ENT

Question 1

What is the treatment for bacterial otitis externa?

Answer 1

Gentamicin drops

Steroid drops

Question 2

Why does having a hearing aid increase the risk of otitis externa?

Answer 2

Keeps air in auditory canal continuously moist

Question 3

What can overuse of gentamicin ear drops lead to?

Answer 3

Secondary fungal infection

Question 4

A 57 year old mechanic presents with unilateral left sided tinnitus and hearing loss. On examination you notice he is unable to abduct his left eye. What is the likely cause?

Answer 4

Acoustic neuroma

Question 5

What is a cholesteatoma?

Answer 5

Keratinising squamous epithelium that grow and invade structures in the middle ear so patient can present with facial nerve problems, sensorineural hearing loss, purulent discharge

Question 6

Why might a patient with obstructive sleep apnoea complain of a sore throat?

Answer 6

Mouth breathing: air is not moistened by normal mechanisms in the nose so dries and damages the pharyngeal mucosa

Question 7

What are causes of vertigo?

Answer 7

Benign paroxysmal vertigo
Labyrinthitis
Ménière’s disease

Question 8

What causes benign paroxysmal vertigo?

Answer 8

An otolith in the semicircular canals which disturbs the fluid and causes a sensation of vertigo especially when turning head to side

Question 9

What is treatment for benign paroxysmal vertigo?

Answer 9

Epley manoeuvre

Question 10

What is Ménière’s disease?

Answer 10

Due to over production of fluid within semi circular canals and causes vertigo and tinnitus, hearing loss and aural fullness

Question 11

What is presbyacusis?

Answer 11

Deterioration of hearing related to age
Hearing loss in group situations and when there is background noise
Comes on gradually and is difficult to pinpoint the starting point
Audiogram will show sensorineural deafness in higher frequency ranges

Question 12

What is otosclerosis?

Answer 12

Autoimmune disease where there is bony fusion occurring between ossicles, specifically between foot plate of stapes and oval window
Presents as gradual conductive hearing loss

Question 13

What would expect nasal polyps to look like on examination?

Answer 13

Mucosa appears pale and gelatinous
Polyps found under middle turbinate
They can fill maxillary sinus and extend out from middle meatus

Question 14

What are symptoms of nasal polyps?

Answer 14

Rhinorrhoea

Obstructed nasal airways

Question 15

What is the treatment for chronic otitis media?

Answer 15

Grommet insertion

Question 16

What might a tympanic membrane of an adult look like who had a history of recurrent otitis media with effusion as a child?

Answer 16

Ear drum look retracted and scarred

Tympanosclerosis

Question 17

What is the treatment for chronic otitis media?

Answer 17

Grommet insertion

Question 18

What might a tympanic membrane of an adult look like who had a history of recurrent otitis media with effusion as a child?

Answer 18

Ear drum look retracted and scarred

Tympanosclerosis

Question 19

A 47 year old male has a lump in the back of his neck. It’s 2cm round lesion which is non tender and freely moveable beneath dermis. It’s hard with a smooth surface. The overlying skin is a normal colour and a sinus is visible. What is the likely diagnosis?

Answer 19

Sebaceous cyst

Question 20

A 67 year old female presents to her GP with a soft fluctuant non tender 5cm round mass at the side of her neck. It has been present for many years and caused her no problems. What is the likely diagnosis?

Answer 20

Lipoma

Question 21

What is a laryngocoele?

Answer 21

Rare cause of neck lump in wind instrument players. High pressure in larynx causes outpouching of laryngeal mucosa

Question 22

Where would you find a branchial cyst?

Answer 22

Anterior triangle a third of the way along SCM

Question 23

What is the embryological origin of malleus?

Answer 23

Mesoderm of first pharyngeal arch

Question 24

What are risk factors otitis media?

Answer 24

Younger age 
Male sex
Smoking in the household 
Nursery attendance 
Formula feeding 
Craniofacial abnormalities 
GORD
Dummy use
Winter 
Supine feeding

Question 25

What are symptoms of otitis media?

Answer 25

``` Pain (pulling at ear) Malaise Irritability, crying, poor feeding, restless Fever Coryza/rhinorrhoea Vomiting ```

Question 26

What are signs of otitis media?

Answer 26

High temperature Red, yellow or cloudy tympanic membrane Bulging tympanic membrane Air fluid level behind tympanic membrane Discharge in auditory canal secondary to perforation Red pinna

Question 27

Which cases of acute otitis media should be admitted?

Answer 27

Children under 3 months with a temp 38 or more | Children with suspected complications - meningitis, mastoiditis or facial nerve paralysis

Question 28

What are the most common bacterial pathogens that cause acute otitis media?

Answer 28

Haemophilus influenzae Strep pneumoniae Moraxella catarrhalis Strep pyogenes

Question 29

What are the boundaries of the posterior triangle of the neck?

Answer 29

Sternocleidomastoid Trapezius Middle 3rd clavicle

Question 30

What are the arteries in the anterior triangle of the neck?

Answer 30

Third part of subclavian Transverse cervical Suprascapular Occipital

Question 31

What are the nerves in the posterior triangle?

Answer 31

``` Supraclavicular part of brachial plexus Accessory nerve Cervical plexus Lesser occipital nerve Great auricular nerve Transverse cervical nerve Phrenic nerve Supraclavicular nerve ```

Question 32

What would a perforated eardrum from otitis media look like?

Answer 32

Central perforation | Can see drum margin clearly around hole

Question 33

What is the fistula sign?

Answer 33

Putting pressure on external ear canal by forcibly occluding external auditory meatus with a finger causes vertigo - sign of serious otitis media

Question 34

What is the hallpike manoeuvre?

Answer 34

Patient sits on couch Head turned towards one ear and supported by examiner while patient lies down until head below horizontal Nystagmus noted when head turned to affected ear Diagnose BPPV

Question 35

What is the Epley manoeuvre?

Answer 35

Treat BPPV Uses gravity to relocate otoliths back into utricle where they can no longer stimulate the cupula Patient begins in upright sitting position with legs rotated and head rotated 45 degrees towards side that gave a positive hallpike test Patient quickly and passively forced down backwards into supine position with head in 30 degree neck extension Look for nystagmus Remain in this position 1-2 mins Roll onto shoulder and rotate head another 90 degrees in direction they are facing Look for nystagmus Remain for 1-2 mins Bring up to sitting position while maintaining 45 degree rotation of head

Question 36

What is the management for otitis media?

Answer 36

Treat pain Usually no or delayed prescription (4 days) Antibiotics if: under 2, lasts over 4 days, perforation and discharge, systemically unwell or Immunocompromised

Question 37

What are management options for glue ear?

Answer 37

90% will resolve in a year, so don't need to do anything Auto inflators Grommets if affecting their speech

Question 38

A patient has otitis externa, what advice would you give them?

Answer 38

Antibiotic resistance can be a problem

Question 39

What can lead to Eustachian tube dysfunction?

Answer 39

Upper respiratory tract infection | Hayfever

Question 40

What region do cholesteatomas grow in?

Answer 40

Attic area

Question 41

A 63 year old man presents with unilateral tinnitus, what is the appropriate next step?

Answer 41

Arrange hearing test - rule out acoustic neuroma (deafness)

Question 42

What triad is present in Menieres?

Answer 42

Deafness Tinnitus Vertigo