ENT Questions Flashcards
A 19-year-old woman presents with hearing problems for the past six months. She initially thought it was due to wax but her hearing has not improved after ear syringing. You perform an examination of her auditory system including Rinne’s and Weber’s test:
Rinne’s test:
Left ear: air conduction > bone conduction
Right ear: air conduction > bone conduction
Weber’s test: Lateralises to the left side
What do these tests imply?
Left sensorineural deafness right conductive deafness normal hearing right sensorineural deafness left conductive deafness
right sensorineural deafness
A 27-year-old male presents to the GP with intense left-sided ear pain which he has had for 24 hours. On examination, you see that the left ear is protruding forward, with a tender, boggy mass behind the ear. The tympanic membrane is bulging and erythematous. He is tachycardic and his temperature is 37.9 ºC.
Urgent treatment of this condition is necessary to prevent which complication?
meningitis
skin necrosis of ear
cholesteatoma
acute otitis media
meningitis
Mastoiditis is a medical emergency due to the potential risk of meningitis
A 77-year-old man, Henry, reports that he has had increasing difficulty hearing over the past few months. He usually plays bingo on Tuesday evenings and has noticed that he often has to ask the number caller to repeat themselves. He has also had a complaint from his neighbour who has said that Henry’s television volume is often too loud. Henry comes to see you as he would like to know whether his hearing problems could be something to do with his medications.
Which one of the following medications is associated with ototoxicity?
simvastatin
bendroflumethiazide
quinine
aciclovir
quinine
Ototoxicity results from exposure to drugs or chemicals that damage the inner ear or the vestibulocochlear nerve and hence causes disturbances in hearing and/or balance.
Ototoxic medicines include gentamicin, quinine, furosemide, aspirin and some chemotherapy agents.
A 32-year-old lady presents with episodes of vertigo that come on at random. These ‘dizzy spells’ last for a few minutes to hours, and during this time she also experiences difficulty hearing and ringing in her ear. What is the most likely diagnosis?
BPPV
Vestibular neuronitis
Meniere’s disease
migraine
Meniere’s disease
In Meniere’s disease, vertigo occurs spontaneously. Episodes last for minutes to hours, and are accompanied by unilateral hearing loss and tinnitus
A 42-year-old man presents with a 2 week history of a worsening sore throat, is complaining of painful swallowing. On examination you notice that he has difficulty opening his jaw, purulent tonsils and his uvula is deviated to the right. Given the likely diagnosis, how should this condition be managed?
oral Abx IV Abx oral Abx + tonsillectomy IV Abx + tonsillectomy IV aBX and surgical drainage
Quinsy should be treated with IV antibiotics and surgical drainage, and a tonsillectomy should be considered in 6 weeks
The most likely diagnosis in this case is peritonsillar abscess (quinsy), a complication of bacterial tonsillitis. Though tonsillitis is treated with oral antibiotics, quinsy should be treated with IV antibiotics and surgical drainage, and a tonsillectomy should be considered in 6 weeks.
A 40-year-old woman presents with recurrent episodes of vertigo associated with a feeling or ‘fullness’ and ‘pressure’ in her ears. She thinks her hearing is worse during these attacks. Clinical examination is unremarkable. What is the most likely diagnosis?
meniere’s disease
BPPV
acoustic neuroma
cholesteatoma
meniere’s disease
Features
recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
a sensation of aural fullness or pressure is now recognised as being common
other features include nystagmus and a positive Romberg test
You see a 40-year-old man with reduced hearing on the right side. You examine his ears and note the right ear canal is blocked with wax but the left ear is clear. What would be the expected findings on testing Rinne and Weber?
Weber: sound localises to the right
Rinne’s: -ve on the right. +ve on the left
The Rinne and Weber tests are used to distinguish conductive from sensorineural hearing loss.
This gentleman has wax blocking the right ear canal, so you would expect to find a conductive hearing loss on the right side.
When performing the Weber test, the patient should localise the sound to the side of a conductive hearing loss, as bone conduction is increased. The sound will localise away from a sensorineural hearing loss.
