ENT/Max Fax/Plastics/Opthal

Question 1

3 Ds of epiglotitis

Answer 1

Drooling, dysphagia and distress

Question 2

Most common organisms causing epiglottitis

Answer 2

Streptococcus spp.

(Used to be H.influenzae prior to vaccine)

Question 3

Immediate management of epiglottitis

Answer 3

Keep calm
DON’T EXAMINE THROAT
Oxygen
Nebulised adrenalne
Consider IV cefotaxime or ceftriaxone

Question 4

Differentiate meniere’s disease and labrynthitits

Answer 4

People with meniere’s have a feeling of ‘fullness’ in their ear

Question 5

What should be considered if a presentation of croup doesn’t respond to tx

Answer 5

Bacterial tracheitis

Question 6

CFS rhinnorhea marker

Answer 6

Tau protein / Beta-2 transferrin

Question 6

Which muscle is most likely damaged in an orbital floor #

What visual change does the impairement cause?

Answer 6

Inferior rectus - causing blurred vision on looking up

Question 7

Antibiotics for dental abscess

If systemically ok but immunocompromised

If severe / spreading

Answer 7

1. Penicillin
2. Metronidazole

Question 8

Le fort 1

Answer 8

of anteorlateral nasal fossa margin

(horizontal fracture)

Question 9

Le fort 2

Answer 9

Inferior orbital rim involvement

Pyramidal shape #

Top is the naso frontal area but then extends down

Question 10

Le fort 3

Answer 10

zygomatic arch involvement

Horizontal but starts at nasal frontal area and extends across the orbital walls to the zygoma

Question 11

Complicated crown # =

Answer 11

Fracture that extends into the dental pulp of the tooth

Question 12

Fever pain score

Answer 12

Fever in last 24 hours
Purulence
Attend rapidly under 3 days
Inflamed tonsils
No cough or coyza

Question 13

Common cause of bacterial tracheitis

Answer 13

Staph areus

Question 14

First steps in assessing tracheostomy patency?

Answer 14

Remove speaking valve / cap

And then any inner tubes

Then try and pass a suction catheter

Then deflate cuff, look/listen/feel

Question 15

In what cases are oral abx given AOM in adults?

Answer 15

Don’t need admission to hospital but are systemically unwell or have risk factors for complications

Question 16

Most common organism causing AOM and therefore mastoditis

Answer 16

Strep pneumoniae

Question 17

Treatment for mastoiditis

Answer 17

Admit.
Brad spec abx - cef. & met

Question 18

Glandular fever, findings on FBC

Answer 18

> 20% reactive lymphocytes

Question 19

Gradenigo Syndrome

Answer 19

A clinical triad of otitis media, facial pain and abducens palsy that is most commonly developed from infection in the petrous temporal bone (i.e., petrous apicitis).

Question 20

What is fractured in all Le fort injuries?

Answer 20

Pterygoid plate

Question 21

Peri apical abscess

Answer 21

Infection of the root canal

Question 22

Peridontal abscess

Answer 22

In the peridontal pocket between teeth and gum

Question 23

Manchester mandibular fracture rule

Answer 23

The presence of any of five factors produced a 100% sensitive rule for x ray.

The factors are;

Malocclusion
Trismus
Pain with mouth closed
Broken teeth
Step deformity

Question 24

Ellis tooth # classification

Answer 24

Question 25

Which artery supplies the oculomotor nerve?

Answer 25

Posterior communicating

Question 26

When does Ghonnorhea neonatal conjunctivitis present?

Answer 26

Birth to 5 day post partum

Question 27

When does chlamydia neonatal conjunctivitis present?

Answer 27

5-14 days post birth

Question 28

Zygomaticomaxillary complex # can be made up of

Answer 28

These injuries are usually caused by a direct blow to the malar eminence of the cheek and have four components: Widening of the zygomaticofrontal suture Fracture of the zygomatic arch Fracture of the inferior orbital rim and anterior and posterior maxillary sinus walls Fracture of the lateral orbital rim

Question 29

Vestibular neuronitis vs Labyrinthitis

Answer 29

Both have severe vertigo, with nytagmus away from the lesion But Labyrinthitis: Vertigo can be positional Can be sensorineural hearing loss and tinnitus

Question 30

Meniere’s disease key features

Answer 30

Attacks of vertigo usually 2-3 hours in duration Attacks of vertigo last less than 24 hours Sensation of fullness or pressure in ear(s) Sensorineural hearing loss

Question 31

Which gland is sialolithiasis most commonly found in?

Answer 31

Submandibular

Question 32

CENTOR score

Answer 32

History of a fever (Temp >38°C) Exudate or swelling on tonsils Tender or swollen anterior cervical lymph nodes Absence of cough Score 0 to 2 = 3-17% isolation of streptococcus, antibiotics not recommended Score 3 to 4 = 32-56% isolation of streptococcus, consider immediate treatment with empirical antibiotics or ‘backup prescription.’

Question 33

Epistaxis Additional first aid measures alongside pinching the fleshy part of the nose etc.

Answer 33

Sucking on an ice cube, however, has been shown to reduce nasal blood flow, and applying an ice pack ice directly to the nose may also help.

Question 34

Which vessel most likely to be responsible for a post tonsillectomy bleed?

Answer 34

External palatine vein

Question 35

Mechanism causing Le Fort 1 #

Answer 35

usually result from a force directed in a downward direction against the upper teeth

Question 36

Mechanism causing Le Fort type II fractures

Answer 36

usually result from a force through the lower or mid maxilla.

Question 37

Mechanism causing Le Fort type III fractures

Answer 37

usually result caused by force through the nasal bridge and upper part of the maxilla.

Question 38

Which nerves pass through the superior orbital fissure

Answer 38

Lacrimal nerve (branch of CN V1) Frontal nerve (branch of CN V1) Trochlear nerve (CN IV) Superior division of oculomotor nerve (CN III) Nasociliary nerve (branch of CN V1) Inferior division of oculomotor nerve (CN III) Abducens nerve (CN VI)

Question 39

Reactionary haemorrhage (post tooth extraction)

Answer 39

occurs 2-3 hours after the extraction when the vasoconstrictor effects of the local anaesthetic wear off

Question 40

Secondary haemorrhage (post tooth extraction)

Answer 40

usually occurs at 48-72 hours and occurs if the clot becomes infected

Question 41

2nd line treatment for bacterial conjunctivitis

Answer 41

Fusidic acid 1% eye drops

Question 42

Differentiate conjunctivitis caused by Chlamydia and Gonnorrhoea

Answer 42

Chlamydia is more insidious in the onset

Question 43

Seidel test...

Answer 43

Is used to evaluate ocular trauma. It is performed as follows: A 10% fluorescein strip is applied to the affected area The area is then examined using a cobalt blue filter If aqueous fluid is leaking through a corneal laceration, a stream of fluid will be seen in the pool of dye, as the aqueous fluid dilutes it.

Question 44

Cement can cause what kind of necrosis of the eye?

Answer 44

colliquative necrosis (liquefactive)

Question 44

Hyphaema

Answer 44

Blood in the anterior chamber of his eye

Question 45

Displaced nasal fractures must be reduced with what timeframe?

Answer 45

14 days

Question 46

Antibiotic choice in otitis externa where pseudomonas is suspected?

Answer 46

Ciprofloxacin or aminoglycoside

Question 47

When should aminoglycosides be avoided in otitis externa?

Answer 47

Perforated ear drum

Question 48

Antibiotics for epiglottitis

Answer 48

Antibiotic treatment for confirmed diagnosis once the airway has been secured is usually with intravenous ceftriaxone (2 g OD). Levofloxacin plus teicoplanin is an alternative for penicillin-allergic patients. Local policy and guidelines should be followed.

Question 49

Acute alveolar osteitis

Answer 49

Also known as ‘dry socket’. This occurs when the clot overlying the socket becomes dislodged and leaves the bone and nerve exposed. This can lead to infection and severe pain.

Question 50

The most common locations of madibular fractures are:

Answer 50

Angle of the mandible (27%) Mandibular symphysis (21%) Mandibular condyle and subcondyle (18%)

Question 51

Commonest cause of painful 3rd CN palsy?

Answer 51

Posterior communicating artery aneurysm

Question 52

2nd line for bacterial conjunctivits

Answer 52

Fusidic acid drops

Question 53

Hypopyon

Answer 53

a collection of white blood cells that forms a layer of fluid in the front part of the eye

Question 54

Hyphema

Answer 54

which is blood in the anterior chamber of his eye.

Question 55

Answer 55

Vitreous haemorrhage

Question 56

School exclusion for conjunctivitis

Answer 56

Public Health England does not recommend an exclusion period for viral or bacterial conjunctivitis from school, nursery or childminders except if an outbreak or cluster of cases occurs.

Question 57

Answer 57

Central retinal vein occlusion

Question 58

Answer 58

Central retinal artery occlusion

Question 59

Alkaline chemicals cause what damage to the eye

Answer 59

colliquative necrosis (liquefactive necrosis)

Question 60

Alkaline chemicals cause what damage to the eye