ENT

Question 1

Ménière’s disease:

Presentation

Answer 1

Fluctuating hearing loss that starts unilaterally
Aural fullness
Attacks that last minutes to hours

Diagnosis needs: x2 attacks lasting at least 20 mins, tinnitus/fullness, sensorineural hearing loss

Question 2

Ramsay Hunt Syndrome

Answer 2

Facial nerve herpes zoster

Causing facial paralysis, loss of tastes vestibulocochlear dysfunction, pain

Question 3

Ramsay hunt syndrome:

Tx

Answer 3

Immediate steroids and anti vitals to prevent facial paralysis or hearing loss

Question 4

Tympanic perforation:

Tx

Answer 4

None - will self heal 6-8 weeks

Question 5

Tympanic perforation from otitis media:

Tx

Answer 5

Abx

Question 6

Rinnes test:

Positive

Answer 6

Air conduction is better which is normal

Question 7

Rinnes test:

Negative

Answer 7

Can hear through bone better than through air, which implies conductive hearing loss

Question 8

Webers test:

Sensorineural deafness

Answer 8

Lateralises to unaffected side

Question 9

Webers test:

Conductive deafness

Answer 9

Lateralises to affected side

Question 10

Otitis media:

Presentation and Tx

Answer 10

Bulging tympanic membrane

Abx only if

Question 11

Indications for ABx in sore throat

Answer 11

Systemic upset
Unilateral peritonsilitis
Hx rheumatic fever 
DM/ immunodeficiency 
3 or more centor: tonsilar exudate, lymphadenopathy, fever, no cough

Question 12

Ménière’s disease

Answer 12

Build up of fluid in labyrinth causing vertigo, hearing loss

Question 13

Presbycusis

Answer 13

Age-related sensorineural hearing loss.

Audiometer shows bilateral high frequency loss

Question 14

Otosclerosis

Answer 14

Autosomal dominant
Normal bone replaced by spongey vascular bone
20-40 year olds
Conductive deafness
Tinnitus
Flamingo tympanic membrane

Question 15

Grommet criteria

Answer 15

Bilateral OME lasting 3 months+ with hearing of 25-30 I’m better ear

Question 16

Nasal polyps:

Signs and symptoms

Answer 16

Vary with season or URTI
Rhinitis and sinusitis
Nasal obstruction
Pale/grey
No sensation 
Mobile
Unilateral is malignant until proven otherwise

Question 17

Nasal polyps:

Tx

Answer 17

Steroids - Betamethasone 2 weeks, then fluticasone 3 months

Large polyps:
Oral steroids 30mg OD 1 week then fluticasone 3w

Surgery - FESS

Question 18

Rhinitis:

Ix

Answer 18

Rhinoscopy/endoscopy
Skin prick
RAST

Question 19

Rhinitis:

Types

Answer 19

Allergic
Infective
Idiopathic
Drug-induced (aspirin, NSAIDS, contraceptives, beta blockers)
Pregnancy
Auto-immune: SLE, RA, AIDS,

Question 20

Anosmia:

Causes

Answer 20

Obstructive: polpys, tumor, bony deformity
Mucositis (infective): rhinitis, sinusitis
Neurological: MS, aneurysm, surgery, trauma, Parkinson’s

Question 21

Cholesteatoma

Answer 21

Tissue collection middle ear

Can be congenital, or acquired due to Eustachian tube dysfunction, tympanic membrane trauma, acute otitis media

Progressive conductive hearing loss ottorhea +-vertigo, headache, facial nerve palsy, neck abscess, meningitis

Tx tympanoplasty/mastoidectomy

Can often recur

If left will invade local structure and can cause permanent deafness, facial weakness, brain abcess, death

Question 22

Hoarse voice:

Causes

Answer 22

URTI
laryngeal cancer
Laryngeal palsy 
Vocal nodules 
Reflux pharyngitis

Question 23

Laryngeal cancer:

Signs/ risk factors

Answer 23

Smoking
Referred pain to ear - constant 
Neck lump
Progressive 
Pain

Question 24

Cystic hygroma

Answer 24

From jugular venous sac
Embryological remnant
In posterior triangle usually
Always on the left

Question 25

BPPV

Answer 25

Debris in semicircular canal
Disturbed by head movement, lasts few seconds
Nystagmus seen on hall pike manouevre
Treat with epley manouevre

Question 26

Acoustic neuroma (vestibular schwannoma)

Answer 26

Unilateral hearing loss followed by vertigo
Can start to affect other nerves going through auditory canal (5,6,9,10)
Don’t always need removing