Approach to ENT Complaint

Question 1

What is a Normal Weber test?

Answer 1

midline and can hear equally

Question 2

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

Answer 2

conductive : lateralized to affected side

sensorineural : lateralized to side opposite of the ear

Question 3

What is a normal Rinne Test?

Answer 3

Air conduction > bone conduction

Question 4

Conductive hearing loss Rinne Test result?

Answer 4

Bone conduction > air conduction

Question 5

Causes of sensorineural hearing loss?

Answer 5

• hereditary
• meniere disease
• MS
• trauma
• ototoxic drugs
• barotrauma

Question 6

Causes of conductive hearing loss?

Answer 6

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

Question 7

What are the 3 types of ear infections?

Answer 7

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

Question 8

What are the 5 types of Otitis Media?

Answer 8

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

Question 9

What is acute OM?

Answer 9

symptomatic inflammation of the middle ear caused by bacteria or viruses

Question 10

What is Acute suppurative OM?

Answer 10

acute OM with purulent lateral in the middle ear

Question 11

What is OM with effusion (serous OM)?

Answer 11

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

Question 12

What is chronic OM with effusion?

Answer 12

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

Question 13

What is chronic suppurative OM?

Answer 13

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

Question 14

How to do get otitis external?

How does the patient present?

Answer 14

bacteria entering a small break in skin of ear canal

• drainage from ear
• touching external ear causes pain

Question 15

What is otosclerosis?

Answer 15

abnormal bone growth around stapes

Question 16

What is associated with otosclerosis?

Answer 16

• progressive hearing loss beginning at ages 10-30

- marked hearing loss occurring during middle age

Question 17

What are the two types of otosclerosis?

Answer 17

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

Question 18

What is rhino sinusitis/sinusitis?

Answer 18

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

Question 19

What are some infectious causes of rhino/sinusitis?

Answer 19

• virus

- bacterial

Question 20

What are some other causes of rhino/sinusitis?

Answer 20

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

Question 21

What are signs and symptoms of rhino/sinusitis?

Answer 21

• nasal discharge
• cough
• sneeze
• nasal congestion
• fever
• headache
• pain
• facial pressure

Question 22

Treatment for rhino/sinusitis?

Answer 22

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

Question 23

What is are key indicators of bacterial sinusitis?

Answer 23

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

Question 24

What makes bacterial sinusitis acute?

Answer 24

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

Question 25

What is the Centor score used for?

Answer 25

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

Question 26

What are the Centor criteria?

Answer 26

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+

Question 27

How do you treat with a Centor score of 0?

Answer 27

no further testing or antibiotics indicated

Question 28

How do you treat a Centor score of 1?

Answer 28

No further testing to antibiotics indicated option : perform throat culture of RADT (treat with antibiotics if +)

Question 29

How do you treat a Centor score of 2?

Answer 29

-perform a throat culture or RADT | treat w/ antibiotics if +) (rapid antigen detection testing

Question 30

How do you treat a Centor score of 3?

Answer 30

perform throat culture or RADT (treat with antibiotics if +) -higher chance of pharyngitis that score of 2

Question 31

How do you treat a Centor score of 4+?

Answer 31

consider empiric treatment with antibiotics

Question 32

What is pharyngitis?

Answer 32

inflammation of the pharynx w/ resulting sore throat

Question 33

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

Answer 33

- viral | - bacterial (GABHS, chlamydia pneumonia, mycoplasma pneumonia)

Question 34

Common symptoms for viral pharyngitis?

Answer 34

- coryza (inflammed mucus membrane) - conjunctivitis - malaise/fatigue - hoarseness - low grade fever

Question 35

other possible causes of sore throat other than pharyngitis?

Answer 35

- mononucleosis - GERD - postnasal drip secondary to rhinitis - persistent cough - thyroiditis - allergies - foreign body - smoking

Question 36

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

Answer 36

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

Question 37

Who/when is the highest likelihood to get GABHS?

Answer 37

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

Question 38

What labs should you consider for sore throat?

Answer 38

-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

Question 39

How do you treat sore throat?

Answer 39

- antibiotics (penicillin class) - conservative management - NSAIDS - cough drops - chloraseptic sprays (antiseptic and anesthetic)

Question 40

What is laryngotracheitis?

Answer 40

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

Question 41

causes of laryngotracheitis?

Answer 41

- parainfluenza virus - influenza - respiratory syncytial virus

Question 42

How does a patient with laryngotracheitis present?

Answer 42

- fever - nasal flaring - respiratory retractions - stridor (high pitched wheezing sound caused by obstructed airflow)

Question 43

How to you treat laryngotracheitis?

Answer 43

- oxygen - dexamethasone - nebulized epinephrine - often self limited and no intervention needed

Question 44

What is epiglottis?

Answer 44

- inflammation of the epiglottis and adjacent structure

Question 45

What is the cause of epiglottitis?

Answer 45

haemophilus type b influenza, GABHS

Question 46

What past history indicates epiglottitis?

Answer 46

- rapid onset of symptoms - sore throat - muffled voice - drooling

Question 47

How does a patient present who has epiglottitis?

Answer 47

- high grade fever - toxic appearance - child sitting or leaning forward

Question 48

What is the workup and treatment of epiglottitis?

Answer 48

consider lateral neck XR, WBC - protect the airway (intubate if needed - broad spectrum antibiotics

Question 49

Why do we treat strep?

Answer 49

if not treated -> can lead to rheumatic fever