Exam 2 - HEENT Flashcards
In assessing the head of a newborn/infant, what are some normal findings?
Presence of sutures and fontanelles
In assessing the head of a newborn/infant, what are some abnormal findings?
Cephalohematoma, hydrocephalus, fetal alcohol syndrome, congenital hypothyroidism, congenital syphilis, facial nerve palsy, Down syndrome, battered child syndrome, perennial allergic rhinitis, hyperthyroidism
What would be included in the evaluation of an infant with abnormal facies?
Compare the infants face with the face of the parents
In considering the examination of the thyroid what do you suspect the cause of diffuse enlargement would be?
No discretely palpable nodules
Causes: Graves, Hashimoto’s thyroiditis, endemic goiter
In considering the examination of the thyroid what do you suspect the cause of a single nodule?
May be a cyst, benign tumor, or one nodule within a multi nodular gland (malignancy?)
Risk factors: prior irradiation, hardness, rapid growth, fixation to surrounding tissues, enlarged cervical nodes, male gender
In considering the examination of the thyroid what do you suspect the cause of multiple nodules?
Two or more nodules suggests a metabolic rather than neoplastic process
Risk factors: positive family history, continuing nodular enlargement
How do you use an ophthalmoscope?
1) Darken room, turn on ophthalmoscope light, turn lens disc until large round beam of white light (check on back of hand)
2) Turn lens disc to 0 diopter
3) Hold scope in R hand and to examine patients R eye (same with L hand)
4) Hold scope against medial aspect of bony orbit with handle tilted laterally at 20 degree slant
5) Instruct patient to look up and over your should
6) Sit 15 inches away from patient and at 15 degree lateral to patients line of vision
7) Look for orange glow in pupil (red reflex)
8) Place thumb of other hand across patients eyebrow, move in with scope at 15 degree angle (almost touching eyelashes and thumb of other hand)
What are the diopter settings for on an ophthalmoscope?
Cornea - +20 Lens - +15 Fundus - 0
How would the FNP assess pupillary response?
- Light reaction - Near reaction
How would the FNP assess visual fields by confrontation?
- Static finger wiggle test - Kinetic red target test
How would the FNP assess visual fields by extra ocular movements?
Cardinal directions of gaze (follow finger in H direction)
How would the FNP assess visual fields by convergence?
Patient follows finger as its moved toward the bridge of the nose
What are the various visual field deficits and their etiologies: horizontal defect?
Occlusion of central retinal artery, ischemia of optic nerve
What are the various visual field deficits and their etiologies: blind right eye (right optic nerve)?
Lesion of optic nerve and eye itself
What are the various visual field deficits and their etiologies: bitemporal hemianopsia (optic chiasm)?
Lesion at optic chiasm (fibers crossing over to the opposite side)
What are the various visual field deficits and their etiologies: left homonymous hemianopsia (right optic tract)?
Lesion of optic tract (interrupts fibers on the same side of both eyes) Visual loss is similar and involves half of each field
What are the various visual field deficits and their etiologies: homonymous left superior quadrantic defect (right optic radiation partial)?
Partial lesion of the optic radiation in the temporal lobe, may involve only a portion of the nerve fibers “Pie in the sky” defect
What are the various visual field deficits and their etiologies: left homonymous hemianopsia (right optic radiation)?
Complete interruption of fibers in the optic radiation Visual defect similar to that produced by a lesion of the optic tract
What are the types of double vision: monocular?
Monocular: double vision in one eye caused by (visual fields do not overlap)
What are the types of double vision: binocular?
Binocular: when eyes don’t align with each other as they normally would (visual fields overlap)
What cranial nerve abnormalities does double vision indicate?
Cranial nerves III, IV, VI
What would you expect the normal fundoscopic exam to look like?
Disc: Clear; the central area of the cup is pale Retina: normal red/orange color; the macula is dark Vessels: Arteries appear bright red, vein slightly purple. Arterial to venous ratio is about 2 to 3
What would you expect the fundoscopic exam to look like in someone with hypertension?
Marked arteriolar-venous crossing changes (esp along inferior vessels) Copper wiring of arterioles present Cotton-wool spot just superior to the disc Incidental disc drusen present
What would you expect the fundoscopic exam to look like in someone with diabetes?
Tiny red dots (microaneurysms), ring of hard exudates (white spots) located superotemporally Retinal thickening or edema in area of heard exudates
What would you expect the fundoscopic exam to look like in someone with papilledema?
Color pink, hyperemic (often with loss of venous pulsations) Disc vessels more visible, more numerous, curve over the borders of disc Disc more swollen with margins blurred Physiologic cup not visible
What would you expect the fundoscopic exam to look like in someone with glaucoma?
Increased cupping (backward depression of disc) and atrophy, base of enlarged cup is pale Appearance: death of optic nerve fibers leads to loss of tiny disc vessels
Horizontal diplopia
Blurry vision along horizontal axis (CN III or IV)
Vertical diplopia
Burry vision along vertical axis (CN III or IV)
What are some normal variations of the optic disc: physiologic cupping?
Small whitish depression in optic disc Although sometimes absent, cup is visible either centrally or toward the temporal side of disc Gray spots seen at base
What are some normal variations of the optic disc: rings and crescents?
Appear as either white sclera, black retinal pigment, or both (esp around temporal border of disc) Should not be used in estimate of the diameter
What are some normal variations of the optic disc: medullated nerve fibers?
Irregular white patches with feathered margins
Lumps or swelling around the eye: pinguecula
Harmless yellowish triangular nodule in the bulbar conjunctiva on either side of the iris Appears with aging first on the canal than temporal side
Lumps or swelling around the eye: stye (hordeolum)
Painful, tender, red infection at the inner or outer margin of the eyelid
Lumps or swelling around the eye: xanthelasma
Slightly raised, yellowish, well-circumcised cholesterol-filled plaques that appear along the nasal portions of one or both eyelids
Lumps or swelling around the eye: episcleritis?
Localized ocular inflammation of the episcleral vessels Vessels appear movable over the scleral surface May be nodular or show only redness and dilated vessels
Lumps or swelling around the eye: chalazion?
Subacute nontender, usually painless nodule caused by a blocked meibomian gland May become acutely inflamed but, unlike a stye, points inside the lid rather than on the lid margin
Lumps or swelling around the eye: blepharitis?
Chronic inflammation of the eyelids at the base of their hair follicles
What exam findings of the tympanic membrane are consistent with a normal exam?
Pinkish gray color, malleus lying behind the upper part of the drum, bright cone of light, part of incus visible behind the drum Small blood vessels along the handle of the malleus are normal
What exam findings of the tympanic membrane are consistent with: acute otitis media?
Reddened, loses its landmarks, bulges laterally and toward examiners eye Dilated vessels seen in all segments of drum
What exam findings of the tympanic membrane are consistent with: serous otitis media (serous effusion)?
Amber fluid behind eardrum A fluid level (line between air above and amber fluid below) can be seen on either side of short process Air bubbles may be present within amber chamber
What exam findings of the tympanic membrane are consistent with: tympanosclerosis?
Scarring from deposition of hyaline, calcium, and phosphate crystals in eardrum and middle ear Large, chalky white patch with irregular margins
What exam findings of the tympanic membrane are consistent with: bullous myringitis?
Presence of painful hemorrhagic vesicles on tympanic membrane, ear canal, or both
In considering exam findings of the pharynx and oral mucosa, what findings would you expect in someone with: tonsillitis?
Red throat with white exudates on tonsils, enlarged cervical lymph nodes
In considering exam findings of the pharynx and oral mucosa, what findings would you expect in someone with: thrush?
Thick, white plaques on palate
In considering exam findings of the pharynx and oral mucosa, what findings would you expect in someone with: leukoplakia?
Thickened white patch anywhere in the oral mucosa
In considering exam findings of the lips, what findings would you expect in someone with: angular cheilitis?
Softening of skin at angles of mouth followed by fissuring, saliva wets and macerates unfolded skin Causes: over close the mouth (now teeth or ill-fitting dentures), nutritional deficiency
In considering exam findings of the lips, what findings would you expect in someone with: actinic cheilitis?
Affects primarily the lower lip; lip loses normal redness, becomes scaly, thickened, slightly everted, can predispose SCC Causes: excessive sunlight exposure (fair skinned men who work outdoors)
In considering exam findings of the lips, what findings would you expect in someone with: herpes simplex?
Recurrent painful vesicular eruptions on lips and surrounding skin; as they break, yellow-brown crusts form Cause: HSV
In considering exam findings of the lips, what findings would you expect in someone with: angioedema?
Localized subcutaneous or submucosal swelling, may have associated urticaria and pruritus Causes: leakage of intravascular fluid into interstitial tissue (allergic and NSAID reactions)
In considering exam findings of the tongue, what findings would you expect in someone with: varicose veins?
Small purplish or blue-black round swelling under tongue, involves lingual veins Causes: age
In considering exam findings of the tongue, what findings would you expect in someone with: geographic tongue?
Scattered smooth red areas denuded of papillae, manlike pattern that changes over time Causes: benign condition
In considering exam findings of the tongue, what findings would you expect in someone with: black hairy tongue?
“Hairy” yellowish to brown and black hypertrophied and elongated papillae on tongues dorsum Causes: candida and bacterial overgrowth, antibiotic therapy, poor dental hygiene
In considering exam findings of the tongue, what findings would you expect in someone with: fissured tongue?
Fissures appear with increasing age (aka furrowed tongue) Causes: age
In considering exam findings of the tongue, what findings would you expect in someone with: smooth tongue (atrophic glossitis)?
Smooth and often sore tongue that has lost papillae, sometimes just in patches Causes: deficiency in riboflavin, niacin, folic acid, vitamin B12, pyridoxine, iron, treatment with chemo
In considering exam findings of the tongue, what findings would you expect in someone with: candidiasis?
Thick white coating Causes: candida infection, immunosuppression from chemo, prednisone therapy
In considering exam findings of the tongue, what findings would you expect in someone with: aphthous ulcer (canker sore)?
Painful, shallow whitish-gray oval ulceration surrounded by a halo of reddened mucosa May be single or multiple, can occur on gingiva and oral mucosa
In considering exam findings of the tongue, what findings would you expect in someone with: syphilis?
Painless lesion, slightly raised, oval, covered by grayish membrane May be multiple or occur elsewhere in the mouth
In considering exam findings of the tongue, what findings would you expect in someone with: carcinoma?
Ulcerated lesion, reddened area of mucosa (erythroplakia)
