HEENT Flashcards
Whats the diagnosis?
Exotosis: benign, bony growths
Whats the diagnosis?
Keloid: firm, nodular, hypertrophic mass of scar tissue, may occur after ear piercing
Whats the diagnosis? And what do you do?
Chondrodermatitis helicis: chronic inflammatory lesion that starts out painful or tender papules on the helix of antihelix
Biopsy to rule out carcinoma (benign, sometimes self resolves: unknown cause
Whats the diagnosis?
Tophi: deposit of uric acid crystal’s characteristic of gout
Whats the diagnosis?
Basal cell carcinoma: raised nodule shows the lustrous surface and telangiectatic vessels or basal cell carcinoma, common, slow growing malignancy, growth and ulceration may occur
Whats the diagnosis?
Cutaneous cyst/sebaceous cyst: dome shaped lump in the dermis that forms a benign, closed sack attached to the epidermis
Whats the diagnosis?
Rheumatoid nodules: seen in chronic rheumatoid arthritis (may be on hands or elbows)
Whats the diagnosis?
Periauricular tag: maybe benign and occur by themself OR be associated with congenital syndromes
Whats the diagnosis?
Preauricular sinus/preauricular pit:
May be associated with hearing loss, renal development issues
Screen and repeat hearing screen
Whats the diagnosis?
Acute otitis externa (acute swimmers ear)
Whats the diagnosis?
Acute otitis externa (acute swimmers ear)
Whats the diagnosis?
Perforation of the tympanic membrane
Whats the diagnosis?
Perforation of the tympanic membrane
Whats the diagnosis?
Tympanosclerosis
Whats the diagnosis?
Tympanosclerosis
Whats the diagnosis
Serous otitis or OME (otitis media with effusion) aka same thing
Whats the diagnosis?
Serous otitis or OME
Whats the diagnosis?
Acute otitis media
Whats the diagnosis?
Acute otitis media
Whats the diagnosis?
Bullous myringitis
Whats the diagnosis?
Bullous myringitis
Ear exam under 12 months
Pull auricle down and out
Whats the diagnosis?
Allergic sinuses
(Pale, bluish, red) boggy
What is the diagnosis?
Viral sinuses
Red swollen
Whats is this
Papillae
Normal
Whats the diagnosis?
Apthus ulcer/canker sore: trauma, dental work, ill-fitting dentures, stress, family hx
Suspicious ulcers or nodules should be palpated for thickening or infiltration of the tissues suggestive of malignancy
What is the diagnosis?
Carcinoma on the tongue: usually on side or bade of tongue, any persistent nodule or ucler, red or white, especially if indurated (erythroplakia and leukoplakia)
Whats the diagnosis?
Angular chelitis: nutritional deficits (b2, iron)
Over closure of the mouth (no teeth, ill-fitting dentures)
Infection with candida due to saliva macerating folds
Whats the diagnosis?
Acitinic chelitis: precancerous, lips lose normal redness and may become scaly and somewhat thickened
Primarily affects the lower lip, seen with fair-skinned men, indicates solar damage which predisposes persons to squamous cell carcinoma
Whats the diagnosis?
HSV
Whats the diagnosis
Angioedema: localized subcutaneous or submucosal swelling that is caused by leakage of the intravascular fluid into the interstitial tissue
Whats the diagnosis?
Hereditary hemorrhagic telangiectasia
Multiple red spots on the lips
What is the diagnosis?
Peutz-jeghers syndrome
Prominent small brown pigmented spots in the dermal layer of the lips, buccal mucosa and perioral area, spots may also appear on hands and feet. Spots are rarely found around the nose and mouth
What is the diagnosis?
Syphilitic chancre
Ulcerated papule with indurated edge-infectious
Usually appears after 3-6 weeks of incubating infection
Whats the diagnosis?
Carcinoma
Usually affects the lower lip, scaly plaque
Can be an ulcer with or without a crust or a nodular lesion
Whats the diagnosis?
Large, normal tonsils
Whats the diagnosis?
Exudative tonsils
Red throat, enlarged cervical nodes
Group A strep (anterior)
Mono (posterior)
What is the diagnosis?
Non exudative pharyngitis
What is the diagnosis?
Diptheria
Red throat with grey exudate present on uvula, pharynx and tongue
What is the diagnosis?
Thrush: yeast infection from candida species
Cream colored to blueish white plaques that adhere to tongue, mouth or pharynx
What is the diagnosis?
Kaposi sarcoma
Deep purple lesions suggest low grade vascular tumor associated with Human Herpesvirus 8
Also may affect GI tract and lungs sometimes seen in AIDS
Whats the diagnosis?
Torus palatinus
Midline bony growth of hard palate fairly common in adults
Harmless
What is the diagnosis?
Torus palantinus
What is the diagnosis?
Fordyce spots
Normal sebaceous glands that appear as small yellowish spots in the buccal mucosa or the lips
Usually not numerous
Whats the diagnosis?
Koplik spots
Early sign of measles
Small white specks resembling grains of salt surrounded by a redring background usually appearing on the buccal mucosa first near molars
Measles rash the next day
What is the diagnosis?
Petechiae
Small red spots caused by blood that escapes from the capillaries into the tissues.
May be from tissue-biting, trauma, infection, decreased platelets
Whats the diagnosis?
Leukoplakia: thickened white patch that may occur anywhere on oral mucosa
Benign reactive process of the squamous epithelium that could lead to cancer and should be biopsied.
What is the diagnosis?
Geographic tongue
Maplike appearance (areas stripped of papillae with other normal rough coated areas)
Benign condition
Whats the diagnosis?
Fissured tongue/furrowed tongue
Benign
Increased occurrence with age
May trap food debris
Whats the diagnosis?
Smooth/atrophic glossitis
Loss of papillae
Associated with deficiencies in riboflavin, niacin, folic acid, B12, pyridoxine or iron
Also seen with chemo
What is hyperopia?
Farsightedness
Difficulty seeing up close
What is presbyopia?
Aging vision
Loss of elasticity of the lens related to aging
What is myopia?
Nearsightedness
Difficulty with distances
What is central vision loss?
A literal black spot in center of vision
Usually from damage to the macula (center of the retina)
Etiologies: age-related macular degeneration, retinopathy, macular edema
What is peripheral vision loss? And what can cause it?
Can only see the center
Can be related to ocular migraine or a vitreous floater
Or retinal detachment or a pituitary tumor
Other causes: stroke, retinis pigmentosa, brain aneurysms, and glaucoma
What are vitreous floaters?
Moving specks or strands
Caused by natural shrinking of the gel like fluid in your eye that happens as you age. Microscopic collagen fibers that float into the vitreous and cast shadows on the retina
What is hemianopsia?
One sided loss
Common after stroke or brain injury
Scotomas
Fixed defects
Suggest lesions in the retina or visual pathway
What are the symptoms of Retinal detachment
Flashing lights with new vitreous floaters
What is horizontal diplopia?
Palsy of CN II or VI
Diplopia: lesions of the brain stem or cerebellum or weakness of paralysis of one or more of EOMs
What does diplopia in one eye with the other closed suggest?
Suggests a problem with ocular surface, cornea, lens or macula
What is vertical diplopia?
Palsy of CN III or IV
Physiologic diplopia: normal double vision
Whats the diagnosis?
Goiter
Whats the diagnosis?
Esotropia
(Inward deviation)
Whats the diagnosis?
Exotropia
(Outward deviation)
Disconjugate gaze is
Seen in
Developmental disorders (appearing in early childhood due to an imbalance in ocular muscle tone)
Failure of the eyes to turn together in the same direction
Disorders of the cranial nerves: cranial nerve injury, lesions, MS, syphilis
Whats the diagnosis?
Ptosis
Drooping of upper lid (MG, damage to CN II, damage to the sympathetic nerve supply (Horner syndrome) or congenital
The right ear has the cone of light at?
5 O’clock
What are the two ossicles visible through the tympanic membrane?
Malleus and umbo
Where is the cone of light in the left ear?
At 7 O’clock
What is the hearing pathway?
Conductive: external ear through middle ear
Sensorineural phases: cochlea to cochlear nerve
What things can cause CONDUCTIVE hearing loss?
External: cerumen impaction, SCC,
Benign growths like exostoses or osteomas
Middle ear: otitis media, congenital conditions, cholesteatomas, tumors, perforations
What are SENSORINEURAL conditions?
Congenital/ hereditary, rubella, CMV, menieres disease, noise exposure, ototoxic drugs, acoustic neuroma
What is the diagnosis?
Entropion
Elderly
Inward turning of the lid at the lid margin
Whats the diagnosis?
Exopthalamos and lid retraction
Note the rim of sclera
What is the diagnosis?
Pinguecula
Yellowish triangular nodule in the bulbar conjunctiva
Aging (deposits of protein and fat in the conjunctiva)
Whats the diagnosis?
Episcleritis
Localized ocular inflammation of the episcleral vessels (between the sclera and conjunctiva)
Seen in RA, sjorgen, herpes zoster
What is the diagnosis?
Stye (hordeolum)
Painful, red, tender outer margin of the eyelid (infection of the oil gland often staph)
What is the diagnosis?
Chalazion
Subacute, nontender, palpable nodule-blocked gland (inside the lid rather than on the margin)
Blocked oil gland
What is the diagnosis?
Xanthelasma
Slightly raised, yellow, well circumscribed cholesterol tilled plaques along nasal portions of the eyelids
1/2 of these patients have hyperlipidemia
Also common in biliary cirrhosis
What is the diagnosis?
Blerpharitis
Chronic inflammation of the eyelids at the base of the hair follicle (staph)
Scaling with seborrheic
What is the diagnosis?
Corneal Arcus
Thin, grayish white arc or circle at the edge of the cornea
Aging, common in people with darker skin
Usually benign but can suggest hyperlipoproteinemia in young adults
What is the diagnosis?
Cataracts
Opacity of the lens, visible through the pupil, absence of red reflex
Whos at risk?
Diabetes
Older age
Corticosteroid use
Whats the diagnosis?
Normal eye
Major vessels, slightly darker fovea
Darker macula
Fovea slightly discernible
No light reflex
Choroidal vessels
(People with darker skin may have darker vessels)
Whats the diagnosis?
Papilledema
Disc swollen, margins blurred, physiologic cup not visible
Sign of increased ICP
Usually seen with meningitis, subarachnoid hemorrhage, trauma, mass
What is the diagnosis?
Cotton-wool patches
Soft exudates- white or greyish (smaller than disc)
Usually with HTN, DM, HIV
Represent ischemia of nerve fiber layer
You may see AV crossing or nicking with chronic HTN
Whats the diagnosis?
Proliferative retinopathy with neovascularization
Pre retinal vessels arising on the disc, extending across the disc margins
(Risk for vision loss is high)
Difficulty with vision during close work suggests?
Hyperopia (farsightedness) or presbyopia (aging vision)
Difficulty with seeing things at a distance suggests
Myopia (nearsightedness)
A patient comes in with sudden vision loss that is unilateral and painless. What does the NP consider?
Vitreous hemorrhage from DM or trauma
Retinal detachment
Retinal vein occlusion or central retinal artery occlusion
A patient comes in with unilateral vision loss that is painful. What does the FNP consider for a diagnosis?
Causes are usually in the cornea and anterior chambers such as corneal ulcer, uveitis, traumas hymphema and acute angle closure glaucoma.
Optic neuritis from MS
If associated with headache conduct neuro exam
Unilateral vision loss with a headache,jaw pain or claudication. Whats the possible diagnosis?
Giant cell areritis.
If painless it may be associated with a vascular occlusion, retinal detachment or hemorrhage.
Patient presents with bilateral vision loss that is painless. What diagnosis would you consider?
Vascular etiologies, stroke or non-physiologic causes.
Bilateral vision loss that is painful. What diagnosis would you consider?
Intoxication
Trauma
Chemical or radiation exposures
Gradual vision loss usually arises from?
Cataracts
Glaucoma
Macular degeneration
Slow central vision loss may occur with
Nuclear cataract and macular degeneration
Peripheral vision loss can be caused by?
Advanced open angle glaucoma with unilateral loss with hemianopsia and quadratic defects
(Though they may be symmetric theses conditions are often bilateral disease processes)
Moving specks or strands in the eye suggests what diagnosis?
Vitreous floaters
A patient is complaining of fixed defects in the eyes where they cannot see. What diagnosis does this suggest?
Scrotomas (fixed defects)
Suggest lesions in the retina, visual pathway or brain
Flashing lights with nee vitreous floaters suggests what diagnosis?
Suggest traction on the retina with detachment of the vitreous body from the retina.
PROMPT consultation!! We want to rule out retinal tears or detachments
Diplopia
Is seen in lesions in the brainstem or cerebellum and with weakness or paralysis of one of more extraocular muscles.
Horizontal diplopia
Palsy of CNIII or VI
Vertical diplopia
Palsy of CN III OR CN IV
Diplopia in one eye while the other is closed
Suggests a problem in the ocular surface, cornea, lens or macula
Visual acuity
Expressed as two numbers ( ie 20/30)
First number: the distance of the patient from the chart
Second number: the distance at which the normal eye can read the line of letters
What do you put for a visual acuity for someone wearing glasses?
“Corrected” at the end
Ie. 20/40 corrected
A person is considered legally blind when
Vision in the better eye corrected by glasses is 20/200 or less
Also results from a constricted field of vision, which is 20 degrees or less in the better eye
Hearing loss related to age is…
Gradual
What do you want to know for health history r/t ears?
Hearing loss
Ear pain
Discharge
Tinnitus
Vertigo
If a patient says they feel like they are talking under water
They have a lot of congestion/ fluid in the ear
What test is used for color blindness?
Pseudoisochromatic test
What is the most common color vision abnormality?
Sex-linked congenital red-green deficiencies
Hyper or hypoglobus may refer to deviation in the globe position which may result from
Congenital abnormalities, lacrimal gland enlargement, mucocele or ocular tumors
What could cause proptosis (abnormal eye protrusions)
Thyroid eye disease
Congenital abnormalities
Orbital infections
Ocular tumors
Upslanting palpebral fissures of the eyelids are noted in what diagnosis?
Down syndrome
Lagophthalmos
Failure of eyelids to close
Can happen after neuromuscular palsy, trauma, and thyroid eye disease
It exposes the cornea to serious damage
PLACE stat referral
What is the most common form of glaucoma?
Open angle glaucoma
The normal spatial relation between the iris and the cornea is preserved and the iris is fully lit
Miosis
Constriction of the pupils
Mydriasis
Dilation of the pupils
How does the NP test for light reaction of pupils?
Ask the patient to look into the distance, and shine a bright light obliquely into each pupil in turn.
Look for direct reaction and consensual reactions
What is a direct reaction to light?
Pupillary constriction in the same eye
Consensual reaction
Pupillary constriction in the opposite eye
What is the arrow pointing to?
The optic disc
Artery vs vein of the eye
Artery:
Light red
Smaller (2/3 to 3/4 the diameter of veins)
Light reflex is bright
Veins:
Dark red
Larger
Inconspicuous light reflex or absent
Conjunctivitis
Conjunctival injection: diffuse dilatation of conjunctival vessels with redness that tends to be maximal peripherally.
Mild discomfort rather than pain
Vision not affected
Watery, mucoid discharge
Bacterial, viral and other infections
Subconjunctival hemorrhage
Leakage of blood outside the vessels, producing a homogeneous, sharply demarcated, red area that resolves over 2 weeks
No pin
Vision not affected
No ocular discharge
May result from trauma or bleeding disorders
Corneal injury or infection
Ciliary injection
Moderate to severe pain
Vision usually decreased
Discharge watery or purulent
Abrasions and other injuries
Viral and bacterial infections
Conductive phase of hearing
Part of the hearing pathway from the external ear through the middle ear
Sensorineural phase of hearing
Involves the cochlea and the cochlear branch of CN VIII
Diffuse thyroid enlargement
Suggestive of graves disease, hashimotos thyroiditis or edemic goiter
Single thyroid nodule
May be a cyst, benign tumor or one nodule within a multinodular gland. It raises the question of malignancy.
Risk factors: prior irradiation, hardness, rapid growth, fixation to surrounding tissues, enlarged cervical nodes and occurrence in men.
Sub conjunctival hemorrhages in neonates
Common in neonates born via vaginal delivery
Colobomas
Missing sections of tissue in the eye
Brushfield spots
Seen with an opthalmoscope
A ring of white specks in the iris
Although sometimes seen in normal kids, usually suggests down syndrome
Acoustic blink reflec
Blinking of the infants eyes in response to a sudden sharp sound
Congenital torticollis
“Wry neck”
Is from bleeding into the sternocleidomastoid muscle during the stretching process during delivery or to in utero positioning.
A firm fibrous mass is felt within the muscle 2-3 weeks after birth and generally disappears over months
Name these retraction sites
(Top to bottom)
1. Supraclavicular retractions
2.intercostal retractions
3.substernal retractions
4.Subcostal retractions
This test compares bone conduction and air conduction which aides in determining whether hearing loss is conductive vs senorineural
Rinne test
This examination tool allows you to assess the mobility of the tympanic membrane as you increase and decrease the pressure in the external auditory canal
Pneumatic otoscope
This test assesses for lateralization in unilateral hearing loss
Weber test
What is the weber test?
Unilateral only
Place ontop of patients head
Normally heard in both ears
Weber test: patient hears sound unilaterally in impaired ear
Conductive hearing loss
Webber test: senorineural loss
They hear it in the good ear
Rinne test
Normal: air conduction should be heard longer than bone conduction
For pedi patient ear exam
Infants: down and back
Older kids: up out and back
Centors criteria
(Probability of strep pharyngitis
Fever
Exudate
Anterior cervical lymphadenopathy
Absence of a cough
