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accommodation
increased convexity of the lenses caused by contraction of the ciliary muscles, this change in shape of the lenses brings near objects into focus but is not visible to the examiner
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Acoustic neuroma
intracranial tumor that arises from the Schwann cell sheath that involves either the vestibular or cochlear nerve
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adenoids
common name for the pharyngeal tonsils, which are lymph masses in the wall of the air passageway (pharynx) just behind the nose
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anisocoria
difference in pupillary size of 0.04 mm or greater
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apnea
cessation of breathing
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aqueous humor
the clear, watery fluid circulating in the anterior and posterior chambers of the eye. It is produced by the ciliary body and is reabsorbed into the venous system primarily at the iridocorneal angle by means of the canal of Schlemm
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Argyll-Robertson pupil
pupil that reacts to accommodation but not to light, a finding typical of 3º syphilis
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astigmatism
visual defect in which the unequal curvature of one or more refractive surfaces of the eye, usually the cornea, prevents light rays from focusing clearly at one point on the retina, resulting in blurred vision
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auricles
external structure of the ear
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A-V nicking
vascular abnormality in the retina of the eye, visible on ophthalmologic examination, in which a vein is compressed by an arteriovenous crossing. The vein appears "nicked" as a result of constriction or spasm. It is a sign of hypertension, arteriosclerosis, or other vascular conditions
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boggy mucosa
pale and wet mucosa that suggests chronic allergy
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bruit
an abnormal blowing or swishing sound or murmur heard while auscultating the thyroid, and resulting from blood flowing through a narrow or partially occluded artery. Bruits are usually of low frequency and are heard best with the bell of a stethoscope
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bulbar
bulbar conjunctiva covers most of the anterior eyeball
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bullae
1.0 cm or larger lesion, filled with serous fluid (insect bite)
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caries
a destructive process causing decalcification of the tooth enamel and leading to continued destruction of enamel and dentin, and cavitation of the tooth
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anterior chamber
The part of the anterior cavity of the eye in front of the iris. It contains the aqueous humor.
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cerumen
ear wax - can cause conductive hearing loss
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ciliary injection
peripheral hyperemia of the anterior ciliary vessels which produces a deep red or rose color of the corneal stroma, and must be distinguished from hyperemia of the conjunctival vessels. May spread to the perilimbic corneal tissue. Called also ciliary flush
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cone of light
a triangular reflection observed during an ear examination when the light of an otoscope is focused on the image of the malleus, always anterior
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conjugate gaze
eye movements tract together, parallel eye movements
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conjunctiva
clear mucous membrane with two easily visable components: bulbar conjunctiva covers most of the anterior eyeball; palpebral conjunctiva lines the eyelids
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conjunctivitis
pink eye - Conjuctivitis is an inflammation or redness of the lining of the white part of the eye and the underside of the eyelid (conjunctiva) that can be caused by infection, allergic reaction, or physical agents like infrared or ultraviolet light.
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Cholesteatoma
squamous epithelium that is trapped within the skull base that can erode and destroy important structures within the temporal bone
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consensual reaction
pupillary constriction in the opposite eye
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convergence
an extraocular movement, eyes follow object to within 5-8 cm of the nose
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cover/uncover test
may reveal a slight or latent muscle imbalance not otherwise seen, deviated eye
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differential
diagnosis generated by identifying attributes of each symptom and pursuing related details fundemental to recognizing patterns of disease
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dysconjugate
gaze eye movements don't tract together
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dysphagia
difficulty swallowing
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ectropion
eversion or turning outward, as of the margin of an eyelid
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entropion
inversion, or the turning inward, as of the margin of an eyelid
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epistaxis
bleeding from nasal passageways. Etiology: trauma, inflammation, drying and crusting of the mucosa, tumors, foreign bodies, bleeding disorders
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esotropia
form of strabismus in which the visual axes converge. Also called convergent strabismus, crossed eyes
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exophthalmos
abnormal protrusion of the eyeball
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extraocular movements
coordinated action of six muscles, the four rectus and two oblique, control the eye
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exudate
any fluid released from the body with a high concentration of proteins, cells, or solid debris
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goiter
thyroid gland enlargement which may be caused by thyroiditis, benign thyroid nodules, malignancy, iodine deficiency or any condition that causes hyperfunction or hypofunction of the gland
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growths or FB
can cause conductive hearing loss (foreign bodies) squamous cell CA, psoriasis, artifacts
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hearing loss
conductive (10%) or sensorineural (90%)
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hearing loss associated symptoms
earache, vertigo, tinnitus, drainage, itchy, pressure, fever, dizzy, facial numbness, headache
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hemianopsia
loss of vision in one half of the visual field of one or both eyes
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hirsutism
excess hair growth
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Hoarseness
altered quality of the voice (husky, rough, harsh). Usually attributed to disease of the larynx or pressure on the laryngeal nerves
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hordeolum
sty, a localized inflammatory swelling of one or more glands of the eyelid (glands of Zeis or glands of Moll), points externally, smaller, more painful and may discharge some purulent fluid, self-limiting - short duration
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isthmus
narrow band of thyroid tissue connecting the right and left lobes of the thyroid gland
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kyphosis
exaggeration or angulation of the posterior curve of the thoracic spine, giving rise to the condition commonly known as hunchback (Pott's curvature)
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lacrimation
tear fluid to protect the conjuntiva and cornea from drying, inhibits microbal growth, gives a smooth optical surface to the cornea
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larynx
musculocartilaginous organ at the upper end of the trachea, below the root of the tongue, lined with ciliated mucous membrane, that is part of the airway and the vocal apparatus
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macula
surrounds the fovea but has no discernable margins (named for a microscopic yellow spot)
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Medications that can cause sensorineural hearing loss
ototoxic medications including aminoglycosides, chemotherapy, ASA, quinine, loop diuretics
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malleus
largest of three auditory ossicles in the middle ear. It is attached to the eardrum and articulates with the incus.
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maxilla
paired bone with several processes that forms most of the upper face, roof of the mouth, sides of the nasal cavity and the floor of the orbit. Alveolar process of the maxilla supports the teeth, which is the basis for calling the maxilla the upper jaw
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meibomian gland
parallel row of glands lining the eyelids and opening on the lid margin, location for cyst called chalazion
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chalazion
infection of the meibomian glands, points internally, chronic problem, requires treatment
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Ménière's disease
a disorder caused by excess pressure within the inner ear, characterized by recurrent vertigo (dizziness), hearing loss, tinnitus (a roaring, buzzing or ringing sound in the ears), and aural fullness (idiopathic)
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miosis
abnormal contraction of the pupils, possibly due to irritation of the oculomotor system or paralysis of dilators
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moon facies
as in Cushing's Syndrome
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mydriasis
pronounced or abnormal dilation of the pupil
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neovascularization
formation of new blood vessels in the retina
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noise-induced sensorineural hearing loss
gradual and irreversible, due to cochlear hair cell damage as a result of loud noise exposure
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normocephalic
head and all major organs of the head are in a normal condition and without significant abnormalities
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nystagmus
fine rhythmic oscillation of the eyes (normal in extreme lateral gaze)
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occiput
the back part of the skull
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odynophagia
pain with swallowing
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Otitis externa
inflammation of the ear canal
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Otitis media
inflammation of the middle ear
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Otosclerosis
an abnormal sponge-like bone growing in the middle ear which prevents the ear bones from vibrating in response to sound waves
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otoliths
small particles, composed of a combination of a gelatinous matrix and calcium carbonate in the viscous fluid of the saccule and utricle. The inertia of these small particles causes them to stimulate hair cells when the head moves
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otorrhea
inflammation of the ear with discharge (serous, blood, or purulent), usually soft wax, debris from irritation in the ear canal, or discharge of fluid through a perforated ear drum, frequently associated with ear pain. Can be caused by trauma, acute or chronic otitis media or otitis externa
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ototoxicity
having detrimental effect on CN VIII or the organs of hearing
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palpebral
palpebral conjunctiva lines the eyelids
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papilledema
swelling of the optic disc and anterior buldging of the physiologic cup
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parotitis
inflammation of the parotid gland
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patency
the state of being freely open
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Perforated TM
often a sequela of infections of the middle ear, can also occur as a result of trauma (blow to the head, air or water pressure, instrumentation)
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periorbital
surrounding the socket of the eye
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pharynx
the passageway for air from the nasal cavity to the larynx and for food from the mouth to the esophagus
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photophobia
unusual intolerance to light, occuring in measles, rubella, meningitis, and inflammation of the eyes
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pinguecula
yellow triangular thickening of the bulbar conjuntiva on the inner and outer margins of the cornea (generally due to excessive exposure to sunlight)
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polyps
a swelling or excrescence (tumor) emanating from a mucous membrane; commonly found in vascular organs such as the nose, uterus, colon, and rectum
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preauricular
located in front of the ear
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presbycussis
age-related sensorineural hearing loss due to both genetic and environmental factors
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presbyopia
permanent loss of accomodation of the crystalline lens of the eye that occurs when people are in their mid-40s, marked by the inabillity to maintain focus on objects held near to the eye
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pterygium
triangular thickening of the bulbar conjunctiva extending from the inner canthus to the border of the cornea with the apex toward the pupil
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ptosis
dropping or drooping of the upper eyelid from paralysis
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retro-orbital
behind the eye
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rhinorrhea
drainage from the nose associated with nasal congestion, a sense of stuffiness or obstruction. Etiology: viral infections, allergic rhinitis, vasomotor rhinitis, medication side effects, sinus infection, rhinitis medicamentosa
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rhinitis medicamentosa
A noninfectious, nonallergic rhinitis caused by rebound vasodilation linked to the use of topical vasoconstricting decongestant sprays for more than 4–6 days.
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Rinne
the use of a tuning fork to compare bone conduction hearing with air conduction. Vibrating fork is held on the mastoid process of the ear until the patient no longer hears it, then it is held close to the external auditory meatus, if the subject still hears the vibrations, air conduction exceeds bone conduction which is a normal finding.
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sclera
outer layer of the eyeball made of fibrous connective tissue
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sclerosis
an induration or hardening, especially from inflammation and in diseases of the interstitial substance; applied chiefly to such hardening of the nervous system or to hardening of the blood vessels
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scotoma
an island-like blind spot in the visual field, usually associated with migraines
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serous
thin or watery, rather than syrupy, thick, or viscous
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stapes
the ossicle in the middle ear that articulates with the incus, the footplate of the stapes fits into the oval window
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sternocleidomastoid
one of two muscles arising from the sternum and inner part of the clavicle
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sty
a localized inflammatory swelling of one or more glands of the eyelid, mildly tender and may discharge some purulent fluid
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subconjunctival
beneath the conjunctiva
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Sudden sensorineural hearing loss (SSNHL)
unclear etiology, increased risk for CVA
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Systemic causes of sensorineural hearing loss
meningitis, autoimmune diseases, MS, syphilis, viruses, thyrotoxicosis, other
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three bones of the ear
Malleus (seen in cone of light, articulates with incus), incus, stapes (articulates with incus and fits into oval window)
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tinnitus
a subjective ringing, buzzing, tinkling, or hissing sound in the ear with no external stimulus, can coexist with conductive or sensorineural hearing loss, lesion anywhere along the auditory pathway, may be masked by external noise
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tonic pupil
Adie's pupil - pupil is large, regular, and usually unilateral, reaction to lights is severely reduced and slowed or even absent
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tragus
cartilaginous projection in front of the exterior meatus of the ear
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transillumination
inspection of a cavity or organ by passing a light through its walls, when pus or a lesion is present, the transmission of light is diminished or absent
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turbinates
concha, scroll-like bone on the lateral wall of the nasal cavity
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umbo
the central depressed portion of the concavity on the lateral surface of the tympanic membrane, marks the point where the malleus is attached to the inner surface
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vertex
the top of the head
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vertigo
"dizziness", sensation of true rotational movement of the patient or the surroundings, sensations point primarily to a problem in the labyrinths of the inner ear, peripheral lesions of CN VIII, or lesions in its central pathways or nuclei in the brain, maybe peripheral or central (lesion in CNS). Peripheral vertigo include BPPV, vestibular neuronitis, Ménière's disease, and immune-mediated inner-ear disease
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BPPV
benign paroxysmal positional vertigo - Episodic vertigo that lasts for seconds and is associated with head or body position changes
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Vestibular neuronitis
imbalance in vestibular neurologic input to the central nervous system characterized by abrupt onset of severe, debilitating vertigo with associated unsteadiness, nausea, and vomiting
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Immune-mediated inner-ear disease
characterized by disequilibrium, ataxia (failure of muscular coordination; irregularity of muscular action), motion intolerance, positional and episodic vertigo - includes Ménière's syndrome
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Weber
a test for unilateral deafness, a vibrating tuning fork is held against the midline of the top of the head is perceived as being so located by those with equal hearing ability in the ears, to persons with unilateral conductive-type deafness, the sound will be perceived as being more pronounced on the diseased side, in persons with unilateral nerve-type deafness, the sound will be perceived as being louder in the good ear.
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zygoma
the long arch that joins the zygomatic processes of the temporal and malar bones on the sides of the skull, the malar bone
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conductive hearing loss
problems in the external or middle ear
-
sensorineural hearing loss
problems in the inner ear, the cochlear nerve, or its central connections in the brain CN VIII
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hematemesis/hemoptysis
coughed up or vomiting blood
-
pharyngitis
sore throat - inflammation of pharynx
-
types of sore throat
- Infectious:
- Bacterial: group A strep, gonorrhea, diphtheria, H. influenzae (epiglottitis), syphilis
- Viral: rhinovirus, adenovirus, herpes, CMV, EBV, HIV, influenza, coxsackievirus
- Fungal: candida
- AND
- Noninfectious:
- Most common: allergic rhinitis, sinusitis, postnasal drip, GERD
- Less common: acute thyroiditis, head and neck malignancies, postoperative, postirradiation, burn or inhalation injuries, autoimmune disorders
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limbus
where the bulbar conjunctiva meets the cornea
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tarsal plates
firm strips of connective tissue within the eyelids
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levator palpebrae
muscle that raises the upper eyelid, is innervated by the oculomotor nerve CN III
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lacrimal puncta
two holes medially located on the eyelids where tear fluid drains to the lacrimal sac
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canaliculi
also known as lacrimal ducts, these tube-like structures carry the tears from the eyes (through the puncta) to the lacrimal sac
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ciliary body
the part of the vascular tunic of the eye that connects the choroid with the iris, produces aqueous humor for the anterior chamber of the eye
-
ciliary muscles
muscles that control the thickness of the lens, allowing the eye to focus on near or distant objects
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canal of Schlemm
drainage for the aqueous humor, helps to control pressure inside the eye
-
fundus
posterior part of the eye seen through the opthalmoscope, includes retina, choroid, fovea, macula, optic disc, and retinal vessels
-
fovea
darkened circle on the posterior of the eye that marks the point of central vision
-
red reflex
when light beam is shined on the pupil and orange/red glow is visible, absense of red reflex suggests an opacity of the lens (cataract) or possibly of the vitreous, less commonly a detacted retina or in children retinoblastoma. Artificial eyes have no red reflex
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macular degeneration
cause of poor central vision in older adults
-
cataract
densities in the lens
-
eustachian tube
connects the middle ear to the nasopharynx
-
GAS
group A ß-hemolytic strep
-
suppurative
forming pus (ex: peritonsillar abscess)
-
Centor Clinical Prediction Rule
- -hx of fever
- -absence of cough
- -tonsillar exudates
- -anterior cervical adenopathy
- (if patient has 2 or more, do rapid strep test)
-
PND
- post nasal drip
- (paroxysmal nocturnal dyspnea)
-
URI
upper respiratory infection
-
otorrhea
discharge from ear
-
pars flaccida
- the small, triangular portion of the tympanic membrane lying between the lateral process of the malleus and the margins of the tympanic incisure

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pars tensa
- the drumlike part of the tympanic membrane

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