Upper Respiratory Exam

Question 1

Dizziness

Answer 1

DDX:
ENT issues: BPPV, labyrinthitis, Ménière's disease
Cardiovascular: dysrhythmia, hypotension
Respiratory: hyperventilation
Neuro: Parkinsonism

Question 2

BPPV

Answer 2

Techniques:

• Dix-Hallpike
• Epley Maneuver

Question 3

Streptococcal Pharyngitis

Answer 3

Streptococcus pyogenes

Red dots = palatine petiquei
Beefy red soft palate, enlarged red tonsils, white/yellow patches on tonsils, tiny red hemorrhages on soft palate

Treatment: penicillin

Adapted Centor Criteria

• fever (subjective or measured)
• cervical adenopathy
• tonsilar exudate
• no cough
• age (1 point for age 15 yrs)

Question 4

Cobbles toning

Answer 4

Bumps

Irritation from post nasal drip from rhinitis

Question 5

Tonsiloliths

Answer 5

Crypts = pockets in tonsils, get filled up with mucus, saliva, food => tonsil stones

Question 6

Pneumatic Otoscopy

Answer 6

Puff of air - TM goes away from you => bulging; TM come towards you => retracted
Otosclerosis = scarring of TM - indication of previous infections

Question 7

External Ear Landmarks

Answer 7

Auricle
Helix
Antihelix
Tragus
Triangular fossa
Lobule
External auditory canal

Question 8

Internal Ear Landmarks

Answer 8

Cone of light
Umbo - where eardrum meets tip of malleus; cone of light fans downward and anteriorly
Malleus
Manubrium - handle of malleus
Pars tensa - portions of drum that is inferior to the pars flaccida
Pars flaccida - superior to the malleus
Chorda tympani nerve - runs in the superior part near pars flaccida

Question 9

Examine Ear Canal

Answer 9

Adults: pull up, out, away
Children: pull down, out, away

Normal tympanic membrane = translucent and pearly

Question 10

Conductive Hearing Loss

Answer 10

External or middle ear problem (conductive phase)

Question 11

Sensorineural Hearing Loss

Answer 11

Inner ear, cochlear near or central brain connections problem (sensorineural phase)

Question 12

Whisper Test

Answer 12

Normal: patient correctly repeats sequence or after 2 sequences can identify 3/6

Abnormal: patient incorrectly identifies 4/6

90-100% sensitive
70-87% specific to detect hearing loss of >30 decibels

Question 13

Weber and Rinne Tests

Answer 13

Weber - test for lateralization

• normal = sound lateralized to both ears equally
• abnormal = should lateralized to one ear; conduction loss in that ear or sensorineural loss in opposite ear

Rinne - compares air and bone conduction

• normal = AC > BC
• if AC

Question 14

External Nose Landmarks

Answer 14

Ala nasi
Columella
Vestibule
Bridge

Rhinophyma - acne rosacea
Tenderness - local infection; furuncle

Question 15

Internal Nose Landmarks

Answer 15

Septum
Vestibule
Turbinates

Mucosa

• viral rhinitis: red, edema
• allergic: pale, bluish or red
• septal perforation: cocaine, meth, trauma, surgery

Turbinates are covered by highly vascular mucous membrane and protrude into nasal cavity. Function = cleaning, humidification, temperature control of inspired air

Question 16

Sinuses

Answer 16

Air filled cavities within bones of skull

Frontal (don’t open until after 7 years old)
Maxillary
Ethmoid
Sphenoid

Question 17

External Lip Landmarks

Answer 17

Lips

Vermillion border

Question 18

Internal Mouth Landmarks

Answer 18

Frenulum
- labial (connects lip with gingiva)
- lingual (connects tongue to floor of mouth)
Gingiva - firmly attached to teeth and to maxilla or mandible
Sublingual caruncle - opening to 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 and X
- paralysis = uvula deviates to opposite side and soft palate does not rise with saying “ah”
Uvula
Palatine tonsil
Posterior pharynx

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

Lymph Nodes

Answer 19

Preauricular
Postauricular
Submental
Submandibular
Tonsilar
Anterior cervical
Posterior cervical
Supraclavicular

Question 20

Presbycusis

Answer 20

Loss of higher frequencies

Common in older adults

Question 21

(Acute) Otitis Media

Answer 21

Ear pain - usually unilateral
Middle ear effusion with infection
Associated or preceded by cold symptoms
May have decreased hearing on affected side
May have fever
Obstruction of eustacian tube causes fluid build up in middle ear

Question 22

Otitis Externa

Answer 22

Aka swimmers ear
Unilateral ear pain
Often has purulent drainage
Exquisite pain with palpation of tragus, pin a, or auricle
Moisture becomes trapped in canal allowing for overgrowth of normal flora
Increase risk when ear canals are cleaned with cotton swabs - removes protective cerumen coating

Question 23

Bacterial Sinusitis

Answer 23

Presents with facial pressure and pain (unilateral > bilateral)
Proceeded/associated with cold symptoms
Cold symptoms get better then onset of unilateral sinus pressure
May or may not have fever

Question 24

Tonsillitis

Answer 24

Bacterial

• group A streptococcus
• sour throat, fever, lymphadenopathy (anterior cervical and tonsilar), pain with swallowing

Infectious mononucleosis
- sore throat, +/- fever, lymphadenopathy (posterior cervical, diffuse) fatigue, malaise

Question 25

Serous Otitis (Otitis Media with Effusion)

Answer 25

Middle ear effusion without infection
Bilateral or unilateral
Can be painful (must less severe than otitis media)
Can occur with allergy or URI symptoms
No fever
May have conductive hearing loss

Question 26

Acute Bacterial Rhinosinusitis

Answer 26

Localized pain in frontal and maxillary sinuses
Thick nasal discharge from both nostrils that may be worse on one side
Severe headaches and redness, tenderness, or swelling in or around the eyebrow or eye

Persistent and not improving >10 days
Severe >3-4 days
Worsening or double sickening >3-4 days