HEENT (part 2) Flashcards
What is gouty tophi?
Deposit of uric acid crystals after years of chronically elevated uric acid
What are two common types if skin cancer that appear on the external ear and what do that look like?
BCC: raised, pearly nodule with central telangiectasia
SCC: crusted boarder, central ulceration, bleeding
What CN is associated with hearing?
CN VIII
How do you conduct a gross hearing test?
Rub fingers together by each ear
If gross hearing is reduced, what do you need to distinguish between?
Conductive Loss- problem conducting sound waves (EAC, TM or middle ear) Abnormality usually visible
Sensorineural Loss- disorder of the inner ear, cochlear nerve (CN VIII) impairs transmission of nerve impulse to brain. Problem is NOT visible.
What is air conduction in regards to hearing?
Sound transmitted through air (EAC, TM, middle ear) into cochlea
What is bone conduction in regards to hearing?
Sound transmitted though vibrations in bone. Bypass external & middle ear
oVibration of the skull stimulates the inner ear directly
Air conduction > Bone conduction = ?
Bone conduction > Air conduction = ?
Air conduction > Bone conduction = Normal or sensorineural hearing loss
Bone conduction > Air conduction = conductive hearing loss
What is the purppse of the Weber test?
To test Weber or not the sound latereralizes!! :)
How do you conduct a weber test?
Place vibrating tuning fork on top of the head (bone conduction)
Ask patient where they hear the sound (L, R or both?)
NORMAL: Hear sound in both ears equally ABNORMAL: Sound lateralizes
In a weber test, if the sound lateralizes to the impaired ear, what kind of hearing loss is it?
Conductive hearing loss
In a weber test, if the sound lateralizes to the good ear, what kind of hearing loss is it?
Sensorineural hearing loss
What are some possible causes of conductive hearing loss?
Otitis media, perforation (ruptured eardrum), cerumen (earwax), otosclerosis (abnormal bone growth)
What are some possible causes of sensorineural hearing loss?
Presbycusis (age related hearing loss), noise exposure, head trauma
How do you conduct a rinne test and what does it tests for?
Compares air and bone conduction
Place tip of vibrating tuning fork on mastoid bone
Ask pt if they can hear it; have them tell you when sound stops
Move tuning fork in front of ear; ask if they can still hear it.
If they can still hear the sound, then AC>BC (NORMAL TEST)
Hearing loss R ear
Weber: Lateralize to R
Rinne: BC>AC in R
What kind of hearing loss?
Conductive Hearing loss R
Hearing loss R ear
Weber: Lateralize to L
Rinne: AC>BC in R
What kind of hearing loss?
Sensorineural Hearing loss R
Where is the cone of light located in the ear?
Located in the anterior and inferior quadrant of TM
How do you conduct a phneumatic otoscopic exam and what does it test for?
Used to assess TM mobility, serous otitis media, TM perforations
Speculum large enough for a snug fit
GENTLY squeeze bulb to send a puff of air
against the TM.
Normal ear- TM moves inward
Abnormal- no TM movement
What is tympanosclerosis?
Chalky white patch- Scarring of the TM
Seen in recurrent Otitis Media or hx of tubes or previous perforation
If you see serous effusion with air bubbles during your otoscopic exam and the pt complains of fullness/popping in their ear what might you suspect?
Viral URI or barotrauma (injury caused by increased air/water pressure)
What might you consider if a pt has repeat otis media, persistent effusion, or hearing loss?
Myringotomy Tube
Usually remain in ear for 6-12 months
Frequently fall out on own
If you observe hermorrhagic vesicle and obscured landmarks during your otoscopic exam and conductive hearing loss, what might you suspect?
Bullous Myringitis
If you see drainage and edema of the ear canal and the pt complains of tenderness with movement of the tragus and pinna what might you suspect?
Otitis Externa
How do you test for nasal patency?
Ask patient to occlude one nostril and sniff
How do you conduct a specialized frontal sinus transillumination test?
Place light below brow and look for glow in frontal area (Normal finding)
How do you conduct a specialized maxillary sinus transillumination test?
Place light against cheek bone below eye and look for glow on hard palate (Normal finding)
What may cause a septal perforation and how does it present?
Seen with trauma, infection, cocaine use
Appears with crusting
and epistaxis
Small lesions may whistle
What are nasal polyps?
Soft, pale growths commonly seen in allergic rhinitis, chronic sinusitis and other conditions
Can cause nasal obstruction
Anosmia (loss of smell)
What may cause a septal hematoma and how does it present?
Seen following trauma Sym: Nasal obstruction, pain & tenderness PE: Soft, tender swelling Must rule out septal hematoma in all nasal trauma AND DOCUMENT!
Where do majority of cases of epistaxis occur in?
Kiesselbach’s plexus/area
How will tubinates appear in the case of allergic rhinitis?
Swollen, pale, blue, boggy turbinates, shiners, eye Sxs
How will tubinates appear in the case of sinusitis and URI?
Erythematous turbinates
When you examine the oropharynx what structures and types of things are you looking for?
Color, symmetry, lesions of the lips, teeth/gingivae, buccal mucosa, floor of mouth, hard/soft palate, tongue, tonsil
Inspect soft palate and uvula (CN IX and X) by asking the patient to say “Ah”, gag reflex
What two salivary glands should you palpate for masses and what/where are their ducts?
Parotid: Stensen’s duct- buccal mucosa lateral to molars
Submandibular: Wharton’s duct- floor of mouth under tongue
How do you conduct an examination of the tongue?
Ask patient to stick tongue out looking for any deviation, discoloration
Ask pt to move tongue side to side
Wearing gloves, and using gauze, gently grasp the tip of the tongue while inspecting the lateral margins
Especially important in patients who use tobacco
What is angular cheilitis?
Irritation, fissuring of the skin at the corners of the mouth associated with ill-fitting dentures, vitamin deficiency, excessive salivation
What is oral candidiasis (thrush)?
What patches or plaques on the tongue or buccal mucosa
Can brush the Thrush for Dx
What is leukoplakia?
Potentially PREMALIGNANT
Differentiated from thrush by the inability to remove white area!
Referral for biopsy
What type of carcinoma is the cause of majority of lip and oral carcinomas?
SCC
What is a Torus Palantinus?
Benign, midline mass in hard palate
What does gingivitis cause?
Changes to the Gums Redness
Bleeding
Edema
Tenderness
What is gingival hyperplasia and what can cause it?
Overgrowth of the gum tissue
Can be caused by medications, pregnancy
or puberty
What is tonsillar hypertrophy?
Numerous tonsillar crypts
What is hairy tongue and what can cause it?
Benign Condition
Defect in desquamation of
papillae
Many causes: Candida, Poor hygiene, Abx, Tea, Coffee, Tobacco Use
What is fissured tongue?
Multiple small grooves on dorsal tongue
Benign
What is geographic tongue?
Dorsum of tongue reveals smooth areas void of papillae
Benign
“Map-like”
How does Group A Strep Exudative Tonsillitis present?
ST, fever, No cough, nasal congestion or excessive fatigue *Bilateral exudative tonsillitis, cervical lymphadenopathy Step screen: Positve
How does Mononucleosis present?
Also known as Epstein Barr Virus ST, fever, FATIGUE Tender cervical lymphadenopathy *Bilateral exudative tonsillitis Strep screen: Negative Mono screen: Positive Slight splenomegaly
How does a Peritonsillar Abscess present?
*Unilateral peritonsillar swelling & shifted uvula
Infection spreads into peritonsillar space
“Hot potato voice”
Drooling
How should you evaluate the pts range of motion through
Flexion/extension, rotation, lateral bending
How should you evaluate the pts motor function of CN XI and strength?
Lateral rotation of neck against resistance
Shoulder shrugging against resistance
How do you conduct an examination of the trachea? What might deviation suggest?
Inspect for deviation from midline
Palpate and assess mobility
Deviation may suggest mediastinal mass, pneumothorax (“collapse” of lung)
What might swollen supraclavicular lymph nodes suggest?
Metastasis from lung or GI cancer
How should normal nodes feel?
Small, mobile, and non-tender
When you auscultate the carotid artery, what should you be listening for?
“bruits”—signs of turbulent arterial blood flow
When you palpate the carotid arteries, what should you and your patient do?
Hold your breath
How do you conduct a thyroid examination?
Inspect for enlargement, asymmetry from the front Anterior or Posterior palpation acceptable
Place fingers just below cricoid cartilage on each side of the neck
Palpate isthmus and each lobe
Ask patient to swallow; feel for gland rising beneath fingers
Note the size, shape and consistency
Note any masses, nodules or tenderness
What is an enlarged thyroid called?
Goiter
When should you preform a thyroid auscultation test and how do you do it?
If thyroid gland is enlarged Listen over the lateral lobes to detect a bruit
What is jugular venous distension?
Can have a cardiac or pulmonary cause
Blood flows backward from right atrium into the jugular veins
