HEENT Flashcards

1
Q

What are somatic senses

A

Tactile, thermal, pain and proprioceptive sensations

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2
Q

What are visceral senses

A

Provides sensations to internal organs

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3
Q

What do mechanoreceptors detect

A

Mechanical deformation of adjacent cells

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4
Q

What do thermoreceptors detect

A

Changes in temperature

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5
Q

What do nociceptors detect

A

Pain

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6
Q

What do photoreceptors detect

A

Light

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7
Q

What do chemoreceptors detect

A

The presence of chemicals in solution

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8
Q

What do osmoreceptors detect

A

Osmotic pressure of fluids

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9
Q

Tactile somatic senses are located where

A

In the skin or subcutaneous tissue
(Touch, pressure, vibration, itch and tickle)

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10
Q

Thermal receptors are located where

A

In the epidermis and the dermis

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11
Q

Pain receptors are located everywhere except

A

The brain

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12
Q

Temperatures as low as _____ and as high as ____ can be detected

A

As low as 50F and as high as 118F

Anything above or below that stimulates pain receptors

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13
Q

What is fast pain characterized as

A

Acute, sharp or prickling pain. This pain is precisely located

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14
Q

What is slow pain

A

Chronic, aching, burning or throbbing and is more diffuse

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15
Q

What is proprioception

A

It is known as the kinesthetic sense or the perception of body movements

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16
Q

Where are proprioceptors located in

A

The skeletal muscles, tendons, joint and hair cels in the middle ear that monitor the orientation of the head relative to the ground

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17
Q

Where is the olfactory epithelium found

A

In the inferior surface of the cribriform plate (of the ethmoid bone of the skull)

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18
Q

What is gustation

A

The sense of taste

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19
Q

What is the five primary tastes

A

Salt, sweet, bitter, sour and umami

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20
Q

What CN carries taste information from the anterior 2/3 of the tongue

A

CN VII

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21
Q

What CN carries taste information from the posterior 1/3 of the tongue

A

CN IX

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22
Q

How do tears flow

A

From the lacrimal gland through the lacrimal ducts and then drain from surface of the eye through the lacrimal canaliculi and then to the nasolacrimal duct.

The nasolacrimal duct flows into the nasal cavity

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23
Q

What are the six extrinsic muscles that work together to move the eye ball

A

Superior rectus, inferior rectus, lateral rectus, medial rectus, superior oblique and inferior oblique

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24
Q

What is the middle layer of the eye also called and what three portions compose it?

A

The vascular tunic

And composed of the choroid, ciliary body and the iris

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25
Q

What is the function of the retina

A

It is in the posterior three-quarters of the eye and functions in image formation

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26
Q

What do rods allow us to see

A

Shades of gray in dim light

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27
Q

What do cones allow us to see

A

They are instrumental in color vision and visual acuity

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28
Q

What is a transparent structure that focuses light rays onto the retina

A

The lens

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29
Q

What is the pressure in the eye called and what is it produced by

A

Intra ocular pressure (IOP) and it is produced by the aqueous humor (mainly) and the vitreous body

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30
Q

What is normal IOP

A

~16 mm HG

It helps maintain the shape of the eyeball and keeps the retina in position and nourished

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31
Q

What is the bending of light rays where two different substances meet.

A

Refraction

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32
Q

What structure of the eye carries out 75% of refraction

A

The cornea

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33
Q

What muscle contracts for viewing near objects and relaxes for far objects

A

The ciliary muscle

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34
Q

When does visual stimulation begin

A

With the absorption of light rays by the rods and cones of the retina

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35
Q

What vitamin deficiency decreases rhodopsin production and leads to night blindness

A

Vitamin A

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36
Q

What is the visual pathway to the brain

A

Rods and cones convey impulses, impulses from ganglion cells are conveyed along axons through the retina to the optic nerve (CN II), the optic chiasm, optic tract and cerebral cortex, and sight is perceived in the primary visual areas of the occipital lobe of the brain. (Right side receives images from the left )

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37
Q

What is the external aspect of the ear that collects sound waves and directs them toward the auditory canal

A

Auricle

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38
Q

How is the middle ear connected with the upper part of the throat

A

By way of the auditory tube (Eustachian tubes)

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39
Q

What are the three tiny bones of the middle ear

A

Malleus
Incus
Stapes

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40
Q

What is the physiology of hearing

A

Sound waves enter the ear through the external auditory canal, strike the tympanic membrane and are conducted through the ossicles (malleus, incus and stapes)

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41
Q

What is the auditory pathway to the brain

A

Nerve impulses form the cochlear branch of the vestibulocochlear nerve (VIII) pass to the midbrain and thalamus and ultimately go to the primary auditory area in the temporal lobe

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42
Q

What are the two types of equilibrium

A

Static and dynamic

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43
Q

What is static equilibrium

A

Linear acceleration or deceleration

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44
Q

What is dynamic equilibrium

A

Sudden movements such as rotational acceleration or deceleration

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45
Q

The linkage between the medulla cerebellum and cerebrum enable the cerebellum to play a role in what

A

Maintaining equilibrium

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46
Q

How large is the thyroid typically

A

4 cm
And the right lobe is often 25% larger than the left

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47
Q

Fine or coarse hair may indicate what

A

Related to thyroid disease

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48
Q

What facial features does a person with Down syndrome have

A

Depressed nasal bridge
Epicanthal folds
Mongloid slant of eyes
Low set ears
Large tongue

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49
Q

How does lupus present on the face

A

Butterfly rash
Malar surfaces and bridge of nose
Blush with swelling
Scaly red macullopapular lesions

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50
Q

Where is the most common location of a salivary gland tumor

A

Parotid

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51
Q

Which cranial nerve controls the locator palpebrae superior (elevates and retracts upper eyelid)

A

CN III

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52
Q

Which cranial nerve controls the superior oblique muscles

A

CN IV

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53
Q

Which cranial nerve controls the lateral rectus muscle

A

CN VI

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54
Q

What is the posterior 5/6 of the globe, dense, a vascular white portion of the eye

A

Sclera

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55
Q

What is the anterior 1/6 of the globe and is continuous with the sclera

A

The cornea

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56
Q

What is it called when eye lids do not completely close and what is the common cause of that

A

Lagophthalmos

Common causes are thyroid disease, Bell’s palsy, over aggressive pitosis or blepharoplasty surgical repair

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57
Q

What is it called when the lid is turned away from the eye and may result in excessive tearing

A

Ectropion

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58
Q

What is it called when the lid is turned inward toward the glove

A

Entropion

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59
Q

What is an acute supportive inflammation (staphylococcal) of the follicle of an eye lash that forms an erythematous or yellow lump

A

Hordeolum (stye)

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60
Q

What is crusting along the eyelashes caused by bacterial infection

A

Blepharitis

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61
Q

What is it called when a pupil fails to dilate in the dark

A

Miotic

Commonly caused by ingestion of narcotics or drugs that control glaucoma

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62
Q

What is anisocoria

A

Inequality of pupillary size

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63
Q

What is the pupillary dial action of more than 6mm and failure of the pupils to constrict with light

A

Myadriasis

May indicate coma or may be caused from the use of eye drops

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64
Q

What is a convergence of small fragile arteries and veins located on the anterior superior portion of the septum

A

Kiessalbach plexus

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65
Q

What are stensen ducts

A

Parotid gland outlets that open on the baccalaureate mucosa opposite the second molar on each side of the upper jaw

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66
Q

What are Wharton ducts

A

Open on each side of the frenulum under the tongue

They drain saliva from the submandibular and sublingual glands to the sublingual caruncle at the base of the tongue

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67
Q

What are ototoxic medications

A

Aminoglycosides (gentamicin)
Streptomycin
Quinine
Chemotherapy (cisplatin)
Antimalarial (quinine)
Salicylates
Furosemide
Salt-retaining medications such of corticosteroids

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68
Q

Patients with anterior packing should have the packing removed by an experienced health care provider in what time frame

A

48 to 72 hours

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69
Q

What type of forceps are used in nasal packing

A

Bayonet forceps

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70
Q

Taste buds are found elevations on the tongue called what

A

Papillae

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71
Q

The eyeball measures about 2.5cm (1 in) diameter and is divided into three layers, what are those three layers called

A

Fibrous tunic
Vascular tunic
Retina

72
Q

The external ear consists of what

A

Auricle
External auditory canal and eardrum

73
Q

The middle ear consists of what

A

Auditory (Eustachian) tube
Auditory ossicles
Oval window

74
Q

The inner ear consists of what

A

Bony labyrinth
Membranous labyrinth
Spiral organ (organ of corti) which is the organ of hearing

75
Q

Most vestibular branch axons of the vestibulocochlear (viii) nerve enter the brain stem and terminate where

A

Medulla and pons
Other axons extend to the cerebellum

76
Q

What is myopia

A

Nearsightedness

77
Q

What is hyperopia

A

Farsightedness

78
Q

What is astigmatism

A

Irregular curvature of the cornea or lens

79
Q

To be tasted substances must be dissolved in what

A

Saliva

80
Q

The olfactory epithelium is in the upper portion of the nasal cavity and contains what

A

Olfactory receptors cells
Supporting cells
Basal cells

81
Q

Impulses conduct via the olfactory tract to where

A

Limbic system
Hypothalamus
And cerebral cortex (temporal lobe)

82
Q

What are the receptors of static equilibrium

A

The maculae

83
Q

What organ has the broadest area for referred pain

A

The kidneys

84
Q

Meissner corpuscles are abundant where

A

Fingertips
Palms
Soles

85
Q

What is the ciliary process

A

Consists of folds on the internal surface of the ciliary body whose capillaries secrete aqueous humor

86
Q

What is the function of the ciliary muscle

A

It’s a smooth muscle that alters the shape of the lends for near and far vision (accommodation)

87
Q

What is the vitreous chamber and what does it contain

A

It is the larger of the cavities in the eye and lies between the retina and the lens

It contains a clear, jellylike substance called vitreous body and this material helps maintain the shape of the eye and hold the retina in place

88
Q

The cornea carries out what percentage of refraction

A

75%

89
Q

If someone has a positive Rinne test, what does that mean

A

Normal findings

90
Q

What is the most common craniofacial congenital malformation

A

Oropharyngeal clefts

91
Q

What is the preferred method of cauterization

A

Silver nitrate sticks

92
Q

How long will nasal packing stay in place

A

48 hours

93
Q

What is blepharitis

A

A common chronic bilateral inflammatory condition of the lid margins

94
Q

Anterior blepharitis involves what

A

Lid skin, eyelashes, and associated glands

It may be ulcerative, because of infection by staphylococci or seborrheic in association with seborrhea of the scalp, brows and ears

95
Q

Posterior blepharitis results from what

A

Inflammation of the meibomian glands

96
Q

What are some symptoms of blepharitis

A

Itching, burning, mild pain, foreign body sensation, tearing, erythema of the lids and crusting around the eyes upon awaking

97
Q

What is the treatment for blepharitis

A

Scrub the eyelid margins twice a day with a commercial eyelid scrub (ocusoft) or baby shampoo on a washcloth

Then

Warm compress for 10 to 15 minutes 1-2x/day

98
Q

What is a hordeolum

A

Acute infection that usually involves staphylococcus species

99
Q

What is a chalazion

A

Chronic focal granulomatous inflammation within the eyelid secondary to the obstruction of meibomian gland or gland of zeis (hordeolum)

100
Q

What are some symptoms of a hordeolum

A

Localized eyelid tenderness, swelling and erythema
May have foreign body sensation
Visible or palpable, well-defined subcutaneous nodule in the eyelid
Associated blepharitis or acne rosacea

101
Q

The fibrous tunic is divided into two regions, what are they?

A

The posterior sclera and anterior cornea

102
Q

What structure regulates the amount of light that passes through the lens

A

The iris

103
Q

What structure focuses light rays into the retina

A

The lens

104
Q

In color blindness, what cones are missing

A

Red or green cones

105
Q

What are the receptor organs for equilibrium called

A

Saccule, utricle and semicircular ducts

106
Q

Where are thermorecptors located

A

In the dermis and epidermis

107
Q

Cold receptors are in what

A

The dermis

Hot in the epidermis

108
Q

Exothalmus or eye bulging is associated with what

A

Hyperthyroidism

109
Q

How long do you flush eyes for

A

15-30 minutes

110
Q

What is a complication of auricle hematoma and what is the treatment

A

Cauliflower ear (necrosis of the tissue) treatment is semicircular incision and dissection

111
Q

What temperature is the fluid used to irrigate the ear

A

Body temperature or room temperature

112
Q

What is a common cause of cholesteatoma

A

Eustachian tube dysfunction

113
Q

What type of ETD is when it is excessively open

A

Patulous dysfunction

114
Q

What type of ETD is dilatory dysfunction

A

When it fails to dilate appropriately

115
Q

What is a common cause of mastoiditis

A

Otitis media

116
Q

What is the bacteria associated with mastoiditis

A

Staph aureus

117
Q

What is the treatment for mastoidtis

A

Ceftriaxone

2g every 24 hours

118
Q

What precipitates otitis media

A

URI or ET block

119
Q

What is the treatment for otitis media

A

Augmentin or if PCN allergy Doxycycline or Ceftriaxone

120
Q

What is a complication of otitis media

A

Cholestoma or mastoiditis or Central Nervous system infection

121
Q

Does hearing loss occur at high or low frequency

A

High

122
Q

What do you use to remove a foreign body from the ear

A

Loops and scoops

123
Q

What is a cause of tinnitus

A

Damage to the hair cells, which turbulence in the carotid artery or jugular vein could cause

124
Q

What is a common cause of nasal polyps

A

Asthma/ allergies

Food allergies has a high association

125
Q

What is a complication of a nasal bone fracture

A

Septal hematoma
Nasal deformity

126
Q

What’s the treatment of a broken nose

A

Nothing if nondisplaced give acetaminophen

127
Q

When would you treat sinusitis with antibiotic

A

After 10 days
Other wise treat with NSAIDS/decongestant

128
Q

What gives a wet finger appearance

A

Leukoplakia

129
Q

What is a cause of leukoplakia

A

Smoking, alcohol and denture wear

130
Q

What is the treatment for a PTA

A

Ceftriaxone and metronidazole

131
Q

How would you perform the needle aspiration of a PTA if you had to

A

19-21g needle no more than 1cm incision because of carotid artery placement

132
Q

What’s the most common siladentitis organism

A

Staph aureus

133
Q

When would you see hypopyon

A

Uvelitis, iritis, and corneal ulcer

134
Q

If someone says they have an underwater feeling what does that indicate

A

ETD

135
Q

If you have a blowout fracture what’s involved

A

Orbit floor

136
Q

If you lack a red light reflex what might that mean

A

Cataracts

137
Q

What types of cells make a cholesteatoma

A

Stratified squamous epithelium

138
Q

What’s a complication of cholesteatoma

A

Bone erosion
Inner ear erosion
Death

139
Q

What is the definition of transient vision loss

A

Usually a couple seconds to an hour. No more than 24 hours

140
Q

What is seen on gram stain of gonococcal conjunctivitis

A

Gram negative intercellular diplocci

141
Q

What is the treatment for a corneal ulcer

A

Ciprofloxacin
Fluroquinalone

142
Q

When can you wear contacts again after a corneal ulcer

A

After cleared by optometry

143
Q

What anatomical structures are involved in hordeolum and chalazion

A

Gland of Zeis
Meibomian gland

144
Q

Where does the blood in a hyphema accumulate

A

Within the anterior chamber

145
Q

What anatomical structures are involved in uveitis/iritis

A

Vascular tunic

Choroid, cililary body and iris

146
Q

What is commonly seen in a slit lamp exam of uveitis/iritis

A

Snowflake appearance

147
Q

What is a usual cause of ptergium

A

Sunlight exposure
Chronic inflammation

148
Q

What are symptoms of retinal detachment

A

Flashes of light, floaters, curtain or shadows over field of vision

149
Q

What is seen on the fluorecein stain of someone with a flash burn

A

Microdots on corneal surface

150
Q

I’m an aurical hematoma where does blood accumulate

A

Perichondrium

151
Q

What is signs and symptoms of epiglottitis

A

Rapidly developing sore throat out of proportion to findings
Thumb sign

152
Q

What is the CENTOR criteria

A

Fever (38C)
Lack of cough
Tonsil Exudates
Lymphadenopathy of the anterior cervical

153
Q

What is the gustatory pathway

A

Stimulus: To be tasted, substances (tastants) must be dissolved in saliva.
(2) Once dissolved, tastants enter taste pores and make contact with the gustatory hairs.
(3) The results is an electrical signal that stimulates the gustatory receptor cell to transmit a nerve impulse.
(4) Adaptation to taste occurs quickly and the threshold for taste varies for each of the primary tastes

154
Q

What are Meibomian glands

A

Meibomian glands in the eyelid provide oils to the tear film. Oil glands along the edge of the eyelids where the eyelashes are found.

155
Q

What is the retina?

A

The retina, or inner layer, lies in the posterior three-quarters of the eye and functions in image formation.

156
Q

What is the function of convergence?

A

Convergence is the medial movement of both eyeballs so that they are directed on the object being viewed. This allows for binocular vision, which allows the perception of depth and an appreciation of the three dimensional nature of objects.

157
Q

Structures needed for vestibular senses?

A

Movement of the hair cells stimulates sensory neurons and transmits impulses to the vestibular branch of the vestibulocochlear (VIII) nerve.

158
Q

What makes up the borders of the anterior and posterior triangle of the neck?

A

Anterior triangle – is formed by the medial border of the sternocleidomastoid muscles, the mandible, and the midline.
2) Posterior triangle – is formed by the trapezius and sternocleidomastoid muscles and the clavicle.

159
Q

What is nystagmus and how do you test for it?

A

Have the patient follow your finger in a horizontal plane from extreme lateral (temporal) positions. (involuntary rhythmic movements of the eye).
Sustained nystagmus (horizontal, vertical, rotary, or mixed pattern) could be congenital or acquired

160
Q

What is miosis vs mydriasis

A

Miosis - pupillary constriction to less than 2 mm.
Myadriasis - pupillary dilation of more than 6 mm and failure of the pupils to constrict with light.

161
Q

Where is the macula in relation to the optic disk?

A

It is located approximately 2 disc diameters temporal to the optic disc.

162
Q

What is exophthalmos?

A

protrusion of the eye, increased volume of the orbit content, associated with Graves’ disease

163
Q

What is strabismus?

A

both eyes do not focus on an object simultaneously

164
Q

What is bilateral hemianopia?

A

loss of visual fields close to the temple, usually due to a pituitary tumor, interruption in the optic chiasm

165
Q

What is homonymous hemianopia?

A

loss of half of the field of view on the same side, both eyes. Due to a lesion arising in the optic nerve radiation on either side

166
Q

What are the internal structures of the nose

A

nasal floor, nasal roof, mucous membrane, olfactory epithelium, septum, cribiform plate, adenoids, turbinates and sinuses.

167
Q

What structures in the internal nose are key components for olfaction

A

olfactory epithelium

168
Q

What are turbinates and what is the function?

A

curved bony structure and increases nasal surface to warm, humidify and filter

169
Q

What landmarks demarcate the oropharynx?

A

bilateral anterior and posterior tonsillar pillars

170
Q

Structures needed for hearing?

A

Sound waves enter the ear through the external auditory canal, strike the tympanic membrane, and are conducted through the ossicles (the malleus, incus and stapes).
(2) The stapes repeatedly strikes the oval window, which sets up waves in the perilymph of the cochlea.
(3) Pressure wave changes in the cochlea (spiral organ) move the (4) Pressure wave changes in the cochlea (spiral organ) move the tectorial membrane which moves hair cells that fires action potentials that travel up via the cochlear branch of the vestibulocochlear nerve (CN VIII).

171
Q

Physical exam of the head (visual and palpating)

A

note visual inspection of head position, should be upright and still note any tilting, jerking, or bobbing. For palpating, symmetry, tenderness, clicking/locking [TMJ], hair texture, and salivary glands
STENSON DUCTS: parotid (maxillary) 2nd molar
WHARTON DUCTS: Submandibular duct - small papilla at the sides of the frenulum. Enlarged, tender gland → viral, bacterial infection, ductal stone.
Discrete nodule → cyst or tumor

172
Q

Neck exam of the thyroid:

A

Note any neck fullness (enlarged thyroid)
-Thyroid lobes (if felt) should be small, smooth, and free of nodules.
-The thyroid is approximately 4 cm, and the right lobe is often 25% larger than the left. -Coarse tissue or a gritty sensation suggests an inflammatory process.
-Hard or irregular nodules suggest malignancy.
-Enlarged and tender thyroid may indicate thyroiditis.
-In a hypermetabolic state (hyperthyroidism), vascular sounds (bruits) may be heard

173
Q

Know the steps of a proper eye exam?

A

their right eye to your right eye with the ophthalmoscope in the your right hand. Visualize red reflex, vessels, optic disk, retina or macula

174
Q

What is the whisper test.

A

unable to repeat 50% of sounds means they likely have hearing impairment

175
Q

What appearance of nasal polyps

A

Translucent/pale

Mucous covered is allergies
Blue in color is chronic

176
Q

What are common pathogens of otitis media

A

The most common pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes.