Clin Med-heent Flashcards
Smaller and more widely spaced than normal and notched on their biting surface
Sides of the teeth tapered toward the biting edges.
Upper central incisors permanent most often affected
Hutchinson’s teeth in congenital syphilis
Red purple papules form in the gingival interdental papillae and sometimes on the fingers
Red and soft painless, and bleed easily
Occur in 1-5% pregnancies
Regress after delivery
Pregnancy tumor (pregnancy epulis/pyogenic granuloma)
Gums enlarged by hyperplasia are swollen into heaped up masses that may even cover the teeth.
Gingival hyperplasia
A process that ccur in elderly and
Chewing surfaces of the teeth are worn down by repetitive use so that yellow brown dentin be exposed
Attrition of teeth
Uncommon form of gingivitis occurs suddenly in adolescents and young adults Ulcers develop in interdental papillae Presence of grayish pseudomembrane Red painful gums bleed easily Vincent's infection
Acute necrotizing ulcerative gingivitis
Common in teens and young adults
Red and swollen and interdental papillae are blunted
Plaque can cause this
Marginal gingivitis
Thickened white patch, persistent painless in oral mucosa, undersurface of the tongue.
Benign reactive process
Leukoplakia
Small red spots caused by blood that escapes from capillaries into the tissues
Caused by accidentally biting the cheek
Petechiae
Early sign of measles (rubeola).
White specks like grains of salt
Appear on buccal mucosa near 1st and 2nd molar
Koplik’s spots
Normal sebaceous glands that appear as small yellowish spots in the buccal mucosa or on the lips
Fordyce spots (fordyce granules)
Midline bony growth in the hard palate common in adults
Harmless, size and lobulation vary
Torus palatinus
Deep purple color with low grade vascular tumor assoc. with HV 8
Raised or flat
Kaposi’s sarcoma in aids
Yeast infection from candida species.
Thick white plaques in the mouth
Due to prolonged tx w/ antibiotics or corticosteroids and AIDS
Thrush on the palate
Acute infection caused by corynebacterium rare but impt
Throat is dull, red and gray exudate present on uvula, pharynx and tongue
Diphtheria
Red throat has white exudate on the tonsils
With fever and and enlarged cervical nodes
By gr A strepto infection
Exudative tonsilitis
Normal tonsils large but not infected esp in children
Protrude medially beyond pillars and even to midline
Color is pink
Large normal tonsils
Affects lower lip
Appear as scaly plaque, an ulcer with or without crust
Caused by Prolonged exposure to sun
Carcinoma of the lip
May resemble a carcinoma or crusted cold sore
Ulcerated papule w/indurated edge
From treponema pallidum
Painless, npnsuppurative and heal in 3-6 weeks
Chancre of primary syphilis
Small pgmented brown spots in dermal layer of lips, buccal mucosa
Autosomal dominant syndrome
Peutz-jeghers syndrome
Mutiple small red spots on the lips
Autosomal dominant endothelial disorder causing vascular fragility and AVMs
Nosebleed, GIT bleeding iron deficiency anemia are common
Hereditary hemorrhagic telangiectasia (osler weber rendu syndrome)
Localized subcutaneous or submucosal swelling caused by leakage of intravascular fluid into interstitial space
Benign and resolve within 24-48 hours
Angioedema
Recurrent and painful vesicular eruptions of lips and surrounding skin
Presence of small cluster of vesicles
Herpes simplex (cold sore, fever blister)
Excessive exposure to sunlight And affects primarily lower lip
Lips lose its redness and become scaly, thickened and slightly everted
Actinic cheilitis
Softening of skin at the angles of mouth followed by fissuring
Due to nutritional def or overclosure of the mouth
Angular cheilitis
Painful hemorrhage vesicles in tympanic membrane, ear canal or both
Earache, blood tinged discharge and conductive hearing loss
Caused by mycoplasma, viral and otitis media
Bullous myringitis
Caused by s. Pneumoniae
Eardrum reddens, loses its landmark and bulges laterally
Conductive hearing loss
Acute otitis media with purulent effusion
Caused by viral upper respiratory infections or sudden change in atmospheric pressure
Eustachian tibe cannot equalize pressure in middle and outside ear
Amber fluid in eardrum
Serous effusion
Large chalky white patch with irregular margins
Depositionof hyaline material within the layer of tympanic membrane
Healed perforation and signs of retracted drum
Tympanosclerosis
Holes in th eardrum from purulent infections of the middle ear.
With central and marginal types.
Perforation of the drum
Features of normal eardrum
Color pinkish gray
Malleus lies behind the upper part of the drum
Above short process lies the pars flaccida
Remainder of the drum is pars tensa
From umbo, bright cone of light
One of th most common symptoms in clinical practice
Headache
Most common type of headache, occurring to 70% of patients
Migraine
Enumerate primary headache
Migraine, cluster, tension, chronic daily headaches
Thunderclap headache reaching maximal intensity over several minutes
Subarachnoid hemorrhage
Preceded by sentinel leak headache from vascular leak into subarachnoid space
Subarachnoid hemorrhage
Most important attributes of headache
Severity and chronological pattern
What type of headache is considered if severe and sudden onset
Subarachnoid hemorrhage or meningitis
Type/s of headache that is/are episodic and tend to peak over several hours
Migraine and tension headache
New and persisting, progressively severe headaches
Tumor, abscess or mass lesion
Unilateral headache can be seen in?
Migraine and cluster headache
Headache arise from temporal areas
Tension headache
Headache Arises from retroorbital area/ behind your eyes
Cluster headache
Symptoms common in migraine
Nausea and vomiting
True or False. Vomiting and nausea are also common in brain tumor and subarachnoid hemorrhage.
True
True or false. Approx 60-70% of patients with cluster headache have a symptom of prodrome prior to onset. (Prodrome: euphoria, craving for food, fatigue, dizziness)
False. Should be migraine
T/F. Genetic inheritance appears to be not present in patients with migraine.
False
Difficulty looking with near/close objects
Hyperopia (farsighted)
Aging vision
Presbyopia
Difficulty in looking far objects
Myopia (nearsighted)
Sudden unilateral visual loss that is painless
Vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment, retinal vein occlusion or central artery occlusion
If painful sudden unilateral visual loss causes are
Cornea and anterior chamber in corneal ulcer, uveitis,traumatic hyphema and acute glaucoma, optic neuritis from MS
Bilateral and painless medication that change refraction
Cholinergic, anticholinergic and steroids
If bilateral and painful that change refraction
Chemical or radiation exposures
Onset of bilateral visual loss gradual?
From cataracts or macualr degeneratio
Presence of slow central loss
Nuclear cataract and macular degeneration
Peripheral loss of vision seen in?
Advanced open angle glaucoma
One sided loss of vision seen in?
Hemianopsia and quandrantic defects
Moving specks or strands in the vision can be seen in?
Vitreous floaters
Called as fixed defects or scotomas have lesion on
Retina or visual pathways
Presence of flashing lights or new vitreous floaters
Detachment of vitreous from retina
Seen in lesions in the brainstem or cerebellum or weakness of EOM
Diplopia
Lesion from palsy of cranial nerve 3 or 6
Horizontal diplopia
Lesion from palsy of CN 3 or 4
Vertical diplopia
Diplopia (double vision) in one eye, with the other closed there is a problem in?
Cornea or lens
Hearing loss may be due to what factors?
Congenital, from single mutations
Hearing impairment that have trouble in understanding speech , often complaining thats others mumble , noisy envts make hearing worse
Sensorineural loss
Hearing impairment that noisy envts may help
Conductive hearing loss
Conductive hearing loss problems in?
External or middle ear
Sensorineural loss problems in?
Inner ear, cochlear nerve
Medications that affect hearing are:
Aminoglycosides, aspirin, NSAIDS, quinine and furosemide
What part of the ear that usually pain occur?
External canal in otitis externa and if respiratory infection in otitis media
Features of acute or chronic otitis media
Presence of unusual soft wax, debris from inflammation, or rash in ear canal
A perceived sound, that has no external stimulus commonly a musical ringing or rushing or roaring noise, in one or both ears
Tinnitus
Common complaints in the ear
Earache
May accompany hearing loss, increasing frequency with age.
Tinnitus
Associated with hearing loss and vertigo seen in
Meniere’s disease
Refers to the Perception that the patient or envt is rotating or spinning
Vertigo
Vertigo problem in what part of the ear?
Labyrinths of the inner ear, peripheral lesions of CN 8 or central pathway lesions
Sensation of true rotational movement of the patient or the surroundings
Vertigo
Condition that you feel to fall or pass out
Presyncope
Condition of feeling unsteady or losing balance
Disequilibrium
Refers to drainage from the nose, and often associated with nasal congestion ( sense of stuffiness or obstruction)
Rhinorrhea
Nasal congestion causes
Viral infections, allergic rhinitis(hay fever) and vasomotor rhinitis
Seasonal onset or envtal triggers
Allergic rhinitis
Excessive use of decongestants or use of cocaine
Drug-induced sinusitis
Drugs that may induce stuffiness
Oral contraceptives, reserpine, guanethidine, alcohol, cocaine
T/F. Acute bacterial sinusitis is unlikely viral URI symptoms persist more than 7 days. Both purulent drainage and facial pain are present
True
Called Bleeding from nasal passages
Epistaxis
Origin of the bleeding nose
Paranasal sinuses or nasopharynx
Local causes of epistaxis
Trauma (nose picking), inflammation, drying
Patient coughed up or vomited blood
Hematemesis and hemoptysis
Medication that can cause epistaxis
NSAIDS, anticoagulants
A frequent complaint,usually associated with acute URI.
Sorethroat or pharyngitis
Most often caused by gingivitis
Bleeding gums
Refers to change in voice quality, described as husky,rough, harsh, lower pitched than usual
Hoarseness
Causes of acute hoarseness
Voice overuse
Acute viral laryngitis
Enlarged lymph nodes commonly accompany what condition
Pharyngitis
Condition that has cold intolerance, preference for warm clothing and many blankets and sweating is decrease
Hypothyroidism
Palpations, heat intolerance, weight loss seen in?
Hyperthyroidism
Fine hair is seen in what condition? How about coarse hair?
Fine- hyperthyroidism
Course- hypothyroidism
Presence of redness and scaling on the scalp
Seborrheic dermatitis, or psoriasis
Excessive facial hair occurs in some women with polycystic ovarian syndrome
Hirsutism
Shining onto the retina causes pupillary constriction in both that eyes
Direct reaction
Shining onto the retina causes pupillary constriction in the opposite eye is called
Consensual reaction
What does vision 20/200 means?
At 20 feet the patient can read the print that a person with normal vision could read at 200 feet.
Remember: the larger the second number, the worse the vision.
What does 20/40 corrected means?
Patient could read the 40 line with glasses
Impaired far vision
Myopia
Measurement for snellen chart
20 inches away
Impaired near vision found in middle aged and older people
Presbyopia
Sees better when the card is farther away
Presbyopia
Legally blind means
When vision in better eye , corrected by eyeglasses is 20/200 or less
Technique for early detection of lesions in anterior and posterior visual pathway
Confrontation testing
Causes of anterior pathway defects
Glaucoma, optic neuropathy, optic neuritis, glioma
Posterior pathway defects causes
Stroke and chiasmak tumors
Patient’s left eye repeatedly does not see your fingers until they have crossed the line of gaze
Left temporal hemianopsia
Temporal defect in visual field of one eye suggest that
Nasal defect in the other
Enalrged blind spot occurs in the ff conditions:
Glaucoma, optic neuritis, and papilledema
Red inflamed lid margins often with crusting
Blepharitis
Yellow sclera indication
Jaundice
Sudden increase in IOP when drainage of aqueous humor is blocked
Acute-narrow angle glaucoma
Common form, with normal spatial relation bet iris and cornea is preserved and iris is fully lit
Open angle glaucoma
A fine rhythmic oscillation of the eyes
Nystagmus
Eyes move from up and down
Lid lag
Paralysis of CN 6 there is
Eyes are conjugate in right lateral gaze but not in left lateral gaze
Lid lag present on what condition
Hyperthyroidism
Abnormal protrusion of the eyeballs seen in hyperthyroidism leading to charact “stare” on frontal gaze
Proptosis
Poor convergence seen in condition?
Hyperthyroidism
Test for convergence
Normal converging eyes may follow objects within 5cm-8cm of the nose
Contraindications of mydriatic drops
Head injury and coma
Any suspicioj of narrow angle glaucoma
Absence of red reflex suggest
Opacity of the lens (cataract)
Measurement of optic disc
1.5mm
Note the features seen in optic disc
- Sharpness or clarity of outline disc. Nasal portion of disc margin is blurred
- Disc color. Yellowish orange
- Size of physiologc cup. Horizontal diamter is less than half the horizontal diamter of the disc.
- Comparativ symmetry
Swelling of optic disc and anterior bulging of physiologic cup
Papilledema
Light rays from distance do not focus on retina
Refractive error
Focus anterior to the retina
Myopia
Focus light rays posterior to it
Hyepropia
Arteries vs veins
Arteries: color red, size is smaller , bright light reflex
Veins: dark red, larger size, inconspicuous or absent light reflex
Important cause of poor central vision in older adults
Macular degeneration
Typ of macular degeneration which is more common but less severe
Dry atrophic
Undigested cell debris, hard and sharply defined
Drusen
Movement of auricle and tragus through tug test is painful seen in
Acute otitis externa
Tenderness behind the ear present in
Otitis media
Nontender nodular swellings covered by normal skin deep in ear canals called
Exostoses
Nonmalignant overgrowth which may obscure the drum
Exostoses
Canal is often swolen, narrowed, moist, pale and tender, redness
Acute otitis externa
Skin of canal is thickened, red,itchy
Chronic otitis externa
Feature of retracted drum
Unusual prominent short process and handles that looks more horizontal
Higher frequency hearing loss, miss consonants
Presbyopia
Sound is heard (lateralized to) the impaired ear.
Unilateral conductive hearing loss
Sound is heard in good ear
Unilateral sensorineural hearing loss
Tenderness of nasal tip or alae
Furuncle
Mucosa is reddened and swollen
Viral rhinitis
Pale, bluish, red mucosa
Allergic rhinitis
Pale saclike growths of inflamed tissue that can obstruct air passges or sinuses
Nasal polyps
Local tenderness with symptoms such as pain, fever and nasal discharge
Acute sinusitis
Acute sinusitis involves what parts of the sinuses
Frontal or maxillary sinuses
If there is CN 10 paralysis, what happens?
Soft palate fails to rise, uvula deviates to opposite side
Tonsillar node that pulsates
Carotid artery
Small, hard, tender tonsillar node high and deep and bet mandible and SCM is
Styloid process
Tender nodes:
Hard or fixed nodes:
Inflammation
Malignany
Seen in HIV and AIDS
Generalized lymphadenopathy
Cause hoarseness, shortness of breath, stridor, or dysphagia
Retrosternal goiter
Afferent pupillary defect and most common pupillary abnormality
Marcus Gunn pupil
Pupils contrict normally by what measurement
3mm to 2mm
AV ratio
2:4
Originating from neuronal dysfunction, possibly brainstem origin with low serotonin
Migraine
A unilateral or bifrontal location of pain in primary headache
Migraine
Usually bilateral in location of pain headache
Tension headache
Unilateral usually behind the eyes or temple
Cluster
Throbbing or aching varying severity is found in
Migraine
Deep, continuous and severe quality of headache
Cluster
Steady, pressing or tightening, nonthrobbing headache
Tension
Onset of headache is abruptly
Cluster
Onset of headache is gradual
Tension
Onset of headache is fairly rapid
Migraine
Mucosal inflammation of paranasal sinuses
Headache from sinusitis
Bleeding, most often from a ruptured intracranial aneurysm
Subarachnoid hemorrhage
Very severe, the worst of my life
Subarachnoid hemorrhage
Steady or throbbing:
Aching or throbbing:
Meningitis
Headache from sinusitis
Leakage of blood outside of the vessels producing homogenous sharply demarcated red area
Subconjunctival hemorrhage
Diffuse dilatation of conjunctival vessels with redness that tends to be maximal peripherally
Conjunctivitis
Can produce watery, mucoid, has clear cornea mild discomfort rather than pain, highly contagious, bacterial or viral infections
Conjunctivitis
Increased cortisol production with round or moon face red cheeks
Cushing’s syndrome
Face is edmatous and often pale. Swelling around the eyes and in the morning
Nephrotic syndrome
Severe hypothyroidism with dull, puffy facies. Eyebrows dry and course. Edema around the eyes
Myxedema
Swelling in anterior to the ear lobes and above the angles of jaw, seen in mumps
Parotid gland enlargement
Increased in growth hormone enlargement of both bone and soft tissues.
Acromegaly
Decreased facial mobility blunts expression. Mask like face.
Parkinson’s disease.
Occlusion of branch of central retinal artery
Horizontal defect of visual field
Produces unilateral blindness, lesion on optic nerve.
Blind right eye (right optic nerve)
Lesion on optic chiasm, only fibers crossing over the opposite side. Visual loss involves temporal half of each field. Fibers originate in nasal half.
Bitemporal heminanopsia (optic chiasm)
Lesion of optic tract, interrupts fibers originating from same side of both eyes,
Left homonymous hemianopsia (right optic tract)
Partial lesion of optic radiation in temporal lobe
Homonymous, left superior quadrantic defect (right optic radiation, partial)
Complete interruption of fibers in optic radiation
Left homonymous hemianopsia (right optic radiation)
Drooping of upper eyelid
Ptosis
Damage to sympa nerv supply
Horner’s syndrome
More common in elderly, inward turning of the lid margin
Entropion
Outward turning of the lid margin exposing palpebral conjunctiva , more common in elderly. Can lead to eye no longer drains well and tearing occurs.
Ectropion
Wide eyed stare
Lid retraction
Protrusion of eyeballs, common feature of grave’s disease
Exophthalmos
Harmless, yellowish triangular nodule in bulbar conjunctiva, appears with aging.
Pinguecula
Ocular inflammation of episcleral vessels. Show redness and dilated vessels
Episcleritis
Painful, tender, red infection in margin of eyelid
Sty
Subacute nontender, painless nodule with blocked meibomian glands
Chalazion
Slightly rwised, yellowish, well cicumscribed plaques along nasal portions . May accompany lipd disorders
Xanthelasma
Swelling between lower eyelid and nose. Acut is painful, red and tender. Chronic is obstructiojn of nasolacrimal duct. Tearing prominent
Inflammation of lacrimal sac ( dacryocystitis)
Thin grayish white arc, or circle, accompany normal aging. Hyperlipoproteinemia in young people.
Corneal arcus
Golden to red brown ring, shading to hreen or blue from copper deposition in periphery of cornea found in wilson’s disease
Kayser-fleischer ring
Superficial grayish white opacity in the cornea. Secondary to old injury, or inflammation
Corneal scar
Triangular thickening of bulbar conjunctiva grows slowly across outer surface of cornea
Pterygium
Opacities of the lens visible through the pupil. Old age, smoking. Etc.
Cataract
Looks gray when seen by flashlight. Pupil is dilated widely, gray opacity is see
Nuclear cataract
Produces spokelike shadows that point gray against black seen with flashlight
Peripheral cataract
When anisocoria (unequal pupils) is greater in bright light than dim light, larger pupil cannot constrict. Caused by what?
Blunt trauma to the eye, open angle glaucoma and impaired parasympa nerve supply
When anisocoria is greater in dim light, smaller pupil cannot dilate properly. What condition?
Horner’s syndrome, interruption of sypmpa nerve supply
Pupil is large, regular, and unilateral. Light reaction is reduced severly, slowed or absent,
Tonic pupils (adie’s pupil)
Dilated pupil is fixed to light and near effort. Ptosis of upper eyelid and lateral deviation are present.
CN 3 paralysis
Affected pupil, reacts briskly to light and newr effort. Presence of lighter color of iris
Horner’s syndrome
Small, irregular pupils that accommodate but do not react to light
Argyll robertson pupils
T/F. Unilateral blindness does cause anisocoria
False
Normal variations of optic disc
Rings and crescent are seen Medullated nerve fibers much less common Physiologic cup small whitish depression, at central or temporal. Disc vessels are tiny Sharp disc margins
Death of optic nerve fibers leads to loss of tiny disc vessels
Optic atrophy
Arteries are full and tortuous, incr light reflex
Copper wiring
Portion of narrowed artery has opaque wall, no visible wall
Silver wiring
Arteries are focal or generalized narrowing. Light reflex is narrowed. Arterial wall thickens and less transparent,
Hypertensive retinal artery
Normal retinal artery has:
Arterial wall is transparent.
Column of blood can be seen
Light reflex is narrow about 1/4 the diameter of blood column
Marked AV crossing changes. Copper wiring of arterioles is present.
Hyeprtensive retinopathy
Fundus of light skinned and dark skinned?
Light: brunette color is redder
Dark: grayish brown, almost purplish
Deposit of uric acid crystals in helix, or antihelix
Tophi
Firm nodular hypertrophic mass of scar tissue extending beyond the are of injury
Keloid
Formely known as sebaceous cyst , dome shaped lump in dermis
Cutaneous cyst
Small lumps on helix, or anti helix
Rheumatoid nodules
Raised nodules show lustrous surface and telangectatic vessels
Basal cell carcinoma
Chronic inflammatory lesion, painful, tender, papule on helix, antihelix
Chondrodermatitis helicis
Eroded by chemical reaction. Part is enamel from lingual surfaces of upper incisors exposing yellow brown dentin
Erosion of teeth
Biting surface of teeth caused by rrecurrent trauma as holding nails. Sides of teeth show normal contours. Size and shape of teeth unaffected,
Abrasion of teeth with notching
Dorsum, scattered smooth red areas denuded of papillae. Maplike pattern
Geographic tongue
Yellowish to brown and black elongated papillae on tongue’s dorsum
Hairy tongue
Appear with increasing age, sometims called scrotal tongue. Food debris accumulate in crevices and be irritating
Fissured tongue
Smooth and often sore tongue lost its papillae due to deficiency of nutrients or vitamins.
Smooth tongue (atrophic glossitis)
Thick white coating. Can be scraped off. From candida infections
Candidiasis
Whitish raised areas with feathery, corrugated pattern, often affect sides of tongue. Can be scraped off.
Hairy leukoplakia
Small purplish, or blue black round swellings under the tongue with age
Varicose veins
Painful, round or oval ulcer with whit or yellowish gray and surrounded by halo of reddened mucosa
Aphtous ulcer (canker sore)
Painlss lesion, highly infectious of secondary syphilis. Slightly raised, oval and covered by grayish membrane.
Mucous patch of syphilis
Rounded bony growths on inner surface of mandibles, are bilateral, asymptomatic and harmless
Tori mandibulares
