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A. Block D ENT > Otitis Media > Flashcards

Otitis Media Flashcards

1
Q

Otitis media is an infection of which part of the ear?

1 - outer ear
2 - inner ear
3 - cochlea
4 - middle ear

A

4 - middle ear

Connects the middle ear with the eustachian tube which allowed air to ventilate middle ear and normalises pressure to atmospheric conditions

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2
Q

3 of the following bones are contained within the middle ear. Which one of the following is NOT contained within the middle ear?

1 - malleus
2 - sesamoid
3 - incus
4 - stapes

A

2 - sesamoid
- helps ligaments move over bones and reduce friction

Stapes is the smallest bone.

Outer to inner order is malleus - incus - stapes (MIS)

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3
Q

Which bone does the middle bone lie within?

1 - temporal bone
2 - occipital bone
3 - sphenoid bone
4 - nasal bone

A

1 - temporal bone

Contains mastoid air cells

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4
Q

When looking at the tympanic membrane, the lateral malleolus can be used to identify which ear we are looking at. In the image below, are we looking at a left or right ear?

A
  • right

If it points left then its the left ear

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5
Q

What is the incidence of otitis media?

1 - 25 cases per 100,000
2 - 250 cases per 100,000
3 - 2500 cases per 100,000
4 - 25,000 cases per 100,000

A

2 - 250 cases per 100,000

Affects boy and girls equally

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6
Q

Otitis media can affect any age, but which age is this most common in?

1 - <12 months
2 - <4 y/o
3 - <8 y/o
4 - <16 y/o

A

2 - <4 y/o

Typically aged 6-24 months

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7
Q

Is otitis media more likely to cause conductive or sensorineural hearing loss?

A
  • conductive hearing loss

Anything affecting the external ear, ear canal or middle ear can cause conductive hearing loss

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8
Q

Which of the following is NOT an intrinsic risk factor for otitis media?

1 - gender
2 - atopic predisposition
3 - immunosuppression
4 - conditions affecting ciliary motility

A

1 - gender
- affects boys and girls equally

Conditions affecting ciliary motility include:
- Cystic fibrosis
- Primary ciliary dyskinesia
- Kartagener’s syndrome (autosomal recessive genetic ciliary disorder comprising of the triad of situs inversus, chronic sinusitis, and bronchiectasis.

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9
Q

Which of the following is NOT an extrinsic risk factor for otitis media?

1 - Passive smoking
2 - No pneumococcal vaccination
3 - Daycare
4 - Breast fed Bottle feeding
5 - Use of a dummy (pacifier)
6 - Low socioeconomic status

A

4 - Breast fed

Typically increased risk with bottle feeding as the strong swallow required to feed from a breast induces a sizeable negative pressure in the infants oral cavity allowing eustachian tube insufflation.

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10
Q

Otitis media typically occurs due to which of the following?

1 - wide eustachian tube leading to ascending infection
2 - narrowing of outer ear causing infection of tympanic membrane that spreads to inner ear
3 - oedema and narrowing of eustachian tube, stops ear from draining
4 - all of the above

A

3 - oedema and narrowing of eustachian tube, stops ear from draining

Lack of drainage predisposes inner ear to colonisation of bacteria.

The earache patients typically have is because the blocked eustachian tube does not allow equalisation of pressure in the ear, which could lead to rupture of the tympanic membrane to try and equalise the pressure

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11
Q

Children are more likely to develop otitis media for all of the following reasons, EXCEPT which one?

1 - narrower eustachian tubes
2 - increased fluid in eustachian tubes that can lead to infections
3 - eustachian tubes are more horizontal, inhibiting drainage
4 - more prone to respiratory infections

A

2 - increased fluid in eustachian tubes that can lead to infections

In ear examinations, the horizontal position of the eustachian tubes in children is why we pull the pinna down for paediatric examination, and up for adults

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12
Q

Biofilms can occur in children with otitis media. Are treatments more of less effective in patients with biofilms in otitis media?

A
  • less effective

Antibiotics have poor penetration of the biofilms

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13
Q

3 of the following bacteria account for 95% of bacterial cultured from patients with otitis media. Which one is NOT one of these 3?

1 - Streptococcus pneumoniae
2 - Staphylococcus aureus
3 - Moraxella catarrhalis
4 - Haemophilus influenzae

A

2 - Staphylococcus aureus

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14
Q

What is the cut off for acute otitis media?

1 - <72h
2 - <1 week
3 - <3 weeks
4 - <3 months

A

3 - <3 weeks

> 3 months to be chronic otitis media

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15
Q

Chronic suppurative otitis media (CSOM) is defined as chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges (otorrhoea) through a tympanic perforation. How long must this typically last for to reach this diagnosis?

1 - >2 days
2 - >2 weeks
3 - >2 months
4 - >2 years

A

2 - >2 weeks

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16
Q

All of the following are typical signs that can present in patients with variations of otitis media, EXCEPT which one?

1 - otalgia (ear pain)
2 - tugging or rubbing of the ear
3 - fever occurs in all patients
4 - viral URTI symptoms are common (e.g. coryza)
5 - ear discharge may occur if the tympanic membrane perforates
6 - hearing loss

A

3 - fever occurs in all patients

Fever can occur, but only in around 50% of cases

17
Q

Which of the following may be visible on otoscopy in a patient with otitis media?

1 - bulging tympanic membrane (loss of light reflex)
2 - opacification or erythema of the tympanic membrane
3 - perforation with purulent otorrhoea (discharge, can be red/ywllow)
4 - decreased mobility if using a pneumatic otoscope
5 - all of the above

A

5 - all of the above

18
Q

Which of the following is the most useful diagnostic tool to diagnose a patient with otitis media?

1 - clinical diagnosis
2 - vital signs
3 - head X-ray
4 - biochemistry and blood cultures

A

1 - clinical diagnosis

Examination and history taking

19
Q

All of the following can be complications of otitis media, except which one?

1 - Mastoiditis
2 - Papilledema
3 - Meningitis
4 - Intracranial abscesses
5 - tympanic membrane rupture

A

2 - Papilledema

20
Q

Tympanic Membrane Perforation (Hole)can occur in otitis media. What is important to exclude as a potential cause?

1 - otosclerosis
2 - cholesteatoma
3 - presbyacusis
4 - necrotising otitis externa

A

2 - cholesteatoma

Keratinising squamous epithelium that be locally aggressive through mass effect and secreting enzymes to resorb surrounding structures.

21
Q

Tympanic Membrane Perforation (Hole)can occur in otitis media. The vast majority heal within what time period?

1 - <2 weeks
2 - <4 weeks
3 - <8 weeks
4 - >12 weeks

A

3 - <8 weeks

MUST AVOID WATER IN THE EAR

Otherwise try:

  • topical antibiotics
  • myringoplasty
22
Q

Which of the following should be considered as likely diagnoses in otitis media?

1 - impacted cerumen
2 - Otitis externa
3 - Foreign body
4 - Cholesteatoma
5 - Bullous myringitis
6 - Mastoiditis
7 - Labyrinthitis
8 - all of the above

A

8 - all of the above

23
Q

Does otitis media always require the use of antibiotics?

A
  • no

The majority of cases will resolve without treatment in <3 days

In first 3 days give analgesia, antipyretics and fluids

24
Q

A mum presents to the GP with her daughter who has had pain in her ear for the last 24h that has kept her awake. Following inspected, you diagnose otitis media, but she is otherwise well. What would the initial management be as the GP?

1 - prescribe amoxicillin for 5-7 days
2 - advise to take analgesia, antipyretics and fluids for the first 3days
3 - refer to ENT on standard pathway and in meantime give oral amoxicillin for 5-7 days
4 - urgent referral to ENT

A

2 - advise to take analgesia, antipyretics and fluids for the first 3days

Patients typically get better in the first 3 days

25
Q

In otitis media, how long should patients receive conservative management before they are prescribed antibiotics?

1 - 24h
2 - 3 days
3 - 1 week
4 - 2 weeks

A

2 - 3 days

26
Q

Antibiotics should be considered in otitis media in all of the following circumstances, EXCEPT which one?

1 - systemically unwell
2 - aged >65
3 - high risk of complications
4 - signs of more serious illness

A

2 - aged >65

27
Q

Antibiotics are not always required in otitis media (OM), except in all of the following groups, EXCEPT which one?

1 - Children <2 y/o with bilateral OM
2 - Children <3 months with a temperature >38ºC
3 - Children <5 y/o with previous OM
4 - OM with ear discharge
5 - Systemically unwell patient with OM that persists with positive ear swab
6 - patients at high risk of complication

A

3 - Children <5 y/o with previous OM

28
Q

Which of the following is typically the 1st line treatment for otitis media?

1 - Amoxicillin (5-7 day course)
2 - Erythromycin or clarithromycin
3 - Gentamycin
4 - all of the above

A

1 - Amoxicillin (5-7 day course)

Given orally

2 - Erythromycin or clarithromycin

29
Q

1st line treatment for otitis media is oral amoxicillin for 5-7 days. If patients are allergic to penicillin, what should they be given instead?

1 - Co-amoxiclav
2 - Erythromycin or clarithromycin
3 - Gentamycin
4 - all of the above

A

2 - Erythromycin or clarithromycin

30
Q

Which of the following should be
performed if antibiotics do not begin to improve the symptoms of the patient with otitis media?

1 - referral to ENT
2 - consider alternative diagnosis
3 - add co-amoxiclav to current antibiotic
4 - all of the above

A

3 - add co-amoxiclav to current antibiotic

Refer to hospital if severe systemic infection or complications

31
Q
A
32
Q

Which of the following is NOT a common complications for otitis media (OM)?

1 - Chronic OM
2 - Hearing loss
3 - Tympanic membrane perforation
4 - Tinnitus
5 - Mastoiditis

A

5 - Mastoiditis

Can happen, but not a common complication

33
Q

Which of the following is NOT an uncommon complications for otitis media (OM)?

1 - Mastoiditis
2 - Bacterial meningitis
3 - Tinnitus
4 - Extradural abscess
5 - Subdural abscess
6 - Labyrinthitis
7 - Facial paralysis

A

3 - Tinnitus

This is a common complication of OM

34
Q

All of the following viruses can cause otitis media, but which is the most common?

1 - Respiratory syncytial virus
2 - Coronavirus
3 - Adenovirus
4 - Rhinovirus
5 - Influenza (all types)
6 - Enterovirus
7 Parainfluenza (all types)

A

1 - Respiratory syncytial virus

Accounts for 41-56% of cases

35
Q

All of the following can occur in otitis media, but which is most common?

1 - viral only cause
2 - bacterial only cause
3 - bacteria + viral cause
4 - fungal and viral

A

1 - viral only cause

All others can also occur

A. Block D ENT (26 decks)

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