LCCW EENT Mid 1

CN 1 name and sensory

Olfactory

smell

Tests for CN 1

1. Check patently of airways

2. Have them identify familiar smells

3. Examine internal nose

CN II name and sensory

Optic

Vision

Tests for CN II

Snellen Eye chart (central Vision)

Confrontation (peripheral vision)

Direct and consensual light (CN III too)

Fundoscope exam

What is normal vision? Legally blind?

Normal 20/20

Legally blind 20/200

oculi sinister

left eye

oculi dextra

right eye

oculi unitas

both eyes

CN III name

oculomotor

Motor fxn for CN III

Superior rectus

inferior rectus

medial rectus

inferior oblique

levator palpebrae

constrictor mm

ciliary mm

Tests for CN 3

Eye movements- cardinal field of gaze

accommodation

direct and consensual light

convergence

What is strabismus

eyes don't focus in the same direction

What do you look for during CN III tests

Anisocoria (uneven pupils)

ptosis of eyelid

Miotic pupil

constricted

mydriasis and CN lesion associated with it

Dilated pupil (CN III lesion)

CN IV name and motor fxn

Trochlear

Superior oblique (down and in)

CN V name? motor or sensory?

Trigeminal

Both

Sensory of CN V

To face (V1,2,3 divisions)

Anterior 2/3 tongue general sensation

corneal reflex (with CN VII and III)

Jaw Jerk maxillary reflex

Oclocardiac reflex (with CN X)

Motor of CN V

mm of mastication (temporals and masseter)

medial/ lateral pterygoids

tensor tympani

How to test the mm of mastication

palpate bilaterally while the pt clenches their teeth

How to test the medial/lateral pterygoids

1. look for jaw deviation

2. have them resist side to side jaw movement

3. resist protrusion of lower jaw

What does the tensor tympani do?

dampens continous loud noise

CN VI Name and Motor fxn

Abducens

Motor to Lateral rectus mm (lateral eye movement)

CN VII Name? Sensory or Motor?

Facial

Both

Sensory CN VII

taste to anterior 2/3 of tongue

Motor fxn CN VII

mm of facial expression

Corneal reflex

Stapedius

How to test mm of facial expression

Have pt make 5 faces and check the use of the mm's

What part of the corneal reflex is CN VII

Efferent limb

Closes eye

What does the stapedius mm do?

dampens continuous loud sounds

Parasympathetic CN VII

lacrimal glands

Submaxillary and sublingual glands

CN VIII name and sensory fxn

Vestibularcochlear

hearing

How to test CN VIII hearing

finger rub test

Weber

Rine

How to do Finger rub test

pt eyes closed

rub fingers together next to pt's ear and ask if they can hear it

Slowly move fingers away

Ask pt to tell you when they can't hear rubbing anymore

compare bilaterally

Normal and abnormal findings for the finger rub test

Normal:Pt should be able to hear fingers rubbing about an arms length away

Abnormal: Short side (could hear as far)

How to do the Weber test

Place a 512 Hz tuning fork on the pt's head and as if they hear it in the middle or more in the L or R ear

Normal findings for the Weber test

Normal: Patient should hear in the middle (ears equally)

Ab

How will a conduction problem present itself in the weber test

sound localizes in the bad ear

How will a nerve problem present itself in the Weber test

Sound localizes in good ear

+ Weber test

Sound is louder in L or R ear

How to do the Rinne test

Place 512 Hz tuning fork on the pt's mastoid and begin counting, when they cannot hear it anymore put it in front of the EAM and continue counting

What should the patient be able to hear during the Rinne test

20 seconds on their mastoid and 40 seconds in the air

(1:2 ratio)

+ Rinne test

NORMAL- air conduction in 2x's longer than on the mastoid

CN VIII: a disturbance in the vestibular portion would cause what?

vertigo

disequallibrium

past pointing

Nystagmus

Caloric test/ Barany test

CN IX name? Motor or sensory?

Glossopharyngeal

Both

Sensory or CN IX

Posterior 1/3 of tongue (sensation and taste)

oropharynx

Afferent limb of the carotid sinus

Motor CN IX

stylopharyngeus mm

Parasympathetic CN IX

parotid gland

CN X name

Vagas

Motor Fxn CN X

Pharynx: uvula

Ah test

Efferent gag reflex

efferent carotid sinus reflex

efferent oculocaridiac reflex

What side is the uvula pulled towards

good side

During the ah test, what side are the arches with a lesion

low side= lesion

Sensory CN X

taste: bitter

Name and Motor fxn of CN XI

Spinal accessory

Traps

SCM

How to test the Traps and SCM

Traps: have the patient shrug their shoulders

SCM: Rotate, extend and laterally flex head

Name and Motor fxn of CN XII

Hypoglossal

Intrinsic mm of the tongue

How to test the intrinsic mm of the tongue

protrusion of the tongue (towards side of lesion)

Push tongue into cheek (feels week on contralateral side to lesion)

What 9 things do you inspect on nails

S3 CBPALP

Size

shape

symmetry

color

Bed of nail

plate of nail

angle of the nail

lunula

Paronychium

What is the Paronychium

U shaped skin around the nail

Reedy nail

longitudinal ridging

clinically insignificant

Beaus lines

horizontal grooves

What do beaus lines mean

can mean an interrupted growth cycle for a period of time due to systemic illness

What is the normal color of the lacuna

white/pink

What is a blue lacuna associated with?

wilsons dx (problem with copper in the liver)

What is a red lacuna associated with

cardiac failure

AKA for spoon nails

Koilonychia

What are spoon nails? Why do they occur?

Nails are concave and thin due to iron deficiency anemia

What is Leukonychia

entire nail is totally white

Is Leukonychia a serious condition?

No, its clinically insignificant

What is Terrys nail?

80% white 20% pink at the tip

What is terry nail associated with?

hepatic cirrhosis

What is Lindsays Nail

40% white, 60% pink at the tip

What is Lindsays nail associated with?

increased nitrogenous waste in early renal failure

What are yellow nails

thick porous often associated with fungal infections

What are yellow nails caused by?

old age

diabetes

having feet in a warm, sweaty environment for long periods of time

What is yellow nail syndrome

yellow nails due to decreased lymphatic circulation

*check for associated edema

Congenital loss of nails AKA

congenital anonychia

What nails are affected with congenital anonychia

generally affects the entire limb of the hand or foor

What are splinter hemorrhages

small red lines under the nail that may be benign and aired in manual laborers from micro traumas or could indicate subacute bacterial endocarditis

What is clubbing of the nail

nail angle is 180 degrees of greater

-nail is widened and has springiness and the nail is floating in the nail bed

What is the normal angle of the nail

160

What is nail pitting associated with?

psoriasis

What is onnycholysis

splitting of the nail; the nail separates from the nail bed

onnycholysis is most commonly caused by ______ or also _____ or ________

MC: Trauma

psoriasis or fungus

What is it called when the paronychium is inflamed?

paronychia

When do you observe the patients trachea? Where should it be normally?

before and during swallowing

should be midline

What conditions cause a deviated trachea

pleural effusion

pneumothorax

tumor

collapsed lung

What do you inspect on the thyroid?

For:

enlargement

visible nodules

goiter

How do you check for a substernal goiter or nodule?

When the patient swallows it will become visible

What is normal when moving the trachea?

Freely moving from side to side

crunching is okay

If the trachea is stuck, what may you suspect?

tumor

How do you palpate the thyroid gland?

palpate 1 side at a time using 3 fingers

Place fingers on the lateral aspect with the middle finger at the level of the cricoid

Then, have patient swallow while you palpate each side

What are you looking for when palpating the thyroid

enlargement

tenderness

nodules

What does an enlarged thyroid with NO nodules suggest?

Graves dx

Hashimotos

endemic goiter

infection

What does a multi nodular thyroid gland suggest?

systemic metabolic condition

What does a single nodular thyroid suggest

Cancer

Symptoms of HYPOthyroidism

Dry brittle hair

Dry skin

tired

weight gain

Symptoms of HYPERthyroidism

oily skin

inc. energy

weight loss

inc. sweating

When inspecting the TMJ what are you looking for

swelling and/ or redness

How do you palpate the TMJ

Place tips of fingers in front of the tragus and have patient open their mouth

Note any swelling to tenderness

Snapping and clicking may be normal

When the patient opens their jaw as wide as possible what is a normal width?

3 fingers should be able to fit