ENT: Past Paper Questions Flashcards
A 30-year-old man presents to his GP with bilateral hearing loss that has developed over the last three hours associated with episodes of vertigo and vomiting. He also reports having an upper respiratory tract infection about a week ago.
On examination, he has visible horizontal nystagmus and veers to the right when asked to walk.
What is the most likely diagnosis?
Meniere’s disease
Benign paroxysmal positional nystagmus (BPPV)
Viral labyrinthitis
Vestibular neuronitis
Vestibular schwannoma
Viral labyrinthitis
Viral labyrinthitis typically presents with sudden vertigo and hearing can be affected. A viral infection often precedes its presentation
A 10-year-old boy comes in to see his GP with a week history of reduced hearing and worsening otalgia.
Weber’s test lateralises to the right ear and Rinne’s test is negative in the right ear.
What is the type of hearing loss?
Bilateral sensorineural hearing loss, worse on the left
Left sided conductive hearing loss
Left sided sensorineural hearing loss
Right sided conductive hearing loss
Right sided sensorineural hearing loss
Right sided conductive hearing loss
A 19-year-old man presents with a swelling on the left side of his neck. On examination he has a smooth swelling in between the sternocleidomastoid muscle and the pharynx. It is fluctuant but doesn’t transilluminate or move during swallowing.
Branchial cyst
Branchial cysts often present during intercurrent upper respiratory tract infection
A 28-year-old Bangladeshi woman presents with a three day history of sweats, headache, lethargy and muscle aches. On examination she has bilateral tender swellings in the submandibular region.
Reactive lymph nodes 45%
This patient probably has the ‘flu
- A 17-year-old girl presents with a painless swelling in the neck. She is currently well. A midline, cystic swelling is noted in the region of the hyoid bone. It moves upwards when she swallows or sticks her tongue out.
Reactive lymph nodes 45%
This patient probably has the ‘flu
management of otitis externa
The recommended initial management of otitis externa is:
* topical antibiotic or a combined topical antibiotic with a steroid
* if the tympanic membrane is perforated aminoglycosides are traditionally not used*
* if there is canal debris then consider removal
* if the canal is extensively swollen then an ear wick is sometimes inserted
Second-line options include
* consider contact dermatitis secondary to neomycin
* oral antibiotics (flucloxacillin) if the infection is spreading
* taking a swab inside the ear canal
* empirical use of an antifungal agent
A 72-year-old man presents to his GP due to his wife’s increasing complaints about his deafness. He maintains that she mumbles although he concedes that he can struggle to follow conversations in noisy environments. The patient says that he otherwise feels fine. His past medical history includes both hypertension and chronic obstructive pulmonary disease.
On examination, the GP finds bilateral sensorineural hearing loss. She concludes that presbycusis is the most likely cause and sends him for audiometric testing.
Which is the most likely pattern of this gentleman’s audiogram?
Bilateral low-frequency hearing loss. Bone conduction better than air
Bilateral low-frequency hearing loss. Air conduction better than bone
Bilateral high-frequency hearing loss. Bone conduction better than air
Bilateral high-frequency hearing loss. Air conduction better than bone
Bilateral hearing loss across all frequencies. Bone conduction better than air
Bilateral high-frequency hearing loss. Air conduction better than bone
A 32-year-old nursery teacher complains of progressive hearing loss and tinnitus over the past three months. She denies aural fullness and recent infections. The patient recalls that her mother was diagnosed with a ‘hearing problem’ in her thirties.
External examination of the ear is normal. Rinne test: bone conduction is louder than air conduction in both ears. Weber test: sound localised to the centre of the forehead.
What is the most likely diagnosis?
Acute labyrinthitis
Cholesteatoma
Meniere’s disease
Otosclerosis
Vestibular schwannoma
Otosclerosis is characterised by conductive hearing loss, tinnitus and positive family history
An 11-year-old boy presents with his mother to the GP complaining of a sore throat. It began 5 days ago following him feeling unwell for a couple of days with a runny nose, but no cough. His mother recorded a temperature of 38.5ºC last night. On examination, there is no tonsillar exudate but there is tender lymphadenopathy in the anterior triangle. The chest is clear, and the child’s temperature in the surgery is 36.5ºC.
Should antibiotics be prescribed, and what features of the presentation are important to qualify this decision?
No: History of rhinitis, Lack of tonsillar exudate, Lack of cough
No: Lack of tonsillar exudate
No: Lack of tonsillar exudate, No fever during consultation, Clear chest, <7 day history
Yes: Lack of cough, Recorded fever >38ºC, lymphadenopathy
Yes: >3 day history, Clear chest, Recorded fever >38ºC, lymphadenopathy
using centor
Yes: Lack of cough, Recorded fever >38ºC, lymphadenopathy
Centor
- Tonsillar exudate
- Tender anterior lymphadenopathy or lymphadenitis
- History of fever
- Absence of cough
The presence of 3 or 4 of these gives a 40-60%
