Anatomy 29, Clinical ENT

1. A 5-year-old child presents with loud snoring, daytime fatigue, and poor concentration in
school. On further history, the child has had three documented episodes of tonsillitis per year for
the past three years. What is the most appropriate next step?​
A. Begin allergy testing​
B. Schedule outpatient tonsillectomy​
C. Prescribe amoxicillin for 10 days​
D. Order a sleep study

2. A patient complains of nasal obstruction and reports facial pressure for over 3 months. Nasal
endoscopy reveals nasal polyps. Which triad is most associated with this condition?​
A. Nasal polyps, atopic dermatitis, asthma​
B. Asthma, aspirin sensitivity, nasal polyps​
C. Allergic rhinitis, eczema, aspirin sensitivity​
D. Asthma, allergic rhinitis, GERD

3. A 60-year-old man reports sudden onset unilateral hearing loss. Audiometry confirms
sensorineural hearing loss. What is the most appropriate first-line treatment?​
A. Tympanostomy tube​
B. High-dose oral steroids​
C. Nasal decongestants​
D. Cerumen removal

4. A 30-year-old woman presents with brief episodes of dizziness triggered by turning her head
to the right. Dix-Hallpike maneuver reproduces vertigo. What is the most likely diagnosis?​
A. Vestibular migraine​
B. Meniere’s disease​
C. Benign paroxysmal positional vertigo (BPPV)​
D. Labyrinthitis

5. Which of the following is a typical indication for ear tubes in pediatric patients?​
A. Chronic otitis externa​
B. Unilateral ear wax impaction​
C. Recurrent otitis media with effusion​
D. Sensorineural hearing loss

6. A 50-year-old man reports ear fullness and progressive hearing loss. Audiometry reveals a
conductive pattern. CT shows abnormal bony growth in the middle ear. What is the most likely
diagnosis?​
A. Meniere’s disease​
B. Vestibular neuritis​
C. Otosclerosis​
D. Cholesteatoma
7. Which of the following correctly describes chronic sinusitis?​
A. Symptoms for <4 weeks​
B. Symptoms resolve completely between episodes​
C. ≥4 episodes/year with persistent symptoms in between​
D. ≥12 weeks of symptoms including purulent drainage and facial pain

8. Which of the following vertigo causes is typically treated with the Epley maneuver?​
A. Meniere’s disease​
B. BPPV​
C. Vestibular neuritis​
D. Vestibular migraine

9. Which of the following is an outpatient surgical procedure in children that requires avoidance
of narcotics postoperatively?​
A. Septoplasty​
B. Tympanoplasty​
C. Tonsillectomy​
D. Cochlear implantation

10. Which diagnostic approach is best when evaluating a patient with "dizziness"?​
A. Order CT of the head​
B. Perform Dix-Hallpike regardless of symptoms​
C. Take a detailed history, especially symptom timing and triggers​
D. Order audiometry and vestibular testing for all patients

Answer Key & Explanations

1.​ B. This child meets criteria for recurrent tonsillitis (3/year for 3 years) and has signs of
sleep-disordered breathing – both are indications for tonsillectomy.
2.​ B. Samter’s triad includes asthma, aspirin sensitivity, and nasal polyps.
3.​ B. Sudden SNHL is treated with oral ± intratympanic steroids as first-line therapy.
4.​ C. BPPV is characterized by brief positional vertigo, positive Dix-Hallpike, and is treated
with repositioning maneuvers.
5.​ C. Recurrent middle ear effusion (MEE) is a common reason for placing tympanostomy
tubes.
6.​ C. Otosclerosis involves bony fixation of the stapes, causing conductive hearing loss.
7.​ D. Chronic sinusitis is defined by ≥12 weeks of symptoms, including facial pain and
purulent drainage.
8.​ B. BPPV responds well to canalith repositioning like the Epley maneuver.
9.​ C. Tonsillectomy is usually outpatient in kids and pain management avoids narcotics due
to bleeding risk.
10.​C. Dizziness is non-specific; the best first step is a detailed history to characterize the
type and cause.
 Anatomy 30, Pediatric ENT

1. A 3-year-old presents with fever, irritability, and ear pain. Otoscopy reveals a bulging,
erythematous tympanic membrane with decreased mobility. What is the first-line treatment?​
A. Cefdinir​
B. Amoxicillin​
C. Ciprofloxacin ear drops​
D. Ceftriaxone IM

2. A child with tympanostomy tubes presents with ear drainage. What is the appropriate next
step?​
A. Oral amoxicillin​
B. Observation​
C. Topical ciprofloxacin-dexamethasone drops​
D. IV ceftriaxone

3. A diabetic child presents with severe otalgia, granulation tissue in the canal, and facial nerve
palsy. What is the likely diagnosis?​
A. Acute otitis media​
B. Otitis externa​
C. Necrotizing otitis externa​
D. Mastoiditis

4. A 2-year-old with recurrent otitis media and sleep-disordered breathing is being evaluated.
What management is most appropriate?​
A. Nasal decongestants​
B. Trial of antihistamines​
C. Adenoidectomy ± tympanostomy tubes​
D. Ceftriaxone

5. A neonate develops respiratory distress that improves when crying. Nasal suctioning is
difficult. What is the most likely diagnosis?​
A. Septal hematoma​
B. Adenoid hypertrophy​
C. Bilateral choanal atresia​
D. Epiglottitis

6. Which of the following is true about sinus development in children?​

A. Frontal sinuses are present at birth​
B. Maxillary sinuses are fully developed by 2 years​
C. Ethmoid sinuses are present at birth​
D. Sphenoid sinuses develop after frontal

7. A 5-year-old presents with 14 days of purulent nasal discharge and facial pain. What is the
best initial treatment?​
A. Amoxicillin​
B. Amoxicillin-clavulanate​
C. Nasal steroids only​
D. Observation

8. A child presents with unilateral proptosis, ophthalmoplegia, and decreased vision following
sinusitis. What is the next step in management?​
A. Oral antibiotics​
B. Topical tobramycin​
C. IV ceftriaxone + vancomycin​
D. Emergent enucleation

9. A child has unilateral tearing and mild erythema of the lower eyelid. There is no fever or
swelling. What is the most appropriate initial management?​
A. Antibiotic ointment​
B. Warm compress and nasolacrimal massage​
C. Surgical intervention​
D. CT of the orbits

10. A toddler fails a vision screen and is found to have strabismus. What is the confirmatory
test?​
A. Pupillary light reflex​
B. Fundoscopy​
C. Corneal light reflex and cover-uncover test​
D. Visual evoked potentials

11. A child presents with a history of nosebleeds. The bleeding is from the anterior septum and
he often picks his nose. What is the initial management?​
A. Head back and nasal packing​
B. Cold compress and compression​
C. Silver nitrate cautery​
D. Systemic antibiotics

12. A 4-year-old presents with fever, preseptal swelling, but no proptosis or ophthalmoplegia.
Diagnosis?​
A. Orbital cellulitis​
B. Periorbital cellulitis​
C. Retinoblastoma​
D. Allergic conjunctivitis

13. Which of the following findings most strongly suggests retinoblastoma?​

A. Strabismus​
B. Bilateral conjunctivitis​
C. Leukocoria​
D. Photophobia
14. Which of the following is a common pathogen in acute bacterial conjunctivitis in children?​
A. Staphylococcus epidermidis​
B. Neisseria gonorrhoeae​
C. Nontypable Haemophilus influenzae​
D. HSV-1

15. What is the first-line treatment for allergic conjunctivitis in children?​

A. Tobramycin drops​
B. Observation​
C. Antihistamine drops like ketotifen​
D. Oral steroids

Answer Key with Explanations

1.​ B. Amoxicillin is the first-line treatment for acute otitis media.​

2.​ C. Ciprofloxacin-dexamethasone drops are used for AOM with tubes.​

3.​ C. Necrotizing OE is a Pseudomonas osteomyelitis in immunocompromised patients.​

4.​ C. Recurrent OM with sleep-disordered breathing is an indication for adenoidectomy and

tubes.​

5.​ C. Bilateral choanal atresia causes distress relieved by crying (mouth breathing).​

6.​ C. Ethmoid sinuses are present at birth.​

7.​ A. First-line treatment for pediatric bacterial sinusitis is amoxicillin.​

8.​ C. IV antibiotics are essential for orbital cellulitis.​

9.​ B. Nasolacrimal massage is first-line for dacryostenosis.​

10.​C. Strabismus is diagnosed with corneal light reflex and cover-uncover test.​

11.​B. Initial management includes cold compress and compression.​

12.​B. Periorbital cellulitis has no orbital involvement (proptosis, ophthalmoplegia).​

13.​C. Leukocoria (white pupil reflex) is classic for retinoblastoma.​

14.​C. NTHi is a common pathogen in pediatric bacterial conjunctivitis.​

15.​C. Antihistamine drops like ketotifen are used for allergic conjunctivitis.​
 Neuro 72, Pediatric Neurology

1. A 7-year-old child has bilateral, mild, non-throbbing headaches described as a “tight band”
around the head. There is no nausea, vomiting, or photophobia. What is the most likely
diagnosis?​
A. Migraine​
B. Cluster headache​
C. Tension-type headache​
D. Sinus headache

2. A 3-year-old has had 4 brief (10-second) episodes of staring into space over the past week.
EEG shows a 3 Hz spike-and-wave pattern. What is the most likely diagnosis?​
A. Infantile spasms​
B. Benign rolandic epilepsy​
C. Absence epilepsy​
D. Complex partial seizures

3. A 4-month-old has sudden flexion of the trunk and limbs, developmental regression, and
hypsarrhythmia on EEG. What is the most likely diagnosis?​
A. Benign neonatal seizures​
B. Lennox-Gastaut syndrome​
C. Infantile spasms​
D. Febrile seizure

4. A 2-year-old has a seizure lasting 7 minutes during a fever. It is generalized, and the child
returns to baseline within 20 minutes. What is the appropriate management?​
A. Emergent MRI​
B. Start antiepileptics​
C. Reassurance only​
D. Admit for EEG and lumbar puncture

5. Which condition is most concerning and requires immediate brain imaging before lumbar
puncture?​
A. First-time febrile seizure in toddler​
B. New-onset absence seizures​
C. Focal deficits and papilledema​
D. Post-infectious cerebellitis

6. A 6-year-old presents with acute focal neurologic deficits. What must always be considered
first?​
A. Seizure​
B. Migraine​
C. Pediatric stroke​
D. Guillain-Barré
7. What is the classic EEG finding in Lennox-Gastaut syndrome?​
A. Hypsarrhythmia​
B. Normal EEG​
C. Diffuse slow spike-and-wave​
D. 3 Hz spike-and-wave

8. A preterm neonate (<1500 g) has a bulging fontanel, bradycardia, and apnea. Head
ultrasound shows blood in the ventricles and cortex. What is the IVH grade?​
A. Grade 2​
B. Grade 3​
C. Grade 4​
D. Grade 1

9. What primitive reflex disappears by 12–18 months and is characterized by dorsiflexion of the
great toe after stroking the sole?​
A. Moro​
B. Babinski​
C. Rooting​
D. Stepping

10. A child has ataxia after a recent viral illness. There are no focal deficits or mental status
changes. What is the most likely cause?​
A. Posterior fossa tumor​
B. Post-infectious cerebellitis​
C. Metabolic disorder​
D. Stroke

1.​ C. Tension-type headaches are mild, global, and lack migraine features.
2.​ C. Absence epilepsy presents with brief staring spells and a 3 Hz spike-wave EEG.
3.​ C. Infantile spasms involve sudden flexion, regression, and hypsarrhythmia.
4.​ C. This is a simple febrile seizure (generalized, <15 min, no recurrence)—no workup
needed.
5.​ C. Signs of increased ICP (e.g., focal deficits, papilledema) require imaging before LP.
6.​ C. Stroke until proven otherwise is the mantra for acute focal deficits in children.
7.​ C. Lennox-Gastaut shows diffuse slow spike-and-wave discharges.
8.​ C. Grade 4 = blood in ventricles and extension into cerebral cortex—worst prognosis.
9.​ B. The Babinski reflex is normal in infants and disappears by 12–18 months.
10.​B. Post-infectious cerebellitis is the most common cause of acute ataxia after a viral
illness.​
 Psych 25, Ethics in Psychiatry & Suicide/Violence Assessment

1. A psychiatrist enters a business partnership with a current patient. What best describes this
action?​
A. Ethical if disclosed​
B. Acceptable with consent​
C. Unethical​
D. Legal but not recommended

2. Which of the following elements is NOT required for informed consent?​

A. Competency declaration by a judge​
B. Decision-making capacity​
C. Disclosure of risks and benefits​
D. Voluntary agreement

3. A 15-year-old in North Carolina requests STD testing. What is the appropriate action?​
A. Refuse due to age​
B. Contact parents​
C. Proceed after obtaining minor’s consent​
D. Seek court order

4. What distinguishes capacity from competency?​

A. Competency is determined by physicians​
B. Capacity is a legal judgment​
C. Capacity is task-specific and can fluctuate​
D. Competency is based on informed consent discussion

5. A psychiatrist learns that a patient has a plan to harm a specific person. According to Tarasoff
II, the doctor must:​
A. Only warn the potential victim​
B. Notify police or initiate commitment​
C. Wait until an attempt is made​
D. Maintain confidentiality

6. What are the 4 D’s of medical malpractice?​

A. Duty, Damage, Defense, Delay​
B. Duty, Dereliction, Damage, Direct cause​
C. Diagnosis, Dereliction, Defense, Deception​
D. Diagnosis, Duty, Delay, Damages

7. What is the most important risk factor for suicide?​

A. Family history​
B. Psychiatric hospitalization​
C. Substance use​
D. Prior self-harm
8. A patient with schizophrenia expresses suicidal ideation and has access to a firearm. What is
the best next step?​
A. Schedule weekly therapy​
B. Start SSRI​
C. Hospitalize voluntarily or involuntarily​
D. Reassure and follow up in 2 weeks

9. Which of the following neurobiological findings is associated with suicide?​

A. Increased CSF 5-HIAA​
B. Decreased dopamine in frontal cortex​
C. Decreased CSF 5-HIAA​
D. Increased acetylcholine in basal ganglia

10. Which psychiatric disorder carries the highest risk of completed suicide?​
A. Major depressive disorder​
B. Generalized anxiety disorder​
C. Bipolar disorder​
D. PTSD

11. Which of the following is considered a dynamic (modifiable) risk factor for violence?​
A. History of violence​
B. Male sex​
C. Living in a violent setting​
D. Intellectual disability

12. A man is found not guilty by reason of insanity. This means he:​
A. Was unaware of legal consequences of his actions​
B. Was involuntarily committed prior to the crime​
C. Lacked the ability to understand the criminality of his act or conform behavior​
D. Has been declared permanently incompetent

Answer Key with Explanations

1.​ C. Business relationships with patients are unethical.​

2.​ A. Competency is a legal judgment; capacity, not competency, is required for consent.​

3.​ C. NC law allows minors (13+) to consent for STD testing.​

4.​ C. Capacity is clinical, task-specific, and can fluctuate.​

5.​ B. Tarasoff II requires action to protect the intended victim, such as notifying police or
commitment.​

6.​ B. The four elements are Duty, Dereliction, Damage, and Direct cause.​

7.​ D. Prior self-harm is the most significant predictor of future suicide.​

8.​ C. Active suicidality with means requires hospitalization.​

9.​ C. Suicide has been linked to low CSF serotonin metabolite (5-HIAA).​

10.​C. Bipolar disorder carries a higher suicide risk than MDD.​

11.​C. Dynamic factors include changeable elements like environment.​

12.​C. NGI requires inability to appreciate wrongfulness or conform behavior due to mental
illness.​