2. Learning Objectives
Learning Objectives
The student will be able to identify
The student will be able to identify
different components of the head, eyes,
different components of the head, eyes,
ears, nose, and throat
ears, nose, and throat
The student will be able to identify
The student will be able to identify
anatomic landmarks of the head, eyes,
anatomic landmarks of the head, eyes,
ears, nose and throat
ears, nose and throat
3. The student will be able to identify and
The student will be able to identify and
perform the proper techniques for a basic
perform the proper techniques for a basic
exam of the head, eyes, ear, nose and
exam of the head, eyes, ear, nose and
throat
throat
The student will be able to describe and
The student will be able to describe and
record findings of the head, eyes, ears,
record findings of the head, eyes, ears,
nose and throat examination
nose and throat examination
4. Learning Objectives
Learning Objectives
The student will be able to identify
The student will be able to identify
different disorders of the head, eyes, ears,
different disorders of the head, eyes, ears,
nose, and throat
nose, and throat
The student will be able to identify the
The student will be able to identify the
signs and symptoms of HEENT disorders
signs and symptoms of HEENT disorders
5. Objective 1: Components of the
Objective 1: Components of the
HEENT Exam
HEENT Exam
HEAD
HEAD
inspection:
inspection:
skull- size ,shape, symmetry, deformity
skull- size ,shape, symmetry, deformity
scalp- redness, scaling
scalp- redness, scaling
hair- quantity, distribution ,nits, lice
hair- quantity, distribution ,nits, lice
face – symmetry, involuntary
face – symmetry, involuntary
movements, skin lesions, color,
movements, skin lesions, color,
shape
shape
15. Tests
Tests
Auditory acuity – decreased hearing
Auditory acuity – decreased hearing
Weber test- lateralization
Weber test- lateralization
Rinne test- AC vs BC
Rinne test- AC vs BC
16. Nose and sinuses
Nose and sinuses
Inspection:
Inspection:
External nares – asymmetry, deformity
External nares – asymmetry, deformity
Internal nares with otoscope – swelling,
Internal nares with otoscope – swelling,
turbinates, septal deviation,
turbinates, septal deviation,
perforation, discharge, blood
perforation, discharge, blood
crusting, ulcers, polyps
crusting, ulcers, polyps
20. Objective 2: Anatomic Landmark
Objective 2: Anatomic Landmark
To be able to identify common structures
To be able to identify common structures
in this region which are routinely assessed
in this region which are routinely assessed
during physical exam
during physical exam
29. Objective 3: Physical Exam
Objective 3: Physical Exam
To be able to identify and perform proper
To be able to identify and perform proper
techniques for the basic examination of
techniques for the basic examination of
the head, neck, eyes, ears, nose and
the head, neck, eyes, ears, nose and
throat
throat
30. Procedure
Procedure
HEAD
HEAD
Stand beside or behind the seated patient
Stand beside or behind the seated patient
Observe head position
Observe head position
midline, tilted to one side, rotated
midline, tilted to one side, rotated
35. Inspect the scalp for:
Inspect the scalp for:
- scales
- scales
- scars
- scars
- parasites, nits
- parasites, nits
- mass
- mass
- pay special attention to the areas behind the
- pay special attention to the areas behind the
ears, at the hairline and at the crown of the
ears, at the hairline and at the crown of the
head. Note for any hair loss pattern
head. Note for any hair loss pattern
36. Palpate the scalp for:
Palpate the scalp for:
- tenderness
- tenderness
-mass ( sebaceous cyst, lipoma, tumor)
-mass ( sebaceous cyst, lipoma, tumor)
- or fluctuant scalp masses like
- or fluctuant scalp masses like
hematoma, abscess, depressed fracture
hematoma, abscess, depressed fracture
- scalp movement
- scalp movement
37. Hair : inspect and palpate
Hair : inspect and palpate
- color
- color
- length
- length
- distribution- well distributed
- distribution- well distributed
- pattern of hair loss- receding hair line
- pattern of hair loss- receding hair line
- quantity –thin, thick or fairly abundant
- quantity –thin, thick or fairly abundant
- texture- fine or coarse
- texture- fine or coarse
- moisture – dry or oily
- moisture – dry or oily
- look for lice and nits
- look for lice and nits
38.
39. Palpation of Temporomandibular joint
Palpation of Temporomandibular joint
40. Locate the TMJ with your fingertips placed
just anterior to the tragus of each ear.
Allow your fingertips to slip into the joint
space as the patient’s mouth open and
gently palpate the joint space
41. An audible or palpable snapping or clicking
in the TMJ is not unusual, but pain,
crepitus, locking or popping may indicate
TMJ syndrome
42.
43. Objective 4: Record Findings
Objective 4: Record Findings
To be able the describe and record
To be able the describe and record
findings of the head, neck, eyes, ears and
findings of the head, neck, eyes, ears and
throat
throat
44. Record the Findings
Record the Findings
Normocephalic, head held erect and in the
Normocephalic, head held erect and in the
midline, thick hair, well-distributed, no
midline, thick hair, well-distributed, no
focal areas of hair loss, coarse and dry,
focal areas of hair loss, coarse and dry,
scalp moves freely under examining
scalp moves freely under examining
fingers, no mass or tenderness, temporal
fingers, no mass or tenderness, temporal
arteries palpable but not thickened
arteries palpable but not thickened
45. Describe anatomy and landmark of the
Describe anatomy and landmark of the
FACE
FACE
46.
47. Procedure
Procedure
FACE
FACE
Stand or sit in front of the patient at the same level
Stand or sit in front of the patient at the same level
Inspect the face for:
Inspect the face for:
- skin : color, pigmentation and lesions
- skin : color, pigmentation and lesions
- shape – oval, round, prominent and protruding chin
- shape – oval, round, prominent and protruding chin
- facial expression and involuntary movements
- facial expression and involuntary movements
- edema
- edema
- symmetry – if asymmetric present describe
- symmetry – if asymmetric present describe
eg..shallow nasolabial fold.
eg..shallow nasolabial fold.
48.
49. Palpate the temporal arteries, noting the
Palpate the temporal arteries, noting the
ff:
ff:
- thickening
- thickening
- hardness
- hardness
- tenderness
- tenderness
Auscultate temporal arteries for bruits
Auscultate temporal arteries for bruits
50.
51. Record findings
Record findings
Face is oval in shape, symmetrical, fair
Face is oval in shape, symmetrical, fair
skinned, with occasional pigmented
skinned, with occasional pigmented
papules scattered over the face, no
papules scattered over the face, no
masses, nor involuntary movements,
masses, nor involuntary movements,
temporal artery not visible but palpable
temporal artery not visible but palpable
with strong pulsation, walls not thickened
with strong pulsation, walls not thickened
52. NECK
NECK
Describe the anatomy and landmarks of
Describe the anatomy and landmarks of
the NECK
the NECK
60. Procedure
Procedure
Inspect the neck for :
Inspect the neck for :
- symmetry
- symmetry
- size ( long or short)
- size ( long or short)
- deformity
- deformity
- masses, webbing
- masses, webbing
- alignment of trachea
- alignment of trachea
- jugular vein distention
- jugular vein distention
- carotid artery prominence
- carotid artery prominence
61. Evaluate range of motion of the neck
Evaluate range of motion of the neck
- flex, extend ,rotate and lateral turn of the
- flex, extend ,rotate and lateral turn of the
head and neck
head and neck
- movement should be smooth ,painless
- movement should be smooth ,painless
and should not cause dizziness
and should not cause dizziness
62. Palpate the neck for:
Palpate the neck for:
- tracheal position
- tracheal position
- carotid pulsations
- carotid pulsations
- lymph nodes
- lymph nodes
- thyroid gland
- thyroid gland
66. Procedure
Procedure
LYMPH NODES
LYMPH NODES
The examiner should stand behind the
The examiner should stand behind the
seated patient
seated patient
Use the pads of both index and middle
Use the pads of both index and middle
fingers as you move the skin over the
fingers as you move the skin over the
underlying tissues in each area rather than
underlying tissues in each area rather than
moving your fingers over the skin in a
moving your fingers over the skin in a
rotatory fashion
rotatory fashion
67. Feel in sequence for the following nodes
2. Preauricular –in front of the ear
3. Posterior auricular – superficial to the
mastoid process
4. Occipital – at the base of the skull
5. Tonsillar – at the angle of the mandible
6. Submandibular – midway between the
angle and the tip of the mandible
68. 6. Submental – in the midline
7. Superficial cervical – superficial to the SCM
8. Posterior cervical chain –along the anterior edge
of the trapezius
9. Deep cervical chain –deep into the SCM but
often inaccessible to examination
10. Supraclavicular –deep in the angle formed by
the clavicle and the SCM
69. Palpate the lymph nodes for:
Palpate the lymph nodes for:
- size
- size
- shape
- shape
- delimitation ( discrete or matted together)
- delimitation ( discrete or matted together)
- mobility
- mobility
- consistency
- consistency
- tenderness
- tenderness
Small, mobile, discrete, nontender nodes are
Small, mobile, discrete, nontender nodes are
frequently found in normal persons
frequently found in normal persons
74. Locate for the carotid pulse, in the neck
just medial to and below the angle of the
jaw ( do not palpate simultaneously)
Excessive carotid massage can cause
slowing of the pulse or a drop in blood
pressure
75. If you have difficulty feeling the pulse,
rotate the patient’s head to the side being
examined to relax the SCM muscle
Examine the arterial pulse with the distal
part of the 2nd
and 3rd
fingers
79. Procedure
Procedure
Inspect the trachea for any deviation from
Inspect the trachea for any deviation from
its usual midline position
its usual midline position
Then feel for any deviation by placing your
Then feel for any deviation by placing your
finger along one side of the trachea and
finger along one side of the trachea and
note the space between it and the SCM.
note the space between it and the SCM.
80. Compare it with the other side. The
Compare it with the other side. The
spaces should be symmetrical. If
spaces should be symmetrical. If
asymmetrical there is deviation
asymmetrical there is deviation
81.
82. Describe the anatomy and landmarks of
Describe the anatomy and landmarks of
the THYROID GLAND
the THYROID GLAND
83.
84.
85. Procedure
Procedure
THYROID GLAND
THYROID GLAND
Patient should be seated
Patient should be seated
Inspect the lower half of the neck in the
Inspect the lower half of the neck in the
anterior triangles
anterior triangles
Have him swallow or sip a glass of water
Have him swallow or sip a glass of water
to note any ascending mass in the midline
to note any ascending mass in the midline
or behind the SCM
or behind the SCM
86. If the patient is obese or has a short neck
If the patient is obese or has a short neck
, tilt the head back to be supported by his
, tilt the head back to be supported by his
hands clasped at the occiput.
hands clasped at the occiput.
Ask him to swallow while in this posture
Ask him to swallow while in this posture
The thyroid gland, thyroid cartilage, and
The thyroid gland, thyroid cartilage, and
cricoid cartilage all normally rise as the
cricoid cartilage all normally rise as the
person swallows
person swallows
87. Palpation
Palpation
-best done from behind the patient
-best done from behind the patient
- cricoid cartilage is the basic landmark
- cricoid cartilage is the basic landmark
for examination
for examination
2 methods of palpation:
2 methods of palpation:
f)
f) Palpation from behind
Palpation from behind
g)
g) Frontal palpation of the thyroid gland
Frontal palpation of the thyroid gland
88. Palpate the thyroid gland for :
Palpate the thyroid gland for :
- size
- size
- shape
- shape
- symmetry
- symmetry
- consistency of the gland, tenderness
- consistency of the gland, tenderness
- presence of nodules
- presence of nodules
- movement
- movement
89.
90.
91.
92. Record findings
Record findings
NECK
NECK
Neck is supple with full range of motion,
Neck is supple with full range of motion,
trachea midline, no lymphadenopathy
trachea midline, no lymphadenopathy
noted. A 1x2 cm nodule is palpated in the
noted. A 1x2 cm nodule is palpated in the
right lobe of the thyroid; smooth, soft,
right lobe of the thyroid; smooth, soft,
nontender, moves freely when patient
nontender, moves freely when patient
swallows
swallows
93. Objective 5:Record abnormal
Objective 5:Record abnormal
Findings
Findings
To be able to identify and record different
To be able to identify and record different
disorders of head ,neck, eyes, ears, nose
disorders of head ,neck, eyes, ears, nose
and throat
and throat
94. Facies
Facies
Expression or appearance of the face and
Expression or appearance of the face and
features of the head and neck that when
features of the head and neck that when
considered together, are characteristics of
considered together, are characteristics of
a clinical condition or syndrome
a clinical condition or syndrome
95. Acromegaly
Acromegaly
-large head
-large head
- forward projection of jaw
- forward projection of jaw
- protrusion of frontal bone
- protrusion of frontal bone
96. Cushing Syndrome
Cushing Syndrome
- thin erythematous skin
- thin erythematous skin
- hirsutism
- hirsutism
- rounded or moon
- rounded or moon
shaped face
shaped face
98. Hyperthyroid Facies
Hyperthyroid Facies
- fine moist skin
- fine moist skin
- fine hair
- fine hair
- prominent eyes
- prominent eyes
- lid retraction
- lid retraction
- startled expression
- startled expression
99. (R) Facial Palsy
(R) Facial Palsy
- assymmetry of one side of
- assymmetry of one side of
the face
the face
- eyelid not closing completely
- eyelid not closing completely
- loss of nasolabial fold
- loss of nasolabial fold
- drooping lower eyelid and
- drooping lower eyelid and
corner of the mouth
corner of the mouth
109. HEADACHE
- refers to pain perceived more than
momentarily in the cranial vault , orbits
and the nape. Pain elsewhere in the face
is not included
110. Mechanisms of Headache
1. infection – meningitis, encephalitis
2. arterial dilatation – Malignant
Hypertension
3. hemorrhage – intracebral , subdural and
SAH
4.Expanding mass lesion – brain tumor
111. 5. Trauma – head trauma , inc. ICP
6. Tissue Ischemia – hypoxia, hypoglycemia
113. Muscle Contraction Headache: Tension
Muscle Contraction Headache: Tension
Headache
Headache
- Mild or moderate discomfort, a heavy feeling, a
- Mild or moderate discomfort, a heavy feeling, a
sense of pressure, tight band, steady rather than
sense of pressure, tight band, steady rather than
throbbing
throbbing
- related to emotional tension
- related to emotional tension
- not intensified by coughing
- not intensified by coughing
- improved by shaking the head, massage, mild
- improved by shaking the head, massage, mild
analgesics, application of hot packs
analgesics, application of hot packs
115. Classic Migraine
Classic Migraine
4 phases
4 phases
1. Prodrome- an attack is often triggered
1. Prodrome- an attack is often triggered
by period of anxiety, tension,
by period of anxiety, tension,
bright light, loud noise,
bright light, loud noise,
skipped meals, foods and
skipped meals, foods and
beverages, strong odors and
beverages, strong odors and
change in sleep patterns
change in sleep patterns
116. 2. Aura – visual disturbances
2. Aura – visual disturbances
3. Headache
3. Headache
- frequently present on awakening
- frequently present on awakening
-severe throbbing, boring, aching
-severe throbbing, boring, aching
headache over 1 hr.
headache over 1 hr.
- does not disrupt sleep
- does not disrupt sleep
- increased in the reclining position, shaking
- increased in the reclining position, shaking
the head, coughing or straining at stool
the head, coughing or straining at stool
117. - Associated symptoms are N/V,
Associated symptoms are N/V,
photophobia, annoyance for odors,
photophobia, annoyance for odors,
maybe normal or cold limbs and pale skin
maybe normal or cold limbs and pale skin
4. Recovery
4. Recovery
119. Cluster headache : Histamine headache
Cluster headache : Histamine headache
or Histamine Cephalgia
or Histamine Cephalgia
- due to dilatation of branches of the
- due to dilatation of branches of the
internal carotid artery
internal carotid artery
- 5-6x more common in men
- 5-6x more common in men
- onset is typically 3
- onset is typically 3rd
rd
- 4
- 4th
th
decade of life
decade of life
- commonly episodic and begins w/o
- commonly episodic and begins w/o
aura
aura
120. - Unilateral , severe ,boring,, and throbbing
Unilateral , severe ,boring,, and throbbing
headache that recurs consistently on the
headache that recurs consistently on the
same side lasting an average of 40 min
same side lasting an average of 40 min
- Associated symptoms are flushing,
Associated symptoms are flushing,
rhinorrhea, conjunctivitis, lacrimation,
rhinorrhea, conjunctivitis, lacrimation,
temporal artery dilatation on the affected
temporal artery dilatation on the affected
side, sweating of the skin
side, sweating of the skin
122. Hypertensive headache
- due to segmental dilatation of branches of
external carotid artery
- headache occurs in half of patients with
accelerated HPN without encepalopathy
- Headache often occipital, no aura
- Diastolic pressure must exceed 120 mm hg
to cause headache
123. Brain tumor
- Benign and malignant intracranial
neoplasms compress and place traction on
surrounding structures
- Headache maybe the first symptom, the
onset is recent, a recent change in the
customary headache pattern has occured
124. - An apparent migraine aura persists after
the headache subsides
- Headache starts by abrupt change in
position, exertion and inc. in recumbent
position
- May interfere with sleep
125. Subarachnoid hemorrhage
- Results fr. rupture of a saccular anuerysm
of the circle of willis, preceeded often by a
leakage
- Excruciating generalized headache,
followed by nuchal rigidity, then coma,
often death
126. Meningitis
- Headache , fever and signs of meningeal
irritation ( nuchal rigidity)
- Headache intensified by sudden
movement of the head
127. NECK
NECK
Stiff neck:
Stiff neck:
1) Torticollis ( wryneck)
1) Torticollis ( wryneck)
- the congenital type is due to hematoma
- the congenital type is due to hematoma
or partial rupture of the muscle at birth
or partial rupture of the muscle at birth
resulting in unilateral muscle shortening
resulting in unilateral muscle shortening
132. Thyroid
Thyroid
Thyroid enlargement ( GOITER)
Thyroid enlargement ( GOITER)
- results from:
- results from:
a) hyperplasia of the thyroid tissue
a) hyperplasia of the thyroid tissue
b) infection
b) infection
c) neoplastic growth ( primary thyroid cancer,
c) neoplastic growth ( primary thyroid cancer,
metastatic growth, lymphoma)
metastatic growth, lymphoma)
d) infiltration with foreign substances ( amyloid)
d) infiltration with foreign substances ( amyloid)
-
-
133. - patient complains of fullness of mass in
- patient complains of fullness of mass in
the neck , pressure symptoms
the neck , pressure symptoms
- Determine the size of the component of
- Determine the size of the component of
the gland, extension the gland within the
the gland, extension the gland within the
neck or into the retrosternal space,
neck or into the retrosternal space,
fixation to surrounding structures
fixation to surrounding structures
134. -characterize the enlarge thyroid as diffuse,
-characterize the enlarge thyroid as diffuse,
focal, nodular, or smooth
focal, nodular, or smooth
- tenderness
- tenderness
135. -make an assessment of the state of thyroid
-make an assessment of the state of thyroid
function: Hypothyroid, Hyperthyroid, euthyroid
function: Hypothyroid, Hyperthyroid, euthyroid
- Clinical classification is based whether thyroid is
Clinical classification is based whether thyroid is
diffuse or nodular
diffuse or nodular
- Level of functional thyroid state:
Level of functional thyroid state:
a) toxic goiter
a) toxic goiter
b) nontoxic goiter ( euthyroid or hypothyroid)
b) nontoxic goiter ( euthyroid or hypothyroid)
136. Retrosternal Goiter ( substernal,
Retrosternal Goiter ( substernal,
intrathoracic , or submerged goiter)
intrathoracic , or submerged goiter)
- when the lower border of a goiter can’t
- when the lower border of a goiter can’t
be palpated
be palpated
- Goiter may rise only with inc. intrathoracic
- Goiter may rise only with inc. intrathoracic
pressure like coughing. This is also called
pressure like coughing. This is also called
plunging goiter.
plunging goiter.
137. 2 physical signs of retrosternal goiter
2) Tracheal displacement
3) Venous engorgement in the neck
139. Thyroid syndromes
Thyroid syndromes
- excess or deficit of thyroid hormones
- excess or deficit of thyroid hormones
alter the physical structure of the body to
alter the physical structure of the body to
produce physical signs
produce physical signs
- examine your patient to determine the
- examine your patient to determine the
size of the TG, to assess thyroid function,
size of the TG, to assess thyroid function,
to judge the likehood of cancer
to judge the likehood of cancer
140. Thyroid syndromes
Thyroid syndromes
a) Hyperthyroidism
a) Hyperthyroidism
- overproduction of the thyroid
- overproduction of the thyroid
hormone or excessive thyroid
hormone or excessive thyroid
medication
medication
- often with generalized muscle weakness,
- often with generalized muscle weakness,
energetic, irritable, tachycardic, tremor
energetic, irritable, tachycardic, tremor
frequent defecation, wt. loss , inc appetite
frequent defecation, wt. loss , inc appetite
141. b) Hypothyroidism
b) Hypothyroidism
-due to iodine deficiency, deficit of TH,
-due to iodine deficiency, deficit of TH,
excessive dose of thiouracil drugs,
excessive dose of thiouracil drugs,
lithium, thiocyanates, paraaminosalicylic
lithium, thiocyanates, paraaminosalicylic
acid, phenylbutazone
acid, phenylbutazone
- slow metabolism, fatigue, loss of energy,
- slow metabolism, fatigue, loss of energy,
wt gain, constipation, coldness
wt gain, constipation, coldness
142. Lymph Nodes
Lymph Nodes
Determine if the lymph node is localized
Determine if the lymph node is localized
to the neck or generalized in other parts
to the neck or generalized in other parts
of the body
of the body
Acute cervical lymphadenopathy
Acute cervical lymphadenopathy
1) Localized lymphadenitis
1) Localized lymphadenitis
- common infections of the scalp, face,
- common infections of the scalp, face,
mouth, teeth, pharynx or ear
mouth, teeth, pharynx or ear
143. Submental lymph nodes
- primary lesions from the lower lip,
anterior tongue, floor of the mouth
Posterior cervical lymph nodes and
occipital
- primary lesions from the posterior 2/3 of
the scalp and nasopharynx
144. Anterior cervical lymph nodes
- primary lesions from anterior 2/3 of the
scalp, face including maxillary sinus, oral
cavity ( tongue, tonsils, larynx)
145. 2) Generalized lymphadenitis
2) Generalized lymphadenitis
- syphilis
- syphilis
- rubella
- rubella
- IM
- IM
- HIV
- HIV
- Generalized Furunculosis
- Generalized Furunculosis
146. Chronic localized cervical lymphadenopathy
Chronic localized cervical lymphadenopathy
a) TB
a) TB
b) Hodgkin disease
b) Hodgkin disease
c) actinomycosis
c) actinomycosis
147. d) Virchow node ( sentinel node)
d) Virchow node ( sentinel node)
-enlargement of a single lymph node
-enlargement of a single lymph node
usually in the left supraclavicular group
usually in the left supraclavicular group
- it may be the result of either abdominal or
- it may be the result of either abdominal or
thoracic malignancy
thoracic malignancy
151. Definitions of Parts Shown Above
Definitions of Parts Shown Above
Helix - The in-curve rim of the external ear
Helix - The in-curve rim of the external ear
Antihelix - A landmark of the outer ear
Antihelix - A landmark of the outer ear
Lobule - A landmark of the outer ear. The very bottom part of the outer ear
Lobule - A landmark of the outer ear. The very bottom part of the outer ear
Crest of Helix - A landmark of the outer ear
Crest of Helix - A landmark of the outer ear
ExternalAuditory Meatus - or External Auditory Canal. The auditory canal is
ExternalAuditory Meatus - or External Auditory Canal. The auditory canal is
the channel through which the sounds are led from the ear outside to the
the channel through which the sounds are led from the ear outside to the
middle ear.
middle ear.
Eardrum - (tympanic membrane) A thin layer of skin at the end of the
Eardrum - (tympanic membrane) A thin layer of skin at the end of the
external ear canal
external ear canal
Auditory Ossicles - The three small bones in the middle ear, know as the
Auditory Ossicles - The three small bones in the middle ear, know as the
hammer (malleus), anvil (incus) and stirrup (stapes) which are connected to
hammer (malleus), anvil (incus) and stirrup (stapes) which are connected to
one another. Together these ossicles are called the ossicular chain. Their
one another. Together these ossicles are called the ossicular chain. Their
purpose is to lead the sound striking the eardrum further into the inner ear
purpose is to lead the sound striking the eardrum further into the inner ear
Oval Window - An opening in the bone between the air filled middle ear
Oval Window - An opening in the bone between the air filled middle ear
cavity and the fluid filled inner ear, and is covered by a thin membrane
cavity and the fluid filled inner ear, and is covered by a thin membrane
Cochlea - Part of the inner ear that contains part of the hearing organs.
Cochlea - Part of the inner ear that contains part of the hearing organs.
Semicircular Canals - Part of the organ of balance that is part of the inner ear
Semicircular Canals - Part of the organ of balance that is part of the inner ear
Eighth Nerve - Nerve that transmits messages from the inner ear to the
Eighth Nerve - Nerve that transmits messages from the inner ear to the
brain.
brain.
Eustachian Tube - A tube connecting the middle ear cavity and the pharynx
Eustachian Tube - A tube connecting the middle ear cavity and the pharynx
(back of the throat). It can be opened by coughing or swallowing, though it
(back of the throat). It can be opened by coughing or swallowing, though it
is normally closed. The occasional opening of the Eustachian tube is
is normally closed. The occasional opening of the Eustachian tube is
necessary to equalize the are in the middle ear cavity
necessary to equalize the are in the middle ear cavity
152.
153.
154.
155.
156.
157.
158. Describe common changes with age that
Describe common changes with age that
occur in the head and neck
occur in the head and neck
Identify common abnormalities which may
Identify common abnormalities which may
be found on examination of hair, scalp,
be found on examination of hair, scalp,
skull
skull
159. Identify the purpose of testing :
Identify the purpose of testing :
visual acuity
visual acuity
visual fields by confrontation
visual fields by confrontation
Define exophthalmos and name 2 possible
Define exophthalmos and name 2 possible
causes
causes
160. Identify common abnormalities which may be
Identify common abnormalities which may be
found in examination of:
found in examination of:
eyebrows
eyebrows
eyelids
eyelids
lacrimal apparatus
lacrimal apparatus
Identify the potential significance of:
Identify the potential significance of:
yellow schlera
yellow schlera
pale palpebral conjuctiva
pale palpebral conjuctiva
161. Define or describe the ff: terms or tests related
Define or describe the ff: terms or tests related
to eyes
to eyes
a) anisocoria
a) anisocoria
b) miosis
b) miosis
c) mydriasis
c) mydriasis
d) direct and consensual reactions
d) direct and consensual reactions
e) near reaction
e) near reaction
f) tests for weakness or imbalance of the EOM
f) tests for weakness or imbalance of the EOM
g) nystagmus
g) nystagmus
h) lid lag
h) lid lag
162. Be able to describe the ff: parts of the normal
Be able to describe the ff: parts of the normal
fundoscopic exam and identify them if given a
fundoscopic exam and identify them if given a
diagram
diagram
a) red reflex
a) red reflex
b) optic disc
b) optic disc
c) physiologic cup
c) physiologic cup
d) arterioles
d) arterioles
e) veins
e) veins
f)macula fovea
f)macula fovea
163. Describe or identify each of the ff: and
Describe or identify each of the ff: and
give its significance
give its significance
a) normal blurring of the disc outline on the
a) normal blurring of the disc outline on the
nasal side
nasal side
b) differentiate arterioles from veins
b) differentiate arterioles from veins
c) absent red reflex
c) absent red reflex
d) AV nicking
d) AV nicking
164. Describe or identify the common
Describe or identify the common
abnormalities which may be found in the
abnormalities which may be found in the
PE of patients with
PE of patients with
b)
b) Otitis media
Otitis media
c)
c) Otitis externa
Otitis externa
d)
d) Serous effusions
Serous effusions
e)
e) Retracted drum
Retracted drum
165. Describe the Weber and Rinne test. How they
Describe the Weber and Rinne test. How they
are used to distinguished between conductive
are used to distinguished between conductive
hearing loss and sensorineural hearing loss
hearing loss and sensorineural hearing loss
Describe or identify the common abnormalities
Describe or identify the common abnormalities
which may be seen in the nasal exam of
which may be seen in the nasal exam of
a) nasal mucosa
a) nasal mucosa
b) nasal septum
b) nasal septum
c) frontal and maxillary sinus (palpation,
c) frontal and maxillary sinus (palpation,
transillumination)
transillumination)
166. Describe or identify common abnormalities
Describe or identify common abnormalities
which may be found on examination of
which may be found on examination of
the mouth and pharynx
the mouth and pharynx
List 6 characteristics which can be noted
List 6 characteristics which can be noted
in describing lymph nodes
in describing lymph nodes
Identify potential significance of tender
Identify potential significance of tender
nodes, hard or fixed nodes
nodes, hard or fixed nodes
167. Identify the significance of tracheal
Identify the significance of tracheal
deviation
deviation
Define GOITER
Define GOITER
Describe physical characteristics of the
Describe physical characteristics of the
thyroid in the normal and abnormal states
thyroid in the normal and abnormal states
168. Define the ff: terms
Define the ff: terms
Ptosis
Ptosis
Ectropion
Ectropion
Entropion
Entropion
Define the ff: terms
Define the ff: terms
a) Pinguecula
a) Pinguecula
b) Sty( hordeolum)
b) Sty( hordeolum)
c) Chalazion
c) Chalazion
d) Xanthelasma
d) Xanthelasma
e) Episcleritis
e) Episcleritis
f) Dacryocystitis
f) Dacryocystitis
169. Describe the ff: common causes and
Describe the ff: common causes and
presentation of red eye
presentation of red eye
Define or identify the ff:
Define or identify the ff:
d)
d) Corneal arcus
Corneal arcus
e)
e) Corneal scars
Corneal scars
f)
f) Pterygium
Pterygium
g)
g) cataract
cataract
170. Define the ff:
Define the ff:
a) anisocoria
a) anisocoria
b) Argyll Robertson pupil
b) Argyll Robertson pupil
c) oculomotor nerve paralysis
c) oculomotor nerve paralysis
d) strabismus
d) strabismus
Describe the normal appearance and variation of
Describe the normal appearance and variation of
the optic disc. Be able to describe papilledema
the optic disc. Be able to describe papilledema
and glaucomatous cupping
and glaucomatous cupping
171. Describe the normal retinal arteries and
Describe the normal retinal arteries and
AV crossings. Describe the change that
AV crossings. Describe the change that
occur with HPN including:
occur with HPN including:
a) narrowed light reflex
a) narrowed light reflex
b) copper wire arteries
b) copper wire arteries
c) silver wire arteries
c) silver wire arteries
172. For each of the ff: identify physical finding
For each of the ff: identify physical finding
and cause:
and cause:
a) superficial retinal hemorrhage
a) superficial retinal hemorrhage
b) deep retinal hemorrhage
b) deep retinal hemorrhage
c) pre retinal hemorrhage
c) pre retinal hemorrhage
d) microaneurysm
d) microaneurysm
e) neovascularization
e) neovascularization
173. For each of the ff: identify physical finding
For each of the ff: identify physical finding
and cause:
and cause:
a) cotton wool patch
a) cotton wool patch
b) hard exudates
b) hard exudates
174. If a patient has a chief complaint of any
If a patient has a chief complaint of any
one of the head, eyes, ears, nose and
one of the head, eyes, ears, nose and
throat (HEENT) symptoms, you must
throat (HEENT) symptoms, you must
generally ask all of the HEENT ROS
generally ask all of the HEENT ROS
questions.
questions.
175. The ears, nose, and throat are
The ears, nose, and throat are
anatomically connected, hence infection or
anatomically connected, hence infection or
obstruction in one structure can lead to
obstruction in one structure can lead to
illness or symptoms in the others
illness or symptoms in the others
176.
177.
178. Facial pain
Facial pain
Trigeminal neuralgia (Tic Doulourex)
Trigeminal neuralgia (Tic Doulourex)
- Compression of the 5
Compression of the 5th
th
nerve root by a
nerve root by a
vessel or a neoplasm
vessel or a neoplasm
- 2
2nd
nd
maxillary division ,commonly involved
maxillary division ,commonly involved
- Light touch, chewing, sneezing provokes a
Light touch, chewing, sneezing provokes a
paroxysm
paroxysm
- Hot lancinating ,periodic, unilateral pain
Hot lancinating ,periodic, unilateral pain
179. Herpes zoster
Herpes zoster
- sharp , burning, unilateral pain along the
- sharp , burning, unilateral pain along the
distribution of a branch of the trigeminal
distribution of a branch of the trigeminal
nerve
nerve
Other causes:
Other causes:
acute suppurative sinusitis
acute suppurative sinusitis
Orbital cellulitis
Orbital cellulitis
180. Swelling of the face
Swelling of the face
Parotitis
Parotitis
Preauricular abscess and ulcer
Preauricular abscess and ulcer
Masseter muscle hypertrophy
Masseter muscle hypertrophy
