ENT

Question 1

what is a cystic hygroma and where might you find it

Answer 1

cystic lymphangioma, congenital lymphatic lesion, usually found in armpits or left posterior triangle
-most are evident at birth

Question 2

what is a branchial cyst and where might you find it?

Answer 2

it is a large mobile mass between the sternocleidomastoid muscle and the pharynx

Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood

Question 3

borders of the anterior triangle in the neck

Answer 3

medial side sternocleidomastoid
imaginary mid line
mandible

Question 4

borders of the posterior triangle in the neck

Answer 4

lateral side sternocleidomastoid
middle 1/3 clavicle
trapezius muscle

Question 5

what is FESS

Answer 5

functional endoscopic sinus surgery
drains the paranasal sinuses
in chronic sinusitis or polyposis

Question 6

if patient is having a massive nose bleed what should you do?

Answer 6

-FBC- coagulation screen
-group and save
anterior nasal packing, posterior nasal packing if continued
-admit to the ENT ward
-consider ligation of blood vessel

Question 7

whats the area of the nose called that is most prone to bleeding

Answer 7

Little’s area

Question 8

what blood vessels make up littles area

Answer 8

1. anterior ethmoid
2. sphenopalatine
3. greater palatine

Question 9

what should you advise a patient with epistaxis

Answer 9

avoid hot drinks, hot baths and showers, picking nose, hot and spicy foods

Question 10

what should you do if a patient on warfarin has a nosebleed

Answer 10

omit the warfarin for 24 hours and discuss with a senior

Question 11

common organism to infect the nose`

Answer 11

staph A

Question 12

malignancy in chinese to cause nosebleeding

Answer 12

postnasal space nasopharyngeal carcinoma squamous cell carcinoma

Question 13

Lymphoma neck lump characteristics

Answer 13

rubbery, painless swelling, becomes tender with alcohol, patient may also report night sweats and fever
splenomegaly may be associated also

Question 14

presenting features of nasopharyngeal carcinoma

Answer 14

unilateral otalgia, serous otitis media, epistaxis, feeling of blockage in the nose, hard cervical lymphadenopathy, cranial nerve palsies 3-6

Question 15

tmt nasopharyngeal carcinoma

Answer 15

radiotherapy

Question 16

nasopharyngeal carcinoma is associated with which virus?

Answer 16

EBV

fun fact! also associated with nickel exposure!ask if they worked in furniture manufacture

Question 17

symptoms of rhinosinusitis

Answer 17

-nasal blockage
-discharge
+/-
-loss of sense of smell
-facial pain/pressure

may be associated with nasal polyposis

Question 18

how many weeks must rhinosinusitis be going on for to be considered chronic

Answer 18

12

Question 19

how would you investigate rhinosinusitis

Answer 19

anterior rhinoscopy
nasendoscopy
RAST testing - to find allergens
IgE testing- to look for allergic causes
cANCA- to rule out GPA
ACE- to rule out sarcoidosis
CT SCAN

Question 20

ddx rhinosinusitis

Answer 20

tension headache
migranous headache
atypical facial pain

Question 21

tmt of rhinosinusitis

Answer 21

steroid sprays, antihistamine sprays , systemic steroids, macrolide antibiotics (erythromycin, clarythromycin)
then FESS

Question 22

FESS info, complication

Answer 22

surgery through the nose, to clear out the infective content , may clear small bits of bone and skin/polyps, there are no scars to the face

uncommon
patient may have some orbital bruising

bleeding risk, risk of csf leak, risk of infection

common
mild pain , treatable with simple analgesia