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PAS 765 (Clinical Assessment I) > PE Script HEENT and Neck > Flashcards

PE Script HEENT and Neck Flashcards

1
Q

what two areas need to be inspected during the neck portion of the physical exam

A
  1. neck
  2. thyroid
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2
Q

when inspecting the neck during the neck examination, what four signs should be looked for

A
  1. symmetry
  2. masses
  3. scars
  4. tracheal position
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3
Q

when inspecting the thyroid during the neck examination, what sign should be looked for

A

movement of thyroid or masses suggesting thyroid enlargement

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4
Q

describe the process of examining the thyroid during the neck exam

A

have the patient tilt their head back and swallow water while inspecting

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5
Q

what are 5 areas to inspect while examining the skull

A
  1. skull
  2. scalp
  3. hair
  4. face, nose, mouth
  5. TMJ
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6
Q

when inspecting the skull during the head examination, what two signs should be looked for

A
  1. general size
  2. contour
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7
Q

when inspecting the scalp during the head examination, what three signs should be looked for

A
  1. scaliness
  2. nevi
  3. lesions
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8
Q

when inspecting the hari during the head examination, what four signs should be looked for

A
  1. quantity
  2. distribution
  3. pattern of loss
  4. dandruff
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9
Q

when inspecting the face/nose/mouth during the head examination, what seven signs should be looked for

A
  1. symmetry
  2. contours
  3. involuntary movements
  4. edema
  5. lesions
  6. masses
  7. expression
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10
Q

when inspecting the TMJ during the head examination, what sign should be looked for

A

redness or swelling

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11
Q

what special sign can be identified during the head examination

A

pathognomic facies

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12
Q

pathognomic facies

A

specific facial characteristics indicative of certain diseases

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13
Q

what two areas should be palpated during the head exam

A
  1. hair and scalp
  2. TMJ
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14
Q

when palpating the hair during the head examination, what six signs should be looked for

A
  1. hair texture
  2. quantity and quality
  3. deformities
  4. tenderness
  5. lesions
  6. scaliness
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15
Q

when palpating the TMJ during the head examination, what two signs should be looked for

A
  1. pain
  2. creptius
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16
Q

describe the process of palpating the TMJ during the head exam

A

visualize and palpate the TMJ in motion during opening/closing, protrusion/retrusion, lateral movement

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17
Q

what three areas should be palpated during the neck portion of the physical exam

A
  1. trachea
  2. cervical lymph nodes
  3. thyroid
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18
Q

when palpating the trachea during the neck examination, what sign should be looked for

A

deviation of the trachea from midline

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19
Q

when palpating the cervical lymph nodes during the neck examination, what 10 areas should be palpated

A
  1. occipital
  2. posterior auricular
  3. preauricular
  4. posterior cervical
  5. superficial cervical
  6. supraclavicular
  7. deep cervical
  8. tonsillar
  9. submandibular
  10. submental
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20
Q

when palpating the cervical lymph nodes during the neck examination, what signs should be looked for

A
  1. size
  2. shape
  3. mobility
  4. consistency
  5. tenderness
  6. induration
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21
Q

when palpating the thyroid during the neck examination, what five signs should be looked for

A
  1. size
  2. shape
  3. consistency
  4. tenderness
  5. masses/nodules
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22
Q

describe the process of palpating the thyroid isthmus

A

while standing behind the patient, place your index, middle, and ring fingers of both hands over the tracheal rings and ask them to swallow water

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23
Q

describe the process to palpate the lateral lobes of the thyroid during the neck exam

A

with the hands in the same position used when palpating the isthmus, palpate the lateral lobes and ask them to swallow again

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24
Q

describe how to palpate the thyroid deep to the SCM during the neck exam

A

with the hands in the starting position displace the trachea slightly to the right or left and ask the patient swallow water

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25
Q

if the thyroid is found to be enlarged during the neck exam what is the next step

A

the thyroid should be ausculated over the lateral lobes to assess for bruit

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26
Q

bruit

A

a vascular murmur caused by the partial occlusion of an artery

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27
Q

summarize the process for palpating the thyroid during the neck exam

A
  1. feel for the isthmus
  2. palpate lateral lobes
  3. palpate left and right deep lobes
  4. listen for bruit if necessary
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28
Q

what three pieces of equipment are needed for the eye portion of the physical exam

A
  1. rosenbaum card
  2. penlight
  3. opthalmoscope
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29
Q

during the visual accuity portion of the eye exam, why cranial nerve is being tested

A

CNII

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30
Q

what is used to test visual acuity during the eye portion of the physical exam

A

the rosenbaum card

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31
Q

if visual accuity assessment using the card during the eye exam is not applicable or practical, what else may be used

A

finger counting or light perception

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32
Q

when inspecting the eye what areas should be noted

A
  1. eyebrows
  2. eyelids
  3. lacrimal glands
  4. conjunctiva and sclera
  5. iris and pupils
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33
Q

when inspecting the eyebrows during the neck examination, what three signs should be looked for

A
  1. quantity
  2. distribution
  3. scaliness
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34
Q

when inspecting the eyelids during the neck examination, what five signs should be looked for

A
  1. edema
  2. color
  3. lesions
  4. direction of eyelashes
  5. adequacy of closure
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35
Q

when inspecting the lacrimal gland during the neck examination, what signshould be looked for

A

swelling

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36
Q

when inspecting the conjuctiva/sclera during the neck examination, what three signs should be looked for

A
  1. color
  2. vascular pattern
  3. nodules
  4. swelling
37
Q

when inspecting the iris and pupils during the neck examination, what three signs should be looked for

A
  1. size
  2. shape
  3. symmetry
38
Q

when inspecting the eye during the physical exam, how do you expose the sclera and palpebral conjuctiva

A

depress the lower lid

39
Q

what are nine specific conditions to be aware of when examining the eye

A
  1. icterus
  2. conjuctival inflammation
  3. pterygiums
  4. pinguecula
  5. xanthelasmas
  6. iris lesions
  7. pupillary inequality
  8. nystagmus
  9. strabismus
40
Q

icterus

A

yellowing of the sclera due to high bilirubin

41
Q

pterygium

A

a triangular pink grow on the eye that can cover the sclera

42
Q

pingueculae

A

a yellowish thickened area of the conjunctiva on the sclera

43
Q

a yellowish fat deposit on or around the eyelids

A

xanthelasmas

44
Q

nystagumus

A

a vision condition where the eyes make random uncontrolled movements

45
Q

strabismus

A

misalignment of the eyes (cross eyes, lazy eye)

46
Q

how are the pupillary reflexes tested during the eye portion of the physical exam

A

stand to the side of the patient and bring your light in from the side

47
Q

what cranial nerve is being assessed by testing pupillary reflexs during the eye exam

48
Q

how is the accommodative reflex tested during the eye portion of the physical exam

A

ask the patient to focus on an object about an arms length away, then move the object towards the nose

49
Q

what sign should be noted when assessing pupillary relfexes during the eye exam

A

direct and consensual light reflexes

50
Q
  1. direct pupillary reflex
  2. consensual pupillary reflex
A
  1. direct: the pupil with the light in it constricts
  2. consensual: constriction of one pupil causes constriction of the other
51
Q

what two signs should be looked for when assessing the accomodative reflex during the eye exam

A
  1. convergence of eyes
  2. pupillary constriction
52
Q

how are the extraocular muscles assessed during the eye portion of the physical exam

A

examine the patients eye movements as they follow an object through the six cardinal positions of gaze

53
Q

what three cranial nerves are assessed by inspecting the extraoccular movements during the eye exam

A
  1. CN III
  2. CN IV
  3. CN VI
54
Q

name the muscles and nerves responsible for movement to each of the six cardinal positions of gaze

A
  1. abduction/depression: superior oblique: CN IV
  2. abduction (lateral): lateral rectus, CNVI
  3. elevation/abduction: inferior oblique, CN III
  4. elevation/adduction: superior rectus, CN III
  5. adduction: medial rectus, CNIII
  6. adduction/depression: inferior rectus, CN III
55
Q

what four specific signs should be assessed during inspection of the extraoccular muscle portion of the eye exam

A
  1. EOM paralysis
  2. disconjugate gaze
  3. nystagmus
  4. lid lag
56
Q

what is the special procedure to test for strabismus in the eye exam

A

the cover/uncover test

57
Q

how is the cover uncover test performed

A

the patient focuses on first a far then near object, while the examiner covers and uncovers each eye, looking for deviation of the afflicted eye

58
Q

how are visual fields assessed during the eye exam

A

the confrontation method

59
Q

describe the confrontation method of assessing visual fields

A
  1. stand at arms length from the patient and position both hands on either side of the patients head, lateral to the ears
  2. instruct the patient to point to your fingers when they enter there vision
  3. slowly move your hands towards the patients suspected field of vision
  4. repeat this process from at least 6 directions
60
Q

what sign would be present in an abnormal visual field assessment during the eye exam

A

gross visual field defects

61
Q

during the visual fields portion of the eye exam, what should be done when a defect is noted

A

test one eye at a time

62
Q

what are six assessments specific to the eye exam

A
  1. visual acuity
  2. pupillary reflexes
  3. accomodative reflex
  4. extraoccular muscles
  5. visual fields
  6. fundoscopy
63
Q

describe the process of a fundoscopy (10)

A
  1. hold the opthalmoscope in your right hand
  2. set the focus wheel to zero
  3. have the patient focus on a distant object
  4. darken the room
  5. position yourself about 15 inches away and at a 15 degree angle
  6. direct the opthalmoscope at the patients pupil
  7. look for red reflex
  8. identify the blood vessels of the fundus
  9. examine the disc
  10. repeat with the left hand and eye
64
Q

what 6 structures should be inspected during the fundoscopy portion of the eye exam

A
  1. disc
  2. retina arterioles and venules
  3. fovea
  4. macula
  5. vitreous fluid
  6. lens
65
Q

red reflex

A

a reddish-brown reflection from the fundus when examined with an opthalmoscope

66
Q

what are nine specific signs to look for when performing the fundoscopy portion of the eye exam

A
  1. opacities in the ocular media
  2. disc cupping
  3. vessel narrowing
  4. A-V nicking
  5. papilledema
  6. retinal exudates
  7. macular changes
  8. disc sharpness
  9. color
67
Q

what equipment is needed for inspection of the nose

A

a lighted nasal speculum

68
Q

describe the process for inspecting the nost

A

lift the tip of the nose and direct a lighted speculum into the nostril

69
Q

what are three structures that should be inspected in the nose

A
  1. septum
  2. nasal mucosa
  3. turbinates
70
Q

what are 5 specific signs to look for while inspecting the nose

A
  1. septal deviation
  2. septal perforations
  3. mucosal inflammation
  4. nasal discharge
  5. lesions
71
Q

what are two signs to look for when palpating the nose during the physical exam

A
  1. tenderness
  2. patency of each nostril
72
Q

how is the patency of the nostrils tested during the nose exam

A

by plugging the nostil one side at a time and asking them to breath through their nose

73
Q

what are two pieces of equipment needed to inspect the mouth during the physica exam

A
  1. flashlight
  2. tongue blade
74
Q

what are 11 structures that should be inspected during the mouth exam

A
  1. lips
  2. buccal mucosa
  3. gums
  4. gums
  5. teeth
  6. tongue
  7. palate
  8. floor of mouth
  9. posterior pharnyx
  10. tonsillar pillars
  11. tonsils
75
Q

what are ten specific signs that should be looked for when inspecting the mouth during the physical exam

A
  1. color
  2. inflammation
  3. exudate
  4. swelling
  5. moisture
  6. lesions
  7. ulcers
  8. dental caries
  9. tonsillar enlargement
  10. bad breath
76
Q

T/F its ok to leave dentures in during the mouth exam

A

false, they must be take out

77
Q

dental caries

78
Q

what should be done if there is a lesion found during the mouth inspection portion of the physical exam

A

the tongue, lips, buccal mucosa and floor of the mouth should be palpated

79
Q

what five signs should be looked for when inspecting the auricles during the physical exam

A
  1. deformities
  2. keloids
  3. lesions
  4. lumps
  5. discharge
80
Q

what two structures of the external ear should be palpated during the ear exam

A
  1. tragus
  2. auricle
81
Q

what cranial nerve is being assessed during the hearing screen portion of the ear exam? what is the assessment

A

CN VIII

the whispered voice test

82
Q

describe the procedure of the whispered voice test

A

standing two feet behind the patient, cover one ear and whisiper a number and letter combination. ask them to repeat the combination, then repeat with the other ear

83
Q

what special procedure should be performed in the case of unilateral hearing loss

A

the weber and rinne test

84
Q

decribe the process of the weber test for unilateral hearing loss

A

strike a tuning fork, place it on the patients head, record if they here the sound better in the right ear, left ear, or both

85
Q

describe the rinne test for unilateral hearing loss (two parts)

A
  1. strike a tuning fork and place it on the mastoid process, record how long it takes for the sound to not be hear
  2. strike tuning fork and place it next to the ear, record how long the sound can be heard
86
Q

during the otoscopic portin of the ear exam, what two structures should be inspected

A
  1. tympanic membrane
  2. external auditory canal
87
Q

when inspecting the tympanic membrane during the otoscope exam, what are two things to identift

A
  1. anatomical landmarks
  2. light reflex
88
Q

what is the light reflex seen during the otoscopic exam

A

a cone of light seen reflected off the tympanic membrane at the 4-5oclock position

89
Q

what are 10 signs to look for when performing the otoscopic portion of the ear exam

A
  1. discharge
  2. foreign bodies
  3. erythema
  4. edema
  5. color and contour of ear drum
  6. tympanic scarring or perforation
  7. bulging or retraction
  8. air-fluid levels
  9. bleeding
  10. vascular lesions in the middle ear space

PAS 765 (Clinical Assessment I) (5 decks)

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