Exam 1 Physical Diagnosis Objectives
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Contents |
Chapter 11
Ear
- Describe the structure and innervations of the ear.
- External ear consists of pinna and external auditory canal
- The middle ear or tympanic cavity consists of connections to the mastoid antrum and nasopharyx through the Eustachian tube
- The tympanic membrane forms the lateral boundary of the middle ear, while the cochlea forms the medial boundary
- Sound is conducted from the tympanic membrane to the inner ear by the malleus, incus and stapes
- The tensor tympani [CN V] and the stapedius [CN VII] are also located in the middle ear
- The inner ear is the end-organ for hearing and equilibrium containing the semicircular canals, vestibule and the cochlea
- The hair cells of the organ of corti convert mechanical force into electrochemical signal
- Identify the major symptoms of ear disease and how these symptoms can identify diseases involving the ear: hearing loss, vertigo, tinnitus, otorrhea, otalgia, and itching.
- Hearing loss
- conductive: blocks transmission of sound waves in external canal or middle ear; caused by wax, effusions, foreign bodies
- sensorineural: inner ear structures, auditory nerve or brain stem are dibilitated; caused by prenatal rubella, and lots of other causes.
- Patients with sensorineural talk loudly, conductive speak softly.
- Vertigo: spinning or turning in position; can be otologic, neurologic, psychological, or iatrogenic.
- Meniere’s disease: severe paroxysmal vertigo as a result of labyrinthine lesions
- Tinnitus: sensation of hearing sound such as buzzing or ringing
- Otorrhea: bloody discharge associated with carcinoma or trauma
- Otalgia: pain related to inflammatory conditions or may be referred
- Itching: from primary disorder of external ear or discharge from middle ear
- Hearing loss
- Apply the components of the physical exam of the ear to a patient.
- Inspect external ear structures: tophi, “cauliflower ear” from trauma, cancer, discharge
- Palpate the external ear structures
- Auditory acuity testing: occlude one ear and speak softly into the other; use of 512Hz fork
- Rinne test: air conduction vs bone conduction using fork; placing stem on mastoid process compared against vibratory hearing; usually AC > BC [Rhine positive]
- Weber test: compares bone conduction in both ears by placing fork in middle of forehead; sound heard on ipsi side of conductive problem and contra side of a sensorineural problem
- Example: Rinne positive on both sides -> sensorineural problem; Rinne negative on one side identifies conduction problem on that side
- Otoscopic examination: pull posterior and superior and look at the canal and tympanic membrane (should be pearly gray)
- Injection: dilation of tympanic vessels
- Retraction pocket can indicate Eustachian tube blockage and decreased pressure
- Determination of mobility of tympanic membrane: also uses otoscope; useful for middle ear infection possibility (decreased movement will be detected if fluid present)
- Clinically correlate the symptoms and physical exam findings pertaining to the ear for the following disease processes: conductive and sensorineural hearing loss, otitis media, serous otitis media, otitis externa, and vertigo. Interpret the symptoms of diseases of the ear and apply them clinically to patient.
- Acute otitis externa: p. aeruginosa
- Severe pain accentuated by manipulation of the pinna; lymphadenopathy; fever; normal tympanic membrane
- Summer time
- Bullous myringitis: localized form of external otitis
- Acute viral URI; severe pain; lesions on the skin of the deep external ear canal;
- Self-limited
- Acute otitis media: bacterial infection of the middle ear
- Usually in children;
- Pain, malaise, no pain on external manipulation, fiery red tympanic membrane;
- Winter
- Advanced acute otitis media: rupture of membrane
- Perforations can be central or marginal (more serious and may dispose to a cholesteatoma)
- May result from either otitis media or trauma
- Serous otits media:
- Adults with viral URIs or sudden atmospheric pressure changes
- Tympanic membrane appears yellowish-orange as a result of the amber-colored fluid
- Partial obstruction of the Eustachian tubes:
- Air bubbles or an air-fluid level in the middle ear
- Chronic otitis media: rupture and recurrent middle ear infections
- Foul-smelling, not usually painful
- Retraction pockets: chronic negative pressure within middle ear
- May progress to an acquired cholesteatoma
- Treat with T-tube (tympanostomy)
- Deafness:
- Child: conductive via cerumen, chronic/acute otitis media; sensorinueral via mumps, rubella
- Adult: conductive via tube blockage, viral myringitis, otosclerosis; sensorineural via Meniere’s, ototoxic drugs, acoustic neuroma
- Acute otitis externa: p. aeruginosa
- Generate a diagnosis and/or differential diagnosis based on symptoms and/or physical exam findings of the ear.
Nose
- Describe the structure of the nose.
- Illustrate how the major symptoms of nose diseases are used to identify nose diseases.
- Interpret the symptoms related to the nose and apply them clinically to a patient.
- Apply the components of the physical exam of the nose to a patient.
- Clinically correlate the symptoms and physical exam findings pertaining to the nose for the following disease processes: allergic rhinitis, sinusitis, and nonallergic rhinitis.
- Generate a diagnosis and/or differential diagnosis based on symptoms and/or physical exam findings of the nose.
Chapter 12
- Know the structures of the oral cavity and pharynx.
- Know the functions of the pharynx.
- Subdivisions: nasopharynx, oropharynx, hypopharynx.
- Fxn: provides swallowing, speech, and an airway.
- Know the important symptoms of disease of the oral cavity.
- Ulceration, bleeding, mass, halitosis, xerostomia (dry mouth).
- Apply the components of the physical exam of the oral cavity and pharynx to a patient.
- See cd.
- Clinically correlate the signs and symptoms of the following conditions:
- Aphthous ulcer
- Single canker sore. Most common acute oral ulcer.
- Relatively superficial w/ raised borders. On buccal or labial mucosa.
- Herpetic ulcer
- acute multiple ulcers, associated w/ vesicles.
- On mucocutaneous junction, hard palate, or gingivae.
- Crusting when bullae break.
- Chancre
- Painless, single lesion on lips or tongue.
- Lesion w/o central necrotic material.
- May have tender lymphadenitis.
- Squamous cell carcinoma:
- Single indurated sore on lips, tongue, mouth floor, or tongue (esp. on lateral borders)
- Erythroplakia of mouth floor and soft palate.
- Raised border, absence of necrotic material in crater.
- May have painless lymphadenopathy in neck.
- Candidiasis
- Burning tongue, inside of cheek or throat.
- Whitish pseudomembrane.
- Peeled off to reveal raw, red area that may bleed.
- Erythroplakia
- Painless, red area.
- Granular, red papules that bleed.
- Leukoplakia
- Painless, white area.
- Hyperkeratinized. Can’t be scraped off.
- Looks like flaking white paint. Often speckled w/ red spots.
- If associated with adenopathy, could be malignancy.
- Lipoma
- Painless mass on inner surface of cheek or tongue.
- Yellowish, soft, freely mobile.
- Lichen planus
- Usually no symptoms.
- Erosive form causes burning sores on inner cheeks and tongue.
- White reticulated papules bilaterally in lace-like pattern.
- Erosive form is hemorrhagic, ulcerated w/ possible white areas or bullae.
- May have pseudomembrane covering.
- Mucocele
- Intermittent painless swelling of lower lip, or inside cheek.
- Slightly bluish.
- Dome-shaped, freely-mobile cystic lesion.
- Hairy Tongue
- Gagging sensation.
- Large brown or black painless lesion on top of tongue.
- Elongation of filiform papillae and color change.
- Aphthous ulcer
Chapter 13
- Describe the topographical landmarks of the chest and utilize that knowledge to describe physical findings of the chest.
- Recognize the main symptoms of pulmonary disease and how these symptoms can identify disease.
- Interpret the symptoms of pulmonary disease and apply them clinically to a patient.
- Apply the components of the physical exam of the chest to a patient.
- Clinically correlate the symptoms and physical exam findings pertaining to the chest:
- Pulmonary Edema
- Pneumothorax
- Asthma
- Pneumonia
- Emphysema
- Pulmonary Embolism
- Pleural Effusion
- Generate a diagnosis and/or differential diagnosis based on symptoms and/or physical exam findings of the chest.
Chapter 17
- Describe the topographical landmarks of the abdomen and utilize that knowledge to describe physical findings of the abdomen.
- Recognize where abdominal structures are located by topographical quadrants of the abdomen.
- Recognize the main symptoms of abdominal disease and how these symptoms can identify disease.
- Interpret the symptoms of abdominal disease and apply them clinically to a patient.
- Apply the components of the physical examination of the abdomen to a patient.
- Clinically correlate the symptoms and physical exam findings pertaining to the abdomen.
- Generate a diagnosis and/or differential diagnosis based on symptoms and/or physical exam findings.