ADVANCED ASSESSMENT INTERPRETING
FINDINGS AND FORMULATING
DIFFERENTIAL DIAGNOSES
COMPREHENSIVE EXAMINATION TEST
COMPLETE QUESTIONS AND CORRECT
ANSWERS
●● Abnormal findings of external nose exam?
Answer: a depression of the nasal bridge can result from a fracture of
nasal bone or previous nasal cartilage inflammation , a transverse crease
at the junction between the cartilage and the nose bone may indicate
chronic itching and allergies, discharge
●● Abnormal findings of lips?
Answer: dry and cracked/ cheilitis (dehydration, wind, dentures, braces,
lip licking)
deep fissures at corners of mouth/ cheilosis (riboflavin deficiency,
overclosure of mouth)
swelling (allergy)
pallor (anemia)
circumoral pallor (scarlet fever)
round, oval, irregular blue/gray moles (Puetz-Jeghers syndrome)
lesions, plaques, nodules, ulceration (infections, skin cancer)
,●● Abnormal findings of nasal mucosa and septum?
Answer: purulent discharge may be d/t URI, sinusitis, foreign body.
Increased redness of mucosa my occur due to infection, localized
redness in vestibule may indicate a furncicle, turbinates that are blue,
gray, pale, pink, swollen, boggy may indicate allergies, a polyp may be
seen as a round, elongated mass that is protruding into the nasal cavity
from boggy mucosa
●● Abnormal findings of oral cavity?
Answer: Smooth tongue with slick appearance is glossitis and due to
vitamin B12 deficiency
Hairy tongue with yellow/brown black papillae can be due to abx
Ranula (mucocele) may be seen on the floor of the mouth when duct of a
SL gland is obstructed
Any ulceration, nodule, thick white patch on lateral or ventral side of
tongue may be a malignancy
Deviation of uvula may indicate vagus nerve paraylis
Bifid uvula may be common in Native Americans
●● Abnormal findings of oropharynx?
Answer: red, hypertrophied, exudate tonsils indicate infection, red bulge
adjacent to tonsil and extending beyond midline may be a peritonsilar
abscess, yellowish mucoid film indicates postnasal drip
,●● Abnormal findings of palpating the sinuses?
Answer: swelling or tenderness over them upon palpation may indicate
infection or obstruction
●● Abnormal findings of Weber test?
Answer: if the sound is better in the affected ear then the patient has
conductive hearing loss. If the sound lateralizes to the better ear then it is
sensorineural loss.
●● Abnormal findings when testing extraocular movements?
Answer: if lid lag occurs or sclera is seen above the iris it may indicate
thyroid disease
●● Abnormalities of S1
Answer: a loud sound may be due to the snapping shut of the mitral
valve, increased blood viscosity, fever, anemia, anxiety, exercise and
intensity may be increased with heart block. Decreased intensity may be
due to overlying tissue fat, fluid, pulmonary hypertension, fibrosis, or
calcification of mitral valve
●● Abnormalities of S2
Answer: an increased intensity may indicate systemic HTN, syphilis of
aortic valve, exercise, excitement, pulmonary HTN, mitral stenosis,
CHF. A decreased intensity may indicate shock, immobile valves, aortic
stenosis, pulmonic stenosis, overlying tissue, fat or fluid
, ●● Abnormalities when doing the cover uncover test?
Answer: eye moves outward from the midline (exotropic)
eye moved inward toward the nose (esotropia)
●● Describe how you examine the oral cavity by inspection, testing CN
XII, inspecting floor of mouth , tongue, palate, uvula, and soft palate?
Answer: Inspect dorsum of tongue for swelling, size, color, coating,
ulceration.
Ask patient to extend tongue and check for deviation, tremor, limited
movement (CN XII hypoglossal nerve)
Then ask the patient to touch tongue to tip of palate and inspect floor of
mouth and ventral surface of tongue, frenulum, SL ridge, and wharton
ducts
Then wrap the tongue with a piece of guaze and gently pull it to each
side and inspect
Palpate tongue and floor and floor of mouth for lumps, nodules,
ulceration
Lastly have the patient tilt their head back and look at the palate and
uvula, have patient say "ah" to see if the uvula rises
●● Describe palpating the auricles and mastoid area?
Answer: palpate both of them for any tenderness, swelling, or nodules
FINDINGS AND FORMULATING
DIFFERENTIAL DIAGNOSES
COMPREHENSIVE EXAMINATION TEST
COMPLETE QUESTIONS AND CORRECT
ANSWERS
●● Abnormal findings of external nose exam?
Answer: a depression of the nasal bridge can result from a fracture of
nasal bone or previous nasal cartilage inflammation , a transverse crease
at the junction between the cartilage and the nose bone may indicate
chronic itching and allergies, discharge
●● Abnormal findings of lips?
Answer: dry and cracked/ cheilitis (dehydration, wind, dentures, braces,
lip licking)
deep fissures at corners of mouth/ cheilosis (riboflavin deficiency,
overclosure of mouth)
swelling (allergy)
pallor (anemia)
circumoral pallor (scarlet fever)
round, oval, irregular blue/gray moles (Puetz-Jeghers syndrome)
lesions, plaques, nodules, ulceration (infections, skin cancer)
,●● Abnormal findings of nasal mucosa and septum?
Answer: purulent discharge may be d/t URI, sinusitis, foreign body.
Increased redness of mucosa my occur due to infection, localized
redness in vestibule may indicate a furncicle, turbinates that are blue,
gray, pale, pink, swollen, boggy may indicate allergies, a polyp may be
seen as a round, elongated mass that is protruding into the nasal cavity
from boggy mucosa
●● Abnormal findings of oral cavity?
Answer: Smooth tongue with slick appearance is glossitis and due to
vitamin B12 deficiency
Hairy tongue with yellow/brown black papillae can be due to abx
Ranula (mucocele) may be seen on the floor of the mouth when duct of a
SL gland is obstructed
Any ulceration, nodule, thick white patch on lateral or ventral side of
tongue may be a malignancy
Deviation of uvula may indicate vagus nerve paraylis
Bifid uvula may be common in Native Americans
●● Abnormal findings of oropharynx?
Answer: red, hypertrophied, exudate tonsils indicate infection, red bulge
adjacent to tonsil and extending beyond midline may be a peritonsilar
abscess, yellowish mucoid film indicates postnasal drip
,●● Abnormal findings of palpating the sinuses?
Answer: swelling or tenderness over them upon palpation may indicate
infection or obstruction
●● Abnormal findings of Weber test?
Answer: if the sound is better in the affected ear then the patient has
conductive hearing loss. If the sound lateralizes to the better ear then it is
sensorineural loss.
●● Abnormal findings when testing extraocular movements?
Answer: if lid lag occurs or sclera is seen above the iris it may indicate
thyroid disease
●● Abnormalities of S1
Answer: a loud sound may be due to the snapping shut of the mitral
valve, increased blood viscosity, fever, anemia, anxiety, exercise and
intensity may be increased with heart block. Decreased intensity may be
due to overlying tissue fat, fluid, pulmonary hypertension, fibrosis, or
calcification of mitral valve
●● Abnormalities of S2
Answer: an increased intensity may indicate systemic HTN, syphilis of
aortic valve, exercise, excitement, pulmonary HTN, mitral stenosis,
CHF. A decreased intensity may indicate shock, immobile valves, aortic
stenosis, pulmonic stenosis, overlying tissue, fat or fluid
, ●● Abnormalities when doing the cover uncover test?
Answer: eye moves outward from the midline (exotropic)
eye moved inward toward the nose (esotropia)
●● Describe how you examine the oral cavity by inspection, testing CN
XII, inspecting floor of mouth , tongue, palate, uvula, and soft palate?
Answer: Inspect dorsum of tongue for swelling, size, color, coating,
ulceration.
Ask patient to extend tongue and check for deviation, tremor, limited
movement (CN XII hypoglossal nerve)
Then ask the patient to touch tongue to tip of palate and inspect floor of
mouth and ventral surface of tongue, frenulum, SL ridge, and wharton
ducts
Then wrap the tongue with a piece of guaze and gently pull it to each
side and inspect
Palpate tongue and floor and floor of mouth for lumps, nodules,
ulceration
Lastly have the patient tilt their head back and look at the palate and
uvula, have patient say "ah" to see if the uvula rises
●● Describe palpating the auricles and mastoid area?
Answer: palpate both of them for any tenderness, swelling, or nodules
