Ear, Nose and Throat SAQs

  1. What type of hearing loss is caused by a problem with sound travelling to the inner ear? (1)
  2. What type of hearing loss is caused by a problem with the sensory system or vestibulocochlear nerve? (1)
  3. Name the small bones in the middle ear. (3)
  4. What structure is responsible for regulating the air pressure in the middle ear? (1)
  5. What inner ear structures are responsible for sensing head movement? (1)
  6. What duration of time is used to define sudden onset hearing loss? (1)
  7. What clinical tests can be used to differentiate between the two types of hearing loss? (2) Where do you place the tuning fork for each test? (2)
  8. Give three common classes of medication that can cause hearing loss? (3)
  9. What is plotted on the x-axis of an audiogram? (1)
  10. What is plotted on the y-axis of an audiogram? (1)
  11. What symbols on an audiogram represent left-sided air conduction (1), left-sided bone conduction (1), right-sided air conduction (1) and right-sided bone conduction (1)?
  12. What hearing volume is considered normal? (1)
  13. What frequencies are first affected in presbycusis? (1)
  14. What option is available for patients with presbycusis where hearing aids are not sufficient? (1)
  15. What is the most common cause of sudden sensorineural hearing loss? (1)
  16. What is the first-line investigation in patients with sudden sensorineural hearing loss? (1)
  17. What treatment may be considered in idiopathic sudden sensorineural hearing loss? (1)
  18. Give three possible causes of Eustachian tube dysfunction. (3)
  19. What investigation can be used to assess the pressure in the middle ear in patients with Eustachian tube dysfunction? (1)
  20. What procedure can be used to expand the Eustachian tube? (1)
  21. What causes hearing loss in otosclerosis? (1)
  22. What age range is most commonly affected by otosclerosis? (1)
  23. What type of hearing loss occurs in otosclerosis? (1)
  24. What frequencies are most affected in otosclerosis? (1)
  25. What are the surgical options for treating otosclerosis? (2)
  26. What is the most common bacterial cause of otitis media? (1)
  27. If an antibiotic is required, what do the NICE CKS recommend as first-line for otitis media? (1)
  28. What are the most common bacterial causes of otitis externa? (2)
  29. What combination of medications are included in Otomize spray? (3)
  30. What is important to exclude before using aminoglycoside antibiotic ear sprays or drops? (1) Why? (1)
  31. What treatment option may be used initially to treat otitis externa in patients with a very swollen ear canal where drops or sprays are unlikely to be effective? (1)
  32. What pathogen should be considered where otitis externa is not responding to multiple courses of antibiotics? (1)
  33. What is the medical term for ear wax? (1)
  34. What are the main methods for removing problematic ear wax? (3)
  35. What systemic conditions may be associated with tinnitus? (4)
  36. What is the first-line investigation for further assessment of tinnitus? (1)
  37. What are the four most common causes of peripheral vertigo? (4)
  38. What are the four most common causes of central vertigo? (4)
  39. What specific examination can be used to distinguish between central and peripheral vertigo? (1) What is this an acronym for? (3)
  40. What short-term options are available for managing symptoms of peripheral vertigo? (2)
  41. What manoeuvre can be used to diagnose BPPV? (1)
  42. What manoeuvre can be used to treat BPPV? (1)
  43. What are the two common causes of peripheral vertigo associated with viral upper respiratory tract infections? (2) How do you distinguish between them? (1)
  44. What is the typical triad of symptoms in Ménière's disease? (3)
  45. What medication may be used as prophylaxis in Ménière's disease? (1)
  46. What other two names are used for acoustic neuromas? (2)
  47. What genetic condition do bilateral acoustic neuromas indicate? (1)
  48. What motor nerve is most likely to be affected by an acoustic neuroma? (1)
  49. What is a cholesteatoma? (1)
  50. What are the two typical presenting symptoms of a cholesteatoma? (2)
  51. What is the treatment of a cholesteatoma? (1)
  52. What are the branches of the facial nerve? (5)
  53. What is the sensory function of the facial nerve? (1)
  54. What structures get their parasympathetic supply from the facial nerve? (3)
  55. What clinical finding can distinguish between an upper and lower motor neurone facial nerve palsy? (1)
  56. What are the most common causes of a unilateral upper motor neurone facial nerve palsy? (2)
  57. What is the relatively common idiopathic cause of a lower motor neurone facial nerve palsy? (1) What treatment may be considered? (1) What additional management is required to prevent an important complication? (1)
  58. What virus causes Ramsay-Hunt syndrome? (1) Other than facial nerve palsy, what is the other stereotypical presenting feature? (1)
  59. What plexus and area does bleeding usually originate in epistaxis? (2)
  60. What can be used for nasal cautery in patients with epistaxis? (1)
  61. What topical treatment may be considered after treating an acute nosebleed? (1) In what situations would this be contraindicated? (2)
  62. What are the four sets of paranasal sinuses? (4)
  63. What is the cutoff for chronic rather than acute sinusitis? (1)
  64. What type of surgery may be used in problematic chronic sinusitis? (1)
  65. What is Samter’s triad? (3)
  66. What scoring tool is used to assess sleepiness in patients with obstructive sleep apnoea? (1)
  67. What non-surgical treatment is used for managing obstructive sleep apnoea after addressing reversible risk factors? (1)
  68. What surgical procedure is most commonly used for obstructive sleep apnoea? (1)
  69. What is the name for the ring of lymphoid tissue in the pharynx? (1) What is this comprised of? (4)
  70. What features each score a point to fulfil the Centor criteria? (4)
  71. What alternative to the Centor criteria can be used to calculate the probability of bacterial tonsillitis? (1) What features score a point in this tool? (5)
  72. What is the most common bacterial cause of tonsillitis? (1)
  73. What is the typical first-line antibiotic for bacterial tonsillitis? (1)
  74. What could cause pain, stiffness and swelling of a single joint in someone with recent tonsillitis? (1)
  75. What could cause acute kidney injury in someone with recent tonsillitis? (1)
  76. What could cause a rash, “sandpaper” skin and a “strawberry tongue” in a child with recent tonsillitis? (1)
  77. What is the other name for a peritonsillar abscess? (1)
  78. What is the term for when a patient is unable to open their mouth? (1)
  79. What is the definitive management of a peritonsillar abscess? (1)
  80. How many episodes of tonsillitis in a single year would qualify for a tonsillectomy according to the SIGN guidelines (2010)? (1) How many episodes per year over two years? (1)
  81. What is the main significant and potentially life-threatening complication after a tonsillectomy? (1)
  82. What are the borders of the anterior triangle of the neck? (3)
  83. What are the borders of the posterior triangle of the neck? (3)
  84. What is the usual first-line investigation in suspected infectious mononucleosis? (1)
  85. What initial investigation is used where systemic lupus erythematosus is suspected? (1)
  86. What is the usual first-line imaging investigation for unexplained neck lumps? (1)
  87. What general categories can you use to group the causes of lymphadenopathy? (4)
  88. What location of an enlarged lymph node in the neck would be most concerning for malignancy? (1)
  89. What does a Reed-Sternberg cell found on a lymph node biopsy suggest? (1)
  90. What is the initial investigation of choice in possible leukaemia? (1)
  91. What particular cells do carotid body tumours arise from? (1)
  92. In what directions are carotid body tumours mobile? (1)
  93. What is the classical triad of symptoms in Horner syndrome? (3)
  94. What type of neck lump will move up and down with movement of the tongue? (1) Where will this lump be situated? (1)
  95. What structure do most branchial cysts arise from? (1)
  96. What is the histology of most head and neck cancers? (1)
  97. What habit in south-east Asia is linked with head and neck cancer? (1)
  98. Infection with which viruses can increase the risk of head and neck cancer? (2)
  99. What does cetuximab target to treat cancers of the head and neck? (1)
  100. What is the term that describes an inflamed tongue? (1)
  101. What are the top three causes of angioedema? (3)
  102. What are the top two medications that cause oral candidiasis? (2)
  103. What are the options for treating oral candidiasis in mild to moderate cases? (2)
  104. What condition causes irregularly shaped patches on the tongue, somewhat resembling a map? (1)
  105. What are the key causes of a “strawberry tongue” in children? (2)
  106. What condition results from decreased exfoliation of keratin from the tongue's surface, causing the papillae to elongate and take on an unusual appearance? (1)
  107. What condition causes red patches in the mouth and poses a high risk of cancer? (1)
  108. What condition is associated with Wickham’s striae? (1)
  109. What term describes inflammation of the gums? (1)
  110. What term describes severe and chronic inflammation of the gums and the tissues that support the teeth? (1)
  111. What is the name for hardened plaque on the teeth? (1)
  112. What type of bacteria usually causes acute necrotising ulcerative gingivitis? (1) What antibiotic is most often used to treat this condition? (1)
  113. What type of cancer is most associated with gingival hyperplasia? (1)
  114. What nutritional deficiency leads to gingival hyperplasia? (1)
  115. What are the top three conditions affecting the gastrointestinal tract associated with mouth ulcers? (3)
  116. What duration of “unexplained ulceration” in the mouth would indicate a two week wait urgent cancer referral? (1)
  1. What type of hearing loss is caused by a problem with sound travelling to the inner ear? Conductive hearing loss (1)
  2. What type of hearing loss is caused by a problem with the sensory system or vestibulocochlear nerve? Sensorineural hearing loss (1)
  3. Name the small bones in the middle ear. Malleus (1), incus (1) and stapes (1)
  4. What structure is responsible for regulating the air pressure in the middle ear? Eustachian tube (1)
  5. What inner ear structures are responsible for sensing head movement? Semicircular canals (1)
  6. What duration of time is used to define sudden onset hearing loss? Less than 72 hours (1)
  7. What clinical tests can be used to differentiate between the two types of hearing loss? Where do you place the tuning fork for each test? Weber’s (1) - centre of the forehead (1) and Rinne’s (1) - mastoid process (1)
  8. Give three common classes of medication that can cause hearing loss? Loop diuretics (e.g., furosemide) (1), aminoglycoside antibiotics (e.g., gentamicin) (1) and chemotherapy drugs (e.g., cisplatin) (1)
  9. What is plotted on the x-axis of an audiogram? Frequency in hertz (Hz) (1)
  10. What is plotted on the y-axis of an audiogram? Volume in decibels (dB) (1)
  11. What symbols on an audiogram represent left-sided air conduction? X (1) Left-sided bone conduction? ] (1) Right-sided air conduction? O (1) Right-sided bone conduction? [ (1)?
  12. What hearing volume is considered normal? 0 - 20 dB (1)
  13. What frequencies are first affected in presbycusis? Higher-pitched frequencies (1)
  14. What option is available for patients with presbycusis where hearing aids are not sufficient? Cochlear implants (1)
  15. What is the most common cause of sudden sensorineural hearing loss? Idiopathic (no specific cause) (1)
  16. What is the first-line investigation in patients with sudden sensorineural hearing loss? Audiometry (1)
  17. What treatment may be considered in idiopathic sudden sensorineural hearing loss? Steroids (1)
  18. Give three possible causes of Eustachian tube dysfunction. Viral upper respiratory tract infection (1), allergies (e.g., hayfever) (1) or smoking (1)
  19. What investigation can be used to assess the pressure in the middle ear in patients with Eustachian tube dysfunction? Tympanometry (1)
  20. What procedure can be used to expand the Eustachian tube? Balloon dilatation Eustachian tuboplasty (1)
  21. What causes hearing loss in otosclerosis? Abnormal bone remodelling of the auditory ossicles (1)
  22. What age range is most commonly affected by otosclerosis? Under 40 years (1) 
  23. What type of hearing loss occurs in otosclerosis? Conductive (1) 
  24. What frequencies are most affected in otosclerosis? Lower frequency / pitch (1) 
  25. What are the surgical options for treating otosclerosis? Stapedectomy (1) and stapedotomy (1)
  26. What is the most common bacterial cause of otitis media? Streptococcus pneumoniae (1)
  27. If an antibiotic is required, what do the NICE CKS recommend as first-line for otitis media? Amoxicillin (1)
  28. What are the most common bacterial causes of otitis externa? Pseudomonas aeruginosa (1) and Staphylococcus aureus (1)
  29. What combination of medications are included in Otomize spray? Neomycin (1), dexamethasone (1) and acetic acid (1)
  30. What is important to exclude before using aminoglycoside antibiotic ear sprays or drops? A perforated tympanic membrane (1) Why? Aminoglycoside antibiotics are ototoxic and can cause hearing loss if they get past the tympanic membrane (1)
  31. What treatment option may be used initially to treat otitis externa in patients with a very swollen ear canal where drops or sprays are unlikely to be effective? Ear wick (1)
  32. What pathogen should be considered where otitis externa is not responding to multiple courses of antibiotics? Fungal infection (e.g., aspergillus or candida) (1)
  33. What is the medical term for ear wax? Cerumen (1)
  34. What are the main methods for removing problematic ear wax? Ear drops (1), ear irrigation (1) and microsuction (1)
  35. What systemic conditions may be associated with tinnitus? Anaemia (1), diabetes (1), thyroid disorders (1) and hyperlipidaemia (1)
  36. What is the first-line investigation for further assessment of tinnitus? Audiometry (1)
  37. What are the four most common causes of peripheral vertigo? Benign paroxysmal positional vertigo (BPPV) (1), Ménière’s disease (1), vestibular neuronitis (1) and labyrinthitis (1)
  38. What are the four most common causes of central vertigo? Posterior circulation infarction (stroke) (1), tumour (1), multiple sclerosis (1) and vestibular migraine (1)
  39. What specific examination can be used to distinguish between central and peripheral vertigo? HINTS examination (1) What is this an acronym for? Head impulse (1), nystagmus (1) and test of skew (1)
  40. What short-term options are available for managing symptoms of peripheral vertigo? Prochlorperazine (1) and antihistamines (e.g., cyclizine, cinnarizine and promethazine) (1)
  41. What manoeuvre can be used to diagnose BPPV? Dix-Hallpike manoeuvre (1)
  42. What manoeuvre can be used to treat BPPV? Epley manoeuvre (1)
  43. What are the two common causes of peripheral vertigo associated with viral upper respiratory tract infections? Vestibular neuronitis (1) and labyrinthitis (1) How do you distinguish between them? LabyrinthitisLoss of hearing, NeuronitisNo loss of hearing (1)
  44. What is the typical triad of symptoms in Ménière's disease? Hearing loss (1), vertigo (1) and tinnitus (1)
  45. What medication may be used as prophylaxis in Ménière's disease? Betahistine (1)
  46. What other two names are used for acoustic neuromas? Vestibular schwannomas (1) and cerebellopontine angle tumours (1)
  47. What genetic condition do bilateral acoustic neuromas indicate? Neurofibromatosis type II (1)
  48. What motor nerve is most likely to be affected by an acoustic neuroma? Facial nerve (1)
  49. What is a cholesteatoma? An abnormal collection of squamous epithelial cells in the middle ear (1)
  50. What are the two typical presenting symptoms of a cholesteatoma? Foul discharge from the ear (1) and unilateral conductive hearing loss (1)
  51. What is the treatment of a cholesteatoma? Surgical removal (1)
  52. What are the branches of the facial nerve? Temporal (1), zygomatic (1), buccal (1), marginal mandibular (1) and cervical (1)
  53. What is the sensory function of the facial nerve? It carries taste from the anterior 2/3 of the tongue (1)
  54. What structures get their parasympathetic supply from the facial nerve? Submandibular (1) and sublingual salivary glands (1) and lacrimal gland (stimulating tear production) (1)
  55. What clinical finding can distinguish between an upper and lower motor neurone facial nerve palsy? The forehead is spared in an UMNL and not spared in a LMNL (1)
  56. What are the most common causes of a unilateral upper motor neurone facial nerve palsy? Cerebrovascular accidents (strokes) (1) and tumours (1)
  57. What is the relatively common idiopathic cause of a lower motor neurone facial nerve palsy? Bell’s palsy (1) What treatment may be considered? Prednisolone (1) What additional management is required to prevent an important complication? Lubricating eye drops to prevent exposure keratopathy (1)
  58. What virus causes Ramsay-Hunt syndrome? Varicella zoster virus (VZV) (1) Other than facial nerve palsy, what is the other stereotypical presenting feature? Painful and tender vesicular rash around the ear on the affected side (1)
  59. What plexus and area does bleeding usually originate in epistaxis? Kiesselbach’s plexus (1), located in Little’s area (1)
  60. What can be used for nasal cautery in patients with epistaxis? Silver nitrate sticks (1)
  61. What topical treatment may be considered after treating an acute nosebleed? Naseptin nasal cream (chlorhexidine and neomycin) (1) In what situations would this be contraindicated? Peanut (1) or soya allergy (1)
  62. What are the four sets of paranasal sinuses? Frontal sinuses (1), maxillary sinuses (1), ethmoid sinuses (1) and sphenoid sinuses (1)
  63. What is the cutoff for chronic rather than acute sinusitis? More than 12 weeks (1)
  64. What type of surgery may be used in problematic chronic sinusitis? Functional endoscopic sinus surgery (FESS) (1)
  65. What is Samter’s triad? Nasal polyps (1), asthma (1) and aspirin intolerance/allergy (1)
  66. What scoring tool is used to assess sleepiness in patients with obstructive sleep apnoea? Epworth Sleepiness Scale (1)
  67. What non-surgical treatment is used for managing obstructive sleep apnoea after addressing reversible risk factors? Continuous positive airway pressure (CPAP) (1)
  68. What surgical procedure is most commonly used for obstructive sleep apnoea? Uvulopalatopharyngoplasty (UPPP) (1)
  69. What is the name for the ring of lymphoid tissue in the pharynx? Waldeyer’s tonsillar ring (1) What is this comprised of? The adenoids (1), tubal tonsils (1), palatine tonsils (1) and the lingual tonsil (1)
  70. What features each score a point to fulfil the Centor criteria? Fever over 38ºC (1), tonsillar exudates (1), absence of a cough (1) and tender anterior cervical lymph nodes (lymphadenopathy) (1)
  71. What alternative to the Centor criteria can be used to calculate the probability of bacterial tonsillitis? FeverPAIN score (1) What features score a point in this tool? Fever during previous 24 hours (1), purulence (pus on tonsils) (1), attended within 3 days of the onset of symptoms (1), inflamed tonsils (severely inflamed) (1) and no cough or coryza (1)
  72. What is the most common bacterial cause of tonsillitis? Group A streptococcus (Streptococcus pyogenes) (1)
  73. What is the typical first-line antibiotic for bacterial tonsillitis? Penicillin V (phenoxymethylpenicillin) (1)
  74. What could cause pain, stiffness and swelling of a single joint in someone with recent tonsillitis? Post-streptococcal reactive arthritis (1)
  75. What could cause acute kidney injury in someone with recent tonsillitis? Post-streptococcal glomerulonephritis (1)
  76. What could cause a rash, “sandpaper” skin and a “strawberry tongue” in a child with recent tonsillitis? Scarlet fever (1)
  77. What is the other name for a peritonsillar abscess? Quinsy (1)
  78. What is the term for when a patient is unable to open their mouth? Trismus (1)
  79. What is the definitive management of a peritonsillar abscess? Surgical incision and drainage (1)
  80. How many episodes of tonsillitis in a single year would qualify for a tonsillectomy according to the SIGN guidelines (2010)? Seven (1) How many episodes per year over two years? Five per year for two years (1)
  81. What is the main significant and potentially life-threatening complication after a tonsillectomy? Post-tonsillectomy bleeding (1)
  82. What are the borders of the anterior triangle of the neck? Mandible (1), midline of the neck (1) and the sternocleidomastoid muscle (1)
  83. What are the borders of the posterior triangle of the neck? Clavicle (1), trapezius (1) and sternocleidomastoid muscle (1)
  84. What is the usual first-line investigation in suspected infectious mononucleosis? Monospot test (1)
  85. What initial investigation is used where systemic lupus erythematosus is suspected? Antinuclear antibodies (1)
  86. What is the usual first-line imaging investigation for unexplained neck lumps? Ultrasound (1)
  87. What general categories can you use to group the causes of lymphadenopathy? Reactive (1), infection (1), inflammatory (1) and malignancy (1)
  88. What location of an enlarged lymph node in the neck would be most concerning for malignancy? Supraclavicular (1)
  89. What does a Reed-Sternberg cell found on a lymph node biopsy suggest? Hodgkin’s lymphoma (1)
  90. What is the initial investigation of choice in possible leukaemia? Urgent full blood count (1)
  91. What particular cells do carotid body tumours arise from? Glomus cells (1)
  92. In what directions are carotid body tumours mobile? Side-to-side (but not up and down) (1)
  93. What is the classical triad of symptoms in Horner syndrome? Ptosis (1), miosis (1) and anhidrosis (1)
  94. What type of neck lump will move up and down with movement of the tongue? Thyroglossal cyst (1) Where will this lump be situated? Midline of the neck (1)
  95. What structure do most branchial cysts arise from? Second branchial cleft (1)
  96. What is the histology of most head and neck cancers? Squamous cell carcinoma (1)
  97. What habit in south-east Asia is linked with head and neck cancer? Chewing betel quid (1)
  98. Infection with which viruses can increase the risk of head and neck cancer? Human papilloma virus (HPV) (particularly strain 16) (1) and Epstein-Barr virus (1)
  99. What does cetuximab target to treat cancers of the head and neck? Epidermal growth factor receptors (1)
  100. What is the term that describes an inflamed tongue? Glossitis (1)
  101. What are the top three causes of angioedema? Allergic reactions (1), ACE inhibitors (1) and C1 esterase inhibitor deficiency (hereditary angioedema) (1)
  102. What are the top two medications that cause oral candidiasis? Inhaled corticosteroids (1) and antibiotics (1)
  103. What are the options for treating oral candidiasis in mild to moderate cases? Miconazole gel (1) or nystatin suspension (1)
  104. What condition causes irregularly shaped patches on the tongue, somewhat resembling a map? Geographic tongue (1)
  105. What are the key causes of a “strawberry tongue” in children? Scarlet fever (1) and Kawasaki disease (1)
  106. What condition results from decreased exfoliation of keratin from the tongue’s surface, causing the papillae to elongate and take on an unusual appearance? Black hairy tongue (1)
  107. What condition causes red patches in the mouth and poses a high risk of cancer? Erythroplakia (1)
  108. What condition is associated with Wickham’s striae? Lichen planus (1)
  109. What term describes inflammation of the gums? Gingivitis (1)
  110. What term describes severe and chronic inflammation of the gums and the tissues that support the teeth? Periodontitis (1)
  111. What is the name for hardened plaque on the teeth? Tartar (1)
  112. What type of bacteria usually causes acute necrotising ulcerative gingivitis? Anaerobic bacteria (1) What antibiotic is most often used  to treat this condition? Metronidazole (1)
  113. What type of cancer is most associated with gingival hyperplasia? Acute myeloid leukaemia (1)
  114. What nutritional deficiency leads to gingival hyperplasia? Vitamin C (scurvy) (1)
  115. What are the top three conditions affecting the gastrointestinal tract associated with mouth ulcers? Crohn’s disease (1), ulcerative colitis (1) and coeliac disease (1)
  116. What duration of “unexplained ulceration” in the mouth would indicate a two week wait urgent cancer referral? More than 3 weeks (1)

 

Maximum score = 204

Your % = your score x 0.49

 

Well done on completing this set of questions. Now take your score and enter it into your tracking table to start building up a record of all your hard work and progress!