Head&Neck, EENT

Question 1

*****8 elements to look for?

LQSDT, CMA

Answer 1

• Location
• Quality - (nature of the pain - sharp, dull, acute, chronic?)
• Severity - (scale 1 – 10)
• Duration - (How long has the problem been an issue?)
• Timing - (worse in am/pm? Constant?)
• Context - (any precipitating factors?)
• Modifying Factors - (Does pt. do anything to improve the problem?)
• Associated Signs and Symptoms - (ex. N/V?

Question 2

** Bones immovable except for ______at_______
Note any______
• Crepitation =_____or _______
• Clicking or locking =_________

Answer 2

mandible; TMJ
limited ROM
RA or OA
Displaced cartilaginous meniscus

Question 3

**Skull supported by cervical vertebrae_______

• C7 is the

Answer 3

C1 – C7

important palpable landmark for Stellate ganglion block

Question 4

**Face 2 main things

Answer 4

Expression 
Symmetry ( should be symmetrical)

Question 5

****Asymmetry may indicate:

Answer 5

Central brain lesion - CVA

• CN VII – Bell’s palsy

Question 6

*****Bell’s Palsy is paralysis of facial nerve

Answer 6

VII

Question 7

****Edema in the face shows______and _______

why?

Answer 7

first periorbital and cheeks

Sub-Q tissue here is loose and will accumulate fluid more readily)

Question 8

*****Facial Sensations mediated by______

Answer 8

3 branches of Trigeminal Nerve

Question 9

**3 pr. Salivary glands, what are they ? Which gland indicates ___or ______

Answer 9

Parotids (not normally palpable) (swelling = mumps or AIDS)
Submandibular
Sublingual

Question 10

****Temporal Artery: where

Answer 10

Palpable anterior to ear

• Temporal Arteritis

Question 11

***Assess for NECK

Answer 11

- Symmetry (tilt = spasm)
• ROM
• Lymph Nodes
• Trachea
• Thyroid

Question 12

**Neck Flexion normal degree

Answer 12

85

Question 13

*****Neck EXTENSION normal degree

Answer 13

70

Question 14

**To assess ROM ask patient

Answer 14

• touch chin to chest
• Turn head to right And left
• Touch each ear to shoulder (w/o elevating shoulder)
• Extend head backward

Question 15

• **Note For Neck look for
• ***1.__________
• **2. ______May indicate ______or _______of neck______
• **3. _____ and _____symptoms may indicate _____

Answer 15

Note **pain at any particular movement.

• ***Pain and ratchety movement or limitation may indicate cervical arthritis or inflammation of neck muscles.
• ***(Nuchal rigidity w/ flu-like symptoms may indicate meningitis)

Question 16

*****When nodes are abnormal, check

Answer 16

the area they drain for source of problem.

Question 17

To assess lymph nodes

Answer 17

Finger pads

Gentle pressure

Question 18

• ***To palpate use____ and_______with _____
• **Begin with ______
• ***Palpate with _______
• ***For deep cervical chains_______
• ***For supraclavicular nodes______

Answer 18

• gentle pressure and circular motion with fingerpads.
• Begin with preauricular nodes and work systematically.
• Palpate with both hands to compare symmetry.
• For deep cervical chains, tip pt. head toward side being examined. (Fig. 1)
• For supraclavicular nodes, have pt. hunch shoulders forward (Fig. 2)(NOTE: omohyoid muscle crosses triangle here, don’t mistake it for a node)

Question 19

***Acute infx = WET FFM

Answer 19

nodes bilateral, tender,

enlarged, warm, firm, freely movable.

Question 20

**Chronic inflammation/TB =

Answer 20

nodes clumped.

Question 21

**Cancerous nodes =FUHN

Answer 21

FUNH Fixed, Unilateral, Non-tender, Hard

Question 22

**HIV nodes =

What is common in HIV infection ?

Answer 22

FENM: FIRM, Enlarged, Nontender, Mobile. (Occipital node enlargement common in HIV.)

Question 23

**Trachea is PUSHED toward unaffected unaffected side w/: side w/: in 4 conditions
PATT

Answer 23

• Aortic aneurysm
• Tumor
• Thyroid lobe enlargement
• Pneumothorax

Question 24

****Trachea is PULLED toward affected side w/: LPF

Answer 24

• Large atelectasis
• Pleural adhesion
• Fibrosis

Question 25

*****Tracheal TUG downward synchronous with systole w/:

Answer 25

• Aortic Arch aneurysm

Question 26

*****Normal thyroid | • Note any TEN

Answer 26

- difficult to palpate. | Tenderness Enlargement, Nodular lump.

Question 27

*****Auscultate thyroid if enlarged for_______which indicates _____

Answer 27

bruits (indicates hyperthyroidism).

Question 28

Pupil Light Reflex

Answer 28

• Tests afferent CN 2 & efferent CN 3

Question 29

*****When assessing eyes (FURI)

Answer 29

``` Note any Fixation or lack of Irregular shapes, Response to light. Unequal sizes, ```

Question 30

*****Asymmetric response indicates during _____Indicates _______

Answer 30

Accomodation ; CN 3 damage;

Question 31

What does asymmetry indicate with corneal light reflex? | WHAT SHOULD YOU DO NEXT?

Answer 31

• Asymmetry indicates DEVIATION SECONDARY TO MUSCLE WEAKNESS or PARALYSIS – if present, do Cover Test

Question 32

Cover Test detect

Answer 32

Detects small degree of deviated alignment by blocking FUSION REFLEX

Question 33

****Cover test weaknesses 2, WHAT ARE THEY? DEFINE

Answer 33

* Phoria = mild weakness when fusion is blocked | * Tropia = severe weakness that is constant

Question 34

*****Uneven eye movement or failure to follow =

Answer 34

EOM weakness or CN dysfunction

Question 35

*****Nystagmus INDICATES

Answer 35

semicircular canal ds., paretic eye m., MS or brain lesion

Question 36

****Lid lag INDICATES

Answer 36

hyperthyroidism (normally upper lid always overlaps top of iris)

Question 37

***Optic disc is most__________ | Normal color =

Answer 37

``` prominent landmark (nasal side) Yellow-orange to pink ```

Question 38

****Optic disc Pallor =

Answer 38

CN 2 atrophy

Question 39

****Optic disc Hyperemeia

Answer 39

methanol poisoning

Question 40

Shape of Optic disk | • Irregular =

Answer 40

Glaucoma

Question 41

*****Margins Normal_____ • Blurred margins =______Which indicates _______

Answer 41

Sharp | papilledema = ↑ ICP

Question 42

****Retinal vessels

Answer 42

Arteries are smaller(2:3), brighter red and have arterial light reflex

Question 43

****Retinal Vessel Pathologies | • Absence of major vessels =

Answer 43

occlusion of retinal artery (absence of major vessels)

Question 44

*****Retinal Vessel Pathologies• Constricted arteries =

Answer 44

↓ RBF (retinal blood flow)

Question 45

****“Nicking” at A-V crossing indicates

Answer 45

HTN or arteriosclerosis

Question 46

****Extreme tortuosity or dilated veins indicates

Answer 46

Venous occlusion

Question 47

Note any______/______of canal indicates

Answer 47

redness/swelling otitis externa

Question 48

*****Basal skull Fracture associated with

Answer 48

Frank blood or clear watery drainage (CSF) secondary to trauma

Question 49

****Tympanic membrane Drum should _____not _______or _______ What indicates serous otitis media RED?

Answer 49

* Drum s/b flat, not retracted or bulging (cone of light) * Bubbles or Air/Fluid level behind drum OR Yellow-amber color = serous otitis media * Red = acute otitis media

Question 50

****WEBER Conductive (WCP) hearing loss

Answer 50

Sound lateralizs to POORER ear, poorer ear not distracted by background noise, has a better chance to hear BONE CONDUCTED SOUND; EX : Transient conductive loss with otitis media, serous or purulent

Question 51

****WEBER: Sensorineural loss (WSB)

Answer 51

Sound lateralized to "better" ear or UNAFFECTED EAR. Poor ear is unable to PERCEIVE SOUND .

Question 52

****Rinne Test normal (AC>BC)

Answer 52

Sound is heard twice as long by air conduction as by bone conduction , a POSITIVE RINNE AC>BC

Question 53

Rinne Test Conductive hearing loss (AC

Answer 53

Person hears as long by bone conduction (AC=BC) or even longer (AC

Question 54

Rinne Test Sensorineural loss (AC>BC lower) | what is the normal ratio?

Answer 54

normal ratio of AC> BC , but is reduced overall. Person hears poorly both ways.

Question 55

Grade

Answer 55

1 normal • 2 halfway between tonsillar pillars and uvula • 3 touching uvula • 4 touching each other

Question 56

Koplik spots may indicates

Answer 56

Measles