ENT

Question 1

Menieres anti emetic

Answer 1

prochlorperazine

Question 2

What is the most common cause of hearing impairment post head injury

Answer 2

Perforated tympanic membrane

Question 3

cervical lymphadenopathy suspicious of malignancy Ix

Answer 3

FNAC

Question 4

Tympanometry showing a type B (flat) curve with normal canal volume has a very high positive predictive value for

Answer 4

otitis media with effusion (OME)

Question 5

when to give delayed prescription for ear infection

Answer 5

1-2 days = delayed

Question 6

adult-onset asthma, symptoms of nasal obstruction and bilateral nasal polyps classical features of

Answer 6

Eosinophilic granulomatosis with polyangitis

Question 7

A 50-year-old woman presents to her GP with a painless swelling in her right parotid gland area for the past six months. She also reports experiencing dry mouth and eyes over the same period. She is afebrile, and denies any weight loss over this period. Schirmer’s test is abnormal.
Which of the following is the most likely diagnosis?

Answer 7

The patient’s presentation of painless parotid gland swelling along with symptoms of xerostomia (dry mouth), keratoconjunctivitis sicca (dry eyes) and decreased tear production is highly suggestive of Sjögren’s syndrome. Sjögren’s syndrome is associated with an increased risk of developing lymphoma, particularly mucosa-associated lymphoid tissue (MALT) lymphoma, also known as marginal cell lymphoma, in the salivary glands. The presence of a painless parotid gland swelling raises concern which should be investigated further with imaging studies and possibly biopsy.

Question 8

The Type C tympanogram in the right ear is indicative of

Answer 8

negative middle ear pressure, which often occurs due to Eustachian tube dysfunction.

Question 9

Pleomorphic adenomas are the most common tumours within the parotid gland, however rarely

Answer 9

invade the facial nerve and rarely cause facial nerve palsy

Question 10

Name the malignant tumour of the parotid gland more likely to invade the surrounding structures such as the facial nerve, leading to facial nerve palsy

Answer 10

Adenoid cystic carcinoma

Question 11

A 55 year old man has voice hoarseness, throat pain and right ear pain that has gradually progressed over one week. He has a 20 pack year smoking history and drinks 30 units of alcohol per week. He has no significant medical history and takes no regular medications. ENT examination is unremarkable.
What is the most likely diagnosis?

Answer 11

laryngeal SSC

Question 12

A 54 year old woman presents with acute onset right sided vertigo lasting 15 hours. This is associated with dulling of her hearing on the right side. She states that it began suddenly with no obvious trigger while she was sitting on the sofa. She can hear a faint buzzing in her ear and feels nauseous. She states that she had a mild viral illness one week earlier. On examination all cranial nerves are intact. Otoscopy reveals a translucent tympanic membrane with normal ossicles and no effusion.
What is the most likely diagnosis?

Answer 12

acute (viral) labyrinthitis

Question 13

Biggest head and neck cancer RF

Answer 13

Human papillomavirus type 16 (HPV16) seropositivity is associated with an increased risk of oral, pharyngeal and laryngeal cancer

Question 14

A 72-year-old man presents to the emergency department with recent onset of sore throat, difficulty swallowing and pain on swallowing. From the bedside, you hear a loud, harsh, high-pitched respiratory sound on inspiration. His respiratory rate is 26 and his oxygen saturation is 95% on air. He is started on high-flow oxygen. His respiratory rate and his oxygen saturation remain unchanged. On brief examination, the oropharynx appears unremarkable. There is anterior neck tenderness, especially over the hyoid bone.
What is the best next step in the management of this patient?

Answer 14

Give nebulised adrenaline and IV dexamethasone
This is the correct answer. The most likely diagnosis is supraglottitis (inflammation of the soft tissues just above the vocal cords). Nebulised adrenaline and IV dexamethasone are effective in reducing mucosal oedema. You should call for senior ENT and anaesthetics input immediately as this is an airway emergency and will require a definitive airway

Question 15

A 42-year-old man presents to ENT clinic with a neck lump. He is otherwise asymptomatic. He occasionally drinks alcohol and smokes. The lump is located 7 cm below the right ear lobe, just anterior to the anterior border of the sternocleidomastoid muscle. A biopsy is taken. Pathology results indicate squamous cell carcinoma (SCC) that is p16 positive.
What is the most likely primary site?

Answer 15

Oropharynx
This is the correct answer. p16 is a surrogate marker for human papilloma virus (HPV), and oropharyngeal squamous cell carcinoma (SCC) is very commonly driven by HPV. Oropharyngeal cancer commonly present as an isolated neck mass without any symptoms. Tonsils and tongue base are the primary sites most associated with a HPV+ve oropharyngeal SCC. They tend to be seen in younger (40-50s) patients with little smoking and/or drinking history

Not oral cavity as not HPV driven

Question 16

A 20 year old man presents to his GP complaining of foul smelling discharge from the right ear.
It has been persistent for the past three months and has been getting progressively worse. He is particularly aware of the discharge upon waking, as it covers his pillow. He does not report any pain in his ear, but does report some problems hearing in the right ear.
On examination there are no signs of focal neurology.
What is the definitive management for the most likely diagnosis?

Answer 16

surgical excision for cholesteatoma

Question 17

A 30 year old woman is on the ward 12 hours post-op after parathyroidectomy to remove a parathyroid adenoma. A drain is in situ from the wound. On the ward she suddenly develops respiratory distress. From the end of the bed, an obvious large neck swelling is apparent overlying the surgical site. There are no obvious abnormalities on inspection inside the mouth.
What is the most appropriate initial management?

Answer 17

remove surgical clips

Question 18

haematoma mx

Answer 18

incision and primary closure if 7 days old, otherwise just aspirate

Question 19

A 30 year old woman is involved in a road traffic accident. Primary survey shows no obvious abnormalities and her observations are normal. However, there is blood-stained serous discharge from the right ear. On otoscopy, blood is visualised behind the tympanic membrane. When the discharge is dropped onto filter paper, it demonstrates the “halo sign”.
Which additional finding would be most in keeping with the most likely diagnosis?

Answer 19

Bruising around the mastoid region
This patient has a basal skull fracture, specifically in the middle fossa through the petrous temporal bone. When cerebrospinal fluid leaks through the fracture out of the auditory canal, it can be dropped onto filter paper and a “halo sign” can be seen. Another feature of petrous temporal bone fracture is a collection of blood behind the tympanic membrane. Bruising around the mastoid region is otherwise called “battle sign” and is an additional feature of petrous temporal bone fracture that may take hours to develop

Question 20

Noise-induced hearing loss, the patient has a strong risk factor (heavy metal band) and has sensorineural deafness and tinnitus worse when trying to fall asleep (i.e. worse when the environment is quiet). Established noise-induced hearing loss should be treated with

Answer 20

hearing aids in the first instance

Question 21

watery anterior rhinorrhoea, purulent post-nasal drip, snoring, mouth-breathing and headaches. Diagnosis?

Answer 21

The diagnosis is likely nasal polyps as a complication of chronic sinusitis. Nasal polyps are associated with allergic rhinitis (hay fever), aspirin hypersensitivity, non-allergic rhinitis and cystic fibrosis.

Question 22

Nasal polyps Dx and Mx

Answer 22

Diagnosis is confirmed by anterior rhinoscopy or nasal endoscopy. First-line management comprises topical steroid drops to shrink the polyps. The patient must be counselled to tilt their head upside down when administering the drops, not backwards

Question 23

sensorineural hearing loss (SSNHL) is an

Answer 23

ENT emergency. Differentiate from tympanic membrane rupture

Question 24

what is this

Answer 24

Tympanosclerosis- chalky white patches

Question 25

what is this

Answer 25

cholesteatoma

Question 26

indications for 2 week wait as suspicious of malignancy in paranasal sinus malignancy

Answer 26

This should be suspected in any adult that presents with chronic (>12 weeks) rhinosinusitis for the first time. Additional alarm symptoms include blood-stained nasal discharge and swelling overlying the sinus.

probably SSC

Question 27

unilateral nasal obstruction, epistaxis, facial pain, and/or swelling. Persistent bleeding/crusting

red flags for

Answer 27

The most common presenting symptoms of sinonasal carcinoma

Question 28

An anxious mother has brought her 18 month old son into your practice as he has been crying for the last 2 days with a fever of 38 degrees according to a temperature colour strip she has used at home. He seems playful in clinic but repeatedly tugs at his left ear. On examination with an otoscope you see erythema of the tympanic membrane, which is bulging, and behind it is an effusion.
What is the correct management for this patient?

Answer 28

Analgesia and observe for 48 hours and if symptoms worsen, consider antibiotics
This is the correct option. Antibiotics are only considered for children under two years if they have bilateral otitis media or systemtic infection or symptoms >3 days.