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:


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