ENT card

Question 1

ramsey hunt presentation?

Answer 1

ear pain, cn7 palsy, vesicles around earvertigo, tinnitus,
TX: give aciclovir and pred

Question 2

cx of AOM?
complications?

Answer 2

Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
CSOM, mastoiditis, labyrinthitis, meningitis, abscess, fn palsy

Question 3

chronic suppurative otitis media (CSOM)

Answer 3

perforation of the tympanic membrane with otorrhoea for > 6 weeks

Question 4

post viral infection vertigo with horizontal nystagmus?

Answer 4

hrs to days. vestibular neuronitis., no HL.prochloperazine

Question 5

perforated ear drum - when to refer

Answer 5

if not healed in 6 weeks

Question 6

positive rinne?

Answer 6

air conduction better than bone condution (normal)

Question 7

bone conduction better than air condution in right ear. weber lateralises to right ear. air conduction better than bone conduction in left ear

Answer 7

conductive HL right year

Question 8

positive rinne test B/L (air conduction better). weber lateralises to left ear??

Answer 8

right sensorineural HL

Question 9

post thyroidectomy parasthesia around mouth, muscle cramps/ what is in ECG?

Answer 9

hypocalcaemia - long QT. (when u dont put enough milk in ur tea, u get long QT)

Question 10

2ww pathway for oral cancer?

Answer 10

Unexplained oral ulceration or mass 3 weeks +
Unexplained red, or red and white patches that are painful, swollen or bleeding
Unexplained one-sided pain in the head and neck 4 weeks+ ear ache, but does not result in any abnormal findings on otoscopy
Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks
Unexplained persistent sore or painful throat
Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion

Question 11

abx in AOM?
what to cover diabetes with in OE/

Answer 11

4321 - 4days of fever, <3 months old, <2 and B/L, immunocompromised. amoxicillin

DM+ ottitis externa - cover with ciprofloxacin

Question 12

drugs causing tinnitus? (QANAL?)

Answer 12

quinines, aspirin, nsaids, aminoglycosides, loop diuretics

Question 13

right sided tinnitus, HL, vertigo, 10-30mins, easr feels full

Answer 13

meniere’s. MX: acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit

Question 14

sore throat abx?
scoring systems?

Answer 14

systemic upsert, unilateral peritonsillitis, RF hx, immunodeficient, dm, 3+ centor criteria
centor/ fever pain gives liklihood of isolating streptococci
centor: exudate/ cervical LN, fever, no cough
feverpain: fever 38+, educate, 3 days, inflamed tonsils, no cough
0-1 d/c, 2-3 delayed px, 4+ immediate abx

Question 15

tonsilectomy indications?

Answer 15

7 per year/
5 per year for 2 years,
3 per year for 3 years, disabling and prevent normal functioning
recurrent febrile convulsions
obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
peritonsillar abscess (quinsy) if unresponsive to standard treatment

Question 16

chronic rhinorrhea tx?
red flags?

Answer 16

optimise asthma, triggers, saline irrigation
3 month trial of CS intranasal

red flags:
unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis

Question 17

Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Associated with neurofibromatosis type 2

Answer 17

acoustic neuroma

Question 18

Elderly patient
Dizziness on extension of neck

Answer 18

vertebrobasilar ischaemia

Question 19

facial pain (classically described as frontal pressure pain which is worse on bending forward), nasal discharge (usually thick and purulent) and difficulty breathing

Answer 19

acute sinusitis. pen V if systemically unwell.
cx:Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.
Predisposing factors include:
nasal obstruction e.g. septal deviation or nasal polyps
recent local infection e.g. rhinitis or dental extraction
swimming/diving
smoking

Question 20

what is samter’s triad?

Answer 20

asthma, aspirin sensitivity and nasal polyposis

Question 21

what are associated conditons with nasal polyps?
red flags?

Answer 21

asthma (particularly late-onset asthma)
aspirin sensitivity
infective sinusitis
cystic fibrosis
Kartagener’s syndrome
Churg-Strauss syndrome
refer to eNT always. red flag: unilateral/ bleeding

Question 22

DM with left ear pain, red ear, discharge, not responding to abx?

Answer 22

refer to ENT. malignant OE/pseudomonas elading to temporal bone OM/

Question 23

OM with perforated ear canal?

Answer 23

avoid aminoglycosides

Question 24

vertigo, horizontal nystagmus, no HL no tinnitus, N+V, attacks last hrs/days. post URTI

Answer 24

vestibular neuronitis. buccal/ im prochlorperazine trial. resolves

Question 25

cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy?

Answer 25

ramsey hunt - HZO. give CS and aciclovir

Question 26

flamingo/ blue tinge to TM, HL conductive, 20-40yrs?

Answer 26

otosclerosis (autosomal dominant) - stapedectomy

Question 27

salivery gland tumours?

Answer 27

80% parotid, 80% of these = pleomorphic adenomas, 80% superficial lobe

Question 28

infected tonsil stones?

Answer 28

luduwig’s angina
most stones submandibular

Question 29

rf for glue ear?/ OM with effusion?

Answer 29

male sex
siblings with glue ear
higher incidence in Winter and Spring
bottle feeding
day care attendance
parental smoking

Question 30

B/L parotid gland swelling causes?

Answer 30

viruses: mumps
sarcoidosis
Sjogren’s syndrome
lymphoma
alcoholic liver disease

Question 31

42-year-old man with a 3 month history of chronic cough presents with a persistent headache

Answer 31

chronic sinusitis cough secondary post nasal drip