Case Studies Flashcards
Q: 4 year old boy presents with pain and irritation of left ear - otoscopic examination reveals an insect in left auditory canal - tympanic membrane is not completely visualized
A: Insertion of 2% lidocaine with section or forceps removal
Q: Which of the following is the most common cause of conduction hearing loss in an adult patient?
A: Cerumen impaction
Q: Patient presents with complaint of sudden onset of recurrent episodia vertigo for one week when rolling onto left side - patient states this sensation lasts approx 30 seconds and then goes way - admits to associated nausea - denies associated hearing difficulties or tinnitus - what does he have?
A: Benign positional vertigo
Q: 32 year old family with spiking fevers - seen 4 weeks ago with complaint of left ear pain and was treated for otitis media - continues to have symptoms but now has pain behind the ear - on examination you note left post auricular tenderness and erythema - treatment?
A: Disorder = mastoiditis therefore, treatment is mastoidectomy
Q: Patient presents complaining of right ear pain and itching - on physical examination, you note erythema and edema of right ear canal with purulent exudate - palpation of tragus and manipulation of auricle is painful - tympanic membrane is not well visualized - treatment?
A: Diagnosis - otitis externa Treatment - topical antibiotics (Polymyxin B sulfate)
67 year old male presents with worsening hearing loss in right ear over the past week.
• Conductive vs Sensorineural loss - Nerve vs mechanical damage • PE - Weber (would lateralize to affected ear), big ball of dried cerumen clogged, Rinne • Presbycusis • Age related hearing loss ( higher pitches first) • What kind of exposure can cause the problem? Loud music. • Conductive hearing loss • Use big syringe to dislodge the wax
26 year old male presents to the ED complaining of dental pain to right lower jaw
DDx - infection, trauma, swollen glands, occluded duct, lymphadenitis, TMJ Hx - started 4 days ago, getting worse, history of dental decay ROS - do you go to the dentist? No. Brushing/flossing? Sometimes. Bad taste in mouth? Yes. Smoker? Yes. Fever? No. Tooth loss? Several. PE - oral exam
A concerned mother brings in her 5 year old son who jumped off their deck and landed on his face - has been crying a lot and bleeding out of his mouth - hx? PE? Hx - get as much as you can when dealing with trauma to a child PE - exam the mouth, ears, eyes (full physical)
a. Etiology: physical trauma or accident b. Pathophysiology: blunt force c. Risk factors: lifestyle or accident d. Presentation: copious blood, missing teeth, distraught parents, can’t tolerate hot or cold foods, change in bite i. DDX: maxillary fracture: “tongue depressor test” e. Lab workup: x-rays to check for impacted tooth (best evaluated after patient is cleaned with saline) & also to check to see if they have swallowed tooth! i. rule out mandibular fracture (have them bite down on tongue depressor and then twist…can they break it -if so, no fracture) f. Contraindications: if tooth is physically out, never touch the root (you want to preserve periodontal ligament), always hold it by the crown. i. Either store it in milk or spit or in the side of the mouth (like chew) so it does not die. Must be placed back in the mouth and splinted within 1 hour for best results g. Considerations: refer!! h. Complications: losing a tooth or permanent damage to bone or infection that can turn into systemic problem
Q: a 26 yo female comes to the ED complaining of mouth pain. states it started yesterday and she thinks she has another dental infection. It bothers her the most when she eats but does not have any specific tooth pain. she denies any fever or chills. You recommend?
A: lemon drops & hot packs (we know its not b acterial)
60 year old presents to your clinic complaining of a canker sore on his tongue that will not go away - been there for about 2 months and it’s really starting to bother him.
DDx - throat cancer Risk factors - tobacco and alcohol users, HPV (50 fold increase risk)
12 year old female presents to your clinic complaining of sore throat for 4 days. VS - BP: 118/76, HR: 88, RR: 16, T: 374 DDX?
DDX - Strep? Pharyngitis
Q: 18 year old female presents to the office with fever, fatigue and sore throat. PE reveals an erythematous pharynx, cervical lymphadenopathy and splenomegaly. CBC reveals increased WBC with atypical lymphocytes, normal HgB and Hct and normal platelets. What additional lab tests?
A: Heterophile test
Q: 60 year old patient with a hx of tobacco and alcohol abuse presents for routine physical. Which of the following PE findings is suspicious of oral carcinoma?
A: White lesion that cannot be removed by rubbing
Q: 14 year old male presents with complaint of worsening sore throat for 2 weeks - complains of fever, difficulty swallowing and difficulty opening his mouth - pts mother states his voice seems muffled - on exam, his left tonsil is bulging and uvula is displaced to the right - appropriate management?
A: peritonsillar abscess Treatment: needle aspiration
