EENT Flashcards
Define exophthalmos. Who typically experiences this disorder?
increased axial projection (eye protrusion)
Common finding in. thyroid eye disease and found in about 60% of patients
Define ptosis and causes
Drooping of the upper eyelid.
Causes: senescence (deterioration with age), myasthenia gravis, or damage to the oculomotor nerve (CNIII)
What condition is this?
More common in elderly population
Inward turning of the lid margin. The lower lashes irritate the conjunctiva and lower cornea. Lower lashes may be invisible when turned inward
Entropion
What condition is this?
Lower lid margin turns outward, exposing the palpebral conjunctiva. When this occurs the eye no longer drains well
More common in older adults
Ectropion
What condition is related to elevated intracranial pressure that causes intra-axonal edema along the optic nerve, leading to engorgement and swelling of the optic disc?
papilledema
what sinuses are typically affected when patients present with sinus pressure or sinus infection?
Maxillary sinus (near the cheeks) and ethmoid sinus (near the bridge of the nose)
at what age does the frontal sinus develop. Describe their location
7 years old; near the forehead
What are causes of rhinorrhea
Viral infections. allergic rhinitis (hay fever), and vasomotor rhinitis (itching favors allergic cause)
What term defines unequal pupils
aniscoria
movement of the auricle and tragus is painful in _____ but not painful in _____.
acute otitis externa (inflammation of the ear canal)
not painful in otitis media (inflammation of the middle ear)
What are causes of sensorineural hearing loss
loud noise exposure, inner ear infections, trauma, acoustic neuroma, congenital and familial disorders, and aging
What are the effects of sensorineural hearing loss
Higher registers are lost, so sound may be distorted
Hearing worsens in noisy environment
Voice may be loud because hearing is difficult (due to cochlear nerve and neuronal impulse transmission to the brain is affected)
What are the causes of conductive hearing loss
foreign body, otitis media, perforated eardrum, and otosclerosis of ossicles
What are the effects of conductive hearing loss
little effect on sound
Hearing seems to improve in noisy environment
Voice remains soft because inner ear and cochlear nerve are intact
Acute otitis media with purulent effusion is commonly caused by what bacteria
S. pneumoniae or H. influenzae
xerostomia
dry mouth
white, cottage cheese‐like lesions that can be easily removed with swab is called what?
What is it treated with
Thrush (candida - fungal); treated with anti-fungal
recurrent single or multiple shallow, painful ulcers, that are scattered or grouped are called what?
What is treatment?
Aphthous ulcers
Symptomatic treatment with “Magic Mouthwash”
Multiple ulcers on tonsils, soft palate, uvula (May also
have lesions on hands and soles of feet).
What population does this primarily affect?
Herpangina (Coxsackie virus)
Seen more in kids
painless punched out ulceration on lip, tonsil or palate is called what?
What is treatment?
Syphillis chancre
Treated with PCN.
painful, similar in appearance to aphthous ulcers, but only on mucosa attached to bony
structures is descriptive of what condition?
What is treatment?
Herpes
Treated with anti‐virals.
halitosis
malodorous breath
what structures are part of the oropharynx
uvula, soft palate, palatine tonsils, and posterior wall of the oropharynx
A hump in the middle of the nose is called what?
dorsum convexity
Saddling of the middle of the nose is called what?
dorsum concavity
asymmetric protrusion of the tongue suggests a lesion of what cranial nerve? What way would the tongue turn if there is a lesion?
CN XII
tongue points toward the side of the lesion
what are common causes of otitis media?
- edema and congestion in Eustachian tube
- refulux of bacteria from the nasopharynx
- accumulation of secretions in middle ear increase pathogen growth
Name the structures of the middle ear
malleus, incus, stapes, tympanic membrane (eardrum), tympanic cavity, semicircular canals
Name the structures of the inner ear
cochlea, vestibular nerve, cochlear nerve, estachian tube
Name the structures of the outer ear
auricular lobule (earlobe)
Concha
antihelix
tringular fossa
scapha
helix
temporal muscle
temporal bone
external acoustic meatus (ear canal)
Extraocular muscles:
What movement does the superior rectus muscle control?
What cranial nerve moves it
Moves the eye upward (elevation)
CN III
Extraocular muscle:
What movement does the inferior rectus control
What cranial nerve moves it
Moves the eye downward (depression)
CN III
Extraocular muscle:
What movement does the Medial rectus control
What cranial nerve is associated
Moves the eye inward toward the nose (adduction)
CN III
Extraocular muscle:
What movement does the lateral rectus muscles control
What cranial nerve is associated
Moves the eye outward away from the nose (abduction)
CN VI
Extraocular muscles:
What movement does the superior oblique control
What CN is associated
Rotates the top of the eye toward the nose around the long axis (torsion) and downward
CN VI
Extraocular muscles:
What movement does the inferior oblique muscle control
What CN is associated
Rotates the top of the eye away from the nose around the long axis (extorsion) and moves the eye upward (elevation)
CN III
Name the cranial nerves:
CN VI
CN IV
CN III
CN VI: abducens nerve
CN IV: trochlear nerve
CN III: oculomotor nerve
What cranial nerve control facial expressions and facial muscles?
What movements activate the cranial nerve
Cranial nerve VII (the facial nerve)
Ask person to smile, frown, close eyes tightly, lift eyebrows, show teeth
Describe location of the submental lymph nodes and their direction of lymphatic drainage
in the midline a few centimeters behind the tip of the mandible
external and internal lymphatic drainage (from the mouth and throat)
Describe the location of the submandibular lymph node group and their direction of drainage.
Midway between the angle and the tip of the mandible.
External and internal lymphatic (from the mouth and throat)
Describe the location of the preauricular lymph node group and their direction of lymph drainage
in front of the ear
external lymphatic drainage
Describe the location of the posterior auricular lymph node group and their direction of lymph drainage
superficial to the mastoid process
external lymphatic drainage
Describe the location of the tonsillar (jugulodigastric) lymph node group and their direction of lymph drainage
at the angle of the mandible
internal lymphatic drainage (from the mouth and throat)
Describe the location of the occipital lymph node group and their direction of lymph drainage
at the base of the skull posteriorly
external lymphatic drainage
Describe the location of the anterior superficial cervical lymph node group and their direction of drainage
superficial to the SCM muscle
external lymph drainage
Describe the location of the posterior cervical lymph node group and the direction of drainage
along the anterior edge of the trapezius
external lymph drainage
Describe the location of the deep cervical chain lymph node group and the direction of drainage
Deep to the SCM muscle and often inaccessible to examination
no direction of drainage
Describe the location of the supraclavicular lymph node group and the direction of drainage
deep in the angle formed by the clavicle and the SCM muscle
external lymph drain
Enlarged tender lymph nodes commonly accompany what condition
pharyngitis
Describe symptoms of hypothyroidism
intolerance to cold, weight gain, dry skin, and slowed heart rate
Describe symptoms of hyperthyroidism
intolerance to heat, weight loss, moist velvety skin, and palpitations
redness and scaling on the scalp may indicate what condition
Seborrheic dermatitis
What are the characteristics of lymph nodes during acute infections
nodes are bilateral, enlarged, warm, tender, and firm but freely movable
What are the characteristics of lymph nodes with chronic inflammation, such as tuberculosis
the nodes are clumped
What are the characteristics of cancerous lymph nodes
hard, unilateral, nontender, and fixed
What are the characteristics of lymph nodes with HIV infection
enlarged, firm, non-tender, and mobile
What are the characteristics of lymph nodes when neoplasm in thorax or abdomen is present
single, enlarged, non-tender, hard, left, supraclavicular node (Virchow’s node)
What are the characteristics of lymph nodes when Hodgkin’s lymphoma is present
painless, rubbery, discrete nodes that gradually appear
A tracheal shift pushed to the unaffected side could indicate what conditions?
Aortic aneurysm, tumor, unilateral thyroid lobe enlargement, and pneumothorax
A tracheal shift with the trachea puled toward the affected side could indicate what conditions?
large atelectasis, pleural adhesions, or fibrosis
Lymph nodes greater than how many cm is considered enlargement
> 1 cm
Test muscle strength and status of cranial nerve XI by what movement
trying to resist person’s movements with your hands as person shrugs shoulders and turns head to each side
the internal carotid supplies what area
runs upward to supply the brain
The external carotid supplies what area
the face, salivary glands, and superficial temporal area
What part of the ear mediates conductive hearing
outer and middle ear
What part of the ear mediates sensorineural hearing
the inner ear
What are the 3 pairs of salivary glands and where are they located
Parotid glands: in the cheeks over the mandible anterior to and below the ear
Submandibular glands: beneath the mandible at angle of the jaw
Sublingual glands: in the floor of the mouth
What is the function of the lymphatic system
filter lymph and engulf pathogens, preventing potentially harmful substances from entering the circulation
What do the posterior auricular nodes drain
ear canal, posterior neck and upper ear
What do the superficial cervical nodes drain and what are possible differentials
drains tongue, larynx, oropharynx
Differential: mono, upper respiratory infection, dental disease
What do the supraclavicular lymph nodes drain? What are the differentials
Drains GI/GU tract and pulmonary
Can be a sign of abdominal cancers that metastasize by the lymph system like gastric cancer
What do the submandibular drain and what are the differentials associated
oral cavity
Same as superficial cervical; Differential: mono, upper respiratory infection, dental disease
Where do the epitrochlear lymph nodes drain and what are the differentials associated
Drains the last 2-3 fingers
Differential: lymphoma or melanoma or upper limb infection
What nodes are known as tumor draining nodes
epitrochlear and axillary nodes
Where is lice more likely to be located
at the nape (base of the neck)
What is the light reflex test assessing and what might you be concerned about
assessing brain stem function; might be concerned of possible lesion or tumor at the brain stem
What drug class can cause an abnormal light reflex
barbituates
