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Ears, Nose, Throat

QuestionAnswer
3 functions of ear 1) Identification, localization, and interpretation of sound 2) Mainenance of equilibrium 3) Housing CN VIII
external ear structure auricle and external auditory canal: S shaped (2.5 cm), cartilage (distal 1/3), bone (proximal 2/3), cerumen (protective)
tympanic membrane connects outer and middle ear. Concave, pulled in at center umbo/malleus. Oblique position, light reflex-conical shape, short processes and handle of malleus may be visible, pars tensa>pars flaccida
middle ear air filled cavity that contains incus, stapes, and malleus
3 functions of middle ear 1) transmits sound vibrations to inner ear 2) protects inner ear by reducing amplitude of loud sounds 3) equalizes air pressure on each side of tympanic membrane
eustachian tubes connect middle ear to nasopharynx, allows for equalization of air pressue on each of tympanic membrane so tympanic membrane doesnt rupture
mastoid air filled cavity in temporal bone that is continuous with middle ear
inner ear contains bony labyrinth, which holds sensory organs for equilibrium (semicircular canals) and hearing (cochlea)
cochlea central hearing apparatus that transmits sound to CN VIII
vertigo abnormal sensation of movement, spinning, whirling, staggering gait. Have pt describe symptoms without using the word dizzy
causes of vertigo (nonmedical) seasickness, prolonged/unusual head or neck positions, spinning
medical causes of vertigo benign positional vertigo (<1 min), meniere's disease (30 min-hours, also with tinnitus and hearing loss), constant vertigo (vestibular neuronitis, labrynthitis/inner ear infection), migraine headaches, stroke, tumor
Peripheral Hearing ear transmits sound and converts its vibrations into electrical impulses, which can be analyzed by the brain. Amplitude= how loud sound is. Frequency== pitch/number of cycles
brainstem hearing binaural interaction; permits locating direction of a sound as well as identifying the sound
cortex hearing interprets meaning of sound and begin appropriate response
Otoscope Exam hold like a pen, straighten canal up and back (>3 yrs), or down and out (<3 yrs). Insert <1/2", examine canal, check unaffected ear first
tympanic Membrane- exam landmarks- cone of light at 0500 on rt. TM, and at 0700 on lt TM. Malleus- umbo, handle, short process. Incus and stapes junction
Acute Otitis Media middle ear is infected; redness, bulging or lowered mobility, hard to see landmarks, increased vascularity, deep throbbing pain, earache, fever
serous otitis Media amber-yellow drum. Serum in middle ear transudates to relieve negative pressure from blocked eustachian tube. TM may be retracted, may see air/fluid level, air bubbles. s/s: fullness, transient hearing loss, popping when swallow
otitis externa pain with movement of tragus, secondary to trauma or moisture. Red, swollen, painful canal
risks for otitis externa water in ear, narrowing of external auditory canal, impacted cerumen, dermatologic conditions, diabetes, immunocompromised state, insertion of devices into ear canal
perforated tympanic membrane drum can rupture from increased pressure. Occurs if acute otitis media is not treated OR from trauma
tympanostomy tubes polyethylene tubes inserted surgically into eardrum to relieve middle ear pressure and promote drainage of chronic or recurrent middle ear infections
mastoiditis otitis media causes infection of mastoid air cells and bine. Erythema, edema, pain on auricle and mastoid. Ear displaced forward, toxic appearance
cranial nerve VIII tests gross hearing- whisper test and watch test high frequency- tuning fork tests (weber and rinne)
whisper test one finger twists and person repeats whispered words
Conductive hearing loss mechanical dysfunction in conduction of sound waves of the external ear, tympanic membrane, middle ear, or ossicles
sensorineural loss pathology of the inner ear, cranial nerve VIII or auditory areas of cerebral cortex
mixed loss combo of conductive and sensorineural loss
Functions of the nose identify odors, humidify, warm and filter air, provide resonation of vocal sound
external nose upper 1/3 bone, lower 2/3 cartilage
septum in midline, holds a vascular network called kiesselbach plexus (site of epistaxis)
adenoids located in nasopharynx
turbinates 3 parallel bony projections (superior, middle inferior) in lateral walls of each nasal cavity. Increase surface area so more blood vessel adn mucous membranes are available to warm, humidify and filter air
meatus opening named for the turbinate above it
nasolacrimal ducts drain into inferior meatus
sinuses drain into inferior meatus
external nose exam shape, size, symmetry, flaring/narrowing of nares, columella is < size of one naris, palpate bridge and soft tissues, check patency
nasal drainage unilateral or bilateral. note color, amount, odor.
rhinorrhea mucous drainage (runny nose). Allergy- thin and clear. URI-thick. Purulent- sinusitis (bilateral), FB (unilateral). Epistaxis- bloody
Internal Nose Exam gently insert speculum 1/2". dont touch septum. Check for symmetry, lesions, visible turbinates (get swollen, pale, boggy with allergies)
paranasal sinuses air filled pockets within cranium that communicate with the nasal cavity and are lined with ciliated mucous membranes. they lighten weight of skull bones, serve as resonators for sound production, provide mucous that drains into nasal cavity
4 sinuses frontal (accessible for PE), maxillary (accessible for PE), ethmoid, sphenoid
examining the sinuses inspect for swelling and erythema, palpation for tenderness, percussion for tenderness, transillumination
Mouth and oropharynx functions vocalization, passageway for air and food, initiation of digestion.
taste At least 75% of what we eprceive as taste is smell. Anterior 2/3 tongue= CN VII, sweet and salty. Posterior 1/3 tongue: CN IX, sour, bitter, umami
papillae rough, bumpy elevations on dorsal surface of tongue. Taste buds are located in papillae at back and along side of tongue and on soft palate
supertasters increased number of papillae, more common in women, Asians and African Americana
salivary glands 3 pairs: parotidd glands, submandibular glands, sublingual glands
parotid glands largest salivary glands, lie within cheeks. Stenson's duct runs forward to open on the buccal mucosa opposite second molar
submandibular glands wharton's duct runs up and forward to floor of the mouth and opens at either side of frenulum
sublingual glands lies within floor of the mouth under tongue
chelitis dry, cracked lips
angioedema allergic swelling
herpes labialis cold sores
lip exam symmetry, color, lesions, vermillion border lesion free. Should be pink, clear, moist
buccal mucosa exam inspect for hydration, color, lesions, stenson's ducts, fordyce spots WNL (small, isolated white or yellow papules on mucosa), sebaceous cysts are painless, frenulum sensitive
leukoplakia white raised patches that wont scrape away; precancerous
deeply pigmented mouth endocrine disease
scars in mouth malocclusion
parotitis inflammation of stenson's duct
aphthousulcer canker sore
gums normally pink or coral with stippler surface, check for swelling, retraction of gingival margins, spongy, bleeding, discolored gums.
blue-black line 1 mm from margin of gums lead poisoning
gingivitis bleeding, tenderness, pockets of debris
teeth 1 tooth at 7 mos, permanent teeth 6+, 20 teeth by 2.5 yrs, four 6 yr molars, 4 12 yr molars, 4 wisdom. 32 all together.
teeth exam inspect for caries, make sure anchored, color range and shape, bruxism (clenching or grinding), malocclusion, TMJ
Tongue- dorsal exam Should have dull white coating. check CN XII (hypoglossal), extend tongue, check for fasiculations, deviation, ROM, check tongue strength.
Geographic Tongue pattenr of normal coating interspersed with bright, red, shiny, circular bald areas. Not significant, no known cause
hairy tongue elongation of filiform papillae and painless overgrowth of mycelial threads of fungus infection. Occurs after use of antibiotics (inhibit beneficial bacteria and allow proliferaion of fungus)
smooth, red, slick, tongue mucosa thins and looks red from decreased papillae. Dryness and burning. occurs with niacin deficiency, B12 deficiency (pernicious anemia), folic acid deficiency, and iron deficiency anemia
strawberry tongue strep infection
tongue- dorsal exam check if swelling of Wharton's duct, frenulum, varicosities, mucosa darker, check sides of tongue, cancer risk if smoker
bifid uvula uvula looks partly severed
torus palatinus bony midline projection of hard palate
CN IX (glossopharyngeal) and CN X (vagus) tested together; motor portion of CN X tested only. With phonation, uvula rises and pharynx curtains. Gag reflex test. Taste is posterior 1/3 of tongue (IX)
tonsil exam use bright light and moistened tongue blade. Note size, color, exudate, crypts. Check pharyngeal wall.
tonsilitis strep, viral, mon, gonorrhea
peritonsilar abscess dysphagia, increased temp, pain, red bulge at tonsil, may displace uvula
retropharyngeal abscess dysphagia, inc temp, pain, inc post pharyngeal wall
diptheria caused by Corynebacterium diptheriae, produces toxins and affects other organs. thick grayish black membrane may be present on tonsils, pharynx, uvula, etc and can block airway.
Created by: alexadianna