HEENT Flashcards
What cranial nerve is tested with hearing
CN VIII
What CN is tested with sharp/dull face touching
CN V sensory
What CNs are tested with saying AH
CN IX and X
What CN is tested with palpating masseter muscles while clenching teeth?
CN V motor
What CN is tested with making funny faces
CN VII
What 4 motions do you ask pt to do to assess CN VII
- Raise eyebrows
- Squeeze eyes shut
- Puff out cheeks
- Smile with teeth
Which eye chart do you use from 20 ft away
Snellen
You want the snell family to stay at a distance
What is myopia
Impaired far vision
like MY vision.i wear glasses to see far away
What eye chart do you use from 14 inches away
Rosenbaum
You like smelling roses close up
What is presbyopia
Impaired near vision
The larger the denominator in someone’s vision the _____
Worse the vision
What is the direct pupillary light reflex
Pupil constricts on same side as light
What is the consensual pupillary light reflex
Eye without the light in it still constricts
What is the word for excessive pupil dilation
Mydriasis
myDriasis Dilation
What is the word for excessive pupil constriction
Miosis
What can nystagmus indicate
A variety of neurological conditions
How do you test extraocular muscles
BIG H pattern, stopping at upward and lateral gazes looking for nystagmus
When focusing on something close up do pupils get bigger or smaller
Constricts with near
Narrows with near
What do pupils do when focusing on something far away?
Dilate
Dilate distance
What CN does the lateral rectus
CN VI abducens
What CN does Superior oblique
CN IV trochlear
What CN does all the other eye muscles
CN III oculomotor
Ptosis is seen when which CN is messed up
CN III (levator palpebrae superioris)
Incomplete closure of the eye is seen when which CN is messed up?
CN VII
Orbicularis oculi
Main features of chalazion?
Nontender
Inside lid
Meibomian gland obstruction
Main features of a Hordeolum
Hurts
On eyelid margin
Infection of eyelash
HORdeolum HORRible
What is the dx: patient was sick with inclreasing congestion and pressure for 2 weeks and now has a low fever, pain, swelling and inability to open eye
Periorbital/preseptal cellulitis
What is entropion
Eyelid curling in. Irritates eye bc of eyelashes
What is ectropion?
Eye lid curling out… excessive tearing since puncta is not draining effectively
What side of the eye is a pingueculum on
Either side
Penguins are great on both sides of you
What side of the eye is a pterygium on?
Stretches from medial corner to cornea
What might be causing someone to lose the outer 1/3 of eyebrows
Hypothyroidism
What eye condition is seen with Grave’s disease (thyroid dysfunction)
Exopthalmos
Eyeballs popping out
Nancy Reagan had this and now she is in the grave
How might you tell the difference between conjunctivitis and Uveitis
No discharge with uveitis
What is a hypopyon
Line of inflammatory cells in anterior chamber of eye
What condition is associated with getting a hypopyon?
Uveitis
Does uveitis hurt
YES
Does uveitis/iritis risk vision loss?
Yes
Which is worse: subconjuctival hemmorhage or hyphema?
Hyphema is way worse. Must refer.
You don’t have to do anything to subconjuntival hemmorhageh
What should the cup:disc ratio be
<1:2
What should the AV ratio be
2:3
What side of the eye are you looking at when you look at the macula
Temporal
What are hypertensive vascular changes you might see in the eyes of a HTN or DM patient
Copper wire
Silver wire
A-V nicking
HTN and DM patients need to wire their fridges shut
What two things might be seen with hypertensive retinopathy?
Cotton wool patches
Hemorrhages
What are 3 things you might see with diabetic retinopathy?
Hemorrhages
Hard exudates
Neovascularizations that are more numerous and tortuous than regular blood vessels in eye
What would a cup:disc ratio greater than 1:2 indicate
Glaucoma
What causes papilledema
Increased intracranial pressure
Emergency
What is papilledema
Optic disc swelling due to increased ICP
What would indicate macular degeneration during your opthalmosopic exam
Light reflection decreased when you ask pt to look directly at light
What side of visual field crosses over at optic chiasm?
Temporal field (hits nasal side of eyeball and then crosses over)
What would happen to vision if you had a lesion at the optic chiasm?
You would lose temporal vision. You would have tunnel vision (bitemporal hemianopsia)
What could cause bitemporal hemianopsia? (Tunnel vision)
Pituitary tumor damaging the optic chiasm
What would happen to vision if there was a lesion on the Right optic tract?
You would lose the vision on the Left half of each eye field
Left homonymous hemianopsia
What might the conver-uncover test reveal?
Muscle imbalance like strabismus
What do you do if you notice strabismus in a patient
Refer
What is esotropia v exotropia?
Exotropia- eye drifts out laterally
Esotropia- eye drifts inward
(Ectropion and entropion involves eyelid)
What is the difference between the corneal reflex and the corneal light reflection?
Corneal reflex- touching eye with rolled up cotton
Corneal light reflection- twinkle in eyes
if BC>AC, what kind of hearing loss
Conductive
if AC>BC what kind of hearing?
Normal OR sensorineural
What does the Weber test tell you?
Which ear is better (lateralization or hearing)
In conductive loss, which ear hears the sound in the Weber test?
Bad ear hears it better
In sensorineural hearing loss, the sounds lateralizes to which ear during the Weber test?
Good ear
What is a normal test result of Weber test
Both ears hear equally
What is a normal Rinne test
AC>BC
Weber: lateralize to R
Rinne: BC>AC in R
What type of hearing loss?
Conductive hearing loss in R ear
Weber: lateralizes to L
Rinne: AC>BC in R
Sensorineural loss in R ear
What quadrant of tympanic membrane do you find the cone of light?
Anterior and inferior quadrant
What can cause tympanosclerosis (chalky white scarring on TM)
Recurrent otitis media or history of tubes or perforation
What can cause a bulging red eardrum
Acute otitis media
What can cause the eardrum to popping out and have bubbles behind it
Viral URI/barotrauma usually involving Eustachian tube
WHat must be ruled out in EVERY nasal exam?
Septal hematoma
What would a septal hematoma look like on exam
Soft tender swelling on nasal septum
Where do 90% of all nose bleeds happen
Kiesselbach’s plexus
What would cause swollen pale blue boggy turbinates
Allergic rhinitis
What can cause erythematous turbinates
Sinusitis and URI
Where is Whartons duct
Under tongue for submandibular gland
Where is stensen’s duct
Behind 2nd molar up top for parotid gland
What CN is tested when you stick tongue out and wiggle
CN XII hypoglossal
What is the most common cause of lip carcinoma
SCC
What can cause angular cheilitis
Vitamin deficiency
Excessive salivation
Dentures that don’t fit
What does “brush the thrush” mean?
If you brush off the white oral lesion and its red and irritated under, you have thrush
What is leukoplakia?
White spots in mouth that are possibly precancerous
How would you tell the difference between thrush and leukoplakia?
Try to brush it off, and if it comes off leaving a red part underneath, it’s thrush. Leukoplakia does not brush off.
What is the majority of oral cancer
SCC
What is torus palantinus?
Big benign mass in middle of hard palate
In what condition might you find numerous tonsillar crypts?
Tonsillar hypertrophy
Is hairy tongue a bad thing
No its benign
In what two conditions would you find bilateral exudative tonsillitis?
Group A Strep Exudative Tonsillitis
Mono
What condition causes a hot potato voice
Peritonsillar abscess
What would you see when you look into the throat of someone with a peritonsillar abscess?
UNi lateral tonsil swelling
Shifted uvula
+hot potato voice
+drooling
What lymph nodes suggest metastasis from lung or GI cancers
Supraclavicular
When do you auscultate the thyroid
If its enlarged. Bruits may be present in hyperthyroidism or goiter
When palpating the thyroid for a goiter, what must you ask the patient to do
Swallow
