Question Samples for Students and Residents

[resxn]

Just because, I thought about once a week I'd pose a question that makes you think and can teach you alot especially if you look into the why part of each one. I wouldn't suppose these are questions from the in-service or on boards, but let's just say they may be useful reviewing. I'll post the answers each weekend. If someone has a great answer, I'll quote it rather than writing out my own.

If this is stupid and no one likes to submit any answers, I'll stop. I don't think those who've been through the boards will have much trouble with these, but here goes submission #1:

Which of the following scenarios will have the worst conductive hearing loss and why? Unless stated, assume everything else is normal.
a - 25% TM perforation
b - 100% TM perforation (entirely missing)
c - NL TM and ossicular chain discontinuity
d - 50% TM perforation and ossicular chain discontinuity

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[neutropeniaboy]

Which of the following scenarios will have the worst conductive hearing loss and why? Unless stated, assume everything else is normal.
a - 25% TM perforation
b - 100% TM perforation (entirely missing)
c - NL TM and ossicular chain discontinuity
d - 50% TM perforation and ossicular chain discontinuity

Nice one...classic otology pimp question.

 

[srabiei]

**** C is correct
c - NL TM and ossicular chain discontinuity
Becuses:
Normal TM act as a barrier for sound and ossicular chain discontinuity cut any traveling wave so we have about 60 db CHL

Total perforation has cancelling effect but sound wave reach to Oval or Round window

Other perforation has minimal CHL

 

[resxn]

**** C is correct
c - NL TM and ossicular chain discontinuity
Becuses:
Normal TM act as a barrier for sound and ossicular chain discontinuity cut any traveling wave so we have about 60 db CHL

Total perforation has cancelling effect but sound wave reach to Oval or Round window

Other perforation has minimal CHL

That is correct. I won't say more on this one, pretty straight forward.

I will post the next question tomorrow.

 

[resxn]

This one may not be hard, but you'll certainly see it either by getting pimped or by seeing it on a written exam.

What is the only thyroid cancer which has not been reported in a thyroglossal duct cyst, and why?





Another one not so hard, but good for review:

After a routine FESS, you notice that a patient has one pupil larger than another in the PACU. Intraoperatively, there was nothing to indicate that orbital injury may have occurred. Standard medications were used for anesthesia and decongestion. They do not complain of significant symptoms and have no unexpected pain. There is no periorbital ecchymosis. The dilated pupil appears to constrict minimally to light. No mental status changes.

What is the next best step in management and why?

 

[resxn]

post closed for lack of interest.

 

[Sonnet]

Would have liked to hear the answers.

 

[resxn]

Would have liked to hear the answers.

The first answer is Medullary Thyroid Carcinoma because the parafollicular c-cells do not descend with the thyroid anlauge and instead migrate into it after it reaches it's final destination in the neck. Since MTC only develops from the parafollicular c-cells and not the thyroid tissue that descends from the foramen caecum, MTC has not been reported in a TGDC which is remnant tissue of the anlauge's descent.

The 2nd answer is wait. If there was no indication of intraoperative complications and there are no other signs of orbital injury post-operatively, then watchful waiting is in order. It is likely that oxymetazoline (Afrin) either diffused into the orbit through the lamina, or much more commonly excess afrin dripped out of the nose and into the eye externally where it caused a sympathomimetic response. The dilated pupil post-op is less worrisome than the constricted one in the absence of findings concerning for trauma. The afrin effect should wear off in a couple of hours and certainly it would not hurt to have an ophtho eval because you don't want to miss increasing IOP or a retrobulbar hemorrhage which can occur even without violation of the lamina papyrecea intra-operatively.

 

[Sonnet]

Fascinating! I loved this whole thread, it's intellectually a pleasure to follow the reasoning.

 

[srabiei]

1- what is the most common benign tumor of salivary glands?

2- more difficult:

What the different of PTA (pure tone audiometry) in Otosclerosis and Congenital Fixation of Ossicles

3- Why the SCC of true Vocal cord is better than suprglottic carcinoma?

4- What is the Cogan's Syndrome?

5- which one is more Effective: Epley or Semont' Maneuver?

 

[toofache32]

1- what is the most common benign tumor of salivary glands?

2- more difficult:

What the different of PTA (pure tone audiometry) in Otosclerosis and Congenital Fixation of Ossicles

3- Why the SCC of true Vocal cord is better than suprglottic carcinoma?

4- What is the Cogan's Syndrome?

5- which one is more Effective: Epley or Semont' Maneuver?

1. Pleomorphic adenoma?

2. I have know idea what you're talking about

3. less "rich" lymphatic drainage with vocal cords?

 

[srabiei]

1- what is the most common benign tumor of salivary glands?
mixed tumor

2- more difficult:

What the different of PTA (pure tone audiometry) in Otosclerosis and Congenital Fixation of Ossicles
....as noted by : megboo ...graet

3- Why the SCC of true Vocal cord is better than suprglottic carcinoma?
No lymoh node and early laryngeal symptom like hoarsness

4- What is the Cogan's Syndrome?
again as noted megboo...
vertigo + hearning loss + non-syphilic interstitial keratitis

5- which one is more Effective: Epley or Semont' Maneuver?
epley's more effective

thank megboo...