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DO-HNS (RCSI) study materials
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DO-HNS (RCSI) practice questions

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Question 1Otology and Neuro-otology

Which structure transmits sound vibrations from the tympanic membrane to the oval window?

  1. The ossicular chain Correct answer.
  2. The eustachian tube
  3. The round window membrane
  4. The tensor tympani tendon

Explanation

The malleus, incus and stapes form a lever system that couples the tympanic membrane to the oval window, providing impedance matching. The eustachian tube ventilates the middle ear, and the round window acts as a pressure release.

Question 2Otology and Neuro-otology

A patient reports spinning vertigo lasting 20 to 60 seconds, provoked by rolling over in bed. Which diagnosis is most likely?

  1. Benign paroxysmal positional vertigo Correct answer.
  2. Meniere disease
  3. Vestibular schwannoma
  4. Vestibular neuritis

Explanation

Brief positional vertigo triggered by head movement is the hallmark of BPPV, caused by displaced otoconia in a semicircular canal. The short duration and positional provocation distinguish it from inflammatory or hydroptic causes.

Question 3Otology and Neuro-otology

What is the normal range for the tympanic membrane component of the acoustic reflex threshold in healthy ears?

  1. 5 to 15 dB above hearing threshold
  2. 40 to 60 dB above hearing threshold
  3. 70 to 90 dB above hearing threshold Correct answer.
  4. 20 to 30 dB above hearing threshold

Explanation

The acoustic (stapedial) reflex is normally elicited at roughly 70 to 90 dB above the pure-tone threshold, or around 70 to 90 dB HL in ears with normal hearing. Lower levels suggest recruitment, while higher levels or absence suggest conductive loss or retrocochlear disease.

Question 4Otology and Neuro-otology

Which nerve is most commonly affected in Bell's palsy?

  1. The trigeminal nerve
  2. The glossopharyngeal nerve
  3. The hypoglossal nerve
  4. The facial nerve Correct answer.

Explanation

Bell's palsy is an idiopathic lower motor neuron paralysis of the facial nerve (cranial nerve VII). It produces ipsilateral facial weakness affecting both upper and lower face.

Question 5Otology and Neuro-otology

A 45-year-old presents with a unilateral pulsatile tinnitus synchronous with the heartbeat. Which feature should prompt urgent imaging of the temporal bone?

  1. Tinnitus associated with cervical spine arthritis
  2. Tinnitus that resolves with jaw clenching
  3. Bilateral tinnitus after loud noise exposure
  4. Pulsatile character with a vascular mass behind the tympanic membrane Correct answer.

Explanation

Pulsatile tinnitus with a retrotympanic vascular mass raises concern for a glomus tumour or other vascular lesion and warrants imaging. Non-pulsatile tinnitus related to noise exposure is managed differently.

Question 6Otology and Neuro-otology

Which test assesses the integrity of the horizontal semicircular canal by observing nystagmus after caloric stimulation?

  1. The Romberg test
  2. The caloric test Correct answer.
  3. The Dix-Hallpike test
  4. The head impulse test

Explanation

The caloric test uses warm and cold irrigation to stimulate the horizontal canal and measures the resulting nystagmus, giving a quantitative assessment of canal function. The Dix-Hallpike test provokes positional nystagmus, and the head impulse test examines the vestibulo-ocular reflex at high frequency.

Question 7Otology and Neuro-otology

Which antibiotic class is most strongly associated with ototoxicity affecting both cochlear and vestibular function?

  1. Macrolides
  2. Aminoglycosides Correct answer.
  3. Tetracyclines
  4. Penicillins

Explanation

Aminoglycosides accumulate in hair cells and can cause irreversible sensorineural hearing loss and vestibular damage. The risk increases with prolonged therapy, renal impairment and elevated serum levels.

Question 8Otology and Neuro-otology

What is the most common cause of conductive hearing loss in children?

  1. Otitis media with effusion Correct answer.
  2. Otosclerosis
  3. Presbycusis
  4. Cholesteatoma

Explanation

Otitis media with effusion is the leading cause of conductive hearing loss in childhood, reflecting middle ear fluid rather than ossicular fixation. Otosclerosis usually presents in adulthood, and presbycusis is sensorineural.

Question 9Otology and Neuro-otology

A 60-year-old presents with a unilateral, gradually progressive hearing loss and normal otoscopy. Pure-tone audiometry shows an asymmetric sensorineural loss, and MRI is requested. Which diagnosis must be excluded?

  1. Otitis externa
  2. Otosclerosis
  3. Cholesteatoma
  4. Vestibular schwannoma Correct answer.

Explanation

Asymmetric progressive sensorineural hearing loss in an adult warrants imaging to exclude a retrocochlear lesion such as vestibular schwannoma. MRI with contrast is the investigation of choice.

Question 10Otology and Neuro-otology

Which audiometric pattern is characteristic of a conductive hearing loss?

  1. Air conduction thresholds worse than bone conduction thresholds Correct answer.
  2. Air conduction thresholds worse than bone conduction thresholds with a normal tympanogram
  3. Air and bone conduction thresholds equal with absent otoacoustic emissions
  4. Bone conduction thresholds worse than air conduction thresholds

Explanation

A conductive loss produces an air-bone gap in which air conduction is poorer than bone conduction. Sensorineural loss affects both equally, and mixed loss shows a gap with reduced bone conduction.

Question 11Otology and Neuro-otology

A patient has a positive head impulse test, direction-fixed horizontal nystagmus and no skew deviation. Which diagnosis is most likely?

  1. Cerebellar stroke
  2. Meniere disease
  3. Acoustic neuroma
  4. Vestibular neuritis Correct answer.

Explanation

A positive head impulse test with direction-fixed nystagmus and no skew deviation supports a peripheral vestibular lesion such as vestibular neuritis. Central lesions typically show a normal head impulse test or direction-changing nystagmus with skew.

Question 12Otology and Neuro-otology

Which maneuver is the treatment of choice for posterior canal benign paroxysmal positional vertigo?

  1. Epley manoeuvre Correct answer.
  2. Politzer manoeuvre
  3. Valsalva manoeuvre
  4. Frenzel manoeuvre

Explanation

The Epley manoeuvre uses sequential head and body positions to reposition displaced otoconia from the posterior canal back to the utricle. It is the standard canalith repositioning procedure for posterior canal BPPV.

Question 13Otology and Neuro-otology

A patient with long-standing unilateral chronic suppurative otitis media develops facial nerve palsy. Which complication should be suspected?

  1. Cholesteatoma eroding the fallopian canal Correct answer.
  2. Otitis externa
  3. Serous labyrinthitis
  4. Eustachian tube dysfunction

Explanation

Cholesteatoma can erode bone, including the fallopian canal, causing facial nerve compression and palsy. This is a surgical emergency requiring urgent assessment.

Question 14Otology and Neuro-otology

Which finding on tympanometry suggests a middle ear effusion?

  1. Type As curve with reduced compliance
  2. Type B flat curve Correct answer.
  3. Type C curve with negative peak pressure
  4. Type A curve with a sharp peak

Explanation

A type B flat tympanogram indicates reduced middle ear mobility, typically from effusion or a perforation. Type A is normal, type C suggests negative middle ear pressure, and type As reflects stiff but aerated systems such as otosclerosis.

Question 15Otology and Neuro-otology

What is the typical presentation of a glomus tympanicum tumour?

  1. Painful ear canal swelling with discharge
  2. Sudden sensorineural hearing loss with vertigo
  3. Pulsatile tinnitus with a red-blue mass behind the tympanic membrane Correct answer.
  4. Progressive conductive loss with a normal tympanic membrane

Explanation

Glomus tympanicum tumours arise from paraganglia on the promontory and present with pulsatile tinnitus and a vascular retrotympanic mass. Imaging with CT and MRI helps distinguish them from glomus jugulare lesions.

Question 16Otology and Neuro-otology

Which condition is characterised by episodic vertigo, fluctuating sensorineural hearing loss, tinnitus and aural fullness?

  1. Benign paroxysmal positional vertigo
  2. Superior semicircular canal dehiscence
  3. Vestibular neuritis
  4. Meniere disease Correct answer.

Explanation

The tetrad of episodic vertigo, fluctuating hearing loss, tinnitus and aural fullness defines Meniere disease, thought to result from endolymphatic hydrops. Attacks typically last 20 minutes to several hours.

Question 17Otology and Neuro-otology

A patient develops sudden unilateral sensorineural hearing loss. What is the most appropriate initial management?

  1. Oral antibiotics
  2. High-dose oral corticosteroids started promptly Correct answer.
  3. Reassurance and review in three months
  4. Tympanostomy tube insertion

Explanation

Sudden sensorineural hearing loss is treated as an otological emergency with prompt high-dose corticosteroids, which improve the chance of recovery. Treatment should begin as soon as possible after onset.

Question 18Otology and Neuro-otology

Which type of hearing loss is associated with a normal otoscopic examination and a reduction in otoacoustic emissions?

  1. Cochlear sensorineural hearing loss Correct answer.
  2. Retrocochlear hearing loss
  3. Mixed hearing loss
  4. Conductive hearing loss

Explanation

Otoacoustic emissions reflect outer hair cell function and are reduced or absent in cochlear sensorineural loss. They may be preserved in retrocochlear lesions because the cochlea remains intact.

Question 19Otology and Neuro-otology

A patient reports vertigo and oscillopsia provoked by loud sounds. Which diagnosis should be considered?

  1. Meniere disease
  2. Superior semicircular canal dehiscence Correct answer.
  3. Vestibular neuritis
  4. Acoustic neuroma

Explanation

Sound- or pressure-induced vertigo (Tullio phenomenon) suggests dehiscence of the superior semicircular canal, allowing abnormal pressure transmission to the vestibular system. High-resolution CT confirms the bony defect.

Question 20Otology and Neuro-otology

Which feature distinguishes a central from a peripheral cause of vertigo on examination?

  1. Horizontal nystagmus suppressed by visual fixation
  2. Nausea and vomiting
  3. Vertical or direction-changing nystagmus Correct answer.
  4. Positive head impulse test

Explanation

Central lesions may produce vertical or direction-changing nystagmus that is not suppressed by visual fixation. Peripheral nystagmus is typically horizontal, unidirectional and suppressed by fixation.

Question 21Otology and Neuro-otology

Which investigation is most appropriate to confirm a suspected cholesteatoma?

  1. Pure-tone audiometry
  2. High-resolution CT of the temporal bone Correct answer.
  3. Tympanometry
  4. Serum inflammatory markers

Explanation

High-resolution CT delineates the extent of bony erosion and soft tissue within the middle ear and mastoid, supporting the diagnosis and surgical planning for cholesteatoma. Audiometry assesses function but does not confirm the lesion.

Question 22Otology and Neuro-otology

A patient with a large vestibular schwannoma develops hydrocephalus. What is the most likely mechanism?

  1. Choroid plexus obstruction
  2. Fourth ventricular compression with obstructed cerebrospinal fluid flow Correct answer.
  3. Direct invasion of the lateral ventricle
  4. Overproduction of cerebrospinal fluid

Explanation

Large cerebellopontine angle tumours can compress the fourth ventricle and obstruct cerebrospinal fluid flow, causing obstructive hydrocephalus. This is a neurosurgical emergency.

Question 23Otology and Neuro-otology

Which of the following is the mechanism of action of intratympanic gentamicin in refractory Meniere disease?

  1. Reduction of endolymphatic pressure by diuresis
  2. Blockade of voltage-gated sodium channels in the cochlea
  3. Chemical ablation of vestibular hair cells Correct answer.
  4. Suppression of inflammatory cytokines in the endolymph

Explanation

Intratympanic gentamicin is ototoxic to vestibular hair cells and produces a controlled chemical labyrinthectomy, reducing vertigo attacks. The dose is titrated to limit hearing loss.

Question 24Otology and Neuro-otology

Which pattern of hearing loss is seen in superior semicircular canal dehiscence syndrome?

  1. High-frequency sensorineural loss
  2. Low-frequency conductive loss with normal bone conduction but a negative bone conduction threshold at low frequencies Correct answer.
  3. Flat sensorineural loss
  4. Mixed loss with a large air-bone gap at high frequencies

Explanation

Canal dehiscence produces a low-frequency air-bone gap with supranormal (negative) bone conduction thresholds because the third mobile window increases bone-conducted sound transmission. This distinguishes it from otosclerosis.

Question 25Otology and Neuro-otology

A patient with a skull base fracture has blood behind an intact tympanic membrane and conductive hearing loss. Which structure is most likely disrupted?

  1. The cochlear duct
  2. The vestibular nerve
  3. The endolymphatic sac
  4. The ossicular chain Correct answer.

Explanation

Traumatic ossicular discontinuity, often at the incudostapedial joint, produces conductive hearing loss after head injury. Haemotympanum may coexist and should be distinguished from ossicular disruption on audiometry.

Question 26Otology and Neuro-otology

A 45-year-old woman has a 6-month history of progressive right-sided hearing loss. Otoscopy is normal. Pure-tone audiometry shows a right-sided conductive loss, and the Rinne test is negative on the right. Which additional finding would most suggest otosclerosis?

  1. A normal acoustic reflex with a type A tympanogram
  2. A Carhart notch at 2 kHz on bone conduction Correct answer.
  3. A type B tympanogram with a flat peak
  4. An air-bone gap that disappears on repeat testing

Explanation

Otosclerosis classically produces a conductive loss with a normal tympanic membrane and a characteristic dip (Carhart notch) in bone conduction around 2 kHz. The notch reflects an artefact of stapes fixation rather than true cochlear disease.

Question 27Otology and Neuro-otology

Which structure is most commonly injured when a temporal bone fracture causes a conductive hearing loss with an intact but haemotympanum-filled drum?

  1. The endolymphatic sac
  2. The cochlear duct
  3. The ossicular chain Correct answer.
  4. The vestibular nerve

Explanation

Conductive loss after head trauma with an intact drum usually reflects ossicular discontinuity or fixation, most often at the incudostapedial joint. The cochlea and retrocochlear structures mediate sensorineural rather than conductive loss.

Question 28Otology and Neuro-otology

A 30-year-old man presents with a painless, pulsatile tinnitus and a bluish mass behind the tympanic membrane. Which imaging modality best characterises the lesion and its blood supply?

  1. Magnetic resonance angiography
  2. Computed tomography of the temporal bone
  3. Plain radiography of the skull
  4. Catheter angiography Correct answer.

Explanation

A vascular middle ear mass such as a glomus tumour is best characterised by catheter angiography, which defines the arterial supply and allows embolisation before surgery. It also distinguishes the lesion from other vascular anomalies.

Question 29Otology and Neuro-otology

Which physical examination finding best distinguishes a peripheral from a central cause of vertigo?

  1. Worsening of vertigo with head movement
  2. Presence of nausea and vomiting
  3. Vertigo lasting more than 24 hours
  4. Direction-changing nystagmus on gaze Correct answer.

Explanation

Direction-changing or vertical nystagmus that does not suppress with fixation indicates a central lesion. Peripheral nystagmus is typically horizontal and direction-fixed and suppresses with fixation.

Question 30Otology and Neuro-otology

A patient with a long-standing perforated tympanic membrane develops a persistent foul-smelling discharge. Which organism is most commonly implicated in chronic suppurative otitis media?

  1. Moraxella catarrhalis
  2. Haemophilus influenzae
  3. Streptococcus pneumoniae
  4. Pseudomonas aeruginosa Correct answer.

Explanation

Chronic suppurative otitis media is typically polymicrobial, with Pseudomonas aeruginosa and Staphylococcus aureus among the most frequent isolates. These organisms reflect the chronic, moist environment of a perforated ear.

Question 31Otology and Neuro-otology

Which clinical feature is most consistent with a diagnosis of otitis externa rather than otitis media?

  1. Reduced tympanic membrane mobility on pneumatic otoscopy
  2. A conductive hearing loss of 30 dB
  3. A bulging, erythematous tympanic membrane
  4. Pain exacerbated by movement of the tragus Correct answer.

Explanation

Tragal tenderness and pain on manipulation of the pinna indicate inflammation of the external canal. Middle ear disease typically produces a bulging drum, reduced mobility and conductive loss rather than tragal tenderness.

Question 32Otology and Neuro-otology

A 55-year-old man has a unilateral sensorineural hearing loss and a normal MRI of the internal auditory meatus. Which diagnosis should still be considered given a negative scan?

  1. Presbyacusis
  2. Noise-induced hearing loss
  3. Vestibular schwannoma
  4. Cochlear otosclerosis Correct answer.

Explanation

Cochlear otosclerosis can produce a progressive sensorineural loss without a visible mass on MRI and may be missed on standard sequences. A negative scan does not exclude it, and the diagnosis is supported by family history and audiometric pattern.

Question 33Otology and Neuro-otology

Which audiometric finding is characteristic of a sensorineural hearing loss?

  1. Equal air and bone conduction thresholds with both reduced Correct answer.
  2. Normal bone conduction with reduced air conduction
  3. A conductive loss that improves with the Valsalva manoeuvre
  4. Air conduction thresholds worse than bone conduction thresholds

Explanation

In sensorineural loss, both air and bone conduction are reduced to a similar degree, with no air-bone gap. The deficit lies in the cochlea or auditory nerve rather than in sound transmission through the middle ear.

Question 34Otology and Neuro-otology

A patient with a history of recurrent meningitis is found to have a defect in the tegmen tympani. Which mechanism best explains the recurrent infections?

  1. Retrograde spread along the facial nerve
  2. Haematogenous spread from the nasopharynx
  3. Lymphatic drainage from the external canal
  4. Direct extension of infection from the middle ear to the meninges Correct answer.

Explanation

A bony defect of the tegmen allows direct communication between the middle ear and the intracranial compartment, permitting infection to spread to the meninges. This is why recurrent meningitis warrants imaging for a skull base defect.

Question 35Otology and Neuro-otology

Which test assesses the function of the vertical semicircular canals by recording eye movements in response to head rotation in the plane of each canal?

  1. Auditory brainstem response
  2. Electrocochleography
  3. Video head impulse testing Correct answer.
  4. Caloric testing

Explanation

Video head impulse testing measures the vestibulo-ocular reflex in the plane of each individual semicircular canal, including the vertical canals. Caloric testing assesses only the horizontal canal.

Question 36Otology and Neuro-otology

A patient with a 3-month history of unilateral tinnitus and hearing loss is found to have a small enhancing lesion in the internal auditory canal on MRI. Which management is most appropriate?

  1. Stereotactic radiotherapy
  2. Observation with interval MRI Correct answer.
  3. Intratympanic gentamicin
  4. Immediate surgical excision

Explanation

Small vestibular schwannomas are typically managed with observation and interval imaging, since many grow slowly or not at all. Treatment is reserved for growth, symptoms or patient preference.

Question 37Otology and Neuro-otology

Which feature on examination most suggests a perilymph fistula?

  1. A type C tympanogram
  2. Vertigo and nystagmus provoked by pressure changes or loud sound Correct answer.
  3. A fixed, non-pulsatile mass behind the drum
  4. A positive Rinne test with a normal drum

Explanation

A perilymph fistula creates an abnormal communication between the inner ear and middle ear, so pressure changes or loud sound provoke vertigo and nystagmus (Hennebert and Tullio phenomena). The fistula sign is a characteristic clinical clue.

Question 38Otology and Neuro-otology

Which medication is most appropriate for the acute symptomatic relief of vertigo during an attack of Meniere disease?

  1. Prochlorperazine Correct answer.
  2. Oral corticosteroid
  3. Betahistine
  4. Aminoglycoside

Explanation

Vestibular sedatives such as prochlorperazine provide symptomatic relief of acute vertigo. Betahistine is used for prophylaxis rather than acute control.

Question 39Otology and Neuro-otology

A patient has a conductive hearing loss with a hypermobile tympanic membrane and a type A tympanogram with a high compliance. Which diagnosis is most likely?

  1. Tympanic membrane perforation
  2. Ossicular discontinuity Correct answer.
  3. Otosclerosis
  4. Middle ear effusion

Explanation

Ossicular discontinuity removes the normal impedance of the ossicular chain, producing a hypermobile drum and high-compliance type A tympanogram with a conductive loss. Otosclerosis produces reduced rather than increased compliance.

Question 40Otology and Neuro-otology

Which structure is most at risk during elevation of a cholesteatoma from the medial wall of the middle ear?

  1. The cochlear aqueduct
  2. The inferior petrosal sinus
  3. The facial nerve Correct answer.
  4. The endolymphatic duct

Explanation

The facial nerve runs along the medial wall of the middle ear and is at risk during dissection of cholesteatoma. Its course should be identified before surgery to avoid injury.

Question 41Rhinology and Facial Plastics

Which structure drains the frontal sinus?

  1. Sphenoethmoidal recess
  2. Nasolacrimal duct via the inferior meatus
  3. Frontonasal duct via the middle meatus Correct answer.
  4. Accessory ostium in the superior meatus

Explanation

The frontal sinus drains through the frontonasal duct, which opens into the middle meatus, typically via the ethmoid infundibulum or directly above it. This places frontal drainage within the anterior group of sinus ostia. The remaining options describe drainage pathways of other structures or an anatomical variant not responsible for frontal drainage.

Question 42Rhinology and Facial Plastics

The most common organism isolated in acute bacterial rhinosinusitis in adults is which of the following?

  1. Staphylococcus aureus
  2. Pseudomonas aeruginosa
  3. Moraxella catarrhalis
  4. Streptococcus pneumoniae Correct answer.

Explanation

Streptococcus pneumoniae remains the single most frequently isolated pathogen in community-acquired acute bacterial rhinosinusitis, followed by Haemophilus influenzae. Moraxella catarrhalis is more prominent in children. Staphylococcus aureus and Pseudomonas aeruginosa are more typically associated with nosocomial or chronic settings.

Question 43Rhinology and Facial Plastics

A patient reports clear watery rhinorrhoea that worsens on leaning forward and is unilateral. Which investigation is most appropriate to confirm the suspected diagnosis?

  1. CT of the paranasal sinuses without contrast
  2. Serum total IgE and skin prick testing
  3. Measurement of beta-2 transferrin in the fluid Correct answer.
  4. Nasal swab for bacterial culture

Explanation

Unilateral clear rhinorrhoea that increases with forward flexion suggests a cerebrospinal fluid leak. Beta-2 transferrin is highly specific for CSF and confirms the diagnosis biochemically. Allergy testing, plain sinus CT, and culture do not establish the presence of CSF.

Question 44Rhinology and Facial Plastics

Which artery is the principal blood supply to the anterior nasal septum and is a common source of epistaxis?

  1. Anterior ethmoidal artery
  2. Kiesselbach plexus vessels including the septal branch of the superior labial artery Correct answer.
  3. Greater palatine artery
  4. Sphenopalatine artery

Explanation

Kiesselbach plexus on the anterior septum receives contributions from the anterior ethmoidal, sphenopalatine, greater palatine and superior labial arteries. Bleeding from this region is the commonest form of anterior epistaxis. The individual named arteries contribute to the plexus but the plexus as a whole is the classic source.

Question 45Rhinology and Facial Plastics

Which of the following best describes the correct first-line management of a posterior epistaxis not controlled by packing?

  1. Endoscopic sphenopalatine artery ligation Correct answer.
  2. External carotid artery ligation
  3. Topical silver nitrate cautery
  4. Anterior nasal packing with absorbable material

Explanation

Posterior epistaxis arises mainly from branches of the sphenopalatine artery. When packing fails, endoscopic sphenopalatine artery ligation is the preferred definitive treatment because it is targeted and avoids the morbidity of open ligation. Anterior packing and cautery treat anterior bleeding, and external carotid ligation is a more proximal, higher-morbidity option.

Question 46Rhinology and Facial Plastics

A 30-year-old presents with unilateral nasal obstruction, ipsilateral epiphora and a fleshy mass arising from the middle meatus. What is the most likely diagnosis?

  1. Antrochoanal polyp
  2. Inverted papilloma Correct answer.
  3. Nasopharyngeal carcinoma
  4. Rhinosporidiosis

Explanation

A unilateral fleshy mass arising from the middle meatus in an adult is an inverted papilloma until proven otherwise. Its lateral-wall origin, tendency to cause epiphora through lacrimal obstruction, and unilateral presentation are characteristic. Antrochoanal polyps are usually smooth and arise from the antrum, while carcinoma and rhinosporidiosis have different appearances and demographics.

Question 47Rhinology and Facial Plastics

Which of the following is the most appropriate initial treatment for a patient with mild intermittent allergic rhinitis?

  1. Allergen immunotherapy
  2. Oral corticosteroids for two weeks
  3. Intranasal corticosteroids daily
  4. Oral second-generation antihistamine as needed Correct answer.

Explanation

Mild intermittent allergic rhinitis is managed first with as-needed oral second-generation antihistamines or intranasal antihistamines. Intranasal corticosteroids are first-line for moderate-to-severe or persistent disease. Oral steroids and immunotherapy are reserved for refractory or specific indications.

Question 48Rhinology and Facial Plastics

Which of the following is a recognised complication of endoscopic sinus surgery involving the lateral lamella of the cribriform plate?

  1. Cerebrospinal fluid leak Correct answer.
  2. Epiphora from lacrimal duct injury
  3. Diplopia from medial rectus injury
  4. Trismus from pterygoid injury

Explanation

The lateral lamella of the cribriform plate is the thinnest part of the anterior skull base and is vulnerable during ethmoidectomy, so CSF leak is the classic complication. Epiphora follows lacrimal injury in the inferior meatus, diplopia follows orbital injury, and trismus follows pterygoid involvement, none of which relate to the cribriform plate.

Question 49Rhinology and Facial Plastics

The ostiomeatal complex is best described as which of the following?

  1. The space between the inferior turbinate and the nasal floor
  2. The region of the nasolacrimal duct opening
  3. The opening of the sphenoid sinus into the sphenoethmoidal recess
  4. The common drainage pathway of the anterior ethmoid, maxillary and frontal sinuses Correct answer.

Explanation

The ostiomeatal complex is the confluence of drainage pathways in the middle meatus serving the maxillary, anterior ethmoid and frontal sinuses. Obstruction here underlies most chronic rhinosinusitis. The sphenoid drains separately into the sphenoethmoidal recess, and the inferior meatus and nasolacrimal region are unrelated.

Question 50Rhinology and Facial Plastics

Which of the following describes the correct orientation of the lateral canthal tendon in relation to the orbital rim?

  1. It inserts 2 mm posterior to the anterior lacrimal crest
  2. It inserts onto the orbital floor
  3. It inserts onto the superior orbital rim at the supraorbital notch
  4. It inserts at the lateral orbital rim approximately at the level of the frontozygomatic suture Correct answer.

Explanation

The lateral canthal tendon inserts onto the lateral orbital rim near the frontozygomatic suture, slightly posterior to the anterior surface of the rim. This posterior and superior position gives the eyelid its normal upward lateral tilt. The other options describe the medial canthal tendon or unrelated landmarks.