HEENT 2 Flashcards
What will be inspected in the ear physical exam?
Auricles, mastoid, discharge
What will be palpated in the ear physical exam?
Auricles, mastoid
What structure will we use the otoscope for?
Auditory canal and tympanic membrane
The auricle of the ear should be
Firm, mobile, and non tender without lesions or nodules
What size speculum do you want to use for the otoscopy?
The largest speculum that will fit easily into the canal
When doing an otoscopy, whats important to do?
Pull the patients auricle gently upward, backward, and slightly away from the head
The speculum is inverted gently how far?
1-1.5 cm
Avoid contacting the inner __ of the canal with the speculum
2/3
Is pneumatic otoscopy more readily accomplished with larger or smaller otoscope speculum tip?
Larger, want to see air drum moving when you puff in air
How do you test for hearing?
Gross hearing: whispered voice standing 1-2 feet from pt. Whisper two distinct syllable words (99, baseball, nine-four)
If there is a question of hearing loss, perform hearing tests utilizing a tuning fork
Weber and Rinne. Want to use a 512 Hz tuning fork
Weber hearing tests for what?
Lateralization
How do you do the Weber test?
Place the base of lightly vibrating tuning fork on vertex o the skull or mid forehead, ask pt if they hear in both ears or more on one side
Where does unilateral CONDUCTIVE hearing loss lateralize to with Weber test?
Impaired ear (the person will hear the sound in the bad ear)
Where does unilateraly SENSORINEURAL hearing loss lateralize to with Weber test?
Good ear (sound will be heard in good ear)
What is the most common cause of hearing loss?
Wax
Conductive hearing loss can be due to what?
Otitis media, TM perf, obstruction of ear canal (wax), disruption of ossicles
What does the Rinne test for?
Comparing air conduction to bone conduction
How do you preform the Rinne test?
Place vibrating tuning fork on mastoid bone, behind ear and level with canal. Normally the sound is heard longer through air than through bone (if cant hear, quickly place it close to the ear canal)
Rinne interpretation for CONDUCTIVE hearing loss
Sound is heard through bone as long as or longer than it is through air
Rinne interpretation for SENSORINEURAL hearing loss
Sound is heard longer through air
Cranial nerve 1 test
Use familiar scents, test each nostril separately with eyes closed
What is important to palpate in the mouth/throat area?
Parotid (Stenson’s) ducts and submandibular (Wharton’s) ducts, masses that may not be visible
CN X physical exam
Have the patient say ahhh, note uvula and hard palate. Should rise symmetrically with speaking
CN IX and X physical exam
Check for gag reflex bilaterally
CN XII physical exam
Have patient stick out their tongue and it should remain midline
Stridor
Signifies an upper airway obstruction
What is the grading size for tonsils?
1+, 2+, 3+, 4+
