ENT

Question 1

name some causes of acute otitis media

Answer 1

viral (common)- rhinovirus/ enterovirus/ RSV

bacterial- haem influenzae/ strep pneumoniae

Question 2

what would you see on examination of AOM?

Answer 2

bulging tympanic membrane +/- pus +/- perforated ear drum

Question 3

name some red flags in AOM that would warrant referral

Answer 3

Cellulitis of the outer ear or surrounding skin
Mastoiditis (tender mastoid, often with cellulitis looking ear and ear appears to be pressed forwards)
Headache
Facial palsy
Fever in child under 3 months old

Question 4

antibiotics for AOM

Answer 4

amoxicillin 5 days may improve symptoms earlier but often not used for risk of resistance/ GI upset ?delayed script

Question 5

in AOM if TM rupture, when should you follow up?

Answer 5

2 weeks

Question 6

when should you refer AOM to ENT non-urgently

Answer 6

> = 6 episodes in 12 months

Persisting OME for >3 months (bilateral) or >6 months unilateral

Question 7

what does hearing loss in AOM suggest?

Answer 7

otitis media with effusion

Question 8

how does OME appear on examination?

Answer 8

opaque ear drum
Loss of light reflex
Indrawn or retracted TM – rarely can be bulging
Bubbles in fluid behind TM / fluid level visible behind TM

Question 9

how long for OME to resolve?

Answer 9

up to 1 year 90% resolved

Question 10

indications for surgery in OME

Answer 10

Persistent bilateral OME lasting >3 months, OR
Hearing loss >25dB in the best ear, OR
Language, education or social developmental delay

Question 11

what are indications for surgical treatment of OME

Answer 11

grommets

adenoidectomy

Question 12

what level of hearing loss is significant in OME

Answer 12

> 25dB

Question 13

name 3 RFs for developing OME

Answer 13

cleft palate
chronic sinusitis in adults
parents who smoke

Question 14

name 3 RFs for otitis externa

Answer 14

swimming
humidity
hearing aids

Question 15

OE with out of proportion pain, in immunocompromised patient

Answer 15

necrotising (malignant) OE, infection has spread to mastoid/ temporal bones

Question 16

OE with severe pain, vesicles + crusting, facial palsy

Answer 16

ramsay hunt syndrome, caused by herpes zoster infection

Question 17

first line for OE

Answer 17

topical ABx- aminoglycosides/ ciprofloxacin if TM ruptured +/- steroids. May need wick. aural toileting e.g. micro-suction

Question 18

what are some causes of SNHL in adults?

Answer 18

idiopathic hearing loss
presbyacusis
noise exposure
inflammatory disease
ototoxic drugs
tumours

Question 19

what is presbyacusis?

Answer 19

Loss of hair cells on cochlear as increase in age, High frequencies lost first, low frequencies stay in normal range, no increased air-bone gap
noticed after 60, no tx- aural hearing aids

Question 20

which infections can cause HL

Answer 20

measles
mumps
meningitis

Question 21

which drugs can cause HL

Answer 21

systemic aminoglycosides
cytotoxic agents- cisplatin
salicylate/ quinine (reversible)

Question 22

what are some causes of conductive hearing loss in adults?

Answer 22

external- wax/ exostoses
eardrum- TM rupture
middle ear- otosclerosis

Question 23

what is otosclerosis?

Answer 23

AD inherited condition. New bone growth in middle ear causes fusion of stapes footplate to oval window causing conductive HL

Question 24

Abnormal result on Weber’s test

Answer 24

SNHL- louder in normal ear

CHL- louder in abnormal ear

Question 25

abnormal result in Rinne's

Answer 25

normal/ SNHL- AC>BC | CHL BC>AC

Question 26

name some causes of dizziness

Answer 26

CVD- AF/ arrhythmias, postural hypotension neuro- head inj, MS, tumours otological- meniere's BPPV, vestibular neuritis, others- migraines

Question 27

what is a positive Dix- Hallpike test?

Answer 27

nystagmus, diagnostic of BPPV

Question 28

which manoeuvre can be used to treat BPPV?

Answer 28

Epley's

Question 29

A 50 year old woman with type 2 neurofibromatosis visits her GP with a 2 month history of headaches and dizziness. On examination, she has reduced hearing in one ear.

Answer 29

aoustic neuroma (benign tumour of schwann cells of vestibulocochlear nerve)- ipsilateral CN V, VI, IX and X may be affected ?signs of raised ICP

Question 30

What is meniere's disease?

Answer 30

long term, progressive condition affecting the balance and hearing parts of the inner ear. Symptoms are acute attacks of vertigo, fluctuating tinnitus, increasing deafness, and a feeling of pressure in the ear. ?due to excess fluid in inner ear (endolymphatic hydrops)

Question 31

what is vertigo?

Answer 31

the hallucination of rotation due to the abnormal stimulation of the hair cells of the vestibular system.

Question 32

what can be used in acute attacks of meniere's

Answer 32

Antihistamine

Question 33

what can be used to relieve symptoms in vestibular neuronitis?

Answer 33

vestibular sedatives such as Prochlorperazine

Question 34

what is a cholesteatoma?

Answer 34

non-cancerous skin growth in middle ear, usually as a result of multiple infections

Question 35

which area is most likely to be the cause of epistaxis?

Answer 35

Little's area

Question 36

name some RFs for epistaxis

Answer 36

local- nose picking, dry mucosa (nasal O2/ nasal sprays) | systemic- clotting disorders, HTN, Hereditary Haemorrhagic Telangiectasia (AD, also causes oral telangectasia)

Question 37

management of epistaxis

Answer 37

ABCDE pressure 20 mins, head forward. anterior bleed-> cautery/ merocel nasal pack posterior-> balloon catheter

Question 38

how would a septal haematoma present and why is it important?

Answer 38

bilateral intra-nostril cherry red swelling following trauma. stops blood supply to septum therefore needs emergency incision and drainage

Question 39

name some causes other than allergic of rhinitis?

Answer 39

``` occupational drug induced- aspirin, ACEIs pregnancy idiopathic rhinitis medicamentosa (lots of OTC vasoconstrictor sprays) ```

Question 40

first line management for rhinitis

Answer 40

antihistamine spray +/- steroid (if main symptom blockage)

Question 41

where would you palpate frontal sinuses?

Answer 41

press upwards beneath medial side of supraorbital ridge

Question 42

where would you palpate maxillary sinuses?

Answer 42

below inferior orbital margin

Question 43

where would you palpate ethmoidal sinuses?

Answer 43

medial against medial wall of orbit

Question 44

what is typical of sinusitis pain?

Answer 44

pain/ pressure increased on bending forward

Question 45

most common cause of tonsillitis

Answer 45

viral (70%)

Question 46

most common bacterial cause of tonsillitis

Answer 46

Group A strep

Question 47

4 points on Centor criteria

Answer 47

``` tonsilar exudate temp >38 no cough tender cerviacal lymphadenopathy If all 4 = 50% chance of bacterial cause, give ABx ```

Question 48

what ABx for tonsillitis

Answer 48

Pen V, not amoxicillin as can cause rash in glandular fever

Question 49

what is Quinsy?

Answer 49

this is a peritonsillar abscess

Question 50

what causes glandular fever

Answer 50

EBV

Question 51

When should you consider tonsilectomy?

Answer 51

>5 episode tonsillitis in one calendar year Symptoms ongoing for >1 year Episodes are disabling and prevent normal function Tonsillitis is known to be the cause of the sore throats!

Question 52

which organism causes epiglottitis?

Answer 52

HiB

Question 53

which organism causes croup?

Answer 53

parainfluenza virus

Question 54

what level indicates impaired hearing on audiogram?

Answer 54

above 20dB

Question 55

what on audiogram indicates SNHL?

Answer 55

both air and bone conduction impaired

Question 56

what on audiogram indicates CHL?

Answer 56

only air conduction impaired

Question 57

what on audiogram indicates mixed HL?

Answer 57

both air and bone impaired but air worse than bone