Approach to ENT exam

Question 1

2yo male 4 days fever sore throat, congestion, poor appetite ,pulls of left ear, less active, no C, D, V

Answer 1

1st. Check sinuses : frontal, maxillary,
Pain = infection, pressure = congestion
2. Inspect nose, eyes, mouth (post pharynx, tonsils can have white exudate on it or be swollen), ears,
3. Otoscope : look at turbunates, swollen or pale or clear rhinorrhea are not normal, look at ears
4. Palpate LN, thyroid
4. Nasal obstruction test : breath with 1 ala pressed down
Pressure on tip of nose test : tenderness can mean local infection

Question 2

Cobblestoning

Answer 2

Back of pharynx is bumpy

Question 3

Mouth exam

Answer 3

Mucosa, gingiva, teeth, pharynx, tonsils, tongue, side of mouth buccaneers mucosa, under lips

Question 4

Ear exam

Answer 4

Discharge, tenderness on Tragus can mean infection in middle or inner ear
Otoscope into ear : otitis media = infection of middle ear, building TM and erythma
Pearly white with nice cone reflected light is normal

Question 5

Specialty tests for the ear

Answer 5

Whisper test and the finger rub test

Question 6

Checking LNs

Answer 6

Use 3 middle finger pads

1. Preauricular
2. Posterior auricular,
3. Occipital
4. Superficial cervical
5. Posterior cervical
6. Supraclavicular
7. Tonsilar

Question 7

Is mobile LN fine

Answer 7

Yes , is not mobile and hard it can be malignancy

Question 8

Allergic rhinitis

Answer 8

Nose inflammation, sneezing, discharge, nasal obstruction

Question 9

Anterior epistaxis

Answer 9

Nose bleeds, affects vascular whatershed are of nasal septum (kisselbach’s plexus)
Most common

Question 10

Posterior epistaxis

Answer 10

More significant nose bleeds, posterolateral branches of the sphenopalatine artery

Question 11

Tonsillitis

Answer 11

Tonsils inflamed, from bacteria or virus

Question 12

Infectious mononucleosis

Answer 12

(mono) Virus Epstein Barr Virus, causes F, tonsillar pharyngitis (sore throat), lymphadenopathy (enlarged LN)

Question 13

Sore throat is result from

Answer 13

Inflamed pharynx

Question 14

Pharyngitis

Answer 14

Inflamed pharynx, sore throat, flu, cold, viral or bacterial

Question 15

Viral pharyngitis

Answer 15

Conjunctiva Hoarseness, fatigue, malaise, low grade fever, sore throat

Question 16

How to interpret scores of pharyngitis

Answer 16

0-1 : do nothing
1-3 : strep test done, bacterial or viral
4 or more: strep throat is there and you need to treat them

Question 17

Strep throat has what bacteria

Answer 17

Group a streptococcal from swab at posterior tonsillopharyngeal area
Usually winter and spring, usually NO COUGH,
* tender anterior cervical LN
Group A beta hemolytic streptococcus is what causes this

Question 18

Otitis media
Otitis externa
Labyrinithitis

Answer 18

Middle ear infection
Outer ear infection
Inner ear infection

Question 19

Acute Otitis Media

Answer 19

Bacteria or viral inflammation of middle ear

Question 20

Acute suppurative OM

Answer 20

Purulent material in middle ear

Bulging of ear drum

Question 21

OM with effusion (serous OM)

Answer 21

Inflammation and fluid buildup in middle ear + NO infection

Question 22

Chronic OM with effusion

Answer 22

Fluid keeps returning to middle ear with no infections

Question 23

Chronic suppurative OM

Answer 23

Persistent ear infection can tear and perforate the ear drum (more then 6 weeks)

Question 24

EM

Answer 24

Pain when palpating ear, crusting in the ear

Question 25

Otosclerosis

Answer 25

Abnormal bone growth around the stapes bone , more in females Progressive hearing loss 1. Conductive loss 2. Sensory loss

Question 26

Conductive loss

Answer 26

Ossicle sclerosis becoming a single immovable mass

Question 27

Sensory loss

Answer 27

Otic capsule sclerosis

Question 28

Testing conductive vs sensory hearing loss

Answer 28

1. Weber test : Put tuning fork on forehead , if lateralization happens it is not normal 2. Rinne Test : Put tuning fork on mastoid bone behind ear, plus vibrate tuning fork right next to ear (Conductive = same, sensory opposite) AC > BC = NORMAL BC > AC = Conductive hearing loss

Question 29

Rinne test for sensory loss

Answer 29

Normal for both ears

Question 30

Causes of conductive hearing loss

Answer 30

Cerulean impaction (wax) OM fluid Ossicles dont move Tumors

Question 31

What causes sensoryneural loss

Answer 31

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

Question 32

Rhinosinusitis

Answer 32

Paranasal sinus + nasal cavity is inflamed Due to rhinovirus, flu, para flu, Strep pneumonia, SX: nasal drainage, cough, sneezing, nasal congestion, fever, headache facial pressure ****

Question 33

Inflammatory markers to test for rhinosinusitis

Answer 33

ERS and CRP

Question 34

Bacterial sinusitis

Answer 34

Double sickening = get better then worse, purulent rhinorrhea, high ESR, pressure AND PAIN 2- 3 weeks

Question 35

Croup

Answer 35

Laryngotracheitis Larynx and trachea and bronchi swell = stridor = barking cough, fever, nasal flaring, respiratory retractions = flu, paraflu, = 6mo - 3yo = steeple sign on XR (narrowing of trachea)*

Question 36

Epiglottitis

Answer 36

Medical emergency Inflamed epiglottis from Group A hemolytic strep, Type b flu EX: sore throat, muffled voice, drooling, high fever, tripod position, toxic appearence, XR shows enlarged inflamed epiglottis

Question 37

Vertigo , no hearing loss | 3 causes

Answer 37

1. Eustachian tube dysfunction : tube is inflamed and buildup in OM 2. BPPV : brief episodes of vertigo due to head position, otolysts in the ear 3. .Vestibular Neuritis : nerve inflammation dealing with balance (going to vestibular ganglion),

Question 38

Labyrinthitis

Answer 38

Labyrinth inflamed | Affects both vestibule-cochlear nerve = hearing loss + vertigo

Question 39

Meniere’s Disease

Answer 39

Inner ear disorder, episodes of vertigo, fluctuating healing loss chronic, ringing in ears (tinnitus), pressure in ear, Only one ear usually, can usually start from 20yo-50yo

Question 40

How to DX BPPV

Answer 40

``` Dix- Hallpike maneuver Epley Manuver (at home) ```