Upper Respiratory System

Question 1

When do frontal sinuses develop?

Answer 1

8-10 yrs of age

Question 2

whisper test

Answer 2

softly whisper into each ear & then ask the patient to repeat what you whispered
ex: baseball, 99
OR
place hands near both ear, then rub fingers near the patient’s ears one at a time. Ask pt to say which ear the pt heard the sound

Question 3

pneumatic otoscopy

Answer 3

blows small amount of air into the ear to determine the mobility of the pt’s tympanic membrane. Immobility may be due to fluid accumulation in the middle ear, a perforation, or tympanosclerosis

Question 4

normal lymph nodes

Answer 4

pea size, soft & spongy, non-tender, and mobile

Question 5

pharyngitis

Answer 5

Inflammation of the pharynx with sore throat
most likely causes: viral– adenovirus, rhinovirus, influenza A/B
or bacterial– Group A beta hemolytic streptococcus, chlamydia pneumoniae, & mycoplasma pneumoniae

Question 6

Common symptoms of viral pharyngitis

Answer 6

coryza (inflamed mucus membranes), conjunctivitis, fatigue, hoarseness, and low grade fever

Question 7

Why might a pt report nausea along with a pharyngitis?

Answer 7

pharynx is right next to intra-abdominal organs on the homunculus

Question 8

Probably Group A-beta hemolytic strep (GABHS) if

Answer 8

child 5-15, winter & early spring season,

absence of cough, tender anterior cervical lymphadenopathy, tonsillar exudate, & fever

Question 9

The Centor score

Answer 9

Clinical decision tool for management of sore throat.
Must get a score of 1-3 to perform throat culture. Score of 4 or greater– consider empiric treatment w/ antibiotics

Mainly based on expected symptoms of GABHS

Question 10

Rapid antigen detection test

Answer 10

Detects presence of group A streptococcal
specimen obtained by swab of posterior tonsillopharyngeal
–inoculated onto agar plate for throat culture

Question 11

Monospot test

Answer 11

Rapid slide agglutination test for mononucleosis (AKA Epstein-Barr virus)

Question 12

Outer ear infection

Answer 12

Otitis externa (outer ear canal)
Can be caused by bacteria entering a small break in the skin of canal. Pt may report drainage from ear. Usually associated with pain upon touching external ear structures.

Question 13

Inner ear infection

Answer 13

Labyrinithitis

Question 14

Middle ear

Answer 14

air filled space behind the eardrum

Question 15

Acute Otitis Media

Answer 15

Inflammation of the middle ear that can be caused by bacteria and viruses. Often appears the TM is bulging, erythematous.

Question 16

Acute suppurative OM

Answer 16

acute OM with purulent material in the middle ear

Question 17

OM with effusion (serous OM)

Answer 17

inflammation and fluid buildup (effusion) in the middle ear without bacterial or viral infection. May occur because the fluid buildup persists after an ear infection has resolved.

Question 18

Chronic OM with effusion

Answer 18

Occurs when fluid remains in the middle ear & continues to return without bacterial or viral infection. Children susceptible to new ear infections & may effect hearing.

Question 19

Chronic suppurative otitis media

Answer 19

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

Question 20

Otosclerosis

Answer 20

Abnormal growth around stapes bone

Associated with progressive hearing loss beginning at the ages 10-30, marked hearing loss occurring during middle age

Question 21

Otosclerosis types

Answer 21

1. Conductive loss: Ossicle sclerosis into single immovable mass
2. Sensory loss: Otic capsule sclerosis
   Affects 10% of caucasians, females>males

Question 22

Rhinosinusitis/sinusitis

Answer 22

Mucosal lining in the paranasal sinuses & nasal cavity becomes inflamed.
Infectious causes:
viral–rhinovirus, adenovirus, influenza virus
bacterial–streptococcus pneumoniae, haemophilus influenzae
–labs & imaging not typically needed

Question 23

Signs & symptoms of rhinosinusitis

Answer 23

nasal discharge, cough, sneezing, nasal congestion, fever, HA, pain, & facial pressure

Question 24

Symptomatic treatment of sinusitis

Answer 24

analgesics, intranasal corticosteriods, nasal saline irrigation, decongestants, atihistamine

Question 25

Bacterial sinusitis

Answer 25

Double sickening (initially get slightly better then gets worse), purulent rhinorrhea (mucus along nasal cavities), elevated ESR
Indicated when signs & symptoms pf acute rhinosinusitis persist without evidence of improvement for at least 10 days
Treatment: amoxicillin, augmentin

Question 26

Croup

Answer 26

AKA laryngotracheitis
Swelling of the larynx, trachea, bronchi causing inspiratory stridor & barking cough on children 6 mon-3 yrs.
Presentation: fever, nasal flaring, respiratory retractions, stridor
Typically viral
Treatment: oxygen, dexamethsone, nebulized epi

Question 27

epiglottitis

Answer 27

Inflammation of the epiglottis & adjacent structures
Typical causes: Type B influenza, GABHS
Presentation: high grade fever, toxic appearance, child sitting or leaning forward
Get lateral neck XR, WBC
Treatment: Protect airway! broad spectrum antibiotics

Question 28

Veritgo (dizziness)

Answer 28

Typical Causes:
eustachian tube dysfunction– tube gets inflammed & mucus/fluid builds up
benign paroxysmal positional vertigo–brief episodes of mild to intense dizziness. triggered by specific changes in the position of head
vesitibular neuritis–inflammation of nerve associated w/ balance.
labyrinthitis– inflammation of the labyrinth, affects both branches of the vestibulo-cochlear nerve

Question 29

Meniere’s Disease

Answer 29

Disorder of inner ear that causes episodes of dizziness, fluctuating hearing loss with a progressive, permanent loss of hearing. Can also have ringing and pressure in ear.
typicall only affects one ear.