Misc

Question 1

dysphagia

Answer 1

ADD

Question 2

dysphonia causes

Answer 2

inflammation
muscle tension imbalance
structural/neoplastic
neuromuscular: over/underuse

Question 3

dysphonia assessment

Answer 3

ADD

Question 4

voice therapy

Answer 4

ADD

Question 5

laryngectomy

Answer 5

ADD

Question 6

swallowing phsyiology

Answer 6

ADD

Question 7

SALT investigations

Answer 7

ADD

Question 8

tonsillectomy complicatiosn

Answer 8

ADD

Question 9

grommet complications

Answer 9

ADD

Question 10

otalgia

Answer 10

often with otorhoea
local (ext/mid ear) or referred (TMJ, throat, mouth, dental)
>1/12 with no Dx (check tongue/retromolar) = refer (ENT endoscopy)

*TMJ: dysfunction/arthritis; pain on movement/palpation

Question 11

otorrhoea

Answer 11

often with otalgia
OM: severe pain then d/c, then pain lessens; purulent
cholesteatom: foul-smelling unilateral; check par flaccida

Question 12

saliva functions

Answer 12

lubricate/moist/friction/prevent sticking
bolus formation/softening
speech articulation
digestion, taste, solvent, buffer
immune (lysozymes, IgA, washing)

Question 13

changed voice

Answer 13

polyps, nodules, paralysis/movement, inflammation/infection/irritative laryngitis (smoke/reflux/allergy)

regional paralysis: nerve, tumour, NMJ/mm/nn, AI
hypothyroid hoarseness

Question 14

lost voice

Answer 14

no phonation
articulation
infection
psychological (can cough)

Question 15

UAO emergencies

Answer 15

ADD

Question 16

nasal polyps

Answer 16

allergic: commonest;
obstruction, rhinitis, multiple white/silver polyps
Rx: steroids (shrink), surgery if fails (can recur)

non-allergic:
inverted papilloma/antrochoanal polyp; from sinus into cavity
solitary polyp
Mx: imaging CT >MRI; surgery

Question 17

sore throat DDx

duration, triggers, occupation, smoking and alcohol, acid reflex, ‘lump’

Answer 17

tonsilitis/viral infection/bacterial
-bacterial: centor score, worse >3/d; diphtheria (membrane), staph, strep, myco, clap, pertussis
-glandular fever (EBV), mono
intra-oral lesions/ulcers
neck lumps: 1o cancer, 2o mets, cervical LA

Question 18

RED FLAGS!

Answer 18

hoarse voice >3/52 (tumour)
foul smelling otorrhoea (cholesteatoma)
unilateral foul nasal d/c (foreign body)
unilateral polyp/bloody rhinorrhoea (tumour)
unilateral deafness (tumour)
persistent lump in throat (tumour)

Question 19

tinnitus

can be caused by any hearing loss

Rx: supportive/distraction

Answer 19

common; psych effect (sleep, conc, coping)
history: duration, ‘SOCRATES’, nature (?pulsitile), triggers, RF, impact

bilateral pulsitile: HTN spikes; unilateral: ?glomus tumour (sunset TM)
middle ear pathology: low frequency
Meniere’s: low frequencies
Presbycusis/idiopathic: high frequencies

Question 20

Sore throat - ABx indications

Answer 20

systemic upset
unilateral peritonsilitis
PMH Rheumatic fever
increased infection risk (DM, IC)
3+ Centor criteria (tonsil exudate, fever, no cough, tender cervical LA)