Exam 1: HEENT

the skull has

7 bones

hypo/hyperthyroidism can cause

coarse or fine hear, balding, hair loss, splits ends

your are palpating for

masses, tenderness, injuries, pulses

you inspect for

redness, lesions, swelling, symmetry

giant cell arteritis

visibly enlarge temporal artery

what two sinuses are most likely to be infected

maxillary and frontal

-because they are more superficial

what are the two deeper sinuses

ethmoid, sphenoid

why would you transilluminate a sinus

if tender or if infection is suspected

what glands are anterior to the ear

parotid glands

what are you checking for in a TMJ examine

slow cracking (crepitus) and tenderness

T/F TMJ can cause ear aches

T

what muscles move the jaw superficially

temporalis and masseter

what other two muscles aid jaw movement

lateral pterygoid, medial pterygoid

which nerve are you inspecting for when you have the pt make faces

CN 7 : facial nerve

what is the cartilaginous part of the ear called

pinna or auricle

what are checking behind the ear

mastoid to ensure there is no tenderness, eyrthema, or swelling

**medical emergency if present

what nerve transmits sound to the brain

CN 8 : vestibulocochlear

what does the cochlea do

transmits sound to the nerves

what is it called when a middle ear infection spreads to the mastoid bone

osteomyelitis

which way do you pull the ear to adjust the ear canal for otoscopic exam

up, back, out

which way do yo pull a child 3 and Youngers ear to adjust their ear canal for otoscopic exam

down, back, out

you must position the otoscope ___ looking in

before

cerumen

ear wax

you should send the pt to the ENT if perforations are on

the peripheral of the ear drum

what color is the TM supposed to be

pearly gray

bulging of the TM indicates

infection

malleus and cone of light point/are on what side of the TM

respective to which ear you are looking at

which nerve are you checking with the finger rub test

CN 8 : vestibulocochlear

Webber test

use 512Hz tuning fork in middle of head; should hear bilaterally; if hearing affect sound will go to the affect ear -conductive

Rinne test

512Hz tuning fork; place on mastoid and then in front of ear to check for hearing loss; AC should be great than BC

T/F you can see the upper turbinate upon exam

F: when looking at the nose you will only see the the middle and lower turbinate

which nerve are you checking with smell

CN 1 : olfactory

cracked corners of the mouth indicate

vitamin deficiency

which duct is by the molars

Stenson

which duct is below the tongue

Wharton

sweet or fruity breath can indicate

diabetes

etoh on breath

alcohol

uvula movement indicates which nerve is intact

CN X vagus

what nerves are you checking with the gag reflex

CN IX and X : glossopharyngeal and vagus

what nerve are you checking with tongue movement

CN XII hypoglossal

features of the posterior neck triangle

sternocleidomastoid, trapezius, clavicle

features of the anterior neck triangle

mandible, sternocleidomastoid, midline fo neck

lymph nodes in order of examination

occipital, post auricular, pre auricular, tonsillar, submaxillary, submental, anterior cervical, posterior cervical, supraclavicular

which nerve innervates the shoulder shrug test

CN XI accessory

routine eye examines can catch chronic/systemic disease such as

hypertension and diabetes

what nerve opens the eyelids

CN VIII vestibulocochlear

what nerve closes the eyelids

CN VII facial

what is the iris

color pigmentation of the eye; helps control light entrance

pupil

opening not a structure

limbus

Where the cornea blends into the sclera

conjuctiva

covers the posterior aspect of the lid and the sclera; single membrane that reflects on itself

sclera

white part of the eye

lacrimal gland

produces tears

bones of the eye

frontal, zygomatic, maxilla

macula

contains rods and cones; circular in eye exam

T/F the macula and fovea are the most sensitive part of the eye

T

fovea

center of the macula; will see a glint of light upon exam

when visually inspecting the eye with light what direction should you go in

medial and then lateral; don't stay on the fovea/macula long

how far away should the Rosenbaum eye chart be

14 in

exophtalmos

bulging eyes

ptosis

drooping eyelids

lid lag

delay of moving eyelids down

raccoon eyes indicate

trauma

T/F thyroid conditions can create eye problems

T

which lesion hurts

hordeolum

types of eye lesions

hordeolum, chalazion, scales

chalazion

not painful; accumulation of material in eye; result of blocked gland; large buldge

hordeolum (stye)

erythematous, tender lump within the eyelid

internal vs external styes

internal: meibomian gland; can evolve into chalazion

external: Zeiss or Moll gland along lash line

what is the first line of treatment for a stye

warm compress and mass for 5-6 days; should drain spontaneously

what happens if the stye doesn't go away naturally

antibiotics topical or oral --> I&D w/ referral to opthalmology

entropion

in turning lashes

ectropion

out turning lashes

what do you palpate the lacrimal gland for

regurgitation

blephritis

inflammation of the eyelid

To inspect the conjunctiva have the patient look ___

in all directions with lids pulled away to see as much as possible

very pale underlid indicates

anemia

-hx bleeding

-easy bruising

subconjunctival hemorrhage

usually painless; bleeding under conjuctiva; localized redness; self limiting

if a subconjunctival hemorrhage is spontaneous, this could indicate

uncontrolled HTN

pinguecula

collection of fat, medial or lateral to the iris

-does NOT extend onto cornea

pterygium

opaque fibrovascular tissues, medial to the iris, may interfere with vision

T/F you can use cause to gently remove foreign bodies forms he eye

T: if doesn't come easily make referral

Snellen eye chart

Alphabet

OD

right eye

OS

left eye

OU

both eyes

numerator of vision score

distance from chart

denominator of vision score

distance a normal eye can read a particular line

when should the visual acuity test be done during the exam

First!! w/ the exception of chemical burns

at what score is a person legally blind

20/200

what does the visual field assessment test for

vision field defects

confrontation visual field test

Determines if patient has a full field of vision, without obvious blind spots or vision loss

all muscles of the eye are innervated by CN 8 expect

superior oblique (CN 9) and lateral rectus (CN6)

extra ocular motility testing checks for

nystagmus

nystagmus

abnormal eye movement; can result from vertigo or alc

-horizontal = most likely fine

-vertical = NOT normal; requires further workup

eye movement should be ____ and _____

smooth, symmetric

convergence and accomadtion can be caused by

weak muscles or hypothyroid

a shallow anterior chamber suggests ____

glaucoma

glaucoma

build up of pressure as a result of aqueous humor not draining

-creates buldge

crescent shadow indicates

glaucoma: buldging