Upper Respiratory Competency

Question 1

How should you position the ear canal to examine the tympanic membrane of an adult?

Answer 1

Pull up, out and away

Question 2

How should you position the ear canal to examine the tympanic membrane of a child?

Answer 2

Pull down, out and away

Question 3

How should you direct the otoscope when positioning it into the ear?

Answer 3

Down and forward

Question 4

How do you perform a whisper test?

Answer 4

Stand behind pt, have them occlude one ear, dr exhales and whispers a combination of consonants and numbers (6 long) and ask pt to repeat after you

• Use different combination for the other ear!
• Repeat a different sequence if they respond incorrectly

Question 5

When performing a whisper test you are supposed to use a combination of consonants and numbers. Why consonants and not vowels?

Answer 5

Consonants use higher frequencies than vowels

Question 6

What is a positive versus negative whisper test?

Answer 6

Normal = pt repeats at least 3 of the 6 correctly
Abnormal = 4 of the 6 incorrectly

Question 7

What is presbycusis?

Answer 7

Loss of higher frequency -> common in older adults

Question 8

What accounts for conductive hearing loss?

Answer 8

Sound travels thorugh air and vibrations of the TM are transmitted thorugh the ossicles to the cochlea. Anything that changes this portion accounts for a conductive hearing loss

• Cerumen, tympanic perforation, middle ear effusion

Question 9

What accounts for sensorineural hearing?

Answer 9

The cochlea and the cochlear nerve transmit the impulses to the brain -> anything that changes this phase accounts for a sensorineural hearing loss

Question 10

How do you perform a weber test?

Answer 10

Place tunng fork on forehead or top of head and ask pt to identify if they hear i on one side or both

• Use Rinne test to further evaaluate the type of hearing loss

Question 11

How do you perform a rinne test?

Answer 11

Place tuning fork on mastoid process (bone conductance) and when the pt can no longer hear the vibration quickly put it in front of the ear (air conductance)

Question 12

How do you interpret the results of a rinne test?

Answer 12

AC>BC the ear is normal and there is sensorineural hearing loss in the opposite ear

AC=BC or BC>AC here is conductive loss in that ear

Question 13

When do the frontal sinuses open?

Answer 13

Approximately 7 years old

Question 14

What sinuses can be palpated?

Answer 14

Frontal (between eyes)

Maxillary (below cheek bones)

Question 15

What 3 things do you look carefully for when examining the oral cavity?

Answer 15

Labial mucosa
Frenulum
Gums

Question 16

Define torus palantinus

Answer 16

Common boney growth of hard palate

Question 17

What are you looking for when you have a patient open their mouth and say “Ahhh”?

Answer 17

Watching the soft palate and uvula rise (should be symmetrical)