HEENT Flashcards
(185 cards)
1
Q
A sensation is defined as what?
A
Conscious or subconscious awareness of changes in the external or internal enviroment.
2
Q
What are the 5 special senses?
A
smell taste vision hearing equilibrium
3
Q
What do somatic senses include?
A
tactile
thermal
pain
proprioceptive
4
Q
What do visceral senses provide senses for?
A
Internal organs
5
Q
What are the four conditions that must be satisfied for sensation to occur?
A
Stimulus
Sensory receptor must convert stimulus to an electrical signal
A nerve pathway conducts information to the brain
A region of the brain translates or integrates the nerve impulse into a sensation
6
Q
What is primarily a function of the cerebral cortex IRT to sensations?
A
Perception of conscious awareness and interpretation of sensations
7
Q
What are the functional classifications of receptors?
A
Mechanoreceptor Thermoreceptor Nociceptors Photoreceptors Chemoreceptors Osmoreceptors
8
Q
What type of receptor detects mechanical deformation of adjacent cells?
A
Mechanoreceptors
9
Q
What type of receptor detects changes in temperature?
A
Thermoreceptor
10
Q
What type of receptor detects pain?
A
Nocicereceptor
11
Q
What type of receptor detects light?
A
Photoreceptor
12
Q
What type of receptor dects the presence of chemicals in solution?
A
Chemoreceptor
13
Q
What type of receptor detects the osmotic pressure in fluids?
A
Osmoreceptors
14
Q
Somatic (body) sensations arise from stimulation of what?
A
Sensory receptors in the skin, mucous membrane, muscles, tendons and joints.
15
Q
Tactile receptors for somatic sense are for what?
A
Touch, pressure, vibration, itch and tickle
16
Q
Thermal receptors in the somatic senses are for what?
A
Warm and cold
17
Q
Pain receptors are located in the entire body except where?
A
Brain
18
Q
Encapsulated tacticle sensations?
A
touch pressure and vibration
19
Q
Free tactile sensations?
A
Tickle and itch
20
Q
Where are cold and hot receptors located in the skin?
A
Cold-Epidermis
Hot-Dermis
21
Q
What temperatures activate cold receptors?
A
10-40 Celsius (50-105 F)
22
Q
What temperatures activate warm receptors?
A
32-48 Celsius (90-118F)
23
Q
What temperatures stimulate nociceptors and elicit pain?
A
Below 10C (50F) Above 48C (118F)
24
Q
Proprioceptors are located where?
A
Muscle spindles in muscles
Tendon organs in tendons
Joints in and around synovial
Hair cells in middle ear
25
Olfactory epithelium is found in the inferior space of what structure?
cribriform plate
26
What are the three types of cells in the olfactory epithelium?
receptor
supporting
basal
27
The olfactory tract will project to the cerebral cortex also know as the?
frontal and temporal lobe
28
Axons form CN I and extend through the cribriform plate via what?
holes
29
What are the five primary tastes of gustation aka the sense of taste?
```
Sweet
Salty
Bitter
Sour
Umami
```
30
What are raised bumps on the tongue, where the majority of gustation receptor cells are located, called?
Taste buds or fungiform papillae
31
Taste buds convey impulses to what cranial nerves?
VII (ant 2/3)
IX (post 1/3)
X (epiglottis)
32
The lacrimal glands drain from the surface of the eye through what structure before reaching the nasolacrimal duct?
Lacrimal canaliculi
33
What are the six extrinsic muscles that work to move the eyeball?
```
Superior Rectus
Inferior Rectus
Medial Rectus
Lateral Rectus
Superior Oblique
Inferior Oblique
```
34
What are the external layers of the eyeball?
Fibrous tunic
Vascular tunic (middle)
Retina (inner)
35
What does the fibrous tunic contain?
Posterior sclera
| Anterior cornea
36
What does the vascular tunic or middle layer contain?
Choroid
Ciliary body
Iris
Uvea
37
The retina or inner layer has what layers?
Neural
Pigmented
Inner and outer synaptic
38
What are the photoreceptors in the eyes called?
Rods and cones
39
Rods allow us to see what?
Shades of gray in dim light
40
Cones are instrumental for what?
Color vision
| Visual acuity
41
What are the interior cavities of the eye that are separated by the lens?
Anterior cavity
| Vitreous chamber
42
The anterior cavity contains what type of fluid?
Aqueous humor
43
The vitreous chamber, the larger cavity, contains what type of fluid?
Vitreous body (clear, jelly-like fluid)
44
The pressure in the eye, intra ocular pressure (IOP) is produced by mainly what fluid?
Aqueous humor
45
What maintains the shape of the eyeball?
IOP
46
Accommodation is the ability of the lens to instantly change curvature for what?
Near and far vision
47
Vitamin A deficiency decreases rhodopsin that leads to what condition?
night blindness
48
Sight is perceived in what area of the brain?
Occipital lobe
49
What is another term for the ear?
Auricle
50
What is secreted in the external auditory canal?
Cerumen
51
What are the three bones in the auditory ossicles?
Malleus (makes contact with TM)
Incus
Stapes
52
The middle ear is connected to the upper part of the throat via what?
Eustachian tube
53
What fluid surrounds the membranous labyrinth, inside the bony labyrinth, of the middle ear?
perilymph
54
What is the fluid that is inside of the membranous sacs of the membranous labyrinth?
endolymph
55
Where do vestibulo impulses of CN VIII travel to via cochlear branch?
midbrain and thalamus
56
Where do the cochlear impulses of CN VIII travel to via the cochlear branch?
Temporal lobe
57
Auditory axons crossing enables what for hearing?
Impulses are received from both ears regardless of side of noise.
58
What are the two kinds of equilibrium?
Static
| Dynamic
59
Static equilibrium refers to
linear acceleration/deceleration
60
Dynamic equilibrium refers to
rotational acceleration/deceleration
61
What are the receptor organs for equilibrium in the internal ear?
Saccule
Utricle
Semicircular ducts
62
Linkage between what structures in the brain play a role in maintaining equilibrium?
Medulla cerebellum
| Cerebrum
63
What are the salivary glands?
Parotid
Submandibular
Sublingual
64
What landmarks comprise the anterior triangle of the neck?
Sternocleidomastoid muscles
mandible
the midline
65
What structures make up the posterior triangle of the neck?
Trapezius
Sternocleidomastoid muscles
clavicle
66
What are the Lymph nodes of the head and neck?
```
Post/preauricular
Parotid
Tonsillar
Submandibular
Submental
Anterior deep/superficial chain
Posterior deep/superficial chain
supraclavicular chain
```
67
What is the structure that consists of two lateral lobes and resembles a butterfly on the neck?
Thyroid (right side 25% larger)
68
What are characteristic facies?
expression or appearance that is characteristic of a clinical condition or syndrome
69
Temporomandibular joint space symptoms may cause what?
Tinnitus
70
What is another name for the parotid duct?
Stensen duct
71
What is another name for the submandibular duct?
Wharton duct
72
Bruits over the eye may suggest what?
Cerebral aneurysm
73
Bruits over the temporal artery are associated with what
temporal arteritis
74
Grittiness of the thyroid on palpation may indicate?
Thyroiditis
75
Cushing syndrome is characterized by what facies?
rounded, moon-shaped face
| thin erythematous skin
76
Hyperthyroidism facies are
prominent eyes
lid retraction
staring/startled expression
77
Lupus or SLE facies are?
butterfly rash
blush with swelling
scaly, red maculopapular lesions
78
Thyroglossal duct cyst is identified by?
freely moving cystic mass
high in neck
midline
79
Torticollis, generally from birth trauma, tumors, trauma, infection or drug ingestion is also known as?
Wry neck
80
What are some Thyroid diseases?
Hypo/hyperthyroidism
Myxedema
Graves' disease
Hashimoto disease
81
What are the two layers of the conjunctiva?
Palpebral
| Bulbar
82
What eye muscles does CN III control
Sup/Infer/medial rectus
| inferior oblique
83
What eye muscles does CN IV control
Superior oblique
84
What muscles does CN VI control?
Lateral rectus
85
The uvea is composed of what structures?
iris
ciliary body
choroids
86
Periorbital edema is always abnormal and may represent what conditions?
Thyroid eye disease
Allergies
Renal Disease
Xanthelasma (lipids)
87
Cover-uncover test identifies what condition?
Strabismic eye
88
The macula or fovea is located where in relation of the optic disc?
2 disk diameters laterally or temporally from the optic disc
89
Anterior blepharitis involves what stuructures?
lid skin, eyelash and associated gland
90
Posterior blepharitis results from what
inflammation of meibomian glands
91
Dx?
Blepharitis
92
Sxs of blepharitis?
redrimmed
granulations clinging to lashes
tears may be frothy or abnormally greasy
93
Tx of blepharitis?
```
Baby shampoo
warm compress
massage
artificial tears
Bacitracin ointment
```
94
What glands are associated with hordeolum and chalazion?
Gland of Zeis
| Meibomian
95
DX?
Hordeolum
96
DX?
Chalazion
97
Tx of hordeolum or chalazion?
```
Warm compress 15 min x4/day
massage
discontinue makeup
Do not squeeze
Bactrim BID 5-7 days
```
98
Definitive care if unresolved hordeolum or chalazion?
Referral to ophthalmology for I&D
99
What are the types of conjunctivitis?
Viral
Allergic
Bacterial (non-gonococcal)
Bacterial (gonococcal)
100
What is the most common cause of viral conjuctivitis?
Adenovirus
101
What type of conjunctivitis would typically present with bilateral clear discharge?
Allergic
102
Nongonococcal Bacterial Conjunctivitis is caused by what typically?
```
Staphylococcus aureus
Staphylococcus epidermidis
Hemophilus influenzae
Streptococcus pneumonia
Moraxella catarrhalis
```
103
Gonococcal Bacterial conjunctivitis is typically acquired through?
infected genital secretions
104
DX
Viral conjunctivitis
105
DX?
Bacterial Conjunctivitis
106
What are distinguishing symptoms for nongonococcal and gonococcal bacterial conjunctivitis?
preauricular adenopathy and hyperacute onset with gonococcal
107
Symptoms of conjunctival hemorrage?
Red eye, foreign body sensation, usually asymptomatic unless there is associated chemosis
Blood underneath the conjunctiva, often in one sector of the eye and the entire view of the sclera may be covered by blood
108
Tx of conjunctival hemorrhage?
None required (clears within 2 to 3 weeks)
Artificial Tears for irritation
109
Tx of conjunctival hemorrhage?
None required (clears within 2 to 3 weeks)
Artificial Tears for irritation
110
Symptoms of pterygium
Caused by sunlight exposure, chronic inflammation and oxidative stress
Wing shaped fold of fibrovascular tissue arising from the interpalpebral conjunctiva and extending onto the cornea, usually nasal in location
111
Tx of pterygium
Protect eyes from sun, dust, and wind (UV blocking sunglasses or goggles)
Artificial Tears
Surgical removal if vision is affected
112
Ocular foreign body sxs
Foreign body sensation, tearing, history of trauma; with or without a rust ring
113
ocular foreign body tx
Topical Anesthetic - Proparcaine (Alcaine) 0.5%
Remove foreign body with saline irrigation
Non contact lens wearers
Erythromycin
Contact lens wearers
Ciprofloxacin
114
Sxs of corneal abrasion
Severe pain, tearing, and photophobia
History of trauma to the eye, commonly involving a foreign object (fingernail, piece of paper, or contact lens)
115
Tx of corneal abrasion
Non contact lens wearers
Erythromycin
Contact lens wearers
Ciprofloxacin
Acetaminophen 325-1000mg NSAIDS
116
Sxs of corneal ulcer
Cornea reveals a round or irregular ulcer opacity or infiltrate
Severe ocular pain, photophobia, or blurred vision
Risk factor contact lens wearers
117
Tx of corneal ulcer
Ciprofloxacin
Refer to an opthalmologist to be seen within 12 to 24 hours
DO NOT patch the eye due to risk of Pseudomonas infection
118
Sxs of Hyphema
Trauma or recent ocular surgery
are the most common risk factors
Blood or clot or both in the anterior chamber that may be black or red
Pain, sensitivity to light, blurred, clouded or blocked vision, history of blunt trauma
119
Tx of Hyphema
IMMEDIATE Optometry consult Bed rest with elevation of the head
Place a rigid shield over the involved eye
Avoid antiplatelet/anticoagulant medications (Aspirin/NSAIDS)
Mild Analgesics only! -
Acetaminophen
120
Uveitis or iritis sxs?
Pain, redness, photophobia, visual loss,
hypopyon (WBC pool) and fibrin within the anterior chamber
121
Tx of uveitis or iritis?
Only to be initiated by the opthalmologist Clycloplegic
| Topical Steroid
122
orbital cellulitis sxs?
Risk factors:
Paranasal sinus infection, dental infection, orbital trauma
eyelid edema, erythema, warmth, tenderness, periorbital swelling, tooth pain
restricted extraocular motility with pain with eye movement
123
Orbital cellulitis Tx
Augmentin 875mg PO Ceftriaxone (Rocephin) 2g IM
| Surgery may be required to drain the paranasal sinuses or orbital abscess
124
Orbital fracture sxs?
Pain on attempted eye movement and local tenderness, eyelid edema, crepitus (particularly after nose blowing)
Step off deformity along frontal sinus
Restricted eye movement especially in upward or lateral gaze or both, subcutaneous or conjunctival emphysema, point tenderness,
125
Tx of orbital fracture
Prophylactic oral antibiotics Augmentin 500/125mg TID,
PCN Allergy Doxycycline 100mg PO
Nasal Decongestants Oxymetazoline (Afrin) BID for 3 days
(Instruct PT to NOT BLOW THEIR NOSE)
Immediate surgical repair if suspected muscle entrapment
126
What is another term for corneal ulcer?
infectious keratitis
127
What is the biggest risk factor of corneal ulcers?
improper contact lens use
128
What is a common bacteria to cause corneal ulcerations?
Pseudomonas aeruginosa
129
Hypopyon may come from what disorders?
infection
| autoimmune
130
The middle layer of the eye is the vascular tunic or the?
uvea
131
Acute iritis or uveitis is typically from?
infection
132
Chronic iritis or uveitis is from?
autoimmune disorders
133
examples of autoimmune disorders that could cause iritis or uveitis are?
spondylarthritis
sarcoidosis
SLE (Lupus)
multiple sclerosis
134
nongranulomatus uveitis would indicate what onset?
acute
135
What may be seen on the corneal endothelium in uveitis?
keratic precipitates
136
Orbital cellulitis usually comes from
paranasal sinuses
| dental infection
137
what are the three types of orbital fractures?
orbital rim
blowout
orbital floor
138
tx of orbital fracture?
Prophylactic oral antibiotics Augmentin 500/125mg TID,
PCN Allergy Doxycycline 100mg PO
Nasal Decongestants Oxymetazoline (Afrin) BID for 3 days
(Instruct PT to NOT BLOW THEIR NOSE)
Immediate surgical repair if suspected muscle entrapment
139
Transient visual loss can be caused by?
change in BP
TIA
Migraine
140
What can methanol poisoning or toxins cause in the eyes?
Long lasting sudden vision loss
141
Sxs of retinal detachment?
Flashes of light, floaters, a curtain or shadow moving over the field of vision, peripheral or central visual loss, or both
Risk factors
50 y/o Nearsightedness Cataracts
142
Sxs of flash burn
Caused by use of a sunlamp without eye protection, exposure to a welding arc, or snow blindness
Numerous, microdots on the corneal surface after staining
143
Tx of flash burn
Pain management
Consider opioids
Antibiotics
Erythromycin
Pressure patch for the more affected eye
144
Sxs of chemical burn to eyes
Risk factor
Job exposure Improper PPE use
Excessive tearing, severe eye pain, photophobia, inability to open eyelids
145
Tx of chemical burn to eyes
Immediate irrigation with normal saline for 30 minutes
Erythromycin 0.5% every 1-2 hrs
146
Penetrating wound to eye sxs
Pain, decreased vision, loss of fluid from eye, Hx of trauma, fall, or sharp object entering globe
Low intraocular pressure
147
Tx of penetrating eye wound
Protect the eye with a shield at all times
Elevate the head of the bed to 45 degrees
Cefazolin (Ancef, Kefzol) 1 gm IV
Tetanus shot is last dose over 5 years
Ondansetron (Zofran) 4mg PO/IV
MEDEVAC Surgical repair ASAP
148
Herpetic Lesion of eye sxs
Photophobia, pain, eye redness, and decreased vision
History of oral or genital herpes infection
Dendritic keratitis branching
Eyelid may have typical herpetic vesicular eruptions
Palpable preauricular node
149
tx of herpetic lesion
Topical antiviral
| Valacyclovir (Valtrex) 500mg PO or Acyclovir 400mg PO
150
Tx of foreign body of ear
Cerumen loops/scoops, alligator forceps
Live objects should be drowned with Lidocaine 2%
Irrigation should not be done unless the TM is completely visualized
Topical antibiotics
151
Tx of cerumen impaction
Ear irrigation using body temperature water
Carbamide Peroxide (Debrox) 2-5 drops max of 4 days
152
Tx of mastoiditis
Cefazolin 0.5-1.5g IV TID
Surgery: Tympanocentesis and myringotomy
I&D of periosteal abscess Mastoidectomy may be indicated
153
tx of otitis externa
Drying Agent - 50/50 Alcohol/White Vinegar
Ciprofloxacin Otic (Cetraxal)
Removal of purulent debris filling the ear canal
Apply ear wick if there is substantial edema
Severe cases
Ciprofloxacin 500mg PO
154
Tx of otitis media
Amoxacillin/Clavulanate (Augmentin) 875mg
Ceftriaxone 1 gram IM OR Doxycycline 100mg
Nasal Decongestants
Surgical drainage for severe cases Tympanocentesis
155
Tx of eustachian tube dysfunction
Decongestant Pseudoephedrine 60mg
Oxymetazoline 1-2 sprays
156
Tx of TM perforation
Spontaneous healing occurs in most cases can take 5-6 days to heal
MOI dictates Systemic Antibiotics : Augmentin) 875mg
Doxycycline 100mg
157
barotrauma tx
```
Decongestant
Pseudoephedrine (Sudafed) 60mg, Oxymetazoline (Afrin)
```
Antihistamines as needed for symptomatic relief
158
Eustachian tube is excessively open due to
patulous dysfunction
159
Eustachian tube fails to dilate properly in
dilatory dysfunction
160
Eustachian tube is normally
closed
161
most common reasons for hearing loss
age (presbyacusis)
| trauma(4000hz)
162
Ototoxicity can be caused by
aspirin
| antibiotics
163
tinnitus is divided into two types
objective
| subjective
164
What labs would you want to get for a patient with tinnitus?
CBC
TSH
HIV
RPR
165
Locations for epistaxis
anterior- kiesselbach plexus
| posterior-sphenopalatine artery
166
What coags labs would you want for epistaxis pt?
PT
TT
aPTT
167
Tx of Epistaxis
-Direct pressure by compression of the nares continuously for 10-15 minutes
-Oxymetazoline (Afrin) PLUS tampon
-Lidocaine
-Cauterized with silver nitrate
-Nasal packing
Antibiotics - Cephalexin (Keflex) 500mg, Clindamycin 150mg x5 days (toxic shock)
168
complications of epistaxis?
syncope
169
Reasons for polyps
```
allergies
asthma
cystic fibrosis
alcohol
aspirin
```
170
Major complication of fractured nose?
septal hematoma
171
tx of allergic rhinitis
Intranasal Steroids - Flonase
Antihistamines
Avoiding or reducing expoure to airborne allergens
Nasal saline irrigations
172
Tx of sinusitis
NSAIDS for pain
Oral/nasal decongestant Pseudoephedrine (Sudafed) Nasal Oxymetazoline (Afrin)
Antibiotics if purulent discharge
Augmentin for more than 10 days
Severe - high dose Augmentin 2000mg
If PCN allergy - Doxycycline 100mg
173
typical pathogens of bacterial rhinosinusitis?
```
S pneumoniae
streptococci
H influenzae
S aureus
moraxella catarrhalis
```
174
predisposing factors of epiglottis
DM pts
| contact with A-beta-hemolytic strep
175
sxs of epiglottis
Rapidly developing sore throat or difficulty swallowing is out of proportion to findings
176
tx of epiglottis
IV Antibiotics -
Ceftriaxone 2g IV
Levo 750mg IV
Corticosteroid
Dexamethasone (Decadron) 4- 10mg IV bolus
177
PTA sxs?
Severe sore throat, difficulty swallowing,
muffled "hot potato" voice
trismus (lockjaw), inferior and medial displacement of the infected tonsil, swollen uvula,
Uvula will be deveated, drooling, dehydration
178
PTA Tx
Antibiotic - IV Cefazolin (Ancef) PLUS Metronidizole
Surgery
Needle aspiration WATCH THE AIRWAY!
179
Centor critera
```
Fever >100.4
Tender anterior cervical lymphadenopathy
NO cough
pharyngotonsillar exudates
Age
(MUST HAVE 3 SYMPTOMS!)
```
180
labs for pharyngitis
Rapid strep
monospot
throat culture
HIV
181
Most common organism recovered from drainage in sialadenitis?
S aureus
182
Sxs of sialadentitis
Acute swelling of the parotid or submandibular glands
Increased pain and swelling with meals
Tenderness and erythema of the duct opening
Pus can often be massaged from the duct
183
Tx of sialadentitis
Antibiotics
Clindamycin 450mg PO TID
PLUS
Ciprofloxacin 500mg BID
Measures to increase salivary flow: hydration, warm compress, sialagogues (lemon drops, gum), massage of gland
184
Complications of sialadentitis
ludwigs angina
185
sxs of tonsiloliths
Halitosis
White debris
Bad taste in the back of the throat
