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224 Cards in this Set
- Front
- Back
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What is the functions of the ear?
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identification, localization, and interpretation of sound, as well as in the maintenance of equilibrium
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What are the structures of the external ear?
What is it composed of? |
auricle (or pinna) and external auditory canal
composed of cartilage covered with skin |
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What is the external auditory canal?
How long is it? What is the canal lining protected and lubricated with? |
S-shaped pathway leading to the middle ear,
approximately 2.5 cm long in adults cerumen, secreted by the sebaceous glands in the distal third of the canal |
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What is the middle ear?
What does it contain? What separates the middle ear from the external ear? |
air-filled cavity in the temporal bone
contains the ossicles, three small connected bones (malleus, incus, and stapes) that transmit sound from the tympanic membrane to the oval window of the inner ear tympanic membrane, surrounded by a dense fibrous ring (annulus) |
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How is the mucus from the middle ear removed?
Where does it go? |
rapidly cleared by the ciliary action of the eustachian tube,
a cartilaginous and bony passageway between the nasopharynx and the middle ear |
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What is the inner ear?
What does it contain? |
inner ear is a membranous, curved cavity inside a bony labyrinth
consisting of the vestibule, semicircular canals, and cochlea |
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What is the cochlea?
What is the function and what cranial nerve does it use? |
The cochlea, a coiled structure containing the organ of Corti,
transmits sound impulses to the eighth cranial nerve. |
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What is the function of the semicircular canals?
Where does it send signals to? |
The semicircular canals contain the end organs for vestibular function.
Equilibrium receptors in the semicircular canals and vestibule of the inner ear respond to changes in direction of movement and send signals to the cerebellum for the maintenance of balance. |
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What are the steps from hearing to interpretation of sound?
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external auditory canal → tympanic membrane→ malleus → incus and stapes → oval window of the inner ear → sound waves then travel via the endolymph fluid of the cochlea to the round window where they are dissipated → delicate hair cells of the organ of Corti to strike against the membrane of Corti → eighth cranial nerve → temporal lobe of the brain for interpretation
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What is the function of the nose and nasopharynx?
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Identification of odors
Passageway for inspired and expired air Humidification, filtration, and warmth of inspired air Resonance of laryngeal sound |
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What is the nares?
What is it surrounded by? |
anterior openings of the nose
surrounded by the cartilaginous ala nasi and columella |
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What two bones make the nasal bridge?
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frontal and maxillary bones
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What forms the floor of the nose?
What about the roof? |
The floor of the nose is formed by the hard and soft palate
roof is formed by the frontal and sphenoid bone |
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What is the internal nose covered by?
What is the function of this covering? |
vascular mucous membrane thickly lined with small hairs and mucous secretions
collects and carries debris and bacteria from the inspired air to the nasopharynx for swallowing or expectoration. The mucus contains immunoglobulins and enzymes that serve as a line of defense from infection. Receptors for smell are located in the olfactory epithelium |
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What are the two anterior cavities of the internal nose?
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internal nose is divided by the septum into two anterior cavities: the vestibules
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What is the pathway for inspired air through the nose?
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Inspired air enters the nose through the nares and passes through the vestibules to the choanae, which are posterior openings leading to the nasopharynx
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What is the cribriform plate and what is its function?
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housing the sensory endings of the olfactory nerve, lies on the roof of the nose.
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What is Kiesselbach plexus and where is it?
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convergence of small fragile arteries and veins located superficially on the anterior superior portion of the septum in the nose
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Where are the adenoids?
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The adenoids lie on the posterior wall of the nasopharynx
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What makes up the lateral walls of the nose?
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lateral walls of the nose are formed by turbinates, curved bony structures covered by vascular mucous membrane, that run horizontally and protrude into the nasal cavity
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What is the function of the inferior, medial, and superior turbinates?
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The inferior, medial, and superior turbinates increase the surface area of the nose to warm, humidify, and filter inspired air.
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Where do the following drain?
nasolacrimal duct paranasal sinuses posterior ethmoid sinus |
nasolacrimal duct drains into the inferior meatus
paranasal sinuses drain into the medial meatus posterior ethmoid sinus drains into the superior meatus |
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What are the paranasal sinuses ?
What is their function? Where is it’s opening? |
air-filled, paired extensions of the nasal cavities within the bones of the skull.
They are lined with mucous membranes and cilia that move secretions along excretory pathways. Their openings into the medial meatus of the nasal cavity are easily obstructed. |
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Where is the maxillary sinuses?
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The maxillary sinuses lie along the lateral wall of the nasal cavity in the maxillary bone
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Where is the frontal sinuses?
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The frontal sinuses are in the frontal bone superior to the nasal cavities
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Which two sinuses are accessible for physical examination?
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maxillary and frontal sinuses
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Where is the ethmoid sinuses ?
How about the sphenoid sinuses ? |
The ethmoid sinuses lie behind the frontal sinuses and near the superior portion of the nasal cavity.
The sphenoid sinuses are deep in the skull behind the ethmoid sinuses |
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What is the function of the mouth and oropharynx ?
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Emission of air for vocalization and non-nasal expiration
Passageway for food, liquid, and saliva, either swallowed or vomited Initiation of digestion by masticating solid foods and by salivary secretion Identification of taste |
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What is the vestibule of the oral cavity?
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space between the buccal mucosa and the outer surface of the teeth and gums
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What does the mouth house?
What is it anterior to? What is the roof made of? What hangs in the posterior margin of the roof? |
tongue, teeth, and gums
anterior opening of the oropharynx. bony arch of the hard palate and the fibrous soft palate uvula hangs from the posterior margin of the soft palate |
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What bone is covered by the tissues of the floor of the mouth?
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mandibular bone
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What anchors the tongue to the back of the oral cavity at its base and to the floor of the mouth
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frenulum
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What covers the dorsal surface of the tongue?
What about the ventral surface? |
Thick mucous membrane, supporting the filiform papillae
visible veins and fimbriated folds, which are ridges of thin mucous membrane |
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What salivary glands are in the oral cavity?
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parotid, submandibular, and sublingual salivary glands
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What are the Stensen ducts?
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Outlets of the parotid gland that open on the buccal mucosa opposite the second molar on each side of the upper jaw
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What are Wharton ducts?
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outlets of the submandibular glands, open on each side of the frenulum under the tongue
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Where do the sublingual glands ducts open?
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many ducts opening along the sublingual fold
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What is the gingivae?
What is it attached to? |
fibrous tissue covered by mucous membrane, are attached directly to the alveolar surface.
roots of the teeth are anchored to the alveolar ridges, and the gingivae cover the neck and roots of each tooth |
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In adults, How many permanent teeth is normal?
What is the breakdown of each? incisors, canines, premolars, and molars, wisdom teeth |
Adults generally have 32 permanent teeth consisting of 4 incisors, 2 canines, 4 premolars, and 6 molars, including wisdom teeth, in each jaw
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How is the oropharynx separated from the mouth?
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The oropharynx, conntinuous with but inferior to the nasopharynx, is separated from the mouth by the anterior and posterior tonsillar pillars on each side.
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What is the function of the tonsils?
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lying in the cavity between these pillars, have crypts that collect cell debris and food particles
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What part of the ear develops in the first trimester?
Why is this important? |
inner ear occurs during the first trimester of pregnancy,
an insult to the fetus during that time may impair hearing |
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How is an infant's external auditory canal different then an adults?
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The infant's external auditory canal is shorter than the adult's and has an upward curve
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How is the eustachian tube in an infant different to an adults? Why?
How does it change as a child grows? How can the adenoids affect growth? |
wider, shorter, and more horizontal than the adult's, which allows easier reflux of nasopharyngeal secretions
As the child grows, the eustachian tube lengthens and its pharyngeal orifice moves inferiorly. With the growth of lymphatic tissue, specifically the adenoids, the eustachian tube may become occluded, interfering with aeration of the middle ear. |
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When do the frontal and sphenoid sinuses begin to develop?
When are they fully developed? |
3 years of age
not fully developed until late adolescence, however, they are large enough to become infected in early childhood |
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When do Deciduous teeth begin to calcify?
When do 20 Deciduous teeth appear? |
third month of fetal life, each tooth erupting when it has sufficient calcification to withstand chewing.
The 20 deciduous teeth usually appear between 6 and 24 months of age |
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When do the permanent teeth begin form?
How do these teeth affect the deciduous teeth? When do they begin to erupt? Finish erupting? When do White children's third molars erupt? |
6 months of age
Pressure from these teeth leads to the resorption of the roots of the deciduous teeth until the crown is shed begins about 6 years of age completed around 14 or 15 years of age in most races 18 years of age |
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How does being pregnant affect the nose, pharynx, and eustachian tubes?
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Elevated levels of estrogen cause increased vascularity of the upper respiratory tract.
become engorged, leading to symptoms of nasal stuffiness, decreased sense of smell, epistaxis, a sense of fullness in the ears, and impaired hearing |
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How does being pregnant affect voice? What other side affect?
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Laryngeal changes are also hormonally induced so that hoarseness, deepening or cracking of the voice, vocal changes, or persistent cough may occur.
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What changes to hearing begin at 50yr?
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Hearing tends to deteriorate with degeneration of hair cells in the organ of Corti, usually after age 50
stria vascularis, a network of capillaries that secrete endolymph and promote the sensitization of hair cells in the cochlea, may atrophy, contributing to hearing loss Loss of cortical and organ of Corti auditory neurons interferes with the understanding of speech and localization of sound |
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How does Sensorineural hearing loss first occurs and then progress?
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Sensorineural hearing loss first occurs with high-frequency sounds and then progresses to tones of lower frequency.
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How does aging change the deposition of bone cells along the ossicle chain?
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Hearing deterioration may also result from an excess deposition of bone cells along the ossicle chain, causing fixation of the stapes in the oval window
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How does aging affect Cerumen?
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Fewer sebaceous glands are active, and consequently the cerumen may become very dry.
Cerumen may totally obstruct the external auditory canal, interfering with sound transmission. |
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How does aging affect the tympanic membrane?
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becomes more translucent and sclerotic. Conductive hearing loss occurs in each case.
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When does Deterioration of the sense of smell results from loss of olfactory sensory neurons begin?
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around 60 years of age
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Sense of taste begins deteriorating at about what age?
Why? |
50 years of age
due to a decrease in the number of papillae on the tongue and decreased salivary gland secretion, which reduces the perception of sweet sensations |
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Why are the auricle and nose larger and more prominent in older people?
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Cartilage formation continues in the ears and nose
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In older people, how are the following changed
soft tissues of the mouth gingival tissue tongue |
soft tissues of the mouth change as the granular lining on the lips and cheeks becomes more prominent.
The gingival tissue is less elastic and more vulnerable to trauma. The tongue becomes more fissured. The older adult may have altered motor function of the tongue, leading to problems with swallowing |
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What are risk factors for hearing loss in adults?
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Adults
Exposure to industrial or recreational noise Genetic disease: Ménière disease Neurodegenerative disorder |
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What are risk factors for hearing loss in an infant or child?
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Infants and Children
Prenatal factors: maternal infection, irradiation, drug abuse, syphilis Birth weight less than 1500 g Excessively high bilirubin level Infection: bacterial meningitis, recurrent otitis media Cleft palate, craniofacial abnormalities Ototoxic antibiotic use Head trauma Hypoxic episode |
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What are risk factors for Oral Cancer?
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Older than 40 years of age
Gender: men have twice the rate of women Ethnicity: black Excessive alcohol use Ill-fitting dentures, prior oral lesions Tobacco use: cigarettes, cigars, pipes, chewing tobacco, snuff; risk increases with frequency and duration of tobacco use, smoking history of more than 20 pack-years Occupation: textile industry, leather manufacturing Systemic disease: pernicious or iron-deficiency anemia, HIV infection, lichen planus, previous malignancy, human papillomavirus |
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What is Darwin tubercle?
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a thickening along the upper ridge of the helix (external ear), is an expected variation
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Where are Preauricular pits seen and what race are they common in?
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Preauricular pits are occasionally seen; they often occur in conjunction with lip pits, which are most common in blacks (20%) and least common in Asians (7%), with occurrence in whites being intermediate.
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In color of the auricles; what causes
Blueness Pallor or excessive redness Extreme Pallor |
Blueness may indicate some degree of cyanosis.
Pallor or excessive redness may be the result of vasomotor instability. Frostbite can cause extreme pallor. |
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What is cauliflower ear from?
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unusual size or shape of the auricle
result of blunt trauma and necrosis of the underlying cartilage MMA Fighters |
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What is and where are Tophi?
What causes Tophi? |
small, whitish uric acid crystals along the peripheral margins of the auricles
Gout |
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What are Sebaceous cysts of the auricle?
Cause? |
elevations in the skin with a punctum,
indicating a blocked sebaceous gland |
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An auricle with a low-set or unusual angle may indicate what problem?
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chromosomal aberrations or renal disorders.
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A purulent, foul-smelling discharge in the external auditory canal suggest?
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associated with an otitis or foreign body
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Bloody or serous discharge in the external auditory canal may suggest…
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head trauma
skull fracture |
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Smell the Cerumen
Odor from earwax can be a clue to a problem: Maple syrup - ? Mousy - ? Putrid - ? |
Maple syrup (maple syrup urine disease)
Mousy (Proteus infection) Putrid (Pseudomonas infection) |
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Tenderness or swelling in the mastoid area may indicate what problem?
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mastoiditis
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What is the difference between wet and dry cerumen?
What races gets which one? |
Wet cerumen is dark and sticky and occurs in whites and blacks almost 100% of the time.
Wet cerumen is the result of a dominant gene, so individuals with dry cerumen have two dry cerumen alleles Dry cerumen is light brown to gray, flaky, and sparse; it can lie in the ear canal as a thin flake. Dry cerumen occurs in Asians and Native Americans/American Indians around 85% of the time.. |
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What is a bulging tympanic membrane?
retracted tympanic membrane? |
A bulging tympanic membrane is more conical, usually with a loss of bony landmarks and a distorted light reflex.
A retracted tympanic membrane is more concave, usually with accentuated bony landmarks and a distorted light reflex |
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How do you determine the position of the auricle?
What is the normal 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 touch or be above this line. Then draw another imaginary line perpendicular to the previous line just anterior to the auricle.
The auricle's position should be almost vertical, with no more than a 10-degree lateral posterior angle |
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What is the correct way to do a Examination of the tympanic membrane with the otoscope?
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Be gentle: a viselike grip is not necessary, although a firm, gentle grasp is. Avoid causing discomfort to the patient. Tilt the patient's head toward the opposite shoulder and simultaneously pull the patient's auricle upward and back as the speculum is inserted, thereby straightening the auditory canal to give the best view
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What is mallear blush and what can cause it?
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Reddness, Dilation of the vessels overlying the malleus
applying negative pressure too slowly. The consequent redness, described as a mallear blush, may be the result of the otoscopy and can occur in the absence of infection |
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What Cranial Nerve is evaluated for by a hearing test?
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CN VIII Vestibulocochlear nerve (or auditory-vestibular nerve or statoacustic nerve)
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following Bulging with no mobility |
Pus or fluid in middle ear
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following Retracted with no mobility |
Obstruction of eustachian tube with or without effusion
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following Mobility with negative pressure only |
Obstruction of eustachian tube with or without effusion
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following Excess mobility in small areas |
Healed perforation, atrophic tympanic membrane
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following Amber or yellow |
Serous fluid in middle ear
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following Blue or deep red |
Blood in middle ear
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following Chalky white |
Infection in middle ear
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following Redness |
Infection in middle ear, prolonged crying
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following Dullness |
Fibrosis
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following White flecks, dense white plaques |
Healed inflammation
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Tympanic Membrane Signs and Associated Conditions
What Associated Conditions/Causes can cause the following AIR BUBBLES |
Serous fluid in middle ear
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What is the expected finding for a Weber test?
Rinne test? |
Weber: No lateralization, but will lateralize to ear occluded by patient
Rinne: Air conduction heard longer than bone conduction by 2:1 ratio (Rinne positive) |
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In the Weber test, What is the different results for Conductive Hearing Loss vs Sensorineural Hearing Loss?
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Conductive Hearing Loss: Lateralization of deaf ear unless sensorineural loss
Sensorineural Hearing Loss : Lateralization to better ear unless conductive loss * To test the reliability of the patient's response, repeat the procedure while occluding one ear, asking the patient in which ear the sound is best heard. It should be heard best in the occluded ear |
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In the Rinne test, What is the different results for Conductive Hearing Loss vs Sensorineural Hearing Loss?
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Conductive Hearing Loss: Bone conduction heard longer than air conduction in affected ear (Rinne negative)
Conductive hearing loss results when sound transmission is impaired through the external or middle ear Sensorineural Hearing Loss : Air conduction heard longer than bone conduction in affected ear, but less than 2:1 ratio Sensorineural hearing loss results from a defect in the inner ear that leads to distortion of sound and misinterpretation of speech |
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What does a bilateral watery discharge in the nose suggest?
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associated with sneezing and nasal congestion, is indicative of an allergy
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A unilateral watery discharge from the nose occurring after head trauma may be…
Bloody discharge is common from |
cerebrospinal fluid and indicate a fracture of the cribriform plate
usually results from epistaxis or trauma |
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What can cause the following discharge from the nose?
1. Mucoid discharge 2. bilateral purulent discharge 3. Unilateral, purulent, thick, greenish, and extremely malodorous discharge |
1. rhinitis
2. upper respiratory infection 3. foreign body |
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depression of the nasal bridge can result from?
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fractured nasal bone
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Nasal flaring is associated what condition?
What about narrowing of the nares? transverse crease at the junction between the cartilage and bone of the nose? |
fractured nasal bone
narrowing of the nares on inspiration may be indicative of chronic nasal obstruction and mouth breathing chronic nasal itching and allergies |
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Increased redness of the nasal mucosa may occur with ____
localized redness and swelling in the vestibule may indicate a ____ |
Infection
Furuncle |
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Turbinates that appear bluish gray or pale pink with a swollen, boggy consistency may indicate _____
A rounded, elongated mass projecting into the nasal cavity from boggy mucosa may be a____ |
Allergies
polyp |
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Crusting over the anterior portion of the nasal septum may occur at the site of ____
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epistaxis
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Swelling, tenderness, and pain over the sinuses may indicate what two problems?
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infection or obstruction
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What is cheilitis?
What can cause it? |
Dry, cracked lips (cheilitis) may be caused by dehydration from wind chapping, dentures, braces, or excessive lip licking
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What is cheilosis?
What can cause it? |
Deep fissures at the corners of the mouth (cheilosis) may indicate riboflavin deficiency or overclosure of the mouth, allowing saliva to macerate the tissue
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Swelling of the lips may be caused by ____, whereas angioedema may indicate ____
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Infection
allergy |
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What are lip pits?
Where are they found? What is the % in blacks, whites, and Asians? |
Lip pits, slight dimpling to 4 mm deep, are sometimes found in the commissure of the lips.
They are benign and often occur along with preauricular pits. Lip pits occur in approximately 20% of blacks, 12% of whites, and 7% of Asians. |
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What can cause the following change of color in the Lips
1. Pallor 2. Circumoral pallor 3. Cyanosis/bluish purple lips 4. cherry red lips 5. Round, oval, or irregular bluish gray macules of various intensity on the lips and buccal mucosa |
1. Anemia
2. scarlet fever 3. respiratory or cardiovascular problem 4. acidosis and carbon monoxide poisoning 5. Peutz-Jeghers syndrome |
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When you “Ask the patient to clench his or her teeth and smile so you can observe the occlusion of the teeth”; what cranial nerve are you testing for?
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The facial nerve (cranial nerve VII)
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Protrusion of the upper or lower incisors, failure of the upper incisors to overlap with the lower incisors, and back teeth that do not meet are indications of what 2 problems?
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malocclusion and problems with the bite
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Who have the smallest teeth? largest?
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Whites have the smallest teeth, and blacks have somewhat larger teeth; Asians and Native Americans/American Indians have the largest teeth.
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What are the 3 classes for Classification of Malocclusion
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Class I Molars have customary relationship, but the line of occlusion is incorrect be cause of malpositioned teeth from rotation or other causes
Class II Lower molars are distally positioned in relation to the upper molars; the line of occlusion may or may not be correct Class III Lower molars are medially positioned in relation to the upper molars; the line of occlusion may or may not be correct. |
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What is a Overbite?
When does a Open Bite occur? What about Cross bite? |
Overbite is the amount of overlap of the maxillary incisors over the mandibular incisors.
Open bite occurs when the incisors do not overlap each other at all, resulting in an open space between the incisors when the molars meet. Cross bite occurs when the maxilla anterior teeth are behind the mandibular anterior teeth, or the maxillary posterior teeth are lingual to their typical position or lateral to the mandibular posterior teeth. |
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What are Fordyce spots ?
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Fordyce spots are ectopic sebaceous glands that appear on the buccal mucosa and lips as numerous small, yellow-white, raised lesions; they are an expected variant
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Deeply pigmented buccal mucosa may indicate what condition?
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pathologic condition
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A red spot on the buccal mucosa at the opening of the Stensen duct is associated with ____
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parotitis (mumps)
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____ on the buccal mucosa appear as white, round, or oval ulcerative lesions with a red halo
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Aphthous ulcers
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A thickened white patch lesion that cannot be wiped away may be ______
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leukoplakia, a premalignant oral lesion.
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What is Epulis?
What is the usual cause? |
Epulis, a localized gingival enlargement or granuloma, is usually an inflammatory rather than neoplastic change
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What can cause enlargement of the gums?
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Enlargement of the gums occurs with pregnancy, puberty, phenytoin (Dilantin) therapy, and leukemia
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A blue-black line about 1 mm from the gum margin may indicate what kind of poisoning?
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chronic lead or bismuth poisoning
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Easily bleeding, swollen gums that have enlarged crevices between the teeth and gum margins, or pockets containing debris at tooth margins, are associated with what 2 diseases?
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gingivitis or periodontal disease
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Loose teeth can be the result of what two problems?
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periodontal disease or trauma
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Discolorations on the crown of a tooth should raise the suspicion of ____
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caries
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Tongue Deviation to one side may be caused by what problem?
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tongue atrophy and hypoglossal nerve impairment
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A smooth red tongue with a slick appearance may indicate what deficiency?
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niacin or vitamin B12 deficiency
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hairy tongue with yellow-brown to black elongated papillae on the dorsum sometimes follows what therapy?
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antibiotic therapy
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What is mandibular torus?
Who have it the most? What problem can it cause? |
A bony protuberance, the mandibular torus, occurs on the lingual surface of the mandible, near the canine and premolar teeth, and is an expected variant.
Fewer than 10% of blacks and whites have mandibular tori; Asians and Native Americans/American Indians have them more commonly. The only difficulty with tori is that they cause denture fitting problems. |
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ulcer, nodule, or thickened white patch on the lateral or ventral surface of the tongue may be suggestive of _____
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Malignancy.
human immunodeficiency virus (HIV) infection |
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What is torus palatinus?
Problems? |
The hard palate may have a bony protuberance at the midline, called torus palatinus, which has no clinical consequence
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A nodule on the hard/soft palate that is not at the midline may indicate a ____
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Tumor
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How do you test the movement of the Soft Palate?
What cranial nerves? What problem can cause the soft palate to not move? |
Say “Ah”
CN IX and X (glossopharyngeal and vagus nerves) Failure of the soft palate to rise bilaterally with vocalization may result from paralysis of the vagus nerve. The uvula will deviate to the unaffected side. |
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A red bulge adjacent to the tonsil and extending beyond the midline may indicate a _____
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peritonsillar absces
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yellowish mucoid film in the pharynx is typical of ______
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postnasal drip
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A grayish adherent membrane on the pharynx is associated with ____
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diphtheria
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Elicitation of the gag reflex tests what cranial nerves?
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glossopharyngeal and vagus nerves (cranial nerves IX and X).
Expect a bilateral response |
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What is the Romberg test for?
What does a positive test suggest? What follows a positive test? |
used to screen for equilibrium in most patients.
When a vestibular function disorder is suspected by history or by a loss of balance with the Romberg test, further evaluation of the vestibular branch of the auditory nerve (cranial nerve VIII) is indicated. In most cases, the patient is referred to a specialist for the Nylen-Barany test. |
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How do you perform the Nylen-Barany test?
What are you looking for? |
patient should be supine with the head hyperextended about 45 degrees over the end of the examining table.
When the patient turns his or her head to one side, observe for nystagmus. Repeat the procedure with the patient's head turned to the other side. Nystagmus is an unexpected finding, and if it is present, note the duration and direction of eye movement (horizontal or vertical). |
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Why would you perform a Transillumination of the frontal and maxillary sinuses?
An opaque or dull response indicates? |
sinus tenderness is present or infection is suspected
either the sinus is filled with secretions or it never developed. Asymmetry of transillumination is a significant finding. |
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When can a infant :
Startle reflex, crying, cessation of breathing or movement in response to sudden noise; quiets to parent's voice; makes vowel sounds "oh" or "ah" |
Birth to 3 months
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When can a infant :
Turns head toward source of sound but may not always recognize location of sound; responds to parent's voice; enjoys sound-producing toys; starts babbling |
4 to 6 months
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When can a infant :
Responds to own name, telephone ringing, and person's voice, even if not loud; begins localizing sounds above and below, turns head 45 degrees toward sound; babbles "baba," "mama," "gaga"; begins to imitate speech sounds |
6 to 10 months
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When can a infant :
Recognizes and localizes source of sound; imitates simple words and sounds; understands "no-no" and "bye-bye"; correctly uses "mama" and "dada" |
10 to 12 months
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Newborns are obligatory nose breathers, An obstruction may be from what problems?
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choanal atresia or septal deviation from delivery trauma.
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What sinuses are small during infancy, few problems arise in these areas, and examination is generally unnecessary?
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maxillary and ethmoid sinuses
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In an infant, Nonadherent buccal mucosa patches are usually ______, whereas adherent patches may indicate ______
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milk deposits
candidiasis (thrush) |
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Secretions that accumulate in the newborn's mouth requiring frequent suctioning may indicate ______
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esophageal atresia
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Macroglossia is associated with ____
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congenital hypothyroidism
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What are Epstein pearls-small?
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whitish-yellow masses at the juncture between the hard and soft palate-are common and disappear within a few weeks after birth
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When performing the otoscopic examination, how do you move the auricle for children?
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pull the auricle either downward and back or upward and back to gain the best view of the tympanic membrane. As the child grows, the shape of the auditory canal changes to the S-shaped curve of the adult.
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What ages can you palpate the maxillary sinus?
Frontal sinus? What does tenderness for >10 days mean? |
The maxillary sinuses may be palpated as they are developed by 4 years of age.
The frontal sinuses may be palpated by 5 to 6 years of age when they are developed. Note any tenderness indicating a potential sinus infection in the child with an upper respiratory infection that has not improved after 10 days |
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Flattened edges on the teeth in a child suggest what problem?
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may indicate bruxism, unconscious grinding of the teeth
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What is baby bottle syndrome?
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Multiple brown areas or caries on the upper and lower incisors may be the result of a bedtime bottle of juice or milk, commonly called "baby bottle syndrome"
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Kids Teeth with a black or gray color may indicate ____
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pulp decay or oral iron therapy
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Kids who have Mottled or pitted teeth are often the result of what therapy or problem?
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tetracycline treatment during tooth development or enamel dysplasia
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Kids who have Chalky white lines or speckles on the cutting edges of permanent incisors may result from ____
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excessive fluoride intake
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What are Koplik spots?
What do they indicate? |
white specks with a red base on the buccal mucosa opposite the first and second molars, occur with rubeola in a child with fever, coryza, and cough.
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highly arched palate may be observed in children who are ____
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chronic mouth breathers.
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If the tonsils appear pushed backward or forward, possibly displacing the uvula, consider a _____
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peritonsillar abscess
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What is OTITIS EXTERNA (SWIMMER'S EAR) ?
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Otitis externa is an infection of the auditory canal resulting when trauma or a moist environment favors bacterial or fungal growth
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What is MIDDLE EAR EFFUSION ?
Signs of it? Common causes? |
inflammation of the middle ear resulting in the collection of serous, mucoid, or purulent fluid (effusion)
bulging of the tympanic membrane, limited or absent mobility of the tympanic membrane, air fluid level behind the tympanic membrane, and otorrhea. Conductive hearing loss often results. Obstructed or dysfunctional eustachian tube, allergies, and enlarged lymphoid tissue in the nasopharynx. |
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What is ACUTE OTITIS MEDIA ?
What are the signs? What can cause this? |
abrupt onset of symptoms and signs of middle ear inflammation and middle ear effusion
Signs of middle ear inflammation include distinct erythema of the tympanic membrane or distinct otalgia (ear pain) in the affected ear that interferes with normal activity and sleep bacterial infections |
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What is CHOLESTEATOMA?
What can you see? What can cause a smell? Symptoms? Problem if left untreated? |
epithelial growth that migrates through a perforation in the tympanic membrane
White, shiny, greasy flecks of debris are visualized in the posterior-superior section of the middle ear through the tympanic membrane or through a perforation. A foul-smelling discharge may be found when a perforation is present. Symptoms include progressive hearing loss, fullness in the ear, tinnitus, and mild vertigo. If untreated, the cholesteatoma can lead to intracranial complications by eroding the temporal bone |
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What is OTOSCLEROSIS ?
Symptoms? What kind of hearing loss? |
Otosclerosis is a hereditary condition that is more common in women. Irregular ossification occurs within the bony labyrinth or otic capsule, resulting in fixation of the stapes.
Symptoms include tinnitus and slowly progressive low- to medium-pitch conductive hearing loss, usually noticed between late teens and 30 years of age. Sensorineural hearing loss may also develop, causing a mixed hearing loss. |
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What is MÉNIÈRE DISEASE?
Symptoms? What do patients complain about? |
Ménière disease affects the vestibular labyrinth, leading to profound sensorineural hearing loss.
Symptoms include abrupt and recurrent attacks of severe vertigo, tinnitus, and progressive hearing loss, initially of low tones. The patient may complain of fullness in the ears. The disorder may be unilateral at first and then may involve the other ear. |
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What is LABYRINTHITIS ?
Symptoms? This can come from? |
Inflammation of the labyrinthine canal of the inner ear occurs as a complication of an acute upper respiratory viral or bacterial infection.
Symptoms of severe vertigo, which are associated with nystagmus and which are increased in severity with head movement, may last for several days. Labyrinthitis may be a complication of otitis media or meningitis. |
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What causes SINUSITIS?
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infection of one or more of the paranasal sinuses may be a complication of a viral upper respiratory infection, dental infection, allergies, or a structural defect of the nose.
Sinusitis may be caused by a blockage of the sinus meatus that prevents drainage of secretions from the sinus cavity, by malfunction of the cilia that help move mucus, or by an overproduction of mucus as a result of inflammation. |
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What are the Predictors of Sinusitis?
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The strongest predictor of sinusitis is a combination of four or more of the following signs and symptoms:
(1) maxillary toothache, (2) purulent nasal secretions, (3) dull or opaque sinus transillumination, (4) poor response to decongestants, and (5) colored nasal discharge |
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What are signs of COCAINE ABUSE ?
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chronic nasal symptoms as sniffling, nasal congestion, recurrent nosebleeds, and sinus problems
Signs of very recent insufflation include hyperemia and edema of the nasal mucosa and rhinorrhea. White powder may still be present on the nasal hairs and mustache. Signs of chronic cocaine insufflation include scabs on the nasal mucosa, decreased perception of taste and smell, and perforation of the nasal septum due to ischemic necrosis of the septal cartilage resulting from chronic irritation. |
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What is TONSILLITIS ?
What are the Symptoms? What causes this? What else is enlarged? |
Inflammation or infection of the tonsils is commonly caused by streptococci.
Symptoms include sore throat, referred pain to the ears, dysphagia, fever, fetid breath, and malaise. The tonsils appear red and swollen, and tonsillar crypts are filled with purulent exudate. Tonsils studded with yellow follicles are associated with streptococcal infections. Anterior cervical lymph nodes are enlarged. |
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What are Predictors of Beta Strep Infection?
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Clinical signs most predictive of group A beta-hemolytic Streptococcus (GABHS) include tonsillar enlargement and exudates, tender and enlarged cervical nodes, and pharyngeal erythema. However, even when all these signs are present, they provide no assurance of diagnosis with only a 71% sensitivity and 77% specificity. A throat culture is still vitally important for an accurate diagnosis
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What is PERITONSILLAR ABSCESS?
Symptoms? What is red and swollen? What is present? |
Infection of the tissue between the tonsil and tonsillar pillar occurs as a complication of tonsillitis.
Symptoms include dysphagia, drooling, severe sore throat with pain radiating to the ear, muffled voice, malaise, and fever. The tonsil, tonsillar pillar, and adjacent soft palate become red and swollen. The tonsil may appear pushed forward or backward, possibly displacing the uvula. Cervical lymphadenopathy is present. |
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How do ORAL CANCER appear?
Where are they? What are the signs? What is usually present? |
ulcerative lesion that may be erythematous, white, or pigmented, appearing as piled up edges around a core that often appears on the lateral border or floor of the mouth.
Other locations are the hard and soft palate and the alveolar ridges. Signs include a sore in the mouth that will not heal, a white or red patch on the gums, tongue, tonsil, or buccal mucosa, bleeding, ulceration, and a lump or thickening in the cheek. Early lesions are usually painless, but advanced lesions become painful with erosion of tissue. Cervical adenopathy is usually present |
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What is SLEEP APNEA ?
What problem can this cause? What can this result in? What is the typical patient profile for this? |
periodic cessation of breathing during sleep that is associated with either an obstruction to airflow or with failure of the central nervous system to stimulate the respiratory effort to breathe.
In obstructive sleep apnea, muscles in the nasopharynx, hypopharynx, and pharynx relax during sleep, resulting in loud snoring, restless sleep, and a pause in nasal and oral airflow with respiratory effort. This can result in progressive hypercapnia, hypoxemia, increased pulmonary arterial pressures, and possibly life-threatening cardiac arrhythmias. Patients are typically overweight, middle-aged men who complain of excessive daytime sleepiness and morning headaches. This can occur in preschool children when enlarged tonsils and adenoids obstruct the airway. |
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What race has higher incidence of Cleft Lip and Palate?
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The incidence of cleft lip and palate is higher in whites and Japanese, and lower in blacks.
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What is RETROPHARYNGEAL ABSCESS ?
What can cause this? Who gets this condition a lot? |
abscess is a pediatric emergency because it occludes the airway
trauma to the posterior pharyngeal wall or a dental infection that leads to infection in the retropharyngeal lymph nodes. Group A Streptococcus and Staphylococcus are common causative organisms most common in children younger than 3 to 4 years because the retropharyngeal lymph nodes tend to atrophy by 5 or 6 years of age |
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What is PRESBYCUSIS ?
Cause? What perception is loss? What other problem will occur? |
Presbycusis is a common auditory disorder in which there is bilateral sensorineural hearing loss associated with aging.
It is caused by degenerative changes in the inner ear or auditory nerve. There is a loss in the perception of auditory stimuli-initially of high-frequency sounds-and tinnitus. Speech may be poorly understood when spoken quickly or when background noise is present. |
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What is XEROSTOMIA ?
Causes? What type of patients get this condition? |
Xerostomia is a dry mouth
caused by the ingestion of anticholinergic or antidepressant drugs that interfere with the production of saliva. Xerostomia is also caused by systemic disease such as rheumatoid arthritis, scleroderma, polymyositis, and Sjögren syndrome. heavy smokers or those who have received radiation to the head and neck. |
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Earwax
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Cerumen
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Dry, cracked lips
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Cheilitis
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Epithelial growth migrating through tympanic membrane
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Cholesteatoma
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Coiled structure in inner ear
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Cochlea
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nosebleed
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Epistaxis
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Spots that appear on buccal mucosa; ectopic sebaceous glands
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Fordyce
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Attaches tongue to floor of mouth
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Frenulum
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Located between the mouth and nasopharynx
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Oropharynx
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Malleus, incus, and staples
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Ossicles
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Swimmer’s ear
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Otitis externa
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Ossification that results in fixation of staples
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Otosclerosis
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Projecting shell-like structure on the side of the head; auricle
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Pinna
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Bilateral sensorineural hearing loss associated with aging
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Presbycusis
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Compares bone conduction with air conduction of sound
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Rinne
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Used to screen for equilibrium
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Romberg
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Bony protuberance on lingual surface of mandible
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Torus
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Suspended from the posterior margin of the soft palate
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Uvula
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dizziness
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Vertigo
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Tests lateralization of sound
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Weber
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Dry mouth
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Xerostomia
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Vertigo, nystagmus, inflammation of the labyrinthine canal
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Labyrinthitis
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Ear fullness, tinnitus, affects vestibular labyrinth
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Meniere disease
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Fever, headache, nasal discharge, infection of one or more of the paranasal sinuses.
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Sinusitis
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Dysphagia, fever, fetid breath, referred pain to ears
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Tonsillitis
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Dry mouth, systemic disease
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Xerostomia
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Infection of the auditory canal
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Otitis externa
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Inflammation of middle ear resulting in a collection serious mucoid or purulent fuild
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Middle ear effusion
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Irregular ossification occurs with the bony labyrinth or otic capsule
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Otosclerosis
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The examination for vestibular function disorder is the ______ test.
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Nylen-Barony
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White specks with a red base found on the buccal mucosa opposite the first and second molars are known as _____ and may occur in a child with a fever or with rubeola.
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Koplik spots
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A _____ appears as a blunt point projection up from the upper part of the helix of the ear
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Darwin Tubercle
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Improper position of the teeth I referred to as _____
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Malocculsion
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On the roof of the mouth of an infant, _____ appear as small whitish masses and are considered a normal finding.
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Epstein pearls
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When performing a Weber test, which of the following is considered a normal finding:
A. hears the tone equally in both ears B. hears the tone better in one ear than in other C. hears sounds longer when conducted through air than when conducted through bone D. is able to detect tones of varying frequencies and pitches from a tuning fork |
A. hears the tone equally in both ears
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Which of the following best explain why infants and toddlers are at greater risk for ear infections than older children and adults?
A. Poorly develop immune system B. Immature tympanic membrane C. Wider, shorter, and horizontal eustachian tube D. Excess deposition of bone cells along the ossicle |
C. Wider, shorter, and horizontal eustachian tube
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Which finding is most likely to suggest a foreign object in the nose of a young child?
A. The mother states that the child plays with toys B. The examiner notes a purulent discharge from the child’s nose C. foul smelling odor from the nose D. The child cries when lying down |
C. foul smelling odor from the nose
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The examiner observes a blachish lesion on the top surface of the tongue of an adult patient. Tongue is painful. Which question will be helpful in explaining the finding?
A. Have you been taking antibiotics lately? B. Have you injured your tongue? C. Have you been diagnosed with mouth cancer before? D. When was the last time you brushed your teeth? |
A. Have you been taking antibiotics lately?
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Which of the following situations is an indication for transillumination?
A. Patient complains of epistaxis B. Patient has crepitus with jaw movement C. Parotid gland is palpable and tender D. Patient complains of pain over sinuses with palpation |
D. Patient complains of pain over sinuses with palpation
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The examiner is examining the ears of a child who has a tympanostomy tube in the left ear. Which of the following is an expected finding for the tympanic membrane of this ear?
A. Bulging without mobility B. Retracted with limited mobility C. Chalky white appearance D. Amber-colored appearance |
B. Retracted with limited mobility
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The examiner notes that a patient’s tonsils are enlarged and touch the uvula. This is documented as:
A. 1+ B. 2+ C. 3+ D. 4+ |
C. 3+
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A patient complains of dizziness and a “whirling” sensation. Which of the following questions would be helpful?
A. When was the last time you went swimming? B. Are you taking any medications? C. Have you noticed any discharge coming from your ears? D. Do you work or live in an environment where there is a lot of noise? |
B. Are you taking any medications?
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A adult patient with a history of upper respiratory infection complains of severe vertigo and hearing loss on one side. What examination technique should be used to evaluate equilibrium for suspected vestibular dysfunction?
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Romberg test
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Which statement made by a parent should raise the examiner’s suspicion that the tympanic membrane of a young child has ruptured?
A. She has some bloody, yellowish-looking stuff coming out of her ear B. She has been crying all night, but feels better this morning C. My child has had a fever and earache D. My child’s earwax is dark brown |
A. She has some bloody, yellowish-looking stuff coming out of her ear
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Which of the following statements made by a 72yr old patient would indicate a normal process of aging?
A. My tongue feels swollen B. My tonsils are large and sore C. Food does not taste the same as it used to D. I have white and black spots under my tongue |
C. Food does not taste the same as it used to
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Which of the following behaviors, as described by a parent, may indicate that an infant or young child may have a hearing problem?
A. My 4-month baby does not seem to respond to loud noise B. My 5-month baby is babbling, but she is not yet saying any words C. Sometimes my 3-year old does not pay attention to me D. When my 15-month baby is talking, I sometimes have a hard time understanding her |
A. My 4-month baby does not seem to respond to loud noise
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An infant born weighing less than 1500 grams is at risk for:
A. otosclerosis B. hearing loss C. cleft lip and palate D. choanal atresia |
B. hearing loss
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While examining the ear of a 6-week infant, the examiner observes a tympanic membrane lacking conical appearance and with a diffuse light reflex. These findings:
A. suggest a congenital abnormality B. suggest a ruptured tympanic membrane C. are classic findings for otitis media in the neonate D. are normal |
D. are normal
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Chronic sniffling, nasal congestions, nosebleeds, mucosal scabs, and septum perforation are signs of:
A. chronic allergies B. cocaine abuse C. fungal infection D. turbinate hypertrophy |
B. cocaine abuse
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