ENT passmed

Question 1

Diagnostic investigation for BPPV: (vertigo-positional)

Answer 1

Dix-Hallpike Manoeuvre= diagnostic (positive dix hallpike= means will present with rotatory nystagmus)

• Management= Epley manoeuvre

Question 2

Presentation of Infectious Mononucleosis (glandular fever)?

Answer 2

• large swollen tonsils and lymph nodes
• ‘palpable mass in hypochondriac region’= suggests splenomegaly
• is caused by EBV (ebstein barr virus/also known as Human herpes virus 4)
• Classic triad of symptoms: sore throat, lymphadenopathy, pyrexia
• Consensus guidance in the UK: To avoid playing contact sports for 4 weeks after having glandular fever to reduce risk of splenic rupture.

Question 3

What is the next most appropriate step in management: for unilateral glue ear in adult?

Answer 3

• As it is unilateral, needs urgent referral to ENT.
• as could be a posterior nasal space tumour

Question 4

Atypical looking Lymphocytes, what condition?

Answer 4

Glandular fever (Infectious Mononucleosis)
- Diagnosis is done by Mono spot test (should be done in the 2nd week of illness)

Question 5

Children with glue ear+ having Down’s Syndrome?

Answer 5

Need to be referred to ENT
- If didn’t have glue ear, then can be managed by active observation over 6-12 weeks.

Question 6

Common pathogen for bacterial otitis media (loss of light reflex and bulging erythematous ear canal

Answer 6

H. Influenzae
- normally precedes a URTI

• NB: common cause of Tonsillitis: Strep Pyogenes

Question 7

Any Unilateral symptoms: eg. in chronic rhinosinusitis?

Answer 7

• Referral to ENT

Question 8

What diagnosis is? URTI+taking amoxicillin, resulting in rash?

Answer 8

Glandular fever

Question 9

If signs of acute mastoiditis?

Answer 9

Need to refer urgently to ENT/secondary care

Question 10

Treatment options for: Chronic Rhinosinusitis?

Answer 10

1. Nasal irrigation with saline solution
2. INTRANASAL (not oral) corticosteroids
3. Allergen/irritant avoidance

Question 11

Tinnitus can also be described as?

Answer 11

• ‘a roaring sensation’

Question 12

Meniere’s Disease presentation?

Answer 12

• episodic vertigo
• tinnitus
• sensorineural hearing loss
• Symptoms typically last from 20 mins to several hours

Mx: ENT assessment is required to confirm the diagnosis
- patient should inform DVLA
- for acute attacks: buccal or IM prochlorperazine, admission is sometimes required
- prevention: Betahistine and vestibular rehabilitation exercises.

Question 13

Otitis Externa presentation:

Answer 13

• pain on palpation of the tragus (pulling ear back)
• itching
• discharge and hearing loss

Question 14

what is a complication of glandular fever?

Answer 14

as could result in splenomegaly= Splenic Rupture
- therefore need to avoid contact sports for 4 weeks.

Question 15

what should u not do if acute epiglottis is suspected?

Answer 15

• Do NOT examine the throat
• need urgent admission to hospital
• Cause of acute epiglottitis: Haemophilus Influenzae B

Question 16

Investigation for malignant otitis externa?

Answer 16

• CT scan

Question 17

Management of acute otitis media?

Answer 17

• Majority of patients don’t require antibiotics= only analgesia, unless symptoms are present for more than 4 days, is systemically unwell, is at high risk of complications.

Question 18

Yellow discharge in acute otitis media means?

Answer 18

• most likely indicates perforation, therefore need to start antibiotics: Amoxicillin 1st line or if allergic, Erythromycin

Question 19

Otitis externa in diabetics that is NOT malignant otitis externa?

Answer 19

• Treat with Ciprofloxacin (ear drops): to cover Pseudomonas

Question 20

When should antibiotics be prescribed in Acute Otitis Media?

Answer 20

Antibiotics should be prescribed immediately if:
- Symptoms lasting more than 4 days or not improving
-Systemically unwell but not requiring admission
- Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
-Younger than 2 years with bilateral otitis media
-Otitis media with perforation and/or discharge in the canal

Question 21

Otitis Externa (also known as swimmer’s ear) Mx:

Answer 21

• Topical Antibiotics+/- steroids= 1st line

Question 22

acute otitis media mx;

Answer 22

amoxicillin= 1st line abx.

Question 23

What should you do if there is spreading erythema in the ear? (with otitis externa)

Answer 23

• Is an indication for Oral antibiotics
• Oral Flucloxacillin is 1st line

Question 24

Meniere’s disease presentation: Unilateral or bilateral?

Answer 24

• UNILATERAL
• also has tinnitus, vertigo episodes lasting around 30 mins each and sensorineural hearing loss.