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CABS III > HEENT > Flashcards

HEENT Flashcards

1
Q

function of mucous

A

aids in warming and humidifying inhaled air, traps debris, helps with olfaction

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2
Q

mucous contains

A

immunoglobulins (antibodies), lysozymes, and lactoferrin (a protein that binds iron and has immunological properties making it antiviral and antibacterial)

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3
Q

eustachian tubes

A

connections from the tympanic membrane (middle ear) to the nasopharynx which are normally closed but can be opened by several muscles (more horizontal at an angle of 10 degrees in children versus 45 degrees in adults)

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4
Q

function of eustachian tubes

A

equalize pressure, oxygenate tympanic membrane, and drain fluid

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5
Q

crista galli

A

midline upward projection above the cribriform plate of the ethmoid bone which is the attachment site for the dura mater of the meninges

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6
Q

blood vessel that supplies most of the nose and mouth

A

external carotid artery which branches into facial artery

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7
Q

Kiesselbach’s plexus

A

group of arteries in the anterior septal region formed from small arterial branches off of the sphenopalatine and facial arteries

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8
Q

most common site for epistaxis

A

Kiesselbach’s plexus (anterior aspect of nares)

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9
Q

Woodruff’s plexus

A

group of arteries in the posterior septal region formed from small arterial branches off of the sphenopalatine artery

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10
Q

Bowman’s glands

A

secrete mucous onto the olfactory membrane that aids in trapping odors/chemicals which stimulate neural receptors

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11
Q

olfactory epithelium contains

A

basal cells, olfactory sensory neurons, and supporting epithelial cells (sustentacular cells)

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12
Q

location of olfactory bulb

A

above the cribriform plate of the ethmoid bone

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13
Q

location of olfactory epithelium

A

below the cribriform plate of the ethmoid bone folding down along the nasal septum and over the superior turbinate laterally

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14
Q

visceral responses to smell involve

A

the medial olfactory area (anterior to the hypothalamus) and the reticular formation

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15
Q

complex responses to smell (linking to memory and emotion) involve

A

the amygdala and hippocampus

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16
Q

function of paranasal sinuses

A

assist with further humidification and warming of air during inspiration, improve vocal resonance, and reduce weight of the skull

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17
Q

paranasal sinuses

A

maxillary, frontal, sphenoidal, and ethmoidal

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18
Q

largest of the paranasal sinuses

A

maxillary sinus

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19
Q

hiatus semilunaris

A

where the maxillary and frontal sinuses connect to (and drain into) the nasal cavity

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20
Q

inferior border of maxillary sinus

A

nasal cavity and teeth

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21
Q

superior border of maxillary sinus

A

inferior wall of ortbit

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22
Q

normal number of permanent (adult) teeth

A

32, numbered beginning from posterior upper right and ending at the posterior lower right

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23
Q

normal number of primary teeth in children

A

20, labeled A-T beginning from the posterior upper right and ending at the posterior lower right

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24
Q

ridges on posterior tongue

A

valate papilla

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25
Q

ridges on anterior tongue

A

fungiform papilla

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26
Q

posterior arch (behind uvula) in oral cavity

A

pharyngopalatine arch

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27
Q

palatoglossus (palatoglossal arch)

A

tongue muscle that is attached to the palatine aponeurosis at the top and the side of the tongue at the bottom which receives motor innervation from the pharyngeal branch of the vagus nerve instead of the hypoglossal nerve

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28
Q

most sensitive component of taste

A

bitter - requires the least amount of chemical to stimulate

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29
Q

sense of taste requires

A

chemical activation of taste buds

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30
Q

number of taste cells contained within a taste bud

A

100 taste cells

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31
Q

taste pore

A

made up of taste cells coming together with microvilli which receive chemical stimulation causing depolarization of the cell and change in electrical potential

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32
Q

nerve responsible for taste in anterior 2/3 of tongue

A

facial nerve

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33
Q

nerve responsible for taste in posterior aspect of tongue

A

glossopharyngeal nerve and vagus nerve

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34
Q

synapse pathway of taste signals carried by the facial, glossopharyngeal, and vagus nerve through the CNS

A

first synapse in the solitary nucleus of the medulla oblongata, then cross over and enter the medulla lemniscus of the medulla oblongata, then synapse in the thalamus, and finally, the information is projected to the gustatory cortex of the insula

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35
Q

location of taste reflexes that stimulate saliva production

A

within the brain stem

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36
Q

tonsils

A

made of lymphoid tissue and contain memory immune cells (T and B cells) and crypts that entrap and destroy bacteria which protect against inhaled or ingested pathogens

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37
Q

location of palatine tonsils

A

between the palatoglossal and palatopharyngeal arches

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38
Q

location of pharyngeal tonsils (adenoids)

A

superior and posterior to the uvula in the posterior nasopharynx attached to the sphenoid - only present in young children (reach maximal size by 3-5 years and start to shrink by 7-8 years)

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39
Q

major salivary glands

A

parotid, submandibular, and sublingual glands

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40
Q

type of cells that produce saliva

A

acinar cells

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41
Q

salivary glands are innervated by

A

the facial and glossopharyngeal nerves

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42
Q

glottis

A

opening to the trachea that lies within the larynx and contains the vocal cords (folds)

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43
Q

epiglottis

A

a flap of cartilage that lies above the glottis and over the trachea to protect the airway from food and fluids during swallowing

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44
Q

cricoid cartilage

A

inferior to thyroid cartilage and marks the end of the larynx

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45
Q

Arytenoid and Corniculate cartilages serve as

A

sites for attachment of muscles that regulate tension on the vocal cords and aid in closing the larynx during swallowing

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46
Q

Epiglottic cartilage attaches to

A

the thyroid cartilage and supports the epiglottis

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47
Q

primary function of the larynx

A

voice production/speech

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48
Q

function of vestibular folds (false vocal cords)

A

close off glottis to keep food out

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49
Q

function of vocal folds (true vocal cords)

A

create sound waves through vibration during exhalation when laryngeal muscles pull them across the trachea opening creating tension

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50
Q

risk factors for posterior epistaxis

A

comorbidities associated with the elderly including HTN, atherosclerosis, and anticoagulation

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51
Q

septal hematoma

A

bleeding between the perichondrium and the cartilage of the nasal septum which is usually a result of nasal trauma (occurring 24-72 hours after trauma)

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52
Q

serious complications of septal hematoma

A

septal necrosis and saddle nose deformity or possibly abscess formation causing nasal discomfort, obstruction, rhinorrhea, and fever

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53
Q

rhinitis symptoms

A

sneezing, rhinorrhea, congestion, nasal itching, and coughing

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54
Q

most common cause of rhinitis

A

allergies

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55
Q

atopic triad

A

asthma, eczema (atopic dermatitis), allergies

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56
Q

allergic rhinitis

A

IgE-mediated response associated with inhaled allergens that causes mast cell degranulation and histamine release eventually leading to cytokine influx and infiltration of eosinophils and WBCs resulting in mucosal edema and congestion

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57
Q

allergic rhinitis presentation

A

nasal itching, fatigue due to poor sleep, pale and edematous nasal mucosa, clear rhinorrhea, sneezing, and congestion

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58
Q

non-allergic rhinitis

A

mucosal edema which is usually triggered by strong smells, smoke exposures, temperature changes, or spicy foods causing rhinorrhea and congestion but otherwise feeling well

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59
Q

sinusitis

A

inflammation of the paranasal sinuses most commonly associated with viral URI resulting in edema, mucous production, and obstruction of sinus outflow tract creating pools of stagnant fluid which can eventually lead to bacterial sinusitis

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60
Q

main cause of orbital cellulitis

A

ethmoid sinusitis

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61
Q

acute sinusitis

A

sudden onset of symptoms which lasts < 4 weeks

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62
Q

subacute sinusitis

A

symptoms that last > 4 weeks but < 12 weeks

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63
Q

recurrent sinusitis

A

4 or more episodes (last at least 1 week) of sinusitis within 1 year

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64
Q

chronic sinusitis

A

symptoms lasting > 12 weeks

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65
Q

risk factors for sinusitis

A

anatomical abnormalities including a deviated septum, nasal polyps, trauma, decreased mucous transport due to CF or ciliary dyskinesia, immunodeficiency, body positioning, cocaine, barotrauma, smoking, oxygen use, or NG tube

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66
Q

bacterial sinusitis presentation

A

worsening symptoms for > 10 days and headache, fever, purulent nasal discharge with pain and pressure over the affected sinuses (maxillary usually)

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67
Q

complications of bacterial sinusitis

A

periorbital cellulitis and meningitis or cerebral abscess

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68
Q

aphthous ulcer (canker sore)

A

not completely understood but due to local cell-mediated immune response involving macrophage, lymphocyte, and neutrophil activation typically occurring during times of stress

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69
Q

candidiasis

A

fungal infection with candida albicans (gram-positive yeast with pseudohyphae) which thrives in warm, moist, and dark areas such as in the mouth or skin folds - if recurrent in adults, consider immunocompromised state like HIV or inhaled corticosteroids

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70
Q

thrush

A

candida albicans infection of the mouth in which overgrowth produces pseudomembrane that can be scraped off with a tongue depressor

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71
Q

thrush presentation

A

white pseudomembrane, erythema, discomfort, cotton feeling in the mouth, diminished taste, discomfort eating/swallowing, often associated with angular cheilitis bilaterally

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72
Q

pharyngitis

A

inflammation of the oropharynx mucous membranes causing edema and pain most commonly due to viral (rhinovirus, influenza, adenovirus) or bacterial infection (group A strep, chlamydia, H. influenzae, N. gonorrhea) but can also be associated with allergies, reflux, toxic exposure, and cancer

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73
Q

tonsillitis

A

inflammation of the tonsils due to viral or bacterial pathogens that cause cytokine release leading to increased vascular permeability, swelling, irritation of tonsillar tissue and nasal tissue (if viral), fever, and tonsillar exudate (if GAS)

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74
Q

complications of GAS tonsillitis

A

peritonsillar abscess, neck abscess, otitis media, sinusitis, pneumonia, scarlet fever, bacteremia, osteomyelitis, meningitis, arthritis, erythema nodosum, hepatitis, acute rheumatic fever, and toxic shock syndrome

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75
Q

laryngitis

A

inflammation of vocal cords due to viral (most common) or bacterial (M. catarrhalis, H. influenzae, S. pneumo) infection or yelling/singing/straining voice

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76
Q

acute laryngitis

A

symptoms lasting < 3 weeks

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77
Q

chronic laryngitis

A

symptoms lasting > 3 weeks and usually associated with irritants or laryngopharyngeal reflux

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78
Q

laryngitis presentation

A

PND, cough, sore throat, inflammation, edematous vocal cords, change in vibration of cords, change in voice quality/pitch (deeper)

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79
Q

fibrous tunic of the eye contains

A

cornea and sclera

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80
Q

vascular tunic (uvea) of the eye contains

A

iris, choroid, and ciliary body

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81
Q

sensory/neural tunic of the eye contains

A

retina containing photoreceptors

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82
Q

function of cornea

A

assists with focusing light and protecting the eye

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83
Q

cornea structure

A

clear, avascular, and outer layer contains nociceptors

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84
Q

normal intraocular pressure (IOP)

A

10 - 21

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85
Q

sclera structure

A

white aspect surrounding the eye made of dense connective tissue that connects to the cornea at the limbus and is more thin anteriorly

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86
Q

function of sclera

A

assists with protection and shape of the eye and is the point of attachment for eye muscles

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87
Q

lamina fusca

A

innermost layer of the sclera that absorbs light waves and prevents light from scattering

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88
Q

superior oblique eye muscle movement

A

down and medial

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89
Q

inferior oblique eye muscle movement

A

up and lateral

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90
Q

inferior rectus eye muscle movement

A

down and medial

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91
Q

superior rectus eye muscle movement

A

up and medial

92
Q

lateral rectus eye muscle movement

A

lateral

93
Q

medial rectus eye muscle movement

A

medial

94
Q

oculomotor nerve or CN III eye muscles

A

superior, inferior, and medial rectus and inferior oblique

95
Q

trochlear nerve or CN IV eye muscles

A

superior oblique

96
Q

abducens nerve or CN VI eye muscles

A

lateral rectus

97
Q

iris function

A

part of the vascular tunic of the eye which is responsible for eye color, creates the pupil, and separates the anterior and posterior chambers of the eye

98
Q

iris innervation

A

oculomotor nerve or CN III

99
Q

dilator pupillae function

A

mydriasis (pupil dilation) through sympathetic innervation

100
Q

sphincter pupillae function

A

miosis (pupil constriction) through parasympathetic innervation

101
Q

choroid function

A

part of the vascular tunic that wraps from the ciliary body around the posterior aspect of the eye which delivers nutrients to the photoreceptor neurons and assists with preventing reflection or scattering of light through light absorption

102
Q

ciliary body function

A

part of the vascular tunic of the eye which attaches to the lens and changes its shape by pulling on suspensory ligaments (allowing for near and far accommodation) and secretes aqueous humor filling the anterior chamber

103
Q

lens function

A

transparent structure made up of a capsule, epithelium, and fibers that refracts light and can be pulled to alter the shape and focus light for accommodation via the ciliary body

104
Q

function of the aqueous humor

A

created in the ciliary body through plasma filtration (constantly secreted and reabsorbed) functioning to maintain intraocular pressure and bring nutrients to the avascular aspect of the anterior eye

105
Q

function of the vitreous humor

A

thick, jelly-like fluid in the posterior aspect of the eye functioning to maintain intraocular pressure, hold the eye shape, and transmit light to the retina

106
Q

canal of Schlemm

A

location at which aqueous humor drains from the anterior chamber of the eye and enters the venous system (episcleral vein)

107
Q

the major artery supplying the eye

A

the internal carotid artery which branches into the ophthalmic, posterior ciliary, and central retinal arteries

108
Q

bones comprising the orbital floor

A

maxillary, zygomatic, and palatine bones

109
Q

bone comprising the orbital roof

A

frontal and sphenoid bones

110
Q

lacrimal gland function

A

located above the eye laterally functioning to secrete fluid that moves across the cornea and drains into the upper and lower lacrimal punctum and lacrimal canaliculi

111
Q

nasal lacrimal duct

A

where fluid from the lacrimal duct and sac drain into the nasal cavity

112
Q

meibomian gland function

A

glands that run along the edge of the eyelid that secrete oil which prevents tears from evaporating too quickly and assists with lubricating the eye, there are about 20-30 in the lower eyelid and 40-50 in the upper eyelid

113
Q

macula lutea

A

the area of the retina with the highest visual acuity with the central aspect being the fovea which contains only cones

114
Q

retina components

A

photoreceptors consisting of rods and cones, bipolar cells, and ganglion cells (axons of ganglion cells form optic nerve)

115
Q

cone photoreceptor function

A

contain photopsin, help to identify different colors of the visible light spectrum (red, green, and blue), and are responsible for visual acuity under well lit conditions (photopic vision)

116
Q

rod photoreceptor function

A

contain rhodopsin, help to identify black/white/gray in poorly lit environments, and are responsible for night vision

117
Q

pathway of light through the retina

A

a photon first strikes the photoreceptor causing a chemical change within the rhodopsin or photopsin, this causes a cellular change allowing for ion exchange and hyperpolarization of the cell, the cell then releases glutamate which stimulates bipolar cells which release more glutamate, this triggers an action potential which stimulates ganglion cells and the optic nerve

118
Q

location of a lesion causing total loss of vision in one eye

A

complete lesion on the optic nerve - optic neuritis, ocular stroke

119
Q

location of a lesion causing bitemporal hemianopia

A

lesion of the optic chiasm (chiasmal lesion) - pituitary tumor

120
Q

location of a lesion causing nasal hemianopia

A

lesion of the outer edge of the optic chiasm

121
Q

location of a lesion causing homonymous hemianopia

A

lesion of the optic tract prior to the lateral geniculate nucleus

122
Q

location of a lesion causing homonymous hemianopia with macular sparing

A

lesion of the occipital cortex contralateral to side of vision loss causing the least amount of symptoms due to macular sparing

123
Q

hemianopia

A

loss of one half of vertical visual field

124
Q

anisocoria

A

asymmetric pupil size

125
Q

relative afferent pupillary defect

A

defect in direct response due to nerve damage or severe retinal disease assessed with swinging flashlight test

126
Q

Argyll Robertson pupil

A

seen with neurosyphilis where pupils will not constrict with light but will with accommodation

127
Q

OD

A

right eye

128
Q

OS

A

left eye

129
Q

path of visual stimuli from the retina to the occipital cortex

A

the retina receives input from the opposite side of each eye and visual stimulation travels along the ipsilateral side of the optic nerve, when it reaches the optic chiasm the nasal hemiretina decussate but the temporal hemiretina continue on the ipsilateral side putting the same visual field on the same side for processing, once together they form the right and left visual tracts which pass through the lateral geniculate nuclei where some fibers terminate (reflexive eye movements), the remaining fibers go to the occipital lobe for visual processing

130
Q

corneal abrasion presentation

A

damage to the cornea by mechanical or chemical mechanisms causing a foreign body sensation, photophobia, tearing, and significant eye pain

131
Q

corneal healing process

A

corneal abrasions typically heal within 24-48 hours due to regeneration at the limbus and quick cell turnover

132
Q

complications of corneal abrasion

A

increased risk for bacterial, viral, and fungal eye infections and inflammatory iritis

133
Q

corneal ulcers

A

infection that goes through multiple layers of the cornea associated with trauma, contact lens wear, and dry eyes that is most commonly caused by S. pneumonia, Pseudomonas, and S, aureus infection

134
Q

corneal ulcer presentation

A

severe pain, foreign body sensation, eye discharge, injection of the lid and conjunctiva, and blurry vision (possible visual acuity change depending on location of ulcer)

135
Q

keratitis

A

surrounding inflammation of the cornea that is involved in the development and progression of corneal ulcers and can lead to loss of vision and corneal clouding

136
Q

conjunctivitis

A

inflammation of the conjunctiva most commonly caused by viral infection and associated with adenovirus, measles, influenza, and mumps in which patient often has prior viral illness

137
Q

conjunctivitis presentation

A

tearing, conjunctival injection, irritation (not much pain), clear discharge, may see follicles on slit lamp exam, it can start in one way and eventually affect the other eye as well

138
Q

Hutchinson’s sign

A

herpetic lesions or shingles along the division of the trigeminal nerve causing herpetic lesions on the nose and eventually leading to viral keratoconjunctivitis (due to herpes simplex or herpes zoster), this can cause corneal scarring and eventual loss of vision if not treated

139
Q

bacterial conjunctivitis presentation

A

most commonly caused by S. aureus, S. pneumoniae, H. influenzae, and M. catarrhalis (Pseudomonas if contact lens used) and will present similar to viral conjunctivitis but with more mucopurulent discharge often causing lid adherence

140
Q

hyperacute bacterial conjunctivitis

A

severe diffuse sight-threatening infection with rapid onset (< 12 hours) most commonly associated with N. gonorrhea causing severe eye pain, preauricular lymphadenopathy, and often presenting with urethritis

141
Q

allergic conjunctivitis

A

IgE-mediated hypersensitivity leading to local mast cell degranulation and allergic reaction that is typically bilateral, can see associated chemosis, and can have other accompanying allergic symptoms such as sneezing, rhinorrhea, and congestion

142
Q

pterygium

A

a proliferative disorder hallmarked by the abnormal growth of fibrovascular conjunctival tissue associated with large amounts of UV light exposure resulting in alteration of the limbus and increased angiogenesis which most commonly starts along the nasal aspect of the eye and reaches toward the cornea (can grow over months to years) causing inflammation

143
Q

risk factors for pterygium

A

UV light exposure, abnormal tumor suppressor gene p53, HPV infection, and HLA expression

144
Q

dacryocystitis

A

inflammation of the lacrimal sac most commonly due to Staphylococcus and Streptococcus infection after viral URI causing mucopurulent discharge and erythema along the inferomedial aspect of the eye which can lead to periorbital or orbital cellulitis if not treated

145
Q

cataracts

A

degenerative changes of the crystalline proteins within the lens due to photo-oxidative damage and old cells being compressed centrally resulting in opacification of the lens and loss of transparency - can be age-related or non-age-related (due to trauma, uveitis, scleritis, radiation, and meds)

146
Q

risk factors for cataracts

A

age, sunlight, smoking, ETOH, poor nutrition, metabolic syndrome, DM, HIV, high dose steroid use

147
Q

entropion

A

internal folding of the lower eyelid that may be associated with age, tissue relaxation, or post-infectious (m/c Chlamydia trachomatis) and presents with foreign body sensation (due to lashes rubbing against eye), pain, and tearing

148
Q

ectropion

A

eversion of the lower eyelid that may be associated with age or tissue relaxation which presents with tearing and dry eyes

149
Q

chalazion

A

non-infectious occlusion or obstruction of a meibomian gland in the eyelid due to thick secretions which begins with inflammation and swelling and gives way to a non-tender nodule (usually absorbs over 2-8 weeks)

150
Q

hordeolum

A

infection of a meibomian gland (internal) or a gland of Zeis or Moll (external) most commonly associated with Staphylococcus that can obstruct the eyelash follicle or their glands (Zeis or Moll) and creates a yellow pustule at the base of the lash with surrounding erythema and edema (usually resolves in 2-4 days), can lead to blepharitis if lash follicle is obstructed

151
Q

orbital cellulitis

A

life-threatening and vision-threatening infection of the orbit including surrounding fat and ocular muscles similar to compartment syndrome most commonly due to S. aureus and strep infection that causes pain with eye movement, fever, normal visual acuity that may decrease with time, and possibly proptosis (does not involve the eye globe)

152
Q

location at which bacterial rhinosinusitis can spread to the orbit

A

ethmoid sinuses via the lamina papyracea

153
Q

optic neuritis

A

inflammation that causes demyelination of the optic nerve secondary to immune-mediated reactions involving systemic T cell activation which releases cytokines and B cell activation against myelin (formed by oligodendrocytes)

154
Q

causes of optic neuritis

A

classically MS, can also be due to a viral infection, post-vaccination, inflammation of surrounding structures due to an infection, syphilis, tuberculosis, and sarcoidosis

155
Q

afferent pupillary defect

A

when the light does not get through to the CNS preventing constriction of the pupils when light is pointed in the affected eye, associated with pathology of the optic nerve and optic neuritis (if not present, rules out optic neuritis)

156
Q

glaucoma

A

increased intraocular pressure ( > 21 mmHg) due to obstruction of the canal of Schlemm preventing drainage of aqueous humor from the anterior chamber of the eye which causes optic neuropathy, decreased vascular flow to the retina, and visual loss

157
Q

acute angle closure glaucoma

A

when the lens or peripheral iris blocks the meshwork or canal of Schlemm which results in increased pressure of fluid coming from the ciliary body bowing the iris and closing the outflow tract further, referred to as a pupillary block (more common in people with shallow anterior chambers)

158
Q

acute angle closure glaucoma presentation

A

monocular eye pain, blurry vision loss, headache, conjunctival injection with cloudy cornea, and markedly increased intraocular pressure (maybe > 40 mmHg)

159
Q

causes of papilledema

A

blurred optic disc margins caused by increased ICP due to malignant hypertension, pseudotumor cerebri, intracranial tumors, intracranial hemorrhage, hydrocephalus

160
Q

macular degeneration

A

degenerative disease of the central aspect of the retina (macula lutea) characterized by macular drusen deposits (yellow deposits made of lipids and proteins) that typically starts out as atrophic or “dry” and becomes “wet” as it progresses, resulting in neovascularization, inflammation, and the formation of leaky vessels, causing painless monocular or binocular central vision loss or visual distortion

161
Q

risk factors for macular degeneration

A

increased age, smoking, CVD, HTN, obesity, and sun exposure (may be genetically linked)

162
Q

retinal detachment

A

photoreceptor degeneration caused by detachment of the neurosensory retina from the retinal pigment epithelium layer or choroid which typically occurs spontaneously but can also be associated with trauma, it is most commonly due to vitreous detachment leading to cobweb floaters visualized by patients and can progress over hours to weeks becoming vision-threatening (more likely to progress if tear is along superior aspect, is initially a larger tear, or if the patient moves head/eyes too much)

163
Q

optic neuritis presentation

A

subacute, painful, central vision loss with ranging severity typically coming on over days, sometimes hours

164
Q

retinal detachment presentation

A

acute, painless, progressive, peripheral unilateral vision loss typically with floaters initially and then “curtain coming down” peripherally

165
Q

most common type of retinal detachment

A

rhegmatogenous caused by a hole/tear in the inner neuronal layer causing fluid accumulation between the retinal layers and in the tear pushing the surrounding retina outward and separating it from the pigmented epithelium

166
Q

traction retinal detachment

A

caused by fibrosis/fibrovascular proliferation which leads to scar tissue buildup which pulls off the retina and usually more chronic in presentation

167
Q

exudative/serous retinal detachment

A

caused by the accumulation of subretinal fluid from infection or inflammation (classically) or blood from a retinal vessel that pushes the retina away from its typical anatomic position

168
Q

first branch off the internal carotid artery

A

ophthalmic artery

169
Q

function of ophthalmic artery

A

branches into the central retinal artery (feeds the inner aspect of the retina) and posterior ciliary artery (feeds the macula)

170
Q

central retinal artery occlusion presentation

A

sudden, painless, monocular vision loss where initial symptoms may include amaurosis fugax (sudden transient curtain drop-like vision loss) due to embolus from proximal atherosclerotic disease (associated with carotid disease)

171
Q

central retinal artery occlusion fundoscopic exam findings

A

pale, translucent, and edematous retina where the macula will have intact choroidal circulation (supplied by posterior ciliary artery) and will stand out against the pale retina, referred to as a “cherry red spot”

172
Q

color blindness

A

an x-linked recessive disorder causing an individual to have difficulty discriminating between different colors (typically red-green), especially in dim-lit environments due to low number or lack of certain pigments of cones (typically green) resulting in them seeing gray shades instead of color

173
Q

the external ear canal is lined with

A

keratinized squamous epithelium

174
Q

location of ceruminous glands

A

within the cartilaginous section of the external ear canal

175
Q

function of cerumen

A

acidotic with antimicrobial effect, traps/deters insects, and is hydrophobic

176
Q

location of the umbo

A

middle of the tympanic membrane

177
Q

location of the incus

A

posterior and superior or to the umbo

178
Q

location of the short process of malleus

A

superior to the umbo

179
Q

location of the stapes

A

posterior to the umbo

180
Q

the middle ear is lined with

A

respiratory mucosa

181
Q

age when eustachian tubes become adult size

A

age 6 years

182
Q

length of eustachian tubes

A

36-38 mm

183
Q

eustachian tube muscle function

A

allow for dilation of eustachian tubes

184
Q

effect of ascent on TM

A

ascent causes ear canal pressure to decrease which results in outward bulging of the TM (eustachian tube opens allowing pressure to equalize and TM moves back to normal position)

185
Q

organ of Corti (cochlea) function

A

located within the cochlea where it converts sound waves into nerve impulses and transmits stimuli via the cochlear branch of the vestibulocochlear nerve

186
Q

vestibule function

A

includes the semicircular canals, utricle, and saccule which give us position sense and transmit stimuli via the vestibular branch of the vestibulocochlear nerve

187
Q

components of the inner ear

A

the semicircular canals, utricle, saccule, cochlea which contains the organ of Corti, and the vestibulocochlear nerve

188
Q

components of the middle ear

A

the malleus, incus, stapes, oval window, and eustachian tube opening along with its associated muscles (tensor tympani muscle)

189
Q

pathway of sound through the ear

A

sound from the outside world first strikes the TM causing vibration of the malleus, incus, and stapes which vibrates the oval window of the cochlea transmitting movement via cochlear endolymph which moves the tectorial membrane which causes hair cells with stereocilia to move on the organ of Corti converting movement into nerve impulses (through glutamate release) moving the signal up the spiral ganglion to synapse on the cochlear nerve

190
Q

the utricle generates action potentials for

A

linear acceleration/head movements

191
Q

the saccule generates action potentials for

A

vertical acceleration/head movements

192
Q

location of utricle within inner ear

A

abutting the semicircular canals

193
Q

location of saccule within inner ear

A

abutting the cochlea

194
Q

vestibular system function

A

sensory hair cells called maculae within the utricle and saccule which are covered with gelatinous substance and otoliths create action potentials from mechanical movements (head movements) during which the otoliths and fluid move with gravity displacing the hair cells and triggering action potential to vestibular ganglion

195
Q

semicircular canals contain

A

endolymph

196
Q

crista ampullaris

A

a bulbous structure at the end of each semicircular canal which is the sensory aspect of the canals that contains hair cells and a cupula that generate action potentials when head movements occur (travel along vestibular ganglion)

197
Q

test that can be used to differentiate between peripheral and central causes of vertigo

A

HINTS exam - include the Head impulse test, Nystagmus test, and Test of Skew

198
Q

otitis externa

A

AKA swimmer’s ear, inflammatory process of the external auditory canal caused by infection (most commonly Pseudomonas and Staphylococcus), allergic, or dermatologic pathology leading to itching, irritation, scratching, and further breakdown causing decreased cerumen production and a more alkalotic pH in the canal which leads to bacteria growth

199
Q

otitis externa presentation

A

otalgia, pruritis, ear discharge, may have decreased hearing secondary to partial occlusion, and pain with external manipulation of the ear

200
Q

otitis media

A

inflammation of the middle ear commonly due to prior upper respiratory mucosa inflammation causing a narrowed eustachian tube isthmus preventing the middle ear from draining and leading to increased fluid accumulation and organism overgrowth, most commonly caused by viral infections with RSV, rhinovirus, enterovirus, and coronavirus but can also be due to bacterial infection with S. pneumonia, H. influenza, and M. catarrhalis (H. influenza is m/c in bilateral AOM)

201
Q

risk factors for otitis media

A

age 6 - 12 months due to eustachian tube anatomy, genetic disposition, exposure to pollutants such as tobacco smoking, bottle feeding due to increased colonization

202
Q

most common cause of TM perforation/rupture

A

suppurative AOM

203
Q

ruptured TM will typically heal spontaneously over 4 weeks if

A

defect is less than 25% of TM

204
Q

mastoiditis

A

suppurative infection of mastoid air cells which is a complication of AOM where purulent fluid within the mastoid can cause an abscess destroying bone and the infection can spread to the cranial nerves, temporal bone, and the CNS

205
Q

mastoiditis presentation

A

worsening AOM, pain over mastoid process posterior to the ear, fever/chills, otalgia, post-auricular erythema and tenderness

206
Q

eustachian tube dysfunction

A

dysfunction typically occurs at the cartilaginous part of the eustachian tube, not the bony portion, secondary to functional issue or obstruction, causing an inability to regulate middle ear pressure (creating negative pressure in the ear) most commonly associated with edema but also can be poor muscular function

207
Q

eustachian tube dysfunction presentation

A

otalgia, retracted TM, effusion, decreased pneumatic changes, hearing diminished

208
Q

acoustic neuroma

A

a very slow growing benign tumor of the Schwann cells of the vestibulocochlear nerve that most commonly occurs at the porus acusticus (where cells transition from the CNS to PNS) at the superior and inferior branches

209
Q

acoustic neuroma presenting in pediatric population is concerning for

A

neurofibromatosis type 2 (NF2) which affects chromosome 22 and leads to defect in tumor suppressor gene within Schwann cells (acoustic neuromas are typically bilateral in this population)

210
Q

acoustic neuroma presentation

A

symptoms associated with mass effect and compression on cranial nerves, decreased hearing and tinnitus if cochlear nerve is involved, gait instability if vestibular nerve is involved, facial paresthesia and pain if trigeminal nerve is involved, change in taste and facial paralysis if facial nerve involved, ataxia if continues to grow and compresses cerebellum and brain stem

211
Q

benign paroxysmal positional vertigo (BPPV)

A

most commonly caused by calcium debris in the semicircular canal or canalithiasis most commonly affecting the posterior canal and causing false activation of hair cells similar to that of endolymph moving when there is a real stimulus resulting in a false sense of spinning with an idiopathic origin

212
Q

causes of BPPV

A

usually idiopathic but can also be due to Meniere’s disease, trauma, vestibular neuronitis, and surgery

213
Q

BPPV presentation

A

dizziness or feeling that the “room is spinning” that lasts seconds to minutes brought on by turning or tilting the head, there may be nausea/vomiting but no change in hearing, otalgia, or tinnitus

214
Q

labyrinthitis

A

inflammation of the labyrinth including both branches of the vestibulocochlear nerve associated with viral infection or post-infectious inflammation (otitis media, meningitis, mastoiditis) causing peripheral vertigo, nausea/vomiting, and change in hearing (hearing loss) and tinnitus

215
Q

vestibular neuritis

A

inflammation of the vestibular branch of the vestibulocochlear nerve associated with viral or post-viral inflammation causing peripheral vertigo, nausea/vomiting, but does not affect hearing

216
Q

ototoxic drugs

A

salicylates (aspirin), NSAIDs, aminoglycosides (gentamicin, neomycin), erythromycin, vancomycin, quinidine, loop diuretics (furosemide), chemotherapeutic agents

217
Q

common causes of peripheral vertigo

A

BPPV, Meniere’s, labyrinthitis, alcohol intoxication

218
Q

central causes of vertigo

A

brainstem/cerebellar tumor, stroke or hemorrhage

219
Q

tinnitus

A

perception of sounds that are not related to external stimuli

220
Q

most common cause of subjective hearing loss

A

damage to the cochlear hair cells

221
Q

conductive hearing loss

A

inability to conduct sound waves from the external ear to the inner ear due to disorder with the EXTERNAL or MIDDLE ear

222
Q

sensorineural hearing loss

A

hearing deficit due to pathology within the INNER ear

223
Q

presbycusis

A

age-related symmetrical hearing loss that reduces the ability to perceive higher-frequency sounds that may be associated with intrinsic changes such as change in mitochondrial functioning or HTN or extrinsic changes such as prolonged noise exposure, ototoxic meds, and diet

224
Q

causes of sensorineural hearing loss

A

infections such as viral cochleitis, herpes, influenza, measles, mumps, rubella, HIV, bacterial meningitis, Lyme, TB, syphilis, ototoxic meds, neoplasms, trauma, autoimmune disorders such as SLE, RA, Sjogren’s, Kawasaki, temporal arteritis, vascular injuries such as CVA, TIA, cerebellar infarct, Meniere’s disease, otosclerosis, MS, sarcoidosis, and hypothyroidism

225
Q

Meniere’s disease

A

a disease characterized by increased endolymph pressure, referred to as endolymphatic hydrops, resulting in distortion and distention of the endolymph-containing portions of the labyrinthine system due to trauma, chronic OM, congenital hearing defect, otosclerosis, Paget disease, post-surgical complication, syphilis, or viral labyrinthitis

226
Q

Meniere’s presentation

A

typically patients between the age of 20 - 40 years present with sudden episodic vertigo, unilateral tinnitus, and muffled hearing or hearing loss (may also have aural fullness outside of the above classic triad)

CABS III (5 decks)

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