Head, Eyes, Ears, Nose & Throat – Exam 2 Review Flashcards

Head, Face & Neck – Core Anatomy

• Skull (a.k.a. cranium)
  • Protects brain & special-sense organs.
  • 4 lobes of the cerebrum it encloses:
    • Occipital – posterior
    • Temporal – lateral, around ears
    • Frontal – anterior
    • Parietal – superior/“crown”
• Face
  • Gives non-verbal clues; deformities may signal endocrine or neuro disorders.
  • Accessible salivary glands: parotid (anterior to ear) & submandibular (under jaw).
• Neck as “conduit”
  • Houses blood vessels, muscles, nerves, trachea & esophagus.
  • Trachea must remain mid-line; deviation → airway compromise.
  • Thyroid (endocrine powerhouse)
    • Regulates metabolism, heat, menses, libido.
    • Normally non-palpable; palpate from behind during swallow.
    • Visible goiter or bruit (heard with bell) = pathology.

Lymphatic System of Head & Neck

• Function: \text{Detect} \; & \; \text{drain foreign material ("gunk")}
• Highest node concentration is in head/neck.
• Drainage pattern (superficial → deep → central) crucial for locating infection.
• 10 paired nodes to recognize (p. 254):
  1. Pre-auricular – in front of ear
  2. Post-auricular – behind ear
  3. Occipital – base of skull
  4. Submental – midline under chin
  5. Submandibular – beneath mandible angle
  6. Jugulodigastric (Tonsillar)
  7. Superficial cervical – over SCM
  8. Deep cervical – deep under SCM
  9. Posterior cervical – along trapezius
  10. Supraclavicular – above clavicle
• Normal: non-palpable,

Headaches – Classification & Assessment

• Leading cause of pain & lost productivity.
• Evaluate with PQRSTU mnemonic:
  • Provocation/Palpation • Quality • Region/Radiation
  • Severity • Timing • U How it affects yoU
• Types
  1. Tension (musculoskeletal)
  • Bilateral “vise-like”, gradual, mild–mod; triggers: stress, posture.
  1. Migraine
  • Throbbing, pulsating; aura common; duration 4{-}72 h; triggers: hormones, food, sleep loss, weather; relief: dark room, meds (PRN/ monthly injections).
  1. Cluster (brief, unilateral, orbital) – not fully covered.
• Sleep deprivation = major precipitant; students advised to avoid 4 a.m. cramming.

Subjective Data to Collect (Head/Neck)

• Head injury history
• Dizziness terms
  • Presyncope – light-headed, “swimming”
  • Vertigo – spinning (objective vs. subjective)
  • Disequilibrium – loss of balance (inner-ear)
• Neck pain, limited ROM
• Lumps/swelling
• Past surgeries

Objective Examination Techniques

• General order: Inspect → Palpate → (Percuss) → Auscultate

Skull & Face

• Palpate with finger-tips; note
  • Shape: normocephalic (normal, round)
  • Symmetry, smoothness, tenderness.
• Cranial Nerve screening
  • CN V (Trigeminal): light/sharp touch & masseter strength.
  • CN VII (Facial): smile, frown, puff cheeks, raise brows.

Neck

• ROM: flexion, extension, lateral, rotation.
• Trachea mid-line?
• Carotid pulse one side at a time.
• Thyroid: non-palpable; auscultate for bruit if enlarged.

Cranial Nerves – Quick Reference

Lymph Node Assessment Algorithm

1. Palpate with pads of 2–3 fingers in gentle circular motion.
2. If node felt → document:
   • Size (mm/cm) • Consistency (soft/firm/hard) • Mobility • Tenderness • Laterality
3. Trace drainage area upstream for primary lesion.

Aging Adult – Head & Neck Changes

• Prominent bones/orbits; sagging skin (↓ collagen, fat, moisture).
• Senile tremors (fine). Slower ROM – allow time.
• Sunken mouth with tooth loss; droopy submandibulars.
• Safety: dizziness affects ADLs, driving; home fall-proofing vital.

Abnormal Head/Neck Appearances

• Parkinsonian mask-like face & tremor.
• Cushing (moon face from ↑cortisol or steroids).
• Acromegaly (large skull/hands from GH excess).
• Cachexia (sunken, “wasting”).
• Graves’ (hyper-T₄): exophthalmos.
• Myxedema (hypo-T₄): puffy, cool, dry skin.
• Bell’s Palsy (CN VII palsy) vs. CVA facial droop.

Eye Anatomy & Physiology – Quick Tour

• External
  • Eyelids/lashes – protect, distribute tears.
  • Canthi – inner & outer corners.
  • Conjunctiva – clear mucous membrane.
• Internal (layers)
  1. Sclera & cornea
  2. Uvea: iris (color, controls light), pupil, lens
  3. Retina – visual receptive layer
• 6 extraocular muscles keep eyes aligned.

Visual Reflexes & Accommodation

• Pupillary Light Reflex (sub-cortical, no conscious control)
  • Direct – illuminated pupil constricts.
  • Consensual – opposite pupil constricts simultaneously.
• Accommodation – focus from far → near → pupils constrict & eyes converge.
• Both mediated by CN III.

Key Bedside Tests

1. Snellen chart – stand 20 ft; record as fraction (20/20 normal).
2. Confrontation (CN II)
   • Cover opposite eyes; wiggle fingers from periphery → note first sight.
3. Six Cardinal Fields (EOMs, CN III IV VI)
   • Trace large H or six-point star; look for nystagmus.
4. PERRLA documentation
   • Pupils Equal, Round, Reactive to Light & Accommodation
   • Include size (e.g.
     \text{PERRLA } 5\,\text{mm} \rightarrow 3\,\text{mm constrict}).

Aging Eyes

• Presbyopia (↓ lens elasticity)→ hold reading @ arm’s length.
• Need brighter light; ↑ glare issues → fall risk.
• Common disorders
  • Cataract (lens clouding) – higher in women.
  • Glaucoma (↑IOP) – peripheral loss.
  • Macular degeneration – central vision loss.
  • Diabetic retinopathy – #1 cause blindness (sugar coats retinal nerves).

Ocular Pathologies to Recognize

• Strabismus (eso- vs. exo-)
• Ptosis (lid droop), periorbital edema
• Exophthalmos vs. enophthalmos
• Hordeolum (stye) & chalazion
• Mydriasis (dilated) vs. miosis (pin-point) pupils
• Conjunctivitis (pink-eye, contagious)
• Iritis – halo around iris; urgent.
• Flashes/floaters → suspect retinal detachment, medical emergency.
• Arcus senilis & xanthelasma in elderly (benign lipid changes).

Ear Essentials (brief)

• External ear = pinna/auricle; top aligns with outer canthus.
  • Low-set ears may suggest Down syndrome.
• Whisper test (CN VIII): occlude 1 ear, whisper 3-words behind pt.
• Subjective data: pain, infection, discharge (clear CSF? test for glucose), noise exposure, tinnitus, vertigo, hygiene.
• Presbycusis: gradual bilateral high-frequency loss.
• NO deep Q-tips – may damage canal & tympanum.

Test-Taking Strategy Highlight

1. Read stem 3 times.
2. Highlight/underline cues (e.g.
   “throbbing”, “relieved when lying down”).
3. Rapidly eliminate 2 implausible choices.
4. Re-read for subtle qualifier words, choose best of remaining 2.

Ethical / Practical Points

• Adequate rest crucial for student nurses & patient safety.
• Respect elder independence; allow time yet ensure home safety.
• Infection control: conjunctivitis & ear drainage require precautions.
• When patient reports aura, flashes, or imminent fainting – act immediately to prevent harm.