15: Approach To ENT Complaint

Question 1

When do frontal sinuses develop

Answer 1

Age 8-10

Question 2

Testing for nasal obstruction

Answer 2

Press on each ala and ask pt to breath in and out

Question 3

What does pressing on tip of nose test for

Answer 3

Local infection/ furuncle

Question 4

Cobblestoning of back of throat - explain

Answer 4

Its basically lymphoid tissue - changes w diff conditions

Question 5

Where on external ear to check for tenderness

Answer 5

Travis

Question 6

Two general hearing tests

Answer 6

Ringer rub and whisper test

Question 7

Ten HEENT LNs to palpate **

Answer 7

1. Pre-auricular
2. Posterior auricular
3. Tonsillar
4. Occipital
5. Superficial cervical
6. Posterior cervical
7. Supraclavicular
8. Sub mental
9. Submandibular
10. Deep cervical chain

Question 8

How to palpate thyroid

Answer 8

1. Stand behind and grip neck on both sides, with index fingers just below cricoid cartilage, ask pt to swallow
2. Displace trachea to right and left, palpating, and ask pt to swallow in both positions

Question 9

Allergic rhinitis

Answer 9

Inflammation of nose due to allergen -> sneezing, rhinorrhea, nasal obstruction

Question 10

Anterior epistaxis

Answer 10

Most common nose bleed, usually affects vascular watershed area of nasal septum

Question 11

Posterior epistaxis

Answer 11

Less common, more significant bleeding, affecting posterolateral branches of sphenopalatine A

Question 12

Virus that causes infectious mononucleosis

Answer 12

Epstein Barr Virus

Question 13

Classic triad of mono symptoms

Answer 13

Fever, tonsillar pharyngitis, lymphadenopathy

Question 14

Coryza

Answer 14

Inflamed mucus membrane

Question 15

Ddx for pharyngitis

Answer 15

mono, GERD, post-nasal drip due to rhinitis, persistent cough, thyroiditis, allergies, foreign body, smoking

Question 16

Bacteria that causes strep**

Answer 16

Group A beta-hemolytic streptococcus (streptococcus pyogenes)

Question 17

Centor score for strep: five things that give you a point towards strep

Answer 17

1. Children 3-14 year old
2. fever over 100.4
3. Absence of cough
4. Tender anterior cervical LNs
5. Tonsillar exudate

Question 18

Otitis interna - other name

Answer 18

Labyrinthitis

Question 19

Five types of otitis media

Answer 19

1. Acute OM
2. Acute suppurative OM
3. OM with effusion
4. Chronic OM with effusion
5. Chronic suppurative otitis media

Question 20

Acute suppurative OM

Answer 20

Acute OM with purulent material in the middle ear

Question 21

OM with effusion

Answer 21

Inflammation and fluid buildup in the middle ear without bacterial or viral infection

Question 22

Chronic OM with effusion

Answer 22

Fluid remains in middle ear and continues to return without bacterial/viral infection

Question 23

Chronic suppurative otitis media

Answer 23

Persistent ear infection that often results in tearing or perforation of TM

Question 24

First two tests for pt’s hearing

Answer 24

Weber and Rinne tests

Question 25

Weber hearing test

Answer 25

1. Tuning fork above head at midline - sound should be heard equally 2. If sound lateralizes to a side, do the Rinne test

Question 26

Rinne test

Answer 26

Testing air vs bone conduction - normal hearing should be air conduction heard greater than bone conduction

Question 27

Conductive hearing loss findings on rinne test

Answer 27

Bone conduction > air conduction on affected side

Question 28

Causes of conductive hearing loss

Answer 28

Cerumen impaction, middle ear fluid, lack of movement of ossicles, trauma, other cause of obstruction such as tumors

Question 29

Causes of sensorineural hearing loss

Answer 29

Hereditary, Ménière’s disease, MS, trauma, ototoxic drugs, barotrauma

Question 30

Double sickening

Answer 30

Illness that initially gets slightly better then gets worse

Question 31

What does BPPV stand for?

Answer 31

Benign paroxysmal positional vertigo

Question 32

Two types of otosclerosis

Answer 32

1. Conductive loss: ossicle in a mass | 2. Sensory loss: otic capsule sclerosis

Question 33

With which condition does double sickening occur

Answer 33

Bacterial sinusitis

Question 34

Vertigo due to CN 8 inflammation with just dizziness vs dizziness + hearing loss

Answer 34

Dizziness: vestibular neuritis | Dizziness + hearing loss: labyrinthitis