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Clin Skills > HENT > Flashcards

HENT Flashcards

1
Q

what 4 topics do you want to ask about in regards to head history?

A

headache
head injury
dizziness
lightheadedness

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2
Q

2 topics, face history

A

skin and hair

any changes

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3
Q

5 topics, neck history

A 
lumps
swollen glands
goiter (enlarged thyroid)
pain
stiffness
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4
Q

PE for hair

5 parts

A

hair:
inspection: quantity, distribution, pattern of loss, flaking
palpation: texture

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5
Q

PE scalp

4 parts

A 
SNOB
scaliness 
nevis
other lesions
bumps/lumps
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6
Q

PE skull

7 parts

A 
size 
contours
symm
deformities
lumps
tenderness
sutures (infants- fontanelles)
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7
Q

PE face

6 parts

A 
expression
symm & contour
involuntary movements
edema
masses
skin/facial hair
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8
Q

face palpation

5 parts

A 
TMJ- motion
frontal & max sinus-percuss
parotid gland
temporal arteries
sensation
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9
Q

what nerve innervates the cochlea

A

cochlear nerve CN 8

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10
Q

how do you know which TM it is? right or left?

A

end of malleus curves toward the chin, so left ear will have left curved malleus

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11
Q

what topics do you want to ask about for ear history?

7 parts

A 
Hearing Loss
One-sided?
Timing?
Dizziness/Vertigo
Pain or Itch
Discharge
Tinnitus
Positional effects
Medications
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12
Q

5 causes of earache

A 
Acute otitis media
Otitis externa
Furunculosis
Mastoiditis
Malignancy
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13
Q

earache could be referred pain from what sources?

5 parts

A 
Teeth, Tongue, TMJ
Tonsillitis
Herpes zoster
Carcinoma of pharynx
Cervical spondylosis (age-related wear of vertebrae)
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14
Q

2 types are hearing loss?

A

Conductive
Loss of conduction from the external ear through the middle ear
(ex- sticking finger in their ear,wax buildup, bug in ear)
Sensorineural
Cochlea and cochlear nerve (from disease, tumors, etc)

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15
Q

4 causes of conductive hearing loss

A

Blockage of ear canal
Perforation of TM
Fluid in the middle ear
Damage to ossicles

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16
Q

give examples of things that can cause tinnitus..

A 
Tumors or aneurysms
Presbycusis-hearing loss from aging
Noise-associated hearing loss
Chronic otitis media
Meniere’s disease
Otosclerosis
Ototoxic drugs
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17
Q

what are you doing when you palpate the auricle?

A

Move auricle up and down
Press on tragus bilaterally
Press behind ear
Press on mastoid process

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18
Q

what are you inspecting canals and TM for?

A 
Canals
     Discharge, FB, Erythema, Swelling, Cerumen
TMs
    Color, Contour, Cone of Light
    Handle and short process of malleus
    Pars flaccida and pars tensa
    Mobility
    Perforations
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19
Q

whisper test: how far are you standing away? what kinds of words are you saying?

A

Stand behind or cover mouth
1-2 ft away
Use words with 2 equally accented syllables

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20
Q

how do we test conductive vs SNHL?

A

Rinne

Air vs Bone conduction

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21
Q

expand on the rinne test, how do you tell if they have normal or conductive hearing loss from this test?

A 
Base vibrating on mastoid, level with canal until pt no longer hears
Quickly turn close to ear canal
Hear again?
Normal: AC>BC
Conductive loss: BC=AC or BC>AC
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22
Q

what Hz are the tuning forks at?

A

512 or 1024

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23
Q

what is the weber test? what do the results mean?

A

done on those with hearing loss already detected
Lateralism
Top of Head/Mid-forehead
Equal on both sides?
Unilateral sensorineural loss – hear in good ear
Unilateral conductive loss – hear in affected ear

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24
Q

what is the outside, flared part of the nare called?

A

ala

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25
Q

what is the middle, at the opening of the nose, of the nares called?

A

collumella

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26
Q

what is the inner lip of the nares called?

A

vestibule- hair baring skin- not mucosa

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27
Q

where does the nasolacrimal duct and paranasal sinuses drain into?

A

inferior meatus

28
Q

what portions of the bridge of the nose are bone and cartilage?

A

upper 1/3: bone

lower 2/3: cartilage

29
Q

what do turbinates do?

A

Turbinates increase surface area, covered with mucosa – cleanses, humidifies, controls temp of inspired air

30
Q

where are your nerves for smell located?

A

top of the septum

31
Q

what injury do we worry about with the cartilagenous part of the septum?

A

septal hematoma from trauma, little blood supply

32
Q

what are the two sinuses that you can palpate?

A

frontal and maxillary

33
Q

what do you need to ask about for nose history?

7 parts

A 
Discharge (Rhinorrhea)/Congestion
      One side or both
Blockage
Sneezing
Pain
Changes in sense of smell
Deformity
Epistaxis
*timing, environment, assoc. symptoms, meds
34
Q

what are the 3 parts of nose inspection?

A

Anterior/inferior surfaces
Pen light/Otoscope to visualize vestibules
Gentle pressure on tip widens nostrils
Asymmetry/Deformity

35
Q

what should we look for in nasal mucosa?

A

color, edema, bleeding, exudate

36
Q

what is in the nose palpation part of the exam?

A

looking for nasal and sinus tenderness

-transillumination : look for light on hard palate of mouth

37
Q

what are the posterior and anterior pillars of the mouth?

A

arches in back of mouth from the uvula, posterior appears more medial

38
Q

where is the opening of the parotid duct?

A

inner cheek above bucal mucosa and papilla

39
Q

where is the papilla of the mouth?

A

inner cheek above bucal mucosa, below parotid duct

40
Q

where is the duct of the submandibular gland?

A

under the tongue next to the frenulum

41
Q

what do you want to ask about for history of mouth, teeth and tongue?
7 parts

A 
Pain
Lesions
Too much or too little saliva
Dental & periodontal changes
       Bleeding gums
Difficulties with chewing
Malocclusion
Difficulties with speaking
42
Q

history for lips?

A

lesions, drying

43
Q

what to ask about for oropharynx history? 9 parts

A 
Pain
Hoarseness
Swallowing problems
Respiratory problems
Lump
Hemorrhage
Referred pain
Foreign body
weightloss
44
Q

what 3 things could symptoms of the pharynx be referring to?

A

Local problem
Respiratory problem
Gastrointestinal problem

45
Q

what are you looking for when inspecting and palpating lips- 5? buccal/labial mucosa-4?

A

Inspect and Palpate lips
Color, moisture, lumps, ulcers, scaliness
Inspect and Palpate buccal/labial mucosa
Tongue blade
Color, ulcers, white patches, nodules

46
Q

what to look for when you inspect and palpate teeth?

3 parts

A

Color (pink), swelling, ulceration
Teeth missing, discolored, misshapen
Palpate – loose teeth

47
Q

what to look for when you inspect and palpate hard and soft palate?
2 parts

A

color and architechture

48
Q

inspect and palpate tongue?

5 parts to inspection, 1 to palpation

A

Symmetry (CN XII – hypoglossal), color, texture,
cancerous lesion, nodules, ulcerations
Palpate – grasp tongue tip with gauze and pull to side
bilaterally and palpate; induration?

49
Q

inspect and palpate floor of mouth? 5 parts

A

Color, architecture, lesions, nodules, ulcerations

50
Q

what controls rise and fall of soft palate?

A

CN X- vagal nerve

51
Q

what makes up the anterior triangle of neck?

A

sternocleidomastoid muscle, mandible-jaw line, midline of neck

52
Q

what makes up the posterior triangle of the neck?

A

trapezius muscle, sternocleidomastoid muscle, omohyoid muscle (inferior line)

53
Q

where is the external jugular located in relation to the sternocleidomastoid muscle?

A

superficial to its sternal head

54
Q

where is the internal jugular vein located? where does it drain?

A

deep to sternocleidomastoid muscle. drains directly into the right atrium- fluid will backup into here = jugular veinous distention

55
Q

where is the carotid sinus and artery located in relation to sternocleidomastoid muscle?

A

medial to it

56
Q

what is the cricoid cartilage?

A

the ring shaped cartilage of the laynx, inferior to thyroid cartilage

57
Q

what structure does the thyroid wrap around? how is it shaped? what are the isthmus and lobes?

A

trachea/windpipe.. The two wings or lobes on either side of the windpipe are joined together by a bridge of tissue, called the isthmus, which crosses over the front of the windpipe.

58
Q

why are lymphs important to examine?

A
  1. infection and 2. cancer - look for swelling, tenderness (infection- responding appropriately). If you get swelling without tenderness or other infectious problems- look for infection. if none- CANCER
59
Q

history for neck? 3 parts

A

pain
stiffness
swelling, goiter or nodes

60
Q

inspection of the neck? 5 parts

A 
Symmetry
Masses
Scars
Enlarged nodes
Enlarged glands
     Parotid
     Submandibular
61
Q

palpation of the nodes : what parts of your fingers do you use? what 10 lymphs are you feeling for? 4 characteristics of each?

A

Usually with pads of pointer and middle fingers; neck flexed
Preauricular, Posterior auricular, Occipital, Tonsillar, Submandibular, Submental, Superficial Cervical, Posterior Cervical, Deep Cervical Chain, Supraclavicular
Size, mobility, tenderness, shape
If enlarged or tender
Examine areas they drain
Examine all nodes

62
Q

PE of the neck specific to muscular function? 5 parts

A 
Evaluate range of motion 
Palpate for crepitus (friction between bone and cartilage)
Palpate muscles
Strength of trapezius muscles
Strength of SCM muscles
63
Q

PE trachea and thyroid. 4 parts to inspect and palpate

A

Inspect & palpate for deviation from midline
Palpate above suprasternal notch
Inspect neck using tangential lighting
Inspect & palpate thyroid, patient swallowing

64
Q

what are you looking for in palpation of the thyroid?

6 parts

A

Palpate thyroid from behind, patient swallowing
Size, Shape, Consistency, Nodules, Tenderness
Bruit (abnormal sound)

65
Q

what further exam do you do if thyroid is enlarged? What else will you inspect in regards to neck arteries?

A

auscultate lateral lobes for possible bruit (abnormal sound from narrowing of artery)

  • look for JVD (jugular vein distention) w/ pt sitting
  • if carotids are absent/weak, listen for bruit

Clin Skills (25 decks)

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