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(PA school) CAM I > ENT 3 examples > Flashcards

ENT 3 examples Flashcards

1
Q

A 39 year old pt comes in for facial pain, congestion, and a reduction in her sense of smell for the past 4 months. Upon examination with nasal endoscopy, you note mucopurulent drainage in the ethmoid region.

What is your Dx?

A

Chronic rhinosinusitis

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2
Q

A pt you suspect has CRS (chronic rhinosinusitis) reports a severe headache and double vision. What’s your next step?

A

Immediate evaluation/ consult w specialist

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3
Q

A pt is diagnosed with CRS. They have large polyps. What may be a good short-term Tx?

A

Oral corticosteroids
(Can be used for severe/refractory mucosal edema, reducing polyp size, minimizing inflammation of AFRS fior 10-15 days)

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4
Q

A pt with DM is experiencing fever, facial pain, congestion, and diplopia.
Besides acute bacterial rhinosinusitis (ABRS), what should you be concerned abt? Why?

A

Invasive fungal rhinosinusitis

Although it’s rare, the pt has DM, so they’re at risk.

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5
Q

You diagnose a pt with invasive fungal rhinosinusitis by looking at their CT. Is this enough?

A

No; confirm with tissue biopsy

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6
Q

A pt has a nasal Fx caused by a car accident. Besides a full HEENT eval and X-rays if indicated, what do you need to do?

A

Assess for facial, spine, pulmonary, & intracranial injuries

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7
Q

A pt has a nasal Fx with a septal hematoma. What do you do?

A

Urgent ENT referral

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8
Q

You spot a neoplasm in the sinuses or nasopharynx of your pt. Based on just statistics, what’s it most likely to be?

A

Squamous cell carcinoma (SCC)

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9
Q

A pt has a neoplasm in their nasopharynx. What are two Sx that would make you even more concerned for malignancy than usual?

A

Pain & recurrent hemorrhage

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10
Q

Why might you want to remove a pt’s inverted papilloma even though you know it’s benign?

A

Has malignant potential; SCC seen in ~10% cases

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11
Q

Jill, age 25, is a PA student. She is experiencing painful, acute gingival inflammation & upon examination, you note necrosis.

What should you suspect?

A

Necrotizing ulcerative gingivitis
(“Vincent’s Angina/Trench Mouth”)

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12
Q

You pt has been experiencing a recurring, painful, ulcer of the oral mucosa for the past week. Upon examination you note it’s covered by a white-to-yellow pseudomembrane & surrounded by an erythematous halo.

1) What should be your suspicion?
2) If the pt’s presentation of this condition was more unclear, what would be your next move?

A

1) Apthous stomatitis/ Canker Sore
2) Incisional biopsy

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13
Q

Your pt with a previous Dx of anemia comes in because they have some “spots” on their mouth. You examine them and find white plaques on buccal mucosa, palate, tongue, & oropharynx that can be scraped off.

What did you scrape off? What does your pt have?

A

Pseudomembranous; oral Candidiasis (aka thrush)

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14
Q

You examine your elderly pt and find erythema beneath their upper dentures without plaques.

What could this be? What is this a Sx of?

A

Atrophic (aka denture stomatitis); oral Candidiasis (aka thrush)

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15
Q

You diagnose a pt with thrush. When might you prescribe a longer course of treatment with antifungals?

A

If they have HIV/ AIDS

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16
Q

Your pt with a Hx of odontogenic infections comes in with with neck pain and edema and a fever.

What do you need to rule out? Why?

A

Deep neck abscess; if they have one, it may spread to mediastinum or cause sepsis

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17
Q

Your pt’s tongue is displaced upward and backward, so you think they could have the most common neck space infection, which is what?

A

Ludwig’s angina

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18
Q

Charlie, age 6, is presenting with a severe sore throat that’s rapidly worsening. While you’re talking to his parent, you notice he’s leaning over the chair with his shoulders forward and his head tipped upward.

You immediately suspect what? What should you not do and why?

A

Epiglottitis; don’t perform indirect laryngoscopy due to his age

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19
Q

Your pt has a cold sore. You know they’re experiencing what?

A

Reactivation of HSV-1

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20
Q

Your pt has cold sores every once in a while, and can never tell when they’re about to happen. How do you treat them?

A

No treatment

21
Q

Your pt gets cold sores every once in a while, and can always tell when they’re about to come. How do you treat them?

A

Episodic therapy

22
Q

A pt experiences cold sores frequently and never knows when a new one is about to pop up. How do you treat them?

A

Chronic suppressive therapy

23
Q

True or false: erythema multiforme alongside cold sores is always an indication that your pt needs chronic suppressive therapy

A

True

24
Q

Your pt is super hoarse after their bacterial URI last week. What’s your Tx?

A

Supportive (voice rest, PO hydration, humidified air), antibiotics usually not necessary

25
Q

Your pt with GERD has a scratchy feeling, sore throat, difficulty swallowing. What may they have?

A

Pharyngitis

26
Q

Sam, 25, is an ill-appearing female. While you’re taking her HPI, you note she has a muffled voice. The only noteworthy part of her Hx is that she’s a smoker. Upon examination, you note deviation of the uvula and tender cervical lymphadenopathy. The anterior tonsillar pillar also appears to be erythematic.

You suspect what?

A

Peritonsillar abscess

27
Q

Your pt has a 3cm peritonsillar abscess. Do you drain it or not? Why?

A

Yes, >1cm

28
Q

How might your pts peritonsillar abscess become life-threatening?

A

Can obstruct airway

29
Q

Pt presents in December with scratchy feeling, sore throat, difficulty swallowing.

What do you suspect and what do you need to test for?

A

Pharyngitis; consider SARS-CoV-2 testing

30
Q

Your pt has white exudates on their posterior pharynx and uvula. They’re experiencing hoarseness and a low-grade fever.

What do you suspect? Is this common?

A

Viral pharyngitis; most common cause of pharyngitis

31
Q

Your 20 year old pt is extremely exhausted. During your examination, you notice palatal petechiae and shaggy, white-purple exudates with pharyngeal injection.

You suspect?

A

Mononucleosis

32
Q

Your pt, age 30, has pharyngitis. He is super tired all the time. You examine him and note posterior cervical & auricular lymphadenopathy and hepatosplenomegaly.

You suspect what?

A

Mononucleosis

33
Q

What does your patient with mono need to avoid doing? Why?

A

Contact sports for a minimum of 3-4 weeks; so they don’t rupture their enlarged spleen

34
Q

Your 10 year old pt has acute-onset sore throat and fever. During the exam you note pharyngeal edema, patchy tonsillar exudates, & prominent, tender, anterior cervical lymphadenopathy.

They probably have what?

A

GABHS pharyngitis (group A beta hemolytic pharyngitis)

35
Q

Your 15 year old pt has a scarlatiniform rash, & strawberry tongue as well as a terrible sore throat. You think they have what?

A

GABHS pharyngitis (group A beta hemolytic pharyngitis)

36
Q

Your 25 year old pt has a fever, sudden sore throat, no cough, & patchy tonsillar exudates.

1) You suspect what?
2) Do they meet the testing threshold for this condition? Explain.

A

1) GABHS pharyngitis (group A beta hemolytic pharyngitis)
2) They’re above the threshold, so skip testing (unless it’s a rapid test) and go straight to empiric antibiotics (i.e. penicillin). [they meet 4 of the Centor criteria]

37
Q

Your pt has tender anterior cervical lymphadenopathy, fever, and no cough.

Do you test for strep? Why/ why not?

A

Yes, they meet 3 of the Centor criteria, so they need rapid testing.
Treat if positive, if negative then treat with supportive measures, but send for throat culture.

38
Q

Your pt with GABHS pharyngitis has joint swelling/pain, subcutaneous nodules, erythema marginatum, myocarditis, and chorea.

1) You think they have what rare complication?
2) How might you confirm it?

A

Acute rheumatic fever (ARF); ESR/CRP (would be elevated)

39
Q

Your pt with GABHS pharyngitis has a strawberry tongue. What complication is this a sign of?

A

Scarlet fever

40
Q

Your pt with a sore throat and low-grade fever has an adherent grayish membrane on the back of their throat.

You should be thinking of what condition?

A

Diphtheria

41
Q

Your pt with dehydration is experiencing increased pain and swelling with meals. What could they have?

A

Sialadenitis

42
Q

Your pt with Sjogren’s syndrome is complaining of increased pain with meals in the jaw. You examine them and pus was massaged from the salivary duct.

1) What could they have?
2) What’s one thing that could help treat this?

A

1) Sialadenitis
2) Sialagogues – lemon drops

43
Q

Florence, age 80, just got her hip replaced the other day. She is suddenly experiencing pain and tenderness of the jaw with a fever and chills.

What is the most likely Dx?

A

Suppurative parotitis

44
Q

Jake, age 15, has Sx of suppurative parotitis. What else should you consider?

A

Mumps

45
Q

Your pt has a white, corrugated & painless plaque on their lateral tongue. Is this likely premalignant?

A

No (oral hairy leukoplakia)

46
Q

Raised, firm, white lesions with ulcers at base on the lateral surface of the tongue are suspicious for what?

A

Squamous cell carcinoma (SCC)

47
Q

Wheezing, coughing, or stridor could be Sx of what emergency?

A

Upper airway FB

48
Q

Your pt is drooling and has an inability to handle secretions. What could be the problem?

A

Complete esophageal obstruction by a FB

49
Q
A

(PA school) CAM I (29 decks)

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