ENT

Question 1

How to tell whether someone has otitis media or externa?

Answer 1

externa- itchy, irritated upon palpation of tragus

Question 2

How to tell if ear infection is viral or bacterial?

Answer 2

viral- one ear
bacterial- two ears + fever + loss of appetite…

Question 3

Differentials for nose lesion?

Answer 3

tumour
polyp
trauma
infection

Question 4

Name one scoring system for a sore throat and indication for treatment with antibiotics

Answer 4

CENTOR
FeverPAIN criteria
Indicate likelihood of strep infection

Question 5

How to distinguish between vestibular neuronitis and labrynthitis?

Answer 5

hearing is unaffected in vestibular neuronitis

Question 6

What is the first line treatment for otitis media?

Answer 6

amoxicillin 5-7 days

Question 7

What is the treatment for otitis media with penicillin allergy?

Answer 7

clari or erythromcyin

Question 8

List two complications of acute otitis media

Answer 8

meningitis
mastoiditis
intracranial abscess
sinus thrombosis
facial nerve paralysis
hearing loss
recurrence of infection
tympanic membrane perforation

Question 9

List two bacteria associated with acute otitis media

Answer 9

H.influenzae
Strep pneumoniae
Strep pyogenes
Moraxella catarrhalis

Question 10

List two viruses associated with otitis media

Answer 10

RSV
rhinovirus
adenovirus
influenza virus
parainfluenza virus

Question 11

List two risk factors for otitis media

Answer 11

young age
male
smoking
immunodeficiency
no pneumococcal vaccine

Question 12

What are grommets??

Answer 12

treatment for glue ear-middle part of ear canal fills up with fluid
small tube inserted into ear to drain fluid and keep eardrum open. They fall out naturally within 6 to 12 months

Question 13

What is the treatment for glue ear?

Answer 13

watchful waiting for 3 months and review. If functional impairment then consider surgery or hearing aids. Steroids and decongestants don’t work

Question 14

List two risk factors for tinnitus

Answer 14

age
noise exposure
drugs

Question 15

List one drug associated with tinnitus

Answer 15

NSAIDs
aminoglycosides
diuretics

Question 16

List two red flags associated with tinnitus

Answer 16

1. significant suicide risk
2. sudden onset with significant neurological symptoms/signs/suspected stroke
3. Tinnitus with uncontrolled vestibular symptoms e.g. vertigo

Question 17

Two differentials for tinnitus with vertigo?

Answer 17

Merniere’s, acoustic neuroma, migraine

Question 18

How does infectious mono differ in presentation with bacterial tonsillitis?

Answer 18

mono- ant and post palpable lymph nodes
tonsillits- ant chain only

Question 19

List the typical triad of infectious mono

Answer 19

fever
pharyngitis
cervical lymphadenopathy

Question 20

What are the investigations for mono?

Answer 20

FBC and monospot

Question 21

List two differentials for sudden unexplained sensorineural hearing loss

Answer 21

trauma
stroke
viral
vestibular schwannoma
ototoxicity
autoimmune

Question 22

What is Merniere’s disease?

Answer 22

inner ear disease- vertigo, tinnitus, hearing loss

Question 23

What is the pathophysiology of merniere’s disease

Answer 23

unclear.
buildup of fluid in labyrinth of inner ear

Question 24

List two types of dizziness

Answer 24

vertigo
lightheadedness
presyncope
dysequilibrium

Question 25

Three differentials for dizziness?

Answer 25

vertigo benign paroxysmal positional vertigo complete heart block bicuspid aortic valve

Question 26

Name a score to identify groups which would benefit from antibiotic treatment for tonsilitis

Answer 26

FeverPAIN

Question 27

What is quinsy?

Answer 27

In quinsy, the abscess (a collection of pus) forms between one of your tonsils and the wall of your throat. This can happen when a bacterial infection spreads from an infected tonsil to the surrounding area. Quinsy can occur at any age, but most commonly affects teenagers and young adults.

Question 28

What is the first line choice antibiotic for tonisillitis?

Answer 28

phenoxymethylpenicillin

Question 29

If patient has penicillin allergy, which antibiotic for tonsillitis?

Answer 29

clari or erythro

Question 30

Which antibiotic for tonsillitis is safe to used in pregnancy?

Answer 30

erythromycin

Question 31

List two criteria in FeverPAIN score

Answer 31

Fever in the previous 24h. Purulence of tonsils. Attended rapidly (patient seen in the first 3d of symptoms starting). Inflamed tonsils. No cough/coryza.

Question 32

Patient scores 4 on FeverPAIN. What is your plan?

Answer 32

antibiotics! Score of 0 or 1: treat with simple measures. Score of 2 or 3: offer a back-up prescription to be used if no improvement within 3–5d. Score of 4 or more: offer antibiotics immediately if severe symptoms or a back-up prescription if less severe (diagnostic studies suggest about 60% of these patients will have a strep sore throat).

Question 33

The Centor score stratifies the risk of which infectious agent for tonsilitis?

Answer 33

group A beta-haemolytic strep

Question 34

What is Lemierre's syndrome?

Answer 34

very rare...infection caused by fusobacterium necrophorum- more likely in recurrent infections

Question 35

25 year old with sore throat and fever. More unwell than expected. What could be the causative agent?

Answer 35

Fusobacterium necrophorum- Lemierre's syndrome