Ears, Nose, Throat past paper questions Flashcards
A 65 year old secretary presents to the GP with a hoarse voice, ear pain and weight loss for the past few months. She has a 4cm lump in the left anterior triangle of the neck. She has a past medical history of hypertension and Addison’s disease.
What is the single most important risk factor for the underlying diagnosis?
Addison’s disease
Occupation
Hypertension
Obesity
HPV type 16
HPV type 16
Any patient with hoarse voice and weight loss should be referred urgently for investigation of possible head and neck cancer. This is likely to be malignant given the large lymph node in her neck. The ear pain in this case is likely to be referred from the throat. Human papillomavirus type 16 (HPV16) seropositivity is associated with an increased risk of oral, pharyngeal and laryngeal cancer
A 4-year-old boy presents to the ENT outpatient department with a fluctuant swelling of the midline of the neck. It is non-tender and mobile, and moves on both swallowing and tongue protrusion. He is otherwise well with no significant past medical history.
What is the most likely diagnosis?
Chondroma
Dermoid cyst
Branchial cyst
Thyroglossal duct carcinoma
Thyroglossal cyst
Thyroglossal cyst
A 55 year old man has voice hoarseness, throat pain and right ear pain that has gradually progressed over one week. He has a 20 pack year smoking history and drinks 30 units of alcohol per week. He has no significant medical history and takes no regular medications. ENT examination is unremarkable. What is the most likely diagnosis?
Adenocarcinoma of the larynx
Tonsillitis
Lymphoma
Mastoiditis
Squamous cell carcinoma of the larynx
Squamous cell carcinoma of the larynx
This patient likely has carcinoma of the larynx, due to symptoms of voice hoarseness (implying infiltration of the recurrent laryngeal nerve), throat pain and ear pain (referred pain due to localised nerve infiltration). He also has risk factors of a 20 pack year smoking history and heavy alcohol use. Squamous cell carcinoma is the most common type of laryngeal carcinoma
A 23-year-old man presents to his GP with a persistent runny nose. He says it started after falling off his skateboard about four hours ago, but he has been “bunged up” for the past couple of days due to seasonal allergies. He also complains of a minor headache, which is no worse when bending over.
On examination, there is a thin, clear discharge from the nose. On examination of the nostrils, the nasal cavity contains dried blood.
What is the most likely diagnosis?
Vasomotor rhinitis
Rhinosinusitis
Retained sinonasal irrigation fluid
CSF rhinorrhoea
Allergic rhinitis
CSF rhinorrhoea
This is a classic history of someone with CSF rhinorrhoea. This occurs when there is trauma to the face (often involving the nose) which breaks the fronto-basal skull. This requires urgent imaging as a fracture in this area may allow bacteria to ascend from the nasal cavity to the meninges and neural tissues.
A 30 year old woman is on the ward 12 hours post-op after parathyroidectomy to remove a parathyroid adenoma. A drain is in situ from the wound. On the ward she suddenly develops respiratory distress. From the end of the bed, an obvious large neck swelling is apparent overlying the surgical site. There are no obvious abnormalities on inspection inside the mouth. What is the most appropriate initial management?
Fast-bleep the on-call anaesthetist
IM adrenaline
Remove surgical clips
High-flow oxygen via non-rebreathe mask
IV antibiotics
Remove surgical clips
This patient has developed a massive haematoma overlying the surgical site, likely due to a failure of the drain. This is causing airway compromised and should be remedied within minutes in order to prevent death. The surgical clips should be removed to allow the haematoma to drain emergently. This can be performed by most nurses on the ward, or a doctor
A 9 year old boy has suffered with intermittent episodes of a painful right ear with suppurative discharge for five years. He currently is suffering from an episode which began two days ago. On otoscopy, there is mucosal oedema and profuse white-coloured debris within the external auditory meatus. Given the most likely diagnosis, what is the most appropriate management?
Aural toilet and topical antibiotic
Mastoidectomy
Prolonged course of oral antibiotics
Acetic acid drops
Short course of oral antibiotics
Aural toilet and topical antibiotic
The most likely diagnosis is chronic otitis externa. Aural toilet is required to remove debris so that antibiotics can reach the mucosa, so penetrate the site of infection
A 42-year-old man presents to ENT clinic with a neck lump. He is otherwise asymptomatic. He occasionally drinks alcohol and smokes. The lump is located 7 cm below the right ear lobe, just anterior to the anterior border of the sternocleidomastoid muscle. A biopsy is taken. Pathology results indicate squamous cell carcinoma (SCC) that is p16 positive.
What is the most likely primary site?
Thyroid
Oropharynx
Larynx
Oral cavity
Nasopharynx
Oropharynx
This is the correct answer. p16 is a surrogate marker for human papilloma virus (HPV), and oropharyngeal squamous cell carcinoma (SCC) is very commonly driven by HPV. Oropharyngeal cancer commonly present as an isolated neck mass without any symptoms. Tonsils and tongue base are the primary sites most associated with a HPV+ve oropharyngeal SCC. They tend to be seen in younger (40-50s) patients with little smoking and/or drinking history
A 5-year-old boy with recurrent attacks of otitis media is suspected of developing otitis media with effusion (glue ear).
Which of the following findings is most consistent with unilateral middle ear effusion?
Lateralization with Weber’s test to the unaffected ear
Negative Weber’s test only on the contralateral side
Positive Rinne’s test on the ipsilateral side
Negative Rinne’s test on the ipsilateral side
No lateralization with Weber’s test
Negative Rinne’s test on the ipsilateral side
A 50-year old man presents to the Emergency Department. He has had ongoing epistaxis for the past two hours. His past medical includes Atrial Fibrillation.
His observations are stable. Clinical examination is unremarkable.
The ENT SHO is on their way to review the patient. The patient tells you he is on Warfarin.
On admission his INR was 5.5. His target INR is 2.5 (range 2.0 - 3.0).
What is the most appropriate management in regard to his warfarin?
Stop warfarin
Withhold 1 or 2 doses of warfarin
Stop warfarin and give IV phytomenadione (vitamin K) and prothrombin complex
Stop warfarin and give IV phytomenadione (vitamin K)
Reduce the dose of warfarin
Stop warfarin and give IV phytomenadione (vitamin K)
A 47 year old homosexual man complains of a painful mouth ulcer that has gradually developed over six weeks. He has a 30 pack year smoking history. He has no relevant medical history and takes no regular medications. On examination, there is a large fungating ulcer on the soft palate. In addition, there is painless lymphadenopathy in the head and neck. What is the most likely diagnosis?
Squamous cell carcinoma
Oral malignant melanoma
Adenocarcinoma
Lymphoma
Sarcoma
Squamous cell carcinoma
A 71-year-old man presents to surgery with his wife. She describes his hearing as having been ‘terrible’ for many years but unfortunately it has recently got worse. Otoscopy shows bilateral mild otitis externa with wax blocking the view of the tympanic membranes. Treatment for otitis externa is given, following which you arrange an audiogram:
What does the audiogram show?
Left conductive hearing loss
Bilateral conductive hearing loss
Bilateral sensory hearing loss
Left mixed hearing loss
Left sensorineural hearing loss
]Left mixed hearing loss
A 62-year-old man presents 2 days after receiving a punch to his head on the right side. Since the injury, he feels his hearing has been muffled on the right side. On examination there is no bruising. Both his ears are obscured by a thin translucent layer of wax. On the right, Rinne’s test demonstrates the tuning fork is easier to hear when pressed on the mastoid bone. On Weber’s test the sound is heard best on the right hand side. What is the most likely diagnosis?
Otosclerosis
Base of skull fracture
Otitis media
Earwax
Perforated eardrum
Tympanic membrane perforation is a relatively common complication of trauma to the skull. It is important to distinguish this from sensorineural hearing loss resulting from a base of skull fracture.
Rinne’s test her shows that there is a conductive hearing loss in the affected ear. Weber’s test confirms that there is no sensorineural hearing loss on the right.
A 25-year-old woman presents with recurrent attacks of ‘dizziness’. These attacks typically last around 30-60 minutes and occur every few days or so. During an attack ‘the room seems to be spinning’ and the patient often feels sick. These episodes are often accompanied by a ‘roaring’ sensation in the left ear. Otoscopy is normal but Weber’s test localises to the right ear. What is the most likely diagnosis?
Acoustic neuroma
Vestibular neuritis
Benign paroxysmal positional vertigo
Multiple sclerosis
Meniere’s disease
Meniere’s disease
A 19-year-old woman is on the Specialist Surgical Ward recovering from a tonsillectomy. She returned from theatre 4 hours ago. Nurses report that there appears to be a small amount of bleeding from the wound.
After your initial assessment, what is your next management step?
Pack the oral cavity with gauze
Repeat observations in 4 hours
Arrange immediate return to theatre
Continue with discharge planning
Prescribe appropriate antibiotics
Arrange immediate return to theatre
Primary haemorrhage within hours after tonsillectomy requires immediate return to theatre
