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Patient Assessment > Ear, Nose, Throat > Flashcards

Ear, Nose, Throat Flashcards

1
Q

what is the normal first part of the hearing pathway from the external ear through the middle ear?

A

air conduction (AC)

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2
Q

how does sound waves travel in AC

A

through the air and transmitted from external and middle ear to the cochlea

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3
Q

what is the phase of hearing that is an alternative pathway that bypasses the external and middle ear?

used for testing purpose

A

Bone conduction

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4
Q

how does sound travel for bone conduction?

A

vibrating fork sis placed on the head, and the bone of sull is vibrated

stimulates the cohclea directing

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5
Q

what is the senosrineural phase of hearing?

A

second part of hearing pathway that involves the cochlea and cochlear branch of CN VIII

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6
Q

what type of conduction is more sensitve in hearing loss?

A

AC>BC

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7
Q

what type of condution is more sensitive in conductive hearing loss?

A

BC>AC

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8
Q

what questions should be asked for history of the ears?

A
  • hearing loss
  • earache/ear discharge
  • tinnitus
  • vertigo
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9
Q

what are you inspecting the auricle for?

A

deformities, lumps, pits, skin lesions

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10
Q
A
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11
Q

what test evaluates for ear pain or dischage?

A

Tug Test

  • moves the auricle up and down and presses on tragus
  • press firmly over the mastoid process behind the ear
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12
Q

when would you see a positive tug test?

A

acute otitis externa

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13
Q

when would you see a negative tug test

A

Otitis media

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14
Q

what diseases do you see tenderness over the mastoid process druring the tug test?

A

Otitis media and mastoiditis

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15
Q

where is the inflammation in otitis externa

A

the ear canal is inflamemd

see wax, pus coming from the ear

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16
Q

where in the ear is inflammed with Otitis Media

A

inflammation of the fluid accumulation in the middle ear

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17
Q

Don’t forget to do what during the otoscope ear exam

A

straighten the ear canal by grasping the auricle

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18
Q

what angle do you insert the speculum at into the ear?

A

downward angle

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19
Q

what three things do you inspect for during an otoscope?

A
  1. ear canal for d/c, foreign body, redness or swelling
  2. inspect Tm for color, cone of light, perforations
  3. Mobility of TM can be evaluated with pneumatic otoscope
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20
Q

what conditions do you see decreaswed mobility of the TM

A
  1. serous effusion
  2. thickened tympanic membrane
  3. purulent otitis media
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21
Q

what does perforation of the TM cause upon pneumatic otoscopy

A

no mobility of pneumatic otoscopy

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22
Q

what color is a normal TM

A

pinkish/gray color

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23
Q

what does the malleus lie behind?

A

the upper part of the ear drum

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24
Q

What lies above the malleus

A

pars flaccida

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25
Q

what are the 3 components of the TM

A
  1. lateral process of the malleus
  2. par flaccida
  3. pars tensa
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25
Q
A
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26
Q

where does the cone of light fan down to?

A

fans downward and anteriorly

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27
Q

what is normal in the handle of the malleus

A

small blood vessels

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28
Q

whispered voice test result

if the pt repeats the intial sequence correctly

A

normal hearing in ear

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29
Q

whisphered test results

pt responds incorrecttly or not at all, what do you do

A

repeat that ear with a new combo of letters/ numbers

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30
Q

whispered test results

pt gets 3/6 of the letters/numbers correct

A

passed hearing screening test

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31
Q

whispered voice test results

less than 3/6 correct

c

A

conduct further testing using audiometry

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32
Q

what should you do to the other earing during a whispered voice test

A

occlude it

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33
Q

what test evaluates lateralizatoin

A

Weber test

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34
Q

what does a normal weber test indicate

A

sound heard equally in both ears

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35
Q

for the weber test, the sound is heard best/lateralizes to impaired ear by bone indicates

A

unilateral conductive hearing loss

BC>AC

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36
Q

for the weber test, sound is heard best/lateralizes to the good ear indicates

A

unilateral sensorineural hearing loss

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37
Q

when do you conduct a Rinne test?

A

for pts failing the whispered voice test in order to compare air conduction and bone conduction

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38
Q

what is a normal Rinne test?

A

AC > BC
sound heard longer through the air than the bone

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39
Q

what are the Rinne results indicating conductive hearing loss

A

BC > AC
sound heard longer through bone than air

40
Q

what Rinne results indicate sensorineural hearing loss?

A

AC > BC
air heard longer than bone

41
Q

(—-) environment may help hearing in what hearing loss

A

noisy environment

42
Q

conductive hearing loss

cerumen impaction, otitis externa, SCC, Trauma, Exostasis are problems with (—–)

A

external ear causing conductive hearing loss

43
Q

conductive hearing loss

otitis media, oteosclerosis, Tympanosclerosis, cholesteatoma, perforation of TM, Tumor are problems with (—–)

A

the middle ear causing conductive hearing loss

44
Q

what type of hearing loss causes trouble to understand speech/hearing & noisy envrionments make it worse?

A

sensorineural hearing

45
Q

what are some disorderes of the inner ear?

A
  • congenital/hereditary conditions
  • presbycuris
  • rubella or CMV
  • Meniere disease
  • noise exposure
  • ototoxic drug exposure
46
Q

history to ask about the nose

A
  • rhinorrhea
  • nasal congestion
  • epistaxis
  • sinus trouble
47
Q

step of the nose examination

A
  1. inspect the anterior and inferior surface of the nose
  2. test for nasal obstruction on each nasi (if indicated)
  3. inspect the nasal mucosa, septum, inferior and middle turbinates & meatus with a otosscope
  4. palpate the frontal sinuses
  5. palpate the maxillary sinuses
48
Q

what do you inspect the anterior & inferior surfaces of the nose for?

A
  • asymmetry
  • deformity
  • deviation
  • lower septum
49
Q

how to test for nasal obstruction

A

press on each ala nasi and ask the pt to breathe in

50
Q

what do you inspect the interior of the nose for

A
  • inspect mucosa for color, swelling, bleeding, exudate
  • inspect the septum for deviation, inflammation, perforation, bleeding
  • any abnormalities (polyps or ulcers)
51
Q

what sinuses do you transilluminate

A

frontal and maxillary

52
Q

stenson duct

A

opening of the parotid duct

53
Q

what health history should be asked about the throat?

A
  • sore throat
  • sore tongue
  • bleeding or swollen gums
  • Hoarseness
  • malodorous breath
54
Q

acute hoarseness is

A

from voice overuse, acute viral laryngitis, possible neck trauma
<2weeks

55
Q

chronic Hoarseness

A

> 2 weeks
refer for laryngoscopy

56
Q

what should you consider for chronic hoarseness

A
  • hypothyroisdism
  • acid reflex
  • vocal cord nodules
  • head & neck cancers
  • neurologic disorders (parkinsons, als, myasthenia gravis)
57
Q

what do you inspect the mouth for

A
  • lips
  • oral mucosa
  • gums & teeth
  • roof of mouth (hard palate)
  • Tongue (side & under surface)
  • floor of mouth
58
Q

what do you palpate the mouth for

A

any suspicious lesions for thickening or infiltration of the tx that might suggest malignancy

59
Q

what do you exam of the pharynx

A
  • soft palate
  • anterior & posterior pillars
  • uvula
  • tonsils
  • pharynx
60
Q

what is the grading of the tonsils range

A

0-4

61
Q

Grade 0 tonsils

e

A

entirely within the tonsillar pillar or previously removed by surgery

62
Q

Grade 1+ tonsils

A

tonsils occupy 0-25% of the mouth

63
Q

grade 2+ tonsils

A

tonsils occupy 26-50% of the oropharynx

64
Q

grade 3+ tonsils

A

tonsils occupy 51-75% of the oropharynx

65
Q

grade 4+ tonsils

A

tonsils occupy more than 75% of the oropharynx

66
Q

how to test the hypogloxxal nerve CN XII

A

ask the pt to stick out their tongue and assess for symmerty and deviation

67
Q

lesion of the hypoglossal nerve

A

suggested by asymmetric protrusion/deviation of the tongue to one side

tongue points TOWARD the side of lesion

68
Q

tongue =

A

toward

CN XII sdamage

69
Q

how to test vagus nerve CNX

A
  • ask pt to open mouth and say “ahhhh”
  • if pharynx is not visible use a tongue depresser
  • note the rise of the soft palate and medial position of the uvula
70
Q

vagus nerve paralysis CN x

A

soft palate fails to rise on one side and uvula deviates to the OPPOSITE side

71
Q

uvula points

A

away

72
Q

firm nodular hypertrophic mass of scar tissue extending beyond the area of injury; common in people with darker skin

A

keloid

73
Q

deposit of uric acid crystals characteristic in chronic tophaceous gout
hard nodule on the helix or antihelix

A

tophi

74
Q

what discharge does tophi have

A

white, chalky crystals through the skin

75
Q

small lumps on the helix or antihelix associate with (——); can also be found on hands, surface of ulna, elbow, knees & heels

A

Rheumatoid arthritis

Rheumatoid nodules

76
Q

chronic inflammatory condition that begins as a painful, tender papule on the helix or antihelix; reddening may occur

A

chondrodermatitis helicis
biopsy is Needed

77
Q

Hole in the ear drum from purulent infections of middle ear

A

perforation of TM

78
Q

what may come out of the ear with perforated TM

A

discharge from infected middle ear may drain out through perforated opening

79
Q

scarring process in the middle ear from the otitis media & if severe can entrap ossicles and cause conductive hearing loss

A

Typmanosclerosis

80
Q

what is amber fluid behind the eardrum w/ or w/o bubbles

A

serous effusion

81
Q

what can cause serous effusion

A

viral URI, sudden changes in atmospheric pressure

82
Q

what organism causes acute otitis media w/ purulent effusion

A

s. pneumonia or H. influenzae

83
Q

eardrum is reddened, loses its landmarks, and bulges towards the examiners eyes

A

acute otitis media w/ purulent effusion

84
Q

painful hemorrhagic vesicles appear on the TM, ear canal, or both

A

bullous myringitis

85
Q

what organism causes bullous myringitis

A

mycoplasma, viruses and bacteria OM

86
Q

what hearing loss is more common in children/young people

A

conductive

87
Q

what hearing loss is associated with external or middle ear disorders

A

conductive period

88
Q

is the abnormality visible in conductive hearing loss

A

yes except otosclerosis

89
Q

where does sound lateralize in conductive hearing loss for weber test

A

toward impaired ear

90
Q

what hearing loss is more common in middle or later years

A

sensorineural hearing loss

91
Q

is abnormality visible in sensorineural hearing loss

A

no

92
Q

what part of the ear is associated with sensorineural hearing loss

A

inner ear

93
Q

where does sound lateralize in senosorineural hearing loss

weber’s test

A

to the good ear

94
Q

vestibular neuronitis

A
  • sudden onset
  • hours to weeks
  • hearing not affected
  • no tinnitus
95
Q

acute labryinthitis

A
  • sudden onset
  • hourrs to weeks
  • sensorineural hearing loss unilaterally
  • tinnitus +/-
96
Q

softening of the skin on the angles to the mouth leading to fissuring

A

angular chelitis

97
Q

when is angular chelitis seen

A
  • candida
  • overclosure of the mouth
  • ill fittin gdentures
  • b vitamins or iron deficiency
98
Q
A

Patient Assessment (20 decks)

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