Secondary care

Question 1

What type of hearing loss does Meniere’s cause?

Answer 1

low-frequency sensorineural hearing loss

Question 2

What is the difference between labyrinthitis and vestibular neuronitis?

Answer 2

labyrinthitis = hearing loss
vestibular neuronitis = no hearing loss

Question 3

What are the components of CHARGE syndrome?

Answer 3

colobama
heart defects
atresia choanae
retardation of growth/development
genital/urinary abnormalities
ear abnormalities/deafness

Question 4

What causes laryngomalacia?

Answer 4

floppy voice box

Question 5

Pathogen that causes croup

Answer 5

parainfluenza virus

Question 6

What radiographic sign in seen in croup?

Answer 6

steeple sign

Question 7

Pathogen that causes acute epiglottitis

Answer 7

H.influenza type B

Question 8

Radiographic sign of acute epiglottitis

Answer 8

thumb print

Question 9

Sudden sensorineural hearing loss causes

Answer 9

infection:
- measles
- mumps
- syphilis
- TB

trauma:
- basal skull fracture
- ear surgery

tumour:
- acoustic neuroma

other:
- MS
- idiopathic

Question 10

Management of sudden sensorineural hearing loss

Answer 10

treatment with oral steroids

Question 11

Acoustic neuroma investigation

Answer 11

MRI cerebellopontine angle

Question 12

Pinna haematoma treatment

Answer 12

drainage within 24h of injury
pressure dressing and splintage

Question 13

Pinna haematoma complication

Answer 13

cauliflower ear

Question 14

Acute otitis externa complications

Answer 14

necrotising otitis externa
abscess formation
chronic stenosis of ear canal

Question 15

What is necrotising otitis externa?

Answer 15

infection spreads through soft tissue
osteomyelitis of temporal bone and skull base

Question 16

Most common causative organism of malignant otitis externa and treatment

Answer 16

pseudomonas aeruginosa
ciprofloxacin (Tazocin=combination version)

Question 17

When should aminoglycoside ear drops be avoided?

Answer 17

if perforated tympanic membrane - ototoxic to inner ear

Question 18

What is mastoiditis?

Answer 18

infection from middle ear spreads
abscess in mastoid air spaces of temporal bone

Question 19

Key diagnostic criteria of mastoiditis

Answer 19

septic patient
red bulging tympanic membrane
pinna pushed down and forwards
boggy oedema of mastoid

Question 20

Epistaxis aetiology

Answer 20

non-traumatic:
- age
- nasal oxygen
- medication
- nose blowing/picking

traumatic

sinosal neoplasm
coagulopathy
HHT (hereditary haemorrhagic telangiectasia)

Question 21

Epistaxis discharge advice

Answer 21

do not blow, pick or cause trauma to nose

avoid piping hot food and drink for a day

avoid strenuous activity/exercise for 2 days

antiseptic cream to both nostrils BD for 2 weeks

re-attend A&E if further nosebleed >20 mins

Question 22

Septal haematoma management

Answer 22

incision and drainage under general anaesthesia

swab for MC&S

antibiotics

follow up in 2-3 weeks

Question 23

What is choanal atresia?

Answer 23

present from birth
nasal passages blocked by bone or tissue
can be unilateral or bilateral

Question 23

Which tonsillitis patients need admitting?

Answer 23

unable to swallow saliva or liquids
stertor
suspected quinsy

Question 23

Choanal atresia management

Answer 23

surgery - hole through bone or tissue blocking nasal passages and nasal stents places - stents often need suction after surgery, especially before feed stents removed from 6-12 weeks renal USS and ECG for associated abnormalities (CHARGE syndrome)

Question 24

Quinsy/peritonsillar abscess treatment

Answer 24

analgesia antibiotics fluids incision and drainage under anaesthesia

Question 25

Angioedema management

Answer 25

anaesthetist if airway compromise adrenaline 1:1000 0.5ml IM chlorphenamine + steroids ultimately secure airway with intubation or tracheostomy

Question 26

What is stridor?

Answer 26

harsh high pitched sound of laryngeal and upper tracheal obstruction

Question 27

Adult stridor causes

Answer 27

inflammatory neoplastic autoimmune anaphylaxis

Question 28

Paediatric stridor causes

Answer 28

croup (laryngotracheobronchitis) foreign body aspiration abscess - retropharyngeal epiglottitis anaphylaxis

Question 29

Stridor immediate management

Answer 29

intensive monitoring sit pt upright high flow oxygen nebulised adrenaline - repeated if necessary high dose steroid - dexamethasone 8mg IV avoid putting instruments in patients mouth intubation for acute airway compromise

Question 30

Croup clinical features

Answer 30

barking cough biphasic stridor temperature cyanosis

Question 31

Epiglottitis treatment

Answer 31

minimal airway handling call anaesthetist IV ceftriaxone

Question 32

Risk factor for subglottic stenosis

Answer 32

intubation

Question 33

When is tracheostomy used?

Answer 33

upper airway obstruction prolonged intubation needed