LE3 ENT Flashcards
- The rhinon is the point of articulation of the nasal bone and frontal bone.
A. True
B. False
B. False
High-Yield Rationale: The rhinon is not the articulation point of the nasal bone and frontal bone. Instead, it refers to a midline point at the inferior end of the nasal bones. The articulation point between the frontal bone and nasal bones is the nasion.
- The mesodermal frontonasal process gives rise to the nasal septum and primitive palate (premaxilla).
A. True
B. False
A. True
High-Yield Rationale: The frontonasal process, a mesodermal derivative, contributes to the formation of the nasal septum, premaxilla, and part of the upper face.
- The nasal septum divides the nose into right and left nasal cavities.
A. True
B. False
A. True
High-Yield Rationale: The nasal septum is composed of the perpendicular plate of the ethmoid, the vomer, and septal cartilage, dividing the nasal cavity into two symmetrical halves.
- The ostiomeatal unit includes the maxillary ostium/infundibulum, ethmoid infundibulum, frontoethmoidal complex, uncinate process, hiatus semilunaris, ethmoidal bulla, and middle meatus.
A. True
B. False
A. True
High-Yield Rationale: The ostiomeatal unit is an important functional area in the lateral nasal wall responsible for drainage of the frontal, anterior ethmoid, and maxillary sinuses.
- The inferior meatus contains the opening of the nasolacrimal duct.
A. True
B. False
A. True
High-Yield Rationale: The nasolacrimal duct drains tears from the lacrimal sac into the inferior meatus of the nasal cavity.
- Which of the following describes the paranasal sinuses?
A. Medial to the ethmoids and separates them from the orbit
B. Air-filled spaces lined by respiratory epithelium on either side of the head
C. Located anterior to and above the ethmoid sinuses
D. Posterosuperior to the sphenoid
E. Largest of the paranasal sinuses
B. Air-filled spaces lined by respiratory epithelium on either side of the head
High-Yield Rationale: The paranasal sinuses are air-filled cavities within the skull lined by respiratory mucosa, assisting in humidification, voice resonance, and lightening of the skull.
- The lamina papyracea:
A. Forms part of the orbit
B. Is medial to the ethmoid and separates them from the orbit
B. Medial to the ethmoid and separates them from the orbit
High-Yield Rationale: The lamina papyracea is a thin bony structure forming the medial wall of the orbit and separates it from the ethmoid sinuses, making it susceptible to infections and fractures.
- The maxillary sinuses are:
A. The smallest of the paranasal sinuses
B. Located within the frontal bone
C. The primary site of pituitary tumors
D. Posterior to the nasal cavity
E. The largest paranasal sinuses
E. The largest paranasal sinuses
High-Yield Rationale: The maxillary sinuses are the largest of the paranasal sinuses, located in the maxilla, and are the most commonly affected in sinusitis due to their drainage pattern.
- The pituitary gland is located:
A. In the frontal sinus
B. Within the maxillary sinus
C. Lateral to the nasal cavity
D. Posterior to the sphenoid sinus
D. Posterior to the sphenoid sinus
High-Yield Rationale: The pituitary gland sits within the sella turcica of the sphenoid bone, directly posterior to the sphenoid sinus, making transsphenoidal surgery a common approach for pituitary tumors.
- The frontal sinus is:
A. The smallest of the paranasal sinuses
B. Located within the maxilla
C. Located anterior to and above the ethmoid sinuses
D. Inferior to the sphenoid sinus
C. Located anterior to and above the ethmoid sinuses
High-Yield Rationale: The frontal sinus is located above the ethmoid sinuses and within the frontal bone. It drains into the middle meatus via the frontonasal duct.
- Through which structure do olfactory neurons pass into the nasal cavity?
A. Cribriform Plate
B. Ethmoid Bulla
C. Sphenoid Sinus
D. Inferior Meatus
A. Cribriform Plate
High-Yield Rationale: Olfactory neurons pass through the perforations of the cribriform plate of the ethmoid bone to synapse in the olfactory bulb. This structure is highly susceptible to fracture in head trauma, leading to CSF rhinorrhea.
- The absence of the sense of smell is known as:
A. Hyposmia
B. Anosmia
C. Parosmia
D. Phantosmia
B. Anosmia
High-Yield Rationale: Anosmia is the complete loss of smell, often due to viral infections, trauma, neurodegenerative disorders, or congenital defects such as Kallmann syndrome.
- The mucociliary apparatus is responsible for:
A. Olfactory processing
B. Airflow regulation
C. Physically cleansing inspired air
D. Warming inspired air
C. Physically cleansing inspired air
High-Yield Rationale: The mucociliary apparatus consists of ciliated epithelial cells and mucus-producing goblet cells, which trap and remove inhaled particles and pathogens from the respiratory tract.
- Which virus is responsible for approximately 50% of common colds?
A. Influenza virus
B. Rhinovirus
C. Coronavirus
D. Adenovirus
B. Rhinovirus
High-Yield Rationale: Rhinovirus is the most common cause of the common cold, transmitted via respiratory droplets and direct contact. It primarily affects the upper respiratory tract.
- The most likely cause of unilateral foul-smelling rhinorrhea in a child is:
A. Allergic rhinitis
B. Sinusitis
C. Nasal foreign body
D. Nasal polyps
C. Nasal foreign body
High-Yield Rationale: A nasal foreign body, such as food particles or small objects, is a common cause of unilateral, foul-smelling nasal discharge in children.
- The structure located between the posterior border of the lateral cartilage, considered the narrowest part of the upper respiratory tract, and forming the posterior border of the nasal vestibule is called:
A. Choana
B. Nasal valve (Limen nasi)
C. Ostiomeatal unit
D. Ethmoid bulla
B. Nasal valve (Limen nasi)
High-Yield Rationale: The nasal valve is the narrowest portion of the nasal airway, regulating airflow resistance. It is a common site of nasal obstruction.
- By about the 20th week in utero, failure of resorption of the nasal epithelial plug gives rise to:
A. Choanal atresia
B. Ostiomeatal unit
C. Choanae
D. Columella
E. Zygomatic arch
A. Choanal atresia
High-Yield Rationale: Choanal atresia is a congenital condition where the posterior nasal airway fails to form properly, leading to airway obstruction, especially in neonates. It can be unilateral or bilateral, with the latter being life-threatening.
- The nasal vestibule and the anterior portion of the nasal cavity contain the following EXCEPT:
A. Stratified squamous epithelium
B. Vibrissae
C. Sweat glands
D. Pseudostratified ciliated epithelium with mucous glands
E. Sebaceous glands
D. Pseudostratified ciliated epithelium with mucous glands
High-Yield Rationale: The nasal vestibule is lined by stratified squamous epithelium, contains vibrissae (nasal hairs), sebaceous glands, and sweat glands. The respiratory epithelium (pseudostratified ciliated columnar epithelium with mucous glands) lines deeper parts of the nasal cavity but not the vestibule.
- The paired posterior openings through which the nasal cavities communicate with the nasopharynx are called:
A. Vestibule
B. Choana
C. Columella
D. Ostiomeatal unit
E. Infundibulum
B. Choana
High-Yield Rationale: The choanae are the posterior openings of the nasal cavity that connect to the nasopharynx, allowing air passage from the nose to the throat.
- Which sinus arises from the upper anterior area of the middle meatus as an upgrowth of one of the anterior group of ethmoid air cells?
A. Maxillary sinus
B. Ethmoid sinus
C. Frontal sinus
D. Sphenoid sinus
C. Frontal sinus
High-Yield Rationale: The frontal sinus develops from anterior ethmoid air cells and drains into the middle meatus via the frontonasal duct. It is often implicated in frontal sinusitis.
- At birth, which two sinuses are large enough to acquire sinusitis?
A. Maxillary and ethmoid sinuses
B. Sphenoid and ethmoid sinuses
C. Sphenoid and maxillary sinuses
D. Frontal and maxillary sinuses
E. Frontal and ethmoid sinuses
A. Maxillary and ethmoid sinuses
High-Yield Rationale: The maxillary and ethmoid sinuses are the only sinuses present at birth, making them susceptible to early sinus infections. The sphenoid and frontal sinuses develop later in childhood.
- The bony framework or vault of the nose is formed by:
A. Paired nasal bones
B. Frontal process of maxilla
C. Nasal process of frontal bone
D. All of the above
E. B and C only
D. All of the above
High-Yield Rationale: The nasal vault consists of paired nasal bones, the frontal process of the maxilla, and the nasal portion of the frontal bone, providing structural support.
- The cartilaginous vault of the nose consists of:
A. Upper lateral cartilage
B. Lower cartilage
C. Nasal septum
D. All of the above
E. A and B
D. All of the above
High-Yield Rationale: The nasal cartilaginous framework includes the upper lateral cartilage, lower cartilages, and the nasal septum, contributing to both structure and function.
- The roof of the nasal cavity is formed by:
A. Cribriform plate
B. Undersurface of the sphenoid bone
C. Nasal area of the frontal bone
D. Nasal bones
E. All of the above
E. All of the above
High-Yield Rationale: The nasal cavity roof consists of the cribriform plate (olfactory function), sphenoid bone (posterior part), frontal bone, and nasal bones.
- What forms the boundaries for nasal meatal passages and are scroll-like structures in the lateral wall of the nose, invested by respiratory epithelium?
A. Nasal septum
B. Posterior nares
C. Turbinates
D. Paranasal sinuses
E. Columellae
C. Turbinates
High-Yield Rationale: The nasal turbinates (superior, middle, inferior) increase surface area for humidification, warming, and filtering of air. They are covered by respiratory epithelium.
- The pathogenesis of ___ is believed to involve neurovascular autonomic disturbances in regulating the tonus of nasal mucosal vessels. Symptoms include nasal obstruction, watery rhinorrhea, and sneezing.
A. Allergic rhinitis
B. Vasomotor rhinitis
C. Nasal polyps
D. Rhinitis medicamentosa
E. Atrophic rhinitis
B. Vasomotor rhinitis
High-Yield Rationale: Vasomotor rhinitis is non-allergic and results from autonomic dysfunction, leading to nasal hyperreactivity without an immune-mediated cause.
- The respiratory function of the nose includes:
A. Humidification
B. Temperature control
C. Cleansing and filtration
D. Antibacterial/antiviral activity
E. All of the above
E. All of the above
High-Yield Rationale: The nasal cavity conditions incoming air by humidifying, warming, filtering particles, and providing immune defense through mucosal secretions.
- Functions of the paranasal sinuses include:
A. Lightening of the skull weight
B. Providing bumper-like protection to the face in trauma
C. Voice resonation
D. Contributing to olfaction
E. All of the above
E. All of the above
High-Yield Rationale: The paranasal sinuses lighten the skull, aid in voice resonance, act as a buffer in trauma, and may contribute to olfaction.
- The epithelial lining of the nose consists of the following EXCEPT:
A. Predominantly pseudostratified columnar
B. Stratified squamous in vestibule and nares
C. Nonciliated pseudostratified columnar epithelium containing serous glands and bipolar cells in the roof
D. All of the above
E. A and B only
D. All of the above
High-Yield Rationale: The nasal vestibule has stratified squamous epithelium, while the respiratory portion has pseudostratified ciliated columnar epithelium. The olfactory region has nonciliated pseudostratified columnar epithelium with bipolar olfactory receptor cells.
- Damage to the olfactory epithelium may cause abnormal perception of smell/hyposmia due to:
A. Drugs
B. Viral infections
C. Radiotherapy
D. All of the above
D. All of the above
High-Yield Rationale: Hyposmia (reduced sense of smell) can result from drug-induced toxicity, viral infections (e.g., COVID-19), or radiation exposure affecting the olfactory mucosa and nerves.
- Herniations of intracranial contents through a bony defect in the skull are called:
A. Meningocele
B. Encephalocele
C. Cephalocoele
D. Craniopharyngioma
C. Cephalocoele
High-Yield Rationale: Cephalocoele is the protrusion of intracranial contents (brain and/or meninges) through a congenital or acquired defect in the skull, often occurring in the occipital or frontal regions.
- The following are etiologic agents of acute rhinosinusitis, EXCEPT:
A. Rhinovirus
B. Influenza virus
C. Rotavirus
D. Coronavirus
C. Rotavirus
High-Yield Rationale: Rotavirus primarily causes gastroenteritis, while rhinovirus, influenza virus, and coronavirus are common viral pathogens responsible for acute rhinosinusitis.
- The pathogenesis of nasal polyps includes:
A. Chronic infection
B. History of asthma
C. Hypersensitivity to acetylsalicylic acid (aspirin-exacerbated respiratory disease - AERD)
D. All of the above
D. All of the above
High-Yield Rationale: Nasal polyps are associated with chronic inflammation, asthma, and aspirin hypersensitivity, forming part of Samter’s triad.
- The most common site of complications of sinusitis, particularly due to the thin, delicate lamina papyracea that separates the ethmoid sinus, is the:
A. Brain
B. Orbit
C. Maxilla
D. Nasopharynx
B. Orbit
High-Yield Rationale: The orbit is at high risk for complications of ethmoid sinusitis due to the thin lamina papyracea, leading to conditions such as orbital cellulitis and abscess.
- The principle of ________ is to enlarge tight passages in the middle meatus and ostium of the maxillary sinus, and if necessary, the frontal sinus, to establish normal ventilation and mucociliary flow.
A. Functional endoscopic sinus surgery (FESS)
B. Caldwell-Luc surgery
C. Ethmoidectomy
D. Lateral rhinotomy
A. Functional endoscopic sinus surgery (FESS)
High-Yield Rationale: FESS is a minimally invasive procedure used to restore sinus drainage and improve airflow by widening the natural sinus ostia.
- What is the most common cause of posterior epistaxis?
A. Hypertension
B. Angiofibroma
C. Nasopharyngeal carcinoma
D. Trauma
A. Hypertension
High-Yield Rationale: Posterior epistaxis often originates from the sphenopalatine artery and is commonly associated with hypertension and atherosclerosis.
- Choanal atresia commonly affects both nasal cavities.
A. True
B. False
B. False
High-Yield Rationale: Choanal atresia is usually unilateral, though bilateral cases are more severe and require immediate intervention in neonates.
- Inverting papillomas are translucent, soft intranasal masses affecting both nasal cavities.
A. True
B. False
A. True
High-Yield Rationale: Inverting papillomas are benign but locally aggressive tumors, often presenting with nasal obstruction.
- The management of inverting papilloma includes topical nasal steroids.
A. True
B. False
A. True
High-Yield Rationale: Topical nasal steroids may be used to manage inflammation in inverting papillomas, though surgical removal is often required.
- Mucous retention cysts of the maxillary sinus are not true cysts.
A. True
B. False
A. True
High-Yield Rationale: Mucous retention cysts result from blockage of seromucous glands, forming fluid-filled structures that lack an epithelial lining, making them pseudocysts rather than true cysts.
- The maxillary sinus is the most common site of sinus malignancies.
A. True
B. False
A. True
High-Yield Rationale: The maxillary sinus is the most frequently affected site for paranasal sinus malignancies due to its larger volume and frequent exposure to carcinogens.
- Sinus malignancies are treated with surgery, chemotherapy, and radiotherapy.
A. True
B. False
A. True
High-Yield Rationale: The standard treatment for sinus malignancies involves a multimodal approach, including surgery, chemotherapy, and radiotherapy, depending on tumor stage and location.
- CT is the method of choice for viewing paranasal sinuses.
A. True
B. False
A. True
High-Yield Rationale: CT scan is preferred for evaluating bony structures, sinus drainage pathways, and inflammatory sinus diseases, offering better resolution than plain X-ray.
- MRI is valuable in the evaluation of tumors of the sphenoid cavity.
A. True
B. False
A. True
High-Yield Rationale: MRI provides superior soft tissue contrast, making it valuable for assessing tumors in the sphenoid cavity and detecting intracranial or orbital involvement.
- Axial and coronal cuts are the best views of CT during endoscopic sinus surgery.
A. True
B. False
A. True
High-Yield Rationale: Axial and coronal CT scans provide detailed anatomical visualization of the sinuses, aiding in surgical planning for endoscopic sinus surgery.
- What is the frequency distribution of neck masses in the pediatric age group?
A. Congenital > Inflammation > Neoplastic
B. Inflammation > Neoplastic > Congenital
C. Neoplastic > Inflammation > Congenital
D. Congenital > Neoplastic > Inflammation
A. Congenital > Inflammation > Neoplastic
High-Yield Rationale: Congenital neck masses (e.g., thyroglossal duct cysts, branchial cleft cysts) are the most common in children, followed by inflammatory and neoplastic causes.
- What is the frequency distribution of neck masses in individuals aged 16-40 years?
A. Inflammation > Neoplastic > Congenital
B. Congenital > Inflammation > Neoplastic
C. Neoplastic > Inflammation > Congenital
D. Inflammation > Congenital > Neoplastic
A. Inflammation > Neoplastic > Congenital
High-Yield Rationale: Inflammatory conditions (e.g., lymphadenitis) are the most common causes of neck masses in this age group, followed by neoplastic and congenital masses.
- What is the frequency distribution of neck masses in individuals aged 40 years and older?
A. Neoplastic > Inflammation > Congenital
B. Inflammation > Neoplastic > Congenital
C. Congenital > Inflammation > Neoplastic
D. Inflammation > Congenital > Neoplastic
A. Neoplastic > Inflammation > Congenital
High-Yield Rationale: In older adults, neoplastic masses (malignant or benign tumors) are the most common, followed by inflammatory and congenital causes.
- _________ is the standard diagnostic test for neck masses. It is the most cost-effective and productive single diagnostic evaluation. It is NOT used in neck masses with audible bruits.
A. CT Scan
B. MRI
C. Fine-Needle Aspiration Biopsy (FNAB)
D. Open biopsy
C. Fine-Needle Aspiration Biopsy (FNAB)
High-Yield Rationale: FNAB is the preferred initial diagnostic tool for neck masses, providing a minimally invasive, cost-effective means to obtain cytological samples. However, it is contraindicated in vascular lesions with audible bruits.
- Why do sinonasal neoplasms rarely develop symptoms early?
A. They are benign in nature.
B. They lack vascularization.
C. More than 80% of neoplasms arising from this region are epidermal in origin.
D. The paranasal sinuses are air-filled structures with significant potential space.
D. The paranasal sinuses are air-filled structures with significant potential space.
High-Yield Rationale: Due to the expansive potential space within the sinuses, tumors can grow significantly before causing symptoms, leading to delayed diagnosis.
- Radiographic evaluation of the nose and paranasal sinuses showing erosion, remodeling, expansion, and calcifications is best performed with:
A. MRI
B. CT
C. X-RAY
D. Soft Tissue Lateral View of the Nose
B. CT
High-Yield Rationale: CT scan provides detailed bony anatomy and is the imaging modality of choice for evaluating sinus erosion, expansion, and calcifications, which are indicative of malignancy or aggressive infections.
- The majority of anterior neck masses are ________, and these must be proven to be benign.
A. Hyperplastic thyroid nodules or adenoma
B. Branchial cyst
C. Thyroglossal duct cyst
D. Lymphangioma
A. Hyperplastic thyroid nodules or adenoma
High-Yield Rationale: Most anterior neck masses arise from the thyroid gland and include hyperplastic nodules or adenomas. These require FNAB for evaluation to rule out malignancy.
- If the primary site of a neck mass is unknown, the following diagnostic algorithm should be followed:
A. FNAB → Open biopsy
B. FNAB → Panendoscopy → Open biopsy → If (-), excision biopsy and frozen section → If (+), open neck surgery
C. Excisional biopsy only
D. Sectional biopsy → Panendoscopy
B. FNAB → Panendoscopy → Open biopsy → If (-), excision biopsy and frozen section → If (+), open neck surgery
High-Yield Rationale: The standard approach for an unknown primary tumor includes FNAB followed by panendoscopy and biopsy. If no primary site is identified, excision and frozen section are performed to guide surgical management.
- Which malignancy accounts for 55% of all pediatric cancers and presents with fever, hepatosplenomegaly, and adenopathy?
A. Neuroblastoma
B. Wilms tumor
C. Lymphoma
D. Ewing sarcoma
C. Lymphoma
High-Yield Rationale: Lymphomas (Hodgkin and non-Hodgkin) are the most common pediatric malignancies affecting lymphoid tissues and often present with systemic symptoms and lymphadenopathy.
- A soft, fluctuant, spongy, and transilluminating mass that appears in 90% of cases within the first year of life is most likely:
A. Lipoma
B. Hemangioma
C. Lymphangioma
D. Neurofibroma
C. Lymphangioma
High-Yield Rationale: Lymphangiomas are congenital malformations of the lymphatic system that present as soft, transilluminating masses, commonly affecting the neck.
- Difficulty in opening the mouth, which can be a symptom of Ludwig’s angina or an abscess in the masticator space, is called:
A. Trismus
B. Strabismus
C. Temporomandibular joint dysfunction
D. Odynophagia
A. Trismus
High-Yield Rationale: Trismus (lockjaw) is caused by muscle spasm or infection, such as in Ludwig’s angina, an aggressive cellulitis of the submandibular space.
- Clinical therapeutic antibiotic regimen for an asymmetrical neck mass includes:
A. Suspected as inflammation
B. Treatment should not exceed 2 weeks
C. Advice for follow-up
D. All of the above
D. All of the above
High-Yield Rationale: Empirical antibiotic treatment is indicated for inflammatory neck masses. If there is no improvement after 2 weeks, further evaluation, including biopsy or imaging, is necessary.
- Open nodal biopsy is indicated in cases of:
A. Active infection not responding to conventional antibiotics
B. Progressively enlarging mass
C. Single asymptomatic mass
D. All of the above
D. All of the above
High-Yield Rationale: Open biopsy is warranted when infections persist despite antibiotics, when a mass continues to enlarge, or when malignancy is suspected in an asymptomatic lymph node.
- Tumor malignancies primarily drain into which lymph nodes?
A. Posterior cervical
B. Supraclavicular
C. Submandibular
D. High and mid jugular
A. Posterior cervical
- The most common site where gastrointestinal (GIT), genitourinary (GUT), and lung cancers metastasize is:
A. Supraclavicular
B. Posterior cervical
C. High jugular
D. Mid jugular
A. Supraclavicular
High-Yield Rationale: The supraclavicular lymph nodes (Virchow’s node) are a common site for metastasis from GIT, GUT, and lung cancers due to their role in lymphatic drainage from the thoracic duct.
- The preferred diagnostic imaging modality for evaluating thyroid nodal masses is:
A. CT scan
B. MRI
C. Plain X-ray
D. All of the above
A. CT scan
High-Yield Rationale: CT scan is commonly used for assessing thyroid nodules and their extension into adjacent structures, while ultrasound is the first-line modality for initial thyroid nodule evaluation.
- The most common tumor of the parotid gland in children is:
A. Lymphangioma
B. Hemangioma
C. Lipoma
D. Fibroma
B. Hemangioma
High-Yield Rationale: Hemangiomas are the most common benign vascular tumors of the parotid gland in children, often regressing spontaneously with age.
- A hemangioma in children should be excised under which conditions?
A. Bleeding/coagulopathy due to platelet consumption
B. Infection
C. Heart failure
D. Rapid increase in size
E. All of the above
E. All of the above
High-Yield Rationale: Hemangiomas are usually managed conservatively, but surgical excision is indicated in cases of life-threatening complications such as high-output heart failure, coagulopathy (Kasabach-Merritt syndrome), or rapid growth.
- The functions of the nose include respiration, olfaction, and voice phonation.
A. True
B. False
A. True
High-Yield Rationale: The nose plays a crucial role in respiration (air filtration and humidification), olfaction (smell perception), and phonation (resonance in speech).
- The maxillary and ethmoidal paranasal sinuses are present at birth.
A. True
B. False
A. True
High-Yield Rationale: The maxillary and ethmoid sinuses are the only paranasal sinuses present at birth, while the frontal and sphenoid sinuses develop later in childhood.
- How many pairs of pharyngeal pouches develop during embryogenesis?
A. 3
B. 4
C. 5
D. 6
E. 7
C. 5
High-Yield Rationale: There are five pairs of pharyngeal (branchial) pouches, although the fifth pouch is rudimentary. These pouches give rise to various structures in the head and neck.
- Which structure contains the superior, middle, and inferior pharyngeal constrictors?
A. Esophagus
B. Pharynx
C. Larynx
D. Trachea
E. Hypopharynx
B. Pharynx
High-Yield Rationale: The pharynx contains three constrictor muscles (superior, middle, and inferior) that help in swallowing by propelling food into the esophagus.
- The superior, middle, and inferior pharyngeal constrictors arise from which branchial arches?
A. 1st - 2nd
B. 2nd - 3rd
C. 3rd - 4th
D. 4th - 5th
E. 5th - 6th
D. 4th - 5th
- The mandible is derived from which branchial arch?
A. 1st
B. 2nd
C. 3rd
D. 4th
E. 5th
A. 1st
- Lateral outpouchings of the foregut or the region of the primitive pharynx are called:
A. Pharyngeal pouch
B. Branchial arch
C. Branchial pouch
D. Pharyngeal cleft
E. Pharyngeal arch
A. Pharyngeal pouch
High-Yield Rationale: Pharyngeal pouches are endodermal structures that develop on the internal aspect of the pharyngeal arches and contribute to glandular and lymphoid tissues.
- The thymus develops from which pharyngeal pouch?
A. 1st
B. 2nd
C. 3rd
D. 4th
E. 5th
C. 3rd
High-Yield Rationale: The thymus gland is derived from the 3rd pharyngeal pouch, along with the inferior parathyroid glands. It is essential for T-cell development and immune function.
- The 4th to 5th pharyngeal pouches give rise to:
A. Superior parathyroid gland
B. Thyroid gland
C. Lingular swelling
D. Copula
E. Tuberculum impar
A. Superior parathyroid gland
High-Yield Rationale: The superior parathyroid glands originate from the 4th pharyngeal pouch, while the 5th pouch contributes to the ultimobranchial body, which later integrates into the thyroid gland.
- A precursor of which structure forms a ventral diverticulum of endodermal tissue on the floor of the pharynx between the 1st and 2nd arches? It can also be found between the tuberculum impar and copula.
A. Parathyroid gland
B. Submandibular gland
C. Thyroid gland
D. Parotid gland
E. Sublingual gland
C. Thyroid gland
High-Yield Rationale: The thyroid gland develops as a midline endodermal outgrowth from the pharyngeal floor between the first and second branchial arches.
- The persistence of the connection between the thyroid diverticulum and the floor of the pharynx gives rise to:
A. Branchial cyst
B. Thyroglossal duct cyst
C. Dermoid cyst
D. Pharyngeal pouch remnant
E. Cervical sinus
B. Thyroglossal duct cyst
High-Yield Rationale: A thyroglossal duct cyst results from the failure of the thyroglossal duct to obliterate during embryonic development. It presents as a midline neck mass that moves with swallowing.
- The duct of the submandibular gland that opens on either side of the lingual frenulum is called:
A. Stensen’s duct
B. Wharton’s duct
C. Bartholin’s duct
D. Rivinus’ duct
B. Wharton’s duct
High-Yield Rationale: Wharton’s duct is the excretory duct of the submandibular gland, draining saliva into the mouth on either side of the lingual frenulum.
- A continually but slowly growing palatal bone and horizontal process in the midline of the mandible is called:
A. Osteoma
B. Tori palatinus
C. Torus mandibularis
D. Exostosis
C. Torus mandibularis
High-Yield Rationale: Torus mandibularis is a benign bony growth on the lingual aspect of the mandible, commonly found in adults.
- Motor nerve fibers to the tongue are supplied by which cranial nerve?
A. CN IX
B. CN V
C. CN VII
D. CN XII
D. CN XII (Hypoglossal nerve)
High-Yield Rationale: The hypoglossal nerve (CN XII) innervates all intrinsic and extrinsic tongue muscles except for the palatoglossus.
- Which muscle elevates the soft palate?
A. Tensor veli palatini
B. Palatopharyngeus
C. Levator veli palatini
D. Palatoglossus
C. Levator veli palatini
High-Yield Rationale: The levator veli palatini elevates the soft palate during swallowing to prevent nasal regurgitation.
- Which of the following is NOT part of the nasopharynx?
A. Posterior choanae
B. Eustachian tube
C. Adenoids
D. Palatine tonsil
D. Palatine tonsil
High-Yield Rationale: The palatine tonsils are located in the oropharynx, not the nasopharynx.
- What structure represents the superior interdigitation of the superior constrictor?
A. Waldeyer’s ring
B. Passavant’s ridge
C. Pterygomandibular raphe
D. Pharyngeal raphe
B. Passavant’s ridge
High-Yield Rationale: Passavant’s ridge is a mucosal ridge formed by the superior constrictor muscle, contributing to velopharyngeal closure.
- The palatoglossus muscle represents the posterior border of the oral cavity.
A. True
B. False
A. True
High-Yield Rationale: The palatoglossus muscle forms the anterior pillar of the fauces, marking the border between the oral cavity and oropharynx.
- The hypopharynx includes structures such as the epiglottis and esophagus.
A. True
B. False
A. True
High-Yield Rationale: The hypopharynx extends from the epiglottis to the esophagus and plays a role in swallowing.
- The nasopharynx is the area above and posterior to the hard palate, communicating with the choanae and Eustachian tube.
A. True
B. False
A. True
High-Yield Rationale: The nasopharynx serves as an airway passage and connects to the middle ear via the Eustachian tube.
- Hereditary Hemorrhagic Telangiectasia is an autosomal dominant disorder characterized by multiple telangiectatic lesions in the skin and mucosa.
A. True
B. False
A. True
High-Yield Rationale: Hereditary Hemorrhagic Telangiectasia (HHT) leads to abnormal blood vessel formation, resulting in recurrent epistaxis and mucosal bleeding.
- Whitish lesions in children are considered normal. Histology shows hyperplastic epithelial growth and is not considered malignant.
A. True
B. False
A. True
High-Yield Rationale: Many benign oral lesions in children, such as frictional keratosis, result from chronic irritation and are not precancerous.
- Black hairy leukoplakia is caused by pigmented hypertrophy of the filiform papillae.
A. True
B. False
A. True
High-Yield Rationale: Black hairy tongue results from elongation and hypertrophy of the filiform papillae due to poor oral hygiene, smoking, or antibiotic use.
- Leukoplakia are white lesions seen in the oral cavity with 5 to 10% malignant potential.
A. True
B. False
A. True
High-Yield Rationale: Leukoplakia is a precancerous lesion associated with chronic irritation and has a risk of malignant transformation, particularly in smokers.
- Aphthous stomatitis consists of painful and debilitating oral mucosal ulcerations that usually heal within 10-14 days.
A. True
B. False
A. True
High-Yield Rationale: Aphthous ulcers (canker sores) are recurrent, non-contagious ulcerations that heal spontaneously without scarring.
- Sialolithiasis may cause retention of saliva and secondary infection of the gland.
A. True
B. False
A. True
High-Yield Rationale: Sialolithiasis (salivary gland stones) can block salivary flow, leading to glandular inflammation and bacterial infection.
- Lingual tonsils are subepithelial conglomerations of lymphoid tissue situated in the posterior oropharyngeal aspect of the tongue, which hypertrophy during puberty or post-tonsillectomy.
A. True
B. False
A. True
High-Yield Rationale: Lingual tonsils function as part of the immune system and can enlarge due to immune activation or compensatory hypertrophy after tonsil removal.
- Lingual linea alba is a white linear area of keratinization in the lateral aspect of the tongue formed by friction and molding of the most lateral aspect of the tongue.
A. True
B. False
A. True
High-Yield Rationale: Lingual linea alba is a benign condition caused by chronic mechanical irritation from the teeth.
- Fordyce spots are large tubulovesicular sebaceous glands commonly present on the lips.
A. True
B. False
A. True
High-Yield Rationale: Fordyce spots are ectopic sebaceous glands found on the lips, buccal mucosa, and genitalia, appearing as small yellow-white papules.
- Stomatitis nicotina presents as grayish-white lesions that are thickened and umbilicated.
A. True
B. False
A. True
High-Yield Rationale: Stomatitis nicotina (smoker’s palate) is a benign, reversible hyperkeratosis of the hard palate due to chronic heat exposure from smoking.
- Epulis fissuratum is a sessile inflammatory lesion of the maxillary alveolar edge seen as a product of chronic dental trauma.
A. True
B. False
A. True
High-Yield Rationale: Epulis fissuratum is a hyperplastic response of oral mucosa to chronic irritation from poorly fitting dentures.
- Lichen planus is an immunologic disorder with lymphocyte infiltration in the basal layer of the epithelium.
A. True
B. False
A. True
High-Yield Rationale: Lichen planus is an autoimmune disorder characterized by T-cell-mediated destruction of basal keratinocytes, leading to white reticulated oral lesions.
- Inflammation of the salivary ejector in Wharton’s duct results in cessation of salivary flow into the oral cavity and retention of saliva in the involved gland.
A. True
B. False
A. True
High-Yield Rationale: Wharton’s duct obstruction can lead to sialadenitis, causing pain and swelling of the submandibular gland.
- Peritonsillar abscess causes bulging of the anterior pillar and soft palate with deviation and edema of the uvula.
A. True
B. False
A. True
High-Yield Rationale: Peritonsillar abscess (quinsy) results in a swollen, displaced uvula due to accumulation of pus in the peritonsillar space.
- Ranula is an obstruction of the ducts or canaliculi of exocrine glands seen in the sublingual gland.
A. True
B. False
A. True
High-Yield Rationale: Ranulas are mucoceles of the sublingual gland, appearing as bluish, fluid-filled cysts on the floor of the mouth.
- The sensation of pain, touch, and temperature is transmitted by the lingual nerve, and motor function of the tongue is innervated by the lingual nerve to the chorda tympani.
A. True
B. False
B. False
High-Yield Rationale: The lingual nerve (V3) transmits sensory input from the anterior ⅔ of the tongue, while motor innervation is provided by the hypoglossal nerve (CN XII). The chorda tympani (CN VII) carries taste sensation, not motor function.
- Periodontitis is a chronic degenerative destruction of periodontal structures.
A. True
B. False
A. True
High-Yield Rationale: Periodontitis is an inflammatory disease that destroys the supporting structures of teeth, leading to tooth loss if untreated.
- Erythema multiforme consists of rapidly progressive lesions with necrotizing centers.
A. True
B. False
B. False
High-Yield Rationale: Erythema multiforme is an immune-mediated condition presenting as target lesions with central necrosis, often triggered by infections or medications.
- Sjögren’s syndrome is characterized by parotid gland swelling with associated keratoconjunctivitis and xerostomia.
A. True
B. False
A. True
High-Yield Rationale: Sjögren’s syndrome is an autoimmune disorder causing dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) due to lymphocytic infiltration of exocrine glands, particularly the salivary and lacrimal glands.
- Herpes simplex virus (HSV) infection presents as a vesicular eruption with a dermatomal distribution.
A. True
B. False
B. False
High-Yield Rationale: Herpes simplex virus (HSV) causes grouped vesicles but does NOT follow a dermatomal distribution. Dermatomal vesicular eruptions are characteristic of herpes zoster (shingles), caused by varicella-zoster virus (VZV).
- Candida is part of the normal flora but can become opportunistic under certain conditions.
A. True
B. False
A. True
High-Yield Rationale: Candida albicans is a commensal organism but can cause opportunistic infections (oral thrush, esophagitis) in immunocompromised individuals or those on prolonged antibiotic use.
- Squamous cell carcinoma comprises 80% of upper aerodigestive cancers.
A. True
B. False
A. True
High-Yield Rationale: Squamous cell carcinoma (SCC) is the most common malignancy of the upper aerodigestive tract, strongly associated with smoking and alcohol consumption.
- The frenulum is located anteroinferiorly and connects the tongue to the floor of the mouth and gingiva.
A. True
B. False
A. True
High-Yield Rationale: The lingual frenulum is a midline mucosal fold that anchors the tongue to the floor of the mouth and plays a role in tongue mobility.
- Pott’s disease primarily affects which anatomical space?
A. Retropharyngeal space
B. Prevertebral space
C. Parapharyngeal space
D. Submandibular space
B. Prevertebral space
High-Yield Rationale: Pott’s disease (tuberculous spondylitis) occurs in the prevertebral space, affecting the vertebrae and leading to potential spinal deformities or abscess formation.
- The middle deep cervical fascia surrounds which structures?
A. Infrahyoid strap muscles
B. Visceral division (pharynx, larynx, esophagus, trachea, thyroid, buccopharyngeal fascia)
C. Sternocleidomastoid muscle
D. A and B
D. A and B
High-Yield Rationale: The middle deep cervical fascia encloses the infrahyoid muscles and the visceral structures of the neck, supporting airway and digestive structures.
- The superficial cervical fascia encloses which structures?
A. Platysma
B. Superficial musculoaponeurotic system (SMAS)
C. Epicranium, chest, and axilla
D. All of the above
D. All of the above
High-Yield Rationale: The superficial cervical fascia contains the platysma, SMAS, and extends into the epicranium, chest, and axilla, playing a role in superficial movement of neck structures.
- The deep cervical fascia encloses which structures?
A. Prevertebral fascial layer
B. Surrounds the paraspinous muscles and cervical vertebrae
C. Parapharyngeal space
D. A and B
D. A and B
High-Yield Rationale: The deep cervical fascia provides structural support, enclosing the prevertebral muscles and cervical vertebrae, and separates deep compartments of the neck.
- The parapharyngeal space is best described as:
A. A potential space shaped like an inverted pyramid
B. A space behind the pharynx extending to the skull base
C. A space extending from the mandible to the maxilla
D. A muscular compartment within the lateral pharyngeal wall
A. A potential space shaped like an inverted pyramid
High-Yield Rationale: The parapharyngeal space is a critical potential space for infection spread, extending from the skull base to the hyoid bone.
- The masticator space extends from the angle of the mandible superiorly to the skull base and over the temporalis muscle.
A. True
B. False
A. True
High-Yield Rationale: The masticator space contains the masseter, pterygoid, and temporalis muscles and is a common site for odontogenic infections and tumors.
- The canine space is located between which two muscles?
A. Masseter and temporalis
B. Levator anguli oris and levator labii superioris
C. Orbicularis oris and buccinator
D. Geniohyoid and mylohyoid
B. Levator anguli oris and levator labii superioris
High-Yield Rationale: The canine space is a potential space for infections and abscesses in the midface, located between the levator anguli oris and levator labii superioris.
- The mental space serves as a potential space for abscess spread from which anatomical region?
A. Maxillary sinus
B. Teeth
C. Sublingual gland
D. Soft palate
B. Teeth
High-Yield Rationale: The mental space is a potential space for infection spread from lower incisor dental abscesses, often leading to submental swelling.
- The borders of the posterior triangle of the neck include:
A. Trapezius muscle (posteriorly)
B. Sternocleidomastoid muscle (anteriorly)
C. Omohyoid muscle (inferiorly)
D. The roof is formed by fascia, and the floor is formed by the splenius capitus, levator scapulae, and scalene muscles
E. All of the above
E. All of the above
High-Yield Rationale: The posterior triangle of the neck is an important anatomical region containing the accessory nerve (CN XI) and is involved in cervical lymphadenopathy and trauma cases.
- The carotid sheath can become secondarily involved with any other deep neck space infection by direct spread.
A. True
B. False
A. True
High-Yield Rationale: The carotid sheath contains vital structures (common carotid artery, internal jugular vein, and vagus nerve) and is a major conduit for the spread of deep neck infections.
- Complications of deep neck space infections include:
A. Obstruction + Aspiration
B. Spontaneous rupture of abscess + aspiration pneumonia
C. Spread of infection to the posterior mediastinum
D. All of the above
D. All of the above
High-Yield Rationale: Deep neck infections can lead to airway obstruction, abscess rupture with aspiration pneumonia, and spread to the mediastinum, which can be life-threatening.
- The superficial cervical fascia (SCF) includes the superficial musculoaponeurotic system (SMAS), which extends from the epicranium to the axilla and chest.
A. True
B. False
A. True
High-Yield Rationale: The SCF plays a role in facial expression and extends to the chest and axilla, containing structures like the platysma and facial nerve branches.
- The superficial layer of the deep cervical fascia encloses the sternocleidomastoid (SCM), trapezius, parotid gland, and posterior triangle of the neck.
A. True
B. False
A. True
High-Yield Rationale: The superficial layer of the deep cervical fascia covers the SCM, trapezius, parotid gland, and submandibular gland, providing structural support.
- The middle layer of the deep cervical fascia is composed of:
Muscular division (Infrahyoid strap muscles)
Visceral division (Pharynx, Larynx, Esophagus, Thyroid)
A. True
B. False
A. True
High-Yield Rationale: The middle layer of the deep cervical fascia provides support for airway and digestive structures, enclosing the infrahyoid muscles and visceral organs.
- The boundaries of the peritonsillar space include:
Medially: Capsule of palatine tonsil
Laterally: Superior pharyngeal constrictor
Superiorly: Anterior tonsillar pillar
Inferiorly: Posterior tonsillar pillar
A. True
B. False
A. True
High-Yield Rationale: The peritonsillar space is a potential space that becomes involved in peritonsillar abscesses (quinsy), a common deep neck infection.
- Retropharyngeal abscess commonly presents with:
A. Dysphagia
B. Dyspnea (DOB) and stridor
C. Croupy cough and torticollis
D. All of the above
D. All of the above
High-Yield Rationale: Retropharyngeal abscesses can cause airway compromise (stridor, dyspnea) and dysphagia, and may lead to torticollis due to deep neck inflammation.
- The major salivary glands include:
A. Parotid, sublingual, palatine
B. Submandibular, sublingual, lingual
C. Parotid, submandibular, buccal
D. Sublingual, submandibular, labial
E. Parotid, submandibular, sublingual
E. Parotid, submandibular, sublingual
High-Yield Rationale: The three pairs of major salivary glands produce the majority of saliva:
Parotid (serous secretion via Stensen’s duct)
Submandibular (mixed serous-mucous secretion via Wharton’s duct)
Sublingual (mostly mucous secretion via multiple ducts)
- Minor salivary glands have the following characteristics except:
A. Number 600 to 1000 with greatest density at the hard and soft palate (approx. 250)
B. Located beneath the mucosa in the lamina propria and empty secretions directly through rudimentary ducts
C. Histology: simple tubulo-alveolar structure
D. Saliva predominantly serous
E. None of the above (AOTA - All of the above are correct)
E. None of the above (AOTA - All of the above are correct)
- Acute suppurative sialadenitis is most commonly caused by:
A. Viral infections
B. Bacterial infections (Staphylococcus aureus)
C. Autoimmune disorders
D. Nutritional deficiencies
B. Bacterial infections (Staphylococcus aureus)
High-Yield Rationale: Acute suppurative sialadenitis is most commonly caused by S. aureus, leading to painful glandular swelling, erythema, and pus discharge from the duct.
- The clinical triad of Mikulicz/Sjögren’s syndrome includes:
A. Chronic inflammation of lacrimal and salivary glands
B. Ptyalism (excessive salivation)
C. Collagen disorder
D. A and B
E. A and C
E. A and C
High-Yield Rationale: Sjögren’s syndrome is an autoimmune disorder affecting lacrimal and salivary glands, leading to xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes).
- 75 to 80% of all benign salivary gland tumors are:
A. Mucoepidermoid carcinoma
B. Adenoid cystic carcinoma
C. Mixed tumor (Pleomorphic adenoma)
D. Warthin’s tumor
C. Mixed tumor (Pleomorphic adenoma)
High-Yield Rationale: Pleomorphic adenoma is the most common benign salivary gland tumor, frequently occurring in the parotid gland.
- Warthin’s tumor is characterized by:
A. Occurrence in the parotid gland
B. Histology: papillary cysts + nodules of lymphoid tissue
C. More common among females
D. A and B
D. A and B
High-Yield Rationale: Warthin’s tumor (papillary cystadenoma lymphomatosum) is a benign tumor of the parotid gland associated with smoking and contains cystic structures with lymphoid aggregates.
- Mixed tumor (Pleomorphic adenoma) characteristics include:
A. Origin: mixed epithelial and mesenchymal connective tissue elements
B. Histology: islands of satellite and spindle cells, interspersed with a myxoid background
C. Due to multicentricity, treatment is wide excision with a cuff of normal surrounding tissue
D. All of the above (AOTA)
D. All of the above (AOTA)
High-Yield Rationale: Pleomorphic adenomas are multicentric, requiring complete excision with margins to prevent recurrence.
- The most common tumor of the parotid gland in children is:
A. Lymphangioma
B. Hemangioma
C. Lipoma
D. Fibroma
E. A & B
E. A & B
High-Yield Rationale: Hemangiomas and lymphangiomas are the most common benign parotid tumors in children, typically presenting in infancy.
- The histological features of mucoid cells, epidermal elements, and various degrees of differentiation describe:
A. Pleomorphic adenoma
B. Mucoepidermoid carcinoma
C. Warthin’s tumor
D. Adenoid cystic carcinoma
B. Mucoepidermoid carcinoma
High-Yield Rationale: Mucoepidermoid carcinoma is the most common malignant salivary gland tumor, composed of mucous, intermediate, and squamous (epidermoid) cells.
- Which of the following is not a function of saliva?
A. Digestion (contains amylase and lipase)
B. Antimicrobial protection (contains lysozyme and IgA)
C. Lubrication of food for swallowing
D. Voice modulation
D. Voice modulation
High-Yield Rationale: Saliva plays roles in digestion, protection, and lubrication, but does not directly modulate voice production.
- Saliva contains all of the following except:
A. Calcium and phosphates
B. Amylase and lipase
C. Immunoglobulin A (IgA)
D. Albumin
D. Albumin
High-Yield Rationale: Saliva contains calcium, phosphate, enzymes, and IgA, but does not contain albumin, which is found in plasma.
- The largest of the salivary glands is:
A. Submandibular gland
B. Sublingual gland
C. Parotid gland
D. Palatine gland
C. Parotid gland
High-Yield Rationale: The parotid gland is the largest salivary gland and secretes serous saliva through Stensen’s duct.
- The duct that drains the second-largest salivary gland (submandibular gland) is:
A. Stensen’s duct
B. Wharton’s duct
C. Rivinus’ duct
D. Bartholin’s duct
B. Wharton’s duct
High-Yield Rationale: Wharton’s duct drains the submandibular gland into the sublingual caruncle, near the lingual frenulum.
- All of the following describe the parotid gland except:
A. Serous gland that produces enzymes
B. Paired major salivary gland
C. Innervated by Jacobson’s nerve
D. None of the above
C. Innervated by Jacobson’s nerve
High-Yield Rationale: The parotid gland is innervated by the glossopharyngeal nerve (CN IX) via the auriculotemporal nerve. Jacobson’s nerve (tympanic branch of CN IX) supplies the middle ear mucosa, not the parotid gland.
- The best treatment for recurrent acute suppurative submandibular sialadenitis is:
A. Removal of sialolith (stone)
B. Antibiotics
C. Antibiotics and excision biopsy of the submandibular gland
D. All of the above
D. All of the above
High-Yield Rationale: Recurrent bacterial sialadenitis is often due to a salivary stone (sialolithiasis). Treatment involves antibiotics for infection control and surgical removal of the stone. In chronic cases, gland excision may be necessary.
- Which salivary gland is composed entirely of serous cells, producing watery secretions high in enzymes but low in mucin?
A. Submandibular
B. Parotid
C. Sublingual
B. Parotid
High-Yield Rationale: The parotid gland is composed entirely of serous acini, producing watery, enzyme-rich saliva, including amylase for starch digestion.
- The salivary gland that is primarily made up of mucin cells and secretes the majority of mucus is:
A. Parotid gland
B. Submandibular gland
C. Sublingual gland
D. Minor salivary glands
C. Sublingual gland
High-Yield Rationale: The sublingual gland produces predominantly mucous secretions, which lubricate the oral cavity.
- The salivary parasympathetic nerve supply originates from the superior salivary nucleus in the pons, travels via the nervus intermedius and chorda tympani (CN VII), and joins the lingual nerve to innervate which glands?
A. Parotid and submandibular
B. Parotid and sublingual
C. Submandibular and sublingual
D. Minor salivary glands
C. Submandibular and sublingual
High-Yield Rationale: The superior salivary nucleus (pons) → nervus intermedius → chorda tympani (CN VII) → lingual nerve → submandibular ganglion supplies both the submandibular and sublingual glands.
- Which gland receives parasympathetic innervation via the glossopharyngeal nerve (CN IX), then travels through Jacobson’s nerve to the otic ganglion where it synapses?
A. Submandibular
B. Parotid
C. Sublingual
D. Minor salivary glands
B. Parotid
High-Yield Rationale: The glossopharyngeal nerve (CN IX) → Jacobson’s nerve → otic ganglion → auriculotemporal nerve supplies the parotid gland.
- A mucous retention cyst of the sublingual gland is called:
A. Cystic hygroma
B. Ranula
C. Mucocele
D. Dermoid cyst
C. Mucocele
High-Yield Rationale:
A mucocele is a mucous retention cyst that results from the rupture or blockage of a salivary gland duct, leading to the accumulation of mucin. Mucoceles can occur in any minor salivary gland, including the sublingual gland, but when specifically located on the floor of the mouth, they are referred to as ranulas.
- The most common tumor of the parotid gland in children is:
A. Lymphangioma
B. Hemangioma
C. Lipoma
D. Fibroma
E. A and B
E. A and B
High-Yield Rationale: Hemangiomas and lymphangiomas are the most common benign salivary gland tumors in children, frequently affecting the parotid gland.
- Hemangiomas in children should be excised only in the presence of the following complications:
A. Bleeding/coagulopathy due to platelet consumption
B. Infection
C. Heart failure
D. Rapid increase in size
E. All of the above (AOTA)
E. All of the above (AOTA)
High-Yield Rationale: Indications for hemangioma excision include:
Kasabach-Merritt syndrome (platelet consumption, coagulopathy)
Infection
High-output heart failure (large vascular malformations)
Rapid, disfiguring growth
- Regarding the use of CT, MRI, and PET scans in the diagnosis of thyroid nodules, which statement is correct?
A. PET scan is a definitive diagnostic tool
B. MRI and CT are definitive tests
C. PET scan is part of the routine diagnostic workup, while CT and MRI are not
D. PET scan is unnecessary in thyroid nodule evaluation
D. PET scan is unnecessary in thyroid nodule evaluation
Rationale:
The primary imaging modality for evaluating thyroid nodules is ultrasound (US), which provides critical information on nodule size, composition, echogenicity, vascularity, and suspicious features. Fine-needle aspiration (FNA) biopsy is the gold standard for definitive diagnosis in nodules with suspicious ultrasound characteristics.
- What is the recommended treatment for benign thyroid nodules?
A. TSH suppression is no longer recommended
B. TSH suppression can be done for 6-12 months
C. Surgical excision is required for young patients with benign cystic tumors
D. Surgery is required for young patients with solid tumors
B. TSH suppression can be done for 6-12 months
High-Yield Rationale:
For benign thyroid nodules, TSH suppression therapy with levothyroxine can be used for 6-12 months to reduce nodule size, especially in young patients with non-compressive nodules. However, it is not always effective, and nodules should be monitored for growth or suspicious features that might indicate malignancy. Surgery is not routinely required unless the nodule is large, symptomatic, or shows malignant features on FNA biopsy.
- What is the role of radioactive iodine (RAI) in benign thyroid nodules?
A. RAI is used to treat non-functional benign nodules
B. RAI is only used in Graves’ disease and thyroid cancer
C. RAI is effective in shrinking autonomously functioning thyroid nodules
D. RAI has no role in benign thyroid disease
C. RAI is effective in shrinking autonomously functioning thyroid nodules
High-Yield Rationale: RAI is useful for treating autonomously functioning (toxic) nodules by reducing their activity, but it is not used for non-functioning benign nodules.
- What is the role of surgery in benign thyroid nodules?
A. Indicated if the nodule is large and compressive
B. Required for all nodules >1 cm
C. Always performed before RAI therapy
D. Surgery is not an option for benign nodules
A. Indicated if the nodule is large and compressive
High-Yield Rationale: Surgery is indicated for benign nodules that cause compressive symptoms (e.g., dysphagia, airway obstruction) or cosmetic concerns.
- What is the role of fine-needle aspiration cytology (FNAC) in the diagnosis of thyroid nodules?
A. Determines benignity
B. Positive predictive value: 50-96%
C. Sensitivity: 65-98%
D. Specificity: 72-100%
E. All of the above
E. All of the above
High-Yield Rationale: FNAC is the gold standard for diagnosing thyroid nodules, with high sensitivity and specificity in distinguishing benign from malignant lesions.
- What is a low-risk criterion for well-differentiated thyroid carcinoma (WDTC)?
A. Age <45 years
B. Tumor size <1 cm
C. No extrathyroidal extension
D. No lymph node involvement
E. All of the above
E. All of the above
High-Yield Rationale: Low-risk patients have small, well-differentiated tumors without extrathyroidal extension or lymph node metastases.
- What is an intermediate-risk criterion for well-differentiated thyroid carcinoma (WDTC)?
A. Age 45-55 years
B. Tumor size 2-4 cm
C. Minor extrathyroidal extension
D. Lymph node metastases without distant spread
E. All of the above
E. All of the above
High-Yield Rationale: Intermediate-risk patients have moderate tumor size, limited extrathyroidal invasion, or nodal disease without distant metastasis.
- A patient is diagnosed post-operatively with medullary thyroid carcinoma (MTC). What is the next step?
A. Total thyroidectomy with lymph node dissection
B. Measure serum calcitonin and carcinoembryonic antigen (CEA)
C. Genetic testing for RET mutations
D. All of the above
D. All of the above
High-Yield Rationale: MTC is associated with MEN 2A/2B, requiring genetic testing (RET mutation) and post-op calcitonin/CEA monitoring for disease persistence.
- If a lymph node is positive in medullary thyroid carcinoma, what is the recommended surgical procedure?
A. Total thyroidectomy with central neck dissection
B. Total thyroidectomy without lymph node removal
C. Lobectomy with isthmusectomy
D. Observation only
A. Total thyroidectomy with central neck dissection
High-Yield Rationale: MTC spreads via lymphatics, requiring total thyroidectomy with central and lateral lymph node dissection for nodal involvement.
- By age, the patient is considered low risk.
A. True
B. False
A. True
High-Yield Rationale: Patients <45 years old with well-differentiated thyroid cancer (papillary or follicular) are generally low risk based on age criteria.
- What is the optimal thyroid function test?
A. T4 and TSH
B. T3 and TSH
C. T3 and T4
D. TSH only
A. T4 and TSH
High-Yield Rationale: TSH and free T4 are the best markers for thyroid function, with TSH being the most sensitive test.
- A 54-year-old female presents with a 3 cm anterior neck mass that moves with deglutition. Her thyroid function tests are normal. What is the next step for histologic evaluation?
A. Fine-needle aspiration biopsy (FNAB)
B. Total thyroidectomy
C. CT scan
D. PET scan
A. Fine-needle aspiration biopsy (FNAB)
High-Yield Rationale: FNAB is the first-line diagnostic test for thyroid nodules to differentiate benign from malignant lesions.
- If FNAB results are equivocal or insufficient, what is the next step?
A. Frozen section
B. Repeat FNAB
C. Core needle biopsy
D. CT-guided biopsy
B. Repeat FNAB
High-Yield Rationale: Inconclusive FNAB results require repeat aspiration or core needle biopsy for better tissue sampling.
- The thyroid gland originates embryologically from the:
A. Base of the tongue
B. Fourth pharyngeal pouch
C. Second branchial arch
D. Submandibular duct epithelium
A. Base of the tongue
High-Yield Rationale: The thyroid develops from the foramen cecum at the base of the tongue and descends along the thyroglossal duct to its final position.
- Frozen section is not applicable to follicular thyroid carcinoma.
A. True
B. False
A. True
High-Yield Rationale: Follicular carcinoma is diagnosed based on vascular or capsular invasion, which cannot be determined by frozen section.
- Which of the following describes the paranasal sinuses?
A. Medial to the ethmoids and separates them from the orbit
B. Air-filled spaces lined by respiratory epithelium on either side of the head
C. Located anterior to and above the ethmoid sinuses
D. Posterosuperior to the sphenoid
E. Largest of the paranasal sinuses
B. Air-filled spaces lined by respiratory epithelium on either side of the head
High-Yield Rationale: The paranasal sinuses are air-filled cavities that reduce skull weight, humidify and filter air, and provide resonance for speech. They include the maxillary, frontal, ethmoid, and sphenoid sinuses.
- What is the anatomical significance of the lamina papyracea?
A. Medial to the ethmoids and separates them from the orbit
B. Air-filled spaces lined by respiratory epithelium on either side of the head
C. Located anterior to and above the ethmoid sinuses
D. Posterosuperior to the sphenoid
E. Largest of the paranasal sinuses
A. Medial to the ethmoids and separates them from the orbit
High-Yield Rationale: The lamina papyracea is a thin bony structure that separates the ethmoid sinuses from the orbit. Due to its fragility, infections from the ethmoid sinuses can easily spread into the orbit, causing orbital cellulitis.
- Which of the following statements best describes the maxillary sinus?
A. Medial to the ethmoids and separates them from the orbit
B. Air-filled spaces lined by respiratory epithelium on either side of the head
C. Located anterior to and above the ethmoid sinuses
D. Posterosuperior to the sphenoid
E. Largest of the paranasal sinuses
E. Largest of the paranasal sinuses
High-Yield Rationale: The maxillary sinus is the largest paranasal sinus, located in the maxilla and draining into the middle meatus. It is commonly affected in sinus infections due to its poor drainage when inflamed.
- Which of the following best describes the location of the pituitary gland?
A. Medial to the ethmoids and separates them from the orbit
B. Air-filled spaces lined by respiratory epithelium on either side of the head
C. Located anterior to and above the ethmoid sinuses
D. Posterosuperior to the sphenoid
E. Largest of the paranasal sinuses
D. Posterosuperior to the sphenoid
High-Yield Rationale: The pituitary gland is located in the sella turcica of the sphenoid bone, posterosuperior to the sphenoid sinus, making transsphenoidal surgery a common approach for pituitary tumors.
- Which of the following statements best describes the frontal sinus?
A. Medial to the ethmoids and separates them from the orbit
B. Air-filled spaces lined by respiratory epithelium on either side of the head
C. Located anterior to and above the ethmoid sinuses
D. Posterosuperior to the sphenoid
E. Largest of the paranasal sinuses
C. Located anterior to and above the ethmoid sinuses
High-Yield Rationale: The frontal sinus is located above the ethmoid sinuses in the frontal bone, and it drains into the middle meatus via the frontonasal duct.
- The cribriform plate serves which function?
A. Physically cleanses inspired air
B. Through which olfactory neurons pass into the nasal cavity
C. Absence of sense of smell
D. Unilateral foul-smelling rhinorrhea
E. Causes 50% of common colds
B. Through which olfactory neurons pass into the nasal cavity
High-Yield Rationale: The cribriform plate is part of the ethmoid bone, perforated to allow olfactory nerve fibers (CN I) to pass into the nasal cavity, enabling the sense of smell.
- Anosmia refers to?
A. Physically cleanses inspired air
B. Through which olfactory neurons pass into the nasal cavity
C. Absence of sense of smell
D. Unilateral foul-smelling rhinorrhea
E. Causes 50% of common colds
C. Absence of sense of smell
High-Yield Rationale: Anosmia refers to the loss of smell, which can result from cribriform plate fractures, viral infections, neurodegenerative diseases, or nasal obstruction.
- The mucociliary apparatus functions primarily to:
A. Physically cleanses inspired air
B. Through which olfactory neurons pass into the nasal cavity
C. Absence of sense of smell
D. Unilateral foul-smelling rhinorrhea
E. Causes 50% of common colds
A. Physically cleanses inspired air
High-Yield Rationale: The mucociliary apparatus is essential for clearing inhaled debris, pathogens, and allergens from the respiratory tract using cilia and mucus transport.
- Rhinovirus is the most common cause of?
A. Physically cleanses inspired air
B. Through which olfactory neurons pass into the nasal cavity
C. Absence of sense of smell
D. Unilateral foul-smelling rhinorrhea
E. Causes 50% of common colds
E. Causes 50% of common colds
High-Yield Rationale: Rhinovirus is the most common cause of the common cold, responsible for up to 50% of cases, leading to nasal congestion, rhinorrhea, and sore throat.
- A patient presents with a nasal foreign body. The most likely cause is:
A. Physically cleanses inspired air
B. Through which olfactory neurons pass into the nasal cavity
C. Absence of sense of smell
D. Unilateral foul-smelling rhinorrhea
E. Causes 50% of common colds
D. Unilateral foul-smelling rhinorrhea
High-Yield Rationale: A nasal foreign body is a common cause of unilateral foul-smelling nasal discharge, especially in children, due to retained organic matter leading to infection and decay.
- The functions of the paranasal sinuses include:
A. Lightening of the skull weight
B. Providing bumper-like protection to the face in trauma
C. Voice resonance
D. Contributing to olfaction
E. All of the above
E. All of the above
High-Yield Rationale: The paranasal sinuses serve multiple roles, including reducing skull weight, protecting facial structures, and enhancing voice resonance.
- Which of the following is NOT an etiologic agent of acute sinusitis?
A. Rhinovirus
B. Influenza virus
C. Rotavirus
D. Coronavirus
C. Rotavirus
High-Yield Rationale: Acute sinusitis is mostly caused by respiratory viruses (e.g., rhinovirus, influenza virus, coronavirus) rather than gastrointestinal viruses like rotavirus.
- Which of the following is true regarding nasal polyposis?
A. Chronic inflammation
B. Examination shows mast cells, eosinophils, and increased histamine
C. Hypersensitivity to acetylsalicylic acid
D. All of the above (AOTA)
D. All of the above (AOTA)
High-Yield Rationale: Nasal polyps are associated with chronic inflammation, eosinophilia, and aspirin-exacerbated respiratory disease (AERD) in sensitive individuals.
- The most common site of complications in sinusitis, particularly due to proximity to the ethmoid sinus and the thin, dehiscent lamina papyracea, is the:
A. Cranial cavity
B. Orbit
C. Nasopharynx
D. Maxillary sinus
B. Orbit
High-Yield Rationale: Ethmoid sinus infections can spread through the thin lamina papyracea, leading to orbital cellulitis, abscesses, and potential vision loss.
- Maxillary sinusitis often originates from infections in which set of teeth?
A. Central and lateral incisors
B. Canines and premolars
C. 1st and 2nd molars
D. Wisdom teeth (3rd molars)
C. 1st and 2nd molars
High-Yield Rationale: The roots of the 1st and 2nd molars are in close proximity to the maxillary sinus, making them common sources of odontogenic maxillary sinusitis.
- Which of the following are effective in treating candidiasis?
A. Gentamycin
B. Nystatin
C. Itraconazole
D. All of the above (AOTA)
E. B & C
E. B & C
High-Yield Rationale: Nystatin and itraconazole are antifungal agents used to treat candidiasis, while gentamycin (an aminoglycoside) is ineffective against fungal infections.
- Which of the following is used to treat chickenpox, herpes zoster, and severe recurrent herpes simplex?
A. Acyclovir
B. Valacyclovir
C. Amantadine
D. All of the above (AOTA)
E. A & B
E. A & B
High-Yield Rationale: Acyclovir and valacyclovir are antiviral agents used against varicella-zoster virus (chickenpox, herpes zoster) and herpes simplex virus (HSV). Amantadine is used for influenza, not herpes infections.
- Nystatin is used for:
A. Oral candidiasis
B. Cutaneous fungal infections
C. Vaginal candidiasis
D. All of the above (AOTA)
D. All of the above (AOTA)
High-Yield Rationale: Nystatin is an antifungal agent effective against Candida infections in the oral cavity, skin, and vaginal mucosa.
- Which of the following are the most common pathogens in tonsillitis?
A. Mixed anaerobic and aerobic bacteria
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. All of the above (AOTA)
D. All of the above (AOTA)
High-Yield Rationale: Tonsillitis is commonly caused by mixed anaerobic and aerobic bacteria, with S. pneumoniae and H. influenzae frequently implicated in secondary infections.
- Which of the following are common features of bacterial sore throat?
A. Fever
B. Severe erythema and exudates
C. Lymphadenopathy
D. All of the above (AOTA)
E. A and B only
D. All of the above (AOTA)
High-Yield Rationale: Bacterial pharyngitis, commonly caused by Streptococcus pyogenes, presents with fever, tonsillar exudates, and tender cervical lymphadenopathy.
- Which antibiotic is active against protozoa and anaerobic bacterial infections?
A. Metronidazole
B. Fluconazole
C. Cotrimoxazole
D. Amphotericin
E. Polymyxin B
A. Metronidazole
High-Yield Rationale: Metronidazole is effective against anaerobic bacteria and protozoal infections like Trichomonas, Giardia, and Clostridium difficile.
- Which antibiotic class inhibits bacterial growth by disrupting metabolism, is mostly unaffected by beta-lactamases, and causes photosensitivity, Stevens-Johnson syndrome, and hemolytic anemia?
A. Chloramphenicol
B. Sulfonamides
C. Quinolones
D. Erythromycin
E. Metronidazole
B. Sulfonamides
High-Yield Rationale: Sulfonamides inhibit folate synthesis, making them bacteriostatic, but they can cause hypersensitivity reactions, hemolytic anemia (in G6PD deficiency), and photosensitivity.
- Which antibiotic is used to treat Pseudomonas infections in the head and neck?
A. Fluoroquinolones
B. Amoxicillin
C. Imipenem
D. Sulbactam-ampicillin (Sultamicillin)
E. Ceftriaxone
A. Fluoroquinolones
High-Yield Rationale: Fluoroquinolones (e.g., ciprofloxacin) have excellent activity against Pseudomonas aeruginosa, which is commonly involved in otitis externa and chronic sinus infections.
- Which of the following are ceruminolytics (earwax softeners)?
A. Glycerin
B. Mineral oil
C. Coconut oil
D. All of the above (AOTA)
E. A & B only
D. All of the above (AOTA)
High-Yield Rationale: Ceruminolytics help soften earwax, facilitating its natural removal. Glycerin, mineral oil, and coconut oil are commonly used agents.
- Which conditions indicate the use of nasal topical steroids?
A. Allergic rhinitis
B. Chronic sinusitis
C. Otitis externa
D. All of the above (AOTA)
D. All of the above (AOTA)
High-Yield Rationale: Intranasal steroids are used to reduce inflammation in allergic rhinitis, chronic sinusitis, and some ear infections (e.g., otitis externa with nasal congestion contributing to Eustachian tube dysfunction).
- What is the first-line topical antibiotic treatment for impetigo?
A. Mupirocin
B. Fusidic acid
C. Gentamicin
D. All of the above (AOTA)
D. All of the above (AOTA)
High-Yield Rationale: Mupirocin and fusidic acid are effective against Staphylococcus aureus and Streptococcus pyogenes, the most common causes of impetigo, while gentamicin covers Gram-negative bacteria.
- Which of the following are signs and symptoms of Meniere’s disease?
A. Hearing loss
B. Vertigo
C. Tinnitus
D. All of the above (AOTA)
D. All of the above (AOTA)
High-Yield Rationale: Meniere’s disease is an inner ear disorder causing episodic vertigo, sensorineural hearing loss, and tinnitus due to endolymphatic hydrops.
- Which vasodilating agent is used for the treatment of vertigo?
A. Cinnarizine
B. Furosemide
C. Betahistine
D. A & C
D. A & C
High-Yield Rationale: Cinnarizine and betahistine improve inner ear circulation and reduce vertigo symptoms by acting on histamine receptors and vascular tone.
- Which of the following are supportive treatments for Meniere’s disease?
A. B vitamins
B. Low salt diet
C. Avoid caffeine
D. Avoid monosodium glutamate (MSG)
E. All of the above (AOTA)
E. All of the above (AOTA)
High-Yield Rationale: Dietary modifications, vitamin supplementation, and lifestyle changes help reduce endolymphatic fluid retention, alleviating Meniere’s symptoms.
