Lecture 3: Approach to ENT Exam Flashcards
What do you check as part of the ENT exam?
- Sinus tenderness
- Nose and nasal turbinates
- Mouth and perform oral exam
- Throat and tonsils
- Ears
- Lymph nodes
What sinuses can you palpate for?
Frontal
Maxillary
What would be abnormal to see in a nasal exam?
Pale and swollen turbinates
Rhinorrhea
What do you check in an oral exam?
Gingiva (gums) Mucosa Lip Hard and soft palate Floor of Mouth Tongue
What is cobblestoning?
Swollen lymph tissue normally due to post nasal drip that can irritate mucosa
What is torus palatinus?
Harmless bony growth on hard palate
What are you checking for when performing an ear exam?
Drainage
Redness
Tenderness
Bulging tympanic membrane
What do you check for when examining in lymph nodes?
Texture
Size
Tenderness
What are some hallmarks of a sore throat?
Beefy red soft palate and uvula
Enlarged Tonsils
White or yellow patches on tonsils
Tiny red hemorrhages on soft palate
What is pharyngitis and what are some common symptoms?
Inflammation of pharynx resulting in a sore throat
- inflamed mucus membrane (coryza)
- conjunctivitis
- malaise or fatigue
- voice hoarseness
- low grade fever (viral)
What are the highest causes for group A beta-hemolytic streptococcal infections?
Children b/t ages 5-15 Winter/early spring Absence of cough Tender anterior cervical lymphadenopathy Tonsillar exudate Fever
What is the centor score?
Set of criteria which may be used to identify the likelihood of a bacterial infection in patients complaining of a sore throat
What criteria gives points in a centor score?
Absence of cough Swollen/tender anterior cervical nodes Temperature > 100.4° Tonsillar exudates Age 3-14
If the Centor score is 0 or 1, what do you do?
No further testing or antibiotics needed
If the Centor score is 2 or 3, what do you do?
Perform throat culture and wait for results before treating with antibiotics
If the Centor score is 4 or greater, what do you do?
Treat with empiric antibiotics right away
What is acute otitis media?
Symptomatic inflammation of middle ear due to infection
What is otitis media with effusion?
Fluid buildup in middle ear w/o infection
-can be due to dysfunction to eustachian tube
What is otitis externa?
Infection in outer ear that can happen by bacteria entering small break in skin
What is otosclerosis?
Abnormal bone growth around stapes bone that can be associated w/ hearing loss
In a Weber test, where does conductive hearing loss lateralize to?
Affected side
In a Weber test, where does sensorineural hearing loss lateralize to?
Opposite affected side
In a Rinne Test, what would be expected in conductive loss?
Bone Conduction > air conduction
What can cause conductive hearing loss?
Cerumen impaction Middle ear fluid Lack of movement in ossicles Trauma Obstruction
What can cause sensorineural hearing loss?
Hereditary Meniere Disease MS Trauma Ototoxic Drugs Barotrauma
What is sinusitis?
Inflammation of mucosal lining in paranasal sinuses
-mostly due to infections
What are symptoms of sinusitis?
Nasal discharge Cough Nasal congestion Fever Headache Pain Facial pressure
Describe bacterial sinusitis.
Patient will initially get better then get much worse
What is croup?
Swelling of larynx, trachea, and bronchi that can cause a stridor and barking cough in young children
-sounds scary but not dangerous
What is epiglottitis?
Inflammation of epiglottis and adjacent structures
- high grade fever
- toxic appearance
- tripod stance
- important to treat right away
