Category: Quiz

Inguinal lymph node

INGUINAL LYMPH NODE

Q. 1

Lymphatics from the spongy urethra drain into which of the following lymph nodes?

 A

Sacral nodes

 B

Deep inguinal nodes

 C

Internal inguinal nodes

 D

Superficial inguinal nodes

Q. 1

Lymphatics from the spongy urethra drain into which of the following lymph nodes?

 A

Sacral nodes

 B

Deep inguinal nodes

 C

Internal inguinal nodes

 D

Superficial inguinal nodes

Ans. B

Explanation:

Lymphatics from glans penis, prostatic urethra, spongy urethra and superficial inguinal nodes drains into deep inguinal lymph nodes.


Q. 2

Lymphatic drainage of the cervix occurs by all of the following lymph nodes, EXCEPT?

 A

Parameterial lymph nodes

 B

Deep inguinal lymph nodes

 C

Obturator lymph nodes

 D

Ext. iliac lymph nodes

Q. 2

Lymphatic drainage of the cervix occurs by all of the following lymph nodes, EXCEPT?

 A

Parameterial lymph nodes

 B

Deep inguinal lymph nodes

 C

Obturator lymph nodes

 D

Ext. iliac lymph nodes

Ans. B

Explanation:

Principal nodes involved in the lymphatic drainage of cervix are the obturator, common iliac, external iliac, internal iliac and the nodes of parametrium. Lymphatics from cervix do not drain into the deep iuguinal lymph nodes.


Q. 3

Which of the following is drained directly to deep inguinal lymph nodes:

 A

Glans Penis

 B

Perianal area

 C

Lower abdominal area

 D

Ischiorectal fossa

Q. 3

Which of the following is drained directly to deep inguinal lymph nodes:

 A

Glans Penis

 B

Perianal area

 C

Lower abdominal area

 D

Ischiorectal fossa

Ans. A

Explanation:

A. i.e. Glans penis


Q. 4

Lymphatic drainage of clitoris is to:

 A

Glands of cloquet

 B

Superficial inguinal lymph nodes

 C

Deep inguinal lymph nodes

 D

a and c

Q. 4

Lymphatic drainage of clitoris is to:

 A

Glands of cloquet

 B

Superficial inguinal lymph nodes

 C

Deep inguinal lymph nodes

 D

a and c

Ans. D

Explanation:

A. i.e. Glands of cloquet; C. i.e. Deep injuinal lymph nodes 

–   Glans penis & clitoris drain in deep inguinal lymph nodes of Cloquet or Rosenmuller

Superficial inguinal lymph nodes drain anterior abdominal wall below umbilicus, perineum, anal canal (gluteal region) but not clitoris & toes and fingers.


Q. 5

Superficial inguinal lymph nodes drain from all of the following except:

 A

Urethra

 B

Anal canal below the pectinate line

 C

Glans penis

 D

Perineum

Q. 5

Superficial inguinal lymph nodes drain from all of the following except:

 A

Urethra

 B

Anal canal below the pectinate line

 C

Glans penis

 D

Perineum

Ans. C

Explanation:

Superficial Inguinal Lymph Nodes

  • The horizontal group
  • The medial members of the group receive superficial lymph vessels from the anterior abdominal wall below the level of the umbilicus and from the perineum. The lymph vessels from the urethra, the external genitalia of both sexes (but not the testes), and the lower half of the anal canal are drained by this route.
  • The lateral members of the group receive superficial lymph vessels from the back below the level of the iliac crests.
  • The vertical group lies along the terminal part of the great saphenous vein and receives most of the superficial lymph vessels of the lower limb.

The efferent lymph vessels from the superficial inguinal nodes pass through the saphenous opening in the deep fascia and join the deep inguinal nodes.

Deep Inguinal Lymph Nodes

The deep nodes are located beneath the deep fascia and lie along the medial side of the femoral vein; the efferent vessels from these nodes enter the abdomen by passing through the femoral canal to lymph nodes along the external iliac artery Lymphatic Drainage of the Penis

From most of the penis, lymph drains into the superficial inguinal lymph nodes.

Vessels from the glans penis drain into the deep inguinal lymph nodes.


Q. 6

Lymph from glans penis drains into ‑

 A

Superficial inguinal nodes

 B

Deep inguinal lymph nodes

 C

Obturator nodes

 D

Internal iliac nodes

Q. 6

Lymph from glans penis drains into ‑

 A

Superficial inguinal nodes

 B

Deep inguinal lymph nodes

 C

Obturator nodes

 D

Internal iliac nodes

Ans. B

Explanation:

Vessels from the glans penis drain into the deep inguinal lymph nodes (gland of Cloquet)

From rest of the penis, lymph drains into the superficial inguinal lymph nodes.


Q. 7

Lymphatic drainage of Vulva is into ‑

 A

Obturator nodes

 B

Internal iliac nodes

 C

Superficial inguinal nodes

 D

Paraaortic nodes

Q. 7

Lymphatic drainage of Vulva is into ‑

 A

Obturator nodes

 B

Internal iliac nodes

 C

Superficial inguinal nodes

 D

Paraaortic nodes

Ans. C

Explanation:

Ans. is ‘c’ i.e., Superficial inguinal nodes

Lymphatics of Vulva drain primarily into superficial inguinal lymph nodes and subsequently to deep inguinal and external iliac ndes. Lymphatics of Clitoris primarily drain into deep inguinal nodes.



Carcinoma of Tongue

Carcinoma of Tongue

Q. 1

 Referred otalgia can be due to

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Q. 1

 Referred otalgia can be due to

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Ans. D

Explanation:

 

Causes of referred otalgia

Ear receives nerve supply from Vth (auriculotemporal), 1Xth (tympanic br.) and Xth (auricular br.) cranial nerves; and from C2 (lesser occipital) and C2 and C3 (greater auricular), pain may be referred from these remote areas

1. Via Vth cranial nerve

  • Dental; Caries tooth, apical abscess, impacted molar, malocclusion.
  • Oral cavity; Benign or malignant ulcerative lesions of oral cavity or tongue.
  • Temporomandibular joint disorders; Bruxism, osteoarthritis, recurrent dislocation,  ill-fitting denture.
  • Sphenopalatine neuralgia.

2. Via IXth cranial nerve

  • Oropharynx; Acute tonsillitis, peritonsillar abscess, tonsillectomy. Benign or malignant ulcers of soft palate, tonsil and its pillars.
  • Base of tongue; Tuberculosis or malignancy.
  • Elongated styloid process.

3.   Via Xth cranial nerve. Malignancy or ulcerative lesion of: vallecula, epiglottis, larynx or laryngopharynx, esophagus.

4.   Via C2 and C3 spinal nerves. Cervical spondylitis, injuries of cervical spine, caries spine.


Q. 2

A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is

 A

>No

 B

N1

 C

N2

 D

N3

Q. 2

A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is

 A

>No

 B

N1

 C

N2

 D

N3

Ans. C

Explanation:

Q. 3

Referred otalgia is due to:

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of above

Q. 3

Referred otalgia is due to:

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of above

Ans. D

Explanation:

Q. 4

A patient with carcinoma of tongue is found to have lymph nodes in the lower neck. The treatment of choice for the lymph nodes is:

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Tele radiotherapy

 D

Radical neck dissection

Q. 4

A patient with carcinoma of tongue is found to have lymph nodes in the lower neck. The treatment of choice for the lymph nodes is:

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Tele radiotherapy

 D

Radical neck dissection

Ans. D

Explanation:

Traditionally, the gold standard for control of cervical metastasis has been the radical neck dissection (RND).

The classic RND removes levels I to V of the cervical lymphatics in addition to the SCM, internal jugular vein, and the spinal accessory nerve (CN XI). 

 
Any modification of the RND that preserves nonlymphatic structures (i.e., CN XI, SCM muscle, or internal jugular vein) is defined as a modified radical neck dissection (MRND).

A neck dissection that preserves lymphatic compartments normally removed as part of a classic RND is termed a selective neck dissection (SND).
 
Ref: Weber R.S. (2010). Chapter 18. Disorders of the Head and Neck. In T.R. Billiar, D.L. Dunn (Eds), Schwartz’s Principles of Surgery, 9e.

Q. 5

Which of the following is TRUE differential cause of referred otalgia?

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Q. 5

Which of the following is TRUE differential cause of referred otalgia?

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Ans. D

Explanation:

Otalgia can occur as a symptom of carcinoma on the base of tongue, pharynx or larynx.

 
Ear receives nerve supply from 4 cranial nerves such as trigeminal, facial, glossopharyngeal and vagus; and from two branches of cervical plexus called C2 (lesser occipital) and C2 and C3 (greater auricular), pain maybe referred from these remote areas.
 
Facial nerve refers pain to the external ear canal and post auricular region. Second and third cervical nerves refer pain to the postauricular and mastoid regions. 
 
Trigeminal referred otalgia arise from lesions involving the oral cavity and floor of mouth, teeth, mandible, temporomandibular joint, palate and pre auricular skin.
 
Glossopharyngeal referred otalgia arise from the tonsil, base of the tongue, soft palate, nasopharynx, Eustachian tube and pharynx.
 
Vagal referred otalgia arise from the hypopharynx, larynx and trachea.
 
Differential causes of referred otalgia includes migraine, TMJ syndrome, cervical myalgia, fibromyalgia, dental abscess, head and neck malignancy (neoplasm of nasopharynx, sinus, tonsil, base of tongue, hypopharynx), temporal arteritis, inflammatory sinusitis, carotidynia, trigeminal neuralgia, glossopharyngeal neuralgia and GERD.

Q. 6

A patient has carcinoma of right tongue on its lateral border of anterior 2/3 rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is:

 A

N0

 B

N1

 C

N2

 D

N3

Q. 6

A patient has carcinoma of right tongue on its lateral border of anterior 2/3 rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is:

 A

N0

 B

N1

 C

N2

 D

N3

Ans. C

Explanation:

Since this patient’s cancer has spread to ipsilateral lymph node and is greater than 3cm in size he falls under stage 2a of cancer of oral cavity. 
  • N0: There is no evidence of regional metastasis
  • N1: Metastasis occur to a single ipsilateral lymph node, 3 cm or less in greatest dimension
  • N2a: Metastasis in single ipsilateral lymph node, >3 cm and
  • N2b: Metastasis occur in multiple ipsilateral lymph nodes, all nodes
  • N2c: Metastasis occur in bilateral or contralateral lymph nodes, all nodes

Q. 7

In carcinoma bas of tongue pain is refered to the ear through-

 A

Hypoglossal nerve

 B

Vagus nerve

 C

Glossopharyngeal nerve

 D

Lingual nerve

Q. 7

In carcinoma bas of tongue pain is refered to the ear through-

 A

Hypoglossal nerve

 B

Vagus nerve

 C

Glossopharyngeal nerve

 D

Lingual nerve

Ans. C

Explanation:

C i.e. Glossopharyngeal nerve


Q. 8

Radiotherapy is used for which stage-I cancer 

 A

Colon

 B

Larynx

 C

Anterior 2/3 of tongue

 D

b and c 

Q. 8

Radiotherapy is used for which stage-I cancer 

 A

Colon

 B

Larynx

 C

Anterior 2/3 of tongue

 D

b and c 

Ans. D

Explanation:

B i.e. Larynx; C i.e. Ant 2/3 of tongue

  • Radiotherapy is reserved for early larynx CA which has not involved cartilage or cervical lymphnodes & don’t impair cord mobilityQ.
  • Surgery is the treatment of choice for early lesions suitable for simple infra oral excision, for tumors on the tip of tongue but brachy therapy with iridium wires has the advantage of preserving the tongue.
  • Stomach, colon, lung CA in early stage are treated by surgery.

Q. 9

A patient presented with a 1 x 1.5 cms growth on the lateral border of the tongue. The treatment indicated would be –

 A

Laser ablation

 B

Interstitial brachytherapy

 C

External beam radiotherapy

 D

Chemotherapy

Q. 9

A patient presented with a 1 x 1.5 cms growth on the lateral border of the tongue. The treatment indicated would be –

 A

Laser ablation

 B

Interstitial brachytherapy

 C

External beam radiotherapy

 D

Chemotherapy

Ans. A

Explanation:

Ans is ‘a’ i.e. laser ablation 

Treatment of oral tongue cancer is primarily surgical, with wide local excision and negative margin control.

Small tumors (T1- T2)- may be removed by wide local excision and primary closure or closure by secondary intention.

Excision of larger tumors – requires partial glossectomy or hemiglossectomy.

Schwartz writes- “The CO2 laser may be used for excision of early tongue cancers or for ablation of premalignant lesions.”

If regional lymphnodes are involved- Modified radical neck dissection or selective neck dissection is done.

Indications for postoperative radiation therapy include evidence of perineural or angiolymphatic spread or positive nodal disease.


Q. 10

A patient has carcinoma of tongue in the right lateral aspect with lymph node of 4 cm size in level 3 on the left side of neck, what is the stage ?

 A

NO

 B

N1

 C

N2

 D

N3

Q. 10

A patient has carcinoma of tongue in the right lateral aspect with lymph node of 4 cm size in level 3 on the left side of neck, what is the stage ?

 A

NO

 B

N1

 C

N2

 D

N3

Ans. C

Explanation:

Ans. is ‘c’ i.e. N2 

According to American Joint Committee on Cancer (AJCC), 2002, the regional lymph node staging (N) is common to all head and neck sites, except the nasopharynx.

Regional Lymph Node Staging of Head & Neck Cancers

Classification

Description

NO

No regional lymph node metastasis

N1

Metastasis in a single ipsilateral lymph node,  3 cm in

greatest dimension

N2

Metastasis in a single ipsilateral lymph node, > 3 cm but

< 6 cm in greatest dimension; or in multiple ipsilateral

lymph nodes, none > 6 cm in greatest dimension; or in

bilateral or contralateral lymph nodes, none > 6 cm in

greatest dimension

N2a

Metastasis in single ipsilateral lymph node > 3 cm but

< 6 cm in greatest dimension

N2b

Metastasis in multiple ipsilateral lymph nodes, none > 6

cm in greatest dimension

N2c

Metastasis in bilateral or contralateral lymph nodes, none

> 6 cm in greatest dimension

N3

Metastasis in a lymph node > 6 cm in greatest dimension


Q. 11

Multiple painful ulcers on tongue are seen in all except

 A

Aphthous ulcers

 B

Tuberculous ulcers

 C

Herpes ulcers

 D

Carcinomatous ulcers

Q. 11

Multiple painful ulcers on tongue are seen in all except

 A

Aphthous ulcers

 B

Tuberculous ulcers

 C

Herpes ulcers

 D

Carcinomatous ulcers

Ans. D

Explanation:

Ans is ‘d’ i.e., Carcinomatous ulcer 

Carcinomatous ulcers are painless but may become painful in advanced stages, with extension into surrounding tissues.


Q. 12

A pt. with Ca tongue is found to have lymph nodes in the lower neck. The t/t of choice for the lymph nodes is

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Tele radiotherapy

 D

Radical neck dissection

Q. 12

A pt. with Ca tongue is found to have lymph nodes in the lower neck. The t/t of choice for the lymph nodes is

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Tele radiotherapy

 D

Radical neck dissection

Ans. D

Explanation:

Ans. is ‘d’ ie Radical neck dissection 

“For clinically Node positive necks, frequently the surgical treatment of choice is the MRND or RND.”- Schwartz 9/e p505

The management of cervical node metastasis has already been described in previous question.

Surgical management can be of 3 types: Radical neck dissection (RND), Modified radical neck dissection (MRND) & Selective neck dissection (SND)

Radical neck dissection

is the traditional gold standard for control of cervical metastasis.

–  RND involves removal of levels I to V of the cervical lymph nodes + Sternocleidomastoid, UV and the spinal accessory nerve (CN XI).

Modified radical neck dissection

– is modification of RND that preserves nonlymphatic structures i.e. CN XI, SCM and UV.

MRND has been found to be equally effective in controlling neck disease as RND with superior functional outcome.

Selective neck dissection

– Preservation of any of the levels I through V during neck dissection is known as Selective neck dissection.

– The principle behind preservation of certain nodal groups is that specific primary sites preferentially drain their lymphatics in a predictable pattern. Types of SND include the supraomohyoid neck dissection, the lateral neck dissection, and the posterolateral neck dissection.

“SND is performed on a clinically negative (NO) neck with preservation of nodal groups carrying less than 20% chance of being involved with metastatic disease”- Sabiston 18/e p819


Q. 13

Commonest site of carcinoma tongue –

 A

Apical

 B

Lateral borders

 C

Dorsum

 D

Posterior 1/3

Q. 13

Commonest site of carcinoma tongue –

 A

Apical

 B

Lateral borders

 C

Dorsum

 D

Posterior 1/3

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lateral borders 

Most common site is middle of the lateral border or the ventral aspect of the tongue.


Q. 14

Carcinoma tongue less than 2 cm is treated by

 A

Excision

 B

Radiotherapy

 C

Chemotherapy

 D

Excision and Radiotherapy

Q. 14

Carcinoma tongue less than 2 cm is treated by

 A

Excision

 B

Radiotherapy

 C

Chemotherapy

 D

Excision and Radiotherapy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Excision


Q. 15

Commonest site of carcinoma tongue is –

 A

Dorsum

 B

Ventral aspects

 C

Anterior 2/3 lateral aspect

 D

Tip

Q. 15

Commonest site of carcinoma tongue is –

 A

Dorsum

 B

Ventral aspects

 C

Anterior 2/3 lateral aspect

 D

Tip

Ans. C

Explanation:

Ans. is ‘c’ i.e., Anterior 2/3 lateral aspect


Q. 16

Which is not true of Carcinoma tongue-

 A

Lateral border is involved

 B

Cervical lymph node involvement

 C

Commonly adeno carcinoma

 D

Tobacco chewing is a risk factor

Q. 16

Which is not true of Carcinoma tongue-

 A

Lateral border is involved

 B

Cervical lymph node involvement

 C

Commonly adeno carcinoma

 D

Tobacco chewing is a risk factor

Ans. C

Explanation:

Ans. is ‘c’ i.e., Commonly adeno carcinoma 


Q. 17

60 year old man presents with an ulcer on lateral margin of tongue also complains of ear pain, most probable diagnosis is –

 A

Dental ulcer

 B

Carcinomatous ulcer

 C

Tuberculosis ulcer

 D

Syphilitic ulcer

Q. 17

60 year old man presents with an ulcer on lateral margin of tongue also complains of ear pain, most probable diagnosis is –

 A

Dental ulcer

 B

Carcinomatous ulcer

 C

Tuberculosis ulcer

 D

Syphilitic ulcer

Ans. B

Explanation:

Ans. is ‘b’ i.e., Carcinomatous ulcer 


Q. 18

Carcinoma of the tongue – 

 A

Occurs most commonly on the lateral border of the middle third of tongue

 B

Metastasize readily to cervical lymph nodes

 C

Is usually radiosensitive

 D

All of the above

Q. 18

Carcinoma of the tongue – 

 A

Occurs most commonly on the lateral border of the middle third of tongue

 B

Metastasize readily to cervical lymph nodes

 C

Is usually radiosensitive

 D

All of the above

Ans. D

Explanation:

Ans. is `d’ i.e., All of the above 


Q. 19

Which carcinoma most commonly metastasizes to cervical lymph nodes –

 A

Maxillary sinus

 B

Posterior tongue

 C

Cheek

 D

Hard palate

Q. 19

Which carcinoma most commonly metastasizes to cervical lymph nodes –

 A

Maxillary sinus

 B

Posterior tongue

 C

Cheek

 D

Hard palate

Ans. B

Explanation:

Ans. is ‘b’ i.e., Posterior tongue

See below

Here is the incidence of cervical lymphnode metastasis of various head & Neck tumours

  • Posterior tongue —> 70% (Schwartz 7th/e page 638)
  • Hard palate            —> 10-25 % (7thle page 632)
  • Buccal mucosa —> 56% (7th/e page 631)
  • Maxillary Sinus —> Nodal metastases are rare and occur only in 10-15% cases (p 253 E.N.T. Dhingra 3/e)

Q. 20

The commando operation is – 

 A

Abdomino-perineal resection of the rectum for carcinoma

 B

Disarticulation of the hip for gas gangrene of the leg

 C

Extended radical mastectomy

 D

Excision of carcinoma of the tongue, the floor of the mouth, part of the jaw and lymph nodes enbloc

Q. 20

The commando operation is – 

 A

Abdomino-perineal resection of the rectum for carcinoma

 B

Disarticulation of the hip for gas gangrene of the leg

 C

Extended radical mastectomy

 D

Excision of carcinoma of the tongue, the floor of the mouth, part of the jaw and lymph nodes enbloc

Ans. D

Explanation:

Ans. is ‘d’ i.e., Excision of carcinoma of the tongue, the floor of the mouth, part of the jaw and lymph nodes enbloc


Q. 21

In carcinoma, base of tongue pain is referred to the ear through:

 A

Hypoglossal nerve

 B

Vagus nerve

 C

Glossopharyngeal nerve

 D

Lingual nerve

Q. 21

In carcinoma, base of tongue pain is referred to the ear through:

 A

Hypoglossal nerve

 B

Vagus nerve

 C

Glossopharyngeal nerve

 D

Lingual nerve

Ans. C

Explanation:

 

In carcinoma base of tongue pain is referred to the ipsilateral ear because of the common nerve supply of the base of tongue and ear i.e. Glossopharyngeal nerve.

  • The anterior 2/3 of tongue is supplied by Lingual nerve
  • Lingual nerve is a branch of mandibular N and auriculotemporal N which supplies ear is also a branch of mandibular N. Hence any pain of anterior 2/3 of tongue is referred to ear via mandibular N.
  • Any pain in the posterior 1/3 of tongue is referred to ear via Glossopharyngeal and vagus N.
  • Any pain in the base of tongue is referred to ear via glossopharyngeal N.



Q. 22

Carcinoma tongue most frequently develops from:

 A

Tip

 B

Lateral border

 C

Dorsal portion

 D

All portions equally

Q. 22

Carcinoma tongue most frequently develops from:

 A

Tip

 B

Lateral border

 C

Dorsal portion

 D

All portions equally

Ans. B

Explanation:

Most common site of carcinoma tongue is middle of lateral border or the ventral aspect of the tongue followed by tip and dorsum.


Q. 23

A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is:

 A

NO

 B

N1

 C

N2

 D

N3

Q. 23

A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is:

 A

NO

 B

N1

 C

N2

 D

N3

Ans. C

Explanation:

 

Classification of stage of tumor of oral cavity based on size of lymph node.


Q. 24

A patient with Ca tongue is found to have lymph nodes in the lower neck. Treatment done is :

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Teleradiotherapy

 D

Radical neck dissection

Q. 24

A patient with Ca tongue is found to have lymph nodes in the lower neck. Treatment done is :

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Teleradiotherapy

 D

Radical neck dissection

Ans. D

Explanation:

Q. 25

A patient presented with a 1×1.5 cms growth on the lateral border of the tongue. The treatment indicated would be:

 A

Laser ablation

 B

Interstitial brachytherapy

 C

External beam radiotherapy

 D

Chemotherapy

Q. 25

A patient presented with a 1×1.5 cms growth on the lateral border of the tongue. The treatment indicated would be:

 A

Laser ablation

 B

Interstitial brachytherapy

 C

External beam radiotherapy

 D

Chemotherapy

Ans. B

Explanation:

 

Tumor of lateral border of tongue

T1 stage (< 2cm in size): Insterstitial irradiation or excision (partial glossectomy).

T2 stage (> 2 cm) in size: External beam radiotherapy or hemiglossectomy


Q. 26

Referred pain in the ear is commonly from ___

 A

Maxillary carcinoma

 B

Nasopharyngeal carcinoma

 C

Carcinoma tongue

 D

Malignant otitis externa

Q. 26

Referred pain in the ear is commonly from ___

 A

Maxillary carcinoma

 B

Nasopharyngeal carcinoma

 C

Carcinoma tongue

 D

Malignant otitis externa

Ans. C

Explanation:

 

Referred causes of earache:

As the ear receives nerve supply from:

  • Vth (auriculotemporal branch) cranial nerve-dental, oral cavity, temporomandibular joint disorders and sphenopalatine neuralgia
  • IXth (tympanic branch) cranial nerve -oropharynx, base of tongue, elongated styloid process
  • Xth (auricular branch) cranial nerve-vallecula, epiglottis, larynx, esophagus
  • From C2 (lesser occipital) and C2 and C3 (greater auricular), pain may be referred from these remote areas.

Q. 27

Carcinoma of tongue most commonly occur at:

March 2009

 A

Dorsum

 B

Lateral border of anterior 2/3rd

 C

Lateral border of posterior 1/3rd

 D

Tip

Q. 27

Carcinoma of tongue most commonly occur at:

March 2009

 A

Dorsum

 B

Lateral border of anterior 2/3rd

 C

Lateral border of posterior 1/3rd

 D

Tip

Ans. B

Explanation:

Ans. B: Lateral border of anterior 2/3rd

Carcinoma of the tongue is relatively common in India and forms a significant group.

The anatomical sites that are frequently involved in mouth cancer include the floor of the mouth, the lateral border of the anterior tongue and the retromolar trigone.

Although lesion is either ulcerative or proliferative on an easily visible organ with exceptional mobility,it usually present in late stages. Hence, even though the disease is curable and has a high five years survival rate, presenting in the late stages, reduces five years survival rate.

According to Frenzel, though tumor size does not have direct correlation with prognosis, larger tumor size is associated with shorter survival.


Q. 28

Most common histological type of carcinoma of tongue:

March 2007

 A

Squamous cell carcinoma

 B

Adeno carcinoma

 C

Basal cell carcinoma

 D

Transitional cell carcinoma

Q. 28

Most common histological type of carcinoma of tongue:

March 2007

 A

Squamous cell carcinoma

 B

Adeno carcinoma

 C

Basal cell carcinoma

 D

Transitional cell carcinoma

Ans. A

Explanation:

Ans. A: Squamous cell carcinoma

Tongue development begins during the fourth embryonic week and develops from the region of the first 3-4 branchial arches. The tongue is supplied by the lingual arteries.

Innervation of the tongue includes the lingual and hypoglossal nerves for sensation and movement and the sympathetic, parasympathetic, and special sensory fibers for salivation and taste ability.

The most common histology finding in patients with malignant neoplasms of the base of the tongue is squamous cell carcinoma.

SCC is the predominant histology for tumours arising in the oral cavity and oropharynx.



Inguinal canal

INGUINAL CANAL

Q. 1

True about boundaries of inguinal canal are all EXCEPT:

 A

Conjoint tendon anteriorly

 B

Fascia transversalis is posterior boundary

 C

Inguinal ligament forms base

 D

Internal oblique forms roof

Q. 1

True about boundaries of inguinal canal are all EXCEPT:

 A

Conjoint tendon anteriorly

 B

Fascia transversalis is posterior boundary

 C

Inguinal ligament forms base

 D

Internal oblique forms roof

Ans. A

Explanation:

Conjoint tendon anteriorly

To help define the boundaries, the canal is often further approximated as a box with six sides. Not including the two rings, the remaining four sides are usually called the “anterior wall”, “posterior wall”, “roof”, and “floor”-These consist of the following:

  •          M – Muscles
  • A – Aponeuroses (The A in MALT coincides with the position of the wall—anterior. This can be used to remember that the direction of the mnemonic is anticlockwise)
  • L – Ligaments
  • T – Transversalis/Tendon

Q. 2

Posterior wall of inguinal canal formed by all, except:

 A

Interfoveolar ligament

 B

Parietal peritoneum

 C

Fascia transversalis

 D

Internal oblique 

Q. 2

Posterior wall of inguinal canal formed by all, except:

 A

Interfoveolar ligament

 B

Parietal peritoneum

 C

Fascia transversalis

 D

Internal oblique 

Ans. D

Explanation:

Internal oblique 


Q. 3

Which of the following structures passes behind the inguinal ligament?

1. Femoral branch of genitofemoral nerve
2. Superficial epigastric artery
3. Psoas major
4. Femoral vein
5. Saphenous vein

 

 A

1,2 & 3

 B

3 & 4

 C

1,3,4 & 5

 D

All

Q. 3

Which of the following structures passes behind the inguinal ligament?

1. Femoral branch of genitofemoral nerve
2. Superficial epigastric artery
3. Psoas major
4. Femoral vein
5. Saphenous vein

 

 A

1,2 & 3

 B

3 & 4

 C

1,3,4 & 5

 D

All

Ans. B

Explanation:

Three small cutaneous arteries (superficial external pudendal, superficial epigastric and superficial circumflex iliac arteries) arising from the femoral artery can be seen a little below the inguinal ligaments.

Femoral branch of the genitofemoral nerve pierces the femoral sheath and overlying deep fascia 2 cm below the mid inguinal point.

The great saphenous vein pierces the saphenous opening in the deep fascia (fascia lata) of the thigh and joins the femoral vein 4 cm below and lateral to the pubic tubercle.

So from the above discussion it is clear that femoral branch of the genitofemoral nerve, superficial epigastric artery and saphenous vein passes below (not behind) the inguinal ligament.

Psoas major insertion: The muscle passes behind the inguinal ligament and in front of the hip joint to enter the thigh.
Femoral vein leaves the thigh by passing behind the inguinal ligament.


Q. 4

All are TRUE about the relation of inguinal canal, EXCEPT?

 A

Internal oblique forms the roof

 B

Inguinal ligament forms the floor

 C

Fascia transversalis forms anterior wall

 D

Interfoveolar ligament forms lateral two third of anterior wall

Q. 4

All are TRUE about the relation of inguinal canal, EXCEPT?

 A

Internal oblique forms the roof

 B

Inguinal ligament forms the floor

 C

Fascia transversalis forms anterior wall

 D

Interfoveolar ligament forms lateral two third of anterior wall

Ans. D

Explanation:

Boundaries of Inguinal canal:

  • Floor is formed by the grooved upper surface of the inguinal ligament
  • Roof  is formed by the arching lower fibers of Internal oblique and transverse abdominal muscles.
  • Anterior wall is formed by the external oblique aponeurosis all through it is extentreinforced laterally by the Internal oblique muscle
  • Posterior wall is formed by the transversalis fascia all through its extent, reinforced medially by the conjoint tendon also known as inguinal falx (Fused fibers of transversus abdominis and internal oblique muscles).
Must know:
Contents of the inguinal canal:
In the males,
  • Spermatic cord
  • Ilioinguinal nerve
  • Cremaster and its blood supply
  • Genital branch of genitofemoral nerve
  • Remnants of processes vaginals
In the female
  • Round ligament of uterus, (remnant of Gubernaculum)
  • Genital branch of genitofemoral nerve
  • Ilioinguinal nerve
  • Cremaster and its blood supply
  • Remnants of processes vaginalis.

Q. 5

True about boundaries of inguinal canal are all, EXCEPT:

 A

Conjoint tendon is seen anteriorly

 B

Fascia transversalis forms posterior boundary

 C

Inguinal ligament forms the base

 D

Internal oblique forms the roof

Q. 5

True about boundaries of inguinal canal are all, EXCEPT:

 A

Conjoint tendon is seen anteriorly

 B

Fascia transversalis forms posterior boundary

 C

Inguinal ligament forms the base

 D

Internal oblique forms the roof

Ans. A

Explanation:

Conjoint tendon is formed by the condensation of fibers of internal oblique and transverse abdominis. It forms the posterior wall of inguinal canal.

Boundaries of inguinal canal:

  • Anterior wall of inguinal canalis made up of external oblique aponeurosis with some fibers of internal oblique which attach to lateral part of inguinal ligament.
  • Posterior wall is formed from transversalis facia, except medially where the conjoint tendon from transversus abdominis intervenes.
  • Inferior wall (floor) is formed from the inguinal ligament as it turns inward, and it is composed medially of lacunar ligament.
  • Roof consist of lowermost fibers of internal oblique and transversus abdominis as they arch over the canal to join together as conjoined tendon.

Q. 6

All of the following statements regarding inguinal canal are true, EXCEPT:

 A

Inguinal ligament forms posterior wall of inguinal canal

 B

Internal oblique forms both anterior and posterior wall

 C

Deep inguinal ring is an opening in transversalis abdominis

 D

Superficial inguinal ring is found in external oblique aponeurosis

Q. 6

All of the following statements regarding inguinal canal are true, EXCEPT:

 A

Inguinal ligament forms posterior wall of inguinal canal

 B

Internal oblique forms both anterior and posterior wall

 C

Deep inguinal ring is an opening in transversalis abdominis

 D

Superficial inguinal ring is found in external oblique aponeurosis

Ans. C

Explanation:

Deep inguinal ring is an oval opening in the fascia transversalis, that lies about ½ inch above the inguinal ligament midway between the anterior superior iliac spine and pubis symphysis. Medial to it lies the inferior epigastric vessels.

Superficial inguinal ring is a triangular gap in the external oblique aponeurosis, which lies above and medial to the pubic tubercle.

 


Q. 7

The boundaries of the inguinal triangle include all of the following, EXCEPT:

 A

Lateral border of rectus abdominis

 B

Inguinal ligament

 C

Inferior epigastric artery

 D

Linea alba

Q. 7

The boundaries of the inguinal triangle include all of the following, EXCEPT:

 A

Lateral border of rectus abdominis

 B

Inguinal ligament

 C

Inferior epigastric artery

 D

Linea alba

Ans. D

Explanation:

Inguinal triangle is a region defined by the following structures:

  • Rectus abdominis muscle (medially)
  • Inguinal ligament (inferiorly)
  • Inferior epigastric vessels (superior and laterally)
It is the region in which direct inguinal hernias protrude through the abdominal wall.
The Hesselbach triangle is bounded by the inguinal ligament, the inferior epigastric vessels, and the lateral border of the rectus muscle. A weakness or defect in the transversalis fascia, which forms the floor of this triangle, results in a direct inguinal hernia.

 


Q. 8

All passes through deep inguinal ring, EXCEPT?

 A

Spermatic cord

 B

Internal spermatic fascia

 C

Round ligament

 D

Ilio inguinal nerve

Q. 8

All passes through deep inguinal ring, EXCEPT?

 A

Spermatic cord

 B

Internal spermatic fascia

 C

Round ligament

 D

Ilio inguinal nerve

Ans. D

Explanation:

It transmits the spermatic cord in the male and the round ligament of the uterus in the female into the inguinal canal. Internal spermatic fascia is present in the spermatic cord. Ilio inguinal nerve passes only through superficial inguinal canal and not through deep.

Inguinal canal: contains the spermatic cord and the ilioinguinal nerve in the male, and the round ligament of the uterus and the ilioinguinal nerve in the female. It is an oblique canal about 4 cm. long, slanting downward and medialward, and placed parallel with and a little above the inguinal ligament; it extends from the deep inguinal ring laterally to the superficial inguinal ring medially.

 Deep inguinal ring: hole in transversalis fascia lying 3cm superior to the midpoint of the inguinal ligament.
Contents:
  • Spermatic cord in males
  • Round ligament in females
Superficial inguinal ring: V-shaped defect in the lower medial fibres of the external oblique just superior and lateral to the pubic tubercle.
Contents:
  • Spermatic cord in males
  • Round ligament in females
  • Ilioinguinal  nerve in both males and females

Q. 9

Posterior wall of inguinal canal is formed by all of the following structures, EXCEPT ?

 A

Interfoveolar ligament

 B

Parietal peritoneum

 C

Fascia transversalis

 D

Internal oblique muscle

Q. 9

Posterior wall of inguinal canal is formed by all of the following structures, EXCEPT ?

 A

Interfoveolar ligament

 B

Parietal peritoneum

 C

Fascia transversalis

 D

Internal oblique muscle

Ans. D

Explanation:

The posterior wall of inguinal canal is formed by:
  • Along the whole length: fascia transversalis, extraperitoneal tissue, parietal peritoneum, inferior epigastric vessels.
  • Along the medial two third of the canal: Conjoint tendon, reflected part of inguinal ligament and interfoveolar ligament in the lateral one third.
Structures forming anterior wall of inguinal canal:
  • Along the whole length of canal: skin, superficial fascia, external oblique aponeurosis.
  • Along the lateral third of the canal: The fleshy fibers of the internal oblique muscle are also present deep to the external oblique aponeurosis.
Anterior wall of the inguinal canal is formed in the whole length by the aponeurosis of external oblique muscle.

Q. 10

True about inguinal canal:

 A

It is an Intermuscular canal

 B

Superficial inguinal ring is situated superior and lateral to pubic tubercles

 C

In male vas deference passes through it.

 D

All

Q. 10

True about inguinal canal:

 A

It is an Intermuscular canal

 B

Superficial inguinal ring is situated superior and lateral to pubic tubercles

 C

In male vas deference passes through it.

 D

All

Ans. D

Explanation:

A. i.e. It is an intermuscular canal; B. i.e. Superficial inguinal ring is situated superior & lateral to pubic tubercles; D. i.e. In males vas deferens passes through it


Q. 11

All are true about inguinal canal except :

 A

Conjoint tendon forms part of the posterior wall

 B

Superficial ring is found in ext oblique aponeurosis

 C

Deep ring is an opening in transversalis abdominis

 D

Internal oblique forms both anterior and posterior wall

Q. 11

All are true about inguinal canal except :

 A

Conjoint tendon forms part of the posterior wall

 B

Superficial ring is found in ext oblique aponeurosis

 C

Deep ring is an opening in transversalis abdominis

 D

Internal oblique forms both anterior and posterior wall

Ans. C

Explanation:

C i.e. Deep inguinal ring is an opening in transversalis abdominis


Q. 12

The inguinal canal is NOT bounded posteriorly by:

 A

Transversalis fascia

 B

Internal oblique tendon

 C

Conjoint tendon

 D

Lacunar ligament

Q. 12

The inguinal canal is NOT bounded posteriorly by:

 A

Transversalis fascia

 B

Internal oblique tendon

 C

Conjoint tendon

 D

Lacunar ligament

Ans. D

Explanation:

D i.e. Lacunar ligament


Q. 13

All of the following structures pass through the inguinal canal in females, Except:

 A

Ilioinguinal nerve

 B

Round ligament of uterus

 C

Lymphatics from the uterus

 D

Inferior Epigastric Artery

Q. 13

All of the following structures pass through the inguinal canal in females, Except:

 A

Ilioinguinal nerve

 B

Round ligament of uterus

 C

Lymphatics from the uterus

 D

Inferior Epigastric Artery

Ans. D

Explanation:

D i.e. Inferior Epigastric Artery

–    Inguinal canal is an oblique intermuscular canal in anterior abdominal wall from deep to superficial inguinal rings. It contains (passes) spermatic cord in males, round ligament in females and ilioinguinal nerve in both sexes Constituents of spermatic cord include vas (ductus) deferens, artery of ductus deferens with autonomic sympathetic nerves around it; testicular artery, lymphatics and vein (pampiniform plexus); cremasteric artery & genital branch of genitofemoral nerve supplying cremasteric muscle; and remains of processes vaginalis.

 It contains blood vessels, nerves & lymphatics. The lymphatics drain the uterine region around the entery of uterine tube to the superficial inguinal lymph nodes. 

Genital branch of genitofemoral nerve enters the inguinal canal by deep ring and supplies cremaster muscle and skin of scrotum in males. In females, it accompanies the round ligament and ends in the skin of mons pubis & labium majus(sensory supply)

Superficial inguinal ring is a triangular hiatus (opening) in external oblique aponeurosis, just above & lateral (i.e. suprolateral) to pubic crest (Gray’s)/ to pubicle tubercleQ (Moore).

Inferior epigastric vessels neither pass through deep or superficial inguinal rings nor does it travel through inguinal canalQ. However, inferior epigastric vessels are important posterior relations of medial end of inguinal canal. They lie on fascia transversalis and ascend obliquely behind conjoint tendon into posterior portion of rectus sheath.

Deep inguinal ring is an opening in fascia transversalis  

–    Lacunar ligament along with inguinal ligament forms inferior wall 

Triangle of Doom is bounded by gonadal vessels (lateral), vas deferens (medial), and peritoneal reflection (base).


Q. 14

Which structure(s) passes behind the inguinal ligament:

 A

Femoral branch of genitofemoral nerve

 B

Femoral vein

 C

Psoas major

 D

All

Q. 14

Which structure(s) passes behind the inguinal ligament:

 A

Femoral branch of genitofemoral nerve

 B

Femoral vein

 C

Psoas major

 D

All

Ans. D

Explanation:

A i.e. Femoral branch of genitofemoral nerve; B i.e. Femoral vein ; C i.e. Psoas major


Q. 15

The testis descends the inguinal canal during…month.

 A

5th

 B

6th

 C

7th

 D

8th

Q. 15

The testis descends the inguinal canal during…month.

 A

5th

 B

6th

 C

7th

 D

8th

Ans. C

Explanation:

C i.e. 7th


Q. 16

Superficial inguinal ring in the female transmits:

 A

Broad ligament of uterus

 B

Round ligament of the uterus

 C

Cardinal ligament

 D

None of the above

Q. 16

Superficial inguinal ring in the female transmits:

 A

Broad ligament of uterus

 B

Round ligament of the uterus

 C

Cardinal ligament

 D

None of the above

Ans. B

Explanation:

The superficial inguinal ring is a triangular aperture in the aponeurosis of the external oblique muscle and is situated above and medial to the pubic tubercle.

In the female, the superficial inguinal ring is smaller and difficult to palpate; it transmits the round ligament of the uterus.


Q. 17

The Following Figure Showing the Saggital section of Inguinal Canal . What are the structures forming the Roof of the Canal 

 A

Aponeurosis of External Oblique 

 B

Transverse Abdominal Muscle 

 C

Both of the Above 

 D

None of the Above

Q. 17

The Following Figure Showing the Saggital section of Inguinal Canal . What are the structures forming the Roof of the Canal 

 A

Aponeurosis of External Oblique 

 B

Transverse Abdominal Muscle 

 C

Both of the Above 

 D

None of the Above

Ans. B

Explanation:


Q. 18

All are contents of inguinal canal except ‑

 A

Femoral branch of genitofemoral nerve

 B

Ilioinguinal nerve

 C

Round ligament of uterus

 D

Spermatic cord

Q. 18

All are contents of inguinal canal except ‑

 A

Femoral branch of genitofemoral nerve

 B

Ilioinguinal nerve

 C

Round ligament of uterus

 D

Spermatic cord

Ans. A

Explanation:

Contents of inguinal canal

  • Spermatic cord in male or round ligament of uterus in female.
  • Ilioinguinal nerve : It enters through the interval between external and internal oblique muscles.

Note: Genital branch of genitofemoral nerve is a component of spermatic cord (not femoral branch of genitofemoral nerve).


Q. 19

Nerve entering the inguinal canal through deep inguinal ring ‑

 A

Ilioinguinal nerve

 B

Pudendal nerve

 C

Genital branch of genitofemoral

 D

Superior rectal nerve

Q. 19

Nerve entering the inguinal canal through deep inguinal ring ‑

 A

Ilioinguinal nerve

 B

Pudendal nerve

 C

Genital branch of genitofemoral

 D

Superior rectal nerve

Ans. C

Explanation:

The spermatic cord in males and round ligament of uterus in females, enter the inguinal canal through the deep inguinal ring and pass out through superficial inguinal ring.

Thus consituents of spermatic cord are also components of inguinal canal; these are ductus deferens (vas deferens), testicular artery, cremestric artery, artery to ductus deference, pampiniform plexus, lymphatics, sympathetic plexus, genital branch of genitofemoral nerve, remains of process vaginalis.

Note: Ili oiguinal nerve enters inguinal canal through interval between external and internal oblique muscles (not through deep inguinal ring).


Q. 20

Which is not a content of inguinal canal ‑

 A

Spermatic cord

 B

Ilioinguinal nerve

 C

Genital branch of genitofemoral nerve

 D

Inferior epigastric artery

Q. 20

Which is not a content of inguinal canal ‑

 A

Spermatic cord

 B

Ilioinguinal nerve

 C

Genital branch of genitofemoral nerve

 D

Inferior epigastric artery

Ans. D

Explanation:

Ans. is ‘d’ i.e., Inferior epigastric artery

Contents of inguinal canal

  • Spermatic cord in male or round ligament of uterus in female.
  • Ilioinguinal nerve : It enters through the interval between external and internal oblique muscles.
  • Genital branch of genitofemoral nerve is a constituent of spermatic cord.


Layngomalacia

Layngomalacia

Q. 1

Omega shaped epiglottis is seen in ____________

 A

Laryngomalacia

 B

Epiglottitis

 C

Tuberculosis

 D

Carcinoma of epiglottis

Q. 1

Omega shaped epiglottis is seen in ____________

 A

Laryngomalacia

 B

Epiglottitis

 C

Tuberculosis

 D

Carcinoma of epiglottis

Ans. A

Explanation:

 

  • In laryngomalacia direct laryngoscopy shows elongated epiglottis, curled upon itself (omega–shaped), floppy aryepiglottic folds and prominent arytenoids.
  • Pediatric Epiglottis is omega–shaped and arytenoids relatively large covering significant portion of the posterior glottis.

Q. 2

A 3 month old child presents with intermittent stridor. Most likely cause is:

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Epiglottitis

Q. 2

A 3 month old child presents with intermittent stridor. Most likely cause is:

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Epiglottitis

Ans. B

Explanation:

Q. 3

Which of the following is the commonest cause of stridor in a newborn who born at term?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Q. 3

Which of the following is the commonest cause of stridor in a newborn who born at term?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Ans. A

Explanation:

Laryngomalacia is the most common cause of stridor in infants, and is also the most common congenital laryngeal abnormality, accounting for approximately 60% of cases. Stridor occurs as a result of prolapse of the supraglottic structures into the laryngeal inlet on inspiration. 
 
The epiglottis is classically described as being omega shaped and folded in upon itself so that the lateral margins lie close to each other. The aryepiglottic folds are tall, foreshortened, and thin, and the arytenoids are large with redundant mucosa.
 
Ref: Yates P.D. (2012). Chapter 33. Stridor in Children. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e.

Q. 4

A newborn is found to have stridor. What is the the commonest cause of stridor in a newborn?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Q. 4

A newborn is found to have stridor. What is the the commonest cause of stridor in a newborn?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Ans. A

Explanation:

Laryngomalacia is the most common cause of stridor in infants, and is also the most common congenital laryngeal abnormality, accounting for approximately 60% of cases.
Stridor occurs as a result of prolapse of the supraglottic structures into the laryngeal inlet on inspiration.
 
Also know:
 
Stridor is generally of laryngeal or tracheal origin.
As a general rule, inspiratory stridor originates from the supraglottis and glottis, expiratory stridor from the trachea, and biphasic stridor from the subglottis. 
 
Ref: Yates P.D. (2012). Chapter 33. Stridor in Children. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e.

Q. 5

What is the COMMONEST cause of stridor in a newborn?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Q. 5

What is the COMMONEST cause of stridor in a newborn?

 A

Laryngomalacia

 B

Foreign body

 C

Meconium aspiration

 D

Recurrent laryngeal nerve palsy due to birth

Ans. A

Explanation:

Laryngomalacia is the most common cause of stridor in neonates.
Stridor occurs within the first 2-4 weeks of life.
In this case, stridor becomes worse with crying and agitation and is relieved by lying in the prone position. 

 

 

 

Vocal cord paralysis is the second most common cause of vocal cord paralysis. 

 

  • Stridor is primarily inspiratory in supraglottic disorders such as laryngomalacia.
  • It is biphasic or inspiratory and expiratory in glottic and subglottic disorders such as vocal cord disease, subglottic stenosis.
  • It is expiratory in tracheal disease such as tracheomalacia.

 

Ref: Pediatric Emergency Medicine  By Steven G. Rothrock PAGE 68.

 


Q. 6

What is the treatment of choice in a newborn presented with stridor due to laryngomalacia?

 A

No treatment

 B

Immediate surgery

 C

Steroids

 D

Surgery after 2 years

Q. 6

What is the treatment of choice in a newborn presented with stridor due to laryngomalacia?

 A

No treatment

 B

Immediate surgery

 C

Steroids

 D

Surgery after 2 years

Ans. A

Explanation:

In most patients, laryngomalacia is a self-limiting condition that does not result in any harm to the patient; therefore, observation is all that is required. In the most severe cases of laryngomalacia, which is encountered in a small percentage of patients, a temporary tracheotomy. The main indications for surgery are severe stridor, apnea, failure to thrive, pulmonary hypertension, and cor pulmonale.

 

 

 

Ref: Yates P.D. (2012). Chapter 33. Stridor in Children. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e. 

 


Q. 7

A 3 month old child presents with intermittent stridor. Most likely cause is:

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Foreign body aspiraton

Q. 7

A 3 month old child presents with intermittent stridor. Most likely cause is:

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Foreign body aspiraton

Ans. B

Explanation:

Q. 8

Most common cause of stridor in infants is:

 A

Laryngomalacia

 B

Laryngeal cysts

 C

Vocal cord polyp

 D

None of the above

Q. 8

Most common cause of stridor in infants is:

 A

Laryngomalacia

 B

Laryngeal cysts

 C

Vocal cord polyp

 D

None of the above

Ans. A

Explanation:

Laryngomalacia is the most common cause of stridor in infants and is also the most common congenital laryngeal abnormality, accounting for approximately 60% of cases.


Q. 9

Recognised cause of stridor in newborn-

 A

Cystic hygroma

 B

A Vascular ring

 C

Laryngomalacia

 D

All are true

Q. 9

Recognised cause of stridor in newborn-

 A

Cystic hygroma

 B

A Vascular ring

 C

Laryngomalacia

 D

All are true

Ans. D

Explanation:

Ans. is ‘d’ i.e., All of the above

Stridor

o Stridor refers to the physical finding of excessively noisy breathing and is general due to airway obstruction. Causes of Stridor in a child

Infections                                                                  Congenital                                                 Neoplasms

o Croup (laryngotracheobronchitis)              o Laryngomalacia                              o Subglottic hemangioma

o Epiglotitis                                              o Vocal cord palsy                              o Laryngeal papillomas

o Bacterial tracheitis                                  o Subglottic stenosis

o Retropharyngeal abscess                        o Vascular ring

o Saccular cyst

o Cystic hygroma, when it occurs in larynx then it can cause respiratory tract obustruction


Q. 10

Most common cause of stridor in infant and young children –

 A

Abductor palsy

 B

Croup

 C

Laryngomalacia

 D

Epiglottitis

Q. 10

Most common cause of stridor in infant and young children –

 A

Abductor palsy

 B

Croup

 C

Laryngomalacia

 D

Epiglottitis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Laryngomalacia

Laryngomalacia is the most common congenital laryngeal anomaly.

o It is the most common cause of stridor in infants and children.


Q. 11

A 3 month old child presents with intermittent stridor. Most likely cause is –

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Foreign body aspiration

Q. 11

A 3 month old child presents with intermittent stridor. Most likely cause is –

 A

Laryngotracheobronchitis

 B

Laryngomalacia

 C

Respiratory obstruction

 D

Foreign body aspiration

Ans. B

Explanation:

Ans. is ‘b’ i.e., Laryngomalacia

Larvngomalacia

o Laryngomalacia is the most common congenital laryngeal anomaly.

o It is the most common cause of stridor in infants and children.

  • Symptoms appear in the first 2 weeks of life and increase in severity for upto 6 months.
  • Typical presentation is inspiratory stridor which is exacerbated by any exertion (crying, agitation, feeding), supine position, and viral infection of URT.

Stridor is due to partial collapse of a flaccid supraglottic airway during inspiration.


Q. 12

Most common cause of stridor shortly after  birth –

 A

Laryngeal papilloma

 B

Laryngeal web

 C

Laryngomalacia

 D

Vocal cord palsy

Q. 12

Most common cause of stridor shortly after  birth –

 A

Laryngeal papilloma

 B

Laryngeal web

 C

Laryngomalacia

 D

Vocal cord palsy

Ans. C

Explanation:

Ans. is ‘c’ i.e., Laryngomalacia


Q. 13

A 2-month old infant has had inspiratory stridor since the first month of life, but has been otherwise well. Physical examination is unremarkable except for moderate inspiratory stridor and retractions which are worse when the infant is supine or agitated and better when he is prone and quiet. The most likely cause of these findings is –

 A

Reactive airway disease

 B

Laryngomalacia

 C

Viral croup

 D

An aspirated foreign body

Q. 13

A 2-month old infant has had inspiratory stridor since the first month of life, but has been otherwise well. Physical examination is unremarkable except for moderate inspiratory stridor and retractions which are worse when the infant is supine or agitated and better when he is prone and quiet. The most likely cause of these findings is –

 A

Reactive airway disease

 B

Laryngomalacia

 C

Viral croup

 D

An aspirated foreign body

Ans. B

Explanation:

Ans. is ‘b’ i.e., Laryngomalacia

  • Most common cause of inspiratory stridor in an infant is laryngomalacia.
  • Stridor is exacerbased on agitation, supine position and viral infection.

Q. 14

Most common congenital anomaly of larynx:

 A

Laryngeal web

 B

Laryngomalacia

 C

Laryngeal stenosis

 D

Vocal and palsy

Q. 14

Most common congenital anomaly of larynx:

 A

Laryngeal web

 B

Laryngomalacia

 C

Laryngeal stenosis

 D

Vocal and palsy

Ans. B

Explanation:

Q. 15

Regarding laryngomalacia:

 A

Most common cause of stridor in newborn

 B

Omega-shaped epiglottis

 C

Inspiratory stridor

 D

All

Q. 15

Regarding laryngomalacia:

 A

Most common cause of stridor in newborn

 B

Omega-shaped epiglottis

 C

Inspiratory stridor

 D

All

Ans. D

Explanation:

Q. 16

Which is not true about laryngomalacia?

 A

Omega-shaped epiglottis

 B

Stridor increases on crying, but decreases on placing the child in prone position

 C

Most common congenital anomaly of the larynx

 D

Surgical management of the airway by tracheostomy is the preferred initial treatment

Q. 16

Which is not true about laryngomalacia?

 A

Omega-shaped epiglottis

 B

Stridor increases on crying, but decreases on placing the child in prone position

 C

Most common congenital anomaly of the larynx

 D

Surgical management of the airway by tracheostomy is the preferred initial treatment

Ans. D

Explanation:

 

Laryngomalacia

  • It is the M/C congenital anomaly of the larynx
  • It is the M/C condition causing inspiratory stridor afterbirth.
  • The stridor worsens during sleep and when baby is in supine position (not in prone position). Rather when the child is placed in prone position it is relieved.
  • On laryngoscopy – Epiglottis is omega shaped and aryepiglottis folds are floppy.

Treatment

Conservative Management



Q. 17

About laryngomalacia, all are true except:

 A

MC neonatal respiratory lesion

 B

Decreased symptoms during prone position

 C

Self-limiting by 2-3 years of age

 D

Omega-shaped epiglottis seen

Q. 17

About laryngomalacia, all are true except:

 A

MC neonatal respiratory lesion

 B

Decreased symptoms during prone position

 C

Self-limiting by 2-3 years of age

 D

Omega-shaped epiglottis seen

Ans. B

Explanation:

Q. 18

Most common mode of treatment for laryngomalacia is: 

 A

Reassurance

 B

Medical

 C

Surgery

 D

Wait and watch

Q. 18

Most common mode of treatment for laryngomalacia is: 

 A

Reassurance

 B

Medical

 C

Surgery

 D

Wait and watch

Ans. A

Explanation:

 

In most patients laryngomalacia is a self-limiting condition.

Treatment of laryngomalacia is reassurance to the parents and early antibiotic therapy for upper respiratory tract infections. Tracheostomy is required only in severe respiratory obstruction.

Surgical intervention (supraglottoplasty i.e. reduction of redundant laryngeal mucosa) is indicated for 10% of patients. Main indica­tions for surgery are:

    • Severe stridor
    • Apnea
    • Failure to thrive
    • Pulmonary hypertension
    • Cor pulmonale



Q. 19

MC cause of intermittent stridor in a 10-day-old child shortly after birth is:

 A

Laryngomalacia

 B

Foreign body

 C

Vocal nodule

 D

Hypertrophy of turbinate

Q. 19

MC cause of intermittent stridor in a 10-day-old child shortly after birth is:

 A

Laryngomalacia

 B

Foreign body

 C

Vocal nodule

 D

Hypertrophy of turbinate

Ans. A

Explanation:

 

Laryngomalacia is the most common cause of inspiratory stridor in neonates.

The stridor in case of laryngomalacia is not constantly present, rather it is intermittent. So laryngomalacia is also the M/C cause of intermittent stridor in neonates.


Q. 20

Causes of congenital laryngeal stridor is/are:

 A

Laryngomalacia

 B

Laryngeal papillomatosis

 C

Subglottic papilloma

 D

All

Q. 20

Causes of congenital laryngeal stridor is/are:

 A

Laryngomalacia

 B

Laryngeal papillomatosis

 C

Subglottic papilloma

 D

All

Ans. A

Explanation:

Q. 21

Stridor in an infant is most commonly due to:

March 2010

 A

Diphtheria

 B

Acute epiglottitis

 C

Foreign body aspiration

 D

Laryngomalacia

Q. 21

Stridor in an infant is most commonly due to:

March 2010

 A

Diphtheria

 B

Acute epiglottitis

 C

Foreign body aspiration

 D

Laryngomalacia

Ans. D

Explanation:

Ans. D: Laryngomalacia

Laryngomalacia is the most common cause of inspiratory stridor in the neonatal period and early infancy and accounts for up to 75% of all cases of stridor.

Stridor may be exacerbated by crying or feeding.

Placing the patient in a prone position with the head up improves the stridor; supine position worsens the stridor. Laryngomalacia is usually benign and self-limiting and improves as the child reaches age 1 year.

If significant obstruction or lack of weight gain is present, surgical correction or supraglottoplasty may be considered if tight mucosal bands are present holding the epiglottis close to the true vocal cords or redundant mucosa is observed overlying the arytenoids.s


Q. 22

Following is true about laryngomalacia except ‑

 A

Omega shaped epiglottis

 B

Reassuarance of the patient is the treatment of choice

 C

Condition is first noticed in the first few weeks of life

 D

Expiratory stridor

Q. 22

Following is true about laryngomalacia except ‑

 A

Omega shaped epiglottis

 B

Reassuarance of the patient is the treatment of choice

 C

Condition is first noticed in the first few weeks of life

 D

Expiratory stridor

Ans. D

Explanation:

Ans. is ‘d’ i.e., Expiratory stridor

Laryngomalacia

  • It is the most common congenital abnormality of the larynx. Laryngomalacia is the most frequent cause of stridor or noisy breathing in infants. It occurs as a result of a floppy portion of the larynx (in supraglottic larynx) that has not yet developed the strength to provide rigid support to the airway. During inspiration negative pressure is created through larynx, which results in a collapse of these structures into the airway and a narrower breathing passage. Partial obstruction is the source of the noise with breathing (stridor), and sometimes cyanosis.
  • The hallmark sign includes intermittent stridor mostly in inspiration. It is usually more prominent when the infant is lying on his/her back (supine position, crying, feeding, excited or has a cold. Stridor gets relieved on placing the patient in prone position. This is usually first noticed in the first few weeks of life.
  • It may worsen over the first few months and become louder. This is because as the baby grows, inspiratory force is greater, which causes greater collapse of the laryngeal structures into the airway. This is usually worst at 3-6 months and then gradually improves as the rigidity of the cartilage improves.
  • Most children are symptom free by 1 to 2 years.
  • Sometimes, cyanosis may occur.
  • Direct laryngoscopy shows :-
  • Omega shaped epiglottis, i.e. elongated and curled on itself.
  • Floopy, tall, foreshortened and thin aryepiglottic folds.
  • Prominent arytenoids.
  • In most patients laryngomalacia is a self limiting condition. Treatment of laryngomalacia is reassurance to the parents and early antibiotic therapy for upper respiratory tract infections.

Q. 23

The shape of the epiglottis as shown in the image is seen in cases of ? 

 A

Laryngomalacia.

 B

Tuberculosis.


 C

Carcinoma of epiglottis.

 D

None of the above.

Q. 23

The shape of the epiglottis as shown in the image is seen in cases of ? 

 A

Laryngomalacia.

 B

Tuberculosis.


 C

Carcinoma of epiglottis.

 D

None of the above.

Ans. A

Explanation:

Ans;A.) Laryngomalacia

Omega shaped epiglottis as seen in the image, seen in cases of Laryngomalacia.

Laryngomalacia, shown in the image, is a congenital abnormality of the laryngeal cartilage. 

Laryngomalacia: The epiglottis is small and curled on itself (omega-shaped). Approximation of the posterior edges of the epiglottis contributes to the inspiratory obstruction.

  • In laryngomalacia direct laryngoscopy shows elongated epiglottis, curled upon itself (omega–shaped), floppy aryepiglottic folds and prominent arytenoids.
  • Pediatric Epiglottis is omega–shaped and arytenoids relatively large covering significant portion of the posterior glottis.




Extrahepatic biliary system

EXTRAHEPATIC BILIARY SYSTEM

Q. 1

False about hepatic duct:

 A

Left hepatic duct formed in umbilical fissure

 B

Caudate lobe drains only left hepatic duct

 C

Right hepatic duct formed by V and VIII segments

 D

Left hepatic duct crosses IV segment

Q. 1

False about hepatic duct:

 A

Left hepatic duct formed in umbilical fissure

 B

Caudate lobe drains only left hepatic duct

 C

Right hepatic duct formed by V and VIII segments

 D

Left hepatic duct crosses IV segment

Ans. B

Explanation:

Caudate lobe drains only left hepatic duct 

Caudate lobe is usually drained by both left and right hepatic ducts.

  • The functional anatomy of the liver is composed of 8 segments, each of which is supplied by its own portal triad or pedicle (composed of a portal vein, hepatic artery and a bile duct)
  • These segments are further organised into 4 sectors separated by scissurae containing the 3 main hepatic veins. (Thus the three main hepatic veins divide liver into 4 sectors]. The 4 sectors are even further organized into right & left liver. Segments I to IV compose the left liver and segments V to VIII the right.
  • Thus the right hepatic duct drains all segments of the right lobe and the left duct all segments of the left lobe. Caudate lobe or the segment I is drained by both right and left.



Q. 2

False about hepatic duct:

 A

Left hepatic duct formed in umbilical fissure

 B

Caudate lobe drains only left hepatic duct

 C

Right hepatic duct formed by V and VIII segments

 D

Left hepatic duct crosses IV segment

Q. 2

False about hepatic duct:

 A

Left hepatic duct formed in umbilical fissure

 B

Caudate lobe drains only left hepatic duct

 C

Right hepatic duct formed by V and VIII segments

 D

Left hepatic duct crosses IV segment

Ans. B

Explanation:

Caudate lobe drains only left hepatic duct [Ref: Previous Question]Repeat Mayl 1 Caudate lobe is usually drained by both left and right hepatic ducts.


Q. 3

Liver is divided into eight segments. Right hepatic duct drains all of the following segments, EXCEPT:

 A

Segment VIII

 B

Segment III

 C

Segment V

 D

Segment VI

Q. 3

Liver is divided into eight segments. Right hepatic duct drains all of the following segments, EXCEPT:

 A

Segment VIII

 B

Segment III

 C

Segment V

 D

Segment VI

Ans. B

Explanation:

The right hepatic duct drains the bile ducts from segments V, VI, VII, and VIII, which constitute the right liver.

The left hepatic duct directly drains the bile ducts to segments II, III, and IV, which constitute the left liver. 
Segment I (caudate) is drained by several small ducts.
 
Ref: Principles and Practice of Gastrointestinal Oncology edited by David Kelsen, 2008, Page 484.

Q. 4

The bile passes to the intestine via the hepatic duct. FALSE about hepatic duct is:

 A

Left hepatic duct formed in umbilical fissure

 B

Caudate lobe is drained only by left hepatic duct

 C

Right hepatic duct drains from V- VIII segments

 D

Left hepatic duct crosses IV segment

Q. 4

The bile passes to the intestine via the hepatic duct. FALSE about hepatic duct is:

 A

Left hepatic duct formed in umbilical fissure

 B

Caudate lobe is drained only by left hepatic duct

 C

Right hepatic duct drains from V- VIII segments

 D

Left hepatic duct crosses IV segment

Ans. B

Explanation:

The right and left livers are drained by the right and left hepatic ducts, respectively, whereas the caudate lobe is drained by several small ducts joining the bifurcation and first several centimeters of both hepatic ducts.

Ref: Principles and Practice of Gastrointestinal Oncology edited by David Kelsen, 2008, Page 483.


Q. 5

Predominant blood supply to the supraduodenal bile duct is from vessels ?

 A

Which run upward from the major vessels located near the lower part of bile duct such as the gastroduodenal and retro duodenal artery

 B

Which run downward along the bile duct from right hepatic artery

 C

That arise from hepatic artery proper as it carries up along the common bile duct and supplies it with twigs in a non-axial distribution

 D

That run from cystic artery

Q. 5

Predominant blood supply to the supraduodenal bile duct is from vessels ?

 A

Which run upward from the major vessels located near the lower part of bile duct such as the gastroduodenal and retro duodenal artery

 B

Which run downward along the bile duct from right hepatic artery

 C

That arise from hepatic artery proper as it carries up along the common bile duct and supplies it with twigs in a non-axial distribution

 D

That run from cystic artery

Ans. A

Explanation:

Approximately 60% of the blood supply to the supraduodenal bile duct originates from the pancreaticoduodenal and retroduodenal arteries, whereas 38% of the blood supply originates from the right hepatic artery and cystic duct artery and 2 percent is non-axial.


Q. 6

Which of the following statement is FALSE regarding hepatic duct?

 A

Left hepatic duct formed in umbilical fissure

 B

Caudate lobe drains mostly into the left hepatic duct

 C

Right hepatic duct drains V and VIII segments

 D

Left hepatic duct crosses IV segment

Q. 6

Which of the following statement is FALSE regarding hepatic duct?

 A

Left hepatic duct formed in umbilical fissure

 B

Caudate lobe drains mostly into the left hepatic duct

 C

Right hepatic duct drains V and VIII segments

 D

Left hepatic duct crosses IV segment

Ans. B

Explanation:

Segment I, the caudate lobe, has its own biliary drainage. Variations of this are common, and in 78% of individuals the caudate lobe drains into both the left and right hepatic duct.

 
The right and left hepatic ducts are formed by the confluence of the segmental ducts within the substance of the liver. The left lobar duct forms in the umbilical fissure from the union of ducts from segments II, III and IV.
 
Right hepatic ducts drains segments V to VIII  and arise from the junction of the right anterior and posterior sectoral ducts.
 
Left hepatic duct drains segments II, III and IV that constitutes the left liver. The left hepatic duct transverses beneath the left liver at the base of segment IV, just above and behind the left branch of portal vein, crosses the anterior edge of that vein and joints the right hepatic duct to constitute the hepatic ductal confluence.

Q. 7

False about hepatic duct:

 A

Left hepatic duct formed in umbilical fissure

 B

Caudate lobe drains only left hepatic duct

 C

Right anterior hepatic duct formed by V and VIII segments

 D

Left hepatic duct crosses IV segment

Q. 7

False about hepatic duct:

 A

Left hepatic duct formed in umbilical fissure

 B

Caudate lobe drains only left hepatic duct

 C

Right anterior hepatic duct formed by V and VIII segments

 D

Left hepatic duct crosses IV segment

Ans. B

Explanation:

B i.e. Caudate lobe drains only left hepatic duct


Q. 8

True regarding common bile duct is all except:

 A

Opens 10 cm distal to the pylorus

 B

Lies anterior to I.V.C

 C

Portal vein lies posterior to it

 D

Usually opens into duodenum separate from the main pancreatic duct.

Q. 8

True regarding common bile duct is all except:

 A

Opens 10 cm distal to the pylorus

 B

Lies anterior to I.V.C

 C

Portal vein lies posterior to it

 D

Usually opens into duodenum separate from the main pancreatic duct.

Ans. D

Explanation:

D i.e. Usually opens into duodenum separate from main pancreatic duct


Q. 9

Which of the following statement is true regarding the relation of bile duct:

 A

Posteriorly related to P, part of duodenum

 B

Related posteriorly to the tunnel of pancreatic head

 C

Anteriorly related to Pt part of duodenum

 D

All

Q. 9

Which of the following statement is true regarding the relation of bile duct:

 A

Posteriorly related to P, part of duodenum

 B

Related posteriorly to the tunnel of pancreatic head

 C

Anteriorly related to Pt part of duodenum

 D

All

Ans. C

Explanation:

C i.e. Anteriorly related to first part of duodenum


Q. 10

False statement about common bile duct:

 A

Lies in free margin of lesser omentum

 B

Anterior to first part of duodenum

 C

Right to hepatic artery

 D

Anterior to portal vein

Q. 10

False statement about common bile duct:

 A

Lies in free margin of lesser omentum

 B

Anterior to first part of duodenum

 C

Right to hepatic artery

 D

Anterior to portal vein

Ans. B

Explanation:

B i.e. Anterior to first part of duodenum

–  The bile duct ends by piercing the medial wall of 2nd part of duodenum, 8-10 cm distal to pylorususually after uniting with pancreatic duct to form hepaticopancreatic ampulla or ampulla of vater. Occasionally the pancreatic duct & bile duct open separately into the duodenum.

Bile duct (upper third or supraduodenal part) passes downwards in the free margin of lesser omentum (hepatoduodenal ligament), behind the liver, anterior to the portal vein and to the right of hepatic artery. Middle third (retro duodenal) part and lower third (infraduodenal – pancreatic) portion curves behind the first (1st) part of duodenum and head of pancreas respectively; whereas both parts run in front of (anterior to) IVC.

–   In nut shell, common bile duct lies posterior to liver, duodenum (1st part) & pancreas head (all organs); anterior to portal vein & IVC (both veins); and to the right of hepatic artery & gastro duodenal artery (both arteries).


Q. 11

Right hepatic duct drains all, Except:              

 A

Segment I

 B

Segment III

 C

Segment V

 D

Segment VI

Q. 11

Right hepatic duct drains all, Except:              

 A

Segment I

 B

Segment III

 C

Segment V

 D

Segment VI

Ans. B

Explanation:

Ans is b i.e. Segment III 

  • “The left hepatic duct drains segments II, III, and IV, and the right hepatic duct drains segments V, VI, VII, and VIII. Segment I, the caudate lobe, has its own biliary drainage. Variations of this are common, and in 78% of individuals the caudate lobe drains into both the left and right hepatic duct.”- Diseases of the Liver and Biliary System in Children By Deirdre A. Kelly, Dame Sheila (FRW) Sherlock 3/e p7
  • The right and left hepatic ducts join to form the common hepatic duct which joins the cystic duct to form the common bile duct.
  • Functional anatomy of liver

  • The functional anatomy of the liver is composed of 8 segments, each of which is supplied by its own portal triad or pedicle (composed of a portal vein, hepatic artery and a bile duct)
  • These segments are further organised into 4 sectors separated by scissurae containing the 3 main hepatic veins. (Thus the three main hepatic veins divide liver into 4 sectors]. The 4 sectors are even further organized into right & left liver. Segments Ito IV compose the left liver and segments V to VIII the right.
  • Thus the right hepatic duct drains all segments of the right lobe and the left duct all segments of the left lobe. Caudate lobe or the segment I is drained by both right and left.

Q. 12

Best suture for common bile duct is –

 A

Synthetic absorbable synthetic

 B

Synthetic non-absorbable

 C

Non-synthetic absorbable

 D

Non-synthetic non-absorbable

Q. 12

Best suture for common bile duct is –

 A

Synthetic absorbable synthetic

 B

Synthetic non-absorbable

 C

Non-synthetic absorbable

 D

Non-synthetic non-absorbable

Ans. C

Explanation:

Ans. is ‘c’ i.e. Non-synthetic absorbable 


Q. 13

Common bile duct injuries are most commonly seen in

 A

Radical gastrectomy

 B

Penetrating injuries of abdomen

 C

ERCP & sphincterotomy

 D

Laparoscopic cholecystectomy operation

Q. 13

Common bile duct injuries are most commonly seen in

 A

Radical gastrectomy

 B

Penetrating injuries of abdomen

 C

ERCP & sphincterotomy

 D

Laparoscopic cholecystectomy operation

Ans. D

Explanation:

Ans. is ‘d’ i.e., Laparoscopic cholecystectomy operation 


Q. 14

All of the following are seen with bile duct stone except: 

March 2008

 A

Obstructive jaundice

 B

Distended and palpable gall bladder

 C

Pruritis

 D

Clay coloured stools

Q. 14

All of the following are seen with bile duct stone except: 

March 2008

 A

Obstructive jaundice

 B

Distended and palpable gall bladder

 C

Pruritis

 D

Clay coloured stools

Ans. B

Explanation:

Ans. B: Distended and palpable gall bladder

Jaundice occurs when the CBD becomes obstructed and conjugated bilirubin enters the bloodstream. A history of clay-colored stools and tea-colored urine is obtained from such patients in approximately 50% of cases. The jaundice can be episodic.

Palpable gallbladder (Courvoisier sign) may indicate gall bladder malignancy.


Q. 15

Cell lining of common bile duct is ‑

 A

Stritified Columnar

 B

Stratified squamous

 C

Simple cuboidal

 D

Simple columnar

Q. 15

Cell lining of common bile duct is ‑

 A

Stritified Columnar

 B

Stratified squamous

 C

Simple cuboidal

 D

Simple columnar

Ans. D

Explanation:

Ans. is ‘d’ i.e., Simple columnar

Gall bladder and common bile ducts are lined by simple columnar epithelium.


Q. 16

Sclerosis of bile duct is seen in ‑

 A

Primary sclerosing cholangitis

 B

Obstructive jaundice

 C

Bile duct atresia

 D

Bile stones

Q. 16

Sclerosis of bile duct is seen in ‑

 A

Primary sclerosing cholangitis

 B

Obstructive jaundice

 C

Bile duct atresia

 D

Bile stones

Ans. A

Explanation:

Ans. is ‘a’ i.e., Primary sclerosing cholangitis


Q. 17

Pancreatic & bile duct open into duodenum at‑

 A

Ampulla of vater

 B

Minor duodenal papilla

 C

Duodenal cap

 D

None

Q. 17

Pancreatic & bile duct open into duodenum at‑

 A

Ampulla of vater

 B

Minor duodenal papilla

 C

Duodenal cap

 D

None

Ans. A

Explanation:

Ans. is ‘a’ i.e., Ampulla of vater

  • The bile duct runs downwards and backwards, first in the free margin of the lesser omentum, supraduodenal part; then behind the first part of the duodenum the retroduodenal part; and lastly behind, or embedded in, the head of pancreas infraduodenal part.
  • Near the middle of the left side of the second part of the duodenum it comes in contact with the pancreatic duct and accompanies it through the wall of the duodenum, the intraduodenal part.
  • The course of the duct through the duodenal wall is very oblique.
  • Within the wall the two ducts usually unite to form the hepatopancreatic ampulla, or ampulla of Vater.
  • The distal constricted end of the ampulla opens at the summit of the major duodenal papilla 8 to 10 cm distal to the pylorus.


Portal vein

PORTAL VEIN

Q. 1

True about valves in portal venous system?

 A

Present at the junction of superior mesentric artery with the splenic artery

 B

Within the portal vein only

 C

The whole system is valveless

 D

In the intrahepatic portion of portal vein.

Q. 1

True about valves in portal venous system?

 A

Present at the junction of superior mesentric artery with the splenic artery

 B

Within the portal vein only

 C

The whole system is valveless

 D

In the intrahepatic portion of portal vein.

Ans. C

Explanation:

The whole system is valveless 

  • Venous valves help in unidirectional blood flow in veins
  • The number of valves is greatest below the knee and decrease in number in the more proximal veins.
  • Valveless veins or venous sytem are
  • – Inferior vena Cava

– Common iliac veins

– Portal venous system

– Cranial sinuses


Q. 2

The Portal vein is formed?

 A

By the superior mesenteric vein

 B

By the splenic vein

 C

At the level of 2nd lumbar vertebra

 D

All of the above

Q. 2

The Portal vein is formed?

 A

By the superior mesenteric vein

 B

By the splenic vein

 C

At the level of 2nd lumbar vertebra

 D

All of the above

Ans. D

Explanation:

All of the above


Q. 3 The Normal Portal venous pressure is:
 A 4-6 mm Hg
 B 8-12 mm Hg
 C 26-30 mm Hg
 D 12-16 mm saline
Q. 3 The Normal Portal venous pressure is:
 A 4-6 mm Hg
 B 8-12 mm Hg
 C 26-30 mm Hg
 D 12-16 mm saline
Ans. B

Explanation:

8-12 mm Hg


Q. 4

In a patient with liver cirrhosis, where does portal vein obstruction occur?

 A

Portal vein

 B

Splenic vein

 C

Sinusoids

 D

Hepatic vein

Q. 4

In a patient with liver cirrhosis, where does portal vein obstruction occur?

 A

Portal vein

 B

Splenic vein

 C

Sinusoids

 D

Hepatic vein

Ans. C

Explanation:

In cirrhosis of the liver, portal vein obstruction occur at the level of sinusoids. In cirrhosis there is fibrosis of the liver resulting in architectural distortion with the formation of regenerative nodules. This results in a decrease in hepatocellular mass, its function, and an alteration of blood flow.

Complications of cirrhosis includes portal hypertension and its consequences (such as gastroesophageal variceal hemorrhage, splenomegaly, ascites), hepatic encephalopathy, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome, and hepatocellular carcinoma.

Ref: Harrison’s Internal Medicine, 18th Edition, Page 2598, Chapter 308


Q. 5

Which of the following values indicate normal portal venous pressure?

 A

5 – 10 mm Hg

 B

10 – 15 mm Hg

 C

20 – 25 mm Hg

 D

25 – 30 mm Hg

Q. 5

Which of the following values indicate normal portal venous pressure?

 A

5 – 10 mm Hg

 B

10 – 15 mm Hg

 C

20 – 25 mm Hg

 D

25 – 30 mm Hg

Ans. A

Explanation:

Normal portal venous pressure is 5 – 10mmHg (10 – 15cm saline). Portal venous system contributes 75% of blood and 72% of oxygen supplied to the liver. Portal vein is formed by the confluence of superior mesenteric vein and splenic vein. In an average adult 1000-1500ml /min of portal venous blood is supplied to the liver.


Reference:
Schwartz’s Principles of Surgery 9e chapter 31.


Q. 6

Portal hypertension is defined as hepatic venous pressure gradient more than:

 A

1 mm Hg

 B

5 mm Hg

 C

10 mm Hg

 D

20 mm Hg

Q. 6

Portal hypertension is defined as hepatic venous pressure gradient more than:

 A

1 mm Hg

 B

5 mm Hg

 C

10 mm Hg

 D

20 mm Hg

Ans. B

Explanation:

Portal hypertension is defined as the elevation of the hepatic venous pressure gradient (HVPG) to >5 mmHg. Portal hypertension is caused by a combination of two simultaneously occurring hemodynamic processes.

Ref: Harrison’s principle of internal medicine 17th edition, chapter 302.


Q. 7

Which of the following statement regarding portal venous system is TRUE?

 A

Valves are present at the junction of superior mesenteric vein and splenic vein

 B

Whole system is valveless

 C

Valves are present in the intrahepatic system

 D

There are about 10-12 valves along the entire course

Q. 7

Which of the following statement regarding portal venous system is TRUE?

 A

Valves are present at the junction of superior mesenteric vein and splenic vein

 B

Whole system is valveless

 C

Valves are present in the intrahepatic system

 D

There are about 10-12 valves along the entire course

Ans. B

Explanation:

In adults, the portal vein and its tributaries have no valves. In fetal life and for a short postnatal period valves are demonstrable in its tributaries, but they usually atrophy. Rarely some persist in an atrophic form into adulthood.

Portal venous system comprises of portal vein and its 3 tributaries, splenic vein, superior and inferior mesenteric vein. Thses veins drain the blood from the intestinal tract, from the oesophagus to the rectum, from the spleen and pancreas to the liver. Portal vein carries 75% of total blood flow to the liver. Normal portal pressure is 5 – 10mmHg.


Q. 8

The portal venous system contributes approximately 75% of the blood and 72% of the oxygen supplied to the liver. Which of the following is TRUE about valves in portal venous system?

 A

Present at the junction of superior mesenteric artery with the splenic artery

 B

Within the portal vein only

 C

The whole system is valveless

 D

In the intrahepatic portion of portal vein

Q. 8

The portal venous system contributes approximately 75% of the blood and 72% of the oxygen supplied to the liver. Which of the following is TRUE about valves in portal venous system?

 A

Present at the junction of superior mesenteric artery with the splenic artery

 B

Within the portal vein only

 C

The whole system is valveless

 D

In the intrahepatic portion of portal vein

Ans. C

Explanation:

The portal venous system is without valves and drains blood from the spleen, pancreas, gall bladder, and abdominal portion of the alimentary tract into the liver. 

Tributaries of the portal vein communicate with veins draining directly into the systemic circulation. These communications occur at the gastroesophageal junction, anal canal, falciform ligament, splenic venous bed and left renal vein, and retroperitoneum.
  
 

Q. 9

Portal vein begins at the level of which vertebra?

 A

L2

 B

L4

 C

L5

 D

None of the above

Q. 9

Portal vein begins at the level of which vertebra?

 A

L2

 B

L4

 C

L5

 D

None of the above

Ans. A

Explanation:

The portal vein begins at the level of the second lumbar vertebra and is formed from the convergence of the superior mesenteric and splenic veins. It is 8 cm long and lies anterior to the inferior vena cava and posterior to the neck of the pancreas.


Q. 10

Which one of the following characterizes a portal system of blood vessels?

 A

The absence of a capillary bed, thus shunting arterial blood directly to venules

 B

A capillary bed supplied and drained by a larger, non-capillary vessel

 C

Two capillary beds connected by a larger blood vessel

 D

A continuous capillary bed that extends from one organ to another

Q. 10

Which one of the following characterizes a portal system of blood vessels?

 A

The absence of a capillary bed, thus shunting arterial blood directly to venules

 B

A capillary bed supplied and drained by a larger, non-capillary vessel

 C

Two capillary beds connected by a larger blood vessel

 D

A continuous capillary bed that extends from one organ to another

Ans. C

Explanation:

A portal system of blood circulation is defined as two capillary beds that are joined by an arterial or venous blood vessel. An example is the portal vein connecting the mucosal capillaries of the small intestine to the sinusoids (i.e., capillaries) of the liver. While capillary beds may connect parts of an organ (e.g., adrenal cortex, pancreatic islet), capillaries do not extend between organs.
 

Q. 11

Which of the following vessel provide maximum blood supply to the liver?

 A

Hepatic artery

 B

Portal vein

 C

Superior mesenteric artery

 D

None of the above

Q. 11

Which of the following vessel provide maximum blood supply to the liver?

 A

Hepatic artery

 B

Portal vein

 C

Superior mesenteric artery

 D

None of the above

Ans. B

Explanation:

70% of the blood to the liver is carried by portal vein. Hepatic artery carries 30% of the blood to liver. Hepatic artery provides oxygenated blood to the liver and portal vein brings venous blood rich in products of digestion. 


Q. 12

Which of the following is TRUE about portal vein?

 A

Formed by the superior mesenteric vein

 B

Formed by the splenic vein

 C

Situated deep to the hepatic artery and cystic duct

 D

All of the above

Q. 12

Which of the following is TRUE about portal vein?

 A

Formed by the superior mesenteric vein

 B

Formed by the splenic vein

 C

Situated deep to the hepatic artery and cystic duct

 D

All of the above

Ans. D

Explanation:

Portal vein collects blood from the foregut, midgut, and hindgut. The portal vein is located deep to the hepatic artery and cystic duct and is formed by the union of the superior mesenteric vein and splenic vein, deep to the neck of the pancreas. Blood from portal vein transported to the hepatic sinusoids of the liver for filtration and detoxification. The hepatic sinusoids empty into the common central vein, which empties into the hepatic veins and ultimately drains into the inferior vena cava.

Q. 13

Portal vein is formed by union of which of the following veins?

 A

Superior mesenteric vein & Splenic vein

 B

Superior mesenteric vein & inferior mesenteric vein

 C

Inferior mesenteric vein & Splenic vein

 D

inferior mesenteric vein & Hepatic vein

Q. 13

Portal vein is formed by union of which of the following veins?

 A

Superior mesenteric vein & Splenic vein

 B

Superior mesenteric vein & inferior mesenteric vein

 C

Inferior mesenteric vein & Splenic vein

 D

inferior mesenteric vein & Hepatic vein

Ans. A

Explanation:

Portal vein is formed by the union of Superior mesenteric vein (SMV) and splenic vein posterior to the neck of pancreas. The inferior mesenteric vein drains into the splenic vein. 
  • The hepatic portal vein pass posterior to the first part of duodenum, in the free edge of lesser omentum.
  • At the porta hepatis, it divides into right and left branches supplying the right and left lobes of the liver.
  • Within the sinusoids of the liver, hepatic portal blood and oxygenated blood from the hepatic artery mix together and come into contact with the hepatocytes, where metabolites such as products of digestion are exchanged.
  • Blood from the sinusoids empties into hepatic veins draining the liver and in turn drain into IVC, and blood is returned to heart.

 


Q. 14

The normal portal venous pressure is:

 A

4-6 mm Hg

 B

5-10 mm Hg

 C

26-30 mm Hg

 D

12-16 mm saline

Q. 14

The normal portal venous pressure is:

 A

4-6 mm Hg

 B

5-10 mm Hg

 C

26-30 mm Hg

 D

12-16 mm saline

Ans. B

Explanation:

Portal venous pressure is the blood pressure in the hepatic portal vein, and is normally between 5-10 mmHg.At this pressure very little blood is shunted from the portal venous system into the systemic circulation.
 
Note:
Direct portal venous pressure that is >5 mmHg greater than the inferior vena cava (IVC) pressure, a splenic pressure of >15 mmHg, or a portal venous pressure measured at surgery of >20 mmHg is abnormal and indicates portal hypertension.A portal pressure of >12 mmHg is necessary for varices to form and subsequently bleed.
 
Ref : Geller D.A., Goss J.A., Tsung A. (2010). Chapter 31. Liver. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwartz’s Principles of Surgery, 9e.

Q. 15

The normal portal venous pressure under normal physiological conditions is:

 A

4-6 mmHg

 B

5-10 mmHg

 C

26-30 mm Hg

 D

12-16 mm saline

Q. 15

The normal portal venous pressure under normal physiological conditions is:

 A

4-6 mmHg

 B

5-10 mmHg

 C

26-30 mm Hg

 D

12-16 mm saline

Ans. B

Explanation:

The portal venous system contributes approximately 75% of the blood and 72% of the oxygen supplied to the liver. In the average adult 1000 to 1500 mL/min of portal venous blood is supplied to the liver. The normal portal venous pressure is 5 to 10 mmHg, and at this pressure very little blood is shunted from the portal venous system into the systemic circulation. As portal venous pressure increases, however, the communications with the systemic circulation dilate, and a large amount of blood may be shunted around the liver and into the systemic circulation.
 
Ref: Tsung A. (2010). Chapter 31. Liver. In T.R. Billiar, D.L. Dunn (Eds),Schwartz’s Principles of Surgery, 9e.

 


Q. 16

In portal venous system, valves are present at

 A

The junction of superior mesentric artery with the splenic artery

 B

Within the portal vein only

 C

In the intrahepatic portion of portal vein

 D

The whole system is valveless

Q. 16

In portal venous system, valves are present at

 A

The junction of superior mesentric artery with the splenic artery

 B

Within the portal vein only

 C

In the intrahepatic portion of portal vein

 D

The whole system is valveless

Ans. D

Explanation:

D i.e. The whole system is valveless

Like vena Cava, the portal vein and its tributaries are without valves. The normal pressure in portal vein is 3-5 mmHg and the increase in venous pressure is distributed throughout the splanchenic circulation.


Q. 17

Portal circulation is seen in which of the following endocrine gland :

 A

Pineal gland

 B

Hypophysis cerebri

 C

Pancreas

 D

Ovary

Q. 17

Portal circulation is seen in which of the following endocrine gland :

 A

Pineal gland

 B

Hypophysis cerebri

 C

Pancreas

 D

Ovary

Ans. B

Explanation:

B i.e. Hypophysis cerebri


Q. 18

True about valves in portal venous system:

 A

Present at the junction of superior mesenteric artery with the splenic artery

 B

Within the portal vein only

 C

The whole system is valveless

 D

In the intrahepatic portion of portal vein.

Q. 18

True about valves in portal venous system:

 A

Present at the junction of superior mesenteric artery with the splenic artery

 B

Within the portal vein only

 C

The whole system is valveless

 D

In the intrahepatic portion of portal vein.

Ans. C

Explanation:

C i.e. The whole system is valveless


Q. 19

Portal vein is related to all except :

 A

Pancreas

 B

Gall bladder

 C

Inf. vena cava

 D

CBD

Q. 19

Portal vein is related to all except :

 A

Pancreas

 B

Gall bladder

 C

Inf. vena cava

 D

CBD

Ans. B

Explanation:

B. i.e. Gall Bladder


Q. 20

Left gastric vein drains into:

 A

Inferior vena cava

 B

Portal vein

 C

Directly into splenic vein

 D

Splenic vein through short gastric vein

Q. 20

Left gastric vein drains into:

 A

Inferior vena cava

 B

Portal vein

 C

Directly into splenic vein

 D

Splenic vein through short gastric vein

Ans. B

Explanation:

B i.e. Portal vein

-Left and right gastric veins drain directly into the portal veinQ.

Portal vein is formed by union of superior mesenteric & splenic veins behind the neck of pancreas at the level of L2 vertebrae and runs

upwards with bile duct & hepatic artery (related anteriorly)(2 and inferior i’ena cava (related posteriorly)


Q. 21

All anesthetic agent decrease portal vein flow. Portal flow is maximally reduced by:

 A

Ether

 B

Halothane

 C

Isoflurane

 D

Enflurane

Q. 21

All anesthetic agent decrease portal vein flow. Portal flow is maximally reduced by:

 A

Ether

 B

Halothane

 C

Isoflurane

 D

Enflurane

Ans. B

Explanation:

B i.e. Halothane

All volatile anesthetic agents reduce portal hepatic blood flow. This decrease is greatest with halothane and least with isofluraneQ.


Q. 22

Normal portal vein pressure is –

 A

< 3 mm Hg

 B

3-5 mm Hg

 C

5-10 mm Hg

 D

10 to 1 2mm of Hg

Q. 22

Normal portal vein pressure is –

 A

< 3 mm Hg

 B

3-5 mm Hg

 C

5-10 mm Hg

 D

10 to 1 2mm of Hg

Ans. C

Explanation:

Ans. is ‘c’ i.e., 5-10 mm Hg 


Q. 23

Normal portal venous pressure is:

 A

3-5 cm saline

 B

5-10 cm saline

 C

10-15 cm saline

 D

15-20 cm saline

Q. 23

Normal portal venous pressure is:

 A

3-5 cm saline

 B

5-10 cm saline

 C

10-15 cm saline

 D

15-20 cm saline

Ans. C

Explanation:

Answer is C (10-15 cm Saline)

Normal pressure in portal vein is low ’10 – 15 cm saline’ – Harrison 14th/ 1710.

Normal pressure in portal vein is low ‘5 -10 mm Hg’ – Harrison 16th/e 1863-


Q. 24

Veins draining into portal vein are all except:

 A

Renal vein

 B

Splenic vein

 C

Left gastric vein

 D

Superior mesenteric vein

Q. 24

Veins draining into portal vein are all except:

 A

Renal vein

 B

Splenic vein

 C

Left gastric vein

 D

Superior mesenteric vein

Ans. A

Explanation:

The portal vein drains blood from the abdominal part of the gastrointestinal tract from the lower third of the esophagus to halfway down the anal canal; it also drains blood from the spleen, pancreas, and gallbladder.

The tributaries of the portal vein are the splenic vein, superior mesenteric vein, left gastric vein, right gastric vein, superior pancreaticoduodenal, paraumbilical and cystic veins.

The portal vein enters the liver and breaks up into sinusoids, from which blood passes into the hepatic veins that join the inferior vena cava. The portal vein is about 2 in. (5 cm) long and is formed behind the neck of the pancreas by the union of the superior mesenteric and splenic veins.


Q. 25

Portal hypertension is said to be present if portal venous pressure is more than: 

March 2010

 A

3-5 mm Hg

 B

5-8 mm Hg

 C

10-12 mm Hg

 D

15-20 mm Hg

Q. 25

Portal hypertension is said to be present if portal venous pressure is more than: 

March 2010

 A

3-5 mm Hg

 B

5-8 mm Hg

 C

10-12 mm Hg

 D

15-20 mm Hg

Ans. C

Explanation:

Ans. C: 10-12 mm Hg

Normal portal pressure is generally defined between 5 and 10 mm Hg.

Portal hypertension results when the portal pressure rises to 12 mm Hg or greater and complications can arise, such as varices and ascites.

Many conditions are associated with portal hypertension, of which cirrhosis is the most common cause


Q. 26

Portal vein is formed ‑

 A

Behind the spleen

 B

Behind the tail of pancreas

 C

Behind the neck of pancreas

 D

Behind the second part of duodenum

Q. 26

Portal vein is formed ‑

 A

Behind the spleen

 B

Behind the tail of pancreas

 C

Behind the neck of pancreas

 D

Behind the second part of duodenum

Ans. C

Explanation:

The portal vein is about 8 cm long.

It is formed by union of superior mesenteric vein and splenic vein behind the neck of pancreas at the level of L2 vertebrae in front of inferior vena cava (IVC).


Q. 27

Posterior relation of portal vein ‑

 A

Pancreas

 B

Gall bladder

 C

Inf. vena cava

 D

CBD

Q. 27

Posterior relation of portal vein ‑

 A

Pancreas

 B

Gall bladder

 C

Inf. vena cava

 D

CBD

Ans. B

Explanation:

Ans. is ‘b’ i.e., Gall bladder

Important relations about portal vein

Infraduodenal part

i) Anterior :- Neck of pancreas

ii) Posterior :- IVC

Retroduodenal part

i) Anterior :- Istpart of duodenum, bile duct, gastroduodenal artery

ii) Posterior :- IVC

Supraduodenal part

i) Anterior :- Hepatic artery, bile duct

ii) Posterior :- IVC, separated by epiploic formen


Q. 28

Which of the following does not form portal triad in liver

 A

Hepatic artery

 B

Hepatic vein

 C

Bile duct

 D

Portal vein

Q. 28

Which of the following does not form portal triad in liver

 A

Hepatic artery

 B

Hepatic vein

 C

Bile duct

 D

Portal vein

Ans. B

Explanation:

Ans. is ‘b’ i.e., Hepatic vein

Histology of the Liver

  • Liver is covered by Glisson’s capsule.
  • Liver is divided into hexagonal lobules oriented around the terminal tributaries of the hepatic vein (Terminal hepatic veins), i.e. Terminal hepatic vein is in the centre of the lobule and area around the hepatic vein is called centrilobular zone.
  • At periphery of lobule, lies the portal tract containing hepatic artery, bile duct and portal vein. Area around portal tract is called periportal zone.
  • These three structures (portal vein, hapatic artery and bile duct) form portal triad.
  • Area between periportal zone and centrilobular zone is called midzonal area.
  • All around the central vein are the major parenchymal cells, i.e. hepatocytes.
  • Lobule contains sinusoid (sinusoidal capillaries) which have fenestrated endothelium covering the subendothelial space of Disse. This space contains stellate cell processes and hepatocellular microvilli.
  • Other important cells of liver are Kupffer cells, which belong to monocytic-macrophage sytem and function as phagocytic cells.

Q. 29

Posterior relation of portal vein –

 A

I’ part of duodenum 

 B

Hepatic artery

 C

Bile duct

 D

IVC

Q. 29

Posterior relation of portal vein –

 A

I’ part of duodenum 

 B

Hepatic artery

 C

Bile duct

 D

IVC

Ans. D

Explanation:

Ans. is ‘d’ i.e., IVC 

  • The portal vein is about 8 cm long. It is formed by the union of the superior mesenteric veins and the splenic vein behind the neck of the pancreas at the level of the second lumbar vertebra. The inferior mesenteric vein drains into the inferior mesenteric vein.

Important facts about portal vein

  • 8 cm long
  • The blood flow is slow
  • Stream line flow :- Blood in superior mesentric vein drains, into right lobe of liver. Blood in splenic and inferior mesentric vein drains into left lobe.
  • Relations
  • Infraduodenal part
  1. Anterior :- Neck of pancreas
  2. Posterior :- IVC
  • Retroduodenal part
  1. Anterior :- Ppart of duodenum, bile duct, gastroduodenal artery
  2. Posterior :- IVC
  • Supraduodenal part
  1. Anterior :- Hepatic artery, bile duct.
  2. Posterior :- IVC, separated by epiploic formen
  • Development of Portal vein :
  1. Infra-duodenal part – part of left vitelline vein distal to the dorsal ansatomosis
  2. Retro-duodenal part – dorsal anastomosis between two vitelline veins
  3. Supra-duodenal part – cranial part of right vitelline vein
  • The portal vein receives the following veins :
  1. Splenic vein
  2. Superior mesenteric vein
  3. Left gastric
  4. Right gastric
  5. Superior pancreatico-duodenal
  • Cystic
  • Paraumbilical veins

Q. 30

Portal vein supplies ‑

 A

Spleen

 B

Liver

 C

Pancreas

 D

Colon

Q. 30

Portal vein supplies ‑

 A

Spleen

 B

Liver

 C

Pancreas

 D

Colon

Ans. B

Explanation:

Ans. is ‘b’ i.e., Liver 

  • Portal vein is a vein, still it supply blood to liver (usually a vein drains blood from an organ or tissue).

The liver has dual blood supply :-

  • 20% of blood supply is through the hepatic artery.
  • 80% of blood supply is through the portal vein.


Glomus Jugulare

Glomus Jugulare

Q. 1

Glomus tumor is seen in

 A

Liver

 B

Adrenals

 C

Pitutary

 D

Finger

Q. 1

Glomus tumor is seen in

 A

Liver

 B

Adrenals

 C

Pitutary

 D

Finger

Ans. D

Explanation:

Finger [Ref: CSDT I3/e p1148 (12/c p1266); Anderson 10/e p2559; http://emedicine.medscape.com/article/1083405-overview; http://wwwpubmedcentraLnih.gov/articlerenderjegi?artid=1888624]

  • The glomus tumor is a rare and benign vascular neoplasm that arises from the neuroarterial structure called a glomus body. The normal glomus body is located in the dermis throughout the body, but is more concentrated in the digits. They are believed to function in thermal regulation.
  • The most common site of glomus tumors is subungual and 75% of the lesions occur in the hand.
  • The lesions present most frequently during the fourth and fifth decade of life although they can be found in any age and at any site.
  • The subungual tumors affect women three times more commonly than men.
  • The lesions are usually solitay but mulifocal tumors are also seen.
  • Clinically, glomus tumors are characterized by a triad of

– sensitivity to cold,

– localized tenderness and

– severe intermittent pain.

The pain can be excruciating and is described as a burning or bursting.

  • Grossly, the tumors are usually less than one cm. in size, and appear as small red-blue nodules. The lesion appears as a localized dark red or blue lesion beneath the finger nail, but the subungual lesions can be difficult to detect on clinical examination.
  • Two useful tests for diagnosing glomus tumors, particularly solitary painful glomus tumors (especially those under a nail) are the following:

– disappearance of pain after application of a tourniquet proximally on the arm

– eliciting pain by applying pressure to a precise area with the tip of a pencil

  • Treatment of glomus tumors consists of surgical excision.

Q. 2

Browns sign and a Mass in ear on touch bleeding heavily, cause is:

 A

Glomus Jugulare

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Q. 2

Browns sign and a Mass in ear on touch bleeding heavily, cause is:

 A

Glomus Jugulare

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Ans. B

Explanation:

Q. 3

Pulsatile Tinnitus in ear is due to:

 A

Mastoid reservoir phenomenon

 B

Glomus jugulare tumour

 C

Osteoma

 D

Malignant otitis media 

Q. 3

Pulsatile Tinnitus in ear is due to:

 A

Mastoid reservoir phenomenon

 B

Glomus jugulare tumour

 C

Osteoma

 D

Malignant otitis media 

Ans. B

Explanation:

Q. 4

Mass in ear on touch bleeding hea­vily, cause is:

 A

Glomus Jugulare

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Q. 4

Mass in ear on touch bleeding hea­vily, cause is:

 A

Glomus Jugulare

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Ans. A

Explanation:

Q. 5

A young man underwent surgery for the removal of Glomus tumor. Glomus tumor is seen commonly in:

 A

Liver

 B

Adrenals

 C

Pituitary

 D

Finger

Q. 5

A young man underwent surgery for the removal of Glomus tumor. Glomus tumor is seen commonly in:

 A

Liver

 B

Adrenals

 C

Pituitary

 D

Finger

Ans. D

Explanation:

Glomus tumor is a benign soft-tissue extremity tumors, these lesions arise from dermal neuro myo arterial apparatus (glomus bodies).

Glomus tumor more commonly affects the hand.

In addition to the severe pain, point tenderness and cold sensitivity are associated with these lesions and subungual glomus tumors typically appear as blue, subungual discolorations of 1 to 2 mm.

Tumor excision is the treatment of choice.
 
Ref: Cole P., Heller L., Bullocks J., Hollier L.H., Stal S. (2010). Chapter 16. The Skin and Subcutaneous Tissue. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwartz’s Principles of Surgery, 9e.

Q. 6

True about Glomus juglare are all of the statements, EXCEPT:

 A

Rising sun sign is seen

 B

Involves 9th and 10th cranial nerve

 C

Pulsatile tinnitus is seen

 D

Invades epitympanum

Q. 6

True about Glomus juglare are all of the statements, EXCEPT:

 A

Rising sun sign is seen

 B

Involves 9th and 10th cranial nerve

 C

Pulsatile tinnitus is seen

 D

Invades epitympanum

Ans. D

Explanation:

Glomus jugulare  arise from juglar bulb and extend upward with erosion into the hypotympanum.

Glomus tumors:
  • They arise either from the middle ear (glomus tympanicum) or arise from juglar bulb with upward erosion into the hypotympanum (glomus jugulare).
  • Patients clinically presents with pulsatile tinnitus and hearing loss.
  • On examination a vascular mass is visible behind an intact tympanic membrane
    Rising sun sign is seen when the tumor arise from floor of middle ear cavity. 
  • Pulsation sign (Browns sign) is positive i.e when ear canal pressure is raised using Siegel’s speculum tumor pulsates vigorously and then blanches, reverse happens with release of pressure.
  • Large glomus jugulare tumors are associated with multiple cranial neuropathies, especially involving nerves VII, IX, X, XI, and XII. 
  • Treatment modalities includes surgery, radiotherapy, or both.

Q. 7

A middle aged female presented with complaints of progressive deafness and tinnitus. On examination, deafness is conductive in nature. Otoscopy shows a red reflex through intact tympanic membrane. “Pulsation sign” is positive. 

 
Assertion: The possible diagnosis is glomus tumor, which is the most common benign neoplasm of middle ear.
 
Reason: When ear canal pressure is raised with Siegle’s speculum tumor pulsates vigorously and then blanches and the reverse happens when the pressure is released.
 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 7

A middle aged female presented with complaints of progressive deafness and tinnitus. On examination, deafness is conductive in nature. Otoscopy shows a red reflex through intact tympanic membrane. “Pulsation sign” is positive. 

 
Assertion: The possible diagnosis is glomus tumor, which is the most common benign neoplasm of middle ear.
 
Reason: When ear canal pressure is raised with Siegle’s speculum tumor pulsates vigorously and then blanches and the reverse happens when the pressure is released.
 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. A

Explanation:

Glomus tumour originates from the glomus bodies. It found in the dome of jugular bulb or on the promontory along the course of tympanic branch of IXth cranial nerve.


Q. 8

Syndrome associated with deafness is:

 A

Usher syndrome

 B

Waardenburg syndrome

 C

Pendred syndrome

 D

All of the above

Q. 8

Syndrome associated with deafness is:

 A

Usher syndrome

 B

Waardenburg syndrome

 C

Pendred syndrome

 D

All of the above

Ans. D

Explanation:

More than 200 syndromes are associated with hearing loss. Common syndromic forms of hearing loss, among others, include the following: (1) Usher syndrome (retinitis pigmentosa and hearing loss), (2) Waardenburg syndrome (pigmentary abnormality and hearing loss), (3) Pendred syndrome (thyroid organification defect and hearing loss), (4) Alport syndrome (renal disease and hearing loss), and (5) Jervell and Lange-Nielsen syndromes (prolonged QT interval and hearing loss).


Q. 9

A man presented with pulsatile tinnitus and hearing loss. A vascular mass is seen behind the tympanic membrane. Diagnosis can be:

 A

Glomus Jugulare

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Q. 9

A man presented with pulsatile tinnitus and hearing loss. A vascular mass is seen behind the tympanic membrane. Diagnosis can be:

 A

Glomus Jugulare

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Ans. A

Explanation:

Glomus tumors arise either in the middle ear (glomus tympanicum) or in the jugular bulb with upward erosion into the hypotympanum (glomus jugulare).

They present clinically with pulsatile tinnitus and hearing loss. A vascular mass may be visible behind an intact tympanic membrane.

Large glomus jugulare tumors are often associated with multiple cranial neuropathies, especially involving nerves VII, IX, X, XI, and XII.

Treatment usually requires surgery, radiotherapy, or both.
 

Q. 10

Fisch classification is used for classifying which of the following malignancy?

 A

Paravertebral tumours

 B

Glomus tumor

 C

Synovial sarcomas

 D

Retroperitoneal tumours

Q. 10

Fisch classification is used for classifying which of the following malignancy?

 A

Paravertebral tumours

 B

Glomus tumor

 C

Synovial sarcomas

 D

Retroperitoneal tumours

Ans. B

Explanation:

The two grading systems which has been developed to classify glomus tumors are Fisch classification and Glasscock – Jackson classification.

Fisch classification of glomus tumors:

Class A: Tumors limited to the middle ear cleft.
Class B: Tumors limited to the tympanomastoid area without destruction of bone in the infralabrynthine compartment.
Class C: Tumors extending into and destroying the bone of the infralabrynthine and the apical compartments of the temporal bone.
Class D: Tumors with intracranial intradural extension.


Q. 11

Which of the following presents as a mass in ear, which bleeds heavily on touch?

 A

Glomus Jugulare tumor

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Q. 11

Which of the following presents as a mass in ear, which bleeds heavily on touch?

 A

Glomus Jugulare tumor

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Ans. A

Explanation:

Glomus Jugulare is a slow growing highly vascular lesion which arise in the jugular fossa from paraganglia located within the adventitia of jugular bulb.
Examination of the ear shows a deep mass behind the eardrum.
 
Patients usually presents with hoarseness, dysphagia and tinnitus.
CT shows an irregularly marginated, intensely enhancing destructive lesion centered in the jugular fossa.
MRI shows a salt and pepper appearance which is diagnostic for paraganglioma. 
 

 


Q. 12

Glomus Cells are found in –

 A

Carotid body Tumour

 B

Thyroid carcinoma

 C

Liver carcinoma

 D

None

Q. 12

Glomus Cells are found in –

 A

Carotid body Tumour

 B

Thyroid carcinoma

 C

Liver carcinoma

 D

None

Ans. A

Explanation:

Ans. is ‘a’ i.e., Carotid body tumor

o Non-chromaffin (neuroendocrine) cells of paraganglioma are also called glomus cells.


Q. 13

Marker of glomus tumor –

 A

CD-57

 B

Cytokeratin

 C

S-100

 D

CD-34

Q. 13

Marker of glomus tumor –

 A

CD-57

 B

Cytokeratin

 C

S-100

 D

CD-34

Ans. A

Explanation:

Ans. is ‘a’ i.e., CD-57

o Glomus tumor is a benign mesenchymal neoplasm of the subcutaneous tissue of the distal extremities and head & neck region.

o Immunohistochemistry shows smooth muscle actin, vimentin, collagen IV and CD-57, with little to no expression of neuroendocrine, endothelial or epithelial markers.

o Markers that have been proved consistently negative include cytokeratin, synaptophysin, chromogranin A, CD-31 and S-100 protein.


Q. 14

Glomus tumor is seen in –

 A

Retroperitoneum

 B

Soft tissue

 C

Distal portion of digits

 D

Proximal portion of digits

Q. 14

Glomus tumor is seen in –

 A

Retroperitoneum

 B

Soft tissue

 C

Distal portion of digits

 D

Proximal portion of digits

Ans. C

Explanation:

Ans. is ‘c’ i.e., Distal portion of digits

o It is a benign but painful tumor that arises from the modified smooth muscle cells of the glomus body, a specialized arteriovenous anastomosis that is involved in thermoregulation.

o They are most commonly found in the distal portion of the digits, especially under the fingernails.


Q. 15

Pericyte formation occur in –

 A

Kaposi sarcoma

 B

Glomus tumor

 C

Hemangiopericytoma

 D

b and c

Q. 15

Pericyte formation occur in –

 A

Kaposi sarcoma

 B

Glomus tumor

 C

Hemangiopericytoma

 D

b and c

Ans. D

Explanation:

Ans. is ‘b’ i.e., Glomus tumor ‘c’ i.e., Hemangiopericytoma

o The pericytes are a special variety of cells placed at intervals along certain capillaries. Pericytes are also known as

Rouget cells, mural cells, or adventitial cells.

o The tumors of pericytic differention are :‑

i)        Hemangiopericytoma      iii) Myopericytoma                v) Myofibroma

ii)       Glomus tumor               iv) Glomangiomyoma          vi) Angioleiomyoma

Note :- For exams like AI and AIIMS, hemangiopericytoma is best answer because It is related most definitly to pericytic differentiation.


Q. 16

Glomus tumor is seen in

 A

Liver

 B

Adrenals

 C

Pitutary

 D

Finger

Q. 16

Glomus tumor is seen in

 A

Liver

 B

Adrenals

 C

Pitutary

 D

Finger

Ans. D

Explanation:

Ans is d i.e. Finger 

  • The glomus tumor is a rare and benign vascular neoplasm that arises from the neuroarterial structure called a glomus body. The normal glomus body is located in the dermis throughout the body, but is more concentrated in the digits. They are believed to function in thermal regulation.
  • The most common site of glomus tumors is subungual and 75% of the lesions occur in the hand.
  • The lesions present most frequently during the fourth and fifth decade of life although they can be found in any age and at any site.
  • The subungual tumors affect women three times more commonly than men.
  • The lesions are usually solitay but mulifocal tumors are also seen.
  • Clinically, glomus tumors are characterized by a triad of

– sensitivity to cold,

–  localized tenderness and

– severe intermittent pain.

The pain can be excruciating and is described as a burning or bursting.

  • Grossly, the tumors are usually less than one cm. in size, and appear as small red-blue nodules. The lesion appears as a localized dark red or blue lesion beneath the finger nail, but the subungual lesions can be difficult to detect on clinical examination.
  • Two useful tests for diagnosing glomus tumors, particularly solitary painful glomus tumors (especially those under a nail) are the following:

–  disappearance of pain after application of a tourniquet proximally on the arm

–  eliciting pain by applying pressure to a precise area with the tip of a pencil

– Treatment of glomus tumors consists of surgical excision.

 


Q. 17

The usual location of Glomus jugular tumor is:

 A

Epitympanum

 B

Hypotympanum

 C

Mastoidal cell

 D

Promontory

Q. 17

The usual location of Glomus jugular tumor is:

 A

Epitympanum

 B

Hypotympanum

 C

Mastoidal cell

 D

Promontory

Ans. B

Explanation:

Q. 18

Earliest symptom of glomus tumor is:

 A

Pulsatile tinnitus

 B

Deafness

 C

Headache

 D

Vertigo

Q. 18

Earliest symptom of glomus tumor is:

 A

Pulsatile tinnitus

 B

Deafness

 C

Headache

 D

Vertigo

Ans. A

Explanation:

Q. 19

Pulsatile tinnitus in ear is due to:

 A

Malignant otitis media 

 B

Osteoma

 C

Mastoid reservoirs

 D

Glomus jugulare tumor

Q. 19

Pulsatile tinnitus in ear is due to:

 A

Malignant otitis media 

 B

Osteoma

 C

Mastoid reservoirs

 D

Glomus jugulare tumor

Ans. D

Explanation:

 

Pulsatile tinnitus   – Seen in Glomus tumor

Pulsatile otorrhea  – Seen in ASOM


Q. 20

True about Glomus jugulare tumor:

 A

Most common in male

 B

Arises from non-chromaffin cells

 C

Lymph node metastasis seen

 D

All

Q. 20

True about Glomus jugulare tumor:

 A

Most common in male

 B

Arises from non-chromaffin cells

 C

Lymph node metastasis seen

 D

All

Ans. B

Explanation:

 

Explanation

  • Glomus tumor is more common in females.
  • Glomus tumor is also referred to as chemodectomy or nonchromaffin paraganglion.
  • Glomus tumor is a benign tumor, therefore lymph node metastats is not present.
  • Multicentric tumors are found in 3-10% of sporadic cases and in 25-50% of familial cases.
  • Fluctuating (Pulsatile) tinnitus and conductive hearing loss are the earliest symptoms of glomus tumor.



Q. 21

All are true about glomus jugulare tumors except:

 A

Common in female

 B

Causes sensory neural deafness

 C

It is a disease of infancy

 D

It invades labyrinth, petrous pyramid and mastoid

Q. 21

All are true about glomus jugulare tumors except:

 A

Common in female

 B

Causes sensory neural deafness

 C

It is a disease of infancy

 D

It invades labyrinth, petrous pyramid and mastoid

Ans. C

Explanation:

Q. 22

Brown sign is seen in:

 A

Glomus tumor

 B

Meniere’s desease

 C

Acoustic neuroma

 D

Otoscleorsis

Q. 22

Brown sign is seen in:

 A

Glomus tumor

 B

Meniere’s desease

 C

Acoustic neuroma

 D

Otoscleorsis

Ans. A

Explanation:

Q. 23

Phelp’s sign is seen in:

 A

Glomus jugulare

 B

Vestibular Schawannoma

 C

Maniere’s disease

 D

Neurofibromatosis

Q. 23

Phelp’s sign is seen in:

 A

Glomus jugulare

 B

Vestibular Schawannoma

 C

Maniere’s disease

 D

Neurofibromatosis

Ans. A

Explanation:

 

Phelp’s sign

Rising sun sign                           are all seen in Glomus tumor

Aquino sign

Pulsation sign/brown sign

Phelp sign This sign is seen on CT scan

In CT- in case of glomus jugulare tumor the normal crest between the carotid canal and jugulare tumor is absent whereas it is not so in case of glomus tympanicum

 



Q. 24

The glomus tumor invasion of jugular bulb is diagnosed by

 A

Carotid angiography

 B

Vertebral venousvenography

 C

X-ray

 D

Jugular venography

Q. 24

The glomus tumor invasion of jugular bulb is diagnosed by

 A

Carotid angiography

 B

Vertebral venousvenography

 C

X-ray

 D

Jugular venography

Ans. D

Explanation:

 

MRI – gives soft tissue extent of tumor; Magnetic Resonance Angiography (MRA) shows compression of the carotid artery whereas magnetic resonance venography shows invasion of jugular bulb by the tumor.

 



Q. 25

Which is the most pulsatile tumor found in external auditory meatus which bleeds on touch?

 A

Squamous cell ca of pinna

 B

Basal cell ca

 C

Adenoma

 D

Glomus tumor

Q. 25

Which is the most pulsatile tumor found in external auditory meatus which bleeds on touch?

 A

Squamous cell ca of pinna

 B

Basal cell ca

 C

Adenoma

 D

Glomus tumor

Ans. D

Explanation:

Q. 26

Mass in ear, on touch bleeding heavily, causes: 

 A

Glomus Jugulare

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Q. 26

Mass in ear, on touch bleeding heavily, causes: 

 A

Glomus Jugulare

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Ans. A

Explanation:

Q. 27

FISCH classification is used for:

 A

Juvenile nasopharyngeal angiofibroma

 B

Nasopharyngeal ca

 C

Vestibular schwannoma

 D

Glomus tumour

Q. 27

FISCH classification is used for:

 A

Juvenile nasopharyngeal angiofibroma

 B

Nasopharyngeal ca

 C

Vestibular schwannoma

 D

Glomus tumour

Ans. D

Explanation:

Q. 28

Glomus tumour arises from:

September 2004

 A

Ectoderm

 B

Endoderm

 C

Mesoderm

 D

Neuroectoderm

Q. 28

Glomus tumour arises from:

September 2004

 A

Ectoderm

 B

Endoderm

 C

Mesoderm

 D

Neuroectoderm

Ans. C

Explanation:

Ans. C i.e. Mesoderm


Q. 29

All of the following are true about glomus-jugulare tumor except:           

 A

Commonly metastasizes to lymph nodes

 B

Pulsatile tinnitus and conductive deafness seen

 C

Most commonly affects male

 D

Paraganglioma’s

Q. 29

All of the following are true about glomus-jugulare tumor except:           

 A

Commonly metastasizes to lymph nodes

 B

Pulsatile tinnitus and conductive deafness seen

 C

Most commonly affects male

 D

Paraganglioma’s

Ans. C

Explanation:

 

Glomus jugulare tumors are rare, slow-growing, hypervascular tumors that arise within the jugular foramen of the temporal bone.

They are included in a group of tumors referred to as paragangliomas, which occur at various sites and include carotid body, glomus vagale, and glomus tympanicum tumors

Glomus jugulare tumors occur predominantly in women in the fifth and sixth decades of life. Because of the insidious onset of symptoms, these tumors often go unnoticed, and delay in diagnosis is frequent.

The most common symptoms are conductive hearing loss and pulsatile tinnitus. Other aural signs and symptoms are ear fullness, otorrhea, hemorrhage, bruit, and the presence of a middle ear mass. Significant ear pain is uncommon.


Q. 30

Glomus cells are derived from ‑

 A

Surface ectoderm

 B

Neuroectoderm

 C

Mesoderm

 D

Endoderm

Q. 30

Glomus cells are derived from ‑

 A

Surface ectoderm

 B

Neuroectoderm

 C

Mesoderm

 D

Endoderm

Ans. B

Explanation:

 

Glomus cells are derived from neural crest which itself is derivative of neuroectoderm.

  • Other derivates of neural crest are‑

a) Neural derivatives

  • Sensory neurons of spinal dorsal root ganglia.
  • Sympathetic chain ganglia and plexus (celiac/preaortic/renal ganglia, enteric plexus in GIT, i.e. Auerbachs and Meissner’s)
  • Parasympathetic ganglia and plexus of GIT.
  • Schwann cells of peripheral nerves, satellite cells of all ganglia.
  • Adrenal medulla, chromaffin cells, para follicular C-cells of thyroid gland.
  • Melanocytes and melanoblasts.

b) Mesenchymal derivatives

  • Dermal bones of skull : Frontal, parietal, temporal, nasal, vomer, palatine, mandible, maxillae.
  • Leptomeninges : arachnoid and pia mater (Durameter is mesodermal).
  • Dentine of teeth (odontoblasts).

Eye : choroid, sclera, iris epithelium, pupillary muscles (sphincter and dilator pupillae, ciliary muscles).

  • Pharyngeal arch cartilages.
  • Retinal pigmented epithelium.
  • Connective tissues of head including dermis, tendon, ligaments.
  • Bulbar and conal ridges of heart.



Q. 31

Glomus cells are derived from –

 A

Neural tube

 B

Surface ectoderm

 C

Neural crest

 D

Endoderm

Q. 31

Glomus cells are derived from –

 A

Neural tube

 B

Surface ectoderm

 C

Neural crest

 D

Endoderm

Ans. C

Explanation:

Neural crest


Q. 32

Not a cause of objective tinnitus ‑

 A

Palatal myoclonus

 B

Glomus tumor

 C

Carotid artery aneurysm

 D

Presbyacusis

Q. 32

Not a cause of objective tinnitus ‑

 A

Palatal myoclonus

 B

Glomus tumor

 C

Carotid artery aneurysm

 D

Presbyacusis

Ans. D

Explanation:

Ans. is ‘d’ i.e., Presbyacusis

Tinnitus

  • Tinnitus is ringing sound or noise in the ear.
  • The characteristic feature is that the origin of this sound is within the patient.

Q. 33

Glomus jugulare commonly arises from ‑

 A

Hypotympanum

 B

Mesotympanum

 C

Epitympanum

 D

Prussaks space

Q. 33

Glomus jugulare commonly arises from ‑

 A

Hypotympanum

 B

Mesotympanum

 C

Epitympanum

 D

Prussaks space

Ans. A

Explanation:

Ans. is ‘a’ i.e., Hypotympanum

There are two types of glomus tumors:-

i) Glomus jugulare

These glomus tumors arise from the dome of the internal jugular vein in the hypotympanum and jugular foramen. In jugular foramen they can invade IX to XII cranial nerves.

ii) Glomus tympanicum

They arise from the promontory of the middle ear along the course of the tympanic branch of the IXth cranial nerve.


Q. 34

Earliest symptom of glomus tumor is ‑

 A

Pulsatile tinnitus

 B

Pulsatile otorrhoea

 C

Vertigo

 D

Hearing Loss

Q. 34

Earliest symptom of glomus tumor is ‑

 A

Pulsatile tinnitus

 B

Pulsatile otorrhoea

 C

Vertigo

 D

Hearing Loss

Ans. A

Explanation:

Ans. is ‘a’ i.e., Pulsatile tinnitus

Clinical features of glomus tumor

  • The earliest symptoms of glomus tumour is pulsatile tinnitus (earliest) and hearing loss. Hearing loss is conductive and slowly progressive. These are followed by blood stained otorrhoea and earache.
  • Before the tympanic membrane (eardrum) is perforated a red swelling is seen to arise from the floor of middle ear, i.e. “Rising sun” appearance. This results in a red reflex through the intact tympanic membrane. Sometimes, eardrum may be bluish and bulging.
  • Pulsation sign (Brown sign) is positive, i.e. when ear canal pressure is raised with Siegle’s speculum, tumor pulsates vigorously and then blanches; reverse happens with release of pressure.
  • Aquino sign is positive, i.e. blanching of mass with manual compression of ipsilateral carotid artery.
  • When the tumour perforates the eardrum a polypus will be seen in the meatus and this will bleed profusely if touched.
  • Cranial nerve palsies is a late feature appearing several years after aural symptoms. IX’ to XIIth cranial nerves may be paralysed. This can cause dysphagia and hoarseness, and weakness of trapezius and sternocleidomastoid muscles, unilateral paralysis of soft palate, pharynx and vocal cord.
  • Ausculation with stethoscope over the mastoid may reveal audible systolic bruit.
  • Some glomus tumours secrete catecholamines and produce symptoms like tachycardia, arrhythmias, sweating, flushing and headache etc.
  • Facial palsy may be caused by glomus tympanicum type of glomus tumor.
  • Audiometry shows conductive deafness, However if inner ear is invaded, mixed conductive and sensorineural hearing loss is seen.

Q. 35

The earliest symptom of glomus tumor is 

 A

Pulsatile tinnitus

 B

Hearing loss

 C

Poly growth

 D

Blood stained otorrhoea

Q. 35

The earliest symptom of glomus tumor is 

 A

Pulsatile tinnitus

 B

Hearing loss

 C

Poly growth

 D

Blood stained otorrhoea

Ans. A

Explanation:


Peritoneal cavity- lesseer sac & greater sac

PERITONEAL CAVITY- LESSEER SAC & GREATER SAC

Q. 1

The boundaries of the interconnection between greater sac and lesser sac of peritoneum known as ‘Foramen of Winslow’ are all, EXCEPT:

 A

Caudate lobe of liver

 B

Inferior vena cava

 C

Free border of lesser omentum

 D

4th part of Duodenum

Q. 1

The boundaries of the interconnection between greater sac and lesser sac of peritoneum known as ‘Foramen of Winslow’ are all, EXCEPT:

 A

Caudate lobe of liver

 B

Inferior vena cava

 C

Free border of lesser omentum

 D

4th part of Duodenum

Ans. D

Explanation:

Interconnection between greater sac and lesser sac of peritoneum is known as Foramen of Winslow. It has the following boundaries:

Superior boundary: Caudate lobe of liver

Anterior boundary: Free edge of lesser omentum containing common bile duct, hepatic artery andportal vein.

Inferior boundary: First part of duodenum

Posterior boundary: Inferior vena cava and abdominal aorta


Q. 2

Epiploic foramen provides communication between greater and lesser sacs. The length of the epiploic foramen is:

 A

5 cm

 B

6 cm

 C

4 cm

 D

3 cm

Q. 2

Epiploic foramen provides communication between greater and lesser sacs. The length of the epiploic foramen is:

 A

5 cm

 B

6 cm

 C

4 cm

 D

3 cm

Ans. D

Explanation:

 
The greater and lesser sacs communicate with each other through the epiploic foramen (of Winslow). The foramen is about 3 cm in size and situated opposite the 12th thoracic vertebra.

Q. 3

True about boundaries of lesser Sac:

 A

Posteriorly stomach

 B

Crus of diaphragm anterior

 C

Spleen anteriorly

 D

Greater omentum

Q. 3

True about boundaries of lesser Sac:

 A

Posteriorly stomach

 B

Crus of diaphragm anterior

 C

Spleen anteriorly

 D

Greater omentum

Ans. D

Explanation:

D. i.e. Greater omentum


Q. 4

Lesser sac of stomach is bounded by:

 A

Posterior wall of stomach

 B

Visceral surface of spleen

 C

Under surface of liver

 D

All

Q. 4

Lesser sac of stomach is bounded by:

 A

Posterior wall of stomach

 B

Visceral surface of spleen

 C

Under surface of liver

 D

All

Ans. A

Explanation:

A. i.e. Posterior wall of stomach

–  Lesser sac/ Omental bursa is bounded anteriorly by stomach, caudate lobe of liver, lesser omentum & greater omentum (ant. 2 layers); and posteriorly by structures forming stomach bed (i.e. diaphragm, pancreas, spleen etc) & greater omentum (posterior 2 layers)

Lesser sac or omental bursa is the site for abscess formation in posterior perforation of gastric ulcer and internal hernia through epiploic foramen


Q. 5

Omental bursa (lesser sac)A posteriorly perforating ulcer in the pyloric antrum of the stomach is most likely to produce initial localized peritonitis or abscess formation in the following 

 A

Omental bursa (lesser sac)

 B

Greater sac

 C

Right subphrenic space

 D

Hepato renal space (pouch of Morison)

Q. 5

Omental bursa (lesser sac)A posteriorly perforating ulcer in the pyloric antrum of the stomach is most likely to produce initial localized peritonitis or abscess formation in the following 

 A

Omental bursa (lesser sac)

 B

Greater sac

 C

Right subphrenic space

 D

Hepato renal space (pouch of Morison)

Ans. A

Explanation:

Ans. is ‘a’ i.e., Omental bursa 

  • BDC writes – “The posterior surface of the stomach is related to structures forming the stomach bed, all of which are separated from the stomach by the cavity of the lesser sac.”
  • Thus an ulcer on the posterior wall of stomach would perforate into the lesser sac.
  • Also remember
  • Most perforated ulcers are located on the anterior wall.
  • The mortality rate for perforated gastric ulcer is higher than that for duodenal ulcer. This is generally due to the gastric ulcer patients’ more advanced age, increased medical comorbidities, delay in seeking medical attention, and the larger size of gastric ulcers.

Q. 6

Communicating opening between greater sac and lesser sac‑

 A

Foramen of winslow

 B

Foramen of Monro

 C

Hepatorenal pouch

 D

Pouch of Douglas

Q. 6

Communicating opening between greater sac and lesser sac‑

 A

Foramen of winslow

 B

Foramen of Monro

 C

Hepatorenal pouch

 D

Pouch of Douglas

Ans. A

Explanation:

Epiploic foramen (foramen of winslow or aditus to lesser sac) is a slit-like opening through which lesser sac communicates with greater sac. It is situated at the level of T12 vertebra. Its boundries are :-

  • Anterior :- Right free margin of lesser omentum (contains portal vein, hepatic artery proper and bile duct).
  • Posterior :- IVC, right suprarenal gland and T12 vertebra.
  • Superior :- Caudate lobe of liver.
  • Inferior :- 1 part of duodenum and horizontal part of hepatic artery.


Fracture of the facial bones-Nose,Maxilla,Mandible,Zygomatic

Fracture of the facial bones-Nose,Maxilla,Mandible,Zygomatic

Q. 1

Le Forte II facial fracture implies –

 A

Fracture running through alveolar ridge

 B

Fracture running through midline of the palate and zygomatico maxillary suture

 C

Fracture running through zygomatic process of the maxilla, floor of orbit, root of nose on one side only

 D

Similar to C but on both sides

Q. 1

Le Forte II facial fracture implies –

 A

Fracture running through alveolar ridge

 B

Fracture running through midline of the palate and zygomatico maxillary suture

 C

Fracture running through zygomatic process of the maxilla, floor of orbit, root of nose on one side only

 D

Similar to C but on both sides

Ans. D

Explanation:

Ans. is ‘d’ i.e., Similar to C but on both sides 

Le Fort Classification of Mid-face #s

  • Le Fort I (transverse fracture)

the # line runs above & parallel to the palate and effectively separates the alveolus and palate from the facial skeleton above.

it crosses the lower part of the nasal septum, maxillary antra and the pterygoid plates.

  • Le Fort II fracture

it is pyramidal in shape and passes through the root of nose, lacrimal bone, floor of orbit, upper part of maxillary sinus and pterygoid plates. the orbital floor is always involved

  • Le Fort III fracture (craniofacial dysjunction) there is complete separation of facial bones from the cranial bones.

the # line runs high through the nasal bridge, septum and ethmoids, and through the bones of orbit to the frontozygomatic suture. The zygomatic

arch fractures and the facial skeleton is separated from the bones above at a high level through the lateral wall of maxillary sinus and the pterygoid plates.


Q. 2

Craniofacial dissociation is seen in:

 A

Le Fort 1 fracture

 B

Le Fort 2 fracture

 C

Le Fort 3 fracture

 D

Tripod fracture

Q. 2

Craniofacial dissociation is seen in:

 A

Le Fort 1 fracture

 B

Le Fort 2 fracture

 C

Le Fort 3 fracture

 D

Tripod fracture

Ans. C

Explanation:

Q. 3

CSF rhinorrhea is seen in:

 A

Lefort’s fracture Type I

 B

Nasal fracture

 C

Nasoethmoid fracture

 D

All

Q. 3

CSF rhinorrhea is seen in:

 A

Lefort’s fracture Type I

 B

Nasal fracture

 C

Nasoethmoid fracture

 D

All

Ans. C

Explanation:

 

CSF Rhinorrhea Occurs in fracture of maxilla in Le Fort type II and type III. (as cribriform plate is injured here) and also in nasal fracture class III



Q. 4

Bone commonly fractured in facial injuries is:

March 2009

 A

Nasal bones

 B

Nasoethmoid bone

 C

Zygomatic bone

 D

Mandible

Q. 4

Bone commonly fractured in facial injuries is:

March 2009

 A

Nasal bones

 B

Nasoethmoid bone

 C

Zygomatic bone

 D

Mandible

Ans. A

Explanation:

Ans. A: Nasal Bones

Nasal fracture is the most common facial fracture, and the third most common fracture of the skeleton overall. However, because many fractures are subclinical and many others are associated with multiple trauma, a high percentage are not diagnosed or treated at the time of injury.

These often lead to chronic nasal obstruction and account for many of the septoplasty procedures performed for obstruction and septal deviation.

Most facial fractures can be restored to their preoperative state with proper early intervention


Q. 5

Most common site for fracture mandible:    

TN 11

 A

Condyle

 B

Angle

 C

Body

 D

Symphysis

Q. 5

Most common site for fracture mandible:    

TN 11

 A

Condyle

 B

Angle

 C

Body

 D

Symphysis

Ans. A

Explanation:

Ans. Condyle


Q. 6

LeFort’s fracture would include all of the following, except:      

Manipal 10; WB 09; TN 09; Bihar 10; NIMHANS 14

 A

Maxilla

 B

Mandible

 C

Zygoma

 D

Nasal bones

Q. 6

LeFort’s fracture would include all of the following, except:      

Manipal 10; WB 09; TN 09; Bihar 10; NIMHANS 14

 A

Maxilla

 B

Mandible

 C

Zygoma

 D

Nasal bones

Ans. B

Explanation:

Ans. Mandible


Q. 7

Identify the Type of Le Forte Fracture as shown in the image

 A

Type II

 B

Type III

 C

Type IV

 D

None of the Above

Q. 7

Identify the Type of Le Forte Fracture as shown in the image

 A

Type II

 B

Type III

 C

Type IV

 D

None of the Above

Ans. B

Explanation:


Q. 8

Fracture mandible occurs most common in ‑

 A

Body

 B

Angle

 C

Condylar process

 D

Coronoid process

Q. 8

Fracture mandible occurs most common in ‑

 A

Body

 B

Angle

 C

Condylar process

 D

Coronoid process

Ans. C

Explanation:

Ans. is ‘c’ i.e., Condylar process

Condylar process fractures of the mandible are most common account for 35% of all the fractures of mandible. They are followed by angle, body and symphysis in decreasing order of frequency.

Mnemonic CABS: condylar process >angle >body >symphysis decreasing order of frequency of fracture mandible.


Q. 9

Tripod fracture is the name given for 

 A

Zygomatic fracture

 B

Maxillary fracture

 C

Mandibular fracture

 D

Temporal fracture

Q. 9

Tripod fracture is the name given for 

 A

Zygomatic fracture

 B

Maxillary fracture

 C

Mandibular fracture

 D

Temporal fracture

Ans. A

Explanation:

 

Zygoma fracture is also known as tripod fracture.

Clinical features of zygoma fracture

  • Considerable swelling over zygomatic arch is common and makes clinical diagnosis more difficult.
  • Flattening of malar prominence.
  • Step-deformity of infraorbital margin.
  • Anaesthesia in the distribution of infraorbital nerve.
  • Trismus, due to depression of zygoma on the underlying coronoid process.
  • Oblique palpebral fissure, due to the displacement of lateral palpebral ligament.
  • Restricted ocular movement, due to entrapment of inferior rectus muscle. It may cause diplopia. 
  • Periorbital emphysema, due to escape of air from the maxillary sinus on nose-blowing.
  • The mucosa of the maxillary sinus may be lacerated and cause epistaxis on that side.
  • Fracture of the zygoma may or may not be painful to palpation and running a finger along the zygomatic arch may give a feel of a depressed fracture or a small dimple. The cheek may appear flattened compared to symmetry with the opposite side. This may be obvious immediately following trauma or several days later once swelling has subsided.

Q. 10

Most common site of mandibular fracture is 

 A

Angle of mandible

 B

Condylar process

 C

Coronoid process

 D

Ramus

Q. 10

Most common site of mandibular fracture is 

 A

Angle of mandible

 B

Condylar process

 C

Coronoid process

 D

Ramus

Ans. B

Explanation:

Q. 11

Pyramidal fracture of maxilla is 

 A

Le Fort-1

 B

Le Fort-2

 C

Le Fort-3

 D

Craniofacial disruption

Q. 11

Pyramidal fracture of maxilla is 

 A

Le Fort-1

 B

Le Fort-2

 C

Le Fort-3

 D

Craniofacial disruption

Ans. B

Explanation:

 

Fracture of maxilla

It is classified into 3 types : ‑

  1. Le Fort I (transverse) fracture runs above and parallel to the plate. It crosses lower part of nasal septum, maxillary antra and the pterygoid plates.
  2. Le Fort II (pyramidal) fracture passes through the root of nose, lacrimal bone, floor of orbit, upper part of maxillary sinus and pterygoid plates. This fracture has some features common with the zygomatic fractures.
  3. Le Fort III (craniofacial dysjunction). There is complete separation of facial bones from the cranial bones. The fracture line passes through root of nose, ethmofrontal junction, superior orbital fissure, lateral wall of orbit, frontozygomatic and temporozygomatic sutures and the upper part of pterygoid plates.


Fracture of Temporal bone

Fracture of Temporal bone

Q. 1 Mr sunil, 22 year old male was brought in emergency room after scuffle in which he was punched over his face by a drunkard on road side. The patient was conscious and blood was trickling from right ear. The bleeding was controlled at that time. Next day the Audiometry of the patient showed conductive type of hearing loss. The type of temporal bone fracture the patient has?

 A Longitudinal
 B Transverse
 C Oblique
 D Mixed
 
Q. 1 Mr sunil, 22 year old male was brought in emergency room after scuffle in which he was punched over his face by a drunkard on road side. The patient was conscious and blood was trickling from right ear. The bleeding was controlled at that time. Next day the Audiometry of the patient showed conductive type of hearing loss. The type of temporal bone fracture the patient has?

 A Longitudinal
 B Transverse
 C Oblique
 D Mixed
 
Ans. A

Explanation:

Longitudinal Middle cranial Fossa is involved in 60%-80% of fracture of skull base.
Types of Temporal bone fracture include Longitudinal, Transverse. Mixed, Oblique and Unusual.
Longitudinal #:
-The longitudinal # is one where fracture line runs parallel to the Petrous ridge, that is longitudinal axis of the bone

-It constitutes 85% of all the Temporal Bone #. 23% are bilateral.
-Fracture begins in Squamous Temporal Bone & continues towards the Petrous apex, coursing around the dense Otic capsule bone.
-hearing loss is common after the injury;
-these # invariably results in laceration of the roof of the External Auditory Canal and often the tympanic membrane blood from the middle ear appears in the of External Auditory Canal, leading to a-dictum,that bloody
-Vestibular disorders are unusual

-Spontaneous Nystagmus is Rare.
-Facial N. is usually spared
-Most # extends along the Fallopian Canal rather than across it.
-Facial weakness after this # is usually incomplete and is most often delayed, secondary. to the edema rather than disruption of the nerve.
Transverse #:

 This # runs right angle to the longitudinal axis of the Petrous bone.
This pattern represents 15%-30% of Temporal Bone #.
Caused by: – Blow on the Occipul or less commonly a direct frontal blow.

 Transverse # has a higher mortality than longitudinal # and greater force is requiredto generate them.

 The “Classical’ Transverse # begins in Posterior Cranial Fossa, usually in the region of Foramen Lacerum or Foramen Spinosum.
The hearing loss in transverse # is usually S nsorineural, caused by disruption of the integrity of the labyn or the neurovascular bundle in the internal auditory canal.
Vertigo with spontaneous Nystagmus & post traumatic common after, it.
Facial N. paresis is also common (50%), it is immediate and r intensity than longitudinal #.
Mixed #:
Involves a combination of several of the routes, described.
Oblique #:
Not much is known about this type # but a recent study shows that these types of #s are actually the most common (75%).
Other # of temporal Bone:
# of anterior wall of External Auditory Canal can occur in conjugation with injuries to the Mandible.


Q. 2 A 22 year old young man was brought in emergency room after scuffle in which he was punched over his face by a hooligan road side. The patient  was  conscious  and  blood  was  trickling from right  ear. The  bleeding was  controlled at that time. Next day the Audiometry of the patient showed conductive type of hearing loss. The type of   temporal   bone fracture the patient has? 
 A Longitudinal
 B Transverse
 C Oblique
 D Mixed
Q. 2 A 22 year old young man was brought in emergency room after scuffle in which he was punched over his face by a hooligan road side. The patient  was  conscious  and  blood  was  trickling from right  ear. The  bleeding was  controlled at that time. Next day the Audiometry of the patient showed conductive type of hearing loss. The type of   temporal   bone fracture the patient has? 
 A Longitudinal
 B Transverse
 C Oblique
 D Mixed
Ans. A

Explanation:

Longitudinal Middle cranial Fossa is involved in 60%-80% of fracture of skull base. Types of Temporal bone fracture include Longitudinal, Transverse. Mixed, Oblique and Unusual.

a. Longitudinal #:

•  The longitudinal # is one where fracture line runs parallel to the Petrous ridge, that is longitudinal axis of the bone. it constitutes 85% of all the Temporal Bone #. 23% are bilateral. Fracture begins in Squamous Temporal Bone & continues towards the Petrous apex, coursing around the dense Otic capsule bone. Hearing loss is common after the injury; it is usually mixed hearing loss.

• These # invariably results in laceration of the roof of the External Auditory Canal and often the tympanic membrane blood from the middle ear appears in the of External Auditory Canal, leading to a-dictum, that bloody Otorhea after head injury usually represents a longitudinal temporal bone # until proved otherwise. If the Dura is disrupte CSF may leak through a disrupted Tegmen Tympani, resulting in CSF Otorrhea.

• Spontaneous Nystagmus is Rare.

• Facial N. is usually spared

• Most # extends along the Fallopian Canal rather than across it. Facial weakness after this # is usually incomplete and is most often delayed, secondary. to the edema rather than disruption of the nerve.

b. Transverse #:

• This # runs right angle to the longitudinal axis of the Petrous bone.

• Caused by: – Blow on the Occipul or less commonly a direct frontal blow. Transverse # has a higher mortality than longitudinal # and greater force is required to generate them.

• The “Classical’ Transverse # begins in Posterior Cranial Fossa, usually in the region of Foramen Lacerum or

Foramen Spinosum.

• The hearing loss in transverse # is usually Sensorineural, caused by disruption of the integrity of the labrynth or the neurovascular bundle in the internal auditory canal. Vertigo with spontaneous Nystagmus & post traumatic common after it.Facial n. paresis is also common (50%), it is immediate and greater intensity than longitudinal #.

Mixed #:  Involves a combination of several of the routes, described.

Oblique #: a recent study (not confirmed) shows that these types of #s are actually the most common (75%).

Other # of temporal Bone:

# of anterior wall of External Auditory Canal can occur in conjugation with injuries to the Mandible.


Q. 3

CSF otorrhoea is caused by – 

 A

Fracture of cribriform plate

 B

Fracture of parietal bone

 C

Fracture of petrous temporal bone

 D

Fracture of tympanic membrane

Q. 3

CSF otorrhoea is caused by – 

 A

Fracture of cribriform plate

 B

Fracture of parietal bone

 C

Fracture of petrous temporal bone

 D

Fracture of tympanic membrane

Ans. C

Explanation:

Ans is ‘c’ ie Fracture of petrous temporal bone 

C.S.F. otorrhoea is seen in fracture of temporal bone C.S.F. is seen in external and middle ears TiT – It usually ceases spontaneously, surgical intervention is rarely needed.


Q. 4

Which fracture of the petrous bone will cause facial nerve palsy:

 A

Longitudinal fractures

 B

Transverse fractures

 C

Mastoid

 D

Facial nerve injury is always complete

Q. 4

Which fracture of the petrous bone will cause facial nerve palsy:

 A

Longitudinal fractures

 B

Transverse fractures

 C

Mastoid

 D

Facial nerve injury is always complete

Ans. B

Explanation:

Q. 5

Treatment of choice for mastoid fracture with facial nerve palsy is:

 A

Nerve decompression

 B

High dose of steroid

 C

Sling operation

 D

Repair the fracture and wait and watch

Q. 5

Treatment of choice for mastoid fracture with facial nerve palsy is:

 A

Nerve decompression

 B

High dose of steroid

 C

Sling operation

 D

Repair the fracture and wait and watch

Ans. A

Explanation:

Q. 6

CSF otorrhea is caused by:         

Bihar 10; WB 11; CMC (Vellore) 13

 A

Fracture of cribriform plate

 B

Fracture of parietal bone

 C

Fracture of petrous temporal bone

 D

Fracture of tympanic membrane

Q. 6

CSF otorrhea is caused by:         

Bihar 10; WB 11; CMC (Vellore) 13

 A

Fracture of cribriform plate

 B

Fracture of parietal bone

 C

Fracture of petrous temporal bone

 D

Fracture of tympanic membrane

Ans. C

Explanation:

Ans. Fracture of petrous temporal bone


Q. 7

Artery usually torn in temporal bone fracture is:

Odisha 11

 A

Middle meningeal artery

 B

Posterior auricular artery

 C

Transverse facial artery

 D

Deep temporal artery

Q. 7

Artery usually torn in temporal bone fracture is:

Odisha 11

 A

Middle meningeal artery

 B

Posterior auricular artery

 C

Transverse facial artery

 D

Deep temporal artery

Ans. A

Explanation:

Ans. Middle meningeal artery


Q. 8

Best investigation for temporal bone fracture is:

 A

CT

 B

MRI

 C

X-RAY

 D

Ultrasound

Q. 8

Best investigation for temporal bone fracture is:

 A

CT

 B

MRI

 C

X-RAY

 D

Ultrasound

Ans. A

Explanation:

Ans. CT


Q. 9

CSF otorrhoea is caused by ‑

 A

Rupture of tympanic membrane

 B

Fracture of cribriform plate

 C

Fracture of parietal bone

 D

Fracture of petrous temporal bone

Q. 9

CSF otorrhoea is caused by ‑

 A

Rupture of tympanic membrane

 B

Fracture of cribriform plate

 C

Fracture of parietal bone

 D

Fracture of petrous temporal bone

Ans. D

Explanation:

 

CSF otorrhea

  • CSF otorrhea, i.e., leakage of cerebrospinal fluid through ear structure, is a rare but potentially life threatening situation that requires rapid intervention.
  • The underlying etiology of spinal fluid leak through temporal bone is a violation of the bony and meningeal barriers that separate the subarachoid space from the middle ear and mastoid.
  • This means that a defect must exist not only in the bone, but also in the dura matter.
  • Causes of CSF otorrhea are : ‑

1) Congenital : – Defect in otic capsule.

2) Acquired : – More common than congenital and cause are : –

  1. Surgery : – Post-operative leakage is the most common cause of CSF otorrhea. Surgical causes are acoustic neuroma removal, skull base surgeries and sometimes mastoid surgery.
  2. Trauma : – Fracture of petrous part of temporal can lead to CSF otorrhea.
  3. Infection

3) Spontaneous : – It is without an obvious antecedent pathology. There may be some defect in the temporal bone.



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