LE 3 ENT reviewer Flashcards
(153 cards)
1
Q
A 17-year-old male presents with profuse epistaxis and a nasal mass upon examination. What is the most likely diagnosis?
Choices:
A. Inverting papilloma
B. Angiofibroma
C. Nasopharyngeal carcinoma
D. Massive nasal polyposis
A
B. Angiofibroma
Rationale: Nasopharyngeal angiofibroma is a benign but highly vascular tumor seen almost exclusively in adolescent males. It often presents with profuse epistaxis and a nasal mass.
2
Q
A 40-year-old female presents with a unilateral, greyish, smooth nasal mass. What is the most likely diagnosis unless proven otherwise?
Choices:
A. Inverting papilloma
B. Angiofibroma
C. Nasal polyps
D. Maxillary carcinoma
A
A. Inverting papilloma
Rationale: Inverting papilloma typically presents as a unilateral greyish nasal mass. It is locally aggressive and has malignant potential, requiring biopsy for confirmation.
3
Q
Orbital complications are the most common acute complications arising from bacterial rhinosinusitis. They usually originate from which sinus?
Choices:
A. Frontal
B. Maxillary
C. Ethmoid
D. Sphenoid
A
C. Ethmoid
Rationale: The ethmoid sinus is most commonly involved in orbital complications due to its thin lamina papyracea, allowing easy spread of infection to the orbit.
4
Q
Little’s area is a common site for epistaxis due to which of the following reasons?
Choices:
A. All are correct
B. Thinness of the septal mucosa
C. The rich anastomosis of vessels in the area
D. None of the choices
A
A. All are correct
Rationale: Little’s area, or Kiesselbach’s plexus, is prone to bleeding due to the rich anastomosis of vessels and the thin mucosa overlying them, making it vulnerable to trauma and dryness.
5
Q
What is the best treatment for nasopharyngeal carcinoma?
Choices:
A. Surgery plus chemotherapy
B. Immunotherapy
C. Radiation plus chemotherapy
D. Surgery
A
C. Radiation plus chemotherapy
High-Yield Rationale:
Radiation therapy is the primary treatment for nasopharyngeal carcinoma (NPC), often combined with chemotherapy to improve survival rates. NPC is typically unresectable due to its deep location and close proximity to vital structures.
6
Q
What is the most common sinus involved in a malignant squamous cell tumor of the paranasal sinuses?
Choices:
A. Sphenoid
B. Ethmoid
C. Maxillary
D. Frontal
A
C. Maxillary
High-Yield Rationale:
The maxillary sinus is the most common site for malignant squamous cell carcinoma due to its large surface area and direct exposure to carcinogens such as industrial chemicals and tobacco smoke.
7
Q
Which of the following is a characteristic of a nasal polyp?
Choices:
A. Does not easily bleed with manipulation
B. Often seen occupying the medial wall of the nose
C. Does not shrink with decongestion
D. Usually does not move on probing
A
C. Does not shrink with decongestion
High-Yield Rationale:
Nasal polyps are non-neoplastic, painless, and non-bleeding masses arising from chronic inflammation. Unlike swollen turbinates, they do not shrink with decongestants.
8
Q
Which of the following is the most common early symptom that will make you suspect the presence of a nasopharyngeal mass?
Choices:
A. Nasal congestion
B. Diplopia
C. Epistaxis
D. Unilateral hearing loss
A
D. Unilateral hearing loss
High-Yield Rationale:
Unilateral hearing loss is an early symptom of a nasopharyngeal mass, often due to Eustachian tube obstruction, leading to a middle ear effusion.
9
Q
A 25-year-old female presents with an enlarging mass on the right side of the jaw for 2 months. On PE, a 4 cm firm mass is noted on the right mandible. Oral cavity examination reveals an unerupted right molar. Panoramic X-ray shows expansile “soap-bubble” lesions with well-demarcated borders. What is the most likely diagnosis?
Choices:
A. Ludwig’s Angina
B. Odontogenic infection
C. Ameloblastoma
D. Parapharyngeal Abscess
A
C. Ameloblastoma
High-Yield Rationale:
Ameloblastoma is a benign but locally aggressive odontogenic tumor, commonly associated with an unerupted tooth and presenting with an expansile “soap-bubble” appearance on imaging.
10
Q
A 55-year-old female undergoing chemotherapy and radiation therapy presents with whitish lesions on her tongue, sore throat, and dysphagia. The lesions can be easily scraped off without bleeding. What is the most likely diagnosis?
Choices:
A. Candidiasis
B. Minor Aphthous Ulcers
C. Infectious Mononucleosis
D. Major Aphthous Ulcers
A
A. Candidiasis
High-Yield Rationale:
Oral candidiasis (thrush) presents as easily removable white plaques caused by Candida albicans, particularly in immunocompromised patients (e.g., chemotherapy, diabetes, HIV).
11
Q
According to the Philippine Society of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines, which of the following is NOT an indication for tonsillectomy?
Choices:
A. Recurrent tonsillitis occurring 4x a year
B. Tonsillar hyperplasia with upper airway obstruction
C. Peritonsillar abscess
D. Diphtheria
A
C. Peritonsillar abscess
High-Yield Rationale:
Tonsillectomy is indicated for recurrent tonsillitis, obstructive tonsillar hyperplasia, and complications (e.g., sleep apnea). However, peritonsillar abscess is usually treated with incision and drainage, antibiotics, and steroids, not immediate tonsillectomy.
12
Q
How do you manage a patient with oral candidiasis?
Choices:
A. Oral antiseptic gargle
B. Steroid gel
C. Nystatin oral solution
D. Oral antibiotics
A
C. Nystatin oral solution
High-Yield Rationale:
Nystatin oral solution is the first-line treatment for oral candidiasis. Patients should swish and swallow it 4 times daily for 7-14 days.
13
Q
Ludwig’s Angina is an infection involving which of the following spaces?
Choices:
A. Submental and retropharyngeal spaces
B. Sublingual and submandibular spaces
C. Retropharyngeal and pharyngeal spaces
D. Sublingual and lateral pharyngeal spaces
A
B. Sublingual and submandibular spaces
High-Yield Rationale:
Ludwig’s Angina is a rapidly spreading cellulitis of the sublingual and submandibular spaces, often due to dental infections. It is a life-threatening emergency requiring airway management and IV antibiotics.
14
Q
What is the most common cause of sore throat and fever among children?
Choices:
A. Foreign body
B. Infection
C. Congenital anomaly
D. Tumors
A
B. Infection
High-Yield Rationale:
Most cases of sore throat and fever in children are caused by viral or bacterial infections, with Group A Streptococcus being a common bacterial cause.
15
Q
What is the most common organism causing Acute Tonsillitis?
Choices:
A. Peptostreptococcus
B. Group B beta-hemolytic Streptococcus
C. Group A beta-hemolytic Streptococcus
D. Pneumococcus pneumoniae
A
C. Group A beta-hemolytic Streptococcus
High-Yield Rationale:
Group A Streptococcus (Streptococcus pyogenes) is the most common bacterial cause of acute tonsillitis, often leading to strep throat.
16
Q
What is the treatment of choice for mucocoele?
Choices:
A. Oral antibiotics
B. Gargle
C. Incision and drainage
D. Excision
A
D. Excision
High-Yield Rationale:
Mucoceles (fluid-filled cysts of minor salivary glands) are best treated with complete excision, as incision and drainage alone can lead to recurrence.
17
Q
Which nerve is responsible for the referred pain to the ear when a person has sore throat?
Choices:
A. Jacob’s nerve
B. Jackson’s nerve
C. Johnson’s nerve
D. Jacobson’s nerve
A
D. Jacobson’s nerve
High-Yield Rationale:
Jacobson’s nerve (Glossopharyngeal nerve branch) carries sensory innervation from the pharynx to the middle ear, causing referred otalgia in throat infections.
18
Q
Which of the following is TRUE about the oropharynx?
Choices:
A. Bounded laterally by the palatoglossus and palatopharyngeus muscles
B. Extends from posterior choanae of the nose to the soft palate inferiorly
C. Not accessible to direct examination
D. Contains adenoids tissues
A
A. Bounded laterally by the palatoglossus and palatopharyngeus muscles
High-Yield Rationale:
The oropharynx extends from the soft palate to the epiglottis and is bounded laterally by the palatoglossus and palatopharyngeus muscles, which help form the tonsillar pillars.
19
Q
Which of the following may cause recurrent aphthous stomatitis?
Choices:
A. Vitamin deficiency
B. Trauma
C. Hormonal changes
D. All are correct
A
D. All are correct
High-Yield Rationale:
Recurrent aphthous stomatitis (canker sores) may be triggered by vitamin deficiencies (B12, folate, iron), trauma, stress, hormonal fluctuations, or immune dysregulation.
20
Q
A 2-year-old patient presents to the ER with difficulty breathing, fever, and inspiratory stridor. An anteroposterior neck X-ray reveals a steeple sign. How will you manage the patient?
Choices:
A. All of the choices
B. Supportive treatment
C. Start the patient with IV antibiotics
D. Establish the airway and do immediate tracheostomy
A
B. Supportive treatment
High-Yield Rationale:
The steeple sign on X-ray is characteristic of croup (laryngotracheobronchitis), which is managed with supportive care (humidified air, corticosteroids, and nebulized epinephrine for severe cases).
21
Q
A 20-year-old male presents with sore throat and dysphagia that worsened after 3 days. He now has ear pain, trismus, and a “hot potato voice”. PE reveals soft palate displacement downward and uvula deviation to the left. What is the most likely diagnosis?
Choices:
A. Diphtheria
B. Infectious Mononucleosis
C. Peritonsillar Abscess
D. Acute Tonsillitis
A
C. Peritonsillar Abscess
High-Yield Rationale:
A peritonsillar abscess (quinsy) presents with trismus, muffled “hot potato voice,” uvula deviation, and peritonsillar swelling. Treatment includes needle aspiration or incision and drainage with antibiotics.
22
Q
A patient presents with hoarseness for 1 month following a thyroidectomy. Which nerve is most likely affected?
Choices:
A. External branch of the superior laryngeal nerve
B. Internal branch of the superior laryngeal nerve
C. Recurrent laryngeal nerve
D. None of the choices
A
C. Recurrent laryngeal nerve
High-Yield Rationale:
The recurrent laryngeal nerve (RLN), which innervates all intrinsic laryngeal muscles except the cricothyroid, is commonly injured during thyroid surgery, leading to persistent hoarseness or vocal cord paralysis.
23
Q
A patient came to your clinic due to hoarseness. On history, you noted that the patient is a grade school teacher who gives lectures daily. On physical examination, bilateral vocal fold nodules were noted. Which of the following conditions of phonation is not satisfied in this patient?
Choices:
A. None of the choices
B. Control of length and tension of vocal folds
C. Adequate breath support
D. Favorable vibratory properties
A
D. Favorable vibratory properties
High-Yield Rationale:
Vocal fold nodules cause disruptions in normal vocal fold vibration, leading to dysphonia and hoarseness. These benign lesions develop due to vocal overuse, reducing favorable vibratory properties.
24
Q
A patient complained of hoarseness for 2 weeks. History and physical examination revealed dysphagia described as a constant foreign body sensation during swallowing. What is the most likely site of the lesion?
Choices:
A. Subglottis
B. None of the choices
C. Glottis
D. Supraglottis
A
D. Supraglottis
High-Yield Rationale:
Supraglottic lesions often cause dysphagia and foreign body sensation, as they involve structures above the vocal folds, affecting swallowing and resonance.
25
A 36 pack-year smoker and alcoholic presents with hoarseness. PE reveals a fungating exophytic mass in the glottic area without vocal cord paralysis. Biopsy confirms squamous cell carcinoma (SCC), stage 1. What is the treatment of choice?
Choices:
A. Microlaryngeal surgery followed by radiotherapy
B. Chemotherapy
C. Total laryngectomy followed by radiotherapy
D. Radiotherapy or microlaryngeal surgery
D. Radiotherapy or microlaryngeal surgery
High-Yield Rationale:
Early-stage (Stage I) laryngeal SCC is effectively treated with radiotherapy or microlaryngeal surgery, preserving the voice and function. Total laryngectomy is reserved for advanced cases
26
In the layers of the vocal folds, which layer is made of loose fibers and matrix and vibrates significantly during phonation?
Choices:
A. Deep lamina propria
B. Intermediate lamina propria
C. Superficial lamina propria
D. Vocalis
C. Superficial lamina propria
High-Yield Rationale:
The superficial lamina propria (Reinke’s space) contains loose fibers, allowing free movement of the vocal folds and playing a key role in phonation.
27
Which anatomical structure in the laryngeal framework is the only complete rigid ring within the airway?
Choices:
A. Hyoid bone
B. Cricoid cartilage
C. Thyroid cartilage
D. Epiglottis
B. Cricoid cartilage
High-Yield Rationale:
The cricoid cartilage is the only complete ring in the airway, providing structural support and forming the base of the larynx.
28
What is the most appropriate management for vocal fold nodules?
Choices:
A. Voice rest
B. Laryngeal framework surgery
C. Partial laryngectomy
D. Microlaryngeal surgery
A. Voice rest
High-Yield Rationale:
Vocal fold nodules are treated conservatively with voice rest, speech therapy, and vocal hygiene. Surgery is only indicated for persistent nodules unresponsive to conservative therapy.
29
What is the most common congenital laryngeal abnormality, characterized by abnormal flaccidity of the laryngeal tissues, inspiratory stridor, and worsening with crying and feeding?
Choices:
A. Leukoplakia
B. Laryngomalacia
C. Recurrent respiratory papillomatosis
D. Croup
B. Laryngomalacia
High-Yield Rationale:
Laryngomalacia is the most common congenital laryngeal disorder, caused by immature laryngeal cartilage that collapses during inspiration, leading to stridor.
30
What is the primary and most primitive function of the larynx?
Choices:
A. Articulation
B. Resonance
C. Protection of the lower airway
D. Phonation
C. Protection of the lower airway
High-Yield Rationale:
The larynx's primary function is to protect the lower airway by preventing aspiration during swallowing. Phonation is a secondary function.
31
What is the primary physical examination procedure performed in clinics to examine the larynx?
Choices:
A. Flexible Laryngoscopy
B. Videostroboscopy
C. Direct Laryngoscopy
D. Indirect Laryngoscopy
D. Indirect Laryngoscopy
High-Yield Rationale:
Indirect laryngoscopy using a mirror and light source is the most common initial examination to visualize the larynx in outpatient settings. Flexible laryngoscopy is preferred for detailed evaluation.
32
What type of epithelium lines the free margins of the true vocal cords?
Choices:
A. Cuboidal epithelium
B. Non-keratinizing stratified squamous epithelium
C. Pseudostratified ciliated columnar epithelium
D. Keratinizing stratified squamous epithelium
B. Non-keratinizing stratified squamous epithelium
High-Yield Rationale:
The true vocal cords require non-keratinizing stratified squamous epithelium to withstand vibrational stress during phonation. The rest of the larynx is lined by pseudostratified ciliated columnar epithelium.
33
Which extrinsic ligament of the larynx is significant for establishing emergency surgical airways?
Choices:
A. Cricothyroid membrane
B. Thyrohyoid membrane
C. Hyoepiglottic membrane
D. Cricotracheal membrane
A. Cricothyroid membrane
High-Yield Rationale:
The cricothyroid membrane is used for emergency cricothyroidotomy due to its thinness and superficial location, making it easy to access for an emergency airway.
34
Which extrinsic muscle of the larynx is included in the depressors of the larynx?
Choices:
A. Geniohyoid
B. Mylohyoid
C. Stylohyoid
D. Sternohyoid
D. Sternohyoid
High-Yield Rationale:
Sternohyoid is part of the infrahyoid muscle group, which depresses the larynx after swallowing and during speech.
35
Which intrinsic muscle is a tensor of the larynx?
Choices:
A. Cricothyroid
B. Interarytenoid
C. Posterior cricoarytenoid
D. Lateral cricoarytenoid
A. Cricothyroid
High-Yield Rationale:
Cricothyroid muscle increases tension on the vocal cords, raising pitch by elongating them. It is innervated by the external branch of the superior laryngeal nerve.
36
Which intrinsic muscle of the larynx is supplied by the external branch of the superior laryngeal nerve?
Choices:
A. Lateral cricoarytenoid
B. Posterior cricoarytenoid
C. Cricothyroid
D. Interarytenoid
C. Cricothyroid
High-Yield Rationale:
The cricothyroid is the only intrinsic muscle innervated by the external branch of the superior laryngeal nerve. It tenses the vocal cords, controlling pitch.
37
Which intrinsic muscle of the larynx is the primary abductor?
Choices:
A. Posterior cricoarytenoid
B. Cricothyroid
C. Lateral cricoarytenoid
D. Interarytenoid
A. Posterior cricoarytenoid
High-Yield Rationale:
The posterior cricoarytenoid is the only muscle responsible for vocal cord abduction, allowing for airway opening during breathing.
38
Which function of the larynx shapes the voice into words?
Choices:
A. Articulation
B. Resonance
C. Phonation
D. Modulation
A. Articulation
High-Yield Rationale:
Articulation is the process of shaping raw phonatory sounds into speech, occurring at the tongue, lips, and soft palate.
39
Which law explains the principle of videostroboscopy?
Choices:
A. Bernoulli’s principle
B. Talbot’s law
C. Law of Wrisberg
D. Theory of relativity
B. Talbot’s law
High-Yield Rationale:
Talbot’s law states that rapid successive images appear as a continuous motion, which is the basis of videostroboscopy in laryngeal imaging.
40
Which muscle of the larynx is part of the extrinsic group that provides structural integrity and positioning?
Choices:
A. Lateral cricoarytenoid
B. Posterior cricoarytenoid
C. Sternothyroid
D. Interarytenoid
C. Sternothyroid
High-Yield Rationale:
The sternothyroid muscle is an extrinsic depressor of the larynx, playing a role in positioning and movement rather than phonation.
41
Which of the following are paired laryngeal cartilages?
Choices:
A. Epiglottis
B. Thyroid
C. Cricoid
D. Arytenoids
D. Arytenoids
High-Yield Rationale:
The paired laryngeal cartilages include the arytenoid, corniculate, and cuneiform cartilages. The thyroid, cricoid, and epiglottis are unpaired.
42
Which of the following statements is true about the recurrent laryngeal nerve?
Choices:
A. The recurrent laryngeal nerve provides sensory innervation to the supraglottis
B. The right recurrent laryngeal nerve courses through the aorta
C. The recurrent laryngeal nerve is a branch of the spinal accessory nerve
D. The course of the left recurrent laryngeal nerve is longer because it runs under the ligamentum arteriosum
D. The course of the left recurrent laryngeal nerve is longer because it runs under the ligamentum arteriosum
High-Yield Rationale:
The left recurrent laryngeal nerve loops under the aortic arch and ligamentum arteriosum, making its course longer than the right, which loops under the subclavian artery.
43
Which of the following statements is true regarding the female larynx?
Choices:
A. The thyroid angle in females is 90 degrees, whereas it is 120 degrees in the male larynx
B. The anteroposterior diameter of the female larynx is smaller than the male larynx
C. All of the choices are true regarding the female larynx
D. The thyroid notch is more prominent in females than males
B. The anteroposterior diameter of the female larynx is smaller than the male larynx
High-Yield Rationale:
The female larynx is smaller than the male larynx, leading to a higher-pitched voice. The thyroid angle is actually wider in females (~120°) than males (~90°).
44
Which potential space in the larynx is filled with adipose tissues and is significant in cancer staging and treatment?
Choices:
A. Pre-epiglottic space
B. Reinke’s space
C. Cricotracheal space
D. Santorini’s space
A. Pre-epiglottic space
High-Yield Rationale:
The pre-epiglottic space is rich in adipose tissue and serves as a pathway for cancer spread, making it critical in laryngeal cancer staging and treatment.
45
A negative forced duction test means that diplopia is due to which of the following?
Choices:
A. Increased intraorbital pressure
B. Nerve paresis
C. Herniation of orbital fats
D. Entrapment of the inferior rectus muscle
B. Nerve paresis
High-Yield Rationale:
A negative forced duction test indicates nerve paresis, meaning the eye cannot move due to nerve dysfunction rather than mechanical restriction.
46
The middle layer of the deep cervical fascia encases which of the following?
Choices:
A. Submandibular gland
B. Parotid
C. Infrahyoid muscles
D. Suprahyoid muscles
C. Infrahyoid muscles
High-Yield Rationale:
The middle layer of the deep cervical fascia, also known as the pretracheal layer, encases the infrahyoid muscles, thyroid gland, trachea, and esophagus.
47
The carotid triangle is composed of which of the following structures?
Choices:
A. Common carotid artery, internal jugular vein, CN X
B. CN X, CN XI, CN XII
C. Internal jugular vein, CN X, CN XI
D. CN XI, CN XII, carotid sinus
A. Common carotid artery, internal jugular vein, CN X
High-Yield Rationale:
The carotid triangle, a subdivision of the anterior triangle of the neck, contains the common carotid artery, internal jugular vein, and vagus nerve (CN X).
48
Venous drainage in the anterior neck is carried out by which of the following?
Choices:
A. Brachiocephalic vein
B. Anterior jugular vein
C. Internal jugular vein
D. External jugular vein
B. Anterior jugular vein
High-Yield Rationale:
The anterior jugular vein is responsible for venous drainage of the anterior neck, eventually draining into the external jugular vein or subclavian vein.
49
Which of the following is the middle layer of the deep cervical fascia?
Choices:
A. Pretracheal
B. Carotid sheath
C. Prevertebral
D. Investing layer
A. Pretracheal
High-Yield Rationale:
The pretracheal fascia (middle layer) surrounds the trachea, esophagus, thyroid gland, and infrahyoid muscles, distinguishing it from the investing (superficial), prevertebral (deep), and carotid sheath layers.
50
Which of the following is the thin layer of connective tissue that lies between the dermis of the skin and the investing layer of the deep cervical fascia?
Choices:
A. Superficial cervical fascia layer
B. Platysma
C. Deep layer of the deep cervical fascia
D. Enveloping layer
A. Superficial cervical fascia layer
High-Yield Rationale:
The superficial cervical fascia lies between the skin and the investing layer of the deep cervical fascia, containing fat, nerves, blood vessels, and the platysma muscle.
51
In a Sistrunk operation, which of the following is removed to prevent recurrence of a thyroglossal duct cyst?
Choices:
A. No need to remove part or all of the hyoid bone
B. The whole hyoid bone
C. Central portion of the hyoid bone
D. Lateral portions of the hyoid bone
C. Central portion of the hyoid bone
High-Yield Rationale:
A Sistrunk procedure involves removal of the central portion of the hyoid bone, as the thyroglossal duct tract commonly passes through this region, reducing recurrence risk.
52
The largest salivary gland can be located in which area?
Choices:
A. Superior and posterior to the external auditory meatus
B. Superior and anterior to the external auditory meatus
C. Inferior and anterior to the external auditory meatus
D. Inferior and posterior to the external auditory meatus
C. Inferior and anterior to the external auditory meatus
High-Yield Rationale:
The parotid gland, the largest salivary gland, is located inferior and anterior to the external auditory meatus, extending over the masseter muscle.
53
What is the most common malignant salivary gland tumor?
Choices:
A. Pleomorphic adenoma
B. Adenoid cystic carcinoma
C. Warthin's tumor
D. Mucoepidermoid carcinoma
D. Mucoepidermoid carcinoma
High-Yield Rationale:
Mucoepidermoid carcinoma is the most common malignant tumor of the salivary glands, typically affecting the parotid gland. It has a variable prognosis depending on grade.
54
Which salivary gland disorder is associated with systemic ailments such as chronic alcoholism, vitamin deficiency, diabetes mellitus, and protein deficiencies?
Choices:
A. Sialadenosis
B. Pleomorphic adenoma
C. Chronic recurrent parotitis
D. Sjögren's syndrome
A. Sialadenosis
High-Yield Rationale:
Sialadenosis is a non-inflammatory, non-neoplastic enlargement of the salivary glands associated with systemic conditions like alcoholism, diabetes, and malnutrition.
55
Ranula is a retention cyst most commonly derived from which of the following?
Choices:
A. Sublingual gland
B. Parotid gland
C. Submandibular gland
D. None of the choices
A. Sublingual gland
High-Yield Rationale:
A ranula is a mucous retention cyst originating from the sublingual gland, presenting as a bluish swelling on the floor of the mouth.
56
Which of the following is the blood supply of the superior parathyroid gland?
Choices:
A. Inferior thyroid artery
B. Superior thyroid artery
C. Middle thyroid artery
D. None of the choices
B. Superior thyroid artery
High-Yield Rationale:
The superior parathyroid glands receive blood supply from the superior thyroid artery, which branches from the external carotid artery.
57
Which of the following salivary glands produce primarily mucous secretion?
Choices:
A. Submandibular gland
B. None of the choices
C. Parotid gland
D. Sublingual gland
D. Sublingual gland
High-Yield Rationale:
The sublingual gland produces mainly mucous secretions, while the submandibular gland produces mixed (serous > mucous) secretion, and the parotid gland is purely serous.
58
Which of the following salivary glands produce a largely serous salivary secretion?
Choices:
A. Sublingual gland
B. None of the choices
C. Submandibular gland
D. Parotid gland
D. Parotid gland
High-Yield Rationale:
The parotid gland is the largest salivary gland and secretes purely serous saliva, which is rich in enzymes for digestion.
59
Which parotid gland tumor is exclusively seen in elderly males?
Choices:
A. Monomorphic adenoma
B. Lymphoma
C. Pleomorphic adenoma
D. Warthin's tumor
D. Warthin's tumor
High-Yield Rationale:
Warthin’s tumor (papillary cystadenoma lymphomatosum) is a benign parotid tumor exclusively found in older males, and it has a strong association with smoking.
60
A patient with tenderness and swelling of the thyroid gland came to the clinic. What is the most likely diagnosis?
Choices:
A. Silent thyroiditis
B. Subacute thyroiditis
C. Hashimoto's thyroiditis
D. Granulomatous thyroiditis
B. Subacute thyroiditis
High-Yield Rationale:
Subacute thyroiditis (de Quervain’s thyroiditis) presents with painful thyroid enlargement and elevated inflammatory markers, often following a viral infection.
61
Hürthle cell carcinoma, a more aggressive variant of thyroid carcinoma, is classified under which type?
Choices:
A. Papillary thyroid carcinoma
B. Medullary thyroid carcinoma
C. Follicular thyroid carcinoma
D. Anaplastic thyroid carcinoma
C. Follicular thyroid carcinoma
High-Yield Rationale:
Hürthle cell carcinoma is a subtype of follicular thyroid carcinoma, known for its higher metastatic potential and resistance to radioactive iodine therapy.
62
Which thyroid carcinoma has the pathognomonic histopathologic finding of "Orphan Annie eye nuclei"?
Choices:
A. Anaplastic thyroid carcinoma
B. Follicular thyroid carcinoma
C. Papillary thyroid carcinoma
D. Medullary thyroid carcinoma
C. Papillary thyroid carcinoma
High-Yield Rationale:
Papillary thyroid carcinoma is the most common thyroid cancer and is characterized histologically by "Orphan Annie eye" nuclei, which appear clear due to dispersed chromatin.
63
The anterior cervical triangle consists of four subordinate triangles. Which of the following is one of them?
Choices:
A. Occipital
B. Muscular
C. Subclavian
D. Supraclavicular
B. Muscular
High-Yield Rationale:
The anterior cervical triangle contains muscular, submandibular, submental, and carotid triangles, while the occipital and supraclavicular triangles belong to the posterior cervical triangle.
64
The deep cervical fascia comprises which of the following layers?
Choices:
A. Investing, pretracheal, paratracheal, carotid sheath
B. Investing, enveloping, pretracheal, paratracheal
C. Investing, pretracheal, prevertebral, carotid sheath
D. Investing, pretracheal, paratracheal, prevertebral
C. Investing, pretracheal, prevertebral, carotid sheath
High-Yield Rationale:
The deep cervical fascia is divided into four layers:
Investing layer (surrounds all neck structures)
Pretracheal layer (encloses trachea, esophagus, thyroid)
Prevertebral layer (covers cervical spine and muscles)
Carotid sheath (contains common carotid artery, internal jugular vein, vagus nerve).
65
This autoimmune disorder is a common cause of hyperthyroidism in females and is treated with antithyroid medications, beta-blockers, and radioactive iodine.
Choices:
A. Granulomatous thyroiditis
B. Hashimoto's thyroiditis
C. Grave's disease
D. Silent thyroiditis
C. Grave’s disease
High-Yield Rationale:
Grave's disease is the most common cause of hyperthyroidism, associated with thyroid-stimulating immunoglobulins (TSI), leading to diffuse goiter and exophthalmos.
66
Which is the most common thyroid carcinoma with a high cure rate?
Choices:
A. Medullary thyroid carcinoma
B. Papillary thyroid carcinoma
C. Anaplastic thyroid carcinoma
D. Follicular thyroid carcinoma
B. Papillary thyroid carcinoma
High-Yield Rationale:
Papillary thyroid carcinoma is the most common and least aggressive thyroid malignancy, with a high survival rate due to slow growth and effective treatment options.
67
Which thyroid disease is characterized by rapid, painful swelling of the thyroid gland, requiring steroids but not antibiotics?
Choices:
A. Grave’s disease
B. Silent thyroiditis
C. Hashimoto’s thyroiditis
D. De Quervain’s thyroiditis
D. De Quervain’s thyroiditis
High-Yield Rationale:
De Quervain’s (subacute) thyroiditis is painful, often post-viral, and treated with NSAIDs or steroids, as antibiotics are not needed.
68
What is the most common cause of hypothyroidism in iodine-sufficient areas?
Choices:
A. Hashimoto's thyroiditis
B. Silent thyroiditis
C. Granulomatous thyroiditis
D. Subacute thyroiditis
A. Hashimoto's thyroiditis
High-Yield Rationale:
Hashimoto's thyroiditis is the leading cause of hypothyroidism in iodine-rich regions, characterized by autoimmune-mediated thyroid destruction.
69
This thyroid disease is characterized by rapid, painful swelling of the thyroid gland where steroids are used to reduce inflammation, but antibiotics are not indicated.
Choices:
A. Grave’s disease
B. Silent thyroiditis
C. Hashimoto’s thyroiditis
D. De Quervain’s thyroiditis
D. De Quervain’s thyroiditis
High-Yield Rationale:
De Quervain’s thyroiditis (subacute thyroiditis) is a self-limiting inflammatory condition often caused by viral infections. It presents with painful thyroid swelling, fever, and hyperthyroid symptoms, and is treated with NSAIDs or steroids (not antibiotics).
70
What is the most common cause of hypothyroidism in iodine-sufficient areas?
Choices:
A. Hashimoto’s thyroiditis
B. Silent thyroiditis
C. Granulomatous thyroiditis
D. Subacute thyroiditis
A. Hashimoto’s thyroiditis
High-Yield Rationale:
Hashimoto’s thyroiditis is the leading cause of hypothyroidism in iodine-sufficient areas. It is an autoimmune disease characterized by lymphocytic infiltration, thyroid atrophy, and anti-thyroid peroxidase antibodies (anti-TPO).
71
What structure divides the anterior and posterior triangles of the neck?
Choices:
A. Scalene muscle
B. Omohyoid muscle
C. Sternocleidomastoid muscle
D. Trapezius muscle
C. Sternocleidomastoid muscle
High-Yield Rationale:
The sternocleidomastoid (SCM) muscle acts as the boundary between the anterior and posterior cervical triangles, serving as an important anatomical landmark.
72
What triangle is bounded by the anterior belly of the digastric anteriorly, posterior belly of the digastric posteriorly, and lower border of the mandible?
Choices:
A. Subclavian triangle
B. Submental triangle
C. Muscular triangle
D. Submandibular triangle
D. Submandibular triangle
High-Yield Rationale:
The submandibular triangle (also called the digastric triangle) is an anterior cervical triangle that contains the submandibular gland, facial artery, and lymph nodes.
73
What triangle is bounded by the anterior border of the sternocleidomastoid muscle, superior belly of the omohyoid muscle, and inferiorly by the clavicle or sternum?
Choices:
A. Muscular triangle
B. Submental triangle
C. Submandibular triangle
D. Subclavian triangle
A. Muscular triangle
High-Yield Rationale:
The muscular triangle is part of the anterior cervical triangle and contains:
Infrahyoid muscles (sternohyoid, sternothyroid, thyrohyoid, and omohyoid)
Thyroid gland
Larynx and trachea
It is bounded by:
Anterior border of the sternocleidomastoid (SCM) muscle
Superior belly of the omohyoid muscle
Midline of the neck (clavicle or sternum inferiorly)
74
Where does a thyroid tumor drain?
Choices:
A. Level 2, 3, 4, 5
B. Level 2, 4, 5, 6
C. Level 1, 3, 4, 6
D. Level 3, 4, 5, 6
D. Level 3, 4, 5, 6
High-Yield Rationale:
Thyroid lymphatic drainage occurs mainly in levels 3, 4, 5, and 6, with level 6 (central compartment) being the first site of spread.
75
Which of the following are diagnostic procedures and imaging studies for a thyroid work-up?
Choices:
A. Thyroid ultrasound, neck ultrasound, MRI, and CT scan
B. Neck ultrasound, MRI, CT scan, and thyroid scan
C. Fine-needle aspiration biopsy, thyroid ultrasound, neck ultrasound, MRI
D. Thyroid ultrasound, thyroid hormone levels, fine-needle aspiration biopsy, CT scan
D. Thyroid ultrasound, thyroid hormone levels, fine-needle aspiration biopsy, CT scan
High-Yield Rationale:
A thyroid work-up involves:
Thyroid ultrasound (first-line imaging)
Thyroid hormone levels (TSH, FT3, FT4) to assess function
Fine-needle aspiration biopsy (FNAB) for malignancy suspicion
CT scan (for large goiters or metastatic evaluation)
76
Which of the following types of thyroid carcinoma exhibits capsular or vascular invasion?
Choices:
A. Papillary thyroid carcinoma
B. Anaplastic thyroid carcinoma
C. Follicular thyroid carcinoma
D. Medullary thyroid carcinoma
C. Follicular thyroid carcinoma
High-Yield Rationale:
Follicular thyroid carcinoma (FTC) is distinguished from follicular adenoma by the presence of capsular and/or vascular invasion, making histopathologic examination essential for diagnosis.
77
A 1-year-old boy was brought to the clinic with a mass at the left lateral neck area. What should be the primary consideration as to the nature of the mass?
Choices:
A. Neoplastic
B. None of the choices
C. Inflammatory
D. Congenital
D. Congenital
High-Yield Rationale:
Neck masses in children are commonly congenital, such as branchial cleft cysts or thyroglossal duct cysts. Inflammatory causes are also common but require an infectious history.
78
A 15-year-old girl came into the clinic due to a painless and tense swelling at the anterior neck. On physical examination, the mass was noted anterior to the sternocleidomastoid muscle. What is the most likely diagnosis?
Choices:
A. Branchial cleft cyst
B. Thyroglossal duct cyst
C. Branchial cleft fistula
D. Lymphangioma circumscriptum
A. Branchial cleft cyst
High-Yield Rationale:
A branchial cleft cyst is a painless, congenital lesion commonly located anterior to the SCM, usually enlarging after an upper respiratory infection.
79
A 25-year-old female presented with fever and pain in the right preauricular area. On physical examination, the right parotid area appeared swollen, tender, and erythematous. The orifice of the duct was also swollen with minimal purulent discharge. What is the most likely diagnosis?
Choices:
A. Chronic sialadenitis
B. Sialolithiasis
C. Mumps
D. Acute bacterial sialadenitis
D. Acute bacterial sialadenitis
High-Yield Rationale:
Acute bacterial sialadenitis often occurs due to Staphylococcus aureus infection, with pain, swelling, erythema, and pus from the Stensen’s duct.
80
A 3-year-old boy came for consultation due to a slow-growing lateral neck mass. On physical examination, the mass is painless, soft, doughy, and transilluminates. What is the most likely diagnosis?
Choices:
A. Cystic hygroma
B. Lymphangioma circumscriptum
C. Branchial cleft cyst
D. Hemangioma
A. Cystic hygroma
High-Yield Rationale:
Cystic hygromas are lymphatic malformations commonly found in the posterior triangle of the neck, presenting as soft, painless, and transilluminating masses.
81
A 5-year-old boy developed acute painful swelling of the parotid gland accompanied by fever, which resolved in 2 weeks. What is the primary consideration?
Choices:
A. Bacterial parotitis
B. Viral parotitis
C. Acute sialadenitis
D. Sialadenosis
B. Viral parotitis
High-Yield Rationale:
Mumps (viral parotitis) presents with bilateral or unilateral parotid gland swelling, fever, and pain, and is self-limiting within 2 weeks.
82
A 53-year-old male presented with a soft, painless, slow-growing mass in the right parotid area. The patient has a history of smoking, and ultrasonography revealed cysts in the involved gland. What is the most likely diagnosis?
Choices:
A. Warthin's tumor
B. Pleomorphic adenoma
C. Mucoepidermoid carcinoma
D. Adenoid cystic carcinoma
A. Warthin’s tumor
High-Yield Rationale:
Warthin’s tumor (papillary cystadenoma lymphomatosum) is a benign, cystic parotid tumor, associated with smoking, and commonly presents as bilateral or multicystic lesions.
83
A 64-year-old female presented with a slow-growing mass at the left parotid area for more than 3 years. Months before consultation, she noted facial weakness and palpable nodes at the lateral neck. What is the most likely diagnosis?
Choices:
A. Mucoepidermoid carcinoma
B. Adenoid cystic carcinoma
C. Pleomorphic adenoma
D. Papillary cystadenoma lymphomatosum
A. Mucoepidermoid carcinoma
High-Yield Rationale:
Mucoepidermoid carcinoma is the most common malignant salivary gland tumor, often presenting as a painless slow-growing mass with facial nerve involvement.
84
A mass located at the midline of the neck that moves with tongue protrusion is most likely:
Choices:
A. Thyroglossal duct cyst
B. Branchial cleft cyst
C. Lymphangioma
D. Thyroid nodule
A. Thyroglossal duct cyst
High-Yield Rationale:
A thyroglossal duct cyst is a congenital midline neck mass that moves with swallowing and tongue protrusion, arising from thyroid descent remnants.
85
Branchial cleft malformations are usually found where in relation to the sternocleidomastoid (SCM) muscle?
Choices:
A. Posterior to the SCM
B. Anterior to the SCM
C. No relation to the SCM
D. Beneath the SCM
B. Anterior to the SCM
High-Yield Rationale:
Branchial cleft anomalies are typically found along the anterior border of the SCM, with cysts, sinuses, or fistulae.
86
The standard method of surgery for this type of lesion is the Sistrunk operation.
Choices:
A. Thyroglossal duct cyst
B. Lymphangioma
C. Branchial cleft cyst
D. Hemangioma
A. Thyroglossal duct cyst
High-Yield Rationale:
A Sistrunk operation is performed for thyroglossal duct cyst removal, involving excision of the central portion of the hyoid bone to prevent recurrence.
87
The sublingual glands secrete mostly what type of saliva?
Choices:
A. Both serous and mucous
B. Serous
C. Acinic
D. Mucous
D. Mucous
High-Yield Rationale:
The sublingual glands primarily secrete mucous-rich saliva, while the parotid glands secrete serous saliva and the submandibular glands secrete a mixed (serous > mucous) secretion.
88
To prevent recurrence of a thyroglossal duct cyst, a Sistrunk operation should include removal of what structure?
Choices:
A. Foramen cecum
B. Lingual thyroid
C. Body of the hyoid bone
D. Entire thyroglossal duct
C. Body of the hyoid bone
High-Yield Rationale:
A Sistrunk operation involves removal of the thyroglossal duct cyst along with the central portion of the hyoid bone, as the thyroglossal tract often passes through it, reducing recurrence risk.
89
What is the most common type of malignant salivary gland tumor?
Choices:
A. Adenoid cystic carcinoma
B. Pleomorphic adenoma
C. Warthin’s tumor
D. Mucoepidermoid carcinoma
D. Mucoepidermoid carcinoma
High-Yield Rationale:
Mucoepidermoid carcinoma is the most common malignant salivary gland tumor, primarily affecting the parotid gland, with low-grade and high-grade variants affecting prognosis.
90
What structure divides the parotid gland into superficial and deep lobes?
Choices:
A. Masseter muscle
B. Lingual nerve
C. Facial nerve
D. Ramus of the mandible
C. Facial nerve
High-Yield Rationale:
The facial nerve (CN VII) passes through the parotid gland, functionally dividing it into the superficial and deep lobes.
91
Which imaging study is the first-line choice in evaluating salivary gland masses?
Choices:
A. MRI
B. CT scan
C. X-ray
D. Ultrasound
D. Ultrasound
High-Yield Rationale:
Ultrasound is the first-line imaging study for salivary gland masses, as it differentiates solid from cystic lesions and guides fine-needle aspiration (FNA) when needed.
92
Which of the following is considered the second most common malignancy of the salivary gland, often affecting the minor salivary glands in the palate, with local infiltration leading to pain and nerve deficits?
Choices:
A. Mucoepidermoid carcinoma
B. Adenoid cystic carcinoma
C. Carcinoma ex pleomorphic adenoma
D. Acinic cell carcinoma
B. Adenoid cystic carcinoma
High-Yield Rationale:
Adenoid cystic carcinoma is the second most common salivary gland malignancy, with a slow but aggressive growth pattern, perineural invasion, and a tendency for hematogenous spread.
93
A 40-year-old male presents with a 2x2 cm right preauricular mass. Fine needle aspiration biopsy showed pleomorphic adenoma. Which of the following statements is correct regarding this case?
Choices:
A. Treatment of choice is superficial parotidectomy
B. The tumor has a rapid growth pattern
C. Treatment of choice is total parotidectomy with facial nerve sacrifice
D. This is the most common malignant neoplasm of the salivary gland
A. Treatment of choice is superficial parotidectomy
High-Yield Rationale:
Pleomorphic adenoma is the most common benign salivary gland tumor, usually in the parotid gland. Superficial parotidectomy is the treatment of choice to prevent recurrence or malignant transformation.
94
Among head and neck cancers, which has the highest propensity to metastasize to distant sites?
Choices:
A. Nasopharyngeal carcinoma
B. Thyroid carcinoma
C. Oropharyngeal carcinoma
D. Laryngeal carcinoma
A. Nasopharyngeal carcinoma
High-Yield Rationale:
Nasopharyngeal carcinoma (NPC) frequently metastasizes to distant sites, including lungs, bones, and liver, due to early lymphatic spread and vascular invasion.
95
For advanced laryngeal carcinoma, what is the advocated treatment?
Choices:
A. Total laryngectomy plus radiotherapy
B. Partial laryngeal surgery
C. Chemotherapy
D. Radiotherapy
A. Total laryngectomy plus radiotherapy
High-Yield Rationale:
Total laryngectomy + radiotherapy is the treatment of choice for advanced laryngeal cancer (T3/T4 tumors) when organ preservation is not feasible.
96
In laryngeal carcinoma, which subsite has a better prognosis due to limited lymphatic drainage and early diagnosis?
Choices:
A. Infraglottis
B. Subglottis
C. Supraglottis
D. Glottis
D. Glottis
High-Yield Rationale:
Glottic carcinoma has a better prognosis because the glottis has minimal lymphatic drainage, leading to earlier detection due to hoarseness before significant spread.
97
Malignancies of the glottis usually cause which symptom?
Choices:
A. Referred otalgia
B. Dysphagia
C. Odynophagia
D. Hoarseness
D. Hoarseness
High-Yield Rationale:
Glottic cancer (vocal cord cancer) often presents early with hoarseness due to direct involvement of the vocal cords, allowing for early detection and treatment.
98
Patients with which type of cancer have a poor prognosis, even with aggressive multimodal treatment?
Choices:
A. Nasopharyngeal cancer
B. Laryngeal cancer
C. Thyroid cancer
D. Hypopharyngeal cancer
D. Hypopharyngeal cancer
High-Yield Rationale:
Hypopharyngeal cancer has a poor prognosis due to late presentation, aggressive local invasion, and early metastasis. It is often detected at an advanced stage, reducing survival rates despite surgery, chemotherapy, and radiotherapy.
99
The nasal cavity and paranasal sinuses contain different cell types, leading to various cancers. Which of the following is the most common type?
Choices:
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Lymphoma
D. Esthesioneuroblastoma
B. Squamous cell carcinoma
High-Yield Rationale:
Squamous cell carcinoma (SCC) is the most common malignancy of the nasal cavity and paranasal sinuses, accounting for 80% of cases, often linked to smoking, wood dust exposure, and chronic inflammation.
100
The oral cavity has a rich lymphatic supply. Initial nodal metastasis occurs in which lymph node levels?
Choices:
A. Level IV-V
B. Level I-III
C. Level III-V
D. Level II-IV
B. Level I-III
High-Yield Rationale:
Cancers of the oral cavity first metastasize to Level I (submental, submandibular), Level II, and Level III nodes, due to their proximity to the primary tumor site.
101
The most common initial symptom of nasopharyngeal carcinoma (NPC) is a painless lump in which lymph node level?
Choices:
A. Level II
B. Level IA
C. Level III
D. Level IB
A. Level II
High-Yield Rationale:
Nasopharyngeal carcinoma frequently presents with Level II cervical lymphadenopathy, often as the first and only symptom, due to its propensity for early lymphatic spread.
102
This is a vascular tumor that occurs exclusively in adolescent males, is histologically benign, but can invade the skull base.
Choices:
A. Rhabdomyosarcoma
B. Esthesioneuroblastoma
C. Nasopharyngeal carcinoma
D. Juvenile nasopharyngeal angiofibroma
D. Juvenile nasopharyngeal angiofibroma
High-Yield Rationale:
Juvenile nasopharyngeal angiofibroma (JNA) is a benign but aggressive vascular tumor seen in adolescent males, causing nasal obstruction and recurrent epistaxis.
103
What is the most common symptom in hypopharyngeal cancers?
Choices:
A. Odynophagia
B. Hemoptysis
C. Halitosis
D. Leukoplakia
A. Odynophagia
High-Yield Rationale:
Painful swallowing (odynophagia) is the most common symptom of hypopharyngeal cancer, often progressing to dysphagia and weight loss due to tumor invasion.
104
When present, this is a late symptom of carcinoma of the tongue.
Choices:
A. Fixation/Frozen tongue
B. Bleeding
C. Non-healing ulcer
D. Erythroplakia
A. Fixation/Frozen tongue
High-Yield Rationale:
Fixation of the tongue occurs in advanced carcinoma due to tumor invasion into deep musculature and surrounding structures, indicating poor prognosis.
105
Which of the following is a major risk factor for cancers of the lip?
Choices:
A. Betel nut chewing
B. Alcohol
C. Excessive sun exposure
D. Poor oral hygiene
C. Excessive sun exposure
High-Yield Rationale:
Lip cancers (commonly squamous cell carcinoma) are associated with chronic sun exposure, especially in outdoor workers.
106
Which of the following is the most dangerous form of skin cancer, originating from melanocytes in the basal layer of the epidermis?
Choices:
A. Malignant Melanoma
B. Basal Cell Carcinoma
C. Squamous Cell Carcinoma
D. Adenocarcinoma
A. Malignant Melanoma
High-Yield Rationale:
Malignant melanoma is highly aggressive, with early metastasis to lymph nodes and distant organs, making early detection critical.
107
Which of the following factors increases the risk of nasal cavity and paranasal sinus cancers?
Choices:
A. Diet and Lifestyle
B. Age and Gender
C. Family history and Work exposure
D. Sun exposure and HPV
C. Family history and Work exposure
High-Yield Rationale:
Wood dust exposure, leather industries, and chronic inflammation are risk factors for sinonasal cancers, with genetic predisposition playing a role.
108
Which is the WHO Nasopharyngeal Carcinoma Classification Subtype for Type 2a?
Choices:
A. Keratinizing basal cell carcinoma
B. Keratinizing squamous cell carcinoma
C. Non-Keratinizing undifferentiated carcinoma
D. Keratinizing undifferentiated carcinoma
B. Keratinizing squamous cell carcinoma
High-Yield Rationale:
WHO Type 2a NPC refers to keratinizing squamous cell carcinoma, associated with worse prognosis than non-keratinizing subtypes.
109
Which is a benign but locally invasive neoplasm, known as the most common odontogenic tumor?
Choices:
A. Odontogenic cyst
B. Ranula
C. Follicular cyst
D. Ameloblastoma
D. Ameloblastoma
High-Yield Rationale:
Ameloblastomas arise from odontogenic epithelium, are locally invasive, and require surgical excision due to high recurrence rates.
110
Which is the most common skin malignancy occurring in sun-exposed areas like the forehead, nose, and ears, with local invasion but no metastasis?
Choices:
A. Basal Cell Carcinoma
B. Keratoacanthoma
C. Malignant Melanoma
D. Squamous Cell Carcinoma
A. Basal Cell Carcinoma
High-Yield Rationale:
Basal cell carcinoma (BCC) is the most common skin malignancy, locally invasive but rarely metastasizes, often presenting as a pearly, ulcerated lesion.
111
Which is the most common site for oropharyngeal carcinoma?
Choices:
A. Soft palate
B. Tonsil
C. Base of tongue
D. Lips
B. Tonsil
High-Yield Rationale:
HPV-associated oropharyngeal squamous cell carcinoma most commonly arises in the tonsils, followed by the base of the tongue.
112
Which is the most common site of malignant tumors in the paranasal sinuses?
Choices:
A. Ethmoid
B. Maxillary
C. Sphenoid
D. Frontal
B. Maxillary
High-Yield Rationale:
Maxillary sinus carcinoma is the most common paranasal malignancy, often presenting late due to nonspecific symptoms.
113
Which is the most common site of hypopharyngeal carcinoma?
Choices:
A. Pyriform sinus
B. Posterior cricoid area
C. Posterior pharyngeal wall
D. Lateral pharyngeal wall
A. Pyriform sinus
High-Yield Rationale:
Pyriform sinus carcinoma accounts for over 70% of hypopharyngeal cancers, often presenting late with dysphagia, odynophagia, and weight loss, leading to poor prognosis.
114
Which is the most common type of carcinoma of the lip?
Choices:
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Adenoid cystic carcinoma
D. Mucoepidermoid carcinoma
A. Squamous cell carcinoma
High-Yield Rationale:
Squamous cell carcinoma (SCC) is the most common lip cancer, typically affecting the lower lip due to chronic sun exposure, smoking, and HPV infection.
115
Which is the most common type of melanoma, typically arising in the setting of a preexisting nevus, and commonly diagnosed in the fourth or fifth decade of life?
Choices:
A. Superficial spreading melanoma
B. Nodular melanoma
C. Hemangioma
D. Pyogenic granuloma
A. Superficial spreading melanoma
High-Yield Rationale:
Superficial spreading melanoma accounts for 70% of melanomas, often evolving from a preexisting nevus, with horizontal growth before vertical invasion.
116
A 68-year-old female diabetic patient presents with sore throat and dysphagia. On oral cavity inspection, you note pharyngeal erythema, edema, and multiple whitish plaques on the mucosa. What is your diagnosis?
Choices:
A. Diphtheria
B. Candidiasis
C. Aphthous Ulcers
D. Infectious Mononucleosis
B. Candidiasis
High-Yield Rationale:
Oral candidiasis (thrush) is common in diabetics and immunocompromised patients, presenting with removable white plaques on an erythematous base.
117
A competent throat performs which of the following functions?
Choices:
A. Voice production
B. Swallowing
C. All of the choices
D. Airway maintenance
C. All of the choices
High-Yield Rationale:
The pharynx and larynx are involved in voice production (phonation), airway protection, and swallowing coordination.
118
An 18-year-old male presents with sore throat, fever, body malaise, fatigue, and tender cervical lymphadenopathy. On oral examination, you note a whitish membrane covering the tonsils. What is your diagnosis?
Choices:
A. Acute Tonsillitis
B. Infectious Mononucleosis
C. Aphthous Ulcers
D. Candidiasis
B. Infectious Mononucleosis
High-Yield Rationale:
Epstein-Barr virus (EBV) infectious mononucleosis presents with exudative pharyngitis, posterior cervical lymphadenopathy, and fatigue, often mimicking strep throat.
119
The oropharynx is the division of the pharynx that:
Choices:
A. Extends from posterior choanae of the nose to the soft palate inferiorly
B. Bounded laterally by the palatoglossus and palatopharyngeus muscles
C. Not accessible to direct examination
D. Contains adenoid tissues
B. Bounded laterally by the palatoglossus and palatopharyngeus muscles
High-Yield Rationale:
The oropharynx extends from the soft palate to the hyoid bone and is laterally bounded by the palatoglossus and palatopharyngeus muscles.
120
Which statement is true about Epiglottitis?
Choices:
A. "Thumb sign" can be seen on lateral X-ray of the neck
B. Haemophilus viridans is the causative organism
C. Treatment is incision and drainage
D. Widening of retropharyngeal space can be seen on lateral X-ray of the neck
A. "Thumb sign" can be seen on lateral X-ray of the neck
High-Yield Rationale:
The "thumb sign" on lateral neck X-ray is diagnostic of epiglottitis, caused by Haemophilus influenzae type B, requiring urgent airway management.
121
What is the significance of the ostiomeatal complex?
Choices:
A. It is a congenital anomaly
B. It is a site of cancer
C. It is a frequent origin of infection
D. It is a common drainage pathway of sinuses
D. It is a common drainage pathway of sinuses
High-Yield Rationale:
The ostiomeatal complex is the key drainage site for the frontal, maxillary, and anterior ethmoid sinuses. Blockage here predisposes to sinus infections.
122
Which best characterizes hyponasal speech?
Choices:
A. Increased resonance chamber/volume
B. Heard in congested patients
C. None of the choices
D. Common in cleft patients
B. Heard in congested patients
High-Yield Rationale:
Hyponasal speech occurs when nasal airflow is blocked, often due to congestion, nasal polyps, or adenoid hypertrophy, leading to muffled resonance.
123
Which is the largest sinus in the anterior group?
Choices:
A. Maxillary
B. Sphenoid
C. Frontal
D. Ethmoid
A. Maxillary
High-Yield Rationale:
The maxillary sinus is the largest of the paranasal sinuses and is most commonly affected in sinus infections due to poor drainage against gravity.
124
Which is the most anterior sinus?
Choices:
A. Ethmoid
B. Frontal
C. Maxillary
D. Sphenoid
B. Frontal
High-Yield Rationale:
The frontal sinus is the most anterior sinus, located above the orbit, and drains via the frontonasal duct into the middle meatus.
125
Which is true about the olfactory epithelium?
Choices:
A. It is easily damaged by external factors
B. It contains cranial nerve II
C. It is located at the nasal floor
D. It is well developed in humans as opposed to canines
A. It is easily damaged by external factors
High-Yield Rationale:
The olfactory epithelium, located in the superior nasal cavity, is highly sensitive and can be damaged by infections, chemicals, or trauma, leading to anosmia.
126
Which is true about the sinuses?
Choices:
A. Has olfactory neurons
B. They continuously produce mucus
C. Lined by stratified cuboidal epithelium
D. Usually filled with liquid
B. They continuously produce mucus
High-Yield Rationale:
The paranasal sinuses are lined by ciliated pseudostratified columnar epithelium, which continuously produces mucus for humidification and protection.
127
Which of the following is a consequence of impairment of mucociliary flow?
Choices:
A. All of the choices
B. Mucosal inflammation
C. Sinus fluid accumulation
D. Bacterial infection
A. All of the choices
High-Yield Rationale:
Impairment of mucociliary clearance leads to fluid accumulation, bacterial infection, and chronic inflammation, which predispose to sinusitis and respiratory infections.
128
Which sinus is not involved in the ostiomeatal complex?
Choices:
A. Sphenoid
B. Ethmoid
C. Maxillary
D. Frontal
A. Sphenoid
High-Yield Rationale:
The ostiomeatal complex is the common drainage pathway for the frontal, maxillary, and anterior ethmoid sinuses, but not the sphenoid sinus, which drains separately into the sphenoethmoidal recess.
129
Which sinus is the most posterior and is adjacent to the pituitary gland?
Choices:
A. Frontal
B. Maxillary
C. Ethmoid
D. Sphenoid
D. Sphenoid
High-Yield Rationale:
The sphenoid sinus is located posteriorly, just inferior to the pituitary gland, making it a surgical approach site for transsphenoidal hypophysectomy.
130
A 3-year-old male presents with fever, cough, and hoarseness. On auscultation, inspiratory stridor is noted. Laryngoscopy reveals swelling below the vocal folds. What is the most likely diagnosis?
Choices:
A. Recurrent respiratory papillomatosis
B. Acute epiglottitis
C. Laryngotracheobronchitis
D. Acute laryngitis
C. Laryngotracheobronchitis
High-Yield Rationale:
Laryngotracheobronchitis (Croup) is a viral infection causing subglottic inflammation and barking cough, commonly in children under 5 years old.
131
A one-month-old infant presents with inspiratory stridor since birth, which worsens when crying and when supine. What is the most likely diagnosis?
Choices:
A. Upper respiratory tract infection
B. Foreign body aspiration
C. Laryngomalacia
D. Subglottic hemangioma
C. Laryngomalacia
High-Yield Rationale:
Laryngomalacia is the most common congenital cause of stridor, due to floppy supraglottic structures collapsing during inspiration, worsened in supine position.
132
A patient presents with hoarseness and admits to being very talkative. Indirect laryngoscopy reveals bilateral lesions on the mid-segment of the vocal folds. What is the most likely diagnosis?
Choices:
A. Sulcus vocalis
B. Vocal fold nodule
C. Vocal fold polyp
D. Vocal fold granuloma
B. Vocal fold nodule
High-Yield Rationale:
Vocal nodules are bilateral, symmetric lesions on the vocal folds due to chronic vocal strain, commonly seen in teachers and singers.
133
Congenital subglottic stenosis is defined as a subglottic diameter of:
Choices:
A. Less than 5mm in full-term
B. Less than 4mm in preterm
C. Less than 4mm in full-term
D. Less than 5mm in preterm
C. Less than 4mm in full-term
High-Yield Rationale:
Subglottic stenosis is diagnosed when the subglottic airway diameter is less than 4mm in full-term infants or less than 3mm in preterm infants, leading to airway obstruction.
134
How will you manage a case of Laryngotracheobronchitis (Croup)?
Choices:
A. Antibiotics
B. Chemotherapy
C. Surgery
D. Supportive treatment
D. Supportive treatment
High-Yield Rationale:
Croup (Laryngotracheobronchitis) is a viral illness managed with humidified oxygen, corticosteroids (dexamethasone), and nebulized epinephrine for severe cases. Antibiotics are not indicated.
135
The arytenoid cartilages have two processes. The muscular process is the attachment for which muscles?
Choices:
A. Interarytenoid and Lateral cricoarytenoid
B. Posterior cricoarytenoid and cricothyroid
C. Lateral cricoarytenoid and Posterior cricoarytenoid
D. Thyroarytenoid and Interarytenoid
C. Lateral cricoarytenoid and Posterior cricoarytenoid
High-Yield Rationale:
The muscular process of the arytenoid cartilages serves as the attachment for the lateral cricoarytenoid (adducts vocal cords) and posterior cricoarytenoid (abducts vocal cords) muscles.
136
The most appropriate management for vocal fold nodule is?
Choices:
A. Partial laryngectomy
B. Microlaryngeal surgery
C. Voice therapy
D. Laryngeal framework surgery
C. Voice therapy
High-Yield Rationale:
Vocal fold nodules are often due to vocal overuse and are typically treated first with voice therapy to reduce strain and promote healing. Surgery is reserved for severe cases.
137
The two thyroid laminae meeting at midline form the laryngeal prominence, which is more acutely angled in:
Choices:
A. Infants
B. The laryngeal prominence has the same angle for all individuals
C. Females
D. Males
D. Males
High-Yield Rationale:
The laryngeal prominence (Adam’s apple) is more acutely angled in males due to a larger thyroid cartilage and a more prominent thyroid angle during puberty.
138
What area of the larynx is most commonly affected by cancer?
Choices:
A. Transglottic area
B. Supraglottic area
C. Subglottic area
D. Glottic area
D. Glottic area
High-Yield Rationale:
The glottic area, which includes the vocal cords, is the most common site for laryngeal cancer, particularly squamous cell carcinoma due to high exposure to carcinogens from smoking and alcohol.
139
What condition represents accumulation of gelatinous inflammatory fluid in the Reinke's space?
Choices:
A. Sulcus vocalis
B. Intracordal cyst
C. Vocal fold polyp
D. Polypoid corditis
D. Polypoid corditis
High-Yield Rationale:
Polypoid corditis (also known as Reinke's edema) is characterized by fluid accumulation in Reinke’s space and leads to hoarseness due to the swelling of the vocal folds.
140
What is the best and simplest way to examine the larynx at the clinic/OPD?
Choices:
A. Indirect laryngoscopy
B. Direct laryngoscopy
C. Videostroboscopy
D. Palpation
A. Indirect laryngoscopy
High-Yield Rationale:
Indirect laryngoscopy is a non-invasive, simple procedure that uses a laryngoscope with a mirror to visualize the larynx and is commonly performed in the outpatient clinic.
141
What is the causative agent of Laryngotracheobronchitis?
Choices:
A. Haemophilus influenzae
B. Streptococcus pneumonia
C. Human papilloma virus
D. Parainfluenza virus
D. Parainfluenza virus
High-Yield Rationale:
Parainfluenza virus is the most common cause of Laryngotracheobronchitis (Croup), a viral infection that leads to inflammation and swelling of the upper airways, causing stridor and barking cough in children.
142
What is the most common congenital anomaly of the larynx?
Choices:
A. Laryngeal web
B. Vocal cord nodules
C. Laryngomalacia
D. Subglottic stenosis
C. Laryngomalacia
High-Yield Rationale:
Laryngomalacia is the most common congenital anomaly of the larynx and is caused by floppy supraglottic structures, leading to stridor and worsening in supine position.
143
What is the most common type of carcinoma of the larynx?
Choices:
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Lymphoma
D. Basal cell carcinoma
B. Squamous cell carcinoma
High-Yield Rationale:
Squamous cell carcinoma is the most common type of laryngeal cancer, often linked to smoking and alcohol consumption, particularly in the glottic area.
144
What is the most primitive and most important function of the larynx?
Choices:
A. Respiration
B. Airway protection
C. Phonation
D. Forceful inspiration
B. Airway protection
High-Yield Rationale:
The larynx's primary function is to protect the airway by preventing aspiration through the closure of the vocal cords during swallowing, a function that precedes phonation.
145
Which benign vocal fold lesion arises when a duct of a mucus gland becomes plugged and retains glandular secretion?
Choices:
A. Epidermoid inclusion cyst
B. Vocal fold nodule
C. Sulcus vocalis
D. Mucus retention cyst
D. Mucus retention cyst
High-Yield Rationale:
A mucus retention cyst results from a blocked mucus gland duct, causing fluid accumulation within the gland. This is different from nodules or polyps, which result from mechanical strain.
146
Which law explains the principle of videostroboscopy?
Choices:
A. Bernoulli principle
B. Theory of relativity
C. Talbot's law
D. Wrisberg law
C. Talbot's law
High-Yield Rationale:
Talbot's law states that a series of still images viewed in rapid succession appear as continuous motion, forming the basis of videostroboscopy, which evaluates vocal fold vibration.
147
Which of the following contributes to the development of Recurrent Respiratory Papillomatosis?
Choices:
A. HPV 11 and 16
B. HPV 6 and 16
C. HPV 16 and 18
D. HPV 6 and 11
D. HPV 6 and 11
High-Yield Rationale:
Recurrent Respiratory Papillomatosis (RRP) is caused by low-risk HPV types 6 and 11, leading to benign exophytic growths in the airway that can cause hoarseness and airway obstruction.
148
Which of the following is INCORRECT when performing a classic indirect laryngoscopy?
Choices:
A. The examined area is inverted
B. The patient is in a sitting upright position slightly leaning forward with the neck slightly flexed
C. The dominant hand holds the tongue in place with gauze, and the non-dominant hand holds the laryngeal mirror
D. The patient is asked to take a deep breath and say "eeee"
A. The examined area is inverted
High-Yield Rationale:
In indirect laryngoscopy, the laryngeal image appears upright, not inverted, because the mirror reflects the larynx directly rather than flipping the image.
149
Which of the following is TRUE regarding the "Adam's apple"?
Choices:
A. More prominent in the pediatric age group
B. Prominent in the male sex
C. Part of the cricoid cartilage
D. Vibrates to produce the deep voice in males
B. Prominent in the male sex
High-Yield Rationale:
The Adam’s apple is the laryngeal prominence of the thyroid cartilage, which is more pronounced in males due to pubertal hormonal changes leading to voice deepening.
150
Which of the following refers to the modulation of sound by passage through body tissues?
Choices:
A. Articulation
B. Mucosal wave
C. Resonance
D. Phonation
C. Resonance
High-Yield Rationale:
Resonance refers to sound modulation as it passes through the pharynx, nasal, and oral cavities, affecting voice quality and timbre.
151
Which statement is true regarding vocal nodules?
Choices:
A. Often require surgical therapy
B. Usually respond to medical and behavioral therapy
C. Always result in dysphonia
D. They are congenital in nature
B. Usually respond to medical and behavioral therapy
High-Yield Rationale:
Vocal nodules are benign and typically improve with voice therapy and rest, rather than requiring surgical intervention.
152
Which structure is NOT part of the supraglottis?
Choices:
A. Epiglottis
B. Aryepiglottic fold
C. False vocal cords
D. True vocal cords
D. True vocal cords
High-Yield Rationale:
The supraglottis includes the epiglottis, aryepiglottic folds, and false vocal cords, while the true vocal cords belong to the glottic region.
153
Which structure is the primary structure preventing laryngeal aspiration?
Choices:
A. True vocal cords
B. False vocal cords
C. Prolonged intubation
D. Epiglottis
D. Epiglottis
High-Yield Rationale:
The epiglottis covers the glottis during swallowing, preventing aspiration of food and liquid into the airway, while the false and true vocal cords also contribute secondarily.
