ENT

Question 1

Common site of epistaxis?

Answer 1

Anterior part of medial wall

Most internal and external carotidal branches anastomose here

Question 2

What artery supplies most of nasal cavitY?

Answer 2

Sphenopalantine artery

From External Carotid artery

Question 3

Systemic causes of epistaxis?

Answer 3

Coagulopathies e.g. haemophilia, vWD, overwarfarinization

Question 4

Local causes of 코피?

Answer 4

Life threatening = carotid blowout.
Trauma to nose.

Question 5

Complication from use of nasal packing? Give what

Answer 5

Toxic Shock Syndrome.
Give prophylactic clindamycin or penicillin.

Question 6

Complication and conditions a/w JNA?

Answer 6

Complication = OM with effusion
Conditions = Sinusitis, OSA

Question 7

Epidemiology of JNA?

Answer 7

Adolescent male

Question 8

Complication of septal hematoma?

Answer 8

Due to rupture of vessels in nasal septum causing separation of perichondrium from cartilaginous portion.
Can cause septal abscess -> septal perforation -> saddle nose deformity

Question 9

Mx of septal hematoma?

Answer 9

urgent refer to ENT for I&D to prevent hematoma from becoming abscess

Question 10

Immediate mx of epistaxis?

Answer 10

Epistaxis first aid
Topic decongestants
AgNO3 cautery

Question 11

2nd line mx of epistaxis?

Answer 11

Through endoscope.
Packing or electrocautery

Merocel mainly used over balloon

Question 12

Red flags of epistaxis?

Answer 12

Unilateral
Blood stained secretions
Large volume
Short hx
Eye involvement

Question 13

Worrying causes of epistaxis?

Answer 13

Unilateral OME
Unilateral polyp (NPC)
Cervical lymphadenopathy
CN palsies

Question 14

Mx of nasal frac?

Answer 14

Reassess pt in 3-5 days after edema subsides
Rx Nasal frac for cosmesis and NO
M&R within 2 weeks

Question 15

Can vestibular neuritis have BPPV symptoms?

Answer 15

Can have a bit lol

Question 16

Causes of nasal obstruction?

Answer 16

Anatomy - deviated septum, inf turb hypertrophy
Rhinitis
Rhinosinusitis

+ polyps / foreign body

Question 17

Mx of NPC?

Answer 17

Stage 1 = IMRT
Stage 2 = IMRT / chemo-IMRT
Stage 3 = Chemo-IMRT
Stage 4 = Neoadjuvant chemo f/u chemo-IMRT

Question 18

Clinical presentation of NPC?

Answer 18

CN palsy
Tinnitus
Nasal obstruction
Epistaxis
Deafness
Blood in saliva
Neck lump

ascending order of prevalence

Question 19

What is leukoplakia

Answer 19

White patch in oral cavity that cannot be scraped off.
6% risk of malignancy

Question 20

Causes of inflammatory cervical LNs

Answer 20

SLE
Kikuchi’s disease
Kimura disease

Question 21

Pattern of LN spread in H&N cancer?

Answer 21

Cancers of H&N spread to neck LNs in predicable pattern.
Skip mets is rare.
Cancers from diff locations spread to diff levels first

Question 22

What is quinsy?

Answer 22

Spread of infection into peritonsillar space

Question 23

Signs and symptoms of quinsy?

Answer 23

Fever
Sever unilat sore throat, drooling, halitosis
Trismus, hot-potato voice
Uvula deviation to contralat side
Fluctuant soft palate swelling

Question 24

Mx of quinsy?

Answer 24

I&D under LA
Abx
Elective tonsillectomy if repeated

Question 25

Cause of acute tonsilitis?

Answer 25

Often viral infection before bacterial superinfection Commonly GAS (beta-hemolytic)

Question 26

Symptoms and signs of acute tonsilitis?

Answer 26

Fever, sore throat, halitosis, odynophagia Tender cervical adenopathy, red and exudative tonsils

Question 27

Mx of acute tonsilitis?

Answer 27

Penicillin 10 days Elective tonsillectomy for recurrent tonsilitis

Question 28

Pathogens for acute supraglottitis or epiglottitis?

Answer 28

H. Influenzae Strep pneumo Streps beta hemolytic Staph aureus

Question 29

Symptoms and signs of acute supraglottitis or epiglottitis?

Answer 29

High fever Muffled voice Stridor Dysphagia Odynophagia Drooling ## Footnote Sudden onset, short course

Question 30

Mx of acute supraglottitis / epiglottitis?

Answer 30

Evaluate airway Steroids to reduce airway edema IV abx Hydration + humidification

Question 31

Mx of oropharyngeal candidiasis?

Answer 31

Topical nystatin swish and swallow PO fluconazole for severe infection

Question 32

Facts about retropharyngeal abscess?

Answer 32

Usu in kids <4yo GAS, Staphs, respiratory anaerobes A/w prior URTI with suppurative adenitis or retropharyngeal LN

Question 33

Symptoms of retropharyngeal abscess?

Answer 33

Fever Dysphagia Stiff neck!!! Neck pain Respi distress

Question 34

Imaging for retropharyngeal abscess?

Answer 34

Lateral neck XR = widened prevertebral soft tissue CT neck

Question 36

Which cervical LN level hit from which conditions?

Answer 36

Tongue SCC = 2 Oral cavity / oropharynx = 1 NPC = level 2, 5 Thyroid = Level 4

Question 37

Ocular manifestations of RA?

Answer 37

Keratoconjunctivitis sicca Peripheral ulcerative keratitis Contact lens cornea Corneal melt Episcleritis / scleritis ## Footnote Sicca is commonest