Chapter 10 Head, Eyes, Ears, Nose, and Throat FINAL EXAM Flashcards
Facial muscles are innervated by what cranial nerves?
V (Trigeminal)
VII (Facial)
The opening between the eyelids is termed?
Palpebral fissure
Two thin, transparent mucous membranes termed _______ lie between the eyelids and the eyeball
Conjunctivae
1) Bulbar conjunctiva-covers the scleral surface of the eyeballs
2) Palpebral conjuunctiva-lines the eyelids and contains blood vessels, nerves, hair follicles, and sebaceous glands. One of the sebaceous glands, the meibomian gland, secretes an oily substance that lubricates the lids, prevents excessive evaporation of tears, & provides an airtight seal when the lids are closed
Tears, formed by the lacrimal glands, combine with sebaceous secretions to maintain?
A constant film over the cornea
In the inner (or medial) canthus small openings termed the ______ _______ drain tears from the eyeball surface through the lacrimal sac into the nasolacrimal ducts
Lacrimal puncta
The globe of the eye, also known as the “eyeball” is surrounded by three separate layers:
1) sclera
2) uvea
3) retina
Describe the sclera of the eye
tough, fibrous outer layer commonly referred to as the white of the eye. Merges w/cornea in front of the globe at the junction termed limbus. Cornea covers iris & pupil. It is transparent, avascular, and richly innervated with sensory nerves via the ophthalmic branch of the trigeminal nerve V. Constant wash of tears provides cornea w/oxygen supply and protects its surface from drying. An important corneal function is to allow light transmission through the lens to the retina
Describe the uvea of the eye
Middle layer, consists of the choroid posteriorly & the ciliary body and iris anteriorly
- choroid layer is highly vascular & supplies retina w/blood.
- iris=circular, muscular membrane that regulates pupil dilation & constriction via the oculomotor nerve III.
- central opening of iris, the pupil, allows light transmission to the retina through the transparent lens
- ciliary body is a thickened region of the choroid that has two functions: (1) adjusts shape of lens to accommodate vision @ varying distances, (2) produces transparent aqueous humor (fluid the helps maintain intraocular pressure & metabolism of the lens & posterior cornea). Aqueous humor fills the anterior chamber between the cornea & lens and flows between the lens and the iris
Describe the retina of the eye
Inner layer, an extension of CNS
- transparent layer has photoreceptor cells, rods & cones, scattered throughout its surface. These cells perceive images & colors in response to varying light stimuli
- rods=low levels of light
- cones=higher levels of light
- macula lutea densely packed peripherally w/rods
- fovea centralis (small depression in center of macula lutea on the posterior wall of the retina) concentrated w/cones NO rods
- perforating retina is optic disc, head of the optic nerve II. Contains NO rods or cones, causing a small blind spot located 15 degrees laterally from center of vision
- The central retinal artery and central vein bifurcate at the optic disc and feed into smaller branches throughout the retinal surface
Vision, the primary function of the eyes, occurs when?
Rods and cones in the retina perceive images and colors in response to varying stimuli
The lenses are constantly adjusting to stimuli at different distances through?
Accommodation
When the lenses bring an image into focus what happens?
Nerve impulses transmit the information from the retina along the optic nerve and optic tract, reaching the visual cortex (located in the occipital lobe of each cerebral hemisphere) for cognitive interpretation
Six extraocular muscles and three cranial nerves allow for eye movement in six directions
1) The medial, inferior, & superior rectus muslces and the inferior oblique muscles, guided by the oculomotor nerve (cranial nerve III), control upward outer, lower outer, upward inner, & medial eye movements
2) The superior oblique muscle controls lower medial movement, innervated by the trochlear nerve (cranial nerve IV)
3) The lateral rectus muscle controls lateral eye movement, innervated by the abducens nerve (cranial nerve VI)
The external ear is composed of the?
Auricle (pinna) and the external auditory ear canal
The auricle (pinna) is composed of?
Cartilage and skin
External ear: the helix is the prominent outer rim; the concha is the ?
Deep cavity in front of the external auditory meatus
The bottom portion of the ear is referred to as the?
Lobule
The auricle (pinna) is attached to?
The head by skin, extension cartilage to the external auditory canal cartilage, ligaments, & muscles (the anterior, superior, and posterior auricular muscles)
The auricle (pinna) serves three main functions
1) Collection and focus of sound waves
2) location of sound ( by turning the head until the sound is loudest)
3) protection of the external ear canal from water and particles
The adult’s external ear canal is an?
S-shaped pathway leading from the outer ear to the tympanic membrane (TM), commonly known as the eardrum
The lateral one third of the ear canal has a cartilaginous portion framework; the medial two thirds of the canal are surrounded by bone The skin covering the cartilaginous portion of the auditory canal has hair follicles surrounded by sebaceous glands that secrete?
Cerumen (earwax). The hair follicles and cerumen protect the middle ear & inner ear from particles & infection
The middle ear is an?
Air filled cavity separated from the external ear canal by the tympanic membrane (TM). The TM, composed of layers of skin, fibrous tissue, & mucous membrane, is shiny & pearl gray. It is translucent, permitting limited visualization of the middle ear cavity
- middle ear contains 3 tiny bones: malleus, incus, & stapes (ossicles)
- lying between the nasopharynx and the middle ear is the eustachain tube. It opens briefly during yawning, swallowing, or sneezing to equalize the pressure of the middle ear to the atmosphere
- function of middle ear: amplification of sound. Sound waves cause the TM to vibrate; this vibration is transmitted through the ossicles to inner ear. The amplification results from the ossicles and from the size (area) difference between the TM and the oval window, an oval shaped aperture in the wall of the middle ear leading to the inner ear
The inner ear is encased in a bony labyrinth that contains three primary structures:
1) The vestibule
2) Semicircular canals
3) cochlea
The vestibule (inner ear) & the semicircular canals (inner ear) contain?
Receptors responsible for balance & equilibrium
The coiled snail-shaped cochlea contains?
The organ of Corti, the structure responsible for hearing
- specialized hair cells on the organ of corti act as sound receptors
- sound waves that reach the cochlea cause movement of the hair cells, which in turn transmit the impulses along the cochlear nerve branch of the acoustic nerve (cranial nerve VIII) to the temporal lobe of the brain, where interpretation of sound occurs
The nose serves as a?
Passageway for inspired and expired air. It humidifies, filters, & warms air before it enters the lungs and conserves heat and moisture during exhalation. Other functions of the nose include identifying odors and giving resonance to laryngeal sounds
The upper third of the nose is encased in bone, and the lower two thirds are composed of cartilage. The floor of the nasal cavity is the?
Hard palate
The septal cartilage maintains the shape of the nose and separates the?
nares (nostrils), which maintain an open passage for air
The nasal cavity is lined with?
highly vascular mucous membranes containing cilia (nasal hairs) that trap airborne particles and prevent them from reaching the lungs.
Three turbinates (inferior, middle, & superior) line the lateral walls of the nasal cavity, providing a?
Large surface area of nasal mucosa for heat and water exchange as air passes through the nose
-space between the inferior & middle turbinates is the middle meatus, which is an outlet for drainage from the frontal, maxillary, and anterior ethmoid sinuses
The nasal lacrimal duct drains into the?
inferior meatus, & the posterior ethmoid sinus drains into the middle & superior meatus
Paranasal sinuses extend out of the nasal cavities through narrow openings into the skull bones to form four paired, air filled cavities
Sphenoid, frontal, ethmoid, and maxillary, that make the skull lighter
-they are lined with mucous membranes & cilia that move secretions along excretory pathways
Within the mouth are several structures, including the lips, tongue, teeth, gums, and salivary glands. The roof of the mouth consists of the?
Hard palate, near the front portion of the oral cavity, and a soft palate, toward the back of the pharynx
The tongue has hundreds of taste buds (papillae) on its dorsal surface. The taste buds distinguish
Sweet, sour, bitter, & salty tastes
-the ventral (bottom) surface of the tongue is smooth & highly vascular
Humans have two sets of teeth
deciduous teeth (baby teeth) and permanent teeth
- 32 permanent: 12 incisors, 8 premolars, 12 molars
- teeth tightly encased in mucous membrane-covered, fibrous gum tissue, & rooted in the alveolar ridges of the maxilla and mandible
Three pairs of salivary glands
The parotid, submandibular, sublingual, all release saliva through small opening (ducts) in response to presence of food
- lie anterior to ears, immediately above mandibular angle, & drain into oral cavity through Stensen’s ducts (parotid gland openings). These are visible adjacent to the upper second molars
- submandibular glands tucked under the mandible & lie approximately midway between the chin & posterior mandibular angle
- Wharton’s ducts, the openings for the submandibular glands, are visible on either side of the lingual frenulum under the tongue
- sublingual glands (smallest salivary glands), lie on floor of the mouth and drain through 10-12 tiny ducts that cannot be seen with the naked eye
The oropharynx includes the?
Structures at the back of the mouth that are visible on examination: the uvula, the anterior & posterior pillars, the tonsils, & the posterior pharyngeal wall
- uvula is suspended midline from soft palate, which extends out to either side to form the anterior pillar
- tonsils are masses of lymphoid tissue that are tucked between the anterior and posterior pillars. May be atrophied in adults to point of being barely visible
- posterior pharyngeal wall is visible when tongue is extended and depressed. It is highly vascular & may show color variations of red and pink because of the presence of small vessels and lymphoid tissue
- epiglottis, a cartilaginous structure that protects the laryngeal opening, sometimes projects into pharyngeal area and is visible as the tongue is depressed
Structures within the neck include the?
Cervical spine, sternocleidomastoid muscle, hyoid bone, larynx, trachea, esophagus, thyroid gland, lymph nodes, carotid arteries, and jugular veins
The neck is formed by the bones within the upper spine (cervical vertebrae), which are supported by?
ligaments & the sternocleidomastoid and trapezius muscles
-these structures allow for the extensive movement w/in the neck
The relationship of neck muscles to one another and to adjacent bones creates?
Anatomic landmarks called triangles
- the medial borders of the sternocleidomastoid muscles and the mandible form the anterior triangle. Inside this triangle lie the hyoid bone, thyroid and cricoid cartilage, larynx, trachea, esophagus, and anterior cervical lymph nodes
- hyoid bone is a U-shaped bone at the base of the mandible that anchors the tongue. Only bone in the body that does not articulate with another bone
- posterior triangle formed by trapezius and sternocleidomastoid muscles and the clavicle; it contains the posterior cervical lymph nodes
The larynx (voice box) lies just below the pharynx and just above the trachea. The larynx acts as a?
Passageway for air (into trachea) and allows for vocalization w/vocal cords
- largest component of larynx is thyroid cartilage (Adam’s apple) located in the anterior portion of the neck
- thyroid cartilage: tough, shield-shaped structure w/a notch in the center of its upper border that protrudes in the front of the neck, protecting the other structures w/in the larynx (epiglottis, vocal cords, upper aspect of the trachea)
The thyroid gland, largest endocrine gland in the body, produces two hormones
1) Thyroxine (T4) and triiodothyronine (T3), which regulate cellular metabolism
- mental & physical growth & development depend on thyroid hormones
- thyroid gland positioned in the anterior portion of neck, below larynx, situated on front & sides of trachea
- Right & left lobes of the thyroid gland are butterfly shaped, joined in the middle by the isthmus
- isthmus lies across trachea under the cricoid cartilage (uppermost ring of the tracheal cartilages) & tucks behind the sternocleidomastoid muscle
The carotid arteries and internal jugular veins lie?
Deep and parallel to the anterior aspect of the sternocleidomastoid muscle
-carotid pulses palpated along the medial edge of the sternocleidomastoid muscle in the lower third of the neck.
Lymph nodes are tiny oval clumps of lymphatic tissue, usually located in groups along blood vessels. Nodes located in subcutaneous connective tissue are called?
Superficial nodes; those beneath the fascia of muscles or within various body cavities are called deep nodes
- deep nodes are not accessible to inspection or palpation
- superficial nodes are accessible to palpation & can become enlarged and tender, providing early signs of inflammation
In the head, lymph nodes are categorized as?
Preauricular, postauricular, occiptial, parotid, retropharyngeal (tonsilar), submandibular, submental, sublingual
In the neck, lymph nodes are found in?
Chains & are named according to their relation to the sternocleidomastoid muscle & the anterior & posterior triangles of the neck.
-lymph nodes in neck include: anterior & posterior cervical chains, sternomastoid nodes, and the supraclavicular nodes
What is a risk factor for macular degeneration and autoimmune disorder?
HTN
Present health status: Do you take any medications? If so what do you take and how often?
- AEs of medications can cause symptoms associated with the head and neck regions. Taking ototoxic medications such as aminoglycosides (an antibiotic) increases one’s?
- long term corticosteroid use is a known risk factor for?
Risk for hearing loss
-long term corticosteroid use is a known risk factor for glaucoma and cataracts
Myringotomy is a common surgical procedure of the?
Ears among children
Family history: Does anyone in your family have conditions impacting hearing, vision, or thyroid?
Cataracts, glaucoma, presbycusis, Meniere’s disease, and hyperthyroidism are examples of conditions that have familial tendencies and may increase a patient’s risk. Hearing loss has also been tied to genetic mutations of the GJB2 gene
Personal and Psychosocial history: When were your last routine examinations (dental, vision, hearing)? Do you use any corrective devices (contact lenses, glasses, hearing aids, dentures)?
These questions help to understand a patient’s health promotion practices. Routine dental examinations and examination of the eyes and ears are recommended
Personal and Psychosocial history: Do you use nicotine products or drink alcohol? If so how often and how much?
These questions help understand a patient’s potential risks for problems involving the head, eyes, and mouth. Chronic alcohol intake and smoking are risk factors for many problems, including cataracts, glaucoma, and cancers of the oropharynx
Cluster headaches occur?
More than once a day and last for less than an hour to about 2 hours. They may follow this pattern for a couple of months and then disappear for months to years
Migraine headaches may occur?
At periodic intervals and may last from a few hours to 1-3 days
Sinus headaches may cause?
Tenderness over frontal or maxillary sinuses
Tension headaches tend to be located in the?
Front or back of the head
Migraine and cluster headaches are usually?
Unilateral (only one side of an organ)
Cluster headaches produce?
Pain over the eye, temple, forehead, and cheek
Tension headaches are described as?
Viselike
Migraine headaches produce?
Throbbing pain
Cluster headaches cause?
A burning or stabbing feeling behind one eye
Migraines may be accompanied by?
Visual disturbances, N/V
Cluster headaches may occur with?
Nasal stuffiness or discharge, red teary eyes, or drooping eyelids
Possible triggers for headaches include?
Stress, fatigue, exercise, food, and alcohol
Conditions that precipitate headaches include?
HTN, hypothyroidism, and vasculitis
Migraines are frequently associated with?
Menstrual periods
Rest can help relieve what type of headaches?
Migraine
Movement helps relieve what types of headaches?
Cluster
Dizziness is a feeling of?
Faintness experienced within the patient
Vertigo is a?
Sensation that the environment is whirling around external to the patient
The perception of movement distinguishes?
Dizziness from vertigo. Nearly all patients who self-report a sensation of motion have vertigo
Headache triggering foods
- alcohol: sulfites
- avocado
- bacon: nitrites
- bananas
- canned figs
- chicken livers
- chocolate
- citrus fruits: lemon, lime, orange, grapefruit
- herring
- hot dogs
- meats, processed: bolonga, salami, pepperoni
- monosodium glutamate (chinese food)
- nuts
- onions
- sunflower seeds
- tea & coffee (caffeinated or decaffeinated)
- yogurt
Presyncope
Feeling of faintness and impending loss of consciousness-often a cardiovascular symptom
Disequilibrium
Feeling of falling-often a locomotor problem
Vertigo
Sensation of movement, usually rotational motion such as whirling or spinning. Subjective vertigo is the sensation that one’s body is rotating in space; objective vertigo is the sensation that objects are spinning around the body. Vertigo is the cardinal symptom of vestibular dysfunction
Light-headedness
Vague description of dizziness that does not fit any of the other classifications-usually idiopathic or psychogenic
A sudden onset of visual symptoms may indicate?
A detached retina and requires emergency referral
Difficulty with vision: Involvement of both eyes tends to indicate a?
Systemic problem
Difficulty with vision: Involvement of one eye is a?
Local problem
Symptoms commonly associated with visual difficulty
Headaches, dizziness, and nausea
Risk factors for cataracts
- age: between 65 & 74; 70% of adults had opague areas, 18% had cataracts; between 75-84 yrs, 90% of adults had opague areas, 50% had cataracts
- gender: women greater than men
- ethnicity: African Americans higher risk
- smokers: smoking 20 or more cigarettes daily have twice the risk
- alcohol: chronic drinkers of alcohol increased risk
- light exposure: exposure to low-level ultraviolet B or occupational exposure such as arc welding increases risk
- medication: corticosteroids taken on regular long term basis have higher risk
- chronic disease: diabetes mellitus increases risk
Risk factors for Glaucoma
- age: risk increases each year over age 50
- family history: those w/history of glaucoma in a first degree relative have 3x risk
- ethnicity: African Americans more likely to develop open-angle glaucoma than Caucasians. Asians and Alaska Natives have an increased risk for closed-angle glaucoma
- medication: corticosteroids (inhaled steroids) taken on regular, long term basis
- chronic disease: diabetes mellitus & HTN
Hearing loss associated with aging
Presbycusis occurs gradually and increases with advancing age, particularly with high frequencies
Risk factors for hearing loss
- Age: after 50
- Environmental noise (repeated exposure to loud noise >80 dB)
- Ototoxic medications (aminoglycosides, salicylates, furosemide)
- Family history (sensorineural hearing loss)
- Autoimmune disorders (sensorineural hearing loss)
- History of congenital hearing loss
Other symptoms associated with hearing loss
Fevers, headaches, visual changes
Ear pain can be related to an?
Infection in the mouth, sinuses, or throat
Pain caused by an ear infection involving the external ear or ear canal?
Increases with movement of the ear
Ear pain caused by otitis media?
Does not change with manipulation of the ear
Ear discharge may be a sign of?
Bacterial otitis media
Bacterial infection discharge description
Thick or purulent green-yellow, malordorous discharge
Discharge associated with a foreign body or chronic sinusits
A foul smelling discharge, especially unilateral discharge
Discharge associated with allergies
Profuse watery discharge
Discharge from neoplasm, trauma, or an opportunistic infection such as a fungal disease
Bloody discharge
A nose bleed (epistaxis) may occur secondary to?
Trauma, chronic sinusitis, malignancy, or a bleeding disorder; it may also result from cocaine abuse
Associated symptoms consistent with allergic rhinitis include?
Itching, swelling, discharge from the eyes, postnasal drip, and cough
Associated symptoms for individuals with infections
Fatigue, fever, and pain
If the patient uses nasal spray other than normal saline, alert him or her that?
It should only be used for only 3-5 days to avoid causing rebound congestion
Common associated symptoms of sore throat include?
Fever & fatigue
Possible symptoms of oral cancer include
Bleeding, lumps, and thickened ares in the mouth
-enlarged lymph nodes might be associated with cancer or an infection
Painful ulcerations may impair?
Adequate nutritional intake
Risk factors for oropharyngeal cancer
- age: increased after 40, peak incidence between 64-74
- gender: 2:1 male to female incidence
- race: African Americans higher incidence
- tobacco: 90% of individuals who develop oral cancer are tobacco users
- alcohol: 75-80% of individuals who develop oral cancer consume excessive amounts of alcohol
- exposure to sunlight: 30% of those who have cancer on the lip have an outdoor occupation with prolonged exposure to sun
- history of previously diagnosed cancer
- immunosuppression
Normocephalic
The term designating that the skull is symmetric and appropriately proportioned for the size of the body
Microcephaly is?
An abnormally small head
Macrocephaly is?
An abnormally large head