ENT

Question 1

Which bone can you see on ear drum?

Answer 1

malleus

Question 2

2 causes of conductive hearing loss

Answer 2

Outer - Wax / object

Middle - Otitis media / otosclerosis

Question 3

4 causes of SN hearing loss

Answer 3

Congenital Infections (Rubella, CMV, Syphillis)

Neoplasm: Acoustic Neuroma

Infection: Meningitis

Idiopathic: Merniere‘s

Ototoxic Dx (Aminoglycosides)

Age: Presbycusis

Noise Induced

Neurovascular

Question 4

33y complains of poor hearing in the left ear, which has become worse in the past year. She has a family history of uncle and father going deaf in their 40’s

Examination reveals normal ear drums and tuning-fork testing shows Weber test localising to the right and a negative Rinne test on that side.

Dx?
Pathology?
Sx?
Ix?
Mx?

Answer 4

Otosclerosis

AD - hard bone in labyrinth replaced with spongey bone

Sx

• hearing loss usually bilateral
• tinitus
• Vertigo

Ix

• Audiogram (conductive loss)
• Tympanogram
• CT scan

Mx
Observation – if mild
Hearing Aid – if symptomatic

Stapedectomy

Question 5

Unilateral SN hearing loss is what?

Mx?

Answer 5

Acoustic neuroma

Observation if slow
Surgical / radio

Question 6

3 year old presented with fever, irritability, ear tugging, not responding when called by mum

OE: bulging, erythematous TM with a absence of light reflex

Dx?
Comps?

Answer 6

Acute otitis media

Mastoiditis
Intracranial Infection / meningitis

Question 7

A 24-year old has had problems with his ears for most of his life. He has had three sets of grommets for glue ear and numerous ear infections. However, he now has a constant discharge from his right ear for 3 months, which is foul-smelling.

Examination shows the ear canal to be full of debris and mucus. Once this had been removed, a polyp was seen to be filling most of the ear canal, obscuring the tympanic membrane.

Dx?
What is it?
Sx?
Ix?
Mx?

Answer 7

Cholesteatoma
Keratinising squamous epithelium

Sx
Hearing loss (conductive)
Discharge (otorrhea)
foul-smelling

Ix
Otoscopy

Mx
Surgical removal
-Atticotomy – if small and limited to the attic
-Radical Mastoidectomy – if more advanced and extends into mastoid

Question 8

3 Comps of cholesteatoma

Answer 8

Erodes into:

Ossicles – causing conductive deafness

Facial Nerve – causing facial palsy

Labyrinth – causing vertigo

Tegmen (roof of middle ear) – causing intracranial sepsis

Cochlea – causing sensorineural deafness

Sigmoid Sinus – causing it to thrombosis

Question 9

UMN/LMN facial palsy

Ix?

4DDx

Answer 9

forehead spared in UMN
totaL weakness in LMN

• Audiogram
• Stapedial reflexes
• MRI / CT in some cases

trauma - temporal bone fracture

Infection -Ramsay unt syndrome
cholestanoma
otitis media

Neuro
Ms

Neoplasm
Parotid

Idiopathic
Bells

Question 10

Ramsay hunt is what?
3sx?
Ix?
Mx?

Answer 10

Reactivation of varacella zoster in geniculate ganglion

Pain, CNVII palsy, vesicles, hearing loss

PCR for VZV
pure tone audiometry

Corticosteroids
acyclovir
eye care - eg lube eye drops

Question 11

Most common cause of epistaxis ?

name of area on septum it usually originates?

Answer 11

Trauma

Little’s area

Question 12

2 reasons to do FBC in epistaxis

Answer 12

anaemia

thrombocytopenia

Question 13

Epistaxis initial mx

If no sucsess?

Answer 13

sit upright and lean forwards
apply ice to bridge of nose

Monitor - pulse / BP
-IV acess / fluids if needed

packing

• > Cauterisation for anterior / balloon for posterior
• > Embolisation of artery

Question 14

Pain on swallowing is called?

Answer 14

odynophagia

Question 15

2 DDx for tonsilitis?

Answer 15

infectious mononucleosis
Scarlett fever
Diptheria

Question 16

Why not amox if tonsilitis

Answer 16

if actually EBV -> rash

Question 17

Which sided recurrent laryngeal nerve palsy is more common?

Answer 17

Left - longer course than right

Question 18

What muscle in swallowing not supplied by recurrent laryngeal

Answer 18

cricothyroid - superior laryngeal

Question 19

How to view vocal cords

Answer 19

laryngoscopy

Question 20

2sx of vocal cord palsy

Answer 20

hoarseness
reduced volume of voice
SOB
cough

Question 21

name 3/5 facial nerve branches

Answer 21

temporal 
zygomatic 
buccal 
marginal mandibular 
Cervical

Question 22

2 long term comps of bells palsy

Answer 22

damage to eye - due to reduced lacrimation / unable to close
altered taste
psychological

Question 23

4DDx of vertigo

Answer 23

menniers 
BPPV 
vestibular neuritis 
acoustic neuroma 
MS
Drugs - gent / metronidazole / diuretics

Question 24

Mx of BPPV

Answer 24

Reassure
Reduce alcohol

Medical - betahistine

Surgical

Question 25

otitis media
2 bugs?
2 things seen on otoscopy?
mx?

Answer 25

strep pneumonia
h influenza

Bulging ear drum
red / dull appearance
prominent vessles
perforation

Amox
analgesia
antipyretics

Question 26

How is kids eustachian tube different to adults? what does this mean?

Answer 26

Shorter / narrower

-> poor drainage + more likely to get infections of middle ear

Question 27

what is a positive rinnes

Tuning fork Hz?

Answer 27

air > bone = benign

512Hz

Question 28

Name 2 paranasal sinuses?

Epithelium?

Answer 28

maxillary, ethmoid, sphenoid, frontal

ciliated pseudostratified columnar

Question 29

Mx of acute sinusitis

Answer 29

analgesia / antipyretics
decongestants
[amox - some peeps say no]

Question 30

2 causes of sinusitis

Answer 30

following URTI
Swimming
tauma
Ca

Question 31

2 signs parotid swelling is malignant

Answer 31

pain
fast growing
CNVII palsy
fixing to other structures