FRCS ( ORL-HNS) Part one

1. FRCS ( ORL-HNS)Part one Tuesday 13th July 2011 Toynbee Club Meeting St Mary’s Hospital

2. FormatSBA • Paper 1 [2 hours] • Single Best Answer Paper (SBA) • 110 Multiple Choice Questions • (Single Best Answer Format; 1 from 5) )

3. Sample A previously fit 38 year old woman is referred with an incomplete unilateral facial palsy of two weeks duration. Apart from the left sided nasal obstruction, crusting of recent onset and some wheezing, she has otherwise been well. Examination reveals a left sided facial palsy of House Brackmann grade 2, some granularity of the nasal septal mucosa and bilateral cervical lymphadenopathy. A few sibilant rhonchi can be heard in the chest. Which one of the following investigations would be most effective in establishing a diagnosis? A c-ANCA B Chest X-ray C Differential white cell count D Serum ACE E Urinalysis

4. In the investigation of allergic rhinitis, the radioallergoabsorbent test (RAST) is used to detect which of the following in the patients serum? A Immunoglobulin A B Immunoglobulin D C Immunoglobulin E D Immunoglobulin G E Immunoglobulin M

5. A 25 year old novice SCUBA diver dives to 30m. During the ascent he experiences otalgia. Which of the following is the most likely cause? A Negative interstitial pressure within middle ear mucosa B Referred pain from a molar tooth due to trapped gas below a filling C Referred pain from an aggernasi cell D Referred pain from an ipsilateralconchabullosa E Referred pain from overstretching of stretch receptors in the trachea

6. Which of the following statements regarding the cause of facial trauma is true? A Assault is the commonest cause of facial trauma in the UK B Facial injury in the home is the most common in the 30-50 age group C In the UK, consumption of alcohol by the victim or the assailant occur in less than 25% of cases D The design and construction of beer glasses has been shown to have no effect on the incidence of maxillofacial injuries E Worldwide, road traffic accidents play a small part in the cause of maxillofacial injury

7. A 58 year old woman has undergone a thyroid lobectomy for what was thought to be a solitary “cold” adenoma. Ten days later the histology report confirms the diagnosis as a medullary carcinoma. What is the best advice on future management? A Careful follow up in the multidisciplinary outpatient clinic B Chemotherapy and radiotherapy C Radio-iodine therapy D Regular monitoring of calcitonin levels E Total thyroidectomy and removal of any enlarged lymph nodes

8. Format EMI • Paper 2: [2 hours 30 minutes] • Extending Matching Item Paper (EMI) • 135 Multiple Choice Questions • (Extended Matching Item Format)

9. SOLID TUMOURS A Adenocarcinoma B Chondrosarcoma C Esthesioneuroblastoma D Glioblastoma E Medullary cell carcinoma F Medulloblastoma G Nephroblastoma H Osteosarcoma I Paraganglioma J Plasmacytoma K Rhabdomyosarcoma L Squamous cell carcinoma M Teratoma From the options shown above, choose the single most likely diagnosis for each of the scenarios below. Each option may be used once, more than once or not at all. A 20 year old man complains of a sensation of blockage of his left nasal airway, reduced sense of smell and epistaxis.

10. SOLID TUMOURS A Adenocarcinoma B Chondrosarcoma C Esthesioneuroblastoma D Glioblastoma E Medullary cell carcinoma F Medulloblastoma G Nephroblastoma H Osteosarcoma I Paraganglioma J Plasmacytoma K Rhabdomyosarcoma L Squamous cell carcinoma M Teratoma From the options shown above, choose the single most likely diagnosis for each of the scenarios below. Each option may be used once, more than once or not at all. An 8 year old girl has left sided nasal obstruction, blood-stained discharge and swelling of the left cheek.

11. SOLID TUMOURS A Adenocarcinoma B Chondrosarcoma C Esthesioneuroblastoma D Glioblastoma E Medullary cell carcinoma F Medulloblastoma G Nephroblastoma H Osteosarcoma I Paraganglioma J Plasmacytoma K Rhabdomyosarcoma L Squamous cell carcinoma M Teratoma From the options shown above, choose the single most likely diagnosis for each of the scenarios below. Each option may be used once, more than once or not at all. A 24 year old pregnant woman reaches term and is due to deliver imminently. An ultrasound scan of the baby shows a large complex mass of the neck compressing the trachea.

12. Structure • 1. Paeds ( embryology & Syndromes)2. Otol (including neuro-otol and audiology)3. Rhinology (including Facial plastic)4. Head and neck5. Medical jurisdiction (ie ethics, consent, GMC, DVLA ,data protection etc)6. Basic sciences (immuno, embryo, genetics pharmacol)7. Stats and screening8. ?Medicine relevant to ENT (rheumatol, CT diseases, microbiol), maybe this can be distributed between 1-4?)

13. Recent FRCS Classification of questions • 5 stat and screening ( simple) • 10 basics (anatomy ( 3 embryology)) • 10 electrophysiology tests ( very hard) • 10 jurisdiction, consent, DVLA and ethical • 50 medicine and neurology related questions ( mostly about neurology) • 50 otology and neuro-otology including audiology • 15 head and neck (benign & oncology) • 20 rhinology ( 10 complications of FESS) • 10 paediatric ( audiology, airway and neck masses) • 50 mixed and common sense questions ( simple)

14. You have to answer 150 out 253 questions correctly

15. Resources £ 42 used £ 40 used £ 40 used £ 60 new

16. Best book £ 42 used 400 pages 3500 Q & A Up2date & Coves everything Hard to digest American Style

17. Courses

18. Questions