ENT

Question 1

Lower pitched sound lost more (female easier to hear)
Conductive Hearing Loss
Tinnitus
FH

Answer 1

Otosclerosis

Question 2

(Squamous epithelial cells) - white debris/crust
Foul discharge, unilateral conductive HL
Vertigo, pain, FN Palsy

Answer 2

Cholesteatoma

Question 3

Webers louder in affected ear. BC>AC(abnormal Rinnes)

Answer 3

conductive

Question 4

Webers louder in normal ear (Rinne positive

Answer 4

sensorineural HL

Question 5

Mx sudden onset sensorineural hL

Answer 5

referred to ENT - treated with high dose oral corticosteroids. MRI usually done to exclude vest schwannoma.

Question 6

SN HL
High pitched sounds lost first

Answer 6

Presbycusis

Question 7

meds that cause HL (mostly SN) - ototoxic

Answer 7

loop diuretics, aminoglycosides (gentamicin), chemo drugs (cisplatin). Tend to be SN

Question 8

Mx otitis media

Answer 8

More in children after URTI
Delay Abc 48-72hrs

(only give Abx to perf tympanic membrane if it occurred after otitis media)

Question 9

Otitis externa - what Bactria is it usually and mx

Answer 9

More in adults, freq swimmer
Itch/pain
Usually pseudomons (can be staph aureus)
Clean with drops, topical ear drops (ciprofloxacin) +/- dexamethasone

Question 10

Answer 10

cholesteatoma

Question 11

Peripheral vs central vertigo

Answer 11

Peripheral Vertigo - Sudden onset, short, often HL/tinnitus, intact coordination, more severe nausea

Central Vertigo - Gradual onset, persistent, usually no HL/T, impaired coordination, mild nausea

Question 12

Dizziness Triggered by movement. No HL/Tinnitus

dx, mx

Answer 12

BPPV

Dix Hallpike to Dx
Epley is Mx

Question 13

HL, Tinnitus, vertigo, fullness in ear
Not ass with movement
Spontaneous nystagmus

Answer 13

Menieres D
Betahistine

Question 14

Acute vestibular neuritis vs
Labyrinthitis and mx of each

Answer 14

AVN - no HL
vest rehab and antiemetics

Labyrinthitis - HL
Prochlorperazine in acute phase only

Both in HINTs exam - eyes saccade.

Question 15

Elderly patient, dizziness on extension of neck

Answer 15

vertebrobasilar ischaemia

Question 16

Unilateral sensorineural HL
Unilateral Tinnitus
Dizzy/imbalane
Sensation fullness in ear
FN palsy

Answer 16

Acoustic neuroma

Bilat NF T2

Question 17

Acute and preventative tx for vestibular migraine

Answer 17

Visual aura + headaches. Triggers
Acute = triptans
Prevent = propranolol/ topiramate/amitriptyline

Question 18

lump
Upper Ant triangle, pulsatile, painless, bruit. Move side to side but not up and down

Answer 18

carotid body tumour

Question 19

lump
Mobile, non tender, soft, fluctuant
Move up and down with movement of tongue
Midline
Mor ein <20

Answer 19

Thyroglossal cyst

Question 20

lump
congenital, mostly LHS at birth

Answer 20

cystic hygroma

Question 21

lump
Ant to SCM (lateral), oval/round, soft, mobile
Benign, unilateral
Acellular fluid with cholesterol crystals

Answer 21

branchial cyst

Question 22

lump
Older men, usually not seen but if they are then large midline lump
Gurgles on palpitation
DYsphagia, regurg, chronic cough, halitosis

Answer 22

pharyngeal pouch

Question 23

UMN vs two types lMN facial nerve palsy

Answer 23

umm = forehead spared -stroke

LMN - forehead affected
-Bells palsy = unila LMN FN Palsy. If <72hrs then prednisolone and lubricating eye drops
- Ramsay Hunt = Unilat LMN FNP. Painful vesicular rash around ear. Oral Prednisolone and aciclovir

Question 24

Epistaxis mx

Answer 24

Pinch at least 20mins - if successful then antiseptic to decrease crusting
packing/cautery (if source visible)
Haem unstable - admit
All failed = sphenopalatine ligation in theatre

Question 25

Post op bleeding after tonsillectomy - mx

6-8hrs vs 5-10 days after

Answer 25

All post op haemorrhages assessed by ENT
Primary in first 6-8hrs after - imm return to theatre
Secondary haemorrhage 5-10 days after - ass with wound ifnection. Admission + Abx. Severe might need surgery

Question 26

progressive cellulitis that invades floor mouth and soft tissues of neck. Most from infections in mouth and spread into submandibular space. Neck swelling, dysphagia, fever. Life threatening. Airway Mx and Iv Abx

Answer 26

Ludwigs angina