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Intro to Patient > Head and Neck Exam 1 > Flashcards

Head and Neck Exam 1 Flashcards

1
Q

General Appearance

A 
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
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2
Q

Overview: Head Exam

A

Examine hair, scalp, skull, and face

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3
Q

Overview: Eye Exam

A

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

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4
Q

Overview: Ear Exam

A

Inspect auricles, canals, and drums
Check auditory acuity
-if diminished check lateralization: Weber test
-and compare air and bone conduction (Rinne test)

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5
Q

Overview: Nose and Sinus Exam

A

Examine external nose.
Inspect nasal mucosa, septum and turbinates using light and nasal speculum
Palpate for tenderness of frontal and maxillary sinuses

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6
Q

Overview: Throat (or mouth and pharynx) Exam

A

Inspect lips, oral mucosa, gums, teeth, tongue, palate, tonsils, and pharynx
May also assess cranial nerves during this portion of the examination

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7
Q

Overview: Neck Exam

A

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

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8
Q

Examination of Eyes

A

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)

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9
Q

Eye Conditions

A

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
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10
Q

Examination of Ears

A 
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
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11
Q

Weber’s Test

A

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?”
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12
Q

Rinne’s Test

A

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?”
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13
Q

Weber’s Test Interpretation

A

Normal: sound heard in midline

Conducive hearing loss: sound heard in bad ear

Sensorineural hearing loss: sound heard in good ear

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14
Q

Rinne’s Test Interpretation

A

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)

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15
Q

Examination of Nose

A

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

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16
Q

Examination of Para-Nasal Sinuses

A 
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?
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17
Q

Examination of Throat/Oral/Oropharynx

A 
Inspection 
Palpation/percussion 
Normal anatomy 
Start from outside - work to inside 
Dentition
18
Q

Peri-Oral and Intra-Oral Examination

A

Systematic assessment of lips; labial mucosa and sulcus (the gutter); commissures; buccal mucosa and sulcus; gingiva and alveolar ridge; tongue; floor of mouth; hard and soft palate; pharynx; tonsillar bed

Begin by observing lips and commissures (open AND closed)
-could be problem hiding in commissures

Note color, texture, surface abnormalities of vermillion borders (which are where lip becomes skin)
***loss of vermillion border is indicative of lip cancer

19
Q

Inspection of Lips and Peri-Oral Region

A

Salivary gland hypofunction (dry mouth)
Dry/chapped lips/mucosa
Mouth opening restricted (bc of pain)
Angular cheilitis - inflammation and small cracks in corners of mouth
Tongue papillary atrophy - loss of lingual papillae (taste buds)

20
Q

Examination of Labial Mucosa

A

With patient’s mouth partially open, visually examine and palpate labial mucosa and sulcus of maxillary vestibule, frenum (skin piece at midline), and mandibular vestibule

 - labial mucosa = inner lips 
 - palpate bc there are minor salivary glands in this mucosa; if hard portions, good chance it’s cancer

Observe color, texture, and any swelling or other abnormalities in the vestibular mucosa and gingiva

21
Q

Examination of Buccal Mucosa

A

Retract buccal mucosa (cheeks)
Examine right and left buccal mucosa extending from labial commissure posterior to anterior tonsillar pillar

Note any change in pigmentation, color texture, mobility, and other mucosal abnormalities

Carefully examine commissures - do NOT retract with instruments
-not palpating and could even be blocking vision

Parotid gland located between first and second molar on each side high on buccal mucosa - “Stenson’s duct”

22
Q

Examination of Gingiva

A

Examine buccal and labial aspects of gingival tissue and alveolar processes
-proceed from 1 to 32 (maxillary right posterior to maxillary left posterior, then drop the mandibular left posterior to mandibular right posterior)

Examine palatial and lingual aspects of gingival tissue and alveolar process (same direction)

Note any changes in color texture, pigmentation, mobility, and other gingival abnormalities

23
Q

Mallampati Score

A

Used in anesthesia
An assessment of airway architecture as it applies to endotracheal intubation
-really just a description of how closed off back of the throat is
May be associated with obstructive sleep apnea or even snoring

Class 1: good
Class 2: slightly less open
Class 3: can barely see uvula
Class 4: can’t really see back of the throat at all (very bad)

***patient must stick out their tongue in order to get accurate reading

24
Q

Palatine Tonsils - Oro/Pharyngeal Airway

A

HPV cancers almost always (75-80% of the time) effect tonsils
-THIS CANCER IS ON THE RISE
Should assess tonsils for asymmetry FOR EVERY SINGLE PATIENT

25
Q

Examination of Tongue

A

With tongue at rest, partially open mouth, inspect dorsum for swelling, ulceration, coating, variation in size, color, or texture

Examine papillae (taste buds) and tip

Patient should extend tongue - not motion, direction, and abnormalities
-grasp tongue with 2x2 and palpate all surfaces (looking for granular cell tumor or squamous cell cancer)

Inspect lateral borders to tonsillar pillars, ventral surface

 - “ventrum of tongue” = belly of the tongue 
     - precancerous lesions  
 - IF THERE’S CANCER IT’S MOST LIKELY GOING TO BE ON LATERAL PORTION (especially in posterior area)
26
Q

Examination of Floor of Mouth

A

With tongue elevated, inspect for changes in color, texture, swellings, or other surface abnormalities

Mandibular tori
-bony projections on floor of mouth

  • **important to see entire floor of mouth posteriorly
    • another hotspot for oral cancer

Also look at teeth here…

 - caries 
 - oral candidiasis: “yeast infection” (can be white or red)

Look for salivary stones or salivary pooling

27
Q

Examination of Hard Palate

A

Mouth wide open and patient’s head tilted back (depress base of tongue with index finger/mirror)

Minor salivary glands line hard palate
-hard “node thing” - high likelihood that it’s salivary gland cancer

First inspect hard palate, then inspect the soft palate behind it
-“say ah”: should we soft palate vibrate and move up

Also look at teeth here…

 - can see caries 
 - or oral candidiasis: “yeast infection” (can be white or red)
28
Q

Linea Alba

A

“White line” where upper and lower teeth meet on the buccal mucosa
-be careful, white patches/sections are not the same as white LINES

29
Q

Palatine Torus

A

Growth of bone in midsection of palate
Different than a tumor
-bony hard (tumors would be woody hard - have a little give to it)

On roof of mouth it is not uncommon for tori to be not symmetric

Only removed if affecting mouth in serious way

30
Q

Oral Cancer Risk Assessment: Low

A

No tobacco, alcohol use, minimal sun exposure

31
Q

Oral Cancer Risk Assessment: Elevated

A

Minimal tobacco use, minimal alcohol use, moderate sun exposure, gender, poor nutrition and habit, fair skin, drug use

excessive smokeless tobacco use, excessive alcohol consumption, excessive sun exposure, family history, HPV exposure, previous history of oral cancer, immunocompromised, gender, severely poor nutrition and habit, fair skin

Note: where its a little or a lot of something bad - still elevated somehow (just different levels of elevated)

32
Q

Oral Cancer Relative 5 Year Survival

A

Oro-pharyngeal: 67%

Anterior oral cavity = 60%

As of Aug. 2016

33
Q

70% of Leukoplakia Occurs…

A

Lip vermillion, buccal mucosa, gingiva

34
Q

90%. Of Dysplasia Occurs…

A

Tongue, lip vermillion, and FOM

35
Q

Oral Cavity Squamous Cell Cancer (OCSCC) Incidence Rates (IR)

A

For most sites, including lip, gingiva, and FOM have decreased in US
-consistent with declines of drug and alcohol use

36
Q

Oro/Pharyngeal Squamous Cell Cancers (OPSCC) Incidence Rates (IR)

A

Base of tongue, tonsil, soft palate, and pharyngeal wall
Have SIGNIFICANTLY INCREASED, particularly in white men
-increase due to HPV (human papilloma virus)
-sexual habit issue - men have much more difficulty clearing HPV

***subtypes 16 and 18 are associate with these types of cancers

37
Q

Incidence Rates (IR) for Oral Tongue Squamous Cell Cancer (OTSCC)

A

Anterior 2/3 of the tongue
Increasing in white men and women
On lateral border of tongue

Cause of this is unknown

 - patients have zero risk factors 
 - much more difficult to treat (usually just have to cut out a good portion of the tongue)
38
Q

Consequences of Oral Cancer

A

Radiation therapy and complications
Surgical resection
Morbidity and Debility
Diminished quality of life

39
Q

Intraoral Examination Components

A

Dental examination

Oral mucosal examination

40
Q

Extraoral Examination Components

A 
Facial inspection 
Head and neck evaluation 
     -lymph node exam 
     -salivary gland exam 
     -thyroid exam 
Temporomandibular exam 
Cranial nerve exam

Intro to Patient (10 decks)

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