ENT

Question 1

Eosinophilic granulomatosis with polyangitis key features

Answer 1

Adult-onset asthma
Nasal obstruction symptoms
Systemic upset - fatigue

Bilateral nasal polyps

Question 2

Supraglottitis - features

Answer 2

Short Hx of sore throat, odynophagia, dysphagia, hoarseness

If more severe compromise - may start drooling or showing signs of respiratory compromise (STRIDOR, raised RR)

Question 3

Supraglottitis - Ix and emergency Rx

Answer 3

A-E!!!!
- (do NOT formally assess the throat - may cause oedema and therefore cause sudden complete airway obstruction)

Escalate to ENT and anaesthetics

IV steroids + nebulised adrenaline (1:1000)

Close monitoring - RR & sats especially
May need airway support/ Rx

Other
- If pyrexic - blood cultures, IV Abx

Question 4

Most common site for salivary gland tumours?

Answer 4

Parotid

Question 5

% of tumours in parotid that are benign?

Answer 5

80%

Most common benign = Pleomorphic adenoma (80%)

Question 6

Features of malignant parotid tumours?

how differentiate from benign

Answer 6

Malignant tend to invade into surrounding structures - especially the facial nerve (palsy)

Question 7

Commonest cause of symmetrical bilateral hearing loss

Answer 7

Presbycusis

• gradual
• most notable at higher frequencies

Natural ageing - damage to cochlear hair cells and auditory nerve fibres symmetrically over time

Question 8

RFs for oral cancer

Answer 8

• Smoking
• Alcohol
• Poor diet (low in fruit and veg)
• Male
• Immunosuppression
• HPV or EBV infection
• Radiation exposure
• FHx

Question 9

Oral cancer features

Answer 9

• Bleeding
• Odynophagia
• Dysphagia
• Swelling/ ulceration (unilateral, persistent)
• Neck lump
• Loosening of teeth
• Paraesthesia of tongue/ areas of mouth
• Systemic features - weight loss
• Referred otalgia

Question 10

Pinna haematoma Rx

Answer 10

Incision with primary closure

(if left unTx - risk of ischaemic necrosis and fibrosis - causing ‘cauliflower ear’

Question 11

Medications causing tinnitus

Answer 11

Aspirin
NSAIDs
Loop diuretics
Aminoglycosides

Question 12

Sialolithiasis features

Answer 12

Facial pain - colicky
Discomfort on eating
Dry mouth
Halitosis
Smooth swelling - post-prandial swelling

80% = in submandibular galnd - stones in ducts e.g. Wharton’s duct

Question 13

Siladenitis - explain

Answer 13

Staoh aureus infection
Pus leaking from duct, erythema

Serious complication - submandibular abscess (can spread through deep fascial spaces and occluse the airway)

Question 14

Rx of pt who presents with sudden sensorineural deafness

Answer 14

Urgent referral to ENT
Audiogram
MRI Brain

High dose oral corticosteroids

Most = idippathic but exclude central causes e.g. Stroke or acoustic neuroma

Question 15

Carhart’s notch

Answer 15

Loss of bone conduction at 2000Hz

Question 16

Audiogram finding in otosclerosis

Answer 16

Carhat’s notch - loss of bone conduction at 2000Hz

Question 17

DDx of tinnitus

Answer 17

V - stroke/ TIA (?)
I - Ramsay-Hunt, labyrinthitis, otitis media
T - trauma, noise-induced, perforation of TM
Idiopathic - Meniere's
N - acoustic neuroma
Congenital
Drug - ototoxic
Degenerative - Presbycusis

Question 18

DDx for conductive hearing loss

Answer 18

Wax impaction
TM perforation
Otosclerosis
Otitis media with effusion
Chronic suppurative otitis media 
Eustachian tube dysfunction

Question 19

Type of hypersensitivity reaction underpinning allergic rhinitis

Answer 19

Type I

• IgE, eosinophilic

Question 20

Rx of nasal polyps

Answer 20

Nasal steroids
(Head upsides down to administer and stay upside down for few mins after so drops hit back of nose, not throat)

Question 21

Peritonsillar abscess (qunisy) KEY features

Answer 21

Trismus (inability to open mouth)

Deviation of uvula away from affected side

Question 22

Tuning fork for hearing tests

Answer 22

512 Hz

128Hz = vibration - ‘128 vibrate’