Download Palestine Medical Council Certificate Examination

Palestine Medical Council Certificate Examination
Specialty: ENT
Please answer all the 100 questions provided
for each question, select the one most appropriate answer.
Time allowed: 3 hours
For each of the following multiple choice questions, select the one
most appropriate answer:
1. The landmark of the lateral surface of the temporal bone which acts as a guide to the surgical
approach of the antrum is the:
A. Notch of Rivinus
B. Suprameatal spine of Henle
C. Temporal line
D. Tympanosquamous suture
E. Trautman triangle
2. Severe epistaxis originating above the middle turbinate and not controlled by packing requires
legation of the:
A. Anterior ethmoidal artery
B. Maxillary artery
C. Sphenopalatine artery
D. Internal carotid artery
E. External carotid artery
3. The utricle and saccule are connected by:
A. Cochlear aqueduct
B. Ducts reunions
C. Semicircular canals
D. Common crus
E. Endolymphatic duct
4. The plate of the bone which separates the attic from the middle cranial fossa is called:
A. Aditus and antrum
B. Macewen plate
C. Tegmen tympani
D. The sinodural angle
E. Trautman triangle
5. Development of the hard palate:
A. Is from a median premaxilla and two lateral maxillary processes
B. Is from an anterior premaxilla, median maxilla, and posterior uvular processes
C. Includes a central area derived from the lower edge of the nasal septum
D. Is primarily from the bucconasal membrane:
6. The parasympathetic innervation of the submandibular gland is carried by the:
A. Vidian nerve
B. Chorda tympani
C. Lesser petrosal nerve
D. Otic ganglion
E. Glossopharyngeal nerve
7. A patient given 3 L (3000 ml) of 5% dextrose-containing intravenous solutions daily will receive
about:
A. 250 cal/24 hr
B. 600 cal/24 hr
C. 1000 cal/24 hr
D. 2000 cal/24 hr
E. 3000 cal/24 hr
8. Respiratory dead space, i.e. , the volume from the nose and mouth down to the alveoli, is about:
A. 75 ml
B. 150 ml
C. 350 ml
D. 450 ml
E. 550 ml
9. The stream of inspired air in the nose travels:
A. A straight course from nostril to choana
B. In a high curve through the nasal chamber
C. Along the inferior turbinate
D. Along the floor of the nose
E. In numerous eddies occupying most of the nasal chamber
10. Pseudoepitheliomatous hyperplasia:
A. Usually precedes cholesteatoma formation
B. Is viral in etiology
C. Accompanies laryngeal papilloma
D. Is best treated by radiation
E. Is a type of acanthosis which superficial resembles malignancy
11. Mixed tumor of a salivary gland is so named because it
A. May be found in the submaxillary or parotid gland
B. May be either benign or malignant
C. Contains both epithelial and connective tissue elements
D. Contains both squamous cell and adenocarcinoma components
12. Squamous epithelium of the upper respiratory tract abruptly changes to a respiratory type at the
junction of the:
A. Hypopharynx and larynx
B. Epiglottis and ventricular band
C. False and true vocal cords
D. Glottic and subglottic larynx
E. Trachea and main-stem bronchus
13. The essential radiologic finding in coalescent or surgical mastoiditis is:
A. Poor temporal bone pneumatization
B. Diffuse clouding of mastoid cells
C. Radiolucent defect in the antral area
D. Rarefaction and loss of distinctness of the cell partition
E. Erosion of the dural or sinus plate
14. The speech reception threshold is that decibel level at which:
A. A list of phonetically balanced words can be repeated correctly
B. 50% of a list of spondee words can be repeated correctly
C. 50% of a list of phonetically balanced words can be repeated correctly
D. A list of spondee words can be repeated correctly
15. In evaluating the need for masking we calculate that the energy loss across the head by air
conduction is about:
A. 15 dB
B. 30 dB
C. 50 dB
D. 75 dB
16. In evaluating the need for masking we calculate that the energy loss across the head by bone
conduction is about:
A. 15 dB
B. 30 dB
C. 50 dB
D. 85 dB
17. Temporary threshold shift is commonly with:
A. Meniere disease
B. Ototoxic drugs
C. Presbycusis
D. Noise exposure
E. Tone decay
18. The most frequent cause of perforation of the nasal septum is:
A. Congenital
B. Tuberculosis
C. Syphilis
D. Chronic infection
E. Operative trauma
19. The most common causal factor in hyperplastic rhinitis is:
A. Allergy
B. Bacterial infection
C. Septal deviation
D. Chemical irritation
E. Previous nasal surgery
20. In hereditary hemorrhagic telangiectasis (Osler-Weber-Rendu disease):
A. Clotting time is prolonged
B. Platelet count is decreased
C. Partial thromboplastin time is prolonged
D. Bleeding time is prolonged
E. All coagulation studies are normal
21. The chief shortcoming of intranasal antrostomy has been:
A. Occurrence of a bony sequestrum
B. Closing of the window
C. Inability to use the procedure for bilateral disease
D. Disruption of normal physiology
E. Failure to remove diseased sinus mucosa
22. An endocrine dysfunction not infrequently found in vasomotor rhinitis patients is:
A. Diabetes insipidus
B. Diabetes mellitus
C. Hypothyroidism
D. Hyperparathyroidism
E. Primary aldosteronism
23. The most common cause of oroantral fistula is:
A. Maxillary sinusitis
B. Dental extraction
C. Odontogenic cyst
D. Osteomyelitis of the maxilla
E. Carcinoma of the maxilla
24. The immunoglobulin in the allergic-anaphylactic reaction is:
A. IgA
B. IgD
C. IgE
D. IgG
E. IgM
25. A cardiac condition that may occur secondary to hypertrophied tonsils and adenoids is:
A. Atrial septal defect
B. Bundle branch block
C. Patent ducts arteriosus
D. Cor pulmonale
E. Coarctation of the aorta
26. The usual finding in glossodynia (burning tongue) is:
A. Hypertrophy of the circumvallate
B. Beefy red tongue
C. Cheilitis
D. Positive serology
E. No clinically detectable lesion
27. The diagnosis of scarlet fever is confirmed by:
A. The presence of a pharyngeal pseudomembrane
B. The presence of a fusospirochete
C. A positive tellurite culture
D. The Schick test
E. The Dick test
28. A parotid tumor which may occur bilaterally and which gives a “hot” scan with technetium 99m is:
A. Pleomorphic adenoma
B. Oxyphilic adenoma
C. Oncocytoma
D. Warthin tumor
E. Squamous cell carcinoma
29. Chronic nonobstructive sialodochiectasis (sialectasis) presents a sialographic pattern of:
A. Diffuse dilatation of the peripheral ducts
B. Structure of the peripheral ducts
C. One or more calculi
D. Displacement of the ductal system
E. Absence of ductal filling
30. Swelling of the parotid glands not infrequently follows ingestion of:
A. Mercury
B. Hypertonic glucose
C. Lipase
D. Iodides
E. Amylase
31. Cricoarytenoid joint arthritis is best differentiated from unilateral vocal cord paralysis is by:
A. Suspension laryngoscopy
B. Laryngeal electromyography
C. Latex agglutination test
D. Passive mobility test
E. CT scan of the larynx
32. A tracheostomy located between the cricoid cartilage and first tracheal ring is:
A. A good procedure in most situation
B. Called a cricothyrotomy
C. More difficult to perform than the usual tracheostomy at a lower level
D. Often complicated by subglottic stenosis
E. Useful in the short-necked individual
33. The key to identification of the recurrent laryngeal nerve during thyroid surgery is:
A. The superior thyroid artery
B. The middle thyroid vein
C. The inferior thyroid artery
D. The parathyroid glands
E. With a nerve stimulator
34. In the previously radiated neck, a precaution taken during radical neck dissection is:
A. Tracheotomy
B. Preservation of the spinal accessory nerve
C. Avoidance of electrocautery
D. Use of a muscle flap for carotid artery protection
E. Preservation of the internal jugular vein
35. The key to surgical removal of a branchial cleft cyst is:
A. Aspiration of the cyst before surgery
B. Transaction of the sternocleidomastoid muscle
C. Removal of the medial portion of the hyoid bone
D. Dissection of the duct to its pharyngeal origin
E. Cautery of the base
36. During the course of mediastinoscopy, a biopsy of a lymph node at the origin of the right main
bronchus followed by profuse dark bleeding suggests damage to the:
A. Superior vena cava
B. Azygos vein
C. Right pulmonary artery
D. Subclavian vein
E. Innominate vein
37. Cerebellar signs such as nystagmus, dysarthria, and ataxia may be produced by:
A. Corticosteroids
B. Diphenylhydantion (phenytoin-Dilantin)
C. Vitamin C
D. Diphenhydramine (Benadryl)
E. Cephalothin
38. The greatest single factor in reconstructive skin flap necrosis is:
A. Hematoma formation
B. Inadequate arterial inflow
C. Poor nutritional state of patient
D. Excessive tension
E. Excessive length/ width ratio
39. The most common management of a depressed zygomatic fracture (not associated with maxillary
fracture) is by:
A. Gillies elevation via temporal incision
B. Open reduction and transosseous wiring
C. Placement of a Kirshner pin
D. External traction from a plaster cap
E. Watchful waiting
40. In the typical blow-out fracture of the orbit, motion of the eye is affected primarily in:
A. Upward gaze
B. Downward gaze
C. Medial gaze
D. Lateral gaze
41. In a child where several attempts at closure of a cleft palate have failed, the best management is:
A. Secondary closure at age 16
B. Utilization of a posterior pharyngeal flap
C. Use of a vomer flap
D. Using an external skin tube pedicle
E. Use of a prosthesis
42. While doing Functional Endoscopic Sinus Surgery, the surgeon is trying to preserve middle turbinate
and work lateral to it. Middle turbinate of nose is part of which bone:
A. Ethmoid bone
B. Maxillary bone
C. Palatine bone
D. Vomer bone
E. Not a part of any of these but a separate bone
43. Which of the following statements is true:
A. External auditory canal is 2/3rd cartilage and 1/3rd bone
B. Eustachian tube is 1/3rd cartilage and 2/3rd bone
C. Internal auditory canals all bone
D. Canal of tensor tympani muscle is 1/4th cartilage and 3/4th bone
44. A 38-year old female patient was subjected to subtotal thyroidectomy.The parathyroid glands were
identified and preserved. After extubation the patient had difficulty in breathing and had stridor. You
suspect paralysis of the main abductor of larynx, the posterior crico-arytenoid muscle. Which of the
following nerves was most likely damaged during operation:
A. Phrenic
B. External laryngeal
C. Internal laryngeal
D. Recurrent laryngeal
E. Superior laryngeal
45. Endolymphatic K+ ion concentration is near:
A. 5 meq/L
B. 50 meq/L
C. 100 meq/L
D. 150 meq/L
E. Not yet known
46. An 85 year old woman who complains of difficulty in hearing conversational speech also
complains about the noise her grandchildren are making. What best explains these
complaints?
A. Hypersensitivity of hair cells in the inner ear
B. Impaired sound localization
C. Wax obstructing the external auditory canal
D. Otosclerosis
E. High frequency hearing loss
47. A 16-year-old boy has a 1-day history of pain in the right ear. He swims every morning. The
right ear canal is red and swollen. He has pain when the auricle is pulled or the tragus is
pushed. Which of the following is the most likely diagnosis?
A. Acute otitis media
B. Bullous myringitis
C. Chronic otitis media
D. External otitis
E. Mastoiditis
48. The most common cause of cerebro spinal otorrhea is:
A. Rupture of tympanic membrane
B. Fracture of petrous ridge
C. Fracture of mastoid air cells
D. Fracture of parietal bone
E. Fracture of nasal bone
49. The quality of voice in a patient with gross adenoids hypertrophy is described as:
A. Rhinolalia aperta
B. Rhinolalia clausa
C. Hoarse
D. Hot potato voice
50. The inner ear is a derivative of:
A. Ectoderm
B. Endoderm
C. Mesoderm
D. Neural crest cells
51. In managing epistaxis, posterior nasal packing:
A. Should be the first line therapy
B. Should be avoided
C. Should not be performed with anterior for hypoxia, apnea, and arrhythmias
D. Requires the patient to be monitored for hypoxia, apnea, and arrhythmias
E. May predispose to hypocarbia
52. Management of deviated nasal fractures in children should include all of the following except:
A. Early closed nasal reduction
B. General anesthesia during closed nasal reduction
C. Immediate incision and drainage of septal hematoma
D. Nasal stenting after closed nasal reduction for infants less than 6 months of age
E. Open reduction for injuries with deviation greater than one-half the width of the nasal bridge
53. The most important tool in making the diagnosis of allergy is
A. A positive skin prick test
B. A positive intradermal skin test
C. A positive history for symptoms associated with exposure
D. A total IgE >100 IU/mL
E. A n mRAST value of class II or higher
54. Nonallergic rhinitis usually presents with all of the following symptoms except:
A. Rhinorrhea
B. Nasal congestion
C. Nasal obstruction
D. Itching
E. Negative skin test
55. The patient with a sinus computed tomography showing mucosal thickening the osteomeatal
complex:
A. Requires endoscopic sinus surgery
B. May have a cold, a bacterial sinus infection, nasal polyps, or an irreversible obstruction of the
maxillary infundibulum
C. Should be treated with a broad-spectrum antibiotic
D. Requires a culture-directed antibiotic and nasal steroid sprays
56. All of the following are true about nasal steroid except:
A. Are contraindicated in infectious sinusitis
B. More potent nasal steroids like fluticasone may have some pituitary suppression
C. Should be used cautiously in elderly patients taking inhaled steroids
D. Septal perforation is a rare side effect
E. Are effective against acute and late-phase effects
57. Which of the following statements are true:
A. Most instances of CSF rhinorrhea caused by closed-head trauma resolve with conservative
management
B. Most instances of nontraumatic CSF rhinorrhea require operative repair
C. Endoscopic repair of CSF rhinorrhea has emerged method for surgical closure of skull base
defects when operative closure is indicated
D. Only pedicled mucosal flaps can be reliably used to reconstruct the site of a CSF leak
E. All of the above
58. Computed tomography scans are the best imaging study for detection of:
A. Neoplasm
B. Calculi
C. Abscesses
D. Chronic inflammatory disease
E. Parapharyngeal masses
59. Which statement about facial nerve injury is true
A. Repair should be delayed 7 days
B. Best results are obtained when repair occurs after 14 days
C. It should be performed on injuries medial to the lateral canthus
D. Best results are obtained the sooner repair is performed
E. Branches may be stimulated up to 96 hours after injury
60. Which of the following statements regarding treatment of oropharyngeal carcinoma is true:
A. For early tonsil cancer there is no significant different in survival between surgery and
primary radiotherapy
B. Primary closure of the tongue base defect can be performed only if less the tongue an 25% of
the tongue base is removed
C. Tumors of the upper pharyngeal wall are usually accessible through a transoral route
D. For soft palate cancer radiotherapy should be considered for lesions less than 2cm in diameter
E. Wide resection of the tonsil and surrounding soft tissues can result in significant adverse
effects on function
61. Oxygen desaturation is usually more severe with:
A. Mixed apnea
B. Obstructive sleep apnea
C. Control apnea
D. Snoring
62. Laryngospasm is more likely to occur in a patient who is:
A. Hypoxic
B. Hypercarbic
C. Acidotic
D. Lightly anesthetized
E. Deeply anesthetized
63. Which feature is not important to voice production:
A. Hypernasality
B. Clenched jaw
C. Neck extension
D. Decreased thyrohyoid space
E. None of the above
64. Which of the following statements best describes the rule computed tomography of the larynx after
blunt trauma:
A. All patients which suspected laryngeal injuries should undergo computed tomography to
document the extent of their injury
B. Computed tomography should be use only when the results of the study will influence course
of treatment
C. Suspected fractures of the laryngeal skeleton that are difficult to document by physical
examination should be viewed by computed tomography
D. B and C
E. All of the above
65. Optimal results after vocal fold surgery maybe best achieved by including:
A. Postoperative absolute voice rest
B. Smoking cessation
C. Antireflux therapy
D. Preoperative and postoperative voice therapy
E. Preoperative steroids
66. Which of the following tracheal tumors comprise most primary tracheal neoplasm in adults:
A. Carcinoid and adenoid cystic carcinoma
B. Adenoid cystic carcinoma and squamous cell carcinoma
C. Granular cell tumor and squamous cell carcinoma
D. Papilloma and granular cell carcinoma
E. Carcinoid and leiomyoma
67. Which bacteria are most commonly cultured from deep space neck abscesses:
A. Aerobic gram-negative bacilli
B. Actinomyces Israeli
C. Streptococci species
D. Staphylococci species
E. Pseudomonas species
68. The common soft tissue sarcoma of the head and neck in children is:
A. Angiosarcoma
B. Chondrosarcoma
C. Osteosarcoma
D. Rhabdomyosarcoma
E. Ewing’s sarcoma
69. Otolaryngologic manifestations hypothyroidism include all of the following except
A. Sensorineural hearing loss and tinnitus
B. Sinus congestion
C. Enlargement of the tongue
D. Husky, raspy voice
70. where does the recurrent laryngeal nerve enter the laryngeal framework:
A. Deep to the inferior thyroid artery
B. Lateral to the inferior constrictor muscle
C. Between the arch of the cricoid cartilage and the inferior corn of the thyroid cartilage
D. Through the cricothyroid muscle
71. which of the following biochemical profiles is found in patients with primary hyperparathyroidism:
A. Increased serum calcium, increased serum vitamin D, decreased urinary calcium
B. Increased serum calcium, increased serum phosphate, decreased serum vitamin D
C. Decreased serum phosphate, increased urinary calcium, normal serum vitamin D
D. Increased serum phosphate, increased urinary calcium, decreased serum vitamin D
E. Increased serum calcium, increased serum phosphate, normal serum vitamin D
72. Within the middle cranial fossa, the arcuate eminence of the superior surface of the temporal bone
corresponds to:
A. Cochlea
B. Superior semicircular canal
C. Tegmen tympani
D. Geniculate ganglion
73. All of the following contribute to the sensory innervations of the external ear except:
A. Jacobsen’s nerve
B. Great auricular nerve
C. Auriculotemporal nerve
D. Facial nerve
E. Vagus nerve
74. Pulsatile tinnitus is uncommon in which clinical conditions:
A. Pseudotumor cerebri
B. Otosclerosis
C. Acoustic neuroma
D. Dural arteriovenous fistula
75. Which of the following statements about bullous myringitis is true:
A. The infection is usually painless
B. The etiology may be viral
C. The presentation involves an sensorineural hearing loss alone
D. The hearing loss is usually permanent
E. The drainage is typically thick and mucopurulent
76. Clear otorrhea from a ventilation tube may arise from:
A. Bullous myringitis
B. Gustatory otorrhea
C. Spontaneous cerebrospinal fluid leak
D. Atypical tuberculosis
E. Chloroma formation
77. Which of the following disorders can mimic the symptoms and signs of chronic otitis media
A. Langerhans cell histiocytosis
B. Tuberculosis
C. Wegener’s granulomatosis
D. All of the above
E. None of the above
78. Otoacoustic emission can be used clinically in patients with noise-induced hearing loss (NIHL) to
accomplish all but which one of the following:
A. To detect the initial stages of NIHL
B. To specify damage to the inner hair cell system
C. To estimate the configuration of the audiogram
D. To objectively monitor the progression of NIHL in instances of continued exposure
E. To determine the frequency /amplifying characteristics of a prescribed digital hearing aid
79. Which of the following statements about aminoglycoside antibiotics is false:
A. Aminoglycoside antibiotics may cause permanent sensorineural hearing loss
B. Permanent vestibular damage may result from aminoglycoside therapy
C. Serum levels are predictive of aminoglycoside vestibular toxicity
D. Oscillopsia is a symptom of sever vestibular damage from aminoglycoside antibiotic
treatment
E. Intratympanic therapy with gentamycin carries a risk of permanent sensorineural hearing loss
80. During mastoidectomy, the sigmoid sinus is injured. The bleeding is ultimately controlled, and the
procedure is completed. After awakening the patient reports visual changes and persistent headaches.
Which of the following is not indicated:
A. Magnetic resonance imaging
B. Magnetic resonance venography
C. Ophthalmology consultation
D. Immediate surgical exploration
E. All of these are indicated
81. The second branchial arch gives rise to the:
A. 1Xth cranial nerve
B. Semilunar ganglion V3
C. Geniculate ganglion V11
D. Recurrent laryngeal nerve
82. The hyoid bone is usually calcified by age:
A. 4 year
B. 10 year
C. 20 year
D. 2 year
83. Wood workers have an increased incidence of this type of tumor:
A. Adeno carcinoma
B. Squamous cell carcinoma
C. Adenoid cystic carcinoma
D. Malignant mixed tumor
84. The strap muscle of the neck are enveloped in the:
A. Deep layer of the deep cervical fascia
B. Middle layer of the deep cervical fascia
C. Superficial layer of the deep cervical fascia
D. Carotid sheath
E. None of the above
85. The incidence of rheumatic fever with untreated acute streptococcal tonsillitis is:
A. 1%
B. 3%
C. 5%
D. 8%
E. 10%
86. The most common site of deep hemangiomas within the head and neck are within the:
A. Omohyoid space
B. Masseter muscle
C. Submandibular space
D. Lower neck
87. A nasal smear showing mastocytosis with eosinophilia is typical of:
A. Allergic rhinitis
B. Vasomotor rhinitis
C. Atrophic rhinitis
D. Rhinitis medicamentosa
E. Viral rhinitis
88. A 30 years old female had a previous frontal fracture and was treated with observation. She presents
6 monthly later with severe headache. The most likely diagnosis is:
A. Mucocele
B. Temporal arteritis
C. CSF leak
D. Migraine
E. Meningitis
89. The most common complication of cholesteatoma:
A. Facial nerve paralysis
B. Brain abscess
C. Semicircular canal erosion
D. Supperative labyrinthitis
E. Sensorineural hearing loss
90. Recurrent acute otitis media:
A. Affects 10% of children in first decade
B. Hereditary
C. Allergy is the principal cause
D. Is associated with nasal polyp
91. The frontal sinus is fully developed by------year(s) of age:
A. 11
B. 4
C. 8
D. 16
E. 18
92. What structure is visible in the wall of the sphenoid sinus:
A. Optic nerve
B. Internal carotid artery
C. Maxillary nerve
D. Ophthalmic artery
E. Facial nerve
93. The most common cause of chronic parotitis is:
A. Structure of the anterior part of Stenen’s duct
B. Obstruction due to stones
C. Compression by tumor
D. Structure of the duct orifice
E. Congenital dilation of the main duct
94. During a tonsillectomy, the surgeon accidentally traverses the tonsil bed and muscle directly
posterolateral. Which of the following structures is in most danger of being damaged?
A. Common carotid artery
B. Hypoglossal nerve
C. Ascending pharyngeal artery
D. Mandibular nerve
E. External carotid artery
95. Which of the following arteries is not usually seen in neck dissection:
A. Superior thyroid
B. Lingual
C. Ascending pharyngeal
D. External maxillary
E. Occipital
96. Which of the following are not removed in radical neck dissection:
A. Submental nodes
B. Jugular nodes
C. Spinal accessory nodes
D. The tail of the parotid gland
E. All of the above are removed in radical neck dissection
97. Trismus associated with deep neck infection is most indicative of:
A. Peritonsillar abscess
B. Parapharyngeal abscess
C. Parotitis
D. Submandibular abscess
E. Infection tracking along the carotid sheath
98. The tensor veli palatine muscle is innervated by the:
A. Mandibular division of the trigeminal nerve
B. Maxillary division of the trigeminal nerve
C. Glossopharyngeal nerve
D. Vagus nerve
E. Hypoglossal nerve.
99. A common reason that revision stapes surgery is necessary is:
A. Tympanic membrane perforation
B. Formation of adhesions in the middle ear
C. Exostosis of the external auditory canal
D. Incus erosion
E. Malignant external otitis
100.
A.
B.
C.
D.
what are the embryologic origins of the laryngeal cartilages
First branchial arch
Second branchial arch
Third branchial arch
Fourth, fifth, and sixth branchial arches
Good luck