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70 Cards in this Set

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Name the external structures of the ear.
Auricle or pinna (consists of movable cartilage and skin)
-Landmarks: helix, antihelix, tragus, antitragus are used as reference points when documenting findings.
List the structures of the Middle Ear and its function.
Middle: Tiny air-filled cavity within bone
-Consists of Tympanic Membrane, Stapes, Malleus and Incus
-Conducts sound vibration and protects the inner ear from amplitude: it also tries to equalize the pressure on the tympanic membrane
Describe the aspects of the inner ear.
Consists of the cochlea, semicircular canals and the vestibular nerve.
-Aids in converting sound wave to electrical impulses
-Helps regulate equilibrium
Describe the Tympanic Membrane.
-Eardrum
-Normally shiny but translucent, should be able to see the bones
-Oval in shape and slightly concave and pulled to the center by the malleus bone.
-the pars tensa is a tense tissue
-When the pt coughs it appears red.
-Sound waves cause vibrations on the ear drum that is then sent to the bones of the ear to be relayed to the cranial nerve.
Why do children get infections in their ear more often than adults?
The eustachian tube that connects their nose to their ear is horizontal and thus infection can travel easily to the ears.
What is otosclerosis?
An abnormal spongy bone growth in the middle ear that causes hearing loss.
-The most frequent type of hearing loss in adults. Usually occurs in women during pregnancy or those with a family history
-White women are effected most.
What is Presbycusis?
Age related hearing loss.
-Can result from over working the ears.
-Loud music, concerts, airports etc.
What are the two pathways of hearing?
-The most typical is form is air conduction
-Bone conduction is also a pathway.
What questions should you ask when conducting an ear exam?
-Earaches
-Infections
-Discharge
-Hearing loss
-Environmental Noise
-Tinnitus: ringing in the ears
-Vertigo: spinning
-Self care behavior: Q-Tips
What are three types of normal hearing test?
-Conversational Test: can they hear you while talking
-Finger Rubbing: rub your fingers next to each ear
-Whisper test: cover one ear and whisper a 2 syllable word in the other
What is the Weber Test?
Use a 512 fork in the midline of the head
-Ask if sound is louder in one hear in one ear than the other
-Lateralizes the midline, left or right
-If there is conductive loss the sound will be louder in the blocked ear
-If nerve damage: the sound will go to the good ear because the bad ear is dead.
What is the Rinne Test?
-Place a tuning fork on the mastoid bone and ask the pt when they hear the sound disappear.
-Then place the fork next to the ear ask wait for the sound to disappear
-In normal hearing the air conduction will be 2x as long as the bone.
-Conductive loss: The air will equal the bone or will be less than the bone.
-Never Damage: If the nerve is dead you will not hear at all.
When you inspect the ear what should you look for?
Any lesions especially on the top of the pinna or nodules: people with gout will get chalky white substance in a nodule.
What should you palpate on the ear?
-Tragus: should have no pain, if there is there may be an infection
-Mastoid Process: should not be painful, but an ear infection may cause tenderness.
-mastoiditis: the mastoid will feel spongy and painful
What is cerumen?
Ear wax

-You should have some to help protect the ear

-An abundance may cause hearing loss, tinnitus or dizziness
What is Exostosis?
-Discreet, hard, round or oval outcropping
-formation of new bone on the surface of a bone
-Seen in swimmers and surfers
-Develops over many years and can result in infections, pain and hearing loss.
What is Otitis Externa?
-Scaling or crusting, inflammation and discharge in the ear canal
-pain on movement of the tragus especially
-may have palpable nodes
-ask about swimming, frequent ear cleaning
Describe Serous Otitis Media
-Tympanic Mem is retracted and has decreased motility
-Thin serous effusion give a yellowish appearance
-Bubbles apparent if eustachian tube is blocked
-bubbles mean that the ear is completely blocked and nothing is draining
-Not treated with antibiotics. The fluid is not infected. Treated with DECONGESTANTS
Describe an ear infection
The TM will be pushing out towards you an can be very red and filled with pus.
What causes a perforated TM?
-Loud noises, trauma, damage
-toothpicks, bobbypins etc
-It will heal but with a scar and possibly a decrease in hearing
What does scarring look like in the ear?
-TM will have a white chalky appearance
What is a Tympanostomy Tube and when is it used?
This is a tube that is surgically inserted, mostly in children who get frequent ear infections.
-The tube helps to equalize pressure and helps with drainage.
List the landmarks of the nose.
-Bridge
-Free corner or tip
-Nares- openings
-Kiesselback region- anteroinferior part of the nasal spetum, where four arteries anastomose
-Columella-means the little column between the nares
-Ala nasi- expanded out wall of cartilage on each side of the nose
What is the function of the nose?
Warms, moistens and filters inhaled air.
-Houses the sensory organ for smell and innervated by CN I
What are the turbinants in the nose and their function?
-Located on the lateral wall
-Include the Superior meatus (ethmoid bone), the middle meatus (sinuses) and the inferior meatus (tears)
-These increase the surface area and are rich with blood which helps to warm the air.
What is the color of the nose compared to the mouth?
The nose is much redder because it has a rich blood supply.
Where is cranial nerve I located?
At the top of the nasal passage.
What are the anterior and remainder of the nasal cavity lined with>?
-Anterior: coarse nasal hairs for filtering
-Remainder of cavity is lined with ciliated mucous membranes to filter dust and bacteria
What and where are the sinuses?
-They are air-filled pockets within the cranium to lighten weight of the skull
-Four pairs
-Only frontal and maxillary can be examined in a physical exam
What are some questions you should ask when examining the nose?
-Discharge
-Frequent colds
-Sinus pain
-Trauma
-Epistaxis
-Allergies
-Altered smell
What should you inspect and palpate in the physical exam of the nose?
-Inspect for symmetry and if there is a deviated or perforated septum
-Evaluate airway patency: Breathe in with one nostril then the other.
-Palpate or percuss sinus areas
Transillumination- shine a light in the eye and can see it in the nose.
what do polyps look like in the nose?
-yellowy
-Any growth must be biopsied
-They are non tender and make people snore, or chose or clogs the sinuses.
What is acute and allergic rhinnitis?
-Allergic: will be more water, itchy nose and eyes accompanied by nasal congestion, sneexing and the turbinates will be swollen.
-Acute: swollen and bright red and watery clear discharge. Maybe pus with a sinus infection.
What is a perforated septum?
-Common
-snorting cocaine or overusing sinus sprays
-Whole is the septum wall
What is transillumination?
Technique to test the sinuses are air filled. Shine a light down the corner of the eye with the pt mouth open and should be able to see the light inside the mouth.
What is the function of the mouth?
-First segment of the digestive system and airway or respiratory system.
-In addition, the mouth contains taste buds and aids in speech production.
List the structures of the oral cavity.
-Teeth: 32 as adults and 20 temporary (deciduous) in children (grown in by age 2)
-Hard palate: is bone with tissue over it and looks more white
-Soft palate: pink and more mobile
-Uvula and posterior and anterior pillars
-Tongue
-Valiate papilla
Where are the tonsils located?
Between the anterior and posterior pillars in the oral cavity
What is the function of the tonuge?
Can change shape which helps with swallowing
-cleans the teeth
-helps with speech
-contains taste buds
What is the valiate papilla?
-Bumps located on the back of the tongue and may be very prominent in some pts.
Where is parotid gland and what if it is inflamed?
-Located in the cheesk
-drains through the Stenson duct which are located above the second molars
-If swollen it may be a sign of mumps, infection or cancer.
Where is the submandibular gland and where is it secreted?
-Located below the mandible
-Secretes into the Warton's Duct located under the tongue
Where are the openings of the sublingual glands?
-There are many so we cannot truly check them during a physical exam
What questions should you ask during the physical exam of the mouth?
-Sores or lesions
-Sore Throat
-Bleeding gums
-Toothache
-Hoarseness
-Dysphagia (difficulty swallowing with solids, liquids or both)
-Altered taste
-Smoking or alcohol
-Self care
-
What to inspect during the Physical exam of the mouth
-Lips: color, swellings, ulcers
-Gums and teeth- any absent or in good repair. Gums should look pink or coral and have a dotted surface
-Buccal mucosa
-Tongue
-Stenson and Warton's Ducts
-Tonsil

-
What is the grading scale for tonsils?
-None: write tonsils absent
-1+: visible
-2+: half way to uvula
-3+: (almost) touching uvula
-4+: touching eacother (EMERGENCY)
What grade of tonsils is normal for children?
3+
How do you assess the hypoglossal cranial nerve?
-Have pt stick out their tongue and ask them to move side to side.
-If the tongue deviates to one side there may be damage to the nerve on that side.
What is a Scrotal tongue?
-aka Fissure tonue
-looks liek a scrotum: normal but can get food caught in the fissures.
What is a geographic tongue?
-Normal but the tongue looks like some one has printed a map on their tongue
What are Fordyce Spots?
Little dots in the Buccal or on the inside of the cheek and completely normal
What is Torus Palatinus?
Hard palate appears more ridged and sticks out slightly.
What are Cryptic Tonsils?
Large tonsils, but completely normal for that pt. They may get food stuck in them and may cause pain.
-The crypts are a result of the food stuck in them
What is viral pharyngitis?
-Back of the pharynx looks like cobble stones, very red, scratchy or sore throat
What is bacterial pharyngitis?
Excrudite will appear on the tonsils. Accompanied by fever, very red, pus on the tonsils and possibly body aches.
What are the salivary glands and vessels of the Neck?
-Parotid and submandibular glands
-External jugular vein: can be used to see if the pt has increased venous pressure
-We commonly use internal jugular vein.
What muscles of the neck are innervated by cranial nerve 11?
Sternocleidomastoid and the trapezius muscles
What is the function of the lymph nodes?
Protect against invading organisms. The lymph system runs alongside the venous system
-Removes excess proteins and bacteria from interstitial system
What is the function of the lymph node beads?
They are the location where the toxic substances collect and swell.
What will the lymph nodes of a person with Hodgkin's lymphoma have?
They will have generalized swelling of all lymph nodes of the body.
What are the lymph nodes of the head and neck?
-Pre auricular
-Posterior auricular
-Occipital
-Tonsilor (jugulardygastric)
-Submandibular
-Sublingual
-Submental
-Superficial cervical
-Posterior cervical
-Deep cervical
-Supra clavicular
-Infraclavicular
What is the function of the thyroid gland?
Endocrine gland for metabolism and straddles the trachea
What is the location of the thyroid gland?
-Straddles the trachea
-Isthmus lies over the trachea at 2nd and 3rd tracheal ring
-Just before isthmus is the cricoid cartilage with thryroid cartilage above that (Adam's Apple)
IIf you feel lymph nodes, what is normal?
They should be soft, movable, less than 1 cm and non tender
What is possible if a bunch of lymph nodes are enlarged together on the side of the chin?
May be TB
What if the trachea is misaligned?
The pt is under distress. Possible a collapsed lung or if only slight may be a thyroid problem
What are you looking for when you auscultate the carotid artery?
Bruit: a whooshing sound of turbulent blood flow (70% blockage)
How do you test CN 11
-Have pt lift shoulders against resistance for sternocleidomastoid
-Have pt push cheek against hand for masseter muscle
How should you palpate the trachea?
From behind and gently.
What is a goiter?
Enlarged thyroid gland
--maybe underactive, overactive or normal.