1. A 14 years old boy presents to your clinic with a small dimple just in front of the left ear since birth. The dimple was sore and discharging 3 months ago and is well these days. The father asks you to remove this dimple. What would be your approach?
(A) Leave it as such because it a benign disease
(B) Advise X-ray and then excise it
(C) Excise it under local anesthesia
(D) Refer it to ENT to excise it with facial nerve monitoring
? Preauricular sinus
? Surgery with facial nerve monitoring
2. A 57 years old man presents with 2 days history of pain and swelling of the left ear. On examination the auricle is inflamed and ear lobe is normal. What is the most likely diagnosis?
(A) Cellulitis
(B) Perichondritis
(C) Otitis externa
(D) Perichondral hematoma
(E) Skin allergy
3. Case same as above. How would you manage this patient?
(A) Cloxacillin
(B) Cloxacillin + Metronidazole
(C) Amoxicillin
(D) Loratidine + Amoxacillin
(E) Loratidine + topical antibiotics
4. A 24 years old man resents with pain and swelling of the left ear since 2 days. On examination the entire left external ear is inflamed. What is the most likely diagnosis?
(A) Cellulitis
(B) Perichondritis
(C) Otitis externa
(D) Perichondral hematoma
(E) Skin allergy
5. Case same as above. How would you manage this patient?
(A) Cloxacillin
(B) Cloxacillin + Metronidazole
(C) Amoxicillin
(D) Loratidine + Amoxacillin
(E) Loratidine + topical antibiotics
6. A 65 years old presents to your clinic with a small painless wound on the right ear since 1 month. What is the most likely diagnosis?
(A) Perichondritis
(B) Basal cell carcinoma
(C) Otitis externa
(D) Perichondral hematoma
(E) Cellulitis
7. Case same as above. How would you manage this patient?
(A) Topical antibiotics
(B) Cloxacillin
(C) Cloxacillin + Topical antibiotics
(D) Cautry
(E) Biopsy
8. Which one is not a contraindication to the ear syringing ?
(A) Only hearing ear
(B) History of Tympanic Membrane perforation
(C) Previous ear surgery
(D) Recent ear trauma
(E) History of otitis externa
9. A 32 years man was hit on his left ear during a street fight. He presents to your clinic with swelling of external ear. He does not want to hospital because of fear of police. On examination the both sides of the left auricle are swollen, red and tender.How would you manage this case?
(A) Diclofenac
(B) Diclofenac and aspiration of the pinna
(C) Cloxacillin and excision of the swelling
(D) Diclofenac and Cloxacillin and pressure bandage
(E) Diclofenac, Cloxacillin, aspiration and pressure dressing
10. Case same as in Question # 9. What is the most likely diagnosis?
(A) Cellulitis
(B) Perichondritis
(C) Otitis externa
(D) Perichondral hematoma
(E) Perichondral edema
11. A 25 years old man comes to your clinic and tells you that one of fast friend put a small object in his ear during play. You examined his ear and found a small bead attached to the superior aspect of the ear canal. How would you manage this patient?
(A) Leave it as such
(B) Put local anesthetic drops in the ear and then remove it
(C) Remove it with wax removing loop
(D) Antibiotic drops and refer to ENT
(E) Immediately refer to ENT
12. A 24 years old woman complains of right earache 2 days after Tonsillectomy. She is on oral antibiotics. On examination hearing is normal and the Tympanic membranes are normal bilaterally. What is the most likely cause of ear pain?
(A) Serous otitis media
(B) Adenoiditis secondary to tonsillectomy
(C) Eustachian tube dysfunction
(D) It is a complication of anesthesia
(E) Referred pain
13. A 7 years old boy presents with fever and pain in right ear since 2 days. On examination the child is febrile, irritable and the tympanic membrane is red, bulging. What is the most likely diagnosis?
(A) Acute otitis media
(B) Otitis media with small perforation
(C) Serous otitis media
(D) Normal ear
(E) Acute on chronic otitis media
14. How would you manage this patient?
(A) Paracetamol
(B) Paracetamol and Amoxicillin
(C) Paracetamol, Amoxicillin and Antibiotic ear drops
(D) Paracetamol, Amoxicillin and grommet insertion
(E) Refer to ENT
15. Case same as above. Which organism is the most common cause of this condition?
(A) Streptococcus pneumoniae
(B) Haemophilus influenzae
(C) Strep pyogenes
(D) Moraxella catarrhalis
(E) Staphylococcus
16. A 5 years old girl presents with heaviness of right year since 1 month. The child is other wise fine and scores good in school. The tympanic membrane looks dull with air bubbles. How would you manage this patient?
(A) Refer to ENT for grommet insertion
(B) Refer for audiometry
(C) 10 days of oral antibiotics and then reassess
(D) CBC, ESR, X-ray nasopharynx
(E) Follow up in your clinic
17. Case same as in Question # 16. What is the most accurate diagnostic test for this condition?
(A) Tympanometry
(B) Audiometry
(C) BERA (Brainstem Evoke Response Audiometry)
(D) Limited CT scan of the ear
(E) Caloric test
18. A 27 years old housewife presents with pain in left ear since 5 days. The pain is aggravated by the chewing and laughing. She also has fever of 1020 F. Her preauricular lymph node is palpable. On examination the ear looks like this; Which clinical sign would be useful to further reinforce your diagnosis?
(A) Hearing test
(B) Rennie test
(C) Weber test
(D) Tragus sign
(E) None of the above
19. Case same in Question # 18. How would you manage this patient?
(A) Oral antibiotics
(B) Topical antibiotics
(C) Topical steroids + Topical Antibiotics
(D) Oral antibiotics + Topical antibiotics
(E) Incision and oral antibiotics
20. A 32 years old shopkeeper presents to your clinic with 3 days history of rhinorhea, fever and cough. He is taking treatment from an ENT surgeon who has advised surgery after 2 weeks. His past history has been unremarkable. What would like to tell him?
(A) Go ahead with surgery as planned
(B) Surgery is unnecessary for him
(C) Delay surgery for three months for resolution of acute condition
(D) Should choose Septoplasty over Sub mucosal resection
(E) None of the above
21. Mr. Smith comes to your clinic with pain in right ear since 2 days. On examination there are few vesicles on the external ear canal and Tympanic membrane. You also noticed the following facial features.What is the most likely diagnosis?
(A) Bells palsy
(B) Sarcoidosis
(C) Diabetic mononeuropathy
(D) Ramsay Hunt Syndrome
(E) Otomycosis
22. Case same as above. How would you manage this patient?
(A) Steroids
(B) Acyclovir
(C) Antibiotics
(D) Vitamin B 12
(E) None of the above
23. A 6 years old girl presents with 2 days history of fever, difficulty in swallowing, drowsiness. On examination there is a grayish white layer in the throat and the neck is swollen. Her pulse is 130/ minute and extremities are cold. How would you manage this patient?
(A) Refer to ENT OPD
(B) Refer to ICU
(C) IV line, Erythromycin for 24 hours and then decide
(D) Amoxicillin and steroids
(E) Erythromycin and removal of the membrane
24. A 45 years old woman presents to your clinic with a painless lump on the left side of her neck since 2 months. She has lost 4 KG during this period. The lump is hard, immobile, painless and irregular. What is the most likely diagnosis?
(A) Virchow?s lymph node
(B) Tuberulosis
(C) Pancoast?s tumor
(D) Tumor of left lobe of thyroid
(E) Sarcoidosis
25. Case same as Question # 24. How would you investigate this patient as a family physician?
(A) Excision biopsy under local anesthesia in your clinic
(B) FNA of the lump
(C) CBC, ESR, electrolytes
(D) Chest X-ray, ultrasound abdomen
(E) Bone marrow biopsy
26. A 9 years old girl presents with a small swelling in the neck since birth. It is painless and is not growing in size.Which single clinical sign would be most useful in this case?
(A) Swallowing
(B) Indirect laryngoscopy
(C) Protruding tongue
(D) Blowing out air against closed mouth
(E) Trans illumination
27. A 45 years old chronic Beatle nut eater presents with difficulty in opening his mouth since 6 months. The oral mucosa is thick and white all over. What is the most likely diagnosis?
(A) Scleroderma
(B) Oral Candida infection
(C) Mucosal atrophy
(D) Sub mucous fibrosis
(E) Leukoplakia
28. A 9 years old boy presents to your clinic with fever, throat pain, drooling and restlessness. There is an audible husky inspiratory sound. What is the most likely diagnosis?
(A) Diphtheria
(B) Peritonsillar abscess
(C) Ludwig?s angina
(D) Epiglottitis
(E) Foreign body in the throat
29. Case same as above. What clinical error would you like to avoid in this case?
(A) Examining the throat
(B) Palpating the throat
(C) Painful stimulus to the patient
(D) None of the above
(E) All of the above
30. Case same as above. How would you manage this patient?
(A) Refer immediately
(B) Pass a nasogastric tube and then refer
(C) Insert oral airway and then refer
(D) IV steroids and antibiotics and then refer
(E) None of the above
31. A 3 year old with unilateral foul-smelling bloody discharge.
(A) Adenoidal Hypertrophy
(B) Allergic rhinitis
(C) Carcinoma
(D) Foreign body
32. A 19 year old rugby player who has been hit on the nose and is now complaining of bilateral nasal obstruction. On examination there is bright red midline swelling visible from both nostrils.
(A) Papilloma
(B) Rhinitis medicamentosa
(C) Septal haematoma
(D) Unilateral choanal atresia
33. A 43 year old is suffering from chronic nasal obstruction and discharge. She has used over the counter nasal sprays for months and feels that the problem is worsening.
(A) Papilloma
(B) Rhinitis medicamentosa
(C) Septal haematoma
(D) Unilateral choanal atresia
34. A 78 year old has noticed right sided nasal obstruction associated with a bloody discharge that has developed over the last month.
(A) Adenoidal Hypertrophy
(B) Allergic rhinitis
(C) Carcinoma
(D) Foreign body
35. A 22 year old complains that the same time every year she develops blocked nose with profuse watery discharge.
(A) Adenoidal Hypertrophy
(B) Allergic rhinitis
(C) Carcinoma
(D) Foreign body
36. A 45 year old man is referred to you by his dentist, who noticed a pale grey opaque areas interspersed with a few red inflamed patches on his tongue while scraping the tobacco stains of his teeth
(A) Lichen planus
(B) Basal cell carcinoma
(C) Angular stomatitis
(D) Ulcerative stomatitis
37. An elderly man with ill-fitting dentures complains of painful inflamed cracks at the corners of his mouth
(A) Lichen planus
(B) Basal cell carcinoma
(C) Angular stomatitis
(D) Ulcerative stomatitis
(E) Gingivitis
38. A 55 year old man presents with bleeding gums. On examination there is a line of inflammation at the border of the gum, the intradental papillae are swollen, and he has halitosis.
(A) Apthous Ulcer
(B) Leukoplakia
(C) Mucocoele
(D) Gingivitis
(E) Oral candidiasis
39. A 67 year old man with COPD has recently had an infective excerbation. He complains of an unpleasant taste in his mouth, and examination reveals white deposits adhering to the mucous membranes.
(A) Apthous Ulcer
(B) Leukoplakia
(C) Mucocaele
(D) Gingivitis
(E) Oral candiasis
40. A 61 year old smoker has noticed a gradual change in voice over the last 2 months.
(A) Functional Paralysis
(B) Hypothyroidism
(C) Laryngeal Carcinoma
(D) Oesophageal reflux
41. A 58 year old woman feels that her voice is much more croaky that it used to be, and has been gradually tired for the last 6 months. She feels depressed and ahs gained weight. What is the most appropriate diagnosis?
(A) Functional Paralysis
(B) Hypothyroidism
(C) Laryngeal Carcinoma
(D) Oesophageal reflux
42. A 38 year old opera singer is concerned that the timbre of her voice is changing. What is the most likely diagnosis?
(A) Overuse
(B) Sinusitis
(C) Viral laryngitis
(D) Vocal cord nodules
43. A 32 year old lecturer has a 1 week history of low grade fever, bodyaches, runny nose and malaise associated with hoarseness.
(A) Overuse
(B) Sinusitis
(C) Viral laryngitis
(D) Vocal cord nodules
44. A 79 year old woman with a pulsatile mass in the anterior triangle. What is the most likely diagnosis?
(A) Branchial cyst
(B) Carotid body aneurysm
(C) Cervical rib
(D) Cystic hygroma
45. A 15 year old with a midline lump that moves on protruding the tongue. What is most likely diagnosis?
(A) Reactive Lymphadenitis
(B) Sarcoidosis
(C) Sebaceous cyst
(D) Thyroglossal cyst
46. A 32 year old with diffuse smooth midline swelling that moves on swallowing. What is most likely diagnosis?
(A) Goitre
(B) Laryngocoele
(C) Lymphoma
(D) Pharyngeal pouch
47. A 9 year old boy returns from his summer holiday with a painful ear which is keeping him awake all night. He is unable to tolerate examination of the affected side.
(A) Infective otitis media
(B) Otitis externa
(C) Temporomandibular joint dysfunction
(D) Tonsillitis
48. A 30 year old man presents with a 2 ? day history of malaise, fever, bad oral smell, painful swallowing and bilateral ear ache. Examination of the ears is normal.
(A) Infective otitis media
(B) Otitis externa
(C) Temporomandibular joint dysfunction
(D) Tonsillitis
(E) Peritonsillar abscess
49. A 7 year old boy presents with a 10 day history of malaise, low grade pyrexia and a painful discharging ear. Examination reveals tenderness behind the ear, but you are unable to visualize his tympanic membrane.
(A) Ramsay hunt?s syndrome
(B) Chondrodermatitis nodularis helicis externa
(C) Mastoiditis
(D) Barotrauma
50. A 15 year old boy complains of reduced hearing in left ear since two months. On examination bone conduction is more than air conduction in left ear and Weber is localized to left side. How would you interpret these findings?
(A) Conduction loss in left ear
(B) Conduction loss in right ear
(C) Sensory loss in left ear
(D) Sensory loss in right ear
(E) Both sensory plus conduction loss in left ear
51. A 22 years student presents with reduced hearing in right ear. She had a high grade fever in the last month. On examination air conduction is more than bone conduction in both ears and Weber is localized to left ear. How would you interpret the findings?
(A) Conduction loss in left ear
(B) Conduction loss in right ear
(C) Sensory loss in left ear
(D) Sensory loss in right ear
(E) Both sensory plus conduction loss in left ear
(F) Same as above
52. A mother brings her 11 years old son because he is becoming hard of hearing since 3 months. On examination bone conduction is better than air conduction in both ears and Weber is centralized. How would you interpret these findings?
(A) Bilateral sensory loss
(B) Bilateral conduction defect
(C) Bilateral sensory + conduction defect
(D) Normal at this age
(E) None of the above
53. A mother brings her 3 years old child son with complaints of fever and right ear discharge since 1 day. The discharge is yellow and purulent. On examination the external canal is full of pus. What is the most likely diagnosis
(A) Acute Otitis media
(B) Otitis media with effusion
(C) Chronic Otitis media
(D) Otitis externa
(E) None of the above
54. Case same as above. How would you manage this case?
(A) Refer
(B) Start treatment and refer
(C) Treat for 24 hrs and then refer
(D) Investigate and refer
(E) Treat him yourself
55. Which antibiotic would you like to prescribe to him?
(A) Cefixime
(B) Cefradine
(C) Amoxicillin
(D) Erythromycin
(E) Clarithromycin
56. Which symptomatic treatment would you like to prescribe?
(A) Paracetamol
(B) Chlorpheniramine
(C) Citrizine
(D) Betamethasone ear drops
(E) All of the above
57. What is the most likely outcome of this child assuring he doesn?t have any other medical problem?
(A) Spontaneous recovery in 6 months
(B) Spontaneous recovery in 6 weeks
(C) 60% chance of Chronic Suppurative Otitis Media (CSOM)
(D) The condition will remain as such for rest of the life
(E) Permanent Deafness
58. A 6 year old girl presents to you with bilateral ear discharge. He mother tells you that she speaks in nasal tone. Her weight is 16 KG. What symptoms would you further explore in the history to find the cause of ear discharge?
(A) Snoring
(B) Mouth breathing
(C) Wheezing
(D) A and B
(E) All of the above
59. Which single investigation would you order to confirm your diagnosis?
(A) CBC
(B) Throat swab
(C) Culture of ear discharge
(D) X-ray paranasal sinuses
(E) X ray nasopharynx
60. A 54 years old man presents with right ear pain and discharge since 3 days. There is no fever. His past medical history is unremarkable. How would you manage this patient?
(A) Refer immediately.
(B) Start treatment and refer
(C) Treat him yourself
(D) If he doesn?t respond in 1 week then refer
(E) Investigate and confirm your diagnosis and then decide
61. A 45 years old woman presents with episodic history of dizziness, earache and progressive sensorineural deafness. What is the most likely diagnosis?
(A) Benign Positional vertigo
(B) Otosclerosis
(C) Mennier?s disease
(D) B 12 deficiency
(E) Acoustic neuroma
62. A 54 years old man presents with sensorineural deafness of right ear since 3 months. There is no ear ache or ear discharge. The tympanic membranes are normal. How would manage this patient?
(A) Refer to ENT
(B) Refer to Neurophysician
(C) Reassure him
(D) A trial of antibiotics and then decide
(E) Start tricyclic antidepressant
63. A 38 year old female comes to your office a 1 year history of episodic dizziness, ringing in both ears, a feel?ing of fullness, and hearing loss. The symptoms came an every 1-2 weeks and .usually last far 12 hours. Nausea and vomiting are present. When asked to describe the dizziness, the patient says that "the world is spinning around. On physical examination, the patient has horizontal nystagmus. The slow phase of the nystagmus is to the left, and the rapid phase is to the Right. Audiagrams reveal bilateral sensorineural hearing loss in the low frequencies. What is the most likely diagnosis in this patient?
(A) Vesubular neuritis
(B) Acute labyrinthitis
(C) Benign pasitianal vcrtigo.
(D) Arthastatic hypatensian
(E) Meniere's disease
64. The treatment of this disorder includes which .of the fallowing:
(A) Decrease caffeine intake
(B) Decrease alcohol intake
(C) Use a thiazide diuretic
(D) Use of antiemetic far nausea and vomiting
(E) All of the Above
65. A 23-year-old female comes to your office with a 1 month history of dizziness. She "feels dizzy" when she, stands up (as if she is going to faint). The sensation disappears within a minute. She has a history of major depression and she is taking Doxepin. The patient's blood pressure is 140/90 mm Hg sitting md decreases to 90/170 mm Hg when she stands. There is no ataxia, no nystagmus, and no other symptoms. What is the most likely diagnosis in this patient?
(A) Vestibular neuronitis
(B) Ncute labyrinthitis
(C) Benign positional vertigo
(D) Orthostatic hypotension
(E) Meniere's disease
66. What is the best treatment for the patient described in case above?
(A) An antiseptic
(B) Education and reassurance
(C) A thiazide diuretic
(D) A change in the antidepressant
(E) B and D
67. A. 30-year-old male comes to your office for assessment of dizziness." The dizziness occurs when he rolls over from the lying position to either the left side or the right side. It also occurs when he is looking up. He describes sensation of "the world spinning around" him. The episodes usually last for 10-15 seconds. What is the most likely diagnosis in this patient?
(A) Vestibular neuronitis .
(B) Acute labyrinthitis
(C) Positional vertigo
(D) Orthostatic hypotension
(E) Meniere's disease
68. What is the treatment of choice for the patient described in case above?
(A) Avoidance of alcohol and caffeine
(B) Dimenhydrinate
(C) A thiazide diuretic
(D) Reassurance and simple exercises
(E) Edolymphatic surgery
69. A 39-year-old female comes to your office with a 4-day history of "unrelenting dizziness." The dizziness is associated with nausea and vomiting. There has been no hearing loss, no tinnitus, and no sensation of aural fullness. The patient has just recovered from an upper-respiratory tract infection. On examination, nystagmus is present. The slow phase of the nystagmus is toward the left, and the rapid phase of the nystagmus is toward the right. There is a significant ataxia present. What is the most likely diagnosis in this patient?
(A) Acute labyrinthitis
(B) Benign positional vertigo
(C) Orthostatic hypotension
(D) Meniere's disease
70. What is the treatment of choice for the patient described in case above?
(A) Avoidance of alcohol and caffeine
(B) A thiazide diveretic
(C) Endolymphatic surgery
(D) Reassurance and antiemetics
(E) Prochlorperazine
71. A 26-year-old female comes to your office with a 6-day history of severe dizziness associated with ataxia and right? sided hearing loss. She had an upper-respiratory tract infec?tion 1 week ago. At that time her right ear felt plugged. On examination, there is fluid behind the right ear?drum. There is horizontal nystagmus present with the slow component to the right and the quick component to the left. Ataxia is present. What is the most likely diagnosis in this patient?
(A) Acute labyrinthitis
(B) Benign positional vertigo
(C) Orthostatic hypotension
(D) Meniere's disease
72. What is the most common cause of sensorineural hearing loss in the adult population?
(A) Meniere's disease
(B) Chronic otitis media
(C) Presbycusis
(D) Otosclerosis
(E) Mastoiditis
73. What is the most common cause of conductive hearing loss in adults who have normal-appearing tympanic membranes?
(A) Meniere's disease
(B) Chronic otitis media
(C) Presbycusis
(D) Otosclerosis
(E) Mastoiditis
74. A. 37-year-old female comes to your office for assessment o hearing loss. She has had problems intermittently for the past 12 months. On examination, the Weber tuning fork test lateralizes to the right ear, and the Rinne tuning fork test is negative in the right ear (bone conduction is greater than air conduction [BC>AC)) . This suggests which one of the following hearing losses?
(A) A right-sided conductive hearing loss
(B) A left-sided conductive hearing loss
(C) A right-sided sensorineural hearing loss
(D) A left-sided sensorineural hearing loss
(E) A or d
75. A 43-year-old male comes to your office for assessment of hearing loss. He has had hearing difficulties for the past 4 years. On examination, the Weber tuning fork test lateralizes to the left ear. The Rinne tuning fork test is positive: (AC>BC) in both ears. This suggests which one of the following hearing losses?
(A) A right-sided conductive hearing loss
(B) A left-sided conductive hearing loss
(C) A right-sided sensorineural hearing loss
(D) A left~sided sensorineural hearing loss
(E) B or c
76. A 42-year-old woman comes to your office complaining of severe facial pain in the region of her right maxilla, fever, and a purulent discharge from her right nose, all of which started after a recent upper-respiratory infection. Her temperature is 101 F. There is tenderness over the right maxillary sinus and a greenish discharge in her right nares. The rest of her examination is normal. Which of the following statements concerning this patient is (are) true?
(A) The most common causes are allergic and viral
(B) Rhinovirus. Is the most common among of viral causes
(C) Viral often is accompanied by fever, malaise, and systemic symptoms
(D) A and b only ,
(E) A, b, and c are true
77. Acute bacterial sinusitis is caused most commonIy by which of the following organisms
(A) Strep. Prieumonae
(B) Haemophilus influenzae
(C) Moraxella catarhalis
(D) S. pyogenes
(E) Staphylococcus aureus
78. What is the antibacterial drug of first choice for modetate to severe acute bacterial sinusitus?
(A) Amoxicillin clavulanic acid (10-14 day course)
(B) Cotrimoxazole (10~ 14 day course)
(C) cefuroxiine (10-14day course)
(D) ciprofloxacin (10day course)
(E) Erythromycin (10-day course)
79. Which of the following anatomic forms of acute bacterial sinusitis is most serious?
(A) Maxillary sinusitis
(B) Ethmoidal sinusitis
(C) Frontal sinusitis
(D) Mandibular sinusitis e. Anterior sinusitis
80. A mother comes to your office with her 24-month-old daughter. The child developed an upper-respiratory tract infection approximately 1 week ago. Two days ago the child began complaining of pain in the right ear. On examination, the child has nasal congestion and a hyperemic throat. The left tympanic membrane is normal, and the right tympanic membrane is bulging and red. There appears to be fluid behind it, The lungs are clear. The child's temperature is 39.5? C. What is the most likely diagnosis in this child?
(A) Acute otitis media (AOM)
(B) Otitis media without effusion
(C) Chronic otitis media (COM)
(D) Otitis media. With effusion (OME)
(E) None of the above
81. An 8-month-old male is brought to your clinic. He has had an upper-respiratory tract infection but has no signs of acute ear infection such as irritability, poor sleeping, pulling at his ears, or fever.
On examination, the tympanic mem?brane is dull and bulging but not red. The rest of the examination is benign besides a mild clear rhinorrhea. What is the most likely diagnosis in this child?
(A) Acute otitis media
(B) Otitis media without effusion
(C) Chronic otitis media
(D) Otitis media with effusion
(E) None of the above
82. A 7-month-old child is brought to your clinic by his mother He has had an upper-respiratory tract infection for the past 3 days. On examination, there is erythema of the left tympanic membrane with opacification. There are no other signs or symptoms. What is the most likely diagnosis in this patient?
(A) Acute otitis media
(B) Otitis Media Without Effusion
(C) Chronic
(D) OME
(E) None Of The Above
83. A nine years old child is brought to your office with a dis?charge from the left ear that has been present for the last 2 weeks. The child has a history of frequent ear infec?tions, all of which have been treated with antibiotics. What is the most likely diagnosis in this patient?
(A) Acute otitiis media
(B) Otitis Media Without Effusion
(C) Chronic otitis media
(D) Otitis media with effusion
(E) Mastoiditis
84. What are the three most common bacterial organ?isms in order of frequency that are responsible for the Acute Otitis Media?
(A) Streptococcus pneumolliae, group A streptococci, Haemophilus influenzae
(B) S. pneumonae, H. influenzae, Staphylococcus aureus
(C) S.pneumonae, H. influenzae, Moraxella
(D) H. influenzae, S. pneumonae, group A streptococci
(E) H. influenzae, S. pneumonae, M. catarr/wlis
85. What is the drug of first choice for the condition acute ottitis media?
(A) Penicillin
(B) Amoxicillin
(C) Erythromycin
(D) Cefaclor
(E) Amoxicillin-cavulanic acid
86. A 7 years old boy has been brought to your clinic with reduced hearing since 2 months. Clinical examination is normal except dull tympanic membrane. What should be the next approporiate clinical assessment?
(A) Rennie and weber
(B) Perform a myringotomy and suck out all the fluid that is present
(C) Perform a pneumatic otoscopy to assess the movement of the tympanic membrane
(D) Refer the child ent specialist.
(E) None of the above
87. Which of the following statements regarding treatment of the condition described in acute otitis media?
(A) Earache and fever should be treated with aspirin
(B) Topical decongestants are useful in improving eustachian tube dysfunction
(C) Ear drops do not provide significant relief in children
(D) Systemic antihistamine-decongestants have been shown to improve the symptoms and shorten the course of disease
(E) All of the above statements are true
88. How is recurrent otitis media defined?
(A) Three or more episodes of AOM that occur within 6 months within a year
(B) Four or more episodes of AOM that occur within 6 months, or five episodes that occur within a year.
(C) Five or more epfa>des of aom that occur within 6 months or six episodes that occur within a year
(D) Six or more episodes of ADM that occur within 6 months, or eight episodes within a year
(E) 10 or more episodes of AOM that occur within 6 months, or three or more episodes that occur within a year
89. Which of the following statements regarding recurrent otitis media is true?
(A) Recurrent AOM usually occur in the winter or early spring
(B) Recurrent bouts of AOM should be managed by myringotomy and the insertion of venti-lation tubes
(C) Medical management appears to be less effec?tive and is not as safe as myringotomy and tubes in children with recurrent AOM.
(D) Amoxici1lin does not have a major role to play in the management of recurrent ADM
(E) Antibiotic prophylaxis should be given for at least 6 months to a year
90. Which of the following intracranial complications may occur with otitis media?
(A) Meningitis
(B) Subdural empyema
(C) Brain abscess
(D) All of the above
(E) A and c only
91. Which of the following is NOT a possible extra?cranial complication of otitis media?
(A) Mastoiditis
(B) Cholesteatoma
(C) Labyrinthitis
(D) Facial paralysis
(E) Otic hydrocephalus
92. Which of the following is false about Acute Otitis Media?
(A) Infants and young children are at highest risk
(B) 40% of children will have an effusion that persists for 4 weeks
(C) Boys tend to have a higher incidence of aom than girls do
(D) Nearly 90% of children will have an episode of aom by age 3 years
(E) Incidence of aom peaks between 6 to 13 months of age
93. Tympimocentesis with aspiration of middle ear fluid should not be considered in which patients except:
(A) A child who presents with Acute otitis media and com?plains of tinnitus, vertigo, and hearing loss
(B) A child who develops a suppurative intra cranial complication of Otitis Media
(C) An patient who is immunologically impaired and does not improve with antibiotic treatment
(D) A child who has extreme ear pain and appears ill.
(E) A child, who is already taking antibiotics
94. A 19 years old college student presents to your clinic with one day history of 1010 F fever and malaise. His college examinations are coming up next week. His past history is unremarkable.
On examination his throat is mildly hyperemic. What could be the best management is this case?
(A) Paracetamol + chlorpheneramine + Gargles
(B) Paracetamol + Amoxicillin + Gargles.
(C) Paracetamol + chlorpheneramine + Amoxcillin
(D) Paracetamol + chlorpheneramine + Amoxcillin + Gargles
(E) Paracetamol + gargles.
95. Which one of the following statements about the differential diagnosis of rhinitis is correct?
(A) Lymphadenopathy is associated with allergic rhinitis.
(B) Vasomotor rhinitis is seasonal, not perennial.
(C) Occupational rhinitis can be allergic or nonallergic.
(D) Allergic rhinitis is only seasonal.
96. In addition to Staphylococcus aureus, which one of the following is the next most common pathogen isolated from ears with chronic suppurative otitis media?
(A) Streptococcus pneumoniae.
(B) Haemophilus influenzae.
(C) Moraxella catarrhalis.
(D) Pseudomonas aeruginosa.
(E) Serratia marcescens.
97. A 50-year-old patient complains of hearing loss. He denies noise exposure at work but says that he has a hard time hearing the television unless he turns up the volume. He denies any discharge from the ears, vertigo or fever, but he has had some intermittent ringing of the right ear. A Weber test reveals lateralization to the left. A Rinne test shows better air conduction than bone conduction bilaterally. What is the most appropriate diagnosis?
(A) Conductive deficit.
(B) Sensorineural deficit of the right ear.
(C) Mixed deficit.
(D) Temporal threshold shift.
98. A 22 years old man presents with vertigo on turning his face to right . He does not have hearing problem, ear complaint, or headache his general and systemic exams are normal. Halpick maneurer elicits nystaginus on R lateral gaze. Which one of the following treatments would be most appropriate for this patient who has benign paroxysmal
(A) Canalith repositioning procedure
(B) Meclizine (Antivert)
(C) Diazepam
(D) Low-salt diet
(E) Hydrochlorothiazide
99. A 40 years old man comes with tinnitus in both ear .His hearing is normal .Ear examination is also normal Which one of the following may lead to tinnitus without hearing loss?
(A) External ear infection.
(B) Cerumen impaction.
(C) Middle ear fluid.
(D) Furosamide
(E) Otosclerosis.
100. Which one of the following recommendations about antibiotics for the prevention of cold symptoms is CORRECT?
(A) Antibiotics are recommended for patients with purulent nasal discharge after three to five days.
(B) Antibiotics are recommended to prevent pneumonia.
(C) Antibiotics are not recommended for patients with a suspected cold.
(D) Antibiotics are recommended for adults with cold and fever after three to five days.
101. A 48 year old man complains of hearing loss, tinnitus in the right ear, and vertigo for the past 6 months. In addition, he has facial pain and weakness of his facial muscles. On physical examination, he has a facial palsy on the right side. Which of the following is the most likely diagnosis?
(A) Acoustic neuroma
(B) Bell palsy
(C) Benign positional vertigo
(D) Lyme disease
(E) Meniere disease
102. Which one of the following is not a cause of conductive hearing loss that may lead to tinnitus?
(A) External ear infection.
(B) Cerumen impaction.
(C) Middle ear fluid.
(D) Loop diuretic medications.
(E) Otosclerosis.
MCQ# ANSWER MCQ# ANSWER MCQ# ANSWER MCQ# ANSWER
1 D 27 D 53 A 79 C
2 B 28 D 54 E 80 A
3 A 29 E 55 C 81 D
4 A 30 A 56 A 82 B
5 A 31 D 57 A 83 C
6 B 32 C 58 D 84 C
7 E 33 B 59 E 85 B
8 E 34 C 60 B 86 C
9 E 35 B 61 C 87 cancelled
10 D 36 C 62 A 88 A
11 C 37 E 63 E 89 A
12 E 38 E 64 E 90 D
13 A 39 E 65 D 91 E
14 B 40 C 66 E 92 D
15 A 41 B 67 C 93 cancelled
16 E 42 D 68 D 94 E
17 A 43 C 69 A 95 C
18 D 44 B 70 E 96 D
19 D 45 D 71 B 97 B
20 B 46 A 72 C 98 A
21 D 47 B 73 D 99 D
22 B 48 D 74 D 100 C
23 B 49 C 75 C 101 A
24 A 50 A 76 E 102 D
25 D 51 D 77 A
26 C 52 B 78 A
(A) Leave it as such because it a benign disease
(B) Advise X-ray and then excise it
(C) Excise it under local anesthesia
(D) Refer it to ENT to excise it with facial nerve monitoring
? Preauricular sinus
? Surgery with facial nerve monitoring
2. A 57 years old man presents with 2 days history of pain and swelling of the left ear. On examination the auricle is inflamed and ear lobe is normal. What is the most likely diagnosis?
(A) Cellulitis
(B) Perichondritis
(C) Otitis externa
(D) Perichondral hematoma
(E) Skin allergy
3. Case same as above. How would you manage this patient?
(A) Cloxacillin
(B) Cloxacillin + Metronidazole
(C) Amoxicillin
(D) Loratidine + Amoxacillin
(E) Loratidine + topical antibiotics
4. A 24 years old man resents with pain and swelling of the left ear since 2 days. On examination the entire left external ear is inflamed. What is the most likely diagnosis?
(A) Cellulitis
(B) Perichondritis
(C) Otitis externa
(D) Perichondral hematoma
(E) Skin allergy
5. Case same as above. How would you manage this patient?
(A) Cloxacillin
(B) Cloxacillin + Metronidazole
(C) Amoxicillin
(D) Loratidine + Amoxacillin
(E) Loratidine + topical antibiotics
6. A 65 years old presents to your clinic with a small painless wound on the right ear since 1 month. What is the most likely diagnosis?
(A) Perichondritis
(B) Basal cell carcinoma
(C) Otitis externa
(D) Perichondral hematoma
(E) Cellulitis
7. Case same as above. How would you manage this patient?
(A) Topical antibiotics
(B) Cloxacillin
(C) Cloxacillin + Topical antibiotics
(D) Cautry
(E) Biopsy
8. Which one is not a contraindication to the ear syringing ?
(A) Only hearing ear
(B) History of Tympanic Membrane perforation
(C) Previous ear surgery
(D) Recent ear trauma
(E) History of otitis externa
9. A 32 years man was hit on his left ear during a street fight. He presents to your clinic with swelling of external ear. He does not want to hospital because of fear of police. On examination the both sides of the left auricle are swollen, red and tender.How would you manage this case?
(A) Diclofenac
(B) Diclofenac and aspiration of the pinna
(C) Cloxacillin and excision of the swelling
(D) Diclofenac and Cloxacillin and pressure bandage
(E) Diclofenac, Cloxacillin, aspiration and pressure dressing
10. Case same as in Question # 9. What is the most likely diagnosis?
(A) Cellulitis
(B) Perichondritis
(C) Otitis externa
(D) Perichondral hematoma
(E) Perichondral edema
11. A 25 years old man comes to your clinic and tells you that one of fast friend put a small object in his ear during play. You examined his ear and found a small bead attached to the superior aspect of the ear canal. How would you manage this patient?
(A) Leave it as such
(B) Put local anesthetic drops in the ear and then remove it
(C) Remove it with wax removing loop
(D) Antibiotic drops and refer to ENT
(E) Immediately refer to ENT
12. A 24 years old woman complains of right earache 2 days after Tonsillectomy. She is on oral antibiotics. On examination hearing is normal and the Tympanic membranes are normal bilaterally. What is the most likely cause of ear pain?
(A) Serous otitis media
(B) Adenoiditis secondary to tonsillectomy
(C) Eustachian tube dysfunction
(D) It is a complication of anesthesia
(E) Referred pain
13. A 7 years old boy presents with fever and pain in right ear since 2 days. On examination the child is febrile, irritable and the tympanic membrane is red, bulging. What is the most likely diagnosis?
(A) Acute otitis media
(B) Otitis media with small perforation
(C) Serous otitis media
(D) Normal ear
(E) Acute on chronic otitis media
14. How would you manage this patient?
(A) Paracetamol
(B) Paracetamol and Amoxicillin
(C) Paracetamol, Amoxicillin and Antibiotic ear drops
(D) Paracetamol, Amoxicillin and grommet insertion
(E) Refer to ENT
15. Case same as above. Which organism is the most common cause of this condition?
(A) Streptococcus pneumoniae
(B) Haemophilus influenzae
(C) Strep pyogenes
(D) Moraxella catarrhalis
(E) Staphylococcus
16. A 5 years old girl presents with heaviness of right year since 1 month. The child is other wise fine and scores good in school. The tympanic membrane looks dull with air bubbles. How would you manage this patient?
(A) Refer to ENT for grommet insertion
(B) Refer for audiometry
(C) 10 days of oral antibiotics and then reassess
(D) CBC, ESR, X-ray nasopharynx
(E) Follow up in your clinic
17. Case same as in Question # 16. What is the most accurate diagnostic test for this condition?
(A) Tympanometry
(B) Audiometry
(C) BERA (Brainstem Evoke Response Audiometry)
(D) Limited CT scan of the ear
(E) Caloric test
18. A 27 years old housewife presents with pain in left ear since 5 days. The pain is aggravated by the chewing and laughing. She also has fever of 1020 F. Her preauricular lymph node is palpable. On examination the ear looks like this; Which clinical sign would be useful to further reinforce your diagnosis?
(A) Hearing test
(B) Rennie test
(C) Weber test
(D) Tragus sign
(E) None of the above
19. Case same in Question # 18. How would you manage this patient?
(A) Oral antibiotics
(B) Topical antibiotics
(C) Topical steroids + Topical Antibiotics
(D) Oral antibiotics + Topical antibiotics
(E) Incision and oral antibiotics
20. A 32 years old shopkeeper presents to your clinic with 3 days history of rhinorhea, fever and cough. He is taking treatment from an ENT surgeon who has advised surgery after 2 weeks. His past history has been unremarkable. What would like to tell him?
(A) Go ahead with surgery as planned
(B) Surgery is unnecessary for him
(C) Delay surgery for three months for resolution of acute condition
(D) Should choose Septoplasty over Sub mucosal resection
(E) None of the above
21. Mr. Smith comes to your clinic with pain in right ear since 2 days. On examination there are few vesicles on the external ear canal and Tympanic membrane. You also noticed the following facial features.What is the most likely diagnosis?
(A) Bells palsy
(B) Sarcoidosis
(C) Diabetic mononeuropathy
(D) Ramsay Hunt Syndrome
(E) Otomycosis
22. Case same as above. How would you manage this patient?
(A) Steroids
(B) Acyclovir
(C) Antibiotics
(D) Vitamin B 12
(E) None of the above
23. A 6 years old girl presents with 2 days history of fever, difficulty in swallowing, drowsiness. On examination there is a grayish white layer in the throat and the neck is swollen. Her pulse is 130/ minute and extremities are cold. How would you manage this patient?
(A) Refer to ENT OPD
(B) Refer to ICU
(C) IV line, Erythromycin for 24 hours and then decide
(D) Amoxicillin and steroids
(E) Erythromycin and removal of the membrane
24. A 45 years old woman presents to your clinic with a painless lump on the left side of her neck since 2 months. She has lost 4 KG during this period. The lump is hard, immobile, painless and irregular. What is the most likely diagnosis?
(A) Virchow?s lymph node
(B) Tuberulosis
(C) Pancoast?s tumor
(D) Tumor of left lobe of thyroid
(E) Sarcoidosis
25. Case same as Question # 24. How would you investigate this patient as a family physician?
(A) Excision biopsy under local anesthesia in your clinic
(B) FNA of the lump
(C) CBC, ESR, electrolytes
(D) Chest X-ray, ultrasound abdomen
(E) Bone marrow biopsy
26. A 9 years old girl presents with a small swelling in the neck since birth. It is painless and is not growing in size.Which single clinical sign would be most useful in this case?
(A) Swallowing
(B) Indirect laryngoscopy
(C) Protruding tongue
(D) Blowing out air against closed mouth
(E) Trans illumination
27. A 45 years old chronic Beatle nut eater presents with difficulty in opening his mouth since 6 months. The oral mucosa is thick and white all over. What is the most likely diagnosis?
(A) Scleroderma
(B) Oral Candida infection
(C) Mucosal atrophy
(D) Sub mucous fibrosis
(E) Leukoplakia
28. A 9 years old boy presents to your clinic with fever, throat pain, drooling and restlessness. There is an audible husky inspiratory sound. What is the most likely diagnosis?
(A) Diphtheria
(B) Peritonsillar abscess
(C) Ludwig?s angina
(D) Epiglottitis
(E) Foreign body in the throat
29. Case same as above. What clinical error would you like to avoid in this case?
(A) Examining the throat
(B) Palpating the throat
(C) Painful stimulus to the patient
(D) None of the above
(E) All of the above
30. Case same as above. How would you manage this patient?
(A) Refer immediately
(B) Pass a nasogastric tube and then refer
(C) Insert oral airway and then refer
(D) IV steroids and antibiotics and then refer
(E) None of the above
31. A 3 year old with unilateral foul-smelling bloody discharge.
(A) Adenoidal Hypertrophy
(B) Allergic rhinitis
(C) Carcinoma
(D) Foreign body
32. A 19 year old rugby player who has been hit on the nose and is now complaining of bilateral nasal obstruction. On examination there is bright red midline swelling visible from both nostrils.
(A) Papilloma
(B) Rhinitis medicamentosa
(C) Septal haematoma
(D) Unilateral choanal atresia
33. A 43 year old is suffering from chronic nasal obstruction and discharge. She has used over the counter nasal sprays for months and feels that the problem is worsening.
(A) Papilloma
(B) Rhinitis medicamentosa
(C) Septal haematoma
(D) Unilateral choanal atresia
34. A 78 year old has noticed right sided nasal obstruction associated with a bloody discharge that has developed over the last month.
(A) Adenoidal Hypertrophy
(B) Allergic rhinitis
(C) Carcinoma
(D) Foreign body
35. A 22 year old complains that the same time every year she develops blocked nose with profuse watery discharge.
(A) Adenoidal Hypertrophy
(B) Allergic rhinitis
(C) Carcinoma
(D) Foreign body
36. A 45 year old man is referred to you by his dentist, who noticed a pale grey opaque areas interspersed with a few red inflamed patches on his tongue while scraping the tobacco stains of his teeth
(A) Lichen planus
(B) Basal cell carcinoma
(C) Angular stomatitis
(D) Ulcerative stomatitis
37. An elderly man with ill-fitting dentures complains of painful inflamed cracks at the corners of his mouth
(A) Lichen planus
(B) Basal cell carcinoma
(C) Angular stomatitis
(D) Ulcerative stomatitis
(E) Gingivitis
38. A 55 year old man presents with bleeding gums. On examination there is a line of inflammation at the border of the gum, the intradental papillae are swollen, and he has halitosis.
(A) Apthous Ulcer
(B) Leukoplakia
(C) Mucocoele
(D) Gingivitis
(E) Oral candidiasis
39. A 67 year old man with COPD has recently had an infective excerbation. He complains of an unpleasant taste in his mouth, and examination reveals white deposits adhering to the mucous membranes.
(A) Apthous Ulcer
(B) Leukoplakia
(C) Mucocaele
(D) Gingivitis
(E) Oral candiasis
40. A 61 year old smoker has noticed a gradual change in voice over the last 2 months.
(A) Functional Paralysis
(B) Hypothyroidism
(C) Laryngeal Carcinoma
(D) Oesophageal reflux
41. A 58 year old woman feels that her voice is much more croaky that it used to be, and has been gradually tired for the last 6 months. She feels depressed and ahs gained weight. What is the most appropriate diagnosis?
(A) Functional Paralysis
(B) Hypothyroidism
(C) Laryngeal Carcinoma
(D) Oesophageal reflux
42. A 38 year old opera singer is concerned that the timbre of her voice is changing. What is the most likely diagnosis?
(A) Overuse
(B) Sinusitis
(C) Viral laryngitis
(D) Vocal cord nodules
43. A 32 year old lecturer has a 1 week history of low grade fever, bodyaches, runny nose and malaise associated with hoarseness.
(A) Overuse
(B) Sinusitis
(C) Viral laryngitis
(D) Vocal cord nodules
44. A 79 year old woman with a pulsatile mass in the anterior triangle. What is the most likely diagnosis?
(A) Branchial cyst
(B) Carotid body aneurysm
(C) Cervical rib
(D) Cystic hygroma
45. A 15 year old with a midline lump that moves on protruding the tongue. What is most likely diagnosis?
(A) Reactive Lymphadenitis
(B) Sarcoidosis
(C) Sebaceous cyst
(D) Thyroglossal cyst
46. A 32 year old with diffuse smooth midline swelling that moves on swallowing. What is most likely diagnosis?
(A) Goitre
(B) Laryngocoele
(C) Lymphoma
(D) Pharyngeal pouch
47. A 9 year old boy returns from his summer holiday with a painful ear which is keeping him awake all night. He is unable to tolerate examination of the affected side.
(A) Infective otitis media
(B) Otitis externa
(C) Temporomandibular joint dysfunction
(D) Tonsillitis
48. A 30 year old man presents with a 2 ? day history of malaise, fever, bad oral smell, painful swallowing and bilateral ear ache. Examination of the ears is normal.
(A) Infective otitis media
(B) Otitis externa
(C) Temporomandibular joint dysfunction
(D) Tonsillitis
(E) Peritonsillar abscess
49. A 7 year old boy presents with a 10 day history of malaise, low grade pyrexia and a painful discharging ear. Examination reveals tenderness behind the ear, but you are unable to visualize his tympanic membrane.
(A) Ramsay hunt?s syndrome
(B) Chondrodermatitis nodularis helicis externa
(C) Mastoiditis
(D) Barotrauma
50. A 15 year old boy complains of reduced hearing in left ear since two months. On examination bone conduction is more than air conduction in left ear and Weber is localized to left side. How would you interpret these findings?
(A) Conduction loss in left ear
(B) Conduction loss in right ear
(C) Sensory loss in left ear
(D) Sensory loss in right ear
(E) Both sensory plus conduction loss in left ear
51. A 22 years student presents with reduced hearing in right ear. She had a high grade fever in the last month. On examination air conduction is more than bone conduction in both ears and Weber is localized to left ear. How would you interpret the findings?
(A) Conduction loss in left ear
(B) Conduction loss in right ear
(C) Sensory loss in left ear
(D) Sensory loss in right ear
(E) Both sensory plus conduction loss in left ear
(F) Same as above
52. A mother brings her 11 years old son because he is becoming hard of hearing since 3 months. On examination bone conduction is better than air conduction in both ears and Weber is centralized. How would you interpret these findings?
(A) Bilateral sensory loss
(B) Bilateral conduction defect
(C) Bilateral sensory + conduction defect
(D) Normal at this age
(E) None of the above
53. A mother brings her 3 years old child son with complaints of fever and right ear discharge since 1 day. The discharge is yellow and purulent. On examination the external canal is full of pus. What is the most likely diagnosis
(A) Acute Otitis media
(B) Otitis media with effusion
(C) Chronic Otitis media
(D) Otitis externa
(E) None of the above
54. Case same as above. How would you manage this case?
(A) Refer
(B) Start treatment and refer
(C) Treat for 24 hrs and then refer
(D) Investigate and refer
(E) Treat him yourself
55. Which antibiotic would you like to prescribe to him?
(A) Cefixime
(B) Cefradine
(C) Amoxicillin
(D) Erythromycin
(E) Clarithromycin
56. Which symptomatic treatment would you like to prescribe?
(A) Paracetamol
(B) Chlorpheniramine
(C) Citrizine
(D) Betamethasone ear drops
(E) All of the above
57. What is the most likely outcome of this child assuring he doesn?t have any other medical problem?
(A) Spontaneous recovery in 6 months
(B) Spontaneous recovery in 6 weeks
(C) 60% chance of Chronic Suppurative Otitis Media (CSOM)
(D) The condition will remain as such for rest of the life
(E) Permanent Deafness
58. A 6 year old girl presents to you with bilateral ear discharge. He mother tells you that she speaks in nasal tone. Her weight is 16 KG. What symptoms would you further explore in the history to find the cause of ear discharge?
(A) Snoring
(B) Mouth breathing
(C) Wheezing
(D) A and B
(E) All of the above
59. Which single investigation would you order to confirm your diagnosis?
(A) CBC
(B) Throat swab
(C) Culture of ear discharge
(D) X-ray paranasal sinuses
(E) X ray nasopharynx
60. A 54 years old man presents with right ear pain and discharge since 3 days. There is no fever. His past medical history is unremarkable. How would you manage this patient?
(A) Refer immediately.
(B) Start treatment and refer
(C) Treat him yourself
(D) If he doesn?t respond in 1 week then refer
(E) Investigate and confirm your diagnosis and then decide
61. A 45 years old woman presents with episodic history of dizziness, earache and progressive sensorineural deafness. What is the most likely diagnosis?
(A) Benign Positional vertigo
(B) Otosclerosis
(C) Mennier?s disease
(D) B 12 deficiency
(E) Acoustic neuroma
62. A 54 years old man presents with sensorineural deafness of right ear since 3 months. There is no ear ache or ear discharge. The tympanic membranes are normal. How would manage this patient?
(A) Refer to ENT
(B) Refer to Neurophysician
(C) Reassure him
(D) A trial of antibiotics and then decide
(E) Start tricyclic antidepressant
63. A 38 year old female comes to your office a 1 year history of episodic dizziness, ringing in both ears, a feel?ing of fullness, and hearing loss. The symptoms came an every 1-2 weeks and .usually last far 12 hours. Nausea and vomiting are present. When asked to describe the dizziness, the patient says that "the world is spinning around. On physical examination, the patient has horizontal nystagmus. The slow phase of the nystagmus is to the left, and the rapid phase is to the Right. Audiagrams reveal bilateral sensorineural hearing loss in the low frequencies. What is the most likely diagnosis in this patient?
(A) Vesubular neuritis
(B) Acute labyrinthitis
(C) Benign pasitianal vcrtigo.
(D) Arthastatic hypatensian
(E) Meniere's disease
64. The treatment of this disorder includes which .of the fallowing:
(A) Decrease caffeine intake
(B) Decrease alcohol intake
(C) Use a thiazide diuretic
(D) Use of antiemetic far nausea and vomiting
(E) All of the Above
65. A 23-year-old female comes to your office with a 1 month history of dizziness. She "feels dizzy" when she, stands up (as if she is going to faint). The sensation disappears within a minute. She has a history of major depression and she is taking Doxepin. The patient's blood pressure is 140/90 mm Hg sitting md decreases to 90/170 mm Hg when she stands. There is no ataxia, no nystagmus, and no other symptoms. What is the most likely diagnosis in this patient?
(A) Vestibular neuronitis
(B) Ncute labyrinthitis
(C) Benign positional vertigo
(D) Orthostatic hypotension
(E) Meniere's disease
66. What is the best treatment for the patient described in case above?
(A) An antiseptic
(B) Education and reassurance
(C) A thiazide diuretic
(D) A change in the antidepressant
(E) B and D
67. A. 30-year-old male comes to your office for assessment of dizziness." The dizziness occurs when he rolls over from the lying position to either the left side or the right side. It also occurs when he is looking up. He describes sensation of "the world spinning around" him. The episodes usually last for 10-15 seconds. What is the most likely diagnosis in this patient?
(A) Vestibular neuronitis .
(B) Acute labyrinthitis
(C) Positional vertigo
(D) Orthostatic hypotension
(E) Meniere's disease
68. What is the treatment of choice for the patient described in case above?
(A) Avoidance of alcohol and caffeine
(B) Dimenhydrinate
(C) A thiazide diuretic
(D) Reassurance and simple exercises
(E) Edolymphatic surgery
69. A 39-year-old female comes to your office with a 4-day history of "unrelenting dizziness." The dizziness is associated with nausea and vomiting. There has been no hearing loss, no tinnitus, and no sensation of aural fullness. The patient has just recovered from an upper-respiratory tract infection. On examination, nystagmus is present. The slow phase of the nystagmus is toward the left, and the rapid phase of the nystagmus is toward the right. There is a significant ataxia present. What is the most likely diagnosis in this patient?
(A) Acute labyrinthitis
(B) Benign positional vertigo
(C) Orthostatic hypotension
(D) Meniere's disease
70. What is the treatment of choice for the patient described in case above?
(A) Avoidance of alcohol and caffeine
(B) A thiazide diveretic
(C) Endolymphatic surgery
(D) Reassurance and antiemetics
(E) Prochlorperazine
71. A 26-year-old female comes to your office with a 6-day history of severe dizziness associated with ataxia and right? sided hearing loss. She had an upper-respiratory tract infec?tion 1 week ago. At that time her right ear felt plugged. On examination, there is fluid behind the right ear?drum. There is horizontal nystagmus present with the slow component to the right and the quick component to the left. Ataxia is present. What is the most likely diagnosis in this patient?
(A) Acute labyrinthitis
(B) Benign positional vertigo
(C) Orthostatic hypotension
(D) Meniere's disease
72. What is the most common cause of sensorineural hearing loss in the adult population?
(A) Meniere's disease
(B) Chronic otitis media
(C) Presbycusis
(D) Otosclerosis
(E) Mastoiditis
73. What is the most common cause of conductive hearing loss in adults who have normal-appearing tympanic membranes?
(A) Meniere's disease
(B) Chronic otitis media
(C) Presbycusis
(D) Otosclerosis
(E) Mastoiditis
74. A. 37-year-old female comes to your office for assessment o hearing loss. She has had problems intermittently for the past 12 months. On examination, the Weber tuning fork test lateralizes to the right ear, and the Rinne tuning fork test is negative in the right ear (bone conduction is greater than air conduction [BC>AC)) . This suggests which one of the following hearing losses?
(A) A right-sided conductive hearing loss
(B) A left-sided conductive hearing loss
(C) A right-sided sensorineural hearing loss
(D) A left-sided sensorineural hearing loss
(E) A or d
75. A 43-year-old male comes to your office for assessment of hearing loss. He has had hearing difficulties for the past 4 years. On examination, the Weber tuning fork test lateralizes to the left ear. The Rinne tuning fork test is positive: (AC>BC) in both ears. This suggests which one of the following hearing losses?
(A) A right-sided conductive hearing loss
(B) A left-sided conductive hearing loss
(C) A right-sided sensorineural hearing loss
(D) A left~sided sensorineural hearing loss
(E) B or c
76. A 42-year-old woman comes to your office complaining of severe facial pain in the region of her right maxilla, fever, and a purulent discharge from her right nose, all of which started after a recent upper-respiratory infection. Her temperature is 101 F. There is tenderness over the right maxillary sinus and a greenish discharge in her right nares. The rest of her examination is normal. Which of the following statements concerning this patient is (are) true?
(A) The most common causes are allergic and viral
(B) Rhinovirus. Is the most common among of viral causes
(C) Viral often is accompanied by fever, malaise, and systemic symptoms
(D) A and b only ,
(E) A, b, and c are true
77. Acute bacterial sinusitis is caused most commonIy by which of the following organisms
(A) Strep. Prieumonae
(B) Haemophilus influenzae
(C) Moraxella catarhalis
(D) S. pyogenes
(E) Staphylococcus aureus
78. What is the antibacterial drug of first choice for modetate to severe acute bacterial sinusitus?
(A) Amoxicillin clavulanic acid (10-14 day course)
(B) Cotrimoxazole (10~ 14 day course)
(C) cefuroxiine (10-14day course)
(D) ciprofloxacin (10day course)
(E) Erythromycin (10-day course)
79. Which of the following anatomic forms of acute bacterial sinusitis is most serious?
(A) Maxillary sinusitis
(B) Ethmoidal sinusitis
(C) Frontal sinusitis
(D) Mandibular sinusitis e. Anterior sinusitis
80. A mother comes to your office with her 24-month-old daughter. The child developed an upper-respiratory tract infection approximately 1 week ago. Two days ago the child began complaining of pain in the right ear. On examination, the child has nasal congestion and a hyperemic throat. The left tympanic membrane is normal, and the right tympanic membrane is bulging and red. There appears to be fluid behind it, The lungs are clear. The child's temperature is 39.5? C. What is the most likely diagnosis in this child?
(A) Acute otitis media (AOM)
(B) Otitis media without effusion
(C) Chronic otitis media (COM)
(D) Otitis media. With effusion (OME)
(E) None of the above
81. An 8-month-old male is brought to your clinic. He has had an upper-respiratory tract infection but has no signs of acute ear infection such as irritability, poor sleeping, pulling at his ears, or fever.
On examination, the tympanic mem?brane is dull and bulging but not red. The rest of the examination is benign besides a mild clear rhinorrhea. What is the most likely diagnosis in this child?
(A) Acute otitis media
(B) Otitis media without effusion
(C) Chronic otitis media
(D) Otitis media with effusion
(E) None of the above
82. A 7-month-old child is brought to your clinic by his mother He has had an upper-respiratory tract infection for the past 3 days. On examination, there is erythema of the left tympanic membrane with opacification. There are no other signs or symptoms. What is the most likely diagnosis in this patient?
(A) Acute otitis media
(B) Otitis Media Without Effusion
(C) Chronic
(D) OME
(E) None Of The Above
83. A nine years old child is brought to your office with a dis?charge from the left ear that has been present for the last 2 weeks. The child has a history of frequent ear infec?tions, all of which have been treated with antibiotics. What is the most likely diagnosis in this patient?
(A) Acute otitiis media
(B) Otitis Media Without Effusion
(C) Chronic otitis media
(D) Otitis media with effusion
(E) Mastoiditis
84. What are the three most common bacterial organ?isms in order of frequency that are responsible for the Acute Otitis Media?
(A) Streptococcus pneumolliae, group A streptococci, Haemophilus influenzae
(B) S. pneumonae, H. influenzae, Staphylococcus aureus
(C) S.pneumonae, H. influenzae, Moraxella
(D) H. influenzae, S. pneumonae, group A streptococci
(E) H. influenzae, S. pneumonae, M. catarr/wlis
85. What is the drug of first choice for the condition acute ottitis media?
(A) Penicillin
(B) Amoxicillin
(C) Erythromycin
(D) Cefaclor
(E) Amoxicillin-cavulanic acid
86. A 7 years old boy has been brought to your clinic with reduced hearing since 2 months. Clinical examination is normal except dull tympanic membrane. What should be the next approporiate clinical assessment?
(A) Rennie and weber
(B) Perform a myringotomy and suck out all the fluid that is present
(C) Perform a pneumatic otoscopy to assess the movement of the tympanic membrane
(D) Refer the child ent specialist.
(E) None of the above
87. Which of the following statements regarding treatment of the condition described in acute otitis media?
(A) Earache and fever should be treated with aspirin
(B) Topical decongestants are useful in improving eustachian tube dysfunction
(C) Ear drops do not provide significant relief in children
(D) Systemic antihistamine-decongestants have been shown to improve the symptoms and shorten the course of disease
(E) All of the above statements are true
88. How is recurrent otitis media defined?
(A) Three or more episodes of AOM that occur within 6 months within a year
(B) Four or more episodes of AOM that occur within 6 months, or five episodes that occur within a year.
(C) Five or more epfa>des of aom that occur within 6 months or six episodes that occur within a year
(D) Six or more episodes of ADM that occur within 6 months, or eight episodes within a year
(E) 10 or more episodes of AOM that occur within 6 months, or three or more episodes that occur within a year
89. Which of the following statements regarding recurrent otitis media is true?
(A) Recurrent AOM usually occur in the winter or early spring
(B) Recurrent bouts of AOM should be managed by myringotomy and the insertion of venti-lation tubes
(C) Medical management appears to be less effec?tive and is not as safe as myringotomy and tubes in children with recurrent AOM.
(D) Amoxici1lin does not have a major role to play in the management of recurrent ADM
(E) Antibiotic prophylaxis should be given for at least 6 months to a year
90. Which of the following intracranial complications may occur with otitis media?
(A) Meningitis
(B) Subdural empyema
(C) Brain abscess
(D) All of the above
(E) A and c only
91. Which of the following is NOT a possible extra?cranial complication of otitis media?
(A) Mastoiditis
(B) Cholesteatoma
(C) Labyrinthitis
(D) Facial paralysis
(E) Otic hydrocephalus
92. Which of the following is false about Acute Otitis Media?
(A) Infants and young children are at highest risk
(B) 40% of children will have an effusion that persists for 4 weeks
(C) Boys tend to have a higher incidence of aom than girls do
(D) Nearly 90% of children will have an episode of aom by age 3 years
(E) Incidence of aom peaks between 6 to 13 months of age
93. Tympimocentesis with aspiration of middle ear fluid should not be considered in which patients except:
(A) A child who presents with Acute otitis media and com?plains of tinnitus, vertigo, and hearing loss
(B) A child who develops a suppurative intra cranial complication of Otitis Media
(C) An patient who is immunologically impaired and does not improve with antibiotic treatment
(D) A child who has extreme ear pain and appears ill.
(E) A child, who is already taking antibiotics
94. A 19 years old college student presents to your clinic with one day history of 1010 F fever and malaise. His college examinations are coming up next week. His past history is unremarkable.
On examination his throat is mildly hyperemic. What could be the best management is this case?
(A) Paracetamol + chlorpheneramine + Gargles
(B) Paracetamol + Amoxicillin + Gargles.
(C) Paracetamol + chlorpheneramine + Amoxcillin
(D) Paracetamol + chlorpheneramine + Amoxcillin + Gargles
(E) Paracetamol + gargles.
95. Which one of the following statements about the differential diagnosis of rhinitis is correct?
(A) Lymphadenopathy is associated with allergic rhinitis.
(B) Vasomotor rhinitis is seasonal, not perennial.
(C) Occupational rhinitis can be allergic or nonallergic.
(D) Allergic rhinitis is only seasonal.
96. In addition to Staphylococcus aureus, which one of the following is the next most common pathogen isolated from ears with chronic suppurative otitis media?
(A) Streptococcus pneumoniae.
(B) Haemophilus influenzae.
(C) Moraxella catarrhalis.
(D) Pseudomonas aeruginosa.
(E) Serratia marcescens.
97. A 50-year-old patient complains of hearing loss. He denies noise exposure at work but says that he has a hard time hearing the television unless he turns up the volume. He denies any discharge from the ears, vertigo or fever, but he has had some intermittent ringing of the right ear. A Weber test reveals lateralization to the left. A Rinne test shows better air conduction than bone conduction bilaterally. What is the most appropriate diagnosis?
(A) Conductive deficit.
(B) Sensorineural deficit of the right ear.
(C) Mixed deficit.
(D) Temporal threshold shift.
98. A 22 years old man presents with vertigo on turning his face to right . He does not have hearing problem, ear complaint, or headache his general and systemic exams are normal. Halpick maneurer elicits nystaginus on R lateral gaze. Which one of the following treatments would be most appropriate for this patient who has benign paroxysmal
(A) Canalith repositioning procedure
(B) Meclizine (Antivert)
(C) Diazepam
(D) Low-salt diet
(E) Hydrochlorothiazide
99. A 40 years old man comes with tinnitus in both ear .His hearing is normal .Ear examination is also normal Which one of the following may lead to tinnitus without hearing loss?
(A) External ear infection.
(B) Cerumen impaction.
(C) Middle ear fluid.
(D) Furosamide
(E) Otosclerosis.
100. Which one of the following recommendations about antibiotics for the prevention of cold symptoms is CORRECT?
(A) Antibiotics are recommended for patients with purulent nasal discharge after three to five days.
(B) Antibiotics are recommended to prevent pneumonia.
(C) Antibiotics are not recommended for patients with a suspected cold.
(D) Antibiotics are recommended for adults with cold and fever after three to five days.
101. A 48 year old man complains of hearing loss, tinnitus in the right ear, and vertigo for the past 6 months. In addition, he has facial pain and weakness of his facial muscles. On physical examination, he has a facial palsy on the right side. Which of the following is the most likely diagnosis?
(A) Acoustic neuroma
(B) Bell palsy
(C) Benign positional vertigo
(D) Lyme disease
(E) Meniere disease
102. Which one of the following is not a cause of conductive hearing loss that may lead to tinnitus?
(A) External ear infection.
(B) Cerumen impaction.
(C) Middle ear fluid.
(D) Loop diuretic medications.
(E) Otosclerosis.
MCQ# ANSWER MCQ# ANSWER MCQ# ANSWER MCQ# ANSWER
1 D 27 D 53 A 79 C
2 B 28 D 54 E 80 A
3 A 29 E 55 C 81 D
4 A 30 A 56 A 82 B
5 A 31 D 57 A 83 C
6 B 32 C 58 D 84 C
7 E 33 B 59 E 85 B
8 E 34 C 60 B 86 C
9 E 35 B 61 C 87 cancelled
10 D 36 C 62 A 88 A
11 C 37 E 63 E 89 A
12 E 38 E 64 E 90 D
13 A 39 E 65 D 91 E
14 B 40 C 66 E 92 D
15 A 41 B 67 C 93 cancelled
16 E 42 D 68 D 94 E
17 A 43 C 69 A 95 C
18 D 44 B 70 E 96 D
19 D 45 D 71 B 97 B
20 B 46 A 72 C 98 A
21 D 47 B 73 D 99 D
22 B 48 D 74 D 100 C
23 B 49 C 75 C 101 A
24 A 50 A 76 E 102 D
25 D 51 D 77 A
26 C 52 B 78 A
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