HEENT Flashcards
1
Q
what does HEENT stand for?
A
Head face and neck Eyes Ears Nose mouth Throat
2
Q
swelling of the lymph nodes
A
lymphademia
3
Q
opening between the upper and lower lid
A
Palpebral fissure
4
Q
inner corner of eye, tear duct
A
Caruncle
5
Q
what tube connects the ear and the nose?
A
Eustachian Tube
6
Q
ear wax
A
Cerumen
7
Q
What CN is involved with hearing? number function abnormal finding test
A
Vestibulocochlear VIII sense of earing, balance, equilibrium Diminished hearing Whispered voice test, hearing test
8
Q
What CN is involved with smell? number function abnormal finding test
A
Olfactory I sense of smell Anosmia (unilateral) smell test (coffee, alcohol swab, cinnamon)
9
Q
also known as smell blindness, is the loss of the ability to detect one or more smells
A
Anosmia
10
Q
what structure warms and filters air in the nose?
A
Turbinates
11
Q
What CN is involved with Taste? number function abnormal finding test
A
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
12
Q
Nasopharynx
A
the upper part of the pharynx, connecting with the nasal cavity above the soft palate.
13
Q
taste buds
A
papillae
14
Q
what are the symptoms form meningitis?
A
stiff neck (espically when looking down), headache, fever
15
Q
what are the symptoms form Meningitis?
A
stiff neck (espically when looking down), headache, fever
16
Q
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.
A
Tension headache
17
Q
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.
A
Cluster headaches
18
Q
Build-up of pressure within the sinus cavities. Pain is centered behind the forehead and cheek bones
A
Sinus Headache
19
Q
Headache caused by changes in the brain and blood vessels. Symptoms include pains, N/V, visual changes (sensitivity to light).
A
Migraine Headache
20
Q
Describe how to tell the difference in CSF and blood from the ear
A
CSF is clear
A mixture of blood and CSF will have a halo around it if dropped onto fabric.
21
Q
What is the first assessment done with a patient who has suffered a brain injury?
A
change in LOC
22
Q
the perception of 2 images of a single object
A
Diplopia
23
Q
Sudden “floaters” in the field of vision are concerning why?
A
Could indicate retinal detachment
24
Q
if a patient is pulling on the ear complaining of pain what could this mean?
A
inner ear infection b/c it would hurt to pull if it was middle ear pain
25
what could indicate a foreign object in the ear?
Ear discharge: clear, bloody, purulent
26
nose bleed
epistaxis
27
ringing in the ears
tinnitus
28
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
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29
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
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30
Subjective data for Hearing loss
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OPQRSTU
Certain sounds that are difficult to hear
Tinnitus
Onset sudden or gradual
Other symptoms (URI)
Recent travel
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31
URI
Upper respiratory infection
32
Subjective data for Throat
OPQRSTU
PND, infection, allergies
Others at home sick or just recovered
Children have a higher incidence of developing strep
33
PND
Post Nasal Drip
34
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?
```
35
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
36
"smile lines"
nasolabial folds
37
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
38
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)
39
Normal node palpation
If you can feel them at all they should be movable, discrete, soft, and nontender
40
If nodes are enlarged, bilateral, warm, tender, and firm but freely movable for <14 days' duration.
This is a sign of what?
Acute infection
41
If nodes are clumped together
| This is a sign of what?
Chronic inflammation
42
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
43
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
44
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.
45
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
46
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
47
Pupil condition in 5% of pop. one is larger than the other
Aniscoria
48
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
49
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)
50
Visual Acuity test
| What CN are being tested?
Snellen Eye Chart, pt. stands 20ft away
CN II, Optic (vision)
51
Corneal Light reflex test
"sparkle in your eye" should be in the same place in each eye.
52
PERRLA
Pupils are Equal Round Reactive to Light and Accommodating
53
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)
54
EOM
Extra Ocular Movement
55
Inspection of Ocular Fundus looks at what structures?
optic disk, retinal vessels, and macula
56
what should be observed when looking at the Red reflex:
should be present bilaterally
57
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
58
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
59
what should be observed during inspection of ears?
```
External ears
Auditory Canal: foreign bodies, discharge, cerumen
Tympanic Membrane (use otoscope)
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60
what should be observed during palpation of ears?
Pinna, tragus, lobule, and mastoid process
| Note tenderness, bogginess (edema), or crepitus
61
Inflammation of mastoid process could mean what?
Possible infection to brain
62
what is the term for "swelling of the optic disk"?
Papilledema
63
If margins of the optic disk are blurry what could this be a sign of?
ICP
64
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
65
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
66
linea alba
line from teeth on buccal membrane
67
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
68
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
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69
term for bad breath odor
Halitosis
70
The indentations on the tonsils are called what?
Crypts
71
What is the term for the normal "wavy" finding of gums
Stippple
72
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
73
Term for bulging eyes
exophthalmos
74
how are turning forks used to assess hearing
conductive loss vs sensorineural
| not very reliable
75
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.
76
What are the unfused cranial structures of an infant skulls called?
Fontanels
77
What is a symptom of dehydration in babies heads?
Sunken fontanels (check for turgor as well)
78
What is a symptom of ICP in babies heads?
Swollen fontanels
79
Describe an infants vision up to 8 mo.
- can use peripheral
- binocularity developed at 3-4 months
- macula developed at 8 months
80
What does the macula do?
area of keenest vision
81
what is binocularity?
the ability of both eyes to focus on an object
82
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
83
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
84
yellowish nodules on sclera from exposure to environmental elements
Pingueculae
85
lipid material causes grey/white arc around cornea
Arcus Senilis
86
soft yellow plaques occurring on lids at inner canthus
Xanthelasma
87
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.
88
Age-related macular degeneration (AMD)—
Fatty deposits in macular cause loss of central vision. Peripheral vision is not affected;
89
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.
90
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.
91
Potential variations in Black populations (3)
- Brown macules (freckles) on sclera
- Gray-blue color to sclera
- Yellowish fatty nodules under lids away from cornea
92
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
93
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
94
a benign milky, bluish-white, opaque area occurring on buccal mucosa; seen more often in Blacks.
Leukoedema: turns white when cheek is pulled
95
bony ridge on hard palate seen in 20-35% of Americans; more common in American Indians and Asians
Torus Palatinus
96
Bifid Uvula:
cleft uvula, is a uvula that is split in two. Occurs in 10% of some American Indian groups
97
Abnormal accumulation of cerebrospinal fluid(CSF) may develop from infancy to adulthood.
Hydrocephalus
98
How does hydrocephalus manifest in children
Gradual increase in ICP leads to an actual enlargement of head
Bulging fontanels, Dilated scalp veins, “Sunsetting” eyes
99
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)
100
H/A
Headache
101
Cushing’s Syndrome manifestations
Caused by excess cortisol levels from from tumor or chronic corticosteroid use
Moon face
102
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
103
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.
104
“lazy eye”
amblyopia
105
abnormal ocular alignment due to extraocular muscle weakness
| Objective findings
Strabismus
- Asymmetrical corneal light reflexo
- Abnormal cover/uncover test
106
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
107
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.
108
IOP
Intraocular Pressure
109
presbycusis
a sensorineural loss in the aging adult
110
ear pain
otalgia
111
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Otitis Media (OM)
clinical findings
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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
112
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Otitis Externa (OE)
clinical findings
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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
113
Tophi
Small, white/yellow, hard nodules, usually at helix of ear
Non-tender
Contain uric acid crystals = sign of chronic gout
114
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).
115
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
116
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.
117
edematous -
Swollen with an excessive accumulation of fluid
118
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
119
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.
120
relating to or denoting the period between the appearance of initial symptoms and its full development
Prodromal
121
Chelitis
Painful fissures at corners of mouth occur with excess salivation and Candida (yeast) infection
122
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.
123
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.
124
Atrophic Glossitis
Smooth, glossy (magenta) tongue accompanied by dryness and burning
Occurs with Vitamin B deficiency and pernicious anemia
125
Black hairy tongue
Fungal infection occurring after use of antibiotics (tetracycline) or with heavy smoking
126
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
127
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.
128
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.
129
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
```
130
Parotid gland
function
enlargement meaning
Secrets saliva through Stensen's duct to moisten the mouth
| Sign of mumps
131
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
