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PD ENT Flashcards

1
Q

Inspection and otoscopy of ear

A

External ear
External auditory canal
Tympanic membrane

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2
Q

Palpation of ear

A

External structures

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3
Q

Hearing tests

A

Whisper test
Weber test
Rinne test

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4
Q

What questions do we ask about difficulty of hearing?

A

Onset of hearing loss

Unilateral or bilateral

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5
Q

What factors could contribute to hearing loss?

A

Medications (aminoglycosides)
Trauma
Vertigo
Family Hx of hearing loss

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6
Q

Inspection of external ear

A 
Mastoid process
Auricle
Tragus
Scaphoid fossa
Helix
Antihelix
Lobule
Auditory canal
Meatus
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7
Q

Assessment of ears

A

Position
Shape
Color
Lesions

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8
Q

Position of ears

A

Down syndrome

Outstanding ears

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9
Q

Shape of ears

A 
Microtia
Creased lobule
Elongation
Replcaition of lobes
Gouty tophus
Cauliflower ear
Darwin's tubercle
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10
Q

Color of ears

A

Inflammation
Infection
Hemangiomas

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11
Q

Lesions of ears

A 
Scars
Hematomas
Dermatitis
Trauma
Infectious processes
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12
Q

Area surrounding the ears

A 
Always look behind patient's pinna
Battle sign
Preauricular pits
Erythema
Edema
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13
Q

Hair distribution in ears

A

Hairy tragus

Hairy pinna

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14
Q

Microtia

A 
Gross hypoplasia of the pinna
Blind or absent auditory canal
Bilateral
Could have completely formed and functioning cochlea
Helped with hearing aides and surgery
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15
Q

Preauricular pits

A

Autosomal dominant, unilateral 75%
Can become infected
Surgical excision if repeated infections

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16
Q

Outstanding ears

A

Angle between auricle and side of head is greater than normal
Not pathologic
Easily surgically corrected

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17
Q

Darwin’s tubercle

A

Small cartilaginous protuberance, most commonly along concave edge of posterosuperior helix
Normal variation

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18
Q

Gouty tophi

A

Deposits of uric acid crystals

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19
Q

Hairy tragus/pinna

A

Most common in men, occurs with aging

Common in people of Indian descent

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20
Q

Creased lobe

A

May be associated with increased risk for CAD

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21
Q

Hematomas
Cause
Sequela

A

Accumulation of blood between skin and cartilage
Blunt trauma most common cause
Inspect for trauma and check hearing
Cauliflower ear is late sequela

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22
Q

Cauliflower ear

Cause

A

Caused by repeated trauma to auricle
Subperichondrial separation with focal generation of fibrous tissue and scar formation
Potential hearing loss, can be surgically corrected

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23
Q

Keloid

A

Abnormal wound healing
Excessive bulk produced at site of cutaneous injury (highly compacted bundles of hyalinized collagen)
Common in AA, and older than 20

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24
Q

Battle sign

A

Hematoma behind the ear

Indication of base of skull fracture

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25
Palpation
``` Nodules Swelling Tenderness Warmth Assessment of lesions ```
26
Otoscopy
Visualize auditory canal and TM
27
Otoscopy in adults versus children
Adults: pinna upward and outward Children: pinna down and back
28
What does straightening of the canal allow for?
Better visualization of the tympanic membrane
29
Where does the auditory canal start and end?
External auditory meatus and medially TM
30
What joint makes up part of the posterior external auditory canal wall?
TMJ
31
Skin adheres to periosteum along the ... and to cartilage and soft tissue along the ...
Inner 2/3, outer 1/3
32
Skin of the outer 1/3 contains what structures?
Hairs and glands that secrete cerumen
33
Where is cerumen not produced?
Middle or inner canal
34
What is the average length of the auditory canal?
3.7 cm
35
Innervation of auditory canal
CN V, VII, X
36
What does the stimulation of a small branch of the vagus nerve (Arnold's nerve) do to the patient?
Cough during exam
37
What is the blood supply to the auditory canal?
Branches of auricle temporal branch of the inferior maxillary artery
38
The canal ... from the pinna to the TM
Conducts sound waves
39
Cerumen impaction
Painful depending on extent of cerumen Conductive hearing loss Common in elderly and children
40
Tx for cerumen impaction
Debrox drops, irrigation, curette/otoloop
41
Otitis externa
``` Swimmer's ear, common in summer Painful infection of skin Swelling erythema or canal Pinna edematous and red Narrowed lumen with purulent drainage ```
42
Bacterial causes of otitis externa
Pseudomonas, Staph aureus
43
Tx of otitis externa
Otic drops, oral abx
44
Common foreign body in the ear
Q tip, beans, peas, jewelry | Common in kids and psych
45
Result from foreign body
Complete conductive hearing loss
46
Caution with foreign body
Don't irrigate if organic material suspected or insects | Carefl not to cause TM perforation
47
Exostosis
Small boney growths of canal Benign Multiple and bilateral Aris more commonly near TM
48
Exostosis Tx
Usually no tx necessary unless recurrent cerumen impactions
49
Cholesteatoma
Overgrowth of epidermal tissue, usually in pts with hx of chronic otitis media Canal or middle ear Painful, erode into bone Conductive or sensorineural hearing loss
50
Middle ear
Small air filled cavity within temporal bone | Lined with squamous epithelium
51
Boundaries of middle ear
TM oval window and round window
52
What is the opening in the posterior wall in the middle ear?
Opening to mastoid sinus
53
Where does infection of epithelial lining of the middle ear come from?
Nasopharynx via the eustacian tube
54
What structure transmits sound waves through the middle ear?
TM vibrates, transmitting sound waves from the canal into mechanical motion, setting the ossicles into motion
55
Ossicles
Malleus, incus, stapes | Augment vibrations and distribute mechanical energy to cochlea
56
Eustachain tube
Connects middle ear to posterior portion of nasopharynx | Neutralizes internal and external air pressures
57
Why do children have more otitis media infections?
Eustachian tube is much smaller and more horizontal, so pathogens are more easily introduced to the middle ear
58
Otitis media
Hx of recent URI Bacterial or viral More common in infants and children Unilateral
59
Complications of otitis media
``` Mastoiditis Meningitits Osteomyelitis Sigmoid sinus thrombosis Facial nerve involvement ```
60
Common pathogens causing otitis media
Strep pneumoniae Haemophilus influenzae M. cattarhalis
61
S&S of otitis media
``` Pain Fever Erythematous, building TM Decreased TM mobility TM may rupture and cause purulent drainage in external auditory canal Decreased hearing Effusion behind TM ```
62
Serous otitis media | Pts
Can procede AOM May be due to poor Eustachian tube function May be concurrent with URI Common in people with allergies Look for fluid, bubbles behind TM, TM not inflamed
63
Bullous myringitits
Otalgia Erythematous TM Blisters Accompanies URI symptoms
64
Pathogens of bullous myringitits
Mycoplasma pneumoniae | Virus
65
Cause of TM perforations
Trauma Infection Barotrauma (divers, airplane)
66
Results of TM perforation
Conductive hearing loss | Increased risk of infection
67
Cuase of TM scarring
Previous infections Trauma Perforations
68
Results of TM scarring
Decreased hearing over time due to decreased mobility of TM
69
Otosclerosis
Progressive hearing loss | Due to deposition of bone in cochlea/stapes foot
70
S&S of otosclerosis
No pain Tinnitus Normal TM Patent Eustachian tube Common in females, 30-40, familial tendency
71
Tx otosclerosis
Stapedectomy
72
Hemotympanum
blood in middle ear behind TM Result of head trauma or severe barotrauma Could be painful
73
Tx hemotympanum
Spontaneous resolution over several weeks is normal
74
Result of hemotympanum
Could result in conductive hearing loss
75
Pneumatic otoscopy
Done if loss of mobility of TM is suspected Puff of air from otoscope gulf creates a positive pressure, and the TM should move inward, then return to normal position quickly
76
No movement or decreased movement during pneumatic otoscopy
Increased pressure within middle ear is suspected
77
Cause of no movement
Porr functioning Eustachian tube | Fluid within middle ear
78
Is pneumatic otoscopy part of the normal physical exam?
No
79
What are the three hearing tests?
Whisper Rinne Weber
80
Whisper test
Occlude opposite ear, stand behind patient and whisper words for patient to repeat, or ask a simple question and ask for an answer Patient should be able to hear your whisper from 1-2 feet away from their ear
81
What does the whisper test test?
Grossly defines hearing
82
What does the Weber test test?
If hearing loss is noted in history or detected on exam
83
Weber test
Bottom of vibrating tuning fork is placed on midline of patient's head Ask patient if sound is heard equally in both ears, or better in one ear (lateralization of sound) Should be heard equally
84
2 abnormal results of Weber test
Conductive hearing loss in the lateralizing ear | Sensorineural loss in the ear opposite of the lateralizing ear
85
What test is used as a follow up after the Weber test?
Rinne test
86
Rinne test
Placing the base of vibrating tuning fork against patients mastoid process Ask when patient no longer hears the sound Quickly position vibrating fork 1-2 cm from auditory canal and ask when sound is no longer heard Count the time sound is heard
87
What is a normal Rinne test?
Air conduction is twice as long as bone conduction
88
Conductive loss in Rinne test?
Bone conduction is longer than air conduction in affected ear
89
Sensorineural loss in Rinne test
Air conduction is longer or equal to bone conduction in affected ear
90
Functions of the nose
``` Airway Warms air Filtration of dust particles, pathogens Humidification of air Receives secretions from sinuses and eyes Peripheral organ of smell ```
91
CN for smell
CN I Olfactory
92
History complaints relating to the nose
``` Nasal obstruction Discharge Epistaxis Change in sense of smell Trauma Itching nose Olfactory hallucinations ```
93
Inspection of nose
``` Shape Size Color Patent nares Columnella, septum midline Ala flaring Discharge Lesions ```
94
External/middle/inner ear - conductive/sensorineural
External middle ear - conductive hearing loss | Inner ear - sensorineural hearing loss
95
Rhinophyma
Bulbous enlargement of the distal 2/3 of nose from multiple sebaceous adenomas Follows long standing rosacea
96
Saddle nose | Causes
Sunken bridge Loss of cartilage from septal hematoma or abscess Congenital or acquired syphilis
97
Internal inspection
Stabilize head, tilt head back Gently introduce speculum Avoid touching septum
98
Observation of internal inspection
``` Anterior nares Mucosa Septum Turbinates Posterior nares ```
99
Inspection of mucosa
``` Edematous Pale Erythematous Moist/dry Discharge ```
100
Inspection of septum
Deviation | Perforation
101
Posterior nares
Open to the nasopharynx
102
Watery clear discharge
Allergies Vial rhinitis/URI Rhinitis medicamentosa CSF leak
103
Purulent discharge
Viral URI Bacterial sinusitis Foreign body
104
Serosanginous discharge
Trauma | Neoplasm
105
Bloody (sanginous) discharge
``` Trauma Coagulopathies Carcinoma Vasculitis HTN Ulceration Drug use ```
106
Nasal polyps | Examples
soft protrusions of mucosa Pale, edematous, non tender Chronic allergic rhinitis Positive relationship with asthma
107
What do you need to determine with epistaxis?
Anterior or posterior bleed
108
Which is more common, anterior or posterior bleeds? Which is more serious?
Anterior is most common 90% | Posterior has greatest risk to hemorrhage
109
Anterior bleed Causes Risk factors
Digital trauma to Kiesselbach's plexus | Trauma, dry/cold weather, dehydration, blood thinners
110
Anterior bleed tx
Small - cauterize with silver nitrate sticks | Extensive - nasal packing
111
Posterior bleed | Risk factors
Acute blood loss anemia | HTN, coagulopathies, blood thinners, carcinoma
112
Posterior bleed tx
Posterior packing Transfusion Hospitalization*
113
What is the most common malformation of the nasal airway?
Choanal atresia
114
Choanal atresia | Who present with it?
Congenitally closed orifice Usually infants have difficulties breathing with first URI If bilateral, respiratory distress at birth
115
Hyperosmia causes
Addison's disease Allergies Hunger Nausea
116
Cacosmia | Causes
Perception of four odor when one doesn't exist Sinusitis Psych DO Tumor Tetracyclines
117
Anosmia causes
``` Infection Allergies Septal deviation Pregnancy Tumor Trauma to head or nose Sjogren's syndrome Diabetes Polyps Zinc deficiency Vitamin A deficiency Schizophrenia ```
118
Paranasal sinus tenderness
Palpate over frontal and maxillary sinuses looking for swelling or tenderness Percuss sinuses
119
Causes of sinus tenderness
Swelling, tenderness, and pain may indicate infection or obstruction
120
Functions of oropharynx
Emission of air for vocalization and respiration Passageway for food, liquid, saliva, vomitus Initiation of digestion - mastication and salivary enzymes Identification of taste
121
History of complaints for oropharynx
``` Pain Lesions Difficulty swallowing/chewing Dry mouth Excess salivation Decreased taste, bad taste Halitosis ```
122
Inspection of lips and mouth
``` Symmetry Color Swelling/edema Moisture Lesions ```
123
Pallor in lips causes
Anemia Vitamin deficiencies Scarlet fever
124
Cyanosis in lips causes
Hypoxia | Cardiac and respiratory DO
125
Erythema in lips causes
CO poisoning Infection Allergy
126
Swelling edema in lips causes
Allergies Trauma Infections
127
Dry lips and mouth causes
Dehydration Mouth breathing Sjogren's syndrome
128
Lesions in lips in mouth causes
Neoplasm Infection Irritations
129
Cheilosis
Fissures/cracks at angles of lips
130
Causes of cheilosis
``` Dehydration Ill fitting dentures Nervous habit Riboflavin deficiency Medications (chemo) Malignancy ```
131
Angioedema | Causes
Swelling of one or both lips Develops rapidly Usually not pruritic Allergic reaction, anaphylaxis, infection
132
SCC
``` Non painful Lesions grow slowly, often bleed Non healing Most common oral tumor Hx of sun exposure ```
133
Herpes Simplex Virus
HS1, could be HS2 Groups of vesicles with clear fluid on erythematous base May be painful, burn Develop in times of illness or stress
134
Petz Jehger's syndrome | Associated with...
Blue or black patches of pigmentation in skin or mucosa (buccal, fingers, hands, face) Associated with FAP, internal bleeding, anemia
135
Chancre
Primary lesion of syphilis Painless, raised border Button like Can become crusted or ulcerated
136
Inspection of teeth
``` Number Missing or loose Dental hygiene Color, staining Shape Caries Malocclusion Abscesses Dental appliances ```
137
Malocclusion
Crowding of teeth | Upper molars should rest directly on lower molars and upper incisors should override lower incisors slights
138
Causes of malocclusion
Congenital Trauma Jaw pain Thumb sucking
139
Hutchinson teeth | Cause
Notching of the permanent upper central incisors Small than normal, tips resemble a cone Congenital syphilis
140
Tetracycline staining
Mother took tetracycline while in utero, or tetracycline was given as a child Before 1980
141
Inspection of gingiva
``` Color Bleeding Swelling Hyperplasia Masses/lesions ```
142
Gingivitis
Inflammation of the gums | Erythematous, swollen, bleeds easily
143
Causes of gingivitis
``` Poor hygiene Systemic infection Leukemia Vitamin deficiencies Pregnancy OCP DM ```
144
Gingival hypertrophy
Insidious onset Non painful Non pathologic
145
Causes of gingival hypertrophy
``` Dilatin Cyclosporin Leukemia Pregnancy OCP Genetic disorders Crohn's Sarcoidosis ```
146
Peridontitis (pyorrhea)
``` Receding and bleeding gums Often painful Halitosis Pus pockets form between gums and teeth Anaerobes ```
147
Cause and result of peridontitis
Caused by untreated gingivitis | Common cause of tooth loss
148
Periapical abscess
Tender swelling in adjacent gum Sinus tract may form draining pus Common cause of toothache Pain accentuated by tapping tooth
149
Scurvy
Vitamin C deficiency Deep red/purple, swollen gums Tender, bleed easily
150
Vincent stomatitis
Trench mouth, acute necrotizing ulcerative gingivitis Abrupt onset, painful, increased salivation Punched out ulcers covered in gray yellow membrane Halitotis is horrible Systemically ill
151
Cause of vincent stomatitis
Anaerobes (Fusobacterium)
152
Kaposi sarcoma
Malignancy of vascular origin Red/blue plaques and nodules Commonly found on skin Seen in advanced AIDS
153
Inspection of buccal mucosa
``` Color Moisture Exudates Masses, lesions Ulcers Stensen's duct ```
154
Apthous ulcers
Canker sores Painful ulcers with white floor and yellow margins on erythematous base Anteriorly in mouth on tip or sides of tongue and labial/buccal mucosa
155
Cause of apthous ulcers
Virus Malnutrition Stress
156
Oral candidiasis
White, raised exudates on buccal mucosa, palate, pharynx, or tongue Can interfere with taste and eating Scrapable Not painful
157
Risk factors for oral candidiasis
``` Antibiotics Steroids Immunosuppression HIV/AIDS Cancer, chemo DM ```
158
Leukoplakia
Appears anywhere in oral cavity Painless white plaque adherent to mucous membrane Not scrapable Premalignant lesions
159
Risk factors for leukoplakia
Smoker HIV/AIDS Autoimmune DO Alcohol abuse
160
Fordyce spots
Mucosal sebaceous cysts Small white or yellow spots on mucosa of lips, cheeks, tongue Painless, non pathologic
161
Inspection of palate
Continuity of palate (clefts) Lesions Masses Color
162
Cleft palate
Midline opening in hard palate due to congenital failure of fusion of the maxillary process Usually associated with cleft lip Severity varies
163
Complications of cleft palate
``` Breathing and speech difficulty Hearing deficits Chronic otitis media Degluttination deficits Improper teeth development/feeding problems ```
164
Torus palatinus
``` Bony outgrowth of the palate Non painful Benign Arises in puberty 25% women, 15% men ```
165
What is the bony outgrowth of the mandible?
Torus mandibularis
166
Inspection of the uvula
``` Color Size Lesions Masses Deviation ```
167
Bifid uvula
May indicate underlying cleft palate | Need to palpate palate to assure bony closure
168
Uvular deviation causes
Peritonsillar abscess | Lesion/defect of CN X
169
Which way will the uvula deviate with a lesion?
Have patient say ahh Uvula will deviate away from side that has lesion/defect Soft palate on affected side will not rise
170
Inspection of the tongue
``` Size Papillae Deviation Moisture Masses/lesions Dorsal and ventral surfaces ```
171
Tongue deviation
Due to lesion/abnormality of CN XII or muscle weakness of tongue muscles
172
Which way will the tongue deviate?
Towards side of the lesion or weakness
173
Fissured tongue
Median sulcus is deepened Dorsal surface interrupted with transverse furrow Harmless, inherited
174
What would longitudinal furrowing indicate?
Syphilitic glossitis
175
Geographic tongue
Migratory glossitis Irregular patches of bright red denuded epithelium - no papillae Patches heal in a few days, only to develop new ones in other areas Harmless, idiopathic
176
Varicose veins
Normal, more common in elderly
177
Hairy tongue
Overgrowth of filiform papillae Yellow, brown, green, black Bacterial or fungal overgrowth may play a role Non pathologic
178
Risk factors for hairy tongue
Poor oral hygiene Antibiotics Smokers Coffee drinker
179
Glossitis
Sore, painful, tnder, erythematous tongue
180
Causes of glossitis
``` Nutritional deficiencies Autoimmune Medications Smoking, alcohol Infection Trauma Dehydration ```
181
Atrophic glossitis
``` Atrophy of papillae Dryness Intermittent burning Paresthesia of taste Tongue becomes smaller Slick and glistening surface Small, punctate red dots ```
182
Cause of atrophic glossitis
Poor nutrition | Alcoholic with vitamin deficiencies - folic acid, B vitamins
183
Inspection of pharynx
``` Presence of tonsils Size of tonsils Swelling Exudate Post nasal drip Masses, lesions ```
184
Grading tonsillar size
1 - visible 2 - halfway between tonsillar pillars and uvula 3 - touching uvula 4 - touching each other (kissing tonsils)
185
Pharyngitis accounts for 20% of ... and 50% of ...
Outpatient sick visits | Outpatient antibiotics
186
Bacterial causes of pharyngitis
Group A Strep Neisseria gonorrhea Corneybacterium diptheriae
187
Viral causes of pharyngitis
``` Rhinovirus HSV CMV Adenovirus Echovirus EBV Parainfluenza Coxsackie virus ```
188
Other causes of pharyngitis
``` Allergies Sinusitis GERD Peritonsilar abscess Carcinoma Fungal infections ```
189
Incubation of Group A strep
2-5 days
190
Symptoms of Group A strep
``` Sore throat Fever/chills Malaise Headache Nausea Vomiting Abdominal pain ```
191
PE with Group A strep
Erythema of pharynx and uvula Enlarged tonsils, patchy white exudates Enlarged, tender anterior cervical LN
192
Diagnosis for Group A strep
Rapid strep test | If negative, culture for 24 hours
193
Tx for Group A strep
Pen VK Amoxicillin Erythromycin
194
Viral pharyngitis tx
NO ABX Motrin, tylenol Warm salt water gargles Lots of fluids and rest
195
Diphtheria S&S
``` Sore throat Hoarseness Malaise Fever Nasal discharge Tenacious gray membrane on pharynx, tonsil, palate, or uvula ```
196
Diphtheria cause
Corneybacterium diphtheriae
197
Complications of diphtheria
Myocarditis | Neuropathies
198
Infectious mononucleosis
``` Fatigue Malaise Fever Lymphadenopathy Pharyngitis Headache Hepatosplenomegaly ```
199
Cause of mono
EBV | CMV
200
Tx for mono
``` Rest Fluids Proper nutrition Time Avoid contact sports and heavy lifting NO ABX ```
201
Peritonsillar abscess S&S
``` PAIN Deviation of uvula Fever Odynophagia Hot potato voice LAD ```
202
Tx for peritonsillar abscess
I&D often required | Abx, usually IV to start
203
Oral HIV/AIDS manifestations
``` Hairy leukoplakia Oral candidiasis Herpes simplex Kaposi's sarcoma Apthous ulcers Peridontal disease ```

Physical Diagnosis (10 decks)

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