Head and Neck
Which 2 major neck muscles may experience hypertrophy with prolonged increased work of breathing? What are these muscles called?
Sternocleidomastoid and trapezius
Accessory muscles
What is the whisper test? How is it adminstered?
The whisper test evaluates for loss of high-frequency sounds. Instruct the patient to plug (or plug for the patient) the ear opposite to the one you are testing. With your head behind or to the side (to prevent lip reading) and approximately 45 cm (18 in.) from the patient’s ear, whisper three items that include letters and numbers.
This membrane lines the inner eyelid and covers the sclera. This membrane can become inflamed and infected when exposed to bacteria or irritation.
Conjunctiva
Which 2 sets of sinuses can be assessed during a HEENT assessment?
Frontal (above the eyebrows) and maxillary (below the eyes)
This large salivary gland is located bilaterally within the cheeks, anterior to the ears. Swelling of this gland is common with mumps.
Parotid gland
Located under cartilage, this lobular gland secretes hormones that regulate metabolism. Older adults frequently experience problems related to this gland.
Thyroid
Describe the difference between conductive and sensorineural hearing loss.
Conductive= mechanical issue in external or middle ear
Sensorineural- problem beyond middle ear, either in cochlea, organ of corti, auditory nerve, or auditory cortex. Presbycusis
***DAILY DOUBLE**
What is a unilateral cover test?
What is the Hirschberg test?
Unilateral cover test: During the unilateral cover test, ask the patient to focus on a distant object while you cover each eye separately. Gaze should be steady and fixed.
Hirschberg: An assessment of the corneal light reflex.
Instruct the patient to stare straight ahead at the bridge of your nose. Stand in front of the patient and shine a penlight at the bridge of the patient’s nose. Note where the light reflects on the cornea of each eye. Normal findings = Light reflection is in exactly the same spot in both eyes.
What happens to our sense of smell as we age, and why?
Decrease in sense of smell, due a decrease in olfactory sensory nerve fibers.
There are various changes that occur in the mouth with aging, xerostomia being one of them. Define this term
Decreased saliva production.
What is a suture?
A suture is a non-moveable joint between 2 cranial bones. These joints are solidified as we age.
Tinnitus and vertigo are two subjective complaints related to the ears function. Describe these symptoms.
Tinnitus- ringing in the ears.
Vertigo- spinning sensation
This inner layer of the eye receives sensory input through the pupil, and transmits it to the brain for processing. This internal structure can only be viewed using an ophthalmoscope.
Retina
What is anosmia?
Anosmia is the partial or full loss of smell. Anosmia can be a temporary or permanent condition.
What function do tonsils serve? How do you locate them?
Lymphatic tissue that contribute to our immune system.
Mouth starts at the lips and ends at the anterior tonsillar pillar. Tonsils are behind the anterior tonsillar pillar. The throat starts at the back soft palate and extends to the oropharynx.
What characteristics of a lymph node should be assessed in palpation? Name at least 4.
Name the 2 tests that we perform during an assessment of the ears, and what normal findings are.
-Rinne test: To evaluate AC vs BC. Normal = AC > BC.
BC that is longer than or the same as AC is evidence of conductive hearing loss.
-Weber test: To evaluate unilateral hearing loss. Sound should be heard equally on both sides.
Unilateral identification of the sound indicates sensorineural loss in the ear in which the patient did not hear or had reduced perception of the sound. SNHL on one side may be related to an inner ear disorder such as Meniere disease or a vestibular schwannoma (acoustic neuroma).
What lifestyle or personal factors may you ask about in a subjective assessment of the eyes?
Exposure to toxins, chemicals, infections, or allergens at work? PPE worn?
Stress levels
Diet/nutrition
Use of sunglasses
-What would hard, rubbery, irregular and fixed lymph nodes possibly indicate?
-Palpable, tender, and warm lymph nodes usually indicate an infection in the area from which the lymph vessels drain to that node.
-Hard, rubbery, irregular, fixed, and nontender lymph nodes are a possible sign of lymphoma.
Name 3 changes in the structure or function of the mouth that may occur with aging.
Decreased saliva production, decrease in # of taste buds, thinning of cheek tissues and tongue, tooth loss, receding gums, teeth become more brittle.
These structures are most prevalent in the head and neck. Their function is to drain and filter fluid from tissues and the bloodstream, they serve as part of our immune system.
Lymph nodes
Name 3 risk factors that increase the risk for otitis media.
Lower SES
Secondhand smoke
Pacifier use
Propping bottles for feeding or bottle feeding when supine
Daycare attendance and having siblings.
What past medical history may you ask about during subjective assessment of the eyes? Describe at least 3 areas/questions.
Any current vision changes or problems?
Hx of cataracts, glaucoma, high BP, diabetes, thyroid disease, eye injury, or eye surgeries?
Last eye exam or screening for glaucoma
Use of corrective equipment (glasses and contacts)
Exposure to viruses that can cause vision problems, rubella and congenital syphilis
Medications
Family history
These lifestyle choices are the #1 risk factors for developing cancer of the mouth, neck, and throat.
Alcohol use and tobacco use
From anterior to posterior, name the main structures that make up the mouth and throat, must name at least 8 for credit.
Lips, teeth, soft palate, tongue, buccal mucosa, hard palate, uvula, anterior tonsillar pillar, tonsils, posterior tonsillar pillar, pharynx