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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
medications that may affect hearing
``` ahminoglycosides aspirin NSAIDS quinine furosemide ```
26
sore tongue - consider?
aphthous ulcers | if smooth - nutritional deficiency
27
hoarseness - consider?
voice overuse acute viral laryngitis neck trauma ``` >2 weeks: hypothyroid vocal cord nodule CA neuro disorder (Parkinsons, amyotrophic lateral sclerosis, MG) ```
28
hair & thyroid function
fine hair - hyper | coarse hair - hypo
29
enlarged skull - consider?
hydrocephalus Paget disease if step-off - trauma
30
what does CN IV (trochlear) damage lead to?
diplopia
31
tests for visual fields by confrontation
static finger wiggle | kinetic red target test
32
visual field defects - consider?
``` glaucoma optic neuropathy optic neuritis glioma stroke chasmal tumor ```
33
enlarged blind spot - consider?
glaucoma optic neuritis papilledema
34
miosis vs mydrasis
mitosis - contraction | madrasis - dilation
35
poor convergence - consider?
hyperthyroidism
36
contraindications for mydriatic drops
head injury.coma | narrow angle glaucoma
37
absence of red reflex - consider?
cataract opacity of vitreous detached retina retinoblastoma (kids)
38
refractive errors: myopia vs hyperopia
myopia - light rays focus anterior to retina (retinal structures look larger) hyperopia - light rays focus posterior
39
tug test (ear)
movement of auricle and tragus | painful = actue otits externa not in otitis media, instead have tenderness behind ear
40
disorders of external ear and middle ear cause?
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
disorders of inner ear cause?
sensorineural hearing loss from congenital and hereditary conditions, viral infections, Menieres, noise exposure, ototoxic drugs, acoustic neuroma
42
Exostosis
contender nodular selling covered by normal skin deep in ear canals nonmalignant overgrowths which may obscure eardrum
43
prominent short process and prominent handle of malleus - abnormal dx?
retracted drum
44
Whisper Test
stand 2ft behind pt test one ear at a time exhale to ensure quiet voice whisper 2 combo of letters/numbers
45
Weber Test
base of tuning fork vibrating on top of head same in both ears? unilateral sound heard in good ear
46
Rinne Test
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
nasal mucosa: viral vs allergic rhinitis
viral: red, swollen allergic: pale, blush, red
48
nasal polyps - abnormal dx?
``` (pale saclike growths of inflamed tissue that can obstruct air passage or sinuses) allergic rhinitis ASA sensitivity asthma chronic sinus infections CF ```
49
CN X paralysis soft palate and uvula assessment
soft palate fails to rise | uvula deviates to the opposite side (points away from the lesion)
50
Neck lymph nodes
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
enlargement of supraclavicular node on left -abnormal dx?
metastatis from thoracic or abdominal malignancy
52
tender nodes vs fixed nodes
tender - inflammation | fixed - malignancy
53
general lymphadenopathy
multipel infectious, inflammatory conditions: | HIV, mono, lymphoma, leukemia, sarcoidosis
54
Tension Headache
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
Migraines
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
Cluster Headaches
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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