Shared Flashcard Set

Details

HEENT and lymph node examination
ECM II Quiz 1
49
Medical
Graduate
10/19/2009

Additional Medical Flashcards

 


 

Cards

Term

[image]

Name the nodes

Definition
[image]
Term

[image]

Name the nodes

 

Definition
[image]
Term

[image]

Name the nodes

Definition
[image]
Term
[image]
Definition
[image]
Term
The Five Characteristics of LN
Definition
  • Size
  • Mobility
  • Discrete or matted
  • Consistency
  • Tenderness
Term
Normal characteristics of lymph nodes
Definition
  • Small, mobile, discrete, rubbery, non-tender = normal
  • Tender = inflammation
  • Hard or fixed = malignancy
  • Fluctuant nodes = pus
  • Doughy (compressible) = caseation (TB)
Term
Discrete, rubbery, non-tender enlarged LN is indicative of what disease?
Definition
Leukemia/Lymphoma
Term
Multiple, non-tender, matted, suppurative (purulent) LN's indicate what disease?
Definition
Tuberculosis
Term
Palpable, deep-left clavicular (Virchow's node) lymphadenapothy indicates what disease?
Definition
Intra-abdominal malignancy
Term
Stony hard, non-tender LN's are indicative of what type of disease?
Definition
Carcinomatous
Term
Enlarged epitrochlear node is indicative of what disease?
Definition
TB
Term
Genital lesions with enlarged satellite nodes are indicative of which diseases?
Definition
  • Syphillis, gonorrhea, chancroid, lymphogranuloma venereum
  • Tuberculosis
  • Penile cancer
Term
Inoculation sore with satellite nodes inflammation suggests which diseases?
Definition
  • Strep infection, syphillis, TB, sporotrichosis, anthrax, etc.
  • Primary neoplasm
Term
History corroborating AOM
Definition
  • Male
  • Age ~2 yrs
  • Attends daycare
  • Disease manifests in Fall/Winter
  • Exposed to cigarette smoke
  • Note: breast-feeding is believed to offer protection
Term
Pertinent symptoms of AOM
Definition
  • Most common are bulging tymanic membrane (LR = 51) with cloudy color (LR = 34) and impaired mobility (LR = 31)
  • Despite what's taught, distinctly red coloration is only somewhat indicative of AOM (LR = 8.4)
  • Non-specific symptoms (ear pulling, irritability, cough, rhinitis, fever) occur in ~70% of children WITHOUT AOM
Term
Tracheal deviations indicate what?
Definition
  • Deviate TOWARDS the side with volume loss
  • Deviate AWAY from sides with effusion or pneumothorax
Term
How is the Weber test performed and what does it indicate?
Definition
  • Tuning fork is held to center of forehead
  • Sound lateralizes TOWARDS ear with conductive hearing loss
  • Sound lateralizes AWAY from ear with sensorineural hearing loss
Term
How is the Rinne test performed? What does it indicate?
Definition
  • Pitchfork is struck and placed on mastoid process. Patient indicates when sound has stopped, at which point pitchfork is held to ear.
  • In normal conditions, air conduction is greater than bone (patient can hear pitchfork when held to ear)
  • In conductive hearing loss, bone conduction is greater than air (patient cannot hear pitchfork when held to ear)
Term
Causes of conductive hearing loss
Definition
  • Serous otitis media
  • Cerumen impaction
  • Cholesteatoma (marginal TM rupture)
  • Ostosclerosis
  • Foreign body
Term
Causes of sensorineural hearing loss
Definition
  • Congenital
  • Bacterial meningitis
  • Otic syphilis
  • Collagen-vascular disease
  • Loud noise
  • Ototoxic drugs (e.g. aminoglycosides)
  • Age (i.e. presbycusis)
  • W/ balance disturbance
    • Viral labyrinthitis
    • Meniere's disease
Term
Which facial node is not usually inflamed in otitis media?
Definition
Pre-auricular
Term
What are the major landmarks of the ear?
Definition
[image]
Term
[image]
Definition

 

Acute otitis media – Look for outward bulging of white opaque tympanic membrane.  also associated with rhinitis, ear pain, cough, irritability and fever

Term
[image]
Definition

Bulous myringitis

  • Localized type of Otitis Externa
  • Associated with acute viral URI.
  • Bullous, hemorrhagic lesions on skin in deep inner ear/surface of the tympanic membrane.  
  • Bloody discharge.  
  • Self-limited     
Term
[image]
Definition
Tympanosclerosis – horseshoe shaped large white chalky covering on tympanic membrane.  Increased membrane thickness from chronic inflammation
Term
[image]
Definition
Serous effusion (aka serous otitis media) - clear liquid and air bubbles in the middle ear canal, "plugged ears" due to viral URI's or pressure changes. Air bubbles in Eustachian tube, draws fluid into ears
Term
[image]
Definition
Tympanic membrane perforation - most likely due to trauma or infection
Term
Assume a patient has cerumen build-up in left ear. What hearing test results would you expect to see?
Definition

The Rinne to be neg on the left, and the Weber to lateralize to the left ear.

Term
Describe the pathology of cerumen
Definition
  • Either a dark/sticky or yellow/crumbly waxy build-up in the ear
  • Leads to conductive hearing loss
  • No fever or pain
  • Feeling of fullness or tinnitus
  • Risk factors = use of Q-tip to clean ear canal, use of stethoscope, hearing aid or ear bud
Term
[image]
Definition

Healthy tympanic membrane. Note pearly gray color and translucence.

  1. Short process of malleus
  2. Cone of light
  3. Handle of the malleus
  4. Short process of malleus 
  5. “Chorda tympani”
  6. The incus 
  7. The round window niche;
  8. The promontory,
  9. eustachian tube orifice

[image]

Term
[image]
Definition
Otitis externa: pain on pressure of tragus (pre-insertion), history of water insertion, afebrile, no nasal congestions
Term
[image]
Definition
Hemotympanum- bloody effusion, indicative of head trauma (basilar skull fracture)
Term
[image]
Definition

Pharyngitis (tonsilitis?)

 

 

Note the contrast between the pink color of the soft palate and the “beefy red” color of the tonsils and uvula. You can see the anterior tonsillar pillars, continuous with the uvula. The posterior tonsilar pillars are visible behind the tonsils. Note the patchy white exudate coating the tonsils, which is suggestive of group A beta-hemolytic strep or EBV infection.

 

Term
[image]
Definition

 

Peritonsillar abscess in an adolescent. Note the edema above the tonsil on the right, and the displacement of the uvula to the left. The patient had severe pain on swallowing, and “trismus”—inability to fully open the mouth—because of spasm of the pterygoid muscle which is contiguous to the abscess.

Preschoolers—aged 2-4—can get a “retropharyngeal” abscess, meaning an infection in the potential space between the posterior pharyngeal wall and the prevertebral fascia. They may present with inspiratory noise, high fever, drooling, and refusal to move the neck/head. Do not struggle to examine the throat of a child with such a presentation—get urgent ENT consultation for help in managing the airway.

 

 

Term
[image]
Definition

Suggestive of GAS (Group A strep) pharyngitis- note petechiae on hard palate.

 

Diagnosis would be supported by headache, fever, or abdominal pain, as well as cervical LAD and odor of breath. Rhinorrhea, cough or hoarseness suggests viral process.

Term
[image]
Definition
Nasal polyps- in adults, suggests long-term allergic reaction, in children can be indicative of cystic fibrosis (get sweat test)
Term
[image]
Definition

Aphthous ulcer

  • Painful ulcer
  • 20% of population
  • Etiology – stress, fatigue, hormonal changes, biting, food allergies
  • Treat with topical analgesic
Term
Aphthous ulcer
Definition

A white halo surrounded by erythematous halo on unkeratinized mucosa.  Small, <5mm in anterior mouth and large >5mm in posterior mouth.  Painful.

Term
[image]
Definition

Herpetic lip lesion

 

HSV-1 and HSV-2.  On keratinized epithelia only.  55% of adults

Term
[image]
Definition

Tongue squamous cell carcinoma

 

  • Most common site of malignant growth in head & neck
  •  Risk factors - cigarette smoking, tobacco chewing, alcohol ingestion, betel nut chewing
  •  Exophytic lesion or nonhealing ulcer often with submucosal extension
  •  Diagnosed by tissue biopsy
  •  Regional lymph node metastases often present
  •  CT imaging & endoscopic examination under GA to stage lesion & r/o synchronous lesions
  •  Rx is surgery, RT or both, chemo sometimes

 

Term
Tongue Squamous cell Carcinoma
Definition

Tongue squamous cell carcinoma

 

  • Most common site of malignant growth in head & neck
  •  Risk factors - cigarette smoking, tobacco chewing, alcohol ingestion, betel nut chewing
  •  Exophytic lesion or nonhealing ulcer often with submucosal extension
  •  Diagnosed by tissue biopsy
  •  Regional lymph node metastases often present
  •  CT imaging & endoscopic examination under GA to stage lesion & r/o synchronous lesions
  •  Rx is surgery, RT or both, chemo sometimes

 

Term
[image]
Definition

Candiadiasis (or thrush)

  • Fungal 
  • Predisposing factors-oral antibiotic use, pregnancy, immunodeficiency, HIV, nutritional deficits, systemic steroids
  • Soft, white plaques that can be removed, leaving an erythematous suface
  • Usually asymptomatic
  • Rx: topical nystatin or systemic therapy for resistant cases
Term
[image]
Definition

Leukoplakia

  • White patch or plaque
  • Related to tobacco use or trauma
  • 25% chance of malignancy
Term
[image]
Definition

Gingival enlargement

  • Inflammation of gums
  • Can be due to prolonged use of phenytoin, cyclosporin, calcium channel blockers, hemotologic malignancy
  • Seen in patients with AIDs and diabetes (high blood glucose)
  • Gums foggy and erythromatic
Term
Patient (baby) comes in with large tongue, umbilical hernia, poor growth, short extremities. What is the diagnosis, and what other symptoms would you expect.
Definition
  • Congenital hypothyroidism (cretinism)
  • Lethargy, edema, persistently open fontanelles, course voice
  • Considered emergency; early dx is essential since disease can be irreversible
  • Treat with thyroxine
Term
What lab values/symptoms would you expect to see with Hashimoto's?
Definition
  • High TSH, with low T3/T4 (hypothyroidism)
  • Positive anti-TPO
  • Slow speech, bradycardia, puffy facies, dry skin, delayed relaxation of deep tendon reflexes
  • Also known as acquired hypothyroidism due to Chronic Lymphocytic Thyroiditis
Term
What are the symptoms/lab values for Graves disease?
Definition
  • Low TSH, high T3/T4 (hyperthyroidism)
  • Thyroid stimulating immunoglobulins
  • Ultrasound: Increase blood flow, no focal nodularity
  • Radioiodine Uptake: high radioiodine uptake
  • Rapid speech, staring, thyroid uniformly firm and diffusely enlarged , proximal muscle weakness, hyper-reflexia

[image] [image]

Term
What are the clinical features of papillary thyroid carcinoma?
Definition
  • thyroid gland enlarged asymmetrically, hard consistency, fixed mass apparent with swallow
  • TSH normal
  • No anti-thyroid antibodies detected 
  • Cold, non-functioning nodule when radioactive iodine scintigraphy is administered
  • Bimodal age distribution (occurs in young and old, but not middle aged) in men
Term
What are the clinical manifestations of an ectopic thyroid gland?
Definition
  • Presents as hypothyroidism (high TSH, low T3/T4), without any anti-TPO or anti-TG
  • Stunted growth/maturation
  • Pale appearance, no thyroid enlargement, delayed reflex relaxation
  • Typically seen in patients with family history of "thyroid problems"
  • Failure of fourth pharyngeal arch to descend causes lingual growth
Supporting users have an ad free experience!