HEENT Flashcards
A sensation is defined as what?
Conscious or subconscious awareness of changes in the external or internal enviroment.
What are the 5 special senses?
smell taste vision hearing equilibrium
What do somatic senses include?
tactile
thermal
pain
proprioceptive
What do visceral senses provide senses for?
Internal organs
What are the four conditions that must be satisfied for sensation to occur?
Stimulus
Sensory receptor must convert stimulus to an electrical signal
A nerve pathway conducts information to the brain
A region of the brain translates or integrates the nerve impulse into a sensation
What is primarily a function of the cerebral cortex IRT to sensations?
Perception of conscious awareness and interpretation of sensations
What are the functional classifications of receptors?
Mechanoreceptor Thermoreceptor Nociceptors Photoreceptors Chemoreceptors Osmoreceptors
What type of receptor detects mechanical deformation of adjacent cells?
Mechanoreceptors
What type of receptor detects changes in temperature?
Thermoreceptor
What type of receptor detects pain?
Nocicereceptor
What type of receptor detects light?
Photoreceptor
What type of receptor dects the presence of chemicals in solution?
Chemoreceptor
What type of receptor detects the osmotic pressure in fluids?
Osmoreceptors
Somatic (body) sensations arise from stimulation of what?
Sensory receptors in the skin, mucous membrane, muscles, tendons and joints.
Tactile receptors for somatic sense are for what?
Touch, pressure, vibration, itch and tickle
Thermal receptors in the somatic senses are for what?
Warm and cold
Pain receptors are located in the entire body except where?
Brain
Encapsulated tacticle sensations?
touch pressure and vibration
Free tactile sensations?
Tickle and itch
Where are cold and hot receptors located in the skin?
Cold-Epidermis
Hot-Dermis
What temperatures activate cold receptors?
10-40 Celsius (50-105 F)
What temperatures activate warm receptors?
32-48 Celsius (90-118F)
What temperatures stimulate nociceptors and elicit pain?
Below 10C (50F) Above 48C (118F)
Proprioceptors are located where?
Muscle spindles in muscles
Tendon organs in tendons
Joints in and around synovial
Hair cells in middle ear
Olfactory epithelium is found in the inferior space of what structure?
cribriform plate
What are the three types of cells in the olfactory epithelium?
receptor
supporting
basal
The olfactory tract will project to the cerebral cortex also know as the?
frontal and temporal lobe
Axons form CN I and extend through the cribriform plate via what?
holes
What are the five primary tastes of gustation aka the sense of taste?
Sweet Salty Bitter Sour Umami
What are raised bumps on the tongue, where the majority of gustation receptor cells are located, called?
Taste buds or fungiform papillae
Taste buds convey impulses to what cranial nerves?
VII (ant 2/3)
IX (post 1/3)
X (epiglottis)
The lacrimal glands drain from the surface of the eye through what structure before reaching the nasolacrimal duct?
Lacrimal canaliculi
What are the six extrinsic muscles that work to move the eyeball?
Superior Rectus Inferior Rectus Medial Rectus Lateral Rectus Superior Oblique Inferior Oblique
What are the external layers of the eyeball?
Fibrous tunic
Vascular tunic (middle)
Retina (inner)
What does the fibrous tunic contain?
Posterior sclera
Anterior cornea
What does the vascular tunic or middle layer contain?
Choroid
Ciliary body
Iris
Uvea
The retina or inner layer has what layers?
Neural
Pigmented
Inner and outer synaptic
What are the photoreceptors in the eyes called?
Rods and cones
Rods allow us to see what?
Shades of gray in dim light
Cones are instrumental for what?
Color vision
Visual acuity
What are the interior cavities of the eye that are separated by the lens?
Anterior cavity
Vitreous chamber
The anterior cavity contains what type of fluid?
Aqueous humor
The vitreous chamber, the larger cavity, contains what type of fluid?
Vitreous body (clear, jelly-like fluid)
The pressure in the eye, intra ocular pressure (IOP) is produced by mainly what fluid?
Aqueous humor
What maintains the shape of the eyeball?
IOP
Accommodation is the ability of the lens to instantly change curvature for what?
Near and far vision
Vitamin A deficiency decreases rhodopsin that leads to what condition?
night blindness
Sight is perceived in what area of the brain?
Occipital lobe
What is another term for the ear?
Auricle
What is secreted in the external auditory canal?
Cerumen
What are the three bones in the auditory ossicles?
Malleus (makes contact with TM)
Incus
Stapes
The middle ear is connected to the upper part of the throat via what?
Eustachian tube
What fluid surrounds the membranous labyrinth, inside the bony labyrinth, of the middle ear?
perilymph
What is the fluid that is inside of the membranous sacs of the membranous labyrinth?
endolymph
Where do vestibulo impulses of CN VIII travel to via cochlear branch?
midbrain and thalamus
Where do the cochlear impulses of CN VIII travel to via the cochlear branch?
Temporal lobe
Auditory axons crossing enables what for hearing?
Impulses are received from both ears regardless of side of noise.
What are the two kinds of equilibrium?
Static
Dynamic
Static equilibrium refers to
linear acceleration/deceleration
Dynamic equilibrium refers to
rotational acceleration/deceleration
What are the receptor organs for equilibrium in the internal ear?
Saccule
Utricle
Semicircular ducts
Linkage between what structures in the brain play a role in maintaining equilibrium?
Medulla cerebellum
Cerebrum
What are the salivary glands?
Parotid
Submandibular
Sublingual
What landmarks comprise the anterior triangle of the neck?
Sternocleidomastoid muscles
mandible
the midline
What structures make up the posterior triangle of the neck?
Trapezius
Sternocleidomastoid muscles
clavicle
What are the Lymph nodes of the head and neck?
Post/preauricular Parotid Tonsillar Submandibular Submental Anterior deep/superficial chain Posterior deep/superficial chain supraclavicular chain
What is the structure that consists of two lateral lobes and resembles a butterfly on the neck?
Thyroid (right side 25% larger)
What are characteristic facies?
expression or appearance that is characteristic of a clinical condition or syndrome
Temporomandibular joint space symptoms may cause what?
Tinnitus
What is another name for the parotid duct?
Stensen duct
What is another name for the submandibular duct?
Wharton duct
Bruits over the eye may suggest what?
Cerebral aneurysm
Bruits over the temporal artery are associated with what
temporal arteritis
Grittiness of the thyroid on palpation may indicate?
Thyroiditis
Cushing syndrome is characterized by what facies?
rounded, moon-shaped face
thin erythematous skin
Hyperthyroidism facies are
prominent eyes
lid retraction
staring/startled expression
Lupus or SLE facies are?
butterfly rash
blush with swelling
scaly, red maculopapular lesions
Thyroglossal duct cyst is identified by?
freely moving cystic mass
high in neck
midline
Torticollis, generally from birth trauma, tumors, trauma, infection or drug ingestion is also known as?
Wry neck
What are some Thyroid diseases?
Hypo/hyperthyroidism
Myxedema
Graves’ disease
Hashimoto disease
What are the two layers of the conjunctiva?
Palpebral
Bulbar
What eye muscles does CN III control
Sup/Infer/medial rectus
inferior oblique
What eye muscles does CN IV control
Superior oblique
What muscles does CN VI control?
Lateral rectus
The uvea is composed of what structures?
iris
ciliary body
choroids
Periorbital edema is always abnormal and may represent what conditions?
Thyroid eye disease
Allergies
Renal Disease
Xanthelasma (lipids)
Cover-uncover test identifies what condition?
Strabismic eye
The macula or fovea is located where in relation of the optic disc?
2 disk diameters laterally or temporally from the optic disc
Anterior blepharitis involves what stuructures?
lid skin, eyelash and associated gland
Posterior blepharitis results from what
inflammation of meibomian glands
Dx?
Blepharitis
Sxs of blepharitis?
redrimmed
granulations clinging to lashes
tears may be frothy or abnormally greasy
Tx of blepharitis?
Baby shampoo warm compress massage artificial tears Bacitracin ointment
What glands are associated with hordeolum and chalazion?
Gland of Zeis
Meibomian
DX?
Hordeolum
DX?
Chalazion
Tx of hordeolum or chalazion?
Warm compress 15 min x4/day massage discontinue makeup Do not squeeze Bactrim BID 5-7 days
Definitive care if unresolved hordeolum or chalazion?
Referral to ophthalmology for I&D
What are the types of conjunctivitis?
Viral
Allergic
Bacterial (non-gonococcal)
Bacterial (gonococcal)
What is the most common cause of viral conjuctivitis?
Adenovirus
What type of conjunctivitis would typically present with bilateral clear discharge?
Allergic
Nongonococcal Bacterial Conjunctivitis is caused by what typically?
Staphylococcus aureus Staphylococcus epidermidis Hemophilus influenzae Streptococcus pneumonia Moraxella catarrhalis
Gonococcal Bacterial conjunctivitis is typically acquired through?
infected genital secretions
DX
Viral conjunctivitis
DX?
Bacterial Conjunctivitis
What are distinguishing symptoms for nongonococcal and gonococcal bacterial conjunctivitis?
preauricular adenopathy and hyperacute onset with gonococcal
Symptoms of conjunctival hemorrage?
Red eye, foreign body sensation, usually asymptomatic unless there is associated chemosis
Blood underneath the conjunctiva, often in one sector of the eye and the entire view of the sclera may be covered by blood
Tx of conjunctival hemorrhage?
None required (clears within 2 to 3 weeks)
Artificial Tears for irritation
Tx of conjunctival hemorrhage?
None required (clears within 2 to 3 weeks)
Artificial Tears for irritation
Symptoms of pterygium
Caused by sunlight exposure, chronic inflammation and oxidative stress
Wing shaped fold of fibrovascular tissue arising from the interpalpebral conjunctiva and extending onto the cornea, usually nasal in location
Tx of pterygium
Protect eyes from sun, dust, and wind (UV blocking sunglasses or goggles)
Artificial Tears
Surgical removal if vision is affected
Ocular foreign body sxs
Foreign body sensation, tearing, history of trauma; with or without a rust ring
ocular foreign body tx
Topical Anesthetic - Proparcaine (Alcaine) 0.5%
Remove foreign body with saline irrigation
Non contact lens wearers
Erythromycin
Contact lens wearers
Ciprofloxacin
Sxs of corneal abrasion
Severe pain, tearing, and photophobia
History of trauma to the eye, commonly involving a foreign object (fingernail, piece of paper, or contact lens)
Tx of corneal abrasion
Non contact lens wearers
Erythromycin
Contact lens wearers
Ciprofloxacin
Acetaminophen 325-1000mg NSAIDS
Sxs of corneal ulcer
Cornea reveals a round or irregular ulcer opacity or infiltrate
Severe ocular pain, photophobia, or blurred vision
Risk factor contact lens wearers
Tx of corneal ulcer
Ciprofloxacin
Refer to an opthalmologist to be seen within 12 to 24 hours
DO NOT patch the eye due to risk of Pseudomonas infection
Sxs of Hyphema
Trauma or recent ocular surgery
are the most common risk factors
Blood or clot or both in the anterior chamber that may be black or red
Pain, sensitivity to light, blurred, clouded or blocked vision, history of blunt trauma
Tx of Hyphema
IMMEDIATE Optometry consult Bed rest with elevation of the head
Place a rigid shield over the involved eye
Avoid antiplatelet/anticoagulant medications (Aspirin/NSAIDS)
Mild Analgesics only! -
Acetaminophen
Uveitis or iritis sxs?
Pain, redness, photophobia, visual loss,
hypopyon (WBC pool) and fibrin within the anterior chamber
Tx of uveitis or iritis?
Only to be initiated by the opthalmologist Clycloplegic
Topical Steroid
orbital cellulitis sxs?
Risk factors:
Paranasal sinus infection, dental infection, orbital trauma
eyelid edema, erythema, warmth, tenderness, periorbital swelling, tooth pain
restricted extraocular motility with pain with eye movement
Orbital cellulitis Tx
Augmentin 875mg PO Ceftriaxone (Rocephin) 2g IM
Surgery may be required to drain the paranasal sinuses or orbital abscess
Orbital fracture sxs?
Pain on attempted eye movement and local tenderness, eyelid edema, crepitus (particularly after nose blowing)
Step off deformity along frontal sinus
Restricted eye movement especially in upward or lateral gaze or both, subcutaneous or conjunctival emphysema, point tenderness,
Tx of orbital fracture
Prophylactic oral antibiotics Augmentin 500/125mg TID,
PCN Allergy Doxycycline 100mg PO
Nasal Decongestants Oxymetazoline (Afrin) BID for 3 days
(Instruct PT to NOT BLOW THEIR NOSE)
Immediate surgical repair if suspected muscle entrapment
What is another term for corneal ulcer?
infectious keratitis
What is the biggest risk factor of corneal ulcers?
improper contact lens use
What is a common bacteria to cause corneal ulcerations?
Pseudomonas aeruginosa
Hypopyon may come from what disorders?
infection
autoimmune
The middle layer of the eye is the vascular tunic or the?
uvea
Acute iritis or uveitis is typically from?
infection
Chronic iritis or uveitis is from?
autoimmune disorders
examples of autoimmune disorders that could cause iritis or uveitis are?
spondylarthritis
sarcoidosis
SLE (Lupus)
multiple sclerosis
nongranulomatus uveitis would indicate what onset?
acute
What may be seen on the corneal endothelium in uveitis?
keratic precipitates
Orbital cellulitis usually comes from
paranasal sinuses
dental infection
what are the three types of orbital fractures?
orbital rim
blowout
orbital floor
tx of orbital fracture?
Prophylactic oral antibiotics Augmentin 500/125mg TID,
PCN Allergy Doxycycline 100mg PO
Nasal Decongestants Oxymetazoline (Afrin) BID for 3 days
(Instruct PT to NOT BLOW THEIR NOSE)
Immediate surgical repair if suspected muscle entrapment
Transient visual loss can be caused by?
change in BP
TIA
Migraine
What can methanol poisoning or toxins cause in the eyes?
Long lasting sudden vision loss
Sxs of retinal detachment?
Flashes of light, floaters, a curtain or shadow moving over the field of vision, peripheral or central visual loss, or both
Risk factors
50 y/o Nearsightedness Cataracts
Sxs of flash burn
Caused by use of a sunlamp without eye protection, exposure to a welding arc, or snow blindness
Numerous, microdots on the corneal surface after staining
Tx of flash burn
Pain management
Consider opioids
Antibiotics
Erythromycin
Pressure patch for the more affected eye
Sxs of chemical burn to eyes
Risk factor
Job exposure Improper PPE use
Excessive tearing, severe eye pain, photophobia, inability to open eyelids
Tx of chemical burn to eyes
Immediate irrigation with normal saline for 30 minutes
Erythromycin 0.5% every 1-2 hrs
Penetrating wound to eye sxs
Pain, decreased vision, loss of fluid from eye, Hx of trauma, fall, or sharp object entering globe
Low intraocular pressure
Tx of penetrating eye wound
Protect the eye with a shield at all times
Elevate the head of the bed to 45 degrees
Cefazolin (Ancef, Kefzol) 1 gm IV
Tetanus shot is last dose over 5 years
Ondansetron (Zofran) 4mg PO/IV
MEDEVAC Surgical repair ASAP
Herpetic Lesion of eye sxs
Photophobia, pain, eye redness, and decreased vision
History of oral or genital herpes infection
Dendritic keratitis branching
Eyelid may have typical herpetic vesicular eruptions
Palpable preauricular node
tx of herpetic lesion
Topical antiviral
Valacyclovir (Valtrex) 500mg PO or Acyclovir 400mg PO
Tx of foreign body of ear
Cerumen loops/scoops, alligator forceps
Live objects should be drowned with Lidocaine 2%
Irrigation should not be done unless the TM is completely visualized
Topical antibiotics
Tx of cerumen impaction
Ear irrigation using body temperature water
Carbamide Peroxide (Debrox) 2-5 drops max of 4 days
Tx of mastoiditis
Cefazolin 0.5-1.5g IV TID
Surgery: Tympanocentesis and myringotomy
I&D of periosteal abscess Mastoidectomy may be indicated
tx of otitis externa
Drying Agent - 50/50 Alcohol/White Vinegar
Ciprofloxacin Otic (Cetraxal)
Removal of purulent debris filling the ear canal
Apply ear wick if there is substantial edema
Severe cases
Ciprofloxacin 500mg PO
Tx of otitis media
Amoxacillin/Clavulanate (Augmentin) 875mg
Ceftriaxone 1 gram IM OR Doxycycline 100mg
Nasal Decongestants
Surgical drainage for severe cases Tympanocentesis
Tx of eustachian tube dysfunction
Decongestant Pseudoephedrine 60mg
Oxymetazoline 1-2 sprays
Tx of TM perforation
Spontaneous healing occurs in most cases can take 5-6 days to heal
MOI dictates Systemic Antibiotics : Augmentin) 875mg
Doxycycline 100mg
barotrauma tx
Decongestant Pseudoephedrine (Sudafed) 60mg, Oxymetazoline (Afrin)
Antihistamines as needed for symptomatic relief
Eustachian tube is excessively open due to
patulous dysfunction
Eustachian tube fails to dilate properly in
dilatory dysfunction
Eustachian tube is normally
closed
most common reasons for hearing loss
age (presbyacusis)
trauma(4000hz)
Ototoxicity can be caused by
aspirin
antibiotics
tinnitus is divided into two types
objective
subjective
What labs would you want to get for a patient with tinnitus?
CBC
TSH
HIV
RPR
Locations for epistaxis
anterior- kiesselbach plexus
posterior-sphenopalatine artery
What coags labs would you want for epistaxis pt?
PT
TT
aPTT
Tx of Epistaxis
-Direct pressure by compression of the nares continuously for 10-15 minutes
-Oxymetazoline (Afrin) PLUS tampon
-Lidocaine
-Cauterized with silver nitrate
-Nasal packing
Antibiotics - Cephalexin (Keflex) 500mg, Clindamycin 150mg x5 days (toxic shock)
complications of epistaxis?
syncope
Reasons for polyps
allergies asthma cystic fibrosis alcohol aspirin
Major complication of fractured nose?
septal hematoma
tx of allergic rhinitis
Intranasal Steroids - Flonase
Antihistamines
Avoiding or reducing expoure to airborne allergens
Nasal saline irrigations
Tx of sinusitis
NSAIDS for pain
Oral/nasal decongestant Pseudoephedrine (Sudafed) Nasal Oxymetazoline (Afrin)
Antibiotics if purulent discharge
Augmentin for more than 10 days
Severe - high dose Augmentin 2000mg
If PCN allergy - Doxycycline 100mg
typical pathogens of bacterial rhinosinusitis?
S pneumoniae streptococci H influenzae S aureus moraxella catarrhalis
predisposing factors of epiglottis
DM pts
contact with A-beta-hemolytic strep
sxs of epiglottis
Rapidly developing sore throat or difficulty swallowing is out of proportion to findings
tx of epiglottis
IV Antibiotics -
Ceftriaxone 2g IV
Levo 750mg IV
Corticosteroid
Dexamethasone (Decadron) 4- 10mg IV bolus
PTA sxs?
Severe sore throat, difficulty swallowing,
muffled “hot potato” voice
trismus (lockjaw), inferior and medial displacement of the infected tonsil, swollen uvula,
Uvula will be deveated, drooling, dehydration
PTA Tx
Antibiotic - IV Cefazolin (Ancef) PLUS Metronidizole
Surgery
Needle aspiration WATCH THE AIRWAY!
Centor critera
Fever >100.4 Tender anterior cervical lymphadenopathy NO cough pharyngotonsillar exudates Age (MUST HAVE 3 SYMPTOMS!)
labs for pharyngitis
Rapid strep
monospot
throat culture
HIV
Most common organism recovered from drainage in sialadenitis?
S aureus
Sxs of sialadentitis
Acute swelling of the parotid or submandibular glands
Increased pain and swelling with meals
Tenderness and erythema of the duct opening
Pus can often be massaged from the duct
Tx of sialadentitis
Antibiotics
Clindamycin 450mg PO TID
PLUS
Ciprofloxacin 500mg BID
Measures to increase salivary flow: hydration, warm compress, sialagogues (lemon drops, gum), massage of gland
Complications of sialadentitis
ludwigs angina
sxs of tonsiloliths
Halitosis
White debris
Bad taste in the back of the throat
