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Clinical Skills > ENT > Flashcards

ENT Flashcards

1
Q

name some ear symtpoms a px may present with

A

pain - otalgia
discharge - otorrhoea
deafness/ difficulty hearing
tinnitus
truama
foreign body
dizzy

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2
Q

what to investigate about ear otorrhea?

A

discharge - otorrhoea: amount, smell, watery, purulent, blood, mucus

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3
Q

hearing loss red flags?

A

unilateral
suddent onset
other CN/ cerebellar signs
abnormal tympanic membrane (ear drum)

in children: ALL deafness as can delay speech and lang

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4
Q

Otitis externa red flags?

A

painless discharge
pain not in synch w findings
recurrent/ persistent unilateral infections
> week duration
cerebellar involv/ CN weakness

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5
Q

ear exam (IPPA)

A

Inspect
Palpitation
Percussion
A: N/A look in ear w otoscope

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6
Q

what would you inspect in an ear examination

A

external auditory meatus and pinna for scars, redness and visible discharge

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7
Q

what would you palpate during an ear examination

A

tragus, pinna, external auditory meatus

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8
Q

what does percussion involve in an ear examination

A

rinne and weber test

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9
Q

which cranial nerve does the rinne and weber test involve

A

8

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10
Q

if you look inside an ear with an otoscope and see no fluid level or inflammation, what would this tell you about the health of the ear

A

normal

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11
Q

what abnormal findings could you find within the ear using an otoscope

A

impacted wax
exostoses
perforated tympanic membrane

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12
Q

what weber test result would you expect in a normal ear? forehead

A

both equal

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13
Q

what rinnes test result would you expect in a normal ear

A

air conduction greater than bone conduction

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14
Q

what webers test result would you see in conductive deafness

A

louder in ear with conductive deafness

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15
Q

what result would you expect to see with the rinnes test in an ear with conductive deafness

A

bone conduction greater than air conduction

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16
Q

what result on the weber test would indicate sensorineural deafness

A

louder in ear without the deafness

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17
Q

what result in the rinnes test would you expect in sensorineural deafness

A

air conduction greater than bone conduction

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18
Q

if bone conduction is greater than air conduction in the rinnes test is deafness conducive or sensorineural BC>AC

A

conductive

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19
Q

if AC>BC: deafness conductive or sensorineural?

A

sensorineural

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20
Q

which cranial nerve is the nose anatomy associated with

A

1 olfactory

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21
Q

nasal symptoms?

A

obstruction blockage/one or both sides
dishcarge
loss smell
deformity
pain
trauma
foreign body
sneeze
snore
blcoked nose
itching
headache/ heaviness

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22
Q

nose red flags (epistaxis)

A

haemorrhagic shock
bleeding not stopped by direct pressure
recurrent unilateral epistaxis
signs suggestive of bleeding disorder/ anticoagulation
dizziness
sinus pain

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23
Q

throat symptoms that indicate that there may be a problem

A

pain
difficulty swallowing
bad taste in mouth
pus or exudate
change or loss in voice
associated earache

24
Q

throat/swallowing red flags

A

pain swallowing
difficulty swallowing
hoarseness
bad breath
lock jaw

25
Q

throat emergency red flags !!!

A

airway closed
increased pulse
restlessness
retractions
anxiety increased
inspiratory stridor
drooling

AIRRAID

26
Q

throat exam… coordination of swallowing is controlled by which nerves

A

trigeminal
facial
glossopharyngeal
vagus
hypoglossal

27
Q

what number cranial nerve is the trigeminal

A

5

28
Q

what number cranial nerve is the facial

A

7

29
Q

what number cranial nerve is the glossopharyngeal

A

9

30
Q

what number cranial nerve is the vagus

A

10

31
Q

what cranial nerve number is the hypoglossal

A

12

32
Q

would a throat examination that presents with tonsiliitis or peritonsillar abscess/ quinsy be considered normal or abnormal

A

abnormal

33
Q

ENT associated assessment?

A

lymph nodes exam

34
Q

would a throat examination that presents with tonsiliitis or peritonsillar abscess/ quinsy be considered normal or abnormal

A

FEVERPAIN

35
Q

list some different parameters included in the feverpain criteria

A

fever during past 24h
purulence
attend rapidly within 3 days of onset
severely inflammed tonsils
no cough or coryza

36
Q

each fever pain criteria score 1 point with a max score of 5, what do higher causes suggest

A

more severe symptoms and likely streptococcal cause

37
Q

the centor criteria can also be used for ent associated symptom assessment with each scoring a point of 1 with a maximum of 4. A higher score is associated with an increased likelihood of isolating streptococcus. What different parameters are looked at

A

tonsillar exudate
tender anterior cervical lymphadenopathy
history of fever >38
absence of cough

38
Q

what score uses physiological measurements to routinely record patients in hospital and aims to acutely ill patients including those with sepsis

A

NEWS

39
Q

early warning signs of sepsis: main 4?

A

fever/ low body temp
chills and shiver
fast heartbeat
fast breathing

40
Q

what 6 physiological parameters are measured in the news score

A

respiration rate
oxygen saturation
systolic bp
pulse rate
level of consciousness
temp

41
Q

what questions would you ask someone who plays a watersport and comes to see you complaining of hearing loss

A

pain and socrates
muffled or complete loss
uni or bilateral
tried anything
onset
worsening
wax in ears
related to cough or cold - wider symptoms

42
Q

what examinations would you conduct if someone presents with hearing loss

A

otoscope examination
cranial nerve 8
looking at external ear

43
Q

what questions would you ask someone who has come to see you in a minor ailment clinic complaining of a sore throat

A

cough or cold recently
on any meds
trauma
symptom duration
history of sore throat
anything makes it better or worse

44
Q

What treatment would you recommend if the sore throat tonsils did not appear pustular?

A

Pen b for bacterial

45
Q

what might carbimazole and clarithromycin cause in the mouth

A

metallic taste

46
Q

give one important piece of dietary counselling that patients taking penicllin V for tonsillitis should be made aware of

A

take on empty stomach 30 mins before meals or 2 hrs after meals

47
Q

why is it important that patients take pen v on an empty stomach

A

low ba and reduces more if you have food in your stomach

48
Q

why is pen v a first line antibiotic of choice for things like tonsillitis or other infections that involve the throat?

A

covers streptococcus - the bacteria causing it

49
Q

what would be an appropriate second line antibiotic that covers strep if patients have a pencillin allergy

A

clarithromycin

50
Q

clarithromycin might be easier for some patients compared to pen v as the dosing frequency is bd instead of qds, however what are some cons

A

metallic taste in mouth
large tablet size
difficult to swallow with sore throat

51
Q

what treatments can you recommend for tonsils that are not pustular

A

diflam
lozenges
saltwater rinse
corsodyl
honey lemon drink
avoid hot drinks
ice cream
paracetamol

52
Q

what are the pros of using diflam sprays with benzocaine in it

A

spray can be directed to the back of the throat for pain relief

53
Q

how would you use the feverpain or centor score to decide a treatment plan with the patient

A

risk escalation
identifies strep throat
higher score means escalation needed

54
Q

What medication history would make you refer the sore throat patient?

A

Carbimazole sore throat refer
Immunosuppressants
Anything that puts u at risk of neutropenia sepsis
Sore throat early sign of something serious deteriorate quickly

55
Q

any immunosuppressant drug can cause neutropenic sepsis and a self limiting infection can be x in these patient

A

fatal

Clinical Skills (12 decks)

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