ENT

Question 1

What are some features of BPPV?

Answer 1

• Vertigo triggered by change in head position
• May be associated with nausea
• Each episode typically lasts 10-20 seconds
• Positive Dix-Hallpike

Question 2

Vertigo, tinnitus and hearing loss is most likely to indicate?

Answer 2

Meniere’s disease

Question 3

What is the management for acute attacks of Meniere’s disease?

Answer 3

Buccal or IM prochlorperazine

Question 4

What is the management for prevention of Meniere’s disease?

Answer 4

Betahistine and vestibular rehabilitation exercises may be of benefit

Question 5

Features of Viral Labyrinthitis?

Answer 5

• Recent viral infection
• Sudden onset
• Nausea and vomiting
• Hearing may be affected

Question 6

Features of Vestibular neuronitis?

Answer 6

• Recent viral infection
• Recurrent vertigo attacks lasting hours or days
• No hearing loss

Question 7

What are some differentials for tonsillitis?

Answer 7

Pharyngitis: Symptoms include sore throat, fever and headache, unlike tonsillitis patients do not usually have lymphadenopathy
Mononucleosis: Characterized by fatigue, sore throat, fever and swollen lymph nodes. Key difference is the presence of extreme fatigue and splenomegaly

Question 8

What is Lemierre’s Syndrome?

Answer 8

It is a complication of tonsillitis where inflammation leads to pharyngotonsillitis, inflammation within the internal jugular vein and septic emboli.
Treatment may require high-dose benzylpenicillin and surgical debridement.

Question 8

What is a retropharyngeal abscess?

Answer 8

It is a rare complication of tonsillitis characterised by soft tissue swelling, more common in young children. Symptoms include a stiff and extended neck and refusal to eat or drink.

Question 8

What is the most common complication of tonsillitis?

Answer 8

Recurrent tonsillitis.

Question 9

What are some risk factors for head and neck neoplasms?

Answer 9

• Smoking
• Alcohol misuse
• Viral Infections, HPV (Specifically type 16) and EBV
• Exposure to radiation, including both UV and ionizing radiation
• Immunosuppression
• Occupational exposure to harmful substances like acid mists, asbestos, wood dust
• Family history

Question 10

What are some indications for Adenoidectomy?

Answer 10

• Recurrent or persistent otitis media (due to obstruction of the eustachian tube by enlarged adenoids)
• Adenoid hypertrophy resulting in upper airway obstruction
• In association with a tonsillectomy for recurrent tonsillitis
• Recurrent or chronic sinusitis or adenoiditis
• Dysphagia with failure to thrive
• Speech impairment

Question 11

What type of reaction is Allergic Rhinitis?

Answer 11

Type 1 hypersensitivity reaction

Question 12

What is the first-line treatment of otitis externa?

Answer 12

• Topical antibiotic or a combined topical antibiotic with a steroid

Question 13

What is the treatment of Ramsey Hunt syndrome?

Answer 13

Oral Aciclovir (800mg orally 5 times a day for 7 days) and corticosteroids (Prednisolone 60mg orally daily for 5 days)

Question 14

What bacteria are commonly implicated in Otitis Media?

Answer 14

Streptococcus Pneumoniae
Haemophilus Influenzae
Moraxella Catarrhalis

Question 15

What is the management of recurrent or chronic sinusitis?

Answer 15

• Avoid Allergen
• Intranasal corticosteroids
• Nasal irrigation with saline solution

Question 16

What are some red flag symptoms in Chronic Sinusitis?

Answer 16

• Unilateral symptoms
• Persistent symptoms despite compliance with 3 months of treatment
• Epistaxis

Question 17

What are some complications of Rhinosinusitis?

Answer 17

• Persistent infection
• Orbital Cellulitis
• Intracranial involvement: Meningitis and encephalitis
• Mucoceles
• Osteomyelitis
• Pott’s puffy tumour (Subperiosteal abscess)

Question 18

What is a cholesteateoma?

Answer 18

Cholesteateoma is a complication of chronic otitis media caused by the abnormal accumulation of skin, squamous epithelium within the middle ear cleft and mastoid air cells

Question 19

What is the diagnostic criteria for acute rhinosinusitis?

Answer 19

Sudden onset of symptoms for less than 12 weeks duration including one of:

Nasal blockage/congestion OR nasal discharge
Facial pain/pressure OR loss/reduction of sense of smell

Question 20

What bacteria are commonly implicated in Otitis Externa?

Answer 20

• Pseudomonas Spp
• Staphylococcus Aureus

Question 21

What are the clinical features of mastoiditis?

Answer 21

Similar symptoms and signs of acute otitis media in addition to inflammation over the mastoid process (retro-auricular), pinna protrusion, and loss of post-auricular sulcus.

Question 22

What are the clinical features of a cholesteateoma?

Answer 22

A cholesteateoma presents with persistent foul smelling discharge, headache and otalgia

Question 23

What is the management of a Cholesteatoma?

Answer 23

Surgical intervention to remove the abnormal skin and squamous epithelium accumulation. This approach helps prevent severe complications such as facial nerve palsy and CNS complications

Question 24

What imaging is recommended for a suspected middle ear cholesteatoma?

Answer 24

High-resolution CT scan of the petrous temporal bone

Question 25

What is a Schwartze sign and when is it seen?

Answer 25

It is reddish discoloration of the promontory seen during otoscopic examination . The discoloration is the result of the increased blood flow to the promontory due to the characteristic otosclerotic lesion. Occurs in up to 10% of patients with otosclerosis

Question 26

What structures are in the inner ear?

Answer 26

- Semicircular canals - Vestibule (Middle section) - Cochlear

Question 27

What is the most common cause of a perforated tympanic membrane?

Answer 27

Infection Other causes include barotrauma or direct trauma

Question 28

What is the management of a perforated tympanic membrane?

Answer 28

- No treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. - Refer to ENT if not resolving within this time

Question 29

What would you find on otoscopy in otitis media?

Answer 29

- Bulging tympanic membrane --> Loss of light reflex - Opacification or erythema of the tympanic membrane - Perforation with purulent otorrhoea - Decreased mobility if using a pneumatic otoscope

Question 30

When should you prescribe antibiotics in otitis media?

Answer 30

- Symptoms lasting more than 4 days and not improving - Systemically unwell - Immunocompromise - Younger than 2 years with bilateral otitis media - Otitis media with perforation and/or discharge in the canacl

Question 31

What is Presbycusis?

Answer 31

Type of sensorineural hearing loss that affects elderly individuals. Occurs as sensory hair cells and neurons in the cochlea atrophy over time.

Question 32

What is the treatment of Ramsey Hunt syndrome?

Answer 32

- High dose aciclovir - High dose steroids - Eye protection

Question 33

What drugs give you Gingival hyperplasia?

Answer 33

Phenytoin Ciclosporin CCBs AML

Question 34

What are the main features of Cholesteatoma?

Answer 34

- Foul-smelling, non resolving discharge - Hearing loss

Question 35

What is the management of cholesteatoma?

Answer 35

Patients are referred to ENT for consideration of surgical removal

Question 36

Where is the most likely source of bleeding in Epistaxis?

Answer 36

Kiesselbach's plexus

Question 37

If bleeding in Epistaxis does not stop after 10-15minutes of continuous pressure what should you do?

Answer 37

- If you can see the bleed --> Cautery - If no obvious source of bleeding --> Packing

Question 38

What should be done for patients with epistaxis that have failed all emergency management?

Answer 38

May require sphenopalatine ligation in theatre

Question 39

When should someone with acute sensorineural hearing loss be seen?

Answer 39

It is an emergency and requires urgent referral to ENT for audiology assessment and brain MRI

Question 40

What symptoms can impacted ear wax cause?

Answer 40

- Pain - Conductive hearing loss - Tinnitus - Vertigo

Question 41

What are some risk factors for Glue ear?

Answer 41

- Male sex - Siblings with glue ear - Higher incidence in winter/spring - Day care attendance - Parental smoking - Bottle feeding

Question 42

What is Little's area?

Answer 42

Little's area in the anterior nasal septum is the site of Kiesselbach's plexus, supplied by 4 arteries. Epistaxis therefore most commonly originates from the anterior of the nose.

Question 43

What predisposing factors are there for Black Hairy tongue?

Answer 43

- Poor oral hygiene - Antibiotics - Head and neck irradiation - HIV - IVDU

Question 44

How do you get black hairy tongue?

Answer 44

Results from defective desquamation of the filiform papillae

Question 45

What is Ludwig's Angina?

Answer 45

Life-threatening cellulitis of the soft tissues involving the floor of the mouth and neck

Question 46

What are the features of nasal polyps?

Answer 46

- Nasal obstruction - Rhinorrhoea, sneezing - Poor sense of taste and smell

Question 47

What is the management of nasal polyps?

Answer 47

All patients with suspected nasal polyps should be referred to ENT for a full examination. - Topical corticosteroids shrink polyp size in around 80% of patients

Question 48

What is a red flag symptoms of nasal polyps?

Answer 48

Unilateral polyps

Question 49

What are the features of a thyroglossal cyst?

Answer 49

Usually midline, between the isthmus of the thyroid and the hyoid bone. Moves upwards with protrustion of the tongue

Question 50

Why should you refer urgently for Unilateral glue ear?

Answer 50

They need evaluation for a posterior nasal space tumour

Question 51

What are the red flag signs of a neck lump that point towards malignancy?

Answer 51

- A hard and fixed mass - The patient is over 35 years old - The presence of a mucosal lesion - A history of persistent hoarseness or dysphagia - The presence of Trismus - The presence of unilateral ear pain

Question 52

What is the initial management for epistaxis?

Answer 52

Lean forward and apply pressure to pinching the outside of their nose just above the nostrils for 15 minutes

Question 53

What is the management for septal haematoma?

Answer 53

Immediately refer to ENT for incision and drainage under general anaesthetic. Must be done quickly to preserve blood supply to the nasal cartilage. Untreated can lead to saddle-nose deformity

Question 54

What is Samter's triad?

Answer 54

Asthma, Aspirin sensitivity and nasal polyposis

Question 55

What is the penicillin allergy alternative for tonsillitis?

Answer 55

Clarithromycin

Question 56

What should you do in primary haemorrhage following tonsillectomy

Answer 56

Immediate return to theatre Primary haemorrhage = 6 to 8 hours following tonsillectomy

Question 57

What is Ramsey Hunt caused by?

Answer 57

Herpes Zoster Oticus

Question 58

Why do Auricular Haematomas require urgent referral to ENT?

Answer 58

They are a build up on blood between the cartilage and perichondrium. They can restrict blood supply and lead to necrosis of the connective tissue/

Question 59

What is the treatment of Quinsy?

Answer 59

Needle aspiration or I&D + IV Antibiotics, some may use steroids

Question 60

What are the symptoms of Nasopharyngeal carcinoma?

Answer 60

Otalgia Unilateral serous otitis media Nasal obstruction, discharge and/or epistaxis Cranial nerve palsys

Question 61

What is the management of a nasal septal haematoma?

Answer 61

- Surgical drainage - Intravenous antibiotics

Question 62

What type of nystagmus indicates BPPV on Dix-Hallpike manouvre?

Answer 62

Vertical Nystagmus

Question 63

In what condition would you see bilateral vestibular schwannomas?

Answer 63

Neurofibromatosis type 2

Question 64

What is the investigation of choice for vestibular schwannomas?

Answer 64

MRI Cerebellopontine angle

Question 65

Why do you get trismus in quinsy?

Answer 65

The pus causes the pterygoid muscles to go into spasm preventing them from opening their mouth.

Question 66

What lymph node is most commonly involved with a quinsy?

Answer 66

Jugulodiagastric lymph node