NMTEE Flashcards
The nose
function
1st segment of respiratory system
function: warms, moistens, and filters inhaled air. Sensory organ for smell
The nose: external anatomy
- nares - oval openings
- vestibule - just inside each nare where it widens
- Columella - divides the two nares, continues with nasal septum inside
- ala: the lateral wing of the nose
- upper 1/3 is bone, rest is cartilage
The nose: internal anatomy
Mucus membrane: darker than oral, richer vascular supply to warm air
- septum: divides nasal cavity medially
- superior, middle, inferior turbinates- bony projections which increase surface area so more mucous membrane is available to warm, humidify and filter air
- olfactor nerve - transmits to temporal lobe to interpret smell
Sinuses -what are they
what sinuses are palpable
not palpable?
air-filled pockets in the carnium that provide mucous to the nasal cavity. Opening is narrow into nose, easily blocked which creates pressure or sinusitis.
PALPABLE
1. Frontal - above nose, medial to eyebrows
2. Maxillary - beside nose on cheeks
NOT PALPABLE
3. ethmoid - inner eye on nose
4. sphenoid- behind nose
The mouth - what makes up the oral cavity?
- palate?
- uvula?
- tongue?
- frenulum?
Oral cavity - short passage between lips, palate, cheeks and tongue. Contains teeth, gums, tongue and salivary glands. Part of respiratory and digestive system
- Hard palate: anterior roof, made of bone
- Soft palate: posterior roof, made of muscle
- uvula: projection hanging down middle of soft palate
- tongue: muscle with tastebuds (functions for mastication, swallowing, speech and tasting).
- papillae are taste buds, at back of tongue have large vallate papillae
- Frenulum: midline fold of tissue that connects tongue to floor or mouth
Salivary glands
name them, and function
function- moistens foods and starts digestion process
- parotid gland (largest)
- submandibular gland
- sublingual gland
Throat (or pharynx) - describe the parts
Throat/pharynx - area behind the mouth and nose
- Nasopharynx - behind nasal cavity, continuous with oropharynx
- Oropharynx - seperated from oral cavity by the tonsillar pillars on each side.
Tonsils - lymphatic tissue mas
- Laryngopharynx, food and air pass through before enter trachea (respiratory system) or esophagus (digestive system)
Developmental considerations of Nose, Mouth, Throat for Infants and Children
- salivation starts around 3 mo (drooling b/c can’t coordinate swallowing)
- deciduous teeth (20 baby teeth, erupt between 6-24 mo)
- permanent teeth (around 6-7 yrs)
Developmental considerations of Nose, Mouth, Throat for pregnancy
- increased vascularity and blood volume: increase nasal stuffiness and epistaxis (nose bleed), bleeding of gums
Developmental considerations of Nose, Mouth, Throat for Older Adults
- decreased sense of smell (nasal hairs become more coarse, olfactory nerve fibers decrease around 60)
- loss taste sensation (decreased number of tastebuds)
- receding gum and tooth loss
Epistaxis
when is it concerning?
nose bleeds
> 20 mins = urgent attention; high blood pressure, clotting issue, fracture
rhinorrhea
discharge from nose
what can cause an altered sense of smell?
naturally decreases with age, allergies, smoking, head injury
Buccal mucosa
lining of cheeks and back of lips (inside mouth) - should be pink, smooth and moist
Stensen’s duct
(or parotid duct) secretes saliva near. dimple near second molar on buccal mucosa (Cheek)
Fordyce’s granules
visible sebaceous cysts (yellow dots) that are benign on buccal mucosa (cheek)
torus palatinus
harmless, bony growths on hard palate. can vary in size and shape
How do you grade tonsils?
0 - removed
1- tonsils are visible
2- tonsils are halfway between side of throat and uvula
3- tonsils are touching uvula
4- tonsils are touching each other (kissing tonsils - worried about airway)
(0,1,2=healthy)
The ear
function?
describe 3 parts
function - sensory organ for hearing and equilibrium
- external: pinna/auricle to tympanic membrane
- middle: tympanic membrane to oval window
- inner: oval window in
External ear anatomy
- pinna
- tragus
- lobule
- external ear canal
- typanic membrane
- Pinna- funnels sound waves into the ear
- Tragus- can occlude ear by pushing
- Lobule- where ear piercing is
- External auditor canal- ear canal to tympanic membrane.. lined with cerumen
- Typmanic membrane (ear drum) separates external and middle ear
Middle ear
Contains?
Functions?
a tiny air-filled cavity in the temporal bone
- contains auditory ossicles:
1. malleus
2. incus
3. stapes
- has eustachian tube
function:
- conducts vibration from outer to inner ear
- protects inner ear by reducing sound
- equalizes air pressure on either side of ear drum (via eustachian tube)
Inner ear
bony labyrinth
structures and function
bony labyrinth: holds the sensory organ for equilibrium and hearing, which includes
- vestibule
- semicircular canal
- cochlea (central hearing apparatus)
expain the process of Hearing
- sound waves > external ear canal > vibrations on tympanic membrane
- vibrations carred through middle ear ossicles > oval window
- vibrations travel through semicircular canal, vestibule, and cochlea and dissipate at the round window
- basilar membrane lining in inner ear vibrates according to the frequency being transmitted > causes organ of corti (hearing organ) to move
- organ of corti transmits vibration into electrical impulses to CNIII
- brainstem - binaural interaction (enables person to locate the direction of sound and identify the sound)
- cortex- interprets meaning of sound
Hearing loss - 2 ways
- Conductive hearing loss: mechanical dysfunction in external or middle ear (impacted cerumen, foreign bodies, perforated eardrums, pus/serum middle ear)
- Sensoriuneuroal hearing loss: dysfunction of inner ear, Cranial nerve VIII or auditory areas in cerbral cortex. sound cannot be processed properly
- can be a mixed loss
Equilibrium: how does it work
Labyrinth in inner ear provides constant information to the brain about the body’s position in space
- if labyrinth is inflamed, can cause vertigo by feeding wrong info to body
Ear developmental considerations for infants and children
- Rubella: can damage organ of Corti in utero, causing hearing impairments
- Eustachian tube is shorter and more horizontal, makes it easier for pathogens from nasopharynx to migrate to ear
Ear developmental considerations for Adults
- Otosclerosis: common cause of conductive hearing loss between 20-40; gradual hardening of stapes to become fixed in the oval window.
Impeding transmission of sound, causes progressive deafness
Ear developmental considerations for Older Adults
- Cilia in external canal becomes coarser/ decrease sound waves travelling and cause cerumen to accumulate = reducing hearing
- impact cerumen is common cause of reversible hearing loss
- Presbycusis: type of hearing loss that occurs with ageing. Gradual sensorineural loss caused by nerve degeneration in inner ear or auditory nerve
When inspected the tympanic membrane with the otoscope, what would you expect?
shiny, translucent, pearly gray
- cone of light
- flat or slightly concaved
- no perforations
The eyes
function
function - sensory organ of vision
External eye anatomy palpable fissures canthus caruncle canjunctiva sclera cornea limbus lacrimal gland puncta lacrimal sac
- Palpable fissures - open space between eyels
- Canthus: corner of eye where eyelids meet (medial and lateral)
- Caruncle: inner canthus, small fleshy mass containing sebacious glands
- Conjunctiva: transparent covering, thin mucous membrane between eyelid and eyeball
- Sclera: white part of eye
- Cornea: translucent layer over iris and pupil
- Limbus: small area between corna and sclera
- Iris: coloured part
- Lacrimal gland: provides constant irrigation and releases tears. in upper eyelid. drains to puncta into lacrimal sac and empties into nose
- Puncta: visible on upper and lower eyelids at inner canthus
Internal eye anatomy Slera Choroid Lens Anterior/posterior chambers - aqueous humor Vitreous body Retina
- Sclera- tough protective white covering
- Choroid: darkly pigmented to prevent light from reflecting internally, heavily vascularized as it delivers blood to retina.
- Lens: transparent disc behind pupil. helps focus vision
- Anterior and posterior chamber, Aqueous humor: produced by ciliary body, continuous flow to deliver nutrients and drain waste
- Vitreous body: gelatinous big area
- Retina: visual receptive layer where light waves change to nerve impulses, surrounded in vitreous humor
Structures present in retina
optic disk - which nerves emerge Optic nerve Retinal vessels -arteries an veins Macula - darker red circle Fovea Centralis - dark center of macula, sharpest area of vision
Optic chiasm
x-shaped structure formed by the optic nerves crossing in the brain. images on retina are upside down and backwards
Visual reflexes
- pupillary light reflex:
a. direct light reflex - constriction of pupil when light is exposed to one eye
b. consensual light reflex- the other eye, not exposed, also constricts - fixation: rapid movement (you can’t see) to keep image in center of fovea centralis
- accommodation: coordinate change in pupil size in both eyes to look at close and far away items
PERRLA
pupils, equal, round, reactive to light and accommodating
Eye developmental considerations for infants and children
limited eye function at birth - macula is not fully formed until about 4 months, matures at 8 months
Eye developmental considerations for older adults
- decreased tear production (Dryness)
- arcus senilis
- less elastic lens
- presbyopia
- floaters
- macular degeneration
- cataracts
- glaucoma
- diabetic retinopathy
Arcus senilis
hallow ring around iris, caused by lipid material in OA
Presbyopia
(around age 40) - effects ability for eyes to change shape, noticed most in near vision
Floaters
debris in the vitreous humor of eye
Macular degeneration
increases as we age, break down of cells in macula causing reduced central vision (peripheral may still be good)
Cataracts
lens clouded instead of clear from protein that forms on the lens, surgically treated
Glaucoma
increased ocular pressure from aqueous humor not draining properly
decreases peripheral vision
Diabetic retinopathy
OA with diabeters are prone, damage to tiny blood vessels in retina causing blood leaks which can cause cloudy vision. Usually affects both eyes
