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Flashcards in head + neck Deck (44)
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1

inspection of face, head and neck

expresssion
symetry
swellings/pulsations
hair - distribution, loss
shape of face + skull
scars
skin - rashes, acne, blisters, vitiligo
movements - weakness

2

inspection of eyes

lid lag
proptosis --> Grave's
eyemovements
sclera - jaundice, anaemia

3

inspection of skull and face

facial symmetry
features of Cushing's e.g. moon face
features of acromegaly e.g. large skull, coarsened features, bitemporal hemianopia

4

inspection of nose

observe nasal pyramid
any discharge
block one nostril with thumb and assess airlfow in other then switch
elevate tip of nose to inspect nasal vestibule with otoscope

5

inspection of ears

inspect pinna: nodules, lesions, redness, swelling, scars
inspect mastoid region: redness, swellings, scars
external auditory meatus for discharge

6

what look for during auriscope examination of external auditory canal

excess ear wax --> conductive hearing loss
redness + oedema --> otitis externa
discharge --> otitis externa/media
foreign bodies

7

what look for during auriscope examination of tympanic membrane

colour (red = inflammation)
shape - should be relatively flat
light reflex - cone of light

8

causes for buldging and retracting tympanic membrane

buldging: increased middle ear pressure e.g. otitis media with effusion

retraction: reduced middle ear pressure e.g. URTI

9

where should light reflex be seen on left and right tympanic membranex

L ear: 7-8 o'clock

R ear: 4-5 o'clock

10

what would cause absence/distortion of tympanic membrane light reflex

otitis media

11

palpation of skull + face

mastoid processes
orbital margin - note irregularilty
temporal arteries for tenderness
maxilla and mandible
TM joint - open/close and side to side

12

palpation of nose

nasal cartilages and bones to check alignment and tenderness

paranasal air sinuses for tenderness

13

palpation of ears

pull pinna
mastoid process

14

whispered hearing test

stand 60cm away and rub tragus of oppposite ear
in normal sound level speak out some numbers and get patient to repeat after you
then do again but whisper

repeat both ears

15

rinne's hearing test

hold tuning fork infront of ear and then behind it on mastoid process

ask patient where they heard it louder - infront or behind ear

16

positive (normal) Rinne's

air conduction > bone conduction

17

negative Rinne's

bone conduction > air conduction

conductive deafness

18

Weber's test

place activated tuning fork on patient's forehead

it is heard equally in both ears or heard louder in one side

19

normal Weber's test result

heard equally in both ears

20

Weber's result indicating senosrineural deafness

heard louder on side of intact/normal ear

21

weber's result indicating conductive deafness

sound louder on side of affected/abnormal ear

22

inspection of mouth

lips: cyanosis, angular stomatits
mouth: dentition, hard + soft palates, cheeks, parotid duct, oropharynx, tongue, tonsils, underside tongue, frenulum
bite

23

inspection of neck

scars
swelling
lump: size, shape, skin changes
movement with tongue protrusion: get them to stick out tongue
movement with swallowing: give them sip of water

24

palpation of neck

tracheal positions
swellings + lymph nodes in Z shape

25

what needs to be talked about if lump/swelling found in neck

mobile?
cystic? (compressible)
vascular? (pulsatile)
nodular? (hard)
midline? thyroid swelling/thyroglossal cyst
lateral? anterior or posterior triangle?
if node then which clinical level

26

level of lymph neck nodes: I

submental/submandibular

27

level of lymph neck nodes: II

upper deep cervical

28

level of lymph neck nodes: III

mid deep cervical

29

level of lymph neck nodes: IV

lower deep cervical

30

level of lymph neck nodes: V

posterior triangle