secondary care

Question 1

what tuning for is used for ear examination and why must it be that frequency

Answer 1

512 Hz -> if it is a lower frequency then the vibration will be felt more easily and hear less easily

Question 2

what are the 5 cardinal symptoms of otology

Answer 2

1. pain
2. discharge
3. tinnitus
4. vertigo
5. hearing loss

Question 3

mgx for simple otitis externa

Answer 3

1. abx drops - ciprofloxacin/gentamicin
2. keep ears dry e.g. cover in vaseline if going in water

Question 4

what causative organism does otitis externa with yellow discharge indicate

Answer 4

pseudamonas areugosia

Question 5

what causative organism does otitis externa with white creamy discharge indicate

Answer 5

s. Aureus

Question 6

what causative organism does otitis externa with white discharge indicate

Answer 6

candida

Question 7

what causative organism does otitis externa with black spores in discharge indicate

Answer 7

apergillus

Question 8

how long should anti-fungals be given for in otitis externa

Answer 8

2 weeks and then a further 2 weeks after resolving

Question 9

what is “swimmer’s ear”

Answer 9

otitis externa

Question 10

what are the ENT lymphnode categories

Answer 10

1a - submental
1b - submandibular
2 - upper jugular (base of skull -> hyloid)
3 - hyloid -> cricoid
4 - lower jugular
5 -posterior triangle (posterior SCM, boarder of trapezius, middle 1/3 of clavical)
6 - anterior triangle (including thyroid)
7 - superior mediastinum

Question 11

why does the thyroid move when swallowing

Answer 11

it is connected to the trachea via barry’s ligament

Question 12

why do thyroglossal cyst move on tongue protrusion

Answer 12

embryologically, the thyroid develops from the base of the tongue -> cyst arises from cluster of cells left during formation and so they are attached to the tongue

Question 13

why can throat pain be referred to the ear

Answer 13

the ear is supplied by the glossopharengeal and vagus nerves (jacob’s plexus) which can refer pain there from the ear

Question 14

examples of drugs that can cause salivary drying (3)

Answer 14

1. amytriptiline
2. opiates
3. lithium

Question 15

how can a lipoma be distinguished from other cystic swellings

Answer 15

edges are not distinct

Question 16

what are the 3 major salivary glands

Answer 16

1. parotid
2. sublingual
3. submandibular

Question 17

what is stenson’s duct

Answer 17

the main excretory duct of the parotid gland

Question 18

what is the rule of 80s (salivary tumours)

Answer 18

80% of all salivary tumors are in the parotid, 80% of parotid tumors are benign, and 80% of the benign tumors that arise in the parotid are pleomorphic adenomas

Question 19

what is a pleomorphic adenoma

Answer 19

benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland

Question 20

what is wharton’s duct

Answer 20

the submandibular gland’s primary excretory duct

Question 21

what nerves run near to the submandibular gland

Answer 21

CN VII (marginal mandibular); CN XII; lingual nerve (CN V3)

Question 22

what is pemberton’s sign

Answer 22

used to evaluate venous obstruction in patients with goiters -> The sign is positive when bilateral arm elevation causes facial plethora

Question 23

why does pemberton’s sign arise

Answer 23

It has been attributed to a “cork effect” resulting from the thyroid obstructing the thoracic inlet (due to goitre), thereby increasing pressure on the venous system

Question 24

what other symptom is associated w glandular fever (other than swollen tonsils)

Answer 24

hepato/splenomegaly

Question 25

what are the tonsil grades

Answer 25

grade 1 - This is the normal size of the tonsils, Tonsils occupy less than 25 percent of the oropharynx. The tonsils are not visible properly. grade 2 - This size is also considered as normal size and the tonsils extend to the pillars. Tonsils occupy 26 to 50 percent of the oropharyngeal airway. grade 3 - The tonsils can get infected leading to its inflammation. Due to this inflammation, these take up 75% of the oropharyngeal airway. Also, tonsils extend beyond pillars but stop beyond the midline. grade 4 - The tonsils reach each other and extend to the midline. This is the most enlarged size of tonsils as these take more than 75% of the airways.

Question 26

3 key features of quinsy

Answer 26

1. trismus 2. unilateral deviation/uvula deviation 3. voice change (hot potato)

Question 27

abx for quinsy

Answer 27

IV - benzyl penicillin (+fluids + steroids) oral - Pen V (Phenoxymethylpenicillin)

Question 28

where is the aspiration performed in quinsy

Answer 28

at the base of the uvula and tonsillar pharyngeal wall

Question 29

indications for tonsillectomy

Answer 29

1. tonsillitis 7 times in 1 year 2. peritonsilar abscess 3. asymetrical abscess 4. suspicion of malignancy 5. OSA/ snoring 6. speech abnormalities 7. dysphagia

Question 30

risks of neck abscess draining (3)

Answer 30

1. incomplete drainage 2. recurrence 3. risk of injury to important structures e.g. carotid sheath

Question 31

what is the centor criteria

Answer 31

determines the likelihood of there being a bacterial tonsillitis 1. fever ≥ 38 °C 2. absence of cough 3. swollen anterior cervical lymph nodes 4. tonsillar exudates or swelling

Question 32

complications of tonsillectomy

Answer 32

1. Odynophagia (pain on swallowing) 2. bleeding (primary within 24hrs due to surgical reasons or secondary due to infection) 3. pulmonary complications 4. infection

Question 33

what should be done in epistaxis to prevent vomiting

Answer 33

sit pt forwards and spit blood out so as to not aspirate of swallow -> swallowing blood can induce vomiting

Question 34

why does CPAP machine usage increase the risk of epistaxis

Answer 34

it dries out the nasal mucosa

Question 35

what is an ear wick

Answer 35

a device used to put abx drops into the ear when the ear canal is very swollen/narrow -> otitis externa

Question 36

how long is the antifungal treatment of otomycosis usually for

Answer 36

1 month

Question 37

otitis externa mimic

Answer 37

furunculosis in ear - an infected hair follicle at the entrance to the ear canal; Symptoms may include: sudden onset, extreme pain and a red swelling in the outer canal

Question 38

what is the sinonasal outcome test (SNOT)

Answer 38

a validated patient-reported outcome measure for chronic rhinosinusitis

Question 39

dislocation of what leads to deviated frontal septum

Answer 39

Columella: The tissue that links the nasal tip to the nasal base, and separates the nares

Question 40

what simple test can be used to assess nasal airwaypatency

Answer 40

condensation test

Question 41

what is a nasal polyp

Answer 41

oedema of mucous lining of the nose causing herniation through the basement membrane

Question 42

if nasal polyps are present in children what other underlying condition might this indicate

Answer 42

Cystic fibrosis

Question 43

nasal polyps mgx

Answer 43

1. systemic sterois 2. steroid spray 3. antohisthamine 4. monteluekast 5. abx

Question 44

what is nasal vestibulitis

Answer 44

an infection in your nostrils, near the opening of your nose

Question 45

nasal vestibulitis mgx

Answer 45

1. nasceptin 2. bactroban 3. vaseline

Question 46

hoe does septal perforation lead to being unable to breath properly

Answer 46

results in turbulent disrupted airflow through the airways

Question 47

what is an inverted papilloma

Answer 47

a benign but locally aggressive tumor that arises in the nasal cavity and paranasal sinuses - may present as a polyp