ENT

Question 1

Classical triad of PD + other features

Answer 1

Rigidity
Resting tremor
Bradykinesia

Shuffling gait
Mask like face
Micorgraphia
Dementia

Question 2

Normal pressure hydrocephalus presentation

Answer 2

Characterised by progressive mental impairment and dementia
Difficulty walking
Impaired bladder control
Gait disturbance is often most noticeable symptom
No rigidity/ tremor

Question 3

Progressive supranuclear palsy

Answer 3

Starts with impairment of balance- falls
Vertical gaze palsy
Symmetrical onset
Poorly responsive to levodopa

Question 4

Corticobasal syndrome

Answer 4

Begins as a movement disorder
Unilateral absence of moment
Muscle rigidity with tremor
Progressive neurological disorder that can also affect cognition

Question 5

Multi system atrophy

Answer 5

Shy drawer is a type 
Fts; Parkinsonism 
Autonomic disturbance- post hypotension, atomic bladder
Cerebrellar signs 
Poor response to levodopa

Question 6

NICE guidelines - sore throat and antibiotics

Answer 6

Features of marked systemic upset secondary to acute sore throat
Unilateral peritonsillitits
Hx of RF
Increased risk from acute infection- diabetes/ immunodeficiency
Patients with acute sore throat/ when 3 or more center criteria are present

Question 7

Centor criteria

Answer 7

Tonsillar exudate
Tender anterior cervical LN or lymphadenitits
Hx of fever
Absence of cough

3 or more 40-60% chance strep group A beta haemolytic

Question 8

Ménière’s disease

Answer 8

Disorder of inner ear of unknown cause
Characterised by excessive pressure and progressive dilation of the endolymphatic system. 
More common in middle aged adults
May be seen at any age
M & F equally effected

Question 9

Features of Ménière’s disease

Answer 9

Recurrent episodes of vertigo tinnitus and sensorineural hearing loss . VERTIGO. PROMINENT SYMPTOM
Sensation of aural fullness or pressure common
Nystagmus and positive Romberg test
Episodes lasts minutes to hours
Typically unilateral but bilateral symptoms may develop after a number of years

Question 10

NATURAL HX of menieres

Answer 10

Symptoms resolves in the majority of patients after 5-10 years
Usually left with a degrees of hearing loss
Psychological distress is common

Question 11

Mgmt of Ménière’s disease

Answer 11

ENT assessment to confirm diagnosis
Acute atttacks- buccaneers or IM prochlorperazine
Prevention; betahistine and vestibular rehab

Question 12

Nasal tumors

Answer 12

Nosebleeeds, persistent blocked nose
Blood strained mucus
Decreased sense of smell

Question 13

Smokers cough

Answer 13

Chronic cough that occurs as a result of damage and destruction of cilia

Question 14

Nasal polyp

Answer 14

Nasal obstruction, sneezing, rhionorrhoea, poor sense of taste and smell
Sinister if unilateral symptoms or bleeding

Question 15

Post nasal drip

Answer 15

Excessive mucus production but nasal mucosa

Excess mucus accumulates in the throat and bad of nose- chronic cough and bad breath

Question 16

Causes of tinnitus

Answer 16

Otoscloeroiss 
Acoustic neuroma 
Hearing loss 
Drugs- aspirin, aminoglycosides, loop diuretics and Quinine 
Impacted ear wax
Chronic suprrurative OM

Question 17

Otosclerosis

Answer 17

Onset 29-40 
Conductive deafness
Tinnitus 
Normal tympanic membrane- 10% flamingo tongue
Positive family history 
10% flamingo tinge- hyperaemia 
Hearing aid 
Stapedectomy

Question 18

Acoustic neuroma

Answer 18

Hearing loss
Vertigo 
Tinnitus
Absent corneal reflex
Neurofibromatosis type 2

CNV absent corneal reflex
CN VII facial palsy
CNVIII hearing loss vertigo tinnitus

Question 19

Cholesteatoma

Answer 19

Consist of squamous epithelium trapped within the skull base causing local destruction
Most common in patients 10-20
Main fts- foul discharge
Hearing loss
Vertigo 
Facial nerve palsy

Question 20

Glue ear

Answer 20

OM with effusion
Peaks at 2
Hearing loss is usually the presenting feature
Secondary problems such as speech and language delay

Question 21

Ototoxic drugs

Answer 21

Aminogglycosides- gentamicin
Furosemide
Aspirin

Question 22

Perforated TM

Answer 22

Most common cause is infection
May lead to hearing loss
Increased risk of OM
No tx usually needed- 6-8 weeks to heal - try and avoid water in ear
Antibiotics inf perforation happened after infection
Myringoplasty if it wont heal

Question 23

Reactive lymphadenopathy

Answer 23

Most common cause of neck swellings

May be a history of local infection or generalized viral illness

Question 24

Lymphoma

Answer 24

Rubbery, painless lymphadenopathy
Pain when drinking alcohol- VERY UNCOMMON
Night sweats and splenomegaly

Question 25

Thyroid swelling

Answer 25

May be hypo eu or hyper | Moves upward on swallowing

Question 26

Thyrglossal cyst

Answer 26

Common under 20 Usually midline between isthmus of thyroid and hyoid one Moves upwards with protrusion of the tongue May be painful if infected

Question 27

Pharyngeal pouch

Answer 27

More common in older men Posteromedial herniation between thyropharyngeus and cricipharyngeus muscles. Usually not seen unless large, then a midline lump- gurgles on palpating Typical symptoms are dysphasia regurg aspiration and cough, halitosis and throat infections

Question 28

Cystic hygroma

Answer 28

Congenital lymphatic lesion typically found in the neck, classically on the left side Most evident at birth 90% present by 2yrs Fluctuant and transilluminable

Question 29

Brachial cyst

Answer 29

An oval mobile cystic mass that develops between the SCM and pharynx Develop due to failure of obliteration of the second brachial cleft in embryonic development Present in early adulthood

Question 30

Cervical rib

Answer 30

More common in adult females | 10% develop thoracic outlet syndrome

Question 31

Carotid aneurysm

Answer 31

Pulsatile lateral neck mass which doesn’t move on swallowing

Question 32

Nasopharyngeal carcinoma

Answer 32

Squamous cell carcinoma of the nasopharyngeal Rare on most parts of the world apart from s. China Associated with EBV

Question 33

Causes of vertigo

Answer 33

``` Viral labyrinthitis Vestibular neuronitits BPPV Ménière’s disease Bertebrobasilar ischemia Acoustic neuroma Trauma MS Ototoxicity ```

Question 34

Viral labyrinthitis

Answer 34

Recent viral infection Sudden onset Nausea and vomiting Hearing may be affected

Question 35

Vestibular neuronitis

Answer 35

Recent viral infection Recurrent vertigo attacks lasting hours/days No hearing loss

Question 36

BPPV

Answer 36

``` Gradual onset.. Average age of onset 55years Triggered by change in head position Each episode lasts 10-20 seconds May have nausea Positive dix hallpike manoeuvre ``` Tx; spontaneous resolution weeks to months Epley manoeuvre- successful in 805

Question 37

Vertebrobasialr ischaemia

Answer 37

Elderly patient | Dizziness on extension of neck

Question 38

Complications of thyroid surgery

Answer 38

Anatomical- recurrent laryngeal nerve damage Bleeding- respiratory compromise Damage to parathyroid glands- hypocalcemia

Question 39

Ramsay- Hunt syndrome

Answer 39

Shingles affecting the facial nerve Auricular pain- first features Facial nerve palsy Vesicular rash around ear Vertigo and tinnitus Oral aciclovir and corticosteroids

Question 40

Sinusitis

Answer 40

Inflammation of the mucous membranes of the paranasal sinuses Usually strep pneumonia, h influenza, rhinovirus Fts nasal discharge Facial pain- pressure frontal- worse bending forward Post nasal drip Analgesia Inhaled decongesations OAB not normally indicated

Question 41

Nasal polyps

Answer 41

1% of adults 2-4 more times common in males ``` Associations Asthma * Samters triad Aspirin sensitivity * Infective sinusitis CF ``` Fts Nasal obs Rhinorrhoea Sneezing- poor taste and smell Refer ENT

Question 42

2 week referral to oral surgery if

Answer 42

Unexplained oral ulceration persisting for more 3weeks Unexplained red/ white patches painful swollen and bleeding Unexplained lump persisting more 3 weeks

Question 43

Otalgia

Answer 43

In absence of any ear sings is a ref flag for head and neck malignancy

Question 44

Complications of tonsillitis

Answer 44

Otitis media Quinsy Rheumatic fever and glomerulonephritis very rarely

Question 45

INdications for tonsillectomy

Answer 45

NICE- fiver or more episodes per year | Disabling and prevent normal functioning

Question 46

Complications of tonsillectomy

Answer 46

Primary <24hrs- haemorrhage in 2-3%, pain | Secondary- same

Question 47

Hoarseness

Answer 47

``` Causes ; Voice overuse Smoking Viral illness Hypothyroidism GORD Laryngeal cancer Lung cancer ``` Always do CXR Referral if >45 persistent and unexplained hoarseness

Question 48

Benign tumours ENT

Answer 48

80% of all salivary gland tumours occur in the parotid gland and 80% of these are benign . Median age 50’s

Question 49

Examples of benign tumours

Answer 49

Benign pleomorphic adenoma or benign mixed tumour Warthin tumour Monoporphic adenoma Haemiangioma

Question 50

Benign pleomorphic adenoma or benign mixed tumour

Answer 50

Most common parotid neoplasm 80% Slow growing lobular Recurrence of 1-5% Malignant degeneration in 2-10% of adenoma

Question 51

Warthin tumour

Answer 51

``` Second most common benign parotid tumor Most common bilateral benign neoplasm of the parotid Male predominance 6th 7 th decade Malignancy trasnformation is rare ```

Question 52

Monomorphic adenoma

Answer 52

Less than 5% of tumours | Slow growing

Question 53

Haemangioma

Answer 53

Differential for a parotid mass in ac hold 90% of parotid tumours in children less than 1 year Hypervascular on imaging Spontaneous regression may occur

Question 54

Malignant tumours

Answer 54

Mucoepidermoid carcinoma Adenoid cystic carcinoma Mixed tumours

Question 55

Sjögren’s syndrome

Answer 55

Autoimmune Parotid enlargement, xerostomia and keratoconjuncitvitis sicca 90% female Bilateral non tender englargement of gland Increased risk of subsequent lymphoma

Question 56

Sarcoidosis

Answer 56

Paroid involvement in 6% Bilateral Gland non tender Xerostomia

Question 57

Black hairy tongue

Answer 57

Common due to defective desquamation of the filliform papillae Tongue may be brown, green, pink , other RF; poor oral hygiene, OAB, head and neck radiation, HIV, IV drug Mgmt; tongue scraping to exclude candida

Question 58

Sudden sensorineural hearing loss

Answer 58

Majority of cases is idiopathic | Some evidence that high does steroids 60mg/dat for 1/52 improves prognosis. Urgent ENT referral

Question 59

Epidermoid cysts

Answer 59

Common cutaneous cysts proliferation of epidermal cells Typically asymptomatic Firm round central punctual may be present

Question 60

Gingivitis

Answer 60

Secondary to poor dental hygiene Presentation can range from simple gingivits( painless red swelling of gum margin which bleeds on contact) to acute necrotizing ulcerative gingivits (painful bleeding gums with halitosis and punched out ulcers on gums Refer to dentist 3days if metronidazole/amoxicillin Cholrhexidine mouthwash

Question 61

Sialadenitis

Answer 61

Inflammation of the salivary gland often secondary to obstruction by a stone impacted in the duct

Question 62

Salivary glands

Answer 62

Parotid glands are anterior and inferior to each ear Submandibular lie below the angle of the jaw Sublingual lie beneath the tongue

Question 63

Nasal septal haematoma

Answer 63

Complication of nasal trauma Development of a haematoma between the septal cartilage and the overlying perichondrium Features; may be precipitated by minor trauma Sensation of nasal obstruction Pain and rhionorrhoea Bilateral red swelling Feels boggy Surgical drainage Iv antibiotics If untreated- septal necrosis, saddle nose deformity