Head and Neck Flashcards
Parkinsons
-Facial mobility decreased resulting in blunt expression “Masked” appearance -decreased blinking and a characteristic stare with an upward gaze -slow movements and shuffling gait
Exophthalmos
-eyeball protrudes forward -bilateral suggest presence of Grave’s disease -unilateral doesn’t r/o grave’s disease
Hordeolum
-aka sty -painful tender, erythematous infection in a gland at the margin of the eyelid
Subconjunctival hemorrhage
-leakage of blood outside of the vessels -produces a homogenous, sharply demarcated bright red area -fades over several days, turning yellow, then disappears -no associated eye pain, ocular discharge, or changes in visual acuity, cornea is clear -many times associated with severe cough, chocking or vomiting, which increase venous pressure -rarely caused by serious condition -reassurance usually only treatment necessary
Ptergium
triangular thickening of bulbar conjunctiva -grows slowly across outer surface of cornea, usually from nasal side -reddening may occur and it may interfere with vision as it encroaches on pupil
Migranes
-unilateral headache is often seen -commonly associated with phonophobia and photophobia
“red flag” headach
-new severe headache >50 -acute onset -“worst headache of my life -very high bp -rash or signs of infection -known presence of cancer, HIV, or pregancy; vominting, recent head trauma and persistent neurologic problems
Retinal detachment
sudden painless unilateral vision loss
Optic neuritis
-sudden, painful unilateral loss of vision -in MS sudden painful loss of vision may accompany optic neuritis.
Diplopia, present with one eye covered
- irregularity in cornea or lens -double vision in one eye alone points to a problem in “processing” the light rays of an incoming image. -other causes of diplopia result in a misalignment of the 2 eyes
With epistaxis consider
-hematemesis
Glaucoma - what should be noted on funduscopic exam
Increasing cup-to-disc ration
Audiometric testing
very sensitive method for detecting hearing loss
Fovea
-Area of fundus that is central focal point for incoming images -fovea is area of retina that is responsible for central vision -surrounded by macula which is responsible for more peripheral vision -optic disc and physiologic cup are where the optic nerve enters the eye
Consensual reaction
-light pointed at patient’s pupil -other pupil contracts though it is not exposed to bright light
what is true if vision is 20/100
she can see at 20 feet what a normal person can see at 100 feet
Right homonymous hemianopsia
-on visual confrontation testing, a stroke patient is unable to see your fingers on his entire right side with either eye covered -right hemonymous hemianopsia because right visual field in both eyes is affected -bitemporal hemianopsia refers to loss of both lateral visual fields
anisocoria
-difference in pupillary size of 0.04 mm or greater -visible is approximately 35% of healthy people. If pupullary reactions are normal, considered benigh -can been associated with serious pathology -may be caused by Horner’s syndrome - affected pupil, though small, reacts briskly to light and near effort. Ptosis of the eyelid is present, perhaps with loss of sweating on forehead. In congenital Homer’s the involved iris is lighter in color -causes include blunt trauma to eye, open-angle glaucoma and impaired parasympathetic nerve supply to iris.
Hypertensive retinopathey
Have bilateral red reflexes
Normal Optic Disc
- Tiny disc vessels five normal color to disc
- Appearance
- color yellowish orange to creamy pink
- disc vessels tiny
- disc margins sharp (except perhaps nasally)
- the physiologic cup is located centrally or somewhat temporally. It may be conscpicious or absent. its diameter from side to side is usually less than half the disc.
Papilledema
- Elevated ICP caauses intraaxonal edema along the optic nerve, leading to engorgement and swelling of the optic disc
- appearance
- color pink, hyperemic
- often with loss of venous pulsations
- disc vessels more visible, more numerous, cirve over the borders of the iris
- disc swollen with margins blurred
- physiologic cup is not visible
- seen in intracranial mass, lesion, or hemorrhage, meningitis
Physiologic Cupping
- physiologic cup is small whitish depression in the optic disc, the entry point for the retinal vessels. Although sometimes absents, the cup is usually visible either centrally or toward the temporal side of the disc. Grayish spots are often seen at its base.
- Inspect the physiologic cup. Its horizontal diameter should not exceed 1/2 the horizontal diameter of the entire disc (the “cup-to-disc ratio”). Otherwise, suspect pathologic optic disc cupping. Glaucoma is the commonest cause.
Glaucomatous Cupping
- Increased pressure within the eye leads to increased cupping (backward depression of the disc) and atrophy
- base of the enarged cup is pale
- appeance
- physiologic cup is enlarged
- accompanying more than half of the disc’s diameter
- at times extending to the edge of the disc
- retinal vessels since in and under it and may be displaced nasally
- physiologic cup is enlarged
Superficial Retinal Hemorrhage
Preretinal hemorrhage
Deep retinal hemorrhage
Cotton Wool Patches
- They are caused by damage to nerve fibers and are a result of accumulations of axoplasmic material within the nerve fiber layer.
- Associated findings include microvascular infarcts and hemorrhages.
- From Bates
- results from infarcted nerve fibers
- seen in htn and many other conditions
Drusen
- yellowish round spots
- appear in normal aging but may also accompany various conditions, including age-related macular degeneration
Hypertensive Retiopathy
- copper wiring of arterioles is present
- sometimes arteries, especially those close to disc, become full and somewhat tortuous and develop and increases light reflex with a bright coppery luster
