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Boards 2 chiroessentials (1) > General diagnosis - HEENT exam > Flashcards

General diagnosis - HEENT exam Flashcards

1
Q

Acute Glaucoma

A

Urgent referral
Painful red eye, hard eyeball, hazy vision (early on)
Sudden increase in IOP with narrow angle b/w iris and cornea which obstructs aqueou humor into the canal of Schlemm.

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2
Q

Adie’s pupil, tonic or bored housewife’s pupil

A

Neurologist referral
one pupil is dilated and reacts poorly to light
benign condition mainly affects young women

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3
Q

Argyll Robertson pupil or prostitute’s pupil

A

Neurologist referral
one pupil small, react poorly to light (will retract to accommodation), VDRL will be +
Seen in tertiary syphilis, MS, SLE and diabetes mellitus

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4
Q

Blepharitis

A

Dermatologist referral
swollen itching tender eyelids
inflammation of the eyelids
may be d/t: staphylococcal infection, allergy or seborrhea

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5
Q

cavernous sinus thrombosis

A

Urgently refer to hospital for antibiotics
swollen eyelids (periorbital edema), diplopia d/t damage to CN 3, 4 or 6 (which pass through the cavernous sinus)
clot formation in cavernous sinus in the brain following spread of infection from the face

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6
Q

chalazion

A

ophthalmologist referral
painless swelling on inside of the eyelid (can become infected and painful)
benign granulomatous lesion in the tarsal (meibomian) gland of the eyelid

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7
Q

Chronic glaucoma

A

ophthalmologist referral
gradual loss of vision (periphery causing tunnel vision)
- gradual increase of IOP d/t excessive production of aqueous humor or obstruction of the canal of Schlemm
- associate with increase cupping of optic disc d/t raised IOP

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8
Q

conjunctivitis

A

PCP referral
itching, pain, tearing, red eye with discharge
infection of conjunctiva
MC viral but can be bacterial (gonococcal in neonates)

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9
Q

Diabetic retinopathy

A

ophthalmologist
blurred vision
damage to retinal in poorly controlled diabetes mellitus
- microaneurysms (dots), flame hemorrhages in the retina

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10
Q

Ectropion

A

plastic surgeon referral
external sagging of the lower eyelid
old age

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11
Q

Entropion

A

ophthalmologist referral
painful eye with interned lower eye lid
may be congenital or acquired after scarring d/t trachomatis

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12
Q

Eustachian tube blockage

A

ENT specialist referral if chiro care unsuccessful

  • decreased hearing with retracted tympanic membrane
  • blocked Eustachian tube may follow URI
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13
Q

Hordeolum

A

PCP referral (ophthalmic antibiotic may be needed)
Red painful swelling on the margin of the eyelid
infected hair follicle of an eyelash (staphylococcal in nature)

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14
Q

Horner’s syndrome

A

Neurologist
unilateral ptosis, miosis and anhydrosis
- damage to sympathetic chain or ganglia in the neck
- associated with Pancost tumor, carotid artery dissection or brain stem ischemia

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15
Q

Iritis

A

ophthalmologist referral
painful gritty feeling with redness mainly around the iris (circumcorneal)
inflammation of the iris
associated with SLE, ulcerative colitis, Crohn’s disease or sarcodosis

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16
Q

Macular degeneration

A

ophthalmologist referral
central loss of vision (macula/lat tooptic disc: blurred and may be pigmented)
age-related

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17
Q

Meniere’s diease

A

ENT specialist referral if dietary changes and chiropractic care are unsuccessful

  • pts become progressively deaf
  • syndrome has recurring attacks of vertigo, tinnitus and hearing loss (idiopathic)
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18
Q

Myashenia gravis

A

Co-manage with neurologist

  • bilateral ptosis, diplopia that worsens as the day progresses
  • autoimmune disorder d/t antibodies to acetylocholine r/c at the neuro-muscular junction
  • Tensilon (edrophonium) test will be +
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19
Q

Otitis externa

A

ENT specialist referral
ear pain (worse with traction), swollen ear canal with discharge
- inflammation of the eternal auditory cana; bacterial or fungal in origin or allergic in nature
- chronic otits externa may be related to ear wax impaction

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20
Q

Peritonsillar abcess

A

ENT specialist referral
fever, severe sore throat, unilateral swollen pharyngeal tonsil hot potato voice
- abscess related to severe tonsillitis

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21
Q

Otitis media

A

ENT specialist if chiro care unsuccessful

  • ear pain mild hearing loss, may have slight fever, loss of appetite, tympanic membrane is red and bulging
  • inflammation of the middle ear
  • viral or bacterial (MC in kids: hemophilus influenza)
  • common in kid b/c straight Eustachian tubes
  • Weber’s test: lateralize to the affected side
  • Rinne test: may show bone conduction > air conduction in the affected ear
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22
Q

Pinguecula

A

reassure pts
does not grow on the cornea
yellow triangular thickening of the bulbar conjunctiva on the inner and outer margins of the cornea. The base points toward the corners of the eye.

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23
Q

Pterygium

A

ophthalmologist referral if pterygium starts to encroach on the cornea

  • triangular thickening of the bulbar conjunctiva extending from the medial corned of the eye towards the cornea with the apex pointing towards the corners of the eye (can encroach on the cornea).
  • related to chronic irritation and hot climates
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24
Q

Seborrheic dermatitis

A

dermatologist referral if treatment with a shampoo (selenium sulfide) is not helpful

  • dandruff, scaly itching eyebrows and eyelids
  • inflammation of skin with a high concentration of sebaceous glands
  • idiopathic or Pityrosporum ovale (fungal skin organism)
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25
Q

AC twice as long as BC

A

Normal

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26
Q

AC/BC are both decrease in one ear

A

Nerve conduction deafness

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27
Q

BC>AC with Rinne test

A

Serous Otitis Media

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28
Q

BL dilated pupils

A

Cocaine, barbiturate or amphetamin abuse

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29
Q

BL pinpoint pupils

A

Heroin use

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30
Q

BL swollen optic discs (papilledema)

A

Raised intracranial pressure, brain tumor

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31
Q

blue sclera in infant with many fracutres

A

osteogenesis imperfect

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32
Q

blurred margins of the macula or pigmentation

A

macular degeneration

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33
Q

copper or silver wiring of the retinal arterioles

A

hypertensive retinopathy

34
Q

cupped optic disc

A

chronic glaucoa

35
Q

enlarged tongue (macroglossia)

A

hypothyroidism in infants

36
Q

exophthalmos

A

hyperthyroidism or orbital tumor

37
Q

flame hemorrhages and dots (mirco-aneurysms)

A

diabetic retinopathy

38
Q

foul purulent unilateral nasal discharge

A

sinusitis or foreign body in nose

39
Q

goiter with brittle dry coarse hair

A

myxedema (hypothyroidism)

40
Q

goiter with exophthalmos or tachycardia

A

Graves’ disease

41
Q

gray ring around cornea (arcus snilis)

A

hyperlipidemia

42
Q

hears better in one ear with Weber test

A

problem with one of the ears

43
Q

large head in child with open fontanelles

A

hydrocephalus

44
Q

lid lag

A

hyperthyroidism

45
Q

loss of red pupil light reflex

A

Cataract or neuroblastormam loss of outer third of eyebrow

46
Q

loss of outer third of eyebrow

A

hypothyroidism or leprosy

47
Q

midline neck mass moves with tounge

A

thyroglossal cyst

48
Q

midline bony mass in the hard palate

A

torus palatinus

49
Q

Mucopurulent discharge from ear

A

otitis media

50
Q

nasal septum perforation

A

Cocaine abuse

51
Q

pale conjunctiva

A

anemia

52
Q

periorbital edema

A

cellulitis, cavernous sinus thrombosis

53
Q

painful boil on the margin of the eyelid

A

external stye (hordeolum)

54
Q

painful red eye with purulent discharge

A

conjunctivitis

55
Q

painful eye with circumcorneal redness

A

iritis

56
Q

painful red eye with tense eyeball

A

acute glauoma

57
Q

painless boil on the inside of an eyelid

A

internal stye (chalazion)

58
Q

pain on pulling the ear up and backwards

A

otitis extena

59
Q

pale swollen bluish nasal mucosae

A

chronic allergies

60
Q

Ptosis: BL

A

myasthenia gravis, lambert eaton syndrome

61
Q

Ptosis: unliateral

A

Horner;s syndrome

62
Q

puffy eyelids especially in the morning

A

renal dysfuction

63
Q

pupil accommodates bud does not react to light

A

Argyll Robertson pupil (tertiary syphilis)

64
Q

pupil is dilated and react poorly to light

A

Adie’s pupil

65
Q

pupil is small and constricted (miosis)

A

Horner’s syndrome

66
Q

Redd bulging tympanic membrane

A

otitis media

67
Q

retracted tympanic membrane

A

Eustachian tube blockage

68
Q

scale on eyebrows

A

seborrheic dermatitis

69
Q

swollen itching eyelids

A

blepharitis

70
Q

tophus on helix of the ear

A

chronic gout

71
Q

tongue-beef red color

A

vitamin B12 deficiency

72
Q

Tongue-magenta color

A

Riboflavin deficiency

73
Q

Tongue-pale

A

Iron deficiency

74
Q

Triangular fleshy growth in medial side of sclera

A

Pterygium

75
Q

Turned in or out lower eyelids

A

entropion or ectropion

76
Q

unilateral swollen tonsil with severe sore throat

A

Peritonsillar absess

77
Q

yellow thickening of the bulbar conjunctiva

A

pingecula

78
Q

vertigo with hearing loss and tinnitus

A

meniere’s disease

79
Q

xerophthalmia

A

vitamin a deficiency

80
Q

yellow sclera

A

jaundice (icterus) or carotenemia

81
Q

yellow plaque in upper medial eyelid

A

xanthelesma (hyperlipidema)

Boards 2 chiroessentials (1) (25 decks)

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