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CMED - ENT > L1 History and Physical Exam > Flashcards

L1 History and Physical Exam Flashcards

1
Q

NB points in ENT History?

A

PC - location, duration, frequency, quality. Agg and alliev factors. Associated symptoms (fever, chills, cough, heartburn, dizziness etc)

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2
Q

5 things to ask about the ear?

A

tinnitus, otalgia, otorrhea, hearing loss, vertigo

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3
Q

Unilateral ear pain Red flag?

A

if looks normal NB look in mouth, throat and refer to ENT for scope particularly if smoker or drinker… could be referred pain from malignancy etc

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4
Q

5 things to ask about face?

A

swelling, pain, numbness (CN 5), cranial nerve dysfunction

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5
Q

To ask about the nose?

A

“congestion, rhinorrhea, post-nasal drip,
epistaxis, impaired smell, facial pain. Unilateral symptoms / eye symptoms = red flag (complications of infection/malignancy), anosmia (no smell), hyposmia (reduction of smell)
“

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6
Q

To ask about Sinuses

A

pressure and pain

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7
Q

To ask about Throat?

A

odynophagia, dysphagia, globus sensation, throat clearing

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8
Q

To ask about the larynx?

A

voice changes, weakness, hoarseness, stridor, dyspnea

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9
Q

inspiratory stridor suggests?

A

obstruction at level of glottus or above

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10
Q

expiratory stridor suggests?

A

lower resp issue more so

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11
Q

biphasic stridor

A

obstruction at glottus or below

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12
Q

What is otaligia?

A

“Pain of the ear

primary = from inside the ear
secondary = from outside the ear”

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13
Q

What is otorrhea?

A

Drainage of liquid from the ear

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14
Q

What is post nasal drip?

A

Postnasal drip is when more mucus than normal gathers and drips down the back of your throat. You may feel like you have a tickle in the back of your throat. Postnasal drip can be a bothersome condition that can lead to a chronic cough. The glands in your nose and throat are constantly making mucus.

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15
Q

What is epistaxis?

A

The medical name for a nose bleed

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16
Q

What are nasal red flag associated symptoms?

A

“Unilateral symptoms
eye symptoms “

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17
Q

What is odynophagia?

A

Pain on swallowing

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18
Q

What is globus sensation?

A

Globus pharyngis or globus sensation is the persistent but painless sensation of having a pill, food bolus, or some other sort of obstruction in the throat when there is none. Swallowing is typically performed normally, so it is not a true case of dysphagia, but it can become quite irritating.

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19
Q

What is stridor?

A

High pitched wheezing sound caused by obstructed airways

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20
Q

What are the components of an ear exam?

A

“1. Clean hands, intro, consent, check for oralgia
2. Inspect: Pinna, post and pre auricular area
3. Otoscopy: Ear canal, tympanic membrane
4. Tuning fork tests
5. Whisper test”

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21
Q

What is an otoscopy?

A

“Medical device to look inside the ears. Potentiall gives a view of the ear canal and tympanic membrane or eardrum. The TM is the border separating the external ear canal from the middle ear and its characteristics can be indicative of various diseases of the middle ear. The presence of Cerumen (earwax), shed skin, pus, canal skin oedema, foreign body and various diseases can obscure the view of the eardrum but confirm the presence of obstructing symptoms.

examine eustachian tube function with the valsava maneouvre “

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22
Q

What diseases may be diagnosed by an otoscope?

A

Otitis media (infection of the middle ear) and otitis externa

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23
Q

What is an auricular haematoma?

A

“An auricular haematoma refers to a collection of blood between the cartilage of the ear and the overlying perichondrium. It is usually occurs as a result of trauma, commonly seen in contact sports (e.g. rugby).

The accumulation of blood can disrupt the blood supply to the cartilage, and requires prompt drainage. Untreated cases can result in avascular necrosis of the cartilage, resulting in a ‘cauliflower ear’ deformity.”

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24
Q

What is the external acoustic meatus?

A

“a sigmoid shaped tube that extends from the deep part of the concha to the typanic membrane. The external 1/3 is made up of cartilage and the inner 2/3 are formed of temporal bone.

S shaped curve as follows:
1. initially travels in superoanterior direction
2. then turns slightly to move superoposteriorly
3. then ends by running in an inferoanterior direction “

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25
Q

What is the tympanic membrane?

A

lies at the distal end of the external acoustic meatus. It is a connective tissue structure covered with skin on the outside and a mucous membrane on the inside. The membrane is connected to the surrounding termporal bone by a fibrocartilaginous ring. It is translucent so the structures within the middle ear can be observed during otoscopy.

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26
Q

What is perforation of the tympanic membrane?

A

“The tympanic membrane is a relatively thin connective tissue structure, and is susceptible to perforation (usually by trauma or infection).

An infection of the middle ear (otitis media) causes pus and fluid to build up behind the tympanic membrane. This causes an increase in pressure within the middle ear, and eventually the eardrum can rupture.

In some cases the tympanic membrane heals itself, but in larger perforations surgical grafting may be required.”

27
Q

How to describe a tympanic membrane perforation?

A
  1. Size - pinhole, small, large
  2. Location - quadrant, central vs marginal
  3. Effusion - dry vs wet
28
Q

What is the vascular supply to the external ear?

A

“The external ear is supplied by branches of the external carotid artery:

Posterior auricular artery
Superficial temporal artery
Occipital artery
Maxillary artery (deep auricular branch) – supplies the deep aspect of the external acoustic meatus and tympanic membrane only.

Venous drainage is via veins following the arteries listed above.”

29
Q

What are the borders of the middle ear?

A

“The middle ear can be visualised as a rectangular box, with a roof and floor, medial and lateral walls and anterior and posterior walls.

Roof – formed by a thin bone from the petrous part of the temporal bone. It separates the middle ear from the middle cranial fossa.
Floor – known as the jugular wall, it consists of a thin layer of bone, which separates the middle ear from the internal jugular vein
Lateral wall – made up of the tympanic membrane and the lateral wall of the epitympanic recess.
Medial wall – formed by the lateral wall of the internal ear. It contains a prominent bulge, produced by the facial nerve as it travels nearby.
Anterior wall – a thin bony plate with two openings; for the auditory tube and the tensor tympani muscle. It separates the middle ear from the internal carotid artery.
Posterior wall (mastoid wall) – it consists of a bony partition between the tympanic cavity and the mastoid air cells.
Superiorly, there is a hole in this partition, allowing the two areas to communicate. This hole is known as the aditus to the mastoid antrum.”

30
Q

What is the function of the auditory tube?

A

“The auditory tube (eustachian tube) is a cartilaginous and bony tube that connects the middle ear to the nasopharynx. It acts to equalise the pressure of the middle ear to that of the external auditory meatus.

It extends from the anterior wall of the middle ear, in an anterior, medioinferior direction, opening onto the lateral wall of the nasopharynx. In joining the two structures, it is a pathway by which an upper respiratory infection can spread into the middle ear.

The tube is shorter and straighter in children, therefore middle ear infections tend to be more common in children than adults.”

31
Q

What is otitis media with effusion?

A

“Otitis media with effusion is commonly known as glue ear. It arises from persistent dysfunction of the auditory tube. If the auditory tube is unable to equalise middle ear pressure (due to blockage, inflammation, genetic mutation), a negative pressure develops inside the middle ear

This negative pressure draws out a transudate from the mucosa of the middle ear, creating an environment suitable for pathogens to replicate and cause infection.

Upon inspection of a patient with otitis media with effusion, the eardrum will appear inverted, with fluid visible inside the ear.”

32
Q

What is mastoiditis?

A

“Middle ear infections (otitis media) can spread to the mastoid air cells. Due to their porous nature, they are a suitable site for pathogenic replication.

The mastoid process itself can get infected, and this can spread to the middle cranial fossa, and into the brain, causing meningitis.

If mastoiditis is suspected, the pus must be drained from the air cells. When doing so, care must be taken not to damage the nearby facial nerve. (+ culture)”

33
Q

Whats Webers test

A

”

It can detect unilateral (one-sided) conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss).

Strike tuning fork and place on the base of the forhead. Ask if the sound is heard, in the middle of the head or both ears equally, towards the left or right. “

34
Q

What is conductive hearing loss?

A

Conductive hearing loss (CHL) occurs when there is a problem transferring sound waves anywhere along the pathway through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles).

35
Q

What is sensorineural hearing loss?

A

“Sensorineural hearing loss (SNHL) is a type of hearing loss in which the root cause lies in the inner ear or sensory organ (cochlea and associated structures) or the vestibulocochlear nerve (cranial nerve VIII). SNHL accounts for about 90% of reported hearing loss[citation needed]. SNHL is usually permanent and can be mild, moderate, severe, profound, or total. Various other descriptors can be used depending on the shape of the audiogram, such as high frequency, low frequency, U-shaped, notched, peaked, or flat.

Sensory hearing loss often occurs as a consequence of damaged or deficient cochlear hair cells.[disputed – discuss] Hair cells may be abnormal at birth or damaged during the lifetime of an individual. There are both external causes of damage, including infection, and ototoxic drugs, as well as intrinsic causes, including genetic mutations. A common cause or exacerbating factor in SNHL is prolonged exposure to environmental noise, or noise-induced hearing loss. Exposure to a single very loud noise such as a gun shot or bomb blast can cause noise-induced hearing loss. Using headphones at high volume over time, or being in loud environments regularly, such as a loud workplace, sporting events, concerts, and using noisy machines can also be a risk for noise-induced hearing loss.

Neural, or ““retrocochlear””, hearing loss occurs because of damage to the cochlear nerve (CVIII). This damage may affect the initiation of the nerve impulse in the cochlear nerve or the transmission of the nerve impulse along the nerve into the brainstem.”

36
Q

“How do you interpret a webers test?

Normal?
“

A

“Symmetric hearing = normal
tone is heard centrally or bilaterally “

37
Q

Conductive hearing loss?

A

heard at one side at the affected ear

38
Q

Sensorineural hearing loss?

A

Heard at one side to the better ear

39
Q

Whats Rinne’s test?

A

“Primarily used to evaluate for hearing loss in one ear by comparing the perception of sound through bone conduction on mastoid to air conduction. Quick screening tool for conductive hearing loss.

BC: Strike the fork and hold the base pressed against the mastoid for 2 seconds

AC: immediately transfer the fork placing the tips of the tines in line with the axis of EAC”

40
Q

Rinnes test Interpretation: AC is louder than BC?

A

“Rinnes positive
normal ears & most SNHL”

41
Q

Rinnes test Interpretation: BC is louder than AC

A

“Rinnes negative
significant conductive element “

42
Q

Whisper test

A

“Stand arm’s length (60cm) behind the seated patient so they cannot read your lips.
Rub tragus to mask non-tested ear
Whisper bisyllabic numbers = 12dB
Will need 2/3 correct
Fail — increase voice to conversational 50dB
Fail — loud 75dB
Fail — move closer 15 cm — whisper 35dB
Fail — conversational 55dB
“

43
Q
A

“saddle nose deformity
causes
trauma, untreated septal haematoma, iatrogenic if we over ressect the cartilage in a septoplasty overtime this happens, medical causes congenital, wegners, GPA, malignancy”

44
Q
A

“tip ptosis (saggy tip)
dorsal hump “

45
Q
A

“Rhinophyma
cause unknown subtype of severe rosacea
BCCs can hide in it
“

46
Q
A

Telangiectasias
Hereditary Hemorrhagic Telangiectasias

47
Q

Exam Q What are the 6 subsites of the oral cavity?

A

“Buccal mucosa
Alveolar margins + gingiva upper
Alveolar margins + gingiva lower
Hard palate
Floor of mouth
Anterior 2/3 Tongue
Lips
Retromolar trigones

”

48
Q

The boundaries of the anterior triangle of the neck are:

A

Superior: the inferior border of the mandible.
Medial: the midline of the neck.
Lateral: the anterior border of the sternocleidomastoid.

49
Q

The boundaries of the posterior triangle of the neck are:

A

Anterior: the posterior margin of the sternocleidomastoid muscle.
Posterior: the anterior margin of the trapezius muscle.
Inferior: the middle one-third of the clavicle.

50
Q

What to look for when assessing a neck lump

A

“Ss
Site
Size
Shape
Surface (skin)
Surround (skin)

Ts
Tender
Transluminable
Temperature

Fs
Fluctuance
Fixed
Fields

”

51
Q

neck lump is soft?

A

cyst

52
Q

neck lump is hard?

A

malignancy

53
Q

neck lump is rubbery?

A

lymph node

54
Q

lump is fluid filled?

A

cyst

55
Q

lump is warm?

A

increased warmth may suggest an inflammatory or infective cause (e.g. infected epidermoid cyst).

56
Q

neck mass is pulsating?

A

suggests vascular origin (e.g. carotid body tumour, aneurysm).

57
Q

neck mass is tender?

A

may indicate infective and/or inflammatory aetiology (e.g. ruptured epidermoid cyst, infected cyst).

58
Q

apply a light source to the lump, if it is illuminated it suggests

A

the lump is fluid-filled (e.g. cystic hygroma).

59
Q

auscultate the lump to listen for a bruit suggestive of

A

vascular aetiology (e.g. carotid artery aneurysm).

60
Q
  1. Start under the chin (1), then move posteriorly palpating beneath the mandible (submandibular), turn upwards at the angle of the mandible (tonsillar and parotid lymph nodes) and feel anterior (preauricular lymph nodes) and posterior to the ears (posterior auricular lymph nodes).
  2. Follow the anterior border of the sternocleidomastoid muscle (anterior cervical chain) down to the clavicle, then palpate up behind the posterior border of the sternocleidomastoid (posterior cervical chain) to the mastoid process.
  3. Palpate over the occipital protuberance (occipital lymph nodes).
  4. Ask the patient to tilt their head (bring their ear towards their shoulder) each side in turn, and palpate behind the posterior border of the clavicle in the supraclavicular fossa (supraclavicular and infraclavicular lymph nodes).
A

submental lymph nodes

61
Q
  1. Start under the chin (submental lymph nodes), then move posteriorly palpating beneath the mandible (2), turn upwards at the angle of the mandible (2b) and feel anterior (preauricular lymph nodes) and posterior to the ears (posterior auricular lymph nodes).
  2. Follow the anterior border of the sternocleidomastoid muscle (anterior cervical chain) down to the clavicle, then palpate up behind the posterior border of the sternocleidomastoid (posterior cervical chain) to the mastoid process.
  3. Palpate over the occipital protuberance (occipital lymph nodes).
  4. Ask the patient to tilt their head (bring their ear towards their shoulder) each side in turn, and palpate behind the posterior border of the clavicle in the supraclavicular fossa (supraclavicular and infraclavicular lymph nodes).
A

submandibular

tonsillar and parotid lymph nodes

62
Q
  1. Start under the chin (submental lymph nodes), then move posteriorly palpating beneath the mandible (submandibular), turn upwards at the angle of the mandible (tonsillar and parotid lymph nodes) and feel anterior (preauricular lymph nodes) and posterior to the ears (posterior auricular lymph nodes).
  2. Follow the anterior border of the sternocleidomastoid muscle (3) down to the clavicle, then palpate up behind the posterior border of the sternocleidomastoid (3b) to the mastoid process.
  3. Palpate over the occipital protuberance (occipital lymph nodes).
  4. Ask the patient to tilt their head (bring their ear towards their shoulder) each side in turn, and palpate behind the posterior border of the clavicle in the supraclavicular fossa (supraclavicular and infraclavicular lymph nodes).
A

anterior cervical chain

posterior cervical chain

63
Q

What are the levels of the neck

A

Level I, submental (IA) and submandibular (IB);

level II, upper internal jugular nodes;

level III, middle jugular nodes;

level IV, low jugular nodes;

level V, posterior triangle nodes;

level VI, central compartment;

level VII, superior mediastinal nodes.

CMED - ENT (3 decks)

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