H&P Midterm HEENT Flashcards
What are the 10 cranial nerves
1 olfactory
2 optic
3 oculomotor
4 trochlear
5 trigeminal
6 abducens
7 facial
8 vestibulochochlear
9 glossopharyngeal
10 vagus
11 spinal accessory
12 hypoglossal
What do I inspect and palpate on the head
Hair
skull/scalp
face
skin
what are the 5 areas of importance when gathering hx about visual distrubances
location (uni/bilateral, central, peripheral, entire field)
quality (painful/painless)
timing (sudden/gradual)
setting (worse up close or far away, do they wear glasses)
assoc sx (specks/floaters/fixed or moving ect)
meibomian glands
sebaceous gland at the rim of the eyelid
palpable fissure
opening between eyelids
dacryoadenitis
inflammation of the lacrimal gland
cornea
transparent protective outer later of the eye that covers the iris, pupil, and anterior chamber.
sensitive to touch, temp, and chemicals
provides the most optical power to the eye
what provides the most optical power to the eye
the cornea
what is the only part of the human body that has no blood supply
the cornea
what do you inspect the cornea for
opacities, abrasions or copper deposition (copper band around outside of eye).
iris
thin pigmented muscular curtain. perforated centrally to make the pupil. normally fairly flat.
How do I check for glaucoma?
Light shown from temporal side. Normal is no shadow in the iris.
+, shadow appears on iris, forming a crescent shape in the iris. See slide 17.
sclera
white outer layer of connective tissue covered by conjunctiva.
Conjunctiva (two types)
a clear thin transparent membrane that covers the outer surface of the eye (bulbar conjunctiva) and lines the inside of the eyelid (palpebral conjunctiva.
What do you inspect the pupils for? what cranial nerve relates to this?
pupillary size changes in response to:
light
focus on near/far object
medications
CN 2 and 3
what is normal pupil size
3-5mm
What does PERRL(A) stand for?
Pupils Equal Round and Reactive to Light (and Accommodation)
What is anisocoria?
Pupillary size inequality
benign is pupillary reactions are normal and/or inequality is <.5mm
how do you inspect pupillary reaction to light
shine a bright light obliquely into one pupil
normal reaction = light will cause both pupils to contstrict
CN 3
do eyes dilate or constrict when focusing near / far away
dilate = far away
constrict = near
How do I check eye alignment?
Shine light straight onto pt’s eye from 2 ft away. Light should appear in the center of their pupil.
Abnormal = esotropia
describe extra ocular muscle examination technique. what CN is this?
ask pt to follow your finger in all 6 directions of gaze
CN 3, 4, 6.
which eye muscles go with which cranial nerve
LR6 SO4 R3
lateral rectus = 6 (lateral movement)
superior oblique = 4 (down and out)
rest = 3 (everything else)
What is proptosis? what indicates proptosis?
Protrusion of eyeball. a positive lid lag assessment indicates proptosis (when the eyelid does not move with the eye)
What is a Snellen chart?
Visual acuity chart with the letters. Handheld is 14 inches away, normal is 20 ft away.
Why is visual acuity written with 2 numbers?
First # is how far the chart is
Second # is how far a normal eye can read that line.
20/30 means chart is 20 ft away. A normal eye can read the letters from 30 ft away still.
the larger the second number the worse the vision
Minimum VA for DL is 20/40.
What are the abnormalities for Visual acuity called?
Myopia = impaired far vision
Hyperopia = impaired near vision
Presbyopia = loss of focus (old eyes)
Legal blindness = 20/200 or worse.
How do I document each eye’s Visual acuity?
OD = right
OS = left
OU = both
binocular vs monocular vision
binocular = the overlap of visual fields when using two eyes
monocular = he lateral vision that one eye sees but the other cannot
What are some visual field defects?
Horizontal defect (loss of one eye’s lower half)
Blind R eye
Bitemporal hemianopsia (loss of lateral visual field, optic chiasm lesion)
L homonymous hemianopsia (loss of both left visual fields, R optic tract lesion)
Homonymous L superior quadrantic defect
Honestly its easier just to look at slide 37 and just draw this out.
What is refraction adjustment for?
Hyperopia is corrected via clockwise rotation, ^ focal power, focal point towards yourself.
Myopia is corrected via counterclockwise rotation, decrease focal power, focal point away from yourself.
How do I adjust aperture?
Dilated eyes need big apertures.
Normal eyes need small apertures.
What kind of glow should I see in a fundoscopic exam?
Red/orange reflex.
Lack of red/orange reflex suggests cataracts, corneal scarring, vitreous hemorrhage, or retinoblastoma.
What does the optic disk look like in a fundoscopic exam?
Round yellowish-orange circle. Follow blood vessels towards nose if not visible.
What can systemic HTN lead to in the retina?
Focal narrowing of retinal arteries
AV nicking (vein disappears under artery)
Increased light reflex of retinal arteries (copper wire appearance)
What does uncontrolled DM appear as in the retina?
retinopathy which appears as cotton wool spots and retinal hemmorhages.
label the pink spots
k
What are some ear abnormalities?
Otitis media (purulent fluid in middle ear)
Retraction of TM (problems with the eustachian tube)
what is the treatment for recurrent otitis media
tympanostomy tubes
What are te tests for auditory acuity and what CN do they relate to
whisper test
Weber test
Rinne Test
CN 8
describe normal and abnormal hearing tests from the weber test
normal: hear ringing in both ears
abnormal (conductive hearing loss) - sound is lateralized to defective ear
abnormal (sensorineural) - sound is lateralized to the good ear
what does the rinne test compare
what are the possible normal/abnormal outcomes
air v bone conduction.
normal hearing and sensorineural hearing loss = AC>BC
conductive hearing loss = BC>AC
What are the two types of hearing loss?
Conductive (air - results from problems in external or middle ear, preventing sound waves to reach inner ear)
Sensorineural (bone - results in problems from inner ear preventing sound waves from being properly processed)
What is the whisper test?
Whisper at least a two syllable word behind a patient, have them cover one ear.
What does the Weber test test for?
Lateralization of bone conduction. Should hear equally.
Requires a 512 Hz tuning fork on top of head.
What does the Rinne test test for?
Comparing air to bone conduction.
512 Hz tuning fork to mastoid. Once pt can’t hear, bring the fork near their ear.
Normal is hearing the vibration near the air canal even after bone conduction is gone.
What are stenson’s ducts?
Each parotid duct that opens onto the buccal mucosa.
what are the CN for the pharynx
CN IX, X
tonsils are characterized by using what size chart
using a 1-4+ scale with 4+ being touching/kissing tonsils.
How do I know if I’m on a lymph node?
Lymph nodes should be rollable in 2 directions.
Up, down, side to side.
What am I looking for in anterior neck inspections?
Upward movement of thyroid and contour/symmetry when swallowing.
