Download ENT – Second Long Exam (2010-2011) Which of the following is the

ENT – Second Long Exam (2010-2011)
1. Which of the following is the narrowest portion
of the nasal passage which most significantly
contributes to total airflow resistance?
a. Anterior choana
b. Posterior choana
c. Limen nasi
d. Nasal vestibule
2. The blood supply to the nose arises from both
the external and internal carotid system. The
following statement best describes this
distribution
a. The maxillary artery is implicated in
causing cavernous sinus thrombosis
b. The opthalmic artery from the external
carotid system gives rise to the
ethmoidal arteries
c. The internal nose receives blood from
the terminal branches of the
sphenopalatine artery
d. The sphenopalatine artery from the
external carotid system is the main
blood supply of the internal nose
3. Understanding the physics of nasal airflow
provides insight into process of warming and
humidification of inspired air. The following
statement occurs during nasal inspiration
a. Increasing airflow velocity is desirable
because it promotes warming and
humidification
b. Water is withdrawn from inspired air to
reduce the amount of insensible loss
c. Inspired air is heated by 25% on
entering the nasopharynx, with
relative humidity of over 90%
d. Transforming turbulent to laminar
airflow is integral to nasal airconditioning functions
4. The nose is essential for olfaction. The following
statement best describes this unique role:
a. Olfactory epithelium covers the anterior
inferior part of the septum
b. On inspiration, the liquid-soluble and
lipid-soluble substances create an
olfactory impression
c. the olfactory bulb is connected to the
olfactory tract to the tertiary olfactory
center in the cortex
d. olfactory mucosa contains between
100-200 million bipolar sensory cells in
just a few centimeters
5. The most important mechanical defense of the
nasal mucosa is the mucocilliary apparatus. The
following statement best describes its
properties:
a. cilliary motion is influenced by
temperature and humidity, and not by
gravity
b. Mucus has a superficial sol layer where
trapping of microscopic debris occurs
c. Mucociliary transport is directed
anteriorly and toward the nares in
allergic patients with dripping noses
d. Fine salt is placed on the anterior end of
the inferior turbinate may be
monitored to test mucocilliary
clearance
6. The mucosal lining of the oropharynx is
a. Strat. Ciliated epith
b. Strat. Columnar epith
c. Stratified non-keratinized squamous
epith
d. Stratified keratinized squamous epith
7. Which of the following statements is true about
the pharynx?
a. Bounded posteriorly by the cervical
vertebrae
b. Bounded laterally by the mandibular
alveolus
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c. Bounded anteriorly by the base of the
tongue
d. Bounded inferiorly by the superior
border of the cricoid cartilage
Which of the following best describes normal
swallowing
a. The bolus of food swallowed is
transported into the stomach within 710 seconds
b. Involuntary reflex adduction of the
vocal cords happens during the
esophageal phase
c. The pharyngeal phase begins with the
pressing of the food against the hard
palate with the tongue
d. Oral phase elicits an involuntary
swallowing reflex
Which of the following pharyngeal muscles
opens the auditory canal during swallowing?
a. Superior constrictor
b. Middle constrictor
c. Stylopharyngeus
d. Salpingopharyngeus
The primary function of the pharynx is:
a. Initiate immune response to infection
b. Express phonation
c. Conduct respiration
d. Coordinate glutition
The tongue in a patient with right CNXII deficit
would:
a. Deviate toward the left
b. Deviate toward the right
c. Stay in the midline
d. Not move at all
Which of the following structures facilitate
spread of inflammatory lesions from the lip to
the cranial cavity?
a. Occipital vein
b. Facial vein
c. Maxillary vein
d. Superficial temporal vein
Which of the following statement regarding the
oral cavity is true:
a. Twenty deciduous teeth erupt in
childhood and are gradually replaced
by the permanent dentition
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b. Lingual tonsils are located at the apex of
the tongue
c. Lining of the oral cavity consists of a
simple squamous epithelium
d. The hard palate supports the uvula and
two pairs of muscular pharyngeal
arches
The main function of the larynx is:
a. Initiates phonation
b. Coordinates glutition
c. Airway protection
d. Respiration
The temporal relationship between the
separation of the superior edges of the vocal
folds and the closure of the lower edges is best
accounted for by:
a. Neurochronaxic theory
b. Bernoulli effect
c. Ishizaka’s two-mass model
d. The “body-cover” concept of phonation
What is the cadaveric position of the vocal
folds:
a. Vocal folds fully apposed
b. Vocal folds fully abducted
c. Vocal folds in the paramedian position
d. Unilateral vocal fold abducted.
Glottic adduction during expiration:
a. Increases expiratory resistance to
airflow, prolonging exhalation
b. Decreases expiratory resistance to
airflow, shortening exhalation
c. Increases expiratory resistance to
airflow, shortening exhalation
d. Decreases expiratory resistance to
airflow, prolonging exhalation
Which of the following supplies the sensory
innervation to the mucosa of the lining of the
upper portions of the larynx
a. Recurrent laryngeal nerve
b. Internal branch of the superior
laryngeal nerve
c. External branch of the superior
laryngeal nerve
d. Arnold’s nerve
19. The supraglottis is defined by the tip of the
epiglottis and vallecula superiorly and which is
the following structures inferiorly:
a. Under surface of the false vocal cords
b. Lower border of the cricoid cartilage
c. Region of the ventricles
d. Area of the aryepiglottic folds
20. Which of the following muscles of the larynx is
supplied by the superior laryngeal nerve:
a. Posterior cricoarytenoid
b. Cricothyroid
c. Thyroarytenoid
d. Lateral cricothyroid
21. Nasal breathing is favored by constriction of
the oropharyngeal passage, which is primarily
accomplished by activation of the:
a. Musculus uvulae
b. Palatoglossus
c. Palatopharyngeus
d. Levator veli palatini
22. The most important pharyngeal dilator is the:
a. Hyloglossus
b. Mylohyoid
c. Geniohyoid
d. Genioglossus
23. In a newborn, the epiglottis is in contact with
the soft palate making the baby:
a. Obligate nasal breather
b. Obligate mouth breather
c. Some during sleep
d. Aspirate every after feedings
24. Type of articulation of the crico-arytenoid joint:
a. Hinge joint
b. Pivot joint
c. Gliding joint
d. Ball and socket joint
25. Contraction of the posterior cricoarytenoid
muscle pulls the muscular process of the
arytenoid:
a. Anteriorly and cephalad
b. Anteriorly and caudally
c. Posteriorly and cephalad
d. Posteriorly and caudally
26. Which of the following is observed during
laryngeal stroboscopy?
a. Mucosal waves
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b. Integrity of the neuromuscular unit
c. Subglottic pressure
d. Intensity of phonation
Following total thyroidectomy, a patient
developed breathy voice that fatigues easily,
she also noted failure to sing higher notes.
Which of the following could have been
injured?
a. Unilateral recurrent laryngeal nerve
b. Bilateral recurrent laryngeal nerve
c. Unilateral superior laryngeal nerve
d. Bilateral superior laryngeal nerve
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b. //
c. Pseudostratified columnar epithelium
d. Transitional epithelium
Gradual onset of hoarseness may indicate which
of the following pathology:
a. Neurogenic origin
b. Psychogenic origin
c. Lesion of the vocal cord
d. Trauma
The most basic method of examining the larynx
is:
a. Direct laryngoscopy
b. Indirect laryngoscopy
c. Laryngeal stroboscopy
d. Flexible nasopharyngoscopy
This test is best performed on patients with
evidence of movement disorders of the vocal
folds:
a. Laryngeal videostroboscopy
b. Rigid laryngoscopy
c. Flexible laryngoscopy
d. Laryngeal electromyography
A patient with an abductor spasmodic
dysphonia may have which of the following
voice quality:
a. Strained
b. Breathy
c. Aphonia
d. Rough
Hoarseness due to malignancy of the larynx
involves the:
a. Epiglottis
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b. False vocal folds
c. True vocal folds
d. Subglottic area
The vibratory rate of the human true vocal
folds:
a. 10-100 cycles per sec
b. 50-750 cycles per sec
c. 75-1000 cycles per sec
d. 300-3000 cycles per sec
Which principle in physics helps in the vibration
of the vocal fold during phonation?
a. Newton’s principle
b. Bernoulli’s principle
c. Principle of action-reaction
d. Principle of mass action
A 5 year old boy comes to the ER because of
persistent nose bleeding. Immediate
management includes the following measure:
a. Do nasal packing
b. Request for bleeding profile work-up
c. Apply digital pressure to the anterior
nose
d. Infuse IV fluids to restore fluid volume
In evaluating olfactory disorders, the clinical
history usually establishes precipitating events.
Sudden olfactory loss suggest the following
possibility:
a. Neoplasm
b. Head trauma
c. Inflammatory process
d. Degenerative process
A 30 y.o. male complained of midfacial pain and
yellowish nasal discharge 2 weeks after
persistent “cold”. After an endoscopic
examination, the ORLHNS specialist concluded
that the patient suffers from rhinosinusitis of
the “anterior group”. The following statement
give evidence to his observation:
a. Mucopurulent discharge was seen in
front of the torus tubarius
b. Mucopurulent discharge was seen
pooling at the nasal vestibule
c. Mucopurulent discharge was seen
draining from the superior meatus
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d. Mucopurulent discharge was seen
coming from the sphenoethmoidal
recess
A 60 y.o. diabetic female developed nasofacial
cellulitis 1 week after suffering from
furunculosis of the nasal dorsum. The following
statements is true of this condition:
a. Surgical drainage through the glabella is
the treatment of choice
b. The most common pathologic
microorganism isolated is S. Aureus
c. Cavernous sinus thrombosis may result
from direct extension through the
cribriform plate
d. Valves venous network in this area
accounts for the high incidence of CNS
complications
A 60 y.o. female suffered a cerebrovascular
ischemic attack. After which she was unable to
recognize scents. This type of olfactory
dysfunction is called:
a. Agnosia
b. Parosmia
c. Hyposmia
d. Phantosmia
Which of the following enhances hormonal
rhinitis:
a. Testosterone
b. Estrogen
c. Progesterone
d. Diethylstilbestrol
Which of the following best describes allergic
rhinitis:
a. Nasal inflammation resulting from an
IgE mediated response
b. Characterized by nasal obstruction and
yellowish purulent rhinorrhea
c. Associated with asthma in 25% of cases
d. And insignificant global health problem
Which of the following is suggestive of allergic
rhinitis?
a. History of rhinorrhea an exposure to
allergens
b. Maxillary sinus air-fluid level on CT scan
c. Negative skin prick test
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d. A white glistening mass on nasal
endoscopy
A 35 y.o. male complains of nasal congestion
whenever exposed to perfume. The patient
most probably has the following condition:
a. Dysosmia
b. Allergic rhinitis
c. Vasomotor rhinitis
d. Rhinitis medicamentosa
A 40 y.o. male has severe allergic rhinitis and
nasal polyposis. The following type of olfactory
dysfunction (dysosmia) is a very likely
accompanying complaint
a. Agnosia
b. Parosmia
c. Hyposmia
d. Phantosmia
Most important step in treatment of nonspecific chronic rhinitis
a. Decongestants
b. Antihistamine + steroids
c. Remove irritants
d. Saline spray
Which of the following is the treatment of
choice for persistent severe allergic rhinitis?
a. Intranasal steroids alone
b. 1st generation antihistamine and
anticholinergics
c. Systemic and intranasal steroids with
immunotherapy
d. H1 receptor blocker antihistamine alone
Which of the following countries have the
lowest prevalence rate of allergic rhinitis
a. USA
b. Greece
c. UK
d. Australia
Mrs. Cruz developed rhinosinusitis 2 months
after tooth extraction oh her left maxillary first
premolar. This could be due :
a. Oroantral fistula
b. Trauma
c. Persistent dental infection
d. Unerrupted tooth
50. The most common bacteria isolated from the
maxillary sinus in adults with acute bacterial
rhinosinusitis
a. Strep. Pneumoniae
b. Staph. Aureus
c. H. Influenzae
d. M. Catarrhalis
51. Head ache emanating from the medial canthus
is usually due to:
a. Sphenoid sinusitis
b. Frontal sinusitis
c. Ethmoid sinusitis
d. Maxillary sinusitis
52. Which of the following is classified as a major
symptom of rhinosinusitis?
a. Nasal congestion
b. Cough
c. Fever
d. Irritability
53. Children with rhinosinusitis usually presents
with foul smelling nasal discharge which is
usually due to:
a. Hypertrophic turbinates
b. Foreign body
c. Adenoidal hypertrophy
d. Septal deviation
54. The initial management of rhinitis
medicamentosa when suspected is to:
a. Discontinue the drug
b. Use nasal douche
c. Use topical steroids
d. Take oral decongestants
55. Which of the following plain radiographic views
best describe the maxillary sinus?
a. Caldwell view
b. Water’s view
c. Lateral view
d. Stenver’s view
56. Which of the following diagnostic tools for
patient with rhinosinusitis accurately defines
key anatomic structures
a. Plain radiography
b. Ultrasound
c. CT scan
d. Doppler scan
57. Which of the following statements is true
regarding imaging of paranasal sinus tumor?
a. 90% of cases will present with bone
destruction
b. X-ray of the paranasal sinuses is
sufficient for diagnosis
c. CT scan without bone window is
adequate
d. MRI will demonstrate bone destruction
better than CT scan
58. Neck dissection is seldom performed for
sinonasal malignancies because regional
metastasis is approximately:
a. 20%
b. 40%
c. 60%
d. 80%
59. Mr. De los Santos complains of paresthesia on
the left side of his face. This could be due to
tumor extension with the involvement of the
a. Infraorbital nerve
b. Sphenopalatine nerve
c. Glossophryngeal nerve
d. Hypoglossal nerve
60. Tumors of the paranasal sinuses are usually in
the advanced stage at the time of diagnosis
because:
a. It mimics chronic inflammatory disease
such as sinusitis
b. Delay in diagnosis
c. Reluctance of surgeons to pursue an
aggressive treatment
d. Complex anatomy of the region
61. Ohngren’s line is an imaginary line that divides
the maxillary antrum into a suprastructure and
an infrastructure. This line runs from the:
a. Inner canthus of the eye to the angle of
the mandible
b. Nasion to the angle of the mandible
c. Glabella to the angle of the mandible
d. Nasal tip to the angle of the mandible
62. Maxillary sinus carcinoma involving the
suprastructure has a poorer prognosis because
of its tendency to extend intracranially due to
its proximity to the
a. Cribriform plate
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b. Anterior ethmoids
c. Hard palate
d. Soft palate
Neck dissection is seldom done in cases of
paranasal sinus tumors because its lymphatic
spread is to the:
a. Retropharyngeal nodes
b. Parapharyngeal nodes
c. Posterior cervical nodes
d. Submandibular nodes
Choanal atresia can be diagnosed at birth by:
a. Passing a catheter into the nasal cavity
b. Direct laryngoscopy
c. Posterior rhinoscopy
d. X-ray of the nasopharynx
Blood-tinged nasal discharge in a 66 y.o. male
accompanied by level II neck mass in the left
and aural fullness on the same side can be due
to :
a. Anthrochoanal polyp
b. Nasopharyngeal carcinoma
c. Hypertrophic adenoids
d. Nasal polyps
The best diagnostic modality in a patient
suspected with nasopharyngeal angiofibroma is:
a. Radiography of the nasopharynx
b. Punch biopsy of the nasopharynx
c. MRI of the nasopharynx with contrast
d. Plain CT scan of the nasopharynx
Which of the following is related to the
nasopharyngeal carcinoma?
a. HIV
b. EBV
c. HSV
d. Papilloma virus
Blood-tinged nasal discharge in a 13 y.o. boy is
best evaluated by:
a. Anterior rhinoscopy
b. Posterior rhinoscopy
c. Nasal endoscopy
d. Paranasal sinus x-rays
What is the primary treatment of choice for
nasopharyngeal carcinoma?
a. Surgical excision
b. Embolization
c. Chemotheraphy
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d. Radiotherapy
The posterior boundary of the oropharynx
includes the prevertebral fascia of the :
a. 1st and 2nd cervical vertebra
b. 2nd and 3rd cervical vertebra
c. 3rd and 4th cervical vertebra
d. 4th and 5th cervical vertebra
The palatine tonsils differ from the rest of the
waldeyer’s ring because of its:
a. Morphological crypts
b. Number of lymphoid tissues
c. Lack of efferent blood supply
d. Location at the center of the ring
The most common manifestation of hyperplasia
of the pharyngeal tonsils is
a. Mouth breathing
b. Nasal breathing
c. Difficulty swallowing
d. Painful swallowing
The most common etiology of acute pharyngitis
is
a. Bacterial
b. Fungal
c. Parasitic
d. Viral
The laboratory result that is suggestive of
infectious mononucleosis is:
a. Leukopenia
b. Leukocytosis
c. Lymphocytosis
d. Eosinophilia
A 13 y.o. boy complaining of nasal obstruction,
snoring, anorexia and hyponasal voice is most
likely experiencing:
a. Adenoiditis
b. Acute tonsillitis
c. Lingual tonsillitis
d. Diphtheria
A feverish 5 y.o. boy with enlarged, hyperemic
palatine tonsils is suspected to have
a. Tonsilolithiasis
b. Tonsillitis
c. Pharyngitis
d. Infectious mononucleosis
A newborn male was delivered by normal
spontaneous delivery and was noted to have
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inspiratory stridor. Which of the following
condition does he most likely have:
a. Vocal fold paralysis
b. Spasmodic dysphonia
c. Laryngomalacia
d. Bronchomalacia
A 3 y.o. child with acute fever, sore throat,
odynophagia, stridor, drooling and a hot potato
voice most likely has:
a. Foreign body in the throat
b. Peritonsillar abscess
c. Epiglottitis
d. Laryngomalacia
Hoarseness a day after developing upper
respiratory tract infection can be due to:
a. Acute laryngitis
b. Laryngopharyngeal reflux disease
c. Vocal fold polyp
d. Vocal fold nodule
Supraglottitis is best treated with which of the
following:
a. 1st gen. Cephalosporins
b. 2nd gen Cephalosporins
c. 3rd gen cephalosporins
d. 4th gen cephalosporins
Securing an immediate airway in an emergency
situation is best done by making an incision
a. At the cricothyroid membrane
b. Between the 1st and 2nd tracheal rings
c. Between the 2nd and 3rd tracheal rings
d. Between the 3rd and 4th tracheal rings
Progressive hoarseness in a 56 y.o. smoker
would most likely be due to:
a. Supraglottic carcinoma
b. Glottic carcinoma
c. Subglottic carcinoma
d. Hypopharyngeal carcinoma
Vocal fold nodules are managed initially by:
a. Direct laryngoscopy
b. Voice therapy
c. Vocal fold stripping
d. Radiotherapy
Which statement is true about hypopharyngeal
neoplasms?
a. Benign tumors are very common
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b. Malignant tumors are commonly
diagnosed in the early stages
c. Malignant tumors histologically are
usually squamous cell carcinoma
d. Hoarseness is the earliest manifestation
A 55 y.o. female complaining of progressive
difficulty in swallowing was noted to have a
muffled voice and weight loss (28lbs in the last
3 months). What diagnostic test would you
request?
a. Barium swallow
b. CT scan of the neck
c. Soft tissue lateral x-ray of the neck
d. Ultrasound of the neck
A T4 hypopharyngeal carcinoma is described as
a. Tumor confined to one site
b. Tumor confined to multiple sites or an
adjacent site without fixation to
surrounding structures
c. Tumor confined to multiple sites or an
adjacent site with fixation to
surrounding structures
d. Tumor extends beyond the
hypopharynx with invasion of
surrounding structures
What is the treatment of choice for a
hypopharyngeal carcinoma with extension to
the larynx and cervical soft tissues?
a. Radiotherapy with adjuvant
chemotherapy
b. Near total pharyngectomy
c. Near total pharyngectomy with post op
radiotherapy
d. Near total laryngopharyngectomy with
post op radiotherapy
A patient was noted to have a 2cm exophtic
mass on the right pyriform sinus. Which of the
following symptoms would the patient present
with initially?
a. Otalgia
b. Dyspnea
c. Hoarseness
d. Stridor
Advance stages of hypopharyngeal and
laryngeal cancers have similar signs and
symptoms. If you are presented with such a
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patient, which of the following is the most
important factor in the overall outcome in your
management?
a. Prognosis
b. Management
c. Surgical approach
d. Etiology
Hoarseness due to unilateral vocal fold paralysis
is best treated by:
a. Medialization surgery
b. Lateralization surgery
c. BOTOX injection
d. Phonosurgery
A 1 y.o. boy with progressive hoarseness
accompanied by stridor may be suffering from:
a. Vocal fold paralysis
b. Laryngeal papilloma
c. Vocal fold nodule
d. Vocal fold cyst
Muffled voice quality in supraglottitis is due to:
a. Vocal fold edema
b. Epiglottic edema
c. Subglottic edema
d. Vocal fold paralysis
Edema of the larynx in laryngopharyngeal reflux
is due to:
a. HCl
b. Pepsin
c. Bile
d. Mucin
This disease is caused mainly by group A
coxsackie virus and usually affects young
children but also occurs in adults:
a. Herpangina
b. Ludwig’s angina
c. Behcet’s disease
d. SLE
Patient came in with bullae on the oral mucosa,
fever, lethargy accompanied by regional
lymphadenitis. What is the etiologic agent of
the disease?
a. HSV type 1
b. HSV type 2
c. Varicella zoster virus
d. Group A coxsackie virus
96. What is the most common precancerous lesion
of the lips and oral cavity?
a. Leukoplakia
b. Bowen’s disease
c. Squamous cell CA
d. Pleomorphic adenoma
97. Most predominant malignant tumors of the oral
cavity?
a. Squamous cell CA
b. Basal cell CA
c. Kaposi sarcoma
d. B-cell lymphoma
98. What is the treatment of choice of malignant
tumor of the oral cavity?
a. Surgical excision with radio therapy
b. IV antibiotics
c. Oral steroids
d. Anti0infalmmatory medication
99. This disease occurs in persons with weakened
host resistance due to radiation, DM and long
term antibiotic use or HIV infection. Physical
exam of the oral cavity shows whitish, firmly
adherent plaques on the oral mucosa. When
scraped off it would reveal an erythematous
bleeding surface
a. Candidiasis
b. Actinomycosis
c. Tinea cruris
d. Aspergillosis
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It is an atrophic inflammatory condition
of the tongue base. It has an accompanying
feature of pernicious anemia. Symptoms
include burning tongue, dry mouth and altered
sense of taste.
a. Hunter’s glossitis
b. Benign migratory glossitis
c. Black hairy tongue
d. angioedema