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Health Assessment | Exam 2 > ENT > Flashcards

ENT Flashcards

1
Q

Meds that affect hearing…

A
  • Aminoglycosides
    • Aminoglycosides can cause hearing loss, specifically gentamicin
  • Aspirin
  • NSAIDs
  • Quinine
  • Furosemide
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2
Q

Concerning/Common S&S EARS

A
  • Hearing loss: may be congenital, from single-gene mutations
    • Distinguish between conductive and sensorineural loss
  • Otalgia (earache)
  • Otorrhea (discharge)
    • Cerumen (wax) normally found in ear
      • Tend to be yellowish-dark brown color
      • Consistency: sticky
      • Falls out of ear on its own or removed w/ washing
      • Can build up ⇒ blocks ear canal (wax blockage)
      • One of most common causes of hearing loss
      • East Asians or Native Americans → usually drier and whitish gray
  • Tinnitus: common Sx that increases in frequency w/ age
    • When associated w/ hearing loss and vertigo ⇒ suggests Meniere Disease
  • Vertigo: perception that pt or environment is rotating or spinning
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3
Q

Concerning/Common S&S NOSE

A
  • Rhinorrhea (runny nose):
    • Sneezing, watery eyes, throat discomfort, itchy eyes/nose/throat
    • Can be worsened w/ excessive use of decongestants ⇒ causes vasomotor rhinitis
    • Environmental triggers or seasonal association ⇒ suggests allergic rhinitis
  • Congestion: If pt’s nasal congestion limited to one side ⇒ consider deviated nasal septum, foreign body, or tumor
  • Epistaxis (bloody nose):
    • Assess if pt on anticoagulation therapy or aspirin bc ⇒ they interfere w/ clotting
    • Nasal sprays, if overused ⇒ can contribute to rebound effect ⇒ causing inflammation and congestion
  • Change in smell: Loss of smell and taste ⇒ associated w/ COVID-19 infection
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4
Q

Concerning/Common S&S THROAT

A
  • Hoarseness: Acute hoarseness might be caused by voice overuse or acute viral laryngitis
  • Sore tongue: Note findings under tongue– aphthous ulcers or atrophic glossitis
  • Bleeding gums: Most often caused by gingivitis: inflammation of gingiva
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5
Q

Weber Test

A
  • tests lateralization
  • Norm: sound is heard equal bilaterally
  • In conductive hearing loss ⇒ sound lateralizes to impaired ear
  • In unilateral sensorineural hearing loss ⇒ sound heard in good ear
  • Restricted to pts w/ unilateral hearing loss bc pts w/ normal hearing may lateralize (hear sound on 1 side) and pts w/ bilateral conductive or sensorineural deficits won’t lateralize
  • Steps: place base of lightly vibrating tuning fork on top of pt’s head or mid-forehead → ask where pt hears sound → normally sound heard midline or equally in both ears
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6
Q

Rinne Test

A
  • compares air and bone conduction
  • Norm: air conduction lasts longer than bone conduction (AC > BC)
  • In conductive hearing loss ⇒ sound heard thru bone as long as or longer than it is through air (BC = AC or BC > AC)
  • In sensorineural hearing loss ⇒ sound heard longer thru air than bone (AC > BC)
  • Hearing is decreased in both hearing losses
  • Steps: place base of lightly vibrating tuning fork on mastoid bone, behind ear and lvl w/ canal → when pt can’t hear sound anymore place fork close to ear canal → ask pt if vibration is heard
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7
Q

Tonsil Grading

A
    • 1: tonsils visible
    • 2: tonsils between tonsillar pillars and uvula
    • 3: tonsils touching uvula
    • 4: tonsils touching each other
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8
Q

Gag Reflex CN IX and X Test

A
  • Tests: gag reflex of CN IX (glossopharyngeal) and X (vagus)
  • Steps: palpate palatal arches w/ tongue depressor one at time and wait for normal gag reflex
    Abnormal results:
  • If no gag reflex ⇒ indicates one side of IX glossopharyngeal nerve is damaged
  • Soft palate doesn’t rise and uvula deviates to opposite side away from lesion ⇒ indicates damaged X vagus nerve
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9
Q

4 MAIN TYPES OF DESCRIBED DIZZINESS

A
  • Vertigo
    • Strong sense of motion or spinning
    • Can be peripheral or central
  • Disequilibrium
    • Common: pts have it temporarily or infrequently
    • Feeling off-balance
    • Unsteady / Wobbly
  • Lightheadedness
    • Woozy
    • Disconnected from environment
  • Presyncope
    • Feeling of losing consciousness
    • About to faint
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10
Q

Peripheral Vertigo General Info

A
  • Onset: Sudden
  • Intermittent w/ severe Sxs
  • Affected by head position and movement
  • NV more frequent
  • Motor function, coordination, gait intact
  • Causes: less severe
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11
Q

Central Vertigo General Info

A
  • Onset: Gradual
  • Constant w/ milder Sxs
  • Unaffected by head position and movement
  • NV less frequent
  • Motor function, loss of coordination, gait instability frequent
  • Causes: more severe
  • Duration: variable but rarely continuous
  • Hearing: unaffected
  • Tinnitus: absent
  • Additional features: usually w/ other brainstem deficits– dysarthria, ataxia, crossed motor and sensory deficits
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12
Q

Peripheral Vertigo: Meniere Disease

A
  • Onset: sudden
  • Duration: several hrs – ≥1 day
  • Hearing: sensorineural hearing loss– recurs, eventually progresses
  • Tinnitus: present, fluctuating
  • Additional features: pressure or fullness in affected ear, NV, nystagmus
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13
Q

Otitis Media (what, cause, common in, identified during which tests)

A
  • What: inflammation of middle ear (Classified as primary otalgia (ear pain))
  • Cause: bacterial infection
  • More common in children than adults
  • Tested/Identified during:
    • Conductive vs. neurosensory hearing loss w/ Tuning Fork Test
      • This is unilateral conductive hearing loss → sound heard in/lateralized to impaired ear
    • Palpation of Tragus and Pinna
      • Pt feels pain during palpation
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14
Q

Otitis Media S&S

A
  • Serous effusion, thickened drum, purulent otitis media ⇒ can decrease mobility
    • With any perforation ⇒ there’ll be no mobility
  • Tenderness behind hear
  • Might see distorted light reflex
  • Can’t see landmarks of ossicles bc tympanic membrane or eardrum is bulging
    • Bulges laterally toward examiner’s eye
    • Red bulging drum ⇒ indicates purulent otitis media
  • May have drainage behind eardrum
  • Dilated blood vessels can be seen in all segments of drum
  • Diffuse redness of entire eardrum may follow w/ discharge of purulent material to ear canal
  • Earache
  • Fever
  • Hearing loss
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15
Q

Otitis Externa / “Swimmer’s Ear”

A
  • What: inflammation of ear canal/outer ear (Classified as primary otalgia (ear pain))
  • Cause: frequent submersion of ear in water
  • Tested/Identified during: External Meatus Patency when pulling ear up to look at canal → painful for pt
  • S&S:
    • Ear canal is swollen, tender, narrowed, moist, pale, and/or reddened
    • If chronic, skin canal thickened, red, itchy
    • Pt feels pain if you put otoscope in or if you pull ear up
    • Hearing loss
    • Drainage
    • Swelling
    • Edema
    • Erythema
    • Pain
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16
Q

Allergic Rhinitis

A
  • What: runny nose due to allergies / inflammation of nose when IS reacts to environmental allergens that body doesn’t recognize (atopic disease)
  • S&S:
    • Mucosa pale, bluish, red
    • Nasal discharge and congestion, post nasal drip (may cause sore throat)
    • Sneezing
    • Watery, itchy eyes
    • Fatigue
    • Pale and boggy turbinates (curving bony structures, covered by highly vascular mucous membrane protrude into nasal cavity)
    • Allergic shiners (little black eye on inferior aspect of eye or below lid)
17
Q

Sore throat: Viral

A
  • Onset: gradual
  • Cough
  • Mild, if at all: fever, chills, and/or headaches
18
Q

Sore throat: Strep

A
  • Cause: A B hemolytic strep
  • Can lead to future problems w/ heart/kidney infections
  • Common in: school-aged kids or adults
  • Onset: abrupt
  • Dysphagia
  • Red, swollen tonsils and throat
  • Pus in back of throat
  • White spots on tongue
  • Swollen lymph nodes in neck
  • Fever chills, and/or headaches
19
Q

Candidas Albicans / “Oral Thrush”

A
  • What: overgrowth of yeast fungi on tongue
  • S&S:
    • Painful, esp if you scrape it w/ tongue depressor
    • White patches or raised white spots on tongue
  • Cause: fungal infection
  • Common in: infants but still need to be treated bc it can impact baby’s ability to eat
    • In breastfeeding infants → treat mom bc they can keep passing thrush between baby and breast (normal but still need treatment)
    • Uncommon in older children and adults ⇒ suspect immunocompromised states, HIV, immunosuppressive meds, etc.
20
Q

red flag for throat

A

Thrush in older children and adults bc they shouldn’t have it ⇒ means they’re immunocompromised, have HIV, take immunosuppressive meds

21
Q

age-related considerations EARS

A
  • Infants
    • Hearing assessments before newborns go home because it’s important for development ⇒ any congenital hearing deficits needs to be addressed and/or any hearing conditions to be corrected
    • Look for auricle/ear lobe for formation, flexibility
    • Look at auditory canal and tympanic membrane
  • Children: During otoscopic exam: pull earlobes down instead of up if they’re < 3 yo
  • Older Adults
    • Hearing changes w/ age
    • Increase in cerumen impact: cerumen increases ⇒ earwax dries ⇒ impacts hearing and makes it difficult to see tympanic membrane to assess for issues
    • Hearing loss in later yrs isn’t just from noise exposure, also from presbycusis: age-associated hearing loss
  • Pregnant Women: Bulging or Retraction of tympanic membrane due to fluid imbalance
22
Q

age-related considerations NOSE

A
  • Infants: Inspect nares if they can breathe through nose
  • Children: Frontal sinuses don’t develop until age 7+ ⇒ kids shouldn’t be having sinus infections then
  • Older Adults: Drying mucosa
  • Pregnant Women: Sinus congestion
23
Q

age-related considerations THROAT

A
  • Infants: Should be assessed for cleft palate by running finger on roof of mouth
  • Older Adults: Drying mucosa
    • Saliva cleanses and lubricates mouth but many meds reduce salivary flow ⇒ increases risk for tooth decay, mucositis, gum disease from xerostomia (dryness of mouth)
  • Pregnant Women: Hypertrophy of gums (swelling)
24
Q

Conductive Loss (what, causes, usual age of onset)

A
  • External or middle ear disorder ⇒ impairs sound conduction to inner ear
  • Causes:
    • Foreign body
    • Otitis media
    • Perforated eardrum
    • Otosclerosis of ossicles
  • Usual age of onset: childhood + young adults up to age 40
25
Q

conductive hearing loss (ear canal and drum effects)

A
  • Abnormality usually visible
  • Hearing seems to improve in noisy environment
  • Voice becomes soft bc inner ear and cochlear nerve intact
26
Q

conductive hearing loss in weber test

A
  • Sound lateralizes to impaired ear ⇒ room noise not well heard ⇒ detection of vibrations improves
27
Q

conductive hearing loss in rinne test

A
  • Bone conduction longer than or equal to air conduction (BC ≥ AC)
28
Q

sensorineural loss (what, causes, usual age of onset)

A
  • Inner ear disorder involves cochlear nerve and neuronal impulse transmission to brain
  • Causes:
    • Loud noise exposure
    • Inner ear infections
    • Trauma
    • Tremors
    • Congenital and familial disorders
    • Aging
  • usual age of onset: Middle or Later yrs
29
Q

sensorineural loss ear canal and drum effects

A
  • Problem not visible
  • Higher registers lost ⇒ sound distorted
  • Hearing worsens in noisy environment
  • Loud voice bc hearing difficult
30
Q

sensorineural loss in weber test

A
  • Sound lateralizes to good ear bc inner ear or cochlear nerve damage impairs transmission to affected ear
31
Q

sensorineural loss in rinne test

A
  • Air conduction longer than bone conduction (AC > BC)
  • Inner ear or cochlear nerve less able to transmit impulses regardless of how vibrations reach cochlea ⇒ normal pattern prevails

Health Assessment | Exam 2 (3 decks)

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