Midterm- HEENT Flashcards
cranial bones
frontal
parietal
occipital
temporal
sutures of the skull
coronal, sagittal, lambdoid
how many facial bones?
14
facial features innervated by which nerve?
CN 7
which cranial nerve innervates the neck?
cranial nerve XI
spinal accessory
the thyroid is two lobes connected by what?
isthmus
when a patient comes in with a broad complaint, what should you look at?
thyroid
how do you check for lymphadenopathy (infection of lymph system)?
push and do tiny circles with a little pressure
meibomian glands
secrete lubrication onto eyelids
palpebral
lines eyelids
clear with small vessels
bulbar
overlayes eyeball with the sclera showing thru
limbus
location where the conjunctiva merge with the cornea to cover and protect the iris and pupil
puncta
lines up with lacrimal sac, tears run down junction of puncta/lacrimal sac and down your nose
lacrimal apparatus
constant irrigation to keep conjunctiva/cornea moist
lacrimal gland in upper outer corner secretes tears
extraocular muscles
6
straight and rotary movement
eyes move as a pair because of binocular vision
movement stimulated by CN VI (abducens), CNIV (trochlear), CN III (oculomotor)
outer layer of eye
sclera and cornea
sclera
tough, protective, continuous
cornea
smooth, transparent, covers iris and allows light into the eye
CN V (sensation)
CN VII (motor)- corneal reflex
middle layer of eye
vascular choroid continuous with ciliary body and iris
lens, pupil, aqueous humor, CN III
inner layer of eye
retinal structures
optic disc, vessels, macula
HTN and DM most often target which organs?
heart, kidney, eyes
who needs an eye exam?
anyone with vision changes
greater than 40
neuro-ICP
CM, HTN
risk factors for eye problems
middle aged and older
family history of glaucoma
high intraocular pressure
african american
east asians
farsighted
had eye injury/surgery
DM
HTN
history of taking steroids
eye tests
pocket snellen
test acuity at a distance
greater denominator the worse the vision
looking for wrong answer, squinting, leaning forward
smallest line that patient can identify more than half of the letters
newborn eye exam
look at face and follow light
1 month- fixes on object
1.5 months-coordinated eye movements
3 months- eyes converge
12 months- acuity around 50/50
> 4 years- 20/40
4 and older- 20/30
refractive and correctable eye errors
myopia (nearsightedness)
astigmatism (irregular curvature of the eyes surface)
presbyopia (age related farsightedness)
treatable and reversible but blinding eye disease
cataracts
uveitis (inflammation of the uvea) related to autoimmune disease infections)
which systemic diseases affect eyes?
DM, HTN, hyperthyroidism
infectious disorders that affect eyes?
CMV
toxoplasmosis
congenital toxoplasmosis
congenital toxoplasmosis
enlargement of liver and spleen, blindness and mental retardation
external ear
auricle or pinna
helix
antihelix
tragus
antitragus
lobule
external audtiory meatus
middle ear
tympanic membrane separates external from internal
translucent
pearly gray
sound waves hitting this are what sets off the process for us to hear and vibrate
protects inner ear by reducing amplitude
allows equalization of pressures
which part of the ear is responsible for sound waves hitting this and sets off the process for us to hear and vibrate?
middle ear
malleus
incus
stapes
when can damage to the middle ear happen?
diving
inner ear
bony labyrinth
cochlea
vestibule and semicircular canals
cochlea
sensory organ for hearing
vestibule and semicircular canals
sensory organ for equilibrium
mechanism of hearing
transmits sounds-vibration-analyzed by brain
normal is air conduction
alternate is bone conduction
hearing loss
equilibrium
bone conduction for hearing
vibrations transmitted directly to CN VIII
hearing loss
sensorial
conductive
sensorial hearing loss
pathology inner ear, CN VIII or auditory area of cerebral cortex
conductive hearing loss
dysfunction of external ear/middle ear
cerumen, FB, perforated TM, otosclerosis
equilibrium of ear
labyrinth informs brain of place in space
inflammation= staggering gait
vertigo= strong spinning, whirling sensation
function of nose
warms, moistens, and filters air
external nose
nares
vestibule
columella
alar
vestibule of nose
widening of nares
columella of nose
divides nares
alar of nose
outside wing
internal nose
nasal cavity- olfactory receptors- CNI
septum rich vascular network
turbinate’s
nasal septum
turbinate’s in internal nose
3 parallel to increase surface area to moisten and warm
paranasal sinuses
paranasal sinuses
part of turbinate’s of inner nose
air filled pockets
frontal
maxillary
ethmoid
sphenoid- deep
nasal bones of children
not present until 4-7
oral cavity
lips
teeth
gums
palate- hard/soft
cheeks
tongue
frenulum
salivary glands
salivary glands
parotid, submandibular, sublingual
parotid- largest salivary gland
throat
oropharynx
tonsillar pillars
tonsils
nasopharynx
nasopharynx
adenoids
eustachian tube openings
difficulty swallowing
tonsils
abscess
dysphagia
why is it important to follow up on hoarseness
worry about tumor or something with vocal chords
oral cancer
HPV causes 70%
4-5x increase in oral cancer over the last 10 years
what should you recommend to patients to prevent oral cancer?
vaccine for HPV
risks for oral cancer
multiple oral sexual partners
tobacco use
ETOH
when combined 15x more risk
tobacco product risk for oral cancer
snuff
50x increase risk among dip users
OSA
not necessarily the obese patient
insomnia
snoring
dry mouth
headache
memory loss
depression
fatigue
nocturia
in home or sleep apnea testing is the best way to diagnose
what is important to know about treating sleep apnea?
must have sleep apnea testing for insurance to pay for CPAP
abnormal palpation of auscultation of temporal artery
tortuous, hardened, tender as in arteritis, bruit upon auscultation
unilateral head swelling in infant
ductal calculus (stone), infection
painless swelling- tumor
bilateral head swelling in infants
malnutrition (painless0
sjogren’s syndrome (chronic autoimmune disease)
ETOH
DM, HIV, thyroidtoxosis, leukemia infiltrates and lymphomas
drugs
salivary glands
can get enlarged/back up/infected
suck on hard candy to get block out
parotid- located below and in front of ears
submandibular- medially and anteriorly to angles of mandible
sublingual- located in the floor of the mouth beneath the tongue
parotid salivary gland
most often where the problem arises
largest
duct makes a turn where things can get stuck
hypothyroid symptoms
dry hair
puffy face
everything is slow
weight gain
constipation
brittle nails
depression
fatigue
muscle aches
hyperthyroid symptoms
hair loss
bulging eyes
seating
rapid HR
weight loss
regular gas
soft nails
sleeping difficulties
heat intolerance
infertility
abnormal palpation of thyroid
enlarged lobes, tenderness, nodules, lumps
not usually palpable
abnormal auscultation of thyroid
bruit indicates hyperplasia seen in hyperthyroidism
inspection of eyebrows
absent lateral 1/3= hypothyroidism- queen annes sign
may be contributed to cosmetics, medications, skin disease
eyelid inspection
lid lag=hyperthyroidism
incomplete closure
ptosis
ectropian
entropion
scaling
redness
drainage
lipid spots
eye ptosis
aging
secondary to trauma/surgery
congenital
myasthenia gravis
eye ectropion
lid rolls out
eye entropion
lid rolls in
scaling of eyes
ulcerative blepharitis
women using old mascara
lipid spots on eyes
xanthelasma
bilirubin seen in eyes
to see jaundice in bright light- 1.5-1.7
artificial light- >4
normal- 0.3-1.2
blue sclera
OI
brittle bones due to lack of collagen
history of multiple fractures
younger the age of onset, more severe
abnormal cornea and lens inspection
cloudiness, abrasion
irregular ridges in reflected light
eye problems
pinguecula
pterygium
surfers or farmers eye (sun)
hordeolum
chalazion
pinguecula
small rounded yellowish collection on conjunctiva secondary to actinic exposure (sun)
pterygium
similar to pinguecula but grows over iris and attached to middle of eye
hordeolum
sty
local staph infection or hair follicles at lid margin
sticks up from lid
painful, red, swollen
chalazion
beady nodule protruding on the lid
infection of meibomian glands
non-tender
firm
discrete swelling
when inflammed points inward
not on the lash line
looks and feel more like a nodule
infection of meibomian glands
can get a stone in them
close and then fluids back up
size and shape of external ear
microtia <4cm
macrotia >10cm
nodule
tophi- gout
keloid-scarring
weber test
place vibrating tuning fork midline of skull
should hear equally in both ears
abnormal is louder in one ear than the other
abnormal weber test
conductive loss because of cerumen- will hear louder in bad ear
cerumen blocking tympanic membrane so nothing to fight with sounds
sensorial loss will hear louder in good ear (bad ear had nerve damage)
rinne test
compares AC to BC
abnormal: bone conduction longer than air concution
abnormal rinne test
indicates conductive loss
ex: cerumen
landmarks for otoscope
external calas
tympanic membrane
normal is shiny, pearly, gray
cone shapes light reflex- 5 o clock right and 7 o clock left
see reflections of umbro, manubrium, short process
abnormal findings with otoscope
yellow amber color of drum
red color
air/fluid bubbles behind drum
bulging drum
blue or dark red color
diminished/absent landmarks
black/white dots in canal or drum
otitis media findings with otoscope
yellow/amber color of drum
red color
air/fluid bubbles behind drum
diminished/absent landmarks (chronic)
bulging drum indicates what?
increased ear pressure
blue or dark red color on otoscope
blood or trauma
black/white dots in canal or drum
fungal infection
nose problems
rhinophyma
allergic rhinitis
rhinophyma
nose problem
related to rosacea
fair skin
lighter colored hair
blue/green eyes
family history
transillumination of nose
using penlight, press against superior orbital ridge
normal: diffuse red glow
abnormal: no glow-inflamed sinus
abnormal lips
pallor, cyanosis, cherry red, cheilitis
pallor of lips
shock/anemia
cyanosis of lips
hypoxemia
cherry red lips
CO2/ASA poisoning
cheilitis of lips
cracking at corners
tissue degeneration
risk factor for squamous cell carcinoma
early sign of crohns
nutritional deficiency
problems of mouth
HSV
angioedema
teeth erosion
gum erosion
keposi’s sarcoma
fissured tonue
candida tongue
atrophic glossitis
black hairy tongue
hairy leukoplakia
geographic tongue
oral apthous ulcer
angioedema
drug reaction
anaphylaxis
gum erosion
gingivitis
scurvy
meds- dilantin, cyclosporin
fissured tongue
dehydration
atrophic glossitis
vitamin B12 deficiency
beefy red tongue
black hairy tongue
can get after atbx
poor oral hygiene
drinking a lot of pepto bismol
regular use of hydrogen peroxide or something really astringent
excessive amounts of coffee or tea
hairy leukoplakia
white, warty, painless plaques on lateral aspect of the tongue
cannot scrape off
immunocompromised
geographic tongue
doesn’t mean anything
oral apthous ulcer
stress
injury
certain foods- acidy foods
complex ulcers
complex ulcers of the mouth
impaired immune system/nutritional problems
GI disease
impaired immune system/nutritional problems causing complex ulcers of the mouth
cancer patient
deficiencies
GI disease causing complex ulcers of the mouth
celiac
crohns
white membrane covering of the throat
mono, leukemia, diphtheria
halitosis
bad breath
strep
abnormal buccal mucosa
brown patches= addison’s
stenson’s opening red with mumps
koplick spots prodromal for measles
leukoplakia
leukoplakia of buccal mucosa
white discharge
cannot remove
abnormal oral palate
polyps, hard looks yellow with jaundice, oral kaposi’s sarcoma
abnormal confrontation of eyes
suggestive of peripheral loss- needs more testing
corneal light reflex test
assess parallel alignment of the eye axis
shine light from 12 inches away while patient stares straight ahead
reflection of light on corneas should be symmetrical in the center of each cornea
abnormal corneal light reflex test
deviation in alignment may be due to muscle weakness or paralysis
cover/uncover eye test
detects small degrees of deviated alignment
patient stares at your nose cover 1 eye, note uncovered eye- gaze should remain normal
uncover eye- if weakness exist, the eye would habe drifted
nystagmus
dysfunction in cerebellum, vestibularis, and oculomotor
toxic metabolic causes
lesion
opthlamoscope
black #= positive diopter for anterior ocular structures
red #= negative diopter for more posterior structures
small round light- used with small undilated pupils
large round light- routine exam of dilated eyes
green light- used to assess retinal hemorrhages and small vessel changes
ocular fundus exam
in dark room
have patient look at something behind you- not the light!
elicit red reflex- 8-10 inches away with lens @0
close in with lens (black) and focus on the optic disc at the nasal side of the retina
change lens to red to look at posterior structures
follow vessels centrally
findings of ocular fundus exam
disc- nasal side of retina
color- creamy yellow/orange
round or oval
distinct sharp margins
cup-disc ratio: cup horizontal diameter not >1/2 disc diameter
cup normally away (indent in saucer)
vessels of eye
follow a paired artery/vein to periphery
color on ocular fundus exam
arteries bright light red with a central white reflex stripe
veins are larger, darker and have no white reflex stripe
abnormal= absence
A:V width ratio on ocular fundus exam
2/3 or 4/5 diameter of vein
abnormal=constricted or dialted
caliber on ocular fundus exam
arteries/vessels decrease as they extend outward
focal constriction, neurovascularization
A-V crossing on ocular fundus exam
should be within 2 DD of disc
abnormal: nicking, pinching, engorged, >2DD
tortuosity on ocular fundus exam
mild in both eyes- usually congenital
abnormal: extreme or asymmetry
macula on ocular fundus exam
1 DD in since
2 DD temporal to the disc
done last, may cause discomfort
fova centralis= site of sharpest/keenest vision
background abnormalities on ocular fundus exam
papilledema
AV nicking
flame hemorrhage
papilledema
bulging disc
increased ICP
HTN
AV nicking
HTN
flame hemorrhage
HTN
retinal hemorrhages
microaneurysms
neurovascularization
cotton wool patches
hard exudates
drusen bodies
retinal hemorrhages
red dots, sign of bleeding
DM
microaneurysms in eye
red dots, bleeding
HTN/DM
neurovascularization in eye
small contralateral tortuous vessels
DM
cotton wool patches in eyes
white fluffy spots
HTN
DM
hard exudates in eyes
hard white spots
HTN
DM
drusen bodies in eyes
random white bodies normally seen increase with age, earliest feature of age-related macular degeneration
eye emergencies
foreign bodies
red eye
pain
acute angle closure
foreign bodies in eyes
fluorescein stain and slit lamp- if there’s a rust ring them they need ophthalmology ASAP
some things can just be flushed out
chemical are more problematic
red eye
hyperemic and congested may be vision threatening- always evaluate thoroughly
acute angle closure
glaucoma buildup of pressure= pain, nausea, change in visual acuity, red teary eye
cloudy cornea
red eyes
forward bowing iris
mid-dilation of the pupil
high IOP
red reflex of eye
should see full red reflex
loss of red reflex
leukocoria (white pupil)
retinal detachment
retinoblastoma
most common itraocular malignancy in childhood
60% present with leukocoria
arcus senilis
stromal lipid deposition
atherosclerotic CV disease
prevalence increases with age
not pathological in >40, should be absent in the young
unequal pupils
anisocoria
physiologic- 20%
pharmacologic dilation
horner’s syndrome
3rd nerve palsy
horner’s syndrome
unequal pupils
cluster headaches
ipsilateral side of headache- pupil will stay slightly dilated
subconjunctival hemorrhage
trauma
usually not an emergency but may indicate fragility of vessels
if headache or HTN along with that- changes picture
during the eye exam, the NP should attempt to visualize the physiologic cup. what is true of this?
blurring of the nasal outline is normal
on ophthalmic examination, there appears to be a narrowing or blocking of the vessels. the significance of this finding is…
the client needs to be evaluated for chronic hypertension
ms. shell presents with sinus pain, pressure, and yellow nasal discharge. your examination of the patient would include palpation and transillumination of the…
frontal and maxillary
they are the only ones that are truly available to palpate
transillumination of the ethmoid is over the bridge of the nose
the sphenoid is behind the ethnoid so they are not accessible
what should be assessed in a client with a potential corneal abrasion?
visual acuity
a 3 year old boys is brought to the office because he has had a fever and has been tugging on his right ear since yesterday. he has had clear drainage from his nose. on physical exam of the ear, the right tympanic membrane is red and bulging with loss of landmarks. there is no drainage. what is your most likely diagnosis?
otitis media
