Midterm- HEENT Flashcards

Question

newborn eye exam

Answer 1

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

Answer 2

myopia (nearsightedness) astigmatism (irregular curvature of the eyes surface) presbyopia (age related farsightedness)

Answer 3

cataracts uveitis (inflammation of the uvea) related to autoimmune disease infections)

Answer 4

DM, HTN, hyperthyroidism

Answer 5

CMV toxoplasmosis congenital toxoplasmosis

Answer 6

enlargement of liver and spleen, blindness and mental retardation

Answer 7

auricle or pinna helix antihelix tragus antitragus lobule external audtiory meatus

Answer 8

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

Answer 9

middle ear malleus incus stapes

Answer 10

bony labyrinth cochlea vestibule and semicircular canals

Answer 11

sensory organ for hearing

Answer 12

sensory organ for equilibrium

Answer 13

transmits sounds-vibration-analyzed by brain normal is air conduction alternate is bone conduction hearing loss equilibrium

Answer 14

vibrations transmitted directly to CN VIII

Answer 15

sensorial conductive

Answer 16

pathology inner ear, CN VIII or auditory area of cerebral cortex

Answer 17

dysfunction of external ear/middle ear cerumen, FB, perforated TM, otosclerosis

Answer 18

labyrinth informs brain of place in space inflammation= staggering gait vertigo= strong spinning, whirling sensation

Answer 19

warms, moistens, and filters air

Answer 20

nares vestibule columella alar

Answer 21

widening of nares

Answer 22

divides nares

Answer 23

outside wing

Answer 24

nasal cavity- olfactory receptors- CNI septum rich vascular network turbinate's nasal septum

Answer 25

3 parallel to increase surface area to moisten and warm paranasal sinuses

Answer 26

part of turbinate's of inner nose air filled pockets frontal maxillary ethmoid sphenoid- deep

Answer 27

not present until 4-7

Answer 28

lips teeth gums palate- hard/soft cheeks tongue frenulum salivary glands

Answer 29

parotid, submandibular, sublingual parotid- largest salivary gland

Answer 30

oropharynx tonsillar pillars tonsils nasopharynx

Answer 31

adenoids eustachian tube openings

Answer 32

tonsils abscess dysphagia

Answer 33

worry about tumor or something with vocal chords

Answer 34

HPV causes 70% 4-5x increase in oral cancer over the last 10 years

Answer 35

vaccine for HPV

Answer 36

multiple oral sexual partners tobacco use ETOH when combined 15x more risk

Answer 37

snuff 50x increase risk among dip users

Answer 38

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

Answer 39

must have sleep apnea testing for insurance to pay for CPAP

Answer 40

tortuous, hardened, tender as in arteritis, bruit upon auscultation

Answer 41

ductal calculus (stone), infection painless swelling- tumor

Answer 42

malnutrition (painless0 sjogren's syndrome (chronic autoimmune disease) ETOH DM, HIV, thyroidtoxosis, leukemia infiltrates and lymphomas drugs

Answer 43

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

Answer 44

most often where the problem arises largest duct makes a turn where things can get stuck

Answer 45

dry hair puffy face everything is slow weight gain constipation brittle nails depression fatigue muscle aches

Answer 46

hair loss bulging eyes seating rapid HR weight loss regular gas soft nails sleeping difficulties heat intolerance infertility

Answer 47

enlarged lobes, tenderness, nodules, lumps **not usually palpable**

Answer 48

bruit indicates hyperplasia seen in hyperthyroidism

Answer 49

absent lateral 1/3= hypothyroidism- queen annes sign may be contributed to cosmetics, medications, skin disease

Answer 50

lid lag=hyperthyroidism incomplete closure ptosis ectropian entropion scaling redness drainage lipid spots

Answer 51

aging secondary to trauma/surgery congenital myasthenia gravis

Answer 52

lid rolls out

Answer 53

lid rolls in

Answer 54

ulcerative blepharitis women using old mascara

Answer 55

xanthelasma

Answer 56

to see jaundice in bright light- 1.5-1.7 artificial light- >4 normal- 0.3-1.2

Answer 57

OI brittle bones due to lack of collagen history of multiple fractures younger the age of onset, more severe

Answer 58

cloudiness, abrasion irregular ridges in reflected light

Answer 59

pinguecula pterygium surfers or farmers eye (sun) hordeolum chalazion

Answer 60

small rounded yellowish collection on conjunctiva secondary to actinic exposure (sun)

Answer 61

similar to pinguecula but grows over iris and attached to middle of eye

Answer 62

sty local staph infection or hair follicles at lid margin sticks up from lid painful, red, swollen

Answer 63

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

Answer 64

can get a stone in them close and then fluids back up

Answer 65

microtia <4cm macrotia >10cm nodule tophi- gout keloid-scarring

Answer 66

place vibrating tuning fork midline of skull should hear equally in both ears abnormal is louder in one ear than the other

Answer 67

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)

Answer 68

compares AC to BC abnormal: bone conduction longer than air concution

Answer 69

indicates conductive loss ex: cerumen

Answer 70

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

Answer 71

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

Answer 72

yellow/amber color of drum red color air/fluid bubbles behind drum diminished/absent landmarks (chronic)

Answer 73

increased ear pressure

Answer 74

blood or trauma

Answer 75

fungal infection

Answer 76

rhinophyma allergic rhinitis

Answer 77

nose problem related to rosacea fair skin lighter colored hair blue/green eyes family history

Answer 78

using penlight, press against superior orbital ridge normal: diffuse red glow abnormal: no glow-inflamed sinus

Answer 79

pallor, cyanosis, cherry red, cheilitis

Answer 80

shock/anemia

Answer 81

CO2/ASA poisoning

Answer 82

cracking at corners tissue degeneration risk factor for squamous cell carcinoma early sign of crohns nutritional deficiency

Answer 83

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

Answer 84

drug reaction anaphylaxis

Answer 85

gingivitis scurvy meds- dilantin, cyclosporin

Answer 86

dehydration

Answer 87

vitamin B12 deficiency beefy red tongue

Answer 88

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

Answer 89

white, warty, painless plaques on lateral aspect of the tongue cannot scrape off immunocompromised

Answer 90

doesn't mean anything

Answer 91

stress injury certain foods- acidy foods complex ulcers

Answer 92

impaired immune system/nutritional problems GI disease

Answer 93

cancer patient deficiencies

Answer 94

celiac crohns

Answer 95

mono, leukemia, diphtheria

Answer 96

bad breath strep

Answer 97

brown patches= addison's stenson's opening red with mumps koplick spots prodromal for measles leukoplakia

Answer 98

white discharge cannot remove

Answer 99

polyps, hard looks yellow with jaundice, oral kaposi's sarcoma

Answer 100

suggestive of peripheral loss- needs more testing

Answer 101

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

Answer 102

deviation in alignment may be due to muscle weakness or paralysis

Answer 103

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

Answer 104

dysfunction in cerebellum, vestibularis, and oculomotor toxic metabolic causes lesion

Answer 105

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

Answer 106

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

Answer 107

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)

Answer 108

follow a paired artery/vein to periphery

Answer 109

arteries bright light red with a central white reflex stripe veins are larger, darker and have no white reflex stripe abnormal= absence

Answer 110

2/3 or 4/5 diameter of vein abnormal=constricted or dialted

Answer 111

arteries/vessels decrease as they extend outward focal constriction, neurovascularization

Answer 112

should be within 2 DD of disc abnormal: nicking, pinching, engorged, >2DD

Answer 113

mild in both eyes- usually congenital abnormal: extreme or asymmetry

Answer 114

1 DD in since 2 DD temporal to the disc done last, may cause discomfort fova centralis= site of sharpest/keenest vision

Answer 115

papilledema AV nicking flame hemorrhage

Answer 116

bulging disc increased ICP HTN

Answer 117

HTN retinal hemorrhages microaneurysms neurovascularization cotton wool patches hard exudates drusen bodies

Answer 118

red dots, sign of bleeding DM

Answer 119

red dots, bleeding HTN/DM

Answer 120

small contralateral tortuous vessels DM

Answer 121

white fluffy spots HTN DM

Answer 122

hard white spots HTN DM

Answer 123

random white bodies normally seen increase with age, earliest feature of age-related macular degeneration

Answer 124

foreign bodies red eye pain acute angle closure

Answer 125

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

Answer 126

hyperemic and congested may be vision threatening- always evaluate thoroughly

Answer 127

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

Answer 128

should see full red reflex

Answer 129

leukocoria (white pupil) retinal detachment

Answer 130

most common itraocular malignancy in childhood 60% present with leukocoria

Answer 131

stromal lipid deposition atherosclerotic CV disease prevalence increases with age not pathological in >40, should be absent in the young

Answer 132

anisocoria physiologic- 20% pharmacologic dilation horner's syndrome 3rd nerve palsy

Answer 133

unequal pupils cluster headaches ipsilateral side of headache- pupil will stay slightly dilated

Answer 134

trauma usually not an emergency but may indicate fragility of vessels if headache or HTN along with that- changes picture

Answer 135

blurring of the nasal outline is normal

Answer 136

the client needs to be evaluated for chronic hypertension

Answer 137

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

Answer 138

visual acuity

Answer 139

otitis media