ENT

Question 1

Which of the following are NOT aetiological factors in laryngeal or pharyngeal cancer?

Question 1Select one:

A.
Human papilloma virus

B.
Cigarette smoking

C.
Drinking alcohol

D.
Working with hardwoods

Answer 1

Hardwood dust exposure is not a recognised factor in the development of cancer of the larynx. It has been associate with cancer i the paranasal sinuses but not elsewhere in the upper aerodigestive tract.

At this age recurrent acute otitis media is common. Six episodes a year may be seen in children with normal immunity and does not require further investigation unless other symptoms such as hearing loss are also found.

Question 2

Which of the following symptoms is often the sole presenting complaint in cancers of the head and neck?
Please select all that apply.

Select one or more:

A.
Shortness of breath

B.
Haemoptysis

C.
Hoarseness

D.
Sensation of a lump in the throat (globus)

E.
Dysphagia

Answer 2

Hoarseness is often the reason patients present with cancers of the head and neck. This may either be due to tumours of the vocal cord itself or tumours of the hypopharynx causing immobility of the vocal cord.

Question 3

Certain symptoms have been defined as ‘red flags’ which should result in patients being referred urgently and being given an ENT appointment within 2 weeks. Which of the situations below are NOT mentioned in the guidelines for urgent referral?

Answer 3

Globus sensation alone is not recommended for urgent referral. If patients have associated hoarseness or dysphagia, or if there is other cause for suspicion, then referral should be urgent

Question 4

Mr McKay’s tumour involves the hypopharynx. Which of the following sites are found within the hypopharynx?
Select all that apply

Question 4Select one or more:

A.
Pyriform Fossa

B.
Posterior Pharyngeal Wall

C.
Larynx

D.
Postcricoid Region

Answer 4

Pyriform Fossa,

Posterior Pharyngeal Wall,

Postcricoid Region

Question 5

Mr McKay has a fixed left vocal cord and his CT scan demonstrates at least one lymph node in his neck, measuring slightly over 1 cm, is involved with disease. No distant metastatic spread has been demonstrated.

Answer 5

T3N1M0
T The size and extent of the main tumor
N The number of nearby lymph nodes that have cancer
M Whether the cancer has spread to other parts of the body

Question 6

What features of the history or examination would encourage you to refer Kirsty to secondary care?

Question 2Select one:

A.
Episodes of otalgia every 8 weeks

B.
History suggesting hearing loss for 12 weeks

C.
An episode of ear discharge

D.
A perforated ear drum

Answer 6

History suggesting hearing loss for 12 weeks

Episodes of otalgia every 8 weeks
At this age recurrent acute otitis media is common. Six episodes a year may be seen in children with normal immunity and does not require further investigation unless other symptoms such as hearing loss are also found.

Question 7

Which of the following organisms are NOT commonly found in acute otitis media?

Question 3Select one:

A.
Streptococcus pneumoniae

B.
Haemophilus influenzae

C.
Moraxella catarrhalis

D.
Staphylococcus aureus

Answer 7

Staphylococcus aureus

Moraxella catarrhalis
This is one of the bacteria commonly associated with acute otitis media.

Question 8

Via what route does the normal middle ear receive the air within it?

Question 6Select one:

A.
Via the sinuses

B.
Via the Eustachian tube

C.
Via the mastoids

D.
Via the tympanic membrane

Answer 8

The normal middle ear absorbs a certain amount of the gas within it continuously. This needs to be replaced. A small volume of air passes up the Eustachian tube when it opens with swallowing, maintaining atmospheric pressure within the middle ear cleft.

Question 9

There is evidence that certain additional treatments can improve the resolution of the underlying otitis media with effusion. Sometimes these are offered at the same time as grommet insertion.

Select the one correct treatment from the list below

Question 13Select one:

A.
Antibiotics

B.
Tonsilectomy

C.
Adenoidectomy

D.
Cranial Osteopathy

Answer 9

Adenoidectomy

While antbiotics may help in the treatment of the recurrent acute otitis media asociated with otitis media with effusion there is no evidence that they influence the rate of resolution of the effusion or the Eustachian tube function

Question 10

Which of the following is thought to be the underlying pathophysiology behind otitis media with effusion?

Question 14Select one:

A.
Allergy to dairy products

B.
Upper respiratory tract infection

C.
Poor Eustachian tube function

D.
Tonsillitis

Answer 10

Poor Eustachian tube function

While an upper respiratory tract infection may cause middle ear effusion this will normally resolve within a few weeks at most. When the effusion is persistent for 3 months there must be some other cause.

Question 11

Which of the following treatments would be an appropriate choice for management of otitis media with effusion, characterised principally by moderate conductive hearing loss?

Question 17Select one:

A.
Hearing aid provision

B.
Long term low dose antibiotics

C.
Avoidance of certain foods

D.
Nasal steroid sprays

Answer 11

Hearing aid provision

Antibiotics have not been shown to alter the course of otitis media with effusion.

Question 12

how do grommets prevent accumulation of a middle ear effusion?

Question 20Select one:

A.
By improving Eustachian tube function

B.
By allowing equalisation of pressure between the air in the middle ear and the atmosphere

C.
By allowing the middle ear effusion to drain via the grommet

D.
By allowing the effusion to pass down the Eustachian tube

Answer 12

By allowing equalisation of pressure between the air in the middle ear and the atmosphere

No. Insertion of a grommet has no effect on eustachian tube function. The grommet prevents the hearing loss and recurrent infection while it is in situ. During this time Eustachian tube function will improve in the majority, so it is no longer required once it has spontaneously extruded.

Question 13

A mother brings her six-month-old baby to your GP surgery first thing one morning because the baby has been awake since 2 a.m. screaming with pain and refusing to sleep. He has had a cold for 2 days and seemed to have a raised temperature last night. The baby had finally fallen asleep at 7 a.m., exhausted, and when his mum picked him up to come to the surgery, she noticed some green discharge on the pillow that appeared to have come from his right ear. You examine the baby and see that his right ear canal is full of pus and that it is difficult to visualise the right tympanic membrane.

1. What is this organism likely to be?
2. What condition is the baby suffering from?
3. What treatment would you recommend for his condition?
   4.

Answer 13

1. Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis are most commonly reported globally,but pathogen dominance varies between countries
   Gram positive vs Gram negative
   You see here the G+ in violet or blue (as it retains both the cristal violet and safranin) while Gram negative bacteria when washed with alcohol loose the Crystal violet and retain the safranin (pink)
2. Suspect acute otitis media in children with ear pain (ear symptoms can be subtle especially in young pre-verbal children), with or without fever
   The presence of middle ear effusion on otoscopy is a prerequisite for diagnosis of acute otitis media
   Confirming diagnosis by pneumatic otoscopy can reduce overdiagnosis and unnecessary antibiotic prescribing.
3. phenoxymethylpenicillin
   Consider oral antibiotics in systemically unwell children, those at high risk of complications because of pre-existing comorbidity, children under 2 with bilateral acute otitis media and in children of any age with acute otitis media and acute ear discharge caused by a spontaneous rupture of the eardrum
   4.

Question 14

A 19-year-old female medical student attends your GP surgery with a very sore throat which she has had for the last 3 days. On examination, you see that her throat is red and inflamed with a small amount of exudate over the tonsils. She has cervical lymphadenopathy.
The student also complains of feeling very tired all the time and you think her mucus membranes are slightly pale. You take a throat swab for bacterial culture and a full blood count to check her haemoglobin. Reports received back from the Haematology and Microbiology laboratories are available for you to see. The photograph shows a picture of her blood film, which shows large atypical lymphocytes.
1. what is the likely diagnosis
2. What tests can be done to confirm the diagnosis?
3. She started developing a rush after an antibotic started which antibiotic did she likely started on and what type of rush is specifally presenting with ?

Answer 14

1.Glandular fever
Fever, pharyngitis and ymphadenopathy is the classic triad
2. Epstein-Barr virus Viral Capside Antigen IgM
Heterophile antibody
Paul-Bunnell test (sheep red blood cells)
Monospot test (horse red bloods)
3. a generalized maculopapular, urticarial, or petechial rash is occasionally seen. usually occurred following the administration ofampicillinoramoxicillin; in patient with EBV.

Question 16

A 40-year-old man, a keen swimmer, comes to see you complaining of pain in both ears which has been present for about one week. He is otherwise well. On examination, you notice that the external auditory canal is inflamed and appears to have grey/black patches of wax. The tympanic membrane is intact and looks healthy. You take swabs for culture from both ears and the organism shown on the plate is grown after three days. The film provided shows a** microscopic preparation of this organism stained with lactophenol cotton blue.** The organism has been identified as Aspergillus niger.
1. What condition does the patient have?
2. How has he acquired this infection?
3. What treatment would you recommend?
4. Name two other organisms that commonly cause
otitis externa.

Answer 16

1. Otomycosis
2. Swimming, trauma, heat, moisture
3. Topical clotrimazole (trade name canesten)
4. The most common cause of otitis externa is bacterial infection, caused byPseudomonas aeruginosa
   orStaphylococcus aureus

Question 17

A 14-year-old girl attends your surgery complaining of a very painful throat and difficulty swallowing. On examination, the throat is very red and inflamed with pus on the tonsils. She has cervical lymphadenopathy, and she looks flushed. Her temperature is** 38.5ºC**. You take a throat swab for bacterial culture and receive the report shown. There is also a Gram film and a culture plate of the organism to examine.
1. What condition does the patient have?
2.Should she receive antibiotics, and if so, what?
3. Name two possible serious (but rare) complications of this infection?

Answer 17

1. BACTERIAL cause is Streptococcus pyogenes (also known as Group A streptococcus, or Group A Beta Haemolytic Strep)
2. Yes,Phenoxymethylpenicillin
3. The potential complications of group AStreptococcus(GAS) pharyngeal infection include both suppurative (eg, peritonsillar abscess, otitis media, sinusitis) and inflammatory, nonsuppurative conditions. Acute rheumatic fever (ARF) is one of the nonsuppurative complications (others include scarlet fever and acute glomerulonephritis [AGN], PANDAS syndrome—Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci).

Question 18

A 6-week-old baby is brought to your surgery with sticky eyes. On examination, the conjunctivae are inflamed. He has a mild upper respiratory infection, but is otherwise well. You take an eye swab and send it for bacterial culture. Examine the culture plate, Gram film and laboratory culture report.
1. What clinical condition does the baby have?
2.How has the baby acquired this infection?
3.Name two organisms that cause this infection?
4. What treatment would you recommend?
Name one rare but possible complication of giving this antibiotic
(when given systemically)
5. If this infection had presented in the first few days of life,
what other possible causes of infection should you consider?

Answer 18

1. conjunctivites
2. Sticky or runny eyes are very common in this age group
   Local introduction of the infection
   One in five babies quoted as having blocked tear ducts at birth.
3. The key differential diagnosis at this point is ophthalmia neonatorum, and the most important causative organisms areNeisseria gonorrhoeaeandChlamydia trachomatis, although there are others such asStreptococcus pneumoniaeandStaphylococcus aureus.
   4a. Topical treatment with chloramphenicol or fusidic when there is evidence of bacterial infection such as injected conjunctiva and yellow discharge for more than 48 hours (often spreading from one to both eyes)
   4b. Gray baby syndrome in premature infants (circulatory collapse)
   and Aplastic anemia
4. • Gonococcal ophthalmia occur in the first few days of life
     -Chlamydial disease usually presents between five and 14 days
     - Delayed treatment ofN. gonorrhoeae, in particular, can cause sight-threatening corneal ulceration.

Question 19

This young boy presents to A&E with a swollen eye and double vision. There is** no** history of any injury but he is pyrexial at 38ºC. On examination the eyelid is very swollen and the** eye movements are restricted.**
1. What is your working diagnosis?
2. What microbiological and non-microbiological investigations
would you order and why?
3.What treatment would you start?
4. What complications can occur?

Answer 19

1. Subperiosteal Abscess
2. Blood cultures
   Nasal swab
   Radiology (CT)
3. Ceftriaxone+ Flucloxacillin + Metronidazole Step down Co amoxi clav. +clindomycin
4. Orbital damage
   Brain abscess
   Meningitis
   Septic Cavernous sinus thrombosis
   Vision loss

Question 20

When managing tinnitus in primary care, what considerations would warrant urgent referral?

Question 3Answer

a.
Sudden onset of significant neurological symptoms or signs

b.
Hearing loss that has developed suddenly over a period of 3 days or less

c.
Persistent tinnitus having received tinnitus support in the past

d.
A high risk of suicide

e.
Sudden onset pulsatile tinnitus

Answer 20

a.
b.Refer people very urgently (to be seen within 24 hours) if they have tinnitus and hearing loss that has developed suddenly (over a period of 3 days or less) in the past 30 days – refer to ear, nose, and throat or an emergency department.
d.

Question 21

Many patients are now referred directly to audiology for assessment for a hearing aid by their General Practitioners. Most hospitals have criteria that patients must fulfil in order to be referred directly. Which of the criteria below are in use by NHS Tayside?
(select all the apply)

Question 8Select one or more:

A.
Patients must have no Tinnitus

B.
Patients must have roughly equal hearing loss in both ears

C.
Patients must be aged over 75

D.
Patients must hot have sudden onset hearing loss

E.
Patients with perforations, discharge or any other obvious abnormality should be referred to ENT first for assessment

Answer 21

B. Patients must have roughly equal hearing loss in both ears

D. Sudden onset hearing loss of recent onset should be referred as an emergency to ENT as it should have treatment commenced immediately and should also be investigated further.

E. Patients with perforations, discharge or any other obvious abnormality should be referred to ENT first for assessment.

Question 22

Please describe the appearance of the PTA and pattern of hearing loss?

Answer 22

The PTA demonstrates left sensorineural hearing loss at 3 successive frequencies >30dB

Question 23

Which of the following are NOT appropriate long-term treatments for allergic rhinitis? Choose one of the options below.

Question 2Select one:

A.
Nasal sterioids

B.
Topical decongestitants

C.
Systemic antihistamines

D.
Topical sodium cromoglicate

E.
Topical antihistamines

Answer 23

B Topical nasal decongestant sprays or drops will cause Rhinitis Medicamentosa if used in the long term. These treatments are useful in the short-term for conditions such as acute sinusitis or viral upper respiratory tract infections.

Question 24

Select the common allergen(s) below commonly implicated in allergic rhinitis.

Question 3Select one or more:

A.
House dust mite

B.
Milk

C.
Bleach

D.
Feathers

E.
Grass Pollens

F.
Eggs

G.
Cladosporidium

Answer 24

House dust mite, Feathers, Grass Pollens, Cladosporidium

Question 25

Answer 25

Question 26

Answer 26

Question 27

Answer 27

Question 28

Answer 28

Question 29

Taste and smell receptors are called Blank 1 . Taste receptor cells are replaced every Blank 2 , and olfactory receptors are replaced every Blank 3 . Both taste and smell receptors are replaced by . The olfactory bulb neurons pass along the Blank 5 to reach the Blank 6 and olfactory areas.

Answer 29

1. Taste and smell receptors are called chemoreceptors → ✅ Correct. Chemoreceptors detect chemical stimuli, which is the basis of taste and smell. 2. Taste receptor cells are replaced every 10 days → ✅ Correct. Taste buds regenerate frequently due to the harsh environment of the oral cavity. Olfactory receptors are replaced every 2 months → ✅ Correct. Olfactory receptor neurons have a longer lifespan but still regenerate. Both taste and smell receptors are replaced by basal cells → ✅ Correct. Basal cells serve as stem cells that generate new sensory receptor cells. The olfactory tract leads to the olfactory cortex, 5. The olfactory tract leads to the olfactory cortex, primarily in the temporal lobe.

Question 30

The vagus nerve passes out of the cranial cavity via the Blank 1 Question 7 foramen. The first (most superior) nerve to branch off of the vagus nerve is the Blank 2 Question 7 . The vagus nerve descends through the neck within the Blank 3 Question 7 . The Blank 4 Question 7 nerve branches off the vagus in the mediastinum and ascends.

Answer 30

The vagus nerve passes out of the cranial cavity via the jugular foramen → ✅ Correct. The vagus nerve exits the skull through the jugular foramen, along with the glossopharyngeal (CN IX) and accessory (CN XI) nerves. The first (most superior) nerve to branch off of the vagus nerve is the superior laryngeal nerve → ✅ Correct. The superior laryngeal nerve is an early branch of the vagus and divides into internal (sensory) and external (motor) branches to innervate structures of the pharynx and larynx. The vagus nerve descends through the neck within the carotid sheath → ✅ Correct. The carotid sheath contains the vagus nerve (CN X), common carotid artery, and internal jugular vein as they descend through the neck. The recurrent laryngeal nerve branches off the vagus in the mediastinum and ascends. → ✅ Correct. The recurrent laryngeal nerve branches at different levels: Right side: Loops around the subclavian artery Left side: Loops around the aortic arch It then ascends back toward the larynx, providing motor innervation to most of the intrinsic laryngeal muscles.

Question 31

Regarding causes of vertigo, select the most appropriate option from the list provided. Each option maybe used once, more than once or not at all. Most likely diagnosis for vertigo lasting 20 minutes to several hours Answer 1 Question 8 Choose... Most likely diagnosis for vertigo lasting days-weeks Answer 2 Question 8 Choose... Most likely diagnosis for vertigo lasting just seconds to minutes Answer 3 Question 8 Choose... BPPV is usually triggered by? Answer 4 Question 8 Choose... Condition(s) associated with hearing loss and/or Tinnitus Answer 5 Question 8 Choose...

Answer 31

1. Most likely diagnosis for vertigo lasting 20 minutes to several hours ✅ Correct answer: Meniere's disease (Not Labyrinthitis) Meniere's disease is characterized by episodic vertigo lasting 20 minutes to several hours, accompanied by hearing loss, tinnitus, and aural fullness. Labyrinthitis typically causes vertigo lasting days to weeks, not just hours. 2. Most likely diagnosis for vertigo lasting days to weeks ✅ Correct answer: labyrinthitis often follows a recent viral infection and can cause severe vertigo lasting days to weeks, sometimes with nausea and imbalance. 3. Most likely diagnosis for vertigo lasting just seconds to minutes ✅ Correct answer: BPPV (Benign Paroxysmal Positional Vertigo) BPPV causes brief episodes of vertigo, lasting seconds to minutes, triggered by head movements. 4. BPPV is usually triggered by? ✅ Correct answer: Positional changes BPPV occurs due to displaced otoliths (canaliths) in the semicircular canals, which cause vertigo with positional changes (e.g., rolling in bed, looking up). ✅Meniere's and Labyrinthitis"

Question 32

From the questions below, choose the most appropriate answer from the options provided. First line treatment in a child with persistent otitis media with effusion (glue ear)(OME) Answer 1 Question 9 Choose... In diagnosing glandular fever what might be seen on blood film Answer 2 Question 9 Choose... Other than antibiotics, what other treatment may be given in severe tonsilitis Answer 3 Question 9 Choose... Second line treatment of child with persistent otitis media with effusion Answer 4 Question 9 Choose... Otitis media with effusion will NOT have the symptoms and signs of acute inflammation. True or False?

Answer 32

✅ Correct answer:Adenoidectomy is a surgical procedure involving the removal of the adenoids, which are lymphoid tissues located in the nasopharynx (behind the nose and above the soft palate). It is often considered in children with recurrent or chronic ear (OME) , nose, and throat (ENT) issues. Enlarged adenoids can obstruct the Eustachian tube, impairing middle ear ventilation and contributing to fluid buildup. ✅Glandular fever (infectious mononucleosis, caused by Epstein-Barr virus) leads to atypical lymphocytes on a blood smear. These are large, irregularly shaped lymphocytes responding to viral infection. ✅ **Correct answer: Steroids (e.g., Dexamethasone) In severe tonsillitis, steroids (like dexamethasone) help reduce swelling and pain. IV fluids, analgesia, and airway management may also be needed. ✅ Correct answer: Grommet (ventilation tube) insertion Antibiotics are NOT routinely given for OME unless there is superimposed bacterial infection. If OME persists for >3 months with hearing loss, the second-line treatment is grommet insertion. Otitis media with effusion will NOT have the symptoms and signs of acute inflammation. True or False? ✅ Correct answer: True OME does NOT cause fever, ear pain, or redness of the tympanic membrane. Instead, it leads to painless hearing loss and a dull tympanic membrane due to fluid buildup.

Question 33

Considering neck lumps, match each option below with the most appropriate answer form the list provided. Rarely, patient may report pain when drinking alcohol. Answer 1 Question 10 Choose... Most commonly seen in older men Answer 2 Question 10 Choose... Usually a lump located between isthmus of thyroid and hyoid bone Answer 3 Question 10 Choose... Usually present within the first 2 years of life Answer 4 Question 10 Choose... The most common cause of neck swellings Answer 5 Question 10 Choose... Moves upwards on swallowing Answer 6 Question 10 Choose...

Answer 33

✅ Correct answer: Hodgkin’s Disease (Lymphoma) Alcohol-induced lymph node pain is a rare but characteristic feature of Hodgkin’s lymphoma. This pain is thought to be caused by vascular expansion within the lymph node when alcohol is consumed. ✅ Correct answer: Pharyngeal pouch Pharyngeal pouches (Zenker’s diverticulum) occur mostly in older men due to weakness in the pharyngeal wall. Symptoms include dysphagia (difficulty swallowing), regurgitation of food, and gurgling sounds in the neck. ✅ Correct answer: Thyroglossal cyst Thyroglossal cysts are midline neck lumps found between the thyroid isthmus and hyoid bone. They move upwards on swallowing and protrusion of the tongue. Branchial cysts are found laterally (NOT in the midline). ✅ Correct answer: Cystic hygroma Cystic hygromas are congenital lymphatic malformations that appear in the neck or axilla within the first 2 years of life. ✅ most common Reactive lymphodenpathy ✅ Goiter

Question 34

Considering neck lumps, match each description with the most likely diagnosis from the list provided. Pulsatile lateral neck lump Answer 1 Question 11 Choose... Neck lump that is associated with dysphagia, aspiration and chronic cough Answer 2 Question 11 Choose...

Answer 34

✅ Correct answer: Carotid aneurysm or Carotid body tumor A pulsatile lateral neck lump suggests a vascular origin. Carotid aneurysms or carotid body tumors (paragangliomas) are the most common causes. Pulsatile lateral neck lump Answer 1 Question 11 Carotid aneurysm Neck lump that is associated with dysphagia, aspiration and chronic cough Answer 2 Question 11 Pharyngeal pouch

Question 35

Select the most appropriate answer from the options below. Each answer may be used once, more than once or not at all. What is the name of a scoring system used to asses if a sore throat is likely to be caused by a bacterial source Answer 1 Question 12 The most common bacterial cause for a sore throat is Answer 2 Question 12 The vast majority of tonsillitis cases are causes by what group of pathogens Answer 3 Question 12 Throat swabs are routinely taken in primary care, True or False? Answer 4 Question 12

Answer 35

✅ Correct answer: Centor criteria Centor criteria help determine the likelihood of Group A Streptococcus (GAS) pharyngitis. Factors include: Fever >38°C Absence of cough Tender anterior cervical lymphadenopathy Tonsillar exudates A score of 3 or 4 increases the likelihood of a bacterial infection and may warrant antibiotics. ✅ Correct answer: Streptococcus pyogenes (Group A strep) Streptococcus pyogenes (GAS) is responsible for bacterial tonsillitis and pharyngitis. It can lead to complications like rheumatic fever and post-streptococcal glomerulonephritis. ✅ Correct answer: Viruses Most tonsillitis cases (~70-90%) are viral, caused by: Adenovirus Rhinovirus Influenza Epstein-Barr virus (EBV) (causing infectious mononucleosis/glandular fever) ✅ Correct answer: False Throat swabs are not routinely done because most cases are viral and self-limiting. They are usually reserved for: Recurrent tonsillitis Suspected bacterial cases (especially in high-risk patients) Centor score ≥3-4

Question 36

Select the most appropriate answer from the list provided. Each answer may be used once, more than once or not at all. Most common bacterial cause of otitis media Answer 1 Question 13 Choose... Most common cause of otitis externa Answer 2 Question 13 Choose... Which bacterial: Gram positive cocci chains Answer 3 Question 13 Choose... The pathogen that causes glandular fever Answer 4 Question 13 Choose... The organism that produces a potent exotoxin Answer 5 Question 13 Choose...

Answer 36

✅ Correct answer: Streptococcus pneumoniae Streptococcus pneumoniae (most common) ***Haemophilus influenzae (second most common) Moraxella catarrhalis* ✅ Correct answer: Staphylococcus aureus Staphylococcus aureus is the most common bacterial cause. Pseudomonas aeruginosa is also a common cause, particularly in swimmer's ear. ✅ Correct answer: Streptococcus pyogenes Streptococcus pyogenes (Group A Strep) is a Gram-positive cocci that forms chains under a microscope. Staphylococcus aureus, in contrast, appears as Gram-positive cocci in clusters. ✅ Correct answer: Epstein-Barr virus (EBV) EBV causes infectious mononucleosis (glandular fever). Symptoms include sore throat, fever, lymphadenopathy, and splenomegaly. ✅Corynebacterium diphtheriae → Produces diphtheria toxin, a deadly exotoxin. Streptococcus pyogenes → Produces streptolysin O and erythrogenic toxin (causes Scarlet Fever). Staphylococcus aureus → Produces TSST-1 (Toxic Shock Syndrome Toxin-1) and enterotoxins.

Question 37

Select the correct option from the list below for each. Each answer may be used once or not at all. In a tension pneumothorax, in what direction does the trachea deviate - towards or away from the side of the pneumothorax? Answer 1 Question 14 Choose... At what vertebral level is the hyoid cartilage located? Answer 2 Question 14 Choose... At what vertebral level is the cricoid cartilage located? Answer 3 Question 14 Choose... At what vertebral level is the thyroid cartilage located? Answer 4 Question 14 Choose...

Answer 37

In a tension pneumothorax, the trachea deviates away from the side of the pneumothorax due to the increased pressure in the affected hemithorax pushing the mediastinum towards the opposite side. Hyoid cartilage: Located at C3. Cricoid cartilage: Located at C6. Thyroid cartilage: Located at C4/5/6.

Question 38

Answer 38

Otitis externa

Question 39

Answer 39

Cholesteatoma

Question 40

Answer 40

Normal ear with grommet

Question 41

Answer 41

***Glandular fever *

Question 42

Answer 42

Candidiasis

Question 43

In a patient with vertigo, which 4 features would suggest a diagnosis of Labyrinthitis? Question 20Select one or more: a. Will get nystagmus following the hallpike test b. Experience aural fullness of affected ear c. May experience tinnitus on affected side d. Associated with hearing loss or tinnitus e. Occurs in association with visual disturbance, weakness or numbness f. May be associated with a viral infection g. Episodes of vertigo lasting days to weeks h. Occurs spontaneously

Answer 43

b. Experience aural fullness of affected ear c. May experience tinnitus on affected side d. Associated with hearing loss or tinnitus f. May be associated with a viral infection g. Episodes of vertigo lasting days to weeks h. Occurs spontaneously

Question 44

patient has cardiac surgery and wakes up with a hoarse voice which nerve is likley damage

Answer 44

Recurrent laryngeal nerve (a branch of the vagus nerve

Question 45

which of these phases is swallowing Masticator phase Pharyngeal phase Buccal phase Nasal phase

Answer 45

Pharyngeal phase

Question 46

which nerve responsible for reffered otalgia from the oropharynx

Answer 46

The glossopharyngeal nerve CN IX

Question 47

Which of these blood vessles supply the nose / nasal cavity

Answer 47

Maxillary artery (main contributor) → Gives off: * Sphenopalatine artery (main artery of the nasal cavity) * Greater palatine artery * Ascending pharyngeal artery

Question 48

in the middle ear the stapes footplate sint on what part of the inner ear

Answer 48

Cochlear (oval window )

Question 49

the facial nerve travels through the internal acoustic meatus which bone of the skull is this located ?

Answer 49

**Temporla bone **The facial nerve (cranial nerve VII) enters the internal acoustic meatus along with the vestibulocochlear nerve (cranial nerve VIII). This opening is found in the petrous portion of the temporal bone, which is the hardest part of the skull. After entering the internal acoustic meatus, the facial nerve travels through the facial canal, then exits the skull via the stylomastoid foramen.

Question 51

On flexible laryngoscopy, she is noted to have a left vocal cord that fails to elongate during phonation. Which nerve has most likely been damaged?

Answer 51

* Damage to the external laryngeal nerve results in a vocal cord that cannot be tensed due to loss of cricothyroid function. This results in an inability to **produce notes of high frequency**. * The thyroid gland has two nerves as close relations: the external laryngeal and recurrent laryngeal nerves. * The recurrent laryngeal nerve is intimately related to the inferior poles of the thyroid, including the inferior thyroid artery. It innervates all the intrinsic muscles of the thyroid, **except the cricothyroid muscle which is innervated by the external branch of the superior laryngeal nerve**. * The cricothyroid is the only muscle that elongates the vocal cords. * Therefore, damage to the external laryngeal nerve results in a vocal cord that cannot be tensed due to loss of cricothyroid function. This results in an inability to produce notes of high frequency.

Question 52

Which of the following paranasal sinuses drains into the sphenoethmoid recess? Maxillary sinus Anterior ethmoidal sinus Frontal sinus Sphenoidal sinus Middle ethmoidal sinus

Answer 52

The sphenoidal sinus drains into the sphenoethmoid recess, posterior and superior to the superior concha. Maxillary Sinus Middle meatus via semilunar hiatus. Anterior Ethmoidal Middle meatus via semilunar hiatus. Frontal Sinus Middle meatus via infundibulum. Middle Ethmoidal Middle meatus via ethmoid bulla.