HEENT Flashcards
the sinuses
frontal, ethmoid, sphenoid, maxillary
medications that increase nasal congestion
angiotensin-converting enzyme inhibitirs (ACE), beta blockers and OCP.
rhinorrhea
nasal discharge
unilateral nasal discharge indicates….
obstruction, polyp, tumor or foreign body
epistaxis
nose bleeds
herbal therapy that contributes to epistaxis
ginko biloba increases risk for bleeding related to anti platelet activity
common disorders of the nose
common cold, URI, sinusitis, allergic rhinitis, asthma
crepitus on palpation of the sinus indicates….
a large amount of exudates
transillumination of the sinuses
a red glow for air filled, when red is absent the sinus is filled with fluid or drainage
allergic rhinitis
bilateral clear discharge, boggy nasal mucosa, allergic shiners and nasal crease on exam. Often the patient and family have a history of seasonal allergies, eczema or asthma
sinusitis
thick green to dark yellow, often foul smelling discharge, absence of red glow upon transillumination. patient will report dull ache over the cheeks and above eyes that increases when bending over.
radioallergosorbent test (RAST)
a blood assay of the IgE antibodies which can indentify specific allergens.
intradermal sensitivity studies
suspected allergens are planted under the skin and the response is evaluated, a local reaction can occur
eosinophil count
a mucus smear from the nasal passage is assessed to gauge the degree of reaction but lacks specificity
Other condition that may affect nasal congestion
thyroid conditions
nasal/sinus considerations in the pregnant patient
increased congestion due to changes in hormones, circulating fluid volume.
increased vascularity due to changing hormones contribute to nosebleeds
nasal/sinus considerations of the geriatric patient
decreased hydration leads to increased frailty of the mucosa. Anticoagulant therapy can increase bleeding.
salivary glands of the oropharynx
parotid gland - in cheek anterior to ear, secretes via stensons ducts located in the cheek, sublinguial gland - secretes via whartons ducts located on either side of the frenulum, and submandibular gland - located under the tongue and secretes via the ducts on the floor of the mouth posterior to whartons ducts
nerve enervate of the mouth and tongue
IX and X - swallowing, rise of palate, gag reflex
V, VII, X and XII - modulate voice, speech
XII the tongue
dysphonia
disturbance of pitch
dysphagia
difficulty swallowing
dysarthria
disturbance of speech
differential of sore throat symptoms by etiology
bacterial are often abrupt, with severe pain and difficulty swallowing
viral are usually gradual (and can be post-bacterial) and not as severe in quality
allergic associated - often characterized as itchy, scratchy or irritated
nutritional deficiencies associated with bleeding gums
vitamin K or vitamin C deficiency
medications that increase risk for bleeding gums
oral contraceptives, hormone replacement therapy, anticoagulants, aspring, NSAIDS, ginko biloba
halitosis
bad breath
differential of halitosis based on odor description
sweet and fruity - diabetes fecal - large bowel obstruction musty, sweet, or mousy hay odor - hepatic encephalopathy musty or ammonia - end stage renal dz musty - common cold or chronic sinusitis
tooth pain
often caused by tooth decay, loss of filling or development of carry, eruption of wisdom teeth
common mouth ulcerations
canker sores often occur in winter and spring, and have sudden onset, located in the mouth
impetigo - honey colored exudate, usually perioral
herpetic lesions have prodromal sx, perioral location
candida - white lesions that can be scraped off leaving shallow ulcerations, located within the mouth on palate bucal surfaces and tongue
white lesion that cannot be moved - consider cellular dysplasia or early squamous cell CA
social and family history components to oral cancer
increased risk with family history, smoking, oral tobacco use, and ETOH
leukoplakia
white patches which can be considered a precancerous lesion
bacterial pharyngitis, tonsillitis
actue onset, with family or colleguaes who’ve been ill, often in winter or spring.
erythem of the pharynx or tonsils with white to yellow exudate is seen, fever of 101 or greater
Dx with culture and sensitivity, quick beta strep test
viral pharyngitis, tonisilitis
rapid onset, with system sx, cough, rhinnorrhea, conjunctivitis, rarely exudate will be seen
irritation of throat r/t post nasal drip
seasonal allergies, in Hx, mild to moderate pain that increases when lying down per pt. On inspection, clear nasal discharge that drains to the posterior throat, congestion, and boggy nasal turbinates
common mouth findings in pregnancy
gingival hyperplasia and bleeding
mouth considerations for the older patient
problems assoc. with the loss of teeth, changes in taste, dental caries, dry mouth, varicose veins under tongue common
palpebral fissure
the opening of the eyelids
meiobian glands
glads along the tarsal plastes within the eyelids which secret an oily lubricating substance at the lid margin to prevent excessive evaporation of tears and provide a seal when eyes are closed
levator palpebrae
muscle that controls the upper eyelid, innervated by the oculomotor nerve
kerratitis sicca
dry eyes, caused by an imbalance between tear production and tear drainage via the nasolacrimal ducts
aqueous humor
a fluid that circulations through the posterior changer through the pupil to anterior chamber and is produced by the ciliary body, drains out through the canal of Schlemm. Intraocular pressure should be 15 mmHg + or - 3mm
macula lutea and fovea
fovea is a small depression in the retinal surface that marks the point of central vision, surrounded by darkened area which is the macula and distinguishes fine detail and colors
optic disc
location of the optic nerve and retinal vessels
ciliary body
controls the thickness of the lens to accomodate for a clear focused image to refracted onto the retina. it also produces aqueous humor
rods and cones of the retina
translate the lith into electrical impuls
convergence
the movement of the eyes inward, which brings images together. extraoccular muscles maintain the balance to hold two images parallel
common causes of severe eye pain
corneal ulcer, uveitis, acute angle-closure glaucoma and endopthalmitis
glaucoma sx
presents with eye pain, photophobia, and visualization of halos
endocrine conditions with eye manifestations
diabetes - diabetic retinopathy, vascular disease
cardiac conditions with eye manifestations
hypertension can result in ocular hemorrhage
neurologic conditions with eye manifestations
headache - papilledema (increased ICP) and glaucoma (increased IOP)
nystagmus - congenital - hydrocephalus, diencephalic tumors, medication toxicity, Arnold-chiari malformation, brain tumor, anomalies
nystagmus - acquired- blindness, MS peripheral vestibular dz, cerebellar or brain stem disease, drug use
Handheld near vision screaner
Rosenbaum or Jaeger
Color vision plates
Ishihara or Hardy Rand Ritter
proptosis
abnormal protrusion of the eye which may indicate graves disease
ptosis
eyelid droop which can indicate 3rd nerve palsy or myasthenia gravis
xanthelasma
creamy yellow plaques on teh eyelids indicating abnormal lipid deposits
hordeolum
a style, or abscess in teh eyelash follicle
chalazion
inflammatory granuloma of the meibomian gland
blepharitis
crusting of the eyelids, thickening othe eyelids and plgugin gof the meibomian glands
pterygia
tissue growth from the periphery toward the cornea, often develop in response to chronic irritation of he cornea, such as from wind
arcus senilis
a white opaque ring around the limbus, may indicate hyperlipidemia in those under 40
hyphema
blood in the anterior chamber is usually the result of trauma or surgery
absence of red reflex
retinal detachment, chorioretinitis, retinostoma
leukokoria
white retinal reflex
soft contact lense wearers are at risk for this infection
Pseudomonas
foreign body in eye
tearing, visualization of body, relief of pain after irrigation, Dx with flueorescein stain, examination with cobalt blue light, opthalmic or slit lamp examination
corneal abrasion
accompanied by tearing, photophobia, corneal defect, Dx with Fluorescein stain, examination with cobalt blue light, otphtalmic or slit lamp examination
herpetic lesions of eye
herpetic rash may be present, eye pain, no hx of trauma, vesicular rash may be sen, if nose is involved then ocular involvement is likely, epithelial dendrite stains green with fluorescein stain on eye.
ossicles
malleus - hammer
incus - anvil
stapes - stirrups
typanic membrane landmarks
cone of light, ?
common causes of otalgia (ear pain)
primary - infections, inflammations of middle and external ear structures
secondary - TMJ problems, dental adn periodontal problems, infections in the sinuses and nasopharyngeal areas, lesions of the tongue, cervical MSK problems and neuralgias involving cranial nerves V, VII, IX and cervial cerves I, II, and III
causes of gradual hearing loss
presbycusis, ototoxic drugs, chronic infection, otosclerosis, brain attack
causes of sudden hearing loss
acute otitis media, nasophyringeal infections, meningitis, sudden occlusion of external ear canal, sudden accumulation of middle ear fluid or blood, acute performation of tympanic membrane
tinnitus
originate in central auditory system and affect 10% of population
gradual onsent tinnitus causes
advancing age, meieres disease, otosclerosis, metabolic conditions of diabetes and hypothyroidism, and TMJ
acute onset tinnitus causes
acoustic and baro trauma, acute occlusion, allergies, sudden alteration of BP up or down, head and neck injury, acute ototoxic drug therapy and infections
otorrhea
discharge from ear
clear mucoid - chronic otitis media with TM perforation
clear watery - CSF d/t basilar skull fx and TM perforation, eczema of external ear
white - fungal infection or term conditons of ext ear
bloody- chronic infection or trauma
brown/gray - liquefied cerumen
vertigo
dizziness related to disorder of the inner ear
breif vertigo
associated with benign paroxysmal positional vertigo
veritgo that last hours
usually associated with menieres Dz, viral labrynthitis, perilymph fistula
long periods of vertigo
assocated with vertibrobasilar insufficiency, other CNS conditions, systemic autiommune dzi like rheumatoid dz, systemic metabolic dz like DM or hypothyroid
ototoxic drugs
aminoglycosides, salicylates, loop diuretics, nitrogen mustards, bleomycin, cisplatimun, vincristine, heavy metal exposure, and quinine derivatives.
tinnitus related drugs
ACE inhibitors, macrolides, quinolones, slufa antibiotics, tricyclic antidepressants, antihistamines, beta blockers, CA channel blockers, some narcotics, and NSAIDS
congential syndromes associated with inheritied ear conditions
down syndrome, usher syndrome, treacher collins syndrome, fetal alcohol syndrome, crouzon syndrome, alport syndrome, hemifacial microsemia, stickler syndrome, branchio-otorenal syndrome, Pendred syndrome, CHARGE association, neurofibromatosis type II, Waarden bur syndrome, congential rubella syndrome, pierr robine syndrome, trisomy 13, and cleft lip/palate
bulging tympanic membrane
reliable indicator of acute otitis media
presbycusis
age related hearing loss common in elderly
Geographic tongue
Benign variation of smooth tongue and raised papillae, has a map like appearance
Hairy tongue
Black hairy appearance, elongated darkened papillae, benign
Often due to staining or antibiotic treatment
Nodes of the neck
Preauricular Post-auricular Occipital Tonsilar Submaxillary Submental Superficial cervical Deep cervical Posterior cervical Supraclavicular Infraclavicular
