Upper Respiratory Exam + Competency Flashcards
What might you see in the pharynx that indicates drainage down the back of the throat which has irritated the mucosa?
Cobblestoning
What causes streptococcal pharyngitis
Group A beta-hemolytic streptococcus (strep pyogenes)
The highest likelihood of group A beta hemolytic streptococcus is indicated by the AFACT mnemonic, what does it stand for?
Age (children 5-15) Fever Absence of cough Cervical lymphad. (Tender anterior) Tonsillar exudate
Also more common in winter and early spring
What might you see in the pharynx of someone with strep?
Beefy red soft palate and uvula
Enlarged red tonsils
White or yellow patches on tonsils
Tiny red hemorrhages on soft palate
What scoring system is used as a CDM tool to determine course of action for patients with CC of sore throat?
Modified Centor Criteria
What is the Centor scoring system?
Age: 1 point for 3-14, 0 pts for 15-44, -1 for >45
Fever: temp over 100.4
Absence of cough = +1
Cervical adenopathy = +1
Tonsilar exudate = +1
0,1 = no additional testing or treatment
2,3 = perform throat culture or RADT (rapid antigen detection testing)
4,5 = consider empiric tx with abx
What might patients report with GABH?
Sore throat Headache Fatigue Fever Body aches Nausea
Why might a patient with pharyngitis complain of nausea?
Pharynx is right next to intra-abdominal organs on the somatosensory homunculus
[could also be from swallowing nasal secretions]
______ = caused by mucus and food that get trapped in the crypts of the tonsils; cause bad breath
Tonsiloliths (tonsil stones)
What would you call a middle ear infection
Acute otitis media
Otitis media with effusion
What would you call an inner ear infection
Labyrinthitis
Vestibular neuritis
what type of ear infection involves erythematous, bulging TM which has reduced mobility when pneumatic otoscope is used?
Acute otitis media
_______ is symptomatic inflammation of the middle ear that can be caused by bacteria OR viruses
Acute OM
_____________is acute OM with purulent material in the middle ear
Acute suppurative OM
______________ is inflammation and fluid buildup in the middle ear WITHOUT bacterial or viral infection
May occur because the fluid buildup persists after an ear infection has resolved. May also occur because of some dysfunction or noninfectious blockage of eustachian tubes
OM with effusion (serous OM)
__________ occurs when fluid remains in the middle ear and continues to return without bacterial or viral infection
This makes children susceptible to new ear infections and may affect hearing
Chronic OM with effusion
__________ is a persistent ear infection that often results in tearing or perforation of the eardrum
Chronic suppurative OM
What is considered “chronic” for OM?
Lasting more than 6 weeks
Would you prescribe abx for OM with effusion?
No, no bacteria or viruses present
___________ is abnormal bone growth around the stapes bone; associated with progressive hearing loss beginning between ages 10-30. Marked hearing loss during middle age
Otosclerosis
What are the 2 types of otosclerosis?
Conductive loss - ossicle sclerosis into a single immovable mass; middle ear
Sensory loss - otic capsule sclerosis; inner ear
[affects about 10%of caucasians, females more than males]
What is the results of the weber test for someone with conductive hearing loss vs sensorineural
Conductive: Sound lateralizes to the affected side
Sensorineural: lateralizes to side opposite the affected side
Normal vs. conductive loss result of rinne test
Normal: air conduction > bone conduction
Conductive loss: bone conduction > air conduction
What are some osteopathic considerations for otitis media?what is important to do FIRST?
Open thoracic inlet FIRST
Viscerosomatic reflex (sympathetic T1-4, parasymp: vagus)
Sinus milking
Galbreath technique
Temporal rocking
V-spread
What is the technical term for bacterial sinus infection
Acute rhinosinusitis (bacterial)
Signs/symptoms of acute rhinosinusitis
Persistent and not improving x7-10 days
Severe for 3-4 days
Maybe fever
Worsening or double-sickening 3-4 days into illness
Purulent mucus from nose
ESR > 10 mm/hr
Maxillary tooth pain
Most common causes of bacterial sinusitis
Strep pneumoniae, H. Influenzae, moraxella catarrhalis
Tx for bacterial sinusitis - what is first choice, and what is given if patient has drug allergy to first choice?
First choice = amoxicillin with or w/o clavulanate
If allergy: doxycycline or respiratory fluroquinalone
When would you switch someone’s abx for bacterial sinusitis
If they worsen within 7 days while on abx
T/F: long-course abx tend to be more effective at treating bacterial sinusitis
False, no statistically significant diff between the two
What is the most common cause of acute viral rhinosinusitis
Viral URI
Pt presenting during first 3-4 days of illness - can’t tell if viral or bacterial rhinosinusitis. How can you conclude that it is likely bacterial?
Presence of double sickening at day 5-10
How would you treat viral acute rhinosinusitis
Watchful waiting
Symptomatic tx: saline rinse, analgesics, intranasal steroids
Consider abx after 7-10 days - SNAP = safety net antibiotic prescription may be given with instructions
Most common cause of eustachian tube dysfunction
ET gets inflamed and mucus or fluid builds up; caused by cold, flu, sinusitis, allergies
_____ == sudden sesnation that youre spinning or that inside of your head is spinning; causes brief episodes of mild to intense dizziness; usually triggered by changes in head position
BPPV
________ = affects branch associated with balance, resulting in dizziiness or vertigo but NO CHANGE IN HEARING.
Vestibular neuritis (may also be called neuronitis)
______ = occurs when infection affects both branches of vestibulocochlear n., resulting in HEARING CHANGES
Labyrinthitis
_______ = disorder of inner ear causing episodes of vertigo and fluctuating hearing loss with progresive, ultimately permanent hearing loss, tinnitus, feeling of ear fullness
Often affects only 1 ear
Can occur at any age, starts at ages20-50
Meniere’s diseae
Most common cause of BPPV
Canalithiasis (debris floating in canal portion of SCC)
Cause of BPPV other than canalithiasis
Cupulolithiasis (debris adhered to cupula of crista ampulars)
Diagnosis technique for BPPV
Dix-Hallpike maneuver
Dx and tx of epley maneuver
Epley maneuver
