ENT

Question 1

Benign pleomorphic adenoma

Answer 1

most common benign tumour of parotid gland

Question 2

Benign pleomorphic adenoma- features

Answer 2

gradual onset, painless unilateral swelling of the parotid gland
typically movable on examination rather than fixed

Question 3

Benign pleomorphic adenoma- treatment

Answer 3

surgical excision- due to risk of malignant transformation

Question 4

red flag symptoms chronic sinusitis

Answer 4

unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis

Question 5

Drugs causing tinnitus

Answer 5

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

Question 6

suspected laryngeal cancer referral guidelines

Answer 6

Aged >45 and:
persistent unexplained hoarseness or
An unexplained lump in the neck.

Question 7

treatment for chronic symptoms in vestibular neuronitis

Answer 7

Vestibular rehabilitation exercises

Question 8

Otitis externa: Poor response to topical antibiotics

Answer 8

should be referred to ENT- microsuction and insertion of a pope wick

Question 9

Globus, hoarseness and no red flags

Answer 9

laryngopharyngeal reflux

Question 10

laryngopharyngeal reflux Tx

Answer 10

PPI and lifestyle advice

Question 11

Unilateral middle ear effusion in adult

especially in smokers and people of Chinese or South-East Asian origin

Answer 11

?nasopharyngeal cancer
2ww referral

Question 12

‘metastatic SCC in a lymph node’ in posterior triangle of neck

Answer 12

nasopharyngeal cancer

Question 13

Branchial cysts

Answer 13

congenital abnormalities associated with the formation of a neck lump located in the anterior triangle

cholesterol crystals

Question 14

Otalgia in the absence of any ear signs

Answer 14

is a red flag for head and neck malignancy

Question 15

sialadenitis

Answer 15

inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct

Question 16

Rhinitis medicamentosa

Answer 16

is a condition of rebound nasal congestion brought on by extended use of topical decongestants

(tachyphylaxis)

Question 17

perforated tympanic membrane Tx

Answer 17

should resolve spontaneously in 6-8 weeks

myringoplasty may be performed if the tympanic membrane does not heal by itself

Question 18

Elderly patient dizzy on extending neck

Answer 18

Vertebrobasilar ischaemia

Question 19

contraindications to cochlear implant

Answer 19

Lesions of cranial nerve VIII or in the brain stem causing deafness
Chronic infective otitis media, mastoid cavity or tympanic membrane perforation
Cochlear aplasia

Question 20

Ludwig’s angina features

Answer 20

neck swelling
dysphagia
fever

Question 21

what is Ludwig’s angina

Answer 21

progressive cellulitis that invades the floor of the mouth and soft tissues of the neck,
Most cases result from odontogenic infections which spread into the submandibular space.

Question 22

Ludwig’s angina Tx

Answer 22

airway management
intravenous antibiotics

Question 23

Most common cause of Sudden onset SNHL

Answer 23

idiopathic

Question 24

most common bacterial causes of otitis media

Answer 24

Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis.

Question 25

vestibular neuronitis vs viral labyrinthitis

Answer 25

hearing normal in vestibular neuronitis

Question 26

Septal haematoma Tx

Answer 26

urgent referral to ENT for incision and drainage and antibiotics

if left untreated –> irreversible septal necrosis may develop within 3-4 days.

Question 27

thyroid surgery complications

Answer 27

anatomical such as recurrent laryngeal nerve damage.

Bleeding. Owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema.

Damage to the parathyroid glands resulting in hypocalcaemia.

Question 28

acute OM otoscopy

Answer 28

bulging tympanic membrane → loss of light reflex

Question 29

otitis externa with spreading erythema

Answer 29

oral Flucloxacillin is first-line.

Question 30

acoustic neuroma- cranial nerves affected and symptoms

Answer 30

cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy

Question 31

acute necrotising ulcerative gingivitis Tx

Answer 31

Paracetamol + oral metronidazole + chlorhexidine mouthwash

Question 32

Gingival hyperplasia

Answer 32

phenytoin, ciclosporin, calcium channel blockers and AML

Question 33

acute otitis media otoscopy

Answer 33

The tympanic membrane appears erythematous, inflamed
Bulging

Question 34

otitis media with effusion otoscopy

Answer 34

Tympanic membrane discolouration - e.g. yellowing
Air/fluid level, or bubbles behind the TM
Retracted TM (indrawn due to pressure)
Blunting of light reflex

Question 35

chronic suppurative otitis media otoscopy

Answer 35

Perforated tympanic membrane
Dried discharge or debris in ear canal

Question 36

chronic suppurative otitis media

Answer 36

A complication of AOM in which there is chronic inflammation within the middle ear, resulting in recurrent otorrhoea through a perforated tympanic membrane.

Question 37

otitis media with effusion

Answer 37

The accumulation of fluid (effusion) within the middle ear

~ glue ear

Question 38

Unilateral glue ear in an adult

Answer 38

needs evaluation for a posterior nasal space tumour

Question 39

Otitis media with perforation and/or discharge in the canal

Answer 39

oral amoxicillin 5 days
review in 6 weeks

Question 40

Treatment of Ramsay Hunt syndrome consists of

Answer 40

oral aciclovir and corticosteroids

Question 41

HiNTS exam consists of

Answer 41

Head impulse
Nystagmus
Test of Skew
Hearing

Question 42

otitis media with perforation

Answer 42

If there is perforation, there may be discharge in the canal

Question 43

difficulty fixating on the examiner’s nose during the head impulse test, and a corrective saccade is observed

Answer 43

positive –> peripheral cause of vertigo