Head/Neck/ENT Lecture Flashcards
Tangential lighting
- Indirect or cross lighting
- Works to enhance inspection
Palpation can be used to assess:
- Size
- Presence of mass/abnormality
- Presence of tenderness
Tenderness is in the ____ portion of SOAP note, pain is in the _____ portion
Objective
Subjective
Percussion is used to assess:
- Presence of fluid
- Enlargement of organs
- Solidification of normally hollow body parts (e.g. lungs)
Percussion is used mainly with which body parts?
Lungs
Abdomen
Sinuses
Peripheral nerves
Auscultation is used mainly with which body parts?
Heart
Lungs
Abdomen
*Also for bruits elsewhere
Special tests
NOT a part of inspection, palpation, percussion, auscultation
Inspection of head:
Symmetry
Distribution of hair
Areas of baldness
Flakes, rash, nits
What would make a head asymmetric?
- Untreated craniosynostosis (as an infant)
- Prior head trauma
What would make a head increased in size?
- Hydrocephalus (infants)
- Acromegaly
- Paget’s disease
What would make a head decreased in size?
Microcephaly
Palpation of the head includes:
- Skull for masses, defects, tenderness
- Texture of hair
Possible abnormalities found with palpation of head:
-Defects d/t trauma or surgeries
Thin hair could indicate:
- Iron deficiency anemia
- Thyrotoxicosis (hyper)
Coarse hair could indicate:
Hypothyroidism
Inspection of the neck includes looking for:
- Masses, scars, deformities
- Swelling
- Deviation of trachea
- Goiter
Why do we have patient swallow during neck exam?
Evaluate thyroid - it moves up and down with swallowing
How to palpate thyroid:
- Stand behind pt
- Neck relaxed, slightly flexed
- Find cricoid cartilage
- Have pt swallow
- Displace trachea to each side and palpate opposite side
T/F: Goiter is a sign of abnormal thyroid function.
FALSE, it is not necessarily an indication of abnormal function
When do we auscultate the thyroid?
IF it is enlarged, to listen for a bruit
*Bruit may be present in hyperthyroidism, but not always
Name the lymph nodes we palpate:
Preauricular, postauricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical, supraclavicular
What is Virchow’s node?
- Enlarged and/or firm supraclavicular node on the LEFT
- Can indicate gastric cancer
Inspection of the carotid artery:
- Medial to SCM
- Look for any visible pulsations
- AUSCULTATE prior to palpation
What is a thrill?
- Palpable counterpart of a bruit
- Vibration due to turbulence in a vessel
Auscultation of the carotid
- To identify a bruit
- Pt must hold breath to eliminate tracheal noise
Carotid bruits
- May indicate stenosis
- Sometimes they are aortic murmurs that radiate to neck
T/F: Always palpate carotids one at a time
True - palpating both simultaneously can cause total occlusion of blood flow to the brain
Inspection of the ears:
- Each auricle for lumps, skin lesions
- Note piercings
- Grossly inspect ear canal for redness, cerumen, discharge
Palpation of the ears:
- Ask about pain first!
- Then palpate auricle and tragus for tenderness
- Tug test
- Mastoid
Tug test positive:
Otitis externa
T/F: pts with otitis media will have pain with tug test
FALSE, they will not have pain on tug test
Tenderness of mastoid may indicate:
- Mastoiditis
- Otitis media
Special tests of the ear:
- Auditory acuity
- Lateralization (Weber)
- Air/Bone conduction (Rinne)
Auditory acuity test
“Finger rub”
Crude test of hearing
Lateralization hearing test
- Weber
- Place 512 tuning fork on top midline of head
- Normal: equal both ears
Conductive hearing loss Weber test results
-Hears the tone in AFFECTED ear
Need Rinne to figure this out
Sensorineural hearing loss Weber test results
-Hears the tone in UNAFFECTED ear
Need Rinne to figure this out
Normal response of Rinne test:
Air > bone conduction
Next to ear is louder
Conductive hearing loss Weber & Rinne results:
- Weber lateralizes to 1 ear
- Rinne B > A in same ear
Sensorineural hearing loss Weber & Rinne results:
- Weber lateralizes to 1 ear
- Rinne A > B in same ear
Sensorineural hearing loss Weber & Rinne results:
- Weber lateralizes to 1 ear
- Rinne A > B in same ear
Conductive hearing loss
Outer or middle ear
Sensorineural hearing loss
Inner ear or CN 8
What to look for on otoscopic exam?
- Cone light reflex (below malleus)
- Handle and short process of malleus in upper portion of TM
- Note color and position of TM
Normal color and position of TM
Red/pale or pink/yellow
Neutral position
TM red and bulging associated with?
Otitis media
TM retracted a/w?
Tympanosclerosis
TM air-fluid level a/w?
Otitis media
TM has vesicles a/w?
Bullous myringitis
Inspection of the nose:
- Nares for flaring
- Nasal bone for symmetry
- Mucus membranes
- Septum
- Turbinates
- Discharge
Nasal speculum should open in which direction inside the patient’s nose?
North to South
Septum is sensitive
Normal findings of septum, turbinates, mucosa, discharge?
- 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
Normal findings of septum, turbinates, mucosa, discharge?
- 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
Septum perforation a/w?
Cocaine inhalation (or other drugs)
Edematous and erythematous nasal mucosa a/w?
Acute rhinitis
Pale, boggy, swollen nasal mucosa a/w?
Allergic rhinitis
Hypertrophied turbinates?
Chronic rhinitis
Nasal polyps
Soft, gray occluding lesions in nasal passages
Pus in nasal passages?
Sinusitis
Nasal patency test
Pt occludes one nostril, breathes out the other
Which sinuses can be percussed?
Frontal
Maxillary
Normal inspection of exterior mouth:
No sores, well hydrated, no cracking, no cyanosis
Inspect teeth for:
Wear, decay, missing
Inspect dorsal tongue for:
Geographic tongue, hydration, atrophy, fasciculations
Stenson’s duct location
Buccal mucosa at 2nd upper molar
Deviation of uvula indicates:
CN 10 problem
Deviation of tongue indicates:
CN 12 problem
Torus palatinus
Hard lump on hard palate
Common finding, benign
