Upper Respiratory Exam

Question 1

What is the umbo?

Answer 1

where eardrum meets tip of the manubrium of malleus

Question 2

What is the manubrium?

Answer 2

handle of malleus (part that you can see)

Question 3

What are the two portions of the eardrum?

Answer 3

pars flaccida = superior

pars tensa = inferior

Question 4

What is the nerve in the eardrum and where would you see it?

Answer 4

chorda typani nerve - runs in superior part near pars flaccida

Question 5

How do you perform a whisper test?

Answer 5

dr stands behind pt and has them occlude one ear
dr exhales fully and then whispers a combo of numbers and letters
normal: pt repeats sequence or after 2 sequences can ID 3/6
abnormal: pt incorrectly iDs 4 of 6

Question 6

How do you perform a weber test?

Answer 6

tests for lateralization
vibrating fork placed in top of pt’s head or on middle of forehead
if they hear it better on one side –> should do Rinne test to see if the side lacking has issues

Question 7

How do you perform a Rinne test?

Answer 7

put vibrating for on mastoid bone behind ear
when pt can no longer hear sound –> put fork close to ear canal and ask if they can hear sound and for how long
normal: AC>BC
* if Weber was abnormal and Rinne was normal, suspect sensorineural loss in opposite ear
If AC = BC or BC>AC –> conductive loss to that ear

Question 8

What nerves control the soft palate?

Answer 8

CN 9 and 10

Question 9

What would you see in paralyses of the soft palate?

Answer 9

uvula deviates to opposite side and soft palate doesn’t rise with saying “ah”

Question 10

What are the 4 sets of lymph nodes you should know how to palpate?

Answer 10

anterior cervical
posterior cervical
submandibular
supraclavicular

Question 11

When are frontal sinuses developed?

Answer 11

8 to 10 years of age

in forehead

Question 12

If you expect an ear infection, what PE do you perform?

Answer 12

check eyes
check sinuses for tenderness
check nose and nasal turbinates
check throat, tonsils
check external and internal ear

Question 13

What does otitis media look like?

Answer 13

Will see bulging tympanic membrane with varying degrees of erythema
will distort cone of light/ it won’t be seen

Question 14

What is pharyngitis?

Answer 14

inflammation of pharynx with resulting sore throat
Can be viral or bacterial
Can see coryza, conjuctivitis, malaise or fatigue, hoarseness, and low grade = suggest viral

Question 15

What is coryza?

Answer 15

inflamed mucus membrane

Question 16

Why can patients report nausea with sore throat?

Answer 16

the pharynx is right next to intra-abdominal organs on the somatosensory map

Question 17

What is GABHS?

Answer 17

group A beta-hemolytic streptococcus

Question 18

What things let you know a sore through has the highest likelihood of being GABHS?

Answer 18

children 5-15
winter and early spring
absence of cough
tender anterior cervical lymphadenopathy
tonsillar exudate
fever

Question 19

What is the centor score?

Answer 19

Each risk factor for GABHS gets one point
if 0 or 1 –> no further antibiotic testing necessary
if 1-3 –> do culture –> can tell if antibiotics or not
if 4 or greater –> can consider empiric tx with antibiotics

Question 20

What does a rapid antigen detection test look for?

Answer 20

detects presence of group A strep

Question 21

What is a monospot test?

Answer 21

rapid slide agglutination test for mononucleosis

Question 22

What are the 4 types of middle ear infections?

Answer 22

acute otitis media
acute suppurative OM: acute OM w/ purulent material in middle ear
OM with effusion: inflammation and fluid buildup in the middle ear without bacterial or viral infection; may occur bc fluid buildup persists after an ear infection has resolved
Chronic OM w effusion: persistent infection that often results in tearing of the eardrum

Question 23

What is an inner ear infection called?

Answer 23

labyrinithitis

Question 24

What is considered chronic?

Answer 24

lasting more than 6 weeks

Question 25

What do you see in otitis externa?

Answer 25

outer ear canal infection
can be caused by bacteria entering a small break in skin of canal
pts may report drainage from the ear
usually associated with pain upon touching the external ear structures

Question 26

What is otosclerosis?

What are the 2 types?

Answer 26

abnormal bone growth around stapes bone
progressive hearing loss beginning at ages 10-30, marked loss in middle age
1) conductive loss - ossicle scleroses into a single immovable mass
2) sensory loss - otic capsule sclerosis, affects 10% of caucasians females > males

Question 27

If you had conductive hearing loss, what would you see on the weber and rinne tests?

Answer 27

Weber lateralizes to bad ear

Rinne: see BC>AC on bad ear

Question 28

If you had sensorineural loss, what would you see on the Weber and Rinne tests?

Answer 28

Weber lateralizes to good ear

Rinne: normal on both ears

Question 29

What are causes of conductive hearing loss?

Answer 29

cerumen impaction, middle ear fluid, lack of movement of the ossicles, trauma, other causes of obstruction such as tumors

Question 30

What are causes of sensorineural hearing loss?

Answer 30

hereditary, meniere dx, MS, trauma, ototoxic drugs, etc

Question 31

What are the most common viral causes of rhinosinusitis/sinusistis?

Answer 31

rhinovirus, adenovirus, influenza, parainfluenza

Question 32

What symptoms are suspicious of bacterial sinusitis?

Answer 32

double sickening, purulent rhinorrhea, elevated ESR

no improvement for at least 10 days beyond onset of upper respiratory Sx

Question 33

What are first line antibiotics for bacterial sinusitis?

Second line?

Answer 33

amoxicillin, augmentin

doxycycline, levaquin, clindamycin, and cefixime

Question 34

What is croup?

Answer 34

laryngotracheitis
swelling of the larynx, trachea, bronchi causing inspiratory stridor and barking cough in kids 6 mos to 3 yrs
fever, nasal flaring also
Tx: oxygen, dexamethasone, nebulized epi

Question 35

What is epiglottitis?

Answer 35

inflammation of epiglottis and adjacent structures
cause: haemophilus type b influenza, GABHS
high-grade fever, toxic appearance, child sitting or leaning fwd
protect airway! broad spectrum antibiotics

Question 36

What are the 5 main ENT causes of vertigo?

Answer 36

eustachian tube dysfunction - most common
benign paroxysmal positional vertigo (BPPV) - sudden sensation of spinning
vestibular neuritis = inflammation of the nerve
labyrinthitis - when infection affects both branches of vestibulo-cochlear nerve
meniere’s disease

Question 37

What is Miniere’s disease?

Answer 37

disorder of the inner ear that causes episodes in which you feel as if you’re spinning and have fluctuating hearing loss until permanent loss
in most cases, affects only one ear
usually starts btw ages 20-50, but can occur at any age

Question 38

What are the 2 causes of BPPV?

Answer 38

1. Caalithiasis (canal stones) = otoconial debris floating freely in the canal portion of the SCC; most common; posterior SCC m/c involved
2. Cupulolithiasis = otoconial debris are adhered to the cupola of the crista ampullaris; not free floating, not common

Question 39

What are the diagnosis and treatment techniques for BPPV?

Answer 39

diagnosis = dix-hallpike maneuver

diagnosis and tx = epley maneuver

Question 40

If a pt has a lesion to CN 9 and 10, what would you see?

Answer 40

uvula deviates to opposite side of lesion

soft palate will not rise