ENT

Question 1

Common organisms in acute otitis media

Answer 1

Streptococcus pneumoniae

Haemophilus influenzae

Question 2

Management of chronic suppurative otitis media

Answer 2

Discharge can be controlled by cleaning the ear and
introducing eardrops.

Risks of ototoxicity: drops should be used for a maximum of 2 weeks

There is a risk of dmamage to the ossicles - long process of incus most commonly

Myringoplasty performed to prevent discharge, improve healing or allow patient to swim

Question 3

Causes of sensorineural deafness

Answer 3

Presbycusis

Aminoglycosides

Cisplatinum

Mumps

Rubella

Unilateral: Cerebellopontine angle tumour

Question 4

Ménière’s disease

Answer 4

Fluctuating deafness, tinnitus and vertigo

Endolymphatic hydrops

Tx: betahistine

Procedures of last resort are surgical destruction of the labyrinth, or section of the vestibular nerve

Question 5

Herpes zoster infection of the geniculate ganglion

Answer 5

Ramsay-Hunt

Herpes Zoster

Causes facial nerve palsy
Associated vertigo and deafness

Question 6

Paranasal sinus tumours

Answer 6

Most common is squamous cell carcinoma

Adenocarcinomas seen in occupations with large wood-dust expsoure

Most common sites: Maxillary and ethmoid sinus

Question 7

Adenoids

Answer 7

B-cell predominant lymphoid tissue

Enlargement causes:

• Glue ear
• Nasal obstruction
• Sleep apnoea

Question 8

Carcinoma of the nasopharynx

Answer 8

Associated with EBV

Presentation:

• Middle ear effusion
• Nasal obstruction
• Epistaxis
• Cervical lymphadenopathy

Skull base invasion –> opthalmoplegia

Mx: Radiotherapy

Question 9

Benign but locally invasive angiofibroma of the nasopharynx

Answer 9

Male adolescents

Presentation: nasal obstruction and epistaxis

Treated by (open or transnasal endoscopic) surgical excision.

Question 10

Rannulas

Answer 10

Retention cysts inferior to the tongue

Blockage of the opening of minor mucous secreting glands

Question 11

Caner of the tongue

Answer 11

Sqaumous cell carcinoma of the tongue is the most common

Lymphatic spread to submittal and deep cervical nodes

Treatment is with local excision if low stage or radiotherapy
If higher stage may need to resect with mandible

Question 12

Indications for tonsillectomy

Answer 12

Episodes of sore throat are disabling

Seven or more clinically documented adequately treated sore throats in the preceding year

Five or more episodes of sore throat in each year for the preceding two years

Three or more episodes of sore throat in each year for the preceding three years

Question 13

Cancer of the tonsils

Answer 13

B cell Lymphoma

Squamous cell
-HPV associated

Question 14

Referred dysphagia

Answer 14

Level of obstruction is always the level below to that it is referred to

Question 15

Paterson-Brown-Kelly syndrome

Answer 15

Iron deficiency anaemia, glossitis, stomatitis and post-cricoid web

Later develops into post-cricoid cancer

Question 16

Lyryngomalacia

Answer 16

Congenital condition which most children grow out of by two

Aryepiglottic folds are high, soft and tend to collapse

Causes inspiratory stridor worsened during period of URTI

In severe of no resolving causes –> CO2 laser to reduce bulkiness of aryepiglottic folds

Question 17

Reinke’s oedema

Answer 17

Build up of fluid deep to vocal cord epithelium

Seen in women smokers that have chronic laryngitis

Mx: Drainage

Question 18

Recurrent laryngeal nerve injuries

Answer 18

More commonly right sided due to intra-thoracic course
e.g. invasive bronchial carcinoma

Unilateral lesion causes weak breathy voice
Mx: Injection of bulk or fat lateral to vocal cord

Bilateral –> stridor

Question 19

Cancer of the larynx

Answer 19

Nearly all are squamous cell carcinomas

Smoking and drinking

Tumours of the glottis / true vocal cords present early due to hoarseness
-As they have little lymphatics they are usually T1 and respond well to laser resection

Larger lesions may grow into supraglottic space and present with airway obstruction

Mx early lesion: radiotherapy or laser resection

Later higher stage: resection of the larynx and creation ion end tracheostome
–> patients produce speech by air trapping or using a valve + surgically created oesophago-tracheal puncture

Question 20

Site of a tracheostomy

Answer 20

Anterior tracheal wall at second - third TRACHEAL rings

Question 21

Removal of a thyroglossal cyst

Answer 21

Removal of the persistent thyroglossal duct, cyst, part of the hyoid in continuity with section of tongue reduces recurrence

Question 22

Branchial cysts

Answer 22

Lateral neck swellings

Remnant of second and third branchial arches

Contain opaque fluid and cholesterol crystals

Fistulas to skin and surrounding organs can develop

Question 23

Cystic hygroma

Answer 23

Rare benign lymphangioma

Present in early life

Complete excision difficult

Question 24

Dermoid cysts

Answer 24

Often midline neck swelling or submandibular

Contain dermal appendages so have hair etc.
-> unlike sebaceous cysts

Question 25

Laryngoceole

Answer 25

Herniation of laryngeal mucosa into neck

Lateral

Become distended with valsalva

Question 26

Superficial parotidectomy

Answer 26

Bening. neoplasma

Excision of benign lesion with a cuff of normal tissue

Reduces risk of damage to facial nerve

Question 27

Most common salivary gland tumour

Answer 27

Pleomorphic adenomas