ENT

Question 1

Acute epiglottitis:
- cause
- Sx
- diagnosis
- Mx

Answer 1

Cause: haemophilus type B

Features: stridor, drooling, ‘tripod’ position

Diagnosis:
- clinical
- XR: ‘thumb sign’ and ‘steeple sign’

Mx:
- emergency airway support
- oxygen
- IV ABX
- DO NOT LOOK IN THROAT

Question 2

Acute otitis media
- cause
- features
- otoscopy findings
- management
- complications

Answer 2

Cause: strep pneumoniae, haemophilus influenzae, moraxella catarrhalis

Features: pain, fever, hearing loss, recent viral URTI, ear discharge if perf

Otoscopy:
- loss of light reflex on bulging tympanic membrane
- perforation

Mx:
Most will resolve within 3 days

ABX immediately if:
- >4 days
- systemically unwell
- <2yo with bilateral otitis media
- perforation

Complication:
- mastoiditis
- meningitis
- brain abscess
- facial nerve palsy

Question 3

Otitis externa
- causes
- features
- Mx
- malignant OE

Answer 3

Causes
- infection: staph.aureus psuedomonas
- recent swimming
- allergic dermaitis

Features:
- ear pain, itching
- otoscopy: red, swollen canal

Initial MX:
- topical antibiotic or a combined topical antibiotic with a steroid
Second line: - neomycin
- oral flucloxacillin if infection spreading
- empirical use of antifungal

Fail to respond: refer to ENT

Question 4

Nasopharyngeal carcinoma
- associations
- presenting features
- imaging
- treatment

Answer 4

Association: EBV, southern China

Presentation:
systemic - cervical lymphadenopathy
local - otalgia, unilateral serous otitis media, nasal obstruction +/- epistaxis, cranial nerve palsy e.g. III-VI

Imaging - combined CT and MRI

Mx - radiotherapy

Question 5

Menieres disease
- Sx
- Mx

Answer 5

Features:
- episodes of vertigo, tinnitus & hearing loss
- aural fullness
- nystagmus and positive romberg

Mx:
- ENT assessement
- DVLA informed
- acute: buccal/IM prochlorperazine
- prevention: betahistine and vestibular rehab

Question 6

Benign paroxysmal positional vertigo (BPPV)
- features
- diagnosis
- management

Answer 6

Features:
- vertigo triggered by head position, lasting 10-20 seconds associated with nausea

Diagnosis:
+ve Dix-Hallpike maeovure showing rotatory nystagmus

Mx:
- Symptomatic relief - epley-manoevure
- teaching patient exercises they can do at home e.g. Brandt-Daroff exercises
- medication: betahistine

Question 7

Acute sinusitis - management

Answer 7

Analgesia
Intranasal corticosteroids if Sx for >10 days
Oral ABX if severe - phenoxymethylpenicillin

Question 8

Rinne and Weber test

Answer 8

Question 9

Vestibular neuronitis
- Sx
- Mx

Answer 9

Sx:
- recent vertigo lasting hours-days
- nausea & vomiting
- NO HEARING LOSS
- recent viral infection

Mx:
- buccal/IM prochlorperazine
- antihistamine (cinnarizine, cyclizine, or promethazine)
- vestibular rehab