ENT Flashcards
Throat history (9)
Pain
Discharge
Odynophagia (painful swallowing)
Hoarseness
Cough
Haemoptysis
Lump
Reflux symptoms
Risk factors for head and neck cancer
Weber test: what is it? If pt hears sound in R ear?
Middle of forehead: identify affected side
Pt hears sound in R ear:
- conductive loss in R ear
- sensorineural loss in L ear
Suspecting EBV and associated splenogmegaly ?
Avoid contact sport etc. due to risk of splenic rupture
Otitis externa: what additional signs would you anticipate? (6)
1 impaired hearing
2 painful - pinna/tragus
3 itchy
4 external auditory meatus swelling, erythema with purulent discharge (complete obstruction possible)
5 TM not always visible
6 TM perforation - possible to have secondary otitis externa associated with otitis media
Unique about bony ear canal?
Skin and bone, no subcutaneous tissue
What is happening in the little’s area?
Anastamoses between internal and external carotids
Comprehensive assessment of ENT (6)
Complete history
Physical examination
Endoscopic assessment of upper aerodigestive tract
Imaging studies US/CT scan
Biopsy
Treatment
Nasal Hx (8)
Obstruction
Rhinorrhoea
Post nasal drop
Facial pain
Epistaxis
Disordered smell
Allergic symptoms
Trauma/surgery/medications/exposures
3 rules of thumb for neck examination
1 neck nodes are very common in children
2 small non enlarging mobile nodes common in young adults
3 any persistent or enlarging neck mass in adults warrants further investigation
Clinical criteria that suggest beta haemolytic streptococcus (4)
1 absence of cough
2 presence of fever
3 pharyngeal exudate
4 anterior cervical lymphadenopathy
Safe vs unsafe tympanic membrane perforation?
Safe: perforation surrounded by tympanic membrane
Unsafe: attic region, directly connected to ear canal
Nasal polyps: bilateral vs unilateral indicate?
Bilateral: usually sign of chronic sinus disease
Unilateral: may represent underlying tumour
AOM with effusion signs
1 Sign in children
2 Otoscopy
1 poor speech development
2 otoscopy: TM will appear dull +/- visible fluid level
US or CT scan?
US: thyroid
CT: non thyroid
If you think it is thyroid problem and do CT, thyroid takes up all contrast and affects future investigations
Complications of AOM (5)
1 hearing loss
2 TM perforation
3 mastoiditis
4 labyrinthitis
5 meningitis
Differentiate polyp vs turbinate
sensation
Polyp = no
Turbinate = yes!
Rinne test: what is it? positive vs negative result? why can’t you do a Rinne test in isolation?
Air vs bone conduction
Positive finding: normal
- air conduction is louder than bone conduction
Negative finding: abnormal
- bone conduction is louder than air conduction
- conductive loss
Bone conduction is able to conduct to the other side.
Modified Centor score
1 age +1 if 3-14, +0 if 15-44, -1 if >45
2 +1 cough absent
3 +1 temp. > 38
4 +1 exudate or swelling on tonsils
5 +1 tender/swollen anterior cervical lymph nodes
What Hz for tuning fork tests?
512 Hz
What is little’s area?
1cm in, septal area
Where nosebleed’s come from (commonly)
Where a collection of 3 blood vessels meet
Ear examination (6)
Look: scars, inflammed, discharge etc?
Pinna
External auditory canal
Tympanic membrane
Middle ear space
Tuning fork tests
Audiogram
Common bacteria for otitis externa?
Pseudimona aeruginosa
ENT history: FHx and MHx (3)
Hx ear disease/surgery
FHx hearing loss
Ability to valsalva - eustachian tube and middle ear function
Risk factors for head and neck cancer (5)
Smoking
Alcohol
FHx
Chewing tobacco and Betel nut
Viruses (EBV - nasopharyngeal and HPV - tonsilar)
Hx presenting complaint: stridor
DDX children (2) and adults (3)
Children - infection, foreign bodies
Adults - tumour, trauma, infection
Common bacteria for otitis media? (3)
Morazella catarrhalis
Haemophilus influenzae
Staphylcoccus
ENT history: HPC (7)
Otalgia (4 CNs that supply ear)
Referred pain?
Otorrhoea
Hearing loss
Tinnitus
Veritgo/imbalance
Previous trauma/noise
