ENT

Question 1

Otitis externa management?

Answer 1

Consider cleaning
Analgesia (paracetamol + ibuprofen)
Consider TOPICAL antibiotic + steroid
If perforated ear drum = quinolone

Question 2

Who to admit for acute otitis media?

Answer 2

< 3 months and fever > 38C

Patients with acute complications

Question 3

Treatment for acute otitis media (without effusion)

Answer 3

Treat pain and fever
Paracetamol
OR
NSAID

Question 4

When to prescribe antibiotic for otitis media (without effusion)

Answer 4

Symptoms > 4 days (and not improving)
Systemically unwell
High risk of complications

Question 5

Management of acute otitis media with effusion?

Answer 5

Active observation (6-12 weeks)
No antibiotics

(children with Down’s syndrome or cleft palate - immediate ENT referral)

Question 6

Diagnosing chronic suppurative otitis media

Answer 6

• Painless ear examination with perforated tympanic membrane
• Ear discharge > 2 weeks without pain/fever
• History of:
  Acute otitis media
  OME/Grommets
  Ear trauma

Question 7

Cholesteatoma - when to arrange ROUTINE ENT referral?

Answer 7

Characteristic cholesteatoma
OR
Persistent occlusion of external auditory canal with purulent discharge

Question 8

Cholesteatoma - when to arrange EMERGENCY ENT referral?

Answer 8

Facial nerve palsy
Neuro symptoms (indicative of intracranial abscess or meningitis)

Question 9

Allergic rhinitis - as required treatment?

Answer 9

Intranasal azelastine

Oral antihistamine (cetirizine or loratidine)
IF:
Conjuncitivitis present
Children aged 2 - 5
Or they prefer oral treatment

Question 10

Test for BPPV?

Answer 10

Dix- Hallpike manoeuvre

Question 11

Treat BPPV?

Answer 11

Epley manoeuvre

Question 12

Home treatment for BPPV?

Answer 12

Brandt-Daroff exercises

Question 13

When to remove earwax?

Answer 13

When canal is full and anyone of:
Hearing loss
Earache
Tinnitus
Vertigo
Cough thought to be due to wax

Question 14

Meniere’s disease characteristics?

Answer 14

Tinnitus
Vertigo
Intermittent hearing loss
Aural fullness
Attacks last minutes to hours (2-3hrs)

Question 15

Drug to prevent recurrent attacks in Meniere’s?

Answer 15

Betahistine

Question 16

Acute sinusitis summary?

Answer 16

98% people have a virus - 2.5 weeks self limiting
Paracetamol/Ibuprofen
Nasal decongestant
Saline nasal irrigation
Fluids

Question 17

Subjective and objective tinnitus?

Answer 17

Is it heard through stethoscope - if yes, objective +vice versa

Question 18

Causes of unilateral subjective tinnitus

Answer 18

Acoustic neuroma

Meniere’s disease

Question 19

Causes of bilateral subjective tinnitus

Answer 19

Noise-induced hearing loss
Age related hearing loss
Drug induced ototoxicity

Question 20

Vestibular neuronitis and labrynthitis patient?

Answer 20

Young, middle aged, previously well adults

Question 21

Features of vestibular neuronitis and labrynthitis?

Answer 21

Vertigo - occurs spontaneously
Nausea and vomiting
Nystagmus

NB Hearing loss (and tinnitus) is associated with labrynthitis

Question 22

Treatment for vestibular neuronitis?

Answer 22

Usually settles, but if vomiting and nausea a problem:
Prochlorperazine
- buccal or deep IM if needed to rapidly alleviate
OR
- 3 days then PRN

Question 23

Acute necrotizing ulcerative gingivitis treatment?

Answer 23

Metronidazole
Paracetamol/ibuprofen
Chlorhexidine mouthwash

See dentist urgently

Question 24

Acoustic neuroma nerve impacts?

Answer 24

CNVIII - hearing loss, tinnitus, vertigo
CNVII - facial palsy
CNV- absent corneal reflex

Question 25

Drugs associated with tinnitus (bilateral)?

Answer 25

Aspirin
Aminoglycosides
Loop diuretics
Quinine