Physical Assessment: Ears, Mouth And Neck

Front 1

Name the external structures of the ear.

Back 1

Auricle or pinna (consists of movable cartilage and skin)
-Landmarks: helix, antihelix, tragus, antitragus are used as reference points when documenting findings.

Front 2

List the structures of the Middle Ear and its function.

Back 2

Middle: Tiny air-filled cavity within bone
-Consists of Tympanic Membrane, Stapes, Malleus and Incus
-Conducts sound vibration and protects the inner ear from amplitude: it also tries to equalize the pressure on the tympanic membrane

Front 3

Describe the aspects of the inner ear.

Back 3

Consists of the cochlea, semicircular canals and the vestibular nerve.
-Aids in converting sound wave to electrical impulses
-Helps regulate equilibrium

Front 4

Describe the Tympanic Membrane.

Back 4

-Eardrum
-Normally shiny but translucent, should be able to see the bones
-Oval in shape and slightly concave and pulled to the center by the malleus bone.
-the pars tensa is a tense tissue
-When the pt coughs it appears red.
-Sound waves cause vibrations on the ear drum that is then sent to the bones of the ear to be relayed to the cranial nerve.

Front 5

Why do children get infections in their ear more often than adults?

Back 5

The eustachian tube that connects their nose to their ear is horizontal and thus infection can travel easily to the ears.

Front 6

What is otosclerosis?

Back 6

An abnormal spongy bone growth in the middle ear that causes hearing loss.
-The most frequent type of hearing loss in adults. Usually occurs in women during pregnancy or those with a family history
-White women are effected most.

Front 7

What is Presbycusis?

Back 7

Age related hearing loss.
-Can result from over working the ears.
-Loud music, concerts, airports etc.

Front 8

What are the two pathways of hearing?

Back 8

-The most typical is form is air conduction
-Bone conduction is also a pathway.

Front 9

What questions should you ask when conducting an ear exam?

Back 9

-Earaches
-Infections
-Discharge
-Hearing loss
-Environmental Noise
-Tinnitus: ringing in the ears
-Vertigo: spinning
-Self care behavior: Q-Tips

Front 10

What are three types of normal hearing test?

Back 10

-Conversational Test: can they hear you while talking
-Finger Rubbing: rub your fingers next to each ear
-Whisper test: cover one ear and whisper a 2 syllable word in the other

Front 11

What is the Weber Test?

Back 11

Use a 512 fork in the midline of the head
-Ask if sound is louder in one hear in one ear than the other
-Lateralizes the midline, left or right
-If there is conductive loss the sound will be louder in the blocked ear
-If nerve damage: the sound will go to the good ear because the bad ear is dead.

Front 12

What is the Rinne Test?

Back 12

-Place a tuning fork on the mastoid bone and ask the pt when they hear the sound disappear.
-Then place the fork next to the ear ask wait for the sound to disappear
-In normal hearing the air conduction will be 2x as long as the bone.
-Conductive loss: The air will equal the bone or will be less than the bone.
-Never Damage: If the nerve is dead you will not hear at all.

Front 13

When you inspect the ear what should you look for?

Back 13

Any lesions especially on the top of the pinna or nodules: people with gout will get chalky white substance in a nodule.

Front 14

What should you palpate on the ear?

Back 14

-Tragus: should have no pain, if there is there may be an infection
-Mastoid Process: should not be painful, but an ear infection may cause tenderness.
-mastoiditis: the mastoid will feel spongy and painful

Front 15

What is cerumen?

Back 15

Ear wax

-You should have some to help protect the ear

-An abundance may cause hearing loss, tinnitus or dizziness

Front 16

What is Exostosis?

Back 16

-Discreet, hard, round or oval outcropping
-formation of new bone on the surface of a bone
-Seen in swimmers and surfers
-Develops over many years and can result in infections, pain and hearing loss.

Front 17

What is Otitis Externa?

Back 17

-Scaling or crusting, inflammation and discharge in the ear canal
-pain on movement of the tragus especially
-may have palpable nodes
-ask about swimming, frequent ear cleaning

Front 18

Describe Serous Otitis Media

Back 18

-Tympanic Mem is retracted and has decreased motility
-Thin serous effusion give a yellowish appearance
-Bubbles apparent if eustachian tube is blocked
-bubbles mean that the ear is completely blocked and nothing is draining
-Not treated with antibiotics. The fluid is not infected. Treated with DECONGESTANTS

Front 19

Describe an ear infection

Back 19

The TM will be pushing out towards you an can be very red and filled with pus.

Front 20

What causes a perforated TM?

Back 20

-Loud noises, trauma, damage
-toothpicks, bobbypins etc
-It will heal but with a scar and possibly a decrease in hearing

Front 21

What does scarring look like in the ear?

Back 21

-TM will have a white chalky appearance

Front 22

What is a Tympanostomy Tube and when is it used?

Back 22

This is a tube that is surgically inserted, mostly in children who get frequent ear infections.
-The tube helps to equalize pressure and helps with drainage.

Front 23

List the landmarks of the nose.

Back 23

-Bridge
-Free corner or tip
-Nares- openings
-Kiesselback region- anteroinferior part of the nasal spetum, where four arteries anastomose
-Columella-means the little column between the nares
-Ala nasi- expanded out wall of cartilage on each side of the nose

Front 24

What is the function of the nose?

Back 24

Warms, moistens and filters inhaled air.
-Houses the sensory organ for smell and innervated by CN I

Front 25

What are the turbinants in the nose and their function?

Back 25

-Located on the lateral wall
-Include the Superior meatus (ethmoid bone), the middle meatus (sinuses) and the inferior meatus (tears)
-These increase the surface area and are rich with blood which helps to warm the air.

Front 26

What is the color of the nose compared to the mouth?

Back 26

The nose is much redder because it has a rich blood supply.

Front 27

Where is cranial nerve I located?

Back 27

At the top of the nasal passage.

Front 28

What are the anterior and remainder of the nasal cavity lined with>?

Back 28

-Anterior: coarse nasal hairs for filtering
-Remainder of cavity is lined with ciliated mucous membranes to filter dust and bacteria

Front 29

What and where are the sinuses?

Back 29

-They are air-filled pockets within the cranium to lighten weight of the skull
-Four pairs
-Only frontal and maxillary can be examined in a physical exam

Front 30

What are some questions you should ask when examining the nose?

Back 30

-Discharge
-Frequent colds
-Sinus pain
-Trauma
-Epistaxis
-Allergies
-Altered smell

Front 31

What should you inspect and palpate in the physical exam of the nose?

Back 31

-Inspect for symmetry and if there is a deviated or perforated septum
-Evaluate airway patency: Breathe in with one nostril then the other.
-Palpate or percuss sinus areas
Transillumination- shine a light in the eye and can see it in the nose.

Front 32

what do polyps look like in the nose?

Back 32

-yellowy
-Any growth must be biopsied
-They are non tender and make people snore, or chose or clogs the sinuses.

Front 33

What is acute and allergic rhinnitis?

Back 33

-Allergic: will be more water, itchy nose and eyes accompanied by nasal congestion, sneexing and the turbinates will be swollen.
-Acute: swollen and bright red and watery clear discharge. Maybe pus with a sinus infection.

Front 34

What is a perforated septum?

Back 34

-Common
-snorting cocaine or overusing sinus sprays
-Whole is the septum wall

Front 35

What is transillumination?

Back 35

Technique to test the sinuses are air filled. Shine a light down the corner of the eye with the pt mouth open and should be able to see the light inside the mouth.

Front 36

What is the function of the mouth?

Back 36

-First segment of the digestive system and airway or respiratory system.
-In addition, the mouth contains taste buds and aids in speech production.

Front 37

List the structures of the oral cavity.

Back 37

-Teeth: 32 as adults and 20 temporary (deciduous) in children (grown in by age 2)
-Hard palate: is bone with tissue over it and looks more white
-Soft palate: pink and more mobile
-Uvula and posterior and anterior pillars
-Tongue
-Valiate papilla

Front 38

Where are the tonsils located?

Back 38

Between the anterior and posterior pillars in the oral cavity

Front 39

What is the function of the tonuge?

Back 39

Can change shape which helps with swallowing
-cleans the teeth
-helps with speech
-contains taste buds

Front 40

What is the valiate papilla?

Back 40

-Bumps located on the back of the tongue and may be very prominent in some pts.

Front 41

Where is parotid gland and what if it is inflamed?

Back 41

-Located in the cheesk
-drains through the Stenson duct which are located above the second molars
-If swollen it may be a sign of mumps, infection or cancer.

Front 42

Where is the submandibular gland and where is it secreted?

Back 42

-Located below the mandible
-Secretes into the Warton's Duct located under the tongue

Front 43

Where are the openings of the sublingual glands?

Back 43

-There are many so we cannot truly check them during a physical exam

Front 44

What questions should you ask during the physical exam of the mouth?

Back 44

-Sores or lesions
-Sore Throat
-Bleeding gums
-Toothache
-Hoarseness
-Dysphagia (difficulty swallowing with solids, liquids or both)
-Altered taste
-Smoking or alcohol
-Self care
-

Front 45

What to inspect during the Physical exam of the mouth

Back 45

-Lips: color, swellings, ulcers
-Gums and teeth- any absent or in good repair. Gums should look pink or coral and have a dotted surface
-Buccal mucosa
-Tongue
-Stenson and Warton's Ducts
-Tonsil

-

Front 46

What is the grading scale for tonsils?

Back 46

-None: write tonsils absent
-1+: visible
-2+: half way to uvula
-3+: (almost) touching uvula
-4+: touching eacother (EMERGENCY)

Front 47

What grade of tonsils is normal for children?

Back 47

3+

Front 48

How do you assess the hypoglossal cranial nerve?

Back 48

-Have pt stick out their tongue and ask them to move side to side.
-If the tongue deviates to one side there may be damage to the nerve on that side.

Front 49

What is a Scrotal tongue?

Back 49

-aka Fissure tonue
-looks liek a scrotum: normal but can get food caught in the fissures.

Front 50

What is a geographic tongue?

Back 50

-Normal but the tongue looks like some one has printed a map on their tongue

Front 51

What are Fordyce Spots?

Back 51

Little dots in the Buccal or on the inside of the cheek and completely normal

Front 52

What is Torus Palatinus?

Back 52

Hard palate appears more ridged and sticks out slightly.

Front 53

What are Cryptic Tonsils?

Back 53

Large tonsils, but completely normal for that pt. They may get food stuck in them and may cause pain.
-The crypts are a result of the food stuck in them

Front 54

What is viral pharyngitis?

Back 54

-Back of the pharynx looks like cobble stones, very red, scratchy or sore throat

Front 55

What is bacterial pharyngitis?

Back 55

Excrudite will appear on the tonsils. Accompanied by fever, very red, pus on the tonsils and possibly body aches.

Front 56

What are the salivary glands and vessels of the Neck?

Back 56

-Parotid and submandibular glands
-External jugular vein: can be used to see if the pt has increased venous pressure
-We commonly use internal jugular vein.

Front 57

What muscles of the neck are innervated by cranial nerve 11?

Back 57

Sternocleidomastoid and the trapezius muscles

Front 58

What is the function of the lymph nodes?

Back 58

Protect against invading organisms. The lymph system runs alongside the venous system
-Removes excess proteins and bacteria from interstitial system

Front 59

What is the function of the lymph node beads?

Back 59

They are the location where the toxic substances collect and swell.

Front 60

What will the lymph nodes of a person with Hodgkin's lymphoma have?

Back 60

They will have generalized swelling of all lymph nodes of the body.

Front 61

What are the lymph nodes of the head and neck?

Back 61

-Pre auricular
-Posterior auricular
-Occipital
-Tonsilor (jugulardygastric)
-Submandibular
-Sublingual
-Submental
-Superficial cervical
-Posterior cervical
-Deep cervical
-Supra clavicular
-Infraclavicular

Front 62

What is the function of the thyroid gland?

Back 62

Endocrine gland for metabolism and straddles the trachea

Front 63

What is the location of the thyroid gland?

Back 63

-Straddles the trachea
-Isthmus lies over the trachea at 2nd and 3rd tracheal ring
-Just before isthmus is the cricoid cartilage with thryroid cartilage above that (Adam's Apple)

Front 64

IIf you feel lymph nodes, what is normal?

Back 64

They should be soft, movable, less than 1 cm and non tender

Front 65

What is possible if a bunch of lymph nodes are enlarged together on the side of the chin?

Back 65

May be TB

Front 66

What if the trachea is misaligned?

Back 66

The pt is under distress. Possible a collapsed lung or if only slight may be a thyroid problem

Front 67

What are you looking for when you auscultate the carotid artery?

Back 67

Bruit: a whooshing sound of turbulent blood flow (70% blockage)

Front 68

How do you test CN 11

Back 68

-Have pt lift shoulders against resistance for sternocleidomastoid
-Have pt push cheek against hand for masseter muscle

Front 69

How should you palpate the trachea?

Back 69

From behind and gently.

Front 70

What is a goiter?

Back 70

Enlarged thyroid gland
--maybe underactive, overactive or normal.