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Head and Neck Review by Minnie > Clinical Medicine > Flashcards

Clinical Medicine Flashcards

1
Q

Describe the clinical presentation of peritonsillar abscess

What is the treatment?

A
  • 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

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2
Q

What is the correct order for an oral presentation?

A
  1. Opening statement
  2. HPI
  3. Additional medical history
  4. Physical exam findings
  5. Labs and other studies
  6. Assessment and plan
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3
Q

What substance is used for contrast in MRI?

A

Gadolinium

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4
Q

Which imaging modality uses the terms “hyper/hypoattenuating?”

A

CT

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5
Q

How would you describe this tympanic membrane?

A
  • 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
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6
Q

Describe the presentation of viral pharyngitis

A

Pharyngitis may accompanied by:

  • Rhinorrhea
  • Cough
  • Fever
  • Diffuse, mild erythema
  • Cobblestoning of posterior oropharynx
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7
Q

What test is the examiner performing?

What are they looking for?

A

Supraspinatus test

  • Test for supraspinatus tendonitis, tear, or weakness
  • Positive test = pain and/or weakness
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8
Q

What imaging modality is used for acute rhinosinusitis?

A

None - it is a clinical diagnosis

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9
Q

How would you describe this tympanic membrane?

What is the most likely diagnosis?

A
  • Opaque
  • Bulging
  • White

Most likely acute otitis media

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10
Q

If you see conjuctivitis with pharyngitis, what is the most likely cause?

A

Adenovirus

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11
Q

What special test can be used to see if a patient has a meniscus tear?

A

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

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12
Q

What special test can be used to see if a patinet has an LCL tear?

A

Varus stress test

(Push the knee into a varus position)

Varus = knees further apart

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13
Q

In what scenarios will you use imaging in acute rhinosinusitis?

A

If it is complicated

  • Spreadign to soft tissue of face, orbit, or intracranially
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14
Q

How do you distinguish between the mouth sores of HSV-1 and those of Coxsackie virus?

A
  • HSV-1: Anterior oral cavity
    • Primary infection -> Gingivostomatitis
      • Ulcers will be in the anterior oropharynx
    • Reactivation sores are usually on the lips
  • Coxsackie virus: posterior oral cavity/oropharynx
    • Herpangina
    • May also see vesicles on hands and feet
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15
Q

Which imaging modality uses the terms “hyper/hypointense” or “increased/decreased signal?”

A

MRI

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16
Q

What substance is used for contrast in CT?

A

Iodinated contrast

17
Q

Describe a history consistent with streptococcal pharyngitis

A
  • Fever
  • Sore throat
  • Vomiting and/or diarrhea
  • No cough or rhinorrhea
  • P/E
    • Anterior cervical lymphadenopathy
    • Scarlet fever (strawberry tongue, sandpaper rash)
18
Q

What test is the examiner performing?

What are they looking for?

A

Neer Impingement

  • Test for subacromial shoulder impingement
    • Ex: Rotator cuff tendonitis
  • Positive test = pain with maneuver
19
Q

What similarities do streptococcal pharyngitis and EBV have?

How can you distinguish between them?

A

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)
20
Q

What is your next step in managing this patient?

A

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

21
Q

How would you describe this tympanic membrane?

What is the most likely diagnosis?

A
  • 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

22
Q

What results from Rhinne and Weber tests would indicate conductive hearing loss?

A
  • Weber
    • Lateralizes to the impaired ear
  • Rhinne
    • BC > AC: abnormal = (-) Rhinne test
23
Q

How would you describe this tympanic membrane?

What is the most likely diagnosis?

A
  • 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

24
Q

How would you describe this tympanic membrane?

What is the most likely diagnosis?

A

We can’t see the TM!

Bullous myringitis is in the way

Caused by Strep. pneumoniae, H. influenzae, or M. catarrhalis

25
Q

Which nerve is in danger if tumor is spreading from the sinuses into the middle ear and mastoid air cells?

A

Facial nerve (CN VII)

26
Q

What test is the examiner performing?

What are they looking for?

A

Hawkings impingement sign

  • Test for rotator cuff/supraspinatus tendonitis
  • Positive test = pain with maneuver
27
Q

Which imaging modality is most commonly used to evaluate inflammatory sinus disease?

A

CT

  • Uncomplicated chronic sinusitis
  • May need MRI if complicated

Note: Sinusitis is a clinical diagnosis. Imaging is to confirm clinical findings

28
Q

What 4 characteristics of the tympanic membrane are you looking for during the otoscope exam?

A
  • Translucency
  • Color
  • Position
  • Mobility
29
Q

What results from Rhinne and Weber tests would indicate sensorineural hearing loss?

A
  • Weber
    • Lateralizes to the good ear
  • Rhinne
    • AC > BC (Normal; this is a (+) Rhinne test)
30
Q

What special tests can be used to see if a patinet has an ACL tear?

A

Lachman test

Anterior drawer sign

31
Q

How would you describe this tympanic membrane?

What is the most likely diagnosis?

A
  • 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

32
Q

What is this ear pathology?

What other clinical signs/symptoms would you expect?

A

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:

33
Q

What special test can be used to see if a patinet has an MCL tear?

A

Valgus stress test

(You are pushing the knee into a valgus position)

Valgus = “knock-kneed”

34
Q

What special test can be used to see if a patinet has a PCL tear?

A

Posterior drawer sign

Head and Neck Review by Minnie (8 decks)

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