Exam of head and neck and ENT lecture

Question 1

What are the 4 cornerstones of a physical exam in general:

Answer 1

1 Inspection
2 palpation
3 percussion
4 auscultation

Question 2

Exam of the head includes what cornerstones of physical exam?

Answer 2

Inspection

palpation

Question 3

What are we looking for on inspection of the head?

Answer 3

symmetry
distribution of hair
areas of baldness
nits, flaking, rashes

Question 4

what are we feeling for on palpation of the head?

Answer 4

masses
defects
tenderness
hair texture

Question 5

What does thin hair indicate?

Answer 5

iron deficiency anemia, thyrotoxicosis

Question 6

What does coarse hair indicate?

Answer 6

hypothyroidism

Question 7

What cornerstones of physical exam are used in exam of the neck?

Answer 7

Inspection
Palaption
ausculation

Question 8

Inspection of the neck looks for?

Answer 8

masses
scars
deformities
swelling
deviation of trachea
enlargement of thyroid

Question 9

Palpation of the neck looks for?

Answer 9

palpable thyroid for presence/absence of nodules
have pt swallow
Lymph nodes

Question 10

What is an enlarged supraclavicular node on the L side a sign of?

Answer 10

Virchow’s node-ominous sign for gastric Ca.

Question 11

What must you do prior to palpating the neck?

Answer 11

listen for carotid bruit

Question 12

What cornerstones of physical exam are used when evaluated the carotids?

Answer 12

Inspection
palpation
auscultation *** auscultation first

Question 13

What must you have pt do when auscultating the carotid artery?

Answer 13

have pt hold their breath

Question 14

What cornerstones of physical exam are used when evaluating the ears?

Answer 14

Inspection
Palpation
(special test)

Question 15

What are you looking for on inspection of the ears?

Answer 15

piercings
auricles
ear canal for redness, cerumen, d/c, FB

Question 16

What should you do prior to palpating the pt’s ear?

Answer 16

Ask if they have pain.

Question 17

Pt’s with otitis media will have ________ with the tug test.

Answer 17

No pain

Question 18

tenderness of mastoid may indicate

Answer 18

mastoiditis or otitis media

Question 19

What special test tests for lateralization?

Answer 19

Weber test

Question 20

What special test tests for air vs. bone conduction

Answer 20

Rinne test

Question 21

On Weber test what might be indicated if the pt. lateralized to 1 ear?

Answer 21

Unilateral conductive loss-tone will be percieved in the affected ear.
OR
Unilateral sensorineural loss-tone will be perceived in UNaffected ear.

Question 22

On Rinne test what might be indicated if the pt lateralized to one ear and bone conduction is better than air conduction?

Answer 22

conductive hearing loss

Question 23

One Rinne test what might be indicated if the pt lateralized to one ear and air conduction is better than bone conduction in the same ear?

Answer 23

Sensorineural hearing loss

Question 24

Conductive hearing loss:

Answer 24

loss related to problems of the outer or middle ear (otitis media, cerumen,)

Question 25

Sensorineural hearing loss:

Answer 25

Inner ear or auditory (CN8) problem (menieres dz, trauma, aging)

Question 26

On otoscopic exam you should be looking for:

Answer 26

Cone of light
Handle and short process of malleus
Note color and position:
normal: pinkish color, neutral position

Question 27

exam of the nose includes what physical exam cornerstones?

Answer 27

Inspection

palpation

Question 28

What do you evaluate for on inspection of the nose?

Answer 28

nares for flaring
Nasal bone for symmetry
mucus membranes
nasal septum
turbinates
nasal discharge

Question 29

What are the cornerstones of physical exam for the nasal sinuses?

Answer 29

Inspection
palpation
percussion