Exam Q

Question 1

Where do 90% of nose bleeds arise from?

Answer 1

Kiesselbach's plexus 
Superficial arteries in the anterior septum 
Anterior ethmoidal artery
Greater palatine artery
Sphenopalatine artery 
Superior labial artery

Question 2

What is sialadenitis?

Answer 2

Inflammation of one or more of the major salivary glands
Usually due to bacterial infection, autoimmune, ductal stenosis
Underlying cause: stones (sialolithiasis) or reduced salivary production
Painful facial swelling, fever, dysphagia
Differentials: mumps, dental abscess, Ludwig’s angina

Question 3

What is the feverPAIN score for streptococcus pharyngitis?

Answer 3

Fever 1
Pus 1
Attenuates quickly 1
Inflamed tonsils 1
No cough 1 
A score of 4 or more is associated with 62-65% isolation of streptococcus

Question 4

What is benign paroxysmal positional vertigo (BPPV)?

Answer 4

Short lived attack often lasting less than 30 seconds
Usually triggered by a change in head position
Due to displaced otolith particles
Diagnosed with the dix-hallpike manoeuvre
Treated with the Epley manoeuvre
Peak in 50-70
Other: vestibular neuritis and labrynthitis

Question 5

What is the Dix-hallpike manoeuvre?

Answer 5

Patient lies on couch so head overhangs
Patient sits up and turns their head to face the examiner
Examiner holds the patient’s head and quickly lays the patient flat
Eyes must remain open
Repeat test on other side

Question 6

What is globus pharyngeus?

Answer 6

Subjective feeling of a lump in the throat
Diagnosis of exclusion
Eating and drinking can relieve sensation
Pain free
May be associated cough
CBT if associated psychological condition, speech and language therapy

Question 7

What is osteosclerosis?

Answer 7

Autosomal dominant condition characterised by ankylosis of the stapes footplate to the oval window
Hearing loss occurs during middle age and is exacerbated by pregnancy
Normla otoscopy
Rinne’s negative in affected side

Question 8

What are red flags for a neck lump?

Answer 8

A hard and fixed mass.
The patient with the neck lump is over 35-years-old.
The presence of a mucosal lesion in the head or neck.
A history of persistent hoarseness or dysphagia.
The presence of trismus.
The presence of unilateral ear pain (referred from tongue base).

Question 9

What is acoustic neuroma?

Answer 9

Benign tumour that arises from cranial nerve VIII
Unilateral sensorineural hearing loss 
Unilateral or asymmetrical tinnitus 
Altered facial sensation 
Balance problems and dizziness
Headache 
MRI used to diagnose 
Risk factors include neurofibromatosis 
Ionising radiation 
Damage to gene on chromosome p22

Question 10

What are the common benign neck lumps?

Answer 10

Cystic hygroma (children, congenital)
Thyroglossal cyst (children, congenital)
Branchial cyst (most common congenital cause)
Ranula
Laryngocele (rare more common in wind instrument players/glass blowers)
Sialedenitis/sialithiasis
Pharyngeal puch

Question 11

What are the characteristics of the common benign neck lumps?

Answer 11

Thyroglossal cyst: connection between caecum of the tongue and the pyramidal lobe of the thyroid gland
Cystic hygroma: Posterior triangle of neck, present at birth or before 2
Ranula: Mucocele in the floor of the mouth originating from the sublingual glands
Laryngocele: air pocket that arises from the deepest point of the laryngeal ventricle

Question 12

What are the clinical presentations of benign neck lumps?

Answer 12

Thyroglossal cyst: Moves upwards when individual swallows or protrudes their tongue
Branchial cyst: Painless, slow growing, smooth, fluctuant swellings in lateral neck
Cystic hygroma: seen in USS in pregnancy, neck and axillae, soft painless swellings sometimes translucent
Ranula: clear/blueish cysts
Laryngocele: air filled cyst, intermittent neck swelling, becomes palpable when the valsalva manoeuvre is performed

Question 13

What are the management options for benign neck lumps?

Answer 13

Thyroglossal cyst: refer to ENT for Sistrunk’s procedure
Branchial cyst: refer to ENT, antibiotics, excision
Cystic hygroma: sclerotherapy or surgical removal
Ranula: Excision including the sublingual gland
Layngocele: excision

Question 14

What is Waldeyer’s ring?

Answer 14

Pharyngeal (adenoids), tubal, palatine (tonsils), lingual tonsils

Question 15

What are the causes of objective tinnitus?

Answer 15

Vascular disorders causing turbulent flow
Arteriovenous malformations
Vascular tumours
Carotid or vertebral artery stenosis, dissection or aneurysms
Valvular disorders
High cardiac output- anaemia

Question 16

How does an ear drum appear in otitis media with effusion?

Answer 16

Reduced mobility of the eardrum with hyperaemia
Middle ear effusion may appear golden-brown or blue
Bubbles may be seen through the drum
Retracted drum with prominent malleus and occasional vesicles

Question 17

What are the surgical options for OME?

Answer 17

Myringotomy: aspiration of fluid under GA if symptoms persist over 3 months
Insertion of a grommet
Anterior or inferior radial myringotomy us used to insert grommet

Question 18

What is the role of the recurrent laryngeal nerve?

Answer 18

Branch of the vagus nerve (X)
Provides sensory innervation tot he trachea and larynx below the level fo the vocal cords and motor innervation to all the intrinsic muscles of the larynx, except the cricothyroid muscle (supplied by external laryngeal nerve)

Question 19

What is the treatment for otitis externa?

Answer 19

2% acetic acid, neomycin, ahminoglycosides (topical antibiotics)
Wick inserted if swelling severe
Can add corticosteroid

Question 20

What is Ludwig’s angina?

Answer 20

Severe bacterial infection that can arise due to dental infection
Associated with progressive cellulitis and oedema of the soft tissue of the floor of the mouth
Life-threatening to to risk of air compromise

Question 21

What is the centor criteria for giving antibiotics in tonsillitis?

Answer 21

Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of severe (over 38)
Absence of cough
Each criteria scores 1 point
3 or 4 associated with a 32-52% of isolating streptococcus app

Question 22

What is Ramsay Hunt syndrome (herpes zoster)?

Answer 22

Presents with triad of LMN facial paralysis, earache and vesicles on the face or ear
Other features include vertigo or tinnitus
Steroid and acyclovir can prevent hearing loss

Question 23

What are the indications for surgery in chronic suppurative otitis media?

Answer 23

Perforation that persists beyond 6 weeks
Otorrhea that persists for 6 weeks despite antibiotic use
Cholesteatoma formation
Radiographic evidence of chronic mastoiditis
Conductive hearing loss