Otorhinolaryngology clinic day Flashcards
A 43 year old male truck driver has conductive hearing loss in right ear. What do you expect to see with Weber and Rinne tests?
Weber: lateralizes to right
Rinne: BC > AC on right, AC < BC on left
A 27 year old female chef has sensorineural hearing loss in right ear. What do you expect to see with Weber and Rinne tests?
Weber: lateralizes to left
Rinne: AC > BC on left; AC > BC on right but not as much time difference as on left
A 5 year old girl is brought to clinic with ear pain x 4 days. Upon otoscopic exam you see erythema and a hypomobile TM, but no drainage. What is your diagnosis? What pathogens are likely involved?
acute otitis media
strep, h. influenzae
Parents bring their 7 year old son to your office, saying he is having trouble hearing. Your HPI reveals hx of 6 episodes of acute otitis media in the past year, and your exam reveals purulent otorrhea and a perforated TM. What is your diagnosis? What pathogens are likely involved?
chronic otitis media
P. aeruginosa, staph
After diagnosing a 3 year old girl with acute otitis media, you don’t see her again for 2 months. When her mother brings her back in, she has been spiking fevers and has postauricular redness and swelling, with tenderness to palpation. What is your diagnosis?
mastoiditis
A 35 year old male lawyer visits your clinic complaining of hearing loss. Your HPI reveals a 5 year history of allergic rhinitis. He doesn’t take anything for his allergic rhinitis, because he “doesn’t like feeling sleepy.” Upon otoscopic exam you observe a dull and hypomobile TM, with air bubbles in the middle ear. What is your diagnosis and your treatment plan? What obstruction can develop with longstanding allergic rhinitis?
serous otitis media
corticosteroids
nasal polyps
Your patient is a 44 year old female hairstylist with a CC of “drainage from ear x 3 weeks.” You have seen this patient several times over the past 2 years and know she has had many viral URIs and prolonged eustachian tube dysfunction. Your otoscopic examination shows a TM perforation exuding keratin debris. What is your diagnosis? What do you tell her about her likely required treatment, and the consequences if not treated?
cholesteatoma
surgery will likely be required to remove the infected sac
if left alone, cholesteatomas can erode bone, destroy ossicles, or involve the facial nerve
A 36 year old female store manager comes to see you complaining of hearing loss and tinnitus that has been getting worse for 8 months. Your HPI reveals that her father and grandfather both had similar issues. What are you thinking for diagnosis, and what is the treatment for this diagnosis? What is a risk if she doesn’t get treatment?
- -otosclerosis
- -hearing aid or surgical replacement of the stapes with a prosthesis (stapedectomy)
- -When otosclerotic lesions impinge on the cochlea, permanent sensory hearing loss occurs
A 17 year old female soccer player presents with history of a soccer ball hitting the left side of her head 2 days ago. She now complains of slight hearing loss in left ear. Your exam shows a dark purple TM. What is your diagnosis? What is your treatment? If there was NO history of trauma, what would you do?
hemotympanum
no treatment required; should resolve over the next few weeks
if no hx of trauma, need CT or MRI to identify vascular malformations/tumor
25 year old male triplets Tom, Dick, and Harry come to your office together, saying they each have runny noses, slight dry cough, eye irritation, and occasional headache. Upon exam, Tom has clear rhinorrhea and pale turbinates. Dick has clear rhinorrhea and erythematous turbinates. Harry has purulent rhinorrhea and says his “cold” has lasted at least 3 weeks. What are your diagnoses?
Tom: allergic rhinitis
Dick: viral rhinitis
Harry: bacterial rhinitis
A 65 year old female postal worker with longtime Type I diabetes presents with facial pain and nasal drainage. Your exam shows a black eschar on the middle turbinate. What is your diagnosis?
rhinocerebral mucormycosis (invasive fungal sinusitis)
Your patient has a maxillary sinus infection, and is asking about possible complications. If a sinus infection doesn’t clear, and patient develops symptoms of fever, decreased vision, papilledema, and problems with extraocular movements, what complication would you suspect?
cavernous sinus thrombosis
A 76 year old female homemaker complains of a “runny nose” whenever she goes outside in the winter. She is worried that she is allergic to the trees outside her house. You question her further, and discover that this rhinorrhea only occurs in cold weather, and not in the spring. What is your diagnosis?
vasomotor rhinitis
A 31 year old male barista comes to your urgent care clinic with facial trauma after a misplaced kick at his karate class. Your initial inspection and palpation of the nose reveals a nasal fracture, and now you are going to perform a nasoscopic exam.
What signs told you there was a nasal fracture?
What are you going to look for inside the nose, and why?
Inspection and palpation showed tenderness, crepitance, and mobile bony segments, which indicate nasal fracture.
You need to assess for septal hematoma, which would look like a widening of the anterior septum. You need to identify this because the septal cartilage has limited and specific blood supply, and an untreated septal hematoma will result in loss of the nasal cartilage, which will mean deformity for your patient.
Your next patient is a 21 year old female college student who goes to school full time as well as works nights at your hospital. She says she has bleeding, painful gums x 1 week as well as fever today. She hasn’t had any tooth pain or problems. When you examine her you find halitosis and cervical lymphadenopathy but no edema or erythema in her neck. What is your diagnosis? What causes this?
Vincent’s infection, aka necrotizing ulcerative gingivitis, aka trench mouth
caused by spirochetes/fusiform bacilli
