HEENOT Flashcards
Present/past medical Hx to look out for
Eye disorders Ear infections Sinus infections Throat infections Allergies Thyroid disease Cancer
Past surgical Hx to look out for
Head and neck procedures/medication
Cataract correction
Lasik eye correction
Ear tubes
Tonsillectomy
Wisdom teeth removal
Family hx to look out for
Thyroid, atopic triad
General signs to look out for
Fever
Chills
weight changes
Integumentary signs to look out for
Rashes
Face signs to look out for
Tenderness/swelling
Eyes signs to look out for
pain
redness
drainage
itching
Ear signs to look out for
tinnitus
ear pain
drainage
Nose signs to look out for
congestion
rhinorrhea
sneezing
epistaxis
Throat signs to look out for
Pain
dysphagia
hoarseness
Neck signs to look out for
lymphadenopathy
Gordon health patterns to reference
Sleep
Sexuality (infections)
Nutrition/metabolic
Head exam:
Aligned?
Normocephalic
Face exam
Scars
Lesions
Symmetry
Muscle weakness
Tell-tale signs on initial exam
Allergic shiners
Nasal crease in allergies
Noisy nasal breathing
Patient voice points to listen to
Breathy voice
Nasaly
Stridor?
External eye points of interest
Eyebrow thinning/symmetry
Eyelashes (even distribution and direction of curl, infestations)
Able to close eyelids fully/lesions
Eye abnormalities
Ptosis
Entropion
Hordeolum (sty)
PERRLA for eye assessment
Pupils
Equal
Round (should be perfectly round)
Reactive (should react to:
Light: dilation/contraction
Accommodation
(Looking far away pupils dilate, looking close pupils constrict)
Red light reflex
Detect cataract and retinoblastoma
Reddish-orange reflection of light from fundus
How to hold opthalamascope
Hold right hand, use your right eye and examine the patient’s right eye
Vice versa for left
Cataracts
Clouding of lens
Leading cause of blindness worldwide
Risk factors: Age UV B light Diabetes Cigarettes HTN Steroid use Obesity Beta blockers Female
Further eye testing
Peripheral vision
6 cardinal fields (slowly) (three descending vertical on left side, three descending vertical on right side)
Ear external exam
Alignment Deformities Nodules Ulcers Lesions
Otoscopy use
External auditory canal for erythema, stenosis, debris/discharge
Examine tympanic membrane for
Normal: shiny, translucent, visible light reflex (R 5o clock vs. L 7 o clock)
White= scarring
Redness, bulging, dull, retraction= infection
Perforations and tubes
Whisper test
6 words on each side, should hear at least 3/6
What size otoscope?
Biggest that will fit
Rinne test for ears
determine conductive or sensorineural hearing loss
Place tuning fork on mastoid behind ear
Patient will tell you when sound disappears
Then put tuning fork to ear
If air conduction>bone conduction they should hear it
Weber test for hearing
Tuning fork on top/center of head
Normal=equal on both sides
Check if sound is lateralized
ear abnormalities
Otitis externa (swimmers ear)=crusty, inflammed, nasty af
Otitis media (ear infection)=red and opaque
Tympanostomy tubes
Scarring= opaque white
Which ear has cone of light at 7 O clock
Left ear
Which ear has cone of light at 5 o clock
Right ear
Nose external exam
Deformities, symmetry, size/nare patency
Press on maxillary and frontal sinus
Nasal speculum to find
Septum (deviation)
Rhinorrhea
Masses
Polyps (peeled grapes)
Prominent vessels (snorting drugs)
Allergies (pale/blue, puffy)
Abnormal nose findings
Sinusitis
Epistaxis
Deviated septums
Polyps
Grading tonsils
1 and 2 normal
1+: fills <25% oropharynx between tonsil pillars
2+: 25-50%
3+: 50-75%
4+: >75% (almost or fully touching each other)
Posterior pharyngeal wall look for
Erythema
Drainage
Purulence
Exudates
Cobblestone appearance (allergies)
Black harry tonge
Smokers, pepto bismol, antibiotics
Leukoplakia in mouth
Permanent white marks in mouth
Can turn to oral cancer
Head lymph nodes should be
Less than 1cm or invisible
Soft
Doesnt move
Meniere’s disease
Inner ear disease that causes dizzy spells (verigo) and hearing loss.
Can affect one or both ears.
atopic triad
Eczema, allergies, asthma
Delayed gagging is common in
Elderly
ectropion vs entropion
Ectropion: eyelid turns outwards
Entropion: eyelid inwards
Allergic shiners
Allergy symptom
Looks like you got punched in the eye