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PCM II Midterm > Approach to ENT Exam > Flashcards

Approach to ENT Exam Flashcards

1
Q

Why would you ask about tobacco in household for 2 year old pt in case #1?

A

2nd hand smoke can cause lung damage

allergic irritant which makes them more susceptible to viral infections

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2
Q

What exam do you perform for case #1?

A

cc of fever, sore throat & congestion

ENT exam

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3
Q

Steps of ENT exam

A

check for sinus tenderness

check the nose & nasal turbinates

check the mouth

check the throat & tonsils

check the ears

check the lymph nodes

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4
Q

What are you looking for when examining sinus tenderness?

A

if one area hurts a lot more than other areas

frontal & maxillary sinuses

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5
Q

How do you examine the nose?

A

using otoscope

look @ nasal septum & turbinates

have pt hold nose up & put @ entry way to nostril

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6
Q

What is clear rhinnorhea?

A

sparkly stuff on nasal septum & inf turbinate

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7
Q

What do you look @ in the mouth?

A

for an oral complaint:

oral mucosa
oral gingiva

palpate both mucose & gingiva

grip tongue to check lateral borders

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8
Q

What disease is associated with bronze/brown spots in oral cavity?

A

Addison’s disease

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9
Q

What are some abnormalities you will see on tongue?

A

Yeast (cottage cheese)

Beefy, red tongue (vitamin deficiency)

Bleeding tongue

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10
Q

What is cobblestoning?

A

patches of lymph tissues that are swollen on tonsils & back of throat

due to post nasal drip (mucus down back of throat)

irritates mucosa

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11
Q

What is cobblestoning often associated with?

A

acid reflux disease

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12
Q

Torus palatinus

A

NORMAL, harmless bony growth

if impacts speech of swallowing, may be removed

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13
Q

How do you examine the ear?

A

check external ear

check for drainage & redness

check for tenderness of tragus

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14
Q

What is the Whisper test for?

A

tests for hearing

softly whisper into each ear & ask pt to repeat what you said

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15
Q

Pneumatic Otoscopy

A

used to examine ear

puff of air into ear to detect if tympanic membrane moves or not

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16
Q

What are you looking @ during ear exam?

A

tympanic membrane & proximal external ear

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17
Q

What is important to document from ear exam?

A

cone of light

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18
Q

Describe otitis media presentation in ear exam

A

fluid behind tympanic membrane causes bulging TM

no cone of light

some degree of erythema

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19
Q

How do you examine the LNs?

A

with finger pads

circles w/ fingers to see if LN is swollen

look for texture, size & tenderness

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20
Q

What were the abnormal findings of PE for case #1?

A

mildly injected conjunctiva bilaterally (something is affecting eyes)

clear fluid behind R TM

cobblestoning of pharynx

clear rhinorrhea w/ inflamed turbinates bilaterally

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21
Q

What are possible differentials for case #1?

A

Viral pharyngitis (viral is more common)

Acute otitis media

Strep (need to always rule it out)

22
Q

Signs of Strep Throat

A

pre-pallatine petechiae

hypertrophied tonsils w/ extradate

inflammed uvula

beefy red soft palate

23
Q

Pharyngitis

A

inflammation of pharynx/throat

24
Q

Common symptoms of viral pharyngitis

A

coryza (runny nose)

conjunctivitis

malaise/fatigue

low grade fever

25
Streptococcal Pharyngitis
group A strep usually can clear on own but treated b/c can cause rheumatic fever & other issues
26
Common symptoms assoc w/ strep throat
``` sore throat headache fatigue fever body aches nausea ```
27
Why do pts feel nausea w/ strep throat?
b/c of homonculus pharynx is near intra-abdominal organs!
28
When is Group A strep most likely?
children 5-15 winter/early spring absence of cough tender anterior cervical lymph nodes tonsillar exudate fever
29
What is the centor score?
tells if pt needs to be treated w/ antibiotics for strep depending on history
30
What criteria of centor score give you points?
absence of cough swollen nodes temperature of >100.4 age 3 to 14 years **if score>4 then treat w/ antibiotics
31
When do you do a rapid strep test?
for centor score of 2 & 3 if positive, treat w/ antibiotics
32
What labs should you consider post ENT PE?
rapid strep test may consider mono (monospot test) throat culture
33
What treatment should you consider?
antibiotics NSAIDs for sore throat
34
Why do you often have a sore ear assoc w/ sore throat?
b/c of eustachian tube in ear that empties into back of throat (all connected!)
35
Pathologies assoc w/ middle ear
acute otitis media otitis media w/ effusion
36
Pathologies assoc w/ outer ear
otitis externa
37
Pathologies assoc w/ inner ear
labyrinithitis
38
Suppurative OM
acute OM w/ purulent material in middle ear
39
OM w/ effusion
inflammation or buildup in middle ear WITHOUT bacterial or viral infection just a fluid issue (due to eustachian tube dysfunction)
40
What is different in exam btwn acute otitis media & otitis media w/ effusion?
acute has bulging TM & is red OM w/ effusion still has cone of light but has air bubbles & fluid level
41
Why would you want to treat OM w/ effusion?
if chronic, can cause hearing loss
42
Otitis externa
swollen ear canal from break in skin treat w/ drops to treat actual infection
43
Otosclerosis
abnormal bone growth around stapes bones assoc w/ hearing loss from 10yo-30yo
44
Implications of Weber test findings
normal hearing: do not hear on 1 side more than other conductive hearing test: hear on 1 ear better than other sensorineural loss: lateralizes to side opp of affected ear
45
Implications of Rinne test
with abnormal Weber test normal: air conduction > bone conduction (hear better when in front of ear) conductive loss is when don't hear it better when move turning fork to front
46
What is conductive hearing loss?
external canal of ear is blocked
47
Rhinosinusitis
inflammation of mucosal lining in paranasal sinuses & nasal cavity
48
What is common in bacterial sinusitis?
double sickening think you are getting better but then get even worse (more pressure, fever)
49
Croup
barking seal cough viral cause swelling of larynx, trachea & bronchi self-resolving
50
Epiglottitis
inflammation of epiglottis & adj structures child will have high fever & toxic appearance EMERGENTd

PCM II Midterm (15 decks)

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