PD - ENT Exam

Question 1

normal appearance of the tympanic membrane

Answer 1

pearly-gray, ovoid, and semi-transparent

Question 2

light reflex

Answer 2

From the lower end of the malleus handle, a triangle of light reflects off the pars tensa.

Question 3

how to test mobility of the tympanic membrane

Answer 3

via insufflation.

a small puff of air is introduced into the external auditory canal and mobility of the tympanic membrane is observed.

Question 4

2 tests for auditory acuity

Answer 4

1. whispered voice test: occlude one ear by pressing tragus; whisper word into
   other ear and ask patient to repeat.
2. finger rub test

Question 5

Weber test

Answer 5

tests for LATERALIZATION.

strike the 512-Hz tuning fork and place the handle in center of pt’s forehead. should hear = in both ears.

Conductive hearing loss: Lateralize sound to AFFECTED side.

Sensorineural hearing loss: Lateralize sound to UNAFFECTED side.

Question 6

Rinne test

Answer 6

strike 512-Hz fork, place handle on mastoid process until sound is inaudible to pt, then place in front of ext aud meatus.

Shows air conduction > bone conduction (unless there is conductive hearing loss).

conductive hearing loss: BC>AC.

sensorineural deafness: AC and BC impaired, but AC>BC remains.

Question 7

In patients who report either tinnitus (ear ringing) or vertigo, it is important to test…

Answer 7

BALANCE

Question 8

Ear exam steps

Answer 8

1. external inspection and palpation
2. auditory acuity test
3. air and bone conduction (Rinne/Weber)
4. otoscope exam
5. balance test (if vertigo sx)

Question 9

Nose/sinus exam steps

Answer 9

1. inspection (external)
2. nasal obstruction test (have pt occlude one nostril and sniff)
3. inspection (internal)
4. palpation

Question 10

Kiesselbach’s Plexus

Answer 10

Anastomosis between sup. labial a. + ant. ethmoidal a.

Question 11

Oropharynx exam inspection

Answer 11

• Palatoglossal arch and palatopharyngeal arch (palatine tonsils).
• Stenson’s Duct (parotid), Wharton’s Duct (submandibular).

Question 12

How to inspect the nasopharynx, larynx, and hypopharynx

Answer 12

The nasopharynx, larynx, and hypopharynx can NOT be directly visualized

Ask pt to speak to evaluate phonation.

Question 13

CN functions to examine during oropharynx exam

Answer 13

-Elicit gag reflex (CN IX and X)

• check CN XII (stick tongue out, if
  there is a lesion, tongue will deviate toward side of lesion)
• look for uvular deviation (away from side of lesion).

Question 14

anterior triangle borders

Answer 14

midline of neck

SCM

mandible

Question 15

posterior triangle borders

Answer 15

SCM

trapezius

clavicle

Question 16

How to evaluate the motion of the thyroid gland

Answer 16

ask pt to swallow

Question 17

location of thyroid gland

Answer 17

approximately in the area of the 2nd-4th tracheal rings

2 fingers beneath cricoid ring

Question 18

the normal thyroid gland is easy to palpate, T or F?

Answer 18

the normal thyroid gland is difficult to palpate, soft and indistinct.

Question 19

lymph nodes to examine during neck exam

Answer 19

• preauricular
• posterior auricular
• occipital
• submandibular
• submental
• superior cervical
• posterior cervical
• inferior cervical
• supraclavicular

Question 20

Neck exam steps

Answer 20

1. inspection (symmetry, enlarged nodes, tracheal deviation, IJV/EJV, thyroid gland)
2. auscultate (carotid bruits)
3. palpate (cartilages, thyroid glands, SCM, nodes)