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152.Explanation Correct Answer - C Ans. is 'c' i.e., Rhinosporidiosis Rhinosporidiosis Rhinosporidiosis is a chronic granulomatous infection of the mucous membrane that usually manifests as vascular friable polyps that arise from the nasal mucosa. The etiological agent is Rhinosporidium seeberi. Rhinosporidium seeberi is an aquatic bacterum (not a fungus). Infection usually results from a local traumatic inoculation with the organism. It is seen in India, Pakistan and Sri Lanka. In India, most of the cases are seen in Southern states. Infection of the nose and nasopharynx is observed in 70% of persons with rhinosporidiosis; infection of palpebral conjunctiva or associated structures (including lacrimal apparatus) is observed in 15% of cases. Other structures of the mouth and upper airway may be sites of disease. Disease of the skin, ear, genitals and rectum has also been described. Rhinosporidiosis is an infection that typically limited to the mucosal epithelium. The disease progress with local replication of R seeberi and associated hyperplastic growth of host tissue and a localized immune response. Clinical features of Rhinosporidiosis Rhinosporidiosis presents as soft leafy polypoidal mass (soft polyp), which is pink to purple in colour studded with white dots, i.e. strawberry appearance. This appearance results from sporangia,which is visible as grey or yellow spots in the vascular polypoid masses. Because the polyps are vascular and friable, they bleed easily upon manipulation. Treatment The treatment of choice is surgical excision. Complete excision of mass is done with diathermy knife and cauterization of base. Dapsone is being tried for treating rhinosporidiosis but with limited success Join @ENThubs

151.Explanation Correct Answer - C Ans. is 'c' i.e., Beta hemolytic streptococcus Peritonsillar abscess (Ouinsy) Quinsy consists of suppuration outside the capsule in the area around the capsule. There is collection of pus between the capsule of tonsil and the superior constrictor muscle, i.e. in the peritonsillar area. Peritonsillar abscess is a complication of tonsillitis and is most commonly caused by group A beta - hemolytic streptococcus. Clinical features of Quinsy Clinical features are divided into :? General : They are due to septicaemia and resemble any acute infection. 1. They include fever (up to 104°F), chills and rigors, general malaise, body aches, headache, nausea and constipation. 2. Local : 3. Severe pain in throat. Usually unilateral. 4. Odynophagia. It is so marked that the patient cannot even swallow his own saliva which dribbles from the angle of his mouth. Patient is usually dehydrated. 5. Muffled and thick speech, often called "Hot potato voice". 6. Foul breath due to sepsis in the oral cavity and poor hygiene.7. Ipsilateral earache. This is referred pain via CN IX which supplies both the tonsil and the ear. 8. Trismus due to spasm of pterygoid muscles which are in close proximity to the superior constrictor. Examination findings 1. The tonsil, pillars and soft palate on the involved side are congested and swollen. Tonsil itself may not appear enlarged as it gets buried in the oedematous pillars. 2. Uvula is swollen and oedematous and pushed to the opposite side. 3. Bulging of the soft palate and anterior pillar above the tonsil. 4. Mucopus may be seen covering the tonsillar region. 5. Cervical lymphadenopathy is commonly seen. This involves jugulodigastric lymph nodes. 6. Torticollis : Patient keeps the neck tilted to the side of abscess. Treatment of peritonsillar abscess IV fluids Antibiotics : High dose penicllin. (iv benzipenicillin) is the DOC. In patients allergic to penicillin erythromycin is the DOC. Incision and drainage per orally, if the abscess does not resolve depite high dose of iv antibiotics Tonsillectomy is done 6 weeks following an attack of quinsy (interval tonsillectomy). Join @ENThubs

150.Explanation Correct Answer - A Ans. is 'a' i.e., Serous otitis media Any accumulation of fluid behind tympanic membrane causes structural changes in tympanic membrane causing it to appear blue, be it pus, blood or serous fluid. The most common cause of fluid accumulation in middle ear is serous otitis media or glue ear (most common cause) and haemotympanum. Other causes of blue tympanic membrane are glomus tumor, hemangioma of middle ear, and cholesterol granuloma. Join @ENThubs

149.Explanation Correct Answer - D Ans. is 'd' i.e., All of the above Join @ENThubs

148.Explanation Correct Answer - D Ans. is 'd' i.e., Moderately severe Join @ENThubs

147.Explanation Correct Answer - A Ans. is 'a' i.e., Anteroinferior Cone of light Seen in anteroinferior quadrant of the tympanic membrane is actually the reflection of the light projected into the ear canal to examine it. This part reflects it because it is the only part of tympanic membrane that is approximately at right angles to the meatus. This difference in different part of the tympanic membrane is due to the handle of malleus which pulls the tympanic membrane and causes it to tent inside. Thus, the handle of malleus causes tenting and because of tenting the antero-inferior quardrant is at right angles to the meatus and thus reflects the light (leading to cone light). Join @ENThubs

146.Explanation Correct Answer - B Ans. is 'b' i.e., Radiotherapy Treatment of nasopharyngeal carcinoma Irradiation is treatment of choice (external radiotherapy)., Radical neck dissection is required for persistent nodes when primary has been controlled and in post radiation cervical metastasis. Systemic chemotherapy is used as palliation for distant metastases or radiation failure. For advanced stages (stage III & IV), the cure rate can be doubled when chemotherapy is combined with radiotherapy Join @ENThubs