ENT

Question 1

A child presenting with fever, irritability, malaise and pain in the ear with no effect on hearing is likely what?

Answer 1

Acute otitis media

Question 2

When are antibiotics prescribed for acute otitis media?

Answer 2

• child <3 months
• child <2 years with bilateral OM
• sx persisting >4 days
• perforated membrane

Question 3

How does acute mastoiditis present? What is it a complication of?

Answer 3

Boggy mass over over mastoid process (post auricular swelling), tender to palpation, often systemically unwell.
Otitis media.

Question 4

Cholesteatoma is a complication of what? What is it?

Answer 4

Chronic otitis media.
Accumulation of skin and squamous epithelium within middle ear and mastoid air cells.

Question 5

What differentiates mild, moderate, severe, and malignant Otitis externa?

Answer 5

Mild: itchy ear associated with some discharge, no pain, tympanic membrane visible
Moderate: pain, discharge, can view tympanic membrane
Severe: pain, discharge, external auditory meatus occluded so cannot view membrane
Malignant: spreads to skull base causing osteomyelitis and can cause cranial nerve palsies

Question 6

A schwann cell tumour in the subarachnoid area is what? What are the sx? How do we investigate?

Answer 6

Vestibular schwannoma.
Sensorineural hearing loss, tinnitus (CN 8 impacted), loss of corneal reflex (CN 5 compression), headaches (mass effects).
MRI head.

Question 7

What is presbycusis?

Answer 7

Age related sensorineural hearing loss

Question 8

Build up of lymphatic fluid in inner ear causing dilation of endolymphatic spaces is what? What are the sx?

Answer 8

Meniere’s Disease.
Tinnitus, vertigo, low-mid frequency sensorineural hearing loss, ‘fullness of ear’, occurs in episodes which can be 20 minutes - 12 hours.

Question 9

How is Meniere’s disease managed?

Answer 9

Initially with reduced salt intake diet and diuretics to reduce fluid in the endolymphatic spaces.
Betahistine can be used prophylactically to prevent episodes.
For acute attacks can use prochloperazine.

Question 10

What is Battle Sigb?

Answer 10

Bruising of the mastoid process due to a subcutaneous haematoma, indicative of a skull fracture.

Question 11

A history of facial swelling without any red flag features is most commonly what?

Answer 11

Benign pleomorphic adenoma - benign parotid tumour.

Question 12

What is Warthins tumour?

Answer 12

benign parotid tumour associated with RFs (smoking, male, etc). Often occurs bilaterally.

Question 13

What is an adenoid cystic carcinoma? Why does it have a higher risk of complications than benign tumours of the parotid gland?

Answer 13

Malignant tumour of the parotid gland.
Malignant nature makes it much more likely to invade surrounding structures such as facial nerve.

Question 14

What are the RED FLAGS for nasal pathology (6)?

Answer 14

• Unilateral obstruction
• bloody discharge
• facial pain/swelling
• trismus (jaw muscle spasm)
• epiphora (watery/runny eye)
• proptosis (eyeball protrusion)

Question 15

Bilateral cherry red swelling on rhinoscopy is what? How is it managed?

Answer 15

Septal haematoma (bleeding under the perichondrium lining of septal cartilage).
Mx: emergency incision and drainage to prevent infection and cosmetic deformities.

Question 16

What is empty nose syndrome?

Answer 16

Secondary atrophic rhinitis. Pts present with dyspnoea, paradoxical nasal obstruction, dryness, and crusting after a turbinectomy.

Question 17

How do we manage allergic rhinosinusitis?

Answer 17

Oral antihistamines, topical steroids.

Question 18

What is Santa’s Tryad?

Answer 18

Asthma, nasal polyps, aspirin sensitivity.
Indicates severe inflammation of the airway.

Question 19

What is achalasia? How do we investigate this?

Answer 19

Failure of lower oesophageal sphincter to relax.
Dysphagia, regurgitation, weight loss.
Manometry (shows incomplete closure of lower oesophageal sphincter on swallowing as well as a lack of peristalsis).

Question 20

How do we manage Achalasia?

Answer 20

Medically: botulinum injections, CCBs, nitrates.
Surgically: oesophageal dilation, Heller’s myotomy.

Question 21

Achalasia is a RF for what malignancy?

Answer 21

SCC of oesophagus.

Question 22

What causes Ramsay-Hunt Syndrome? What are the Sx? How is it managed?

Answer 22

Varicella zoster reactivation - ear pain, hearing loss, tinnitus, vertigo, dry eyes/mouth, change in taste sensation, vesicular rash in affected ear.
Manage with prednisolone and oral aciclovir.

Question 23

What organisms most commonly cause otitis externa?

Answer 23

staph aureus and pseudomonas aeruginosa

Question 24

How do you manage sudden sensorineural hearing loss?

Answer 24

Admit, high dose steroids, consider antivirals.

Question 25

What is often the primary site for a P16 +ve SCC? (Biopsy taken from isolated mass in the neck)
What does P16 +ve mean?

Answer 25

Oropharynx (tonsils/tongue).
P16 is a surrogate marker for HPV.

Question 26

What is a branchial cleft cyst? Where are they located?

Answer 26

Embryological remnant of the branchial arch.
Usually below ear and anterior to sternocleidomastoid.

Question 27

What is seen on cytology of a branchial cleft cyst?

Answer 27

Cholesterol crystals due to breakdown of cells within.

Question 28

What age do branchial cleft cysts present? What can cause them to grow?

Answer 28

> 10 years old.
URTIs can cause them to grow.