HEENT (Eyes, Ears, Throat)

Question 1

Headache

Answer 1

Most important attributes of a headache is (1) its severity, and (2) chronologic pattern

Question 2

Severe and of sudden onset

Answer 2

Consider subarachnoid hemorrhage or meningitis

Question 3

Tension headaches

Answer 3

Often arise in temporal areas

Question 4

Cluster headaches

Answer 4

May be retro-orbital

Question 5

Valsalva Maneuvers

Answer 5

May increase pain from acute sinusitis or from mass lesion due to changing ICP

Question 6

Genetics

Answer 6

Genetic inheritance appears to be present in 30 - 50% of patients with migraine

Question 7

*Remember

Answer 7

WHO advises against using estrogen-progestin contraceptives in women with migraines over 35 (with aura)

Question 8

Farsightedness

Answer 8

Hyperopia

Question 9

Aging vision

Answer 9

Prebyopia

Question 10

Nearsightedness

Answer 10

Myopia

Question 11

Sudden, unilateral loss that is painless

Answer 11

PainLESS. Consider vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion

Question 12

Sudden, unilateral loss with pain

Answer 12

WITH pain. Causes are usually in the cornea and interior chamber as in corneal ulcer, uveitis, traumatic hyphema, and acute glaucoma. Optic neuritis from multiple sclerosis may also be painful.

Question 13

Vision changes that are bilateral and painless

Answer 13

Medications that change refraction such as cholinergics, anticholinergics, and steroids may contribute.

Question 14

Vision changes that are bilateral and painful

Answer 14

Consider chemical or radiation exposures

Question 15

If onset of bilateral vision loss is gradual…

Answer 15

Usually arises from cataracts or macular degeneration

Question 16

Nuclear cataract

Answer 16

Slow, central vision loss

Question 17

Macular degeneration

Answer 17

Slow, central vision loss

Question 18

Slow, central vision loss

Answer 18

Nuclear cataract, macular degeneration

Question 19

Peripheral loss

Answer 19

Advanced open-angle glaucoma

Question 20

One-sided loss

Answer 20

Hemianopsia and quadrantic defects

Question 21

Moving specks or strands

Answer 21

Vitreous floaters

Question 22

Fixed defects (scotomas)

Answer 22

Lesions in the retinal or visual pathways

Question 23

Flashing lights, or new vitreous floaters…

Answer 23

Suggest detachment of vitreous from retina. Prompt eye consultation needed.

Question 24

Diplomia

Answer 24

Double vision. Seen in lesions of the brainstem or cerebellum, or weakness or paralysis of one or more extraocular muscles - as in horizontal diplomia from palsy of cranial nerve 3 or 6, or vertical diplopia from palsy of CN 3 or 4

Question 25

Horizontal diplopia

Answer 25

CN 3 or 6

Question 26

Vertical diplopia

Answer 26

CN 3 or 4

Question 27

Diplopia in one eye, with the other closed

Answer 27

Suggests a problem in the cornea or lens

Question 28

Ears - conductive loss

Answer 28

Problems in the external or middle ear. Noisy environments may help

Question 29

Ears - sensorineural loss

Answer 29

Problems in the inner ear, the cochlear nerve, or its central connections to the brain. People with sensorineural loss have particular trouble understanding speech, often complaining that others mumble - noisy environments make hearing worse

Question 30

Ear Ache

Answer 30

Pain occurs in the external canal in otitis externa - and, if respiratory infections - in the inner ear in otitis media

Question 31

Otis Externa

Answer 31

Pain in the external ear canal

Question 32

Otitis Media

Answer 32

Pain in the inner ear - caused by respiratory infections

Question 33

Tinnitus

Answer 33

A perceived sound that has no external stimuli (ringing in ears)

Question 34

Meniere’s Disease

Answer 34

Tinnitus associated with hearing loss and vertigo

Question 35

Vertigo

Answer 35

Spinning. Point primarily to a problem in the labyrinths of the inner ear, peripheral lesions of CN 8, or lesions in its central pathways or nuclei in the brain.

Question 36

Rhinorrhea

Answer 36

Drainage from the nose - is often associated with nasal congestion. S&S include sneezing, watery eyes, sore throat, itching in eyes, nose, and throat

Question 37

Acute bacterial sinusitis

Answer 37

Unlikely until viral URI symptoms persist more than 7 days. Both purulent drainage and facial pain should be present for diagnosis

Question 38

Epistaxis

Answer 38

Nose bleed