Approach to ENT Exam Flashcards
Why would you ask about tobacco in household for 2 year old pt in case #1?
2nd hand smoke can cause lung damage
allergic irritant which makes them more susceptible to viral infections
What exam do you perform for case #1?
cc of fever, sore throat & congestion
ENT exam
Steps of ENT exam
check for sinus tenderness
check the nose & nasal turbinates
check the mouth
check the throat & tonsils
check the ears
check the lymph nodes
What are you looking for when examining sinus tenderness?
if one area hurts a lot more than other areas
frontal & maxillary sinuses
How do you examine the nose?
using otoscope
look @ nasal septum & turbinates
have pt hold nose up & put @ entry way to nostril
What is clear rhinnorhea?
sparkly stuff on nasal septum & inf turbinate
What do you look @ in the mouth?
for an oral complaint:
oral mucosa
oral gingiva
palpate both mucose & gingiva
grip tongue to check lateral borders
What disease is associated with bronze/brown spots in oral cavity?
Addison’s disease
What are some abnormalities you will see on tongue?
Yeast (cottage cheese)
Beefy, red tongue (vitamin deficiency)
Bleeding tongue
What is cobblestoning?
patches of lymph tissues that are swollen on tonsils & back of throat
due to post nasal drip (mucus down back of throat)
irritates mucosa
What is cobblestoning often associated with?
acid reflux disease
Torus palatinus
NORMAL, harmless bony growth
if impacts speech of swallowing, may be removed
How do you examine the ear?
check external ear
check for drainage & redness
check for tenderness of tragus
What is the Whisper test for?
tests for hearing
softly whisper into each ear & ask pt to repeat what you said
Pneumatic Otoscopy
used to examine ear
puff of air into ear to detect if tympanic membrane moves or not
What are you looking @ during ear exam?
tympanic membrane & proximal external ear
What is important to document from ear exam?
cone of light
Describe otitis media presentation in ear exam
fluid behind tympanic membrane causes bulging TM
no cone of light
some degree of erythema
How do you examine the LNs?
with finger pads
circles w/ fingers to see if LN is swollen
look for texture, size & tenderness
What were the abnormal findings of PE for case #1?
mildly injected conjunctiva bilaterally (something is affecting eyes)
clear fluid behind R TM
cobblestoning of pharynx
clear rhinorrhea w/ inflamed turbinates bilaterally
What are possible differentials for case #1?
Viral pharyngitis (viral is more common)
Acute otitis media
Strep (need to always rule it out)
Signs of Strep Throat
pre-pallatine petechiae
hypertrophied tonsils w/ extradate
inflammed uvula
beefy red soft palate
Pharyngitis
inflammation of pharynx/throat
Common symptoms of viral pharyngitis
coryza (runny nose)
conjunctivitis
malaise/fatigue
low grade fever
Streptococcal Pharyngitis
group A strep
usually can clear on own but treated b/c can cause rheumatic fever & other issues
Common symptoms assoc w/ strep throat
sore throat headache fatigue fever body aches nausea
Why do pts feel nausea w/ strep throat?
b/c of homonculus
pharynx is near intra-abdominal organs!
When is Group A strep most likely?
children 5-15
winter/early spring
absence of cough
tender anterior cervical lymph nodes
tonsillar exudate
fever
What is the centor score?
tells if pt needs to be treated w/ antibiotics for strep depending on history
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
When do you do a rapid strep test?
for centor score of 2 & 3
if positive, treat w/ antibiotics
What labs should you consider post ENT PE?
rapid strep test
may consider mono (monospot test)
throat culture
What treatment should you consider?
antibiotics
NSAIDs for sore throat
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!)
Pathologies assoc w/ middle ear
acute otitis media
otitis media w/ effusion
Pathologies assoc w/ outer ear
otitis externa
Pathologies assoc w/ inner ear
labyrinithitis
Suppurative OM
acute OM w/ purulent material in middle ear
OM w/ effusion
inflammation or buildup in middle ear WITHOUT bacterial or viral infection
just a fluid issue (due to eustachian tube dysfunction)
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
Why would you want to treat OM w/ effusion?
if chronic, can cause hearing loss
Otitis externa
swollen ear canal from break in skin
treat w/ drops to treat actual infection
Otosclerosis
abnormal bone growth around stapes bones
assoc w/ hearing loss from 10yo-30yo
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
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
What is conductive hearing loss?
external canal of ear is blocked
Rhinosinusitis
inflammation of mucosal lining in paranasal sinuses & nasal cavity
What is common in bacterial sinusitis?
double sickening
think you are getting better but then get even worse (more pressure, fever)
Croup
barking seal cough
viral cause
swelling of larynx, trachea & bronchi
self-resolving
Epiglottitis
inflammation of epiglottis & adj structures
child will have high fever & toxic appearance
EMERGENTd
