2. URE Flashcards
Upon inspection of the ear, what are we mainly looking at?
external ear
how we do examine the ear can
straighten
adults=> pull up, out and posterior
kids=> pull down, out and posterior
Normal tympanic membrane is
translucent and pearly
Ear examination allow you to see: •
Cone of Light • Umbo- \_\_\_\_\_\_\_\_ • Malleus • Manubrium- \_\_\_\_\_\_\_ • Pars tensa- \_\_\_\_\_\_\_\_ • Pars Flaccida- \_\_\_\_\_\_ • Chorda tympani nerve- Runs in the \_\_\_\_\_\_\_\_
umbo is where the eardrum meets the tip of the malleus. From here, the light fans downward and anterior
manubrium is the handle of the malleus
pars tensa is below the pars flaccida
pars flaccida is located above the malleus
chorda tympani runs the superior part, near the pars flaccida
Perform the Whisper test.
what is normal and abnormal
Doctor stands behind the patient. Have patient occlude one ear. The doctor exhales fully and then whispers a combination of numbers and letters (ex: 2-K-4). The patient repeats the sequence. Repeat with a different sequence if responds incorrectly.
Normal: patient correctly repeats the sequence or after 2 sequences, can identify 3 of the 6.
Abnormal: patient incorrectly identifies 4 of the 6
Webers test tests for __________.
Rinne test tests for _____________.
Webers- lateralization
Rhinne- tests air vs bone conduction
If AC > BC; then what?
Weber is abnormal
Rinne is normal
Patient has sensorineural deficits in the opposite ear
If BC >AC; then what?
Patient has conductive hearing loss in the SAME ear.
Perform the Rinne and Weber test and understand the clinical significance.
- Weber test for lateralization:
vibrate tune fork and place it on head
Normal: patient can hear sound equally at at both ears. Abnormal: hears stronger in one ear then the other. If abnormal: do rhinne. - Rinne test will tell us if it is conduction loss in same ear or sensorineural loss in opp. ear.
To do so, set the tuning fork and place it behind ear on the mastoid process. When the patient stops hearing the sound, place bring it in front of the ear.
conductive loss is d/t what?
cerum impaction fluid in middle ear ossicles dont move trauma obstruction
Sensorineural loss can be d/t what?
usually d/t inner ear, cochlear nerve or central brain connection problems
genes
meneirze dz
MS
drugs
• Aphthous ulcers
canker sores
• Cheilitis
red cracks on corner of mouth d/t Vb12 or iron def
• Gingivitis
swelling or ulceration of guns
torus palatinus
benign lump on hard palate
what external structures do we look at when looking at mouth and throat
Lips
Vermillion border
what external landmarks do we look at when examining nose
[insert pic]
what internal landmarks do we look at when examining nose
- septum
- vestibule (the most anterior part of the nasal cavity
- turbinates: covered by mucosa and clean, humdify, and control temp of air
Perform examination of the nose, sinuses and name structures.
- look at external landmarks; apply pressure to tip of nose to and check tenderness
- look at internal landmarks by using otoscope and look at mucosa and check 4:
A. viral rhinitis (red and edema)
B. allergic (pale, bluish or red)
C. Septal perforation d/t cocaine, meth, trauma or surgery
3. Look at sinuses: A. frontal B. maxillary C. ethmoid D. sphenoid sinuses
- Palpate maxillary sinuses and frontal (under the brow bone)
Sinuses are air filled cavities in the skull of the bone.
which sinuses dont open until after 7 YO
frontal sinuses
Perform examination of the lymph nodes of the head and neck.
To check LN: use pads of middle 3 fingers and look for: texture, size and tenderness.
LN include:
- Pre-auricular
- post-auricular
- submental
- submandibular
- tonsilar
- anterior cervical
- posterior cervical
- supraclavicular
is pharyngitis always strep?
NOO
what is pharyngitis?
viral or bacterial inflammation of the pharynx, causing a sore throat
What are common sx for viral pharyngitis?
- coryza (inflammed mucus membrane).
- conjunctivitis
- malaise or fatigue
- hoarseness
- low-grade fever
Steptococcal pharyngitis is d/t
GABHS (streptococcus pyogenes: bacterial).
Sx of stretococcal pharyngitis
- sore thorat
- HA
- fatgiue
- body aches
- naseau**** occurs bc the pharynx is located near intra-abdominal organs on homunuculus
who and when is it more likely to get strep pharyngitis (GABHS)
1. children 5-15 2, winter and early spring 3, no cough 4, anterior cervical lymphadenopathy is tender, 5. tonsillar exudate, 6. fever.
what labs do we perform if someone comes in with what we think is phargygitis?
FIRST CONSIDER DIFFERENTIALS
- rapid steptococcal test antigen testing to test for group A Bhs
2 throat swab
- monospot test
Acute otitis media (AOM
inflammation of middle ear d/t bacteria or viruses.
TM is bulging, red, reduced mobility
Acute suppurative OM
[acute OM] + [purulent material] in the middle ear.
Otitis media with effusion (serous OM)
inflammation + fluid buildup in behind the eardrum (middle ear) WITHOUT bacterial or viral infection.
- Can be d/t fluid that stays after AOM or blockage of eustachian tubes that can last 3 months.
- If chronic (>6 wks), makes kids susceptible to new ear infections
Otitis media with effusion (serous OM) that is chronic (>6 wks) does what
makes kids susceptible to near ear infections
Chronic suppurative OM
persistent EI that causes tearing of eardrum
Otitis externa
bacteria enters small break in skin in the canal, causing drainage or pain when touching the external ear
inner ear infection is called
Labyrinthitis
Otitis Media with Effusion
(aka Serous Otitis Media) can last _________, called ________. This can affect what?
3 months
chronic otitis media with
effusion
hearing
