The Ear

1
MCQ COMMENTARY
The Ear
2

• The following are anatomic structures of the
  auricle except
• 1- Helix
• 2-Tragus
• 3-Concha
• 4-Antrum

• Answer 4
• The antrum is the largest air cells of the
  mastoid bone

3

• The auriculo temporal nerve
• 1- supplies the skin of the upper 2/3 of the
  lateral surface of the auricle
• 2- is a branch of maxillary nerve
• 3- supplies the middle ear mucosa through the
  tympanic plexus
• 4- non of the above

• Answer 1
• The auriculo-temporal nerve is a branch of
  mandibular division of the trigeminal nerve
• The middle ear mucosa is supplied by the tympanic
  branch of Glosspharyngeal nerve called Jacobson
  nerve

4

• The lobule of the ear has its sensory innervation
  from
• 1- great auricular nerve
• 2- auriculotemporal nerve
• 3-arnold branch of vagus
• 4- facial nerve

• Answer 1

5

• The tympanic membrane is divided into
• 1- Two equal parts called pars tensa and pars
  flaccida
• 2- A major upper part called pars flaccida and a
  small lower part called pars tensa
• 3- A small upper part called pars flaccida and a
  major lower part called pars tensa
• 4- non of the above

• Answer 3

6

• The bulge seen on the medial wall of the middle
  ear is
• 1- known as the promontory
• 2- formed by the bony semicirculr canal
• 3- is formed by the basal turn of the bony
  cochlea
• 4- all of the above
• 5- both 1 and 2
• 6- both 1 and 3

• Answer 3

7

• The Eustachian tube is opened by contraction
  of
• 1- tensor tympani muscle
• 2-levator palati muscle
• 3- tensor palati muscle
• 4-Salpingopharyngeus muscle

• Answer 3

8

• The sensory end-organ of the semicircular canal
  is
• 1- the organ of Corti
• 2- the macula
• 3- the crista
• 4- non of the above

• Answer 3
• The organ of Corti is the sensory end organ of
  hearing in the cochlea
• The macula is the sensory end organ in the
  utricle and saccule

9

• Auricular hematoma
• 1- may be complicated by otitis externa
• 2- cauliflower ear is one of its complications
• 3- evacuation of the extra-vasated blood is not
  essential
• 4- all of the above

• Answer 2
• Auricular hematoma may be complicated by
  perichondritis and cauliflower ear
• evacuation of the extra-vasated blood is
  essential to avoid complications

10

• It is better to avoid ear wash for removal of
• 1- wax
• 2- animate foreign body
• 3- impacted vegetable foreign body
• 4- non of the above

• Answer 3
• Vegetable FB will swell if ear wash fails to
  get it out which will cause more impaction

11

• It is better to avoid ear wash for removal of
• 1- wax
• 2- animate foreign body
• 3-calculator battery
• 4- non of the above

• Answer 3
• Dont wash if the FB is a calculator battery as
  this may lead to leak of acid and chemical burn
  of the skin

12

• The causative organism in ear fruncle is
• 1- proteus
• 2- Pseudomonas
• 3- staph. Aeureus
• 4- E coli

• Answer 3

13

• The causative organism in malignant otitis
  externa
• 1- proteus
• 2-Pseudomonas
• 3-staph. Aeureus
• 4- morexella catarrhalis

• Answer 2

14

• Malignant otitis externa is
• 1- a truly malignant disease eroding the external
  canal
• 2- is most commonly seen in elderly uncontrolled
  diabetics
• 3- staphylococcus aureus is the causative
  organism
• 4- non of the above

• Answer 2

15

• In the adult, the Eustachian tube is
  approximately the following lehgth
• 1- 30 mm
• 2- 20 mm
• 3- 36 mm
• 4- 45 mm

• Answer 3

16

• In Gradenigo syndrome diplopia is due to
  inflammation of the following cranial nerve
• 1- IV nerve
• 2- V nerve
• 3- III Nerve
• 4- VI nerve

• Answer 4
• This syndrome is charecterized by
• 1- otorrhoea
• 2-facial pain due to irritation of V cranial
  nerve
• 3-diplopia and squint due to irritation of VI
  cranial nerve in Dorello canal

17

• Conductive deafness in longtudinal temporal bone
  fracture may be due to
• 1- Rupture of the tympanic membrane
• 2- Ossicular disruption
• 3- Non of the above
• 4- Both 1 and 2

• Answer 4

18

• Longtudinal temporal bone fracture
• 1- is less common than the transverse type
• 2- is usually associated with sensori-neural
  hearing loss
• 3- facial nerve paralysis is a common association
  with this type
• 4- non of the above

• Answer 4

19

• The following organisms are involved in acute
  otitis media except
• 1- streptococcus pneumonia
• 2-hemophilus influenza
• 3-Pseudomonas aeroginosa
• 4-morexella cararrhalis

• Answer 3

20

• All of the following are diagnostic of tympanic
  membrane retraction except
• 1- fore-shortened handle of malleus
• 2- prominent lateral process of malleus
• 3- Schwartz sign
• 4- distorted cone of light

• Answer 3
• Schwartz sign is a flamingo red tinge of the
  tympanic membrane due to increased vascularity of
  the promontory and indicates active otosclerosis

21

• Throbbing and severe earach is present in the
  following stage of acute otitis media
• 1- stage of salpingitis
• 2- stage of catarrhal otitis media
• 3- stage of suppurative otitis media
• 4- stage of tympanic membrane perforation

• Answer 3

22

• The tympanic membrane perforation in acute otitis
  media is
• 1- central in the pars tensa
• 2- marginal in the pars tensa
• 3- small in the pars flaccida
• 4- non of the above

• Answer 1

23

• Type c tympanogram is consistent with
• 1- secretory otitis media
• 2- otosclerosis
• 3- Eustachian tube dysfunction
• 4- otosclerosis

• Answer 3
• In Type C there is
• Normal compliance but
• the peak of the
• tympanogram is at
• the negative side so it is
• consistent with ET
• dysfunction in which
• there is negative
• pressure in the middle
• ear

24

• Answer 2

• By central drum perforation we mean
• 1- a perforation at the central part of the drum
• 2- a perforation in the pars tensa which is
  surrounded by a rim of tympanic membrane
• 3- a perforation of the pars flaccida
• 4- a perforation in the pars tensa which is not
  surrounded by a rim of tympanic membrane

25

• Answer 3

• All of the following may be seen in the
  tubotympanic type of chronic suppurative otitis
  media except
• 1- mucopurulent otorrhoea
• 2- central tympanic membrane perforation
• 3- marginal tympanic membrane perforation
• 4- profuse otorrhoea

26

• Answer 2

• Cholesteatoma is characterized by
• 1- continuous mucopurulent ear discharge
• 2-A foul smelling ear discharge
• 3- A central tympanic membrane perforation
• 4- non of the above

27

• Answer 3

• A child with retraced drum and conductive
  deafness after inadequate treatment of acute
  suppurative otitis media is suffering from
• 1-chronic tubotympanic otitis media
• 2-chronic atticoantral otitis media
• 3- otitis media with effusion
• 4- all of the above
• 5-non of the above

28

• The commonest cause of conductive deafness in
  children is
• 1- wax
• 2-secretory otitis media
• 3-otomycosis
• 4- otosclerosis

• Answer2

29

• The commonest cause of conductive deafness in
  adults is
• 1- wax
• 2-secretory otitis media
• 3-otomycosis
• 4- otosclerosis

• Answer1

30

• In a patient suffering from purulent otorrhoea
  and attic perforation
• 1- treatment is essentially surgical
• 2- medical treatment and follow up is sufficient
• 3- myringoplasty is the only needed treatment
• 4- non of the above

• Answer 1
• The presence of foul odour
• otorrhoea and attic
• perforation is diagnostic of
• cholesteatoma. Treatment
• of this case is essentially
• surgical by mastoidectomy
• operation ( radical or
• modified radical)

31

• In a 45 years old female patient presenting with
  pulsating tinnitus and red mass behind the drum,
  all of the following are true except
• 1- glomus tumour is a possible diagnosis
• 2-more assessment is needed by CT scan or MRI
• 3- MRI angiography confirm the diagnosis
• 4-biopsy is essential to verify the pathological
  nature

• Answer 4
• Biopsy is contraindicated as it will lead to
  profuse bleeding

32

• Bezold abscess is a collection of pus
• 1- above and in front of the auricle
• 2-behind the auricle
• 3-in the upper part of the neck deep to the
  sternomastoid
• 4- in the peritonsillar space

• Answer 3

33

• During ear examination the reservoir sign is
  diagnostic of
• 1- acute otitis media
• 2- mastoiditis
• 3- petrositis
• 4- cholesteatoma

• Answer 2

34

• An early and diagnostic sign of mastoiditis
  is
• 1- reservoir sign
• 2-sagging of the posterosuperior part of the bony
  canal
• 3-perforated tympanic membrane
• 4- postauricular mastoid abscess

• Answer 2
• Sagging means bulging downwards of the
  posterosuperior part of the bony external canal
  and is due to periostitis of the bone overlying
  the mastoid antrum. It is an early and diagnostic
  sign of mastoiditis

35

• Answer 2

• Vertigo and nystagmus induced by pressure on the
  tragus is diagnostic of
• 1- serous labyrinthitis
• 2- circumscribed per- labyrintserous
• 3 suppurative labyrinthitishitis
• 4- all of the above

36

• Answer 2

• In a case of cholesteatoma, sever spontaneous
• vertigo with Nausea and vomiting is suspicious
  of
• 1- circumscribed peri-labyrinthitis
• 2- diffuse serous labyrinthitis
• 3- extradural abscess
• 4- petrositis

37

• In a patient having acute suppurative otitis
  media with bulging drum, myringotomy is
  benificial to
• 1-drain the middle ear
• 2- avoid rupture of the tympanic membrane
• 3-avoid complications
• 4-all of the above

• Answer 4

38

• The most common complication of myringotomy
  operation is
• 1- injury of facial nerve
• 2-dislocation of the incus
• 3-injury of the jagular bulb
• 4- residual perforation

• Answer 4

39

• In myringotomy operation the posterosuperior
  quadrant of the tympanic membrane must be avoided
• 1- to avoid injury of dehiscent jagular bulb
• 2- to avoid injury of the ossicles
• 3- non of the above
• 4- both 1 2

• Answer 2

40

• The combination of
• unilateral otorrhoea,
• severe facial pain and
• diplopia is known as
• 1- Piere Robin syndrome
• 2- Gradenigos syndrome
• 3- Kartagner syndrome
• 4- Ramsay Hunt sundrome

• Answer 2

41

• A child with an attic drum perforation who
  developed nausea, projrctile vomiting and fever
  of 40 degree is suspicious to have got
• 1- otogenic meningitis
• 2- otogenic labyrinthitis
• 3- petrositis
• 4- mastoiditis

• Answer 1

42

• The first line of treatment in a child who
  develops lower motor neurone facial paralysis
  after acute otitis media is
• 1- antibiotics and corticosteroids
• 2- decompression of facial nerve
• 3- exploration of facial nerve
• 4- myringotomy

• Answer 4

43

• Intermittent fever with
• rigors and headach in a
• patient with cholesteatma
• may be due to
• 1-otogenic meningitis
• 2-otogenic brain abscess
• 3- lateral sinus thrombophlebitis
• 4-extradural abscess

• Answer 3

44

• A positive Kernig sign means
• 1-reflex flexion of the hips and knees when the
  neck is flexed
• 2- inability to extend the knee completely when
  the hip is flexed on the abdomen
• 3- inability to do rapid ulternating movement
• 4- non of the above

• Answer 2

45

• A positive Brudzniski sign means
• 1-reflex flexion of the hips and knees when the
  neck is flexed
• 2- inability to extend the knee completely when
  the hip is flexed on the abdomen
• 3- inability to do rapid ulternating movement
• 4- non of the above

• Answer 1

46

• Answer 3
• in mastoiditis there is profuse mucopurulent
  or purulent otorrhoea which recurs rapidly after
  remova ( a diagnostic sign called reservoir sign)

• A persistent profuse ear discharge after acute
  otitis media is
• 1- cholesteatoma
• 2- secretory otitis media
• 3-mastoiditis
• 4- diffuse otitis externa

47

• In otitic barotrauma, the following statements
  are correct except
• 1-occurs during airplane ascent
• 2- occurs during airplane rapid descent
• 3- can cause rupture of the tympanic membrane
• 4- occurs during diving

• Answer 1

48

• The commonest cause of vertigo is
• 1- menieres disease
• 2-labyrinthitis
• 3-benign paroxysmal positional vertigo
• 4-ototoxicity

• Answer 3

49

• Most cases of extradural abscess of the temporal
  lobe
• 1- are asymptomatic and discovered accidentally
  during mastoidectomy
• 2- present with persistent ipsilateral temporal
  headach
• 3- present with vertigo
• 4- present with pulsating discharge,hearing loss
  and tinnitus

• Answer 1

50

• The type of hearing loss in otosclerosis may be
• 1- conductive
• 2- sensorineural
• 3-mixed
• 4-all of the above

• Answer 4
• In stapedial otosclerosis hearing loss is
  conductive
• In cochlear type the hearing loss is
  sensorineural
• In combined otosclerosis the hearing loss is mixed

51

• The commonest cause of bilateral sensorineural
  hearing loss in elderly individuals is
• 1- cochlear otosclerosis
• 2- presbyacusis
• 3- diabetes milltus
• 4- ototoxicity

• Answer 2

52

• A 30 years old patient with recurrent attacks of
  vertigo, hearing loss and tinnitus associated
  with nausea and vomiting has
• 1- benign paroxysmal positional vertigo
• 2-vestibular neuronitis
• 3-Menieres disease
• 4-acoustic neuroma

• Answer 3
• 1- In benign paroxysmal positional vertigo there
  is recurrent attacks of vertigo for seconds which
  occurs when the patient assumes certain head
  position
• 2- in vestibular neuronitis there is sudden
  severe vertigo for dayes but bo hearing loss
• 3- in Menieres disease recurrent attacks of
  vertigo, hearing loss and tinnitus associated
  with nausea and vomiting and the patient is free
  between attacks
• 4- In Acoustic neuroma there is unilateral
  persistent tinnitus and gradually progressive
  hearing loss but vertigo is uncommon

53

• Before tympanoplasty in a 30 years old patient,
  the following is required
• 1- audiogram
• 2- ensure dry perforation
• 3-treatment of any underlying nasal or paranasal
  sinus infection
• 4-all of the above
• 5- non of the above

• Answer 4

54

• The XI, X and XI cranial nerves may be involved
  in all of the following except
• 1-acoustic neuroma
• 2-transverse temporal bone fracture
• 3-malignant otitis externa
• 4- squamous cell carcinoma of the middle ear

• Answer 2
• in transverse temporal bone fracture the
  involved nerves are VII VIII

55

• In lower motor neurone facial paralysis with
  intact taste sensation at the anterior 2/3 of the
  tongue, the level of the lesion is
• 1- in the internal auditory canal
• 2-in the horizontal tympanic part
• 3- in the vertical part above the stapes
• 4- in the stylomastoid foramen

• Answer 4

56

• Failure to close the eye voluntarily is a symptom
  of
• 1- paralysis of the trigeminal nerve
• 2- upper motor neurone facial paralysis
• 3- lower motor neurone facial paralysis
• 4- non of the above

• Answer 3

57

• Uncontrolled diabetes in elderly patient may
  predispose to
• 1- cholesteatoma
• 2- malignant otitis externa
• 3- presbyacusis
• 4- vestibular neuronitis

• Answer 2

58

• A large near total perforation following acute
  necrotizing otitis media must be followed up for
  fear of
• 1- recurrent middle ear infection
• 2- secondary acquired cholesteatoma
• 3-retraction pocket
• 4-tympanosclerosis

• Answer 2

59

• By modified radical mastoidectomy we mean
• 1- removal of mastoid air cells and all middle
  ear contents
• 2- removal of diseased mastoid air cells
• 3- removal of mastoid air cells and all middle
  ear contents with preservation of healthy
  remnants of tympanic membrane and ossicles
• 4- non of the above

• Answer 3

60

• By radical mastoidectomy operation we mean
• 1- removal of mastoid air cells and all middle
  ear contents except stapes
• 2- removal of diseased mastoid air cells
• 3- removal of mastoid air cells and all middle
  ear contents with preservation of healthy
  remnants of tympanic membrane and ossicles
• 4- non of the above

• Answer 1

61

• Extensive cholesteatoma is best treated by
• 1- cortical mastoidectomy
• 2- radical mastoidectomy
• 3- modified reducal mastoidectomy
• 4- myringotomy wiyh insertion of T tube

• Answer 2

62

• Which of the following statements
• is false concerning Cochlear
• implant
• 1-postlingually deaf get far better benefit than
  prelingually deaf
• 2-it is indicated in total sensory hearing loss
• 3-the auditory nerve should be intact
• 4- After the operation speech discrimination is
  good and lip reading is not needed

• Answer 4

63

• Which of the following statements
• is wrong concerning myringotomy
• Operation
• 1- it is indicated in acute suppurative
• otitis media with bulging drum
• 2- it is indicated in secretory otitis
• media after failure of medical
• Treatment
• 3- it is better done in the postero
• superior quadrant of the tympanic
• membrane
• 4-residual perforation of the tympanic
• membrane is one of its complications

• Answer 3

64

• . Etiology for pulsatile tinnitus includes the
  followings except
•  a) Arteriovenous malformation of neck. 
• b) Otosclerosis. 
• c) Glomus jugulare tumors. 
• d) Hyperthyroidism. 
• e) Atherosclerosis.

• Answer b

65

• Which of the following drugs are known to
  cause tinnitus?  
• Salicylates. 
• Loop Diuretics. 
• Aminoglycosides. 
• NSAID. 
• All of the above

• Answer e

66

• Which of the following is associated with
  objective tinnitus
• Menière's disease. 
• Ear wax impaction. 
• Acoustic neuroma. 
• Palatal myoclonus. 
• Middle ear effusion

• Answer d

67

• The following have an ototoxic effect except
• 1- gentamycin
• 2- frusemide
• 3- streptomycin
• 4- amoxicilline
• 5- quinine

• Answer 4