Shadow Health - HEENT Tina Jones: Updated A+ Guide
Solution
Present Health Status - ANSWER-Changes in patient's overall health
-Changes to eyes, ears, nose, or mouth
-Chronic conditions
-Medications (what and how often)
-Last routine examinations (dental, vision, and hearing)
-Daily practices
-Occupational or recreational risks for injury to eyes, ears, or mouth
-Nicotine or alcohol?
Past Medical History - ANSWER-Injury to eyes, ears, mouth, or neck?
-Surgery involving eyes, nose, ears, mouth, or neck?
-Chronic infections affecting eyes, ears, sinuses, or throat?
Family History - ANSWER-Family history of cancer
-Does anyone in your family have conditions impacting hearing, vision, or thyroid?
Head Assessment - ANSWER-Inspection of head, scalp, face
-Movement: flexion 45 degrees, lateral bending 40 degrees in each direction,
hyperextension 55 degrees
-Palpation of head and scalp
-Palpation of temporal artery
-ROM of TMJ
Neck Assessment - ANSWER-Inspection of skin
-Testing ROM
-Observation of carotid arteries and jugular veins
-Palpation of trachea
-Inspection, palpation, and auscultation of the thyroid gland
Jugular Vein Distention - ANSWER-Vein distended on either side of neck
-Look with pen light, head turned to one side
-Sign of congestive heart failure if present
Palpation of Thyroid - ANSWER-Little larger than thumb pad; often not detected
-Should move freely and be nontender
-If easily palpated before swallowing, enlarged
-Lumps, tenderness, nodules abnormal
-Feel from behind patient
Hyperthyroidism - ANSWER-Associated with excessive production and secretion of
thyroid hormone
-Graves' disease=most common cause
, -Clinical findings: increased metabolism, enlargement of thyroid gland and
exophthalmos
Hypothyroidism - ANSWER-Result of decreased production of thyroid hormone
-Clinical findings: overall decreased metabolism, goiter may be seen; may feel slow,
tired, sluggish
Lymph Nodes - ANSWER-Preauricular, occipital, postauricular, submental,
submaxillary, tonsillar, anterior cervical, posterior cervical, supraclavicular
-Should NOT generally be palpable
-Lymph nodes enlarged, tender, firm, move freely suggest infection
-Malignancy suspected if nodes are unilateral, hard, asymmetric, fixed, nontender
Mouth & Pharynx Inspection - ANSWER-Lips
-Teeth and gums
-Tongue
-Posterior pharynx
-Tonsils
-Can use tongue depressor or gloves and gauze to move tongue
Oro-Pharyngeal Cancer Risk Factors - ANSWER-Age: increases after 40, peaks 64-74
-Gender: 2:1 M:F
-Ethnicity: African-Americans highest risk
-Tobacco: 90%
-Alcohol: 75-80%
-Sunlight exposure: lip cancer
-Previous cancer
-Immunosuppression
-HPV
Sore Throat Questions - ANSWER-How long have you had a sore throat?
-Describe? Hurt to swallow? Associated with fever, cough, fatigue, swollen lymph
nodes?
-Other around you sick? Dust/fumes at work? Dry air?
-How have you been treating your sore throat? Effective or no?
Tonsilitis - ANSWER-Infection of tonsils
-Clinical findings: sore throat, pain with swallowing (odynophagia), fever, chills,
tender cervical lymph nodes
-Enlarged and red tonsils
-Possible white or yellow exudate
-Tonsils grades 1+ to 4+
Assessment of Ear - ANSWER-Inspect and palpate external ear
-Otoscopic exam
-Assess hearing (Whisper, Finger rub, Weber, and Rinne tests)
Solution
Present Health Status - ANSWER-Changes in patient's overall health
-Changes to eyes, ears, nose, or mouth
-Chronic conditions
-Medications (what and how often)
-Last routine examinations (dental, vision, and hearing)
-Daily practices
-Occupational or recreational risks for injury to eyes, ears, or mouth
-Nicotine or alcohol?
Past Medical History - ANSWER-Injury to eyes, ears, mouth, or neck?
-Surgery involving eyes, nose, ears, mouth, or neck?
-Chronic infections affecting eyes, ears, sinuses, or throat?
Family History - ANSWER-Family history of cancer
-Does anyone in your family have conditions impacting hearing, vision, or thyroid?
Head Assessment - ANSWER-Inspection of head, scalp, face
-Movement: flexion 45 degrees, lateral bending 40 degrees in each direction,
hyperextension 55 degrees
-Palpation of head and scalp
-Palpation of temporal artery
-ROM of TMJ
Neck Assessment - ANSWER-Inspection of skin
-Testing ROM
-Observation of carotid arteries and jugular veins
-Palpation of trachea
-Inspection, palpation, and auscultation of the thyroid gland
Jugular Vein Distention - ANSWER-Vein distended on either side of neck
-Look with pen light, head turned to one side
-Sign of congestive heart failure if present
Palpation of Thyroid - ANSWER-Little larger than thumb pad; often not detected
-Should move freely and be nontender
-If easily palpated before swallowing, enlarged
-Lumps, tenderness, nodules abnormal
-Feel from behind patient
Hyperthyroidism - ANSWER-Associated with excessive production and secretion of
thyroid hormone
-Graves' disease=most common cause
, -Clinical findings: increased metabolism, enlargement of thyroid gland and
exophthalmos
Hypothyroidism - ANSWER-Result of decreased production of thyroid hormone
-Clinical findings: overall decreased metabolism, goiter may be seen; may feel slow,
tired, sluggish
Lymph Nodes - ANSWER-Preauricular, occipital, postauricular, submental,
submaxillary, tonsillar, anterior cervical, posterior cervical, supraclavicular
-Should NOT generally be palpable
-Lymph nodes enlarged, tender, firm, move freely suggest infection
-Malignancy suspected if nodes are unilateral, hard, asymmetric, fixed, nontender
Mouth & Pharynx Inspection - ANSWER-Lips
-Teeth and gums
-Tongue
-Posterior pharynx
-Tonsils
-Can use tongue depressor or gloves and gauze to move tongue
Oro-Pharyngeal Cancer Risk Factors - ANSWER-Age: increases after 40, peaks 64-74
-Gender: 2:1 M:F
-Ethnicity: African-Americans highest risk
-Tobacco: 90%
-Alcohol: 75-80%
-Sunlight exposure: lip cancer
-Previous cancer
-Immunosuppression
-HPV
Sore Throat Questions - ANSWER-How long have you had a sore throat?
-Describe? Hurt to swallow? Associated with fever, cough, fatigue, swollen lymph
nodes?
-Other around you sick? Dust/fumes at work? Dry air?
-How have you been treating your sore throat? Effective or no?
Tonsilitis - ANSWER-Infection of tonsils
-Clinical findings: sore throat, pain with swallowing (odynophagia), fever, chills,
tender cervical lymph nodes
-Enlarged and red tonsils
-Possible white or yellow exudate
-Tonsils grades 1+ to 4+
Assessment of Ear - ANSWER-Inspect and palpate external ear
-Otoscopic exam
-Assess hearing (Whisper, Finger rub, Weber, and Rinne tests)
