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PCM III Test 2 > Respiratory/HENT exam > Flashcards

Respiratory/HENT exam Flashcards

1
Q

fetal alcohol syndrome

A

mild microcephaly: head looks bullet shaped

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2
Q

broad nasal bridge

A

fragile X syndrome

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3
Q

hurler syndrome

A

low nasal bridge (pushed down at bottom level of eyes), frontal prominence

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4
Q

treacher collins

A
  • palpebral fissures that slant downward
  • low set ears (top of ear should be at lateral palpebral fissure)
  • micrognathia = small mouth
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5
Q

acromegally

A

caused by pituitary tumors

- elongated head, coarse facial features, jaw is wide, low forehead

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6
Q

Cushing’s disease

A

increased secretion of cortisol

  • “mooned fascies” : face looks swollen and rounded
  • reddened cheeks
  • hirsuitism
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7
Q

hypothyroidism

A
  • “puffiness of face”

- thinning and coarsening of the eyebrows and hair

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8
Q

look at anatomy of ear

A

slide 15

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9
Q

ear height?

A

The top of the auricle should touch or be above an imaginary line between the inner canthus of the eye and the most prominent protuberance of the occiput.

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10
Q

preauricular pit

A

Developmental defect in the branchial arches

–> infected pit

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11
Q

keloid

A

overgrowth of collagen in scar tissue

- keloids grow beyond the borders of the original injury

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12
Q

cauliflower eaer

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

i.e. boxers

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13
Q

light reflex

A

can deduce if they have increased pressure in middle ear –> will be a diffuse and spread out cone/or may be moved

should be at about 5 o-clock in right ear

7 ‘clock in left ear

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14
Q

impacted cerumen

A

complaint of not being able to hear

  • due to ear wax buildup due to someones genetics
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15
Q

otitis externa

A

“swimmer’s ear” - intense pain and loss of hearing in one ear

  • if pull gently on ear lobe then its otitis externa (pulling on infected auditory canal)

This is an infection of the external canal. The canal is painful when the auricle is pulled.

Otitis externa is often caused by the canal remaining moist. The bacteria responsible for the infection is most often **Pseudomonas.

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.

Not treated, acute otitis externa can be dangerous. This is especially true in diabetics where it can spread and cause an infection of the soft tissues of the base of the skull called Malignant Otitis Externa.

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16
Q

otitis media

A

AOM = 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.

appears as marked inflammation of tympanic membrane - cone of light is out of position and is spread out

Otitis media w/ effusion = OME = fluid in the middle ear

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17
Q

glue ear

A

repeated episodes of otitis media –> viscous fluid –> needs to go to ENT specialist

The middle ear becomes filled with glue-like fluid.

Glue ear is common, but the reason why fluid builds up is not clear

The fluid dampens the vibrations of the eardrum and bones in the middle ear decreasing auditory acuity

Treatment is usually surgical, a tiny cut is made in the eardrum, the fluid is drained and a myringotomy tube is inserted.

** determined by hx of otitis media thats recurrent **

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18
Q

perforation

A

can be caused by increased pressure in middle ear or even a loud ear i.e. explosion

even though its perforated the persons hearing loss only decreases by 20%

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19
Q

hemotypanum

A

collection of blood in middle ear thats visible through the TM

usually caused by head trauma

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20
Q

TM retraction

A

i.e. repeated otitis media

Usually a sequela of glue ear

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

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21
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

results in reddened inflamed looking process

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22
Q

epistaxis

A

“nose bleeds”

  • *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.
  • -> commonly caused by nose-picking, just need to pack the nares to stop the bleeding

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.
–> this one is big time emergency, can result in exanguination - need to take a foley catheter and pull up balloon and pull it forward to stop the bleeding - usually will see blood running down back of throat, but don’t see anything anteriorly

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23
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

decreased ability to breath in through nose

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24
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.

  • can be viral, allergic or bacterial (bacterial is the most dangerous, can result in bacterial absesses in brain- pt. presents as febrile and tenderness to palpation)

** most common are frontal and maxillary **
frontal = midline above
eyebrows
ethmoid = b/w eyebrows (upper bridge of nose)
sphenoid = lower bridge of nose
maxillary = lateral of nose

25
Q

basal cell carcinoma

A

Most common skin cancer

Slow growing- just an overgrowth of tissue and just seems to be a nodule growing

Often found on sun exposed areas

Fair skinned individuals

Over exposure to radiation; solar, x-rays , etc.

bridge of nose, tops of ears, scalp

26
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 - appears split and ulcerated - these met early and are very dangers

27
Q

Herpes Simplex

A
  • see painful combination of vesicles and ulcers

HSV-1 accounts for about 80% of cases

Stage 1-Most of the time infection is asymptomatic
Stage 2-The virus goes into a latent stage and migrates to dorsal root ganglion
Stage 3-Either physical or emotional distress causes a recurrence of the infection frequently at the original site of infection

28
Q

Peutz-Jeghers syndrome

A

An autosomal dominant disease - disorder of GI tract

Melanin deposition of mucous membranes: see freckle like spots on lips that are dark

Have multiple intestinal polyps

15-fold increase in cancers of the gastrointestinal tract

29
Q

tooth attrition

A

tooth grinding

30
Q

thrush

A 
An oral infection (white overgrowth in mouth) caused by an overgrowth of Candida albicans seen commonly in:
Infants
Immunosuppressed patients - HIV
Patients on antibiotic therapy
Patients on chemotherapy

Patients usually complain of irritation of the mouth and altered taste

31
Q

Geographic tongue

A

Appearance is caused by loss of papillae
May be linked to Vitamin B deficiency
No treatment is necessary

32
Q

Fissured tongue

A

Probably a genetic condition

Usually asymptomatic and noticed on routine examination - see weird crypts in the tongue

33
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 - though at higher risk for oral cancers

34
Q

oral carcinoma

A

Generally aggressive cancers

Main risk factors are chronic alcohol use and smoking

Frequently detection is delayed because of inadequate examinations

35
Q

tonisillar carcinoma

A
  • these are fairly rare and are usually squamous cell
  • there is link to HPV infection

Often present late in the course of the disease since there are few early symptoms

36
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

37
Q

tonsillitis

A

typically seen in children ages 6-16

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.

38
Q

nail clubbing

A

distal most areas overgrow the bony areas as compensatory response for chronic hypoxia, their nails slope downward === COPD or Cardiac diseases = indicative of chronic hypoxia

39
Q

tactile fremitus

A

will feel consolidation–> causing increased vibration during breathing

40
Q

where is lobe differentiation on the back?

A

spinous proces of T3

41
Q

pneumonia

A

*alveoli are infected, don’t distend with air, will hear decreased breath sounds when alveoli are inflamed

Auscultation:

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

Percussion:
- Dullness

Special Tests:

  • Bronchophony-Increased
  • Tactile fremitus-Increased

sound moves better through fluid than it does through air

42
Q

COPD

A

Auscultation

  • Decreased breath sounds throughout lung fields (due to alveoli becoming enlarged, less airflow)
  • Primarily wheezing but may have rhonci

Percussion
- Hyperresonance: sounds like a very hollow sound

Special Tests

  • Bronchophony-Decreased
  • Tactile fremitus-Decreased

see more vertical heart on CXR, lung markings are darker, AP diameter enlarged

43
Q

CHF

A

Auscultation ** most key **

  • Decreased breath sounds most prominent in dependent portions of the lung (due to fluid being in interstitial space) - effects both lungs equally
  • Rales (crackles)

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

Special Tests

  • Bronchophony-Usually unchanged
  • Tactile fremitus-Usually unchanged

On CXR:
- see enlarged heart, see fluid in the lungs - complete whiteness all over all lung fields

44
Q

Pneumothorax

A
  • affected side has completely absent breath sounds

Auscultation
Breath sounds decreased or absent on affected side

Percussion
Marked hyperresonance

Special Tests - nearly absent
Bronchophony-Decreased
Tactile fremitus-Decreased

45
Q

pleural effusion

A

** fluid in the interpleural space ** most common cause on one side is due to lung cancer

Auscultation: almost no breath sounds
- Decreased or absent on affected side

Percussion
- Dullness on affected side

Special Tests
Bronchophony-Unchanged
Tactile fremitus-Decreased

46
Q

sensorineural hearing loss

A

Weber test: the sound will lateralize to the unaffected/undamaged hear - “the good ear hears better”

Rinne: normally AC>BC

47
Q

conductive hearing loss

A

Weber test: the sound will lateralize to the affected/damaged ear - sound goes to side of conduction defect - “ the bad ear will appear to hear better”

Rinne: BC>AC

48
Q

harsh, loud high pitched, over trachea

A

tracheal breath sounds

49
Q

loud/high pitched, heard over manubrium

A

bronchial breath sounds

50
Q

heard over 1st/2nd ICS anteriorly and b/w scapula posteriorly

A

bronchovesicular breath sounds = mainstem bronchi area

51
Q

soft low pitched sound hear in lungs

A

vesicular breath sounds - heard over most of general fields

52
Q

crackles/rales

A

short nonmusical hair rubbing sound = pneumonia, CHF, fibrosis (due to opening sound of alveoli)

coarse crackles = CHF/pneumonia - caused by airway opening and secretions in airways
fine crackles = fibrosis

53
Q

wheezes

A

musical sound heard during expiration when flow goes through narrowed bronchi

= asthma, COPD, bronchitis

54
Q

Rhonchi

A

low pitched, bubbly sounds heard in inspiration/expiration = fluid due to inflammation of airway/secretions

55
Q

pleural rub

A

“creaking leather” - heard when pleural surfaces are inflamed/thickened by path process

56
Q

stridor

A

wheeze heard in kids during inspiration that is louder in neck = indicates partial obstruction of larynx or trachea

57
Q

what if egophony/bronchophony are louder?

A

lung consolidation like pneumonia OR pleural effusion

** also see increased tactile fremitus in this case**

58
Q

pectus carinatum vs. excavatum

A

pigeon chest - sternum is dsplaced anterirly

excavatum = depression of lower portion of sternum - in severe cases the heart may be compressed

59
Q

barrel chest

A

COPD pts or asthmatics

lateral/AP measurement is less than 2:1

PCM III Test 2 (6 decks)

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