Foreign Bodies in the Ear — MCQs

10 questions

A patient presents with acute appendicitis. What is NOT to be done?

A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?

Mainstay of treatment of glue ear -

Which factor indicates a BETTER prognosis for a broken instrument in a root canal?

Which of the following is the LEAST likely risk factor for developing acute otitis externa?

What is the treatment of choice for atticoantral type of chronic suppurative otitis media (CSOM)?

A 5-year-old child presents with reduced hearing for the past 2-3 months. Based on the otoscopy findings shown, what is the most likely diagnosis?

Which of the following is the MOST common complication of chronic otitis media?

In air blast injury, which is the most commonly affected organ? CMC (Vellore) 07; AI 09; AIIMS 10; NEET 14

Q10

Best method of detection of retained glass intraocular foreign body is:

Foreign Bodies in the Ear Indian Medical PG Practice Questions and MCQs

Question 1: A patient presents with acute appendicitis. What is NOT to be done?

A. Give antibiotics
B. Do primary survey
C. Perform appendectomy
D. Check for visual acuity (Correct Answer)

Explanation: ***Check for visual acuity*** - **Visual acuity** assessment is not relevant to the diagnosis or management of **acute appendicitis**. - This examination is typically performed in cases of suspected eye injury, vision changes, or neurological issues that affect vision. - In the context of acute appendicitis, checking visual acuity would be inappropriate and waste valuable time. *Give antibiotics* - **Antibiotics** are crucial in managing **acute appendicitis** to prevent progression to perforation and reduce postoperative infection risk. - They are typically administered preoperatively and continued postoperatively, especially in cases of complicated appendicitis. - Broad-spectrum antibiotics covering **gram-negative organisms and anaerobes** are standard practice. *Do primary survey* - A **primary survey** (ABCDE approach) is essential in any emergent patient presentation to assess and manage immediate **life-threatening conditions**. - While appendicitis itself may not be immediately life-threatening, ensuring patient stability and ruling out other serious conditions is critical. - This is standard emergency medicine practice and should always be performed. *Perform appendectomy* - **Appendectomy** (surgical removal of the appendix) is the definitive treatment for **acute appendicitis**. - This is the standard of care and should be performed once the diagnosis is confirmed and the patient is stable. - Either open or laparoscopic approach can be used depending on clinical factors and surgeon expertise.

Question 2: A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?

A. FB in larynx
B. Angioneurotic edema (Correct Answer)
C. Parapharyngeal abscess
D. FB bronchus

Explanation: Andioneurotic edema - The combination of **tongue swelling**, **neck swelling**, **stridor**, and **hoarseness of voice** following peanut ingestion is highly suggestive of **angioneurotic edema**, a severe allergic reaction that can lead to airway obstruction [1]. - This is a life-threatening condition requiring immediate medical intervention, often associated with generalized **anaphylaxis** when triggered by allergens [2]. *FB in larynx* - While a **foreign body (FB) in the larynx** can cause stridor and hoarseness, the widespread swelling of the tongue and neck points away from a localized laryngeal obstruction [3]. - A laryngeal FB would typically be associated with a more sudden onset of choking and coughing, not diffuse edema [3]. *Parapharyngeal abscess* - A **parapharyngeal abscess** would typically present with **fever**, **severe throat pain**, and **trismus** (difficulty opening the mouth), which are not mentioned in this scenario. - The acute, rapid onset of symptoms after peanut consumption is inconsistent with the slower progression of an abscess. *FB bronchus* - A **foreign body in the bronchus** would primarily cause **coughing**, **wheezing**, and possibly **respiratory distress**, often unilateral, rather than severe global swelling of the tongue and neck. - Inspiratory stridor and hoarseness are more indicative of upper airway involvement than bronchial obstruction.

Question 3: Mainstay of treatment of glue ear -

A. Temporal bone resection
B. Tonsillectomy & adenoidectomy
C. Radical Mastoidectomy
D. Myringotomy + aeration to middle ear (Correct Answer)

Explanation: ***Myringotomy + aeration to middle ear*** - **Myringotomy** involves creating a small incision in the eardrum to drain fluid, and inserting a **grommet (ventilation tube)** to aerate the middle ear, which is the primary treatment for persistent glue ear (otitis media with effusion). - This procedure aims to restore ventilation to the middle ear, allowing trapped fluid to drain and preventing recurrent fluid accumulation, which improves hearing. *Temporal bone resection* - This is a major surgical procedure involving the removal of part of the temporal bone, typically reserved for extensive **malignant tumors** or severe infections, and is not indicated for glue ear. - It carries significant risks and is disproportionate to the treatment of a benign condition like glue ear. *Tonsillectomy & adenoidectomy* - While **adenoidectomy** can sometimes be performed in conjunction with grommet insertion if enlarged adenoids contribute to eustachian tube dysfunction, it is not the **primary treatment** for glue ear itself. - **Tonsillectomy** is generally performed for recurrent tonsillitis and has no direct role in treating glue ear. *Radical Mastoidectomy* - This is a highly invasive surgical procedure involving the removal of the mastoid air cells and part of the external auditory canal, typically performed for severe **cholesteatoma** or chronic mastoiditis. - It is an extensive and risky operation that is not appropriate for the management of glue ear, which is a much milder condition.

Question 4: Which factor indicates a BETTER prognosis for a broken instrument in a root canal?

A. Instrument is lodged in the bone beyond the apical area
B. Instrument is smaller than size 20
C. The instrument is located in the apical third of the canal. (Correct Answer)
D. Instrument is in the middle third of the canal

Explanation: ***The instrument is located in the apical third of the canal.*** - Instruments fractured in the **apical third** generally have a better prognosis because the instrument acts as a **permanent obturation** in an already disinfected and cleaned area, preventing further bacterial ingress. - The small size of the canal apically means the fractured segment is less likely to significantly obstruct further cleaning or lead to severe extrusion of debris. *Instrument is smaller than size 20* - **Smaller instruments** can be more difficult to retrieve and might be pushed deeper into the canal, potentially beyond the apex, making removal or bypass challenging. - While smaller, they still obstruct the canal and can act as a **nidus for bacterial growth** if the canal is not adequately disinfected beyond the fragment. *Instrument is lodged in the bone beyond the apical area* - An instrument lodged in the periapical bone indicates **perforation** beyond the canal, which significantly worsens the prognosis due to potential **damage to periapical tissues**, infection, and difficulty of retrieval. - This scenario often leads to **chronic inflammation**, bone loss, and the need for complex surgical intervention. *Instrument is in the middle third of the canal* - A fractured instrument in the **middle third** typically has a worse prognosis compared to the apical third, as a significant portion of the canal remains uncleaned and unfilled beyond the fragment. - This position allows for continued **bacterial leakage** and proliferation in the untreated apical segment, potentially leading to persistent infection and treatment failure.

Question 5: Which of the following is the LEAST likely risk factor for developing acute otitis externa?

A. Presbycusis (Correct Answer)
B. Tympanic membrane perforation
C. Frequent swimming
D. Use of hearing aids

Explanation: ***Presbycusis*** - **Presbycusis** is age-related sensorineural hearing loss affecting the **inner ear (cochlea)** and auditory nerve pathways - It is a **degenerative condition** with NO involvement of the external auditory canal - There is **no pathophysiological mechanism** linking presbycusis to acute otitis externa, as it does not affect the ear canal's skin barrier, moisture balance, or susceptibility to infection - This is the **LEAST likely** risk factor among the options *Frequent swimming* - **Major risk factor** for acute otitis externa ("swimmer's ear") - Water exposure washes away protective **cerumen** and increases canal pH - Creates a **moist environment** ideal for bacterial proliferation, especially ***Pseudomonas aeruginosa*** and *Staphylococcus aureus* - Maceration of canal skin compromises the natural barrier *Use of hearing aids* - **Well-documented risk factor** for otitis externa - Hearing aids **occlude the ear canal**, trapping moisture and debris - Can cause **mechanical trauma** to the delicate canal skin - Creates a warm, humid environment promoting bacterial and fungal growth - Regular users are at increased risk, especially with poor hygiene *Tympanic membrane perforation* - While primarily associated with **chronic otitis media**, a perforation can predispose to external canal complications - May allow **moisture entry** and middle ear drainage into the canal - However, the direct risk for acute otitis externa is less significant compared to factors that directly affect the external canal environment - Still more relevant than presbycusis, which has no connection to the external ear

Question 6: What is the treatment of choice for atticoantral type of chronic suppurative otitis media (CSOM)?

A. Tympanoplasty
B. Modified radical mastoidectomy (Correct Answer)
C. None of the options
D. Antibiotics

Explanation: ***Modified radical mastoidectomy*** - The **atticoantral type of CSOM** is characterized by active **cholesteatoma**, which requires surgical removal to prevent further bone erosion and complications. - A **modified radical mastoidectomy** is the treatment of choice as it removes the cholesteatoma and diseased mastoid air cells while aiming to preserve residual hearing. *Antibiotics* - While topical or systemic antibiotics may be used to control acute infections or discharge in CSOM, they do not eradicate **cholesteatoma**. - **Cholesteatoma** is an epidermoid cyst that requires surgical excision, as antibiotics alone cannot resolve it. *Tympanoplasty* - **Tympanoplasty** is primarily performed to reconstruct the tympanic membrane (eardrum) and/or the ossicular chain to restore hearing. - It is typically indicated for the **tubotympanic type of CSOM** (safe type) without cholesteatoma, not for the atticoantral type which involves cholesteatoma. *None of the options* - This option is incorrect because **modified radical mastoidectomy** is a well-established and necessary treatment for the atticoantral type of CSOM involving cholesteatoma.

Question 7: A 5-year-old child presents with reduced hearing for the past 2-3 months. Based on the otoscopy findings shown, what is the most likely diagnosis?

A. Myringitis
B. Otitis media with effusion (Correct Answer)
C. Acute ear infection
D. Air in the middle ear

Explanation: ***Otitis media with effusion*** - The image clearly shows the presence of **bubbles behind the tympanic membrane**, indicating fluid accumulation in the middle ear. - This fluid leads to **reduced hearing**, as reported in the 5-year-old child, consistent with otitis media with effusion (OME), also known as "glue ear." *Myringitis* - Myringitis typically presents with **inflammation of the tympanic membrane**, often with vesicles or bullae on the drum, which are not visible here. - While it can cause pain, it does not typically show the characteristic bubbles signifying middle ear effusion. *Acute ear infection* - An **acute otitis media** would show a **bulging, erythematous (red), and opaque tympanic membrane** due to inflammation and pus, which is not consistent with the image. - Systemic symptoms like fever and severe ear pain would also be expected with an acute infection. *Air in the middle ear* - The presence of **air in the middle ear is normal** and indicates a healthy, functioning Eustachian tube. - The visible bubbles in the image are consistent with **fluid and air-fluid levels**, not just air, and indicate a pathological condition affecting hearing.

Question 8: Which of the following is the MOST common complication of chronic otitis media?

A. Hearing loss (Correct Answer)
B. Epistaxis
C. Facial nerve paralysis
D. Mastoiditis

Explanation: ***Hearing loss*** - **Chronic otitis media** is the **MOST common complication**, affecting virtually all patients to some degree. - Damage to the **ossicles**, tympanic membrane perforation, and middle ear effusion lead primarily to **conductive hearing loss**. - Long-standing disease can also cause **sensorineural hearing loss** through toxin diffusion to the inner ear or erosion of the otic capsule. - This is the hallmark and nearly universal consequence of chronic otitis media. *Epistaxis* - **Epistaxis (nosebleeds)** originates from the nasal passages and has no direct relationship to middle ear pathology. - Not a complication of **chronic otitis media**. *Facial nerve paralysis* - While a recognized complication, **facial nerve paralysis** is relatively uncommon and typically occurs with **cholesteatoma** eroding the facial nerve canal or in severe suppurative disease. - Represents an advanced complication rather than the most frequent outcome. *Mastoiditis* - **Mastoiditis** is indeed a complication of chronic otitis media, occurring when infection spreads to the **mastoid air cells**. - Presents with postauricular tenderness, swelling, and fever. - However, with modern antibiotic therapy, it is **less common** than hearing loss, which occurs in nearly all cases of chronic otitis media.

Question 9: In air blast injury, which is the most commonly affected organ? CMC (Vellore) 07; AI 09; AIIMS 10; NEET 14

A. Stomach
B. Lungs
C. Liver
D. Eardrum (Correct Answer)

Explanation: ***Eardrum*** - The **eardrum (tympanic membrane)** is the most commonly affected organ in air blast injuries due to its thin, delicate structure and direct exposure to pressure waves. - Its rupture threshold is relatively low, making it highly susceptible to damage from sudden changes in air pressure. *Stomach* - While **hollow organs** like the stomach can be affected by blast injuries (secondary to barotrauma), they are less commonly ruptured than the eardrum. - Injury to the stomach generally requires a higher intensity blast or immersion in water. *Lungs* - **Pulmonary barotrauma** (blast lung) is a serious consequence of blast injury, characterized by hemorrhage, edema, and contusions. - However, the eardrum is far more frequently (and often mildly) injured compared to severe lung damage. *Liver* - The **liver**, being a solid organ, is generally more resistant to direct blast effects compared to hollow or air-filled structures. - Liver injuries from blast are more often due to secondary trauma (e.g., impact from flying debris) rather than the primary blast wave itself.

Question 10: Best method of detection of retained glass intraocular foreign body is:

A. CT scan (Correct Answer)
B. Radiography
C. Ultrasonography
D. Tonography

Explanation: ***CT scan*** - **CT scans** are highly sensitive for detecting **intraocular foreign bodies**, especially radiopaque materials like glass, and can accurately localize them within the eye. - They provide detailed cross-sectional images, which are crucial for surgical planning and assessing associated orbital injuries. - CT is particularly useful when **ultrasound is contraindicated** (suspected globe rupture) or for **metallic foreign bodies**. *Ultrasonography* - **Ultrasonography (B-scan)** is highly effective for detecting glass foreign bodies, as glass creates **high reflectivity** on ultrasound imaging. - It provides excellent visualization of intraocular structures and can detect both radiopaque and radiolucent foreign bodies. - However, it is **contraindicated** if globe rupture is suspected due to the risk of extruding intraocular contents, making CT the safer alternative in such cases. - Its utility can be limited by acoustic shadowing and requires skilled interpretation. *Radiography* - While **radiography** can detect some metallic foreign bodies, it has **limited sensitivity** for small or non-metallic intraocular foreign bodies like glass due to potential superimposition of bony structures. - Its two-dimensional nature can also make precise **localization difficult**. *Tonography* - **Tonography** is a diagnostic test used to measure the **outflow of aqueous humor** from the eye, primarily to evaluate for glaucoma. - It is **not used for detecting or localizing foreign bodies**; its purpose is entirely different, focusing on intraocular pressure dynamics.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free