ENT

Question 1

Where is the problem is conductive hearing loss?

Answer 1

due to external / middle ear

Question 2

Where is the problem is sensorineural hearing loss?

Answer 2

due to inner ear / CNVIII

Question 3

Signs of CHL compared to normal on rinnes test?

Answer 3

Normal = air conduction > bone conduction

CHL = bone conduction > air conduction

Question 4

Signs of CHL and SNHL compared to normal on weber test?

Answer 4

Normal =equal

CHL = lateralises to affected ear

SNHL = sound louder in normal ear

Question 5

Common organisms of Acute Otitis Media and how does it happen?

Answer 5

URTI migrates to middle ear via eustachian tube

common organisms : strep pneumoniae and h.influenzae

Question 6

When should Abx be given in Acute Otitis Media and what is given?

Answer 6

Symptoms for more than 4 days, under 2 years old, systemically unwell or perforation

Amoxicillin for 5-7 days

Question 7

Acute Otitis Media

Common complications?

Answer 7

hearing loss

mastoiditis

Question 8

CHOLESTEATOMA

symptoms?

Answer 8

foul smelling brown discharge

hearing loss

Question 9

CHOLESTEATOMA

signs on otoscopy?

Answer 9

Otoscopy

‘attic crust’ - seen in the uppermost part of the ear drum

Question 10

CHOLESTEATOMA

What congenital abnormality increases the risk?

Answer 10

Cleft palate increases the risk by 100 fold

Question 11

CHOLESTEATOMA

What is it?

Answer 11

Growth of keratinising squamous epithelial cells trapped in skull base causing localised destruction

Question 12

Otitis Externa

What is it commonly known as?

Symptoms?

Answer 12

Swimmers ear

SWIM DIP
Discharge
Itch
Pain

Question 13

Otitis Externa

Common causing bacteria?

Answer 13

pseudomonas aeruginosa

staph aureus

Question 14

Otitis Externa

Treatment?

Answer 14

topical antibiotic or a combined topical antibiotic with a steroid

if a pt fails to respond to tx refer to ENT

Question 15

BPPV

Features?

Answer 15

vertigo triggered by change in head position associated with nausea lasting 10-20 seconds

Question 16

BPPV

Cause?

Answer 16

canaliths (crystals) in semi-circular canals

Question 17

BPPV

What test is a positive sign?

Answer 17

Hallpike manoeuvre

causes rotatory nystagmus

Question 18

Symptomatic relief of BPPV?

Answer 18

Epley manoeuvre (successful in around 80% of cases)

Question 19

Meniere’s Disease

features including Triad?

how long do episodes last and how long may someone have symptoms for?

Answer 19

Vertigo
Tinnitus
Sensorineural hearing loss

+ sensation of fullness in the ear

episodes lasting minutes to hours
resolve after 5-10 years

Question 20

What causes Meniere’s Disease

Answer 20

Excessive pressure and progressive dilation of the endolymphatic system

Question 21

What is Vestibular Neuronitis

Answer 21

cause of vertigo that often develops following a viral infection.

Question 22

Features of Vestibular Neuronitis?

Answer 22

vertigo lasting hours - days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus

Question 23

Management of Vestibular neuronitis?

Answer 23

1st - vestibular rehabilitation exercises

2nd - a short oral course of prochlorperazine

Question 24

Most common type of head and neck cancer?

Answer 24

Squamous cell carcinomas

Question 25

how can vestibular neuritis be distinguished from Labyrinthitis

Answer 25

vestibular neuritis = the vestibular nerve is involved, hence there is no hearing impairment; Labyrinthitis is used when both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment.

Question 26

Features of Labyrinthitis?

Answer 26

Patients typically present with an acute onset of: vertigo: not triggered by movement but exacerbated by movement nausea and vomiting hearing loss tinnitus preceding or concurrent symptoms of upper respiratory tract infection

Question 27

What causes a Septal Haematoma and what happens if it is left untreated?

Answer 27

Trauma untreated causes irreversible septal necrosis and 'saddle nose' deformity

Question 28

Sign of Septal Haematoma

Answer 28

Feeling of nasal obstruction and classically, bilateral swelling arising from septum

Question 29

Management of recurrent or chronic sinusitis?

Answer 29

avoid allergen intranasal corticosteroids nasal irrigation with saline solution

Question 30

What to do if acute sinusitis lasts more than 10 days?

Answer 30

intranasal corticosteroids may be considered

Question 31

Epistaxis common location of bleeds?

Answer 31

Anterior (90%) - Klasselbach's Plexus Posterior - Woodnuffs Plexus

Question 32

Epistaxis management?

Answer 32

1) Lean forward with mouth open and pinch cartilage for 20 mins 2) Cauterise bleeding if it can be visualised 3) Pack the nose if it can't be visualised 4) Give topical antiseptic (Naseptin) if first aid measures successful