advanced physical assessment ear, nose, throat (ENT)

bilateral sensorineural hearing loss associated with aging?

presbycusis

Dysphagia, fever and fetid breath are symptoms associated with ?

Tonsillitis or pharyngitis.

infection of the auditory canal

otitis externa

fever, headache, nasal discharge, infection to one or more paranasal sinuses?

Acute sinusitis

hereditary condition of unknown cause in which irregular ossification occurs in the ossicles of the middle ear, esp. of the stapes, causing hear loss.
Causes chronic progressive deafness, esp. for low tones

otosclerosis

rare disorder of unknown etiology within the labyrinth of the inner ear that can lead to progressive loss of hearing
Symptoms: vertigo, hearing loss, tinnitus, and a sensation of pressure in the ear

Meniere disease

Ear fullness, tinnitus, affects vestibular labyrinth

Meniere disease (hearing loss, tinnitus and vertigo).

inflammation of the middle ear resulting in a collection of fluid

Middle ear effusion

Epithelial growth that migrates through a perforation of tymphanic membrane

Cholesteatoma

Xerostomia

Dryness of the mouth caused by reduction of saliva

Labyrinthitis/Vestibular Neuritis

Vertigo, disequilibrium, imbalance, nausea (2)

Weber test

hearing test using a tuning fork; distinguishes between conductive and sensorineural hearing loss

When performing weber test which is considered normal?

Hears the tone equally in both ears.

Which of the following best explains by infants and toddlers ?

wider, shorter, horizontal, less stiff than adults Eustachian tubes

which statement made by a 72 year old would indicate normal?

food does not taste the same as it used to

The nurse is examining a patient's ears and notices cerumen in the external canal. Which of the following statements about cerumen is correct?
1.
Sticky honey-colored cerumen is a sign of infection.
2.
The presence of cerumen is indicative of poor hygiene

3.
The purpose of cerumen is to protect and lubricate the ear.

Which of the following statements concerning the eustachian tube is true?
1.
It is responsible for the production of cerumen.
2.
It remains open except when swallowing or yawning.
3.
It allows passage of air between the middle and outer ear.
4.
It helps e

4.
It helps equalize air pressure on both sides of the tympanic membrane.

A patient with a middle ear infection asks the nurse, "What does the middle ear do?" The nurse responds by telling the patient that the middle ear functions to:
1.
maintain balance.
2.
interpret sounds as they enter the ear.
3.
conduct vibrations of sound

ANS: 3
Among its other functions, the middle ear conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear.

Which of the following cranial nerves is responsible for conducting nerve impulses to the brain from the organ of Corti?
1.
CN I
2.
CN III
3.
CN VIII
4.
CN XI

ANS: 3
The nerve impulses are conducted by the auditory portion of CN VIII to the brain.

Which of the following statements is true concerning air conduction?
1.
It is the most efficient pathway for hearing.
2.
It is caused by the vibrations of bones in the skull.
3.
The amplitude of sound determines the pitch that is heard.
4.
A loss of air c

1.
It is the most efficient pathway for hearing.

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:
1.
the cochlea.
2.
cranial nerve VIII.
3.
the organ of Corti.
4.
the

ANS: 4
If the labyrinth ever becomes inflamed, it feeds the wrong information to the brain, creating a staggering gait and a strong, spinning, whirling sensation called vertigo.

A 31-year-old patient tells the nurse that he has noticed a progressive loss in his hearing. He says that it does seem to help when people speak louder or if he turns up the volume. The most likely cause of his hearing loss is:
1.
otosclerosis.
2.
presbyc

ANS: 1
Otosclerosis is a common cause of conductive hearing loss in young adults between the ages of 20 and 40 years.

Roomberg test is used to assess ?

the balance or equilibrium

The organ of Corti is located in the:
a.
vestibule
c.
scala vestibuli
b.
semicircular canal
d.
cochlear duct

d.
cochlear duct

torus palatinus

a bony protuberance in the midline of the hard palate in the mouth.

Why are infants more prone to ear infections than adults?

The eustachian tube is wider shorter and more horizontal in infants/children, hence, more exposed to bacteria.

Sensory organ of hearing

cochlea

sinusitis

most important clinical signs: maxillary toothache, purulent nasal secretion, poor response to decongestants, poor transillumination, and pt report of colored nasal secretions.

deep fissures at corner of mouth: riboflavin deficiency, overclosure of mouth, allowing saliva to macerate tissue

Cheilosis

What two tests evaluate the IX (glossopharyngeal ) and X (vagus) CN?

-elicit gag reflex and saying "Aahhhh

Mrs. Jones is a 45-year-old patient who presents to your office with a complaint of fatigue. On examination, you observe a blackish area on the top surface of the tongue. Mrs. Jones tells you that her tongue is painful. Which question by the examiner woul

Have you been taking antibiotics lately?

Which of the following situations is an indication for transillumination?
The patient complains of epistaxis.
The patient has crepitus with jaw movement.
The parotid gland is palpable and tender.
The patient complains of pain over the sinuses with palpati

The patient complains of pain over the sinuses with palpation

Mr. Torres brings his 8-year-old son in with a complaint of sore throat. On examination, you note that the patient's tonsils are enlarged and nearly touch the uvula. This is documented as:
1+.
2+.
3+.
4+.

3+

Mr. Jones presents to your office following a fist fight. Upon examination of the tympanic membrane, you notice a blue color. This indicates the patient has:
a cerebral spinal fluid leak.
blood in the middle ear.
high wax production.
fluid in the middle e

blood in the middle ear

When examining a patient's ear, you hear a cracking sound when you ask the patient to yawn. This finding is indicative of:
external otitis media
otitis externa
acute otitis media
otitis media with effusion

otitis media with effusion

Which behavior described by a parent indicates that an infant or young child may have a hearing problem?
"My 4-month-old baby does not seem to respond to loud noises."
"My 5-month-old baby is babbling, but she is not yet saying any words."
"Sometimes my 3

My 4-month-old baby does not seem to respond to loud noises.

A function of cerumen in the ear canal is to provide:
vibration.
lubrication.
sound transmission.
adhesiveness.

lubrication.

Weber test

Weber Test�
Vibrationis heard equally well in both ears no lateralization of sound to either ear�
Conductive Hearing Loss -lateralization of sound to poor ear�
Sensorineural Hearing Loss -lateralization of sound to the good ear

Rinne test

Air conduction sound is normally heard longer than bone conduction sound (AC > BC) -usually twice as long�
Conductive Loss -bone conduction sound is heard longer than or equally as long as air conduction sound (BC > AC)�
Sensorineural Loss -air conduction

Mrs. Lukin is a 46-year-old patient who complains of seasonal allergies. During her examination, which of the following pairs of sinuses are accessible for physical examination?
Ethmoid and sphenoid
Maxillary and sphenoid
Frontal and ethmoid
Maxillary and

Maxillary and frontal

purulent drainage associated with pain and a popping sensation

External Otitis with Perforation of the TM

Absence of red glow transilluminating the frontal sinuses indicates??

sinus filled with fluid or pus

ankyloglossia

tongue-tie; a defect of the tongue characterized by a short, thick frenulum

fine sandpapery, punctate rash starting on trunk may cover entire body--?

Scarlet fever

�Life-threatening infection in the lateral pharyngeal space that has the potential to occlude the airway; most commonly occurs in children

Retro pharyngeal abscess

A bony protuberance at the midline of the hard palate that is of no clinical significance is called:
aphthous torinus.
torus palatinus.
palates crypts.
molluscum palatinus.

torus palatinus.

Mrs. Wheeler is a 64-year-old patient who presents to your office. She tells you that she has a vitamin B12 deficiency. The examiner can easily detect this by observing:
a geographic tongue.
a black hairy tongue.
purplish swellings under the tongue.
a smo

a smooth tongue

A sensorineural hearing loss is the result of:
impaired conduction through the middle/external ear.
impaired transmission of sound through the tympanic membrane.
a defect in the inner ear that leads to distortion of sound and misrepresentation of speech.

a defect in the inner ear that leads to distortion of sound and misrepresentation of speech.

Mr. Kooler is a 38-year-old patient who, during the Weber test, indicates that sound is heard better in one ear. This is described as:
reinforcement.
redirection.
lateralization.
predilection.

lateralization

The pneumatic attachment to the otoscope is used to evaluate which characteristic of the tympanic membrane?
Vibrations
Mobility
Tension
Strength

mobility

A tympanic membrane that is retracted is also more:
concave.
convex.
impacted.
dilated.

dilated

Mrs. Vellok is a 38-year-old patient who presents with a complaint of hearing loss. On examination, pulling Mrs. Vellok's auricle upward and back facilitates visualization of the tympanic membrane by:
stretching the tympanic membrane.
straightening the Eu

straightening the auditory canal.

Mr. Jones, a 48-year-old man, presents to your office with a complaint of hearing loss. On examination, the auditory canal is found to be obstructed with cerumen. Which tool is best to use for cleaning out an obstructed auditory canal?
Body temperature wa

Body temperature water irrigation

During the course of the interview, a patient indicates that he has been given the drug gentamicin (an aminoglycoside antibiotic) for an upper respiratory infection. Based on this information, you would check for which type of problem?
Dizziness and verti

Hearing loss

The function of the turbinates in the nose is to:
increase turbulent airflow into the posterior nasopharynx.
provide a receptacle for excess mucus.
increase the surface area of the nose.
serve as a sounding board to vocalization

increase the surface area of the nose.

A function of cerumen in the ear canal is to provide:
vibration.
lubrication.
sound transmission.
adhesiveness.

lubrication.