ENT

Question 1

What is benign paroxysmal positional vertigo?

Answer 1

Vertigo lasting seconds to minutes on changing head position (sitting to lying down, turning head suddenly)

Question 2

What causes benign paroxysmal positional vertigo?

Answer 2

Displacement of otoliths (from degeneration, trauma or post-viral) into the canals, resulting in canaliths

Question 3

How is benign paroxysmal positional vertigo managed?

Answer 3

Epley/Semont manoeuvres for posterior canal BPPV

Barbeque manoeuvre for horizontal canal BPPV

Question 4

What are the signs and symptoms of benign paroxysmal positional vertigo?

Answer 4

Less than 30s
Very intense, sudden onset
Nausea
Imbalance
Lightheadedness
No other neuro/otological symptoms
Normal neuro/oto exam

Question 5

How do you investigate benign paroxysmal positional vertigo?

Answer 5

Dix-Hallpike testing
Suddenly lower pt to supine, neck off couch 30 degrees below horizontal
+ve = vertigo + nystagmus
-ve –> CNS problem?

Question 6

Who is benign paroxysmal positional vertigo most common in?

Answer 6

50-70yos

Question 7

What are the risk factors for benign paroxysmal positional vertigo?

Answer 7

Increasing age
Female
Head trauma
Ear trauma/surgery
Migraines
Meniere's disease

Question 8

What is Meniere’s disease?

Answer 8

Recurrent episodes of tinnitus, paroxysmal vertigo and unilateral fluctuating hearing loss

Question 9

What causes Meniere’s disease?

Answer 9

Disturbed homeostasis of endolymph - fluid in inner ear

Question 10

How is Meniere’s disease investigated?

Answer 10

No specific test
Audiogram + MRI to rule out causes
+ve Romberg’s test - swaying/falling when stood with eyes closed
+ve Fukada’s stepping test - turn towards affected side when asked to march with eyes closed

Question 11

When does Meniere’s disease usually present?

Answer 11

40yo onwards

Question 12

What is a thyroglossal cyst?

Answer 12

Remnant found along the course of descent of the thyroid gland

Question 13

What causes a thyroglossal cyst?

Answer 13

• Thyroglossal duct –> tract of embryonic mesoderm –> descends to pretracheal site during development to form thyroid gland
• Duct normally disappears in week 6, if some tissue remains along its course, can develop into cyst
• 1% of cases associated w lingual/ectopic thyroid tissue

Question 14

Who usually gets thyroglossal cysts?

Answer 14

• Kids/adolescents

- Mean age = 5

Question 15

How does a thyroglossal cyst present?

Answer 15

• Midline, smooth, round swelling/lump (95% left side)
• Between thyroid notch and hyoid bone, can be found in submental region
• Moves upwards on tongue protrusion and swallowing
• Transilluminable
• Asymptomatic
• Tenderness/rapid enlargement due to infection in 5%

Question 16

How is a thyroglossal cyst investigated?

Answer 16

USS or MRI
Bloods - TFTs
FNA cytology - pre-op, usually benign epithelia, resp or squamous

Question 17

What is tonsillitis?

Answer 17

Infection of the tonsils

Question 18

What causes tonsillitis?

Answer 18

Most commonly bacterial:
B haemolytic Streptococcus
Pneumococcus
Haemophilus influenzae

Can also occur post viral infection

Question 19

How does tonsillitis present?

Answer 19

Sore throat
Enlarged tonsils
Difficulty swallowing
Malaise
Exudative inflammation
Pyrexia
Lymphadenopathy
Bad breath
Ear ache

Question 20

What are the risk factors for tonsillitis?

Answer 20

5-15yo

Enclosed spaces - schools, prisons etc

Question 21

How is tonsillitis investigated?

Answer 21

Diagnosed on Hx and exam

Can do throat culture - delays treatment so not useful