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PCM Final > HEENT > Flashcards

HEENT Flashcards

1
Q

Head inspection

A

hair distribution, quantity scalp: scaling, nevi skull: size and contour face: expression and contour (asymmetry, swelling, masses) skin: color, pigmentation, hair distribution, lesions

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2
Q

Head palpation

A

hair texture, skull lumps, sinuses, skin texture and temperature, paresthesias always remember to try and gently reproduce symptoms

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3
Q

Parts of the eye: limbus

A

connection between the sclera and the edge of the iris through the conjuctiva, keeps stuff from bleeding into the anterior chamber. Where conjunctiva meets cornea

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4
Q

Parts of the eye: conjunctiva

A

protective membrane that covers all parts of the anterior globe, folding back on itself at superior and inferior fornix then extending onto the inner surface of upper and lower palpebra. It allows eye motion, moving with it. The epithelium over the cornea is very sensitive so when scratched there is significantly more eye pain and photophobia than if there is damage or a foreign body impacting the sclera

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5
Q

Parts of the eye: sclera

A

Whites of eyes

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6
Q

Parts of the eye: canthus

A

Lateral and medial, corners

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7
Q

Parts of the eye: iris and pupil

A

Iris = colored part Pupil = where light goes through

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8
Q

Eye inspection

A

Position and alignment of eyes Eyebrows: quantity and distribution Eyelids: edema, color, lesions, adequacy of closed eyelids (ptosis, exopthalamus, unilateral or bilateral) Check lacrimal gland for swelling Conjunctiva and sclera: color and vascular pattern Cornea and lens: opacity Iris: markings clearly defined Pupils: size, shape, reaction to light

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9
Q

Ptosis

A

Lid partially or fully closed; drooping without specific anatomical markers to define it. Typically noted when asymmetry exists.

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10
Q

Exopthalamus

A

Globe bulging forward so ,at rest, the lid is not able to reach the upper edge of the iris. Most typical for posterior fat pad growth stimulated in hyperthyroidism/Graves disease, doesn’t hurt

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11
Q

Visual acuity test

A

Very important part of exam! Central vision: Snellen eye chart; position patient 20 feet from the wall chart Patients should wear glasses if needed Test one eye at a time: Avoid squinting closed eye! Then test both together Near vision: hand-held card (can also use to test visual acuity at the bedside) use distance stated on card

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12
Q

Peripheral vision test

A

Screening: both eyes at same time; start in the temporal fields Further testing: If a defect is found, test one eye at a time

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13
Q

Extraocular movements

A

Six cardinal directions of gaze test each muscle and Convergence. “H” test

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14
Q

Nystagmus

A

Involuntary rapid, rhythmic movement of eye in any direction (horizontal, vertical, or rotatory)

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15
Q

Strabismus and Cover Test

A

Misalignment of eyes relative to each other. If untreated can cause amblyopia (visual loss) of one eye Cover test: Stare at one spot, Cover one eye, Holding gaze, cover other eye, If eye uncovered moves, some degree of strabismus exists

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16
Q

Subconjunctival hemorrhage

A

pain free, stops at limbus, no treatment

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17
Q

Corneal abrasion

A

Severe photophobia (light sensitivity) Fluoriscein stain Topical antibiotic +/- patching

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18
Q

Ears: auricle and pinna

A

external ear

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19
Q

Ear canal, tympanic membrane, malleus

A

can see during exam cannot see middle and inner ear

20
Q

Eustachian tube

A

Comes in from behind the nose, equalizes air pressure, gives kids ear infections (either straight or angled down, so stuff runs right in, as we grow it angles up a little so adults do not get a lot of ear infections)

21
Q

Ear inspection

A

Auricle for redness, lesions Ear canal: Discharge, foreign bodies, redness, swelling Tympanic membrane: Color, contour, mobility

22
Q

Ear palpation

A

Auricle for lumps and tenderness

23
Q

To see the ear canal and drum

A

Use an otoscope with the largest ear speculum that the canal will accommodate. Position the patient’s head so that you can see comfortably through the instrument. To straighten the ear canal, grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head. Holding the otoscope handle between your thumb and fingers, brace your hand against the patient’s face. Your hand and instrument follow unexpected movements by the patient. Insert the speculum gently into the ear canal, directing it somewhat down and forward.

24
Q

What you should look for in otoscope

A

Visualizing the parts of the malleus and the cone of light helps define a misshapen tympanic membrane: effusion, scarring, partial retraction from perforation that never healed…. Malleus in a normal ear is visualized WELL Red = infection

25
Q

Insufflation

A

Used to test tympanic membrane mobility: gently puff air in the ear canal looking for TM motion = insufflation Nonmobile TM: fluid, mass, sclerosis Hypermobile TM: ossicle bones disrupted

26
Q

Auditory acuity

A

Test one ear at a time Finger rub with their eyes closed Whisper test, standing 1-2 feet behind patient, softly say “nine-four,” “baseball” “ice cream”

27
Q

Air and bone conduction: Weber Test

A

Lateralization of sound (one side louder)? Is it equal? On top of head Look for lateralization: If occurs, use Rinne to further define the problem May be normal in equal, bilateral hearing loss

28
Q

Air and bone conduction: Rinne Test

A

Compare time of air vs. bone conduction In normal hearing, Air conduction is heard after bone conduction is lost. AC>BC

29
Q

Evaluation of hearing loss: conductive loss and sensorineural loss

A

The definition of conductive loss is bone conducting sound better than air. Sound waves are not reaching or being conducted through the middle ear bone apparatus. When the cochlear nerve is abnormal, this defines sensorineural hearing loss and both bone and air conduction is poor.

30
Q

Weber/Rinne

A

Weber lateralizes right: right = loud/ left = soft IF: Rinne R: BC > AC or BC = AC = abnormal (negative) test L: AC > BC = normal (positive) test then Right ear is bad ear with conductive loss IF: Rinne R: AC > BC = normal L: AC > BC = normal then Right is good ear with sensorineural loss in Left ear

31
Q

Sensorineural loss

A

Inner ear disorder involves cochlear nerve and neuronal impulse transmission to the brain. Causes include loud noise exposure (>85 db), inner ear infections, trauma, tumors, congenital and familial disorders, and aging

32
Q

Conductive loss

A

External or middle ear disorder impairs sound conduction to inner ear. Causes include foreign body, otitis media, perforated eardrum, and otosclerosis of ossicles

33
Q

Nose and sinuses: inspection

A

Asymmetry or deformity Inside of nose: Mucosa – color, swelling, bleeding, exudate, ulcers, or polyps Septum – deviation, inflammation, or perforation Turbinates – use otoscope or nasal speculum to view middle and inferior turbinates (not superior)

34
Q

Palpation of sinuses

A

frontal, maxillary, ethmoid

35
Q

Mouth and pharynx inspection

A

Lips: Note color, moisture, lumps, ulcers, cracking,or scaliness Oral mucosa: Note color, ulcers, and nodules Gums and teeth: Note color, presence, and position of teeth Roof of mouth: Note color Tongue and floor of mouth: Note color and texture, ulcers, nodules Pharynx: soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx Note color, symmetry, presence of exudate, swelling, ulceration, or tonsillar enlargement

36
Q

Oral disease risk factors

A

Tobacco and alcohol use (cancers) Family history of oral cancers Lack of mouth guard use for sports Methamphetamine use (erosions) Bulemia (erosions) Significant GERD (erosions)

37
Q

Screening oral exam: observation

A

Remove all dentures and appliances Teeth and oral hygiene Palate and gums Buccal mucosa Floor of mouth & tongue (lateral borders & undersurface) Posterior pharynx

38
Q

Screening and oral exam: palpation

A

floor of mouth and neck

39
Q

Screening and oral exam: record

A

Signs of caries (White spots, brown spots, pits) Signs of periodontal disease -Poor oral hygiene (presence of plaque) -Erythematous or receded gums -Loose teeth Signs of other oral disease -Soft tissues lesions -Tooth erosion

40
Q

Neck inspection

A

Symmetry, masses, scars, enlarged glands or lymph nodes Trachea – position, alignment Thyroid gland - symmetry

41
Q

Neck palpation

A

Lymph nodes (size, shape, mobility, consistency, tenderness): Preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, superficial anterior cervical, posterior cervical, supraclavicular

42
Q

Thyroid gland

A

Flex neck slightly forward Place fingers of both hands with index fingers just below the cricoid cartilage Ask patient to swallow; feel for the thyroid (including isthmus) rising up under your finger pads (not always palpable) Palpate lateral to the trachea for the right and left lobes of the thyroid Note the size, shape, and consistency Identify any nodules or tenderness If enlarged, listen with bell over lateral lobes to detect a bruit

43
Q

Tonsilitis

A

enlarged, red tonsils, white patches, want to sample around white patches when you swab, could be strep, staph, or mono

44
Q

Thyromegaly

A

enlarged thyroid

45
Q

Maxillary sinusitis

A

sinus infection, X-rays should just show black area, if white, might be infected (fluid-filled)

46
Q

Lymphadenitis

A

swollen nodes, can be unilateral or bilateral

47
Q

Parotosis

A

swollen nodes under ears

PCM Final (8 decks)

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