ENT

Question 1

How does Ramsay hunt syndrome present?

Answer 1

• auricular pain
• facial nerve palsy
• vesicular rash around ear
• vertigo and tinnitus

Question 2

What is the management of Ramsay hunt syndrome?

Answer 2

Oral aciclovir and corticosteroids (+ eye protection)

Question 3

How does hypocalcaemia present?

Answer 3

SPASMODIC:
Seizures/spasms
Perioral parasthesia
Anxiety/irritability
Spasms - trousseau’s sign
Muscle tone inc
Orientation impairment
Dermatitis herpetiformis
Impetigo herpetiformis
Chvostek’s sign

Question 4

Complications of thyroid surgery

Answer 4

• anatomical - recurrent laryngeal nerve damage
• bleeding - can lead to respiratory compromise owing to laryngeal oedema
• damage to parathyroid glands resulting in hypocalcaemia

Question 5

What are the features of vestibular neuronitis?

Answer 5

recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus

Question 6

What is the management of vestibular neuronitis?

Answer 6

buccal or intramuscular prochlorperazine for severe cases

a short oral course of prochlorperazine for less severe cases

Question 7

How does BPPV present?

Answer 7

Vertigo triggered by change in head position (eg rolling over in bed or gazing upwards)
May be associated with nausea
Each episode typically lasts 10-20 seconds

Question 8

What exercises are used to manage BPPV?

Answer 8

Brandt-Daroff Exercises

Question 9

How is secondary post-tonsillectomy haemorrhage managed?

Answer 9

(5-10days most commonly)
Associated with wound infection
Rx usually with admission and abx

Question 10

What is otosclerosis?

Answer 10

AD, replacement of bone by vascular spongy bone
Onset 20-40y
Features:
- conductive deafness
- tinnitus
- tympanic membrane - 10% may have a flamingo tinge (hyperaemia)
- positive family hx

Question 11

What is the management for nasal septal haematoma?

Answer 11

Immediate ENT referral

Question 12

What is the main side effect of using topical decongestants for prolonged periods?

Answer 12

Tachyphylaxis/malignant tolerance

Question 13

What are the features of cholesteatoma?

Answer 13

Foul-smelling, non-resolving discharge from ear
Hearing loss
Others inc vertigo, facial nerve palsy, cerebellopontine angle syndrome

Question 14

What is seen on otoscopy in cholesteatoma?

Answer 14

Attic crust

Question 15

What is presbycusis?

Answer 15

Age-related hearing loss
Sensorineural
Atrophy of sensory hair cells and neurons in cochlea
Bilateral high-frequency hearing loss
AC>BC

Question 16

Viral labyrinthitis vs vestibular neuronitis

Answer 16

VN -> no hearing loss, recurrent vertigo attacks
VL -> sudden onset, nausea and vomiting, hearing loss

Question 17

When should antibiotics be given in AOM?

Answer 17

• symptoms >4 days
• systemically unwell but not requiring admission
• immunocompromise/high risk of comps
• <2y with bilateral AOM
• AOM with perforation

Question 18

What is the first aid advise for patients having a nosebleed?

Answer 18

Pinch nostrils and lean forward for 20 mins

Question 19

medication for vestibular neuronitis?

Answer 19

prochlorperazine

Question 20

mgt for primary post tonsillectomy bleed?

Answer 20

return to theatre

Question 21

biggest risk factor for malignant otitis externa?

Answer 21

diabetes mellitus

Question 22

mgt for quincy?

Answer 22

IV abx and surgical drainage

Question 23

use of HiNTs exam?

Answer 23

HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke

Question 24

typical BPPV history?

Answer 24

vertigo triggered by change in head position (e.g. rolling over in bed or gazing upwards)
may be associated with nausea
each episode typically lasts 10-20 seconds

Question 25

diagnostic maneuvre for BPPV?

Answer 25

dix hallpike

Question 26

management maneuvre for BPPV?

Answer 26

epley