(PCM L1) 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 (clear discharge)
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 (rubbery, hard, soft)
Size (pea size, quarter size)
Tenderness
Mobility or adhered
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
1. conductive loss: ossicle sclerosis into a single immovable mass
2. sensory loss: otic capsule sclerosis
Affects 10% of Caucasians (female > male)
What is the Weber test?
Place vibrating tuning fork on middle or head of forehead
- Normal: sounds equal on both ears
- Abnormal: If sound lateralizes to one ear, it is either conduction loss in that ear or sensorineural loss in the opposite ear.
In a Weber test, where does conductive hearing loss lateralize to?
In a Weber test, where does sensorineural hearing loss lateralize to?
Affected side
Opposite affected side
In a Rinne Test, what would be expected in conductive loss?
Bone Conduction > air conduction
- Vibrating tuning for placed on mastoid bone behind
- When pt no longer hears sound, quickly place fork close to ear canal and inquire if they can hear the sound and for how long they hear it.
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 rhinosinusitis/sinusitis?
Inflammation of mucosal lining in paranasal sinuses
-mostly due to infections
*rhinosinusitis = both/sinusitis = one
What are symptoms of rhinosinusitis/sinusitis?
Nasal discharge Cough Nasal congestion Fever Headache Pain Facial pressure
Describe bacterial sinusitis.
Double sickening (patient will initially get better then get much worse), purulent rhinorrhea, elevated ESR
- Acute bacterial rhinosinusitis is indicated when signs and symptoms of acute rhinosinusitis persist w/out evidence of improvement for at least ten days beyond onset of upper respiratory symptoms
- Treat with antibiotics
What is croup (laryngotracheitis)?
Swelling of larynx, trachea, and bronchi that can cause a stridor and barking cough in young children
- caused by parainfluenza virus, influenza, respiratory syncytial virus
- history: barking cough
- presentation: fever, nasal flaring, respiratory retractions, stridor
- workup: usually not indicated but can perform XR
What is epiglottitis?
Inflammation of epiglottis and adjacent structures
- causes: heamophilus type b influenza, group a beta hemolytic streptococcus
- history: rapid onset of symptoms, sore throat, muffled voice, drooling
- presentation: high grade fever, toxic appearance, tripod stance, important to treat right away
- workup: consider lateral neck XR, WBC
- treatment: protect airway!, broad spec. antibiotics
What do you test for in/on the nose?
- Inspect for lesions, midline, deformity etc.
- Nasal obstruction (press on each nasi ala and ask pt to inhale)
- Press on tip of nose (tenderness, infection, furuncle)
What is the finger rub test?
Place hand near both ears then rub fingers near patient ear one at a time, allow patient to tell examiner which ear the patient hear the sound
What is the whisper test?
- Examiner stands behind pt, has pt occlude one ear
- Whisper combination of letters or numbers into non-occluded ear and have pt repeat
How is the thyroid palpated?
Stand behind pt
1. Have patient flex neck slightly to relax SCM
2. Place fingers of both hands on patient’s neck so
that index fingers lie just below cricoid cartilage.
3. Have patient swallow so thyroid rises up under finger pads.
4. Displace trachea to right and palpate right lobe.
Repeat for left lobe.
Allergic rhinitis
Inflammation in the nose caused by allergen characterized by sneezing, rhinorrhea, and nasal obstruction
Anterior epistaxis
Most common nose bleed usually affects the vascular watershed area of the nasal septum (Kisselbach’s plexus)
Posterior epistaxis
Less common, usually this is causes a more significant bleeding and affects posteriolateral branches of the sphenopalatine artery
Tonsillitis
Inflammation of the tonsils usually due to a specific bacterial or viral infection
Infections mononucleosis
Illness caused by a virus called Epstein Barr Virus and causes triad of fever, tonsillar pharyngitis (sore throat), and lymphadenopathy (enlarged lymph nodes)
Labs to consider performing when diagnosing streptococcus
- Rapid antigen detection test or rapid
What is acute suppurative otitis media?
Acute otitis media with purulent material in middle ear
What is chronic otitis media with effusion?
Occurs when fluid remains in middle ear and continues to return w/out bacterial or viral infection.
Makes children susceptible to new ear infections and may affect hearing
What is suppurative chronic otitis media?
Persistent ear infection that often results in tearing or perforation of eardrum
What differentials suggest ENT causes of vertigo?
- Eustachian tube dysfunction
- Benign paroxysmal position vertigo (BPPV)
- Vestibular neuritis
- Laybrinthitis
- Meniere’s disease
What is eustachian tube dysfunction
Most common, tube is inflamed and mucus or fluid builds up. From flu, sinus infection or allergies
What is benign paroxysmal position vertigo (BBPV)?
Brief episodes of mild to intense dizziness. Usually triggered by changes in position of head
What is vestibular neuritis?
Branch associated with balance, NO changes in hearing, damage to sensory neurons of vestibular ganglion
What is labyrinthitis?
Occurs when infection affects both branches of vestibulo-cochlear nerve, hearing changes, dizziness/vertigo
What is Meniere’s disease?
Disorder of inner ear causes episodes in which you feel as if you are spinning (vertigo). Fluctuating hearing loss with progressive loss. Ringing in ear (tinnitus), sometimes feeling of pressure.
May only effect one ear. Chronic condition, starting between ages of 20 and 50 but can happen at any age
What are the techniques for BPPV?
- Dix-Hallpike maneuver (diagnosis)
- Epley maneuver (diagnosis and treatment)
