ENT Approaches & Management

Question 1

epistaxis mx

Answer 1

ABCs
stop bleed:
i. pressure + ice cube

unstable:
critci care: IV crystalloids
ABCs, ENT MO
GXM, PT, FBC,
ECG vitals

stopped; silver nitrate

TRO carotid blowout or NPC

still bleeding
Anterior pack:
abx (staph toxic ss) + decong
Merocel sponge / bismuth iodine paraffin paste ribbon gauze

posterior pack - gauze, foley
silv nitrate

endoscope + electrocautery

surgical - ligate ethmoidal artery

Question 2

Cn7 palsy and bells signs

Answer 2

LMN palsy:
lid closue, drool, taste
Bells: URTI
exposure keratitis

Question 3

DDx of cn7 palsy

Answer 3

Stroke - forehead sparing

Intracranial - Meningioma and acoustic/facial neuroma

lntratemporal: Acute/chronic ear disease, herpes zoster ramsay hunt, temp #/tumour

extratemp: parotid malig (earlobe deviation)

Question 4

mx of bells

Answer 4

within 3 days - 7days
steroids
PO pred 1mg/kg 1 week + tapering dose
PO acyclovir

eye care:
- tears. taping, eye gel.

Question 5

TM perf sx and mx

Answer 5

pain, tinnituys, hearing loss, vertigo, bleeding

analgesia
fluoroquinolones

ear dry
- swimming; vaseline soaked cotton ball

> 90 spont healing in 3 mths

Question 5

acute OM causes, sx, fndings

Answer 5

otalgia, fever, discharge

viral:
RSV, RV, flu v, av

bact:
Strep p, Hib, Moraxella

bulging red tm
perf tm w mucopurulent

Question 6

causes of Sudden SNHL, progressive, bilateral progressive SNHL

Answer 6

infection - herpes, MMR, syph, TB, mycoplasma

trauma: tearing labyrinthine membranes
vasc: cochlear blood flow

autoimmune
drugs : amino, malaria, loop diuretics

Question 7

mx of Acute OM

Answer 7

aigmentin 10 days
oxymetazolin topical
oral antihistamiens - promethazine

analgeisa

Question 8

CSOM mx

Answer 8

TM non healing + CHL
topical fluro – cpro
ENT aural toilet + microsuction

myringoplasty

Question 9

acute OE

indication for oral abx

Answer 9

itching, pain, discharge
inflammation/furuncle

topical abx + steroids
cirpo

oral abx: fever + lymphadenitis

swimmng; vaseline ball

Question 10

tonsilitis & quinsy sx & causes

Answer 10

fever + sore throat
injected, swollen, purulent exudate

viral
Diptheria
IM
Strep throat

quinsy:
tonsilitis + odynophagia, dysphagia, trismus
uvula displacement

Question 11

mx of tonsillitis

Answer 11

lonzenge

abx guided by centor criteria >4
IV pen

Question 12

centor score

Answer 12

> 38
3-14,44 (+1/0/-1)
tonsils swell/exu
nodes (anterior cervical)
cough absent +1

Question 13

quinsy tx

Answer 13

ENT
I&D
LA
ABx augmentin