Oto-rhino-laryngologic

illustrations
Free Gift from ENT department
Prof Dr.Ahmed Allam
Oto-rhino-laryngologic
illustrations
By
Prof.Dr. Ahmed Allam
Prof. & Head of ENT Department
Benha Faculty of Medicine

Pro f. Dr. Mo ss ad Elsis y

Prof. of ENT
Benha Faculty of Medicine
 The following are
anatomic structures
of the auricle except
 Answer : 4
1- Helix
 The antrum is
2-Tragus
the largest air
3-Concha
cells of the
4-Antrum mastoid bone
  Answer: 1
 The auriculo  The auriculo-temporal
temporal nerve nerve is a branch of
1- supplies the skin of mandibular division of
the upper 2/3 of the the trigeminal nerve
lateral surface of  The middle ear
the auricle mucosa is supplied by
2- is a branch of the tympanic branch
maxillary nerve of Glosspharyngeal
3- supplies the middle nerve called Jacobson
ear mucosa through nerve
the tympanic plexus
4- non of the above
 The lobule of the
ear has its sensory  Answer: 1
innervation from
1- great auricular
nerve
2- auriculotemporal
nerve
3-arnold branch of
vagus
4- facial nerve
 The tympanic membrane is
divided into:
1- Two equal parts called pars
tensa and pars flaccida
2- A major upper part called pars
flaccida and a small lower
part called pars tensa  Answer : 3
3- A small upper part called pars
flaccida and a major lower
part called pars tensa
4- non of the above
 The bulge seen on the
medial wall of the middle
ear is
1- known as the promontory
2- formed by the bony
semicirculr canal  Answer : 3
3- is formed by the basal turn
of the bony cochlea
4- all of the above
5- both 1 and 2
6- both 1 and 3
 The Eustachian tube
 Answer : 3
is opened by
contraction of
1- tensor tympani
muscle
2-levator palati muscle
3- tensor palati muscle
4-Salpingopharyngeus
muscle
 The sensory end-
organ of the
 Answer : 3
semicircular
 The organ of Corti is
canal is the sensory end
1- the organ of organ of hearing in
Corti the cochlea
 The macula is the
2- the macula sensory end organ
3- the crista in the utricle and
saccule
4- non of the above
 Auricular hematoma  Answer : 2
 Auricular
1- may be complicated by hematoma may be
otitis externa complicated by
2- cauliflower ear is one perichondritis and
cauliflower ear
of its complications evacuation of the
3- evacuation of the extra-vasated
extra-vasated blood is blood is essential
to avoid
not essential complications
4- all of the above
 It is better to avoid
ear wash for
removal of
1- wax
2- animate foreign  Answer : 3
body Vegetable FB
3- impacted vegetable will swell if ear
wash fails to get
foreign body it out which will
cause more
4- non of the above impaction
 It is better to avoid
ear wash for
removal of
1- wax
 Answer : 3
2- animate foreign
 Don’t wash if the
body FB is a calculator
3-calculator battery battery as this
may lead to leak
4- non of the above of acid and
chemical burn of
the skin
 The causative
organism in ear
fruncle is
 1- proteus
 2- Pseudomonas  Answer :3
 3- staph. Aeureus
 4- E coli
 The causative
organism in
malignant otitis
externa
 1- proteus
 2-Pseudomonas
 Answer : 2
 3-staph. Aeureus
 4- morexella
catarrhalis
 Malignant otitis
externa is
1- a truly malignant
disease eroding the
external canal
2- is most commonly
seen in elderly
uncontrolled  Answer : 2
diabetics
3- staphylococcus
aureus is the
causative organism
4- non of the above
 In the adult, the Eustachian
tube is approximately the
following lehgth
1- 30 mm
 Answer : 3
2- 20 mm
3- 36 mm
4- 45 mm
 In Gradenigo syndrome  Answer : 4
diplopia is due to  This syndrome is
charecterized by:
inflammation of the 1- otorrhoea
following cranial nerve 2-facial pain due to
 1- IV nerve irritation of V
cranial nerve
 2- V nerve 3-diplopia and
squint due to
 3- III Nerve irritation of VI
 4- VI nerve cranial nerve in
Dorello canal
 Conductive deafness in
longtudinal temporal bone
fracture may be due to:
 1- Rupture of the
tympanic membrane  Answer : 4
 2- Ossicular disruption
 3- Non of the above
 4- Both 1 and 2
 Longtudinal temporal
bone fracture :
1- is less common than the
transverse type
2- is usually associated with  Answer : 4
sensori-neural hearing
loss
3- facial nerve paralysis is a
common association with
this type
4- non of the above
 The following
organisms are involved
in acute otitis media
except
1- streptococcus
pneumonia
 Answer : 3
2-hemophilus influenza
3-Pseudomonas
aeroginosa
4-morexella cararrhalis
 All of the following
are diagnostic of
tympanic membrane
retraction except Answer : 3
 Schwartz sign is a
1- fore-shortened
flamingo red tinge of
handle of malleus the tympanic
2- prominent lateral membrane due to
process of malleus increased vascularity
of the promontory and
3- Schwartz sign indicates active
4- distorted cone of otosclerosis
light
 Throbbing and severe
earach is present in the
following stage of acute
otitis media
1- stage of salpingitis
2- stage of catarrhal otitis
media
 Answer : 3
3- stage of suppurative
otitis media
4- stage of tympanic
membrane perforation
 The tympanic membrane
perforation in acute
otitis media is
1- central in the pars tensa
2- marginal in the pars
tensa  Answer : 1
3- small in the pars flaccida
4- non of the above
 Type c tympanogram  Answer : 3
is consistent with In Type C there is
1- secretory otitis Normal compliance but
the peak of the
media
tympanogram is at
2- otosclerosis the negative side so it is
consistent with ET
3- Eustachian tube
dysfunction in which
dysfunction there is negative
4- otosclerosis pressure in the middle
ear
  Answer: 2

 By central drum perforation we mean

1- a perforation at the central part of the drum
2- a perforation in the pars tensa which is
surrounded by a rim of tympanic membrane
3- a perforation of the pars flaccida
4- a perforation in the pars tensa which is not
surrounded by a rim of tympanic membrane
  Answer: 3

 All of the following may be seen in the

tubotympanic type of chronic suppurative
otitis media except
1- mucopurulent otorrhoea
2- central tympanic membrane perforation
3- marginal tympanic membrane perforation
4- profuse otorrhoea
  Answer: 2

Cholesteatoma is characterized by
 1- continuous mucopurulent ear
discharge
 2-A foul smelling ear discharge
 3- A central tympanic membrane
perforation
 4- non of the above
  Answer: 3

A child with retraced drum and conductive

deafness after inadequate treatment of
acute suppurative otitis media is suffering
from
 1-chronic tubotympanic otitis media
 2-chronic atticoantral otitis media
 3- otitis media with effusion
 4- all of the above
 5-non of the above
 The commonest cause of
conductive deafness in
children is:
1- wax  Answer:2
2-secretory otitis media
3-otomycosis
4- otosclerosis
 The commonest
cause of conductive
deafness in adults is:
1- wax  Answer:1
2-secretory otitis media
3-otomycosis
4- otosclerosis
 In a patient suffering from
purulent otorrhoea and
attic perforation
1- treatment is essentially
surgical
2- medical treatment and
follow up is sufficient
3- myringoplasty is the only
needed treatment
4- non of the above
 Answer :1
The presence of foul odour
otorrhoea and attic
perforation is diagnostic of
cholesteatoma. Treatment
of this case is essentially
surgical by mastoidectomy
operation ( radical or
modified radical)
 In a 45 years old female
patient presenting with
pulsating tinnitus and red
mass behind the drum, all
of the following are true
except
1- glomus tumour is a  Answer :4
possible diagnosis  Biopsy is
2-more assessment is needed contraindicated
by CT scan or MRI as it will lead to
3- MRI angiography confirm profuse
the diagnosis bleeding
4-biopsy is essential to verify
the pathological nature
 Bezold abscess is a
collection of pus
1- above and in front of
the auricle
2-behind the auricle  Answer : 3
3-in the upper part of
the neck deep to the
sternomastoid
4- in the peritonsillar
space
 During ear examination
the reservoir sign is
diagnostic of
1- acute otitis media
2- mastoiditis
3- petrositis  Answer :2
4- cholesteatoma
 An early and diagnostic
sign of mastoiditis is
 Answer : 2
 1- reservoir sign  Sagging means bulging
 2-sagging of the downwards of the
posterosuperior part of posterosuperior part of
the bony canal the bony external canal
 3-perforated tympanic and is due to periostitis
membrane of the bone overlying
 4- postauricular the mastoid antrum. It
mastoid abscess is an early and
diagnostic sign of
mastoiditis
  Answer : 2

 Vertigo and nystagmus induced by

pressure on the tragus is diagnostic
of
 1- serous labyrinthitis
 2- circumscribed per- labyrintserous
 3 suppurative labyrinthitishitis
 4- all of the above
  Answer : 2

In a case of cholesteatoma, sever spontaneous

vertigo with Nausea and vomiting is suspicious of
 1- circumscribed peri-labyrinthitis
 2- diffuse serous labyrinthitis
 3- extradural abscess
 4- petrositis
 In a patient having acute
suppurative otitis media
with bulging drum,
myringotomy is benificial
to
 Answer : 4
1-drain the middle ear
2- avoid rupture of the
tympanic membrane
3-avoid complications
4-all of the above
 The most common
complication of
myringotomy operation is

 1- injury of facial nerve

 2-dislocation of the incus  Answer : 4
 3-injury of the jagular bulb
 4- residual perforation
 In myringotomy operation the
posterosuperior quadrant of
the tympanic membrane must
be avoided
 1- to avoid injury of dehiscent
jagular bulb  Answer : 2
 2- to avoid injury of the
ossicles
 3- non of the above
 4- both 1 & 2
The combination of
unilateral otorrhoea,
severe facial pain and  Answer : 2
diplopia is known as
1- Piere Robin syndrome
2- Gradenigo’s syndrome
3- Kartagner syndrome
4- Ramsay Hunt sundrome
 A child with an attic
drum perforation who
developed nausea,
projrctile vomiting and
fever of 40 degree is  Answer : 1
suspicious to have got
 1- otogenic meningitis
 2- otogenic labyrinthitis
 3- petrositis
 4- mastoiditis
 The first line of treatment
in a child who develops
lower motor neurone
facial paralysis after
acute otitis media is
1- antibiotics and
corticosteroids
2- decompression of facial
nerve  Answer : 4
3- exploration of facial nerve
4- myringotomy
Intermittent fever with
rigors and headach in a
patient with cholesteatma
may be due to  Answer : 3
1-otogenic meningitis
2-otogenic brain abscess
3- lateral sinus
thrombophlebitis
4-extradural abscess
 A positive Kernig sign
means
1-reflex flexion of the hips
and knees when the neck
is flexed
2- inability to extend the  Answer : 2
knee completely when
the hip is flexed on the
abdomen
3- inability to do rapid
ulternating movement
4- non of the above
 A positive Brudzniski sign
means
1-reflex flexion of the hips
and knees when the neck
is flexed
2- inability to extend the knee  Answer : 1
completely when the hip is
flexed on the abdomen
3- inability to do rapid
ulternating movement
4- non of the above
  Answer : 3
in mastoiditis there is profuse
mucopurulent or purulent
otorrhoea which recurs rapidly
after remova ( a diagnostic
sign called reservoir sign)

A persistent profuse ear

discharge after acute
otitis media is
1- cholesteatoma
2- secretory otitis media
3-mastoiditis
4- diffuse otitis externa
 In otitic barotrauma, the
following statements are
correct except
 1-occurs during airplane
 Answer :1
ascent
 2- occurs during airplane
rapid descent
 3- can cause rupture of
the tympanic membrane
 4- occurs during diving
 The commonest
cause of vertigo is
 1- meniere’s disease
 Answer : 3
 2-labyrinthitis
 3-benign paroxysmal
positional vertigo
 4-ototoxicity
 Most cases of extradural
abscess of the temporal
lobe
1- are asymptomatic and
discovered accidentally  Answer : 1
during mastoidectomy
2- present with persistent
ipsilateral temporal
headach
3- present with vertigo
4- present with pulsating
discharge,hearing loss
and tinnitus
 The type of hearing  Answer :4
loss in otosclerosis  In stapedial
otosclerosis
may be hearing loss is
conductive
1- conductive
 In cochlear type
2- sensorineural the hearing loss
is sensorineural
3-mixed  In combined
4-all of the above otosclerosis the
hearing loss is
mixed
 The commonest cause
of bilateral
sensorineural hearing
loss in elderly  Answer : 2
individuals is
1- cochlear otosclerosis
2- presbyacusis
3- diabetes milltus
4- ototoxicity
  Answer: 3
 A 30 years old patient 1- In benign paroxysmal
positional vertigo there is
with recurrent attacks recurrent attacks of vertigo
for seconds which occurs
of vertigo, hearing when the patient assumes
certain head position
loss and tinnitus 2- in vestibular neuronitis
associated with there is sudden severe vertigo
for dayes but bo hearing loss
nausea and vomiting 3- in Meniere’s disease
has recurrent attacks of
vertigo, hearing loss and
1- benign paroxysmal tinnitus associated with
nausea and vomiting and
positional vertigo the patient is free between
2-vestibular neuronitis attacks
4- In Acoustic neuroma
3-Meniere’s disease there is unilateral
persistent tinnitus and
4-acoustic neuroma gradually progressive
hearing loss but vertigo is
uncommon
 Before tympanoplasty in a
30 years old patient, the
following is required
1- audiogram
2- ensure dry perforation
 Answer : 4
3-treatment of any
underlying nasal or
paranasal sinus infection
4-all of the above
5- non of the above
 The XI, X and XI cranial
nerves may be involved in
all of the following except  Answer : 2
1-acoustic neuroma  in transverse
2-transverse temporal bone temporal bone
fracture fracture the
3-malignant otitis externa involved nerves
4- squamous cell carcinoma are VII & VIII
of the middle ear
 In lower motor neurone
facial paralysis with intact
taste sensation at the
anterior 2/3 of the tongue,
the level of the lesion is
1- in the internal auditory
canal
2-in the horizontal tympanic  Answer : 4
part
3- in the vertical part above
the stapes
4- in the stylomastoid foramen
 Failure to close the
eye voluntarily is a
symptom of
1- paralysis of the
trigeminal nerve
2- upper motor
neurone facial  Answer : 3
paralysis
3- lower motor neurone
facial paralysis
4- non of the above
 Uncontrolled diabetes in
elderly patient may
predispose to  Answer : 2
1- cholesteatoma
2- malignant otitis externa
3- presbyacusis
4- vestibular neuronitis
 A large near total
perforation following
acute necrotizing otitis
media must be followed
up for fear of
1- recurrent middle ear  Answer : 2
infection
2- secondary acquired
cholesteatoma
3-retraction pocket
4-tympanosclerosis
 By modified radical
mastoidectomy we mean
 1- removal of mastoid air cells
and all middle ear contents
 2- removal of diseased
mastoid air cells
 3- removal of mastoid air cells
and all middle ear contents with  Answer : 3
preservation of healthy
remnants of tympanic membrane
and ossicles
 4- non of the above
 By radical mastoidectomy
operation we mean
 1- removal of mastoid air
cells and all middle ear
contents except stapes
 2- removal of diseased  Answer : 1
mastoid air cells
 3- removal of mastoid air cells
and all middle ear contents
with preservation of healthy
remnants of tympanic
membrane and ossicles
 4- non of the above
 Extensive cholesteatoma is
best treated by
1- cortical mastoidectomy
 Answer : 2
2- radical mastoidectomy
3- modified reducal
mastoidectomy
4- myringotomy wiyh
insertion of T tube
Which of the following statements
is false concerning Cochlear
implant
1-postlingually deaf get far better
benefit than prelingually deaf  Answer :4
2-it is indicated in total sensory
hearing loss
3-the auditory nerve should be
intact
4- After the operation speech
discrimination is good and lip
reading is not needed
Which of the following statements
is wrong concerning myringotomy
Operation

1- it is indicated in acute suppurative

otitis media with bulging drum

2- it is indicated in secretory otitis

media after failure of medical  Answer : 3
Treatment

3- it is better done in the postero

superior quadrant of the tympanic
membrane

4-residual perforation of the tympanic

membrane is one of its complications
. Etiology for pulsatile
tinnitus includes the
followings except:
a) Arteriovenous
malformation of neck.
b) Otosclerosis.
c) Glomus jugulare  Answer :b
tumors.
d) Hyperthyroidism.
e) Atherosclerosis.
 Which of the
following drugs are
known to cause
tinnitus?  Answer :e
b) Salicylates.
c) Loop Diuretics.
d) Aminoglycosides.
e) NSAID.
f) All of the above
Which of the following is
associated with
objective tinnitus
b) Menière's disease.
c) Ear wax impaction.  Answer :d
d) Acoustic neuroma.
e) Palatal myoclonus.
f) Middle ear effusion
 The following have
an ototoxic effect
except
1- gentamycin
2- frusemide
3- streptomycin  Answer :4
4- amoxicilline
5- quinine
The following Paranasal
sinuses drain into the
Ostiomeatal complex except  Answer :1
1- posterior ethmoid sinuses
2- frontal sinus
3-maxillary sinus
4-anterior ethmoid sinuses
Posterior ethmoid
sinus drain into
1- middle meatus
 Answer :3
2-inferior meatus
3- superior meatus
4-sphenoethmoidal
recess
 Cacosmia means
1-complete loss of smell
2-diminution of the sense
of smell
3-smelling bad odour due  Answer : 3
to the presence of
noxious substance in the
nose
4- smelling of non existing
odor
The lacrimal sac drains
into
1- middle meatus  Answer: 2
2-inferior meatus
3- superior meatus
4-sphenoethmoidal recess
 The external carotid
artery gives blood
supply to the nose
through the following
branches except
 1- sphenopalatine artery  Answer : 4
 2-greater palatine artery
 3- superior labial artery
 4-anterior ehmoidal
artery
 In a patient presenting to the
emergency room with fractured
nose associated with edema
1- postpone reduction for one
week
 Answer :2
2- immediate reduction of the
nasal fracture is needed
3- patient should be prepared for
immediate septorhinoplasty
4- postpone for one month before
reduction
 in a patient presenting with
severe throbbing pain in the
nasal vestibule
 1- the likely diagnosis is
vestibulitis
 2- squeezing pus from the  Answer : 4
swelling is recommended
 3- the causative organism is
streptococcus hemolyticus
 4- checking the blood sugar
in recurrent cases is
recommended
 A four years old child
presented with left
nasal offensive nasal
discharge. You should  Answer : 3
suspect
1- choanal atresia
2- adenoid
3- foreign body impaction
4- rhinosinusitis
 In a patient presenting with
right watery clear nasal
discharge that increases with
straining, the following
statements are correct except

 1-cerebrospinal rhinorrhoea is
suspected
 2-CT scan with intrathecal dye
injection is necessary
 3-biochemical analysis of the
nasal discharge should be done  Answer : 4
 4- nasal drops and packing are
helpful to the patient
 5- patient should avoid nose
blowing and leaning forewards
 A 19 years old female
presented with anosmia
and crusty nose. Her
mother described bad
odour of her daughter’s
nose. The most likely  Answer : 4
diagnosis is

1- rhinoscleroma
2- foreign body in the nose
3- chronic sinusitis
4-atrophic rhinitis
 In atrophic rhinitis the
following signs are seen
except
 1- reddish non ulcerating
firm nodules at the muco-  Answer : 1
cutaneous junction
 2-roomy nose
 3-greenish offensive crusts
 4-pale and atrophic
mucosa
 One of the following
statements is not correct
concerning rhinosclerma
1- it is the commonest
specific infective
granuloma in Egypt
2- the disease is endemic in
Kalyobeyah  Answer : 4
3- biopsy is needed to
confirm diagnosis
4- the causative organism is
klebsiella ozynae
 The histopathological
picture of scleroma
includes the following
except  Answer : 4
 1- Muklicz cells
 2- Russels bodies
 3- plasma cells and
lymphocytes
 4- neutophils
 The causative organism in
common cold is
 Answer : 2
1- influenza virus type A
2- Rhinovirus
3- streptococcus pneumonia
4- Moraxella catarrhalis
 The causative
organism in
influenza is
 1- Haemophilus
influenza
 2- influenza virus
 Answer : 2
type A, B, C
 3-Rhinovirus
 4- non of the above
 The following antibiotics
are effective in
rhinoscleroma except
 1- rifampicin
 2-quinolones
 3- ampicillin  Answer : 3
 4- 3rd generation
cephalosporins
 The organism
involved in the
pathogenesis of
atrophic rhinitis is
 1- klebsiella
rhinoscleromatis
 Answer : 2
 2-klebsiella ozynae
 3-non of the above
 4- all of the above
 The following statements are
correct concerning lupus
vulgaris except

 1- I t is caused by attenuated
tubercle bacilli
 2- reddish ulcerating nodules
at the mucocutaneous junction  Answer : 3
are seen
 3-perforation of the hard
palate is characteristic sign
 4- perforation of cartilagenous
part of the septum may occur
 5- tuberculin test is positive
 Syphilis of the nose
causes
1- bony septal
perforation
2- palatal perforation
3-saddle nose  Answer : 4
deformity
4-all of the above
 40 years old male presented
with left nasal obstruction
and fleshy reddish nasal
mass. There is a history of
recuurence after previous
surgery 2 years ago
1- the likely diagnosis is
nasopharyngeal angiofibroma
 Answer : 2
2- inverted papilloma is
suspected
3- allergic nasal polypi is a
possible diagnosis
4- non of the above
 In a teenager presented
with unilateral nasal
obstruction with single pale
grayish glistenibg soft
pedunculated mass. The
most likely diagnosis is:  Answer : 3
1- nasopharyngeal
angiofibroma
2-inverted papilloma
3- antrochoanal polyp
4-non of the above
 A patient with a C-
shaped deviated
nasal septum may
suffer from all of the
following symptoms
 Answer : 4
except
 1- epistaxis
 2- unilateral nasal
obstruction
 3- facial pain
 4- parosmia
 A patient presented with
bilateral nasal obstruction
after nasal trauma. The
patient temperature is 38
There is throbbing nasal  Answer : 3
pain. Your diagnosis is
 1- nasal frunculosis
 2- septal hematoma
 3-septal abscess
 4- non of the above
 The commonest cause
of septal perforation is
 1- septal abscess  Answer : 3
 2- lupus vulgaris
 3- septal operations
 4-habitual nose picking
 The criteria of early
congenital syphilis are
1- persistent rhinorrhoea,
vestibulitis with fissuribg
of the upper lip
 Answer : 1
2- notching of the upper
central incisors with
keratitis
3-peforation of the nasal
septum
4- non of the above
All of the following
 Answer : 3
comprise Hatchinson’s
triade except
1- notching of the upper
central incisor
2- interstitial keratitis
3-septal perforation
4-sensorineural hearing
loss
 All of the following
statements are correct
concerning septal
perforation except
 1- it is commonly
asymptomatic  Answer : 3
 2-epistaxis may occur
on separation of crusts  the commonest
 3-the commonest cause cause is septal
is habitual nose picking operations
 4- surgical closure is not
successful in most cases
 Fracture of the middle
third of the face that runs
transversly through the
floor of the maxillary
sinus and nasal cavity is
known as
 Answer : 1
 1- Le Forte 1 fracture
 2- Le Forte 2 fracture
 3- Le Forte 3 fracture
 4- non of the above
 The commonest cause
of oro-antral fistula is
 1- nasal syphilis
 2- cancer of the maxilla  Answer : 4
 3-osteomyelitis of the
maxilla
 4- extraction of 2nd
premolar and first molar
tooth
A 25 years old patient
with fever, mucopurulent
nasal discharge and
pain over the cheeks is  Answer : 2
suffering from
1- Frontal sinusitis
2- Acute maxillary sinusitis
3- Ethmoidal sinusitis
4- Chronic maxillary
sinusitis
 Uncontrolled diabetic patient
was diagnosed as having acute
sinusitis. His general condition
deteriorated rapidly. Nasal
examination revealed blackish  Answer : 2
crusts, the most likely
diagnosis is
1- mycetoma
2- acute fulminating fungal
sinusitis
3- allergic fungal sinusitis
4- chronic indolent fungal sinusitis
 An atopic 35 years old patient
presented with unilateral nasal
obstruction. Examination
revealed unilateral multiple nasal
polypi and CT scan revealed
 Answer : 2
unilateral sinus opacity with
hyperdense spots . what is your
diagnosis?
1- allergic nasal polypi
2- acute fulminating fungal sinusitis
3- allergic fungal sinusitis
4- chronic indolent fungal sinusitis
 The commonest
benign tumor of the
paranasal sinuses is
 Answer : 2
 1- inverted papilloma
 2-osteoma
 3-nasopharyngeal
angiofibroma
 4- non of the above
 The following are
causes of unilateral
offensive nasal  Answer : 3
discharge except
 1- nasal malignancy
 2- nasal foreign body
 3- nasal allergy
 4- allergic fungal
sinusitis
 A 3 years old male child
with recurrent epistaxis,
subcutaneous hematoma
and swollen joints after
minor trauma is probably  Answer : 2
suffering from
 1- thrombocytopenic
purpura
 2- hemophilia
 3- leukemia
 4- rheumatic fever
 All of the follpwing
arteries share in
Keisselbach’s plexus
except
1- anterior ethmoidal artery  Answer : 2
2- posterior ethmoidal
artery
3- greater palatine artery
4- superior labial artery
5- sphenopalatine artery
 Parosmia means

 1- smelling of bad odour

due to the presence of
noxious substance in
the patient nose
 2- smelling of non
existing odor
 3-complete loss of the  Answer : 2
sense of smell
 4-diminution of the
sense of smell
 All of the following are
charecteristic of rhinolalia
clausa except
 1- it is caused by bilateral  Answer :4
nasal obstruction
 2- there is decreased nasal
resonance
 3- it affects the letters m& n
 4- it is a manifestation of
cleft palate
 Keisselbach’s plexus
accounts for the
following percentage
of epistaxis  Answer : 5
 1- 50%
 2-60%
 3-70%
 4-80%
 5-90%
 To define the offending
allergen in allergic rhinitis
the following is done
1- microscopic examination  Answer : 2
of a nasal smear
2- skin sensitivity test
3- blood examination for IgE
level
4- all of the above
5- non of the above
 A septal abscess
must be drained
immediately for fear
of  Answer : 2
 1-frontal lobe
abscess
 2- cavernous sinus
thrombophlebitis
 3- nasal deformity
 4- orbital cellulitis
 A rhinolith is caused by

 1-neglected foreign body in

the nose  Answer : 3
 2- precipitation of calcium
salts on a blood clot or
inspissated mucus
 3 – all of the above
 4- non of the above
Which of the following
nasal foreign bodies
is irritating and cause
inflammatory reaction  Answer : 1
 1- bean Vegetable FB are
 2- button irritating and cause
inflammatory
 3- bead reaction
 4- a piece of plastic because of fatty
acids
 Cerebrospinal rhinorrhoea
is characterized by all of
the following except
 Answer : 4
 1- watery and salty
 2- does not stiffen
handkerchief
 3-increase on straining
 4- bilateral
 Of the nasal foreign bodies
one of the following may  Answer : 3
cause nasal septal
perforation This is due to
1- metallic foreign body leakage of
2- vegetable foreign body chemicals from
3- calculator battery
the battery
4- rhinolith
 Deviated nasal septum
can be associated with
 Answer : 4
 1- unilateral nasal
obstruction
 2- bilateral nasal
obstruction
 3- epistaxis
 4- all of the above
 Which of the following is
wrong concerning submucous
resection septal operation
 1- it is contraindicated before
the age of 18
 2- it can be done under local  Answer :3
anaesthesia
 3- the incidence of septal
perforation is less than
septoplasty operation
 4- the incidence of septal
hematoma is more common
than septoplasty operation
 The nasopharynx
takes its sensory
nerve supply from
 1- trigeminal nerve  Answer : 1
 2- glossopharyngeal
nerve
 3- vagus nerve
 4- non of the above
 The oropharynx
takes its sensory
nerve supply from
 1- trigeminal nerve  Answer : 2
 2-
glossopharyngeal
nerve
 3- vagus nerve
 4- non of the above
 The hypopharynx
takes its sensory
nerve supply from
 1- trigeminal nerve  Answer : 3
 2- glossopharyngeal
nerve
 3- vagus nerve
 4- non of the above
 The Eustachian tube

 1- opens in the lateral

wall of the oropharynx
 Answer : 4
 2- is opened by the
levator palati muscle
 3- wider in the adult
than in infants
 4- non of the above
 5- all of the above
 The part of the pharynx
that lies in front of the
3rd to 6th cervical  Answer : 3
vertebra is
1- oropharynx
2- nasopharynx
3- hypopharynx
4- the whole pharynx
 The part of the
pharynx that lies in
front of the 2nd and
3rd cervical vertebra
is
1- oropharynx
 Answer : 1
2- nasopharynx
3- hypopharynx
4- laryngopharynx
 The voluntary stage of
swallowing is
 1- the oral phase
 2- the pharyngeal  Answer : 1
phase
 3- the esophageal
phase
 4- both 1 and 2
 Snoring is defined as

 1- difficult noisy breathing

due to partial obstruction
of the larynx,trachea or
bronchi  Answer : 2
 2-noisy breathing during
sleep due to vibration of
the hypotonic dynamic
walls of the pharynx
 3- both 1 and 2 are right
 4- both 1 and 2 are wrong
 Dysphagia means
 1- painful swallowing
 2-difficult swallowing
 3- sensation of the act  Answer : 4
of swallowing
 4- all of the above
 A swelling may be felt
in the neck which may
gurgle on palpation,
a sign known as
1-Boyce's sign.  Answer : 1
2-Moure’s sign
3-Greisinger’s sign
4-kernig sign
 A middle aged female with
gradually progressive
dysphagia, koilonychia,
hypochromic anaemia and  Answer : 1
glazed tongue is suffering
from
 1- Plummer Vinson
syndrome
 2- hypopharyngeal
carcinoma
 3- oesophageal carcinoma
 4- achalasia
 The most common
cause for pharyngeal  Answer : 2
and oral ulceration is
 1- Behcet disease
 2- aphthous ulcers
 3- tuberculous ulcers
 4- syphilitic ulcer
 In a teenager male with
recurrent severe left
epistaxis , pallor and
conductive deafness of  Answer : 3
the left ear, you should
suspect
 1- antrochoanal polyp
 2- inverted papilloma
 3- nasopharyngeal
angiofibroma
 4- septal hemangioma
 The best investigation to
confirm the diagnosis of
nasopharyngeal
angiofibroma is
 Answer : 3
 1- biosy
 2-CT scan
 3-carotid angiography
 4- non of the above
 Trotter’s triad consists of all
of the following except
 1-unilateral conductive
hearing loss  Answer : 3
 2-ipsilateral earache and
facial pain
 3- ipsilateral proptosis
 4- ipsilateral immobilization
of the soft palate
 The commonest site of
origin of nasopharyngeal
carcinoma is  Answer : 2
 1-roof
 2- the fossa of Rosenmuller
 3-superior surface of the
soft palate
 4- Eustachian tube orifice
In a child aging 3 years with
Mouth breathing, hyponasality
and Snoring of long duration,
you suspect
 1- bilateral choanal atresia
 2- adenoid
 3- acute rhinitis
 4- non of the above

 Answer :2
 The commonest
cause of obstructive
sleep apnea in adult
is  Answer : 3
 1- allergic rhinitis
 2-allergic nasal
polypi
 3-marked obesity
 4-elongated uvula
 The commonest
cause of obstructive
sleep apnea in
children is  Answer : 4
 1- bilateral choanal
atresia
 2- allergic nasal
polypi
 3- marked obesity
 4- Adenoid
 A 4 years old child
presented by his mother
complaining of lack of
attention, mouth breathing  Answer : 3
and hyponasality
 1- secretory otitis media is
suspected
 2- adenoid is suspested
 3-both 1 and 2
 4- non of the above
 In diphtheria, the
antitoxic serum is
given
1- to neutralize the
circulating exotoxin  Answer : 1
2- to neutralize the
fixed exotoxin
3- to kill the diphtheria
bacilli
4- all of the above
 Adenoids can cause
school retardation
as a result of  Answer : 4
1- excessive daytime
sleepiness
2-impaired hearing
3- recurrent infection
4- all of the above
 True pharyngeal
membrane occurs in
1- vincent angina
 Answer : 4
2-diphtheria
3- infectious mononucleasis
4- acute membranous
tonsilitis
 The following are
features consistent with
postcricoid carcinoma
except
1- dysphagia is more to
fluids  Answer : 1
2- rapid loss of weight
3- Moure’s sign can be
detected
4- dysphagia is rapidly
progressive , first to
soilds then to solids and
fluids
Nasopharyngeal
carcinoma can cause
paralysis of the  Answer : 2
following nerves except
1- the vagus nerve
2-the facial nerve
3-the glossopharyngeal
nerve
4-the abducent nerve
 Excessive tobacoo
smoking and alcohol
intake are predisposing
factors to the following
except  Answer : 1
1- nasopharyngeal
carcinoma
2- oropharyngeal
carcinoma
3- hypopharyngeal
carcinoma
4- oesophageal carcinoma
 The main arterial supply
of the tonsil is from
 1- ascending palatine
artery  Answer : 4
 2- descending palatine
artery
 3- dorsalis linguae
artery
 4- tonsillar artery
 5-ascending pharyngeal
artery
 The commonest
causative organism in
acute tonsilitis is
 Answer : 3
1- staphylococcus aureus
2- haemophylus influenza
3- streptococcus
haemolyticus
4- Morhexella catarrhalis
 Moure’s sign can be
detected in
Answer : 3
1- nasopharyngeal
Moure;s sign means
carcinoma
absence of laryngeal
2- oropharyngeal click which can be
carcino,a detected in normal
individuals on
3-postcricoid carcinoma moving the larynx
4- supraglottic from side to side
carcinoma
The diagnostic manifestation
of a Parapharyngeal abscess is
 Answer : 4
1- Trotter’s triad
2- Geisenger’s sign
3-Gradenigo triade
4- Boeck’s triade
Un ulcer with undermined
edge and yellow caseous
 Answer : 2
floor is consistent with
1- traumatic ulcer
2-tuberculous ulcer
3- syphilitic ulcer
4- malignant ulcer
Un ulcer with everted
edge , necrotic floor
and indurated base is
consistent with
 Answer : 4
1- traumatic ulcer
2-tuberculous ulcer
3- syphilitic ulcer
4- malignant ulcer
The palatine tonsil is
different from the lymph
node in that
1- the tonsil has only
efferent lymph vessels
 Answer : 1
2- the tonsil has efferent
and afferent lymph
vessels
3- the tonsil has afferent
lymphatics only
4- the tonsil is completely
capsulated
The earliest and commonest
complication of diphtheria is
1- heart failure  Answer : 4
2- palatal paralysis
3-laryngeal obstruction
4-acute nephritis
The earliest and Commonest
neurological complication of
Diphtheria is  Answer : 3

1- paralysis of occular
muscles
2-paralysis of the diaphragm
3-palatal paralysis
4-laryngeal paralysis
Tonsillectomy is not indicated
in
1-chronic tonsillitis
2- history of peritonsillar  Answer : 4
abscess
3- diphtheria carrier resistant
to penicilline therapy
4- acute tonsilitis
All of the following are signs of
chronic tonsillitis except
1- inequality of the size of both
tonsils  Answer : 3
2- irregularity of the surface of
the tonsils
3- membrane on the tonsils
4- persistent enlargement of
jagulodigastric lymph node
Concerning contraindications of
Tonsillectomy, which of the
following statements is wrong
1- tonsillectomy is
contraindicated in acute
tonsilitis  Answer : 4
2-rheumatic fever is a
contraindication to avoid
bacterial endocarditis
3- it is contraindicated in
haemophilia
4- it is contraindicated in
tuberculous cervical
lymphadenopathy
 In a 3 years old child presenting
with bleeding from the mouth 5
days after tonsillectomy
1- ligation of bleeding points should
be carried out immediately  Answer : 3
2- the cause of bleeding in this
patient is slippage of a loose
ligature
3- if conservative measures fail to
stop bleeding consider packing
the tonsillar bed with absorbable
haemostatic material
4- non of the above
Adenoidectomy operation is
contraindicated in
1- acute upper respiratory tract
infection and the operation is
postponed for 3 weeks
2- cleft palate  Answer : 4

3- hempophilia
4- all of the above
 Which of the following is not
true concerning active
immunization against
diphtheria
1- it is compulsory and given at
the age of 2,4 and 6 month  Answer: 3
 2-it is given to contacts of
diphtheretic patients
 3- it is given to diphtheria
patients
 4- booster doses are given
at the age of 18 months and
5 years
In achalasia of the cardia
1- dysphagia is more to solids than to
fluids
2-there is irregular filling defect in
barium swallow
3-hour glass appearance is a
characteristic feature in barium
swallow
4- barium swallow shows marked
dilatation of the lower 2/3 of the
esophagus with smooth tapering lower
end
Answer: 4
 Which of the following is not
true concerning esophageal
carcinoma
1- dysphagia is more to solids
than to fluids  Answer: 4
2- loss of weight is marked
3- it is more common in males
than females
4- the esophagus is markedly
dilated above the
esophageal stenotic part
 Esophageal perforation
may be associated with
1-surgical emphysema in
the neck  Answer: 4
2-pneumothorax
3- mediastinitis
4- all of the above
 The commonest
esophageal foreign body
is
1- fish bone  Answer: 3
2-disc batteries
3- coins
4- pins
 the length of the adult
esophagus is about
1-15 cm
2- 25 cm  Answer: 2
3- 30 cm
4- 35 cm
 The esophagus is
crossed by the left main
bronchus and aortic
arch at about:
1- 15 cm from the incisor  Answer: 2
teeth
2- 25 cm from the incisor
teeth
3- 30 cm from the incisor
4- 40 cm from the incisor
 The gastro-esophageal
sphincter lies at about
1- 15 from the incisor teeth  Answer: 3
2- 25from the incisor teeth
3- 40 from the incisor teeth
4- 50 from the incisor teeth
 The crico-pharyngeal
sphincter lies at about
1- 15 from the incisor teeth  Answer: 1
2- 25 from the incisor teeth
3- 40 from the incisor teeth
4- 50 from the incisor teeth
 The crico-pharyngeal
sphincter lies at
1- 15 cmfrom the incisor
teeth
2- 6 inches from the  Answer: 4
incisor teeth
3- at the level of 6th
cervical vertebra
4- all of the above
5- non of the above
 A teenager with left recurrent severe epistaxis
and left nasal obstruction. Examination revealed
left pink nasal mass which bleeds on touch
 You suspect:………………………..
 Two investigations to be done:
 1-
 2-

Nasopharyngeal angiofibroma
1-CT scan
2-Angiography
 A 35 years old lady develops
hoarsness of voice after a neck
surgery
You suspect:

Unilateral vocal cord paralysis

Intubation granuloma
 A 30 years old
female presented
with bilateral
impairment of
hearing

Otosclerosis
 A 55 years old patient
presented with unilateral
tinnitus and progressive
impairment of hearing of
one year duration.
 Suggest 2 investigations
 You suspect…………….

ABR
MRI
Acoustic neuroma
 A diabetic patient well known to have
left chronic ear discharge developed
left facial pain and diplopia on looking
to the left side

Petrositis
Gradenigo syndrome
A 3 years old child whose mother
noticed offensive right nasal
discharge

right nasal foreign body

 A 3 years old child with a history of
common cold before a few days. He
developed right facial paralysis.
Examination revealed reddish drum.
 Diagnosis
 First step in treatment :

Otitic facial paralysis

Myringotomy
 A patient attended the ENT clinic for
ear wash. She felt pain during wash
with water coming from her nose

Traumatic drum perforation

 A patient presented with left facial
paralysis discovered while he was
shaving. No abnormality was seen at
ENT examination. CT scan and MRI
revealed no head and neck abnormality

Bell’s palsy
 The mother of this
child described in-
attention of her child
 You suspect
 Another investigation
to be done?

Secretory otitis media

Tympanometry
 This man presented
with dysphagia

Achalasia
 60 years old man presented with
dysphagia to solids more than fluids
and loss of weight of 3 months
duration. Three weeks ago he
developed right painless neck swelling

Hypopharyngeal carcinoma
with spread to cervical lymph nodes
 A 35 years old patient presented with
recurrent attacks of vertigo for seconds
occurring when he assumes certain head
position. His hearing was normal
 Diagnosis:

Benign paroxysmal positional vertigo

 25 YEARS OLD PATIENT WHO HAD BURN IN HIS
LIMB WAS ADMITTED IN A HOSPITAL FOR 10
DAYS FOR MANAGEMENT OF HIS BURN. AFTER
DISCHARGE HE PRESENTED TO THE ENT CLINIC
WITH BILATERAL HEARING LOSS.
EXAMINATION REVEALED NORMAL TYMPANIC
MEMBRANE.

SNHL following ototoxic drugs

 A 23 years old patient has severe sore throat.
Temperature is 39.5, after 2 days, he
developed severe dysphagia, throbbing pain
referred otalgia and drooling of saliva
 He is most probably suffering from:…………..

Peritonsillar abscess
 A 23 years old patient has severe sore
throat. After 3 days, he developed severe
dysphagia, throbbing pain referred otalgia
and drooling of saliva. Neck examination
revealed a tender swelling in the right side
of the neck

Right parapharyngeal abscess

 A 24 year old male patient presented because of
severe pain in the throat and the left ear that
increased with swallowing of sudden onset and 2
days duration. He gave a history of sore throat and
fever a few days prior to the condition. On
examination, the patient looked very ill and has a
thickened voice. The temperature was 39.5 C and
the pulse 110/minute. The patient had fetor of the
breath and was unable to open his mouth. There
was marked edema of the palate concealing the
left tonsil that was found injected. There was a
painful hot swelling located below the left angle of
the mandible. The left tympanic membrane was
normal.

 Look at previous quiz

 A 35 years old patient presentes with mild
sore throat with painful limited neck
movement. There is a history of admission in
chest hospital. Examination revealed a
midline swelling in the posterior pharyngeal
wall
 Diagnosis
 Investigation

Chronic retropharyngeal abscess

X ray or CT scan of the neck (shows widening of prevertebral
space and destruction of cervical spines)
 A 2.5 years old child presented by his
parents who noticed sudden inability of the
child to swallow and regurgitation of
undigested food. Temperature was normal
and clinical ENT examination was normal.
You suspect……………….

Foreign body in the esophagus

 An infant 3 months after birth develops
inspiratory stridor which improves on lying
on prone position. The infant cry was
normal. Temperature was 37.
 You suspect………………..

laryngomalacia
 A 3 month old infant presented with left
persistent nasal obstruction and thick
mucoid nasal discharge noticed since birth.
 You suspect ……………….
 How to investigate

Unilateral choanal atresia

CT scan or X-ray with instillation of lipidol
 A newly born infant has difficult breathing
with intermittent cyanosis. Examination
revealed bilateral nasal mucoid discharge. A
small catheter can not be passed through the
nose to the pharynx. Laryngeal examination
revealed no abnormality.
 You suspect

Bilateral choanal atresia

 A 20 years old female presented with
crusty nose and anosmia. Examination
revealed roomy nose, greenish crusts and
pale atrophic nasal mucosa

Atrophic rhinitis
 A 25 years old female from Benha presented
with chronic persistent nasal obstruction.
Nasal examination revealed reddish non
ulcerating firm nodules at the muco-
cutaneous junction. Biopsy was taken
 You suspect…………………….

Rhinoscleroma
 A 25 years old female from Benha
presented with biphasic stridor and
expectoration of greenish crusts. The
patient has a history of chronic persistent
nasal obstruction with crusty nasal
discharge.

Sleroma of the nose and larynx

 A 40 years old male presented with hoarsy
weak voice and severe throat pain referred
to the ear. There is a history of admission
in a chest hospital. Examination revealed
pale laryngeal mucosa with interarytenoid
granulations

Tuberculous laryngitis
 A 45 years old patient presented with
pulsating tinnitus in his right ear.
Examination: look at right image
 Diagnosis

Glomus jagulari
 A 40 year old female has
been complaining of nasal
troubles of a long duration
in the form of bilateral
nasal obstruction,
anosmia and nasal
crustation. Two months
ago she developed mild
 Rhinolaryngeo
stridor that necessitated a
tracheostomy later on. scleroma
She received medical
treatment for her  Ototoxicity
condition, but 1 month
later developed severe to
profound hearing loss that
necessitated the use of a
hearing aid.