Ear, Nose, and Neck Abnormalities

Question 1

What is the Weber test?

Answer 1

• Place vibrating tuning fork (512 Hz) on top of patient’s head
• Ask patient where he/she hears the sound
• Sound should be heard in both ears equally

Question 2

When doing a Weber test, what does lateralization to the impaired ear mean?

Answer 2

• Unilateral conduction loss lateralizes to the impaired ear (conduction loss lateralizes to the “cruddy” ear)
• Why? One theory: with conductive loss, sound conducts preferentially through bone
• Can occur with: otitis media, TM perforation, cerumen impaction, otosclerosis (abnormal bone growth in middle ear), others

Question 3

When doing a Weber test, what does lateralization to the good ear mean?

Answer 3

• Unilateral sensorineural loss lateralizes to the good ear (sensorineural loss lateralizes to the “super” ear)
• Why? The affected ear is less effective at picking up sound no matter how it reaches the inner ear
• Can occur with: presbycusis, noise exposure, head trauma

Question 4

What is the Rinne test?

Answer 4

• Place tip of vibrating tuning fork on mastoid bone & ask patient if he/she can hear it
• Tell him/her to tell you when the sound stops
• Then move tuning fork to opening of ear canal & ask if patient can still hear it
• If they can still hear it, AC > BC which is normal

Question 5

What does Rinne tests evaluate?

Answer 5

• Air conduction vs bone conduction
• Normally AC > BC
• If unilateral conduction loss is present BC > AC
• Sensorineural loss produces decreased AC > BC

Question 6

What are the landmarks on the tympanic membrane?

Answer 6

• Pars Flaccida
• Handle of the Malleus
• Umbo
• Pars Tensa
• Cone of light

Question 7

What is Rhinophyma?

Answer 7

-Large bulbous ruddy appearance of the nose, cause unknown, related to rosacea

Question 8

Describe Viral rhinitis

Answer 8

-Mucosa typically red & swollen with purulent drainage

Question 9

Describe Allergic rhinitis

Answer 9

-Mucosa pale, bluish or red, tubinates boggy and drainage is clear

Question 10

Describe the Throat exam

Answer 10

• Inspect lips, teeth, gums, mucosa, tonsils (with verbalization)
• Ask patient to say “Ahh” (CN IX, X)
• Test tongue protrusion & side to side (CN XII)
• Palpate the oral cavity (gloved, bimanual)

Question 11

What are some abnormal lip findings?

Answer 11

• Herpes labialis (cold sore)
• Angular cheilitis (in corner of mouth)
• Aphthous ulcer (white ulcer behind the lips)

Question 12

What is Torus mandibularis?

Answer 12

• Rounded, bony growths that vary in size and lobulation

- Common, benign, harmless

Question 13

Describe the Anterior Triangle

Answer 13

• Formed by the border of sternocleidomastoid muscle, mandible, and midline of neck
• Contents: hyoid bone, cricoid cartilage, trachea, and anterior cervical lymph nodes

Question 14

Describe the Posterior triangle

Answer 14

• Formed by sternocleidomastoid muscle, trapezius, and clavicle
• Contents: posterior cervical lymph nodes

Question 15

What would cause a Pemberton sign?

Answer 15

1) Goiter diagnosis most reliable when visible in normal position & palpable
2) Palpable infraclavicular lymph nodes assoc. with breast cancer, lymphoma