Category: Quiz

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.



Csom

CSOM

Q. 1

A child presents with left ear hearing loss of three month duration. On examination, foul smelling purulent discharge is seen with perforation in pars flaccida. What is the most appropriate management?

 A

Topical antibiotics and decongestants for 4 weeks.

 B

Aural toileting

 C

Tympano-mastoid exploration

 D

Type I tympanoplasty

Q. 1

A child presents with left ear hearing loss of three month duration. On examination, foul smelling purulent discharge is seen with perforation in pars flaccida. What is the most appropriate management?

 A

Topical antibiotics and decongestants for 4 weeks.

 B

Aural toileting

 C

Tympano-mastoid exploration

 D

Type I tympanoplasty

Ans. C

Explanation:

 

  • Foul smelling discharge and perforation in the Pars flaccida suggest CSOM of the unsafe type (Atticoantral type)
  • This type of CSOM is often associated with a bone eroding process such as cholesteatoma, granulations or osteitis. Risk of complications is high
  • Surgery is the mainstay of treatment.
  • The primary aim is to remove the disease process by tympano-mastoid exploration and render the ear safe.
  • Tympano-mastiod exploration can be done through various procedures.

1. Canal wall down procedures

– Atticotomy, modified radical mastoidectomy and rarely radical mastoidectomy.

2. Canal wall up procedures

  • Tympanoplasty is a surgical procedure that repairs or reconstructs the hearing mechanism.

‘Type I Defect is perforation of tympanic membrane which is

repaired with a graft. It is also called myringoplasty.

-Type II Defect is perforation of tympanic membrane with erosion of malleus. Graft is placed on the incus or remnant of malleus.

‘Type III Malleus and incus are absent. Graft is placed directly on the stapes head. It is also myringostapediopexy or columella tympanoplasty.

-Type IV Only the footplate of stapes is present. It is exposed to the external ear, and graft is placed between the oval and round windows. A narrow middle ear (cavum minor) is thus created, to have an air pocket around the round window. A mucosa-lined space extends from the eustachian tube to the round window. Sound waves in this case act directly on the footplate while the round window has been shielded.

Type V Stapes footplate is fixed but round window is functioning. In such cases, another window is created on horizontal semicircular canal and covered with a graft. Also called fenestration operation.


Q. 2

A 30-year-old,lady, with a history of chronic otitis and sinusitis is found to have a low serum IgA level. All other immunoglobulin classes are found to be normal. Which of the following statements is correct?

 A

She may suffer an anaphylactic reaction following the administration of blood products

 B

Not associated with other autoimmune disorders

 C

Intravenous immunoglobulin (IVIG) is the treatment of choice

 D

All of the above

Q. 2

A 30-year-old,lady, with a history of chronic otitis and sinusitis is found to have a low serum IgA level. All other immunoglobulin classes are found to be normal. Which of the following statements is correct?

 A

She may suffer an anaphylactic reaction following the administration of blood products

 B

Not associated with other autoimmune disorders

 C

Intravenous immunoglobulin (IVIG) is the treatment of choice

 D

All of the above

Ans. A

Explanation:

The patient is suffering from isolated IgA deficiency.

 
IgA deficiency is the most common PID.
It is asymptomatic in most cases; however, individuals may present with increased numbers of acute and chronic respiratory infections that may lead to bronchiectasis.
In addition, over their lifetime, these patients experience an increased susceptibility to drug allergies, atopic disorders, and autoimmune diseases.
Serum antibodies to IgA are reported in as many as 44% of patients with selective IgA deficiency.
If these antibodies are of the IgE isotype, they can cause severe or fatal anaphylactic reactions after intravenous administration of blood products containing IgA.
 
Administration of intravenous immunoglobulin (IVIG), which is >99% IgG, is not indicated because most IgA-deficient patients make IgG antibodies normally. Many IVIG preparations contain sufficient IgA to cause anaphylactic reactions.

Q. 3

Which of the following condition is most commonly associated with cholesteatoma formation?

 A

Central perforation

 B

Attico-antral perforation

 C

Tubo-tympanic disease

 D

Otosclerosis

Q. 3

Which of the following condition is most commonly associated with cholesteatoma formation?

 A

Central perforation

 B

Attico-antral perforation

 C

Tubo-tympanic disease

 D

Otosclerosis

Ans. B

Explanation:

Atticoantral type of CSOM is most commonly associated with cholesteatoma, granulations or osteitis. It is associated with an attic or marginal perforation.

Tubotympanic type of CSOM is associated with central perforation.


Q. 4

A 10 year boy presents with discharge and hearing disturbance in the left ear. On examination of the left ear, a central perforation is noted. Which of the following is the surgical management of choice in this patient?

 A

Myringoplasty

 B

Modified radical mastoidectomy

 C

Radical mastoidectomy

 D

Clearance and antibiotics

Q. 4

A 10 year boy presents with discharge and hearing disturbance in the left ear. On examination of the left ear, a central perforation is noted. Which of the following is the surgical management of choice in this patient?

 A

Myringoplasty

 B

Modified radical mastoidectomy

 C

Radical mastoidectomy

 D

Clearance and antibiotics

Ans. A

Explanation:

Q. 5

A man presented with complaints of scanty, foul smelling, painless discharge from the ear. It is characteristic feature of the following lesion:

 A

ASOM

 B

Cholesteatoma

 C

Central perforation

 D

Otitis externa

Q. 5

A man presented with complaints of scanty, foul smelling, painless discharge from the ear. It is characteristic feature of the following lesion:

 A

ASOM

 B

Cholesteatoma

 C

Central perforation

 D

Otitis externa

Ans. B

Explanation:

Patients with acquired cholesteatomas typically present with recurrent or persistent purulent otorrhea and hearing loss. The discharge is scanty & always foul-smelling due to bone destruction. Facial nerve twitching, palsy, or paralysis can also result from the inflammatory process or from mechanical compression of the nerve. 
 
Ref: Chang C. (2012). Chapter 50. Cholesteatoma. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e.

Q. 6

Which of the following is the treatment of choice for atticoantral variety of chronic suppurative otitis media?

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation lube

Q. 6

Which of the following is the treatment of choice for atticoantral variety of chronic suppurative otitis media?

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation lube

Ans. A

Explanation:

Atticoantral type of CSOM involves the attic of the tympanic membrane and is often associated with cholesteatoma formation.

In this type, a retraction pocket develops in the pars flaccida and a cholesteatoma develops if the squamous epithelium cannot migrate out of this pocket.

It is associated with a number of complications and the surgery is the primary modality of treatment.

Surgical procedures indicated in this condition are atticotomy, mastoidectomy or combined approach tympanoplasty.

 
Tubotympanic type of CSOM involves the anteroinferior part of the middle ear cleft and is associated with a permanent central perforation. It is not associated with serious complications and it is called safe or benign CSOM.
 

Q. 7

Ossicle M/C involved in CSOM:

 A

Stapes

 B

Long process of incus

 C

Head of malleus

 D

Handle of malleus

Q. 7

Ossicle M/C involved in CSOM:

 A

Stapes

 B

Long process of incus

 C

Head of malleus

 D

Handle of malleus

Ans. B

Explanation:

Q. 8

True about safe CSOM:

 A

Etiology is multiple bacteria

 B

Oral antibiotics are not affective

 C

Ear drops have no role

 D

Ottic hydrocephalus is a known complication

Q. 8

True about safe CSOM:

 A

Etiology is multiple bacteria

 B

Oral antibiotics are not affective

 C

Ear drops have no role

 D

Ottic hydrocephalus is a known complication

Ans. A

Explanation:

 

CSOM is caused by multiple bacteria – both aerobic and anaerobic.

Their is no sex predilection in CSOM – both sexes are affected equally.                              

Treatment of Tubotympanic type of CSOM is aural toileting and antibiotic ear drops. Dhingra 5th/ed


Q. 9

Treatment of choice in central safe perforation is:

 A

Modified mastoidectomy

 B

Tympanoplasty

 C

Myringoplasty

 D

Conservative management

Q. 9

Treatment of choice in central safe perforation is:

 A

Modified mastoidectomy

 B

Tympanoplasty

 C

Myringoplasty

 D

Conservative management

Ans. D

Explanation:

Q. 10

Cholesteatoma is commonly caused by:

 A

Attico-antral perforation

 B

Tubotympanic disease

 C

Central perforation of tympanic membrane

 D

Meniere’s disease

Q. 10

Cholesteatoma is commonly caused by:

 A

Attico-antral perforation

 B

Tubotympanic disease

 C

Central perforation of tympanic membrane

 D

Meniere’s disease

Ans. A

Explanation:

 

Tubotympanic type (safe or benign type)

  • It is associated with central perforation of tympanic membrane and involves the anterior inferior part of middle ear cleft (eustachian tube and mesotympanum).
  • There is no association with cholesteatoma.
  • Tubotympanic type is also called safe or benign type as there is no risk of serious complicatiions.

Attico-antral type (unsafe or dangerous type)

  • It is associated with an attic or a marginal perforation of the tympanic membrane and involves postero-superior part of middle ear cleft (attic, antrum and mastoid).
  • The attico-antral disease is characterized with cholesteatoma which erodes the bone.
  • Risk of intracranial extension of infection, and thus the risk of complication, is very high, therefore it is called dangerous or unsafe ear.

Q. 11

Cholesteatoma occurs in:

 A

CSOM with central perforation

 B

Masked mastoiditis

 C

Coalescent mastoiditis

 D

Acute necrotizing otitis media

Q. 11

Cholesteatoma occurs in:

 A

CSOM with central perforation

 B

Masked mastoiditis

 C

Coalescent mastoiditis

 D

Acute necrotizing otitis media

Ans. D

Explanation:

Q. 12

Cholesteotoma is seen in:

 A

ASOM

 B

CSOM

 C

Secretory ottitis media 

 D

Osteosclerosis

Q. 12

Cholesteotoma is seen in:

 A

ASOM

 B

CSOM

 C

Secretory ottitis media 

 D

Osteosclerosis

Ans. B

Explanation:

Q. 13

Perforation of tympanic membrane with destruction of tympanic annulus is called:

 A

Attic

 B

Marginal

 C

Subtotal

 D

Total

Q. 13

Perforation of tympanic membrane with destruction of tympanic annulus is called:

 A

Attic

 B

Marginal

 C

Subtotal

 D

Total

Ans. B

Explanation:

Q. 14

What is true in case of perforation of pars flaccida?

 A

CSOM is a rare cause

 B

Associated with cholesteatoma

 C

Usually due to trauma

 D

All of the above

Q. 14

What is true in case of perforation of pars flaccida?

 A

CSOM is a rare cause

 B

Associated with cholesteatoma

 C

Usually due to trauma

 D

All of the above

Ans. B

Explanation:

 

Tympanic membrane can be divided in 2 parts:

Pars tensa  : It forms most of the tympanic membrane. Its periphery is thickened to form fibro cartilaginous ring called as annulus tympanicus.

Pars Flaccida : It is situated above the lateral process of malleus between the notch of Rivinus and the anterior and posterior malleolar fold.


 

 


Q. 15

Prior H/O ear surgery and Scanty, foul smelling, painless discharge from the ear is characteristic feature of which of the following lesions:

 A

ASOM

 B

Cholesteatoma

 C

Central perforation

 D

Otitis externa

Q. 15

Prior H/O ear surgery and Scanty, foul smelling, painless discharge from the ear is characteristic feature of which of the following lesions:

 A

ASOM

 B

Cholesteatoma

 C

Central perforation

 D

Otitis externa

Ans. B

Explanation:

 

Cholesteatoma / attico antral type of CSOM / marginal perforation is characterised by scanty foul smelling, painless discharge from the ear.

The foul smell is due to saprophytic infection and osteitis


Q. 16

Which is true about Cholesteatoma (Atticoantral)?

 A

Scanty, malodorous discharge

 B

Otalgia

 C

Central perforation

 D

All

Q. 16

Which is true about Cholesteatoma (Atticoantral)?

 A

Scanty, malodorous discharge

 B

Otalgia

 C

Central perforation

 D

All

Ans. A

Explanation:

 

  • Cholestatoma is associated with atticoantral type of CSOM / atticoantral or marginal perforation (and not central perforation).
  • Cholesteatoma leads to destruction of bones therefore there is scanty foul smelling discharge and ossicular necrosis.
  • Hearing loss occurs if ossicles are involved.
  • It is of conductive type but if complications like labyrinthitis intervene, SNHL may also be seen.
  • Bleeding may occur from granulations or polyp.
  • Otalgia is not seen in case of cholesteatoma.



Q. 17

The treatment of choice for atticoantral variety of chronic suppurative otitis media is:

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation tube

Q. 17

The treatment of choice for atticoantral variety of chronic suppurative otitis media is:

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation tube

Ans. A

Explanation:

Q. 18

Treatment of choice for Perforation in pars flaccida of the tympanic membrane with cholesteatoma is: 

 A

Myringoplasty

 B

 Modified Radical Mastoidectomy [MRM]

 C

Antibiotics

 D

Radical mastoidectomy

Q. 18

Treatment of choice for Perforation in pars flaccida of the tympanic membrane with cholesteatoma is: 

 A

Myringoplasty

 B

 Modified Radical Mastoidectomy [MRM]

 C

Antibiotics

 D

Radical mastoidectomy

Ans. B

Explanation:

Q. 19

A child presents with ear infection with foul smelling discharge. On further exploration, a small perforation is found in the pars flaccida of the tympanic membrance. Most appropriate next step in the management would be:

 A

Topical antibiotics and decongestants for 4 weeks

 B

IV antibiotics and follow up after a month

 C

Tympanoplasty

 D

Tympano-mastoid exploration

Q. 19

A child presents with ear infection with foul smelling discharge. On further exploration, a small perforation is found in the pars flaccida of the tympanic membrance. Most appropriate next step in the management would be:

 A

Topical antibiotics and decongestants for 4 weeks

 B

IV antibiotics and follow up after a month

 C

Tympanoplasty

 D

Tympano-mastoid exploration

Ans. D

Explanation:

 

  • Tympano-mastiod exploration can be done through various procedures: – Canal wall down procedures
  • Atticotomy, and rarely radical mastoidectomy. – Canal wall up procedures
  • Cortical mastoidectomy

Q. 20

Treatment of choice for CSOM with vertigo and facial nerve palsy is:

 A

Antibiotics and labyrinthine sedative

 B

Myringoplasty

 C

Immediate mastoid exploration

 D

Labyrinthectomy

Q. 20

Treatment of choice for CSOM with vertigo and facial nerve palsy is:

 A

Antibiotics and labyrinthine sedative

 B

Myringoplasty

 C

Immediate mastoid exploration

 D

Labyrinthectomy

Ans. C

Explanation:

Q. 21

A patient of CSOM has choleastatoma and presents with vertigo . Treatment of choice would be:

 A

Antibiotics and labyrinthine sedative

 B

Myringoplasty

 C

Immediate mastoid exploration

 D

Labyrinthectomy

Q. 21

A patient of CSOM has choleastatoma and presents with vertigo . Treatment of choice would be:

 A

Antibiotics and labyrinthine sedative

 B

Myringoplasty

 C

Immediate mastoid exploration

 D

Labyrinthectomy

Ans. C

Explanation:

 

The patient is presenting with CSOM and vertigo which means cholesteatoma has led to fistula formation involving semicircular canals which in turn has caused vertigo.

So the management is immediate mastoid exploration to remove the cholesteatoma.



Q. 22

A patient of CSOM with cholesteatoma present with acute onset of vertigo. Treatment is: 

 A

Immediate exploration

 B

Antibiotics + steroids

 C

Labyrinthine sedatives + antibiotics

 D

Labyrinthine sedatives only

Q. 22

A patient of CSOM with cholesteatoma present with acute onset of vertigo. Treatment is: 

 A

Immediate exploration

 B

Antibiotics + steroids

 C

Labyrinthine sedatives + antibiotics

 D

Labyrinthine sedatives only

Ans. A

Explanation:

Q. 23

Most common organism cultured in CSOM is ‑

 A

Staphylococcus aureus

 B

Staphylococcus epidermidis

 C

Streptococcus pneumonia

 D

Pseudomonas seruginosa

Q. 23

Most common organism cultured in CSOM is ‑

 A

Staphylococcus aureus

 B

Staphylococcus epidermidis

 C

Streptococcus pneumonia

 D

Pseudomonas seruginosa

Ans. D

Explanation:

Ans. is ‘d’ i.e., Pseudomonas aeruginosa

Microbiology of CSOM

  • Pus culture in both types of aerobic and anaerobic CSOM may show multiple organisms.
  • Most commonly isolated organisms are gram negative bacilli, i.e., Pseudomonas, proteus, E.coli.
  • These organisms are not commonly found in the respiratory tract, while commonly found in the skin of external ear.

Q. 24

Most common cranial nerve involved in CSOM is ‑

 A

V

 B

VII

 C

IX

 D

XI

Q. 24

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



Acute Suppurative Otits Media

Acute Suppurative Otits Media

Q. 1

Most common site of perforation of tympanic membrane in ASOM is

 A

Anterior superior quadrant

 B

Anterior inferior quadrant

 C

Posterior superior quadrant

 D

Posterior inferior quadrant

Q. 1

Most common site of perforation of tympanic membrane in ASOM is

 A

Anterior superior quadrant

 B

Anterior inferior quadrant

 C

Posterior superior quadrant

 D

Posterior inferior quadrant

Ans. B

Explanation:

Q. 2

Most common extra-cranial compli­cation of ASOM is:

 A

Facial nerve paralysis

 B

Lateral sinus thrombosis

 C

Subperiosteal abscess

 D

Brain abscess

Q. 2

Most common extra-cranial compli­cation of ASOM is:

 A

Facial nerve paralysis

 B

Lateral sinus thrombosis

 C

Subperiosteal abscess

 D

Brain abscess

Ans. C

Explanation:

Q. 3

A previously healthy 18-month-old girl is brought to the office with 2 days of irritability, poor appetite, and pulling at her left ear. She has no known allergies, and her temperature is 102.8 F. She is easily consoled by the mother and moves her neck spontaneously without discomfort. There is a clear discharge from the nares. The left tympanic membrane is erythematous, dull, and bulging. Which of the following virulence factors is generally absent in the strains of the causative organism that produce otitis media, compared with those that produce epiglottitis or meningitis?

 A

Beta-Lactamase

 B

IgA protease

 C

Lipopolysaccharide

 D

Polyribitol phosphate

Q. 3

A previously healthy 18-month-old girl is brought to the office with 2 days of irritability, poor appetite, and pulling at her left ear. She has no known allergies, and her temperature is 102.8 F. She is easily consoled by the mother and moves her neck spontaneously without discomfort. There is a clear discharge from the nares. The left tympanic membrane is erythematous, dull, and bulging. Which of the following virulence factors is generally absent in the strains of the causative organism that produce otitis media, compared with those that produce epiglottitis or meningitis?

 A

Beta-Lactamase

 B

IgA protease

 C

Lipopolysaccharide

 D

Polyribitol phosphate

Ans. D

Explanation:

This is most likely a case of Haemophilus influenzae otitis media. 95% of all cases of invasive disease (epiglottitis, meningitis) due to H. influenzae are caused by type b organisms that possess a polyribitol phosphate capsule. Otitis media is generally not caused by type b organisms.
 
Beta-Lactamase is an important pathogenic feature of Moraxella catarrhalis, which is another important cause of otitis media, but would not be an agent of epiglottitis or meningitis.
 
IgA protease is produced by Streptococcus pneumoniae and Neisseria meningitidis. Both of these cause meningitis, but not as commonly in this age group, and would not be the most common causes of otitis media in this case.
 
Lipopolysaccharide (choice C) is present in all gram-negative bacteria and would not be a distinguishing feature between those that cause otitis media and epiglottitis.
 
Ref: Brooks G.F. (2013). Chapter 18. Haemophilus, Bordetella, Brucella, and Francisella. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg’s Medical Microbiology, 26e.

Q. 4

Which of the following organism is the most common cause of Acute otitis media in children?

 A

Staphylococcus aureus

 B

Moraxella catarrhalis

 C

Haemophilus Influenzae

 D

Streptococcus pneumoniae

Q. 4

Which of the following organism is the most common cause of Acute otitis media in children?

 A

Staphylococcus aureus

 B

Moraxella catarrhalis

 C

Haemophilus Influenzae

 D

Streptococcus pneumoniae

Ans. D

Explanation:

Streptococcus pneumoniae is the most common organism causing acute otitis media.

It accounts for roughly 30% of the cases. Other causative organisms includes Haemophilus influenzae (20%) Moraxella catarrhalis (12%), Streptococcus pyogenes and Staphylococcus aureus.


Q. 5

Most common site of perforation of tympanic membrane in acute suppurative otitis media is:

 A

Anterior superior quadrant

 B

Anterior inferior quadrant

 C

Posterior superior quadrant

 D

Posterior inferior quadrant

Q. 5

Most common site of perforation of tympanic membrane in acute suppurative otitis media is:

 A

Anterior superior quadrant

 B

Anterior inferior quadrant

 C

Posterior superior quadrant

 D

Posterior inferior quadrant

Ans. B

Explanation:

In acute suppurative otitis media, 85% of cases show a small perforation in antero-inferior quadrant of pars tensa.

Perforations in this location were associated with smooth margins, good drainage of pus, and a favorable clinical course.

Hence this area is termed as “perforation zone”.

Only 15% of perforations occurred in other locations, most typically the posterior-superior quadrant.


Q. 6

A child is brought to the emergency department with signs of meningeal irritation. She had suppurative otitis media in the last week. Infection of middle ear can spread to CNS through:

 A

Venous plexus

 B

Cochlear aqueduct

 C

Cochlear nerve sheath

 D

Bloodstream

Q. 6

A child is brought to the emergency department with signs of meningeal irritation. She had suppurative otitis media in the last week. Infection of middle ear can spread to CNS through:

 A

Venous plexus

 B

Cochlear aqueduct

 C

Cochlear nerve sheath

 D

Bloodstream

Ans. B

Explanation:

 

In the setting of middle ear infection, bacterial infection can invade through the round window causing acute suppurative labyrinthitis. 

From the labyrinth, bacteria gain access to the cochlear aqueduct, forming a conduit between the perilymph and the cerebrospinal fluid (CSF) resulting in meningeal infiltration.


Q. 7

During follow up of a case of acute otitis media, a 6 year old child found to have glue ear with no symptoms. Next step of management is:

 A

Wait and watch

 B

Antibiotics

 C

Corticosteroids

 D

Antihistamines

Q. 7

During follow up of a case of acute otitis media, a 6 year old child found to have glue ear with no symptoms. Next step of management is:

 A

Wait and watch

 B

Antibiotics

 C

Corticosteroids

 D

Antihistamines

Ans. A

Explanation:

Close to 90% of episodes of otitis media with effusion (glue ear) resolve spontaneously after an acute otitis media episode is diagnosed. 
 
The American Academy of Pediatrics 2004 consensus guideline recommends watchful waiting without immediate use of antibiotics for children with uncomplicated otitis media with effusion.


Q. 8

The quadrant for a myringotomy in a case of acute suppurative otitis media is:

 A

Anterosuperior

 B

Anteroinferior

 C

Posteroinferior

 D

Posterosuperior

Q. 8

The quadrant for a myringotomy in a case of acute suppurative otitis media is:

 A

Anterosuperior

 B

Anteroinferior

 C

Posteroinferior

 D

Posterosuperior

Ans. C

Explanation:

In acute suppurative otitis media, a circumferential incision is made in the posteroinferior quadrant of tympanic membrane, midway between handle of malleus and tympanic annulus, avoiding injury to incudostapedial joint.
 

Q. 9

Commonest cause of acute otitis media in children is:

 A

H. influenzae

 B

Streptococcus pneumoniae

 C

Staphylococcus aureus

 D

Pseudomonas

Q. 9

Commonest cause of acute otitis media in children is:

 A

H. influenzae

 B

Streptococcus pneumoniae

 C

Staphylococcus aureus

 D

Pseudomonas

Ans. B

Explanation:

Nasopharyngeal colonization with Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis increases the risk of otitis media, whereas colonization with normal flora such as viridans streptococci may prevent otitis by inhibiting growth of these pathogens.

The most common cause of acute otitis media in children is Streptococcus pneumoniae with 35%, H.influenzae with 25% & Moraxella catarrhalis with 15%.


Q. 10

In a 4 year old child with ASOM the infecting organism is likely to be-

 A

Pneumococcus

 B

Rinfluenza

 C

Streptococcus

 D

Staphylococcus

Q. 10

In a 4 year old child with ASOM the infecting organism is likely to be-

 A

Pneumococcus

 B

Rinfluenza

 C

Streptococcus

 D

Staphylococcus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Pneumococcus

Three most common organisms causing ASOM S. pneumoniae (40%), H. influenzae (25-30%), Moraxella, catarrhalis (10-15%)

Note – H.influenzae causing ASOM is nontypable. The incidence of H.influenzae type ‘b’ has decreased because of widespread use of Hib vaccine.


Q. 11

A 3-month-old male infant developed otitis media for which he was given a course of Co-trimoxazole. A few days later, he developed extensive peeling of the skin; there were no mucosal lesions and the baby was not toxic. The most likely diagnosis is ‑

 A

Toxic epidermal necrolysis

 B

Staphylococcal scalded skin syndrome

 C

Steven Johnson syndrome

 D

Infantile pemphigus

Q. 11

A 3-month-old male infant developed otitis media for which he was given a course of Co-trimoxazole. A few days later, he developed extensive peeling of the skin; there were no mucosal lesions and the baby was not toxic. The most likely diagnosis is ‑

 A

Toxic epidermal necrolysis

 B

Staphylococcal scalded skin syndrome

 C

Steven Johnson syndrome

 D

Infantile pemphigus

Ans. B

Explanation:

Ans. is ‘b’ i.e., Staphylococcal Scalded skin syndrome

o The extensive peeling of the skin after H/O drug intake makes it look like a case of Toxic epidermal necrolysis or Steven’s Jhonson syndrome on the first instance. But it is a case of staphylococcal scalded skin syndrome.

         Note that all the disease given in the question can cause extensive peeling of the skin.

o The points which favour the diagnosis of staphylococcal scalded skin syndrome are

         Mucosa is spared in staphylococcal scalded skin syndrome.

Absence of toxicity.

 S.S.S. usually have primary infection at sites other than skin eg – Nasopharynx, conjuctiva, throat middle ear (otitis media).

o Now, about the individual diseases

Staphylococcal scalded skin syndrome

  • Usually begins as prodrome. The acute phase starts with the onset of erythematous rash in the periorbital and perioral area and is tender.

o These erythematous rashes are soon (within hrs or days) followed by wrinkling or sloughing of the skin. o The sloughing can be provoked by stroking of the skin (Nikolsky’s sign).

  • In later stage, large flaccid bullae may develop. These bullae can cause loss of water and electrolyte. o Fever irritability and lethargy are common but systemic toxicity is not seen.

o The entire illness resolves within about 10 days.

Toxic epidermal necrolvsis ‑

  • It is a severe form of drug reaction.
  • Toxemia is characteristic
  • It is characterized by bullae that arise on widespread areas of erythema and then they slough leaving behind raw ulcerated skin.
  • Oral mucosa especially the lips, genital mucosa and conjunctiva are ofter involved. In some cases cornea is also involved leading to corneal opacities.

o Drugs commonly involved in TEN are —> Thioacetazone, INH, Sulphonamides, Phenolphthalein

Stevens Jhonson syndrome ‑

  • It is also a severe form of drug eruption.

o Toxemia is characteristically present.

o It is less severe than toxic epidermal necrolysis. In Steven’s Jhonson’s syndrome bullaes and epidermal detachment is seen in > 10% of total surface area. Where as in TEN it is seen in > 30% of total surface area. o Mucous membrane is involved

o Common drugs causing this reaction —> Sulphonamides, Tetracycline, Oral antidiabetic drugs.


Q. 12

A 16 year old student reported for the evaluation of multiple hypopigmented macules on the trunk and limbs. All of the following tests are useful in making a diagnosis of leprosy, except:

 A

Sensation testing

 B

Lepromin test

 C

Slit smears

 D

Skin biopsy

Q. 12

A 16 year old student reported for the evaluation of multiple hypopigmented macules on the trunk and limbs. All of the following tests are useful in making a diagnosis of leprosy, except:

 A

Sensation testing

 B

Lepromin test

 C

Slit smears

 D

Skin biopsy

Ans. B

Explanation:

B i.e. Lepromin test

Lepromin test has no diagnostic value; it has only prognostic significanceQ as it tells about cell mediated immunity & classify the type of disease. Lepromin test is most positive in TT because cell mediated immunity is least suppressedQ


Q. 13

Commonest cause of acute otitis media in children is: 

 A

H. inflenzae

 B

S-pneumoniae

 C

S aureus

 D

Pseudomonas

Q. 13

Commonest cause of acute otitis media in children is: 

 A

H. inflenzae

 B

S-pneumoniae

 C

S aureus

 D

Pseudomonas

Ans. A

Explanation:

Q. 14

Commonest causative organism for ASOM in 2 years child is:

 A

Pneumococcus

 B

H. influenzae

 C

Staphylococcus

 D

Streptococcus

Q. 14

Commonest causative organism for ASOM in 2 years child is:

 A

Pneumococcus

 B

H. influenzae

 C

Staphylococcus

 D

Streptococcus

Ans. A

Explanation:

 

Most common cause of acute otitis media:

  • Streptococcus pneumonia / pneumococcus (35-40% cases)
  • H. influenza (25-30%)
  • M. catarrhalis (10-20%)



Q. 15

True statement about ASOM is:

 A

Most frequently it resolves without sequelae

 B

Commonly follows painful parotitis

 C

Radical mastoidectomy is required for treatment

 D

Most common organism is pseudomonas

Q. 15

True statement about ASOM is:

 A

Most frequently it resolves without sequelae

 B

Commonly follows painful parotitis

 C

Radical mastoidectomy is required for treatment

 D

Most common organism is pseudomonas

Ans. A

Explanation:

Q. 16

Cart Wheel sign is seen in:

 A

ASOM

 B

AOM

 C

OME

 D

CSOM

Q. 16

Cart Wheel sign is seen in:

 A

ASOM

 B

AOM

 C

OME

 D

CSOM

Ans. A

Explanation:

 

  • There is congestion of pars tensa
  • Leash of blood vessels appear along the handle of malleus and at the periphery giving it a cartwheel like appearance.
  • Transluscency is reduced.
  • Later tympanic membrane appears red and bulging with loss of landmarks.
  • Tympanic membrane is immobile n pneumatic ostoscopy



Q. 17

Acute suppurative otitis media is treated using all except:

 A

Erythromycin

 B

Penicillin

 C

Streptomycin

 D

Cephalosporin

Q. 17

Acute suppurative otitis media is treated using all except:

 A

Erythromycin

 B

Penicillin

 C

Streptomycin

 D

Cephalosporin

Ans. C

Explanation:

Q. 18

Pulsatile otorrhoea is seen in:

 A

Glomus tumour

 B

CSF otorrhea

 C

ASOM

 D

Fistula

Q. 18

Pulsatile otorrhoea is seen in:

 A

Glomus tumour

 B

CSF otorrhea

 C

ASOM

 D

Fistula

Ans. C

Explanation:

Q. 19

Most common perforation site in tympanic membrane in ASOM:

 A

Antero-inferior

 B

Postero-inferior

 C

Antero-superior

 D

Postero-superior

Q. 19

Most common perforation site in tympanic membrane in ASOM:

 A

Antero-inferior

 B

Postero-inferior

 C

Antero-superior

 D

Postero-superior

Ans. A

Explanation:

Q. 20

Light house sign is seen in:

 A

ASOM

 B

CSOM

 C

Meniere’s disease

 D

Cholesteatoma

Q. 20

Light house sign is seen in:

 A

ASOM

 B

CSOM

 C

Meniere’s disease

 D

Cholesteatoma

Ans. A

Explanation:

 

  • Light house sign is seen in acute ASOM and in acute mastoiditis following ASOM.
  • There is mucopurulent or purulent discharge, which is often pulsatile
  • On otoscopy examination of ear, this pulsatile discharge reflects light which is called as light house effect



Q. 21

A boy with ASOM undergoing treatment with penicillin therapy for 7 days now presents with subsidence of pain and persistence of deafness, Diagnosis is:

 A

Ototoxicity

 B

Secretory otitis media

 C

Adhesive otitis media

 D

Tympanosclerosis

Q. 21

A boy with ASOM undergoing treatment with penicillin therapy for 7 days now presents with subsidence of pain and persistence of deafness, Diagnosis is:

 A

Ototoxicity

 B

Secretory otitis media

 C

Adhesive otitis media

 D

Tympanosclerosis

Ans. B

Explanation:

 

  • Inadequate antibiotic treatment of acute suppurative otitis media may inactivate infection but fail to resolve it completely.
  • Low grade infection lingers on which acts as a stimulus for the mucosa to secrete more mucus which leads to development of serous/secretory otitis media.

Q. 22

To do myringotomy in ASOM, the incision is given in posteroinferior region, this is the preferred region for all the following reasons except.

 A

It is easily accessible

 B

Damage to ossicular chain does not occur

 C

Damage to chorda tympani is avoided

 D

It is the very vascular region

Q. 22

To do myringotomy in ASOM, the incision is given in posteroinferior region, this is the preferred region for all the following reasons except.

 A

It is easily accessible

 B

Damage to ossicular chain does not occur

 C

Damage to chorda tympani is avoided

 D

It is the very vascular region

Ans. D

Explanation:

 

In SOM, myringotomy is done in antero-inferior quadrent because:

It is relatively avascular area. blood loss is less

No important structures are present here. No possibility of them being damaged.

To stimulate Eustachian tube (which also lies in antero inferior quadrant)



Q. 23

Most common complication of acute otitis media in children:

 A

Deafness

 B

Mastoiditis

 C

Cholesteatoma

 D

Facial nerve palsy

Q. 23

Most common complication of acute otitis media in children:

 A

Deafness

 B

Mastoiditis

 C

Cholesteatoma

 D

Facial nerve palsy

Ans. B

Explanation:

 

  • Most common complication following ASOM is mastoiditis.
  • Facial nerve palsy is an uncommon complication of ASOM
  • Cholesteatoma is not associated with ASOM
  • Deafness is the presenting feature of ASOM and not complication.



Q. 24

Most common extra-cranial complication of ASOM is:

 A

Facial nerve paralysis

 B

Lateral sinus thrombosis

 C

Mastoiditis

 D

Brain abscess

Q. 24

Most common extra-cranial complication of ASOM is:

 A

Facial nerve paralysis

 B

Lateral sinus thrombosis

 C

Mastoiditis

 D

Brain abscess

Ans. C

Explanation:

Q. 25

A-7 year child presenting with acute otitis media, does not respond to ampicillin. Examination reveals full and bulging tympanic membrane, the treatment of choice is: 

 A

Sytemic steroid

 B

Ciprofloxacin

 C

Myringotomy

 D

Cortical mastoidectomy

Q. 25

A-7 year child presenting with acute otitis media, does not respond to ampicillin. Examination reveals full and bulging tympanic membrane, the treatment of choice is: 

 A

Sytemic steroid

 B

Ciprofloxacin

 C

Myringotomy

 D

Cortical mastoidectomy

Ans. C

Explanation:

 

 

Indications of myringotomy in acute otitis media:

  • Drum is bulging + acute pain.
  • Incomplete resolution despite antibiotics when drum remains full with persistent conductive deafness.
  • Persistent effusion beyond 12 weeks.



Q. 26

For ASOM, myringotomy is done in which quadrant?

 A

Antero-inferio

 B

Antero-superior

 C

Postero-superior

 D

Postero-inferior

Q. 26

For ASOM, myringotomy is done in which quadrant?

 A

Antero-inferio

 B

Antero-superior

 C

Postero-superior

 D

Postero-inferior

Ans. D

Explanation:

Q. 27

Light house sign in seen in ASOM in which stage?

 A

Stage of suppuration

 B

Stage of hyperaemia

 C

Stage of resolution

 D

Stage of pre-suppuration

Q. 27

Light house sign in seen in ASOM in which stage?

 A

Stage of suppuration

 B

Stage of hyperaemia

 C

Stage of resolution

 D

Stage of pre-suppuration

Ans. A

Explanation:

 

In the stage of supperation of ASOM, pus formation occurs, hence in this stage pulsatile otorrhea or light house sign in seen.


Q. 28

For ASOM, Myringotomy is done in which quadrant:

 A

Antero-inferior

 B

Antero-superior

 C

Postero-superior

 D

Postero-inferior

Q. 28

For ASOM, Myringotomy is done in which quadrant:

 A

Antero-inferior

 B

Antero-superior

 C

Postero-superior

 D

Postero-inferior

Ans. D

Explanation:


Otits Media with Effusion

Otits Media with Effusion

Q. 1 In chronic secretory otitis media, the treatment of choice is:
 A Cortical mastoidectomy
 B Radical mastoidectomy
 C Grommet tube insertion
 D Antibiotics and antihistaminic for 6 weeks
Q. 1 In chronic secretory otitis media, the treatment of choice is:
 A Cortical mastoidectomy
 B Radical mastoidectomy
 C Grommet tube insertion
 D Antibiotics and antihistaminic for 6 weeks
Ans. C

Explanation:

Otitis media with effusion (glue ear) or non-suppurative otitis media or sero mucinous otitis media or exudative otitis media is a very common condition in children and majority of children experience at least one episode in their life. Primary cause is poor Eustachian tube function in children. As the O2 is continuously absorbed by the middle ear mucosa it results in negative middle ear pressure unless the Eustachian tube opens to replenish the ear. Negative pressure leads to transudation of fluid into the middle ear and if the hypoxia continues a mucoid exudate is produced by the glands of middle ear mucosa (glue ear). Majority of children need no treatment. but, if required, surgery is the only effective way of curing glue ear and both ventilation tube (grommet) and adenoidectomy are effective. Myringotomy should be followed by grommet insertion to maintain the aeration of middle ear. It should be left in situ for weeks or months or until it is spontaneously extruded.


Q. 2

Weber Fechner Law is:

 A

Magnitude of stimulus strength perceived is approximately proportionate to the log of the intensity of stimulus strength

 B

Magnitude of stimulus strength perceived is directly proportional to the intensity of stimulus strength

 C

Threshold of receptor is directly proportional to stimulus strength

 D

Threshold of receptor is inversely proportional to stimulus strength

Q. 2

Weber Fechner Law is:

 A

Magnitude of stimulus strength perceived is approximately proportionate to the log of the intensity of stimulus strength

 B

Magnitude of stimulus strength perceived is directly proportional to the intensity of stimulus strength

 C

Threshold of receptor is directly proportional to stimulus strength

 D

Threshold of receptor is inversely proportional to stimulus strength

Ans. A

Explanation:

Magnitude of stimulus strength perceived is approximately proportionate to the log of the intensity of stimulus strength [Ref: Guyton 11/e p594; Ganong 22/e 126]

Weber – Fechner law

  • It states that the magnitude of the sensation felt in proportionate to the log of intensity of the stimulus.
  • Example – A person holding 30 grams weight in his hand can barely detect a I gm rise in weight (a rise than 1 gm would not be detectable). But when he holds 300 gm of weight. he can rarely detect a 10 gm increase in weight (a rise less than 10 gm would not be detectable to him. So a 300 gm wt. and (Say) 307 gm of weights would appear same to him.)
  • This is expressed mathematically as

Interpreted signal strength = Log x stimulus intensity + constant

 

 


Q. 3

Treatment of choice for glue ear is

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Q. 3

Treatment of choice for glue ear is

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Ans. C

Explanation:

 

(also k/a Serous otitis media, secretory otitis media, Mucoid otitis media)

  • OME is characterized by a non-purulent effusion of the middle ear that may be either mucoid or serous.
  • Symptoms usually involve hearing loss or aural fullness but typically do not involve pain or fever. In children hearing loss is generally mild and is often detected only with an audiogram.
  • The fluid is nearly sterile.
  • The condition is commonly seen in school-going children. It is the leading cause of hearing loss in children. Pathogenesis
  • Two main mechanisms are thought to be responsible.
  1. Eustachian tube dysfunction
  2. Increased secretory activity of middle ear mucosa

Treatment

  • Treatment may be medical or surgical
  • Medical measures are controversial and involve
  1. Decongestants
  2. Antiallergic measures
  3. Antibiotics
  4. Middle ear aeration

– Valsalva manoeuvre

– politzerisation or eustachian tube catheterization

– chewing gum

  • Surgical

1.Myringotomy and aspiration of fluid

2. Grommet or ventilation tube insertion

3. Surgical t/t of causative factor – adenoidectomy, tonsillectomy, and/or wash out of maxillary antra.


Q. 4

Treatment of choice for glue ear is:

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics and antibiotics

Q. 4

Treatment of choice for glue ear is:

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics and antibiotics

Ans. C

Explanation:

Q. 5

Glue ear:

 A

Is painful

 B

Is painless

 C

Radical mastoidectomy is required

 D

NaF is useful

Q. 5

Glue ear:

 A

Is painful

 B

Is painless

 C

Radical mastoidectomy is required

 D

NaF is useful

Ans. B

Explanation:

Ans:B.)Is painless.

OTITIS MEDIA WITH EFFUSION

  • SynonymsSerous Otitis Media / Secretory Otitis Media / Mucoid Otitis Media/ Glue Ear/Non-Suppurative Otitis Media/Silent Otits Media.
  • Non purulent sterile effusion accumulates in the middle ear cavity.
  • Painless condition
  • MCC of conductive deafness in school-going children

ETIOLOGY OF OTITS MEDIA WITH EFFUSION

  • Malfunctioning of Eustachian tube (adenoid hyperplasia, chronic rhinitis, sinusitis & tonsillitis, tumors of nasopharynx, cleft palate)
    • Cause of U/L secretory otitis media in an adult is Nasopharyngeal Carcinoma.
    • Patients with Wegener’s Granulomatosis may present with Secretory Otitis Media
      • Characteristic triad of Wegener’s granutomatosis is vasculitis of the upper respiratory tract (serious otitis media and epistaxis), vasculitis of the lower respiratory tract (hemoptysis) and vasculitis of the kidney (proteinuria).
  • Allergy
  • Unresolved otitis media
  • Viral infection – adeno and rhinoviruses.

CLINCAL FEATURES OF OTITS MEDIA WITH EFFUSION

Symptoms:

  • Hearing loss (<40DB)
  • Delayed and defective speech
  • Mild ear ache.

Otoscopy :

  • Dull and opaque tympanic membrane.
  • Intact tympanic membrane.Colour may be Yellow/Grey/Blue.
  • Loss of light reflex
  • Thin leash of blood vessels seen along the handle of malleus (less marked than ASOM)
  • Retracted TM
  • Bulging of the posterior part of TM
  • Fluid level and air bubbles seen
  • Mobility restricted

Tuning fork tests :Conductive deafness of 20-40 dB
Impedance Audiometry:confirmatory test for Secretory Otits Media,Shows Type -B curve.
X-ray Mastoid: Clouding of air cells.

MANAGEMENT OF OTITS MEDIA WITH EFFUSION
Medical Treatment:

  • Decongestant , Anti allergic, Antibiotics , Middle ear aeration (Valsalva maneuver)
  • Watchful waiting  is recommended without immediate use of antibiotics for children with uncomplicated otitis media with effusion.
Surgical Treatment:
  • 1. Myringotomy and fluid aspiration: 2 incisions one in the antero inferior and other antero superior quadrant of the TM to aspirate thick glue like secretions.(Beer can principle)
  • 2. Grommet insertion: left in place till spontaneously extruded
    • In chronic secretory otitis media(also known as Glue ear), the treatment of choice is Myringotomy with ventilation tube insertion
  • 3. Tympanotomy (or) cortical mastoidectomy-very limted role
  • 4. Surgical t/t of causative factor – adenoidectomy, tonsillectomy, and/or wash out of maxillary antra.
    • Treatment of choice in a patient presenting with mouth breathing, recurrent serous otitis media and adenoid facies is Adenoidectomy.

SEQUELAE OF SOM

  • Atrophic tympanic membrane and atelectasis of middle ear
  • Ossicular necrosis
  • Tympanosclerosis
  • Retraction pockets and cholesteatoma
  • Cholesterol granuloma

Q. 6

A mother brought her child with glue ear. Child had otitis media two weeks before. What is the treatment of choice for glue ear?

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Q. 6

A mother brought her child with glue ear. Child had otitis media two weeks before. What is the treatment of choice for glue ear?

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Ans. C

Explanation:

Otitis media with effusion (OME or glue ear) is defined as fluid in the middle ear space without clinical signs of inflammation or acute symptoms of illness. Otitis media with effusion usually follows an episode of acute otitis media. 

The guideline recommendation for the management of OME is that ventilating tubes should be placed after an effusion has persisted for 4 months and is accompanied by a bilateral hearing impairment of 20 dB or greater.
 

Q. 7

Glue ear is also known as:

 A

Acute suppurative otitis media

 B

Chronic suppurative otitis media

 C

Chronic secretory otitis media

 D

None of the above

Q. 7

Glue ear is also known as:

 A

Acute suppurative otitis media

 B

Chronic suppurative otitis media

 C

Chronic secretory otitis media

 D

None of the above

Ans. C

Explanation:

Q. 8

What is the treatment of choice for glue ear?

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Q. 8

What is the treatment of choice for glue ear?

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Ans. C

Explanation:

 
 

Q. 9

During follow up of a case of acute otitis media, a 6 year old child found to have glue ear with no symptoms. Next step of management is:

 A

Wait and watch

 B

Antibiotics

 C

Corticosteroids

 D

Antihistamines

Q. 9

During follow up of a case of acute otitis media, a 6 year old child found to have glue ear with no symptoms. Next step of management is:

 A

Wait and watch

 B

Antibiotics

 C

Corticosteroids

 D

Antihistamines

Ans. A

Explanation:

Close to 90% of episodes of otitis media with effusion (glue ear) resolve spontaneously after an acute otitis media episode is diagnosed. 
 
The American Academy of Pediatrics 2004 consensus guideline recommends watchful waiting without immediate use of antibiotics for children with uncomplicated otitis media with effusion.


Q. 10

A 18-month-old boy is brought by parents to his family physician with a 2-day history of fever, irritability, and frequent tugging of his left ear. The physician diagnoses acute otitis media and treated with antibiotics. In follow-up 2 months later, otoscopic examination, air-fluid levels are seen in the left ear. Medical management is failed to resolve the effusion. Treatment of choice in this child is:

 A

Conservative

 B

Tympanoplasty

 C

Myringotomy with ventilation tube insertion

 D

Myringotomy with diode laser

Q. 10

A 18-month-old boy is brought by parents to his family physician with a 2-day history of fever, irritability, and frequent tugging of his left ear. The physician diagnoses acute otitis media and treated with antibiotics. In follow-up 2 months later, otoscopic examination, air-fluid levels are seen in the left ear. Medical management is failed to resolve the effusion. Treatment of choice in this child is:

 A

Conservative

 B

Tympanoplasty

 C

Myringotomy with ventilation tube insertion

 D

Myringotomy with diode laser

Ans. C

Explanation:

Surgical measures of serous otitis media:
  • Myringotomy and aspiration of fluids
  • Grommet insertion
  • Tympanotomy or cortical mastoidectomy
  • Surgical treatment of causative factor
 

Q. 11

Commonest cause of hearing loss in children is:

 A

CSOM

 B

ASOM

 C

Acoustic – neuroma

 D

Chronic secretory otitis media

Q. 11

Commonest cause of hearing loss in children is:

 A

CSOM

 B

ASOM

 C

Acoustic – neuroma

 D

Chronic secretory otitis media

Ans. D

Explanation:

Q. 12

Cause of U/L secretory otitis media in an adult is:

 A

CSOM

 B

Nasopharyngeal carcinoma

 C

Mastoiditis

 D

Foreign body of external ear

Q. 12

Cause of U/L secretory otitis media in an adult is:

 A

CSOM

 B

Nasopharyngeal carcinoma

 C

Mastoiditis

 D

Foreign body of external ear

Ans. B

Explanation:

 


 


Q. 13

Acute non suppurative otitis media in adults is due to:

 A

Allergic rhinitis

 B

URTI

 C

Trauma

 D

Malignancy

Q. 13

Acute non suppurative otitis media in adults is due to:

 A

Allergic rhinitis

 B

URTI

 C

Trauma

 D

Malignancy

Ans. D

Explanation:

Q. 14

Glue ear:

 A

Is painful

 B

Is painless

 C

Radical mastoidectomy is required

 D

NaF is useful

Q. 14

Glue ear:

 A

Is painful

 B

Is painless

 C

Radical mastoidectomy is required

 D

NaF is useful

Ans. B

Explanation:

 

Glue Ear/serous Otitis Media is a painless condition


Q. 15

Secretory otitis media is diagnosed by:

 A

Impedance audiometry

 B

Pure tone audiometry

 C

X-ray

 D

a and c

Q. 15

Secretory otitis media is diagnosed by:

 A

Impedance audiometry

 B

Pure tone audiometry

 C

X-ray

 D

a and c

Ans. A

Explanation:

 

Pure tone audiometry gives information about the quantity and quality of hearing loss.

In secretory otitis media: conductive deafness of 20-40 dB is seen (which is not a specific finding as conductive deafness can be seen in many other conditions). Therefore, pure tone audiometry is not diagnostic of serous otitis media but provides an assessment of the hearing loss and is therefore important in monitoring the progress of the condition and provides information useful for management decisions

On otoscopy: Tympanic membrane appears dull, opaque with loss of light reflex

X-ray mastoid: Shows clouding of air cells. (not diagnostic)

Impedance audiometry is an accurate way of diagnosing serous otitis media. It shows type B tympanogram which is diagnostic of fluid in ear.


Q. 16

Bluish tympanic membrane is seen in:

 A

Early ASOM

 B

Glue ear

 C

Cholesteatoma

 D

Cholesterol granuloma

Q. 16

Bluish tympanic membrane is seen in:

 A

Early ASOM

 B

Glue ear

 C

Cholesteatoma

 D

Cholesterol granuloma

Ans. B

Explanation:

 

In glue ear (serous otitis media) Tympanic membrane is dull opaque with loss of light reflex and appears yellow / grey / blue in colour.

  • Normal colour of tympanic membrane is pearly grey.
  • Congested membrane with prominent blood vessels (cartwheel sign) is seen in early stages of acute otitis media.
  • Bluish discoloration is seen in haemotympanum.
  • Flamingo pink color is seen in otosclerosis.



Q. 17

Treatment of choice for glue ear is:

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics and antibiotics

Q. 17

Treatment of choice for glue ear is:

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics and antibiotics

Ans. C

Explanation:

 

Treatment of choice for glue ear is insertion of grommet (i.e., ventilation tube insertion).

Tympanotomy / cortical mastoidectomy has a very limited role. and is not done nowadays for serious otitis media.


Q. 18

Following statements are true about otitis media with effusion in a child:

 A

Immediate myringotomy is done

 B

Type B tympanogram

 C

The effusion of middle ear is sterile

 D

b and c

Q. 18

Following statements are true about otitis media with effusion in a child:

 A

Immediate myringotomy is done

 B

Type B tympanogram

 C

The effusion of middle ear is sterile

 D

b and c

Ans. D

Explanation:

 



Q. 19

In serous otitis media, which one of the following state­ments is true?

 A

Sensorineural deafness occurs as a complication in 80% of the cases

 B

Intracranial spread of the infection complicates the clini­cal courses

 C

Tympanostomy tubes are usually required for treatment

 D

Gram-positive organisms are grown routinely in culture in the aspirate

Q. 19

In serous otitis media, which one of the following state­ments is true?

 A

Sensorineural deafness occurs as a complication in 80% of the cases

 B

Intracranial spread of the infection complicates the clini­cal courses

 C

Tympanostomy tubes are usually required for treatment

 D

Gram-positive organisms are grown routinely in culture in the aspirate

Ans. C

Explanation:

 

 


Q. 20

Procedure for serous otitis media is:

 A

Tympanoplasty

 B

Mastoidectomy

 C

Myringotomy

 D

Medical treatment

Q. 20

Procedure for serous otitis media is:

 A

Tympanoplasty

 B

Mastoidectomy

 C

Myringotomy

 D

Medical treatment

Ans. C

Explanation:

 

In Children

TOC of serous otitis media – myringotomy + insertion of grommet (ventilation tube) along with adenoidectomy (if features of adenoid hyperplasia are present) or tonsillectomy

In Adults (Scotts Brown 7th ed )

In case of serous otitis media without nasopharyngeal carcinoma.

Myringotomy with ventilation tube insertion is done (In adults ventilation tube improves hearing for a very short term < 1 yr) 

Then there are two treatment options: (i) Hearing aid (ii) Myringotomy without ventilation tube insertion

Recently, CO, laser assisted tympanic membrane ventilation has been advocated for the treatment of adult OME.



Q. 21

Otitis media with effusion is also known as:

 A

Serous otitis media

 B

Suppurative otitis media

 C

Mucoid otitis media

 D

a and c

Q. 21

Otitis media with effusion is also known as:

 A

Serous otitis media

 B

Suppurative otitis media

 C

Mucoid otitis media

 D

a and c

Ans. D

Explanation:

Q. 22

A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and . hematuria and epistaxis for one and half months her. Hemoglobin is 7 gm. B.P. > 170/100, ptoreinuria +++, RA positive (+ve) and ANCA positive (+ve), the likely cause is-

 A

Wegener’s granulo matosis

 B

Rheumiatoid arthritis

 C

Rapidly proliferative glomerulonephritis

 D

Good pasteur’s syndrome

Q. 22

A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and . hematuria and epistaxis for one and half months her. Hemoglobin is 7 gm. B.P. > 170/100, ptoreinuria +++, RA positive (+ve) and ANCA positive (+ve), the likely cause is-

 A

Wegener’s granulo matosis

 B

Rheumiatoid arthritis

 C

Rapidly proliferative glomerulonephritis

 D

Good pasteur’s syndrome

Ans. A

Explanation:

Answer is A (Wegener’s granulomatosis):

The patient in question is presenting with the charachteristic triad of Wegener’s granutomatosis namely, vasculitis of the upper respiratory tract (serious otitis media and epistaxis), vasculitis of the lower respiratory tract (hemoptysis) and vasculitis of the kidney (proteinuria)

Presence of ANCA and Rheumatoid factor further support the diagnosis of Wegener’s granulomatosis which is the single best answer of choice.


Q. 23

A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and hematuria and epistaxis for one and half months her hemoglobin is 7 gm. B.P is > 170/100, proteinuria +++, RA – ve and ANCA – ve, the likely cause is‑

 A

Wegener’s granulomatosis

 B

Rheumiatoid arthritis

 C

Rapidly proliferative glomerulonephritis

 D

Goodpasteur’s syndrome

Q. 23

A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and hematuria and epistaxis for one and half months her hemoglobin is 7 gm. B.P is > 170/100, proteinuria +++, RA – ve and ANCA – ve, the likely cause is‑

 A

Wegener’s granulomatosis

 B

Rheumiatoid arthritis

 C

Rapidly proliferative glomerulonephritis

 D

Goodpasteur’s syndrome

Ans. A

Explanation:

Answer is A>D (Wegener’s granulumatosis > Goodpasture’s Syndrome);

The patient in question is presenting with characteristic clinical triad of Wegener’s granulomatosis, namely, Vasculitis of upper respiratory tract (serous otitis media, epistaxis), Vasculitis of lower respiratory tract (cough and hemoptysis) and vasculitis of the kidney (proteinuria)

Although positive ANCA assays are often instrumental in suggesting the diagnosis of WG, Negative ANCA assays do not preclude the diagnosis, 10% of patients with disseminated WG and upto 30% of patients with limited WG may be negative for ANCA

The clinical picture is classical of Wegner’s Granulomatosis. However, the absence of ANCA confuses the diagnosis. Nevertheless the presence or absence of ANCA should be adjunctive and in the presence of a classical clinical picture of WG, tissue diagnosis (biopsy) should be performed to confirm the diagnosis.

Definitive diagnosis of WG is established by tissue biopsy and not by presence or absence of ANCA

Pulmonary + Renal Syndrome
Pulmonary (Hemoptysis) + Renal (Proteinuria) manifestations

Wegener’s granulomatosis

Classical Clinical presentation is one of a young Male/Female (male: female=1:1) presenting with upper respiratory tract features (Otitis media, Epistaxis) along with hemoptysis and acute glomerulonephritis+

ANCA is usually positive and suggests the diagnosis

Negative ANCA does not preclude the diagnosis. In the presence of classical clinical picture a provisional diagnosis of WG should be made on clinical ground and confirmed/ excluded by tissue biopsy

The patient in question is presenting with classical clinical triad of Wegener’s granulomatosis. Although ANCA is negative a negative ANCA does not preclude the diagnosis of WG. Based on the strong clinical suspicion, WG should the single best initial provisional diagnosis and tissue biopsy should be performed.

Goodpasture’s syndrome

 

Classical clinical presentation is one of a young male smoker (male female=3-4:1) presenting with hemoptysis and signs of acute glomerulonephritis

 

Although disease may be preceeded by an upper respiratory tract infection, upper respiratory tract involvement features like otitis media and epistaxis are not characterstic of good pasture’s syndrome

 

ANCA is usually negative

 

Diagnosis is made by detecting serum levels of Anti GBM antibodies

 

The patient in question is not presenting with classical clinical features of good pasture’s syndrome and serum levels of Anti GBM antibodies have not been provided in the question. These make a diagnosis of Good pasture’s syndrome less likely.




Q. 24

Conducting hearing loss with intact tympanic membrane ‑

 A

Presbycausis

 B

Meniere’s disease

 C

Glue ear

 D

Acoustic neuroma

Q. 24

Conducting hearing loss with intact tympanic membrane ‑

 A

Presbycausis

 B

Meniere’s disease

 C

Glue ear

 D

Acoustic neuroma

Ans. C

Explanation:

Ans. is ‘c’ i.e., Glue ear

Among the given options, only glue ear (serous otitis media) is a cause of conductive deafness.


Q. 25

Following is the preferred treatment of Serous Otitis Media –

 A

Grommet surgery

 B

Oral Amoxicillin for 5 – 10 days

 C

Modified radical mastoidectomy

 D

Bed rest, antipyretics and adequate fluid intake

Q. 25

Following is the preferred treatment of Serous Otitis Media –

 A

Grommet surgery

 B

Oral Amoxicillin for 5 – 10 days

 C

Modified radical mastoidectomy

 D

Bed rest, antipyretics and adequate fluid intake

Ans. A

Explanation:

Ans. is ‘a’ i.e., Grommet surgery

Treatment of otitis media

Following two treatments have been described : ‑

1) Watchful waiting

  • Watchful waiting is the active monitoring of the condition and hearing in anticipation of spontaneous resolution. Guidlines aimed at both primary care and specialist otolaryngologist broadly agree that a watch­ful waiting period for about three months is the initial management of children with serous otitis media. Therefore, unless there are also signs of an infection, most health care providers will not treat SOM at first Instead, they will recheck the problem in 2-3 months. This should be coupled with reassurance that doing nothing is as likely as doing something to result in resolution of the SOM and the associated symptoms.

2) Surgery

  • Surgical intervention is recommended when watchful waiting and monitoring of hearing has confirmed failure of resolution of SOM. Following surgical intervention are used commonly : –
  1. Myringotomy and aspiration offluid : -An incision is made in tympanic membrane and fluid aspirated with suction.
  2. Grommet (ventilation tube) surgery : – If myringotomy and aspiration combined with medical measures has not helped and fluid recurs, a grommet is inserted to provide continued aeration of middle ear. This is the most common surgical intervention for SOM. Most prefered site of grommet insertion is antero-inferior through circumferential or radial incision.
  3. Surgical treatment of causative factor : – Adenoidectomy, tonsillectomy etc.

Medical measures are controversial and involve : ‑

  1. Decongestants
  2. Antiallergic measures
  3. Antibiotics
  4. Middle ear aeration :- Valsalva maneuver, Politzerisation or eustachian tube catheterization, Chewing gum.

Q. 26

Patient presents with mouth breathing, recurrent serous otitis media and adenoid facies. What is the best line of management ?

 A

Adenoidectomy

 B

Tonsillectomy

 C

Antibiotics

 D

Supportive therapy

Q. 26

Patient presents with mouth breathing, recurrent serous otitis media and adenoid facies. What is the best line of management ?

 A

Adenoidectomy

 B

Tonsillectomy

 C

Antibiotics

 D

Supportive therapy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Adenoidectomy

The triad of nasal and aural symptoms with adenoid facies points to the diagnosis of enlarged adenoids.

For the treatment of enlarged adenoids when symptoms are not marked breathing excercise, decongenstant nasal drops and antihistaminics are used and when symptoms are marked, adenoidectomy is done.

We have a patient with marked and recurrent symptoms thus adenoidectomy is the treatment of choice.


Q. 27

All are true about serous otitis media except 

 A

Also called glue ear

 B

Affect school going children

 C

Type C tympanogram

 D

Fluid in middle ear

Q. 27

All are true about serous otitis media except 

 A

Also called glue ear

 B

Affect school going children

 C

Type C tympanogram

 D

Fluid in middle ear

Ans. C

Explanation:

 

Serous otitis media

  • Serous otitis media (SOM) has many synonyms : Serous otitis media, otitis media with effusion, glue ear, non-suppurative otitis media, mucoid otitis media, silent otitis media. SOM is an insidious condition in which there is thick or sticky non-purulent fluid behind the eardrum in the middle ear, but there is no ear infection, i.e., effusion of middle ear without infection. Fluid in the middle ear is sterile. SOM occurs most commonly in school going children and SOM is the commonest cause of childhood hearing loss.

Etiopathogenesis

1) Eustachian tube dysfunction

  • Eustachian tube dysfunction, coupled with recurrent upper respiratory tract infection is the most important factor in the development of SOM. Normally eustachian tube helps to drain fluids to prevent them from building up in the ear. In Eustachian tube dysfunction, it is unable to drain the fluid. Following can cause Eustachian tube block :-
  1. Respiratory tract infection :- Adenoid, rhinitis, tonsillitis, sinusitis.
  2. Allergies
  3. Benign and malignant tumor of nasophar-ynx.

2) Unresolved otitis media

  • Inadequate antibiotic therapy in acute suppurative otitis media may inactivate infection but fails to resolve it completely. Low grade infection lingers on and acts as stimulus for mucosa to secrete more fluid.

Clinical features

  • Unlike children with an ear infection (ASOM), children with SOM do not act sick. o The only presenting symptom may be hearing loss with fullness in ear.

Otoscopic finding of SOM

  • Air bubbles on the surface of ear drum
  • Fluid behind the eardrum.
  • Dullness of the eardrum when a light is used, with loss of light reflex. o Eardrum may appear yellow, grey or bluish in colour.
  • Retracted eardrum with decreased mobility
  • Tympanometry shows type B tympanogram.


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