ENT

Question 1

When to give ABX in otitis media?

Answer 1

Symptoms >4 days
Systemically unwell
<2 years and bilateral
Perforation or discharge

Question 2

ABX in otitis media?

Answer 2

5/7 amoxicillin or erythro/clarithro if allergic

Question 3

Usual course of otitis media?

Answer 3

3 days but up to 1 week

Question 4

Malignant otitis externa?

Answer 4

Unremitting pain and fever >39 Granulation tissue or bone seen near ear canal. Facial nerve paralysis

Question 5

Achalasia presentation?

Answer 5

Dysphagia to both liquids and solids, can be pain on eating and heartburn

Question 6

A barium swallow which shows a grossly expanded oesophagus that tapers at the lower oesophageal sphincter - what is this?

Answer 6

Achalasia

Question 7

What can you give if pt cant take oral levodopa but needs something for acute symptoms

Answer 7

Dopamine agonist patch

Question 8

Otitis media signs and symptoms?

Answer 8

otalgia, preceding URTI, bulging membrane, myringitis(erythema of membrane)

Question 9

Acute otitis externa presentation?

Answer 9

presence of rapid onset (generally within 48 hours) of symptoms within the past 3 weeks, coupled with signs of ear canal inflammation

Question 10

Most common organisms for otitis externa?

Answer 10

Pseudomonas or staph

Question 11

Webers test localises to right hand side. Rinnes test is negative (bone>air) on right hand side what type of deafness?

Answer 11

Right conductive

Question 12

If bone conduction is better than air conduction which deafness?

Answer 12

Conductive

Question 13

Webers localises to right, rinnes positive (Air>bone) on right what deafness?

Answer 13

Left sensorineural

Question 14

If air better than bone conduction what result is this ?

Answer 14

Normal but if webers lateralised to that side it is sensorineural of the other side

Question 15

Webers localises to the left hand side , rinnes is positive on left (air>bone)?

Answer 15

Right sensorineural

Question 16

Right conductive loss what test results?

Answer 16

Webers localises to the right, rinnes is negative (bone>air)

Question 17

Left sided webers test and negative rinnes on this side, ? loss

Answer 17

Conductive loss on left

Question 18

Transilluminant cyst in posterior triangle neck?

Answer 18

Cystic hygroma

Question 19

Haemorrhage 5-10 days after tonsillectomy with fever what to do?

Answer 19

Haemorrhage 5-10 days after tonsillectomy is commonly associated with a wound infection and should therefore be treated with antibiotics

Admit

Question 20

Persistent unexplained hoarseness in a patient aged >45 years old

Answer 20

Urgent referral to ENT

Question 21

Visible haematuria when to refer?

Answer 21

> 45

Question 22

Non visible haematuria with dysuria or white cell count when to refer?

Answer 22

If over 60

Question 23

Sudden and near complete loss of vestibular loss in a young person?

Answer 23

Vestibular neuronitis

Question 24

Vestibuloneuronitis hearing changes?

Answer 24

None

Question 25

Bilateral conductive hearing loss in young person?

Answer 25

Otosclerosis- family history present

Question 26

What would make you think that an epistaxis was posterior rather than anterior?

Answer 26

Bleeding from both nostrils, profuse and cannot be found on nasal speculum

Question 27

What to consider giving if nose bleed stops on its own?

Answer 27

Naseptin to prevent infection and crusting (vestibulitis)

Question 28

When to consider cautery of nose bleed?

Answer 28

If can see spot, small area and does not stop after 10-15mins

Question 29

Consider nasal packing if?

Answer 29

Cautery unsuccessful or cannot see area of bleeding

Question 30

How often need tetanus?

Answer 30

Every ten years or so

Question 31

Clear unilateral leakage from nose think what?

Answer 31

CSF leak

Question 32

Imaging in nasal trauma/fracture?

Answer 32

Avoid as does not usually add to management

Question 33

When to refer nose trauma to ENT?

Answer 33

Haematoma marked deviation Widened intracanthal distance Facial anaesthesia

Question 34

Nasal irrigation for what conditions?

Answer 34

Sinus, post nasal drip, allergic rhinitis

Question 35

First line treatments for rhinitis (allergic)?

Answer 35

Intranasal antihistamine or oral antihistamine such as loratadine ( slower onset)

Question 36

First line options for allergic rhinitis not working what to consider?

Answer 36

Steroid spray during allergen exposure eg fluticasone | benefit takes up to 2 weeks of use

Question 37

Very severe allergic rhinitis and disabling?

Answer 37

Short course of oral steroid

Question 38

When should sinusitis be seen in hospital?

Answer 38

Very severe systemic infection, orbital cellulitis, and reduced vision. Swelling over frontal bones or meningism

Question 39

Sinusitis how long for symptoms before ABX? How long to start to get better?

Answer 39

10 days, usually get better within 2-3 weeks

Question 40

Decongestants and antihistamines in sinusitis?

Answer 40

No evidence

Question 41

Sinusitis symptoms for 10+ days and NO improvement consider?

Answer 41

High dose nasal steroid 200micrograms mometasone

Question 42

ABX for sinusitis?

Answer 42

Pen VK 500mg QDS 5/7 Or co-amox if bad! Or doxy or clarithro if pen allergic

Question 43

Polyps when to refer?

Answer 43

Unilateral or bleeding etc diagnosis unclear, poor response to steroids

Question 44

Associations with nasal polyps?

Answer 44

Aspirin, CF, Churg strauss (eosiniphillic)

Question 45

Are nasal polyps allergic in nature?

Answer 45

No

Question 46

Carbimazole user presents with sore throat?

Answer 46

Stop drug check FBC urgently

Question 47

Alternative to Pen VK for tonsillitis?

Answer 47

Clarithro,

Question 48

What is the Fever PAIN score

Answer 48

``` Fever in last 24hrs Purulence Attend rapidly 3/7 Inflamed No cough >4 prescribe ```

Question 49

Centor criteria?

Answer 49

Exudate, Lymph nodes Fever >38 Absence of cough 3 or 4 consider prescribing

Question 50

Epiglottisis diagnosis?

Answer 50

'tripod' position of the patient, drooling, high fever, and a toxic appearance. muffled voice and stridor

Question 51

Risks for epiglottitis?

Answer 51

Non vaccination HiB, middle age

Question 52

Important measure in acute epiglottitis?

Answer 52

Laryngoscopy and possibility of securing airway, can do lateral neck Xray

Question 53

Oral tumour likely type?

Answer 53

SCC

Question 54

Strongest risk for oral cancer?

Answer 54

Alcohol and smoking history, but HPV infection strongly implicated in non smokers/drinkers

Question 55

Red flags for trigeminal neuralgia?

Answer 55

Sensory change, desfness, skin or oral lesions, pain in ophthalmic division optic neuritis MS history Onset <40years

Question 56

Trigeminal neuralgia symptoms?

Answer 56

Severe shock like pain in trigeminal nerve distribution- usually jaw or cheek Unilateral usually Short lived recurrent episodic Cold air and light touch to face can provoke (occasional autonomic features)

Question 57

First line treatment for trigeminal neuralgia?

Answer 57

Titrate up carbamazepine arrange follow up

Question 58

Carbamazepine not tolerated or ineffective?

Answer 58

Refer do not offer other drugs

Question 59

Carbamazepine and oral contraceptive and DOACS?

Answer 59

Possibly makes ineffective

Question 60

Carbamazepine does what to CYP450

Answer 60

Induces

Question 61

CRAPGPS something me to rage what drugs?

Answer 61

Induce me | Carbemazepines Rifampicin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbitone Sulphonylureas

Question 62

vertigo: not triggered by movement but exacerbated by movement nausea and vomiting hearing loss: may be unilateral or bilateral ?

Answer 62

Labyrinthitis - note hearing loss as opposed to non in vestibular neuronitis

Question 63

spontaneous unidirectional horizontal nystagmus towards the unaffected side sensorineural hearing loss: shown by Rinne's test and Weber test what could cause this?

Answer 63

Labyrinthitis

Question 64

Extra luminal causes of dysphagia?

Answer 64

Spondylosis and mediastinal mass

Question 65

Mechanical causes of dysphagia?

Answer 65

Malignancy, strictures, web, pharyngeal pouch

Question 66

Neuromuscular causes of dysphagia?

Answer 66

Achalasia, Spasm and myasthenia gravis

Question 67

All patients who present with difficulty swallowing do what?

Answer 67

Upper GI endoscopy may need a barium swallow too | Undertake an FBC

Question 68

Neuro causes of dysphagia?

Answer 68

Stroke, parkinsons, MS