Head and Neck Exam 1 Flashcards
PE Questions
Any problems with your hearing? Any nasal stuffiness or discharge?
What do we look for in the scalp?
Scaliness, lumps, nevi, or other lesions
What do we look for and note in the skull?
Size and contour; deformities, depressions, lumps, or tenderness
What could an enlarged skull signify?
Hydrocephalus or Paget’s disease of bone
What could cause tenderness or drop-off in the head?
Head trauma
What do we note and observe in the patient’s face?
- Facial expression and contours
2. Observe for asymmetry, involuntary movements, edema, and masses.
What 3 things could cause facial swelling?
- Cushing’s Syndrome (cortisol, red cheeks)
- Nephrotic Syndrome (edematous and pale)
- Myxedema (severe hypothyroidism, puffy face, dry skin)
3 other types of facial problems
- Parotid Gland Enlargement (obesity, diabetes, mumps, swelling in face)
- Acromegaly (GH increase with bone and soft tissue increase, elongated head, enlarged face features, bony)
- Parkinson’s Disease (masklike, depressed facial mobility, decreased blinking, face and neck forward)
Do we inspect the ear?
Yes
6 types of lumps on or near the ear
- Keloid (hypertrophic mass of scar, more common in darker skinned people)
- Tophi (deposit of uric acid, appears in helix or anti-helix, can also appear in joints)
- Cutaneous Cyst (formerly sebaceous cyst, lump in dermis)
- Chondrodermatitis Hellicis (inflammation on helix or anti-helix, must rule out carcinoma here)
- Basal Cell Carcinoma (slow growing malignancy, rarely metastasizes, more frequent in light skinned people over exposed to sun)
- Rheumatoid Nodules (in chronic RA, look for on helix or anti-helix, ulna distal to elbow)
Epidermoid Cyst
Common in face and neck
Pilar (Trichilemmal) Cyst
Common on scalp
What is the Tug Test?
Movement of auricle and tragus
When is the Tug Test painful?
Acute otitis externa but NOT acute otitis media
What can be present in otitis media?
Tenderness behind the ear
What is the umbo?
Where the eardrum meets the tip of the malleus
Cone of Light Test
Shine light in ear to look for white cone in divided lower quadrant - should be anterior and down
What is perforation of the ear drum usually caused by? What is scarred?
Purulent infections in the middle ear - eardrum itself is scarred
Tympanosclerosis
Inferior portion of this left eardrum, large, chalky white patch with irregular margins
What is Serous Effusion usually caused by?
Viral URI or by sudden changes in atmospheric pressure
Give an example of a viral URI
Otitis media with serous effusion
What causes Acute Otitis Media with Purulent Effusion? Symptoms?
Bacterial infection from S. Pneumoniae and H. Influenza
Earache, fever, and hearing loss
What causes Bullous Myringitis?
Mycoplasma, viral, and bacterial otitis media
How far behind the patient do we stand for Whispered Voice Test for Auditory Acuity?
2 feet
How do we perform a Whispered Voice Test for Auditory Acuity?
- Exhale a full breath before whispering to ensure a quiet voice
- Whisper a combination of three numbers and letters, such as 3-U-1 (change for other ear)
What is a normal whispered voice test?
Patient repeats at least three out of the possible six numbers and letters correctly.
Where do we divide conductive and sensorineural?
Middle and Inner ear (past middle is sensorineural)
What is the Rinne Test?
Compare air conduction (AC) and bone conduction (BC)
Conductive Hearing Loss
Sound is heard through bone as long as or longer than it is through air
Formula for Conductive Hearing Loss
BC = AC or BC > AC
Sensorineural Hearing Loss
Sound is heard longer through air
Formula for Sensorineural Loss. What do we assume?
AC > BC, i.e. the “normal pattern”
Sensorineural loss is not complete
What do we inspect and note for the nose and paranasal sinuses?
Surface of the nose; asymmetry or deformity
What do we test for in the nose and paranasal sinuses?
Nasal Obstruction
What do we inspect for inside the nose?
Largest ear speculum available (with otoscope)
What do we try to see with the otoscope?
Inferior and middle turbinates, the nasal septum, and the narrow nasal passage between them
What do we note in the nasal septum?
Deviation, inflammation, or perforation
Epistaxis
Nosebleed
Common cause of epistaxis?
Lower anterior portion of septum where finger can reach
Could we see fresh blood or crusting?
Yes
What are causes of septal perforation?
Trauma, surgery, and intranasal use of cocaine or amphetamines
Could we see ulcers or polyps?
Yes
What are some conditions conducive to polyps?
Allergic rhinitis, aspirin sensitivity, asthma, chronic sinus infections, and cystic fibrosis
Do we palpate for sinus tenderness?
Yes
What could suggest acute sinusitis?
Local tenderness, together with symptoms such as pain, fever, and nasal discharge involving frontal or maxillary sinuses
Is Transillumination of the Sinuses highly sensitive or specific for for assessing Sinusitis?
No
What do we look for in Transillumination of the Sinuses?
Dim red glow as light is transmitted through air-filled frontal sinus to forehead
What does an absence of glow in Transillumination of the Sinuses suggest?
Thickened mucosa or secretions in the frontal sinus, but it may also result from developmental absence of one or both sinuses.
