OSCE 9 - Upper Respiratory exam

Question 1

lymph nodes of the head and neck

Answer 1

a. Preauricular
b. Postaruicular
c. Submental
d. Submandibular
e. Tonsillar
f. Anterior cervical
g. Posterior cervical
h. Supraclavicular

Question 2

abnormal findings of ear (3)

Answer 2

otitis media
serous otitis
otitis externa / swimmers ear

Question 3

otitis media

Answer 3

middle ear effusion with infection; usually unilateral pain, preceded by URI symptoms, often has fever, may have conductive hearing
loss

Question 4

serous otitis

Answer 4

middle ear effusion without infection, bilateral or unilateral, can be painful (but less severe than OM), can occur w/allergy or URI symptoms, no fever, may have conductive hearing loss

Question 5

otitis externa/ swimmers ear

Answer 5

generally unilateral, exquisite pain,
usually has drainage coming from the ear canal, caused my moisture being trapped in external auditory canal and overgrowth of normal flora

Question 6

s/s of sinus infeciton, what exams, abnormal findings that would confirm diagnosis?

Answer 6

[ SiLENT ]
a. Look in the ears. There may be an effusion behind the TM (due to
occlusion of the Eustachian tube).
b. Look in the nose. There may be turbinate engorgement, erythema, and
mucopurulent PND.
c. Look at the posterior pharynx. There may be mucopurulent PND.
d. Press on the Frontal and Maxillary tender points to assess location of
infection.
e. Examine the lymph nodes of the head and neck. There may be tender
symmetric enlargement particularly in the anterior cervical chain

Question 7

conductive vs. sensorineural problem

Answer 7

Conductive hearing loss –external or middle ear problem
(conductive phase)
Sensorineural loss –inner ear, cochlear nerve or central brain
connections problem (sensorineural phase)

Question 8

rinne test

Answer 8

Compares air and bone conduction
-Vibrating tuning fork placed on mastoid bone behind ear &
level with the canal. When patient no longer hears sound,
quickly place fork close to ear canal & inquire if can hear
the sound & for how long they hear it.
 Normal: AC>BC
 If AC=BC or BC>AC there is conductive loss to that ear
 If weber was abnormal and Rinne was normal, suspect
sensorineural loss in the opposite ear

Question 9

external landmarks of nose

Answer 9

• Ala nasi
   Columella
   Vestibule
   Bridge

Question 10

ear exam findings - red, edema?
pale, bluish or red?
septal perforation?

Answer 10

red, edema = viral rhinitis
pale, bluish/ red = allergic
septal perfoation = cocaine, meth, trauma, surgery

Question 11

function, def. of turbinates

Answer 11

• highly vascular mucous membrane protruding into nasal cavity
• cleansing,
  humidification, & temperature control of inspired air

Question 12

sinuses on face

Answer 12

Frontal- do not open until after 7 years
old
 Maxillary
 Ethmoid
 Sphenoid

Question 13

soft palate innervation

Answer 13

CN 9 and 10

Question 14

uvula and soft palate if “ah” when paralyzed

Answer 14

uvula deviated to opposite side

soft palate does not rise when saying “ah”

Question 15

2 types of frenulum and what they do

Answer 15

o Labial- connects lip with gingiva

o Lingual- connects tongue to floor of mouth

Question 16

gingiva

Answer 16

firmly attached to teeth and to maxilla or mandible

Question 17

Sublingual caruncle

Answer 17

opening to the
sublingual ducts- on either side of
lingual frenulum

Question 18

Lesser sublingual ducts located at

Answer 18

at base of

tongue

Question 19

benign lump on hard palate

Answer 19

torus palatinus

Question 20

B12 or iron deficiency, candidiasis, red cracks at

corners of mouth

Answer 20

cheilitis

Question 21

canker sores

Answer 21

aphthous ulcers

Question 22

swelling or ulcerations gums

Answer 22

gingivitis