Passmed

Question 1

What investigation should patients with suspected laryngeal cancer and horse voice have before attending urgent ENT clinic to rule out another cause?

Answer 1

Chest x ray to rule out an apical lung lesion

Question 2

What are the causes of a horse voice?

Answer 2

voice overuse
smoking
viral illness
hypothyroidism
gastro-oesophageal reflux
laryngeal cancer
lung cancer

Question 3

What is the most appropriate treatment method for a patient presenting with profuse epistaxis where the bleeding site is unable to be localised?

Answer 3

Anterior nasal packing

Cautery and cryotherapy require the bleeding site to be visible

Question 4

How should a patient presenting with a 6 week history of a 1cm by 1cm mouth ulcer be refered?

Answer 4

A 2 week wait referral for oral surgery as any ulcers lasting longer than 3 weeks are suspicious

Question 5

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 test results imply?

Answer 5

They imply a right sensorineural hearing loss

Question 6

In what situations would antibiotics be advised over conservative management for acute otitis media?

Answer 6

If there is a perforation
If the patient is systemically unwell
If there is immunocompromise

Question 7

What are the centor criteria for tonisllitis?

Answer 7

This is for it being bacterial:

• temp over 38
• exudate on tonsils
• Absence of cough
• tender anterior lymphadenopathy

Question 8

What are the presenting features of nasopharangeal carcinoma?

Answer 8

Cervical lymphadenopathy
Otalgia
Unilateral otits media
Nasal obstruction/epistaxis
Cranial nerve palsies

Question 9

What is the appropriate management for bacterial tonsillitis?

Answer 9

Phenoxymethylpenicillin for 10 days

Question 10

What are the cebtor criteria for tonsillitis?

Answer 10

Tonsillar exudate
Lack of cough
History of fever
Tender anterior cervical lymphadenopathy

Question 11

When should antibiotics be prescribed for otitis media?

Answer 11

If it is present for more than 4 days
Bilateral in under 2s
Systemic upset
Otitis media with perforation or discharge

Question 12

A 42-year-old man with a 3 month history of chronic cough presents with a persistent headache, what is the diagnosis?

Answer 12

This patient has chronic sinusitis. The cough is secondary to a post-nasal drip

Question 13

What is tachyphlaxis?

Answer 13

the phenomenon of having to use increasing doses over a prolonged period to provide the same effect. happens with nasal decongestants

Question 14

What is a red flag for epistaxis?

Answer 14

Recurrent unilateral bleeding

Question 15

What is ludwig’s angina?

Answer 15

Cellulitis of the floor of the mouth

Question 16

How does webers test localise in conductive hearing loss?

Answer 16

To the size that is affected

Question 17

When reading an audiogram what is normal?

Answer 17

Normal is anything above 20dB

Question 18

What is seen on otoscopy for cholesteatoma?

Answer 18

An attic crust in the upper part of the ear drum

Question 19

What kind of hearing loss does otosclerosis cause?

Answer 19

This is a genetic condition that causes a bilateral conductive pattern of hearing loss due to ossification of the ossicular chain

Question 20

What is the management for acute otitis externa?

Answer 20

For mild cases topical acetic acid 2% spray

For more severe cases 7 days antibiotics with or without a topical steroid

Question 21

What is the treatment of bleeding in the first 24 hours following tonsilectomy?

Answer 21

Immediate return to theatre due to risk of further bleeding

Question 22

How are polyps usually treated?

Answer 22

Intranasal steroids can shrink polyps by up to 80%

Question 23

How should a single unilateral polyp be treated?

Answer 23

It is important to exclude malignancy

Question 24

How should sinusitis without systemic upset be treated?

Answer 24

If the symptoms have been present for 10 days or longer then consider intranasal corticosteroids

Question 25

What is the usual healing time for a perforated eardrum?

Answer 25

6-8 weeks

Question 26

A 10-year-old child presents with enlarged tonsils that meet in the midline. Oropharyngeal examination confirms this finding and you also notice peticheal haemorrhages affecting the oropharynx. On systemic examination he is noted to have splenomegaly. What is the diagnosis?

Answer 26

Infectious mononucleosis (glandular fever)

Question 27

What is a tonsillar swelling that is only on one side?

Answer 27

Quinsy

Question 28

What is the treatment for a non healing tympanic perforation?

Answer 28

myringoplasty which is an operation performed to repair the perforation. This is appropriate as spontaneous healing has failed to occur. Following a perforation healing should occur within 6-8 weeks however in this situation it has failed to occur after 6 months, making waiting another 6-8 weeks inappropriate

Question 29

What is the treatment of a quinsy?

Answer 29

Should consider surgical drainage and IV antibiotics

Tonsilectomy should be considered in 6 weeks

Question 30

What is the management of sudden sensorineural hearing loss in adults?

Answer 30

Refer urgently to ENT and start high dose steroids

ENT will MRI to check for an acoustic neuroma