ENT

Question 1

name some ear symtpoms a px may present with

Answer 1

pain - otalgia
discharge - otorrhoea
deafness/ difficulty hearing
tinnitus
truama
foreign body
dizzy

Question 2

what to investigate about ear otorrhea?

Answer 2

discharge - otorrhoea: amount, smell, watery, purulent, blood, mucus

Question 3

hearing loss red flags?

Answer 3

unilateral
suddent onset
other CN/ cerebellar signs
abnormal tympanic membrane (ear drum)

in children: ALL deafness as can delay speech and lang

Question 4

Otitis externa red flags?

Answer 4

painless discharge
pain not in synch w findings
recurrent/ persistent unilateral infections
> week duration
cerebellar involv/ CN weakness

Question 5

ear exam (IPPA)

Answer 5

Inspect
Palpitation
Percussion
A: N/A look in ear w otoscope

Question 6

what would you inspect in an ear examination

Answer 6

external auditory meatus and pinna for scars, redness and visible discharge

Question 7

what would you palpate during an ear examination

Answer 7

tragus, pinna, external auditory meatus

Question 8

what does percussion involve in an ear examination

Answer 8

rinne and weber test

Question 9

which cranial nerve does the rinne and weber test involve

Answer 9

8

Question 10

if you look inside an ear with an otoscope and see no fluid level or inflammation, what would this tell you about the health of the ear

Answer 10

normal

Question 11

what abnormal findings could you find within the ear using an otoscope

Answer 11

impacted wax
exostoses
perforated tympanic membrane

Question 12

what weber test result would you expect in a normal ear? forehead

Answer 12

both equal

Question 13

what rinnes test result would you expect in a normal ear

Answer 13

air conduction greater than bone conduction

Question 14

what webers test result would you see in conductive deafness

Answer 14

louder in ear with conductive deafness

Question 15

what result would you expect to see with the rinnes test in an ear with conductive deafness

Answer 15

bone conduction greater than air conduction

Question 16

what result on the weber test would indicate sensorineural deafness

Answer 16

louder in ear without the deafness

Question 17

what result in the rinnes test would you expect in sensorineural deafness

Answer 17

air conduction greater than bone conduction

Question 18

if bone conduction is greater than air conduction in the rinnes test is deafness conducive or sensorineural BC>AC

Answer 18

conductive

Question 19

if AC>BC: deafness conductive or sensorineural?

Answer 19

sensorineural

Question 20

which cranial nerve is the nose anatomy associated with

Answer 20

1 olfactory

Question 21

nasal symptoms?

Answer 21

obstruction blockage/one or both sides
dishcarge
loss smell
deformity
pain
trauma
foreign body
sneeze
snore
blcoked nose
itching
headache/ heaviness

Question 22

nose red flags (epistaxis)

Answer 22

haemorrhagic shock
bleeding not stopped by direct pressure
recurrent unilateral epistaxis
signs suggestive of bleeding disorder/ anticoagulation
dizziness
sinus pain

Question 23

throat symptoms that indicate that there may be a problem

Answer 23

pain
difficulty swallowing
bad taste in mouth
pus or exudate
change or loss in voice
associated earache

Question 24

throat/swallowing red flags

Answer 24

pain swallowing
difficulty swallowing
hoarseness
bad breath
lock jaw

Question 25

throat emergency red flags !!!

Answer 25

airway closed increased pulse restlessness retractions anxiety increased inspiratory stridor drooling AIRRAID

Question 26

throat exam... coordination of swallowing is controlled by which nerves

Answer 26

trigeminal facial glossopharyngeal vagus hypoglossal

Question 27

what number cranial nerve is the trigeminal

Answer 27

5

Question 28

what number cranial nerve is the facial

Answer 28

7

Question 29

what number cranial nerve is the glossopharyngeal

Answer 29

9

Question 30

what number cranial nerve is the vagus

Answer 30

10

Question 31

what cranial nerve number is the hypoglossal

Answer 31

12

Question 32

would a throat examination that presents with tonsiliitis or peritonsillar abscess/ quinsy be considered normal or abnormal

Answer 32

abnormal

Question 33

ENT associated assessment?

Answer 33

lymph nodes exam

Question 34

would a throat examination that presents with tonsiliitis or peritonsillar abscess/ quinsy be considered normal or abnormal

Answer 34

FEVERPAIN

Question 35

list some different parameters included in the feverpain criteria

Answer 35

fever during past 24h purulence attend rapidly within 3 days of onset severely inflammed tonsils no cough or coryza

Question 36

each fever pain criteria score 1 point with a max score of 5, what do higher causes suggest

Answer 36

more severe symptoms and likely streptococcal cause

Question 37

the centor criteria can also be used for ent associated symptom assessment with each scoring a point of 1 with a maximum of 4. A higher score is associated with an increased likelihood of isolating streptococcus. What different parameters are looked at

Answer 37

tonsillar exudate tender anterior cervical lymphadenopathy history of fever >38 absence of cough

Question 38

what score uses physiological measurements to routinely record patients in hospital and aims to acutely ill patients including those with sepsis

Answer 38

NEWS

Question 39

early warning signs of sepsis: main 4?

Answer 39

fever/ low body temp chills and shiver fast heartbeat fast breathing

Question 40

what 6 physiological parameters are measured in the news score

Answer 40

respiration rate oxygen saturation systolic bp pulse rate level of consciousness temp

Question 41

what questions would you ask someone who plays a watersport and comes to see you complaining of hearing loss

Answer 41

pain and socrates muffled or complete loss uni or bilateral tried anything onset worsening wax in ears related to cough or cold - wider symptoms

Question 42

what examinations would you conduct if someone presents with hearing loss

Answer 42

otoscope examination cranial nerve 8 looking at external ear

Question 43

what questions would you ask someone who has come to see you in a minor ailment clinic complaining of a sore throat

Answer 43

cough or cold recently on any meds trauma symptom duration history of sore throat anything makes it better or worse

Question 44

What treatment would you recommend if the sore throat tonsils did not appear pustular?

Answer 44

Pen b for bacterial

Question 45

what might carbimazole and clarithromycin cause in the mouth

Answer 45

metallic taste

Question 46

give one important piece of dietary counselling that patients taking penicllin V for tonsillitis should be made aware of

Answer 46

take on empty stomach 30 mins before meals or 2 hrs after meals

Question 47

why is it important that patients take pen v on an empty stomach

Answer 47

low ba and reduces more if you have food in your stomach

Question 48

why is pen v a first line antibiotic of choice for things like tonsillitis or other infections that involve the throat?

Answer 48

covers streptococcus - the bacteria causing it

Question 49

what would be an appropriate second line antibiotic that covers strep if patients have a pencillin allergy

Answer 49

clarithromycin

Question 50

clarithromycin might be easier for some patients compared to pen v as the dosing frequency is bd instead of qds, however what are some cons

Answer 50

metallic taste in mouth large tablet size difficult to swallow with sore throat

Question 51

what treatments can you recommend for tonsils that are not pustular

Answer 51

diflam lozenges saltwater rinse corsodyl honey lemon drink avoid hot drinks ice cream paracetamol

Question 52

what are the pros of using diflam sprays with benzocaine in it

Answer 52

spray can be directed to the back of the throat for pain relief

Question 53

how would you use the feverpain or centor score to decide a treatment plan with the patient

Answer 53

risk escalation identifies strep throat higher score means escalation needed

Question 54

What medication history would make you refer the sore throat patient?

Answer 54

Carbimazole sore throat refer Immunosuppressants Anything that puts u at risk of neutropenia sepsis Sore throat early sign of something serious deteriorate quickly

Question 55

any immunosuppressant drug can cause neutropenic sepsis and a self limiting infection can be x in these patient

Answer 55

fatal