Week1 Flashcards
What parts of the chief complaint are applicable to most all issues?
LOCQSMA
Can you use PSFS for EENT?
Not recommended because it is more for musculoskeletal presentations
What are associated symptoms questions for eyes?
Begin with the open question: “do you have any other symptoms or problems?”
Eyes: besides eye pain, any changes in vision? Blind spots? Blurriness/double vision? Haloes around lights? Etc
What are associated symptom questions for ears?
Begin with the open question: “do you have any other symptoms or problems?”
Ears: besides ear pain, change in hearing? Dizziness/balance problems? Tinnitus?
What are associated symptom questions for nose/sinus?
Begin with the open question: “do you have any other symptoms or problems?”
Nose/sinus: trouble breathing? Change in sense of smell? Running nose? Headache? Discharge (including back of throat)? If there is discharge, what color is it?
What are associated symptom questions for throat?
Begin with the open question: “do you have any other symptoms or problems?”
Throat: besides sore throat, trouble swallowing? If so, solids or liquids?
*chronic hoarseness can be a red flag in an older patient with no apparent cause (tumor affecting recurrent laryngeal nerve)
When should you be concerned abou hoarseness
- Have had for several weeks - a month +
- no obvious cause (yelling, pharyngitis, etc)
- older patient (60+)
***worry about SOL compressing the vocal cords
What are the big 5 constitutional symptoms (for infections, cancer, autoimmune inflammatory disease, etc)
Fever Weight loss/change Fatigue Malaise Loss of appetite
If you have a patient who comes in with a EENT issue but YOU ARE SHORT ON TIME, what area of EENT questions can you cut out?
Eyes, they are not as commonly associated with ENT. ENT are all very connected to each other though
What are the clue for pharyngitis?
Fever, tonsillitis exudate, tender anterior cervical lymphadenopathy, absence of cough
What are the signs/symptoms for glaucoma?
- > 50
- blurred vision, occasionally multicolored haloes around lights
- eye pain
- headache
What does PERRLA stand for?
Pupils equal, round, react the light, accommodate
What CN are you examining with the corneal reflex?
5 and 7
What are you looking for with an otoscope and what can each tell you?
- Inflammation (rhinitus, sinusitis)
- Discharge (rhinitus, rhinosinusitis)
- Polyps (multiple in kids= polycystic disease, solitary in >50 = referred for biopsy for tumor)
- deviated septum (at risk for sinusitis)
- trouble sleeping (sleep apnea)
What are the exam procedures for rhinosinusitis?
Scope, light
Some do Sinus percussion
Whenever an infection is suspected anywhere in the head, the PE must include: (3)
Temperature, throat exam, palpate cervical lymph nodes
What are the common causes of otalgia linked with abnormal ear examination?
Otitis media
Otitis externa
Foreign bodies
Barotraumas (shattered ear drum)
What is Acute otitis media? Will it respond to antibiotics
Bacterial middle ear infection
It might
What is otitis media with effusion? Will antibiotics help
Fluid in the middle ear due to past AOM, a viral infection, or Eustachian tube blockage
No
What are differences between AOM and OME (presentation, onset, temp)?
AOM = patient presents ill/sick, rapid onset (<48 hours), temperature >101F adult or >102F child
OME = patient presents normal timidly sick, slower onset,temp normal or <101 adult <102F child, normal to refracted tympanic membrane
What are the common causes of otalgia associated with normal ear examination? (4)
TMJ syndrome, dental causes, pharyngitis or tonsillitis, cervical spine syndrome
Explain TMJ causing otalgia
Patients report pain or crepitus with talking or chewing and a habit of clenching the teeth and biting the inside of the lips and mouth. Examination shows tenderness of the TMJ, crepitus or clicking on mandible motion, and possibly restricted jaw movement.
Explaindental causes of otalgia
These include caries or periodontal abscess (the most common dental causes), impacted third molars, or pulpitis. Mouth examination of the oral cavity may show caries, abscess, gingivitis, facial swelling, and teeth tender to percussion.
Explain otalgia from referred neck tissues
C2, C3 cervical nerve roots in cervical spine arthritis. There may be crepitus or pain with neck movement, decreased cervical range of motion, and/or tender spinous processes or paraspinal muscles.
Symptomatic treatment is appropriate for adults younger than 40 years who are in otherwise good health with normal ear examination, unless symptoms persist.
What is the difference between rhinitis and rhinosinusitis?
Rhinitis is only in the nasal passages, rhinosinusitis includes the sinuses
What are the risk factors for rhinosinusitis?
- deviated septum and other anatomical variations
- tooth infection
- GERD
- vitamin D deficiency
- Aspirin intake
What is the presentation and timing of rhinitis?
2-3 days, mild symptoms
What is the presentation and timing of viral RS?
4-7 days (may go 14 days with symptoms steadily improving), mild to moderate symptoms
What is the presentation and timing of bacterial RS?
> 10 days, or a “double sickening” around day 5-7or very severe symptoms at day 3 or 4
What are the cardinal diagnostic criteria for rhinosinusitis?
Sudden onset of symptoms often occurring after a short course of rhinitis (several days) and consisting of
1- nasal discharge (anterior or posterior)
OR
2- facial pain-pressure-fullness
OR
Reduction/loss of smell
PODS (Pain or facial pressure, nasal Obstruction, discolored Discharge, loss of Smell)
Which PE finding is most accurate at diagnosing rhinosinusitis?
?
What are other symptoms of RS other than the cardinal diagnostic criteria
?
