Respiratory/HENT exam Flashcards
fetal alcohol syndrome
mild microcephaly: head looks bullet shaped
broad nasal bridge
fragile X syndrome
hurler syndrome
low nasal bridge (pushed down at bottom level of eyes), frontal prominence
treacher collins
- palpebral fissures that slant downward
- low set ears (top of ear should be at lateral palpebral fissure)
- micrognathia = small mouth
acromegally
caused by pituitary tumors
- elongated head, coarse facial features, jaw is wide, low forehead
Cushing’s disease
increased secretion of cortisol
- “mooned fascies” : face looks swollen and rounded
- reddened cheeks
- hirsuitism
hypothyroidism
- “puffiness of face”
- thinning and coarsening of the eyebrows and hair
look at anatomy of ear
slide 15
ear height?
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.
preauricular pit
Developmental defect in the branchial arches
–> infected pit
keloid
overgrowth of collagen in scar tissue
- keloids grow beyond the borders of the original injury
cauliflower eaer
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
light reflex
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
impacted cerumen
complaint of not being able to hear
- due to ear wax buildup due to someones genetics
otitis externa
“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.
otitis media
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
glue ear
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 **
perforation
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%
hemotypanum
collection of blood in middle ear thats visible through the TM
usually caused by head trauma
TM retraction
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
rhinitis
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
epistaxis
“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
septal perforation
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
Sinusitis
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
basal cell carcinoma
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
Squamous cell carcinoma
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
Herpes Simplex
- 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
Peutz-Jeghers syndrome
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
tooth attrition
tooth grinding
thrush
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
Geographic tongue
Appearance is caused by loss of papillae
May be linked to Vitamin B deficiency
No treatment is necessary
Fissured tongue
Probably a genetic condition
Usually asymptomatic and noticed on routine examination - see weird crypts in the tongue
Hairy Leukoplakia
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
oral carcinoma
Generally aggressive cancers
Main risk factors are chronic alcohol use and smoking
Frequently detection is delayed because of inadequate examinations
tonisillar carcinoma
- 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
torus palatinus
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
tonsillitis
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.
nail clubbing
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
tactile fremitus
will feel consolidation–> causing increased vibration during breathing
where is lobe differentiation on the back?
spinous proces of T3
pneumonia
*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
COPD
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
CHF
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
Pneumothorax
- 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
pleural effusion
** 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
sensorineural hearing loss
Weber test: the sound will lateralize to the unaffected/undamaged hear - “the good ear hears better”
Rinne: normally AC>BC
conductive hearing loss
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
harsh, loud high pitched, over trachea
tracheal breath sounds
loud/high pitched, heard over manubrium
bronchial breath sounds
heard over 1st/2nd ICS anteriorly and b/w scapula posteriorly
bronchovesicular breath sounds = mainstem bronchi area
soft low pitched sound hear in lungs
vesicular breath sounds - heard over most of general fields
crackles/rales
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
wheezes
musical sound heard during expiration when flow goes through narrowed bronchi
= asthma, COPD, bronchitis
Rhonchi
low pitched, bubbly sounds heard in inspiration/expiration = fluid due to inflammation of airway/secretions
pleural rub
“creaking leather” - heard when pleural surfaces are inflamed/thickened by path process
stridor
wheeze heard in kids during inspiration that is louder in neck = indicates partial obstruction of larynx or trachea
what if egophony/bronchophony are louder?
lung consolidation like pneumonia OR pleural effusion
** also see increased tactile fremitus in this case**
pectus carinatum vs. excavatum
pigeon chest - sternum is dsplaced anterirly
excavatum = depression of lower portion of sternum - in severe cases the heart may be compressed
barrel chest
COPD pts or asthmatics
lateral/AP measurement is less than 2:1
