Bailey Ch 9 no.
144-
155– Ch 7 1-18
Dr. M. Destrian Cossandra
144. Which ofthe following electrocochleographic
responses is atypical for the associated pathology?
A. Reduced summating potential/action
potential (SP/AP) ratio in superior
semicircular canal dehiscence
Chapter 9 B. Increased SP/AP ratio in Meniere disease
C. Increased SP/AP ratio in perilymph fistula
D. Absent in profound sensorineural hearing A
loss
144.Answer:A.Similar elevations in the SP/Ap ratio
have,however,been reported in perilymph fistula,autoimmune
innereardisease,andsuperiorsemicircularcanaldehiscence.
PAGE2283
145. A 7-year-old, otherwise healthy child with a
normal otologic examination experiences a unilateral
sudden mixed hearing loss documented by pure-tone
audiometry. The most appropriate additional study is:
A. Auditory brainstem-response audiometry
B. Distortion product otoacoustic emissions
C. MRI
D. Ultrasound
C
E. Exploratory tympanotomy
145. Answer: C. An MRI scan would be appropriate in an
adult. MRI as high resolution T2 images are excellent in
detecting inner ear malformations and have the
advantage of also showing the VIlith nerve and
brainstem. It also has no ionizing radiation. One
consideration for choosing cr may be the need for
general anesthetic in a younger child for MRI. PAGE
2591
146. Which of these factors is nearly as
important as occupational noise exposure as a
cause of adult hearing loss in America?
A. Use of MP3 players
B. Ototoxicity
C. Head injury
D. Recreational shooting
E. Acoustictumors D
146. Answer: D. Adults do not use MP3 players as much as youth
and adolescents. There is insufficient evidence of noise-induced
hearing loss (NIHL) from personal stereo systems. The most
important nonoccupational source of NIHL is gunfire. (PAG E 2535)
Ototoxicity and acoustic neuroma are relatively rare.
147. A 65-year-old patient has a 1-year history of left
pulsatile tinnitus. An MRI reveals a brightly enhancing
diffuse lesion in the left jugular foramen with multiple
flow voids. During surgical resection ofthis mass,
proximal and distal venous control is obtained. Which
vessel is most likely to complicate surgical resection of
this mass?
A. Cavernous sinus
B. Basilar artery
C. Inferior petrosal sinus
C
D. Superior petrosal sinus
147. Answer: C. The tumor likely describes a glomus jugulare.
Proximal control isolates the sigmoid sinus and would include the
superior petrosal sinus. The cavernous sinus is remote from this
area. The inferior petrosal sinus provides venous drainage into the
medial aspect ofthe vascular tumor and is encountered during
resection ofthe body ofthe tumor.
PAG ES 2580-2581
148.Aminoglycoside susceptibility is affected
by which of the following genetic inheritance
pathways ?
A. Autosomal dominant
B. Autosomal recessive c. X-linked
D . Mitochondrial
E. None of the above
D
148.Answer:D.Patients having inherited mitochondrial
susceptibility can experience sensorineural hearing loss whether it
is given intravenously or by transtympanic delivery. The pattern of
inheritance is through a maternally transmitted mitochondrial
defect, the A1555G mutation. PAGE 2545
149. In congenital malformation ofthe ear canal and middle ear,
compared to normal course, the facial nerve course is typically:
A. More anteriorly displaced only
B. More anteriorly and laterally (superficially) displaced
C. More posteriorly displaced only
D. More posteriorly and medially (deeply) displaced
B
149. Answer: B. In ears with congenital defects of the outer or
middle ear, the implication of this pattern of development is that
the facial nerve lies more anteriorly and superficially in the lateral
temporal bone. PAG E 2444
150. Which of these best describes pulsatile tinnitus during
pregnancy?
A. It will not resolve postpartum.
B. It indicates preeclampsia.
C. It occurs due to a high-flow state.
D. It can be treated by plasmapheresis.
C
150.Answer: C. Pregnancy is associated with hypervolemia and
increased cardiac output. It resolves postpartum and is not an
indication of preeclampsia. Plasmapheresis is not advisable. PAG E
2609
151. A 31-year-old man with chronic otitis media resulting in
cholesteatoma. Which complication is depicted on this image?
A. Lateral semicircular canal fistula
B. Tegmentympanierosion
C. Tegmen mastoideum erosion
D. Fallopian canal erosion
E. Cerebral abscess
A
151. Answer A. The bony covering of the anterior limb of the lateral
semicircular canal is eroded by the soft-tissue mass that fills the
middle ear. The tegmen is not depicted on this more-inferior axial
image. The bony covering of the tympanic segment of the facial
nerve is intact.
152. A young adult with microtia.What surgically important
structure is depicted by the arrow?
A. Posterior semicircular canal
B. Lateralized facial nerve
C. Dysmorphic ossicles
D. Enlarged vestibular aqueduct
E. Stapes footplate sclerosis
B
152.Answer B. In aural atresia, the tympanic segment of the facial
nerve may be displaced to the lateral side of the middle ear, where
it is at risk during surgery. This finding should always be sought
preoperatively.
153. A 60-year-old with hearing loss. What pattern of hearing loss
would be expected with this cr appearance?
A. Conductive hearing loss
B. Sensorineural hearing loss
C. Mixed hearing loss
D. Intact hearing
E. Tullio phenomenon
C
153. Answer C. Bone loss surrounding the cochlea and in the
region of the fissula ante fenestram indicates a diagnosis of
otosclerosis, which classically presents with mixed hearing loss.
Tullio phenomenon is more closely associated with superior
semicircular canal dehiscence.
154. An 8-year-old trauma patient. The arrow
indicates:
A. A normal suture line
B. The vestibular aqueduct
C. The superior petrosal vein
D. The sub arcuate ecanal
E. A capsule-violating temporal bone fracture
E
154.Answer E. There are many normal lucencies that can be seen
on CT of the temporal bone and should not be mistaken for
fracture. But in this case, there is truly a fracture running anterior-
posterior through the otic capsule. Air in the vestibule and internal
auditory canal are important secondary signs of fracture.
155.An 89-year-old man in motor vehicle accident.
What is the most likely cause for his hearing loss?
A. Recurrent cholesteatoma
B. Capsule-violating temporal bone fracture
C. Displaced stapes prosthesis
D. Otosclerosis
E. Perilymphatic fistula
C
155. Answer C. The stapes prosthesis in this image is displaced
posterior to the oval window. There is no evidence of fracture or
soft-tissue mass or gas in the inner ear. The density of the otic
capsule is normal.
1.The optimal treatment of advanced-stage nasopharyngeal (NP)
carcinoma is:
A. Surgery and postoperative radiotherapy
B. Induction chemotherapy and radiotherapy (CRT)
Chapter 7 C. Concomitant CRT
D. Adjuvant CRT
E. Radiotherapy and brachytherapy
C
1. Answer: C. Advanced NP carcinoma is technically inoperable.
Multiple studies have shown concomitant CRT has the best
outcomes when compared to neoadjuvant CRT or surgery
followed by adjuvant CRT. PAGES 1887-1888
2. A 62-year-old man presents with a mass extending from the
right true vocal cord superiorly into the ventricle and false vocal
cord, which is biopsy-proven squamous cell carcinoma. The true
vocal cord is fixed. There is only unilateral disease. What is the best
treatment option?
A. Chemoradiation therapy
B. Laser resection
C. Supraglottic laryngectomy
D. Supracricoid laryngectomy
A
2. Answer: A. Retrospective studies have suggested that voice
conserving surgeries can equal or exceed Chemoradiation (CRT) in
the setting of stage III laryngeal cancer. At this time, however, the
best evidence (level I) is for CRT in terms of disease control.
Comparison studies of functional outcomes are pending. PAG E 1
695
3. Radiographic imaging for cNO patients results in a significant
false-positive rate and
the potential for some patients' necks to be overtreated. True or
false?
A. True B. False
A
3. Answer: A. Radiologic criteria for suspicious nodes are based
on size, shape, and fluorodeoxyglucose (FDG)-uptake criteria and
do not distinguish between benign reactive lymph nodes and
metastatic nodes, and are associated with a significant false-
positive rate. Imaging is not as accurate as elective neck dissection
in staging the cNO neck PAGES 1840-1841
4. What is not part of MEN Ila syndrome?
A. Medullary thyroid carcinoma
B. Pheochromocytoma
C. Primary hyperparathyroidism
D. Marfanoid habitus
D
4. Answer: D. The most common type of MENII is MEN IIA,
which is characterized by the triad ofMTC, pheochromocytoma,
and primary hyperparathyroidism. PAGE 2127
5. A 48-year-old has surgery for a T2NO squamous cancer ofthe
lateral tongue. Pathology reveals the margins are negative. There is
no perineural tumor and 5 of 24 nodes are involved with
extracapsular extension. Best evidence suggests that the patient
needs:
A. No further therapy
B. Conventional radiation
C. Hyperfractionated radiation
D. Chemoradiation therapy
D
5. Answer: D. Clinical trial data have shown that patients with
the high-risk features of microscopically involved margins or
extracapsular spread in lymph nodes in surgical specimens
benefited from the addition of platinum-based chemotherapy to
postoperative radiation. PAGES 1864, 1701
6. Which laryngeal site is the most at risk of developing
radionecrosis?
A. Cricoid
B. Thyroid lamina
C
c. Arytenoid
D . Epiglottis
6. Answer: C. Chondroradionecrosis occurs in approximately 5%
of patients with laryngeal cancer, and the most common cartilage
affected is the arytenoid cartilage. PAGE 1968
7.The utility of sentinel node biopsy is higher in patients with
tumors in:
A. Floor of the mouth
B. Oral tongue
c. Lower gum
D.Base o f the tongue
E.Larynx
B
7. Answer: B. Sentinel node biopsy has been shown to be useful
in oral tongue cancer. It is not as useful for floor of mouth or gum
tumors because of the proximity of the primary site to the neck
which can obscure identification of nodes in level I because of
residual radioactivity at the primary site, and is less useful for
oropharyngeal and laryngeal cancers because of greater difficulty
accessing the primary site for injection and a higher incidence of
bilateral nodal drainage. PAG ES 1 81 4
8. What is the most common cause for failed tracheoesophageal
(TE) voice?
A. Microstomia
B. Valve failure
C. Hypopharyngeal bar
D. Granuloma
C
8.Answer:C.Inorder for fluent TE speech to occur, there must be
sufficient relaxation of the pharynx. Failure to maintain fluent
speech is typically due to spasm of the cricopharyngeus and
inferior and middle constrictor muscles when speech was
attempted. A hypopharyngeal bar corresponding to these
muscles can be seen using barium swallow. A column of air
distends the esophagus proximal to the bar when phonation is
attempted. PAG E 1 980
9. Which of the following is the first priority in selecting
reconstructive options for any size full-thickness lip defect?
A. Preserve or restore the dynamic function of the lip
B. Restore competence of the oral sphincter
C. Optimize the cosmetic result
D. Retain ability to use dentures
E. Single-stage reconstruction
B
9. Answer: B. The oral sphincter is crucial for maintaining oral
competence, which is important for eating, speech, and
aesthetics. Reconstructive options should attempt to maintain or
reconstruct a competent sphincter, without sacrificing tumor
extirpation. PAG E 1 794
10. A 47-year-old presents with a firm submucosal mass adjacent
to the maxillary first molar. What is the most likely diagnosis?
A. Squamous cancer
B. Minor salivary gland tumor
C. Odontogenic tumor
D. Pseudoepitheliomatous hyperplasia
B
10. Answer: B. Minor salivary gland tumors can occur anywhere in
the oral cavity, but most commonly arise from the hard palate.
These typically present as submucosal masses and may account
for 50% ofhard palate tumors. PAGE 1868
11. What structures does the head and neck surgeon have to
include when resecting a tumor of the posterior pharyngeal wall
that can lead to significant dysphagia?
A. Prevertebral fascia
B . Pharyngeal constrictors
C. Pharyngeal plexus
D. Cricoarytenoid muscles
C
11. Answer: C. Resection of the tumor should include prevertebral
musculature if the prevertebral fascia is involved, and a
retropharyngeal nodal dissection should be performed with
tumors involving the posterior pharyngeal wall. Surgical dissection
in this area leads to denervation of the pharyngeal plexus, which
can result in significant dysphagia and aspiration. PAGE 1927
12.The development of a cutaneous malignancy is associated with
chronic exposure to:
A. Ammonia
B. Arsenic
c. Chromium
D. Benzene
B
12.Answer: B. Chronic exposure to arsenic (as seen in Fowlers
solution) has been associated with the development of multiple
squamous and basal cell carcinomas. PAG E 1 723
13. Successful parathyroidectomy is usually best predicted by:
A. Localization with ultrasound
B. Frozensection
C. Intra operative parathyroid hormone (PTH) reduction to
normal
D. Ionized serum calcium
C
13. Answer: C. A drop in intraoperative PTH levels to normal levels
is predictive of surgical success. There is a high false-positive rate
when a reduction of intraoperative PTH to 50% ofpreoperative
levels rather than the normal level is used, which can be
associated with double adenomas or parathyroid hyperplasia.
Ionized calcium levels, intraoperative ultrasound, and frozen
sections do not predict biochemical success of surgery.
PAGES 2138-2139
14. A 15-year-old boy presents with epistaxis and right orbital
proptosis with diplopia.
Radiographic studies, including a CT scan with and without
contrast, and an MRI with contrast are consistent with an
advanced juvenile nasopharyngeal angiofibroma extending
intracranially on the right with inferior orbital fissure invasion and
middle cranial fossa invasion. Your proposed surgical management
should include:
A. Endoscopic resection
B. Endoscopic resection following angiographic embolization
C. Combined endoscopic and open resection
D. Transfacial resection following angiographic embolization
with follow-up potential transcranial resection
D
14. Answer: D. The lateral preauricular approaches are largely
reserved for intracranial extension and can be combined with an
anterior approach in the same setting or as a separate procedure.
The lateral preauricular infratemporal approach provides
contiguous access along the middle cranial fossa up to the
cavernous sinus. PAGE 2027, TABLE 127.8
15.Which of the following is true regarding organ
preservation therapy for a T4aN1s quamous cell
carcinoma of the larynx?
A. Is associated with reduced survival due to
distant metastatic disease
B. Is more likely when cetuximab is added to
radiation
C. Is more likely to require salvage
laryngectomy
D. Is more likely using induction
chemotherapy, followed by radiation C
15. Answer: C. Both the Veterans Affairs Laryngeal Cancer Study
and Radiation Therapy Oncology Group 91-11 demonstrated that
patients with T4 disease have a higher salvage laryngectomy rate
and poorer survival when organ preservation is employed.
PAGES 1695-1696
16. Which of the following salivary cancers is most associated with
pain and perineural spread of tumor?
A. Acinic cell cancer
B. Adenoid cystic cancer
C. High-grade mucoepidermoid cancer
D. Squamous cell cancer
B
16. Answer: B. Adenoid cystic cancer has a proclivity for perineural
invasion, which is a hallmark of this disease and traditionally
causes pain. PAG E 1 765
17. In a patient with elevated serum calcium, elevated parathyroid
hormone, and elevated urine calcium, the most common diagnosis
is:
A. A single parathyroid adenoma
B. Parathyroid hyperplasia
C.Hypocalciuric hypercalcemia
D.Secondary hyperparathyroidism
A
17. Answer: A. A solitary parathyroid adenoma is the most
common cause of primary hyperparathyroidism and more
common than hyperplasia or double adenomas. Hypercalcemia is
not associated with secondary hyperparathyroidism, and the
presence of an elevated urine calcium rules out familial
hypocalciuric hypercalcemia. PAGE 2132
18. What is the advantage of intensity-modulated radiation therapy
(IMRT) over 3D?
A. Reduced dose to the parotid glands and other normal
tissues
B. Increased dose to the tumor
C. Shorter treatment time
D. All of the above
A
18.Answer:A.The use of IMRT employs multiple beams to allow
effective tumor dose while reducing dose to uninvolved tissues.
PAGE 1687
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