ENT

Question 1

Bacterial Pharyngitis Physical Exam

Answer 1

• tonsillar exudate
• pharyngeal erythema
• tender ANTERIOR CERVICAL lymphadenopathy
• no nasal discharge or edema
  lungs clear

Question 2

Peritonsillar Abscess Exam

Answer 2

• hx of sore throat, drooling, trismus (unable to open mouth), “HOT POTATO VOICE”
• extremely swollen and fluctuant tonsil
• DEVIATION OF UVULA to opposite side

Question 3

Infectious Mononucleosis findings

Answer 3

• MALAISE STARTED BEFORE SORE THROAT
• headache
• Low-grade fever
• abdominal discomfort
• POSTERIOR LYMPHADENOPATHY
• hepatosplenomegaly

Question 4

Initial diagnostic test (IM)

Answer 4

Mono-spot

Question 5

Modified Centor Criteria

Answer 5

• tells who needs to be tested for rapid strep

Tonsillar exudate +1
Tender anterior cervical adenopathy +1
Fever +1
Absence of cough +1
Age: < 15 y.o +1; >45 y.o -1

• More than 1, you have to test

Question 6

Diagnosis of IM

Answer 6

• if IM suspected = Monospot (initial test) - detection of heterophil antibodies
• If Monospot is negative and clinical findings suggest IM = specific IgM antibodies = confirm dx

Question 7

Lab findings with Dx of IM

Answer 7

• lymphocytosis on CBC
• atypical lymphocyte on blood smear
• elevated liver enzymes

Question 8

Best initial therapy

Answer 8

supportive therapy

Question 9

IM therapy

Answer 9

• supportive

- return to sports 4 WEEKS AFTER ILLNESS ONSET

Question 10

Allergic Rhinitis

Answer 10

• hx of asthma, seasonal allergies
• BILATERAL nasal congestion
• Clear rhinorrhea
• BILATERAL CONJUNCTIVITIS
• sneezing
• nasal ITCHING
• no fever
• ALLERGIC SHINERS
• PALE NASAL MUCOSA

Question 11

Acute Rhinosinusitis Testing

Answer 11

clinical dx

- no test needed

Question 12

Bacterial Rhinosinusitis Tx

Answer 12

Augmentin

-respiratory FQ if pt has allergy to PCN

Question 13

Criteria for ABX Therapy

Answer 13

1. severe symptoms for 3 consecutive days w/out improvement
2. symptoms for 10 days w/o improvements
3. Double Sickening: symptoms, improve, then worsen

Question 14

Acute Otitis Media

Answer 14

• no tragal tenderness
• no adenopathy
• external auditory canal w/o erythema
• TM opaque, bulging and immobile
• decreased hearing

Question 15

Malignant otitis externa findings

Answer 15

• severe otalgia that extends to TMJ
• pain with chewing
• nocturnal pain
• edema
• erythema of ear canal extending to pinna and mandibular area
• cranial nerve palsies (facial)

Question 16

Otitis media with effusion

Answer 16

• tympanic membrane with bubbles or fluid filled
• RETRACTED (malleus appears more prominent)
• decreased mobility of TM
• hearing loss without pain
• no fever

Question 17

When to start ABX for acute otitis media

Answer 17

signs of tympanic membrane effusion (bulging, not moveable) and inflammation (pain/fever)

Question 18

Best initial tx OM

Answer 18

Amoxicillin: young children

Augmentin