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NR511 - Differential Diagnosis > Midterm - ENT disorders > Flashcards

Midterm - ENT disorders Flashcards

1
Q

Sinusitis

A

Inflammation and swelling of the sinuses.

Infection of adjacent structure (mastoiditis, meningitis) referral required.

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2
Q

Where is pain felt in ethmoid sinus problems?

A

Behind the eyes and high on the nose

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3
Q

What is the most commonly affected sinus in sinusitis?

A

Maxillary - largest sinus

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4
Q

Signs and symptoms of sinusitis

A
  1. Pain and pressure over the cheek
  2. Inability to transilluminate the cavity indicates it is full of purulent material
  3. Discolored nasal discharge
  4. Poor response to decongestants
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5
Q

How to diagnose sinusitis?

A

URI for rat least seven days and two of the following symptoms
1. Colored nasal drainage
2. Poor response to decongestants
3. Facial/sinus pain
4. Headache

Viruses may produce all of the clinical manifestations, patient with 7-day criteria more likely to have bacterial rather than viral URI

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6
Q

Otitis externa

A

Tenderness on traction of the pinna or pressure over the tragus. Erythematous ear canal history of recent swimming

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7
Q

Otitis media

A

Diagnose with otoscopic exam. Tympanic membrane is red and bulging without visible effusion. Light reflex absent or diminished. Mobility is decreased. External auditory canal is erythematous.

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8
Q

Treatment for otitis media

A
  1. Treatment for peds with mild symptoms and no daycare attendance and no abx in the last 90 days then amoxicillin 40-45mg/kg/day PO in two doses for 10 days
  2. Followup 48-72 hours if symptoms have not resolved or followup after completion of abx
  3. Change in hearing and speech and language delays indicate more aggressive treatment and referral is needed.
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9
Q

Acute angle-closure glaucoma

A

Increased intraocular pressure. Medical emergency when left untreated and can cause blindness. Sudden onset of symptoms:

  1. Blurred vision
  2. Red eye
  3. Unilateral pain
  4. Pressure
  5. Headache
  6. Seeing halos around lights
  7. Photophobia
  8. Peripheral vision loss
  9. Central vision loss

NP MUST ASSESS VISION LOSS ON PRESENTATION

Can cause severe damage to the optic nerve

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10
Q

Strategy to relieve middle ear pressure due to barotrauma

A

Use of nasal steroids and decongestants.

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11
Q

Sensorineural hearing loss

A

Comes from exposure to loud noises, inner ear infections, tumors, congenital and familial disorders and aging

Example: presbycusis

Any client that presents with sudden sensorineural hearing loss should be referred to otorhinolaryngolist for further diagnosis and treatment

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12
Q

Conductive hearing loss

A

Bone conduction is greater than air conduction so the patient will report bone conduction sound longer than air conduction sound

Serious otitis media can result in conductive hearing loss

Produces high-frequency hearing loss that is bilateral and symmetrical

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13
Q

Cerumen impaction

A
  1. Cause of conductive hearing loss,
  2. Differential diagnosis, otitis media
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14
Q

Weber test

A

Tuning fork placed on top of the head equal distance from the ears. Sound should be the same in both ears.

Conductive loss – louder in the bad ear

Sensorineural loss – louder in good ear

Perform the Weber and Rinne test to determine if it is primarily conductive or sensorineural

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15
Q

Tinnitus

A

Ringing or buzzing noise in one or both ears, may be constant or come and go. Often associated with hearing loss. May be caused by fluid in the ear.

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16
Q

Bilateral high pitched tinnitus may be caused by…

A
  1. Severe HTN diastolic over 120
  2. Evaluate with orthostatic measurements
  3. Refer patient
17
Q

How to minimize symptoms of tinnitus

A
  1. Background music during the day and sleep
  2. Smoking cessation
  3. Decrease caffeine, chocolate, alcohol, salt
  4. Fatigue makes it worse
    a. Good sleep hygiene
    b. encourage rest
  5. encourage gum and swallowing on airplanes to promote estuation tube opening and equalization of pressure
18
Q

What type of disorders is tinnitus usually associated with?

A

Depressive disorders
1. Screen for psychological disorders and depression

19
Q

Mononeucleosis

A

Viral syndrome characterized by prolonged malaise and fatigue, fever, sore throat, and tender cervical lymphadenopathy.

20
Q

Symptoms of mononucleosis

A
  1. Fatigue
  2. Sore throat
  3. Mild nasal and throat erythema
  4. Edematous, enlarged tonsils bilaterally, erythema of pharyngeal wall and tonsillar exudates
  5. Inflamed posterior cervical lymph nodes
  6. Monospot test if strep has been ruled out
21
Q

What is the hallmark symptom of mononeucleosis?

A

Inflamed posterior cervical lymph nodes

22
Q

Epiglottitis

A

A life-threatening, rapidly progressive cellulitis of the epiglottis that may cause complete airway obstruction.
Epiglottitis begins as a cellulitis between the tongue base and the epiglottis; the epiglottis is then pushed posteriorly. The epiglottis becomes swollen and threatens airway patency.

Epiglottitis is more common and more severe in young children, but it may occur in older children and adults

23
Q

Symptom cluster of epiglottitis

A
  1. Sore throat
  2. Difficulty swallowing
  3. Copious oral secretions
  4. Respiratory difficulty
  5. Stridor
  6. Fever
  7. No pharyngeal erythema or cough
24
Q

Symptoms of epiglottis in pediatrics that may indicate airway obstruction

A
  1. Stridor
  2. Restlessness
  3. Nasal flaring
  4. Use of accessory muscles
25
Q

Pharyngitis

A

Inflammation of the pharynx that cause discomfort, scratchiness, pain and difficulty swallowing

26
Q

Symptoms of pharyngitis

A
  1. Fever
  2. Fatigue
  3. Cervical lymphadenopathy
27
Q

Evaluate pharyngitis with which tests?

A
  1. Monospot
  2. Strep test
  3. Throat culture
28
Q

Treatment for strep throat

A

10-day course of penicillin V potassium (500mg PO 2x/day) or benzathine penicillin IM once (1.2 million units)

29
Q

Hoarseness/Dysphonia

A

Changes in the pitch or quality of voice – weak, scratchy, husky.

Diagnostic laryngoscopy.

Differential diagnosis papillomatosis (related to infection)

30
Q

Causes of dysphonia

A
  1. Overuse or misuse of voice
  2. Viruses
  3. Growth on vocal chords (cysts, papillomas, polyps & nodules)
  4. GERD
31
Q

Peritonsillar abscess

A

Acute pharyngeal infection common in young adults and adolescents

INFECTION IS USUALLY UNILATERAL AND LOCATED BETWEEN THE TONSIL AND SUPERIOR PHARYNGEAL CONSTRICTOR MUSCLE

32
Q

Symptoms of peritonsillar abscess

A
  1. Gradual onset of severe unilateral sore throat
  2. Odynophyagia
  3. Fever
  4. Otalgia
  5. Asymmetric cervical lymphadenopathy
  6. Lock jaw
  7. Hot potato voice
  8. Toxic appearance
  9. Failure to recognize parents
  10. Irritability
  11. Inability to be consoled/distracted
  12. Drooling
  13. Severe halitosis
  14. Tonsillar erythema
  15. Exudates
  16. Bulge with deviation in the soft palate and uvula

Refer to emergency if concerns for airway or sepsis.

33
Q

Allergic Rhinitis

A

Hypersensitivity (IgE mediated) to airborne irritants affecting eyes, nose, sinuses, throat and bronchi. Diagnosed with patient history and physical exam. Teach patients to avoid environmental triggers.

34
Q

Symptoms of allergic rhinitis

A

a. Persistent
b. Seasonal in nature
c. Turbinates are pale due to venous engorgement

35
Q

Symptoms of viral rhinitis

A

a. Watery rhinorrhea
b. Nasal congestion
c. Nasal speech
d. Forced mouth breathing

36
Q

Rebound rhinitis caused by…

A

Overuse of nasal sprays

Stop use, resolves in 2-3 weeks

37
Q

Atopic triad

A

Genetic predisposition toward allergic reactivity may be the most important etiological factor in atopic conditions

Personal or family history of ASTHMA, ALLERGIC RHINITIS, ECZEMA is often present

38
Q

Tests for tinnitus

A
  • Tympanometry
  • acoustic reflex measurement
  • acoustic refletrometry
39
Q

Differential diagnosis for dysphonia

A

Papillomatosis (related to infection)

NR511 - Differential Diagnosis (8 decks)

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