Upper Respiratory System Flashcards
1
Q
Conditions found with:
- Sore Throat (2)
- Ear Infection (2)
- Common cold
- acute childhood illnesses( 2)
- Dizziness
A
Sore throat
- streptococcal
- viral and allergic etiology
Ear infections
- acute otitis media
- acute otitis externa
Common Cold
- acute rhinosinusitis
Acute childhood illness
- croup
- epiglottis
Dizziness
- benign positional vertigo
2
Q
Sinus development- when?
A
8-10 years of age
3
Q
Abnormal vs Normal nose
A
abnormal:
- pale and swollen turbinates
- clear rhinorrhea
4
Q
Abnormal vs Normal throat
A
Abnormal:
- tonsillar erythema
- swelling
- exudate
- tonsillar swelling
5
Q
Cobblestoning
A
appearance of pharynx
- cobblestone like in tonsils, pharynx
6
Q
Oral Exam
A
- more extensive than neede for patients with sore throat
- use gloves
- get good view of oral mucosa and gingiva
- palpate oral mucosa and gingiva
- check ventral aspect of tongue
- grip tongue with gauze to check lateral borders
7
Q
Anatomy of Mouth
A
- gingiva
- mucosa
- vestibule
- hard palate
- tonsillar area
- soft palate
- tongue
8
Q
What to check for in the ear?
A
- check external ear
- check for any drainage, redness
- check for tenderness of tragus
9
Q
Anatomy of Ear
A
- Helix
- antihelix
- tragus
- lobule
- entrance to ear canal
10
Q
Whisper Test
A
- softly whisper into each ear then ask patient to repeat what was whisper
- rub fingers near patient ear one at a time
11
Q
Abnormal Ear condition
A
- Otitis media
- bulging TM with varying erythema
12
Q
What to check for in Lymph Nodes?
A
- use pads of middle three fingers
- check texture (rubbery, soft)
- check size (pea size, quarter size)
- check for tenderness
13
Q
Possible differentials for upper respiratory tract (6)
A
- streptococcal pharyngitis
- viral pharyngitis
- acute otitis media
- otitis externa
- bacterial sinusitis
- acute rhinosinusitis
14
Q
Strep Throat
A
- beefy red soft palate
- uvula
- enlarged red tonsils
- white or yellow patches on the tonsils
- tiny red hemorrhages on the soft palate
15
Q
Pharyngitis
A
- inflammation of pharynx with resulting sore throat
16
Q
Cause of pharyngitis (infectious cause)
A
- Viral (adenovirus, rhinovirus, coronaviruses, enterovirus, influenza A and B, parainfluenza viruses, respiratory syncytial virus)
- Bacterial ( GABHS, chlamydia pneumoniae, mycoplasma pneumoniae)
17
Q
Symptoms of viral pharyngitis
A
- coryza ( inflamed mucus membrane)
- malaise, fatigue
- hoarseness
- low grade fever
18
Q
Other differential diagnosis of pharyngitis
A
mononucleosis, gerd, postnasal drip secondary to persistent cough, thyroiditis, allergies, foreign body, smoking
19
Q
Streptococcal Pharyngitis
A
Group A beta-hemolytic streptococcus (pyogenes)
20
Q
Symptoms of Streptococcal Pharyngitis (6)
A
- sore throat
- headache
- fatigue
- fever
- body aches
- nausea
21
Q
Pharynx location
A
- right next to intraabdominal organs on homunculus
- “ felt so good it made my toes curl”
22
Q
Highest likehood of GABHS (5)
A
- children 5-15
- winter and spring season
- absence of cough
- tender anterior cervical lymphadenopathy
- tonsillar exudate
- fever
23
Q
Tests/ Labs for Upper Respiratory Tract (3)
A
1) Rapid Antigen Detection/ rapid streptococcal antigen test
- detect presence of group A streptococcal
2) Throat culture
- throat swab of posterior tonsilopharyngeal and inoculated onto agar plate
3) Monospot test
- rapid slide agglutination test for mononucleosis
24
Q
Treatments for Upper Respiratory Tract
A
- antibiotics
- NSAIDS
- cough drip
- chloraseptic rays
25
Ear Infections in middle (2), outer, inner ear
1) Middle ( air filled behind eardrum)
- acute otitis media (AOM)
- otitis media with effusion
2) Outer
- otitis externa
3) Inner
- Labyrinithitis
26
Otitis Media types ( 4)
1) Acute Otitis Media
- symptomatic inflammation caused by bacteria or virus
- TM is bulging
- Red
- TM has reduced mobility
2) Otitis Media with Effusion (serous)
- inflammation and buildup without bacterial or viral infection
- fluid behind ear drum
- can last 3 months
- can affect hearing especially if it is chronic
3) AOM ( suppurative)
- like #1 with purulent material in ear
4) Chronic suppurative otitis media
- persistent ear infection that often results in tearing or perforation of eardrum
27
Otitis Externa
- caused by bacteria entering a small break in skin of canal
- drainage from ear
- pain upon touching external ear structures
28
Otosclerosis
| - Types (2)
- abnormal bone growth around stapes bone
- progressive hearing loss btw 10-30 yo
- affect 10 % of Caucasian
- females> males
1) Conductive loss- ossicle sclerosis into single immovable mass
2) Sensory loss- otic capsule sclerosis
29
Weber Test
Put tuning fork on forehead
Normal: hear equally
Conductive loss: lateralizes to affected side
Sensorineural loss: lateralizes to side opposite the affected ear
30
Rinne Test
Normal: air conduction> bone conduction
| Conduction loss: bone conduction> air conduction
31
Causes of Conductive Hearing loss
- middle ear fluid
- lack of ossicles movement
- trauma
- obstruction ( Tumor)
32
Causes of Sensorineural hearing loss
- hereditary
- MS
- trauma
- ototoxic drugs
- barotrauma
33
Rhinosinusitis/ Sinusitis
- causes
- symptoms
- treatment
- mucosal lining in paranasal sinuses and nasal cavity becomes inflamed
- infectious/ virus causes
- symptoms: nasal discharge, cough, sneezing, congestion, fever, headache
- no lab or imaging needed
Treatment: analgesics, intranasal corticosteroids (flonase), nasal saline irrigation, decongestants, antihistamine
34
Bacterial Sinusitis
| - Treatment
- double sickening, purulent rhinorrhea
- acute bacterial sinusitis
Treatment
1st: amoxicillin, Augmentin
2nd: doxycycline, levaquin, clindamycin, cefixime
35
Croup
- causes
- symptoms
- treatment
aka Laryngotracheitis
- swelling of larynx, trachea, bronchi causing inspiratory stridor/barking cough
Causes: parainfluenza virus, influenza, respiratory syncytial virus
Treatment: oxygen, dexamethasone, epinephrine,
36
Epiglottitis
- causes
- symptoms
- treatment
- inflammation of epiglottis or adjacent structures
Causes: Haemophilus Type B influenza, Group A beta hemolytic steptococcus
Symptoms: sore throat, muffled voice, drooling, high grade fever, toxic appearance, CHILD SITTING or LEANING FORWARD
Treatment: Protect airway, antibiotics
37
Differentials for ENT causes of Vertigo (5)
1) Eustachian Tube dysfunction
- tube get inflamed
- mucus/ fluid build up
causes: flu, sinus infection, allergies
2) Benign paroxysmal positional vertigo( BPPV)
- intense dizziness
3) Vestibular Neuritis
- inflammation of the nerve
- affect branches associated with balance
- dizziness
- neuronitis ( damage to sensory neurons of vestibular ganglion)
- NO changes in HEARING
4) Labyrinthitis
- inflammation of labyrinth
- infection affecting both vestibulo-cochlear nerve
- dizziness/vertigo
5) Meniere's disease
- disorder in inner ear
- episodes of spinning (vertigo)
- fluctuating hearing loss-> could lead to permanent hearing loss
- ringing in ear
- typically affects 1 ear
- chronic
38
Two Types of BPPV
1) Canalithiasis ( canal stones)
- otoconial debris floating freely in canal portion of SCC
- free floating
- most common
- Posterior SCC m/c involved
2) Cupulolithiasis (cupula stones)
- otoconial debris are adhered to cupula of crista ampullaris
- not free floating
- not common
