HEENT Flashcards
Palatal petechiae not commonly seen but high specific for this diagnosis
Group A Streptococcal
Treated with antibiotics to prevent complications such as rheumatic fever and/or poststreptococcal glomerulonephritis
Group A Streptococcal
4 point scoring system used to assist with risk stratification for GAS and if there is a need to culture
Centor Criteria
- Fever
- Tonsillar exudates
- Anterior cervical lymphadenopathy
- Absence of cough
Centor Criteria
Used in the evaluation of a patient presenting with hearing loss
Tuning forks
Due to a fungal infection involving the mucosal surfaces
Candidiasis
Is a thin white lesion on the mucosal surface which is typically not painful or rub off. It can be a premalignant lesion in some cases.
Leukoplakia
The three symptoms of:
1. 2-4 weeks of purulent nasal drainage
2. Unilateral or bilateral nasal obstruction
3. Facial pain or pressure
are considered the cardinal symptoms of:
acute rhinosinusitis
More likely to have other upper respiratory (“cold”) symptoms
viral pharyngitis
Anterior cervical node lymphadenopathy/tonsillar inflammation
common signs of GAS
AC less than BC
Conductive hearing loss
An indicative sign of puberty is
enlargement of the sebaceous glands
Do you assess mental health when doing an episodic visit for a skin concern?
Yes, mental health is LARGELY affected by skin disorders
Key Findings:
closed or open comedones, papules, pustules, nodules, or cysts, post-inflammatory hyperpigmentation, often occurs in adolescents but can affect adults as well
Acne
Key Findings:
Erythematous, hyperkeratotic scaly macules, papule and/or plaques on sun-damaged skin, rough to palpation, typically seen on the face, ears, scalp, neck, and extremeties
Actinic keratosis
Key Findings:
Red bite mark in a random distribution or in a 3 cluster pattern, mildly erythematous/puritic, can cause insomnia, anxiety, secondary infections
Bed bug bites
Key Findings:
erythema, edema of skin, pain, fever, leukocytosis, mildly elevated ESR, unilateral, indistinct borders
Cellulitis
Key Findings:
dry/scaling, pruritic papules/vesicles/bullae with an erythematous base, crusting or oozing present, occurs in areas with the irritant makes contact with the body
Contact dermatitis
Key Findings:
pruritis, erythematous lesions, xerosis, lichenifications, excoriation; commonly as scaly plaques of the cheeks, forehead, scalp and upper extremities
Eczema
Key Findings:
slow growing, asymptomatic, mobile nodules
Epidermoid cysts
Key Findings:
“bulls eye” rash, appears 3-30 days after tick bite, may be mild in color, nonpruritic, nonpainful
Erythema migrans (the lyme rash)
Key Findings:
itching/sore papule/pustule rash, commonly seen in areas where razors are used
Folliculitis
Key Findings:
rash that runs along a dermatome, can be pustule or scaly depending on phase; prodromal phase: tingling, pruritis, burning, throbbing, stabbing pain; acute phase: fatigue, malaise, headache, low grade fever, rash, eruption of lesions
Herpes Zoster (shingles)
Key Findings:
Dark nodular area, can be asymmetric, have border irregularity, color variation, diameter usually larger than 6mm (can be smaller), most commonly on sun-exposed areas of the body
Melanoma
Key Findings:
hyperkeratotic papules with rough irregular surface, commonly occur on the hand and knees, size from 1mm-1cm
Nongenital warts
Key Findings:
slow growing, sun-exposed skin, non-healing sore, waxy papule with central depression, bleed to trauma, crusting, rolled borders, can have translucency
Basal cell carcinoma
Key Findings:
slow growing, raised, firm skin-colored or pink, hyperkeratotic papule/plaque, normally seen over sun-damaged areas
Squamous cell carcinmoa
Key Findings:
reddish/pink, well-demarcated macules, papules and plaques with a silvery scale, pinpoint bleeding with removal of the scales (Auspitz sign)
Psoriasis
Key Findings:
hx of facial flushing; nontransient erythema, telangiectasia, roughness of the skin, comedones absent, neck/upper chest flushing, thickening of the skin of the nose
Rosacea
Key Findings:
intense pruritic rash that worsens at night, lesions seen in a linear pattern, can resemble pimples, eczema or insect bites
Scabies
Key Findings:
red, scaly patches with annular borers and a central clearing, can have a burning sensation
Tinea corporis
Key Findings:
raised wheals that blanch to palpation, appear anywhere on the body, can be pruritic, usually disappear in 24 hours
Urticaria (hives)
Is imaging a standard of practice for concussions?
No, it is not indicated unless there is a worsening of symptoms and concern for a bleed
Key Findings:
Incoordination, delayed verbal expression, inability to focus, blank stare/stunned expression, headache, dizziness, N/V, emotionality and memory deficits
Concussion (acute mild TBI)
Key Findings:
cold intolerance, fatigue, weakness, weight gain, constipation, cognitive dysfunction, bradycardia, diastolic HTN, delayed tendon reflexes, dry/coarse skin, periorbital edema, enlarged tongue, myxedema, heavy menstrual bleeding
Hypothyroidism
Key Findings:
increased perspiration, heat intolerance, hyperpigmentation, itching, thinning hair, lid lag, proptosis/exophthalmos, tachycardia, systolic HTN, A. Fib, weight loss, goiter, anxiety, ammenorrhea
Hyperthyroidism
Nourishes the lens and cornea, is rapidly replaced
Aqueous humor
Fills the cavity of the eye to maintain shape, is not rapidly replaced
Vitreous humor
What is the normal IOP
<21mmHg
When should formal visual screenings begin?
Between ages 4 and 5 and occur every 2 years there after
A cloudy change to the lens of the eye due to a protein buildup
Cataracts
Key Findings:
reddened sclera, watery drainage, occurring often concomitantly with viral URI
Viral conjunctivitis
Key Findings:
scleral erythema, lid swelling, purulent eye drainage, crusting/matting especially in the morning, very contagious
Bacterial conjunctivitis (pink eye)
Elevated IOP from insufficient aqueous humor drainage accompanied by blurry vision, eye pain, headaches, N/V, light halos, eye redness
Glaucoma
Age-related degenerative disease of the macula resulting in central vision loss
Macular degeneration
Key Findings:
floaters, blurry vision, poor night vision, impaired color vision, blank/dark areas in the visual fields
Retinopathy
Acute pustular infection of the eyelid
Sty
Misalignment of the eyes due to an imbalance of EOM function causing one eye to fixate
Strabismus (lazy eye)
Where do most nosebleeds occur from?
The anterior septum
How many lymph nodes are in the head/neck?
Over 300
When does hearing loss screenings need to begin according to USPSTF documents?
> 50 y/o
Key Findings:
otalgia (unilateral), fever, difficulty hearing, bulging erythematous tympanic membrane, can occur concurrently with viral URI, S/S in children can be a tugging at the ear/ear pain
Otitis media (ear infection)
Ringing in the ear
tinnitus
Vascular lesion involving the middle ear and petrous bone
Glomus tumor
Smooth, skin-lined bony lesion in the ear cannal
Osteoma
Key Findings:
sneezing, post-nasal drip, nasal congestion, rhinorrhea, boggy nasal mucosa, posterior pharynx cobblestone
Allergic rhinitis
Key Findings:
nasal congestion, nasal obstruction, postnasal drip, rhinorrhea, “allergy symptoms”, boggy pale enlarged turbinate, round symmetric pale grape-like masses
Nasal polyps
Major risk factors of all HEENT cancers are…
tobacco use, alcohol use, HPV
Mucosal-lined, soft lesions filled with thick fluid accompanied by cough, scratchy throat, halitosis
Tonsil cyst
Key Findings:
found more often in young children, cause by Coxsackie group A viruses, high fever, headache, anorexia, sore throat, ulcerative lesions of the mouth/throat
Herpangina
Spots in the eyes are called…
scotomas
What is the air conduction to bone conduction ratio?
2:1
