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Health Assessment > HEENT (Exam 2) > Flashcards

HEENT (Exam 2) Flashcards

1
Q

Name the 4 cranial bones

A

• frontal
• parietal
• occipital
• temporal

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2
Q

Name the 4 major cranial sutures

A

• coronal
• sagittal
• lamboid
• metopic

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3
Q

Are sutures firmly joined at birth?

A

No!

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4
Q

How many facial bones do we have?

A

14

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5
Q

The brain is suspended in the skull by ________

A

membranous meninges

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6
Q

What are the purpose of meninges?

A

shock absorbers to prevent trauma

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7
Q

Cranial nerve VII: Name and function

A

Facial nerve; appearances and expressions

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8
Q

Cranial nerve V: Name and Function

A

trigeminal nerve; facial sensations

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9
Q

What are the four functions of the salivary glands?

A

• moisturize mouth
• aid in swallowing
• aid in digestion of food
• protect teeth from bacteria

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10
Q

Internal carotid (neck) supplies blood to…

A

the brain

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11
Q

External carotid (neck) supplies blood to the…

A

face and salivary glands

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12
Q

Cranial nerve XI: Name and Function

A

spinal accessory; innervates neck muscles

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13
Q

Sternomastoid muscles: Function

A

head rotation and flexion

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14
Q

Trapezius muscle: Function

A

shoulder movement, extends and turns the head

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15
Q

The thyroid is the _____ endocrine gland in the body and both lobes are joined by the _____ below the cartilage

A

largest; isthmus

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16
Q

What is the thyroid cartilage commonly referred to as?

A

adam’s apple

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17
Q

Where are the bodies greatest supply of lymph nodes?

A

the head and the neck

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18
Q

All head and neck structures eventually drain into the _________

A

deep cervical chain

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19
Q

What are the 2 major roles of the lymphatic system?

A

• detects and eliminates foreign substances
• filters lymph and engulfs pathogens

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20
Q

In an infant, cranial bones are separated by _______

A

sutures

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21
Q

Sutures and fontanelles permit _______

A

brain growth in an infant

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22
Q

When do sutures ossify?

A

6-18 months

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23
Q

When do fontanelles close?

A

2 months-2 years

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24
Q

When does the lymphoid tissue grow to adult size in an infant?

A

by 6 years old; but well developed at birth

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25
Q

_________ of the thyroid cartilage happens during adolescence

A

enlargement

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26
Q

Why does the thyroid gland enlarge during pregnancy?

A

increased vascularity

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27
Q

What are the 4 types of headaches?

A

• tension
• sinus
• cluster
• migraine

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28
Q

When would a severe, sudden headache be more alarming in a patient?

A

if the patient doesn’t usually have headaches

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29
Q

How to detect head injury?

A

concussion or blunt trauma and a change in LOC (OLDCARTS!!)

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30
Q

What are the 3 types of dizziness?

A

• presyncope
• vertigo (objective v. subjective)
• disequilibrium (shaking when walking)

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31
Q

Lumps: Tenderness v. Persistent lump

A

acute infection; possible malignancy

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32
Q

History of smoking and alcohol are related to the increased risk of ______

A

head and neck cancer

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33
Q

Subjective data: Neck includes 7 things, which are….

A

• headaches
• head injury
• dizziness
• history of head or neck surgery
• lumps or swelling
• neck pain/limitation of motion
• PCC

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34
Q

Subjective data: Neck pain

A

any associated upper extremity numbness or tingling?

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35
Q

Meningitis symptoms (3)

A

• acute onset stiffness
• headache
• fever

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36
Q

Subjective data: PCC (patient centered care)

A

helmet use? stress? coping mechanisms?

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37
Q

Tension (stress) Headaches

A

• musculoskeletal origin
• most common (39-78%)
• 3 times more common in WOMEN than MEN
• 3 categories (episodic infrequent, episodic frequent, chronic)

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38
Q

Episodic infrequent Tension HA

A

<1 day a month

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39
Q

Episodic frequent tension HA

A

<15 days a month for 3 months

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40
Q

Chronic tension HA

A

> 15 days a month for 3 months

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41
Q

Tension HA: OLDCARTS (Onset)

A

variable, patient dependent

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42
Q

Tension HA: OLDCARTS (Location)

A

usually both sides; forehead, sides and back of head

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43
Q

Tension HA: OLDCARTS (Duration)

A

30 minutes-7 days

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44
Q

Tension HA: OLDCARTS (Character)

A

band-like tightness, viselike non-throbbing

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45
Q

Tension HA: OLDCARTS (Aggravating)

A

stress, anxiety, depression, poor posture, poor sleep

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46
Q

Tension HA: OLDCARTS (Relieving)

A

NSAIDS, tricyclic antidepressants, reducing stress, applying ice or heat to sore muscles, cognitive behavioral therapies, physical therapy, massages

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47
Q

Tension HA: OLDCARTS (Timing/Treatments Tried)

A

situational; in response to overwork, posture

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48
Q

Tension HA: OLDCARTS (Severity)

A

mild-moderate pain (Pain rating 1-5)

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49
Q

Migraine HA

A

• trigeminal nerve/vascular origin
• 15% prevalence
• recurrent HA of moderate-severe intensity (5-10), lasting 4-72 hours
• 3 times more common in WOMEN than MEN
• 3 categories (migraine WITH AURA, migraine W/O AURA, chronic)

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50
Q

Migraine HA: OLDCARTS (Onset)

A

variable, patient dependent

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51
Q

Migraine HA: OLDCARTS (Location)

A

commonly one sided, pain often being the eyes, temples or forehead

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52
Q

Migraine HA: OLDCARTS (Duration)

A

rapid onset, peaks 1-2 hr, lasts 4-72 hours

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53
Q

Migraine HA: OLDCARTS (Character)

A

throbbing and pulsating

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54
Q

Migraine HA: OLDCARTS (Aggravating Factors)

A

premenstrual hormonal fluctuations, drinks (alcohol and caffeine), foods (cheese, chocolate, salty/processed), additives (MSG, aspartame)

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55
Q

Migraine HA: OLDCARTS (Relieving Factors)

A

lie down, darken room and sleep; NSAIDS and preventative medications

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56
Q

Migraine HA: OLDCARTS (Timing)

A

4 stages: prodrome, aura, migraine attack (4-72 hours), postdrome (24-48 hours; fatigue and irritability)

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57
Q

Prodrome

A

hours-days before migraine; change in mood, sensitivity to light/sound/smell, fatigue

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58
Q

Aura

A

5-60 min; visual changes, tingling in extremities, vertigo, speech change

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59
Q

Cluster Headaches

A

• rare
• 3 times more common in MEN than WOMEN
typical starts in 20s-40s

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60
Q

Cluster HA: OLDCARTS (Onset)

A

variable; can occur multiple times a day in clusters that last weeks

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61
Q

Cluster HA: OLDCARTS (Location)

A

always one sided, around eye or temple

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62
Q

Cluster HA: OLDCARTS (Duration)

A

abrupt onset, peaks in minutes, lasts 15 min-3 hours

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63
Q

Cluster HA: OLDCARTS (Character)

A

continuous, sharp, burning, piercing, excruciating

64
Q

Cluster HA: OLDCARTS (Aggravating Factors)

A

alcohol, nitroglycerin, histamine, organic compounds (paint, perfume…)

65
Q

Cluster HA: OLDCARTS (Relieving Factors)

A

inhaled oxygen (high dose and flow rate), corticosteroids, calcium channel blockers

66
Q

Cluster HA: OLDCARTS (Timing)

A

1-2 a day up, to 8 a day for weeks/months; then remission for months or years; often occurs at night or waking from sleep

67
Q

Cluster HA: OLDCARTS (Severity)

A

very severe, 7-10

68
Q

History for Infants/Children: Head and Neck

A

• maternal alcohol or drug use
• type of delivery
• growth pattern of the head

69
Q

History for Aging Adult: Head and Neck

A

• dizziness (assess for injury)
• neck pain
• can they drive?

70
Q

Objective data: Palpate the Skull for..

A

• size and shape (normocephalic v. micro/macrocephalic)
• normal bone protrusions w/o tenderness (note any lumps, depressions or protrusions
• palpate temporal artery and temporomandibular joint (note crepitation, limited ROM, tenderness)

71
Q

Objective Data: Neck

A

• symmetry
• any enlargements?
• ROM
• trachea (palpate for midline positioning)

72
Q

Objective data: Lymph Nodes

A

• palpate with gentle pressure in circular motion in drain areas
• should be soft, movable and non-tender

73
Q

Lymph Nodes: Abnormal Findings

A

• enlargements/masses (infection, chronic inflammation, HIV, neoplasms, lymphoma?)
• lymphadenopathy (>1cm lymph node enlargement from infection, allergy or neoplasm

74
Q

Palpating the thyroid

A

• difficult; can have patient tilt head back and take a sip of water and inspect how patient swallows

75
Q

Assessing Cranial Nerve XI (Spinal Accessory)

A

•inspect sternomastoid and trapezius muscle for equal size and bilateral movement
• assess motor function and strength

76
Q

Eyes: Function and Structure

A

carries visual data; protected by orbital socket, eyelashes and eyelids

77
Q

Cornea Function

A

covers and protects the iris and pupil

78
Q

Conjunctiva

A

transparent protective cover

79
Q

Lacrimal apparatus

A

produces tears and keeps the eyes moist

80
Q

Extraocular muscles

A

4 straight (rectus) muscles, 2 slanting (oblique) muscles

81
Q

Rectus Eye Muscles

A

• superior
• inferior
• lateral
• medial

82
Q

Oblique Eye Muscles

A

• superior
• inferior

83
Q

What is conjugate eye movement?

A

when both eyes move, their axes remain parallel

84
Q

Humans have ________, ________ vision

A

binocular and single-image

85
Q

What are the 3 cranial nerves that control eye movement?

A

• CN III (oculomotor)
• CN IV (trochlear)
• CN VI (abducens)

86
Q

CN III (Oculomotor)

A

superior, inferior, and medial rectus and inferior oblique

87
Q

CN IV (Trochlear)

A

superior oblique

88
Q

CN VI (Abducens)

A

lateral rectus, abducts the eye

89
Q

Sclera

A

the protective white covering; outer layer

90
Q

Cornea

A

transparent and sensitive, important for light refraction; outer layer
corneal reflex

91
Q

Choroid

A

• highly vascularized to supply retina; middle layer
• dark pigment to prevent light reflection
• iris and pupil

92
Q

Iris

A

• contracts pupil for bright light and near vision accommodation
• dilates pupil for dim light and far vision

93
Q

Retina

A

visual receptive layer; inner layer
• optic disc, retinal vessels, macula

94
Q

Collecting Subjective Eye Data

A

• vision difficulty
• pain (foreign bodies, scratches, light sensitivity)
• history of strabismus (misaligned eyes)
• history of diplopia (seeing double)
• redness or swelling?
• watery or discharge?
• history of eye issues
• glaucoma family or personal history
• use of glasses and last eye exam
• PCC (how do you care for your eyes?)

95
Q

Objective data: Eyelids

A

• inspect for tremors
• no ptosis (lid lag), discharge or crusting
• check for ability to open and close
• observe for flakiness and redness
• note eversion/inversion of lids

96
Q

Objective Data: Conjunctiva and Sclera

A

• clear, moist, white sclera (no icteric aka yellowness, exudates, or lesions)
• no conjunctivitis or pterygium
• inspect cornea and lens for transparency (glaucoma?)

97
Q

Pterygium

A

abnormal growth of conjunctiva, can impair vision

98
Q

Objective Data: Iris and Pupils

A

• color and shape
• inspect CN III (oculomotor): size, shoe, equality of pupils
• direct and consensual response of light
• convergence test

99
Q

What is the convergence test?

A

moving your finger closer to a patients face, noticing the whole pupil moves toward the nose and pupils will constrict (cross eyed)

100
Q

Convergence

A

motor movement of the pupil

101
Q

Accommodation

A

change in size of the pupil in response to a closer object

102
Q

Normal resting pupil size is…

A

3-5 mm

103
Q

PERRLA stands for…

A

Pupils
Equal
Round
Reactive
Light
Accommodation

104
Q

Visual Acuity (CN II: Optic)

A

snellen chart:
• legal blindness (20/200)
• numerator: distance of patient from chart
• denominator: distance which average patient can read (20/20 is normal)
near vision screening- 14 inches (rosenbaum)

105
Q

Six cardinal fields of gaze

A

nystagmus (oscillating movement), mild nystagmus ok in extreme lateral position

corneal light reflex (Hirschberg test)

106
Q

Red reflex (ocular fundus ADVANCED PRACTICE)

A

red glow filling patients pupil in response to the ophthalmoscope reflecting light off the retina

optic disc appears as setting sun
retinal vessels
macula

107
Q

Visual Fields

A

confrontation test (peripheral vision)

108
Q

External Ear (auricle or pinna)

A

• funnels sound waves into opening
• has glands that produce ceremen for protection
• lymphatic drainage flows to parotid, mastoid and superficial cervical nodes

109
Q

Middle Ear

A

•auditory ossicles
•eustachian tube
• conducts sound vibrations from outer ear
• protects the inner ear by reducing amplitude of loud sounds
• allows equalization of air pressure of each side of tympanic membrane to prevent rupture

110
Q

Auditory ossicles Bones

A

malleus, incus, stapes

111
Q

Eustachian tube

A

connects middle ear with nasopharynx and allows the passage of air

112
Q

Inner Ear

A

holds sensory organs for equilibrium and hearing
vestibule and semicircular canals
cochlea for central hearing

113
Q

Three Levels of Hearing: Peripheral

A

sound waves
organ of corti (hair cells bend and turn vibrations into electrical impulses)

114
Q

Three Levels of Hearing: Brainstem

A

location and identification of sound
CN VIII sends signals to brainstem

115
Q

Three Levels of Hearing: Cerebral Cortex

A

interprets meaning of sound to initiate a proper response

116
Q

Hearing Loss: Conductive

A

• middle/external ear
• usually partial loss
• impacted cerumen, foreign bodies, perforated tympanic membrane, pus, otosclerosis

117
Q

Hearing Loss: Sensorineural

A

• usually inner ear, CN VIII, or auditory areas of cerebral cortex
• prebycusus
• ototoxic drugs

118
Q

Prebycusis

A

age related nerve degeneration

119
Q

Equilibrium

A

labyrinth- feeds brain info about body’s position to determine verticality or depth

misinformation may cause staggering gait or vertigo

120
Q

Developmental Considerations: Infants and Children

A

• eustachian tube is shorter and wider, more horizontal (easier for pathogens to go to middle ear)
• external ear canals shorter and opposite slope

121
Q

Otosclerosis

A

conductive hearing loss between 20-40; bone formation and fixation impedes transmission

122
Q

Developmental Considerations: Aging Adult

A

• cilia becomes course and stiff
• hearing aids (cerumen impaction)
• presbycusis

123
Q

Subjective Ear Data

A

• earache (otalgia)
• infections or history
• discharge (otorrhea)
• hearing loss
• environmental noise and damage
• tinnitus
• vertigo
• dizziness
• PCC (hygiene, use of hearing aids, workplace ear protection, last ear check?)
• past medical history/family history

124
Q

Objective Data: Ears

A

• inspect auricles (size and shape, landmarks, consistent color and symmetry)
• inspect external auditory canal (discharge) and meatus
• check movement of auricle and tragus for tenderness

125
Q

Hearing Tests

A

•audiometric most accurate
• whispered voice test 2 ft behind
• tuning forks (weber and rinne)

126
Q

Nose

A

• CN I (Olfactory)
• Turbinates (superior, middle, and inferior) warm, humidify, and filter air
• sinuses drain into middle meatus
• tears drain into inferior meatus

127
Q

External Nose

A

bone
cartilage
nares

128
Q

Sinuses

A

• ciliated mucous membrane, easily occluded
• 4 sets (maxillary, frontal, ethmoid, sphenoid)

129
Q

Mouth

A

• taste buds in the papillae at back and sides of tongue and soft palate

130
Q

Tongue

A

mastification
swallowing
teeth cleansing
speech formation

131
Q

Salivary glands

A

parotid, submandibular, and sublingual
• moisten and lubricate food
• starts digestion
• cleans and protects mucosa

132
Q

Teeth

A

adults have 32
crown, neck, root

133
Q

Oropharynx (Throat)

A

separated from the mouth by bilateral tissue folds
tonsils (lymphoid tissue)

134
Q

Nasopharynx

A

above oropharynx and behind nasal cavity
adenoids and eustachian tube openings
rich lymphatic network

135
Q

Developmental Considerations: Infants and children

A

• salivation starts at 3 months old, drooling
• 20 deciduous teeth (by 2.5 years old)
• nose develops shape during adolescence (12-13 years old)

136
Q

Developmental Considerations: Pregnant Women

A

nasal stuffiness and epistaxis (nose bleeds) due to increased vascularity
gums may be more sensitive

137
Q

Developmental Considerations: The Aging Adult

A

more prominent nose
increased risk of malignant lesions
receeding gums and tooth loss

138
Q

Subjective Data: Nose

A

• discharge (rhinorrhea)
• frequent colds (infection?)
• sinus pain
• trauma
• epistaxis (frequent, amount, which nostrils)
• allergies
• altered smell

139
Q

How to control nosebleeds?

A

sit, lean forward, and compress lower soft part of nose 15-20 minutes

140
Q

Subjective Data: Mouth and Throat

A

• sores and lesions
• sore throat
• bleeding gums and toothache (heat v. cold sensitivity)
• hoarseness and snoring
• dysphagia
• altered taste
• smoking and alcohol consumption
• PCC (dental care/dentures)

141
Q

Objective Data: Nose

A

• inspect external nose (midline position, nasal flaring)
• inspect internal nose (color, discharge/odor, masses/lesions, swelling of turbinates)

142
Q

Objective Data: Sinuses

A

palpate frontal, maxillary sinuses and percuss for tenderness

143
Q

Objective Data: Mouth

A

• inspect mouth, lips, gums, teeth, mucosa (pink) with penlight
• pharyngeal wall
• bimanual palpation of mouth when indicated in adults

144
Q

Objective Data: Throat

A

• inspect and grade tonsils (0-2+)
• assess position of uvula
• CN XII (hypoglossal): extension of the tongue, check for symmetry

145
Q

Health Promotion for HEENT!

A

• helmets
• use of seatbelts
• sunglasses-cataracts
• vitamin a deficiency (night blindness)
• routine screenings and exams
• routine checkups
• oral health
• ear plugs/decrease music volume

146
Q

CN I: Olfactory

A

sensory type; smell

147
Q

CN II: Optic

A

sensory type; vision

148
Q

CN III: Oculomotor

A

mixed type; extraocular eye movement, opening of lids, pupil constriction, lens shape

149
Q

CN IV: Trochlear

A

motor type; down and inward movement of eye

150
Q

CN V: Trigeminal

A

mixed type; mastication muscles; face, cornea and mucous membrane sensations

151
Q

CN VI: Abducens

A

motor type; lateral movement of eye

152
Q

CN VII: Facial

A

mixed type; facial muscles, speech, taste, saliva and tear secretion

153
Q

CN VIII: Acoustic

A

sensory type; hearing and equilibrium

154
Q

CN IX: Glossopharyngeal

A

mixed type; pharynx, taste, parotid gland, carotid reflex

155
Q

CN X: Vagus

A

mixed type; pharynx and larynx, carotid reflex, general sensation from carotid body

156
Q

CN XI: Spinal Accessory

A

motor type; movement of trapezius and stermomastoid muscles

157
Q

CN XII: Hypoglossal

A

motor type; movement of tongue

Health Assessment (14 decks)

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