Approach To ENT Complaint

Question 1

When do the frontal sinuses develop?

Answer 1

8-10 years of age

Question 2

What can cause cobblestoning?

Answer 2

Inflammation or infection

Possibly allergies as well

Question 3

What is allergic rhinitis?

Answer 3

Inflammation in the nose caused by an allergen characterized by sneezing, rhinorrhea (nasal discharge), and nasal obstruction

Question 4

What is anterior epistaxis (nosebleeds)?

Answer 4

Most common nose bleed usually affects the vascular watershed area of the nasal septum (Kiesselbach’s plexus)

Question 5

What is posterior epistaxis?

Answer 5

Less common

Usually this causes a more significant bleeding and affects the posterolateral branches of the sphenopalatine artery

Question 6

What is tonsillitis?

Answer 6

Inflammation of the tonsils usually due to a specific bacterial or virus

Question 7

What is infectious mononucleosis?

Answer 7

Illness caused by a virus called Epstein Barr virus and causes triad of fever, tonsillar pharyngitis (sore throat) and lymphadenopathy (enlarged LNs)

Question 8

What is pharyngitis?

Answer 8

Inflammation of the pharynx with resulting sore throat

Question 9

What are the most likely infectious causes for pharyngitis?

Answer 9

Viral and bacterial

Question 10

What are common sx for viral pharyngitis?

Answer 10

Coryza (inflamed mucous membrane), conjunctivitis, malaise or fatigue, hoarseness, and low grade fever suggest the presence of viral pharyngitis

Question 11

What causes streptococcal pharyngitis (strep throat)?

Answer 11

Group A beta hemolytic streptococcus

Question 12

What are some sx of strep throat?

Answer 12

Sore throat, HA, fatigue, fever, body aches, nausea

Question 13

Highest likelihood of group A beta hemolytic streptococcus (GABHS) if what?

Answer 13

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

Question 14

What are labs to consider performing for pharyngitis?

Answer 14

Rapid Ag test or rapid strep Ag test (detects presence of strep)
Throat culture (throat swab)
Mono spot test (test for mononucleosis)

Question 15

What are middle ear infections?

Answer 15

Acute otitis media (AOM)

Otitis media with effusion

Question 16

What is otitis externa?

Answer 16

Outer ear infection

Question 17

What is labyrinthitis?

Answer 17

Inner ear infection

Question 18

What is acute OM?

Answer 18

Symptomatic inflammation of the middle ear that can be caused by bacteria or viruses

Question 19

What is acute suppurative OM?

Answer 19

Acute OM with purulent material in the middle ear

Question 20

What is OM with effusion (serous OM)?

Answer 20

Inflammation and fluid buildup (effusion) in the middle ear without bacterial or viral infection
This may occur bc the fluid buildup persists after an ear infection has resolved
May also occur bc of SD or noninfectious blockage of the Eustachian tubes

Question 21

What is chronic OM with effusion?

Answer 21

Occurs when fluid remains in the middle ear and continues to return without bacterial or viral infection
Makes children susceptible to new ear infections and may affect hearing

Question 22

What is chronic suppurative otitis media?

Answer 22

A persistent ear infection that often results in tearing or perforating of the eardrum

Question 23

What will the ear look like with acute OM?

Answer 23

Often appears the TM is building
Erythematous
TM has reduced mobility when pneumatic otoscope is used

Question 24

What will the ear look like with otitis media with effusion?

Answer 24

Fluid behind ear drum
Often follows AOM
Can last 3 months (if persists called chronic OM with effusion)
Can affect hearing esp if its chronic

Question 25

Describe otitis externa

Answer 25

Can be caused by bacteria entering a small break in skin of canal Pts may report drainage from ear Usually associated with pain upon touching the external ear structures

Question 26

What is otosclerosis?

Answer 26

Abnormal bone growth around stapes bone Associated with progressive hearing loss beginning at ages 10-30 Marked hearing loss occurring during middle age Affects more females than males

Question 27

What are the two types of otosclerosis?

Answer 27

Conductive and sensory loss

Question 28

What is conductive loss?

Answer 28

Ossicle sclerosis into a single immovable mass

Question 29

What is sensory loss?

Answer 29

Otic capsule sclerosis

Question 30

What is an abnormal Weber test?

Answer 30

If sound lateralizes to one ear it is either conduction loss in that ear or sensorineural loss in the opposite ear

Question 31

What are some causes for conductive hearing loss?

Answer 31

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

Question 32

What are causes for sensorineural hearing loss?

Answer 32

Hereditary, Meniere disease, MS, trauma, ototoxic drugs, barotrauma, etc

Question 33

What is rhinosinusitis/sinusitis?

Answer 33

Mucosal lining in the paranasal sinuses and nasal cavity becomes inflamed Bacterial and viral causes

Question 34

What are other causes for rhinosinusitis/sinusitis?

Answer 34

Dental infections and procedure, iatrogenic causes (sinus surgery, nasogastric tubes, etc), immunodeficiency, impaired ciliary motility, mechanical obstruction

Question 35

What are signs and sx for rhinosinusitis/sinusitis?

Answer 35

Nasal discharge, sneezing, cough, nasal congestion, fever, Ha, pain and facial pressure

Question 36

What is bacterial sinusitis?

Answer 36

``` Suspicion of acute bacterial sinusitis Double sickening (initially get slightly better than gets worse), purulent rhinorrhea, elevated ESR ```

Question 37

When is acute bacterial rhinosinusitis indicated?

Answer 37

When signs or sx of acute rhinosinusitis persist without evidence of improvement for at least 10 days beyond the onset of upper respiratory sx

Question 38

What is croup (laryngotracheitis)?

Answer 38

Swelling of the larynx, trachea, bronchi causing inspiratory stridor and barking cough in children 6 mo to 3 years old Causes: parainfluenza virus, influenza, respiratory syncytial virus Hx: barking cough Presentation: fever, nasal flaring, respiratory retractions, stridor Can perform XR

Question 39

What is epiglottitis?

Answer 39

Inflammation of the epiglottis and adjacent structures Causes: haemophilus type B influenza, group A beta hemolytic streptococcus Hx: rapid onset of sx, sore throat, muffled voice, drooling Presentation: high grade fever, toxic appearance, child sitting or leaning forward Consider lateral neck XR, elevated WBC

Question 40

What is the most common cause of Eustachian tube dysfunction?

Answer 40

When the tube gets inflamed and mucus or fluid builds up Causes include: flu, sinus infection, or allergies Can cause vertigo

Question 41

What is BBPV?

Answer 41

One of the MC causes of vertigo Sudden sensation that youre spinning or that the inside of your head is spinning Causes brief episodes of mild to intense dizziness Triggered by specific changes in the position of your head

Question 42

What is vestibular neuritis (inflammation of the nerve)?

Answer 42

Affects the branch associated with balance, resulting in dizziness or vertigo but no change in hearing

Question 43

What is labyrinthitis?

Answer 43

Occurs when an infection affects both branches of the vestibulocochlear nerve resulting in hearing changes as well as dizziness or vertigo

Question 44

Describe Meniere’s disease

Answer 44

Disorder of the inner ear that causes episodes in which you feel as if youre spinning (vertigo) and you have fluctuating hearing loss with a progressive permanent hearing loss, ringing of the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear Affects one ear Usually starts between ages 20-50

Question 45

Which techniques can be used to diagnose BPPV?

Answer 45

Dix-Hallpike maneuver and Epley maneuver