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Pt Assess Final > Head/Neck/ENT Lecture > Flashcards

Head/Neck/ENT Lecture Flashcards

1
Q

Tangential lighting

A
  • Indirect or cross lighting

- Works to enhance inspection

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2
Q

Palpation can be used to assess:

A
  • Size
  • Presence of mass/abnormality
  • Presence of tenderness
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3
Q

Tenderness is in the ____ portion of SOAP note, pain is in the _____ portion

A

Objective

Subjective

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4
Q

Percussion is used to assess:

A
  • Presence of fluid
  • Enlargement of organs
  • Solidification of normally hollow body parts (e.g. lungs)
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5
Q

Percussion is used mainly with which body parts?

A

Lungs
Abdomen
Sinuses
Peripheral nerves

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6
Q

Auscultation is used mainly with which body parts?

A

Heart
Lungs
Abdomen
*Also for bruits elsewhere

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7
Q

Special tests

A

NOT a part of inspection, palpation, percussion, auscultation

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8
Q

Inspection of head:

A

Symmetry
Distribution of hair
Areas of baldness
Flakes, rash, nits

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9
Q

What would make a head asymmetric?

A
  • Untreated craniosynostosis (as an infant)

- Prior head trauma

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10
Q

What would make a head increased in size?

A
  • Hydrocephalus (infants)
  • Acromegaly
  • Paget’s disease
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11
Q

What would make a head decreased in size?

A

Microcephaly

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12
Q

Palpation of the head includes:

A
  • Skull for masses, defects, tenderness

- Texture of hair

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13
Q

Possible abnormalities found with palpation of head:

A

-Defects d/t trauma or surgeries

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14
Q

Thin hair could indicate:

A
  • Iron deficiency anemia

- Thyrotoxicosis (hyper)

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15
Q

Coarse hair could indicate:

A

Hypothyroidism

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16
Q

Inspection of the neck includes looking for:

A
  • Masses, scars, deformities
  • Swelling
  • Deviation of trachea
  • Goiter
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17
Q

Why do we have patient swallow during neck exam?

A

Evaluate thyroid - it moves up and down with swallowing

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18
Q

How to palpate thyroid:

A
  • Stand behind pt
  • Neck relaxed, slightly flexed
  • Find cricoid cartilage
  • Have pt swallow
  • Displace trachea to each side and palpate opposite side
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19
Q

T/F: Goiter is a sign of abnormal thyroid function.

A

FALSE, it is not necessarily an indication of abnormal function

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20
Q

When do we auscultate the thyroid?

A

IF it is enlarged, to listen for a bruit

*Bruit may be present in hyperthyroidism, but not always

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21
Q

Name the lymph nodes we palpate:

A

Preauricular, postauricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical, supraclavicular

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22
Q

What is Virchow’s node?

A
  • Enlarged and/or firm supraclavicular node on the LEFT

- Can indicate gastric cancer

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23
Q

Inspection of the carotid artery:

A
  • Medial to SCM
  • Look for any visible pulsations
  • AUSCULTATE prior to palpation
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24
Q

What is a thrill?

A
  • Palpable counterpart of a bruit

- Vibration due to turbulence in a vessel

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25
Q

Auscultation of the carotid

A
  • To identify a bruit

- Pt must hold breath to eliminate tracheal noise

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26
Q

Carotid bruits

A
  • May indicate stenosis

- Sometimes they are aortic murmurs that radiate to neck

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27
Q

T/F: Always palpate carotids one at a time

A

True - palpating both simultaneously can cause total occlusion of blood flow to the brain

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28
Q

Inspection of the ears:

A
  • Each auricle for lumps, skin lesions
  • Note piercings
  • Grossly inspect ear canal for redness, cerumen, discharge
29
Q

Palpation of the ears:

A
  • Ask about pain first!
  • Then palpate auricle and tragus for tenderness
  • Tug test
  • Mastoid
30
Q

Tug test positive:

A

Otitis externa

31
Q

T/F: pts with otitis media will have pain with tug test

A

FALSE, they will not have pain on tug test

32
Q

Tenderness of mastoid may indicate:

A
  • Mastoiditis

- Otitis media

33
Q

Special tests of the ear:

A
  • Auditory acuity
  • Lateralization (Weber)
  • Air/Bone conduction (Rinne)
34
Q

Auditory acuity test

A

“Finger rub”

Crude test of hearing

35
Q

Lateralization hearing test

A
  • Weber
  • Place 512 tuning fork on top midline of head
  • Normal: equal both ears
36
Q

Conductive hearing loss Weber test results

A

-Hears the tone in AFFECTED ear

Need Rinne to figure this out

37
Q

Sensorineural hearing loss Weber test results

A

-Hears the tone in UNAFFECTED ear

Need Rinne to figure this out

38
Q

Normal response of Rinne test:

A

Air > bone conduction

Next to ear is louder

39
Q

Conductive hearing loss Weber & Rinne results:

A
  • Weber lateralizes to 1 ear

- Rinne B > A in same ear

40
Q

Sensorineural hearing loss Weber & Rinne results:

A
  • Weber lateralizes to 1 ear

- Rinne A > B in same ear

41
Q

Sensorineural hearing loss Weber & Rinne results:

A
  • Weber lateralizes to 1 ear

- Rinne A > B in same ear

42
Q

Conductive hearing loss

A

Outer or middle ear

43
Q

Sensorineural hearing loss

A

Inner ear or CN 8

44
Q

What to look for on otoscopic exam?

A
  • Cone light reflex (below malleus)
  • Handle and short process of malleus in upper portion of TM
  • Note color and position of TM
45
Q

Normal color and position of TM

A

Red/pale or pink/yellow

Neutral position

46
Q

TM red and bulging associated with?

A

Otitis media

47
Q

TM retracted a/w?

A

Tympanosclerosis

48
Q

TM air-fluid level a/w?

A

Otitis media

49
Q

TM has vesicles a/w?

A

Bullous myringitis

50
Q

Inspection of the nose:

A
  • Nares for flaring
  • Nasal bone for symmetry
  • Mucus membranes
  • Septum
  • Turbinates
  • Discharge
51
Q

Nasal speculum should open in which direction inside the patient’s nose?

A

North to South

Septum is sensitive

52
Q

Normal findings of septum, turbinates, mucosa, discharge?

A
  • Septum midline
  • Turbinates project into nasal passage leaving room for air passage
  • Mucosa is red but not “angry”
  • Discharge, if any, is scant and thin
53
Q

Normal findings of septum, turbinates, mucosa, discharge?

A
  • Septum midline
  • Turbinates project into nasal passage leaving room for air passage
  • Mucosa is red but not “angry”
  • Discharge, if any, is scant and thin
54
Q

Septum perforation a/w?

A

Cocaine inhalation (or other drugs)

55
Q

Edematous and erythematous nasal mucosa a/w?

A

Acute rhinitis

56
Q

Pale, boggy, swollen nasal mucosa a/w?

A

Allergic rhinitis

57
Q

Hypertrophied turbinates?

A

Chronic rhinitis

58
Q

Nasal polyps

A

Soft, gray occluding lesions in nasal passages

59
Q

Pus in nasal passages?

A

Sinusitis

60
Q

Nasal patency test

A

Pt occludes one nostril, breathes out the other

61
Q

Which sinuses can be percussed?

A

Frontal

Maxillary

62
Q

Normal inspection of exterior mouth:

A

No sores, well hydrated, no cracking, no cyanosis

63
Q

Inspect teeth for:

A

Wear, decay, missing

64
Q

Inspect dorsal tongue for:

A

Geographic tongue, hydration, atrophy, fasciculations

65
Q

Stenson’s duct location

A

Buccal mucosa at 2nd upper molar

66
Q

Deviation of uvula indicates:

A

CN 10 problem

67
Q

Deviation of tongue indicates:

A

CN 12 problem

68
Q

Torus palatinus

A

Hard lump on hard palate

Common finding, benign

Pt Assess Final (7 decks)

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