Skull, Face, Nose and Ears Exam Flashcards
Introduction
Clean hands Introduction Check name and DOB/age Explanation and gain consent Inspection, Auriscopy, Palpation, Hearing tests
Inspection (general)
8
Expression Symmetry Swellings Hair distribution Shape of face and skull Scars Skin changes (rash, acne, blisters, vitiligo) Movements (weakness)
Inspection (eyes)
4
Lid lag
Eye movements
Sclera (jaundice, anaemia)
Thyroid eye disease
Inspection (skull and face)
4
Facial symmetry
Cushings?
Acromegaly?
Bone changes?
Inspection (nose)
3
Look from in front, the side and above Notice any discharge Air flow (block one nostril, check the other)
Inspection (ears)
5
Pinna (outer ear) - nodules or other lesions
Mastoiditis - pinna pushed forward
External auditory meatus (note any discharge)
Behind the pinna (for scars)
Mastoid process (bruising or Battle’s sign)
Auriscopy
In any pain?
Seated comfortable
Largest appropriate speculum
Patient slightly turn head away from examiner
Inspect outer ear and the meatus
Gently pull pinna upwards and backwards
Rest your little finger on patient’s cheek
Inspect the auditory canal and visualise the tympanic membrane looking for surface landmarks
Remove auriscope gently and repeat on other ear
Change speculum if any discharge was present
Palpation (skull and face)
5
Each mastoid process Orbital margin, note orbital notch Tenderness along temporal artery Maxilla and mandible TM joint with two fingers, ask to open mouth and move jaw side to side
Palpation (nose)
Nasal cartilage and bone
Tenderness over paranasal sinuses (maxillary, ethmoidal, frontal)
Palpation (ear)
Press in front of meatus or pull gently on the pinna
discomfort could suggest infection in the canal
Hearing tests
Whispered voice test
Rinnie’s (512 Hz)
Weber’s (512 Hz)
