Ch 11: Ear, Nose, Throat, Eye, And Mouth Disorders Flashcards
1
Q
What is the sclera?
A
White of the eye, forms outer protective layer of the eye
2
Q
Whats the cornea?
A
Its clear and located in the center of the most anterior portion of the eye
3
Q
Conjunctiva
A
Thin mucous membrane that covers the anterior eye and lines the eyelids
4
Q
Iris
A
Gives the eye it color, and includes muscles that work to constrict or dilate the pupil
5
Q
Pupil
A
Dark center of the eye, controls the amount of light let into the eye
6
Q
Anterior chamber
A
Space between the cornea and iris and is filled w/aqueous humor.
7
Q
Lens
A
Clear, biconvex structure located just posterior to the pupil and iris
8
Q
Ciliary body
A
Muscular ring, through which through contraction and relaxation controls the shape of the lens and the degree of focus on near and far objects. (Also produces the aqueous humor that fills the anterior chamber)
9
Q
Retina
A
Multilayer tissue that lines the inner, posterior portion of the eye
10
Q
Macula
A
Located in the center of the retina and provides detailed central vision
11
Q
Fovea
A
Located within the center of the macula, and is responsible for the sharpest detail in central vision
12
Q
Optic nerve
A
Located at the back of the eye and transmits nerve impulses from the eye to the brain. (Portion of the optic nerve, the optic disc is visible w/opthalamoscope)
13
Q
The eye sockets are formed by what bones?
A
7 bones: frontal, zygomatic, maxillary, ethmoidal, sphenoid, lacrimal, and palatine
14
Q
What areas of the eye socket are weakest and as a result more susceptible to blow-out fractures?
A
Orbital floor and medial walls
15
Q
What muscles control eye movement?
A
4 rectus muscles-adduct, abduct, elevate and depress
2 oblique muscles- circular movements
16
Q
Lacrimal apparatus
A
Functions to produce, distribute, and collect tears (can be damaged w/lacerations involving medial portion of eyelids)
17
Q
What are the 3 main sections of the ear?
A
External ear, middle ear, inner ear
18
Q
The external ear contains?
A
Auricle and the external auditory canal
19
Q
The middle ear contains?
A
-tympanic membrane-forms the most outer part of the middle ear
-ossicle bones-malleus, incus, and stapes
20
Q
Inner ear contains?
A
Cochlea and semicircular canals (function to continue the conversion of sound waves to nerve impulses for the brain to interpret)
21
Q
Eustachian tube
A
Connects the middle ear to the nasal passages and regulates the amount of pressure within the middle ear
22
Q
List the paranasal sinuses
A
Frontal, sphenoid, ethmoidal, maxillary
23
Q
Pharynx is divided into
A
Nasopharynx, oropharynx, and laryngopharynx
24
Q
Below the laryngopharynx, the pharynx becomes
A
Esophagus
25
The epiglottis lies between which two structures, and functions to?
Oropharynx and laryngopharynx, functions to prevent food from entering the larynx
26
3 main functions of the larynx
1. Prevent food and fluid from entering the trachea, 2. Produce sound vibrations, 3. To assist in the cough mechanism
27
How many teeth do adults have?
32 total, 16 in upper jaw and 16 in lower jaw
28
The visible layer of the tooth is known as? The layer below it is called?
Visible layer-crown
Layer below-dentin
29
Retrobulbar
Behind the globe
30
How does eye discharge present in someone with allergies or viral infections?
Clear, watery substance, affects both eyes
31
How does eye discharge present in someone with a bacterial infection?
White/yellow colored discharge, starts in one eye and may migrate to the other (usually through rubbing eyes)
32
Diplopia
Double vision
33
Double vision (diplopia) results from?
-head injury
-systemic conditions like multiple sclerosis, diabetes, myasthenia gravis
34
Itching is associated with what pathologies
Allergy or eye infections
35
Photophobia
Sensitivity to light
36
Photophobia associated w/what pathologies?
Corneal abrasions
37
Ptosis
Drooping of the eyelid
38
Tearing in the eye results to this structure being damaged
Injury/illness involving lacrimal apparatus can cause increased/decreased tearing
39
Halos are associated with what pathologies?
Glaucoma, corneal edema, corneal scarring, dislocated intraocular lens
40
Photopsia
Brief light flashes
41
Light flashes and floaters are associated with what pathologies?
Retinal tear or detachment, require immediate referral
42
Anisocoria
Unequal pupils
43
Regarding anisocoria, when is immediate referral required?
Pupils have greater than 0.5 mm difference in size, abnormal pupillary reactions, history of head/eye trauma
44
Nystagmus
Rhythmic oscillation of the eyes
45
Nystagmus presents with what pathologies?
Head injuries or other neurological pathologies
46
Protruding eyes or retracting of the eyelids is aka?
Exopthalmos
47
Protruding eyes (exopthalmos), is associated with what pathology?
Graves disease
48
Patient states that there is a curtain over their vision, what pathology is associated with this symptom and how do you refer?
Curtain is associated with a detached retina or detached vitreous, warrants emergency medical treatment
49
Tinnitus
Ringing in the ears
50
Tinnitus is associated with what pathology?
Ruptured tympanic membrane
51
Palpation of the tragus and traction of the ear lobe will cause pain in patients with what pathology?
Otitis externa
52
Patients presenting with increased pressure behind the tympanic membrane which causes a sensation of pressure and pain have what pathology?
Otitis media
53
Damage to what sections of the ear can result in partial or complete hearing loss?
Damage to the middle and inner ear structures
54
Throat infections present with the following symptoms
Throat pain, white/red spots on the tonsils and soft palate
55
Swollen, red and bleeding gums when brushed are all signs of what pathology?
Gingivitis
56
Sensitivity to hot/cold food or beverages stems from?
Demineralization of the teeth secondary to plaque or cavities
57
Halitosis
Bad breath, associated with poor dental hygiene or periodontal disease (gum disease)
58
White/yellow plaques that develop on the tongue, cheeks, or palate are associated with what pathology?
Fungal infections of the mouth like oral candidiasis
59
A tear-drop shape or an irregularly peaked pupil suggest what pathology?
Globe rupture and should be treated as a medical emergency
60
How to test direct vs consensual eye response?
Direct-shine light into one eye directly in front of the eye, and that eye should constrict
Consensual- shine light directly into one eye and observe opposite eye reaction, opposite eye should constrict as well
61
Things to include in an eye first aid kit
62
To assess a patients extraocular muscles following an eye injury what ways would you have the patient look?
Lat, med, up, down, diagonally up and out, diagonally down and out
63
With blow out fractures what muscle commonly gets injured and how does this affect the patient?
Entrapment of the inferior vastus muscle, prevents patient from looking up
64
Fluorescein dye test
65
Subconjunctival hemorrhage
Bleeding under the clear conjunctiva, caused by trauma, forceful coughing, high blood pressure. In absence of trauma, generally benign, resolve on their own in 1-3 weeks
66
Corneal abrasions
Most common sports injury, as a result of a direct blow to the eye by an external object.
-Can also be caused by object becoming trapped between the upper lid and cornea, and is rubbed in an attempt to get object out
67
S&S of corneal abrasions
Photophobia, eye pain, sensation of “grittiness” in the eye, increased tearing, redness, possible swelling
68
Treatment of corneal abrasions
-refer to physician
-eye patch not recommended, they decrease oxygen delivery to abrasion, increase moisture and infection rate
-physicians will prescribe topical antibiotic drops to prevent infection and topical nsaids to reduce pain
-re-evaluated after 24 hrs, re-eval 3-4 days later
-typically heal after 24-72 hours, deep lesions 4-5 days
69
Hyphema
Injury caused by a direct blow to the globe and results in bleeding within the anterior chamber
(Forces strong enough to cause hyphema can cause a ruptured globe, rule out pathology as well)
70
Hyphema S&S
Eye pain, photophobia, blurred vision
71
Special considerations w/patients w/sickle cell and hyphema
-increased ocular pressure and potential for a secondary bleeding incident
72
Treatment for hyphema
-referred to ophthamologist or emergency room
-topical corticosteroid, rigid eye shield, analgesics for eye pain, NSAIDs avoided, elevate the head 30 degrees
-reassessed daily
73
Ruptured globe
Blunt or penetrating trauma to the orbit or globe
(May not be apparent upon inspection, most ruptures occur in areas that arent visible)
74
Ruptured globe S&S
Eye pain, decreased vision, possible diplopia (double vision)
75
Ruptured globe key signs
-excessive subconjuctival bleeding
-swelling
-irregular pupil shape
-asymmetry in depth of anterior chamber
-enophthalmos (recession of the globe w/in the orbit)
-exophthalmos (protrusion of the globe beyond the orbit
76
Ruptured globe treatment
-protect from pressure/contact, apply hard eye shield
-leave any foreign bodies in place
-ER
77
Orbital fracture moi
Blunt trauma to the orbit
(Forces strong enough to cause a fracture can also rupture globe and damage soft tissue surrounding eye)
78
Blow out fracture refers to what areas being fractured
Floor and medial walls are fractured, they are the weakest part of the orbit
79
Orbital fracture S&S
-pain, diplopia, periorbital swelling, ecchymosis, enophthalmos
-palpation may detect a bony step-off and point numbness in upper cheek area
-eye movement may be limited and painful, inferior rectus muscle can be entrapped prevent pt from looking up
-pts remain out of participation for months mb permanently
80
Detached retina
Sudden jarring of the head causes separation of the retina from the back wall (in some cases a sneeze, no apparent cause in others)
81
Detached retina S&S
-floaters, blind spots/shadows, bright flashes of light, curtain falling over their field of vision
82
Detached retina treatment
-warrants immediate referral to ophthamalogist
-longer the retina is detached from the blood supply, greater chance of permanent damage
-pts held out for a long time to minimize reoccurence of injury
83
Conjunctivitis
Inflammation of the conjunctiva either from allergens or infection (bacterial or viral).
84
Conjunctivitis S&S, differentiate between allergy and infection
White of the eye appears swollen and reddened (pink eye)
Allergy: itching, mucoid drainage, affects both eyes
Infection: burning, purulent drainage (pus), begins unilaterally can spread to other eye by rubbing
(Highly contagious, not share towels or rub eyes during sports participation)
85
Treatment of conjunctivitis, allergic and infectious
Allergic: antihistamines or anti-inflammatories
Infectious: antibiotic eyedrops or ointment. Instruct patient to not rub face, wash hands constantly.
(Eye infections w/significant pain and photophobia suggest more serious condition such as corneal injury or a herpes viral infection, refer for this)
86
Stye
Infection of an eyelid duct or follicle, aka hordeolum. Caused by staphylococcal bacteria.
87
Stye S&S
-localized pain on the margin of the eyelid
-lacrimation (tears)
-sensation of “something in the eye”
-inspection reveals round red lump on the lid margin
88
Stye treatment
Treated w/a warm, moist compress for 10 minutes a few times per day, should completely resolve in a few days.
-makeup wear should be avoided
-lesions in other parts of eye or no resolution of symptoms within 1-2 week require referral to an opthamologist
89
Glaucoma
Eye disease caused by optic nerve damage secondary to increased intraoccular pressure
90
Mechanism behind gradual loss of eyesight in glaucoma
-anterior chamber is filled w/aqueous solution. Level of fluid in this area is constantly filled/drained to maintain healthy level of pressure
-damage to the draining mechanism causes an increase in intraoccular pressure, increase in pressure is transmitted to the back of the eye causing damage to the optic nerve
-Optic nerve damage first leads to a loss of peripheral sight
91
Risk factors for glaucoma
1-positive family history
2-age (40+)
3-nearsightedness
4-diabetes
5-hypertension
6-black race
92
Glaucoma treatment
-no cure, use of drops/medications to reduce intraoccular pressure, surgery to replace drainage system
-high risk individuals checked yearly, no at risk individuals should be check every 2 years staring at age 40 (early detection is key to preventing the loss of sight)
93
Auricular hematoma
-repeated trauma or friction to the external ear can lead to an auricular hematoma between the thin layer of skin that covers the ear and the cartilage that composes the ear
-as the hematoma develops, the skin will separate from the cartilage, forming a palpable collection of fluid
94
Auricular hematoma treatment
-ice and compression can reduce size of hematoma
-prompt referral to a physician for drainage to reduce scarring
95
What is cauliflower ear?
When scar tissue develops in the auricular hematoma leading to a cauliflower like appearance on the external ear
96
Auricular hematoma RTP
(To prevent rebleeding, physicians will apply compression like a button sutured to the front and back of the ear or a silicone splint or cast is applied to the ear)
-splint left in place for 7-14 days, athletes in noncontact sports can rtp right away, athletes in contact sports can return right away if head gear is worn
-if compression is held in place by sutures, rtp is delayed until sutures are removed
97
Ruptured tympanic membrane
Sudden changes in pressure or the insertion of foreign objects can cause a ruptured tympanic membrane
98
Ruptured tympanic membrane S&S
-sudden ear pain
-sudden relief of ear pain followed by drainage from the ear
-tinnitus (rining/buzzing in ears)
-decrease in hearing (degree of hearing loss is usually related to the size of the perforation)
99
Causes of a ruptured tympanic membrane
-direct blow to the ear
-increased pressure in middle ear as a result of infection
-changes in cabin pressure when flying (ascent/descent)
-sudden loud noise (gunshot)
100
Ruptured tympanic membrane treatment
-otoscope to evaluate ear, inability to view the membrane bc of wax/drainage or visual confirmation of a hole in membrane=referral to a physician
-heal on their own within 2-3 weeks, occasionally surgery is required to fix opening
-during healing: patients should wear earplugs during showers/baths, tylenol/nsaids for ear pain
101
Otitis externa
-aka swimmers ear
-frequent exposure to water flushes the protective cerumen (wax) from the ear and can cause infections of the external ear canal
102
Otitis externa S&S
-ear drainage, canal swelling, erythema (reddening of the skin)
that can be visualized w/an otoscope
-decrease hearing, itching, produce pain when auricle is gently pulled or tragus is palpated
103
Otitis externa treatment
-irrigation w/sterile saline/hydrogen peroxide, inserting antibiotic/antifungal eardrops, discontinuing swimming
-within 3 days pain and erythema decrease and swimming can resume
104
How to prevent otitis externa
-earplugs while swimming
-carefully drying ears
-using drying agents (boric acid solution)
-avoiding use of swabs
105
Otitis media
An infection of the middle ear that often follows or accompanies URIs (upper respiratory infections)
106
Otitis media S&S
-ear pain w/out tenderness to touch
-fever
-feeling of pressure in ear
-slight loss of hearing
-occasionally dizziness
-otoscopic examination: reveal red tympanic membrane bulging/retracted
