ENT

Question 1

What is malignant otitis externa? Who gets it?

Answer 1

Osteomyelitis of external auditory canal and skull base
Elderly patients with diabetes
Severe ear pain, prominent discharge, external auditory canal erythema

Question 2

What is otosclerosis?

Answer 2

Bony overgrowth of the stapes footplate, resulting in conductive hearing loss

Question 3

What does CPAP do to nose?

Answer 3

Cold, dry, pressurized air:
1. Recurrent epistaxis
2. Dryness
3. Obstruction

Nasal mucosa appears dry and erythematous with significant crusting

Question 4

Oxymetazoline

Answer 4

Topical vasoconstrictor - can be used for acute epistaxis if nostril pinching doesn’t work

Not useful for prevention
Should not be used >3 days due to risk of rebound congestion

Question 5

What is perilymphatic fistula?

Answer 5

Leakage of endolymph from semicircular canals and cochlea, a result of head injury or barotrauma

1. Progressive sensorineual hearing loss due to hair cell damage
2. Episodic vertigo with nystagmus with inner ear pressure changes due to sudden increase in leakage
   Tullio phenomenon: clap by patient’s ear to send pressure difference via ossicle solid conduction and watch for nystagmus

Question 6

What causes Meniere disease symptoms?

Answer 6

Increased volume and pressure of endolymph in vestibular system

Question 7

Sign of nasal septum perforation? Causes?

Answer 7

Whistling noise heard during respiration

Causes:
Trauma or surgery due to hematoma or abscess
Syphilis, tuberculosis
Intranasal cocaine
Sarcoidosis, granulomatosis with polyangiitis

Question 8

Ludwig angina

Answer 8

Rapidly progressive cellulitis of submandibular and sublingual spaces –> acute airway obstruction

Most from contiguous spread of polymicrobial dental infections in mandibular molars

Woody, brawny neck without lymphadenopathy

Question 9

Danger of retropharyngeal space infection

Answer 9

Extend through alar fascia into danger space, posterior mediatinum –> acute necrotizing mediastinitis

Question 10

Purpose of head thrust test

Answer 10

Test vestibuloocular reflex, affected by peripheral vestibulopathies
Not used for BPPV

Question 11

Rhinitis medicamentosa - difference with allergic rhinitis

Answer 11

Beefy red edematous, rather than pale edematous

Stop nasal decongestant, use nasal glucocorticoid if needed to help or systemic if severe

Question 12

Aspirin-exacerbated respiratory disease has what trifecta?

Answer 12

1. Asthma (severe, persists into adulthood)
2. Aspirin/NSAID-induced bronchospasm or nasal congestion
3. Chronic rhinosinusitis and nasal polyposis

Mediated more by leukotrienes, not IgE

Question 13

Pyogenic granuloma

Answer 13

Benign vascular tumor that can occur on nasal septum and cause congestion
Vascular, friable

Question 14

Nasopharyngeal carcinoma is linked to what virus?

Answer 14

EBV reactivation

Question 15

Lateral tongue hairy white plaques in immunocompromised

Answer 15

Oral hairy leukoplakia - EBV - no malignancy potential, unlike other leukoplakia

Question 16

Ranula vs mucocele

Answer 16

Ranula: pseudocyst of major salivary glands, blue swelling on floor of mouth lateral to midline

Mucocele: pseudocyst of minor salivary glands, smooth swellings in buccal mucosa, not blue

Question 17

Posterior epistaxis artery

Answer 17

Posterolateral branches of sphenopalatine artery

Question 18

Sleep-disorded breathing - management

Answer 18

Both adenoidectomy and tonsillectomy (vs just tonsils with recurrent infections)