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/red and swollen turbinates
Rhinorrhea
Septal deviation
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 are the most common symptoms of viral pharyngitis?
- inflamed mucus membrane (coryza)
- conjunctivitis
- malaise or fatigue
- voice hoarseness
- low grade fever
What are the most common symptoms for group A beta-hemolytic streptococcal infections/GABHS (bacterial pharyngitis)?
Children b/t ages 5-15 Winter/early spring Absence of cough Tender anterior cervical lymphadenopathy Tonsillar exudate Fever
What is the centor score and what do the results mean?
Score that determines risk for bacterial pharyngitis
0»_space;> low risk»_space;» no further treatment
2-3»_space;> moderate risk»_space;> abx if + throat culture
4 or higher»_space;> high risk»_space;> abx
What criteria gives points in a centor score?
Absence of cough Swollen/tender anterior cervical nodes Temperature > 100.4° Tonsillar exudates Age 3-14
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 see ear bubbles behind the TM
-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?
When is this associated with conductive and when is it associated with sensorineural?
Abnormal bone growth around stapes bone that can be associated w/ hearing loss
Conductive: ossicle merging
Sensorineural: otic capsule sclerosis
How do you interpret the results of the Weber test?
Lateralized side either has conductive hearing loss on that side, or sensorineural hearing loss on the opposite side
In a Rinne Test, what would be expected in conductive loss?
Bone Conduction time > air conduction time
What can cause conductive hearing loss?
Cerumen impaction Middle ear fluid Lack of movement in ossicles Trauma Obstruction
(basically outer and middle ear problems)
What can cause sensorineural hearing loss?
Hereditary Meniere Disease MS Trauma Ototoxic Drugs Barotrauma
(basically inner ear or nerve problems)
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 (double sickening)
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 by type b haemophilus influenza or GABHS
- high grade fever
- toxic appearance
- tripod stance
- drooling
- muffled voice
-important to treat right away
