Cornwall Regional Hospital- Department of ENT head & Neck surgery

E.N.T-Otorhinolaryngology Clerkship
Instructions: Read each question carefully and then select the single best answer
Part I: Otology/Ear

1) A 21-year-old swimmer presents with severe ear pain, discharge and itching in his left ear for 2 days.
On physical exam pain is elicited when tragal pressure. The auditory meatus is oedematous and
erythematous with yellowish debris. What is the next best step in the management of this patient?
a. Prescribe NSAIDs
b. Apply topical ciprofloxacin ear drops
c. Request CT scan of the temporal bone
d. Irrigating or suctioning of the ear canal
e. Request an audiogram

2) A 42-year-old patient with HIV and diabetes complains of marked otalgia and otorrhea for 2 weeks.
Otoscopy reveals purulent discharge and granulation tissue on the floor of the external auditory
canal. Which of the following statements is likely to be most accurate?
a. If an ear swab is taken, Proteus mirabilis is most likely to be isolated
b. The granulation tissue should be biopsied to rule out a possible malignancy
c. A perforation in the pars flaccida is characteristic of this condition
d. Her condition is most likely caused by reactivated varicella zoster virus
e. Oral amoxicillin is considered the treatment of choice

3) A 52-year-old woman presents with “really bad dizziness in the mornings” that occurs whenever she
changes head position. She goes on to explain that the episodes last less than 1 minute and is
accompanied by nausea but no vomiting. Which of the following statements is correct?
a. Her clinical presentation is most suggestive of Meniere’s disease
b. A negative dix-hall-pike test rules out BPPV as a possible cause of her symptoms
c. A canalith is most likely present in the superior semicircular duct
d. A vestibular schwannoma is the most likely diagnosis and a CT or MRI is indicated
e. The Epley manouvre may provide symptomatic relief
 Part II: Nose & Paranasal Sinuses

4) A 15-year-old female is brought to the emergency department with bleeding from both nostrils. She
reports that prior to this she was at a party. On inspection, she has perioral hyperpigmentation.
Rhinoscopy shows bleeding arising from the anterior inferior nasal septum. Her vital signs show a BP
147/90 and Pulse of 110 bpm. Which of the following statements is the best course of action at this
time?
a. The patient should be asked to sit up, compress the nasal bones and tilt the head backwards
b. A Foley catheter should be inserted immediately and both nasal cavities packed with ribbon
gauze soaked in antiseptic cream
c. internal carotid artery ligation may be necessary if she continues to have severe epistaxis
d. urgent transfusion with platelets and whole blood
e. if nasal compression fails to stop the bleeding, silver nitrate cautery may be required

5) Which of the following would be most useful in determining the cause of nasal bleeding in the above
patient?
a. Juvenile nasopharyngeal angiofibroma is very likely to be the cause of bleeding in this teenager
b. CT facial bones and paranasal sinuses is necessary to rule out a septal haematoma or nasal bone
fracture
c. Perioral hyperpigmentation is pathognomonic of Osler-Weber-Rendu Syndrome
d. Elevated blood pressures indicate that essential hypertension is the most likely the cause of this
patient’s epistaxis
e. The emergency physician should enquire if the patient has been snorting cocaine

6) A 14-year-old male presents to the Otolaryngology clinic with a complaint of unilateral nasal
obstruction. He denies hearing loss or epistaxis. On examination of the mouth a mass is seen hanging
down from the nasopharynx. No lymph nodes are palpable. Computed tomography shows a mass
arising from the maxillary antrum with widening of the maxillary ostium and no associated bony
destruction. What is the most likely diagnosis?
a. Antrochoanal polyp
b. Nasopharyngeal carcinoma
c. Juvenile nasopharyngeal angiofibroma
d. Squamous cell carcinoma of the maxilla
e. Inverted papilloma

7) The patient above is scheduled for functional endoscopic sinus surgery (F.E.S.S) to remove the lesion
described above. The ENT surgeon should recall that…
a. The posterior ethmoidal, maxillary and sphenoidal sinuses all drain into the middle meatus
b. The maxillary sinus is lined by stratified squamous epithelium
c. The maxillary sinus is innervated by branches the superior alveolar nerves
d. The maxillary sinus receives its blood supply from the first part of the maxillary artery
e. The lamina papyracea separates the maxillary antrum from the orbit

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