HEENT 2

Question 1

What will be inspected in the ear physical exam?

Answer 1

Auricles, mastoid, discharge

Question 2

What will be palpated in the ear physical exam?

Answer 2

Auricles, mastoid

Question 3

What structure will we use the otoscope for?

Answer 3

Auditory canal and tympanic membrane

Question 4

The auricle of the ear should be

Answer 4

Firm, mobile, and non tender without lesions or nodules

Question 5

What size speculum do you want to use for the otoscopy?

Answer 5

The largest speculum that will fit easily into the canal

Question 6

When doing an otoscopy, whats important to do?

Answer 6

Pull the patients auricle gently upward, backward, and slightly away from the head

Question 7

The speculum is inverted gently how far?

Answer 7

1-1.5 cm

Question 8

Avoid contacting the inner __ of the canal with the speculum

Answer 8

2/3

Question 9

Is pneumatic otoscopy more readily accomplished with larger or smaller otoscope speculum tip?

Answer 9

Larger, want to see air drum moving when you puff in air

Question 10

How do you test for hearing?

Answer 10

Gross hearing: whispered voice standing 1-2 feet from pt. Whisper two distinct syllable words (99, baseball, nine-four)

Question 11

If there is a question of hearing loss, perform hearing tests utilizing a tuning fork

Answer 11

Weber and Rinne. Want to use a 512 Hz tuning fork

Question 12

Weber hearing tests for what?

Answer 12

Lateralization

Question 13

How do you do the Weber test?

Answer 13

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

Question 14

Where does unilateral CONDUCTIVE hearing loss lateralize to with Weber test?

Answer 14

Impaired ear (the person will hear the sound in the bad ear)

Question 15

Where does unilateraly SENSORINEURAL hearing loss lateralize to with Weber test?

Answer 15

Good ear (sound will be heard in good ear)

Question 16

What is the most common cause of hearing loss?

Answer 16

Wax

Question 17

Conductive hearing loss can be due to what?

Answer 17

Otitis media, TM perf, obstruction of ear canal (wax), disruption of ossicles

Question 18

What does the Rinne test for?

Answer 18

Comparing air conduction to bone conduction

Question 19

How do you preform the Rinne test?

Answer 19

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)

Question 20

Rinne interpretation for CONDUCTIVE hearing loss

Answer 20

Sound is heard through bone as long as or longer than it is through air

Question 21

Rinne interpretation for SENSORINEURAL hearing loss

Answer 21

Sound is heard longer through air

Question 22

Cranial nerve 1 test

Answer 22

Use familiar scents, test each nostril separately with eyes closed

Question 23

What is important to palpate in the mouth/throat area?

Answer 23

Parotid (Stenson’s) ducts and submandibular (Wharton’s) ducts, masses that may not be visible

Question 24

CN X physical exam

Answer 24

Have the patient say ahhh, note uvula and hard palate. Should rise symmetrically with speaking

Question 25

CN IX and X physical exam

Answer 25

Check for gag reflex bilaterally

Question 26

CN XII physical exam

Answer 26

Have patient stick out their tongue and it should remain midline

Question 27

Stridor

Answer 27

Signifies an upper airway obstruction

Question 28

What is the grading size for tonsils?

Answer 28

1+, 2+, 3+, 4+