ENT specialist referral if dietary changes and chiropractic care are unsuccessful - pts become progressively deaf - syndrome has recurring attacks of vertigo, tinnitus and hearing loss (idiopathic)

Co-manage with neurologist - bilateral ptosis, diplopia that worsens as the day progresses - autoimmune disorder d/t antibodies to acetylocholine r/c at the neuro-muscular junction - Tensilon (edrophonium) test will be +

ENT specialist if chiro care unsuccessful - ear pain mild hearing loss, may have slight fever, loss of appetite, tympanic membrane is red and bulging - inflammation of the middle ear - viral or bacterial (MC in kids: hemophilus influenza) - common in kid b/c straight Eustachian tubes - Weber's test: lateralize to the affected side - Rinne test: may show bone conduction > air conduction in the affected ear

ophthalmologist referral if pterygium starts to encroach on the cornea - triangular thickening of the bulbar conjunctiva extending from the medial corned of the eye towards the cornea with the apex pointing towards the corners of the eye (can encroach on the cornea). - related to chronic irritation and hot climates

General diagnosis - HEENT exam Flashcards by Noelle Brown

Acute Glaucoma

Urgent referral
Painful red eye, hard eyeball, hazy vision (early on)
Sudden increase in IOP with narrow angle b/w iris and cornea which obstructs aqueou humor into the canal of Schlemm.

How well did you know this?

Not at all

Perfectly

Adie’s pupil, tonic or bored housewife’s pupil

Neurologist referral
one pupil is dilated and reacts poorly to light
benign condition mainly affects young women

How well did you know this?

Not at all

Perfectly

Argyll Robertson pupil or prostitute’s pupil

Neurologist referral
one pupil small, react poorly to light (will retract to accommodation), VDRL will be +
Seen in tertiary syphilis, MS, SLE and diabetes mellitus

How well did you know this?

Not at all

Perfectly

Blepharitis

Dermatologist referral
swollen itching tender eyelids
inflammation of the eyelids
may be d/t: staphylococcal infection, allergy or seborrhea

How well did you know this?

Not at all

Perfectly

cavernous sinus thrombosis

Urgently refer to hospital for antibiotics
swollen eyelids (periorbital edema), diplopia d/t damage to CN 3, 4 or 6 (which pass through the cavernous sinus)
clot formation in cavernous sinus in the brain following spread of infection from the face

How well did you know this?

Not at all

Perfectly

chalazion

ophthalmologist referral
painless swelling on inside of the eyelid (can become infected and painful)
benign granulomatous lesion in the tarsal (meibomian) gland of the eyelid

How well did you know this?

Not at all

Perfectly

Chronic glaucoma

ophthalmologist referral
gradual loss of vision (periphery causing tunnel vision)
- gradual increase of IOP d/t excessive production of aqueous humor or obstruction of the canal of Schlemm
- associate with increase cupping of optic disc d/t raised IOP

How well did you know this?

Not at all

Perfectly

conjunctivitis

PCP referral
itching, pain, tearing, red eye with discharge
infection of conjunctiva
MC viral but can be bacterial (gonococcal in neonates)

How well did you know this?

Not at all

Perfectly

Diabetic retinopathy

ophthalmologist
blurred vision
damage to retinal in poorly controlled diabetes mellitus
- microaneurysms (dots), flame hemorrhages in the retina

How well did you know this?

Not at all

Perfectly

Ectropion

plastic surgeon referral
external sagging of the lower eyelid
old age

How well did you know this?

Not at all

Perfectly

Entropion

ophthalmologist referral
painful eye with interned lower eye lid
may be congenital or acquired after scarring d/t trachomatis

How well did you know this?

Not at all

Perfectly

Eustachian tube blockage

ENT specialist referral if chiro care unsuccessful

decreased hearing with retracted tympanic membrane
blocked Eustachian tube may follow URI

How well did you know this?

Not at all

Perfectly

Hordeolum

PCP referral (ophthalmic antibiotic may be needed)
Red painful swelling on the margin of the eyelid
infected hair follicle of an eyelash (staphylococcal in nature)

How well did you know this?

Not at all

Perfectly

Horner’s syndrome

Neurologist
unilateral ptosis, miosis and anhydrosis
- damage to sympathetic chain or ganglia in the neck
- associated with Pancost tumor, carotid artery dissection or brain stem ischemia

How well did you know this?

Not at all

Perfectly

Iritis

ophthalmologist referral
painful gritty feeling with redness mainly around the iris (circumcorneal)
inflammation of the iris
associated with SLE, ulcerative colitis, Crohn’s disease or sarcodosis

How well did you know this?

Not at all

Perfectly

Macular degeneration

ophthalmologist referral
central loss of vision (macula/lat tooptic disc: blurred and may be pigmented)
age-related

How well did you know this?

Not at all

Perfectly

Meniere’s diease

ENT specialist referral if dietary changes and chiropractic care are unsuccessful

pts become progressively deaf
syndrome has recurring attacks of vertigo, tinnitus and hearing loss (idiopathic)

How well did you know this?

Not at all

Perfectly

Myashenia gravis

Co-manage with neurologist

bilateral ptosis, diplopia that worsens as the day progresses
autoimmune disorder d/t antibodies to acetylocholine r/c at the neuro-muscular junction
Tensilon (edrophonium) test will be +

How well did you know this?

Not at all

Perfectly

Otitis externa

ENT specialist referral
ear pain (worse with traction), swollen ear canal with discharge
- inflammation of the eternal auditory cana; bacterial or fungal in origin or allergic in nature
- chronic otits externa may be related to ear wax impaction

How well did you know this?

Not at all

Perfectly

Peritonsillar abcess

ENT specialist referral
fever, severe sore throat, unilateral swollen pharyngeal tonsil hot potato voice
- abscess related to severe tonsillitis

How well did you know this?

Not at all

Perfectly

Otitis media

ENT specialist if chiro care unsuccessful

ear pain mild hearing loss, may have slight fever, loss of appetite, tympanic membrane is red and bulging
inflammation of the middle ear
viral or bacterial (MC in kids: hemophilus influenza)
common in kid b/c straight Eustachian tubes
Weber’s test: lateralize to the affected side
Rinne test: may show bone conduction > air conduction in the affected ear

How well did you know this?

Not at all

Perfectly

Pinguecula

reassure pts
does not grow on the cornea
yellow triangular thickening of the bulbar conjunctiva on the inner and outer margins of the cornea. The base points toward the corners of the eye.

How well did you know this?

Not at all

Perfectly

Pterygium

ophthalmologist referral if pterygium starts to encroach on the cornea

triangular thickening of the bulbar conjunctiva extending from the medial corned of the eye towards the cornea with the apex pointing towards the corners of the eye (can encroach on the cornea).
related to chronic irritation and hot climates

How well did you know this?

Not at all

Perfectly

Seborrheic dermatitis

dermatologist referral if treatment with a shampoo (selenium sulfide) is not helpful

dandruff, scaly itching eyebrows and eyelids
inflammation of skin with a high concentration of sebaceous glands
idiopathic or Pityrosporum ovale (fungal skin organism)

How well did you know this?

Not at all

Perfectly

AC twice as long as BC

Normal

AC/BC are both decrease in one ear

Nerve conduction deafness

BC>AC with Rinne test

Serous Otitis Media

BL dilated pupils

Cocaine, barbiturate or amphetamin abuse

BL pinpoint pupils

Heroin use

BL swollen optic discs (papilledema)

Raised intracranial pressure, brain tumor

blue sclera in infant with many fracutres

osteogenesis imperfect

blurred margins of the macula or pigmentation

macular degeneration

copper or silver wiring of the retinal arterioles

hypertensive retinopathy

cupped optic disc

chronic glaucoa

enlarged tongue (macroglossia)

hypothyroidism in infants

exophthalmos

hyperthyroidism or orbital tumor

flame hemorrhages and dots (mirco-aneurysms)

diabetic retinopathy

foul purulent unilateral nasal discharge

sinusitis or foreign body in nose

goiter with brittle dry coarse hair

myxedema (hypothyroidism)

goiter with exophthalmos or tachycardia

Graves' disease

gray ring around cornea (arcus snilis)

hyperlipidemia

hears better in one ear with Weber test

problem with one of the ears

large head in child with open fontanelles

hydrocephalus

lid lag

hyperthyroidism

loss of red pupil light reflex

Cataract or neuroblastormam loss of outer third of eyebrow

loss of outer third of eyebrow

hypothyroidism or leprosy

midline neck mass moves with tounge

thyroglossal cyst

midline bony mass in the hard palate

torus palatinus

Mucopurulent discharge from ear

otitis media

nasal septum perforation

Cocaine abuse

pale conjunctiva

anemia

periorbital edema

cellulitis, cavernous sinus thrombosis

painful boil on the margin of the eyelid

external stye (hordeolum)

painful red eye with purulent discharge

conjunctivitis

painful eye with circumcorneal redness

iritis

painful red eye with tense eyeball

acute glauoma

painless boil on the inside of an eyelid

internal stye (chalazion)

pain on pulling the ear up and backwards

otitis extena

pale swollen bluish nasal mucosae

chronic allergies

Ptosis: BL

myasthenia gravis, lambert eaton syndrome

Ptosis: unliateral

Horner;s syndrome

puffy eyelids especially in the morning

renal dysfuction

pupil accommodates bud does not react to light

Argyll Robertson pupil (tertiary syphilis)

pupil is dilated and react poorly to light

Adie's pupil

pupil is small and constricted (miosis)

Horner's syndrome

Redd bulging tympanic membrane

otitis media

retracted tympanic membrane

Eustachian tube blockage

scale on eyebrows

seborrheic dermatitis

swollen itching eyelids

blepharitis

tophus on helix of the ear

chronic gout

tongue-beef red color

vitamin B12 deficiency

Tongue-magenta color

Riboflavin deficiency

Tongue-pale

Iron deficiency

Triangular fleshy growth in medial side of sclera

Pterygium

Turned in or out lower eyelids

entropion or ectropion

unilateral swollen tonsil with severe sore throat

Peritonsillar absess

yellow thickening of the bulbar conjunctiva

pingecula

vertigo with hearing loss and tinnitus

meniere's disease

xerophthalmia

vitamin a deficiency

yellow sclera

jaundice (icterus) or carotenemia

yellow plaque in upper medial eyelid

xanthelesma (hyperlipidema)

General diagnosis - HEENT exam Flashcards

(81 cards)