Sensorineural Hearing loss

Sensorineural Hearing loss

Q. 1 A  90-year-old  male  complains  of  hip  and back pain. He has also developed headaches, hearing loss, and tinnitus. On physical exam the skull appears enlarged, with prominent superficial veins. There is marked kyphosis, and the bones of the leg appear deformed. Plasma alkaline phosphatase is elevated. A skull x-ray shows sharply demarcated lucencies in the frontal, parietal, and  occipital bones.  X-rays of  the  hip show  thickening  of  the  pelvic  brim.  The  most likely diagnosis is
 A Multiple myeloma
 B Paget’s disease 
 C Hypercalcemia
 D Metastatic bone disease
Q. 1 A  90-year-old  male  complains  of  hip  and back pain. He has also developed headaches, hearing loss, and tinnitus. On physical exam the skull appears enlarged, with prominent superficial veins. There is marked kyphosis, and the bones of the leg appear deformed. Plasma alkaline phosphatase is elevated. A skull x-ray shows sharply demarcated lucencies in the frontal, parietal, and  occipital bones.  X-rays of  the  hip show  thickening  of  the  pelvic  brim.  The  most likely diagnosis is
 A Multiple myeloma
 B Paget’s disease 
 C Hypercalcemia
 D Metastatic bone disease
Ans. B

Explanation:

This patient has widespread Paget’s disease of bone. Excessive resorption of bone is followed by replacement of normal marrow with dense, trabecular, disorganized bone. Hearing loss and tinnitus are due to direct involvement of the ossicles of the inner ear. Plasma alkaline phosphatase levels represent increased bone turnover. Neither myeloma or metastatic bone disease  would  result  in  bony  deformity such  as skull   enlargement.   Alkaline   phosphatase   is   a marker of bone formation and does not rise in pure lytic lesions such as multiple myeloma.


Q. 2

An adolescent female has headache which is intermittent in episode in associated with tinnitus, vertigo and hearing loss. There is history of similar complains in her mother. Most likely diagnosis 

 A

Basilar migraine

 B

Cervical spondylosis

 C

Temporal arteritis

 D

Vestibular neuronitis

Q. 2

An adolescent female has headache which is intermittent in episode in associated with tinnitus, vertigo and hearing loss. There is history of similar complains in her mother. Most likely diagnosis 

 A

Basilar migraine

 B

Cervical spondylosis

 C

Temporal arteritis

 D

Vestibular neuronitis

Ans. A

Explanation:

Basilar migraine [Ref: CMDT 09 p. 849]

  • It is a case of Basilar migraine
  • Since it was believed to have originated in the basilar artery it was earlier called basilar artery migraine, but the absence of consistent evidence for basilar artery involvement lead to renaming as Basilar migraine only.
  • Basilar migraine is characterized by aura comprising of a bewildering variety of signs and symptoms of the visual cortex and brain stem.

– Basilar migraine mimicks ischemic strokes of the brainstem and the posterior cortical regions.

  • The aura which lasts for 10-45 minutes usually begin with typical migrainous disturbance of vision and is characterized by : ?

– Visual symptoms in both the temporal and nasal, fields.

– Dysorthria

– Vertigo

– Tinnitus

– Decreased hearing

– Double vision

– Ataxia

– B/L paresthesia

B/L paresis

– Decreased level of consciousness

  • After the aura is over a severe throbbing occipital headache supervenes.

Q. 3

60 yrs old male with bony abnormality at upper tibia associated with sensori neural hearing loss. On laboratory examination serum alkaline phosphatase levels are (440 mU/1) elevated and serum Ca++ and PO4 are normal. Skeletal survey shows ivory vertebrae and cotton wool spots in x-ray skull. Diagnosis is :

 A >Fibrous dysplasia
 B >Paget disease
 C >Osteosclerotic metastasis
 D >Osteoporosis
Q. 3

60 yrs old male with bony abnormality at upper tibia associated with sensori neural hearing loss. On laboratory examination serum alkaline phosphatase levels are (440 mU/1) elevated and serum Ca++ and PO4 are normal. Skeletal survey shows ivory vertebrae and cotton wool spots in x-ray skull. Diagnosis is :

 A >Fibrous dysplasia
 B >Paget disease
 C >Osteosclerotic metastasis
 D >Osteoporosis
Ans. B

Explanation:

Paget disease [Ref Harrison 16/e, p 2279-2281; Greenspan Orthopedic Radiology 3/e, p 805-809; Apley’s 8/e, p 126-127; Chandrasoma Taylor Pathology 3/e, p 965-966 (T67-1)]

The clinical and lab. findings in this elderly male along with characteristic x-ray findings are indicative of Paget ds. Paget disease

  • Paget disease, a relatively common bone disorder, is a chronic progressive disturbance in bone metabolism that primarily effects older persons.
  • Male > Females (3 : 2)
  • Pathology
  • The basic pathological process in Paget disease involves the balance between hone resorption and new bone formation (Osteoclastic and osteoblastic bone activity)
  • The disease passes through three stages :

1st – Orteolytic or hot phase

the pathological process is initiated by overactive osteoclastic bone resorption.

IInd – Intermediatior Mixed phase

– Osteoclastic hone resorption is followed by compensatory increase in osteoblastic new bone formation. 111rd – Cool Phase

– this is sclerotic phase in which the osteoblastic activity is greatly in excess of osteoclastic resorption, leading to marked thickening of bony trabeculae and cortex.

  • New pagetic bone is structurally disorganized and more susceptible to bowing and fracture.
  • Although most patients are asymptomatic, a variety of symptoms and complications may result directly from bony involvement or secondarily from the expansion of bone and subsequent compression of neural tissue (sensorineural hearing loss in this patient due to compression of choclear nerve from temporal bone involvement)
  • Biochemically the increase in osteoblastic activity is reflected in elevated levels of serum alkaline phosphatase which can rise to extremely high values.
  • The increase in osteoclastic bone resorption is reflected in high urinary levels of hydroxyproline, which is formed as a result of collagen breakdown.
  • Distribution
  • The distribution of the disease varies from monostotic involvement to widespread disease.
  • Pelvis is the most commonly involved bone followed by femur, skull, tibia, vertebrae.
  • Clinical manifestations
  • Asymptomatic patients are often diagnosed by discovery of an elevated alkaline phosphatase level on routine blood chemistry or from an abnormality on a skeletal radiograph obtained for other reasons.
  • Pain is the most common presenting symptom. It occurs due to increased bony vascularity, expanding lytic lesions, fractures, bowing or other deformities of the extremities.
  • Bowing of the femur or tibia causes gait abnormalities and abnormal mechanical stresses with secondary osteoarthritis of the hip or knee joints.
  • Back pain results due to enlarged pagetic vertebrae, vertebral compression fractures, spinal stenosis or kyphosis.
  • Skull involvement may cause headache, symmetric or assymmetric enlargement of the parietal or frontal bones (frontal bossing) and increased head size
  • Cranial expansion may narrow cranial foramine and cause neurological complications including hearing loss from choclear nerve damage from temporal bone involvement, cranial nerve palsies, and softening of the base of the skull (platybasia) and the risk of brainstem compression.
  • Pagetic involvement of the facial bones may cause facial deformities, loss of teeth or other dental conditions.
  • Other complications are

– Fractures (most common complication)

– Neoplastic transformation: development of bone sarcoma (most commonly osteosarcoma) is a rare but serious complication of Paget disease.

– Cardiovascular complications : The extensive arteriovenous shunting and marked increase in blood flow through the vascular pagetic bone leads to a high output state and cardiac enlargement.

  • Diagnosis
  • The diagnosis may be suggested on clinical examination by the enlarged skull with frontal bossing, bowing of an extremity, or short stature with simian posturing.
  • A warm extremity on palpation may suggest an underlying pagetic bone
  • Radiological findings

Radiographic features depend on the stage of the disorder

  • In the early osteolytic phase

– active bone resorption is evident as a radioluscent wedged area in long bones termed as ‘candle flame’ or ‘blade of grass’.

in the flat bones such as the calvarium or the iliac bone, purely osteolytic lesion is noted, k/a osteoporosis circumscripta

  • Later phases of new bone formation

– Bone remodelling appears radiographically as thickening of the cortex, coarse trabeculation and enlargement or expansion of an entire bone or area of a long bone.

– Vertebral cortical thickening of the superior and inferior end plates creates a ‘picture frame vertebra’. – Diffuse radiodense enlargement of a vertebra is referred to as ‘ivory vertebra’.

Skull x ray shows focal patchy densities – cotton ball appearance, which is quite characteristic of Paget

disease.

– Pelvic radiograph demonstrate disruption or fusion of the sacro-iliac joints and softening with protrusio

acetabuli

– Long bones reveal bowing deformities and typical pagetic changes of cortical thickening and expansion and

areas of lucency and sclerosis.

  • Biochemical findings

T alkaline phosphatase levels (indicative of osteoblastic activity, marker of bone (formation) – T Urinary hydroxyproline levels (marker of bone resorption)

[The parallel rise in serum alkaline phosphatase and urinary hydroxyproline levels confirm bone formation and resorption in Paget disease}

  • The degree of bone marker elevation reflects the extent and severity of the disease. – Urinary and serum deoxypyridinoline N-telopeptide, and C-telopeptide levels are products of degradation and are more specific for bone resorption than hydroxyproline.

– Serum calcium and phosphate levels are normal

  • Treatment

– Paget disease is treated with drugs which suppress the very high rates of bone resorption and secondarily decrease the high rates of bone formation

  • Bisphosphonates

Etidronate                     – A lendronare

– Tiludronate                   – Risedronate

– Pamidronate

  • Calcitonin

Q. 4

A clinical condition seen in a 24 year old male is characterised by a facial palsy and is often associated with facial pain and the appearance of vesicles on the canal and pinna. Vertigo and sensor neural hearing loss (VIIIth nerve) accompanying it is suggestive of:

 A

Downs Syndrome

 B

Bells Palsy

 C

Pendred Syndrome

 D

Ramsay Hunt Syndrome

Q. 4

A clinical condition seen in a 24 year old male is characterised by a facial palsy and is often associated with facial pain and the appearance of vesicles on the canal and pinna. Vertigo and sensor neural hearing loss (VIIIth nerve) accompanying it is suggestive of:

 A

Downs Syndrome

 B

Bells Palsy

 C

Pendred Syndrome

 D

Ramsay Hunt Syndrome

Ans. D

Explanation:

Q. 5

What is indicated by the term ‘Phon’?

 A

Psycho-acoustic index of loudness

 B

Noise induced hearing loss

 C

Sound spectrum

 D

Octave Band Frequency Analyzer

Q. 5

What is indicated by the term ‘Phon’?

 A

Psycho-acoustic index of loudness

 B

Noise induced hearing loss

 C

Sound spectrum

 D

Octave Band Frequency Analyzer

Ans. A

Explanation:

Noise may be expressed in psycho-acoustic terms – the phon. The phon is a psyho-acoustic index of loudness. It takes into consideration intensity and frequency.

Also remember:

“Octave Band Frequency Analyser,” which measures the noise in octave bands. The resulting plot shows the “sound spectrum” and indicates the characteristics of the noise, whether it is mainly high-pitched, low-pitched or of variable pitch.

Ref: Park’s textbook of Preventive and Social Medicine, 21stedition, page-684


Q. 6

60 yrs old male with bony abnormality at upper tibia associated with sensorineural hearing loss. On laboratory examination serum alkaline phosphatase levels are (440 mU/1) elevated and serum Ca2+ and P042- are normal. Skeletal survey shows ivory vertebrae and cotton wool spots in x-ray skull. Diagnosis is:

 A

Fibrous dysplasia

 B

Paget disease

 C

Osteosclerotic metastasis

 D

Osteoporosis

Q. 6

60 yrs old male with bony abnormality at upper tibia associated with sensorineural hearing loss. On laboratory examination serum alkaline phosphatase levels are (440 mU/1) elevated and serum Ca2+ and P042- are normal. Skeletal survey shows ivory vertebrae and cotton wool spots in x-ray skull. Diagnosis is:

 A

Fibrous dysplasia

 B

Paget disease

 C

Osteosclerotic metastasis

 D

Osteoporosis

Ans. B

Explanation:

Serum alkaline phosphatase (ALP) is in Paget’s disease elevated but calcium, parathyroid hormone, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D levels are normal.

Cranial expansion may narrow cranial foramens and cause neurologic complications including hearing loss from cochlear nerve damage from temporal bone involvement. 

Skull radiographs reveal regions of “cotton wool,” or osteoporosis circumscripta, thickening of diploic areas, and enlargement and sclerosis of a portion or all of one or more skull bones.
Vertebral cortical thickening of the superior and inferior end plates creates a “picture frame” vertebra.
Diffuse radiodense enlargement of a vertebra is referred to as “ivory vertebra.”

 

 

 

Ref: Favus M.J., Vokes T.J. (2012). Chapter 355. Paget’s Disease and Other Dysplasias of Bone. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.

 


Q. 7

The pathognomonic feature of classic alport syndrome is:

 A

Lenticonus and hematuria

 B

Hematuria and sensorineural hearing loss

 C

Sensorineural hearing loss and lenticonus

 D

Hematuria and hyperextensibility of joints

Q. 7

The pathognomonic feature of classic alport syndrome is:

 A

Lenticonus and hematuria

 B

Hematuria and sensorineural hearing loss

 C

Sensorineural hearing loss and lenticonus

 D

Hematuria and hyperextensibility of joints

Ans. A

Explanation:

The diagnosis of classic alport syndrome is based on X-linked inheritance of hematuria, sensorineural hearing loss, and lenticonus. The lenticonus together with hematuria is pathognomonic of classic Alport syndrome. 


Reference:
Harrisons Principles of Internal Medicine, 18th Edition, Pages 3213-14

Q. 8

All are features of Alport syndrome, except:

 A

Hematuria

 B

Sensorineural hearing loss

 C

Lenticonus

 D

Hypertelorism

Q. 8

All are features of Alport syndrome, except:

 A

Hematuria

 B

Sensorineural hearing loss

 C

Lenticonus

 D

Hypertelorism

Ans. D

Explanation:

Classic Alport syndrome is with hematuria, sensorineural deafness, and conical deformation of the anterior surface of the lens (lenticonus).


Reference:
Harrisons Principles of Internal Medicine, 18th Edition, Page 3213

Q. 9

All are TRUE about alport syndrome, EXCEPT:

 A

Hereditary nephropathy

 B

Sensorineural hearing loss

 C

Microscopic hematuria during early childhood

 D

Renal failure occurs in 50% of affected males

Q. 9

All are TRUE about alport syndrome, EXCEPT:

 A

Hereditary nephropathy

 B

Sensorineural hearing loss

 C

Microscopic hematuria during early childhood

 D

Renal failure occurs in 50% of affected males

Ans. D

Explanation:

Alport syndrome in its classic form is a hereditary nephropathy associated with
1. Sensorineural hearing loss and 2. Ocular manifestations.

  • The characteristic renal features is persistent microscopic hematuria appearing in early childhood.
  • Proteinuria is often absent in the early stages of the disease, but increases progressively with age and a nephrotic syndrome may develop.
  • Renal failure occurs in  all affected males, and in most cases during the third or fourth decade.
  • Juvenile AS is defined as mean age at onset of ESRD ≤30 years, and adult AS as mean age at onset of ESRD >30 years.

Ref: Dan Med Bull 2009; 56:105-52.


Q. 10

The diagnostic criteria as proposed by FLINTER for Alport syndrome has all the  features, EXCEPT:

 A

Positive family history

 B

Typical changes in renal biopsy specimen

 C

High tone sensorineural deafness

 D

Cardiovascular changes

Q. 10

The diagnostic criteria as proposed by FLINTER for Alport syndrome has all the  features, EXCEPT:

 A

Positive family history

 B

Typical changes in renal biopsy specimen

 C

High tone sensorineural deafness

 D

Cardiovascular changes

Ans. D

Explanation:

Diagnostic criteria for classical X-linked Alport syndrome.
At least three of the following four criteria must be fulfilled for a diagnosis
of Alport syndrome to be made clinically:

In a patient with microscopic hematuria

  • A positive family history of hematuria with or without chronic
  • renal failure.
  • Typical ultrastructural GBM changes in a renal biopsy specimen.
  • High-tone sensorineural deafness.
  • Characteristic ophthalmological signs (lenticonus and/or macular
  • flecks)

Ref: Dan Med Bull 2009; 56:105-52


Q. 11

Which of the following statements concerning sensorineural hearing loss in children with bacterial meningitis are TRUE?

 A

It occurs rarely (less than 5% of cases)

 B

It occurs more commonly when Haemophilus influenza type B rather than Streptococcus pneumonia is the causative organism of the meningitis

 C

Its onset often is late in the clinical course, after discontinuation of antimicrobial therapy

 D

Prompt institution of antimicrobial therapy appears not to influence the incidence

Q. 11

Which of the following statements concerning sensorineural hearing loss in children with bacterial meningitis are TRUE?

 A

It occurs rarely (less than 5% of cases)

 B

It occurs more commonly when Haemophilus influenza type B rather than Streptococcus pneumonia is the causative organism of the meningitis

 C

Its onset often is late in the clinical course, after discontinuation of antimicrobial therapy

 D

Prompt institution of antimicrobial therapy appears not to influence the incidence

Ans. D

Explanation:

Sensorineural hearing loss is detected by evoked-response audiometry in between 5 and 10% of children with bacterial meningitis. Up to 30% of children with meningitis caused by S. pneumoniae will have hearing deficits. Hearing loss generally is noted early in the course of bacterial meningitis and occurs despite prompt initiation of appropriate antimicrobial therapy. All children with bacterial meningitis should have hearing assessment by evoked-response audiometry before or soon after hospital discharge.
 
Ref: Roos K.L., Brosch J.R. (2012). Chapter 199. Meningitis and Encephalitis. In G.V. Lawry, S.C. McKean, J. Matloff, J.J. Ross, D.D. Dressler, D.J. Brotman, J.S. Ginsberg (Eds), Principles and Practice of Hospital Medicine.

Q. 12

Sensorineural deafness may be feature of all of the following conditions, EXCEPT:

 A

Alport syndrome

 B

Bartter syndrome

 C

Nail-patella syndrome

 D

Distal renal tubular acidosis

Q. 12

Sensorineural deafness may be feature of all of the following conditions, EXCEPT:

 A

Alport syndrome

 B

Bartter syndrome

 C

Nail-patella syndrome

 D

Distal renal tubular acidosis

Ans. C

Explanation:

Alport syndrome, Bartter syndrome and distal renal tubular acidosis are all associated with sensorineural hearing loss.

Alport syndrome  consist of nephritis and progressive sensorineural hearing loss.

Bartter syndrome consist of hypokalemia, metabolic alkalosis and sensorineural hearing loss.

Distal renal tubular acidosis is associated with growth retardation and hearing loss.


Q. 13

A 40 year old man presents to the general medicine clinic complaining of progressive hearing loss in his right ear. He says that over the past year, he has had difficulty hearing conversations in noisy places such as restaurants. In the past few months, he has experienced occasional ringing in his right ear. His hearing in his left ear has not been affected. He denies headache, vertigo, otalgia, facial pain, or weakness. He has no medical problems and does not take any medications. Otoscopic examination reveals pearly gray tympanic membranes bilaterally without any bulge or retraction. A Weber’s test is performed, and the patient reports hearing the vibration loudest in his left ear. Which of the following findings would MOST likely be observed in this patient?

 A

Air conduction equals bone conduction in his left ear

 B

Air conduction equals bone conduction in his right ear

 C

Air conduction is greater than bone conduction in his right ear

 D

Bone conduction is greater than air conduction in his left ear

Q. 13

A 40 year old man presents to the general medicine clinic complaining of progressive hearing loss in his right ear. He says that over the past year, he has had difficulty hearing conversations in noisy places such as restaurants. In the past few months, he has experienced occasional ringing in his right ear. His hearing in his left ear has not been affected. He denies headache, vertigo, otalgia, facial pain, or weakness. He has no medical problems and does not take any medications. Otoscopic examination reveals pearly gray tympanic membranes bilaterally without any bulge or retraction. A Weber’s test is performed, and the patient reports hearing the vibration loudest in his left ear. Which of the following findings would MOST likely be observed in this patient?

 A

Air conduction equals bone conduction in his left ear

 B

Air conduction equals bone conduction in his right ear

 C

Air conduction is greater than bone conduction in his right ear

 D

Bone conduction is greater than air conduction in his left ear

Ans. C

Explanation:

This patient has sensorineural deafness in his right ear due to his acoustic neuroma. In the normal ear, air conduction is greater than bone conduction. An ear with sensorineural deafness will still have air conduction greater than bone conduction, however both will be qualitatively decreased.

 

Q. 14

A 6 year old boy with congenital hearing loss approached an ENT surgeon for cochlear implantation. TRUE regarding cochlear implants is:

 A

Contraindicated in children less than 5 years of age

 B

Implanted in mild-to-moderate deafness

 C

Malformed cochlea is not a contraindication

 D

Inserted through oval window

Q. 14

A 6 year old boy with congenital hearing loss approached an ENT surgeon for cochlear implantation. TRUE regarding cochlear implants is:

 A

Contraindicated in children less than 5 years of age

 B

Implanted in mild-to-moderate deafness

 C

Malformed cochlea is not a contraindication

 D

Inserted through oval window

Ans. C

Explanation:

Congenital malformations of the cochlea are not contraindications to cochlear implantation.

Contraindications for Cochlear Implants:

1. Deafness caused by lesions of the acoustic nerve or the central auditory pathway

2. Active middle ear infections

3. Cochlear ossification that prevents electrode insertion

4. Tympanic membrane perforation

 

Appropriate age for cochlear implantation is between 2-17 years. Bilateral severe-to-profound sensorineural hearing loss is the main criteria for implantation. The electrode is inserted through the round window into the scala tympani of the cochlea.


Q. 15

Aminoglycoside class of drugs causes hearing loss by damaging?

 A

Inner hair cells of basal turn

 B

Outer hair cells of basal turn

 C

Inner hair cells of apical turn

 D

Outer hair cells of apical turn

Q. 15

Aminoglycoside class of drugs causes hearing loss by damaging?

 A

Inner hair cells of basal turn

 B

Outer hair cells of basal turn

 C

Inner hair cells of apical turn

 D

Outer hair cells of apical turn

Ans. B

Explanation:

Ans. is ‘b’ i.e., Outer hair cells of basal turn

o Aminoglycosides affect exclusively outer hair cells, particularly of basal coil of cochlea.


Q. 16

The late features of kernicterus include all except –

 A

Hypotonia

 B

Sensorineural hearing loss

 C

Choreoathetosis

 D

Upward gaze palsy

Q. 16

The late features of kernicterus include all except –

 A

Hypotonia

 B

Sensorineural hearing loss

 C

Choreoathetosis

 D

Upward gaze palsy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Hypotonia

Hypotonia is an early feature (in Phase I)

Clinical features

o Clinically, kernicterus is described in 3 phases, which may progress over 24 hours to 7 days :‑

1. Phase I —>           Poor suck, lethargy, hypotonia, depressed sensorium.

2. Phase II —>          Fever, hypertonia progressing to opisthotonus.

3. Phase III —>         High pitched cry, convulsions, death.

3 Long term survivors demonstrate choreoathetoid cerebral palsy, upward gaze palsy, sensorineural hearing loss and mental retardation.


Q. 17

All of the following are true about Noonan syndrome except-

 A

Equal incidence in boys and girls

 B

Testosterone is always normal level

 C

Karyotype is normal

 D

Sensorineural hearing loss is present

Q. 17

All of the following are true about Noonan syndrome except-

 A

Equal incidence in boys and girls

 B

Testosterone is always normal level

 C

Karyotype is normal

 D

Sensorineural hearing loss is present

Ans. B

Explanation:

Ans. is ‘b’ i.e., Testosterone is always normal level

o Testosterone levels are often low in Noonan syndrome.


Q. 18

Exposure to noise above- causes permanent hearing loss –

 A

90 dB

 B

100 dB

 C

125 dB

 D

160 dB

Q. 18

Exposure to noise above- causes permanent hearing loss –

 A

90 dB

 B

100 dB

 C

125 dB

 D

160 dB

Ans. D

Explanation:

Ans. is ‘d’ i.e., 160 dB 


Q. 19

Anterior uveitis in hypertensive patient, Drug of choice is to decrease the 10P

 A

Lanatoprost

 B

Pilocarpine

 C

Epinephrine

 D

Timolol

Q. 19

Anterior uveitis in hypertensive patient, Drug of choice is to decrease the 10P

 A

Lanatoprost

 B

Pilocarpine

 C

Epinephrine

 D

Timolol

Ans. D

Explanation:

D i.e. Timolol

In inflammatory glaucomas (e.g. hypertensive uveitis as Fuchs uveitis syndrome & Posner-Schlossman syndrome also k/a glaucomatocyclitic crisis) the following drugs should be avoided.

1.    Prostaglandin analogues e.g. latanoprost Q breakdown the blood aqueous barrier and may exacerbate cystoid macular oedema

2.    Miotic (e.g. physostigmine & Pilocarpine is also contraindicated Q) as it will promote the development of posterior synechiae.


Q. 20

All of the following can cause hearing loss except:

 A

Measles

 B

Mumps

 C

Chickenpox

 D

Rubella

Q. 20

All of the following can cause hearing loss except:

 A

Measles

 B

Mumps

 C

Chickenpox

 D

Rubella

Ans. C

Explanation:

Q. 21

All are causes of sensorineural deafness Except: 

 A

Old age

 B

Cochlear otosclerosis

 C

Loud sound

 D

Rupture of tympanic membrane

Q. 21

All are causes of sensorineural deafness Except: 

 A

Old age

 B

Cochlear otosclerosis

 C

Loud sound

 D

Rupture of tympanic membrane

Ans. D

Explanation:

Q. 22

Virus causing acute onset sensorineural deafness:

 A

Corona virus

 B

Rubella Measles

 C

Mumps

 D

b and c

Q. 22

Virus causing acute onset sensorineural deafness:

 A

Corona virus

 B

Rubella Measles

 C

Mumps

 D

b and c

Ans. D

Explanation:

Q. 23

Sensorineural deafness may be a feature of all, except:

 A

Nail-patella syndrome

 B

Distal renal tubular acidosis

 C

Bartter syndrome

 D

None

Q. 23

Sensorineural deafness may be a feature of all, except:

 A

Nail-patella syndrome

 B

Distal renal tubular acidosis

 C

Bartter syndrome

 D

None

Ans. D

Explanation:

Q. 24

Sensorineural deafness is seen in:

 A

Alport’s syndrome

 B

Pendred’s syndrome

 C

Treacher-Collins syndrome

 D

All

Q. 24

Sensorineural deafness is seen in:

 A

Alport’s syndrome

 B

Pendred’s syndrome

 C

Treacher-Collins syndrome

 D

All

Ans. D

Explanation:

Q. 25

Fluctuating recurring variable sensorineural deafness is seen in:

 A

Serous otitis media

 B

Heamotympanum

 C

Perilabyrinthine fistula 

 D

Labrinthine concussion

Q. 25

Fluctuating recurring variable sensorineural deafness is seen in:

 A

Serous otitis media

 B

Heamotympanum

 C

Perilabyrinthine fistula 

 D

Labrinthine concussion

Ans. C

Explanation:

Q. 26

Threshhold for moderate hearing loss is:

 A

26-40dB

 B

0-25dB

 C

41-55dB

 D

More than 91 dB

Q. 26

Threshhold for moderate hearing loss is:

 A

26-40dB

 B

0-25dB

 C

41-55dB

 D

More than 91 dB

Ans. C

Explanation:

Q. 27

Meniere’s disease is characterized by:

 A

Conductive hearing loss and tinnitus

 B

Vertigo ear discharge tinnitus and headache

 C

Vertigo, tinnitus, hearing loss and headache

 D

Vertigo, tinnitus and hearing loss

Q. 27

Meniere’s disease is characterized by:

 A

Conductive hearing loss and tinnitus

 B

Vertigo ear discharge tinnitus and headache

 C

Vertigo, tinnitus, hearing loss and headache

 D

Vertigo, tinnitus and hearing loss

Ans. C

Explanation:

Q. 28

The earliest symptom of acoustic nerve tumor is:

 A

Sensorineural hearing loss

 B

Tinnitus

 C

Vertigo

 D

Otorrhea

Q. 28

The earliest symptom of acoustic nerve tumor is:

 A

Sensorineural hearing loss

 B

Tinnitus

 C

Vertigo

 D

Otorrhea

Ans. A

Explanation:

Q. 29

A child aged 3 years, presented with severe sensorineural deafness, was prescribed hearing aids, but showed no improvement. What is the next line of management:

 A

Fenestration surgery

 B

Stapes mobilisation

 C

Cochlear implant

 D

Conservative

Q. 29

A child aged 3 years, presented with severe sensorineural deafness, was prescribed hearing aids, but showed no improvement. What is the next line of management:

 A

Fenestration surgery

 B

Stapes mobilisation

 C

Cochlear implant

 D

Conservative

Ans. C

Explanation:

Q. 30

10-year-old boy is having sensorineural deafness, not benefited by hearing aids. Next best management is:

 A

Cochlear implant

 B

Stapes fixation

 C

Stapedectomy

 D

Fenestration

Q. 30

10-year-old boy is having sensorineural deafness, not benefited by hearing aids. Next best management is:

 A

Cochlear implant

 B

Stapes fixation

 C

Stapedectomy

 D

Fenestration

Ans. A

Explanation:

Q. 31

Prolonged exposure to noise levels greater than the following can impair hearing permanently:

 A

40 decibels

 B

85 decibels

 C

100 decibels

 D

140 decibels

Q. 31

Prolonged exposure to noise levels greater than the following can impair hearing permanently:

 A

40 decibels

 B

85 decibels

 C

100 decibels

 D

140 decibels

Ans. C

Explanation:

 

A noise of 90 dB SPL, 8 hours a day for 5 days per week is the maximum safe limit as recommended by ministry of labour, govt of India-rules under factories act.


Q. 32

Presbycusis is:

 A

Loss of accommodation power

 B

Hearing loss due to aging

 C

Noise induced hearing loss

 D

Congenital deafness

Q. 32

Presbycusis is:

 A

Loss of accommodation power

 B

Hearing loss due to aging

 C

Noise induced hearing loss

 D

Congenital deafness

Ans. B

Explanation:

 



Q. 33

The acceptable noise level that can be tolerated without any damage to hearing is: 

March 2009

 A

85 dB

 B

90 dB

 C

95 dB

 D

100 dB

Q. 33

The acceptable noise level that can be tolerated without any damage to hearing is: 

March 2009

 A

85 dB

 B

90 dB

 C

95 dB

 D

100 dB

Ans. A

Explanation:

Ans. A: 85 dB

Sound pressure is measured in decibels (dB).

The average person can hear sounds down to about 0 dB, the level of rustling leaves.

If a sound reaches 85 dB or stronger, it can cause permanent damage hearing.

With extended exposure, noises that reach a decibel level of 85 can cause permanent damage to the hair cells in the inner ear, leading to hearing loss.


Q. 34

Earliest symptom of acoustic neuroma is:

 A

Facial weakness

 B

Unilateral sensorineural deafness

 C

Reduced corneal reflex

 D

Cerebellar signs

Q. 34

Earliest symptom of acoustic neuroma is:

 A

Facial weakness

 B

Unilateral sensorineural deafness

 C

Reduced corneal reflex

 D

Cerebellar signs

Ans. B

Explanation:

Q. 35

Prolonged exposure to levels greater than the following can impair hearing permanently:

 A

40 decibels

 B

85 decibels

 C

100 decibels

 D

140 decibels

Q. 35

Prolonged exposure to levels greater than the following can impair hearing permanently:

 A

40 decibels

 B

85 decibels

 C

100 decibels

 D

140 decibels

Ans. C

Explanation:

Q. 36

41-55 dB of hearing loss is categorized as _________

 A

Mild

 B

Moderate

 C

Moderately severe

 D

Severe

Q. 36

41-55 dB of hearing loss is categorized as _________

 A

Mild

 B

Moderate

 C

Moderately severe

 D

Severe

Ans. B

Explanation:

Q. 37

The limit of loudness (expressed as decibels) that workers can tolerate without substantial damage to their hearing, during their work hours, is:

 A

55

 B

65

 C

75

 D

85

Q. 37

The limit of loudness (expressed as decibels) that workers can tolerate without substantial damage to their hearing, during their work hours, is:

 A

55

 B

65

 C

75

 D

85

Ans. D

Explanation:

 

A noise of 90 dB (A) SPL, 8 hours a day for 5 days per week is the maximum safe limit as recommended by Ministry of Labour, Govt. of India-Model rules under Factories act

Noise induced hearing loss

  • Hearing loss can result from damage to structures or nerve fibers in the inner ear that respond to sound.
  • This type of hearing loss, termed “noise-induced hearing loss,” is usually caused by exposure to excessively loud sounds and cannot be medically or surgically corrected.
  • Noise-induced hearing loss can result from a one-time exposure to a very loud sound (at or above 120 decibels), blast, impulse, or by listening to loud sounds (at or above 85 decibels) over an extended period.
  • The louder the sound, the shorter the time period before hearing damage occurs.

Q. 38

Which is not seen in Meniere’s disease:

 A

Tinnitus

 B

Hearing loss

 C

Loss of consciousness

 D

Vertigo

Q. 38

Which is not seen in Meniere’s disease:

 A

Tinnitus

 B

Hearing loss

 C

Loss of consciousness

 D

Vertigo

Ans. C

Explanation:

 

Cardinal symptoms of Meniere’s disease are: Episodic vertigo, fluctuating hearing loss, tinnitus and sense of fullness or pressure in the involved ear

Meniere’s disease

“Classic Meniere’s” is considered to have the following symptoms:

  • Attacks of rotational vertigo that can be severe, incapacitating, unpredictable, and last anywhere from minutes to hours, but generally no longer than 24 hours.
  • This combines with an increase in volume of tinnitus and temporary, albeit significant, hearing loss.
  • Hearing may improve after an attack, but often becomes progressively worse.
  • Nausea, vomiting, and sweating sometimes accompany vertigo, but are symptoms of vertigo, and not of Meniere’s.
  • Fluctuating, progressive, unilateral or bilateral hearing loss, usually in lower frequencies.
  • For some, sounds can appear tinny or distorted, and patients can experience unusual sensitivity to noises.
  • Unilateral or bilateral tinnitus.
  • A sensation of fullness or pressure in one or both ears.
  • Some may have parasitic symptoms, which aren’t necessarily symptoms of Meniere’s, but rather side effects from other symptoms.
  • Vertigo may induce nystagmus, or uncontrollable rhythmical and jerky eye movements, usually in the horizontal plane, reflecting the essential role of non-visual balance in coordinating eye movements.
  • Sudden, severe attacks of dizziness or vertigo, known informally as “drop attacks,” can cause someone who is standing to suddenly fall
  • Meniere’s disease is idiopathic, but it is believed to be linked to endolymphatic hydrops, an excess of fluid in the inner ear.
  • Edolymphatic fluid bursts from its normal channels in the ear and flows into other areas, causing damage. This is called “hydrops.”
  • The membranous labyrinth, a system of membranes in the ear, contains a fluid called endolymph.
  • The membranes can become dilated like a balloon when pressure increases and drainage is blocked.
  • This may be related to swelling of the endolymphatic sac or other tissues in the vestibular system of the inner ear, which is responsible for the body’s sense of balance.
  • Endolymphatic duct may be obstructed by scar tissue, or may be narrow from birth.
  • In some cases there may be too much fluid secreted by the stria vascularis.
  • The symptoms may occur in the presence of a middle ear infection, head trauma, or an upper respiratory tract infection, or by using aspirin, smoking cigarettes, or drinking alcohol.

A detailed otolaryngological examination, audiometry and head MRI scan should be performed to exclude a vestibular schwan.noma or superior canal dehiscence which would cause similar symptoms.

There is no definitive test for Meniere’s, it is only diagnosed when all other causes have been ruled out.


Q. 39

60 years old man with sensorineural deafness and bony abnormality in left leg has S.Ca2+-9.5 and alkaline phosphate 440mu/1 skeletal survey shows ivory vertebra and cotton wool spots on skull most probable diagnosis:

 A

Paget’s disease

 B

Osteosclerotic metastasis

 C

Osteoporosis

 D

Fibrous dysplasia

Q. 39

60 years old man with sensorineural deafness and bony abnormality in left leg has S.Ca2+-9.5 and alkaline phosphate 440mu/1 skeletal survey shows ivory vertebra and cotton wool spots on skull most probable diagnosis:

 A

Paget’s disease

 B

Osteosclerotic metastasis

 C

Osteoporosis

 D

Fibrous dysplasia

Ans. A

Explanation:

Ans. Paget’s disease


Q. 40

Irreversible hearing loss caused by ‑

 A

Gentamycin

 B

Clarithromycin

 C

Both of the above

 D

None of the above

Q. 40

Irreversible hearing loss caused by ‑

 A

Gentamycin

 B

Clarithromycin

 C

Both of the above

 D

None of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., Gentamycin

  • Gentamycin is the most commonly used of the aminoglycosides. It produces vestibular toxicity and irreversible hearing loss.
  • Clarithromycin is known to produce reversible hearing loss.

Q. 41

When the patient fails to understand normal speech, but can understand shouted or amplified speech the hearing loss, is termed ‑

 A

Mild hearing loss

 B

Moderate hearing loss

 C

Severe hearing loss

 D

Profound hearing loss

Q. 41

When the patient fails to understand normal speech, but can understand shouted or amplified speech the hearing loss, is termed ‑

 A

Mild hearing loss

 B

Moderate hearing loss

 C

Severe hearing loss

 D

Profound hearing loss

Ans. C

Explanation:

Ans. is ‘c’ i.e., Severe hearing loss



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