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Flashcards in Head and Neck Exam Deck (20):
1

Inspection Points on Head

(5 regions, 2/2/2/2/4 specifics)

 

  1. Hair - distribution, quantity
  2. Scalp – scaling, nevi
  3. Skull – size, contour
  4. Face – expression, contours
  5. Skin – color, pigmentation, hair distribution, lesions
     

2

Head Palpation

(4 regions, what to look for in each)

  1. Hair -  texture
  2. Skull – lumps
  3. Face – sinuses
  4. Skin – texture, temperature

3

External Ear Canal Inspection

(2 regions 8/4 specifics)

Pinna

  1. size 
  2. position
  3. deformity
  4. inflammation
  5. symmetry
  6. nodules
  7. scars
  8. lesions

External Auditory Canal, for presence of ear discharge 

  1. color
  2. consistency
  3. clarity
  4. presence or absence of any odor

4

Palpation, External Ear

(3 regions)

Check for tenderness, nodules, and pn

  1. Pinna
  2. Perauricular area
  3. Mastoid process

5

Auditory Acuity Testing

(list 3 tests)

  1. Whisper Test
  2. Weber Test
  3. Rinne Test

6

Whisper Test

(function, 5 step process)

Function: assessment of hearing impairment

Procedure:

  1. Have patient occlude one ear.
  2. Stand 1-2 feet behind patient, softly say “ninety-four” or “baseball”
  3. Ask patient to repeat what you whispered into the non-occluded ear. 
  4. Repeat on other ear.
  5. If patient can’t hear increase the volume of your voice until it is heard

7

Weber Test

(purpose, 2 step procedure, result interpretation)

Purpose: assess seound lateralization

Procedure:

  1. Place the base of the tuning fork on midline of the patient’s skull
  2. Ask the patient if they hear the sound louder on one side or if it is equal on both sides

Results:

  • Normal hearing = no sound lateralization, patient hears sound or feels vibration in middle
  • Conductive hearing loss = sound lateralization to AFFECTED ear
  • Sensorineural hearing loss = sound lateralization to NON-AFFECTED ear

8

Rinne Test

(purpose, 3 step process, results)

Purpose: assess air vs. bone conduction in the auditory system

Procedure

  1. Apply the base of the tuning fork against the patient’s mastoid process until they no longer hear the sound
  2. Place it, still vibrating, next to the patient’s ear canal
  3. Repeat with opposite ea

Results:

  • normal = air > bone conduction
  • conductive hearing loss = bone > air conduction

9

Otoscopic Exam

(2 structures, 4/6 specifics)

Auditory meatus

  1. Foreign body
  2. Cerumen
  3. Inflammation
  4. Discharge

Tympanic Membrane (see chart)

A image thumb
10

External Nose Inspection

(5 points to note)

  1. Swelling
  2. Trauma
  3. Deviation
  4. Congenital abnormalities
  5. Nare symmetry (have pt extend neck)

11

Palpation, External Nasal Exam

(2)

  1. Test airway patency: occlude one nostril and ask the patient to sniff then exhale and look for mirror fogging or movement of cotton wisp
  2. Palpation of sinuses: frontal and maxillary

12

Internal Nasal Exam

(3 regions to observe c 6/3/2 specifics)

Mucosa –

  1. color
  2. swelling
  3. bleeding
  4. exudate
  5. ulcers
  6. polyps

Septum –

  1. deviation
  2. inflammation
  3. perforation

Turbinates – use otoscope to view middle and inferior turbinates

13

What structure is not visible in the nose during otoscopic exam?

Superior tubercle 

14

Mouth/Pharynx Observation

(6 regions, descriptors of each)

  1. Lips - Note color, moisture, lumps, ulcers, cracking, or scaliness
  2. Oral mucosa - Note color, ulcers, and nodules
  3. Gums and teeth - Note color, presence, and position of teeth
  4. Roof of mouth - Note color
  5. Tongue and floor of mouth - Note color and texture, ulcers, nodules
  6. Pharynx: soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx
    • Note color, symmetry, presence of exudate, swelling, ulceration, or tonsillar enlargement

15

Neck Inspections

(3 general, 2 regions)

General:

  1. Masses
  2. Scars
  3. "Enlarged glands," lymph nodes

Trachea:

  1. Position
  2. Alignment 

Thyroid gland:

  1. Symmetry 

16

Palpation, Neck

Palpate the following lymph nodes for size, shape, delimitation, mobility, consistency, and tenderness:

  1. Preauricular
  2. Posterior auricular
  3. Occipital
  4. Tonsilar
  5. Submandibular
  6. Submental
  7. Superficial cervical
  8. Posterior cervical
  9. Deep cervical chain
  10. Supraclavicular

A image thumb
17

Thyroid Gland Palpation

(7 steps)

  1. Flex neck slightly forward
  2. Place fingers of both hands with index fingers just below the cricoid cartilage
  3. Ask patient to swallow; feel for the thyroid isthmus rising up under your finger pads (not always palpable)
  4. Displace trachea to the right and palpate laterally for the right lobe of the thyroid
  5. Repeat on the left side
  6. Note the size, shape, and consistency, identify any nodules or tenderness
  7. If enlarged, listen over lateral lobes to detect a bruit

18

Central Venous Pressure Estimatino

(

  1. Position the patient supine with the head of the table elevated 30 degrees.
  2. Use side lighting to observe for venous pulsations in the neck
  3. Sternal angle is used as a reference point, RA is approximately 5-7 cm lateral and inferior to this point
  4. Estimate the height of the external jugular venous column in reference to the sternal angle
    • Normal venous column should be no more than 2-3 cm above the sternal angle
  5. If the measurement is 4 cm or greater, central venous pressure is elevated

A image thumb
19

Carotid Pulse Assessment

(1 Procedural tip, 2 types of results)

Procedural Tip: Avoid compressing both carotids at same time, this could cause syncope, or lead to bradycardia

Assess the amplitude of the pulse:

Small, thready or weak pulse in cardiogenic shock

Bounding pulse in aortic insufficiency

20

Bruits Auscultation

(4 steps)

  1. ​Choose to auscultate for bruits - middle aged/elderly pts and anyone suspected of arterial narrowing, in order to assess risk of embolic stroke
  2. Place the bell of the stethoscope over each carotid artery in turn.
  3. Ask the patient to stop breathing momentarily.
  4. Listen for a blowing or whosshing sound--a bruit. Do not be confused by heart sounds or murmurs transmitted from the chest.