Approach to ENT Flashcards
How do you test for nasal obstruction?
- Press on each ala nasi and ask patient to breathe in
What does a mouth exam involve?
- Look at oral mucosa and gingiva
- palpate oral mucosa and gingiva
- Check ventral aspect of tongue, below, and sides
- Look at buccal mucosa
Describe finger rub test.
Place hand near both ears and rub fingers near one ear at a time. Have patient tell you what side they hear the sound on
What is the whisper test?
Stand behind patient and ask them to cover one ear. Softly whisper different letters and numbers and ask patient to repeat.
How do you palpate thyroid?
- Place fingers of both hands on neck with index fingers below the criocid cartilage
- Ask patient to swallow
- Displace trachea to the right with the fingers of the left hand, with right hand palpate laterally for right lobe of thyroid in the space btw displaced trachea and SCM
Lymph nodes to check?
- Preauricular
- Posterior auricular
- Tonsilar
- Occipital
- Superficial cervical
- Posterior cervical
- Supraclavicular
- Submental
- Submandibular
- Deep cervical chain
Allergic rhinitis?
- Inflammation in nose caused by allergen characterized by sneezing rhinorrhea and nasal obstruction
Anterior epistaxis?
- Most common nosebleed usually affects vascular watershed area of nasal septum
Posterior epistaxis?
- Less coommon usually causes more significant bleeding and affects posterolateral branches of sphenopalatine artery
Tonsillitis
Inflammation of tonsils due to bacteria or virus
Infectious mononucleosis
- Vasued by epstein barr virus and causes triad of fever, tonsillar pharyngitis, and lymphadenopathy
What is pharyngitis?
- Inflammation of the pharynx resulting in sore throat
- Most likely caused by:
- adenovirus, rhinovirus, coronavirus, enterovirus, flu
- Bacterial, group A beta hemolytic streptococcus
What are other differentials for a sore throat?
- mono
- GERD
- postnasal drip secondary to rhinitis
- persistent cough
- thyroiditis
- allergies
- foreign body
- smoking
What is streptococcal pharyngitis?
- caused by group A beta hemolytic streptococcus (streptococcous pyogenes)
- sx:
- sore throat
- headache
- fatigue
- fever
- body aches
- nausea
What symptoms are seen with highest likelihood of GABHS?
- children 5-15
- winter and early spring
- absence of cough
- tender anterior cervical lymphadenopathy
- tonsillar exudate
- fever
What is acute otitis media?
- symptomatic inflamation of middle ear caused by bacteria or viruses
What is acute suppurative OM?
- acute OM with purulent material in middle ear
What is OM with effusion?
- Inflammation and fluid buildup in middle ear without bacterial or viral infection
- May occur bc fluid buildup persists after an ear infection has resolved
what is Chronic OM with effusion?
- Occurs when fluid remians in middle ear and continues to return without bacterial or vifrral infection
- Makes kids susceptible to new infection and can impact hearing
Chronic suppurative OM?
- persistent ear infection resulting intearing or perfoeation of eardrum
- More than 6 weeks is chronic
What is otitis externa?
- Outter ear infection
- can be caused by bactera entering a small break in skin of canal
- Patient can report drainage from ear
- Usually assoc with pain on touching external ear structures
Otosclerosis?
- abnormal bone growth around stapes
- associated with progressive hearing loss beginning ages 10-30
- Conductive loss: ossicles sclerosis into single immovable mass
- Sensory loss: otic capsule sclerosis
What is the weber test?
- Helps determine conductive vs sensorineural hearing loss
- place vibrating tuning fork on middle of head or forehead and ask if there is a difference btw the ears
- normal should be same bilaterally
- If problem sound will lateralize to one ear
- If abnormal do Rinne test
What is rinne test?
- Place tuning fork on mastoid process testing bone conduction and once they cant hear it you place it next to ear and ask them to tell you when they cant hear it
- Normal is to hear longer in air conduction than bone conduction
What results will indicate conductive loss?
- Weber: lateralizes
- Rinne: BC > AC
What test results indicate sensorineural loss?
- Weber: Lateralizes to good ear
- Rinne: AC >BC
What causes sensorineural hearing loss?
- Hereditary
- Meniere disease
- MS
- Trauma
- Ototoxic drugs
- Barotruama
What causes conductive hearing loss?
- Cerumen impaction
- Middle ear fluid
- Lack of ossicle movement
- Trauma
- Tumors
Rhinosinusitis?
- Mucosal lining in paranasal sinuses and nasal cavity become inflammed
- Infectious causes:
- Viruses or bacterial
- Dental infections and procedures, iatrogenic causes,immunodeficieny, impaired ciliary motility, mechanical obstruction
- Sx:
- nasal discharge, cough, sneezing, nasal congestion,fever headache, pain, and facial pressure
Bacterial sinusitis?
- Suspicion of acute bacterial sinusitis
- Double sickening (after 2-3 weeks initally gets better but then gets worse) purulent rhinorrhea, elevated ESR
- Pain upon tapping sinuses
- needs antibiotics
Croup?
- Laryngotracheitis
- Swelling of larynx trachea and bronchi causing stridor and barking cough in kids 6 months to 3 yrs
- Caused by viruses
- Hx: barking cough
- Tx: oxygen, dexamethasone, breathing treatment (nebulized epinephrine) often self limited and no intervention needed
What sign on x ray indicates croup?
Steeple sign, narrowing of trachea
Epiglottitis?
- Inflammation of epiglottis and adjacent structures
- Caused by Haemophilus type B influenza and GABHS
- Hx: rapid onset sore throat, muffled voice, drooling
- Presents with high fever, toxic appearance, child sitting/leaning forward
- Workup: consider lateral neck XR, elevate WBC
- Tx: protect airway, may need to intubate, broad spectrum antibiotics
Differnetials for (ENT) vertigo?
- Eustachian tube dysfxn
- BPPV
- Vestibular neuritis
What is the most common cause of vertigo?
- BPPV
- sudden sensation that your spinning
- Triggered by specific changes in head position
What is vestibular neuritis?
- Inflammation of nerve affecting branch assoc with balance resulting in dizziness but no hearing loss
Labyrinthitis?
- Occurs when infection affects both branches of vestibulo cochlear nerve resuting in hearing chagnes and dizziness or vertigo
Meniere’s disease?
- Disorder of inner ear feeling that youre spinning and fluctuating hearing loss with progressive permanent loss of hearing, riniging and feeling of fullness or pressure in ear
- Usually affects only one ear
- Starts btw 20 and 50
- Chronic condition
