475.

1-Pathogen commonly implicated in acute suppurative otitis media

inclued, excipet:

A. streptococcus pyogenes.

B. hemophilus influenzae.

C. moraxella catarrhalis.

D. pseudomoneus aerogenosa.

2. Which test reflects the vestibulo-spinal function ?

A. Headshake nystagmus.

B. Electronystagmography.

C. Rotatary chair testing.

D. Tandem walking test.

E. Positional test.

3. Following is true regarding rhinitis medicamentosa

A. It is caused by steroid drops

B. There is atrophy of inferior turbinate

C. It is caused by oral pseudoephidrine

D. Septoplasty is treatment of choice

E. It is caused by vasoconstrictive drops

4. Following are causes of epistaxis except

A. Trauma

B. Ostler

,s disease

C. Nasal polyp

D. Septal perforation
E. Idiopathic

5. A patient has been put on IV heparin for pulmonary embolism .He

started

nose bleed . His PT is 50 seconds. His treatment is

A. Give adrenaline

B. Give normal saline

C. Give protamine sulphate

D. Give blood transfusion

E. Give transamine

476. 6-A young boy of ten years age went for swimming. Next day he

developed nasal congestion, fever and headache .He deteriorated over

next twenty four hours and developed redness and edema of both

eyelids on left side. His likely diagnosis is :

A. Acute maxillary sinusitis

B. Cavernous sinus thrombosis

C. Meningitis

D. Erysipelas

E. Acute ethmoiditis

7. Allergic rhinitis

A. Is a type 1 IgE mediated hypersensitivity reaction

B. Is a type 2 IgM mediated reaction

C. IgA antibodies are produced in desensitization process which block

IgE
D. Total serum IgE levels have to be checked before starting

immunotherapy

E. Is very common in old age.

8. A young woman was on contraceptive pills due to which she

developed deep vein thrombosis .She was placed on warfarin .She

started bleeding from nose. The best test to check her coagulation

status is :

A. Bleeding time

B. Clotting time

C. Platelet count

D. Activated partial thromboplastin time

E. Hess test.

9. A young boy was involved in road traffic accident and broke his nose.

Next day he noticed a watery fluid coming from his left nostril.

Which test will you do to confirm the nature of fluid.

A. Blood sugar

B. Blood sugar in the fluid collected from nose

C. Leukocyte count in fluid

D. Do biochemical analysis of fluid and match the findings with findings

of specimen collected by lumbar puncture

E. Protein levels in nasal fluid

477. 10-A 40 year old man who is on steroids developed boil in the nose

.Two days later he developed swelling of eye lids on one side with
chemosis and opthalmoplegia of extraoccular muscles . He also has

fever. Which investigation will clinch the diagnosis .

A. Total leukocyte count

B. ESR

C. X-ray Para nasal sinuses

D. MRI scan

E. Quickenstead

,s test

11. A young girl has developed saddling of nose after trauma .The best

thing to do is

A. Septoplasty

B. Tip plasty

C. SMR

D. Augmentation rhinoplasty

E. septorhinoplasty

12. Following are measures for house dust mite avoidance in allergic

rhinitis except.

A. Do dry dusting

B. Avoid carpets in bed room

C. Use polythine bedcovers for mattress

D. Wash bed linen in boiling water

E. Do not do dusting in the morning.

13. The skeleton of nasal tip is formed by.

A. Caudal end of the septal cartilage

B. Lower lateral cartilage

C. Upper lateral cartilage

D. Sesamoid cartilage

E. Hyaline cartilage

14. A two year old child is having unilateral nasal discharge which is foul

smelling and purulent the likely diagnosis is.

A. Adenocarcinoma of nose

B. Foreign body nose

C. Sinusitis

D. Nasal polyp

E. Rhinitis

478. 15-The best treatment for recurrent nasal polyps is?

A. Intranasal polypectomy

B. Transantral ethmoidectomy

C. Functional endoscopic sinus surgery

D. Steroids

E. Transantral ethmoidectomy with postoperative inhaled steroids.

16. Major portion of nasal cavity is lined by?

A. Columnar epithelium (respiratory type)

B. Olfactory epithelium

C. Squamous epithelium

D. Skin

E. Cuboidal epithelium
17. Following structures open into middle meatus?

A. Frontal sinus

B. Nasolacrimal duct

C. Sphenoid sinus

D. Posterior ethmoid cells

E. Hiatus semilunaris

18. The middle turbinate?

A. Is part of ethmoid bone

B. Is part of maxilla

C. Is a separate bone

D. It is only mucosal structure

E. It contains cartilage and bone covered with mucosa

19. CSF formation is a process of:

a) Transudation.

b) Exudation.

c) Ultrafiltration.

d) Filtration.

e) Translocation.
479. 20-The patient has developed traumatic CSF rhinorrhoea .The best way

to localize the site of leak is?

A. CT scan

B. MRI scan

C. Radioisotope scan

D. Use florescence dye intrathecally and examine nose with blue

nasoendoscope

E. Examine nose with endoscope

21. Which cranial nerve lies in cavernous sinus as lateral relation of

sphenoid sinus?

A. Trochlear nerve

B. Facial nerve

C. Vidian nerve

D. Sphenoplatine nerve

E. Mandibular division of maxillary nerve

22. Skeletal support to columella is provided by?

A. Caudal end of quadrilateral cartilage

B. Middle crura of allay cartilage

C. Medial crura of allar cartilage

D. Medial crural feet of allar cartilage

E. Anterior nasal spine.

23. The floor of maxillary sinus is closely related to?

A. Canine teeth

B. Molar teeth
C. Premolar teeth

D. Second premolar and first molar

E. All of above

24. A young boy was involved in road traffic accident . He developed

vertigo when he tried to move about . On examination he had blue ear

drum and facial palsy on right side. Audiogram done two weeks later

confirmed sensorineural hearing loss. The likely diagnosis is?

A. Transverse fracture of temporal bone

B. Longitudinal fracture of temporal bone

C. Ossicular chain disruption

D. Disruption of spiral ganglion

E. Brain contusion

480

25. A two year old child is suffering from acute otitis media. His pain is

not relieved in spite of adequate treatment .The best treatment in this

situation is?

A. Change antibiotic

B. Increase analgesic dose

C. Do hot fomentation

D. Give lignocaine ear drops

E. Do myringotomy.
26. Which of the following is not a clinical feature of baurotraumatic

otitis media?

A. Otalgia

B. Deafness

C. Tinnitus

D. Blue ear drum

E. Purulent ear discharge

27. Which of the following is not included in the treatment of

perichondritis of pinna?

A. Local antibiotics

B. Systemic antibiotics

C. Incision and drainage

D. Removal of necrotic cartilage

E. Subsequent plastic surgery

28. A thirty year old lady had flue which was followed by severe otalgia

and tinnitus. One day later she had blood stained discharge from ears

and on otoscopy had reddish vesicles on ear drum. She is suffering

from :

A. Malignant otitis externa

B. Otitis externa hemorrhagica

C. Ramsay-Hunt syndrome

D. Hemotympanum

E. Acute otitis media

481. 29-A two year child is very slow in developing language. On otoscopy
he has dull ear drum. Investigation of choice is?

A. Audiogram

B. X-ray mastoids

C. Tympanogram

D. Serum bilirubin

E. Nystagmogram

30. Following are characteristics of discharge in unsafe chronic

supurative otitis media except?

A. Thick discharge

B. Scanty discharge

C. Odorless discharge

D. Blood stained discharge

E. Purulent discharge

31. A 20 year old boy had long standing foul smelling ear discharge.

Recently he has developed otalgia, fever, headache and vomiting .The

likely diagnosis is?

A. Brain abscess

B. Bezolds abscess

C. Perilabyrinthine fistula

D. Otitis externa

E. Meningitis.

32. Which of the following is not a cause of hoarseness?

A. Carcinoma of right bronchus

B. Acute laryngitis
C. Thyroidectomy

D. Hypothyroidism

E. Carcinoma of larynx

33. Which of the following is not true regarding tracheobronichial

foreign body in the children?

A. The child presents with breathing difficulty

B. The foreign body usually lodges in left bronchus

C. The foreign body is best removed using rigid bronchoscope

D. X-ray chest will show expiratory emphysema on involved side

E. Cheat X-ray will show Mediastinal shift to involved side

482. 34-A thirty year old lady has five children. She is complaining of

hoarseness for last one month which is not improving. She never had

any surgery .Her probable diagnosis is?

A. Carcinoma of larynx

B. Vocal cord nodules

C. Reinke

,s edema

D. Hypothyroidism

E. Recurrent laryngeal nerve palsy.

35. A six months old baby has strider which gets worse on crying and

improves on lying in prone position .He is suffering from?

A. Laryngeal web

B. Subglottic stenosis

C. Laryngomalscia
D. Congenital paralysis of vocal cord

E. Vocal cord polyp

36. Absolute indication for tonsillectomy is?

A. Chronic tonsillitis

B. Rheumatic fever

C. Diphtheria carrier

D. Obstructive sleep apnea

E. Glassopharyngeal neurectomy

37. Which of the following statements is not rue regarding

oropharyngeal herpes zoster?

A. Vesicles appear in the distribution of ninth and tenth cranial nerves

B. Vesicles are unilateral

C. Pharyngeal condition may be associated with geniculate herpes

D. Healing occurs leaving scarring

E. Acyclovir when used early is helpful.

38. Which of the following is not a clinical feature of adenoid

hypertrophy?

A. Nasal obstruction

B. Snoring

C. Eustachian tube obstruction

D. Nocturnal cough

E. Chronic suppurative otitis media

483. 39-Which of the following is not true regarding acute reteropharyngeal

abscess?

A. It is limited to one side of the midline

B. It forms due to suppuration in reteropharyngeal lymph node

C. Produces difficulty in breathing and suckling

D. It is common in children

E. Incision and drainage is done from outside trough carotid sheath.

40. Surgical emphysema after trachestomy is corrected by:

a)taking more stitches of the wound

b)cold compresses

c)widening of the wound by removal of some stitches

d)antihistaminic intake.

41. Saddle nose may be due to the following except:

a)overresection of septal cartilage

b)nasal trauma

c)septal abcess

d)rhinosceleroma
42. The most serious complication after tonsillectomy:

a)respiratory obstruction

b)reactionary haemorrhage

c)incomplete removal

d)infection.

43. Otoscopic manifestation of chronic secretory otitis media may

include the following except:

a)perforation at pars flaceida

b)transverse handle of malleous

c)absent cone of light

d)air bubbles behind the tympanic membrane.

44. A newly born infant with respiratory distress & difficult feeding is

more likely to be due to:

a)laryngeal web at the anterior half of vocal cords

b)bilateral posterior choanal atresia

c)congenital subglottic stenosis

d)congenital meatal atresia

484. 45-The most common cause of oroantral fistula is:

a)acute sinusitis

b)car accident

c)dental extraction of upper second premolar tooth

d)radical antrum operation.

46. The most common cause for posterior septal perforation is:

a)TB

b)syphilis
c)leprosy

d)scleroma.

47. Moure's sign is:

a)presence of laryngeal click

b)absence of laryngeal click

c)external neck swelling

d)internal pharyngeal swelling.

48. The following symptoms are true of primary atrophic rhinitis except:

a)bad odour felt by the patient

b) bad odour felt by others

c)epistaxis

d)sense of nasal obstruction

49. Unilateral malignant tumor of the vocal cord with subglottis

ectension & lymph node metastasis is best treated by:

a)unilateral cordectomy

b)total laryngectomy with neck dissection

c)cheomotherapy

d)tracheostomy only.

50. For assessment of the skull base and intracranial extension of

cancer,

which combination of studies is most informative?

A. PET and CT

B. CT and MRI

C. PET and MRI

D. MRI and MR angiography

E. PET/CT and MRI .

485. 51-The MR findings of glomus jugulare paraganglioma include a:

A. T1 and T2 ?salt and pepper? appearance.

B. T1 and T2 ?ground glass? appearance.

C. T1 and T2 high signal for cystic necrosis.

D. T1 and T2 high signal within the petromastoid air cells.

52. A jugular foramen schwannoma

A. Has no ?pepper? flow voids, even if it is a large tumor.

B. Has characteristic flow voids.

C. Is a benign tumor of sympathetic nerves in the jugular foramen.

D. Has a high T1 signal.

53-The classic imaging finding in clival meningioma is

A. ?Dural tails.?

B. Flow voids.

C. Central calcification.

D. Peripheral necrosis.

54. The classic CT appearance of fibrous dysplasia of the skull base

includes

A. Pagetoid mixed pattern.

B. Sclerotic pattern.

C. Cystic pattern.

D. All of the above.

55. Langerhans histiocytosis of the skull base has also been known as

A. Hand-Schüller-Christian disease.

B. O?Neill-Morris-Wreesman syndrome.

C. Schüller Siwe syndrome.

D. Delkargios syndrome .

56. All of the following structures extend through the foramen ovale
except the?

A. Mandibular nerve.

B. Cranial nerve (CN) V3.

C. Meningeal branch of the mandibular nerve.

D. Accessory meningeal artery.

486. 57-All of the following structures extend through the jugular foramen

except the

A. Inferior petrosal sinus.

B. Glossopharyngeal nerve.

C. Middle meningeal artery.

D. Sigmoid sinus.

58. All of the following structures extend through the foramen magnum

except the

A. Meninges.

B. Vertebral arteries.

C. Posterior meningeal artery.

D. Medulla oblongata.

59. The agger nasi air cell is

A. The largest and most consistent ethmoid air cell.

B. Positioned anterior to the insertion of the inferior turbinate.

C. Positioned anterior to the insertion of the middle turbinate.

D. Consistently pneumatized.

60. The uncinate process may be attached to any of the following

except the

A. Skull base.

B. Lamina papyracea.

C. Nasal septum.

D. Middle turbinate.

61. On a coronal CT scan, the ethmoid roof is noted tobe 7 mm above

the cribriform plate, which makes this a Keros type

A. I.

B. II.

C. III.

D. IV.

487. 62-The sphenoid sinus ostium is generally located

A. Superior to the superior turbinate 1 to 1.5 cm above the roof of the

choana.

B. Inferior to the superior turbinate 1 to 1.5 cm above the roof of the

choana.

C. Medial to the superior turbinate 1 to 1.5 cm above the roof of the

choana.

D. Lateral to the superior turbinate 1 to 1.5 cm above the roof of the

choana.

63. Mandibular swing should not be performed alone when

A. The tumor is lateral to the IC

A. B. The tumor extends beyond the floor of the middle cranial fossa.

C. The tumor involves intracranial structures.

D. Any of the above is true.

64. Which of the following is not a risk factor for oral cancer?

A. Tobacco

B. Alcohol

C. Fanconi anemia

D. Herpes simplex virus

E. Human immunodeficiency virus (HIV) infection.

65. Postoperative chemoradiation therapy is indicated in patients with

A. Positive neck nodes.

B. Vascular invasion.

C. Perineural invasion.

D. T4 tumors.

E. Extracapsular lymph node spreading.

66. In nasopharyngeal cancer the most common site of metastases is

the

A. Bone.

B. Liver.

C. Lung.

D. Brain.

488. 67-NPC is highly sensitive to

A. Doxorubicin (Adriamycin).
B. Methotrexate.

C. Cyclophosphamide.

D. Platinum-based regimens.

68. The preferred imaging study for evaluating the intracranial or

perineural extent of nasopharyngeal tumors is.

A. CT.

B. Enhanced magnetic resonance imaging (MRI).

C. Enhanced CT.

D. Ultrasonography.

69. The parapharyngeal space extends from the skull base to the

A. Hyoid.

B. Level of the epiglottis.

C. Level of the angle of the mandible.

D. Level of the postcricoid region.

70. The masticator space includes the following muscles, except the

A. Medial pterygoid.

B. Lateral pterygoid.

C. Posterior digastric.

D. Temporalis.

71. A nasopharyngeal primary SCC with extension to the oropharynx

without parapharyngeal space extension is stage

A. T1.

B. T2.
C. T3.

D. T4.

72. Esophageal webs are associated with the following, except

A. Plummer-Vinson syndrome.

B. Celiac disease.

C. Gastroesophageal reflux disease (GER

D. .

D. Bullous pemphigoid .

489. 73-Cancer is limited to the True vocal cord, but paralysis is present.

A. T1a

B. T1b

C. T2

D. T3

E. T4a.

74. Vocal cord fixation is most likely due to invasion of the

A. Conus elasticus.

B. Quadrangular membrane.

C. Paraglottic space.

D. Broyle tendon.

75. Which of the following would not be recommended as part of the

treatment for a T1 piriform sinus hypopharynx tumor?

A. Transoral laser resection of the primary tumor with negative margins

B. Radiation therapy alone

C. Transcervical lateral pharyngectomy

D. Bilateral neck dissection after surgery for the primary tumor

E. Concomitant chemoradiation therapy.

76. A 75-year-old woman presents with an incidentally found T1

hypopharynx tumor of the medial piriform sinus. CT and PET findings

are negative for cervical disease. She undergoes surgical resection of

the primary lesion. Which of the following is the best next step in

treatment of the neck?

A. No neck dissection necessary

B. Ipsilateral neck dissection only

C. Bilateral neck dissection

D. Ipsilateral radiation therapy to the neck

E. Bilateral radiation therapy to the neck.

77. The radiological demarcation between level I and level II in the

neck is:

A. A vertical line through the posterior border of the submandibular

gland.

B. The posterior belly of the digastric muscle.

C. The mylohyoid muscle.

D. A vertical line through the tip of the greater cornu of the hyoid bone.

490. 78-Which of the following is most accurate at staging the neck in

patients with SCC of the larynx who have not received any previous

treatment?

A. Clinical palpation
B. MRI

C. PET-CT

D. US-FN

A.

79. The treatment of choice for lymphadenopathy caused by atypical

mycobacteria in children is

A. Rifampicin-based antimicrobial chemotherapy.

B. Sulfa-based antimicrobial chemotherapy.

C. Complete surgical excision without antimicrobials.

D. Surgical curettage and debulking followed by antimicrobial therapy.

80. Sacrifice of which of the following structures constitutes an

extended MRND?

A. Accessory nerve, hypoglossal nerve, internal jugular vein

B. Sternomastoid muscle, omohyoid muscle, and internal jugular vein

C. Accessory nerve, sternomastoid muscle, and internal jugular vein

D. Accessory nerve, internal jugular vein, and submandibular gland.

81. Which of the following statements regarding second arch branchial

cysts is true?

A. The peak age of presentation is in the teenage years.

B. Most cases will have a rudimentary tract extending deeply to the

tonsillar fossa.

C. Approximately 10% to 30% are bilateral.

D. These cysts may become inflamed in patients with acute tonsillitis

because of lymphoid tissue in the wall.

82. In patients with differentiated thyroid cancermetastatic to the lateral

side of the neck, which preoperative investigation should be considered

routine?

A. Ultrasound examination

B. PET scan

C. Contrast-enhanced CT of the neck

D. Diagnostic radioiodine scan

491. 83-Which of the following side effects is associated with the

administration of radioactive iodine?

A. Dysphagia

B. Xerostomia

C. Secondary malignancy

D. All of the above.

84. What is the rate of incidental malignancy in multinodular goiters?

A. Less than 5%

B. 5% to 10%

C. 10% to 30%

D. 30% to 50%.

85. Which of the following areas is a common site for nodal metastases

from thyroid cancers?

A. The perifacial lymph nodes

B. Level IV posterior to the great vessels

C. Level II superior to the accessory nerve

D. The parapharyngeal space

86. Children who are seen with papillary thyroid cancer are at high risk

of

A. Locally advanced primary tumors.

B. Bony metastases.

C. Pulmonary metastases.

D. Local recurrence.

87. The most important differential diagnosis in patients with suspected

anaplastic thyroid cancer is

A. Poorly differentiated thyroid cancer.

B. Lymphoma.

C. Sarcoma.

D. Metastatic melanoma.

88. The next step in managing a patient with normal clinical

examination results and a rising thyroglobulin level after surgery for

thyroid cancer is.

A. Elective neck dissection.

B. Ultrasound imaging.

C. Therapeutic radioiodine.

D. Tyrosine kinase inhibitor therapy.

.
492. 89-The most reliable landmark for the facial nerve in parotid surgery is

the

A. Tragal pointer.

B. Posterior belly of the digastric.

C. Tympanomastoid suture line.

D. Bony cartilaginous ear canal.

90. Characteristic MRI findings for pleomorphic adenoma include

A. Hyperintensity on T1.

B. Hyperintensity on T2.

C. Enhancement with gadolinium.

D. A and

B. E. B and

C.

91. Which of the following statements about recurrent minor salivary

gland cancer is correct?

A. Local recurrences require chemoradiation therapy.

B. Local recurrences indicate a palliative course.

C. Local recurrences do not necessarily portend a decreased chance of

survival.

D. Surgical intervention is not a therapeutic option for local recurrences

92. Paragangliomas often have demonstrable feeder vessels that most

commonly arise from the

A. External carotid artery.

B. Internal carotid artery.

C. Ascending pharyngeal artery.

D. Lingual artery.

E. Superior thyroid artery.

93. The parapharyngeal space is bounded by the following structures,

except the

A. Base of the skull.

B. Lateral pharyngeal wall.

C. Masseter muscle.

D. Pterygoid muscles.

E. Prevertebral muscles..

493. 94-A 35-year-old man presents with a 3-cm schwannoma of the

cervical plexus. The best next step is

A. Observation with repeated imaging in 6 months.

B. Radiation therapy.

C. Chemotherapy.

D. Early surgical intervention.

95. The differential diagnosis of a 3-cm mass on the right side of the

neck located in the carotid space should include all of the following,

except a

A. Glomus vagale tumor.

B. Carotid body tumor.

C. Schwannoma of the vagus nerve.

D. Pleomorphic adenoma of the deep lobe of the parotid gland .

96. Which vein is not a reliable recipient for venous drainage of a free

flap?

A. External jugular vein

B. Internal jugular vein

C. Facial vein

D. Anterior jugular vein

E. Middle thyroid vein.

97. Which nerve is used in the sensate radial forearm free flap?

A. The lateral antecubital cutaneous nerve is used.

B. The sensory branch of the radial nerve is used.

C. The radial forearm flap cannot be raised as a sensate flap.

D. The medial antecubital cutaneous nerve is used.

E. The posterior cutaneous nerve of the forearm is used.

98. Which is true regarding the deltopectoral flap?

A. The donor site can be closed primarily.

B. It is the preferred choice for pharyngeal reconstruction.

C. The blood supply is from the axillary artery.

D. It should be raised as a musculocutaneous flap to preserve the blood

supply.

E. The distal end of the flap has the most tenuous blood supply.

494. 99-The blood supply to the skin paddle of the fibula osteocutaneous

flap
A. Is highly unreliable.

B. Is always anterior to the fibula.

C. Is always in the posterior intermuscular septum.

D. Is usually located in the proximal one third of the bone.

E. Can be better protected with harvesting of acuff of soleus or flexor

hallucis longus muscle.

100. Which is true regarding the pectoralis major muscle?

A. The blood supply is from the pectoral branch of the thoracoacromial

artery.

B. The nerve supply is from the long thoracic nerve.

C. The main blood supply to the muscle is from the internal mammary

artery.

D. The lateral thoracic artery should be preserved.

E. The nerve supply is from the axillary nerve.

101. Which one is not a pivotal flap?

A. Bilobed flap

B. Rhombic flap

C. V-Y flap

D. Z-plasty

E. Paramedian forehead flap.

102. Which one of these defects is better reconstructed with a free

flap?

A. A glossectomy defect less than 30%

B. A lateral marginal mandibulectomy defect in a nonirradiated patient

with more than 1 cm of thickness of remaining mandible

C. A mucosal defect of the floor of the mouth

D. A mucoperiosteal defect of the hard palate

E. A hemiglossectomy defect

495. 103-Which vessel is not a first choice option in microvascular

anastomosis in the neck?

A. Superior thyroid artery

B. Facial artery

C. Lingual artery

D. Transverse cervical artery

E. Occipital artery.

104. Which tumor is most likely to have retropharyngeal lymph node

metastasis?

A. Nasopharynx

B. Oral cavity

C. Glottic larynx

D. Parotid .

105. Which of the following is the most common late sequela after

radiation therapy to the head and neck?

A. Osteoradionecrosis

B. Feeding tube dependence

C. Hypothyroidism

D. Brachial plexopathy.
106. After radiation therapy, which of the following is not a suspicious

feature of a persistent metastatic lymph node?

A. Size greater than 1.5 cm

B. Focal enhancement on CT

C. Well-circumscribed node

D. Calcification.

107. The presence of peripheral cysts around the intracranial

component of a sinonasal lesion is generally associated with which of

the following tumors?

A. Sinonasal undifferentiated carcinoma

B. Melanoma

C. Esthesioneuroblastoma

D. Squamous cell carcinoma

E. Adenoid cystic carcinoma.

496. 108-Which of the following tumors is not commonly associated with

lateral retropharyngeal lymphadenopathy?

A. Nasopharyngeal carcinoma

B. Paranasal sinus carcinoma

C. Tonsil carcinoma

D. Papillary carcinoma of the thyroid

E. Pyriform sinus carcinoma.

109. Hypopharyngeal cancers can cause paralysis of the ipsilateral vocal

cord by all of the following mechanisms except

A. Direct invasion of the paraglottic space.

B. Direct invasion of the cricoarytenoid joint.

C. Perineural involvement of the recurrent laryngeal nerve.

D. Direct invasion of the recurrent laryngeal nerve.

E. Involvement of the recurrent laryngeal nerve by paratracheal

lymphadenopathy.

110. Insulin Diabetic Patient undergoing total thyroidectomy, should

a. Be admitted 1 hour before surgery

b. Receive pre operative insulin pre-

c. Receive intravenous normal saline preoperatively

d. Receive a glucose, insulin and potassium infusion preoperatively

e. Should receive intravenous insulin intraoperatively.

111. Total serum thyroxine is reduced by

a. Oral contraceptive pills

b. Pregnancy

c. Nephrotic Syndrome
d. Propanolol.

112. Facial Nerve Is Not Fully Developed Untill A Childe Is:

A. 1 Year

B. 2 Year

C. 4 Year

D. 6 Year

E. 8 Year.

497. 113-The Differential Diagnosis Of Acute Facial Nerve Parlysis , Should

Not Include:

A. Sarcoidoisis

B. Herbes Zoster

C. Kawasaki?s Disease

D. Lyme Disease

E. Shwanoma.

114. The most common source of infection of the lateral pharyngeal

space is from the

A. Floar of the mouth

B. Neck

C. Mastoid

D. Soft palate

E. Tonsils.

115. lateral pharyngeal space is devided into two compartments by the

A. 11th cranial nerve

B. Carotid sheath

C. Styloid process

D. Carotid artery

E. Jugular artery .

116. parotid gland is separated from submandibular gland by

A. Mylohyoid

B. Stylohyoid

C. Stylomandibular ligament

D. Posterior belly of digastric.M

E. Anterior belly of digastric,m.

117. A congenital choanal atresia is:

A. Most commonly a membranosious closure

B. Mostly aunilateral

C. Commoner in female

D. Of early presentation in unlilateral cases.

E. Not a life threatening condition jn bilateral cases

498. 118-The interaural difference in wave V of ABR must not exceed :

A. 0.2 msec

B. 1 msec

C. 0.1 msec

D. 2.4 msec

119. Which of the following is MOST specific for otosclerosis:

A. Hyperacusis Willichii

B. Normal tymponometry with lost reflexes.

C. Carhart's notch.

D. Schwart's sign.

E. None of the above

120. 3 years old child with sinusitis , you expect affected sinuses are :

A. Frontal and maxillary.

B. Frontal and ethmoidal.

C. Sphenoidal and maxillary

D. Maxillary and ethmoidal.

121. Patient with right complete facial paralysis is working in a noisy for

20. years,you can expect:

A. Right ear hearing loss is less at 4kHz.

B. Left ear hearing is worse than right.

C. Both ears got equal hearing.

D. Right ear hearing loss is more at 4kHz .

122. Cochlear microphonics originate from:

A. Cochlear nerve.

B. Basilar membrane.

C. Outer hair cells.

D. Inner hair cells.

123. Compoud action potential originates from:

A. Auditory nerve.

B. Basilar membrane.

C. Outer hair cells.

D. Inner hair cells..

499. 124-The endocochlear potential originates from:

A. Basilar membrane.

B. Outer hair cells.

C. Stria vascularis.

D. Inner hair cells .

125. The 4th branchial arch nerve develops into:

A. The glossopharyngeal nerve.

B. Vagus nerve.

C. Mandibular nerve.

D. Superior laryngeal nerve.

126. The most common complication of FESS:

A. Bleeding.

B. Cranial complictions.

C. Anosmia.

D. Synaechia..

127. The MOST common route of spread of supraglottic carcinoma :

A. Lymphatic.

B. Blood spread.

C. Anteriroly through fenestra of cartilage to pre-epiglottic space.

D. Inferiorly to the lung.

128. Early signs of respiratory failure:

A. Cyanosis.

B. Tachypnea.

C. Subcostal retraction.

D. Biphasic stridor.

E. Irritability and gasping.

129. Exostosis is characterised by all except:

A. Multiple.

B. Bilateral.

C. Peduculated.

D. Usually in cold water divers.

E. Lamellated bone .

500. 130-In a patient with right paralytic labyrinth, which of the following is

correct:

A. Right beating nystagmus.

B. Left beating nystagmus.

C. Vertical nystagmus.

D. Total hearing loss.

131. In acoustic neuroma, you can find:

A. High frequency SNHL.

B. Low frequency SNHL.

C. Flat audiogram.

D. Notch at 2 KHZ.

132. In modified radical neck dissection type I , which of the following

will be preserved:

A. Thoracic duct.

B. Spinal accesory nerve.

C. Internal jugular vein.

D. Sternomastoid muscle.

E. 2 & 3.

133. Trotter' triad consisit of all of the following except:

A. Bilateral conductive hearing loss.

B. Otalgia and facial pain.

C. Unilateral immobile soft palate.

D. Unilateral ear effusion.

134. The nasopalatine nerve supplies sensation to the mucosa of the?

A. Anterior premaxillary palate.

B. Soft palate.

C. Lateral nasal passage.

D. Anterior cheek.

135. The most commonly injured branch of the facial nerve in

rhytidectomy is the?
A. Temporal.

B. Marginal mandibular.

C. Buccal.

D. Cervical.

E. Zygomatic .

501. 136-Infection spread from the maxillary sinus intracranially most

likely travels through the ?

A. Angular veins.

B. Ophthalmic artery.

C. Superior labial veins.

D. Pterygoid plexus .

137. Which virus is especially associated with unilateral sensorineural

hearing loss?

A. cytomegalovirus

B. rubella

C. rubeola

D. adenovirus

E. mumps.

138. Susceptibility to noise-induced hearing loss may be potentiated by

A. genetic predisposition.

B. smoking.

C. the gender of the subject.

D. excessive alcohol intake.

E. heart disease.
139. Which is the most common traumatic ossicular abnormality?

A. necrosis of the long process of the incus

B. incudostapedial joint disarticulation

C. fracture of the stapes suprastructure

D. fixation of the incus

E. dislocation of the stapes footplate.

140. Which of the following is untrue about Waardenburg?s syndrome

(WS)?

A. It may be associated with Hirschsprung?s disease.

B. Dystopia canthorum occurs in WS1 and WS3.

C. Hearing loss is typically mixed in nature.

D. Profound hearing loss is common.

E. It may be associated with heterochromia iridis.

502. 141-Branchio-oto-renal syndrome may be associated with the

following, except

A. dilated vestibular aqueduct.

B. autosomal recessive inheritance.

C. mutations in EYA1.

D. renal anomalies.

E. marked phenotypic variability.

142. Which of the following statements is most accurate about

congenital hearing loss?

A. The incidence is decreasing.

B. Fifty percent or more is inherited.

C. It is always profound.

D. It may be late in onset.

E. It is nearly always sensorineural in nature.

143. The most reliable means of improving hearing in the patient with

otosclerosis is a

A. hearing aid.

B. fenestration operation of Lempert.

C. stapedectomy.

D. stapedotomy

E. partial stapedectomy.

144. The principal objective in stapes surgery is to

A. protect the inner ear from intense sound.

B. increase round window membrane mobility.

C. restore ossicular continuity.

D. restore sound pressure transmission to the inner ear.

E. increase fluid movement in the inner ear.

145. Which of the following does not describe Carhart?s notch?

A. ranges in magnitude up to 15 dB

B. is centered at 2 kHz

C. is an apparent sensorineural hearing loss

D. usually disappears after stapes surgery

E. occurs without a conductive hearing loss.

503. 146-The most frequent site of first occurrence of otosclerosis is in the

A. oval window rim.

B. fossula post fenestram.

C. round window niche.

D. fissula ante fenestram.

147. Computed tomography scanning is superior to magnetic resonance

imaging in establishing which one of the following diagnoses?

A. Bezold?s abscess

B. coalescent mastoiditis

C. epidural abscess

D. cerebellar abscess

E. subdural empyema.

148. Critical steps in constructing a canal wall down mastoid cavity

include all of the following except

A. removal of the mastoid tip.

B. obliteration of the mastoid with soft tissue.

C. wide saucerizarion of the cavity.

D. always drilling parallel to the facial nerve and using copious irrigation

to identifythe sheath before exposing it.

E. removal of conchal cartilage when performing the meatoplasty.

149. The most critical factor in avoiding injury to the facial nerve during

mastoid operations is

A. use of a facial nerve monitor.

B. a preoperative CT scan.

C. drilling parallel to the nerve.

D. using a diamond bur.

E. exposing the sheath of the nerve by removing the overlying bone.

150. Therapy that has been proven to help in otitis media (OM) includes

all of the following except

A. antibiotics.

B. antihistamines.

C. corticosteroids.

D. tympanostomy tube placement.

E. analgesics.

504. 151-Advanced malignancies of the temporal bone are best treated with

a. Surgery only

b. Radiation only

c. Surgery and radiation

d. Chemotherapy

152. What is the most common cause of inoperability in congenital

aural atresia?

a. Absence of the oval window

b. A facial nerve overlying the oval window

c. Poor mastoid pneumatization

153. One of these complications is not seen with underlay

tympanoplasty grafting:

a. Reperforation

b. Blunting

c. Infection

d. Myringitis of the graft.

d. Unilateral atresia.

154. Which one of following statements is correct?

a. Blunting is a complication of underlay tympanoplasty.

b. The rate of take for overlay tympanoplasty is greater than for

underlay tympanoplasty.

c. Lateralization is a complication of underlay tympanoplasty.

d. Myringitis is not seen after underlay tympanoplasty.

155. Cartilage should be considered as a graft material in the following

situations:

a. The atelectatic ear

b. Cholesteatoma

c. A perforation anterior to the annulus

d. A draining perforation

e. All of the above

156. Contraindications to canal wall reconstruction

tympanomastoidectomy include

a. Mastoid cholesteatosis

b. Sinus tympani involvement

c. Facial paralysis
d. Tegmen defect with meningoencephalic herniation

505. 157-The most common intraoperative finding associated with revision

stapedectomy is

a. Perilymph fistula

b. Prolapsed facial nerve

c. Displaced prosthesis

d. Fibrosis of oval window tissue.

158. Presence of acoustic reflexes on a preoperative audiogram should

prompt the operating surgeon to

a. Cancel the surgery.

b. Order a CT scan.

c. Consider superior semicircular canal dehiscence as a cause of the

conductive hearing impairment.

d. Do all of the above.

159. What segment of the facial nerve is most commonly damaged as a

result of temporal bone trauma?

a. Intracranial

b. Meatal

c. Labyrinthine/perigeniculate

d. Tympanic

160. Which of the following is considered to be an absolute

contraindication to cochlear implantation?

a. Duration of deafness greater than 30 years

b. Auditory neuropathy

c. Enlarged vestibular aqueduct

d. Michel aplasia

e. All of the above

161. An absolute contraindication to middle fossa vestibular nerve

section is

a. An only hearing ear

b. Bilateral Ménière?s disease

c. Incapacitating vertigo

d. Diuretic allergy

e. Age less than 60 years

506. 162-The most common form of BPPV results from

a. Anterior canal canalithiasis

b. Lateral canal cupulolithiasis

c. Lateral canal canalithiasis

d. Posterior canal cupulolithiasis

163. What is the most common serious complication of superior canal

dehiscence (SC

D. plugging surgery in the initial 24 hours after surgery?

a. Aphasia

b. Hematoma

c. Seizure

d. Meningitis

e. Posterior canal canalithiasis

164. Gradenigo?s syndrome usually includes all of the following except

a. Retro-orbital pain

b. Fourth cranial nerve palsy

c. Otorrhea

d. Hearing loss

e. Sixth nerve palsy.

165. Which of the following drugs is most likely to cause permanent

hearing loss?

A. erythromycin
B. quinine

C. cisplatin

D. penicillin G

166. A 30 years old patient with recurrent attacks of vertigo, hearing

loss and tinnitus associated with nausea and vomiting has

a- benign paroxysmal positional vertigo

b-vestibular neuronitis

c-Meniere?s disease

167. The inner ear is ebmbryologically derived from

A. ectoderm

B. entoderm

C. mesoderm

D. all of the above

507. 168-All of the following are examples of absorbable suture, except

which of the following?

A. Polyglactin

B . Poliglecaprone 2 5

c. Polypropylene

D . Polydioxanone
d-acoustic neuroma.

169. In a diagnostic workup of headache, further radiologic evaluation

with MRI or cr scan is indicated in which of the following

circumstances?

A. Pulsatile headaches

B. Headache awakening one from sleep

C. Onset of headache in childhood

D. Unilateral headache

170. Which drug is most likely to be effective for the treatment of

migraine-associated vertigo?

A. Sumatriptan

B . Meclizine

c. Nortriptyline

D . Diazepam

171. Which of the following descriptions is characteristic of carcinoma in

situ?

A. Pushing borders with mild atypia along the basal layer

B. Mild atypia, but with violation of the underlying basement membrane

C. Full-thickness cellular atypia with an intact basement membrane

D. Moderate atypia extending into the upper third of the mucosa .

172. Robotic surgery benefits from:

A. 360° wristed motion

B . Scaled motion with tremor suppression

C. Binocular magnification

D. Both B and C

E. All of the above

508. 173-A cerebrospinal fluid leak during ethmoidectomy is most likely to

occur at:

A. The junction of fovea ethmoidalis and lamina papyracea

B. The medial fovea ethmoidalis

C. The insertion of the uncinate process

D. The planum sphenoidale

174. To best determine whether the lamina papyracea is intact, which

test or procedure should be used?

A. Intraoperative CT scan

B. Fat float test

C. Bulb press test

D. Endoscopic dissection and search for orbital fat

175. Which of these is the most commonly identified organism in

subperiosteal orbital abscess due to sinusitis?

A. Pseudomonas aeruginosa

B. Haemophilus influenzae

C. Streptococcus pneumoniae
D. Streptococcus viridans .

176. What is the initial radiographic study of choice in a patient with

suspected cerebrospinal fluid (CSF) leak from accidental trauma?

A. High-resolution CT scan

B. MR imaging

c. cr cisternogram

D. Radionuclide cisternogram

E. MR cisternogram

177. Which of the following is not considered part of the nasal valve?

A. Head of the inferior turbinate

B. Bony piriform aperture

C. Nasal floor

D . Membranous septum

509. 178-Which of the following most commonly causes nasal valve

obstruction?

A. Previous rhinoplasty

B. Turbinate hypertrophy

C. Nasal polyposis

D. Congenital

179. Which of the following glands produce the majority of the

unstimulated saliva?
A. Parotid glands

B. Minor salivary glands

C. Sublingual glands

D. Submandibular glands .

180. Based on the multicellular theory of tumorigenesis,

mucoepidermoid carcinoma arises from:

A. Excretory duct cells

B. Acinar cells

C. Striated duct cells

D. Intercalated duct cells

181. Workup for a new diagnosis of vocal fold paralysis does not

routinely include:

A. Cf scan

B . Laryngeal electromyography (LEMG)

C. Swallowing assessment

D. Serology

182. What is the first-line treatment for recurrent respiratory

papillomatosis?

A. Surgical removal

B. Inhaled cidofovir

C. High-dose oral steroid burst

D. Azathioprine

E. Radiation therapy
510. 183-Stroboscopy allows assessment of the following except:

A. Vocal fold closure

B. Vocal fold mobility

C. Mucosal pliability

D . Vocal fold level during phonation

E. Vocal fold sub-epithelial pathology .

184. Continuous positive airway pressure (CPAP) is effective for

obstructive sleep apnea because it:

A. Supports the soft palate

B. Compresses the tongue base

C. Stimulates activity of dilating muscles

D. Prevents pharyngeal collapse during expiration

E. Forces the pharynx open after obstruction

185. Temporary vocal fold augmentation materials include:

A. Silas tic

B. Hyaluronic acid

c. Titanium

D . Gore-Tex

E. Teflon

186. Which of the following is the most common cause of iatrogenic

bilateral vocal fold paralysis?

A. Cervical spine surgery

B . Lung surgery

c. Thyroid surgery

D . Carotid surgery

187. Where are septal fractures most commonly seen?

A. Above the interface with the maxillary crest

B. At the caudal septum

C. At the junction of the cartilage with the perpendicular plate of the

ethmoid bone

D. Right where the cartilage interfaces with the maxillary crest

E. Mediastinoscopy

511. 188-Which of the following is one of the most important factors in

successful frontal sinus obliteration?

A. Choosing the correct obliteration material

B. Complete removal of all sinus mucosa

C. Choosing the appropriate plate size for posterior table reconstruction

D . Use of atraumatic technique for elevation of the pericranial flap

189. Which of the following nasal bone fractures are most likely to be

associated with other facial fractures?

A. Displaced nasal fractures

B. Fractures of the caudal aspect of the nasal bones

C. Fractures of the cephalic end of the nasal bones

190. Which is not a vertical buttress of the face?

A. Zygomaticomaxillary

B. Zygomatic arch

C. Nasomaxillary

D. Pterygomaxillary

D. Fractures of the nasal sidewall

191. Robin sequence is characterized by:

A. Micrognathia, cleft palate, and glossoptosis

B . Micrognathia, cleft palate, and airway obstruction

C. Cleft palate, airway obstruction, and glossoptosis

D. Micrognathia, glossoptosis, and airway obstruction.

192. Which of the following is the second most commonly occurring

type of tracheoesophageal fistula (TEF) ?

A. Proximal TEF with distal esophageal atresia (E

A. B. Proximal EA with distal TEF

C. H-type TEF

D . Proximal and distal TEF with EA

193. Which of these is the most likely diagnosis in a neonate with

expiratory stridor and a brassy cough?

A. Congenital subglottic stenosis

B. Tracheomalacia

C. Robin sequence

D . Bilateral vocal fold paralysis

512. 194-. Imaging for pediatric rhinosinusitis is most accurately

accomplished with:

A. Plain films

B. CT scans

C. MRI

D . Maxillary sinus transillumination

195. A child with bilateral second branchial cleft anomalies {BC

A. may

have all of the following except:

A. Bilateral preauricular pits

B . Sensorineural hearing loss

C. Renal disease

D. Microtia

E. Autosomal recessive inheritance.

196. Recurrent respiratory papillomatosis (RRP) demonstrates a

predilection for which of the following sites?

A. Junction of ciliated and squamous epithelium

B. The undersurface of the vocal folds

C. The laryngeal ventricle

D. All of the above

197. Which of the following is currently the most common indication for

tracheotomy in the pediatric population?

A. Providing access for pulmonary toilet

B. Airway obstruction from subglottic stenosis

C. Airway obstruction from craniofacial abnormalities

D. Respiratory failure and ventilator dependence

198. All of the following are appropriate associations on radiologic

evaluations except:

A. Steeple sign-laryngotracheitis

B. Thumbprint sign-epiglottitis

C. Air trapping on chest radiograph-vocal cord immobility

D. Thickened soft tissue overlying

C. spine-retropharyngeal

abscess/phlegmon

513. 199-The most common presenting symptoms in children with recurrent

respiratory papillomatosis (RRP) are:

A. Dysphagia and poor weight gain

B. Dyspnea with exertion

C. Progressive hoarseness and stridor

D. Odynophagia
200. Which laryngeal site is the most at risk of developing

radionecrosis?

A. Cricoid

B . Thyroid lamina

c. Arytenoid

D . Epiglottis

201. Which of the following salivary cancers is most associated with

pain and perineural spread of tumor?

A. Acinic cell cancer

B. Adenoid cystic cancer

C. High-grade mucoepidermoid cancer

D. Squamous cell cancer

202. Fibrous dysplasia is commonly treated with:

A. Observation

B . Recontouring and esthetic surgery

C. Wide local excision

D. Chemotherapy.

203. The most common acute toxicity observed after oral radiation

therapy are:

A. Mucositis, osteonecrosis, and xerostomia

B . Mucositis, carotid endarteritis, and xerostomia

C. Mucositis, dysphagia, and xerostomia

D. Mucositis, fibrosis, and xerostomia

204. The commonest presenting symptom of nasopharyngeal (NP)

carcinoma is

A. Epistaxis

B. Hearing loss due to serous otitis media

C. Enlarged cervical lymph node

D. Nasal obstruction

514. 205-Which of these is the most common presenting symptom( s) for

tracheal adenoid cystic carcinoma?

A. Hemoptysis

B . Dyspnea

c. Fever

D . Dysphagia

206. What is the only absolute contraindication to primary

tracheoesophageal puncture?

A. Obesity

B. Prior radiation

C. Partial pharyngectomy
D. Separation of trachea and esophageal party wall

E. Neck mass

E. Abducent nerve palsy.

207. Accurate diagnosis of obstructive sleep apnea {OS

A. can best be

made by:

A. A careful history with a complete review of systems

B. Bed partner history

C. Physical examination of the upper airway

D . A home sleep study or an in-lab polysomnogram

208. Clinical outcomes in the assessment of obstructive sleep apnea

(OS

A. treatment include:

A. Apnea-hypopnea index

B. Daytime sleepiness

C. Airway collapsibility

D. Oxygen desaturation

209. What is considered the gold standard for treatment of obstructive

sleep apnea in adults?

A. Nasal septoplasty

B. Positive airway pressure therapy

C. Uvulopalatopharyngoplasty

D. Tongue base reduction therapy

515. 210-Most cases of sudden sensorineural hearing loss (SSNHL) are

caused by:

A. Temporal bone trauma

B. Genetic predisposition

C. Neurologic disease

D. No identifiable source \ediopathic .

211. Spontaneous hearing recovery after a sudden sensorineural

hearing loss, if it is to occur, occurs within what time frame?

A. 3 days

B. 2 weeks

C. 2 months

D. 6 months

212. Which of the following indications in congenital aural atresia is the

most important determinant of surgical candidacy by CT scan?

A. Degree of mastoid pneumatization

B . Size and position of ossicles

C. Thickness of atretic bone

D. Size of middle ear

213. Which of the following is true regarding the presence of

semicircular canal fistula from erosion by cholesteatoma?

A. Most patients complain of vertigo .

B. The maj ority involve the posterior semicircular canal .

C. Removal of the matrix from a fistula inevitably results in an

anacoustic ear.

D. It is best managed with topical neomycin.

E. In an extensive fistula with a contacted mastoid, a canal-wall-down (

CW

D. procedure is best .

214. Which of the following define the superior boundary of the sinus

tympani:

A. Subiculum.

B. Fossula of the cochlear window.

C. Meatal fossa.

D. Ponticulus.

E. Fossaovalis..

516. 215-The most common congenital ossicular anomalies is :

A. Stapes anomalies.

B. Malleus anomalies.

C. Incudo-stapedeal joint anomalies.

D. Incudo-malleal joint anomalies.

E. Incus anomalies.

216. Acute sppurative otitis media associated to facial palsy is adequatly

treated with:

A. Myringotomy and systemic A

B. B- Cortical mastoidectomy with systemic A

B. C-Cortical mastiodectomy with facial n. decompression.

D. Myringotomy with facial n.decompression.

E. Systemic AB .

217. The best line of treatment of uncontroled unilateral Meniere?s

disease with sever Vertigo and profound SNHL is ?

A. intrtympanic injection of corticisteroids.

B. intratympanic injection of gentamycin.

C. Labrinthectomy.

D. Vestibular nerve neuroectomy.

E. Ultrasound destruction of semicircular canals.

218. CSF is produced by a process of ultrafiltration mainly from the

following cells:

A. Ependymal cells.

B. Epithelial cells of choroid plexus.

C. Glial cells.

D. Intimal cells of I

C. blood vessels.

E. Ventricular supporting cells.

219-The most common cause of unilateral proptosis in adults is:

A. orbital pseudotumour

B. Graves ophthalmopathy

C. paranasal isnus tumours

D. lymphomas

E. meningioma
.

517. Except

In salivary gland tumours all the following are true

220.

A. The commonest parotid tumour is pleomorphic adenoma.

B. The adenolymphoma (Warthin?s tumour) is commoner in young

women, is painful and grows rapidly.

C. A submandibular tumour is more likely to be malignant than a parotid

tumour.

D. In mucoepidermoid carcinoma, recurrence rates and survival

correlate

with histological grade.

E. Distant metastases after many years are characteristic of

adenoidcystic carcinoma.

221. Malignant changes of long standing recurrent pleomorphic

adenoma of the parotid are suspected:

A. If the recurrence is a single module of tumor.

B. If the recurrence is multiple small modules.

C. When the recurrence is in the deep lobe of parotid.

D. When previous surgery was a simple lumpectomy.

E. If patient had previous surgery plus radiotherapy .

222. The most reliable diagnostic tool for lateral sinus thrombosis is:

A. MRI.

B. MR

A. C- CT scan.

D. Echo of high neck.

E. Lumbar puncture

223. The auriculo temporal nerve

A. supplies the skin of the upper 2/3 of the lateral surface of the auricle

B. is a branch of maxillary nerve

C. supplies the middle ear mucosa through the tympanic plexus

D. non of the above

224. The Eustachian tube is opened by contraction of

A. tensor tympani muscle

B. levator palati muscle

C. tensor palati muscle

D. Salpingopharyngeus muscle

518. 225-The sensory end-organ of the semicircular canal is :

a- the organ of Corti

b- the macula
c- the crista

d- non of the above .

226. All of the following are diagnostic of tympanic membrane

retraction except

a- fore-shortened handle of malleus

b- prominent lateral process of malleus

c- Schwartz sign

d- distorted cone of light

227. Bezold abscess is a collection of pus :

a- above and in front of the auricle

b-behind the auricle

c-in the upper part of the neck deep to the sternomastoid

d- in the peritonsillar space

228. The most common complication of myringotomy operation is

a- injury of facial nerve

b-dislocation of the incus

c-injury of the jagular bulb

d- residual perforation

229. Intermittent fever with rigors and headach in a patient with

cholesteatma may be due to :

a-otogenic meningitis

b-otogenic brain abscess

c- lateral sinus thrombophlebitis

d-extradural abscess

230. A persistent profuse ear discharge after acute otitis media is

a- cholesteatoma

b- secretory otitis media

c-mastoiditis

d- diffuse otitis externa

519. 231-In otitic barotrauma, the following statements are correct except:

a-occurs during airplane ascent

b- occurs during airplane rapid descent

c- can cause rupture of the tympanic membrane

d- occurs during diving

232. The commonest cause of vertigo is

a- meniere?s disease

b-labyrinthitis

c-benign paroxysmal positional vertigo

d-ototoxicity

233. Most cases of extradural abscess of the temporal lobe

a- are asymptomatic and discovered accidentally during mastoidectomy

b- present with persistent ipsilateral temporal headach

c- present with vertigo

d- present with pulsating discharge,hearing loss and tinnitus .

234. The type of hearing loss in otosclerosis may be

a- conductive

b- sensorineural

c-mixed

d-all of the above

235. A 30 years old patient with recurrent attacks of vertigo, hearing

loss and tinnitus associated with nausea and vomiting has

a- benign paroxysmal positional vertigo

b-vestibular neuronitis

c-Meniere?s disease

d-acoustic neuroma

236. In lower motor neurone facial paralysis with intact taste sensation

at the anterior 2/3 of the tongue, the level of the lesion is :

a- in the internal auditory canal

b-in the horizontal tympanic part

c- in the vertical part above the stapes

d- in the stylomastoid foramen

520. 237-By modified radical mastoidectomy we mean

a- removal of mastoid air cells and all middle ear contents

c- removal of diseased mastoid air cells

c- removal of mastoid air cells and all middle ear contents with

preservation of healthy remnants of tympanic membrane and ossicles

d- non of the above .

238. Which of the following is associated with objective tinnitus

a-Menière's disease.

b-Ear wax impaction.

c-Acoustic neuroma.

d-Palatal myoclonus.

e-Middle ear effusion

239. THE SECOND COMMONEST CPA MASS LESION IS:

A. GLIOMA

B. ANEURYSM

C. MENINGIOMA

D. EPIDERMOID
240. External auditory canal receives blood supply from all the arteries

except:

A. Posterior auricular

B. Superficial temporal

C. Facial

D. Maxillary

241. Lymphatic drainage of pinna goes to:

A. Parotid node

B. Retroauricular node

C. Superficial cervical node along external jugular vein

D. All of the above .

242. Tegmen tympani is formed by:

A. Petrous part

B. Squamous part

C. Both of the above

D. Mastoid part

521. 243-glossopharyngeal nerve enters the middle ear through:

A. Roof

B. Floor

C. Anterior wall

D. Posterior wall

244. Processus cochleariformis contains:

A. Basal turn of cochlea

B. Tensor tympani tendon

C. Stapedius tendon

D. Apex of the cochlea

245. Central axis of cochlea is known as:

A. Spiral lamina

B. Modiolus

C. Processus cochleariformis

D. Crus commune .

246. Which of the following involve the floor of the mouth:

a- Ludwig's angina.

b- Infectious mononucleosis.

c- Peritonsillar abscess.

d- Glossitis.

247. Which is not correct for infectious mononucleosis:

a- it is viral.

b- Affect lymph glands.

c- Confirmed by Paul banner test.

d- There is increase in the count of monocytes.

248. all are present in the medial wall of tympanic cavity except:

a- oval window

b- Round window

c- Pyramid

d-promontory

e-tympanic part of facial nerve

e- There is increase in the count of lymphocytes

522. 249-Most benign tumor of frontal sinus

a- fibroma

b- polyp

c- angioma
d- osteoma

e- papilloma .

250-Which of the following is not the site for PARAGANGLIOMA?

a . Carotid bifurcation

b. Jugular foramen

c. Promontory in middle ear

d. Geniculate ganglion

251. Greisinger?s sign means:

A· Pain over the tempromandibular joint

B· Pain in the eye

C· Pain and tenderness over the mastoid

D· Pain and tenderness over the auricle

252. Fossa of Rosenmullar is a common site for:

A· Angiofibroma

B· Lipoma

C· Adenoid

D· Nasopharyngeal carcinoma

253. Early sign of nasopharyngeal carcinoma is:

A· Unilateral secretory otitis media

B· Trotter?s triad

C· Petrositis

D· Nasal obstruction

254. Reactionary bleeding after adenoidectomy is treated by:

A· Removal of the remnants and posterior pack

B· Antibiotics
C· Anterior nasal pack

D· Ligation of the bleeding vessel

523. 255-The usual cause of reactionary post-tonsillectomy bleeding is:

A· Slipped ligature

B· Wound infection

C· Tonsillar remnant

D· Early extubation

256. In multiple laryngeal papillomata, all of the following are true

accept:

A· Occurs in children

B· Affects only the glottic area

C· Recurrence is common

D· Best treated by laser surgery

257. Trotter?s triad is a clinical diagnosis of:

A· Nasopharyngeal angiofibroma

B· Nasopharyngeal cyst

C· Petrositis

D· Nasopharyngeal carcinoma

258. Posterior nasal packing is indicated in all of the following situations

except:

A· Severe posterior epistaxis

B· Antro-choanal polyp

C· Reactionary post-adenoidectomy bleeding

D· After removal of nasopharyngeal angiofibroma .

259. Griessinger?s sign is positive in:

A· Acute petrositis

B· Acute sinusitis

C· Acute labyrinthitis

D· Lateral sinus thromophelbitis

260. During total laryngectomy for malignancy, which of the following

maneuvers is not performed?

A. The strap muscles are divided and removed with the larynx.

B. The inferior constrictor is separated from the thyroid cartilage.

C. The vallecula is entered below the hyoid bone.

D. The trachea and esophagus are separated in an areolar plane,

which may beentered superiorly or inferiorly.

E. Tracheal transection occurs at least 2 cm below the tumor

524. 261-Total laryngogectomy for laryngeal cancer was first performed in

1873. by

A. Lange (United States).

B. Watson (Scotland).

C. Billroth (Austria).

D. Czerny (Austria).

E. Trotter (England).
262. Pharyngoesophageal reconstruction

A. is usually achievable with skin or dermal grafts.

B. seldom results in the resumption of swallowing.

C. is incompatible with speech rehabilitation.

D. is best accomplished by gastric transposition when the

esophagectomy extends low in the thorax.

E. cannot include neck skin reconstruction

263. Contraindications to total laryngopharyngectomy include

A. laryngeal spread of hypopharyngeal tumors.

B. extrapharyngeal spread.

C. superior mediastinal node metastasis.

D. deep invasion of the vertebral bodies.

E. vocal cord fixation

264. Which of the following has little effect on recorded auditory brain

stem response potentials during acoustic tumor removal?

A. filter types and settings

B. near- versus far-field recordings

C. depth of anesthesia

D. acoustic interference

E. rate of stimulation

265. Before beginning the removal of a cerebellopontine angle tumor,

the functional integrity of the facial nerve monitoring system should be

checked. Which method is preferred?

A. tapping the electrode tip

B. observing the stimulus artifact

C. stimulating the facial nerve in the mastoid segment

D. stimulating the muscle directly

E. measuring electrode impedances

525. 266-Which of the following cochlear components in most sensitive to

acoustic overstimulation?

A. inner hair cells

B. outer hair cells

C. spiral ganglion cells

D. dendritic endings of the cochlear nerve

267. The major effect of facial nerve monitoring during acoustic tumor

removal surgery is

A. decreased surgical time.

B. fewer postoperative complications.

C. increased proportion of cases with House-Brackmann grade I or II

results postoperatively

D. decreased incidence of House-Brackmann grade V and VI results

postoperatively.

E. reduced medicolegal risks.

268. Which of the following components of the auditory pathway is

suspected of contributing to the susceptibility of an individual to sound

overexposure effects?

A. cochlear efferent system

B. medial geniculate

C. auditory cortex

D. middle ear

269. The frequency region first affected by habitual exposure to

excessive sound is typically ___ kHz.

A. 0.5 to 2

B. 3 to 6

C. 6 to 8

D. 8 to 10

270. Herpes zoster oticus (Ramsay-Hunt syndrome)

A. is caused by primary varicella zoster virus infection.

B. produces bilateral vertigo and hearing loss mainly in the elderly.

C. produces unilateral facial weakness, ear pain, and occasional vertigo

or hearing loss mainly in the elderly.

D. produces unilateral loss of facial sensation, ear pain, vertigo, and

hearing loss mainly in the elderly.

E. none of the above

526. 271-Rubella causes the greatest fetal cochlear damage when the

maternal infection occurs

A. during the first trimester.

B. during the second trimester.

C. during the third trimester.

D. anytime during the pregnancy

272. The modern stapedectomy was first described in 1956 by

A. Toynbee.

B. Rosen.

C. Shea, Jr.

D. House

273. At times early stapes fixation of otosclerosis can be diagnosed

A. by seeing stapes fixation on physical examination.

B. by seeing an abnormality of the tympanic membrane.

C. when a maximum conductive hearing loss is present on audiogram.

D. when an on-off stapedial reflex can be seen on impedance

audiometry

274. What is the most common site of fixation of the stapes?

A. annular ligament

B. posterior crus

C. anterior crus

D. entire footplate

275. The facial recess provides access to the

A. internal auditory canal.

B. retrolabyrinthine air cells.

C. epitympanic space.

D. posterior mesotympanum.

E. mastoid antrum

276. Surface landmarks used for cortical mastoidectomy include the

A. sinodural angle of Citelli.

B. petrosquamous (Korner's) septum.

C. temporal line.

D. scutum

527. 277-Which of the following is an advantage of the modified radical

mastoidectomy over the intact wall procedure?

A. the ability to maintain the normal anatomy of the external ear canal

B. the ability to easily identify recurrent cholesteatoma

C. fewer episodes of postoperative otorrhea

D. superior hearing results

E. the fact that long-term follow-up is not necessary .

278. Which of the following is the most significant variable in successful

hearing restoration following ossiculoplasty?

A. size of the mastoid

B. presence or absence of middle-ear mucosa

C. eustachian tube function

D. type of prosthesis used

279. Which of the following is never required in the medial surface

tympanic membrane grafting technique?

A. deepithelialization of the surface of the tympanic membrane

remnant

B. lateralization of a medially rotated malleus handle

C. gelatin sponge packing in the eustachian tube

D. removal of a prominent bony protrusion of the anterior canal wall

280. A maximal conductive hearing loss occurs with which combination

of conditions?

A. ossicles intact, perforation centered over the round window

B. ossicles intact, total perforation

C. ossicular discontinuity, total perforation

D. ossicular discontinuity, intact tympanic membrane.

281. Which of the following temporal bone injuries carries the most

urgent need for surgical exploration?

A. transverse petrosa fracture with severe vertigo and nystagmus

B. longitudinal fracture with cerebrospinal fluid leakage and bleeding

from the external auditory canal

C. transverse temporal bone fracture

with immediate complete facial paralysis

D. penetrating tympanic membrane injury to the posterosuperior

quadrant with severe vertigo and nystagmus

E. triangular, trapdoor depressed tympanic membrane perforation

528. 282-The most useful radiographic study to evaluate the majority of

patients with trauma to the temporal bone is

A. axial computed tomography.

B. coronal computed tomography.

C. magnetic resonance imaging without contrast enhancement.

D. magnetic resonance imaging with contrast enhancement.

E. digital subtraction angiography .

283. Bezold's abscess results when mastoid infection

A. erodes the outer cortex of the mastoid tip.

B. in the zygomatic air cell erodes through the cortical bone at the

zygoma.

C. perforates the medial aspect of the mastoid tip.

D. perforates the outer cortex at the root of the zygoma into the

mandibular fossa

E. erodes the cortex through the area perforata

284. Which of the following is the poorest choice for first-line

antimicrobial therapy in acute otitis media?

A. erythromycin/sulfisoxazole

B. trimethoprim?sulfamethoxazole

C. clarithromycin or azithromycin

D. ciprofloxacin

E. amoxicillin

285. Infection spreads from the middle-ear cavity by which of the

following pathways?

A. periphlebitis or thrombophlebitis

B. bony erosion

C. direct extension through preexisting pathways

D. all of the above

E. a and c

286. In cholesteatomas, most bone resorption occurs because of

A. pressure necrosis.

B. the action of osteoblasts.

C. the action of osteoclasts.

D. the action of mononuclear phagocytes.

E. alkaline phosphatase

529. 287-Patients with aural cholesteatomas most commonly seek medical

advice because of

A. imbalance and vertigo.

B. chronic purulent drainage.

C. conductive hearing loss.

D. pain.

E. facial tics.

288-Children with a history of chronic otitis media with effusion have

mastoids that are

A. well pneumatized and sclerotic.

B. well pneumatized but not sclerotic.

C. poorly pneumatized and sclerotic.

D. poorly pneumatized but not sclerotic.

E. no different than those of normal children

289. Valsalva's and Politzer's tests of eustachian tube function assess

A. active tubal opening function but not tubal patency.

B. active tubal opening function and tubal patency.

C. tubal patency but not active tubal opening function.

D. tubal closing function but not tubal opening function.

E. tubal protective function but not tubal closing function

290. The infant eustachian tube differs developmentally from that in

adults in that the tube in infants is

A. longer.

B. shorter.

C. less compliant.

D. stiffer.

E. more efficient

291. The only muscle that actively opens the eustachian tube is the

A. levator veli palatini.

B. tensor veli palatini.

C. salpingopharyngeus.

D. lateral pterygoid.

E. medial pterygoid.

530. 292-Which of the following statements represents a characteristic of

the loudness of tinnitus?

A. Loudness matching with pure tones shows a close relationship to

subjective tinnitus loudness.

B. Loud tinnitus only occurs at pitch-matched frequencies with hearing

loss greater than 30 d

B. C. Loudness frequently fluctuates daily.

D. Parauditory tinnitus is perceived as louder than sensorineural

tinnitus.

E. Distressingly loud tinnitus is more characteristic of middle-aged

individuals than of the elderly

293. An ipsilateral retroauricular thrill in a patient with tinnitus suggests

A. a venous hum.

B. a carotid?cavernous fistula.

C. a glomus jugulare tumor.

D. a glomus vagale tumor.

E. an occipital arteriovenous malformation

294. Which of the following drugs is mostly likely not ototoxic?

A. bisphosphonate

B. vancomycin

C. carboplatin

D. deferoxamine

295. Which of the following drugs has the greatest vestibulotoxicity?

A. neomycin

B. netilmicin

C. streptomycin

D. kanamycin

296. Which of the following medications is known to cause cochlear

outer hair-cell damage?

A. furosemide

B. vancomycin

C. cisplatin

D. erythromycin

531. 297-In addition to facial nerve paralysis, the most common finding in
Ramsay-Hunt syndrome is

A. otalgia.

B. internuclear ophthalmoplegia.

C. downbeat nystagmus.

D. conductive hearing loss.

E. pulsatile tinnitus

298. Which of the following statements regarding otomycosis is true?

A. Systemic treatment is necessary.

B. Aspergillus and Candida are the most common responsible genera.

C. Invasive fungal infections are common in immunocompetent

patients.

D. The most common complaint is severe otalgia.

E. It occurs most commonly in diabetic

299. Which of the following statements regarding necrotizing external

otitis are true?

A. Staphylococcus is the predominant pathogen.

B. It occurs only in elderly, diabetic patients.

C. Diagnosis is made by gallium-67, technetium-99m, and high-

resolution computed tomography.

D. Surgical intervention is usually limited to minimal debridement.

E. Mortality is 75%.

300. The optimum surgical approach for the auditory brain stem

implant is the

A. middle cranial fossa.

B. retrosigmoid.

C. suboccipital.

D. transcochlear.

E. translabyrinthine

301. The target region for the auditory brain stem implant is the

A. interstitial nucleus of Cajal.

B. dorsal and ventral cochlear nuclei.

C. zona inserta of the cochlear nerve.

D. roof of the fourth ventricle.

E. superior and medial vestibular nuclei.

532. 302-A 30-year-old woman in good health with which of the following

would be the best candidate for an Audiant bone-anchored hearing aid?

A. bilateral sloping moderate to profound sensorineural hearing loss

B. bilateral flat moderate sensorineural hearing loss

C. bilateral 60-dB conductive hearing loss from EAC atresia

D. bilateral moderate CHL from ossicular discontinuity

E. bilateral severe mixed hearing loss from otosclerosis

303. In children 6 to 24 months of age, the technique most commonly

used to assess hearing is

A. behavioral observation audiometry.

B. visual reinforcement audiometry.

C. conditioned play audiometry.

D. conventional audiometry.

E. auditory brain stem response audiometry

304. Facial nerve stimulation during cochlear implant use is most likely

to occur in patients with deafness from

A. large vestibular aqueduct syndrome.

B. aminoglycoside ototoxicity.

C. temporal bone fracture.

D. congenital cytomegalovirus infection.

E. autoimmune inner-ear disease

305. The most accurate information needed for planning reconstruction

of the ossicular chain is provided by

A. tympanometry.

B. computed tomography scanning.

C. pure tone and speech audiometric testing.

D. impedence testing.

E. intraoperative ossicular assessment

306. Which of the following should raise the greatest suspicion that a

CHL on the audiogram is not, in fact, conductive at all?

A. an absent ipsilateral acoustic reflex

B. a word understanding score of 64%

C. a type A tympanogram

D. a type Ad tympanogram

E. a type C tympanogram

533. 307-The transmission of sound energy through the middle ear in

humans is influenced most by the

A. areal ratio of the round-to-oval window.

B. ossicular lever ratio.

C. pars flaccida.

D. peripheral third of the pars tensa.

E. central two thirds of the pars tensa.

308. The use of intratympanic aminoglycoside antibiotics for the control

of vertigo in Ménière's disease

A. is beneficial only with complete ablation of ipsilateral peripheral

vestibular function.

B. has a lower incidence of postoperative hearing loss.

C. decreases endolymph volume secondary to toxic effects on the

dark cells of the vestibular labyrinth.

D. is restricted to bilateral disease.

E. is contraindicated in the elderly.

309. Which of the following is thought to be of greatest importance in

the etiology of Ménière's disease?

A. failure of the resorption limb of radial endolymph flow.

B. failure of the resorption of longitudinal endolymph flow.

C. immune complex reactions in the stria vascularis.

D. enlargement of the vestibular aqueduct and endolymphatic sac.

E. decreased endolymph production by the dark cells of the vestibular

labyrinth .

310. Shrapnell's membrane is attached directly to the squama of the

temporal bone at the

A. suprameatal spine.
B. petrosquamous suture.

C. tympanic sulcus.

D. notch of Rivinus.

E. cribriform area

311. The most common cause of inherited congenital deafness is

A. the oculoauriculovertebral spectrum.

B. autosomal recessive inheritance.

C. Stickler syndrome.

D. Usher's syndrome.

E. branchio-otorenal syndrome

534. 312-Which test reflects vestibulospinal function?

A. headshake nystagmus

B. electronystagmography

C. rotatory chair testing

D. tandem walking

E. positional testing

313. Thyroid cancer

A. does not occur in multinodular goiter.

B. is frequently undetectable by palpation.

C. constitutes 50% of endocrine malignancies.

D. is found as an occult malignancy in 1% of autopsies.

E. is more frequent than benign thyroid lesions in irradiated thyroid

glands .
314. What is the most common ectopic location for a missing superior

parathyroid gland?

A. intrathymic

B. carotid sheath

C. intrathyroidal

D. superior mediastinal

E. retroesophageal?retropharyngeal area

315. Which pharyngeal pouch gives rise to the superior parathyroid

glands?

A. first

B. second

C. third

D. fourth

E. fifth

316. Inspiratory stridor tends to occur when there is an obstruction

A. above the level of the vocal cords.

B. at the level of the vocal cords.

C. below the level of the vocal cords.

D. in the nasal airway.

E. all of the above

535. 317-Otolaryngology patients with reflux disease appear to differ from

most gastroenterology patients in that they

A. are obese.

B. have dysphagia.
C. have heartburn.

D. have regurgitation.

E. have daytime reflux

318. Which test is the most sensitive for the diagnosis of

extraesophageal reflux?

A. barium esophagography

B. esophagoscopy and biopsy

C. radionuclide scanning

D. ambulatory pH monitoring

E. Bernstein acid perfusion test

319. Which technique can be used for cricopharyngeal spasm after total

laryngectomy to improve voice?

A. pharyngeal plexus neurectomy

B. cricopharyngeal myotomy

C. botulinum toxin injection of the pharynx

D. all of the above .

320. The only absolute contraindication to performing a secondary

tracheoesophageal puncture for speech rehabilitation is

A. stomal stenosis.

B. pharyngeal stenosis.

C. decreased vision.

D. manual dexterity.

E. severe chronic obstructive airway disease

321. In rheumatoid arthritis involving the larynx,

A. onset is slow and progressive, without airway emergencies.

B. cricoarytenoid joint arthritis occurs in the majority.

C. laryngeal muscles are unaffected.

D. rheumatoid nodules do not occur.

E. symptoms are often a presenting feature of the disease

536. 322-The best indication for use of the Co2 laser in laryngeal surgery is

A. excision of benign vocal fold polyps.

B. the treatment of recurrent respiratory papillomas.

C. vaporization of a vocal fold lesion.

D. excision of an anterior commissure vocal fold carcinoma .

323. Which pharyngoesophageal reconstruction technique results in the

highest rateof postoperative pharyngocutaneous fistula?

A. free jejunal transposition

B. pectoralis major myocutaneous flap

C. gastric pull-up

D. radial forearm free flap

E. deltopectoral flap

324. Which technique is most useful for reconstruction after total

laryngopharyng

-oesophagectomy?

A. free jejunal transposition

B. radial forearm free flap

C. pectoralis major myocutaneous flap

D. lateral thigh fasciocutaneous flap

E. gastric pull-up

325. In treating laryngeal granulomas,

A. it is essential to remove the precipitating factor.

B. speech therapy is usually not required.

C. patients should not be treated for reflux if radiographic studies are

negative.

D. excision with the carbon dioxide laser should be avoided

326. Which of the following statements regarding surgical treatment of

vocal fold cysts is true?

A. Vaporization of the cyst and overlying mucosa with the carbon

dioxide laser is the best treatment.

B. Marsupialization using microlaryngeal scissors is the best treatment.

C. Endoscopic microaspiration of cysts is the easiest and most

effective treatment.

D. Excision preserving the overlying mucosa is the ideal treatment.

E. Rate of recurrence is low regardless of the surgical treatment

537. 327-Preepiglottic space involvement by supraglottic carcinoma is

associated with

A. cricoid cartilage involvement.

B. a positive Delphian node.

C. thyroid cartilage involvement.

D. level IV node involvement.

E. bilateral cervical metastases.

328. In treating early vocal fold cancer,

A. carbon dioxide laser excision offers a higher cure rate than does

radiotherapy.

B. carbon dioxide laser excision is more effective than is radiation

therapy if the tumor involves the anterior commissure.

C. radiation therapy is associated with less morbidity than is endoscopic

excision.

D. laser excision should not be attempted in cases of recurrence.

E. endoscopic excision offers a one-session treatment as opposed to

multiple sessions with radiotherapy

329. The best initial treatment of infantile subglottic hemangiomas is

A. carbon dioxide laser vaporization.

B. tracheotomy and open excision

C. conservative treatment with steroids and observation.

D. the Nd:YAG laser.

330. The most sensitive test to assess arytenoid mobility in patients

with unilateal or bilateral vocal fold motion impairment is

A. laryngeal electromyography.

B. flexible fiberoptic laryngoscopy.

C. flow?volume loop and spirometry.

D. dynamic laryngeal computed tomography.

E. direct laryngoscopy and arytenoid palpation .

331. Which of the following is the least acceptable treatment for vocal

nodules?

A. precise vaporization with the microspot Co2 laser set a 0.5 W

B. vocal fold stripping

C. precise removal with forceps and microscissors

D. voice therapy from a speech pathologist

538. 332-Which kind of laryngeal cyst has been reported in association with

larynx cancer?

A. anterior saccular

B. lateral saccular

C. epidermoid inclusion

D. mucus retention

333. The best method to assess both the etiology and degree of

aspiration is

A. videolaryngoscopy.

B. pharyngeal manography.

C. scintigraphy.

D. dynamic magnetic resonance imaging.

E. videofluoroscopic swallowing study

334. Vocal nodules

A. often require surgical therapy.

B. always result in dysphonia.

C. are congenital.

D. are synonymous with vocal cord cysts.

E. usually respond to medical and behavioral therapy

335. Optimal results after vocal fold surgery may be best achieved by

including

A. postoperative absolute voice rest.

B. smoking cessation.

C. antireflux therapy.

D. preoperative and postoperative voice therapy.

E. perioperative steroids

336. Which of the following is a contraindication for MRI ?

A. cardiac pacemaker

B. metallic cochlear implant

C. cerebral aneurysm clip

D. all of above

337. Retropharyngeal space enlargement can occur in

A. retropharyngeal abscess.

B. lymphoma.

C. cystic hygroma.

D. all of the above

539. 338-Laryngeal stroboscopy is

A. unable to assist in the diagnosis of glottic cancer.

B. unable to reveal vocal scanning effects.

C. a series of light flashes coordinated with fundamental vocal

frequency.
D. very useful in patients with vocal fold paralysis.

E. only able to demonstrate the vertical mucosal wave.

339. A chyle leak can be treated by all of the following except

A. bed rest.

B. continued suction drainage.

C. a long-chain fatty-acid diet.

D. pressure dressings.

E. A chyle leak can be treated by all of the above

340. Which structure is situated between the aryepiglottic fold and the

vestibular fold?

A. conus elasticus

B. saccule

C. triangular membrane

D. ventricle

E. quadrangular membrane

341. Patients with cricothyroid joint arthritis frequently complain of

A. dysphagia.

B. aspiration.

C. hoarseness.

D. odynophagia.

E. neck pain

342. Lymphomas of the head and neck present in all of the following

areas except
A. the cervical nodes.

B. Waldeyer's ring.

C. the thyroid gland.

D. the subdermal layer of skin.

E. the orbit.

540. 343-Which of the following lymph node groups is removed in

posterolateral neck dissection?

A. suboccipital

B. perilateral

C. postauricular

D. periparotid

E. a and c

344. Which nerves are routinely preserved in supraomohyoid neck

dissections?

A. motor branches of the cervical plexus

B. greater auricular nerve

C. ansa cervicalis

D. sensory branches of the cervical plexus

E. a, b, and d

345. Neurofibromas differ from schwannomas in that

A. schwannomas are not encapsulated.

B. neurofibromas can be easily resected from the nerve of origin.

C. neurofibromas do not undergo sacomatous transformation.

D. neurofibromas are not encapsulated

346. von Recklinhausen's disease is characterized by

A. autosomal dominant inheritance.

B. more than five café-au-lait spots on the body.

C. positive family history in around 50% of cases.

D. possible association with spinal bifida.

E. all of the above

347. Which nodes are most frequently involved in squamous cell

carcinoma of the upper aerodigestive tract?

A. external jugular

B. upper jugular

C. submandibular

D. supraclavicular

E. preauricular

541. 348-The best incision to explore the carotid sheath for a unilateral

penetrating neck injury is a(n)

A. modified Conley incision.

B. lateral cervical incision along the anterior sternocleidomastoid

muscle.

C. MacFee incision.

D. H incision.

E. Schobinger incision

349. Which zone of the neck has the most difficult surgical access?

A. base of the skull region

B. midcervical region
C. lower cervical region below the cricoid

D. posterior neck triangle

E. anterior cervical triangle

350. The anatomic boundaries of zone III of the neck are from the

A. hyoid to the base of the skull.

B. superior border of the thyroid cartilage to the base of the skull.

C. hyoid to the mandible angle.

D. mandible angle to the base of the skull.

E. clavicle to the cricoid

351. The prevertebral fascia envelops all of the following except the

A. vagal nerve.

B. brachial plexus.

C. sympathetic trunk.

D. cervical nerve plexus.

E. phrenic nerve

352. Which of the following surgical principles for dealing with deep

neck infection is false?

A. Establishing an airway is the first priority.

B. Wide debridement of necrotic fascia and skin is necessary in

treating patients with cervical fasciitis.

C. External drainage of all deep neck abscesses is necessary.

D. Normal anatomy is often distorted.

E. Ligation of thrombosed vessels may be necessary

if thrombosis has occurred

542. 353-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

354. Nasopharyngeal angiofibroma ?

A. is a common tumor of the head and neck.

B. arises from the posterolateral wall of the roof of the nose.

C. is seen only in patients in their teenage years or younger.

D. requires angiography for diagnosis.

E. is unlikely to be resectable through a lateral rhinotomy approach

355. Apnea is defined as a cessation of air flow at the nostrils and

mouth for _ seconds.

A. 5

B. 10

C. 15

D. 20

356. What is the predominant blood supply to the platysmal

myocutaneous flap?

A. submental branch of the facial artery

B. transverse cervical artery

C. platysmal branch of the occipital artery

D. ascending cervical artery

357. Nodal metastases in nasopharyngeal carcinoma

A. are rarely the presenting symptom.

B. indicate a worse prognosis if bilateral.

C. indicate a worse prognosis if low in the neck.

D. are not treated surgically.

E. should be confirmed by open biopsy prior to definitive therapy.

543. 358-Nasopharyngeal carcinoma

A. commonly presents as serous otitis media.

B. behaves more aggressively in Chinese populations.

C. has strong human leukocyte antigen associations in non-Chinese

populations.

D. may be excluded on nasopharyngeal examination if the mucosa is

macroscopically normal.

E. invades the skull base in only 10% of cases.

359-Residual disease after resection of nasopharyngeal angiofibroma

A. may remain asymptomatic.

B. has a natural history of relentless progression.

C. will eventually require a secondary form of treatment

D. is often fatal.

E. has a worse outcome in older patients

360. Otalagia may occur via cranial nerve

A. IX, from the glottic larynx.

B. IX, from the anterior lateral tongue.

C. X, from the hard palate.

D. IX, from the retromolar trigone.

E. V, from the oropharynx

361. What is the appropriate treatment for a T1N0 midline soft palate

lesion?

A. complete local excision and no postoperative radiation therapy if

margins are clear

B. complete local excision and postoperative radiation therapy to the

primary lesion if the margins are positive

C. radiation therapy to the primary lesion and both necks

D. radiation therapy to the primary lesion only

E. radiation therapy to the primary lesion and one side of the neck

362. The factor that is least likely to influence prognosis in squamous

cell carcinoma of the oropharynx is

A. tumor size.

B. depth of invasion.

C. histologic differentiation.

D. blood transfusion.

E. decreased proportions of cytotoxic suppressor cells

544. 363-Which type of malignant tumor may have a bilateral presentation?

A. mucoepidermoid carcinoma

B. adenoid cystic carcinoma

C. expleomorphic carcinoma

D. adenocarcinoma
E. acinic cell carcinoma

364. What is the most common presenting symptom of a malignant

parotid tumor?

A. facial nerve paralysis

B. skin ulceration

C. nodal metastasis

D. painless swelling

E. pain

365. Which of the following does not influence the timing and

performance of facial reanimation?

A. donor site morbidity

B. proximal and distal nerve integrity

C. age

D. inability to close the eyelid

E. patient expectations

366. What is the most successful approach for repair of most cribriform

cerebrospinal fluid leaks?

A. intranasal

B. external nasal

C. transantral

D. intradural

E. extradural

367. Cerebrospinal fluid leak may be confidently diagnosed by all of the

following means except

A. B2 transferrin.

B. computed tomography cisternography.

C. intrathecal dye injection.

D. intrathecal radio-tracer injection.

E. glucose oxidase test paper

545. 368-Which of the following would not explain the development of a

delayed

cerebrospinal fluid leak?

A. delayed increase in intracranial pressure

B. lysis of a clot in areas of dehiscence

C. resolution of edema

D. neural degeneration of olfactory fibers

E. wound maturation

369. The technique of removal of the intrasinus septum of the frontal

sinus is termed

A. the Ridell procedure.

B. the Lothrop (Chaput-Mayer) procedure.

C. Killian's procedure.

D. Lynch frontoethmoidectomy.

E. Kummel-Beck trephination

370. One contraindication to the Caldell-Luc operation is

A. foreign body in the antrum.

B. mucocele.

C. unerupted teeth in children.

D. antral cysts

371. During inspiration the main current of airflow in a normal nasal

cavity is through:

A. Middle part of the cavity in middle meatus in a parabolic curve

B. Lower part of the cavity in the inferior meatus in a parabolic curve

C. Superior part of the cavity in the superior meatus

D. Through olfactory area

372. Which o fthe following is the most common etiological agent in

paranasal sinus mycoses?

a) Aspergillus spp

b) Histoplasma

c) Conidiobolus coronatus

d) Candida albicans

546. 373-audiogram in early meniere's disease shows:

a-notch at 2 kHz in bone conduction.

b-notch at 4 kHz in air conduction.

c-a flat curve.

d-a rising curve

374. Melkersson-Rosenthal syndrome includes all except:

a-facial paralysis.

b-fissured tongue.

c-circumoral oedema.

d-sarcoidosis

375. In ramsay hunt syndrome,vesicular eruptions are seen in all the

following areas except?

a-concha.

b-posteromedial surface of pinna.

c-soft palate.
d-tragus and surrounding skin

376. recurrent facial paralysis is seen in all except:

a-acoustic neuroma.

b-diabetes.

c-sarcoidosis.

d-cholesteatoma.

377. landmark used for identification of geniculate ganglion of facial n.

is:

a-oval window.

b-processus cochleariformis.

c-pyramid.

d-digastric ridge

547. 378- Commonest complication of CSOM is

a) conductive deafness

b) Meningitis

c) temporal lobe abscess

d) Cholesteotoma

379. Unilateral nasal obstruction in a child is most

often due to

a) foreign body

b) chaonal atresia

c) polyps

d) fungal infection

380. Regarding multiple papillomas in the larynx which of the following

statements are correct:

a) common in infants and children

b) viral in origin

c) vocal cords usual site

d) treatment is removal by direct laryngoscopy

e) All are correct

548. 381- Hard elongated swelling in the tonsillar fossa

after tonsillectomy is:

a) thrombosed vein

b) tonsilolitth

c) elongated styloid process

d) calcified esophagus

382. Treatment of choice for otosclerosis is

a) Stepedectomy
b) fenestration

c) Hearing aid

d) taympanoplasty

383. Multi perforations of the tympanic membrane is

characteristic of otitis media due to

a) Staphylococcal

b) Strepta

c) tuberculous

d) Pneumococcal

549. 384- Carcinoma larynx with no neck secondaries is

treated by

a) laryngectomy

b) Laryngectomy and radical neck dissection

c) Radiation
d) Radiation & laryngectomy

385. Treatment of cholesteatoma of the middle ear

in a 6 year old

a) Radical mastoidectomy

b) modified radical mastoidectomy

c) simple mastoidectomy

d) None

386. The earliest symptom of acoustic neuroma is

a) deafness

b) Tinnitus

c) Vertigo

d) facial weakness
550. 387- Tonsils develop embryologically from

a) First pharyngeal pouch

b) Second pharyngeal pouch

c) Third pharyngeal pouch

d) Fourth phafyrfgea4pouch

388. Lancinating pain around the tonsils during eating

is indicative of:

a) Trigeminal neuralgia

b) Glossophyngeal neuralgia

c) facial neuralgia

d) None of the above

389- Polyp which has a mulberry appearance and

bleeding on touch is due to

a) Malignancy
b) Rhinosporiodisis

c) Antrochoanal polyp

d) Nasopharyngeal angiofibroma

551. 390-Which type of diverticulum is common in the

oesophagus

a) traction type

b) pulsion type

c) rolling hernia

d) none

391. Which collagen disease most commonly affects

the esophagus

a) Scleroderma

b) SLE

c) Polyarteritis nodosa
d) Wegners

392. Unsafe otitis media in a child with high fever

and convulsion, the diagnosis is

a) temporal lobe abscess

e) cerebellar abscess

b) meningitis

c) lateral sinus thrombosis

552. 393-Treatment of maxillary antral carcinoma (T3 No)

is

a) Only surgery

b) surgery and radiotherapy

c) chemotherapy of radiotherapy

d) radiotherapy only
394. Labyrinthine artery is a branch of

a) Internal carotid artery

b) Basilar artery

c) Posterior cerebellar artery

d) Anterior inferior cerebellar artery

395. Apple-jelly nodules on the nasal septum are

found in cases of:

a) Tuberculosis

b) Lupus vulgaris

c) Syphilis

d) Scleroma

e) None of the above

553. 396-Costen's syndrome refers to neuralgia

originating in the:
a) Temporomandibular joint

b) Optic foramen

c) Meatal foramen

d) Sphenopalatine ganglion

397. Areas of carcinoma of oral mucosa can be

identified by staining with:

a) 1 % zinc chloride

b) 2 % silver nitrate

c) Gentian violet blue

d) 2 % toluidine blue

398. Gustatory sweating and flushing (Frey's

syndrome) follows damage to the:

a) Trigeminal nerve
b) Facial nerve

c) Glossopharyngeal nerve

d) Vagus nerve

e) Auriculotemporal nerve

554. 399-Hyposthesia of the posterior aspect of the

external auditory canal may be an early sign of:

a) Trigeminal neuralgia

b) Costen?s syndrome

c) Lateral sinus thrombosis

d) Multiple sclerosis

e) Acoustic neuroma

400. Hyposthesia of the posterior aspect of the

external auditory canal may be an early sign of:

a) Trigeminal neuralgia
b) Costen?s syndrome

c) Lateral sinus thrombosis

d) Multiple sclerosis

e) Acoustic neuroma

401. Medication which may prevent rapid progress of

cochlear otosclerosis is

a) steroids

b) antibiotics

c) fluorides

d) vitamins

555. 402-Conditions that may cause esophageal strictures include all of the

following except

A. Behçet?s syndrome.

B. gastroesophageal reflux.

C. caustic ingestion.
D. polymyositis.

E. Crohn?s disease.

403. A white boy presents with a history of chronic sinusitis, pulmonary

infection, and malabsorption. Which of the following tests is the most

specific for his disease?

A. sweat chloride

B. c-ANCA

C. erythrocyte sedimentation rate

D. angiotensin converting enzyme level

E. rheumatoid factor

404. Which of the following therapeutic agents can be most

successfully used in the acute management of hereditary angioedema?

A. epinephrine

B. corticosteroid

C. antihistamine

D. C1-INH concentrate

E. attenuated androgen

405. The treatment of choice for verrucous carcinoma is

A. surgical resection followed by chemotherapy.

B. surgical resection followed by radiation therapy.

C. chemotherapy followed by radiation therapy.

D. radiation therapy followed by chemotherapy.

E. surgical resection.
406. A patient presents with bilateral cauliflower ear deformity, saddle

nose deformity, and stridor. Which of the following therapeutic agents

may be useful?

A. cidofovir

B. interferon

C. dapsone

D. attenuated androgens

E. C1-INH concentrate

556. 407-The ?gold standard? for treatment of advanced Wegener?s

granulomatosis is glucocorticoids and

A. trimethoprim and sulfamethoxazole.

B. methotrexate.

C. quinolone antibiotics.

D. cyclophosphamide.

E. dapsone.

408. The virus most commonly causing mumps (epidemic parotitis) is a

A. coxsackievirus.

B. poxvirus.

C. paramyxovirus.

D. herpesvirus.

E. papovavirus.

409. The fascia covering the parotid and submandibular glands

originates from which layer?

A. the superficial cervical fascia

B. the visceral or middle layer of the cervical fascia

C. the superficial layer of the deep cervical fascia

D. the superficial musculoaponeurotic system

E. the carotid sheath

410. Regional metastases to cervical lymph nodes decrease 5-year

survival rates by

A. 10%.

B. 20%.

C. 50%.

D. 80%.

E. 90%.

411. The most common synchronous secondary primary tumor in

patients with laryngeal carcinoma is

A. floor of the mouth carcinoma.

B. bronchogenic carcinoma.

C. base of the tongue carcinoma.

D. lymphoma.

E. esophageal carcinoma

557. 412-Which procedure is not indicated for vocal fold paralysis with

aspiration?

A. tracheostomy

B. laryngectomy

C. arytenoidectomy

D. medialization thyroplasty
E. Teflon injection

413. Isolated laryngeal candidiasis is usually secondary to

A. prolonged antimicrobial use.

B. systemic corticosteroid use.

C. inhaled corticosteroid use.

D. insulin-dependent diabetes.

414. Which section of the tracheobronchial system exhibit seromucous

glands?

A. Segmental bronchi

B. bronchioles

C. bronchioles terminales

D. bronchioles respiratory

E. alveolar ducts

415. Alveolar type II cells contain many lamellar bodies throughout

their cytoplasm containing:

A. Lysosomes

B. Phagocytosed debris

C. Secretory material

D. Mitochondria

E. infection with human immunodeficiency virus

416. The function of the ciliated epithelial cells of the respiratory

mucosa is:

A. secrete mucus
B. move mucus toward the pharynx

C. move macrophages toward the alveoli

558. 417-Concerning the thymus:

A. Lymphoid nodules form thymic cortex.

B. Epithelial reticular cells form Hassal?s corpuscles.

C. T cells migrate into medulla to become immunologically competent

D. Macrophage are essential component of blood thymus barrier.

418. Which of the following is thought to function in preventing

immune response against self antigens:

A. B cells.

B. T memory cells.

C. T helper cells.

D. T suppressor cells.

419. Which of the following are important factors in considering a

temporalis muscle transposition procedure?

a. Airway structure

b. Appearance of nasolabial structures

c. Type of smile on unaffected side

d. b and c

e. All of the above

D. are sensory cells

420. The best treatment of postoperative trismus is

a. Temporomandibular joint (TMJ) resection

b. TMJ prosthesis

c. Stretching therapy

d. Laser scar ablation

e. Steroid injection into the pterygoid muscles

421. Sagging of the postero-superior wall of the EAC occurs in:

a. Acute mastoiditis.

b. Furunculosis of the external ear.

c. Otitis media.
d. Petrositis.

422. Gradinigo syndrome occurs in:

a. Acute mastoid abscess.

b. Acute petrositis.

c. Chronic otitis media.

d. Secretory otitis media.

559. 423-Tobey-Ayer's test is a characteristic sign in:

a. Brain abscess.

b. Lateral sinus thrombosis.

c. Extradural abscess.

d. Meningitis.

e. Cavernous sinus thrombosis.

424. The fluids presents in secretory otitis media is:

a. Mucopurulent.

b. Serosanguinous.

c. Exudates.

d. Transudates.

e. Mixture of exudates & transudates.

425. Longitudinal fracture of the temporal bone may be associated with

all of the following EXCEPT:

a. LMNL facial palsy.

b. Traumatic perforation of the tympanic membrane.

c. Conductive hearing loss.

d. Profound hearing loss.

426. ABR "Auditory Brain stem Response" is used in:

a. Test of hearing in malingering.

b. Test of hearing in retrochoclear lesion.

c. Detection of acoustic neuroma.

d. All of the above.

427. The most accurate diagnostic test to detect degeneration of the

facial nerve:

a. Nerve excitability test.

b. Electromyography.

c. Electroneurography.

d. Stapedial reflex.

560. 428-The most common vertigo is:

a. Acoustic neuroma.

b. Ototoxicity.
c. Meniere's disease.

d. Benign paroxysmal positional vertigo.

429. The commonest organism in malignant otitis externa:

a. Streptococci.

b. Pneumococci.

c. Pseudomonas aeroginosa.

d. Moraxella catarrhalis.

430. Mixed hearing loss may be caused by one of the following:

a. Otosclerosis.

b. Meniere's disease.

c. Ear wax.

d. Acoustic neuroma.
431. Fluctuant SNHL usually occurs in:

a. Presbyacusis.

b. Meniere's disease.

c. Otosclerosis.

d. All of the above.

432. Nystagmus & vertigo induced by pressure on the tragus is a sign

of:

a. Fistula complicating cholesteatoma.

b. Benign paroxysmal vertigo.

c. Vestibular neuritis.

d. Cholesteatoma only.

433. The earliest symptom in a case with cholesteatoma that indicates

intracranial complication is:

a. Persistent headache.
b. Facial palsy.

c. SNHL.

d. Squint.

561. 434-A false +ve fistula test is due to:

a. Labyrinthine fistula with dead ear.

b. Cholesteatoma bridging an inner ear fistula.

c. Hyper mobile footplate of the stapes.

d. All of the above.

435. The concept that the facial nerve supplies the auricle is related to:

a. Ramsy-Hunt syndrome.

b. Jugular foramen syndrome.

c. Horner's syndrome.
d. Bell's palsy.

436. Topognostic test is used in the assessment of facial paralysis

include all the following EXCEPT:

a. Schirmer test.

b. Stapedial reflex.

c. Electroneurography.

d. Gustatory test.

437. All are true about rhinoscleroma EXCEPT:

a. It is endemic in Egypt.

b. It is a disease of low immunity & low resistance.

c. It runs in families due to genetic inheritance.

d. It is sub-epithelial inflammatory granuloma.

438. Mikulicz cell is a characteristic histological finding in:

a. Rhinoscleroma.

b. Rhinosporodosis.

c. Aspergillosis.

d. Sarcoidosis.

439. Perforation of bony part of the nasal septum occurs in:

a. Sarcoidosis.

b. Rhinoscleroma.

c. Tuberculosis.

d. Syphilis.

562. 440-Spontaneous recovery is usual in:

a. Rhinosporodosis.

b. Sarcoidosis.
c. Tuberculosis.

d. Syphilis.

441. The causative agent of rhinoscleroma is:

a. Sporozoon.

b. Low virulent T.B bacillus.

c. Treponema Ballidum.

d. Gram ?ve short capsulated diplobacillus.

442. The causative agent of lupus vulgaris is:

a. Sporozoon.

b. Low virulent T.B bacillus.

c. Treponema Ballidum.

d. Gram ?ve short capsulated diplobacillus.

443. All the following lines of treatment could be applied in

rhinoscleroma EXCEPT:

a. Rifampicin.

b. Cytotoxic drugs.

c. Surgery to canalize the stenosed canal.

d. Laser surgery.

444. Unilateral polypoidal mass arising from the lateral wall of the nose

in 55 years old man is most probably:

a. Inverted papilloma.

b. Rhinoscleroma.

c. Allergic nasal polyp.

d. Antrochoanal polyp.

445. Rhinoscleroma characterized by the following EXCEPT:

a. Hard-like nodules.
b. Histopathology shows Mikulicz cells.

c. Responses to rifampicin.

d. Ulceration of the surrounding tissue.

563. 446-Resistant epistaxis from below the middle turbinate requires

ligation of:

a. The anterior ethmoidal artery.

b. The sphenopalatine artery.

c. The maxillary artery.

d. The internal jugular vein.

447. Nasopharyngeal carcinoma cause Horner's syndrome as a result of

infiltration of:

a. 3rd cranial nerve.

b. 5th cranial nerve.

c. 7th cranial nerve.

d. Cervical sympathetic chain.

448. Surgery is contraindicated for ca.of maxillary sinus if X-ray refeal

of invovement of:

A. Floor of the orbit.

B. Foramen ovale.

C. Lateral antral wall.

D. Lamina papyracea.

E. Lateral ptyregoid plate

449. The best results in the treatment of advance ca.maxilla are

achieved by:

A. Surgery alone.

B. Radiation alone.

C. Surgery and radiation.

D. Surgery and chemotherpy.

450. In sudden recent unilateral hearing loss with vertigo:

A. Betahestine is the treatment of choice.

B. should be treated as an emergency.

C. Injectable steroid should be given for all patients.

D. The patient should be refered for out patient for investigations.

E. Antimicrobial treatment is of no value.

564. 451-Primary atrophic rhinitis is characterized by all of the following

except:

A. Recurrent epistaxis

B. Anosmia

C. Bad odor smelled by the neighbors

D. Affects male only

E. Laser resection

452. Functional endoscopic sinus surgery is the operation of

choice in all of the following except:

A. Chronic sinusitis

B. Mucocele of the paranasal sinuses

C. Nasal polyposis

D. Twisted nose

453. An adult presented with acute onset dysphagia, edema

of the uvula and palate, medially pushed tonsil and trismus is

most likely to have:

A. Parapharyngeal abscess

B. Acute retropharyngeal

C. Quinsy

D. Chronic retropharyngeal abscess

454. The following are signs of chronic tonsillitis except:

A. Enlarged cervical lymph nodes

B. Inequality of the size of the tonsils

C. Pus in the tonsillar crypts

D. Edema of the uvula

455. In multiple laryngeal papillomata, all of the following are

true accept:

A. Occurs in children

B. Affects only the glottic area

C. Recurrence is common

D. Best treated by laser surgery

565. 456-T.B of the larynx mostly affects:

A. Posterior part of the larynx

B. Supraglottis

C. Anterior part of the larynx

D. Subglottis

457. Safe type of chronic suppurative otitis media is characterized by:

A. Scantly offensive ear discharge

B. Profuse mucopurulent ear discharge

C. Marginal perforation

D. All of the above

458. Absent laryngeal click may suspect:

A. Supraglottic carcinoma

B. Pyriform fossa tumor

C. Subglottic cancer

D. Post-cricoid carcinoma
459. Myringotomy is indicated in:

A. Secretory otitis media

B. Acute otitis media with bulging drum

C. Otitic barotrauma

D. All of the above

460. The most serious complication following adenotonsillectomy is:

A. Reactionary hemorrhage

B. Respiratory obstruction

C. Respiratory infection

D. Non of the above

461. All the following are signs of chronic tonsillitis except:

A. Inequality of size

B. Congested anterior pillars

C. Presence of crypts over the medial tonsillar surface

D. Enlarged cervical lymph nodes

566. 462-Posterior nasal packing is indicated in all of the following situations

except:

A. Severe posterior epistaxis

B. Antro-choanal polyp

C. Reactionary post-adenoidectomy bleeding

D. After removal of nasopharyngeal angiofibroma

463. Shwartz?s sign may be positive in:

A. Chronic suppurative otitis media

B. Atelactatic middle ear

C. Meniere?s disease

D. Otosclerosis

464. Griessinger?s sign is positive in:

A. Acute petrositis

B. Acute sinusitis

C. Acute labyrinthitis

D. Lateral sinus thromophelbitis

465. Recurrent laryngeal nerve is motor to all of the intrinsic muscles of

the larynx except:

A. Vocalis muscle

B. Posterior cricoarytenoid muscle

C. Lateral cricoarytenoid muscle

D. Cricothyroid muscle

466. The only abductor muscle in the larynx is:

A. Sternothyroid muscle

B. Lateral cricoarynoid muscle

C. Cricothyroid muscle

D. Posterior cricoarynoid muscle

467. Cortical mastoidectomy is indicated in:

A. acute mastoiditis not responding to medical treatment

B. Bezold?s abscess

C. mastoid abscess
D. all of the above

567. 468-Facial nerve gives secretomotor supply to:

A. parotid gland

B. submandibular salivary gland

C. pituitary gland

D. thyroid gland

469. All the following are possible complications of acute sinusitis

except:

A. temporal lobe brain abscess

B. cavernous sinus thrombosis

C. orbital cellulitis

D. osteomylaitis

470. One of the signs of otogenic cerebellar abscess is:

A. hemiplegia

B. hemianethesia

C. aphasia

D. dysdiodokokainesia

471. Acute pulmonary edema occurring on opening of the trachea

during tracheostomy is due to:

A. sudden drop of pressure in the tracheobronchial tree and lungs

B. sudden wash of carbon dioxide

C. injury of the esophagus

D. non of the above

472. Hump nose is managed by:

A. Reduction rhinoplasty

B. Augmentation rhinoplasty

C. Nasal tip reconstruction

D. All of the above

473. Rhinoscleroma is treated by the following except:

A. Streptomycin

B. Rifampicin

C. Radiotherapy

D. Puncture and lavage

568. 474-Apnea immediately after tracheostomy is treated by:

A. Multiple skin incisions

B. Inhalation of oxygen

C. Temporary closure of the tracheostomy opening

D. Intubation

475. Kernig?s sign is present in:

A. Otitic meningitis

B. Otitic brain abscess

C. Otitic hydrocephalus

D. All of the above

476. The main site of ossicular necrosis in chronic suppurative otitis

media is:

A. Incudomalleolar joint
B. Long process of incus

C. Stapedial arches

D. Handle of malleus

477. On tracheostomy, apnea developed after incising the trachea is

due to:

A. Sudden wash of CO2 in the trachea

B. Sudden release of the pressure in the trachea

C. Reflex vagal stimulation

D. Non of the above

478. The most common cause of esophageal stricture in children is:

A. Esophageal carcinoma

B. Diphtheria

C. Achalasia of the cardia

D. Corrosive intake

479. Fossa of Rosenmullar is a common site for:

A. Angiofibroma

B. Lipoma

C. Adenoid

D. Nasopharyngeal carcinoma

569. 480-Early sign of nasopharyngeal carcinoma is:

A. Unilateral secretory otitis media

B. Trotter?s triad

C. Petrositis
D. Nasal obstruction

481. All of the following are removed in radical neck dissection EXCEPT:

A. sternocleidomastoid muscle

B. external carotid artery

C. internal jugular vein

D. spinal accessory nerve

E. submaxillary gland

482. Regarding laryngeal cancer, which of the following is FALSE?

A. hoarseness appears early

B. involved nodes are not palpable in 35% of cases

C. distant metastasis appears early

D. direct extension is common

E. it is 90% five-year curable when limited to one cord

483. Which of the following factors is NOT associated with squamous

cell carcinoma

of the larynx?

a) male sex

b) age in fifth and sixth decades

c) history of woodworking
d) large ethanol intake

e) tobacco smoking

484. In LeFort I fractures, the fragment consists of all of the following

EXCEPT

a) upper teeth and palate

b) lower portions of the pterygoid processes

c) portions of the walls of both maxillary antra

d) nasal spine

e) bridge of the nose

570. 485-In general, traumatic perforations of the tympanic membrane:

a) are a surgical emergency

b) will heal spontaneously in most cases

c) usually require operative repair

d) require microsurgical repair

e) require a graft for repair

486. The MOST common organism in acute otitis media of older

children and adults is:

a) Staphylococcus

b) Streptococcus

c) Hemophilus influenzae

d) Klebsiella pneumoniae

e) Pseudomonas

487. Small, malignant tumours of the larynx that are intrinsic in origin

and have not spread beyond the larynx are BEST treated by:

a) irradiation

b) laryngofissure

c) total laryngectomy
d) total laryngectomy and radical neck dissection

e) radium needle implants

488. Mixed tumours of the salivary gland:

a) are most common in the submaxillary gland

b) are usually malignant

c) are most common in the parotid gland

d) usually cause facial paralysis

e) are associated with calculi

489. Which of the following is NOT a cause for conductive hearing loss?

a) otitis media

b) otosclerosis

c) noise-induced hearing loss

d) perforation of the tympanic membrane

e) ossicular chain disruption

571. 490-Conductive hearing losses are usually reversible. Which of the

following conditions is reversible by surgical treatment?

a) otosclerosis

b) presbycusis

c) sudden hearing loss

d) ototoxicity

e) meningitis

491. What is the BEST treatment for most cases of sensorineural

hearing loss associated with aging (presbycusis)?

a) nothing

b) hearing aid
c) ear trumpet

d) diuretic therapy

e) labyrinthectomy

492. The MOST common benign lesion of the external ear is:

A. melanoma

B. chondrodermatitis nodularis chronicus helicus

C. cerumenoma

D. actinic keratosis

E. exostosis of the canal

493. MOST of the infectious and/or inflammatory diseases involving the

middle ear space are secondary to:

A. ciliary dyskinesia

B. resistant pathogens

C. eutstachian tube dysfunction

D. tobacco abuse

E. allergic diathesis

494. Acute otitis is:

A. a rare condition

B. the most common reason ill children visit the doctor

C. usually not accompanied by pain and fever

D. caused by coliform bacteria

E. treated by placing ventilating tubes

572. 495-The MOST common cause for infant stridor, accounting or 60% of

the cases, is:

A. subglottic hemangioma

B. vocal cord paralysis

C. laryngomalacia

D. congenital webs

E. laryngeal cleft

496. What is the MOST common cause of acquired subglottic stenosis?

A. motor vehicle trauma

B. prolonged endotracheal intubation

C. chronic bronchitis

D. tracheoesophageal fistula

E. previous tracheal surgery

497. A 5-year-old child has persistent serous effusions in both ears for

6. months after a routine acute infection. He has a 40-dB condutive

heraring loss in bothears and has been having trouble in school. What

would be the BEST treatment for this child?

A. observe the child for another 3 months

B. prescribe amoxicillin for 10 days

C. recommend hearing aids

D. place ventilating tubes

E. prescribe prophylactic antibiotics for 3 months

498. The following clinical entities are common causes for tinnitus

EXCEPT:

A. high-frequency hearing loss

B. Ménière?s disease

C. ototoxic drugs

D. loud noise exposure

E. acute otitis media

499. Vertigo is very common in all of the following conditions EXCEPT:

A. vestibular neuritis

B. Ménière?s disease

C. presbycusis

D. viral labyrinthitis

E. benign paroxysmal positional vertigo

573. 500-The fastest, safest means of establishing a surgical airway is:

A. endoscopic intubation

B. tracheotomy under local anesthesia

C. tracheotomy under general anesthesia

D. cricothyrotomy

E. puncture through the thyroid membrane

501. The most common cause of unilateral proptosis in adults is:

A. orbital pseudotumour

B. Graves ophthalmopathy
C. paranasal isnus tumours

D. lymphomas

E. meningioma

502. The most common cause of unilateral proptosis in children is:

A. dermoid

B. orbital cellulitis

C. rhabdomyosarcoma

D. lymphangioma

E. capillary haemangioma

503. The most common otolaryngologic manifestation of Wegener?s

granulomatosis at onset is:

A. subglottic stenosis

B. septal perforation

C. hearing loss

D. sinusitis

E. otitis media

504. Excision of the vocal cord and a segment of underlying thyroid

cartilage with or without the ipsilateral arytenoid. Which of the

following is the best description of such maneuver?

A. laryngofissure with cordectomy .

B. supracricoid laryngectomy

C. vertical partial laryngectomy .

D. vestibulectomy

E. cordectomy
574. 505-The proper placement of a Teflon injection in the vocal fold is:

A. as far lateral as possible

B. in Reinke?s space

C. superior to level of the glottis

D. inferior to the level of the glottis

E. in one mass at the level of the vocal process

506. The most common cause of vocal cord paralysis in the adult is

A. surgical trauma

B. Malignancy

C. neurological disorder

D. Idiopathic

E. infections

507. A patient with gastroesophageal reflux a lesion of the middle

portion of the true vocal cord. This finding most likely suggest:

A. Reinke?s oedema

B. contact ulcer

C. Granuloma

D. Carcinoma

E. glottic stenosis

508. A 28 year old patient is diagnosed as having an intracordal vocal

fold cyst. The operative technique of choice is:

A. needle aspiration

B. steroid injection

C. marsupillization
D. vaporization with CO2 laser

E. excision with mucosal preservation

509. Which of the following vocal cord lesions is most appropriate for

CO2 laser excision?

A. polyp

B. nodule

C. intracordal cyst

D. sulcus vocalis

E. papilloma

575. 510-Intubation granuloma can be seen after endotracheal intubation.

On indirect laryngoscopy, the lesion is seen in the following anatomic

position on the vocal cords

A. anterior commisure

B. junction of anterior 1/3, posterior 2/3

C. mid vocal cords

D. posterior 1/3

E. vocal process of the arytenoids

511. A patient referred for evaluation of vertigo has slurred speech.

Speech evaluation reveals ataxic dysarthria. The diagnosis most likely :

A. parkinsonism

B. cerebral palsy

C. brainstem stroke

D. myasthenia gravis

E. multiple sclerosis
512. The most accurate diagnosis of a superior laryngeal nerve

paralysis is made by:

A. - history

B. - physical examination

C. - electroglottography

D. - electromyography

E. - phonoanalysis

513. Bilateral recurrent laryngeal nerve paralysis as the result of

external trauma is most commonly associated with:

A. cricotracheal separation

B. thyroid cartilage fracture

C. arytenoid cartilage dislocation

D. epiglottic prolapse

E. anterior commissure avulsion

514. The sensitivity of a test is defined by which one of the following?

A. true positive/ (true positive + false positive)

B. true positive/ (true positive + false negative)

C. true negatives/ (true negatives + false positive)

D. true negatives/ (true negative + false negative)

E. true positives/ (true negatives + false positives)

576. 515-The specificity of a test is defined by which one of the following?

A. true positive/ (true positive + false positive)

B. true positive/ (true positive + false negative)

C. true negatives/ (true negatives + false positive)

D. true negatives/ (true negative + false negative)

E. true positives/ (true negatives + false positives)

516. Of the following complications of parotidectomy, the most common

is

A. Haematoma

B. Seroma

C. flap necrosis

D. infection

E. salivary fistula

517. What is the most characteristic presentation of sarcoidosis?

A. lymphadenopathy

B. facial paralysis

C. airway obstruction

D. characteristic chest X-ray

E. parotid swelling

518. Distant metastasis are most likely to occur with which of the

following parotid malignancy?

A. acinous cell carcinoma

B. malignant oncocytoma

C. high grade mucoepidermoid carcinoma

D. adenocarcinoma

E. adenoid cystic carcinoma

519. Which of the following factors increases the likelihood of

pleomorphic adenoma recurrence following tumour resection and

postoperative radiation therapy for recurrent tumour?

A. patient age

B. presence of gross tumour following surgical resection

C. total delivered radiation dose

D. number of previous recurrences

E. number of radiation fractions per day

577. 520-Treatment of recurrent pleomorphic adenoma of the parotid

should include:

A. radiation therapy

B. tumour enucleation

C. observation until the tumour becomes symptomatic

D. tumour resection, removal of residual gland and facial nerve

preservation

E. enbloc resection of the tumour with surrounding tissue including the

facial nerve with immediate grafting

521. The presence of lung metastases in a patient with a history of

adenoid cystic carcinoma of the head and neck is associated with:

A. an average survival of less than one year

B. an average survival of greater than 2 years

C. an average survival shorter than with metasteses in other

organs

D. long term cure with a regimen of chemotherapy and radiartion

therapy

E. regional lymph node disease

522. Of the following, the most common primary sarcoma of the major

salivary glands is:

A. malignant fibrous histiocytoma

B. leiomyosarcoma

C. neurosarcoma

D. angiosarcoma

E. osteosarcoma

523. The most common therapeutic option in the management

of patients with carcinoma of unknown primary is:

A. radiotherapy

B. modified neck dissection

C. chemoradiotherapy

D. radiotherapy with salvage surgery

E. selective neck dissection

578. 524-Of biopsy-proven granulomatous inflammation of a cervical lymph

node in a child, the most common cause is:

A. Mycobacterium tuberculosis

B. S. aureus

C. anaerobes

D. cat-scratch disease

E. non-tuberculous mycobacteria

525. A barium swallow of a patient who experienced a sensation of

food sticking, heartburn and episodic choking reveals a marked

cricopharyngeal impression. Which of the following steps would be

most helpful in making a diagnosis?

A. Upper oesophageal sphincter manometry

B. 24-hour ambulatory pH monitoring

C. Pharyngeal plexus block

D. Trial of H2 blockers

E. oesophagoscopy

526. What is the correct treatment of an asymptomatic Zenker?s

diverticulum detected accidentally on a barium study?

A. diverticulectomy

B. diverticulopexy

C. observation

D. cricopharyngeal myotomy

E. Dohlman procedure with CO2 laser

527. A 51-year-old male is sent for a barium swallow &the report comes

back as a peristalsis, esophageal dilatation, and failure of the

lower oesophageal sphincter to relax with retention of ingested

material.This patient probably has:

A. achalasia of the cardia

B. diffuse esophageal spasm

C. oesophageal carcinoma

D. pharyngeal pouch

E. trachea-oesophageal fistula

528. The most common cause of a platelet-related clotting disorder is

A. Idiopathic thrombocytopenic purpura.

B. Megaloblastic anemia

C. Von Willebrand?s disease

D. Aspirin therapy

579. 529-The inner ear has become damaged in the following diseases

except

A. Autoimmune inner ear disease

B. Relapsing polychondritis

C. Mixed connective tissue disease.

D. Polyarteritis nodosa

530. Which of the following lung capacities cannot be measured by a

spirometer?

A. Total lung capacity

B. Inspiratory capacity

C. Vital capacity

D. Functional residual capacity.

531. Which of the following statements is false?

A. OSAS has no effect on intellectual performance.

B. OSAS is more common in males than females.

C. OSAS is associated with increased incidence of myocardial infarction

and stroke.

D. Diminished pharyngeal muscle tone will aggravate symptoms of

snoring and sleep apnea.

E. The most frequently occurring daytime symptom of OSAS is

sleepiness.

532. All of the following are amide local anesthetics except

A. Lidocaine

B. Bupivacaine

C. Ropivacaine

D. Tetracaine.

E. Mepivacaine

533. Which of the following drugs is most likely to cause permanent

hearing loss?

A. erythromycin

B. quinine

C. cisplatin.

D. penicillin G

580. 534-In an otherwise healthy patient with advanced laryngeal cancer,

the treatment regimen that is most likely to result in preservation of the

larynx at 2 years is

A. concurrent chemotherapy and radiation therapy

B. induction chemotherapy followed by radiation.

C. radiation followed by adjuvant chemotherapy

D. total laryngectomy followed by radiation

E. radiation alone

535. An example of a gene identified as playing a role in the molecular

generation of head and neck cancer is

A. Tumor necrosis factor _ (TNF-_)

B. Tubulin

C. p53

D. DNA polymerase

536. Which of the following is an infectious etiology of

laryngotracheobronchitis, or ?croup??

A. Haemophilus influenzae

B. Staphylococcus aureus

C. Branhamella catarrhalis

D. Parainfluenza type 3

E. Varicella

537. The narrowest portion of an infant?s upper airway is

A. The carina

B. The vocal cords

C. The subglottic space

D. The nasal airway

E. The pharynx

538. A patient is noted to have a draining sinus tract deep in the

external canal. Surgical resection will include a dissection of

A. The jugular vein

B. The superficial temporal artery

C. The hyoid bone

D. The stapes

E. The facial nerve

581. 539-The central portion of the hyoid bone should be removed when

removing a

A. Dermoid

B. Thyroglossal duct cyst

C. Thyroid nodule

D. Branchial cleft cyst

E. Thymic cyst

540. The removal of a second branchial cleft sinus tract may require

removal of

A. The thyroid gland

B. The tonsil

C. The parotid gland

D. The hypoglossal nerve

E. The hyoid bone

541. Which of the following types of radiographic evaluations may be

used to evaluate patients with airway noise?

A. Barium swallow study

B. CT

C. MRI

D. Ultrasound

E. All of the above

542. The p53 gene encodes for a protein that

A. Enhances hearing acuity

B. Increases tumor metastases

C. Arrests the cell cycle at G1 in a cell with damaged DNA

D. All of the above

543. Usher?s syndrome type 1 affects

A. The visual system only

B. The auditory system only

C. The vestibular system only

D. All of the above

544. The dorsal (pars superior) portion of the otocyst forms

A. The cochlea

B. The bony portion of the labyrinth

C. The semicircular ducts and the utricle

D. The ossicular chain

E. The tympanic membrane

582

545. Rubella infection of the inner ear can result in

A. Scheibe-type dysplasia of the cochlea and saccule

B. Agenesis of the stria vascularis

C. Malformation of the anterior crista

D. Agenesis of a cochlear duct

E. Duplication of the lateral semicircular duct

546. Von Hippel-Lindau disease may cause otologic symptoms

mimicking

A. Meniere?s disease

B. Benign positional vertigo

C. Presbycusis

D. Sudden idiopathic deafness

547. The appropriate behavioral assessment procedure for a typically

developing 12-month-old infant is

A. Visual reinforcement audiometry

B. Play audiometry

C. Immittance audiometry

D. Otoacoustic emissions

548. For evaluation of tinnitus, the optimal imaging modality is

A. Computed tomographic (CT) scan with intravenous (IV) contrast

B. Positron emission tomographic (PET) scanning

C. Angiography

D. T2-weighted magnetic resonance imaging (MRI)

E. MRI with IV contrast

549. Temporal bone trauma causing facial nerve paralysis is best

evaluated by

A. Surgical exploration

B. CT scan with IV contrast

C. MRI

D. CT scan without contrast high resolution

550. Penetration of which structure allows infection to spread from the

paranasal sinuses to the orbit?

A. Basal lamella

B. Fovea ethmoidalis

C. Uncinate process

D. Lamina papyracea

583. 551-What is a postnatal derivative of the first branchial cleft?

A. The footplate of the stapes

B. The external acoustic meatus

C. The cervical sinus (of His)

D. The incudomalleolar joint

E. The middle ear cavity

552. What is the nerve that innervates the muscle derived from the

third branchial arch?

A. The trigeminal nerve

B. Cranial nerve VII

C. The glossopharyngeal nerve

D. The hypoglossal nerve

E. The recurrent laryngeal branch of the vagus nerve

553. Most acoustic neuromas arise from which of the following nerves?

A. Superior vestibular nerve

B. Acoustic portion of the eighth nerve

C. Inferior vestibular nerve

D. Nervus intermedius
554. Which of the following is not a contraindication for a patient to

undergo magnetic resonance imaging (MRI) scanning?

A. Titanium reconstruction plates

B. Cardiac pacemaker

C. Intracranial aneurysm clip

D. Cochlear implant

555. The best study to evaluate for metastatic nodal disease in the

neck is

A. Ultrasound

B. MRI scan

C. Computed tomographic (CT) scan

D. Plain films

584. 556-The most specific sign of metastatic disease within a lymph node

is

A. Central necrosis

B. Oblong shape

C. Enhancement

D. High signal on T1-weighted image

557. Laryngeal stroboscopy is the least likely to benefit patients who

have:

A. spasticity

B. nonvibrating segment

C. intracordal mass lesion

D. early vocal cord cancer

E. vocal cord at different level

558. a patient with Gastroesophageal reflux has a lesion of the middle

portion of the true vocal cord. This finding most likely suggests:

A. reinke?s edema

B. glottic stenosis

C. contact ulcer

D. granuloma

E. carcinoma

559. In patients with spastic dysphonia, botulinum toxin works by:

A. an unkown mechanism.

B. preventing calcium-dependent release of acetylcholine.

C. increasing calcium-dependent release of acetylcholine

D. increasing level of dopamine in the centeral nervous system.

E. decreasing level of dopamine in the centeral nervous system

560. One stage laryngotracheoplasty for repair of subglottic stenosis in

children avoids all of the following postoperative sequelae except

A. multiple procedures

B. ongoing tracheotomy care

C. need for prologed antibiotic therapy

D. problems of prolonged indwelling laryngeal stent

E. pulmonary atlectasis and neuromuscular weakness

585. 561-Increased strain in muscles used for vocalization may be

associated with all of the following except:

A. asthma

B. bruxism

C. beta adrenergic blockade

D. ventral abdominal hernia

E. sensorineural hearing loss

562. Which of the following anatomic sites of the respiratory tract is at

least risk for the development of recurrent papillomatosis?

A. mid area of the laryngeal surface of the epiglottis

B. nasopharyngeal surface of the soft palate

C. midthoracic tracheobronchial tree

D. false vocal cords

E. true vocal cords

563. Which of the following factors is the most associated with a

decreased likelihood of complication with bronchoscopic removal of a

foreign body?

A. type of foreign body

B. location of foreign body

C. use of telescopic -guided forceps

D. administration of halothane anesthesia

E. bronchoscopic experience of the surgeon

564. A patient undergoing videostroboscopy has normal vocal fold

mucosal waves. This finding is most consistent with a diagnosis of:

A. tuberculosis of the larynx

B. cricoarytenoid joint ankylosis

C. neurogenic vocal fold paralysis

D. submucosal fibrosis of the vocal fold

E. invasive squamous cell carcinoma of the vocal fold

565. A patient referred for evaluation of vertigo has slurred speech.

Speech evaluation reveals ataxic dysarthria. The diagnosis most likely

is:

A. Parkinsonism

B. cerebral palsy

C. brainstem stroke

D. multiple sclerosis

E. myasthenia gravis

587. 571-Which is of the following antihistamines has the longest half-life?

A. astemazole

B. loratidine

C. terfenadine

D. diphenhydramine

E. chlorpheniramine

572. Which of the following symptoms is least likely to be associated

with a cluster headache?

A. Unilateral nasal congestion and rhinorrhea

B. reddening and tearing of one eye

C. sever uniocular pain

D. extreme restlessness

E. nausia and vomiting

573. the most common site of occurrence of nasal polyps is the:

A. nasal mucosa

B. anterior ethemoid

C. posterior ethemoid

D. inferior turbinate

E. osteomeatal region

574. patients who have the highest serum level of bacteria specific IgE

are likely to have:

A. asthma

B. nasal polyosis

C. allergic rhinitis

D. atrophic rhinitis

E. sphenoid sinusitis

575. After endoscopic sinus surgery significant postoperative bleeding

following removal of packing is usually best controlled by:

A. cautery

B. embolization

C. turbinate resection

D. repaking the nose

E. transantral maxillary artery ligation

588. 576-when injury to the lacrimal system is suspected during endoscopic

sinus surgery, the surgeon should :

A. immediatly perform a dacrocystogram

B. perform an external dacrocystorhinostomy

C. perform an endoscopic dacrocystorhinostomy

D. place silastic tubing stents in the lacrimal drainage system

E. completes the procedure, taking care to avoid additional injury

577. Intranasal corticosteroid treatment of allergic rhinitis may have all

of the following effects except:

A. decrease rhinorrhea

B. decrease nasal congestion

C. decrease subjective symptoms of asthma

D. decrease bronchial sensitivity to metacholine challenge

E. increased peak expiratory flow rates

578. the most common cause of recurrent epistaxis after diagnostic

angiography and embolization of the internal maxillary artery is:

A. incomplete embolization

B. recanalization of the artery

C. systemic bleeding diathesis

D. inability to locate the bleeding site

E. continued bleeding from the ethmoid arteries.

579. the most important test in the definitive diagnosis of a 4 year old

child with nasal polyposis and frequent refractory sinusitis is:

A. sweat chloride

B. biopsy of polyp

C. HIV antibody titer

D. pulmonary function

E. quantitative immunoglobulin
589. 580-Absolute bone conduction is reduced in

(a) Otosclerosis

(b) Otitis media with effusion

(c) Endolymphatic hydrops

(d) Traumatic ossicular dislocation

581. Most useful test to diagnose ossicular discontinuity is

(a) Evoked response audiometry

(b) Impedance audiometry

(c) Pure-tone audiometry

(d) Rinne test

590. 582-Which operation is indicated in coalescent

mastoiditis?

(a) Schwartz mastoidectomy

(b) Bondy's operation

(c) Fenestration operation

(d) Combined approach

583. Blue drum is seen in

(a) Acute otitis media

(b) Congenital cholesteatoma

(c) Glomus tumour

(d) Tympanosclerosis

584. Trismus in peritonsillar abscess is due to spasm of

(a) Superior constrictor muscle

(b) Medial pterygoid

(c) Masseter

(d) Temporalis muscle

591. 585-Body of incus is lodged in

(a) Epitympanum

(b) Mesotympanum

(c) Hypotympanum

(d) Protympanum

586. Rehabilitation of the potential for voice after

laryngectomy includes all except

(a) Electrolarynx

(b) Tracheo-oesophageal puncture and voice

prosthesis

(c) Oesophageal voice

(d) Tracheostomy tube with a speaking valve

587. Facial nerve supplies all of the following muscles

except

(a) Stapedius

(b) Anterior belly of digastric

(c) Buccinator

(d) Stylohyoid

592. 588-Trautmann's triangle is a landmark for

(a) Mastoid antrum

(b) Facial recess

(c) Posterior cranial fossa

(d) Endolymphatic sac

589. Best pre-operative measure to reduce blood

loss at surgery in angiofibroma is

(a) Hormonal therapy

(b) Pre-operative radiotherapy

(c) Embolisation

(d) Cryotherapy

590. Type of tympanoplasty in which graft is placed

directly on the head of stapes is called

(a) Type II

(b) Type III

(c) Type IV

(d) Type V

593. 591-Preferred incision for a radical neck dissection

in an irradiated patient is

(a) Haynes-Martin

(b) Mc Fee

(c) Schobinger
(d) Sorenson

592. Which of the following is primarily affected

in Meniere's disease?

(a) Middle ear

(b) Cochlea

(c) VIIIth cranial nerve

(d) Tubal function

593. Which of the following sites is the origin of

laryngocele

(a) Aryepiglottic fold

(b) Laryngeal saccule

(c) Ventricle of Morgagni

(d) Vestibular fold

594. 594-Gradenigo's syndrome is characterized by all

of the following except

(a) Retrobulbar pain

(b) Paralysis CN VI

(c) Spread of middle ear infection to petrous

apex

(d) Cavernous sinus thrombosis

595. Bilateral abductor paralysis is treated by

(a) Thyroplasty type I

(b) Injection of gelfoam into the cord

(c) Lateralisation of arytenoid

(d) Injection of fat into the cord

596. Mickulitz cell is seen in

(a) Rhinoscleroma

(b) Rhinosporidiosis

(c) Salivary gland disease

(d) Thyroiditis

595. 597-Decreased lacrimation on Schirmer's test

indicates a lesion of CN VII

(a) Proximal to geniculate ganglion

(b) In tympanic segment

(c) Vertical segment above the nerve to

stapedius

(d) Vertical segment above the origin of chorda

tympani

598. Meniere's disease is characterised by all

of the following except

(a) Low-pitched tinnitus

(b) Stabbing pain in the ear

(c) Intolerance to loud sounds

(d) Positive Rinne test

599. A 40-year-old man presented with severe attacks

of vertigo. He had history of upper respiratory infection

a week before. No complaints of hearing loss, tinnitus

or facial paralysis. Likely diagnosis in this case is

(a) Benign paroxysmal positional vertigo

(b) Vestibular neuronitis

(c) Meniere's disease

(d) Serous labyrinthitis

596. 600-surgical emphysema after trachestomy is corrected by:

a)taking more stitches of the wound

b)cold compresses

c)widening of the wound by removal of some stitches

d)antihistaminic intake.

601. 60 years old male smoker presents with a unilateral, asymmetric

nodular neck mass. gave him a 2 week trial of antibiotics without

effect.What should be done first?

A ? patient should be followed for an additional 2 weeks

B ? physical exam followed by FNA of the node

C ? open incisional biopsy

D ? schedule patient for modified neck dissection.

602. If neck biopsy occurs prior to definitive treatment which of the

outcomes are worse with metastatic cervical carcinoma?

A. wound necrosis

B. regional neck recurrence

C. distant metastasis

D. all of the above

603. During general anesthesia for a parathyroidectomy for relief of

hyperparathyroidism, you should monitor the ECG closely for?

A Prolonged QT Interval

B. Shortened QT interval

C. Shortened PR Interval

D. None of the above

604. You are performing a general anesthetic for a patient undergoing

dissection of the lower neck for malignancy when you notice a 20% drop

in oxygen saturation, diminished ECG amplitude, a drop in blood

pressure, and diminished breath sounds. Based on these findings, you

suspect?

A. Inadvertent migration of the endotracheal out of the trachea and into

the pharynx

B. Pulmonary embolus

C. Pneumothorax

D. Malfunction of the anesthesia monitors

597. 605. Which induction agent is the best choice for the moderate

hypothyroid patient?
A. Propofol

B. Thiopental

C. Etomidate

D. ketamine.

606. The histopathologic finding associated with the greatest degree of

residual/ recurrent conductive hearing loss after stapedotomy is:

A. Resorptive osteitis of the incus.

B. Prosthesis abutting the bony margin of the oval window.

C. New bone formation in the oval window.

D. Presence of the prosthesis lying on a footplate fragment.

E. Obliteration of the round window by

607. Acute sppurative otitis media associated to facial palsy is adequatly

treated with:

A. Myringotomy and systemic A

B. B- Cortical mastoidectomy with systemic A

B. C-Cortical mastiodectomy with facial n. decompression.

D. Myringotomy with facial n.decompression.

E. Systemic A

B. otosclerosis.

608. Which of the following should raise the greatest suspicion that a

conductive hearing loss on the audiogram is not in fact,conductive at

all?:

A. An absent ipsilateral acoustic reflex.

B. A word understanding score of 64%.

C. Atype A tympanogram.

D. A type Ad tympanogram.

E. Atype C tympanogram.

598. 609-The best investigation to confirm the diagnosis of nasopharyngeal

angiofibroma is

A. biosy

B. CT scan

C. carotid angiography

D. non of the above.

610. The best line of treatment of uncontroled unilateral Meniere?s

disease with severe vertigo and profound SNHL is?

A. Intratympanic injection of corticosteroids.

B. Intratympanic injection of gentamycin.

C. Labrinthectomy.

D. Vestibular nerve neurectomy.

E. Ultrasound destruction of the semicircular canals.

611. The most common age when a thyroglossal cyst usually present

is?

A. At birth.

B. 5-8 years.

C. 8-15 years.

D. 15-18 years.

E. More than 18 years.

612. The buccinator muscle .all are true except:

a. is attached to both jaws opposite the molar teeth

b. is supplied by the facial nerve

c. is continuous with the superior constrictor of the pharynx

d. is a muscle of mastication

e. is pierced by the parotid duct opposite the second upper molar tooth.

613. The parotid gland .all are true except:

a. extends behind the temporamandibular joint

b. is separated from the submandibular gland by sphenomandibular

ligament

c. receives secrotomotor fibres which emerge from the brain in the

glossopharyngeal nerve

d. when acutely enlarged results in pain sensation being transmitted

along the great auricular nerve

e. has a palpable duct

599. 614-The best line of treatment of an infant with subglottic

harmangioma and mild stridor is?

A. Laser coagulation.

B. Tracheostomy.

C. Systemic steroid.

D. Observation.

E. Surgical excision.

615. What type of frontal cell is characterized by a large single cell

pneumatizing cephalad into the frontal sinus?

A. I

B. II

C. III

D. IV.

616. The Messecklinger approach to sinus surgery is ___ to __

dissection.

A. anterior; posterior

B. posterior; anterior

C. lateral; medial

D. medial; lateral

617. What is the most posterior ethmoid cell?

A. agger nasi.

B. Haller.
C. Onodi.

D. Semon .

618. Which of the following is not a major complication of endoscopic

sinus surgery?

A. orbital hematoma

B. blindness

C. diplopia.

D. periorbital emphysema.

600. 619- Which of the following is not a minor complication of endoscopic

sinus surgery?

A. anosmia

B. hyposmia

C. epistaxis

D. periorbital ecchymosis

620. Revision surgery of the paranasal sinus for persistent maxillary

disease may be attributed to any of the following except

A. inadequate removal of the uncinate process.

B. middle turbinate destabilization and lateralization.

C. overwidening of the natural ostium.

D. creation of the posterior fontanelle ostium.

E. refractory rhinitis.

621. One contraindication to the Caldwell-Luc operation is

A. foreign body in the antrum.

B. mucocele.

C. unerupted teeth in children.

D. antral cysts

622. The technique of removal of the intrasinus septum of the frontal

sinus is termed

A. the Ridell procedure.

B. the Lothrop (Chaput-Mayer) procedure.

C. Killian's procedure.

D. Lynch frontoethmoidectomy.

E. Kummel-Beck trephination.

623. The technique of creating a vascularized anterior frontal sinus

table by preserving periosteal integrity when approaching the frontal

sinus is termed

A. the Ridell procedure.

B. the Lothrop (Chaput-Mayer) procedure.

C. frontal osteopathic flap.

D. Lynch frontoethmoidectomy.

E. Killian's procedure.

601. 624- Which of the following is not a complication of external

ethmoidectomy?

A. cranial nerve II injury

B. lacrimal sac injury

C. supraorbital nerve injury

D. infraorbital nerve injury

E. cerebrospinal fluid leak.

625. Which component of the nasal septum may be bilaminar?

A. quadrangular cartilage

B. vomer

C. perpendicular plate of the ethmoid

D. none of the above

E. all of the above

626. The nasal septum and which of the following make up the nasal

valve angle?

A. lower lateral cartilages

B. head of the inferior turbinate

C. upper lateral cartilages

D. pyriform aperture

E. nasal bones

627. Which of the following is not a complication of septal surgery?

A. palatal hypesthesia

B. cerebrospinal fluid leak

C. airway obstruction

D. intranasal synechiae

E. All are recognized complications.

628. Which of the following cannot reduce the incidence of septal

perforations?

A. avoidance of the submucous resection

B. closure of mucosal flap tears

C. replacement of morselized cartilage

D. application of tight septal splints and packing

E. quilting suture to coapt mucosal flaps and eliminate dead

space

602. 629- Blood supply to the cartilaginous nasal septum is directly via the

A. anterior ethmoid artery.

B. posterior ethmoid artery.

C. labial artery.

D. sphenopalatine artery.

E. overlying mucoperichondrium.

630. The risk of sinonasal cancer is increased with exposure to all of

the following except

A. hydrocarbons.

B. wood particles.

C. thorium dioxide.

D. salted fish.

631. What is the commonly accepted point of origin of juvenile

nasopharyngeal angiofibroma?

A. superior/posterolateral nasal cavity

B. nasopharynx

C. posterior nasal septum

D. superoposterior base of the skull

632. Juvenile nasopharyngeal angiofibroma is classically associated

with all of the following except

A. epistaxis.

B. nasal obstruction.

C. retrobulbar pain.

D. adolescent boys

633. Which of the following statements regarding nasal cavity

malignant melanoma is true?

A. The probability of death does not decrease with time as it

does with other tumors.

B. Cure rates are high.

C. Incidence of local recurrence is low.

D. It originates more commonly in the sinuses than in the nasal

cavity.

603. 634-What are the histologic features of esthesioneuroblastoma?

A. well-differentiated cells with abundant cytoplasm

B. poorly differentiated cells with multiple mitotic figures

C. undifferentiated small neuroepithelial cells with densely

staining nucleoli and scant cytoplasm

D. granular cells in various stages of differentiation with a high

mitotic rate

635. Which of the following cochlear components in most sensitive to

acoustic overstimulation?

A. inner hair cells

B. outer hair cells

C. spiral ganglion cells

D. dendritic endings of the cochlear nerve

636. The type of hearing loss caused by sound overexposure with the

most insidious nature is

A. temporary threshold shift.

B. acoustic trauma.

C. noise-induced hearing loss.

D. all of the above

637. The frequency region first affected by habitual exposure to

excessive sound is typically ________ kHz.

A. 0.5 to 2

B. 3 to 6

C. 6 to 8

D. 8 to 10

638. Which recently discovered objective measure of cochlear function

promises to be capable of detecting noise-induced hearing loss at an

early stage of development that precedes detection by the pure-tone

audiogram?

A. auditory brain stem response

B. middle-latency evoked response

C. electrocochleography
D. evoked otoacoustic emissions

604. 639- Which of the following has been proposed as the mechanism by

which the sensory cell degenerates following sound overexposure?

A. metabolic exhaustion due to overuse

B. activity-induced ischemia

C. ionic poisoning due to microbreaks in the cytoarchitecture of

the organ of Corti

D. all of the above

640. Which of the following components of the auditory pathway is

suspected of contributing to the susceptibility of an individual to sound

overexposure effects?

A. cochlear efferent system

B. medial geniculate

C. auditory cortex

D. middle ear

641. Which of the following agents interacts with loud sounds

synergistically to produce noise-induced hearing loss?

A. some medicinal drugs

B. some industrial chemicals

C. segmental or whole-body vibration

D. all of the above

642. What noise level (in dB

A. requires industries to implement a

hearing-conservation program?

A. 80

B. 85

C. 90

D. 100

643. Which entity holds that if one sound contains half as much energy

as a second sound, but lasts twice as long, both sounds are capable of

producing the same amount of damage to the ear?

A. dBA scale

B. linear decibel scale

C. distortion-product otoacoustic emissions

D. equal-energy principle

605. 644- What role does the otolaryngologist play in dealing with noise-

induced hearing loss?

A. diagnose the condition

B. counsel patients on preventive measures

C. provide medicolegal testimony in workmen's compensation

cases

D. all of the above

645. What is the most common site of fixation of the stapes?

A. annular ligament

B. posterior crus

C. anterior crus

D. entire footplate
646. At times early stapes fixation of otosclerosis can be diagnosed

A. by seeing stapes fixation on physical examination.

B. by seeing an abnormality of the tympanic membrane.

C. when a maximum conductive hearing loss is present on

audiogram.

D. when an on-off stapedial reflex can be seen on impedance

audiometry

647. The modern stapedectomy was first described in 1956 by

A. Toynbee.

B. Rosen.

C. Shea, Jr.

D. House.

648. Measurement of the distance from the incus to the footplate is

important in order to determine

A. if stapes fixation is the cause of hearing loss.

B. the proper length of prosthesis needed to avoid damage to

the contents of the vestibule.

C. the type of prosthesis required.

D. all of the above

606. 649-A major advantage of using a microdrill is that it

A. creates a perfect round 0.7-mm fenestra.

B. is easier to use than a laser.

C. is atraumatic.

D. Any type of prosthesis can be used

650. Which of the following is an advantage of the modified radical

mastoidectomy over the intact wall procedure?

A. the ability to maintain the normal anatomy of the external ear

canal

B. the ability to easily identify recurrent cholesteatoma

C. fewer episodes of postoperative otorrhea

D. superior hearing results

E. the fact that long-term follow-up is not necessary

651. Surface landmarks used for cortical mastoidectomy include the

A. sinodural angle of Citelli.

B. petrosquamous (Korner's) septum.

C. temporal line.

D. scutum.

E. Ponticulus .

652. The tegmen tympani

A. separates the mastoid air cells from the middle fossa.

B. lies just medial the descending facial nerve and is difficult to

visualize directly.

C. is also known as the posterior fossa dural plate.

D. is the mastoid cortex landmark that corresponds to the

mastoid antrum.

E. is an important landmark for locating the facial nerve

653. The facial recess provides access to the

A. internal auditory canal.

B. retrolabyrinthine air cells.

C. epitympanic space.

D. posterior mesotympanum.

E. mastoid antrum

607. 654-Careful opening of the subarcuate cell tract

A. will allow the surgeon to clean out the sinus tympani.

B. is an alternate route to the antrum.

C. allows drainage of the petrous apex.

D. will expose the internal auditory canal.

E. exposes the horizontal facial nerve .

655. Following a properly performed radical mastoidectomy,

A. there should never be any more episodes of otorrhea.

B. there should be a second-stage ossicular reconstruction

within 12 months.

C. it is relatively easy to reconstruct the posterior canal wall.

D. there is a maximum conductive hearing loss.

E. it is impossible to use a hearing aid on that side.

656. The advisability of extracranial-to-intracranial bypass during

extirpative skull-base surgery for lesions involving the internal carotid

artery is best determined by

A. physical findings.

B. anamnestic information.

C. cerebral angiography.

D. magnetic resonance angiography.

E. the xenon?computed tomography balloon occlusion test.

657. Which of the following skull-base surgical approaches provides

direct access to the petrous apex and infralabyrinthine areas?

A. infratemporal

B. midface degloving

C. basal subfrontal

D. anterior craniofacial

E. extended maxillotomy

658. For tumors involving the middle cranial fossa and the more inferior

portions of the infratemporal fossa, the best approach is the

A. lateral facial.

B. lateral transtemporal sphenoid.

C. transparotid.

D. midface degloving.

E. transmandibular.

608. 659-For large lesions of the clivus that extend into the parapharyngeal

space, adequate exposure is obtained by

A. transethmoidal?sphenoidotomy.

B. transseptal?sphenoidotomy.

C. lateral rhinotomy.
D. transantral.

E. transoral with mandibulotomy.

660. Good exposure of the ethmoid block is obtained by

A. lateral rhinotomy.

B. transseptal sphenoid.

C. transpalatal.

D. transoral.

E. Mandibulotomy

661. Which of the following is not an indication for open rhinoplasty?

A. severe asymmetry of the lateral bony walls

B. congenital anomalies

C. use of a columellar strut

D. extremely wide bony or cartilaginous hump

E. nasal deformity that is difficult to assess

662. The fascial graft technique

A. is best accomplished through an open rhinoplasty approach.

B. softens implant irregularities.

C. uses temporalis fascia or synthetic sheeting.

D. has minimal donor site morbidity.

E. all of the above.

663. Which of the following statements is false?

A. In a previously operated nose, mucoperiostial flap elevation

should begin at the maxillary crest and proceed upward.

B. Release of septal angulations and fibrous contractions is

important in septal framework surgery.

C. In correction of septal curvature, cartilage wedges are

removed from the concave side of the septum while cartilage

scoring is used on the convex side.

D. Most angulations and deviations of the septum occur at the

bony?cartilaginous junction

609. 664-Major characteristics of the unilateral cleft-lip nasal deformity do

not include

A. ipsilateral retrodisplacement of the lower lateral cartilage.

B. lateral and inferior displacement of the ipsilateral alar base.

C. ipsilateral maxillary underdevelopment.

D. ipsilateral domal depression .

665. Which of the following statements regarding spreader grafts is

false?

A. Spreader grafts are placed between the septal cartilage and

the lower lateral cartilages.

B. Spreader grafts may be used unilaterally or bilaterally.

C. Auricular or septal cartilages may be used.

D. Spreader grafts are most easily placed via a closed

rhinoplasty approach.

E. Ideally, spreader grafts should be placed submucosally

666. The relationship between the function of the upper and lower

lateral cartilage in the majority of humans is

A. interlocked scroll.

B. overlap.

C. end-to-end contact.

D. opposed scroll.

667. Reflex lacrimal gland secretion is mediated by parasympathetic

fibers of cranial nerve

A. V.

B. VII.

C. III.

D. IX.

668. The sphenopalatine ganglion is

A. a special sensory afferent.

B. sympathetic.

C. parasympathetic.

D. a somatic sensory afferen

610. 669-The nasopalatine nerve supplies sensation to the mucosa of the

A. anterior premaxillary palate.

B. soft palate.

C. lateral nasal passage.

D. anterior cheek.

670. The anatomic boundaries of zone III of the neck are from the

A. hyoid to the base of the skull.

B. superior border of the thyroid cartilage to the base of the skull.

C. hyoid to the mandible angle.

D. mandible angle to the base of the skull.

E. clavicle to the cricoid .

671. Which zone of the neck has the most difficult surgical access?

A. base of the skull region

B. midcervical region

C. lower cervical region below the cricoid

D. posterior neck triangle

E. anterior cervical triangle

672. A 40-year-old man who sustained a stab wound to zone III of the neck is

hemodynamically stable but has an acute hypoglossal nerve paralysis. What is

the next diagnostic step?

A. four-vessel angiography

B. computed tomography

C. magnetic resonance imaging

D. lateral soft tissue of the neck

E. direct laryngoscopy

673. The best incision to explore the carotid sheath for a unilateral penetrating

neck injury is a(n)

A. modified Conley incision.

B. lateral cervical incision along the anterior sternocleidomastoid muscle.

C. MacFee incision.

D. H incision.

E. Schobinger incision
t.

611. 674-What injured area is the most commonly missed when evaluating a

penetrating neck injury during endoscopy?

A. esophageal inlet

B. distal cervical esophagus

C. nasopharynx

D. vallecula

E. supraglottic area

675. Recognised complications of acute suppurative otitis media

include except?

A. Temporal bone abscess.

B. Facial nerve palsy.

C. Abducent nerve palsy.

D. Bartholin abscess.

E. Cholesterol granuloma.
ANSWERS

612. 216:A

217:C

218:B

219:B

220:B

221:C

222:A

223:A

224:C

225:C

226:C

227:C
228: D

229:C

230:C

231:A

232:C

233:A

234:D

235:C

236:D

237:C

238:D

239:C

240:C

241:A
242:C

243:B

244:B

245:B

246:A

247:D

248:C

249;D

250:D

173:B

174:C

175:D

176:A
177:D

178:B

179:D

180:A

181:D

182:A

183:B

184:D

185:B

186:C

187:A

188:B

189:C

190:B
191:D

192:C

193:B

194:B

195:E

196:D

197:D

198:C

199:C

200:C

201:B

202:A

203:C
204:C

205:B

206:D

207:D

208:B

209:B

210:D

211:B

212:D

213:E

214:D

215:B

130:B

131:A
132:B

133:A

134:A

135:B

136:D

137:E

138:A

139:B

140:C

141:B

142:B

143:A

144:D
145:E

146:D

147:B

148:B

149:C

150:B

151:C

152:C

153:B

154:B

155:E

156:A

157:C

158:D
159:C

160:D

161:A

162:E

163:B

164:B

165:C

166:C

167:A

168:C

169:B

170:C

171:C
172:E

87:B

88:B

89:C

90:E

91:C

92:C

93:C

94:D

95:D

96:D

97:A

98:E

99:E
100:A

101:C

102:E

103:E

104:A

105:C

106:C

107:C

108:B

109:C

110:D

111:C

112:C
113:C

114:E

115:C

116:C

117:C

118:A

119:D

120:D

121:D

122:C

123:A

124:C

125:D

126:D
127:C

128:B

129:C

44:B

45:C

46:B

47:B

48:A

49:B

50:B

51:A

52:A

53:A
54:D

55:A

56:C

57:C

58:C

59:C

60:C

61:B

62:C

63:D

64:D

65:E

66:A

67:D
68:B

69:C

70:C

71:A

72:C

73:D

74:C

75:E

76:C

77:A

78:D

79:C

80:A
81:D

82:A

83:D

84:C

85:B

86:C

1:D

2:D

3:E

4:C

5:C

6:E

7:A
8:D

9:D

10:D

11:D

12:A

13:B

14:B

15:E

16:A

17:A

18:A

19:C

20:D

21:A
22:C

23:D

24:A

25:E

26:E

27:E

28:B

29:C

30:C

31:E

32:A

33:B

34:B
35:C

36:D

37:D

38:E

39:E

40:C

41:D

42:A

43:A

613.