HEAD AND NECK Flashcards
Classification fo headache where there’s no identified underlying disease.
Primary Headache
Examples of Primary Headache
Migraine, tension, cluster, chronic daily headache
Classification of headache where there is identified underlying disease from structural, systenic, infectious causes.
Life threatening causes: meningitis, subarachnoid hemorrhage, mass lesion
Secondary Headache
A perceived musical ringing or rushing sound that has no external stimuli.
tinnitus
A red, painless eye is seen in which condition?
subconjunctival hemorrhage
This refers to bleeding from the nasal passages
epistaxis
The following are headache warning signs except
progressively frequent over 3 weeks
Hyperopia – ?
Presbyopia – ?
Hyperopia – farsightedness
• Presbyopia – aging vision
Valsalva and leaning forward – ?
• Valsalva and lying down – ?
Valsalva and leaning forward – increase pain in sinusitis
• Valsalva and lying down – increase pain mass lesion
Bilateral and painless loss of vision-
Bilateral and painful loss of vision -
Bilateral and painless loss of vision- Giant-cell arteritis
Bilateral and painful loss of vision- Chemical or radiation exposures
Severe and Sudden onset like a “thunderclap”
Subarachnoid Hemorrhage; meningitis
Episodic and peak over several hours headache?
Migraine and tension headaches
New, persisting and progressively severe headache
Tumor/mass lesion, brain abscess
Unilateral headache?
Migraine and cluster headaches
Headache according to Location?
• Temporal area –
• Retro-orbital –
Temporal area – Tension headache
• Retro-orbital – cluster headache
Prodrome of euphoria, craving of food, fatigue or dizziness?
Migraine headache
Visual aura of migraine headache
• Spark photopsias –
• Fortifications –
• Scotomas –
Visual aura of migraine headache
• Spark photopsias – flashes of light
• Fortifications – zig-zag arcs of light
• Scotomas – areas of visual loss with surrounding normal vision
Unilateral and painless visual loss associated disease
- Vitreous hemorrhage – Diabetes Mellitus or Trauma
- Macular degeneration
- Retinal detachment
- Retinal vein occlusion
- Central retinal artery occlusion
Painful visual loss associated disease
- Corneal ulcer
- Uveitis
- Traumatic hyphema
- Acute angle closure glaucoma
- Optic neuritis
Gradual bilateral vision loss
- Cataracts
* Macular degeneration
Location of visual loss?
• Central loss
• Peripheral loss
• One-sided loss
Central loss
• Nuclear cataract
• Macular degeneration
Peripheral loss
• Open-angle glaucoma
One-sided loss
• Hemianopsia
• Quadrant anopsia
Moving specs or strand in the visions
Fixed
•Are there flashing lights in the field of vision?
Moving specs or strand
- Vitreous floaters
Fixed
• Lesion in the retina or visual pathways.
Are there flashing lights in the field of vision?
•Flashing lights with new vitreous floaters.
•Detachment of vitreous body from the retina.
Red eye with gritty sensation
Viral conjuctivitis
Red painful eye includes
- Hyphema
- episcleritis
- acute angle closure glaucoma
- herpes/fungal keratitis
- foreign body
- saecoid uveitis
Lesion in the brainstem, cerebellum, CN III/VI palsy
Horizontal Diplopia
CN II or IV palsy
Vertical Diplopia
Problem of the cornea or lens
Diplopia in one eye with the other closed
Diseases associated:
- Sensorineural hearing loss
- Conductive hearing loss
Sensorineural hearing loss • Inner ear • Cochlear nerve • Trouble understanding speech • Complain that others mumble • Noisy environment make hearing worse
Conductive hearing loss
• Problems in the external and middle ear.
• Noisy environment may help hearing become better.
Medications associated symptoms of earache or vertig
- Aminoglycosides
- Aspirin
- NSAID’s
- Quinine
- Furosemide
- Inflammation of the external ear canal
- Infection of the middle ear
- *yellow-green discharge
- Otitis Externa
- Otitis Media
- Acute otitis externa and acute or chronic otitis media with perforation usually
When associated with hearing loss and vertigo.
Ménière disease
Vestibular disease due to peripheral causes in the inner ear
- Benign positional vertigo
- Labyrinthitis
- Vestibular neuritis
- Ménière disease.
Central Neurologic Cause of Vertigo
- Cerebellum or Brainstem
• Ataxia
• Diplopia
• Dysarthria
Detects lesions in the anterior and posterior visual pathway.
• Two tests to achieve the best results:
- static finger wiggle test
* kinetic red target test.
Which test will you perform in assessing for visual fields by confrontation?
static finger wiggle test
A difference in pupillary diameter of 0.4 mm or greater is called
anisocoria
Which of the following examinations will you perform to assess for visual field defects?
Static finger wingle test
Anterior pathway defects of Visual Fields by Confrontation
- Glaucoma
- Optic neuropathy
- Optic neuritis
- Glioma
Posterior pathway defects of Visual Fields by Confrontation
- Stroke
* Chiasmal tumors
Occlusion of a branch of the central retinal artery may cause a horizontal (altitudinal) defect. Ischemia of the optic nerve can produce a similar defect.
Horizontal Defect
A lesion of the optic nerve, and of the eye itself, produces unilateral monocular blindness.
Blind Right Eye (RIght Optic Nerve)
A lesion at the optic chiasm (such as pituitary tumor), may involve only fibers crossing over to the opposite side. SInce these fibers originate in the nasal half of each retina, visual loss involves the temporal half of each field.
Bitemporal Hemianopsia (Optic Chiasm)
A lesion of the optic tractm interrupts fibers originating on the same side of both eyes. Visual loss in the eyes is, therefore, similar and involves half of each field (hemianopsia).
Left Homonymous Hemiaopsia (Right Optic Tract)
A partial lesion of the optic radiation in the temporal lobe, may involve only a portion of the nerve fibers, producing, for example, a homonymous quadrantic (pie in the sky) defect.
Homonymous left Superior Quadrantic Defect (Right Optic Radiation, Partial)
A complete interruption of fibers in the optic radiation, produces a visual defect similar to that produced by a lesion of the optic tract.
Left Homonymous Hemianopsia (RIght Optic Radiation)
Visual Fields by Confrontation Diseases
• Enlarged blind spot
•Occurs in conditions affecting the optic nerve
- Glaucoma
- Optic neuritis
- Papilledema
Inward deviation of position and alignment of the eyes
Esotropia
- Outward deviation
* Seen in Graves disease or ocular tumors
Exotropia
•Upslanting palpebral fissures of the eyelids
Down syndrome
Red inflamed lid margins occur in
blepharitis
