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N507 Exam 1 > (7) HEENT > Flashcards

(7) HEENT Flashcards

1
Q

HEENT: common & concerning symptoms

A 
headache
change in vision (blurred, loss of vision, floaters, flashing)
eye pain, redness, tearing
double vision (diplopia)
hearing loss, earache, ringing in the earring (tinnitus)
dizziness and vertigo
nosebleed (epistaxis)
sore throat, hoarseness
swollen glands
goiter
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2
Q

headache warning signs

A
  • progressively frequent or severe over 3 month period
  • sudden onset “thunderclap” or “worst ever”
  • new onset after 50 y/o
  • aggravated/relieved by position change
  • precipitated by Valsalva or exertion
  • w/ fever, night sweats, weight loss
  • presence of CA, HIV, pregnancy
  • recent head trauma
  • change in pattern
  • lack of similar headache in past
  • associated papilledema, neck stiffness, focal neurological deficits
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3
Q

3 most important attributes of headaches:

A

severity
chronologic pattern
associated symptoms

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4
Q

primary headache

A

migraine
tension
cluster
chronic daily

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5
Q

secondary headache

A

arise from underlying structural, systemic, infectious causes
abnormal dx: meningitis, subarachnoid hemorrhage

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6
Q

thunderclap headache

A

reach max intensity over several minutes

abnormal dx: subarachnoid hemorrhage (often preceded by sentinel leak headache from vascular leak into subarachnoid space)

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7
Q

sudden onset, sever headache - consider?

A

subarachnoid hemorrhage

meningitis

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8
Q

migraine and tension headache

A

episodic
peak over several hours
may be unilateral
tension - temporal areas

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9
Q

new, persisting progressively severe headaches - consider?

A

tumor
abscess
mass lesion

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10
Q

retro-orbital headache - consider?

A

cluster headache

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11
Q

N/V w/ headache - consider?

A

migraine
brain tumor
subarachnoid hemorrhage

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12
Q

hyperopia
presbyopia
myopia

A

hyperopia - farsightedness (difficulty close)
presbyopia - align vision
myopia - nearsightedness (difficulty far)

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13
Q

sudden vision loss is unilateral & painless - consider?

A 
vitreous hemorrhage from diabetes or trauma
macular degeneration
retinal detachment
retinal vein occlusion
central retinal artery occlusion
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14
Q

sudden, painful unilateral vision loss - consider?

A 
causes usually in cornea and anterior chamber:
corneal ulcer
uveitis
traumatic hyphema
acute angle closure glaucoma

optic neuritis from MS

immediate referral

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15
Q

sudden bilateral vision loss - consider?

A

if painless consider vascular etiologies:
giant-cell arteritis

if painful consider chemical or radiation exposures

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16
Q

gradual bilateral vision loss - consider?

A

cataracts

macular degeneration

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17
Q

slow central vision loss - consider?

A

nuclear cataract

macular degeneration

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18
Q

peripheral vision loss - consider?

A

open-angle glaucoma

(one sided) hemianopsia and quadratic defects

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19
Q

flecks in vision - consider?

A

floaters
fixed defects
scotomas
lesions in retina or visual pathways

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20
Q

flashing lights in vision - consider?

A

w/ new floater = retinal detachment

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21
Q

red eye - consider?

A

painless - subconjunctival hemorrhage (viral conjunctivitis)

painful - hyphema, episcleritis, acute angle closure glaucoma, herpes keratitis, foreign body, fungal keratitis, sarcoid uvetitis

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22
Q

diplopia - consider?

A

lesson in brainstem/cerebellum

w. weakness/paralysis of extra ocular muscles - CN II or II palsy

in one eye = problem w/ lens or cornea

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23
Q

sensorineural hearing loss

A

results from problems in inner ear, cochlear nerve, or its central connections in the brain

often have trouble understanding speech, problems w/ noisy environments

24
Q

conductive hearing loss

A

results from problems in external or middle ear

noisy environments may help

25
Q

medications that may affect hearing

A 
ahminoglycosides
aspirin
NSAIDS
quinine
furosemide
26
Q

sore tongue - consider?

A

aphthous ulcers

if smooth - nutritional deficiency

27
Q

hoarseness - consider?

A

voice overuse
acute viral laryngitis
neck trauma

>2 weeks:
hypothyroid
vocal cord nodule
CA
neuro disorder (Parkinsons, amyotrophic lateral sclerosis, MG)
28
Q

hair & thyroid function

A

fine hair - hyper

coarse hair - hypo

29
Q

enlarged skull - consider?

A

hydrocephalus
Paget disease

if step-off - trauma

30
Q

what does CN IV (trochlear) damage lead to?

A

diplopia

31
Q

tests for visual fields by confrontation

A

static finger wiggle

kinetic red target test

32
Q

visual field defects - consider?

A 
glaucoma
optic neuropathy
optic neuritis
glioma
stroke
chasmal tumor
33
Q

enlarged blind spot - consider?

A

glaucoma
optic neuritis
papilledema

34
Q

miosis vs mydrasis

A

mitosis - contraction

madrasis - dilation

35
Q

poor convergence - consider?

A

hyperthyroidism

36
Q

contraindications for mydriatic drops

A

head injury.coma

narrow angle glaucoma

37
Q

absence of red reflex - consider?

A

cataract
opacity of vitreous
detached retina
retinoblastoma (kids)

38
Q

refractive errors: myopia vs hyperopia

A

myopia - light rays focus anterior to retina (retinal structures look larger)
hyperopia - light rays focus posterior

39
Q

tug test (ear)

A

movement of auricle and tragus

painful = actue otits externa
not in otitis media, instead have tenderness behind ear

40
Q

disorders of external ear and middle ear cause?

A

conductive hearing loss

external: cerumen impaction, infection, trauma, squamous cell carcinoma, benign bony growths
middle: otitis media, congenital, cholesteatomas, otosclerosis, tumors, perforation of tympanic membrane

41
Q

disorders of inner ear cause?

A

sensorineural hearing loss

from congenital and hereditary conditions, viral infections, Menieres, noise exposure, ototoxic drugs, acoustic neuroma

42
Q

Exostosis

A

contender nodular selling covered by normal skin deep in ear canals
nonmalignant overgrowths which may obscure eardrum

43
Q

prominent short process and prominent handle of malleus - abnormal dx?

A

retracted drum

44
Q

Whisper Test

A

stand 2ft behind pt
test one ear at a time
exhale to ensure quiet voice
whisper 2 combo of letters/numbers

45
Q

Weber Test

A

base of tuning fork vibrating on top of head
same in both ears?
unilateral sound heard in good ear

46
Q

Rinne Test

A

vibrating tuning form to mastoid behind ear level w/ canal
when pt no longer hears sound place form close to ear and ask if hears vibration (fork U facing forward)
AC>BC normally

conductive hearing loss BC=AC or BC>AC
sensorineural hearing loss AC>BC

47
Q

nasal mucosa: viral vs allergic rhinitis

A

viral: red, swollen
allergic: pale, blush, red

48
Q

nasal polyps - abnormal dx?

A 
(pale saclike growths of inflamed tissue that can obstruct air passage or sinuses)
allergic rhinitis
ASA sensitivity
asthma
chronic sinus infections
CF
49
Q

CN X paralysis soft palate and uvula assessment

A

soft palate fails to rise

uvula deviates to the opposite side (points away from the lesion)

50
Q

Neck lymph nodes

A

Preauricular - front of ear
Posterior auricular - superficial to mastoid process
Occipital - at base of skull posteriorly
Tonsillar - at angle of manidble
Submandibular - midway between angle and tip of mandible
submental - midline a few cm behind tip of mandible
superficial cervical - superficial to sternocleidomastoid
posterior cervical - along anterior edge of trapezius
deep cervical chain - deep to sternocleidomastoid and often inaccessible to exam (hook fingers around side of muscle to find them)
supraclavicular - deep in angle formed by clavicle and sternocleidomastoid

51
Q

enlargement of supraclavicular node on left -abnormal dx?

A

metastatis from thoracic or abdominal malignancy

52
Q

tender nodes vs fixed nodes

A

tender - inflammation

fixed - malignancy

53
Q

general lymphadenopathy

A

multipel infectious, inflammatory conditions:

HIV, mono, lymphoma, leukemia, sarcoidosis

54
Q

Tension Headache

A

Process: unclear
Prevalence: most common
Location: bilateral
Quality: steady, mild-moderate, non throbbing, pressing/tightening
Timing: gradual onset, episodic, 30min-7days
Symptoms: photophobia, photophobia, nausea, scalp tenderness, no nausea
Triggers: muscle tension (driving/typing),stress, no sleep
Relieve: massage, relax

55
Q

Migraines

A

Process: neural dysfunction (low serotonin)
Prevalence: 10% of headaches
Location: unilateral or bifrontal or global
Quality: throbbing/aching, moderate-sever, aura
Timing: rapid, peak 1-2 hrs, lasts 4-72 hrs, recurrent
Symptoms: pN/V, photo/phonophobia, aura
Triggers: ETOH, foods, stress, altitude, menses, lights
Relieve: quiet, dark room, sleep, arterial pressure

56
Q

Cluster Headaches

A

Process: unclear, maybe hypothalamic
Prevalence: rarest
Location: unilateral, behind temple/eye
Quality: sharp, continuous, severe
Timing: abrupt, peaks in minutes, 15min-3hrs, episodic in clusters
Symptoms: unilateral autonomic sx - lacrimation, rhirrohea, mitosis, ptosis, eyelid edema, conjunctival infection
Triggers: ETOH?

N507 Exam 1 (10 decks)

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