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Questions and Answers
An adult patient has a full set of teeth. How many teeth should be present, including wisdom teeth?
An adult patient has a full set of teeth. How many teeth should be present, including wisdom teeth?
- 34
- 28
- 32 (correct)
- 30
When numbering adult teeth, which tooth is designated as number 1?
When numbering adult teeth, which tooth is designated as number 1?
- The right maxillary third molar (correct)
- The right maxillary central incisor
- The right mandibular third molar
- The left maxillary third molar
In the adult dentition numbering system, which numbers correspond to the lower jaw teeth?
In the adult dentition numbering system, which numbers correspond to the lower jaw teeth?
- 1 to 16
- 16 to 32
- 8 to 24
- 17 to 32 (correct)
During a thyroid exam, where is the thyroid gland located in relation to the suprasternal notch?
During a thyroid exam, where is the thyroid gland located in relation to the suprasternal notch?
The isthmus of the thyroid gland overlies which of the following structures?
The isthmus of the thyroid gland overlies which of the following structures?
When inspecting the thyroid gland, what technique is used to visualize its contours more effectively?
When inspecting the thyroid gland, what technique is used to visualize its contours more effectively?
During a thyroid exam, the patient is asked to swallow water. What is the primary reason for this action?
During a thyroid exam, the patient is asked to swallow water. What is the primary reason for this action?
What does a goiter indicate during a thyroid examination?
What does a goiter indicate during a thyroid examination?
When palpating the thyroid gland using the posterior approach, where should the examiner position their fingers?
When palpating the thyroid gland using the posterior approach, where should the examiner position their fingers?
What should you suspect if the lower pole of the thyroid is not palpable during examination?
What should you suspect if the lower pole of the thyroid is not palpable during examination?
During the anterior approach to thyroid palpation, after locating the thyroid isthmus, what is the next step?
During the anterior approach to thyroid palpation, after locating the thyroid isthmus, what is the next step?
A soft thyroid gland that may be nodular upon palpation, is most likely associated with which condition?
A soft thyroid gland that may be nodular upon palpation, is most likely associated with which condition?
A firm thyroid gland is most likely associated with which of the following conditions?
A firm thyroid gland is most likely associated with which of the following conditions?
A tender thyroid gland upon palpation is most indicative of:
A tender thyroid gland upon palpation is most indicative of:
When is it most appropriate to auscultate the thyroid gland for a bruit?
When is it most appropriate to auscultate the thyroid gland for a bruit?
A systolic or continuous bruit heard over the thyroid lobes may indicate:
A systolic or continuous bruit heard over the thyroid lobes may indicate:
Which characteristics are commonly associated with benign thyroid nodules?
Which characteristics are commonly associated with benign thyroid nodules?
What percentage of thyroid nodules are estimated to be malignant?
What percentage of thyroid nodules are estimated to be malignant?
What is typically the next step in evaluating a thyroid nodule after it has been detected during a physical exam?
What is typically the next step in evaluating a thyroid nodule after it has been detected during a physical exam?
Which of the following characteristics would raise the most suspicion for malignancy in a thyroid nodule?
Which of the following characteristics would raise the most suspicion for malignancy in a thyroid nodule?
What is the likely cause if a newborn is unable to open one eye?
What is the likely cause if a newborn is unable to open one eye?
Nystagmus persisting beyond the first few days of life in a newborn may indicate which of the following?
Nystagmus persisting beyond the first few days of life in a newborn may indicate which of the following?
The 'doll's eye reflex' is observed in a newborn. What finding is expected during this test?
The 'doll's eye reflex' is observed in a newborn. What finding is expected during this test?
What is the significance of intermittent crossed or divergent eyes in a newborn during the first few months of life?
What is the significance of intermittent crossed or divergent eyes in a newborn during the first few months of life?
What is the expected resolution time for subconjunctival hemorrhages resulting from vaginal delivery in a newborn?
What is the expected resolution time for subconjunctival hemorrhages resulting from vaginal delivery in a newborn?
What are colobomas in the context of a newborn eye exam?
What are colobomas in the context of a newborn eye exam?
What do Brushfield spots in the iris of a newborn strongly suggest?
What do Brushfield spots in the iris of a newborn strongly suggest?
A newborn presents with ocular discharge and tearing. What should be suspected?
A newborn presents with ocular discharge and tearing. What should be suspected?
Which of the following reflexes is used to assess vision reflexively in a newborn?
Which of the following reflexes is used to assess vision reflexively in a newborn?
What expected finding during the acoustic blink reflex?
What expected finding during the acoustic blink reflex?
Why isn't the acoustic blink reflex considered a definitive hearing test for newborns?
Why isn't the acoustic blink reflex considered a definitive hearing test for newborns?
Which of the following is considered a risk factor for hearing defects in newborns?
Which of the following is considered a risk factor for hearing defects in newborns?
If a newborn does not track your face or a bright light, what condition should be suspected?
If a newborn does not track your face or a bright light, what condition should be suspected?
What is the appropriate lighting when examining the eyes of a newborn?
What is the appropriate lighting when examining the eyes of a newborn?
During the first year of life, how does a child's visual acuity change?
During the first year of life, how does a child's visual acuity change?
What is an expected finding in the ear exam of a normal neonate?
What is an expected finding in the ear exam of a normal neonate?
A newborn's eyes are examined, and a red reflex is noted. What does this finding indicate?
A newborn's eyes are examined, and a red reflex is noted. What does this finding indicate?
After repeated stimuli during an acoustic blink reflex assessment, what might occur?
After repeated stimuli during an acoustic blink reflex assessment, what might occur?
What is the significance of assessing the ear canal direction in a neonate?
What is the significance of assessing the ear canal direction in a neonate?
Which of the following conditions does not affect the eyes of neonates?
Which of the following conditions does not affect the eyes of neonates?
During an otoscopic exam on a neonate, what anatomical feature causes the examiner to pull the auricle downward?
During an otoscopic exam on a neonate, what anatomical feature causes the examiner to pull the auricle downward?
When performing an otoscopic examination on an older child, why is it important to pull the pinna upward?
When performing an otoscopic examination on an older child, why is it important to pull the pinna upward?
A small pit or skin tag near the tragus of a neonate's ear could be a benign branchial cleft remnant. When should this finding raise concern?
A small pit or skin tag near the tragus of a neonate's ear could be a benign branchial cleft remnant. When should this finding raise concern?
During pneumatic otoscopy, no movement of the tympanic membrane is observed despite a good seal. What is the most likely interpretation of this finding?
During pneumatic otoscopy, no movement of the tympanic membrane is observed despite a good seal. What is the most likely interpretation of this finding?
Which of the following symptoms, when observed during an otoscopic examination, is most indicative of acute mastoiditis?
Which of the following symptoms, when observed during an otoscopic examination, is most indicative of acute mastoiditis?
In a child diagnosed with acute otitis media, what is the most helpful symptom?
In a child diagnosed with acute otitis media, what is the most helpful symptom?
What finding during an otoscopic examination is most indicative of acute otitis media?
What finding during an otoscopic examination is most indicative of acute otitis media?
You are preparing to perform an otoscopic exam on a toddler. Which approach is MOST appropriate for positioning the child?
You are preparing to perform an otoscopic exam on a toddler. Which approach is MOST appropriate for positioning the child?
What is the primary purpose of performing pneumatic otoscopy?
What is the primary purpose of performing pneumatic otoscopy?
What should a clinician do first to ensure accurate results when performing pneumatic otoscopy?
What should a clinician do first to ensure accurate results when performing pneumatic otoscopy?
During an otoscopic examination of a newborn, vernix caseosa is noted in the ear canal. How does this impact the examination?
During an otoscopic examination of a newborn, vernix caseosa is noted in the ear canal. How does this impact the examination?
A 6-year-old child is brought in for evaluation and the physician has determined that an otoscopic examination needs to be performed. What is the most appropriate way to position the ear?
A 6-year-old child is brought in for evaluation and the physician has determined that an otoscopic examination needs to be performed. What is the most appropriate way to position the ear?
A parent brings their child in, and the child has been recently diagnosed with acute otitis media. The parent is concerned about hearing loss. What is the most appropriate response?
A parent brings their child in, and the child has been recently diagnosed with acute otitis media. The parent is concerned about hearing loss. What is the most appropriate response?
When performing an otoscopic examination on a young child, which of the following strategies is MOST effective in gaining their cooperation?
When performing an otoscopic examination on a young child, which of the following strategies is MOST effective in gaining their cooperation?
Why is it important to perform the otoscopic exam last in young children?
Why is it important to perform the otoscopic exam last in young children?
Which otoscope handle position is a recognized technique for performing an otoscopic exam on a child?
Which otoscope handle position is a recognized technique for performing an otoscopic exam on a child?
During pneumatic otoscopy on a 3-year-old, the tympanic membrane moves inward with positive pressure but doesn't return to its original position when pressure is released. What is the MOST likely cause?
During pneumatic otoscopy on a 3-year-old, the tympanic membrane moves inward with positive pressure but doesn't return to its original position when pressure is released. What is the MOST likely cause?
An infant is brought in for a well-child visit. During the otoscopic examination, the light reflex on the tympanic membrane appears diffuse. What is the most appropriate action?
An infant is brought in for a well-child visit. During the otoscopic examination, the light reflex on the tympanic membrane appears diffuse. What is the most appropriate action?
Which of the following is the MOST accurate description of how the ear canal should be examined in a neonate?
Which of the following is the MOST accurate description of how the ear canal should be examined in a neonate?
What is the most appropriate speculum size to use for an otoscopic exam in pediatric patients?
What is the most appropriate speculum size to use for an otoscopic exam in pediatric patients?
Flashcards
Number of adult teeth
Number of adult teeth
There are 32 adult teeth, numbered 1 to 16 right to left on the upper jaw, and 17 to 32 left to right on the lower jaw.
Thyroid gland location
Thyroid gland location
The thyroid gland is usually located above the suprasternal notch, with the isthmus spanning the 2nd, 3rd, and 4th tracheal rings just below the cricoid cartilage.
Goiter
Goiter
Enlargement of the thyroid to twice its normal size.
Thyroid palpation: Posterior approach
Thyroid palpation: Posterior approach
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Thyroid palpation: Anterior approach
Thyroid palpation: Anterior approach
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Thyroid consistency
Thyroid consistency
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Thyroid bruit significance
Thyroid bruit significance
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Benign thyroid nodules
Benign thyroid nodules
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Neonate's reaction to light
Neonate's reaction to light
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Inability to open eye (neonate)
Inability to open eye (neonate)
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Examining infant eye movements
Examining infant eye movements
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Neonate visual tracking issues
Neonate visual tracking issues
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Newborn eye alignment
Newborn eye alignment
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Brushfield spots
Brushfield spots
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Assessing infant vision
Assessing infant vision
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Acoustic Blink Reflex
Acoustic Blink Reflex
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Neonate ear exam: Auricle pull direction
Neonate ear exam: Auricle pull direction
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Older child ear exam: Auricle pull direction
Older child ear exam: Auricle pull direction
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Pediatric exam order
Pediatric exam order
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Keys to examining children
Keys to examining children
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Preauricular pit significance
Preauricular pit significance
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Acute mastoiditis signs
Acute mastoiditis signs
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Acute otitis media signs
Acute otitis media signs
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Pneumatic otoscopy purpose
Pneumatic otoscopy purpose
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Absent TM movement meaning
Absent TM movement meaning
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Study Notes
Otoscopic Exam in Pediatric Patients
- Perform this exam last in young children
- Correct speculum size is important
- Positioning is critical for visualization
- For neonates, pull the auricle downward to align with the ear canal.
- For older children/adolescents, pull the auricle upward.
General Approach to Pediatric Exams
- Start with the least distressing procedures and end with ears/throat.
- Children may feel vulnerable when supine; enlist parental help if needed.
- Key elements include patience, distraction, play, flexibility, and a gentle but firm approach.
Otoscopic Examination (Neonate)
- Initially, only assess canal patency due to potential TM obstruction by vernix caseosa.
- Small pit or skin tag near the tragus might be a benign branchial cleft remnant.
- These can indicate renal disease or hearing loss if there's a relevant family history.
- The light reflex is diffuse initially, forming the typical cone shape over several months.
Ears (Older Infants/Children)
- Examination can be difficult if children are fearful and may require brief restraint.
- Two common positions are supine with parental restraint or sitting on a parent's lap with head stabilization.
- Make a game of looking into the ears and demonstrate that the speculum doesn't hurt.
- In older children, pull the pinna upward due to the upward and backward angle of their external canal.
- Acute mastoiditis can cause the auricle to protrude forward/outward with redness, swelling, and tenderness over the mastoid area.
Holding the Otoscope
- Two methods: handle pointing upward/laterally or handle pointing down toward the child’s feet (favored by many pediatricians).
- A red, bulging TM with a dull/absent light reflex, diminished mobility, and purulent material behind the TM suggests acute otitis media.
- Ear pain is the most useful symptom.
Pneumatic Otoscopy
- Improves accuracy in diagnosing otitis media by assessing TM mobility with pressure changes.
- Check for leaks by covering the speculum tip and squeezing the bulb.
- Place it snugly in the canal to form a seal
- In a normal ear, the TM moves inward with air introduction and outward when air is removed.
- No movement indicates middle ear effusion (otitis media with effusion) or poor technique.
- Children with acute otitis media might flinch from pain with air pressure.
- Temporary hearing loss can persist for months with effusion.
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