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PCM III Exam 2 > Respiratory and HEENT exam > Flashcards

Respiratory and HEENT exam Flashcards

1
Q

Head and Face inspection

A

Shape of head and face
- Congenital abnormalities

Hair pattern and texture
-Thyroid dysfunction

Head motion (tremors and tics)
- Neurologic disorders

Expression of the face
- Psychological disorders

Movements of the forehead, eyes, and mouth
- Neurologic disorders

Edema, puffiness or localized swelling
- Heart failure, infection

Prominent features
- Congenital abnormalities

Hirsutism
- Endocrine disorders

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2
Q

Fetal Alcohol Syndrome

A 
small head
low nasal bridge
epicanthal folds
small eye openings
flat midface
short nose
thing upper lip
smooth philtrum
underdeveloped jaw
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3
Q

fragile X

A

long face

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4
Q

hurler syndrome

A

very hairy

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5
Q

Treacher Collins Syndrome

A

big front of face

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6
Q

Acromegaly

A

Elongated head
Coarsened facial features
Bony overgrowth of forehead, nose and lower jaw

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7
Q

Cushing’s disease

A

round / moon facies

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8
Q

ear inspection and palpation

A 
Inspection
Auricle for redness, lesions
Canal 
Discharge, foreign bodies, redness, swelling
Tympanic membrane 
Color and contour

Palpation
Auricle for masses or tenderness

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9
Q

Preauricular Pit

A

Developmental defect in the branchial arches

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10
Q

Keloid

A

Overgrowth of collagen in scar tissue

Keloids grow beyond the borders of the original injury

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11
Q

Cauliflower Ear

A

Usually caused by repeated blows to the external ear among boxers and wrestlers
Hematoma separates the cartilage from the perichondrium
Scar tissue fills the gap between the two layers

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12
Q

Otoscopic Examination

A

Insert largest speculum that the ear will accommodate
Pull the ear up and back
Inspect the canal and the tympanic membrane

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13
Q

Otitis Externa

A 
Infection of auditory canal
Prolonged swimming
Humidity
Sweating
Ear plugs/hearing aids
Aggressive ear cleaning
Foreign body/impacted cerumen
Derm conditions: eczema, psoriasis (nail pitting)
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14
Q

Otitis Externa symptoms

A 
Otalgia (external +/- internal)
Itching
Discharge
Hearing loss of sense of fullness
Radiation to mastoid, jaw or internal
Most common in children, immune compromised (medication, chronic infection, chemotherapy, diabetes)
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15
Q

Acute Otitis Externa

A 
Focused HEENT:
Detail on ear exam
Mastoids
Neck palpation
Lymph nodes

DDX:
OM with perforation
Mastoiditis
Canal carcinoma

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16
Q

otitis externa responsible parties and treatment

A

The bacteria responsible for an acute infection is most often Pseudomonas or Staphylococcus Aureus.
Chronic infections (>3m) are fungal or allergic in origin
Oral antibiotics are usually not effective. Ear drops must be used and the canal must be opened and if possible cleaned.
A solution of 1 part white vingear (5% acetic acid) mixed with 3 parts water is often helpful in preventing this disorder. (frequent swimmer)

Clean and remove FB if needed
Keep dry: 3-10 days (adult? ear plugs? Severity?)
Oral analgesics, can consider topical lidocaine
Do not mess with it
Topical antibiotics/steroid 5-10 days
Ok with perforation: fluoroquinolones only

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17
Q

Otitis Media

A

This is a bacterial infection of the middle ear. This infection is one of the most common reason for pediatric physician visits.

Left untreated, 50% of all cases of otitis media will clear without antibiotics, but 1 in 400 will progress to acute coalescent mastoiditis, a life threatening ear infection; and rarely meningitis, a life threatening brain infection, can occur.

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18
Q

otitis media symptoms/ infections

A 
URI symptoms, fever, anorexia, vomiting, diarrhea    young>>adult
Otalgia, hearing loss, “popping” 
Winter and daycare
Many viral 
Frequent co-infection with 
- Strep Pneumoniae
- H. Influenzae
- Moraxella Catarrhalis
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19
Q

otitis media exam

A 
Bilateral ear exam
           tenderness, canal, TM, mobility
Nose and Oral exam often involved
Cervical LN
Lungs
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20
Q

otitis media treatment

A 
Pain control: oral, topical
Decongestants?
Antibiotics: severity, >48 hrs, >102°F,  under 24 months old; 
Amoxicillin 80 mg/kg/day given bid
Augmentin dose for amoxicillin component
Cephalosporins for PCN allergic
Ceftriaxone 50 mg/kg IM x1
5-10 days: age and severity (younger=longer)
		Follow Up!
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21
Q

Hemotympanum

A

A collection of blood in the middle ear that is visible through the tympanic membrane
Usually caused by head trauma

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22
Q

Tympanic Membrane Retraction

A

A portion of the tympanic membrane is weakened and retracts into the middle ear as a result of the relative negative pressure
Auditory acuity can be compromised because the tympanic membrane is draped over the ossicles and impedes their vibration

23
Q

Rhinitis

A

Inflammation of the inner lining of the nose is characterized by an itchy/runny nose, sneezing, and nasal congestion.
Allergic rhinitis is usually caused by an antigen or group of antigens, i.e. animals, dust, fabrics

Seasonal allergic rhinitis (also called hay fever) is usually caused by pollen in the air, and sensitive patients have symptoms during peak times of the year

24
Q

Epistaxis

A

Anterior epistaxis is the most common type, accounting for about 90 % of nosebleeds. Bleeding is usually visible on inspection and typically occurs in the area Kesselbach’s plexus.Etiologies include arid climates, inhaled irritants, hypertension, coagulopathies and inhaled drug use, primarily cocaine.

In general, posterior epistaxis occurs in older patients, who have fragile vessels because of hypertension, atherosclerosis, coagulopathies, or weakened tissue. Bleeding is profuse because of the larger vessels in that location (usually, the sphenopalatine artery) and usually requires hospitalization and surgical treatment.

25
Q

Deviated Septum

A

A condition whereby the nasal septum is deviated laterally, can either be congenital or secondary to trauma.

26
Q

Septal Perforation

A

Etiologies include any condition where the blood supply to the septum is chronically compromised
Commonly caused by inhalation (Snorting) of vasoconstrictive substances, i.e. cocaine

27
Q

Sinusitis

A

Anything that causes swelling in the sinuses or keeps the cilia from moving mucus can cause sinusitis. This can occur because of changes in temperature or air pressure such as swimming or diving.

Sinus infections can occur after an upper respiratory infection. The virus infects the mucus membranes of the sinuses, causing them to swell and narrow. The mucus membranes increase secretions, but the secretions are trapped in the swollen sinuses. This stagnant mucus in the sinuses becomes secondarily infected with bacteria.

28
Q

Oral Cavity

A

Always use a tongue blade and a light source

Inspect:
Teeth
Gums
Buccal mucosa
All surfaces of tongue
Hard palate
Posterior oropharynx
- Uvula
- Tonsils or absence thereof
29
Q

Basal Cell Carcinoma

A 
Most common skin cancer
Slow growing
Often found on sun exposed areas 
Fair skinned individuals
Over exposure to radiation; solar, x-rays , etc.
30
Q

Squamous Cell Carcinoma

A

Risk factors are very similar to basal cell
More aggressive and metastasizes early
Usually appears as a scaly, crusting patch

31
Q

Herpes simplex

A

HSV-1 accounts for majority of cases
Asymptomatic shedding occurs that is still contagious. Most contagious when symptomatic.
Either physical or emotional distress causes a recurrence of the infection frequently at the original site of infection

32
Q

Peutz-Jeghers Syndrome

A

An autosomal dominant disease
Melanin deposition of mucous membranes
Multiple intestinal polyps
15-fold increase in cancers of the gastrointestinal tract

33
Q

tooth attrition vs erosion

A

grinding vs acid from bulemia, e.g.

34
Q

Thrush

A

An oral infection caused by an overgrowth of Candida albicans seen commonly in:

  • Infants
  • Immunosuppressed patients
  • Patients on antibiotic therapy
  • Patients on chemotherapy

Patients usually complain of irritation of the mouth and altered taste

35
Q

Geographic Tongue

A 
Appearance is caused by loss of papillae
May be linked to Vitamin B deficiency
No treatment is necessary
Not contagious
More prominent with fever, upper respiratory infection  
Can be mildly tender
36
Q

Fissured Tongue

A

Probably a genetic condition
Usually asymptomatic and noticed on routine examination
May be Vitamin A deficiency. Rare in USA except in inflammatory bowel diseases causing poor absorption.

37
Q

Hairy Leukoplakia

A

Usually an early sign of HIV infection
Associated with pipe smoking and chewing tobacco or snuff
May resemble thrush
Usually painless
Rarely undergoes malignant transformation

38
Q

Oral Carcinoma

A

Generally aggressive cancers
Main risk factors are chronic alcohol use and smoking
Frequently detection is delayed because of inadequate examinations

39
Q

Tonsillar Carcinoma

A

Usually squamous cell
There is likely a link to HPV infection
Often present late in the course of the disease since there are few early symptoms

40
Q

Torus Palatinus

A

A hard bony growth in the center of the roof of the mouth (hard palate). It is
Not a tumor but rather a benign bony growth called an exostosis.
Commonly occurs in females over the age of 30 and rarely needs treatment.
Occasionally it is removed for the proper fitting of dentures

41
Q

Tonsillitis

A

This is a common condition which is usually caused by gram positive bacteria. If the organism is Streptococcus pyrogenes , there is a risk of developing rheumatic fever.
Often multiple different bacteria exists in the tonsillar crypts, which can be difficult to culture.
Treatment with antibiotics to prevent rheumatic fever or tonsillar abscess formation is usually advisable.

42
Q

Respiratory-General Appearance

A 
Colors:
- Cyanotic (Hypoxemia)
- Pink (emphysema, CO2 toxicity)
- Pallor (anemia)
Respiratory rate
Respiratory effort  
Using accessory muscles of respiration 
Cough
Wheeze
Nicotine staining of fingers
43
Q

Respiratory inspection

A

Tracheal position
- May be displaced by neck mass, pneumothorax or lung mass

Deformities of the thorax

  • Funnel Chest (pectus excavatum)
  • – Depression in lower portion of sternum
  • – Compression of heart & great vessels may cause murmurs

Barrel chest
- AP diameter is increased with age & in chronic obstructive pulmonary disease (COPD)

44
Q

Pigeon chest (Pectus carinatum)

A

Sternum is displaced anteriorly, increasing AP diameter

Adjacent costal cartilages are depressed

45
Q

Funnel chest (Pectus excavatum)

A

Depression of lower portion of the sternum

In severe cases, the heart or great vessels may be compressed

46
Q

Barrel Chest

A

Seen in chronic asthmatics or patients with COPD
Caused by chronic air trapping in the alveoli
Lateral/ AP chest measurement is less than 2:1

47
Q

Respiratory palpation

A

Tenderness may indicate a rib fracture
Decreased motion with respiration may indicate bronchial obstruction or pleural effusion
Subcutaneous emphysema is seen with pneumothorax
Tactile fremitus is helpful in diagnosing consolidation

48
Q

Respiratory auscultation

A

Provides the majority of information in the pulmonary examination
Knowledge of the underlying anatomy is essential to making an accurate diagnosis
You are listening to moving air and anything that alters the architecture of the pulmonary tree will alter the flow of air.
Bates chart pages 328-331 describe changes in pathology well.

49
Q

Pneumonia

A

Auscultation

  • Decreased breath sounds over affected area
  • Sounds over affected area are bronchial rather than vesicular
  • Primarily rales but may have wheezing or rhonchi

Percussion
Dullness

Special Tests
Bronchophony-Increased
Tactile fremitus-Increased

50
Q

COPD physical exam

A

Auscultation
Decreased breath sounds throughout lung fields
Primarily wheezing but may have rhonci

Percussion
Hyperresonance

(Special Tests)
Tactile fremitus-Decreased

51
Q

Congestive Heart Failure PE

A

Auscultation

  • Decreased breath sounds most prominent in dependent portions of the lung
  • Rales (crackles)

Percussion
- May be unchanged or decreased (dull) over dependent portions of the lungs

Special Tests

  • Bronchophony-Usually unchanged
  • Tactile fremitus-Usually unchanged
52
Q

Pneumothorax PE

A

Auscultation
- Breath sounds decreased or absent on affected side

Percussion
- Marked hyperresonance

Special Tests

  • Bronchophony-Decreased
  • Tactile fremitus-Decreased
53
Q

Pleural Effusion

A

Auscultation
- Decreased or absent on affected side

Percussion
- Dullness on affected side

Special Tests

  • Bronchophony-Unchanged
  • Tactile fremitus-Decreased

PCM III Exam 2 (9 decks)

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