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MCQs

MCQs for

for the

the DOHNS

DOHNS

Mr SS Ahluwalia

Mr

Ahluwalia

  • 1. 1. Recurrent

Recurrent Laryngeal

Laryngeal Nerve

Nerve

A.)

A.)

Has only

Has

only motor

motor fibres

fibres

B.)

B.) Supplies

Supplies all

all of

of the

the muscles

muscles of

of the

the

larynx

larynx

C.)

C.) Lies

Lies inin the

the tracheo

tracheo oesophageal

oesophageal groove

groove

onon the

the Left

Left

D.)

D.) Hooks

Hooks under

under the

the aortic

aortic arch

arch onon the

the

right

right

E.)

E.) isis intimately

intimately associated

associated with

with the

the

superior thyroid

superior

thyroid artery

artery

Recurrent Laryngeal

Recurrent

Laryngeal Nerve

Nerve

Answers

Answers

A.)

A.) False

False

B.)

B.) False

False

C.)

C.) True

True

D.)

D.) False

False

E.)

E.) False

False

Recurrent Laryngeal

Recurrent

Laryngeal Nerve

Nerve

Discussion

Discussion

Left

Left –– under

under aortic

aortic arch

arch (L(L 66 thth arch

arch artery)

artery)

Right

Right –– under

under subclavian

subclavian artery

artery (( 44 thth arch

arch

artery)

artery)

Originates

Originates from

from Vagus

Vagus XX

Motor

Motor toto all

all intrinsic

intrinsic laryngeal

laryngeal muscles

muscles

except cricothyroid

except

cricothyroid (ext

(ext laryng

laryng n.

n. from

from sup

sup

laryng branch

laryng

branch of

of vagus

vagus))

Sensory

Sensory toto subglottic

subglottic mucosa

mucosa and

and pharynx

pharynx

  • 2. 2. Otology

Otology

A.)

A.) The

The scala

scala media

media and

and tympani

tympani contain

contain

perilymph whilst

perilymph

whilst the

the scala

scala vestibuli

vestibuli contains

contains

endolymph

endolymph

B.)

B.) Chorda

Chorda tympani

tympani supplies

supplies taste

taste toto the

the

posterior 2/3

posterior

2/3 of

of the

the tongue

tongue

C.)

C.) Tendon

Tendon of

of the

the stapedius

stapedius muscle

muscle emerges

emerges

from the

from

the base

base of

of the

the pyramid

pyramid

D.)

D.) Tympanic

Tympanic membrane

membrane isis approx

approx 1cm

1cm inin

diameter

diameter

Otology

Otology Answers

Answers

A.)

A.) False

False

B.)

B.) False

False

C.)

C.) False

False

D.)

D.) True

True

Otology discussion

Otology

discussion

The

The scala

scala media

media contains

contains endolymph

endolymph (K/

(K/nana))

The

The scal

scal vestibuli

vestibuli contains

contains perilymph

perilymph (k/NA)

(k/NA)

The

The scala

scala tympani

tympani contains

contains perilymph

perilymph and

and isis

continuous with

continuous

with the

the vestibuli

vestibuli at

at the

the apex.

apex.

The

The chorda

chorda tympani

tympani and

and facial

facial nerve

nerve pass

pass

through the

through

the middle

middle ear

ear

Taste

Taste anterior

anterior 2/3

2/3 tongue

tongue

  • 3. 3. Thyroid

Thyroid and

and Parathyroids

Parathyroids

A.)

A.) The

The thyroid

thyroid may

may bebe supplied

supplied by

by the

the thyroid

thyroid

ima

ima artery

artery

B.)

B.) The

The superior

superior parathyroids

parathyroids are

are derived

derived form

form

the 33 rdrd pouch

the

pouch

C.)

C.) The

The thyroid

thyroid isis enclosed

enclosed by

by platysma

platysma

D.)

D.) The

The recurrent

recurrent laryngeal

laryngeal nerve

nerve isis intimately

intimately

related

related toto the

the inferior

inferior thyroid

thyroid artery

artery

E.)

E.) The

The thyroid

thyroid isis embryologically

embryologically related

related toto the

the

foramen

foramen caecum

caecum

Thyroid and

Thyroid

and Parathyroids

Parathyroids

Answers

Answers

A.)

A.) True

True

B.)

B.) False

False

C.)

C.) False

False

D.)

D.) True

True

E.)

E.) True

True

Thyroid and

Thyroid

and Parathyroids

Parathyroids

Discussion

Discussion

The

The thyroid

thyroid isis supplied

supplied by

by the

the superior,

superior,

inferior thyroid

inferior

thyroid and

and thryoid

thryoid ima

ima arteries.

arteries.

Drained

Drained via

via the

the sup,

sup, middle

middle && inf

inf thyroid

thyroid

veins

veins

Enclosed

Enclosed by

by pretracheal

pretracheal fascia

fascia

Superior

Superior parathyroids

parathyroids derived

derived from

from the

the 44 thth

arch and

arch

and inferior

inferior from

from the

the 33 rdrd arch

arch

Thyroid

Thyroid descends

descends from

from the

the foramen

foramen

caecum

caecum

  • 4. 4. Nose

Nose and

and Sinuses

Sinuses

A.)

A.) The

The nose

nose isis supplied

supplied exclusively

exclusively by

by the

the

ICA

ICA

B.)

B.) The

The septum

septum isis composed

composed of

of triangular

triangular

cartilage and

cartilage

and bone

bone

C.)

C.) The

The anterior

anterior ethmoid

ethmoid artery

artery isis aa

branch

branch of

of the

the ECA

ECA

D.)

D.) The

The nasal

nasal valve

valve isis situated

situated at

at the

the

middle

middle meatus

meatus

Nose and

Nose

and Sinuses

Sinuses Answers

Answers

A.)

A.) False

False

B.)

B.) False

False

C.)

C.) False

False

D.)

D.) False

False

Nose and

Nose

and Sinuses

Sinuses

Discussion

Discussion

Septum

Septum –– quadrilateral

quadrilateral cartilage,

cartilage, vomer

vomer,,

perpendicular

perpendicular plate

plate of

of the

the ethmoid

ethmoid &&

maxillary

maxillary crest

crest

ECA

ECA –– Internal

Internal maxillary

maxillary –– SPA

SPA && greater

greater

palatine

palatine artery

artery

ICA

ICA –– ophthalmic

ophthalmic artery

artery –– anterior

anterior &&

posterior ethmoidal

posterior

ethmoidal artery

artery

Nasal

Nasal valve

valve isis ant

ant toto the

the ant

ant inf

inf turbinate

turbinate

Nasal

Nasal Septum

Septum

Nasal Nasal Septum Septum
  • 5. 5. Facial

Facial Nerve

Nerve

A.)

A.) Terminal

Terminal branches

branches include

include Temporal

Temporal

and

and Zygomatic

Zygomatic

B.)

B.) IsIs aa purely

purely motor

motor nerve

nerve

C.)

C.) Emerges

Emerges from

from the

the stylomastoid

stylomastoid

foramen

foramen

D.)

D.) Synapses

Synapses at

at the

the geniculate

geniculate ganglion

ganglion

E.)

E.) Traverses

Traverses the

the Internal

Internal Acoustic

Acoustic Meatus

Meatus

with the

with

the Vestibulocochlear

Vestibulocochlear nerve

nerve

A.)

A.) True

True

B.)

B.) False

False

C.)

C.) True

True

D.)

D.) True

True

E.)

E.) True

True

Facial

Facial Nerve

Nerve

Answers

Answers

Facial

Facial nerve

nerve

Discussion

Discussion

Motor

Motor and

and sensory

sensory

Infratemporal

Infratemporal && Extratemporal

Extratemporal portions

portions

Stylomastoid

Stylomastoid foramen

foramen and

and divides

divides into

into T,

T,

Z, B,

Z,

B, M,

M, CC nerves

nerves within

within parotid

parotid gland

gland

Facial

Facial expression,

expression, lacrimation

lacrimation,, salivation

salivation

Taste

Taste sensation

sensation anterior

anterior 2/3

2/3 of

of tongue

tongue

  • 6. 6. Muscles

Muscles of

of the

the Larynx

Larynx

A.)

A.) Cricothyroid

Cricothyroid tenses

tenses the

the vocal

vocal folds

folds

B.)

B.) Lateral

Lateral cricoarytenoid

cricoarytenoid abducts

abducts the

the vocal

vocal folds

folds

C.)

C.) Posterior

Posterior cricoarytenoid

cricoarytenoid abducts

abducts the

the vocal

vocal

folds

folds

D.)

D.) Thyroarytenoid

Thyroarytenoid isis supplied

supplied by

by the

the recurrent

recurrent

laryngeal

laryngeal nerve

nerve

E.)

E.) Cricothyroid

Cricothyroid isis supplied

supplied by

by the

the external

external

laryngeal

laryngeal nerve

nerve

Muscles of

Muscles

of Larynx

Larynx

Answers

Answers

A.)

A.) True

True

B.)

B.) False

False

C.)

C.) True

True

D.)

D.) True

True

E.)

E.) True

True

Muscles of

Muscles

of Larynx

Larynx

Discussion

Discussion

Tensor

Tensor –– Cricothyroid

Cricothyroid –– External

External Laryngeal

Laryngeal

Nerve Nerve

Relaxor

Relaxor –– Thyroarytenoid

Thyroarytenoid –– RLN

RLN

Adductor

Adductor –– Lateral

Lateral Cricoarytenoid

Cricoarytenoid –– RLN

RLN

-- Transverse

Transverse Arytenoid

Arytenoid -- RLN

RLN

Abductor

Abductor –– Posterior

Posterior Cricoarytenoid

Cricoarytenoid -- RLN

RLN

  • 7. 7. The

The tonsil

tonsil

A.)

A.) Palatoglossus

Palatoglossus lies

lies anterior

anterior toto the

the tonsil

tonsil

B.)

B.) The

The tonsil

tonsil isis supplied

supplied by

by the

the tonsillar

tonsillar

artery, aa branch

artery,

branch of

of the

the pharyngeal

pharyngeal artery

artery

C.)

C.) The

The ECA

ECA lies

lies 2.5cm

2.5cm behind

behind and

and lateral

lateral

toto the

the tonsil

tonsil

D.)

D.) Lymph

Lymph drains

drains toto the

the upper

upper deep

deep

cervical && jugulodigastric

cervical

jugulodigastric lymph

lymph nodes

nodes

Tonsil

Tonsil Answers

Answers

A.)

A.) True

True

B.)

B.) False

False

C.)

C.) False

False

D.)

D.) True

True

Tonsil Discussion

Tonsil

Discussion

The

The tonsil

tonsil lies

lies between

between the

the palatoglossus

palatoglossus

and

and palatopharyngeus

palatopharyngeus,, superiorly

superiorly the

the

palate and

palate

and inferiorly

inferiorly the

the tongue.

tongue.

Supplied

Supplied by

by the

the tonsillar

tonsillar artery

artery via

via the

the

facial

facial artery.

artery.

The

The ICA

ICA lies

lies 2.5cm

2.5cm behind

behind && lateral

lateral toto the

the

tonsil

tonsil

Insulin Diabetic

Insulin

Diabetic Patient

Patient undergoing

undergoing

total thyroidectomy,

total

thyroidectomy, should

should

a.

a.

b.

b.

Be admitted

Be

admitted 11 hour

hour before

before surgery

surgery

False

False

Receive

Receive pre

pre--operative

operative insulin

insulin

False

False

  • c. c. Receive intravenous

Receive

intravenous normal

normal saline

saline preoperatively

preoperatively

False False

  • d. d. Receive aa glucose,

Receive

glucose, insulin

insulin and

and potassium

potassium infusion

infusion

preoperatively

preoperatively

True

True

  • e. e. Should

Should receive

receive intravenous

intravenous insulin

insulin intraoperatively

intraoperatively

False False

IDDM surgical

IDDM

surgical patients

patients

All

All patients

patients must

must bebe admitted

admitted before

before any

any period

period of

of

starvation

starvation

Normal

Normal insulin

insulin dose

dose regimes

regimes usually

usually include

include

intermediate/long

intermediate/long acting

acting insulin,

insulin, therefore

therefore stop

stop all

all

normal doses

normal

doses

Maintain

Maintain hourly

hourly blood

blood glucose

glucose readings

readings between

between 66--1212

mmol/L/L using

mmol

using aa dextrose,

dextrose, insulin

insulin and

and potassium

potassium sliding

sliding

scale infusion

scale

infusion

Run

Run patient

patient’’ss ‘‘hyperglycaemic

hyperglycaemic’’ during

during surgery

surgery

Keep

Keep onon sliding

sliding scale

scale until

until back

back toto normal

normal diet,

diet, and

and then

then

watch

watch BMs

BMs closely

closely whilst

whilst onon normal

normal s/c

s/c insulin

insulin regime

regime

Total

Total serum

serum thyroxine

thyroxine isis reduced

reduced by

by

  • a. a. Oral

Oral contraceptive

contraceptive pills

pills

False

False

  • b. b.

Pregnancy

Pregnancy

False

False

  • c. c. Nephrotic

Nephrotic Syndrome

Syndrome

True

True

  • d. d. Propanolol

Propanolol

False

False

Total

Total serum

serum thyroxine

thyroxine

Thyroxine

Thyroxine (T4)

(T4) isis present

present inin serum

serum as

as free

free T4T4 and

and bound

bound

T4.

T4.

The bound

The

bound form

form predominates

predominates and

and isis bound

bound toto

thyroglobulin (TBG),

thyroglobulin

(TBG), prealbumin

prealbumin and

and albumin

albumin

This

This bound

bound form

form of

of T4T4 serves

serves as

as aa reservoir,

reservoir, hence

hence

buffers

buffers against

against wild

wild fluctuations

fluctuations of

of free/active

free/active T4T4

InIn pregnancy,

pregnancy, TBG

TBG rises,

rises, reducing

reducing free

free T4T4 which

which

stimulates

stimulates TSH

TSH production,

production, and

and therefore

therefore T4T4 production.

production.

Total T4T4 therefore

Total

therefore rises,

rises, although

although free

free T4T4 does

does not

not

InIn Nephrotic

Nephrotic syndrome,

syndrome, TBG

TBG and

and albumin

albumin isis lost.

lost. Free

Free T4T4

consequently rises,

consequently

rises, inhibiting

inhibiting TSH

TSH production

production and

and T4T4

synthesis. Total

synthesis.

Total T4T4 therefore

therefore falls

falls

The following

The

following are

are absorbable

absorbable sutures

sutures

  • a. a. gut

Cat

Cat gut

True

True

b.

b.

Silk

Silk

False

False

  • c. c. Polyamide

Polyamide (Nylon)

(Nylon)

False

False

  • d. d. Polyglactin

Polyglactin ((Vicryl

Vicryl))

True

True

  • e. e. Polyglyconate

Polyglyconate ((Maxon

Maxon))

False

False

Sutures

Sutures

Absorbable

Absorbable

Non--absorbable

Non

absorbable

Cat

Cat gut

gut

Polydioxanone (PDS)

Polydioxanone

(PDS)

Polyglactin ((Vicryl

Polyglactin

Vicryl))

Vicryl Rapide

Vicryl

Rapide,, Monocryl

Monocryl etc

etc

Polyamide (Nylon)

Polyamide

(Nylon)

Polypropylene ((Prolene

Polypropylene

Prolene))

Polytetrafluoroethylene Polytetrafluoroethylene

(PTFE

(PTFE or

or Goretex

Goretex))

Silk

Silk

Surgery onon the

Surgery

the submandibular

submandibular gland

gland

  • a. a. AnAn incision

incision onon the

the lower

lower border

border of

of the

the mandible

mandible isis safe

safe

b.

b.

False

False

The submandibular

The

submandibular gland

gland isis seen

seen toto wrap

wrap around

around the

the

posterior border

posterior

border of

of mylohyoid

mylohyoid

True

True

  • c. The

c.

The facial

facial artery

artery and

and vein

vein are

are divided

divided as

as they

they course

course

through the

through

the deep

deep part

part of

of the

the gland

gland

False False

  • d. d. The

The hypoglossal

hypoglossal nerve

nerve isis seen

seen toto loop

loop under

under the

the

submandibular duct

submandibular

duct

False False

  • e. e. Damage

Damage toto the

the lingual

lingual nerve

nerve will

will cause

cause loss

loss of

of

sensation toto the

sensation

the posterior

posterior third

third of

of the

the tongue

tongue

False False

Submandibular gland

Submandibular

gland surgery

surgery

Incision

Incision isis usually

usually two

two finger

finger breaths

breaths below

below mandible

mandible toto

avoid

avoid marginal

marginal mandibular

mandibular nerve

nerve

Gland

Gland has

has deep

deep and

and superficial

superficial parts

parts that

that wrap

wrap around

around

posterior border

posterior

border of

of mylohyoid

mylohyoid

Facial

Facial vessels

vessels are

are divided

divided and

and ligated

ligated superficial

superficial toto the

the

gland.

gland. Artery

Artery hooks

hooks over

over the

the top

top of

of gland,

gland, and

and may

may bebe

encountered

encountered several

several times!

times!

Lingual

Lingual nerve

nerve and

and not

not hypoglossal

hypoglossal ‘‘double

double crosses

crosses’’ the

the

duct.

duct. Passing

Passing under

under the

the duct,

duct, from

from lateral

lateral toto medial,

medial,

then running

then

running forwards

forwards onon hyoglossus

hyoglossus at

at aa level

level above

above

the duct

the

duct

Lingual

Lingual nerve

nerve supplies

supplies the

the anterior

anterior two

two thirds

thirds of

of the

the

tongue

tongue

AA 1111 month

month old

old child

child presenting

presenting with

with aa

midline

midline cystic

cystic swelling

swelling just

just below

below the

the

midline

midline

  • a. a. Ultrasound

Ultrasound isis helpful

helpful inin the

the diagnosis

diagnosis

  • b. b.

True

True

Technetium scanning

Technetium

scanning aids

aids diagnosis

diagnosis

True

True

  • c. c. Typically

Typically has

has anan associated

associated lingual

lingual thyroid

thyroid

False

False

  • d. d. Often resolves

Often

resolves spontaneously

spontaneously

False

False

  • e. e. Often recurs

Often

recurs ifif excision

excision does

does not

not remove

remove the

the body

body of

the hyoid

the

hyoid

of

True

True

Otosclerosis

Otosclerosis

  • a. a. Patients

Patients often

often require

require surgery

surgery inin both

both ears

ears

True

True

  • b. b.

Otoscopy isis normal

Otoscopy

normal

True

True

  • c. c. May bebe associated

May

associated with

with aa white

white forelock

forelock and

and

heterochromia

heterochromia

False False

  • d. d. Causes conductive

Causes

conductive hearing

hearing loss

loss

True

True

  • e. e. May bebe associated

May

associated with

with blue

blue sclera

sclera

True

True

Otosclerosis

Otosclerosis

Only

Only 15%

15% of

of otosclerosis

otosclerosis isis truly

truly unilateral

unilateral

The

The ‘‘flamingo

flamingo flush

flush or

or Schwartze

Schwartze sign

sign isis very

very uncommon

uncommon

Unilateral

Unilateral SNHL,

SNHL, white

white forelock,

forelock, eye

eye lidlid deformity

deformity with

with

heterochromia describes

heterochromia

describes Waardenburg

Waardenburg’’ss syndrome

syndrome (AD

(AD

syndrome)

syndrome)

Conductive

Conductive loss

loss occurs.

occurs. Carhart

Carhartss notch

notch isis aa rise

rise inin BCBC

thresholds

thresholds at

at 2kHz

2kHz due

due toto stapes

stapes inertia

inertia

There

There isis anan association

association with

with Osteogenesis

Osteogenesis Imperfecta

Imperfecta

Juvenile angiofibroma

Juvenile

angiofibroma

  • a. a. Patients

Patients have

have often

often had

had repeated

repeated episodes

episodes of

of epistaxis

epistaxis

True

True

  • b. b.

ItIt isis aa tumour

tumour of

of young

young boys

boys with

with aa mean

mean age

age of

of 1414 at

at

presentation presentation

True

True

  • c. c. Bone erosion

Bone

erosion of

of the

the greater

greater wing

wing of

of the

the sphenoid

sphenoid does

does

not

not occur

occur

False False

  • d. d. External

External beam

beam radiotherapy

radiotherapy isis first

first--line

line treatment

treatment

False False

Juvenile angiofibroma

Juvenile

angiofibroma

Tumour

Tumour of

of young

young boys

boys who

who suffer

suffer severe

severe bouts

bouts of

of

epistaxis, hyponasal

epistaxis,

hyponasal speech

speech and

and otalgia

otalgia

Starts

Starts inin the

the sphenopalatine

sphenopalatine foramen,

foramen, invades

invades the

the

pterygopalatine fossa,

pterygopalatine

fossa, and

and then

then the

the infratemporal

infratemporal fossa

fossa

toto eventually

eventually erode

erode the

the anterior

anterior face

face of

of the

the greater

greater wing

wing

of the

of

the sphenoid

sphenoid

Surgery

Surgery with

with pre

pre--operative

operative embolisation

embolisation gives

gives best

best

results

results

Never

Never biopsy

biopsy the

the tumour!

tumour!

Tracheostomy

Tracheostomy

  • a. a. Fenestration

Fenestration isis made

made through

through the

the first

first tracheal

tracheal ring

ring

False

False

b.

b.

Can

Can lead

lead toto tracheal

tracheal stenosis

stenosis

True

True

  • c. c. Recurrent

Recurrent laryngeal

displaced

displaced

laryngeal nerves

nerves must

must bebe identified

identified and

and

False

False

  • d. d. Increases

Increases anatomical

anatomical dead

dead space

space

False

False

  • e. e. Improves

Improves the

the efficiency

efficiency of

of coughing

coughing and

and therefore

therefore

improves bronchial

improves

bronchial toilet

toilet

False False

Tracheostomy

Tracheostomy

Fenestration

Fenestration isis usually

usually made

made between

between the

the 22 ndnd and

and 33 rdrd

rings

rings

Large

Large circumferential

circumferential fenestrations

fenestrations may

may lead

lead toto stenosis

stenosis

following decannulation

following

decannulation

Recurrent

Recurrent laryngeal

laryngeal nerves

nerves are

are not

not usually

usually identified

identified

Anatomical

Anatomical dead

dead space

space isis reduced.

reduced. Air

Air nono longer

longer passes

passes

through the

through

the nose,

nose, naso

naso and

and oropharynx

oropharynx and

and supraglottis

supraglottis

Reduces

Reduces the

the efficiency

efficiency of

of coughing

coughing but

but allows

allows bronchial

bronchial

toilet inin those

toilet

those who

who have

have lost

lost ability

ability toto cough

cough

Vocal cord

Vocal

cord nodules

nodules

  • a. a. May

May become

become malignant

malignant

False

False

  • b. b.

Respond favourably

Respond

favourably toto speech

speech therapy