Ears Nose and Mouth

Question 1

Physical Exam

Answer 1

Assess gross hearing
Rinne and Weber test
Inspect auricle
Palpate mastoid process
Press tragus
Inspect canal
Inspect tympanic membrane

Question 2

Gross Hearing

Answer 2

Whispered voice test
Conversational speech
Rubbed fingers
if abnormal, asses Weber and Rinne test

Question 3

Weber Test

Answer 3

place fork on midline of head
ask if sound is louder in one ear than other
should be equal

Question 4

lateralization

Answer 4

hearing on both sides equally

Question 5

Rinne Test

Answer 5

normal air > bone conduction

if blocked, bone > air

Question 6

Conductive loss

Answer 6

blocking vibrations
external or middle disorder impairs conduction
Weber: sound will lateralize to impaired ear
Rine: bone > air
Foreign body, impacted cerumen, otitis externa
Tympanosclerosis
Otosclerosis

Question 7

Tympanosclerosis

Answer 7

scar tissue on tympanic membrane

Question 8

Sensorineural loss

Answer 8

-impaired vestibulocochlear nerve CN VIII or neuronal impulse
-higher tones lost
-hearing worse in noisy environment
-voice gets louder
-weber sound lateralizes to good ear
Rinne AC >BC
causes: aging, exposure to loud, inner ear infection, trauma, acoustic neuroma

Question 9

acoustic neuroma

Answer 9

tumor growing inside ear, impedes CN VIII

Question 10

Inspect external ear

Answer 10

• changes in skin, common for skin cancer
• symmetry
• piercings, scars, keloids
• palpate tragus and mastoid
• inspect behind for eczema and fissures

Question 11

Otoscopic exam

Answer 11

evaluate external canal
assess tympanic membrane
asses for foreign body, cholesteatoma, fluid
Lift up and pull back

Question 12

cholesteatoma

Answer 12

An abnormal skin growth in the middle ear behind the eardrum is called cholesteatoma. Repeated infections and/or a tear or pulling inward of the eardrum can allow skin into the middle ear.

Question 13

Cone of light

Answer 13

indicates TM is soft, no pressure or fluid
R at 5:00
L at 7:00

Question 14

Otitis External

Answer 14

external canal inflammation
exuduate my block TM
usually from swimming, trauma, dermatologic condition
P aeruginosa and staph epidermidis
Treatment antibx drops

Question 15

Exostosis

Answer 15

nontender outgrowths of bone covered by normal skin deep in ear canals
nonmalignant, may obscure ear drum
seen in swimmers

Question 16

serous otitis

Answer 16

common with viral upper respiratory infections
common reason for otalgia
can occur from flying

Question 17

otalgia

Answer 17

ear pain

Question 18

acute otitis media

Answer 18

middle ear infection

• whitish discoloration
• marked erythema
• bulging TM

Question 19

Bullous Myringitis

Answer 19

painful vesicles appear on TM
common organism mycoplasm, viral, or bacterial otitis media
treat with macrolide

Question 20

Cholesteatoma

Answer 20

• accumulation of squamous epithelium (skin)
• usually result of chronic otitis media or congenital
• unchecked may cause hearing loss
• refer to ENT, surgical removal

Question 21

Perforated TM

Answer 21

holes in eardrum, usually result of purulent infections if middle ear
-central perforations, do not extend to margin of drum
marginal perforations involve margin, harder to heal
no drops, emergency/ENT

Question 22

Tympanosclerosis

Answer 22

healed perforation
large chalky white patch with irregular margins
deposition of hyaline material develops after several episodes of OM

Question 23

Tympanostomy tubes

Answer 23

• used for ventilation of middle ear
• young children usually age 2 after many otitis media infections
• water precautions
• fall out as child grows

Question 24

Nose physical exam

Answer 24

Inspect and palpate:
-external nose
-nasal vacity (nasal septum, turbinates, mucosa)
test patency of nostril
palpate sinus areas
frontal and maxillary sinus transillumination

Question 25

External nose

Answer 25

normal | deviated septum

Question 26

Nasal patency

Answer 26

tests ability to breath through nostril, one at time | CN I usually not tested unless complaint

Question 27

Nasal cavity

Answer 27

middle turbinate, inferior turbinate, vestibule, septum | turbinates healthy or red/swollen

Question 28

viral rhinitis

Answer 28

mucosa reddened and swollen

Question 29

allergic rhinitis

Answer 29

``` pale, bluish, or red response to environmental allergens assoc with sneezing, rhinorrhea, nasal obstruction, itchy eyes, nose and palate seasonal fall and spring cough r/t post nasal drip turbinates pale and boggy (swollen) ```

Question 30

allergic signs

Answer 30

``` Allergic salute (nose tilts up due to swelling) allergic shiners (black eyes) ```

Question 31

Nasal polyps

Answer 31

-polyps are pale, semitransluscent masses that usually come from middle meatus -often associated with chronic allergic rhinitis (come back if removed)

Question 32

Septal perforation

Answer 32

caused by trauma, surgery, and intranasal use of cocaine or ampthetamines (drugs that dec blood flow)

Question 33

Transillumination

Answer 33

``` normal = glows red, air abnormal = no glowing, full of fluid (sinusitis) ```

Question 34

Mouth and throat physical exam

Answer 34

Inspect: lips, dentition, gums, buccal mucosa, tongue, palate, pharynx (uvula, pillars, tonsils, laryngeal wall), tongue, sublingual, eval Stenson and Wharton's ducts, CN XII, CN IX, CN X

Question 35

Angular Cheilitis

Answer 35

fissures in angles, nutritional defect or poor dentition

Question 36

Herpes Simplex

Answer 36

vesicular lesions, contagious sores, fluid filled and painful

Question 37

Angioedema

Answer 37

usually resolved but may be life threatening | *can be caused by ace inhibitors

Question 38

Carcinoma of the lip

Answer 38

usually lower lip, associated with tobacco use

Question 39

Gums

Answer 39

caries and periodontitis

Question 40

Geographic tongue

Answer 40

map like texture of tongue, normal

Question 41

candidiasis

Answer 41

yeast infection white lesions on tongue or inner cheek can be caused be inhaled steroids (teach to rinse mouth) "oral thrush"

Question 42

smooth tongue

Answer 42

atrophic glossitis - tender, painful, depapillation atrophy of tongue B12/niacin deficiency

Question 43

CN IX, X, XII

Answer 43

CN IX: glossopharyngeal CN X: Vagus CN XII: hypoglossal

Question 44

Cryptic tonsils

Answer 44

develop small pockets or pits called crypts. These crypts can trap food and form small growths called tonsilliths or tonsil stones

Question 45

Grading Tonsils

Answer 45

1+ = visible 2+ = halfway between pillars nad uvula 3+ = touching uvula 4+ touching each other Normal 1+ and 2+ not visible: retracted or removed

Question 46

Pharyngitis

Answer 46

inflammation causing sore throat | common caused by strep, 85% viral, also mononucleosis

Question 47

Karposi Sarcoma

Answer 47

hard/soft palate deep purple lesions, raised or flat oral cancer assoc. with AIDS

Question 48

Herpangina (coxsackie)

Answer 48

viral with ulcers and lesions inside mouth sore throat and fever supportive therapy, rest pain relief