11/13/2013

11/13/2013

Answers:

In what disease can Auspitz sign be observed?
A) SCCA 
B) BCCA 
C) Contact Dermatitis 
D) Atopic Dermatitis 
E) Psoriasis

Auspitz sign is bleeding on pinpoint areas when skin is scratched and is indicative of psoriasis. Psoriatic lesions can be present on the external ear.

What is the most common neoplasm of the auricle?

Basal Cell Carcinoma is the most common accounting for 45% of auricular neoplasms. It most often presents on the posterior pinna or preauricular region.

MC Questions:
With regards to embryology, Meckel's cartilage leads to formation of the --- whereas Reichert cartilage leads to formation of the---.
A) Stapes Footplate; Sphenomandibular ligament 
B) Long Process of Incus; Stapes Suprastructure
C) Body of Incus; Mandible  
D) Head of Malleus; Manubrium of Malleus

Free Response Question:
All of the muscles of facial expression are innervated on their deep side except for what three exceptions?

Quick Facts:

Jugular Vein Anomalies (Jugular bulb dehiscence):
-sigmoid sinus and inf. petrosal sinus converge at jugular bulb.
-usually surrounded by bone in jugular fossa, but can have congenital dehiscence.
-“High riding” bulb = bulb that rises above the inferior aspect of the bony annulus or the basal round of the cochlea.
-Present in 5% of people, may be related to poor pneumatization of mastoid.
-Can present with tinnitus, vestibular symptoms and CHL (due to compression of middle ear contents)
-Most commonly discovered incidentally on exam.
-Classically a blue mass is seen posteroinferior quadrant of TM.
-At risk of inadvertent laceration during myringotomy.

11/12/2013

11/12/2013

Answers:

What is the most common organism responsible for otomycosis?
A) Aspergillus 
B) Candida 
C) Tinea 
D) Coccidio 
E) Pseudomonas

Aspergillus is the most common organism (80%) to cause otomycosis. Candida is the second most common organism.

What is the classic finding for malignant otitis externa on physical exam?

Granulation tissue on the EAC floor at the osteocartilaginous junction.

MC Questions:
In what disease can Auspitz sign be observed?
A) SCCA 
B) BCCA 
C) Contact Dermatitis 
D) Atopic Dermatitis 
E) Psoriasis

Free Response Question:
What is the most common neoplasm of the auricle?

Quick Facts:

Melanoma of External Ear:
-10 yr survival rate of 70%.
-Most present on helix.
-Initially painless but lesion often changes in size, ulceration/bleeding.
-Do thorough H&N exam for possible mets.
-Dx on biopsy. Must do metastatic eval (CXR, LFT, possible CT/MRI/radionuclide bone scans)
-Stage using AJCC guidelines.
-DDx includes benign lesions/BCCA/SCCA.
-Can use RTX palliatively
-Surgical resection dependent on histo/stage.
-Management of regional lymphatics is controversial. Sentinel lymph node biopsy is well accepted for N0 lesions w/ >1mm depth.
-Prevent by avoiding sun exposure.