Clinical Medicine Flashcards
Describe the clinical presentation of peritonsillar abscess
What is the treatment?
- Sore thorat, worse on one side
- Asymmetric lymphadenopathy
- Fever
- Muffled “hot potato” voice
- Trouble opening the mouth
Treat with abx, pain control, and incision + drainage
Imaging necessary only if you suspect a deeper tissue infection
What is the correct order for an oral presentation?
- Opening statement
- HPI
- Additional medical history
- Physical exam findings
- Labs and other studies
- Assessment and plan
What substance is used for contrast in MRI?
Gadolinium
Which imaging modality uses the terms “hyper/hypoattenuating?”
CT
How would you describe this tympanic membrane?
- Translucent
- Normal position
- Surrounding blood vessels are erythematous
- The TM is NOT erythematous
- This is seen with fever, crying, inflammation, but does not indicate acute otitis media
Describe the presentation of viral pharyngitis
Pharyngitis may accompanied by:
- Rhinorrhea
- Cough
- Fever
- Diffuse, mild erythema
- Cobblestoning of posterior oropharynx
What test is the examiner performing?
What are they looking for?
Supraspinatus test
- Test for supraspinatus tendonitis, tear, or weakness
- Positive test = pain and/or weakness
What imaging modality is used for acute rhinosinusitis?
None - it is a clinical diagnosis
How would you describe this tympanic membrane?
What is the most likely diagnosis?
- Opaque
- Bulging
- White
Most likely acute otitis media
If you see conjuctivitis with pharyngitis, what is the most likely cause?
Adenovirus
What special test can be used to see if a patient has a meniscus tear?
McMurray test
- Internally rotate with varus stress for lateral meniscus
- Externally rotate with valgus stress for medial meniscus
Click or pop with maneuver indicates meniscus tear
What special test can be used to see if a patinet has an LCL tear?
Varus stress test
(Push the knee into a varus position)
Varus = knees further apart
In what scenarios will you use imaging in acute rhinosinusitis?
If it is complicated
- Spreadign to soft tissue of face, orbit, or intracranially
How do you distinguish between the mouth sores of HSV-1 and those of Coxsackie virus?
-
HSV-1: Anterior oral cavity
- Primary infection -> Gingivostomatitis
- Ulcers will be in the anterior oropharynx
- Reactivation sores are usually on the lips
- Primary infection -> Gingivostomatitis
-
Coxsackie virus: posterior oral cavity/oropharynx
- Herpangina
- May also see vesicles on hands and feet
Which imaging modality uses the terms “hyper/hypointense” or “increased/decreased signal?”
MRI
What substance is used for contrast in CT?
Iodinated contrast
Describe a history consistent with streptococcal pharyngitis
- Fever
- Sore throat
- Vomiting and/or diarrhea
- No cough or rhinorrhea
- P/E
- Anterior cervical lymphadenopathy
- Scarlet fever (strawberry tongue, sandpaper rash)
What test is the examiner performing?
What are they looking for?
Neer Impingement
- Test for subacromial shoulder impingement
- Ex: Rotator cuff tendonitis
- Positive test = pain with maneuver
What similarities do streptococcal pharyngitis and EBV have?
How can you distinguish between them?
Both may have cervical lymphadenopathy, tonsilar hypertrophy +/- exudates, fever
- Streptococcal pharyngitis
- Positive rapid strep test
- Less fatigue
- Shorter duration of symptoms
- Usually occurs in younger children
- EBV
- Presence of reactive lymphocytes
- Positive monospot test
- Longer lasting symptoms
- More fatigue
- Usually presents in older patinets (Teenage/young adult)
What is your next step in managing this patient?
Let it heal on its own
Maybe give topical antibiotics to prevent infection, advise patient not to go swimming or submerge head underwater
This is a traumatic perforation of the TM, but it is small enough that it will heal without intervention, as long as it doesn’t get infected
How would you describe this tympanic membrane?
What is the most likely diagnosis?
- Translucent
- Amber-colored
- Normal position
- Would expect decreased or sluggish motility
Otitis media with effusion
The amber color is from serous or proteinaceous material in the middle ear; it isn’t infected now, but may become infected
May be due to eustachian tube dysfunction
What results from Rhinne and Weber tests would indicate conductive hearing loss?
- Weber
- Lateralizes to the impaired ear
- Rhinne
- BC > AC: abnormal = (-) Rhinne test
How would you describe this tympanic membrane?
What is the most likely diagnosis?
- Translucent
- Retracted
- Normal color
- White spot = sclerosis from traumatic perforation or recurrent ear infection
- Likely is not causing hearing problems at this point
TM retraction like this may indicate eustachian tube dysfunction; negative pressure in the middle ear is pulling the TM in. If this is really bad, it can cause the TM to burst
How would you describe this tympanic membrane?
What is the most likely diagnosis?
We can’t see the TM!
Bullous myringitis is in the way
Caused by Strep. pneumoniae, H. influenzae, or M. catarrhalis
Which nerve is in danger if tumor is spreading from the sinuses into the middle ear and mastoid air cells?
Facial nerve (CN VII)
What test is the examiner performing?
What are they looking for?
Hawkings impingement sign
- Test for rotator cuff/supraspinatus tendonitis
- Positive test = pain with maneuver
Which imaging modality is most commonly used to evaluate inflammatory sinus disease?
CT
- Uncomplicated chronic sinusitis
- May need MRI if complicated
Note: Sinusitis is a clinical diagnosis. Imaging is to confirm clinical findings
What 4 characteristics of the tympanic membrane are you looking for during the otoscope exam?
- Translucency
- Color
- Position
- Mobility
What results from Rhinne and Weber tests would indicate sensorineural hearing loss?
- Weber
- Lateralizes to the good ear
- Rhinne
- AC > BC (Normal; this is a (+) Rhinne test)
What special tests can be used to see if a patinet has an ACL tear?
Lachman test
Anterior drawer sign
How would you describe this tympanic membrane?
What is the most likely diagnosis?
- Translucent
- Normal position
- Fluid behind the TM
Typical appearance of resolving acute otitis media
DO NOT give abx at this point; should continue to resolve
What is this ear pathology?
What other clinical signs/symptoms would you expect?
Cholesteatoma
- Ear lesion composed of epithelial cells
- History of recurrent ear infections, foul-smelling discharge, hearing loss
- Must be excised!
May also look like this:
What special test can be used to see if a patinet has an MCL tear?
Valgus stress test
(You are pushing the knee into a valgus position)
Valgus = “knock-kneed”
What special test can be used to see if a patinet has a PCL tear?
Posterior drawer sign
