Clinical Medicine-ENT
Self-Assessment
Directions: Select the single most correct answer for each of the following questions.
1. The incubation period for infectious mononucleosis is:
A. 10 to 14 days
B. 14 to 21 days
C. 21 to 29 days
D. 30 to 50 days
E. 50 to 60 days
2. Serum heterophile antibodies (Monospot) are found in 75% of patients with Epstein-Barr
virus (EBV) mononucleosis by the:
A. Third day of the illness
B. Seventh day of the illness
C. Tenth day of the illness
D. Fourteenth day of the illness
E. Twenty-first day of the illness
3. After Epstein-Barr virus (EBV) mononucleosis, the Monospot will remain positive for:
A. One to two months after the infection
B. Two to three months after the infection
C. Three to six months after the infection, but can persist for one year
D. One to three years after the infection
E. For the life of the patient
4. All of the following statements concerning laryngitis are true EXCEPT:
A. Adenoviruses and influenza are the most common causes of acute symptoms
B. Bacterial causes include Moraxella catarrhalis, Corynebacterium diphtheriae, and
Haemophilus influenzae
C. Laryngitis is frequently caused by vocal abuse
D. Laryngitis often lasts a month or more
E. Tobacco smoke is often associated with laryngitis
5. Doraldo, a 15 year old Jamaican boy was seen in a rural clinic during a medical mission.
He has a six year history of persistent (and progressive) hoarseness, and was told that he
had “growths” on his vocal cords. His once beautiful singing voice is now just a whisper
and he is having shortness of breath. Doraldo most likely has:
A. Vocal nodules, also known as “singer’s nodules” or “preacher’s nodules” caused by
poor voice use or overuse
B. Hyperkeratosis, (“whiskey voice”) associated with smoking and/or alcohol abuse
C. Laryngeal papillomatosis: human papilloma virus (HPV) type 6 and 11
D. Leukoplakia, related to voice and alcohol abuse, and smoking
E. Carcinoma, the most serious cause of hoarseness
6. A 23 year old smoker (one-half pack a day for three years) presents to your clinic two
days after being treated for strep throat, and is currently taking penicillin VK 500mg four
times per day (QID). He states that the “antibiotics are not working” because he has
fever (102°F) and progressive pain on swallowing, especially on the right side of his
throat, right ear pain, headache, and malaise. He states that he is not able to even
swallow his saliva and has difficulty opening his mouth. On physical examination, you
note that the posterior pharynx is diffusely erythematous with unilateral swelling of the
peritonsillar area with grayish-white exudate, and tender tonsillar nodes, particularly on
the right side. This patient most likely has:
A. Epstein-Barr virus (EPV) Mononucleosis
B. Diphtheria
C. Acute epiglotitis with lymphadenitis
D. Peritonsillar abscess
E. Pharyngeal carcinoma
7. In differentiating a viral pharyngitis from a Streptococcal pharyngitis, which of the
following MUST be included?
A. Complete blood count (CBC) with differential
B. Cold agglutinin antibody test
C. Erythrocyte sedimentation rate (ESR)
D. Throat culture
E. WBC
8. Because of the emergence of resistant strains, the drug of choice for Group A beta-
hemolytic Streptococcal (GABHS) infection is:
A. Streptomycin
B. Clarithromycin
C. Garamycin
D. Penicillin
E. Ceftriaxone
9. Of the following choices, which is considered THE MOST COMMONLY occurring
symptom in children with Group A beta-hemolytic Streptococcal (GABHS) pharyngitis?
A. Enlarged lymph nodes
B. Gastritis
C. Fever
D. Scarlatiniform rash
E. Strawberry tongue
10. A 3 year-old girl presents with a foul-smelling post-nasal drip, a temperature of 102F
(38.8 C), and perceptible swelling of the face. Which is the most important reason to
diagnose and treat this child’s disease in a timely fashion?
A. It is associated with a malodorous discharge
B. It is probably caused by maxillary sinusitis
C. It may be caused by lactamase-producing organisms
D. Orbital cellulitis is a feared complication
E. Treatment must be carried out for 3 weeks
11. A 24 year-old man complains of a stuffy nose in the aftermath of a viral cold of 5 days
duration. He has taken a proprietary nasal spray for self-treatment of this symptom for
the past 3 days and has noted that the stuffiness has become bilateral and has now
interfered seriously with his sleep. An accepted treatment approach to his condition is:
A. Discontinuance of the medication, followed by inhaled glucocorticoids for a brief
period, and humidification
B. Discontinuance of the present spray, followed by prescription of more potent
vasoconstrictors in a topical preparation
C. Discontinuance of the present spray in favor of longer-acting nasal decongestants
D. Skin testing and desensitization
E. Topical application of a basophile-stabilizing agent, such as cromolyn
12. The three most frequent bacterial causes of otitis media (in descending order) are:
A. Streptococcus pyogenes, Staphylococcus aureus, Klebsiella pneumoniae
B. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
C. Moraxella catarrhalis, Pseudomonas species, Haemophilus influenzae
D. Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus
E. Moraxella catarrhalis, Streptococcus pyogenes, Staphylococcus aureus
13. The defining characteristic of malignant otitis externa is:
A. Conductive hearing loss
B. Pseudomonas species
C. Associated diabetes mellitus
D. Osteomyelitis of the bony canal or mastoid
E. Requirement of intravenous antibiotics
14. A 35-year-old woman’s routine audiogram at her place of employment found a
conducting hearing loss on the left. She is vaguely aware of an increasing tendency to
turn her right ear toward conversation and to use that ear on the telephone. She denies
pain, recent upper respiratory infection, atopic constitution, or allergic symptoms. Both
eardrums are normal in appearance and move briskly when she performs a modified
Valsalva maneuver. What is the most likely diagnosis?
A. Cholesteatoma
B. Temporomandibular joint (TMJ) syndrome
C. Secretory otitis media
D. Purulent otitis media
E. Otosclerosis
15. In order to prevent rheumatic fever in children infected with beta-hemolytic
Streptococcus pyogenes, treatment must begin within how many days after onset?
A. 2 days
B. 5 days
C. 9 days
D. 15 days
E. 20 days
16. A male teenager complains of having severe mouth soreness for 10 days. Examination
discloses a fetid odor and fibrous pseudomembrane on many gingival crests. The
name of his condition is:
A. Necrotizing gingivitis
B. Periodontal abscess
C. Dentigerous cyst
D. Herpes labialis
17. During a routine periodic evaluation, gingival hypertrophy is found in a 25-year-old male
patient who has a history of cerebral palsy and seizures. The most likely cause is:
A. Heredity
B. Medication
C. Ascorbic acid deficiency
D. Poor oral hygiene
E. Mycotic overgrowth
18. Which ototoxic medication is most likely to cause primarily irreversible sensory hearing
loss?
A. Aminoglycocides
B. Corticosteroids
C. Flouroquinalones
D. Salicylates
19. Which of the following commonly causes vertigo, and is associated with progressive
unilateral conductive hearing loss that may go undetected in an otherwise healthy adult
patient for 2 – 3 years?
A. Acoustic neuroma
B. Multiplesclerosis
C. Otosclerosis
D. Tympanosclerosis
20. The most frequent use of antibiotics in the U.S. is for the treatment of:
A. Urinary tract infections (UTIs)
B. Pharyngitis
C. Otitis media (OM)
D. Sexually transmitted diseases (STDs)
E. Skin infections
21. What are the two most common predisposing factors to Otitis media (OM) in children?
A. Upper respiratory infections (URIs) and day care attendance
B. URIs and secondary smoke exposure
C. Allergies and bottle feeding
D. Influenza viruses and allergies
E. Day care attendance and allergies
22. Regarding otitis media (OM) in children, all of the following statements are true
EXCEPT:
A. Bottle-fed babies lack the immuno-protective effects of human milk during the early
months and are thus more prone to OM
B. Allergies associated with cow’s milk may be more common than previously
recognized and are considered a risk factor for OM
C. Oligosaccharides in human milk may help fight OM
D. Feeding positions have been implicated as predisposing factors for OM in infants
E. The use of pacifiers has not been associated with higher rates of OM in children
23. Regarding acute suppurative otitis media (OM), which of the following organisms is
most likely to cause persistent infections in children (the one least likely to resolve)?
A. Haemophilus influenza
B. Streptococcus pneumoniae
C. Moraxella catarrhalis
D. Staphylococcus aureus
E. Group A beta-hemolytic Streptococcus
24. What is the most predictive sign of acute suppurative otitis media (OM)?
A. Ear pulling and/or otalgia
B. Fever
C. The appearance of the tympanic membrane (TM) as viewed by an otoscope
D. Decreased motility of the TM by pneumatic otoscopy
E. Tragal tenderness
25. Signs and symptoms of acute labyrinthitis include all of the following EXCEPT:
A. Severe vertigo
B. Tinnitus
C. Nystagmus
D. Nausea
E. Vomiting
26. A pedunculated mass in the nose that is nontender is most likely a:
A. Furuncle
B. Granuloma
C. Polyp
D. Rhinophyma
27. A patient has a white, indurated 3 cm oral lesion on his buccal mucosa that has been
present and growing for 3 months. Given this information, the most likely diagnosis is:
A. Aphthous stomatitis
B. Candidiasis
C. Leukoplakia
D. Lichen planus
28. A 40 year-old presents with 2 day history of tooth pain and left cheek swelling. The most
likely source of the problem is tooth number:
A. 9
B. 14
C. 21
D. 32
29. The majority of head and neck cancers are:
A. Squamous cell carcinomas of the mucosa of the upper aerodigestive tract
B. Adenocarcinomas of the major salivary glands
C. Squamous cell carcinomas of the mucosa of the thyroid gland
D. Adenocarcinomas of the minor salivary glands
30. Shared risk factors for both squamous cell carcinoma of the head and neck and salivary
gland neoplasms are:
A. Smoking
B. Alcohol consumption
C. Low-dose ionizing radition
D. Both A and B are correct
Answers:
1. D
2. B
3. C
4. D
5. C
6. D
7. D
8. D
9. C
10. D
11. A
12. B
13. D
14. E
15. C
16. A
17. B
18. A
19. C
20. C
21. A
22. E
23. A
24. D
25. B
26. C
27. C
28. B
29. A
30. B