ENT

Question 1

Differences between adult and paediatric airways

Answer 1

• Smaller mandible
• Larger head and occiput
• Bulging occipital process (Flexed neck)
• Tongue is relatively larger
• Epiglottis is longer and floppier
• Larynx is higher and more anterior
• Narrowest part is cricoid ring (until about 5 years)
• Airway is shorter and narrower
• Smaller diameter at airway, therefore, higher resistance to airflow

Question 2

Causes of paediatrics stridor and their expected stridor qualities

Answer 2

Question 3

General causes of stridor for varying age groups

Answer 3

Question 4

Anatomical structures involved in jaw (bilateral TMJ) dislocation + reduction techniques

Answer 4

Mandibular condyle (of mandible) moves anteriorly and out of mandibular fossa (of temporal
bone)

Syringe technique:
- 10mL syringe placed between mandibular and maxillary molars
- Patient to roll syringe anterior and posterior

Manual reduction:
- Gloves/rolled gauze, thumbs placed on mandibular molars
- Firm, constant inferoposterior pressure until reduction
- May require procedural sedation

On discharge:
Simple analgesia
Soft/liquid diet
Avoid yawning and large bites
If recurrent, maxfax review

Only image if traumatic

Question 5

Clinical signs of occult nasal foreign body

Answer 5

• Foul smelling rhinorrhoea / purulent discharge
• Unilateral epistaxis
• Unilateral nasal obstruction / mouth breathing
• Pressure necrosis
• Septal necrosis especially with battery or paired disc magnet foreign bodies
• Less specific – facial swelling and fever

Question 6

Nasal foreign body: indications for ENT referral

Answer 6

• Posterior FB not easily visualised
• Chronic or impacted FB with marked inflammation
• Penetrating or hooked FB
• Failure to remove in emergency due to poor cooperation, bleeding, limited instrumentation

Question 7

Indications for antibiotics in acute otitis media

Answer 7

• <6mo old
• Immunocompromised
• Aboriginal or Torres Strait Islander
• Only hearing ear
• Cochlear implant
• Possible supperative complication
• Nil improvement after 48 hours conservative management

Question 8

Antibiotics for AOM incl. penicillin hypersensitivity

Answer 8

1. Amoxicillin 30mg/kg BD for 5 days

If no improvement at 48 hours:
2. Amoxicillin-clavulanate 22.5mg/kg BD for 5 days

If delayed/non-severe hypersensitivity:
3. Cefuroxime 10mg/kg (3mo-2 years) or 15mg/kg (2 year+) BD for 5 days

If immediate or severe hypersensitivity:
4. Trimethoprim/sulfamethoxazole 4-20mg/kg BD for 5 days

Question 9

Complications of acute otitis media

Answer 9

Tympanic Membrane Perforation
Mastoiditis
Cholesteatoma
Intracranial Extension
Chronic Otitis media with effusion
Hearing loss

Question 10

Neck zone boundaries and contents

Answer 10

Zone I: clavicles to cricoid cartilage
- Vascular: Vertebral and proximal carotid artiries; major thoracic vessels
- Airway: Lungs, oesophagus, trachea
- Other: Thoracic duct, spinal cord, superior mediastinum

Zone II: Cricoid cartilage to angle of mandible
- Vascular: carotids, vertebral arteries, judular veins
- Airway: Oesophagus, trachea, larynx
- Other: Spinal cord

Zone III: Angle of mandible to base of skull
- Vascular: Distal carotid and vertebral arteries
- Airway: Pharynx
- Other: Spinal cord

Question 11

Physical findings of reported strangulation injury requiring further investigation

Answer 11

1. Visible local bruising/swelling/petechiae
2. Dyspnoea/stridor
3. Dysphonia/voice change
4. Neurological deficit
5. Carotid bruit
6. Bony c-spine tenderness
7. History of LOC or altered GCS