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70 Cards in this Set
- Front
- Back
Name the external structures of the ear.
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Auricle or pinna (consists of movable cartilage and skin)
-Landmarks: helix, antihelix, tragus, antitragus are used as reference points when documenting findings. |
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List the structures of the Middle Ear and its function.
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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 |
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Describe the aspects of the inner ear.
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Consists of the cochlea, semicircular canals and the vestibular nerve.
-Aids in converting sound wave to electrical impulses -Helps regulate equilibrium |
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Describe the Tympanic Membrane.
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-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. |
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Why do children get infections in their ear more often than adults?
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The eustachian tube that connects their nose to their ear is horizontal and thus infection can travel easily to the ears.
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What is otosclerosis?
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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. |
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What is Presbycusis?
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Age related hearing loss.
-Can result from over working the ears. -Loud music, concerts, airports etc. |
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What are the two pathways of hearing?
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-The most typical is form is air conduction
-Bone conduction is also a pathway. |
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What questions should you ask when conducting an ear exam?
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-Earaches
-Infections -Discharge -Hearing loss -Environmental Noise -Tinnitus: ringing in the ears -Vertigo: spinning -Self care behavior: Q-Tips |
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What are three types of normal hearing test?
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-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 |
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What is the Weber Test?
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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. |
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What is the Rinne Test?
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-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. |
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When you inspect the ear what should you look for?
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Any lesions especially on the top of the pinna or nodules: people with gout will get chalky white substance in a nodule.
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What should you palpate on the ear?
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-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 |
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What is cerumen?
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Ear wax
-You should have some to help protect the ear -An abundance may cause hearing loss, tinnitus or dizziness |
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What is Exostosis?
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-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. |
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What is Otitis Externa?
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-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 |
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Describe Serous Otitis Media
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-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 |
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Describe an ear infection
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The TM will be pushing out towards you an can be very red and filled with pus.
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What causes a perforated TM?
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-Loud noises, trauma, damage
-toothpicks, bobbypins etc -It will heal but with a scar and possibly a decrease in hearing |
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What does scarring look like in the ear?
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-TM will have a white chalky appearance
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What is a Tympanostomy Tube and when is it used?
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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. |
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List the landmarks of the nose.
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-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 |
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What is the function of the nose?
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Warms, moistens and filters inhaled air.
-Houses the sensory organ for smell and innervated by CN I |
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What are the turbinants in the nose and their function?
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-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. |
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What is the color of the nose compared to the mouth?
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The nose is much redder because it has a rich blood supply.
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Where is cranial nerve I located?
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At the top of the nasal passage.
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What are the anterior and remainder of the nasal cavity lined with>?
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-Anterior: coarse nasal hairs for filtering
-Remainder of cavity is lined with ciliated mucous membranes to filter dust and bacteria |
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What and where are the sinuses?
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-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 |
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What are some questions you should ask when examining the nose?
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-Discharge
-Frequent colds -Sinus pain -Trauma -Epistaxis -Allergies -Altered smell |
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What should you inspect and palpate in the physical exam of the nose?
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-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. |
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what do polyps look like in the nose?
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-yellowy
-Any growth must be biopsied -They are non tender and make people snore, or chose or clogs the sinuses. |
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What is acute and allergic rhinnitis?
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-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. |
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What is a perforated septum?
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-Common
-snorting cocaine or overusing sinus sprays -Whole is the septum wall |
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What is transillumination?
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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.
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What is the function of the mouth?
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-First segment of the digestive system and airway or respiratory system.
-In addition, the mouth contains taste buds and aids in speech production. |
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List the structures of the oral cavity.
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-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 |
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Where are the tonsils located?
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Between the anterior and posterior pillars in the oral cavity
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What is the function of the tonuge?
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Can change shape which helps with swallowing
-cleans the teeth -helps with speech -contains taste buds |
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What is the valiate papilla?
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-Bumps located on the back of the tongue and may be very prominent in some pts.
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Where is parotid gland and what if it is inflamed?
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-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. |
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Where is the submandibular gland and where is it secreted?
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-Located below the mandible
-Secretes into the Warton's Duct located under the tongue |
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Where are the openings of the sublingual glands?
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-There are many so we cannot truly check them during a physical exam
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What questions should you ask during the physical exam of the mouth?
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-Sores or lesions
-Sore Throat -Bleeding gums -Toothache -Hoarseness -Dysphagia (difficulty swallowing with solids, liquids or both) -Altered taste -Smoking or alcohol -Self care - |
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What to inspect during the Physical exam of the mouth
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-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 - |
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What is the grading scale for tonsils?
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-None: write tonsils absent
-1+: visible -2+: half way to uvula -3+: (almost) touching uvula -4+: touching eacother (EMERGENCY) |
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What grade of tonsils is normal for children?
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3+
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How do you assess the hypoglossal cranial nerve?
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-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. |
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What is a Scrotal tongue?
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-aka Fissure tonue
-looks liek a scrotum: normal but can get food caught in the fissures. |
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What is a geographic tongue?
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-Normal but the tongue looks like some one has printed a map on their tongue
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What are Fordyce Spots?
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Little dots in the Buccal or on the inside of the cheek and completely normal
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What is Torus Palatinus?
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Hard palate appears more ridged and sticks out slightly.
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What are Cryptic Tonsils?
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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 |
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What is viral pharyngitis?
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-Back of the pharynx looks like cobble stones, very red, scratchy or sore throat
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What is bacterial pharyngitis?
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Excrudite will appear on the tonsils. Accompanied by fever, very red, pus on the tonsils and possibly body aches.
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What are the salivary glands and vessels of the Neck?
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-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. |
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What muscles of the neck are innervated by cranial nerve 11?
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Sternocleidomastoid and the trapezius muscles
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What is the function of the lymph nodes?
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Protect against invading organisms. The lymph system runs alongside the venous system
-Removes excess proteins and bacteria from interstitial system |
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What is the function of the lymph node beads?
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They are the location where the toxic substances collect and swell.
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What will the lymph nodes of a person with Hodgkin's lymphoma have?
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They will have generalized swelling of all lymph nodes of the body.
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What are the lymph nodes of the head and neck?
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-Pre auricular
-Posterior auricular -Occipital -Tonsilor (jugulardygastric) -Submandibular -Sublingual -Submental -Superficial cervical -Posterior cervical -Deep cervical -Supra clavicular -Infraclavicular |
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What is the function of the thyroid gland?
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Endocrine gland for metabolism and straddles the trachea
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What is the location of the thyroid gland?
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-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) |
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IIf you feel lymph nodes, what is normal?
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They should be soft, movable, less than 1 cm and non tender
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What is possible if a bunch of lymph nodes are enlarged together on the side of the chin?
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May be TB
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What if the trachea is misaligned?
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The pt is under distress. Possible a collapsed lung or if only slight may be a thyroid problem
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What are you looking for when you auscultate the carotid artery?
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Bruit: a whooshing sound of turbulent blood flow (70% blockage)
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How do you test CN 11
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-Have pt lift shoulders against resistance for sternocleidomastoid
-Have pt push cheek against hand for masseter muscle |
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How should you palpate the trachea?
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From behind and gently.
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What is a goiter?
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Enlarged thyroid gland
--maybe underactive, overactive or normal. |