ENT + Neurology

Question 1

Pt presents with typical Bell’s palsy

- key hx questions to ask

Answer 1

1. Pain in or behind ear
2. Vesicular rash near ear
3. Loss of taste
4. Hyperacusis
5. Any symptoms of stroke - abnormal gait
6. Impaired blinking / eye watering / pain
7. Tick bites
8. PHx similar episodes

Question 2

3 specific mx steps for Bell’s palsy

Answer 2

1. Prednisolone 1mg/kg up to 75mg for 5 days
2. Lubricating eye drops for affected eye
3. Adhesive patch or tape over eye

Question 3

DDx facial nerve palsy

Answer 3

1. Bell’s Palsy
2. Ramsay hunt syndrome
3. Stroke
4. Aneurysm of basilar / vertebral / carotid arteries
5. Parotid gland tumour
6. Acoustic neuroma

Question 4

DDx vertigo

Answer 4

1. Labyrinthitis
2. Meniere’s disease
3. Acoustic neuroma
4. MS
5. Ramsay Hunt Syndrome
6. CVA
7. BPPV
8. Vestibular neuronitis
9. Vestibular migraine

Question 5

Hx questions for vertigo

Answer 5

1. Timeframe of vertigo - duration of attacks
2. Recent viral URTI
3. FMHx Meniere’s
4. Otalgia / fullness in ear
5. Vesicles on ear
6. Tinnitus
7. Recent ataxia / numbness of face
8. Triggers for attacks
9. Headaches
10. Nausea or vomiting
11. Systemic symptoms of infection, fever

Question 6

Otitis media - who needs abx?

Answer 6

1. Infants younger than 6 months
2. Children younger than 2 years with bilateral infection
   children who are systemically unwell
3. Children with otorrhoea
4. ATSI
5. Children at high risk of complications- immunocompromised

Question 7

Abx for otitis media

Answer 7

Amoxicillin 15mg/kg TDS 5/7

Allergies:

• Cefuroxime 15mg/kg BD 5/7
• Trimethoprim+Sulfamethoxazole BD 5/7

Question 8

Signs & Sx MND

Answer 8

• weakness or muscle wasting (hands first, weak grip)
• stumbling (foot drop)
• difficulty with swallowing
• difficulty with speech
• fasciculations of skeletal muscle
• cramps & muscle pain
• emotional instability, depression

Question 9

Tx for trigeminal neuralgia

Answer 9

Carbemazepine MR 100mg BD

Question 10

Triad of symptoms in Meniere’s disease

Answer 10

1. Episodic vertigo
2. Tinnitus
3. Hearing loss

Question 11

Mx croup

Answer 11

Single dose of corticosteroids in ALL children

• Prednisolone 1mg/kg PO
• Dexamethasone 0.15mg/kg PO

Question 12

Restless leg syndrome - possible causes

Answer 12

• anaemia / iron deficiency
• uraemia
• hypothyroidism
• pregnancy
• drugs

Question 13

3 long long term mx options for Meniere’s disease

Answer 13

• low sodium intake 2-3g daily
• avoid caffeine
• hydrochlorothiazide 25mg daily
• refer audiologist for hearing aid
• refer ENT for surgical opinion