HENT Exam Flashcards
What are potential causes of nasal stuffiness or discharge?
Infection, allergies, tumor, and trauma (either direct or indirect)
What is rhinotillexomania?
Compulsive nose picking
What should you look for when inspecting the scalp?
Scaliness, lumps, nevi, or other lesions
What could an enlarged skull signify?
Hydrocephalus, Paget’s disease
What should you look for when inspecting the skull?
General size and contour, any deformities, depressions, lumps, or tenderness
When might palpable tenderness or step-offs be present in the skull?
After head trauma
What should you look for when inspecting the face?
Facial expression, contours, asymmetry, involuntary movements, edema, masses, etc
What is a keloid?
A firm, nodular, hypertrophic mass of scar tissue extending beyond the area of injury
What is a tophi?
A deposit of uric acid crystals characteristic of chronic tophaceous gouts that appears as hard nodules in the helix or antihelix and may discharge chalky white crystals through the skin
What is a cutaneous cyst?
A dome-shaped lump in the dermis that forms a benign closed firm sac attached to the epidermis; formerly called a sebaceous cyst
What is chondrodermatitis helicis?
A chronic inflammatory lesion that starts as a painful, tender papule on the helix or antihelix and in later stage can be ulcerated or crusted. A biopsy is needed to rule out carcinoma
What is basal cell carcinoma?
A common, slow-growing malignancy that rarely metastasizes and can be seen as a raised nodule with a lustrous surface and telangiectatic vessels
What are rheumatoid nodules?
Small lumps on the helix or antihelix and additional nodules elsewhere on the hands and along the surface of the ulna distal to the elbow and on the knees and heels, common in chronic rheumatoid arthritis
A painful “tug test” likely indicates what?
Acute otitis externa - inflammation of the ear canal
What usually causes perforations of the eardrum?
Purulent infections of the middle ear
What would you expect to see in chronic infection of the middle ear that causes perforation?
The eardrum itself is scarred and no landmarks are visible
What is tympanosclerosis?
A deposition of hyaline material within the layers of the tympanic membrane that sometimes follows a severe episode of otitis media, seen as large, chalky white patches with irregular margins
What typically causes serous effusions?
Viral upper respiratory infections (otitis media with serous effusion) or by sudden changes in atmospheric pressure
What happens during serous effusion?
Air is absorbed from the middle ear into the bloodstream and serous fluid accumulates in the middle ear instead
What commonly causes acute otitis media with purulent effusion?
Bacterial infection from S. pneumoniae or H. influenzae
What would you expect to see during an ear exam with a patient with acute otitis media with purulent effusion?
Reddened eardrum that loses its landmarks and bulges laterally
What causes bullous myringitis?
Mycoplasma, viral, and bacterial otitis media
What happens in bullous myringitis?
Painful hemorrhagic vesicles appear on the tympanic membrane, the ear canal, or both
How would you test for lateralization (Weber test)?
Place the base of the lightly vibrating tuning fork firmly on top of the patient’s head or on the mid forehead and determine if sound is heard
During the Weber test, the sound is heard in the good ear when what type of hearing loss is present?
Unilateral sensorineural hearing loss
During the Weber test, the sound is heard in the bad ear when what type of hearing loss is present?
Unilateral conductive hearing loss
How would you perform the Rinne test?
Place the base of a lightly vibrating tuning fork on the mastoid bone, behind the ear and level with the canal. When the patient can no longer hear the sound, quickly place the “U” of the fork facing forward and ascertain whether the sound can be heard again
What would be considered a normal result of the Rinne test?
Normally, sound is heard longer through air than through bone
What would be the expected result of the Rinne test if conductive hearing loss is present?
Sound is heard through the bone as long as or longer than it is through air
How would you test for nasal obstruction?
By pressing on each ala nasi in turn and asking the patient to breathe in
When inspecting the inside of the nose, what should you try to look for?
Inferior and middle turbinates, the nasal septum, and the narrow nasal passage between them
What are potential abnormalities you might find when inspecting the nose?
Deviation, inflammation, perforation, and masses
What are some conditions conducive to nasal polyps?
Allergic rhinitis, aspirin sensitivity, asthma, chronic sinus infections, and cystic fibrosis
What are potential causes of septal perforation?
Trauma, surgery, and intranasal use of cocaine or amphetamines
What are nasal polyps?
Pale saclike growths of inflamed tissue that can obstruct the air passage or sinuses
What would you expect to see with acute sinusitis involving the frontal or maxillary sinuses?
Local sinus tenderness, pain, fever, and nasal discharge
What might cause an absence of glow during transillumination of the sinuses?
A thickened mucosa or secretions in the frontal sinuses, but it may also result from developmental absence of one or both sinuses
What types of problems with a patient’s mouth, throat, tongue, or teeth should you ask about?
Pain, sores, spots, swelling, lumps, dryness, hoarseness
What could cause problems of a patient’s mouth, throat, tongue, or teeth?
Infections, nutritional deficiencies, inflammation, systemic disorders, tumors, immunologic reactions, normal variants, trauma
What could stiffness, lumps, or pain in the neck indicate?
Issues with the thyroid or lymph nodes, musculoskeletal pain, or referred pain
What can cause angular cheilitis?
Nutritional deficiency or overclosure of the mouth, as seen in people with no teeth or ill-fitting dentures
What can angular cheilitis secondarily cause?
Saliva wets and macerates the infolded skin, often leading to secondary infection with Candida
What causes actinic cheilitis?
Excessive exposure to the sun, primarily affecting the lower lip
What are signs of actinic cheilitis?
The lip loses its normal redness and may become scaly, somewhat thickened, and slightly everted
What can HSV form on the lips?
Cold sores, starting with a small cluster of vesicles developing followed by them breaking, forming a yellow-brown crust
What is angioedema?
A localized subcutaneous or submucosal swelling caused by leakage of intravascular fluid into interstitial fluid
What are the two common causes of angioedema?
Angioedema triggered by mast cells in allergic reaction (with associated urticaria and pruritus) and angioedema from bradykinin and complement-derived mediators
What do multiple small red spots on the lips suggest?
Hereditary hemorrhagic telangiectasia
Along with the prominent brown pigmented spots associated with Peutz-Jeghers Syndrome, what else is common?
Numerous intestinal polyps
What is chancre of primary syphilis?
An ulcerated papule with an indurated edge that usually appears after 3-6 weeks of incubating infection from Treponema pallidum
Carcinoma of the lip appears as what?
A scaly plaque, an ulcer with or without a crust, or as a nodular lesion, typically on the lower lip
What are you looking for when you inspect the oral mucosa?
Color, presence of ulcers, white patches, and nodules
What is torus palatinus?
A midline bony growth in the hard palate, fairly common in adults
What are fordyce spots?
Normal sebaceous glands that appear as small yellowish spots in the buccal mucosa or on the lips
What are Koplik’s Spots?
An early sign of measles; small white specks that resemble grains of salt on a red background
What are petechiae?
Small red spots caused by blood that escapes from capillaries into the tissues
What is leukoplakia?
A thickened white patch that can occur anywhere in the oral mucosa. It is a benign reactive process but should be biopsied because it can lead to cancer
What is plaque?
The soft white film of salivary salts, proteins, and bacteria that covers teeth and can lead to gingivitis
What is typically also present in cases of acute necrotizing ulcerative gingivitis?
Fever, malaise, enlarged lymph nodes, and ulcers that develop in the interdental papillae
What are common causes of gingival hyperplasia?
Phenytoin therapy, puberty, pregnancy, and leukemia
What is a pregnancy tumor in the gums?
Red purple papules of granulation tissue that form in the gingival interdental papillae. They typically regress after childbirth.
What is attrition of the teeth?
The chewing surfaces of teeth are worn down by repetitive use, so the yellow-brown dentin becomes exposed. This is common in many elderly people.
What can cause erosion of the teeth?
Teeth can be eroded by chemical action, such as that caused by recurrent regurgitation of the stomach contents as in bulimia
What can cause abrasion of the teeth with notching?
The biting surface of the teeth can become abraded or notched by recurrent trauma, such as holding nails. The sides of these teeth show normal contours and the size and spacing of teeth are unaffected.
What would Hutchinson’s Teeth in congenital syphilis present as?
Teeth that are smaller and more widely spaced than normal and are notched on their biting surfaces. The sides of the teeth taper toward the biting edges.
What is a geographic tongue?
A benign condition where the dorsum shows scattered smooth red areas denuded of papillae
What is a hairy tongue?
A benign condition associated with antibiotic therapy, Candida infection, and poor dental hygiene that presents as “hairy” yellowish to brown and black elongated papillae on the dorsum of the tongue.
What is a fissured tongue?
A benign condition, as fissures appear with increasing age, sometimes termed “scrotal tongue.” Food debris may accumulate in the crevices and become irritating.
What is a smooth tongue (atrophic glossitis)?
A smooth and often sore tongue that has lost its papillae, suggesting a deficiency in riboflavin, niacin, folic acid, vitamin B12, pyridoxine, or iron, or treatment with chemotherapy.
How can candidiasis affect the tongue?
It can cause a thick white coating on the tongue, though infection can still occur without it. It is seen in immunosuppression from chemotherapy or prednisone therapy.
What is hairy leukoplakia?
Whitish raised areas with a feathery or corrugated pattern, most often affecting the sides of the tongue. These areas can’t be scraped off.
What conditions are associated with hairy leukoplakia?
HIV and AIDS infections
What is an aphthous ulcer (canker sore)?
A painful, round or oval ulcer that is white or yellowish gray and surrounded by a halo of reddened mucosa
What is a mucous patch of syphilis?
A highly infectious, painless lesion of secondary syphilis that presents as slightly raised, oval, and covered by a grayish membrane
What are tori mandibulares?
Harmless, rounded bony growths on the inner surfaces of the mandible
What should you note when inspecting the soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx?
Color and symmetry, look for exudate, swelling, ulceration, or tonsillar enlargement
What are crypts of the tonsils?
Deep in-foldings of squamous epithelium that sometimes have whitish spots of normal exfoliating epithelium
What would you expect to see in exudative tonsilitis?
A red throat with exudate on the tonsils, along with fever and enlarged cervical lymph nodes, likely caused by group A strep infection or infectious mononucleosis
What would you expect to see in inspection of the pharynx of a patient with diphtheria?
A dull red throat with a gray exudate (pseudomembrane) present on the uvula, pharynx, and tongue
What are predisposing factors of candidiasis leading to thrush on the palate?
Prolonged treatment with antibiotics or corticosteroids and AIDS
What is Kaposi’s Sarcoma in AIDS?
Deep purple lesions suggest Kaposi’s sarcoma, which is a low-grade vascular tumor associated with human herpesvirus 8.
What could cause deviation of the trachea?
Masses in the neck or problems in the thorax, like a mediastinal mass, atelectasis, or a large or tension pneumothorax
Enlargement of a supraclavicular node, especially on the left, suggests what?
Possible metastasis from a thoracic or an abdominal malignancy
What are the six lymph nodes you should palpate on the head?
Occipital, post-auricular, pre-auricular, tonsillar, submandibular, submental
What should you note when examining lymph nodes?
Size, shape, delimitation (discrete or matted together), mobility, consistency, and any tenderness
What do tender nodes suggest?
Inflammation
What do hard or fixed nodes suggest?
Malignancy
Where would you likely find the thyroid isthmus?
It is usually overlying the second, third, and fourth tracheal rings
