General diagnosis - HEENT exam Flashcards
Acute Glaucoma
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.
Adie’s pupil, tonic or bored housewife’s pupil
Neurologist referral
one pupil is dilated and reacts poorly to light
benign condition mainly affects young women
Argyll Robertson pupil or prostitute’s pupil
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
Blepharitis
Dermatologist referral
swollen itching tender eyelids
inflammation of the eyelids
may be d/t: staphylococcal infection, allergy or seborrhea
cavernous sinus thrombosis
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
chalazion
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
Chronic glaucoma
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
conjunctivitis
PCP referral
itching, pain, tearing, red eye with discharge
infection of conjunctiva
MC viral but can be bacterial (gonococcal in neonates)
Diabetic retinopathy
ophthalmologist
blurred vision
damage to retinal in poorly controlled diabetes mellitus
- microaneurysms (dots), flame hemorrhages in the retina
Ectropion
plastic surgeon referral
external sagging of the lower eyelid
old age
Entropion
ophthalmologist referral
painful eye with interned lower eye lid
may be congenital or acquired after scarring d/t trachomatis
Eustachian tube blockage
ENT specialist referral if chiro care unsuccessful
- decreased hearing with retracted tympanic membrane
- blocked Eustachian tube may follow URI
Hordeolum
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)
Horner’s syndrome
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
Iritis
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
Macular degeneration
ophthalmologist referral
central loss of vision (macula/lat tooptic disc: blurred and may be pigmented)
age-related
Meniere’s diease
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)
Myashenia gravis
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 +
Otitis externa
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
Peritonsillar abcess
ENT specialist referral
fever, severe sore throat, unilateral swollen pharyngeal tonsil hot potato voice
- abscess related to severe tonsillitis
Otitis media
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
Pinguecula
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.
Pterygium
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
Seborrheic dermatitis
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)
AC twice as long as BC
Normal
AC/BC are both decrease in one ear
Nerve conduction deafness
BC>AC with Rinne test
Serous Otitis Media
BL dilated pupils
Cocaine, barbiturate or amphetamin abuse
BL pinpoint pupils
Heroin use
BL swollen optic discs (papilledema)
Raised intracranial pressure, brain tumor
blue sclera in infant with many fracutres
osteogenesis imperfect
blurred margins of the macula or pigmentation
macular degeneration
copper or silver wiring of the retinal arterioles
hypertensive retinopathy
cupped optic disc
chronic glaucoa
enlarged tongue (macroglossia)
hypothyroidism in infants
exophthalmos
hyperthyroidism or orbital tumor
flame hemorrhages and dots (mirco-aneurysms)
diabetic retinopathy
foul purulent unilateral nasal discharge
sinusitis or foreign body in nose
goiter with brittle dry coarse hair
myxedema (hypothyroidism)
goiter with exophthalmos or tachycardia
Graves’ disease
gray ring around cornea (arcus snilis)
hyperlipidemia
hears better in one ear with Weber test
problem with one of the ears
large head in child with open fontanelles
hydrocephalus
lid lag
hyperthyroidism
loss of red pupil light reflex
Cataract or neuroblastormam loss of outer third of eyebrow
loss of outer third of eyebrow
hypothyroidism or leprosy
midline neck mass moves with tounge
thyroglossal cyst
midline bony mass in the hard palate
torus palatinus
Mucopurulent discharge from ear
otitis media
nasal septum perforation
Cocaine abuse
pale conjunctiva
anemia
periorbital edema
cellulitis, cavernous sinus thrombosis
painful boil on the margin of the eyelid
external stye (hordeolum)
painful red eye with purulent discharge
conjunctivitis
painful eye with circumcorneal redness
iritis
painful red eye with tense eyeball
acute glauoma
painless boil on the inside of an eyelid
internal stye (chalazion)
pain on pulling the ear up and backwards
otitis extena
pale swollen bluish nasal mucosae
chronic allergies
Ptosis: BL
myasthenia gravis, lambert eaton syndrome
Ptosis: unliateral
Horner;s syndrome
puffy eyelids especially in the morning
renal dysfuction
pupil accommodates bud does not react to light
Argyll Robertson pupil (tertiary syphilis)
pupil is dilated and react poorly to light
Adie’s pupil
pupil is small and constricted (miosis)
Horner’s syndrome
Redd bulging tympanic membrane
otitis media
retracted tympanic membrane
Eustachian tube blockage
scale on eyebrows
seborrheic dermatitis
swollen itching eyelids
blepharitis
tophus on helix of the ear
chronic gout
tongue-beef red color
vitamin B12 deficiency
Tongue-magenta color
Riboflavin deficiency
Tongue-pale
Iron deficiency
Triangular fleshy growth in medial side of sclera
Pterygium
Turned in or out lower eyelids
entropion or ectropion
unilateral swollen tonsil with severe sore throat
Peritonsillar absess
yellow thickening of the bulbar conjunctiva
pingecula
vertigo with hearing loss and tinnitus
meniere’s disease
xerophthalmia
vitamin a deficiency
yellow sclera
jaundice (icterus) or carotenemia
yellow plaque in upper medial eyelid
xanthelesma (hyperlipidema)
