ENT

Question 1

Describe the origin of epistaxis

Answer 1

Originates from Kiesselbach’s plexus which is also known as little’s area

Question 2

What is the management of epistaxis?

Answer 2

Sit up
Tilt head forward

If doesn’t stop after 15 mins:
Nasal packing
Nasal cautery

Question 3

What is benign paroxysmal positional vertigo?

Answer 3

Most common cause of vertigo characterised by sudden onset dizziness and vertigo triggered by changes in head position.

Question 4

What are the features of BPPH?

Answer 4

Vertigo triggered by change in head position
Nausea
Episode typically lasts 10-20s
Positive Dix-Hallpike manoeuvre (Vertigo and nystagmus)

Question 5

What is the management of BPPV?

Answer 5

Usually resolves spontaneously after few weeks-months

Epley manoeuvre

Betahistine

Question 6

What is the causative organism in epiglottitis?

Answer 6

Haemophilus influenza type B

Question 7

What is the presentation of Epiglottitis?

Answer 7

Sore throat and stridor
Drooling
Tripod position
High fever
Difficulty or painful swallowing
Septic and unwell appearance

Question 8

What are the investigation and diagnosis for epiglottitis?

Answer 8

Lateral xray of neck: thumb sign or thumbprint sign

Diagnosis: direct visualisation only by senior/airway trained staff

Question 9

What is the management of epiglottitis?

Answer 9

Intubate
IV antibiotics (cefrtriaxone)
Steroids (dexamethasone)

Question 10

What is infectious mononucleosis?

Answer 10

Caused by EBV.

Spread by saliva

Question 11

What are the features of infectious mononucleosis?

Answer 11

Fever
Sore throat
Fatigue
Lymphadenopathy
Tonsillar enlargement
Splenomegaly

Rash following antibiotics (amoxicillin or cefalosporins)

Question 12

What are the investigations for infectious mononucleosis?

Answer 12

Monospot test
Paul-Bunnell test

Specific antibody test

Question 13

What is the management of infectious mononucleosis?

Answer 13

Usually self limiting - lasting 2-3 wks

Question 14

What is the complications of infectious mononucleosis?

Answer 14

Burkitt’s lymphoma is associated with EBV

Question 15

What is labyrinthitis?

Answer 15

Inflammatory disorder of the membranous labyrinth affecting both vestibular and cochlear end organs

Question 16

What is the presentation of labyrinthitis?

Answer 16

Vertigo
N+V
Hearing loss
Tinnitus
Preceding or concurrent sy of URTI

Question 17

What are the signs of labyrinthitis?

Answer 17

Spontaneous horizontal nystagmus
Sensorinueral hearing loss
Abnormal head impulse test
Gait disturbance

Question 18

What is the diagnosis and management of labyrinthitis?

Answer 18

Largely based on history and examination

Management:
Usually self-limiting
Prochlorperazine or antihistamines

Question 19

What is meniere’s disease?

Answer 19

Disorder of the inner ear characterised by excessive pressure and progressive dilation of the endolymphatic system.

Question 20

What are the features of meniere’s disease?

Answer 20

Recurrent vertigo, tinnitus and hearing loss
Sensation of aural fullness or pressure
Nystagmus and positive romberg test
Episodes last min-hours
Typically unilateral but can become bilateral

Question 21

What is the diagnosis and management of meniere’s disease?

Answer 21

ENT assessment required to confirm diagnosis

Patient informs DVLA and stop driving until control of symptoms

Acute: buccal or IM prochlorperazine

Prevention: Betahistine and vestibular rehab exercises.

Question 22

What is otosclerosis and give the inheritance?

Answer 22

Replacement of normal bone by vascular spongy bone.

Autosomal dominant and affects young adults

Question 23

What is the features of otosclerosis?

Answer 23

Conductive deafness
Tinnitus
normal TM
Positive family history

Question 24

What is the management of otosclerosis?

Answer 24

Hearing air

Stapedectomy

Question 25

What is the causative organism of otitis media/

Answer 25

Strep Pneumonia is most common cause Other causes: Haemophilus influenzae Moraxella catarrhalis Staph aureus

Question 26

What is the presentation of otitis media?

Answer 26

``` Ear pain Reduced hearing URTI syndroms Balance issues Vertigo Discharge ```

Question 27

What is the examination of otitis media

Answer 27

Otoscopy shows bulging red inflamed looking membrane. If perforated: discharge and hole in TM

Question 28

What is the management of otitis media?

Answer 28

Resolve without antibiotics unless: Immunocomprimised, <2yr or otorrhoea = amoxicillin Simple analgesics Antibiotics and review if perforated TM

Question 29

What are the features of otitis externa?

Answer 29

Ear pain Itch Discharge Otoscopy: red, swollen or eczematous canal

Question 30

What is the management of otitis externa?

Answer 30

1. Topical antibiotic or combined topical antibiotic with a steroid 2. Consider contact dermatitis secondary to neomycin Oral antibiotics Taking a swab Empirical use of antifungal agent

Question 31

What is sinusitis

Answer 31

Can be bacterial or viral. Usually lasts 2-3 weeks and resolves without treatment

Question 32

What is the management of sinusitis?

Answer 32

Symptoms <10days = no abs No improvement after 10 days = 2 weeks high dose steroid nasal spray No improvement after 10 days and likely bacterial cause = consider delayed or immediate prescription abs ``` 1. Penicillin V for 5 days course Alternatives: Clarithromycin Erythromycin Doxycycline ```

Question 33

What is tonsillitis and give the causative agents

Answer 33

Inflammation of the tonsils Most common cause = viral infection Most common bacteria = Group A strep (strep pyogenes) Second more common bacteria = Strep pneumonia

Question 34

What are the features of tonsillitis?

Answer 34

Sore throat Painful swallowing Red, inflamed and enlarged tonsils ± Exudates

Question 35

What is the centor criteria?

Answer 35

Used to estimate probability that tonsillitis is due to bacteria 3 or more = abs Fever >38 Tonsillar exudates Absence of cough Tender cervical lymphadenopathy

Question 36

What is the management of tonsillitis?

Answer 36

Only if centor score >3 or feverpain score >4 give abs Pen V for 10 days Clarithromycin if allergic to penicillin

Question 37

Investigation for achalasia?

Answer 37

Oesophageal manometry study

Question 38

Treatment for achalasia?

Answer 38

Pneumatic dilation

Question 39

What is the surgical treatment for achalasia?

Answer 39

Heller cardiomyotomy