LATEST OTOLARYNGOLOGY – HEAD & NECK
SURGERY CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF OTOLARYNGOLOGY
(ABMS) | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 45-year-old man presents with unilateral nasal
obstruction and recurrent epistaxis. Nasal
endoscopy reveals a pink, lobulated mass in the left
nasal cavity. Biopsy is most likely to show which of
the following histologic findings?
A) Respiratory epithelium with goblet cell hyperplasia
B) Inverted growth of non-keratinizing squamous
epithelium with intraepithelial microabscesses
C) Ciliated columnar epithelium with subepithelial
eosinophilic infiltration
D) Papillary fronds lined by respiratory epithelium
Correct answer: B
Rationale: Inverted papilloma is characterized by
inverted growth of non-keratinizing squamous
epithelium into the underlying stroma with
intraepithelial microabscesses. It has an association
with squamous cell carcinoma and requires complete
surgical excision.
,2. A 55-year-old man with a 30-pack-year smoking
history presents with hoarseness for 8 weeks.
Flexible laryngoscopy shows a leukoplakic lesion of
the right true vocal fold. What is the most appropriate
next step?
A) Observation for 3 months
B) Empirical proton pump inhibitor therapy
C) Direct laryngoscopy with excisional biopsy
D) CT scan of the neck with contrast
Correct answer: C
Rationale: Any persistent laryngeal leukoplakia in a
patient with smoking history requires biopsy to rule
out dysplasia or carcinoma. Observation or empirical
PPI is inappropriate without histologic diagnosis. CT
is adjunctive but does not replace tissue diagnosis.
3. A 6-month-old infant presents with progressive
stridor that worsens with agitation and crying but
improves when prone. Flexible laryngoscopy is
normal. What is the most likely diagnosis?
A) Laryngomalacia
B) Vocal fold paralysis
C) Subglottic stenosis
,D) Vascular ring
Correct answer: A
Rationale: Laryngomalacia is the most common
cause of stridor in infants. Stridor worsens with
agitation, feeding, and supine positioning; improves
with prone positioning. Flexible laryngoscopy shows
omega-shaped epiglottis and arytenoid prolapse.
Vocal fold paralysis presents with weak cry.
4. A 32-year-old woman presents with acute-onset
vertigo, nausea, and unilateral hearing loss. On
examination, she has left-beating nystagmus that
increases when looking to the left. She reports a
recent viral upper respiratory infection. What is the
most likely diagnosis?
A) Benign paroxysmal positional vertigo
B) Meniere's disease
C) Vestibular neuritis
D) Labyrinthitis
Correct answer: C
Rationale: Vestibular neuritis presents with acute,
prolonged vertigo (hours to days) without hearing
loss, following viral illness. Nystagmus is
unidirectional, horizontal, and increases when
, looking toward the unaffected ear. Labyrinthitis
includes hearing loss.
5. A 68-year-old man with a 50-pack-year smoking
history presents with a 3-month history of
odynophagia and right otalgia. Flexible laryngoscopy
reveals an exophytic lesion of the right pyriform
sinus. What is the most common histologic type of
this malignancy?
A) Adenocarcinoma
B) Squamous cell carcinoma
C) Lymphoma
D) Small cell carcinoma
Correct answer: B
Rationale: Hypopharyngeal cancers (pyriform sinus
most common site) are >90% squamous cell
carcinoma. Risk factors include tobacco and alcohol.
Otalgia (referred pain via vagus nerve) is a common
presenting symptom.
6. A 2-year-old child presents with a 2-day history of
fever, drooling, stridor, and refusal to swallow. The
child is sitting upright with chin thrust forward. What
is the most appropriate next step?
SURGERY CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF OTOLARYNGOLOGY
(ABMS) | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 45-year-old man presents with unilateral nasal
obstruction and recurrent epistaxis. Nasal
endoscopy reveals a pink, lobulated mass in the left
nasal cavity. Biopsy is most likely to show which of
the following histologic findings?
A) Respiratory epithelium with goblet cell hyperplasia
B) Inverted growth of non-keratinizing squamous
epithelium with intraepithelial microabscesses
C) Ciliated columnar epithelium with subepithelial
eosinophilic infiltration
D) Papillary fronds lined by respiratory epithelium
Correct answer: B
Rationale: Inverted papilloma is characterized by
inverted growth of non-keratinizing squamous
epithelium into the underlying stroma with
intraepithelial microabscesses. It has an association
with squamous cell carcinoma and requires complete
surgical excision.
,2. A 55-year-old man with a 30-pack-year smoking
history presents with hoarseness for 8 weeks.
Flexible laryngoscopy shows a leukoplakic lesion of
the right true vocal fold. What is the most appropriate
next step?
A) Observation for 3 months
B) Empirical proton pump inhibitor therapy
C) Direct laryngoscopy with excisional biopsy
D) CT scan of the neck with contrast
Correct answer: C
Rationale: Any persistent laryngeal leukoplakia in a
patient with smoking history requires biopsy to rule
out dysplasia or carcinoma. Observation or empirical
PPI is inappropriate without histologic diagnosis. CT
is adjunctive but does not replace tissue diagnosis.
3. A 6-month-old infant presents with progressive
stridor that worsens with agitation and crying but
improves when prone. Flexible laryngoscopy is
normal. What is the most likely diagnosis?
A) Laryngomalacia
B) Vocal fold paralysis
C) Subglottic stenosis
,D) Vascular ring
Correct answer: A
Rationale: Laryngomalacia is the most common
cause of stridor in infants. Stridor worsens with
agitation, feeding, and supine positioning; improves
with prone positioning. Flexible laryngoscopy shows
omega-shaped epiglottis and arytenoid prolapse.
Vocal fold paralysis presents with weak cry.
4. A 32-year-old woman presents with acute-onset
vertigo, nausea, and unilateral hearing loss. On
examination, she has left-beating nystagmus that
increases when looking to the left. She reports a
recent viral upper respiratory infection. What is the
most likely diagnosis?
A) Benign paroxysmal positional vertigo
B) Meniere's disease
C) Vestibular neuritis
D) Labyrinthitis
Correct answer: C
Rationale: Vestibular neuritis presents with acute,
prolonged vertigo (hours to days) without hearing
loss, following viral illness. Nystagmus is
unidirectional, horizontal, and increases when
, looking toward the unaffected ear. Labyrinthitis
includes hearing loss.
5. A 68-year-old man with a 50-pack-year smoking
history presents with a 3-month history of
odynophagia and right otalgia. Flexible laryngoscopy
reveals an exophytic lesion of the right pyriform
sinus. What is the most common histologic type of
this malignancy?
A) Adenocarcinoma
B) Squamous cell carcinoma
C) Lymphoma
D) Small cell carcinoma
Correct answer: B
Rationale: Hypopharyngeal cancers (pyriform sinus
most common site) are >90% squamous cell
carcinoma. Risk factors include tobacco and alcohol.
Otalgia (referred pain via vagus nerve) is a common
presenting symptom.
6. A 2-year-old child presents with a 2-day history of
fever, drooling, stridor, and refusal to swallow. The
child is sitting upright with chin thrust forward. What
is the most appropriate next step?
