ENT

Question 1

A 36-year-old man presents with recurrent episodes of right-sided tinnitus, hearing loss and vertigo. These episodes typically last between 10-30 minutes. He also describes a ‘full’ sensation in his right ear. Otoscopy is unremarkable and the cranial nerve examination is normal.

Answer 1

Meniere’s disease

Question 2

A 31-year-old man presents with bilateral hearing loss and tinnitus. There is a family history of similar problems. Examination of the tympanic membranes is unremarkable. Audiometry shows bilateral conductive hearing loss.

Answer 2

Otosclerosis

Question 3

A 2-year-old boy is brought in by his mother due to concerns about his hearing and delayed speech. She has noticed problems for the past three months. You can see from the notes that he has had frequent courses of amoxicillin for otitis media in the past. There is no evidence of excessive ear wax on examination.

Answer 3

Glue ear

Question 4

A 19-year-old presents to his general practitioner (GP) with an asymptomatic right sided neck lump that he noticed 4 weeks previously. On examination the lump is soft and mobile, is within the dermal layer of the skin and on transillumination the area is equal to the surrounding tissue. There is no central punctum. What is the most likely diagnosis?

Answer 4

Lipoma

Question 5

A 44-year-old woman presents with a neck swelling. She is systemically well. On examination she is noted to have a midline, non-tender neck swelling which moves upwards when she swallows.

Answer 5

goitre

Question 6

A newborn baby is noted to have a large swelling on the left-side of the neck. On examination a soft, fluctuant and highly transilluminable lump is noted just beneath the skin.

Answer 6

Cystic hygroma

Question 7

An 18 year old student presents to your GP practice after presenting to you a week ago with a supraclavicular neck lump. The last consultation reads that she had also been feeling unwell with night sweats and loss of appetite. On examination the neck lump was rubbery and non-tender.

A biopsy has been taken and she has come for the results. The report shows cells with a ‘mirror image nuceli’ .

What is the most likely diagnosis?

Answer 7

Hodgkin’s lymphoma

Question 8

A 23-year-old man is diagnosed as having nasal polyps. Sensitivity to which medication is associated with this condition?

Answer 8

Asprin

Question 9

A 74-year old man presents with dizziness. He describes the dizziness as a spinning sensation which came on suddenly this morning while he was doing the gardening. He also complains of right sided hearing loss over the past 9 months, which is progressively getting worse. The hearing loss is present throughout the day. On examination, he does not have nystagmus or middle ear signs. Weber’s test lateralises to the left ear and Rinne’s is positive in both ears.

What is the most likely diagnosis?

Answer 9

Acoustic neuroma

Question 10

A 77-year-old man, Henry, reports that he has had increasing difficulty hearing over the past few months. He usually plays bingo on Tuesday evenings and has noticed that he often has to ask the number caller to repeat themselves. He has also had a complaint from his neighbour who has said that Henry’s television volume is often too loud. Henry comes to see you as he would like to know whether his hearing problems could be something to do with his medications.

Which one of the following medications is associated with ototoxicity?

• Simvastatin
• bendoflumethiazide
• Quinine
• Aciclovir
• Amlodipline

Answer 10

Quinine

Question 11

A 62-year-old man with a 3 month history of dizziness when he rolls over in bed. Episodes last for about 20 seconds

Answer 11

Benign paroxysmal positional vertigo

Question 12

A 51-year-old female with a 3 week history of vertigo, right ear tinnitus and the sensation of fullness in her right ear

Answer 12

Meniere’s disease

Question 13

A 33-year-old with coryzal symptoms presents with a one day history of vertigo and nausea. There is no hearing loss on examination

Answer 13

Viral labyrinthitis

Question 14

A 48-year-old female presents to the GP with a lump in throat. She can swallow foods and liquids normally if she tries, although she has noticed the discomfort is worse on swallowing saliva. She does not have any pain on swallowing, chest pain or heart burn. Her appetite is normal.

What is the most likely diagnosis?

Answer 14

Globus pharyngis

Question 15

A 20-year-old girl presents with a thyroid cancer, she is otherwise well with no significant family history. On examination she has a nodule in the left lobe of the thyroid with a small discrete mass separate from the gland itself. Which of the following is the most likely cause?

Answer 15

Papillary carcinoma

Question 16

A 21-year-old man presents with halitosis and mouth pain. Examination reveals very poor dental hygiene with bleeding gums and widespread gingival ulceration. He has a temperature of 38.0ºC. You advise him to see a dentist. What other treatment options should be offered?

Answer 16

Paracetamol + oral metronidazole + chlorhexidine mouthwash

Question 17

A 42-year-old woman presents as she has noticed a ‘droop’ in the right side of her face since she woke up this morning. There is no associated limb weakness, dysphagia or visual disturbance. On examination you notice right-sided upper and lower facial paralysis. Which one of the following features would be most consistent with a diagnosis of Bell’s palsy?

Answer 17

Hyperacusis

Question 18

A 74-year-old man presents with a 8-week history of right sided otalgia. This is associated with a sore throat and odynophagia. He smokes 20 cigarettes every day and is known to be a heavy drinker. On examination of the ear there are no abnormalities noted.

What is the most likely cause of the otalgia?

Answer 18

Referred pain from nasopharyngeal carcinoma

Question 19

A 51-year-old female presented to her GP with a nodule on the thyroid region of her neck. She has a past medical history of Cushing’s disease and small mucosal neuromas. She was referred to the ENT surgeons who performed a biopsy and unfortunately diagnosed her with having thyroid cancer. On her blood tests, she was noted to have a raised calcitonin level. From the information provided above, what type of thyroid cancer is this lady most likely suffering from?

Answer 19

Medullary

Question 20

A 24-year-old man who is suffering from sinusitis asks about using Sudafed (pseudoephedrine). Which one of the following medications would make the use of Sudafed contraindicated?

• Sodium valproate
• Monoamine oxidase inhibitor
• Salbutamol
• Triptan
• Selective serotonin reuptake inhibitor

Answer 20

Monoamine oxidase inhibitor

A monoamine oxidase inhibitor combined with pseudoephedrine could potentially cause a hypertensive crisis.

Question 21

You review a 25-year-old man who has allergic rhinits. He has been using intranasal oxymetazoline which he bought from the local chemist for the past 10 days. What is the main side-effect of using topical decongestants for prolonged periods?

Answer 21

Tachyphylaxis

Question 22

A 80-year-old lady presents with a 5 day history painful left sided neck swelling below the angle of the jaw. She also complains of a foul taste in her mouth. On examination, she has a temperature of 37.8ºC and a 4x5cm submandibular mass which is tender to palpation. There is associated tender lymphadenopathy. What is the most likely diagnosis?

Answer 22

Sialadenitis

Question 23

You see a 40 year old man with reduced hearing on the right side. You examine his ears and note the right ear canal is blocked with wax but the left ear is clear. What would be the expected findings on testing Rinne and Weber?

Answer 23

Weber: sound localises to the right; Rinne: negative on the right and positive on the left

Question 24

A 25-year-old women presents with a slowly enlarging mass on the side of the face. Clinical examination demonstrates that the mass is located in the tail of the parotid gland. There is no evidence of facial nerve involvement. What is the most likely cause?

Answer 24

Pleomorphic adenoma

Question 25

A 25-year-old teacher comes to see you as she is worried that she is going deaf as she finds it increasingly difficult to hear things that her pupils are saying and often has to ask them to speak louder. She also has occasionally experienced ringing in both of her ears. She first noticed these symptoms 1 year ago but says they have gradually worsened since she became pregnant 3 months ago.

Rinne’s and Webers tests are performed. Rinne’s test shows that she can hear bone conduction louder than air conduction bilaterally, Weber’s test does not lateralise to either side.

Which one of the following is the most likely diagnosis?

Answer 25

Otosclerosis

Question 26

A 45-year-old lady has recently undergone a thyroidectomy for treatment of medullary thyroid cancer. Which of the following tumour markers is used clinically to screen for recurrence?

• Free T3
• Thyroglobulin
• Calcitonin
• Free T4
• Thyroid stimulating hormone

Answer 26

Calcitonin