Otorhinolaryngology clinic day Flashcards Preview

Clin Med part II > Otorhinolaryngology clinic day > Flashcards

Flashcards in Otorhinolaryngology clinic day Deck (28)
Loading flashcards...
1
Q

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?

A

Weber: lateralizes to right
Rinne: BC > AC on right, AC < BC on left

2
Q

A 27 year old female chef has sensorineural hearing loss in right ear. What do you expect to see with Weber and Rinne tests?

A

Weber: lateralizes to left
Rinne: AC > BC on left; AC > BC on right but not as much time difference as on left

3
Q

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?

A

acute otitis media

strep, h. influenzae

4
Q

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?

A

chronic otitis media

P. aeruginosa, staph

5
Q

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?

A

mastoiditis

6
Q

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?

A

serous otitis media
corticosteroids
nasal polyps

7
Q

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?

A

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

8
Q

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?

A
  • -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
9
Q

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?

A

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

10
Q

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?

A

Tom: allergic rhinitis
Dick: viral rhinitis
Harry: bacterial rhinitis

11
Q

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?

A

rhinocerebral mucormycosis (invasive fungal sinusitis)

12
Q

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?

A

cavernous sinus thrombosis

13
Q

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?

A

vasomotor rhinitis

14
Q

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?

A

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.

15
Q

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?

A

Vincent’s infection, aka necrotizing ulcerative gingivitis, aka trench mouth

caused by spirochetes/fusiform bacilli

16
Q

Your PA mentor congratulates you on your diagnosis of the college student with necrotizing ulcerative gingivitis, and asks you how you knew it wasn’t Ludwig’s angina. What do you tell her?

A

Ludwig’s angina is an infection of the sublingual/submaxillary spaces, usually following a mandibular tooth infection. It would present with edema and erythema of the upper neck, with the tongue displaced upward and back, and pus on the floor of the mouth.

causative bacteria may be strep, staph, bacteroides, fusobacterium

17
Q

You see a 51 year old male unemployed janitor. He presents with white patches on his tongue. Your HPI elicits the following information:
–he has a 35 pack/year smoking history
–he has a 10 year history of unprotected sex with female street sex workers
–he drinks one bottle of bourbon per night
What are your top 2 differential diagnoses, and why?
What are two quick tests you will perform to help narrow your diagnosis?

A
  1. Oral candidiasis
    - -hx of unprotected sex with unknown partners = risk of HIV. Candidiasis is often the first manifestation of HIV in patients with no known predisposing cause for candidiasis
  2. Leukoplakia
    - -hx of heavy smoking & alcohol use

Tests
–try to scrape the white patches off of the tongue: oral candidiasis = easy to scrape off; leukoplakia = cannot remove white patches

–KOH prep: if candidiasis, will show spores and mycelia

18
Q

It turned out that you were not able to scrape off the white patches from the tongue of your 51 year old unemployed janitor patient. You scrutinize his tongue more closely, and realize that there is also erythroplakia present.
What is erythroplakia? Why is it critical to recognize it? What is your next step?

A

Erythroplakia is a lesion of the mucosa that is erythematous rather than white.

About 90% of cases of erythroplakia are either dysplasia or carcinoma.

You need to perform an excisional biopsy of the area.

19
Q

You are a second year PA on a family practice rotation, and a first year PA asks you, “I get confused by all these patients with mouth sores. How can I tell the difference between canker sores, herpetic stomatitis, herpangina, and hand-foot-mouth disease?”
What do you answer?

A
  • -canker sores (aphthous stomatitis): usually single or a few only; have disabling pain. No other associated symptoms; can occur at any age
  • -herpetic stomatitis: kids; multiple painful sores in anterior mouth (usually gingiva, lip, tongue, buccal mucosa)
  • -herpangina: kids; HIGH fever; multiple painful sores on soft palate
  • -hand-foot-mouth disease: kids; stomatitis; vesicular rash on hands and feet
20
Q

Your patient is a 6 year old boy with a sore throat and a scarlatiniform pharyngeal rash, whose mother asks you if he has strep throat. You call to mind the
Centor Criteria - what are they?

A
  1. history of fever over 38 C
  2. lack of cough
  3. tonsillar exudate
  4. anterior lymphadenopathy
21
Q

You evaluate your 6 year old patient with sore throat and scarlatiniform pharyngeal rash according to the Centor Criteria. What do you do next if the score is:
0?
2?
4?

A

score of 0: diagnosis not strep throat. Do not treat for strep throat

score of 2: order rapid strep test or throat culture

score of 4: diagnosis of strep throat. Treat for strep throat (pen V or cephalosporin)

22
Q

Your clinic is in an area of the state where there is a high rate of vaccine refusal amongst parents for their children. You see an 8 month old female for sore throat, nasal discharge, and low grade fever. Upon conclusion of your exam you diagnose diphtheria. What did you find on your exam that led you to this diagnosis?

A

gray tonsillar pseudomembrane

23
Q

A 20 year old female student at PSU comes to your clinic feeling tired and feverish. She is concerned that she has mono, since three people in her dorm have it and they all share lip balm, sodas, etc. What physical findings would you expect to find if she has mono? What tests might you run? What causes mono? How will you NOT treat it?

A
  • -marked lymphadenopathy
  • -splenomegaly
  • -enlarged tonsils
  • -“shaggy white-purple tonsillar exudate”
  • -Monospot test will be positive 4 weeks after onset; lymphocytosis
  • -caused by Epstein-Barr virus
  • -do NOT treat with ampicillin…will likely cause a generalized, itchy, maculopapular rash
24
Q

A 41 year old male economics professor visits your office complaining of hearing loss (he can’t hear the bass on his stereo anymore), and some “dizziness” that comes and goes. Upon further questioning about his dizziness, he says that sometimes he feels as though the room is spinning even though he is not moving. What disorder do you suspect and why? What is the treatment for this disorder?

A

Menieres disease - episodic vertigo with low-frequency hearing loss
low salt diet & diuretics

25
Q

Your patient is a 9 year old girl whom you have seen several times for strep throat. Her caregiver is not consistent with giving her the antibiotics you have prescribed repeatedly. You are concerned about complications from untreated strep throat. What are these potential complications?

A

scarlet fever
glomerulonephritis
rheumatic myocarditis
peritonsillar abscess

26
Q

You suspect that your 9 year old patient with untreated strep throat now has a peritonsillar abscess. What are the signs of peritonsillar abscess?

A

muffled “hot potato” voice
severe sore throat & odynophagia
trismus
medial deviation of the soft palate

27
Q

A 28 year old female basketball coach presents with a CC of “when I move my head to the right, I get dizzy for a minute or two. If I hold still, it goes away.” What do you suspect? What key questions are you going to ask her? What test are you going to perform and how will you interpret the results of this test?

A

Benign paroxysmal positioning vertigo

Ask her what she means by “dizzy” - lightheaded or like the room is spinning (true vertigo)
Ask her about hearing loss - there is no hearing loss with BPPV

Dix-Hallpike maneuver - look for nystagmus beating toward the left (unaffected side)

28
Q

Your patient, a 33 year old male upholsterer, is complaining of feeling that the room is spinning. He has this sensation continuously. He says he does not have hearing loss, and he is recovering from a cold. What do you suspect? What would you suspect if he did have hearing loss?

A

Continuous vertigo without hearing loss, and history of viral illness, should make you think vestibular neuronitis.

Continuous vertigo with hearing loss, and possibly with bacterial infection symptoms, should make you think labyrinthitis.