The Head and Neck - Bates Flashcards
H/A warrants careful eval for life-threatening causes such as ___, ___ ___, or ___ ___.
meningitis, subarachnoid hemorrhage, mass lesion
Migraines, tension, cluster, and chronic h/a are all ___ types of h/a
primary
Underlying structural, systemic, or infectious causes such as meningitis or subarachnoid hemorrhage are all ___ types of h/a
secondary
H/A warning signs include: progressively frequent or severe over a ___ month period, sudden onset like a “___” or “the ___ h/a of my life”, new onset after age ___, aggravated or relieved by change in ___, precipitated by the ___ maneuver, assoc sympt of ___, ___ ___ or wt ___, presence of ___, ___ inf, or ___, recent ___ trauma, assoc ___, ___ stiffness, or focal ___ deficitis.
3, thunderclap, worst, 50, position, valsalva, fever, night sweats, loss, CA, HIV, pregnancy, head, papilledema, neck, neurologic
Most important attributes of h/a are its ___ and ___ ___.
severity, chronologic pattern
If h/a is severe and of sudden onset, consider ___ ___ or ___
subarachnoid hemorrhage, meningitis
___ and ___ h/a are episodic and tend to peak over several hrs.
Migraine, tension
New and persisting, progressively severe h/a raise concerns of ___, ___, or ___ ___.
tumor, abscess, mass lesion
Unilateral h/a occurs in ___ and ___ h/a
migraine, cluster
___ h/a often arise in the temporal areas, whereas ___ h/a may be retro-orbital.
Tension, cluster
N/V are commonly seen w/___.
migraines
60-70% of pt’s w/migraines experience aura’s, such as ___ ___ (flashes of light), ___ (zig-zag arc of light), and ___ (area of visual loss w/surrounding normal vision).
spark photopsias, fortifications, scotomata
Women w/migraines of aura should avoid use of ___-___ contraceptives.
estrogen-progestin
Ask if ___, ___ or changing the ___ of the head affects the h/a.
coughing, sneezing, position
Ask about ___ hx. Genetic inheritance appears to be present in 30-50% of pt’s w/___.
family, migraines
\_\_\_ = farsightedness \_\_\_ = aging vision \_\_\_ = nearsightedness \_\_\_ = double-vision
hyperopia
presbyopia
myopia
diplopia
If sudden unilateral visual loss is PAINLESS, consider vitreous hemorrhage from ___ or ___, macular ___, retinal ___. If PAINFUL, causes are usually in the ___ and anterior chamber as in corneal ___, ___, and acute ___. If bilateral and painless, typically occurs d/t medications that change refraction such as ___, ___, and ___.
diabetes, trauma, degeneration, detachment
cornea, ulcer, uveitis, glaucoma
cholinergics, anticholinergics, steroids
Bilateral gradual visual loss usually arises from ___ or ___ ___.
cataracts, macular degeneration
Moving specks or floaters suggest ___ in the retina or visual pathways.
lesions
Ask about ___ in or around the eyes, ___, and excessive ___ or watering.
pain, redness, tearing
___ hearing loss results from problems in the external or middle ear, whereas ___ hearing loss arises from problems in the inner ear, the cochlear nerve, or its central connections in the brain.
Conductive, sensorineural
Ppl w/sensorineural loss have trouble understanding ___. ___ env help ppl w/conductive loss.
speech, noisy
Meds that affect hearing include:
NSAIDS, aminoglycosides, ASA, quinine, furosemide
In otitis ___, there is pain in the external canal, tragus, and pinna. In otitis ___, there is pain in the inner ear or may be referred from others structures in the mouth, throat, or neck.
externa, media
___ is ringing, rushing, or roaring in the ears and is commonly seen in ___ dis.
tinnitus, Meniere’s
Feeling light-headed, weak in the legs or about to faint points to ___.
presyncope
___ aka dizziness occurs in benign positional vertigo, labyrinthitis, and Meniere’s dis.
Vertigo
___ refers to drng from the nose ans is often assoc w/nasal congestion. Freq accomp by sneezing, watery eyes, throat discomfort, itching in the eyes, nose and throat.
Rhinorrhea
Seasonal onset or env triggers suggest ___ ___.
allergic rhinitis
___-___ rhinitis occurs in excessive use of decongestants, or use of cocaine.
Drug-induced
Acute bacterial sinusitis is unlikely until viral ___ sympt persist more than ___ days.
URI, 7
Will typically exp purulent nasal discharge and tooth/facial/maxillary pain w/___.
sinusitis
Consider deviated nasal septum, nasal polyp, or foreign body is nasal congestion on ___ side.
one
___ is blding from the nasal passages. Causes include ___, ___, drying/crusting of the ___ ___, ___, and ___ ___.
Epistaxis, trauma, inflam, nasal mucosa, tumors, foreign bodies
Sore throat and/or pharyngitis are freq complaints assoc w/___.
URI
Blding gums most often caused by ___.
gingivitis
Hoarseness occurs from ___ overuse and ___. Other risk factors are env ___, ___, ___, and inhalation of fumes or other irritants.
voice, laryngitis, allergies, GERD, smoking,
Enlged tender lymph nodes commonly accompany ___.
pharyngitis
Thyroid function may be increased, decreased, or normal w/___.
goiter
Intolerance to cold, preference for warm clothing or many blankets, and decreased sweating suggest ___.
hypothyroidism
Intolerance to heat, palpitations, and involuntary wt loss suggest ___.
hyperthyroidism
clouding of the lens = ___
subretinal hemorrhages or exudates = ___ ___
change in color and size of optic disc = ___
cataracts
macular degeneration
glaucoma
___ is the leading cause of blindness in African Americans and second leading cause of blindness overall.
Glaucoma
In ___ ___-___ ___, there is gradual loss of vision as a result of the loss of retinal ganglion cell axons. Risk factors include age over ___, ___ hx, ___-___ descent, ___, ___, and ___ ___
primary open-angle glaucoma (POAG), 65, family, African-American, diabetes, myopia, ocular HTN
USPTF recommends screening adults __ yrs of age and older.
50
Groups at risk for hearing loss are those w/a hx of ___ hearing loss, ___, ___, ___, or exposure to hazardous ___ levels at work or on the battlefield.
familial, syphilis, rubella, meningitis, noise
W/oral health, ask about ___, ___, and ___ use, changes in ___ flow from meds, and proper use of ___.
diet, tobacco, alcohol, salivary, dentures
Fine hair is seen in ___, whereas coarse hair is seen in ___.
hyperthyroidism, hypothyroidism
Redness and scaling of the scalp may indicate ___ ___ or ___.
seborrheic dermatitis, psoriasis
An enlged skull may signify ___.
hydrocephalus
___ is excessive facial hair and occurs in some women w/___.
Hirsutism, PCOS
The ___ gland lies w/in the bony orbit, above and lateral to the eyeball.
lacrimal
The muscles of the ___ control pupillary size. Muscles of the ___ body control the thickness of the lens, allowing the eye to focus on near or distant objects.
iris, ciliary
A clear liquid called ___ ___ fills the anterior/posterior chambers of the eye and drains out thru the ___ of ___. This helps to control the ___ inside the eye.
aqueous humor, canal of schlemm, pressure
You can find the optic nerve and retinal vessels at the ___ __.
optic disc
A ___ ___ is the entire area seen by an eye when it loos at a central pt.
visual field
To see an image, light reflected from the image must pass thru the ___ and be focused on sensory neurons in the ___.
pupil, retina
Pupillary size changes in response to ___ and to the effort of ___ on a near object.
light, focusing
A light beam shining onto one retina causes pupillary constriction in both that eye, termed the ___ ___ to light, and in the opposite eye, the ___ ___.
direct reaction, consensual reaction
The pathways diverge in the midbrain and impulses are transmitted thru the oculomotor nerve, CN ___, to the constrictor muscles of the iris of each eye.
III
When a person shifts gaze from a far object to a near one, the pupils ___.
constrict
___ is an increased convexity of the lenses caused by contraction of the ciliary muscles.
Accomodation
CN ___ is principally responsibly for moving the Rt eye, whereas CN ___ is principally responsible for moving the Lt eye.
III, IV
To test the acuity of central vision, use a ___ chart and position the pt ___ ft from the chart. Ask pt to cover one eye and read the smallest line of print possible.
Snellen, 20
Visual acuity is expressed as 2 numbers (20/20), the first indicates the distance of the ___ from the chart, and the second indicates the distance at which a ___ eye can read the line of letters.
pt, normal
A person is considered legally blind when vision is ___/___ or less.
20/200
In the static finger wiggle test, ask the pt to look w/both eyes into your eyes, wiggle your fingers and bring them slowly forward toward the ___ vision line. Ask the pt to tell you as soon as he/she sees the finger mvmnt.
central
A temporal defect in the visual field of one eye suggests a ___ defect in the other eye.
nasal
Inward or outward deviation of the eyes and abnormal protrusion is seen in ___ dis or ocular ___.
Grave’s, tumors
A yellow sclera indicates ___
jaundice
Inspect the size, shape, and symmetry of the ___. Large is > ___mm, small is < ___mm
pupils, 5, 3
\_\_\_ = constriction of the pupils \_\_\_ = dilation of the pupils
Miosis
Mydriasis
___ is a difference in pupillary size of 0.04 mm or greater.
Aniscoria
___ reaction is pupillary constriction in the same eye. ___ reaction is pupillary constriction in the opposite eye.
Direct, consensual
___ is a fine rhythmic oscillation of the eyes and can be seen in various ___ conditions.
Nystagmus, neurologic
To test the 6 extraocular mvmnts (EOM’s), ask the pt to follow your ___ as you make a wide ___ or ___ in the air.
finger, H, star
When testing for ___, ask the pt to follow your finger/pencil as you move it in toward the bridge of the nose.
convergence
Place yourself about ___ inches away from pt when using the ophthalmoscope and check for the ___ reflex. Absence of a red reflex suggests an ___ of the lens (cataract) or a ___. An ___ eye will have no red reflex.
15, red, opacity, retinoblastoma, artificial
___ is swelling of the optic disc and could indicate disorders of the ___, ___, ___ hemorrhage, trauma, and mass ___.
Papilledema, brain, meningitis, subarachnoid, lesions
___ ___ is an important cause of poor central vision in older adults.
Macular degeneration
Ear has 3 compartments: ___, ___, and ___.
external, middle, inner
The ___ ear comprises the auricle and ear canal, as well as the helix, antihelix, and tragus.
external
The ___ ear comprises the ossicles - the malleus, the incus, and the stapes.
middle
The ___ ear comprises the cochlea, semicircular canals, and auditory nerve.
inner
First part of the hearing pathway from the external ear thru the middle ear, known as the ___ phase. Second part of the pathway involves the cochlea and cochlear nerve is the ___ phase.
conductive, senorineural
___ conduction is more sensitive than ___ conduction.
Air, bone
To straighten the ear canal in an adult, pull the auricle ___ , ___, and ___ from the head.
up, back, away
To straighten the ear canal in infants/peds, pull the auricle ___, ___, and ___ from the head.
down, back, away
The ear canal is often swollen, narrowed, moist, pale, and tender in otitis ___.
externa
Will see a red, bulging TM in acute purulent otitis ___. Mobility will also be ___.
media, decreased
Stand ___ ft behind the pt in the ___ test. For pt’s who fail this test, use a ___ ___.
2, whisper, tuning fork
An abnormality of the whispered voice test would be that the pt only repeats ___ of the 6 numbers correctly.
4
Testing for lateralization w/the tuning fork is known as ___ test and it is placed on pt’s ___.
Weber, head
Comparing air conduction w/bone conduction w/the tuning fork is known as ___ test and it is placed on the ___ ___.
Rinne, mastoid process
Can see ___ and ___ turbinates, but not the ___ turbinate.
inferior, middle, superior
Only the ___ and ___ sinuses are accessible on clinical exam. Press up on the under-side of the brows for ___ and underneath the cheek bones for ___.
frontal, maxillary, frontal, maxillary
Test for nasal ___ by pressing on each side of the nose and asking the pt to breathe in.
obstruction
In ___ ___, the mucosa is reddened and swollen. In ___ ___, it may be pale, bluish, or red.
viral rhinitis
allergic rhinitis
The labial ___ connects each lip w/the gingiva.
frenulum
Normal # of adult teeth is ___.
32
Tonsils should be ___ or ___.
small, absent
Asymmetric protrusion suggests a lesion of the hypoglossal, CN ___.
XII
Tongue CA is a common oral CA especially in med older than ___, ___, ___ chewers, and ___ drinkers.
50, smokers, tobacco, alcohol
Assess the ___ by having pt say “ah” or “yawn”, testing the vagal nerve, CN ___.
pharynx, X
Tonsillar exudates are common in ___ ___.
strep pharyngitis
The ___ ___ ___ passes diagonally over the surface of the sternomastoid.
external jugular vein
Thyroid gland is usually located above the ___ notch.
suprasternal
Palpate lymph nodes and note size, shape, mobility, consistency, and any tenderness. Should be ___, ___, ___, and ___.
small, mobile, discrete, nontender
Generalized lymphadenopathy is seen in ___, ___, ___, ___, ___, and ___.
HIV, AIDS, mono, lymphoma, leukemia, sarcoidosis
Masses in the neck may push the ___ to one side or the other.
trache
The thyroid cartilage, cricoid cartilage, and thyroid gland all rise w/___ and then fall to their resting positions.
swallowing
Retrosternal ___ can cause hoarseness, SOB, stridor, or dysphagia from tracheal compression.
goiters
Thyroid gland should be ___ in Grave’s dis and ___ in Hashimoto’s thyroiditis.
soft, firm
JVD is commonly seen in ___.
CHF
Exopthalmos is present in approx 60% of pt’s w/___ dis.
Grave’s
When the light beam shines into the normal Rt eye, there should be brisk ___ of both pupils.
constriction
When shining the light through the hard palate, a reddish glow indicates a normal ___-filled ___ sinus.
air, maxillary
