ENT

Question 1

Presbyacusis

Answer 1

Old age bilateral hearing loss

Bilateral high frequency sensorineural hearing loss

Difficulty following conversations

Question 2

Otosclerosis

Answer 2

Autosomal dom

Age 20-40

conductive deafness
tinnitus
10% have flamingo tinge on TM
Family history

Question 3

Glue Ear

Answer 3

OM with effusion

peak age 2 years

hearing loss usually presentation

Question 4

Menieres

Answer 4

Middle aged adults

vertigo tinnitus and hearing loss

nystagmus and + Rhomberg

Aural fullness

Minutes to hours duration

Question 5

Ototoxic drugs

Answer 5

Gentamicin (aminoglycosides)
Furosemide
Aspirin in OD
quinine

Question 6

Acoustic Neuroma

Answer 6

Hearing loss, tinnitus vertigo

absent corneal reflex

facial palsy

neurofibromatosis type 2 - bilateral

Question 7

Post nasal drip

Answer 7

chronic cough, bad breath

Question 8

Fever Pain

Answer 8

Fever - 1
Pus on tonsils - 1
Attends rapidly (</= 3 days) - 1
Inflamed tonsils - 1
No cough - 1

2/3 = delayed ABX

4/5 = ABX

Question 8

Centor Criteria

Answer 8

tonsillar exudate - 1
tender cervical LN - 1
Fever - 1
No cough - 1

3 or more = ABX

Question 9

Strep throat

Answer 9

phenoxymethylpenicillin 10 days

Clarithromycin if pen allergy

Question 10

dysphagia, regurgitation, aspiration and chronic cough more commonly in older men

Answer 10

pharyngeal pouch

posteriomedial herniation

midline lump if large

GURGLES on palpation

Question 11

cystic hygroma

Answer 11

90% age <2
classically left side
most evident at birth
non tender
transilluminates

Question 12

Branchial Cyst

Answer 12

oval mobile cystic mass
between sternocleidomastoid and pharynx
usually early adulthood

Question 13

Cervical rib

Answer 13

young
women>men
hard lump at bottom of neck
can have thoracic outlet syndrome

Question 14

Rinnes Test

Answer 14

tuning fork over mastoid until cant hear then over ear canal

normal = AC>BC

conductive loss –> BC>AC

sensorineural loss –> AC still >BC

Question 15

Webers Test

Answer 15

Tuning fork onto forehead

Conductive loss = louder in affected ear

SN loss = louder in unaffected ear

Question 16

sudden unilateral sensorineural hearing loss

Answer 16

refer urgently to ENT and start high dose steroids 60mg/day for 7 days

usually idiopathic but can be vestibular swannoma

Question 17

perforated TM - check ups

Answer 17

2 week GP
6 weeks - consider ENT if still present

keep ear dry
no need further ABX if dry

Question 18

Chronic sinusitis

Answer 18

management-
avoid allergen
intranasal steroids
nasal washout

red flags-
unilateral
persistent despite 3 months Rx
epistaxis

Question 19

when to refer oral ulcers under 2ww

Answer 19

> 3 weeks

Question 20

Menieres Disease

Answer 20

vertigo
tinnitus
hearing loss (sensorineural)

aural fullness common

vertigo minutes to hours not related to head movement

acute Rx - prochlorperazine

prevention - betahistine/vestibular rehab

Question 21

acute sinusitis

Answer 21

Rx

uncomplicated <10 days - analgesia

uncomplicated >10 days - IN steroids

NEVER PO steroids or IN decongestants

PenV if complicated