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214 Cards in this Set
- Front
- Back
the external ear canal is protected and lubricated with _____ which is secreted by ____
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cerumen; sebaceous glands
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within which bone is the middle ear found?
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temporal bone
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name the 3 ossicles
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malleus, incus and stapes
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the ossicles transmit sound from the tympanic membrane to _____
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oval window
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this surrounds the tympanic membrane
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dense fibrous ring called the annulus
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another name for the center of the TM
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umbo
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the eustachian tube passes between the nasopharynx and which part of the ear?
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middle ear
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____ allows the TM to vibrate freely
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equalized pressure in the middle ear
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the inner ear consists of
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vestibule, semicircular canals and cochlea
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this structure transmits sound impulses to the 8th CN and contains
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cochlea; organ of Corti
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____ contain the end organs for vestibular function
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semicircular canals
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equilibrium receptors are in the ____ and ____
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semicircular canals and vestibule
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equilibrium receptors respond to ____ and send signals to the ____ to maintain balance
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changes in direction of movement; cerebellum
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sound waves travel from the oval window to the ____
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cochlea
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sound waves travel via the endolymph from the cochlea to the _____
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round window
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this is the location where impulses in the sensory endings of the 8th CN begin and are transmitted to:
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membrane of Corti; temporal lobe
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anterior openings of the nose
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nares
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these bones form the nasal bridge
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maxillary and frontal bones
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floor of the nose is formed by
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hard and soft palate
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roof of the nose is formed by
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frontal and sphenoid bone
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a septum divides the internal nose into 2 anterior cavities called
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vestibules
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posterior openings leading to the nasopharynx
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choanae
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this house the sensory endings of the olfactory nerve
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cribiform plate
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the Kiesselbach plexus lies where on the septum?
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anterior superior portion
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adenoids are where in relation to the nasopharynx?
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posterior wall of nasopharynx
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the cribiform plate lies where?
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roof of the nose
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the lateral walls of the nose are formed by ___
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turbinates
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curved bony structures covered by vascular mucous membrane that runs horizontally and protrudes into nasal cavity
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turbinates
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the turbinates serve this function
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increase the SA of the nose to warm, humidify and filter inspired air
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area below each turbinate
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meatus
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nasolacrimal duct drains into ___
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inferior meatus
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paranasal sinus drains into ___
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medial meatus
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posterior ethmoid sinus drains into ___
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superior meatus
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air-filled paired extensions of the nasal cavities
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paranasal sinuses
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this sinus lies along the lateral wall of the nasal cavity in the maxillary bone
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maxillary sinus
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these 2 sinuses are the only ones accessible for PE
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maxillary and frontal
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these sinuses lie behind the frontal sinuses and near the superior portion of the nasal cavity
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ethmoid sinuses
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these sinuses are deep in the skull behind the ethmoid sinuses
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sphenoid sinuses
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the oral cavity is divided into ___ and ____
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mouth and vestibule
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this is the space between the buccal mucosa and outer surface of teeth and gums
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vestibule
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the mouth is the anterior opening of the ____
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oropharynx
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roof of the mouth is formed by
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hard palate and soft palate
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the uvula hangs from the hard or soft palate?
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soft
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the floor of the mouth is formed by tissue covering which bone?
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mandibular
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___ anchors the tongue to the floor of the mouth
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frenulum
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these 3 glands are located in the tissue surrounding the oral cavity
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parotid, submandibular and sublingual
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___ are outlets of the parotid glands than open on the ____ opposite the second molar on each upper jaw
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Stensen ducts; buccal mucosa
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___ are outlets of the submandibular glands and open on each side of the ____
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Wharton ducts; frenulum
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sublingual ducts open along the ___
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sublingual fold
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how many permanent teeth are normal?
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32
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what is a common variant of the normal # of permanent teeth and in what population is this common?
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28; Asian (30%) and white/Native Am (10-15%)
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the roots of permanent teeth are anchored to ___
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alveolar ridges
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how many incisors, canines, premolars and molars are there?
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4, 2, 4, 6
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the oropharynx is seperated from the mouth by
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tonsillar pillars
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development of the inner ear occurs during which trimester?
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first
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an infants EAC is shorter or longer than an adults?
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shorter and has an upward curve
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the frontal and sphenoid sinuses begin to develop at age ___ and finish developing by ___
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3 yo; late adolescence
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deciduous teeth begin to calcify at what month of fetal life?
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3
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how many deciduous teeth are there?
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20
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all deciduous teeth usually appear between what ages?
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6-24 mo
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permanent teeth start forming at what age?
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6 mo
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eruption of permanent teeth begins at what age and ends by what age?
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6 yo; 14/15 yo
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estrogen causes an increased vascularity in the UR tract causes these sx: (5)
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nasal stuffiness, decreased smell, epistaxis (bleeding), sense of fullness in the ears and impaired hearing
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laryngeal changes occur due to hormones causing these sx: (4)
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hoarseness, deepening/cracking of voice, vocal changes and persistent cough
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what causes hearing loss in old age and at what age does this begin?
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degeneration of hair cells in the organ of Corti or atrophy of stria vascularis; 50 yo
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network of capillaries that secrete endolymph and promote sensitization of hair cells in the cochlea
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stria vascularis
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sensorineural hearing loss begins with what frequency sounds and progresses to ___ frequency:
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higher; lower
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excess deposition of bone cells along ossicles can cause
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hearing loss
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what causes conductive hearing loss in old age?
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the TM becomes more translucent and sclerotic
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deterioration of sense of smell results from loss of ___ and begins around what age?
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olfactory sensory nerves; 60 yo
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sense of taste deteriorates due to ___ around age ___
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decreased # of papillae on the tongue and decreased salivary gland secretion; 50 yo
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this reduces the perception of sweet sensations
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decreased salivary gland secretion
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this lining of the lips and cheeks becomes more prominent with old age
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granular lining
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hearing loss risk factors for adults (3)
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exposure to industrial/recreational noise, Meniere disease, neurodegenerative disease
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hearing loss risk factors for kids/infants (8)
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prenatal factors (maternal infection, iiradiation, drug abuse, syphilis), low birth weight (< 1500 g), high bilirubin level, infection (bact meningitis, otitis media), cleft palate/craniofacial abnormalities, ototoxic antibiotic use, head trauma, hypoxia
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risk factors for oral cancer (8)
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> 40 yo, male gender, black ethnicity, excess alcohol, ill-fitting dentures or prior oral lesions, tobacco use, occupation (textile, leather), systemic disease (pernicious/Fe def anemia, HIV, lichen planus, malignancy, HPV)
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thickening along upper ridge of helix; expected or not?
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Darwin tubercle; expected
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preauricular pits are found where and are expected or not?
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front of ear where upper auricle originates; expected
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preauricular pits often occur in conjunction with ___ and are most common in what race?
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lip pits; blacks
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bluness of the auricle can indicate
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cyanosis
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pallor or excessive redness of the auricle can indicate
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vasomotor instability
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extreme pallor of the auricle can indicate
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frostbite
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this ear abnormality is a result of blunt trauma and necrosis of the underlying cartilage
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cauliflower ear
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small, whitish uric acid crystals along the peripheral margins of the auricles
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tophi
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tophi may indicate
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gout
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elevations in the skin with a punctum indicating a blocked sebaceous gland
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sebaceous cyst
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an auricle with a low set or unusual angle may indicate what? (2)
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chromosomal aberrations or renal disorders
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a purulent foul-smelling discharge is associated with what? (2)
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otitis or foreign body
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smell of earwax (cerumen) may indicate what in the following? maple syrup, mousy, putrid
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maple syrup urine disease, Proteus infection, Pseudomonas infection
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pain in the lobule may indicate
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inflammation of the EAC
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tenderness or swelling of the mastoid area may indicate
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mastoiditis
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Where do you place the tuning fork to perform the Weber test?
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on the vertex
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TM signs and associated conditions/causes: bulging with no mobility
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pus or fluid in middle ear
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TM signs and associated conditions/causes: retracted with no mobility
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obstruction of eustacian tube with or without effusion
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TM signs and associated conditions/causes: mobility with negative pressure only
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obstruction of eustacian tube with or without effusion
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TM signs and associated conditions/causes: excess mobility in small areas
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healed perforation, atrophic TM
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TM signs and associated conditions/causes: amber or yellow color
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serous fluid in middle ear
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TM signs and associated conditions/causes: blue or deep red color
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blood in middle ear
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TM signs and associated conditions/causes: chalky white color
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infection in middle ear
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TM signs and associated conditions/causes: redness
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infection in middle ear; prolonged crying
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TM signs and associated conditions/causes: dullness
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fibrosis
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TM signs and associated conditions/causes: white flecks, dense white plaques
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healed inflammation
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TM signs and associated conditions/causes: air bubbles
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serous fluid in middle ear
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ratio of normal air to bone conduction
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2:1
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this type of hearing loss results when sound transmission is impaired through the external or middle ear
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conductive hearing loss
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this type of hearing loss results from a defect in the inner ear that leads to distortion of sound and misinterpretation of speech
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sensorineural hearing loss
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expected findings of Weber test
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no lateralization, will lateralize to occluded ear
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expected findings of Rinne test
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AC:BC = 2:1
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conductive hearing loss findings of Weber test
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lateralization of deaf ear
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conductive hearing loss findings of Rinne test
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BC hear longer in affected ear
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sensorineural hearing loss finding in Weber test
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lateralization to better ear
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sensorineural hearing loss in Rinne test
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AC > BC but less than 2:1
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Dx: bilateral watery discharge associated with sneezing and nasal congestion
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allergy
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Dx: unilateral watery discharge after head trauma
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CSF fluid and cribiform plate fracture
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Dx: bloody discharge
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epistaxis or trauma
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Dx: mucoid discharge
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rhinitis
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Dx: bilateral discharge
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URI
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Dx: unilateral, purulent thick greenish and malodorous discharge
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foreign body
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Dx: nasal flaring
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respiratory distress
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Dx: nare narrowing on inspiration
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chronic nasal obstruction and mouth breathing
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Dx: transverse crease at the junction between cartilage and bone of nose
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chronic nasal itching and allergies
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Which 2 turbinates are visible upon inspection?
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middle and inferior
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Dx: localized redness and swelling in vestibule of nose
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furnucle
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Dx: turbinate appearing bluish gray or pale pink with a swollen, boggy consistency
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allergies
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Dx: rounded, elongated mass projecting into the nasal cavity from boggy mucosa
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polyp
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Dx: asymmetric size of posterior nasal cavities
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deviation of septum
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Dx: crusting over the anterior portion of the septum
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epistaxis
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cheilits
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dry, cracked lips
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cheilosis
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deep fissures in the corner of the mouth
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Dx: cheilosis
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riboflavin def or overclosure of mouth
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Dx: pallor of the lips
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anemia
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Dx: circumoral pallor
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scarlet fever
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Dx: cherry red color of lips
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acidosis and CO poisoning
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Dx: round oval or irregular bluish gray macules on lips and buccal mucosa
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Peutz-Jeghers syndrome
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clenching the teeth tests which CN?
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CN 7
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Dx: grayish, white benign lesion on buccal mucosa occuring most often in blacks
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leukoedema
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ectopic sebaceous glands that appear on the buccal mucosa and lips as numberous small yellow-white raised lesions
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Fordyce spots
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Dx: deeply pigmented buccal mucosa
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endocrine pathology
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Dx: red spot on buccal mucosa at the opening of the Stensen duct
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parotitis/mumps
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white round or oval ulcerative lesions with a red halo on the buccal mucosa
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aphthous ulcers
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thickened white patch lesion that cannot be wiped away
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leukoplakia
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localized gingival enlargement or ganuloma
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epulis
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enlargement of the gums occurs in these 4 situations
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pregnancy, puberty, phenytoin therapy and leukemia
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Dx: blue-black line about 1 mm from the gum margin
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chronic lead or bismuth poisioning
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Dx: easily bleeding, swollen gums that have enlarged crevices between the teeth and gum margins or pockets containing debris at tooth margins
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gingivitis or periodontal disease
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extension of the tongue while looking for deviation, tremor and limited movement tests for which CN?
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12
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Dx: smooth red tongue with a slick appearance
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vit B12 def or niacin def
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9 oral manifestations of HIV infection
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oral hairy leukoplakia, angular cheilitis, candidiasis, herpex simplex, zoster, HPV, aphthous ulcers, periodontal disease, Kaposi sarcoma
|
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white irregular lesions on lateral side of tongue or buccal mucosa; may have prominent folds or hairy projections
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oral hairy leukoplasia
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creamy white plaques on oral mucosa that bleed when scraped
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candidiasis
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recurrent vesicular crusting lesion on the vermillion border of the lip
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herpes simplex
|
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vesicular and ulcerative oral lesions in distribution of trigeminal nerve; may also be on gingiva
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herpes zoster
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single or multiple sessile or pedunculated nodules in oral cavity
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HPV
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recurrent circumscibed ulcers with an erythematous margin
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aphthous ulcers
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incompletely formed BVs proliferate in the mouth, forming lesions of various hades and sizes as blood extravasates in response to malignant tumor of epith
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Kaposi sarcoma
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bony protuberance on the lingual surface of the mandible near the canine and premolar teeth
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mandibular torus
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asking the pt to say "ah" tests which CNs?
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9 and 10
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failure of soft palate to rise bilaterally with vocalization is a result of paralysis of which CN?
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10
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with paralysis of CN 10, which way will the uvula deviate?
|
to the unaffected side
|
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Dx: red bulge adjacent to the tonsil and extending beyond the midline
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peritonsillar abscess
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Dx: yellowish mucoid film in pharynx
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postnasal drip
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Dx: grayish adherent membrane
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diphtheria
|
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gag reflex tests which CNs?
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9 and 10
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Nylen Barany test tests for what?
|
evaluate of the vestibular branch of the auditory nerve
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Dx: drooling in an infant over 12 mo
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neurologic disorder
|
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macroglossia is associated with what ocngenital anomaly?
|
hypothyroidism
|
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small whitish yellow masses at the juncture between the hard and soft palate in infants
|
epstein pearls
|
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bruxism
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unconscious teeth grinding
|
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Dx: flattened edges on the teeth
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bruxism
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Dx: multiple brown areas or caries on upper and lower incisors of infants
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baby bottle syndrome
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Dx: mottled or pitted teeth in infants
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tetracycline tx during tooth development or enamel dysplasia
|
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Dx: chalky white lines or speckles on cutting edges of permanent incisors in infants
|
excessive fluoride intake
|
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Dx: white specks with a red base on the buccal mucosa opposite the first and second molars in infants
|
Koplik spots
|
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Koplik spots are associated with
|
rubeola
|
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presbycusis
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sensorineural hearing deterioration with advancing age
|
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2 common causes of conductive hearing loss in older adults
|
otosclerosis and impacted cerumen
|
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infection of the auditory canal resulting when trauma or a moist environment favors bacterial or fungal growth
|
otitis externa (swimmer's ear)
|
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Dx: buging of TM, limited or absent mobility of TM, air fluid level behind the TM and otorrhea
|
middle ear infection
|
|
causes of middle ear infection (3)
|
obstructed or dysfunctional eustachian tube, allergies and enlarged lymphoid tissue in nasopharynx
|
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Dx: itching in ear canal, pain with movement of pinna, watery then purulent discharge, conductive hearing loss, red edematous canal and obscured TM
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otitis externa
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Dx: abrupt onset, fever, feeling of blockage, deep seated earache, discharge only if TM ruptures, conductive loss as middle ear fills with pus, bulging TM with erythema, limited or absent movement
|
acute otitis media
|
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Dx: sticking or cracking sound on yawning or swallowing, discomfort, feeling of fullness, no discharge, conductive hearing loss as middle ear fills with fluid, TM retracted or bulging, impaired motility
|
middle ear effusion
|
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epithelial growth that migrates through a perforation in the TM
|
cholesteatoma
|
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result of untreated cholesteatoma
|
erosion of the temporal bone
|
|
hereditary condition, irregular ossification within the bony labyrinth or otic capsule resulting in fixation of stapes
|
otosclerosis
|
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Dx: tinnitus and slowly progressive low to medium pitch conductive hearing loss, sensorineural hearing loss may develop
|
otosclerosis
|
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disease that affects the vestibular labyrinth leading to profound sensorineural hearing loss
|
Meniere disease
|
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Dx: abrupt and recurrent attacks of vertigo, tinnitus and progressive hearing loss, fullness in ears, unilateral then bilateral
|
Meniere disease
|
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labyrinthitis occurs as a complication of what? (4)
|
acute URI or bacterial infection, otitis media or meningitis
|
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Dx: vertigo, nystagmus which are increased in severity with head movement
|
labyrinthitis
|
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paranasal sinusitis may be a result of what? (4)
|
viral URI, dental infection, allergies or structural defect of nose
|
|
acute sinusitis is characterized by what?
|
URI that worsens after 5 days, persists longer than 10 days and has more severe sx than typical URI
|
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Dx: purulent nasal or postnasal drainage, nasal congestion, facial pain or pressure
|
sinusitis
|
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Dx: in child, rhinorrhea, cough, fever, halitosis, hyponasal speech, pain or HA, periorbital swelling, postnasal drip, absent transillumination
|
sinusitis
|
|
5 strongest predictors of sinusitis
|
maxillary toothache, purulent nasal secretions, dull or opaque sinus transillumination, poor response to decongestants and colored nasal discharge
|
|
Dx: sniffling, nasal congestion, recurrent nosebleeds, sinus problems, scabs on nasal mucosa, decreased perception of taste and smell, nasal septum perforation
|
cocaine abuse
|
|
common cause of tonsillitis
|
streptococci
|
|
Dx: sore throat, referred pain to ears, dysphagia, fever, fetid breath, malaise
|
tonsilitis
|
|
clinical signs most predictive for group A beta-hemolytic streptococcus
|
tonsililar enlargement and exudates, tender and enlarged cervical nodes, pharyngeal erythema
|
|
infection of the tissue between the tonsil and tonsillar pillars that occurs as a complication of tonsilitis
|
peritonsillar abscess
|
|
Dx: dysphagia, drooling, severe sore throat with pain radiating to the ear, muffled voice, malaise and fever
|
peritonsillar abscess
|
|
ulcerative lesion that may be erythematous, white or pigmented, apperaing as piled up edges around a core that often appears on the lateral border or floor of mouth
|
oral cancer
|
|
Dx: sore in mouth that will not heal, white or red patch, bleeding ulceration, lump or thickening
|
oral cancer
|
|
long term problems affecting those with cleft palate/lip
|
hearing loss, chronic otitis media, speech difficulties, feeding problems and improper tooth development and alignment
|
|
in what races are cleft palate/lip most common?
|
whites and Japanese
|
|
causes of retropharyngeal abscess
|
trauma to posterior pharyngeal wall or dental infection
|
|
common causative organisms of retropharyngeal abscess
|
group A streptococcus and Staphylococcus
|
|
Dx: child, acutely ill, febrile, drooling, anorexic and restless, respiratory distress, muffled voice and stridor
|
retropharyngeal abscess
|
|
at what age do the retropharyngeal nodes tend to atrophy?
|
5 or 6 yo
|
|
common auditory disorder in which there is bilateral sensorineural hearing loss associated with aging
|
presbycusis
|
|
cause of presbycusis
|
degenerative changes in inner ear or auditory nerve
|
|
Dx: loss in perception of auditory stimuli, initially high freq and tinnitus
|
presbycusis
|
|
dry mouth caused by ingestion of anticholinergic or antidepressant drugs that interfere with production of saliva or systemic diseases or in heavy smokers
|
xerostomia
|
|
systemic diseases that cause xerostomia
|
RA, scleroderma, polymyositis and Sjogren syndrome
|