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ECOS2 final > Approach to ENT exam > Flashcards

Approach to ENT exam Flashcards

1
Q

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

A

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

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2
Q

Cobblestoning

A

Back of pharynx is bumpy

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3
Q

Mouth exam

A

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

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4
Q

Ear exam

A

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

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5
Q

Specialty tests for the ear

A

Whisper test and the finger rub test

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6
Q

Checking LNs

A

Use 3 middle finger pads

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

Is mobile LN fine

A

Yes , is not mobile and hard it can be malignancy

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8
Q

Allergic rhinitis

A

Nose inflammation, sneezing, discharge, nasal obstruction

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9
Q

Anterior epistaxis

A

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

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10
Q

Posterior epistaxis

A

More significant nose bleeds, posterolateral branches of the sphenopalatine artery

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11
Q

Tonsillitis

A

Tonsils inflamed, from bacteria or virus

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12
Q

Infectious mononucleosis

A

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

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13
Q

Sore throat is result from

A

Inflamed pharynx

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14
Q

Pharyngitis

A

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

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15
Q

Viral pharyngitis

A

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

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16
Q

How to interpret scores of pharyngitis

A

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

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17
Q

Strep throat has what bacteria

A

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

18
Q

Otitis media
Otitis externa
Labyrinithitis

A

Middle ear infection
Outer ear infection
Inner ear infection

19
Q

Acute Otitis Media

A

Bacteria or viral inflammation of middle ear

20
Q

Acute suppurative OM

A

Purulent material in middle ear

Bulging of ear drum

21
Q

OM with effusion (serous OM)

A

Inflammation and fluid buildup in middle ear + NO infection

22
Q

Chronic OM with effusion

A

Fluid keeps returning to middle ear with no infections

23
Q

Chronic suppurative OM

A

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

24
Q

EM

A

Pain when palpating ear, crusting in the ear

25
Q

Otosclerosis

A

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

26
Q

Conductive loss

A

Ossicle sclerosis becoming a single immovable mass

27
Q

Sensory loss

A

Otic capsule sclerosis

28
Q

Testing conductive vs sensory hearing loss

A
  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
29
Q

Rinne test for sensory loss

A

Normal for both ears

30
Q

Causes of conductive hearing loss

A

Cerulean impaction (wax)
OM fluid
Ossicles dont move
Tumors

31
Q

What causes sensoryneural loss

A

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

32
Q

Rhinosinusitis

A

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 **

33
Q

Inflammatory markers to test for rhinosinusitis

A

ERS and CRP

34
Q

Bacterial sinusitis

A

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

35
Q

Croup

A

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)*

36
Q

Epiglottitis

A

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

37
Q

Vertigo , no hearing loss

3 causes

A
  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),
38
Q

Labyrinthitis

A

Labyrinth inflamed

Affects both vestibule-cochlear nerve = hearing loss + vertigo

39
Q

Meniere’s Disease

A

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

40
Q

How to DX BPPV

A 
Dix- Hallpike maneuver
Epley Manuver (at home)

ECOS2 final (3 decks)

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