Speciality: Ears, Nose and Throat

Question 1

Otosclerosis

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 1

1. AD inherited. Deafness due to fixation of the stapes on the oval window.
2. Typically affects young adults.
   - Conductive deafness
   - Tinnitus
   - Normal tympanic membrane
   - FHx
3. Clinical
4. Hearing aid
   - Stapedectomy

Question 2

Viral labyrinthitis Vs vestibular neuronitis

Answer 2

VL - Recent viral infection. Sudden. N&V. Hearing affected.
VN - Recent viral infection. Sudden. Hearing spared.

Question 3

Nasal polyps

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 3

1. associated w/ Asthma, aspirin sensitivity, infective sinusitis, CF, kartagener’s syn, churg-strauss syn.
2. Nasal obstruction
   - sneezing
   - poor sense of smell and taste.
3. Endoscopic investigation.
4. ENT referral
   - Topical/inhaled steroids can reduce size by 80%
   - Urgent ENT referral if unilateral. Red flag for nasopharyngeal Ca.

Question 4

Cholesteatoma;

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 4

1. Non-cancerous growth of squamous epithelium trapped in the skull base causing local destruction.
2. 10-20yo
   - Cleft palate association.
   - Foul-smelling non-resolving discharge
   - Hearing loss
   - Vertigo
3. Otoscopy - attic crust
4. ENT ?Surgical removal

Question 5

Neck Lumps

Answer 5

• Lymphadenopathy
• Lymphoma
• Thyroid swelling
• Thyroglossal cyst
• Pharyngeal pouch
• Cystic hygroma
• Branchial cyst
• Carotid aneurysm

Question 6

Reactive cervical lymphadenopathy

Answer 6

• Neck lump
• Common
• Hx of local or systemic infection.

Question 7

Lymphoma

Answer 7

• Rubbery, painless node
• Pain when drinking alcohol
• B symptoms

Question 8

Thyroid Swelling

Answer 8

• Mid line
• Moves upwards when swallowing
• Hx or Sx of thyroid disease

Question 9

Thyroglossal cyst

Answer 9

• Patient <20yo
• Midline between the isthmus of the thyroid and the hyoid bone.
• Moves upwards w/ protrusion of the tongue

Question 10

Pharyngeal pouch

Answer 10

• Older men
• Herniation between the thryopharyngeus and cricopharynxgeus muscles.
• Midline lump if large.
• Dysphagia, regurgitation, bad breath etc.

Question 11

Cystic hygroma

Answer 11

• Congenital lesion
• L sided neck.
• Often presents in kid hood.

Question 12

Branchial cyst

Answer 12

• Oval, mobile cyst which develops between the SCM and pharynx.
• Present from early adulthood.

Question 13

Nasopharyngeal Ca

Answer 13

• often occult primary, presents w/ mets.
• More common in asian people.
• Presents w/ epistaxis, headaches, lymph node mets and hearing loss.

Question 14

laryngeal Ca

Answer 14

• People aged 45yo and older w/ persistent hoarseness of voice or unexplained neck lump.

Question 15

Oral Ca

Answer 15

• Unexplained ulceration in the oral cavity lasting for 3 or more weeks.
• Persistent lump in the neck.
• Lumo
• Red or red and white patch.

Question 16

Facial pain ddx

Answer 16

• Sinusitis
• Trigeminal neuralgia
• Cluster headache
• Temporal arteritis

Question 17

Sinusitis

Answer 17

• Facial fullness and tenderness

- Nasal discharge, pyrexia and post nasal drip.

Question 18

Trigeminal neuralgia

Answer 18

• Unilateral face pain.
• Brief electric shock type pain.
• Can be triggered by touching.

Question 19

Cluster headache

Answer 19

• Once/twice daily
• Clusters
• Intense pain around one eye + redness, tearing, nasal blockage.

Question 20

Temporal arteritis

Answer 20

• Pain around eyes and temples
• Tender to touch
• Raised ESR.

Question 21

Acute tonsillitis

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 21

1. Strep pyogenes in the most common.
   - Viral
2. Pharyngitis, fever, malaise, lymphadenopathy.
   - Tonsils are oedematous w/ yellow or white pustules.
3. Clinical
   - Bloods
   - Swabs
   - CENTOR
4. Pen V