ENT

Question 1

Otitis Media - Definition

Answer 1

Infection of the middle ear

Question 2

Otitis Media - Causes

Answer 2

• Viral: Most common

- Bacterial: Strep. pneumoniae, h. influenzae, strep. pyogenes

Question 3

Otitis Media - Clinical features

Answer 3

• Pain
• Fever
• Discharge (only if +perforation)

Question 4

Otitis Media - Examination findings

Answer 4

• Red, bulging, tympanic membrane

Question 5

Otitis Media - Investigations

Answer 5

Clinical diagnosis

Question 6

Otitis Media - When are antibiotics given

Answer 6

• Systemically Unwell
• Evidence of ear drum perforation (discharge)
• Vulnerable patients (e.g. immunocompromised)

Question 7

Otitis Media - Complications

Answer 7

• Intratemporal: glue ear, drum perforation, mastoiditis, facial nerve involvemnt
• Intracranial: Meningitis, brain abscess
• Systemic: sepsis, IE, septic arthritis

Question 8

Epistaxis - Anterior v Posterior bleeds

Answer 8

Anterior - 90%
- from littles area

Posterior - 10%

• from deep nose structures
• more common in older people
• risk of airway compromise

Question 9

Epistaxis - Little’s area

Answer 9

• Aka Kiesselbach’s plexus

- Anastomosis of 5 arteries

Question 10

Epistaxis - Elements of history to look at

Answer 10

• Trauma (common)
• Foreign bodies (common)
• Finger picking (v common in children)
• Neoplasm
• Cocaine
• PMH: HTN + diabetes

Question 11

Epistaxis - Management (anterior)

Answer 11

• ABCDE approach
• Simple measures: pinch nose, ice pack to neck, suck ice
• Chemical cautery (if necessary)

Question 12

Epistaxis - Management (posterior)

Answer 12

• ABCDE approach
• Folle catheter through nose
• String of swabs soaked in lidocaine/adrenalin
• Definitive: nasal endoscopy

Question 13

Nasal fracture - presentation

Answer 13

History of trauma

Question 14

Nasal fracture - important complication

Answer 14

Septal Haematoma

• can cause avascular necrosis of cartilage
• leads to saddle-shaped nose
• management: incision + drainage

Question 15

Nasal fracture - Management

Answer 15

• Manipulation under anaesthetic

- 1 week after injury

Question 16

What to do about foreign body in Nose

Answer 16

Always take it out

- risk of aspiration

Question 17

What are the components of the CENTOR criteria

Answer 17

• Pyrexia
• Tonsillar exudate
• No cough
• Tender lymphadenopathy

> 2 suggest need for antibiotics

Question 18

Tonsilitis - Cause

Answer 18

• Viral (most common)

- Bacterial: s. pyogenes + s. aureus

Question 19

Tonsilitis - Clinical features

Answer 19

• Pain on swallowing
• Pyrexia + malaise
• Halitosis
• Trismus (locked jaw)

Question 20

Tonsilitis - Management

Answer 20

• Analgesia
• Antibiotics (based on CENTOR)
• If they can’t eat/drink: admit
• If EBV: no contact sport, amoxicillin will cause rash

Question 21

What are the indications for tonsilectomy

Answer 21

1. Frequency of tonsilitis
   - 7 times in a year for 1 year
   - 5 times a year for 2 years
   - 3 times a year for 3 years
2. Suspected malignancy
3. Peritonsillar abscess
4. Sleep apnoea

Question 22

What is a quinsey

Answer 22

A peritonsillar abscess

Question 23

Quinsey - Clinical features

Answer 23

• Sore throat
• Halitosis, trismus + pyrexia (much worse than tonsilitis_
• On examination: uvula pushed down + away from abscess

Question 24

Quinsey - Management

Answer 24

• IV antibiotics

- Definitive: incision + drainage

Question 25

Epiglotitis - Cause

Answer 25

• Most common is HiB (massively reduced due to vaccine)

- Also Group A strep

Question 26

Epiglotitis - Clinical features

Answer 26

• Stridor
• ‘Toxic looking’
• Drooling
• Tripod sign

Question 27

What do you need to remember when examining suspected epiglotitis

Answer 27

DO NOT examine with instruments

Question 28

Epiglotitis - Management

Answer 28

• In A&E: nebulised adrenaline

- Definitive: intubated in theatre