ENT Flashcards
A 60 year old gentlemen who has a history of recurrent rhinosinusitis presents to the GP complaining of a headache and swelling on his forehead. He reports that for the past week he has not been feeling himself and has felt hot and sweaty.
On examination there is a swelling in the region of the frontal bone which is tender to palpation. He has a temperature of 38 degrees. There are no signs of focal neurology, meningism or decreased visual acuity.
What is the single most likely cause of this patient’s swelling?
-Perioribital cellulitis
-orbital cellulitis
-mucocele
-pott’s puffy tumour
-meningitis
A 50 year old man presents to his general practitioner complaining of recurrent episodes of “the world spinning.” Upon further questioning, he reveals that these episodes always occur when he turns his head to the right. Cranial nerve examination shows no abnormalities; in particular, there is no evidence of hearing loss or tinnitus. Given the likely diagnosis, what is the most appropriate treatment?
52 year old female presents to her GP complaining of gradual onset difficulty swallowing. She reports that her swallowing difficulties are worse with solid food than fluids and also reports associated chest pain on swallowing. She denies weight loss or night sweats. She is a non smoker and non drinker. Examination is unremarkable.
In what cases of otitis media do you prescribe antibiotics?
Antibiotics should be prescribed immediately if:
-Symptoms lasting more than 4 days or not improving
-Systemically unwell but not requiring admission
-Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
-Younger than 2 years with bilateral otitis media
-Otitis media with perforation and/or discharge in the canal
If an antibiotic is given, a 5-7 day course of amoxicillin is first-line. In patients with penicillin allergy, erythromycin or clarithromycin should be given.
An 18-year-old man presents to the emergency department after sustaining a nasal injury following a car accident. On examination, the nose is swollen with some bruising and suspected nasal deviation to the left. Anterior rhinoscopy shows a bilateral cherry-red swelling arising from the nasal septum.
Which is the most appropriate treatment for this patient?
-silver nitrate cautery
-anterior nasal packing
-posterior nasal packing
-emergency incision and drainage
-incision and drainage in 3-5 days
emergency incision and drainage
Needs to be done urgently to prevent septal perforation and necrosis (can get AVN of the septal hyaline cartilage)
A 59 year old man comes to see his GP complaining of noise sensitivity in his left ear. The tensor tympani muscle is one of two small muscles located in the middle ear. Its purpose is to dampen loud sounds that might otherwise cause damage to the ear.
What is the innervation of the tensor tympani muscle?
Mandibular branch of the trigeminal nerve
A 58-year-old lorry driver presents with a lump in his neck. He first noticed it after recovering from a ‘cold’ 2 months ago. The patient reports no change in the size of the lump. He is otherwise well in himself and denies dysphagia, odynophagia, weight loss or loss of appetite. He is a heavy smoker and drinks alcohol daily. On examination, you feel a hard, fixed lump in the anterior triangle of the neck.
Which of the following is the best next investigation?
Ultrasound is the imaging modality of choice for a neck lump. Ultrasound ultimately allows for an ultrasound guided biopsy (either fine needle aspiration or core biopsy) which is crucial for investigating a neck lump. The biopsy may not be required if the ultrasound does not show a suspicious lesion
A 55 year old woman presents to clinic with a history of a lump overlying her right angle of mandible that is slowly growing in size. She has no other symptoms and on examination the overlying skin is normal. What is the most likely diagnosis?
A 16 year old boy sees his GP due to pain and intense itching in his left ear which has been increasing over the last week and affecting his school work. It has also prevented him from swimming which he is upset about as he has a race coming up next month. On examination with an otoscope you can see erythema and partial occlusion of the auditory canal secondary to oedema. What is the best management for this patient?
A 21-year-old man is referred for genetic testing for suspected hereditary haemorrhagic telangiectasia (HHT). He is one of five children and two brothers who have the condition. Their father also suffers from the condition but their mother does not.
What is the pattern of inheritance of hereditary haemorrhagic telangiectasia?
A 20-year-old female presents to her GP, worried that her hearing is poor. She has a history of recurrent ear infections as a child and had a grommet inserted at age 7.
On otoscopy, the tympanic membrane of her right ear appears white.
What is the most likely diagnosis?
Tympanosclerosis
A 79 year old gentleman presents with progressive dysphagia over the last 6 months. He reports that he feels as if food is sticking in his throat. He has no real issues with fluids but he often has coughing fits after eating and can sometimes regurgitate food hours after eating it. His wife reports significant halitosis. He reports 2kg of weight loss over the last 6 months.
On examination, the swallowing movement is preserved. Gurgling sounds can be heard in the neck.
What is the likely diagnosis?
Pharyngeal pouch
gurgling sounds in the neck is quite a good giveaway
