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103 Cards in this Set
- Front
- Back
Sternomastoid muscle
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Muscle that arises from sternum & medial part of clavicle & extends diagonally across neck to mastoid process behind ear; head rotation & head flexion; innervated by CN XI (spinal accessory)
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Trapezius muscle
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Muscle that arises from occipital bone & the vertebrae & extends fanning out to scapula & clavicle; the pr form a trapezoid shape on upper back; move the shoulders & extend & turn the head
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Preauricular
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Lymph nodes in front of ear
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Posterior auricular
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Lymph nodes superficial to the mastoid process
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Occipital
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Lymph nodes at the base of the skull
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Submental
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Lymph nodes behind the tip of the mandible
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Submandibular
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Lymph nodes halfway b/n the angle & tip of the mandible
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Jugulodigastric
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Lymph nodes under the angle of the mandible
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Superficial cervical
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Lymph nodes overlying the sternomastoid muscle
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Deep cervical
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Lymph nodes deep under the sternomastoid muscle
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Posterior cervical
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Lymph nodes in the posterior triangle along the edge of the trapezius muscle
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Supraclavicular
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Lymph nodes just above & behind the clavicle, at the sternomastoid muscle
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Anterior triangle
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Lies in front, b/n sternomastoid & midline of body, w/its base along lower border of mandible & apex down at suprasternal notch
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Posterior triangle
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Behind sternomastoid, w/trapezius muscle on other side & w/its base along the clavicle below; contains posterior belly of omohyoid muscle
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Lymphadenopathy
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Enlargement of the lymph nodes (>1 cm) from infection, allergy, or neoplasm
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Acute infection
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In this abnormal finding, nodes are bilateral, enlarged, warm, tender, & firm but freely moveable
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Cancer
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In this abnormal finding, nodes are hard, unilateral, nontender, fixed
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Tympanic membrane
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eardrum; separates external & middle ear & is tilted obliquely to the ear canal, facing downward & somewhat forward; shiny, translucent membrane w/pearly gray color & prominent cone of light in anteroinferior quadrant (R-5:00, L-7:00); oval, slightly concave
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Malleus
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"Hammer"; first of the 3 middle ear ossicles; made up of umbo, manubrium, & short process
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Pars flaccida
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Small, slack, superior section of tympanic membrane
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Pars tensa
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Thick, taut, central/inferior section of tympanic membrane
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Annulus
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Outer fibrous rim of the drum
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Conductive hearing loss
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Involves mechanical dysfunction of external/middle ear; partial loss b/c person able to hear if sound amplitude is increased enough to reach normal nerve elements in inner ear; causes: impacted cerumen, foreign bodies, perforated tympanic membrane, pus/serum in middle ear, otosclerosis (decrease in mobility of ossicles)
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Otosclerosis
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Gradual hardening that causes foot plate of stapes to become fixed in oval window --> decrease in mobility of ossicles
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Sensorineural hearing loss
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Pathology of inner ear, CN VIII, or auditory areas of cerebral cortex; increase in amplitude may not enable person to understand words; causes: presbycusis, ototoxic drugs (affect hair cells in cochlea)
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Presbycusis
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Gradual nerve degeneration in inner ear/auditory nerve that occurs w/aging
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Otitis media
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Middle ear infection that occurs b/c of obstruction of eustachian tube or passage of nasopharyngeal secretions into middle ear; one of most common illnesses in children
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Cerumen
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Yellow waxy material that lubricates & protects ear canal; genetically determined, comes in two major types
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Dry cerumen
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Gray, flaky, frequently forms a thin mass in ear canal; Asians & American Indians have 84% frequency
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Wet cerumen
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Honey brown to dark brown & moist; Blacks have 99% frequency, whites have 97% frequency
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Inspecting w/otoscope
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Pull pinna up & back on adult, pull pinna down & back on infant & child < 3 yrs; hold otoscope upside down, have dorsa of hand along pt's cheek; insert speculum along axis of canal, put eye up to otoscope; may need to rotate otoscope slightly to visualize all the eardrum
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Whispered voice test
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Rapidly push tragus in & out of auditory meatus, shield lips; 1-2 ft from pt's ear, exhale & whisper slowly 2-syllable words (e.g. Tuesday, baseball); normal = pt repeats ea. word correctly
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Tuning fork tests
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Measure hearing by air conduction (AC) or bone conduction (BC); AC - through ear canal & middle ear, usu. more sensitive; BC - sound vibrates through cranial bones to inner ear; to activate tuning fork, hold it by stem & strike tines softly on back of hand
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Weber test
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Valuable when pt reports hearing better w/one ear than the other; place vibrating tuning fork in midline of person's skull, ask whether tone sounds the same in both ears or better in one; normal = tone should sound equally loud in both ears
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Rinne test
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Compares air conduction & bone conduction sound; place stem of vibrating tuning fork on person's mastoid process, ask pt to signal when sound goes away; quickly invert fork so vibrating end near ear canal, person should still hear sound; normal = positive Rinne test (AC > BC, sound heard twice as long by air conduction)
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Frostbite
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Reddish blue discoloration & swelling of auricle after exposure to extreme cold; vesicles/bullae may develop, person feels pain & tenderness, & ear necrosis may ensue
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Otitis externa
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"Swimmer's ear"; infection of outer ear, w/severe painful movement of pinna & tragus, redness & swelling of pinna & canal, scanty purulent discharge, scaling, itching, fever, enlarged tender regional lymph nodes; hearing normal/slightly diminished; more common in hot humid weather; after swimming, skinfolds set up for infection
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Darwin's tubercle
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Small painless nodule at helix; congenital variation, not significant
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Tophi
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Small, whitish-yellow, hard, nontender nodules in/near helix/antihelix; contain greasy, chalky material of uric acid crystals; sign of gout
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Keloid
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Overgrowth of scar tissue, invades original site of trauma; more common in dark-skinned ppl, in ear it is most common at lobule at site of pierced ear
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Carcinoma
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Ulcerated crusted nodule w/indurated base that fails to heal; bleeds intermittently; must refer for biopsy; usu. occurs on superior rim of pinna (most sun exposure); may occur in ear canal & show chronic serosanguineous/bloody discharge
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Furuncle
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Exquisitely painful, reddened, infected hair follicle; may occur on tragus, cartilaginous part of ear canal; regional lymphadenopathy often accompanies it
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Perforation (TM)
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Usu. appears as round/oval darkened area on drum; central - occur in pars tensa, marginal - occur at annulus, attic perforation - when they occur in pars flaccida (superior part of drum); causes: untreated acute otitis media, trauma
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Cochlea
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Inner ear structure containing the central hearing apparatus
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Eustachian tube
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Connects middle ear w/nasopharynx & allows passage of air
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Helix
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Superior, posterior free rim of pinna
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Incus
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"Anvil"; middle of the 3 middle ear ossicles
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Mastoid
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Bony prominence of skull located just behind ear
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Organ of Corti
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Sensory organ of hearing
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Pinna
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Auricle or outer ear
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Stapes
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"Stirrup"; inner of the 3 middle ear ossicles
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Tinnitus
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Ringing in the ears
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Umbo
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Knob of malleus that shows through the tympanic membrane
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Vertigo
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Spinning, twirling sensation
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Cholesteatoma
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Overgrowth of epidermal tissue in middle ear/temporal bone, may result over the years after marginal TM perforation; pearly white, cheesy appearance; can erode bone & produce hearing loss; early signs: otorrhea, unilateral conductive hearing loss, tinnitus
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Otorrhea
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Discharge from the ear
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Otalgia
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Pain in the ear
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Weber test - conductive loss
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Sound lateralizes to affected/poorer ear b/c it's not distracted by background noise & has better chance to hear bone-conducted sound
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Weber test - sensorineural loss
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Sound lateralizes to unaffected/better ear b/c affected/poor ear is unable to perceive sound
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Rinne test - conductive loss
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Sound is heard as long (AC=BC) or longer (AC<BC) by bone conduction; negative Rinne test
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Rinne test - sensorineural loss
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Normal ratio of AC>BC is intact but reduced overall; person hears poorly both ways
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Hyperthyroidism
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Goiter; exophthalmos; symptoms: nervousness, fatigue, weight loss, muscle cramps, heat intolerance; signs: tachycardia, shortness of breath, excessive sweating, fine muscle tremor, thin, silky hair & skin, infrequent blinking, staring appearance
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Hypothyroidism
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Deficiency of thyroid hormone, when severe, causes a non-pitting edema or myxedema; puffy edematous face, esp. around eyes (periorbital edema), coarse facial features, dry skin, dry coarse hair & eyebrows
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Turbinates
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3 parallel bony projections that increase surface area so that more blood vessels & mucous membranes are available to warm, humidify, & filter inhaled air
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Frontal sinus
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Sinus located in frontal bone above & medial to orbits
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Maxillary sinus
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Sinus in maxilla (cheekbone) alone side walls of nasal cavity
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Ethmoid sinus
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Sinus b/n the orbits
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Sphenoid sinus
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Sinus deep w/in skull in sphenoid bone
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Hard palate
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Part of the arching roof of the mouth that is made up of bone & whitish in color
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Soft palate
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Arch of muscle that is pinker, mobile
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Parotid, submandibular, sublingual
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3 pairs of salivary glands (name them)
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Function of salivary glands
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Secrete saliva, which moistens & lubricates the food bolus, starts digestion, & cleans & protects the mucosa
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Parotid gland
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Largest of the salivary glands; lies w/in the cheeks in front of the ear extending from the zygomatic arch down to angle of the jaw; Stensen's (its duct)
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Stensen's duct
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Duct of the parotid gland that runs forward to open on the buccal mucosa opposite the second molar
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Submandibular gland
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Walnut-sized; lies beneath mandible at angle of the jaw; Wharton's (duct)
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Wharton's duct
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Duct of the submandibular gland that runs up & forward to the floor of the mouth & opens at either side of frenulum
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Frenulum
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Midline fold of tissue that connects tongue to floor of the mouth
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Sublingual gland
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Smallest of the salivary glands, almond-shaped; lies w/in floor of the mouth under the tongue; has many small openings along sublingual fold under the tongue
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Bifid uvula
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Uvula is split either completely or partially; may indicate a submucous cleft palate, which may affect speech development b/c it prevents necessary air trapping; occurs in some Native American groups (18%) & Asians (10%), uncommon in whites, rare in blacks
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Cleft lip
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Maxillofacial clefts are the most common congenital deformities of head & neck; incidence highest in American Indians & Japanese & lowest in blacks; early treatment preserves functions of speech & language formation & deglutition (swallowing)
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Cleft palate
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Failure of fusion of maxillary processes; congenital defect; wide variation occurs in extent of cleft formation, from upper lip only, palate only, uvula only, to cleft of the nostril & the hard & soft palates; most common in American Indians & Asians & least common in blacks
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Rhinitis
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Nasal mucosa swollen, bright red w/an upper respiratory infection
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Chornic allergy
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Mucosa looks swollen, boggy, pale, gray
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Inspecting the nasal cavity
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Gently lift up tip of nose w/your finger, & insert into nasal vestibule the short wide-tipped speculum attached to the otoscope head; view each nasal cavity w/person's head erect & then w/head tilted back; normal = red color & smooth moist surface; note swelling, discharge, bleeding, foreign body
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Superior turbinate
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Which turbinate cannot be inspected w/the otoscope?
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U-shaped area under the tongue behind the teeth
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Where do oral malignancies most likely develop on the tongue?
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Tonsils
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Oval, surface rough & peppered w/indentations; located behind anterior tonsillar pillar; pink like oral mucosa
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Tonsil grade
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1+ visible, 2+ halfway b/n tonsillar pillars & uvula, 3+ touching the uvula, 4+ touching each other
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Tonsil - acute infection
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Tonsils enlarged to 2+, 3+, 4+
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Testing CN X (vagus)
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Ask the person to say "ahhh" & note soft palate & uvula rise in the midline
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Testing CN IX (glossopharyngeal) & X (vagus)
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Touch the posterior wall of oral cavity w/tongue blade to elicit gag reflex
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Testing CN XII (hypoglossal)
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Ask the person to stick out the tongue; normal = it protrudes in the midline; note any tremor, loss of movement, or deviation to the side
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Epistaxis
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May be spontaneous from local cuase or a sign of underlying illness; causes: nose picking, forceful coughing/sneezing, fracture, foreign body, rhinitis, heavy exertion, coagulation disorder; bleeding from anteror septum is easily controlled, rarely severe; posterior hemorrhage is less common (<10%) but more profuse, harder to manage, more serious
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Kiesselbach's plexus in anterior septum
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Most common site of nosebleed
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Acute rhinitis
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1st sign is a clear, watery discharge, rhinorrhea, which later becomes purulent; accompanied by sneezing & swollen mucosa, which causes nasal obstruction; turbinates are dark red, swollen
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Allergic rhinitis
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Rhinorrhea, itching of nose & eyes, lacrimation, nasal congestion, sneezing; note serous edema & swelling of turbinates to fill the air space; turbinates usu. pale (may appear violet) & their surface looks smooth, glistening; may be seasonal/perennial, depending on allergen; strong family history of seasonal allergies
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Herpes Simplex 1
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Cold sores; clear vesicles w/surrounding indurated erythematous base that evolve into pustules, which rupture, weep, & crust, & heal in 4-10 days; most likely site is lip-skin junction & infection often recurs in same site; caused by herpes simplex virus (HSV-1); highly contagious & spread by direct contact; recurrent herpes infections may be precipitated by sunlight, fever, colds, allergy; very common lesion (50% of adults)
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Gingivitis
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Gum margins are red, swollen, & bleed easily; gingival tissue has desquamated (peeled off), exposing roots/teeth; inflammation usu. due to poor dental hygiene or vitamin C deficiency; may occur in pregnancy/puberty b/c of changing hormonal balance
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Koplik's spots
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Small blue-white spots w/irregular red halo scattered over mucsoa opposite the molars; early sign & pathognomonic of measles
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Candidiasis (monilial infection)
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White, cheesy, curdlike patch on buccal mucosa & tongue; scrapes off, leaving raw, red surface that bleeds easily; termed "thrush" in newborn; opportunistic infection that occurs after use of antibiotics, corticosteroids, & in immunosuppressed persons
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Oral Kaposi's sarcoma
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Bruiselike, dark red/violet, confluent macule; usu. on hard palate, may be on soft plalte or gingival margin; oral lesions may be among earliest lesions to develop w/AIDS
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Perforated nasal septum
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Hole in septum, usu. in cartilaginous part; may be caused by snorting cocaine, chronic infection, trauma from continual picking of crusts, nasal surgery; seen directly or as spot of light when penlight directed into other naris
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CAUTION
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Changes in bathroom habits; A sore that doesn't heal; Unusual discharge/bleeding; Thickness/lumps in breast or other areas; Indigestion & difficulty in swallowing; Obvious changes in moles/warts; Nagging cough & hoarseness
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