Exam Q2

Question 1

What are the causes of otitis externa?

Answer 1

Infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
seborrhoeic dermatitis
contact dermatitis (allergic and irritant)

Question 2

What are the features of Meniere’s disease?

Answer 2

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
episodes last minutes to hours
typically symptoms are unilateral but bilateral symptoms may develop after a number of years

Question 3

What can cause sudden onset SNHL?

Answer 3

Autoimmune conditions (e.g. Behcet's or SLE)
Infectious causes (e.g. bacterial meningitis, mumps, Lyme's disease)
Metabolic causes (e.g. diabetes, hypothyroidism), or neoplasm.

Question 4

What are the presenting features of nasopharyngeal carcinoma?

Answer 4

Cervical lymphadenopathy
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/or epistaxis 
Cranial nerve palsies III-VI

Question 5

What are the NICE indications for antibiotics in a sore throat?

Answer 5

Features of marked systemic upset secondary to the acute sore throat
unilateral peritonsillitis
a history of rheumatic fever
an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present
phenoxymethylpenicillin or erythromycin (if the patient is penicillin allergic) should be given

Question 6

Which drugs can cause tinnitus?

Answer 6

Aspirin/NSAIDS
Aminoglycosides
Loop diuretics
Quinine

Question 7

What are the features of quinsy (peritonisllar abscess)?

Answer 7

Severe throat pain, which literalists to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility
Managed with needle aspiration or incision & drainage + intravenous antibiotics
tonsillectomy should be considered to prevent recurrence

Question 8

What are the features of vestibular neuronitis?

Answer 8

Cause of vertigo that often develops after an infection
recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus

Question 9

What are the causes of gingival hyperplasia?

Answer 9

Drugs: phenytoin, ciclosporin, calcium channel blockers (esp nifedipine)
Acute myeloid leukaemia

Question 10

What are the differences between viral labyrinthitis and vestibular neuritis?

Answer 10

Viral labyrinthitis: URTI, vertigo, vomiting, hearing affected, sudden onset
Vestibular neuritis: recovering from URTI, recurrent attacks of vertigo, nausea and vomiting, no hearing loss or tinnitus

Question 11

Which antibiotics should be used in ear infections?

Answer 11

Ciprofloxacin- malignant otitis externa for P. aeruginosa
Flucloxacillin- uncomplicated otitis externa
Amoxicillin: otitis media

Question 12

What is malignant otitis externa?

Answer 12

Uncommon type of otitis externa that is found in immunocompromised individuals (90% cases found in diabetics)
most commonly caused by Pseudomonas aeruginosa
Infection commences in the soft tissues of the external auditory meatus, then progresses to involve the soft tissues and into the bony ear canal
Progresses to temporal bone osteomyelitis
Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

Question 13

What are the other types of parotid disorders?

Answer 13

HIV infection:
Typically presents as bilateral, multicystic, symmetrical swelling
Risk of malignant transformation is low and management usually conservative
Sjogren’s syndrome:
Autoimmune disorder characterised by parotid enlargement, xerostomia and keratoconjunctivitis sicca
Bilateral, non tender enlargement of the gland is usual
Sarcoidosis:
Bilateral in most cases
Gland is not tender
Xerostomia may occur

Question 14

What are the complications following thyroid surgery?

Answer 14

Anatomical such as recurrent laryngeal nerve damage.
Bleeding. Owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema.
Damage to the parathyroid glands resulting in hypocalcaemia.

Question 15

Which medications can cause tinnitus?

Answer 15

Aspirin/NSAIDs (naproxen)
Aminoglycosides
Loop diuretics
Quinine

Question 16

What is the management for vestibular neuronitits?

Answer 16

vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms
buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases
a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases

Question 17

What are the second line options for otitis externa?

Answer 17

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