OSCE Review: ENT

1. impaired transmission in outer/middle ear
2. AOM, MEE, obstruction
3. Weber test (vertex of head), sound to affected ear, Rinne (air/bone) = bone > air

1. disruption to nerves, 1/5 by 55yo
2. neural degeneration, congenital, noise-induced
3. Weber = sound to good ear, Rinse = nl (AC > BC)

1. gradual hearing loss
2. MCC of SNHL
3. MC in men
4. high frequency

*aminoglycosides (tobramycin, gentamycin, streptomycin)
*Vancomycin

1. dt viral illness
2. dizzy AND nl hearing
3. rehydrate, meds (meclizine, benedryl, prednisone), better in 1 month

1. inflammation of labyrinth (inner ear (vestibule, semi-circular canals, cochlea))
2. MCC = infxn
3. dizzy, vertigo, AND hearing loss
4. refer, rehydrate, Abx/Antivirals, high dose CS, meds (meclizine, bendryl, diazepam),audiogram @ 1st visit

1. recurrent/progressive HL (starts unilateral --> bilateral)
2. unknown, distension of endolymphatic compartment of inner ear
3. HL + tinnitus/vertigo/N/V, aural fullness, recurrent/progressive
4. rehydrate, diuretic, ear meds (meclizine, benedryl, prednisone), surgical intervention

1. spinning
2. dt otoliths in semicircular canals
3. dizzy, nystagmus (rotary), lasts days-weeks, reproduced w/ Dix-Hallpike maneuver
4. Epley maneuver

1. benign tumor of 8th CN (schwanooma)
2. insidious SNHL, tinnitus, vertigo, dx = CT/MRI
3. surgery

1. infxn of middle ear
2. >/= 3 in 6mo,>/= 4 in 1 yr
3. H. flu, M. cat, S. pneumo

*deformity (ET short, ET abnl, facial)
*daycare *allergies
*immunodeficient
*<6mo & no breastfed
*1st infxn <1yr *male
*smoke *low SES

*otalgia, URI sx, Fever, fullness, HL, pull on ear, irritable
*decreased mobility of TM, otorrhea w/ perf

*Early: dull eardrum, clear fluid, increased vascularization
*Late: bulge/cloudy erythematous TM, bubbles, purulence

*APAP or ibuprfen for pain
*Watchful waiting (NOT for <6mo, 6-2yo w/ certian dx, 6- up w/ severe illness)
*Amoxicillin (Amoxil), extended spectrum PCN, 80-90mg/kg divided BID-TID x7-10d
*improve w/in 72 hrs
*PE tubes if recurrent

1. fluid in middle ear
2. otalgia, HL, NO FEVER

1. permanent alteration of middle ear surfaces
2. HL, drainage/odor, F
3. topical Abx

1. infxn of external ear/auditory canal
2. P. aeruginosa
3. otalgia, F, HL, ear pain w/ pinna manipulation
4. keep dry, bacterial cause = Abx drops, CS sol'n

1. complication of AOM, inflammation of mastoid air cells
2. tender, HA, otalgia, F
3. Admit, temporal bone CT, IV Abx

1. highly contagious infxn
2. GABHS
3. MC in 5-15yo

1. acute onset, ST, dysphagia, F, exudates, malaise, erythematous, tender anterior cervical nodes
2. NEED ALL 4: fever, tender anterior cervical nodes, exudates, no cough

1. rapid strep, incresed WBC
2. Supportive (analgesic, rest, fluid); PCN
-Adults: 500mg BID x 10d
-Child: 250mg BID x 10d; not contagious after 24 hrs, change toothbrush

1. MCC of ST, insidious onset, coryza, lacks exudates
2. ST, cough, HA, enlarged tonsils
3. r/o strep, monospot
4. supportive, salt H2O, APAP

1. pus b/t anterior tonsillar pillars & superior pharyngeal constrictor muscle
2. trismus, "hot potato voice," drool, deviated soft palate/uvula
3. aspiration or I&D, Abx, tonseillectomy if indicated, IV rehydrate & pain

1. MCC of hoarseness, usu dt virus
2. smokers
3. supportive, voice rest, refer if >2wks/smoke/no cause/pain/neck mass/chronic EtOH

1. canker sores
2. kids 10-19, F > M
3. topical steroids, anti-inflammatories, good hygiene

1. life-threatening infection
2. H. flu, strep, pneumococcous, staph
3. MC kids 2-6yo

*abrupt onset *fever --> stridor
*4D's: drool, dysphagia, dysphonia, distress (resp)
*tripod

E = muffled voice
E = minimal cough
E = no URTI hx
C = hoarse voice
C = barking croup
C = + hx of URTI

1. don't culture/examine throat, never leave alone, leukocytosis + left shift, THUMBPRINT sign on lateral xr
2. maintain airway, CS, Abx IV (Cefotaxime/ceftriaxone), tx household contacts w/ rifampin....HIB vaccine

1. croup or LTB
2. viral cause (fall/winter), MCC of upper airway obstruction/stridor in kids
3. MC in 6mo -3yo

1. URI, barky cough, stridor (at night), F, nasal flare, no drool
2. xr = steeple sign
3. admit, humidification, CS

1. Virus, H. flu, M. cat, S. pneumo
2. Acute <4 wks, subacute 4-12 wks, chronic >12wks

1. URI, allergic rhinitis, asthma, smoking, dental procedures, anatomical abnl, FB
2. HA, retroorbital pain, otalgia, nasal congestion, sinus pain, tooth pain,

*bacteria sx >10d or worsening, purulent d/c, unilateral pain/tender, Fever

1. CT
2. symptomatic = nasal saline, decongestant, warm packs, analgesics, expectorant
*Abx (10d w/ pain & purulence) = Amox, Amox/Clav, 2nd/3rd gen Ceph

*Amox: 1g PO TID x10d
*Amox/Clav (Augmentin) - beta-lactam PCN: 2000/125 mg BID x10d

1. common cold, URTI
2. runny nose, scratchy throat, HA, malaise, cough, F
3. r/o strep
4. symptomatic (H2O, rest)
-decongestant (pseudoephedrine)
-antitussive (dexromethorphan (robitussin)
-expectroant (Guaifensin)

1. infectious via saliva, cause = EBV, MC 10-30yo
2. fatigue, ST, malaise, low grade F, petechiae, rash
3. TRIAD = fever, tonsillar pharyngitis, lymphadenopathy (post chain)

1. mono spot, WBC, EBV titer, r/o strep
2. APAP/NSAIDS, gargle w/ lidocaine, rest, avoid contact activity (increase of spleen rupture), steroids if enclosing throat

1. IgE mediated response
2. itchy eyes/throat, runny nose, sneeze, congestion, allergic shiners (increase BF), allergic salute (nasal crease), Dennie Morgan lines (edema/thickening)

*Antihistamine (2nd gen): loratidine (Claritin) 10mg QD
*Antihistamine (1st gen): Diphenhydramine (Benadryl): 25-50mg q4-6hrs
*Decongestant = Pseudoephedrine (Sudafed), alpha adrenegic agonist 30-60mg/dose q6hr
*Intranasal CS: Fluticasone (Flonase) 2 sprays (50mcg) per nostril QD
*Afrin x 3-5d (avoid rhinitis medicamentosa)
*remove animals, put pillows/mattress in plastic

1. swollen parotid/submandibular, xerostomia, xerophthalmia
2. + Schirmer's test (filter paper in lower conjunctiva <5mm in 5 min)
3. Moisture replace, NSAIDS