Head&Neck, EENT Flashcards
*****8 elements to look for?
LQSDT, CMA
- Location
- Quality - (nature of the pain - sharp, dull, acute, chronic?)
- Severity - (scale 1 – 10)
- Duration - (How long has the problem been an issue?)
- Timing - (worse in am/pm? Constant?)
- Context - (any precipitating factors?)
- Modifying Factors - (Does pt. do anything to improve the problem?)
- Associated Signs and Symptoms - (ex. N/V?
** Bones immovable except for ______at_______
Note any______
• Crepitation =_____or _______
• Clicking or locking =_________
mandible; TMJ
limited ROM
RA or OA
Displaced cartilaginous meniscus
**Skull supported by cervical vertebrae_______
• C7 is the
C1 – C7
important palpable landmark for Stellate ganglion block
**Face 2 main things
Expression Symmetry ( should be symmetrical)
****Asymmetry may indicate:
Central brain lesion - CVA
• CN VII – Bell’s palsy
*****Bell’s Palsy is paralysis of facial nerve
VII
****Edema in the face shows______and _______
why?
first periorbital and cheeks
Sub-Q tissue here is loose and will accumulate fluid more readily)
*****Facial Sensations mediated by______
3 branches of Trigeminal Nerve
**3 pr. Salivary glands, what are they ? Which gland indicates ___or ______
Parotids (not normally palpable) (swelling = mumps or AIDS)
Submandibular
Sublingual
****Temporal Artery: where
Palpable anterior to ear
• Temporal Arteritis
***Assess for NECK
- Symmetry (tilt = spasm) • ROM • Lymph Nodes • Trachea • Thyroid
**Neck Flexion normal degree
85
*****Neck EXTENSION normal degree
70
**To assess ROM ask patient
- touch chin to chest
- Turn head to right And left
- Touch each ear to shoulder (w/o elevating shoulder)
- Extend head backward
- **Note For Neck look for
- ***1.__________
- **2. ______May indicate ______or _______of neck______
- **3. _____ and _____symptoms may indicate _____
Note **pain at any particular movement.
- ***Pain and ratchety movement or limitation may indicate cervical arthritis or inflammation of neck muscles.
- ***(Nuchal rigidity w/ flu-like symptoms may indicate meningitis)
*****When nodes are abnormal, check
the area they drain for source of problem.
To assess lymph nodes
Finger pads
Gentle pressure
- ***To palpate use____ and_______with _____
- **Begin with ______
- ***Palpate with _______
- ***For deep cervical chains_______
- ***For supraclavicular nodes______
- gentle pressure and circular motion with fingerpads.
- Begin with preauricular nodes and work systematically.
- Palpate with both hands to compare symmetry.
- For deep cervical chains, tip pt. head toward side being examined. (Fig. 1)
- For supraclavicular nodes, have pt. hunch shoulders forward (Fig. 2)(NOTE: omohyoid muscle crosses triangle here, don’t mistake it for a node)
***Acute infx = WET FFM
nodes bilateral, tender,
enlarged, warm, firm, freely movable.
**Chronic inflammation/TB =
nodes clumped.
**Cancerous nodes =FUHN
FUNH Fixed, Unilateral, Non-tender, Hard
**HIV nodes =
What is common in HIV infection ?
FENM: FIRM, Enlarged, Nontender, Mobile. (Occipital node enlargement common in HIV.)
**Trachea is PUSHED toward unaffected unaffected side w/: side w/: in 4 conditions
PATT
- Aortic aneurysm
- Tumor
- Thyroid lobe enlargement
- Pneumothorax
****Trachea is PULLED toward affected side w/: LPF
- Large atelectasis
- Pleural adhesion
- Fibrosis
*****Tracheal TUG downward synchronous with systole w/:
• Aortic Arch aneurysm
*****Normal thyroid
• Note any TEN
- difficult to palpate.
Tenderness Enlargement, Nodular lump.
*****Auscultate thyroid if enlarged for_______which indicates _____
bruits (indicates hyperthyroidism).
Pupil Light Reflex
• Tests afferent CN 2 & efferent CN 3
*****When assessing eyes (FURI)
Note any Fixation or lack of Irregular shapes, Response to light. Unequal sizes,
*****Asymmetric response indicates during _____Indicates _______
Accomodation ; CN 3 damage;
What does asymmetry indicate with corneal light reflex?
WHAT SHOULD YOU DO NEXT?
• Asymmetry indicates DEVIATION SECONDARY TO MUSCLE WEAKNESS or PARALYSIS – if present, do Cover Test
Cover Test detect
Detects small degree of deviated alignment by blocking FUSION REFLEX
**Cover test weaknesses
2, WHAT ARE THEY?
DEFINE
- Phoria = mild weakness when fusion is blocked
* Tropia = severe weakness that is constant
*****Uneven eye movement or failure to follow =
EOM weakness or CN dysfunction
*****Nystagmus INDICATES
semicircular canal ds., paretic eye m., MS or brain lesion
**Lid lag INDICATES
hyperthyroidism (normally upper lid always overlaps top of iris)
***Optic disc is most__________
Normal color =
prominent landmark (nasal side) Yellow-orange to pink
**Optic disc Pallor =
CN 2 atrophy
**Optic disc Hyperemeia
methanol poisoning
Shape of Optic disk
• Irregular =
Glaucoma
*****Margins
Normal_____
• Blurred margins =______Which indicates _______
Sharp
papilledema = ↑ ICP
**Retinal vessels
Arteries are smaller(2:3), brighter red and have arterial light reflex
**Retinal Vessel Pathologies
• Absence of major vessels =
occlusion of retinal artery (absence of major vessels)
*****Retinal Vessel Pathologies• Constricted arteries =
↓ RBF (retinal blood flow)
**“Nicking” at A-V crossing indicates
HTN or arteriosclerosis
**Extreme tortuosity or dilated veins indicates
Venous occlusion
Note any______/______of canal indicates
redness/swelling otitis externa
*****Basal skull Fracture associated with
Frank blood or clear watery drainage (CSF) secondary to trauma
**Tympanic membrane
Drum should _____not _______or _______
What indicates serous otitis media
RED?
- Drum s/b flat, not retracted or bulging (cone of light)
- Bubbles or Air/Fluid level behind drum OR Yellow-amber color = serous otitis media
- Red = acute otitis media
**WEBER Conductive (WCP) hearing loss
Sound lateralizs to POORER ear, poorer ear not distracted by background noise, has a better chance to hear BONE CONDUCTED SOUND; EX : Transient conductive loss with otitis media, serous or purulent
**WEBER: Sensorineural loss (WSB)
Sound lateralized to “better” ear or UNAFFECTED EAR. Poor ear is unable to PERCEIVE SOUND .
**Rinne Test normal (AC>BC)
Sound is heard twice as long by air conduction as by bone conduction , a POSITIVE RINNE AC>BC
Rinne Test Conductive hearing loss (AC
Person hears as long by bone conduction (AC=BC) or even longer (AC
Rinne Test Sensorineural loss (AC>BC lower)
what is the normal ratio?
normal ratio of AC> BC , but is reduced overall. Person hears poorly both ways.
Grade
1 normal
• 2 halfway between tonsillar pillars and uvula
• 3 touching uvula
• 4 touching each other
Koplik spots may indicates
Measles
