ENT

Question 1

Classic presentation of cholesteotoma?
Finding on PE?
Mgmt?

Answer 1

Discharge from ear canal and hearing impairment
“Polyp” is a cholesteotoma until proven otherwise
Referral to ENT
Note: it is an abnormal collection of squamous epithelial cells within the middle ear and mastoid process, it is erosive to local structures.

Question 2

Once a thyroglossal duct cyst has been identified clinically what is the next step in mgmt?

Answer 2

Ultrasound neck to look for normal thyroid tissue

Need to make sure a patient has a normal thyroid gland prior to surgery and that the cyst does not represent the sole functioning thyroid tissue.

Question 3

Indications for referral of otitis external to ENT

Answer 3

Treatment failure
Cellulitis extending past the margin of the external ear canal
Extreme pain
Extensive swelling and discharge likely to require suction or insertion of ear wick
Concern for possible malignant otitis externa

Question 4

Indications for referral of otitis media with effusion to ENT?

Answer 4

1. Symptoms persist past 6-12 weeks
2. Severe hearing difficulty
3. Immediately for T21 or cleft palate pt

Question 5

Teenage male presenting with hx of nasal obstruction and recurrent ear infections and epistaxis, exam shows a red-blue mass in the nostril. What pathology

Answer 5

Juvenile angiofibroma

Note: benign but can be locally destructive. Tx is with surgical excision

Question 6

Causes of vocal cord paralysis?

Answer 6

Injury of the recurrent laryngeal nerve such as

1. Stretching of neck during difficult delivery
2. Aberrant vessel
3. CNS lesion (Arnold Chiari malformation, posterior fossa tumor or hydrocephalus)
4. Iatrogenic such as during a TEF repair

Question 7

Children with acute sinusitis typically present with facial pain and headaches T/F

Answer 7

F - that is the more common presentation in adults/adolescents

In younger children: cough, worse when supine, nasal discharge with sore throat and halitosis

Question 8

When is the peak age for acute pharyngitis?

Answer 8

4 - 7 yrs old

Note: rare in children < 1 yr

Question 9

Tx of Ludwig angina?

Answer 9

Ampicillin/sulbactam
or
Pen G + metronidazole
or 
Clindamycin 

Note: need broad coverage of beta lactase producing aerobes and anaerobes and staph aureus

Question 10

Stiff neck, dysphagia and dyspnoea, excessive drooling and symmetrical submandibular swelling with crepitus. What diagnosis?

Answer 10

Ludwigs angina

Note: this is a rapidly evolving bilateral polymicrobial cellulitis of the submandibular and sublingual spaces. Can be complication of dental infection

Question 11

What is the most common presentation of OSA in children?

Answer 11

Behavioural issues, mood swings, ADHD like symptoms

Note: this is more common than excessive daytime sleepiness

Question 12

Risk factors for vocal cord dysfunction?

Answer 12

Females
Obesity
Mental health disorders (esp OCD or anxiety)
Medical personnel

Question 13

Management of small isolated ear drum perforation

Answer 13

Prophylactic antibiotic ear drops and referral to ENT OPD to see in 1-2 days

Question 14

Management of septal haematoma is drainage, packing of the nasal cavity and close follow up with ENT T/F

Answer 14

F - these are correct but also need to start of broad spec antibiotic with staph coverage due to risk of abscess formation