HEENT Exam - Abby: finished! :)

Question 1

Head inspection

Answer 1

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

Question 2

Head palpation

Answer 2

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

Question 3

Parts of the eye: limbus

Answer 3

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

Question 4

Parts of the eye: conjunctiva

Answer 4

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

Question 5

Parts of the eye: sclera

Answer 5

Whites of eyes

Question 6

Parts of the eye: canthus

Answer 6

Lateral and medial, corners

Question 7

Parts of the eye: iris and pupil

Answer 7

Iris = colored part Pupil = where light goes through

Question 8

Eye inspection

Answer 8

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

Question 9

Ptosis

Answer 9

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

Question 10

Exopthalamus

Answer 10

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

Question 11

Visual acuity test

Answer 11

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

Question 12

Peripheral vision test

Answer 12

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

Question 13

Extraocular movements

Answer 13

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

Question 14

Nystagmus

Answer 14

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

Question 15

Strabismus and Cover Test

Answer 15

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

Question 16

Subconjunctival hemorrhage

Answer 16

pain free, stops at limbus, no treatment

Question 17

Corneal abrasion

Answer 17

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

Question 18

Ears: auricle and pinna

Answer 18

external ear

Question 19

Ear canal, tympanic membrane, malleus

Answer 19

can see during exam cannot see middle and inner ear

Question 20

Eustachian tube

Answer 20

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)

Question 21

Ear inspection

Answer 21

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

Question 22

Ear palpation

Answer 22

Auricle for lumps and tenderness

Question 23

To see the ear canal and drum

Answer 23

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.

Question 24

What you should look for in otoscope

Answer 24

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

Question 25

Insufflation

Answer 25

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

Question 26

Auditory acuity

Answer 26

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”

Question 27

Air and bone conduction: Weber Test

Answer 27

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

Question 28

Air and bone conduction: Rinne Test

Answer 28

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

Question 29

Evaluation of hearing loss: conductive loss and sensorineural loss

Answer 29

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.

Question 30

Weber/Rinne

Answer 30

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

Question 31

Sensorineural loss

Answer 31

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

Question 32

Conductive loss

Answer 32

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

Question 33

Nose and sinuses: inspection

Answer 33

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)

Question 34

Palpation of sinuses

Answer 34

frontal, maxillary, ethmoid

Question 35

Mouth and pharynx inspection

Answer 35

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

Question 36

Oral disease risk factors

Answer 36

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)

Question 37

Screening oral exam: observation

Answer 37

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

Question 38

Screening and oral exam: palpation

Answer 38

floor of mouth and neck

Question 39

Screening and oral exam: record

Answer 39

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

Question 40

Neck inspection

Answer 40

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

Question 41

Neck palpation

Answer 41

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

Question 42

Thyroid gland

Answer 42

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

Question 43

Tonsilitis

Answer 43

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

Question 44

Thyromegaly

Answer 44

enlarged thyroid

Question 45

Maxillary sinusitis

Answer 45

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

Question 46

Lymphadenitis

Answer 46

swollen nodes, can be unilateral or bilateral

Question 47

Parotosis

Answer 47

swollen nodes under ears