Upper Respiratory System

Question 1

What three things should you check on the ear?

Answer 1

1. External ear
2. Look for drainage/redness
3. Tenderness of the tragus

Question 2

Ear infections: 3 sections

Answer 2

1. Middle: air filled spaced behind eardrum
   - acute otitis media
   - otitis media with effusion
2. Outer (outer ear canal)
   - otitis externa
3. Inner (inner ear structures)
   - labyrinithitis

Question 3

Whisper Test

Answer 3

• Softly whisper in the patients ears and ask the patient to repeat what you whispered
• place fingers near ear, and rub fingers near patient’s ear to see if they can hear it (do one ear at a time, and see if the patient can identify which ear you were behind)

Question 4

Croup

Answer 4

Laryngotracheitis

-swelling of the larynx, trachea, bronchi causing inspiratory stridor and barking cough in children 6mo to 3 yr

Question 5

Why might patients report nausea with throat problems?

Answer 5

pharynx is right next to intraabdominal organs on the homunculus

Question 6

OM with effusion

Answer 6

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

Question 7

Acute OM

Answer 7

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

Question 8

Acute suppurative OM

Answer 8

acute OM with purulent material in the middle ear

Question 9

Chronic OM with effusion

Answer 9

occurs when fluid remains in the middle ear and continues to return without bacterial or viral infection

Question 10

What can cause progressive hearing loss starting age 10-30?

Answer 10

Otosclerosis (abnormal bone growth around stapes bones)

Question 11

Highest likelihood of GABHS if…

Answer 11

1. Children 5-15
2. Winter and early spring seasons
3. Absence of cough
4. Tender anterior cervicl lymphadenopathy
5. Tonsillar exudate
6. Fever

Question 12

Pharyngitis

Answer 12

• inflammation of pharynx with resulting sore throat

- common symptoms for viral: coryza, conjunctivitis, malaise, hoarseness, and low grade fever

Question 13

Rhinosinusitis/Sinusitis

Answer 13

• mucosal lining in the paranasal sinuses and nasal cavity becomes inflamed
• signs/symptoms: nasal discharge, cough, sneezing, nasal congestion, fever, headache, pain, facial pressure

Question 14

Chronic suppurative otitis media

Answer 14

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

Question 15

At what age do children develop frontal sinuses?

Answer 15

7

Question 16

Rinne Test

Answer 16

Normal: air conduction > bone conduction

Conductive Loss: bone conduction > air conduction

Question 17

Epiglottitis

Answer 17

inflammation of the epiglottis and adjacent structures

Question 18

Weber Test

Answer 18

Normal: midline and hear equally
Conductive Loss: lateralized to the affected side
Sensorineural Loss: Lateralized to the side opposite the affected ear

Question 19

How do you check the lymph nodes?

Answer 19

1. Using the pads of the middle three fingers
2. Check texture (rubbery, hard, soft…)
3. Check for size (pea size, quarter size…)
4. Check for tenderness

Question 20

Streptococcal Pharyngitis

Answer 20

group A-beta hemolytic streptococcus (streptococcus pyogenes)