Head and neck

Question 1

33yo male presents with a white lesion of his oral mucosa. He is a smoker

Answer 1

Leukoplakia

Question 2

A male smoker presents with oral pain and a persistent sore throat and dysphagia. On examination a neck mass is noted

Answer 2

Oropharyngeal SCC

Question 3

A 10yo boy presents with a fever, sore throat and painful swallowing. He does not have a cough. Pus is noted on his tonsils on examination

Answer 3

Tonsillitis

Question 4

A 26yo female presents with dry eyes and dry mouth. Schirmer’s test is positive

Answer 4

Sjogren’s syndrome

Question 5

A patient presents with unilateral tonsil swelling

Answer 5

Quinsy

Question 6

A 62yo male presents with a slowly enlarging, non-tender facial mass. The tumour is determined to be the most common head and neck tumour

Answer 6

Salivary gland tumour

Question 7

A 22yo female presents with a 7 day history of facial pain with associated nasal congestion and hyposmia. Her symptoms resolve 2 days later without antibiotics

Answer 7

Acute sinusitis (viral)

Question 8

A 36yo woman presents with facial pain over her sinuses, nasal congestion and a headache. She has had these symptoms for about 3 months

Answer 8

Chronic sinusitis

Question 9

A 24yo male with chronic sinusitis presents with bilateral nasal obstruction. After rhinoscopy, intranasal corticosteroids are prescribed

Answer 9

Nasal polyps

Question 10

A 65yo known smoker presents with progressive hoarseness and dysphagia

Answer 10

Carcinoma of the larynx

Question 11

A 30yo patient presents with a neck mass. The mass is unilateral and is smooth, fluctuant and non-tender on palpation

Answer 11

Branchial cleft cyst

Question 12

An 8yo boy presents with otalgia and tragal tenderness. On examination, the ear canal is swollen and inflamed

Answer 12

Otitis externa

Question 13

A 12 month old boy presents tugging at his ear and with a fever for 1 day. Otoscopy is performed

Answer 13

Acute otitis media

Question 14

A 3yo boy shows delay in language development. His mother admits that he had many ear infections as a child. What is the likely cause of this language impairment?

Answer 14

Chronic otitis media with effusion causing hearing loss

Question 15

A 34yo Aboriginal man presents with hearing loss and otorrhoea. Otoscopy is performed as shown

Answer 15

Cholesteatoma

Question 16

A 45yo patient presents with sudden unilateral hearing loss that began 4 days previously. Audiology reveals hearing loss in more than 3 frequencies of at least 30dB

Answer 16

Sudden sensorineural hearing loss

Question 17

A 55yo female patient presents with vertigo. Upon further questioning, she reveals the vertigo comes on when she is in bed, typically lasts about 20 seconds and is severe

Answer 17

BPPV

Question 18

A 40yo patient presents with episodic, sudden onset vertigo. The vertigo usually lasts about 2 hours.

She also complains of a feeling of fullness in her ears and tinnitus of a roaring quality.

Answer 18

Meniere’s disease

Question 19

A 22yo presents with trouble seeing. Visual acuity reveals 6/12 in each eye. This is corrected by pinhole

Answer 19

Refractive error

Question 20

A 5yo child presents with red eye and purulent discharge from his eyes. His eyelids are stuck together in the morning

Answer 20

Conjunctivitis (bacterial)

Question 21

A 44yo patient with known IBD blurred vision and watery discharge. They have dull pain in the orbital region that is tender to palpation and some photophobia

Answer 21

Anterior uveitis

Question 22

A 72yo male presents complaining of blurred vision and says that he does not feel he sees colours as brightly. Slit lamp examination of the anterior chamber reveals the pathology

Answer 22

Cataracts

Question 23

A patient with known hypertension presents for an eye examination. This appearance is seen on fundoscopy

Answer 23

Hypertensive retinopathy (grade IV)

Question 24

A patient with known diabetes presents to their optometrist. On questioning they report seeing an occasional floater and mild decrease in visual acuity

Answer 24

Diabetic retinopathy (proliferative)

Question 25

A 78yo patient presents complaining of blurred vision. Choroidal neovascularisation is noted on fundoscopy

Answer 25

Wet macular degeneration

Question 26

An 82yo smoker presents with blurred vision. Fundoscopy is performed

Answer 26

Dry macular degeneration

Question 27

A patient presents with a headache, drowsiness and nausea. Fundoscopy is performed

Answer 27

Papilloedema

Question 28

A 64yo patient presents with gradual vision loss. There is no associated pain.

Opthalmoscpopy reveals optic nerve cupping and retinal haemorrhage

Answer 28

Open-angled glaucoma

Question 29

A female patient presents with rapid vision loss that she describes as tunnel vision. Her eye appears red and the cornea is cloudy and oedematous.

She also has associated headache, nausea and vomiting

Answer 29

Closed-angle glaucoma

Question 30

A patient presents with unilateral lid closure. The affected eye appears “down and out”. What CN nerve is affected?

Answer 30

CNIII palsy

Causes: compressive, vascular, trauma, vasculitis, demyelinating disease, idiopathic

Question 31

A patient presents with difficulty reading, on examination. The patient has vertical and torsional diplopia. What CN is affected?

Answer 31

CNIV palsy

Causes: trauma, microvascular disease, tumour, demyelination, vasculitis, idiopathic, congenital

Question 32

A patient presents with double vision on right lateral gaze. What CN is affected?

Answer 32

CNVI palsy

Causes: vascular, raised ICP, tumours, trauma, demyelinating, vasculitis, idiopathic