HEENT Flashcards
benign condition
scattered smooth red areas denuded of papillae
geographic tongue
may follow antibiotic Tx, or occur spontaneously
hairy tongue
benign
fissured / scrotal tongue
suggests deficiency in riboflavin, niacin, folic acid, vit B12, pyridoxine, or iron
may also be a SE of chemo
smooth tongue
aka atrophic glossitis
thick white coating from particular infection
red surface where area was scraped off
seen in immunosuppressed conditions
candidiasis
These whitish raised areas with a feathery or corrugated pattern most often affect the sides of the tongue. Unlike candidiasis, these areas cannot be scraped off. They are seen with HIV and AIDS.
hairy leukoplakia
visual field loss on the same side in both eyes
Homonymous Hemianopsia
Photo is LEFT homonymous hemianopsia
Visual loss on outer sides
Bitemporal Hemianopsia
vision missing in inner half of both L & R eye
binasal
- rim of sclera is visible between upper lid & iris
- lid lag
- eyeball protrudes forward
exophthalmos & lid retraction
when bilateral, suggests infiltrative ophthalmopathy of graves hyperthyroidism. edema of the eyelids & conjunctival injection may be associated.
Unilateral: in graves or tumor or inflammation in the orbital → hyperthyroidism
drooping of upper lid
Where is this seen?
ptosis
seen in myasthenia gravis (MG), damage to the oculomotor nerve, damage to sympathetic nerve supply.
A weakened muscle, relaxed tissues, and weight of herniated fat may cause senile ptosis. may also be congenital
opacities of the lenses, most common in old age
cataracts
Painful, tender red infection in a gland at the margin of the eyelid
Sty
red throat, white exudate on tonsils
may be due to group A strep or mono
exudative tonsillitis
might just be called tonsillitis
reddened throat, no exudate.
focus is on throat, not tonsils here
pharyngitis
diffuse, nonpitting, tense swelling
develops rapidly & typically disappears over subsequent hrs or days
allergic in nature, sometimes associated w/ hives
does not itch
hint: african americans w/ ACEs
angioedema
Name some red flags w/ the head
- recent onset (<6 mo)
- onset after 50 YO
- acute, like a thunderclap or “worst headache of my life” → think: subarachnoid hemorrhage r/t head injury, meningitis, stroke
- elevated BP
- presence of rash or signs of infection
- presence of cancer, HIV, pregnancy
- vomiting → migraines, brain tumors, subarachnoid tumors
- recent head trauma
- persisting neuro deficits.
- neuronal dysfnc, imbalance of excitatory & inhibitory neurotransmitters & affecting craniovascular modulation
- typically unilateral
- throbbing, aching
- rapid onset, peak in 1-2 hrs
- associated: n/v, photophobia, phonophobia, visual auras, motor auras of hand & arm, sensory auras (numbness, tingling)
- aggravated by alcohol, some foods, tension, noise, bright light
- relieved by quiet, dark room, sleep
migraine
- usually bilateral, generalized or localized to back of head and upper neck
- pressing, tightening pain, mild to moderate intensity
- Gradual onset, often recurrent or persistent over long pds of time
- can last minutes to days
- Associated: sometimes photophobia, phonophobia. NO NAUSEA.
- Aggravated by sustained msk tension (driving, typing)
- relieved by: massage, relaxation
Tension
- unilateral, usually behind or around eye
- pain is deep, continuous, severe.
- Abrupt onset, peaks w/in minutes. lasts up to 3 hrs
- episodic, clustered in time, several each day for 4-8 wks, then relief for 6-12 mo
- associated: lacrimation (tears), rhinorrhea, miosis, ptosis, eyelid edema, conjunctival infx.
- aggravated by: alcohol
cluster headache
- mucosal inflammation of paranasal sinuses
- usually above eye (frontal) or over maxillary sinuses
- aching, throbbing; varying in severity
- associated: local tenderness, nasal congestion, discharge, fever.
- aggravated by coughing, sneezing, jarring the head
- relieved by nasal decongestants and antibiotics
sinusitis
- infection –> brain
- generalized, very severe, steady throbbing pain.
- Fairly rapid onset
- Associated: fever, stiff neck
- can’t put their chin to their chest because it hurts the back of their neck.
- lymph nodes are inflamed
- abscess in neck region
meningitis
specifically the infection is of the meninges surrounding the brain
- permanent surprised affect on face - mask like appearance.
- Can’t smile, can’t frown, expressionless disease
- decreased blinking & characteristic stare.
- neck and upper trunk tend to flex forward, the patient seems to peer upward toward the observer.
- Facial skin becomes oily, and drooling may occur.
Parkinson’s
Where in the ear is vertigo affected by?
Where in the brain is vertigo affected by?
What is vertigo?
Bony labyrinths
CN VIII (8) - vestibulocochlear
Room is spinning
- increased adrenal cortisol production
- round or “moon” face with red cheeks
- buffalo hump
- truncal obesity, skinny arms & legs
- Excessive hair growth may be present in the mustache and sideburn areas and on the chin
- hirsutism in women
CUSHING’S
- Increased growth hormone
- enlargement of both bone and soft tissues
- Head is elongated, with bony prominence of the forehead, nose, and lower jaw.
- Soft tissues of nose, lips, ears also enlarge.
- Facial features appear generally coarsened
acromegaly
- nervousness
- weight loss despite increased appetite
- excess sweating/heat intolerance
- palpitations
- frequent bowel movements
- proximal msk weakness & tremors
- exophthalmos
- increased systolic & decreased diastolic
- tachycardia, afib
HINT: Everything is FAST
Hyperthyroidism
- fatigue, lethargy
- modest weight gain w/ anorexia
- dry, coarse skin & cold intolerance
- swelling of hands, face, legs
- constpiation
- weakness, msk cramp, arthralgia, paresthesias, impaired memory & hearing
- decreased systolic, increased diastolic
- bradycardia, hypothermia
HINT: Everything is sloooooow
HyPOthyroidism
Outer Ear
- responsible for:
- hearing loss causes:
●Auricle: gather sound waves & funnel them down to ear canal
●goes up to tympanic membrane
●hearing loss causes: impacted cerumen, foreign bodies, external otitis
Middle Ear
- responsible for
- consists of
- hearing loss causes
- conducts sound, equalizes air pressure, reduces loudness
- consists of auditory ossicles (malleus, incus, stapes) & eustachian tube (equalizes ear pressure
- hearing loss causes: otitis media, serous otitis, otosclerosis
Inner Ear
- Consists of
- Responsible for
- Hearing loss causes
●labyrinth - semicircular canals, vestibule, cochlea
●responsible for balance & transmission of sound to brain
●hearing loss causes: meniere’s disease, nose exposure, presbycusis, ototoxicity
Which hearing loss is associated w/ elderly? Which is associated with younger children or young adulthood?
Which helps if there is background noise? Which does NOT help when there is background noise?
- Sensorineural: generally w/ older people
- People w/ sensorineural loss have particular trouble understanding speech → worse w/ noise
- Conductive: generally w/ children to young adulthood
- If conductive hearing loss, noisy environments help
What medications affect hearing?
aminoglycosides (antibacterial)
quinine (antimalarial)
vanc
aspirin
NSAIDs
furosemide (lasix)
What is the condition associated with hearing loss w/ older age?
presbycusis
What disorders are associated w/ earaches?
- otitis externa - swimmer’s ear
- otitis media - respiratory infex
- may have discharge
What condition is associated with tinnitus, vertigo, and hearing loss? (all 3 symptoms at once)
meniere’s disease
near faint from “feeling faint or lightheaded”
causes: OH, esp from meds, arrhythmias, vasovagal attacks (5%)
Presyncope
or
Pre-syncope
unsteadiness or imbalance when walking, esp in older ptns
causes: fear of walking, visual loss, weakness from msk problems, peripheral neuropathy (up to 15%)
Dysequilibrium
What do you test in an ear physical exam?
Weber
Rinne
Whisper
- Weber: lateralization
- Rinne: bone conduction vs air conduction
- Whisper: high frequency loss & gross hearing
What do you suspect when you look in the ear and see a bulging ear drum?
Otitis media
While collecting history of the nose and sinuses, ptn complains of having rhinorrhea. What question would nurse ask to determine associated manifestations of this symptom?
■which side does it occur?
■how long does it last?
■color of drainage?
■are there other symptoms?
■are there other symptoms?
What do you suspect if you see congestion in a ptn after he/she had an upper respiratory infection, fever/local headache, tenderness?
acute bacterial sinusitis
90%
What are some drugs that cause congestion?
oral contraceptives, reserpine (HTN drug), alcohol
nasal sprays –> rebound congestion
What should you suspect in a ptn w/ unilateral congestion?
deviated nasal septum, foreign body, tumor, polyps
What test can you perform in a ptn w/ acute sinusitis to confirm their diagnosis?
What other symptoms might you see?
transilluminate the sinuses
local tenderness + pain + fever + nasal discharge
What is sore throat usually associated with?
What could it also be associated w/?
What is a non-medical reason you might have a sore throat?
URI
strep
overuse
What do you think when your ptn’s voice is hoarse?
smoking, allergy, voice abuse, hypothyroidism, chronic infx like TB, tumors
What might you suspect in a ptn w/ sore TONGUE?
ulcer?
nutritional deficiency?
Where can you check for cyanosis or pallor in a dark-skinned ptn?
mucous membrane
conjunctiva
What are the top 2 cancers of the mouth?
Which ptns would you especially look for ulcers, gingivitis, and mouth cancers?
1: lip
smokers & drinkers
The nursing student states that she is able to see the patient’s adenoid tonsils when inspecting patient’s mouth. The patient has never had his tonsils removed. Why would you follow up with the nursing student?
You should not be able to see the ADENOID tonsils unless the palantine tonsils were removed AND the adenoids are inflamed.
The patient has +4 tonsils but no inflammation, and her airway is not occluded. She wants to have her tonsils removed. What education would you provide her?
- keep your tonsils unless there is an airway issue.
- higher incidence of strep (tonsils = lymph system), which can lead to further complications
Highest priority nursing diagnosis for ptn w/ inflamed golf ball tonsils?
■ineffective airway clearance
■impaired gas exchange
■acute pain
■altered fluid & electrolyte imbalance
■ineffective airway clearance
What result would you see in a patient whose CN X is paralyzed?
one side of the soft palate won’t rise and uvula deviates to the opposite side
hyperopia
farsighted
presbyopia
eye can’t focus close-up (elderly)
myopia
nearsighted
area of lost/depressed vision within visual field, surrounded by an area of normal vision
scotoma
diplopia
double vision → may be issue w/ CN 3, 4, or 6, OR cornea/lens issue
What does it mean if your vision is 20/200?
You can only see at 20 feet what normal people can see @ 200 feet.
Also, you are LEGALLY blind in the corrected eye.
What are the 6 cardinal directions?
R superior L superior
R lateral L lateral
Right inferior L inferior
A consensual light reflex is present when which of the following occurs?
A. the right pupil dilates when a light is shone on the left pupil
B. the left pupil dilates immediately after the light is removed from the left pupil
C. the right pupil constricts when a light is shone into the left pupil
D. the left pupil constricts after the light is removed from the right pupil
the right pupil constricts when a light is shone into the left pupil
In the Corneal Light Reflex, the nurse notes that one dot is seen at 5 o’clock and the other white dot is seen at 2 o’clock. What does this indicate?
EOM weakness/strabismus
Accommodation test asks the person to focus on an object far away then shift to a nearby object. The normal response is….
constricted and converged pupils
What is the normal pupil size?
What is abnormal?
4 mm
<3 or >5
What causes the following?
When greater in bright light than in dim light, larger pupil cannot constrict properly
can be harmless or caused by blunt trauma to eye, open angle glaucoma, impaired parasympathetic nerve supply to the iris→ tonic pupil, oculomotor nerve paralysis, brain injury, brain tumor.
What causes the following?
When greater in dim light, smaller pupil cannot dilate properly.
horner syndrome, caused by an interruption of the sympathetic nerve supply
