Final - ear, nose, throat images Flashcards
What are you looking for in a normal tympanic membrane
Pearly grey membrane, semitransparent
You’re looking in an ear and you see dense white patches. What is it and will it affect hearing?
Tympanosclerosis
scarring/calcium deposition within the layers of TM that may or may not affect hearing
What is it when the tympanic membrane is red and bulging?
Acute otitis media
Pt presents with fever and deep ear pain, what is it? How would you manage it?
Acute otitis media
due to viral (majority) or bacterial infection
Mgmg: watchful waiting unless symptoms are severe/prolonged
“My ear was really hurting, now it feels better but there’s this stuff draining from it…”
what is it?
Acute otitis media with perforation
pressure from infection in middle ear caused TM rupture
Pt presents with pain, erythema, and swelling over mastoid process. What is this?
Mastoiditis: infection of the air cells in the mastoid bone that is almost always associated with middle ear infection that spread.
Pt presents with pain, erythema, and swelling over mastoid process. How would you manage/treat this patient
Management: send to emergency department. Will need CT or MRI of mastoid and be hospitalized for IV antibiotics
Ear feels “plugged” but not painful. What do you call this?
Serous otitis media
AKA otitis media with effusion
Ear feels “plugged” but not painful. Is the tympanic membrane mobile or not? What is this this commonly seen with?
Serous otitis media has decreased TM mobility
Common with URIs and/or eustachain tube dysfxn
What is it called when the tube(s) get plugged, sounds are muffled and the ear feels full? And possibly pain.
Eustachian tube dysfunction
How does eustachian dysfunction effect the middle ear cavity?
Either otitis media with effusion OR
negative pressure on middle ear and retracted tympanic membrane (pictured)
What might be happening with this child that cannot breath out of his mouth? And what are treatment options?
Nasopharyngeal obstruction by adenoids
Tx: swallowing, yawning, chewing gum, self autoinflation or Eustachian Tube manipulation procedure
What is pictured?
Tympanostomy tube
On nose exam, mucosal color is pinkish, there is no swelling and there is minimal or clear discharge. Is this a typical or atypical nasal exam?
Typical
Sometimes this causes one-sided congestion. What is happening here?
deviated nasal septum
congenital or due to trauma
Purulent exudate suggests what?
Infection. Cannot say if its viral or bacterial, but we know there are WBCs in the area.
Erythematous, swollen turbinates, increased serous (pictured) or purulent nasal discharge
Rhinitis : inflammed nasal mucosa
Coryza: irritation and swelling of mucous membrane in the nose
Pt presents with frequent throatclearing and chronic cough. What is most likely the problem and what does it cause?
Post-Nasal Drip (PND) because mucous accumulates and drips down the back of the throat
Cobblestoning of oropharynx (previous image)
Violet-bluish (violaceous), pale or erythematous mucosa. What is this?
Allergic rhinitis
Pale, saclike protrusions of hypertrophied mucosa (name and explain what its associated with)
Nasal polyps
associated with chronic allergies and chronic rhinosinusitis
How do the sinuses drain?
- Ciliary action in the sinus cavities moves secreted mucus toward and
- through ostium. Mucus from
- ostiomeatal complex (confluence of maxillary ethmoid and frontal sinuses) normally
- drains into middle turbinate space and out
If these are painful on palpation, what does it suggest? And what next exam techniques might you do?
Rhinosinusitis (RH) because the sinuses may not be draining.
- tap upper molars: pain is (+) for RH - not very sensitive, but very specific test
- sinus transilluminatin: shine a light in their eyeball and look into mouth to see red glow. Absense of glow is (+) for RH. Not sensitive nor specific.
What is this? And what would a bruit suggest?
Goiter; hyperthyroidism
There are 4 complications with rhinosinusitis. What is this one:
Soft tissue infection anterior or posterior to the orbit but not invading structures, vision not affected.
Periorbital edema/cellulitis
There are 4 complications with rhinosinusitis. What is this one:
patients may have limitation of extraocular movement, exophthalmos, and visual changes
Orbital abscess
(pus collection in orbit)
There are 4 complications with rhinosinusitis. What is this one:
Swellingon forehead or scalp
Pott’s puffy tumor
osteomyelitis of the frontal bone with the development of subperiosteal abscess
There are 4 complications with rhinosinusitis. What is this one:
Infection spreads from nose/sinuses into vein and causes septic thrombosis of the cavernous sinus
Cancerous sinus thrombosis
30% mortality even with treatment
Symptoms: sudden onset high fever and deep pain in eyes with opthalmoplegia (palsies of CNIII, IV, VI), ptosis, proptosis, chemosis
Cavernous sinus thrombosis
What is this?
Cleft lip and/or palate
Common symptoms prodrome: burning, tingling, itching
Herpes labialis (cold sores)
Edentulous patient with fissuring at the angles of the mouth
Angular cheilitis
Ulcerated or crusted lesion that won’t go away
Squamous cell carcinoma
Stone formation in salivary gland or duct is called what
sialolithiasis
Unilateral, painful, facial swelling from a stone in the duct
sialadenitis
caused by sialolithiasis
?
mucocele
minor salivary gland nodule
?
aphthous ulcer
Will scrape off
Thrush, candida yeast infection
Thick white plaque that does not scrape off
Leukoplakia
(potentially cancerous)
Thick white plaque that is potentially cancerous. What is it and how would you manage this?
Leukoplakia
Management: refer for biopsy if present for >2-3 weeks
Red swollen gum margins caused by plaque
gingivitis
What is this? How would you manage it?
tooth abscess
refer to PCP, Urgyen care, dentist
Painless white stuff that does not scrape off under the tongue
leukoplakia
Chronic raised white lesion, firm, painless
carcinoma
Sides of tongue, white will NOT scrape off, seen in HIV/AIDs
hairy leukoplakia
Benign bony growth(s) in submandibular area. (How would you manage this?)
torus mandibularis (Plural: mandibular tori)
no management required
Benign bony growth on hard palate
torus palatinus
No fever, no sore throat, no lymphadenopathy
bilaterally enlarged tonsils (probably not infected)
Inflamed tonsils, sore throat, +/- exudate
tonsilitis
Inflamed tonsils, sore throat WITH exudate… what is it? Common causes?
Tonsilitis with exudate, duh.
Common causes: viral URI and bacterial infections
No cough, with tender anterior cervical adenopathy, fever and tonsillar exudates
Strep throat (pharyngitis)
Strep Score: need 2+ “CAFE” points
+1 point = Cough ABSENT
+1 point = Adenopathy
+1 point = Fever
+1 point = Exudate
Management:
Strep Score 0-1 provide symptomatic conservative care
Strep Score 2-4 antigen test (+) refer to PCP or urgent care for antibiotics or (-) send throat culture
What is this?
>1 cm, hard, non tender, margins less defined, fixed, often unilateral
metastatic malignant lymph node
What is this?
>1 cm, rubbery/firmish, non moveable, non tender, discrete margins
lymphoma
What is this?
>1 cm, soft, moveable, tender, discrete margins, sometimes overlying red skin
infectious LAD (lymphadenitis)
Most common location for lymphadenopathy for mono?
posterior cervical
Name of the node if you find one here?
Location: supraclavicular nodes
Name: Virchow’s node
