Comprehensive Physical Examination of Sinuses, Mouth, Ears, and Respiratory System

How do you palpate the frontal sinuses?

Press up and under the eyebrows with your thumbs.

How do you palpate the maxillary sinuses?

Press below the cheekbones with your thumbs.

What is a normal finding during sinus palpation?

No tenderness or pain.

What should you inspect on the lips?

Color and moisture.

What should you inspect on the teeth and gums?

Condition, alignment, and swelling.

What does a tonsil grade of 1+ mean?

Tonsils are visible.

What does a tonsil grade of 2+ mean?

Tonsils are halfway between the tonsillar pillars and uvula.

What does a tonsil grade of 3+ mean?

Tonsils are touching the uvula.

What does a tonsil grade of 4+ mean?

Tonsils are touching each other.

Which tonsil grades may be normal in healthy individuals, especially children?

1+ and 2+.

What characteristics should be assessed when inspecting the tongue?

Color, moisture, and surface characteristics.

What is the normal appearance of the ventral surface of the tongue?

Smooth and glistening.

What area of the mouth is the most likely site for oral malignancies?

The U-shaped area under the tongue.

What is Stensen's duct?

An expected dimple opposite the second molar.

What subjective data should be collected when assessing the nose?

Rhinorrhea, frequent colds, sinus pain, trauma, epistaxis, allergies, and changes in smell.

What is rhinorrhea?

Nasal discharge.

What is epistaxis?

A nosebleed.

What subjective data should be collected for the mouth and throat?

Sores, lesions, bleeding gums, toothaches, hoarseness, dysphagia, smoking, and alcohol use.

What is dysphagia?

Difficulty swallowing.

What does CN I control?

Sense of smell.

What is an easy way to remember CN IX?

CN IX = swallowing.

What is an easy way to remember CN X?

CN X = say 'AH' and check the uvula.

How is CN XII tested?

Ask the patient to stick out their tongue.

What is a normal finding when testing CN XII?

The tongue protrudes midline without tremors or deviation.

What are normal inspection findings of the outer ear?

Ears are equal in size bilaterally, with intact skin and no lumps or lesions.

What is Darwin's tubercle?

A normal congenital variation of the helix.

What structures should be palpated for tenderness during an ear assessment?

The helix , tragus, and lobes.

What is the normal appearance of the tympanic membrane (TM)?

Shiny, translucent, and pearl-gray.

What landmarks should be visible when inspecting the tympanic membrane?

The malleus and cone-shaped light reflex.

Where is the normal light reflex located?

In the anteroinferior quadrant of the tympanic membrane.

What size otoscope speculum should be used?

The largest size that fits comfortably.

How do you position the pinna for an adult or older child?

Pull up and back.

How do you position the pinna for an infant or child under age 3?

Pull straight down.

What is air conduction (AC)?

The normal and most efficient pathway of hearing.

What is bone conduction (BC)?

Skull vibrations transmit sound directly to the inner ear and CN VIII.

What is the normal relationship between air and bone conduction?

AC > BC.

How is the whispered voice test performed?

Whisper two-syllable words from about 2 feet behind the patient.

What is a normal Weber test result?

Sound is heard equally in both ears.

What does the Romberg test assess?

Balance and proprioception.

What subjective data should be collected during an ear assessment?

Earaches, infections, discharge, hearing loss, noise exposure, tinnitus, and vertigo.

What is tinnitus?

Ringing in the ears.

What is vertigo?

A spinning sensation.

What are the major anterior thoracic landmarks?

Suprasternal notch, sternum, and Angle of Louis.

Why is the Angle of Louis important?

It marks the tracheal bifurcation and corresponds with the second rib.

What are the major posterior thoracic landmarks?

Vertebra prominens (C7), spinous processes, inferior border of the scapula, and twelfth rib.

How many lobes does the right lung have?

Three lobes.

Why is the right lung shorter?

Because of the liver.

How many lobes does the left lung have?

Two lobes.

Why is the left lung narrower?

To accommodate the heart.

Which lung lobes make up almost the entire posterior chest?

The lower lobes.

What are the four major functions of the respiratory system?

Supply oxygen, remove carbon dioxide, maintain acid-base balance, and perform heat exchange.

What subjective data should be collected for the respiratory system?

Cough, SOB, chest pain with breathing, history of infections, smoking history, and TB exposure.

What are the two main types of cough?

Productive and nonproductive.

What equipment is used during a respiratory assessment?

Stethoscope, pulse oximeter, and spirometer.

Where are bronchial breath sounds normally heard?

Over the trachea.

Where are bronchovesicular breath sounds normally heard?

Over the major bronchi.

Where are vesicular breath sounds normally heard?

Over the peripheral lung fields.

What do crackles sound like?

Popping sounds.

What do wheezes sound like?

Musical or squeaking sounds.

What does stridor sound like?

A high-pitched inspiratory crowing sound.

What are atelectatic crackles?

Nonpathologic crackles that disappear after a few breaths.

What does forced expiratory time measure?

It helps detect airflow obstruction.

What does a spirometer measure?

Lung function and lung health.

What does pulse oximetry measure?

Oxygen saturation (SpO₂).

What is the correct sequence for a respiratory physical assessment?

Inspection → Palpation → Percussion → Auscultation.

What do you assess during inspection of the thorax and lungs?

Chest shape, configuration, and respiratory effort.

Why is palpation performed during a respiratory assessment?

To assess symmetric chest expansion and tactile fremitus.

What is tactile fremitus?

Vibrations felt through the chest wall when the patient speaks.

Why is percussion performed during a respiratory assessment?

To determine the density of underlying tissue.

What is the normal percussion sound over healthy lung tissue?

Resonance.

Why is auscultation performed?

To evaluate the quality and symmetry of breath sounds bilaterally.

What is physical abuse?

The use of physical force resulting in injury or death.

What is sexual abuse?

Attempted or completed sexual acts without permission or consent.

What is neglect?

Failure to provide for basic needs.

What is psychological or emotional abuse?

A pattern of behavior that harms self-worth or uses humiliation and isolation to maintain control.

What are immediate and chronic health effects of violence?

Physical injury,, mental health problems, suicide risk, PTSD, and substance abuse.

How should suspected abuse be documented?

Use detailed, objective, nonbiased notes, injury maps, and photographs with consent.

How should a patient's statements about abuse be documented?

Verbatim—in the patient's exact words.

Why should the entire body be examined when assessing for abuse?

Because injuries may be hidden under clothing.

What objective findings may indicate abuse?

Atypical bruising patterns or bruises shaped like an object.