ENT

Question 1

Primary causes of otalgia?

Answer 1

Perichondritis/chondritis
Shingles
Otitis Externa
Furuncles (viral - self-limiting)
Acute Otitis Media
Bullous myringitis (viral - self-limiting)

Question 2

Secondary causes of otalgia?

Answer 2

MSK/Cervical spine - involving great auricular nerve (a branch of cervical plexus)
Dental disease (tooth impaction, abscess or TMJ dysfunction)
Paranasal sinus disease/post-nasal space
Throat: tonsilitis/tumour?

Question 3

What is a cholesteatoma?

Answer 3

Invasive growth of keratinising epithelium. Presents with hearing loss and offensive discharge

Question 4

Causes of chondritis/perichondritis?

Answer 4

Cellulitis, otitis externa

Question 5

Consequences of untreated chondritis?

Answer 5

Irreversible loss of cartilage - in nose: saddle deformity, in ear: cauliflower ear

Question 6

What is Ramsay Hunt Syndrome?

Answer 6

Facial nerve palsy and vesicles in ear due to reactivation of Herpes Zoster in facial nerve. (shingles)

Question 7

A diabetic with persistent, very painful OE you are worried about. What is going on?

Answer 7

Swab grows psuedomonas aeurginosa.
Necrotising (old name: malignant) otitis externa
Can expose bone.
Requires IV antibiotics (ciprofloxacin/clindamycin)

Question 8

Where is the light reflex point on the tympanic membrane/other anatomy stuff of TM?

Answer 8

Towards the nose.

Question 9

Difference between odynophagia and dysphagia?

Answer 9

Odynophagia: painful swallon and dysphagia: difficulty swallowing

Question 10

Common causes of epistaxis?

Answer 10

Hypertension, bleeding disorders, medication, sinusitis, fractured nose, picking of nose, growth in the nose

Question 11

Advice after a nosebleed

Answer 11

Do not blow it for 3 days
Avoid allergens
If sneeze - keep mouth open
Avoid hot drinks, spicy food and alcohol
For 2 weeks: avoid strenuous exercise, bending, straining on the toilet and heavy lifting. 
24 hour rest

Question 12

Advice for a nosebleed.

Answer 12

Sit up straight with head forward
Pinch nose just blow bone: for 10 minutes
If bleeding continues suck some dry ice.

Question 13

What to assess when looking at TM?

Answer 13

Colour, position, integrity, sclerosis/scarring, fluid/meniscus level, mobility (using pneumatic otoscope/valsalva)

Question 14

By how many times does the stapes amplify sound?

Answer 14

20 times

Question 15

On an audiogram what is left/right?

Answer 15

Left = x, right = O (R [face] L)

Question 16

Good way to manage parents who want antibiotics for AOM?

Answer 16

Deferred prescription

Question 17

What is the most reliable way to diagnose OME?

Answer 17

Lack of mobility of TM (98% concordance)

Question 18

Common AOM bugs?

Answer 18

staph aureus, strep pneumococcus, haemophilus influenzae, moraxella catarrahalis