HEENT Exam Flashcards
Headache “Red Flag” warnings
Progressively frequent or severe over 3-month period
Sudden “Thunderclap” or “Worst headache of my life!” (subarachnoid hemorrhage in 70% of cases)
New onset after the age of 50
Positional change helps or aggravates
Caused by Valsalva maneuver
With fever, night sweats, or weight loss
Patient hx of cancer, HIV, pregnancy
Recent head trauma
Associated papilledema, neck stiffness, focal neurologic deficits
Hair Physical Exam features
Quality
Distribution
Texture
Pattern of loss
Skin flaking or caking
Parasites
Scalp Physical Exam Features
Scaliness
Lumps
Nevi
Other lesions
Face Physical Exam Features
Expression
Symmetry
Involuntary movement
Edema
Masses
Skull Physical Exam Features
Observe general shape & size
Deformities
Tenderness
Skin Physical Exam Features
Color
Pigmentation
Texture
Thickness
Scars
Lesions
Lymph nodes on the Head/Neck:
Preauricular
Posterior auricular
Occipital
Tonsillar
Submandibular
Submental
Superficial cervical
Posterior cervical
Deep cervical chain
Supraclavicular
Neck physical exam features
Symmetry, masses, scars, enlarged glands or lymph nodes
Trachea – position, alignment
Thyroid gland - symmetry
Pupillary Reactions
Dilation
Constriction
Consensual reaction
_______ is decreased pupil size. Occurs in response to light or focusing on distant objects.
Constriction
_____ is increased size of the pupil. Occurs in the dark, when focusing on close objects, and emotional events
Dilation
The _____ is the opening between the eyelids.
palpebral fissure
Types of vision disturbances
HYPEROPIA - Farsightedness (Near objects appear blurry)
MYOPIA - Nearsightedness (distant objects appear blurry)
PRESBYOPIA - Farsightedness due to old age
SCOTOMA - Partially diminished or entirely degenerated area of vision. Can be a “blind spot” or a dark or distorted area
_____ is farsightedness
Hyperopia
______ is Nearsightedness
Myopia
Common eye presenting symptoms
Visual disturbances, spots (scotomas), flashing lights, pain, redness, excessive tearing, double vision (diplopia)
Eye inspection includes what things
- Position and alignment of eyes
- Eyebrows - quantity, distribution
- Lacrimal apparatus - Swelling of Lacrimal gland/sac
- Eyelids: Width of palpebral fissures, Edema, color, lesions, Adequacy of closed eyelids
- Conjunctiva and sclera: Color, vascular pattern
- Cornea and lens - opacities
- Iris - markings clearly defined
- Pupils - size, shapy, symmetry, reaction to light
How to test for visual acuity?
Central vision: Snellen eye chart; position patient 20 feet from the chart
Patients should wear glasses if needed
Test one eye at a time
20/20 is an average, so about 50% of population will have better vision
Near vision: hand-held card (can also use to test visual acuity at the bedside); Maxwell Quick Medical Reference has one on the back.
What are we looking for with testing extraocular movements?
- Abnormal conjugate movements
- Nystagmus (When the eyes make repetitive, uncontrolled movements)
- Lid lag
- Convergence
______ - Microinfarcts of the retinal nerve fiber layer.
Cotton-wool patches
______ - Chronic hypertension causes stiffening and hardening of the arteries which displace the veins.
Causes a “nicked” appearance
Arterio-Venous (AV) Nicking
_____ - Deterioration of the central portion of the retina (macula)
Macular Degeneration
_____ - Swelling of the optic disc, due to ↑ intracranial pressure
Papilledema
_____ Due to death of optic nerve fibers, from glaucoma
Optic Cupping
Age related hearing loss is called
Presbycusis
Conductive hearing loss vs. Sensorineural loss
Conductive loss
External or middle ear issue
- Cerumen impaction
- Otitis Externa
- Otitis Media
- Perforated TM
Sensorineural loss
Inner ear, cochlear nerve, or brain.
- Presbycusis
- Viral Infections
- Meniere disease
- Noise Exposure
Peripheral vs. Central Vertigo
Peripheral: “I am spinning”
Increased nausea
Negative CNS exam
Position related changes
Horizontal nystagmus
Central: “Room is spinning around me”
Originates in the central nervous system.
Not position related
Abnormal neuro exam
Ex - lesions of cranial nerve VIII
Vertical nystagmus
Weber Test evaluates for ____
Lateralization
Rinne Test compares ____ vs _____
air (AC) ; bone conduction (BC)
Hoarseness or _____ (change in voice quality)
Dysphonia
Abnormal mouth and throat findings
Cobblestoning of Posterior pharynx
Aphthous ulcers
Oral candidiasis
Strep Pharyngitis
EBV pharyngitis
(Mono)
