ENT

Question 1

Otitis externa
- what bacteria
- mild vs infected treatment

Why urgent referral for malignant OE

Answer 1

P.aeruginsomas

Acetic acid
Abx + steroid drops

Risk of osteomyelitis

Question 2

Drugs that cause HL

Answer 2

Aminoglycosides (gentamicin, neomycin) - irreversible
Loop diuretics (furosemide, bumetamide) - largely reversible
Chemotherapeutic agents (cisplatin, carboplatin) - irreversible
Aspirin, NSAIDs- reversible

Question 3

Causes of congenital hearing loss

• special baby care unit x 10 more likely earring loss than peers

Answer 3

Toxoplasmosis
Rubella
CMV
Herpes
Syphilis
Neonatal hypoxia
Rhesus incompatibility

Question 4

Hearing test
- at birth
- At 6-9months

Answer 4

Oto-acoustic emissions
Distraction testing
Audiometery >5years

Question 5

OM effusion
- period of observation
- concerns for urgent referral

Answer 5

3months
- <61, hearing concerns or downs

Question 6

Risks for Cholesteatoma

Answer 6

ET dysfunction
FHx
Bisphosphates

Question 7

Description of Rennes and Webber’s

Answer 7

Rinnes = AC is > BC
Webbers - lateralised to good ear in SL, bad ear in conductive

Question 8

Criteria for immediate ENT referral in hearing loss

Answer 8

<3days, 3fre 30db
Within 30days, any neurological symptoms or post-trauma
Start def after discussion with ENT

Question 9

If HL is >30days ago - what is referral

Answer 9

2WW urgent
Also if ?NPC or cholesteroma

Question 10

What tinnitus symptoms warrant urgent ENT referral

Answer 10

Unilateral, pulstaile, neuro symptoms

Question 11

Tx for reducing frequency of menires
- avoid in

Answer 11

Betahistime (asthma, PU)
Also bendrufthaize, low salt, vest rehab

Question 12

Differentiation between Thyroglossal cyst and brachial

Answer 12

T = moves up on tongue protrusion, midline, 15-30 years (common!)

B = at junction of sternmastoid, Fluctant lump, 16-30

Question 13

Chronic sinusitis
- main stay of treatment
- if blocked nose
- water eyes
- asthma
- doesn’t want steroid

Answer 13

Nasal saline irrigiatation
Antihistamines
Intranasal steroid (fluticasone, momestasone)

Decongestants (Xylometazole’ ‘Pseudoperfi’)
- only 7 days
Ipratium bromide drops
LTRA
Sodium cromoglicate

Hay fever topical eye drops ‘Chromil’ like Nedocromil

Question 14

When would a sore throat require urgent FBC

Answer 14

DMARD
Carbimazole

Question 15

Criteria for ?PEN V in sore throat for 10days (>4)
- if allergic

Answer 15

Fever within 24hours
Pus on tonsils
Attends within 3 days
Inflamed tonsils
No cough/corzyal

Erythromycin or Clari

Question 16

What might you seen in back ground retinopathy

Answer 16

Microaneurysms (lots of cappillaries)
Dot and blot haemorrhages (bleeding cappilaries)

Question 17

what indicaties the progression from background o pre-porliferaive retinopathy

Answer 17

Reinal ischaemia
- coton wool spots (dead nerve cells)
- venous changes

–> routine opthal referral

Question 18

changes indicating proliferative retinopathy

what our pathology does this lead the risk to

treatment

Answer 18

neovascularisation
- urgent opthal referral

advanced this can cause
- viterous haemorrhage
- retinal detachements
- rubeosisis (gluacoma)

pan-retinal photocoagulation

Question 19

what occurs in diabetic maculatoapthy

Answer 19

now present of hard exudates + macular oedema
- routine referral

Question 20

what are the 3 grades of hypertensive retinopathy

Answer 20

1 = ateriolar narrowing
2 - AV nippinh (narrowing + compression)
3 = like diabetic retinopathy- retinal haemorrhages, hard exudaes and coton wool spots

4 (malignat) - as 3 but also with optic disc swelling
- will have symptms of reduced acuity, headaches

Question 21

what will optic cuppig indicate

swollen optic disc

Answer 21

gluacoma

raised ICP

Question 22

recommended treatent for a small FB in eye

Answer 22

Local anaesthetic eye drops act for about 15 minutes, so an eye pad to prevent injury is not required.
Chomplemhicol eye drops for 5 days
She should not replace the contact lenses until 24 hours after the antibiotic course has been completed.

discussion with an ophthalmologist in view of the history of contact lens use.
re-examine after 24 hours using fluorescein stain, to ensure the corneal abrasion is healing.

Question 23

Treatment for primary (chronic) open angle gluacoma

Answer 23

First-line treatment is with prostaglandin analogues (Latanoprost) which increase aqueous humour drainage.
If prostaglandin analogues are not tolerated then topical beta-blockers can be used. Third-line treatment includes alpha adrenoreceptor agonists or carbonic anhydrase inhibitors.

Question 24

treatment for acute open angle glaucome

Answer 24

pilocarpine hydrochloride - Miotic eye drops

then reduce production of aqueous humour - , Topical prostaglandin analogues - lanatonprost, caution in COPD
BB
carbonic anhydrase - Oral acetazolamide or Topical brinzolamide
Brimonidine - caution in CVD

Question 25

what might pain and reduce acuity 2 weeks after cataract surgey indicate

Answer 25

endophthalmitis
- urgent referral

crystaloid macular oedema migh just show reduced acuity
- topical NSAIDs

Question 26

The most common postoperative complication of cataract

Answer 26

Posterior capsular opacification — this is a consequence of proliferation of remnants of lens epithelial cells.
This proliferative opaque membrane causes decreased visual acuity, blurred vision, or glare. It occurs gradually months or years after surgery. It can be corrected by laser treatment.

Question 27

Posterior vitreous detachment vs retinal detachement

Answer 27

Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision

Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss