➢ Case 1:

A 45-year-old carpenter started complaining of gradual onset of hoarseness. He has recurrent attacks
of cough and chocking. He smokes 10 cigarettes per day. He has already sought medical advice for his
condition and has received medical treatment, but his condition did not improve.
On examination you find the following:
1. What is the appropriate pathology?
a) Lt vocal cord paralysis
b) Rt cord nodule
c) Lt cord leucoplakia
d) epiglottic mass

2. What is the most common cause of this pathology?

a) Smoking
b) voice abuse
c) thyroidectomy
d) type of work(work hazard)

3. What investigation should be performed for this patient ?

a) CT petrous bone
b) abnormal ultrasound
c) carotid angiography
d) CT chest and lungs

4. IF hoarseness and chocking do not improve, what is management for such case?
a) Excision of the nodule by microlaryngosurgry
b) Excision of epiglottic mass
c) Endoscopic cordectomy for leucoplakia
d) Vocal cord injection
➢ Case 2:

A 5 years old girl has visited out patient clinical with her parents .they noticed deterioration in her
hearing in the recent days .Her teachers also noticed that the parents reported that she snores
frequently at night .
On examination her ears you notice the following (picture):
1. What is the most likely diagnosis ?
a) Acute suppurative otitis media
b) otomycosis
c) otitis media with effusion
d) Glomulus Jugular

2. IF an audiogram is performed, what could be the result ?

a) Anormal audiogram
b) low tone conductive hearing loss
c) high tone sensori neural hearing loss
d) low tone sensori neural hearing loss

3. which tympanogram reflects the current condition?

a) type A
b) type B
c) type As
d) type C

4. The treatment of choice is:

a) Ear packing with antibiotic ointment
b) Myringoplasty
c) Systemic antibiotics
d) myringotomy

5. which procedure is indicated as a complimentary treatment?

a) adenoidectomy
b) tonsillectomy
c) endoscopic sinus surgery
d) turbinectomy
➢ Case 3:

A young boy presents with persistent throat pain fever of 40 C and has painful swallowing radiating
to the ear .opening the mouth is painful there is a fetor oris . the patient also complains of malaise ,
enlarged and tender neck glands
On examination the following picture appeared:
1. The most accurate diagnosis is:
a) oral thrush
b) aphthous ulcer
c) diphtheria
d) acute tonsillitis

2. there is pain in the ear this is radiated along:

a) vagus nerve
b) trigeminal nerve
c) glossopharyngeal nerve
d) facial nerve

3. All the following are possible investigations except:

a) open biopsy
b) throat swab
c) total leucocytic count
d) monospot test

4. treatment of this child is by:

a) immunoglobulins
b) incision and drainage
c) immediate surgery
d) antibiotic and analgesics

5. if this condition is recurrent which of the following is needed?

a) tonsillectomy
b) immunization
c) chemotherapy
d) blood transfusion
➢ Case 4:

A 30 years old woman has been complaining of attacks of left ear discharge
This discharge sometimes has a very bad odour .her complaint dated since childhood She reported
also that hearing is not that good in that ear .you noticed that the discharge is really foul odour .you
examined her under the microscope and noticed the following picture:
1. the offensive discharge is usually an indication of:
a) furunculosis
b) attic antral disease
c) eustachian tube obstruction
d) tubotympanic otitis media

2. this pathology is :
a) A bony lesion that invades the middle ear
b) A malignant tumour of the middle ear
c) An infectious lesion due to diabetes
d) An infected keratin containing sac

3. this condition usually starts at:

a) the facial nerve canal
b) the mastoid
c) the eustachian tube area
d) the attic

4. Complications of the underlying pathology include the following except :

a) meningitis
b) facial nerve palsy
c) frontal lobe abscess
d) cerebellar abscess

5. The patient experience vertigo on pushing the tragus you suspect a fistula in:
a) promontory
b) round window
c) posterior semi-circular canal
d) lateral semi-circular canal
➢ Case 5:

Mrs.F returned from the dentist and started experiencing an unpleasant sensation in her nose
especially after drinking
You examine her and see the following:
1. you ask her if she had :
a) her canine tooth extracted
b) her upper 2 premolar removed
c) dental caries
d) plaque cleaned
2. you perform a CT scan which may reveal all the following except:
a) absent bone between the floor of maxillary sinus and the oral cavity
b) opaque maxillary sinus
c) obliterated osteomeatal complex
d) dentigerous cyst
3. treatment is best done by:
a) advancement surgical flap
b) replace missing tooth
c) free surgical flap
d) closure with medical glue and paste

➢ Case 6:

Male patient complains of progressive unilateral nasal discharge and obstruction .There is no
epistaxis . on examination the patient , the mass appears firm and fibrous . you then order a
radiological image to confirm your diagnosis .
1. this mass seems to be arising from:
a) ethmoid sinus
b) sphenoid sinus
c) frontal sinus
d) maxillary sinus
2. your diagnosis is probably:
a) allergic polyposis
b) mucocele
c) antrochoanal polyp
d) fungal sinusitis
3. the aetiology of this lesion is:
a) congenital
b) traumatic
c) inflammatory
d) neoplastic
4. you advise your patient to:
a) performs endoscopic surgery
b) follow a course of local steroid therapy
c) take amphotericine B (antifungal)
d) not to worry and use anti decongestants for nasal obstruction
➢ Case 7:

Mrs.Z (picture) underwent thyroid surgery at the hospital .She also had to undergo another
procedure that the surgeon found essential.
1. what happened during surgery ?
a) the surgeon injured the right superior laryngeal nerve
b) the vocal folds where injured by endotracheal tube during anaesthesia
c) the surgeon injured the recurrent laryngeal nerves
d) this is a normal procedure after thyroidectomy

2. the value of this procedure is:

a) to bypass obstruction
b) diminish breathing effort by increasing the respiratory dead space
c) allow for suction of oesophageal secretions
d) feeding the patient

3. opening of 1 and 2 rings are better avoided because of:

a) difficult surgery
b) injury to thyroid gland
c) laryngeal perichondritis
d) vagus nerve injury

4. severe haemorrhage 10 days following this procedure originates from ;

a) jugular vein
b) innominate vein
c) inferior thyroid vein
d) subclavian vein
➢ Case 8:

A 29 year old female patient complains of unilateral foeitid intermittent purulent ear discharge since
childhood. She also report that the hearing in the same ear is not good
You examine her under the microscopic and notice the following picture:
1. The offensive discharge is usually an indication of:
a) a Furunculosis
b) Attico-antral disease
c) Tympanosclerosis
d) Tubotympanic otitis media

2. this pathology is:

a) An infected keratin -containing sac
b) A tumour in the middle eat
c) A bony lesion invading the middle ear
d) An infectious lesion

3. You would expect an X-Ray to show a mastoid cavity:

a) Anatomical, regular and clean
b) Non-anatomical. regular and clean
c) Non anatomical, irregular with areas of bone sequestra
d) Non anatomical, irregular and clean

4. Complications of the underlying pathology include the following except:

a) Facial nerve paralysis
b) Orbital cellulitis
c) Cerebellar abscess
d) Meningitis

5. The patient experiences vertigo on pushing the tragus; you suspect a fistula in:
a) The promontory
b) Stapes footplate
c) Posterior semi-circular canal
d) lateral semi-circular canal

6. You would recommend the following investigation except:

a) Neurological
b) Audiogram
c) Bacteriological
d) Radiological

7. Treatment of this condition is:

a) Systemic antibiotics (Aminoglycosides)
b) Cortical mastoidectomy
c) Radical mastoidectomy
d) Radiotherapy
➢ Case 9:

A young women has been suffering of unilateral progressive conductive hearing loss. She also
complain of pulsatile tinnitus in the same ear.
You examine her under the microscopic and notice the following picture:
1. You suspect she has:
a) Squamous cell carcinoma of the external ear
b) Acoustic neuroma
c) Meniere's disease
d) Glomus jugular

2. The condition evolves and the patient presents a few months later with the following except:
a) Facial paralysis
b) Vertigo and unsteadiness
c) Optic neuritis
d) Projectile vomiting

3. You pursue your investigation doing the following except:

a) Audiogram
b) Glycerol test and electrocochleography
c) Angiography
d) CT scan

4. Definitive treatment is:

a) Vestibular neurectomy
b) Destructive labyrinthectomy
c) Embolization and radical mastoidectomy
d) Chemotherapy
➢ Case 10:

A 45 year-old carpenter complains of bilateral nasal obstruction which had started 5 years ago
This was at first intermittent and then became permanent. He gives a history of sneezing and watery
nasal discharge. He was exposed to two nasal operations before .
You order a CI scan and find the following:
1. This lesion is most probably:
a) Allergic polypi
b) Invasive fungal mass
c) Malignant mass
d) Rhinoscleroma.

2. The following cells arc involved in this pathology:

a) Macrophages
b) Mast cells
c) Antigen presenting cells
d) Plasma cells

3. How can one prove the diagnosis?

a) Nasal endoscopy.
b) Biopsy.
c) Nasal smear.
d) Culture and sensitivity

4. What could have been the previous operations:

a) Biopsies.
b) Caldwell luc.
c) Maxillectomies.
d) Polypectomies

5. The main line of treatment of this case is:

a) Ethmoidectomy
b) Rifampicin
c) Surgical maxillectomy.
d) Radiotherapy.
➢ Case 11:

A child of 8 months is presented by his parents with the complaint of stridor which at first inspiratory
but the biphasic. Later, his symptoms worsened with cough eumonias breathy voice.
1. You suspect:
a) Asthma
b) Papillomatosis
c) Croup
d) Vocal nodule
2. You immediately decide to do:
a) Full blood analysis for infectious disease with sputum culture
b) Tracheostomy
c) Direct laryngoscopy
d) Flexible nasopharyngoscopy
3. The causative aetiology is
a) Congenital condition
b) Allergic condition
c) Human papilloma virus
d) Haemophilus microorganism
4. The following is true about this lesion except:
a) Malignant transformation is common
b) Can spread anywhere in the larynx
c) Tends to regress spontaneously
d) Always multiple
5. Treatment is usually by
a) Broad spectrum antibiotics
b) Interferon therapy
c) Steam inhalation
d) Systemic corticosteroids

➢ Case 12:

Mrs.f returned from the dentist and started experiencing an unpleasant sensation her nose especially
after drinking
You examine her and see the following:
1. You ask her if she had
a) Her canine tooth extracted
b) Her upper 2nd molar removed
c) Dental caries
d) Plaque cleaned
2. You perforin a CT scan which may reveal all the following except:
a) Absent bone between the .floor of maxillary sinus and the oral cavity
b) Opaque maxillary sinus
c) Obliterated osteomealal complex
d) Dentigerous cyst
3. Treatment is best done by:
a) Advancement surgical flap
b) Replace missing tooth
c) Free surgical flap
d) Closure with medical glue and paste
➢ Case 13:

Mr. T has been going regular to the club swimming pool during his summer vacation. After returning
from his holidays, he presents to the out patient clinic with ear problems in the form of itching and
block. You examine him:
1. You suspect:
a) Traumatic perforation of the drum
b) Cholesteatoma
c) Chronic suppurative otitis India
d) Otomycosis

2. What type of deafness would you associate with his condition?

a) Conductive hearing loss
b) Sensorineural hearing loss
c) Mixed hearing loss
d) Presbycusis

3. The usual causative organism:

a) Streptococcus viridans
b) Pseudomonas aeruginosa
c) Aspergillus Niger
d) Proteus mirabilis

4. The treatment you propose is:

a) Admit for surgery, tympanoplasty
b) Broad spectrum cream, alcohol salicylic acid drops, cleaning ear, during ear
c) Cleaning ear, drying ear alcohol salicylic acid drops, antifungal drops
d) Stapedectomy
➢ Case 14:
A young girl presents with persistent pain in the throat,, high temperature and possibly chills, he also
has pain radiating to the ear on swallowing. Opening the mouth is difficult and painful, but your
examination reveals the picture. There is a fetor oris. The patient also complains of malaise as well as
enlarged and tender neck glands
1. Differential diagnosis may include al the following, except:
a) Infectious mononucleosis
b) Measles
c) Diphtheria
d) Acute tonsillitis

2. You are not sure of you diagnosis, so you decide NOT to give this antibiotic:
a) Ampicillin
b) Quinolones
c) Amoxycillin
d) Cephalexin

3. All of the following may help in reaching a proper diagnosis:

a) Morphology of the membrane
b) Throat swab
c) Erythrocyte sedimentation rate
d) Monospot test

4. There is pain in the ear; this is radiated along:

a) Vagus nerve
b) Trigeminal nerve
c) Glossopharyngeal nerve
d) Facial nerve

5. A chronic condition includes all the following except:

a) Oozing of pus on pressure
b) Oedematous uvula
c) Enlarged jugulo-digastric lymph glands
d) Congested anterior pillars

6. Treatment of this child is by:

a) Immunoglobulins
b) Incision and drainage
c) Immediate surgery
d) Antibiotics and analgesics
➢ Case 15:

This man underwent a right acoustic neuroma excision. Post-operatively, he complained of right
ocular dryness and blurring of vision Examination revealed conical exposure with poor lid closure.
Your most probable diagnosis is:
1. Your most probable diagnosis is:
a) Lower motor neuron facial nerve paralysis
b) Lower motor neuron trigeminal nerve paralysis
c) Upper motor neuron facial nerve paralysis
d) Upper motor neuron trigeminal nerve paralysis

2. The most probable aetiology in general is:

a) Plasma cell tumour
b) Idiopathic
c) Surgical trauma
d) Otitis media

3. Neurapraxia means:
a) Loss of continuity of axons and endoneurial sheaths
b) Complete degeneration
c) Reversal conduction block
d) Loss of continuity of axons with intact endoneurial sheaths

4. In this type of lesion, there is:

a) Paralysis only of the muscles of the lower half of the face on the same side
b) Paralysis involves voluntary but spares emotional movement
c) Paralysis involves emotional and voluntary movements
d) Paralysis of the muscles of the opposite side

5. You examine this patient and recommend for him the most accurate prognostic investigation in
the first week:
a) High resolution CT scan
b) Nerve excitability
c) Electromyography
d) Electroneuronography

6. Management of this case is:

a) Vasodilators
b) Nerve grafting
c) Steroids
d) Antibiotics