Week 3 - HEENT Flashcards

Question

Inspecting the nasal cavity and mucosa

Answer 1

1. Inspect the nares with an otoscope with largest speculum 2. Tilt head back and inspect each nostril avoiding contact with nasal septum (handle to the side) 3. Look at inferior and middle turbinates, nasal septum, narrow nasal passage between them - Some asymmetry is normal - Look for color, swelling, bleeding or exudate (clear, mucopurulent, purulent) * Viral rhinitis – red and swollen mucosa * Allergic rhinitis – pale, bluish, red

Answer 2

Palpate frontal and maxillary sinuses for tenderness - Local tenderness with symptoms like facial pain, pressure, fullness, purulent discharge, nasal obstruction, smell disorder for more than 7 days suggests acute bacterial rhinosinusitis involving frontal or maxillary sinuses

Answer 3

Sensation of true rotational movement off the patient or surroundings. Point to a problem with the labyrinths of the inner ear, peripheral lesions of CN VIII or lesions in its central pathways or nuclei in the brain

Answer 4

o Perceived sound that has no external stimulus – ringing, rushing, roaring noise in one or both ears. o May accompany hearing loss,

Answer 5

- Drainage from the nose that is often associated with nasal congestion, sense of stuffiness or obstruction. Often accompanied by watery eyes, itchy nose, sore throat

Answer 6

Infection of the external portion of the ear – pain when pulling the auricle up

Answer 7

infection of the middle ear, may cause tympanic membrane swelling and/or purulent fluid in the middle ear.

Answer 8

o Labial frenulum o 32 teeth o Tongue with papillae o Hard palate o Soft palate o Uvula o Posterior pharynx o Posterior pillar o Anterior pillar o Buccal mucosa (lines the cheeks)

Answer 9

- Inspect the lips (color, moisture, lumps, ulcers, cracking, or scaliness). o Inspect the oral mucosa (discoloration, ulcers, white patches, nodules). - Palpate the oral mucosa (if indicated for any lesions, thickening). - Inspect the gingiva (erythema, discoloration, ulceration, swelling). - Inspect the gum margins and interdental papillae (swelling, ulceration). - Inspect the teeth (missing, discolored, misshapen, or abnormally positioned). - Inspect the roof (hard palate) and floor of the mouth (erythema, discoloration, nodules, ulcerations, or deformities). - Test the hypoglossal nerve, or CN XII (symmetry of tongue protrusion). - Inspect the tongue (color, texture, lesions). - Palpate the tongue (if indicated for any lesions, thickening). - Inspect the soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx (color, symmetry, exudate, swelling, ulceration, or tonsillar enlargement). - Test the vagus nerve, or CN X (symmetry of uvula).

Answer 10

o Say ahh with tongue in - rise of the soft palate – test of the CNS X (vagus nerve), check for uvula deviation (will point to opposite side and away from the lesion) o Inspect soft palate, anterior and posterior pillars, uvula, tonsils

Answer 11

Inspection and palpation remain standard for detection of oral cancers

Answer 12

Tonsils are graded on a scale from 0 to 4. 0 - you've had them removed 1 - they're barely visible, 2 - they're normal 3 - they're large and just about touching that thing that hangs down at the back of your throat called the uvula 4 - they're ginormous

Answer 13

- Respiratory distress? - Tachypnea - Cyanosis/pallor - Diaphoresis - Clubbing - Audible sounds of breathing (wheezing, stridor) - Use of accessory muscles

Answer 14

- Focus on areas of bruising, tenderness, respiratory expansion, fremitus (vocal resonance) - Note any crepitus - Abnormalities or masses - Test chest expansion - look for asymmetry/barrel chest

Answer 15

- Flat - Dull - Resonant - Hyper resonant - Tympanitic

Answer 16

Helps establish whether underlying tissues are air-filled, fluid-filled or consolidated

Answer 17

soft and low pitched

Answer 18

inspiratory and expiratory sounds are equal in lengths, may be separated by silent interval

Answer 19

louder, harsher, higher in pitch with short silence between inhalation and exhalation

Answer 20

large harsh sounds heard over the trachea in the neck

Answer 21

softer, higher pitched more frequent than coarse crackles. Heard mid to later inspiration, short duration, and higher frequency than coarse.

Answer 22

appear in early inspiration and throughout expiration, popping sound, longer duration, and lower frequency than fine crackles. Result of boluses of gases passing through the airways as the open and close intermittently

Answer 23

continuous musical sounds that occur during rapid airflow when bronchial airways are narrowed almost to the point of closure. Inspiratory, expiratory of biphasic

Answer 24

lower pitch than wheezes (same mechanism as wheeze), may disappear with coughing. -Snoring

Answer 25

Ladder pattern Start upper right, then left alternating down the ladder for 5 levels then auscultate upper and then lower lateral levels

Answer 26

Ladder pattern start on upper right, ladder down 4 levels then lateral top (right and left) and lateral bottom (left and right)

Answer 27

- Inspect the chest (deformities, muscle retraction, lag). - Palpate the chest (tenderness, bruising, sinus tracts, respiratory expansion, fremitus). - Percuss the chest (flat, dull, resonant, hyperresonant or tympanitic). - Auscultate the chest (breath sounds, adventitious, transmitted voice sounds).

Answer 28

1 - sternal angle/angle of Lois is the 2nd rib 2 - back/neck bony prominence - C7 then T1 3 - inferior tip of the scapula is the 7th rib

Answer 29

covers the outer surface of the lungs

Answer 30

lines the pleural cavity along the inner rib case and upper surface of the diaphram

Answer 31

Reflex response to stimuli that irritate receptors in the larynx, trachea or large bronchi (mucus, pus, blood, allergens, dust, foreign bodies, hot/cold air) May be cardiovascular or GI in origin - Acute – less than 3 weeks - Subacute 3-8 weeks - Chronic – 8+ weeks

Answer 32

Spitting up blood

Answer 33

Lungs and pericardium have no pain receptors - pain often comes from pleural receptors or intercostal muscles GERD and anxiety may also cause chest pain

Answer 34

Lungs and pericardium have no pain receptors - pain often comes from pleural receptors or intercostal muscles GERD and anxiety may also cause chest pain

Answer 35

continuous high frequency high pitched musical sound produced during airflow through narrowing in the upper respiratory tract, immediate intervention needed. Best heard over the neck

Answer 36

series of precordial crackles synchronous with heartbeat, not respiration. Best hear in left lateral position. Occurs due to air entry into the mediastinum causing mediastinal emphysema a Produces severe chest pain.

Answer 37

discontinuous, low frequency grating sound that arises from inflammation and roughening of the visceral pleura as it slides against the parietal pleura. Occurs during inspiration and expiration, best heard at the axilla and lung bases.

Answer 38

Episodic wheezing and dyspnea but cough may occur along, often with hx of allergies. Cough at times with thick mucoid sputum especially near the end of an attack.

Answer 39

- Breath sounds bronchial or bronchovesicular - Spoken EE sounds like AY - Spoken words louder - Whispered words louder and clearer - Increased tactile fremitus

Answer 40

- Breath sounds are decreased, muffled or distant to absent - Transmitted voice sounds and fremitus are decreased

Answer 41

- Dullness with percussion - Lateral displacement of the trachea - Clearing of crackles, wheezes, or rhonchi after coughing or position change suggests inspissated secretions

Answer 42

Examine the thyroid gland to identify nodules - Nodules greater than or equal to 2 cm, and fixed to adjacent tissues are concerning for malignancy - US to determine if biopsy is indicated

Answer 43

Inspection - Alone, neck back - With swallowing Palpation - Posterior approach - Index fingers below cricoid cartilage Anterior approach - Palpate between cricoid cartilage and suprasternal notch - Retract SCM muscle slightly with one hand, use the other to palpate the thyroid Note shape/size/consistency - Soft in graves disease - hyperthyroidism - Firm in Hashimoto thyroiditis (body attacks thyroid - hypothyroidism) o If enlarged, listen for a bruit o Found in graves disesase and toxi multinodular goiter

Answer 44

o Preauricular o Postauricular o Tonsillar o Occipital – base of skill behind ear o Submandibular o Submental o Anterior superficial cervical—palpate for these nodes anterior and superficial to the SCM muscle. o Posterior cervical—palpate along the anterior edge of the trapezius by flexing the patient’s neck slightly forward toward the side being examined (Fig. 11-10). o Deep cervical chain—deep in the SCM muscle and often inaccessible to examination. Hook your thumb and fingers around either side of the SCM muscle to find them. o Supraclavicular—palpate deep in the angle formed by the clavicle and the SCM muscle

Answer 45

o Examine the hair (quantity, distribution, texture, any pattern of loss). o Examine the scalp (scaliness, lumps, nevi, lesions). o Examine the skull (size, contour, deformities, depressions, lumps, tenderness). o Inspect the skin in the head and face (expression, contours, asymmetry, involuntary movements, edema, masses). o Palpate the cervical lymph nodes (size, shape, delimitation, mobility, consistency, tenderness). o Examine the trachea (deviation, breath sounds over it). o Examine thyroid gland (size, shape, and consistency).