Clinical Exam Ent Chapter

Front 1

Length of external auditory canal

Back 1

2.5 cm in adults

Front 2

Secreted by sebaceous glands in distal 1/3 of canal

Back 2

Cerumen

Front 3

Most of tympanic membrane is __ while superior portion is __

Back 3

Tense (pars tensa); flaccid (pars flaccid)

Front 4

Bone that can be seen through tympanic membrane

Back 4

Malleus

Front 5

Organ of corti (part of cochlea) transmits impulses to:

Back 5

8th cranial n

Front 6

Path of hearing

Back 6

Sound waves enter external auditory canal → tympanic membrane → vibrates attached malleus → vibrates incus and stapes → oval window of inner ear (where stapes attached) → endolymph fluid of chochlea → round window → hair cells of Organ of Corti → 8th cranial n → temporal lobe

Front 7

2 bones that form nasal bridge

Back 7

Frontal and maxillary bones

Front 8

2 bones that form roof of nose

Back 8

Frontal and sphenoid bones

Front 9

Convergence of small fragile arteries and veins superficially on anterior superior portion of the septum

Back 9

Kiesselbach plexus

Front 10

Lie on the posterior wall of the nasopharynx

Back 10

Adenoids

Front 11

Drainages of nasolacrimal duct, paranasal sinuses and posterior ethmoid sinus

Back 11

Inferior, medial and superior meatus (respectively)

Front 12

Development of sinuses by age

Back 12

Maxillary & ethmoid (birth), sphenoid (tiny cavity at birth but develops at puberty), then frontal sinus (develops 7-8 yrs old)

Front 13

Tongue is anchored to what 2 structures

Back 13

Base to back of oral cavity; floor of mouth by frenulum

Front 14

Outlets of the parotid gland; open on buccal mucosa opposite the 2nd molar on each side of upper jaw

Back 14

Stensen ducts of parotid gland

Front 15

Open on each side of the frenulum under the tongue

Back 15

Wharton ducts of submandibular glands

Front 16

Usual number of teeth in adults

Back 16

32 (exception, Asians have no wisdom teeth so 28 teeth, followed by whites and native Americans; rare in blacks)

Front 17

Inferior to nasopharnx, separated fr/mouth by anterior and posterior tonsillar pillars

Back 17

Oropharynx

Front 18

Fetal development of inner ear occurs:

Back 18

1st trimester

Front 19

How does infant ears differ fr/adults

Back 19

Infant external auditory canal is shorter and has upward curve; allows easier reflux of nasopharyngeal secretions

Front 20

Age when deciduous teeth calcify

Back 20

Fetal 3rd month

Front 21

When do 20 deciduous teeth appear

Back 21

6-24 mo

Front 22

Eruption time frame of permanent teeth

Back 22

6 yrs – 14-15 yrs (white children 3rd molars ~ 18 yrs old)

Front 23

Elevated levels of estrogen in pregnancy causes:

Back 23

Increased vacularity of UR tract; stuffy nose, ↓ smell, epistaxis (bleeding fr/nose); hoarseness, vocal changes or persistent cough

Front 24

Hearing begins to deteriorate at what age? Why?

Back 24

After age 50; degeneration of hair cells of organ of Corti

Front 25

Sensorineural hearing loss occurs first with:

Back 25

High frequency then progresses to lower frequency

Front 26

Atrophy of stria vascularis that secrete endolymph can cause

Back 26

↓ sensitation leading to hearing loss

Front 27

Onset of instant hearing loss may indicate:

Back 27

Vascular disruption

Front 28

Aminoglycosides, salicylates, furosemide, streptomycin, quinine, ethacrynic acid and cisplatin

Back 28

Ototoxic meds

Front 29

Genetic disease assctd w/hearing loss

Back 29

Meniere disease

Front 30

Low birth weight (< 1500 g), ↑ bilirubin level, maternal infx, syphilis during prenatal period, cleft palate, craniofacial abnormalities, head trauma, hypoxic episode, infections

Back 30

Risk factors for infant/child hearing loss

Front 31

Risk factors for oral cancer

Back 31

> 40 yrs, male, black, alcohol abuse, ill-fitting dentures/prior oral lesions, tobacco use, occupation (textile or leather manufacturing), systemic disease (anemia, HIV, lichen planus, prior malignancy)

Front 32

Dry mouth

Back 32

Xerostomia

Front 33

Anticholinergics, diuretics, antiHT, antihistamines, antispasmodics, antidepressants, tranquilizers

Back 33

Meds that ↓ salivation

Front 34

Thickening along the upper ridge of the helix; expected variant

Back 34

Darwin tubercle

Front 35

Blueness of auricles indicate __, while pallor or excessive redness indicates __

Back 35

Vasomotor instability; frostbite (extreme pallor)

Front 36

Can be result of blunt trauma or necrosis of underlying cartilage of ear

Back 36

Cauliflower ear

Front 37

Small, whitish uric acid crystals along peripheral margins of the auricles can indicate:

Back 37

Gout

Front 38

Elevations in the skin w/a punctum indicating a blockage

Back 38

Sebaceous cyst

Front 39

An auricle with a low set or unusual angle may indicate:

Back 39

Chromosomal or renal disorders

Front 40

Depth to insert the speculum in the ear

Back 40

1-1.5 cm (1/2 inch)

Front 41

Which landmarks should be visible on the tympanic membrane

Back 41

Umbo, handle of malleus, and light reflex

Front 42

A bulging tympanic membrane is more __ while a retracted membrane is more ___

Back 42

Conical (loss of bony landmarks); concave (accentuated landmarks, distorted light reflex)

Front 43

Use to assess the mobility of the tympanic membrane

Back 43

Pneumatic otoscopy

Front 44

Maple syrup odor from earwax can indicate

Back 44

Maple syrup urine disease

Front 45

Mousey odor from earwax can indicate

Back 45

Proteus infx

Front 46

Putrid odor from earwax can indicate

Back 46

Pseudomonas infx

Front 47

Distance Dr stands for whisper test

Back 47

1-2 ft (atleast 50% correct response is expected)

Front 48

Tests for lateralization of sound

Back 48

Weber test (tuning fork on midline of skull)

Front 49

In the Rinne test, air conduction should be __ than bone conduction

Back 49

2x

Front 50

When sound transmission is impaired through external or middle ear

Back 50

Conductive hearing loss

Front 51

Defect in middle ear that leads to distortion of sound and misinterpretation of speech

Back 51

Sensorineural hearing loss

Front 52

If bone conduction is heard longer than air conduction in affected ear, then Rinne is ___ and pt has __ hearing loss

Back 52

Negative; conductive

Front 53

If air conduction is longer than bone, but less than 2x as long, then pt has __ hearing loss

Back 53

Sensorineural

Front 54

In the Weber test, __ hearing loss results in lateralization of deaf ear, and __ hearing loss results in lateralization to the better ear

Back 54

Conductive; sensorineural

Front 55

In Weber test, sound should be best heard in the __ ear

Back 55

Occluded??? Pg 330

Front 56

Bilateral water discharge from nose, with sneezing and nasal congestion indicates

Back 56

Allergy

Front 57

Unilateral watery discharge after head trauma can indicate

Back 57

Fracture of cribiform plate → cerebrospinal fluid

Front 58

Profuse bleeding fr/the nose

Back 58

Epistaxis

Front 59

Mucoid discharge is seen in ___, while bilateral purulent discharge can be seen in ___

Back 59

Rhinitis; upper respiratory infx

Front 60

Unilateral, purulent, thick, greenish and very malodorous discharge may indicate

Back 60

Foreign body in nose

Front 61

Which turbinates are visible in nasal exam

Back 61

Middle and inferior

Front 62

Turbinates that appear bluish gray or pale pink w/swollen, boggy consistency can indicate:

Back 62

Allergies

Front 63

Rounded, elongated mass projecting in to the nasal cavity fr/boggy mucosa may be a:

Back 63

Polyp

Front 64

Deep fissures at the corners of the mouth, aka ___, may indicate:

Back 64

Cheilosis; riboflavin deficiency or overclosure of mouth

Front 65

Pale lips can indicate __, while circumoral pallor can indicate __

Back 65

Anemia; scarlet fever

Front 66

Give indications for bluish purplish lips

Back 66

Respiratory/cardiovascular problem

Front 67

Give indications for cherry red lips

Back 67

Acidosis and carbon monoxide poisoning

Front 68

Give indications for irregular bluish gray macules on lips and buccal mucosa

Back 68

Peutz-Jeghers syndrome

Front 69

Size of teeth by race, from largest to smallest

Back 69

Orientals/Native Americans > blacks > whites

Front 70

Grayish-white benign lesion of the buccal mucosa that occurs in 70-90% of blacks and 40% of whites

Back 70

Leukoedema

Front 71

Type of malocclusion when molars have customary relationship, but line of occlusion incorrect because of rotated teeth or other causes

Back 71

Class I

Front 72

Type of malocclusion when lower molars are distally positioned in relation to upper molars; line of occlusion MAY be correct

Back 72

Class II

Front 73

Type of malocclusion when lower molars are medially positioned in relation to upper molars, line of occlusion MAY be correct

Back 73

Class III

Front 74

Ectopic sebaceous glands on buccal mucosa and lips that are numerous and small, yellow-white, raised; an expected variant

Back 74

Fordyce spots

Front 75

Deeply pigmented buccal mucosa can indicate

Back 75

Endocrine pathology

Front 76

Red spot on the buccal mucosa at the opening of the Stensen duct is asstd w/:

Back 76

Parotitis (mumps)

Front 77

Appear on the buccal mucosa as white, round, or oval uncreative lesions with a red halo

Back 77

Apthous ulcers

Front 78

Blue-black line about 1 mm from the gum margin may indicate

Back 78

Chronic lead or bismuth poisoning

Front 79

A protruded tongue deviates to the __ side of lesion and tests for which cranial nerve

Back 79

Same side; hypoglossal nerve (CN 12)

Front 80

A smooth red tongue w/ a slick appearance can indicate:

Back 80

Niacin or Vit B12 deficiency

Front 81

A hairy tongue w/yellow-brown to black elongated papillae on the dorsum:

Back 81

Can follow antibiotic therapy

Front 82

High risk site for oral cancer

Back 82

Vermilion border of the lips

Front 83

Manifestations of oral hairy leukoplakia, angular cheilitis candidiasis, herpes simplex, herpes zoster, human papillomavirus, apthous ulcers, periodontal dis, and Kaposi sarcoma are indicated in what disease?

Back 83

HIV infx

Front 84

An ulcer, nodule, or thickened white patch on the lateral or ventral surface of the tongue can suggest

Back 84

Malignancy

Front 85

A bony protuberance on the lingual surface of the mandible that is more common in Orientals and Native Americans

Back 85

Mandibular torus

Front 86

Bony protuberance at the midline of the hard palate

Back 86

Torus palatines

Front 87

During aaah, failure of soft palate to rise bilaterally may result from paralysis of:

Back 87

Vagus nerve

Front 88

Observing uvula during aaah, it deviates to the __ side, and test for which nerves?

Back 88

Unaffected side; glossopharyngeal (CN 9) and vagus (CN 10)

Front 89

How can u help a person w/ gag reflex using tongue blade?

Back 89

Wet w/warm water

Front 90

A red bulge adjacent to the tonsil and extending beyond the midline can indicate

Back 90

Peritonsillar abscess

Front 91

A grayish adherent membrane on the pharynx is asstd w/:

Back 91

Diphtheria

Front 92

A yellowish mucoid film in the pharynx is asstd w/:

Back 92

Postnasal drip

Front 93

The gag reflex tests (should be a bilateral response):

Back 93

Glossopharyngeal and vagus nerves (CN 9 and 10)

Front 94

Pt lies supine with head hyperextended 45 degrees over exam table while dr observes for nystagmus, unexpected finding with duraction and vertical/horizontal movement of eyes noted

Back 94

Nylen-Barany test

Front 95

When using transillumination of the sinuses in a dark room, what are unexpected findings?

Back 95

Asymmetry of transillumination; opaque or dull response

Front 96

To determine the height of auricles, you make an imaginary line between what 2 landmarks

Back 96

Outer canthus of eye and prominent portion of occiput (auricle should be no more than 10 d from vertical)

Front 97

Premature infant auricles:

Back 97

Have slower recoil

Front 98

Auricles poorly shaped or below the imaginary line are asstd w/:

Back 98

Renal or congenital disorders

Front 99

A small preauricular skin tag or pit just anterior to the tragus of an infant can indicate:

Back 99

A remnant of the first branchial cleft

Front 100

Expected age an infant responds to his/her name

Back 100

6-10 mo

Front 101

Age that an infant turns head toward source of sound

Back 101

4-6 mo

Front 102

Age that infant has a startle reflex due to loud noise

Back 102

Birth – 3 mo

Front 103

Age that infant recognizes and localizes source of sound; imitates simple words and sounds

Back 103

10-12 mo

Front 104

With breathing difficulty of an infant when expiring through noncompressed naris, what should be done?

Back 104

Pass small catheter through each naris to the choana to determine obstruction (from choanal atresia or septal deviation from delivery trauma)

Front 105

Secretions that accumulate in the newborns mouth requiring frequent sunctioning may indicate:

Back 105

Esophageal atresia

Front 106

Adherent white patches of the tongue or buccal mucosa (in an infant or adult) can indicate:

Back 106

Candidiasis (thrush)

Front 107

Drooling over 12 months of age can indicate:

Back 107

Neurological disorder

Front 108

Macroglossia of the infant is asstd w/:

Back 108

Congenital anomalies or hypothyroidism

Front 109

A narrow, flat palate roof or high, arched palate (asstd w ___) can cause what problems

Back 109

Congenital anomalies; feeding or speech problems

Front 110

Small, whitish masses between the hard and soft palate of the newborn and are common; disappear within a few weeks after birth

Back 110

Epstein pearls

Front 111

Multiple brown areas or caries on the upper and lower incisors of children may indicate

Back 111

Baby bottle syndrome

Front 112

Children with black or gray color on teeth may indicate

Back 112

Oral iron therapy

Front 113

Mottled or pitted teeh on children usually result of:

Back 113

Tetracycline tx during tooth development or enamel dysplasia

Front 114

Chalky white lines or speckles on the cutting edges of permanent incisors of children may result from:

Back 114

Excessive fluoride intake

Front 115

White specks called ___with a red base on the buccal mucosa opposite the first and second molars that occur with fever, coryza (acute rhinitis) and cough can indicate:

Back 115

Koplik spots; rubeola

Front 116

Describe grading of enlarged tonsils

Back 116

1+ visible, 2+ halfway between tonsillar pillars and uvula, 3+ nearly touching uvula, 4+ touching each other

Front 117

If tonsils appear pushed backward or forward, possibly displacing the uvula, consider:

Back 117

Peritonsillar abscess

Front 118

Hearing deterioration w/advanced age (presbycusis) marked by greater difficulty in understanding speech rather than all sounds; bilateral

Back 118

Sensorineural hearing deterioration

Front 119

Three common findings in the mouths of older adults

Back 119

Fissured tongue, varicose veins on tongue, attrition of teeth

Front 120

Infection of auditory canal resulting from trauma or moist environment that favors bacterial or fungal growth

Back 120

Otitis external aka swimmer’s ear

Front 121

Collection of serous, mucoid, or purulent fluid (effusion) of the middle ear that results in conductive hearing loss

Back 121

Middle ear effusion

Front 122

Type of ear infx with itching in the ear canal that is intense when the pinna is moved, or with chewing

Back 122

Otitis externa

Front 123

Ear infx with fever, feeling of blockage, tugging at earlobe, anorexia, irritability, dizziness, vomiting and diarrhea; deep-seated earache

Back 123

Acute otitis media

Front 124

Ear infx with sticking or cracking sound on yawning or swallowing, no signs of acute infx and uncommon to have pain

Back 124

Middle ear effusion

Front 125

Ear infx that results in at first water, then purulent and thick discharge with pus, musty and foul-smelling

Back 125

Otitis externa

Front 126

Acute otitis media occurrence by race, from most to least

Back 126

Native Americans, Alaskan, Canadian > whites > blacks

Front 127

Ear infx that causes bulging of tympanic membrane

Back 127

Acute otitis media

Front 128

Most common ear infx of childhood with lower incidence in adults

Back 128

Acute otitis media

Front 129

White, shiny, greasy flecks of debris/epithelial growth seen on the posterior superior middle ear through the tympanic membrane or perforation; can cause progressive hearing loss, tinnitus, mild vertigo; can lead to intracranial complications by eroding the temporal bone

Back 129

Cholesteatoma

Front 130

Hereditary condition more common in women; ossification occurs within bony labyrinth or otic capsule fixating the stapes; progressive hearing loss w/onset late teens-30 yrs; sensorineural hearing loss

Back 130

Otosclerosis

Front 131

Disease that affects the vestibular labyrinth, leading to profound sensorineural hearing loss, mild vertigo, tinnitus, unilateral at first then involves other ear

Back 131

Meniere Disease

Front 132

Inflammation of the labyrinthine canal of the inner ear due to acute upper respiratory infx; severe vertigo, nystagmus and increase severity w/head movement; total sensorineural hearing loss on affected side

Back 132

Labyrithitis

Front 133

Maxillary toothache, purulent nasal secretions, dull/opaque transillumination, poor response to decongestants, and colored nasal discharge are strong predictors of: (4 or more)

Back 133

Sinusitis

Front 134

Children that suffer from upper respiratory symptoms, nasal discharge, low-grade fever, daytime cough, malodorous breath, cervical adenopathy and morning eye swelling with no headache may indicate:

Back 134

Sinusitis

Front 135

Scabs on nasal mucosa, ↓ perception of taste and smell, perforation of the nasal septum can indicate:

Back 135

Chronic cocaine insufflation (snorting—word of the day )

Front 136

Tonsillitis studded w/yellow follicles most commonly caused by:

Back 136

Streptococcus infection

Front 137

Tonsils that appear red, swollen, with tonsillar crypts filled with purulent exudates; which lymphs would be enlarged?

Back 137

Tonsillitis; anterior cervical

Front 138

Moderate/severe tonsillar swelling, moderate/sever cervical lymphadenopathy, scarlatiniform rash with no coryza (acute rhinitis) highly indicative of:

Back 138

Group A beta-hemolytic streptococcus

Front 139

Infx of tissue between tonsil and pharynx, complication of tonsillitis; can cause dysphagia, drooling, sore throat w/pain radiating to the ear, muffled voice and fever; tonsil may appear pushed forward/backward

Back 139

Peritonsillar abscess

Front 140

Congenital malformation of the face as a fissure of the upper lip or palate

Back 140

Cleft lip and/or palate

Front 141

Drymouth caused by ingestion of anticholinergic or antidepressants drugs that interfere w/production of saliva; rheumatoid arthritis, scleroderma, polymyositis, and Sjogren syndrome; heavy smokers or those who have had radiation to the head and neck

Back 141

Xerostomia