HEENT

Question 1

When assessing HAs what should we rule out first?

Answer 1

Life threatening causes

Question 2

What is presbycusis?

Answer 2

Loss of hearing with age

Question 3

What is the function of the auditory ossicles?

Answer 3

Transmit vibration from TM to inner ear

Question 4

What is the function of the Eustachian tube?

Answer 4

Equalize air pressure from middle ear to nasopharynx

Question 5

How does the anatomical position of the Eustachian tube differ in children and adults?

Answer 5

More horizontal in children, more angled in adults

Question 6

T/F. The labyrinth is the structure of the inner ear responsible for balance and transmission of sound.

Answer 6

True

Question 7

What are the structures of the middle ear?

Answer 7

Auditory ossicles and Eustachian tube

Question 8

What is the function of the labyrinth?

Answer 8

Responsible for balance and transmission of sound

Question 9

What is the function of the cochlea?

Answer 9

Converts vibrations and sends them through the cochlear nerve to the brain

Question 10

What makes up the labyrinth?

Answer 10

Semicircular canals, vestibule, and cochlea

Question 11

What immunizations are we considering that could be related to the head and face?

Answer 11

Meningitis, mumps, shingles, and HPV

Question 12

What are some HA red flags?

Answer 12

Sudden or recent onset, > 50, thunderclap, elevated BP, rash or signs of infection, presence of cancer, HIV, or pregnancy, vomiting, recent head trauma.

Question 13

Oral cancer poses a much higher risk in which ethnic group?

Answer 13

African American men

Question 14

Parkinson’s is a disease of what structure of the brain?

Answer 14

Disorder of the cerebellum

Question 15

MS can be classified as what type of disorder?

Answer 15

Motor neuron disorder

Question 16

How do we grade tonsil size if the tonsils are crossing the midline and “kissing”?

Answer 16

4+

Question 17

What does a 3+ tonsil grade mean?

Answer 17

tonsils can touch the uvula, but they don’t go pass the midline pushing the uvula.

Question 18

What is a 2+ tonsil grade?

Answer 18

tonsils are halfway in between the anterior arch and uvula.

Question 19

How do we grade tonsils if they are behind posterior pillar?

Answer 19

1+

Question 20

What kind of tissue are tonsils made of?

Answer 20

Lymph tissue

Question 21

Which Snellen test do we use if the patient is not literate?

Answer 21

Use the “E” or “C” chart and ask the patient what way is the letter pointing.

Question 22

What Snellen test option do you have for pediatric patients?

Answer 22

shapes chart

Question 23

What is strabismus?

Answer 23

“Lazy eye”, eye misalignment.

Question 24

In what kind of patient are you most likely to see scleral edema?

Answer 24

fluid overload

Question 25

What is ptosis?

Answer 25

Drooping of the eyelid

Question 26

What is exophaltmos?

Answer 26

bulging of the eyes usually seen in Grave's disease

Question 27

What is miosis?

Answer 27

pinpoint pupils

Question 28

How do we test for strabismus?

Answer 28

Cover-uncover test

Question 29

What is mydriasis?

Answer 29

Blown pupils

Question 30

What is anisocoria?

Answer 30

difference in pupil size which can be normal as long as both still react to light

Question 31

What is dyscoria?

Answer 31

Irregular pupil shape which can come from trauma or infection

Question 32

What are we looking for with the convergence test?

Answer 32

eyes moving symmetrically as an object comes closer

Question 33

What does accommodation refer to?

Answer 33

Constriction of the pupils

Question 34

What can unequal corneal light reflex indicate?

Answer 34

strabismus or amblyopia

Question 35

what are the 2 muscles of the eye?

Answer 35

Rectus and oblique

Question 36

What is hyperopia?

Answer 36

Farsightedness

Question 37

What is myopia?

Answer 37

near sighted

Question 38

What is presbyopia?

Answer 38

Far sighted caused by loss of elasticity in the lens usually caused by age

Question 39

What should be considered if the patient has sudden onset of blurry vision?

Answer 39

retinal detachment, occluded veins or arteries, ulcer, or macular degeneration.

Question 40

What is conductive hearing loss?

Answer 40

Think obstruction

Question 41

What is sensorineural hearing loss?

Answer 41

Think inner ear disease

Question 42

What are some potential problems causing sensorineural hearing loss?

Answer 42

Meniere's disease, loud noise exposure, presbycusis, ototoxicity. -cochlear, auditory nerve damage or auditory area of cerebral cortex is damaged.

Question 43

What are some of the potential problems causing middle ear conductive hearing loss?

Answer 43

OM, serous otitis, otosclerosis

Question 44

What are possible causes of pre-syncope events?

Answer 44

orthostatic hypotension caused by certain drugs, dysrhythmias, and vasovagal response

Question 45

What are the characteristics of Meniere's disease?

Answer 45

sudden onset, lasting several hours to 1 day or more, recurrent; sensorineural hearing loss; tinnitus is present and fluctuating; sensation of pressure or fullness in the ear, N/V, nystagmus.

Question 46

What type of hearing loss is seen with Meniere's disease?

Answer 46

sensorineural

Question 47

What is conductive hearing loss?

Answer 47

external or middle ear disorder that impairs sound conduction to inner ear.

Question 48

What are possible causes of conductive hearing loss?

Answer 48

cerumen impaction, FB, otitis externa, perforated eardrum, and otosclerosis of ossicles

Question 49

What is sensorineural hearing loss?

Answer 49

Inner ear disorder that involves cochlear nerve and neuronal impulse transmission to the brain.

Question 50

What are the 2 most common types of angioedema?

Answer 50

Allergic rxns and NSAID rxns

Question 51

What associated symptoms usually accompany angioedema?

Answer 51

urticaria and pruritis

Question 52

Vertigo is a spinning sensation accompanied by what 2 other symptoms?

Answer 52

Nystagmus and ataxia

Question 53

A lesion on what part of the CNS can cause vertigo?

Answer 53

lesion on cerebral brainstem

Question 54

What is an autoimmune disease that causes ptosis of the eyes?

Answer 54

Myasthenia gravis

Question 55

In what disease can exophthalmos be seen?

Answer 55

Graves

Question 56

What are possible causes of conjunctivitis?

Answer 56

Bacterial, viral, and other infections; allergy; irritation

Question 57

What are the 4 categories of primary headaches?

Answer 57

Tension, cluster, chronic, and migraine

Question 58

What is a Rinne's test?

Answer 58

vibrating tuning fork is placed behind the ear on the mastoid process .

Question 59

If patient does not pass the whisper test what is the next step?

Answer 59

Assess hearing loss by doing the Rinne's or Weber test

Question 60

What is the Weber test?

Answer 60

vibrating tuning fork is placed on top of the head or forehead

Question 61

What are the findings of sensorineural hearing loss using the Weber test?

Answer 61

sound is heard louder in unaffected ear

Question 62

Which hearing test do we use to test for air vs bone conduction?

Answer 62

The Rinne's test

Question 63

When doing the Rinne's test what are the findings of conductive hearing loss?

Answer 63

Sound is heard longer in bone than in air

Question 64

When doing the Rinne's test what are the findings of sensorineural hearing loss?

Answer 64

sound is heard longer through air

Question 65

Where is the location of a meningitis and hemorrhagic (subarachnoid) HA?

Answer 65

Generalized

Question 66

What is the quality and severity of a subarachnoid (thunderclap) HA?

Answer 66

very severe, "worst HA of my life"

Question 67

What is the time of onset for a subarachnoid HA?

Answer 67

Sudden, less than a minute

Question 68

What is the duration of a subarachnoid HA?

Answer 68

Variable, usually days

Question 69

What are associated sx of subarachnoid HA?

Answer 69

Nausea, vomiting, loss of consciousness, neck pain. Possible prior neck symptoms from “sentinel leaks”

Question 70

What are the associated sx of meningitis?

Answer 70

Fever, stiff neck, photophobia, change in mental status

Question 71

What is the quality and severity of a meningitis HA?

Answer 71

Steady or throbbing, very severe

Question 72

What is the time of onset of a meningitis?

Answer 72

Fairly rapid, usually <24 hours; may be sudden onset

Question 73

What is the duration of meningitis?

Answer 73

Variable, usually days