Category: Quiz

Malignant Otitis Externa

Malignant Otitis Externa

Q. 1

Malignant otitis externa is caused by _____________________

 A

Staphylococcus aureus

 B

Pseudomonas aeruginosa 

 C

Candida albicans

 D

Candida albicans

Q. 1

Malignant otitis externa is caused by _____________________

 A

Staphylococcus aureus

 B

Pseudomonas aeruginosa 

 C

Candida albicans

 D

Candida albicans

Ans. B

Explanation:

 

MALIGNANT (NECROTISING) OTITIS EXTERNA:

  • It is an inflammatory condition caused by pseudomonas infection usually in the elderly diabetics, or in those on immunosuppressive drugs.
  • Its early manifestations resemble diffuse otitis externa but there is excruciating pain and appearance of granulations in the meatus. Facial paralysis is common. Infection may spread to the skull base and jugular foramen causing multiple cranial nerve palsies. Anteriorly, infection spreads to temporomandibular fossa, posteriorly to the mastoid and medially into the middle ear and petrous bone.
  • CT scan is useful, to know the extent of disease.
  • Treatment consists of high doses of i.v. antibiotics directed against pseudomonas (tobramycin, ticarcillin or third generation cephalosporins). Antibiotics are given for 6-8 weeks or longer. Diabetes should be controlled. Surgical debridement of devitalised tissue and bone should be done judiciously.

Q. 2

Malignant otitis externa results from infection by which of the following organisms

 A Klebsiella
 B Enterococcus
 C Pseudomonas aeroginosa
 D Strep tococcal pneumonia
Q. 2

Malignant otitis externa results from infection by which of the following organisms

 A Klebsiella
 B Enterococcus
 C Pseudomonas aeroginosa
 D Strep tococcal pneumonia
Ans. C

Explanation:

Pseudomonas aeroginosa


Q. 3

Which of the following is true regarding malignant otitis externa?

 A

Caused by pseudomonas

 B

Seen in elderly diabetics

 C

Granulation tissue may be present in the external auditory canal

 D

All the above

Q. 3

Which of the following is true regarding malignant otitis externa?

 A

Caused by pseudomonas

 B

Seen in elderly diabetics

 C

Granulation tissue may be present in the external auditory canal

 D

All the above

Ans. D

Explanation:

Q. 4

Which of the organism causes malignant otitis externa?

 A

Staphylococcus aureus

 B

Pseudomonas aeruginosa

 C

Candida albicans

 D

E. coli

Q. 4

Which of the organism causes malignant otitis externa?

 A

Staphylococcus aureus

 B

Pseudomonas aeruginosa

 C

Candida albicans

 D

E. coli

Ans. B

Explanation:

Malignant (necrotizing) otitis externa is a particularly aggressive life-threatening form of infection caused by Pseudomonas aeruginosa infection. It usually in the elderly diabetics, or in those on immunosuppressive drugs. Its early manifestations resemble diffuse otitis externa but there is excruciating pain and appearance of granulations in the meatus. Facial paralysis is common.


Q. 5

Which of the following is NOT a typical feature of malignant otitis externa?

 A

Caused by Pseudomonas aeruginosa

 B

Patients are usually old

 C

Mitotic figures are high

 D

Patient is immunocompromised

Q. 5

Which of the following is NOT a typical feature of malignant otitis externa?

 A

Caused by Pseudomonas aeruginosa

 B

Patients are usually old

 C

Mitotic figures are high

 D

Patient is immunocompromised

Ans. C

Explanation:

High mitotic figures are suggestive of a malignant pathology. Malignant otitis externa is an infective condition, not a malignant one.


Q. 6

External otitis is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonists ear

 D

ASOM

Q. 6

External otitis is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonists ear

 D

ASOM

Ans. C

Explanation:

Humidity and hot climate are one of the predisposing factors for otitis externa. Hence – otitis externa is also k/a Singapore ear (where climate is hot & humid) or Telephonist ear as talking on phone causes humidity around ear) or Swimmers ear.

 


Pseudomonas aeruginosa is a normal inhibitant of external ear. Its numbers are kept in balance by the normal acidity of EAC. Prolonged swimming or abusive use of cotton typed ear buds can alter the pH, producing a more basic environment in which pseudomonas grows rapidly.



Q. 7

Malignant otitis externa is caused by: 

 A

S. aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Q. 7

Malignant otitis externa is caused by: 

 A

S. aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Ans. C

Explanation:

Ans. is c is P. aeruginosa


Q. 8

True statement about malignant otitis externa is:

 A

Not painful

 B

Common in diabetics and old age

 C

Caused by streptococcus

 D

All of the above

Q. 8

True statement about malignant otitis externa is:

 A

Not painful

 B

Common in diabetics and old age

 C

Caused by streptococcus

 D

All of the above

Ans. B

Explanation:

Q. 9

Malignant otitis externa is:

 A

Malignancy of external ear

 B

Caused by hemophilus influenzae

 C

Blackish mass of aspergillus

 D

Pseudomonas infection in diabetic patient

Q. 9

Malignant otitis externa is:

 A

Malignancy of external ear

 B

Caused by hemophilus influenzae

 C

Blackish mass of aspergillus

 D

Pseudomonas infection in diabetic patient

Ans. D

Explanation:

Q. 10

Malignant otitis externa is characterized:

 A

Caused by pseudomonas aeruginosa

 B

Malignancy of external auditory canal

 C

Granulation tissue is seen in the floor of external auditory canal

 D

a and c

Q. 10

Malignant otitis externa is characterized:

 A

Caused by pseudomonas aeruginosa

 B

Malignancy of external auditory canal

 C

Granulation tissue is seen in the floor of external auditory canal

 D

a and c

Ans. D

Explanation:

Q. 11

An elderly diabetic presents with painful ear discharge and edema of the external auditory canal with facial palsy, not responding to antibiotics. An increased uptake on technetium bone scan is noted. The most probable diagnosis is

 A

Malignant otitis externa

 B

Malignancy of the middle ear

 C

Infective disease of the middle ear

 D

Malignancy of nasopharynx with Eustachian tube ob­struction

Q. 11

An elderly diabetic presents with painful ear discharge and edema of the external auditory canal with facial palsy, not responding to antibiotics. An increased uptake on technetium bone scan is noted. The most probable diagnosis is

 A

Malignant otitis externa

 B

Malignancy of the middle ear

 C

Infective disease of the middle ear

 D

Malignancy of nasopharynx with Eustachian tube ob­struction

Ans. A

Explanation:

Q. 12

Facial nerve palsy is seen in:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Eczematous otitis externa

Q. 12

Facial nerve palsy is seen in:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Eczematous otitis externa

Ans. C

Explanation:

Q. 13

A female diabetic having severe ear pain and granulation tissue in external ear with Facial palsy is due to:

 A

Malignant otitis externa 

 B

Herpes zoster otitis

 C

Otomycosis

 D

None

Q. 13

A female diabetic having severe ear pain and granulation tissue in external ear with Facial palsy is due to:

 A

Malignant otitis externa 

 B

Herpes zoster otitis

 C

Otomycosis

 D

None

Ans. A

Explanation:

 

 Malignant otitis externa – can cause destruction of tissues of canal, pre and post auricular region by various enzymes like leci­thinase and hemolysis.

Infection can spread to skull base and jugular foramen causing multiple cranial nerve palsies in which most common is facial nerve palsy.



Q. 14

Diffuse otitis externa is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonist’s ear

 D

ASOM

Q. 14

Diffuse otitis externa is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonist’s ear

 D

ASOM

Ans. C

Explanation:

Q. 15

Regarding necrotizing otitis externa all are true except:

 A

Caused by pseudomonas

 B

Surgery never done

 C

Facial nerve involved

 D

Common in diabetics

Q. 15

Regarding necrotizing otitis externa all are true except:

 A

Caused by pseudomonas

 B

Surgery never done

 C

Facial nerve involved

 D

Common in diabetics

Ans. B

Explanation:

Q. 16

Facial nerve palsy is seen in this condition:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Cerebellar abscess

Q. 16

Facial nerve palsy is seen in this condition:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Cerebellar abscess

Ans. C

Explanation:

Q. 17

A 75-year old diabetic patient presents with severe ear pain and granulation tissue at external auditory canal with facial nerve involvement. The most likely diagnosis is:

 A

Malignant otitis externa

 B

Nasopharyngeal carcinoma

 C

Acute suppurative otitis media

 D

Chronic suppurative otitis media

Q. 17

A 75-year old diabetic patient presents with severe ear pain and granulation tissue at external auditory canal with facial nerve involvement. The most likely diagnosis is:

 A

Malignant otitis externa

 B

Nasopharyngeal carcinoma

 C

Acute suppurative otitis media

 D

Chronic suppurative otitis media

Ans. A

Explanation:

Q. 18

 Causative organism for malignant otitis externa is

 A

Hemophilus

 B

Staphylococcus

 C

Streptococcus

 D

Pseudomonas

Q. 18

 Causative organism for malignant otitis externa is

 A

Hemophilus

 B

Staphylococcus

 C

Streptococcus

 D

Pseudomonas

Ans. D

Explanation:

 

Malignant/necrotizing otitis externa is a disorder involving inflammation and damage of the bones and cartilage at the base of the skull.

Malignant otitis externa is caused by the spread of an outer ear infection (otitis externa, also called swimmer’s ear). It is an uncommon complication of both acute swimmer’s ear and chronic swimmer’s ear.

Risks for this condition include:

  • Chemotherapy
  • Diabetes
  • Weakened immune system

External otitis is often caused by difficult-to-treat bacteria such as pseudomonas. The infection spreads from the floor of the ear canal to the nearby tissues and into the bones at the base of the skull.

The infection and inflammation may damage or destroy the bones. The infection may spread more and affect the cranial nerves, brain, or other parts of the body.


Q. 19

Malignant otitis externa is caused by:   

 A

S.aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Q. 19

Malignant otitis externa is caused by:   

 A

S.aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Ans. C

Explanation:

 

Malignant (necrotising) otitis externa is an inflammatory condition caused by pseudomonas infection

Necrotizing external otitis (malignant otitis externa)

  • It is an uncommon form of external otitis occurs mainly in elderly diabetics.
  • It can develop due to a severely compromised immune system.
  • Beginning as infection of the external ear canal, there is extension of infection into the bony ear canal and the soft tissues deep to the bony canal.

The hallmark of malignant otitis externa (MOE) is unrelenting pain that interferes with sleep and persists even after swelling of the external ear canal may have resolved with topical antibiotic treatment.

Natural history

  • MOE follows a much more chronic and indolent course than ordinary acute otitis externa.
  • There may be granulation involving the floor of the external ear canal, most often at the bony-cartilaginous junction.
  • Paradoxically, the physical findings of MOE, at least in its early stages, are often much less dramatic than those of ordinary acute otitis externa.
  • In later stages there can be soft tissue swelling around the ear, even in the absence of significant canal swelling. While fever and leukocytosis might be expected in response to bacterial infection invading the skull region, MOE does not cause fever or elevation of white blood count.

Treatment of MOE

  • Unlike ordinary otitis externa, MOE requires oral or intravenous antibiotics for cure.
  • Diabetes control is also an essential part of treatment.
  • When MOE goes unrecognized and untreated, the infection continues to smolder and over weeks or months can spread deeper into the head and involve the bones of the skull base, constituting skull base osteomyelitis (SBO). The infecting organism is almost always pseudomonas aeruginosa, but it can instead be fungal (aspergillus or mucor).
  • MOE and SBO are not amenable to surgery, but exploratory surgery may facilitate culture of unusual organism(s) that are not responding to empirically used anti-pseudomonal antibiotics.
  • The usual surgical finding is diffuse cellulitis without localized abscess formation. SBO can extend into the petrous apex of the temporal bone or more inferiorly into the opposite side of the skull base.

Complications

  • As the skull base is progressively involved, the adjacent exiting cranial nerves and their branches, especially the
    facial nerve and the vagus nerve, may be affected, resulting in facial paralysis and hoarseness, respectively.
  • If both of the recurrent laryngeal nerves are paralyzed, shortness of breath may develop and necessitate tracheotomy.
  • Profound deafness can occur, usually later in the disease course due to relative resistance of the inner ear structures

Q. 20

Sago grain appearance is seen in ‑

 A

Healed myringitis bullosa

 B

Otomycosis

 C

Malignant otitis externa

 D

Keratosis obturans

Q. 20

Sago grain appearance is seen in ‑

 A

Healed myringitis bullosa

 B

Otomycosis

 C

Malignant otitis externa

 D

Keratosis obturans

Ans. A

Explanation:

Ans. is ‘a’ i.e., Healed myringitis bullosa

Otitis externa haemorrhagica

  • This condition is also known as Bullous myringitis or myringitis bullosa.
  • This condition is extremely painful and has sudden onset.
  • It is thought to be due to mycoplasma pneumoniae or viral infection, usually influenza’.
  • There may be a mild conductive deafness and a mildly discharging car.
  • The appearance of haemorrhagic bullae on the tympanic membrane and in the deep meatus is characteristic. The bullae are filled with serosanguinous fluid and blood.
  • On healing, bullae look like Sago-grain.
  • Therefore “Sago-grain” appearance of tympanic membrane is seen in healed myringitis bullosa.

Q. 21

Malignant otitis externa is caused by ‑

 A

S. aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Q. 21

Malignant otitis externa is caused by ‑

 A

S. aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Ans. C

Explanation:

Ans. is ‘c’ i.e., P. aeruginosa

Malignant otitis externa

Malignant otitis externa, also called necrotizing external otitis, is a misnomer as it is not a neoplastic condition, rather it is an infectious condition. Malignant otitis externa is a disorder involving inflammation and damage of the bones and cartilage at the base of skull in temporal bone as a result of spread of infection from outer ear. Malignant otitis externa is often caused by difficult to treat bacteria such as pseudomonas aeruginosa. Only rare cases of malignant otitis externa due to S.aureus, Proteus mirabilis and Aspergillus fumigatus have been reported. The infection spreads from the floor of the ear canal to the nearby tissues and into the bones at the base of the skull. The infection and inflammation may damage or destroy the bones. The infection may spread more and affect the cranial nerves, brain, or other parts of the body.

Predisposing factors for malignant otitis externa

Elderly diabetics (most common predisposing factor)

Individuals with altered immune function (immunodeficiency)

Chemotherapy

Clinical features of malignant otitis externa

Severe pain :- inside the ear and may get worse when moving head.

Granulation tissue in the external auditory canal, at the junction of bony and cartilagenous part.

Drainage from the ear – yellow, yellow – green, foul smelling, persistent.

Fever

Itching of ear or ear canal

Troubled swallowing & weakness of face.

Complications

Cranial nerve palsies :- most commonly facial nerve is involved. Other cranial nerves can also be involved (glossopharyngeal, vagus, spinal accessory, hypoglossal, abducens, trigeminal).

Jugular venous thrombosis

Cavernous sinus thrombosis

Meningitis

Treatment of malignant otitis externa

In all cases, the external ear canal is cleansed and a biopsy specimen of the granulation tissue sent for culture. IV antibiotics is directed against the offending organism. For Pseudomonas aeruginosa, the most common pathogen, the regimen involves an antipseudomonal penicillin or cephalosporin (3′d generation piperacillin or ceftazidime) with an aminoglycoside. A fluoroquinolone antibiotic can be used in place of the aminoglycoside. Ear drops containing antipseudomonal antibiotic e.g. ciproflaxacin plus a glucocorticoid is also used. Early cases can be managed with oral and otic fluoroquinolones only. Extensive surgical debridement once an important part of the treatment is now rarely needed.


Q. 22

Fowl smelling ear discharge with presence of pale granulation tissue in ear in an adolescent boy is suggestive of ‑

 A

Cholesteatoma

 B

Exostosis

 C

Otomycosis

 D

Malignant otitis externa

Q. 22

Fowl smelling ear discharge with presence of pale granulation tissue in ear in an adolescent boy is suggestive of ‑

 A

Cholesteatoma

 B

Exostosis

 C

Otomycosis

 D

Malignant otitis externa

Ans. A

Explanation:

Ans. is ‘a’ i.e., Cholesteatoma

Fowl smelling ear discharge with presence of granulation tissue in earin adolescent boy is suggestive chronic suppurativeotits media of the unsafe type (atticoantral disease). Such patients have underlying cholesteatomaalongwith evidence of bone destruction.

Clinical features of cholesteatoma/atticoantral CSOM

  • Otorrhoea :- Scanty, foul smelling discharge due to bone destruction.
  • Hearing loss :- Initially conductive due to destruction of ossicles. Later sensorineural element may be added, which results in mixed hearing loss.
  • Bleeding :- May occur from granulation or the polyp when cleaning the ear.
  • Tympanic membrane show posterior marginal or attic perforation. Also granulation tissue and polyps may be present in ear.

Q. 23

Malignant otitis externa is most commonly caused by –

 A

P. aeruginosa

 B

S. aureus

 C

St. penumoniae

 D

S. epidermidis

Q. 23

Malignant otitis externa is most commonly caused by –

 A

P. aeruginosa

 B

S. aureus

 C

St. penumoniae

 D

S. epidermidis

Ans. A

Explanation:

Ans. is ‘a’ i.e., P. aeruginosa


Q. 24

In malignant otitis externa which nerve commonly affected ‑

 A

Abducent

 B

Facial

 C

Auditory

 D

Vagus

Q. 24

In malignant otitis externa which nerve commonly affected ‑

 A

Abducent

 B

Facial

 C

Auditory

 D

Vagus

Ans. B

Explanation:

 

Most commonly facial nerve is involved. Other cranial nerves can also be involved (glossopharyngeal, vagus, spinal accessory, hypoglossal, abducens, trigeminal).



CSF Rhinorrhoea

CSF Rhinorrhoea

Q. 1

CSF rhinorrhea “immediate” management is

 A

Plugging with petrolleum jelly plugs

 B

Wait & watch for 7 days + antibiotics

 C

Blow the nose repeatedly

 D

Surgery

Q. 1

CSF rhinorrhea “immediate” management is

 A

Plugging with petrolleum jelly plugs

 B

Wait & watch for 7 days + antibiotics

 C

Blow the nose repeatedly

 D

Surgery

Ans. B

Explanation:

 

CSF rhinorrhea may be classified as:

  • Traumatic (>90%) – Approximately 80% of all traumatic leaks occur in the setting of accidental trauma, and the remaining traumatic leaks occur after neurosurgical and rhinological procedures
  • Nontraumatic (Nontraumatic etiologies include neoplasms and hydrocephalus

High pressure flow- intracranial tumours & hydrocephalous

Low pressure flow- congenital defects

  • Most common site for leak is through cribrtform plate and ethmoidal air sinuses.
  • Less common sites are through frontal and sphenoidal sinuses.

Rarely, the leak can originate in the middle or posterior cranial fossa and can reach the nasal cavity by way of the middle ear and eustachian tube

Diagnosis:

  • Basic clinical tests

– Rhinoscopy-visualisation of CSF leakage from paranasal sinuses

– Tissue test-unlike nasal mucous ,CSFdoes not cause a tissue to stiffen

– Filter paper test-sample of nasal discharge on a filter paper exhibits a light CSF border and a dark central area of blood ‘double ring sign’ or ‘ halo sign’ (in cases of traumatic CSF leak where blood and CSF are mixed.) – Queckenstedt test-compression of jugular veins leads to increased CSF leakage d/t increase in 1CP

  • Biochemical tests:

– Concentrations of glucose & protein are higher in CSF than in nasal discharge.

– 12-transferrin is the preferred biochemical marker of CSF. It helps in distinguishing CSF from other nasal secretions.

Beta-trace protein (11TP) is another chemical marker that could be used for the detection of CSF

  • CSF tracers:

Intrathecal fluorescein dye administration, radionuclide cisternography, CTcisternography

  • Radiological studies:

High-resolution CT provides detailed information about the bony skull base anatomy, and MR1 assesses soft tissues , including unrecognized tumors and coincidental meningoencephaloceles

Treatment:

  • Traumatic rhinorrhea often stops spontaneously
  • Conservative treatment consists of 1-2 weeks trial of?

– Strict bed rest – Head elevation – Stool softeners

– Advising patient to avoid coughing, sneezing, nose blowing, and straining

– Prophylactic antibiotics

– Subarachnoid drainage through a lumbar catheter

  • Surgical repair is generally advocated in patients with large fistulas especially in the presence of pneurnocephalous.

 


Q. 2

CSF Rhinorrhea is usually due to fracture of cribriform plate. Cribriform plate is a part of: 

 A

Vomer

 B

Ethmoid

 C

Maxilla

 D Zygomatic bone
Q. 2

CSF Rhinorrhea is usually due to fracture of cribriform plate. Cribriform plate is a part of: 

 A

Vomer

 B

Ethmoid

 C

Maxilla

 D Zygomatic bone
Ans. B

Explanation:

Ethmoid


Q. 3

A patient is brought to the emergency department following head trauma. He is conscious and complaining of fluid is coming out of his nostrils. He didn’t have a running nose before the trauma. 

 
Assertion: CSF examination produces clinically detectable signs of the ring sign, double-ring sign or halo sign in CSF Rhinorrhea.
 
Reason: CSF will separate from blood when the mixture is placed on filter paper resulting in a central area of blood with an outer ring or halo. Blood alone does not produce a ring.
 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. 3

A patient is brought to the emergency department following head trauma. He is conscious and complaining of fluid is coming out of his nostrils. He didn’t have a running nose before the trauma. 

 
Assertion: CSF examination produces clinically detectable signs of the ring sign, double-ring sign or halo sign in CSF Rhinorrhea.
 
Reason: CSF will separate from blood when the mixture is placed on filter paper resulting in a central area of blood with an outer ring or halo. Blood alone does not produce a ring.
 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:

Halo sign/Handkerchief sign is a finding in CSF rhinorrhea when CSF is mixed with Blood.

The best ring is obtained with a 50: 50 mix of blood and CSF.

Ref: Diseases of Ear, Nose and Throat by PL Dhingra, 4th Edition, Pages 155, 156.

Q. 4

A female in the emergency department is found to have CSF rhinorrhea following a motor vehicle accident. What is the first line of treatment for CSF rhinorrhoea in this patient?

 A

Immediate plugging of nose with petroleum gauze

 B

Forceful blowing of nose

 C

Craniotomy

 D

Observation for 7 – 10 days with antibiotic therapy

Q. 4

A female in the emergency department is found to have CSF rhinorrhea following a motor vehicle accident. What is the first line of treatment for CSF rhinorrhoea in this patient?

 A

Immediate plugging of nose with petroleum gauze

 B

Forceful blowing of nose

 C

Craniotomy

 D

Observation for 7 – 10 days with antibiotic therapy

Ans. D

Explanation:

Early cases of post-traumatic CSF rhinorrhea are managed conservatively by placing the patient in semi-sitting position, avoiding blowing of nose, sneezing and straining. Prophylactic antibiotics are also administered to prevent meningitis. 

Persistent cases of CSF rhinorrhoea are treated surgically through nasal endoscopic or intracranial approach. Nasal endoscopic approach is useful for leaks from the frontal sinus, cribriform plate, ethmoid or sphenoid sinuses.


Q. 5

CSF rhinorrhea is seen in:

 A

Lefort’s fracture Type I

 B

Nasal fracture

 C

Nasoethmoid fracture

 D

All

Q. 5

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. 6

True about CSF rhinorrhea is:

 A

Occurs due to break in cribriform plate

 B

Contains glucose

 C

Requires immediate surgery

 D

a and b

Q. 6

True about CSF rhinorrhea is:

 A

Occurs due to break in cribriform plate

 B

Contains glucose

 C

Requires immediate surgery

 D

a and b

Ans. D

Explanation:

 

 

 

– Early cases of post traumatic CSF rhinorrhea are managed conservatively. Only those cases where CSF rhinorrhea occurs persistently

– Surgical management should be done


Q. 7

Immediate treatment of CSF rhinorrhea requires:

 A

Antibiotics and observation

 B

Plugging with paraffin guage

 C

Blowing of nose

 D

Craniotomy

Q. 7

Immediate treatment of CSF rhinorrhea requires:

 A

Antibiotics and observation

 B

Plugging with paraffin guage

 C

Blowing of nose

 D

Craniotomy

Ans. A

Explanation:

 

  • Early cases of post traumatic CSF rhinorrhea are managed conservatively (by placing the patient in propped up position, avoiding blowing of nose, sneezing and straining) and
  • Prophylactic antibiotics (to prevent meningitis).
  • Persistent cases are treated surgically by nasal endoscopy or by intracranial route.

 

Endoscopic closure of (SF leak is now the treatment of choice in majority of patients but it should not be done immediately. First patient should be subjected to diagnostic evaluation and after site of leakage is confirmed, it should be closed endoscopically. – Scott-Brown


Q. 8

Management of persistent cases of CSF rhinorrhea is:

 A

Head low position on bed

 B

Endoscopic repair

 C

Straining activities

 D

All of the above

Q. 8

Management of persistent cases of CSF rhinorrhea is:

 A

Head low position on bed

 B

Endoscopic repair

 C

Straining activities

 D

All of the above

Ans. B

Explanation:

CSF rhinorrhoea

  • It refers to the drainage of cerebrospinal fluid through the nose.
  • Measures of CSF components such as beta-2 transferrin has been shown to have a high positive predictive value.
  • It has also been noted to be characterized by unilateral discharge.
  • It is a sign of basal skull fracture.
  • Management includes watchful waiting – leaks often stop spontaneously; if this does not occur then neurosurgical closure is necessary to prevent the spread of infection to the meninges.

Q. 9

CSF rhinorrhoea is due to the fracture of which of the following 

March 2008

 A

Nasal bones

 B

Cribriform plate

 C

Temporal bone

 D

Maxillary bone

Q. 9

CSF rhinorrhoea is due to the fracture of which of the following 

March 2008

 A

Nasal bones

 B

Cribriform plate

 C

Temporal bone

 D

Maxillary bone

Ans. B

Explanation:

Ans. B: Cribriform Plate

CSF rhinorrhoea can follow a head injury.

CSF from anterior cranial fossa reaches the nose by way of cribriform plate, ethmoid air cells or frontal sinus. CSF from middle cranial fossa reaches the nose via sphenoid sinuses.

Sometimes, injuries of the temporal bone result in leakage of CSF into the middle ear and thence via the Eustachian tube into the nose (otorhinorrhoea).

The meninges are torn and cerebrospinal fluid leaks down the nose.

Ascending infection may cause meningitis


Q. 10

True about CSF rhinorrhea:       

UP 09

 A

Commonly occurs due to break in cribriform plate

 B

Contains less amount of proteins

 C

Decreased glucose content confirms diagnosis

 D

Immediate surgery is required

Q. 10

True about CSF rhinorrhea:       

UP 09

 A

Commonly occurs due to break in cribriform plate

 B

Contains less amount of proteins

 C

Decreased glucose content confirms diagnosis

 D

Immediate surgery is required

Ans. A

Explanation:

Ans. Commonly occurs due to break in cribriform plate


Q. 11

CSF rhinorrhea is diagnosed by:

MP 07

 A

Glucose estimation

 B

Halo sign

 C

Immunoelectrophoresis

 D

All

Q. 11

CSF rhinorrhea is diagnosed by:

MP 07

 A

Glucose estimation

 B

Halo sign

 C

Immunoelectrophoresis

 D

All

Ans. D

Explanation:

Ans. All


Q. 12

Diagnostic test for CSF rhinorrhea is ‑

 A

Beta – 2 microglobulin

 B

Beta – 2 transferrin

 C

Thyroglobulin

 D

Transthyretin

Q. 12

Diagnostic test for CSF rhinorrhea is ‑

 A

Beta – 2 microglobulin

 B

Beta – 2 transferrin

 C

Thyroglobulin

 D

Transthyretin

Ans. B

Explanation:

Ans. is ‘b’ i.e., Beta-2 transferrin


Q. 13

Common site for CSF Rhinorrhoea is ‑

 A

Ethmoidal sinus

 B

Frontal sinus

 C

Petrous

 D

All

Q. 13

Common site for CSF Rhinorrhoea is ‑

 A

Ethmoidal sinus

 B

Frontal sinus

 C

Petrous

 D

All

Ans. A

Explanation:

 

The cribriform plate and air cells of the ethmoid sinus account for maximum number of CSF leaks, i.e., through anterior cranial fossa.

Other sites are frontal sinus, area of sellatursica and sphenoid sinus.

Rare sites of leak are middle or posterior cranial fossa and CSF can reach the nasal cavity by way of the middle ear and Eustachian tube.

Traumatic leak → Cribriform plate and ethmoidal air cells.

Spontaneous (non-traumatic) leak →  Cribriform plate.



Hypospadias

Hypospadias

Q. 1

Most common type of hypospadias is?

 A Glandular
 B

Penile

 C Scrotal
 D

Perineal

Q. 1

Most common type of hypospadias is?

 A Glandular
 B

Penile

 C Scrotal
 D

Perineal

Ans. A

Explanation:

Glandular REF: Bailey and love 24th ed p. 1389

Hypospadias is most common congenital malformation of urethra

Types of hypospadias

  • Glandular (50-70%)
  • Penile
  • Subcoronal
  • Penoscrotal
  • Scrotal
  • Perineal

Q. 2

Commonest hypospadias is:

 A

Penile

 B

Glandular

 C

Scrotal

 D

A or C

Q. 2

Commonest hypospadias is:

 A

Penile

 B

Glandular

 C

Scrotal

 D

A or C

Ans. B

Explanation:

Ans. is ‘b’ i.e. Glandular

  • Hypospadias is a condition in which the urethral meatus opens on the underside of penis or the perineum (i.e. ventral surface of penis) proximal to the tip of the glans penis.
  • There are several types of hypospadias acccccording to location

Q. 3

The best time for surgery of hypospadias is –

 A

1-4 months of age

 B

6-10 months of age

 C

12-18 months of age

 D

2-4 years of age

Q. 3

The best time for surgery of hypospadias is –

 A

1-4 months of age

 B

6-10 months of age

 C

12-18 months of age

 D

2-4 years of age

Ans. B

Explanation:

Ans. is ‘b’ i.e., 6 – 10 months 

“The best time for surgery for hypospadias is between 6-12 months of age” – Cambell’s Urology


Q. 4

Features of hypospadias are all except –

 A

Chordee

 B

Hooded prepuce

 C

No-treatment required with glandular veriety

 D

Cryptorchidism

Q. 4

Features of hypospadias are all except –

 A

Chordee

 B

Hooded prepuce

 C

No-treatment required with glandular veriety

 D

Cryptorchidism

Ans. D

Explanation:

Ans is ‘d’ i.e., Cryptorchidism 

  • Cambell’s Urology defines hypospadias as an association of 3 anatomic and developmental anomalies of penis.

1)       An abnormal ventral opening of the urethral meatus

2)       An abnormal Ventral curvature of the penis (chordee)

3)       A abnormal distribution of foreskin with a ‘hood’ present dorsally and deficient foreskin ventrally (hooded prepuce)

  • Remember that Cryptorchidism is not a feature of hypospadias. But it may be seen associated with hypospadias in 8-9% of cases [Ref: Cambell’s Urology 8/e p2291, Smith’s Urology 17/e p631 (16/e p618)]

Q. 5

In hypospadias all are seen except –

 A

Hooded penis

 B

Dorsal chordee

 C

Spatulated glans

 D

Meatal stenosis

Q. 5

In hypospadias all are seen except –

 A

Hooded penis

 B

Dorsal chordee

 C

Spatulated glans

 D

Meatal stenosis

Ans. B

Explanation:

Answer is ‘b’ i.e. Dorsal chordee 

  • Ventral chordee is seen in hypospadias
  • Dorsal chordee is a feature of epispadias

Q. 6

True about hypospadias is all except – 

 A

Bifid scrotum

 B

Meatal stenosis

 C

Mental Retardation

 D

Spatulated glans

Q. 6

True about hypospadias is all except – 

 A

Bifid scrotum

 B

Meatal stenosis

 C

Mental Retardation

 D

Spatulated glans

Ans. C

Explanation:

Answer is ‘c’ i.e. Mental Retardation 

  • Meatal stenosis may be associated with hypospadias and needs meatotomy for correction.
  • Bifid scrotum may be seen in penoscrotal, scrotal & perinea! hypospadias.

Q. 7

True about Hypospadias is ‑

 A

Meatal stenosis

 B

Dorsal hood

 C

Proximal opening of meatus

 D

All

Q. 7

True about Hypospadias is ‑

 A

Meatal stenosis

 B

Dorsal hood

 C

Proximal opening of meatus

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e. Meatal stenosis; ‘b’ i.e. Dorsal hood; ‘c’ i.e. Proximal opening of meatus 


Q. 8

Which is not true of Hypospadias –

 A

Chordee is reversed after 5 years

 B

Glandular type needs no treatment

 C

Circumcision should not be done

 D

Surgical correction has good results in infancy

Q. 8

Which is not true of Hypospadias –

 A

Chordee is reversed after 5 years

 B

Glandular type needs no treatment

 C

Circumcision should not be done

 D

Surgical correction has good results in infancy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Chordee is reversed after 5 years 


Q. 9

Penis is curved in downward direction in all types of hypospadias except –

 A

Glandular

 B

Coronal

 C

Penile

 D

Perineal

Q. 9

Penis is curved in downward direction in all types of hypospadias except –

 A

Glandular

 B

Coronal

 C

Penile

 D

Perineal

Ans. A

Explanation:

Ans. is ‘a’ i.e., Glandular 


Q. 10

Epispadias in relation to hypospadias ‑

 A

Is more common

 B

Less common

 C

Occures with the same frequency

 D

Is difficult to treat

Q. 10

Epispadias in relation to hypospadias ‑

 A

Is more common

 B

Less common

 C

Occures with the same frequency

 D

Is difficult to treat

Ans. B

Explanation:

Ans. is ‘b’ i.e., Less common 


Q. 11

In severe hypospadias the possibility of an intersex problem is settled by –

 A

Careful inspection of genitals

 B

Biopsy for gonadal tissue

 C

Karyotyping

 D

Hormone assay

Q. 11

In severe hypospadias the possibility of an intersex problem is settled by –

 A

Careful inspection of genitals

 B

Biopsy for gonadal tissue

 C

Karyotyping

 D

Hormone assay

Ans. C

Explanation:

Ans. is ‘c’ i.e., Karyotyping 


Q. 12

All of following are seen in hypospadias except ‑

 A

Ectopia vesicae

 B

Hooded prepuce

 C

Chordee

 D

Infertility

Q. 12

All of following are seen in hypospadias except ‑

 A

Ectopia vesicae

 B

Hooded prepuce

 C

Chordee

 D

Infertility

Ans. A

Explanation:

Ans. is ‘a’ i.e., Ectopia vesicae 


Q. 13

Most common type of hypospadias is:

September 2011

 A

Glandular

 B

Penile

 C

Coronal

 D

Perineal

Q. 13

Most common type of hypospadias is:

September 2011

 A

Glandular

 B

Penile

 C

Coronal

 D

Perineal

Ans. A

Explanation:

Ans. A: Glandular

Glandular hypospadias is common and does not usually require treatment

Hypospadias:

  • The external meatus opens on the underside of the penis or the perineum, and the inferior aspect of the prepuce is poorly developed (hooded prepuce)
  • Meatal stenosis occurs
  • Bifid scrotum
  • 6 – 10 months of age is the best time for surgery




Scapula

SCAPULA

Q. 1

The muscles of scapula which function as retractors are given below, EXCEPT?

 A

Trapezius

 B

Rhomboid major

 C

Rhomboid minor

 D

Levator scapulae

Q. 1

The muscles of scapula which function as retractors are given below, EXCEPT?

 A

Trapezius

 B

Rhomboid major

 C

Rhomboid minor

 D

Levator scapulae

Ans. D

Explanation:

Three muscles make up of retractors of the scapula. They are,

  • Rhomboid major

  • Rhomboid minor (The rhomboid muscles attach to the spinous processes of C7–T5 and the medial border of the scapula, resulting in scapular retraction)

  • Middle fibers of trapeziuscourse horizontally from the lower nuchal ligament and thoracic vertebrae to the scapula, causing scapular retraction.

 These muscles primarily tug the shoulder blade back toward the vertebral column. The levator scapula muscle is located deep to the trapezius muscle and superior to the rhomboids causing elevation and downward rotation of the scapula.


Q. 2

All of the following muscles elevate scapula, EXCEPT?

 A

Trapezius

 B

Levator scapulae

 C

Latissimus dorsi

 D

Rhomboid major

Q. 2

All of the following muscles elevate scapula, EXCEPT?

 A

Trapezius

 B

Levator scapulae

 C

Latissimus dorsi

 D

Rhomboid major

Ans. C

Explanation:

The latissimus dorsi acts on the humerus causing powerful adduction, extension, and medial rotation of the arm.

  • Superior fibers of the trapezius cause scapular elevation and upward rotation. Middle fibers causes scapular retraction. Inferior fibers causes scapular depression and upward rotation.
  • The levator scapula muscle attaches to the cervical vertebrae and the superior angle of the scapula, causing elevation and downward rotation of the scapula.
  • The rhomboid muscles attach to the spinous processes of C7–T5 and the medial border of the scapula, resulting in scapular retraction also also helps in elevation of scapula.

Q. 3

Which is the muscle that draws the scapula forward ?

 A

Trapezuis

 B

Rhomboides

 C

Serratus anterior

 D

Levator scapulae

Q. 3

Which is the muscle that draws the scapula forward ?

 A

Trapezuis

 B

Rhomboides

 C

Serratus anterior

 D

Levator scapulae

Ans. C

Explanation:

Serratus anterior protracts the scapula, it acts as a main muscle in reaching and pushing movements. It also helps in raising the arm fully. The muscular digitations of serratus anterior can be seen and felt when the outstretched hand pushes against resistance. In case of paralysis, the lower angle of the scapula stands out prominently, there is projection of scapula also termed as winging of scapula.

Must know:

Seratus anterior is innervated by the long thoracic nerve also known as nerve of bell.

Good to know:

Dropped shoulder occurs as a result of paralysis of the trapezius muscle. With paralysis of the trapezius muscle a drop shoulder with rotation of the angle of the scapula towards the midline and restricted abduction of the arm is caused. Trapezius is supplied by accessory nerve.


Q. 4

All of the following muscles are used for the retraction of scapula, EXCEPT?

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Q. 4

All of the following muscles are used for the retraction of scapula, EXCEPT?

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Ans. D

Explanation:

The levator scapula muscle attaches to the cervical vertebrae and the superior angle of the scapula, causing elevation and downward rotation of the scapula.

 Trapezius elevates, retracts, depresses, and rotates scapula. The rhomboid muscles attach to the spinous processes of C7–T5 and the medial border of the scapula, resulting in scapular retraction. 

Q. 5

The spine of the scapula can be palpated at which of the following level of vertebrae?

 A

T 1

 B

T 3

 C

T 5

 D

T 7

Q. 5

The spine of the scapula can be palpated at which of the following level of vertebrae?

 A

T 1

 B

T 3

 C

T 5

 D

T 7

Ans. B

Explanation:

Spine of the scapula lies at the level of T3 vertebrae. Scapular spine is seen on the posterior surface of the scapula and it expands into a terminal process called acromion process.

The scapulae overlie the posterior portion of the thoracic wall, and cover the upper seven ribs. The superior angle of scapula can be palpated at the T1 vertebral level and the inferior angle lies  at the level of T7 vertebrae.


Q. 6

Inferior angle of scapula lies at –

 A

T6

 B

T7

 C

T3

 D

T12

Q. 6

Inferior angle of scapula lies at –

 A

T6

 B

T7

 C

T3

 D

T12

Ans. B

Explanation:

Important landmarks of scapula

i) Inferior angle overlaps seventh rib or seventh intercostal space and lies opposite to tip of T7 spinous process.

ii) Superior angle lies opposite to tip of T2 spinous process.

iii) Lateral angle corresponds to glenoid fossa.

iv) Junction of medial (vertebral) border corresponds to tip of T3 spine.


Q. 7

Which border of scapula is not palpable ‑

 A

Medial

 B

Lateral

 C

Inferior

 D

Superior

Q. 7

Which border of scapula is not palpable ‑

 A

Medial

 B

Lateral

 C

Inferior

 D

Superior

Ans. D

Explanation:

“The medial border, inferior angle and part of the lateral border of scapula can be palpated on a patient as can the spine and acromian. The superior border and angle of the scapula are deep to soft tissue and are not readly palpable”


Q. 8

Superior angle of scapula lies at which level ‑

 A

T7

 B

T12

 C

T2

 D

C5

Q. 8

Superior angle of scapula lies at which level ‑

 A

T7

 B

T12

 C

T2

 D

C5

Ans. C

Explanation:

Ans. is ‘c’ i.e., T2


Q. 9

Winging of scapula is seen in paralysis of which muscle‑

 A

Serratus anterior

 B

Supraspinatus

 C

Pectoralis major

 D

Infraspinatus

Q. 9

Winging of scapula is seen in paralysis of which muscle‑

 A

Serratus anterior

 B

Supraspinatus

 C

Pectoralis major

 D

Infraspinatus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Serratus anterior


Q. 10

Congenital elevation of scapula is called ‑

 A

Sprengelshouder

 B

Bouchard

 C

Boutennier

 D

None of the above

Q. 10

Congenital elevation of scapula is called ‑

 A

Sprengelshouder

 B

Bouchard

 C

Boutennier

 D

None of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., Sprengel shoulder

Congenital high scapula (sprengel’s shoulder)

  • Congenital high scapula is an uncommon congenital deformity characterized by an abnormally high position and relative fixity of scapula.
  • The anomaly represents a failure of the scapula to descend during development to its normal thoracic position.

Q. 11

Patient presented with this condition of scapula in the clinic ,it is due involvement of?

 A

Medial pectoral nerve palsy

 B

Lateral pectoral nerve palsy

 C

Nerve to serratus anterior palsy

 D

Nerve to Latissimus dorsi palsy

Q. 11

Patient presented with this condition of scapula in the clinic ,it is due involvement of?

 A

Medial pectoral nerve palsy

 B

Lateral pectoral nerve palsy

 C

Nerve to serratus anterior palsy

 D

Nerve to Latissimus dorsi palsy

Ans. C

Explanation:

Winging of scapula

  • The most common cause of scapular winging is serratus anterior paralysis.
  • This is typically caused by damage to the long thoracic nerve.
  • This nerve supplies the serratus anterior, which is located on the side of the thorax and acts to pull the scapula forward

Q. 12

All of the following muscles are used for this action of scapula as seen in image, EXCEPT?

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Q. 12

All of the following muscles are used for this action of scapula as seen in image, EXCEPT?

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Ans. D

Explanation:

This action is retraction of scapula

  


Q. 13

Which muscle causes retraction of scapula ‑

 A

Serratus anterior

 B

Levator scapulae

 C

Rhomboideus major 

 D

Supraspinatus

Q. 13

Which muscle causes retraction of scapula ‑

 A

Serratus anterior

 B

Levator scapulae

 C

Rhomboideus major 

 D

Supraspinatus

Ans. C

Explanation:

Ans. is ‘c’ i.e., Rhomboideus major

Movements of scapula Muscles causing movements
Elevation Trapezius (upper part), levator scapulae
Depression Pectoralis minor, serratus anterior
Protraction Serratus anterior, pectoralis minor
Retraction Rhomboideus major Rhomboideus minor, Trapezius
Forward rotation of inferior angle(for overhead abduction) Trapezius (upper fibers), serratus anterior (lower fibers) 
Backward rotation Levator scapulae, rhomboideus major and minor

Q. 14

Winging of scapula is due to which of these conditions?

 A

Long thoracic nerve pals

 B

Thoraco-dorsal nerve palsy

 C

Erb’s palsy

 D

Klumpke’s palsy

Q. 14

Winging of scapula is due to which of these conditions?

 A

Long thoracic nerve pals

 B

Thoraco-dorsal nerve palsy

 C

Erb’s palsy

 D

Klumpke’s palsy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Long thoracic nerve palsy 



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