Chapter 10: HEENT Flashcards
Accommodation
adjustment, especially of the eye for seeing objects at various distances
Cardinal Fields of Gaze
determine how well the 6 extraocular eye muscles are working along with Cranial Nerves 3, 4, 6
Consensual Reaction
reaction of the other pupil after a light test in the first
- identical change in pupil size in both eyes when light is shone into one eye
Constriction
closing of the eye pupil
- to limit the amount of light that enters the pupil
- for close vision
Dilation
widening of the eye
- to allow more light to enter the eye
Cornea
clear, bowl-shaped structure at the front of the eye, located in front of the colored part of the eye (iris)
- controls and focuses the light that enters the eye
Cover and Uncover Test
observing movement and response of uncovered eye while the other is covered
Exophthalmos
abnormal protrusion of the eyeballs
- sign of hyperthyroidism
Helix
margin of the ear’s auricle
Hirschberg Test
corneal light reflex test
-shine light in eyes and the light reflection should be at the same point in each eye
Inner and Out Canthus
inner and outer angular junction of the eyelids at either corner of the eyes
- corner of the eyes
Iris
circular opening that allows light into the eye
Limbus
edge of corneas where it joins the sclera
Nystagmus
involuntary movement of the eye
Palperbral Fissure
elliptic space between the medial and lateral canthi of the two open lids
Perrla
Acronym
- Pupils are Equal, Round, Reactive to Light with Accommodations
Pinna
projecting part of the ear
Peripheral Vision
angle between the axis of the eye looking directly at the examiner and the peripheral axis where the object is first seen
Presbyopia
loss of the eyes’ lens to accommodate to near vision; occurs around age 40
- leads to Farsightedness
- will see patient move the cards further away to see clearly
Pupil
black circular area of eye that lets in light
Rinne Test
evaluates hearing loss in one ear
- place tuning fork at mastoid process and then in front of the patient’s ear
Sclera
tough fibrous tunic forming the outer envelope of the eye and covering all of the eyeball except the cornea
- white outer layer of the eyeball
Snellen Charts
traditional eye chart with a large letter E at the top followed by progressively smaller print
Strabismus
cross-eyed, optic axes cannot be directed to the same object
- caused by weakness of extraocular muscles
Thyroid
hormone glad that plays an important role in metabolism, growth, and development of human body
Tonsils
soft organs located at each side of the back of the throat; part of the immune system
Visual Acuity (Distance)
ability of the eye to distinguish shapes and the details of objects at a given distance
Visual Acuity (Near Vision)
measurement of how well you can see close objects; usually 16-18 inches
Trachea
tube about 4 inches long and less than an inch in diameter allowing air to pass into the body; commonly called the windpipe
Weber Test
hearing screening test done with a tuning fork to detect one-sided conductive hearing loss in the middle ear and unilateral sensorineural inner ear hearing loss
Dizziness vs. Vertigo
- D: feeling like you will faint
- V: feeling like the world is spinning
What is presyncope ?
feelings of faintness
What is disequilibrium ?
feeling of falling
What is Bell’s Palsy ?
- whole 1 side of face is paralyzed or numb
- affects CN VII
- usually temporary
- has wrinkles on side of face that can still be moved and none of the side that can’t be moved
What is CVA (cerebral vascular accident) ?
- think of stroke
- affects CN VII
- has wrinkles on both side of face
- opposite site of injury will be the side that if affected
- motor response in upper part is normal
- caused by blood clot or hemorrhage
- loss of blood flow (oxygen) to the brain
From what side of the brain does the innervation to the muscles of the upper face come from ?
- both sides of the brain
From what side of the brain does the innervation to the muscles of the lower face come from ?
- from the opposite side of the brain only
How do we test for visual acuity ?
Snellen chart (CN II)
What are the conditions to use the Snellen chart ?
- stand 20 ft away from chart
- cover one eye at a time
- well lighted room
- read smallest line possible
- when documenting say if they use correction glasses or contacts
What eye chart can we use for people who can’t read letters ?
e-chart
What is considered legally blind ?
20/200
What are the conditions to use the Jaeger/Rosenbaum chart ?
- hold chart about 14 inches away from the eye
- use to test for near vision for ages 40 and over
What does 20/25 mean for visual acuity ?
you can see at 20 feet what someone with normal vision can see at 25
- the larger the denominator the poorer the vision
What is myopia ?
- nearsighted
What is hyperopia ?
farsighted
What is Astigmatism ?
visual distortion resulting from an irregular corneal curvature that prevents light rays from being focused clearly on the retina
What is Strabismus ?
when eyes aren’t in alignment with each other
- moves to focus after being uncovered
- caused by extraocular muscle weakness or paralysis
What is Nystagmus ?
involuntary movement of the eyeball in a horizontal, vertical, rotary, or mixed direction
- can be congenital or acquired from multiple causes
How do we test for strabismus ?
cover-uncover test
What does the confrontation test assess for ?
assess for peripheral vision
How do you perform the confrontation test ?
- face patient and stand or sit at a distance of 2-3 ft
- ask patient to cover one eye with an opaque card and look directly at you
- cover your own eye directly opposite the patient’s covered eye
- bring your finger or pencil from the farthest periphery and bring it gradually closer to the midline
- you and the patient should see the object at the same time
What is enophthalmos ?
eyelid and lashes are rolled in (trauma, congenital, syndromes)
- eyes are sunken in
What is coloboma ?
a hole in a structure of the eye
What is Ptosis ?
lid is covering a portion of the pupil
Conjunctiva
the mucous membrane that covers the front of the eye and lines the inside of the eyelids
- doesn’t cover the cornea
What is conjunctivitis ?
red conjunctiva with purulent drainage
What is the Hirschberg test used for ?
corneal light reflex for symmetry
How do you perform the Hirschberg test ?
- patient stares straight ahead with both eyes open
- shine penlight toward the bridge of the nose (middle of both eyes) about 12-15 inches away
- light reflections should appear symmetric in both corneas
What does asymmetrical light reflections in the eye indicate ?
weak extra-ocular muscles
- perform cover-uncover test if found
When do you perform the cover-uncover test ?
if corneal light reflex is asymmetric
How do the pupils react when you look at a close and distant image ?
- Close: pupils constrict
- Distant: pupils dilate
When assessing for PERRLA should you check for pupil size before or after you shine the light ?
- before because the light will change the size of the pupil
How and when should your further access for hearing ?
based on conversation
- if patient leans forward as you talk
- watches lips as you speak
- asks to repeat yourself
- misunderstands questions
What does low set ears indicate ?
- abnormal
- congenital diseases like down syndrome
What is the Whisper voice test ?
- have patient occlude 1 ear
- while stand 1-2 ft in front of or bedside whisper 1 or 2 syllable words
- patient should hear 50% of words
- do with both ears
What is the Finger rubbing test ?
- have patient close eyes
- hold your fingers 3-4 inches from the patients ear, briskly rub your index finger against your thumb
- patients with high-frequency hearing loss may not be able to hear the noise
What does failure of eyes to move in parallel mean when doing the 6 cardinal fields of gaze ?
weakness of the extraocular muscles or abnormality associated with the cranial nerve
- nystagmus
What is conduction hearing loss in the Weber test ?
sound will lateralize to the defective ear because its traveling through the bone
What is sensorineural hearing loss in the Weber test ?
sound lateralizes to the unaffected ear
What does tenderness of the mastoid area mean ?
indicate mastoiditis
What does tenderness of the helix of the ear mean ?
an inflammation within the auditory canal
If you have conductive hearing loss what does that mean for your bone and air conduction ?
bone conduction longer than air conduction in the affected ear
If you have sensorineural hearing loss what does that mean for your bone and air conduction ?
air conduction longer than bone conduction in the affected ear
With is considered a normal finding when performing the Rinne test for hearing loss ?
- you should hear the air conduction twice as long as the bone conduction
What does tenderness of sinuses indicate ?
sinus congestion or infection
What does dry, flaking, cracked lips mean ?
- dehydration
- wind exposure
What does pale lips mean ?
- anemia or shock
What does cyanotic or circumoral lips mean ?
hypoxemia or hypothermia
What does cracks and erythema in corner of mouth mean ?
Vit B deficiency
What does smooth, beefy-red, edematous with a slick appearance of the tongue mean ?
possible vit B difciency
What does irregular patches, map-like appearances of the tongue mean ?
geographic tongue
What does a enlarged tongue indicate ?
down syndrome or hypothyroidism
What is Leukoplakia ?
white patch or plaque on oral mucosa that can’t be scraped off
What is Goiter ?
enlarged thyroid
- may be seen as fullness in the neck
What are signs of Hyperthyroidism ?
excessive secretion of thyroid hormone; commonly caused by Graves disease
- Increased metabolism
- weight loss
- enlargement of thyroid gland
- exophthalmos
- auscultation of the goiter may reveal a bruit
- decreased skin thickness
- diaphoresis
- warm/hot skin
What are signs of Hypothyroidism ?
decreased production of thyroid hormone
- decreased metabolism
- weight gain
- slow motion with depressed effect
- goiter may be seen because of increases in thyroid stimulation hormone
- enlarged tongue
- dull, coarse, brittle hair
What can cause hypothyroidism ?
- autoimmune thyroiditis
- iodine deficiency
- decreased section of thyroid-releasing hormone from the hypothalamus
- congenital defects
- as a result of the treatment of hyperthyroidism
- atrophy of thyroid gland or iodine deficiency
What is myopia ?
nearsightedness
What is hyperopia ?
farsightedness
What is presbyopia ?
lens gradually loses ability to bring close objects into clear focus
- natural part of aging
