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mOSCEs > head + neck > Flashcards

head + neck Flashcards

1
Q

inspection of face, head and neck

A 
expresssion 
symetry 
swellings/pulsations 
hair - distribution, loss
shape of face + skull 
scars
skin - rashes, acne, blisters, vitiligo 
movements - weakness
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2
Q

inspection of eyes

A

lid lag
proptosis –> Grave’s
eyemovements
sclera - jaundice, anaemia

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3
Q

inspection of skull and face

A

facial symmetry
features of Cushing’s e.g. moon face
features of acromegaly e.g. large skull, coarsened features, bitemporal hemianopia

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4
Q

inspection of nose

A

observe nasal pyramid
any discharge
block one nostril with thumb and assess airlfow in other then switch
elevate tip of nose to inspect nasal vestibule with otoscope

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5
Q

inspection of ears

A

inspect pinna: nodules, lesions, redness, swelling, scars
inspect mastoid region: redness, swellings, scars
external auditory meatus for discharge

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6
Q

what look for during auriscope examination of external auditory canal

A

excess ear wax –> conductive hearing loss
redness + oedema –> otitis externa
discharge –> otitis externa/media
foreign bodies

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7
Q

what look for during auriscope examination of tympanic membrane

A

colour (red = inflammation)
shape - should be relatively flat
light reflex - cone of light

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8
Q

causes for buldging and retracting tympanic membrane

A

buldging: increased middle ear pressure e.g. otitis media with effusion
retraction: reduced middle ear pressure e.g. URTI

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9
Q

where should light reflex be seen on left and right tympanic membranex

A

L ear: 7-8 o’clock

R ear: 4-5 o’clock

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10
Q

what would cause absence/distortion of tympanic membrane light reflex

A

otitis media

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11
Q

palpation of skull + face

A 
mastoid processes
orbital margin - note irregularilty 
temporal arteries for tenderness
maxilla and mandible 
TM joint - open/close and side to side
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12
Q

palpation of nose

A

nasal cartilages and bones to check alignment and tenderness

paranasal air sinuses for tenderness

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13
Q

palpation of ears

A

pull pinna

mastoid process

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14
Q

whispered hearing test

A

stand 60cm away and rub tragus of oppposite ear
in normal sound level speak out some numbers and get patient to repeat after you
then do again but whisper

repeat both ears

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15
Q

rinne’s hearing test

A

hold tuning fork infront of ear and then behind it on mastoid process

ask patient where they heard it louder - infront or behind ear

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16
Q

positive (normal) Rinne’s

A

air conduction > bone conduction

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17
Q

negative Rinne’s

A

bone conduction > air conduction

conductive deafness

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18
Q

Weber’s test

A

place activated tuning fork on patient’s forehead

it is heard equally in both ears or heard louder in one side

19
Q

normal Weber’s test result

A

heard equally in both ears

20
Q

Weber’s result indicating senosrineural deafness

A

heard louder on side of intact/normal ear

21
Q

weber’s result indicating conductive deafness

A

sound louder on side of affected/abnormal ear

22
Q

inspection of mouth

A

lips: cyanosis, angular stomatits
mouth: dentition, hard + soft palates, cheeks, parotid duct, oropharynx, tongue, tonsils, underside tongue, frenulum
bite

23
Q

inspection of neck

A

scars
swelling
lump: size, shape, skin changes
movement with tongue protrusion: get them to stick out tongue
movement with swallowing: give them sip of water

24
Q

palpation of neck

A

tracheal positions

swellings + lymph nodes in Z shape

25
Q

what needs to be talked about if lump/swelling found in neck

A 
mobile?
cystic? (compressible) 
vascular? (pulsatile) 
nodular? (hard) 
midline? thyroid swelling/thyroglossal cyst
lateral? anterior or posterior triangle?
if node then which clinical level
26
Q

level of lymph neck nodes: I

A

submental/submandibular

27
Q

level of lymph neck nodes: II

A

upper deep cervical

28
Q

level of lymph neck nodes: III

A

mid deep cervical

29
Q

level of lymph neck nodes: IV

A

lower deep cervical

30
Q

level of lymph neck nodes: V

A

posterior triangle

31
Q

level of lymph neck nodes: VI

A

pre-tracheal nodes

32
Q

palpation of mouth

A

palpate areas for cystic swellings, irreg + rough areas, stones in parotid duct

floor mouth and under tongue
inside cheeks
salivary glands
substance of tonuge

33
Q

when is percussion considered

A

if palpable thyroid swelling consider percussion for retrosternal thyroid

34
Q

auscultation of neck

A

carotid artery bruits

enlarged thyroid

35
Q

what may cause soft bruit of thyroid

A

Grave’s disease

36
Q

conductive hearing loss

A

disruption to mechanical transfer of sound in outer ear, eardrum or ossicles

37
Q

sensorineural hearing loss

A

cochlear or central damage

38
Q

causes of conductive hearing loss

A 
chronic middle ear infection 
wax
tumour of middle ear
otosclerosis
trauma to TM/ossicles
otitis externa
middle ear effusion
39
Q

causes sensorineural hearing loss

A 
birth injury 
genetic e.g. alport's syndrome 
pre-natal infection e.g. rubella 
infection: meningitis, measles, mumps
trauma
menieres disease
degenerative 
acoustic neuroma
40
Q

fundoscopy: assessing optic disc

A
  • borders should be clear and well defined (blurry = papilloedema)
  • should be orange will paler centre (all pale = optic atrophy = optic neuritis)
41
Q

fundoscopy: assessing retina

A 
haemorrhages - diabetic retinopathy 
exudates - diabetic retinopathy 
detachment 
tears
arteriolar narrowing - hypertensive retinopathy
42
Q

fundoscopy: assess vessels

A

tortuous?
congested?
atriovenous nipping

43
Q

fundoscopy: diabetic retinopathy findings

A

cotton wool spots
hard exudates
haemorrhages
abnormal growth blood vessels

44
Q

fundoscopy: hypertensive retinopathy findings

A 
cotton wool spots
flame haemorrhages
hard yellow exudates
optic disc oedema 
atriovenous nipping
arteriolar narrowing

mOSCEs (13 decks)

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