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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.

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151. Peritonsillar abscess is caused most commonly by ?

Anonymous Quiz

25%

a) Streptococcus pneumoniae

26%

b) Staphylococcus aureus

43%

c) Beta hemolytic streptococcus

d) H. influenzae

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151. Peritonsillar abscess is caused most commonly by ?

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).

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152. Strawberry oppearance is seen in ?

Anonymous Quiz

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152. Strawberry oppearance is seen in ?

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

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