HEENT 1 Flashcards
(127 cards)
1
Q
How are headaches classified?
A
Primary or secondary
2
Q
What are some life-threatening causes to headaches?
A
Meningitis, subarachnoid hemorrhage, mass lesion
3
Q
What types of headaches can be primary?
A
Migraine, tension, cluster, and chronic daily headaches
4
Q
What do secondary headaches arise from?
A
Underlying structural, systemic, or infections like meningitis, subarachnoid hemorrhage
5
Q
What type of headache can be life threatening?
A
Secondary
6
Q
Red flags for headaches
A
Frequent or severe over 3 mos, like a “thunderclap or worst HA of my life,” new onset after 50yo, aggravated by change in position precipitated by Valsalva
7
Q
What is a subarachnoid hemorrhage until proven otherwise?
A
Thunderclap or worst headache of my life
8
Q
Hyperopia
A
Far-sighted
9
Q
Presbyopia
A
Age related far-sightedness
10
Q
Myopia
A
Near-sighted
11
Q
Scotomas
A
Partial alteration of vision
12
Q
Other Red flags associated with HAs
A
Recent head trauma, papilledema, neck stiffness, or focal neuro deficits
13
Q
If patient has unilateral head pain, that usually means what type of headache?
A
Migraine or cluster
14
Q
IF patient has a headache in the temporal areas, what kind of HA can it be?
A
Tension
15
Q
If a patient has head pain in the retro-orbital area, what type of headache is it?
A
Cluster
16
Q
Nausea and vomiting are common with what?
A
Migraines, brain tumors, and subarachnoid hemorrhages
17
Q
If coughing, sneezing, or changing position makes the HA worse…
A
Can be from acute sinusitis or from a mass lesion
18
Q
Sudden unilateral painless vision loss can signal what?
A
Vitreous hemorrhage (DM or trauma), retinal detachment, retinal vein occlusion, or central retinal artery occlusion
19
Q
Sudden unilateral painful vision loss can signal what?
A
Corneal ulcer, uveitis, traumatic hyphema, acute glaucoma, optic neuritis (MS)
20
Q
What does gradual bilateral vision loss arise from?
A
Cataracts or macular degeneration
21
Q
Slow central vision loss can signal what?
A
Nuclear cataract, macular degeneration
22
Q
Slow peripheral vision loss can signal what?
A
Advanced open angle glaucoma
23
Q
Slow one-sided vision loss can signal what?
A
Hemianopsia and quadrantic defects
24
Q
Moving specks in the eye
A
Vitreous floaters
25
Fixed specks or defects in the eye
Scotomas, lesions in the retina or visual pathways
26
Lights flashing may accompany what other eye symptom?
Vitreous floaters
27
What do flashing lights or new vitreous floaters suggest?
Detachment of vitreous from the retina
28
What else is important to ask for an eye exam?
Pain in or around the eye, redness, excessive tearing or watering
29
Diplopia
Double vision
30
What is diplopia seen in?
Lesions in the brainstem or cerebellum, or from weakness or paralysis of one or more extraocular muscles
31
Horizontal diplopia
Palsy of CN III or VI
32
Vertical diplopia
Palsy of CN III or IV
33
Diplopia in one eye with the other closed suggests what?
A problem in the cornea or lens
34
Conductive loss of hearing results from what?
Problems in the external or middle ear
35
Sensorineural hearing loss results from what?
Problems in the inner ear, the cochlear nerve, or its central connections in the brain
36
Sensorinerual hearing loss
Trouble understanding speech, complain that others mumble, noisy environments make it worse
37
Conductive hearing loss
Noisy environments help
38
Pain occurs in the external canal in what?
Otitis externa
39
External canal ear pain associated with a respiratory infection
Otitis media
40
Ear pain can also be referred from where?
Other structures in the mouth, throat, or neck
41
Tinnitus
Perceived sound that has no external stimulus, ringing or rush or roaring noise in one or both ears
42
Tinnitus associated with hearing loss and vertigo
Meiniere's disease
43
Vertigo
Refers to the perception that the patient or the environment is rotating or spinning
44
Vertigo points problems to where?
The labyrinths of the inner ear, peripheral lesions of CN VIII, or lesions in the central pathways or nuclei in brain
45
Vertigo is the sensation of what?
True rotational movement of the patient or the surroundings
46
Disequilibrium is what?
Has to do with one feeling unsteady or losing their balance
47
If there is true vertigo, need to distinguish between what?
Peripheral from central neurologic causes
48
What is a helpful special test used to help differentiate between peripheral vs central vertigo?
Dix-Halpike maneuver
49
Rhinorrhea refers to
Drainage from the nose
50
Rhinorrhea is frequently accompanied by what?
Sneezing, watery eyes, throat discomfort, itching in the eyes nose and throat
51
What are some causes of rhinorrhea?
Viral infection, allergic rhinitis and vasomotor rhinitis
52
Rhinitis medicamentosa
Excessive use of decongestants
53
Acute bacterial sinusitis is unlikely unless the viral symptoms persist for how long?
More than 7 days with purulent drainage and facial pain
54
Epistaxis
Bleeding from the nasal passages
55
What are some common causes of epistaxis?
Anticoagulants, NSAIDs, and coagulopathies (Von Willebrands)
56
Sore tongue
Result from a local lesions as well as form systemic illness
57
Aphthouse ulcers and the sore smooth tongue can be signs of what?
Nutritional deficiency
58
Bleeding from the gums is most likely from what?
Gingivitis
59
Acute hoarseness can be from what
Voice overuse and acute viral laryngitis
60
What can accompany pharyngitis and sinusitis?
Enlarged tender lymph nodes
61
What is suggestive of hypothroidism?
Temperature intolerance and sweating
62
What is suggestive of hyperthyroidism?
Palpitations and involuntary weight loss
63
With a goiter, what can happen to thyroid function?
It can increase, decrease, or be normal
64
An enlarged skull may signify what?
Hydrocephalus or Paget's disease of bone
65
Hirsutism
Occurs in some women with polycystic ovary syndrome
66
NEVER proceed to the rest of the eye exam without what?
Visual acuity
67
What else are we doing on an eye exam?
Visual fields, conjunctiva and sclera, cornea lens and pupils, EOM, fundi (optic disk, retina, vessels, fovea and macula)
68
What is the snellen eye chart used for?
Visual acuity
69
How far away does the patient stand when looking at the eye chart?
20 feet
70
When looking at the snellen eye chart, the best vision is recorded as what?
As the line the patient can read more than 1/2 the letters of
71
What do the numbers mean when recording visual acuity? Ex: 20/20
First number is how far away the person is from the chart, the second is the distance at which the normal eye can read the line of letters
72
What is the Rosenbaum eye chart used for?
Near vision test, held 14 inches from the eye
73
Visual acuity test
Test each eye individually, then both together. Record as: Right eye/ Left eye/ Both eyes
74
How do you test the pts visual fields by confrontation?
Pt focuses on examiners eyes, place hands 2 feet apart laterally and pt has to point to fingers as soon as they are seen
75
If the results of the visual field exam are abnormal, what do you do next?
Test unilaterally with on eye covered
76
What does the Hirschberg exam test for?
Position and alignment of the eyes
77
Hypotropia
One eye turns down
78
Hypertropia
One eye turns up
79
Exotropia
One eye turns out
80
Esotropia
One eye turns in
81
Hirschberg test is useful for what?
Manifest deviations (tropias)
82
What can detect AND confirm tropias?
Cover test
83
What is ptosis?
Low lying upper lid during primary gaze
84
What open the eye?
Levator palpebrae and CN III
85
What is defined as the inability to full close the eyelids?
Lagophthalmos
86
What closes the eye?
Orbicularis muscle and CN VII
87
Which CN is impacted in Bells phenomenon?
CN VII Facial Nerve
88
What is Xanthelasma?
Yellow plaques on the eye from hypercholesterolism
89
Chalazion
Lump in the tear gland of the eye
90
Dacryoadenitis
Inflammation of the lacrimal gland
91
Dacryocystitis
Inflammation of the nasolacrimal gland
92
Lacrimal gland produces what
Aqueous tears
93
Meibomian gland produces what
Sebaceous tear film
94
What is the process of tear production?
Tear production -> Supero-lateral fornix -> superior and inferior nasal lacrimal puncta -> canaliculi -> lacrimal sac -> nasolacrimal duct
95
What are we inspecting the conjunctiva for?
Injection, pallor, pigmentation, swelling, masses, hemorrhage, foreign bodies
96
What are we inspecting the sclera for?
Nodules, hyperemia, discoloration
97
What is icterus?
Jaundice
98
Blue sclera can come from what?
Osteogenesis imperfecta
99
Scleromalacia perforans
Necrotizing scleritis, can lead to blindness
100
Cornea should be...
Clear without cloudiness, opacities or defects (abrasions, ulcerations)
101
What can be used to examine the cornea?
Anesthesia, fluorescein stain and woods lamp
102
Arcus senilus
Grey or white arc visible above or below the outer part of the cornea
103
Kayser-Fleischer ring is what?
Cu+ deposition. Associated with Wilsons disease
104
What else can be found on the cornea?
HSV keratitis, corneal abrasion, keratoconus (thinning disorder of the cornea)
105
What is a coloboma?
A defect or hole in the iris
106
What do we look for when inspecting the anterior chamber?
Hyphema, hypopyon
107
How is it best to asses the depth of the anterior chamber?
Laterally to medially
108
What is the disease if the cresentic shadow is noted nasally?
Narrow-angle glaucoma
109
The lens should be inspected with what kind of lighting?
Oblique
110
Cataracts, opacities, and dislocation can be inspected for where?
Lens
111
RAPD
Relative afferent pupillary defect
112
Marcus Gunn Pupil
Afferent pupillary defect
113
Adie's Pupil
Tonic pupil, one or both pupils are abnormally dilated with delayed constriction
114
Horner's Syndrome
Eye has ptosis, miosis and anhydrosis
115
Argyll Robertson Pupils
Small, irregular pupils
116
Anisocoria
Unequal pupils
117
What is seen in cerebral aneurysm, trauma, and a tumor?
Oculomotor nerve palsy
118
LR6SO4
EOM with nerve controls
119
Nystagmus affects what gaze usually?
Upward and lateral gaze
120
How far do you stand away from pt when doing the ophthalmoscopic exam?
15 inches, 15 degrees lateral to them as well
121
What color are arteries when looking during an ophthalmoscopic exam
Light red
122
What color are veins when looking during an ophthalmoscopic exam
Dark red
123
What size are arteries when looking during an ophthalmoscopic exam
Smaller
124
What size are veins when looking during an ophthalmoscopic exam
Larger
125
What is the light reflex on arteries when looking during an ophthalmoscopic exam?
Bright
126
What is the light reflex on veins when looking during an ophthalmoscopic exam?
Absent
127
What is normal intraocular pressure?
10-22 mmHg
