Upper Respiratory Exam Flashcards
What is the umbo?
where eardrum meets tip of the manubrium of malleus
What is the manubrium?
handle of malleus (part that you can see)
What are the two portions of the eardrum?
pars flaccida = superior
pars tensa = inferior
What is the nerve in the eardrum and where would you see it?
chorda typani nerve - runs in superior part near pars flaccida
How do you perform a whisper test?
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
How do you perform a weber test?
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
How do you perform a Rinne test?
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
What nerves control the soft palate?
CN 9 and 10
What would you see in paralyses of the soft palate?
uvula deviates to opposite side and soft palate doesn’t rise with saying “ah”
What are the 4 sets of lymph nodes you should know how to palpate?
anterior cervical
posterior cervical
submandibular
supraclavicular
When are frontal sinuses developed?
8 to 10 years of age
in forehead
If you expect an ear infection, what PE do you perform?
check eyes check sinuses for tenderness check nose and nasal turbinates check throat, tonsils check external and internal ear
What does otitis media look like?
Will see bulging tympanic membrane with varying degrees of erythema
will distort cone of light/ it won’t be seen
What is pharyngitis?
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
What is coryza?
inflamed mucus membrane
Why can patients report nausea with sore throat?
the pharynx is right next to intra-abdominal organs on the somatosensory map
What is GABHS?
group A beta-hemolytic streptococcus
What things let you know a sore through has the highest likelihood of being GABHS?
children 5-15 winter and early spring absence of cough tender anterior cervical lymphadenopathy tonsillar exudate fever
What is the centor score?
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
What does a rapid antigen detection test look for?
detects presence of group A strep
What is a monospot test?
rapid slide agglutination test for mononucleosis
What are the 4 types of middle ear infections?
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
What is an inner ear infection called?
labyrinithitis
What is considered chronic?
lasting more than 6 weeks
What do you see in otitis externa?
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
What is otosclerosis?
What are the 2 types?
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
If you had conductive hearing loss, what would you see on the weber and rinne tests?
Weber lateralizes to bad ear
Rinne: see BC>AC on bad ear
If you had sensorineural loss, what would you see on the Weber and Rinne tests?
Weber lateralizes to good ear
Rinne: normal on both ears
What are causes of conductive hearing loss?
cerumen impaction, middle ear fluid, lack of movement of the ossicles, trauma, other causes of obstruction such as tumors
What are causes of sensorineural hearing loss?
hereditary, meniere dx, MS, trauma, ototoxic drugs, etc
What are the most common viral causes of rhinosinusitis/sinusistis?
rhinovirus, adenovirus, influenza, parainfluenza
What symptoms are suspicious of bacterial sinusitis?
double sickening, purulent rhinorrhea, elevated ESR
no improvement for at least 10 days beyond onset of upper respiratory Sx
What are first line antibiotics for bacterial sinusitis?
Second line?
amoxicillin, augmentin
doxycycline, levaquin, clindamycin, and cefixime
What is croup?
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
What is epiglottitis?
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
What are the 5 main ENT causes of vertigo?
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
What is Miniere’s disease?
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
What are the 2 causes of BPPV?
- Caalithiasis (canal stones) = otoconial debris floating freely in the canal portion of the SCC; most common; posterior SCC m/c involved
- Cupulolithiasis = otoconial debris are adhered to the cupola of the crista ampullaris; not free floating, not common
What are the diagnosis and treatment techniques for BPPV?
diagnosis = dix-hallpike maneuver
diagnosis and tx = epley maneuver
If a pt has a lesion to CN 9 and 10, what would you see?
uvula deviates to opposite side of lesion
soft palate will not rise
