Upper Respiratory Exam + Competency

Question 1

What might you see in the pharynx that indicates drainage down the back of the throat which has irritated the mucosa?

Answer 1

Cobblestoning

Question 2

What causes streptococcal pharyngitis

Answer 2

Group A beta-hemolytic streptococcus (strep pyogenes)

Question 3

The highest likelihood of group A beta hemolytic streptococcus is indicated by the AFACT mnemonic, what does it stand for?

Answer 3

Age (children 5-15)
Fever
Absence of cough
Cervical lymphad. (Tender anterior)
Tonsillar exudate

Also more common in winter and early spring

Question 4

What might you see in the pharynx of someone with strep?

Answer 4

Beefy red soft palate and uvula

Enlarged red tonsils

White or yellow patches on tonsils

Tiny red hemorrhages on soft palate

Question 5

What scoring system is used as a CDM tool to determine course of action for patients with CC of sore throat?

Answer 5

Modified Centor Criteria

Question 6

What is the Centor scoring system?

Answer 6

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

Question 7

What might patients report with GABH?

Answer 7

Sore throat
Headache
Fatigue
Fever
Body aches
Nausea

Question 8

Why might a patient with pharyngitis complain of nausea?

Answer 8

Pharynx is right next to intra-abdominal organs on the somatosensory homunculus

[could also be from swallowing nasal secretions]

Question 9

______ = caused by mucus and food that get trapped in the crypts of the tonsils; cause bad breath

Answer 9

Tonsiloliths (tonsil stones)

Question 10

What would you call a middle ear infection

Answer 10

Acute otitis media

Otitis media with effusion

Question 11

What would you call an inner ear infection

Answer 11

Labyrinthitis

Vestibular neuritis

Question 12

what type of ear infection involves erythematous, bulging TM which has reduced mobility when pneumatic otoscope is used?

Answer 12

Acute otitis media

Question 13

_______ is symptomatic inflammation of the middle ear that can be caused by bacteria OR viruses

Answer 13

Acute OM

Question 14

_____________is acute OM with purulent material in the middle ear

Answer 14

Acute suppurative OM

Question 15

______________ 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

Answer 15

OM with effusion (serous OM)

Question 16

__________ 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

Answer 16

Chronic OM with effusion

Question 17

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

Answer 17

Chronic suppurative OM

Question 18

What is considered “chronic” for OM?

Answer 18

Lasting more than 6 weeks

Question 19

Would you prescribe abx for OM with effusion?

Answer 19

No, no bacteria or viruses present

Question 20

___________ is abnormal bone growth around the stapes bone; associated with progressive hearing loss beginning between ages 10-30. Marked hearing loss during middle age

Answer 20

Otosclerosis

Question 21

What are the 2 types of otosclerosis?

Answer 21

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]

Question 22

What is the results of the weber test for someone with conductive hearing loss vs sensorineural

Answer 22

Conductive: Sound lateralizes to the affected side

Sensorineural: lateralizes to side opposite the affected side

Question 23

Normal vs. conductive loss result of rinne test

Answer 23

Normal: air conduction > bone conduction

Conductive loss: bone conduction > air conduction

Question 24

What are some osteopathic considerations for otitis media?what is important to do FIRST?

Answer 24

Open thoracic inlet FIRST

Viscerosomatic reflex (sympathetic T1-4, parasymp: vagus)

Sinus milking
Galbreath technique
Temporal rocking
V-spread

Question 25

What is the technical term for bacterial sinus infection

Answer 25

Acute rhinosinusitis (bacterial)

Question 26

Signs/symptoms of acute rhinosinusitis

Answer 26

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

Question 27

Most common causes of bacterial sinusitis

Answer 27

Strep pneumoniae, H. Influenzae, moraxella catarrhalis

Question 28

Tx for bacterial sinusitis - what is first choice, and what is given if patient has drug allergy to first choice?

Answer 28

First choice = amoxicillin with or w/o clavulanate If allergy: doxycycline or respiratory fluroquinalone

Question 29

When would you switch someone's abx for bacterial sinusitis

Answer 29

If they worsen within 7 days while on abx

Question 30

T/F: long-course abx tend to be more effective at treating bacterial sinusitis

Answer 30

False, no statistically significant diff between the two

Question 31

What is the most common cause of acute viral rhinosinusitis

Answer 31

Viral URI

Question 32

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?

Answer 32

Presence of double sickening at day 5-10

Question 33

How would you treat viral acute rhinosinusitis

Answer 33

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

Question 34

Most common cause of eustachian tube dysfunction

Answer 34

ET gets inflamed and mucus or fluid builds up; caused by cold, flu, sinusitis, allergies

Question 35

_____ == 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

Answer 35

BPPV

Question 36

________ = affects branch associated with balance, resulting in dizziiness or vertigo but NO CHANGE IN HEARING.

Answer 36

Vestibular neuritis (may also be called neuronitis)

Question 37

______ = occurs when infection affects both branches of vestibulocochlear n., resulting in HEARING CHANGES

Answer 37

Labyrinthitis

Question 38

_______ = 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

Answer 38

Meniere's diseae

Question 39

Most common cause of BPPV

Answer 39

Canalithiasis (debris floating in canal portion of SCC)

Question 40

Cause of BPPV other than canalithiasis

Answer 40

Cupulolithiasis (debris adhered to cupula of crista ampulars)

Question 41

Diagnosis technique for BPPV

Answer 41

Dix-Hallpike maneuver

Question 42

Dx and tx of epley maneuver

Answer 42

Epley maneuver