Upper Respiratory Exam Flashcards
Dizziness
DDX: ENT issues: BPPV, labyrinthitis, Ménière's disease Cardiovascular: dysrhythmia, hypotension Respiratory: hyperventilation Neuro: Parkinsonism
BPPV
Techniques:
- Dix-Hallpike
- Epley Maneuver
Streptococcal Pharyngitis
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)
Cobbles toning
Bumps
Irritation from post nasal drip from rhinitis
Tonsiloliths
Crypts = pockets in tonsils, get filled up with mucus, saliva, food => tonsil stones
Pneumatic Otoscopy
Puff of air - TM goes away from you => bulging; TM come towards you => retracted
Otosclerosis = scarring of TM - indication of previous infections
External Ear Landmarks
Auricle Helix Antihelix Tragus Triangular fossa Lobule External auditory canal
Internal Ear Landmarks
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
Examine Ear Canal
Adults: pull up, out, away
Children: pull down, out, away
Normal tympanic membrane = translucent and pearly
Conductive Hearing Loss
External or middle ear problem (conductive phase)
Sensorineural Hearing Loss
Inner ear, cochlear near or central brain connections problem (sensorineural phase)
Whisper Test
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
Weber and Rinne Tests
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
External Nose Landmarks
Ala nasi
Columella
Vestibule
Bridge
Rhinophyma - acne rosacea
Tenderness - local infection; furuncle
Internal Nose Landmarks
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
Sinuses
Air filled cavities within bones of skull
Frontal (don’t open until after 7 years old)
Maxillary
Ethmoid
Sphenoid
External Lip Landmarks
Lips
Vermillion border
Internal Mouth Landmarks
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
Lymph Nodes
Preauricular Postauricular Submental Submandibular Tonsilar Anterior cervical Posterior cervical Supraclavicular
Presbycusis
Loss of higher frequencies
Common in older adults
(Acute) Otitis Media
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
Otitis Externa
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
Bacterial Sinusitis
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
Tonsillitis
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
Serous Otitis (Otitis Media with Effusion)
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
Acute Bacterial Rhinosinusitis
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
