EENT Note Packet Exam 1 Material

What conditions can cause the trachea to be deviated?

tumor, pleural effusion, pneumothorax, atelectasis

If the trachea is stuck, what might you suspect?

cancer

A diffusely enlarged thyroid with no nodules suggests...

infection, hyper or hypo thyroidism

A multinodular thyroid suggests...

systemic metabolic condition

a single nodule in the thyroid suggests...

cancer

TMJ inspection...

swelling, symmetry, redness

palpate TMJ joint

in front of tragus, feel for smooth ROM, snapping or clicking may be normal

assess TMJ ROM

open jaw as wide as possible (3+ fingers), protrude jaw forward (bottom teeth go beyond top)

muscles of mastication palpation & muscle testing

masseters, temporalis, medial pterygoids

check muscle strength/ability to resist as the patient moves the jaw side to side ...

and as the patient opens mouth

which CN innervates the muscles of mastication?

CN V

the jaw jerk reflex is innervated by which cranial nerve?

CN V

how do we check Chvostek's sign?

tap area of parotid gland one side at a time

What is abnormal when performing Chvostek's sign?

spasm of facial muscles on the side tapped (hypocalcemia)

Nerve exiting locations to be aware of when palpating lymph nodes...

supraorbital notch, infraorbital foramen, point of the larynx, supraclavicualr fossa

Lymph nodes to palpate during lymph exam...

preauricular, postauricular, occipital, tonsillar, submandibular, submental, superficial cervical, deep cervical, posterior cervical, supraclavicular

Where is Virchow's node found? What does it mean?

left supraclavicular fossa, metastasis

Normal lymph findings...

soft, not tender, moveable, small

Infected lymph findings...

boggy, tender, moveable, enlarged

Cancerous lymph findings...

hard, might be tender, not moveable, enlarged

Calcified lymph findings...

hard, not tender, moveable, variable in size

During a rub test, what is the minimum distance from the ear?

arm's length

The result for bilateral hearing loss for the finger rub is...

short distance on both sides

What tuning fork is used to perform the Weber and Rinne tests?

256Hz or 512 Hz

Normal Weber test findings...

sound heard equally in both ears

Weber test conduction deficit is...

sound is heard louder in "bad" ear

Weber test nerve/sensorineural deficit is...

sound is heard louder in "good" ear

Weber bilateral hearing loss...

sound is heard equally in both ears

How do we find the "bad" ear?

short side on the rub test

What is the interpretation of the Rinne test?

air conduction lasts 2x as long as bone conduction

What is a normal Rinne test?

a positive finding

Rinne test conduction deficit is...

<2:1 air to bone ratio

Rinne test nerve/senorineural deficit is...

<20 seconds on mastoid

Rinne test bilateral hearing loss is...

decreased count on both sides

External ear inspection...

lesions, deformities, size, shape, exudates, color, symmetry, position

What is a cauliflower ear?

healed hematoma (scar tissue)

What is the clinical significance of cauliflower ear?

can obstruct the ear canal, resulting in conduction hearing loss

Excessive cerumen can result in...

conduction hearing loss, coughing, tinnitus, vertigo

Define otorrhea

discharge from the ear

What are polyps?

benign growths on ear

What condition is associated with polyps?

chronic otitis externa/swimmer's ear

Conditions that may cause nodules on the pinna of the ear...

gouty tophi, rheumatoid nodules, leprosy, basal cell/squamous cell carcinoma, keloids, chondrodermatitis nodularis helicis, cutaneous cyst, hematoma

Excess growth of the bony lining of the ear canal is called...

exostosis/surfer's ear

Which is the faster growing; basal cell or squamous cell carcinoma?

squamous cell carcinoma

Define the middle ear...

portion of ear from the tympanic membrane to the oval and round windows

Name the ossicles of the middle ear...

malleus, incus, stapes

Which cranial nerve innervates the tensor tympani muscle?

CN V

Which cranial nerve innervates the stepedius?

CV VII

What is the function of the tensor tympani and stapedius?

dampen continuous loud noises

What are the contents of the inner ear?

cochlea, vestibular apparatus, vestibule, semicircular canals nerves

What 6 things should we note about the tympanic membrane?

color, position, landmarks, cone of light, perforations, fluid level

Normal color of the tympanic membrane...

gray/pink

Abnormal color of the tympanic membrane...

red/amber

Normal position of the tympanic membrane...

neutral

Abnormal position of the tympanic membrane...

bulging/retracted

The cone of light in the tympanic membrane should point towards the...

chin

Appearance of the cone of light with a retracted tympanic membrane is...

narrowed

Appearance of the cone of light with a bulging tympanic membrane is...

diffuse or scattered

Which of the ear ossicles is NOT visible through the tympanic membrane?

stapes

The two parts of the tympanic membrane are called the ______ and ______.

pars flaccida, pars tensa

Symptoms of a blocked Eustachian tube...

ear feels stopped up/intermittent pain, decreased hearing, retracted tympanic membrane

Which population most commonly experiences plugging of the Eustachian tube?

children

List the characteristics of serous otitis media....

minimal or no fever, mild to moderate pain, amber colored TM, fluid behind TM, position of TM is retracted or neutral

List the characteristics of suppurative otitis media...

fever, very painful throbbing, beefy red colored TM, bulging TM, pus behind TM

Which is more painful, acute supportive otitis media or chronic otitis media?

acute

What is tympanosclerosis?

scar tissue on TM

What is otitis exerna?

fungal or bacterial growth on outer ear or ear canal

Who is most likely to develop otitis externa?

"swimmer's ear" - people with chronically wet ears

What are the characteristics of Meniére's disease?

tinnitus, decreased hearing, vertigo

How long does Meniére's disease last?

months to years

How is Meniére's disease treated?

adjustments, herbal diuretics, low sodium diet

What are the characteristics of acute toxic labrynthitis?

severe loss of balance, tinnitus, vertigo, hearing loss, nystagmus

How long does acute toxic labrynthitis typically last?

6-8 weeks

What are the risk factors for developing Meniére's disease or labrynthitis?

large amounts of alcohol, history of allergies, fatigue, stress, viral infections, smoking, respiratory infections, medications such as asprin

Consensual light reflex tests what cranial nerves?

II and III

Cranial nerve ____ carries light towards the brain.

II

Cranial nerve ____ carries the response from the brain to ____ the pupil.

III, constrict

If the direct eye does not constrict, but the consensual eye does, it is a _____ lesion to CN ____.

direct, III

If the direct eye constricts and the consensual eye does not constrict, it is a ____ lesion to CN ____.

consensual, III

If the direct eye does not constrict, and the consensual eye also does not constrict, it is a ____ lesion to CN ____.

direct, II

____: pupils are not equal in size

anisocoria

____: dilated pupil

mydriasis

____: constricted pupil

miosis

The ciliary body is innervated by CN ____.

III

Accommodation lost with aging, generally in populations >40 years old is called...

presbyopia

With near vision, the eyes tend to slightly ____ and the pupils _____. These are functions of CN ____.

converge, constrict, III

Repetitive, jerky eye movements are called...

nystagmus

When eyes are not facing the same direction it is called...

strabismus