ent

Question 1

NICE recommend that clinicians consider a suspected cancer pathway referral (for an appointment within 2 weeks) for laryngeal cancer in people aged 45 and over with:
____________________

Answer 1

persistent unexplained hoarseness or
an unexplained lump in the neck

Question 2

rules for interpreting audiogram

Answer 2

< 20 = normal. > 20 = abnormal (need loudness to hear)

Air > bone = normal (alphabetically you I remember as A comes before B)

Bone > air = abnormal (it is abnormal to start counting alphabets from B)
this is conduction loss

Air + Bone loss = mixed sensory and conduction loss

Question 3

sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo –> ?

Answer 3

Acute viral labrynthitis

Question 4

Non-resolving otitis externa with worsening pain. Mx?

Answer 4

should be referred urgently to ENT

Question 5

Horizontal nystagmus is a feature of____________

Answer 5

vestibular neuronitis

Question 6

Recurrent otitis externa following numerous antibiotic treatment should raise suspicion of ________

Answer 6

Candida infection

Question 7

Meniere’s tends to come in ________

Answer 7

episodes; no Hx makes Dx unlikely

Question 8

otitis externa tx?

Answer 8

topical ciprofloxacin + dexamethasone

Question 9

Gingival hyperplasia: _______________________________

Answer 9

phenytoin, ciclosporin, calcium channel blockers and AML

Question 10

‘Double-sickening’ suggests –>

Answer 10

bacterial sinusitis

Question 11

__________ may be useful in the acute phase of vestibular neuronitis, but should be stopped after a few days as it delays recovery by interfering with central compensatory mechanisms

Answer 11

Prochlorperazine

Question 12

All post-tonsillectomy haemorrhages should be assessed by ENT

Question 13

Unilateral glue ear in an adult:

Answer 13

needs evaluation for a posterior nasal space tumour

Question 14

how would you describe the pain in sinusitis

Answer 14

frontal pressure pain which is worse on bending forward

Question 15

tx for sinusitis lasting 10 or more days?

Answer 15

intranasal corticosteroids

Question 16

what is double sickening

Answer 16

‘double-sickening’ may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection

Question 17

auricular haematomas - who is it common in? what do you want to avoid? how will you manage?

Answer 17

rugby players/wrestlers

cauliflower ear

samdeday assessment by ENT, incision and drainage

Question 18

BPPV - Dx? TX?

Answer 18

Dx: Dix-hallpike manoeuvre
Tx: Epley manoeuvre

Question 19

branchial cyst

Answer 19

smooth, soft, fluctuant, non-tender, does not move on swallowing, does not transilluminate

Question 20

Pt born with cleft palate has foul-smelling, non-resolving discharge and hearing loss

Answer 20

Cholesteatoma - non-cancerous growth of squamous epithelium

Question 21

what do you see on otoscopy for cholesteatoma?

Answer 21

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

Question 22

acoustic neuromas: damage to
- cranial nerve VIII:
- cranial nerve V:
- cranial nerve VII:

Answer 22

• cranial nerve VIII: hearing loss, vertigo, tinnitus
• cranial nerve V: absent corneal reflex
• cranial nerve VII: facial palsy

Question 23

epistaxis: anterior vs posterior bleeds

Answer 23

anterior: visible source of bleeding, usually due to damage to Kiesselbache plexus

Posterior: more profuse bleeding, originates in deeper structures, higher risk of aspiration and airway compromise

Question 24

Epistaxis Mx

Answer 24

1. is pt stable? if yes
   - Sit forward with mouth open
   - Pinch nose firmly

If unsuccessful,
3. use topical antiseptic like Nasepetin

If bleeding persists for 10-15 min, consider
4. cautery - used if source of bleed is visible
5. packing if bleeding point cannot be visualised/cautery not tolerated

If pt unstable –> surgery (sphenopalatine ligation)

Question 25

features of head/neck cancers

Answer 25

- neck lump - hoarseness - persistent sore throat - persistent mouth ulcer

Question 26

2 week wait for head and neck cancers: laryngeal, oral, thyroid

Answer 26

1. laryngeal: age >45 with persistent unexplained hoarseness/neck lump 2. ulceration in oral cavity lasting for more than 3 weeks 3. thyroid: unexplained thyroid lump

Question 27

When investigating patients with hoarseness a _______ should be considered

Answer 27

chest x-ray to exclude apical lung lesions.

Question 28

ear condition mostly found in diabetics + caused by pseudomonas aeruginosa

Answer 28

malignant otitis externa --> progresses to temporal bone osteomyelitis

Question 29

Tx for Meniere's: acute/prevention

Answer 29

acute: buccal/IM prochlorperazine prevention: betahistine/vestibular rehab exercises

Question 30

Samter's triad

Answer 30

- asthma - nasal polyps - aspirin sensitivity

Question 31

nose features that always require investigation

Answer 31

unilateral Sx

Question 32

what shrinks nasal polyps well

Answer 32

topical corticosteroids

Question 33

Cancer that is - associated with EBV - cervical lymphadenopathy - otalgia, unilateral serous OM - nasal obstruction - cranial nerve palsies

Answer 33

nasopharyngeal CT/MRI (combined) treat with radiotherapy

Question 34

you can tell its a thyroid swelling because

Answer 34

moves upwards with swallowing

Question 35

otoscopy: red, swollen, or eczematous canal = _______. mx?

Answer 35

otitis externa topical antibiotic or a combined topical antibiotic with a steroid

Question 36

severe throat pain localising to one side + deviation of uvula to unaffected side + trismus + reduced neck mobility =

Answer 36

Peritonsillar abscess (quinsy)

Question 37

which post-tonsillectomy haemorrhages must be seen by ENT?

Answer 37

all Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre. Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics.

Question 38

CENTOR score

Answer 38

Cough absent Exudative tonsils Node - lymphadenopathy Temperature

Question 39

Tx for sudden-onset SHL?

Answer 39

- urgent ENT referral - high-dose corticosteroids

Question 40

cyst that moves upwards with protrusion of tongue?

Answer 40

thyroglossal cyst

Question 41

Elderly patient Dizziness on extension of neck

Answer 41

Vertebrobasilar ischaemia

Question 42

impt sign of acoustic neuroma?

Answer 42

absent corneal reflex

Question 43

____________ is a treatment option for chronic rhinosinusitis

Answer 43

Nasal irrigation with saline solution

Question 44

Unilateral glue ear in an adult:

Question 45

Antibodies titres for streptolysin O

Answer 45

Diseases include rheumatic fever, post streptococcal glomerulonephritis and scarlet fever

Question 46

Tx for otitis externa

Answer 46

NICE recommend that for mild cases (mild discomfort and/or pruritus; no deafness or discharge), consider prescribing topical acetic acid 2% spray. When features of more severe inflammation are present they advise 7 days of a topical antibiotic with or without a topical steroid. oral antibiotics (flucloxacillin) if the infection is spreading If a patient fails to respond to topical antibiotics then the patient should be referred to ENT.

Question 48

Otitis externa in diabetics: in non-diabetics:

Answer 48

treat with ciprofloxacin to cover Pseudomonas gentamicin

Question 49

After fundoscopy, next Ix for suspected agre-related wet macular degenration

Answer 49

fluorescein angiography --> particularly useful for identifying macular neovascularisation, which is a hallmark of wet age-related macular degeneration (AMD)

Question 50

Otitis externa in diabetics: treat with

Answer 50

ciprofloxacin to cover Pseudomonas

Question 51

A 45-year-old male presents with a painful and swollen right cheek. He reports having a bad taste in his mouth and difficulty opening his mouth due to pain. Examination reveals a tender and erythematous swelling of the right parotid gland. The patient is febrile and has an elevated white blood cell count. What is the most likely diagnosis?

Answer 51

Sialadenitis inflammation of the salivary glands. The parotid gland is the most commonly affected, and the presentation can be acute or chronic. Sialadenitis is typically caused by bacterial infection, and the symptoms include painful swelling of the affected gland, difficulty opening the mouth, fever, and a bad taste in the mouth. Treatment includes antibiotics and adequate hydration. Complications of sialadenitis include abscess formation, duct obstruction, and recurrent infections.

Question 52

_______________ characteristically contain cholesterol crystals + commonly in anterior triangle of neck. ___________is more common in posterior triangle and transilluminates

Answer 52

Branchial cysts Cystic hyGLOWma = transilluminates

Question 53

____________________ is the persistent sensation of having a 'lump in the throat', when there is none

Answer 53

Globus pharyngis (also known as globus hystericus)