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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
Q

Streptococcal Pharyngitis

A

group A strep

usually can clear on own but treated b/c can cause rheumatic fever & other issues

26
Q

Common symptoms assoc w/ strep throat

A 
sore throat
headache
fatigue
fever 
body aches
nausea
27
Q

Why do pts feel nausea w/ strep throat?

A

b/c of homonculus

pharynx is near intra-abdominal organs!

28
Q

When is Group A strep most likely?

A

children 5-15

winter/early spring

absence of cough

tender anterior cervical lymph nodes

tonsillar exudate

fever

29
Q

What is the centor score?

A

tells if pt needs to be treated w/ antibiotics for strep depending on history

30
Q

What criteria of centor score give you points?

A

absence of cough

swollen nodes

temperature of >100.4

age 3 to 14 years

**if score>4 then treat w/ antibiotics

31
Q

When do you do a rapid strep test?

A

for centor score of 2 & 3

if positive, treat w/ antibiotics

32
Q

What labs should you consider post ENT PE?

A

rapid strep test

may consider mono (monospot test)

throat culture

33
Q

What treatment should you consider?

A

antibiotics

NSAIDs for sore throat

34
Q

Why do you often have a sore ear assoc w/ sore throat?

A

b/c of eustachian tube in ear that empties into back of throat (all connected!)

35
Q

Pathologies assoc w/ middle ear

A

acute otitis media

otitis media w/ effusion

36
Q

Pathologies assoc w/ outer ear

A

otitis externa

37
Q

Pathologies assoc w/ inner ear

A

labyrinithitis

38
Q

Suppurative OM

A

acute OM w/ purulent material in middle ear

39
Q

OM w/ effusion

A

inflammation or buildup in middle ear WITHOUT bacterial or viral infection

just a fluid issue (due to eustachian tube dysfunction)

40
Q

What is different in exam btwn acute otitis media & otitis media w/ effusion?

A

acute has bulging TM & is red

OM w/ effusion still has cone of light but has air bubbles & fluid level

41
Q

Why would you want to treat OM w/ effusion?

A

if chronic, can cause hearing loss

42
Q

Otitis externa

A

swollen ear canal from break in skin

treat w/ drops to treat actual infection

43
Q

Otosclerosis

A

abnormal bone growth around stapes bones

assoc w/ hearing loss from 10yo-30yo

44
Q

Implications of Weber test findings

A

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
Q

Implications of Rinne test

A

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
Q

What is conductive hearing loss?

A

external canal of ear is blocked

47
Q

Rhinosinusitis

A

inflammation of mucosal lining in paranasal sinuses & nasal cavity

48
Q

What is common in bacterial sinusitis?

A

double sickening

think you are getting better but then get even worse (more pressure, fever)

49
Q

Croup

A

barking seal cough

viral cause

swelling of larynx, trachea & bronchi

self-resolving

50
Q

Epiglottitis

A

inflammation of epiglottis & adj structures

child will have high fever & toxic appearance

EMERGENTd

PCM II Midterm (15 decks)

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