ENT Chapter Flashcards
The nurse is examining a patient’s ears and notices cerumen in the external canal. Which of these statements about cerumen is correct?
A. Sticky honey-colored cerumen is a sign of infection.
B. The purpose of cerumen is to protect and lubricate the ear.
C. The presence of cerumen is indicative of poor hygiene.
D. Cerumen is necessary for transmitting sound through the auditory canal.
B. The purpose of cerumen is to protect the ear
A 31-year-old patient tells the nurse that he has noticed pain in his left ear when people speak loudly to him. The nurse knows that this finding:
A. is a characteristic of recruitment.
B. may indicate a middle ear infection.
C. is normal for people of that age.
D. indicates that the patient has a cerumen impaction.
A. Characteristic of recruitment
A colleague is assessing an 80-year-old patient who has ear pain and asks him to hold his nose and swallow. The nurse knows that which of the following is true concerning this technique?
A. This is especially useful in assessing a patient with an upper respiratory infection.
B. This should not be used in an 80-year-old patient.
C. This technique is helpful in assessing for otitis media.
D. This will cause the eardrum to bulge slightly and make landmarks more visible.
B. This should not be used in an 80 year old
The projections in the nasal cavity that increase the surface area are called the:
A. septum.
B. meatus.
C. Kiesselbach plexus.
D. turbinates.
D. Turbinates
The nurse is doing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale, gray, and swollen. What would be the most appropriate question to ask the patient?
A. “Have you been having frequent nosebleeds?”
B. “Do you have an elevated temperature?”
C. “Have you had any symptoms of a cold?”
D. “Are you aware of having any allegies?”
D. Are you aware of having any allergies
When assessing the tongue of an adult, the nurse knows that an abnormal finding would be:
A. a thin white coating over the tongue.
B. visible venous patterns on the ventral surface.
C. a smooth glossy dorsal surface.
D. raised papillae on the dorsal surface.
C. Smooth glossy tongue
Which of these techniques best describes the test the nurse should use to assess the function of cranial nerve X?
A. Assess movement of the hard palate and uvula with the gag reflex.
B. Ask the patient to say “ahhh” and watch for movement of the soft palate and uvula.
C. Have the patient stick out the tongue and observe for tremors or pulling to one side.
D. Observe the patient’s ability to articulate specific words.
B. Ask the patient to say Ahh
The nurse is performing a middle ear assessment on a 15-year-old patient who has a history of chronic ear infections. When examining the right tympanic membrane, the nurse sees the presence of dense white patches. The tympanic membrane is otherwise unremarkable. It is pearly, with the light reflex at 5 o’clock and landmarks visible. The nurse should:
A. consider that these findings may represent the presence of blood in the middle ear.
B. know that these are scars caused from frequent ear infections.
C. refer the patient for the possibility of a fungal infection.
D. be concerned about the ability to hear because of this abnormality on the tympanic membrane.
B. Know that these scars are caused by frequent ear infections
During an interview, the patient states he has the sensation that “everything around him is spinning.” The nurse recognizes that the portion of the ear responsible for this sensation is:
A. the cochlea.
B. cranial nerve VIII.
C. the labyrinth.
D. the organ of Corti.
C. The labyrinth
The nurse is assessing an 80-year-old patient. Which of these findings would be expected for this patient?
A. An increased production of saliva
B. Finer and less prominent nasal hair
C. A decreased ability to identify odors
D. Hypertrophy of the gums
C. A decreased ability to identify odors
When assessing the tongue of an adult, the nurse knows that an abnormal finding would be:
A. visible venous patterns on the ventral surface.
B. a smooth glossy dorsal surface.
C. raised papillae on the dorsal surface.
D. a thin white coating over the tongue.
B. a smooth glossy dorsal surface..
What is the most common cause of conductive hearing loss in adults between the ages if 20-40 years of age?
Otosclerosis
Wet cerumen
Wet cerumen is honey brown to dark brown and moist. Occurs in Caucasians and African Americans.
Any discharge from your ears?
Ask patient if their is any relationship between the discharge and the ear pain?
dry Cerumen
Dry cerumen is gray, flaky, and frequently found in Asians and American Indians
What is presbycusis?
A gradual onset over the years, whereas a trauma sudden loss is often sudden. REFER any SUDDEN loss in one or both ears NOT associated with upper respiratory infection (URI)
What is tinnitus?
Tinnitus is ringing, crackling,or buzzing in your ears.
Tinnitus
Many medications have ototoxic sequale so be sure to ask if they are taking any medications.
What is recruitment?
A marked loss when speech is at low intensity, but sound actually becomes PAINFUL when the speaker repeats in a loud voice.
Vertigo
Ever felt vertigo; that is, the room spinning around or yourself spinning? (Vertigo is a true twirling motion)
Objective vertigo
Feels like the room spins
Subjective vertigo
Person feels like he or she spins
Distinguish true vertigo from dizziness or light headed ness
Inspect and palpate the external ear
The ears are equal bilaterally with no swelling or thickening.
Ears of unusual size and shape may be normal due to family trait and not of any clinical significance.
Skin condition
The skin color should be consistent with the face. The skin should be intact with no lumps or lesions.
Darwin’s tubercle
A small, painless nodule at the helix. This is NOT significant!
Tenderness of the ear
Pinna and trays should feel firm and free of pain. Palpate the mastoid process and that should be pain free.
The external auditory meatus
Note the size or the opening to direct your choice or speculum for otoscope. No swelling, redness, or discharge should be present. Some cerumen is typically present
Impacted cerumen
Is a common cause of conductive hearing loss
The nurse needs to pull the portion of the ear that consists of moveable cartlidge and skin down and back when administering ear drops. This portion of the ear is called: A. Outer meatus B. Auricle C.concha D. Mastoid process
B. Auricle
A patient with a middle ear Infection asks the nurse,”what does the middle ear do”? The nurse responds by telling:
A. Interpret sounds as they enter the ear
B. Conduct vibrations of sounds to the inner ear
C. Maintain balance
D. Increase amplitude or sound for the inner ear to function
B. Conduct vibrations of sounds to the inner ear
Inspect with the otoscope
Choose the largest speculum to fit comfortably in the ear canal and attach it to an otoscope. Tilt the person’s head slightly away from you toward the opposite shoulder. Pull the pinna up and back. Hold the pinna firmly but gently. Do not release traction until you’ve finished the exam.
A 70 yr old patient tell the nurse that he has noticed that he is having trouble hearing, especially in large groups. He says he can't always tell where the sound in coming from and the words often sound mixed up. What might the nurse suspect as the cause for this change? A. Cilia becoming course and stiff B. Nerve degeneration C. Scarring of the tympanic membrane D. Atrophy of the apocrine glands
B. Nerve degeneration
The primary purpose of the ciliates mucous membrane in the nose is to:
A. Filter course particles from inhaled air
B. Warm the inhaled air
C. Filter out dust and bacteria
D. Facilitate movement of air through the nares
C. Filter out dust and bacteria
The nurse is using an otoscope to assess the nasal cavity. Which of these is correct?
A. Avoid touching the nasal septum with the speculum
B. Gently displace the nose to the side that is being examined
C.insert the speculum tip medial to avoid touching the
A. Avoid touching the nasal septum with the speculum
allows passage of air; cloed until sallowing or yawning
eustachian tube
The tympanic membrane is a translucent membrane with a _____ color and a _____.
pearly gray
prominent cone of light in the anteroinferior quadrant
the inner ear is embedded in ___. you can assess the function of the inner ear but is ____ in the examination.
bone
not accessible
air conduction is ___ than bone conduction
greater
cranial nerve ___ from each ear send signals to both sides of the brainstem
VIII
a _____ hearing loss involves a mechanical dysfunction of external or middle ear.
conductive
a decrease in mobility of the ossicles
otosclerosis
____hear loss signifies pathology of the inner ear, cranial nerve VIII, or the auditory areas of the cerebral cortex.
sensorineural (or perceptive)
a gradual nerve degeneration that occurs with aging
presbycusis
a ___ hearing loss is a combination of conductive and sensorineural types in the SAME ear.
mixed
strong, spinning, whirling sensation
vertigo
____ is common cause of conductive hearing loss in young adults between the ages of 20 and 40 years,
otosclerosis
in an aging person, the cilia lining the ear canal becomes ___.
coarse and stiff
the wet cerumen phenotype occurs more often in _____whereas dry cerumen is more frequent in ____.
caucasians and african american
asians and american indians.
___ may be directly due to ear diease or may be referred pain from a problem in the teeth or oropharynx.
otalgia
infected canal or perforated eardrum
otorrhea which can be external otitis, acute otitis media, cholestratoma
purulent, sanguineous or watery discharge
external otitis
purulent discharge
acute otitis media with perforation
dirty yellow/ gray discharge foul odor.
cholesteatoma
hold the otoscope ___ along your fingers and have the ___ along the persons cheek braced to steady the otoscope.
upside down
dorsa of your hand
the cone-shaped light reflex is prominent in the anteroinferior quadrant ( at the ____ in the right drum & the ____ in the left drum)
5 o’clock position
7 o’clock position
the ____ assess the ability of the vestibular apparatus in the inner ear to help maintain standiing balance.
romberg test
the aging adult, during otoscopy, the eardrum normally may be ___ in color and more ___, __ than in the younger adults. it also may looked ____.
whiter
opaque
duller
thickened
reddish blue discoloration and swelling of auricle after exposure to extreme cold.
frostbite
inflammation of loose, subcutaneous connective tissue. shows as thickening and induration of auricle with distorted contours.
cellulitis
location is commonly behind lobule, in the postauricular fold. a nodule with central black panctum indicated blocked sabeceous gland.
sebaceous cyst
small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contain greasy, chalky material of uric accid crystals
tophi
sign of gout
tophi
painful nodules that develop on the rim of the helix as a result of repetitive mechanical pressure or enviromental trauma. they are small, indurated, dull red, poorly defind, and very painful
chondrodermiatitis nodularis helicus
ulcerated , crusted nodule with indurated base that fails to heal. bleeds intermittently. usually occurs on the superior rim of pinna, which has the most sun exposure. may occur also in ear canal and show chronic discharge that is either serosanguineous or bloody.
carcinoma
Perforation
Typically with perforation of the ear drum, pain occurs first , stops with a popping sensation, then drainage occurs. A
Hearing loss
Can cause social isolation and lessen pleasure or leisure activities.
Environmental noise
Ask about any loud noises at home, work, or for pleasure.
Old trauma to hearing initially goes unnoticed but results in further decibel loss in years later.
Self care behaviors
Ask about self care behaviors. For example: do you clean your ears with q tips? How often? Do you have your hearing checked? If so, how often?
Aging adults ears
Coarse, wiry hairs may be present at the opening of the ear canal. The ear drum may be whiter in color and more opaque, duller than the younger adult.
Presbycusis
High tone frequency hearing loss is apparent in older adults. Condition is revealed during the whispered voice test.
Tophi
Small, whitish, yellow, hard, nontender nodules in or near helix or anti helix; contain greasy, chalky material of Uric acid crystals and are a sign of gout
Xerostomia (dry mouth)
A side effect of many drugs: antidepressants, anticholinergics, antispasmodics, anti hypertensives. Antipsychotics, etc. so make sure you ask what medications are you taking!
