IDC Head & Neck Pt. 2

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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?

  • 34
  • 28
  • 32 (correct)
  • 30

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?

  • 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?

<p>Usually above the suprasternal notch (D)</p> Signup and view all the answers

The isthmus of the thyroid gland overlies which of the following structures?

<p>The 2nd, 3rd, and 4th tracheal rings (A)</p> Signup and view all the answers

When inspecting the thyroid gland, what technique is used to visualize its contours more effectively?

<p>Tangential lighting below the cricoid cartilage (D)</p> Signup and view all the answers

During a thyroid exam, the patient is asked to swallow water. What is the primary reason for this action?

<p>To observe the upward movement of the thyroid gland (C)</p> Signup and view all the answers

What does a goiter indicate during a thyroid examination?

<p>Enlarged thyroid gland (D)</p> Signup and view all the answers

When palpating the thyroid gland using the posterior approach, where should the examiner position their fingers?

<p>Just below the cricoid cartilage (A)</p> Signup and view all the answers

What should you suspect if the lower pole of the thyroid is not palpable during examination?

<p>Retrosternal location (D)</p> Signup and view all the answers

During the anterior approach to thyroid palpation, after locating the thyroid isthmus, what is the next step?

<p>Retract the sternocleidomastoid muscle on one side (C)</p> Signup and view all the answers

A soft thyroid gland that may be nodular upon palpation, is most likely associated with which condition?

<p>Graves' disease (C)</p> Signup and view all the answers

A firm thyroid gland is most likely associated with which of the following conditions?

<p>Hashimoto's thyroiditis (D)</p> Signup and view all the answers

A tender thyroid gland upon palpation is most indicative of:

<p>Thyroiditis (C)</p> Signup and view all the answers

When is it most appropriate to auscultate the thyroid gland for a bruit?

<p>When the thyroid gland is visibly enlarged. (C)</p> Signup and view all the answers

A systolic or continuous bruit heard over the thyroid lobes may indicate:

<p>Hyperthyroidism (A)</p> Signup and view all the answers

Which characteristics are commonly associated with benign thyroid nodules?

<p>Uniform, ovoid, and mobile (B)</p> Signup and view all the answers

What percentage of thyroid nodules are estimated to be malignant?

<p>Approximately 5% (D)</p> Signup and view all the answers

What is typically the next step in evaluating a thyroid nodule after it has been detected during a physical exam?

<p>Ultrasound and possible fine-needle aspiration (A)</p> Signup and view all the answers

Which of the following characteristics would raise the most suspicion for malignancy in a thyroid nodule?

<p>Rapid growth and fixation to surrounding tissues. (D)</p> Signup and view all the answers

What is the likely cause if a newborn is unable to open one eye?

<p>Congenital ptosis or CN III palsy. (A)</p> Signup and view all the answers

Nystagmus persisting beyond the first few days of life in a newborn may indicate which of the following?

<p>Poor vision or CNS disease. (A)</p> Signup and view all the answers

The 'doll's eye reflex' is observed in a newborn. What finding is expected during this test?

<p>Eyes remaining fixed in one direction when the head is turned. (D)</p> Signup and view all the answers

What is the significance of intermittent crossed or divergent eyes in a newborn during the first few months of life?

<p>It is a normal occurrence that usually resolves spontaneously. (A)</p> Signup and view all the answers

What is the expected resolution time for subconjunctival hemorrhages resulting from vaginal delivery in a newborn?

<p>A couple of weeks. (B)</p> Signup and view all the answers

What are colobomas in the context of a newborn eye exam?

<p>Missing sections of the iris or retina. (D)</p> Signup and view all the answers

What do Brushfield spots in the iris of a newborn strongly suggest?

<p>Strong association with Down syndrome. (D)</p> Signup and view all the answers

A newborn presents with ocular discharge and tearing. What should be suspected?

<p>Possible dacryocystitis or nasolacrimal duct obstruction. (D)</p> Signup and view all the answers

Which of the following reflexes is used to assess vision reflexively in a newborn?

<p>Optic blink reflex. (A)</p> Signup and view all the answers

What expected finding during the acoustic blink reflex?

<p>Blinking in response to a sudden sharp sound. (B)</p> Signup and view all the answers

Why isn't the acoustic blink reflex considered a definitive hearing test for newborns?

<p>Habituation may occur after several stimuli. (A)</p> Signup and view all the answers

Which of the following is considered a risk factor for hearing defects in newborns?

<p>Low birth weight. (D)</p> Signup and view all the answers

If a newborn does not track your face or a bright light, what condition should be suspected?

<p>Congenital cataracts or other disorder. (B)</p> Signup and view all the answers

What is the appropriate lighting when examining the eyes of a newborn?

<p>Subdued lighting. (A)</p> Signup and view all the answers

During the first year of life, how does a child's visual acuity change?

<p>Visual acuity sharpens as focusing improves. (A)</p> Signup and view all the answers

What is an expected finding in the ear exam of a normal neonate?

<p>Correct ear position. (C)</p> Signup and view all the answers

A newborn's eyes are examined, and a red reflex is noted. What does this finding indicate?

<p>Healthy, normal eye. (C)</p> Signup and view all the answers

After repeated stimuli during an acoustic blink reflex assessment, what might occur?

<p>Habituation. (B)</p> Signup and view all the answers

What is the significance of assessing the ear canal direction in a neonate?

<p>To identify potential hearing loss. (D)</p> Signup and view all the answers

Which of the following conditions does not affect the eyes of neonates?

<p>Epicanthic folds. (D)</p> Signup and view all the answers

During an otoscopic exam on a neonate, what anatomical feature causes the examiner to pull the auricle downward?

<p>The downward direction of the infant's ear canal. (A)</p> Signup and view all the answers

When performing an otoscopic examination on an older child, why is it important to pull the pinna upward?

<p>To straighten the ear canal, which angles upward and backward in older children. (C)</p> Signup and view all the answers

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?

<p>If there is a family history of renal disease or hearing loss. (C)</p> Signup and view all the answers

During pneumatic otoscopy, no movement of the tympanic membrane is observed despite a good seal. What is the most likely interpretation of this finding?

<p>Middle ear effusion or poor examination technique. (D)</p> Signup and view all the answers

Which of the following symptoms, when observed during an otoscopic examination, is most indicative of acute mastoiditis?

<p>Auricle protruding forward/outward with redness, swelling, and tenderness over the mastoid area. (A)</p> Signup and view all the answers

In a child diagnosed with acute otitis media, what is the most helpful symptom?

<p>Ear pain (C)</p> Signup and view all the answers

What finding during an otoscopic examination is most indicative of acute otitis media?

<p>A red, bulging tympanic membrane with a dull or absent light reflex and diminished mobility. (A)</p> Signup and view all the answers

You are preparing to perform an otoscopic exam on a toddler. Which approach is MOST appropriate for positioning the child?

<p>Seat the child on the parent's lap, securing the child's head against the parent's chest. (B)</p> Signup and view all the answers

What is the primary purpose of performing pneumatic otoscopy?

<p>To evaluate the mobility of the tympanic membrane in response to pressure changes. (A)</p> Signup and view all the answers

What should a clinician do first to ensure accurate results when performing pneumatic otoscopy?

<p>Check for leaks by covering the speculum tip and squeezing the bulb. (A)</p> Signup and view all the answers

During an otoscopic examination of a newborn, vernix caseosa is noted in the ear canal. How does this impact the examination?

<p>It may obscure the tympanic membrane, limiting the examination. (D)</p> Signup and view all the answers

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?

<p>Pull the auricle up and back. (C)</p> Signup and view all the answers

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?

<p>Temporary hearing loss can occur, but typically resolves within a few months. (D)</p> Signup and view all the answers

When performing an otoscopic examination on a young child, which of the following strategies is MOST effective in gaining their cooperation?

<p>Use distraction, play, and a gentle but firm approach. (D)</p> Signup and view all the answers

Why is it important to perform the otoscopic exam last in young children?

<p>Because it is the most invasive and distressing procedure, and it is important to start with the least distressing procedures first and leave it for last. (B)</p> Signup and view all the answers

Which otoscope handle position is a recognized technique for performing an otoscopic exam on a child?

<p>Handle pointing down toward the child's feet. (A)</p> Signup and view all the answers

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?

<p>Middle ear effusion. (A)</p> Signup and view all the answers

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?

<p>Document the finding as normal, as the cone shape of the light reflex does not fully develop for a few months. (C)</p> Signup and view all the answers

Which of the following is the MOST accurate description of how the ear canal should be examined in a neonate?

<p>Gently pull the auricle downward and outward to straighten the ear canal. (D)</p> Signup and view all the answers

What is the most appropriate speculum size to use for an otoscopic exam in pediatric patients?

<p>The largest size that fits comfortably. (C)</p> Signup and view all the answers

Flashcards

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

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

Enlargement of the thyroid to twice its normal size.

Thyroid palpation: Posterior approach

Stand behind the patient, flex the neck slightly, and palpate below the cricoid cartilage as the patient swallows water.

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Thyroid palpation: Anterior approach

Locate the thyroid isthmus, retract the SCM, and palpate the thyroid while the patient swallows.

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Thyroid consistency

Soft thyroid consistency may indicate Graves disease, firm may indicate Hashimoto thyroiditis or malignancy, and tender indicates thyroiditis.

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Thyroid bruit significance

A systolic or continuous bruit over the thyroid may indicate hyperthyroidism from Graves disease or toxic multinodular goiter.

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Benign thyroid nodules

These nodules tend to be uniform, ovoid, not fixed to surrounding tissues, and are usually benign.

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Neonate's reaction to light

Bright light should cause a newborn to blink. Subdued lighting is recommended for examination.

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Inability to open eye (neonate)

A newborn who cannot open their eye may have congenital ptosis (birth trauma or CN III palsy).

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Examining infant eye movements

During examination, hold the baby upright and rotate slowly to observe sclerae, pupils, irises, and EOMs.

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Neonate visual tracking issues

Failure to track a face or light could indicate congenital cataracts or another disorder.

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Newborn eye alignment

Intermittent crossed or divergent eyes, in the first few months, can be normal and usually resolve spontaneously.

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Brushfield spots

A ring of white specks in the iris that strongly suggests Down syndrome(though can appear in normal children).

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Assessing infant vision

Vision is assessed reflexively with pupillary constriction, blinking to bright light (optic blink reflex), and blinking at quick approach.

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Acoustic Blink Reflex

A sudden sharp sound should cause the infant to blink. Habituation may occur after several stimuli.

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Neonate ear exam: Auricle pull direction

In neonates, due to canal direction, pull the auricle downward during otoscopic exam.

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Older child ear exam: Auricle pull direction

In older children, due to canal angle, pull the auricle upward during otoscopic exam.

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Pediatric exam order

Start with less distressing exams, saving ears/throat for last to reduce anxiety.

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Keys to examining children

Patience, distraction, play, flexibility, and a gentle but firm approach are crucial.

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Preauricular pit significance

Small pit/skin tag near tragus; may indicate renal disease or hearing loss if family history present.

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Acute mastoiditis signs

Auricle protrudes, area over mastoid red, swollen, and tender.

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Acute otitis media signs

Bulging, red TM, dull/absent light reflex, diminished mobility, purulent material behind TM.

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Pneumatic otoscopy purpose

Assesses TM mobility by changing canal pressure; detects middle ear effusion.

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Absent TM movement meaning

No TM movement during pneumatic otoscopy suggests middle ear effusion or poor technique.

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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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