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History and Physical 1 > HEENT 1 > Flashcards

HEENT 1 Flashcards

1
Q

How are headaches classified?

A

Primary or secondary

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2
Q

What are some life-threatening causes to headaches?

A

Meningitis, subarachnoid hemorrhage, mass lesion

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3
Q

What types of headaches can be primary?

A

Migraine, tension, cluster, and chronic daily headaches

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4
Q

What do secondary headaches arise from?

A

Underlying structural, systemic, or infections like meningitis, subarachnoid hemorrhage

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5
Q

What type of headache can be life threatening?

A

Secondary

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6
Q

Red flags for headaches

A

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

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7
Q

What is a subarachnoid hemorrhage until proven otherwise?

A

Thunderclap or worst headache of my life

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8
Q

Hyperopia

A

Far-sighted

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9
Q

Presbyopia

A

Age related far-sightedness

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10
Q

Myopia

A

Near-sighted

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11
Q

Scotomas

A

Partial alteration of vision

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12
Q

Other Red flags associated with HAs

A

Recent head trauma, papilledema, neck stiffness, or focal neuro deficits

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13
Q

If patient has unilateral head pain, that usually means what type of headache?

A

Migraine or cluster

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14
Q

IF patient has a headache in the temporal areas, what kind of HA can it be?

A

Tension

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15
Q

If a patient has head pain in the retro-orbital area, what type of headache is it?

A

Cluster

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16
Q

Nausea and vomiting are common with what?

A

Migraines, brain tumors, and subarachnoid hemorrhages

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17
Q

If coughing, sneezing, or changing position makes the HA worse…

A

Can be from acute sinusitis or from a mass lesion

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18
Q

Sudden unilateral painless vision loss can signal what?

A

Vitreous hemorrhage (DM or trauma), retinal detachment, retinal vein occlusion, or central retinal artery occlusion

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19
Q

Sudden unilateral painful vision loss can signal what?

A

Corneal ulcer, uveitis, traumatic hyphema, acute glaucoma, optic neuritis (MS)

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20
Q

What does gradual bilateral vision loss arise from?

A

Cataracts or macular degeneration

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21
Q

Slow central vision loss can signal what?

A

Nuclear cataract, macular degeneration

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22
Q

Slow peripheral vision loss can signal what?

A

Advanced open angle glaucoma

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23
Q

Slow one-sided vision loss can signal what?

A

Hemianopsia and quadrantic defects

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24
Q

Moving specks in the eye

A

Vitreous floaters

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25
Q

Fixed specks or defects in the eye

A

Scotomas, lesions in the retina or visual pathways

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26
Q

Lights flashing may accompany what other eye symptom?

A

Vitreous floaters

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27
Q

What do flashing lights or new vitreous floaters suggest?

A

Detachment of vitreous from the retina

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28
Q

What else is important to ask for an eye exam?

A

Pain in or around the eye, redness, excessive tearing or watering

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29
Q

Diplopia

A

Double vision

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30
Q

What is diplopia seen in?

A

Lesions in the brainstem or cerebellum, or from weakness or paralysis of one or more extraocular muscles

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31
Q

Horizontal diplopia

A

Palsy of CN III or VI

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32
Q

Vertical diplopia

A

Palsy of CN III or IV

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33
Q

Diplopia in one eye with the other closed suggests what?

A

A problem in the cornea or lens

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34
Q

Conductive loss of hearing results from what?

A

Problems in the external or middle ear

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35
Q

Sensorineural hearing loss results from what?

A

Problems in the inner ear, the cochlear nerve, or its central connections in the brain

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36
Q

Sensorinerual hearing loss

A

Trouble understanding speech, complain that others mumble, noisy environments make it worse

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37
Q

Conductive hearing loss

A

Noisy environments help

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38
Q

Pain occurs in the external canal in what?

A

Otitis externa

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39
Q

External canal ear pain associated with a respiratory infection

A

Otitis media

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40
Q

Ear pain can also be referred from where?

A

Other structures in the mouth, throat, or neck

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41
Q

Tinnitus

A

Perceived sound that has no external stimulus, ringing or rush or roaring noise in one or both ears

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42
Q

Tinnitus associated with hearing loss and vertigo

A

Meiniere’s disease

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43
Q

Vertigo

A

Refers to the perception that the patient or the environment is rotating or spinning

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44
Q

Vertigo points problems to where?

A

The labyrinths of the inner ear, peripheral lesions of CN VIII, or lesions in the central pathways or nuclei in brain

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45
Q

Vertigo is the sensation of what?

A

True rotational movement of the patient or the surroundings

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46
Q

Disequilibrium is what?

A

Has to do with one feeling unsteady or losing their balance

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47
Q

If there is true vertigo, need to distinguish between what?

A

Peripheral from central neurologic causes

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48
Q

What is a helpful special test used to help differentiate between peripheral vs central vertigo?

A

Dix-Halpike maneuver

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49
Q

Rhinorrhea refers to

A

Drainage from the nose

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50
Q

Rhinorrhea is frequently accompanied by what?

A

Sneezing, watery eyes, throat discomfort, itching in the eyes nose and throat

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51
Q

What are some causes of rhinorrhea?

A

Viral infection, allergic rhinitis and vasomotor rhinitis

52
Q

Rhinitis medicamentosa

A

Excessive use of decongestants

53
Q

Acute bacterial sinusitis is unlikely unless the viral symptoms persist for how long?

A

More than 7 days with purulent drainage and facial pain

54
Q

Epistaxis

A

Bleeding from the nasal passages

55
Q

What are some common causes of epistaxis?

A

Anticoagulants, NSAIDs, and coagulopathies (Von Willebrands)

56
Q

Sore tongue

A

Result from a local lesions as well as form systemic illness

57
Q

Aphthouse ulcers and the sore smooth tongue can be signs of what?

A

Nutritional deficiency

58
Q

Bleeding from the gums is most likely from what?

A

Gingivitis

59
Q

Acute hoarseness can be from what

A

Voice overuse and acute viral laryngitis

60
Q

What can accompany pharyngitis and sinusitis?

A

Enlarged tender lymph nodes

61
Q

What is suggestive of hypothroidism?

A

Temperature intolerance and sweating

62
Q

What is suggestive of hyperthyroidism?

A

Palpitations and involuntary weight loss

63
Q

With a goiter, what can happen to thyroid function?

A

It can increase, decrease, or be normal

64
Q

An enlarged skull may signify what?

A

Hydrocephalus or Paget’s disease of bone

65
Q

Hirsutism

A

Occurs in some women with polycystic ovary syndrome

66
Q

NEVER proceed to the rest of the eye exam without what?

A

Visual acuity

67
Q

What else are we doing on an eye exam?

A

Visual fields, conjunctiva and sclera, cornea lens and pupils, EOM, fundi (optic disk, retina, vessels, fovea and macula)

68
Q

What is the snellen eye chart used for?

A

Visual acuity

69
Q

How far away does the patient stand when looking at the eye chart?

70
Q

When looking at the snellen eye chart, the best vision is recorded as what?

A

As the line the patient can read more than 1/2 the letters of

71
Q

What do the numbers mean when recording visual acuity? Ex: 20/20

A

First number is how far away the person is from the chart, the second is the distance at which the normal eye can read the line of letters

72
Q

What is the Rosenbaum eye chart used for?

A

Near vision test, held 14 inches from the eye

73
Q

Visual acuity test

A

Test each eye individually, then both together. Record as: Right eye/ Left eye/ Both eyes

74
Q

How do you test the pts visual fields by confrontation?

A

Pt focuses on examiners eyes, place hands 2 feet apart laterally and pt has to point to fingers as soon as they are seen

75
Q

If the results of the visual field exam are abnormal, what do you do next?

A

Test unilaterally with on eye covered

76
Q

What does the Hirschberg exam test for?

A

Position and alignment of the eyes

77
Q

Hypotropia

A

One eye turns down

78
Q

Hypertropia

A

One eye turns up

79
Q

Exotropia

A

One eye turns out

80
Q

Esotropia

A

One eye turns in

81
Q

Hirschberg test is useful for what?

A

Manifest deviations (tropias)

82
Q

What can detect AND confirm tropias?

A

Cover test

83
Q

What is ptosis?

A

Low lying upper lid during primary gaze

84
Q

What open the eye?

A

Levator palpebrae and CN III

85
Q

What is defined as the inability to full close the eyelids?

A

Lagophthalmos

86
Q

What closes the eye?

A

Orbicularis muscle and CN VII

87
Q

Which CN is impacted in Bells phenomenon?

A

CN VII Facial Nerve

88
Q

What is Xanthelasma?

A

Yellow plaques on the eye from hypercholesterolism

89
Q

Chalazion

A

Lump in the tear gland of the eye

90
Q

Dacryoadenitis

A

Inflammation of the lacrimal gland

91
Q

Dacryocystitis

A

Inflammation of the nasolacrimal gland

92
Q

Lacrimal gland produces what

A

Aqueous tears

93
Q

Meibomian gland produces what

A

Sebaceous tear film

94
Q

What is the process of tear production?

A

Tear production -> Supero-lateral fornix -> superior and inferior nasal lacrimal puncta -> canaliculi -> lacrimal sac -> nasolacrimal duct

95
Q

What are we inspecting the conjunctiva for?

A

Injection, pallor, pigmentation, swelling, masses, hemorrhage, foreign bodies

96
Q

What are we inspecting the sclera for?

A

Nodules, hyperemia, discoloration

97
Q

What is icterus?

98
Q

Blue sclera can come from what?

A

Osteogenesis imperfecta

99
Q

Scleromalacia perforans

A

Necrotizing scleritis, can lead to blindness

100
Q

Cornea should be…

A

Clear without cloudiness, opacities or defects (abrasions, ulcerations)

101
Q

What can be used to examine the cornea?

A

Anesthesia, fluorescein stain and woods lamp

102
Q

Arcus senilus

A

Grey or white arc visible above or below the outer part of the cornea

103
Q

Kayser-Fleischer ring is what?

A

Cu+ deposition. Associated with Wilsons disease

104
Q

What else can be found on the cornea?

A

HSV keratitis, corneal abrasion, keratoconus (thinning disorder of the cornea)

105
Q

What is a coloboma?

A

A defect or hole in the iris

106
Q

What do we look for when inspecting the anterior chamber?

A

Hyphema, hypopyon

107
Q

How is it best to asses the depth of the anterior chamber?

A

Laterally to medially

108
Q

What is the disease if the cresentic shadow is noted nasally?

A

Narrow-angle glaucoma

109
Q

The lens should be inspected with what kind of lighting?

110
Q

Cataracts, opacities, and dislocation can be inspected for where?

111
Q

RAPD

A

Relative afferent pupillary defect

112
Q

Marcus Gunn Pupil

A

Afferent pupillary defect

113
Q

Adie’s Pupil

A

Tonic pupil, one or both pupils are abnormally dilated with delayed constriction

114
Q

Horner’s Syndrome

A

Eye has ptosis, miosis and anhydrosis

115
Q

Argyll Robertson Pupils

A

Small, irregular pupils

116
Q

Anisocoria

A

Unequal pupils

117
Q

What is seen in cerebral aneurysm, trauma, and a tumor?

A

Oculomotor nerve palsy

118
Q

LR6SO4

A

EOM with nerve controls

119
Q

Nystagmus affects what gaze usually?

A

Upward and lateral gaze

120
Q

How far do you stand away from pt when doing the ophthalmoscopic exam?

A

15 inches, 15 degrees lateral to them as well

121
Q

What color are arteries when looking during an ophthalmoscopic exam

122
Q

What color are veins when looking during an ophthalmoscopic exam

123
Q

What size are arteries when looking during an ophthalmoscopic exam

124
Q

What size are veins when looking during an ophthalmoscopic exam

125
Q

What is the light reflex on arteries when looking during an ophthalmoscopic exam?

126
Q

What is the light reflex on veins when looking during an ophthalmoscopic exam?

127
Q

What is normal intraocular pressure?

A

10-22 mmHg

History and Physical 1 (6 decks)

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