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Advanced Health Assessment > HEENT > Flashcards

HEENT Flashcards

1
Q

Whats the diagnosis?

A

Exotosis: benign, bony growths

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2
Q

Whats the diagnosis?

A

Keloid: firm, nodular, hypertrophic mass of scar tissue, may occur after ear piercing

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3
Q

Whats the diagnosis? And what do you do?

A

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

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4
Q

Whats the diagnosis?

A

Tophi: deposit of uric acid crystal’s characteristic of gout

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5
Q

Whats the diagnosis?

A

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

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6
Q

Whats the diagnosis?

A

Cutaneous cyst/sebaceous cyst: dome shaped lump in the dermis that forms a benign, closed sack attached to the epidermis

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7
Q

Whats the diagnosis?

A

Rheumatoid nodules: seen in chronic rheumatoid arthritis (may be on hands or elbows)

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8
Q

Whats the diagnosis?

A

Periauricular tag: maybe benign and occur by themself OR be associated with congenital syndromes

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9
Q

Whats the diagnosis?

A

Preauricular sinus/preauricular pit:
May be associated with hearing loss, renal development issues

Screen and repeat hearing screen

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10
Q

Whats the diagnosis?

A

Acute otitis externa (acute swimmers ear)

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11
Q

Whats the diagnosis?

A

Acute otitis externa (acute swimmers ear)

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12
Q

Whats the diagnosis?

A

Perforation of the tympanic membrane

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13
Q

Whats the diagnosis?

A

Perforation of the tympanic membrane

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14
Q

Whats the diagnosis?

A

Tympanosclerosis

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15
Q

Whats the diagnosis?

A

Tympanosclerosis

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16
Q

Whats the diagnosis

A

Serous otitis or OME (otitis media with effusion) aka same thing

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17
Q

Whats the diagnosis?

A

Serous otitis or OME

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18
Q

Whats the diagnosis?

A

Acute otitis media

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19
Q

Whats the diagnosis?

A

Acute otitis media

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20
Q

Whats the diagnosis?

A

Bullous myringitis

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21
Q

Whats the diagnosis?

A

Bullous myringitis

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22
Q

Ear exam under 12 months

A

Pull auricle down and out

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23
Q

Whats the diagnosis?

A

Allergic sinuses
(Pale, bluish, red) boggy

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24
Q

What is the diagnosis?

A

Viral sinuses
Red swollen

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25
Q

Whats is this

A

Papillae

Normal

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26
Q

Whats the diagnosis?

A

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

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27
Q

What is the diagnosis?

A

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)

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28
Q

Whats the diagnosis?

A

Angular chelitis: nutritional deficits (b2, iron)

Over closure of the mouth (no teeth, ill-fitting dentures)

Infection with candida due to saliva macerating folds

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29
Q

Whats the diagnosis?

A

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

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30
Q

Whats the diagnosis?

A

HSV

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31
Q

Whats the diagnosis

A

Angioedema: localized subcutaneous or submucosal swelling that is caused by leakage of the intravascular fluid into the interstitial tissue

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32
Q

Whats the diagnosis?

A

Hereditary hemorrhagic telangiectasia
Multiple red spots on the lips

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33
Q

What is the diagnosis?

A

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

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34
Q

What is the diagnosis?

A

Syphilitic chancre
Ulcerated papule with indurated edge-infectious
Usually appears after 3-6 weeks of incubating infection

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35
Q

Whats the diagnosis?

A

Carcinoma

Usually affects the lower lip, scaly plaque
Can be an ulcer with or without a crust or a nodular lesion

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36
Q

Whats the diagnosis?

A

Large, normal tonsils

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37
Q

Whats the diagnosis?

A

Exudative tonsils
Red throat, enlarged cervical nodes

Group A strep (anterior)
Mono (posterior)

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38
Q

What is the diagnosis?

A

Non exudative pharyngitis

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39
Q

What is the diagnosis?

A

Diptheria

Red throat with grey exudate present on uvula, pharynx and tongue

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40
Q

What is the diagnosis?

A

Thrush: yeast infection from candida species
Cream colored to blueish white plaques that adhere to tongue, mouth or pharynx

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41
Q

What is the diagnosis?

A

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

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42
Q

Whats the diagnosis?

A

Torus palatinus

Midline bony growth of hard palate fairly common in adults

Harmless

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43
Q

What is the diagnosis?

A

Torus palantinus

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44
Q

What is the diagnosis?

A

Fordyce spots

Normal sebaceous glands that appear as small yellowish spots in the buccal mucosa or the lips

Usually not numerous

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45
Q

Whats the diagnosis?

A

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

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46
Q

What is the diagnosis?

A

Petechiae
Small red spots caused by blood that escapes from the capillaries into the tissues.

May be from tissue-biting, trauma, infection, decreased platelets

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47
Q

Whats the diagnosis?

A

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.

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48
Q

What is the diagnosis?

A

Geographic tongue

Maplike appearance (areas stripped of papillae with other normal rough coated areas)

Benign condition

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49
Q

Whats the diagnosis?

A

Fissured tongue/furrowed tongue
Benign
Increased occurrence with age
May trap food debris

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50
Q

Whats the diagnosis?

A

Smooth/atrophic glossitis
Loss of papillae
Associated with deficiencies in riboflavin, niacin, folic acid, B12, pyridoxine or iron

Also seen with chemo

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51
Q

What is hyperopia?

A

Farsightedness
Difficulty seeing up close

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52
Q

What is presbyopia?

A

Aging vision
Loss of elasticity of the lens related to aging

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53
Q

What is myopia?

A

Nearsightedness
Difficulty with distances

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54
Q

What is central vision loss?

A

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

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55
Q

What is peripheral vision loss? And what can cause it?

A

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

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56
Q

What are vitreous floaters?

A

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

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57
Q

What is hemianopsia?

A

One sided loss
Common after stroke or brain injury

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58
Q

Scotomas

A

Fixed defects
Suggest lesions in the retina or visual pathway

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59
Q

What are the symptoms of Retinal detachment

A

Flashing lights with new vitreous floaters

60
Q

What is horizontal diplopia?

A

Palsy of CN II or VI

Diplopia: lesions of the brain stem or cerebellum or weakness of paralysis of one or more of EOMs

61
Q

What does diplopia in one eye with the other closed suggest?

A

Suggests a problem with ocular surface, cornea, lens or macula

62
Q

What is vertical diplopia?

A

Palsy of CN III or IV
Physiologic diplopia: normal double vision

63
Q

Whats the diagnosis?

A

Goiter

64
Q

Whats the diagnosis?

A

Esotropia
(Inward deviation)

65
Q

Whats the diagnosis?

A

Exotropia
(Outward deviation)

66
Q

Disconjugate gaze is

A

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

67
Q

Whats the diagnosis?

A

Ptosis
Drooping of upper lid (MG, damage to CN II, damage to the sympathetic nerve supply (Horner syndrome) or congenital

68
Q

The right ear has the cone of light at?

A

5 O’clock

69
Q

What are the two ossicles visible through the tympanic membrane?

A

Malleus and umbo

70
Q

Where is the cone of light in the left ear?

A

At 7 O’clock

71
Q

What is the hearing pathway?

A

Conductive: external ear through middle ear

Sensorineural phases: cochlea to cochlear nerve

72
Q

What things can cause CONDUCTIVE hearing loss?

A

External: cerumen impaction, SCC,
Benign growths like exostoses or osteomas

Middle ear: otitis media, congenital conditions, cholesteatomas, tumors, perforations

73
Q

What are SENSORINEURAL conditions?

A

Congenital/ hereditary, rubella, CMV, menieres disease, noise exposure, ototoxic drugs, acoustic neuroma

74
Q

What is the diagnosis?

A

Entropion
Elderly
Inward turning of the lid at the lid margin

75
Q

Whats the diagnosis?

A

Exopthalamos and lid retraction
Note the rim of sclera

76
Q

What is the diagnosis?

A

Pinguecula
Yellowish triangular nodule in the bulbar conjunctiva
Aging (deposits of protein and fat in the conjunctiva)

77
Q

Whats the diagnosis?

A

Episcleritis
Localized ocular inflammation of the episcleral vessels (between the sclera and conjunctiva)

Seen in RA, sjorgen, herpes zoster

78
Q

What is the diagnosis?

A

Stye (hordeolum)
Painful, red, tender outer margin of the eyelid (infection of the oil gland often staph)

79
Q

What is the diagnosis?

A

Chalazion

Subacute, nontender, palpable nodule-blocked gland (inside the lid rather than on the margin)

Blocked oil gland

80
Q

What is the diagnosis?

A

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

81
Q

What is the diagnosis?

A

Blerpharitis

Chronic inflammation of the eyelids at the base of the hair follicle (staph)
Scaling with seborrheic

82
Q

What is the diagnosis?

A

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

83
Q

What is the diagnosis?

A

Cataracts
Opacity of the lens, visible through the pupil, absence of red reflex

Whos at risk?
Diabetes
Older age
Corticosteroid use

84
Q

Whats the diagnosis?

A

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)

85
Q

Whats the diagnosis?

A

Papilledema

Disc swollen, margins blurred, physiologic cup not visible
Sign of increased ICP

Usually seen with meningitis, subarachnoid hemorrhage, trauma, mass

86
Q

What is the diagnosis?

A

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

87
Q

Whats the diagnosis?

A

Proliferative retinopathy with neovascularization

Pre retinal vessels arising on the disc, extending across the disc margins

(Risk for vision loss is high)

88
Q

Difficulty with vision during close work suggests?

A

Hyperopia (farsightedness) or presbyopia (aging vision)

89
Q

Difficulty with seeing things at a distance suggests

A

Myopia (nearsightedness)

90
Q

A patient comes in with sudden vision loss that is unilateral and painless. What does the NP consider?

A

Vitreous hemorrhage from DM or trauma
Retinal detachment
Retinal vein occlusion or central retinal artery occlusion

91
Q

A patient comes in with unilateral vision loss that is painful. What does the FNP consider for a diagnosis?

A

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

92
Q

Unilateral vision loss with a headache,jaw pain or claudication. Whats the possible diagnosis?

A

Giant cell areritis.

If painless it may be associated with a vascular occlusion, retinal detachment or hemorrhage.

93
Q

Patient presents with bilateral vision loss that is painless. What diagnosis would you consider?

A

Vascular etiologies, stroke or non-physiologic causes.

94
Q

Bilateral vision loss that is painful. What diagnosis would you consider?

A

Intoxication
Trauma
Chemical or radiation exposures

95
Q

Gradual vision loss usually arises from?

A

Cataracts
Glaucoma
Macular degeneration

96
Q

Slow central vision loss may occur with

A

Nuclear cataract and macular degeneration

97
Q

Peripheral vision loss can be caused by?

A

Advanced open angle glaucoma with unilateral loss with hemianopsia and quadratic defects

(Though they may be symmetric theses conditions are often bilateral disease processes)

98
Q

Moving specks or strands in the eye suggests what diagnosis?

A

Vitreous floaters

99
Q

A patient is complaining of fixed defects in the eyes where they cannot see. What diagnosis does this suggest?

A

Scrotomas (fixed defects)
Suggest lesions in the retina, visual pathway or brain

100
Q

Flashing lights with nee vitreous floaters suggests what diagnosis?

A

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

101
Q

Diplopia

A

Is seen in lesions in the brainstem or cerebellum and with weakness or paralysis of one of more extraocular muscles.

102
Q

Horizontal diplopia

A

Palsy of CNIII or VI

103
Q

Vertical diplopia

A

Palsy of CN III OR CN IV

104
Q

Diplopia in one eye while the other is closed

A

Suggests a problem in the ocular surface, cornea, lens or macula

105
Q

Visual acuity

A

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

106
Q

What do you put for a visual acuity for someone wearing glasses?

A

“Corrected” at the end

Ie. 20/40 corrected

107
Q

A person is considered legally blind when

A

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

108
Q

Hearing loss related to age is…

A

Gradual

109
Q

What do you want to know for health history r/t ears?

A

Hearing loss
Ear pain
Discharge
Tinnitus
Vertigo

110
Q

If a patient says they feel like they are talking under water

A

They have a lot of congestion/ fluid in the ear

111
Q

What test is used for color blindness?

A

Pseudoisochromatic test

112
Q

What is the most common color vision abnormality?

A

Sex-linked congenital red-green deficiencies

113
Q

Hyper or hypoglobus may refer to deviation in the globe position which may result from

A

Congenital abnormalities, lacrimal gland enlargement, mucocele or ocular tumors

114
Q

What could cause proptosis (abnormal eye protrusions)

A

Thyroid eye disease
Congenital abnormalities
Orbital infections
Ocular tumors

115
Q

Upslanting palpebral fissures of the eyelids are noted in what diagnosis?

A

Down syndrome

116
Q

Lagophthalmos

A

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

117
Q

What is the most common form of glaucoma?

A

Open angle glaucoma

The normal spatial relation between the iris and the cornea is preserved and the iris is fully lit

118
Q

Miosis

A

Constriction of the pupils

119
Q

Mydriasis

A

Dilation of the pupils

120
Q

How does the NP test for light reaction of pupils?

A

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

121
Q

What is a direct reaction to light?

A

Pupillary constriction in the same eye

122
Q

Consensual reaction

A

Pupillary constriction in the opposite eye

123
Q

What is the arrow pointing to?

A

The optic disc

124
Q

Artery vs vein of the eye

A

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

125
Q

Conjunctivitis

A

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

126
Q

Subconjunctival hemorrhage

A

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

127
Q

Corneal injury or infection

A

Ciliary injection

Moderate to severe pain
Vision usually decreased
Discharge watery or purulent

Abrasions and other injuries
Viral and bacterial infections

128
Q

Conductive phase of hearing

A

Part of the hearing pathway from the external ear through the middle ear

129
Q

Sensorineural phase of hearing

A

Involves the cochlea and the cochlear branch of CN VIII

130
Q

Diffuse thyroid enlargement

A

Suggestive of graves disease, hashimotos thyroiditis or edemic goiter

131
Q

Single thyroid nodule

A

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.

132
Q

Sub conjunctival hemorrhages in neonates

A

Common in neonates born via vaginal delivery

133
Q

Colobomas

A

Missing sections of tissue in the eye

134
Q

Brushfield spots

A

Seen with an opthalmoscope
A ring of white specks in the iris
Although sometimes seen in normal kids, usually suggests down syndrome

135
Q

Acoustic blink reflec

A

Blinking of the infants eyes in response to a sudden sharp sound

136
Q

Congenital torticollis

A

“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

137
Q

Name these retraction sites

A

(Top to bottom)
1. Supraclavicular retractions
2.intercostal retractions
3.substernal retractions
4.Subcostal retractions

138
Q

This test compares bone conduction and air conduction which aides in determining whether hearing loss is conductive vs senorineural

A

Rinne test

139
Q

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

A

Pneumatic otoscope

140
Q

This test assesses for lateralization in unilateral hearing loss

A

Weber test

141
Q

What is the weber test?

A

Unilateral only
Place ontop of patients head
Normally heard in both ears

142
Q

Weber test: patient hears sound unilaterally in impaired ear

A

Conductive hearing loss

143
Q

Webber test: senorineural loss

A

They hear it in the good ear

144
Q

Rinne test

A

Normal: air conduction should be heard longer than bone conduction

145
Q

For pedi patient ear exam

A

Infants: down and back
Older kids: up out and back

146
Q

Centors criteria

A

(Probability of strep pharyngitis
Fever
Exudate
Anterior cervical lymphadenopathy
Absence of a cough

Advanced Health Assessment (5 decks)

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