-
Question 1
Incorrect
-
A 30-year-old female has been experiencing epistaxis for 30 minutes. Her Hb is 14 grams per decilitre, MCV 90 fl, WBC count is normal, PT/APTT/Bleeding time are normal. What is the most probable cause of her current condition?
Your Answer: Platelets
Correct Answer: Anatomical
Explanation:Normal PT, APTT, and bleeding times rule out any platelet or coagulation factor disorders. Her normal WBC levels also rule out sepsis. Normal haemoglobin and MCV levels rule out any RBC disorders. With all differentials ruled out, the cause of this patient’s epistaxis is an anatomical defect.
-
This question is part of the following fields:
- ENT
-
-
Question 2
Incorrect
-
A 24-year-old man is evaluated for facial pain and fever lasting four days. Symptoms began with an upper respiratory tract infection accompanied by purulent nasal discharge; he then began to have pain over the right cheek and developed a fever of 38.4°C. On examination, he has a purulent nasal discharge and tenderness over the right maxilla. CT shows right maxillary sinusitis. Which of the following is the most appropriate antibiotic treatment for this patient?
Your Answer: Ciprofloxacin
Correct Answer: Amoxicillin
Explanation:Acute bacterial sinusitis usually occurs following an upper respiratory infection that results in obstruction of the osteomeatal complex, impaired mucociliary clearance, and overproduction of secretions. Sinusitis can be treated with antibiotics, decongestants, steroid drops or sprays, mucolytics, antihistamines, and surgery (lavage). Studies have shown that 70% of cases of community-acquired acute sinusitis in adults and children are caused by Streptococcus pneumoniae and Haemophilus influenzae. Most guidance favours amoxicillin as first line treatment. There seems to be little evidence base for this, however. BMJ’s clinical evidence website found three RCTs which showed no difference between amoxicillin and placebo (in patients without bacteriological or radiological evidence of sinusitis). However, there were no RCTs examining the effects of co-trimoxazole, cephalosporins, azithromycin, and erythromycin. Second line therapies include ciprofloxacin and co-amoxiclav. First and second generation cephalosporins are not generally favoured.
-
This question is part of the following fields:
- ENT
-
-
Question 3
Incorrect
-
A 3-month-old baby was brought to the paediatrics ward by her mother with a complaint of noisy breathing and difficulty feeding. On examination, the baby had a mild inspiratory stridor, and subsequent laryngoscopy reveals an omega-shaped epiglottis. Which of the following is the most likely diagnosis in this case?
Your Answer:
Correct Answer: Laryngomalacia
Explanation:Omega-shaped epiglottis is a characteristic feature in the X-ray of a patient with laryngomalacia.
-
This question is part of the following fields:
- ENT
-
-
Question 4
Incorrect
-
A 40-year-old male presented to the OPD complaining of dysphagia. General physical examination revealed creamy white patches on the tongue as well as on the inner side of the cheeks. There was slight bleeding when an attempt was made to scrape off the white patches. What is the most likely diagnosis in this case?
Your Answer:
Correct Answer: Candida albicans
Explanation:Candida Albicans is a pathogenic yeast which forms a thrush in the oral cavity. Candida also causes infection in the oesophagus, known as oesophageal candidiasis, that can manifest as dysphagia.
-
This question is part of the following fields:
- ENT
-
-
Question 5
Incorrect
-
A 12-year-old boy hit his head on a pole on the school playground. His friends noted that he lost consciousness for a few seconds. The school nurse sent him to the Emergency Department as he had a small nasal bleed that stopped spontaneously. In the intervening two hours, he has noticed a watery discharge from his nose. On examination, there is considerable bruising on his nose and forehead, he was complaining of a headache. Which is the most appropriate diagnosis?
Your Answer:
Correct Answer: Basilar skull fracture
Explanation:Orbital bone fracture: The child has sustained a head injury and subsequently describes a CSF rhinorrhoea (indicating a cerebro-spinal fluid leak). CSF rhinorrhoea can occur in skull or nasal bone fractures. Given the symptoms of loss of consciousness and headache, this child is more at risk of having suffered a skull fracture requiring emergency CT head investigation and specialist neurosurgical management. An ethmoid bone fracture may also present this way. A skull x ray would help to determine an air fluid level and indeed allow some visualisation of the nasal bones, though in children the nasal bones do not visualise well due to lack of fusion. Either way this child would need assessment in the nearest Emergency Department and the school would be expected to follow a ‘head injury’ protocol.
-
This question is part of the following fields:
- ENT
-
-
Question 6
Incorrect
-
Which of the following is a feature of cholesteatoma?
Your Answer:
Correct Answer: Conductive deafness
Explanation:A cholesteatoma is a non-neoplastic growth of squamous epithelium in the middle ear, most probably due to negative pressure inside the middle ear. Cholesteatoma can damage the middle ear ossicles, decreasing the sound that reaches the inner ear leading to conductive deafness.
Otitis externa is an inflammatory condition of the external ear and is not associated with a cholesteatoma.
Grommets are tympanostomy tubes that are used for the sake of aeration of middle ear in cases where the middle ear has fluid.
A cholesteatoma is not often associated with pain and is therefore often discovered during an ear examination.
Candidal infection of the ear causes inflammation in the external ear and is not related to the formation of a cholesteatoma. -
This question is part of the following fields:
- ENT
-
-
Question 7
Incorrect
-
A 34 year old male presented with swelling in the submandibular region. It becomes more painful and prominent after chewing. He also revealed a history of a sour taste in his mouth and the area is tender and sore on palpation. Choose the most appropriate diagnosis from the list of options.
Your Answer:
Correct Answer: Chronic recurrent sialadenitis
Explanation:Symptoms are consistent with chronic recurrent sialadenitis: pain, swelling, increased pain after chewing, tenderness in the submandibular region. Usually secondary to sialolithiasis or stricture.
-
This question is part of the following fields:
- ENT
-
-
Question 8
Incorrect
-
A 4-year-old female was suffering from an upper respiratory tract infection. Her mother treated her with paracetamol only, for 5 days. After that, she presented in the emergency room with severe pain in her left ear, high-grade fever and irritability. What is the most likely diagnosis?
Your Answer:
Correct Answer: Otitus media (OM)
Explanation:Upper respiratory tract infection when not treated accordingly can lead to otitis media and the patient presents with severe earache and fever.
-
This question is part of the following fields:
- ENT
-
-
Question 9
Incorrect
-
A 57 year old male presents to the clinic with intermittent episodes of vertigo, tinnitus and hearing loss. Which drug treatment would be the best for this patient?
Your Answer:
Correct Answer: Buccal Prochlorperazine
Explanation:Prochlorperazine is an anti-sickness drug which acts to reduce the impact of the abnormal signals coming from the balance organ helping to relieve the symptoms of nausea, vomiting and vertigo associated with Meniere’s disease, labyrinthitis and other inner ear disorders. It is a prescription only medication available as a tablet, injection and buccal preparation. It is usually taken as needed, rather than on a regular basis. Prochlorperazine affects the dopamine receptors in an area of the brain that controls nausea and vomiting. Prochlorperazine controls nausea and vomiting by blocking dopamine receptors found in the trigger zone and prevents it from sending messages to the vomiting centre that would otherwise cause nausea and vomiting.
-
This question is part of the following fields:
- ENT
-
-
Question 10
Incorrect
-
A 7-year-old girl was brought to the OPD with a history of a large swelling on the side of her neck with associated lymph node swellings in her neck and axilla. Which if the following investigations will you order next?
Your Answer:
Correct Answer: Lymph node biopsy
Explanation:As there is lymphadenopathy already present in this patient, doing a biopsy of the lymph nodes will rule out metastasis of any underlying tumour.
-
This question is part of the following fields:
- ENT
-
-
Question 11
Incorrect
-
A 6 month old child was brought in after choking on a foreign body, which had resulted in the child having difficulty breathing. The best possible site for the incision would be?
Your Answer:
Correct Answer: Cricoid cartilage
Explanation:Cricothyroidectomy is done in life threatening condition, where an incision is made in cricothyroid membrane to establish a patent airway.
-
This question is part of the following fields:
- ENT
-
-
Question 12
Incorrect
-
A 3-year-old was brought to the ED after falling from his mothers arms. The mother reports hearing a popping sound when his face hit the floor. Examination revealed swelling and bruising on the right mandible. Which of the following investigations should be ordered next?
Your Answer:
Correct Answer: Facial X ray
Explanation:The swelling and bruising on the mandible needs to be checked for fractures. A facial X-ray can adequately visualize this.
-
This question is part of the following fields:
- ENT
-
-
Question 13
Incorrect
-
A 2 year old boy was brought to the physician by his mother with a history of a swelling on the right side of his neck that is extending from the angle of mouth to the middle 1/3rd of sternocleidomastoid muscle. On examination the swelling was on the anterolateral aspect of the muscle and was found to be brilliantly transilluminant. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Lymphangioma
Explanation:A lymphangioma is a swelling or mass that occurs mainly in the head, neck, and mouth. Lymphangiomas are the result of a congenital condition and are usually apparent at birth, or at least by the time a person is 2 years old. It is rare in adult population and when detected, it can be treated with surgical excision. Branchial cyst in most cases does not transilluminate which lymphangioma does.
-
This question is part of the following fields:
- ENT
-
-
Question 14
Incorrect
-
A 12-year-old female presented with a bleeding nose. On examination by the ENT surgeon, it was noticed that the bleeding was coming from the anterior part of the nose and the bleeding point was clearly visualised. Which of the following options is the most suitable choice in this case?
Your Answer:
Correct Answer: Cautery
Explanation:In the case of anterior nasal bleeds, when the bleeding point is clearly visualised the best management step is cautery, either electrical or chemical.
-
This question is part of the following fields:
- ENT
-
-
Question 15
Incorrect
-
A hypertensive old woman develops gingival hyperplasia. What is the single most likely diagnosis?
Your Answer:
Correct Answer: Nifedipine
Explanation:Calcium channel blockers are medications proven to cause side effects such as gingival hyperplasia. Calcium channel blocking drugs are contraindicated in hypertensive patients with second and third degree heart block, sick sinus syndrome, and severe heart failure.
-
This question is part of the following fields:
- ENT
-
-
Question 16
Incorrect
-
A 6 year old male presented in the OPD with the complaint of nasal bleeding which started 3 days before. Now on examination, there is no bleeding and only slight redness of the anterior mucosa is present. Which of the following steps is the most suitable one now?
Your Answer:
Correct Answer: Reassurance
Explanation:Epistaxis is common in younger children usually due to nose picking. After the episode is over no active management is required and reassurance should be given to the patient and his attendants.
-
This question is part of the following fields:
- ENT
-
-
Question 17
Incorrect
-
A 45 year old male with asthma presented with postnasal drainage, a dull headache and snoring. On examination there were two reddish masses in both nostrils. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Nasal polyp
Explanation:Nasal polyps are abnormal lesions that originate from any portion of the nasal mucosa or paranasal sinuses. They are more common among asthmatics. Symptoms include nasal airway obstruction, postnasal drainage, dull headaches, snoring, and rhinorrhoea.
-
This question is part of the following fields:
- ENT
-
-
Question 18
Incorrect
-
A 35 year old male presented with a nasal polyp. Which of the following is true regarding nasal polyps?
Your Answer:
Correct Answer: Can cause anosmia
Explanation:Nasal polyps are a known cause of anosmia, by preventing the flow of scented air to the olfactory mucosa high in the nasal cavity. They are usually watery-pink or greyish colour. Polyp recurrence is common following polypectomy. Topical corticosteroids are of use in the primary treatment of small and medium sized nasal polyps. Beclomethasone dipropionate, flunisolide and budesonide sprays have also been shown to delay the recurrence of polyps after surgery. Nasal polyps usually arise in the maxillary sinus.
-
This question is part of the following fields:
- ENT
-
-
Question 19
Incorrect
-
A 34 year old man is complaining of painful vesicles around his right ear. Upon examination he has a facial palsy and the vesicles extend towards his tympanic membrane. Hypoacusis is also present. Choose the most likely diagnosis.
Your Answer:
Correct Answer: Ramsay-Hunt syndrome
Explanation:Ramsay-Hunt syndrome or herpes zoster oticus presents with painful vesicles which affect the facial nerve and induce hearing loss in the affected ear.
-
This question is part of the following fields:
- ENT
-
-
Question 20
Incorrect
-
A 31-year-old woman complains of frequent epistaxis attacks, nasal congestion, painful sensations on one side of the face and drooping of eyelid on the same side. What is the most probable diagnosis?
Your Answer:
Correct Answer: Maxillary sinus carcinoma
Explanation:Malignant tumours of the nasal cavities and paranasal sinuses are uncommon. They constitute less than one per cent of all tumours and less than three per cent of head and neck tumours. Carcinoma of the maxillary sinus is the most common of the sinonasal malignancies. Sinus cancers signs and symptoms include nosebleeds, sense of smell reduction, or pain below the eyes.
-
This question is part of the following fields:
- ENT
-
-
Question 21
Incorrect
-
A 9-year-old male presented in the emergency room with sudden nosebleed that started 15 minutes ago. Which management step should be taken in such a case?
Your Answer:
Correct Answer: Press soft parts of the nose
Explanation:With children nosebleeds often occur after nose picking and are benign in nature. For active bleeding, pressing of soft parts of the nose is required to stop the bleeding before doing anything else.
-
This question is part of the following fields:
- ENT
-
-
Question 22
Incorrect
-
A 21 year old asthmatic presented with complaints of a dry cough and hoarseness of voice. He has been taking oral and inhaled corticosteroids for many years. The most likely causative factor for the hoarseness of voice would be?
Your Answer:
Correct Answer: Laryngeal candidiasis
Explanation:Laryngeal candidiasis is one of the leading cause of hoarseness of voice in patients who are taking corticosteroids. As a result of decreased immunity, chances of fungal infections are increased.
-
This question is part of the following fields:
- ENT
-
-
Question 23
Incorrect
-
A 23 year old male has complained of pain when swallowing and dysphagia. He has a sore mouth and soreness in the corners of his mouth. From the list of options, what is the single most likely diagnosis for this patient?
Your Answer:
Correct Answer: Candida infection
Explanation:The symptoms could indicate CMV or Candida infections, but CMV is much less common.
-
This question is part of the following fields:
- ENT
-
-
Question 24
Incorrect
-
A young child presents with a dull and greyish tympanic membrane and no shadow of the handle of malleus is evident. His mother complains that he does not respond when she calls him and that he lately raises the volume of the TV. What is the most likely diagnosis?
Your Answer:
Correct Answer: Secretory OM
Explanation:In secretory OM, effusion in the middle ear is present which does not produce any pain to the patient in comparison to acute OM which produces otalgia. The family members are the ones to notice hearing loss as the patient usually is not aware of it. On otoscopy, the features described in the question are prominent. Otitis externa is usually painful and it also produces an itching sensation. Chronic otitis media is painful and may interfere with balance problems. Cholesteatoma is an abnormal cystic growth in the middle ear that usually discharges foul-smelling fluids and as it grows, otalgia can appear.
-
This question is part of the following fields:
- ENT
-
-
Question 25
Incorrect
-
A 16 year old boy presented, complaining that an insect had lodged in his left ear. Which of the following can be considered as the most appropriate method to remove the insect?
Your Answer:
Correct Answer: Syringe the ear with warm water
Explanation:Removal of foreign bodies from the ear is indicated whenever a well-visualized foreign body is identified in the external auditory canal. Insects are better extracted with suction than with forceps or hooks. From the given answers, irrigation with warm water is the most suitable answer.
-
This question is part of the following fields:
- ENT
-
-
Question 26
Incorrect
-
A 20-year-old female complains of a 2-week history of swelling in the midline of the neck which moves upwards when she sticks out her tongue. Which of the following is the best investigation that should be done next in this case?
Your Answer:
Correct Answer: FNAC
Explanation:FNAC (Fine Needle Aspiration Cytology) is the most important investigation. The aspirate can be cultured to identify the strain responsible for the cyst formation in this patient. The cytology can also rule out malignancy.
-
This question is part of the following fields:
- ENT
-
-
Question 27
Incorrect
-
A 48 year old patient presents with subjective symptoms such as fullness of the left ear and tinnitus. He also experiences recurrent vomiting. What is the most appropriate treatment?
Your Answer:
Correct Answer: Buccal prochlorperazine
Explanation:Meniere’s disease is a disorder of the inner ear. The cause is unknown, however it typically presents with nausea/vomiting, vertigo and ear complaints such as fullness of the ear, deafness and tinnitus. There is no cure for Meniere’s disease but medications, diet, physical therapy and counselling, and some surgical approaches can be used to manage it. Buccal prochlorperazine is used for relieving nausea, vomiting and vertigo attacks associated with Meniere’s disease and other inner ear disorders, such as labyrinthitis.
-
This question is part of the following fields:
- ENT
-
-
Question 28
Incorrect
-
A 70-year-old chronic smoker presented with difficulty in opening his mouth and right sided ear pain for six months, which was increasing in severity. On examination, there was an ulcer at the base of their tongue and two hard, non-tender cervical lymph nodes. What is the most possible cause for this presentation?
Your Answer:
Correct Answer: Oropharyngeal malignancy
Explanation:The smoking history, ulcer at the base of the tongue, earache, difficulty in opening the mouth, and hard non tender lymph nodes favours the diagnosis of oropharyngeal malignancy. The other given conditions would generally not result in ulceration of the tongue and Herpes would have vesicles and associate pain over the affected nerve distribution.
-
This question is part of the following fields:
- ENT
-
-
Question 29
Incorrect
-
A 8 year old boy presented with acute onset of nasal obstruction. His parents gave a recent history of nasal trauma. On examination he was febrile and his nasal bones were straight. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Septal abscess
Explanation:History of fever is suggestive of an infective focus. A straight nasal bones excludes a nasal bone fracture. A nasal septal abscess is defined as a collection of pus between the cartilage or bony septum and it is an uncommon disease which should be suspected in a patient with acute onset of nasal obstruction and recent history of nasal trauma.
-
This question is part of the following fields:
- ENT
-
-
Question 30
Incorrect
-
A 17-year-old male was found unconscious in his room. On examination, he was tachycardic with a high fever. He was also bleeding from his nose and a perforated nasal septum. Which of the following is the most probable cause?
Your Answer:
Correct Answer: Cocaine Overdose
Explanation:Snorting cocaine is the most common form of cocaine consumption. The cocaine is absorbed into the bloodstream which also leads to a decrease in oxygen in the tissues. This decreased oxygen in the nasal septum tissue causes perforations or holes in the septum. Cocaine causes other side effects like palpitations, high blood pressure and high fever. Overdoses of heroin, alcohol, carbon monoxide and marijuana do not present with such symptoms.
-
This question is part of the following fields:
- ENT
-
SESSION STATS - PERFORMANCE PER SPECIALTY
