head + neck Flashcards
inspection of face, head and neck
expresssion symetry swellings/pulsations hair - distribution, loss shape of face + skull scars skin - rashes, acne, blisters, vitiligo movements - weakness
inspection of eyes
lid lag
proptosis –> Grave’s
eyemovements
sclera - jaundice, anaemia
inspection of skull and face
facial symmetry
features of Cushing’s e.g. moon face
features of acromegaly e.g. large skull, coarsened features, bitemporal hemianopia
inspection of nose
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
inspection of ears
inspect pinna: nodules, lesions, redness, swelling, scars
inspect mastoid region: redness, swellings, scars
external auditory meatus for discharge
what look for during auriscope examination of external auditory canal
excess ear wax –> conductive hearing loss
redness + oedema –> otitis externa
discharge –> otitis externa/media
foreign bodies
what look for during auriscope examination of tympanic membrane
colour (red = inflammation)
shape - should be relatively flat
light reflex - cone of light
causes for buldging and retracting tympanic membrane
buldging: increased middle ear pressure e.g. otitis media with effusion
retraction: reduced middle ear pressure e.g. URTI
where should light reflex be seen on left and right tympanic membranex
L ear: 7-8 o’clock
R ear: 4-5 o’clock
what would cause absence/distortion of tympanic membrane light reflex
otitis media
palpation of skull + face
mastoid processes orbital margin - note irregularilty temporal arteries for tenderness maxilla and mandible TM joint - open/close and side to side
palpation of nose
nasal cartilages and bones to check alignment and tenderness
paranasal air sinuses for tenderness
palpation of ears
pull pinna
mastoid process
whispered hearing test
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
rinne’s hearing test
hold tuning fork infront of ear and then behind it on mastoid process
ask patient where they heard it louder - infront or behind ear
positive (normal) Rinne’s
air conduction > bone conduction
negative Rinne’s
bone conduction > air conduction
conductive deafness
Weber’s test
place activated tuning fork on patient’s forehead
it is heard equally in both ears or heard louder in one side
normal Weber’s test result
heard equally in both ears
Weber’s result indicating senosrineural deafness
heard louder on side of intact/normal ear
weber’s result indicating conductive deafness
sound louder on side of affected/abnormal ear
inspection of mouth
lips: cyanosis, angular stomatits
mouth: dentition, hard + soft palates, cheeks, parotid duct, oropharynx, tongue, tonsils, underside tongue, frenulum
bite
inspection of neck
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
palpation of neck
tracheal positions
swellings + lymph nodes in Z shape
what needs to be talked about if lump/swelling found in neck
mobile? cystic? (compressible) vascular? (pulsatile) nodular? (hard) midline? thyroid swelling/thyroglossal cyst lateral? anterior or posterior triangle? if node then which clinical level
level of lymph neck nodes: I
submental/submandibular
level of lymph neck nodes: II
upper deep cervical
level of lymph neck nodes: III
mid deep cervical
level of lymph neck nodes: IV
lower deep cervical
level of lymph neck nodes: V
posterior triangle
level of lymph neck nodes: VI
pre-tracheal nodes
palpation of mouth
palpate areas for cystic swellings, irreg + rough areas, stones in parotid duct
floor mouth and under tongue
inside cheeks
salivary glands
substance of tonuge
when is percussion considered
if palpable thyroid swelling consider percussion for retrosternal thyroid
auscultation of neck
carotid artery bruits
enlarged thyroid
what may cause soft bruit of thyroid
Grave’s disease
conductive hearing loss
disruption to mechanical transfer of sound in outer ear, eardrum or ossicles
sensorineural hearing loss
cochlear or central damage
causes of conductive hearing loss
chronic middle ear infection wax tumour of middle ear otosclerosis trauma to TM/ossicles otitis externa middle ear effusion
causes sensorineural hearing loss
birth injury genetic e.g. alport's syndrome pre-natal infection e.g. rubella infection: meningitis, measles, mumps trauma menieres disease degenerative acoustic neuroma
fundoscopy: assessing optic disc
- borders should be clear and well defined (blurry = papilloedema)
- should be orange will paler centre (all pale = optic atrophy = optic neuritis)
fundoscopy: assessing retina
haemorrhages - diabetic retinopathy exudates - diabetic retinopathy detachment tears arteriolar narrowing - hypertensive retinopathy
fundoscopy: assess vessels
tortuous?
congested?
atriovenous nipping
fundoscopy: diabetic retinopathy findings
cotton wool spots
hard exudates
haemorrhages
abnormal growth blood vessels
fundoscopy: hypertensive retinopathy findings
cotton wool spots flame haemorrhages hard yellow exudates optic disc oedema atriovenous nipping arteriolar narrowing
