ENT

Question 1

which disorder is associated with the following description:

• Hearing loss, vertigo, tinnitus
• Absent corneal reflex is important sign
• Associated with neurofibromatosis type 2

Answer 1

acoustic neuroma

Question 2

which disorder is associated with the following characteristics:

• Elderly patient
• Dizziness on extension of neck

Answer 2

vertebrobasilar ischaemia

Question 3

which disorder is associated with the following:

• associated with hearing loss, tinnitus and sensation of fullness or pressure in one or both ears

Answer 3

meniere’s disease

Question 4

which disorder is characterised by the following:

• gradual onset
• triggered by change in head position
• each episode lasts 10-20 seconds

Answer 4

benign paroxysmal positional vertigo

Question 5

which disorder is characterised by the following:

• recent viral infection
• recurrent vertigo attacks lasting hours or days
• no hearing loss

Answer 5

vestibular neuronitis

Question 6

brainstorm some causes of vertigo:

Answer 6

• posterior circulation stroke
• trauma
• multiple sclerosis
• ototoxicity e.g. gentamicin

Question 7

describe webers test

Answer 7

• vibrating tuning fork
• in centre of head
• sound travels to both ears
• if sound louder is one ear (say left)
• will indicate conductive hearing loss in the opposite (right) ear

Question 8

describe Rinne’s test

Answer 8

• tuning fork next to each ear in turn
• placed on mastoid process
• if its louder on bone - indicates conductive hearing loss

Question 9

what are acoustic neuromas ?

Answer 9

tumours of the vestibulocochlear nerve

form of sensorineural hearing loss

Question 10

describe positive Rinne’s test

Answer 10

‘positive test’: air conduction (AC) is normally better than bone conduction (BC)

‘negative test’: if BC > AC then conductive deafness

Question 11

exostosis caused by:

Answer 11

• repeated exposure to cold water and wind
• causes benign bony growth
• in external auditory canal
• form of conductive hearing loss

Question 12

30 y/o female
pc: recurrent LHS nose bleeds, lasting 9 mins, starts again on cough

what part of the history prompts urgent investigation:

Answer 12

• unilateral epistaxis is a red flag symptom

Question 13

which disorder is characterised by the following:

• recent viral infection
• sudden onset
• nausea and vomiting
• hearing may be affected

Answer 13

viral labyrinthitis

Question 14

what distinguishes vestibular neuronitis from labyrinthitis

Answer 14

unaffected hearing in vestibular neuronitis

Question 15

finger spasms when blood pressure was taken

Answer 15

trousseau’s sign

Question 16

firstline management for patient with otitis media with no improvement of symptoms after 2-3 days

Answer 16

start amoxicillin

Question 17

what is the common anatomical origin of a nose bleed?

Answer 17

• anterior nasal septum

- ‘little’s area’ confluence of 4 arteries

Question 18

nasal decongestants should not be used for prolonged periods of time as…

Answer 18

• increasing doses will be required to achieve the same effect
• known as tachyphylaxis

Question 19

following perforation of tympanic membrane - healing should occur within

Answer 19

6 to 8 weeks

if not… then mringoplasty can be performed to repair the perforation

Question 20

The cyst is filled with acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium

This cyst is a benign, developmental defect of the branchial arches.

typical examination features

• unilateral
• anterior to sternocleidomastoid
• non-tender

Answer 20

branchial cyst

Question 21

non-cancerous growth of squamous epithelium that is ‘trapped’ within the skull base causing local destruction.

• foul smelling discharge
• hearing loss

Answer 21

cholesteatoma

Question 22

quinsy should be treated with:

Answer 22

• IV antibiotics

- surgical drainage

Question 23

past medical history of chronic ear infections and offensive discharge are suggestive of

Answer 23

cholesteatoma

Question 24

2 y/o lil baby

• lump in neck
• swelling in subcut tissue of posterior triangle
• transilluminates

classic description of:

Answer 24

cystic hygroma

• collection of dilated lymphatic sacs
• which are fluctuant and brilliantly trans illuminable

Question 25

40 y/o female - painless neck lymo - mass beneath sternocleidomastoid - history of regurg of undigested food - coughing at night - halitosis - throat infections classic history of:

Answer 25

pharyngeal pouch

Question 26

32 y/p female - recurrent infections and abscesses in neck - midline defect with overlying scab - moves upwards on tongue protrusion what is it:

Answer 26

thyroglossal cyst | - connection with foramen caecum means it will move on tongue protrusion

Question 27

shingles affecting the facial nerve. This results in ear pain, vesicles in the external ear canal associated with vertigo and deafness. indicative of:

Answer 27

Ramsay-hunt syndrome - herpes zoster oticus - caused by reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve

Question 28

management of ramsay-hunt syndrome

Answer 28

oral aciclovir and corticosteroids usually given

Question 29

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 29

sarcoidosis Sarcoid occurs bilaterally in 70% of cases and facial nerve involvement is recognised. Treatment is conservative in most cases although individuals with facial nerve palsy will usually receive steroids with good effect.

Question 30

An 18-year-old boy presents with pancreatitis. He has bilateral painful parotid enlargement. likely to be:

Answer 30

viral parotitis

Question 31

A 50-year-old lady presents with symptoms of a dry mouth that has been present for the past few months. She also has a sensation of grittiness in her eyes. On examination she has a diffuse swelling of her parotid gland. There is no evidence of facial nerve palsy. likely diagnosis:

Answer 31

sjogren's syndrome

Question 32

high-frequency loss associated with ageing

Answer 32

presbyacusi

Question 33

what describes the replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window.

Answer 33

otosclerosis

Question 34

management of otosclerosis

Answer 34

hearing aid stapedectomy

Question 35

A 64-year-old woman with a one week history of pain above and lateral to her left eye. On examination she is tender over that area. indicative of:

Answer 35

temporal arteritis

Question 36

A 62-year-old woman presents with a two week history of shooting pains across her left cheek. The pain is sometimes triggered by touching her face. She has no past medical history note indicative of:

Answer 36

trigeminal neuralgia

Question 37

common cause of bacterial otitis media

Answer 37

Haemophilus influenzae is a common cause of bacterial otitis media

Question 38

The combination of asthma, aspirin sensitivity and nasal polyps is known as

Answer 38

Samter's triad In patients with asthma, aspirin and other NSAIDs should be avoided as these may precipitate an asthma exacerbation.

Question 39

Features - ear pain, itch, discharge -otoscopy: red, swollen, or eczematous canal indicative of:

Answer 39

otitis externa causes of otitis externa include - infection: bacterial (staph. aureus, pseudo. aeruginosa) of fungal - seborrheic dermatitis - contact dermatitis

Question 40

An 8-year-old child presents with enlarged tonsils that meet in the midline and are covered with a white film that bleeds when you attempt to remove it. He is pyrexial but otherwise well. indicative of:

Answer 40

acute bacterial tonsillitis

Question 41

A 10-year-old child presents with enlarged tonsils that meet in the midline. Oropharyngeal examination confirms this finding and you also notice peticheal haemorrhages affecting the oropharynx. On systemic examination he is noted to have splenomegaly. indicative of:

Answer 41

infectious mononucleosis

Question 42

James, 40, has presented to his GP with weakness of the right side of his face, which examination confirms. James also reveals that he has experienced pain in his ear and otoscopy reveals the presence of vesicles on his tympanic membrane. Which of the following is the likely diagnosis?

Answer 42

ramsay hunt syndrome

Question 43

A 33-year-old with coryzal symptoms presents with a one day history of vertigo and nausea. There is no hearing loss on examination

Answer 43

vestiubular neuronitis

Question 44

A 62-year-old man with a 3 month history of dizziness when he rolls over in bed. Episodes last for about 20 seconds

Answer 44

benign paroxysmal positional vertigo

Question 45

A 51-year-old female with a 3 week history of recurrent attacks of vertigo, right ear tinnitus and the sensation of fullness in her right ear. On testing, there is noted to be right-sided hearing loss affecting low frequencies.

Answer 45

meniere's disease

Question 46

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

Answer 46

Otitis externa

Question 47

A 4-year-old is brought to the general practitioner by her mother. She has been distressed with ear pain for the past 14 hours. She is constantly touching and pulling at her ear. Whilst she is sat in the waiting room her mother notices a discharge of foul smelling fluid from the ear, following which the pain resolves.

Answer 47

Acute suppurative otitis media