HENT Flashcards
what 4 topics do you want to ask about in regards to head history?
headache
head injury
dizziness
lightheadedness
2 topics, face history
skin and hair
any changes
5 topics, neck history
lumps swollen glands goiter (enlarged thyroid) pain stiffness
PE for hair
5 parts
hair:
inspection: quantity, distribution, pattern of loss, flaking
palpation: texture
PE scalp
4 parts
SNOB scaliness nevis other lesions bumps/lumps
PE skull
7 parts
size contours symm deformities lumps tenderness sutures (infants- fontanelles)
PE face
6 parts
expression symm & contour involuntary movements edema masses skin/facial hair
face palpation
5 parts
TMJ- motion frontal & max sinus-percuss parotid gland temporal arteries sensation
what nerve innervates the cochlea
cochlear nerve CN 8
how do you know which TM it is? right or left?
end of malleus curves toward the chin, so left ear will have left curved malleus
what topics do you want to ask about for ear history?
7 parts
Hearing Loss One-sided? Timing? Dizziness/Vertigo Pain or Itch Discharge Tinnitus Positional effects Medications
5 causes of earache
Acute otitis media Otitis externa Furunculosis Mastoiditis Malignancy
earache could be referred pain from what sources?
5 parts
Teeth, Tongue, TMJ Tonsillitis Herpes zoster Carcinoma of pharynx Cervical spondylosis (age-related wear of vertebrae)
2 types are hearing loss?
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)
4 causes of conductive hearing loss
Blockage of ear canal
Perforation of TM
Fluid in the middle ear
Damage to ossicles
give examples of things that can cause tinnitus..
Tumors or aneurysms Presbycusis-hearing loss from aging Noise-associated hearing loss Chronic otitis media Meniere’s disease Otosclerosis Ototoxic drugs
what are you doing when you palpate the auricle?
Move auricle up and down
Press on tragus bilaterally
Press behind ear
Press on mastoid process
what are you inspecting canals and TM for?
Canals
Discharge, FB, Erythema, Swelling, Cerumen
TMs
Color, Contour, Cone of Light
Handle and short process of malleus
Pars flaccida and pars tensa
Mobility
Perforationswhisper test: how far are you standing away? what kinds of words are you saying?
Stand behind or cover mouth
1-2 ft away
Use words with 2 equally accented syllables
how do we test conductive vs SNHL?
Rinne
Air vs Bone conduction
expand on the rinne test, how do you tell if they have normal or conductive hearing loss from this test?
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
what Hz are the tuning forks at?
512 or 1024
what is the weber test? what do the results mean?
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
what is the outside, flared part of the nare called?
ala
what is the middle, at the opening of the nose, of the nares called?
collumella
what is the inner lip of the nares called?
vestibule- hair baring skin- not mucosa
where does the nasolacrimal duct and paranasal sinuses drain into?
inferior meatus
what portions of the bridge of the nose are bone and cartilage?
upper 1/3: bone
lower 2/3: cartilage
what do turbinates do?
Turbinates increase surface area, covered with mucosa – cleanses, humidifies, controls temp of inspired air
where are your nerves for smell located?
top of the septum
what injury do we worry about with the cartilagenous part of the septum?
septal hematoma from trauma, little blood supply
what are the two sinuses that you can palpate?
frontal and maxillary
what do you need to ask about for nose history?
7 parts
Discharge (Rhinorrhea)/Congestion
One side or both
Blockage
Sneezing
Pain
Changes in sense of smell
Deformity
Epistaxis
*timing, environment, assoc. symptoms, medswhat are the 3 parts of nose inspection?
Anterior/inferior surfaces
Pen light/Otoscope to visualize vestibules
Gentle pressure on tip widens nostrils
Asymmetry/Deformity
what should we look for in nasal mucosa?
color, edema, bleeding, exudate
what is in the nose palpation part of the exam?
looking for nasal and sinus tenderness
-transillumination : look for light on hard palate of mouth
what are the posterior and anterior pillars of the mouth?
arches in back of mouth from the uvula, posterior appears more medial
where is the opening of the parotid duct?
inner cheek above bucal mucosa and papilla
where is the papilla of the mouth?
inner cheek above bucal mucosa, below parotid duct
where is the duct of the submandibular gland?
under the tongue next to the frenulum
what do you want to ask about for history of mouth, teeth and tongue?
7 parts
Pain
Lesions
Too much or too little saliva
Dental & periodontal changes
Bleeding gums
Difficulties with chewing
Malocclusion
Difficulties with speakinghistory for lips?
lesions, drying
what to ask about for oropharynx history? 9 parts
Pain Hoarseness Swallowing problems Respiratory problems Lump Hemorrhage Referred pain Foreign body weightloss
what 3 things could symptoms of the pharynx be referring to?
Local problem
Respiratory problem
Gastrointestinal problem
what are you looking for when inspecting and palpating lips- 5? buccal/labial mucosa-4?
Inspect and Palpate lips
Color, moisture, lumps, ulcers, scaliness
Inspect and Palpate buccal/labial mucosa
Tongue blade
Color, ulcers, white patches, nodules
what to look for when you inspect and palpate teeth?
3 parts
Color (pink), swelling, ulceration
Teeth missing, discolored, misshapen
Palpate – loose teeth
what to look for when you inspect and palpate hard and soft palate?
2 parts
color and architechture
inspect and palpate tongue?
5 parts to inspection, 1 to palpation
Symmetry (CN XII – hypoglossal), color, texture,
cancerous lesion, nodules, ulcerations
Palpate – grasp tongue tip with gauze and pull to side
bilaterally and palpate; induration?
inspect and palpate floor of mouth? 5 parts
Color, architecture, lesions, nodules, ulcerations
what controls rise and fall of soft palate?
CN X- vagal nerve
what makes up the anterior triangle of neck?
sternocleidomastoid muscle, mandible-jaw line, midline of neck
what makes up the posterior triangle of the neck?
trapezius muscle, sternocleidomastoid muscle, omohyoid muscle (inferior line)
where is the external jugular located in relation to the sternocleidomastoid muscle?
superficial to its sternal head
where is the internal jugular vein located? where does it drain?
deep to sternocleidomastoid muscle. drains directly into the right atrium- fluid will backup into here = jugular veinous distention
where is the carotid sinus and artery located in relation to sternocleidomastoid muscle?
medial to it
what is the cricoid cartilage?
the ring shaped cartilage of the laynx, inferior to thyroid cartilage
what structure does the thyroid wrap around? how is it shaped? what are the isthmus and lobes?
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.
why are lymphs important to examine?
- 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
history for neck? 3 parts
pain
stiffness
swelling, goiter or nodes
inspection of the neck? 5 parts
Symmetry
Masses
Scars
Enlarged nodes
Enlarged glands
Parotid
Submandibularpalpation of the nodes : what parts of your fingers do you use? what 10 lymphs are you feeling for? 4 characteristics of each?
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
PE of the neck specific to muscular function? 5 parts
Evaluate range of motion Palpate for crepitus (friction between bone and cartilage) Palpate muscles Strength of trapezius muscles Strength of SCM muscles
PE trachea and thyroid. 4 parts to inspect and palpate
Inspect & palpate for deviation from midline
Palpate above suprasternal notch
Inspect neck using tangential lighting
Inspect & palpate thyroid, patient swallowing
what are you looking for in palpation of the thyroid?
6 parts
Palpate thyroid from behind, patient swallowing
Size, Shape, Consistency, Nodules, Tenderness
Bruit (abnormal sound)
what further exam do you do if thyroid is enlarged? What else will you inspect in regards to neck arteries?
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
