HEENT Flashcards
(281 cards)
1
Q
What is the equipment needed for a HEENT exam?
A
- stethoscope
- opthalmoscope
- otoscope (+/- pneumatic bulb)
- snellen or rosenbaum eye chart
- tuning fork (256 Hz vs 512 Hz)
- tongue blade
- cotton tipped applicator
- gloves, gauze
2
Q
ROS Head
A
headache, vertigo, syncope, head trauma
3
Q
ROS eyes
A
visual acuity changes, blurred vision, diplopia, photophobia
4
Q
ROS ears
A
change in acuity, discharge, pain, tinnitus, recurrent ear infections
5
Q
ROS nose
A
obstruction, discharge, epistaxis, pain
6
Q
ROS Mouth
A
toothaches, bleeding gums, sore throat, dysphagia, hoarseness, change in taste
7
Q
ROS neck
A
pain, stiffness, swelling/ masses
8
Q
Normally the head and scapl are
A
normocephaic, atraumatic
9
Q
inspection (face, skull, hair, scalp)
A
- trauma
- symmetry
- skin lesions
- scales
- hair distribution
- etc
10
Q
palpation (face, skull, hair, scalp)
A
- Lumps
- bumps
- tenderness
- lesions
- describe regions based on underlying bone
11
Q
head and scalp percussion
A
sinuses
12
Q
head and scalp auscultation
A
vascular sounds
13
Q
CN visual acuity
A
CN2
14
Q
CN hearing
A
CN8
15
Q
CN EOMs
A
CN3, 4, 6
16
Q
CN facial expression
A
CN 7
17
Q
CN mastication, clench
A
CN5 motor
18
Q
CN sharp/dull face touch
A
CN5 sensory
19
Q
CN soft palate/ uvula “Ah”
A
CN 9, 10
20
Q
CN movement of tongue
A
CN12
21
Q
CN head and shoulder movement
A
CN 11
22
Q
Inspect hair for
A
- lice, nits
- hair loss
- quantity, distribution, texture
23
Q
alopecia areata
A
autoimmune condition causing hair loss “patchy”
24
Q
seborrheic dermatitis
A
- “dandruff”
- greasy
- yellowish
- scaly
- can be on scalp, nasolabial folds, eyebrows, forehead
25
psoriasis
* autoimmune dermatologic condition
* silvery white sharply dermarcated plaques and coarse scale
* can be quite thick, usually not associated with hair loss
26
tinea capitis
* fungal infection of scalp
* scaly patches or plaques with or without inflammation
* kerion- raised boggy secondarily infected fungal lesion of hair
27
inspect face for
* landmarks for asymetry
* lesions, rashes, swelling
* characterisitic "facies associated with disease states
28
acromegaly
* increase of growth hormone
* enlargement of bone and soft tissues
* elongated head with bony prominence of the forehead, nose, and lower jaw
* enlarged nose, lips, and ear soft tissues
* coarsened facial features
29
myxedema
* severe hypothyroidism
* dull, puffy facies
* pronounced edema around the eyes that does not pit with pressure
* dry, coarse, thinned hair and eyebrows
* dry skin
30
neprotic syndrome
* edematous face
* pale
* swelling first appears around eyes in the morning
* slitlike eyes with severe edema
31
cushings syndrome
* increased adrenal hormone
* round moon face
* red cheeks
* excessive hair growth on mustache, sideburn areas, and chin
32
parotid gland enlargement
* chronic bilateral
* may be associated with obesity, diabetes, cirrhosis
* swellings anterior to the ear lobes and above the angles of the jaw
* gradual unilateral enlargement suggests neoplasm
* acute enlargement seen in mumps
33
parkinsons
* decreased facial mobility blunts expression
* mask face
* decreased blinking
* characteristic stare
* neck and trunk flex forward
* patient peers upwards
* oily skin
* drooling
34
palpate bones for
tendernous
35
where do you palpate/ percuss
over maxillary and frontal sinuses
36
Temporomandibular Joint palpation
* palpate joint
* listen and feel for clicks
* check ROM
* open/close, move side to side
* palpate massetere muscles (CN5)
* clench teeth
37
what does the trigmeninal nerve do
* sensory
* opthalmic, maxillary, mandibular
* lightly touch in all 3 areas bilaterally with Qtip
* motor
* palpate masseter muscle, clench teeth
38
how to test CN7
* check for facial symmetry
* wrinkle forehead "raise your eyebrows"
* squeeze eyes shut
* puff out cheeks
* smile- "show your teeth"
39
acromegaly
* excessive growth hormone production
* large hands and feet
* excessive facial bone growth and enlarged jaw
40
bells palsy
* idiopathic facial nerve paralysis causing muscle weakness on one side of face
* difficulty closing one eye
* flattened nasolabial fold
41
how to assess the temporal artery
palpate and ausculate for bruits
42
giant cell (tempora)l arteririts
* adults \>50
* new HA
* jaw claudication
* elevated ESR
* associated condition PMR
43
tarsal plates of eyelids
firm strip of CT
44
meibomian glands of eyelids
sebaceous glands
45
bulbar conjunctiva of eyelids
covers anterior eyeball
46
palpebral conjunctiva
covers inner eyelids
47
visual acquity tests
snellen chart
rosenbaum pocket chart
48
what does 20/200 mean
pt sees at 20 ft what someone with normal vision sees at 200 ft
49
snellen chart screens for
myopia
50
distance that snellen chart tests
20 feet
51
myopia
impaired far vision
52
rosenbaum pocket chart screens for
presbyopia
53
presbyopia
impaired near vision
54
distance that rosenbaum tests at
14 inches; bedside screen
55
for x/y vision, the larger the denominator
the worse the vision
56
when examinating the lacrimal apparatus look for
excess tearing/ dryness
57
when examining the bulbar conjunctiva and sclera, look for
infection, inflammation, icterus
58
when examining the palpebral conjunctiva look for
pallor
59
when examining the pupils look for
* equality and pupillary reaction (direct and consensual)
* convergence
* near-far accomodation
60
when examining the eyes, you assess
* lacrimal apparatus
* bulbar conjunctiva and sclera
* palpebral conjunctiva
* cornea and lens
* pupils
61
PPERRL
Pupils Equal Round Reactive to Light
62
pupil inspection
size, shape, equality
63
miosis
excessive pupillary constriction
64
mydriasis
excessive pupillary dilation
65
ansicoria
pupils are unequal size
66
direct pupillary light reflex
pupil constricts on same side as light when you shine bright light in obliquely
67
consensual pupillary light reflex
pupil constricts in opposite eye of the one one you shine a bright light into obliquely
68
EOMI
extraocular muscles
69
EOMI testing
* tests 6 cardinal directions of gaze
* move fingers through a large H to test EOMs
* ask pt to keep head in meidline and just move eyes
* make sure H is big enough for full ROM
* watch for conjugate (parallel) movements
* pause at upward and lateral gaze to detect nystagmus
* after H pattern, pt follows finger to assess convergence with near vision
70
nystagums
fine rhythmic oscillation of the eyes
71
Near far accomodation testing
* pt focuses on object 10 cm away then an object greater than 6 feet away
* watch for pupillary constriction with near and dilation with distance
* Narrows with Near
* Dilates with Distance
72
corneal light reflection
shine light into pt's eyes and note corneal light reflection
73
corneal light reflection tests for
conjugate gaze
74
extraocular movements
lateral rectus- CN6
superior oblique- CN4
all others- CN3
75
eyelid examination
look for
* edema
* lesions
* width of palpebral fissures
* condition and direction of the eyelashes
* adequacy with which the eyes closes
* ptosis
* incomplete closure
76
Ptosis seen with problem with CN
3
77
incomplete eye closure seen with problem with CN
7
78
chalazion
nontender
meibomian (sebaceous) gland obstruction/ inflammation
points inside lid
79
hordeolum
aka stye
tender, red infection near hair follicles of eyelashes
like pimple or boil poining on eyelid margin
80
which one hurts, chalazion or hordeolum?
hordeolum- it's horrible
81
dacryocystitis
lacrial sac inflammation/ infection
usually secondary to blockage of nasolacrimal duct
sweling b/w base of nose and eye
82
orbital contact dermatitis
ex pt would be 50 yo male went camping and now returned with itchy rash on face
now developed swelling and itching around eyes, right eye more than left
83
periorbital/ preseptal cellulitis
example would be 32 yo with low grade fever, swelling, redness, pain and inability to open L eye
also has increased nasal congestion, facial pressure, and headache x 2 weeks prior to symptoms
no hx or trauma
84
entropion
eyelid inversion
more common in elderly
inward turning of the lid margin
irrititation of the conjunctiva and cornea
85
ectropion
eyelid eversion
margin of lower lid turns outwards
exposes palpebral conjunctiva
more common in elderly
excessive tearing can occur as puncta may not drain effectively
86
pingueculum
yellow trianglular nodule on the bulbar conjucntiva on either side of the iris
harmless
vision WNL
87
pterygium
medial sclera triangular thickening of bulbar conjunctiva that extends from inner canthus to cornea
## Footnote
**may interfere with vision**
88
scleral icterus
yellow discoloration of sclera
elevated bilirubin
jaundiced skin
89
xanthelasma
sharply demarcated yellow deposits of fat under the skin around eyelids
associated with hyperlipidemia
90
viral conjunctivitis
not usually goopy
91
bacterial conjunctivitis
usually goopy
92
types of conjunctivitis
viral, bacterial, allergic, irritant
93
exophthalmos
abnormal protrusion of the eyeball
seen in graves disease (thyroid dysfunction)
94
what causes loss to the lateral 1/3 of eyebrows
thyroid dysfunction
95
episcleritis
central nodule with radiation of vessels
most often associated with systemic disease
occasionally associated with autoimmune conditions
usually self limiting and benign
96
uveitis
aka iritis
red, painful, photophobia, no discharge
causes:
* infectious- herpes and CMV
* autoimmune/ systemic immune- sarcoidosis, juvenile idiopathic arthritis, IBD (Crohns, UC)
* idiopathic
97
subconjunctival hemorrhage
hx of cough, straining, coumadin use (if coumadin use may be more serious and need to review labs)
asymptomatic
self limiting
if recurrent, consider bleeding disorder
98
hyphema
grossly visible blood in anterior chamber
usually secondary to trauma
vision threatening- refer
99
corneal abrasian
can be visualized with fluorescein stain
pt example- 22 yo with R eye foreign body sensation since mowing the lawn
increased photophobia, lacrimation, pain
100
corneal chemical burn
usually pt provids hx of liquid or gas splashed in eye
immediate and prolonged irrigation
101
cataract
clouding, opacity of the lens
causes painless progressive vision loss
risk factors- age, smoking, DM, corticosteroids, ETOH
102
opthalmoscope aperture- small
easier view through non-dilated pupil
103
opthalmoscope aperture- large
view through dilated pupil
104
opthalmoscope aperture- grid
make measurements
105
opthalmoscope aperture- slit
determine elevation or concavity in retina
106
opthalmoscope aperture- cobalt filter
for fluorescein staining to visualize corneal lesions
107
how to do opthalmoscopic exam
darken room
may use small or large round beam of light on scope
do not use maximum light
ask pt to try to keep both eyes open
turn disc to 0 diopters, keep index finger on dial in order to adjust focus as needed
ask pt to look over shoulder at fixed point on wall that is at eye level
R hand, R eye, Pt R eye
L hand, L eye, Pt L eye
approach pt's eye about 15 degrees lateral to pt's line of vision
look for red reflex first- absent red reflex= opacity of lens (cataracts, detached retina, retinoblastoma, artificial eye)
brace yourself with hand on pt's shoulder or brow
move closer to pt's eye almost touching their eyelashes
follow blood vessels centrall to find optic disc (nasal side of fundus)
adjust diopter dial to adjust focus
always compare findings bilaterally
note disc margins, color, size of central cup (cup: disc ration is \< 1:2)
inspect vessels
inspect for hemorrhage exudate, and edema of optic disc (papilledema)
view macula, fovea
108
veins of the eyes are ____ and _____ than arteries
larger and darker
109
eye artery to vein ratio is
2:3
110
how do you view the macula/ fovea
pt looks directly into the the light (temporal)
111
what is the macula/ fovea responsible for
central vision
112
pan optic
larger
increases distance b/w pt and clinician
clinician my use the same eye to examine both of the pt's eyes
most clinicial settings do not have
113
hyptertensive vascular changes- copper wire
vessels get full and tortuous with increased light reflex
coppery luster
114
hyptertensive vascular changes- silver wire
vessel wall becomes too opaque and blood cannot be seen
115
hyptertensive vascular changes- AV nicking
artery-vein nicking
appearance of breaks in vein when artery and vein cross
116
hypertensive retinopathy- cotton wool patches
aka soft exudates
white, gray, ovoid lesions with irregular (soft) borders
caused by infarcted nerve fibers
also seen in DM
117
hyptertensive retinopathy- hemorrhages
caused by microaneurysms
118
diabetic retinopathy
hemorrhages can be seen along with hard exudates
hard (well defined borders) exudates are cream/ yellow and appear bright common with DM and HTN
neovasculation
119
neovascularization
development of new blood vessels arising from the disc and extending to the margins
caused by abnormal permeability and vascular occlusion
more numerous and torturous
120
glaucoma with cupping
increased pressure within eye resulting in abnormal cupping (backward depression of disc)
represents optic nerve damage
normal up to disc ratio is \< 1:2, but in glaucoma the ratio is \> 1:2 because of intraocular pressure
may have an abnormal anterior chamber depth on exam
121
detached retina
curtain like shadow over vision
flashes, floaters, risk of vision loss
122
papilledema
optic disc swelling caused by increased intracranial pressure
pt may have severe HA, nausea, vomiting
123
macular degeneration
observed in the last step of eye exam, normal would have reflection of light
with degeneration there is decreased reflection
degeneration is due to build up of dusen (cellular debris)
124
Specialized vision tests
visual field
cover-uncover
anterior chamber
corneal reflex
lid eversion
125
How to check visual fields
provide sit at same level of pt to ensure similar visual fields
pt closes one eye and looks at providers nose
examiner closes opposite eye to mimic pts visual fiedl
examiner places handto periphery of visual field, checks each eye individually and tests all 4 quadrants
"while looking at my nose, how many fingers am I holding up?"
next provider moves wiggling fingers slowly from periphery (in each quadrant) centrally
"while looking at my nose, please say now when you can see my wiggling fingers"
check all 4 quadrants and each eye individually
then perform the wiggling finger technique, moving fingers peripherally to centrally in each quadrant and pt says "now" when they see the fingers
126
normally what i see on the nasal side
hits the opposite (temporal) side of the retina and stays on the same side
127
normally what i see on the temporal side
hits the opposite (nasal) side of the retina and crosses at the optic chiasm
128
visual field defects- horizontal defect
occlusion of a branch of the cenral retinal artery may cause a horzontal (altitudinal) defect. Shown is the lower field defect associated with occlusion of the superior branch of this artery.
129
visual field defects- blind eye
defect at the optic nerve before the optic chiasm (neither the nasal or temporal sight will make it to the brain)
130
visual field defects- lesion at the optic chiasm
causes defect in both temporal fields (bitemporal hemianopsia)
ex Pituitary tumor
131
visual field defects- lesion on optic tract behind chiasm
produces defects on opposite side
defets on R optic tract causes L homonymous hemianopsia
defect on L optic tract causes R homonymous hemianopsia
ex: stroke, tumor
132
cover- uncover test will test for
muscle imbalance not otherwise seen in general eye exam
you occlude each eye in alternating fashion and observe for change in fixation of the uncovered eye. Also assess for movement of the covered eye after cover is moved
133
when do you do the cover-uncover test
when you see an abnormeal corneal light reflection
134
striabismus
misalignment of the eyes
deviation of the eyes from their normally conjugate position
can be congenital or acquired
one of the most common eye problems in children (4% of children under 6)
check visual acquity if strabismus is detected and refer
135
esotropia
eye turns in medially
a type of strabismus
light will be displaced laterally on affected eye
136
exotropia
eye turns out laterally
a type of strabismus
light will be displaced medially on affected eye
137
hypertrophia
eye turns up
a type of strabismus
138
hypotropia
eye turns down
a type of strabismus
139
anterior chamber depth tests for
increased intraocular pressure
ex glaucoma
140
how to do anterior chamber depth test
shine light from temporal side of patient's eye (towards nose)
look for shadow on the medial aspect of the iris
"crescent shadow"
141
corneal light reflection tests for
ocular alignment
142
corneal reflex tests
CN5 sensory and CN7 motor
143
how to do corneal reflex test
gently touch the edge of the cornea with a rolled cooton and observe for response blink
144
what is this?
alopecia areata
145
what is this?
seborrheic dermatitis
146
what is this?
psoriasis
147
what is this?
tinea capitis
148
what is this?
acromegaly
149
what is this?
bells palsy
150
what are the arrows
green- pupil
gray- medial canthus
blue- limbus- where the bulbar conjunctiva merges with cornea
orange- lateral canthus
151
what are the arrows
green- lacrimal gland
black- lacrimal sac with puncta
blue- nasolacrimal duct
152
what is this?
chalazion- nontender
153
what is this?
hordeolum- painful
154
what is this?
dacrycocytis
aka lacrimal sac inflammation
155
what is this?
orbital contact dermatitis
156
what is this?
periorbital/ preseptal cellulitis
157
what is this?
entropion
158
what is this?
ectropion
159
what is this?
pingueculum
160
what is this?
pterygium
161
what is this?
scleral icterus
162
what is this?
xanthelasma
163
what is this?
viral conjunctivitis
164
what is this?
bacterial conjunctivitis
165
what is this?
exophthalmos
166
what is this?
episcleritis
167
what is this?
uveitis aka iritis
painful
168
what is this?
subconjunctival hemorrhage
169
what is this?
hyphema
170
what is this?
corneal abrasion with fluorescein stain
171
what is this?
corneal chemical burn
172
what is this?
eye puncture
173
what is this?
cataract
174
what is this?
hemorrhages- hypertensive retinopathy
175
what is this?
hypetertensive retinopathy
176
what is this?
creamy exudates in diabetic retinopathy
177
what is this?
a normal fundus
178
what is this?
fundus with neovascularization from diabetic retinopathy
179
the one on the left is a normal fundus, what is the one on the right
fundus with cupping from glaucoma
abnormal optic nerve
180
what is this?
detached retina
181
what is this?
papilledema
182
what is this?
macular degeneration
183
what is this?
blind right eye- right optic nerve lesion
184
what is this?
bitemporal hemianopsia- optic chiasm lesion
185
what is this?
left homonymous hemianopsia
right optic tract lesion
186
what is this?
crescent shadow from abnormal intraocular pressure
187
we inspect the ear for
deformities, lesions
188
we palpate the ear
the pinna, the tragus, and the mastoid for tenderness
example- otitis externa causes pain when there is movement of the helix and tragus
189
the length of the external auditory canal is
24 mm ending in the tympanic membrane
190
gouty tophi
deposit of uric acid crystals that occurs aftery years of chronically elevated uric acid
191
what is this?
gouty tophi
192
basal cell carcinoma
raised nodule with central telangiectasia
193
squamous cell carcinoma
crusted border with central ulceration and bleeding
194
what is this?
basal cell carcinoma
195
what is this?
squamous cell carcinoma
196
how do you do a gross hearing test
rub fingers together by each ear
if hearing is reduced you need to distinguish between conductive hearing loss and sensorineural hearing loss
197
conductive loss
problme conducting sound waves (EAC, TM or middle ear)
**abnormality is usually visible**
198
sensorineural hearing loss
disorder of the inner ear
cochlear nerve impairs transmission of nerve impulse to the brain
**problem is not visible**
199
specialized tuning fork test- weber
tests for
lateralization
200
specialized tuning fork test- rinne
tests for
compares air conduction to bone conduction
201
air conduction
sound transmitted through the air (EAC --\> TM --\> middle ear) into cochlea
202
bone conduction
sound transmitted through vibrations in bone
bypass external and middle ear
vibration of the **SKULL** stimulates the inner ear directly
203
normally which is greater, air or bone conduction?
AC
204
with conductive hearing loss which is greater, air or bone conduction
BC
205
with sensorineural hearing loss, which is greater, air or bone conduction
air
206
how to do a weber test
* place the vibrating tuning fork on top of the pt's head and ask where they hear the sound, L, R, or both
* normally they should hear sound in both ears equally
* unilateral conductive loss- the sound lateralizes (is heard best) to the impaired (bad) ear
* ex: otitis media, perforation, cerumen, otoscerlosis
* unilateral sensorineural loss- the sounds lateralizes (is heard best) to the good ear because the bad ear cannot trasmit the impulse.
* there is no signal transduced by the cochlea on the affected side
* caused by damage to the inner ear
* ex: presbycusis (age related hearing loss), noise exposure, head trauma
207
weber test sound lateralizes to impaired ear
conductive hearing loss
208
weber test sound lateralizes to good ear
sensorineural loss
209
damage to inner ear causes
sensorineural loss
210
how to do a rinne test
place tip of vibrating tuning fork on mastoid bone
ask pt if they can hear it, have them tell you when the sound stops
move tuning fork in front of ear, ask if they can still hear it
if they **CAN** then AC \> BC, therefore a normal test
211
in a rinne test, normal is
AC \> BC
212
in a rinne test, with BC \> AC, you would have
unilateral conductive loss
the sound hear through bone is longer than through air
in the impaired ear BC \> AC but in the good ear AC\> BC
213
in a rinne test with AC \> BC, you would have
a normal result **OR** unilateral sensorineural loss
unilateral sensoriuneural loss the sound is heard longer through air because AC and BC are reduced equally and the normal pattern prevails
AC \> BC in both ears
214
where is the loss? if it lateralizes (sound is heard best) to the damaged ear it is
conductive loss
215
where is the loss? if it lateralizes (sound is heard best) to the good ear it is
sensorineural loss
216
how to do an otoscope exam of the ear
brace yourself with 1 or 2 fingers against patients head
pull auricle (pinna) upward and back and insert otoscope slightly down and forward
in infants pull auricle down and back
inspect EAC for cerumen, lesions, foreign body, d/c
inspect tympanic membrane for redness, retraction, bulging, perforations, scarring
217
the middle ear anatomy
air filled, there is a cone of light (light reflection) located in the anterior inferior quadrant of the tympanic membrane
bony landmarks- malleus and umbo (visible)
218
pneumatic otoscopy is used to test
tympanic membrane (TM) mobility
see if there is serous OM or TM perforations
219
how to do pneumatic otoscopy
speculum large enough for a snug fit
gently squeeze bulb to send a puff of air against the TM- normally the TM would move inwards, if no movement then thre is effusion
220
tympanosclerosis
chalky white patch of scarring on the TM
caused by recurrent otitis media or hx of tubes or previous perforation
221
what is this
TM perforation
222
what is this?
tympanosclerosis
223
what is this?
bulging erythematous TM consistent with acute otitis media
224
what is this?
foreign bodies in the ear
225
what is this?
serous effusion with air bubbles
usually caused by viral URI or barotrauma
eustachian tube dysfunction often involved
symptoms include- fullness in ear, popping in ear
226
what is this?
myringotomy tube
usually remains in ear for 6-12 months
usually falls out on own
used for: repeat bouts of OM, persistent effusion, hearing loss
227
what is this?
bullous myringitis
painful hemorrhagic vesicles
+/- hearing loss during infection
228
what is this?
otitis externa
infection of the EAC
notice the drainage and edema of the canal
tenderness and movement of the tragus and pinna
229
what do the turbinates do
clean, humidify and warm air
230
what is the meatus
groove below each turbinate
231
what does the inferior meatus drain
nasolacrimal duct
232
what does the middle meatus drain
the paranasal sinuses
233
we inspect and palpate the external nose/ nasal bridge
to evaluate for asymmetry, deformities, tenderness
234
how do you test for nasal patency
ask pt to occlude one nostril and sniff
235
how to do a nasal speculum exam
gently insert speculum into nose
avoid touching septum and turbinates
use light source
inspect internal nasal septum, mucosa, turbniates
look for septal deviation or perforation, inflammation, polyps, d/c
236
to transilluminate frontal sinus, place the light
below the brow and look for glow (normal)
237
to transilluminate the maxillary sinus place the light
agains the cheek bone below the eye and look for glow on the hard palate (normal)
238
what is this
septal deviation
symptoms- nasal obstruction, headache, change in smell
see spurs and crests
239
what is this?
septal perforation
seen with trauma, infection, cocaine, s/p surgery
symptoms- crusting, epistaxis
small lesions may whistle
240
what is this?
nasal polyps
soft, translucent growths
can cause nasal obstruction
anosmia
241
what is this?
foreign body
242
what is this?
septal hematomas
seen following trauma
more common in peds pts
symptoms- increased nasal obstruction, pain, tenderness
PE: **soft, tender, swelling**
must rule out septal hematomal in all nasal trauma and document
243
what is this?
epsitaxis
highly vascular region of the anteroinferior nasal septum
90% of all epistaxis occur in the kiesselbachs plexus/ area
244
why do you get these?
rhinitis and sinusitis
245
why would you have swollen, pale, blue, boggy turbinates
allergic rhinitis (AR)
also would have shiners and eye Sxs
246
why would you have erythematous turbinates
sinusitis and URI
also drainage- mucoid vs. clear vs. purulent
247
why would have you tendernous to palpation of sinuses
sinusitis
248
anatomy of the mouth and pharynx
lips, tongue, buccal mucosa, 32 adult teeth, gingiva, tonsils, anterior/posterior pillars, hard & soft palate, uvula, whartons duct (drains submandibular gland), stensons duct (drains parotid gland)
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how to examine oropharynx
inspect lips, teeth, gingivae, buccal mucosa, floor of mouth, hard & soft palates, tongue, tonsils, pillars, and posterior orpharynx for **color, symmetry, lesions**
inspect palate and uvula
CN 9 and 10- ask pt to say "Ah", gag reflex, consider wetting tongue blade if pt has a sensitive gag reflex
palpation- bimanually
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examine salivary glands
palpate for masses
parotid- stensons duct- buccal mucosa lateral to molars
submandibular- whartons ducts- floor of mouth under tongue
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ask pt to stick out tongue and move it side to side; assesses function of CN\_\_
12
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bimanual exam of oropharynx
palapate oropharynx with gloved hand
palpate wall of mouth between internal and external fingers (what bimanual means)
feel floor of mouth, tongue for masses, induration
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how to extend lateral margins of tongue
wearing gloves, use gause to grasp the tip of tongue
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what is this?
squamous cell carcinoma
when doing an oral exam, look for sores that dont heal and newly formed lesions
consider risk factors
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what is this?
angular cheilitis
irritation, fissuring of the skin at the corners of the mouth associated with ill fitting dentures, vitamin deficiency, and excessive salivation
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what is this?
oral candidas (thrush)
white patches or plaques on the tongue or bucacl mucosa
uncommon among healthy adults
**can brush away**
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what is this?
leukolplakia
potentially premalignant
differentiated by thrush by **inability to remove white area**
referral for biopsy recommended
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what is this?
oral carcinoma
through physical exam is necessary
majority of oral cancer is SCC
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what is this?
torus palatinus
benign, midline mass of the palate
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what is this
gingivitis
causes changes to the gums
* redness
* bleeding
* edema
* tenderness
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what is this?
gingival hyperplasia
can be caused by medication such as dilantin (phytoin), cyclosporine, Ca channel blockers
can also be caused by poor dental hygiene and pregnany
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what is this?
tonsillar hypertrophy
numerous tonsilar crypts
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what is this?
hairy tongue
benign condition
defect in desquamation of papillae
many causes- Abx, tea, coffee, tobacco use
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what is this?
fissured tongue
multiple small grooves on the dorsum of tongue
benighn
increasing incidence with advanced age
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what is this?
geographic tongue
dorsum of tongue shows smooth areas void of papillae
benign
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what is this?
bilateral exudative tonsilitis
could be caused by Group A strep OR mononucleosis (Epstein Barr virus)- determine diagnosis by strep screen/ culture and mono screen
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strep A
ex pt: worsening sore throat x 2 days, fever of 102, n/v, 3 friends with similar Sxs, no cough, nasal congestion, fatigue
bilateral exudative tonsilitis and cervical LAD
diagnosed determined by pos strep screen/ culture
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mononucleosis
ex pt- sore throat x 5 days, fever 101, fatigue, tender anterior and posterior cervical LAD
bilateral exudative tonsilitis
slight splenomegaly
diagnosed by negative strep screen, positive mono screen
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what is this?
peritonsillar abscess
unilateral peritonsillar swelling and shifted uvula
infections spreads into the peritonsillar space
drooling
hot potato voice
very sore
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anatomy of neck
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how to examine the neck
inspect while observing the patient swallowing
look for symmetry, masses, scars, nodes, tracheal position, thyroid
evaluate ROM- flexion, extension, rotation, lateral bending
evaluate motor function of CN 11 and strength
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how to evaluate motor fxn of CN11 and strength
lateral rotation of neck against resistance
shoulder shrugging against resistance
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examination of the trachea
inspect for deviation from midline- deviation may suggest mediastinal mass/ pneumothorax
palpate and assess mobility
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label these lymph nodes
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how to examine lymph nodes
use pads of your index and middle fingers
neck should be relaxed
can examine one side or both sides at once
note size, shape, consistency, mobility or tenderness of nodes
shotty (small, mobile, nontender) nodes are common in children
supraclavicular LN may suggest metastasis from lung or GI cancer
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how to do a carotid artery exam
auscultate each carotid, listening for "bruits" (signs of turbid arterial blood flow... whooshing)
palpate the carotid arteries using gentle pressure and only one side at a time
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examine the thyroid
inspect for enlargement, asymmetry from the front
from the posterior or anterior, place fingers below cricoid cartilage on each side of the neck
palpate the isthmus and each lobe
ask pt to swallow, feel for gland rising beneath fingers, note size, shape, and consistency
note any masses, nodules, or tenderness
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goiter
an enlarged thyroid aka thyromegaly
can be present in multiple forms of thyroid dysfunction
remember to palpate the thyroid while pt swallows
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what do you do if they have an enlarged thyroid?
auscultate
listen over the lateral lobes to detect a bruit
bruits may be present in hyperthyroidism or toxic multinodal goiter
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tracheal deviation
trachea shifts to one side or other because of goiter pnueumothorax, or tumor
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what is this?
JVD- jugular venous distension
caused by cardiac and pulmonary dx
blood flows backwards from right atrium into the jugular veins
