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Physical Assessment > Ears Nose and Mouth > Flashcards

Ears Nose and Mouth Flashcards

1
Q

Physical Exam

A 
Assess gross hearing
Rinne and Weber test
Inspect auricle
Palpate mastoid process
Press tragus
Inspect canal
Inspect tympanic membrane
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2
Q

Gross Hearing

A

Whispered voice test
Conversational speech
Rubbed fingers
if abnormal, asses Weber and Rinne test

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3
Q

Weber Test

A

place fork on midline of head
ask if sound is louder in one ear than other
should be equal

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4
Q

lateralization

A

hearing on both sides equally

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5
Q

Rinne Test

A

normal air > bone conduction

if blocked, bone > air

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6
Q

Conductive loss

A

blocking vibrations
external or middle disorder impairs conduction
Weber: sound will lateralize to impaired ear
Rine: bone > air
Foreign body, impacted cerumen, otitis externa
Tympanosclerosis
Otosclerosis

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7
Q

Tympanosclerosis

A

scar tissue on tympanic membrane

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8
Q

Sensorineural loss

A

-impaired vestibulocochlear nerve CN VIII or neuronal impulse
-higher tones lost
-hearing worse in noisy environment
-voice gets louder
-weber sound lateralizes to good ear
Rinne AC >BC
causes: aging, exposure to loud, inner ear infection, trauma, acoustic neuroma

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9
Q

acoustic neuroma

A

tumor growing inside ear, impedes CN VIII

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10
Q

Inspect external ear

A
  • changes in skin, common for skin cancer
  • symmetry
  • piercings, scars, keloids
  • palpate tragus and mastoid
  • inspect behind for eczema and fissures
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11
Q

Otoscopic exam

A

evaluate external canal
assess tympanic membrane
asses for foreign body, cholesteatoma, fluid
Lift up and pull back

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12
Q

cholesteatoma

A

An abnormal skin growth in the middle ear behind the eardrum is called cholesteatoma. Repeated infections and/or a tear or pulling inward of the eardrum can allow skin into the middle ear.

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13
Q

Cone of light

A

indicates TM is soft, no pressure or fluid
R at 5:00
L at 7:00

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14
Q

Otitis External

A 
external canal inflammation
exuduate my block TM
usually from swimming, trauma, dermatologic condition
P aeruginosa and staph epidermidis
Treatment antibx drops
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15
Q

Exostosis

A

nontender outgrowths of bone covered by normal skin deep in ear canals
nonmalignant, may obscure ear drum
seen in swimmers

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16
Q

serous otitis

A

common with viral upper respiratory infections
common reason for otalgia
can occur from flying

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17
Q

otalgia

A

ear pain

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18
Q

acute otitis media

A

middle ear infection

  • whitish discoloration
  • marked erythema
  • bulging TM
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19
Q

Bullous Myringitis

A

painful vesicles appear on TM
common organism mycoplasm, viral, or bacterial otitis media
treat with macrolide

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20
Q

Cholesteatoma

A
  • accumulation of squamous epithelium (skin)
  • usually result of chronic otitis media or congenital
  • unchecked may cause hearing loss
  • refer to ENT, surgical removal
21
Q

Perforated TM

A

holes in eardrum, usually result of purulent infections if middle ear
-central perforations, do not extend to margin of drum
marginal perforations involve margin, harder to heal
no drops, emergency/ENT

22
Q

Tympanosclerosis

A

healed perforation
large chalky white patch with irregular margins
deposition of hyaline material develops after several episodes of OM

23
Q

Tympanostomy tubes

A
  • used for ventilation of middle ear
  • young children usually age 2 after many otitis media infections
  • water precautions
  • fall out as child grows
24
Q

Nose physical exam

A

Inspect and palpate:
-external nose
-nasal vacity (nasal septum, turbinates, mucosa)
test patency of nostril
palpate sinus areas
frontal and maxillary sinus transillumination

25
Q

External nose

A

normal

deviated septum

26
Q

Nasal patency

A

tests ability to breath through nostril, one at time

CN I usually not tested unless complaint

27
Q

Nasal cavity

A

middle turbinate, inferior turbinate, vestibule, septum

turbinates healthy or red/swollen

28
Q

viral rhinitis

A

mucosa reddened and swollen

29
Q

allergic rhinitis

A 
pale, bluish, or red
response to environmental allergens
assoc with sneezing, rhinorrhea, nasal obstruction, itchy eyes, nose and palate
seasonal fall and spring
cough r/t post nasal drip
turbinates pale and boggy (swollen)
30
Q

allergic signs

A 
Allergic salute (nose tilts up due to swelling)
allergic  shiners (black eyes)
31
Q

Nasal polyps

A

-polyps are pale, semitransluscent masses that usually come from middle meatus
-often associated with chronic allergic rhinitis
(come back if removed)

32
Q

Septal perforation

A

caused by trauma, surgery, and intranasal use of cocaine or ampthetamines (drugs that dec blood flow)

33
Q

Transillumination

A 
normal = glows red, air
abnormal = no glowing, full of fluid (sinusitis)
34
Q

Mouth and throat physical exam

A

Inspect: lips, dentition, gums, buccal mucosa, tongue, palate, pharynx (uvula, pillars, tonsils, laryngeal wall), tongue, sublingual, eval Stenson and Wharton’s ducts, CN XII, CN IX, CN X

35
Q

Angular Cheilitis

A

fissures in angles, nutritional defect or poor dentition

36
Q

Herpes Simplex

A

vesicular lesions, contagious sores, fluid filled and painful

37
Q

Angioedema

A

usually resolved but may be life threatening

*can be caused by ace inhibitors

38
Q

Carcinoma of the lip

A

usually lower lip, associated with tobacco use

39
Q

Gums

A

caries and periodontitis

40
Q

Geographic tongue

A

map like texture of tongue, normal

41
Q

candidiasis

A

yeast infection
white lesions on tongue or inner cheek
can be caused be inhaled steroids (teach to rinse mouth)
“oral thrush”

42
Q

smooth tongue

A

atrophic glossitis - tender, painful, depapillation
atrophy of tongue
B12/niacin deficiency

43
Q

CN IX, X, XII

A

CN IX: glossopharyngeal
CN X: Vagus
CN XII: hypoglossal

44
Q

Cryptic tonsils

A

develop small pockets or pits called crypts. These crypts can trap food and form small growths called tonsilliths or tonsil stones

45
Q

Grading Tonsils

A

1+ = visible
2+ = halfway between pillars nad uvula
3+ = touching uvula
4+ touching each other

Normal 1+ and 2+
not visible: retracted or removed

46
Q

Pharyngitis

A

inflammation causing sore throat

common caused by strep, 85% viral, also mononucleosis

47
Q

Karposi Sarcoma

A

hard/soft palate
deep purple lesions, raised or flat
oral cancer assoc. with AIDS

48
Q

Herpangina (coxsackie)

A

viral with ulcers and lesions inside mouth
sore throat and fever
supportive therapy, rest pain relief

Physical Assessment (5 decks)

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