How many bones in the cranium
What do you ask in a HEENT Health history?
Tinniuts, Incontinence, memory loss, epilepsy, CVA, family history, head trama, sinus problems, headache..etc
What do you inspect in the head and face?
Midline, hair distribution, symmetry, facial expression, color, abnormal movments.
What do you palpate in the head/face?
Scalp and hair texture, masses, tenderness, swelling, muscle tone, temportal artery, TMJ
What do you auscultate in the Head/Face
What is Normocephalic, Microcephalic, macrocephalic mean?
- Normocephalic-Normal size and shape
- Mircocephalic- Small head
- Macrocephalic- Big Head
What is hydrocephalic?
Water in the head
What is a TIC?
A nervous disorder
What is exophthalmos?
Bulging of the eyes from their orbit
What is acromegaly?
Acromegaly is a chronic metabolic disorder in which there is too much growth hormone and the body tissues gradually enlarge
How do you assess the eyes?
- Get a current status: problems with vision, corrective lenses.
- Past history: changes, sports, flaters, surgeries, drainage, etc
What is the Snellen Chart?
- THe assessment of distance vision
- -Patient stands 20 fe away
- -Test one eye at a time and then together
- -Read smallest line possible
- -Visual acuity as a fraction
What do you inspect in the eye?
Look at the conjunctiva, etc with an otoscope
Palpation of the eyes
Palpate eyelids for swelling, eyeball, lacrimal sac
What does the lacrimal sac turn into?
The nasolacrimal duct
What is myopia?
What is PERRLA?
- Assessment of the pupils:
- Ractive to
- Light and
What do you examine with an Opthalmoscope?
Red reflex, optic fundus, optic disk, blood vessels, and macula
Assessment of the ears
Changes in hearing, ear pain, cerumen, tinnitus, problems with dizziness, medicaitons, chronic ear infections
Examination of the Ears?
- Inspect color, size, drainage
- Assess for lesions
- Palpate Tragus
- Mastoid Process
- Pull heliz backwards
What are the different hearing assessments?
- The gross hearing test
- Whisper Test
- Watch Tick test
- Rinne's Test
- Weber's Test
What is the whisper test?
Stand one-two ft behind the patient and have them cover one ear and whisper a few words and have them repeat back to you
What is the watch tick test?
Holding a pocket watch and slowly pulling away from the patient until they cannot hear it anymore.
What is the Weber's Test?
- A tuning fork is placed in the patient's forehead and should be heard equally in both ears.
- If conductive loss, heard louder in affective ear
- If sensorineural loss, head louder in unaffective ear
What is the Rinne Test?
- Comparing air and bone conduction with a tuning fork.
- AC>BC, normal positve
- AC< BC, negative Rinne Test
What is conduction deafness?
Interruption of the sound vibrations in their passage from the outer world to the nerve cells in the inner ear
What is sensoineural deafness?
In nerve deafness, some defect in the sensory cells of the inner ear (e.g., their injury by excessive noise) or in the vestibulocochlear nerve prevents transmission of sound impulses from the inner ear to the auditory centre in the brain
Examine external ear canal, assess cerumen, tympanic membrane, TM should be pearly gray, cone of light
What do you assess when looking at the Nose?
Inspect: Symmetry, deformity, swelling, nasal flaring, and nasal spectulum.
Palpate: for tenderness and nasal patency
What do you assess for the Sinuses
- Inspect: Frontal and maxillary sinuses for inflammation
- Palpate nad percuss for tenderness
- Transillumintion-shining light through a body cavity
What do you assess for the mouth?
- Inspect: Lips, gums, mucosa, teeth, hard and soft palate, anterior/ posterior tonsils, pharynx, tongue,
- Stenson- saliva duct
- Wharton Duct- submandibular gland opening into the mouth
What do you assess in the Neck?
- Inspect: Scars, Masses, Trachea
- Palpate: Thyroid
What are the brain lobes:
What are the two componets of the Nervous System?
- CNS- Brain and spinal cord
- PNS- Cranial and spinal nerves, autonomic nervous system.
What is in the brainstem?
- Contains the midbrain, pons, and medulla oblongata.
- Relays impulses from spinal cord to cerebrum
What does the medulla control?
The cardiac, respiratory, and vasomoter centers
What does the cerebellum do?
- Maintenance of the equilibrium
- coordination of movement
- maintenance of muscle tone
What does the Olfactory (I) Nerve do?
- -Smell, assess sense of smell
- Normal Results: Correctly identifies scent in each nostil
- Abnormal: Inablitiy to id scent may be due to nasal disease or smoking
Optic (II) Nerve
- Assess using snellen chart
- Normal Results: 20/20, full visual fields, optic disc intact
- Abnormal Results: <20/20, loss of visual fields, papilledma
Oculomotor (III), rochlear (IV), Abducens (VI)
- -All motor
- -EOM (extra-ocular movement)
- Pupil size, shape and equality, reaction to light
- EOM in 6 cardinal fields of gaze
- Normal: No ptosis, nystagmus, Perrla
- S- light touch, pain, temp, corneal reflex
- M- Masseter and temportalis strength
- Clench teeth (M)
- Corneal Reflex
- Sharp v Dull
- Light touch
- Normal: Muscles contract bilaterally
- S- Taste anterior 2/3
- M- Facial Movements
- Symmtery of face
- Facial Movements
- Taste of sweet, sour, and salty, not bitter
- Abnormal: Inability to do movements may indicate CVA (Stroke), Bells palsy
- Cochlear: gross hearing
- Vestibular: equilibrium
- Hearing (whisper
- Weber and Rinne Test
- Normal: Whisper heard from 1-2 ft, AC>BC, vibration heard = in both ears
Glosssopharyngeal (IX) and Vagus (X)
- S- Taste posterior 1/3- Bitter
- M- Soft palate and uvula, gag reflex, swallowing
Spinal Accessory (XI)
- Sternocldidomastoid and trapezuis movement
- Shrug shoulders
- Rotate Head
- Normal: Symmetric, strong cnotractions of muscles
- Tongue movement and lingual sounds
- Normal: Tongue movement is symmetric, smooth
Should Lymph nodes be felt?
Should older adults have an increased ROM?
NO, it will be decreased
How should the corneal reflex be tested?
With a cotton wisp
Should the pupillary reflex be bilateral?
Yes it should, even if the other eye is covered up
-Often go unnoticed until very bad
What is accommodation?
Allows eyes to focus on objects
What is a cataract?
The clouding of the eye's lense
What is glaucoma?
The loss of retainal gaglioan cells-neuropathy
What is macular degeneration?
The backdown of retina macula
What is the most common HEENT problem?
What are some differences in the eldery HEENT
- -Shortening of the neck
- -Gums decrease
- -Gag reflex is sluggish
- -Smell is diminished
- -Decrease of pupil size
- -Prebyopia-eyes lose ability to focus
What are the components of the Lymphatic System
Fluid, collecting ducts, lymph tissue- all over but not in the brain
What role bone marrow, thymus, spleen, and lymph nodes play in the lymphatic system
- Bone marrow- makes B cells
- Thymus- Make T-cless
- Spleen- largest lymph organ
- Nodes- antibodies and lymphocytes
What is the lymphatic fluid circulation?
- Lymph fluid is clear, composed of H20, and protein.
- Differenet flow in different ways
What are lymphocytes?
- Recognize foregin substances and respond, stimulate producitonof more B and T cells
- Makes up 20-40% of WBC
- Normal: Unable to palpate or see
- Abnormal: Enlarged nodes, able to palpate, tenderness, firm, hard nodes.
- Larger in child and teens
Where are some lymph nodes in the body?
Cervical chair, axilla, breasts, thymus, tonsils, adenolds, peyers atches, spleen (White-lymph, red- Veins), groin
What are the adenoids?
What are the peyer's patches?
- GALT_ gut associated Lymphoid Tissue
- Present in mucosa and submucosa of small intestine (mainly ileum)
What do you ask in a health history for lymphatics?
Mastectomy, hodgkinds, organ transplant, HIV, FH, current infection, lymphedema
What is lymphedema?
excess lymph tissue in arm or leg, swelling painful, hard to treat, firm feeling, cluster
How do you examine Lymphatics?
- Inspect: Red streaks, enlarged nodes, lesions, edema, erythema
- Palpate: Superficial nodes and characteristics
What are characteristics of infected lymph nodes?
May be indicated when nodes are palpable bilaterally, feel large, warm, tender, firm but freely movable
What are characterisitics of malignant lymph nodes?
may be indicated when nodes are unilateral, hard, discrete, asymmetric, fixed, not painful, nontender.
What is cancer matastesis?
Pathway of cancer
What are old adult lymphatics?
Nodes diminish, decrease and become more fibrotic with age, impaired ability to resist infection
When does breast development begin?
- Begins at age 10-11
- Stimulated by estrogen release during puberty
What are features of breasts?
- Function: Milk production and lactation
- Tail of spense, coopers ligaments, nipple, areola, lobe, lobules, alveoi, lumphatic drainage
What is teh tail of spence?
90% of breast cancer occurs here
What is the difference between lobes and lobules?
Lobules are milk processing glands
What lymph nodes are in the breasts?
The axillary nodes: central, pectoral, subscapular, lateral, internal mammary chain
What are breast health maintenace activites?
Diet, exercise, breast self-exam, and mammogram
What do you ask in a breast health history?
Age, Gender, Race, common chief complanits, breast masses, past history, family history
What areas do you assess in a breast assessment?
Breasts, areolar areas, nipples, axillae
What characterisitics are assessed in the breast exam?
Color, vascularity, thickening, size and symmetry, contour, lesions, discharge
What do you palpate in a breast exam?
Sequential manner, suprclaviuclar and infraclauvicular nodes, breasts, arms at side, arms rasied, axillary nodes, supine position
What are characteristics of breast masses?
Location, size, number, definition, mobility, tenderness, erythema, dimpling or retraction
What are normal findings for a breast exam?
- Breast and axillae are flesh colored
- areolar areas and nipples are darker in pigmentation
- moles are normal
- no thickening
- minor size variations
- usually breast on dominant side is larger
- nipples should point upwards and out, sometimes downwards and out
What are some breast cancer risk factors?
Age > 50, personal history, family history, meopuase at advanced age, menarche at an early age, obseity, american descent, estogen tehrapy, first birth after age 30, higher education/class, >3 alcohol servings a day
What is included in a breast self exam?
Performed once a month, performed on a fixed date each month, or 8 days after period, avoid completein during menstruation or ovulation, use calender for reminder, and include significant other in process
How do you perform a breast self-exam?
- Lie down
- I arm up, other feeling
- Use finger pads
- Go up and down
- 3 levels of pressure: Light, medium, and firm
- In mirror with hands on hip
What is included in a GSE?
- Penis: Assess for tenderness, pulsations, masses
- Urethral meatus: Discharge
- Scrotum: Masses, tenderness, spermatic cord
- Inguinal area: Hernias
What are normal findings of a GSE for males?
- -Testicles are firm, smooth, equal in size
- -Spermatic cord is smooth and round
- -small, freely moblie lymph nodes in inguinal area
- - Scrotal skinis pigmented, rugated, and thin
- -No inflammation or swelling in scrotal area
- -Left scrotal sac is lower than the right
What are risk factors of testicular cancer?
- - age 25-44
- -Mother uses birth control or x-rays
- -Mother or sister having breast cancer
- -White, high class
- -Early puberty
- -Family History
What is in a GSE-Female?
- Mons pubis- look for bumps, warts, or ulcers-note change in skin color
- Check clitoir and clitoral hood
- Examine the labia minora and majora
- move to perineum and check carefully
What to look for in a GSE-Female?
- -Any new mole, wart, or growth
- -Any areas of discolored skin
- -Ulcers or sores without a known cause
- -Areas of continuing pain, swelling, or itching
What are risk factors of cervical cancer?
HPV, infection, late teens- mid-30s, multiple sex partners, failture to have pap test, HIV, smoking, use of OCPs for more than 5 years