Examination of Skull, Face, Nose and Ears Flashcards
Inspection of face, head and neck
SSSSSHEM
Symmetry
Swellings
Shape of face and skull
Scars
Skin (rashes, acne, blisters and vitiligo)
Hair
Expression
Movements
Examination of the eyes
Lid lag
Proptosis
Eye movements
Sclera for jaundice or anaemia
Features of thyroid eye disease
Inspection of the skull and face
Symmetry
Cushingoid featres
Acromegaly features
Bony changes
Inspection of nose
Look from front, side and above - nasal pyramid and discharge
Check air flow
Look at nasal vestibule - elevate tip of nose to do so
Inspection of the ears
Pinna - nodules
Pinna pushed forward = mastoiditis
External aditory meatus - discharge
Behind pinna for scars
Mastoid process for bruising or battle’s sign
Auriscope
Screen for pain
Inspect the outer ear and the meatus, then gently pull back pinna upwards and backwards
Visualise tympanic membrane and surface landmarks
What do you palpate?
Skull, face, nose and ears
Skull - mastoid process, orbital margins, tenderness along temporal artery, maxilla, mandible, T-M joint (ask patient to open and close their mouth and move it side to side)
Nose - nasal cartilage, tenderness over paranasal sinuses (maxillary, ethmoid, frontal)
Ears - assess for discomfort (press in front of meatus/pull on pinna)
Palpate gently over each mastoid process - looking for tenderness
What happens after palpation?
Hearing tests
Rinnes and Webers
What tuuning fork do you use for hearing tests?
512 Hz tuning fork
In what order do yo do the whispered voice test?
Conversational voice at 60cm - then whisper at 60cm
If not heard do conversational voice at 15cm then loud voice
