MCQs on ENT diseases

ByAMC Wise

Question 2201-1

A 3-year-old child presents to you with irritability, pulling at their ear, and a fever for the past two days. On examination, you observe a bulging and erythematous tympanic membrane in the right ear. The child has been experiencing a cold and nasal congestion recently. What is the most likely diagnosis?

  • A) Allergic Rhinitis
  • B) Pharyngitis
  • C) Sinusitis
  • D) Otitis Media
  • E) Tonsillitis

Answer: D) Otitis Media

Otitis media is a common condition in children, characterized by inflammation of the middle ear. It often presents with ear pain, irritability, fever, and pulling at the ear. Examination may reveal a bulging and erythematous tympanic membrane. In this case, the child’s recent cold and nasal congestion are common predisposing factors for the development of otitis media.

Question 2201-2

A 2-year-old child is brought to the GP with complaints of ear pulling and fever. On examination, the tympanic membrane is red and bulging, with the loss of anatomical landmarks. What is the most appropriate next step in management?

  • A) Analgesics and watchful waiting
  • B) Prescribe amoxycillin
  • C) Prescribe cefaclor
  • D) Refer to an otolaryngologist
  • E) Administer antibiotic ear drops

Answer: B) Prescribe amoxycillin

The presence of a red and bulging tympanic membrane with the loss of anatomical landmarks and is an indication to start antibiotic therapy in Otitis Media. Amoxicillin is the initial antibiotic of choice. (amoxycillin 15 mg/kg 8 hourly up to 500 mg (PO) for 5 days
or amoxycillin 30 mg/kg 12 hourly (PO) for 5 days)

Question 2201-3

A 4-year-old child with a viral upper respiratory tract infection (URTI) presents with mild reddening of the eardrum. The child has no systemic features such as fever or vomiting. What is the most appropriate next step in the management?

  • A) Prescribe amoxycillin immediately
  • B) Refer for a myringotomy
  • C) Administer analgesics and watchful waiting
  • D) Refer to an audiologist for hearing assessment
  • E) Prescribe antibiotic ear drops

Answer: C) Administer analgesics and watchful waiting

Explanation: In the absence of systemic features and with mild reddening of the eardrum in the context of a viral URTI, the best practice is symptomatic relief with analgesics and watchful waiting.

Antibiotic eardrops are indicated for the treatment of acute otorrhoea in children with grommets only.

Question 2201-4

A 5-year-old child presents with persistent middle ear effusions following an episode of otitis media. What potential impact does persistent middle ear effusions have on the child’s development?

  • A) Respiratory distress
  • B) Gastrointestinal bleeding
  • C) Language and cognitive development
  • D) Visual impairment
  • E) Cardiovascular abnormalities

Answer: C) Language and cognitive development

If not treated properly, Persistent middle ear effusions may affect the language and cognitive development of young children.

Question 2201-5

What is the recommended follow-up timeframe for parents to contact their doctor if no improvement occurs in a child with acute otitis media with oral antibiotics?

  • A) 24 hours
  • B) 48 hours
  • C) 72 hours
  • D) 96 hours
  • E) 1 week

Answer: C) 72 hours

Parents should be encouraged to contact their doctor if no improvement occurs within 72 hours in a child with acute otitis media. This is particularly important as lack of improvement within this timeframe may indicate a resistant organism or suppuration.

Cefaclor or Amoxycillin/potassium clavulanate can be used if initial treatment with Amoxycillin fails.

Question 2201-6

A 3-year-old child develops pain, swelling, and tenderness behind the ear, along with a general deterioration in their condition. What is the most appropriate immediate action?

  • A) Prescribe oral antibiotics
  • B) Administer pain relief medication
  • C) Prescribe ciprofloxacin ear drops
  • D) Refer for an ENT opinion
  • E) Refer for myringotomy

Answer: D) Refer for an ENT opinion

The symptoms described are indicative of acute mastoiditis, a serious complication of otitis media. Immediate referral is required ENT opinion.

Question 2201-7

A 2-year-old child with a persistent ear effusion for 3 months is brought to the GP. What is the recommended course of action for this patient?

  • A) Prescribe a second course of oral antibiotics
  • B) Observe for another 3 months
  • C) Prescribe Ciprofloxacin ear drops
  • D) Prescribe bromhexine elixir
  • E) Refer for hearing assessment and ENT opinion

Answer: E) Refer for an ENT opinion

If an effusion lasts for more than 3 months, it is recommended to arrange for a hearing assessment and referral to an ENT surgeon for possible tympanostomy tube (grommet) insertion.

Question 2201-8

A 3 year old child is diagnosed with serous otitis media (glue ear), with loss of drum mobility as confirmed by pneumatic otoscopy. What is the most appropriate next step in the management of this child?

  • A) Refer for Myringotomy
  • B) Prescribe Bromhexine elixir
  • C) Prescribe Amoxicillin
  • D) Prescribe Cefaclor
  • E) Hospital admission

Answer: B) Bromhexine elixir

Serous otitis media (glue ear) is due to the incomplete resolution of suppurative otitis
media.

Most cases of glue ear resolve spontaneously.

Medications such as bromhexine elixir and Demazin syrup, along with other interventions like autoinflations and ‘Otovent’ assisted nasal inflation can be used as treatment options of serous otitis media.

Question 2201-9

A 2 year old child is having recurrent episodes of acute otitis media, with 4 episodes during the last 6 months. What is the recommended approach for chemoprophylaxis in this child?

  • A) Prescribe amoxycillin once daily
  • B) Prescribe ciprofloxacin ear drops
  • C) Observe without antibiotic prophylaxis
  • D) Prescribe amoxycillin twice daily
  • E) Administer cefaclor daily

Answer: D) Prescribe amoxicillin twice daily

Fore recurrent acute otitis media, Amoxycillin twice daily is the first-choice antibiotic for chemoprophylaxis, administered for 4 months. This is indicated if episodes occur more often than every other month or three or more episodes in 6 months or more than four in 12 months.

Question 2201-10

What is not a valid clinical indication for antibiotic use in children with painful otitis media in Australia?

  • A) Children less than 2 years with unilateral otitis media
  • B) A sick child with fever and vomiting
  • C) Loss of landmarks of the tympanic membrane
  • D) Red–yellow bulging tympanic membrane
  • E) A child with persistent fever and pain after 48 hours of conservative approach

Answer: A) Children less than 2 years with unilateral otitis media

Clinical indications for antibiotics in children with painful otitis media include those <2 years with bilateral otitis media, a sick child with fever, vomiting, red–yellow bulging TM, loss of TM landmarks or perforation, and persistent fever and pain after 48 hours of conservative approach.

References