Physical Examination and Health Assessment: HEENT, Breasts, and Thorax/Lungs

Comprehensive vocabulary flashcards reviewing the anatomical structures, assessment techniques, cranial nerve tests, normal findings, and pathological conditions of the nose, mouth, throat, breasts, axillae, thorax, and lungs.

Ciliated Mucous Membrane (Nose)

Specialized mucosal lining containing cilia that lines the entire nasal cavity and paranasal sinuses; it warms, moistens, and filters inhaled air while producing mucus to trap particulate matter.

Turbinates

Three bony projections (superior, middle, and inferior) located on the lateral walls of each nasal cavity that increase surface area to enhance air warming, humidification, and filtering.

Nasal Polyps

Smooth, pale gray, benign growths that accompany chronic allergies; they are movable and non-tender, distinguishing them from normal turbinates.

Tonsillar Crypts

Deep indentations peppering the oval, rough-surfaced lymphoid tissue of normal palatine tonsils.

Tonsil Grading Scale

Clinical rating of tonsillar enlargement: $1+$ is visible; $2+$ is halfway between tonsillar pillars and uvula; $3+$ is touching the uvula; $4+$ is touching each other ("kissing tonsils").

Acute Tonsillitis / Pharyngitis

Bright red, swollen tonsils covered with white or yellow exudate, accompanied by fever and enlarged lymph nodes (commonly caused by streptococcal infection).

Peritonsillar Abscess

A complication of untreated streptococcal infection that causes severe neck swelling and high fever.

Gag Reflex (Cranial Nerve Testing)

Reflex elicited by touching the posterior pharyngeal wall with a tongue blade, assessing CN IX (Glossopharyngeal) and CN X (Vagus).

Phonation Uvula Rise (Cranial Nerve Testing)

Test having the patient say "ahhh" to observe the soft palate and uvula rise in the midline, assessing CN X (Vagus).

Tongue Protrusion (Cranial Nerve Testing)

Maneuver assessing midline movement and forward protrusion of the tongue, evaluating CN XII (Hypoglossal).

Seasonal Allergic Rhinitis (Hay Fever)

Condition characterized by itching of the nose and eyes, lacrimation, sneezing, and pale, swollen, boggy turbinates or nasal polyps.

Acute Rhinitis (Nonallergic / Common Cold)

Inflammation characterized initially by clear, watery discharge that becomes purulent, accompanied by dark red, swollen nasal mucosa and turbinates.

Acute Sinusitis

Condition where inflamed, narrowed sinus openings become occluded, leading to sinus pain, facial pressure, purulent discharge, and tenderness to palpation.

Paranasal Sinuses

Air-filled pockets within the cranium consisting of the frontal sinuses (in the frontal bone above and medial to orbits), maxillary sinuses (cheekbones/maxilla), ethmoid sinuses (between orbits), and sphenoid sinuses (deep in sphenoid bone).

Xerostomia

Dryness of the oral mucosa, frequently caused by prescription or over-the-counter medications.

Oral Carcinoma

Oral cancer linked to tobacco use, heavy alcohol consumption, and HPV; most commonly located in the U-shaped area under the tongue behind the teeth.

Candidiasis (Thrush)

Monilial fungal infection presenting as cheesy white patches on the buccal mucosa or tongue that scrape off, leaving a raw, bleeding surface.

Herpes Simplex 1 (HSV-1)

Infection causing cold sores or fever blisters that present as clear vesicles with a surrounding red indurated base at the mucocutaneous lip border.

Aphthous Ulcers (Canker Sores)

Painful, small round or oval ulcers with a white base and red halo, triggered by stress, food allergies, or trauma.

Atrophic Glossitis (Glossy Tongue)

Smooth, slick red tongue caused by Vitamin B12, folic acid, or iron deficiency.

Black Hairy Tongue

Fungal infection characterized by elongation and painless black discoloration of the filiform papillae.

Geographic Tongue

Benign condition characterized by smooth red patches surrounded by raised white or yellow borders on the dorsal surface of the tongue.

Ankyloglossia

"Tongue-tied" condition caused by a short lingual frenulum that fixes the tip of the tongue to the floor of the mouth.

Leukoplakia

Chalky white, thick, raised precancerous patch on the oral mucosa or tongue edge that does not scrape off.

Breast Cancer Risk Factors

Factors including female gender, age ($> 50\text{ years}$), family history, BRCA1/BRCA2 gene mutations, early menarche, late menopause, hormone replacement therapy (HRT), alcohol consumption, obesity, and never breastfeeding.

Gynecomastia

Benign enlargement of male breast tissue during puberty or aging; palpates as a smooth, firm, movable disk beneath the nipple and is temporary.

Tail of Spence

Superior lateral projection of breast tissue that extends from the upper outer quadrant into the axilla.

Upper Outer Quadrant (Breast)

The anatomical site of the breast where the majority of breast tumors are located.

Axillary Lymph Node Groups

Four lymphatic chains draining the breast: Central axillary (high in axilla), Pectoral/anterior (lateral edge of pectoralis major), Subscapular/posterior (lateral border of scapula), and Lateral (along the humerus).

Cooper's Ligaments Retraction

Contraction of fibrous suspensory ligaments caused by growing neoplasms, producing skin dimpling or pitting on the breast.

Peau d'orange

Edema of breast tissue resulting in a thickened, pig-skin or orange-peel appearance caused by lymphatic obstruction.

Mastitis

Inflammatory, tender, red, swollen, hot, and indurated breast mass occurring during lactation, accompanied by systemic fever and chills.

Benign (Fibrocystic) Breast Disease

Condition characterized by multiple, bilateral, tender, rubbery, freely movable breast nodules associated with cyclic premenstrual engorgement and discomfort.

Vertical Strip Pattern

The recommended palpation technique for breast tissue examination, performed with the patient in a supine position and ipsilateral arm raised overhead.

Breast Self-Exam (BSE)

Best performed right after the menstrual cycle (days $4\text{ to }7$) when breasts are least engorged and tender; menopausal individuals should select the same day each month.

Costal Angle

Angle formed where the right and left costal margins meet at the xiphoid process; normally $\le 90^\circ$, but widens to $> 90^\circ$ in barrel chest associated with COPD and emphysema.

Tactile Fremitus

Palpable vibration transmitted through the tracheobronchial tree to the chest wall while the patient repeats resonant phrases such as "99" or "blue moon".

Resonance

Low-pitched, clear, hollow percussion sound predominant over healthy adult lung tissue.

Hyperresonance

Lower-pitched booming percussion sound found in states of hyperinflation, such as Emphysema or Pneumothorax.

Dullness (Thoracic Percussion)

Soft, muffled thud elicited over abnormal dense tissue, such as in Pneumonia, Pleural Effusion, Atelectasis, or Tumor.

Bronchial (Tracheal) Breath Sounds

Harsh, hollow, loud breath sounds heard over the trachea with inspiration shorter than expiration ($2:3$ ratio).

Bronchovesicular Breath Sounds

Moderate-pitched breath sounds heard over major bronchi where inspiration duration equals expiration duration ($1:1$ ratio).

Vesicular Breath Sounds

Low-pitched, soft rustling breath sounds heard over peripheral lung fields where inspiration is longer than expiration ($3:1$ ratio).

Symmetrical Chest Expansion Test

Technique evaluating lung expansion by placing hands posterolaterally at T9/T10, pinching a skin fold, and observing symmetric movement during deep inspiration.

Bronchophony

Auscultation test where the patient repeats "99"; abnormal transmission sounds clear and distinct, signaling lung consolidation.

Egophony

Auscultation test where the patient says "ee-ee-ee"; abnormal finding occurs when the sound changes to a nasal, bleating long "a-a-a" over consolidated areas.

Whispered Pectoriloquy

Auscultation test where the patient whispers "1-2-3"; abnormal transmission sounds clear, distinct, and amplified over consolidated lung tissue.

Barrel Chest

Thoracic configuration where the anteroposterior (AP) diameter equals the transverse diameter ($1:1$ ratio instead of normal $1:2$), resulting from chronic hyperinflation in COPD and emphysema.

Tachypnea

Rapid, shallow breathing pattern with an elevated respiratory rate $> 20\,\text{breaths/min}$.

Bradypnea

Slow breathing pattern with a decreased respiratory rate $< 12\,\text{breaths/min}$.

Cheyne-Stokes Respiration

Abnormal respiratory cycle that waxes and wanes in depth in a regular pattern, punctuated by regular periods of apnea.

Stridor

High-pitched, monophonic inspiratory crowing sound caused by upper airway obstruction from swollen tissues or a foreign body (e.g., croup).

Pleural Friction Rub

Coarse, grating, or rubbing adventitious sound produced when inflamed, roughened pleural surfaces rub together.

Fine Crackles

High-pitched, short popping adventitious sounds heard during inspiration as deflated alveoli suddenly pop open, resembling hair rolled between fingers.

Coarse Crackles

Loud, low-pitched bubbling and gurgling adventitious sounds produced when inhaled air collides with secretions in large bronchi and trachea, sounding like Velcro.

Atelectatic Crackles

Non-pathologic, fine crackling sounds heard in axillae and bases that disappear after a few deep breaths or a cough.

Wheezing

High-pitched, musical squeaking adventitious sound caused by air squeezed through narrowed or compressed airways (e.g., asthma, emphysema).

Rhonchi

Low-pitched, monophonic snoring or moaning adventitious sounds caused by airflow obstruction in larger airways (e.g., bronchitis, COPD).

Pneumothorax

Presence of free air in the pleural space causing partial or total lung collapse; exhibits unequal chest expansion, decreased/absent fremitus, hyperresonance, and diminished breath sounds.

Asthma

Allergic hypersensitivity reaction causing bronchospasm, mucosal edema, and airway narrowing; manifests as dyspnea, chest tightness, prolonged expiration, and high-pitched wheezing.

Tuberculosis (TB)

Infection caused by tubercle bacilli resulting in Ghon lesions and cavitation; features cough, fever, night sweats, fatigue, weight loss, hemoptysis, and upper lobe crackles.

Congestive Heart Failure (CHF - Pulmonary Findings)

Left ventricular failure leading to pulmonary congestion and fluid leakage into alveoli; produces dyspnea, orthopnea, tachypnea, skin pallor, and bilateral fine crackles at the lung bases.

Crepitus

Coarse, crackling sensation palpable over the chest wall surface caused by air abnormally leaking from lung tissue into subcutaneous spaces.

Atelectasis

Condition involving collapsed alveoli or an entire shrunken section of the lung resulting from airway obstruction, external compression, or surfactant deficiency.