ENT Flashcards
(23 cards)
What are the Weber and Rinne test? What Hz should the tuning fork be?
Weber Test Normal: midline and hear equally. Conductive Loss: Lateralizes to the affected side. Sensorineural Loss: Lateralizes to the side opposite the affected ear
Rinne Test Normal: Air conduction > bone conduction Conductive Loss: Bone conduction > air conduction
512 Hz for tuning fork
What are you feeling for in the lymph nodes? How should you palpate?
Use the pads of the middle three fingers? Texture (rubbery, hard, soft), size (pea size, quarter size), and tenderness
How does Strep throat present? What can it be confused with?
STREP: ‘Beefy red soft palate’ yellow/white patches on tonsils, hemorrhages on soft palate.
Confused with: PHARYNGITIS (GABHS): inflammation of pharynx which causes sore throat (Viral infection)
Common symptoms of viral pharyngitis? (also known as GABHS)
Coryza (inflamed mucus membrane), conjunctivitis, malaise or fatigue, hoarseness, and low grade fever suggest the presence of viral pharyngitis. Sore throat, headache, fatigue, fever, nausea (pharynx is next to intraabdominal organs on the homunculus)
What does GABHS stand for? When is it most likely
Group A beta-hemolytic streptococcus (Streptococcus pyogenes)
• Children 5-15 • Winter and early Spring seasons • Absence of cough • Tender anterior cervical lymphadenopathy • Tonsillar exudate • Fever
Lymph nodes: how to palpate. Size? Shape? Consistency? Tenderness? Mobility? Overlying skin?
use pads of middle 3 fingers.
Size
Normal = pea-sized Abnormal = large
Shape
Normal = round/regular Abnormal = irregular
Consistency
Normal = spongy Abnormal= hard
Tenderness
Normal = non-tender Abnormal = tender ·
Mobility
Normal = mobile Abnormal = fixed ·
Overlying skin
Normal = baseline Abnormal = red, warm, edematous
What should be on the differential docket with sore throats?
Mononucleosis, viral pharyngitis, bacterial pharyngitis, throat irritation from cough
What are the different kinds of ear infections
Middle (air filled space behind the eardrum) -Acute otitis media (AOM) -Otitis media with effusion
Outer (outer ear canal) -Otitis externa
Inner (inner ear structures) -Labyrinithitis
What are the different kids of Otitis Media?
- Acute OM: inflammation of middle ear from bacteria or viruses
- Acute suppurative OM: purulent material in middle ear + Acute OM
- OM with effusion (Serous om) inflammation and fluid buildup in middle ear (blockage of eustachian tubes, may see bubbles)
- Chronic 0M with effusion (fluid stays in middle ear and returns without infection ( in kiddos)
- Chronic suppurative otitis media: Persistent ear infection that often results in tearing or perforation of eardrum (chronic considered more than 6 weeks)
What is otitis Externa
Can be caused by bacteria entering a small break in skin of canal
Patients may report drainage from the ear
Usually associated with pain upon touching the external ear structures
What is Otosclerosis? What are the two types?
Abnormal bone growth around stapes bone.
-progressive hearing loss beginning at ages 10-30. TWIO TYPES 1) Conductive loss – Ossicle sclerosis into a single immovable mass. 2) Sensory loss - Otic capsule sclerosis Affects about 10% of Caucasians, females>males
Clinical presentation of Rhinosinusitis/ Sinusitis
Mucosal lining in the paranasal sinuses and nasal cavity becomes inflamed. nasal discharge, cough, sneezing, nasal congestion, fever, headache,
pain, facial pressure
Infectious causes of Rhinosinusitis/ Sinusitis
Most common viruses are rhinovirus, adenovirus, influenza virus, and parainfluenza virus. – Common bacterial causes include Streptococcus pneumoniae….
Dental infections and procedure, Iatrogenic causes (i.e. sinus surgery, nasogastric
tubes, etc. ) immunodeficiency, Impaired ciliary motility, Mechanical obstruction
What is acute bacterial sinusitis ? Symptoms? treatment?
Acute bacterial rhinosinusitis is indicated when signs or symptoms of acute rhinosinusitis persist without evidence of improvement for at
least 10 days beyond the onset of upper respiratory symptoms
TRT: amoxicillin, augmentin
What is croup? Cause? Epidemology? Clinical presentation? Treatment?
Laryngotracheitis
Causes: parainfluenza virus, influenza, respiratory syncytial virus
barking cough in children 6
month to 3 years old
Presentation: fever, nasal flaring, respiratory retractions, stridor
Treatment: Oxygen, Dexamethasone, nebulized epinephrine, often self limited and no intervention
needed
What is epiglottitis? Epidemology? Clinical presentation? Treatment?
Inflammation of the epiglottis and adjacent structures
Cause: Haemophilus Type b influenza, Group A beta hemolytic streptococcus
History: Rapid onset of symptoms, sore throat, muffled voice, drooling
Presentation: High-grade fever, toxic appearance, child sitting or leaning forward TRIPOD
Workup: consider lateral neck XR, WBC
Treatment: protect airway!!! (intubate if needed), broad spectrum antibiotics
Structures to visualize in ear
Cone of light umbo malleus manubrium pars tensa pars flaccida chorda tympani nerve
how do you pull ear to examine?
adults: UP, OUT, POSTERIOR (Adults are grown UPs)
CHILDREN: DOWN, OUT, POSTERIOR
What is the whisper test?
Doctor stands behind the patient. Have patient occlude one ear. The doctor exhales fully and then whispers a combination of numbers and letters (ex: 2-K-4). The patient repeats the sequence. Repeat with a different sequence if responds incorrectly.
Normal: patient correctly repeats the sequence or after 2 sequences, can identify 3 of the 6.
Abnormal: patient incorrectly identifies 4 of the 6
If the mucosa of the nose is: -red, edema -pale, bluish, red -if there is a septal perforation.. what should you be thinking?
- red, edema: infection
- pale, blueish, red: allergic
- if there is a septal perforation.. snow, meth, trauma surgery
How do you evaluate sinus
frontal (do NOT open until AFTER 7 years of age) press up under bony brows
maxillary
ethymoid
sphenoid
Uh oh.. in the mouth we have
1) aphthous ulcers
2) chelitis
3) gingivitis
4) torus palatinus
● Aphthous ulcers – canker sores
Cheilitis – B12 or iron deficiency, red cracks at corners of mouth
Gingivitis – swelling or ulcerations gums
Torus palatinus – benign lump on hard palate
10 lymph nodes to palpate
Preauricular posterior auricular occipital tonsillar submandibular submental superficial cervical posterior cervical deep cervical suptraclavicular
