Head, Neck, and Ear Exam Flashcards

These flashcards cover key concepts and techniques related to the head, neck, and ear examination, as outlined in the lecture notes.

What are the two triangles defined by the sternocleidomastoid muscle in the neck exam?

The Anterior Triangle and the Posterior Triangle.

What anatomical landmark should be inspected when assessing for neck vessel visualization?

The angle of the patient's neck.

What are the two distinct paired salivary glands located near the mandible?

Parotid gland and Submandibular gland.

What is the significance of the thyroid gland inspection during a neck exam?

To check for enlargement (goiter) and observe movement upon swallowing.

What does a + Tug test indicate in ear examination?

It suggests otitis externa or other underlying ear issues.

What leads to conductive hearing loss?

Disorders affecting the external and middle ear, such as cerumen impaction or middle ear infection.

What is the normal finding of the Rinne test?

Air conduction is greater than bone conduction (AC > BC).

What structures are palpable midline in the neck?

Hyoid bone, thyroid cartilage, cricoid cartilage, tracheal rings, thyroid gland.

What does nystagmus refer to in ear examinations?

Involuntary eye movement, often associated with vestibular disorders.

What should be noted when palpating lymph nodes in the neck?

Size, shape, delimitation, mobility, consistency, and tenderness.

What are the key anatomical landmarks used to document the physical exam of the head, neck, and ear?

Skull, facial bones, salivary glands, SCM, trapezius, clavicle, thyroid and cricoid cartilages, trachea, thyroid gland, and ear structures.

What information is most pertinent in the history for head, neck, and eye complaints?

Onset, location, duration, associated symptoms (pain, swelling, visual changes, dizziness), trauma, infection, or systemic symptoms.

What is proper technique for examining the head, neck, and eyes?

Inspect

Palpate

Auscultate

Assess ROM

Document findings clearly (symmetry, tenderness, lymph nodes, thyroid, etc.).

How should you document a normal exam of the head, neck, and eyes?

“Head: normocephalic, atraumatic. Eyes: PERRLA, EOMI, sclera clear, conjunctiva normal. Neck: no lymphadenopathy, thyroid normal, trachea midline.”

What anatomical landmarks are important when documenting the ear, nose, and throat exam?

External auditory canal, TM, nasal septum, turbinates, tonsils, uvula, and oropharynx.

What are key historical questions for ear, nose, and throat complaints?

Hearing loss, pain, discharge, vertigo, nasal obstruction, congestion, sore throat, recent infection, and medication use.

At what angle of inspection is it best to visualize neck vessels?

30 degrees (head elevated while supine).

What are key differences between a lymph node and a gland?

Nodes: small, smooth, ovoid, mobile. Glands: larger, lobulated, irregular, less mobile.

What are some causes of tracheal deviation?

Pulled toward affected side: atelectasis, pneumonectomy, fibrosis. Pushed away: pneumothorax, pleural effusion.

Which group of lymph nodes is often inaccessible on exam?

Deep cervical chain.

What part of the ear interprets rotational movement?

Semicircular canals of the inner ear.

What is the Rinne test, and what is a normal finding?

Compares air vs bone conduction. Normal: AC > BC (2:1 ratio).

Which artery passes upward in front of the ear?

Superficial temporal artery.

What facial signs are characteristic of Cushing syndrome?

“Moon” face, red cheeks, hirsutism (mustache, sideburns, chin).

What causes nephrotic facies and what does it look like?

Glomerular disease

pale, puffy face, periorbital edema, pitting.

Describe myxedema facies.

Dull, puffy face with non-pitting edema, especially around eyes; caused by hypothyroidism.

What are the features of parotid gland enlargement?

Swelling anterior to ear lobe and above jaw angle; causes include mumps, neoplasm, DM, obesity, or cirrhosis.

What findings should be assessed when inspecting the skull?

Symmetry, contour, lumps, tenderness, deformities.

What scalp and hair findings are important?

Lice, dandruff, alopecia, texture (fine/coarse), and scaling or lesions.

What facial features are inspected for abnormality?

Asymmetry, involuntary movement, edema, masses, and skin changes.

What are the boundaries of the anterior and posterior neck triangles?

Anterior: mandible, SCM, midline. Posterior: SCM, trapezius, clavicle.

Which veins and arteries are key neck landmarks?

Carotid artery and internal jugular vein (deep), external jugular vein (crosses SCM diagonally).

Which lymph node groups are in the head and neck?

Submental, submandibular, preauricular, posterior auricular, tonsillar, occipital, anterior & posterior cervical, deep cervical, supraclavicular.

How do you describe lymph node abnormalities?

Note size, shape, mobility, tenderness, consistency. Tender = infection; hard/fixed = malignancy; “shotty” = benign small nodes.

What is the difference between generalized and localized lymphadenopathy?

Generalized = multiple regions

systemic cause; Localized = local infection or malignancy.

What does stridor indicate when auscultating the trachea?

High-pitched, musical sound from airway obstruction

respiratory emergency.

How do you palpate the thyroid gland using the posterior approach?

From behind, place fingers below cricoid, ask patient to swallow, feel for isthmus and lobes, displacing trachea as needed.

What does a retrosternal thyroid mean?

Thyroid extends behind the sternum; lower poles not palpable.

What is the structure and function of the pinna?

Cartilaginous external ear that directs sound waves into the canal.

What bone is behind the ear and clinically relevant?

Mastoid process (check for tenderness or infection).

What are the three middle ear ossicles?

Malleus, incus, stapes.

What is the role of the Eustachian tube?

Connects middle ear to nasopharynx for pressure equalization and drainage.

Which inner ear structures are responsible for balance and hearing?

Cochlea = hearing; Semicircular canals = rotational balance; Otolith organs = linear movement.

How do conductive and sensorineural hearing losses differ?

Conductive = external/middle ear; Sensorineural = inner ear or nerve damage.

List common causes of conductive hearing loss.

Cerumen impaction, otitis externa/media, trauma, otosclerosis, TM perforation.

List causes of sensorineural hearing loss.

Presbycusis, noise exposure, viral infection, ototoxic drugs, Meniere’s, acoustic neuroma.

What are key history questions for hearing complaints?

Onset, side, progression, noise exposure, medications, vertigo, tinnitus, otorrhea.

Which drugs can cause hearing loss?

Aminoglycosides, cisplatin, carboplatin (permanent); aspirin, NSAIDs, quinine, loop diuretics (temporary).

When examining the ear, which ear do you inspect first if one is painful?

The asymptomatic ear first.

What findings might you see on otoscopy?

Cerumen, blood, pus, perforated TM, retraction/bulging, foreign bodies, or fluid behind TM.

What are normal TM landmarks?

Cone of light, handle of malleus, translucent appearance, intact membrane.

What are the three main hearing tests?

Gross hearing, Weber, and Rinne tests.

How is the whispered voice test performed?

Occlude non-test ear, whisper 3 letters/numbers, assess correct repetition (\ge3/6 = normal).

What does the Weber test assess?

Lateralization of sound (midline = normal).

In Weber test, which side hears better in conductive vs sensorineural loss?

Conductive

affected side; Sensorineural

unaffected side.

What is an abnormal Rinne finding for conductive hearing loss?

BC \ge AC.

When should a hearing aid be removed for an ear exam?

Before inspection to visualize canal and TM.

How do cochlear implants work?

Bypass damaged cochlea to directly stimulate auditory nerve.

What precautions should be taken with cochlear implant patients?

Avoid deep otoscopy or manipulating external components.

What is an example of normal documentation for the ear?

“Ears: non-tender, no erythema or swelling. Canals clear. TM intact with visible landmarks.”

How is a normal head and neck exam documented?

“Head normocephalic, atraumatic. Neck midline, no lymphadenopathy, thyroid without nodules or goiter.”

What should be included when describing lymph nodes?

Location, size, consistency, mobility, tenderness, delimitation.

Which anatomical landmarks must you document for the head, neck, and ear exam?

Skull/facial bones, salivary glands (parotid, submandibular), SCM, trapezius, clavicle, thyroid & cricoid cartilages, trachea, thyroid gland, external/internal jugular, carotid, and ear structures.

What history elements matter for head/neck/eye complaints?

Lumps, location, “mass in >40 yo = malignancy until proven otherwise”, headache, neck pain, thyroid symptoms (heat/cold intolerance, weight change, palpitations, skin changes).

What is the proper technique for head/neck/eye exam (sequence & key moves)?

Inspect skull/face/hair/scalp

palpate skull/face/mandible

inspect neck (& swallowing)

palpate lymph nodes & thyroid (posterior approach)

auscultate trachea for stridor if needed

document.

How do you accurately document a normal head & neck & eye exam?

“Head normocephalic, atraumatic. Neck: spine midline, full ROM, no LAD, thyroid without nodules/goiter. Eyes: PERRLA, EOMI, conjunctiva normal, no papilledema on fundus.”

Which ENT landmarks must be documented?

EAC, TM with landmarks, nasal septum/turbinates, oral mucosa/uvula/tonsils/oropharynx.

What history is key for ear, nose, and throat complaints?

Hearing loss pattern, tinnitus/otorrhea/otalgia/vertigo, meds (ototoxic), sudden SNHL

urgent ENT; nasal patency/obstruction; sore throat.

What is the proper technique for the ear exam?

Inspect auricle/canal/TM, palpate pinna (tug test), mastoid tenderness, otoscopy with traction to straighten canal, identify cone of light & malleus, assess TM color/position/mobility & canal contents.

How do you document a normal ENT exam succinctly?

“Ears: nontender, canals clear, TM intact, landmarks visible. Nose atraumatic, patent, pink moist mucosa, turbinates not enlarged. Throat mucosa pink, no lesions, uvula midline, dentition good, OP clear.”

At what angle do you best visualize neck vessels/JVP?

Head elevated ~30° (supine).

What are the differences between a lymph node and a gland?

Nodes: small, round/ovoid, smooth. Glands: larger, lobulated, irregular surface.

List causes of tracheal deviation and whether they push or pull.

Push away: pneumothorax, pleural effusion. Pull toward: atelectasis, pneumonectomy, pleural/pulmonary fibrosis.

Which lymph nodes are often inaccessible on PE?

Deep cervical chain.

Which inner ear structure interprets rotational movement?

Semicircular canals.

What is nystagmus?

Involuntary rhythmic eye movement—commonly vestibular; evaluate when vertigo is reported.

What is the Rinne test and what is a normal result?

Compares AC vs BC with a tuning fork; normal = AC > BC (~2:1).

Which artery runs just anterior to the ear?

Superficial temporal artery.

How do you palpate the skull/face systematically?

From crown

parietal

occipital; palpate temples, facial bones, mandibles.

What facial changes suggest Cushing syndrome?

“Moon face”, red cheeks, possible hirsutism.

Which findings suggest nephrotic syndrome facies?

Pale, periorbital edema with pitting from low oncotic pressure.

What features define myxedema (hypothyroid) facies?

Dull, puffy face; non-pitting periorbital edema.

How do you recognize parotid enlargement and common causes?

Swelling anterior to earlobe/above jaw angle; unilateral gradual = neoplasm; acute = mumps/bacterial; chronic bilat = DM/obesity/cirrhosis.

What are the boundaries of the anterior vs posterior triangle?

Anterior: mandible, SCM, midline. Posterior: SCM, trapezius, clavicle.

Which vessels cross or lie near the SCM and why do we care?

External jugular crosses SCM (JVP here); carotid/internal jugular run deep.

Name all the head/neck lymph node groups you must check.

Submental, submandibular, preauricular, posterior auricular, tonsillar, occipital, anterior & posterior cervical, deep cervical chain, supraclavicular.

How do you describe an abnormal node? Which patterns suggest what?

Record size/shape/mobility/consistency/tenderness; tender = infection; hard/fixed = malignancy; “shotty”= small/mobile/nontender.

How do you palpate each key lymph group? (locations you’ll be tested on)

Submental (midline behind chin tip), submandibular (midway angle

tip mandible), pre/post-auricular, tonsillar (angle of mandible), occipital (base of skull), anterior superficial cervical (anterior to SCM), posterior cervical (anterior edge trapezius w/ slight neck flex), deep cervical chain (deep to SCM; often inaccessible), supraclavicular (deep in clavicle–SCM angle).

What is a goiter and how do you inspect for it?

Thyroid \ge2\times normal size; watch swallowing for upward thyroid movement.

How do you palpate the thyroid (posterior approach) correctly?

Fingers below cricoid, ask to swallow

feel isthmus; then palpate lobes by displacing trachea and feeling between it and relaxed SCM.

What suggests a retrosternal thyroid?

Lower pole not palpable.

What is stridor and why is it red-flag?

High-pitched musical sound from severe subglottic/tracheal obstruction

respiratory emergency.

List the outer ear structures and canal facts you will be asked.

Pinna/helix; canal ~24 mm; outer ⅓ cartilage hair-bearing (cerumen glands); inner ⅔ bone (pressure hurts); mastoid behind ear.

Name the ossicles and the tube that equalizes pressure.

Malleus, incus, stapes; Eustachian tube drains to nasopharynx.

Which inner ear parts handle hearing, rotational, and linear motion?

Cochlea = hearing; semicircular canals = rotation; otolith organs = linear.

What are ⭐ classic conductive vs sensorineural causes?

Conductive: cerumen, otitis externa/media, trauma, otosclerosis/cholesteatoma, TM perf, tumors.

Sensorineural: congenital, presbycusis, viral (rubella/CMV), Meniere, noise, ototoxic meds, acoustic neuroma.

Which history details separate conductive vs sensorineural loss?

Conductive often hears better in noise; SNHL

“people mumble,” speech clarity issues; sudden SNHL

urgent ENT.

Which meds are ototoxic (permanent vs temporary)?

Permanent: aminoglycosides, cisplatin, carboplatin. Temporary: aspirin/NSAIDs, quinine, loop diuretics.

What must you inspect on the auricle/canal before otoscopy?

Lesions, swelling, scaling, discharge, erythema, ecchymosis, Battle sign.

Why examine the asymptomatic ear first and what is a + tug test?

Avoid provoking pain; + tug test (auricle traction pain) suggests otitis externa.