Exam #2: Ears & Nose Flashcards
What are the causes of rhinorrhea?
- Viral Infection
- Allergic Rhinitis or “hay fever”
- Vasomotor Rhinitis
What does a seasonal onset or environmental trigger suggest in regards to rhinorrhea?
Allergic rhinitis
What causes drug-induced rhinitis?
- Excessive use of decongestants
- Cocaine
What should be considered if nasal congestion is only one one side?
- Deviated Septum
- Nasal Polyp
- Foreign Body
- Granuloma
- Carcinoma
What are the causes of epistaxis?
- Digital trauma
- Inflammation
- Drying & crusting of the nasal mucosa
- tumor
- foreign body
What three things can contribute to epistaxis?
1) Anticoagulants
2) NSAIDs
3) Coagulopathies
When inspecting the external ear, what are you looking for?
- Deformity
- Lesion
- Canal Exudate
Palpation of the tragus prior to otoscopic examination is painful, what is this an indication of?
Otitis Externa
How do you check nasal patency?
Occlude one nare and have patient breathe in
How do you position the ear canal in an adult?
Retract pinna up, out, and back
How do you position the ear canal in a child?
Retract the pinna down, out, and back
Which sinuses can you transilluminate?
Frontal and maxillary
Weber Test
- 512 Hz
- Place fork in middle of patient’s vertex
- Ask where they hear the sound
Whisper Test
- Stand behind and to the side of the patient
- Instruct patient to put finger in ear
- Exhale fully, then whisper 3 letters or numbers
- Ask patient to repeat what they heard
Rinne Test
- 512 Hz
- Place fork on mastoid process, and ask patient to tell you when they no longer hear the sound
- place fork infront of ear
- Normal is 2:1 longer in air than bone
Conductive Hearing Loss
- External or middle ear disorder
- Caused by foreign body, otitis media, perforated eardrum, otosclerosis
- Sound lateralizes to IMPAIRED ear (Weber Test)
- Bone conduction longer than or equal to air conduction
Sensorineural Hearing Loss
- Inner ear disorder that involves the cochlear nerve
- Caused by exposure to loud noise, ear infection, trauma, acoustic neuroma, aging, familial disorder
- Sound lateralizes to GOOD ear (Weber Test)
- Air conduction longer than bone conduction (Rinne Test)
What is a relationship between the ear and the eye in a pediatric patient?
Upper portion of the auricle joins that scalp at or above the level of the canthus
In an infant, which direction is the ear canal oriented?
Directly downward
Why is an ear exam difficult in the new born?
Accumulation of the vernix caseosa
Obligate nose breathers
term given to newborns meaning that they must breathe through the nose
What is diminished movement on pneumatic otoscopy an indication of?
Ear effusion & Otitis Media
What can a crease on the nose and “shiners” can be an indication of?
Allergies
Which sinus is present in a 1 year-old?
Maxillary
When do the sphenoid and ethmoid sinuses start to develop?
6 years
When does the frontal sinus start to develop?
10 years
When are the sinuses fully developed?
21 years
When examining the mouth of an infant, what are you looking for?
Clefts in the palate or lips
When do teeth start to appear in the infant?
6-7 months (~4 teeth every 4 months afterward)
What are antenatal teeth?
Teeth that are present at birth and removed
When do kids get the full complement of teeth?
2-3 years
When do kids shed their primary teeth?
5 years
Halitosis
Bad breath
Referring to the pediatric patient, when are the tonsils the largest?
Middle childhood (compared to infancy and adolescence)
Signs of nasal foreign body
- Unilateral Rhinitis
- Halitosis
