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(PA school) HAPE > Lecture 3.1 HEENT (3%) > Flashcards

Lecture 3.1 HEENT (3%) Flashcards

1
Q

What are the 3 types of headaches?

A

Migraine, tension, and cluster

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2
Q

Describe migraine headaches

A

1) Often has prodrome, frequently a visual aura
2) Can include spark photopsia, fortifications, scotomas
3) Frequent family history; MC in women

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3
Q

Describe tension headaches

A

“Bandlike” headache; feels like squeezing

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4
Q

Describe cluster headaches

A

1) Severe HA, behind the eyes
2) Comes in “clusters” of HA for weeks at a time
3) MC in men

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5
Q

Secondary headaches can also occur; what are the 2 most worrisome causes of those?

A

Intracranial hemorrhage and meningitis

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6
Q

Describe whether tension headaches, migraines, and cluster headaches are bilateral, bifrontal, global, or unilateral.

A

1) Tension headaches usually bilateral.
2) Migraines 70% unilateral; 30% of the time bifrontal or global. Throbbing or aching, usually not less than moderate. accompanied by aura in up to 30%.
3) Cluster usually unilateral and behind eye or temple.

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7
Q

1) Out of tension headaches, migraines, and cluster headaches, which can last up to 3 days?
2) Which is/ are unilateral?
3) List them in order from slow to fast onset

A

1) Migraines
2) Migraines and cluster headaches
3) Tension, migraines, cluster

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8
Q

What can headaches (HA) with associated with fever, night sweats, or weight loss be due to?

A

1) Cancer or TB (sweats, weight loss)
2) Meningitis (fever)

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9
Q

1) What can a sudden onset “thunderclap” headache be a sign of?
2) What can a headache and recent head trauma be a sign of?

A

1) SA hemorrhage
2) Bleeding

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10
Q

What are the 7 concerning headache (HA) complaints?

A

1) Progressively frequent or severe over 3-month period
2) Sudden onset “thunderclap”
-SA hemorrhage
3) New recurrent headaches after 50 years old
4) Associated with fever, night sweats, or weight loss
-cancer or TB (sweats, weight loss)
-meningitis (fever)
5) Recent head trauma
-bleeding
6) Change in pattern from past headaches
7) Associated papilledema, neck stiffness, or focal neurologic signs

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11
Q

1) What can trouble with close work indicate?
2) What can trouble with far distance indicate?

A

1) Hyperopia (farsightedness) or Presbyopia (aging vision)
2) Myopia (nearsightedness)

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12
Q

If a pt has sudden, unilateral, and painless vision loss, what is often the cause? Give examples

A

Often vascular:
1) Retinal vein occlusion
2) Central retinal artery occlusion
3) Vitreous hemorrhage (DM, trauma)
4) Retinal detachment

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13
Q

If a pt has sudden, unilateral, painful vision loss, what should you be thinking of? Give examples

A

Cornea and anterior chamber:
1) Acute angle closure glaucoma
2) Corneal ulcer
3) Uveitis
4) Traumatic hyphema
5) Optic neuritis (MS)

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14
Q

If a pt has sudden, bilateral, painless vision loss, what should you be thinking of?

A

Vascular: Giant cell arteritis (although! usually unilateral and somewhat painful)

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15
Q

If a pt has sudden, bilateral, painful vision loss, what should you be thinking of? (2 things)

A

1) Radiation
2) Chemical exposure

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16
Q

What are 3 causes of gradual vision loss?

A

Cataracts, macular degeneration, glaucoma

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17
Q

What are 2 causes of slow and central vision loss?

A

Macular degeneration and nuclear cataract

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18
Q

What is a cause of peripheral vision loss?

A

Advanced open-angle glaucoma

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19
Q

What are the two types of specks in vision?

A

1) Moving: “floaters”
2) Fixed: “scotomas” due to retinal lesions or lesions in visual pathway

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20
Q

What are two causes of painless redness of the eyes?

A

1) Subconjunctival hemorrhage
2) Viral conjunctivitis

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21
Q

What are 4 causes of painful red eye?

A

Acute angle closure glaucoma, herpes keratitis, FB (foreign body), uveitis

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22
Q

What does a patient complaining of “flashing lights” and new floaters in their vision suggest?

A

Vitreous detachment

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23
Q

1) What does diplopia mean?
2) What are some causes?

A

1) Double vision
2)
-Lesions of brainstem or cerebellum
-Weakness of extra-ocular muscles
-Lesion in cranial nerves (3, 4, 6)
-Lens deformity
-Physiologic cause

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24
Q

What should you ask a pt about vision loss?

A

Timing, character, location, etc. (7 attributes of a symptom)

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25
Q

What are the two types of hearing loss? What’s the difference?

A

Sensorineural: neurological
Conductive: blockage

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26
Q

Describe the abilities of people with sensorineural hearing loss and conductive hearing loss to hear in noisy environments

A

1) Sensorineural: difficulty with lots of background noise
2) Conductive: noisiness may actually help patients understand distinct sounds – like speech

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27
Q

What associated symptoms of hearing loss should you pursue? List why you should pursue each

A

1) Is there pain? Dizziness? Vertigo? Medications?
-Aminoglycosides in particular are ototoxic
2) Is their discharge?
-Otitis externa, or chronic otitis media that has perforated
3) Is there ringing in the ear?
-This + dizziness = Meniere’s (most likely)

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28
Q

Dizziness is nonspecific; what two terms should you use instead? Define them

A

1) Lightheadedness: presyncope
2) Vertigo: spinning sensation (patient or surroundings)

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29
Q

What are the two types of vertigo? What are the causes of each?

A

1) Central: cerebral vascular disease (stroke), brainstem lesion, posterior fossa tumor, or maybe just migraine
2) Peripheral vertigo may by BPPV, vestibular neuritis, labyrinthitis, Meniere’s disease

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30
Q

1) What are some causes of rhinorrhea?
2) What two things should you consider when trying to find the cause of rhinorrhea?

A

1) Viral infection, allergic rhinitis (usually with pruritis), vasomotor rhinitis
2)
-Timing: seasonal = allergies
-Setting: drug-induced may pertain to decongestants, cocaine use

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31
Q

URI that gets worse could be due to what?

A

Bacterial sinusitis (rhinosinusitis)

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32
Q

1) What should you consider if a pt has unilateral congestion?
2) What are some other potential causes of congestion?

A

1) Deviated septum, polyp, carcinoma
2) Drug-induced (Afrin)

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33
Q

1) Define epistaxis
2) What should you consider when evaluating the causes of epistaxis?

A

1) Nosebleed
2)
-Ant. Or post.? The latter tends to move down the throat
-Differentiate from hemoptysis and hematemesis
-Chronic? Consider med list: anticoagulants, NSAIDS. Also consider coagulopathy, AV malformation

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34
Q

What are 3 causes of sore throats?

A

Strep pharyngitis, epiglottitis, abscess

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35
Q

What are 2 causes of sore tongues?

A

Aphthous ulcers, nutritional deficiency

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36
Q

What are 3 causes of bleeding gums?

A

Gingivitis, platelet disorder, coagulopathy

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37
Q

1) How would you describe hoarseness?
2) What are some potential causes of hoarseness?

A

1) Husky, rough, harsh, lower-pitched speech
2) Laryngitis, trauma, CA, hypothyroidism, reflux, vocal cord nodules

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38
Q

What are some causes of enlarged neck? What is one negative thing one of those causes could indicate?

A

Think lymph nodes or thyroid: goiter could indicate hyper/hypo thyroid, or neither

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39
Q

1) What are some symptoms of hypothyroid?
2) What are some symptoms of hyperthyroid?
*don’t need to specifically know these

A

1) Hypo: Cold intolerance, weight gain, dry skin, slow heart
2) Hyper: Heat intolerance, weight loss, moist velvety skin, palpitations

40
Q

1) Vision loss prevalence increases with what?
2) Why is it important to treat vision loss in older adults?
3) Is vision loss correctable?

A

1) Prevalence increases with age
2) In older adults, poor vision = poor quality of life, decreased functional capacity, increased falls (which leads to increased mortality)
3) Often correctable (80% of the time)

41
Q

1) What a common cause of vision loss in the US?
2) What are the risk factors for this condition?
3) What damages the eyes? What is this associated with?

A

1) “Progressive open angle closure glaucoma” (but macular degeneration also common)
2) DM, black ancestry, over age 65
3) UV light damages eyes as well; associated with development of cataracts

42
Q

1) More than _____ over fifty and ______% of folks over 80 have hearing loss
2) ______________ is the most common age-related cause of HL

A

1) >1/3 over fifty and 80% of folks over 80
2) Presbycusis

43
Q

1) _______% of folks over ____ are edentulous (missing teeth)
2) What is a warning sign for oral cancer?
3) What should you promote regarding oral health?

A

1) 25% of folks over 50
2) Leukoplakia
3) Daily hygiene

44
Q

1) What 3 things should you avoid for oral health?
2) Tobacco and ETOH account for what percent of oral cancers?

A

1) Excessive starches, excessive sugars, and tobacco use
2) 75%

45
Q

What is the primary screening for oral cancers?

A

Your exam

46
Q

How should you inspect the skull? Visually, palpate, or both? What should you look for?

A

Visually inspect and palpate:
1) Contour of the skull, any asymmetry
2) Deformities, depressions, lumps, tenderness, crepitus
-Especially Enlargement (Paget disease or hydrocephalus)

47
Q

1) How should you inspect the face? Visually, palpate, or both?
2) What should you look for and why?

A

1) Visually inspect and palpate
2) Asymmetry (CVA past or new), involuntary movements, edema, and masses

48
Q

What 3 things should you look for on the mastoid process?

A

Check for warmth, redness, tenderness

49
Q

What are 3 facial/ skull trauma signs you should look for? Know the locations of each

A

1) Battle sign (at base of skull)
2) Racoon Sign (underneath eyes)
3) Damage to the pterion (the joint of the 4 bones in temple)

50
Q

What should you examine on the eyelids? (6)

A

1) Width of palpebral fissures
-Top lid should cross the iris
2) Check edema of lids; also inspect over lacrimal sac and gland for swelling
3) Check for color change in lids, erythema in particular
4) Assess for lesions
5) Condition and direction of lashes
6) Assess for proper closure of the eye

51
Q

1) What 2 things should you inspect the lacrimal glands for?
2) What may each indicate?

A

1) Inspect for tearing / dryness
2)
-Tearing: increased production, conjunctival inflammation, corneal irritation, or ectropion
-Dryness: Sjogren syndrome

52
Q

How should you examine the conjunctiva?

A

Pull lower lid down and inspect conjunctiva, then ask patient to look up, each side, and down

53
Q

What should you look for on the sclera of the eye?

A

1) Note vasculature, do you see injections? Ciliary flush? (lots of injections around the eye)
2) Do you note jaundice? Scleral icterus?

54
Q

1) How should you inspect visual fields?
2) What should you do if a defect is discovered/

A

1) Static Finger Wiggle Test:
-From “behind” the pt’s periphery, move inward in all 4 quadrants and at the “equator”
2) If a defect is discovered, test the eyes independently and define its border

55
Q

What nerves control extraocular movements?

A

It’s all CN 3, except for abducens (6) and trochlear (4)
(Think because he’s superior, he looks down on CN III)

56
Q

How should you assess extraocular movements?
What nerves control what movements?

A

1) Assess for conjugate motion, nystagmus (pause with lateral gaze) and lid lag (lid is too high with downward gaze)
2)
-Eye moving laterally is CNVI
-Medial and downward are CNIV
-Everything else is 3

57
Q

When should convergence occur?

A

5-8 cm

58
Q

1) What should you inspect the cornea and lens for?
2) What are you looking for?

A

1) Opacity with oblique lighting using a penlight
2) Lateral light causing pronounced crescent medial shadow is abnormal and may suggest glaucoma

59
Q

What should you inspect the pupil for? (4 things)

A

PERRLA
1) Measure pupil (miosis or mydriasis).
-Also a big deal to have 2 pupils of different size.
2) Test pupillary reaction to light – direct and consensual
3) Perform Near test to assess accommodation
-or test with convergence
4) Assess ocular alignment
-Reflection in the cornea should be the same with light shown 2 ft away (reflection should be slightly nasal to center on each side)

60
Q

What are the 7 steps of an eye exam?

A

1) Eyelids
-incl. lacrimal glands
2) Conjunctiva
3) Sclera
4) Visual Fields
5) Inspect cornea and lens for opacity with oblique lighting
6) Pupil
(PERRLA)
7) Visual acuity

61
Q

1) What is the light reaction?
2) What nerves mediate it?

A

1) When light hits the eye – the affected pupil constricts (direct reaction) as well as the contralateral eye (consensual)
2) CNs 2 and 3

62
Q

What is near reaction (accommodation)?

A

Pupils constrict when gaze shifts from far to near

63
Q

What are the autonomic effects on the pupil?

A

Parasympathetic constricts
Sympathetic dilates

64
Q

What is visual acuity considered? How should you test visual acuity?

A

1) The “vital sign” of the eyes
2) Use Snellen chart if available:
-Cover one eye and perform test – then the other, then both
-Use glasses/contacts if they wear them
-First number = distance to chart
-The second number = distance at which normal eye can see image

65
Q

1) How do you test a pt’s visual acuity if you don’t have a chart?
2) How do you test a pt’s visual acuity if they can’t read?
3) How do you test a pt’s visual acuity if they cannot see see your fingers?

A

1) If no chart, use print and note the size
2) If they cannot read print, use your fingers
3) If they cannot see your fingers, use a penlight to see if they can tell light from dark

66
Q

What should you examine while using an ophthalmoscope on the eye? (3 categories)

A

1) Retina and vasculature
2) Optic disc
3) Macula/fovea

67
Q

Describe the Marcus Gunn Pupil (afferent pupillary defect) test. Describe how it would go if there was damage to the left optic nerve.

A

If there is damage to the L optic nerve:
1) Shine light in R eye
-Constriction of both pupils occurs due to direct and consensual response
2) Shift light to L eye
-The L eye will appear to dilate, because L nerve is not “taking in” the light signal properly
(dilating in the presence of light is wrong)

68
Q

How should you inspect the external ear? What should you inspect and palpate? What should you do if there’s pain with palpation?

A

Inspect and palpate:
1) Inspect for deformity, masses, lesions erythema, edema, discharge
Canal will be swollen and red in OE – not so in OM
2) Palpate: Move auricle, Press tragus, check for motion with pain
-Perform “tug test” if pain > OE (otitis externa)

69
Q

How do you do a gross hearing test? (3 different ways)

A

1) Whispered test
-Rub contralateral tragus and whisper letters or numbers
-Normal is at least 3/6 correctly
2) The “snap test”
-Snap your fingers on either side
3) The “finger rub” test
-Rub your 3rd and 1st digits together

70
Q

How do you use an otoscope to inspect the ear? (4 steps)

A

1) Brace the scope
2) Inspect external ear canal
-Discharge, FB, erythema, edema, excessive cerumen, masses
2) Lift the auricle up in adults; pull down in peds
3) Insert only well enough to see; gently!
-Downward and forward
4) Note the status of external ear canal
-Is there FB, erythema, edema, discharge?

71
Q

What should you look for when using an otoscope?

A

1) Note cone of light distribution
-Color of drum “pearly grey”
-Red or bulging in OM
2) Note handle of malleus; goes from cone of light upward

72
Q

What are the two special hearing tests?

A

Webber and Rene

73
Q

When do you use a Webber hearing test? How do you conduct it? What will it indicate?

A

1) When you know one ear is affected, and want to know what kind it is.
2) Use tuning fork on the middle of their head.
3)
-Lateralization is abnormal – should be heard equally well in each ear
-If conduction is affected, the tone will be louder in the effected side
-If sensorineural malady exists, tone will be louder on the contralateral side

74
Q

How do you conduct a Rene hearing test? What will it indicate?

A

1)
-Place tuning fork on mastoid
-When sound is gone, move to the ear canal with “U” forward
2)
-Is it heard again? This is normal.
-In conductive hearing loss, bone conduction is greater than air conduction

75
Q

What are the 6 steps of an ear exam?

A

(1) Inspect and (2) Palpate the auricle
3) Gross hearing test
4) Otoscope
5) Inspect the TM
6) Special Hearing Tests

76
Q

What are the steps of a nose exam? Describe each step

A

1) Visually Inspect for asymmetry, lesion, swelling, erythema
2) Palpate the bridge and tip of the nose
-Occlude each nares and check patency of contralateral side
3) Palpate frontal and maxillary sinuses
-Tenderness suggests bacterial infection; esp with fever, worsening sx, and sx > 7 days
4) Inspect the nares with otoscope
-You should be able to see inferior and middle turbinate
-Inspect mucosa (ed and swollen, suspect allergic rhinitis)
5) (5) Inspect mucosa
Color, swelling, bleeding, exudate, ulcers, polyps
(6) Key pathology alert:
Inspect the septum
It may be deviated, or you may see septal hematoma here
(Tumors here are very rare, but are virulent)

77
Q

What are the first 3 (out of 6) steps of a mouth and pharynx exam? Describe each step

A

(1) Inspect lips for color and moisture
-Note any lumps, ulcers, cracking, or scaliness
(2) Inspect oral mucosa
-Use light
-Note ulcers, growths, bleeding gums
-Look on sides of tongue; look under tongue!
-Do not miss a cancer because of lazy exam
-Look at buccal mucosa as well
(3) Inspect the posterior pharynx
-Looking at color, swelling, lesions, symmetry, uvula deviation, tonsillar exudate, ulcers
-Is the airway patent!

78
Q

What are the last 3 (out of 6) steps of a mouth and pharynx exam? Describe each step

A

4) Inspect and palpate teeth
-Do you see caries, abnormal positioning, missing teeth
-Are the teeth firmly implanted?
(5) Palpate the gums
-Abscess or mass
(6) Palpate the floor of the mouth
-Is there induration, mass, growth, tenderness

79
Q

1) Who are oral lesions common in?
2) What type are they usually?
3) When should an oral mass be bx’d?

A

1) Common in men greater than 50 and tobacco users
2) Usually squamous cell
Exp on side or base of tongue
3) Any persistent mass is suspect and should be bx’d

80
Q

What should you note about the tongue and uvula?

A

1) Asymmetric protrusion of the tongue
2) Rise of the uvula and any deviation of the uvula

81
Q

What miscellaneous things should you note about the mouth and pharynx? What is an emergent concern?

A

1) Cobblestoning, erythema, purulence, ulcerations, petechiae etc
2) Any pronounced swelling in the pharynx is of emergent/urgent concern

82
Q

List the 6 steps of a neck exam

A

1) Insepct the neck
2) Inspect and palpate TMJ
3) Palpate for LAD
4) Palpate trachea
5) Inspect and (6) Palpate thyroid

83
Q

1) What should you look for when inspecting the neck?
2) What should you look for when inspecting or palpating the TMJ?

A

1) Inspect the neck
Look for masses, surgical scars, asymmetry
(2) Inspect and palpate TMJ for swelling or redness, and palpate ROM

84
Q

1) What should you palpate for LAD (lymphadenopathy) on the neck?
2) What should you do when you see a lesion?
3) What are small, indiscreet nodes termed as, and are they normal?
4) What nodes are ominous?

A

1)
-Pre auricular, post auricular, occipital, submandibular, submental nodes
-Anterior/superficial cervical, posterior cervical nodes
-Superior clavicular and inferior clavicular nodes
2) When you see a lesion, look for a node
3) Shoddy”; are normal
$) Hard, fixed nodes

85
Q

1) What should you look for when palpating the trachea?
2) What should you look for when inspecting and palpating the thyroid?

A

1) Check for tenderness with displacement; palpate hyoid, thyroid cartilage, cricoid cartilage
2)
-Tip neck back and use tangential lighting if needed to check the outline
-Have patient swallow
-Palpate thyroid gland from behind with your fingers flat and gently pressing over the thyroid gland

86
Q

How should you palpate the thyroid gland? Why?

A

From behind with your fingers flat and gently pressing over the thyroid gland (will compress it if you palpate too hard)

87
Q

Describe the duration and course of tension headaches, migraines, and cluster headaches

A

1) Tension: 30 mins to 7 days; episodic, may be chronic
2) Migraines: 4-72 hours; recurrent, usually monthly, but weekly in 10%, peak incidence early to mid adolescence.
3) Cluster: 15 mins to 3 hours; episodic, clustered in time, with several each day for 4-8 weeks and then relief for 6-12 months.

88
Q

Describe the quality and severity of tension headaches, migraines, and cluster headaches

A

1) Tension: Usually a steady pain (not usually throbbing), mild to moderate.
2) Migraine: Throbbing or aching, usually not less than moderate. accompanied by aura in up to 30%.
3) Cluster: Sharp, continuous, intense, and severe intensity.

89
Q

Describe the associated symptoms of tension headaches, migraines, and cluster headaches

A

1) Tension: Sometimes photophobia, phonophobia; scalp tenderness; nausea absent
2) Migraines: Prodrome, nausea, vomiting, photophobia, phonophobia; aura in 30%; either visual (flickering, zig-zagging lines) or motor (paresthesia of hand, arm, or face, or language dysfunction).
3) Cluster: Unilateral autonomic symptoms: lacrimation, rhinorrhea, miosis, ptosis, eyelid edema, conjunctival infection

90
Q

Out of tension headaches, migraines, and cluster headaches, which involve photophobia?

A

Tension headaches and migraines

91
Q

Out of tension headaches, migraines, and cluster headaches, which involve nausea? Which involve rhinorrhea and ptosis?

A

Migraines involve nausea; cluster headaches involve rhinorrhea and ptosis

92
Q

What can headaches (HA) associated with weight loss or night sweats be due to? (2 things)

A

1) Cancer
2) TB

93
Q

What can headaches (HA) with associated with fever be due to?

A

Meningitis

94
Q

Hyperopia (farsightedness) or presbyopia (aging vision) both cause what?

A

Trouble with close work

95
Q

What can Giant cell arteritis cause?

A

Vision loss that is sudden, either somewhat painful or painless, and unilateral or bilateral (usually uni),

96
Q

Traumatic hyphema, optic neuritis (MS), Acute angle closure glaucoma, corneal ulcer, and uveitis all cause vision loss of what nature?

A

Sudden, unilateral, and painful

97
Q

Which of the two causes of vertigo is the one often hoped for?

A

Peripheral

(PA school) HAPE (41 decks)

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