of ear pain? On examination the both sides of the left auricle are swollen, red and tender. (A) Serous otitis media (B) Adenoiditis secondary How would you manage this case? to tonsillectomy (C) Eustachian tube dysfunction (D) It is a complication of anesthesia (E) Referred pain (A) Diclofenac (B) Diclofenac and aspiration of the pinna (C) Cloxacillin and excision of the swelling (D) Diclofenac and Cloxacillin and pressure bandage 13. A 7 years old boy presents with fever and pain in right ear since 2 days. On examination the child is febrile, irritable and the tympanic membrane is red, bulging. (E) Diclofenac, Cloxacillin, aspiration and pressure dressing 10. Case same as above. What is the most likely diagnosis? (A) (B) (C) (D) (E) Cellulitis Perichondritis Otitis externa Perichondral hematoma Perichondral edema What is the most likely diagnosis? (A) Acute otitis media (B) Otitis media with small 11. A 25 years old man comes to your clinic and tells you that one of fast friend put a small object in his ear during play. You examined his ear and found a small bead attached to the superior aspect of the ear canal. How would you manage this patient? perforation (C) Serous otitis media (D) Normal ear (E) Acute on chronic otitis media 14. How would you manage this patient? (A) Paracetamol (B) Paracetamol and Amoxicillin (C) Paracetamol, Amoxicillin and Antibiotic ear drops (A) Leave it as such (B) Put local anesthetic drops in (D) Paracetamol, Amoxicillin and grommet insertion (E) Refer to ENT the ear and then remove it (C) Remove it with wax removing loop (D) Antibiotic drops and refer to ENT (E) Immediately refer to ENT 15. Case same as above. Which organism is the most common cause of this condition? -2- CME for Family Physicians ENT (A) (B) (C) (D) (E) (B) (C) (D) (E) Streptococcus pneumoniae Haemophilus influenzae Strep pyogenes Moraxella catarrhalis Staphylococcus Rennie test Weber test Tragus sign None of the above 19. Case same as above. How would you manage this patient? 16. A 5 years old girl presents with heaviness of right year since 1 month. The child is other wise fine and scores good in school. The tympanic membrane looks dull with air bubbles. How would you manage this patient? (A) Oral antibiotics (B) Topical antibiotics (C) Topical steroids + Topical Antibiotics (D) Oral antibiotics + Topical antibiotics (E) Incision and oral antibiotics 20. A 32 years old shopkeeper presents to your clinic with 3 days history of rhinorhea, fever and cough. He is taking treatment from an ENT surgeon who has advised surgery after 2 weeks. His past history has been unremarkable. What would like to tell him? (A) Refer to ENT for grommet insertion (B) Refer for audiometry (C) 10 days of oral antibiotics and then reassess (D) CBC, ESR, X-ray nasopharynx (E) Follow up in your clinic 17. Case same as above. What is the most accurate diagnostic test for this condition? (A) Go ahead with surgery as planned (A) Tympanometry (B) Audiometry (C) BERA (Brainstem Evoke (B) Surgery is unnecessary for him (C) Delay surgery for three months for resolution of acute condition Response Audiometry) (D) Should choose Septoplasty (D) Limited CT scan of the ear (E) Caloric test over Sub mucosal resection (E) None of the above 21. Mr. Smith comes to your clinic with pain in right ear since 2 days. On examination there are few vesicles on the external ear canal and Tympanic membrane. You also noticed the following facial features. What is the most likely diagnosis? 18. A 27 years old housewife presents with pain in left ear since 5 days. The pain is aggravated by the chewing and laughing. She also has fever of 1020 F. Her preauricular lymph node is palpable. On examination the ear looks like this; Which clinical sign would be useful to further reinforce your diagnosis? (A) Bells palsy (B) Sarcoidosis (C) Diabetic mononeuropathy (A) Hearing test -3- CME for Family Physicians ENT (D) Ramsay Hunt Syndrome (E) Otomycosis (E) Sarcoidosis 25. Case same as above. 22. Case same as above. How would you manage this patient? (A) (B) (C) (D) (E) How would you investigate this patient as a family physician? Steroids Acyclovir Antibiotics Vitamin B 12 None of the above (A) Excision biopsy under local (B) (C) (D) 23. A 6 years old girl presents with 2 days history of fever, difficulty in swallowing, drowsiness. On examination there is a grayish white layer in the throat and the neck is swollen. Her pulse is 130/ minute and extremities are cold. (E) 26. A 9 years old girl presents with a small swelling in the neck since birth. It is painless and is not growing in size. Which single clinical sign would be most useful in this case? (A) (B) (C) (D) How would you manage this patient? Swallowing Indirect laryngoscopy Protruding tongue Blowing out air against closed mouth (E) Trans illumination (A) Refer to ENT OPD (B) Refer to ICU (C) IV line, Erythromycin for 24 hours and then decide (D) Amoxicillin and steroids (E) Erythromycin and removal of 27. A 45 years old chronic Beatle nut eater presents with difficulty in opening his mouth since 6 months. The oral mucosa is thick and white all over the membrane 24. A 45 years old woman presents to your clinic with a painless lump on the left side of her neck since 2 months. She has lost 4 KG during this period. The lump is hard, immobile, painless and irregular. What is the most likely diagnosis? (A) (B) (C) (D) (E) What is the most likely diagnosis? (A) (B) (C) (D) anesthesia in your clinic FNA of the lump CBC, ESR, electrolytes Chest X-ray, ultrasound abdomen Bone marrow biopsy Virchow’s lymph node Tuberulosis Pancoast’s tumor Tumor of left lobe of thyroid -4- Scleroderma Oral Candida infection Mucosal atrophy Sub mucous fibrosis Leukoplakia CME for Family Physicians ENT 28. A 9 years old boy presents to your clinic with fever, throat pain, drooling and restlessness. There is an audible husky inspiratory sound. obstruction. On examination there is bright red midline swelling visible from both nostrils. (A) (B) (C) (D) What is the most likely diagnosis? (A) (B) (C) (D) (E) 33. A 43 year old is suffering from chronic nasal obstruction and discharge. She has used over the counter nasal sprays for months and feels that the problem is worsening. Diphtheria Peritonsillar abscess Ludwig’s angina Epiglottitis Foreign body in the throat (A) (B) (C) (D) 29. Case same as above. What clinical error would you like to avoid in this case? (A) (B) (C) (D) (E) Papilloma Rhinitis medicamentosa Septal haematoma Unilateral choanal atresia 34. A 78 year old has noticed right sided nasal obstruction associated with a bloody discharge that has developed over the last month. Examining the throat Palpating the throat Painful stimulus to the patient None of the above All of the above (A) (B) (C) (D) 30. Case same as above. How would you manage this patient? Adenoidal Hypertrophy Allergic rhinitis Carcinoma Foreign body 35. A 22 year old complains that the same time every year she develops blocked nose with profuse watery discharge. (A) Refer immediately (B) Pass a nasogastric tube and then refer (A) (B) (C) (D) (C) Insert oral airway and then refer (D) IV steroids and antibiotics and then refer (E) None of the above Adenoidal Hypertrophy Allergic rhinitis Carcinoma Foreign body 36. A 45 year old man is referred to you by his dentist, who noticed a pale grey opaque areas interspersed with a few red inflamed patches on his tongue while scraping the tobacco stains of his teeth 31. A 3 year old with unilateral foul-smelling bloody discharge. (A) (B) (C) (D) Papilloma Rhinitis medicamentosa Septal haematoma Unilateral choanal atresia Adenoidal Hypertrophy Allergic rhinitis Carcinoma Foreign body (A) (B) (C) (D) 32. A 19 year old rugby player who has been hit on the nose and is now complaining of bilateral nasal -5- Lichen planus Basal cell carcinoma Angular stomatitis Ulcerative stomatitis CME for Family Physicians ENT 37. An elderly man with ill-fitting dentures complains of painful inflamed cracks at the corners of his mouth (A) (B) (C) (D) (E) (C) Laryngeal Carcinoma (D) Oesophageal reflux 42. A 38 year old opera singer is concerned that the timbre of her voice is changing. What is the most likely diagnosis? Lichen planus Basal cell carcinoma Angular stomatitis Ulcerative stomatitis Gingivitis (A) (B) (C) (D) 38. A 55 year old man presents with bleeding gums. On examination there is a line of inflammation at the border of the gum, the intradental papillae are swollen, and he has halitosis. (A) (B) (C) (D) (E) 43. A 32 year old lecturer has a 1 week history of low grade fever, bodyaches, runny nose and malaise associated with hoarseness. Apthous Ulcer Leukoplakia Mucocoele Gingivitis Oral candidiasis (A) (B) (C) (D) 39. A 67 year old man with COPD has recently had an infective excerbation. He complains of an unpleasant taste in his mouth, and examination reveals white deposits adhering to the mucous membranes. (A) (B) (C) (D) (E) Overuse Sinusitis Viral laryngitis Vocal cord nodules 44. A 79 year old woman with a pulsatile mass in the anterior triangle. What is the most likely diagnosis? (A) (B) (C) (D) Apthous Ulcer Leukoplakia Mucocaele Gingivitis Oral candiasis Branchial cyst Carotid body aneurysm Cervical rib Cystic hygroma 45. A 15 year old with a midline lump that moves on protruding the tongue. What is most likely diagnosis? 40. A 61 year old smoker has noticed a gradual change in voice over the last 2 months. (A) (B) (C) (D) Overuse Sinusitis Viral laryngitis Vocal cord nodules (A) (B) (C) (D) Functional Paralysis Hypothyroidism Laryngeal Carcinoma Oesophageal reflux Reactive Lymphadenitis Sarcoidosis Sebaceous cyst Thyroglossal cyst 46. A 32 year old with diffuse smooth midline swelling that moves on swallowing. What is most likely diagnosis? 41. A 58 year old woman feels that her voice is much more croaky that it used to be, and has been gradually tired for the last 6 months. She feels depressed and ahs gained weight. What is the most appropriate diagnosis? (A) (B) (C) (D) (A) Functional Paralysis (B) Hypothyroidism Goitre Laryngocoele Lymphoma Pharyngeal pouch 47. A 9 year old boy returns from his summer holiday with a painful ear which -6- CME for Family Physicians ENT is keeping him awake all night. He is unable to tolerate examination of the affected side. high grade fever in the last month. On examination air conduction is more than bone conduction in both ears and Weber is localized to left ear. (A) Infective otitis media (B) Otitis externa (C) Temporomandibular joint How would you interpret the findings? (A) (B) (C) (D) (E) Conduction loss in left ear Conduction loss in right ear Sensory loss in left ear Sensory loss in right ear Both sensory plus conduction loss in left ear (F) Same as above dysfunction (D) Tonsillitis 48. A 30 year old man presents with a 2 – day history of malaise, fever, bad oral smell, painful swallowing and bilateral ear ache. Examination of the ears is normal. 52. A mother brings her 11 years old son because he is becoming hard of hearing since 3 months. On examination bone conduction is better than air conduction in both ears and Weber is centralized. (A) Infective otitis media (B) Otitis externa (C) Temporomandibular joint dysfunction (D) Tonsillitis (E) Peritonsillar abscess How would you interpret these findings? (A) Bilateral sensory loss (B) Bilateral conduction defect (C) Bilateral sensory + conduction 49. A 7 year old boy presents with a 10 day history of malaise, low grade pyrexia and a painful discharging ear. Examination reveals tenderness behind the ear, but you are unable to visualize his tympanic membrane. defect (D) Normal at this age (E) None of the above (A) Ramsay hunt’s syndrome (B) Chondrodermatitis nodularis 53. A mother brings her 3 years old child son with complaints of fever and right ear discharge since 1 day. The discharge is yellow and purulent. On examination the external canal is full of pus. helicis externa (C) Mastoiditis (D) Barotrauma 50. A 15 year old boy complains of reduced hearing in left ear since two months. On examination bone conduction is more than air conduction in left ear and Weber is localized to left side. What is the most likely diagnosis (A) (B) (C) (D) (E) How would you interpret these findings? (A) (B) (C) (D) (E) Conduction loss in left ear Conduction loss in right ear Sensory loss in left ear Sensory loss in right ear Both sensory plus conduction loss in left ear Acute Otitis media Otitis media with effusion Chronic Otitis media Otitis externa None of the above 54. Case same as above. How would you manage this case? (A) (B) (C) (D) 51. A 22 years student presents with reduced hearing in right ear. She had a -7- Refer Start treatment and refer Treat for 24 hrs and then refer Investigate and refer CME for Family Physicians ENT (E) Treat him yourself 59. Which single investigation would you order to confirm your diagnosis? 55. Which antibiotic would you like to prescribe to him? (A) (B) (C) (D) (E) (A) (B) (C) (D) (E) Cefixime Cefradine Amoxicillin Erythromycin Clarithromycin 60. A 54 years old man presents with right ear pain and discharge since 3 days. There is no fever. His past medical history is unremarkable. 56. Which symptomatic treatment would you like to prescribe? (A) (B) (C) (D) (E) CBC Throat swab Culture of ear discharge X-ray paranasal sinuses X ray nasopharynx Paracetamol Chlorpheniramine Citrizine Betamethasone ear drops All of the above How would you manage this patient? (A) (B) (C) (D) Refer immediately. Start treatment and refer Treat him yourself If he doesn’t respond in 1 week then refer (E) Investigate and confirm your diagnosis and then decide 57. What is the most likely outcome of this child assuring he doesn’t have any other medical problem? (A) Spontaneous recovery in 6 (B) (C) (D) (E) 61. A 45 years old woman presents with episodic history of dizziness, earache and progressive sensorineural deafness. months Spontaneous recovery in 6 weeks 60% chance of Chronic Suppurative Otitis Media (CSOM) The condition will remain as such for rest of the life Permanent Deafness What is the most likely diagnosis? (A) (B) (C) (D) (E) 58. A 6 year old girl presents to you with bilateral ear discharge. He mother tells you that she speaks in nasal tone. Her weight is 16 KG. 62. A 54 years old man presents with sensorineural deafness of right ear since 3 months. There is no ear ache or ear discharge. The tympanic membranes are normal. What symptoms would you further explore in the history to find the cause of ear discharge? (A) (B) (C) (D) (E) Benign Positional vertigo Otosclerosis Mennier’s disease B 12 deficiency Acoustic neuroma How would manage this patient? Snoring Mouth breathing Wheezing A and B All of the above (A) (B) (C) (D) Refer to ENT Refer to Neurophysician Reassure him A trial of antibiotics and then decide (E) Start tricyclic antidepressant -8- CME for Family Physicians ENT 63. A 38 year old female comes to your office a 1 year history of episodic dizziness, ringing in both ears, a feeling of fullness, and hearing loss. The symptoms came an every 1-2 weeks and .usually last far 12 hours. Nausea and vomiting are present. When asked to describe the dizziness, the patient says that "the world is spinning around. (A) (B) (C) (D) (E) 66. What is the best treatment for the patient described in case above? On physical examination, the patient has horizontal nystagmus. The slow phase of the nystagmus is to the left, and the rapid phase is to. the Right Audiagrams reveal bilateral sensorineural hearing loss in the low frequencies. (A) (B) (C) (D) (E) An antiseptic Education and reassurance A thiazide diuretic A change in the antidepressant B and d 67. A. 30-year-old male comes to your office for assessment of dizziness." The dizziness occurs when he rolls over from the lying position to either the left side or the right side. It also occurs when he is looking up. He describes sensation of "the world spinning around" him. The episodes usually last for 10-15 seconds. What is the most likely diagnosis in this patient? (A) (B) (C) (D) (E) Vestibular neuronitis Ncute labyrinthitis Benign positional vertigo Orthostatic hypotension Meniere's disease Vesubular neuritis Acute labyrinthitis Benign pasitianal vcrtigo. Arthastatic hypatensian Meniere's disease What is the most likely diagnosis in this patient? 64. The treatment of this disorder includes which .of the fallowing: (A) (B) (C) (D) (E) (A) (B) (C) (D) Decrease caffeine intake Decrease alcohol intake Use a thiazide diuretic Use of ant emetic far nausea and vomiting (E) All of the Above (F) None of the above Vestibular neuronitis . Acute labyrinthitis Positional vertigo Orthostatic hypotension Meniere's disease 68. What is the treatment of choice for the patient described in case above? 65. A 23-year-old female comes to your office with a 1 month history of dizziness. She "feels dizzy" when she, stands up (as if she is going to faint). The sensation disappears within a minute. She has a history of major depression and she is taking Doxepin. (A) Avoidance of alcohol and caffeine (B) Dimenhydrinate (C) A thiazide diuretic (D) Reassurance and simple exercises (E) Edolymphatic surgery The patient's blood pressure is 140/90 mm Hg sitting md decreases to 90/170 mm Hg when she stands. There is no ataxia, no nystagmus, and no other symptoms. 69. A 39-year-old female comes to your office with a 4-day history of "unrelenting dizziness." The dizziness is associated with nausea and vomiting. There has been no hearing loss, no tinnitus, and no sensation of aural fullness. The What is the most likely diagnosis in this patient? -9- CME for Family Physicians ENT patient has just recovered from an upper-respiratory tract infection. . . On examination, nystagmus is present. The slow phase of the nystagmus is toward the left, and the rapid phase of the nystagmus is toward the right. There is a significant ataxia present. (B) (C) (D) (E) 73. What is the most common cause of conductive hearing loss in adults who have normal-appearing tympanic membranes? What is the most likely diagnosis in this patient? (A) (B) (C) (D) (E) (A) (B) (C) (D) (E) Vestibular neuronitis Acute labyrinthitis Benign positional vertigo Orthostatic hypotension Meniere's disease (A) Avoidance of alcohol and caffeine A thiazide diveretic Endolymphatic surgery Reassurance and antiemetics Prochiorperazine 71. A 26-year-old female comes to your office with a 6-day history of severe dizziness associated with ataxia and right sided hearing loss. She had an upper-respiratory tract infection 1 week ago. At that time her right ear felt plugged. On examination, there is fluid behind the right eardrum. There is horizontal nystagmus present with the slow component to the right and the quick component to the left. Ataxia is present. (A) A right-sided conductive hearing loss (B) A left-sided conductive hearing loss (C) A right-sided sensorineural hearing loss (D) A left-sided sensorineural hearing loss (E) A or d 75. A 43-year-old male comes to your office for assessment of hearing loss. He has had hearing difficulties for the past 4 years. On examination, the Weber tuning fork test lateralizes to the left ear. The Rinne tuning fork test is positive: (AC>BC). ' This suggests which one of the following hearing losses? What is the most likely diagnosis in this patient? (A) (B) (C) (D) (E) Meniere's disease Chronic otitis media Presbycusis Otosclerosis Mastoiditis 74. A. 37-year-old female comes to your office for assessment o hearing loss. She has had problems intermittently for the past 12 months. On examination, the Weber tuning fork test lateralizes to the right ear, and the Rinne tuning fork test is negative in the right ear (bone conduction is greater than air conduction [BC>AC)). . This suggests which one of the following hearing losses? 70. What is the treatment of choice for the patient described in case above? (B) (C) (D) (E) Chronic otitis media Presbycusis Otosclerosis Mastoiditis Vestibular neuronitis Acute labyrinthitis Benign positional vertigo Orthostatic hypotension Meniere's disease (A) A right-sided conductive hearing loss (B) A left-sided conductive hearing loss 72. What is the most common cause of sensorineural hearing loss in the adult population? (A) Meniere's disease - 10 - CME for Family Physicians ENT (C) A right-sided hearing loss (D) A left~sided hearing loss (E) B or c 79. Which of the following anatomic forms of acute bacterial sinusitis is most serious? sensorineural sensorineural (A) (B) (C) (D) 76. A 42-year-old woman comes to your office complaining of severe facial pain in the region of her right maxilla, fever, and a purulent discharge from her right nose, all of which started after a recent upper-respiratory infection. Her temperature is 101 F. There is tenderness over the right maxillary sinus and a greenish discharge in her right nares. The rest of her examination is normal. Which of the following statements concerning this patient is (are) true? 80. A mother comes to your office with her 24-month-old daughter. The child developed an upper-respiratory tract infection approximately 1 week ago. Two days ago the child began complaining of pain in the right ear. On examination, the child has nasal congestion and a hyperemic throat. The left tympanic membrane is normal, and the right tympanic membrane is bulging and red. There appears to be fluid behind it, The lungs are clear. The child's temperature is 39.5° C. What is the most likely diagnosis in this child? (A) The most common causes are allergic and viral (B) Rhinovirus. Is the most common among of viral causes (C) Viral often is accompanied by fever, malaise, and systemic symptoms (D) A and b only , (E) A, b, and c are true (A) (B) (C) (D) Acute otitis media (AOM) Otitis media without effusion Chronic otitis media (COM) Otitis media. With effusion (OME) (E) None of the above 77. Acute bacterial sinusitis is caused most commonIy by which of the following organisms (A) (B) (C) (D) (E) Maxillary sinusitis Ethmoidal sinusitis Frontal sinusitis Mandibular sinusitis e. Anterior sinusitis 81. An 8-month-old male is brought to your clinic. He has had an upper-respiratory tract infection but has no signs of acute ear infection such as irritability, poor sleeping, pulling at his ears, or fever. On examination, the tympanic membrane is dull and bulging but not red. The rest of the examination is benign besides a mild clear rhinorrhea. What is the most likely diagnosis in this child? Strep. Prieumonae Haemophilus influenzae Moraxella catarhalis S. pyogenes Staphylococcus aureus 78. What is the antibacterial drug of first choice for modetate to severe acute bacterial sinusitus? (A) (B) (C) (D) (E) (A) Amoxicillin clavulanic acid (1014 day course) (B) Cotrimoxazole (10~ 14 day course) (C) cefuroxiine (10-14day course) (D) ciprofloxacin (10day course) (E) Erythromycin (10-day course) Acute otitis media Otitis media without effusion Chronic otitis media Otitis media with effusion None of the above 82. A 7-month-old child is brought to your clinic by his mother He has had an upper-respiratory tract infection for the past 3 days. - 11 - CME for Family Physicians ENT On examination, there is erythema of the left tympanic membrane with opacification. There are no other signs or symptoms. 86. A 7 years old boy has been brought to your clinic with reduced hearing since 2 months. Clinical examination is normal except dull tympanic membrane. What should be the next approporiate clinical assessment? What is the most likely diagnosis in this patient? (A) (B) (C) (D) (E) Acute otitis media Otitis Media Without Effusion Chronic OME None Of The Above (A) Rennie and weber (B) Perform a myringotomy and suck out all the fluid that is present (C) Perform a pneumatic otoscopy to assess the movement of the tympanic membrane (D) Refer the child ent specialist. (E) None of the above 83. A nine years old child is brought to your office with a discharge from the left ear that has been present for the last 2 weeks. The child has a history of frequent ear infections, all of which have been treated with antibiotics. What is the most likely diagnosis in this patient? (A) (B) (C) (D) (E) 87. Which of the following statements regarding treatment of the condition described in acute otitis media? (A) Earache and fever should be Acute otitiis media Otitis Media Without Effusion Chronic otitis media Otitis media with effusion Mastoiditis treated with aspirin (B) Topical decongestants are useful in improving eustachian tube dysfunction (C) Ear drops do not provide significant relief in children (D) Systemic antihistaminedecongestants have been shown to improve the symptoms and shorten the course of disease (E) All of the above statements are true 84. What are the three most common bacterial organisms in order of frequency that are responsible for the Acute Otitis Media? (A) Streptococcus pneumolliae, (B) (C) (D) (E) group A streptococci, Haemophilus influenzae S. pneumonae, H. influenzae, Staphylococcus aureus S.pneumonae, H. influenzae, Moraxella H. influenzae, S. pneumonae, group A streptococci H. influenzae, S. pneumonae, M. catarr/wlis 88. How is recurrent otitis media defined? (A) Three or more episodes of AOM that occur within 6 months within a year (B) Four or more episodes of AOM that occur within 6 months, or five episodes that occur within a year. (C) Five or more epfa>des of aom that occur within 6 months or six episodes that occur within a year (D) Six or more episodes of ADM that occur within 6 months, or eight episodes within a year 85. What is the drug of first choice for the condition acute ottitis media? (A) (B) (C) (D) (E) Penicillin Amoxicillin Erythromycin Cefaclor Amoxicillin-cavulanic acid - 12 - CME for Family Physicians ENT (E) 10 or more episodes of AOM (B) 40% of children will have an that occur within 6 months, or three or more episodes that occur within a year effusion that persists for 4 weeks (C) Boys tend to have a higher incidence of aom than girls do (D) Nearly 90% of children will have an episode of aom by age 3 years (E) Incidence of aom peaks between 6 to 13 months of age 89. Which of the following statements regarding recurrent otitis media is true? (A) Recurrent AOM usually occur (B) (C) (D) (E) in the winter or early spring Recurrent bouts of AOM should be managed by myringotomy and the insertion of ventilation tubes Medical management appears to be less effective and is not as safe as myringotomy and tubes in children with recurrent AOM. Amoxici1lin does not have a major role to play in the management of recurrent ADM Antibiotic prophylaxis should be given for at least 6 months to a year 93. Tympimocentesis with aspiration of middle ear fluid should not be considered in which patients except: (A) A child who presents with (B) (C) 90. Which of the following intracranial complications may occur with otitis media? (A) (B) (C) (D) (E) (D) (E) Meningitis Subdural empyema Brain abscess All of the above A and c only 94. A 19 years old college student presents to your clinic with one day history of 1010 F fever and malaise. His college examinations are coming up next week. His past history is unremarkable. On examination his throat is mildly hyperemic. What could be the best management is this case? 91. Which of the following is NOT a possible extracranial complication of otitis media? (A) (B) (C) (D) (E) Acute otitis media and complains of tinnitus, vertigo, and hearing loss A child who develops a suppurative intra cranial complication of Otitis Media An patient who is immunologically impaired and does not improve with antibiotic treatment A child who has extreme ear pain and appears ill. A child, who is already taking antibiotics (A) Paracetamol + Mastoiditis Cholesteatoma Labyrinthitis Facial paralysis Otic hydrocephalus (B) (C) (D) 92. Which of the following is false about Acute Otitis Media? (E) (A) Infants and young children are at highest risk - 13 - chlorpheneramine + Gargles Paracetamol + Amoxicillin + Gargles. Paracetamol + chlorpheneramine + Amoxcillin Paracetamol + chlorpheneramine + Amoxcillin + Gargles Paracetamol + gargles. CME for Family Physicians ENT 95. treatments would be most appropriate for this patient who has benign paroxysmal Which one of the following statements about the differential diagnosis of rhinitis is correct? (A) Canalith repositioning (B) (C) (D) (E) (A) Lymphadenopathy is associated with allergic rhinitis. (B) Vasomotor rhinitis is seasonal, not perennial. (C) Occupational rhinitis can be 99. allergic or nonallergic. (D) Allergic rhinitis is only seasonal. 96. In addition to Staphylococcus aureus, which one of the following is the next most common pathogen isolated from ears with chronic suppurative otitis media? (A) (B) (C) (D) (E) 97. External ear infection. Cerumen impaction. Middle ear fluid. Furosamide Otosclerosis. 100. Which one of the following recommendations about antibiotics for the prevention of cold symptoms is CORRECT? A 50-year-old patient complains of hearing loss. He denies noise exposure at work but says that he has a hard time hearing the television unless he turns up the volume. He denies any discharge from the ears, vertigo or fever, but he has had some intermittent ringing of the right ear. A Weber test reveals lateralization to the left. A Rinne test shows better air conduction than bone conduction bilaterally. What is the most appropriate diagnosis? (A) Antibiotics are recommended for patients with purulent nasal discharge after three to five days. (B) Antibiotics are recommended to prevent pneumonia. (C) Antibiotics are not recommended for patients with a suspected cold. (D) Antibiotics are recommended for adults with cold and fever after three to five days. (A) Conductive deficit. (B) Sensorineural deficit of the right ear. 101. A 48 year old man complains of hearing loss, tinnitus in the right ear, and vertigo for the past 6 months. In addition, he has facial pain and weakness of his facial muscles. On physical examination, he has a facial palsy on the right side. Which of the following is the most likely diagnosis? (C) Mixed deficit. (D) Temporal threshold shift. 98. A 40 years old man comes with tinnitus in both ear .His hearing is normal .Ear examination is also normal Which one of the following may lead to tinnitus without hearing loss? (A) (B) (C) (D) (E) Streptococcus pneumoniae. Haemophilus influenzae. Moraxella catarrhalis. Pseudomonas aeruginosa. Serratia marcescens. procedure Meclizine (Antivert) Diazepam Low-salt diet Hydrochlorothiazide A 22 years old man presents with vertigo on turning his face to right . He does not have hearing problem, ear complaint, or headache his general and systemic exams are normal. Halpick maneurer elicits nystaginus on R lateral gaze. Which one of the following (A) Acoustic neuroma (B) Bell palsy - 14 - CME for Family Physicians ENT (C) Benign positional vertigo (D) Lyme disease (E) Meniere disease 102. Q8. Which one of the following is not a cause of conductive hearing loss that may lead to tinnitus? (A) External ear infection. (B) Cerumen impaction. (C) Middle ear fluid. (D) Loop diuretic medications. (E) Otosclerosis. - 15 -