ENT Chapter 4

Question 1

Tinnitus (TI): How is it classified

Answer 1

Objective - audible to the examiner and rare

Subjective - only patient hears it

Question 2

TI: What other diagnosis needs to be excluded?

Answer 2

acoustic neuroma (10% present this way.)

Question 3

What is the histology of acoustic neuromas

Answer 3

benign subarachnoid tumours - cause problems by local pressure

Question 4

Which tests are done to determine vertigo is present?

Answer 4

Romberg’s, Provocation test, Hallpike test

Question 5

Name the types of vertigo

Answer 5

Benign paroxysmal positional vertigo, Ménière’s disease, acute vestibular failure

Question 6

What treatment is effective in 80% of vertigo cases?

Answer 6

Epley manoeuvre.

Question 7

Define Rhinosinusitis

Answer 7

in adults, it’s the inflam of the nose and paranasal sinuses with>2 symptoms, one of which must be nasal blockage/obstruction/congestion/discharge +/- facial pain/pressure, reduction/loss of smell

Question 8

What is the ASA triad?

Answer 8

Asthma, nasal polyps, aspirin intolerance

Question 9

!!! Nosebleed (NB) - causes?

Answer 9

local trauma, facial trauma, dry/cold weather, dyscrasia/haemophilia, septal perforation

Question 10

In anterior epistaxis, where does the bleed most commonly come from?

Answer 10

septum: Little’s area (Kiesselbach’s plexus) -> where anterior ethmoidal, sphenopalatine and facial arteries anastomose to form ANTERIOR ANASTOMOTIC ARCADE

Question 11

What causes a sore throat?

Answer 11

acute pharyngitis vs tonsillitis

Question 12

When do you give antibiotics?

Answer 12

3-3 of centor criteria present

Question 13

What causes a red pin-prick blanching rash, facial flush with circumoral pallor and strawberry tongue?

Answer 13

Scarlet fever

Question 14

What do you need to watch out for in a kid with stridor?

Answer 14

impending obstruction: swallowing difficulty/drooling pallor/cyanosis, trachea; tug..

Question 15

What is the leading cause of stridor?

Answer 15

Croup/laryngotracheobronchitis

Question 16

What is the main congenital anomaly of the larynx presenting with stridor?

Answer 16

Laryngomalacia

Question 17

Dysphagia (difficulty swallowing) - what is the gold standard investigation

Answer 17

Endoscopy - serious unless sore throat: Malignancy, neurology…

Question 18

Most common head and neck cancer?

Answer 18

Squamous cell carcinoma (HNCC)

Question 19

Which age group does it affect most ?

Answer 19

> 80% _> over 50yo

Question 20

Patient: typical older patient, smoker, sore throat, lump in neck, referred otalgia.

Answer 20

Oropharyngeal carcinoma, usually advanced at px

Question 21

Name 1 infratemporal, 1 intracranial and 1 other cause of Facial palsy

Answer 21

parotid tumour, stroke, Lyme disease

Question 22

Which palsy is a LMN facial palsy?

Answer 22

Bell’s Palsy (70% of facial palsies). Treat with Prednisolone

Question 23

What is the first question to ask about neck lumps and why?

Answer 23

How long? If <3 weeks, further Ix is unwise as it is probably reactive lymphadenopathy

Question 24

Which investigation is commonly used for suspicious lymph nodes?

Answer 24

Fine-needle aspiration cytology

Question 25

What is the most likely diagnosis for a mid-line lump?

Answer 25

Dermoid cyst

Question 26

What’s the 80% rule on the salivary gland?

Answer 26

80% of salivary tumours are parotid, 80% benign pleomorphic adenomas, 80% in the superficial lobe

Question 27

What is sialolithiasis?

Answer 27

Salivary stones. Smaller may pass, bigger might need surgery