ENT Flashcards
1
Q
Q: What is acute otitis media, and who is most affected?
A
A: Acute otitis media is common in young children, with around half of children having three or more episodes by age 3.
2
Q
Q: What typically precedes acute otitis media, and what is the main cause of infection?
A
A: Viral upper respiratory tract infections (URTIs) typically precede otitis media, but most infections are secondary to bacteria, especially Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
3
Q
Q: How do viral URTIs contribute to acute otitis media?
A
A: Viral URTIs disturb the normal nasopharyngeal microbiome, allowing bacteria to infect the middle ear via the Eustachian tube.
4
Q
Q: What are the common clinical features of acute otitis media?
A
A: Common features include otalgia, ear tugging or rubbing, fever (in about 50% of cases), hearing loss, recent viral URTI symptoms, and ear discharge if the tympanic membrane perforates.
5
Q
Q: What are the possible otoscopy findings in acute otitis media?
A
A: Findings include a bulging tympanic membrane (loss of light reflex), opacification or erythema of the tympanic membrane, perforation with purulent otorrhoea, and decreased mobility if using a pneumatic otoscope.
6
Q
Q: What criteria are commonly used to diagnose acute otitis media?
A
A: Diagnosis is based on acute onset of symptoms, otalgia or ear tugging, middle ear effusion, bulging or otorrhoea of the tympanic membrane, decreased mobility on pneumatic otoscopy, and inflammation of the tympanic membrane.
7
Q
Q: How is acute otitis media managed?
A
A: Acute otitis media is generally self-limiting, but analgesia should be given for otalgia. Parents should seek medical help if symptoms worsen or do not improve after 3 days. Antibiotics may be required in certain cases.
8
Q
Q: When should antibiotics be prescribed for acute otitis media?
A
A: Antibiotics should be prescribed if symptoms last more than 4 days, the patient is systemically unwell but not requiring admission, or in cases of immunocompromise, high risk, bilateral otitis media in children under 2, or otitis media with perforation or discharge.
9
Q
Q: What is the first-line antibiotic for acute otitis media?
A
A: A 5-7 day course of amoxicillin is the first-line antibiotic. If allergic to penicillin, erythromycin or clarithromycin should be used.
10
Q
Q: What are common sequelae of acute otitis media?
A
A: Common sequelae include perforation of the tympanic membrane (otorrhoea), chronic suppurative otitis media (CSOM), hearing loss, and labyrinthitis.
11
Q
Q: What are the potential complications of acute otitis media?
A
A: Complications can include mastoiditis, meningitis, brain abscess, and facial nerve paralysis.
12
Q
Q: What is acute sinusitis, and what are the common infectious agents?
A
A: Acute sinusitis is an inflammation of the mucous membranes of the paranasal sinuses, typically caused by Streptococcus pneumoniae, Haemophilus influenzae, and rhinoviruses.
13
Q
Q: What are the predisposing factors for acute sinusitis?
A
A: Predisposing factors include nasal obstruction (e.g., septal deviation or nasal polyps), recent local infection (e.g., rhinitis or dental extraction), swimming/diving, and smoking.
14
Q
Q: What are the common clinical features of acute sinusitis?
A
A: Features include facial pain (typically frontal pressure pain worsened by bending forward), thick and purulent nasal discharge, and nasal obstruction.
15
Q
Q: How is acute sinusitis generally managed?
A
A: Management includes analgesia, intranasal decongestants or saline (with limited evidence), intranasal corticosteroids (if symptoms persist for more than 10 days), and antibiotics in severe cases.
16
Q
Q: What is the first-line antibiotic for acute sinusitis according to the BNF?
A
A: The first-line antibiotic is phenoxymethylpenicillin, with co-amoxiclav used for patients who are systemically unwell, have more serious symptoms, or are at high risk of complications.
17
Q
Q: What is “double-sickening” in the context of acute sinusitis?
A
A: “Double-sickening” refers to a situation where an initial viral sinusitis worsens due to a secondary bacterial infection.
18
Q
Q: What is allergic rhinitis, and what are the common allergens involved?
A
A: Allergic rhinitis is an inflammatory disorder of the nose caused by sensitization to allergens such as house dust mites and pollens from grass, trees, and weeds.
19
Q
Q: How is allergic rhinitis classified, and what are the types?
A
A: Allergic rhinitis can be classified as seasonal (e.g., hay fever due to pollen), perennial (symptoms year-round), or occupational (due to exposure to workplace allergens).
20
Q
Q: What are the common clinical features of allergic rhinitis?
A
A: Features include sneezing, bilateral nasal obstruction, clear nasal discharge, post-nasal drip, and nasal pruritus.
21
Q
Q: How is allergic rhinitis managed in mild-to-moderate intermittent or mild persistent cases?
A
A: Management includes allergen avoidance and the use of oral or intranasal antihistamines.
22
Q
Q: What treatment is recommended for moderate-to-severe persistent allergic rhinitis or when initial treatment is ineffective?
A
A: Intranasal corticosteroids are recommended, and occasionally a short course of oral corticosteroids may be needed for significant life events.
23
Q
Q: What is the role of nasal decongestants in the management of allergic rhinitis?
A
A: Short courses of topical nasal decongestants (e.g., oxymetazoline) may be used, but prolonged use should be avoided due to the risk of tachyphylaxis and rebound hypertrophy (rhinitis medicamentosa).
24
Q
Q: What is an audiogram, and when is it typically used?
A
A: An audiogram is a test used to assess hearing difficulties, and it is usually the first-line investigation when a patient complains of hearing issues.
25
Q: How is sensorineural hearing loss identified on an audiogram?
A: In sensorineural hearing loss, both air and bone conduction are impaired.
26
Q: How is conductive hearing loss identified on an audiogram?
A: In conductive hearing loss, only air conduction is impaired, while bone conduction remains normal.
27
Q: How is mixed hearing loss identified on an audiogram?
A: In mixed hearing loss, both air and bone conduction are impaired, with air conduction typically being worse than bone conduction.
28
Q: What are auricular haematomas, and who are they common in?
A: Auricular haematomas are common in rugby players and wrestlers.
29
Q: Why is prompt treatment important for auricular haematomas?
A: Prompt treatment is essential to avoid the formation of "cauliflower ear."
30
Q: How should auricular haematomas be managed?
A: Auricular haematomas require same-day assessment by an ENT specialist.
31
Q: What is the preferred treatment for auricular haematomas?
A: Incision and drainage have been shown to be superior to needle aspiration for treating auricular haematomas.
32
Q: What is benign paroxysmal positional vertigo (BPPV), and how is it characterized?
A: BPPV is a common cause of vertigo characterized by the sudden onset of dizziness and vertigo triggered by changes in head position.
33
Q: What is the typical age of onset for BPPV, and how common is it in younger patients?
A: The average age of onset is 55 years, and it is less common in younger patients.
34
Q: What are the common clinical features of BPPV?
A: Features include vertigo triggered by changes in head position (e.g., rolling over in bed or gazing upwards), nausea, episodes lasting 10-20 seconds, a positive Dix-Hallpike manoeuvre, and rotatory nystagmus.
35
Q: How is the Dix-Hallpike manoeuvre performed, and what does a positive test indicate?
A: The patient is rapidly lowered to the supine position with an extended neck. A positive test recreates the symptoms of BPPV.
36
Q: What is the prognosis of BPPV, and how do symptoms usually resolve?
A: BPPV has a good prognosis, with symptoms typically resolving spontaneously after a few weeks to months.
37
Q: What are some treatment options for BPPV?
A: Treatment options include the Epley manoeuvre (successful in around 80% of cases), vestibular rehabilitation exercises like Brandt-Daroff exercises, and medication such as Betahistine, though medication is of limited value.
38
Q: How common are recurrences of BPPV, and when do they typically occur?
A: Around half of people with BPPV will experience a recurrence of symptoms 3-5 years after diagnosis.
39
Q: What is black hairy tongue, and what causes it?
A: Black hairy tongue is a condition caused by defective desquamation of the filiform papillae, leading to a discolored tongue (which may be brown, green, pink, or another color).
40
Q: What are the common predisposing factors for black hairy tongue?
A: Predisposing factors include poor oral hygiene, antibiotics, head and neck radiation, HIV, and intravenous drug use.
41
Q: How should black hairy tongue be managed?
A: Management includes tongue scraping and the use of topical antifungals if Candida is involved.
42
Q: Why should the tongue be swabbed in cases of black hairy tongue?
A: The tongue should be swabbed to exclude Candida infection as a cause.
43
Q: What is a branchial cyst, and what is it filled with?
A: A branchial cyst is a benign developmental defect of the branchial arches, filled with acellular fluid containing cholesterol crystals and encapsulated by stratified squamous epithelium.
44
Q: What complications can arise from a branchial cyst?
A: Branchial cysts may have a fistula and are prone to infection. They may enlarge following a respiratory tract infection.
45
Q: When do branchial cysts typically present, and where are they usually located?
A: Branchial cysts typically present in late childhood or early adulthood as asymptomatic lateral neck lumps, usually located anterior to the sternocleidomastoid muscle.
46
Q: What are the typical examination features of a branchial cyst?
A: Features include being unilateral (typically on the left side), lateral, anterior to the sternocleidomastoid muscle, slowly enlarging, smooth, soft, fluctuant, non-tender, possibly with a fistula, no movement on swallowing, and no transillumination.
47
Q: What are the differential diagnoses for a neck lump in children?
A: Differential diagnoses include congenital conditions (branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation), inflammatory conditions (reactive lymphadenopathy, lymphadenitis), and neoplastic conditions (lymphoma, thyroid tumor, salivary gland tumor).
48
Q: How is a branchial cyst diagnosed and investigated?
A: Diagnosis involves excluding malignancy, ultrasound, referral to ENT, and fine-needle aspiration.
49
Q: How are branchial cysts treated?
A: Branchial cysts are treated by ENT surgeons, either conservatively or through surgical excision. Antibiotics are required for acute infections.
50
Q: What is a cholesteatoma, and what causes it?
A: A cholesteatoma is a non-cancerous growth of squamous epithelium trapped within the skull base, causing local destruction.
51
Q: At what age is cholesteatoma most common, and what increases its risk?
A: Cholesteatoma is most common in patients aged 10-20 years, and being born with a cleft palate increases the risk around 100-fold.
52
Q: What are the main features of cholesteatoma?
A: Main features include foul-smelling, non-resolving discharge and hearing loss.
53
Q: What other features may occur due to local invasion of cholesteatoma?
A: Other features may include vertigo, facial nerve palsy, and cerebellopontine angle syndrome.
54
Q: What is the characteristic otoscopic finding in cholesteatoma?
A: The characteristic finding is an "attic crust" seen in the uppermost part of the ear drum.
55
Q: How is cholesteatoma managed?
A: Patients are referred to ENT for consideration of surgical removal.
56
Q: What is chronic rhinosinusitis, and how long does it last?
A: Chronic rhinosinusitis is an inflammatory disorder of the paranasal sinuses and nasal passages that lasts for 12 weeks or longer.
57
Q: What are the common predisposing factors for chronic rhinosinusitis?
A: Predisposing factors include atopy (hay fever, asthma), nasal obstruction (e.g., septal deviation or nasal polyps), recent local infections (e.g., rhinitis or dental extraction), swimming/diving, and smoking.
58
Q: What are the common features of chronic rhinosinusitis?
A: Features include facial pain (typically frontal pressure pain worse when bending forward), nasal discharge (clear in allergic/vasomotor cases, thicker and purulent in secondary infections), nasal obstruction (e.g., mouth breathing), and post-nasal drip (which may cause chronic cough).
59
Q: How is recurrent or chronic rhinosinusitis managed?
A: Management includes allergen avoidance, intranasal corticosteroids, and nasal irrigation with saline solution.
60
Q: What are the red flag symptoms of chronic rhinosinusitis that warrant further investigation?
A: Red flags include unilateral symptoms, persistent symptoms despite 3 months of treatment, and epistaxis (nosebleeds).
61
Q: What is a cochlear implant, and when is it offered?
A: A cochlear implant is an electronic device offered to patients with severe-to-profound hearing loss.
62
Q: How is suitability for a cochlear implant determined in children and adults?
A: In children, suitability is based on audiological assessment and difficulty developing basic auditory skills. In adults, it is determined after a trial of appropriate hearing aids for at least 3 months, with limited or no benefit shown.
63
Q: What are the common causes of severe-to-profound hearing loss in children and adults?
A: In children, causes include genetic factors, congenital infections (e.g., cytomegalovirus, rubella, varicella), idiopathic causes, and post-infectious (e.g., post-meningitis). In adults, causes include viral-induced sudden hearing loss, ototoxicity, otosclerosis, Meniere disease, and trauma.
64
Q: What is required before a cochlear implant assessment?
A: Patients must exhaust all medical therapies for underlying causes of hearing loss and explore conventional amplification strategies (e.g., hearing aids) without success in supporting daily functioning or language development.
65
Q: What is crucial for the success of a cochlear implant?
A: The presence of surviving spiral ganglion neurons is crucial for the implant's success, as the destruction or degeneration of the organ of Corti necessitates the implant.
66
Q: What complications can arise from cochlear implant surgery?
A: Complications include infection, facial paralysis due to nerve injury, cerebrospinal fluid (CSF) leakage, and meningitis. Vaccination against Streptococcus and Haemophilus is recommended to reduce the risk of meningitis.
67
Q: What are the contraindications and relative contraindications for a cochlear implant?
A: Contraindications include lesions of cranial nerve VIII or brain stem, chronic infective otitis media, mastoid cavity or tympanic membrane perforation, and cochlear aplasia. Relative contraindications include chronic infections, tympanic membrane perforation, and lack of interest in using the implant for oral communication.
68
Q: What should patients understand before getting a cochlear implant?
A: Patients should understand the expected outcomes and limitations of the cochlear implant device.
69
Q: How does the cochlear implant device work?
A: Externally, the microphone picks up sound, which is processed into a digital signal by the sound processor and sent to the transmitter coil. Internally, the receiver and electrodes process the signal as the inner ear hair cells would in a normal ear, allowing the brain to comprehend the sound.
70
Q: What is the success rate of cochlear implants?
A: Cochlear implants have a very high success rate, with less than 0.2% of recipients rejecting the device and a failure rate of around 0.5% requiring reimplantation.
71
Q: What are the most common causes of hearing loss?
A: The most common causes of hearing loss are ear wax, otitis media, and otitis externa.
72
Q: What is presbycusis, and how does it affect hearing?
A: Presbycusis is age-related sensorineural hearing loss, where patients may describe difficulty following conversations, and audiometry shows bilateral high-frequency hearing loss.
73
Q: What is otosclerosis, and what are its key features?
A: Otosclerosis is an autosomal dominant condition where normal bone is replaced by vascular spongy bone, typically occurring in people aged 20-40. Key features include conductive deafness, tinnitus, a possible flamingo tinge of the tympanic membrane, and a positive family history.
74
Q: What is glue ear, and what age group is most affected?
A: Glue ear, also known as otitis media with effusion, is common in children around 2 years of age. It often presents with hearing loss and may lead to secondary problems like speech delay, behavioral issues, or balance problems.
75
Q: What are the key features of Meniere's disease?
A: Meniere's disease is characterized by recurrent episodes of vertigo, tinnitus, and sensorineural hearing loss. Vertigo is typically the prominent symptom, and other features include aural fullness, nystagmus, a positive Romberg test, and episodes lasting minutes to hours.
76
Q: What drugs can cause ototoxicity leading to hearing loss?
A: Drugs that can cause ototoxicity include aminoglycosides (e.g., Gentamicin), furosemide, aspirin, and some cytotoxic agents.
FAV.Q&A
Furosemide
Aminoglycoside
Vancomycin
Quinine
Aspirin
77
Q: What is the effect of noise damage on hearing, and who is at risk?
A: Noise damage causes bilateral hearing loss, typically worse at frequencies of 3000-6000 Hz, and workers in heavy industry are particularly at risk.
78
Q: What are the features of an acoustic neuroma (vestibular schwannoma)?
A: Features depend on the affected cranial nerves, with unilateral hearing loss, vertigo, and tinnitus affecting cranial nerve VIII, absent corneal reflex affecting cranial nerve V, and facial palsy affecting cranial nerve VII.
79
Q: What is neurofibromatosis type 2, and what is its association with acoustic neuromas?
A: Neurofibromatosis type 2 is associated with bilateral acoustic neuromas.
80
Q: What is ear wax, and what is its role?
A: Ear wax is a normal physiological substance that helps protect the ear canal.
81
Q: What symptoms can be caused by impacted ear wax?
A: Impacted ear wax can cause pain, conductive hearing loss, tinnitus, and vertigo.
82
Q: What are the main treatment options for impacted ear wax in primary care?
A: The main treatment options are ear drops or irrigation ('ear syringing').
83
Q: When should treatment for impacted ear wax be avoided?
A: Treatment should not be given if a perforation is suspected or if the patient has grommets.
84
Q: What types of ear drops may be used for impacted ear wax?
A: Types of ear drops that may be used include olive oil, sodium bicarbonate 5%, and almond oil.
85
Q: What is the difference between anterior and posterior epistaxis?
A: Anterior epistaxis usually has a visible source of bleeding and is caused by capillary damage in Kiesselbach's plexus, while posterior epistaxis tends to be more profuse and originates from deeper structures, often in older patients.
86
Q: What are some common causes of epistaxis?
A: Common causes include nose picking, trauma, foreign bodies, bleeding disorders, immune thrombocytopenia, juvenile angiofibroma, cocaine use, hereditary haemorrhagic telangiectasia, and granulomatosis with polyangiitis.
87
Q: What are the first aid measures for managing epistaxis in a stable patient?
A: The patient should sit forward with their mouth open to avoid blood flowing into the nasopharynx. Pinch the soft part of the nose firmly for at least 20 minutes and ask the patient to breathe through their mouth.
88
Q: What topical treatments can help reduce crusting and the risk of vestibulitis in epistaxis?
A: Topical antiseptics like Naseptin (chlorhexidine and neomycin) or Mupirocin can help, but Naseptin should be avoided in patients with peanut, soy, or neomycin allergies.
89
Q: What should be avoided to reduce the risk of re-bleeding in epistaxis patients?
A: Patients should avoid blowing or picking their nose, heavy lifting, exercise, lying flat, drinking alcohol, or consuming hot drinks.
90
Q: What should be done if bleeding persists after 10-15 minutes of pressure on the nose?
A: If bleeding persists, cautery or nasal packing should be considered. Cautery is preferred if the source of the bleed is visible and well-tolerated.
91
Q: How should cautery be performed for epistaxis?
A: Use a topical local anaesthetic spray (e.g., Co-phenylcaine) and wait 3-4 minutes. Apply a silver nitrate stick for 3-10 seconds to the visible bleeding point, ensuring not to cauterise areas not requiring treatment.
92
Q: What is the alternative to cautery if the bleeding point cannot be visualized?
A: Nasal packing should be used if cautery is not possible or the bleeding point cannot be seen. The patient should be anaesthetized, and the packing should be inserted while they are sitting forward.
93
Q: When should patients with epistaxis be admitted to the hospital?
A: Patients should be admitted if they are haemodynamically unstable, if the bleeding source is unknown or posterior, or if the bleed does not stop after emergency management.
94
Q: What is the last resort treatment for severe, unmanageable epistaxis?
A: Sphenopalatine ligation may be required in theatre for patients with severe epistaxis that does not respond to other emergency management.
95
Q: What are the main branches of the trigeminal nerve that innervate the face?
A: The ophthalmic (V1), maxillary (V2), and mandibular (V3) branches of the trigeminal nerve.
96
Q: How does facial pain travel from the face to the brain?
A: Pain sensation from the face travels via the trigeminal nerve to the trigeminal nucleus in the brainstem, where it is relayed to higher cortical centers.
97
Q: What are some common causes of facial pain?
A: Trigeminal neuralgia, sinusitis, dental problems, tension-type headache, migraine, and giant cell arteritis.
98
Q: What is trigeminal neuralgia, and how does it present?
A: Trigeminal neuralgia is characterized by severe, lancinating facial pain along one or more branches of the trigeminal nerve.
99
Q: How does sinusitis cause facial pain?
A: Sinusitis typically presents with facial pain accompanied by symptoms such as nasal discharge or congestion.
100
Q: What dental issues can lead to facial pain?
A: Dental caries or abscesses can cause localized facial pain.
101
Q: How does tension-type headache present with facial pain?
A: Tension-type headaches present with a band-like pressure around the forehead that may extend into the facial regions.
102
Q: What symptoms are associated with migraines and facial pain?
A: Migraines typically involve unilateral, throbbing head and face pain, often accompanied by nausea, vomiting, or photophobia.
103
Q: How can giant cell arteritis present in older patients?
A: In older patients, new onset facial pain may be a sign of giant cell arteritis, which can threaten vision.
104
Q: What are the drug causes of gingival hyperplasia?
A: Phenytoin, ciclosporin, and calcium channel blockers (especially nifedipine).
105
Q: What are some other causes of gingival hyperplasia besides drugs?
A: Acute myeloid leukaemia, particularly the myelomonocytic and monocytic types.
106
Q: What is gingivitis usually secondary to?
A: Poor dental hygiene.
107
Q: What are the clinical presentations of gingivitis?
A: Simple gingivitis (painless, red swelling of the gum margin that bleeds on contact) to acute necrotizing ulcerative gingivitis (painful bleeding gums with halitosis and punched-out ulcers on the gums).
108
Q: How should simple gingivitis be managed?
A: Advise the patient to seek routine regular review by a dentist; antibiotics are not usually necessary.
109
Q: What is the management for acute necrotizing ulcerative gingivitis?
A: Refer the patient to a dentist and recommend oral metronidazole for 3 days, chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouthwash, and simple analgesia. Amoxicillin may also be used.
Paracetamol + oral metronidazole + chlorhexidine mouthwash
110
Q: What is glue ear?
A: Glue ear describes otitis media with an effusion (serous otitis media), and it is common in childhood.
111
Q: What are the risk factors for glue ear?
A: Male sex, siblings with glue ear, higher incidence in Winter and Spring, bottle feeding, day care attendance, and parental smoking.
112
Q: At what age does glue ear peak?
A: Glue ear peaks at 2 years of age.
113
Q: What is the most common presenting feature of glue ear?
A: Hearing loss is usually the presenting feature, and glue ear is the most common cause of conductive hearing loss and elective surgery in childhood.
114
Q: What secondary problems may be seen in children with glue ear?
A: Speech and language delay, behavioural or balance problems.
115
Q: What are the treatment options for glue ear?
A: Active observation for 3 months for first presentation, grommet insertion to allow air to pass into the middle ear, and adenoidectomy.
116
Q: What is head and neck cancer?
A: Head and neck cancer is an umbrella term that typically includes cancers of the oral cavity, pharynx (oropharynx, hypopharynx, and nasopharynx), and larynx.
117
Q: What are some common features of head and neck cancer?
A: Neck lump, hoarseness, persistent sore throat, and persistent mouth ulcer.
118
Q: What are the NICE suspected cancer pathway referral criteria for laryngeal cancer?
A: For people aged 45 and over with persistent unexplained hoarseness or an unexplained lump in the neck, a referral for an appointment within 2 weeks should be considered.
119
Q: What are the NICE suspected cancer pathway referral criteria for oral cancer?
A: Referral for oral cancer should be considered for people with unexplained ulceration in the oral cavity lasting for more than 3 weeks or a persistent lump in the neck. A dentist should urgently assess people with a lump on the lip or oral cavity, or a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.
120
Q: What are the NICE suspected cancer pathway referral criteria for thyroid cancer?
A: A suspected cancer pathway referral should be considered for thyroid cancer in people with an unexplained thyroid lump.
121
Q: What are common causes of hoarseness?
A: Voice overuse, smoking, viral illness, hypothyroidism, gastro-oesophageal reflux, laryngeal cancer, and lung cancer.
122
Q: When investigating hoarseness, what should be considered to exclude apical lung lesions?
A: A chest X-ray should be considered to exclude apical lung lesions.
123
Q: What are the referral guidelines for suspected laryngeal cancer in people aged 45 and over?
A: A suspected cancer pathway referral to an ENT specialist should be considered for people with persistent unexplained hoarseness or an unexplained lump in the neck.
124
Q: What is laryngopharyngeal reflux (LPR)?
A: LPR is a condition caused by gastro-oesophageal reflux resulting in inflammatory changes to the larynx/hypopharynx mucosa.
125
Q: What is the most common sensation reported by patients with LPR?
A: Around 70% of patients report the sensation of a lump in the throat, known as 'globus', typically felt in the midline and worse when swallowing saliva.
126
Q: What are some common features of LPR?
A: Hoarseness (70%), chronic cough (50%), dysphagia (35%), heartburn (30%), and sore throat.
127
Q: How is LPR diagnosed?
A: LPR is diagnosed clinically in the absence of red flags, with no further investigations required unless red flags are present, such as persistent unilateral throat discomfort, dysphagia, odynophagia, or persistent hoarseness.
128
Q: What are some management options for LPR?
A: Lifestyle measures (avoiding triggers like fatty foods, caffeine, chocolate, and alcohol), proton pump inhibitors, and sodium alginate liquids (e.g. Gaviscon).
129
Q: What is Ludwig's angina?
A: Ludwig's angina is a type of progressive cellulitis that invades the floor of the mouth and soft tissues of the neck, usually resulting from odontogenic infections.
130
Q: What are the common features of Ludwig's angina?
A: Neck swelling, dysphagia, and fever.
131
Q: Why is Ludwig's angina considered a life-threatening condition?
A: It is a life-threatening emergency due to the rapid potential for airway obstruction.
132
Q: What is the management of Ludwig's angina?
A: Airway management and intravenous antibiotics.
133
Q: What is malignant otitis externa?
A: Malignant otitis externa is an uncommon type of otitis externa that primarily affects immunocompromised individuals, especially diabetics, and is commonly caused by Pseudomonas aeruginosa.
134
Q: How does malignant otitis externa progress?
A: It begins in the soft tissues of the external auditory meatus and progresses to involve the bony ear canal and eventually leads to temporal bone osteomyelitis.
135
Q: What are the key features in the history of malignant otitis externa?
A: Diabetes or immunosuppression, severe unrelenting otalgia, temporal headaches, purulent otorrhea, and possibly dysphagia, hoarseness, or facial nerve dysfunction.
136
Q: How is malignant otitis externa diagnosed?
A: A CT scan is typically done to diagnose malignant otitis externa.
137
Q: What is the treatment for malignant otitis externa?
A: Urgent referral to ENT for non-resolving otitis externa with worsening pain and intravenous antibiotics that cover pseudomonal infections.
138
Q: What causes mastoiditis?
A: Mastoiditis typically develops when an infection spreads from the middle ear to the mastoid air spaces of the temporal bone.
139
Q: What are the features of mastoiditis?
A: Features include severe otalgia (classically behind the ear), a history of recurrent otitis media, fever, swelling, erythema, and tenderness over the mastoid process, possible external ear protrusion, and ear discharge if the eardrum has perforated.
140
Q: How is mastoiditis diagnosed?
A: The diagnosis is typically clinical, but a CT scan may be ordered if complications are suspected.
141
Q: What is the management for mastoiditis?
A: The management includes intravenous antibiotics.
142
Q: What are the complications of mastoiditis?
A: Complications can include facial nerve palsy, hearing loss, and meningitis.
143
Q: What is Meniere's disease?
A: Meniere's disease is a disorder of the inner ear of unknown cause, characterized by excessive pressure and progressive dilation of the endolymphatic system.
144
Q: What are the features of Meniere's disease?
A: Features include recurrent episodes of vertigo, tinnitus, and sensorineural hearing loss, with vertigo usually being the prominent symptom. A sensation of aural fullness or pressure is common. Other features include nystagmus, a positive Romberg test, and symptoms that typically last minutes to hours. Symptoms are usually unilateral but may become bilateral after several years.
145
Q: What is the natural history of Meniere's disease?
A: Symptoms resolve in the majority of patients after 5-10 years, but most patients will experience some degree of hearing loss. Psychological distress is common.
146
Q: How is Meniere's disease managed?
A: ENT assessment is required to confirm the diagnosis. Patients should inform the DVLA and cease driving until symptoms are controlled. Acute attacks are treated with buccal or intramuscular prochlorperazine, and sometimes admission is required. Prevention includes betahistine and vestibular rehabilitation exercises.
147
Q: When should a 2-week wait referral to oral surgery be made for mouth lesions?
Unexplained oral ulceration or mass persisting for more than 3 weeks.
Unexplained red or red and white patches that are painful, swollen, or bleeding.
Unexplained one-sided pain in the head and neck area for more than 4 weeks, associated with earache but without abnormal findings on otoscopy.
Unexplained recent neck lump or a previously undiagnosed lump that has changed over 3 to 6 weeks.
Unexplained persistent sore or painful throat.
Symptoms in the oral cavity lasting more than 6 weeks without a definitive benign diagnosis.
148
Q: What factors increase the level of suspicion for mouth lesions requiring referral?
A: Increased suspicion is warranted in patients who are over 40, smokers, heavy drinkers, or those who chew tobacco or betel nut (areca nut).
149
Q: What percentage of adults in the UK have nasal polyps?
A: Around 1% of adults in the UK have nasal polyps.
150
Q: In which demographic group are nasal polyps more common?
A: Nasal polyps are 2-4 times more common in men and are not commonly seen in children or the elderly.
151
Q: What are the key associations with nasal polyps?
Asthma (particularly late-onset asthma)
Aspirin sensitivity
Infective sinusitis
Cystic fibrosis
Kartagener's syndrome
Churg-Strauss syndrome
The combination of asthma, aspirin sensitivity, and nasal polyposis is known as Samter's triad.
152
Q: What are the main features of nasal polyps?
Nasal obstruction
Rhinorrhoea and sneezing
Poor sense of taste and smell
153
Q: What symptoms of nasal polyps always require further investigation?
A: Unilateral symptoms or bleeding always require further investigation.
154
Q: How are nasal polyps managed?
A: All patients with suspected nasal polyps should be referred to ENT for a full examination. Topical corticosteroids can shrink polyp size in around 80% of patients.
155
Q: What is a nasal septal haematoma?
A: Nasal septal haematoma is a complication of nasal trauma that occurs when a haematoma forms between the septal cartilage and the overlying perichondrium.
156
Q: What is the most common symptom of nasal septal haematoma?
A: The most common symptom is nasal obstruction.
157
Q: What are other features of nasal septal haematoma?
Pain
Rhinorrhoea
On examination, a bilateral red swelling arising from the nasal septum. This can be differentiated from a deviated septum by gently probing the swelling, as nasal septal haematomas are typically boggy, whereas septums are firm.
158
Q: What is the management for nasal septal haematoma?
Surgical drainage
Intravenous antibiotics
159
Q: What can happen if a nasal septal haematoma is left untreated?
A: If untreated, irreversible septal necrosis may develop within 3-4 days, leading to a 'saddle-nose' deformity due to pressure-related ischaemia of the cartilage.
160
Q: What type of cancer is nasopharyngeal carcinoma?
A: Nasopharyngeal carcinoma is a squamous cell carcinoma of the nasopharynx.
161
Q: Where is nasopharyngeal carcinoma most commonly seen?
A: It is rare in most parts of the world, except for individuals from Southern China.
162
Q: What virus is associated with nasopharyngeal carcinoma?
A: Nasopharyngeal carcinoma is associated with Epstein-Barr virus (EBV) infection.
163
Q: What are the systemic presenting features of nasopharyngeal carcinoma?
A: Systemic features include cervical lymphadenopathy.
164
Q: What are the local presenting features of nasopharyngeal carcinoma?
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge, and/or epistaxis
Cranial nerve palsies (e.g., III-VI)
165
Q: What imaging is used for nasopharyngeal carcinoma?
A: Combined CT and MRI are used for imaging.
166
Q: What is the first-line treatment for nasopharyngeal carcinoma?
A: Radiotherapy is the first-line therapy.
167
Q: What is the most common cause of neck swellings?
A: Reactive lymphadenopathy, often associated with local infection or a generalized viral illness.
168
Q: How can lymphoma-related lymphadenopathy be described?
A: Lymphadenopathy is rubbery and painless, and the phenomenon of pain while drinking alcohol is very uncommon. It may also be associated with night sweats and splenomegaly.
169
Q: What are the features of thyroid swelling?
A: It may present with hypo-, eu-, or hyperthyroid symptoms and moves upwards on swallowing.
170
Q: Where is a thyroglossal cyst typically located, and how can it be described?
A: It is usually midline, between the isthmus of the thyroid and the hyoid bone. It moves upwards with the protrusion of the tongue and may be painful if infected.
171
Q: What is a pharyngeal pouch, and what are its features?
A: A pharyngeal pouch is a posteromedial herniation between the thyropharyngeus and cricopharyngeus muscles, usually found in older men. If large, it presents as a midline lump in the neck that gurgles on palpation. Symptoms include dysphagia, regurgitation, aspiration, and chronic cough.
172
Q: What is a cystic hygroma?
A: A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side. Most are evident at birth, with 90% presenting before 2 years of age.
173
Q: What is a branchial cyst?
A: An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx, resulting from failure of the second branchial cleft to obliterate during embryonic development. It typically presents in early adulthood.
174
Q: What is a cervical rib, and what syndrome may it cause?
A: A cervical rib is more common in adult females and may cause thoracic outlet syndrome in about 10% of cases.
175
Q: How does a carotid aneurysm present?
A: A pulsatile lateral neck mass that does not move on swallowing.
176
Q: What are common causes of otitis externa?
A: Causes include bacterial infections (e.g., Staphylococcus aureus, Pseudomonas aeruginosa), fungal infections, seborrhoeic dermatitis, contact dermatitis (allergic and irritant), and recent swimming.
177
Q: What are the typical features of otitis externa?
A: Features include ear pain, itching, discharge, and on otoscopy, a red, swollen, or eczematous ear canal.
178
Q: What is the recommended initial management for otitis externa?
A: The initial management includes topical antibiotics or a combined topical antibiotic with a steroid. If the tympanic membrane is perforated, aminoglycosides are traditionally avoided. If there is canal debris, consider removal, and if the canal is swollen, an ear wick may be inserted.
179
Q: What are second-line management options for otitis externa?
A: Second-line options include considering contact dermatitis secondary to neomycin, oral antibiotics (e.g., flucloxacillin) if the infection is spreading, taking a swab from the ear canal, and empirical use of an antifungal agent.
180
Q: What should be done if a patient with otitis externa fails to respond to topical antibiotics?
A: The patient should be referred to ENT for further evaluation.
181
Q: What is malignant otitis externa, and in which patients is it more common?
A: Malignant otitis externa is a condition where infection extends into the bony ear canal and the soft tissues deep to the bony canal. It is more common in elderly diabetics and may require intravenous antibiotics.
182
Q: What is otosclerosis?
A: Otosclerosis is the replacement of normal bone by vascular spongy bone, leading to progressive conductive deafness due to the fixation of the stapes at the oval window.
183
Q: What is the inheritance pattern of otosclerosis?
A: Otosclerosis is autosomal dominant.
184
Q: At what age does otosclerosis typically onset?
A: Otosclerosis typically affects young adults, with onset usually between 20-40 years.
185
Q: What are the features of otosclerosis?
A: Features include conductive deafness, tinnitus, a normal tympanic membrane in most patients, and a 'flamingo tinge' in 10% of patients caused by hyperaemia. A positive family history is often present.
186
Q: What are the management options for otosclerosis?
A: Management includes the use of hearing aids and stapedectomy (surgical intervention).
187
Q: What is the most common benign parotid tumour?
A: The most common benign parotid tumour is a benign pleomorphic adenoma (80% of cases).
188
Q: What are the features of a benign pleomorphic adenoma?
A: Features include slow growth, lobular shape, poor encapsulation, and a recurrence rate of 1-5% with appropriate excision. Malignant degeneration occurs in 2-10% of cases.
189
Q: What is Warthin's tumour and what are its key associations?
A: Warthin's tumour is the second most common benign parotid tumour, associated with smoking and more common in older adults (sixth to seventh decades). It is also the most common bilateral benign parotid tumour.
190
Q: What is the risk of malignant transformation in Warthin's tumour?
A: Malignant transformation is rare (almost unheard of).
191
Q: What is the most common parotid tumour in children?
A: Haemangioma is the most common parotid tumour in children under 1 year of age and may spontaneously regress.
192
Q: What is the most common malignant parotid tumour?
A: Mucoepidermoid carcinoma is the most common malignant parotid tumour, accounting for 30% of all parotid malignancies.
193
Q: What is the treatment for lymphoma in the parotid?
A: Treatment for parotid lymphoma typically involves chemotherapy (and radiotherapy), and diagnosis should be based on regional nodal biopsy rather than parotid resection.
194
Q: What is the role of FNAC in parotid gland disease?
A: FNAC (Fine Needle Aspiration Cytology) is used in most cases to diagnose parotid gland lesions.
195
Q: What is the usual surgical treatment for benign parotid tumours?
A: Superficial parotidectomy is usually performed for benign tumours.
196
Q: What is the usual treatment for malignant parotid tumours?
A: Malignant tumours typically require a radical or extended radical parotidectomy, with neck dissection determined by the risk of nodal involvement.
197
Q: What is the association between HIV infection and the parotid gland?
A: Lymphoepithelial cysts are associated with HIV infection and typically present as bilateral, multicystic, symmetrical swelling in the parotid gland.
198
Q: What are the features of parotid involvement in Sjogren's syndrome?
A: Sjogren's syndrome is characterized by bilateral, non-tender enlargement of the parotid gland, xerostomia, and a lymphocytic infiltrate in acinar units.
199
Q: How is parotid involvement in sarcoidosis managed?
A: Parotid involvement in sarcoidosis is usually managed conservatively, as the gland is non-tender and xerostomia may occur.
200
Q: What is the most common cause of a perforated tympanic membrane?
A: The most common cause of a perforated tympanic membrane is infection. Other causes include barotrauma and direct trauma.
201
Q: How can a perforated tympanic membrane affect hearing?
A: A perforated tympanic membrane may lead to hearing loss, depending on the size of the perforation, and increases the risk of otitis media.
202
Q: What is the typical management for a perforated tympanic membrane?
A: In most cases, no treatment is needed as the tympanic membrane will heal after 6-8 weeks. It is advised to avoid getting water in the ear during this time.
203
Q: When are antibiotics prescribed for a perforated tympanic membrane?
A: Antibiotics are commonly prescribed for perforations that occur following an episode of acute otitis media, as supported by NICE guidelines in 2008.
204
Q: What is myringoplasty?
A: Myringoplasty is a surgical procedure that may be performed if the tympanic membrane does not heal by itself.
205
Q: What is the typical cause of a peritonsillar abscess?
A: A peritonsillar abscess typically develops as a complication of bacterial tonsillitis.
206
Q: What are the key features of a peritonsillar abscess?
A: Features include severe throat pain that lateralizes to one side, deviation of the uvula to the unaffected side, trismus (difficulty opening the mouth), and reduced neck mobility.
207
Q: What is the urgency of treating a peritonsillar abscess?
A: Patients with a peritonsillar abscess need urgent review by an ENT specialist.
208
Q: How is a peritonsillar abscess managed?
A: Management includes needle aspiration or incision and drainage, along with intravenous antibiotics.
209
Q: What procedure should be considered to prevent recurrence of a peritonsillar abscess?
A: Tonsillectomy should be considered to prevent recurrence.
210
Q: What is pleomorphic adenoma?
A: Pleomorphic adenoma (also known as a benign mixed tumour) is a benign tumour of the parotid gland, and it is the most common tumour of the parotid gland.
211
Q: At what age does pleomorphic adenoma typically appear?
A: Pleomorphic adenoma typically appears at the age of 40-60 years.
212
Q: What is the pathophysiology of pleomorphic adenoma?
A: Pleomorphic adenoma is characterized by the proliferation of epithelial and myoepithelial cells of the ducts and an increase in stromal components. It is slow-growing, lobular, and not well encapsulated.
213
Q: What are the clinical features of pleomorphic adenoma?
A: The clinical features include gradual onset, painless unilateral swelling of the parotid gland, which is typically movable on examination rather than fixed.
214
Q: How is pleomorphic adenoma managed?
A: The management of pleomorphic adenoma is surgical excision.
215
Q: What is the prognosis of pleomorphic adenoma?
A: The recurrence rate is 1-5% with appropriate excision (parotidectomy), and recurrence may be secondary to capsular disruption during surgery. Malignant transformation occurs in 2-10% of adenomas observed for long periods, with carcinoma ex-pleomorphic adenoma most frequently occurring as adenocarcinoma.
216
Q: How long does pain last after a tonsillectomy?
A: Pain may increase for up to 6 days following a tonsillectomy.
217
Q: What is a feared complication following tonsillectomy?
A: Haemorrhage is a feared complication following tonsillectomy.
218
Q: When does primary (reactionary) haemorrhage typically occur after a tonsillectomy?
A: Primary, or reactionary, haemorrhage most commonly occurs in the first 6-8 hours following surgery.
219
Q: How is primary haemorrhage managed?
A: Primary haemorrhage is managed by immediate return to theatre.
220
Q: When does secondary haemorrhage occur after tonsillectomy?
A: Secondary haemorrhage occurs between 5 and 10 days after surgery.
221
Q: What are the common causes and treatments for secondary haemorrhage after tonsillectomy?
A: Secondary haemorrhage is often associated with a wound infection. Treatment usually involves admission and antibiotics, with severe bleeding requiring surgery.
222
Q: What is the incidence of secondary haemorrhage after tonsillectomy?
A: Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.
223
Q: What is presbycusis?
A: Presbycusis is a type of sensorineural hearing loss that affects elderly individuals, typically involving high-frequency hearing.
224
Q: How does presbycusis progress over time?
A: Presbycusis progresses slowly, with sensory hair cells and neurons in the cochlea atrophying over time.
225
Q: What are some factors associated with presbycusis?
A: Arteriosclerosis, diabetes, accumulated noise exposure, drug exposure, stress, and genetic predisposition are all factors.
226
Q: What are the common symptoms of presbycusis?
A: Symptoms include difficulty understanding speech, needing increased volume for TV or radio, difficulty using the telephone, loss of directionality of sound, and worsening symptoms in noisy environments.
227
Q: What is hyperacusis in the context of presbycusis?
A: Hyperacusis is heightened sensitivity to certain frequencies of sound, though it is less common.
228
Q: Is tinnitus common in presbycusis?
A: No, tinnitus is uncommon in presbycusis.
229
Q: What might the Weber's test show in presbycusis?
A: The Weber's test may show bone conduction localization to one side if the sensorineural hearing loss is not completely bilateral.
230
Q: What is typically observed in otoscopy for a patient with presbycusis?
A: Otoscopy is normal, ruling out other causes like otosclerosis, cholesteatoma, or conductive hearing loss.
231
Q: What would tympanometry show in presbycusis?
A: Tympanometry would show normal middle ear function with hearing loss (Type A).
232
Q: What pattern of hearing loss is found in audiometry for presbycusis?
A: Audiometry typically shows bilateral sensorineural pattern hearing loss.
233
Q: What causes Ramsay Hunt syndrome?
A: Ramsay Hunt syndrome is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
234
Q: What is often the first feature of Ramsay Hunt syndrome?
A: Auricular pain is often the first feature of Ramsay Hunt syndrome.
235
Q: What is the characteristic rash seen in Ramsay Hunt syndrome?
A: A vesicular rash around the ear is characteristic of Ramsay Hunt syndrome.
236
Q: What are other common symptoms of Ramsay Hunt syndrome?
A: Other features include facial nerve palsy, vertigo, and tinnitus.
237
Q: What is the typical management for Ramsay Hunt syndrome?
A: Oral aciclovir and corticosteroids are usually given for Ramsay Hunt syndrome.
238
Q: What does Rinne's test assess?
A: Rinne's test helps differentiate conductive and sensorineural deafness by comparing air conduction (AC) and bone conduction (BC).
239
Q: How is Rinne's test performed?
A: A tuning fork is placed over the mastoid process until the sound is no longer heard, then repositioned just over the external acoustic meatus.
240
Q: What does a 'positive' Rinne test result indicate?
A: A 'positive' Rinne test occurs when air conduction (AC) is better than bone conduction (BC), which is normal.
241
Q: What does a 'negative' Rinne test result indicate?
A: A 'negative' Rinne test occurs if bone conduction (BC) is greater than air conduction (AC), suggesting conductive deafness.
242
Q: What does Weber's test assess?
A: Weber's test helps identify the type of hearing loss (sensorineural vs. conductive) by localizing sound to one side.
243
Q: How is Weber's test performed?
A: A tuning fork is placed in the middle of the forehead, equidistant from both ears. The patient is asked which side is loudest.
244
Q: What does it mean if sound lateralizes to the unaffected ear during Weber's test?
A: In unilateral sensorineural deafness, sound lateralizes to the unaffected ear.
245
Q: What does it mean if sound lateralizes to the affected ear during Weber's test?
A: In unilateral conductive deafness, sound lateralizes to the affected ear.
246
Q: How do Rinne's and Weber's test results correlate in normal hearing?
A: In normal hearing: Rinne test shows AC > BC bilaterally, and Weber test shows sound heard midline.
247
Q: How do Rinne's and Weber's test results correlate in conductive hearing loss?
A: In conductive hearing loss: Rinne test shows BC > AC in the affected ear and AC > BC in the unaffected ear, and Weber test lateralizes to the affected ear.
248
Q: How do Rinne's and Weber's test results correlate in sensorineural hearing loss?
A: In sensorineural hearing loss: Rinne test shows AC > BC bilaterally, and Weber test lateralizes to the unaffected ear.
249
Q: How many pairs of salivary glands are there?
A: There are three pairs of salivary glands: parotid, submandibular, and sublingual.
250
Q: What is the most common site for salivary gland tumors?
A: The parotid glands are the most common site for salivary gland tumors.
251
Q: What type of tumor is most common in the parotid glands?
A: Pleomorphic adenomas are the most common type of tumor in the parotid glands, accounting for 80% of tumors.
252
Q: Where in the parotid gland do most tumors occur?
A: Most tumors occur in the superficial lobe of the parotid gland (80%).
253
Q: What are signs of a malignant salivary gland tumor?
A: Malignant tumors present with a short history, pain, hot skin, hardness, fixation, and possible cranial nerve VII involvement.
254
Q: What is the most common benign parotid tumor?
A: Pleomorphic adenoma is the most common benign parotid tumor (80% of parotid tumors).
255
Q: What are the features of a pleomorphic adenoma?
A: Pleomorphic adenomas are slow-growing, painless lumps commonly occurring in middle-aged individuals.
256
Q: What is the treatment for pleomorphic adenomas?
A: The treatment is superficial parotidectomy, but there is a risk of facial nerve (CN VII) damage.
257
Q: What is another name for Warthin's tumor?
A: Warthin's tumor is also known as adenolymphoma.
258
Q: What are the clinical features of Warthin's tumor?
A: Warthin's tumors are softer, more mobile, and fluctuant, though they can be difficult to differentiate from other tumors.
259
Q: What is a common symptom of salivary gland stones?
A: Recurrent unilateral pain and swelling during eating are common symptoms of salivary gland stones.
260
Q: What complication may occur if salivary stones become infected?
A: Infected salivary stones can lead to Ludwig's angina.
261
Q: Where are most salivary gland stones found?
A: Most salivary gland stones (80%) are found in the submandibular gland.
262
Q: How are salivary gland stones diagnosed?
A: Salivary gland stones can be diagnosed using plain x-rays or sialography.
263
Q: What is the treatment for salivary gland stones?
A: The treatment for salivary gland stones is surgical removal.
264
Q: What viral infection can cause salivary gland enlargement?
A: Mumps, a viral infection, can cause salivary gland enlargement.
265
Q: What bacterial infection can lead to salivary gland enlargement?
A: Acute bacterial infection secondary to dehydration or diabetes can lead to salivary gland enlargement.
266
Q: What autoimmune disorder is associated with salivary gland enlargement?
A: Sjögren's syndrome (including in conditions like rheumatoid arthritis) is associated with salivary gland enlargement.
267
Q: What conditions are encompassed under the term "sore throat"?
A: Sore throat includes pharyngitis, tonsillitis, and laryngitis.
268
Q: How is a sore throat diagnosed?
A: The diagnosis of a sore throat is clinical, and throat swabs and rapid antigen tests are not routinely carried out.
269
Q: What is the first-line treatment for pain relief in sore throat?
A: Paracetamol or ibuprofen can be used for pain relief.
270
Q: Are antibiotics routinely indicated for a sore throat?
A: No, antibiotics are not routinely indicated for a sore throat.
271
Q: When are antibiotics indicated for sore throat according to NICE guidelines?
A: Antibiotics are indicated in the presence of marked systemic upset, unilateral peritonsillitis, a history of rheumatic fever, increased risk from acute infection, or when 3 or more Centor criteria are present.
272
Q: What are the Centor criteria for sore throat?
Presence of tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever
Absence of cough
273
Q: What is the Centor score for a high likelihood of streptococcal infection?
A: A Centor score of 3 or 4 corresponds to a 32 to 56% likelihood of isolating streptococci.
274
Q: What are the FeverPAIN criteria for sore throat?
Fever over 38°C
Purulence (pharyngeal/tonsillar exudate)
Attend rapidly (3 days or less)
Severely inflamed tonsils
No cough or coryza
275
Q: What is the likelihood of isolating Streptococcus with a FeverPAIN score of 4 or 5?
A: A FeverPAIN score of 4 or 5 corresponds to a 62% to 65% likelihood of isolating streptococci.
276
Q: What antibiotics are given if indicated for a sore throat?
A: Phenoxymethylpenicillin is typically given, or clarithromycin if the patient is penicillin-allergic.
277
Q: Where do 80% of salivary gland calculi occur?
A: 80% of salivary gland calculi occur in the submandibular gland.
278
Q: What is the composition of most submandibular stones?
A: Submandibular stones are usually composed of calcium phosphate or calcium carbonate.
279
Q: What symptoms are typical of sialolithiasis?
A: Patients typically experience colicky pain and post-prandial swelling of the gland.
280
Q: How are submandibular stones diagnosed and treated?
A: Diagnosis is made with sialography, and stones impacted in the distal aspect of Wharton's duct may be removed orally. Other stones or chronic inflammation may require gland excision.
281
Q: What is the most common cause of sialadenitis in the submandibular gland?
A: Sialadenitis is usually caused by Staphylococcus aureus infection.
282
Q: What are the symptoms of sialadenitis?
A: Symptoms include pus leaking from the duct, erythema, and possible development of a submandibular abscess.
283
Q: Why is a submandibular abscess a serious complication?
A: A submandibular abscess can spread through other deep fascial spaces and potentially occlude the airway.
284
Q: How are submandibular gland tumours diagnosed?
A: Diagnosis usually involves fine needle aspiration cytology, and imaging with CT and MRI.
285
Q: How should masses of the submandibular glands be managed?
A: Due to the high prevalence of malignancy, all masses in the submandibular glands should generally be excised.
286
Q: What is the most common cause of sudden-onset sensorineural hearing loss (SSNHL)?
A: The majority of SSNHL cases are idiopathic.
287
Q: Why is it important to differentiate between conductive and sensorineural hearing loss in cases of sudden onset hearing loss?
A: Differentiating between conductive and sensorineural hearing loss is important because sudden-onset sensorineural hearing loss (SSNHL) requires urgent referral to ENT.
288
Q: What is the role of MRI in the management of SSNHL?
A: An MRI scan is usually performed to exclude a vestibular schwannoma.
289
Q: What is the first-line treatment for SSNHL?
A: High-dose oral corticosteroids are used by ENT for all cases of SSNHL.
290
Q: Where is a thyroglossal cyst typically located?
A: It is usually found midline, between the isthmus of the thyroid and the hyoid bone.
291
Q: How does a thyroglossal cyst move during tongue protrusion?
A: It moves upwards with protrusion of the tongue.
292
Q: What can occur if a thyroglossal cyst becomes infected?
A: The cyst may become painful if infected.
293
Q: What anatomical complication may occur following thyroid surgery?
A: Recurrent laryngeal nerve damage.
294
Q: How can bleeding after thyroid surgery lead to complications?
A: Bleeding can cause a haematoma, which may rapidly lead to respiratory compromise due to laryngeal oedema.
295
Q: What is a potential complication resulting from damage to the parathyroid glands during thyroid surgery?
A: Hypocalcaemia.
296
Q: What is tinnitus?
A: Tinnitus is the perception of sounds in the ears or head that do not come from an outside source.
297
Q: What are some common causes of tinnitus?
A: Causes include idiopathic (unknown cause), Meniere's disease, otosclerosis, sudden onset sensorineural hearing loss (SSNHL), acoustic neuroma, hearing loss (e.g., from loud noise or presbycusis), certain drugs (e.g., aspirin, aminoglycosides), and impacted ear wax.
298
Q: What are the symptoms associated with Meniere's disease?
A: Meniere's disease is associated with hearing loss, vertigo, tinnitus, and a sensation of fullness or pressure in one or both ears.
299
Q: What is the typical presentation of tinnitus in otosclerosis?
A: Onset is usually between 20-40 years, with tinnitus, conductive deafness, and a normal tympanic membrane, although 10% may have a "flamingo tinge" caused by hyperaemia.
300
Q: What is the most important sign of acoustic neuroma?
A: An absent corneal reflex is an important sign. It is also associated with neurofibromatosis type 2.
301
Q: When is imaging required in tinnitus cases?
A: Imaging is generally needed for unilateral, pulsatile tinnitus, or if there are other neurological or otological signs. MRI is used for non-pulsatile tinnitus and MRA is used for pulsatile tinnitus.
302
Q: What is the primary management for tinnitus?
A: Management includes investigating and treating any underlying cause, amplification devices if associated with hearing loss, and psychological therapy (e.g., cognitive behavioural therapy) for some patients. Tinnitus support groups may also help.
303
Q: What are common complications of tonsillitis?
A: Complications of tonsillitis include otitis media, quinsy (peritonsillar abscess), and rarely rheumatic fever and glomerulonephritis.
304
Q: What are the NICE criteria for considering tonsillectomy?
Sore throats are due to tonsillitis (not recurrent upper respiratory infections)
The person has 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years, with no other explanation for recurrent symptoms
The episodes of sore throat are disabling and prevent normal functioning.
305
Q: What are other indications for tonsillectomy besides recurrent tonsillitis?
A: Other indications include recurrent febrile convulsions secondary to tonsillitis, obstructive sleep apnoea, stridor, dysphagia due to enlarged tonsils, and peritonsillar abscess (quinsy) unresponsive to standard treatment.
306
Q: What are the primary complications of tonsillectomy?
A: Primary complications (within 24 hours) include haemorrhage (2-3% of cases, usually due to inadequate haemostasis) and pain.
307
Q: What are secondary complications of tonsillectomy?
A: Secondary complications (24 hours to 10 days) include haemorrhage (usually due to infection) and pain.
308
Q: What is vertigo?
A: Vertigo is the false sensation that the body or environment is moving.
309
Q: What are the main causes of vertigo?
Viral labyrinthitis
Vestibular neuronitis
Benign paroxysmal positional vertigo (BPPV)
Meniere's disease
Vertebrobasilar ischemia
Acoustic neuroma
Other causes: posterior circulation stroke, trauma, multiple sclerosis, ototoxicity (e.g., gentamicin).
310
Q: What are the characteristics of viral labyrinthitis?
A: Recent viral infection, sudden onset, nausea and vomiting, hearing may be affected.
311
Q: What are the characteristics of vestibular neuronitis?
A: Recent viral infection, recurrent vertigo attacks lasting hours or days, no hearing loss.
312
Q: What are the characteristics of benign paroxysmal positional vertigo (BPPV)?
A: Gradual onset, triggered by changes in head position, each episode lasts 10-20 seconds.
313
Q: What are the characteristics of Meniere's disease?
A: Associated with hearing loss, tinnitus, and sensation of fullness or pressure in one or both ears.
314
Q: What are the characteristics of vertebrobasilar ischemia?
A: Common in elderly patients, dizziness on extension of the neck.
315
Q: What are the characteristics of acoustic neuroma?
A: Associated with unilateral hearing loss, vertigo, tinnitus, absent corneal reflex, and often linked to neurofibromatosis type 2.
316
Q: What is vestibular neuronitis?
A: Vestibular neuronitis is a cause of vertigo that often develops following a viral infection.
317
Q: What are the features of vestibular neuronitis?
Recurrent vertigo attacks lasting hours or days
Nausea and vomiting may be present
Horizontal nystagmus is usually present
No hearing loss or tinnitus
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Q: What is the differential diagnosis for vestibular neuronitis?
Viral labyrinthitis
Posterior circulation stroke (distinguished using the HiNTs exam).
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Q: How is vestibular neuronitis managed?
Buccal or intramuscular prochlorperazine for rapid relief in severe cases
A short oral course of prochlorperazine or an antihistamine (cinnarizine, cyclizine, or promethazine) for less severe cases
Vestibular rehabilitation exercises for chronic symptoms.
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Q: What is viral labyrinthitis?
A: Viral labyrinthitis is an inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs. It is the most common form of labyrinthitis.
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Q: How does viral labyrinthitis differ from vestibular neuritis?
A: Viral labyrinthitis involves both the vestibular nerve and the labyrinth, causing vertigo and hearing impairment. Vestibular neuritis involves only the vestibular nerve, leading to vertigo without hearing loss.
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Q: What are the typical symptoms of viral labyrinthitis?
Acute onset of vertigo, not triggered by movement but worsened by movement
Nausea and vomiting
Hearing loss (unilateral or bilateral, varying in severity)
Tinnitus
Preceding or concurrent symptoms of upper respiratory tract infection
horizontal nystagmus
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Q: What are the signs of labyrinthitis?
Spontaneous unidirectional horizontal nystagmus towards the unaffected side
Sensorineural hearing loss (shown by Rinne's and Weber's tests)
Abnormal head impulse test (impaired vestibulo-ocular reflex)
Gait disturbance (patient may fall towards the affected side)
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Q: How is viral labyrinthitis diagnosed?
A: The diagnosis is largely based on history and clinical examination.
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Q: How is viral labyrinthitis managed?
Episodes are usually self-limiting
Prochlorperazine or antihistamines may help reduce dizziness.
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'Vesicles on the tympanic membrane'
ramsay hunt
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Management for otitis media with effusion (glue ear) but the child has downs
refer urgently to ENT
has cleft palate
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What is second line for otitis externa
oral flucloxacillin
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Causes of conductive hearing loss
otosclerosis
ear wax
otitis externa
glue ear
foreign body
cholesteatoma
eustachian tube dysfunction
perforated tympanic membrane
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Causes of senso-neural hearing loss
Presbycusis (age-related hearing loss).
Noise-induced hearing loss.
Meniere's disease.
Ototoxic medications (e.g., aminoglycosides, cisplatin).
Labyrinthitis.
Acoustic neuroma (vestibular schwannoma).
Multiple sclerosis.
Stroke affecting the auditory pathway.
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Antibiotic used in otitis externa
ciprofloxacin
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What do you do if glue ear is unilateral
refer to ENT 2 week wait
333
What type of hearing loss does a base of skull fracture result in
sensorineural
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how should prochlorperazine be used in vestibular neuronitis
used only in acute phase as can delay recovery
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What virus is linked to tonsil cancer
HPV
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