ENT

Question 1

What is tinnitus?

Answer 1

perception of sound in the absence of any external auditory stimulus

Question 2

What sounds are heard in tinnitus?

Answer 2

Sounds may be described as ringing, humming, buzzing, hissing, clicking, or pulsing

Question 3

How is tinnitus diagnosed?

Answer 3

Clinically

Audiometry

Question 4

What can cause tinnitus?

Answer 4

Hearing loss, noise damage, ageing, medication use, sounds produced by adjacent structures

Question 5

What is the management of tinnitus?

Answer 5

treat underlying cause
education - relaxation techniques, CBT
If hearing loss - hearing aids
If no hearing loss - tinnitus masking device

Question 6

Define acute pharyngitis

Answer 6

rapid onset of sore throat and pharyngeal inflammation

Question 7

What suggests bacterial pharyngitis rather than viral?

Answer 7

Absence of cough, nasal congestion, and nasal discharge

Question 8

What is the treatment of acute pharyngitis?

Answer 8

Supportive

ABs

Question 9

What does sore throat comprise?

Answer 9

pharyngitis, tonsillitis, laryngitis

Question 10

What is the management for a general sore throat?

Answer 10

paracetamol or ibuprofen for pain relief

antibiotics are not routinely indicated

Question 11

What are NICE’s indications for ABs for a sore throat?

Answer 11

marked systemic upset secondary to the acute sore throat
unilateral peritonsillitis
a history of rheumatic fever
an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present

Question 12

What are Centor criteria?

Answer 12

core 1 point for each (maximum score of 4)
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

Question 13

What ABs are used for sore throat if indicated?

Answer 13

phenoxymethylpenicillin or clarithromycin (if the patient is penicillin-allergic) should be given.

Either a 7 or 10 day course should be given

Question 14

What is dysphonia?

Answer 14

Hoarseness

Question 15

What are some differentials for hoarseness?

Answer 15

Acute/Chronic/Reflux laryngitis
Vocal fold nodule/cyst/polyps
Fibrous mass
Voice overuse
Viral illness

Question 16

Why might you do a CXR in hoarsness?

Answer 16

Exclude apical lung lesions

Question 17

What might cause nasal discharge?

Answer 17

Sinusitis
Rhino-sinusitis
Allergic rhinitis

Question 18

What can cause ear discharge?

Answer 18

Ear infection e.g. otitis media, otitis externa

Question 19

Define tonsilitis

Answer 19

Inflammation of the tonsils; specifically it is an infection of the parenchyma of the palatine tonsils

Question 20

What are presenting features of tonsilitis?

Answer 20

Pain on swallowing
Fever
Tonsillar exudate
Sudden onset sore throat
N+V
Cough/Runny nose
Tonsillar enlargement/erythema
Enlarged anterior cervical lymph nodes

Question 21

What investigations are done for tonsilitis?

Answer 21

Throat culture
Rapid streptococcal antigen test
But not necessary

Question 22

What is the management for tonsilitis?

Answer 22

Analgesia
ABs
Tonsillectomy > 5 episodes a year

Question 23

Define acute rhino sinusitis

Answer 23

Inflammation of the tonsils; specifically it is an infection of the parenchyma of the palatine tonsils

Question 24

What can cause rhinosinusitis?

Answer 24

Viral/bacterial infection

Question 25

What can you distinguish between viral and bacterial sinusitis?

Answer 25

<10 days = viral

>10 days = bacterials

Question 26

What are some presenting features of rhino-sinusitis?

Answer 26

Purulent nasal discharge
Facial pain/pressure
Cough
Myalgia
Sore throat
Hyposmia

Question 27

What are some RFs for rhino-sinusitis?

Answer 27

Viral URTI

Allergic rhinitis

Question 28

What is the management for rhino-sinusitis?

Answer 28

Supportive
Generally self-limiting
Rest, hydration, warm facial packs