ENT Finals Ratio – Samplex

● Tumors of Head and Neck

● Facial Clefts and Facial Plastic Surgery
● Maxillofacial Trauma
1. In cleft surgery, the surgeon is Precautions:
advised to excise excess nasal In General do not perform the
cartilage if he / she also needs following:
to perform a nasal tip ● Perform any nasal tip
modification. modification concomitantly w/
● True cleft palate repair
● Damage or excise any nasal
● False
cartilage
● Perform simultaneous cleft
palate repair
● Excise any normal landmarks
2. Diplopia is an indication of Signs and Symptoms:
injury to the: - Palpable deformity of
● Maxilla infraorbital rim
● Naso-ethmoidal fracture - Diplopia on upward gaze
- Hypesthesia of the cheek
● Zygoma
- Flattening of the lateral aspect
● Nasal bone fracture of the cheek
-
Periorbital ecchymosis
-
Inferior displacement of the
globe
3. Adenocarcinoma is the most Squamous Cell Carcinoma
common malignancy in the - Most Common
nasopharynx.
● True Adenocarcinoma
● False - 2nd Most Common

4. The Millard technique is a Millard Technique

rotation advancement flap used - Rotation Advancement Flap
in cheiloplasty.
● True Rose Thompson
● False - Straight line closure

Tenisson-Randall
- Triangular Flap
5. Indirect tests for head and neck Diagnostic Tools: Head & Neck Tumors
tumors entail gathering of
tumor tissue and sending it to DIRECT
pathology section for analysis. - FNAB / Cytology
● True - Core Needle Biopsy
- Incisional Biopsy
● False
- Excisional Biopsy

INDIRECT
- Ultrasound

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 - CT scan
- MRI
- Angiography
- Thyroid Scan
6. Soft tissue lateral x-ray is done Soft Tissue Lateral X-ray
to visualize nasal bone fracture. - Nasal Bone Fracture
● True - Lucency: indicate a break in the
● False integrity of the bone or trapped
air in the subcutaneous tissue
7. In a cleft lip, a notch may also Cleft Lip
be present in the corresponding - Simplest kind of cleft which does
alveolar process. not have the underlying cleft of
● True the premaxilla
● False - Notch may be present in the
corresponding alveolar process
8. The most commonly fractured Incidence of Mandibular Fracture:
part of the mandible is: - Angle: 28.5%
● Body - Body: 25%
● Condyle - Condylar Process: 23.6%
- Symphysis: 14%
● Angle
- Ramus: 5.6%
● Alveolus - Alveolar Process: 2.4%
- Coronoid Process: 0.9%
9. Branchial cleft cysts are present - Smooth, painess, slowly growing
at birth or at infancy. mass on lateral SCM border
● True - 20-30 y/o
● False - Vestigial remnants of the fetal
branchial apparatus
- Mass in the anterior border of
the SCM
10. Malignant Fibrous Histiocytoma Rhabdomyosarcoma
is the most common sarcoma in - Most common sarcoma in
children. children
● True - Malignant tumors of connective
● False tissue origin
- Usually near orbit, PNS &
nasopharynx
- Diagnosis: biopsy
- Treatment: Surgery + Radiation +
Chemotherapy

Malignant Fibrous Histiocytoma

- Most common sarcoma of the
head & neck in ADULTS
- Most common in the maxilla or
mandible
- Associated with previous
radiation treatment
- Wide surgical excision +
Radiation + Chemotherapy

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 11. The most commonly fractured Nasal Bone Fracture
facial bone is the mandible. - Most common and easily
● True fractured bone
● False
Mandible Fracture
- 2nd most commonly fractured
bone
12. Core needle biopsy is preferred FNAB
over fine needle biopsy in neck - Is preferred for head and neck
tumors. tumors due to less trauma
● True - Uses a gauge 23 or smaller
● False needle
- Aspirate the tumor, smear to a
slide, send for histopathology
examination
13. The most common presenting Hoarseness is the most common
symptom of Laryngeal CA is presentation and is accompanied by
hoarseness. dyspnea.
● True - Tumor grows on the vocal cord.
● False Preventing the true vocal cord
from approximating hence
hoarseness occurs
- Tumor becomes too large ->
dyspnea
14. Diplopia on upgrade gaze in It is due to the entrapment of the
orbital floor fracture is due to inferior rectus muscle.
nerve impingement.
● True
● False
15. Incision biopsy should be done Angiography - diagnostic modality of
to establish a definitive choice
diagnosis in carotid body
tumors.
● True
● False
16. The division between the Incisive Foramen - separates the
primary palate and the primary from secondary palate
secondary palate is the
prolabium.
● True
● False
17. This is the rule of 10s, described Optimal Age For Operation:
as the optimal age and - Over 10lbs
condition of the patient for - Over 10 weeks
undergoing cleft surgery: over - Over 10 grams hgb
10kg in weight, over 10 weeks of
age, over 10g Hgb.
● True
● False

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 18. These are the three main Three Main Deformities:
deformities that are addressed - Maxillary Deformity
when one does cheiloplasty: - Lip Deformity
maxillary deformity, lip - Nasal Deformity
deformity, palate deformity.
● True
● False
19. Adenocarcinoma is the most Squamous Cell Carcinoma (SCCA) is
common head and neck the most common malignancy in the
malignancy. head and neck (90%)
● True
● False
20. Orbital floor fracture is a variant The floor of the orbit is the most
of zygomatic bone fracture. common portion of the orbit to sustain
● True fracture. A classic radiographic finding
● False in blow-out fractures is the presence of
a polypoid mass (tear-drop)
protruding from the floor of the orbit
into the maxillary antrum.
21. Fractures of the maxilla are also Coined to a French physician who
known as Le Fort fracture. experimented on several cadavers.
● True
● False
22. Treatment priority in Treatment Priorities:
maxillofacial trauma should be - Evaluation and treatment of
given to: CNS injuries
● Disoriented and unconscious - Problems regarding
patient sensorium, thus the
patient is admitted with a
● Bony deformity noted on nasal
neurosurgeon /
and mandibular bone neurologist
● Rigid and very tender abdomen - Evaluation and treatment of
● Profuse bleeding on laceration abdominal and thoracic injuries
of the cheek - Treatment of soft tissues, facial
and extremities injuries
- Reduction of fractures
- Always the last and the
fractures are not treated
initially
- We wait for the resolution
of the edema before we
do the reduction
23. In a unilateral complete cleft lip Usually, a split (cleft) in the lip or
and palate, the palatal process palate is immediately identifiable at
of the opposite side is not fused birth. Cleft lip and cleft palate may
with the nasal septum. appear as:
● True
- A split in the lip and roof of the
● False
mouth (palate) that a ects one
or both sides of the face

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 -
A split in the lip that appears as
only a small notch in the lip or
extends from the lip through the
upper gum and palate into the
bottom of the nose
- A split in the roof of the mouth
that doesn't a ect the
appearance of the face
24. Zygomatic arch can be easily Soft Tissue Lateral X-ray
visualized by: - Nasal Bone Fracture
● Soft tissue lateral x-ray
● Submentovertical x-ray Submentovertical X-ray
- Zygomatic Arch Fracture
● Upright Waters’ view
● Panoramic x-ray Upright Waters’ View
- Teardrop deformity seen in
Orbital Floor Fracture

Panoramic X-ray
- Mandible Fracture
25. Application of Barthon’s Treatment:
bandage is employed in: - Stabilization by figure of 8 or
● Orbital floor fracture Barthon’s bandage
● Mandibular bone fracture
● Nasal bone fracture
● Zygomatic bone fracture
26. One of the basic objectives in Basic Objectives of Repair:
the repair of a cleft lip is to - Preserve philtrum, cupid’s bow,
lengthen the patient’s lip. pout & musculocutaneous
● True junction
● False - Lengthen lip
- Reconstruct - Orbicularis Oris
muscle
- Correct distortion - Alar base &
Columella
- Require Orthodontic Correction
for deformed alveolus
27. An incomplete cleft lip extends Incomplete Cleft
from the vermillion to just short - Extend from the vermillion to
of the floor of the nasal just short of the floor of the
vestibule. nasal vestibule
● True
Complete Cleft
● False
- Extend into the floor of the
nares
28. A V-Y pushback is another A V-Y pushback is a two-flap
cheiloplasty technique that palatoplasty technique.
mainly uses two flaps.
● True
● False

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 29. Basal cell CA is the most Basal Cell Carcinoma
common skin malignancy. - Most common skin carcinoma
● True - <1% metastatic rate - good
● False prognosis
- High sunlight exposure
- Treatment: Moh’s Pathologically
Controlled Excision
30. In general, the faster the tumor Tumor Growth Pattern
growth, the chances of - The faster the tumor grows, the
malignancy are lower. higher chances of malignancy
● True
● False
31. True for adenocarcinoma: Adenocarcinoma
● Ulcerated lesions - Generally submucosal, smooth,
● Comprise 90% of head and neck firm, round mass
malignancies - Usually seen in major and minor
salivary glands
● Strong correlation with alcohol
- It is also seen in the GIT
intake and smoking - It has an equal prevalence
● Submucosal, smooth, firm among men and women
masses - Not related to tobacco or
● Associated with tissue necrosis alcohol use
around the primary tumor - No correlation with smoking and
alcohol ingestion
- Younger age group, M=F
32. Most common sarcoma in Rhabdomyosarcoma
children usually occurs in the - Most common sarcoma in
PNS, orbit and nasopharynx. children
● Osteosarcoma - Malignant tumors of connective
● Glioma tissue origin
- Usually near orbit, PNS &
● Rhabdomyosarcoma nasopharynx
- Diagnosis: biopsy
- Treatment: Surgery + Radiation +
Chemotherapy
33. Treatment priority in Treatment Priorities:
maxillofacial trauma injury is to - Evaluation and treatment of
evaluate intrathoracic and intra CNS injuries
abdominal trauma. - Problems regarding
● True sensorium, thus the
patient is admitted with a
● False
neurosurgeon /
neurologist
- Evaluation and treatment of
abdominal and thoracic injuries
- Treatment of soft tissues, facial
and extremities injuries
- Reduction of fractures
- Always the last and the
fractures are not treated
initially

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 - We wait for the resolution
of the edema before we
do the reduction
34. Class II occlusion will have the Class I Occlusion
appearance of a prominent - Normal ideal occlusion
midface. - Mesiobuccal cusp tip of the
● True maxillary 1st molar align or
● False interdigitate with the groove of
the mandibular 1st molar
- Maxillary 1st molar - reference
for our tooth occlusion
- Normal ideal dentition

Class II Occlusion
- Mesiobuccal cusp tip of the
maxillary 1st molar is anterior to
the buccal groove of the
mandibular 1st molar
- Prominent midface, recessive jaw

Class III Occlusion

- Mesiobuccal cusp tip of the
maxillary 1st molar is posterior
to the buccal groove of the
mandibular 1st molar
- Excessive growth of the
mandible/protruding mandible
- Concave facial profile
35. Restricted upward gaze in Due to the entrapment of the inferior
zygomatic bone fracture is due rectus muscle.
to entrapment of the inferior
oblique muscle.
● True
● False
36. Primary treatment for Lymphoma:
lymphomas in the head and ● Rapid growth
neck: ● Soft, smooth, mobile and elastic
● Preoperative chemotherapy and nodes
surgery ● Hodgkin or Non-Hodgkin
● Surgery with post op Lymphoma
radiotherapy ● Rapid growth in Waldeyer’s Ring
● Diagnosis:
● Radiotherapy with
○ Incision or excision biopsy
chemotherapy
of the a ected lymph
● Surgery with post op node
chemotherapy ● Treatment:
● Preoperative chemotherapy, ○ Treatment involves the use
surgery and post op of radiation therapy
radiotherapy and/or chemotherapy
depending upon the
pathologic type and

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 clinical stage of the
disease.
37. Primary treatment for Nasopharyngeal Carcinoma
nasopharyngeal CA ● Squamous cell carcinoma,
● Surgery Adenocarcinoma, or Lymphoma
● Chemotherapy ● Epstein Barr Virus infection
● Laser therapy ● Diagnosis:
● Radiotherapy ○ Direct visualization -
Nasal Endoscopy
● Cryosurgery
○ Biopsy - punch forceps
● Treatment:
○ Radiation - treatment of
choice
○ SCCA - Radiotherapy
(radiosensitive in the
nasopharynx)
○ Surgery has no role
38. The presence of the infraorbital Hypesthesia of the neck
foramen renders the mandible ● Numbness of the cheek because
weak. the 2nd division of the
● True trigeminal nerve, the maxillary
● False nerve coming out of the
infraorbital foramen is damaged
39. The most commonly fractured Nasal bone fracture - most common
facial bone is the mandible. and easily fracture bone
● True
● False Mandibular bone fracture - 2nd most
commonly fractured bone
40. Cleft lip palate repair rule of 10. Optimal Age for Operation (Rule of
● 10 weeks, 10 kg, 10 hgb Over 10)
● 10 months, 10 kg, 10 hct ● Over 10 lbs
● 10 weeks, 10 lbs, 10 hgb ● Over 10 weeks
● 10 weeks, 10 lbs, 10 hct ● Over 10 grams Hemoglobin
● 3 months (most opportune time)
● Surgeon’s Primum non nocere -
when not sure seek HELP
41. Tear drop deformity is seen in an By radiographic examination, the fat
orbital floor fracture, best seen herniation will be seen as a teardrop
in what imaging modality? deformity. While the blood inside the
● Soft tissue lateral x-ray maxillary sinus will show as an air-fluid
● Upright Waters’ view deformity that’s why we need to do an
Upright Water’s View
● Submentovertical x-ray
● Teardrop deformity - Fat
● Panoramic x-ray herniation
● Air-fluid deformity - Blood inside
the maxillary sinus

Soft tissue lateral x-rays → nasal bone

fracture
Submentovertical x-ray → zygoma arch
fracture

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 Panoramic x-ray → mandible fracture
42. Enophthalmos is a complication Zygomatic and Orbital Floor Fractures
of: ● Recognition and treatment of a
● Maxillary bone fracture fractured zygoma or orbital
● Nasal bone fracture floor are extremely important. If
● Zygomatic bone fracture these fractures are untreated,
sequelae may include:
● Mandibular bone fracture
○ Flattened cheek
○ Ocular manifestations
such as enophthalmos or
diplopia
43. In maxillofacial injury wherein Maintenance of the airway is the first
the airway is compromised and priority and may involve suctioning of
tracheal ventilation is very the oral or nasal cavity to remove
necessary, it is best for a blood or other debris.
general physician to do: ● If the patient is comatose or if
● Endotracheal intubation mandibular fracture has
resulted in instability of the floor
● Placing an oral / nasal airway
of the mouth with prolapse of
● Tracheostomy the tongue into the pharynx →
● Emergency tracheostomy an oral airway may be required
● If, for whatever reason, an oral
airway is unsatisfactory and
tracheal ventilation is
necessary, endotracheal
intubation is the method of
choice
● Emergency tracheostomy →
avoided if at all possible, since
the procedure is fraught with
hazard if the operator is not
intimately familiar with the
anatomy and experienced in the
surgical technique. Emergency
tracheostomy should be
resorted to only if all other
measures have failed or if
laryngeal injury is suspected
44. Septal hematoma is managed Management of septal hematoma
by: includes:
● Intravenous antibiotic ● Incision and drainage of the
● Mental foramen hematoma
● Nasal vasoconstrictor ● Placement of a temporary drain
● Application of intranasal
● Incision & drainage
dressings to compress the
septal mucosa and minimize the
risk of re-formation of the
hematoma, and
● Initiation of antibiotic therapy to
decrease the risk of infection

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 45. In treating soft tissue injuries of The initial management of facial
the face: wounds requires meticulous attention
● Vigorous debridement is the to technique and a gentle concern for
rule the tissues.
● Remove all small fragments Cleansing and debridement of wounds
to decrease the bacterial count and
● Lacerations are sutured at a remove devitalized tissue and any
later time foreign material that would increase
● Debridement must be kept to the chance of infection or of tattooing
absolute minimum the tissues.
Methods of cleansing/debridement
include:
● Irrigation
● Removal with solvents
● Mechanical abrasion (by means
of a brush or dermabrasion), or
● Excision

The initial excisional debridement on

the face should be conservative, as the
excellent blood supply allows the
repair of severely damaged tissue.
46. True of Cystic Hygroma: Cystic Hygroma
● Mostly occur during the 2nd & ● Painless thin walled cysts along
3rd decade of life lymphatic channels
● Presents as a painless gradually ● Common in infants or children
enlarging mass along the SCM below 2 years old
● Originate from the foramen ● Lymphangioma arising from
vestigial lymph channels in the
cecum
neck
● A lymphangioma from the ● Approximately 80% of the time
vestigial lymph channels* there is only a painless cyst in
● All of the above the posterior cervical triangle or
supraclavicular area.
47. Most common paranasal sinus SCCA - most common
a icted with squamous cell CA: ● (maxillary > ethmoid > frontal >
● Sphenoid sphenoid)
● Frontal ● Maxillary sinus is the most
● Ethmoid common site
● The ethmoid is the second most
● Maxillary
common site
● None
● Frontal and sphenoid sinuses
are rare
48. Metastatic adenocarcinoma Adenocarcinoma in a cervical node
arise from the following except: most frequently represents metastatic
● Tongue disease from the thyroid gland,
● Thyroid gland salivary glands, or gastrointestinal
tract
● Parotid gland
● GIT
● None

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 49. The best technique to get a Lymphoma:
histologic diagnosis of ● Rapid growth
malignant lymphoma: ● Soft, smooth, mobile and elastic
● Incisional biopsy nodes
● Core needle biopsy ● Hodgkin or Non-Hodgkin
● Fine needle aspiration biopsy Lymphoma
● Rapid growth in Waldeyer’s Ring
● Excision biopsy
● Diagnosis:
○ Incision or excision
biopsy of the a ected
lymph node
● Treatment:
○ Treatment involves the use
of radiation therapy
and/or chemotherapy
depending upon the
pathologic type and
clinical stage of the
disease.
50. Nasopharyngeal CA: ● A viral etiology, specifically the
● Associated with EBV Epstein-Barr virus, has been
● High incidence in cantonese associated with the
chinese development of nasopharyngeal
● Lateral neck mass is usually the carcinoma.
● Cantonese Chinese have a high
first presenting symptoms
incidence of nasopharyngeal
● A&B cancer, suggesting a racial
● All predilection.
● The most common presenting
sign of nasopharyngeal
carcinoma is a posterior high
cervical lymph node
51. Secondary Cleft Palate - Female
52. 8 - 24 months is the most opportune time for repair - Palatorrhaphy
53. Anterior palate divides from secondary palate - Incisive Foramen
54. A defect that extends to the vermillion border just short of the nasal
vestibule - Incomplete
55. Optimal age for cleft repair is over 10 weeks - Cheiloplasty
56. Cleft Lip Repair - Cheiloplasty
57. V-Y Pushback - Palatorrhaphy
58. Face Lift - Rhytidectomy
59. Mandibular deformity is one of the 3 main deformities - Cleft palate
patients
60. Rotation advancement flap - Millard Technique
References:
- Adams Fundamentals of Otolaryngology
- Beloi Trans
- Beshywap ENT Trans
- Marupok Ghorls Samplex
- Oratio Samplex
- Pewpew Samplex

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 ● Fascial Spaces
● Salivary Glands
● Wound Healing, Flaps & Grafts
1. True of collagen synthesis Collagen lysis occurs simultaneously
except: with collagen formation; after
● Collagen is composed of groups digestion of collagenase
of glycoprotein
● Collagen lysis occurs only after
collagen synthesis
● If there is alteration in the
balance between collagen
synthesis and lysis, keloid and
hypertrophic scar occur
● Collagen lysis can be inhibited
by corticosteroid

2. Advantage of using local Advantages of Vasoconstrictors in

anesthetics with a Anesthetics:
vasoconstrictor, except: ● Decreases blood blow
● It maintains the maximum dose ● Prolong e ect of drugs
limit at 300 mg/patient ● Minimizes the amount of drugs
● It renders the surgical field needed
avascular ● Less of the drug is absorbed
● It allows longer e ect / amount
Safe dose of Lidocaine with
of drug in the surgical field Epinephrine is 7.5 mg/kg or 500 mg
● Minimal amount of the
anesthesia is absorbed
● None of the above

3. Adequate cleansing and Methods of Cleansing / Debridement

debridement of the wound is include:
very important and can be done ● Irrigation
by the following, except: ● Removal with solvents
● A copious irrigation with sterile ● Mechanical abrasion
water or isotonic solutions ● Excision
● Mechanical abrasions with a
brush or dermatome
● Excision of the wound edges and
bed
● None of the above

4. True about the suture material Mattress suture penetrates only

and closure techniques EXCEPT: subcuticular tissues of the flap side
● In general, absorbable sutures
are placed in deeper layers

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 ● Braided sutures have the
advantage of knot stability but a
disadvantage of easy
contamination
● Mattress sutures are place
deeper in wound where the
edges are under tension
● Used of small instruments,
hooks, adequate and wide
undermining can minimize injury
to wound edges
● None of the above

5. Preferred donor site for skin Skin grafts are taken from:
graft are the following except: ● extremities
● Upper arms ● buttocks
● Chest ● scalp
● Scalp ● abdomen
● Abdomen
● None

6. The sternohyoid lies underneath Middle Layer of Deep Cervical Fascia

the deep component of the deep - Limited to the anterior neck
cervical fascia. below the hyoid bone
● True (Pretracheal or Visceral Layer)
● False - Attached to the investing layer
at the lateral borders of the
strap muscles on each side of
the neck
- Encapsulates the thyroid gland
- Extends posterior above the
hyoid as the layer encircling the
pharyngeal muscles
- A thin fascial sheath arises from
it enclosing the esophagus and
the hypopharynx
- Layer continuous with the
Pericardium

7. The platysma lies underneath Superficial Cervical Fascia

the superficial component of the - Encircles the scalp, face and
deep cervical fascia. neck subcutaneously
● True - Encloses the muscles of
● False expression and platysma

8. Papillary Cystadenoma ● Cystadenolymphoma / Warthin’s

Lymphomatosum is another Tumor / Papillary
name of Pleomorphic Adenoma. ● Cystadenoma Lymphomatosm
● True Pleomorphic Adenoma / Benign

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 ● False Mixed Tumor

9. The Intercalated ducts drains Acinus is drained by series of ducts;

directly into the acinus. Intercalated ducts help drain saliva
● True through the ductal system;
● False

10. In this method of wound closure, Primary Intention - skin edges

the wound is left open for a approximated using any acceptable
short period of time before it is closure method
closed.
● Third intention Secondary Intention - wound is left
open; heals through epithelization
● Skin grafting
and contraction
● Primary intention
● Secondary intention Third Intention / Delayed Primary
Intention - wound is left open for
SHORT PERIOD of time then closed by
Primary Intention

Skin Graft - Epidermis + Part of Dermis

11. This is an example of a free flap: Free Flap:

● Radial forearm flap ● Radial Forearm Flap
● Latissimus dorsi flap ● Anterolateral Thigh Flap
● Transposition flap ● Fibular Osteocutaneous Free
● Pectoralis major myocutaneous Flap
flap
Latissimus dorsi flap - Regional:
Myocutaneous Flap
Transposition flap- Local Flap
Pectoralis major myocutaneous flap -
Regional: Myocutaneous Flap

12. Adequate supply of oxygen and In order for collagen synthesis to

vitamin C is needed for proper properly occur, these 2 should be
collagen synthesis. adequately present:
● True - Oxygen
● False - Vitamin C

These are essential cofactors for the

rapid production of collagen.

13. True with the early phase of All True

collagen synthesis, except: Early Phase of Collagen Synthesis
● Low strength/mass ratio ● Low strength/mass ratio
● None of the above ● Poorly organized
● Poorly organized ● Low tensile strength

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 ● Low tensile strength Mature Phase
● More Compact
● Greater Tensile Strength

14. The middle component of the Deep Component of the Deep Cervical
deep cervical fascia is Fascia conceals the ‘Danger Space’
continuous with the danger found between the Alar and True
space. Vertebral Parts
● True
● False

15. In retropharyngeal abscess, Suppuration occurs between posterior

there is a suppurative process pharyngeal WALL and PREVERTEBRAL
occurring in between the FASCIA
submucous pharyngeal fascia
and the posterior pharyngeal
wall.
● True
● False

16. In parapharyngeal abscess, Parapharyngeal Abscess

there is a suppurative process (+) Neck swelling, fever, limitation of
occurring in between the head and neck movement
submucous pharyngeal fascia
and the posterior pharyngeal
wall
● True
● False

17. The superficial component of Superficial Layer of Deep Cervical

the deep cervical fascia splits to Fascia
enclose the muscles of - AKA Investing layer
mastication and the mandible. - Encircles the neck superficially
● True and attached to the nuchal
ligament of the vertebrae
● False
posteriorly
- Splits to enclose the SCM,
trapezius, mandible and
muscles of mastication
- Lies anterior to the strap
muscles of the neck
- It becomes external to the
suprahyoid muscles above the
level of the hyoid
- Forms the parotid gland
capsule
- Forms the capsules of the
parotid and

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 submandibular gland

18. Malignant tumor of the salivary Adenoid Cystic Carcinoma - Lymph

gland that rarely metastasizes. node metastasis is common
● Acinar Cell Carcinoma Mucoepidermoid Carcinoma -
● Adenoid Cystic Carcinoma metastasis usually LYMPHOGENOUS
● Mucoepidermoid Carcinoma Squamous Cell Carcinoma - Malignant
● Squamous Cell Carcinoma tumor of the Head and Neck

19. Essential factors for the survival 3 Essential Factors in Skin Graft:
of a graft: ● Viable recipient bed
● Viable recipient bed, close ● Close contact between graft
contact between graft and bed, and bed
immobilization of the graft, time ● Immobilization of the graft
of graft placement
● Viable recipient bed
● Viable recipient bed, close
contact between graft and bed,
immobilization of the graft
● Viable recipient bed and close
contact between graft and bed

20. Which among the following The monofilament sutures exhibit less
sutures exhibit less resistance to resistance to passage through tissue
passage through tissue? than multifilament suture.
● Braided sutures
● None of the above
● Multifilament sutures
● Monofilament suture

21. This gland lies beneath the Submandibular Gland - lies within the
horizontal ramus of the Submandibular Trigone or Digastric
mandible and lies within the Triangle; beneath the horizontal ramus
digastric triangle. of mandible
● Sublingual gland
Sublingual Gland - anterior
● Submandibular gland
submucous part of the oral floor
● Parotid gland Parotid gland - retromandibular fossa
● Minor salivary gland Minor Salivary Gland - under the
mucosa

22. Monofilament sutures are less The monofilament sutures exhibit less
sti and have a higher resistance to passage through tissue
coe cient of friction when used than multifilament suture.
in wound closure.
● True Multifilament Suture - materials are
less sti but have a higher coe cient
● False
of friction.

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 23. A 5-year-old boy was diagnosed Treatment:
with mumps. How is this best Supportive
managed? ▪ Analgesic
● Oral antibiotics ▪ Increase fluid intake
● Gentian violet painted over the ▪ Salivary stimulation
a ected side
● Antiviral medications
● Supportive treatment

24. This type of flap has its base Interpolated Flaps

located at some distance from - Liner configuration
the defect, the pedicle must pass - Base is located at some
over or under the intervening distance from the defect
tissue. - Pedicle must pass over or under
● Transposition flap intervening tissue
- Disadvantage: second surgical
● Rotational flap procedure to resect the pedicle
● Interpolated flap - On occasions, the pedicle
● Pedicled flap can be reduced to
subcutaneous tissue only
and brought under the
intervening skin as an
island flap to allow a
single stage
reconstruction

25. At the emergency room, a Epinephrine

patient came in with a lacerated - Vasoconstriction
wound on the upper lip area, - Provides less oozing on surgical
with the knowledge on hand on bed
application of local anesthesia, - Prolongs e ect of anesthesia
what will you incorporate with
lidocaine to control further
bleeding?
● Lidocaine alone will do since it
has vasodilator e ect
● Epinephrine, since it is
vasodilator
● Lidocaine alone will do since it
has vasoconstrictor e ect
● Epinephrine, since it is
vasoconstrictor

26. Structure that drains the Rivinus duct - drains Sublingual gland
parotid: Wharton's duct - drains
● Rivinus duct Submandibular and some Sublingual
● Wharton's duct

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 ● Secretory duct
● Stensen's duct

27. Best describes Myoepithelial Myoepithelial cells:

Cells: ● Contractile
● Drains the acini ● Surround the acini and
● Necessary for saliva production intercalated ducts are
● Surrounds the acini and ● Help drain the saliva through
intercalated ducts the ductal system
● Contracts to the express saliva
from the excretory duct

28. Transmission of Mumps or acute Droplet Transmission

viral sialadenitis is primarily
airborne.
● True
● False

29. One absolute contraindication Sialography

to doing sialography is the - Radiograph with contrast media
presence of inflammation. - Injecting a dye/contrast media
● True into the duct and obtaining a
● False radiograph
- Most detailed view of ductal
systems
- Contraindicated when there is
acute inflammation

30. The middle component of the Middle component of the deep

deep cervical fascia is cervical fascia:
continuous with the pericardium. ● Layer continuous with the
● True Pericardium
● False

31. The styloid process and the Parapharyngeal space AKA

carotid arteries are found within Pterygomandibular or
the confinement of the Pterygomaxillary Space
parapharyngeal space ● Concealed within the:
● True ○ Carotid vessels
● False ○ Styloid process

32. The carotid sheath is found in Carotid sheath is found in between the
between the layers of the layers of the Pre- Tracheal and
superficial component and the Prevertebral layers; DEEP component
middle component of the deep of the deep cervical fascia.
cervical fascia.
● True
● False

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 33. The thyroid gland is Middle component of the deep
encapsulated by the middle cervical fascia → encapsulates the
component of the deep cervical thyroid gland
fascia.
● True
● False

34. A 36-year-old man presented Suppurative sialadenitis - painful,

with di use enlargement of both di use swelling
parotid glands for several Sialolithiasis - pain with eating and
months. He claims that it salivary colic
remains the same whenever he Viral sialadenitis - di use painful
eats and is not painful. What is swelling, can be unilateral or bilateral
the likely diagnosis?
● Sialadenosis
● Suppurative sialadenitis
● Sialolithiasis
● Viral sialadenitis

35. What is the best initial test to FNAB has 80% Accuracy
perform in patients who need
histologic diagnosis of their
salivary gland tumor?
● Ultrasound
● Minimally Invasive Incision
Biopsy
● Core Needle Biopsy
● Fine Needle Aspiration Biopsy

36. Type of advancement flap that is Y-V advancement flap

used to improve symmetry of the ● Y-shaped incision was made
wound. initially
● V-Y advancement flap ● V-shaped flap recoils or is
● Unilateral advancement flap pushed towards the area that
needs supplementation
● Y-V advancement flap*
● Flap is PULLED or STRETCHED
● Bilateral advancement flap
towards the area of
supplementation. The flap
augments the area of the
common limb of the Y
● Y-V advancement flaps are
indicated where the surgeon
wants to decrease the
redundancy of an area by
moving a tissue away from the
site
● Occasionally, by locating a free
margin of a facial structure
using Y-V flap can be useful to

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 improve symmetry

37. This flap is supplied by the Pectoralis Myocutaneous flap -

thoracoacromial artery. Thoracoacromial artery
● Temporal flap
● Radial forearm flap Latissimus dorsi Myocutaneous flap -
Thoracodorsal artery
● Pectoralis major myocutaneous
flap
● Latissimus dorsi flap

38. Types of local flap are always Subcutaneous surface - surface of

used with another flap or grafts hinge flap and used with another flap
to provide external defect that provides external defect
coverage. coverage
● Hinge flap
Rotational flap → useful in repairing
● Free flap
medial cheek defect located near
● Rotational flap nasofacial sulcus or nasal sidewalls
● Advancement flap

39. The middle component of the Deep component of the deep cervical
deep cervical fascia anteriorly fascia:
overlies the scalene muscles. ● Anteriorly covers the vertebral
● True bodies and scalenes
● False ● Laterally covers the
paraspinous and deep neck
muscles

Middle component of the deep

cervical fascia → encapsulates the
thyroid gland

40. The deep component of the Middle component of the deep

deep cervical fascia extends cervical fascia:
posteriorly above the hyoid ● Extends posterior above the
bone only as the layer encircling hyoid as the layer encircling the
the muscles of mastication. pharyngeal muscles
● True
● False

41. Your brother asked you why he Sialorrhea - excessive flow of saliva
drools when he sleeps. You know from the mouth (drooling). Maybe due
for a fact that even as a kid, he to neurologic diseases or mechanical
is a snorer and frequently sleeps obstruction
in a prone position with his
mouth open. Which of the Why do some people drool? Is it
because of excessive saliva
following is the LIKELY reason
production?
why he has sialorrhea while he
● It actually has something to do
sleeps? with sleep position

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 ● The parotid glands are typically ● Most commonly, droolers sleep
more active at rest in a prone position with their
● He snores which dries up the mouths open
oral cavity which in turn
stimulates minor salivary glands
to produce more saliva for
lubrication
● He produces more saliva at
night
● He sleeps in a prone position
with his mouth open

42. A patient came into the Third Intention/Delayed Primary

emergency room because of a Intention:
draining abscess on his ● Wound left open for short
post-surgical wound. Upon period of time and then closed
removal of the sutures and by primary intention
debridement, what will be your ● Used with contaminated
next best step? wounds to decrease the risk of
infection
● Close the wound via delayed
primary intention
● Will admit the patient and put
the patient in high dose
antibiotics, wound debridement
delayed for a week
● Will not remove the sutures and
delay the debridement to
decrease further wound
infection
● Close the wound primarily

43. The parotid gland is Superficial AKA Investing layer:

encapsulated by the visceral ● Encircles the neck superficially
layer. and is attached to the nuchal
● True ligament of the vertebrae
● False posteriorly.
● Splits to enclose the SMC,
trapezius, mandible, and
muscles of mastication
● Lies anterior to the strap
muscles of the neck
● It becomes external to the
suprahyoid muscles above the
level of the hyoid
● Forms the parotid gland
capsule
○ Forms the capsule of the
parotid and the

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 submandibular gland

44. The superficial component of Superficial AKA Investing layer:

the deep cervical fascia overlies ● Encircles the neck superficially
the thyro-hyoid muscle. and is attached to the nuchal
● True ligament of the vertebrae
● False posteriorly.
● Splits to enclose the SMC,
trapezius, mandible, and
muscles of mastication
● Lies anterior to the strap
muscles of the neck
● It becomes external to the
suprahyoid muscles above the
level of the hyoid
● Forms the parotid gland
capsule
○ Forms the capsule of the
parotid and the
submandibular gland

45. A parotid mass that is painless, Suggestive of Benign Tumor:

but movable is likely malignant. ● Slow growth (months to year)
● True ● Painless, movable
● False* ● No signs of infiltration
● No other symptoms

Suggestive of Malignant Tumor:

● Rapid growth (weeks to months)
● Painful and fixed
● With local infiltration
● Enlarged lymph nodes
● Facial nerve paralysis

46. The surgeon can place the Surgery scars may be camouflaged by
incision on a wrinkle or skin placing the incision along favorable
crease to minimize the visual lines and approximating wound edges
impact of scars when doing without tension.
surgery.
● True Incisions are less apparent if they are
concealed in natural creased lines
● False and into shadows.

Usually, the creased lines are the lines

of least tension and such areas - the
tendency for widening of scars is
minimal

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 47. The choice of proper flap and Choice of technique depends on:
graft selection will be based on ● Functional and cosmetic goals
the following EXCEPT: ● Size of the defect
● Available local tissue ● Availability of local tissue
● Patient in critical state and ● Condition of the patient
needs urgent management ● Experience of the physician
● Cosmesis
● Experience of the medical team

48. Which of the following heals via Primary Intention

re-epithelization only. ● Simplest and fastest type of
● Tertiary intention wound closure
● Delayed primary intention ● Re-epithelialization only
● Primary intention* ● Lower risk of infection, minimal
tissue loss and minimal scarring
● Secondary intention
● skin edges approximated using
sutures of staple wire

Secondary Intention
● Wound heals via
epithelialization and
contraction
Delayed primary Intention
● Wound left open for short
period of time and then closed
by primary intention
● Used with contaminated
wounds to decrease the risk of
infection

49. An advantage of a Advantages of THIN skin graft

split-thickness skin graft is that ● Better take
they are able to retain more of ● Require less nourishment
the characteristics of the normal
skin (color,texture, etc) compared Advantage of THICK skin graft
to when a full thickness skin ● Retain more of the
graft is used. characteristics of normal skin,
including color, texture, and
● True
thickness
● False
● Contract less
● Resistant to trauma

50. Saliva secretion is primarily Secretion controlled by

controlled by: parasympathetic cholinergic stimuli
● Parasympathetic cholinergic
stimulus
● Parasympathetic adrenergic
stimulus

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 ● Sympathetic cholinergic
stimulus
● Sympathetic adrenergic stimulus

51. This cutaneous flap is supplied Deltopectoral flap – which is based on

by the internal mammary the anterior perforators
arteries. of the internal mammary artery
● Latissimus dorsi flap
● Temporal flap Pectoralis Myocutaneous flap -
Thoracoacromial artery
● Pectoralis major myocutaneous
flap Latissimus dorsi Myocutaneous flap -
● Deltopectoral flap Thoracodorsal artery

52. The Wharton’s Duct drains the Wharton’s duct drains the
sublingual gland. submandibular gland
● True
● False

53. The superficial component of Superficial AKA Investing layer:

the deep cervical fascia overlies ● Encircles the neck superficially
the sterno-hyoid muscle. and is attached to the nuchal
● True ligament of the vertebrae
● False posteriorly.
● Splits to enclose the SMC,
trapezius, mandible, and
muscles of mastication
● Lies anterior to the strap
muscles of the neck
● It becomes external to the
suprahyoid muscles above the
level of the hyoid
● Forms the parotid gland
capsule
○ Forms the capsule of the
parotid and the
submandibular gland

54. The superficial component of Superficial AKA Investing layer:

the deep cervical fascia splits to ● Encircles the neck superficially
enclose the sternocleidomastoid and is attached to the nuchal
and trapezius muscle. ligament of the vertebrae
● True posteriorly.
● False ● Splits to enclose the SMC,
trapezius, mandible, and
muscles of mastication
● Lies anterior to the strap
muscles of the neck
● It becomes external to the
suprahyoid muscles above the

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 level of the hyoid
● Forms the parotid gland
capsule
○ Forms the capsule of the
parotid and the
submandibular gland

55. The deep component of the Middle component of the deep

deep cervical fascia extends cervical fascia:
posteriorly above the hyoid ● Extends posterior above the
bone only as the layer encircling hyoid as the layer encircling the
the pharyngeal muscles. pharyngeal muscles
● True
● False

56. Most common malignancy of salivary glands - Mucoepidermoid

57. Disease commonly associated with dry eyes and dry mouth - Sjogren
Syndrome
58. Danger space of the neck is found - Deep Component Deep Cervical
Fascia
59. Sublingual glands empties its salivary secretions - Ducts of Rivinus
60. Produces the most saliva while we eat - Parotid Glands

References:
- Adams Fundamentals of Otolaryngology
- Beloi Trans
- Beshywap ENT Trans
- Marupok Ghorls Samplex
- Oratio Samplex
- Pewpew Samplex

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