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160 Advanced ENT MCQs
surgery followed by proton therapy, due to a reduced level of complications to sur-
rounding tissue in comparison to traditional photon therapy.
79. Answer B
These are challenging cases, complicated more so in this scenario by pregnancy.
Histological tissue sampling is crucial for the management of such cases and until tissue
diagnosis is confirmed one should make every attempt to preserve vision where pos-
sible. In a similar scenario, maximal endoscopic debulking allowed for visual preserva-
tion and the histology was consistent with rhabdomyosarcoma, which was treated with
chemoradiotherapy. Management of the pregnancy would require termination if the
fetus were not a viable age for survival.
80. Answer C
This question tests the anatomy of the cavernous sinus. Structures on the lateral wall of
the cavernous sinus from superior to inferior are the oculomotor nerve, trochlear nerve
and the ophthalmic and maxillary branches of the trigeminal nerve. Structures passing
medially are the internal carotid artery and abducens nerve.
The Knosp grading is a common system used to classify cavernous sinus invasion by
pituitary macroadenomas. It is crucial in terms of operative planning to signify the
likelihood of recurrence/residual tumour. Three lines are drawn (medial tangent,
intercarotid line and lateral tangent) between the supraclinoid and cavernous ICA on
coronal MRI sequences, which permit grading. Grade 3 tumours extend lateral to the
lateral tangent (grade 3A extend above the intracavernous carotid the into the supe-
rior cavernous sinus and 3B extend below the intracavernous carotid into the inferior
cavernous sinus). Complete encasement is a grade 4 on the Knosp classification. In
the scenario described, extension into the superior cavernous sinus would be most
likely to affect the oculomotor and trochlear nerves.
81. Answer A
Symptoms and signs of heavy metal poisoning vary according to the metal type and
the chronicity of the exposure. Toxicity can result from acute exposure to large amounts
or repeated exposure to small quantities. Heavy metals generate reactive oxygen spe-
cies and subsequently cause oxidative stress to cells.
Arsenic poisoning is associated with a variety of dermatological and systemic mani-
festations due in part to the allosteric inhibition of pyruvate dehydrogenase, that
converts pyruvate into acetyl-coA and is hence crucial to cellular respiration. Chronic
exposure typically results from drinking contaminated groundwater. The highest
groundwater arsenic levels have been recorded in Brazil, Cambodia, Afghanistan,
Australia and Bangladesh.
Arsenic exposure can lead to the development of basal cell carcinoma (BCCs) and
squamous cell carcinoma in situ, often on the trunk, and can result in palmoplantar
keratosis, a condition characterised by thickening and scaling of the skin on the palms
and soles. Mees lines, also known as leukonychia striata, are horizontal white lines that
appear across the nails. They are typical of arsenic, thallium and selenium poisoning
and have been reported in patients undergoing chemotherapy. They represent tem-
porary interruptions in nail growth.
Chapter 4: Rhinology and Facial Plastic Surgery 161
82. Answer B
Basal cell carcinoma (BCC) is the most common type of skin cancer, and can present
in various subtypes, each with distinct characteristics. BCCs can be considered high-risk
(morpheaform, infiltrative or basosquamous types) and low-risk (nodular and superficial
types) depending on their invasive behaviour and recurrence risk. Clinically, morphea-
form BCC present as a smooth flesh-coloured plaque or scar with ill-defined borders.
It may be difficult to diagnose given that it does not resemble the typical nodular or
superficial BCCs.
Morpheaform BCC secrete collagenases (matrix metalloproteinases), which enable
them to invade and move between embryonic fusion planes (EFP) in the skin and
cause local tissue destruction. EFPs are regions of mesenchymal and ectodermal
fusion of the primordial facial processes. It has been suggested that EFPs differ in con-
nective tissue structure from that of the surrounding area and hence facilitate deeper
tissue invasion.
83. Answer B
The lymphatic drainage of the external nose primarily drains to the submental (Level IA)
and submandibular (Level IB) nodes. Of these, the Level IB (submandibular) nodes serve
as the major drainage point.
84. Answer C
A shortened columella is often seen in unilateral cleft lip patients post repair and
can have significant aesthetic implications. AV-Y advancement flap is the favoured
method for lengthening the columella in such cases. AV incision is made at the base
of the columella, and the tissue is advanced upward, eventually being sutured in a Y
configuration. This technique lengthens the columella without the need to introduce
extra tissue. Another method is the lateral crural steal, which lengthens the columella by
repositioning the lower lateral cartilages.
85. Answer C
The rhinion represents the most depressed point along the nasal bridge at the inter-
section between the nasal bones and the upper lateral cartilages. The thinnest skin
of the nasal dorsum is sited here. This is an important consideration in rhinoplasty and
post trauma as any bony irregularities will be visible. The radix is the soft tissue over the
nasion, the point at which the frontal and nasal bones meet. The lower third of the nose
and the glabella (the area of skin between the eyebrows) have thicker skin with more
sebaceous tissue.
86. Answer D
Of overall complications following facelift surgery, haematoma formation is the most
common, with an incidence of approximately 2%. Risk factors for post-operative hae-
matomas include male sex, hypertension, and use of anticoagulants. Approximately
90% of haematomas occur in the first 24 hours after facelift surgery. Small haemato-
mas can cause contour irregularities and pigmentation changes. Asignificant hae-
matoma, such as one measuring 4 cm in diameter, can compromise the blood supply
to the overlying skin flap. This can lead to devascularisation, and eventually skin
162 Advanced ENT MCQs
necrosis. Although temporising measures such as suture removal and bedside hae-
matoma drainage have been described, immediate evacuation in theatre is recom-
mended to identify bleeding sites to relieve the pressure and ensure the survival of the
flap.
87. Answer D
Rhinophyma is a subtype of rosacea characterised by erythema, telangiectasias and
skin thickening predominantly of the lower third of the nose, leading to a bulbous,
nodular appearance. It is more common in men and typically presents in the sixth to
seventh decade of life. The exact aetiology is unknown, but it is not related to alco-
hol consumption, contrary to popular belief. While several treatment modalities can
address rhinophyma, dermabrasion is often preferred for the best cosmetic outcome.
This procedure involves mechanically shaving down the skin to improve its contour and
appearance. It can be very effective in reducing the bulk and achieving a smoother,
more refined nasal contour. Other treatments like topical agents and oral antibiot-
ics mainly address inflammation and may not significantly improve the cosmetic
appearance.
88. Answer D
Nasoethmoidal fractures involve the central midface. These fractures can result from
high-energy blunt trauma, such as a motor vehicle accident. Clinically, they often
present with telecanthus, a widened and flattened nasal bridge with increased inter-
canthal distance. This is because the medial canthal tendons may be disrupted or
detached, leading to an increase in the distance between the eyes. Clear fluid from
the nose can be indicative of a cerebrospinal fluid (CSF) leak, which can be associ-
ated with these fractures due to proximity to the cribriform plate.
89. Answer C
Upper blepharoplasty is designed to remove excess skin (and sometimes fat) from the
upper eyelids. Dermatochalasis is a term used to describe redundant eyelid skin and
is a typical sign of periocular aging. Eyelid ptosis can be quantified by the margin-
reflex distance-1 (MRD-1), measured from the midpoint of the upper eyelid margin to
the centre of the pupil. The normal range is 4–4.5 mm and under 2 mm is considered
ptotic.
When performing this procedure, it is essential to avoid excising too much skin, which
can result in an inability to close the eye completely (lagophthalmos) or other com-
plications, including scleral show. Typically, a maximum of 8–10 mm can be safely
excised. The exact amount varies depending on individual anatomy and the degree
of skin redundancy.
90. Answer D
The lateral helical rim-mastoid distance is ideally 2–2.5 cm with an auriculocephalic
angle of 25–35 degrees; larger values are consistent with prominauris. The verti-
cal height of the ear should be approximately 6 cm with a width 55% of its length.
Prominauris generally results from an underdeveloped antihelical fold or less commonly
excess conchal cartilage.
The Mustardé technique involves the use of permanent mattress sutures placed
through the cartilage to create or enhance the antihelical fold. This is one of the most
Chapter 4: Rhinology and Facial Plastic Surgery 163
common techniques utilised for correcting prominent ears. The Furnas technique
is used to correct excessive conchal cartilage by using four permanent sutures to
secure the conchal bowl to the mastoid periosteum or cartilage of the ear (concho-
mastoid sutures). The Stenström technique uses scoring or shaving of the anterior sur-
face of the cartilage to weaken it, facilitating its reshaping. The Converse technique is
a combination of cartilage excision and suturing to reshape the antihelical fold and
reduce the conchal prominence. In the Davis technique, the hypertrophic cartilage
of the posterior conchal wall and bowl are excised (usually involving a small kidney
bean wedge of excess cartilage).
91. Answer C
Pemphigus vulgaris (PV) is an autoimmune blistering disorder that results from autoan-
tibodies that target the keratinocyte adhesion proteins, desmoglein 3 (and sometimes
desmoglein 1). This results in loss of cellular desmosomes, and a loss of cell-cell adhe-
sion (with a histopathological finding of acantholysis and intraepidermal blistering).
Agenetic predisposition to PV has been linked with human leukocyte antigen (HLA)
class II alleles (e.g. DQB1*0503 and DRB1*0402). Some cases may be drug-induced (e.g.
captopril and non-steroidal anti-inflammatories). The disease initially presents with oral
ulcers (80% of cases) which may rupture leaving painful erosions. Cutaneous blisters
appear in about 75% of patients after the oral ulcers and are flaccid and rupture easily.
The Nikolsky sign describes exfoliation of the outermost layer of skin with minor pressure.
It is present in Stevens-Johnson syndrome (SJS), staphylococcal scalded skin syndrome,
pemphigus foliaceus and PV. It is useful to distinguish between PV (in which the sign is
present) and bullous pemphigoid (in which it is not). Corticosteroids are the mainstay
of treatment of PV, but second-line treatment involves other immunosuppressants or
biologics.
Bullous pemphigoid typically results in tense blisters, whereas PV leads to flaccid ones,
and typically spares the oral mucosa. Bullous pemphigoid is associated with antibod-
ies against hemidesmosome components, which lead to subepidermal blistering.
Bullous impetigo is caused by the exfoliative toxin Aproduced by Staphylococcus
aureus and causes reddish blisters on the skin of the face and chest which then
burst leaving a honey-coloured crust. SJS is a mucocutaneous drug hypersensitivity
reaction characterised by erythematous skin eruptions that progress to blisters and
erosions accompanied by systemic symptoms, including sepsis, pneumonia and
multi-organ failure. Erythema multiforme appears as red patches that evolve into
target lesions most typically on the hands; it often results after infections (e.g. myco-
bacterium, streptococci, salmonella) or drug exposure (e.g. penicillin, sulphonamides,
aspirin).
Given the presentation of painful oral ulcers, soft blisters, extension of blisters with
lateral pressure and histopathological findings, the most likely diagnosis for this patient
is P V.
92. Answer C
The external nasal skin is supplied by ophthalmic (V1) and maxillary (V2) branches
of the trigeminal nerve (CN V) nerve. The infratrochlear (V1) and supratrochlear (V1)
nerves supply the radix and cranial part of the dorsum. The external nasal branch of the
anterior ethmoid nerve (V1) innervates middle vault and nasal tip.
164 Advanced ENT MCQs
The infraorbital nerve (V2) supplies the lateral nose and lateral tip. The nasal branch
from the anterior superior alveolar nerve (V2) supplies the columella. Given the loca-
tion of the pain, the patient is likely suffering from external nasal nerve neuralgia. It
has been reported that this may respond to local anaesthetic blockade, with admin-
istration of local anaesthetic into the external nasal nerve which is found 6 –7 mm
lateral to the nasal dorsum at the level of the keystone area (where the nasal bones
meet the upper lateral cartilages, as well as the cartilaginous septum and bony
septum).
93. Answer D
Basal cell carcinoma (BCC) is a common skin cancer, especially on the face. The goal
of treatment is to achieve complete tumour removal whilst maintaining function and
cosmesis. The recommended margin for excision of a BCC on the face typically varies
based on the clinical and histological characteristics of the lesion.
A number of surgical and medical therapies may be used to treat BCCs. For low-risk
lesions (defined as low risk of recurrence, e.g. small nodular or superficial BCCs), these
include electrodesiccation and curettage or surgical excision, topical 5-fluorouracil
(5-FU) or imiquimod and photodynamic therapy. Mohs surgery, which combines
staged resection under local anaesthesia with frozen section evaluation, is indicated
for high-risk lesions at increased risk of recurrence and in functional or cosmetically
sensitive areas. These would include lesions larger than 2 cm and aggressive subtypes
such as infiltrative, morpheaform or micronodular.
For this low-risk lesion the 4 mm margin provides an appropriate balance between
ensuring complete removal of the tumour and preserving surrounding healthy tissue
for better cosmetic results. It allows for a safety margin to account for any micro-
scopic extensions of the tumour beyond the visible margins and has been reported to
achieve >95% tumour clearance rate. High-risk lesions generally require wider margins
(5 –10 mm).
94. Answer C
The diagnostic work-up for a potential melanoma on the neck is a critical process to
evaluate the lesion’s characteristics and establish the need for further intervention.
Dermoscopy is a non-invasive diagnostic tool that allows for detailed examination of
the skin lesion’s surface. It provides magnified views of the lesion and facilitates assess-
ment of various features including pigmentation patterns, borders and the presence of
specific structures like globules and dots. This is important to distinguish between benign
and potentially malignant lesions, including melanoma. Direct excision of the lesion
to obtain tissue samples for histopathological examination should be considered only
after a thorough evaluation, including dermoscopy, has raised suspicion of melanoma.
Punch biopsy of suspected melanoma is not recommended. Clinical observation with-
out intervention is not recommended for a potential melanoma, since early detection
and biopsy are crucial for timely management. Sentinel lymph node biopsy is a proce-
dure used to assess the spread of melanoma to regional lymph nodes and is typically
not part of the initial diagnostic work-up.
95. Answer D
Chondrodermatitis nodularis helicis (CNH) is a painful condition characterised by a
tender nodule or small lump on the helix or antihelix. It is commonly associated with
Chapter 4: Rhinology and Facial Plastic Surgery 165
trauma that causes localised vasculitis. Biopsy should be undertaken to distinguish from
other benign or malignant causes, which may mimic CNH. Relieving pressure on the
area with packing or padding is the mainstay of treatment although occasionally other
modalities may be used, for example cryotherapy, intralesional steroids or laser excision.
96. Answer A
Full thickness skin grafts include the epidermis and entire dermis (with hair follicles).
These grafts are useful in nasal, auricular and eyelid defects. Advantages of these
grafts include better colour/texture/thickness match, durability, decreased wound con-
traction vs split thickness skin graft (STSG). Disadvantages include a higher metabolic
rate, longer revascularisation time, decreased uptake percent compared to STSG and
donor site morbidity. Graft survival depends on adequate recipient blood supply and
patient risk factors (smoking, vascular disease, history of radiation). Graft failure can
occur secondary to haematoma (most common), seroma, infection, graft mobility and
wound tension.
97. Answer D
A paramedian forehead flap (PMFF) one/two/three stage axial flap is used mostly for
nasal defects. It is based on the supratrochlear artery (identified at the supraorbital
rim 1.7–2.2 cm from midline) which runs superficial to the corrugator muscle (divided
during elevation) and deep to the orbicularis oculi, and pierces the frontalis muscle
2 cm superior to the rim. While it was initially described as a 2-stage procedure, the
addition of a third intermediate stage has been introduced. Proponents of the 3-stage
approach argue that the intermediate step improves flap perfusion, especially in smok-
ers and patients with comorbidities that could compromise tissue healing (e.g. diabe-
tes, rheumatologic diseases, vasculopathies). The 3-stage approach has also been
purported to expand lining and structural support options and provide superior flap out-
comes. There are also three varieties of the interpolated forehead flap: 1) paramedian:
reputed to have increased dermal vascularity (despite similar viability) given centre
position over pedicle with less desirable scar line than midline flap; 2) midline: offers a
longer skin paddle with more favourable scar line. For the patient described, a midline
forehead flap would reduce the need to go into the hair and hence bring hair down
with flap; 3) single stage: limited to young, healthy patients without small vessel disease;
requires de-epithelialisation and tunnelling under the glabella.
98. Answer C
Sellar defects and leaks are categorised as follows: Grade 0 (no visible leak on
Valsalva), Grade 1 (mild leak, with no obvious diaphragmatic defect), Grade 2 (moder-
ate leak with obvious diaphragmatic defect) and Grade 3 (high-flow leak with large
diaphragmatic defect). The referenced paper provides an algorithmic approach for
the repair of CSF leaks depending on leak grade.
Park JH, Choi JH, Kim YI, Kim SW, Hong YK. Modified Graded Repair of Cerebrospinal
Fluid Leaks in Endoscopic Endonasal Transsphenoidal Surgery. J Korean Neurosurg
Soc. 2015 Jul;58(1):36–42.
99. Answer B
Pitanguy and Ramos described a line starting from a point 0.5 cm below the tragus that
extended in the direction of the brow, passing 1.5 cm above the lateral extension of
the eyebrow. With this approximation, the nerve lies 2–3 cm from the lateral orbital rim
166 Advanced ENT MCQs
at the level of the lateral canthus (Figure4.6). Note the frontal branch is on the deep
surface of the temporoparietal fascia when above the zygomatic arch. At the level of
the arch, the nerve is relatively deep and adjacent to the periosteum.
Figure4.6 Pitanguy’s line diagram.
Photo: https://plasticsurgerykey.com/4-frontal-branch-of-the-facial-nerve/
100. Answer B
The relevant and main parasympathetic neurotransmitter within the nose, which
causes blood vessel vasodilatation, is acetylcholine. Over-the-counter nasal medica-
tions such as Xylometazoline cause vasoconstriction locally within the nose via adren-
ergic stimulation. This vasoconstriction leads to a reduction in soft tissue swelling and/
or oedema, and as a result, improved nasal flow.
DO I: 10.1201/9 7810 034 55 05 9-5
CHAPTER5: EVIDENCE-BASED MEDICINE,
STATISTICS AND MISCELLANEOUS
1. A study into the effectiveness of a
novel intratympanic drug for the
treatment of sudden sensorineural
hearing loss reports that the differ-
ence in hearing outcomes between
the novel drug-treated group and the
standard-of-care treatment group
was statistically significant (p-value=
0.002). Which of the following state-
ments is correct?
A A p-value <0.05 means the differ-
ence is clinically meaningful
B The higher the p-value the more
clinically meaningful the result
C The threshold for statistical signifi-
cance is always p<0.05
D A p-value of 0.002 means that the
result has a 99.8% chance of being
true
E A p-value of 0.002 means the dif-
ference between the groups would
have a 0.2% chance of occurring
by chance
2. A research study compared the
olfactory dysfunction in men and
women with COVID-19. At 6 months,
the odds ratio of olfactory dysfunc-
tion in women compared to men was
3.1 (95% CI 1.2 to 9.4, p-value= 0.01).
Which statement is correct?
A Men experienced more olfactory
dysfunction than women 6 months
after COVID-19 infection
B Women experienced approximately
three times the severity of olfactory
dysfunction compared to men 6
months after COVID-19 infection
C The odds ratio of olfactory dys-
function in women is calculated
by dividing the number of women
with olfactory dysfunction by the
number of men with olfactory
dysfunction
D The odds ratio indicates that more
women than men experienced
olfactory dysfunction 6 months after
COVID-19 infection
E A lower p-value means a more
clinically significant difference in
olfactory dysfunction
3. You are wanting to investigate
whether the choice of intranasal
steroid affects the symptom con-
trol of chronic rhinosinusitis. You
decide this is best approached by
a randomised controlled trial (RCT).
Which of the following statements is
correct?
A RCTs are better suited for retrospec-
tive analysis
B RCTs are particularly suited for the
evaluation of rare outcomes such
as the development of glaucoma
with intranasal steroid usage
C Randomisation by online randomi-
sation software can minimise the
effect of confounding factors
D Using the first letter of the patient’s
name as a method of randomising
patients would remove the chance
of allocation bias
E An RCT design for this study is
appropriate since RCTs require
shorter follow-up periods
168 Advanced ENT MCQs
4. In a meta-analysis conducted to evalu-
ate the efficacy of a tonsillectomy for
treating recurrent tonsillitis, the research-
ers include studies with varying surgical
techniques. Which statistical method
is commonly used in meta-analysis to
address this heterogeneity and provide
a pooled estimate of treatment effect?
A Sensitivity analysis
B Funnel plot analysis
C Fixed-effects model
D Random-effects model
E Stratified analysis
5. You are explaining the use of vestibular
evoked myogenic potentials (VEMPs) in
the investigation of superior semicircular
canal dehiscence (SSCD) to a medi-
cal student. You explain that the test at
your centre has a sensitivity of 85%. The
medical student asked what this means.
What is another way to explain this?
A 85% of those with a positive test have
SSCD
B The test correctly identifies 85% of
patients without SSCD
C The test has a 15% probability to
return a false positive result
D 85% of those with SSCD will have a
positive test result
E The test is not reliable for diagnosing
SSCD
6. You are designing a randomised con-
trolled trial to assess the apnoea-hypop-
nea index (AHI) after cold steel and
coblation tonsillectomy in children diag-
nosed with obstructive sleep apnoea.
Asample size of 100 was calculated
based on an 80% power to detect a
3-point difference in AHI. You were able
to recruit 90 patients to the trial and you
report that AHI was significantly lower
in the coblation group (p-value= 0.04).
Which of these statements is correct?
A It is likely that there is a clinically
meaningful difference in the AHI
between the groups
B The power to detect a difference of
3 points was lower than 80%
C The trial was adequately powered to
reject the null hypothesis
D The difference in AHI between the
2 groups is significantly larger than 3
points
E The trial should have been stopped if
the number of recruited patients was
less than 100
7. In a population-based study investi-
gating the prevalence of laryngeal
cancer among individuals who smoke
and those who do not, what type of
epidemiological study design is most
suitable for assessing the association
between smoking and laryngeal can-
cer risk?
A Case-control study
B Cross-sectional study
C Cohort study
D Randomised controlled trial
E Ecological study
8. For which of the following situations
would an independent sample t-test be
appropriate?
A Comparing patient body weight
between those with and without
tonsillitis
B Comparing pain on a Likert scale
before and after tonsillectomy
C Comparing patient satisfaction
before and after tonsillectomy for
recurrent tonsillitis
D Comparing the proportion of patients
with recurrent sore throats in those
who have had or have not had
tonsillectomy
E Comparing patient systolic
blood pressure before and after
tonsillectomy
9. You are analysing the results of your
personal series of thyroidectomies.
You find that the Pearson correla-
tion between patient satisfaction and
Chapter 5: Evidence-Based Medicine, Statistics and Miscellaneous 169
length of stay is -0.7 (p= 0.01). Which of
the following is correct?
A Longer patient stays were associated
with greater patient satisfaction
B A correlation coefficient of -0.7 indi-
cates a strong statistical significance
C There is a strong negative correla-
tion between the length of stay and
patient satisfaction
D There is a weak correlation between
the length of stay and patient
satisfaction
E A p-value of 0.05 would suggest a
more statistically significant result
than a p-value of 0.01
10. A journal article reports the result of a
randomised controlled trial comparing
vocal cord injection with a new bio-
material to a placebo. They report the
difference in voice outcome between
the intervention and control group as
measured on a 0–10 cm visual ana-
logue scale (VAS) was 1.2 cm (95%
CI -1.2 cm to 3.6 cm). Which of these
statements is correct?
A 95% of the group treated with the
new material had voice improve-
ment of between -1.2 cm and 3.6 cm
B 5% of the control group had voice
improvement of between -1.2 cm
and 3.6 cm
C The improvement in voice outcomes
of the new material could have been
due to chance
D A VAS is an inappropriate tool for use
with this type of data
E Estimating 99% confidence inter-
vals would give a more accurate
estimate
11. How much adrenaline is contained in 1
ml of 1:10,000 solution?
A 1 microgram
B 10 micrograms
C 100 micrograms
D 1000 micrograms
E 10000 micrograms
12. How much cocaine is in 10 ml of
Moffett’s solution containing 2 ml of
10% cocaine?
A 2 mg
B 20 mcg
C 200 mcg
D 20 mcg
E 200 mg
13. A 12-month-old baby weighing 10 kg
undergoes microlaryngoscopy and
bronchoscopy. During the procedure
lidocaine 10% spray is used. If each
spray delivers 10 mg of lidocaine what is
the number of sprays that can be used?
A 1
B 2
C 3
D 4
E 5
14. What is the maximum safe dose of
lidocaine that can be given to an 80 kg
man?
A 240 mg
B 250 mg
C 320 mg
D 350 mg
E 560 mg
15. What is the maximum recommended
safe dose of lidocaine with adrenaline?
A 5 mg/kg
B 6 mg/kg
C 7 mg/kg
D 8 mg/kg
E 9 mg/kg
16. A 45-year-old man with a prior history of
myocardial infarction and atrial fibrilla-
tion undergoes tonsillectomy and you
wish to administer a long-acting local
anaesthetic for post-operative pain.
Which of the following is the best option?
A Bupivacaine
B Levobupivacaine
C Lidocaine
D Cocaine
E Procaine