Ear and throat disease

Question 1

cause of dizzy patient

Answer 1

ENT
cardiovascular 
metabolic 
anxiety 
neurological 
trauma 
migraine 
drug side effects

Question 2

define dizziness

Answer 2

non specific feeling of vertigo, pre-syncope, disequilibrium

Question 3

features of cardiac dizziness

Answer 3

lightheaded
palpitations
syncope

Question 4

features of neurological dizziness

Answer 4

blackout 
visual disturbance 
paraesthesia 
weakness 
speech/swallow issues

Question 5

features of vestibular dizziness

Answer 5

motion

spinning, fall, pushed

Question 6

assoaicted symptoms with vertigo

Answer 6

hearing loss 
tinnitus 
aural pressure 
migraines 
sound/pressure indiced symptoms

Question 7

dizzy rolling in bed?

Answer 7

BPPV

Question 8

severe attack of dizziness lasting for hours with nausea and vomiting

Answer 8

vestibular neuritis

Question 9

light sensitive and dizzy?

Answer 9

migraine

Question 10

one ear feeling full and dizzy?

Answer 10

meniere’s disease

Question 11

investigations to take for dizziness and vertigo?

Answer 11

blood pressure 
otoscopy 
neurological examination 
balance 
audiometry

Question 12

what is the vestibulo-ocular reflex

Answer 12

focus eyes in distance, turning head causes deflection to allow eye focus
fluid shift in the horizontal VC deflects cupula to opposite side of turn and stimulates the left or right semi circular canal
leads to deflected eye movement

Question 13

when the head turns right, the ___ horizontal canal is stimulated and the ___ is inhibited leading to eye movement on the ___ side

Answer 13

right
left
left

Question 14

when the head turns left, the ___ horizontal canal is stimulated and the ___ is inhibited leading to eye movement on the ___ side

Answer 14

left
right
right

Question 15

describe how nystagmus may occur in vestibular pathology

Answer 15

firing potential is lost on the affected side, with the other side being dominant. this leads to one side being the dominant in vestibulo-ocular reflex
this leads to nystagmus

Question 16

what is the head impulse test

Answer 16

test vestibular-ocular reflex by rotating head and observing eye movement
use goggles to determine delay

Question 17

cause of BPPV

Answer 17

trauma
ear surgery
idiopathic

Question 18

pathophysiology of BPPV

Answer 18

otoconia from utricle is displaced into semicircular canal, usually posterior

Question 19

presenting features of BPPV

Answer 19

vertigo on looking up, turning in bed, lying down, bending, rising, moving head quickly

Question 20

how can BPPV be distinguished from vertebrobasillar insuffiency

Answer 20

difficulty speaking, swallow, weakness, numbness, visual disturbance

Question 21

diagnostic test for BPPV

Answer 21

dix hallpike test 
sit up with enough room to lay down 
vertical/torsional geotropic nystagmus
vertigo 
sick

Question 22

best treatment for BPPV

Answer 22

epley manoeuvre

Question 23

other management for BPPV

Answer 23

semont manoeuvre

brant-daroff exercises - 10 reps 3x a day for 1 weeek

Question 24

features of vestibular neuronitis/labyrinthitis

Answer 24

prolonged vertigo for days
associated tinnitus
prodromal viral symptoms

Question 25

management of vestibular neuronitis/labyrinthitis

Answer 25

self limiting if prolonged then investigate rehabilitate 3 days in bed, 3 weeks off work, 3 months off balance

Question 26

features of meniere's disease

Answer 26

fecurrent, spontaneous and rotational vertigo with 2 episodes >20 mins new tinnitus aural fullness SNHL, low freq

Question 27

management of meniere's disease

Answer 27

supportive, intratympanic steroids, gentamicin, surgery, diuretics tinnitus therapy hearing aids salt restriction, alcohol, caffeine, stress

Question 28

what is a vestibular schwannoma, what symptoms may it cause and how is it diagnosed

Answer 28

rare, benign tumour of VIII sheath imbalance, hearing loss with tinnitus asymmetric hearing loss by MRI

Question 29

management of migraine and vertigo

Answer 29

lifestyle - alcohol, caffeine, stress, citrus fruit, sleep triptans propranolol, amitriptyline

Question 30

features associated wth migraine and vertigo?

Answer 30

``` ataxia vertigo phonophobia motion sickness hearing loss ```

Question 31

what is otitis externa and what causes it

Answer 31

inflammation fo skin of ear canal almost always infectrive - bacterial/fungal caused by water, cotton buds, hearing aids, skin issues

Question 32

in who is acuite otitis media more common

Answer 32

children

Question 33

causes of OME in children

Answer 33

eustachian tube block or dysfunction

Question 34

causes of OME in adults

Answer 34

nasopharyngeal carcinoma/lymphoma | rhinosinusitis

Question 35

what is cholesteatoma, is it congenital or acquired, features

Answer 35

keratin in middle ear hearing loss and discharge usually acquired but can be congenital

Question 36

complications of acuite otitis media/cholesteatoma

Answer 36

sensorineural hearing loss, tinnitus, vertigo, facial palsy brain abscess or meningitis venous sinus thrombosis

Question 37

what is presbycusis and what frequency is the hearing loss

Answer 37

age related sensorineural hearing loss | high frequency

Question 38

in who is otosclerosis more common

Answer 38

young women pregnancy familial

Question 39

common cause of acute otitis media

Answer 39

preceding URTI in children

Question 40

what makes up waldeyer's ring

Answer 40

palatine tonsils adenoid tonsils lingual tonsil

Question 41

histology of the tonsils

Answer 41

stratified squamous crypts adenoids formed of ciliated pseudostratified columnar

Question 42

upper aerodigestive histology?

Answer 42

ciliated columnar respiratory type | squamous

Question 43

histology of oral cavity, pharynx, vocal cords and oesophagus

Answer 43

squamous

Question 44

pathogens in acute tonsillitis

Answer 44

``` EBV adenovirus rhinovirus enterovirus influenza and parainfluenza GAS , haemophilus influenzae, s aureus, strep pneumoniae ```

Question 45

symptoms of viral tonsilitis

Answer 45

malise sore throat fever possible lymphadenopathy <4days

Question 46

symptoms of bacterial tonsilitis

Answer 46

``` around a week systemic upset fever lymphadenopathy odonophagia halitosis ```

Question 47

management of tonsillitis

Answer 47

``` eat and drink rest OTC analgesia penicillin consider tonsillectomy steroids fluids ```

Question 48

what is a peritonsillar abscess, what are the symptoms and management

Answer 48

pus production between tonsil and muscle unolateral throat pain, odynophagia, medially displaced tonsil and uvula, trismus aspirate, abx

Question 49

signs of infectious mononucleosis

Answer 49

tonsillar enlargemnt with membranous exudate cervical lymphadenopathy palatal petechial haemorrhage hepatosplenomegaly

Question 50

disgnosis of infectious mononucleosis

Answer 50

``` atypical monocytes monospot paul bunnel test low CRP deranged LFTs ```

Question 51

management of infectious mononucleosis

Answer 51

symptomatic steroids if bad abx, not amox

Question 52

features of tonsillar obstructive hyperplasia

Answer 52

snoring muffled voice dysphagia

Question 53

features of adenooid obstructive hyperplasia

Answer 53

mouth breathing snoring AOM/OME hyponasal voice

Question 54

features of chronic tonsilitis

Answer 54

``` chronic sore throat malodourus breath tonsilith peritonsillar oedema tender cervical lymphadenopathy ```

Question 55

in who is OME more common

Answer 55

``` children males day care older siblings recurrent URTI ```

Question 56

cause of OME

Answer 56

``` recurrent AOM or URTI premature craniofacial abnormality immune deficiency smoking day care allergy nutrition bottle feed seasonal ```

Question 57

symptoms of OME

Answer 57

``` deafness behaviour issues poor school performance balance issues speech delay ```

Question 58

diagnosis of OME

Answer 58

hx, otoscopy, tuning fork | audiometry and tympanometry

Question 59

signs of OME on examiantion

Answer 59

TM retraction and reduced mobility and colour | visible middle ear fluid

Question 60

management of OME

Answer 60

waiting, review at 3m with PTA, otoscope and tympanometry if persistent refer if <3, or >3 and first line - grommets if >3 and 2nd line - grommets and adenoidectomy

Question 61

complication of grommet insertion

Answer 61

``` infection early extrusion retention perforation swimming issues ```