Category: Quiz

Fluid of inner ear

Fluid Of Inner Ear

Q. 1

Endolymph in the inner ear:

 A

Is a filterate of blood serum

 B

Is secreted by Stria vascularis

 C

Is secreted by Basilar membrane

 D

Is secreted by Hair cells

Q. 1

Endolymph in the inner ear:

 A

Is a filterate of blood serum

 B

Is secreted by Stria vascularis

 C

Is secreted by Basilar membrane

 D

Is secreted by Hair cells

Ans. B

Explanation:

Is secreted by Stria vascularis [Ref: Ds. of ENT by P.L. Dhingra 5/e p12] Repeat from May 09

There are 2 main fluids in the inner ear:

  • Endolymph

– It fills the entire membranous labyrinth

– Resembles intracellular. fluid, being rich in K ions.

–  It is secreted by the secretory cells of the stria vascularis of the choclea and by the dark cells (present in the utricle and near the ampullated ends of semicircular ducts).

  • Perilymph

–  It fills the space between the bony and the membranous labyrinth.

–  It resembles extra cellular fluid being rich in Na ions.

– It communicates with CSF through the aqueduct of cochlea which opens into the scala tympani near the round window.

– There are 2 views regarding its formation:

i)    It is a filterate of blood serum and is formed by capillaries of the spiral ligament

ii)     It is a direct continuation of CSF and reaches the labyrinth via aqueduct of cochlea.


Q. 2

Which of the following structures contains endolymph?

 A

Helicotrema

 B

Scala media

 C

Scala tympani

 D

Scala vestibuli

Q. 2

Which of the following structures contains endolymph?

 A

Helicotrema

 B

Scala media

 C

Scala tympani

 D

Scala vestibuli

Ans. B

Explanation:

The cochlea of the inner ear is a coiled structure filled with endolymph and perilymph. Within it are three longitudinal compartments. The membranous labyrinth within the cochlea is called the scala media, or cochlear duct. This compartment contains the hair receptors and is filled with endolymph that is secreted by the stria vascularis. The composition of endolymph resembles intracellular fluid (K+> Na+).

The two perilymph-filled compartments, the scala tympani and the scala vestibuli surround the cochlear duct. This space is continuous with subarachnoid space, and therefore the perilymph closely resembles cerebrospinal fluid. The helicotrema is the apical connection between the scala tympani and scala vestibuli.
 
The spiral ganglion is located in the modiolus (the cochlear part of the body labyrinth), and contains the cell bodies of the bipolar cells that comprise the cochlear division of the eighth nerve.

Q. 3

Endolymph in the inner ear:

 A

 has low concentration of K+ and high concentration of Na+

 B

Is secreted by Stria vascularis

 C

Is secreted by Basilar membrane

 D

None is true

Q. 3

Endolymph in the inner ear:

 A

 has low concentration of K+ and high concentration of Na+

 B

Is secreted by Stria vascularis

 C

Is secreted by Basilar membrane

 D

None is true

Ans. B

Explanation:

Endolymph is formed in the scala media by the stria vascularis. Endolymph has high concentration of K+ and low concentration of Na+.

Cells in the stria vascularis have high concentration of Na+ K+ ATPase activity. 

Q. 4

Endolymphatic duct drains into :

 A

Subdural space

 B

External space

 C

Subarachnoid space

 D

Succulus

Q. 4

Endolymphatic duct drains into :

 A

Subdural space

 B

External space

 C

Subarachnoid space

 D

Succulus

Ans. A

Explanation:

Ans:A.)Subdural 

Perilymph drains into subarachnoid space through the aqueduct of cochlea… 
Endolymph is absorbed in subdural space.


Q. 5

Site where endolymph is seen:

 A

Scala vestibuli

 B

Scala media

 C

Helicotrema

 D

Organ of corti

Q. 5

Site where endolymph is seen:

 A

Scala vestibuli

 B

Scala media

 C

Helicotrema

 D

Organ of corti

Ans. B

Explanation:

Q. 6

The function of stria vascularis is:

 A

To produce perilymph

 B

To absorb perilymph

 C

To maintain electric milieu of endolymph

 D

To maintain electric milieu of perilymph

Q. 6

The function of stria vascularis is:

 A

To produce perilymph

 B

To absorb perilymph

 C

To maintain electric milieu of endolymph

 D

To maintain electric milieu of perilymph

Ans. C

Explanation:

 

Scala vestibuli and scala tympani are filled with perilymph, whereas scala media/membranous cochlea is filled with endolymph. 


Q. 7

Endolymph in the inner ear:

 A

Is a filterate of blood serum

 B

Is secreted by stria vascularis

 C

Is secreted by basilar membrane

 D

Is secreted by hair cells

Q. 7

Endolymph in the inner ear:

 A

Is a filterate of blood serum

 B

Is secreted by stria vascularis

 C

Is secreted by basilar membrane

 D

Is secreted by hair cells

Ans. B

Explanation:

Q. 8

Endolymph is rich in ‑

 A

Na+

 B

Cl

 C

HCO3

 D

K+

Q. 8

Endolymph is rich in ‑

 A

Na+

 B

Cl

 C

HCO3

 D

K+

Ans. D

Explanation:

Ans. is ‘d’ i.e., K+

Fluid in inner ear

  • There are two main fluids in the inner ear : –

(i) Perilymph                  

(ii) Endolymph

Perilymph

  • It resembles ECF and is rich in Nu+ ions. It fills the space between bony and the membranous labyrinth, i.e., Scala vestibuli and scala tympani. It communicates with CSF through the aqueduct of Cochlea which opens into the scala tympani near the round window. Therefore It closely resembles CSF. It is formed by : –

i) It is a filterate of blood serum and is formed by capillaries of the spiral ligament.

ii) It is a direct continuation of CSF and reaches the labyrinth via aqueduct of cochlea.

Endolymph

It fills the entire membranous labyrinth including scala media (cochlear duct). It resembles intracellular fluid, being rich in IC ions. It is secreted by the secretory cells of the stria vascularis of the cochlea and by the dark cells (present in the utricle and near the ampullated ends of semicircular ducts).



Semicircular canals of inner ear

SEMICIRCULAR CANALS OF INNER EAR

Q. 1

Semicircular canal perceives ___________

 A

Linear acceleration

 B

Angular acceleration

 C

Both

 D

None

Q. 1

Semicircular canal perceives ___________

 A

Linear acceleration

 B

Angular acceleration

 C

Both

 D

None

Ans. B

Explanation:

 

They respond to angular acceleration and deceleration.

The three canals lie at right angles to each other but the one which lies at right angles to the axis of rotation is stimulated the most.

Thus horizontal canal will respond maximum to rotation on the vertical axis and so on.

Due to this arrangement of the three canals in three different planes, any change in position of head can be detected.


Q. 2

Which of the following structures is responsible for detecting rotational acceleration?

 A

Cochlea

 B

Fovea centralis

 C

Saccule

 D

Semicircular canals

Q. 2

Which of the following structures is responsible for detecting rotational acceleration?

 A

Cochlea

 B

Fovea centralis

 C

Saccule

 D

Semicircular canals

Ans. D

Explanation:

The semicircular canals are responsible for detecting rotational acceleration. As the head is rotated, fluid currents in the endolymph cause the deflection of the cupula and stimulate its hair cells. The magnitude of the fluid currents is proportional to the rotational acceleration, and the direction is related to the direction of the acceleration.

The cochlea is the inner ear structure in which the mechanical energy of sound waves is transduced into neural impulses.
 
The fovea centralis is the location on the retina responsible for most color vision. The saccule and utricle are inner ear structures that detect linear acceleration.

Q. 3

Arcuate eminence of the petrous temporal bone is caused by :

 A

Superior semicircular canal

 B

Posterior semicircular canal

 C

Lateral semicircular canal

 D

Cochlea

Q. 3

Arcuate eminence of the petrous temporal bone is caused by :

 A

Superior semicircular canal

 B

Posterior semicircular canal

 C

Lateral semicircular canal

 D

Cochlea

Ans. A

Explanation:

A i.e. Superior Semicircular Canal;


Q. 4

Horizontal semicircular canal is

 A

Anterior

 B

Superior

 C

Posterior

 D

Lateral

Q. 4

Horizontal semicircular canal is

 A

Anterior

 B

Superior

 C

Posterior

 D

Lateral

Ans. D

Explanation:

D i.e Lateral


Q. 5

Crus commune is a part of:

 A

Cochlea

 B

Middle ear

 C

Semi circular canal

 D

Vestibule

Q. 5

Crus commune is a part of:

 A

Cochlea

 B

Middle ear

 C

Semi circular canal

 D

Vestibule

Ans. C

Explanation:

 

Semicircular Canals

  • There are 3 semicircular canals – the lateral, posterior and superior which lie in a plane of right angles to one another
  • Each canal has an ampullated end which opens independently into the vestibule and a non ampullated end
  • The non-ampullated ends of posterior and superior canals unite to form a common channel called the crus commune.
  • So the three canals open into the vestibule by 5 openings.

 

 

Q. 6

Semicircular canals are stimulated by:

 A

Gravity

 B

Linear acceleration

 C

Rotation

 D

Sound

Q. 6

Semicircular canals are stimulated by:

 A

Gravity

 B

Linear acceleration

 C

Rotation

 D

Sound

Ans. C

Explanation:

Q. 7

Horizontal semicircular canal responds to:

 A

Horizontal acceleration 

 B

Rotational acceleration

 C

Gravity

 D

Anteroposterior acceleration

Q. 7

Horizontal semicircular canal responds to:

 A

Horizontal acceleration 

 B

Rotational acceleration

 C

Gravity

 D

Anteroposterior acceleration

Ans. B

Explanation:

Q. 8

Angular movements are sensed by:

 A

Cochlea

 B

Saccule

 C

Utricle

 D

Semicircular canals

Q. 8

Angular movements are sensed by:

 A

Cochlea

 B

Saccule

 C

Utricle

 D

Semicircular canals

Ans. D

Explanation:

Q. 9

True about semicircular canals is:         

September 2005

 A

Submerged in a fluid called endolymph

 B

Base of cupula is in close contact with afferent fibres of cochlear division of the eight cranial nerve

 C

Arranged at right angles to each other

 D

Associated with hearing

Q. 9

True about semicircular canals is:         

September 2005

 A

Submerged in a fluid called endolymph

 B

Base of cupula is in close contact with afferent fibres of cochlear division of the eight cranial nerve

 C

Arranged at right angles to each other

 D

Associated with hearing

Ans. C

Explanation:

Ans. C: Arranged at right angles to each other

3 semicircular canals in each vestibular apparatus known as anterior, posterior and lateral (horizontal) semicircular canals. They are arranged at right angles to each other.

They are filled with endolymph

Base of cupula is in close contact with afferent fibers of vestibular division of the eight cranial nerve



Internal ear

INTERNAL EAR

Q. 1

Otoacoustic emissions arise from ______

 A

Outer hair cells

 B

Inner hair cells

 C

Both

 D

Organ of corti

Q. 1

Otoacoustic emissions arise from ______

 A

Outer hair cells

 B

Inner hair cells

 C

Both

 D

Organ of corti

Ans. A

Explanation:

 

Otoacoustic Emissions (OAEs)

They are low intensity sounds produced by outer hair cells of a normal cochlea and can be elicited by a very sensitive microphone placed in the external ear canal and an analysis by a computer. Sound produced by outer hair cells travels in a reverse direction:

Outer hair cells→basilar membrane→ perilymph→ oval window→ ossicles→ tympanic membrane→ ear canal.


Q. 2

Shortest part of VIIth cranial nerve is in:

 A

Pons

 B

Superior colliculus

 C

Stylomastoid region

 D

Labyrinthine canal 

Q. 2

Shortest part of VIIth cranial nerve is in:

 A

Pons

 B

Superior colliculus

 C

Stylomastoid region

 D

Labyrinthine canal 

Ans. D

Explanation:

Q. 3

Which of the following structures contains endolymph?

 A

Helicotrema

 B

Scala media

 C

Scala tympani

 D

Scala vestibuli

Q. 3

Which of the following structures contains endolymph?

 A

Helicotrema

 B

Scala media

 C

Scala tympani

 D

Scala vestibuli

Ans. B

Explanation:

The cochlea of the inner ear is a coiled structure filled with endolymph and perilymph. Within it are three longitudinal compartments. The membranous labyrinth within the cochlea is called the scala media, or cochlear duct. This compartment contains the hair receptors and is filled with endolymph that is secreted by the stria vascularis. The composition of endolymph resembles intracellular fluid (K+> Na+).

The two perilymph-filled compartments, the scala tympani and the scala vestibuli surround the cochlear duct. This space is continuous with subarachnoid space, and therefore the perilymph closely resembles cerebrospinal fluid. The helicotrema is the apical connection between the scala tympani and scala vestibuli.
 
The spiral ganglion is located in the modiolus (the cochlear part of the body labyrinth), and contains the cell bodies of the bipolar cells that comprise the cochlear division of the eighth nerve.

Q. 4

In which of the following part, VIIth nerve take a narrowest path during its entire course?

 A

Pons

 B

Sup. colliculus

 C

Stylomastoid region

 D

Labyrinthine canal

Q. 4

In which of the following part, VIIth nerve take a narrowest path during its entire course?

 A

Pons

 B

Sup. colliculus

 C

Stylomastoid region

 D

Labyrinthine canal

Ans. D

Explanation:

At the lateral portion of the IAC, the facial nerve pierces the meatal foramen to enter the labyrinthine segment.

The labyrinthine segment is notable in that it is the narrowest portion 

As a result, it is believed that infections or inflammations of the facial nerve within this region can lead to temporary or permanent paralysis of the nerve, such as in Bell’s palsy.
 

Q. 5

Which of the following chambers of the cochlea is filled with a fluid similar to intracellular fluid with high K+ and low Na+?

 A

Scala vestibuli

 B

Scala media

 C

Scala tympani

 D

All of the above

Q. 5

Which of the following chambers of the cochlea is filled with a fluid similar to intracellular fluid with high K+ and low Na+?

 A

Scala vestibuli

 B

Scala media

 C

Scala tympani

 D

All of the above

Ans. B

Explanation:

The cochlea is divided into three chambers by a basilar and reissner’s membrane.

The upper chamber is known as scala vestibuli, the lower chamber is scala tympani and the middle chamber is known as scala media.

Endolymph is a potassium rich fluid and is present in scala media. Its composition is similar to intracellular fluid. The endolymph here is secreted by the stria vascularis which forms the lateral wall of scala media.
 
Perilymph is a fluid present in scala vestibuli and scala tympani. Its composition is similar to extracellular fluid in that it is high in Na+ and low in K+.
 

Q. 6

Labyrinthine artery is a branch of?

 A

Posterior inferior cerebellar artery

 B

Vertebral artery

 C

Posterior cerebral artery

 D

Anterior inferior cerebellar artery

Q. 6

Labyrinthine artery is a branch of?

 A

Posterior inferior cerebellar artery

 B

Vertebral artery

 C

Posterior cerebral artery

 D

Anterior inferior cerebellar artery

Ans. D

Explanation:

The labyrinthine artery (auditory artery, internal auditory artery), a long slender branch of the anterior inferior cerebellar artery (85%-100% cases) or basilar artery.


Q. 7

True about internal ear anatomy

 A

Three semicircular canals here 6 openings into the vestibule

 B

The angle between anterior & posterior SCC is 180°

 C

Vestible is the central chamber

 D

Spiral canal makes 2 turns

Q. 7

True about internal ear anatomy

 A

Three semicircular canals here 6 openings into the vestibule

 B

The angle between anterior & posterior SCC is 180°

 C

Vestible is the central chamber

 D

Spiral canal makes 2 turns

Ans. C

Explanation:

C i.e. Vestible is the central chamber


Q. 8

Promontory seen in the middle ear is:

 A

Jugular bulge

 B

Basal turn of cochlea

 C

Semicircular canal

 D

Head of incus

Q. 8

Promontory seen in the middle ear is:

 A

Jugular bulge

 B

Basal turn of cochlea

 C

Semicircular canal

 D

Head of incus

Ans. B

Explanation:

Q. 9

Inner ear bony labyrinth is:

 A

Strongest bone in the body

 B

Cancellous bone

 C

Cartilaginous bone

 D

Membranous bone

Q. 9

Inner ear bony labyrinth is:

 A

Strongest bone in the body

 B

Cancellous bone

 C

Cartilaginous bone

 D

Membranous bone

Ans. C

Explanation:

 

Bony labyrinth is an example of cartilaginous bone (i.e. a bone which ossification cartilage).


Q. 10

Cochlear aqueduct:

 A

Connects internal ear with subarachnoid space

 B

Connects cochlea with vestibule

 C

Contains endoylymph

 D

Same as S media

Q. 10

Cochlear aqueduct:

 A

Connects internal ear with subarachnoid space

 B

Connects cochlea with vestibule

 C

Contains endoylymph

 D

Same as S media

Ans. A

Explanation:

Q. 11

Organ of corti is situated in:

 A

Scala media

 B

Sinus tympani

 C

Sinus vestibuli

 D

Saccule

Q. 11

Organ of corti is situated in:

 A

Scala media

 B

Sinus tympani

 C

Sinus vestibuli

 D

Saccule

Ans. A

Explanation:

Q. 12

Endolymphatic duct connects which structure?

 A

Scala media to subdural space

 B

Scala vestibule to aqueduct of cochlea

 C

Scala tympani to aqueduct of cochlea

 D

Scala tympani to subdural space

Q. 12

Endolymphatic duct connects which structure?

 A

Scala media to subdural space

 B

Scala vestibule to aqueduct of cochlea

 C

Scala tympani to aqueduct of cochlea

 D

Scala tympani to subdural space

Ans. A

Explanation:

 

Endolymphatic duct – It is a part of membranous labyrinth (Scala media)

  • It is formed by union of saccule and utricle
  • It connects scala media to subdural space
  • Its terminal part is dilated to form the endolymphatic sac
  • Endolymphatic sac lies between the two layers of dura on the posterior surface of petrous bone
  • Surgical importance – Endolymphatic sac is exposed for drainage or shunt operation in Meniere’s disease

 


Q. 13

Site where endolymph is seen:

 A

Scala vestibuli

 B

Scala media

 C

Helicotrema

 D

Organ of corti

Q. 13

Site where endolymph is seen:

 A

Scala vestibuli

 B

Scala media

 C

Helicotrema

 D

Organ of corti

Ans. B

Explanation:

Q. 14

What are the boundaries of Trauttmann’s triangle?

 A

Bony labyrinth anteriorly

 B

Bony labyringh posteriorly

 C

Sigmoid sinus posteriorly

 D

a and c

Q. 14

What are the boundaries of Trauttmann’s triangle?

 A

Bony labyrinth anteriorly

 B

Bony labyringh posteriorly

 C

Sigmoid sinus posteriorly

 D

a and c

Ans. D

Explanation:

 

Trautmann’s triangle is bounded by the bony labyrinth anteriorly, sigmoid sinus posteriorly and the dura or superior petrosal sinus superiorly


Q. 15

Not included in bony labyrinth:

 A

Cochlea

 B

Semicircular canal

 C

Organ of Corti

 D

Vestibule

Q. 15

Not included in bony labyrinth:

 A

Cochlea

 B

Semicircular canal

 C

Organ of Corti

 D

Vestibule

Ans. C

Explanation:

Q. 16

The bony cochlea is a coiled tube making turns around a bony pyramid called:

 A

2, 1/4 modiolus

 B

2, 1/2 helicotrema

 C

2, 3/4 modiolus

 D

2, 3/4 helicotrema

Q. 16

The bony cochlea is a coiled tube making turns around a bony pyramid called:

 A

2, 1/4 modiolus

 B

2, 1/2 helicotrema

 C

2, 3/4 modiolus

 D

2, 3/4 helicotrema

Ans. C

Explanation:

Q. 17

Sense organ for hearing is

 A

Organ of Corti

 B

Cristae

 C

Macula

 D

None

Q. 17

Sense organ for hearing is

 A

Organ of Corti

 B

Cristae

 C

Macula

 D

None

Ans. A

Explanation:

Q. 18

Hair cell of organ of Corti is supported by:

 A

Onodi cells

 B

Deiter cell

 C

Hensen cell

 D

b and c

Q. 18

Hair cell of organ of Corti is supported by:

 A

Onodi cells

 B

Deiter cell

 C

Hensen cell

 D

b and c

Ans. D

Explanation:

 

Supporting cells in organ of corti are PHD i.e. Pillar cells, Hensen cells and Dieter cells.

Hellar cells are ethmoidal air cell that extend along the medial roof of the maxillary sinus.

They may exist as a discrete cells or the may open into maxillary sinus or infundibulum                                

                                                      



Q. 19

Endolymph is rich in ‑

 A

Na+

 B

Cl

 C

HCO3

 D

K+

Q. 19

Endolymph is rich in ‑

 A

Na+

 B

Cl

 C

HCO3

 D

K+

Ans. D

Explanation:

Ans. is ‘d’ i.e., K+

Fluid in inner ear

  • There are two main fluids in the inner ear : –

(i) Perilymph                  

(ii) Endolymph

Perilymph

  • It resembles ECF and is rich in Nu+ ions. It fills the space between bony and the membranous labyrinth, i.e., Scala vestibuli and scala tympani. It communicates with CSF through the aqueduct of Cochlea which opens into the scala tympani near the round window. Therefore It closely resembles CSF. It is formed by : –

i) It is a filterate of blood serum and is formed by capillaries of the spiral ligament.

ii) It is a direct continuation of CSF and reaches the labyrinth via aqueduct of cochlea.

Endolymph

It fills the entire membranous labyrinth including scala media (cochlear duct). It resembles intracellular fluid, being rich in IC ions. It is secreted by the secretory cells of the stria vascularis of the cochlea and by the dark cells (present in the utricle and near the ampullated ends of semicircular ducts).


Q. 20

Horizontal acceleration with forward movement in the sagittal plane is detected by ‑

 A

Macula of Utricle

 B

Macula of Saccule

 C

Lateral semicircular canal

 D

Posterior semicircular canal

Q. 20

Horizontal acceleration with forward movement in the sagittal plane is detected by ‑

 A

Macula of Utricle

 B

Macula of Saccule

 C

Lateral semicircular canal

 D

Posterior semicircular canal

Ans. A

Explanation:

Ans. is ‘a’ i.e., Macula of utricle


Q. 21

Movement of the structure marked as “A” in the picture below causes vibration in ? 

 A

Scala media.

 B

Scala tympani.

 C

Scala vestibuli.

 D

Semicircular canal.

Q. 21

Movement of the structure marked as “A” in the picture below causes vibration in ? 

 A

Scala media.

 B

Scala tympani.

 C

Scala vestibuli.

 D

Semicircular canal.

Ans. C

Explanation:

The structure marked as A in the picture above represents the stapes.

Movement of stapes causes vibration in Scala vestibuli.



Mastoid antrum

MASTOID ANTRUM

Q. 1

Mac Ewan’s triangle is the landmark for:

 A

Maxillary sinus

 B

Mastoid antrum

 C

Frontal sinus

 D

None

Q. 1

Mac Ewan’s triangle is the landmark for:

 A

Maxillary sinus

 B

Mastoid antrum

 C

Frontal sinus

 D

None

Ans. B

Explanation:

Q. 2

The suprameatal triangle overlies:

 A

Mastoid antrum

 B

Mastoid air cells

 C

Antrum

 D

Facial nerve

Q. 2

The suprameatal triangle overlies:

 A

Mastoid antrum

 B

Mastoid air cells

 C

Antrum

 D

Facial nerve

Ans. A

Explanation:

Q. 3

Anatomical landmark indicating position of mastoid antrum:

 A

Suprameatal triangle

 B

Spine of Henle

 C

Tip of the mastoid process

 D

None

Q. 3

Anatomical landmark indicating position of mastoid antrum:

 A

Suprameatal triangle

 B

Spine of Henle

 C

Tip of the mastoid process

 D

None

Ans. A

Explanation:

Q. 4

All of the follwoing are of the size of adult at birth expect? 

 A

Tympanic membrane

 B

Ossicle

 C

Tympanic cavity

 D

Mastoid

Q. 4

All of the follwoing are of the size of adult at birth expect? 

 A

Tympanic membrane

 B

Ossicle

 C

Tympanic cavity

 D

Mastoid

Ans. D

Explanation:

 

 

Development of the mastoid air cell system does not occur until afterbirth, with about 90% of air cell formation being completed by the age of six with the remaining 10% taking place up to age of 18

 



Q. 5

Which of the following is not a pneumatic bone?

 A

Ethmoid

 B

Sphenoid

 C

Maxillary

 D

Mastoid

Q. 5

Which of the following is not a pneumatic bone?

 A

Ethmoid

 B

Sphenoid

 C

Maxillary

 D

Mastoid

Ans. D

Explanation:

Q. 6

Which of the following forms lateral wall of mastoid antrum?      

 A

Mastoid process

 B

Suprameatal triangle

 C

Petrous temporal bone

 D

Tympanic cleft

Q. 6

Which of the following forms lateral wall of mastoid antrum?      

 A

Mastoid process

 B

Suprameatal triangle

 C

Petrous temporal bone

 D

Tympanic cleft

Ans. B

Explanation:

The lateral wall of the mastoid antrum is formed by a plate of bone which is on average 1.5 dm thick in the adult. It is marked externally on the surface of mastoid by suprameatal/ MacEwen’s triangle

Mastoid antrum/ Tympanic antrum/ Antrum mastoideum/ Valsalva’s antrum

It is a cavity in the petrous portion of the temporal bone, communicating posteriorly with the mastoid cells and anteriorly with the epitympanic recess of the middle ear via the aditus to mastoid antrum (entrance to the mastoid antrum).

  • In the temporal bone, between the posterior wall of the external acoustic meatus and the posterior root of the zygomatic process is the area called the suprameatal triangle, mastoid fossa, foveola suprameatica, or Macewen’s triangle, through which an instrument may be pushed into the mastoid antrum.
  • In the adult, the antrum lies approximately 1.5 to 2 cm deep to the suprameatal triangle.
  • This is an important landmark when performing a cortical mastoidectomy.

Q. 7

Shortest skull diameter:  

March 2013

 A

Biparietal

 B

Mentovertical

 C

Bitemporal

 D

Bimastoid

Q. 7

Shortest skull diameter:  

March 2013

 A

Biparietal

 B

Mentovertical

 C

Bitemporal

 D

Bimastoid

Ans. D

Explanation:

Ans. D i.e. Bimastoid

Fetal skull

  • Shortest diameter of fetal skull: Bimastoid (7.5 cm)
  • Largest diameter of fetal skull: Mentovertical (14 cm)

Q. 8

Mastoid antrum is present in which part of temporal bone‑

 A

Tympanic

 B

Petrous

 C

Squamous

 D

Mostoid

Q. 8

Mastoid antrum is present in which part of temporal bone‑

 A

Tympanic

 B

Petrous

 C

Squamous

 D

Mostoid

Ans. B

Explanation:

Mastoid

  • It is an air sinus in the petrous temporal bone.
  • Its upper anterior wall has the opening of aditus, while medial wall is related to posterior semicircular canal (SCC).
  • Posteriorly lies the sigmoid sinus.
  • The posterior belly of digastric muscle forms a groove in the base of mastoid bone.
  • The corresponding ridge inside the mastoid lies lateral not only to sigmoid sinus but also to facial nerve and is a useful landmark.
  • The roof is formed by tegmen antri separating it from middle cranial fossa and temporal lobe of brain. o Anteroinferior is the descending part of facial nerve canal (or fallopian canal).
  • Lateral wall is formed by squamous temporal bone and is easily palpable behind the pinna.


Contents of tympanic cavity/ middle ear

CONTENTS OF TYMPANIC CAVITY/ MIDDLE EAR

Q. 1

The stapes is a derivative of:

 A

1st arch

 B

2nd arch

 C

3rd arch

 D

4th arch 

Q. 1

The stapes is a derivative of:

 A

1st arch

 B

2nd arch

 C

3rd arch

 D

4th arch 

Ans. B

Explanation:

2nd arch


Q. 2

Which structure is attached to the center of the tympanic membrane?

 A

Footplate of the stapes

 B

Handle of the malleus

 C

Long process of the incus

 D

Tragus

Q. 2

Which structure is attached to the center of the tympanic membrane?

 A

Footplate of the stapes

 B

Handle of the malleus

 C

Long process of the incus

 D

Tragus

Ans. B

Explanation:

Q. 3

Stapes foot plate covers which of the following structure?

 A

Round window

 B

Oval window

 C

Inferior sinus tympanum

 D

Pyramid

Q. 3

Stapes foot plate covers which of the following structure?

 A

Round window

 B

Oval window

 C

Inferior sinus tympanum

 D

Pyramid

Ans. B

Explanation:

The stapes is the smallest bone in the human body and is located in the oval window.

Foot plate of the stapes rest on oval window, which is an opening of the vestibule and the scala vestibuli of the cochlea.

The oval window is located at the bottom of a deep depression outlined by the facial nerve superiorly, the promontory inferiorly, the cochleariform process anteriorly and the pyramidal eminence posteriorly. 
 

Q. 4

Which of the following contract together with stapes to stiffen the ossicular chain and protect the inner ear from noise damage?

 A

Scala media

 B

Tensor tympani

 C

Scala vestibuli

 D

Semicircular canal

Q. 4

Which of the following contract together with stapes to stiffen the ossicular chain and protect the inner ear from noise damage?

 A

Scala media

 B

Tensor tympani

 C

Scala vestibuli

 D

Semicircular canal

Ans. B

Explanation:

Stapedius and tensor tympani muscles contract through a neural reflex arc mediated by loud sounds (>80 dB).

They act to stiffen the ossicular chain and protect the inner ear from noise damage, particularly at low frequencies.

In contrast, cholesteatoma formation in the middle ear can contact the ossicular chain, increasing the total mass, causing a predominantly high-frequency conductive hearing loss.
 

Q. 5

The tensor tympani muscle is inserted to the handle of malleus. The nerve supply to tensor tympani is?

 A

Vagus nerve

 B

Glossopharyngeal nerve

 C

Trigeminal nerve

 D

Facial nerve

Q. 5

The tensor tympani muscle is inserted to the handle of malleus. The nerve supply to tensor tympani is?

 A

Vagus nerve

 B

Glossopharyngeal nerve

 C

Trigeminal nerve

 D

Facial nerve

Ans. C

Explanation:

The motor pure branches of mandibular division of trigeminal nerve:

  • Masseteric nerve (masseter muscle)
  • Deep temporal nerves (temporalis muscle)
  • Pterygoid nerves (pterygoid muscles)
  • Nerve of the tensor tympani muscle
  • Nerve to the tensor veli palatini muscle

Q. 6

The stapes is a derivative of which of the following pharyngeal arch?

 A

1st arch

 B

2nd arch

 C

3rd arch

 D

4th arch

Q. 6

The stapes is a derivative of which of the following pharyngeal arch?

 A

1st arch

 B

2nd arch

 C

3rd arch

 D

4th arch

Ans. B

Explanation:

Structures derived from second pharyngeal arch are stapes, styloid process of temporal bone, lesser cornu of hyoid bone and upper part of hyoid bone.

 
Skeletal and ligamentous elements derived from pharyngeal arches:
 

First arch

Malleus and incus
Portions of the mandible
Meckels cartilage
Sphenomandibular ligament
Anterior ligament of malleus

Second arch

stapes
Styloid process of temporal bone
Lesser cornu of hyoid bone
Upper part of hyoid bone

Third arch

Greater cornu of hyoid bone
Lower part of hyoid bone

Fourth arch

Thyroid cartilage
Cricoid cartilage
Arytenoid cartilage
Corniculate and Cuneiform cartilage

Q. 7

Malleus and Incus are derived from‑

 A

First arch

 B

Second arch

 C

Third arch

 D

Fourth arch

Q. 7

Malleus and Incus are derived from‑

 A

First arch

 B

Second arch

 C

Third arch

 D

Fourth arch

Ans. A

Explanation:

A i.e. First arch


Q. 8

Skeletal element of second branchial arch-

 A

Malleus

 B

Incus

 C

Meckel’s cartilage

 D

Stapes

Q. 8

Skeletal element of second branchial arch-

 A

Malleus

 B

Incus

 C

Meckel’s cartilage

 D

Stapes

Ans. D

Explanation:

D i.e. Stapes


Q. 9

Foot plate of stapes is developed from :

 A

Meckel’s cartillage

 B

Otic capsule

 C

Reicherts cartilage 

 D

Hyoid arch

Q. 9

Foot plate of stapes is developed from :

 A

Meckel’s cartillage

 B

Otic capsule

 C

Reicherts cartilage 

 D

Hyoid arch

Ans. C

Explanation:

C i.e. Reicherts cartilage 


Q. 10

Following are derived from II arch except :

 A

Malleus/ lncus

 B

Stylohyoid ligament

 C

Stylohyoid ligament

 D

Smaller cornu of hyoid

Q. 10

Following are derived from II arch except :

 A

Malleus/ lncus

 B

Stylohyoid ligament

 C

Stylohyoid ligament

 D

Smaller cornu of hyoid

Ans. A

Explanation:

A. i.e. Malleus and Incus

Foot plate of stapes develops from 2″” pharyngeal (hyoid) arch cartilage k/a Reichert cartilage. Second arch cartilage Vt formation of Stapes, Styloid process, Stylohyoid ligament, Small cornu & Superior body of hyoid bone = All “S”. First arch cartilage I/ t formation of malleus, incus, anterior ligament of malleus & spheno mandibular ligament.


Q. 11

Superior malleolar ligament connects ‑

 A

Malleus to incus

 B

Head of malleus to roof of epitympanum

 C

Incus to fossa incudis

 D

Malleus to fossa incudis

Q. 11

Superior malleolar ligament connects ‑

 A

Malleus to incus

 B

Head of malleus to roof of epitympanum

 C

Incus to fossa incudis

 D

Malleus to fossa incudis

Ans. B

Explanation:

–  Superior Malleolar fold, like the superior malleolar ligament, extends between superior surface of malleus head and superior attic wall (epitympanion)(2

Superior incudal fold, like superior incudal ligament, extends between the superior aspect of incus body & superior attic wall.

Medial incudal fold, is between long process of incus & tendon of stapedial muscle (as far as pyramidal eminence) Lateral malleolar fold is b/w neck of malleolus & scutum forming superior border of prussalc’s space.

–  Prussak’s space lies between shrapnell’s membrane & lateral malleolor ligament.

–   Anterior & posterior malleolar ligament arise from neck of malleolus from anterior & posterior aspect respectively. The anterior malleolar ligament extends from long process of malleolus towards the anterior attic wall

Discomalleolar ligament & anterior malleolar ligament damage during temporomandibular joint surgery may cause damage of middle ear. This may be a risk factor in the dissemination of infection from one area to the other. Interossicular fold lies b/w malleolus handle and long process of incus.


Q. 12

“Cone of light” is due to:

 A

Malleolar fold

 B

Handle of malleus

 C

Anterior inferior quadrant

 D

Stapes

Q. 12

“Cone of light” is due to:

 A

Malleolar fold

 B

Handle of malleus

 C

Anterior inferior quadrant

 D

Stapes

Ans. B

Explanation:

 

Cone of Light

  • Seen in anteroinferior quadrant of the tympanic membrane is actually the reflection of the light projected into the ear canal to examine it.
  • This part reflects it because it is the only part of tympanic membrane that is approximately at right angles to the meatus.
  • This difference in different parts of the tympanic membrane is due to the handle of malleus which pulls the tympanic membrane and causes it to tent inside.
  • Thus, the handle of malleus causes tenting and because of tenting the anteroinferior quardrant is at right angles to the meatus and thus reflects the light (leading to cone light).



Q. 13

Regarding stapedial reflex, which of the following is true:

 A

It helps to enhance the sound conduction in middle ear

 B

It is a protective reflex against loud sound

 C

It helps in masking the sound waves

 D

It is unilateral reflex

Q. 13

Regarding stapedial reflex, which of the following is true:

 A

It helps to enhance the sound conduction in middle ear

 B

It is a protective reflex against loud sound

 C

It helps in masking the sound waves

 D

It is unilateral reflex

Ans. B

Explanation:

Ans. is b i.e. It is a protective reflex against loud sounds 

 Stapedius muscle helps to dampen very loud sound and thus prevents noise trauma to the inner ear. It is supplied by VII nerve (facial nerve). Lesions of facial nerve lead to loss of stapedial reflex and hyperacusis or phonophobia i.e. intolerance to loud sounds. For more details see chapter – physiology of hearing and assessment of hearing loss of the guide Stapedial reflex = Acoustic reflex



Q. 14

All are components of epitympanum except:

 A

Body of incus

 B

Head of malleus

 C

Chorda tympani

 D

Footplate of stapes

Q. 14

All are components of epitympanum except:

 A

Body of incus

 B

Head of malleus

 C

Chorda tympani

 D

Footplate of stapes

Ans. D

Explanation:

Q. 15

Movement of stapes causes vibration in:

 A

Scala media

 B

Scala tympani

 C

Scala vestibuli

 D

Semicircular canal

Q. 15

Movement of stapes causes vibration in:

 A

Scala media

 B

Scala tympani

 C

Scala vestibuli

 D

Semicircular canal

Ans. C

Explanation:

Q. 16

Bones of middle ear are responsible for which of the following?

 A

Amplification of sound intensity

 B

Reduction of sound intensity

 C

Protecting the inner ear

 D

Reduction of impedance to sound transmission

Q. 16

Bones of middle ear are responsible for which of the following?

 A

Amplification of sound intensity

 B

Reduction of sound intensity

 C

Protecting the inner ear

 D

Reduction of impedance to sound transmission

Ans. D

Explanation:

 

Broadly hearing mechanism can be divided into:

  • Mechanical conduction of sound (done by middle ear).
  • Transduction of mechanical energy into electrical impulses (done by sensory system of cochlea)
  • Conduction of electrical impulse to brain (i.e. auditory pathway)

i. Conduction of sound:

  • It is done mainly by middle ear. Middle ear not just simply conducts the sound but converts sound of great amplitude and less force to that of less amplitude and greater force.
  • This function of the middle ear is called as impedance matching mechanism or the transformer action.

ii. Transduction of mechanical energy to electrical impulse:

  • Movements of the stapes footplate causes vibrations in scala vestibuli followed by scala tympani and is transmitted to the cochlear fluids which brings about movement of the basilar membrane.
  • This sets up shearing force between the tectorial membrane and the hair cells.
  • The distortion of hair cells gives rise to electrical nerve impulse.

 

A sound wave, depending on its frequency, reaches maximum amplitude on a particular place on the basilar membrane, and stimulates that segment (traveling wave theory of von Bekesy).

Higher frequencies are represented in the basal turn of cochlea and the progressively lower one toward the apex.


Q. 17

Tendon of which muscle passes through the pyramid in middle ear

 A

Incus

 B

Stapedius

 C

Malleus

 D

Tensor veli palatine

Q. 17

Tendon of which muscle passes through the pyramid in middle ear

 A

Incus

 B

Stapedius

 C

Malleus

 D

Tensor veli palatine

Ans. B

Explanation:

A conical projection called the pyramid lies near the junction of the posterior and medial walls of the middle ear. It has an opening at its apex for the passage of the tendon of the stapedius muscle


Q. 18

Function of ossicles in middle ear is to _______

 A

Amplify intensity of sound

 B

Protect from loud sound

 C

Conduct sound energy from the tympanic membrane to the oval window and then to the inner ear fluid

 D

None of the above

Q. 18

Function of ossicles in middle ear is to _______

 A

Amplify intensity of sound

 B

Protect from loud sound

 C

Conduct sound energy from the tympanic membrane to the oval window and then to the inner ear fluid

 D

None of the above

Ans. C

Explanation:

 

The ossicles (auditory ossicles) are the three smallest bones in the body, the malleus, the incus, and the stapes.

They are contained within the middle ear space and serve to transmit sounds from the air to the fluid-filled labyrinth (cochlea).


Q. 19

Fossa incudis is related to ‑

 A

Head of malleus

 B

Long process of incus

 C

Short process of incus

 D

Foot process of stapes

Q. 19

Fossa incudis is related to ‑

 A

Head of malleus

 B

Long process of incus

 C

Short process of incus

 D

Foot process of stapes

Ans. C

Explanation:

  • Fossa incudis contains short process of Incus.
  • Head of malleus is attached to epitympanum by ligament of head of malleus.
  • Long process of incus is attached to head of stapes.
  • Footplate of stapes lies over oval window.

Q. 20

Reichert’s cartilage derivative is ‑

 A

Malleus

 B

Inchus

 C

Stapes suprastructure

 D

Sphenomandibular ligament

Q. 20

Reichert’s cartilage derivative is ‑

 A

Malleus

 B

Inchus

 C

Stapes suprastructure

 D

Sphenomandibular ligament

Ans. C

Explanation:

The cartilage of second pharyngeal arch (hyoid arch) is known as Reicherts cartilage and contributes as :- (i) Stapes (except footplate), (ii) Styloid process, (iii) Stylohoid ligament, (iv) Lesser cornu and superior part of body of hyoid bone.

However, footplate of stapes develop from otic capsule.



Atrophic Rhinitis

Atrophic Rhinitis

Q. 1

A female presented with long standing nasal obstruction. She also complaints about comments from her friends telling about foul smell coming from her nose which she could not recognise. On evaluation, atrophic rhinitis is diagnosed. What can be the etiology in this patient to develop secondary atrophic rhinitis?

 A

Chronic sinusitis

 B

Nasal trauma

 C

Oropharyngeal cancer

 D

Strong hereditary factors

Q. 1

A female presented with long standing nasal obstruction. She also complaints about comments from her friends telling about foul smell coming from her nose which she could not recognise. On evaluation, atrophic rhinitis is diagnosed. What can be the etiology in this patient to develop secondary atrophic rhinitis?

 A

Chronic sinusitis

 B

Nasal trauma

 C

Oropharyngeal cancer

 D

Strong hereditary factors

Ans. A

Explanation:

Specific infections like syphilis, lupus, leprosy, and rhinoscleroma may cause destruction of the nasal structures leading to atrophic changes.

Atrophic rhinitis can also result from long-standing purulent sinusitis, radiotherapy to nose or excessive surgical removal of turbinates.

Extreme deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side. 

 

Q. 2

A 45 year old diabetic patient comes with complaints of hoarseness of voice which temporarily improves on coughing and removal of crusts. On examination, atrophic laryngeal mucosa covered with foul smelling crusts. On removal of crusts, mucosa showed excoriation and bleeding.

Assertion: This is case of atrophic laryngitis, and is associated with atrophic rhinitis.

Reason: Diabetes is the predisposing factor.
 

 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. 2

A 45 year old diabetic patient comes with complaints of hoarseness of voice which temporarily improves on coughing and removal of crusts. On examination, atrophic laryngeal mucosa covered with foul smelling crusts. On removal of crusts, mucosa showed excoriation and bleeding.

Assertion: This is case of atrophic laryngitis, and is associated with atrophic rhinitis.

Reason: Diabetes is the predisposing factor.
 

 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. C

Explanation:

Atrophic laryngitis or Laryngitis sicca is characterized by atrophy of laryngeal mucosa and crust formation.

Condition is often seen in women and is associated with atrophic rhinitis and pharyngitis. Not associated with diabetes.

 

Q. 3

All are implicated in etiology of atrophic rhinitis except:

 A

Chronic sinusitis

 B

Nasal deformity

 C

DNS

 D

Strong hereditary factors

Q. 3

All are implicated in etiology of atrophic rhinitis except:

 A

Chronic sinusitis

 B

Nasal deformity

 C

DNS

 D

Strong hereditary factors

Ans. C

Explanation:

Ans. is c i.e. DNS


Q. 4

Which of the following organisms is known to cause Atrophic Rhinitis:

 A

Klebsiella pneumoniae

 B

Klebsiella ozaenae

 C

Streptococcus pneumoniae

 D

Streptococcus foetidis

Q. 4

Which of the following organisms is known to cause Atrophic Rhinitis:

 A

Klebsiella pneumoniae

 B

Klebsiella ozaenae

 C

Streptococcus pneumoniae

 D

Streptococcus foetidis

Ans. B

Explanation:

 

Organism known to cause atrophic Rhinitis are:

  • Coccobacillus ozaena
  • Diphtheroid bacillus
  • Kiebsiella ozaenae                                                                
  • Bordettela bronchiseptica
  • Pasteurella multocida
  • P. vulgaris
  • E. coli
  • Staphylococcus                                                                    
  • Streptococcus

Q. 5

Cause of nasal obstruction in atrophic rhinitis:

 A

Crusting

 B

Polyp

 C

Secretions

 D

DNS

Q. 5

Cause of nasal obstruction in atrophic rhinitis:

 A

Crusting

 B

Polyp

 C

Secretions

 D

DNS

Ans. A

Explanation:

Q. 6

All are true regarding atrophic rhinitis except:

 A

More common in males

 B

Crusts are seen

 C

Anosmia is noticed

 D

Young’s operation is useful

Q. 6

All are true regarding atrophic rhinitis except:

 A

More common in males

 B

Crusts are seen

 C

Anosmia is noticed

 D

Young’s operation is useful

Ans. A

Explanation:

Q. 7

Merciful anosmia is seen in:

 A

Atrophic rhinitis

 B

Allergic rhinitis

 C

Ethmoidal polyposis

 D

Wegener’s granulomatosis

Q. 7

Merciful anosmia is seen in:

 A

Atrophic rhinitis

 B

Allergic rhinitis

 C

Ethmoidal polyposis

 D

Wegener’s granulomatosis

Ans. A

Explanation:

 

In atrophic rhinitis, there is foul smell from the nose, making the patient a social outcast though the patient himself is unaware of the smell due to marked anosmia which accompanies the degenerative changes. This is called as merciful anosmia.


Q. 8

Regarding atrophic rhinitis, which is INCORRECT:

 A

Common in females

 B

Anosmia

 C

Due to chronic use of nasal drops

 D

None of the above

Q. 8

Regarding atrophic rhinitis, which is INCORRECT:

 A

Common in females

 B

Anosmia

 C

Due to chronic use of nasal drops

 D

None of the above

Ans. C

Explanation:

 

Rhinitis medicamentosa (or RM) is a condition of rebound nasal congestion brought on by extended use of topical decongestants (e.g., oxymetazoline, phenylephrine,xylometazoline, and naphazoline nasal sprays) that work by constricting blood vessels in the lining of the nose.


Q. 9

Young’s operation is done for:           

 March 2013 

 A

Atrophic rhinitis

 B

Vasomotor rhinitis

 C

Antrachonal polyp

 D

Allergic rhinitis

Q. 9

Young’s operation is done for:           

 March 2013 

 A

Atrophic rhinitis

 B

Vasomotor rhinitis

 C

Antrachonal polyp

 D

Allergic rhinitis

Ans. A

Explanation:

Ans. A: Atrophic rhinitis

Young’s operation is a surgery designed for the treatment of atrophic rhinitis.

The surgical procedure involves closure of the nasal cavity affected with atrophic rhinitis by creating mucocutaneous flaps. These flaps are sutured together in two layers: first the mucosal layer, then the skin layer. The nasal cavity is kept closed for a period of 6 months or later; then an examination is done – if the crusts have disappeared, a revision surgery is performed and the nasal cavity is reopened


Q. 10

Which of the following organisms is known to cause Atrophic rhinitis ‑

 A

Klebsiella ozaena

 B

Klebsiella pneumonia

 C

Streptococcus pneumonia

 D

Streptococcus foetidis

Q. 10

Which of the following organisms is known to cause Atrophic rhinitis ‑

 A

Klebsiella ozaena

 B

Klebsiella pneumonia

 C

Streptococcus pneumonia

 D

Streptococcus foetidis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Klebsiella ozaena

Atrophic rhinitis (Ozaena)

Atrophic rhinitis is a chronic inflammation of nose characterized by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements. Atrophic rhinitis may be primary or secondary : ‑

1) Primary atrophic rhinitis

The primary pathology is inflammation and atrophy of the nose. Generally, atrophic rhinitis refers to primary atrophic rhinitis. Causes are : –

i) Hereditary

ii) Endocrinal pathology – Starts at puberty. Stops after menopause

iii) Racial factors – Seen more in Whites and Yellow races

iv) Nutritional deficiency – Deficiency of vitamin A, D, E and iron may be responsible for it.

v) Infective – Klebsiella ozanae, Diphtheriods, P. vulgaris, E.coli, Staphylococci, Streptococci.

vi)  Autoimmune process – Causing destruction of nasal, neurovascular and glandular elements may be the cause.

2) Secondary atrophic rhinitis

Specific infections, such as syphilis, lupus, leprosy, and rhinoscleroma, may cause destruction of the nasal structures leading to atrophic changes. Can also results from long standing purulent sinusitis , radiotherapy of nose, excessive surgical removal of the turbinate and as complication of DNS on the root side of nose.

 


Q. 11

Youngs surgery is done for the treatment of ‑

 A

Atrophic rhinitis

 B

Rhinoscleroma

 C

Deviated nasal septum

 D

Choanal atresia

Q. 11

Youngs surgery is done for the treatment of ‑

 A

Atrophic rhinitis

 B

Rhinoscleroma

 C

Deviated nasal septum

 D

Choanal atresia

Ans. A

Explanation:

Ans. is ‘a’ i.e., Atrophic rhinitis

Surgical treatment of Atrophic rhinitis

1) Young’s operation

2) Modified Young’s operation

3) Narrowing of the nasal cavity by (Lautenslagers operation) ‑

4) Lautenslagers operation



Middle ear

MIDDLE EAR

Q. 1

All of the following are TRUE about the middle ear, EXCEPT:

 A

The joints between ossicles are synovial

 B

The chorda tympani nerve is related to the lateral wall

 C

The facial nerve passes in a canal situated in the medial and anterior walls

 D

The auditory tube connects the nasopharynx with the anterior wall

Q. 1

All of the following are TRUE about the middle ear, EXCEPT:

 A

The joints between ossicles are synovial

 B

The chorda tympani nerve is related to the lateral wall

 C

The facial nerve passes in a canal situated in the medial and anterior walls

 D

The auditory tube connects the nasopharynx with the anterior wall

Ans. C

Explanation:

The facial nerve passes in a canal situated in the posterior and medial walls of the middle ear. It is not associated with the anterior wall. 

 


Q. 2

Tympanic plexus present in –

 A

Tunica adventitia of internal jugular vein

 B

Medial projection of middle ear cavity

 C

Part of tympanic membrane

 D

All

Q. 2

Tympanic plexus present in –

 A

Tunica adventitia of internal jugular vein

 B

Medial projection of middle ear cavity

 C

Part of tympanic membrane

 D

All

Ans. B

Explanation:

B i.e. Medial projection of middle ear cavity 

Tympanic nerve arises from the glossopharyngeal nerve, just below the jugular foramen. It passes through the floor of middle ear and reaches onto the mucous membrane covering the promontory(2, where it splits into branches and joint branches of internal carotid plexus to form tympanic plexus.

Promontary is round bulging in the medial or labyrinthine wall of middle ear cavityQ produced by the first turn of cholea.


Q. 3

The distance between tympanic membrane and medial wall of middle ear at the level of center is:

 A

3 mm

 B

4 mm

 C

6mm

 D

2 mm

Q. 3

The distance between tympanic membrane and medial wall of middle ear at the level of center is:

 A

3 mm

 B

4 mm

 C

6mm

 D

2 mm

Ans. D

Explanation:

Q. 4

Narrowest part of middle ear is:

 A

Hypotympanum

 B

Epitympanum

 C

Attic

 D

Mesotympanum

Q. 4

Narrowest part of middle ear is:

 A

Hypotympanum

 B

Epitympanum

 C

Attic

 D

Mesotympanum

Ans. D

Explanation:

 

When seen in corona section, the cavity of the middle ear is biconcave, as the medial and lateral walls are closest to each other in the center.


Q. 5

Sensory nerve supply of middle ear cavity is provided by:

 A

Facial

 B

Glossopharyngeal

 C

Vagus

 D

Trigeminal

Q. 5

Sensory nerve supply of middle ear cavity is provided by:

 A

Facial

 B

Glossopharyngeal

 C

Vagus

 D

Trigeminal

Ans. B

Explanation:

 

  • The nerve supply of middle ear is derived from tympanic plexus which lies over the promontory.
  • The inferior ganglion of the glossopharyngeal nerve gives off the tympanic nerve which enters the middle ear through the tympanic canaliculus and takes part in formation of the tympanic plexus on the medial wall of middle ear.
  • This distributes it fibres to the middle ear, and also to the auditory tube, aditus ad atrum mastoideum (aditus to mastoid antrum).
  • Glossopharyngeal nerve —> Tympanic nerve/tympanic plexus —> Auditory tube

Q. 6

Tegmen seperates middle ear from the middle cranial fossa containing temporal lobe of brain by: 

 A

Medial wall of middle ear

 B

Lateral wall of middle ear

 C

Roof of middle ear

 D

Anterior wall of middle ear

Q. 6

Tegmen seperates middle ear from the middle cranial fossa containing temporal lobe of brain by: 

 A

Medial wall of middle ear

 B

Lateral wall of middle ear

 C

Roof of middle ear

 D

Anterior wall of middle ear

Ans. C

Explanation:

Q. 7

Floor of middle ear cavity is in relation with:

 A

Internal carotid artery

 B

Bulb of the internal jugular vein

 C

Sigmoid sinus

 D

Round window

Q. 7

Floor of middle ear cavity is in relation with:

 A

Internal carotid artery

 B

Bulb of the internal jugular vein

 C

Sigmoid sinus

 D

Round window

Ans. B

Explanation:

 

  • Internal carotid A is related to anterior wall of middle ear.
  • Round window is seen on the medial wall of middle ear.
  • Sigmoid sinus is not related to middle ear (directly, it lies posterior to mastoid).



Q. 8

Promontory seen in the middle ear is:

 A

Jugular bulge

 B

Basal turn of cochlea

 C

Semicircular canal

 D

Head of incus

Q. 8

Promontory seen in the middle ear is:

 A

Jugular bulge

 B

Basal turn of cochlea

 C

Semicircular canal

 D

Head of incus

Ans. B

Explanation:

Q. 9

Eustachian tube opens into middle ear cavity at:

 A

Anterior wall

 B

Medial wall

 C

Lateral wall

 D

Posterior wall

Q. 9

Eustachian tube opens into middle ear cavity at:

 A

Anterior wall

 B

Medial wall

 C

Lateral wall

 D

Posterior wall

Ans. A

Explanation:

 

The tympanic end of the eustachian tube is bony and is situated in the anterior wall of middle ear.

The pharyngeal end of the tube is slit like and is situated in the lateral wall of the nasopharynx, 1-1.25 cm behind the posterior end of inferior tubinate.



Q. 10

Which of the following is not a route of spread of infec­tion from middle ear?

 A

Directly through openings such as round window and oval window

 B

By bony invasion

 C

Osteothrombotic route

 D

Lymphatics

Q. 10

Which of the following is not a route of spread of infec­tion from middle ear?

 A

Directly through openings such as round window and oval window

 B

By bony invasion

 C

Osteothrombotic route

 D

Lymphatics

Ans. D

Explanation:

Q. 11

Lateral wall of middle ear is formed by:

 A

Tegmen tympani

 B

Mastoid process

 C

Promontory

 D

Tympanic membrane

Q. 11

Lateral wall of middle ear is formed by:

 A

Tegmen tympani

 B

Mastoid process

 C

Promontory

 D

Tympanic membrane

Ans. D

Explanation:

 

  • Roof – Thin plate called as tegmen tympani
  • Floor – Jugular bulb
  • Anterior wall – Internal carotid artery
  • Posterior wall – Lies close to mastoid air cells
  • Medial wall – labyrinth
  • Lateral wall – tympanic membrane



Q. 12

Scutum is present in middle ear ‑

 A

Roof

 B

Lateral wall

 C

Medial wall

 D

Floor

Q. 12

Scutum is present in middle ear ‑

 A

Roof

 B

Lateral wall

 C

Medial wall

 D

Floor

Ans. B

Explanation:

 Lateral wall


Q. 13

Which of the following is not a derivative of the middle ear cleft ‑

 A

Semicircular canal

 B

Mastoid air cell

 C

Tympanic cavity

 D

Eustachian tube

Q. 13

Which of the following is not a derivative of the middle ear cleft ‑

 A

Semicircular canal

 B

Mastoid air cell

 C

Tympanic cavity

 D

Eustachian tube

Ans. A

Explanation:

Ans. is ‘a’ i.e., Semicircular canal

The middle – ear cleft in the temporal bone includes :‑

  1. Eustachian tube
  2. The middle ear (tympanic cavity)
  3. Aditus which leads posteriorly to the mastoid antrum and air cells.


Lateral Sinus Thrombophlebitis

Lateral Sinus Thrombophlebitis

Q. 1

Grisengers sign is seen in:

 A

Cavernous sinus thrombosis

 B

Superior sagittal sinus thrombosis

 C

Inferior sagittal sinus thrombosis

 D

Lateral sinus thrombosis

Q. 1

Grisengers sign is seen in:

 A

Cavernous sinus thrombosis

 B

Superior sagittal sinus thrombosis

 C

Inferior sagittal sinus thrombosis

 D

Lateral sinus thrombosis

Ans. D

Explanation:

Q. 2

Tober Ayer test is positive in:

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid hemorrhage 

Q. 2

Tober Ayer test is positive in:

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid hemorrhage 

Ans. A

Explanation:

Q. 3

Lateral sinus thrombosis is asso­ciated with all except:

 A

Greisinger sign

 B

Gradenigo sign

 C

Lily crowe sign

 D

Tobey Ayer test

Q. 3

Lateral sinus thrombosis is asso­ciated with all except:

 A

Greisinger sign

 B

Gradenigo sign

 C

Lily crowe sign

 D

Tobey Ayer test

Ans. A

Explanation:

Q. 4

A 30 year old male is having attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following would be the operation of choice?

 A

Intact canal wall mastoidectomy

 B

Canal wall down mastoidectomy

 C

Mastoidectomy with cavity obliteration

 D

Simple mastoidectomy with Tympanoplasty

Q. 4

A 30 year old male is having attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following would be the operation of choice?

 A

Intact canal wall mastoidectomy

 B

Canal wall down mastoidectomy

 C

Mastoidectomy with cavity obliteration

 D

Simple mastoidectomy with Tympanoplasty

Ans. B

Explanation:

Canal wall down mastoidectomy is done in cases of attic cholesteatoma. In this procedure mastoid cavity is left open into the external auditory canal.

Since the patient in the question is suffering from attic cholesteatoma and secondary complications canal wall down mastoidectomy would be the treatment of choice.

Other indications of this procedure includes extensive chronic otits media, formation of a new attic retraction pocket with disease following a previously performed canal wall up procedure, lateral semicircular canal fistula in the only hearing ear.


Q. 5

A patient with ear discharge presents with diplopia and fever. What is the most probable diagnosis?

 A

CSOM

 B

Meningitis

 C

Lateral sinus thrombosis

 D

Petrositis

Q. 5

A patient with ear discharge presents with diplopia and fever. What is the most probable diagnosis?

 A

CSOM

 B

Meningitis

 C

Lateral sinus thrombosis

 D

Petrositis

Ans. C

Explanation:

Presence of fever and diplopia in a patient with ear discharge suggests lateral sinus thrombosis, an intracranial complication of chronic suppurative ottitis media. 


Q. 6

‘Griesinger sign’ is otalgia along with pain and edema over mastoid. It is typically seen in:

 A

Lateral sinus thrombosis

 B

Acoustic neuroma

 C

Otosclerosis

 D

CSOM

Q. 6

‘Griesinger sign’ is otalgia along with pain and edema over mastoid. It is typically seen in:

 A

Lateral sinus thrombosis

 B

Acoustic neuroma

 C

Otosclerosis

 D

CSOM

Ans. A

Explanation:

  • Lateral sinus thrombosis is a ominous complication of acute OM. It arises from extension of infection and inflammation in the mastoid, with eventual inflammation of the adjacent lateral or sigmoid sinus.
  • Headache is the most common symptom, with papilledema, sixth-nerve palsy, and vertigo being less frequently present.
  • Occlusion of the lateral sinus produces pain over the ear and mastoid and may cause edema over the mastoid (Griesinger sign). 
  • Involvement of cranial nerves V and VI produces ipsilateral facial pain and lateral rectus weakness (Gradenigo syndrome).

Q. 7

Griesinger’s sign is observed in which of the following condition?

 A

Abducent nerve paralysis

 B

Otosclerosis

 C

Lateral sinus thrombosis

 D

Petrositis

Q. 7

Griesinger’s sign is observed in which of the following condition?

 A

Abducent nerve paralysis

 B

Otosclerosis

 C

Lateral sinus thrombosis

 D

Petrositis

Ans. C

Explanation:

Griesinger’s sign: Erythema and oedema posterior to the mastoid process resulting from septic thrombosis of the mastoid emissary vein. It is seen in lateral sinus thrombosis.


Q. 8

Which of the following CNS condition shows positive Tober Ayer test?

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid haemorrhage

Q. 8

Which of the following CNS condition shows positive Tober Ayer test?

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid haemorrhage

Ans. A

Explanation:

Tober Ayer test is positive in lateral sinus thrombosis or sigmoid sinus thrombosis. This test is to record CSF pressure by manometer and to see the effect of manual compression of one or both jugular veins. Compression on vein on the thrombosed side produces no effect while compression of vein on healthy side produces rapid rise in CSF pressure which will be equal to bilateral compression of jugular veins.
 
 
 
Clinical features of lateral sinus thrombosis:
  • Hectic Picket-fence type of fever with rigors
  • Headache
  • Progressive anemia and emaciation
  • Griesinger’s sign
  • Papilloedema
  • Tober Ayer test
  • Crowe-Beck test
  • Tenderness along jugular vein

Q. 9

Tober Ayer’s test is positive in which of the following condition?

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid haemorrhage

Q. 9

Tober Ayer’s test is positive in which of the following condition?

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid haemorrhage

Ans. A

Explanation:

Positive Queckenstedt test or Tobey Ayer test is present in lateral sinus thrombosis. It refers to a   lack of increase in CSF pressure during compression of internal jugular vein ipsilateral to a thrombosed lateral sinus.

 
It can also be diagnosed by CT scan or MRI. MR venogram is helpful in showing the degree of thrombus extension within the venous system. 
 
Patients presents with low grade intermittent fever, that can progress to a spiking, picket fence pattern secondary to the dissemination of septic emboli into the systemic circulation. They can also develop torticollis and neck tenderness particularly along the course of internal jugular vein. 
 

 


Q. 10

Lateral sinus thrombosis is associated with all except:

 A

Greisinger sign

 B

Gradenigo sign

 C

Lily-Crowe sign

 D

Tobey Ayer test

Q. 10

Lateral sinus thrombosis is associated with all except:

 A

Greisinger sign

 B

Gradenigo sign

 C

Lily-Crowe sign

 D

Tobey Ayer test

Ans. B

Explanation:

Q. 11

Griesinger’s sign is seen in:

 A

Lateral sinus thrombosis 

 B

Meningitis

 C

Brain abscess

 D

Cerebellar abscess

Q. 11

Griesinger’s sign is seen in:

 A

Lateral sinus thrombosis 

 B

Meningitis

 C

Brain abscess

 D

Cerebellar abscess

Ans. A

Explanation:

Q. 12

A -30-yead old male is having Attic cholesteatoma of left ear with lateral sinus thromboplebitis. Which of the following will be the operation of choice?

 A

Intact canal will be the operation of choice

 B

Simple mastoidectomy with Tympanoplasty

 C

Canal wall down mastoidectomy

 D

Mastodidectomy with cavity obliteration

Q. 12

A -30-yead old male is having Attic cholesteatoma of left ear with lateral sinus thromboplebitis. Which of the following will be the operation of choice?

 A

Intact canal will be the operation of choice

 B

Simple mastoidectomy with Tympanoplasty

 C

Canal wall down mastoidectomy

 D

Mastodidectomy with cavity obliteration

Ans. C

Explanation:

In Attic cholesteatoma, if it invades eustachian tube or perilabyrynthine tissue, then manage­ment is Radial Mastoidectomy. 


Q. 13

Presence of delta sign on contrast enhanced CT SCAN suggests presence of ‑

 A

Lateral Sinus thrombophlebitis

 B

Cholesteatoma

 C

Cerebellar abscess

 D

Mastoiditis

Q. 13

Presence of delta sign on contrast enhanced CT SCAN suggests presence of ‑

 A

Lateral Sinus thrombophlebitis

 B

Cholesteatoma

 C

Cerebellar abscess

 D

Mastoiditis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Lateral Sinus thrombophlebitis

LATERAL SINUS THROMBOPHLEBITIS (SIGMOID SINUS THROMBOSIS)

Lateral or sigmoid sinus thrombophlebitis arises from inflammation in the adjacent mastoid. It may occur as a complication of : ‑

  1. Acute coalescent mastoiditis
  2. CSOM and cholesteatoma

Clinical features

  • Hectic Picket-Fence type of fever with rigor.
  • Headache, Progressive anemia and emaciation.
  • Griesinger’s sign : – odema over the posterior part of mastoid due to thrombosis of mastoid emissary veins.
  • Papilloedema
  • Tobey-Ayer test :- Compression of vein on the thrombosed side produces no effect while compression of vein on healthy side produces rapid rise in CSF pressure which will be equal to bilateral compression of jugular veins.
  • Crowe-Beck test :- Pressure on jugular vein of healthy side produces engorgement of retinal veins. Pressure on affected side does not produce such change.
  • Tenderness along jugular vein
  • Imaging studies
  • Contrast-enhanced CT scan can show sinus thrombosis by typical delta-sign. It is a triangular area with rim enhancement, and central low density area is seen in posterior cranial fossa on axial cuts.
  • Delta-sign may also be seen on contrast enhanced MRI.


Tympanic Membrane Of Ear/ EARDRUM

Tympanic Membrane Of Ear/ EARDRUM

Q. 1

Which structure is attached to the center of the tympanic membrane?

 A

Footplate of the stapes

 B

Handle of the malleus

 C

Long process of the incus

 D

Tragus

Q. 1

Which structure is attached to the center of the tympanic membrane?

 A

Footplate of the stapes

 B

Handle of the malleus

 C

Long process of the incus

 D

Tragus

Ans. B

Explanation:

Q. 2

The following structure represents all the 3 components of the embryonic disc-

 A

Tympanic membrane

 B

Retina

 C

Meninges

 D

None of the above

Q. 2

The following structure represents all the 3 components of the embryonic disc-

 A

Tympanic membrane

 B

Retina

 C

Meninges

 D

None of the above

Ans. A

Explanation:

A i.e. Tympanic membrane

Tympanic membrane derived from first pharyngeal membrane (which seperates 1st pharyngeal groove from 1st pharyngeal pouch) represents all three layers of embryonic disco. It develops from three sources. 1) External very thin skin is derived from ectoderm of 1st pharyngeal groove; 2) Medoderm of 1st & 2hd pharyngeal arches; 3) Internal lining is derived from endoderm of tubotympanic recess, (a derivative of 1st pharyngeal pouch).


Q. 3

Nerve supply of the tympanic membrane is by the

 A

Auriculotemporal

 B

Lesser occipital

 C

Greater occipital

 D

Parasympathetic ganglion

Q. 3

Nerve supply of the tympanic membrane is by the

 A

Auriculotemporal

 B

Lesser occipital

 C

Greater occipital

 D

Parasympathetic ganglion

Ans. A

Explanation:

A i.e. Aurico-temporal nerve


Q. 4

What is the color of the normal tympanic membrane?

 A

Pearly white

 B

Gray

 C

Yellow

 D

Red

Q. 4

What is the color of the normal tympanic membrane?

 A

Pearly white

 B

Gray

 C

Yellow

 D

Red

Ans. A

Explanation:

Q. 5

The most mobile part of the tympanic membrane:

 A

Central

 B

Peripheral

 C

Both

 D

None of the above

Q. 5

The most mobile part of the tympanic membrane:

 A

Central

 B

Peripheral

 C

Both

 D

None of the above

Ans. B

Explanation:

   


Q. 6

Pars flaccida of the tympanic membrane is also called 

 A

Reissner’s membrane

 B

Shrapnell’s membrane

 C

Basilar membrane

 D

Secondary tympanic membrane

Q. 6

Pars flaccida of the tympanic membrane is also called 

 A

Reissner’s membrane

 B

Shrapnell’s membrane

 C

Basilar membrane

 D

Secondary tympanic membrane

Ans. B

Explanation:

 

Situated above the lateral process of malleus between the notch of Rivinus and the anterior and posterior malleal folds.

  • Reissner’s membrane – Separates scala media from scala vestibuli in the inner ear
  • Basilar membrane – Seen in scala media and supports the organ of corti
  • Secondary Tympanic Membrane – Closes the scala tympani at the site of round window 

Q. 7

The distance between tympanic membrane and medial wall of middle ear at the level of center is:

 A

3 mm

 B

4 mm

 C

6mm

 D

2 mm

Q. 7

The distance between tympanic membrane and medial wall of middle ear at the level of center is:

 A

3 mm

 B

4 mm

 C

6mm

 D

2 mm

Ans. D

Explanation:

Q. 8

Distance of promontory from tympanic membrane:

 A

2 mm

 B

5 mm

 C

6 mm

 D

7 mm

Q. 8

Distance of promontory from tympanic membrane:

 A

2 mm

 B

5 mm

 C

6 mm

 D

7 mm

Ans. A

Explanation:

Q. 9

Surface area of tympanic membrane:

 A

55 mm2

 B

70 mm2

 C

80 mm2

 D

90 mm2

Q. 9

Surface area of tympanic membrane:

 A

55 mm2

 B

70 mm2

 C

80 mm2

 D

90 mm2

Ans. D

Explanation:

Q. 10

The effective diameter of the tympanic membrane:

 A

25 mm2

 B

30 mm2

 C

40 mm2

 D

45 mm2

Q. 10

The effective diameter of the tympanic membrane:

 A

25 mm2

 B

30 mm2

 C

40 mm2

 D

45 mm2

Ans. D

Explanation:

 

Area of tympanic membrane is 90 mm2.

Effective area is 55 mrn2(approximately 2/3 of the total area).

Significance of large area of tympanic membrane – The area of tympanic is much larger than area of stapes footplate, which helps in converting sound of greater amplitude but lesser force to that of lesser amplitude and great force.


Q. 11

Lateral wall of middle ear is formed by:

 A

Tegmen tympani

 B

Mastoid process

 C

Promontory

 D

Tympanic membrane

Q. 11

Lateral wall of middle ear is formed by:

 A

Tegmen tympani

 B

Mastoid process

 C

Promontory

 D

Tympanic membrane

Ans. D

Explanation:

 

  • Roof – Thin plate called as tegmen tympani
  • Floor – Jugular bulb
  • Anterior wall – Internal carotid artery
  • Posterior wall – Lies close to mastoid air cells
  • Medial wall – labyrinth
  • Lateral wall – tympanic membrane




Complications of Otits Media

Complications of Otits Media

Q. 1

Commonest complication of CSOM is:

 A

Bezolds abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Q. 1

Commonest complication of CSOM is:

 A

Bezolds abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Ans. B

Explanation:

Q. 2

Commonest complication of CSOM is:

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Q. 2

Commonest complication of CSOM is:

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Ans. B

Explanation:

Q. 3

Gradenigo’s syndrome involves the following cranial nerves:

 A

IV, VII

 B

V, VI

 C

VI, DC

 D

VII, VIII

Q. 3

Gradenigo’s syndrome involves the following cranial nerves:

 A

IV, VII

 B

V, VI

 C

VI, DC

 D

VII, VIII

Ans. B

Explanation:

Q. 4

All of the following are features of Gradenigo’s syndrome?

 A

It causes diplopia

 B

It is characterized by retro-orbital pain

 C

It is associated with involvement of the Cranial nerves V and VI

 D

All of the above

Q. 4

All of the following are features of Gradenigo’s syndrome?

 A

It causes diplopia

 B

It is characterized by retro-orbital pain

 C

It is associated with involvement of the Cranial nerves V and VI

 D

All of the above

Ans. D

Explanation:

Clinical features of gardenigo syndrome consist of a triad of deep retro orbital pain, paralysis of ipsilateral laeral rectus muscle from the involvement of abducens nerve(diplopia) as it cross the petrous bone and otitic infection with purulent discharge. This syndrome is also associated with features such vertigo and hearing loss either from a concomitant bacterial labrynthitis or from involvement of eight cranial nerve in its bony canal.

Ref: Companion to Clinical Neurology By William Pryse-Phillips, 2nd Edition, Page 404


Q. 5

What is the COMMONEST complication of CSOM?

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Q. 5

What is the COMMONEST complication of CSOM?

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Ans. B

Explanation:

Mastoiditis is the most common complication of CSOM. Acute mastoiditis usually accompanies or follows acute suppurative otitis media.

Complications of otitis media are classified into two main groups:
A.Intratemporal:
  • Mastoiditis
  • Petrositis
  • Facial paralysis
  • Labyrinthitis
B.Intracranial:
  • Extradural abscess
  • Subdural abscess
  • Meningitis
  • Brain abscess
  • Lateral sinus thrombophlebitis

Q. 6

Which among the following is the COMMONEST complication of CSOM?

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Q. 6

Which among the following is the COMMONEST complication of CSOM?

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Ans. B

Explanation:

Mastoiditis is the most common complication of otitis media. Mastoiditis refers to inflammation of the air cells in the mastoid process.
 
Patients usually presents with fever and local pain. The classic triad consists of:
  • Prominent auricle with retro orbital swelling
  • Tenderness over the mastoid
  • Otorrhea
It is best diagnosed using CT scan. It shows clouding of the mastoid air cells and middle ear spaces. It can also demonstrate erosion of the mastoid bone structure.
 

Q. 7

Gradenigo’s syndrome involves all of the following cranial nerves, except:

 A

IV

 B

V

 C

VI

 D

VII

Q. 7

Gradenigo’s syndrome involves all of the following cranial nerves, except:

 A

IV

 B

V

 C

VI

 D

VII

Ans. D

Explanation:

Gradenigo’s syndrome is characterized by pain in the face (from irritation of the trigeminal nerve) retroorbital pain,AOM, and ipsilateral abducens nerve paresis.

The syndrome is produced by disease of the tip of the petrous bone and most often occurs as a rare complication of otitis media with mastoiditis or petrous bone tumors.
 
 

 


Q. 8

Gradenigo’s syndrome involves all of the following cranial nerves, EXCEPT:

 A

IV

 B

V

 C

VI

 D

VII

Q. 8

Gradenigo’s syndrome involves all of the following cranial nerves, EXCEPT:

 A

IV

 B

V

 C

VI

 D

VII

Ans. A

Explanation:

Gradenigo’s syndrome is characterized by facial pain, particularly in the first division of the trigeminal nerve and diplopia due to sixth cranial nerve palsy. It is associated with disease at the apex of the petrous temporal bone where the abducens nerve is closely related to the trigeminal nerve. Facial nerve palsy and deafness (VIII nerve palsy) is also considered to be a part of this syndrome.

 
Causes includes:
  • Inflammation (petrositis, possibly spreading from a local infection such as otitis or mastoiditis)
  • Tumors ( cholesteatoma, chordoma, meningioma, nasopharyngeal carcinoma, metastatic disease)
  • Skull base fracture

Q. 9

The most common complication of chronic suppurative otitis media is:

 A

Meningitis

 B

Intracerebral abscess

 C

Cholesteatoma

 D

Conductive deafness

Q. 9

The most common complication of chronic suppurative otitis media is:

 A

Meningitis

 B

Intracerebral abscess

 C

Cholesteatoma

 D

Conductive deafness

Ans. B

Explanation:

Q. 10

Commonest complication of CSOM is:

 A

Sub periosteal abscess 

 B

Mastoiditis

 C

Brain absess

 D

Meningitis

Q. 10

Commonest complication of CSOM is:

 A

Sub periosteal abscess 

 B

Mastoiditis

 C

Brain absess

 D

Meningitis

Ans. C

Explanation:

 



Q. 11

Extracranial complications of CSOM:

 A

Epidural abscess

 B

Facial nerve plasy

 C

Hearing loss

 D

All

Q. 11

Extracranial complications of CSOM:

 A

Epidural abscess

 B

Facial nerve plasy

 C

Hearing loss

 D

All

Ans. B

Explanation:

Q. 12

Extracranial complications of CSOM:

 A

Labyrinthitis

 B

Otitic hyrocephalus

 C

Bezold’s abscess

 D

a and c

Q. 12

Extracranial complications of CSOM:

 A

Labyrinthitis

 B

Otitic hyrocephalus

 C

Bezold’s abscess

 D

a and c

Ans. D

Explanation:

 

Extra cranial complications of CSOM are:

  • Petrositis (gradenigo syndrome)
  • Labyrinthitis
  • Osteomyelitis of temporal bone
  • Septicemia / pyaemia
  • Otogenic Tetanus.
  • F. Facial nerve palsy
  • Acute Mastoiditis: – Postaural sub periosteal abscess

– Zygomatic abscess

-Luc’s abscess

-Citelli abscess

–  Bezold abscess


Q. 13

Acute mastoiditis is characterized by all except: 

 A

Clouding of air cells

 B

Obliteration of retroauricular sulcus

 C

Deafness

 D

Outward and downward deviation of the pinna

Q. 13

Acute mastoiditis is characterized by all except: 

 A

Clouding of air cells

 B

Obliteration of retroauricular sulcus

 C

Deafness

 D

Outward and downward deviation of the pinna

Ans. B

Explanation:

Q. 14

Essential radiological feature of acute mastoiditis is:

 A

Temporal bone pneumatisation

 B

Clouding of air cells of mastoid

 C

Rarefaction and tuning of petrous bone

 D

Thickening of temporal bone

Q. 14

Essential radiological feature of acute mastoiditis is:

 A

Temporal bone pneumatisation

 B

Clouding of air cells of mastoid

 C

Rarefaction and tuning of petrous bone

 D

Thickening of temporal bone

Ans. B

Explanation:

Q. 15

In Mastoiditis tenderness is/are present at:

 A

Tragus

 B

Concha

 C

Mastoid tip

 D

All

Q. 15

In Mastoiditis tenderness is/are present at:

 A

Tragus

 B

Concha

 C

Mastoid tip

 D

All

Ans. C

Explanation:

Q. 16

All are true for Gradenigo’s syndrome except:

 A

It is associated with jugular vein tenderness

 B

It is caused by an abscess in the petrous apex

 C

It leads to involvement of the Cranial nerves V and VI.

 D

It is characterized by retro-orbital pain

Q. 16

All are true for Gradenigo’s syndrome except:

 A

It is associated with jugular vein tenderness

 B

It is caused by an abscess in the petrous apex

 C

It leads to involvement of the Cranial nerves V and VI.

 D

It is characterized by retro-orbital pain

Ans. A

Explanation:

Q. 17

Gradenigo’s syndrome characterised by all except:

 A

Retroorbital pain

 B

Profuse discharge from the ear

 C

VII nerve palsy

 D

Diplopia

Q. 17

Gradenigo’s syndrome characterised by all except:

 A

Retroorbital pain

 B

Profuse discharge from the ear

 C

VII nerve palsy

 D

Diplopia

Ans. C

Explanation:

Q. 18

Most common nerve to be damaged in CSOM is

 A

III

 B

VII

 C

IV

 D

VI

Q. 18

Most common nerve to be damaged in CSOM is

 A

III

 B

VII

 C

IV

 D

VI

Ans. B

Explanation:

 

Facial nerve is the M/C nerve to be damaged in CSOM.



Q. 19

All of the following are included in Gradenigo’s triad EXCEPT:    

 A

Abducent nerve palsy

 B

Retro-orbital pain

 C

Aural discharge

 D

Palatal palsy

Q. 19

All of the following are included in Gradenigo’s triad EXCEPT:    

 A

Abducent nerve palsy

 B

Retro-orbital pain

 C

Aural discharge

 D

Palatal palsy

Ans. D

Explanation:

 

Gradenigo’s syndrome/ Gradenigo-Lannois syndrome/ Petrous apicitis

  • It is a complication of otitis media and mastoiditis involving the apex of the petrous temporal bone.
  • It was first described by Giuseppe Gradenigo in 1904 when he reported a triad of symptoms consisting of periorbital unilateral pain related to trigeminal nerve involvement, diplopia due to sixth nerve palsy and persistent otorrhea, associated with bacterial otitis media with apex involvement of the petrous part of the temporal bone (petrositis).

Q. 20

Gradenigo syndrome is characterized by all except ‑

 A

Diplopia

 B

Retro-orbital pain

 C

Persistent ear discharge

 D

Vertigo

Q. 20

Gradenigo syndrome is characterized by all except ‑

 A

Diplopia

 B

Retro-orbital pain

 C

Persistent ear discharge

 D

Vertigo

Ans. D

Explanation:

Ans. is d i.e., Vertigo

Infection of mastoid and middle ear may be complicated by the spread of infection within the temporal bone into petrous apex. Petrositis is an extension of infection from middle ear and mastoid to the petrous part of the temporal bone.

Gradenigo’s syndrome is the classical presentation and consists of a triad of : –

  • External rectus palsy (VIth nerve/abducent nerve palsy) causing diplopia.
  • Deep seated orbital or retroorbital pain (Vth nerve involvement).
  • Persistent ear discharge due to ipsilateral acute or chronic otitis media.

Associated symptoms of otitis media are also present e.g., conductive deafness. Other symptoms are fever, head­ache, vomiting, and sometimes neck rigidity. Some patient may get facial paralysis and recurrent vertigo due to involvement of facial and statoacoustic nerves.


Q. 21

All are true for gradenigo’s syndrome except ‑

 A

Associated with intermittent ear discharge

 B

Associated with conductive hearing loss

 C

Causes diplopia

 D

Leads to retro orbital pain

Q. 21

All are true for gradenigo’s syndrome except ‑

 A

Associated with intermittent ear discharge

 B

Associated with conductive hearing loss

 C

Causes diplopia

 D

Leads to retro orbital pain

Ans. A

Explanation:

Ans. is ‘a’ i.e., Associated with intermittent ear discharge


Q. 22

In a patient with CSOM, labrynthine fistula most commnonly involves ‑

 A

Superior SCC

 B

Lateral SCC

 C

Posterior SCC

 D

Utricle

Q. 22

In a patient with CSOM, labrynthine fistula most commnonly involves ‑

 A

Superior SCC

 B

Lateral SCC

 C

Posterior SCC

 D

Utricle

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lateral SCC

  • Labrynthine fistula is almost exclusively reported in association with chronic otitis media and cholesteatoma.
  • The most commonly affected canal is lateral (horizontal) semicircular canal, but involvement of the posterior and superior canals as well as other regions of labyrinth have been reported.
  • The incidence of labrynthine fistula in chronic otitis media is approximately 10%.



Q. 23

Most common cranial nerve involved in CSOM is ‑

 A

V

 B

VII

 C

IX

 D

XI

Q. 23

Most common cranial nerve involved in CSOM is ‑

 A

V

 B

VII

 C

IX

 D

XI

Ans. B

Explanation:

Ans. is ‘b’ i.e., VII


Q. 24

Gradenigo’s syndrome consists of the following except ‑

 A

Retro-orbital pain

 B

Persistent ear discharge

 C

External rectus palsy

 D

Convulsions

Q. 24

Gradenigo’s syndrome consists of the following except ‑

 A

Retro-orbital pain

 B

Persistent ear discharge

 C

External rectus palsy

 D

Convulsions

Ans. D

Explanation:

Ans. is ‘d’ i.e., Convulsions

Infection of mastoid and middle ear may be complicated by the spread of infection within the temporal bone into petrous apex. Petrositis is an extension of infection from middle ear and mastoid to the petrous part of the temporal bone. Gradenigo’s syndrome is the classical presentation and consists of a triad of : –

i)  External rectus palsy (VIth nerve/abducent nerve palsy) causing diplopia.

ii) Deep seated orbital or retroorbital pain (Vth nerve involvement).

iii) Persistent ear discharge due to ipsilateral acute or chronic otitis media.

 Associated symptoms of otitis media are also present e.g., conductive deafness. Other symptoms are fever, headache, vomiting, and sometimes neck rigidity. Some patient may get facial paralysis and recurrent vertigo due to involvement of facial and statoacoustic nerves.



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