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ENT MCQ Revision ‘A game of 20 questions’Overview of the session 20 MCQ Questions Polls Learning Points • Taken from PassMedicine • Will show the question on • Once the correct answer is • Covers the major themes screen, along with a poll to shown, we’ll walk through put your answer why this is the case • As per normal exam conditions, you will have 80 seconds to answer the question • I won’t pick anyone out to answer any questions!1)1)1)1)1)1)2)2)2) Meniere’s disease - Is a cause of vertigo - Episodes would last 2-3 hours - Unrelated to head position - Aural fullness / hearing loss Multiple Sclerosis - Vertigo unlikely in MS - If present, unlikely to be short-lasting, related to head position and would expect other features of UMN lesion / optic neuritis BPPV Posterior - Recurrent episodes circulation stroke Viral labyrinthitis - Well inbetween - Sudden onset of - Typically after a viral infection - Turning over in bed of persistent - 10-20s vertigo - Would expect hearing loss - Would be 1 constant episode of vertigo - No other symptoms3)3)3) Antibiotics should be prescribed for otitis media if; A) Symptoms have lasted more than 4 days or not improving B) Systemically unwell (but not requiring hospital admission) C) Patient is immunocompromised or at high risk of developing complications D) Younger than 2 years old with bilateral otitis media E) Otitis media with perforation and/or discharge in the external canal3) Discuss with ENT - Tympanic membrane perforation is common complication of otitis media and does not always need ENT input Reassure and give analgesia - This is general advice for those that don’t meet antibiotic criteria 7 day course of antibiotic spray - This is part of the management of otitis externa - Aminoglycosides (neomycin) is ototoxic 7 day course of amoxicillin - Perforated with discharge in the Review again in 12-16 weeks - Most of the time they heal within 4-8 weeks canal - Good practise in children to review them, - Under 2 with bilateral otitis media however should be done earlier than 12-16 - Amoxicillin is first line for otitis weeks media4)4)5)5)5) Small amount of wax - Wouldn’t explain discharge - Likely too small to affect hearing Chronic otitis media - Tympanic membrane looks normal Bullous myringitis - This is an infection of tympanic membrane causing fluid filled blisters Cholesteatoma - Affects 10-20 year olds Retained grommet - Would expect to still see the grommet on - Classic attic crust appearance otoscopy - Foul-smelling persistent discharge - Unilateral hearing loss6)6)6) IV tazocin - This can be given for necrotising otitis externa, which is characterised by bony involvement - This is seen in elderly diabetics and is extremely painful Oral amoxicillin - As mentioned before, this is given in certain circumstances for otitis media Oral ciprofloxacin Neomycin with dexamethasone ear spray - Not used for otitis externa - Treatment for otitis externa is antibiotic spray or combined antibiotic and steroid Topical hydrocortisone cream spray - Steroid drop/spray needed in combination with antibiotic - Cream would not reach ear canal7)7)7) Acute labyrinthitis - Denies recent infection - Would expect it to resolve within a week Cholesteatoma - Unilateral conductive hearing loss - Foul smelling discharge Meniere’s disease - Unilateral sensorineural hearing loss Otosclerosis - Would also expect aural fullness and vertigo attacks - Bilateral conductive hearing loss - Doesn’t explain family history - Positive family history (autosomal dominant) - ‘Flamingo tinged’ tympanic membrane Vestibular schwannoma - Unilateral sensorineural hearing loss - Would also expect facial nerve palsies and ataxia8)8)8) Elective grommet insertion - They have otitis media with effusion but mastoiditis has clinical priority Oral antibiotics - Mastoiditis requires IV antibiotics to prevent intracranial infection Reassurance and safety netting - Would be inappropriate even if it was just the otitis media, as has lasted more IV Antibiotics than 4 days + systemically unwell - Patient has mastoiditis (tender over mastoid process, displacement of external Urgent surgical drainage ear, septic picture, hx of otitis media) - This can be done once it’s unresponsive to IV antibiotics and there are signs of - IV antibiotics is 1st line intracranial or extracranial complications9)9)10)10)10) Viral Labyrinthitis Vestibular Neuronitis - The vestibular nerve and labyrinth are - Only the vestibular nerve is involved involved - Is a cause of vertigo in someone with a - Is a cause of vertigo in someone with a recent viral illness recent viral illness - N for no hearing loss - L for (hearing) loss11)11)11) Anterior packing - This is done next for posterior bleeds - here the bleed is visible anyway Cautery - This is done next for anterior bleeds - as seen here Naseptin - This is chlorhexidine and neomycin - This is given once bleeding has stopped to prevent crusting Pinch nostrils and lean forward Refer to ENT for posterior packing - First line immediate steps for - This would be done for a posterior bleed if epistaxis anterior packing still hasn't worked - Needs to be done for 20 mins first - If all this is unsuccessful for posterior bleed, unless hemodynamically unstable then sphenopalatine ligation in theatre is required12)12)12) Cefalexin - This is an antibiotic, which is not typically used for this, especially as its likely to be viral Intranasal corticosteroids - Can be used if symptoms last longer than 10 days Intranasal decongestants Analgesia - Can be used for short courses however - 1st line management for acute generally avoided due to dependence and sinusitis limited evidence Phenoxymethylpenicillin - Can be used if you suspect a bacterial cause, however here there is clear coryzal symptoms13)13)13) CENTOR Criteria FEVERPain Score Cervical lymphadenopathy Fever over 38°C Exudate of tonsils Purulence No cough Attend rapidly (3 days or less) Temperature Inflamed tonsils No cough13)13) CENTOR Criteria FEVERPain Score Cervical lymphadenopathy Fever over 38°C Exudate of tonsils Purulence No cough Attend rapidly (3 days or less) Temperature Inflamed tonsils No cough14)14)14) Criteria needed for a tonsillectomy 1 Five or more sore throats a year 2 Sore throats are due to tonsillitis 3 Symptoms have been occurring for at least a year 4 Sore throat episodes are disabling and prevent normal functioning14)15)15)15) CT Chest - Can exclude lung tumour compressing laryngeal nerve, however ordered by ENT Routine referral to ENT - Never do routine referrals for suspected cancer Sending the patient to the ED - Patient is not acutely unwell, and would just end up with a referral to ENT Urgent referral to ENT - Refer for suspected laryngeal cancer for Urgent referral to a respiratory clinic anyone over 45 with either - Given the hoarse voice, you should be highly suspicious of a malignancy involving the A. Unexplained hoarse voice laryngeal nerves, which requires an ENT B. Unexplained neck lump referral16)16)16)Thank you! Any questions → joshua.williams@student.manchester.ac.uk luqman.aizan@student.manchester.ac.uk Please fill out the feedback form! Next session is this thursday on paediatric pyloric stenosis, gastroschisis & exomphalos, appendicitis, undescended testis and more!