HEENT 1 Flashcards
How are headaches classified?
Primary or secondary
What are some life-threatening causes to headaches?
Meningitis, subarachnoid hemorrhage, mass lesion
What types of headaches can be primary?
Migraine, tension, cluster, and chronic daily headaches
What do secondary headaches arise from?
Underlying structural, systemic, or infections like meningitis, subarachnoid hemorrhage
What type of headache can be life threatening?
Secondary
Red flags for headaches
Frequent or severe over 3 mos, like a “thunderclap or worst HA of my life,” new onset after 50yo, aggravated by change in position precipitated by Valsalva
What is a subarachnoid hemorrhage until proven otherwise?
Thunderclap or worst headache of my life
Hyperopia
Far-sighted
Presbyopia
Age related far-sightedness
Myopia
Near-sighted
Scotomas
Partial alteration of vision
Other Red flags associated with HAs
Recent head trauma, papilledema, neck stiffness, or focal neuro deficits
If patient has unilateral head pain, that usually means what type of headache?
Migraine or cluster
IF patient has a headache in the temporal areas, what kind of HA can it be?
Tension
If a patient has head pain in the retro-orbital area, what type of headache is it?
Cluster
Nausea and vomiting are common with what?
Migraines, brain tumors, and subarachnoid hemorrhages
If coughing, sneezing, or changing position makes the HA worse…
Can be from acute sinusitis or from a mass lesion
Sudden unilateral painless vision loss can signal what?
Vitreous hemorrhage (DM or trauma), retinal detachment, retinal vein occlusion, or central retinal artery occlusion
Sudden unilateral painful vision loss can signal what?
Corneal ulcer, uveitis, traumatic hyphema, acute glaucoma, optic neuritis (MS)
What does gradual bilateral vision loss arise from?
Cataracts or macular degeneration
Slow central vision loss can signal what?
Nuclear cataract, macular degeneration
Slow peripheral vision loss can signal what?
Advanced open angle glaucoma
Slow one-sided vision loss can signal what?
Hemianopsia and quadrantic defects
Moving specks in the eye
Vitreous floaters
Fixed specks or defects in the eye
Scotomas, lesions in the retina or visual pathways
Lights flashing may accompany what other eye symptom?
Vitreous floaters
What do flashing lights or new vitreous floaters suggest?
Detachment of vitreous from the retina
What else is important to ask for an eye exam?
Pain in or around the eye, redness, excessive tearing or watering
Diplopia
Double vision
What is diplopia seen in?
Lesions in the brainstem or cerebellum, or from weakness or paralysis of one or more extraocular muscles
Horizontal diplopia
Palsy of CN III or VI
Vertical diplopia
Palsy of CN III or IV
Diplopia in one eye with the other closed suggests what?
A problem in the cornea or lens
Conductive loss of hearing results from what?
Problems in the external or middle ear
Sensorineural hearing loss results from what?
Problems in the inner ear, the cochlear nerve, or its central connections in the brain
Sensorinerual hearing loss
Trouble understanding speech, complain that others mumble, noisy environments make it worse
Conductive hearing loss
Noisy environments help
Pain occurs in the external canal in what?
Otitis externa
External canal ear pain associated with a respiratory infection
Otitis media
Ear pain can also be referred from where?
Other structures in the mouth, throat, or neck
Tinnitus
Perceived sound that has no external stimulus, ringing or rush or roaring noise in one or both ears
Tinnitus associated with hearing loss and vertigo
Meiniere’s disease
Vertigo
Refers to the perception that the patient or the environment is rotating or spinning
Vertigo points problems to where?
The labyrinths of the inner ear, peripheral lesions of CN VIII, or lesions in the central pathways or nuclei in brain
Vertigo is the sensation of what?
True rotational movement of the patient or the surroundings
Disequilibrium is what?
Has to do with one feeling unsteady or losing their balance
If there is true vertigo, need to distinguish between what?
Peripheral from central neurologic causes
What is a helpful special test used to help differentiate between peripheral vs central vertigo?
Dix-Halpike maneuver
Rhinorrhea refers to
Drainage from the nose
Rhinorrhea is frequently accompanied by what?
Sneezing, watery eyes, throat discomfort, itching in the eyes nose and throat