End of Rotation Flashcards
1. The middle ear ossicles derive from which branchial arch/es? A. 1st B. 2nd and 3rd C. 1st and 2nd D. 1st and 3rd
Answer: C. “The malleus can be considered to derive from the cartilage of the first branchial arch (Meckel’s cartilage), while the incus and stapes derive from the cartilage of the second branchial arch (Reichert’s cartilage).” (Boies p. 32)
2. What kind of tympanic membrane perforation is considered “unsafe”? A. Tubal B. Central C. Marginal D. Partial
Answer: C. “(Tubal and central perforations) are generally safe; (marginal and pars flaccida perforations) are more serious.” (Boies p. 91)
- What is the basic causative factor in acute otitis media?
A. Congestion of the nose and nasopharynx
B. Increase in middle ear pressure
C. Presence of pathogens in the upper respiratory tract
D. Obstruction of the Eustachian tube
D
- What is the primary aim of surgery for chronic otitis media?
A. Eradication of infection
B. Re-creating an intact tympanic membrane
C. Reconstruction of the ossicles
D. Restoration of normal hearing
Answer: A. “Surgery is aimed at eradicating infection and obtaining a safe, dry ear through a variety of tympanoplasty and mastoidectomy procedures. The primary purpose of surgery is removal of disease and is achieved if proper healing results.” (Boies p. 113)
- What will you do with chronic otitis externa with granulation that persists after appropriate medical management?
A. Treat with IV antibiotics
B. Order TB-PCR of the external ear canal granulation
C. Order a culture and sensitivity study of the external ear canal granulation
D. Do a biopsy of the external ear canal granulation
Answer: D. “The persistence of infection and granulation tissue despite treatment will require a biopsy to exclude malignancy.” (Ann Acad Med Singapore, 34:330-4) “A chronic external otitis that does not respond to the preceding recommendations requires a biopsy.” (Boies p. 89) Malignant otitis media/skull base osteomyelitis signs and symptoms: “destruction with a lot of granulation in the external ear canal”. (Caparas p. 60)
- Which is NOT a hallmark of cholesteatoma?
A. Inflammatory effusion behind an intact tympanic membrane
B. Keratinizing squamous epithelium found in bony spaces at an abnormal location
C. Inflammatory osteoclastic process where bone is destroyed
D. Fetid aural discharge
Answer: A. “…cholesteatoma, which is keratinizing squamous epithelium (“skin”) that becomes entrapped in the middle ear space and mastoid.” (Boies p. 112) “Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear leading to hearing loss that surgery can often improve….Initially, the ear may drain fluid with a foul odor. (http://www.entnet.org/content/cholesteatoma) See also Caparas pp. 65-66.
7. Petrositis becomes evident when weakness of which cranial nerve occurs? A. 5th cranial nerve B. 6th cranial nerve C. 7th cranial nerve D. 8th cranial nerve
Answer: B. G[rad]enigo’s syndrome (petrositis): [R]etroorbital pain, [A]bducent nerve paralysis (diplopia), ear [D]ischarge
- Characteristic of spontaneous nystagmus of vestibular origin
A. Most pronounced in the central position and during fixation
B. Fast phase toward the right with right gaze and to the left with left gaze
C. No clearly definable fast and slow component
D. Always beats towards the same side and markedly suppressed by visual fixation
Answer: D? “Diseases affecting the vestibular labyrinth or nerve (including the root entry zone) cause a jerk nystagmus with linear or constant velocity slow phase drifts. Characteristically, the nystagmus increases when the eyes are turned in the direction of the quick phases (Alexander’s law), and can be markedly suppressed by visual fixation. The direction of the unidirectional nystagmus is related to the geometrical relationship of the semicircular canals with the fast phase opposite to the side of the lesion. A change in head position often exacerbates the nystagmus.) (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279674/) “peripheral causes of vertigo – fixation suppresses nystagmus” (Caparas p. 76)
- Benign Paroxysmal Positional Vertigo (BPPV) is
A. A peripheral vestibular pathology caused by precipitation of sodium chloride particles in the semicircular canals
B. Associated with tinnitus and ear fullness
C. Caused by calcium carbonate crystals floating in the endolymph or lodged in the cupula of the semicircular canals
D. Provoked head movement, fatigable, and vertigo last one hour or longer
Answer: C. “Pathogenesis: otoconia of utricle is loose and moves with changes in position (cupulolithiasis) or calcium carbonate crystals float with endolymphatic spiral (canalithiasis).” (Caparas p .77) BPPV lasts
- A 30-year-old female complains of hearing loss, pulsatile tinnitus on the right side of three years duration. No ear discharge, otalgia. Otoscopy reveals an intact red tympanic membrane. What is the next step?
A. Order an imaging study with contrast
B. Do tympanocentesis
C. Treat with intratympanic steroids
D. Treat with topical otic drops with steroids
Answer: A? (Agree. Consider Glomus Tumors (Tympanicum Jugulare)) -
Possible vascular problem? See http://www.dizziness-and-balance.com/disorders/hearing/tinnitus/pulsatile.html
- What is the Osteomeatal Complex (OMC)?
A. An area on the medial nasal wall where ostia of paranasal sinuses except the sphenoid open into the nasal cavity in a duct-like fashion
B. An area bounded laterally by the middle turbinate
C. An area bounded medially by the lamina papyracea
D. A functionally significant anatomic area which includes the uncinate process, hiatus
Answer: D. “Area on the lateral nasal wall where ostia of paranasal sinuses (except) sphenoid open into the nasal cavity in a duct-like fashion. Its boundaries are the middle turbinate on the medial aspect and the lamina papyracea on the lateral aspect. Functionally significant anatomic structures include the uncinated process, semilunar hiatus, frontal recess, ethmoid bulla, ethmoid infundibulum, and maxillary sinus ostium.” (Caparas pp. 98 – 99). A should be lateral nasal wall. B should be bounded by middle turbinate. C should be bounded laterally by lamina papyracea.
