ENT emergencies

Question 1

Features of peritonsillar abscess (quinsy):

Answer 1

Sever throat pain which lateralises to one side
Deviation of the uvula to the unaffected side
Trismus (difficulty opening mouth)
Reduced neck mobility

Question 2

Treatment of quinsy?

Answer 2

Needle aspiration with local anaesthesia

Question 3

Features of retropharyngeal abscess:

Answer 3

Neck pain
Trismus
Spiking fever
Noisy breathing
Diagnose with CT

Question 4

What is the Rinne test?

Answer 4

Tests for conductive hearing loss
Test bone conduction by striking tuning fork and placing on the mastoid process then next to air
Air conduction should be louder than bone conduction
If BC is louder this suggests conductive hearing loss
“Rinne under the Pinne”

Question 5

What is the Weber test?

Answer 5

Tests for sensorineural hearing loss
Strike tuning fork and place on centre of forehead
If SHL in one ear then it will be heard louder in the unaffected ear and the other ear has SHL
“Tells you Weber it’s right or left”

Question 6

Management of sudden sensorineural hearing loss?

Answer 6

History: sudden/rapidly progressive hearing loss
Oral prednisone 1 mg/kg
Refer

Question 7

What causes otitis externa?

Answer 7

Water ingress and local trauma

Pseudomonas and aeruginosa

Question 8

Treatment for otitis externa?

Answer 8

Ciprofloxacin drops and analgesia

Aural toilet

Question 9

What causes otitis media?

Answer 9

Same organisms as in URTI
H. influenzae
S. pneumoniae

Question 10

What does perforation suggest in the context of otitis media?

Answer 10

Resolution

Question 11

Complications of acute otitis media (rare):

Answer 11

Mastoiditis potentially causing abscess and meningitis

Venous thrombosis

Question 12

Features of facial nerve palsy:

Answer 12

Muscle weakness
Loss of taste in anterior 2/3 of tongue
Loss of sensation in ear canal
Lack of secretomotor function (no lacrimation can cause corneal damage)

Question 13

Treatment of Bell’s palsy:

Answer 13

1 mg/kg prednisolone

Question 14

Cancerous non-Bell’s causes of facial nerve palsy:

Answer 14

Parotid malignancy - adenoid cystic cancer
Facial neuroma
Vestibular schwannoma

Question 15

Infectious non-Bell’s causes of facial nerve palsy:

Answer 15

Granulomatous disease - WG, Sarcoid, TB
Lyme disease
HIV
Chronic suppurative otitis media (CSOM - inflammation of middle ear post URTI and otitis media)

Question 16

What is Ramsey Hunt syndrome?

Answer 16

A non-Bell’s cause of facial nerve palsy that causes vesicles on distribution of secretomotor fibres
Causes balance problems and facial weakness

Question 17

Temporal bone fracture complications:

Answer 17

CSF leaking out of the ear
Facial weakness
Taste CSF down Eustachian tube if ear drum is intact

Question 18

Osler-Weber-Rendu syndrome (HHT)?

Answer 18

Telangiectasia
Abnormal blood vessels forming in skin and mucous membranes - epistaxis
Can cause anaemia

Question 19

Cautery agents in epistaxis?

Answer 19

AgNO3

Bipolar

Question 20

Anterior epistaxis:

Answer 20

More common
Less serious
Younger patients

Question 21

Posterior epistaxis:

Answer 21

Less common
More serious
Older
Woodruff’s plexus (pharyngeal and post nasal and post ethmoid - ophthalmology)

Question 22

Which arteries might be ligated in surgical treatment of epistaxis?

Answer 22

Sphenopalatine (endoscopic)
Maxillary (transmaxillary)
Anterior/posterior ethmoid
External carotid

Question 23

Complications of nasal fracture:

Answer 23

Orbital rim step
Diplopia
Infraorbital sensory loss
Septal haematoma
CSF rhinorrhoea

Question 24

Symptoms of acute rhino-sinusitis:

Answer 24

Pain bending forwards and in teeth with no cheek swelling
Fever
Nasal purulence

Question 25

Cause of acute rhino-sinusitis:

Answer 25

Double sickening (bacterial infection on top of viral URTI)

Question 26

Complications of acute rhino-sinuisitis:

Answer 26

``` Orbital cellulitis Frontal osteomyelitis Meningitis Cerebral abscess Cavernous sinus thrombosis ```

Question 27

Treatment of acute rhino-sinusitis:

Answer 27

Decongestants: ephedrine 2 drops QDS; otrivine Abx Steroids: flixinaise, becanaise

Question 28

Risk of orbital cellulitis?

Answer 28

Development of chemises due to venous congestion, abscess development and subsequent rapid (hours) blindness First to go is colour vision

Question 29

Treatment of complicated ARS:

Answer 29

Orbital collection drainage (external/endo) Drainage of intracranial collection Abx/decongestants/wash out sinuses

Question 30

Management of airway obstruction:

Answer 30

O2 or heliox (O2 and helium), adrenaline nebuliser Establish safe airway and intubate Needle crike and jet ventilation Cricothyroidotomy Tracheostomy with local anaesthetic if necessary

Question 31

Weber test in conductive hearing loss?

Answer 31

Patient will hear the sound louder on the affected side

Question 32

What is presbycusis?

Answer 32

Age-related sensorineural hearing loss | Loss of hearing high frequency sound

Question 33

What is otosclerosis?

Answer 33

Autosomal dominant condition affects 20-40 y/o Abnormal bone growth in ear Unilateral conductive deafness

Question 34

What is glue ear?

Answer 34

2 years old - conductive hearing loss Otitis media with effusion Secondary speech, balance and behavioural issues

Question 35

Causes of drug ototoxicity?

Answer 35

Aminoglycosides e.g. gentamicin Furosemide Aspirin Cytotoxics

Question 36

Noise damage to hearing?

Answer 36

Bilateral | 3000-6000 Hz

Question 37

Acoustic neuroma/vestibular schwannoma?

Answer 37

CN VIII: hearing loss, vertigo, tinnitus CN V: absent corneal reflex CN VII: facial palsy

Question 38

Symptoms of otitis externa?

Answer 38

Severe pains | Headaches

Question 39

Sign of otitis externa?

Answer 39

Granulation tissue in the external auditory meatus