extras

Question 1

4 medications that cause gingival hyperplasia

Answer 1

phenytoin, ciclosporin, calcium channel blockers and AML

Question 2

what cysts contain cholesterol crystals in the fluid extracted.

Answer 2

branchial cysts

Question 3

branchial cysts are found where and in front of what muscle

Answer 3

Branchial cysts are congenital abnormalities associated with the formation of a neck lump located in the anterior triangle. They characteristically appear in-front on sternocleidomastoid.

Question 4

why do branchial cysts develop

Answer 4

he wall of a branchial cyst is typically lined with squamous or columnar cells. They develop due to the failure of the second and third branchial arches to fuse in-utero.

Question 5

describe the treatment for otititis externa

mild cases
when more severe

Answer 5

NICE recommend that for mild cases (mild discomfort and/or pruritus; no deafness or discharge), consider prescribing topical acetic acid 2% spray.

When features of more severe inflammation are present, such as in this case, they advise 7 days of a topical antibiotic with or without a topical steroid.

always with simple analgesia

Question 6

when do you take swabs for otitis externa

Answer 6

Taking swabs from the ear is not useful routinely as virtually all bacteria detected are sensitive to the high concentrations of antibiotic in topical medications.

However, this should be done if there is no response to an initial course of treatment or infections are recurrent.

Question 7

pain on palpation of the tragus, itching, discharge and hearing loss

Answer 7

otitis externa

Question 8

in all cases of sensoneural hearing loss what is given

Answer 8

High-dose oral corticosteroids are used by ENT for all cases of SSNHL.

Question 9

impacted ear wax

Answer 9

olive oil

Question 10

chronic rhino red flags 3

Answer 10

Red flags symptoms
unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis

Question 11

Auricular haematomas are common in rugby players and wrestlers. Prompt treatment is important to avoid the formation of ‘cauliflower ear’.

Management

Answer 11

auricular haematomas need same-day assessment by ENT
incision and drainage has been shown to be superior to needle aspiration

Question 12

A 54-year-old woman presents with a neck swelling. She is systemically well apart from some recent weight loss. On examination she is noted to have a midline, non-tender neck swelling which moves upwards when she swallows.

Answer 12

Goitre42%

Patients with a goitre are often euthyroid or have minor symptoms. A thyroglossal cyst would be unusual at this age - they typically present in patients < 20 years old.

Question 13

tx options for chronic rhinosinusitis 3

Answer 13

avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution

Question 14

A 67-year-old gentleman comes in to your practice complaining of ‘dizziness’. He has a past medical history of hypertension, hypercholesterolaemia and hay fever. He is an ex-smoker with a forty pack-year history.

On closer questioning, he describes a sudden onset of a sensation at 9am this morning - ‘like the room is spinning’ - accompanied by nausea but no vomiting. The dizziness has persisted and is constant.

On examination he looks well, blood pressure 170/120 mmHg, with other observations in normal range. Cardiac, respiratory and ENT examination is unremarkable. On neurological examination he has normal power, tone, sensation and reflexes throughout both upper and lower limbs bilaterally. There is notable nystagmus on cranial nerve testing. There is also mild past pointing and dysdiadochokinesis.

What is the most appropriate action?

Answer 14

This gentleman has a history suggestive of vascular disease, and has presented with acute onset of symptoms suggesting a posterior stroke.

Question 15

downs syndrome presenting with glue ear or OM what should happen

Answer 15

Children presenting with glue ear with a background of Down’s syndrome or cleft palate should be referred to ENT

Important for meLess important
For the majority of children, otitis media with effusion (OME), or glue ear, can be managed by active observation over 6-12 weeks. Patients with Down’s syndrome or cleft palate are less likely to recover spontaneously from OME, and therefore require immediate referral to ENT.

Question 16

samter triad

Answer 16

In patients with asthma, aspirin and other NSAIDs should be avoided as these may precipitate an asthma exacerbation. The combination of asthma, aspirin sensitivity and nasal polyps is known as Samter’s triad.

Question 17

pseudoephedrine

Answer 17

nasal decongestant

Question 18

Otitis externa in diabetics: treat with

Answer 18

ciprofloxacin to cover Pseudomonas

Question 19

perforated ear drum management

at what point do you refer to ENT

Answer 19

A perforated eardrum will usually heal by itself within 6-8 weeks. Patients with a perforation should be advised that the eardrum is a skin-like structure and therefore it heals in the same way as a cut on the skin. They should avoid getting water into the ear as this can impair healing and increase the chance of infection.

ENT referral after 6w

Question 20

if ear drum has not healed naturally what can they do

Answer 20

myringoplasty with steriod ear drops and ventilation to treat perforation

Question 21

sudden onset s hearing loss

Answer 21

steriods oral and ent referral

Question 22

tachyphylaxis

Answer 22

rapid diminishing response to a drug

Question 23

exotosis

Answer 23

repeated exposure to cold water and wind - benign bony growth in external auditory canal

Question 24

rinnes test how do you perform it

Answer 24

but tuning fork on mastoid process ask them to tell you when they can hear it and when it stops and then but it outside there ear

positive is air over bone
negaitve other way round

Question 25

weber test

Answer 25

tuning fork on forehead does it lateralise to any side

Question 26

barotrauma

Answer 26

injury caused by change in air pressure

ear/lung

Question 27

chronic vestibular neuritis tx

Answer 27

verstibular rehab

Question 28

Intranasal steroids should only be considered for sinusitis if symptoms have persisted for

Answer 28

10 days or more - so just give analgesia

Question 29

what form of nose bleed packing is the most suitable management option for epistaxis where the bleed site is difficult to localise

Answer 29

anterior

Question 30

mastoiditis requires what tx

Answer 30

IV abx

Question 31

Immunocompromised patients with poor dentition can develop airway compromise from cellulitis at the floor of the mouth known as Ludwig’s angina.

It is deadly, as it spreads in the fascial spaces of the head and neck. Due to the infection, the swelling that ensues from the inflammation begins to push the floor of the mouth upwards and blocks air entry. This patient has a compromised immune system (IVDU puts one at risk for HIV and henceforth AIDS) and poor dentition which increases one’s risk for this condition.

what other condition can predispose you to this too.

Answer 31

Pericoronitis (inflammation surrounding a partially erupted wisdom tooth) can also predispose one to this. Angina comes from the Greek word ‘strangling’. Ludwig’s angina is not to be confused with angina pectoris, which is a cardiac pathology.

Question 32

when should Prochlorperazine be used in vestibular neuronitis

Answer 32

Prochlorperazine may be useful in the acute phase of vestibular neuronitis, but should be stopped after a few days as it delays recovery by interfering with central compensatory mechanisms

Question 33

In a young adult with parotid swelling and pancreatitis/orchitis/reduced hearing/meningoencephalitis suspect

Answer 33

mumps

viral parotitis

Question 34

A 50-year-old female presents with bilateral parotid gland swelling and symptoms of a dry mouth. On examination she has bilateral facial nerve palsies. This improved following steroid treatment.

Answer 34

sarcoidosis

Question 35

Unilateral glue ear in an adult needs evaluation

Otoscopic examination reveals viscous bubbles behind the tympanic membrane.

Answer 35

posterior nasal space tumour

Question 36

The HiNTs exam can be used to distinguish what from what

Answer 36

vestibular neuronitis from posterior circulation stroke

vestibular neuronitis
Head impulse Loss of fixation with corrective saccades when head turned to the right
Nystagmus Unidirectional, Beating
Test of skew Grossly absent
Hearing No deficits

Question 37

Non-resolving unilateral discharge suggests

Answer 37

cholestatoma

Question 38

drug causes of gingival lhyperplasia

Answer 38

phenytoin
ciclosporin
calcium channel blockers (especially nifedipine)

Question 39

All mouth ulcers persisting for greater than 3 weeks should be

Answer 39

2ww oral

Unexplained oral ulceration or mass persisting for greater than 3 weeks
Unexplained red, or red and white patches that are painful, swollen or bleeding
Unexplained one-sided pain in the head and neck area for greater than 4 weeks, which is associated with ear ache, but does not result in any abnormal findings on otoscopy
Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks
Unexplained persistent sore or painful throat
Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion

Question 40

when is ECT perf