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

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2
Q

Whats the cornea?

A

Its clear and located in the center of the most anterior portion of the eye

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3
Q

Conjunctiva

A

Thin mucous membrane that covers the anterior eye and lines the eyelids

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4
Q

Iris

A

Gives the eye it color, and includes muscles that work to constrict or dilate the pupil

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5
Q

Pupil

A

Dark center of the eye, controls the amount of light let into the eye

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6
Q

Anterior chamber

A

Space between the cornea and iris and is filled w/aqueous humor.

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7
Q

Lens

A

Clear, biconvex structure located just posterior to the pupil and iris

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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)

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9
Q

Retina

A

Multilayer tissue that lines the inner, posterior portion of the eye

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10
Q

Macula

A

Located in the center of the retina and provides detailed central vision

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11
Q

Fovea

A

Located within the center of the macula, and is responsible for the sharpest detail in central vision

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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)

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13
Q

The eye sockets are formed by what bones?

A

7 bones: frontal, zygomatic, maxillary, ethmoidal, sphenoid, lacrimal, and palatine

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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

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15
Q

What muscles control eye movement?

A

4 rectus muscles-adduct, abduct, elevate and depress
2 oblique muscles- circular movements

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16
Q

Lacrimal apparatus

A

Functions to produce, distribute, and collect tears (can be damaged w/lacerations involving medial portion of eyelids)

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17
Q

What are the 3 main sections of the ear?

A

External ear, middle ear, inner ear

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18
Q

The external ear contains?

A

Auricle and the external auditory canal

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19
Q

The middle ear contains?

A

-tympanic membrane-forms the most outer part of the middle ear
-ossicle bones-malleus, incus, and stapes

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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)

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21
Q

Eustachian tube

A

Connects the middle ear to the nasal passages and regulates the amount of pressure within the middle ear

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22
Q

List the paranasal sinuses

A

Frontal, sphenoid, ethmoidal, maxillary

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23
Q

Pharynx is divided into

A

Nasopharynx, oropharynx, and laryngopharynx

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24
Q

Below the laryngopharynx, the pharynx becomes

A

Esophagus

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25
Q

The epiglottis lies between which two structures, and functions to?

A

Oropharynx and laryngopharynx, functions to prevent food from entering the larynx

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26
Q

3 main functions of the larynx

A
  1. Prevent food and fluid from entering the trachea, 2. Produce sound vibrations, 3. To assist in the cough mechanism
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27
Q

How many teeth do adults have?

A

32 total, 16 in upper jaw and 16 in lower jaw

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28
Q

The visible layer of the tooth is known as? The layer below it is called?

A

Visible layer-crown
Layer below-dentin

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29
Q

Retrobulbar

A

Behind the globe

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30
Q

How does eye discharge present in someone with allergies or viral infections?

A

Clear, watery substance, affects both eyes

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31
Q

How does eye discharge present in someone with a bacterial infection?

A

White/yellow colored discharge, starts in one eye and may migrate to the other (usually through rubbing eyes)

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32
Q

Diplopia

A

Double vision

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33
Q

Double vision (diplopia) results from?

A

-head injury
-systemic conditions like multiple sclerosis, diabetes, myasthenia gravis

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34
Q

Itching is associated with what pathologies

A

Allergy or eye infections

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35
Q

Photophobia

A

Sensitivity to light

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36
Q

Photophobia associated w/what pathologies?

A

Corneal abrasions

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37
Q

Ptosis

A

Drooping of the eyelid

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38
Q

Tearing in the eye results to this structure being damaged

A

Injury/illness involving lacrimal apparatus can cause increased/decreased tearing

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39
Q

Halos are associated with what pathologies?

A

Glaucoma, corneal edema, corneal scarring, dislocated intraocular lens

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40
Q

Photopsia

A

Brief light flashes

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41
Q

Light flashes and floaters are associated with what pathologies?

A

Retinal tear or detachment, require immediate referral

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42
Q

Anisocoria

A

Unequal pupils

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43
Q

Regarding anisocoria, when is immediate referral required?

A

Pupils have greater than 0.5 mm difference in size, abnormal pupillary reactions, history of head/eye trauma

44
Q

Nystagmus

A

Rhythmic oscillation of the eyes

45
Q

Nystagmus presents with what pathologies?

A

Head injuries or other neurological pathologies

46
Q

Protruding eyes or retracting of the eyelids is aka?

A

Exopthalmos

47
Q

Protruding eyes (exopthalmos), is associated with what pathology?

A

Graves disease

48
Q

Patient states that there is a curtain over their vision, what pathology is associated with this symptom and how do you refer?

A

Curtain is associated with a detached retina or detached vitreous, warrants emergency medical treatment

49
Q

Tinnitus

A

Ringing in the ears

50
Q

Tinnitus is associated with what pathology?

A

Ruptured tympanic membrane

51
Q

Palpation of the tragus and traction of the ear lobe will cause pain in patients with what pathology?

A

Otitis externa

52
Q

Patients presenting with increased pressure behind the tympanic membrane which causes a sensation of pressure and pain have what pathology?

A

Otitis media

53
Q

Damage to what sections of the ear can result in partial or complete hearing loss?

A

Damage to the middle and inner ear structures

54
Q

Throat infections present with the following symptoms

A

Throat pain, white/red spots on the tonsils and soft palate

55
Q

Swollen, red and bleeding gums when brushed are all signs of what pathology?

A

Gingivitis

56
Q

Sensitivity to hot/cold food or beverages stems from?

A

Demineralization of the teeth secondary to plaque or cavities

57
Q

Halitosis

A

Bad breath, associated with poor dental hygiene or periodontal disease (gum disease)

58
Q

White/yellow plaques that develop on the tongue, cheeks, or palate are associated with what pathology?

A

Fungal infections of the mouth like oral candidiasis

59
Q

A tear-drop shape or an irregularly peaked pupil suggest what pathology?

A

Globe rupture and should be treated as a medical emergency

60
Q

How to test direct vs consensual eye response?

A

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
Q

Things to include in an eye first aid kit

A
62
Q

To assess a patients extraocular muscles following an eye injury what ways would you have the patient look?

A

Lat, med, up, down, diagonally up and out, diagonally down and out

63
Q

With blow out fractures what muscle commonly gets injured and how does this affect the patient?

A

Entrapment of the inferior vastus muscle, prevents patient from looking up

64
Q

Fluorescein dye test

A
65
Q

Subconjunctival hemorrhage

A

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
Q

Corneal abrasions

A

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
Q

S&S of corneal abrasions

A

Photophobia, eye pain, sensation of “grittiness” in the eye, increased tearing, redness, possible swelling

68
Q

Treatment of corneal abrasions

A

-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
Q

Hyphema

A

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
Q

Hyphema S&S

A

Eye pain, photophobia, blurred vision

71
Q

Special considerations w/patients w/sickle cell and hyphema

A

-increased ocular pressure and potential for a secondary bleeding incident

72
Q

Treatment for hyphema

A

-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
Q

Ruptured globe

A

Blunt or penetrating trauma to the orbit or globe
(May not be apparent upon inspection, most ruptures occur in areas that arent visible)

74
Q

Ruptured globe S&S

A

Eye pain, decreased vision, possible diplopia (double vision)

75
Q

Ruptured globe key signs

A

-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
Q

Ruptured globe treatment

A

-protect from pressure/contact, apply hard eye shield
-leave any foreign bodies in place
-ER

77
Q

Orbital fracture moi

A

Blunt trauma to the orbit
(Forces strong enough to cause a fracture can also rupture globe and damage soft tissue surrounding eye)

78
Q

Blow out fracture refers to what areas being fractured

A

Floor and medial walls are fractured, they are the weakest part of the orbit

79
Q

Orbital fracture S&S

A

-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
Q

Detached retina

A

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
Q

Detached retina S&S

A

-floaters, blind spots/shadows, bright flashes of light, curtain falling over their field of vision

82
Q

Detached retina treatment

A

-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
Q

Conjunctivitis

A

Inflammation of the conjunctiva either from allergens or infection (bacterial or viral).

84
Q

Conjunctivitis S&S, differentiate between allergy and infection

A

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
Q

Treatment of conjunctivitis, allergic and infectious

A

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
Q

Stye

A

Infection of an eyelid duct or follicle, aka hordeolum. Caused by staphylococcal bacteria.

87
Q

Stye S&S

A

-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
Q

Stye treatment

A

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
Q

Glaucoma

A

Eye disease caused by optic nerve damage secondary to increased intraoccular pressure

90
Q

Mechanism behind gradual loss of eyesight in glaucoma

A

-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
Q

Risk factors for glaucoma

A

1-positive family history
2-age (40+)
3-nearsightedness
4-diabetes
5-hypertension
6-black race

92
Q

Glaucoma treatment

A

-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
Q

Auricular hematoma

A

-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
Q

Auricular hematoma treatment

A

-ice and compression can reduce size of hematoma
-prompt referral to a physician for drainage to reduce scarring

95
Q

What is cauliflower ear?

A

When scar tissue develops in the auricular hematoma leading to a cauliflower like appearance on the external ear

96
Q

Auricular hematoma RTP

A

(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
Q

Ruptured tympanic membrane

A

Sudden changes in pressure or the insertion of foreign objects can cause a ruptured tympanic membrane

98
Q

Ruptured tympanic membrane S&S

A

-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
Q

Causes of a ruptured tympanic membrane

A

-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
Q

Ruptured tympanic membrane treatment

A

-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
Q

Otitis externa

A

-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
Q

Otitis externa S&S

A

-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
Q

Otitis externa treatment

A

-irrigation w/sterile saline/hydrogen peroxide, inserting antibiotic/antifungal eardrops, discontinuing swimming
-within 3 days pain and erythema decrease and swimming can resume

104
Q

How to prevent otitis externa

A

-earplugs while swimming
-carefully drying ears
-using drying agents (boric acid solution)
-avoiding use of swabs

105
Q

Otitis media

A

An infection of the middle ear that often follows or accompanies URIs (upper respiratory infections)

106
Q

Otitis media S&S

A

-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