Head and Neck (HEENT) Flashcards
1
Q
Temporomandibular Joint
A
- Formed by the temporal bone and the mandible
- Responsible for opening and closing mouth
- Condylar synovial joint
- External pterygoids: open mouth
- Masseter, temporalis, internal pterygoids: close mouth (CN V)
2
Q
How to Examine the TMJ
A
- Inspect: swelling or redness near external auditory meatus
- Palpate: fingers in front of tragus, palpate (while patient uses joint) for clicking or pain
- ROM: have patient (Open and close mouth, Jut jaw forward (protrusion and retraction), Move jaw side to side)
3
Q
External ear
A
auricle, canal, tympanic membrane
4
Q
middle ear
A
air-filled cavity containing the ossicles: malleus, incus, stapes
5
Q
inner ear
A
cochlea, vestibular apparatus
6
Q
physical exam of the ear
A
- inspection of outer ear
- palpation
- examination using otoscope
- assessment of hearing
7
Q
otoscopic examination
A
allows direct visualization of the ear canal and the tympanic membrane
8
Q
Ramsey Hunt Syndrome
A
Herpetic infection of the geniculate ganglion. Can also affect CN VIII, causing hearing loss.
9
Q
Cauliflower ear
A
- Cauliflower ear (complication of hematoma auris, perichondrial hematoma, or traumatic auricular hematoma) is a condition that occurs when the external portion of the ear suffers a blow, blood clot or other collection of fluid under the perichondrium.
- This separates the cartilage from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin.
- As a result, the outer ear becomes permanently swollen and deformed, resembling a cauliflower.
10
Q
Proper exam technique
A
- hold the scope “upside-down”
- use other hand to distract auricle
11
Q
pneumatic otoscopy
A
- Puff of air onto TM during examination
- Normal TM should be mobile and flutter with air puff
- Used to assess patients with possible otitis media or effusion
12
Q
cerumen
A
earwax
13
Q
serous otitis media
A
- allergies (ear fullness or pressure in ears are common complaints)
- you would see loss of mobility of tympanic membrane here
14
Q
suppurative otitis media
A
- cone of light is displaced (abnormal light reflects)
- significant erythema
- cant see ossicles
15
Q
tympanic perforation
A
opaque, no light reflects, cant see ossicles
16
Q
tympanosclerosis
A
scar tissue along tympanic membrane
multiple infections can lead to this
kids that have had tubes usually have a little tympanosclerosis depending on how long the tubes were in
17
Q
mechanics of hearing
A
Two separate (but connected) mechanisms (Conductive and Sensorineural)
18
Q
conductive hearing
A
- Sound waves vibrate through the air, through the ear canal, to the tympanic membrane, vibrating the ossicles.
- Alternatively, sound waves can vibrate through bone, and directly vibrate the ossicles, bypassing the tympanic membrane.
- Conductive hearing loss: ear canal blockage, perforation of TM, or problem with the ossicles.
19
Q
sensorineural hearing
A
- The ossicles transmit vibrations to the oval window, which in turn transmits vibrations into the cochlea, which is lined with specialized receptors. These send signals to the brain via the cochlear nerve (CN VIII).
- Sensorineural hearing loss: disruption of the neural pathway, either in the inner ear or in the brain.
20
Q
Evaluation of Hearing ability
A
-“Gross” evaluation includes finger rub or whispered voice
Patient occludes one ear
-Examiner rubs fingers and checks distance at which patient can still hear
-Whisper a word behind patient, ask patient to repeat word
21
Q
special tests for evaluating hearing loss
A
If you note a patient with decreased hearing acuity: Grab your tuning fork and perform the following two tests
- Rinné (compares air conduction and bone conduction)
- Weber (tests for lateralization)
22
Q
Rinne Test
A
- Place handle of tuning fork on mastoid process. Ask patient to raise hand when she can no longer hear it. Then hold the fork close to the ear.
- In a normal ear, air conduction is greater than bone conduction (patient will hear the forks).
- In an ear with conductive hearing loss, bone conduction is greater than air conduction (patient won’t hear the forks).
- In an ear with sensorineural hearing loss, overall hearing is decreased, but air conduction is greater than bone conduction (like in a normal ear).
23
Q
Weber Test
A
- Place the vibrating tuning fork on the top of the patient’s head.
- If sound lateralizes to the BAD ear, then conductive hearing loss is present. This is because bone conduction is still functioning normally.
- If sound lateralizes to the GOOD ear, then sensorineural hearing loss is present. The sound is not getting transmitted via the nerve to the brain in the bad ear.
24
Q
inspection and palpation of the nose
A
- alignment
- body crepitus
- nasal tenderness
- sinus tenderness
- speculum exam
25
common complaints
- sore throat (pharyngitis, tonsilitis, peritonsillar abscess)
- bleeding gums
- toothache
- oral lesions (ulcers, lumps)
- facial swelling
- hoarsness/voice changes
26
inspection of lips
- color
- moisture
- cracking
- lesions
27
inspection of oral mucosa
- color
- ulcers
- patches and lesions
- nodules
28
inspection of teeth and gingiva
- Color
- Gum margins and interdental papillae
- Missing, loose, or broken teeth
- Discoloration of teeth
- Position & alignment of teeth
29
inspection of tongue
- movement
- symmetry
- color/texture
- lesions/coatings
- protrusion (CNXII)
30
Inspection of the floor of mouth
-lesions
31
inspection of the roof of the mouth
- color
| - architecture
32
inspection of the pharynx
- May need to use tongue depressor
- Say “Ahhhhh”
- Color
- Symmetry
- Exudates
- Swelling
- Ulceration
- Tonsillar Enlargement
- Things you examine: Soft Palate, Anterior and Posterior Pillars, Uvula, Tonsils, Pharynx
33
palpation of the mouth
- Wear gloves
- Hold tongue with gauze, use other hand to palpate inside mouth
- Be sure to palpate floor of mouth and cheeks
- Cancers here may not be visible
34
inspection of the trachea
- Try to identify the thyroid and cricoid cartilage
- Is the trachea midline?
- Thyroid gland: Tilt the patient’s head back, May be easier to visualize if the patient swallows, Note contour, symmetry, size
35
Palpation of neck
- Position patient with neck slightly forward, may be turned to one side as needed
- Note any neck masses and their characteristics:
- Any palpable mass should be measured and documented
- painless/tender?
- soft/rubbery/fluctuant/hard?
- mobile/fixed?
- smooth/irregular?
36
Palpation of lymph nodes in the neck
```
Preauricular
Posterior auricular
Occipital
Tonsillar
Submandibular
Submental
Superficial cervical
Posterior cervical
Deep cervical
Supraclavicular
```
37
palpation of the trachea and thyroid gland
```
Trachea
-Check for deviation
-Feel for crepitus
Thyroid gland
-Examine the patient from behind
-Note size, shape, consistency, nodules, tenderness, or thrills
-Most masses are benign
```
38
Head, Ears, and Nose Examination
- inspect the head and scalp for nits, lesions, alopecia
- inspect the head and face for symmetry and swelling
- inspect the external ears for lesions, including behind the ears
- palpate the auricle, tragus, and mastoid, bilaterally for tenderness
- inspect the auditory canal bilaterally for erythema, obstruction, and cerumen
- inspect the tympanic membrane bilaterally for landmarks, bulging, retraction, perforations, erythema, fluid
- test hearing acuity to finger rub or whispered voice bilaterally (CN VIII)
- Test lateralization (Weber test) using 512 Hz tuning fork
- compare air and bone conduction (Rinne test) using 512 Hx tuning fork
- Inspect external nose for lesions and deformity
- inspect internal nose and turbinates for polyps and septal deviations
- inspect internal nose for mucosa for lesions, edema, erythema
- palpate sinuses (maxillary and frontal) for tenderness
- test for nasal obstruction bilaterally
- test sense of smell in each nostril separately (CN I)
39
Oropharynx and neck examination
- inspect lips for lesions and symmetry
- inspect gums and interdental papillae for erythema and swelling
- inspect teeth for occlusion, looseness, and caries
- inspect buccal mucosa for lesions
- inspect hard and soft palate and uvula for lesions, erythema, swelling, symmetry
- inspect tongue and floor of mouth for lesions, swelling
- identify orifices of wharton's ducts and stenson's ducts
- inspect tonsillar pillars and tonsils for erythema, exudates, swelling, symmetry
- check mobility of tongue (CNXII)
- observe the palate and uvula for rising on phonation (CN IX and X)
- inspect symmetry of neck, masses, and scars
- inspect thyroid for symmetry and masses
- ask patient to swallow and observe symmetrical movements
- ask patient to shrug shoulders against resistance (CN XI)
- palpate thyroid for thrills, masses, tenderness
- palpate thyroid from behind and ask patient to swallow, feel for masses or enlargement
- palpate all lymph nodes for tenderness, induration, masses
