head + neck

Question 1

inspection of face, head and neck

Answer 1

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

Question 2

inspection of eyes

Answer 2

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

Question 3

inspection of skull and face

Answer 3

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

Question 4

inspection of nose

Answer 4

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

Question 5

inspection of ears

Answer 5

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

Question 6

what look for during auriscope examination of external auditory canal

Answer 6

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

Question 7

what look for during auriscope examination of tympanic membrane

Answer 7

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

Question 8

causes for buldging and retracting tympanic membrane

Answer 8

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

Question 9

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

Answer 9

L ear: 7-8 o’clock

R ear: 4-5 o’clock

Question 10

what would cause absence/distortion of tympanic membrane light reflex

Answer 10

otitis media

Question 11

palpation of skull + face

Answer 11

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

Question 12

palpation of nose

Answer 12

nasal cartilages and bones to check alignment and tenderness

paranasal air sinuses for tenderness

Question 13

palpation of ears

Answer 13

pull pinna

mastoid process

Question 14

whispered hearing test

Answer 14

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

Question 15

rinne’s hearing test

Answer 15

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

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

Question 16

positive (normal) Rinne’s

Answer 16

air conduction > bone conduction

Question 17

negative Rinne’s

Answer 17

bone conduction > air conduction

conductive deafness

Question 18

Weber’s test

Answer 18

place activated tuning fork on patient’s forehead

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

Question 19

normal Weber’s test result

Answer 19

heard equally in both ears

Question 20

Weber’s result indicating senosrineural deafness

Answer 20

heard louder on side of intact/normal ear

Question 21

weber’s result indicating conductive deafness

Answer 21

sound louder on side of affected/abnormal ear

Question 22

inspection of mouth

Answer 22

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

Question 23

inspection of neck

Answer 23

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

Question 24

palpation of neck

Answer 24

tracheal positions

swellings + lymph nodes in Z shape

Question 25

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

Answer 25

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

Question 26

level of lymph neck nodes: I

Answer 26

submental/submandibular

Question 27

level of lymph neck nodes: II

Answer 27

upper deep cervical

Question 28

level of lymph neck nodes: III

Answer 28

mid deep cervical

Question 29

level of lymph neck nodes: IV

Answer 29

lower deep cervical

Question 30

level of lymph neck nodes: V

Answer 30

posterior triangle

Question 31

level of lymph neck nodes: VI

Answer 31

pre-tracheal nodes

Question 32

palpation of mouth

Answer 32

palpate areas for cystic swellings, irreg + rough areas, stones in parotid duct floor mouth and under tongue inside cheeks salivary glands substance of tonuge

Question 33

when is percussion considered

Answer 33

if palpable thyroid swelling consider percussion for retrosternal thyroid

Question 34

auscultation of neck

Answer 34

carotid artery bruits enlarged thyroid

Question 35

what may cause soft bruit of thyroid

Answer 35

Grave's disease

Question 36

conductive hearing loss

Answer 36

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

Question 37

sensorineural hearing loss

Answer 37

cochlear or central damage

Question 38

causes of conductive hearing loss

Answer 38

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

Question 39

causes sensorineural hearing loss

Answer 39

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

Question 40

fundoscopy: assessing optic disc

Answer 40

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

Question 41

fundoscopy: assessing retina

Answer 41

``` haemorrhages - diabetic retinopathy exudates - diabetic retinopathy detachment tears arteriolar narrowing - hypertensive retinopathy ```

Question 42

fundoscopy: assess vessels

Answer 42

tortuous? congested? atriovenous nipping

Question 43

fundoscopy: diabetic retinopathy findings

Answer 43

cotton wool spots hard exudates haemorrhages abnormal growth blood vessels

Question 44

fundoscopy: hypertensive retinopathy findings

Answer 44

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