Ear nose and throat

Question 1

Which vertigo conditions have..

Normal hearing

Hearing loss

Answer 1

Normal: BPPV, Vestibular neuronitis

Loss: Labyrinthitis, meniere’s, acoustic neuroma

Question 2

How do BPPV and VN differ on…

Duration

History

Investigation

Answer 2

BPPV // VN

<60s // <72hrs

Head movement // Viral URTI

Dix-Hallpike // Head impulse

Question 3

What is the treatment for

BPPV

Vestibular neuronitis

Answer 3

Epley

Prochlorperazine

Question 4

How do you differentiate between labyrinthitis and Meniere’s in terms of duration and hisory?

How do you treat them?

Answer 4

Labyrinthitis: ~72hrs, viral and ear infections

Meniere’s: 20m to hours, Fullness and imbalance

Both get prochlorperazine + antihistamines

Meniere’s has beta-histine for prevention

Question 5

Constant dizzyness with unilateral hearing loss and facial palsy indicates what?

How do you investigate and manage the condition?

Answer 5

Acoustic neuroma (vestibular schwanomma)

2WW for MRI

<3cm: Radiotherapy

>3cm: Surgical excision

Question 6

What ear conditions cause pain?

Answer 6

Otitis externa

Otitis media

Mastoiditis

Question 7

How can you differentiate between otitis externa, media and mastoiditis in terms of

Symptoms

History

Otoscopy

Answer 7

OE // AOM // Mastoiditis

Discharge and itchy // conductive hearing loss, fever // Severe pain, protruding ear, systemic unweel

Hx swimming // URTI // otitis media

red swollen, flaky canal // buldging tympanic membrane // possible perforation, ear discharge

Question 8

How do you treat otitis externa?

Answer 8

1st: topical antibiotics (acetic acid) +/- steroid

+ oral abx/antifungals if spreading

Failsure: ENT referral

Question 9

What do you do with a diabetic with deep ear pain, discharge and temporal headaches

Answer 9

Urgently refer for CT and IV antibiotics

Likely malignant otitis externa

Question 10

What organisms typically cause malignant otitis externa?

Answer 10

Pseudomonas

Question 11

What antibiotic is first line in otitis media and when should you give it?

Answer 11

Amoxicillin 5-7 days (macrolide if allergic)

Give if…

• >4 days
• systemically unwell without admission need
• Vulnerable (<2yrs, IC)
• Perforation or discharge in canal

-

Question 12

What is the treatment for mastoiditis?

Answer 12

IV antibiotics

Question 13

What are the complications of mastoiditis?

Answer 13

Meningitis

Hearing loss

Facial nerve palsy

Question 14

How does cholesteatoma difer from otitis or mastoiditis?

Answer 14

Non painful

Smelly discharge

Conductive hearing loss

Hx cleft palate

Question 15

What does the following show on otoscopy?

Answer 15

Attic crust (red arrow), bone (blue arrow)

Cholesteatoma

Question 16

How do you manage cholesteatoma?

Answer 16

Refer to ENT for CT petrous bones

Question 17

Painless conductive hearing loss in a young child indicates what and how do you treat it?

Answer 17

Glue ear

Grommet for 10 months

Adenoidectomy

Question 18

How does presbycussis and otosclerosis compare in terms of…

Hearing loss

Age of onset

Tinnitus

Answer 18

Presbycussis // Otosclerosis

Bilateral conductive // Bilateral sensory

Increases with age // 20-40s, family history

Common // Uncommon

Question 19

How do you confirm presbycusis?

Answer 19

-ve otoscopy, tympanometry and inflammatory markers

Question 20

How can you tell if tonsillitis would benefit from antibiotics

Answer 20

CENTOR >=3 OR FeverPAIN >=4

Fever >38 degrees

Purulence

Acute onset (FeverPain)

Inflammation

No cough

Question 21

For tonsilitis, what is the

Bacterial cause

Antibiotic therapy

Answer 21

Group A strep (pyogenes)

1st: Pen V (phenpen) 10 days (doxy, clarithromycin)

Question 22

When would a tonsillectomy be considered?

Answer 22

7 bouts in 1yr

5 bouts in 2 yrs

3 bouts in 3 yrs

Question 23

What is the management pathway for sinusitis

Answer 23

Conservative for 10 days

> 10 days, bacterial cause unlikely: Nasal spray

>10 days, bacterial cause likely: PhenPen

Question 24

How is post-tonsillectomy bleeding managed?

Answer 24

6-8hrs: Theatre

5-10 days: Admit for IV antibiotics

Question 25

How does mouth opening and uvula deviation play a role in sore throat

Answer 25

Trismus and deviation of uvula to one side indicates quinsy

Needs incision, drainage and IV antibiotics

Question 26

How can you tell between anterior and posterior nosebleed clinically?

Answer 26

Posterior is more likely bilateral and profuse

Posterior is venous (Wooruff) while anterior is arterial (Kiesselbachs)

Question 27

What is the management steps of nosebleed?

Answer 27

1. Sit face forward and pinch cartilage for 20 mins
2. Cauterise if visible, pack if fails
3. Ligate/embolise

Question 28

When do you admit for nosebleed?

Answer 28

Profuse, bilateral or non-visualised

Question 29

Following nasal trauma, what is important to examine for?

Answer 29

Boggy septum

Boggy: Incise and drain haematoma <24hrs

Not: Splint + outpatient review

Question 30

Sore throat with enlarged ant and posterior chains with raised WCC and ALT indicates what condition?

How do you investigate and treat it?

Answer 30

Infectious mononucleosis

2 week monospot

Conservative

Avoid heavy contact due to splenic rupture risk

Question 31

What nature of nose symptoms are worrying?

Answer 31

Unilateral (eg mass leakage)

Urgent referral