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129 Cards in this Set

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What is the name of the location on the lips where you would apply lip liner?
Vermillion border
Give the name for the middle crease at the base of the nose.
Columella
Where is the nasal alae and philtrum located?
Indentation between the upper lip and the base of the nose
During which stage of life is it common for a person to hear themselves talk on the inside of their ear?
Pregnancy
Where is the eustachian tube located?
Enters above the palate into the nasal pharynx
What are the common cranial nerves associated with ENT?
I: Olfactory
V: Facial sensation
VII: facial movements, tears taste and acoustic reflex
IX: Taste
X: taste
XI: Taste and swallowing
XII: tongue movements
Why is it important to assess above and below the area fo complaint in children?
They often have referred pain
What is the rate of profound hearing loss in children?
1-2 per 1000
___% of NICU graduates develop some form of sensorineural hearing loss?
12
Describe the newborn screening tool of otoacoustic emission.
Like a tympanogram listens for action potentials of the cochlea and that is what it picks up. Picks up cochlea function
T or F: otoacoustic emission measures hearing?
False: more acoustic function
The BEAR screen is a little more accurate than otoacoustic emission but it misses the ___ and ___.
Low and high frequencies
What is the diagnostic test for hearing?
Brain stem evoked response
___ babies are born everyday with hearing loss.
33
50% of hearing loss in children are contributed to ___ factors and likely to increase.
genetic
US hospitals must pay for the ___ test in order to get federal funding.
BAER
What are the 2 major types of hearing loss?
1. Conductive
2. Sensori-neural
What are the common maternal illness associated with early hearing loss? Which is the most common?
1. CMV*
2. Maternal rubella
3. Genetic disorders leading to malformation of the cochlea
4. Sepsis with prolonged acidosis
5. oxygen deprivation and hyperbilirubinemia
Which illness has been known to cause hearing loss, but is on the decline with the increase in vaccination?
Meningitis
Name 3 common medications known to cause hearing loss.
1. Lasix
2. aminoglycosides
3. vancomycin
What thyroid disorder has been linked to hearing loss?
Congential hypothyroidism
List the characteristics of Large Cochlear aqueduct syndrome
1. Onset of hearing loss is 6-7 months with progressive worsening
2. Balance is off with progressive loss
3. tends to stabalize at 50 dB
4. they should not play football
2 common reasons for conductive hearing loss are ___ and ___?
Excess cerumen and foreign objects
What syndrome which is associated with deafness also hasa white forelock and eye abnormalities?
Waandenburg syndrome
Which 2 syndromes causing deafness are associated with Long QT?
1. Jervell Syndrome
2. Lange Nielsen syndrome
Which ion is distrupted with ion channelopathies leading to progressiv hearing loss?
Potassium
___% of the genetic syndromes causing hearing loss are recessive.
80
Which organ is vital to assess if hearing loss is found in children?
Kidneys: they are both formed together in the 8th week of gestation
What are 3 symptoms of Alport's syndrome?
1. Renal disease
2. hearing loss
3. nematouria
Which genes are associated with non-syndromic hearing loss?
Human KCNQ4 mutations known as DFNA2
What is the goal of newborn screening for hearing?
Eraly intervention by age 6 months
1/3 of genetic hearing loss is ___?
syndromic
Fot the 2/3s non-syndromic genetic hearing loss, what may be the cause?
Mitochondrial defect
What are the non-genetic causes of hearing loss?
CMV, high bili, trauma, meningitis, noise induced hearing loss
How does a person with conductive hearing loss, "hear"?
They can understand what you are saying, but hear you very quietly
In sensorineural hearing loss, the person can hear what you say but___.
They do not understand what you are saying
List some common causes of sensorineural hearing loss.
1. Noise induced hearing loss
2. Presbycusis
3. Meniere's Disease
4. Tumors of the auditory nerve
If a person has a Eustachian tube dysfunction, ear fluid, hole in the eardrum or fixed middle ear bone, they will be diagnosed with ____ hearing loss.
conductive
during the inspection of the hear with the otoscope, if the speculum touches the ear canal, what will happen?
You will see a red reflex of the eardrum
Large ears are often found in which disorder?
Fragile X
If the external ear has dimples, tags or nodules, this represents remnats of the first ___ ___.
brachial cleft
Low set ears can be associated with ___ or ____ abnormalities.
Kidney or chromosomal
Enlarge ____ nodes and external otitis with ___ can make the ear protrude.
post auricular; cellulitis
What do pre-auricular pits in caucasions often indicate?
Sinus tract or kidney problems
Pre-auricular pits can often lead to ___ cysts.
branchial
what direction does the ear canal face in older children?
Downward and forward
What is the likely diagnosis if pulling on the auricle causes pain?
Furuncle or external otitis media
What is an easy way to get rid of earwax?
A few cc's of colace allowed to stay in the canal for 10-15 mins, then irrigate
Describe the symptoms of external otitis media.
1. pain on movement of the auricle
2. canal may be red, friable and full of pus
3. inspect the entire TM looking at landmarks, color, contour and perforations
Pseudomonas infections of the external ear canal have a distinct ___.
ODOR!
Infections of the external are often related to changes in ___ of the ear canal.
pH
What types of organism can cause infections of the external ear canal?
fungal, viral, bacterial or yeast
why do infections of the throat in children 0-3 years old often go to the ear?
beacause the eustachian tube is wide/straight and short, then the eardrum gets retracted, the tube closes tightly and the infection gets caught
List the pathophysiology of Otitis Media.
1. Middle ear cavity filled with air and is steril under normal circumstances
2. air enters the middle ear when you swallow throug the eustachian tube
3. when the ET does not function, middle ear cavity does not ventilate normally
4. Negative air pressure results as the air is absorbed
5. Fluid effused in the middle ear
6. Bacteria comes from nasopharynx into the middle ear cavity leading to AOM
What is the name of the part of the ear drum that lies above the short process of the malleus?
Pars Flaccida
What is the pars Tensa?
everything below the short process of the malleus
what does an amber colored tympanic membrane indicate?
Serous fluid
what does a blue or deep red tympanic membrane indicate/
blood in the middle ear
IF the TM has a chalky white color, the patient has a history of recurrent ___.
infection
how does healed areas of the tympanic membrane appear?
White
If the tympanic membrane has a dull tone, it is indicative of ___.
fibrosis
What is the hallmark sign of otitis?
bulging og the tympanic membrane
tenderness to palpation of the __ is indicative of otitis externa.
tragus
What is otorrhea?
otitis externa, aka swimmers ear
why does swimmers ear occur?
The pH of the alkaline pool causes ability of bacteria in the ear to grow.
What are the symptoms of otitis externa?
Severe pain and sense of fullness in the ear
What are the pathogens that are connected with otitis externa?
Bacterial, viral (HSV, Varicella), fungal (candida, aspergillus niger)
If a HCP cannot get medication into the ear to treat otitis externa, what will be the next method?
Insertion of an expandable methylcellulose oto-wick or sponge (ear wick) which will be cahnged every 2 days
What is the treatment for otitis externa?
1. Debridement of the ear canal
2. topical antibiotics
3. fungal infection: acetic drops or antifungal drops
Why does mastoiditis occur?
Accumulation of the purulent exudate in middle ear does not drain through the ET or perforated TM but spread to mastoid bone. Air cells are destroyed and progresses to coalescent phase
what does a tympanogram show?
Retraction
What are findings on the TM with chronic otitis?
Have ear drum folds
What are the common symptoms/signs of poor eustachian tube function?
Eardrum folds and retraction of the manubrium
What might the patient need to be treated for with eustachian tube dysfunction?
allergies
What can occur from rubbing the nose?
nasal pleat or allergic crease
If the color of the nasal mucosa is red, what does that mean>
infection
An allergy will turn the nasal mucosa a ___ ___ color.
Pale boggy
Chronic rhinits makes the nasal mucosa what color?
swollen grayish
Which form of nasal infection has purulent discharge?
viral only
What are the nasal indicators of streptococcus infection?
Discharge and crusty nose
What are the 4 possible causes of watery nasal secretions?
1. Allergy
2. Common cold
3. illicit drug use
4. rarely skull fracture
What is the best indicator for a foreign body in the nasal cavity?
Purulent foul smelling secretion
if a child has a foul smelling odor with no nasal foreign body, what may be the cause?
metabolic disorder
What are the 5 most common complaints in regards to the nose?
1. Foreign body
2. Epistaxis
3. sinusitis/purulent rhinitis
4. allergic rhinitis
5. nasal polyps
What is the number one complaint of nasal problems?
Epistaxis
What is the proper treatment for epistaxis?
pinch the nose and lean forward
Where does a nose bleed usually occur in children?
in the anterior nose
what is the medical term for the plexus inside the nose?
Kiesselbach's area
What maligniant neoplasms can cause epistaxis?
lymphoma or rhabdomyosarcoma
which coagulopathies can cause nosebleeds in children?
1. Von willedbrand disease
2. hemophilia
3. liver disease
What benign masses are associated with nose bleeds?
1. Pyogenic granuloma
2. papilloma
What is the name of the medication for nosebleeds that must be taken tid for one week?
Bactroban
Name the topical vasoconstrictors used to treat nosebleeds.
1. Neo-Synephrine
2. Nasal sponge: must be remove in 48 hours
3. antibiotic RX
4. Nosebleed QR
Describe the symptoms of allergic rhinitis.
1. inflammation
2. Edema
3. weeping of nasal mucosa (stringy secretions)
If nasal polyps are discovered, what test must be conducted in children?
Sweat test for cystic fibrosis
How would you describe nasal polyps?
grape-like finger erruptions usually caused by allergy
If a midface trauma occurs, what must the person be assessed for in terms of clear fluid leaks from the nose?
possible skull fracture through the cribriform plate
What must always be done if a child has trauma to the face?
Extra ocular movements test
When should the HCP conduct the mouth and throat exam on a child?
At the very end of the exam
What is angular chelitis?
fissures that occur on the sides of the mouth after exposre to wind, sun
What does cheilosis resemble and what causes it?
Resembles angular cheilitis and occurs do to nutritional deficiency, strep or yeast or lip lickers dermatitis
what should the pediatric HCP do with the tongue blade prior to the mouth exam?
Moisten it
Other than saying "AHHH" during the mouth exam, what should the HCP ask the child to say?
HAH-HAH
What is the name of the foul smelling debris found in cryptic tonsils?
Tonsilleths
What are the possible causes of painful mouth ulcers?
1. aphthous ulcers of unknown etiology
2. immune deficiency
3. erythema multiforme
4. leukemia
5. folic acid
6. B12 deficiency
7. Inflammatory bowel disease: crohns
8. neutropenia
9. niacin deficiency
at what age do the tonsils reach their peak size and then start to reduce?
age 7
Describe 1+ tonsils.
if they are visible only slightly beyond the tonsillar pillars
what are 2 + tonsils?
midway between tonsillar pillars and the uvula
Tonsils that are nearly touching the uvula have what grade?
3+
if tonsils are touching at the midline and occluding view of the oropharynx they have ___ grade
4+
A bifib uvula is indicative of a ___ ___ and the child often gets recurrent ___ ___.
submucous cleft; otitis media
Where are the adenoids located?
above the soft palate
what can large adenoids cause?
eustachian tube dysfunction and sleep obstructive apnea
What is the sign of uvulitis?
red uvula
Kids who have strep throat often have what symptoms?
vomiting, belly pain and tachycardia outside of the proportion to fever
What occurs on the tongue in scarlet fever?
strawberry tongue
describe the rash associated with scarlet fever.
pastillas lines on the whole body with a sand paper rash
which disease has a rash that starts at the back of the ear and travels down
measles
What is the most common deep infection of the neck?
peritonsillar abscess
What is a peritonsillar abcsess?
bulge of tonsillar pillar between capsule and the superior constructor muscle--> causes pain. Obstruction and infection of the weber gland
what agent is the most common cause of cavities?
streptococcus
What oral disorder is known to be the most infectious?
cavities
What % of turner syndrome patients have sleep apnea?
50%
True or false: we treat pediatric sinusitis with antibiotics?
True, not for adults
How many days worth of discharge would sinusitis be a possible diagnosis?
>10-14
Which of the sinuses are present at birth and rapidly grow from birth to 4 and 6-12?
maxillary
The frontal sinuses are the ___ to develop. What age do they begin?
Last; 4-8
which sinus is present at birth but not developed? When does it grow?
Ethmoid: grows rapidly during the first 4 years
The sphenoid sinus is ___ at birth, does not begin to grow rapidly until after __years of age, completes between __ and __.
undeveloped; 5; 12-15