Head and Neck Exam 1 Flashcards
General Appearance
Apparent state of health Level of consciousness Signs of distress -cardiac or respiratory; pain; anxiety/depression Skin color and obvious lesions Dress, grooming, and personal hygiene -appropriate to weather and temperature -clean, properly buttoned/zipped Facial expression -eye contact, appropriate changes in expression Odors of body and breath Posture, gait, motor activity
Overview: Head Exam
Examine hair, scalp, skull, and face
Overview: Eye Exam
Check visual acuity and screen visual fields
Not position and alignment of eyes
Observe eyelids and inspect sclera and conjunctiva of each
Inspect each cornea, iris, and lens with oblique lighting
Compare pupils ad test reactions to light
Assess extraocular movements
Inspect ocular fundi with ophthalmoscope
Overview: Ear Exam
Inspect auricles, canals, and drums
Check auditory acuity
-if diminished check lateralization: Weber test
-and compare air and bone conduction (Rinne test)
Overview: Nose and Sinus Exam
Examine external nose.
Inspect nasal mucosa, septum and turbinates using light and nasal speculum
Palpate for tenderness of frontal and maxillary sinuses
Overview: Throat (or mouth and pharynx) Exam
Inspect lips, oral mucosa, gums, teeth, tongue, palate, tonsils, and pharynx
May also assess cranial nerves during this portion of the examination
Overview: Neck Exam
Inspect and palpate cervical lymph nodes
Note any masses or unusual pulsations
Feel for any deviation of trachea
Observe sound and effort of patient’s breathing
Inspect and palpate thyroid gland
Examination of Eyes
Look for symmetry/asymmetry
Hypertelorism - abnormally large distance between the eyes
Pupils PERRLA
-Pupils Equal, Round, Reactive to Light and Accommodation
Convergence - “follow the pencil”
CN III, IV, VI
CN V - blink
CN VII
Visual acuity 20/20, correlation with normal sight
Nystagmus - fast, uncontrollable eye movement
Visual fields: confrontation - measure outer edge of visual field
Hemianopsia - loss of vision for 1/2 visual field
Presbyopia - loss of ability to focus on close objects (farsighted)
Myopia - far objects blurred (nearsighted)
Eye Conditions
Ptosis - eyelids droop a little
Miosis/Mydriasis - small pupil/large dialated pupil
Anisocoria - pupils are different sizes
Icterus - yellowing of sclera - from jaundice
redness
Blood
Dryness
Pallor - white instead of moist pink inside of socket
-indicates iron deficiency (anemia)
Chalazion - eye gland gets swollen
Conjunctivitis - pink eye
Pterygium - benign; “swimmer’s eye”, response to sun
-whites of eyes look like they’re growing into pupil
-confused with symblepharon (eyeball starts to scar and hold onto eyelid) — can cause blindness
Pupillary reactions:
- pinpoint = opioids - dilated = cocaine
Examination of Ears
Use otoscope to get view of tympanic membrane to see if there’s any fluid behind it Check patency Check for discharge (Q-tips) Weber test Rinne’s Test
Weber’s Test
detects conductive hearing loss (ex. Wax buildup) and sensorineural hearing loss (ex. Age, neurological problem)
- tuning fork placed on midline - “Where can you hear the buzzing noise?”
Rinne’s Test
testing loss of hearing in one ear; compares perception of sounds transmitted by air conduction to those tramitted by bone condition through the mastoid (behind ear)
- tuning fork pressed against mastoid and then 1 cm from ear - “Which is louder?”
Weber’s Test Interpretation
Normal: sound heard in midline
Conducive hearing loss: sound heard in bad ear
Sensorineural hearing loss: sound heard in good ear
Rinne’s Test Interpretation
Normal: air louder than bone (Rinne’s positive)
Conductive hearing loss: bone louder than air (Rinne’s negative)
Sensorineural hearing loss: air louder than bone (Rinne’s FALSE positive)
Examination of Nose
Look for nasal deviation
Check patency;can you move anterior portion up?
Any secretions?
Signs of congestion?
Epistaxis? - nose bleeding
Rhinorrhea? - runny nose (“nose diarrhea)
Scars
Lesions
Supraalar crease (side of nose) - can be lost if someone has infection in canine tooth
Examination of Para-Nasal Sinuses
Check all of them! -multiple (bilateral) -front and maxillary Percussion Trans illumination -if heavy congestion, won’t see the light though the sinus Relate to history Relate to ROS Maxillary sinusitis (cheek sinuses) -discharge? If so, color? -headaches? -pressure?