ENT Flashcards
Common or concerning symptoms of head
Headache
History of head injuries
Common or concerning symptoms of eyes
Pain Redness Excessive tearing Flashing lights Visual loss Double vision
Nose and sinuses common or concerning symptoms
Nose: sneezing, runny nose, congestion, nose bleed (epistaxis)
Sinuses: pain or tenderness
Oropharynx common or concerning symptoms
Gums bleeding, sore throat, trouble swelling, hoarseness
Neck common or concerning symptoms
Swollen salivary glands
Goiter
Inspection of head: hair
Quality, texture, distribution pattern
Scalp inspection
Bumps, textures, redness, any spots if discoloration
Bogginess or edem
Skull inspection
Size and contours
Face inspection
Asymmetry: structural or in facial expression
Skin: temp, texture, edema, masses
Hyperthyroidism and hair
Extra hair growth
Tension type headache distribution
Diffuse-type, musculature
Band across the forehead
Migraine distribution
Focal, vascular
One sided
Closure type headache distribution
Multifocal, vascular
In one focal spot, like the orbit
Brian tumor temporal pattern
Show chronic/insidious onset, steady progression
Migraine gtemproal pattern
Episodic, not at regular frequency
Tension headache temporal pattern
Chronic pattern, fairly regular
Cluster headache temporal pattern
Similar to migraine
Periods where its intense, and periods of remission
Acute onset headache
- urgent/emergency likely
- intracranial hemorrhages
- other cerebrovacualr events
- meningitis or encephalitis
- ophthalmic events
- other less common causes
Subacute onset HA
Non emergent
Auricle exam
Redness, tenderness, masses/lesions
Ear canal exam
Redness, swelling, pain, FB, discharge
Tympanic membrane exam
Color, contour, mobility (sign of altered pressure)
Auditory acuity exam
Finger rub tests, “whispered voice test”
Hearing impairment eval
Questions for the patients
Air condition vs bone condition (Rinne and Weber tests)
External ear exam
Inspection of the external acoustic meatus and the tympanic membrane (at the interior end of the meatus) typically requires “straightening” the somewhat curved contours. Examiner can tug on helix in a lateral, superior, and posterior direction. Beware when inserting otoscope: the length of the meatus is much shorter in infants than in adults
Otitis externa
Pain at outer ear level
Exostosis can be present
Skin of the canal wis often thickened, red, and itchy
Look for color and perfusion differences
View of the tympanic membrane
- parts of the ossicles in the middle ear bulging against the membrane
- abnormal accumulation of fluid/material in the middle ear produces visible changes in the appearance of hte typmpanic membrane, e.g. red with inflammation, normally concave parts become convex due to increased pressure
Retracted membrane in tympanic membrane
Appears bowed inward toward, ossicles more prominent than normal. Assocaited with blockage of Eustachian tube
If the tympanic membrane is bulging externally
Indicates increased pressure/material in middle ear such as excess serious fluid, infection, pus
Color changes to tympanic membrane
- amber or yellow suggests serous fluid build IOP
- white suggests infection
- red suggests blood in middle ear
- all can be assocaited with otitis media (infection)
Perforation of the tympanic memebtane
Often followed by closure and scarring, again association with otitis media
Auditory acuity )hearing sensitivity)
- neurologists test: finger rub
- general physician test: whispered voice test
Frequency specific hearing loss
Age related loss of high frequency sensitivity, suggested selective loss of hair cells in cochlea
Generalized hearing loss
Originate from pathology at various levels: external ear, middle ear, non specific damage to hair cells across cochlea
Unilateral hearing loss
Localization from external ear to ipsilateral medulla (auditory nucleus). Lesions further along auditory pathway in the brain do not result in unilateral deafness
Frequency specific loss
Cochlea
Sensorineural vs conductive hearing loss
Sensorineural
-cochlea or neurological pathology
Conductive
-tympanic membrane and occlusive (middle ear).
Distinguish with the rinne or Weber’s reset
Nose surface
Asymmetry, deformity (deviated septum)
Nasal cavity
- mucosa: color, swelling, bleeding, ulcers or polyps
- turbinates: conchae
- septum: perforation, inflammation
Olfactory neurons
Deep to the superior conchae is where they are located
Paranasal air sinuses
- connection etween nasal cavity and maxillary/sphenoid sinuses
- lined by mucosa, like nasal cavity
- inflamamtion,infection presents as painful
- palpate and test for tenderness
- transillumination is a test for obstruction, inflammation, infection
Normal transillumination of sinuses
Significant “glow” or typical degree transillumination
dull transillumination of sinuses
Reduced transillumination
Opaque transillumination of sinuses
No transillumination
Things to look at for oral cavity and pharynx
- lips
- oral mucosa
- gums and teeth
- hard palate
- tongue and floor
- pharynx
Erosion of teeth
Chemical action
Results from recurrent regurgitation of stomach contents, such as in bulimia
Can see a white rim on the outer edges of the tooth
Tongue
Benign atypical, local infection, systemic vital infection
Smooth tongue
B12 deficiency
Tonsil size
- can be large without pathology
- could block airway
- also note if posterior pharyngeal surface protrudes into paharynx
- must depress the tongue to see epiglottis
Neck exam
- inspect for asymmetry, enlarged salivary glands and lymph nodes, masses
- inspect trachea-position
- inspect and palpate thyroid gland
- palpate lymph nodes in key locations
Questions for patient, related to thyroid function
- have you noticed any swollen glands or lumps in your neck?
- do you dress more warmly or less warmly than others
- do you perspire a lot more or less than others?
Tracheal position
Masses in the neck may cause tracheal deviation to one side, raising suspicion of conditions in the thorax such as mediastinal mass, atelectasia, or a large pneumothorax
Palpating the thyroid
- usually need to extend the neck
- isthmus may not be detectable
- thyroid lobes can be positioned inferiority and posterior to sternum
