Question

Please Write Succinct:

• Review of Systems: Associated symptoms and Risk Factors
• Findings on Focused Physical Exa
• Five Differential Diagnosis

on Ear pain

See example below for question #1:

1. Sore Throat

ROS:

Associated symptoms: fever, redness or eye discomfort, sneezing, wheezing, cough, runny nose, postnasal drip, GERD like symptoms, fatigue, muscle ache, n/v, and diarrhea.

Risk Factors:

Smoking, new sexual partners, irritant exposure, medications, and chronic health problems.

Red flags:

drooling, unable to swallow, unable to lie down, restless, unable to stay still, and unable to talk.

PE findings:

Epiglottis- severe illness with signs of upper airway obstruction such as restlessness, stridor, difficulty breathing, drooling, inability to swallow and high fever signals epiglottis and requires immediate referral. Further examination with a tongue blade could trigger laryngospasms and lead to airway obstruction.

Peritonsillar retropharyngeal abscess- orthopnea, dyspnea, symmetrical swelling, abscess, trismus.

Viral pharyngitis: Erythema, edema of throat, tender posterior cervical nodes.

GAS: temp more than 101.5, exudate anterior cervical lymphadenopathy.

Mononucleosis: presence or absence of pharyngeal exudate, posterior cervical lymphadenopathy, splenomegaly.

Gonococcal pharyngitis: pharyngeal exudate bilateral cervical lymphadenopathy

Inflammation: sinus tenderness, pale or swollen pharynx, postnasal drainage visible, no fever or lymphadenopathy.

Aphthous Stomatitis: shallow ulcers, no vesicles; indurated papules that progress to 1 cm ulcers; ulcer has yellow membrane and red halo; no fever or nodes.

Herpes simplex Lesions: perioral lesions; lymph adenitis; vesicles on palate, pharynx gingiva.

Herpetic pharyngitis: vesicles, ulcers, or exudate of the oral and pharyngeal mucosa.

Candidiasis: curd like white plaques that bleed when scraped off.

Differential diagnosis:

Viral Pharyngitis, Streptococcal Pharyngitis, peritonsillar or retropharyngeal abscess, Mononucleosis, Epiglottis, gonococcal pharyngitis, Herpangina, Vincent angina, Aphthous stomatitis, HSV type 1, Candidiasis, GERD.

Answer 1

ROS:

ASSOCIATED SYMPTOMS:

_ A sharp,sudden pain or a full, continuous pain.

_ feeling of fullness in the ear.

_ A sharp stabbing pain with immediate warm drainage from the ear canal.

_ muffled hearing.

_ nausea.

_ ear drainage.

RISK FACTORS:

_ Seasonal factors.

_ poor air quality.

_ infant feeding.

_ cleft palate.

_ Alaska native heritage.

_ poor air quality.

_ age.

_ Group child care.

RED FLAGS:

_ history of pain,active drainage,or bleeding from an ear.

_ sudden onset or rapidly progressive hearing loss.

_ acute, chronic,or recurrent episodes of dizziness.

_ evidence of congenital or traumatic deformity of the ear.

_ hearing loss with a positive history of ear infections,noise exposure,familial hearing loss,TB, syphilis,HIV,Meniere's disease, autoimmune disorder,oxotoxic medication use, otosclerosis,von Recklinghausen's neurofibromatosis,Paget's disease of bone,ear or head trauma related to onset.

_ visualization of blood,pus,cerumen plug, foreign body,or other material in the ear canal.

_ An unexplained conductive hearing loss or abnormal tympanogram.

_ unilateral or pulsatile tinnitus.

_ unilateral or asymmetric hearing loss ( difference greater than 15 dB pure tone average between ears) or bilateral hearing loss > 30 dB.

_ unilateral or asymmetrical poor speech discrimination scores ( greater than 15% between ears); or bilateral speech discrimination scores <80%.

PE FINDINGS:

Examination of the ear usually reveals abnormal findings in patients with primary otalgia.the pain that originates outside the ear is called secondary otalgia,and the etiology can be difficult to establish.The most common causes of secondary otalgia include temporomandibular joint syndrome and also dental infections which is caused in adults.whereas primary otalgia is common in children, it may be the only presenting symptom in several serious conditions,such as temporal arteritis and malignant neoplasm.when risk factors for malignancy are present ,computed tomography, magnetic resonance imaging,or otolaryngology consultation may be warranted.

DIFFERENTIAL DIAGNOSIS:

Ear pain is a common presentation in the primary care setting with many diverse causes. Pain they originates from the ear is called primary otalgia,and the most common causes are otitis media and otitis external. Examination of the ear usually reveals abnormal findings in patients with primary otalgia.