ENT

Question 1

bacterial sinusitis Fx

Answer 1

Double sickening - unilateral frontal facial pain + nasal discharge, gets better, then gets much worse

Question 2

Common infectious sinusitis causes

Answer 2

Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses

Question 3

Acute sinusitis Mx

Answer 3

Majority self resolve as viral

Nasal corticosteroids - if symptoms >10days

PO Abx if severe - phenoxymethylpenicillin

Question 4

Cholesteatoma Fx

Answer 4

Non resolving, foul smelling discharge
unilateral hearing loss

Other local complications:
vertigo
facial nerve palsy

Otoscopy: “attic crust” - upper part of ear drum

Question 5

Otitis externa Mx

Answer 5

1st - Top Abx (acetic acid 2%) +/- Top steroid

Question 6

Differentiating vertigo symptoms

Answer 6

BPPV - Sx lasting seconds to one minute

Menierres - Sx lasting 30 mints to hours, with associated hearing loss (sensorineural)/ tinnitus/ fullness of ear- recurrent episodes

Labyrinthitis/ Vestibular neuronitis - Sx sudden and constant, last for days, recent viral infection
- Labyrinthitis has associated hearing loss and tinnitus/ neuronitis does not

Vestibular migraine - Episodic, phonophobia, Hx migraines

Question 7

Acoustic neuroma Fx

Answer 7

Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign

Question 8

Performated tympanic membrane Mx

Answer 8

Self resolve after 6-8 weeks - if not resolved then for ENT
advised not to swim during this episode
Abx if OM

Question 9

Vestibular neuronitis Mx

Answer 9

Acute - buccal/ IM prochlorperazine

Chronic (>6 weeks despite acute Mx) - vestibular rehabilitation

Question 10

Otitis medias with effusion Mx

Answer 10

Amoxicillin + FU 2 weeks

Question 11

Gingivitis Mx

Answer 11

Refer to dentist
PO Metronidazole 3/7
Chlorhexidine mouthwash
Analgesia

Question 12

Epistaxis Mx

Answer 12

If no red flags

1st - Naseptin (chlorhexidine/ neomycin) cream
2nd - ENT either “hot clinic” or OP referral

Question 13

Chronic Rhinosinusitis Mx

Answer 13

1st - intranasal corticosteroids/ nasal irrigation with saline

Red flags requiring ENT
- unilateral symptoms
- persistent symptoms >3 months of treatment
- epistaxis

Question 14

Ear Wax Mx

Answer 14

olive oil
sodium bicarb
almond oil

If grommets in situ - refer ENT

Question 15

Otosclerosis Fx

Answer 15

Bilateral conductive hearing loss in young with positive family history

Question 16

Nasal polyp Mx

Answer 16

bilateral
- routine ENT
- Top corticosteroids

unilateral
- urgent ENT

Question 17

Otitis media with effusion (glue ear) Mx

Answer 17

Self resolve within 6-12 weeks

If need abx - Amoxicillin + FU 2 weeks

If has Downs or cleft palate - refer ENT

Question 18

Mouth ulcer Mx

Answer 18

low potency steroid (eg hydrocortisone lozenge), antimicrobial mouthwash, topical analgesia

if >3 weeks = refer

Question 19

BPPV diagnostic tool?

Answer 19

Dix hall-pike
Rotary nystagmus = positive result = BPPV positive
Dix = Diagnostic

Question 20

Samter’s triad is…

Answer 20

Aspirin sensitivity
nasal polyps
asthma

Question 21

Menierres disease Mx

Answer 21

ENT to confirm diagnosis
DVLA - stop driving until control of symptoms

Acute - buccal/ IM Prochlorperazine

Prevention: Betahistine, vestibular rehab

Question 22

Otitis media Mx (without effusion)

Answer 22

1st - self resolve within 3 days
2nd - Amox (Clari/ Eryth if pen allergy)

For Abx if:
<2yo + bilateral OM
Otorrhoea
immunocompromised

Question 23

Acute otitis media Fx

Answer 23

Cause - often viral, bacteria - strep pneumo, h influenza, moraxella

otalgia - eg tugging at ear
fever
hearing loss
recent URTI eg coryza
ear discharge otorrhea - if perforated TM

Question 24

Acute otitis media otoscopy findings

Answer 24

Bulging ear drum
Loss of light reflex
perforation - if purulent

Question 25

Otitis media Mx

Answer 25

1st - supportive only first 3 days

Abx if:
>3 days no improvement
systemically unwell
immunocompromised
<2yo + bilateral AOM
Perforation or discharge

Abx - Amoxicillin 5-7 days. Clari/ eryth if pen allergy

Question 26

Gingival hyperplasia causes

Answer 26

Phenytoin
Ciclosporin
CCB (Nifedipine)
Acute Myeloid Leukaemia

Question 27

EBV is risk factor for what cancer

Answer 27

Lymphoma
Nasopharyngeal Ca