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Flashcards in HEENT Deck (127)
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temporal arteries

palpate & auscultate


Snellen Chart


  • chart tests central vision
  • 20 feet from chart
  • Glasses (except reading) should be worn
  • Test one eye at a time, repeat
  • Have patient cover eye with card. Don’t press eye, can lose vision for a period.
  • Read the smallest line of print reading more than half of letters
  • Record OD (right eye), OS (left eye). OU (both eyes) 20/20, 20/30, and corrected to designate use of glasses
  • If miss one character can say, “20/30 -1” – or office standard


Rosenbaum Chart

(CN II). 

  • Use Rosenbaum chart to assist with screening of presbyopic patients, age 45+ or those wearing bifocals
  • Hold the card 14 inches from patient’s eyes or at a reasonable distance for the patient
  • Test each eye separately with and without glasses
  • Presbyobic patients may read through the bifocal
  • Record the line with the smallest letters/figures
  • Pediatric near allen test – for kids. Can use other symbols than letters as well!


Cover/Uncover Test

tests for strabismus

  • Observation of binocular eye movement
  • Fix gaze on far object
  • Cover one eye and observe
  • Alternate eye
  • Check covered eye for refixation movement
  • Alternating esotropia-covering fixating eye, the opposite eye moves outward
  • Alternating exotropia-outturned eye refixates inward when opposite eye is covered


Inspect eyelids for...

symmetry, ptosis, edema, erythema



Entropian: describe & examination technique

 common in elderly


  • Inward turning of the lid margin
  • Lower lashes may not be apparent as these are engulfed in the margin causing irritation to the conjunctiva and lower cornea
  • Examination technique-squeeze eyes together and open


Inspect sclera and conjunctiva for ...

  • color
  • discharge
  • pterygium
  • corneal arcus/
  • foreign body
  • hemorrhage.

Note and inspect both the bulbar and palpebral conjunctiva

bulbar conjunctive: covers most of anterior eyeball

palpebral conjunctiva: lines the eyelids



  • Elevated, external thickening of the bulbar conjunctiva
  • Extends into corneal surface
  • May obstruct vision: wedge shaped area



  • The lower lid margin is turned outward and exposes the palpebral conjunctiva
  • When the punctum of the lower lid turns outward, the eye drains improperly
  • Common geriatric finding


Headache: Primary vs Secondary

  • Primary (90%):  Migraine, tension, cluster, chronic
  • Secondary: structural, systemic, infectious


Common Primary Headache Types

Cluster, Tension, Migraine

Cluster: tends to be unilateral, retroorbital

Tension: tends to be bilateral, temporal

Migraine: Tends to be unilateral, assoc w/ other symptoms, e.g., aura, photophobia, NA, cravings for food, euphoria, dizziness


Headache + nausea/vomiting, consider...


tumor, subarachnoid hemorrhage, ... (increased ICP)


Valsalva aggravates headache, consider...

acute sinusitis, mass lesion/ICP


Coughing, sneezing  aggravates headache, consider...

increased ICP


Headache Warning SIgns

  • Progressively frequent or severe over 3-month
  • Sudden onset like “thunderclap” or “worse headache of my life” (SA hemorrhage, esp >50 w/following Sx)
  • New onset > 50 years
  • Aggravated or relieved by position change
  • Precipitated by Valsalva maneuver
  • Recent trauma
  • Associated papilledema, neck stiffness or neurologic deficits

Not necessarily together but signal need for further imaging

Could be increased ICP, bleed, progressive concussion, malignancy, etc. = don’t wait


7 bones of skull


  • 2 Frontal
  • 2 Parietal
  • 2 Temporal
  • 1 Occipital


Skull: anatomy of newborn

  • Bones connected by Sutures
  • Posterior fontanel closes by 2 months
  • Anterior fontanel closes by 24 months


Facial anatomy: fused & movable bones

Fused bones

  • Frontal
  • Zygomatic
  • Nasal
  • Ethmoid
  • Lacrimal
  • Sphenoid
  • Maxillary

Movable Bones

  • Mandible


Facial landmarks

  • Palpebral fissures
  • Nasolabial folds

Look for symmetry


Facial innervation

Trigeminal (CNV): Muscles of mouth & jaw

Facial (CN VII): Muscles of eyebrows, forehead, cheeks, lips


Trigeminal nerve: areas of innervation (sensory)


Enlarged skull may indicate...

hydrocephalus or paget’s dz of bone


Vertigo vs dizziness

Vertigo is rotational, not just losing balance


Causes of vertigo

Peripheral: in labyrinths of inner ear, peripheral lesions of CNVIII, indicates vestibular disease. BPPV, labyrinthitis, menieres

Central: CNVIII pathways or nuclei in brain. Ataxia, diplopia, dysarthria, vertigo. Central neurologic causes in cerebellum or brainstem (CVD, posterior fossa tumor)



Symptoms of Menieres

vertigo, tinnitus and hearing loss 


Ototoxic drugs

aminoglycosides, asa, nsaids, furosemide, some chemo


Children and PMH: high risk for hearing loss

  • Prenatal infections
  • Birth weight <1500 gm
  • Hypoxia
  • Craniofacial anomalies
  • High bilirubin
  • Recurrent ear infections
  • Speech or language delay
  • Facial or ear injury
  • Foreign body in ear (children & geriatric- cognitive imp)


Personal/social history & risk for hearing loss

  • Exposure to environmental or industrial noise
  • Use of recreational headphones
  • Use of ear protective equipment                                                                                                           
  • Daycare or preschool
  • Allergies
  • Exposure to second-hand smoke
  • Piercings


Insufflation of ear

Most otoscopes have a small air vent connection that allows the doctor to puff air in to the canal. Observing how much the eardrum moves with air pressure assesses its mobility, which varies depending on the pressure within the middle ear. 



Anatomy of ear