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PCM2 Midterm > Approach to ENT Complaint > Flashcards

Approach to ENT Complaint Flashcards

1
Q

What is a Normal Weber test?

A

midline and can hear equally

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2
Q

What is the difference b/w a sensorineural and conductive loss in a Weber test?

A

conductive : lateralized to affected side

sensorineural : lateralized to side opposite of the ear

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3
Q

What is a normal Rinne Test?

A

Air conduction > bone conduction

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4
Q

Conductive hearing loss Rinne Test result?

A

Bone conduction > air conduction

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5
Q

Causes of sensorineural hearing loss?

A
  • hereditary
  • meniere disease
  • MS
  • trauma
  • ototoxic drugs
  • barotrauma
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6
Q

Causes of conductive hearing loss?

A
  • cerumen impaction
  • middle ear fluid
  • lack of movement of ossicles
  • trauma
  • obstruction (ie tumor)
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7
Q

What are the 3 types of ear infections?

A
  • middle (acute otitis media ; otitis media with effusion)
  • outer (outer ear canal ; otitis externa)
  • inner (labyrinthitis)
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8
Q

What are the 5 types of Otitis Media?

A

1) acute OM
2) Acute suppurative OM
3) OM with effusion (serous OM)
4) Chronic OM with effusion
5) Chronic suppurative OM]

  • chronic = more than 6 weeks
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9
Q

What is acute OM?

A

symptomatic inflammation of the middle ear caused by bacteria or viruses

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10
Q

What is Acute suppurative OM?

A

acute OM with purulent lateral in the middle ear

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11
Q

What is OM with effusion (serous OM)?

A

inflammation and fluid build up (effusion) in the middle ear without a bacterial or viral infection

  • caused by : fluid persisting after infection resolved OR dysfunction/blockage of Eustachian tubes
  • can last 3 months and affect hearing
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12
Q

What is chronic OM with effusion?

A

fluid remains in middle eat and continues to return w/o bar or viral infection.

  • makes children susceptible to new ear infections, may affect hearing
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13
Q

What is chronic suppurative OM?

A

persistent ear infection that results in tearing or perforation of the eardrum

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14
Q

How to do get otitis external?

How does the patient present?

A

bacteria entering a small break in skin of ear canal

  • drainage from ear
  • touching external ear causes pain
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15
Q

What is otosclerosis?

A

abnormal bone growth around stapes

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16
Q

What is associated with otosclerosis?

A
  • progressive hearing loss beginning at ages 10-30

- marked hearing loss occurring during middle age

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17
Q

What are the two types of otosclerosis?

A

1) conductive loss - ossicle sclerosis into a single immovable mass
2) sensory loss - otic capsule sclerosis (`10% of caucasians ; females > males)

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18
Q

What is rhino sinusitis/sinusitis?

A

-mucosal lining in paranasal sinuses and nasal cavity be/c inflamed

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19
Q

What are some infectious causes of rhino/sinusitis?

A
  • virus

- bacterial

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20
Q

What are some other causes of rhino/sinusitis?

A
  • dental infections and procedure
  • sinus surgery
  • nasogastric tubes
  • immunodeficiency
  • impaired ciliary motility
  • obstruction
21
Q

What are signs and symptoms of rhino/sinusitis?

A
  • nasal discharge
  • cough
  • sneeze
  • nasal congestion
  • fever
  • headache
  • pain
  • facial pressure
22
Q

Treatment for rhino/sinusitis?

A
  • analgesics
  • intranasal corticosteroids (Flonase)
  • nasal saline irrigation
  • decongestants
  • antihistamine
23
Q

What is are key indicators of bacterial sinusitis?

A
  • double sickening (initially gets slightly better then gets worse)
  • purulent rhinorrhea
  • elevated ESR
24
Q

What makes bacterial sinusitis acute?

A

-when signs and symptoms of acute rhino sinusitis persist w/o evidence of improvement for at least 10 days beyond onset of URI

25
Q

What is the Centor score used for?

A

To determine whether or not a patient needs antibiotics to treat GABHS causing sore throat

26
Q

What are the Centor criteria?

A

1 point for each :

  • absence of cough
  • swollen and tender anterior cervical nodes
  • temperature > 100.4 F (38C)
  • tonsilar exudates or swelling
  • age : 3-14 years

0 points: age 15-44 years
-1 point : age 45+

27
Q

How do you treat with a Centor score of 0?

A

no further testing or antibiotics indicated

28
Q

How do you treat a Centor score of 1?

A

No further testing to antibiotics indicated

option : perform throat culture of RADT (treat with antibiotics if +)

29
Q

How do you treat a Centor score of 2?

A

-perform a throat culture or RADT

treat w/ antibiotics if +) (rapid antigen detection testing

30
Q

How do you treat a Centor score of 3?

A

perform throat culture or RADT (treat with antibiotics if +)

-higher chance of pharyngitis that score of 2

31
Q

How do you treat a Centor score of 4+?

A

consider empiric treatment with antibiotics

32
Q

What is pharyngitis?

A

inflammation of the pharynx w/ resulting sore throat

33
Q

What are the most likely infections causes of pharyngitis/sore throat?

A
  • viral

- bacterial (GABHS, chlamydia pneumonia, mycoplasma pneumonia)

34
Q

Common symptoms for viral pharyngitis?

A
  • coryza (inflammed mucus membrane)
  • conjunctivitis
  • malaise/fatigue
  • hoarseness
  • low grade fever
35
Q

other possible causes of sore throat other than pharyngitis?

A
  • mononucleosis
  • GERD
  • postnasal drip secondary to rhinitis
  • persistent cough
  • thyroiditis
  • allergies
  • foreign body
  • smoking
36
Q

Symptoms of Streptococcal Pharyngitis? (GABHS - group A beta-hemolytic strep)

A
  • sore throat
  • headache
  • fatigue
  • fever
  • body aches
  • nausea ( pharynx next to intra-ab organs on homonculus)
37
Q

Who/when is the highest likelihood to get GABHS?

A
  • children 5-15 yo
  • winter and early spring seasons
  • absence of cough
  • tender anterior cervical lymphadenopathy
  • tonsillar exudate
  • fever
38
Q

What labs should you consider for sore throat?

A

-depending on differentials (mono, viral pharyngitis, bacterial pharyn, that irritation from cough)

— RADT ( rapid antigen detecting test fot strep)

– throat culture ( throat swab of posterior tonsillopharyngeal area and inoculated onto agar plate)

– monospoit test : rapid slide agglutination test for mono

39
Q

How do you treat sore throat?

A
  • antibiotics (penicillin class)
  • conservative management
  • NSAIDS
  • cough drops
  • chloraseptic sprays (antiseptic and anesthetic)
40
Q

What is laryngotracheitis?

A

aka croup cough

-swelling of the larynx, trachea, bronchi causing inspiratory stridor and barking cough in children 6 mo - 3 yo

41
Q

causes of laryngotracheitis?

A
  • parainfluenza virus
  • influenza
  • respiratory syncytial virus
42
Q

How does a patient with laryngotracheitis present?

A
  • fever
  • nasal flaring
  • respiratory retractions
  • stridor (high pitched wheezing sound caused by obstructed airflow)
43
Q

How to you treat laryngotracheitis?

A
  • oxygen
  • dexamethasone
  • nebulized epinephrine
  • often self limited and no intervention needed
44
Q

What is epiglottis?

A
  • inflammation of the epiglottis and adjacent structure
45
Q

What is the cause of epiglottitis?

A

haemophilus type b influenza, GABHS

46
Q

What past history indicates epiglottitis?

A
  • rapid onset of symptoms
  • sore throat
  • muffled voice
  • drooling
47
Q

How does a patient present who has epiglottitis?

A
  • high grade fever
  • toxic appearance
  • child sitting or leaning forward
48
Q

What is the workup and treatment of epiglottitis?

A

consider lateral neck XR, WBC

  • protect the airway (intubate if needed
  • broad spectrum antibiotics
49
Q

Why do we treat strep?

A

if not treated -> can lead to rheumatic fever

PCM2 Midterm (6 decks)

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