HEENT Flashcards
Unequal pupils - Anisocoria (2) in bright light and dim light
bright light the larger pupil cannot constrict properly. Causes: blunt truama, OAG, Impaired parasympathetic nerve supply to the iris.
dim light the smaller pupil cannot dilate properly, (Horners syndrome) caused by an interupption of sympathetic nervous system.
Tonic Pupil (Aide’s Pupil)
Pupil is large regular and usually unilateral. Reaction to light is severely reduced and is slowed, or absent. Near reaction although slow, is present. Slow accommodation causes blurred vision. Deep tendon reflexes are often decreased.
Oculomotor Nerve CN III Paralysis
Dilated pupil fixed to light and near effort. ptosis of upper eyelid and lateral deviation of the eye are almost always present.
Horner’s Syndrome eyes
the effected pupil (small) reacts briskly to light and near effort. Ptosis of the eyelid is present, perhaps with loss of sweating on the forehead. In congenital Horner’s syndrome, the involved iris is lighter in color than its fellow (heterochromia)
Small irregular pupils
small irregular pupils that do not react to light indicate Argyll Robertson pupils. Seen in central nervous system syphilis.
Dizziness
nonspecific term encompassing several disorders - get a detailed hx to identify primary etiology.. vertigo, presyncope, disquilibrium, psychiatric, mutifactorial
Vertigo Dizzy
a spinning sensation accompanied by nystagmus, and ataxia, usually fromperipheral vestibular dysfunction (40%), but may be brainstem lesion, also althersclerosis, MS, vertebrobasilar migraine, TIA
Presyncope Dizzy
a near faint from “feeling faint of lightheaded - causes include orthostatic hypotn, medication, arrhthmias and vasovagel attacks
Disequilibrium Dizzy
unsteadiness or imbalance when walking. esp. in older pt., (fear of walking, visual loss, weakness musc skeletal, perepheral neuopathay.
Psychiatric Dizzy
anxiety, panic disorder, hyperventilation, depression, somatization disorder, alcohol, and substance use.
Multifactorial Dizziness
unknown up to 20% of pt.s
Cushing syndrome Facial Swelling
increased adrenal cortisol prduction of cushing’s syndrome produces a round or “moon” face with red cheeks.excessive hair growth - side burns, moustach, and chin
Nephrotic Syndrome Facial Swelling
face is edematous and often pale. Swelling appareas first around the eyes and in the morning. eyes may become slitlike when edema is severe
Myxedema Facial Swelling
severe hypothyroidism ahs a dull puffy face. edema often pronounced around the eyes does not pit with pressure. Hair and eyebows are dry coarrse and thinned. the skin is dry.
Parotid Gland Enlargement
chronic bilateral asymptomatic parotic gland enlargement may be associated ith obesity, diabetes, cirrhosis, and other conditions. Swellings anterior to the ear lobes and above the angles of the jaw. Gradual unialteral enlagement suggests neoplasm . Acute enlargement is seen in mumps.
Acromegaly
the increased growth hormone of acromegaly produces enlargement of both bone and soft tissue. head is elogated, with bony prominence of forehead, nose and lower jaw. Soft tissues of the nose lips and ears also enlarge. facial features appear generally coarsened.
Parkinson’s disease
decreased facial mobility blunts expression. masklike face may result with decreased blinking and a characteristc stare. neck and upper trunk tend to flex forward patient seems to peer upward toward the observer. Facial skin bcomes oily, and drooling may occur
Horizontal Defect VFD
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. Bottom Have of R Circle defect.
Blind R Eye (right optic nerve) VFD
A lesion of the optic nerve and of course the eye itself, produces unilateral blindness. Complete R circle defect.
Bitemperal Hemianopsia (optic chiasm) VFD
a lesion at the optic chiasm, may involve only firbers crossing over to the opposite side. snce these fibers originate in the nasal half of each retina, visual loss involves the temporal half of each field. L outer half and R outer half deficits
Left Homonymous Hemianopsia (right optic tract) VFD
a lesion of the optic tract, interrupts fibers originating on the same side of both eyes. visual loss in the the eyes is therefore homonymous and involves half of each field (hemianopsia)
L half of both visual field deficits
Homonymous Left Superior Quadrantic Defect (right optic radiation, partial)
A partial lesion of the optic radiation in the temporal lobe, may involve only a portion of the nerve fibers, producing a homonymous quadrantic defect. Defect in L top quarter of both visual fields
Left Homonymous Hemianopsia (right optic radiation)
A complete interruption of fibers in the optic radiation, produces a visual defect similar to that produced by a lesion of the optic tract.
7 attributes of a symptom
Location - where is it?
Quality - What is it like?
Quantity/Serverity - how bad is it? 1-10 scale
Timing - when does it stop or start
Setting - environmental factors, activities,
Remitting or exacerbation factors - what makes it better or worse?
Associated manifestations - does anything accompay it?
Steps in Clinical reasoning
Identify abnormal findings
Localize findings anatomically
Interpret findings in terms of probable process
Make hypotheses about the nature of the patient’s problem
Test hypothesis
Establish a working diagnosis
Develop Hypotheses abut a pt problem
- select the most specific and critical findings to support hypothesis
- match findings with conditions you know that can produce them
- eliminate diagnostic poss that fail to expain
- weigh in the poss and select the most likely dx
- develop poss explanations
