ENT

Question 1

DDx of vertigo?

Answer 1

CPA tumour
Cerebrovascular disease
Migraine
MS
Cervical vertigo
Drug-induced
Psychological

Question 2

Examples of Cerebellopontine angle tumours?

Answer 2

Vestibular schwannoma
Brainstem glioma
Medulloblastoma
Neurofibromatosis

Question 3

Characteristics of peripheral nystagmus?

Answer 3

Equal in direction, speed & amplitude in both eyes
No change in direction with gaze
Never purely vertical
Suppressed by fixation

Question 4

Causes of BPPV?

Answer 4

Idiopathy >50%
Secondary = trauma, viral labyrinthitis, MD, Migraines

Question 4

Surgery for BPPV?

Answer 4

Indication = refractory to conservative mx
Posterior semicircular canal occlusion
Vestibular neurectomy/singular neurectomy

Question 5

invx for sudden unilateral SNHL?

Answer 5

MRI tro vestibular schwannoma
Blood tests
Syphilis, thyroid, CSR, ERP, RP etc

Question 6

Mx of idiopathic acute unilat SNHL?

Answer 6

Oral Pred 1mg/kg up to 60mg for 10-14D BEST
2nd line intratympanic dexa
Hyperbaric O2 therapy

Question 7

Mx of vestibular schwannoma?

Answer 7

<1.5cm = monitoring
1.5 - 2.5cm = Radiation vs Excision
>2.5cm = excision

Question 8

Pathophysiology of Meniere’s?

Answer 8

Dysregulation of endolymphatic fluid homeostasis -> endolymphatic hydrops

Question 9

Symptoms of MD?

Answer 9

Episodic vertigo, lasts minutes to hours
Tinnitus
Ear fullness
Hearing loss - fluctuating

Question 10

Medical therapy for MD?

Answer 10

Diuretics + low-sodium diet
IT Dexa
Vestibular suppressants
Betahistine hydrochloride
Avoid caffeine + alcohol +derivatives

Question 11

Mx of Labyrinthitis?

Answer 11

Acute phase:
- vestibular sedatives e.g. Stemetil, Sturgeron
- Bed rest
- Betaserc w/wo steroid
- Treat any viral infection
Convalescent phase:
- Betaserc
- Vestibular rehab

Question 12

Cranial nerves usu injured in BOS frac?

Answer 12

CN 6 7 8

Question 13

RF for NPC?

Answer 13

EBV infection
Salt-preserved food
1st degree relative
Epigenetic modulation

Question 14

Histological classification of NPC?

Answer 14

Type 1 = SCC
Type 2 = undifferentiated SCC
2a = keratinizing undiff SCC
2b = non-keratinizing undiff SCC

Type 2b closely a/w EBV

Question 15

Causes of conductive hearing loss - mid ear

Answer 15

AOM
OME
CSOM
Cholesteatoma
Otosclerosis
Temporal bone trauma

Think of ossicular chain disruption as well

Question 16

Causes of Conductive hearing loss - external ear

Answer 16

Foreign body
Otitis externa
TM perforation or retraction

Question 17

Causes of Sensorineural hearing loss - acquired

Answer 17

Noise-induced
Age-related
Infective/inflammatory
Ototoxic drugs
Tumour - Acoustic neuroma, CPA tumour
Meniere’s disease
Perilymph fistula

Question 18

Causes of Sensorineural hearing loss - congenital

Answer 18

Intrauterine TORCH infections
Hereditary - syndromic/not
Birth trauma etc etc

Question 19

Components of GRBAS scale?
For voice evaluation

Answer 19

Grade of hoarseness
Roughness
Breathlessness
Asthenia
Strain

Asthenia = physical weakness or no energy

Question 19

What is the only legit mx for tinnitus?

Answer 19

Tinnitus retraining therapy. Kinda like psychotherapy - to modify emotional rxn to tinnitus.

Everyth else are placebo like gingko, meds wtv.

Question 20

Ddx for unilateral leukoplakia?

Answer 20

Parakeratosis
Hyperkeratosis
Mild/moderate dysplasia
Malignant = SCC
Infective = TB, candida

Question 21

invx of unilateral leukoplakia?

Answer 21

CT neck
Panendoscopy
Biopsy with laser

Question 22

Causes of unilat vocal cord palsy?

Answer 22

Neurological - PICA, MS, AICA, lateral medullary syndrome
Neoplasia - larynx, mediastinum, thyroid, lung
Iatrogenic - Surgery, intubation

Question 23

Mx of unilateral vocal cord palsy?

Answer 23

Conservative = speech therapy Surgical = injection / open surg ## Footnote Surgical for pts with aspiration or need good voice use

Question 24

use single lumen or double lumen tube for tracheostomy?

Answer 24

just double lumen used nowadays. Must do CXR after putting in

Question 25

Cutoff for "large volume" in epistaxis?

Answer 25

Above half cup volume each time

Question 26

What is Wallenberg syndrome?

Answer 26

Neurological condition due to lateral medullary infarction due to occlusion of PICA / Vertebral artery Dysphagia Hoarseness Ataxia / dysmetria / dysdiadochokinesia Horner's Vertigo Nystagmus, diplopia Ipsilateral loss of pain and temp in face Contralat loss of pain and temp in body below face

Question 27

Risk factors for oral cavity cancer?

Answer 27

Smoking Spirits Spices Sharp teeth Sun exposure Syphilis

Question 28

Commonest subsite of oral cancer? Common subtype of oral cancer?

Answer 28

Oral tongue, lateral border SCC commonest.

Question 29

Symptoms of oral canceR?

Answer 29

Non-healing ulcer Oral cavity mass Change in denture fit Bleeding Neck lump Otalgia Dysarthria Trismus

Question 30

Examples of benign cavity lesions?

Answer 30

Torus Lingual thyroid Dermoid Ranula Apthous ulcer Pyogenic granuloma Fibroma Lichen planus Pemphigus / pemphigoid Cancer!

Question 31

What is lichen planus?

Answer 31

T-cell mediated AI disorder where inflammatory cells attack skin annd mucosal keratinocytes.

Question 32

What is otosclerosis?

Answer 32

New bone formation causing fusion of fixation of stapes footplate to the oval window

Question 33

post-op mx of cholesteatoma?

Answer 33

Scan annually cuz recurrence is high. Clearance of mucosa from ear is impaired after cholesteatoma surgery, so earwax accumulation is common ## Footnote Use eardrops!

Question 35

How to classify tinnitus? ## Footnote in hx taking

Answer 35

Pulsatile vs Non-pulsatile. TRO vascular origin cause. Vascular causes - 1. Jugular bulb right below floor of inner ear. If got dehiscence of floor then can have transmitted noise/vibration. 2. Sinus too near the mastoid 3. Glomus jugulare = paraganglioma in mid ear. Will have red hue behind TM with rising sun shape, involving floor of cavity or the TM. Blanching colour points to vascular tumour

Question 36

Otoscopy of OME?

Answer 36

Yellow hue present. If recent OME then it has typical air fluid level that moves with valsalva maneuver.

Question 37

Causes of referred pain in ear?

Answer 37

Tumours of hypopharynx Tonsilitis Sinusitis TMJ disorder Impacted tooth (wisdom tooth) Anything in throat!! e.g. retropharyngeal abscess, epiglottitis, tumour etc

Question 38

Surgery for pseudocyst of pinna? ## Footnote 만두귀. inside got serous fluid

Answer 38

there is separation btw leaflets of cartilage in pinna. Aim is to remove the dead space btw the cartialge to prevent recurrence. They take out the anterior cartilage, then use buttoning/dental roll/tension dressing to keep them tgt.

Question 39

What is a retention cyst in mouth?

Answer 39

Glands in mouth near tonsils get blocked -> forming cyst

Question 40

Which level of LNs does thyroid lymph drain into?

Answer 40

2 3 4 6

Question 41

4Cs for thyroid surgery indications?

Answer 41

Cancer Compressive Cosmesis Control | Usu anyth >2cm we consider excision ## Footnote Also consider if mass is growing retrosternally. Cuz if that happens then any surgery aft that is super hard cuz need to do thoracotomy

Question 42

Why is RLN injury impt for thyroid surgery?

Answer 42

actl RLN is injured rarely, but its hard to find external branch of RLN which controls cricothyroid muscle. The cricothyroid muscle pulls the thyroid palate forward to produce high pitched sound

Question 43

only 3 invx needed to confirm thyroiditis?

Answer 43

TFT FNAC US ## Footnote TSH low + Free T4 high

Question 44

Air bone gap > 60 implies what?

Answer 44

Ossicular discontinuity

Question 45

Are abx very useful for OME?

Answer 45

Not really

Question 46

HEaring loss in Meniere's?

Answer 46

Low frequency hearing loss. With every MD attack the hearing drops a bit, so after 10-15 yrs of MD the SNHL is very profound, although the hearing loss kinda plateaus.