Respiratory/HENT exam

Question 1

fetal alcohol syndrome

Answer 1

mild microcephaly: head looks bullet shaped

Question 2

broad nasal bridge

Answer 2

fragile X syndrome

Question 3

hurler syndrome

Answer 3

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

Question 4

treacher collins

Answer 4

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

Question 5

acromegally

Answer 5

caused by pituitary tumors

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

Question 6

Cushing’s disease

Answer 6

increased secretion of cortisol

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

Question 7

hypothyroidism

Answer 7

• “puffiness of face”

- thinning and coarsening of the eyebrows and hair

Question 8

look at anatomy of ear

Answer 8

slide 15

Question 9

ear height?

Answer 9

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.

Question 10

preauricular pit

Answer 10

Developmental defect in the branchial arches

–> infected pit

Question 11

keloid

Answer 11

overgrowth of collagen in scar tissue

- keloids grow beyond the borders of the original injury

Question 12

cauliflower eaer

Answer 12

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

Question 13

light reflex

Answer 13

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

Question 14

impacted cerumen

Answer 14

complaint of not being able to hear

• due to ear wax buildup due to someones genetics

Question 15

otitis externa

Answer 15

“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.

Question 16

otitis media

Answer 16

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

Question 17

glue ear

Answer 17

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 **

Question 18

perforation

Answer 18

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%

Question 19

hemotypanum

Answer 19

collection of blood in middle ear thats visible through the TM

usually caused by head trauma

Question 20

TM retraction

Answer 20

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

Question 21

rhinitis

Answer 21

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

Question 22

epistaxis

Answer 22

“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

Question 23

septal perforation

Answer 23

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

Question 24

Sinusitis

Answer 24

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

Question 25

basal cell carcinoma

Answer 25

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

Question 26

Squamous cell carcinoma

Answer 26

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

Question 27

Herpes Simplex

Answer 27

- 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

Question 28

Peutz-Jeghers syndrome

Answer 28

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

Question 29

tooth attrition

Answer 29

tooth grinding

Question 30

thrush

Answer 30

``` 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

Question 31

Geographic tongue

Answer 31

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

Question 32

Fissured tongue

Answer 32

Probably a genetic condition Usually asymptomatic and noticed on routine examination - see weird crypts in the tongue

Question 33

Hairy Leukoplakia

Answer 33

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

Question 34

oral carcinoma

Answer 34

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

Question 35

tonisillar carcinoma

Answer 35

- 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

Question 36

torus palatinus

Answer 36

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

Question 37

tonsillitis

Answer 37

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. 

Question 38

nail clubbing

Answer 38

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

Question 39

tactile fremitus

Answer 39

will feel consolidation--> causing increased vibration during breathing

Question 40

where is lobe differentiation on the back?

Answer 40

spinous proces of T3

Question 41

pneumonia

Answer 41

*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

Question 42

COPD

Answer 42

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

Question 43

CHF

Answer 43

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

Question 44

Pneumothorax

Answer 44

- 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

Question 45

pleural effusion

Answer 45

** 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

Question 46

sensorineural hearing loss

Answer 46

Weber test: the sound will lateralize to the unaffected/undamaged hear - "the good ear hears better" Rinne: normally AC>BC

Question 47

conductive hearing loss

Answer 47

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

Question 48

harsh, loud high pitched, over trachea

Answer 48

tracheal breath sounds

Question 49

loud/high pitched, heard over manubrium

Answer 49

bronchial breath sounds

Question 50

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

Answer 50

bronchovesicular breath sounds = mainstem bronchi area

Question 51

soft low pitched sound hear in lungs

Answer 51

vesicular breath sounds - heard over most of general fields

Question 52

crackles/rales

Answer 52

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

Question 53

wheezes

Answer 53

musical sound heard during expiration when flow goes through narrowed bronchi = asthma, COPD, bronchitis

Question 54

Rhonchi

Answer 54

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

Question 55

pleural rub

Answer 55

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

Question 56

stridor

Answer 56

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

Question 57

what if egophony/bronchophony are louder?

Answer 57

lung consolidation like pneumonia OR pleural effusion ** also see increased tactile fremitus in this case**

Question 58

pectus carinatum vs. excavatum

Answer 58

pigeon chest - sternum is dsplaced anterirly excavatum = depression of lower portion of sternum - in severe cases the heart may be compressed

Question 59

barrel chest

Answer 59

COPD pts or asthmatics lateral/AP measurement is less than 2:1