ENT

Question 1

Acute otitis media presentation

Answer 1

otalgia, fever, hearing loss, recent viral URTI and may present with ear discharge in children

Question 2

Acute otitis media otoscope

Answer 2

bulging tympanic membrane with loss of light reflex, perforation with purulent otorrhoea

Question 3

Acute otitis media Management

Answer 3

Generally self-limiting and does not required but if persists more than 4 days.

Abx if perforation or comorbidities

Question 4

Acute sinusitis common causes

Answer 4

Haemophylis influenza and streptococcus pneumonia

Question 5

Acute sinusitis presentation

Answer 5

Facial pain, nasal obstruction and nasal discharge

Question 6

Acute sinusitis management

Answer 6

Analgesia, saline washout and intranasal decongestants
Intranasal corticosteroids if symptoms persist for more than 10 days
Oral Pen V if symptoms are severe

Question 7

Most common organism causing tonsilitis

Answer 7

Strep pyogenes

Question 8

Criteria for tonsilitis

Answer 8

CENTORS criteria:
No cough
Exudative tonsils
Cervical lymphadenopathy
Fever >38

FEVERPAIN score:
Fever for the previous 24 hours
Purulent tonsils
Attends within 3 days
Inflammed tonsils
No cough

Question 9

Management of tonsillitis

Answer 9

If centor score>3 and feverpain score>4, prescribe antibiotics.

PenV (first-line)
Clari (if pen allergic)

Question 10

Allergic rhinitis presentation

Answer 10

Sneezing, nasal obstruction and post-nasal drip

Question 11

Management of allergic rhinitis

Answer 11

Allergen avoidance
Mild-to-moderate -> oral or intranasal antihistamines
Moderate-to-severe -> intranasal corticosteroids

Question 12

Management of auricular haematomas

Answer 12

Same day assessment by ENT for incision and drainage

Question 13

Benign paroxysmal positional vertigo presentation

Answer 13

Vertigo triggered by changes in head position. Lasts for 10-20 seconds each. Associated with nausea

Question 14

Diagnosis of benign paroxysmal positional vertigo

Answer 14

Dix-hallpike manouevre - will show rotatory nystagmus

Question 15

Managment of BPPV

Answer 15

Epley manoeuvre
Betahistine

Question 16

What is a cholesteatoma?

Answer 16

Non-cancerous growth of squamous epithelium

Question 17

Presenting features of cholesteatomas

Answer 17

Foul smelling
Non-resolving discharge
Hearing loss

Question 18

What would you find on otoscopy with cholesteatoma?

Answer 18

Attic crust in the upper most part of the ear drum

Question 19

Management of cholesteatoma

Answer 19

Refer to ENT

Question 20

Cochlear impact suitability

Answer 20

Must have trialled hearign aids for a minimum of 3 months

Question 21

Otosclerosis presentation

Answer 21

conductive hearing loss with positive family history
Autosomal dominant

Question 22

Difference between glue ear and acute otitis media

Answer 22

Glue ear is otitis media with effusions

Question 23

Meniere’s disease triad

Answer 23

Vertigo, tinnitus and hearing loss
sensation of fullness within the ear

Question 24

Acoustic neuroma presentation

Answer 24

Tinnitus, vertigo and hearing loss
facial palsy

Question 25

Ear wax management

Answer 25

Irrigation or ear drops (olive oil)

Question 26

Causes of epistaxis

Answer 26

Trauma Foreign body Nose-picking Cocaine use Granulomatosis with polyangitis Bleeding disorders

Question 27

Management of epistasis

Answer 27

First aid: lean forward and pinch nasal folds If bleeding does not stop: and bleeding point visible - silver nitrate cautery if bleeding point not visible - packing if bleeding continues - theatre for sphenopalatine ligation

Question 28

Management of glue ear

Answer 28

Grommet Adenoidectomy

Question 29

What would you be worried about if patient comes in with unilateral serous otitis media?

Answer 29

Nasopharyngeal cancer

Question 30

How would you manage a perforated tympanic membrane that's not healing?

Answer 30

Myringoplasty

Question 31

Malignant otitis externa - who gets it?

Answer 31

Immunocompromised individuals

Question 32

Malignant otitis externa - common causative organism

Answer 32

pseudomonas aureginosa

Question 33

Malignant otitis externa - progresses to what?

Answer 33

temporal osteomyolitis

Question 34

Diagnosis of Malignant otitis externa

Answer 34

CT scan

Question 35

Malignant otitis externa - management

Answer 35

refer to ENT for IV antibiotics

Question 36

Management of mastoiditis

Answer 36

IV antibiotics

Question 37

What is samster's triad?

Answer 37

Asthma, aspirin sensitivity and nasal polyps

Question 38

Features of nasal polyps

Answer 38

Nasal obstruction, rhinorrhoea and poor sense of taste and smell

Question 39

Management of nasal polyps

Answer 39

Topical corticosteroids to shrink the polyp

Question 40

What features of polyps would make you worry?

Answer 40

Unilateral + bleeding

Question 41

Management of otitis externa

Answer 41

Topical antibiotics and a steroid for 1-2 weeks If patients fail to respond to topical antibiotics, refer to ENT

Question 42

Features of quinsys

Answer 42

Severe throat pain which lateralises to one side Deviation of the uvula to the unaffected side Reduced neck mobility

Question 43

Definition of primary vs secondary haemorrhage following a tonsillectomy

Answer 43

Primary within the first 6-8 hours Secondary within 5-10 days post surgery

Question 44

Management of primary haemorrhage following a tonsillectomy

Answer 44

Immediate return to theatre

Question 45

Management of secondary haemorrhage following tonsillectomy

Answer 45

IV antibiotics and admission

Question 46

Organism causing ramsay hunt syndrome

Answer 46

Varicella zoster virus

Question 47

Features of ramsay hunt syndrome

Answer 47

Auricular pain Facial nerve palsy Vesicular rash around the ear and eye

Question 48

Management of ramsay hunt syndrome

Answer 48

Oral aciclovir and corticosteroid

Question 49

Complications of thyroid surgery

Answer 49

Recurrent laryngeal nerve damage Bleeding Hypocalcaemia - damage to parotid glands