NMTEE

Question 1

The nose

function

Answer 1

1st segment of respiratory system

function: warms, moistens, and filters inhaled air. Sensory organ for smell

Question 2

The nose: external anatomy

Answer 2

• 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

Question 3

The nose: internal anatomy

Answer 3

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

Question 4

Sinuses -what are they
what sinuses are palpable
not palpable?

Answer 4

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

Question 5

The mouth - what makes up the oral cavity?

• palate?
• uvula?
• tongue?
• frenulum?

Answer 5

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

Question 6

Salivary glands

name them, and function

Answer 6

function- moistens foods and starts digestion process

1. parotid gland (largest)
2. submandibular gland
3. sublingual gland

Question 7

Throat (or pharynx) - describe the parts

Answer 7

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)

Question 8

Developmental considerations of Nose, Mouth, Throat for Infants and Children

Answer 8

• 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)

Question 9

Developmental considerations of Nose, Mouth, Throat for pregnancy

Answer 9

• increased vascularity and blood volume: increase nasal stuffiness and epistaxis (nose bleed), bleeding of gums

Question 10

Developmental considerations of Nose, Mouth, Throat for Older Adults

Answer 10

• 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

Question 11

Epistaxis

when is it concerning?

Answer 11

nose bleeds

> 20 mins = urgent attention; high blood pressure, clotting issue, fracture

Question 12

rhinorrhea

Answer 12

discharge from nose

Question 13

what can cause an altered sense of smell?

Answer 13

naturally decreases with age, allergies, smoking, head injury

Question 14

Buccal mucosa

Answer 14

lining of cheeks and back of lips (inside mouth) - should be pink, smooth and moist

Question 15

Stensen’s duct

Answer 15

(or parotid duct) secretes saliva near. dimple near second molar on buccal mucosa (Cheek)

Question 16

Fordyce’s granules

Answer 16

visible sebaceous cysts (yellow dots) that are benign on buccal mucosa (cheek)

Question 17

torus palatinus

Answer 17

harmless, bony growths on hard palate. can vary in size and shape

Question 18

How do you grade tonsils?

Answer 18

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)

Question 19

The ear
function?
describe 3 parts

Answer 19

function - sensory organ for hearing and equilibrium

1. external: pinna/auricle to tympanic membrane
2. middle: tympanic membrane to oval window
3. inner: oval window in

Question 20

External ear anatomy

• pinna
• tragus
• lobule
• external ear canal
• typanic membrane

Answer 20

• 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

Question 21

Middle ear
Contains?
Functions?

Answer 21

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)

Question 22

Inner ear
bony labyrinth
structures and function

Answer 22

bony labyrinth: holds the sensory organ for equilibrium and hearing, which includes

• vestibule
• semicircular canal
• cochlea (central hearing apparatus)

Question 23

expain the process of Hearing

Answer 23

1. sound waves > external ear canal > vibrations on tympanic membrane
2. vibrations carred through middle ear ossicles > oval window
3. vibrations travel through semicircular canal, vestibule, and cochlea and dissipate at the round window
4. basilar membrane lining in inner ear vibrates according to the frequency being transmitted > causes organ of corti (hearing organ) to move
5. organ of corti transmits vibration into electrical impulses to CNIII
6. brainstem - binaural interaction (enables person to locate the direction of sound and identify the sound)
7. cortex- interprets meaning of sound

Question 24

Hearing loss - 2 ways

Answer 24

1. Conductive hearing loss: mechanical dysfunction in external or middle ear (impacted cerumen, foreign bodies, perforated eardrums, pus/serum middle ear)
2. 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

Question 25

Equilibrium: how does it work

Answer 25

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

Question 26

Ear developmental considerations for infants and children

Answer 26

- 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

Question 27

Ear developmental considerations for Adults

Answer 27

- 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

Question 28

Ear developmental considerations for Older Adults

Answer 28

- 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

Question 29

When inspected the tympanic membrane with the otoscope, what would you expect?

Answer 29

shiny, translucent, pearly gray - cone of light - flat or slightly concaved - no perforations

Question 30

The eyes | function

Answer 30

function - sensory organ of vision

Question 31

``` External eye anatomy palpable fissures canthus caruncle canjunctiva sclera cornea limbus lacrimal gland puncta lacrimal sac ```

Answer 31

- 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

Question 32

``` Internal eye anatomy Slera Choroid Lens Anterior/posterior chambers - aqueous humor Vitreous body Retina ```

Answer 32

- 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

Question 33

Structures present in retina

Answer 33

``` 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 ```

Question 34

Optic chiasm

Answer 34

x-shaped structure formed by the optic nerves crossing in the brain. images on retina are upside down and backwards

Question 35

Visual reflexes

Answer 35

1. 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 2. fixation: rapid movement (you can't see) to keep image in center of fovea centralis 3. accommodation: coordinate change in pupil size in both eyes to look at close and far away items

Question 36

PERRLA

Answer 36

pupils, equal, round, reactive to light and accommodating

Question 37

Eye developmental considerations for infants and children

Answer 37

limited eye function at birth - macula is not fully formed until about 4 months, matures at 8 months

Question 38

Eye developmental considerations for older adults

Answer 38

- decreased tear production (Dryness) - arcus senilis - less elastic lens - presbyopia - floaters - macular degeneration - cataracts - glaucoma - diabetic retinopathy

Question 39

Arcus senilis

Answer 39

hallow ring around iris, caused by lipid material in OA

Question 40

Presbyopia

Answer 40

(around age 40) - effects ability for eyes to change shape, noticed most in near vision

Question 41

Floaters

Answer 41

debris in the vitreous humor of eye

Question 42

Macular degeneration

Answer 42

increases as we age, break down of cells in macula causing reduced central vision (peripheral may still be good)

Question 43

Cataracts

Answer 43

lens clouded instead of clear from protein that forms on the lens, surgically treated

Question 44

Glaucoma

Answer 44

increased ocular pressure from aqueous humor not draining properly decreases peripheral vision

Question 45

Diabetic retinopathy

Answer 45

OA with diabeters are prone, damage to tiny blood vessels in retina causing blood leaks which can cause cloudy vision. Usually affects both eyes