HEENT Flashcards
Who is likely to get corneal ulcers?
Soft contact users
Corneal Ulcer
MEDICAL EMERGENCY
S&S: severe eye pain, foreign body sensation, tearing, and photophobia
Presentation:
whitish lesion on the cornea
Use penlight, slit lamp exam, and fluorescein dye test
Pseudomonas, Staphylococcus, or Streptococcus
Complications: Permanent vision impairment d/t scarring or perforation
Herpes Keratitis
S&S: Acute onset of severe eye pain, photophobia, tearing, and blurred vision in one eye
Dx: fluorescein dye
- fernlike lines in the corneal surface w/ fluorescein dye
Complications: permanently damages corneal epithelium, which may result in corneal blindness
Caused by: herpes simplex called herpes simplex keratitis
OR
herpes varicella zoster [shingles] called herpes zoster ophthalmicus
How does herpes keratitis differ from corneal abrasion?
HK: fernlike lines in the corneal surface.
Corneal abrasions: round or irregularly shaped
Herpes simplex keratitis
due to self-inoculation “cold sore”
Herpes zoster ophthalmicus
MEDICAL EMERGENCY
shingles of the trigeminal nerve
acute eruption of crusty rashes that follow the ophthalmic branch -> one side of forehead, eyelids, and tip of nose
Acute Angle-Closure Glaucoma
MEDICAL EMERGENCY
Sudden blockage of aqueous humor causes marked increase of the IOP, resulting in ischemia and permanent damage to the optic nerve
S&S Acute onset of severe eye pain accompanied by headache, nausea/vomiting, halos around lights, lacrimation, and decreased/blurred vision
PE: fixed and mid-dilated pupil(s) that is oval shaped. Slow reaction to light.
cloudy cornea
Cupping of the optic nerve
Multiple Sclerosis (Optic Neuritis)
S&S: Woman 20-30s
loss of visual acuity over hours to days
Color vision is affected & central scotoma (blind spot central vision)
Other neuro sx: aphasia, paresthesia, abnormal gait, spasticity
Fatigue that worsens through day
Refer to neuro
Multiple Sclerosis (Optic Neuritis) - Uhthoff phenomenon
Worsens in high temperatures
Orbital Cellulitis
MEDICAL EMERGENCY
S&S Acute onset of erythematous swollen eyelid with proptosis and pain
history of recent rhinosinusitis or URI
More likely in children
PE: Restricted EOMs w/ pain
Cause: acute bacterial infection of the orbital contents (fat and ocular muscles)
Retinal Detachment
MEDICAL EMERGENCY
S&S: Sudden onset of floaters (or increase in floaters) associated with “looking through the curtain” sensation with sudden flashes of light (photopsia)
Auricular Hematoma
Direct blunt trauma to the ear that can cause bleeding in the auricular cartilage
Drain ASAP
Complications: cauliflower ear
What professions are more at risk for an auricular hematoma
wrestlers, boxers, and mixed martial arts fighters
Acoustic neuroma (vestibular schwannoma)
50s to 60s
Unilateral hearing loss and tinnitus lasting 3 to 4 years
Unsteady walking with veering or tilting
Cause: tumor of acoustic nerve
Refer to neuro
Cholesteatoma
Unilateral heaving loss and discharge - purulent and foul smelling
On exam: TM perforation and White mass or intact with mass behind
H/o chronic or recurrent otitis media
Mass can erode into facial bones
Treat w/ abx or surgery
Refer to otolaryngologist
Battle Sign (Basilar Skull Fracture)
Indicates serious head injury -> ER
Parietal bone fracture w/ linear fracture most common
Cause: fall, assault, MVC, GSW
SS: raccoon eyes and bruising behind ear after trauma
PE: clear, golden serous discharge from ear or nose or hemotympanum (blue/ purple color to TM)
Avulsed tooth
DENTAL EMERGENCY
Need to reimplant tooth quickly
OK if baby tooth
If permanent tooth: don’t touch root, only touch crown
Rinse w/ saline, irrigate socket, reimplant tooth, bite on gauze
Can store tooth in milk, saline, or cheek if unable to reimplant
Peritonsillar Abscess
MEDICAL EMERGENCY
Sx: sore throat, odynophagia, trismus (jaw spasm), not potato voice. Malaise, fever
PE: unilateral swelling, uvula displaced
Diphtheria
REFER TO ED
Contact precaution
Sore throat, fever, and markedly swollen neck (“bull neck”)
Posterior pharynx, tonsils, uvula, and soft palate are coated with a gray to yellow pseudomembrane that is hard to displace
Very contagious
Virchow’s Node (Troisier’s Sign/Node)
enlarged and hard left-sided supraclavicular node(s)
can be malignancy (cancer of GI/GU)
Need biopsy
Normal Findings: Eyes
Fundi: veins larger/darker than arteries
Cones: color perception
Rods: low-light vision (night vision), peripheral vision.
Macula (and fovea): central vision and color vision. Fovea contains large numbers of cones. Diseases of the macula -> loss of central vision
Presbyopia
Age-related
decreased ability of the eye to accommodate and focus due to stiffening of the lenses;
usually starts at the age of 40 years;
near vision is affected with decreased ability to read small print
Blepharitis
Inflammation of the edges of the eyelids
oil glands at the base of the eyelashes become clogged.
eyelids are red, irritated, and itchy. Small scales like dandruff may be present.
Blepharitis tends to recur.
May be associated with dandruff, seborrheic dermatitis, or rosacea.
Normal Findings: Ears
Bones (ossicles) of the ear: Malleus, incus, and stapes. The stapes is the smallest bone in the body.
TM: translucent off-white to gray color with the “cone of light” intact. The pars tensa is located on the lower aspect and appears to bulge slightly. It is the area of the TM where the cone of light is visible.
Tympanogram: most objective measure to test for presence of fluid inside middle ear (results in a straight line vs. a peaked shape). Acute otitis media (AOM) and serous otitis media will show a straight line on testing
Pinna: Has a large amount of cartilage.
Tragus: A small cartilage flap of tissue on the front of the ear.
Cerumen: Ear wax; the color can range from yellow to dark brown.
Normal Findings: Nose
Kiesselbach’s plexus: Located on the anterior inferior aspect of the nose (lower one-third).
Turbinates: Only the inferior nasal turbinates are usually visible. The medial and superior turbinates are not visible without special instruments. Bluish, pale, and/or boggy nasal turbinates are seen in allergic rhinitis.
Cartilage: Lower third of the nose is cartilage.
Septum: Perforation of the nasal septum can result from inhalation of cocaine, which is a potent vasoconstrictor. Refer to plastic surgeon for repair.
Normal Findings: Sinuses
Sinuses are air-filled cavities in the skull. There are four types: ethmoid and maxillary (both present at birth), frontal (age 5 years), and sphenoid (age 12 years). By age 12 years, a child’s sinuses are nearly at adult proportions.
Normal Findings: Mouth
Mucous membranes are pink to dark pink and moist.
The tongue should not be red or swollen (glossitis).
A normal adult has 32 teeth.
Vermilion border: Vermilion border is at the edges of the lips. The corners of the lips are called the oral commissures (cheilosis, perleche).
Leukoplakia
White-to-light-gray patch that appears on tongue, floor of mouth, or inside cheek. Rule out oral cancer. Chewing or smoking tobacco, alcohol abuse, and human papillomavirus (HPV) are risk factors for oral cancer.
Aphthous stomatitis (canker sores)
Painful shallow ulcers on soft tissue of the mouth that usually heal within 7 to 10 days
Cause is unknown.
Treat: “magic mouthwash” (combination of liquid diphenhydramine, viscous lidocaine, and glucocorticosteroid). Swish, hold, and spit every 4 hours as needed.
Orabase cream/ointment (OTC).
Normal Findings: Salivary Glands
There are three salivary glands: parotid, submandibular, and sublingual. The glands may become infected (sialadenitis, sialadenosis, mumps) or can become blocked with calculi (“stone”; sialolithiasis).
Mumps (Parotitis)
School-aged child to adult
Sx: acute onset of fever, headache, fatigue, myalgia, and anorexia. Within 48 hours, the salivary/parotid gland(s) becomes swollen and tender. It can be unilateral (25%) or bilateral. The cheek appears puffy, and the angle of the jaw on the involved side appears swollen. The swelling and tenderness usually subside in about 1 week.
Complications are rare and include orchitis (of one testicle), meningitis, encephalitis, deafness, and others.
Mumps is a nationally notifiable disease; report all cases to local or state health department.
Normal Findings: Tonsils
Also known as the palatine tonsils; tonsils are made up of lymphoid tissue. Butterfly-shaped glands with small pore-like openings that may secrete thick white exudate (mononucleosis) or purulent exudate that is a yellow-to-green color (strep throat).
A peritonsillar abscess (quinsy) is a serious deep-neck infection, and it is a rare complication of tonsillitis. Assess for airway obstruction. About half of cases occur in children and adolescents. Refer to ED or call 911.
Normal Findings: Posterior Pharynx
Hard palate: Look for any openings (cleft palate), ulcers, redness.
Uvula: Should be in midline position; is displaced if infected and abscessed (peritonsillar abscess).
Which lymph nodes enlarge with allergies?
Retropharyngeal lymph nodes can be mildly enlarged and distributed evenly on the back of the throat
Normal Findings: Lymph Nodes
Anterior cervical nodes (superficial chain) drain the lymph from the skin and superficial surfaces of the anterior neck.
Posterior cervical nodes (superficial chain) drain the scalp, neck, and skin of the upper thoracic area.
Which lymph nodes enlarge with viral or bacterial inflection?
The anterior cervical lymph nodes can become enlarged with viral or bacterial infections (strep throat).
Which lymph nodes enlarge with mononucleosis?
Mononucleosis can cause posterior cervical lymphadenopathy.
Palpebral conjunctiva:
Mucosal lining inside eyelids
Bulbar conjunctiva:
Mucosal lining covering the eyes
Buccal mucosa:
Mucosal lining inside the mouth
Soft palate:
Area where uvula, tonsils, and anterior of throat are located
