ENT

Question 1

Vestibular neuronitis
Features (4)

Mx (3)

Answer 1

Vertigo recurrent attacks lasting hours or days
N&V
Horizontal nystagmus
No hearing loss or tinnitus

1. Mx buccal/ IM prochlorperazine
2. Antihistamine e.g cinnarizine/ cyclizine
3. Vestibular rehabilitation if chronic

Question 2

Recent viral infection
Sudden onset
N&V
Hearing affected =

Answer 2

Viral labyrinthitis

Question 3

Meniere’s features (3)
Uni or bi
Sx resolve after how long?
Mx (2)
Driving
Prevention mx (2)

Answer 3

Hearing loss
Tinnitus
Fullness/ sensation/ pressure in one or both ears
Unilateral
5-10 years

1. ENT assessment
   No driving until control of sx - DVLA to be informed
2. IM/buccal prochlorperazine
   Prevention: betahistine + vestib rehab

Question 4

Dizziness on extension of neck
Elderly patient
=

Answer 4

Vertebrobasilar ischaemia

Question 5

Hearing loss
Vertigo
Tinnitus
Absent corneal reflex
=

Answer 5

Acoustic neuroma

Question 6

Acoustic neuroma features (4)

Answer 6

Hearing loss
Tinnitus
Vertigo
Absent corneal reflex

Question 7

Tonsillectomy criteria (4)

Complications
<24 hours
>24 hours

Answer 7

> =5 episodes per year
Sore throat secondary to tonsillitis and not URTI
Sx for at least 1 year
Disabling sx and prevent normal function

<24 hours haemorrhage secondary to inadequate haemostasis
>24 hours secondary to infection

Question 8

Tonsilitis complications (4)

Answer 8

Otitis media
Quinsy (peritonsillar abscess)
Rheumatic fever
Glomerulonephritis

Question 9

Otosclerosis
Age
Features (4)
Mx (2)

Answer 9

20-40yo
Conductive deafness
Tinnitus
Normal TM/ flamingo tinge
Positive FH
Mx hearing aid + stapedectomy

Question 10

Medical name for surfer’s ear
Secondary to?
Features (3)

Answer 10

Exostosis
Secondary to repeated exposure to cold water
Repeated ear infection, reduced hearing, water plugging

Question 11

Sudden onset sensorineural hearing loss
Mx (2)
Ix (1) to r/o which condition?

Answer 11

Urgent referral to ENT
High dose PO steroids
MR to r/o vestibular schwannoma (acoustic neuroma)

Question 12

Sore throat
Indications for abx (5)

Answer 12

Systemic upset
Unilateral peritonsilitis
Hx of rheumatic fever
Increased risk from acute infection e.g child with DM or immunosuppressed
Centor criteria 3 or more

Question 13

CENTOR criteria
When to treat?

Answer 13

Cough - no cough
Exudate
Nodes lymph
Temperature
3 or more

Question 14

FeverPain criteria
FPAIN

Tonsilitis mx (1+ if pen allergic) for how long?

Answer 14

Fever
Purulence
Attend rapids (3 days or less)
Inflamed tonsils
No cough

Phenoxymethylpenicillin or clarithro if pen allergic 7-10 days

Question 15

Rinne’s test explained

Answer 15

Tuning fork over mastoid process until no longer heard then position over external acoustic meatus

Positive test AC better than BC
Negative test BC > AC (conductive hearing loss)

Question 16

Weber’s explained

Answer 16

Place tuning fork on the forehead
If you can hear it louder in one ear then the opposite ear has a sensorineural hearing loss

In unilateral conductive deafness sound is localised to the affected side

Question 17

What is Ramsay Hunt syndrome caused by?

Features (5)

Mx (2)

Answer 17

Varicella zoster (herpes zoster)

Auricular pain
Facial nerve palsy
Vesicular rash around ear
Vertigo
Tinnitus

Mx PO aciclovir and steroids

Question 18

Presbycusis type of hearing loss

Answer 18

Bilateral sensorineural hearing loss

Question 19

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age

Answer 19

Cystic hygroma

Question 20

More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected

Answer 20

Thyroglossal cyst

Question 21

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood

Answer 21

Branchial cyst

Question 22

Features of nasopharyngeal carcinoma (6)

Answer 22

More common in individuals from Southern China
Cervical lymphadenopathy
Otlagia
Serous otitis media unilat
Nasal obstruction/ discharge/ bleeding
CN palsies III-VI

Question 23

Mx nasal septal haematoma (2)

Answer 23

Surgical drainage
IV abx

Question 24

What is Samter’s triad?

Answer 24

Association of asthma, aspirin sensitivity and nasal polyposis

Question 25

Mx nasal polyps (2)

Answer 25

All patients should be referred to ENT Topical corticosteroids shrink polp size

Question 26

2ww criteria for mouth lesions (6)

Answer 26

Unexplained oral ulceration or mass persisting > 3 weeks Unexplained red, or red and white patches that are painful, swollen or bleeding Unexplained one-sided pain in the head and neck area > 4 weeks, assoc with ear ache & normal otoscopy Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks Unexplained persistent sore or painful throat Sx in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion

Question 27

What is Ludwig's angina? Features (3)

Answer 27

Progressive cellulitis invading the floor of the mouth and soft tissues Neck swelling, dysphagia, fever

Question 28

Red flags throat (3)

Answer 28

persistent, unilateral throat discomfort dysphagia, odynophagia (i.e. with food rather than just saliva) persistent hoarseness

Question 29

Suspected laryngeal cancer referral guidelines

Answer 29

45yo => with 1. persistent unexplained hoarseness 2. unexplained lump in the neck

Question 30

When to give abx in otitis media? (5)

Answer 30

Sx >4 days or not improving Systemically unwell Immunocompromised <2yo with bilateral otitis media Otitis media with perforation/ discharge

Question 31

Acute sinusitis - when would intranasal steroids be considered?

Answer 31

Sx >10 days

Question 32

Mx allergic rhinitis (3)

Answer 32

PO or intranasal antihistamines intranasal steroids PO steroids

Question 33

Mx auricular haematomas (2)

Answer 33

Same day assessment by ENT I+D

Question 34

Black hairy tongue predisposing factors (5) Mx (2)

Answer 34

HIV IVDU Poor oral hygiene Abx Head and neck ca Swab for candida - give topical antifungals if needed Tongue scraping

Question 35

Unilateral, smooth, soft, fluctuant, non tender, mass, on the left side lateral and anterior to the sternocleidomastoid muscle - slowly enlarging = Age range Gender Ix Mx

Answer 35

Branchial cyst Late childhood or early adulthood M>F Ix USS Mx ENT FNA

Question 36

Attic crust = Other features (2) Age range Being born with what increases the risk of this Mx

Answer 36

Cholesteatoma Foul smelling, non resolving discharge Hearing loss 10-20 Cleft palate Mx ENT surgery

Question 37

RF for glue ear Gender FH Season Feeding x2 other

Answer 37

Male Siblings with glue ear Higher incidence in winter and spring Bottle feeding Day care attendance Parental smoking

Question 38

Glue ear peaks at what age? Presenting feature Mx (2)

Answer 38

2yo Hearing loss Mx grommet insertion/ adenoidectomy

Question 39

Necrotizing ulcerative gingivitis mx (4)

Answer 39

Refer to dentist PO metro 3/7 Chlorhexidine or hydrogen peroxide mouth wash Simple analgesia

Question 39

Name three drugs that can cause gingival hyperplasia

Answer 39

Phenytoin Ciclosporin CCB (nifedipine)

Question 40

Are anterior or posterior bleeds more common in the elderly? Mx epistaxis (2) What to do if bleeding doesn't stop after 10-15 mins? (5)

Answer 40

Posterior 1. Sit with torso forward, pinch soft area of nose for 20 mins, breathe through open mouth 2. Topical antiseptic e.g naseptin (chlorhexidine and neomycin) to reduce crusting Cautery Blow nose Topical local anaesthetic spray e.g co-phenylcaine Silver nitrate Packing

Question 41

Dental abscess mx abx of choice (1) If severe abx of choice (1)

Answer 41

Amoxi or phenoxy If severe/ spreading/ systemic sx then add metro

Question 41

Name three medications that can cause ototoxicity

Answer 41

Gentamicin Furosemide Aspirin

Question 42

Bilateral acoustic neuromas are seen in?

Answer 42

Neurofibromatosis type 2

Question 43

Who is eligible for cochlear implant? (2) (HINT children, adults criteria)

Answer 43

Children - difficulty in developing basic auditory skills Adults - who have trialled hearing aids for 3 months

Question 44

CI to cochlear implant (3)

Answer 44

Lesion of CNVIII or brainstem Chronic infective otitis media or TM perforation Cochlear aplasia

Question 45

Define chronic rhinosinusitis Predisposing factors (5)

Answer 45

Inflammation of paranasal sinuses >12 weeks Atopy, nasal obstruction, recent local infection, swimming, smoking

Question 46

Mx chronic rhinosinusitis (3)

Answer 46

Avoid allergen Intranasal steroids Nasal irrigation with saline solution

Question 47

Red flags nose symptoms (3)

Answer 47

Unilateral Persistent sx despite compliance with 3 months treatment Epistaxis

Question 48

Associations with nasal polyps (6)

Answer 48

asthma (particularly late-onset asthma) aspirin sensitivity infective sinusitis cystic fibrosis Kartagener's syndrome Churg-Strauss syndrome