ENT

Question 1

Managment overview of oral leukoplakia

Answer 1

Biopsy it, reduce the risk factors, and monitor. Consider surgery

Question 2

What is sialadenosis.

Answer 2

Benign enlargement of the parotid. Painless enlargement, due to alcohol, malnutrtiion, bulimia

Question 3

Thyroglossal duct cyst Mx

Answer 3

Check to see if thyroid gland ok (associated with ectopic thyroid). Then do Sx (remove cyst, tract and part of hyoid)

Question 4

Patient had thyroidectomy for CA. TG starts to increase a few months after.. Dx?

Answer 4

CA returning

Question 5

Which bacteria can cause this paediatric neck mass

Necrotic LNs, voilacious skin

Answer 5

Mycobacterium avium lymphadenitis

Question 6

Dx this

Lateral neck mass, gets bigger on valsalva. Patient is a trumpet player

Answer 6

Laryngeocele

Question 7

Rhinitis medicamentosa

Answer 7

When someone takes nasal decongestant for a long time, the vessels get damaged, releasing edema and causing more nasal decongestion. Turbinates will be beefy red

Question 8

Whistling on insp is a sign of

Answer 8

Nasal perf. Look out for nasal surgery or cocaine use

Question 9

Mx of TMJ disorders

Answer 9

Soft diet and warm compress, then can try night guard if bruxism. Do NSAID if bad or initial did work. Muscle relaxant if muscle spasms,

Question 10

Why can laryngeal or oral squamous cell carcinoma cause otalgia

Answer 10

Referred otalgia, since the CNX and CNIX innervation of larynx and tongue areas converge to the same areas as the ear sensory innervation

Question 11

Invx and mx overview of choanal atresia

Answer 11

If suspect try and pass catheter down nasal cavity. If doesn’t pass, then confirm Dx with CT or endoscopy. Tx by keeping an oral airway until Sx

Question 12

Epiglottis Abx to give empirically

Answer 12

Best to give Ceftriaxone (cover HiB and Strep) and Vanco (cover staphylococcus). Airway should be maintained prior

Question 13

Invx and mx for mastoiditis

Answer 13

Clinical Dx, but can do imaging if unclear or suspect neuro complication. Give Abx and drain

Question 14

Difference in location of issue between expiratory, inspiratory and biphasic stridor.

Answer 14

Insp is supraglottic obs, biphasic is subglottic and exp is tracheo (malacia )

Question 15

Mx for peritonisllar abcess

Answer 15

Needle drainage then Abx

Question 16

Dx

Patient has very similar symptoms to epiglottis. Is a young adult and uvula is deviated to one side

Answer 16

This is peritonsilar abscess

Question 17

Difference in symptoms between viral and bacterial rhinosinusitis. And how to manage each

Answer 17

Viral; no or short lived fever, mild symptoms, resolved in less than 10 days. Bacterial; fever for at least 3 days, symptoms for more than 10 days, and worse signs. Supportive for the former and Abx for thr latter

Question 18

Difference in presentation between acute OM and OM with effusion

Answer 18

AOM has active inflam, so will have bulging TM, fever etc.

Question 19

Managment of O.E.

Answer 19

remove debris, Abx (cover pseudomonas and staph) commonly quinolone, with or without GCs

Question 20

Tx for hairy leukoplakia

Answer 20

Just restore the immunity of the patient

Question 21

Mx of a torus mandibularis or palatirus

Answer 21

If mass becomes symptomatic or compromises the eating, breathing of the patients. Also if it prevents the fitting of dentures.

Question 22

Acute Otitis media vs otitis media with effusion signs and symptoms

Answer 22

AOM will have fever, pain, bulging tympanic membrane that is red and hardly transparent. Whereas OM and effusion is not inflammatory, so no fever, mild pressure, and can see the effusion fluid, but normal a tympanic membrane.

Question 23

OM and effusion Mx (consider if last more than 3 mo)

Answer 23

Observe. If more than 3 months, it is chronic, and should be indicated for a Tymoanostomy

Question 24

First line for necrotising otitis external

Answer 24

IV ciprofloxacin

Question 25

What is paracusis of willisii

Answer 25

In otosclerosis, the patient can often hear better with background noise. Contrasted to presbycusis

Question 26

What is oxymetazoline

Answer 26

Main nasal decong

Question 27

Mx of ruptured tympanic membrane

Answer 27

Reassure and observe, only tympanoplasty if fails to heale

Question 28

How can we reduce the risk of jaw osteonecrosis (say if patient on BPS)

Answer 28

Do dental consultation (do any dental Sx prior to BPS, since it’s a huge compound risk factor). Good oral hygiene and anti bac rinse.

Question 29

Questions that have patient with ulcerated enlarged tonsil,…. Always consider what

Answer 29

Consider SqCC. Old smoker, or young slag (HPV).

Question 30

Patient presents with vertigo and hearing loss on one side. Valsalva worsens vertigo. When dr claps loudly, the patient gets nystagmus (Tullio phenomena)

Answer 30

Perilymphatic fistula

Question 31

Nasal polyp fist line imaging

Answer 31

Coronal sinus CT

Question 32

Nasal polyp first invx? Then the rest of the invx

Answer 32

Nasal speculum. Consider laryngoscope. Coronal Sinus CT Best imaging. Biopsy if atypical

Question 33

Nasal polyp Mx

Answer 33

Oral CS. Recall discussion with Billy.

Question 34

If epistaxis does not improve with initial Conservative management. What do we do

Answer 34

Rhinoscopy to see where the anterior or posterior circulation

Question 35

If anterior epistaxis. What’s the management approach

Answer 35

Conservative therapy first. If doesn’t work can do cauterisation (with silver or electrical). If unilateral we can do packing. A second line would be to do bilateral packing. If none of this works consider posterior

Question 36

Posterior epistaxis management

Answer 36

ENT consultation. Do balloon catheter or Foley catheter

Question 37

Pain with movement of the tragus or Pinner. Is this more a otitis media or a otitis external

Answer 37

OE

Question 38

If the otitis externa has granulation tissue, what does this mean

Answer 38

Usually means it’s malignant

Question 39

What cranial nerve can be involved in malignant otitis external

Answer 39

Facial nerve

Question 40

Puretone audiometry results for conductive disorders

Answer 40

Increased audiometry threshold in air conduction only

Question 41

Pure tone audiometry in sensory hearing loss problems

Answer 41

Increase audiometry threshold in both and bone conduction

Question 42

Oral submucosal fibrosis main cause

Answer 42

Araca nuts (betel, paan)

Question 43

other than biopsy oropharyngeal CA. What else do we need to do

Answer 43

Laryngo broncho esophago scopy to check for 1° CA. Then of course usuals to check for mets

Question 44

Main Tx for Sialithiasis

Answer 44

Conservative. Sialogogues, warm compress, fluids, massage, NSAID.

Question 45

Main appearance different between ranula and mucocele

Answer 45

Ranula is blueish

Question 46

Usually we do self resolution of ranula and mucocele. But what to do if recurs/symptomatic

Answer 46

Sx. Not drain

Question 47

Pleomorphic adenoma Tx

Answer 47

Need to remove. Even though it’s usually benign

Question 48

A positive RINNE means what

Answer 48

Better conduction on air then bone

Question 49

Main way to tell between labyrinthitis and cute vestibular Neuritis

Answer 49

Labyrinthitis will have vertigo and hearing loss Oh vestibular and righteous will not have hearing loss Both of them are a cute and monophasic

Question 50

Compare labyrinthitis with Meniere

Answer 50

Is labyrinthitis is a cute and monophasic, Merania is intermittent and has a bit of tinnitus

Question 51

Necrotising otitis externa management

Answer 51

Give IV antibiotics. Anything that covers pseudomonas

Question 52

Management of otitis media with effusion

Answer 52

Just observe and follow up. If more than three months consider t tube

Question 53

Name me two causes of sialadenosis

Answer 53

Bulimia, booze

Question 54

Before removing a thyroglossal duct cyst, what do I have to do

Answer 54

Just make sure that normal thyroid is okay, because it is associated with ectopic thyroid

Question 55

If thyroglobulin increases after a thyroidectomy, For thyroid cancer,what does this mean

Answer 55

Recurrence of cancer

Question 56

Left or right neck mass, that is painful. History of recent URI. Mass is anterior to the SCM

Answer 56

Branchial cleft cyst

Question 57

Contrast the turbinate in retinitis medicamentosa, versus allergic rhinitis

Answer 57

Beefy read in the prior, more pale in the latter

Question 58

Contrast sialolithiasis management with or without infection

Answer 58

Give water, moist heat, milk the gland, NAISAID. If infected give antibiotics, and refer to ENT to remove the stone

Question 59

Why give Foxy And Vanco for epiglottitis prophylaxis

Answer 59

Because staphylococcus is increasing in this disease, because HIB is Rajitha vaccine

Question 60

Somebody with history of otitis media, and now has tenderness behind ear and ear displaced forward. What is this

Answer 60

Mastoiditis. Clinical diagnosis. If there’s neurological issues do a CT

Question 61

Location wise of an inspirational Striedel versus biphasic strider

Answer 61

Supraglottic, then subglottic respectively

Question 62

Patient has sinusitis, but has yellow green nasal discharge. Had for three days, but doesn’t have a fever. Is this viral or bacterial

Answer 62

Viral.

Question 63

NRDS patient, still needs 02 after one month and has high blood pressure. These are two signs pointing to what

Answer 63

Bronchopulmonary dysplasia

Question 64

What is the often con commitment pathology with laryngomalacia

Answer 64

Gerd

Question 65

Main treatment of laryngomalacia

Answer 65

Should self resolve. If very bad do surgery

Question 66

 If somebody has a pain, but yet the whole year exam as normal. Which two places are you worried about referral

Answer 66

TMJ, or some kind of tongue/laryngeal carcinoma. So if you don’t think it’s TMJ do flexible laryngoscope

Question 67

Chronic large ulcerated right tonsil in younger patient with multiple sexual partners. Around 40 years old

Answer 67

Probably squeamish cell carcinoma from HPV

Question 68

Best medication for otitis externa

Answer 68

Topical quinolone.