Lecture 3: Approach to ENT Exam

Question 1

What do you check as part of the ENT exam?

Answer 1

• Sinus tenderness
• Nose and nasal turbinates
• Mouth and perform oral exam
• Throat and tonsils
• Ears
• Lymph nodes

Question 2

What sinuses can you palpate for?

Answer 2

Frontal

Maxillary

Question 3

What would be abnormal to see in a nasal exam?

Answer 3

Pale/red and swollen turbinates
Rhinorrhea
Septal deviation

Question 4

What do you check in an oral exam?

Answer 4

Gingiva (gums)
Mucosa
Lip
Hard and soft palate 
Floor of Mouth
Tongue

Question 5

What is cobblestoning?

Answer 5

Swollen lymph tissue normally due to post nasal drip that can irritate mucosa

Question 6

What is torus palatinus?

Answer 6

Harmless bony growth on hard palate

Question 7

What are you checking for when performing an ear exam?

Answer 7

Drainage
Redness
Tenderness
Bulging tympanic membrane

Question 8

What do you check for when examining in lymph nodes?

Answer 8

Texture
Size
Tenderness

Question 9

What are some hallmarks of a sore throat?

Answer 9

Beefy red soft palate and uvula
Enlarged Tonsils
White or yellow patches on tonsils
Tiny red hemorrhages on soft palate

Question 10

What are the most common symptoms of viral pharyngitis?

Answer 10

• inflamed mucus membrane (coryza)
• conjunctivitis
• malaise or fatigue
• voice hoarseness
• low grade fever

Question 11

What are the most common symptoms for group A beta-hemolytic streptococcal infections/GABHS (bacterial pharyngitis)?

Answer 11

Children b/t ages 5-15
Winter/early spring
Absence of cough
Tender anterior cervical lymphadenopathy
Tonsillar exudate
Fever

Question 12

What is the centor score and what do the results mean?

Answer 12

Score that determines risk for bacterial pharyngitis

0&raquo_space;> low risk&raquo_space;» no further treatment
2-3&raquo_space;> moderate risk&raquo_space;> abx if + throat culture
4 or higher&raquo_space;> high risk&raquo_space;> abx

Question 13

What criteria gives points in a centor score?

Answer 13

Absence of cough
Swollen/tender anterior cervical nodes
Temperature > 100.4°
Tonsillar exudates
Age 3-14

Question 14

What is acute otitis media?

Answer 14

Symptomatic inflammation of middle ear due to infection

Question 15

What is otitis media with effusion?

Answer 15

Fluid buildup in middle ear w/o infection - can see ear bubbles behind the TM
-can be due to dysfunction to eustachian tube

Question 16

What is otitis externa?

Answer 16

Infection in outer ear that can happen by bacteria entering small break in skin

Question 17

What is otosclerosis?

When is this associated with conductive and when is it associated with sensorineural?

Answer 17

Abnormal bone growth around stapes bone that can be associated w/ hearing loss

Conductive: ossicle merging
Sensorineural: otic capsule sclerosis

Question 18

How do you interpret the results of the Weber test?

Answer 18

Lateralized side either has conductive hearing loss on that side, or sensorineural hearing loss on the opposite side

Question 19

In a Rinne Test, what would be expected in conductive loss?

Answer 19

Bone Conduction time > air conduction time

Question 20

What can cause conductive hearing loss?

Answer 20

Cerumen impaction
Middle ear fluid
Lack of movement in ossicles
Trauma
Obstruction

(basically outer and middle ear problems)

Question 21

What can cause sensorineural hearing loss?

Answer 21

Hereditary
Meniere Disease
MS
Trauma
Ototoxic Drugs
Barotrauma

(basically inner ear or nerve problems)

Question 22

What is sinusitis?

Answer 22

Inflammation of mucosal lining in paranasal sinuses

-mostly due to infections

Question 23

What are symptoms of sinusitis?

Answer 23

Nasal discharge
Cough
Nasal congestion
Fever
Headache
Pain
Facial pressure

Question 24

Describe bacterial sinusitis.

Answer 24

Patient will initially get better then get much worse (double sickening)

Question 25

What is croup?

Answer 25

Swelling of larynx, trachea, and bronchi that can cause a stridor and barking cough in young children
-sounds scary but not dangerous

Question 26

What is epiglottitis?

Answer 26

Inflammation of epiglottis by type b haemophilus influenza or GABHS

• high grade fever
• toxic appearance
• tripod stance
• drooling
• muffled voice

-important to treat right away