ENT

Question 1

what is the common area for epistaxis called

Answer 1

littles area

Question 2

which blood vessels supply the nose

Answer 2

sphenopalatine artery
internal maxillary
external carotid

Question 3

management of epistaxis

Answer 3

inv: clotting, inr, fbc, lft, 
obs
iv access G+S if massive
sit up lean forwards and pinch nose
apply ice pack to bridge of the nose
cautery silver nitrate if visable
anterior/posterior packing
balloon catheters ( probably needed if posterior bleed)
ligation / embolisation of bleeding artery (surgery)

Question 4

2 differentials for tonsillitis

Answer 4

infectious mononucleosis

scarlett fever

Question 5

why do you give penicillin v instead of amoxicillin in tonsilitis

Answer 5

because if its not tonsillitis and its infectious mononucleosis then amoxicillin will cause a maculopapular rash

Question 6

what type of cancer does barretts lead to

Answer 6

oesophageal adenocarcinoma

squamous to columnar epithelium metaplasia

Question 7

describe the pathophys behind vertigo

Answer 7

displacement of otolith in semicircular canals causing endolymph to move abnormally

Question 8

management of bells palsy

Answer 8

prednisolone

if fever etc can give aciclovir

Question 9

what type of nystagmus does bppv cause

Answer 9

rotational

Question 10

3 causative organisms of otitis media

Answer 10

h influenxae
strep pneumonia
moraxella cattarhalis

Question 11

otoscopy of otitis media

Answer 11

bulging red and dull tympanic membrane

Question 12

managment of otitis media

Answer 12

amoxicillin and antipyretics

Question 13

differential for vestibular schwannoma, investigation and management

Answer 13

meningoma (headache, hearing loss)

vertigo: menieres
inv: MRI head (cerebellopontine angle)
management: surgery

Question 14

presentation and management of menieres

Answer 14

tinnitus vertigo and sensorineural hearing loss

mg: inform dvla, buccal prochlorperazine (antiemetic),beta histine

Question 15

management of viral labrynthitis / vestibular neuronitis

Answer 15

short course of cyclizine or promethazine
PLUS
prochlorperazine
all antiemetics

Question 16

what type of nystagmus is seen in labrynthitis and vestibular neuronitis

Answer 16

horizontal

Question 17

what medication can be used to treat bppv

Answer 17

beta histine

Question 18

presentation of cholesteatoma

Answer 18

ear discharge
hearing loss
vertigo
crusty ear drum

Question 19

management of cholesteatoma

Answer 19

urgent ent referral

tympanoplasty

Question 20

symptoms of vestibular schwannoma

Answer 20

vertigo
tinnitus
sensorineural hearing loss
headaches
facial nerve palsy
absent corneal reflex

Question 21

4 causes of facial nerve palsy

Answer 21

bells palsy
vestibular schwannoma
meningoma
parotid adenoma

Question 22

2 week wait referral for ENT (red flags)

Answer 22

multiple unilateral nose bleeds

unilateral nasal polyps

Question 23

signs of posterior nose bleed

Answer 23

usually bilateral and cant see the source

Question 24

symptoms of nasal polyps

Answer 24

snoring
post nasal drip
nasal congestion
mg = polypectomy

Question 25

management of chronic / recurrent sinusitis

Answer 25

intranasal steroid spray
nasal decongestants
nasal irrigation with saline

Question 26

symptoms of nasopharyngeal carcinoma

Answer 26

recurrent unilateral epistaxis
unilateral otitis media
otalgia
lymphadenopathy
nasal obstruction and discharge
cranial nerve palsies
diagnosis: MRI head
management : radiotherapy

Question 27

causes of conductive hearing loss

Answer 27

otosclerosis (young age onset, inherited, progressive)
glue ear
wax build up
tympanic membrane perforation
cholesteatoma
otitis media (rarely)

Question 28

causes of sensorineural hearing loss

Answer 28

presbycusis (age related)
idiopathic
noise damage
vestibular schwannoma
menieres
meningitis
cholesteatoma
ototoxic drugs
congenital rubella or CMV infection

Question 29

differentials for dysphagia

Answer 29

oesophageal cancer - will have red flags and RF

strictures - usually secondary to GORD, not progressive, solids and liquids

oesophagitis - acute, heart burn, pain on swallowing

achalasia - liquids and solids from the start, heartburn, food regurg and aspiration, cough

pharyngeal pouch - halitosis, food regurg, gets stuck
myasthenia gravis - worse throughout day, voice goes quiet etc

mediastinal mass compression - red flags

systemic sclerosis - CREST, calcinosis, raynaeuds, oesophageal dysmotility, sclerodactly, telangiectasia, pulmonary fibrosis so resp symptoms

Question 30

otitis externa presentation and management

Answer 30

itchy painful ear with discharge
otoscopy: inflamed ear canal
mgx: topical fluclox with steroid
if not resolved or worsening oral fluclox
if still not resolved refer to ENT