HEENT, CN, Pain Flashcards
1
Q
Hyperopia
A
farsightedness; difficulty with close work
2
Q
myopia
A
nearsightedness; worsened vision with distances
3
Q
Sudden, unilateral, painless vision loss?
A
vitreous hemorrhage, retinal detachment, retinal vein occlusion or central retinal artery occlusion
4
Q
sudden unilateral, painful visual loss?
A
occur in the cornea and anterior chamber
corneal ulcer, uveitis, traumatic hyphema, acute glaucoma
5
Q
Bilateral vision loss is due to?
A
cataracts or macular degeneration
6
Q
Slow central loss?
A
nuclear cataract and macular degeneration
7
Q
Peripheral loss?
A
advanced open angle glaucoma
8
Q
moving specks or strands
A
vitreous floaters
9
Q
fixed defects
A
scotomas
10
Q
Scotomas suggest?
A
lesions in the retina or visual pathways
11
Q
diplopia
A
double vision
12
Q
horizontal diplopia v. vertical diplopia
A
horizontal- images side to side
vertical- images on top of each other
13
Q
When does diplopia occur?
A
lesions in the brainstem or cerebellum, weakness/paralysis in EOM
14
Q
Horizontal diplopia is due to?
A
palsy of cranial nerve 3 or 6
15
Q
Vertical Diplopia is due to?
A
palsy of CN 3 or 4
16
Q
conductive loss is due to?
A
problem in the external or middle ear
17
Q
sensorineural loss is due to?
A
problems in the inner ear, the cochlear nerve or the central connections in the brain
18
Q
People with sensorineural loss have trouble with what?
A
understanding speech; complaint of others mumbling and cannot hear in noisy environments
19
Q
People with conductive hearing loss have better hearing where?
A
noisy environments
20
Q
Medications that affect hearing loss?
A
AMG, aspirin, NSAIDs, quinine and furosemide
21
Q
Pain in the external canal?
A
otitis externa
22
Q
Pain in the middle ear with URI?
A
otitis media
23
Q
Ear pain can be referred pain from which structures?
A
mouth, throat, neck
24
Q
tinnitus
A
perceived sound with no external stimuli; musical ringing/rushing/roaring noise in one or both ears
25
Tinnitus+hearing loss+vertigo=
meniere's disease
26
unilateral hearing loss, congested, tinnitus=
eustachian tube disfunction
27
vertigo
perception that the patient of environment is rotating/spinning
28
vertigo points to problems in what?
labyrinth of inner ear, peripheral lesions of CN8, or lesions in central pathway/nuclei of brain
29
disequilibrium
one feeling unsteady or losing balance
30
rhinorrhea
drainage from the and associated with nasal congestion
31
epistaxis
bleeding from nasal passages; can originate in paranasal sinuses or nasopharynx
32
hoarseness
change in voice quality; described as husky, rough, harsh, or lower pitch than normal
33
Enlarged lymph nodes accompany what disease?
pharyngitis or sinusitis
34
When assessing thyroid function, ask about temperature intolerance and sweating. This suggests?
hypothyroidism
35
When assessing thyroid function, ask about palpitations and involuntary weight loss. This suggests?
hyperthyroidism
36
Goiters may cause thyroid function to do what?
increase, decrease or remain normal
37
An enlarged skull suggests?
hydrocephalus or Paget's disease
38
What is Hirsutism and what does it suggest?
excessive facial hair; polycystic ovary syndrome
39
What do you do first in an eye exam always?
visual acuity
40
OD/OS/OU in visual acuity test mean?
right eye; left eye; both eyes
41
Snellen eye chart
Patient stands 20 feet from chart and the best vision is recorded as line patient can read more than 1/2 the letters
42
Rosenbaum eye chart
near vision test; held from 14 inches from eye
43
What if patient is unable to see the big E, 3ft away?
Try counting fingers, hand motion or light perception
44
Hirschberg test is for?
manifest deviations, aka tropias
45
How to do Hirshberg test?
Dim lights, patient needs to be focused ahead, light held at 20 inches and central. The eyes should be equally aligned when this test is done.
46
What does the cover test detect?
detect and confirms tropias (manifest deviations)
47
What does the cover/uncover test detect?
detect and confirms phorias (latent deviations)
48
How to do cover test?
Covering the good eye causes deviated eye to focus; have patient focus directly ahead, cover the good eye and observe the deviated eye for correction
49
Ptosis
low lying upper eyelid during primary gaze; due to weak levator palpebrae muscle or CN3
50
Lagophthalmos
inabilty to fully close the eyelids; due to weak orbicularis muscle or CN 7
51
What do you look for when suspecting HSV Keratitis?
dendritic lesion on a stained eye
52
coloboma
defect or hole in iris
53
hyphema vs. hypopyon
hyphema-blood
hypopyon- pus
in the anterior chamber
54
What is a crescentic shadow is noted nasally?
narrow angle galucoma
55
When doing a crescentic shadow, what should light up?
entire limbus
56
What does the near reaction do?
put and object to the bridge of the nose and have the eyes follow leads to pupillary constriction
57
anisocoria
different size pupils; can be due to CN3 palsy
58
What does the wide H in the air test for?
EOM and nerves associated with them as well as nystagmus
59
What points of the wide H test do you pause at? Why?
extreme lateral and upward gaze for nystagmus
60
Convergence test is done why?
to see if your eye follow object toward nasal bridge and don't turn out
61
Arteries vs. veins (color, size, light reflex)
Artery- light red, smaller, bright
| Vein- dark red, larger, absent
62
Papilledema is associated with?
Increased intracranial pressure
63
Loss of venous pulsations, vessels blurred, disk margin blurred and non-visible physiological cup?
papilledema
64
Normal intraoccular pressure
10-22mmHg
65
When doing otoscopy, avoid contacting what part of ear?
Inner 2/3 of the canal with the speculum
66
What size speculum do you get for otoscopy?
The largest one that will fit in ear nicely
67
How do you pull the ear for otoscopy?
upward, back and away from the head
68
What does a pneumatic otoscopy do?
puffs the ear with air to check for mobility; important in pediatrics when assessing for otitis media
69
What size tuning fork for Weber and Rinne?
512Hz
70
What does Weber test for?
lateralization
71
How to do Weber test?
Place base of lightly vibrating tuning fork on the vertex of the skull or the mid forehead. Ask patient if they hear the sound equally in both ear or more prominently on one side
72
In the weber test, if the sound lateralizes to the impaired ear it means?
Unilateral conductive hearing loss; otitis media, TM perforation, obstruction
73
In the weber test, if the sound lateralizes to the good ear it means?
Unilateral sensorineural hearing loss
74
What does the Rinne test compare?
air conduction to bone conduction
75
How to do Rinne test?
Place a lightly vibrating tuning fork on the mastoid bone, behind the ear and level with the canal. When the patient can no longer hear the sound, quickly place the fork close to the ear canal to see if they can hear the sound again. Normally the sound is heard longer through air then through bone.
76
In the Rinne test, sound is heard through bone as long or longer than through the air?
conductive hearing loss
77
In the Rinne test, sound is heard longer through the air?
sensorineural hearing loss
78
How to test CN1?
Have patient close eyes and close nostril not being tested. Put familiar smells up to nostril not occluded and see if they can tell you what it is. Test both nostrils.
79
Bilateral no smell versus unilateral no smell?
Bilateral- anosmia
| Unilateral- CN1 lesions (olfactory nerve or tract)
80
Test CN 10
Have patient say ahh. Note if uvula and hard palate rise symmetrically.
81
Test for CN4 AND 10
gag reflex bilaterally
82
Test CN12
Have patient stick out tongue and it should remain in midline
83
Where do you palpate the thyroid gland posteriorly?
Place index fingers just below the cricoid cartilage and have the patient swallow
84
Test CN11
Have patient push against hand with face to test SCM
| Have patient try to lift shoulders while you press on them to test trapezius
85
Test CN2
visual acuity
86
Test CN3
Look for abnormal pupillary constriction with swinging eye test. If abnormal, palsy present.
87
Test CN3,4 and 6
EOM test with big H
88
Test CN5
3 Tests
1. Palpate the temporal and masseter muscles when patient clenches jaw (motor test)
2. Touch forehead, cheek and jaw with sharp/dull object and ask them if they feel sharp/dull and compare to each side of face
3. Touch cornea of the eye with a cotton ball and see if they blink (normal response). If they don't blink, that is abnormal.
89
Test CN8
Do the whispered voice test to see if they can hear. If not, proceed to Weber and Rinne
90
Test CN9
Ask the patient to speak and see if hoarse voice or if trouble swallowing. May suggest a problem.
91
What happens if an EOM muscle is paralyzed?
Can't turn eye toward the direction it functions
92
What if CN6 is paralyzed?
Can't use lateral rectus muscle to turn the eye outward
93
What does the H test, test for?
Normal EOM, nystagmus, lid lag
94
What is the asiclatory gap associated with?
arterial stiffness and atherosclerotic plaque
95
What is the pressure difference between the arms and legs?
5-10mmHg higher in the arms
96
Pain that is linked to tissue damage to the skin, musculoskeletal or visceral but the sensory nerves are intact. Seen in arthritis or spinal stenosis
nociceptive (somatic)
97
Pain that is a direct consequence of a lesion or disease affecting the somatosensory system. Pain may be present as a burning or lancinating even after the injury has healed. This is seen in CNS brain/spinal cord injuries from stroke or trauma or PNS disorder where pressure is on the spinal nerves
Neuropathic
98
Pain that is an alteration of the CNS processing of sensation, leading to amplified pain signals and response to pain is more severe than normal. Seen with fibromyalgia.
Central sensitization
99
Pain that involves many factors that can influence a patients response of pain. Can include psychiatric conditions, personality/coping styles, cultural norms and social support
psychogenic pain
100
Pain with no identifiable etiology
idiopathic
101
How do you do the swinging light test?
In a dim room, have teh patient look ahead and swing a light from one pupil to the other. A normal response is that both pupils constrict.
102
Abnormal response to swinging light test
optic damage; light shine in normal eye there is constriction of both pupils but when put into bad eye both eyes dilate. Response is an afferent pupil defect, aka Marcus Gunn Pupil
103
Pain not associated with cancer or other medical conditions that persist for more than 3-6mo. Pain lasting more than 1 mo beyond course of an acute illness or injury. Pain recurring at intervals of months or years
Chronic pain
104
How to assess pain
- Location- ask patient to point to area
- Severity- rate 1-10
- Associated features- describe pain and how it started, radiates, exacerbates it, makes it better
- Attempted treatments, related illness, impact on daily activity
- Health disparities
