Category: Quiz

Atrophic rhinitis / Ozaena

Atrophic rhinitis / Ozaena

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

Vidian Neurectomy is indicated in –

 A

Glossopharyngeal neuralgia

 B

Trigeminal neuralgia

 C

Vasomotor rhinitis

 D

Atrophic rhinitis

Q. 2

Vidian Neurectomy is indicated in –

 A

Glossopharyngeal neuralgia

 B

Trigeminal neuralgia

 C

Vasomotor rhinitis

 D

Atrophic rhinitis

Ans. C

Explanation:

Q. 3

Atrophic dry nasal mucosa, extensive encrustations with woody’ hard external nose is suggestive of

 A

Rhinosporidiosis

 B

Rhinoscleroma

 C

Atrophic rhinitis

 D

Carcinoma of nose

Q. 3

Atrophic dry nasal mucosa, extensive encrustations with woody’ hard external nose is suggestive of

 A

Rhinosporidiosis

 B

Rhinoscleroma

 C

Atrophic rhinitis

 D

Carcinoma of nose

Ans. B

Explanation:

Q. 4

All are implicated in etiology of atrophic rhinitis except:

 A

Chronic sinusitis

 B

Nasal deformity

 C

DNS

 D

Strong hereditary factors

Q. 4

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. 5

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. 5

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. 6

Mulberry appearance of nasal mucosal membrane is seen in:

 A

Coryza

 B

Atrophic rhinitis

 C

Maxillary sinusitis

 D

Chronic hypertrophic rhinitis

Q. 6

Mulberry appearance of nasal mucosal membrane is seen in:

 A

Coryza

 B

Atrophic rhinitis

 C

Maxillary sinusitis

 D

Chronic hypertrophic rhinitis

Ans. D

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

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

 A

Klebsiella ozaena

 B

Klebsiella pneumonia

 C

Streptococcus pneumonia

 D

Streptococcus foetidis

Q. 8

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. 9

Youngs surgery is done for the treatment of ‑

 A

Atrophic rhinitis

 B

Rhinoscleroma

 C

Deviated nasal septum

 D

Choanal atresia

Q. 9

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


Q. 10

Cottle test is positive in case of ‑

 A

Deviated Nasal septum

 B

Rhinosporidiosis

 C

Hypertrophied inferior nasal turbinate

 D

Atrophic rhinitis

Q. 10

Cottle test is positive in case of ‑

 A

Deviated Nasal septum

 B

Rhinosporidiosis

 C

Hypertrophied inferior nasal turbinate

 D

Atrophic rhinitis

Ans. A

Explanation:

 

Cottle test : It is used to test nasal obstruction due to abnormality of nasal valve as in case of deviated nasal septum.

In this test, cheek is drawn laterally while the patient breathes quietly. If the nasal airway improves on the test side, the test is positive, and indicates abnormality of the vestibular component of nasal valve.



Septoplasty

Septoplasty

Q. 1

Which of the following surgical procedure can be used as an alternative for SMR (Submucosal Resection)?

 A

Tympanoplasty

 B

Septoplasty

 C

Caldwell Luc operation

 D

Tuboplasty

Q. 1

Which of the following surgical procedure can be used as an alternative for SMR (Submucosal Resection)?

 A

Tympanoplasty

 B

Septoplasty

 C

Caldwell Luc operation

 D

Tuboplasty

Ans. B

Explanation:

In submucosal resection there is removal of the entire septum except for a 1cm wide dorsal and caudal stuart that remains for nasal support.
An alternative to this procedure is septoplasty in which  the surgeon resects only the deviated portion of the nasal septum allowing maximal preservation of this structure.
 
Clinical indications of septoplasty:
  • Deviation of the nasal septum with partial or complete unilateral or bilateral obstruction of airflow
  • Persistent or recurrent epistaxis
  • Evidence of sinusitis secondary to septal deviation
  • Headaches secondary to septal deviation and contact points
  • Anatomic obstruction that makes indicated sinus procedure difficult to perform efficiently
  • Obstructive sleep apnea
  • As an approach to transseptal transsphenoidal approach to pituitary fossa

Q. 2

All of the following true of septoplasty operation for DNS except:

 A

Indicated in septal deviation

 B

Mucoperichondrium is removed

 C

Preferably done after 16 years of age

 D

Done in some cases of epistaxis

Q. 2

All of the following true of septoplasty operation for DNS except:

 A

Indicated in septal deviation

 B

Mucoperichondrium is removed

 C

Preferably done after 16 years of age

 D

Done in some cases of epistaxis

Ans. B

Explanation:

Q. 3

Which is not done in septoplasty:

 A

Elective hypotension

 B

Throat pack

 C

Nasal preparation with 10% cocaine

 D

None

Q. 3

Which is not done in septoplasty:

 A

Elective hypotension

 B

Throat pack

 C

Nasal preparation with 10% cocaine

 D

None

Ans. D

Explanation:

 

Management of Deviated Septum

Minor degrees of septal deviation not causing any symptoms do not require any treatment.

If the patient is more than 17 years of age then the patient is taken up for septal surgery. Any surgery on the septum or on the anterior 1/3rd of nose and adjacent area (e.g. septoplasty, rhinoplasty and Cald Well Luc) is not done before 17 years of age as it interferes with growth of nasal skeleton.

The two types of surgery on septum are:

Sub-mucous resection of septum (SMR): It is done under local anaesthesia with 2% xylocaine and adrenaline. The incision is given 5 mm above the caudal border of the septal cartilage (Killian’s incision).

Mucoperichondrial and mucoperiosteal flaps are raised on both sides of the septum, so that the septum is now free on both sides. Leaving a thin (1 cm) dorsal and a caudal strip, the rest of the septum is removed.

Complication: This can lead to loss of support of dorsum and saddling of nose, perforation of the septum.




Otosclerosis / Otospongiosis

Otosclerosis / Otospongiosis

Q. 1 Otosclerosis typically begins at:
 A Scutum
 B Round window
 C Tympanic membrane
 D Fossa antefenestrum
Q. 1 Otosclerosis typically begins at:
 A Scutum
 B Round window
 C Tympanic membrane
 D Fossa antefenestrum
Ans. D

Explanation:

Fossa antefenestrum


Q. 2

The part most commonly involved in Otosclerosis is:

 A

Oval window

 B

Round window

 C

Tympanic membrane

 D

Malleus

Q. 2

The part most commonly involved in Otosclerosis is:

 A

Oval window

 B

Round window

 C

Tympanic membrane

 D

Malleus

Ans. A

Explanation:

Oval window


Q. 3

In Otosclerosis, the Tympanogram is:

 A

Normal

 B

Type AS

 C

Type B

 D

Type A

Q. 3

In Otosclerosis, the Tympanogram is:

 A

Normal

 B

Type AS

 C

Type B

 D

Type A

Ans. B

Explanation:

Type AS


Q. 4

All of the following statements about the medical management in otosclerosis using sodium flouride are true, EXCEPT:

 A

Acts by inhibiting proteolytic enzymes in cochlea

 B

Acts by inhibiting osteoblastic activity

 C

Is contraindicated in chronic nephritis

 D

Is indicated in patients with a positive Schwartze sign

Q. 4

All of the following statements about the medical management in otosclerosis using sodium flouride are true, EXCEPT:

 A

Acts by inhibiting proteolytic enzymes in cochlea

 B

Acts by inhibiting osteoblastic activity

 C

Is contraindicated in chronic nephritis

 D

Is indicated in patients with a positive Schwartze sign

Ans. B

Explanation:

Sodium fluoride in osteosclerosis increases osteoblastic bone formation and does not inhibit. All the other options are true.
 
There are numerous marrow and vascular spaces with plenty of osteoblasts and osteoclasts in immature active lesions.
Taking oral sodium fluoride can stabilize the hearing loss associated with otosclerosis in about 80% of patients.
This reduces bone absorption and enhances the calcification of new bone, essentially stopping further progression of otosclerotic damage.

Sodium fluoride can also reduce tinnitus and any symptoms of imbalance.

Q. 5

High frequency audiometry uses frequency higher than the frequency region required to understand speech. It is used to monitor which of the following?

 A

Otosclerosis

 B

Ototoxicity

 C

Otospongiosis

 D

Meniere’s disease

Q. 5

High frequency audiometry uses frequency higher than the frequency region required to understand speech. It is used to monitor which of the following?

 A

Otosclerosis

 B

Ototoxicity

 C

Otospongiosis

 D

Meniere’s disease

Ans. B

Explanation:

High-frequency audiometry is specifically for ototoxicity monitoring, comprises air conduction thresholds from 10,000 to 20,000 Hz.

 Most ototoxic hearing losses will first occur in that frequency region, which is higher than the speech range. 


Q. 6

Otosclerosis shows which type of tympanogram?

 A

Type A

 B

Type B

 C

Type C

 D

Type D

Q. 6

Otosclerosis shows which type of tympanogram?

 A

Type A

 B

Type B

 C

Type C

 D

Type D

Ans. A

Explanation:

Type A tympanograms have normal peak height and pressure.

Two variations of the Type A tympanogram also are normal in pressure, but may be shallow (AS), reflecting otosclerosis or middle ear effusion, or peaked very high (AD), reflecting ossicular discontinuity or a monomeric eardrum


Q. 7

Which of the following part of the ear is most commonly involved in otosclerosis?

 A

Oval window

 B

Round window

 C

Tympanic membrane

 D

Malleus

Q. 7

Which of the following part of the ear is most commonly involved in otosclerosis?

 A

Oval window

 B

Round window

 C

Tympanic membrane

 D

Malleus

Ans. A

Explanation:

While otosclerosis may potentially involve any part of the bony labyrinth, it carries a distinct predilection for the region near the anterior border of the oval window (fissula ante fenestram). 

Q. 8

Otosclerosis mostly affects:

 A

Malleus

 B

Stapes

 C

Incus

 D

Tympanic membrane

Q. 8

Otosclerosis mostly affects:

 A

Malleus

 B

Stapes

 C

Incus

 D

Tympanic membrane

Ans. B

Explanation:

  • Otosclerosis is caused by immobility of the stapes.
  • Its most distinctive feature is conductive hearing loss, but sensorineural hearing loss and vertigo are also common; 
  • tinnitus is infrequent.
  • Otosclerosis is suggested by a positive family history, 
  • a tendency toward onset at an earlier age, 
  • the presence of conductive hearing loss, or
  •  bilateral symmetric auditory impairment
  • Treatment with a combination of sodium fluoride, calcium gluconate, and vitamin D may be effective. If not, surgical stapedectomy should be considered.
 

Q. 9

Conductive hearing loss is seen in all of the following except:

 A

Otosclerosis

 B

Otitis media with effusion

 C

Endolymphatic hydrops 

 D

Suppurative otitis media

Q. 9

Conductive hearing loss is seen in all of the following except:

 A

Otosclerosis

 B

Otitis media with effusion

 C

Endolymphatic hydrops 

 D

Suppurative otitis media

Ans. C

Explanation:

 

Endolymphatic hydrops i.e menieres disease leads to SNHL and not conductive hearing loss.



Q. 10

True about otosclerosis:

 A

50% have family history

 B

Males are affected twice than female

 C

More common in Negro’s and African’s

 D

All

Q. 10

True about otosclerosis:

 A

50% have family history

 B

Males are affected twice than female

 C

More common in Negro’s and African’s

 D

All

Ans. A

Explanation:

Q. 11

Common age for otosclerosis is:

 A

5-10 years

 B

10-20 years

 C

20-30 years

 D

30-45 years

Q. 11

Common age for otosclerosis is:

 A

5-10 years

 B

10-20 years

 C

20-30 years

 D

30-45 years

Ans. C

Explanation:

 

  • 50% of patients of otosclerosis have positive family history.
  • Females are more commonly affected than males. 
  • Whites are affected more than negroes.
  • Age = most common between 20-30 years and is rare before 10 and after 40 years.
  • Deafness is increased by pregnancy, menopause, trauma and major operations.
  • Viruses like measles virus have also been associated with it.



Q. 12

The part most commonly involved in Otosclerosis is: 

 A

Oval window

 B

Round window

 C

Tympanic membranes

 D

Malleus

Q. 12

The part most commonly involved in Otosclerosis is: 

 A

Oval window

 B

Round window

 C

Tympanic membranes

 D

Malleus

Ans. A

Explanation:

Ans. is a i.e. Oval window


Q. 13

Most common site for the initiation of otosclerosis is: 

 A

Footplate of stapes     

 B

Margins of stapes

 C

Fissula ante fenestram 

 D

Fissula post fenestram

Q. 13

Most common site for the initiation of otosclerosis is: 

 A

Footplate of stapes     

 B

Margins of stapes

 C

Fissula ante fenestram 

 D

Fissula post fenestram

Ans. C

Explanation:

Q. 14

Otosclerosis tinnitus is due to:

 A

Cochlear otosclerosis

 B

Increased vascularity in lesion

 C

Conductive deafness

 D

All of the above

Q. 14

Otosclerosis tinnitus is due to:

 A

Cochlear otosclerosis

 B

Increased vascularity in lesion

 C

Conductive deafness

 D

All of the above

Ans. A

Explanation:

Q. 15

In majority of the cases with otosclerosis the tympanic membrane is:

 A

Normal

 B

Flamingo-pink

 C

Blue

 D

Yellow

Q. 15

In majority of the cases with otosclerosis the tympanic membrane is:

 A

Normal

 B

Flamingo-pink

 C

Blue

 D

Yellow

Ans. A

Explanation:

Ans. is a i.e. Normal


Q. 16

Gene’s test is for:

 A

Otosclerosis

 B

NIHL

 C

Sensorineural deafness 

 D

None

Q. 16

Gene’s test is for:

 A

Otosclerosis

 B

NIHL

 C

Sensorineural deafness 

 D

None

Ans. A

Explanation:

 

Gene’s Test

This test was earlier done to confirm the presence of otospongiosis.

In this test, BC (bone conduction) is tested and at the same time Siegle’s speculum compresses the air in the meatus.

In normal individuals hearing is reduced after this; i.e. Gelles test is positive; but in stapes fixation, sound is not affected. i.e Gelles test is negative.


Q. 17

Feature in otosclerosis includes:

 A

Sounds not heard in noisy environment

 B

Normal tympanum

 C

More common in males

 D

Malleus is most commonly effected

Q. 17

Feature in otosclerosis includes:

 A

Sounds not heard in noisy environment

 B

Normal tympanum

 C

More common in males

 D

Malleus is most commonly effected

Ans. B

Explanation:

Q. 18

Carhart’s notch in audiometery is seen in:

 A

Ocular discontinuity

 B

Haemotympanum

 C

Otomycosis

 D

Otosclerosis

Q. 18

Carhart’s notch in audiometery is seen in:

 A

Ocular discontinuity

 B

Haemotympanum

 C

Otomycosis

 D

Otosclerosis

Ans. D

Explanation:

 

Carharts notch

  • Bone conduction is normal in otosclerosis.
  • In some cases there is a dip in bone conduction curve which is maximum at 2000 Hz / 2 KHZ called as Carharts notch.
  • Carharts notch is seen only in bone conduction curve.
  • It disappears after successful stapedectomy/stapedotomy.

 

  • The reason why it disappears after successful surgery is that when the skull is vibrated by bone—conduction sound, the sound is detected by the cochlea via 3 routes:

–  Route (a)—is by direct vibration within the skull.

–  Route (b)—is by vibration of the ossicular chain which is suspended within the skull.

–  Route (c)—is by vibrations emanating into the external auditory canal as sound and being heard by the normal air-conduction route.

  • In a conduction type of hearing loss (as in otosclerosis) the latter two routes are deficient but regained by successful reconstruction surgery. Hence bone conduction thresholds improve following surgery.

Q. 19

All are true about otosclerosis except:

 A

Increased incidence in female

 B

Sensorineural deafness

 C

Irreversible loss of hearing

 D

b and c

Q. 19

All are true about otosclerosis except:

 A

Increased incidence in female

 B

Sensorineural deafness

 C

Irreversible loss of hearing

 D

b and c

Ans. D

Explanation:

 

  • In otosclerosis-50% cases have positive family history.
  • Females are affected more than males.
  • Bilateral conductive deafness seen in otosclerosis is not irreversible as it can be successfully treated by stapedectomy / Stapedotomy.
  • Sensorineural hearing loss occurs when later in the course of time 
  • osteosclerotic focus reaches the cochlear endosteum but actually most common hearing loss seen is conductive type.Q
  • Carharts notch is seen in bone conduction curve at 2000 Hz.



Q. 20

Characteristic feature of Otosclerosis are all except: 

 A

Conductive deafness

 B

Positive Rinne’s test

 C

Paracusis willisii

 D

Mobile ear drum

Q. 20

Characteristic feature of Otosclerosis are all except: 

 A

Conductive deafness

 B

Positive Rinne’s test

 C

Paracusis willisii

 D

Mobile ear drum

Ans. B

Explanation:

 

Tuning Fork Tests in Otosclerosis

  • Rinnes test-negative
  • Webers test-lateralised to ear with greater conductive loss
  • Absolute bone conduction-normal (It is decreased in cochlear otosclerosis)
  • Pure tone audiometry-shows loss of air conduction more for lower frequency.

 • Tympanic membrane is normal and mobile in 90% cases. 

  • Schwartz sign—Flammingo cases pink colour of tympanic membrane is seen in 10% cases. It indicates active focus with increased vascularity.
  • Stapes footplate—Shows a rice grain / biscuit type appearance
  • Blue mantles are seen histopathologically.



Q. 21

A 30- year old woman with family history of hearing loss from her mother’s side developed hearing problem dur­ing pregnancy. Hearing loss is bilateral, slowly progres­sive, Pure tone audiometry bone conduction hearing loss with an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Q. 21

A 30- year old woman with family history of hearing loss from her mother’s side developed hearing problem dur­ing pregnancy. Hearing loss is bilateral, slowly progres­sive, Pure tone audiometry bone conduction hearing loss with an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Ans. A

Explanation:

Q. 22

Medication which may prevent rapid progress of cochlear otosclerosis is:

 A

Steroids

 B

Antibiotics

 C

Fluorides

 D

Vitamins

Q. 22

Medication which may prevent rapid progress of cochlear otosclerosis is:

 A

Steroids

 B

Antibiotics

 C

Fluorides

 D

Vitamins

Ans. C

Explanation:

Q. 23

All are true statements regarding use of sodium fluoride in the treatment of otosclerosis except:

 A

It inhibits osteoblastic activity

 B

Used in active phase of otosclerosis when Schwartz sign is positive

 C

Has proteolytic activity (bone enzymes)

 D

Contraindicated in chronic nephritis

Q. 23

All are true statements regarding use of sodium fluoride in the treatment of otosclerosis except:

 A

It inhibits osteoblastic activity

 B

Used in active phase of otosclerosis when Schwartz sign is positive

 C

Has proteolytic activity (bone enzymes)

 D

Contraindicated in chronic nephritis

Ans. A

Explanation:

Ans. is a i.e. It inhibits osteoblastic activity

The most useful medication which prevents rapid progression of cochlear otoscierosis is sodium fluoride

Mechanism of Action

  • It reduces osteoclastic bone resorption and increases osteoblastic bone formation, which promote recalcification and reduce bone remodelling in actively expanding osteolytic lesion.
  • It also inhibits proteolytic enzymes that are cytotoxic to cochlea and lead to SNHL (Hence specially useful in cochlear otosclerosis). 
    • Current Otolaryngology 2nd/ed pg 678 

Q. 24

Following operations are done in case of otosclerosis:

 A

Stapedectomy

 B

Fenestration

 C

Stapedotomy

 D

All

Q. 24

Following operations are done in case of otosclerosis:

 A

Stapedectomy

 B

Fenestration

 C

Stapedotomy

 D

All

Ans. D

Explanation:

Q. 25

In otosclerosis during stapes surgery prosthesis used is:

 A

Round window

 B

Grommet

 C

Total ossiculear replacement

 D

All of the above

Q. 25

In otosclerosis during stapes surgery prosthesis used is:

 A

Round window

 B

Grommet

 C

Total ossiculear replacement

 D

All of the above

Ans. A

Explanation:

Ans. is a i.e. Teflon piston

The currently used prosthesis in otosclerosis surgery are:

  • Teflon (M/C used)
  • Stainless steel
  • Platinum                       — All are MRI compatible
  • Gold
  • Titanium

The prosthesis is placed between the long process of incus and foot plate of stapes



Q. 26

A pure tone audiogram with a dip at 2000 Hz is char­acteristic of:

 A

Presbyacusis

 B

Ototoxicity

 C

Otosclerosis

 D

Nose induced hearing loss

Q. 26

A pure tone audiogram with a dip at 2000 Hz is char­acteristic of:

 A

Presbyacusis

 B

Ototoxicity

 C

Otosclerosis

 D

Nose induced hearing loss

Ans. C

Explanation:

Q. 27

Recruitment test is positive in:             

 A

Retrocochlear lesions

 B

Otosclerosis

 C

Meniere’s disease

 D

None of the above

Q. 27

Recruitment test is positive in:             

 A

Retrocochlear lesions

 B

Otosclerosis

 C

Meniere’s disease

 D

None of the above

Ans. C

Explanation:

Q. 28

Gelle’s test is done/ negative in:           

 A

Senile deafness

 B

Traumatic deafness

 C

Otosclerosis

 D

Serous otitis media

Q. 28

Gelle’s test is done/ negative in:           

 A

Senile deafness

 B

Traumatic deafness

 C

Otosclerosis

 D

Serous otitis media

Ans. C

Explanation:

Q. 29

Blue ear drum is seen in:   

 A

Tympanosclerosis

 B

Secretory otitis media

 C

Otosclerosis

 D

Myringitis bullosa

Q. 29

Blue ear drum is seen in:   

 A

Tympanosclerosis

 B

Secretory otitis media

 C

Otosclerosis

 D

Myringitis bullosa

Ans. B

Explanation:

Q. 30

Paracusis willisii is seen in:      

 

 A

CSOM

 B

ASOM

 C

Otosclerosis

 D

Meniere’s disease

Q. 30

Paracusis willisii is seen in:      

 

 A

CSOM

 B

ASOM

 C

Otosclerosis

 D

Meniere’s disease

Ans. C

Explanation:

 

Diagnosis of otosclerosis

  • Otosclerosis is traditionally diagnosed by characteristic clinical findings, which include progressive conductive hearing loss, a normal tympanic membrane, and no evidence of middle ear inflammation.
  • The cochlear promontory may have a faint pink tinge reflecting the vascularity of the lesion, referred to as the Schwartz sign.
  • Conductive hearing loss is usually secondary to impingement of abnormal bone on the stapes footplate.
  • This involvement of the oval window forms the basis of the name fenestral otosclerosis.
  • The most common location of involvement of otosclerosis is the bone just anterior to the oval window at a small cleft known as the fissula ante fenestram.
  • The fissula is a thin fold of connective tissue extending through the endochondral layer, approximately between the
    oval window and the cochleariform process, where the tensor tympani tendon turns laterally toward the malleus.

Q. 31

Hyperacusis is seen in all of the following except:

 A

Exposure to loud sounds

 B

Otosclerosis

 C

Meniere’s disease

 D

Severe head injury

Q. 31

Hyperacusis is seen in all of the following except:

 A

Exposure to loud sounds

 B

Otosclerosis

 C

Meniere’s disease

 D

Severe head injury

Ans. B

Explanation:

 

Hyperacusis is characterized by an over-sensitivity to certain frequency ranges of sound (a collapsed tolerance to normal environmental sound).

Hyperacusis can be acquired as a result of:

  • The most common cause of hyperacusis is overexposure to excessively high decibel levels (or sound pressure levels).
  • Migraine
  • Severe head trauma
  • Facial nerve dysfunction (to Stapedius)
  • Tension Myositis Syndrome
  • Adverse drug reaction
  • Autism
  • Bell’s palsy
  • Meniere’s disease
  • Asperger syndrome

In cochlear hyperacusis (the most common form of hyperacusis), the symptoms are ear pain, annoyance, and general intolerance to any sounds that most people don’t notice or consider unpleasant.

In vestibular hyperacusis, the sufferer may experience feelings of dizziness, nausea, or a loss of balance when certain pitched sounds are present.

Otosclerosis presents with hearing loss (bilateral and conductive type) and paracusis willisii (patient hears better in noisy environment).


Q. 32

Schwartz sign is seen in

 A

Otosclerosis

 B

Serous otitis media

 C

CSOM

 D

ASOM

Q. 32

Schwartz sign is seen in

 A

Otosclerosis

 B

Serous otitis media

 C

CSOM

 D

ASOM

Ans. A

Explanation:

 

FINDINGS IN OTOSCLEROSIS

Symptoms of otosclerosis

  • Hearing loss :- Bilateral conductive deafness which is painless and progressive with insidious onset. In cochlear otosclerosis sensorineural hearing loss also occurs along with conductive deafness.
  • Paracusis willissii :- An otosclerotic patient hears better in noisy than quiet surroundings.
  • Tinnitus :- More common in cochlear otosclerosis.
  • Speech :- Monotonous, well modulated soft speech.
  • Vertigo :- is uncommon.

Signs in otosclerosis

  • Tympanic membrane is quite normal and mobile.
  • In 10% of cases flamingo – pink blush is seen through the tympanic membrane called as Schwartz sign. Various tests show conductive hearing loss.

Tuning fork tests in otosclerosis

  • As otosclerotic patients have conductive deafness, the tuning fork tests results will be as follows :‑
  1. Rinnes :- Negative
  2. Webers :- Lateralized to the ear with greater conductive loss.
  3. Absolute bone conduction (ABC) :- Normal (can be decreased in cochlear otosclerosis).
  4. Gelles test :- No change in the hearing through bone conduction when air pressure of ear canal is increased by Siegle’s speculum.

Audiometry in otosclerosis

Audiometry is one of the important tools in evaluation of a patient of otosclerosis.Various audiometric tests are :‑

1) Pure tone audiometry

  • Shows loss of air conduction, more for lower frequencies with characteristic rising pattern. Bone conduction is normal. However in some cases, there is a dip in bone conduction curve which is maximum at 2000 Hz (2 KHz) and is called the Carhart’s notch.

2) Impedance audiometry

  • Impedance audiometry shows :-

i) Tympanometry

  • Patient with early disease may show type A tympanogram (because middle ear areation is not affected) Progressive stapes fixation results in classical As type tympanogram.

ii) Acoustic (stapedial reflex)

It is one of the earliest sign of otosclerosis and precedes the development of airbone gap. In early stage, diphasic on-off pattern is seen in which there is a brief increase in compliance at the onset and at the termination, stimulus occurs. This is pathognomonic of otosclerosis. In later stage the reflex is absent.


Q. 33

Fluctuating deafness is seen in

 A

Meniers disease

 B

Otosclerosis

 C

CSOM

 D

ASOM

Q. 33

Fluctuating deafness is seen in

 A

Meniers disease

 B

Otosclerosis

 C

CSOM

 D

ASOM

Ans. A

Explanation:

 

Meniere’s disease is a disorder of the inner ear which is characterized by :-

i) Episodes of vertigo

ii) Tinnitus (ringing in the ears)

iii) Fluctuating sensorineural hearing loss

iv) Feeling of fullness or pressure in ear (aural fullness)



Pinna / Auricle

Pinna / Auricle

Q. 1

Ear pinna develops from ____________

 A

Ectoderm

 B

Endoderm

 C

Mesoderm

 D

All 

Q. 1

Ear pinna develops from ____________

 A

Ectoderm

 B

Endoderm

 C

Mesoderm

 D

All 

Ans. A

Explanation:

 Ans:A.)Ectoderm

  • First branchial cleft is the precursor of external auditory canal.
  • Around the sixth week of embryonic life, a series of six tubercles appear around the first branchial cleft

 

  • Branchial clefts are ectodermal in origin.

Q. 2

The cartilage present in Ear Pinna is:

 A

Hyaline 

 B

Elastic

 C

Fibrocartilage

 D

None

Q. 2

The cartilage present in Ear Pinna is:

 A

Hyaline 

 B

Elastic

 C

Fibrocartilage

 D

None

Ans. B

Explanation:

Elastic Cartilage 


Q. 3

Which of the following is formed at birth?

 A

Mastoid process

 B

Pinna

 C

Otic capsule

 D

Secondary areola

Q. 3

Which of the following is formed at birth?

 A

Mastoid process

 B

Pinna

 C

Otic capsule

 D

Secondary areola

Ans. B

Explanation:

Q. 4

The presence of white fibrocartilage is a feature of all of the following, EXCEPT:

 A

Acetabular labrum

 B

Intervertebral disc

 C

Meniscus

 D

Pinna

Q. 4

The presence of white fibrocartilage is a feature of all of the following, EXCEPT:

 A

Acetabular labrum

 B

Intervertebral disc

 C

Meniscus

 D

Pinna

Ans. D

Explanation:

Pinna is composed of a thin plate of yellow elastic cartilage, covered with integument

It is connected to the surrounding parts by ligaments and muscles; and to the commencement of the external acoustic meatus by fibrous tissue.


Q. 5

All are types of elastic cartilages, EXCEPT:

 A

Pinna

 B

Epiglottis

 C

Tip of arytenoid

 D

Thyroid cartilage

Q. 5

All are types of elastic cartilages, EXCEPT:

 A

Pinna

 B

Epiglottis

 C

Tip of arytenoid

 D

Thyroid cartilage

Ans. D

Explanation:

Cartilage is a fom of connective tissue, which contains a gel like matrix embedded with cells. They are of three types: Hyaline cartilage, elsatic cartilage and fibrous cartilage.

Elastic cartilage consists of numerous yellow elastic fibres embedded in a matrix which explains its flexibility. It is seen in auricle of the ear, external auditory meatus, auditory tube and the epiglottis.

Larynx is composed of several cartilages. The thyroid cartilage, cricoid cartilage, arytenoid cartilages, corniculate cartilages and cuneiform cartilages are all composed of hyaline cartilage.

Ref: Snell’s, Clinicql Anatomy, 7th Edition, Page 39


Q. 6

Fibrocartilage is present in all, EXCEPT:

 A

Pinna

 B

Symphysis pubis

 C

Intervertebral disc

 D

Menisci of knee joint

Q. 6

Fibrocartilage is present in all, EXCEPT:

 A

Pinna

 B

Symphysis pubis

 C

Intervertebral disc

 D

Menisci of knee joint

Ans. A

Explanation:

Fibrocartilage is a white opaque structure due to dense collage fibres (type I and II).

When a fibrous tissue is subjected to pressure it is replaced by fibrocartilage.

It is seen in joints, symphysis, intervertebral discs, menisci and labra (shoulder joint and hip joint).

Pinna is a type of elastic cartilage. Elastic cartilages are seen at sites concerned with production or reception of sounds eg external acoustic meatus (lateral part), auditory tube and epiglottis.


Q. 7

Sensory nerve supply of pinna is :

 A

Mandibular nerve

 B

Maxillary nerve

 C

Facial nerve

 D

Abducent nerve

Q. 7

Sensory nerve supply of pinna is :

 A

Mandibular nerve

 B

Maxillary nerve

 C

Facial nerve

 D

Abducent nerve

Ans. A

Explanation:

Auriculotemporal nerve, a branch of mandibular nerve (V3)(2 supplies the external acoustic meatus, external surface of auricle above this, skin of temporal region and TM joint.


Q. 8

Major part of the skin of pinna is supplied by:

 A

Aurculo temporal nerve

 B

Auricular branch of the vagus

 C

Posterior auricular nerve

 D

Great auricular nerve

Q. 8

Major part of the skin of pinna is supplied by:

 A

Aurculo temporal nerve

 B

Auricular branch of the vagus

 C

Posterior auricular nerve

 D

Great auricular nerve

Ans. D

Explanation:

D i.e. Great auricular


Q. 9

All of the following nerves supply auricle and extrernal meatus except:

 A

Trigeminal nerve

 B

Glossopharyngeal nerve

 C

Facial nerve

 D

Vagus nerve

Q. 9

All of the following nerves supply auricle and extrernal meatus except:

 A

Trigeminal nerve

 B

Glossopharyngeal nerve

 C

Facial nerve

 D

Vagus nerve

Ans. B

Explanation:

Q. 10

Which of the following nerves has no sensory supply to the auricle?

 A

Lesser occipital nerve

 B

Greater auricular nerve

 C

Auricular branch of vagus nerve

 D

Tympanic branch of glossopharyngeal nerve

Q. 10

Which of the following nerves has no sensory supply to the auricle?

 A

Lesser occipital nerve

 B

Greater auricular nerve

 C

Auricular branch of vagus nerve

 D

Tympanic branch of glossopharyngeal nerve

Ans. D

Explanation:

Q. 11

Skin over pinna is fixed:

 A

Firmly on both sides

 B

Loosely on medial side

 C

Loosely on lateral side

 D

Loosely on both side

Q. 11

Skin over pinna is fixed:

 A

Firmly on both sides

 B

Loosely on medial side

 C

Loosely on lateral side

 D

Loosely on both side

Ans. B

Explanation:

Skin over the pinna is closely adherent to the perichondrium on the lateral surface while it is loosely attached on the medial surface.


Q. 12

Major part of the skin of pinna is supplied by:

 A

Auriculotemporal nerve

 B

Auricular branch of vagus

 C

Lesser occipital nerve

 D

Greater auricular nerve

Q. 12

Major part of the skin of pinna is supplied by:

 A

Auriculotemporal nerve

 B

Auricular branch of vagus

 C

Lesser occipital nerve

 D

Greater auricular nerve

Ans. D

Explanation:

Ans. is d i.e. greater auricular nerve


Q. 13

Auricle of the ear is made of:       


 A

Hyaline cartilage

 B

Fibrocartilage

 C

Elastic cartilage

 D

None of the above

Q. 13

Auricle of the ear is made of:       


 A

Hyaline cartilage

 B

Fibrocartilage

 C

Elastic cartilage

 D

None of the above

Ans. C

Explanation:

 

There are three types of cartilage:

  • Hyaline cartilage has a high proportion of amorphous matrix. Throughout childhood and adolescence, it plays an important part in the growth in length of long bones (epiphyseal plates are composed of hyaline cartilage). It has a great resistance to wear and covers the articular surfaces of nearly all synovial joints.
  • Fibrocartilage has many collagen fibers embedded in a small amount of matrix and is found in the discs within joints (e.g., the temporomandibular joint, sternoclavicular joint, and knee joint) and on the articular surfaces of the clavicle and mandible. Fibrocartilage, if damaged, repairs itself slowly in a manner similar to fibrous tissue elsewhere.
  • Elastic cartilage possesses large numbers of elastic fibers embedded in matrix. It is flexible and is found in the auricle of the ear, the external auditory meatus, the auditory tube, and the epiglottis. Elastic cartilage, if damaged, repairs itself with fibrous tissue.

Q. 14

Cauliflower ear seen in:

 A

Hematoma of the auricle

 B

Carcinoma of the auricle

 C

Fungal infection of the auricle

 D

Congenital deformity

Q. 14

Cauliflower ear seen in:

 A

Hematoma of the auricle

 B

Carcinoma of the auricle

 C

Fungal infection of the auricle

 D

Congenital deformity

Ans. A

Explanation:

Cauliflower ear (boxer’s ear, wrestler’s ear) is an acquired deformity of the outer ear.

In this injury, the ear can shrivel up and fold in on itself and appear pale, giving it a cauliflower-like appearance, hence the term cauliflower ear.

Wrestlers, boxers and martial artists in particular are susceptible to this type of injury. When the ear is struck and a blood clot develops under the skin, or the skin is sheared from the cartilage, the connection of the skin to the cartilage is disrupted.


Q. 15

A 12 year old presents with fever, unilateral post auricular pain, mastoid bulging displacing the pinna forward and outwards with loss of bony trabeculae. This patient has history of chronic persistent pus discharge from same ear. Treatment of choice is‑

 A

Antibiotics only

 B

Incision and drainage

 C

Antibiotics, incision and drainage

 D

Mastoidectomy with incision, drainage and antibiotics

Q. 15

A 12 year old presents with fever, unilateral post auricular pain, mastoid bulging displacing the pinna forward and outwards with loss of bony trabeculae. This patient has history of chronic persistent pus discharge from same ear. Treatment of choice is‑

 A

Antibiotics only

 B

Incision and drainage

 C

Antibiotics, incision and drainage

 D

Mastoidectomy with incision, drainage and antibiotics

Ans. D

Explanation:

 

The patient is presenting with features of postauricular subperiosteal abscess. Treatment for this is antibiotics along with drainage of abscess and cortical mastoidectomy.

This patient has developed this abscess as a complication of CSOM (History of chronic ear discharge) for which he requires meastoidectomy.



Malignant Otitis Externa

Malignant Otitis Externa

Q. 1

Malignant otitis externa is caused by _____________________

 A

Staphylococcus aureus

 B

Pseudomonas aeruginosa 

 C

Candida albicans

 D

Candida albicans

Q. 1

Malignant otitis externa is caused by _____________________

 A

Staphylococcus aureus

 B

Pseudomonas aeruginosa 

 C

Candida albicans

 D

Candida albicans

Ans. B

Explanation:

 

MALIGNANT (NECROTISING) OTITIS EXTERNA:

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

Q. 2

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

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

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

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

Explanation:

Pseudomonas aeroginosa


Q. 3

Which of the following is true regarding malignant otitis externa?

 A

Caused by pseudomonas

 B

Seen in elderly diabetics

 C

Granulation tissue may be present in the external auditory canal

 D

All the above

Q. 3

Which of the following is true regarding malignant otitis externa?

 A

Caused by pseudomonas

 B

Seen in elderly diabetics

 C

Granulation tissue may be present in the external auditory canal

 D

All the above

Ans. D

Explanation:

Q. 4

Which of the organism causes malignant otitis externa?

 A

Staphylococcus aureus

 B

Pseudomonas aeruginosa

 C

Candida albicans

 D

E. coli

Q. 4

Which of the organism causes malignant otitis externa?

 A

Staphylococcus aureus

 B

Pseudomonas aeruginosa

 C

Candida albicans

 D

E. coli

Ans. B

Explanation:

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


Q. 5

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

 A

Caused by Pseudomonas aeruginosa

 B

Patients are usually old

 C

Mitotic figures are high

 D

Patient is immunocompromised

Q. 5

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

 A

Caused by Pseudomonas aeruginosa

 B

Patients are usually old

 C

Mitotic figures are high

 D

Patient is immunocompromised

Ans. C

Explanation:

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


Q. 6

External otitis is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonists ear

 D

ASOM

Q. 6

External otitis is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonists ear

 D

ASOM

Ans. C

Explanation:

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

 


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



Q. 7

Malignant otitis externa is caused by: 

 A

S. aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Q. 7

Malignant otitis externa is caused by: 

 A

S. aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Ans. C

Explanation:

Ans. is c is P. aeruginosa


Q. 8

True statement about malignant otitis externa is:

 A

Not painful

 B

Common in diabetics and old age

 C

Caused by streptococcus

 D

All of the above

Q. 8

True statement about malignant otitis externa is:

 A

Not painful

 B

Common in diabetics and old age

 C

Caused by streptococcus

 D

All of the above

Ans. B

Explanation:

Q. 9

Malignant otitis externa is:

 A

Malignancy of external ear

 B

Caused by hemophilus influenzae

 C

Blackish mass of aspergillus

 D

Pseudomonas infection in diabetic patient

Q. 9

Malignant otitis externa is:

 A

Malignancy of external ear

 B

Caused by hemophilus influenzae

 C

Blackish mass of aspergillus

 D

Pseudomonas infection in diabetic patient

Ans. D

Explanation:

Q. 10

Malignant otitis externa is characterized:

 A

Caused by pseudomonas aeruginosa

 B

Malignancy of external auditory canal

 C

Granulation tissue is seen in the floor of external auditory canal

 D

a and c

Q. 10

Malignant otitis externa is characterized:

 A

Caused by pseudomonas aeruginosa

 B

Malignancy of external auditory canal

 C

Granulation tissue is seen in the floor of external auditory canal

 D

a and c

Ans. D

Explanation:

Q. 11

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

 A

Malignant otitis externa

 B

Malignancy of the middle ear

 C

Infective disease of the middle ear

 D

Malignancy of nasopharynx with Eustachian tube ob­struction

Q. 11

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

 A

Malignant otitis externa

 B

Malignancy of the middle ear

 C

Infective disease of the middle ear

 D

Malignancy of nasopharynx with Eustachian tube ob­struction

Ans. A

Explanation:

Q. 12

Facial nerve palsy is seen in:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Eczematous otitis externa

Q. 12

Facial nerve palsy is seen in:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Eczematous otitis externa

Ans. C

Explanation:

Q. 13

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

 A

Malignant otitis externa 

 B

Herpes zoster otitis

 C

Otomycosis

 D

None

Q. 13

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

 A

Malignant otitis externa 

 B

Herpes zoster otitis

 C

Otomycosis

 D

None

Ans. A

Explanation:

 

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

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



Q. 14

Diffuse otitis externa is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonist’s ear

 D

ASOM

Q. 14

Diffuse otitis externa is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonist’s ear

 D

ASOM

Ans. C

Explanation:

Q. 15

Regarding necrotizing otitis externa all are true except:

 A

Caused by pseudomonas

 B

Surgery never done

 C

Facial nerve involved

 D

Common in diabetics

Q. 15

Regarding necrotizing otitis externa all are true except:

 A

Caused by pseudomonas

 B

Surgery never done

 C

Facial nerve involved

 D

Common in diabetics

Ans. B

Explanation:

Q. 16

Facial nerve palsy is seen in this condition:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Cerebellar abscess

Q. 16

Facial nerve palsy is seen in this condition:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Cerebellar abscess

Ans. C

Explanation:

Q. 17

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

 A

Malignant otitis externa

 B

Nasopharyngeal carcinoma

 C

Acute suppurative otitis media

 D

Chronic suppurative otitis media

Q. 17

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

 A

Malignant otitis externa

 B

Nasopharyngeal carcinoma

 C

Acute suppurative otitis media

 D

Chronic suppurative otitis media

Ans. A

Explanation:

Q. 18

 Causative organism for malignant otitis externa is

 A

Hemophilus

 B

Staphylococcus

 C

Streptococcus

 D

Pseudomonas

Q. 18

 Causative organism for malignant otitis externa is

 A

Hemophilus

 B

Staphylococcus

 C

Streptococcus

 D

Pseudomonas

Ans. D

Explanation:

 

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

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

Risks for this condition include:

  • Chemotherapy
  • Diabetes
  • Weakened immune system

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

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


Q. 19

Malignant otitis externa is caused by:   

 A

S.aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Q. 19

Malignant otitis externa is caused by:   

 A

S.aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Ans. C

Explanation:

 

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

Necrotizing external otitis (malignant otitis externa)

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

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

Natural history

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

Treatment of MOE

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

Complications

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

Q. 20

Sago grain appearance is seen in ‑

 A

Healed myringitis bullosa

 B

Otomycosis

 C

Malignant otitis externa

 D

Keratosis obturans

Q. 20

Sago grain appearance is seen in ‑

 A

Healed myringitis bullosa

 B

Otomycosis

 C

Malignant otitis externa

 D

Keratosis obturans

Ans. A

Explanation:

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

Otitis externa haemorrhagica

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

Q. 21

Malignant otitis externa is caused by ‑

 A

S. aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Q. 21

Malignant otitis externa is caused by ‑

 A

S. aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Ans. C

Explanation:

Ans. is ‘c’ i.e., P. aeruginosa

Malignant otitis externa

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

Predisposing factors for malignant otitis externa

Elderly diabetics (most common predisposing factor)

Individuals with altered immune function (immunodeficiency)

Chemotherapy

Clinical features of malignant otitis externa

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

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

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

Fever

Itching of ear or ear canal

Troubled swallowing & weakness of face.

Complications

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

Jugular venous thrombosis

Cavernous sinus thrombosis

Meningitis

Treatment of malignant otitis externa

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


Q. 22

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

 A

Cholesteatoma

 B

Exostosis

 C

Otomycosis

 D

Malignant otitis externa

Q. 22

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

 A

Cholesteatoma

 B

Exostosis

 C

Otomycosis

 D

Malignant otitis externa

Ans. A

Explanation:

Ans. is ‘a’ i.e., Cholesteatoma

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

Clinical features of cholesteatoma/atticoantral CSOM

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

Q. 23

Malignant otitis externa is most commonly caused by –

 A

P. aeruginosa

 B

S. aureus

 C

St. penumoniae

 D

S. epidermidis

Q. 23

Malignant otitis externa is most commonly caused by –

 A

P. aeruginosa

 B

S. aureus

 C

St. penumoniae

 D

S. epidermidis

Ans. A

Explanation:

Ans. is ‘a’ i.e., P. aeruginosa


Q. 24

In malignant otitis externa which nerve commonly affected ‑

 A

Abducent

 B

Facial

 C

Auditory

 D

Vagus

Q. 24

In malignant otitis externa which nerve commonly affected ‑

 A

Abducent

 B

Facial

 C

Auditory

 D

Vagus

Ans. B

Explanation:

 

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



CSF Rhinorrhoea

CSF Rhinorrhoea

Q. 1

CSF rhinorrhea “immediate” management is

 A

Plugging with petrolleum jelly plugs

 B

Wait & watch for 7 days + antibiotics

 C

Blow the nose repeatedly

 D

Surgery

Q. 1

CSF rhinorrhea “immediate” management is

 A

Plugging with petrolleum jelly plugs

 B

Wait & watch for 7 days + antibiotics

 C

Blow the nose repeatedly

 D

Surgery

Ans. B

Explanation:

 

CSF rhinorrhea may be classified as:

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

High pressure flow- intracranial tumours & hydrocephalous

Low pressure flow- congenital defects

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

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

Diagnosis:

  • Basic clinical tests

– Rhinoscopy-visualisation of CSF leakage from paranasal sinuses

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

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

  • Biochemical tests:

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

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

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

  • CSF tracers:

Intrathecal fluorescein dye administration, radionuclide cisternography, CTcisternography

  • Radiological studies:

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

Treatment:

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

– Strict bed rest – Head elevation – Stool softeners

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

– Prophylactic antibiotics

– Subarachnoid drainage through a lumbar catheter

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

 


Q. 2

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

 A

Vomer

 B

Ethmoid

 C

Maxilla

 D Zygomatic bone
Q. 2

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

 A

Vomer

 B

Ethmoid

 C

Maxilla

 D Zygomatic bone
Ans. B

Explanation:

Ethmoid


Q. 3

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

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

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

 B

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

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 3

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

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

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

 B

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

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. A

Explanation:

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

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

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

Q. 4

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

 A

Immediate plugging of nose with petroleum gauze

 B

Forceful blowing of nose

 C

Craniotomy

 D

Observation for 7 – 10 days with antibiotic therapy

Q. 4

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

 A

Immediate plugging of nose with petroleum gauze

 B

Forceful blowing of nose

 C

Craniotomy

 D

Observation for 7 – 10 days with antibiotic therapy

Ans. D

Explanation:

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

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


Q. 5

CSF rhinorrhea is seen in:

 A

Lefort’s fracture Type I

 B

Nasal fracture

 C

Nasoethmoid fracture

 D

All

Q. 5

CSF rhinorrhea is seen in:

 A

Lefort’s fracture Type I

 B

Nasal fracture

 C

Nasoethmoid fracture

 D

All

Ans. C

Explanation:

 

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



Q. 6

True about CSF rhinorrhea is:

 A

Occurs due to break in cribriform plate

 B

Contains glucose

 C

Requires immediate surgery

 D

a and b

Q. 6

True about CSF rhinorrhea is:

 A

Occurs due to break in cribriform plate

 B

Contains glucose

 C

Requires immediate surgery

 D

a and b

Ans. D

Explanation:

 

 

 

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

– Surgical management should be done


Q. 7

Immediate treatment of CSF rhinorrhea requires:

 A

Antibiotics and observation

 B

Plugging with paraffin guage

 C

Blowing of nose

 D

Craniotomy

Q. 7

Immediate treatment of CSF rhinorrhea requires:

 A

Antibiotics and observation

 B

Plugging with paraffin guage

 C

Blowing of nose

 D

Craniotomy

Ans. A

Explanation:

 

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

 

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


Q. 8

Management of persistent cases of CSF rhinorrhea is:

 A

Head low position on bed

 B

Endoscopic repair

 C

Straining activities

 D

All of the above

Q. 8

Management of persistent cases of CSF rhinorrhea is:

 A

Head low position on bed

 B

Endoscopic repair

 C

Straining activities

 D

All of the above

Ans. B

Explanation:

CSF rhinorrhoea

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

Q. 9

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

March 2008

 A

Nasal bones

 B

Cribriform plate

 C

Temporal bone

 D

Maxillary bone

Q. 9

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

March 2008

 A

Nasal bones

 B

Cribriform plate

 C

Temporal bone

 D

Maxillary bone

Ans. B

Explanation:

Ans. B: Cribriform Plate

CSF rhinorrhoea can follow a head injury.

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

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

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

Ascending infection may cause meningitis


Q. 10

True about CSF rhinorrhea:       

UP 09

 A

Commonly occurs due to break in cribriform plate

 B

Contains less amount of proteins

 C

Decreased glucose content confirms diagnosis

 D

Immediate surgery is required

Q. 10

True about CSF rhinorrhea:       

UP 09

 A

Commonly occurs due to break in cribriform plate

 B

Contains less amount of proteins

 C

Decreased glucose content confirms diagnosis

 D

Immediate surgery is required

Ans. A

Explanation:

Ans. Commonly occurs due to break in cribriform plate


Q. 11

CSF rhinorrhea is diagnosed by:

MP 07

 A

Glucose estimation

 B

Halo sign

 C

Immunoelectrophoresis

 D

All

Q. 11

CSF rhinorrhea is diagnosed by:

MP 07

 A

Glucose estimation

 B

Halo sign

 C

Immunoelectrophoresis

 D

All

Ans. D

Explanation:

Ans. All


Q. 12

Diagnostic test for CSF rhinorrhea is ‑

 A

Beta – 2 microglobulin

 B

Beta – 2 transferrin

 C

Thyroglobulin

 D

Transthyretin

Q. 12

Diagnostic test for CSF rhinorrhea is ‑

 A

Beta – 2 microglobulin

 B

Beta – 2 transferrin

 C

Thyroglobulin

 D

Transthyretin

Ans. B

Explanation:

Ans. is ‘b’ i.e., Beta-2 transferrin


Q. 13

Common site for CSF Rhinorrhoea is ‑

 A

Ethmoidal sinus

 B

Frontal sinus

 C

Petrous

 D

All

Q. 13

Common site for CSF Rhinorrhoea is ‑

 A

Ethmoidal sinus

 B

Frontal sinus

 C

Petrous

 D

All

Ans. A

Explanation:

 

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

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

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

Traumatic leak → Cribriform plate and ethmoidal air cells.

Spontaneous (non-traumatic) leak →  Cribriform plate.



Hypospadias

Hypospadias

Q. 1

Most common type of hypospadias is?

 A Glandular
 B

Penile

 C Scrotal
 D

Perineal

Q. 1

Most common type of hypospadias is?

 A Glandular
 B

Penile

 C Scrotal
 D

Perineal

Ans. A

Explanation:

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

Hypospadias is most common congenital malformation of urethra

Types of hypospadias

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

Q. 2

Commonest hypospadias is:

 A

Penile

 B

Glandular

 C

Scrotal

 D

A or C

Q. 2

Commonest hypospadias is:

 A

Penile

 B

Glandular

 C

Scrotal

 D

A or C

Ans. B

Explanation:

Ans. is ‘b’ i.e. Glandular

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

Q. 3

The best time for surgery of hypospadias is –

 A

1-4 months of age

 B

6-10 months of age

 C

12-18 months of age

 D

2-4 years of age

Q. 3

The best time for surgery of hypospadias is –

 A

1-4 months of age

 B

6-10 months of age

 C

12-18 months of age

 D

2-4 years of age

Ans. B

Explanation:

Ans. is ‘b’ i.e., 6 – 10 months 

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


Q. 4

Features of hypospadias are all except –

 A

Chordee

 B

Hooded prepuce

 C

No-treatment required with glandular veriety

 D

Cryptorchidism

Q. 4

Features of hypospadias are all except –

 A

Chordee

 B

Hooded prepuce

 C

No-treatment required with glandular veriety

 D

Cryptorchidism

Ans. D

Explanation:

Ans is ‘d’ i.e., Cryptorchidism 

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

1)       An abnormal ventral opening of the urethral meatus

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

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

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

Q. 5

In hypospadias all are seen except –

 A

Hooded penis

 B

Dorsal chordee

 C

Spatulated glans

 D

Meatal stenosis

Q. 5

In hypospadias all are seen except –

 A

Hooded penis

 B

Dorsal chordee

 C

Spatulated glans

 D

Meatal stenosis

Ans. B

Explanation:

Answer is ‘b’ i.e. Dorsal chordee 

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

Q. 6

True about hypospadias is all except – 

 A

Bifid scrotum

 B

Meatal stenosis

 C

Mental Retardation

 D

Spatulated glans

Q. 6

True about hypospadias is all except – 

 A

Bifid scrotum

 B

Meatal stenosis

 C

Mental Retardation

 D

Spatulated glans

Ans. C

Explanation:

Answer is ‘c’ i.e. Mental Retardation 

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

Q. 7

True about Hypospadias is ‑

 A

Meatal stenosis

 B

Dorsal hood

 C

Proximal opening of meatus

 D

All

Q. 7

True about Hypospadias is ‑

 A

Meatal stenosis

 B

Dorsal hood

 C

Proximal opening of meatus

 D

All

Ans. D

Explanation:

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


Q. 8

Which is not true of Hypospadias –

 A

Chordee is reversed after 5 years

 B

Glandular type needs no treatment

 C

Circumcision should not be done

 D

Surgical correction has good results in infancy

Q. 8

Which is not true of Hypospadias –

 A

Chordee is reversed after 5 years

 B

Glandular type needs no treatment

 C

Circumcision should not be done

 D

Surgical correction has good results in infancy

Ans. A

Explanation:

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


Q. 9

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

 A

Glandular

 B

Coronal

 C

Penile

 D

Perineal

Q. 9

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

 A

Glandular

 B

Coronal

 C

Penile

 D

Perineal

Ans. A

Explanation:

Ans. is ‘a’ i.e., Glandular 


Q. 10

Epispadias in relation to hypospadias ‑

 A

Is more common

 B

Less common

 C

Occures with the same frequency

 D

Is difficult to treat

Q. 10

Epispadias in relation to hypospadias ‑

 A

Is more common

 B

Less common

 C

Occures with the same frequency

 D

Is difficult to treat

Ans. B

Explanation:

Ans. is ‘b’ i.e., Less common 


Q. 11

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

 A

Careful inspection of genitals

 B

Biopsy for gonadal tissue

 C

Karyotyping

 D

Hormone assay

Q. 11

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

 A

Careful inspection of genitals

 B

Biopsy for gonadal tissue

 C

Karyotyping

 D

Hormone assay

Ans. C

Explanation:

Ans. is ‘c’ i.e., Karyotyping 


Q. 12

All of following are seen in hypospadias except ‑

 A

Ectopia vesicae

 B

Hooded prepuce

 C

Chordee

 D

Infertility

Q. 12

All of following are seen in hypospadias except ‑

 A

Ectopia vesicae

 B

Hooded prepuce

 C

Chordee

 D

Infertility

Ans. A

Explanation:

Ans. is ‘a’ i.e., Ectopia vesicae 


Q. 13

Most common type of hypospadias is:

September 2011

 A

Glandular

 B

Penile

 C

Coronal

 D

Perineal

Q. 13

Most common type of hypospadias is:

September 2011

 A

Glandular

 B

Penile

 C

Coronal

 D

Perineal

Ans. A

Explanation:

Ans. A: Glandular

Glandular hypospadias is common and does not usually require treatment

Hypospadias:

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




Scapula

SCAPULA

Q. 1

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

 A

Trapezius

 B

Rhomboid major

 C

Rhomboid minor

 D

Levator scapulae

Q. 1

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

 A

Trapezius

 B

Rhomboid major

 C

Rhomboid minor

 D

Levator scapulae

Ans. D

Explanation:

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

  • Rhomboid major

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

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

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


Q. 2

All of the following muscles elevate scapula, EXCEPT?

 A

Trapezius

 B

Levator scapulae

 C

Latissimus dorsi

 D

Rhomboid major

Q. 2

All of the following muscles elevate scapula, EXCEPT?

 A

Trapezius

 B

Levator scapulae

 C

Latissimus dorsi

 D

Rhomboid major

Ans. C

Explanation:

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

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

Q. 3

Which is the muscle that draws the scapula forward ?

 A

Trapezuis

 B

Rhomboides

 C

Serratus anterior

 D

Levator scapulae

Q. 3

Which is the muscle that draws the scapula forward ?

 A

Trapezuis

 B

Rhomboides

 C

Serratus anterior

 D

Levator scapulae

Ans. C

Explanation:

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

Must know:

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

Good to know:

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


Q. 4

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

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Q. 4

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

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Ans. D

Explanation:

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

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

Q. 5

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

 A

T 1

 B

T 3

 C

T 5

 D

T 7

Q. 5

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

 A

T 1

 B

T 3

 C

T 5

 D

T 7

Ans. B

Explanation:

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

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


Q. 6

Inferior angle of scapula lies at –

 A

T6

 B

T7

 C

T3

 D

T12

Q. 6

Inferior angle of scapula lies at –

 A

T6

 B

T7

 C

T3

 D

T12

Ans. B

Explanation:

Important landmarks of scapula

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

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

iii) Lateral angle corresponds to glenoid fossa.

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


Q. 7

Which border of scapula is not palpable ‑

 A

Medial

 B

Lateral

 C

Inferior

 D

Superior

Q. 7

Which border of scapula is not palpable ‑

 A

Medial

 B

Lateral

 C

Inferior

 D

Superior

Ans. D

Explanation:

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


Q. 8

Superior angle of scapula lies at which level ‑

 A

T7

 B

T12

 C

T2

 D

C5

Q. 8

Superior angle of scapula lies at which level ‑

 A

T7

 B

T12

 C

T2

 D

C5

Ans. C

Explanation:

Ans. is ‘c’ i.e., T2


Q. 9

Winging of scapula is seen in paralysis of which muscle‑

 A

Serratus anterior

 B

Supraspinatus

 C

Pectoralis major

 D

Infraspinatus

Q. 9

Winging of scapula is seen in paralysis of which muscle‑

 A

Serratus anterior

 B

Supraspinatus

 C

Pectoralis major

 D

Infraspinatus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Serratus anterior


Q. 10

Congenital elevation of scapula is called ‑

 A

Sprengelshouder

 B

Bouchard

 C

Boutennier

 D

None of the above

Q. 10

Congenital elevation of scapula is called ‑

 A

Sprengelshouder

 B

Bouchard

 C

Boutennier

 D

None of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., Sprengel shoulder

Congenital high scapula (sprengel’s shoulder)

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

Q. 11

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

 A

Medial pectoral nerve palsy

 B

Lateral pectoral nerve palsy

 C

Nerve to serratus anterior palsy

 D

Nerve to Latissimus dorsi palsy

Q. 11

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

 A

Medial pectoral nerve palsy

 B

Lateral pectoral nerve palsy

 C

Nerve to serratus anterior palsy

 D

Nerve to Latissimus dorsi palsy

Ans. C

Explanation:

Winging of scapula

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

Q. 12

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

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Q. 12

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

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Ans. D

Explanation:

This action is retraction of scapula

  


Q. 13

Which muscle causes retraction of scapula ‑

 A

Serratus anterior

 B

Levator scapulae

 C

Rhomboideus major 

 D

Supraspinatus

Q. 13

Which muscle causes retraction of scapula ‑

 A

Serratus anterior

 B

Levator scapulae

 C

Rhomboideus major 

 D

Supraspinatus

Ans. C

Explanation:

Ans. is ‘c’ i.e., Rhomboideus major

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

Q. 14

Winging of scapula is due to which of these conditions?

 A

Long thoracic nerve pals

 B

Thoraco-dorsal nerve palsy

 C

Erb’s palsy

 D

Klumpke’s palsy

Q. 14

Winging of scapula is due to which of these conditions?

 A

Long thoracic nerve pals

 B

Thoraco-dorsal nerve palsy

 C

Erb’s palsy

 D

Klumpke’s palsy

Ans. A

Explanation:

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



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