Pathology 1 Flashcards
- A mother brings her eight-month-old baby to your GP because the baby has been awake since 2 a.m. screaming with pain and refusing to sleep. He has had a cold for 2 days and seemed to have a raised temperature. The mum noticed some green discharge from his right ear. You examine the baby and see that his right ear canal is full of pus and that it is difficult to visualise the right tympanic membrane. How should you manage this condition ?
A. topical antibiotics B. oral antibiotics C. Hospital admission for IV antibiotics D. Emergency referral to ENT for surgery E. Conservative management
Oral antibiotics should be given in acute otitis media with perforation
This situation describes acute otitis media with perforation - an acute infection of the middle ear, often with bacteria similar to those that cause a typical pneumonia (Streptococcus, pneumoniae, Haemophilus influenzae, Moraxella catarrhalis ).
Acute otitis media is usually managed conservatively, with analgesia e.g. calpol as appropriate. However there are some situations where oral antibiotics are recommended, for example if there is perforation, if the child is systemically unwell, or if there is immunocompromise.
- Which of the following is not a typical feature of malignant otitis externa?
A. Presents as a white pearl behind the tympanic membrane
B. Caused by Pseudomonas aeruginosa.
C. Patient are usually immunocompromised.
D. Presence of granulation tissue.
E. Patients are usually old.
Presents as a white pearl behind the tympanic membrane
- This is a feature of congenital Cholesteatoma (a cyst composed of keratinized desquamated epithelial cells occurring in the middle ear, mastoid, and temporal bone
• two types: congenital and acquired)
Malignant (Necrotizing) Otitis Externa (Skull Base Osteomyelitis)
Definition
• osteomyelitis of the temporal bone
Epidemiology
• occurs in elderly diabetics and immunocompromised patients
Etiology
• rare complication of otitis externa
• Pseudomonas infection in 99% of cases
Clinical Features
• otalgia and purulent otorrhea that is refractory to medical therapy • granulation tissue on the oor of the auditory canal
A 40-year-old man, a keen swimmer, comes to see you complaining of pain in both ears which has been present for about one week. He is otherwise well. On examination, you notice that the external auditory canal is inflamed and appears to have grey/black patches of wax. The tympanic membrane is intact and looks healthy. You take swabs for culture from both ears and the organism has been identified as Aspergillus niger. What is the recommended treatment? A. Penicillin B. Nyastain C. Topical clotrimazole D. Gentamycin 0.3% drops
C. Topical clotrimazole
This a case of otitis externa. It can be caused by bacteria or fungus
Bacterial causes
Staphylococcus aureus
Proteus spp
Pseudomonas aeruginosa
Fungal causes
Aspergillus niger
Candida albicans
Treat depending on culture results
- Topical clotrimazole (trade name canesten) for Aspergillus niger,
- Gentamicin 0.3% drops
A 20 year old man presents with foul smelling pus like discharge and hearing loss for 10 weeks. During an otoscopy what is the most important area of the tymphanic membrane that should be visualised ? A. Attic B. Cone of light C. Annulus D. Pars Tensa E. Lateral process of the malleus
The attic (pars flaccida) is extremely important to visualise., and any crusting or ear wax obscuring the attic is a cholesteatoma until proven otherwise. This is because cholesteatomas have a high risk of complications.
Cholesteatoma
A cholesteatoma consists of squamous epithelium that is ‘trapped’ within the skull base causing local destruction. It is most common in patients aged 10-20 years.
Main features
foul smelling discharge
hearing loss
- Treatment of choice for glue ear which presented for 6 months is
a. Conservative.
b. Adenoidectomy.
c. Myringotomy with ventilation tube insertion.
d. Myringotomy with cold knife.
e. Myringotomy with diode laser.
Myringotomy with ventilation tube insertion.
The best treatment for glue ear is consume time by watchful technique. In most children, episodes of glue ear get better without active treatment. For this reason, Otolaryngologist may simply recommend regular appointments for up to three months so they can check the ears. If he finds a fluid in the space behind the ear drum for more than three months, the beast treatment option is myringotomy with ventilation tube (Grommets) insertion.
Which of the following is not an extracranial complication of chronic suppurative otitis media: A. Sigmoid sinus thrombosis. B. Facial nerve palsy. C. Squamous cell carcinoma. D. Labyrinthitis. E. Hearing loss.
A. Sigmoid sinus thrombosis.
Types of intracranial complications of chronic suppuration otitis media: Extradural abscess Subdural abscess Meningitis Brain abscess Lateral sinus thrombophlebitis. Otitic hydrocephalus
Types of extracranial complications of chronic suppuration otitis media: Mastoiditis Petrositis Labyrinthitis Facial paralysis Mastoid abscesses. Squamous cell carcinoma of the ear.
In right middle ear pathology, Weberʼs test will be A. Lateralized to right side. B. Positive. C. Lateralized to left side. D. Centralized. E. Normal.
A. Lateralized to right side.
Unilateral referred otalgia is due to all of the following except: A. Peritonsillar abscess. B. Ulcer oral tongue. C. Allergic rhinitis. D. Tempromandibular joint dysfunction. E. Cancer of piriform fossa.
C. Allergic rhinitis.
Otalgia or an earache is pain in the ear. Primary otalgia is ear pain that originates inside the ear. Referred otalgia is ear pain that originates from outside the ear. Otalgia is not always associated with ear disease. It may be caused by several other
conditions, such as impacted teeth, sinus disease, inflamed tonsils, infections in the nose and pharynx, throat cancer, and occasionally as a sensory aura that precedes a migraine.
Allergic rhinitis is usually not associated with pain unless there is an infection of the paranasal sinuses.
Most common cause for bilateral conductive deafness in a child is: A. Otitis media with effusion. B. Otosclerosis. C. Acute otitis media. D. Congenital cholesteatoma. E. Chronic suppurative otitis media.
A. Otitis media with effusion
Otitis media with effusion is the most common cause of bilateral conductive
deafness in children.
Otosclerosis is a cause of bilateral conductive deafness but in young adult and is
rare in children.
Acute otitis media is common in young children, might cause a unilateral or
bilateral and not causing persistent deafness unless it progress to chronic state.
Congenital cholesteatoma is rare cause of conductive deafness and mostly
unilateral.
Chronic suppurative otitis media: might cause unilateral or bilateral conductive
deafness but allover is less in occurrence than Otitis media with effusion.
A child aged 3 years presented with severe sensorineural deafness, he was prescribed hearing aids but showed no improvement. What is the next line of management? A. Fenestration. B. Stapes mobilization. C. Cochlear implant. D. Conservative. E. Mastoidectomy.
C. Cochlear implant.
Cochlear implant is the final solution for such child and should be done before the
brain loses the neural plasticity at age of 6-8 years.
The most common cause of peripheral episodic vertigo is:
A. Benign paroxysmal positional vertigo.
B. Meniereʼs disease.
C. Acoustic neuroma.
D. Vascular occlusion of labyrinthine artery.
E. Labyrinthitis.
All are causes of peripheral episodic vertigo but benign paroxysmal positional
vertigo is the most common cause.
A fifty year old male diabetic patient has developed itching in his ears. On otoscopy there is debris with black specks in external auditory canal. The treatment of choice in this case is:-
A. Otosporin ear drops.
B. Gentamicin ear drops.
C. Salicylic acid in spirit drops.
D. Repeated suction toilet with antifungal drops.
E. Oral anti-fungal drugs.
Repeated suction toilet with antifungal drops.
Meticulous and regular aural toilet paying particular attention to the anteroinferior
meatal recess plus antifungal ear drops is the best option for otomycosis.
A 50 year old male patient presented with otalgia, on examination both external auditory canal and tympanic membrane are normal, all of the following might be the sites of origin of his pain except: A. Neck. B. Pharynx. C. Brain. D. Eye. E. Nose
C. Brain
The brain has no pain receptors
A 10 year old boy has had ear problems for many years. He has a fever and you also notice that his mastoid bone is warm and tender to touch. Which of the following is the best course of action? A. Refer routinely to ENT. B. Prescribe topical eardrops. C. Reassure. D. Prescribe antibiotics. E. Refer urgently to ENT.
E. Refer urgently to ENT
Mastoid abscess remains a recognized complication of otitis media despite the advent of antibiotics and need to refer urgently to ENT department.
The cone of light in the tympanic membrane points: A. Posteroinferiorly. B. Superiorly. C. Anteroinferiorly. D. Posteriorly. E. Centrally.
C. Antero inferiorly.
A cone of light can be seen radiating from the tip of the malleus to the periphery in the antero-inferior quadrant
