ENT MCQ SET 4 ON FB Drpulkitagarwal’s DNB ENT & OSCE

Mcq1 .

Best response: D

Although second-hand smoke has been thought to be linked to OM, no studies have
demonstrated direct causation. Epidemiologic studies of OM have demonstrated a higher
incidence of disease in children attending day care, those with a strong family history, those of
Native American ethnicity, and those with significant anatomic abnormalities of the head and
neck.

Mcq2.

Best response: B

Studies have not been able to demonstrate increases in serum IgE levels in children with OME.
Studies have found immune complexes in the serum and middle ear effusion of children with
OME. In addition, other indicators, including increased IgG levels, mast cell degranulation, and
eustachian tube edema secondary to inflammatory mediators, have all been identified.

Mcq3.

Best response: C

Otitis media associated with confirmed or potential suppurative complications is an absolute

indicator for tympanocentesis. In addition, the procedure may be used to relieve severe otalgia
and to confirm the microorganisms present in the middle ear to determine appropriate antibiotic
coverage. Otitis media in the newborn or immunocompromised child also presents the potential
for unusual microorganisms, thus indicating the need for appropriate identification of middle ear
contents.

Mcq4.

Best response: A

Group A Streptococcus is more likely to cause OM than group B. Streptococcus pneumoniae, H.

influenzae, B. catarrhalis, and S. aureus have all been implicated as common pathogens in OM.

Mcq5.

Best response: B
 Controlled studies have failed to demonstrate the efficacy of antihistamines in the treatment of
OM. Similar studies have shown efficacy in the treatment with antibiotics, corticosteroids, and
tympanostomy tubes. Some European studies have demonstrated that analgesics alone without
any other therapy may be efficacious.

Mcq6.

Best response: C

Corticosteroids are thought to increase secretion of eustachian tube surfactant. Corticosteroids

are thought to be useful in the prevention of inflammatory mediators and arachidonic acid. They
are also felt to reduce middle ear viscosity as well as peritubal lymphoid tissue.

Mcq7.

Best response: E

Studies have shown that chronic middle ear fluid may spontaneously resolve up to 12 weeks
after onset. Tympanostomy tubes have been found useful in patients who are unresponsive to
antibiotic therapy, have a significant conductive hearing loss, and demonstrate severe enough
middle ear negative pressure to risk cholesteatoma formation. They are also efficacious in
patients who have antibiotic allergies for which options for treatment are significantly
diminished.

Mcq8.

Best response: E

There is strong evidence that adenoidectomy will assist in relieving all of the conditions listed
except vasomotor rhinitis. At this point, no definitive cause for this entity has been identified.
The nasal obstruction associated with vasomotor rhinitis does not improve with removal of
adenoid tissue.

Mcq9.

Best response: A

All children will ultimately benefit from this vaccine. Pneumococcus is the most common
bacterial cause of OM in children.

Mcq10.

Best response: E
Numerous clinical trials have concluded that some patients may respond to a 21- to 30-day
course of full-dose antibiotic therapy. No data exist for shorter courses of antibiotics. The use of
antihistamines has not proven efficacious in any trial to date. Decongestants have been shown
to be effective in reducing nasal congestion, but efficacy in middle ear disease is uncertain.