Question

Please Write Succinct: on Otitis Media and Otitis Externa

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

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

1.Otitis media : Infection of the ear,that occur in the space behind the ear drum ,it occur due to bacteria or virus infect and trap fluid behind the ear drum,causing pain and swelling /bulgingof the ear drum.

Associated symptoms : irritability ,difficulty in sleeping, tugging or pulling at one or both ears, fever , fluid draining ,loss of balance, hearing difficulty.

Risk factors : Upper respiratory infections like rhinitis, swimming , over crowding, poor living conditions, exposure to cigarette smoking .

Finding in physical examination : To diagnosis of otitis media need to do otoscopic examination we can observe erythema of middle ear, presence of effusion , bulging of the tympanic membrane, cloudy appearance , immobility of tympanic membrane, and perforation.

Differential diagnosis : Otitis media with effusion, chronic otitis media, otitis externa, herpes zoster infection , Upper respiratory tract infections.

2.Otitis externa is an infection of the outer ear canal that runs from the ear drum to the outside of the head.

Associate symptoms : Rhinitis, head ache ,fever, redness and swelling in the outer ear canal, vertigo, itching and irritation, skin peeling around ear canal.

Risk factors : Swimming, over crowding, Entry of dust into ear, rhinitis, pneumonia .

Differential diagnosis : Otitis media, Chronic otitis media , Upper respiratory tract infection, Herpes zoster infection.