Ear, Nose and Throat

Question 1

When is referral to ENT needed for ear drum perforation?

Answer 1

After 6 weeks

Question 2

What is the management of mastoiditis?

Answer 2

IV abx

NOTE: CT only if complications suspected

Question 3

What is the management of otitis externa?

Answer 3

Topical abx +/- topical steroid

Question 4

What are the criteria for tonsillectomy?

Answer 4

1) sore throats are due to tonsillitis (i.e. not recurrent URTI)
2) the person has 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years, and for whom there is no other explanation for the recurrent symptoms)
3) the episodes of sore throat are disabling and prevent normal functioning

Other:
1) recurrent febrile convulsions secondary to episodes of tonsillitis
2) obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
3) peritonsillar abscess (quinsy) if unresponsive to standard treatment

Question 5

What are the CENTOR score criteria?

Answer 5

1) presence of tonsillar exudate
2) tender anterior cervical 3)) lymphadenopathy or lymphadenitis
3) history of fever
4) absence of cough

Question 6

What are the FeverPAIN criteria?

Answer 6

1) Fever over 38°C.
2) Purulence (pharyngeal/tonsillar exudate).
3) Attend rapidly (3 days or less)
4) Severely Inflamed tonsils
5) No cough or coryza

Question 7

What is the antibiotic management of tonsillitis?

Answer 7

phenoxymethylpenicillin

pen allergic: clarithromycin

Question 8

What are the features of an acoustic neuroma (AKA vestibular schwannoma)?

Answer 8

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

NOTE: seen in NF2

Question 9

What is the management of malignant otitis externa?

Answer 9

IV abx (ciprofloxacin)- abx to. cover pseudomonas

Question 10

What is the management of nasal polyps?

Answer 10

All should be referred to ENT

Urgent- if unilateral or bleeding

Question 11

What are the most common causative organisms of bacterial otitis media?

Answer 11

Streptococcus pneumonaie, Haemophilus influenzae
Moraxella catarrhalis

Question 12

What is the management of Meniere’s disease?

Answer 12

1) acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required

2) prevention: betahistine and vestibular rehabilitation exercises may be of benefit

3) Inform DVLA

Question 13

What are causes of gingival hyperplasia?

Answer 13

phenytoin, ciclosporin, calcium channel blockers and AML