Written Midterm Flashcards
What is the term for the ability of a test to rule out a disease that is not present? NIH and SpPin
Specificity
What is the term for the ability of a test to detect the disease when its present? PID and SnNout
Sensitivity
What is the term for the combination of sensitivity and specificity?
Likelihood ratio
Examination of the head includes the assessment of what 5 areas?
- hair
- scalp
- skull
- face
- skin
What 6 things are being assessed with regards to the head?
- quality
- quantity
- distribution
- baldness
- texture
- lice/nits
What 2 things are being assessed with regards to the scalp?
- redness
- scaling
What 4 things are being assessed with regards to the skull?
- deformity
- size
- lumps
- tender spots
What 5 things are being assessed with regards to the face?
- expression
- symmetry
- lumps
- tenderness
- swelling
What 5 things are being assessed with regards to the skin?
- color
- texture
- thickness
- hair distribution
- lesions
When examining the nose, which 3 items should be used?
- large ear speculum
- nasal illuminator
- nasal speculum
Which 3 portions of the nose should be inspected?
- turbinates
- mucosa
- septum
Which area of the nose should contact be avoided due to sensitivity?
nasal septum
What substance can assist in the inspection of swollen mucosa?
0.5% phenylephrine
What should and should not be used to clean instruments after use?
Use: germicidal solution
Do not use: ETOH
How should you hold the scope when inspecting the nose?
Like holding a pencil
Use the nasal speculum to pull which portion of the nose providing traction? What should be avoided?
alar - pull it laterally; avoid the nasal septum
What 3 things are you inspecting for on the inferior turbinate and inferior border of middle turbinate?
- color
- swelling
- polyps
What 3 things are you looking for when inspecting the nasal mucosa?
- color
- swelling
- bleeding
What 2 things are you looking for when inspecting the nasal septum?
- deviation
- perforation
When inspecting the sinuses, transillumination should be done in a darkened room; what should be seen?
Equal glow on each side
If there is diminished glow from sinus transillumination, what 3 things does that indicate?
- fluid
- a mass
- mucosal thickening
While transillumination is useful, what are considerations that need to be made with diagnosis?
It is non-specific and should NOT be considered a substitute for CT studies
Where should the transilluminator be placed to do an inspection of the sinuses?
- inner rim of eyebrow (angled upward)
- over maxillary sinuses (have pt. open mouth to see illumination through palate)
Examination of the mouth includes assessment of which 6 areas?
- lips
- buccal mucosa
- gums
- teeth
- roof of mouth
- tongue
When inspecting the lips, which 6 things should be noted?
-color
-moisture
-lumps
cracking
-ulcers
-lesions
Which 4 things should be looked for on the buccal mucosa? What instruments should be used for the inspection?
-color
-pigmentation
-ulcers
-nodules
Use a tongue blade and light
What are 2 specific conditions looked for in the buccal mucosa? What other 2 areas should be inspected?
- leukoplakia
- candidiasis
- Stensen’s (parotid) duct
- Wharton’s (submandibular) duct
What 7 things are you looking for when you inspect the gums and teeth?
- inflammation
- bleeding
- retraction
- missing teeth
- caries
- fillings
- abnormal shapes or positions
Aside from any inflammation, bleeding, lesions, etc… what are you looking for while inspecting the tongue?
- Symmetry (CN XII)
- Lateral margins and inferior surface (cancer)
What special considerations should be used when inspecting the tongue of someone over 50 who drinks and smokes?
Use gauze and gloves
Which 4 areas should be inspected in addition to the pharynx?
- soft palate
- pillars
- tonsils
- uvula
When inspecting the pharynx, a tongue blade is place in the middle third of the tongue and is tractioned forward and down. What areas should be avoided? Why?
Avoid the back of the tongue as this stimulates gagging
What 4 things are you looking for when inspecting the pharynx?
- color
- symmetry
- swelling
- exudates
What are 4 clinical features that are associated with an increased likelihood of group A beta-haemolytic streptococcus (GABHS) infection?
- fever (history of)
- lack of cough
- tonsillar exudate
- anterior cervical lymphadenopathy
What has the highest sensitivity and specificity in the diagnosis of GABHS in children and adults?
Use of the modified Centor Score coupled with culture
Which 5 things are you looking for when inspecting the neck?
- swelling
- asymmetry
- deviation of the trachea from midline
- palpation of the lymph nodes and submandibular glands
- palpation of the thyroid
When palpating the lymph node chains and submandibular glands, what 5 things should you be noting?
- size
- shape
- mobility
- consistency
- tenderness
What areas are used to locate the thyroid?
- “Adam’s apple”
- cricoid cartilage
What can you have the patient do to better visualize an enlarged thyroid?
Have the patient swallow water, the bolus will assist in visualizing an enlarged thyroid.
When you palpate the front of the thyroid, what are you noting?
- enlargement
- nodules
If the thyroid is enlarged, what should you do? Which instrument should be used? What could this mean?
- listen for bruits
- use the small diaphragm of your stethoscope
- Toxic Goitre
Examination of the ears includes assessment of which 6 areas?
- outer ear
- auricle
- tragus
- mastoid
- ear canal
- tympanic membrane
- auditory acuity
When examining the auricle, tragus, and mastoid, what should you do and what are you looking for?
- Pull on auricle and press tragus for pain
- Inspect auricle and tragus for lesions
- Inspect mastoid for swelling and redness
Using the largest size speculum you can, you should inspect the ear canal for what 4 things?
- swelling
- redness
- pain
- discharge
What are the 6 main landmarks that can be visualized in a normal tympanic membrane?
- umbo
- cone of light
- pars tensa
- pars flaccida
- short process of malleus
- manubrium of malleus
When inspecting the tympanic membrane, which 3 things are you looking for regarding position?
- bulging
- neutral
- retracted
When inspecting the tympanic membrane, which 5 things are you looking for regarding color?
- pearly gray (normal)
- dull
- cloudy
- amber
- red
Insufflation (pneumatic otoscopy) assesses what 2 things?
- presence of fluid effusions
- suppuration in the middle ear
The normal eardrum should move which directions with which types of pressure?
In and out by increasing and decreasing pressure in the ear canal.
Auto-insufflation involves having the patient do what while you watch for movement of the TM? Who is this best used for?
Vasalva maneuver; Adults
Auditory acuity is evaluated by PE using which 2 exams?
- whispered voice test
- tuning fork tests (Weber, Rinne)
When is a patient considered to have passed the whispered voice test?
If they repeat at least 3 out of a possible 6 numbers/letters correctly
Weber and Rinne tests differentiate between which types of hearing loss?
conductive and sensorineural (SN) hearing loss
Which tuning fork test compares bone conduction in both ears?
Weber
Conductive loss lateralizes to which ear, while sensory loss lateralizes to the other?
Conductive = bad ear Sensory = good ear
Which type of tuning fork test compares air conduction (AC) to bone conduction (BC)?
Rinne
What is considered normal on the Rinne test?
AC is greater than BC
What would the Rinne test show if there was conductive loss?
BC is greater than AC
What would the Rinne test show if there is sensorineural loss?
Both AC and BC are reduced, but AC is still greater than BC.
Combined, Weber and Rinne findings compared well to audiology findings with what percentages?
77% sensitivity
86% specificity
With the Weber and Rinne test, which Hz tuning fork should be used?
512 Hz
During the Weber test, where is the tuning fork placed one it has been struck and is vibrating?
on top of the head or mid-forehead
What is the difference between the way the tuning fork is “started” between Weber and Rinne?
Weber - “whack” on rubber
Rinne - pinch
Where is the activated tuning fork placed during the Rinne test? How does the test progress?
Begin on the mastoid until the tuning fork can not be heard, then position the tuning fork just over the ear.
Hearing impairment is a common, chronic condition in which population/age group? What percentage is affected?
Americans aged 65; between 25-40%
Prevalence of hearing impairment increases dramatically with age, what is the percentage of those affected in those over 75 years? What about those older than 85?
40-66%; 80%
What should happen with patients who are unable to perceive the whispered combination?
Referral for formal testing