Physical Assessment: Ears, Nose, Throat

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Questions and Answers

What does the Weber test assess when sound is perceived asymmetrically?

Neither conductive nor sensorineural hearing loss

Both conductive and sensorineural hearing loss (correct)

Only sensorineural hearing loss

Only conductive hearing loss

What is the expected result of a normal Rinne test?

Air conduction (AC) > bone conduction (BC) (correct)

Air conduction (AC) = bone conduction (BC)

Bone conduction (BC) > air conduction (AC)

Bone conduction (BC) = zero

In the Weber test, what does it indicate if sound lateralizes to the impaired ear?

Normal hearing in both ears

Unilateral sensorineural hearing loss

Bilateral sensorineural hearing loss

Unilateral conductive hearing loss (correct)

What does a negative Rinne test indicate?

Conductive hearing loss Signup and view all the answers

What is typically used to assess auditory acuity?

Tuning fork at 512 Hz Signup and view all the answers

What is the primary function of the cochlea in the ear?

Senses and codes vibrations Signup and view all the answers

Which of the following structures is NOT part of the middle ear?

Cochlea Signup and view all the answers

What type of hearing loss is caused by disorders in the cochlea?

Sensorineural hearing loss Signup and view all the answers

Which symptom is associated with a problem in the inner ear?

Tinnitus Signup and view all the answers

What role does the Eustachian tube play in the ear?

Equalizes pressure in the middle ear Signup and view all the answers

Dizziness and vertigo are typically related to issues with which part of the ear?

Inner ear Signup and view all the answers

Which structure connects the middle ear to the nasopharynx?

Eustachian tube Signup and view all the answers

Which cranial nerve is responsible for both hearing and balance?

CN VIII Signup and view all the answers

What type of hearing loss is caused by a lesion in the ossicles?

Conductive hearing loss Signup and view all the answers

Which part of the nose is supported by bone?

Upper third Signup and view all the answers

What is the main function of turbinates in the nasal cavity?

Aid in cleansing and humidification Signup and view all the answers

What is rhinorrhea characterized by?

Nasal discharge Signup and view all the answers

Where does air enter the nasal cavity?

Vestibule Signup and view all the answers

Which sinuses drain into the middle meatus of the nasal cavity?

Frontal and maxillary sinuses Signup and view all the answers

What condition involves bleeding from the nose?

Epistaxis Signup and view all the answers

What role do olfactory receptors in the nasal cavity serve?

Sense of smell Signup and view all the answers

What is a primary characteristic of conductive hearing loss in a noisy environment?

Improvement of symptoms Signup and view all the answers

What should be examined during an ear exam to identify deformities?

Auricle and surrounding tissues Signup and view all the answers

In which condition would you expect tenderness behind the ear during palpation?

Otitis media Signup and view all the answers

How should the auricle be positioned when examining a child’s ear?

Downward and backward Signup and view all the answers

What does a pinkish gray tympanic membrane indicate?

Normal findings Signup and view all the answers

What is a common abnormal finding when examining the tympanic membrane for acute otitis media?

Red or bulging appearance Signup and view all the answers

What indicates a successful mobility check of the tympanic membrane with a pneumatic otoscope?

Mobility with air inflation Signup and view all the answers

Which symptom is commonly associated with acute otitis externa?

Swollen and moist canal Signup and view all the answers

What is a common sign of gingivitis?

Red swollen bleeding gums Signup and view all the answers

Which of the following can indicate a vitamin deficiency when inspecting the tongue?

Smooth tongue Signup and view all the answers

What does a dark line on the gingival margins suggest?

Lead poisoning Signup and view all the answers

Which condition is characterized by a grayish exudate in the pharynx?

Diphtheria Signup and view all the answers

What should be noted during the inspection of the oral mucosa?

Structure intactness and lesions Signup and view all the answers

Which of the following symptoms is associated with hypothyroidism?

Enlarged tongue with indentation Signup and view all the answers

What indicates a potential peritonsillar abscess?

Unilateral red bulge and painful Signup and view all the answers

What condition presents with red swollen tonsils and a bright red pharynx?

Streptococcal pharyngitis Signup and view all the answers

What is the normal color of the nasal mucosa?

Normal red color Signup and view all the answers

What should be inspected during the examination of the external nose?

Asymmetry, deformity, lesions, and inflammation Signup and view all the answers

Which of the following indicates a possible nasal obstruction during the nasal patent test?

Difficulty breathing in while pressing on the ala nasi Signup and view all the answers

What kind of changes might indicate chronic allergy or acute sinus infection when palpating the sinuses?

Increased tenderness in the sinus area Signup and view all the answers

What characteristic of nasal polyps should be noted during inspection?

Smooth pale grey, non-tender, and vascular Signup and view all the answers

Which physical finding is associated with viral rhinitis?

Swollen and reddened mucosa Signup and view all the answers

What is a common symptom one should inquire about when assessing a sore throat?

Duration and severity of sore throat Signup and view all the answers

What indicates normal findings in nasal examination?

Sufficient room for nasal passages Signup and view all the answers

Study Notes

Physical Assessment of Ears, Nose, Throat, and Oral Cavity

This topic covers the physical assessment of the ears, nose, throat, and oral cavity.
Information is presented in chapters 13 and 14.
Specific page numbers are noted.

The Ear

The ear is structured with external, middle, and inner components.
Sound waves travel from the eardrum through tiny bones to the cochlea.
The cochlea transmits these vibrations to the brain.

Middle Ear

The tympanic membrane (eardrum) forms the lateral boundaries of the middle ear.
The middle ear is an air-filled cavity that transmits sound via ossicles (malleus, incus, stapes).
The eustachian tube connects the middle ear to the nasopharynx.

Pathway of Hearing

Sound travels from the outer ear through the middle ear, with the ossicles transmitting vibrations to the cochlea in the inner ear.
The cochlea senses and encodes these vibrations.
Nerve impulses are sent through the cochlear nerve to the brain.

Common/Concerning Symptoms

Hearing problems include loss (one or both ears), sudden or gradual loss, earache, ear discharge, fever, sore throat (possible URT infection), tinnitus, dizziness, and vertigo.
Vertigo involves the perception of spinning.
Nasal discharge and nasal congestion, nosebleeds are also considered concerning symptoms.

Ear Exam

Inspecting the auricle and surrounding tissues, including checking for deformities, lumps, and skin lesions.
Palpate the pinna and tragus to detect tenderness.
Checking the tympanic membrane and the ear canal using an otoscope.
The process involves using the appropriate sized speculum, gently pulling the auricle upward and backward for adults, or downward and backward for children.
Ensure to hold the otoscope as a pen/pencil and use the finger area as a fulcrum to prevent injury during sudden movements.
Checking the ear for discharge, foreign bodies, redness, swelling, cerumen, and for otitis externa (swelling, narrowed, moist, pale, tender), and chronic otitis externa (skin of canal thickened, red and itchy).
Checking the tympanic membrane for color (normally pinkish-gray, but can be red, white, yellow), translucency (usually transparent, but can be opaque), and position (neutral, but can be retracted or bulging), and presence of bright light reflection.
Checking for perforation, bulging, loss of shine, lack of cone of light, opaque tympanic membrane, purulent drainage, and fluid behind the eardrum (serous effusion).
Checking mobility using a pneumatic otoscope.
Conducting the Weber and Rinne tests to evaluate auditory acuity, lateralization of sound, and air versus bone conduction to detect sensorineural and/or conductive hearing loss.

Nose and Paranasal Sinuses

The upper third of the nose is supported by bone; the lower two-thirds, by cartilage.
Air enters the nasal cavity through the nares, moving through the widened vestibule into the narrow nasal passage to the nasopharynx.
The vestibule is lined with hair-bearing skin.
The nasal septum forms the medial wall of each nasal cavity and is supported by bone and cartilage. The septum's lining is a mucous membrane, well-supplied with blood.
The turbinates aid in cleaning, humidifying, and regulating the temperature of inspired air.
The middle meatus drains most of the paranasal sinuses, and the inferior meatus drains the nasolacrimal duct.
The paranasal sinuses are air-filled cavities within the skull bones, lined with mucous membrane, and drain into the nasal cavities.

Throat and Oral Cavity

The examination includes the throat and mouth.
The anatomy of the mouth and pharynx is presented, identifying key structures such as the soft palate, uvula, tonsils, and tongue.
Common/Concerning sore throat symptoms, sores or lesions in the mouth or tongue, hoarseness, gum swelling/bleeding gums (gingivitis), malodorous breath (halitosis), and toothache.
Health considerations include any problems with hoarseness (overuse of voice, allergies, smoking, other inhaled irritants, infection, hypothyroidism, tumors), dysphagia (difficulty swallowing), gastroesophageal reflux disease, neurological problems, or esophageal cancer), and pharyngitis (swollen glands or lumps in the neck).
Consideration of health history involves enlarged thyroid gland (goiter), thyroid function (temperature intolerance, palpitations, changes in weight).

Mouth and Throat Exam

The examination will include the lips (color, moisture, presence of cracking, scaling, lesions, or lumps), looking for signs of pallor (shock or anemia), cyanosis (hypoxemia or chilling), cherry red lips (carbon monoxide poisoning/acidosis/ketoacidosis), herpes simplex (cold sores/fever blisters), angular cheilitis (ulceration at the corner of the mouth in people with nutritional deficiencies, mouth closure problems), edema, and cleft lip.
The teeth and gums(intact or discolored/missing/diseased/loose/abnormal position teeth.
Checking dentures (if the patient wears them), checking discolouration from excessive fluoride use or smoking of teeth, and inspecting for plaques and caries.
Inspecting the gums for color (normally pink, but can be patchy brownish, especially in Black people), swelling, or ulcerations, detecting gingivitis (red, swollen, bleeding gums), and a dark line (lead poisoning).
Inspecting the oral mucosa for color abnormalities and presence of abnormalities/leisions (ulcers, white patches, nodules), and checking for any mucosal irritation.
Inspecting the tongue for color (normally pink and even), surface texture and characteristics (normally rough with papillae). Checking for smooth surfaces and identifying potential fissures or coatins (white patches/leukoplakia).

Pharynx-Examination

Inspecting the pharyngeal wall's color and shape and looking for exudates or lesions. Identifying red, swollen areas with pus could indicate pharyngitis. Detecting grayish exudates might point toward diphtheria.
Examining the palate and pillars, including the uvula. Tonsils should be inspected for color, symmetry, swelling, exudates, or ulcerations. Checking for possible enlargements or unilateral bulges, and pain, could indicate tonsillitis, lymphoma and/or peritonsillar abscesses.
Inspecting the hard palate's color and general shape to look for a cleft palate (or other soft palate variations).
Checking for palatal mobility. This may include asking the patient to say “Ah” while keeping their tongue down to examine the pharynx's integrity and mobility as they phonate. Checking for palatal deviation and paralysis is also important.
Checking gag reflexes (glossopharyngeal CN IX and Vagus CN X).

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Description

This quiz focuses on the physical assessment of the ears, nose, throat, and oral cavity as covered in chapters 13 and 14. It includes information on the structure and function of the ear, the pathway of hearing, and the components of the middle ear. Test your knowledge and understanding of these key topics.