ENT

Question 1

Influenza

Answer 1

Caused by Influenza A and B
Primarily during winter
SSX: generally incubation of 1-2 days —> acute-onset URT/LRT symptoms, myalgias, fevers, weakness

DX: Rapid antigen test
Best established through PCR testing or viral culture

TX:
Antiviral: Zanamivir, oseltamivir (prophylaxis to treat at-risk people)
Most effective when given < 48H of exposure/onset

CX:
Pneumonia (primary complication of pneumonia)
Secondary bacterial pneumonia (Streptococcus pneumoniae)
Others: myosotis, rhabdomyolysis, CNS involvement, myocarditis, pericarditis

Question 2

Most common cause of conductive hearing loss in young people

Answer 2

Otosclerosis
- progressive fixation of the stapes —> bilateral progressive conductive loss.
- Begins in 2nd-3rd decade of life, may advance in pregnancy
- Exam is normal
- Surgery: stapedectomy or stapedotomy [[excellent results]]

Question 3

Common causes of hearing loss (external vs internal)

Answer 3

External canal:
Cerumen impaction, foreign bodies in the ear canal, otitis externa, new growth/mass

Internal canal:
Otitis media, barotrauma, tympanic membrane perforation

Others: presbycusis, otosclerosis, drug-induced (eg, aminoglycosides (gentamicin)), noise-induced….

Question 4

Prebycusis

Answer 4

Age-related hearing loss
High-pitched sounds lost first, so speak loudly in a low-pitched voice

Question 5

Rinne’s Test
Weber’s Test

Answer 5

Rinne’s Test
Conductive hearing loss: BC > AC
Sensorineural hearing loss: AC > BC

Weber’s Tets
Conductive hearing loss: louder in the affected ear
Sensorineural hearing loss: louder in the normal ear

Question 6

Allergic Rhinitis

RF
SX
DX
TX

Answer 6

RF: asthma, atopic dermatitis

SX:
- p/w congestion, rhinorrhea, sneezing, eye irritation, postnasal drip
- generally can identity allergens, may be seasonal
- o/e edematous, pale mucosa, cobblestoning in the pharynx, scleral injection, blue and boggy turbinates

DX:
- based on SX
- skin testing, or
- blood testing - to look for specific IgE Ab via RAST (radioallergosorbent testing)

TX:
- allergen avoidance
- drugs
Antihistamines (diphenhydramine, fexofenadine) - blocks histamine released by mast cells
Intranasal corticosteroids
Sympathomimetics (pseudoephedrine) - alpha adrenergic agonist that vasoconstricts
Intranasal anticholinergic (ipratropium) - decreases mucous membrane secretions
Immunotherapy (“allergy shot”) - slow to take effect, but useful for symptoms that are difficult to control

Question 7

Epistaxis

From where?
SX
TX

Answer 7

90% cases are anterior septum bleeds at Kisselbach plexus

SX:
Posterior bleeds: more brisk, less common, blood is swallowed and not seen
Anterior bleeds: usually less severe, visible, exits nares

TX:
- prolonged and sustained pressure and topical nasal vasoconstrictors (phenylephrine, oxymetazoline)
- if does not stop, cauterise with silver nitrate or insert nasal packing (with abx to prevent toxic shock syndrome, covering for S aureus)
- if severe, clerk, screen, IV access, contact ENT surgeon.

Question 8

Leukoplakia

Answer 8

White patches or plaques in the oral mucosa
Considered precancerous
Cannot be removed by rubbing the mucosal surface

If easily removed, might be Candida.

Can have lesions (chronic irritation OR worst, dysplasia or early invasive SCC)

Common amongst: tobacco chewers