ENT

Question 1

Red flags of chronic sinusitis?

Answer 1

Unilateral
No improvement in 3 months
Epistaxis

Question 2

Causes of chronic sinusitis?

management?

Answer 2

Causes:

• atopy (hay fever)
• obstruction e.g. septal deviation
• recent infection e.g. rhinitis/dental extraction
• swimming/diving
• smoking

Features:
- facial pain worse on bending
- discharge - clear if vasomotor/allergic
(purulent suggests secondary infection)
- nasal obstruction (mouth breathing)
- post nasal drip - chronic cough

Management:

• avoid allergen
• steroid nasal spray
• nasal irrigation with saline

Question 3

Acute sinusitis:

• features?
• management?

Answer 3

Facial pain worse on bending
Nasal discharge, usually thick and purulent
Nasal obstruction

Management:

• pain management
• intranasal corticosteroids if present for >10 days
• penicillin v if severe (having to miss work etc)

Question 4

Indications for tonsillectomy?

Answer 4

• 5+ episodes of tonsillitis per year
• acute episodes are disabling and prevent normal functioning (e.g. work)
• recurrent febrile convulsions due to tonsillitis
• quinsy

Question 5

Causes of vertical nystagmus?

Answer 5

Posterior fossa lesions
Cerebellar lesions
Vitamin deficiencies
Inflammatory/autoimmune conditions

It is always a worrying finding

Question 6

First aid of epistaxis?
If successful?
If not?
When should you admit to emergency dept and hospital?
If these all fail?

Answer 6

Pinch nose and lean forward, don’t lie down, for at least 20 mins
If successful, apply Naseptin (chlorhexidine and neomycin) or Mupirocin

If bleeding continues for 10-15 mins:

• cautery if you can see the bleeding point
• anterior packing if not
• both require LA application

Admit to emergency dept if haemodynamically unstable
Admit to hospital if posterior bleeding source, or <2 y/o (potential presentation of leukaemia/haemophilia)

If all measures fail - surgical ligation of sphenopalatine artery

Question 7

On audiogram how to tell if it is mixed or SNHL if both air and bone low?

Answer 7

If bone = air roughly, SNHL

If air is worse than bone, mixed

Question 8

Causes of hoarseness?

Ix?

Answer 8

• voice overuse
• smoking
• viral illness
• hypothyroidism (Reinke’s oedema)
• GORD
• Lung/laryngeal cancer

Management:

• do CXR for apical lung lesion
• If 45+ with unexplained hoarseness or unexplained neck lump, refer 2 week ENT pathway

Question 9

8 y/o kid comes in with inflamed tonsils that meet in midline, there is a white film covering them which bleeds when you try to remove it, pyrexial but other vitals normal - what is this?
What points away from diphtheria?

Answer 9

Just normal bacterial tonsillitis

Diphtheria - pt would be systemically unwell

Question 10

Presentation of diphtheria?
Ix?
Rx?

Answer 10

Sore throat with grey pseudomembrane over posterior pharyngeal wall
‘bull’ neck due to bulky cervical lymphadenopathy
Systemically unwell
May have cranial nerve neuritis or heart block

Throat swab for culture

IM penicillin and diphtheria antitoxin

Question 11

What is sudden onset sensorineural hearing loss?
Ix?
Rx?

Answer 11

literally just sudden onset SNHL, usually idiopathic
Often have feeling of aural fullness as well

Rule out vestibular schwannoma with MRI

High dose oral corticosteroids

Question 12

Rx for Ramsay Hunt Syndrome?

Answer 12

Oral aciclovir and prednisolone