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ENT Past Year

The document discusses the management of various ENT conditions including nasal polyps, indications for tracheostomy, differential diagnoses and examination for laryngeal lesions, causes of hearing loss and further investigation, and management of epistaxis, nasal obstruction, hemoptysis with neck swelling, and lateral neck masses in children.

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Uzair Muhd
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123 views

ENT Past Year

The document discusses the management of various ENT conditions including nasal polyps, indications for tracheostomy, differential diagnoses and examination for laryngeal lesions, causes of hearing loss and further investigation, and management of epistaxis, nasal obstruction, hemoptysis with neck swelling, and lateral neck masses in children.

Uploaded by

Uzair Muhd
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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ENT Past year

1. Management of nasal polyps


Conservative:
Early polypoidal changes and be revert using anyihistamine (use
steroid if sensitive to antihistamine)
Surgical
poypectomy,functional endoscopic sinus surgery

2. Indication of traheostomy
Respiratory obstruction infection (Acute epiglotitis, diptheria,
peritonsillar abscess), fracture facial skull , larynx carcinoma,
laryngeal web/cyst
Retained secretions coma patient and spinal injury , chest injury
(inability to cough) , aspiration of pharyngeal secretions(bilateral
laryngeal paralysis)
Respiratory insuficiency Chronic bronchitis.

3. Chronic smoker, Unilateral lesion over the laryngeal


a. 3 differential diagnosis (laryngeal cancer) , papilomatosis,
granulomatous laryngeal mass, cyst, vocal cord leukoplakia
b. Methods of examination IDL, endoscopy
c. How you confirm your diagnosis biopsy under GA

4. 65 yo, mechanic, history of anti-TB medication, presented with


bilateral hearing problem
a. 3 differential diagnosis
Drug induced hearing loss (laybrintis)
TB perforated tympanic membrane
Presbycusis
b. What is the finding of tuning fork test in this patient
Rinne test positive
Weber test lateralised to better hearing side.
c. What further investigation will you suggest the patient to do
Pure tone test
Tympanometry
Acoustic test
Evoked Response Audiometry

5. Management of epistaxis
History taking and examination
Then First aid, anterior nasal packing, posterior nasal packing,
silver nitrate cauterization, ligation of maxillary artery.
Monitor haemodynamic, investigate for underlying cause.

6. 15 years old boy complaint of intermittent nasal discharge with


nasal obstruction, snorring, hearring impairment. Give possible
diagnosis. What are the investigation can be done? Treatment??
Differential diagnosis
Foreign body impaction
Nasal polyp
Adenoids
Allergic rhinitis
Deviated nasal septum
Dermoid cyst
Investigation
Treatment

7. How to diagnose a patient with hemoptysis and neck swelling.


History taking
Examination: oral examination, indirect laryngealscopy
Investigation
Full blood count, sputum for TB stain , FNAC, ultrasound, Chest Xray, CT and MRI

8. A 13 years old girl presented with lateral neck mass.


a. What are your differential diagnoses? (2m)
Inflammatory lymph nodes tubercuosis
Lymphoma
Brachial cyst
Cystic hygroma
Subclavian aneurysm
Cervical rib
Thyroid pathology _Goiter
b. Outline your management plan. (3m)
History taking
Physical Examination
Investigation: Full blood count, Sputum smear Zieh-nelson
stain
,
FNAC
(if
result
suspicious,
open
biopsy),Ultrasonography, CT, MRA
Management: treat the underlyling causes.

9. 79 years old patient with tinnitus with history of hypertension and


diabetes mellitus. What are causes and explain.
The differential diagnosis are
Otologic
POS TELINGA
Non-oltologic
Hypertension, Artheroscherosis,
anemia, disease of CNS

hypotension,

hyperthyroidism,

Most probably Presbyacusis associated with hypertension and diabetes.

10.
A 35 years old man presented with stridor. You decided to do a
tracheostomy. What are the complications during the procedure?
Immediate: haemorrhage, apnea, pneumothorax, reccurent
laryngeal nerves injury, eosophagus injury
Intermediate (within 24 hours): reactionary haemorrhage, tube
displacement/blockage , would infection, lung abscess,
Late (weeks or months): haemorrhage, laryngeal stenosis, trachea
stenosis, tracheao-oesophageal fistula . Aspiration pneumonia

11.
A 23 years old lady presented with nasal obstruction, sneezing
and rhinorrhea. She is a oxymetazoline abuser.
a. What are your differential diagnoses? (2m)
Rhinitis medicamentosa
Allergic rhinitis
Nasal polyp
b. Outline your management plan. (3m)
History: frequency of nasal spray
Examination: anterior and posterior rhinoscopy, nasal
endoscope
Investivation: Nasal smear ,
Management: Stop the oxymetazoline , relieve symtoms by steroid
spray (Nasonex mometasone furoate) and anti-histamine,
Loratidine.
Education for patient so she won;t abuse the drug.

12.

Management of epistaxis
First aid , pinch the nose for 10 minutes in Trotters method
Cauterisationls
Anterior nasal packing and posterior nasal packing
Endoscopic cauteryt
Elevation of mucoperichondrial flap and submucous
resection
VI)
Ligation of vessel (maxillary artery)
VII)
I)
II)
III)
IV)
V)

2. a) Give diagnosis otitis externa


b) Cause of otitis externa
I) infective group = bacterial (furuncle, diffuse otitis media,
malignant otitis media) , fungal ( otomycosis) , viral (herpes zoster
oticus, otitis externa haemorrhagica.)
II) Reactive group = eczematous, seborrhoeic otitis externa

13.

Causes of hoarseness of voice


Inflammations: Acute laryngitits, diptheria, tuberculosis,
syphilis
II)
Tumours: papilloma, carcinoma, vocal nodule, vocal polyp
III)
Trauma: submucosal haemorrhage, foreign body
IV)
Paralysis: recurrent or supperior laryngeal nerve lesions.
V)
Congenital: laryngeal web, cyst, laryngocele
I)

14.

A) Draw the retropharyngeal space and briefly explain (2m)

Lies behind the pharynx between the buccopharygeal fascia


covering the pharyngeal constrictor muscles and prevetrebral
fascia. It extend from base of the skull to bifucation of
trachea.Divided into lateral compartment by midline fibrous raphe
called space of Gillette
B) Give incidence, age and treatment for chronic and acute
retropharyngeal abscess (3m)
Common in the children of 3 years old, due to secondary infection of
retropharyngeal lymph node from surrounding infection like
adenoids, sinusitis. In adult from penetrating injury to the posterior
pharyngeal wall.

15.
Give otalgic causes of tinnitus (5m)
Impacted , middle wax, fluid in the middle ear, acute and chronic
otitis media, abnormal patent eustachian tub, miniere disease,
otosclerosis, presbyacusis, noice trauma, ototoxic drug

16.
Child came with unilateral foul discharge. How do you manage
this child. (5m)
i)
Paper and cootremove with forcep
ii)
Rounded object remove by passing a blunt hook
iii)
In babies and uncooperative kid, general analgesia with cuffed
endotracheal tube is used.
iv)
Patient in rose position, a pack is inserted into the
nasopharynx and the foreign object is retrieved with a forcept.
v)
Foreign object lodges far behind the nose may need to be
pushed into nasopharynx before removal.

17.
Child came with dysphagia, neck lump and otalgia. Give
causes of acute dysphagia. (5m)

0sce viv
Combined Specialty Posting 2010/2011
OSCE
1. Anaesthetic equipments name and uses
2. Intubation demonstration
3. Adrenaline, atropine, naloxone: name and uses
4. Picture of diabetic retinopathy
5. Ear model middle ear effusion/otitis media
- interpret tympanogram
6. ENT instruments name and uses
7. ENT patient acute rhinosinusitis

OSCE
1) Ear model + tynpanogram. Interpret
2) Examination of nose (active station)
3) Instruments in ENT (Killian speculum, laryngeal mirror, postnasal
mirror, ...)
VIVA
1) ENT - everything
2) Anaethesia mainly procedure
3) Ophthalmology remember all the things Prof Muthu mention in
class
OSCE :
1. ENT equipments (name it and uses)- pneumotic cuff, suction tip,
tracheostomy tube, indirect laryngoscope, thudicum speculum
2. Ear examination on patient : perforated tympanic membrane
3. X-ray ---adenoid
4. Retropharyngeal abcess (soft tissue X-ray)
5. Examination of nose
6. ENT instrument (5 name and each use)
Instrumentthrudicum forcep, tracheal dilator, IDL mirror, posterior
retinoscopy mirror, metal tougue depressor
o Use of instrument
Picture peritonsillar abscess
o Signs
o Diagnosis
o Management
Ear examination left ear TM perforation, tympanogram,
audiogram (A-B gapping)

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