Upper Respiratory Exam Flashcards
1
Q
What are some external landmarks of the ear?
A
- auricle
- helix
- antihelix
- concha
- antitragus
- tragus
- triangular fossa
- lobule
- external auditory canal
NOTE: outer portion is hairy and contains glands to produce cerumen
2
Q
What are some internal ear structures?
A
- 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
3
Q
How to position ear to examine ear?
A
- 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
4
Q
What is conductive hearing loss?
A
external or middle ear problem (conductive phase)
5
Q
What is sensorineural loss?
A
inner ear, cochlear nerve or central brain connections problem (sensorineural phase)
6
Q
Whisper test
A
- 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
7
Q
Weber test
A
- 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
8
Q
Rinne test
A
- 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
9
Q
What are some external landmarks on the nose?
A
- 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)
10
Q
What are some internal landmarks on the nose?
A
- septum
- vestibule
- turbinates
11
Q
How to examine the internal nose?
A
- 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
12
Q
How to inspect the sinuses?
A
- air filled cavities within bones of skull
13
Q
What are the sinuses?
A
- frontal - do not open until after 7 years old
- maxillary
- ethmoid
- sphenoid
14
Q
How to palpate the sinuses?
A
- frontal sinuses: press up under bony brows
- maxillary sinuses: press up on location of maxillary sinuses
15
Q
What are some external landmarks of the mouth/throat?
A
- lips
- vermillion border
16
Q
What are some internal structures of the mouth/throat?
A
- 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
17
Q
How to inspect the mouth/throat?
A
- 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
18
Q
What are some pathologies of mouth/throat?
A
- 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
19
Q
What are the lymph nodes around the throat?
A
- preauricular
- posterior auricular
- submental
- submandibular
- tonsilar
- anterior cervical
- posterior cervical
- supraclavicular
