HEENT Flashcards
1
Q
Neck Pain
A
can be due to muscular or cervical spinal cord problems
stress and tension may increase neck pain
2
Q
Sudden head and neck pain with elevated temperature and neck stiffness
A
may be a sign of meningeal inflammation
3
Q
Sudden trouble with vision
A
Sudden trouble with vision in one or both eyes or sudden trouble walking, dizziness or loss of balance or coordination may be a sign of impending stroke
4
Q
Lumps or lesions on head/neck
A
lumps or lesions that do not heal may be a sign of cancer
5
Q
Goiter
A
an enlarged thyroid gland or swelling at the base of the neck
also experience a tight feeling in the throat, a hoarse voice, cough, hoarseness, difficulty swallowing, or difficulty breathing
6
Q
Change in skin, hair, nails, energy levels, sleep, and emotional stability?
A
thyroid function
7
Q
Hyperthyroidism vs Hypothyroidism
A
Hypo: constipation, Bradycardia, weight gain, pale dry skin, slowed reflexes, cold intolerance, coarse hair, skin feels cold, no goiter, constipation, puffiness in periorbital region
hyperthyroidism: diarrhea, tachycardia, weight loss, moist skin, heightened reflexes, heat intolerance, fine hair with hair loss, skin feels warm, goiter, frequent bowel movements, exophthalmos (protruding)
8
Q
Most common type of headaches
A
- Vascular (migraines)
- Muscle contraction (tension)
- traction or inflammatory causes
9
Q
Sudden headache with unknown cause
A
stroke
10
Q
Hormone fluctuations and headaches
A
women are more prone to migraines than men usually provoked by hormone fluctuations
11
Q
Meningitis
A
severe headache with stiff neck, vomiting and light sensitivity
12
Q
Headache following a head injury
A
slow bleed
13
Q
Headaches with numbness or tingling in the arms or legs
A
stroke
14
Q
headache lasting for more than 24 hours in someone without a history of headaches
A
ICP
15
Q
Sinus headaches
A
deep, constant throbbing pain
pressure like pain in one specific area of face or head and is tender to touch
16
Q
When does sinus headaches occur?
A
with or after a cold or acute sinusitis or febrile illness with purulent discharge from nose
17
Q
Location of sinus headaches
A
one area of face or along eyebrow ridge and below the cheek bone
18
Q
Duration, severity, and pattern of sinus headaches
A
Duration: last until associated condition improves
severity: moderately severe and not debilitating
pattern: gets worse when they change their position as well as sudden temperature changes
19
Q
Associated factors with sinus headaches
A
nasal drainage, congestion, fever, foul-smelling breath
20
Q
Cluster headache
A
Stabbing pain
may be accompanied by tearing, eyelid drooping, reddened eye or runny nose
may be precipitated by ingesting alcohol
walking and moving around makes it feel better opposite of migraine headaches
21
Q
Location of cluster headaches
A
localized in the eye or orbit and radiating to the facial and temporal regions
pain is always unilateral and always on the same side
22
Q
Cluster duration, severity, and pattern
A
Typically occurs in the late evening or night
severity is intense
pattern is movement or walking back and forth may relieve the discomfort
23
Q
Associated factors of cluster headaches
A
occurs more in young males
occur in cyclical patterns or clusters
may have eye reddening, tearing and nasal congestion
24
Q
Tension Headaches
A
Dull, tight, diffuse
occurs simultaneously with stress, anxiety or depression
usually located in the frontal, temporal or occipital region
25
Tension headaches duration, severity, pattern
Last days, months or years
the severity is aching
relief may be obtained by local heat, massage, analgesics, antidepressants and muscle relaxants
26
Associated factors of tension headaches
affect women more than men
is the most common type of headache
27
Migraine headaches
Accompanied by nausea, vomiting, and sensitivity to noise and light
onset: aura might occur before or during migraines , can be precipitated by emotional disturbances or follow ingestion of alcohol
location: around eyes, cheeks, or forehead
- may affect only one side of the face
INTENSE PAIN
28
Migraine duration, severity, and pattern
Duration lasts up to 3 days
Severity is throbbing and severe
Rest may bring relief
29
Associated factors of migraines
Occurs more often in women
headaches especially migraines tend to run in families
30
Tumor-related headaches
Aching and steady. Neurologic and mental symptoms as well as nausea and vomiting may develop
may develop when coughing, sneezing or sudden movement of the head
location varies with location of the tumor
31
Tumor related headaches duration, severity, and pattern
duration is commonly occurs in the morning and last for several hours
severity is different in tensity
pattern usually subsides later in the day
32
Microcephaly
an abnormally small head
33
Acromegaly
Skull and facial bones are larger and thicker
34
Paget disease
Acorn shape, enlarged skull and bones
35
Neurological disorders
may cause horizontal jerking movement
36
Involuntary nodding movement
may be seen with aortic insufficiency
37
Head tilted to one side
may indicate unilateral vision or hearing deficiencies
38
Drooping, weakness, or paralysis on side
may result from a stroke and is usually seen with paralysis or weakness of other parts of the body
can be a result of bell palsy
39
Mask-like face
can be seen with Parkinson
40
Sunken face with depressed eyes and hollow cheek
typical of cachexia (emaciation)
41
Tightened-hard face
with thinning facial skin seen in scleroderma
42
Temporal arteritis
When the temporal artery is hard, thick, and tender
can lead to blindness
acute and urgent
43
Swelling, enlarged masses
may indicate an enlarged thyroid gland, inflammation of the lump nodes or a tumor
44
Palpating the trachea
find the sternal notch and verify the trachea is midline
45
Trachea pulled to an affected side
Large atelectasis
fibrosis or pleural adhesions
Pneumonectomy
46
Trachea pushed to the unaffected side
in case of: tumor
enlarged thyroid lobe
pneumothorax
aortic aneurysm
47
Palpating the Thyroid
Usually not palpable
if rapid enlargement of a single nodule-consider malignancy
diffuse enlargement think hyperthyroidism
48
Auscultate Thyroid
bruit over the thyroid lobes is often heard with hyperthyroidism
49
Lymph Nodes
enlarged nodes are abnormal
swelling, tenderness, hardness and immobility are abnormal
50
Metastasis from a malignancy in the abdomen and thorax
an enlarged, hard, contender node in the supraclavicular area
51
Hodgkin Lymphoma
cancer of the lymphatic system
52
Preauricular
in front of the ear
53
Posterior auricular
(mastoid)
superficial to mastoid process behind the ear
54
Occipital
at the base of the skull
55
Submental
midline, behind the tip of the mandible
56
Submandibular
halfway between the angle and the tip of the mandible
57
tonsillar
under the angle of the mandible
58
Superficial cervical
overlies the sternomastoid muscle
59
deep cervical
deep under the sternomastoid muscle
60
Posterior cervical
in the posterior triangle along the edge of the trapezius muscle
61
supraclavicular
just above and behind the clavicle at the sternomastoid muscle
62
Red flags for Lymph Nodes
have appeared for no apparent reason
continue to enlarge or have been present for two to four weeks
feels hard or rubbery, or doesn't move when you push on them
accompanied by persistent fever, night swears or unexplained weight loss
63
Sudden changes of vision
are associated with acute problems such as head trauma or increased intracranial pressure
64
Gradual changes of vision
may be related to aging, diabetes, hypertension or neurologic disorders
65
Scotoma
blind spot that is surrounded by either normal or slightly diminished peripheral vision and may be a sign of glaucoma
66
Intermittent blind spots
can be associated with vascular spasms (ophthalmic migraines), pressure on the optic nerve from a tumor or increased ICP
67
Consistent blind spots
may indicated retinal detachment
MED EMERGENCY
report of blind spots is an immediate referral
68
Most common causes of decreased vision in older adults
Cataract formation (lens opacity)
glaucoma from increased intraocular pressure
macular degeneration
69
Macular degeneration
breakdown of cells in macula of retina
irreversible central vision loss
most common cause of blindness
70
Halos or rings around lights?
associated with narrow angle glaucoma
71
Do you have trouble seeing at night?
night blindness is associated with optic atrophy, glaucoma and vitamin A deficiency
72
DO you experience double vision ?
Diplopia
may indicated increased ICP due to injury or a tumor
73
Burning or itching pain
associated with allergies or superficial irritation
74
Throbbing, stabbing or deep aching pain
suggests a foreign body in the eye
most eye disorders are not associated with pain
75
Redness or swelling in the eye
An inflammatory response to allergy, foreign body or bacterial/viral infections
76
Eye discharge
discharge from one or both eyes suggest a bacterial or viral infection
77
Eye exam recommendations
Thorough eye exams are recommended every 2 years for people 18-60 years of age
annual examinations are recommended for people over 60
78
Family history of eye problems
many eye disorders run in families
glaucoma, refraction errors, macular degeneration
79
Pink eye
Pink eye conjunctivitis
tearing of the eye causing it to stick shut
pain, itchy, and burning. complaints of feeling scratchy and crusting on the eye lash
sensitive to bright lights (photophobia)
enlargement of the lymph node
80
Allergic Conjunctivitis
Is more common in people with seasonal allergies
symptoms are intense itching, tearing and inflammation of the eye . As well as sneezing and watery nasal discharge
treatment OTC eye drops or prescription drops
81
Chemical conjunctivitis
irritation caused by a chemical splash or foreign object in the eye
S&S include watery eyes and a mucous discharge, usually clear up on their own within about a day
82
Severe chemical injuries to the eye
alkali burns are medical emergencies and can lead to scarring, damage to the eye or the sight, or even the loss of the eye
83
Bacterial Conjunctivitis
often spreads to both eyes while viral only affects one eye
has heavier discharge than viral and its thick and greenish in color
treated with antibiotic eye drops or ointment
may improve after 3-4 days of treatment, but need to take the entire course of antibiotics to prevent recurrence
84
Viral Conjunctivitis
characterized by excessive watering, rather than heavy discharge
sticky upon awakening but does not have the crust that makes it difficult to open the eye
associated with common cold and runny noses and sinus congestion
lymph nodes around ear and neck are associated with viral conjunctivitis
85
Treating viral conjunctivitis
antibiotics will not work against viruses
no eye drops or ointments are effective against the common viruses that cause viral conjunctivitis
is self limited, which means it will go away bu itself after a short time
86
20/200
legally blind
87
20/30
referral should be for any assessment over 20/30
88
Ishihara test
test for color bindness
rare in female
test between ages 4 and 8
89
optical illusions
information gathered by the eye is processed by the brain, creating a perception that does not match the true image
90
External (outer) ear
contains ear flap known s the auricle or pinna
91
Middle Ear
Tympanic membrane (eardrum) separates the external and middle ear
contains the auditory ossicles: stapes, incus, malleus
conductive hearing problems happen in the middle ear
92
Inner Ear
CONTAINS THE BONY LABRYINTH WHICH INCLUdES:
the vestibule, the semicircular canals and cochlea (central hearing apparatus)
93
Function of inner ear
receives vibrations from the middle ear the stimulates nerve impulses
these impulses travel to the brain and the cerebral cortex interprets the sound
94
AC
The normal pathway of hearing is air conduction and is the most efficient
95
BC
an alternate route of hearing is by bone conduction (BC)
here the bones of the skull vibrate (vibrations are transmitted directly to the inner ear and CN VIII)
96
Conductive hearing loss
involves a mechanical dysfunction of external or middle ear
will be able to hear sound if amplitude is increased
97
What is conductive hearing loss caused by?
impacted cerumen
foreign bodies
a perforated TM
pus or serum in the middle ear
otosclerosis: which is a decrease in mobility of ossicles
98
SENSORINEURAL
(or perceptive) hearing loss
cannot hear you no matter how loud you are
pathology of inner ear, cranial nerve VIII, or auditory areas of cerebral cortex
99
Presbycusis
may be the cause of sensorineural hearing loss which is a gradual nerve denigration that occurs with aging and by ototoxic drugs which affect hair cells in cochlea.
100
Mixed hearing loss
is a combination of conductive and sensorineural types in same ear
101
Sudden decrease in the ability to hear
associated with otitis media or cerumen impaction
102
Sudden sensorineural hearing loss
sudden deafness may be a medical emergency
103
Drainage of the ear
otorrhea usually indicates infection
104
Purulent, bloody drainage in the ear
infection of the eternal ear
external otitis
105
Purulent drainage associated with pain and a popping snesation
characteristic of otitis media with perforation of the tympanic membrane.
if they don't complain anymore they could've ruptured the ear drum
106
Clear draining in the ear
is a medical emergency and can signal spinal fluid
107
Otalgia
earache that occurs with ear infections, cerumen blockage, sinus infections, teeth or gum problems
108
Swimmers ear
pain that occurs with manipulating or wiggling, the pinna may suggest otitis externa (swimmer's ear)
109
Nausea and dizziness and the ear trouble
Patients with ear infections experience nausea and dizziness
110
Ringing in the ears
Tinnitus is associated with excessive earwax buildup, high blood pressure or certain ototoxic medications as well as loud noises
111
Vertigo
true spinning motion may be associated with an inner ear problem
the labryinth in the inner ear feeds information to the brain about body's position in space
information of the labyrinth makes it feed wrong information to the brain, creating a staggering gait and strong spinning, whirling sensation (vertigo)
112
Repeated infections of the ear
can affect the tympanic membrane and hearing
113
Family history of hearing loss
age related hearing loss tens to run in families
114
Misaligned or low set ears
is seen with genitourinary disorders or chromosomal defects
115
Otitis externa or impacted foreign object discharge
Foul smelling, sticky, yellow discharge
116
Ruptured tympanic membrane
Bloody, purulent discharge
117
Skull trauma
cerebrospinal fluid which will be a bloody or watery discharge.
MEDICAL EMERGENCY
118
Tympanic membrane
ear drum should be pearly gray, shiny, and translucent
no building or retraction
slightly concave smooth and intact
light reflex at "5" in the right ear and "7" in the left ear
119
Abnormal findings in the tympanic membrane
Otitis media, serous otitis media, scarring
120
Otitis media
red, buldging ear drum
diminished or distorted light reflex
the membrane does not move or flutter when the bulb is inflated
121
Serous Otitis Media
Yellow, building membrane with bubbles behind it
122
Scarring
White spots on membrane
123
Otosclerosis
Age of 20 and 40 YEARS DISEASE OF THE YOUNG
cause of conductive hearing loss in young adults between ages of 20 and 40 years
gradual hardening that causes the foot plate of the stapes to become fixed in the oval window, impeding transmission of sound and causing progressive deafness
124
Presbycusis
disease of the old
hearing loss that occurs with aging even in people living in quiet environments
caused by nerve degeneration
loss of higher tones occur first (woman's voice)
ability to localize sound is impaired
can filter background noise and feel like people are mumbling
125
Lesions in the mouth or tongue
Lesions that last for 2 weeks need a referral
126
Painful, recurrent ulcers around the mouth
seen with apothous stomatitis (canker sores) and herpes simplex (cold sores)
127
Warning signs of cancer for mouth and tongue
sores that do not heal, persistent red or white patches
a lump or thickening on the tongue or rough, crust, eroded areas are warning signs of cancer and need a referral
128
Gingivitis
red, swollen gums that bleed easily occur in early gum disease which is gingivitis
129
Destruction of the gums with tooth loss
occurs in advanced disease
130
Periodontal disease
is highly correlated with cardiovascular disease
three times more prevalent in AA
131
Pain, tenderness and pressure around the eyes, cheeks, nose or forhead
seen in acute sinusitis which is an infection of the sinuses
132
Chronic sinusitis
the sinuses become inflamed and swollen but symptoms will last 12 weeks or long even with treatment
133
Epistaxis
nose bleeds
local causes are trauma, mucosal irritation, inflammatory diseases or tumors
idiopathic causes which are (unknown cause)
134
Kiesselbach area
located in the anterior part of the septum
is the most common site for nose bleeds
135
Stopping a nose bleed
Have patient sit up with head tilted forward not back, pinch nose between thumb and forefinger to 5 to 15 minutes
136
Thin, watery clear drainage
chronic allergies, but can also be CSF if associated with head injury
137
Yellow or green drainage
is typical of a cold, rhinitis or a sinus infection
138
Most upper respiratory infections are _____?
viral
139
Family history of mouth, throat, nose or sinus cancer
genetic links to these types of cancer
140
Smoking and drinking oral cancer
excessive use of alcohol increases the risk of oral cancer
141
Poor fitting dentures
may lead to poor eating habits
reluctance to speak freely
mouth sores or leukoplakia (thick white patches of cells) which is a precancerous condition
142
Pallor in the lips
seen with anemia and shock
143
Bluish in the lips
cyanotic seen with being cold or hypoxia
144
Reddish in the lips
seen with keto acidosis, carbon monoxide poisoning and COPD with polycythemia
145
Swelling in the lips
seen with local or systemic allergies or anaphylactic reactions
146
Red swollen gums
vitamin C deficiency
gingivitis
leukemia
147
Buccal mucosa abnormalities
Leukoplakia and thrush
148
Leukoplakia
chalky white raised patches that are precancerous
149
Thrush
Whitish curd-like patches that snap off and bleed easily
150
Fruity or acetone breath odor
diabetic ketoacidosis
151
Ammonia breath odor
kidney disease
152
Foul odor
oral or respiratory infection or tooth decay
153
Fecal breath odor
bowel obstruction
154
Sulfur breath odor
end stage liver disease
155
Grading scale for tonsils
1+ visible
| enlarged
2+ halfway between tonsillar pillars and uvula
3+ touching uvula
4+ touching each other
156
Tonsillitis
when the tonsils are covered with exudate
157
Dry tongue with deep longitudinal fissures
a sign of dehydration
158
enlarged tongue
suggests hypothyroidism
acromegaly (pituitary gland produces too much growth hormone)
Down syndrome
159
Small tongue
seen with malnutrition
160
atrophied tongue
seen with damage of cranial nerve XII
161
Bright red throat with yellow or white exudate
pharyngitis
162
Yellow mucus in the throat
seen with postnasal sinus drainage
163
Strep Throat
accounts for only a small portion of sore throats
if untreated it can cause complications such as kidney inflammation or rheumatic fever
has to be treated by antibiotics.
Should always come in if they have a sore throat because you don't know if its strep
164
Characteristics of strep throat
Erythematous posterior pharynx
palatal petechiae
white strawberry tongue
165
Deviated septum
can interfere with the openness of air flow
crooked nose
166
nasal mucosa (turbinates) that are swollen and pale pink or bluish gray
seen with chronic allergies
167
Nasal mucosa that is red and swollen
seen with upper respiratory infection
168
Small pale, round firm overgrowths or masses on the mucosa
are polyps
169
perforated septum is seen with ___?
cocaine use
170
Tender maxillary sinuses
if tender seen with chronic allergies or acute bacterial infection
patient will large amount of exudate in their sinuses crepitus will be felt on palpation of the maxillary sinuses
171
Hypothyroidism on its one
sleepiness, muscle aches, menstrual irregularities
myxedema is a medical emergency
172
Myxedema symptoms
low bp, decreased breathing, decreased body temp, unresponsiveness and even coma
173
what comes along with aura with migraines ?
Aura might occur before or during migraines: visual disturbances, vertigo, tinnitus, numbness or tingling , difficulty speaking
May be precipitated by emotional disturbances
May follow ingestion of alcohol, cheese, chocolate or other foods and substances which patient is sensitive to.
174
aura from migraines
Aura might occur before or during migraines: visual disturbances, vertigo, tinnitus, numbness or tingling , difficulty speaking
May be precipitated by emotional disturbances
May follow ingestion of alcohol, cheese, chocolate or other foods and substances which patient is sensitive to.
175
Hypertensive headache
begins in the morning, decreases during the day
176
temporal arteritis headache
typically occurs in older adults
177
Myxedema
causes facial puffiness, extremity edema, and weight gain
hypothyroidism
178
Graves disease
includes increased appetite, weight loss, nervousness, tremors, and thyroid enlargement (goiter)
Hyperthyroidism
179
Miosis
Pupil constriction
180
Mydriasis
pupil dilation
