ENT

Question 1

Rinne’s and Weber’s results

Answer 1

Rinne’s used to confirm conductive deafness
Weber’s used to localise conductive deafness
If Rinne’s is positive (AC>BC) in both ears problem cannot be conductive deafness, so Weber’s will lateralise to unaffected side = SN deafness
If Rinne’s is positive in one ear, Weber’s will lateralise to affected side to confirm conductive deafness

Question 2

mx for bacterial tonsillitis

Answer 2

phenoxymethylpenicillin for 7-10 days

clarithromycin if penicillin allergy

Question 3

cystic hygroma vs branchial cyst

Answer 3

cystic hygroma = congenital lymphatic lesion found on left side of neck, most are evident at birth, ~90% present <2 years
branchial cyst = oval mobile cystic mass that develops between SCM muscle and pharynx, present in early adulthood

Question 4

what is quinsy

Answer 4

peritonsillar abscess

Question 5

when should ABX be given in acute otitis media?

Answer 5

otitis media with perforation and/or discharge
symptoms lasting >4 days or not improving
systemically unwell but not requiring admission
immunocompromised
<2 years with bilateral otitis media

Question 6

which ABX is used for acute otitis media if indicated

Answer 6

Amoxicillin

Erythromycin/Clarithromycin if penicillin allergy

Question 7

features of otitis externa

Answer 7

pain on palpation of tragus
itching
discharge
hearing loss

Question 8

mx for acute necrotising ulcerative gingivitis

Answer 8

1. oral metronidazole
2. chlorhexidine or hydrogen peroxide mouth wash
3. simple analgesia

Question 9

viral labyrinthitis vs vestibular neuronitis

Answer 9

viral labyrinthitis: recent viral infection, sudden onset vertigo, N&V, hearing may be affected
vestibular neuronitis: recent viral illness, vertigo can last hours/days, NO hearing loss

Question 10

mx of Ramsay Hunt syndrome

Answer 10

oral aciclovir AND corticosteroids

Question 11

Samter’s triad

Answer 11

asthma, aspirin sensitivity and nasal polyposis

Question 12

when should intranasal corticosteroids be considered for acute sinusitis

Answer 12

symptoms for >10 days

Question 13

causes of bacterial otitis media

Answer 13

H. influenzae

S. pneumoniae

Question 14

mx of malignant otitis externa

Answer 14

Ciprofloxacin

Question 15

mx of haemorrhage post-tonsillectomy

Answer 15

all should be assessed by ENT
primary haemorrhage (if haemorrhage occurs in first 6-8 hours) - immediate return to theatre
secondary haemorrhage (5-10 days post-op) - admit for IV ABX as usually due to wound infection

Question 16

most common anatomical origin for epistaxis

Answer 16

anterior nasal septum as Little’s area is located here where there are 4 arteries

Question 17

mx of Meniere’s disease

Answer 17

acute attacks: prochlorperazine (either buccal or IM)

prevention: betahistine

Question 18

mx of bilateral nasal polyps

Answer 18

topical corticosteroids

Question 19

what is meant by double-sickening in sinusitis

Answer 19

initial viral sinusitis worsens due to a secondary bacterial infection

Question 20

epistaxis mx

Answer 20

1. First aid measures, e.g. sit forwards and pinch cartilage. Topical antiseptic, e.g. Naseptin, can be used once bleeding stops following first aid measures
2. Cautery if bleeding point visible, if not then packing
3. If above fails, sphenopalatine ligation

Question 21

drugs that cause ototoxicity (FAV Q+A)

Answer 21

Furosemide
Aminoglycoside
Vancomycin
Quinine
Aspirin

Question 22

hearing loss pattern in presbycusis

Answer 22

bilateral high-frequency hearing loss

Question 23

operation that is performed to repair an unhealing tympanic membrane

Answer 23

myringoplasty

Question 24

causes of gingival hyperplasia

PANIC

Answer 24

Phenytoin
AML
Nifedipine and amlodipine
Inherited and idiopathic
Ciclosporin

Question 25

mx of vestibular neuronitis

Answer 25

vestibular rehabilitation exercises

short oral course of prochlorperazine (or an antihistamine)