Clinical Exam - Ears Nose And Throat

Front 1

the external ear canal is protected and lubricated with _____ which is secreted by ____

Back 1

cerumen; sebaceous glands

Front 2

within which bone is the middle ear found?

Back 2

temporal bone

Front 3

name the 3 ossicles

Back 3

malleus, incus and stapes

Front 4

the ossicles transmit sound from the tympanic membrane to _____

Back 4

oval window

Front 5

this surrounds the tympanic membrane

Back 5

dense fibrous ring called the annulus

Front 6

another name for the center of the TM

Back 6

umbo

Front 7

the eustachian tube passes between the nasopharynx and which part of the ear?

Back 7

middle ear

Front 8

____ allows the TM to vibrate freely

Back 8

equalized pressure in the middle ear

Front 9

the inner ear consists of

Back 9

vestibule, semicircular canals and cochlea

Front 10

this structure transmits sound impulses to the 8th CN and contains

Back 10

cochlea; organ of Corti

Front 11

____ contain the end organs for vestibular function

Back 11

semicircular canals

Front 12

equilibrium receptors are in the ____ and ____

Back 12

semicircular canals and vestibule

Front 13

equilibrium receptors respond to ____ and send signals to the ____ to maintain balance

Back 13

changes in direction of movement; cerebellum

Front 14

sound waves travel from the oval window to the ____

Back 14

cochlea

Front 15

sound waves travel via the endolymph from the cochlea to the _____

Back 15

round window

Front 16

this is the location where impulses in the sensory endings of the 8th CN begin and are transmitted to:

Back 16

membrane of Corti; temporal lobe

Front 17

anterior openings of the nose

Back 17

nares

Front 18

these bones form the nasal bridge

Back 18

maxillary and frontal bones

Front 19

floor of the nose is formed by

Back 19

hard and soft palate

Front 20

roof of the nose is formed by

Back 20

frontal and sphenoid bone

Front 21

a septum divides the internal nose into 2 anterior cavities called

Back 21

vestibules

Front 22

posterior openings leading to the nasopharynx

Back 22

choanae

Front 23

this house the sensory endings of the olfactory nerve

Back 23

cribiform plate

Front 24

the Kiesselbach plexus lies where on the septum?

Back 24

anterior superior portion

Front 25

adenoids are where in relation to the nasopharynx?

Back 25

posterior wall of nasopharynx

Front 26

the cribiform plate lies where?

Back 26

roof of the nose

Front 27

the lateral walls of the nose are formed by ___

Back 27

turbinates

Front 28

curved bony structures covered by vascular mucous membrane that runs horizontally and protrudes into nasal cavity

Back 28

turbinates

Front 29

the turbinates serve this function

Back 29

increase the SA of the nose to warm, humidify and filter inspired air

Front 30

area below each turbinate

Back 30

meatus

Front 31

nasolacrimal duct drains into ___

Back 31

inferior meatus

Front 32

paranasal sinus drains into ___

Back 32

medial meatus

Front 33

posterior ethmoid sinus drains into ___

Back 33

superior meatus

Front 34

air-filled paired extensions of the nasal cavities

Back 34

paranasal sinuses

Front 35

this sinus lies along the lateral wall of the nasal cavity in the maxillary bone

Back 35

maxillary sinus

Front 36

these 2 sinuses are the only ones accessible for PE

Back 36

maxillary and frontal

Front 37

these sinuses lie behind the frontal sinuses and near the superior portion of the nasal cavity

Back 37

ethmoid sinuses

Front 38

these sinuses are deep in the skull behind the ethmoid sinuses

Back 38

sphenoid sinuses

Front 39

the oral cavity is divided into ___ and ____

Back 39

mouth and vestibule

Front 40

this is the space between the buccal mucosa and outer surface of teeth and gums

Back 40

vestibule

Front 41

the mouth is the anterior opening of the ____

Back 41

oropharynx

Front 42

roof of the mouth is formed by

Back 42

hard palate and soft palate

Front 43

the uvula hangs from the hard or soft palate?

Back 43

soft

Front 44

the floor of the mouth is formed by tissue covering which bone?

Back 44

mandibular

Front 45

___ anchors the tongue to the floor of the mouth

Back 45

frenulum

Front 46

these 3 glands are located in the tissue surrounding the oral cavity

Back 46

parotid, submandibular and sublingual

Front 47

___ are outlets of the parotid glands than open on the ____ opposite the second molar on each upper jaw

Back 47

Stensen ducts; buccal mucosa

Front 48

___ are outlets of the submandibular glands and open on each side of the ____

Back 48

Wharton ducts; frenulum

Front 49

sublingual ducts open along the ___

Back 49

sublingual fold

Front 50

how many permanent teeth are normal?

Back 50

32

Front 51

what is a common variant of the normal # of permanent teeth and in what population is this common?

Back 51

28; Asian (30%) and white/Native Am (10-15%)

Front 52

the roots of permanent teeth are anchored to ___

Back 52

alveolar ridges

Front 53

how many incisors, canines, premolars and molars are there?

Back 53

4, 2, 4, 6

Front 54

the oropharynx is seperated from the mouth by

Back 54

tonsillar pillars

Front 55

development of the inner ear occurs during which trimester?

Back 55

first

Front 56

an infants EAC is shorter or longer than an adults?

Back 56

shorter and has an upward curve

Front 57

the frontal and sphenoid sinuses begin to develop at age ___ and finish developing by ___

Back 57

3 yo; late adolescence

Front 58

deciduous teeth begin to calcify at what month of fetal life?

Back 58

3

Front 59

how many deciduous teeth are there?

Back 59

20

Front 60

all deciduous teeth usually appear between what ages?

Back 60

6-24 mo

Front 61

permanent teeth start forming at what age?

Back 61

6 mo

Front 62

eruption of permanent teeth begins at what age and ends by what age?

Back 62

6 yo; 14/15 yo

Front 63

estrogen causes an increased vascularity in the UR tract causes these sx: (5)

Back 63

nasal stuffiness, decreased smell, epistaxis (bleeding), sense of fullness in the ears and impaired hearing

Front 64

laryngeal changes occur due to hormones causing these sx: (4)

Back 64

hoarseness, deepening/cracking of voice, vocal changes and persistent cough

Front 65

what causes hearing loss in old age and at what age does this begin?

Back 65

degeneration of hair cells in the organ of Corti or atrophy of stria vascularis; 50 yo

Front 66

network of capillaries that secrete endolymph and promote sensitization of hair cells in the cochlea

Back 66

stria vascularis

Front 67

sensorineural hearing loss begins with what frequency sounds and progresses to ___ frequency:

Back 67

higher; lower

Front 68

excess deposition of bone cells along ossicles can cause

Back 68

hearing loss

Front 69

what causes conductive hearing loss in old age?

Back 69

the TM becomes more translucent and sclerotic

Front 70

deterioration of sense of smell results from loss of ___ and begins around what age?

Back 70

olfactory sensory nerves; 60 yo

Front 71

sense of taste deteriorates due to ___ around age ___

Back 71

decreased # of papillae on the tongue and decreased salivary gland secretion; 50 yo

Front 72

this reduces the perception of sweet sensations

Back 72

decreased salivary gland secretion

Front 73

this lining of the lips and cheeks becomes more prominent with old age

Back 73

granular lining

Front 74

hearing loss risk factors for adults (3)

Back 74

exposure to industrial/recreational noise, Meniere disease, neurodegenerative disease

Front 75

hearing loss risk factors for kids/infants (8)

Back 75

prenatal factors (maternal infection, iiradiation, drug abuse, syphilis), low birth weight (< 1500 g), high bilirubin level, infection (bact meningitis, otitis media), cleft palate/craniofacial abnormalities, ototoxic antibiotic use, head trauma, hypoxia

Front 76

risk factors for oral cancer (8)

Back 76

> 40 yo, male gender, black ethnicity, excess alcohol, ill-fitting dentures or prior oral lesions, tobacco use, occupation (textile, leather), systemic disease (pernicious/Fe def anemia, HIV, lichen planus, malignancy, HPV)

Front 77

thickening along upper ridge of helix; expected or not?

Back 77

Darwin tubercle; expected

Front 78

preauricular pits are found where and are expected or not?

Back 78

front of ear where upper auricle originates; expected

Front 79

preauricular pits often occur in conjunction with ___ and are most common in what race?

Back 79

lip pits; blacks

Front 80

bluness of the auricle can indicate

Back 80

cyanosis

Front 81

pallor or excessive redness of the auricle can indicate

Back 81

vasomotor instability

Front 82

extreme pallor of the auricle can indicate

Back 82

frostbite

Front 83

this ear abnormality is a result of blunt trauma and necrosis of the underlying cartilage

Back 83

cauliflower ear

Front 84

small, whitish uric acid crystals along the peripheral margins of the auricles

Back 84

tophi

Front 85

tophi may indicate

Back 85

gout

Front 86

elevations in the skin with a punctum indicating a blocked sebaceous gland

Back 86

sebaceous cyst

Front 87

an auricle with a low set or unusual angle may indicate what? (2)

Back 87

chromosomal aberrations or renal disorders

Front 88

a purulent foul-smelling discharge is associated with what? (2)

Back 88

otitis or foreign body

Front 89

smell of earwax (cerumen) may indicate what in the following? maple syrup, mousy, putrid

Back 89

maple syrup urine disease, Proteus infection, Pseudomonas infection

Front 90

pain in the lobule may indicate

Back 90

inflammation of the EAC

Front 91

tenderness or swelling of the mastoid area may indicate

Back 91

mastoiditis

Front 92

Where do you place the tuning fork to perform the Weber test?

Back 92

on the vertex

Front 93

TM signs and associated conditions/causes: bulging with no mobility

Back 93

pus or fluid in middle ear

Front 94

TM signs and associated conditions/causes: retracted with no mobility

Back 94

obstruction of eustacian tube with or without effusion

Front 95

TM signs and associated conditions/causes: mobility with negative pressure only

Back 95

obstruction of eustacian tube with or without effusion

Front 96

TM signs and associated conditions/causes: excess mobility in small areas

Back 96

healed perforation, atrophic TM

Front 97

TM signs and associated conditions/causes: amber or yellow color

Back 97

serous fluid in middle ear

Front 98

TM signs and associated conditions/causes: blue or deep red color

Back 98

blood in middle ear

Front 99

TM signs and associated conditions/causes: chalky white color

Back 99

infection in middle ear

Front 100

TM signs and associated conditions/causes: redness

Back 100

infection in middle ear; prolonged crying

Front 101

TM signs and associated conditions/causes: dullness

Back 101

fibrosis

Front 102

TM signs and associated conditions/causes: white flecks, dense white plaques

Back 102

healed inflammation

Front 103

TM signs and associated conditions/causes: air bubbles

Back 103

serous fluid in middle ear

Front 104

ratio of normal air to bone conduction

Back 104

2:1

Front 105

this type of hearing loss results when sound transmission is impaired through the external or middle ear

Back 105

conductive hearing loss

Front 106

this type of hearing loss results from a defect in the inner ear that leads to distortion of sound and misinterpretation of speech

Back 106

sensorineural hearing loss

Front 107

expected findings of Weber test

Back 107

no lateralization, will lateralize to occluded ear

Front 108

expected findings of Rinne test

Back 108

AC:BC = 2:1

Front 109

conductive hearing loss findings of Weber test

Back 109

lateralization of deaf ear

Front 110

conductive hearing loss findings of Rinne test

Back 110

BC hear longer in affected ear

Front 111

sensorineural hearing loss finding in Weber test

Back 111

lateralization to better ear

Front 112

sensorineural hearing loss in Rinne test

Back 112

AC > BC but less than 2:1

Front 113

Dx: bilateral watery discharge associated with sneezing and nasal congestion

Back 113

allergy

Front 114

Dx: unilateral watery discharge after head trauma

Back 114

CSF fluid and cribiform plate fracture

Front 115

Dx: bloody discharge

Back 115

epistaxis or trauma

Front 116

Dx: mucoid discharge

Back 116

rhinitis

Front 117

Dx: bilateral discharge

Back 117

URI

Front 118

Dx: unilateral, purulent thick greenish and malodorous discharge

Back 118

foreign body

Front 119

Dx: nasal flaring

Back 119

respiratory distress

Front 120

Dx: nare narrowing on inspiration

Back 120

chronic nasal obstruction and mouth breathing

Front 121

Dx: transverse crease at the junction between cartilage and bone of nose

Back 121

chronic nasal itching and allergies

Front 122

Which 2 turbinates are visible upon inspection?

Back 122

middle and inferior

Front 123

Dx: localized redness and swelling in vestibule of nose

Back 123

furnucle

Front 124

Dx: turbinate appearing bluish gray or pale pink with a swollen, boggy consistency

Back 124

allergies

Front 125

Dx: rounded, elongated mass projecting into the nasal cavity from boggy mucosa

Back 125

polyp

Front 126

Dx: asymmetric size of posterior nasal cavities

Back 126

deviation of septum

Front 127

Dx: crusting over the anterior portion of the septum

Back 127

epistaxis

Front 128

cheilits

Back 128

dry, cracked lips

Front 129

cheilosis

Back 129

deep fissures in the corner of the mouth

Front 130

Dx: cheilosis

Back 130

riboflavin def or overclosure of mouth

Front 131

Dx: pallor of the lips

Back 131

anemia

Front 132

Dx: circumoral pallor

Back 132

scarlet fever

Front 133

Dx: cherry red color of lips

Back 133

acidosis and CO poisoning

Front 134

Dx: round oval or irregular bluish gray macules on lips and buccal mucosa

Back 134

Peutz-Jeghers syndrome

Front 135

clenching the teeth tests which CN?

Back 135

CN 7

Front 136

Dx: grayish, white benign lesion on buccal mucosa occuring most often in blacks

Back 136

leukoedema

Front 137

ectopic sebaceous glands that appear on the buccal mucosa and lips as numberous small yellow-white raised lesions

Back 137

Fordyce spots

Front 138

Dx: deeply pigmented buccal mucosa

Back 138

endocrine pathology

Front 139

Dx: red spot on buccal mucosa at the opening of the Stensen duct

Back 139

parotitis/mumps

Front 140

white round or oval ulcerative lesions with a red halo on the buccal mucosa

Back 140

aphthous ulcers

Front 141

thickened white patch lesion that cannot be wiped away

Back 141

leukoplakia

Front 142

localized gingival enlargement or ganuloma

Back 142

epulis

Front 143

enlargement of the gums occurs in these 4 situations

Back 143

pregnancy, puberty, phenytoin therapy and leukemia

Front 144

Dx: blue-black line about 1 mm from the gum margin

Back 144

chronic lead or bismuth poisioning

Front 145

Dx: easily bleeding, swollen gums that have enlarged crevices between the teeth and gum margins or pockets containing debris at tooth margins

Back 145

gingivitis or periodontal disease

Front 146

extension of the tongue while looking for deviation, tremor and limited movement tests for which CN?

Back 146

12

Front 147

Dx: smooth red tongue with a slick appearance

Back 147

vit B12 def or niacin def

Front 148

9 oral manifestations of HIV infection

Back 148

oral hairy leukoplakia, angular cheilitis, candidiasis, herpex simplex, zoster, HPV, aphthous ulcers, periodontal disease, Kaposi sarcoma

Front 149

white irregular lesions on lateral side of tongue or buccal mucosa; may have prominent folds or hairy projections

Back 149

oral hairy leukoplasia

Front 150

creamy white plaques on oral mucosa that bleed when scraped

Back 150

candidiasis

Front 151

recurrent vesicular crusting lesion on the vermillion border of the lip

Back 151

herpes simplex

Front 152

vesicular and ulcerative oral lesions in distribution of trigeminal nerve; may also be on gingiva

Back 152

herpes zoster

Front 153

single or multiple sessile or pedunculated nodules in oral cavity

Back 153

HPV

Front 154

recurrent circumscibed ulcers with an erythematous margin

Back 154

aphthous ulcers

Front 155

incompletely formed BVs proliferate in the mouth, forming lesions of various hades and sizes as blood extravasates in response to malignant tumor of epith

Back 155

Kaposi sarcoma

Front 156

bony protuberance on the lingual surface of the mandible near the canine and premolar teeth

Back 156

mandibular torus

Front 157

asking the pt to say "ah" tests which CNs?

Back 157

9 and 10

Front 158

failure of soft palate to rise bilaterally with vocalization is a result of paralysis of which CN?

Back 158

10

Front 159

with paralysis of CN 10, which way will the uvula deviate?

Back 159

to the unaffected side

Front 160

Dx: red bulge adjacent to the tonsil and extending beyond the midline

Back 160

peritonsillar abscess

Front 161

Dx: yellowish mucoid film in pharynx

Back 161

postnasal drip

Front 162

Dx: grayish adherent membrane

Back 162

diphtheria

Front 163

gag reflex tests which CNs?

Back 163

9 and 10

Front 164

Nylen Barany test tests for what?

Back 164

evaluate of the vestibular branch of the auditory nerve

Front 165

Dx: drooling in an infant over 12 mo

Back 165

neurologic disorder

Front 166

macroglossia is associated with what ocngenital anomaly?

Back 166

hypothyroidism

Front 167

small whitish yellow masses at the juncture between the hard and soft palate in infants

Back 167

epstein pearls

Front 168

bruxism

Back 168

unconscious teeth grinding

Front 169

Dx: flattened edges on the teeth

Back 169

bruxism

Front 170

Dx: multiple brown areas or caries on upper and lower incisors of infants

Back 170

baby bottle syndrome

Front 171

Dx: mottled or pitted teeth in infants

Back 171

tetracycline tx during tooth development or enamel dysplasia

Front 172

Dx: chalky white lines or speckles on cutting edges of permanent incisors in infants

Back 172

excessive fluoride intake

Front 173

Dx: white specks with a red base on the buccal mucosa opposite the first and second molars in infants

Back 173

Koplik spots

Front 174

Koplik spots are associated with

Back 174

rubeola

Front 175

presbycusis

Back 175

sensorineural hearing deterioration with advancing age

Front 176

2 common causes of conductive hearing loss in older adults

Back 176

otosclerosis and impacted cerumen

Front 177

infection of the auditory canal resulting when trauma or a moist environment favors bacterial or fungal growth

Back 177

otitis externa (swimmer's ear)

Front 178

Dx: buging of TM, limited or absent mobility of TM, air fluid level behind the TM and otorrhea

Back 178

middle ear infection

Front 179

causes of middle ear infection (3)

Back 179

obstructed or dysfunctional eustachian tube, allergies and enlarged lymphoid tissue in nasopharynx

Front 180

Dx: itching in ear canal, pain with movement of pinna, watery then purulent discharge, conductive hearing loss, red edematous canal and obscured TM

Back 180

otitis externa

Front 181

Dx: abrupt onset, fever, feeling of blockage, deep seated earache, discharge only if TM ruptures, conductive loss as middle ear fills with pus, bulging TM with erythema, limited or absent movement

Back 181

acute otitis media

Front 182

Dx: sticking or cracking sound on yawning or swallowing, discomfort, feeling of fullness, no discharge, conductive hearing loss as middle ear fills with fluid, TM retracted or bulging, impaired motility

Back 182

middle ear effusion

Front 183

epithelial growth that migrates through a perforation in the TM

Back 183

cholesteatoma

Front 184

result of untreated cholesteatoma

Back 184

erosion of the temporal bone

Front 185

hereditary condition, irregular ossification within the bony labyrinth or otic capsule resulting in fixation of stapes

Back 185

otosclerosis

Front 186

Dx: tinnitus and slowly progressive low to medium pitch conductive hearing loss, sensorineural hearing loss may develop

Back 186

otosclerosis

Front 187

disease that affects the vestibular labyrinth leading to profound sensorineural hearing loss

Back 187

Meniere disease

Front 188

Dx: abrupt and recurrent attacks of vertigo, tinnitus and progressive hearing loss, fullness in ears, unilateral then bilateral

Back 188

Meniere disease

Front 189

labyrinthitis occurs as a complication of what? (4)

Back 189

acute URI or bacterial infection, otitis media or meningitis

Front 190

Dx: vertigo, nystagmus which are increased in severity with head movement

Back 190

labyrinthitis

Front 191

paranasal sinusitis may be a result of what? (4)

Back 191

viral URI, dental infection, allergies or structural defect of nose

Front 192

acute sinusitis is characterized by what?

Back 192

URI that worsens after 5 days, persists longer than 10 days and has more severe sx than typical URI

Front 193

Dx: purulent nasal or postnasal drainage, nasal congestion, facial pain or pressure

Back 193

sinusitis

Front 194

Dx: in child, rhinorrhea, cough, fever, halitosis, hyponasal speech, pain or HA, periorbital swelling, postnasal drip, absent transillumination

Back 194

sinusitis

Front 195

5 strongest predictors of sinusitis

Back 195

maxillary toothache, purulent nasal secretions, dull or opaque sinus transillumination, poor response to decongestants and colored nasal discharge

Front 196

Dx: sniffling, nasal congestion, recurrent nosebleeds, sinus problems, scabs on nasal mucosa, decreased perception of taste and smell, nasal septum perforation

Back 196

cocaine abuse

Front 197

common cause of tonsillitis

Back 197

streptococci

Front 198

Dx: sore throat, referred pain to ears, dysphagia, fever, fetid breath, malaise

Back 198

tonsilitis

Front 199

clinical signs most predictive for group A beta-hemolytic streptococcus

Back 199

tonsililar enlargement and exudates, tender and enlarged cervical nodes, pharyngeal erythema

Front 200

infection of the tissue between the tonsil and tonsillar pillars that occurs as a complication of tonsilitis

Back 200

peritonsillar abscess

Front 201

Dx: dysphagia, drooling, severe sore throat with pain radiating to the ear, muffled voice, malaise and fever

Back 201

peritonsillar abscess

Front 202

ulcerative lesion that may be erythematous, white or pigmented, apperaing as piled up edges around a core that often appears on the lateral border or floor of mouth

Back 202

oral cancer

Front 203

Dx: sore in mouth that will not heal, white or red patch, bleeding ulceration, lump or thickening

Back 203

oral cancer

Front 204

long term problems affecting those with cleft palate/lip

Back 204

hearing loss, chronic otitis media, speech difficulties, feeding problems and improper tooth development and alignment

Front 205

in what races are cleft palate/lip most common?

Back 205

whites and Japanese

Front 206

causes of retropharyngeal abscess

Back 206

trauma to posterior pharyngeal wall or dental infection

Front 207

common causative organisms of retropharyngeal abscess

Back 207

group A streptococcus and Staphylococcus

Front 208

Dx: child, acutely ill, febrile, drooling, anorexic and restless, respiratory distress, muffled voice and stridor

Back 208

retropharyngeal abscess

Front 209

at what age do the retropharyngeal nodes tend to atrophy?

Back 209

5 or 6 yo

Front 210

common auditory disorder in which there is bilateral sensorineural hearing loss associated with aging

Back 210

presbycusis

Front 211

cause of presbycusis

Back 211

degenerative changes in inner ear or auditory nerve

Front 212

Dx: loss in perception of auditory stimuli, initially high freq and tinnitus

Back 212

presbycusis

Front 213

dry mouth caused by ingestion of anticholinergic or antidepressant drugs that interfere with production of saliva or systemic diseases or in heavy smokers

Back 213

xerostomia

Front 214

systemic diseases that cause xerostomia

Back 214

RA, scleroderma, polymyositis and Sjogren syndrome