nodule on edge of posterior helix of the ear is called___?
Darwin Tubercle
three anatomical divisions of the ear
Inner, Outer, and Middle
Name the bones of the middle ear
Maleus, incus, stapes
Which structures of the Malleus can be seen through the tympanic membrane?
Short process, Manubrium
How many deciduous teeth do children have and when do they typically start to appear?
20 teeth that 1st appear around 6 months to 24 months. They erupt anterior to posterior.
How many permanent teeth and when do they come in?
32 permanent teeth. Start to appear @ 6 years and final wisdom teeth appear between 17-21 yrs.
Blunt trauma & necrosis of ear causes _____
Cauliflower ear.
Whitish crystals along peripheral margins of auricle
Tophi: Indicative on gout. White crystals are from uric acid crystals.
Elevated nodule under skin, movable with a punctum
Sebaceous Cyst. Common on back, scalp, behind ears, and scrotom.
Bulging tympanic membrane is indicative of____?
Otitis Media
Auditory cranial nerve
vestibulocochlear VIII
Tuning fork auditory tests
Weber is on forehead
Rinne is on mastoid bone behind ear then out in front of ear
Uneven dividing tissue between the nares
Deviated septum. The picture shows a before and after with corrective surgery.
Allergic salute
Transverse nasal crease from chronic allergy/nose wiping.
Duct exiting out of inner cheek by upper 2nd molar
Stensen duct also known as your parotid duct delivers saliva to mouth. Stones or exudate is abnormal upon "milking". A red spot @ the site of the duct is indicative of Mumps.
Multiple small yellow spots on inside of cheek
Fordyce spots. Expected Variant
Patient presents with unilateral swelling of the cheek, fever, malaise, & HA. What could they have?
Mumps: Parotitis-> swelling of the parotid gland by a virus. Stensen duct is typically inflamed.
Patient has a hard midline bony protuberance of the hard palate of the mouth. What is this?
Torus Palatinus: Normal variance
You notice a darker pigmented area on one side of the hard palate of the mouth. What is this?
Karposi Sarcoma: tumor of the mouth. Can be more red in earlier stages but leaking blood vessels can also cause a darker hematoma look.
Asking the patient to say "ahhh" evaluates which cranial nerves?
Glossopharengeal IX & Vagus X
You notice that a patients uvula deviates upon saying "ahhh". What is this indicative of?
Dysfunction of the Vagus nerve X
How do you test the VIII cranial nerve?
Vestibulocochlear nerve can be tested by the Romberg test. Patient stands with eyes closed feet together and should not sway.
You notice small whitish-yellow masses at the junction of the hard and soft palate of a newborn. What are these?
Epstein Pearls. Typical finding of a newborn. Typically disappear in a few weeks. Normal.
A young child has been crying and screaming during your evaluation. Upon otoscopic evaluation of the ear you see a reddened tympanic membrane. What is this indicative of?
A crying upset child can cause dilation of tympanic blood vessels making a diagnosis of otitis media difficult. A pneumatic otoscope can differentiate the difference in this instance.
At what age do the sinuses develop enough to allow for palpation?
Maxillary sinuses can be assessed by 4 yo.
Frontal sinuses can be assessed by 5-6 yo
A child has a fever, cough, and inflamed nasal passageways. The child has small white specks with a reddened mucosa on the inside of the cheeks.
The white spots are Koplic spots. This child likely has Rudeola (Measles) that has not fully developed the typical exanthem rash measles is known for.
How are tonsils graded?
What is an infection of the ear canal called?
Otitis Externa (Swimmers Ear):
Technical term for ear pain
Otalgia
Epithelial growth of the middle ear, associated with progressive hearing loss & fullness of the middle ear.
Cholesteatoma: Appears as a white growth either behind the tympanic membrane (Picture) or can perforate through revealing its self to examination. Pt should be immediately referred to ENT r/t possible erosion through surrounding structures.
Patient complains of abrupt and recurrent attacks of severe vertigo, tinnitis, progressive hearing loss of low tones, and ear fullness. What might this patient have?
Meniere Disease should be examined. Refer to an otologist. MRI should be obtained to rule out central brain causes.
What characterizes Acute Sinusitis?
URI that worsens after 5 days, persists for 10days and is more severe then a typical URI. Strongest predictors of sinusitis are: Maxillary toothache, purulent nasal secretions, dull/opaque sinus transillumination, poor response to decongestants, & colored
What organism typically causes Tonsillitis?
Typical organism is streptococci. If Anterior cervical lymphadenopathy & no Coryza(nasal inflammation) 65% Group A strept. If scarlatiniform rash also present 95% Group A strept & can give PCN or Amoxacillin.
A 3 yo child presents febrile, drooling, restless, in resp distress with stridor and a muffled voice. The child refuses to move his neck.
Retropharyngeal Abscess. This is an emergency. Neck stiffness is the distinguishing sign. CT with contrast is indicated. Immediate surgical drainage is indicated if severe. Clindamycin for empiric therapy for coverage of GAS, S. Aureus including community
Bilateral sensorineural hearing loss associated with aging.
Presbycusis
Dry mouth is called
Xerostomia
The prevalence Acute Otitis Media significantly declines after what age?
6 yo. Increased age raises the likelihood of secondary otalgia caused by disorders of the head, face, and neck; by sinus or periodontal disease; and by malignancy.
List 5 modifiable risk factors for otitis media
1) smoke exposure
2) childcare
3) recent Airplane passenger or scuba diving
4) Infant or child takes a bottle while lying down
5) recent swimming
Name 3 disease processes that increase your risk for Otitis Media
1) diabetes
2) unrepaired cleft pallet
3) Skin disease such as eczema, psoriasis, dermatisis
You can not visualize the TM due to impacted cerum. What solution do you use to lavage and soften the cerum so it can be removed?
Hydrogen peroxide & Water
1:1
What signs might indicate AOM in an infant?
Irritability, poor feeding, congestion, and fever.
Patient presents with a redden swollen area behind the L ear that is extremely sensitive and is pushing the auricle forward and out. The pt has had an ongoing otitis media infection over the past month. pt is 39.7C. What does the pt have?
Mastoiditis:
Postauricular Erythema, tenderness, edema (81-85%)
Bulging, erythematous, or dull tympanic membrane (60-71%)
Protrusion of auricle (79%)
Fever (76%)
IV antibiotics and myringotomy (� tympanostomy tubes) for uncomplicated acute mastoiditis. Ad
Which lymph nodes are typically affected by AOM & Otitis externa?
Preauricular
During the Weber test, what type of hearing is tested? Will the pt report a louder side in the affected or unaffected ear?
Conductive (Middle ear) hearing loss = bad ear will be louder.
Sensorineural (Inner ear) hearing loss = Good ear will be louder
Describe what the Rinne test tests?
Screens for unilateral conductive (middle ear) hearing loss.
Place fork on mastoid until no longer heard then see if the fork can still be heard when moved in front of ear.
Normal = air conduction (AC) > bone conduction (BC) (+ Rinne)
Conduction loss = BC
What is the best way to test for TMJ?
inraotic manipulation (middle picture) Face the patient, insert a single fingertip in each ear, and pull the patient toward you as the patient is instructed to open and close the mouth. Pain will be elicited in 90% of patients with TMJ disorder
4 yo pt presents with c/o hearing problems in L ear not associated with pain. Pt is recovering from an URI. Otoscopy reveals fluid seen behind the TM. What is this?
Otitis media with Effusion. By definition is painless. Pt may have conductive hearing loss.
What is the prognosis of a perforated TM?
Typically spontaneously heals within 4-6 wks. Produced a conductive hearing loss. If infection is present Ciprofloxacin ear drops are recommended.
A child has strept throat and anterior cervical lymphadenitis but keeps complaining of ear pain despite a normal otoscopic exam. Why is this?
The pain is referral. CN II and CN III innervate the skin and muscles of the neck and include the great auricular nerve, which supplies the external canals and posterior auricular area.
Hoarseness is a cardinal symptom for _______ disease.
Laryngeal
What is the time cut off where a pathological etiology should be investigated for persistent hoarseness?
Adult = > 2 weeks
Child = > 1 week
Differentials include: palsies, polyps, or cysts; laryngeal neoplasm; or congenital disorders of the larynx, or hypothyroidism.
Referral to ENT is indicated.
What is hoarseness lasting less then 2 weeks called. 2 most common causes?
Acute laryngitis:
Most common = Viral URI & Overuse
Less common = Post nasal drip, GERD, Severe hypothyroidism, & Environmental irritants
Why would an APN ask a pt presenting with Acute laryngitis that slowly developed if they have had their tetanus vaccine?
Laryngeal diphtheria causes a downward progression of hoarseness. Tetanus-diphtheria vax boosters are recommended every 10yrs.
A young child presents with barking cough, dyspnea, wheezing, low-grade fever, hoarseness, and an inspiratory stridor. What is the technical name for this? When is it most common?
Laryngotracheobronchitis (Croup).
Most common 3 months-3 yo.
Common cause parainfluenza 1 virus
What are the observational symptomatic differences between allergic & Infectious sinusitis?
Allergic is watery & clear post nasal drip or rhinorrhea.
Infectious (Viral or bacterial produces yellow or green purulent discharge.
Periorbital cellulitis is a common complication of what type of facial infection?
Severe bacterial sinusitis
Immediate Admit for IV Abx. (Broad spectrum Unasyn or ceftriaxone & Flagyl or Clindamycin)
A patients turbinates and mucus membranes are inflamned and red. This finding is described as _____.
Coryza
You suspect frontal sinusitis but are unsure. What easy examination technique can help with your diagnosis?
Transillumination by placing light below the supraorbital rim.
Normal transilluminance of the frontal sinuses (pictured here) rules out sinusitis 90% of the time.
What diagnositc test can help determine etiology of nasopharyngitis or sinusitis.
Nasal cell smear.
Pt presents with recurrent rhinorrhea with clear watery mucus, sneezing, and pruritus. Nasal turbinates are pale and swollen. Nasal smears shows eosinophils. Diagnosis?
Allergic rhinitis
The diagnosis of sinusitis in children requires ....
2 of 3 MAJOR criteria:
Cough, Purulent nasal discharge, or
Purulent pharyngeal drainage.
or
1 major & 2 MINOR criteria:
Sore throat, wheezing, foul breath, facial pain, periorbital edema, headache, earache, fever, or toothache
You see a translucent grape like growth that is mobile in the nasal cavity. What is this?
Nasal Polyp:Risk factors include:
Chronic sinusitis; Allergic fungal sinusitis; Aspirin sensitivity; Cystic fibrosis; & Primary ciliary dyskinesia (Kartagener syndrome)
Treatment: Intranasal corticosteroids for a minimum of 12 wks
If unilateral needs mali
Pain with swallowing is called?
Odynophagia. Indicative of some type of esophagitis.
Name the symptoms of a peritonsillar abscess and cellulitis.
Severe sore throat
Odynophagia
Trismus (Masticatory muscle spasm)
Medial soft palate/peritonsillar fold deviation
Smooth painful tongue from B12/Folate Deficiency
Hunter Glossitis