ENT

Question 1

A 50 year old swimming presented with a 3/7 history of pruritus around the ear after a surfing session. He woke up today with pain worse when moving the pinna and fullness in his ear. On further questioning, the patient has a history of diabetes.

Answer 1

Otitis Externa

Question 2

What are the common bacterial and fungal causes for Otitis externa?

Answer 2

Pseudomonas, E.coli, S. aureus, proteus, Klebsiella

Fungal: Candida, aspergillus

Question 3

Pale cream “wet blotting paper” debris in the ear?

Answer 3

Candida Albicans

Question 4

Black spores in the ear canal…

Answer 4

Aspergillus Nigra

Question 5

Management of otitis externa?

Answer 5

1. Aural toilet
2. Dressing (dry)?
   3a. Analgesia
3. Topical antimicrobes - Sofradex (bacteria) or Kenacomb (fungi)
4. Lifestyle things - prevent scratching, neomycin sulfate, gramicidn and nystatin

Question 6

What is surfer’s ear?

Answer 6

Narrowing of the ear canal - due to bone overgrowth caused by water retention in the ear.

Question 7

A 23-year-old comes to the GP with a painful left ear. On examination, pulling the auricle elicited pain and otoscopy revealed a raised white pustule with surrounding erythema

Answer 7

Furunculosis or Boil

Question 8

What is the cause of a boil/Furunculosis?

Answer 8

Staph infection of the hair follicle in the outer ear canal.

Question 9

How to manage Boil which has lead to surround cellulitis of the ear canal?

Answer 9

Dicloxacillin

Question 10

A 34 year old female attends her GP complaining of worsening unilateral ear pain following an ear piercing. She has removed the ear piercing.

Answer 10

Perichondritis

Question 11

What organism causes Perichondritis and hence what is the management?

Answer 11

Caused by P. pyocyaneus and hence treat with ciprofloxacin

Question 12

Julia an 8 month old girl attends with her father who states that she has recently had a runny nose and was sneezing but had been improving. Last night she was crying inconsolably and pulling her right ear.

Answer 12

Acute Otitis Media

Question 13

Cause of Acute Otitis Media?

Answer 13

Eustacian tube dysfinction leading to stasis of fluid in the inner ear. This can lead to a secondary bacterial or viral infection.

Question 14

Main diagnostic feature of AOM is __________ of the TM

Answer 14

Redness and bulging of Tympanic membrane

Question 15

Indications for antibiotics in AOM? (7)

Answer 15

Children 48hrs
Toxic
Aboriginal
Red-Yellow bulging TM

Question 16

How do you manage AOM with antibiotics?

Answer 16

Analgesics (Panadol/ibuprofen)
Adequate rest in a warm room
Nasal decongestants for nasal congestion

4. Abx: Amoxycillin for 5-7 days

Question 17

Complications of AOM?

Answer 17

Middle ear effusion
Acute Mastoiditis
Serous otitis Media

Question 18

Pain, swelling and tenderness behind the ear?

Answer 18

Acute Mastoiditis

Question 19

Antibiotic prevention of acute otitis media is indicated if it occurs more often than every other month or for _____ or more episodes in _______ months

How do you manage recurrent AOM

Answer 19

Antibiotic prevention of acute otitis media is indicated if it occurs more often than every other month or for three or more episodes in 6 months

Use amoxicillin for abut 4months
and if Child over 18mo then consider pneumococcus vaccine
Avoid smoke/cigarrette exposure

Consider r/v by ENT?

Question 20

Two forms of Chronic suppurative otitis media they both present with ______ and ______ without ______

Answer 20

Both present with deafness and discharge without pain

Question 21

Discharge in Cholesteatoma has ____ odour, is _____ in amount and is {Purulent or mucopurulent}?

Answer 21

Foul odour, Usually scant in amount and Purulent

Question 22

Discharge in Safe chronic otitis media has ____ odour, is _____ in amount and is {Purulent or mucopurulent}?

Answer 22

Inoffensive odour, Can be profuse in amount and is mucopurulent

Question 23

How to monitor Chronic otitis media (safe)

Answer 23

1. monitor closely
2. auraldischarge persists for >6 weeks after course of abx
3. treatment can be with topical steroid and abx combo following ear toilet
4. if persistent - referral to exclude cholesteatoma or chronic osteitis

Question 24

Cholesteatoma is Presence of accumulated _______epithelium in the middle ear (Attic perforation contains such material, safe perforations do not)

Answer 24

Presence of accumulated squamous epithelium in the middle ear (Attic perforation contains such material, safe perforations do not)

Question 25

Cholesteatoma can erode the ______ ear bones and damage the TM and cochlear leading to ________

Answer 25

Erode bones of the temporal and middle ear leading to SNHL

Question 26

Cholesteatoma can erode the ______ ear bones and damage the TM and cochlear leading to ________

Answer 26

Erode bones of the temporal and middle ear leading to SNHL!

Question 27

"Small white pearl" behind an intact tympanic membrane

Answer 27

Congenital Cholesteatoma (Thought to be due to ectopic migration of external canal ectoderm to conductive hearing loss)

Question 28

Treatment of Cholesteatoma?

Answer 28

Referral to ENT --> Audiogram, CT scan, surgical removal is necessary within a few weeks

Question 29

Common cause of discomfort; Typically due to disorders that cause oedema in the tubal lining such as viral URTI or allergy?

Answer 29

Eustachian tube dysfucntion

Question 30

How does Eustachian tube dysfunction present as?

Answer 30

It presents as fullness in the ear, pain of various levels and impairment of hearing. When only partially blocked -swallowing and yawning may elicit a crackling or popping sound

Question 31

Retraction of TM and decreased mobility on pneumatic otoscopy points to?

Answer 31

Eustachian tube dysfunction

Question 32

What is Otic Barotrauma?

Answer 32

Rapid changes in pressure in the presence of an occluded Eustachian tube

Question 33

Causes of conductive hearing loss? (5)

Answer 33

``` Impacted cerumen (wax) - most common Eustachian tube dysfunction Perforated tympanic membrane Cholesteatoma Otosclerosis (commonly stapes) ```

Question 34

Causes of Sensorineural hearing loss? (5)

Answer 34

``` Noise induced deafness (most common) Age related presbycusis Acoustin neuroma (unilateral) Meniere's disease Sudden Sensorineural hearing loss ```

Question 35

How do you investigate hearing loss?

Answer 35

Audiometry - Pure tone vs Impednace tympanometry | Electrical response audiometry

Question 36

24 year old woman from home with husband has come to the GP clinic asking about poor hearing over the past few years. She states that her mother had bilateral cochlear implants by the age of 35.

Answer 36

Otosclerosis

Question 37

What is the most common cause of conductive hearing loss in the adult with a normal tympanic membrane?

Answer 37

Otosclerosis

Question 38

Normal middle ear bone is replaced by vascular spongy none that becomes sclerotic in _______-

Answer 38

Otosclerosis

Question 39

How does Otosclerosis present?

Answer 39

Progressive disease starts in 20's/30's with family history. F >M Affects the foot plates of the stapes or the junction of the incus and stapes. May progress rapidly during pregnancy May have mild sensorineural loss alongside the conductive loss and may be associated with Meniere's syndrome

Question 40

30 year old truck driver and rock concert goer comes in complaining of long-term hearing loss and tinnitus. Ear examination was normal. Audiogram results showed:

Answer 40

Noise induced hearing loss

Question 41

Audiometry shows decreased hearing ability for certain sounds at about 4000 (for both sensory and conductive).... is indicative of

Answer 41

Noise induced hearing loss

Question 42

What are the clinical features of noise-induced hearing loss?

Answer 42

1. Onset of tinnitus after work in excessive noise 2. Speech seems muffled soon after work 3. Temporary loss initially but becomes permanent if noise exposure continues 4. High frequency loss of audiogram

Question 43

40 year old male comes to the GP complaining of rapidly progressive sudden hearing loss in his right ear. Otoscopic examination reveal no wax or abnormalities with the tympanic membrane. Hearing test was organised and the results are:

Answer 43

Sudden Sensorineural hearing loss!

Question 44

SSNHL occurs suddenly or over a period of ____ hrs.

Answer 44

72

Question 45

Causes of SSNHL include:

Answer 45

Trauma, Post-operative, Viral infections,Ototoxic drugs, tumours, Miniere disease, Cochlear otosclerosis

Question 46

How to treat SSNHL?

Answer 46

High dose steroids early; Medical Emergency

Question 47

Are hearing aids more helpful in conductive or SNHL deafness?

Answer 47

Conductive. They help with amplification.

Question 48

In who are cochlear impants used?

Answer 48

Is used in adults and children over 2 years with severe hearing loss unresponsive to powerful hearing aids

Question 49

Difference between Dizziness and Vertigo?

Answer 49

Dizziness - General term described as impairment in spatial perception and stabiltiy Vertigo - An illusion of rotary movement due to disturbed oreintation of the body in space. The sufferer may sense that the environment is moving. Vertigo may result form disease of labyrinth, vestibular nerve or their central connectuons.

Question 50

Vertigo happening for few seconds after waking up with no hearing loss, tinnitus or other features.

Answer 50

Benign Paroxysmal Positional Vertigo

Question 51

Vertigo happening from minutes to hours preceding an attack, Usually fluctuating and affecting one ear with associated tinnitus and pressure in the ear?

Answer 51

Meniere's disease

Question 52

vertigo lasting for hours to days which doesn't present with any other major symtpoms?

Answer 52

Vestibular neuritis

Question 53

Vertigo presenting for days in one ear, with an associated ongoing whistling sound in the ear. Recent history of acute Otitis media

Answer 53

Labyrinthitis

Question 54

Chronic Vertigo, with progressive hearing loss and tinnitus. Alongside ataxia and CN VII palsy

Answer 54

Acoustic neuroma

Question 55

Acute attacks of transient rotatory vertigo lasting seconds to minutes initiated by changing head position

Answer 55

Benign Paroxysm Positional Vertigo

Question 56

How do you diagnose BPV?

Answer 56

Hallpike manoever - hold the patients head and observe for torsional vertigo and nystagmus

Question 57

How do you treat Benign Paroxysmal Vertigo?

Answer 57

Generally tends to recover spontaneously. Can use Epley manoevre and antiemetics

Question 58

Vertigo + Hearing Loss + tinnitus =

Answer 58

Meniere's disease!

Question 59

Why does Meniere's disease occur?

Answer 59

Becaus eof inadequate absorption of endolymph --> this leads to accumulation of endolymph which distorts the membranous labyrinth

Question 60

How do you treat meniere's disease? | - An acute attack

Answer 60

An acute attack should be treated with bed rest and diazepam +/- Stemetil (Prochlorperazine)

Question 61

Long term Mx of Meniere's disease?

Answer 61

Low Salt diet, avoid triggers, alleviate anxiety | Meds - Stemetil (e.g. when ear feels full

Question 62

A 60 year old acupuncturist presented with a 3 day history of vertigo, double vision, nausea and vomiting that has been constant and has caused him to be off work

Answer 62

Vestibular Neuronitis

Question 63

What is vestibular neuronitis

Answer 63

Post viral inflammatory condition of the vestibular nerve.

Question 64

What must be ruled out for Vestibular Neuronitis

Answer 64

Stroke - through a CT scan

Question 65

How do you treat Vestibular Neuronitis?

Answer 65

- Bed rest and supportive care - Diazepam(reduced brainstem response to vestibular stimuli) - Corticosteroids - promotes recovery - can use stemetil too

Question 66

What is Labyrithitis?

Answer 66

Acute infection of the inner ear resulting in vertigo and hearing loss

Question 67

A 14 year old girl presents with a 1 year history of worsening dizziness and vertigo which has resulted in her being away from school for extended period of times. On history, her father suffered from similar symptoms before passing away at the age of 28 from a fall.

Answer 67

Acoustic Neuroma

Question 68

What is an acoustic Neuroma?

Answer 68

It is a benign tumour of the Schwann cells of the vetsibular nerve

Question 69

Risk factors for Acoustic Neuroma?

Answer 69

Exposure to loud sounds, childhood exposure to low dose radiation, Hx of parathyroid adenoma, Type II Neurofibromatosis

Question 70

How does Type II Neurofibromatosis present?

Answer 70

Bilateral acoustic neuroma + cafe aut lait skin lesions + multiple intracranial lesions

Question 71

Is Acoustic neuroma generally with bilateral or unilateral hearing loos and tinnitus?

Answer 71

It presents with unilateral hearing loss and tinnitus

Question 72

Work up for Acoustic neuroma?

Answer 72

Audiogram to confirm assymetrical sensorineural hearing loss | MRI scan - ENT referral

Question 73

What is Rhinitis?

Answer 73

Inflammation of the mucosa of the nasal cavity

Question 74

What is pain in trigeminal neuralgia evoked by?

Answer 74

Light touch, washign, shaving, talking, eating and brushing teeth (trigger)

Question 75

How do you treat Trigeminal neuralgia?

Answer 75

Carbamazapine

Question 76

3 common complications of Tonsillitis?

Answer 76

- otitis media - Quinsy : peritonsillar abscess - Rheumatic fever and GN (rarely)

Question 77

A newborn baby is noted to have a large swelling on the left-side of the neck. On examination a soft, fluctuant and highly transilluminable lump is noted just beneath the skin.

Answer 77

Cystic Hygroma

Question 78

A 75-year-old man presents with dysphagia and halitosis. On the left side of the neck is a small, fluctuant swelling which gurgles when palpated.

Answer 78

Pharyngeal pouch

Question 79

Very common neck swelling - generally present during local infection or a generalised viral illness

Answer 79

Reactive lymphadenopathy

Question 80

Painless neck swelling - associated with night sweats and splenomegaly?

Answer 80

Lymphoma

Question 81

Does Thyroid swelling move upwards on swallowing?

Answer 81

Yes

Question 82

Does a thyroglossal cyst move downwards on protrusion of tongue?

Answer 82

NO. It moves upwards

Question 83

A thyroglossal cyst is generally located between the ______ of the thyroid and the _____ bone

Answer 83

Isthmus of the thyroid and hyoid bone

Question 84

A pharyngeal pouch represents a posteromedial herniation between the _______ and ______ muscles

Answer 84

thyropharyngeus and cricopharyngus muscles

Question 85

Typical symptoms of a pharyngeal pouch:

Answer 85

Presents in an elderly man - usually not large but if large then gurgles on palpation. Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough.

Question 86

Branchial cyst: Develop due to failure of obliteration of the _____ branchial cleft in embryonic development

Answer 86

Second

Question 87

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx

Answer 87

Branchial cyst

Question 88

Pulsatile lateral neck mass which doesn't move on swallowing

Answer 88

carotid aneurysm

Question 89

Inability to move many facial muscles, pain in the ear, taste loss on the front of the tongue, dry eyes and mouth, and a vesicular rash.

Answer 89

Ramsay Hunt syndrome

Question 90

What is Ramsay hunt Syndrome (type II)?

Answer 90

Disorder that is caused by the reactivation fo varicella zoster virus in the geniculate ganglion - nerve cell bundle of the facial nerve.

Question 91

How to treat bells palsy?

Answer 91

Prednisolone

Question 92

How to treat ramsay hunt syndrome?

Answer 92

Aciclovir + oral Steroids

Question 93

5 top features of allergic rhinitis ?

Answer 93

Sneezing, Bilateral nasal obstruction, clear nasal discharge, post-nasal drip and nasal pruritis

Question 94

5 mx points for Allergic Rhinitis

Answer 94

1. Allergen avoidance 2. Antihistamines (Nasal Decongestant) 3. Intranasal corticosteroids 4. Possible oral steroids in exacerbation 5. Allergen immunotherapy

Question 95

Nasal polyps are sensitive to which medication?

Answer 95

Aspirin

Question 96

What is Samter's triad?

Answer 96

The association of asthma, aspirin sensitivity and nasal polyposis

Question 97

What are common associations with nasal polyps?

Answer 97

Asthma, aspirin sensivitiy, Infective sinusitis, CF, Kartagener's syndrome

Question 98

'attic crust' - seen in the uppermost part of the ear drum

Answer 98

Choleastatoma

Question 99

Air and bone conduction are impaired in _____

Answer 99

Sensorineural hearing loss

Question 100

In conductive hearing loss only _______ is imapired

Answer 100

Air conduction

Question 101

In mixed hearing loss both air and bone conduction is impaired, with _____ being worse than_____

Answer 101

Air conduction being worse than bone

Question 102

Offensive ear discharge

Answer 102

Choleastatoma

Question 103

Air conduction is worse than bone conduction means _______ hearing loss

Answer 103

Conductive hearing loss