Head/Neck Flashcards
Cranial Nerve 1
Olfactory; Smell
Cranial Nerve 2
Optic; Vision: Snellen Chart and Visual Field test (peripheral vision)
Cranial Nerve 3, 4, 6
Oculomotor, Trochlear, Abducens ( have pt. follow finger through 6 fields of gaze, measure pupil size and reaction to light, follow finger to nose)
Cranial Nerve 5
Trigeminal: Motor function, have pt. move jaw side to side, clench and bite down. Additionally, has pt close eyes and tell me where my fingers are I touch her face with both soft and sharp )
Cranial Nerve 7
Facial Nerve- smile, frown, blowfish, whistle.
Cranial Nerve 8
Acoustic- hearing- simply verbalize the whisper test
Cranial Nerve 9 & 10
VAGUS- describe how you got to clinic, swallow, cough, tongue depressor.
Cranial Nerve 11
Spinal Accessory- Shoulder Shrug
Cranial Nerve 12
Hypoglossal- Say “D,L,N,T” - protrude tongue move from side to side.
Head and Face exam
1.Patient Sitting.
Focused history: headaches, head injury, loss of consciousness, seizures, facial pain.? Difficulty swallowing, neck pain/stiffness, masses/lumps, hx of thyroid disease?
OLDCART FINDINGS
- Inspect: face for size, shape symmetry, position
- palpate for masses
Macrocephalic
TOO BIG-Two standard deviations above normal
Microcephalic
TOO LITTLE- two standard deviations below normal
Lymph Nodes (10)
- Pre-auricular
- Posterior Auricular
- Occipital
- Tonsillar
- Submandibular
- Submental
- Superficial Cervical
- Posterior Cervical
- Deep Cervical Chain
- Supraclavicular
How should lymph nodes feel
soft, non-tender, discrete, moveable
Trachea
Should be midline, USUALLY NOT PALPABLE
Eye Exam Focused Hx Q
Any changes in vision, do you wear glasses/contacts, any injuries or infection, dry eyes or excessive tearing, surgeries, blurred vision, halos, spots, difficulty w/ night vision, hx of glaucoma? When was your last eye exam, any medications?
Snellen Eye Chart
Person stands 20ft behind chart, covers one eye. Reads lowest line, 20 is always first number
Eye Exam
inspect external structures, eyes, conjunctiva, sclera, eye lashes, Iris, pupils, pupillary light reflex
Pupillary Light Reflex
PERRLA
Pupils Equal, Round, Reactive to Light & Accommodation
Consensual Reflex
Eyes respond equally on both sides
Redlight Reflex
Using Opthalmoscope in dark room- should have positive red light reflex
Focused Hx Questions for Ear Exam
Any trouble hearing, any ringing/buzzing, changes in your hearing, ear drainage, pain, balance problems or head trauma, Noise pollution at work/home.
Ear Exam (5)
Inspect:
- ear placement/attachment /alignment from corner of eye.
- size and shape equal bilaterally
- skin, intact, no lumps bumps
- color appropriate for ethnicity
- ear wax color/consistency/amount
Gross Hearing Test ( whisper test)
stand 1-2 fee behind pt. have them occlude one ear , repeat words you whisper from behind them
Ear Focused Hx Questions
nasal congestion, hx of sinus problems, seasonal or environmental allergies, hx of sinus headaches, nose bleeds, hx broken nose, any changes in smell, do you use any medications.
OLDCART FINDINGS
Ear Exam (6)
- Inspect nose for shape size and symmetry
- discharge?
- nasal flaring or narrowing?
- Palpate ridge and soft tissues
- evaluate patency of nares
- palpate sinuses
Mouth and throat Focused Hx Questions
any sores or lesions? sore throat, yeast infections, bleeding gums, tooth aches, hoarsness, dysphagia ( difficulty swallowing)
altered taste, Smoking,
Mouth/Throat Exam ( 8 Items)
Inspect:
Lips, oral mucosa, gums, teeth, roof of mouth, tongue, tonsils, uvula and floor of mouth for:
Color, moisture, lumps, ulcers, cracking, nodules, swelling, loose teeth, symmetry
Elicit gag reflex
Notice any breath odor
Typamnic membrane
Should be pearly gray
coned shaped light reflex prominence 5:00 in R ear, 7:00 in L
Tonsil Grading
+1 visible
+2 between tonsillar pillars and uvula
+3 Touching Uvula
+4 touching each other
