Questions Flashcards
(41 cards)
[] exercises can be performed by the patient at home to treat BPPV
Brandt-Daroff exercises can be performed by the patient at home to treat BPPV
How do you differentiate between BPPV and Menieres?
BPPV would present with** dizziness and vertigo triggered by quick head movements** e.g. getting out of bed.
Menieres
- vertigo, hearing loss likely due to aural fullness and tinnitis
- attacks sudden onset
- attacks occur in clusters
How do you tell from a hx if AOM –> mastoiditis? [2]
How would you manage this? [1]
The presence of left ear proptosis and post-auricular inflammation should raise suspicion of mastoiditis (spread of bacterial infection into the mastoid air cells).
Mastoiditis can lead to meningitis, facial nerve palsies, and hearing loss and requires immediate medical treatment with broad-spectrum IV antibiotics.
A ptx presents with a lump on the anterior triangle just in front of the sternocleidomastoid muscle and is soft in texture. The lump does not transilluminate but is mobile.
A biopsy is performed and reveals cholesterol crystals in the fluid extracted.
What is this? [1]
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
The fluid may contain cholesterol crystals which are also characteristic.
NB: Lipomas would not contain fluid
A 21-year-old man presents with halitosis and mouth pain. Examination reveals very poor dental hygiene with bleeding gums and widespread gingival ulceration. He has a temperature of 38.0ºC. You advise him to see a dentist. What other treatment options should be offered?
The correct answer is Paracetamol + oral metronidazole + chlorhexidine mouthwash.
This combination provides optimal management for acute necrotising ulcerative gingivitis (ANUG), also known as Vincent’s angina. ANUG is caused by a fusospirochaetal infection, primarily involving Fusobacterium nucleatum and Treponema vincentii. Metronidazole is the antibiotic of choice as it is effective against anaerobic bacteria. Chlorhexidine mouthwash helps reduce bacterial load and promotes healing, while paracetamol addresses pain and fever.
Which one of the following medications is most useful for helping to prevent attacks of Meniere’s disease?
Promethazine
Prochlorperazine
Betahistine
Chlorphenamine
Cinnarizine
Betahistine
- The correct answer is Betahistine. Betahistine is a histamine analogue that works by improving the microcirculation and pressure of the inner ear, which helps to relieve symptoms associated with Meniere’s disease such as vertigo, tinnitus, hearing loss and aural fullness. It is commonly used in the UK for the prophylaxis of this condition due to its effectiveness and relatively low side effect profile.
A patient presents with chronic rhinosinusitis. What would indicate a red flag symptoms with regards to this? [3]
Unilateral symptoms are a red flag for patients with chronic rhinosinusitis
persistent symptoms despite compliance with 3 months of treatment
epistaxis
What is Samter’s triad? [3]
Samter’s triad = asthma + aspirin sensitivity + nasal polyposis
- 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.
on examination, classically a bilateral, red swelling arising from the nasal septum: what does this describe? [1]
on examination, classically a bilateral, red swelling arising from the nasal septum = nasal septal haematoma
What is the management of nasal septal haematoma? [3]
Management
* refer to ENT
* surgical drainage
* intravenous antibiotics
How do you differentiate nasal septal haematoma from a deviated septum? [1]
this may be differentiated from a deviated septum by gently probing the swelling.
- Nasal septal haematomas are typically boggy whereas septums will be firm
Why is it important to treat a nasal septal haematoma? [1]
If untreated irreversible septal necrosis may develop within 3-4 days. This is thought to be due to pressure-related ischaemia of the cartilage resulting in necrosis.
- This may result in a ‘saddle-nose’ deformity
You are working in general practice, a 5-year-old boy is brought in by his mum due to a 3-day history of ear pain. On examination, you suspect a diagnosis of otitis media. Which of the following are a common cause of bacterial otitis media?
Haemophilus influenzae
Staphylococcus aureus
Mycoplasma pneumoniae
Pseudomonas aeruginosa
Klebsiella pneumoniae
Haemophilus influenzae
particularly Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
A 62-year-old man presents to surgery complaining of painful gums. On examination he is noted to have gingival hyperplasia. Which one of the following drugs is most likely to be responsible?
Carvedilol
Amiodarone
Atorvastatin
Nifedipine
Digoxin
A 62-year-old man presents to surgery complaining of painful gums. On examination he is noted to have gingival hyperplasia. Which one of the following drugs is most likely to be responsible?
Carvedilol
Amiodarone
Atorvastatin
Nifedipine
Digoxin
Suitability for a cochlear implant is determined by:
- children [1]
- adults [1]
Suitability for a cochlear implant is determined by:
* In children: audiological assessment and/or difficulty developing basic auditory skills.
* In adults, patients should have completed a trial of appropriate hearing aids for at least 3 months which they have been objectively demonstrated to receive limited or no benefit from.
Contraindications to consideration for cochlear implant? [3]
- Lesions of cranial nerve VIII or in the brain stem causing deafness
- Chronic infective otitis media, mastoid cavity or tympanic membrane perforation
- Cochlear aplasia
Describe a formula for intrepreting Weber and Rinne tests [+]
If Conductive hearing loss:
One: Do Webers - it will lateralise to the affected ear (e.g. right ear impacted - will hear more in right ear)
Two: Do Rinnes: if BC > AC: it is conductive hearing loss; AC > BC in unaffected ear
If Sensorineural hearing loss:
One: Do Webers - it will lateralise to the unaffected ear (e.g. right ear impacted - will hear more in left ear)
Two: Do Rinnes: AC>BC in both ears
10-year-old boy comes in to see his GP with a week history of reduced hearing and worsening otalgia.
Weber’s test lateralises to the right ear and Rinne’s test is negative in the right ear.
What is the type of hearing loss?
Bilateral sensorineural hearing loss, worse on the left
Left sided conductive hearing loss
Left sided sensorineural hearing loss
Right sided conductive hearing loss
Right sided sensorineural hearing loss
10-year-old boy comes in to see his GP with a week history of reduced hearing and worsening otalgia.
Weber’s test lateralises to the right ear and Rinne’s test is negative in the right ear.
What is the type of hearing loss?
Bilateral sensorineural hearing loss, worse on the left
Left sided conductive hearing loss
Left sided sensorineural hearing loss
Right sided conductive hearing loss
Right sided sensorineural hearing loss
On examination, there is no erythema or swelling of her ears and no tenderness on palpation. Rinne tests are positive in both ears (air conduction > bone conduction). On Weber test, the sound lateralized to her right ear.
What type of hearing loss does she have?
Left sided conductive hearing loss
Left sided combined sensorineural and conductive hearing loss
Right sided sensorineural hearing loss
Right sided conductive hearing loss
Left sided sensorineural hearing loss
Left sided sensorineural hearing loss
Sensorineural hearing loss
Rinne result: Air conduction > bone conduction bilaterally
Weber result: Lateralises to unaffected ear
How do you treat a pinna haematoma and why? [2]
Auricular haematomas need same day assessment by ENT
- Pinna haematomas are commonly sustained rugby or boxing injuries.
- Untreated they can lead to a classic ‘cauliflower ear’ deformity.
- Best results are achieved with early incision and drainage (as opposed to needle aspiration) so same day ENT referral is needed.
Tonsilar SCC is associated with [] infection
Tonsilar SCC is associated with HPV infection
Following referral to ENT, patients with sudden-onset sensorineural hearing loss are treated with [1]
Following referral to ENT, patients with sudden-onset sensorineural hearing loss are treated with high-dose oral corticosteroids
A patient presents with classic symptoms of sialolithiasis.
What are these symptoms? [2]
Which gland is commonly affected? [1]
Which duct of this gland commonly gets impacted? [1]
submandibular gland and its main duct (Wharton’s duct)
- Patients typically develop colicky pain and post prandial swelling of the gland
Whartons Duct - Water (lies inferior to) Stensens duct - Sky
WmD - as in weapon of mass destruction but actually it stands for W = wartons ducts and mD = mandibular gland
How do you investigate for ?sialolithiasis? [1]
Investigation involves sialography to demonstrate the site of obstruction and associated other stones
