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Block 6- SHANE > ENT > Flashcards

Flashcards in ENT Deck (57)
1

What are the main features of the tympanic membrane?

posterior and anterior malleolar folds, pars flaccida, umbo, lateral process of the malleus, handle of the malleus

2

Where does the chorda tympani run into the tympanic membrane?

in the upper 1/3 (incisions are always below it in the posteroinferior aspect of the membrane)

3

What equipment should you bring an ear exam?

otoscope, speculum of otoscope tip, and 512 Hz tuning fork

4

What are the standard otoscope tip sizes?

4mm in adults and 2.5 in children

5

Should you use the largest or smallest speculum tip that a patient can handle?

largest

6

Should you start the exam with the health or affected ear? Why?

the healthy to get a better understanding of what is normal to the patient

7

How should the otoscope be held during a hearing exam?

in the hand of the ear being examined and held in a "pen" grip

8

What things should you look for when examining the tympanic cavity?

Is the tympanic membrane smooth or sucked in (retracted)?

Are there any holes?

Are there any deep pockets in the membrane?

9

What is tympanosclerosis?

calcification of the tympanic membrane that causes conductive hearing loss in the ear

10

Where is ear wax created?

ceruminous glands in the outer ear (is aka cerumen).

NOTE: using Q-tips is not recommended and may lead to compaction of the ear wax in the canal

11

How should an otoscope enter the nose?

enter horizontally and then change the angle of the otoscope once inside the nasal cavity

12

T or F. You can assess a patients nasal potency by placing a wooden tongue depressor under their nose

F. you should place a metal tongue depressor under the nose and look for signs of condensation

13

T or F. A pen light is the best source available for a nasal exam

F. A head scope is much better

14

T or F. It is a good idea to give the patient local anaesthetic intranasally before place a nasoendoscope

T

15

T or F. When looking through the nasal cavity while using an otoscope, you can see the inferior turbinate

T

16

The parotid duct is aka?

Stensen's duct (the submandibular duct is aka the Wharton's duct)

17

T or F. The most common place for mouth cancer is the hard palate

F. the common sites for mouth cancer are the retromolar fossa and the floor of the mouth

18

What is a quincy?

A quincy is a collection of pus that develops between the tonsils and the wall of the back of the throat (aka a peritonsillar abscess)

19

What are some risk factors for mouth cancer?

smoking, alcohol, and recreational drugs.

NOT HIV, HOV, lack of fruits and veggies, and betel nut chewing

20

Why do doctors ask patients to say "Ahh'?

elevates the soft palate and allows visualization of the base of the tongue, uvula, tonsillar pillars, and even the hypo pharynx (and to some extent CN IX and X)

21

Cervical lymph nodes are insignificant if what size?

less than 2 cm

22

In the axilla and inguinal regions, what is the max size of a lymph node that will not cause concern?

3cm

23

In the supraclavicular region, what is the max size of a lymph node that ill not cause concern?

1cm

24

What would a lymph node with a soft consistency indicate?

insignficant

25

What would a lymph node with a rubbery consistency indicate?

classically lymphoma

26

What would a lymph node with a hard consistency indicate?

classically malignancy and granulomatous infection

27

Are enlarged inguinal lymph nodes common?

Yes, very are very common. Usually, they are shotty lymph nodes which are small, often hard, lymph nodes that are usually of no clinical concern. The term "shotty" comes from the fact that they have a similar feel to buckshot

28

Why should you test for symmetry in a lymph node exam?

clinically significant nodes are classically asymmetric

29

Are the salivary glands considered lymph nodes?

No

30

How can you distinguish the carotid artery/bulb from lymph nodes?

pulsation

31

What is the most significant area for nodes?

the supraclavicular fossa

32

An enlarged left supraclavicular node (virchow's node) is an indication of what?

abdominal process

33

An enlarged right supraclavicular node is an indication of what?

an intrathoracic process

34

Infraclavicular nodes are an indication of what?

classically breast cancer or malignant lymphoma

35

How are epithrochlear lymph nodes best felt?

by moving fingers up and down. Arm should be relaxed, found right above the olecranon.

36

What do lymph nodes arise from?

some early infection in life

37

A tender lymph nodes would indicate?

classically an infection

38

Classically, a non-tender lymph node would indicate?

malignancy

39

Do patients 2-12 yo commonly present with insignificant lymph nodes in the necks secondary to frequent viral infection?

Yes, it is a normal part of maturation

40

Performing the Exam

Patient should be seated for waste-up lymph nodes. Abnormal lymph nodes are usually not symmetrical so palpate using both hands at the same time. Test post auricular, pre auricular, submandibular, cervical, and supraclavicular nodes.

41

Are posterior auricular nodes typically abnormal?

Yes, you will not typically find any here (same for pre-auricular nodes)

42

Abnormal lymph nodes are usually what shaped?

spherical, normal is flat and oval shaped

43

Are supraclavicular nodes normal?

No, not usually found here. Same with infraclavicular space (breast cancer or lymphoma)

44

Should you be concerned about nodes in the lateral part of the axilla?

No

45

Are there typically inguinal lymph nodes?

Yes, because there are typically infection in that region and they can be palpated

46

Are femoral lymph nodes common?

sometimes, can be felt by rolling the artery

47

Are iliac nodes common?

go over the inguinal ligament into the iliac fossa. They can be

48

Lymph nodes in the abdomen have to be what side before they can be palpated?

5-7cm

49

The first hard structure when palpating down from the chin is what?

top of the thyroid cartilage (will not feel the hyoid bone). Will hit the cricoid cartilage next and then the first two rings of the thyroid

50

The isthmus of the thyroid runs over which two tracheal rings?

2-3

51

Thyroid exam

Get behind the patient. Place the first two digits of both hands just below the cricoid cartilage so that left and right fingers meet on the patient's midline at the 2-3 tracheal rings. Place thumbs posterior to patient's neck and flatten all fingers against the neck. use finger pads, no tips, to palpate. gently draw fingers laterally 1-2 cm and palpate the latter lobes. Ask the patient to swallow

52

What would diffuse enlargement of the isthmus and lateral lobes of the thyroid without nodules indicate?

Grave's disease, hashimoto's thyroid's, endemic goiter

53

What would a single thyroid node indicate?

Cyst, beging tumor, elevates index of suspicion for malignancy.

Assess for rick factors: radiation exposer, hardness, rapid growth, fixation to surrounding tissue, cervical ALD, male, etc.

54

A soft thyroid could indicate?

Graves disease and may have a bruit

55

A firm thyroid could indicate?

Hashimotos, malignancy, and being and malignant nodules

56

A tender thyroid could indicate?

thyroiditis

57

A systolic or continuous bruit may be heard where in relation to the thyroid?

over lateral lobes in hyperthyroidism