Upper Respiratory Exam

Question 1

What are some external landmarks of the ear?

Answer 1

• auricle
• helix
• antihelix
• concha
• antitragus
• tragus
• triangular fossa
• lobule
• external auditory canal
  NOTE: outer portion is hairy and contains glands to produce cerumen

Question 2

What are some internal ear structures?

Answer 2

• cone of light
• umbo- where eardrum meets tip of the malleus; from here cone of light fans downwards and anteriorly
• malleus
• manubrium - handle of malleus
• pars tensa - the part of the eardrum that is inferior to the pars flaccida
• pars flaccida - superior to malleus
• chorda tympani nerve - runs in the superior part near pars flaccida
  NOTE: inner portion surrounded by bone and lined by thin, hairless skin

Question 3

How to position ear to examine ear?

Answer 3

• must straighten canal
• for adults: pull up, out and away
• for children: pull down, out and away
  NOTE: Normal Tympanic Membrane is translucent and pearly

Question 4

What is conductive hearing loss?

Answer 4

external or middle ear problem (conductive phase)

Question 5

What is sensorineural loss?

Answer 5

inner ear, cochlear nerve or central brain
connections problem (sensorineural phase)

Question 6

Whisper test

Answer 6

• Doctor stands behind the patient.
• Have patient occlude one ear.
• The doctor exhales fully and then whispers 3 consonants and a
  vowel in the patient’s un-occluded ear.
• The patient repeats the
  sequence.
• Repeat with a different sequence if responds
  incorrectly.
• if normal: patient correctly repeats the sequence or after 2
  sequences, can identify 3 of the 6.
• if (+): patient incorrectly identifies 4 of the 6

Question 7

Weber test

Answer 7

• test or lateralization
• Vibrating tuning fork placed on top of patient’s head or on middle of forehead
• if normal: sound lateralizes to both ears equally
• if (+): sound lateralizes to one ear, it is either conduction loss in that ear or sensorineural loss in the opp ear

Question 8

Rinne test

Answer 8

• compares air and bone conduction
• Vibrating tuning fork placed on mastoid bone behind ear & level with the canal.
• When patient no longer hears sound, quickly place fork close to ear canal & inquire if can hear
  the sound & for how long they hear it.
• normal: AC>BC
• if AC=BC or BC>AC there is conductive loss to that ear
• if weber was abnormal and Rinne was normal, suspect sensorineural loss in the opp ear

Question 9

What are some external landmarks on the nose?

Answer 9

• ala nasi
• columella
• vestibule
• bridge
  NOTE: lesions (rhinophyma - acne rosacea) or mass on nose, asymm, assess for nasal obstruction, gentle pressure on tip of nose (tenderness - local infection, furuncle)

Question 10

What are some internal landmarks on the nose?

Answer 10

• septum
• vestibule
• turbinates

Question 11

How to examine the internal nose?

Answer 11

• use otoscope
• mucosa (viral rhinitis –red, edema; allergic –pale, bluish or red; septal perforation –cocaine, meth, trauma, surgery),
  foreign body, nasal septum (deviation), turbinates, ulcers, polyps
• Turbinates are covered by highly vascular mucous membrane
  & protrude into nasal cavity; function: cleansing, humidification, & temperature control of inspired air

Question 12

How to inspect the sinuses?

Answer 12

• air filled cavities within bones of skull

Question 13

What are the sinuses?

Answer 13

• frontal - do not open until after 7 years old
• maxillary
• ethmoid
• sphenoid

Question 14

How to palpate the sinuses?

Answer 14

• frontal sinuses: press up under bony brows

- maxillary sinuses: press up on location of maxillary sinuses

Question 15

What are some external landmarks of the mouth/throat?

Answer 15

• lips

- vermillion border

Question 16

What are some internal structures of the mouth/throat?

Answer 16

• frenulum: labial (connects lip with gingiva) and lingual (connects tongue to floor of mouth)
• gingiva: firmly attached to teeth and to maxilla or mandible
• sublingual caruncle: opening to the sublingual ducts (on either side of lingual frenulum)
• lesser sublingual ducts (at base of tongue)
• tongue
• hard/soft palate: soft palate (controlled by CN IX&X); paralysis (uvula deviates to opp side and soft palate doesn’t rise with saying”ah”)
• uvula
• palatine tonsil
• posterior pharynx

Question 17

How to inspect the mouth/throat?

Answer 17

• Apply gloves and use light of otoscope or pen light
• look carefully at labial mucosa, frenulum and gums
• note appearance of teeth and floor of mouth, 16 teeth on each jaw.
• note surface color of tongue
• identify taste buds
• examine margins and inferior surface of tongue

Question 18

What are some pathologies of mouth/throat?

Answer 18

• Aphthous ulcers –canker sores
• Cheilitis –B12 or iron deficiency, candidiasis, red cracks at
  corners of mouth
• Gingivitis –swelling or ulcerations gums
• Torus palatinus –benign lump on hard palate

Question 19

What are the lymph nodes around the throat?

Answer 19

• preauricular
• posterior auricular
• submental
• submandibular
• tonsilar
• anterior cervical
• posterior cervical
• supraclavicular