Rapid DDx: HEENT Flashcards
Firm Painless Lump on Eyelid
Erythema
Swelling
Chalazion
Floaters
Blurred Vision
Impaired color/night vision
Ocular Pain
Photophobia
Excessive lacrimation
posterior uveitis
Red eye
eyelid Edema
chemosis
purulent d/c
Bacterial conjunctivitis
Red eye
eyelid Edema
chemosis
watery/stringing d/c
viral conjunctivitis
Red eye
eyelid Edema
chemosis
watery, mucoid d/c
allergic conjunctivitis
Red eye
eyelid Edema
chemosis
profuse, hyperpurulent d/c
gonococcal d/c
elderly patient
bilateral sxs:
Eye irritation/dryness
sagging eyelid
everted eyelid/lashes
ectropion
elderly patient
bilateral sxs:
corneal abrasion/FB sensation
Chemosis
lacrimation
inverted eyelid/lashes
entropion
tearing
tenderness, erythema, edema, warmth on medial canthal side of lower lid
acute dacrocystitis
mucopurulent drainage from puncta
no acute signs of infx
chronic dacrocystitis
crusting, scaling eyelid
red rim of eyelid
flakes on lashes/lid margins
blepharitis
lid erythema
painful, warm nodule/pustule on eyelid
hordeolum
yellow, elevated nodule on nasal side of sclera
non-growing/non-progressing
pinguecula
Triangular shaped mass that started at medial side of eye
lateral growth
pterygium
diplopia w. upward gaze
orbital emphysema
anesthesia to anteromedial cheek
orbital blowout fx
< 3 yo
leukocoria (absent red light reflex)
retinoblastoma
Age > 75
Bilateral, progressive central vision loss
metamorphopsia (bending of straight lines)
dry macular degeneration
Age > 75
bilateral, aggressive central vision loss
metamorphopsia (bending of straight lines)
wet macular degeneration
Previous cataract surg
Photopsia (flashing lights) –> floaters
progressive unilateral peripheral vision loss
“curtain coming down”
retinal detachment
Day 1 neonate
conjunctivitis sxs
chemical conjunctivitis
Day 2-5 neonate
conjunctivitis sxs
gonococcal conjunctivitis
Days 5-7 neonate
conjunctivitis sxs
chlamydial conjunctivitis
FB sensation in eye
tearing
Red and painful eye
photophobia
ocular FB/corneal abrasian
Chemical exposure
ocular pain
decreaed vision
blepharospasm (difficulty opening eye)
photophobia
ocular chemical burn
Hx of sinus infx
ocular pain with EOMs
Ophthalmoplegia (weakness of EOMs)
proptosis (bulging)
orbital cellulitis
hx of sinus infx
unilateral ocular pain
eyelid erythema and edema
no proptosis or EOM pain/weakness
preseptal cellulitis
Contact lens wearer
ocular pain
photophobia
eye redness
vision changes
bacterial keratitis
acute onset unilateral ocular pain, photophobia, redness and blurred vision.
herpes keratitis
hx inflammatory/autoimmune dz
unilateral severe ocular pain, photophobia, redness, blurred/decreased vision
constricted pupil
anterior uveitis
hx inflammatory/autoimmune dz
blurred/decreased vision
floaters
constricted pupil
low pain
posterior uveitis
> 60 yo DM + TOBB + GC use
slow, progressive vision loss
difficulty with night driving/reading signs
both eyes
cataract
Normal vision
HA
Vomiting
Nausea
papilledema
Woman < 40 yo
painful vision loss
decreased color vision (desaturation)
Central scotoma
Marcus-Gunn Pupil
Unilateral sxs, developed over a day or so
Optic neuritis
Sudden onset severe, unilateral ocular pain
halos around lights
loss of peripheral vision (tunnel vision)
N/V, HA
Worse in dim rooms
Acute narrow angle closure glaucoma
bilateral, painless, slow peripheral vision loss
progress to central vision loss
open angle claucoma
transient monocular vision loss
“curtain came down”
complete recovery within an hour
amaurosis fugax
Hx of atherosclerotic disease
acute, painless monocular vision loss w. amaurosis fugax
ipsilateral carotid bruit
central retinal artery occlusion (CRAO)
sudden onset painless monocular vision loss
+/- marcus gunn pupil
central retinal vein occlusion (CRVO)
Hx of swimming, Q tip use
ear pain
EAC pruritis
otitis externa
severe auricular pain
otorrhea
CN palsies
Radiation of pain to TMJ/pain with chewing
Malignant OE
Hx AOM
Deep ear pain worse at night
fever
lethargic, malaise
Mastoiditis
Persistent, recurrent purulent otorrhea
painless
feeling of ear fullness
conductive hearing loss
chronic otitis media
6-18 mo
Fever
otalgia
ear tugging
acute otitis media
hx of resolved AOM
feeling of fluid in ear
no fever, pain, erythema
otitis media with effusion
Ear fullness/pressure
popping of ears
feeling of being underwater
fluctuating conductive hearing loss
tinnitus
eustachian tube dysfunction
Hx diving
ear pain
ear fullness
hearing loss
barotrauma
Hx of ear fullness and gradual conductive hearing loss
cerumen impaction
Hx of Q-tip use, loud concerts
acute ear pain
hearing loss
pain relief with bloody otorrhea
TM perforation
Hx of ear infx
painless, foul smelling brown/yellow ear d/c
cholesteatoma
FHx of conductive hearing loss
slow, progressive conductive hearing loss at low frequencies
no vertigo
otosclerosis
recurrent, episodic, sudden onset peripheral vertigo
lasts 60s or less
provoked by rolling over in bed, etc.
no hearing loss
BPPV
Hx viral illness
continuous peripheral vertigo
N/V
Gait disturbance
horizontal/rotary nystagmus
Vestibular Neuritis
Hx viral illness
continuous peripheral vertigo
N/V
Gait disturbance
horizontal/rotary nystagmus
unilateral hearing loss
tinnitus
labrynthitis
Episodic peripheral vertigo lasting minutes/hours
fluctuating sensorineural hearing loss
tinnitus
ear fullness
horizontal nystagmus
NV
Menieres disease
Unilateral sensorineural hearing loss
acoustic neuroma
Unilateral sensorineural hearing loss
tinnitus
vertigo
HA
facial numbness
Facial paresis
acoustic neuroma
Duration < 4 weeks
Hx viral URI
facial pain/pressure worse bending over
HA
purulent nasal d/c
fever
nasal congestion
worse after period of improvement
acute rhinosinusiis
Duration > 12 weeks
acial pain/pressure worse bending over
HA
purulent nasal d/c
nasal congestion
chronic sinusitis
Hx DM/immunocompromise
sxs of sinusitis
progressive loss of CNS function
mucormycosis
Clear, watery rhinorrhea
itching of nose, eyes, ears
sneezing
nasal congestion
bluish discoloration around eyes
allergic rhinitis
hx allergic rhinitis
anosmia
obstructed nose breathing
nasal polyps
ST
painful swallowing/phonation
cough, hoarseness, coryza, conjunctivitis, diarrhea
viral acute pharyngitis
ST
painful swallowing/phonation
acute pharyngitis
age > 3yo
dysphagia
fever
ST
Anterior cervical LAD
strep pharyngitis
Hx of viral URI sxs
hoarseness or aphonia
dry/scratchy throat
laryngitis
age 15-30 yo
hx of pharyngitis
muffled voice
dysphagia
drooling
trismus (lock jaw)
peritonsilar abscess
age 2-4 yo
torticollis
neck stiffness, esp. with neck extension
hot potato voice
trismus
drooling
retropharyngeal abscess
HCV infx
lacy leukoplakia/wickham striae
painless
reticular oral lichen planus
HCV infx
red patches along lacy reticular leukoplakia
painful
erythematous oral lichen planus
HCV infx
erosions, painful ulcers along lacy reticular leukoplakia
erosive oral lichen planus
Hx of dental infx
tender, symmetric, swelling “woody” induration and erythema on upper neck and chin
crepitus
pus on floor of mouth
swelling of tongue
no LAD/abscess
ludwig’s angina
immmunocompromised or oral CS use
white, curd like plaques on oral mucosa or tongue
painless
easily scraped off
oropharyngeal candidiasis
small, painful, shallow oval ulcer with erythematous halo on buccal or labial mucosa
apthous ulcer
painless white patchy lesion on oral mucosa
cannot be scraped off
oral leukoplakia
painless, erythematous soft and velvety patch in oral cavity
on mouth floor, soft palate and ventral tongue
erythroplakia
sudden onset of salivary gland pain and swelling
occurs when eating or when about to eat
occurs roof of mouth (stensens) or under tongue (wharton’s)
sialolithiasis (salivery gland stone)
sudden onset
firm, tender gland swelling with purulent d/c
able to express pus if duct is massaged
dysphagia
trismus
fever/chills
acute bacterial sialadenitis
age 6mo-5 yo
hx of fever, anorexia and malaise then appearance of oral lesions
ulcerative lesions of gingiva, vesicles on mucous membraines
perioral vesicular lesions clustered on erythematous base
acute herpetic gingivostomatitis
adult age
fever, malaise, HA
ST
ulcerative lesion with grayish exudate on posterior pharyngeal mucosa
acute herpetic pharyngotonsilitis
Hx of EBV + HIV
painless, white smooth or hairy plaque on lateral tongue
can’t be scraped off
oral hairy leukoplakia
