Repeated Medical PG Question- 70

#ENT(NEET-PG)

Q- A 36 years old obese man was suffering from hyperten­sion and snoring. Patient was a known smoker. In Sleep test, there were 5 apnea/hyperapneas episodes per hour. He was given antihypertensives and advised to quit smoking. Next line of management?

A. Uvulopalatopharyngeoplasty

B. Weight reduction and diet plan

C. Nasal CPAP

D. Mandibularrepositioning sling

Answer is B. Weight reduction and diet plan

The primary treatments of obstructive sleep apnea are: weight loss in those who are overweight, continuous positive airway pressure, and mandibular advancement devices. There is little evidence to support the use of medications or surgery.

Continuous positive airway pressure (CPAP) is effective for both moderate and severe disease. It is the most common treatment for obstructive sleep apnea.

Adherence to CPAP is generally better than that to an MRS, and there is evidence that CPAP improves driving, whereas there are no such data on MRSs. Thus, CPAP is the current treatment of choice (for both moderate and severe disease). However, MRSs are evidence-based second-line therapy in those who fail CPAP.

There is no proven evidence that pharyngel surgery, including uvulopalatopharyngoplasty (whether by scalpel, laser or thermal techniques) helps OSAHS patients.

Q- A patient presents to your clinic for evaluation of defective hearing. Rinne's test shows air conduction greater than the bone conduction on both sides with Weber test lateralized to right ear. What is the next logical step?

 

        A. Normal test

        B. Schwabach's test

         C. Repeat Rinne's test on right side

         D. Wax removal

Answer is B. Schwabach's test

Lateralization of Weber's test to right implies either right-sided conductive deafness or left-sided sensorineural deafness.

Now in conductive deafness bone conduction is better than air conduction in Rinnie's test, hence the patient probably has sensorineural deafness involving the left ear, as per the findings of Rinnie's and Weber tests.

In such a case, Schwabach's test should be performed to see the absolute bone conduction.

Answer is D. Keratosis obturans

▪️Given image is Keratosis obturans, 

otoscope view.

▪️This is a rare condition of the ear canal with a generalised failure of migration of the normalcanal skin.The skin accumulates and the underlying boneis resorbed. Here there is a deep widening of the ear canal with exposure of the circular annulus at the edge of the tympanic membrane (eardrum,centre).

▪️The jugular vein (purple) can be seen through the remaining tissue on the floor of the ear canal.

▪️The eardrum is relatively unaffected here.