Upper Respiratory Exam Flashcards by Christine Ng

External landmarks of the ear

Auricle
Helix
Antihelix
Concha
Antitragus
Tragus
Triangular fossa
Lobule
External auditory canal

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Internal structures of the ear

Cone of light
Umbo
Malleus
Manubrium
Pars tensa
Pars Flaccida
Chorda tympani nerve

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Normal appearance of the tympanic membrane

Translucent and pearly

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What does conductive hearing loss indicate?

External or middle ear problem

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What does sensorineural hearing loss indicate?

Inner ear, cochlear nerve, or central brain connection problem

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Whisper test

Doc stands behind pt. Pt occludes one ear. Doc whispers a combination of numbers and letters and pt repeats

Normal: Pt correctly repeats sequence or after 2 sequences, can identify 3 of 6

Abnormal: Pt incorrectly identifies 4/6

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Weber test

Tests for lateralization of hearing loss

Vibrating tuning for placed on top of pt’s head or middle forehead

Normal: Sound lateralizes to both ears equally

Abnormal: Sound lateralizes to 1 ear, it is conduction loss in that ear or sensorineural loss in the opposite ear

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Rinne test

Compares air and bone conduction

Vibrating tuning for placed on mastoid bone behind ear and level with the canal. When pt no longer hears sound, quickly place fork close to ear canal.

Normal: AC>BC, if Weber test was abnormal, suspect sensorineural loss in opposite ear

If AC=BC or BC>AC there is conductive loss to that ear

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External landmarks of the nose

Ala nasi
Columella
Vestibule
Bridge

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Internal landmarks of the nose

Septum
Vestibule - Most anterior part of nasal cavity
Turbinates

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Location of lymph nodes

Preauricular
Posterior auricular
Submental
Submandibular
Tonsilar
Anterior cervical
Posterior cervical
Supraclavicular

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What are the 4 facial sinuses?

Frontal
Maxillary
Ethmoid
Sphenoid

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External landmarks of the mouth

Lips

Vermillion border

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Internal structures of the mouth

Labial frenulum
Lingual Frenulum
Gingiva
Sublingual caruncle
Lesser sublingual ducts
Tongue
Hard/Soft palate
Uvula
Palatine tonsil
Posterior pharynx

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Appearance of otitis media

Bulging TM with varying degree of Erythema

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What is pharyngitis?

Inflammation of pharynx with resulting sore throat

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Sx of viral pharyngitis

Coryza (inflamed mucus membrane)
Conjunctivitis
Fatigue
Hoarseness
Low grade fever

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Sx of streptococcal pharyngitis

Sore throat
HA
Fatigue
Fever
Body aches
Nausea - because pharynx is next to abdominal organs on homunculus...i guess

Highest likelihood of GABHS if:

Children 5-15
Winter and early spring seasons
Absence of cough
Tender anterior cervical lymphadenopathy
Tonsillar exudate
Fever

Otitis media is an infection of ____

Middle ear

Air-filled space behind the eardrum

Otitis externa is the infection of the ____

Outer ear canal

Labryrinthitis

Infection of the inner ear structures

Affects both branches of vestibulo-cochlear nerve => hearing changes and vertigo

Acute Otitis Media

Symptomatic inflammation of the middle ear that can be caused by bacteria or viruses

Acute suppurative OM

Acute OM with purulent material in the middle ear

OM with effusion

Inflammation and fluid buildup in the middle ear without bacterial ro viral infection May occur because fluid buildup persists after an ear infection has resolved May also occur because of some dysfunction or noninfectious blockage of the eustachian tubes

Chronic OM with effusion

Occurs when fluid remains in the middle ear and continues to return without bacterial or viral infection Makes children susceptible to new ear infections May affect hearing

Chronic suppurative OM

Persistent ear infection that often results in tearing or perforation of the eardrum

Otosclerosis

Abnormal bone growth around stapes bone Associated with progressive hearing loss beginning at ages 10-30, marked hearing loss occurring during middle age

Ossicle sclerosis into a single immovable mass results in ___

Conductive hearing loss

Otic capsule sclerosis results in ___

Sensory hearing loss F>M

Rhinosinusitis/Sinusitis

Mucosal lining in paranasal sinuses and nasal cavity becomes inflamed

Sx of sinusitis/Rhinosinusitis

``` Nasal discharge Cough Sneezing Nasal congestion Fever HA facial pressure ```

Bacterial Sinusitis

Suspicion of acute bacterial sinusitis Gets better then worse, purulent rhinorrhea, elevated ESR Suspected with persistent acute rhinosinusitis without improvement for 10 days

Croup

Swelling of larynx, trachea, bronchi causing inspiratory stridor and barking cough in children 6 mo to 3 yrs old

Causes of croup

Parainfluenza virus Influenza RSV

Epiglottitis

Inflammation of epiglottis and adjacent structures High grade fever, toxic appearance, child sitting or leaning forward May need to intubate

Causes of epiglottitis

Hemophilia Type B influenza | GABHS

Eustachian tube dysfxn

Tube gets inflamed and mucus or fluid builds up => Vertigo Caused by flu, sinus infection, or allergies

Benign Paroxysmal Positional Vertigo

One of the most common causes of vertigo Sudden spinning sensation Triggered by specific changes in head position

Vestibular Neuritis

Inflammation of the nerve associated with balance => Vertigo No change in hearing

Meniere's dz

Disorder of inner ear that causes episodes of vertigo Fluctuating hearing loss with progressive, permanent loss of hearing, ringing in ear Usually unilateral Starts from 20-50

Canalithiasis

Otoconial debris floating freely in the ear canal Free floating Most common

Cupulolithiasis

Otoconial debris adhered to the cupula of the crista ampullaris Not free floating Not common