ENT 1

Question 1

tonsillitis causes viral and bacterial
symptoms
ix
treatment

Answer 1

viral: rhinovirus, adenovirus, influenza, EBV
group a strep, pneumonia, HI

malaise. sore throat. odynophagia. fever, cough, hallitosis

throat swab not recommended. FBC and monospot

supportive. penicillin 10d (clarithro 5d)
IV penicillin IV dexa Iv fluids

Question 2

tonsillectomy and cx
cx of acute tonsillitis
censor criteria

Answer 2

over 7 in 1y over 5 in 2 over 3 in 3
pain esp d5-7, bleeding, infection

local: resp obstruction, absces
general: septiczaemia, rheumatic fever, post strep GN

fever, no cough, cervical LD, tonsils exudate, under 15 add 1, over 44 minus 1
3/4 ABs or if history of OM then ABs

Question 3

chronic causes

symptoms

Answer 3

strep progenies, HI, SA, pneumonia, betal lactamase producing

chronic sore throat, bad breath, peritonsilar erythema, persistent tender cervical LD

Question 4

organic causes of speech and language changes

Answer 4

congenital (laryngeal web)
acquired - trauma
right laryngeal nerve paralysis 
endocrine
;laryngeal disease like cancer

Question 5

quincy symptoms

managemetn

Answer 5

preceecing tonsillitis. unilateral throat paina and odynophagia. trismus. displacement of uvula. concavity of palate lost. hot potato voice medilization of a tonsil. change in voice

aspiratiom and IV benzylpencillin PA clinda PO can’t swallow IV clinda
not resolving at 48 hours add metro

tonsillectomy if history to 2 episodes

Question 6

diphtheria toxins
symp
manageemnt

Answer 6

exotoxin, cardiotoxin, neurotixin
severe sore throat with green/grey psueommebrane across pharynx
anti toxin. erythro/pencillin for 14 days
contact tracing. vaccine available

Question 7

glandular fever cause 
symptoms 
complications
ix
rx

Answer 7

EBV
fever, cervical LD, sore throat, malaise, lethergy, fever, jaundice, splenomegaly, mild rash, atypical lymphocytes

mild thrombocytopenia, splenic rupture, risk of lymphoma in immunosuppressed

EBV IGM, heterophiles AB, FBC, LFTs,
atypical lymphocytes CRP <100, mono spot

bed rest steroids if cx

Question 8

obstructive hyperplasia in adenoids

in tonsils

Answer 8

mouth breathing, hypo nasal voice, snoring, AOM/OME

snoring, muffled voice, dysphagia

Question 9

candida cause
symp
rx

Answer 9

candida albicans, endogenous
white patches on red raw mucosa of throat/mought
nystatin suspension topically

Question 10

laryngeal polyps cause
nodules
polyps

Answer 10

active change in laryngeal mucos a- vocal abuse smoking hypothyroid

young women bilateral middle 1/3 to posterior 1/3 on cords

unilateral and pedenculated

Question 11

contact ulcer is what

cause

Answer 11

benign rposnse to injury
chronic throat
vocal abuse
GORD

Question 12

laryngeal papillomatosis cause 
in who 
symp
ix
rx

Answer 12

HPV 6 and 11
<5 and 20-40s
change in voice quality, hoarseness, SOB, chronic cough, stridor
laryngoscopy and biopsy
surgery

Question 13

laryngomalasia symp

rx

Answer 13

chronic inspiratory stridor. feeding problems

will improve by 2y. surgery if severe

Question 14

laryngeal cancer RF
symp
ix
rx

Answer 14

old, male, smoker
persisten dysphagia, dysphonia, stridor, otalgia, neck nodes, haemoptysis, hoarseness, fatigue, weight down
CXR for lung cancer, flex laryngoscopy, FNA, CT/MRI
radical radiotherapy, laryngectomy: electrolynx, oesophageal voicing, tracheooeseophageal voice prosthesis

Question 15

oropharyngeal cancer symp
pre cancerous
ix
rx

Answer 15

persistent sore throat, lump in mouth/throat, otalgia
leukoplakia, erythroplakia, mixed
biopsy, CXR, CT abd
surgery

Question 16

nasopharyngeal cancer symp
rf
mets
ix
rx

Answer 16

most likely to cause lump in neck, nasal obstruction, deafness. presents at a late stage

chinese, EBV, alcohol

mets-bone, liver, lungs
endoscopy/biopsy, PCR for EBV, MRI for staging

radio

Question 17

sleep apnoea RF
ix
rx
DVLA

Answer 17

enlarged tonsils/adenoids, acromegaly, hypothyroid, obesity, oropharyngeal deformity, drugs: BZDs, opiates, alcohol

epworth scale, overnight polysomnography, 5 episodes 5 espisdes of apnoea/hypopnoea per hour of sleep

underlying cause. CPAP. mandibular enhancement. surgery. in children: remove tonsils/adenoids

tell if using CPAP
tell if dx and sleeping affecting driving

Question 18

otitis externa cause

rx

Answer 18

infections. allergies. irritants. inflam conditions. SA. proteus. pseudomonas. fungal

topical aural toilet
acetic acid 7days
gentison. locrtrom
swab
pseudomonas - cipro
fungal - clotrimazole
ear canal oedema - topical steroid

Question 19

vestibular nystagmus

Answer 19

damage to vestibulocular reflex

involuntary eye movements

Question 20

AOM cause
symptoms
rx

Answer 20

viral with secondary bacterial infections, HI strep pneumonia, strep pyogenes

sudden pain drum perforates pain resolves. red bulging drum can be perforated

80% resolve in 4 days without ABs
bilateral in under 2s or AOM with otto rhea -ABs
amox (clarithro) 5 days
recurrent 3 or over 6m
5 or over in 12m

Question 21

chronic cause

management

Answer 21

cholesteatoma
non-cholesteatoma

perforation

graft it
low dose AB coruse
grommets

Question 22

mastoiditis
follows what
symp
rx

Answer 22

follows OM
tender/erythema overlying mastoid. displacement of ear forward. red/bulging TM
ABs, mastoidecomy

Question 23

OME what is it 
commones cause of what 
symp
ix
rx
cx of grommets

Answer 23

presence of fluid behind an intact drum in the absence of infection

commonest cause of HL in children

poor school performance, behavioural problems, balance problems, speech delay

TM dull retracted and fluid level. CHL

nothing for 3 months
refer for over 3 months, bilateral, CHL >25, speech/lang problems

surgical intervention <3 grommets >3 grommets +/- adenectomy
hearing aids

infection/DC, early extroversion, retention, persistent perf, swimming/bathing

Question 24

otosclerosis

Answer 24

stapediotomy

Question 25

cholesteatoma is what 
symp
primary acquired
secondary acquired 
ix
rx

Answer 25

3d collection of epidermal and connective tissue in middle ear

recurrent ear infection, foul smell, dc, CHL, vertigo, headache, VII palsy

CT - extent of lesion

surgery and follow up as does reoccur

Question 26

congenital cholesteatoma

Answer 26

childhood. incidental finding on asymptotic child

pearly white mass behind intact TM

Question 27

acoustic neuroma is what 
symp
95% what 
others
ix
rx

Answer 27

tumours of CNIIIths arise from schwann

progressive ipsilateral tinnitus, SNHL, impaired facial sensation, balance problems

sporadic and unilateral
bilateral and young - NF2

MRI

conservative. surgery - gamma knife

Question 28

facial nerve palsy bells palsy symptoms
ramsay hunt symptoms

management

Answer 28

viral. red in 72h

pain and vesicles acyclovir

eye care. decompression surgery