HEENT Flashcards
what does HEENT stand for?
Head face and neck Eyes Ears Nose mouth Throat
swelling of the lymph nodes
lymphademia
opening between the upper and lower lid
Palpebral fissure
inner corner of eye, tear duct
Caruncle
what tube connects the ear and the nose?
Eustachian Tube
ear wax
Cerumen
What CN is involved with hearing? number function abnormal finding test
Vestibulocochlear VIII sense of earing, balance, equilibrium Diminished hearing Whispered voice test, hearing test
What CN is involved with smell? number function abnormal finding test
Olfactory I sense of smell Anosmia (unilateral) smell test (coffee, alcohol swab, cinnamon)
also known as smell blindness, is the loss of the ability to detect one or more smells
Anosmia
what structure warms and filters air in the nose?
Turbinates
What CN is involved with Taste? number function abnormal finding test
Facial, VII
Taste (anterior 2/3), sweet/ salty
altered taste
sweet/ salty test
Glassopharyngeal, IX
Taste (posterior 1/3), sour/ bitter
absence of gag reflex, altered taste
gag reflex, sour/ bitter test
Nasopharynx
the upper part of the pharynx, connecting with the nasal cavity above the soft palate.
taste buds
papillae
what are the symptoms form meningitis?
stiff neck (espically when looking down), headache, fever
what are the symptoms form Meningitis?
stiff neck (espically when looking down), headache, fever
A mild to moderate headache often described as feeling like a tight band around the head.
Multiple factors can bring on this type of headache, including stress, inadequate sleep, and thigh muscles in the shoulders, neck, scalp and jaw.
Tension headache
Bouts of frequent attacks, may last from weeks to months, usually followed by long periods of remission. Pain is severe (stabbing), unilateral, usually behind the eye.
Cluster headaches
Build-up of pressure within the sinus cavities. Pain is centered behind the forehead and cheek bones
Sinus Headache
Headache caused by changes in the brain and blood vessels. Symptoms include pains, N/V, visual changes (sensitivity to light).
Migraine Headache
Describe how to tell the difference in CSF and blood from the ear
CSF is clear
A mixture of blood and CSF will have a halo around it if dropped onto fabric.
What is the first assessment done with a patient who has suffered a brain injury?
change in LOC
the perception of 2 images of a single object
Diplopia
Sudden “floaters” in the field of vision are concerning why?
Could indicate retinal detachment
if a patient is pulling on the ear complaining of pain what could this mean?
inner ear infection b/c it would hurt to pull if it was middle ear pain
what could indicate a foreign object in the ear?
Ear discharge: clear, bloody, purulent
nose bleed
epistaxis
ringing in the ears
tinnitus
Subjective data for headaches
OPQRSTU Frequency, duration Triggering factors Visual changes prior to onset Description of pain Associated symptoms: toothache, vision, neck stiffness What is done for treatment
Subjective data for Ear pain
OPQRSTU Related to infection of mouth, sinus, throat Pain pulling on ear Discharge (description of fluid) Infants: 1st one, frequency, smoking
Subjective data for Hearing loss
OPQRSTU Certain sounds that are difficult to hear Tinnitus Onset sudden or gradual Other symptoms (URI) Recent travel
URI
Upper respiratory infection
Subjective data for Throat
OPQRSTU
PND, infection, allergies
Others at home sick or just recovered
Children have a higher incidence of developing strep
PND
Post Nasal Drip
Subjective data for oral lesions
Onset Have you had this before where are the sores other symptoms (enlarged lymph nodes may be associated w/ CA or infection) Sores anywhere else?
Inspection of Head, Face and Neck
CN Test
Symmetry: eyes, eyebrows, ears, palpebral fissures, nasolabial folds, and sides of the mouth.
CN Test: Facial, VII- smile, frown, puff out cheeks, raise eyebrows, scowl
Trachea deformity
Thyroid: Goiter
“smile lines”
nasolabial folds
Palpation of head, face and neck
CN Test for each
Facial sensation
CN test: Trigeminal, V- light facial sensation w/ cotton ball
Temporal tenderness
Mastication
CN test: Trigeminal, V- palpate masseter during clenching
Trachea deformity
Shoulder Shrug
CN test: Accessory, XI- place hands on shoulders and ask to shrug. Rotate head Lft. and Rt. against resistance
Palpation of lymph nodes
order of nodes
Start at preauricular (infront of tragus), Postauricular (at mastoid process), Submandibular (under jaw), Submental (under apex of chin)
Normal node palpation
If you can feel them at all they should be movable, discrete, soft, and nontender
If nodes are enlarged, bilateral, warm, tender, and firm but freely movable for <14 days’ duration.
This is a sign of what?
Acute infection
If nodes are clumped together
This is a sign of what?
Chronic inflammation
If nodes feel like a rock, are unmovable, >3 cm, unilateral, nontender, matted (conglomerated), and fixed to adjacent structures.
This is a sign of what?
Cancer
Palpation and auscultation of the Thyroid Glad
Palpate from behind pt. checking for nodules
If there is goiter, auscultate. Use bell and listen for whooshing. Abnormal if present, indicating hyperplasia of thyroid
Bell’s Palsy vs Stroke
temporary weakness or paralysis of the muscles controlled by CN VII. The entire side of the face will be effected.
In stoke the forehead is often not effected. In addition an arm may also lose movement.
the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells, often as an initial stage in the development of cancer.
hyperplasia
Inspection of the Eyes
Symmetry of brows and lashes, palpebral fissures, lids are not drooping, conjunctiva, sclera coloring, iris shape, pupils normal size- 3 to 5mm
Pupil condition in 5% of pop. one is larger than the other
Aniscoria
Diagnostic Positions test
What CN are being tested?
Cat whiskers test
Observe any EOMs
CN III (oculomotor), IV (Trochlear), VI (Abducen)- all are motor neurons
Visual Fields test
What CN are being tested?
Confrontation: bring fingers to peripheral of pt. and hold up fingers asking them to identify how many fingers you are holding up
CN II, Optic (vision)
Visual Acuity test
What CN are being tested?
Snellen Eye Chart, pt. stands 20ft away
CN II, Optic (vision)
Corneal Light reflex test
“sparkle in your eye” should be in the same place in each eye.
PERRLA
Pupils are Equal Round Reactive to Light and Accommodating
How to test Reactive to Light and Accommodating?
Direct response: using a pen light shine into one cornea (pupil should constrict), then shine in the same pupil again (BOTH pupils should constrict).
Accommodation: Position finger 4” in front of nose (pupils should converge and constrict). Then move finger back (pupils should dilate)
EOM
Extra Ocular Movement
Inspection of Ocular Fundus looks at what structures?
optic disk, retinal vessels, and macula
what should be observed when looking at the Red reflex:
should be present bilaterally
what should be observed when looking at the Optic disk:
located on nasal side of retina; normally creamy yellow-orange to pink, round or oval, with distinct margins
what should be observed when looking at the Retinal Vessels:
any diseases that affect vascular system show signs in retinal vessels
Macula: darker area lateral to optic disk
what should be observed during inspection of ears?
External ears Auditory Canal: foreign bodies, discharge, cerumen Tympanic Membrane (use otoscope)
what should be observed during palpation of ears?
Pinna, tragus, lobule, and mastoid process
Note tenderness, bogginess (edema), or crepitus
Inflammation of mastoid process could mean what?
Possible infection to brain
what is the term for “swelling of the optic disk”?
Papilledema
If margins of the optic disk are blurry what could this be a sign of?
ICP
What should a normal tympanic membrane look like?
Shiny and translucent, pearl-gray color
Flat, slightly retracted at center
Mobile
“cone of light” reflected from the otoscope
What do these abnormal TM colors mean?
Red, blue, opaque, white patches, black/ white dots
Red: Infection in middle ear- Acute otitis media
Blue: Blood behind drum (in middle ear)- trauma, skull fracture
Opaque: Acute otitis media
Dense white patches: Scaring- sequelae (a series) of infections
Black or white dots on the drum: Colony of growth- fungal infection
linea alba
line from teeth on buccal membrane
Inspection of mouth and oral cavity
CN Test
Inspect carefully for lesions; If lesions present, palpate for induration (hardening) with gloved hand
CN XII, Hypoglossal – “stick your tongue out” tongue protrudes in midline
Inspection of palates, uvula and tonsils
CN Test
CN X, Vagus: “ahhhhh” test gag/ swallow Tonsils: pink with indentations 1+ 2+ normal size, not purulent 3+ touching uvula 4+ touching each other
term for bad breath odor
Halitosis
The indentations on the tonsils are called what?
Crypts
What is the term for the normal “wavy” finding of gums
Stippple
Findings in hypo vs hyperthyroidism
Hyop: more common, pt. feels cold, wt. gain, edematous face, goiter, dry skin, depression.
Hyper: goiter, wt. loss, exophthalmos, decreased blinking, smooth soft skin, anxiety
Term for bulging eyes
exophthalmos
how are turning forks used to assess hearing
conductive loss vs sensorineural
not very reliable
What are the causes and manifestations of conductive hearing loss
Causes: Otosclerosis, TM infection or scarring, obstruction
Overall decreased ability to hear; gradual or sudden; unilateral or bilateral; helps when others speak louder; cause may be visible with otoscopic exam.
What are the unfused cranial structures of an infant skulls called?
Fontanels
What is a symptom of dehydration in babies heads?
Sunken fontanels (check for turgor as well)
What is a symptom of ICP in babies heads?
Swollen fontanels
Describe an infants vision up to 8 mo.
- can use peripheral
- binocularity developed at 3-4 months
- macula developed at 8 months
What does the macula do?
area of keenest vision
what is binocularity?
the ability of both eyes to focus on an object
Describe the changes of the eye in an older adult
Pupil size decreases
Visual acuity diminishes gradually after 50y
Decreased tear production (dry eyes)
Lens loses elasticity, becoming hard and glasslike- leads to presbyopia
Normally transparent fibers of lens begin to thicken and yellow, the beginning of cataracts
In the eyes of older adults, the lens loses elasticity and becomes hard and glasslike. This glasslike quality decreases the ability of the lens to change shape to accommodate for near vision, a condition termed:
Presbyopia: term for difficulty seeing near
yellowish nodules on sclera from exposure to environmental elements
Pingueculae
lipid material causes grey/white arc around cornea
Arcus Senilis
soft yellow plaques occurring on lids at inner canthus
Xanthelasma
Cataract formation—
Subjective data
objective data
a clouding of the crystalline lens due to ultraviolet radiation, and/ or age.
Subjective: cloudy or blurred vision; diplopia; glare from headlights, lamps, or sunlight; poor night vision
Objective: cloudy lens can be observed on inspection.
Red reflex is absent because light cannot penetrate opacity of lens. Pupillary light reflex may be absent.
This is curable with lens replacement surgery.
Age-related macular degeneration (AMD)—
Fatty deposits in macular cause loss of central vision. Peripheral vision is not affected;
Glaucoma—
a group of diseases that increases intraocular pressure (IOP) and damages the optic nerve. Results in very gradual loss of peripheral vision
Age is the primary risk, and because women live longer, they account for 61% of those with glaucoma.
Diabetic retinopathy—
Manifestations
damage to the capillaries of the retina.
May result in retinal detachment: acute onset of flashing lights and floaters
“A shadow or diminished vision in one quadrant or one half of visual field“
The leading cause of blindness in adults 25 to 74 years of age. Prevalence has decreased as the result of intensified prevention measures and newer treatments. This could soon be offset by increasing obesity rates.
Potential variations in Black populations (3)
- Brown macules (freckles) on sclera
- Gray-blue color to sclera
- Yellowish fatty nodules under lids away from cornea
Developmental competence: Infants ear
what does this put them at grater risk for?
- Eustachian tube is shorter, wider and more horizontal than adult‘s
- This makes it easier for pathogens to migrate from the nasopharynx. It is surrounded by lymphoid tissue and is easily occluded.
- These factors place infants at greater risk for OM than adults- 90% of children <2y have had OM
When do infants develop teeth?
When do they lose these teeth for permanent ones?
Deciduous teeth erupt 6-24 months; all should appear by 2.5y
Deciduous teeth lost ages 6-12; replaced by permanent
a benign milky, bluish-white, opaque area occurring on buccal mucosa; seen more often in Blacks.
Leukoedema: turns white when cheek is pulled
bony ridge on hard palate seen in 20-35% of Americans; more common in American Indians and Asians
Torus Palatinus
Bifid Uvula:
cleft uvula, is a uvula that is split in two. Occurs in 10% of some American Indian groups
Abnormal accumulation of cerebrospinal fluid(CSF) may develop from infancy to adulthood.
Hydrocephalus
How does hydrocephalus manifest in children
Gradual increase in ICP leads to an actual enlargement of head
Bulging fontanels, Dilated scalp veins, “Sunsetting” eyes
How does hydrocephalus manifest in Adults
Signs of increased ICPare noted because skull is unable to expand
decreased LOC, pupil changes, H/A, ataxia, vomiting)
H/A
Headache
Cushing’s Syndrome manifestations
Caused by excess cortisol levels from from tumor or chronic corticosteroid use
Moon face
Conjunctivitis
clinical findings
“Pink eye” – very contagious
Inflammation of conjunctiva caused by infection, allergic reaction, URI.
Clinical findings: discharge, swollen preauricular lymph nodes, burning, eyelids stuck together in AM
Corneal Abrasion
clinical findings
Causes may include infection; incomplete lid closure, scratches, foreign bodies, or contact lenses poorly fitted or overworno
Clinical findings: intense pain, foreign body sensation; photophobia; tearing and redness.
“lazy eye”
amblyopia
abnormal ocular alignment due to extraocular muscle weakness
Objective findings
Strabismus
- Asymmetrical corneal light reflexo
- Abnormal cover/uncover test
Esotropia
Exotropia
Hypertropia
Hypotropia
- esotropia: Horizontal, inward turn of the eye
- exotropia: Horizontal, outward turn of the eye
- hypertropia: Vertical, upward turn of the eye
- hypotropia: Vertical, downward turn of the eye
What are the causes and manifestations of sensorineural hearing loss
Large majority of hearing loss is sensorineural
Causes: Presbycusis, inner ear pathology, CN VIII dysfunction, stroke, ototoxic drugs
Person first notices high-frequency tone loss; words sound garbled, and the ability to localize sound is impaired.
IOP
Intraocular Pressure
presbycusis
a sensorineural loss in the aging adult
ear pain
otalgia
Otitis Media (OM) clinical findings
An infection of the air-filled space behind the eardrum (the middle ear).
Potential for fever, vomiting, and decreased hearing
TM may be inflamed, red, bulging, immobile.
Purulent drainage from ear with a relief of pain suggests perforation
Recurrent infections may cause scarring (white patches)
Clinical Findings: severe pain when ear is manipulated; redness, swelling, purulent discharge, scaling, fever, and enlarged lymph nodes
Otitis Externa (OE) clinical findings
An infection of the outer ear canal.
Clinical Findings: severe pain when ear is manipulated; redness, swelling, purulent discharge, scaling, fever, and enlarged lymph nodes
May occur after swimming- rubbing alcohol eardrops after swimming can help prevent
Tophi
Small, white/yellow, hard nodules, usually at helix of ear
Non-tender
Contain uric acid crystals = sign of chronic gout
Allergic Rhinitis
clinical findings
allergic vs acute
caused by allergies
Clinical findings: sneezing, congestion, drainage, itchy eyes, cough,fatigue
Turbinates often enlarged and usually appear pale (or violet).
Acute Rhinitis
clinical findings
allergic vs acute
“Common cold”
Clinical Findings: Clear, watery discharge, may later become purulent. Sneezing, nasal itching, cough, nasal obstruction
Turbinates are dark red and swollen
Sinusitis
clinical findings
Infection as a result of pooling secretions within sinuses.
Clinical findings: throbbing pain in affected sinus. fever, thick purulent discharge, and edematous, erythematous nasal mucosa.
edematous -
Swollen with an excessive accumulation of fluid
erythematous
Erythema (from the Greek erythros, meaning red) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries
Herpes Simplex 1
clinical findings
“cold sore” - highly contagious viral infection
Typically a prodromal burning or tingling sensation then clustered lesions appear on lip and skin junction.
Like other herpes infections, lesions progress from vesicles to pustules and finally to crusts.
relating to or denoting the period between the appearance of initial symptoms and its full development
Prodromal
Chelitis
Painful fissures at corners of mouth occur with excess salivation and Candida (yeast) infection
Aphthous Ulcer
clinical findings
“Canker Sore” a common oral lesion affecting up to 30% of adults and 37% of school-age children.
Cause is unknown, but it is associated with stress, fatigue, and food allergy.
Clinical findings: Round or oval ulcerative lesion with a yellow-white center and an erythematous halo, often appear on buccal mucosa, lips, tongue, or palate as round oroval ulcerative
May last up to 2 weeks.
Candidiasis
clinical findings
“thrush”
oral infection caused by fungal infection in those chronically debilitated or immune-suppressed, or as a result of antibiotic therapy.
Can scrape off.
Clinical findings: white plaques on tongue, buccal mucosa, or posterior pharynx. If membrane is peeled off, a raw, bleeding, erythematous, eroded, or ulcerated surface results.
Atrophic Glossitis
Smooth, glossy (magenta) tongue accompanied by dryness and burning
Occurs with Vitamin B deficiency and pernicious anemia
Black hairy tongue
Fungal infection occurring after use of antibiotics (tetracycline) or with heavy smoking
Leukoplakia
a condition in which one or more white patches or spots (lesions) forms inside the mouth.
Cannot be scrapped off
Can lead to CA
Tonsillitis
clinical findings
Infection of the tonsils
Clinical Findings: sore throat, odynophagia, fever, chills, enlarged and tender lymph nodes; tonsils enlarged and covered with exudates.
Peritonsillar Abscess
clinical findings
May result from untreated pharyngitis or tonsillitis
Severe pain, fever, swelling; potential to block the throat resulting in difficulty swallowing, speaking, and breathing.
Down Syndrome
Flat nasal bridge Ear dysplasia (malformation) Upward palpebral slant Epicanthal folds (inner eye) Hypertelorism (wide set eyes) Brushfield spots (iris) Fissured/scrotal tongue; Macroglossia
Parotid gland
function
enlargement meaning
Secrets saliva through Stensen’s duct to moisten the mouth
Sign of mumps
A flat spot may develop on an infants head when they spend too much time lying on their back.
It doesn’t cause brain damage or interfere with a baby’s development.positional Plagiocephaly
positional Plagiocephaly
