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632 Advanced Anesthesia Health Assessment > Head, Neck, Airway Assessment > Flashcards

Head, Neck, Airway Assessment Flashcards

1
Q

What items do you exam in the oral cavity

A
  • Lips
  • Oral mucosa
  • Gingiva
  • Teeth
  • Hard palate
  • Tongue
  • Soft palate
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2
Q

What nerves do you test in an oral cavity exam

A 
Hypoglossal nerve (CN XII)
- symmetry of tongue protrusion
Vagus nerve (CN X)
- symmetry of uvula
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3
Q

What are the most common oral and throat concerning symptoms

A
  • Sore throat
  • Gum swelling/bleeding
  • Hoarseness
  • Malodorous breath
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4
Q

Pharyngitis

A

Associated with an acute URI

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5
Q

What commonly causes bleeding gums?

A

Brushing teeth or Gingivitis .

  • ask about local lesions and any tendency to bleed or bruise elsewhere
  • What medications are they taking
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6
Q

What can cause Hoarseness

A
  • Disease of the larynx to extralaryngeal lesions that press on the laryngeal nerves
  • Environment allergies/inhalation of irritants, Acid reflux, Smoking, Alcohol use, Overuse, Weight loss, Hemoptysis
  • Acute: overuse, viral laryngitis, poss. trauma
  • Chronic (>2wks): reflux, vocal cord nodules, hypothyroidism, head & neck cancers (thyroid masses)
  • Nerve related issues: neurologic disorders like Parkinson disease, ALS, & MG
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7
Q

Common oral causes for Halitosis

A

The unpleasant or offensive odor emanating from the breath.

  • poor oral hygiene
  • tobacco smoking
  • plaque retention on teeth
  • mouth appliances
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8
Q

Systemic causes of Halitosis

A

Common:
- Sinusitis, tonsillitis, pharyngitis, foreign bodies, neoplasms, abscesses, & bronchiectasis
Uncommon:
- GERD, cirrhosis, DM, impaired fat digestion, inborn errors of metabolism (trimethylaminuria)

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9
Q

Name 3 factors out of 7 than can affect maskability

A
  1. Fatty airway/short thick neck
  2. Beard/facial hair
  3. BMI
  4. Sleep apnea
  5. Stiff lungs
  6. No teeth (edentulous)
  7. Blocking the mask seal: high nose, facial tumor, injury, burns)
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10
Q

What are the structures you look for in a Mallampati (not the score)

A
  • Soft palate
  • Anterior tonsillar pillar
  • Posterior tonsillar pillar
  • Uvula
  • Fauces
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11
Q

What is a Class 1 Mallampati score

A

Visualization of soft palate, fauces, uvula, pillars

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12
Q

What is a Class 2 Mallampati score

A

Visualization of soft palate, fauces, portion of uvula (most of it)

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13
Q

What is a Class 3 Mallampati score

A

Visualization of soft palate, base of uvula

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14
Q

What is a Class 4 Mallampati score

A

Visualization of hard palate only

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15
Q

Thyromental distance is used to assess what?

A

The pliable compartment above the larynx that can fit the tongue when swept during intubation.
- short distance or noncompressible tissue = likely a difficult intubation

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16
Q

What does the 3-3-2 method measure?

A
  • 3 fingertips between incisors
  • 3 fingertips between jawline (mentum) & Hyoid bone (TMD)
  • 2 fingertips between hyoid and thyroid notch (Adam’s apple)

Absence of one or more raises the likelihood of an “anterior” larynx

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17
Q

Name 3 out of the 7 Intubation Warning signs

A
  1. Long incisors
  2. < 3 cm between incisors
  3. High arched or narrow palate (teeth closer together)
  4. Overbite or buck teeth
  5. Snoring/OSA/Pregnancy
  6. TMD < 3 finger breadths
  7. ROM of the neck - can’t extend or flex
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18
Q

Which lymph nodes drain portions of the mouth, throat and face?

A
  • Tonsillar nodes
  • Submandibular nodes
  • Submental nodes
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19
Q

During your comprehensive exam what is one clinical symptom that should automatically prompt you to check all lymph nodes?

A

Hemoptysis

- assess bilateral lymph nodes at the same time to compare

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20
Q

How can you differentiate a muscle or artery from a lymph node?

A

You should be able to roll a lymph node in 2 directions

  • up & down
  • side to side
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21
Q

Your patient is demonstrating generalized lymphadenopathy, what differential diagnoses should be applied (5)

A
  1. HIV or AIDs
  2. Infectious mononucleosis
  3. Lymphoma
  4. Leukemia
  5. Sarcoidosis
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22
Q

Enlarged supraclavicular lymph nodes especially on the left or commonly called _________ suggest what diagnoses?

A
  • Virchow’s node
    Diagnoses:
  • Metastasis from a thoracic or an abdominal malignancy
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23
Q

Tender nodes suggest what?

Hard or fixed nodes suggest what?

A

Inflammation

Malignancy

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24
Q

Your patient is undergoing surgery for a concerning symptom in the neck, what should your emergence from anesthesia include ?

A

Have the patient fully awake and negative pressure breathing before you extubate

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25
Q

Key components of Head and Neck exam include

A
  • Examine the hair & scalp
  • Examine the skull
  • Inspect the skin on the head & face
  • Palpate cervical lymph nodes
  • Examine the trachea
  • Examine thyroid gland
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26
Q

You palpate the thyroid and you understand if the gland is soft it represents _______, if it is tender ________, and if it is firm ________.

A

Soft = Graves disease

Tender = Thyroiditis

Firm = Malignancy

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27
Q

As you auscultate the trachea of your patient with Graves disease what do you anticipate ?

A

Continuous bruits

- also seen in patients with MT goiter

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28
Q

In an eye exam the visual field extends farthest in what quadrant/side ?

A

Temporal side

- normally limited by the brows above, the cheeks below, and the nose medially

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29
Q

Due to lack of retinal receptors at the optic disc where do you anticipate the patients blind spot to be in each eye?

A

15 degrees temporal to the line of gaze

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30
Q

What is it called when two visual fields overlap?

A

Area of binocular vision

- this phenomenon allows for stereopsis (3D depth perception)

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31
Q

What are the initial sensory pathways for vision?

A
  • Retina
  • Optic n. (CNII)
  • Optic tract (diverges in the midbrain)
32
Q

What is pupillary accommodation

A
  • An increased convexity of the lenses caused by contraction of the ciliary muscles (behind the iris & is not visible to the examiner
33
Q

What are the autonomic pupil reactions? Parasympathetic vs. Sympathetic

A 
PSNS = pupillary constriction
SNS = pupillary dilation & raising of upper eyelid (Muller's muscle)
34
Q

The extraocular muscles are innervated by three cranial nerves:

A
  1. Abducens (VI) - innervates the lateral rectus m.
  2. Trochlear (IV) - supplies the superior oblique m.
  3. Oculomotor (III) - supplies all the rest of the extraocular m.
35
Q

Difficulty visualizing close objects suggests?

A

Hyperopia (farsightedness) or presbyopia (aging vision)

36
Q

Difficulty visualizing distant objects suggests?

A

Myopia (nearsightedness)

37
Q

Vision loss that is sudden, unilateral & painless could suggest what? (5)

A
  1. Vitreous hemorrhage from Diabetes or trauma
  2. Macular degeneration
  3. Retinal detachment
  4. Retinal vein occlusion
  5. Central retinal artery occlusion (cholesterol or clot)
38
Q

What are causes of painful vision loss?

A

Usually in the cornea & anterior chamber:

  • Corneal ulcer
  • Uveitis
  • Traumatic hyphema (presence of blood within the aqueous fluid of the anterior chamber)
  • Acute angle closure glaucoma
  • Optic neuritis from MS (requires immediate referral)
39
Q

Bilateral and sudden vision loss can result from?

A

Painless

  • Vascular etiologies
  • Stroke or non-physiologic causes

Painful

  • Intoxication
  • Trauma
  • Chemical or radiation exposures
40
Q

Bilateral and gradual vision loss can result from?

A
  • Cataracts
  • Slow central loss = Macular degeneration
  • Peripheral loss = advanced open angle glaucoma
41
Q

What CN palsy will display horizontal diplopia

A

CN III - oculomotor
or
CN VI - abducens

42
Q

What CN palsy will display vertical diplopia

A

CN III - oculomotor
or
CN IV - trochlear

43
Q

If your patient has unilateral diplopia the problem is associated with?

A
  • The ocular surface, cornea, lens, or macula

not in the brain

44
Q

What is the visual acuity test?

A

Snellen eye chart

45
Q

Simple anisocoria?

A

A difference in pupillary diameter >0.4 mm without a known pathologic cause

  • considered benign if it is equal in dim & bright light
  • & there is a brisk pupillary constriction to light
46
Q

Lagophthalmos

A

Failure of the eyelids to close

  • From neuromuscular palsy, trauma, & thyroid ds.
  • will need lubricant before tapping down
47
Q

When might you see sustained nystagmus?

A
  • Ketamine administration
  • Congenital disorders
  • Labyrinthitis (inflammation of the inner ear)
  • Cerebellar disorders
  • Drug toxicity
48
Q

Contraindications for mydriatic drops, name 3

A
  1. Head injury
  2. Coma
  3. Suspicion of narrow-angle glaucoma
49
Q

Your patient presents with Papilledema, increased IOP, emergency what are some anesthetic considerations?

A
  • NO succ., or ketamine
  • No trendelenburg
  • Soften the larynx w/ lidocaine w/ the LTA kit
  • Minimize intubating time (best personnel, & glidescope)
  • IV lidocaine or narcotics to blunt SNS
50
Q

What is Larson’s point?

A

Area around the mastoid process you can press on to send signal to the vagus n. and prevent laryngospasm

51
Q

What is the conductive hearing pathway

A

External ear through the middle ear (conductive phase)

52
Q

What is the sensorineural hearing pathway?

A

Involves the cochlea & the cochlear branch of CN VIII

53
Q

Air conduction (AC)

A

Sound waves travel through the air & are transmitted from the external & middle ear to the cochlea

54
Q

Bone conduction (BC)

A

Used for testing purposes

Bypasses the external & middle ear

A vibrating tuning fork, placed on the head, sets the bone of the skull into vibration & stimulates the cochlea directly

55
Q

In an individual with normal hearing which is more sensitive air conduction (AC) or bone conduction (BC)

A

Air conduction is more sensitive than bone conduction

56
Q

Conductive hearing loss (external and middle ear) causes:

A

External:

  • cerumen impaction
  • infection (otitis externa)
  • Trauma
  • Squamous cell carcinoma
  • Benign bony growths (exostosis, osteoma)

Middle:

  • Otitis media
  • Congenital conditions
  • Otosclerosis
  • Tympanosclerosis
  • Tumors
  • Tympanic membrane perforation
57
Q

Sensorineural hearing loss (inner ear) causes:

A
  • Congenital & hereditary conditions
  • Presbycusis (age related hearing loss)
  • Viral infections: rubella, cytomegalovirus
  • Meniere disease
  • Noise exposure
  • Ototoxic drugs
  • Acoustic neuromas (hearing & balance issues)
58
Q

How do you communicate with someone who has conductive loss compared to sensorineural loss?

A

Conductive = talking louder helps

Sensorineural = talking louder is worse and patient only hears mumbling

59
Q

What are the 4 paired air-filled cavities:

A
  1. Maxillary sinus
  2. Ethmoid sinus
  3. Frontal sinus
  4. Sphenoid sinus
60
Q

Which sinuses are accessible during the clinical exam?

A

Frontal and maxillary sinuses

61
Q

Which medications can cause permanent hearing loss?

A

Aminoglycosides (e.g., gentamicin)
&
Chemotherapeutic agents (e.g., cisplatin & carboplatin)

Inner hearing loss

62
Q

Temporary damage to hearing may be caused by?

A
  • Aspirin
  • Nonsteroidal anti-inflammatory agents
  • Quinine
  • Loop diuretics (e.g., furosemide)

Conductive hearing loss

63
Q

Diagnosis for external canal pain

A

Otitis externa

64
Q

Diagnosis for middle ear pain

A

Otitis media

  • may be referred from other structures (mouth, throat, or neck)
  • perforation = yellow or green discharge
65
Q

When should you suspect your patient has Meniere disease?

A

Tinnitus (ringing in the ear) assoc. w/ fluctuating hearing loss and vertigo

66
Q

Vertigo

A

Sensation of true rotational movement of the patient or the surroundings.
- Problem in the labyrinths of the inner ear
Or
- Peripheral lesions of CN VIII
- Ataxia, diplopia, & dysarthria

67
Q

Presyncope

A

Feeling lightheaded, weak in the legs, or about to faint

  • not due to the ear
  • Possibly from:
  • Arrhythmia, orthostatic hypotension, or vasovagal stimulation
68
Q

What is Rhinorrhea and the assoc. causes ?

A

Drainage from the nose

  • Viral infections
  • Allergic rhinitis (itchching)
  • Vasomotor rhinitis
  • Drug induced rhinitis: overuse of OTC decongestants; cocaine
69
Q

How do you determine if the patient has acute bacterial sinusitis (rhinosinusitis)

A

Considered unlikely until viral URI symptoms persist more than 7 days; both purulent drainage & facial pain should be present for diagnosis
- nasal obstruction & smell disorder

70
Q

How do you test auditory acuity or gross hearing

A

The whispered voice test

  • detects significant hearing loss > than 30 dB
  • Have the patient occlude one ear
  • Stand arms length behind the patient & whisper a combo of 3 letters and numbers
  • formal hearing test is still the reference standard
71
Q

What is the Weber test used for ?

A

Test for lateralization.
- set the tuning fork into light vibration & place on top of the patients head
- Can they hear it on one side or both?
Normal = vibration is heard in the middle or equally in both ears

Patients w/ bilateral conductive or sensorineural deficits will not lateralize

72
Q

What is the Rinne test used for?

A

Compares air conduction and bone conduction.

  • lightly vibrating tuning fork is placed on the mastoid bone
  • when the patient can no longer hear the sound , quickly place the prongs of the fork close to the ear canal

Normal= sound is heard longer through air than bone (AC > BC)
Conductive hearing loss = if sound is = or BC > AC
Sensorineural hearing loss = will test normal

73
Q

Clinical presentations of viral rhinitis

A

The mucosa is reddened and swollen

74
Q

Clinical presentations of allergic rhinitis

A

The mucosa is pale, blushish, or red

Will complain of itching

75
Q

Causes of septal perforation/ulcers

A
  • Trauma
  • Surgery
  • Intranasal cocaine or meth use
76
Q

Describe nasal polyps and the concern for anesthesia.

A

Pale saclike growths of inflamed tissue

  • Can obstruct the air passage
  • seen in allergic rhinitis, aspirin sensitivity, asthma, chronic sinus infections, & cystic fibrosis

632 Advanced Anesthesia Health Assessment (12 decks)

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