Bailey Ch 4 91-98

Ch 5 1-20
Oleh : dr Widyawati
91. Which of the following best describes vocal fold
granuloma?
• A. Is often related to recent endotracheal
intubation
• B. Occurs at the vocal process of the arytenoid
cartilage
• C. Involves caseating nodules on histology
• D. Can often be a recurrent problem
• E. A, B, D
• 91. Answer: E. Caseating nodules on histology
should lead the clinician to suspect a diagnosis
other than granuloma. The most common
location of vocal fold granulomas is near the
vocal process, often related to intubation, and
can be recurrent-particularly in cases with
nonintubated etiology. PAGE 995
• 92. Which of the following is a property of an
ideal laser for laryngeal surgery?
A. Superficial tissue penetration with minimal
collateral tissue injury
B. Ability to cut and coagulate
C. Deliverable through a flexible fiber that can
be passed through a flexible endoscope
D. Hemostatic properties
E. All of the above
• 92. Answer: E. The answers describe ideal
characteristics for any tool used for laryngeal
surgery. PAGE 1086
• 93. Wegener disease has a predilection for
which part of the larynx; and emerging
therapy includes the use of what treatment?
A. Glottis; augmentative cartilage grafts
B. Glottis; monoclonal antibodies
C. Subglottis; augmentative cartilage grafts
D. Subglottis; monoclonal antibodies
E. None of the above
• 93. Answer: D. Wegener disease has a
predilection for the subglottis. Though
unproven at this point, monoclonal antibody
therapy may prevent long-term airway
scarring and stenosis. PAGES 880-881
94. A 68-year-old man with treated right tonsillar
squamous cell carcinoma and longstranding left
vocal cord paralysis. What is the source of the
asymmetric FDG ( fluoro2-deoxyglucose) uptake on
this fused PET (positron emission tomography)/CT
image?
A.Recurrence at the primary site
B. Recurrence in cervical lymph nodes
C. Infection
D. Chondroradionecrosis
E. Vocal fold paralysis
• 94. Answer: E. Paralysis of the left vocal fold
creates asymmetry by decreasing the uptake
on the left side, making the right side seem
too hot by comparison. In truth, the right side
is displaying normal physiologic uptake of
FOG. This uptake is in the wrong location for
either type of recurrence. There are no CT
findings of infection or chondroradionecrosis.
PAGE 160
95. An 81-year-old man with submucosal laryngeal mass.
What is the most likely diagnosis?

A. Osteosarcoma
B. Chondrosarcoma
C. Squamous cell carcinoma {SCC)
D. Hemangioma
E. Polyp
• 95. Answer: B. The calcified matrix within this
tumor consists of arcs and circles, which are
features seen in chondrosarcoma.
Osteosarcoma and SCC would be more
aggressive. Hemangiomas and polyps would
not calcify in this pattern. PAGE 152
96. A 76-year-old woman with difficulty swallowing.
What is the cause of her dysphagia?

A. Larrngeal tumor
B. Cricopharrngeal achalasia
C. Hypopharrngeal tumor
D. Pharrngeal denervation
E. Gastroesophageal reflux
• 96. Answer: B. A smooth posterior indentation
at the level of CS/6, measuring 1 em in vertical
dimension, is usually an unrelaxed
cricopharyngeus muscle. Mucosal tumors
would have an irregular margin. Denervation
presents as asymmetric pharyngeal
contractility. PAGE 822
• 97. A 50-year-old woman with stridor. What is
the most likely cause?

A. Prior tracheostomy causing

tracheomalacia
B. Multinodular goiter
C. Thyroid carcinoma
D. Congenital anomaly
E. The tracheal diameter is within
normal limits
97. Answer: A. This image shows severe
subglottic tracheal stenosis. Goiter usually
causes severe stenosis only at the thoracic inlet.
There are no erosive changes to suggest cancer.
Prior tracheostomy is the most common cause
of subglottic tracheomalacia. PAGE 936
98. To evaluate complaints of dysphagia following
ischemic stroke, videofluoroscopic swallow study
(VFSS) offers what advantage over fiberoptic
endoscopic evaluation of swallowing (FEES)?
• A. Assessment of vocal fold mobility
• B. Detection of frank aspiration
• C. Evaluation of hyolaryngeal elevation
• D. Assessment of laryngeal and pharyngeal mucosal
pathology
• E. Assessment of pharyngeal mucosal pathology
• 98. Answer: C. VFSS permits evaluation
ofhyolaryngeal elevation, which is important
in stroke patients. With FEES, this cannot be
assessed. Both methods can identify frank
aspiration. Answer A is an advantage of FEES.
PAGE 830 AND TABLE 57.5
• 1. Which of the following is an indication for
vascular evaluation in patients with penetrating
trauma to the face?
• A. Active bleeding
• B. No exit wound
• C. Signs of neurological compromise
• D. Penetration posterior to the orbital apex
• E. Penetration posterior to the mandibular angle
plane
• Answer: A. In patients who are asymptomatic,
endoscopy can be postponed for 12 to 24
hours. There are two important exceptions to
this principle. The first is a foreign body that
appears to be a disc battery. The second is if
the foreign object is sharp and/or has the
potential to perforate the esophagus, such as
an open safety pin. PAGE 1406
• 2. When using the coronal flap approach to
expose the zygomatic arch, the dissection should:
• A. Remain above the deep temporal fascia
throughout
• B. Be superficial to the temporoparietal fascia
• C. Transition deep to the deep temporal fascia
onto the temporal fat pad above the arch
• D. Transition deep to the temporalis muscle
above the arch
• 2. Answer: C. Data from newborn hearing
screening programs show that the incidence
of hearing loss is twice as high as all other
diseases screened at birth, occurring in about
2 to 4 per 1,000 births. PAGE 1507
• 3. A 46-year-old man sustained an assault to the
face with a glass bottle and presents with lower
lid laceration medial to the punctum on the left.
Evaluation is likely to reveal injury to:
• A. Canalicular system
• B. Medial rectus
• c. Orbital septum
• D. Nasal bone
• E. Levator aponeurosis
• 3. Answer: C. Prenatal exposure to CMV,
herpes virus, is the most common congenital
viral infection and currently the most common
viral cause of congenital sensorineural hearing
loss. PAGE 1527
• 4. The upper labial sulcus approach is best
utilized to repair:
• A. Zygomaticomaxillary complex fractures
• B. Frontal sinus fractures
• C. Orbital floor blowout fractures
• D. Mandibular condyle fractures
• 4. Answer: B. The anterior neuropore is the
most distal point of the neural crest cell
migration; the lack of neural crest cells and
the relatively late tube closure predispose this
region to developmental defects. PAGE 1445
• 5. Medial orbital wall exposure is accomplished
by which of these statements?
• A. Best accomplished through a transcutaneous
or "Lynch" incision
• B. Optimally done through a transcaruncular,
transconjunctival approach
• C. Best approached from the upper labial sulcus
• D. Ideally gained through an eyebrow or
"gullwing" incision
• 5. Answer: D. Genetic etiology to hearing loss.
Mutations in the Pendrin gene (PDS, SLC26A4)
cause Pendred syndrome but are also
responsible for a nonsyndromic form of
recessive sensorineural hearing loss, DFNB4.
PAGE 1535
• 6. A 12-year-old boy sustained a blow to the eye from
an elbow while jumping on a trampoline. There was no
loss of consciousness. He is brought to the emergency
department 6 hours after the injury and has had one
episode of emesis. Pulse rate is 45 bpm, blood pressure
120/80 mm Hg, and respirations 18/minute.
Examination reveals periorbital ecchymosis and
restriction of extraocular motion, and CT of the head
shows a fracture of the orbital floor. What is the most
appropriate approach to management?
• A. Emergent surgical intervention
• B. Surgery in 24 to 72 hours
• C. Surgery in 4 to 7 days
• D. Observation with reassessment in 7 to 10 days
• 6. Answer: C. This process is a rare, life-
threatening condition associated with two
specific subtypes of vascular tumors, tufted
angioma and kaposiform
hemangioendothelioma. It is not associated
with infantile hemangiomas. In point of fact,
the tumor traps and destroys platelets and is
associated with other coagulopathies. PAGE
1579
• 7. Which of the following is the most common
midface fracture (other than nasal fracture)?
• A. Nasoorbitoethmoid (NOE) fracture
• B. Le Fort 1 fracture
• C. Le Fort 2 fracture
• D. Le Fort 3 fracture
• E. Zygomaticomaxillary (ZMC) fracture
• 7. Answer: A. Answers B (Furlow palatoplasty),
C (Hogan modification), and D (Hynes
pharyngoplasty) are the recommended
procedures. PAGE 1568
8. Rounding of the inferior rectus on CT imaging
is predictive of:
• A. Permanent diplopia on upgaze
• B. Injury to the lacrimal drainage system
• C. Development of delayed enophthalmos
• D. Permanent injury to the infraorbital nerve
• 8. Answer: A. Most pediatric otolaryngologists
would recommend adenoidectomy as the first
step. Whether the adenoid pad is large and
obstructing or small in size, adenoidectomy
should improve symptoms. PAGE5 1459-1460
• 9. A 7-year-old patient sustains a fall and
presents with altered mental status and an
upper eyelid hematoma. Which is the most
likely diagnosis?
• A. Orbital floor blowout fracture
• B. Medial orbital wall fracture
• C. Frontal sinus fracture
• D. Orbital roof fracture
• 9. Answer: B. The advantages of tracheotomy as
opposed to prolonged endotracheal intubation
include the following: shorter, larger tube can be
placed, decreased airway dead space, less
damage to larynx, more comfortable for the
patient, may allow the child to be discharged
from the hospital, even on a ventilator, and care
for a tracheotomy can be performed by trained
caregivers/family members who are not health
care professionals. PAGE 1385
• 10. A 6-year-old girl is brought to the emergency
department after being struck in the nose with a fist
while playing with her sisters. She had immediate
epistaxis, which is now resolved, but she cannot breath
through the right side of her nose. Examination reveals
a painful and blue right-sided intranasal mass which is
compressible with a Q-tip. What is the next best step in
management?
• A. Drainage at the bedside
• B. Operative drainage
• C. Placement of nasal packing
• D. Decongestion with oxymetazoline and follow-up in 7
days when edema has resolved
• 10. Answer: D. Acrocephalosyndactyly type 1.
Features of this autosomal dominant
syndrome include craniosynostosis of the
coronal suture. PAGES 1622-1623
• 11. A 23-year-old man was found down after
being trapped while mountain climbing. The
temperature reached below 0 o C and he
sustained frostbite involving his nose, cheeks, and
ears. What is the most appropriate first step?
• A. Surgical debridement
• B. Antibiotic prophylaxis
• C. Gradual warming beginning at 40 oF
• D. Rapid rewarming in baths at 104°F to 108°F E.
Administration of a vasodilator
• 11. Answer: D. If maximum medical therapy
and adenoidectomy failed, a complete workup
for allergy and/or immune problems should
be done, in addition to obtaining a cr scan to
assess the need for sinus surgery. PAGE 1459
• 12. A 3-year-old child presents to the emergency room
with a deep puncture wound to the left cheek. The
family reports the child was playing with the family cat
when the injury occurred. What is the most common
organism isolated from cat bites?
• A. Moraxella sp.
• B. Pasteurella sp.
• c. Corynebacterium sp.
• D. Streptococcus sp.
• E. Staphylococcus sp.
• 12. Answer: C. Children with tracheal stenosis
generally exhibit a biphasic wet-sounding
breathing pattern referred to as "washing-
machine" breathing. This pattern transiently
clears with coughing. PAGE 1361
• 13. Which type of shock is most common after
trauma?
A. Hypovolemic shock
B. Neurogenic shock
C. Septic shock
D. Cardiogenic shock
E. Central nervous system shock
• 13. Answer: D. The gene that causes Pendred
syndrome has been identified and is named
SLC26A4 (or PDS). The hearing impairment in
Pendred syndrome is associated with
abnormal iodine metabolism, which typically
results in a euthyroid goiter. PAGE 1546
• 14. The appropriate treatment strategy for management of
frontal sinus fractures can be made from assessing which of
these five anatomic parameters?
• A. Nasoorbitoethmoid (NOE) complex fracture, orbital
fracture, frontal recess, anterior table fracture, and posterior
table fracture
• B. Anterior table fracture, posterior table fracture,
nasofrontal recess injury, dural tear/ cerebrospinal fluid (CSF)
leak, and fracture displacement/comminution
• C. Dural tear/CSF leak, NOE complex fracture, nasofrontal
recess injury, orbital roof fracture, and posterior table
fracture
• D. Through-and-through lacerations, orbital roof injury,
frontal recess injury, anterior table fracture, and posterior
table fracture
14. Answer: D. Cafe-au-lait spots and cutaneous
neurofibromas are not consistent findings of
NF2. Axillary freckling is uncommon. Other
neurogenic tumors are common, such as
schwannomas, intracranial or spinal
meningiomas, or astrocytomas. Lisch nodules
are absent in NF2. Posterior cataracts are
common (80%). PAGE 1630
• 15. Intraoperative mydriasis is noted while
repairing an orbital floor fracture. Which of
the following is the most likely cause?
• A. Pressure on the ciliary ganglion
• B. Transection of the optic nerve
• C. Occlusion of the ophthalmic artery
• D. Retrobulbar hematoma
• 15. Answer: C. More than 90% of both third
and fourth branchial cleft anomalies occur on
the left side. PAGE5 1609-1610
• 16. All of the following are absolute indications
for open reduction of condyle fractures except:
• A. Displacement into the middle cranial fossa
• B. Foreign body in the joint capsule (e.g., gunshot
wound)
• C. Lateral extracapsular deviation of the condyle
• D. Unilateral condylar fracture associated with a
single midfacial fracture E. Inability to open
mouth or achieve occlusion after 1 week F. Open
fracture with facial nerve injury
• 16. Answer B. Prior to performing an
adenotonsillectomy, one should always
palpate the palate to check for a submucous
cleft and evaluate the oropharynx for
abnormal pulsatile vessels. This is especially
important in syndromic children so that
surgery can be modified appropriately. PAGE
1301
• 17. Which of the following is the most
common sequela in patients with a gunshot
wound to the mandible zone?
• A. Airway obstruction
• B. Globe injury
• C. Intracranial penetration
• D. Vascular injury
• E. Trismus
• 17. Answer: E. SOB is known to increase the
risk for hyperactivity and symptoms of
attention deficit hyperactivity disorder
(ADHD). The children may have enuresis,
behavior problems, poor school performance,
reduced quality oflife, and growth problems.
PAGE 1436
• 18. Which of the following is correct concerning
immediate facial nerve paralysis after penetrating
trauma?
• A. The nerve injury is usually a contusion.
• B. The nerve injury is usually a transection.
• C. With observation alone, most patients will
recover some facial nerve function.
• D. Surgical repair almost always requires a 12 to 7
crossover or jump-graft technique. E. Functional
result after repair is usually a grade 2 on the
House-Brackmann scale.
• 18. Answer: C. In addition to nasal
obstruction, pituitary disorders along with
dental and facial anomalies are seen with
congenital nasal pyriform aperture stenosis.
PAGE 1316
• 19. Which of the following fractures is most
common in childhood?
• A. Frontal sinus
• B. Orbital
• C. Nasal
• D. Le Fort
• 19. Answer D. Ultrasound is currently the most
important and commonly used means to
diagnose aerodigestive disease because it is
anatomic, physiologic, and noninvasive.
However, the use of MRI is widening, and
reports exist that document the utility of this
modality in the diagnosis of aerodigestive
tract abnormalities that may predict
respiratory embarrassment at delivery. PAGE
1309
• 20. Malunion of a fracture should be
interpreted as:
• A. Instability at 8 to 12 weeks after fixation
• B. Bony union in nonanatomic position
• C. Fibrous union of fracture site
• D. Pseudoarthrosis
• 20. Answer: D. The findings of micrognathia
and glossoptosis in the neonate with airway
obstruction are pathognomonic for Robin
sequence. Cleft palate is seen in
approximately 50% ofthese patients. PAGE
1331