HENT Flashcards
1
Q
List the primary headaches
A
- w.o an identified underlying disease
- migraine
- cluster
- chronic daily
2
Q
List secondary headaches
A
-arise from underlying structural, systemic or infectious causes
EX: meningitis, subarachnoid hem
3
Q
Headache warning signs
A
- 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
4
Q
MC type of headache?
A
Tension
5
Q
Thunderclap HA
A
subarachnoid hem (SAH)
6
Q
severe, sudden onset HA
A
SAH or meningitis
7
Q
Episodic and peaking over several hours—type of HA?
A
Migraine and tension headache
8
Q
New and persisting, or progressively worse HA?
A
tumor
abscess
mass lesion
9
Q
Unilateral HA ?
A
migraine and cluster HA
10
Q
Temporal HA
A
Tension
11
Q
Retro-orbital-location HA
A
(behind eye)
Cluster
12
Q
N/V are common with which HA?
A
migraine
can occur with SAH or tumors
13
Q
Prodrome: visual aura, spark photopsias, fortifications, scotomas
A
Migraine
14
Q
photopsias
A
flashing lights
15
Q
Scotomas
A
areas of visual loss with surrounding normal vision
16
Q
HA worsens when leaning forward or worse with valsalva?
A
sinusitis
17
Q
fortification
A
zig-zag ars of light
18
Q
Medication induced headache: time frame
A
is present greater than or equal to 15 days a month for three months and reverts to less than 15days/MO when med discontinued
19
Q
Enlarged cervical lymph noes in neck?
A
Pharyngitis
20
Q
Goiter indicates?
A
enlargement of thyroid 2x its normal size
- thyroid func can be hyper or hypo
- can be w/ or w.o nodules
21
Q
Persistent neck mass in an adult >40 should raise suspicion of?
A
malignancy
22
Q
pulsating “tonsillar node” is?
A
the carotid artery
23
Q
small hard tender “tonsilar node” high and deep b/w the mandible and SCM is?
A
probably styloid process
24
Q
slow HR, dry skin, intolerance to cold and wt gain?
A
hypothyroidism
25
palpitations, wt loss, intolerant to heat?
hyperT
26
Enlarged skull can idicate?
- hydrocephalus
| - paget disease of bone "brittle bone disease"
27
Step-offs or tenderness post trauma?
skull fx
28
enlargement of a supraclavicular node ESP LEFT suggests? Whats the name of this
metastasis from a thoracic or abdominal malignancy (BC)
| VIRCHOW'S NODE ****
29
tender nodes suggest?
inflammation
30
Hard or fixed nodes suggest?
malignancy
31
If you palpate supraclavicular lymph nodes, what needs to be done?
thorough work-up
32
Things to note when palpating the lymp nodes? (6)
1. size
2. shape
3. delimitation (fixed?)
4. mobility
5. consistency
6. tenderness
33
List of the lymph nodes we palpate?
1. preauricular
2. posterior auricular
3. occipital
4. tonsillar
5. submandibular
6. submental
7. superficial cervical --superficial to SCM
8. posterior cervical--anterior edge of trapezius
9. supraclavicular
34
What can cause tracheal deviation?
- mediastinal masses
- large pneumotx
- atelectasis
35
Position of PTs neck when palpating lymph nodes?
slightly flexed
36
generalized lymphadenopathy seen in
```
infections
inflammatory or malignant conditions like HIV/AIDS
infectious mono
lymphoma
leukemia
sarcoidosis
```
37
Tender thyroid?
thyroiditis
38
Soft thyroid suggests
Graves disease
| +/- nodules present
39
Firm thyroid suggests
Hashimoto thyroiditis
40
Pemberton sign
when arm is elevated, there is flushing from compression of the thoracic inlet from the thyroid gland or clavicular movement
41
Systolic or continous bruits head in neck suggest?
hyperthyroidism fram Graves
42
JVD hallmark sign of?
HF
43
Unusual forward eye protrusion?
Exophthalmos--Graves disease
44
Diplopia, tearing, grittiness, pain from corneal exposure, extraocular muscle dysfunction, eyelid retraction, all are s/s of?
Graves ophthalmopathy
45
Discharge of mucopurulent fluid from the puncta suggests?
Obstructed nasolacrimal duct
46
Bloodshot injected eyes suggest? (3)
infection
inflammation
injury
47
Two components to conjunctiva?
1. bulbar conjunctiva-covers most of the eye--meets cornea at the limbus
2. palpebral conjunctiva--lines eyelids
48
Which conjunctiva lines the eyelids?
palpebral
49
which conjunctiva covers most of the eye--meets cornea at the limbus
bulbar
50
Which CN innervates levator palpebrae?
| role of this muscle?
CN III--occular motor nerve
| raises the upper eyelid
51
Hyperopia
farsightedness
52
Presbyopia
aging vision
53
Myopia
nearsightedness
54
difficulty with close work suggests?
hyperopia or presbyopia (PT age dependent)
55
Difficulty with distant objects suggest?
myopia
56
sudden, unilateral visual loss that is PAINLESS, consider? (5)
- vitreous hem
- macular degeneration
- retinal detachement
- retinal vein occlusion
- central retinal artery occlusion
57
sudden, unilateral visual loss that is PAINFUL? consider? (5)
cornea or anterior chamber involvement
- corneal ulcer
- uveitis
- traumatic hyphema
- acute angle closure glaucoma
58
Where to tears come from?
meibomian glands, conjunctival and lacrimal**** glands
59
Lacrimal puncta
tiny holes where tears drain into
60
iris muscle control?
controls pupillary size
61
ciliary body muscles control?
control thickness of lens/allows for focusing
62
ciliary body produces????
clear liquid--aqueous humor
* *controls pressure!!!!
* *drains out of canal of schlemm
63
posterior part of eye seen through ophthalmoscpoe?
optic fundus
64
enters eyeball posteriorly at the optic disc
optic nerve
65
Darkened circular area that surrounds the point of central vision--looks like a small depression in retinal surface
fovea
66
optic nerve is CN____
II
67
light shining in eye causes pupillary____
constriction--direct reaction to light
68
consensual reaction to light?
when contralateral eye constricts (not the eye with the light directly shining in)
69
Pupils will _____ during near reaction
constrict
70
Superior tarsal muscle does?
raises upper eyelid
| controlled by symp NS
71
EOM
4 rectus, 2 oblique
72
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
73
Sudden vision loss, bilateral and painful..can be? (2)
- giant-cell arteritis
| - non-physiological causes---like chemical or radiation exposure
74
Gradual bilateral vision loss?
cataracts or macular degeneration
75
Slow central field loss indicates?
macular degeneration or nuclear cataract
76
Peripheral loss *tunnel vision* suggests?
open-angle glaucoma (advanced)
77
Hemianopsia
blindness in half of one eye
78
unilateral headache suggests?
migrane
79
Steady, pressing or tightening, non-throbbing pain, mild to moderate intensity suggests which HA?
tension
80
Throbbing or aching, pain, mod-sever in intensity and preceded by an aura suggests which HA?
migraine
81
Sharp continuous intense and severe in intensity can be unilateral or around/behind the eyes suggests which HA?
cluster
82
Timing for cluster HA?
abrupt, peaks within minutes and lasts shorter period of time. ***EPISODIC***
83
Timing for migraines
fairly rapid onset, reaching peak in 1-2 hrs, lasts anywhere from 4 hrs to 3 days, *RECURRENT*
84
Gradual onset of HA?
tension
85
unilateral autonomic symptoms with ____ HA: lacrimation, rhinorrhea, miosis, ptosis, eyelid edema, conjunctival injection
cluster
86
Moving specks or strands suggests?
vitreous floaters
87
Fixed defects or scotomas suggests?
*Scotoma=blind spot*
| suggests---lesions in retina or visual pathway
88
red, painless eye is seen in?
subconjuncitval hemorrahge
89
Red eye with gritty sensation seen in?
viral conjunctivitis
90
Red, painful eye is seen in? (7)
- hyphema
- episcleritis
- acute angle closure glaucoma
- herpes keratitis
- FB
- fungal keratitis
- sarcoid uveitis
91
diplopia is seen with?
- lesions in brainstem or cerebellum
| - corneal or lens problem
92
flashing lights with new vitreous floaters suggest?
detachment of the vitreous body from the retina
| *EMERGENCY*
93
variations in retinal pigmentation, subretinal hemms, and exudates are seen in?
macular degeneration
94
change in color and size of optic disc suggests?
glaucoma
95
Damage to which CN causes diplopia? What muscle is affected
CN IV--trochlear nerve
| -dysfunction of superior oblique muscle--diplopia
96
What does 20/200 vision mean?
at 20 feet, the PT can read print that a person with normal vision could read at 200 feet.
*larger the second number..the worse the vision
97
Myopia causes focusing problems on near or distant objects?
*nearsightedness*
| distant
98
what does 20/40 corrected mean?
PT can read the 20/40 line with glasses
99
Older PTs are at risk for what three eye conditions?
| How often should they get eye exams?
1. glaucoma
2. cataracts
3. mac degen
* every 1-2 years*
100
OD?
right eye
101
OS
left eye
102
OU
both eyes
103
20/20
* first number means?
* second number means ?
first number: indicates PT's distance
| second number: distance at which normal eye can read the numbers
104
What is legally blind?
20/200 in better eye
105
Presbyopia
| -which vision is impaired?
causes focusing problems for near vision
| *will see better when card is AWAY from them
106
PE finds Left homonymous hemianopsia during static finger wiggle test, what does this mean?
PTs left eye does not see the fingers until they have crossed line of gaze
107
Static finger tests tests for?
lesions in visual pathway
108
If gross visual field tests are abnormal, what is the next test to do ?
check fields by confrontation
109
Papilledema on exam suggests?
ICP
110
Cotton wool patches suggset?
HTN retinopathy
111
Findings you will see on HTN retinopathy?
- cotton wool patches
- flame hemorrhages
- Hard exudates
112
Flamed-shaped linear hemorrhages suggest?
flame hemorrhages
| -HTN RETINOPATHY
113
Irregular white patches suggest?
cotton wool spots aka HTN retinopathy
114
Tiny round microaneruyrms are seen with?
diabetic retinopathy
115
Formation of new vessels that appear round and tortuous are seen with?
diabetic retinopathy (neovascularization)
116
Hard exudates are seen in?
HTN and DM retinopathy
117
well defined, yellowish shiny lesions?
hard exudates
118
EYE: multiple areas of hemorrhages with white centers?
| Suggests?
roth spots
| seen in: leukemia and endocarditis
119
Yellowish, triangular nodule on bulbar conjunctiva
| -does NOT cross the limbus
Pinguecla
120
Triangular thickening, grows acorss cornea and can interfere with vision
pterygium
121
Painful, tender, red infection. Nodule on the margin of the lid?
Hordeolum
122
Nontender nodule on lid
Chalazion
| *meibomian gland involved*
123
Painful, tender lacrimal sac and swelling of lacrimal sac
dacrocystitis
124
yellowish plaques on skin.. nasally located.
| Associated with what?
Xanthelasma
| Assoc with hypercholesteremia
125
opacities and clouding of cornea
cataracts
126
White circle around the edge of cornea
| occurs with aging
arcus senilis
127
Green-yellow ring near limbus
assoc with?
what kind of disorder
Kayser-Fleischer rings
Assoc with Wilson's disease
*copper disorder*
128
Findings for DM retinopathy
- hard exudates
- neovasc
- microaneurysms
129
enlarged blind spot occurs in?
- conditions affecting optic nerve
- glaucoma
- optic neuritis
- papilloedema
130
Esotropia
inward deviation
131
Exotropia
outward deviation
132
Scaliness of eyebrows suggest?
seborrheic dermatitis
133
lateral sparsness of eyebrows sugges?
hypothyroidism
134
red inflammed lid margins with crusting?
blepharitis
135
Excessive tearing can be caused by?
- conjunctival inflammatino
- corneal irritation
- impaired drainage
136
really dry eyes (impaired tear drainaged) seen in?
Sjogren syndrome
137
Miosis
pupil constriction
138
mydriasis
pupil dilation
139
Eyes are conjugate in right lateral gaze but not in left lateral gaze.. indicates paralysis of CN____
CN VI--abducens
140
convergence is poor in____?
hyperthyroidism
141
absence of red reflex is seen with?
cataracts
142
enlarged physiologic cup (eye) suggests??
chronic open-angle glaucoma
143
MCC of poor central vision in elderly pt
mac degen
144
diffuse dilation of conjunctival vessels with redness that tends to be maximally periphereal describe??? and is suggestive of waht eye condition?
CONJUNCTIVAL INJECTION
| *conjunctivitis
145
EYE: Leakage of blood outside the vessels--producing a homogenous sharply demarcated red area is describing?
subconjunctival hemm
146
Conjunctival injection, mild discomfort, vision not affected, w/ watery OR mucoid OR mucopurulent dx +/- itching?
CONJUNCTIVITIS:
- watery dx--viral
- mucoid--bacterial
147
sharply demarcated red area, no pain, vision not affected, and resulted either post trauma or severe coughing
Subconjunctival hemm
148
Deeper vessels coming off liimbus are dilated--creating reddish violet flush--what is this?
-can cause diffuse redness
Ciliary flush
149
What conditions can cause ciliary flush?
- corneal inj or inf
- acute iritis
- acute angle close glaucoma
150
diffuse red ciliary flush, severe deep aching pain, decrease vision, fixed and dilated pupil, and a steamy and cloudy cornea?
acute angle closure glaucoma
151
Mod aching deep pain with decreased vision and photophobia. Small and irregular pupils and a clear or slightly cloudy cornea with injection confined to corneal limbus?
Acute iritis
-assoc with herpes zoster
TB
152
Mod-severe superficial pain with decrease vision, watery discharge, pupils normal, cornea usualy normal, and diffuse red ciliary flush?
*post bac or viral infection or post injury*
Corneal injury/abrasion or infection
153
bitemporal hemianopsia on exam suggests?
lesion in optic chiasm
154
Horizontal defect suggests?
occlusion of a branch of central retinal artery
155
Blind right eye suggests>
lesion in right optic nerve
156
left homonymous hemianopsia suggests?
lesion in the right optic tract
157
drooping of upper lid
| causes?
```
ptosis
CAUSES
-myasthenia gravis
-damage to CN III
-Horner syndrome.. damamge to symp ns
```
158
Inward turning of lid margin
| causes?
Entropion
CAUSES:
-aging
*****eyelashes are touching the conjunctivia and lower cornea*****
159
Lower lid margin turns outward
| -causes
ectropion
-excessive tearing
CAUSES: aging
160
general term for unequal pupils
anisocoria
161
affected pupil is small, unilateral, reacts briskly to light and near effort BUT dilates slowly.. esp in dim light. +ptosis and less sweating is seen on the forehead.
HORNER SYNDROME
| triad=miosis, ptosis and anhydrosis
162
the following triad is seen with???
1. miosis
2. ptosis
3. anhydrosis
horner syndrome
163
Entry point for retinal vessels?
physiologic cup--small white depression in optic disc
| *can be absent=normal* and grayish spots can be seen at the base=normal
164
Hallmark of DM retinopathy? (eye exam findnig)
microaneuryisms
165
common feature of proliferative stage of DM retinopathy?
neovascularization
166
soft exudates are also called
cotton-wool patches
167
Soft exudates seen with?
| Hard exudates seen with?
Soft=HTN retinopathy
| Hard=DM retinopathy
168
Drusen indicate?
normal finding in older PTs
| -can point to macular degeneration
169
Hearing disorders of ____ and ____ cause conduction disorders
External and middle ear
170
external ear disorder causing conduction disorder
- cerum impaction
- infection (OE)
- trauma
- SCC
- bening bony growths--exostoses or osteomas
171
middle ear disorder causing conduction disorder
- OM
- congenital conditions
- cholestatomas
- otosclerosis
- tumors
- TM perf
172
Noisy or quiet environments help PTs hear better with conduction hearing loss?
Noisy envi
173
disorders of ____ ear cause sensorineural disorders
inner ear--cochlear nerve, central connection in brain
174
disorders of inner ear causing sensorineural disorders (7)
- congenital and hereditary conditions
- presbycusis
- viral infections like rubella or CMV
- Meniere disease
- noise exposure
- ototoxic drugs
- acoustic neruoma
175
List of ototoxic drugs (5)
1. aminoglucosides*****
2. ASA
3. NSAIDS
4. Quinine (malaria med)
5. lasix/furosemide
176
trouble understanding speech, noisy environments make hearing worse--- suggests what type of hearing loss?
sensorineural
177
+tug test or pain with movement of tragus suggest?
acute Otitis externa
178
-tug test is seen with?
OM
179
Tenderness behind the ear occurs in
OM
180
nontender nodular swellings covered by normal skin deep in ear canal?
exostoses-nonmalignant growths
181
green yellow discharge in the ear suggests?
OE or OM w/ perf
182
ringing in the ear
tinnitus
| can increase normaly with age
183
vertigo can suggest CN____ lesion
CNVIII--vestibochochlear
184
Tinnitus+vertigo+ hearing loss=?
Meniere disease
185
Ear canal appears swollen, narrowed moist pale and tender? +/- red
OE
186
skin of the canal is thick red and itchy?
CHRONIC OE
187
red bulging ear drum w/ loss of bony landmarks suggests?
purulent OM
188
amber fluid behind ear drum with air bubbles and decreased mobility?
MCC?
serious effusion
| MCC is viral infection
189
No TM mobility suggests?
perforation
190
Reduced TM mobility is seen with?
- serious effusion
- OM
- thickened drum
191
Overgrowth of epithelium from middle ear with debris accumulation and erosion of ossicles?
MCC?
Cholesteatoma
| MCC recurrent OM
192
Hemorrhagic vesicles on TM?
Bullous Myringitis
| MCC virus
193
Weber tests for?
lateralization
194
Weber test: sound lateralizes to affected ear means?
| Causes??
Conductive hearing loss
CAUSES:
-cerumen
-OM
195
Weber test: sound lateralizes to the unaffected ear means?
Sensorineural hearing loss
196
Rinne test compares?
```
air conduction(normal pathway of hearing) to bone (stimulates cochlea directly)
*AC>>BC**
```
197
Bone conduction> air conduction means?
conductive hearing loss
198
Air conduction > bone conduction means? (2)
-normal
OR
-sensorineural hering loss
199
Hard nodules of uric acid crystals --found on helix
Tophi
| -GOUT
200
raised nodule with lustrous surface and telangiectatic vessels found on outter ear. SLow growing... which carcinoma?
BCC
201
Scarring of TM from chronic reccurent OM infections
tympanosclerosis--deposites of hyaline and calcium in eardrum and middle ear
202
large chalky white patch with irregular margings of the eardrum?
tympanosclerosis
203
earache, blood-tinged dx from ear and conductive hearing loss? PE: two large bullae on drum with erythematous drum and obscured landmarks.
bullous myringitis
204
localized, subcutaneous or submucosal swelling around or on lips
angioedema
205
Which CNs can you assess by having the PT open mouth and say "ahhhh"
CN X vagus
| CNIX glossopharyngeal
206
tenderness of nasal tip? esp w/ small red swolen area
local infection--furnucle
207
deviation of lower septum is...?
common! rarely causes obstruction
208
nasal mucosa is red and swollen...indicates what type of rhinitis?
Viral rhinitis
209
nasal mucosa is pale and bluish or red and swollen.. indicates what type of rhinitis?
allergic
210
Septal perforation and/or ulceration caused by?
-cocaine or amphetamine use
-trauma
-surgery
-
211
Pale, saclike growths--appear inflammed and can obstruct air passages and sinuses
polyps
| CF
212
Triad for CF?
ASA allergy
allergic rhinitis
polyps nasal
213
Local tenderness with facial pain, pressure or fullnes, purulent nasal dx, nasal obstructions and smell disorder >7 days
acute bacterial rhonosinusitis
| *maxillary sinuses MC
214
Black line in the gingiva can indicate?
lead poisoning
215
```
men >50 Yo
smokers
heavy tobacco chewers
ETOH
are at risk for what kind of tongue/oral cavity disorder?
```
Oral leukoplakia---can develop into SCC
216
Asymmetric protrusion of tongue suggests
| tongue points____?
lesion of CN XII--hypoglossal
| tongue points towards side of lesion
217
Soft palate fails to rise and uvula deviates to the side.. indicates?
CN X paralysis
| *uvula points away from lesion
218
CONTINUOUS vertigo----?
| EPISODIC vertigo-----?
continuous=labrynthitis
episodic=menieres
**how to differentiate bc they both present with
-vertigo
-hearing loss
-tinnitus
and acute onset
219
deep purple oral lesions ..flat or raised
Kaposi sarcoma--HSV 8
220
thick white plaques that are adherent to oral mucosa--can be scrapped off but causes bleeding
Thrush
221
Throat appears dull red, and a gray exudate present on uvula, pharynx and tongue.
Diptheria--emergent
222
What is an early sign of measles
koplik spots
223
small white specks that resemble grains of salt on a red background on buccal mucosa near the first and second molars **
koplik spots--early signs of measles
224
thick white patch in oral cavity that is painless
-PT wil have hx of chewing tobacco/ smoker
-ETOH abuse
and/ OR hx of HPV
Leukoplakia
| --may lead to CA
225
gums appear enlarged, inflammed, swollen and red. can cover the teeth sometimes
gingival hyperplasia
226
Teeth apepar notched on their biting surfaces
Hutchinson teeth in congenital syphilis
227
Thick white coating--some patches of raw mucosa exposed after white was scrapped off
- PTs usually immunosuppressed
- or on prednisone tx
Candidiasis
228
White, raised asympto plaques with a feather or corrugated pattern occuring mainly on the side of the tongue that cannot be scrapped off
PT may have hx of HIV/AIDS or Epstein barr virus infection
Oral hairy leukoplakia
229
painful shallow white/gray oval ulceration surrounded by a halo of reddened mucosa
single or multiple
Aphthous ulcer or canker sore
230
Oral hairy leuokoplakia vs oral leukoplakia
ORAL leuko--possibly pre-malignant
| oral hairy--not premalignant and caused by epstein barr virus or HIV/AIDS
231
oral leukoplakia can be a precursor to ??
SCC
