ENT

Question 1

Otosclerosis sx

Answer 1

conductive hearing loss, tinnitus and positive family history
reddish blush visible on the cochlear promontory
‘flamingo tinge’
. Onset is usually at 20-40 years

Question 2

Mx of perforated ear drum

Answer 2

no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear during this time

Question 3

Nasal polyps. Sensitivity to which medication is associated with this condition?

Answer 3

Aspirin. Nasal polyps are a common finding in patients with aspirin sensitivity, forming part of the Samter’s triad (aspirin sensitivity, asthma and nasal polyps).

Question 4

Ear ache, >1 month with nothing shown on otoscope mx

Answer 4

Unexplained, unilateral ear ache for more than 4 weeks with unremarkable otoscopy should be referred under the 2 week wait

Question 5

Criteria for tonsillectomy

Answer 5

the person has 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years,

Question 6

Hypocalcaemia ECG

Answer 6

QTc elongation

Question 7

Mx of glue ear

Answer 7

children should be observed for 6-12 weeks as symptoms are normally self-limiting and referral should be reserved if symptoms persist beyond this period.

However, referral should be earlier if:
Symptoms are significantly affecting hearing, development or education
Immediate referral in children with Downs syndrome or cleft palate

Question 8

Mx of acute otitis media

Answer 8

Antibiotics should be prescribed immediately if:
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal
Parents given a prescription to use if no improvement in 2–3 days

Amox 5-7 days

Question 9

2ww for Laryngeal cancer

Answer 9

aged 45 and over with:
persistent unexplained hoarseness or
an unexplained lump in the neck

Question 10

2ww Oral cancer

Answer 10

Unexplained oral ulceration or mass persisting for greater than 3 weeks
Unexplained red, or red and white patches that are painful, swollen or bleeding
Unexplained one-sided pain in the head and neck area for greater than 4 weeks, which is associated with ear ache, but does not result in any abnormal findings on otoscopy
Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks
Unexplained persistent sore or painful throat
Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion.

Question 11

Mx of chronic rhinosinitis

Answer 11

avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution

Question 12

Mx of acute sinusitis

Answer 12

Symptoms < 10 days: watch & wait
Symptoms > 10 days - consider intranasal steroid (e.g. mometasone).
Consider antibiotics if
(1) suspected bacterial (purulent d/c, fever)
(2) systemically unwell
(3) immunocompromised
1st line: Phenoxymethylpenicillin

Question 13

Acute sensorineural hearing loss mx

Answer 13

requires urgent referral to ENT for audiology assessment and brain MRI

An MRI scan is usually performed to exclude a vestibular schwannoma.

High-dose oral corticosteroids are used by ENT for all cases of SSNHL.

Question 14

Neuronitis vs labyrinthitis

Answer 14

Neuronitis
Recent viral upper respiratory tract infection, followed by acute vertigo with nausea and horizontal nystagmus, but crucially without auditory symptoms

Labyrithitis
involves both the vestibular and cochlear portions of the inner ear. Therefore, patients typically present with hearing loss and/or tinnitus in addition to vertigo

Question 15

Cause of bacterial otitis media

Answer 15

Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis

Question 16

Mx of bleeding after tonsillectomy

Answer 16

Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.

Secondary occurs at 5-10 days normally- Treatment is usually with admission and antibiotics

Question 17

Menieres disease

Answer 17

vertigo, fluctuating sensorineural hearing loss, and a sensation of fullness or pressure in the affected ear.

Question 18

Meniere disease mx

Answer 18

Routine referral- ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit

Question 19

Cause of gingival hyperplasia

Answer 19

phenytoin
ciclosporin
calcium channel blockers (especially nifedipine)

Question 20

Drugs causing tinnitus

Answer 20

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

Question 21

Mx of acute otitis external

Answer 21

topical antibiotic or a combined topical antibiotic with a steroid

Question 22

Mx of Ramsay Hunt sx

Answer 22

High dose aciclovir, high dose oral steroids and eye protection

Question 23

BPPV diagnosis and mx

Answer 23

positive Dix-Hallpike manoeuvre

Tx Epley manoeuvre (successful in around 80% of cases)

Question 24

medications is most useful for helping to prevent attacks of Meniere’s disease?

Answer 24

Betahistine

Question 25

Ototoxic drugs

Answer 25

aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents

Question 26

Otitis externa in diabetics mx

Answer 26

Cipro to cover pseudo

Question 27

Dry cough and bilateral parotid swelling

Answer 27

Sarcoidosis

Question 28

Presbycusis

Answer 28

Gradual hearing loss related to age Audiometry shows sensorineural hearing loss at the higher frequencies.

Question 29

Red flag of chronic rhinosinusitis

Answer 29

Red flags symptoms unilateral symptoms persistent symptoms despite compliance with 3 months of treatment epistaxis

Question 30

Mx of epistaxis

Answer 30

adequate first aid for 20 minutes (squeeze both nasal ala firmly and sit forward. Ice in the mouth can help) cautery should be used initially if the source of the bleed is visible nasal packing (e.g. with Rapid Rhino. Initially insert into the affected nostril. If unsuccessful, a pack in the other nostril may help. Posterior bleeds can be packed with a posterior pack, or with a Foley catheter). surgical intervention (sphenopalatine artery ligation).

Question 31

Erythematous areas with a white-grey border on tongue

Answer 31

Geographic tongue

Question 32

Nasal polyp mx

Answer 32

Referral: All patients with suspected nasal polyps should be referred to ENT for comprehensive assessment, including nasal endoscopy. Medical treatment: First-line therapy is intranasal corticosteroids (e.g., fluticasone), which reduce polyp size and improve symptoms in approximately 80% of cases.

Question 33

Brachial cyst vs cystic hygroma

Answer 33

Brachial cyst- An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx Usually present in early adulthood It is fluctuant but doesn't transilluminate or move during swallowing. often present during intercurrent upper respiratory tract infection Hygroma- Most are evident at birth, around 90% present before 2 years of age soft, fluctuant and highly transilluminable lump

Question 34

Cholestoma sx

Answer 34

foul-smelling, non-resolving discharge hearing loss Other features are determined by local invasion: vertigo facial nerve palsy cerebellopontine angle syndrome

Question 35

Post nasal drip

Answer 35

excess mucus accumulates in the throat or in the back of the nose resulting in a chronic cough and bad breath.

Question 36

Acoustic neuroma fx

Answer 36

cranial nerve VIII: hearing loss, vertigo, tinnitus cranial nerve V: absent corneal reflex cranial nerve VII: facial palsy

Question 37

Mx of vestibular neuritis

Answer 37

buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms

Question 38

Centor score

Answer 38

presence of tonsillar exudate tender anterior cervical lymphadenopathy or lymphadenitis history of fever absence of cough 3/4 abx

Question 39

Mastoiditis sx and mx

Answer 39

otalgia: severe, classically behind the ear there may be a history of recurrent otitis media fever the patient is typically very unwell swelling, erythema and tenderness over the mastoid process the external ear may protrude forwards ear discharge may be present if the eardrum has perforated Management IV antibiotics

Question 40

Nasal septal haematoma sx and mx

Answer 40

Red swelling arising from the midline, which is slightly boggy. Management surgical drainage intravenous antibiotics

Question 41

Labyrithitis vs neuritis

Answer 41

“Labyrinthitis = Loss of hearing” L = Labyrinth = L = Loss of hearing Affects the entire labyrinth: vestibular + cochlear parts → causes vertigo + hearing loss Neuritis = Nerve only Affects the vestibular nerve only, not the cochlea So: Vertigo, nausea, imbalance — but no hearing loss

Question 42

Rinnes and Webers results

Answer 42

Normal (Rinne Positive): Air conduction > Bone conduction (AC > BC) Abnormal (Rinne Negative): Bone conduction > Air conduction (BC > AC) Same side (ipsilateral) as hearing loss Conductive hearing loss in that ear Opposite side of hearing loss Sensorineural hearing loss in the other ear

Question 43

Hutchinson sign

Answer 43

Hutchinson's sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement

Question 44

2ww criteria for laryngeal cancer

Answer 44

aged 45 and over with: persistent unexplained hoarseness or An unexplained lump in the neck.

Question 45

Complication of mastoiditis

Answer 45

Meningitis

Question 46

Glue ear examination

Answer 46

The TM often appears dull, opaque, and may have a yellowish or amber colour due to the presence of middle ear fluid. Air-fluid level or bubbles: Sometimes visible behind the TM, indicating effusion. Retracted TM

Question 47

Sx of vestibular schwannoma

Answer 47

vertigo, hearing loss, tinnitus and an absent corneal reflex

Question 48

Leukoplakia vs lichen sclerosis vs geographic tongue vs candida

Answer 48

Leukoplakia White, well-demarcated, non-scrapable plaques on oral mucosa (commonly buccal mucosa, tongue, soft palate). Premalignant lesion with risk of progression to squamous cell carcinoma (~1%). Diagnosis of exclusion; biopsy required to rule out malignancy or other causes. Associated with smoking, alcohol, chronic irritation. Geographic Tongue (Benign Migratory Glossitis) Irregular, erythematous patches on dorsal/lateral tongue with white or yellowish serpiginous borders. Lesions change location and pattern over time ("migratory"). Non-premalignant, benign condition often asymptomatic or mild discomfort. No biopsy needed unless atypical features present. Lichen Sclerosus (Oral variant) Chronic inflammatory condition presenting as white, atrophic, sometimes wrinkled plaques on oral mucosa (less common than genital involvement). May cause soreness or burning sensation. Histology shows thinning epithelium, basal cell degeneration, band-like lymphocytic infiltrate. Considered autoimmune; not premalignant but requires monitoring for malignant transformation in genital sites. Candida White, creamy plaques that are usually scrapable, leaving an erythematous or bleeding base underneath

Question 49

Brachial cyst vs cystic hygroma

Answer 49

- Cystic hygroma: Congenital, usually present at birth or within the first 2 years of life. - Branchial cyst: Typically presents in early adulthood. Location: - Cystic hygroma: Commonly found on the left side of the neck, often large and diffuse. - Branchial cyst: Oval, mobile cystic mass located between the sternocleidomastoid muscle and pharynx (anterior border of SCM).

Question 50

Mass formed between SCM and pharynx after URTI

Answer 50

Brachial cyst

Question 51

Type of hearing loss Is otosclerosis and presbycusis

Answer 51

Conductive- oto SN- Pres Both bilateral

Question 52

Acoustic neuroma vs meniere

Answer 52

Acoustic N- progressive constant hearing loss, tinnitus, vertigo high pitch(can be mild) Meniere- episodic hearing loss and vertigo Tinnitus roaring

Question 53

Malignant otitis externa

Answer 53

MOE is a severe complication of OE, where infection spreads into the temporal bone causing acute osteomyelitis. Risk factors include any cause of immunocompromise, most commonly poorly controlled diabetes Severe pain in the affected ear Smelly, purulent discharge Systemic upset - fever, tachycardia Otoscopy: Granulation tissue within the external auditory meatus, exposed bone IV abx for 6 weeks

Question 54

Ix of EBV

Answer 54

If <12 yrs or immunocompromised: EBV serology after 1 week. If >12 yrs and immunocompetent: FBC and Monospot

Question 55

2 scoring systems for tonsillitis and when to give abx

Answer 55

FeverPAIN: Fever, Purulence, Attend <3 days, Inflamed tonsils, No cough. FeverPAIN ≥4 Centor: Cervical LN, Exudate, No cough, Temp >38°C. Centor ≥3: Offer antibiotics.

Question 56

Chronic suppurative otitis media

Answer 56

Often a complication of AOM Non painful. Otorrhoea for > 2 weeks. Conductive HL. Otoscopy: Perforated TM. ENT referral + topical abx

Question 57

Mx of allergic rhinitis

Answer 57

Mild-Mod: 1st line PRN intranasal antihistamine (azelastine) or PRN oral antihistamine (cetirizine/loratadine). Mod-Severe or Step 2: Regular intranasal steroid (mometaonse/fluticasone) symptoms are considered mild to moderate if they have minimal impact on QOL/ADLs/sleep, severe if they have more significant impact.

Question 58

Crusting of the upper tympanic membrane, persistent foul smelling otorrhoea

Answer 58

Cholesteoma

Question 59

Ix of glue ear

Answer 59

Pneumatic otoscopy: assesses TM mobility- distinguishes from other Tympanometry: confirms presence of middle ear effusion. Audiometry should be performed: quantifies hearing loss.

Question 60

Mx of glue ear

Answer 60

1st Line: Watchful waiting for 3 months. Most cases resolve spontaneously. Monitoring should involve 2 audiometry tests, 3 months apart. Referral to ENT: Children with Down’s syndrome or cleft palate. Persistent effusion and hearing loss after 3 months. ENT Management: Autoinflation (e.g. balloon blowing) during observation. Myringotomy and grommet insertion if persistent significant hearing loss.

Question 61

Cerumen blockage

Answer 61

1st Line: Soften wax with ear drops for 5 days: Sodium bicarbonate 5% drops Olive oil drops QDS If symptoms persist: Consider ear irrigation or microsuction for removal

Question 62

2ww for nasopharyngeal cancer

Answer 62

Persistent bleeding/crusting with unilateral nasal obstruction Unilateral middle ear effusion and hearing loss (not linked to infection) Unilateral nasal polyp

Question 63

Glomus Jugulare Tumour

Answer 63

Pulsatile tinnitus Aural fullness Hearing loss (conductive or mixed) Otoscopy: red/blue mass behind athe tympanic membrane

Question 64

Child with reduced hearing and an indrawn, discoloured tympanic membrane mx

Answer 64

Watchful waiting for 3 months Then grommet insertion

Question 65

Sx of Bells Palsy

Answer 65

Upper and lower facial weakness Pain behind ear

Question 66

Cause of otitis external

Answer 66

Pseudomonoas

Question 67

Chondrodermatitis Nodularis Helicis sx and mx

Answer 67

Oval-shaped nodule with a central crust and surrounding erythema First-line treatment = pressure relief and topical steroids.