HENT Flashcards
List the primary headaches
- w.o an identified underlying disease
- migraine
- cluster
- chronic daily
List secondary headaches
-arise from underlying structural, systemic or infectious causes
EX: meningitis, subarachnoid hem
Headache warning signs
- progressive frequent or severe over 3 MO time frame
- thunderclap headache
- “worst headache of my life”
- new onset after age 50
- precipitated by valsalva or exertion
- aggrivated or relieved by position
- assoc s/s of fever, night sweats or wt loss
- presence of CA, HIV, pregnancy
- recent head trauma
- assocc papilledema, neck stiffness or focal neurologic deficits
MC type of headache?
Tension
Thunderclap HA
subarachnoid hem (SAH)
severe, sudden onset HA
SAH or meningitis
Episodic and peaking over several hours—type of HA?
Migraine and tension headache
New and persisting, or progressively worse HA?
tumor
abscess
mass lesion
Unilateral HA ?
migraine and cluster HA
Temporal HA
Tension
Retro-orbital-location HA
(behind eye)
Cluster
N/V are common with which HA?
migraine
can occur with SAH or tumors
Prodrome: visual aura, spark photopsias, fortifications, scotomas
Migraine
photopsias
flashing lights
Scotomas
areas of visual loss with surrounding normal vision
HA worsens when leaning forward or worse with valsalva?
sinusitis
fortification
zig-zag ars of light
Medication induced headache: time frame
is present greater than or equal to 15 days a month for three months and reverts to less than 15days/MO when med discontinued
Enlarged cervical lymph noes in neck?
Pharyngitis
Goiter indicates?
enlargement of thyroid 2x its normal size
- thyroid func can be hyper or hypo
- can be w/ or w.o nodules
Persistent neck mass in an adult >40 should raise suspicion of?
malignancy
pulsating “tonsillar node” is?
the carotid artery
small hard tender “tonsilar node” high and deep b/w the mandible and SCM is?
probably styloid process
slow HR, dry skin, intolerance to cold and wt gain?
hypothyroidism
palpitations, wt loss, intolerant to heat?
hyperT
Enlarged skull can idicate?
- hydrocephalus
- paget disease of bone “brittle bone disease”
Step-offs or tenderness post trauma?
skull fx
enlargement of a supraclavicular node ESP LEFT suggests? Whats the name of this
metastasis from a thoracic or abdominal malignancy (BC)
VIRCHOW’S NODE **
tender nodes suggest?
inflammation
Hard or fixed nodes suggest?
malignancy
If you palpate supraclavicular lymph nodes, what needs to be done?
thorough work-up
Things to note when palpating the lymp nodes? (6)
- size
- shape
- delimitation (fixed?)
- mobility
- consistency
- tenderness
List of the lymph nodes we palpate?
- preauricular
- posterior auricular
- occipital
- tonsillar
- submandibular
- submental
- superficial cervical –superficial to SCM
- posterior cervical–anterior edge of trapezius
- supraclavicular
What can cause tracheal deviation?
- mediastinal masses
- large pneumotx
- atelectasis
Position of PTs neck when palpating lymph nodes?
slightly flexed
generalized lymphadenopathy seen in
infections inflammatory or malignant conditions like HIV/AIDS infectious mono lymphoma leukemia sarcoidosis
Tender thyroid?
thyroiditis
Soft thyroid suggests
Graves disease
+/- nodules present
Firm thyroid suggests
Hashimoto thyroiditis
Pemberton sign
when arm is elevated, there is flushing from compression of the thoracic inlet from the thyroid gland or clavicular movement
Systolic or continous bruits head in neck suggest?
hyperthyroidism fram Graves
JVD hallmark sign of?
HF
Unusual forward eye protrusion?
Exophthalmos–Graves disease
Diplopia, tearing, grittiness, pain from corneal exposure, extraocular muscle dysfunction, eyelid retraction, all are s/s of?
Graves ophthalmopathy
Discharge of mucopurulent fluid from the puncta suggests?
Obstructed nasolacrimal duct
Bloodshot injected eyes suggest? (3)
infection
inflammation
injury
Two components to conjunctiva?
- bulbar conjunctiva-covers most of the eye–meets cornea at the limbus
- palpebral conjunctiva–lines eyelids
Which conjunctiva lines the eyelids?
palpebral
which conjunctiva covers most of the eye–meets cornea at the limbus
bulbar
Which CN innervates levator palpebrae?
role of this muscle?
CN III–occular motor nerve
raises the upper eyelid
Hyperopia
farsightedness
Presbyopia
aging vision
Myopia
nearsightedness
difficulty with close work suggests?
hyperopia or presbyopia (PT age dependent)
Difficulty with distant objects suggest?
myopia
sudden, unilateral visual loss that is PAINLESS, consider? (5)
- vitreous hem
- macular degeneration
- retinal detachement
- retinal vein occlusion
- central retinal artery occlusion
sudden, unilateral visual loss that is PAINFUL? consider? (5)
cornea or anterior chamber involvement
- corneal ulcer
- uveitis
- traumatic hyphema
- acute angle closure glaucoma
Where to tears come from?
meibomian glands, conjunctival and lacrimal** glands
Lacrimal puncta
tiny holes where tears drain into
iris muscle control?
controls pupillary size
ciliary body muscles control?
control thickness of lens/allows for focusing
ciliary body produces????
clear liquid–aqueous humor
- *controls pressure!!!!
- *drains out of canal of schlemm
posterior part of eye seen through ophthalmoscpoe?
optic fundus
enters eyeball posteriorly at the optic disc
optic nerve
Darkened circular area that surrounds the point of central vision–looks like a small depression in retinal surface
fovea
optic nerve is CN____
II
light shining in eye causes pupillary____
constriction–direct reaction to light
consensual reaction to light?
when contralateral eye constricts (not the eye with the light directly shining in)
Pupils will _____ during near reaction
constrict
Superior tarsal muscle does?
raises upper eyelid
controlled by symp NS
EOM
4 rectus, 2 oblique
paralyzed eye movement will appear how?
eye will deviate from normal position….in the direction of the gaze… so right inferior rectus muscle paralyzed.. the gaze will be to the right
Sudden vision loss, bilateral and painful..can be? (2)
- giant-cell arteritis
- non-physiological causes—like chemical or radiation exposure
Gradual bilateral vision loss?
cataracts or macular degeneration
Slow central field loss indicates?
macular degeneration or nuclear cataract
Peripheral loss tunnel vision suggests?
open-angle glaucoma (advanced)
Hemianopsia
blindness in half of one eye
unilateral headache suggests?
migrane
Steady, pressing or tightening, non-throbbing pain, mild to moderate intensity suggests which HA?
tension
Throbbing or aching, pain, mod-sever in intensity and preceded by an aura suggests which HA?
migraine
Sharp continuous intense and severe in intensity can be unilateral or around/behind the eyes suggests which HA?
cluster
Timing for cluster HA?
abrupt, peaks within minutes and lasts shorter period of time. EPISODIC
Timing for migraines
fairly rapid onset, reaching peak in 1-2 hrs, lasts anywhere from 4 hrs to 3 days, RECURRENT
Gradual onset of HA?
tension
unilateral autonomic symptoms with ____ HA: lacrimation, rhinorrhea, miosis, ptosis, eyelid edema, conjunctival injection
cluster
Moving specks or strands suggests?
vitreous floaters
Fixed defects or scotomas suggests?
Scotoma=blind spot
suggests—lesions in retina or visual pathway
red, painless eye is seen in?
subconjuncitval hemorrahge
Red eye with gritty sensation seen in?
viral conjunctivitis
Red, painful eye is seen in? (7)
- hyphema
- episcleritis
- acute angle closure glaucoma
- herpes keratitis
- FB
- fungal keratitis
- sarcoid uveitis
diplopia is seen with?
- lesions in brainstem or cerebellum
- corneal or lens problem
flashing lights with new vitreous floaters suggest?
detachment of the vitreous body from the retina
EMERGENCY