The Head and Neck - Bates

Question 1

H/A warrants careful eval for life-threatening causes such as ___, ___ ___, or ___ ___.

Answer 1

meningitis, subarachnoid hemorrhage, mass lesion

Question 2

Migraines, tension, cluster, and chronic h/a are all ___ types of h/a

Answer 2

primary

Question 3

Underlying structural, systemic, or infectious causes such as meningitis or subarachnoid hemorrhage are all ___ types of h/a

Answer 3

secondary

Question 4

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.

Answer 4

3, thunderclap, worst, 50, position, valsalva, fever, night sweats, loss, CA, HIV, pregnancy, head, papilledema, neck, neurologic

Question 5

Most important attributes of h/a are its ___ and ___ ___.

Answer 5

severity, chronologic pattern

Question 6

If h/a is severe and of sudden onset, consider ___ ___ or ___

Answer 6

subarachnoid hemorrhage, meningitis

Question 7

___ and ___ h/a are episodic and tend to peak over several hrs.

Answer 7

Migraine, tension

Question 8

New and persisting, progressively severe h/a raise concerns of ___, ___, or ___ ___.

Answer 8

tumor, abscess, mass lesion

Question 9

Unilateral h/a occurs in ___ and ___ h/a

Answer 9

migraine, cluster

Question 10

___ h/a often arise in the temporal areas, whereas ___ h/a may be retro-orbital.

Answer 10

Tension, cluster

Question 11

N/V are commonly seen w/___.

Answer 11

migraines

Question 12

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).

Answer 12

spark photopsias, fortifications, scotomata

Question 13

Women w/migraines of aura should avoid use of ___-___ contraceptives.

Answer 13

estrogen-progestin

Question 14

Ask if ___, ___ or changing the ___ of the head affects the h/a.

Answer 14

coughing, sneezing, position

Question 15

Ask about ___ hx. Genetic inheritance appears to be present in 30-50% of pt’s w/___.

Answer 15

family, migraines

Question 16

\_\_\_ = farsightedness
\_\_\_ = aging vision
\_\_\_ = nearsightedness
\_\_\_ = double-vision

Answer 16

hyperopia
presbyopia
myopia
diplopia

Question 17

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 ___.

Answer 17

diabetes, trauma, degeneration, detachment
cornea, ulcer, uveitis, glaucoma
cholinergics, anticholinergics, steroids

Question 18

Bilateral gradual visual loss usually arises from ___ or ___ ___.

Answer 18

cataracts, macular degeneration

Question 19

Moving specks or floaters suggest ___ in the retina or visual pathways.

Answer 19

lesions

Question 20

Ask about ___ in or around the eyes, ___, and excessive ___ or watering.

Answer 20

pain, redness, tearing

Question 21

___ 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.

Answer 21

Conductive, sensorineural

Question 22

Ppl w/sensorineural loss have trouble understanding ___. ___ env help ppl w/conductive loss.

Answer 22

speech, noisy

Question 23

Meds that affect hearing include:

Answer 23

NSAIDS, aminoglycosides, ASA, quinine, furosemide

Question 24

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.

Answer 24

externa, media

Question 25

___ is ringing, rushing, or roaring in the ears and is commonly seen in ___ dis.

Answer 25

tinnitus, Meniere's

Question 26

Feeling light-headed, weak in the legs or about to faint points to ___.

Answer 26

presyncope

Question 27

___ aka dizziness occurs in benign positional vertigo, labyrinthitis, and Meniere's dis.

Answer 27

Vertigo

Question 28

___ 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.

Answer 28

Rhinorrhea

Question 29

Seasonal onset or env triggers suggest ___ ___.

Answer 29

allergic rhinitis

Question 30

___-___ rhinitis occurs in excessive use of decongestants, or use of cocaine.

Answer 30

Drug-induced

Question 31

Acute bacterial sinusitis is unlikely until viral ___ sympt persist more than ___ days.

Answer 31

URI, 7

Question 32

Will typically exp purulent nasal discharge and tooth/facial/maxillary pain w/___.

Answer 32

sinusitis

Question 33

Consider deviated nasal septum, nasal polyp, or foreign body is nasal congestion on ___ side.

Answer 33

one

Question 34

___ is blding from the nasal passages. Causes include ___, ___, drying/crusting of the ___ ___, ___, and ___ ___.

Answer 34

Epistaxis, trauma, inflam, nasal mucosa, tumors, foreign bodies

Question 35

Sore throat and/or pharyngitis are freq complaints assoc w/___.

Answer 35

URI

Question 36

Blding gums most often caused by ___.

Answer 36

gingivitis

Question 37

Hoarseness occurs from ___ overuse and ___. Other risk factors are env ___, ___, ___, and inhalation of fumes or other irritants.

Answer 37

voice, laryngitis, allergies, GERD, smoking,

Question 38

Enlged tender lymph nodes commonly accompany ___.

Answer 38

pharyngitis

Question 39

Thyroid function may be increased, decreased, or normal w/___.

Answer 39

goiter

Question 40

Intolerance to cold, preference for warm clothing or many blankets, and decreased sweating suggest ___.

Answer 40

hypothyroidism

Question 41

Intolerance to heat, palpitations, and involuntary wt loss suggest ___.

Answer 41

hyperthyroidism

Question 42

clouding of the lens = ___ subretinal hemorrhages or exudates = ___ ___ change in color and size of optic disc = ___

Answer 42

cataracts macular degeneration glaucoma

Question 43

___ is the leading cause of blindness in African Americans and second leading cause of blindness overall.

Answer 43

Glaucoma

Question 44

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 ___ ___

Answer 44

primary open-angle glaucoma (POAG), 65, family, African-American, diabetes, myopia, ocular HTN

Question 45

USPTF recommends screening adults __ yrs of age and older.

Answer 45

50

Question 46

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.

Answer 46

familial, syphilis, rubella, meningitis, noise

Question 47

W/oral health, ask about ___, ___, and ___ use, changes in ___ flow from meds, and proper use of ___.

Answer 47

diet, tobacco, alcohol, salivary, dentures

Question 48

Fine hair is seen in ___, whereas coarse hair is seen in ___.

Answer 48

hyperthyroidism, hypothyroidism

Question 49

Redness and scaling of the scalp may indicate ___ ___ or ___.

Answer 49

seborrheic dermatitis, psoriasis

Question 50

An enlged skull may signify ___.

Answer 50

hydrocephalus

Question 51

___ is excessive facial hair and occurs in some women w/___.

Answer 51

Hirsutism, PCOS

Question 52

The ___ gland lies w/in the bony orbit, above and lateral to the eyeball.

Answer 52

lacrimal

Question 53

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.

Answer 53

iris, ciliary

Question 54

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.

Answer 54

aqueous humor, canal of schlemm, pressure

Question 55

You can find the optic nerve and retinal vessels at the ___ __.

Answer 55

optic disc

Question 56

A ___ ___ is the entire area seen by an eye when it loos at a central pt.

Answer 56

visual field

Question 57

To see an image, light reflected from the image must pass thru the ___ and be focused on sensory neurons in the ___.

Answer 57

pupil, retina

Question 58

Pupillary size changes in response to ___ and to the effort of ___ on a near object.

Answer 58

light, focusing

Question 59

A light beam shining onto one retina causes pupillary constriction in both that eye, termed the ___ ___ to light, and in the opposite eye, the ___ ___.

Answer 59

direct reaction, consensual reaction

Question 60

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.

Answer 60

III

Question 61

When a person shifts gaze from a far object to a near one, the pupils ___.

Answer 61

constrict

Question 62

___ is an increased convexity of the lenses caused by contraction of the ciliary muscles.

Answer 62

Accomodation

Question 63

CN ___ is principally responsibly for moving the Rt eye, whereas CN ___ is principally responsible for moving the Lt eye.

Answer 63

III, IV

Question 64

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.

Answer 64

Snellen, 20

Question 65

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.

Answer 65

pt, normal

Question 66

A person is considered legally blind when vision is ___/___ or less.

Answer 66

20/200

Question 67

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.

Answer 67

central

Question 68

A temporal defect in the visual field of one eye suggests a ___ defect in the other eye.

Answer 68

nasal

Question 69

Inward or outward deviation of the eyes and abnormal protrusion is seen in ___ dis or ocular ___.

Answer 69

Grave's, tumors

Question 70

A yellow sclera indicates ___

Answer 70

jaundice

Question 71

Inspect the size, shape, and symmetry of the ___. Large is > ___mm, small is < ___mm

Answer 71

pupils, 5, 3

Question 72

``` ___ = constriction of the pupils ___ = dilation of the pupils ```

Answer 72

Miosis | Mydriasis

Question 73

___ is a difference in pupillary size of 0.04 mm or greater.

Answer 73

Aniscoria

Question 74

___ reaction is pupillary constriction in the same eye. ___ reaction is pupillary constriction in the opposite eye.

Answer 74

Direct, consensual

Question 75

___ is a fine rhythmic oscillation of the eyes and can be seen in various ___ conditions.

Answer 75

Nystagmus, neurologic

Question 76

To test the 6 extraocular mvmnts (EOM's), ask the pt to follow your ___ as you make a wide ___ or ___ in the air.

Answer 76

finger, H, star

Question 77

When testing for ___, ask the pt to follow your finger/pencil as you move it in toward the bridge of the nose.

Answer 77

convergence

Question 78

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.

Answer 78

15, red, opacity, retinoblastoma, artificial

Question 79

___ is swelling of the optic disc and could indicate disorders of the ___, ___, ___ hemorrhage, trauma, and mass ___.

Answer 79

Papilledema, brain, meningitis, subarachnoid, lesions

Question 80

___ ___ is an important cause of poor central vision in older adults.

Answer 80

Macular degeneration

Question 81

Ear has 3 compartments: ___, ___, and ___.

Answer 81

external, middle, inner

Question 82

The ___ ear comprises the auricle and ear canal, as well as the helix, antihelix, and tragus.

Answer 82

external

Question 83

The ___ ear comprises the ossicles - the malleus, the incus, and the stapes.

Answer 83

middle

Question 84

The ___ ear comprises the cochlea, semicircular canals, and auditory nerve.

Answer 84

inner

Question 85

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.

Answer 85

conductive, senorineural

Question 86

___ conduction is more sensitive than ___ conduction.

Answer 86

Air, bone

Question 87

To straighten the ear canal in an adult, pull the auricle ___ , ___, and ___ from the head.

Answer 87

up, back, away

Question 88

To straighten the ear canal in infants/peds, pull the auricle ___, ___, and ___ from the head.

Answer 88

down, back, away

Question 89

The ear canal is often swollen, narrowed, moist, pale, and tender in otitis ___.

Answer 89

externa

Question 90

Will see a red, bulging TM in acute purulent otitis ___. Mobility will also be ___.

Answer 90

media, decreased

Question 91

Stand ___ ft behind the pt in the ___ test. For pt's who fail this test, use a ___ ___.

Answer 91

2, whisper, tuning fork

Question 92

An abnormality of the whispered voice test would be that the pt only repeats ___ of the 6 numbers correctly.

Answer 92

4

Question 93

Testing for lateralization w/the tuning fork is known as ___ test and it is placed on pt's ___.

Answer 93

Weber, head

Question 94

Comparing air conduction w/bone conduction w/the tuning fork is known as ___ test and it is placed on the ___ ___.

Answer 94

Rinne, mastoid process

Question 95

Can see ___ and ___ turbinates, but not the ___ turbinate.

Answer 95

inferior, middle, superior

Question 96

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 ___.

Answer 96

frontal, maxillary, frontal, maxillary

Question 97

Test for nasal ___ by pressing on each side of the nose and asking the pt to breathe in.

Answer 97

obstruction

Question 98

In ___ ___, the mucosa is reddened and swollen. In ___ ___, it may be pale, bluish, or red.

Answer 98

viral rhinitis | allergic rhinitis

Question 99

The labial ___ connects each lip w/the gingiva.

Answer 99

frenulum

Question 100

Normal # of adult teeth is ___.

Answer 100

32

Question 101

Tonsils should be ___ or ___.

Answer 101

small, absent

Question 102

Asymmetric protrusion suggests a lesion of the hypoglossal, CN ___.

Answer 102

XII

Question 103

Tongue CA is a common oral CA especially in med older than ___, ___, ___ chewers, and ___ drinkers.

Answer 103

50, smokers, tobacco, alcohol

Question 104

Assess the ___ by having pt say "ah" or "yawn", testing the vagal nerve, CN ___.

Answer 104

pharynx, X

Question 105

Tonsillar exudates are common in ___ ___.

Answer 105

strep pharyngitis

Question 106

The ___ ___ ___ passes diagonally over the surface of the sternomastoid.

Answer 106

external jugular vein

Question 107

Thyroid gland is usually located above the ___ notch.

Answer 107

suprasternal

Question 108

Palpate lymph nodes and note size, shape, mobility, consistency, and any tenderness. Should be ___, ___, ___, and ___.

Answer 108

small, mobile, discrete, nontender

Question 109

Generalized lymphadenopathy is seen in ___, ___, ___, ___, ___, and ___.

Answer 109

HIV, AIDS, mono, lymphoma, leukemia, sarcoidosis

Question 110

Masses in the neck may push the ___ to one side or the other.

Answer 110

trache

Question 111

The thyroid cartilage, cricoid cartilage, and thyroid gland all rise w/___ and then fall to their resting positions.

Answer 111

swallowing

Question 112

Retrosternal ___ can cause hoarseness, SOB, stridor, or dysphagia from tracheal compression.

Answer 112

goiters

Question 113

Thyroid gland should be ___ in Grave's dis and ___ in Hashimoto's thyroiditis.

Answer 113

soft, firm

Question 114

JVD is commonly seen in ___.

Answer 114

CHF

Question 115

Exopthalmos is present in approx 60% of pt's w/___ dis.

Answer 115

Grave's

Question 116

When the light beam shines into the normal Rt eye, there should be brisk ___ of both pupils.

Answer 116

constriction

Question 117

When shining the light through the hard palate, a reddish glow indicates a normal ___-filled ___ sinus.

Answer 117

air, maxillary