ENT

Question 1

What are some benign tumours of the parotid gland?

Answer 1

Warthin tumour, pleomorphic adenoma

Question 2

Where else would you want to assess if considering a parotid tumour?

Answer 2

Scalp for skin cancer, facial nerve and cervical lymph nodes

Question 3

Which salivary glands tumour are more likely to be malignant? Parotid tumour or tumours of small salivary glands?

Answer 3

Small salivary glands

Question 4

What are three important questions to ask in order to assess severity of someone presenting with an acute sore throat?

Answer 4

Difficulty swallowing, voice changes and trismus

Question 5

How would you manage a patient with a moderate to severe unremitting unilateral sore throat for 3 weeks or more?

Answer 5

Urgent outpatient referral via the suspected cancer pathway

Question 6

What is the most common cause for a painful discharging ear in an adult and a child?

Answer 6

Adult: otitis externa
Child: otitis media with tympanic perforation

Question 7

If a child has acute otitis media with a perforated tympanic membrane (ASOM) how will you manage them?

Answer 7

Offer regular analgesia, ear drops containing an anaesthetic and analgesic for pain. May not require antibiotics- can do a delayed/back-up prescription to take id child does not improve in next 3 days

Question 8

What are red flags associated with acute otitis media?

Answer 8

Sepsis with post auricular swelling, cranial nerve palsy, symptoms of meningism, altered consciousness state

Question 9

Who is most commonly affected by acute otitis media?

Answer 9

Children under 7

Question 10

What is the typical history/presentation of acute otitis media?

Answer 10

Gradually increasing ear pain with no discharge with a red bulging ear drum on otoscopy

Question 11

What is the classic presentation of acute suppurative otitis media?

Answer 11

Gradually increasing otalgia followed by some discharge associated with a reduction in pain. Patinets may feel/hear a pop before noticing the discharge

Question 12

A quick onset dysphagia with infective symptoms would imply what most likely condition?

Answer 12

Tonsillitis

Question 13

A sudden onset dysphagia with neurological symptoms implies what?

Answer 13

A cerebrovascular ischaemic event

Question 14

A gradual onset dysphagia over week to months in the presence of weight loss and smoking history implies what diagnosis?

Answer 14

Malignancy in oropharynx, hypopharynx or oesophagus

Question 15

A long term (months to years) and relatively slow progressing dysphagia may lead you to consider what types of diagnoses?

Answer 15

Benign causes like a pharyngeal pouch
Chronic neurological disorder

Question 16

If someone presents with otalgia with normal otoscopy and the pain is worse in front of the ear and worse on chewing. What is the likely diagnosis?

Answer 16

Temporo-mandicular joint dysfunction

Question 17

What is the likely diagnosis of someone presenting with a right sided neck nodule that moves on swallowing. On examination, they are warm and well perfused, tachycardic, and appears to be staring.

Answer 17

they are likely thyrotoxic with a thyroid nodule

Question 18

how can differentiate a thyroglossal cyst and a thyroid nodule on clinical examination?

Answer 18

thyroglossal cyst will move upwards on tongue protrusion

Question 19

What is there an increased risk of when operating on patient who is hyperthyroid?

Answer 19

risk of thyrotoxic strom and increased risk of bleeding

Question 20

what are risks of a full thyroidectomy?

Answer 20

bleeding, infection, recurrent laryngeal nerve damage, hypothyroidism, hypoparathyroidism (low calcium)

Question 21

what are the paths of the recurrent larygeal nerves?

Answer 21

theintially descend and the right will loop under the right subclavian artery and the left will loop under the aortic arch. they then ascend deep to the thyroid and enter the larynx at the cricothyroid joint.

Question 22

what is the most important blood test to carry out followinga complete thyroidectomy. How does this present?

Answer 22

calcium
low calcium presents as tingling around the lips and fingertips, if severely low then muscle spasms occur

Question 23

what are some features of a parotid lump that may suggest malignancy?

Answer 23

facial nerve paresis, cervical lymphadenopathy that are hard and non-tender

Question 24

what is freys syndrome which can occur following parotid surgery?

Answer 24

abnormal regeneration of the auriculotemporal branch of the mandibular nerve following injury, infection, or surgery in the vicinity of the parotid gland causes its parasympathetic fibres to supply the sweat glands so when eating the patient sweats around preauricular and temporal areas

Question 25

what structure is at risk of damage during surgery in the posterior triangle of the neck? how will this affect the patient?

Answer 25

accessory nerve result in shoulder drop

Question 26

which nerves can be damage during surgery to the submandibular salivary gland?

Answer 26

hypoglossal nerve which runs deep to the gland the lingual nerve which overlies the duct the cervical branch of the facial nerve runs superficially over the gland so can be damaged if using a platysma/high incision

Question 27

what is the medical treatment for chronic rhinosinusitis?

Answer 27

nasal steroid sprays and long course of antibiotics (6-8 weeks)

Question 28

what are potential complications of sinus surgery?

Answer 28

bleeding, infection, CSF leak (basal skull injury), vision loss or disturbance (ethmoid sinuses closely associated with the orbit)

Question 29

how can a septal haematoma be identified on clinical examination?

Answer 29

anterior rhinoscopy and palpation of the bulging septum

Question 30

Which recreational drug is commonly implicated in septal defects and how does it cause this damage?

Answer 30

cocaine it causes loss of blood supply to the cartilage

Question 31

what is the management of a nasal septal haematoma?

Answer 31

Prompt referral to an Ear, Nose, and Throat (ENT) specialist for emergency incision and drainage

Question 32

how will a nasal septal haematoma appear on rhinoscopy?

Answer 32

a bilateral cherry-red swelling

Question 33

with BPPV what would we expect to see on Dix-Hallpike test?

Answer 33

Latency Geotropic intorsional nystagmus Fatigue Habituation on repeating the test

Question 34

what are possible reasons for conductive hearing loss with cholesteatoma?

Answer 34

mucosal inflammation and discharge/debris in ear canal or erosion into the ossicles

Question 35

What could cause a patient with cholesteatoma to experience severe rotatory vertigo?

Answer 35

erosion into the balance organ causing a labrynthine fistula- causing dizziness on pressure change transmitted from the middle ear to the vestibular system

Question 36

What is ludwigs angina?

Answer 36

severe diffuse cellulitis of the floor of the mouth which can push the tongue posteriorly leading to airway compromise

Question 37

What is chronic rhinosinusitis?

Answer 37

An inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer

Question 38

What are some symptoms of chronic rhinosinusitis?

Answer 38

Facial pain- usually worse on bending forwards Nasal discharge- usually clear, if thicker may suggest secondary infection Nasal obstruction Post-nasal drip which may produce chronic cough

Question 39

What is the initial management of chronic rhinosinusitis?

Answer 39

Avoid allergens/triggers, intranasal corticosteroids and nasal irrigation with saline

Question 40

Which exam can be used to distinguish between vestibular neuronitis and a posterior circulation stroke?

Answer 40

HiNTS exam

Question 41

What would be seen on a HiNTS exam if a patient had a peripheral cause of vertigo?

Answer 41

Corrective saccades in the head impulse test A unidirectional nystagmus or none No vertical skew

Question 42

What would be seen on a HiNTS exam if a patient had a central cause of vertigo?

Answer 42

Negative head impulse test, bidirectional or vertical nystagmus and vertical skew

Question 43

A negative head impulse test implies what kind of cause of vertigo?

Answer 43

Central

Question 44

What is the treatment of Ramsey hunt syndrome?

Answer 44

Oral aciclovir and prednisolone

Question 45

What are causes of gingival hyperplasia?

Answer 45

Phenytoin, ciclosporin, calcium channel blockers and AML

Question 46

What is the classic pathological finding of a branchial cyst?

Answer 46

A cellular fluid with cholesterol crystals

Question 47

What is the management of someone who is experiencing chronic symptoms of vestibular neuronitis?

Answer 47

Vestibular rehabilitation

Question 48

What associations are described in samter’s triad?

Answer 48

Nasal polyps, asthma and aspirin sensitivity

Question 49

What is the most common cause of sudden-onset sensorineural hearing loss?

Answer 49

Idiopathic

Question 50

What medication is given to someone presenting with sudden-onset sensorineural hearing loss and what scan will they have done?

Answer 50

High dose oral corticosteroids MRI brain for vestibular schwannoma

Question 51

What is the surgery to repair a tympanic perforation, when would this be performed?

Answer 51

Myringoplasty If the perforation does not eat by itself, which we would expect it to do after 8 weeks

Question 52

What are complications of a perforated tympanic membrane?

Answer 52

Hearing loss and increased risk of otitis media

Question 53

What is the initial management of a perforated tympanic membrane?

Answer 53

Watch and wait and refer to ENT if persists after 6 weeks. Advice to avoid getting water in the ear as can affect healing and increase infection risk

Question 54

Who is referred to ENT via the 2 week wait pathway for laryngeal cancer?

Answer 54

Patients over 45 with persistent unexplained hoarseness or an unexplained lump in the neck

Question 55

Intranasal steroid should only be considered for sinusitis if symptoms have persisted for how many days?

Answer 55

Over 10 days

Question 56

What is first line treatment for otitis externa?

Answer 56

Topical antibiotics with or without topical steroids

Question 57

What are features of laryngopharyngeal reflux?

Answer 57

Sensation of a lump in the throat, hoarseness, chronic cough, dysphagia, heartburn, sore throat

Question 58

What are some examples of ototoxic agents?

Answer 58

Gentamicin, quinine, furosemide, aspirin and platinum chemo therapies

Question 59

What are the names of exercises patients can do at home for BPPV?

Answer 59

Brandt-Daroff

Question 60

What can be associated with a recurrent laryngeal nerve palsy?

Answer 60

Thyroid surgery, polio, aortic aneurysm surgery, carcinoma of oesophagus/bronchus

Question 61

Likely to be seen on examination for a quinsy?

Answer 61

Uvula deviated away from Sid elf infection, unilaterally enlarged tonsil and peritonsillar swelling with mucosal cellulitis

Question 62

what is a Bezold's abscess?

Answer 62

infection following mastoiditis, in which an abscess collects deep to the periosteum of the mastoid bone, and extends inferiorly within the fascia of the sternocleidomastoid muscle