ENT

Question 1

cat scratch fever

Answer 1

bartonella

Question 2

branchial cyst features

Answer 2

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
contain cholesterol crystals

Question 3

centor criteria

Answer 3

For an antibiotic to be necessary, 3 of the following should be present:
Presence of tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever
Absence of cough

Question 4

Presbycusis features

Answer 4

age-related sensorineural hearing loss. Patients may describe difficulty following conversations

Audiometry shows bilateral high-frequency hearing loss

Question 5

ototoxic drugs

Answer 5

aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents
quinine causes tinnitus

Question 6

BPPV manouvers

Answer 6

diagnostic dix-hallpike

treatment- epley

Question 7

epistaxis red flag

Answer 7

recurrent unilateral (nasal cancer)

Question 8

complications of acute mastoiditis

Answer 8

meningitis due to intracranial spread; 
others include cranial nerve palsies, 
hearing loss, 
osteomyelitis 
and carotid artery spasm.

Question 9

Otitis externa in diabetics: treatment

Answer 9

ciprofloxacin to cover Pseudomonas

oral flucloxacillin if erythema is spreading

Question 10

otosclerosis features

Answer 10

autosomal dominant. precipitated by pregnancy

Mx- hearing aid, stapedectomy

Question 11

mx of nasal polyps

Answer 11

unilateral- refer to ENT to exclude malignancy

if small bilateral- due to rhinosinusitis- salin nasal douce and intranasal steroids, non urgent ENT referral

Question 12

cystic hygroma features

Answer 12

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
fluctuant and brilliantly transluminable

Question 13

black hairy tongue pathology

Answer 13

results from defective desquamation of the filiform papillae

Question 14

mass in tail of parotid gland

Answer 14

pleomorphic adenoma- commonest, slow ,smooth, mobile

warthins tumour- cyst and lymphoid tissue common in old men

Question 15

Elderly patient dizzy on extending neck

Answer 15

vertebrobasilar ischaemia

Question 16

rhinitis medicamentosa

Answer 16

condition of rebound nasal congestion brought on by extended use of topical decongestants

Question 17

nasal septal haematoma

Answer 17

haematoma between the septal cartilage and the overlying perichondrium.

may be precipitated by relatively minor trauma
the sensation of nasal obstruction is the most common symptom
pain and rhinorrhoea are also seen
on examination, classically a bilateral, red swelling arising from the nasal septum
this may be differentiated from a deviated septum by gently probing the swelling. Nasal septal haematomas are typically boggy whereas septums will be firm

Management
surgical drainage
intravenous antibiotics

Question 18

cholesteatoma

Answer 18

Cholesteatoma is a non-cancerous growth of squamous epithelium that is ‘trapped’ within the skull base causing local destruction. It is most common in patients aged 10-20 years. Being born with a cleft palate increases the risk of cholesteatoma around 100 fold.

Main features
foul-smelling, non-resolving discharge
hearing loss

Other features are determined by local invasion:
vertigo
facial nerve palsy
cerebellopontine angle syndrome

Otoscopy
‘attic crust’ - seen in the uppermost part of the ear drum

Management
patients are referred to ENT for consideration of surgical removal

Question 19

acute necrotizing gingivitis mx

Answer 19

refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
simple analgesia

Question 20

nasal polyp associations

Answer 20

asthma* (particularly late-onset asthma)
aspirin sensitivity*
infective sinusitis
cystic fibrosis
Kartagener's syndrome
Churg-Strauss syndrome

Question 21

gingival hyperplasia causes

Answer 21

phenytoin
ciclosporin
calcium channel blockers (especially nifedipine)

Other causes of gingival hyperplasia include
acute myeloid leukaemia (myelomonocytic and monocytic types)

Question 22

menieres mx

Answer 22

ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit

Question 23

unexplained hoarseness

Answer 23

2 week wait ent referral

Question 24

bleeding after tonsillectomy mx

Answer 24

primary <24h return to theatre

secondary antibiotics- probably infection

Question 25

recent illness and vertigo

Answer 25

viral labyrinthitis

Question 26

acute sinusitis mx

Answer 26

analgesia
intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited
NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
oral antibiotics are not normally required but may be given for severe presentations. The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’

Question 27

Ramsay Hunt syndrome

Answer 27

type 2, is a condition where reactivation of pre-existing Varicella Zoster virus occurs in the geniculate ganglion. This is the reason for the vesicles on the tympanic membrane. Ramsay Hunt syndrome can also cause pain in the ear, facial paralysis, taste loss, dry eyes, tinnitus, vertigo and hearing loss.

Question 28

quinsy mx

Answer 28

IV antibiotics and surgical drainage, and a tonsillectomy should be considered in 6 weeks

Question 29

vestibular neuronitis features

Answer 29

recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus

Question 30

cause of painless lymph node in posteroir triangle in asian man SCC

Answer 30

nasopharyngeal carcinoma

Question 31

complications of thyroid surgery

Answer 31

Anatomical such as recurrent laryngeal nerve damage.
Bleeding. Owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema.
Damage to the parathyroid glands resulting in hypocalcaemia.

Question 32

s/e of taking nasal decongestants

Answer 32

increasing doses are required to achieve the same effect (tachyphylaxis)

Question 33

ludwig’s angina

Answer 33

Immunocompromised patients with poor dentition can develop airway compromise from cellulitis at the floor of the mouth known as Ludwig’s angina

Question 34

causes of otitis media

Answer 34

Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis.

Question 35

tonsillar SCC associated with

Answer 35

HPV