Chapter 12 Ears, Nose, And Throat

Front 1

What secretes cerumen?

Back 1

The apocrine cells in the distal third of the canal

Front 2

What is the function of cerumen?

Back 2

To protect and line the external auditory canal and provides an acidic pH environment that inhibits the growth of microorganisms.

Front 3

Where is the middle ear located?

Back 3

In an air-filled cavity in the temporal bone

Front 4

In the middle ear, how do the ossicles transmit sound?

Back 4

The malleus, incus, stapes transmit sound from the tympanic membrane to the oval window of the inner ear

Front 5

What are the different regions of the tympanic membrane?

Back 5

Superior portion - Pars Flaccida ( the flaccid portion
Inferior portion - Pars tensa (most of the tympanic membrane

Front 6

What are the different landmarks of the tympanic membrane?

Back 6

The handle of the malleus pulling the TM into a concave shape
The light reflex

Front 7

Where does the eustachian tube drain into?

Back 7

Into the posterior aspect of the inferior turbinate of the nose

Front 8

How does the cochlea transmit sound?

Back 8

The cochlea contains the organ of Corti that transmits sound impulses to the 8th cranial nerve

Front 9

Trace the pathway for sound transmission from ear to brain

Back 9

1. Sound waves travel through the external auditory canal and strikes the TM
2. The malleus, incus, and stapes vibrate
3 The stapes transmit sound through to the oval window of the inner ear
4. Movement of the oval window causes cochlear endolymph fluid motion to be transmitted out the round window
5. These transmissions causes the hair cells of Corti to detect sound and send the info via CN 8
6. The transmissions go to the temporal lobe of the brain

Front 10

What forms the nasal floor?

Back 10

the hard and soft palate

Front 11

What bones are involved in the nasal roof?

Back 11

frontal and sphenoid

Front 12

Where Kiesselbach plexus located?

Back 12

The Kiesselbach plexus is located on the anterior superior portion of the septum

Front 13

What is the function of the turbinates?

Back 13

They increase the nasal surface area to warm, humidify, and filter inspired air.

Front 14

What meatus drains the paranasal sinuses?

Back 14

the medial meatus

Front 15

What sinus drains into the superior meatus?

Back 15

Posterior ethmoid meatus

Front 16

Which sinuses are available for examination?

Back 16

Maxillary and frontal sinuses

Front 17

What are the Stensen ducts?

Back 17

They are parotid duct outlets that open on the buccal mucosa opposite the 2nd molar on each side of the upper jaw

Front 18

What are the Wharton ducts?

Back 18

They are the outlets of the submandibular glands that open on each side of the frenulum under the tongue

Front 19

What initiates the oropharyngeal swallowing?

Back 19

Oropharyngeal swallowing is initiated when food is forced by the tongue toward the pharynx

Front 20

When does embryological development of the inner ear occur?

Back 20

The 1st trimester

Front 21

What action restricts food from entering the nasopharynx?

Back 21

muscles in the pharynx contract and prevent movement of the food into the nasopharynx

Front 22

When do the frontal and sphenoid sinuses develop?

Back 22

at 3 years old

Front 23

What are the anatomical differences between a child and an adult's Eustachian tube?

Back 23

The infant's Eustachian tube if relatively wide, shorter, and more horizontal than an adult's --> this allows easier reflux of nasopharygneal secretions

Front 24

At what age do deciduous teeth appear?

Back 24

between 6 and 24 months of age

Front 25

When do permanent teeth begin forming?

Back 25

by 6 months of age

Front 26

When do permanent teeth erupt?

Back 26

at 6 years of age

Front 27

What causes age-related hearing loss?

Back 27

It is associated with degeneration of hair cells in the organ or Corti,
loss of cortical and organ of Corti auditory neurons,
degeneration of the cochlear conductive membrane
decreased vascularization of the cochlea

Front 28

What causes the loss of conductive hearing?

Back 28

It results from an excess deposition of bone cells along the ossicle chain, causing fixation of the stapes in the oval window

Front 29

What birth weight is risk factor for hearing loss?

Back 29

less than 1500 grams

Front 30

Name some risk factors for oral cancer?

Back 30

men have twice the rate of women
Excessive ETOH use
Tobacco use

Front 31

Do you need the ossicles to transmit sound?

Back 31

NO
Sound vibrations may also be transmitted by bone directly to the inner ear

Front 32

What is the position of the maxillary sinuses?

Back 32

The maxillary sinuses lie along the lateral wall of the nasal cavity in the maxillary bone

Front 33

how many permanent teeth do adults have?

Back 33

32

Front 34

The presence of tophi on the auricles indicate what disease?

Back 34

Tophi- small, whitish uric crystals along the peripheral margins of the auricles - may indicate gout

Front 35

what other landmarks do you use to check the position of the auricle?

Back 35

To check the auricle's position, draw an imaginary line between the inner canthus of the eye and the most prominent protuberance of the occiput.
The top of the auricle should be at or above this line.

Front 36

What are low-set ears?

Back 36

The auricle's position should be almost vertical with no more than a 10 degree lateral posterior angle --> anything more qualifies as low set ears

Front 37

What are the indicators of a bulging tympanic membrane?

Back 37

A bulging tympanic membrane is more conical, with a loss of bony landmarks and a distorted light reflex

Front 38

What are the indicators of a retracted tympanic membrane?

Back 38

It is more concave, with accentuated bony landmarks, and a distorted light reflex

Front 39

Would you expect to have movement of the tympanic membrane membrane with positive or negative pressure?

Back 39

You should expect to have movement with both.

Front 40

What potential scenarios would you expect to have no movement of the tympanic membrane?

Back 40

With a perforated membrane or if a pressure-equalizing tube is in place

Front 41

What is the purpose of the Rinne test?

Back 41

To test whether the patient hears better by air or bone conduction

Front 42

What is the objective of the Weber test?

Back 42

To assess unilateral hearing loss

Front 43

In a normal patient, what would you expect bone or air conduction of sound to be heard the longest?

Back 43

Air -conducted sound is supposed to be heard twice as long as bone conducted sound

Front 44

What should we expect with a negative Weber test?

Back 44

The sound is heard equally in each ear.

Front 45

In the setting of sensorineural hearing loss, the Weber test will have lateralization to the ____ ear and the ____ conduction is heard the longest in the affected ear

Back 45

better
air

Front 46

In the setting of conductive hearing loss, the Weber test will have lateralization to the ____ ear, and ____ conduction is heard longer in the affected ear

Back 46

affected
bone

Front 47

What is a transverse crease at the junction between the cartilage and the bone indicate?

Back 47

It may indicated chronic nasal itching and allergies

Front 48

When you examine a two year old boy, you note a thick green purulent discharge , what should you suspect as a reason?

Back 48

Foreign body

Front 49

How do we differentiate between allergy and rhinitis nasal discharge?

Back 49

Allergy nasal discharge is characterized by bilateral watery discharge and associated sneezing and nasal congestion
Rhinitis is characterized by bilateral mucoid or purulent discharge

Front 50

What is expected to be the appearance of the nasal turbinates with allergies?

Back 50

bluish gray or pale pink with a swollen, boggy consistency

Front 51

When you perform transillumination of the bilateral maxillary sinuses, you note that both are opaque what could this indicate?

Back 51

1. That the sinus is filled with secretions
2. That is never developed

Front 52

What is cheilitis?

Back 52

Dry, cracked lips

Front 53

What is chelosis?
What can cause this condition?

Back 53

Deep fissures at the corners of the mouth
Riboflavin deficiency or overclosure of the mouth --> allows saliva to macerate the tissue

Front 54

How can Peutz-Jaghers syndrome manifest on the lips?

Back 54

With round or irregular bluish gray macules on the lips and buccal mucosa

Front 55

What is a marker of proper occlusion of the teeth?

Back 55

When the upper molars interdigitate with the groove on the lower molars and the premolars and canines interdigitate fully

Front 56

What is a cross-bite?

Back 56

protrusion of lower incisiors or failure of the upper incisors to overlap with the lower incisors

Front 57

What is an overbite?

Back 57

protrusion of the upper incisiors

Front 58

What is an open bite?

Back 58

Failure of the back teeth to meet

Front 59

Where should we expect to locate the Stensen duct in the mouth?

Back 59

In approximate alignment with the 2nd molar

Front 60

What pathology is associated with the Fordyce spots?

Back 60

None
It is an expected variant.
They are ectopic sebaceous glands

Front 61

What changes do we expect with the Stensen ducts with mumps?

Back 61

A red spot on the buccal mucosa at the opening of the Stensen duct

Front 62

What is oral leukoplakia?

Back 62

It is a premalignant oral lesion that appears as a thickened white patch lesion that cannot be wiped away.

Front 63

Is leukoedema, premalignant or benign?

Back 63

Leukoedema, a diffuse filmy grayish surface with white streaks and is a BENIGN lesion

Front 64

What is epulis?

Back 64

A localized gingival enlargement of granuloma --> an inflammatory change

Front 65

What drugs can cause gingival hyperplasia?

Back 65

Phenytoin, cyclosporine, and calcium channel blockers

Front 66

What is a high-risk site for oral cancer?

Back 66

the vermilion border of the lips

Front 67

Extending the tongue, tests what cranial nerve?

Back 67

Hypoglossal ( CN 12)

Front 68

What changes to tongue appearance occur with vitamin B12 deficiency?

Back 68

A smooth red tongue with a slick appearance
Glossitis

Front 69

What pathology does a geographic tongue indicate?

Back 69

NONE
It is a n expecrted variant, with superficial denuded circles or irregular areas exposing the tips of papillae

Front 70

With deviation of the tongue to the right side, which side is the hypoglossal nerve affected?

Back 70

Right,
The tongue deviates to the affected side

Front 71

Where are the Wharton ducts located?

Back 71

On each side of the frenulum

Front 72

How can you differentiate between oral hairy leukoplakia and candidiasis?

Back 72

Candidasis is creamy white plaques on oral mucosa that bleed when scraped
Oral hairy leukoplakia are white, irregular lesions that do not scrape off

Front 73

How can you tell determine between herpes zoster and herpes simplex of the mouth?

Back 73

Herpes zoster are vesicular an ulcerative oral lesions in the distribution of the trigeminal nerve
Herpes simplex are vesicular , crusting lesions on the vermilion border of the lip

Front 74

Midline elevation of the uvula indicates the intact function of which cranial nerves?

Back 74

Vagus( CN 10) and Glossopharyngeal (CN 9)

Front 75

What is torus palatinus?

Back 75

a hard bony protuberance at the midline

Front 76

What side do expect the uvula to deviate to with paralysis of Left vagus injury?

Back 76

To the affected side

Front 77

What are the clinical signs of group A beta-hemolytic strep?

Back 77

Tonsillar enlargement and exudates
Tender and enlarged cervical nodes
Pharyngeal erythema

Front 78

What age do you expect a child to respond to their name

Back 78

7 to 12 months

Front 79

When does a child begin to respond to a parent's voice?

Back 79

4- 6 months

Front 80

When do you expect a child to startle to loud noises

Back 80

from birth to 3 months

Front 81

Newborns are _____ nose breathers

Back 81

obligatory

Front 82

When do you expect drooling as a normal occurrance in an infant?

Back 82

from 6 weeks to 6 months

Front 83

Where should expect to find retention cysts

Back 83

In a newborn, pearl-like retention cysts are found along the buccal mucosa margin and should disappear in 1-2 months

Front 84

What conditions are macroglossia associated with?

Back 84

Congenital hypothyroidism

Front 85

What age do you expect maxillary sinuses to develop?

Back 85

4 years of age

Front 86

What age do you expect frontal sinuses to develop?

Back 86

5 -6 years of age

Front 87

What is bruxism?

Back 87

Flattened edges on the teeth
This may indicate compulsive , unconscious grinding of the teeth

Front 88

The appearance of chalky white lines and speckles on the cutting edges of permanent incisors indicate excessive iron or fluoride therapy?

Back 88

Fluoride therapy

Front 89

what do the presence of Koplik spots indicate?

Back 89

Rubeola
They are white specks with a red base on the buccal mucosa opposite the first and second molars

Front 90

What is the underlying reason for presbycusis?

Back 90

Sensorineural hearing deterioration with advancing age

Front 91

What is difference between +3 and +4 tonsillar enlargement?

Back 91

3+ nearly touching the uvula
4+ touching each other

Front 92

How does eustachian tube obstruction lead to middle ear effusion?

Back 92

The Eustachian tube may be dysfunctional or obstructed by enlarged lymphoid tissue in the nasopharynx, causing the middle ear to absorb the air and create a vacuum; the middle ear mucosa secretes a transudate

Front 93

What is the precipitating event in otitis externa?

Back 93

Water retained in the ear canal that causes tissue maceration , desquamation and micro fissures that favor bacterial or fungal growth

Front 94

What is the appearance of the tympanic membrane with acute otitis media vs otitis media with effusion?

Back 94

In acute otitis media, the bulging TM has a distinct erythema with thickening or clouding
In Otitis media with effusion the TM may be retracted or bulging

Front 95

What is the result of conductive hearing loss in otitis media vs otitis media with effusion?

Back 95

In acute otitis media, conductive hearing loss occurs as middle ear fills with pus
In otitis media with effusion, conductive loss as middle ear fill with fluid

Front 96

Those with sensorineural hearing loss hear ____ in a crowded room and speaks _____

Back 96

poorly
loudly

Front 97

Those with conductive hearing loss hear _____ in a crowded room and speaks ______

Back 97

better
softly

Front 98

Loss of high- frequency sounds are a result of ________ hearing loss

Back 98

sensorineural

Front 99

Loss of low- frequency sounds are a result of _______ hearing loss

Back 99

conductive

Front 100

Cholesteatoma is trapped epithelial tissue _____ the TM

Back 100

Behind
The TM remains intact

Front 101

The loss of understanding of speech and localization of sound correlates to the loss of ____ frequency sound

Back 101

high

Front 102

At what age do you start to experience deterioration of the sense of smell?

Back 102

60 years

Front 103

How do we begin to lose our sense of taste?

Back 103

At about the age of 50 years of age, the number of papillae on the tongue and salivary gland secretions decrease

Front 104

What is a Darwinian tubercle?

Back 104

A normal variant
A thickening along the upper ridge of the helix

Front 105

If a patient occludes their ear, during the Weber test, which ear should hear the sound the best?

Back 105

It should be heard best in the occluded ear

Front 106

What is the appearance of the tympanic membrane in the setting of a cholesteatoma?

Back 106

Spherical white cyst behind intact tympanic membrane

Front 107

what is the pattern of hearing loss in Meniere Disease?

Back 107

Hearing loss to low tones initially with fluctuating progression to profound sensorineural hearing loss

Front 108

What type of nystagmus is present in acute vestibular neuronitis?

Back 108

Spontaneous horizontal nystagmus with or without rotary nystagmus

Front 109

What induces nystagmus in benign paraoxysmal positional vertigo?

Back 109

Dix-Hallpike maneuver

Front 110

What is the causative agent for initiating vertigo in benign paraoxysmal positional vertigo?

Back 110

otolith fragments gravitate into the semicircular canal, and nerve sensors in the canal cause vertigo with head movements

Front 111

Where are Weber's glands?

Back 111

Weber's glands are mucous salivary glands in the space anterior to the tonsil in the soft palate with a duct on the surface of the tonsil

Front 112

What can happen if the Weber's glands become inflamed and the duct is obstructed?

Back 112

It can lead to cellulitis of the soft palate --> peritonsillar abscess

Front 113

What is trismus?

Back 113

Spasm of masticator muscles

Front 114

Where is the displacement of the uvula with a peritonsillar abscess?

Back 114

There is displacement of the uvula to the contralateral side.

Front 115

What movement increases the pain in retropharyngeal abscess?

Back 115

Lateral neck movement

Front 116

Which can cause respiratory distress peritonsillar or retropharyngeal abscess?

Back 116

Retropharyngeal abscess

Front 117

What are some common causative agents for retropharyngeal abscess?

Back 117

group A streptoccoci and Staphylococcus aureus

Front 118

What is the most common cancer in oral cancer?

Back 118

Squamous cell carcinoma

Front 119

what is the most common craniofacial congenital malformation?

Back 119

cleft lip and palate

Front 120

When do you expect the lip and palate to fuse during development?

Back 120

prior to the 12th week of gestation

Front 121

What antibiotic that is given during tooth development can cause mottled or pitted teeth?

Back 121

Tetracycline

Front 122

How do you stimulate the gag reflex in an infant?

Back 122

By touching the tonsillar pillars