ENT

Question 1

Types of stridor and their respective sites of origin

Answer 1

Inspiratory - vocal cords and above
Biphasic - level of cricoid
Expiratory - high trachea

Question 2

How many episodes of tonsillitis do you need in one year to warrant a tonsillectomy

Answer 2

7

Question 3

Post op management of tonsillectomy

Answer 3

Eat and drink immediately to reduce cramps
Analgesia - paracetamol and ibuprofen
Monitor sats

Question 4

Complications of tonsillectomy

Answer 4

Type 2 resp failure as children aren’t used to breathing at night through a non-obstructed airway so respiratory centre needs to reset
Bleeding - get child to suck on ice cube to vasoconstrict blood vessels

Question 5

Examination findings of mastoiditis

Answer 5

Inflamed mastoid
Ear protruded forwards
Bulging tympanic membrane
Fever

Question 6

Investigations for mastoiditis

Answer 6

CT with contrast temporal bones and head

• detects venous sinus thrombosis
• detects intracranial abscesses
• plan surgery for incision and drainage

Question 7

Management of mastoiditis

Answer 7

Admit
IV antibiotics
Analgesia
Fluids
Incision and drainage

Question 8

Complications of mastoiditis

Answer 8

Facial nerve palsy
Intracranial or extracranial abscess
Sigmoid sinus thrombosis

Question 9

Symptoms of retropharyngeal abscess

Answer 9

Stiff neck
Drooling
Voice changes
Stridor
Cough
Visible bulge at back of oropharynx
Odynophagia

Question 10

Management of glandular fever

Answer 10

Penicillin

Advise to avoid contact sport due to splenomegaly and risk of splenic rupture

Question 11

Differential for lateral neck swelling

Answer 11

Cervical lymphadenitis (splits and forms central abscess)
Branchial cyst
Parotid abscess
TB
Atypical mycobacterium - purple discolouration

Question 12

Pathophysiology of periorbital cellulitis

Answer 12

URTI causing ethmoid sinusitis

Spreads to periorbital tissue

Question 13

Examination for periorbital cellulitis

Answer 13

Swollen eyelids
Opthalmoplegia
Conjunctivitis 
Proptosis
Chemosis
Sluggish pupils
Deteriorating vision

Question 14

Management of periorbital sinusitis

Answer 14

Ceftriaxone and metronidazole
Ephedrine eye drops
CT head with contrast if severe
Refer to ENT for incision and drainage

Question 15

Causes of stridor

Answer 15

Croup
Epiglottitis
Retropharyngeal abscess
FB
Vocal cord paralysis e.g post bronchoscopy
Laryngomalacia - congenital softening of larynx tissue
Subglottic stenosis (usually scarring)

Question 16

Management of stridor

Answer 16

Adrenaline nebuliser to decrease swelling by vasoconstriction
Dexamethasone
Heliox (helium and oxygen - Lower density than air so increases laminar air flow)

Question 17

Causes of wheeze

Answer 17

Asthma
Bronchiolitis
Foreign bodies
HF
Bronchopulmonary dysplasia
Cystic fibrosis
Vocal cord dysfunction (exercise induced)
Malacic airway
External compression e.g tumour, vascular ring

Question 18

Types of wheeze

Answer 18

Monophasic - expiration

Biphasic - inspiration and expiration

Question 19

Causes of snoring

Answer 19

Normal variant
Obstructive sleep apnoea - obesity, adenitis, tonsillitis
Central sleep apnoea - Arnold Chiari malformation, CCHS

Question 20

When to refer for snoring

Answer 20

When it causes daytime somnolence