LECT Approach to ENT complaint

Question 1

Sinus Exam

Answer 1

Push at eyebrow moving thumbs together (frontal sinus)
Push on inferior aspect of cheek bones superiorly (maxillary sinus)
*frontal sinus do not develop until 8-10 years old
check for tenderness

Question 2

What do you check with otoscope?

Answer 2

Nose and nasal turbinates
Pale and swollen turbinates
clear rhinnorhea

Question 3

What do you look for in a mouth exam?

Answer 3

Gingiva, mucosa, lips, buccal mucosa, posterior gingiva, vestibule, anterior gingiva, hard palate, soft palate, tonsillar area, ventral and dorsal aspects of tongue, floor of mouth, lateral border of tongue

Question 4

What do you look for in the tonsils and throat?

Answer 4

Tonsillar erythema, swelling, and exudate

cobblestoning of pharynx

Question 5

Torus palatinus

Answer 5

harmless bony growth
oral exostosis
female>male
hereditary
no surgery

Question 6

What do you look for in external ear?

Answer 6

helix, antihelix, entrance to ear canal, lobule, tragus

drainage, redness, tenderness of tragus

Question 7

Pneumatic otoscopy

Answer 7

?

Question 8

Otitis media

Answer 8

bulging Tympanic membrane with erythema

Question 9

Checking lymph nodes

Answer 9

use finger pads of middle three fingers
Texture- rubbery, soft, hard
Size- pea, quarter, etc.
tenderness

Question 10

Pharyngitis

Answer 10

inflammation of pharynx with sore throat
Has bacterial and viral causes
symptoms: coryza (inflamed mucous membrane), conjuctivitis, malaise, fatigue, hoarseness, low-grade fever suggest viral
Other dx: mono, GERD, postnasal drip (rhinitis), persistent cough), thyroiditis, allergies, foreign body, smoking

Question 11

Streptococcal pharyngitis

Answer 11

Caused by Group A beta-hemolytic streptococcus

Symptoms: sore throat, headache, fatigue, fever, body aches, nausea

Question 12

GABHS

Answer 12

Children 5-15
winter and early spring
no cough
tender anterior cervical lymphadenopathy
tonsillar exudate
fever

Question 13

Ear infections

Answer 13

middle: air-filled space behind ear drum
otitis media with effusion, acute otitis media (AOM)
Outer: otitis externa
Inner: Labyrinithitis

Question 14

Acute OM

Answer 14

symptomatic inflammation of middle ear due to bacteria and viruses

Question 15

Acute Suppurative OM

Answer 15

acute OM with purulent material in middle ear

Question 16

OM with effusion

Answer 16

inflammation and fluid buildup in middle ear without bacterial or viral infections. May occur because the fluid buildup persists after an ear infection has resolved or due to dysfunction or blockage of eustachian tubes

Question 17

Chronic OM with effusion

Answer 17

occurs when fluid remains in middle ear and continues to return without bacterial or viral infection. Makes children susceptible to new infections and may affect hearing

Question 18

Chronic suppurative otitis media

Answer 18

persistent ear infection that often results in tearing or perforation of eardrum

Question 19

Otosclerosis

Answer 19

Abnormal bone growth around stapes bone
Associated with progressive hearing loss beginning 10-30 and marked hearing loss in middle age. two types
1. Conductive loss- ossicle sclerosis into a single immovable mass
2. Sensory loss-otic capsule sclerosis affects about 10% of caucasians

Question 20

Weber Test

Answer 20

Normal: midline and hear equally
Conductive loss: lateralizes to affected side
sensorineuronal loss: lateralizes to the side of opposite of the affected ear

Question 21

Rinne Test

Answer 21

Normal: Air conduction> bone conduction

Conductive loss: bone conduction> air conduction

Question 22

Causes of conductive hearing loss

Answer 22

cerumen impaction, middle ear fluid, lack of movement of the ossicles, trauma, other obstruction (tumor)

Question 23

Causes if sensorineuronal hearing loss

Answer 23

hereditary, meniere disease, MS, ototoxic drugs, barotrauma, etc

Question 24

Rhinosinusitis/ sinusitis

Answer 24

mucosal lining in the paranasal sinuses and nasal cavity become inflamed.
Infectious causes:
Viral: rhinovirus, adenovirus, influenza virus, parainfluenza virus
Bacterial: strep pnuemoniae, haemophilius influenzae, moraxella catarrhalis
other causes: dental infection, surgery, immunodeficientcy, impaired ciliary motility,
Symptom: nasal discharge, cough, sneezing, congestion, headache facial pressure

Question 25

Bacterial sinusitis

Answer 25

double sickening (better then worse), purulent rhinorrhea, elevated ESR 
Treatment: antibiotic

Question 26

Croup

Answer 26

Laryngotracheitis
swelling of larynx, trachea, bronchi which causes a barking cough, and stridor
causes: parainfluenza virus, influenza, respiratory synctial virus

Question 27

Epiglottitis

Answer 27

inflammation of epiglottis and adjacent structures
cause: haemophilius type b influenza, group a hemolytic strep
Symptom: rapid onset, sore throat, muffled voice, drooling, high fever, toxic appearence, child sitting or leaning forward.