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Challenge Bowl 🧠🙀 > HEENT (Physical Diagnosis) > Flashcards

HEENT (Physical Diagnosis) Flashcards

1
Q

What are you palpating for when examining a patient’s skin?

A

Temperature
Texture
Turgor

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2
Q

Describe the procedure for orthostatic vitals

A

Obtain BP and pulse in the supine, (sitting), and standing positions

Patient should be supine for five min before the first vitals

Retake vitals after standing for three min and compare

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3
Q

What is considered an abnormal result when doing orthostatic vitals?

A

≥20mmHg drop in SBP or ≥10mmHg drop in DBP

Increase of HR of ≥20 bpm

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4
Q

How do you test CN VII function?

A

Facial muscles

Squeeze eyes shut
Wrinkle forehead
Smile w/ teeth
Puff out cheeks

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5
Q

How do you test CN V sensory function?

A

Have patient close eyes

Ask them to say “Now” each time they feel you touch their face

Use cotton tipped swab to touch forehead, checks, and chin bilaterally

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6
Q

How do you test CN V motor function?

A

Palpate masseter muscle and ask patient to clench teeth

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7
Q

How do you test CN II function?

A

Visual acuity test using Snellen or hand-held Rosenbaum chart

Visual fields testing

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8
Q

How do you test CN VIII function?

A

Hearing test

Have patient close eyes, ask them if they can hear you bilaterally when you rub your fingers together next to each ear

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9
Q

Testing EOMs evaluates what cranial nerves?

A

CN III
CN IV
CN VI

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10
Q

How do you test CN IX and X?

A

Open mouth and say “Ah”

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11
Q

How do you test CN XII?

A

Stick out your tongue and wiggle it side to side

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12
Q

How do you test CN XI?

A

Head rotation and shoulder shrug against resistance

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13
Q

Autoimmune condition causing hair loss

A

Alopecia Areata

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14
Q

Receding or thinning hair

A

Androgenic alopecia

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15
Q

Greasy, yellowish scales

Most common in scalp, nasolabial folds, eyebrows, and forehead

A

Seborrheic Dermatitis

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16
Q

Autoimmune condition characterized by silvery white, sharply demarcated plaques and coarse scale, +/- associated hair loss

A

Psoriasis

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17
Q

Fungal infection of the scalp with scaly patches or plaques w/ or w/o inflammation

A

Tinea Capitis

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18
Q

Raised, boggy, secondarily infected fungal lesion of the hair

A

Kerion

Seen with Tinea Capitis

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19
Q

Increased growth hormone after puberty —> Enlargement of bone and soft tissue in face —> elongated head with bony prominence of the forehead, nose, and lower jaw

A

Acromegaly facie

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20
Q

Facial edema pronounced around eyes that does not pit with pressure —> dully, puffy looking face

A

Myxedema facie

Associated with severe hypothyroidism

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21
Q

I say moon facie, you say…

A

Cushing’s Syndrome

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22
Q

I say parotid gland swelling, you say…

A

Mumps

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23
Q

I say mask-like facie, you say…

A

Parkinson’s Disease

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24
Q

What are the three sensory branches of CN V?

A

Ophthalmic
Maxillary
Mandibular

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25
Q

Idiopathic paralysis of CN VII causing weakness on one side of face

A

Bell’s Palsy

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26
Q

Difficulty closing eye and flattened nasolabial fold

A

Bell’s Palsy

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27
Q

What condition might prompt you to palpate the temporal artery and Auscultate it for bruits?

A

Giant Cell Arteritis

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28
Q

Adult >50 with …

New onset HA
JAW CLAUDICATION
Elevated ESR

A

Giant Cell Arteritis

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29
Q

Giant Cell Arteritis is commonly associated with what condition?

A

Polymyalgia rheumatica (PMR)

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30
Q

What are the different components of the lacrimal apparatus?

A

Lacrimal gland
Lacrimal sac
Puncta
Nasolacrimal duct

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31
Q

Sebaceous glands located on the inner surface of the eyelid

A

Meibomian glands

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32
Q

The snellen chart is used for testing visual acuity at what distance?

A

20 ft

Screens for myopia

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33
Q

The Rosenbaum chart is used for testing visual acuity at what distance?

A

14 inches

Screens for presbyopia

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34
Q

What does it mean when we say a patient has 20/200 vision?

A

Patient sees clearly at 20 feet what a person with normal vision would see at 200 feet

The larger the denominator, the worse the patient’s vision

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35
Q

Excessive constriction of the pupils

A

Miosis

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36
Q

Excessive dilation of the pupils

A

Mydriasis

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37
Q

Pupils that are of unequal size?

A

Anisocoria

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38
Q

What are you evaluating when you pause at the upward and lateral gaze upon testing EOMs?

A

Nystagmus (fine rhythmic oscillation of the eyes)

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39
Q

When checking near-far accommodation, the pupils ______ for near vision and ______ for far vision

A

Narrows (constricts) for Near

Dilates for Distance

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40
Q

Shining light into the patient’s eyes and noting the corneal light reflection rests for…

A

Conjugate gaze

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41
Q

Ptosis indicates a problem with which cranial nerve?

A

CN III

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42
Q

Drooping of eyelid seen with CN III problem

A

Ptosis

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43
Q

Nontender meibomian gland obstruction and inflammation on the inner surface of eyelid

A

Chalazion

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44
Q

Tender, red infection near hair follicle of eyelashes on eyelid margin

A

Hordeolum

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45
Q

Infection/inflammation of the nasolacrimal sac, usually secondary to blockage of the nasolacrimal duct

—> swelling between base of nose and eye

A

Dacryocystitis

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46
Q

32 yo presents with low grade fever, swelling, redness, pain, and inability to open eye

Complains of increasing nasal congestion, facial pressure, and HA x2 weeks prior to these Sx without any treatment

No hx of trauma

What’s your Dx?

A

Periorbital/presentation cellulitis

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47
Q

Lid inversion —> irritation of the conjunctiva and cornea

A

Entropion

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48
Q

Lid eversion that exposes palpebral conjunctiva —> excessive tearing

A

Ectropion

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49
Q

Yellow, triangular nodule on the bulbar conjunctiva on either side of the iris

A

Pingueculum

Harmless, vision WNL

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50
Q

Triangular thickening of the medial bulbar conjunctiva that extends from inner canthus to the cornea

A

Pterygium

May interfere with vision

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51
Q

Yellow discoloration of the sclera associated with elevated bilirubin and jaundiced skin

A

Sclera icterus

52
Q

Sharply demarcated yellow deposits of fat underneath the skin around the eyelids

A

Xanthelasma

Associated with hyperlipidemia

53
Q

Conjunctivitis with clear discharge is more likely ______ while purulent discharge is more likely ______

A

Clear = viral

Pus = bacterial

54
Q

Abnormal protrusion of the eyeball, characteristically seen in Grave’s Disease

A

Exophthalmos

55
Q

Other than bulgy eyes, how will the face of a patient with hyperthyroidism look?

A

Loss of the lateral 1/3 of eyebrows

56
Q

Central nodule with radiation of blood vessels on the sclera

A

Episcleritis

57
Q

Red, painful inflammation of sclera, with photophobia and discharge

A

Uveitis (iritis)

58
Q

Infectious causes of uveitis

A

Herpes

CMV

59
Q

Systemic immune mediated causes of uveitis

A

Sarcoidosis
Juvenile Idiopathic Arthritis
IBD

60
Q

Inflammatory cells in anterior chamber of the eye

A

Hypopyon

61
Q

Blood on the sclera, associated with Hx of cough, sneeze, straining, or Coumadin use

A

Subconjunctival hemorrhage

62
Q

Grossly visible blood in anterior chamber of the eye, usually secondary to trauma

A

Hyphema

63
Q

Photophobia, increased lacrimation, and pain following foreign body sensation in the eye

A

Corneal abrasion

64
Q

How do you diagnose a corneal abrasion?

A

Fluorescein stain —> cobalt filter on ophthalmoscope

65
Q

Clouding (opacity) of the lens causing painless, progressive vision loss

A

Cataract

66
Q

Absence of red reflex during ophthalmoscopic exam could indicate…

A

Cataract
Detached retina
Retinoblastoma
Artificial eye

67
Q

Vascular changes visible on fundoscopic exam indicative of hypertension

A

Copper wire
Silver wire
A-V nicking

68
Q

Cotton wool patches (soft exudates) caused by infarcted nerve fibers

A

Hypertensive retinopathy

69
Q

Hemorrhages and hard exudates, with well-defined borders, that are creamy/yellow and appear bright on fundoscopic exam

A

Diabetic retinopathy

70
Q

Neovascularization visible on fundoscopic exam is indicative of …

A

diabetic retinopathy

71
Q

Cup to disc ratio > 1:2 on fundoscopic exam

A

Increased intraocular pressure (glaucoma)

72
Q

Crescent shadow due to abnormal anterior chamber depth

A

Glaucoma

73
Q

Curtain-like shadow over vision associated with flashes and floaters

A

Detached Retina

74
Q

Optic disc swelling due to increased intracranial pressure

A

Papilledema

75
Q

Area of the retina that absorbs the most light

A

Macula

76
Q

Macular degeneration is due to …

A

Build up of drusen (cellular debris)

As degeneration occurs, the light reflection from the macula decreases

77
Q

A lesion of the right optic nerve would result in what type of visual field defect?

A

Unilateral blindness in the right eye

78
Q

A lesion at the optic chiasm would result in what type of visual field defect?

A

Bitemporal hemianopsia (tunnel vision)

79
Q

A lesion of the optic tract posterior to the optic chiasm would result in what type of visual field defect?

A

Homonymous hemianopsia - loss of half of each field (same side lost in both eyes)

Defect at the R optic tract —> L homonymous hemianopsia

Defect at the L optic tract —> R homonymous hemianopsia

80
Q

If you see an abnormal corneal light reflection, what test should you perform next?

A

Cover Uncover Test

May reveal muscle imbalance

81
Q

Misalignment of the eyes from their normally conjugate position

A

Strabismus

82
Q

What are the four types of strabismus?

A

Esotropia (one eye deviated inward)

Exotropia (one eye deviated outward)

Hypotropia (one eye deviated downward)

Hypertrophia (one eye deviated upward)

83
Q

Light displaced medically on affected eye during corneal light reflection test

A

Exotropia

84
Q

Light displaced laterally on affected eye during corneal light reflection test

A

Esotropia

85
Q

The corneal reflex test evaluates the sensory function of ______ and the motor function of _______

A

CN V sensory

CN VII motor

86
Q

Pain with movement of the helix and tragus of the ear

A

Otitis externa

87
Q

Deposit of uric acid crystals that occur after years of chronically elevated uric acid

A

Gouty tophi

88
Q

Raised nodule with central telangiectasia

A

Basal cell carcinoma

89
Q

Skin lesion with crusted border, central ulceration, and bleeding

A

Squamous cell carcinoma

90
Q

Bone conduction > Air conduction usually indicates…

A

Conductive hearing loss

91
Q

Air conduction > Bone conduction

A

Normal

OR

Sensorineural hearing loss

92
Q

During the Weber test, sound lateralizes to _____ ear in conductive hearing loss and to _____ ear in sensorineural hearing loss

A

To bad ear for conductive

To good ear in SNHL

93
Q

Weber test —> unilateral lateralization to impaired ear

A

Conductive loss

Ex: Otitis media, perforation, cerumen, otosclerosis

94
Q

Weber test —> unilateral lateralization to good ear

A

Sensorineural loss

Ex: Presbycusis, noise exposure, head trauma

95
Q

Normal results for the Rinne Test

A

Air conduction > bone conduction

96
Q

Bony prominence visible in the center of the tympanic membrane

A

Umbo

97
Q

Where will you see the cone of light on examination of the tympanic membrane?

A

Anterior and inferior quadrant of the TM

98
Q

Procedure used to assess TM mobility in cases of suspected serous OM or TM perforations

A

Pneumatic otoscopy

99
Q

Chalky white patch on the TM seen in recurrent otitis media or patients with hx of tubes or previous perforation

A

Tympanosclerosis

100
Q

Patient complains of fullness or popping in ear

Otoscopy shows serous effusion with air bubbles

A

Viral URI or barotrauma —> Eustachian tube dysfunction

101
Q

Myringotomy tubes usually remain in ear for _______

A

6-12 months

Frequently fall out on their own

102
Q

Painful, hemorrhagic vesicles on TM, +/- hearing loss

A

Bulbous myringitis

103
Q

How do you transilluminate the frontal sinuses?

A

Place light below brow and look for glow in frontal area

104
Q

How do you transilluminate the maxillary sinuses?

A

Place light against cheek bone below eye and look for glow on hard palate

105
Q

Symptoms of septal deviation

A

Nasal obstruction, headache, change in smell

May see spurs and crests on exam

106
Q

In peds patients with nasal trauma, you must rule out….

A

Septal hematoma

Sx: Increased nasal obstruction, pain, and tenderness

107
Q

90% of all epistaxis occurs in…

A

Kiesselbach’s plexus - highly vascular region of the anteroinferior nasal septum

108
Q

Swollen, pale, blue, boggy turbinates, +/- shiners/eye symptoms

A

Allergic rhinitis

109
Q

Ducts that drain the submandibular glands on the floor of the oral cavity

A

Wharton’s ducts

110
Q

Ducts that drain the parotid gland in the buffalo mucosa lateral to the molars

A

Stensen’s ducts

111
Q

Irritation, fissuring of the skin at the corners of the mouth associated with ill fitting dentures, vitamin deficiency, or excessive salivation

A

Angular cheilitis

112
Q

White patches or plaques on the tongue or buccal mucosa that can be brushed away

A

Oral candidiasis (thrush)

113
Q

White patches on the tongue or buccal mucosa that cannot be removed by brushing aside

A

Leukoplakia

Potentially premalignant —> must biopsy

114
Q

Majority of oral cancer is …

A

Squamous cell carcinoma

115
Q

Benign midline mass in hard palate

A

Torus palantinus

116
Q

Drugs that can cause gingival hyperplasia

A

Dilantin (phenytoin)

Cyclosporine

CCBs

117
Q

Benign defect in desquamation of tongue papillae associated with abx, tea, coffee, and tobacco use

A

Hairy tongue

118
Q

Benign, map-like areas of smoothness devoid of papillae on surface of tongue

A

Geographic tongue

119
Q 
Worsening sore throat x 2 days
Fever 102
N/V
No cough, nasal congestion, or fatigue
Bilateral exudative tonsilitis
Cervical LAD
A

Group A strep tonsilitis

120
Q 
Sore throat x 5 days
Fever 101
Fatigue
Tender anterior and posterior cervical LAD
BL exudative tonsilitis
Slight splenomegaly
A

Mononucleosis (EBV)

121
Q

Unilateral peritonsilar swelling
Shifted uvula
Hot potato voice
Drooling

A

Peritonsillar abscess

122
Q

Deviation of trachea from midline may suggest…

A

Mediastinal mass

Pneumothorax

123
Q

_______ LAD may suggest metastasis from lung or GI cancer

A

Supraclavicular

124
Q

Carotid bruits are indicative of…

A

Turbulent arterial blood flow, usually secondary to CAD

125
Q

What do you need to ask patient to do during examination of the thyroid?

A

Swallow

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