Ear, Nose + Throat Osce Flashcards
What are some ENT red flags?
- Airway obstruction
- Breathing difficulty
- Circulatory compromise
- Facial fractures
- Croup
- Epistaxis
- Epiglottitis
- Inhaled foreign body
- Related sepsis
- Quinsy
- Anaphylaxis/angio-oedema
What is the name of the external ear?
external auditory meatus (EAM) and pinna
what is the name for the middle of the ear?
tympanic
what is the name for the inner ear?
labyrinthine
How would you examine the external ear?
- begin with the pinna (the mobile part of the external ear)
- look for any deformities or skin changes
- look for scars or pits in front of and behind the ear
- Pinna pull / tug to test for pain - sign of ear infection
- Tragus squeeze to test for pain
- mastoid process for swelling / point tenderness
Name 4 common ear complaints
- Occlusion – wax build up, foreign body, swelling
- Otitis externa – infection of the external ear canal
- Otitis media – infection of the internal ear canal
- Perforation
What are the signs and symptoms of Acute Otitis Externa?
- Pinna and ear canal are red and inflamed
- Severe pain
- Increasing pain on movement of the tragus and pinna
What are the signs and symptoms of Acute Otitis Media?
- Infection in middle ear, characterised by presence of middle ear effusion (glue ear) associated with acute onset of signs and symptoms including:
- Severe pain
- Diminished hearing acuity
- Inflamed, bulging tympanic membrane
- Treatment conservative, Grommets
In an external examination of the nose, what would you look for?
- inspect for deformity
- asymmetry
- inflammation
- skin lesions
- assess patency, block one side of the nostril and see if they can breathe through each side
- palpate sinuses
In an internal examination of the nose, what would you look for?
- note septum
- membranes
- turbinates
What are the differences between anterior epistaxis and posterior epistaxis?
Anterior:
- Bleed fairly slowly
- Self-limiting and resolve quickly
Posterior:
- More severe
- Often cause blood to drain into the throat, causing nausea and vomiting
With a fractured nose, what are important features to note?
- Significant rhinorrhoea runny nose (evaluate for a CSF leak in hospital) or haemorrhage
- Septal haematoma, haemorrhage or deviation
- Marked deviation or epistaxis that is failing to settle.
- Septal haematoma; this requires incision and drainage to prevent abscess and/or necrosis.
What is the treatment for a fractured nose without significant swelling or deformity?
- Patients without significant swelling or deformity may be discharged
- Give advice on using ice/simple analgesia. These will decrease the oedema and pain
- Discharge - review in five days by A&E, GP or by phone
- Patients with significant nasal deviation should be referred to ENT within 7-10 days of the injury
How would you examine the throat?
- Lips: colour, lesions, symmetry
-Oral cavity: breath odour, colour, lesions
-Teeth and gums: redness, swelling, bleeding
-Tongue: colour, texture, lesions, tenderness of floor of mouth
Throat and pharynx:
- colour
- exudate
- uvula
- tonsillar symmetry and enlargement
- possible foreign body
What are the signs and symptoms of tonsillitis?
Swelling and inflammation of the tonsils
- Usually caused by viral infection
- Can also be caused by bacteria
- Normally self resolves in 1 week
- On average, the number of people improving with antibiotics is similar to the number getting adverse effects, such as diarrhoea
What are the signs and symptoms of Pharyngitis?
Inflammation of the pharynx, often due to a rapid onset of sore throat
- Discomfort or pain on swallowing
- Pharyngeal erythema
- Purulent patchy yellow, gray, or white exudate
- Ulcers on the soft palate
What can you use to assess if a patient needs antibiotics for a sore throat?
- FeverPAIN Clinical Score
What is on the FeverPAIN clinical score?
- Fever in the last 24 hours
- Purulence, containing or forming pus
- Attend rapidly under 3 days (seeked help within 3 days)
- Inflamed tonsils
- No cough or coyza (cold)
What are the scores for using antibiotics?
- Score 0-1 = 13-18% streptococci, use NO antibiotic strategy
- Score 2-3 = 34-40% streptococci, use 3 day back-up antibiotic prescription strategy
- Score≥4 = 62-65% streptococci, use immediate antibiotic if severe, or 48 hour short back-up prescription
What are the red flags of a sore throat?
- cant manage fluids
- cant swallow saliva
- trismus
- dehydration
- increasingly unwell eg feeling faint
- confusion
- persistent symptoms
