1
Chapter 11 (Head and Neck)
Cervical lymph nodes p.343-345
1. Submental-palpate in the midline a few centimeters behind the tip of
the mandible.
2. Submandibular- midway between the angle and the tip of the
mandible. These nodes are usually smaller and smoother than the
lobulated submandibular gland against which they lie.
3. Preauricular-Palpate in front of the ear
4. Posterior auricular-Palpate behind the ear and superficial to the
mastoid process
5. Tonsillar (jugulodigastric)-Palpate at the angle of the mandible
6. Occipital-palpated the base of the skull posteriorly
7. Anterior superficial cervical-palpate for these nodes anterior and
superficial to the SCM muscle
8. Posterior cervical- palpate along the anterior edge of the trapezius
by flexing the patient's neck slightly forward towards the side being
examined.
9. Deep cervical chain- deep in the SCM muscle and often inaccessible
to examination. Hook your thumb and fingers around either side of
the SCM muscle to find it.
10. Supraclavicular- palpate deep in the angle formed by the
clavicle and the SCM muscles.
Note: lymph nodes size, shape, delineation (discreet or matted together),
mobility, consistency, and any tenderness.
Thyroid gland p.346-347
Inspection: inspect the neck for the thyroid gland. Tip the patient's head
back slightly. Inspect the region below the cricoid cartilage to identify the
contours of the gland.
Observe the patience SIV allowing: ask the patient to sip some water
and to extend the neck again and swallow. Watch for upward movement of
the thyroid gland, noting its contour and symmetry.
Palpation: palpate the thyroid gland, find your landmarks, notching thyroid
cartilage and cricoid cartilage below it. Locate the thyroid isthmus, usually
overlying the second, third, and 4th tracheal rings.
Note the size, shape, and consistency (soft, firm, or hard) of the gland and
identify any nodules or tenderness. If the thyroid gland is enlarged, listen
,2
over the lateral lobes with a stethoscope to detect a bruit, a sound similar to
a cardiac murmur but of not of cardiac origin period
Chapter 12 (Eyes)
Vision changes p.362-363
Difficulty with close work suggests:
Hyperopia: Farsightedness
Presbyopia: Aging vision
Difficulty with distance vision suggests:
Myopia: near-sightedness
If sudden visual loss is unilateral and painless, consider: vitreous
hemorrhage caused by diabetes or trauma, macular degeneration, retinal
detachment, retinal vein occlusion, or central retinal arterial occlusion.
If painful, causes are usually in the cornea and the anterior chamber such
as the corneal ulcer
Visual acuity p.365-366
Visual acuities expressed in 2 numbers (better than (E. G. 20 /30) indicate
the distance of the patient from the chart, the second the distance at which
the normal eye can read the line of letters. Vision of 20/200 means that 20
feet, the patient can read print that a person with normal vision could read
at 200 feet.
Cornea and lens p.387 Table 12-5
Near reaction p.359 p.371
When a person shifts gaze from a far object to a near object, the pupils
constrict. The response, like the light reaction, is mediated by the ocular
motor nerve (CN III). Coincident with these pupillary constriction, but not
part of it are: 1. convergence of the eyes, a bilateral medial rectus
movement; 2. accommodation, an increased convexity of the lenses caused
by contraction of the ciliary muscles. In Accommodation, the change in
shape of the lens brings near objects into focus. Physically this takes place
behind the iris and is not visible to the examiner.
Chapter 13 (Ears and Nose)
Peripheral vertigo Table 13-1 Page 413
, 3
Conductive vs sensorineural hearing loss: Weber and Rinne test p.407-408
Test for lateralization (Weber test). Said tuning fork to light vibration by
briskly stroking the prongs between the thumb and index finger or by
tapping the prongs on your forearm just in front of your elbow place the
base of the lightly vibrating tuning fork firmly on the top of the patient's
head and or mid forehead as where the patient hears the sound bests: On
one side or both sides?. Normally, the vibration is heard in the midline or
equally in both ears.
Compare air conduction (AC) and bone conduction (BC) (Rinne Test),
placing the base of the lightly vibrating tuning fork on the mastoid bone
behind the ear and level with the canal. When the patient can no longer
hear the sound, quickly place the prong of the fork close to the ear canal
and ask if the patient hears vibration.
Nose p.409-410
Chapter 14 (Throat and Oral Cavity)
Findings in the pharynx, palate, and oral mucosa Table 14-2 (Page 432)
Large normal tonsils: Normal tonsils may be large without being infected,
especially in children. They may protrude immediately along the pillars and
even into the midline.
Exudative tonsils: red throat has a thick white exudate on the tonsils. This,
together with fever and enlarged cervical nodes, increases the probability of
Group A streptococcal infection or infectious mononucleosis.
Pharyngitis: red and throat without exudate. Redness and vascularity of
the pillars and uvula are mild to moderate
Diphtheria: an acute infection caused by Corynebacterium diphtheria. It is
now a rare but still important disease. Prompt diagnosis may lead to life-
saving treatment. The throat is dull, red, and a great exudate is present on
the uvula, Pharynx, and tongue. The airway may become obstructed.
Thrush on the palette: Thrush is a yeast infection from the Candida
species. It may appear as cream colored, bluish white pseudomembranous
patches on the tongue, mouth or fair necks.
Kaposi sarcoma and aids: The deep purplish color of these lesions
suggests Kaposi sarcoma, a low-grade vascular tumor associated with
human herpes virus 8
Chapter 11 (Head and Neck)
Cervical lymph nodes p.343-345
1. Submental-palpate in the midline a few centimeters behind the tip of
the mandible.
2. Submandibular- midway between the angle and the tip of the
mandible. These nodes are usually smaller and smoother than the
lobulated submandibular gland against which they lie.
3. Preauricular-Palpate in front of the ear
4. Posterior auricular-Palpate behind the ear and superficial to the
mastoid process
5. Tonsillar (jugulodigastric)-Palpate at the angle of the mandible
6. Occipital-palpated the base of the skull posteriorly
7. Anterior superficial cervical-palpate for these nodes anterior and
superficial to the SCM muscle
8. Posterior cervical- palpate along the anterior edge of the trapezius
by flexing the patient's neck slightly forward towards the side being
examined.
9. Deep cervical chain- deep in the SCM muscle and often inaccessible
to examination. Hook your thumb and fingers around either side of
the SCM muscle to find it.
10. Supraclavicular- palpate deep in the angle formed by the
clavicle and the SCM muscles.
Note: lymph nodes size, shape, delineation (discreet or matted together),
mobility, consistency, and any tenderness.
Thyroid gland p.346-347
Inspection: inspect the neck for the thyroid gland. Tip the patient's head
back slightly. Inspect the region below the cricoid cartilage to identify the
contours of the gland.
Observe the patience SIV allowing: ask the patient to sip some water
and to extend the neck again and swallow. Watch for upward movement of
the thyroid gland, noting its contour and symmetry.
Palpation: palpate the thyroid gland, find your landmarks, notching thyroid
cartilage and cricoid cartilage below it. Locate the thyroid isthmus, usually
overlying the second, third, and 4th tracheal rings.
Note the size, shape, and consistency (soft, firm, or hard) of the gland and
identify any nodules or tenderness. If the thyroid gland is enlarged, listen
,2
over the lateral lobes with a stethoscope to detect a bruit, a sound similar to
a cardiac murmur but of not of cardiac origin period
Chapter 12 (Eyes)
Vision changes p.362-363
Difficulty with close work suggests:
Hyperopia: Farsightedness
Presbyopia: Aging vision
Difficulty with distance vision suggests:
Myopia: near-sightedness
If sudden visual loss is unilateral and painless, consider: vitreous
hemorrhage caused by diabetes or trauma, macular degeneration, retinal
detachment, retinal vein occlusion, or central retinal arterial occlusion.
If painful, causes are usually in the cornea and the anterior chamber such
as the corneal ulcer
Visual acuity p.365-366
Visual acuities expressed in 2 numbers (better than (E. G. 20 /30) indicate
the distance of the patient from the chart, the second the distance at which
the normal eye can read the line of letters. Vision of 20/200 means that 20
feet, the patient can read print that a person with normal vision could read
at 200 feet.
Cornea and lens p.387 Table 12-5
Near reaction p.359 p.371
When a person shifts gaze from a far object to a near object, the pupils
constrict. The response, like the light reaction, is mediated by the ocular
motor nerve (CN III). Coincident with these pupillary constriction, but not
part of it are: 1. convergence of the eyes, a bilateral medial rectus
movement; 2. accommodation, an increased convexity of the lenses caused
by contraction of the ciliary muscles. In Accommodation, the change in
shape of the lens brings near objects into focus. Physically this takes place
behind the iris and is not visible to the examiner.
Chapter 13 (Ears and Nose)
Peripheral vertigo Table 13-1 Page 413
, 3
Conductive vs sensorineural hearing loss: Weber and Rinne test p.407-408
Test for lateralization (Weber test). Said tuning fork to light vibration by
briskly stroking the prongs between the thumb and index finger or by
tapping the prongs on your forearm just in front of your elbow place the
base of the lightly vibrating tuning fork firmly on the top of the patient's
head and or mid forehead as where the patient hears the sound bests: On
one side or both sides?. Normally, the vibration is heard in the midline or
equally in both ears.
Compare air conduction (AC) and bone conduction (BC) (Rinne Test),
placing the base of the lightly vibrating tuning fork on the mastoid bone
behind the ear and level with the canal. When the patient can no longer
hear the sound, quickly place the prong of the fork close to the ear canal
and ask if the patient hears vibration.
Nose p.409-410
Chapter 14 (Throat and Oral Cavity)
Findings in the pharynx, palate, and oral mucosa Table 14-2 (Page 432)
Large normal tonsils: Normal tonsils may be large without being infected,
especially in children. They may protrude immediately along the pillars and
even into the midline.
Exudative tonsils: red throat has a thick white exudate on the tonsils. This,
together with fever and enlarged cervical nodes, increases the probability of
Group A streptococcal infection or infectious mononucleosis.
Pharyngitis: red and throat without exudate. Redness and vascularity of
the pillars and uvula are mild to moderate
Diphtheria: an acute infection caused by Corynebacterium diphtheria. It is
now a rare but still important disease. Prompt diagnosis may lead to life-
saving treatment. The throat is dull, red, and a great exudate is present on
the uvula, Pharynx, and tongue. The airway may become obstructed.
Thrush on the palette: Thrush is a yeast infection from the Candida
species. It may appear as cream colored, bluish white pseudomembranous
patches on the tongue, mouth or fair necks.
Kaposi sarcoma and aids: The deep purplish color of these lesions
suggests Kaposi sarcoma, a low-grade vascular tumor associated with
human herpes virus 8
