H & P Lecture #2

Otitis externa refers to the inflammation of the ear canal and outer ear, while otitis media refers to the inflammation of the inner ear.

Epistaxis refers to a nosebleed, which is the correct answer given in the options. It is the condition where there is bleeding from the nose, and the most common site for nosebleeds is the lower anterior part of the septum, which is easily accessible by the finger.

Sensorineural hearing loss involves the cochlea and cochlear nerve, which are responsible for transmitting sound signals to the brain. This type of hearing loss is typically caused by damage to the hair cells in the cochlea or issues with the auditory nerve. On the other hand, conductive hearing loss involves the path from the external ear through the middle ear. It is usually caused by problems with the ear canal, eardrum, or the tiny bones in the middle ear that conduct sound.

Purulent exudate is characterized by the presence of pus, which is a thick, yellowish fluid consisting of dead white blood cells, tissue debris, and bacteria. Mucopurulent exudate, on the other hand, contains both mucus and pus. Mucus is a slimy substance produced by the mucous membranes, while pus is the result of an inflammatory response to infection. Therefore, mucopurulent exudate contains both mucus and pus.

Moisture causes maceration of skin of canal, creating a great breeding ground for bacteria--may occur after swimming or bathing. Local trauma by q-tips or paper clips helps infection take hold!

The whisper test screens for hearing loss, as it involves whispering a word or phrase to the individual and determining if they can hear it. The Weber test screens for lateralization of sound, as it involves placing a vibrating tuning fork on the midline of the individual's forehead and determining if the sound is heard equally in both ears or if it is heard more in one ear. The Rinne test screens for air/bone conduction, as it involves comparing the individual's ability to hear sound through air conduction (placing a vibrating tuning fork near the ear) versus bone conduction (placing a vibrating tuning fork on the mastoid bone behind the ear).

The Rinne test is used to evaluate hearing loss by comparing air conduction (AC) and bone conduction (BC) in the affected ear. In a normal hearing individual, AC is greater than BC, indicating that sound waves transmitted through the air are more effective in stimulating the auditory system than those transmitted through bone. This is also the result seen in sensorineural hearing loss, where there is damage to the inner ear or auditory nerve. Therefore, the correct answer is AC>BC.

In the Weber test, the sound lateralizes to the affected ear in a conductive hearing loss. This is because in conductive hearing loss, there is a problem with the conduction of sound from the outer or middle ear to the inner ear. Therefore, when the sound is presented, it is not able to travel efficiently to the inner ear, causing it to be perceived more loudly in the affected ear. On the other hand, in a sensorineural hearing loss, the problem lies in the inner ear or auditory nerve. As a result, when the sound is presented, it is perceived more loudly in the good ear as the affected ear is not able to transmit the sound effectively.

During the Weber test, the 512 Hz tuning fork is indeed used. The "U" shape of the fork should be facing forward, and it should be held at the base. It is important not to touch the tines of the fork to allow for proper sound transmission. Therefore, the given answer "True" is correct.

FALSE!!!! Sensorineural phase: involves cochlea and cochlear nerve; a defect here (inner ear, cochlear nerve, or its central connections in the brain) causes sensorineural hearing loss

At this point, you know that the patient has either conductive loss on the right OR sensorineural on the left.
However, we know that the hearing loss is on the right, because that is where the patient failed the screening whisper test! You could also perform Rinne to confirm our answer, expecting to see BC>AC or BC=AC in the right ear.

Nausea and vomiting are not common symptoms of acute sinusitis. Acute sinusitis is characterized by symptoms such as tenderness with sinus palpation, percussion, and general facial pain, fever, headache, nasal discharge, and post-nasal drip. Nausea and vomiting are more commonly associated with other conditions such as gastroenteritis or migraines. Therefore, in the context of acute sinusitis, nausea and vomiting would be considered atypical symptoms.

During the Rinne test, if bone conduction is equal or greater than air conduction, it suggests a conductive hearing loss. This means that there is a problem with the conduction of sound waves through the outer or middle ear, such as a blockage or damage to the ear canal or middle ear structures. On the other hand, if air conduction is more than twice as long as bone conduction, it indicates a sensorineural hearing loss. This type of hearing loss is caused by damage to the inner ear or auditory nerve, resulting in a reduced ability to perceive sound.

False!! Can be viral OR bacterial!

The tug test is used to determine whether the infection is in the external ear canal (otitis externa) or in the middle ear (otitis media). In otitis externa, the infection is localized in the external ear canal, which is the area that is being tugged during the test. Therefore, a positive tug test would indicate otitis externa. Otitis media refers to an infection in the middle ear, which would not be affected by the tug test. Otitis internus is not a recognized term for an ear infection, so it is not relevant to the question.

Acute otitis externa is described as a swollen canal that is narrow, moist, and tender, and can be pale or erythematous. It is commonly known as "swimmer's ear" and is usually caused by a bacterial infection, although it can also be caused by a fungal infection. This condition refers to inflammation of the outer ear canal, typically resulting from water exposure or trauma to the ear canal. It is characterized by pain, itching, and discharge from the ear. Treatment usually involves antibiotic or antifungal ear drops, and sometimes oral antibiotics may be prescribed.

Based on the information given, the Weber test indicates lateralization to the right ear, suggesting that there is a hearing impairment in the right ear. The Rinne test results show that bone conduction (BC) is greater than air conduction (AC) in the right ear, indicating a conductive hearing loss. Therefore, the correct diagnosis is conductive hearing loss in the right ear.

The tragus is the small pointed projection of cartilage in front of the ear canal. It is located on the inner side of the ear, closer to the middle of the head compared to the other structures listed. The helix is the outer rim of the ear, the lobule is the fleshy lower part of the earlobe, the antihelix is the curved ridge inside the ear, and the antitragus is the small bump opposite the tragus. Therefore, the tragus is the most medial structure among the given options.

When examining a patient with Acute Purulent Otitis Media, the correct finding is a bulging tympanic membrane (TM) with lost landmarks. This indicates that there is an accumulation of pus or fluid behind the eardrum, causing it to bulge outward. The loss of landmarks suggests that the infection has affected the structures within the middle ear, making it difficult to visualize the normal anatomical landmarks. This finding is consistent with the diagnosis of Acute Purulent Otitis Media.

In an otoscopic exam, a medical professional uses an otoscope to examine the ear. Since the question specifies the left ear, it implies that the examiner is facing the patient. In this scenario, the examiner's left hand would be on the same side as the patient's left ear, allowing for easier manipulation of the otoscope. Therefore, the correct answer is true.

The finding of a prominent malleus in a patient with a retracted tympanic membrane suggests eustachian tube dysfunction. The eustachian tube is responsible for equalizing pressure in the middle ear, and dysfunction of this tube can lead to negative pressure in the middle ear, causing the tympanic membrane to retract. The malleus, one of the three small bones in the middle ear, becomes more visible and prominent when the tympanic membrane is retracted. This finding is commonly associated with eustachian tube dysfunction.

The Weber test works by placing a tuning fork on the patient's forehead or midline of the skull and asking them to indicate where they hear the sound the loudest. In a patient with conductive hearing loss, the sound is heard loudest in the affected ear because lower frequency sounds are able to bypass the damaged middle ear and travel through the bones of the skull. If there is an occlusion or blockage in the affected ear, the sound cannot escape and therefore appears louder to the patient.

Patients with Chondrodermatitis nodularis helices chronicus typically complain of pain when laying on the affected ear. This condition is characterized by the development of a small, tender, and inflamed nodule on the ear. The pain is often exacerbated when pressure is applied to the affected area, such as when laying on the ear. Other symptoms may include itching, redness, and thickening of the skin.

When examining a patient with Serous Otitis Media (serous effusion), the correct finding is an amber tympanic membrane (TM) with bubbles and a fluid line that may be seen. This indicates the presence of fluid accumulation in the middle ear. Other findings mentioned in the options, such as a swollen, narrow, moist, and tender canal or a thickened, red, and itchy skin of the canal, are not specific to serous otitis media. The bulging tympanic membrane with lost landmarks is more indicative of acute otitis media, while a prominent malleus is commonly seen in eustachian tube dysfunction.

When transilluminating the sinuses, you place the light source deep under each brow to look for a red glow in the normal (air-filled) frontal sinus. You can have the patient tilt their head and open their mouth while you shine the light down from the inner aspect of each eye to look for a reddish glow through the hard palate indicating a normal (air-filled) maxillary sinus.

Tenderness may be present in palpation of the mastoid in otitis media and mastoiditis. Otitis media is an infection of the middle ear, which can spread to the mastoid bone located behind the ear. Mastoiditis is a complication of otitis media, where the infection spreads to the mastoid bone causing inflammation and tenderness. Palpation of the mastoid in these conditions can elicit pain and tenderness due to the underlying infection and inflammation.

The "O" (Objective) section of a SOAP note is where you place information obtained from the vital signs, physical examination, and diagnostic tests. It also contains information starting from your general inspection and observation of the patient. This section focuses on objective data that can be measured and observed, such as the patient's blood pressure, heart rate, physical findings, and test results. It does not include the chief complaint, HPI, information provided by the patient about their symptoms, or the PMH, Social History, and Family History.

The correct way to perform the proper speculum insertion during the otoscopic exam is to straighten the ear canal by grasping the auricle (outer part of the ear) firmly but gently and pull it upward, backward, and slightly away from the head. Then, insert the speculum into the canal, directing it somewhat down and forward. This technique helps to align the ear canal for better visualization and insertion of the speculum.

The correct answer suggests that the first step when observing abnormal ear conditions such as brown spots, dry patches, or cysts and keloids is to perform a biopsy. This involves taking a small sample of the affected tissue to determine the types of cells present. Biopsy is a common diagnostic procedure used to identify the underlying cause of the abnormalities and guide appropriate treatment decisions. It helps in ruling out potential serious conditions and provides valuable information for further management.

Hearing problems are not an indication for doing a tug test on a patient suspected of having otitis externa. A tug test is performed to assess the mobility of the tympanic membrane, and it is used to diagnose otitis media, not otitis externa. Otitis externa is an infection or inflammation of the outer ear canal, which typically presents with symptoms such as ear pain, ear drainage, and inflammation. However, hearing problems may be associated with both otitis media and otitis externa, but they are not specifically related to the need for a tug test.

The Weber test results indicate that the sound is lateralizing to the left ear, suggesting that there is a problem with the right ear. The Rinne test results show that air conduction (AC) is greater than bone conduction (BC) in both ears. This indicates that the sensorineural mechanism is impaired in the right ear, leading to sensorineural hearing loss. Therefore, the correct diagnosis is sensorineural hearing loss in the right ear.

Chronic otitis externa is described as a thickened, red, and itchy ear canal. This condition is characterized by inflammation and infection of the outer ear canal that persists for a prolonged period of time. It can be caused by various factors such as bacterial or fungal infection, allergies, or skin conditions. Symptoms of chronic otitis externa include itching, redness, swelling, discharge, and discomfort in the ear. Treatment usually involves cleaning the ear canal, using ear drops to reduce inflammation and infection, and addressing any underlying causes.

The given statement is false. In practice, the whisper test is not sufficient to check general hearing. It is a simple screening test that can provide a rough estimate of hearing ability, but it is not comprehensive. A thorough hearing evaluation typically involves a range of tests, including pure-tone audiometry, speech audiometry, and other specialized assessments. These tests help determine the specific type and degree of hearing loss, if any, and guide appropriate treatment options. Therefore, relying solely on the whisper test would not be considered a comprehensive assessment of hearing.

If the Weber test shows lateralization to the right, it indicates that the patient is perceiving sound as louder in the right ear. If the patient has a sensorineural loss on the left side, it means that there is a problem with the inner ear or the auditory nerve on the left side, resulting in reduced hearing in that ear. In the Rinne test, a tuning fork is placed on the mastoid bone behind the ear (BC) and then in front of the ear (AC). In a normal hearing individual, air conduction (AC) is better than bone conduction (BC). Therefore, if the Rinne test is performed on both ears, we would expect AC to be greater than BC on both the left and right sides.

During the "tug test," you would tug on the auricle and tragus of the ear. The auricle refers to the visible outer part of the ear, commonly known as the pinna. The tragus is a small, pointed projection of cartilage located in front of the ear canal. These structures are manipulated during the tug test to assess their mobility and to check for any pain or discomfort experienced by the individual.

Polyps or masses in the sinus can cause an abnormal result when transilluminating the sinuses. Transillumination involves shining a light through the sinuses to detect any abnormalities. Normally, a reddish glow is observed, indicating normal sinuses. However, if there are polyps or masses present in the sinus, the light will not pass through as easily, resulting in the absence of a reddish glow. Therefore, polyps or masses in the sinus are a possible cause of an abnormal result when transilluminating the sinuses.