ENT

Question 1

When to give abx for acute OM

Answer 1

• symptoms >4 days or not improving
• systemically unwell
• immunocompromised/high risk of infection due to heart/kidney/liver/ neuromuscular disease
• <2 years and bilateral OM
• perforation/discharge in canal

Question 2

antibiotic to give in acute OM

Answer 2

5 days amoxicillin

erythromycin/clarithromycin if allergic

Question 3

when to consider antibiotic prophylaxis in acute OM

Answer 3

if 3+ infections in 6 months/4 in a year

Question 4

what type of antibiotic to NOT use if tympanic membrane perforated

Answer 4

aminoglycosides (gentamicin)

Question 5

cause of most mild to moderate hearing loss in children

Answer 5

conductive - secondary to otitis media

Question 6

congenital infection which can cause sensorineural deafness

Answer 6

rubella

Question 7

drugs which can cause sensorineural deafness in children

Answer 7

ahminoglycosides (gentamicin)

furosemide

Question 8

maximum hearing loss in conductive hearing loss (might be more in sensorineural)

Answer 8

max 60 dB

Question 9

audiometry results in presbycusis

Answer 9

bilateral high frequency hearing loss

Question 10

inheritance pattern of otosclerosis

Answer 10

autosomal dominant - replacement of normal bone by vascular spongy bone

onset 20-40 years

Question 11

features of otosclerosis

Answer 11

• conductive deafness
• tinnitus
• positive family history

Question 12

management of otosclerosis

Answer 12

• hearing aids
• ?sodium fluoride/bisphosphonates
• surgery

Question 13

features of Meniere’s disease

Answer 13

recurrent vertigo, tinnitus and sensorineural hearing loss

sensation of aural fullness/pressure

may have nystagmus/positive Romberg test

Question 14

treatment of Meniere’s disease

Answer 14

prochlorperazine
antihistamines
CBT/relaxation therapy

Question 15

ototoxic drugs

Answer 15

aminoglycosides
furosemide
aspirin
some cytotoxics

Question 16

causes of vestibular neuritis

Answer 16

• usually - reactivation of latent HSV1
• autoimmune
• microvascular ischaemia
• following URTI

Question 17

causes of labyrinthitis

Answer 17

mostly viral (following URTI in 50%)

Question 18

which has hearing loss out of labyrinthitis and vestibular neuritis

Answer 18

labyrinthitis (vestibular Neuritis = No hearing loss)

Question 19

drugs given for vertigo, N+V

Answer 19

prochlorperazine/ antihistamines

Question 20

what increases the risk of cholesteatoma

Answer 20

cleft palate (100x)

non-cancerous growth of squamous epithelium

Question 21

symptoms of cholesteatoma if local invasion

Answer 21

• vertigo
• facial nerve palsy
• cerebellopontine angle syndorme

Question 22

sign of cholesteatoma on otoscopy

Answer 22

‘attic crust’ seen in uppermost part of ear drum

Question 23

what counts for 90% of cerebellopontine angle tumours

Answer 23

acoustic neuroma / vestibular schwannoma

Question 24

genetic condition associated with acoustic neuromas

Answer 24

neurofibromatosis type 2

Question 25

investigation for acoustic neuroma

Answer 25

MRI cerebellopontine angle

Question 26

presentation of acoustic neuroma

Answer 26

• vertigo, unilateral sensorineural hearing loss, unilateral tinnitus (CNVIII)
• absent corneal reflex (CNV)
• facial palsy (CNVII)

Question 27

cause of anterior epistaxis

Answer 27

insult in Kiesselbach’s plexus

Question 28

presentation of hereditary haemorrhagic telangiectasia

Answer 28

• autosomal dominant
• recurrent spontaneous nosebleeds
• AVM

Question 29

tumour which can cause epistaxis

Answer 29

juvenile angiofibroma (benign tumour in adolescent males)

Question 30

when are intranasal steroids recommended for acute sinusitis

Answer 30

if >10 days

Question 31

when to refer sinusitis to ENT

Answer 31

3+ infections a year

Question 32

how long is chronic sinusitis

Answer 32

> 12 weeks - check for polyps

Question 33

what to check if nasal polyps in children

Answer 33

check for CF

Question 34

usual pathogen causing tonsillitis

Answer 34

group A beta-haemolytic strep (strep pyogenes)

Question 35

young child with tonsillitis complaining of abdo pain?

Answer 35

mesenteric adenines

Question 36

when to give antibiotics in tonsillitis

Answer 36

• 3+ centor criteria
• unilateral peritonsilitis
• marked systemic upset
• increased risk e.g. immunodeficiency, rheumatic fever, >65 and significant medical history
• feverPAIN score 4/5

Question 37

antibiotic to use in tonsillitis

Answer 37

phenoxymethylpenicillin

if penicillin allergic 5 days clarithromycin

erythromycin if pregnant and allergic

Question 38

when to refer tonsillitis to ENT

Answer 38

• > 7 a year for 1 year
• 5 per year for 2 years
• 3 per year for 3 years

Question 39

renal complication of tonsillitis

Answer 39

post-streptococcal glomerulonephritis

Question 40

causes of laryngitis

Answer 40

• viruses
• trauma
• allergy
• GORD

Question 41

when to refer laryngitis for laryngoscopy

Answer 41

if hoarse voice/voice change >3 weeks

Question 42

type of most oral cavity/pharynx cancers

Answer 42

squamous cell (SCC)

Question 43

risk factors for mouth cancer

Answer 43

• smoking
• HPV
• sunlight (lip melanoma)

Question 44

when to urgently refer for oral cancer

Answer 44

• unexplained ulceration in oral cavity >3 weeks

- persistent unexplained lump in neck

Question 45

1st line medication for trigeminal neuralgia

Answer 45

carbamazepine