ENT

Question 1

Sx of viral labyrinthitis

Answer 1

Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected

Question 2

Sx of Vestibular neuronitis

Answer 2

Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss

Question 3

Sx of BPPV

Answer 3

Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds

Question 4

Sx of Meniere’s disease

Answer 4

Associated with SN hearing loss
Tinnitus
sensation of fullness or pressure in one or both ears

Question 5

Sx of Acoustic neuroma

Answer 5

SN Hearing loss
Vertigo
Tinnitus
Absent corneal reflex
Associated with neurofibromatosis type 2

Question 6

Ix for BPPV

Answer 6

Hallpike manoeuvre

Question 7

Mx for BPPV

Answer 7

Epley manoeuvre

Betahistine

Question 8

what type of hearing loss is Presbycusis

Answer 8

age-related SNHL

Audiometry shows bilateral high-frequency hearing loss

Question 9

what type of hearing loss is otosclerosis

Answer 9

Autosomal dominant, replacement of normal bone by vascular spongy bone

Conductive HL
Tinnitus
Family History

Question 10

what type of HL is glue ear

Answer 10

conductive

Question 11

ototoxic drugs

Answer 11

gentamicin
quinine
furosemide
aspirin

Question 12

how can you differentiate between a facial nerve palsy that is UMN or LMN

Answer 12

LMN - forehead involved

UMN - forehead spared
i.e. stroke

Question 13

how does Bell’s palsy present and Tx

Answer 13

Abrupt onset –eg overnight, unilateral facial weakness, decreased taste, hyperacusis

Tx - prednisolone if they present within 72 hours

Question 14

how does Ramsay Hunt present

Answer 14

Severe otalgia, elderly, facial nerve palsy, vesicles in the ear canal +/- soft palate, deafness, vertigo

Question 15

how does parotid tumour present

Answer 15

Pain, swelling, palsy

Question 16

Tx of Ramsay Hunt syndrome

Answer 16

Aciclovir/valaciclovir and prednisolone

Question 17

what is the usual organism for bacterial tonsillitis and Tx

Answer 17

Group A strep

Mx = Penicillin V and Analgesia.

Admit for IV fluids, steroids and Benzylpenicllin if unable to swallow

Question 18

what is Ix for viral tonsillitis

Answer 18

EBV ix IgM on Monospot/ Paul-Bunnell tests

LFTs
FBC

Question 19

Tx for viral tonsillitis

Answer 19

avoid alcohol/hepatotxic drugs/contact sports,

analgesia

Question 20

how does quincy present

Answer 20

peri-tonsillar abscess

Thick' or 'hot potato' voice 
Stertor
Trismus
Inability to swallow
Pain worse on one side (+/- otalgia)

Question 21

Mx of peri-tonsillar abscess

Answer 21

Drainage
Antibiotics
IV fluids
Dexamethasone
Analgesia

Question 22

escalation cascade of Tx for epistaxis

Answer 22

1 - External pressure to the nose and ice to neck
2 - Silver nitrate Cautery
3 - Nasal packing: Rapid Rhino
4 - Ligation of the sphenopalatine artery (supplies lateral wall of the nose and ligation risks include continued bleeding, visual disturbance and CSF leak)
5 - Ligation of the external carotid
6 - Embolisation

Question 23

what is the most common histological-type of head and neck cancer and what are the risk factors

Answer 23

Squamous

Age
Alcohol and tobacco
Deprivation, comorbidities
HPV 16 and 18

Question 24

what is the most common type of thyroid cancer

Answer 24

papillary

Question 25

what should be in your head when a Q on weird kid neck lumps

Answer 25

Congenital Dermoid Cyst.

Cystic hygroma

Question 26

what should be in your head when a Q on weird adult neck lumps

Answer 26

Branchial Cyst

Carotid body tumour

Question 27

what should be in your head when a Q on weird elderly neck lumps

Answer 27

Malignant cervical lymphadenopathy due to laryngeal/pharyngeal/bronchial carcinoma
Pharyngeal pouch

Question 28

A 5-year-old boy presents with his mother to the GP surgery with a 5 day history of right-sided otalgia and reduced hearing. On examination, he has a temperature of 38.5ºC and a heart rate of 120 bpm. There is swelling around his right ear and the ear appears to be displaced anteriorly. The canal appears normal however the tympanic membrane is red and bulging. What treatment should be initiated?

Answer 28

Refer to secondary care

• has signs of mastoiditis

Question 29

A 55-year-old man from Hong Kong presents with left sided otalgia and recurrent episodes of epistaxis. On examination his pharynx appears normal. Examination of his neck reveals left sided cervical lymphadenopathy. What is the most likely underlying diagnosis?

Answer 29

nasopharyngeal carcinoma

Question 30

A 59-year-old man presents with a severe pain deep within his right ear. He feels dizzy and reports that the room ‘is spinning’. Clinical examination shows a partial facial nerve palsy on the right side and vesicular lesions on the anterior two-thirds of his tongue. What is the most likely diagnosis?

Answer 30

Ramsay-Hunt Syndrome
- Whilst vesicular lesions are more classically seen in the external auditory canal and pinna they may also be seen on the anterior 2/3rds of the tongue and the soft palate.

Question 31

A 45-old-woman comes to see you in the GP surgery complaining of foul smelling discharge from her right ear for the past 3 weeks. She also thinks she has a slight deafness in her right ear and is wondering if she has some wax. However, on examination there is no wax but a crust on the upper part of the tympanic membrane. What is the most likely diagnosis?

Answer 31

Cholesteatoma

The combination of unilateral foul smelling discharge and deafness should always raise the question of a cholesteatoma. If on examination you suspect a cholesteatoma then an ENT referral is needed.

Urgent referral needed