PANCE EENT 5 — Questions and Answers
Question 1: A 50-year-old presents with progressive bilateral conductive hearing loss. Audiometry shows a Carhart notch at 2000 Hz on bone conduction and an absent stapedial reflex. What is the most likely diagnosis?
- Presbycusis
- Otosclerosis (Correct answer)
- Cholesteatoma
- Ossicular chain disruption from trauma
Correct answer: Otosclerosis
Otosclerosis causes progressive conductive hearing loss from abnormal bony fixation of the stapes footplate; the Carhart notch at 2000 Hz and absent stapedial reflex are classic findings.
Question 2: A 10-year-old with recurrent otitis media now has a white pearly mass visible through the tympanic membrane with a foul-smelling discharge. CT shows erosion of the ossicles. What is the diagnosis?
- Tympanosclerosis
- Cholesteatoma (Correct answer)
- Adenoid hypertrophy
- Glomus tympanicum
Correct answer: Cholesteatoma
Cholesteatoma is a destructive accumulation of keratinizing squamous epithelium in the middle ear that erodes ossicles and can extend intracranially; surgical removal is required.
Question 3: A 2-year-old presents with sudden onset of choking followed by persistent unilateral wheezing and decreased breath sounds on the right. The child is now afebrile and in no respiratory distress. Chest X-ray shows right-sided hyperinflation. What is the next step?
- Bronchodilator treatment and observation
- Chest CT scan
- Rigid bronchoscopy for foreign body removal (Correct answer)
- Antibiotic therapy for pneumonia
Correct answer: Rigid bronchoscopy for foreign body removal
Aspirated foreign body in the airway presents with unilateral air trapping and requires rigid bronchoscopy for definitive removal under controlled conditions.
Question 4: A 40-year-old presents with unilateral progressive sensorineural hearing loss, high-frequency tinnitus, and unsteadiness. MRI with gadolinium shows an enhancing cerebellopontine angle mass. What is the most likely diagnosis?
- Meningioma
- Epidermoid cyst
- Vestibular schwannoma (acoustic neuroma) (Correct answer)
- Facial nerve hemangioma
Correct answer: Vestibular schwannoma (acoustic neuroma)
Vestibular schwannoma arises from the Schwann cells of CN VIII at the internal auditory canal, presenting with unilateral sensorineural hearing loss, tinnitus, and imbalance.
Question 5: A 25-year-old presents with painless, progressive bilateral sensorineural hearing loss since age 12. He has no family history of hearing loss. He is found to have hematuria on urinalysis. Renal biopsy shows thinning of the glomerular basement membrane with a split lamina densa. What syndrome is this?
- Waardenburg syndrome
- Usher syndrome
- Alport syndrome (Correct answer)
- Pendred syndrome
Correct answer: Alport syndrome
Alport syndrome is an X-linked disorder of type IV collagen causing sensorineural hearing loss and nephritis with characteristic lamina densa splitting on electron microscopy.
Question 6: A 60-year-old diabetic male presents with severe left-sided otalgia, purulent otorrhea, and granulation tissue visible in the external auditory canal. He has facial nerve palsy. CT shows cortical bone erosion at the skull base. What is the most likely organism?
- Staphylococcus aureus
- Aspergillus niger
- Pseudomonas aeruginosa (Correct answer)
- Streptococcus pneumoniae
Correct answer: Pseudomonas aeruginosa
Malignant (necrotizing) external otitis in diabetics is almost exclusively caused by Pseudomonas aeruginosa; facial nerve palsy indicates skull base osteomyelitis requiring prolonged IV antipseudomonal therapy.
Question 7: A 35-year-old presents with episodic positional vertigo triggered when lying down or rolling over in bed. Episodes last less than 1 minute. Dix-Hallpike test elicits upbeat-torsional nystagmus with a latency of 5 seconds. What is the first-line treatment?
- Vestibular suppressant medications (meclizine)
- MRI of the posterior fossa
- Epley canalith repositioning maneuver (Correct answer)
- Intratympanic gentamicin injection
Correct answer: Epley canalith repositioning maneuver
The Epley canalith repositioning maneuver moves displaced otoliths out of the posterior semicircular canal and is the first-line treatment for posterior canal BPPV.
PANCE EENT 5
A 50-year-old presents with progressive bilateral conductive hearing loss.
Audiometry shows a Carhart notch at 2000 Hz on bone conduction and an absent stapedial reflex.
What is the most likely diagnosis?