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Health Assessment > Week 2: Head & Neck Eyes, Ears, Nose & Throat > Flashcards

Week 2: Head & Neck Eyes, Ears, Nose & Throat Flashcards

1
Q

What is a Migraine Headache

A

Migraine headache: unilateral, atypical appearance, generalized or occipital and gets worst, throbbing (cant work)

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2
Q

What is a Tension Type Headache

A

Tension Type headache: around forehead, band like, pressure, not bad in the morning gets worse (not severe can work through them)

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3
Q

What is Cluster Headache?

A

Cluster headache: generally behind the eye- stabbing pain behind the eye, eyebrow, lacrimal tearing unilaterally (severe and last minutes, multiple times a day)

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4
Q

What is Sinus Headache?

A

Sinus headache: in between the eyes, and generalized

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5
Q

What are Headache Red Flags?

A

“Worst headache” of your life?
Thunderclap? : did you feel or hear thunder, aneurysm
Progressively worsening over 3+months: cancer magilency?
Recent head trauma
Hx of HIV, CA or Pregnant
Vision Changes?
New onset after age 50?
Worse with exercise/exertion or position changes?
Precipitated w/valsalva: pressure cause the headache to really get bad, vascular issues
Pulsatile tinnitus - indicate vascular issue - ringing or sound comes in and out
Neuro: Mental status change or speech changes? (stroke) Papilledema (servere HTN crisis, fundus exam), neck stiffness (menigitis issues) or focal neuro deficits on exam (stroke, seizures)** -

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6
Q

Where are all the lymph nodes

A 
Occipital
Post-auricular
Pre-auricular
Tonsillar
Maxillary
Submental
Posterior Cervical (Behind the SCM) - behinc sternalclavicar mastoid muscle 
Anterior Cervical (In front of the SCM)
Supraclavicular, Infraclavicular
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7
Q

What to assess when looking at nose?

A

Sinus Palpation: frontal, maxillary
Inspect and Palpate External Structures
External symmetry, bridge of nose, septal deviation

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8
Q

What to inspect when looking inside the nose?

A

Mucosa – color, swelling, bleeding, exudate, ulcers, or polyps “boggy” and pale?
Drainage- purulent, thick, watery (green/yellow mucus- doesn’t automatically indicate need for abx)
Septum – deviation, inflammation, or perforation
Turbinates – use otoscope to view middle and inferior turbinates

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9
Q

What are some ear consideration for older adults?

A

Presbycusis: normal hearing loss that occurs with age. Unable to hear distinct words, may sound muffled
Hearing aids? (do they have one and dont wear them? Run out of battery)
Cerumen impaction: common, how do we remove it?
Ear lavage
Hair: excessive, course, may contribute to cerumen
Vertigo: what causes this?
Tinnitus?

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10
Q

Ear Consideration for infants & children?

A

Infants: Examine while asleep
Infants TMs & inner ears may appear red after crying
Do they respond (startle) to loud noise such as clap
Do they turn when called by their own name
Are they allowed to drink a bottle in bed, while lying flat?

Children: Examine while against mom’s chest
Pull ear down
Screening around age 4
Behaviors that warrant concern? 
Intelligible speech by age 2?
Cleaning?  NO
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11
Q

What is the weber test?

A

Weber: Strike the tuning fork (512Hz)- place in middle of scalp
Conductive loss: sound lateralizes to affected ear
Sensorineural loss: lateralizes to normal ear

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12
Q

What is the Rinne test?

A

Rinne: Strike the fork and place on mastoid process, then near ear: time each
Once sound is not heard at mastoid, switch to air conduction
If air conduction is longer than bone conduction: normal
Conductive hearing loss if the sound is heard as long or longer than air

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13
Q

What is Sensorineural hearing loss ?

A

Sensorineural hearing loss occurs when sound waves are not processed correctly.

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14
Q

What is Conductive hearing loss?

A

Conductive hearing loss occurs when sound waves do not reach the inner ear.

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15
Q

How do you assess ear for child vs adult? How do you look in their ears?

A

Child is pull and down, adult, up and back

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16
Q

Mental status change or speech changes? indicates?

A

(stroke)

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17
Q

Papilledema indicates what?

A

(servere HTN crisis, fundus exam),

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18
Q

neck stiffness can indiciate what?

A

(menigitis issues) or

focal neuro deficits on exam (stroke, seizures)** -

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19
Q

Temple area: pain upon palpation of temple area- important for older adults presenting with H/A– why?

A

Temporal arteritis - severe inflammation of temporal artery

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20
Q

older adults consideration

“new onset” of H/A or severe H/A in ≥50 years old is a RED FLAG for… what?

A

Giant Cell Arteritis (GCA) or Temporal Arteritis- assess temporal arteries and should be ruled out: ESR, C-Reactive Protein (not cardiac)

– look for
Jaw Claudication: pain after prolonged chewing (caused by inflammation of the temporal artery)
Vision changes

Could have PMR symptoms (Polymyalgia Rheumatica): whole body aches, perceived weakness of limbs (proximal), fatigued
Possible exam findings: unequal BPs in arms, Bruit of Carotid Artery, murmurs

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21
Q

Thyroid consideration for pregnancy woman

A

Pregnancy variations in thyroid function
Thyroid gland stimulation from human chorionic gonadotropin hormones

Subclinical or overt hyperthyroidism
Fetal dependence on maternal thyroid hormone for brain development
Generally in individuals trying to get pregnant or are pregnant are given higher dose of thyroid meds because higher usage during pregnancy, if not enough can be a risk of losing the pregnancy

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22
Q

What is amiodarone’s consideration for thyroid?

A

it causes potiential hypothyriodism due to iodine contents

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23
Q

T cells and B cells, birth and mature place?

A

Primary lymphatic organs: Red Bone Marrow & Thymus Gland
Red bone marrow: B & T cells originate (b-cells mature there)
Thymus: t-cells mature there

24
Q

What is the significance of Epitrochlear lymphadenopathy

A

Epitrochlear lymphadenopathy (nodes greater than 5 mm) is pathologic and usually suggestive of lymphoma or melanoma.

25
Q

How to assess thyriod gland?

A

Flex neck slightly forward
Place fingers of both hands with index fingers just below the cricoid cartilage
Ask patient to swallow; feel for the thyroid isthmus rising up under your finger pads (not always palpable)
Displace trachea to the right and palpate laterally for the right lobe of the thyroid; repeat on the left side
Note the size, shape, and consistency
Identify any nodules or tenderness
If enlarged, listen over lateral lobes to detect a bruit

26
Q

What do you do if you find nodule or tenderness upon assessment of the neck/thyroid?

A

Identify any nodules or tenderness

If enlarged, listen over lateral lobes to detect a bruit

27
Q

Name the order of the anatomy of neck cartilage

A

hyoid bone
throid cartilage
cricoid cartilage
thyroid gland

28
Q

Cornea –

A

Anterior: allows light to enter eye and is responsive to touch, temperature, chemicals, and particlesAnterior:

29
Q

Sclera

A

Posterior: Sclera – maintains shape of the eye

30
Q

Headache? And/or N/V? can indicate what for the eye disease?

A

(acute glaucoma emergency - eye pain, headache, nausea vomit)

31
Q

Strabismus disease is?

A

Light is reflecting on the pen to the same position on both eyes, then its negative - but if it isnt, then they have Strabismus

indicates muscle weakness whne asymterical

32
Q

Entropion

A

Entropion: lid flipped inward - cause abrasion on scalara, lashes are inward, eyelid are swollen

33
Q

Extropion

A

Extropion: lid is lax and droops - more common with aging, pull eyelid, check for redness and pillar (anemia), allergy (cobblestone like)

34
Q

redness and pillar inside the eye indicates

A

redness and pillar (anemia),

35
Q

allergy in the eyes you will see

A

allergy (cobblestone like in palpebral fissue)

36
Q

what is Pseudostrabismus

A

Pseudostrabismus

The medium campus have thicker skinfold, making the infant look crossed eye but isnt

37
Q

what is Anisocoria?

A

Anisocoria - difference in pupillary size is visible in 35% of healthy people. If pupillary reactions are normal, considered benign.

38
Q

EOMs Controlled by what 3 nerves

A

CN III, IV, & VI

39
Q

What is Papilledema

A

Papilledema
Blurred margins of the optic disc
Swollen appearing vessels
Cant see clear line of optic disk, often due to hypertension for prolonged periods of time

40
Q

What is Presbyopia

A

Presbyopia: need magnification of smaller printed images

41
Q

What is Cataracts?

A

Cataracts: by 70- many older adults begin forming (fibers of the lens begin to thicken and yellow)
Can be caused by htn and dm

42
Q

What is Glaucoma

A

Glaucoma: Optic nerve neuropathy, loss of peripheral vision

43
Q

What is AMD (Age-related macular degeneration):

A

AMD (Age-related macular degeneration): loss of central vision caused by plaques

44
Q

Pinguecula vs Pterygium

A

Pinguecula (yellow plaque like structure, benign will just stay there) & Pterygium (will cross lymbic line and lead to obstruction of vision and need treatment eventually)

45
Q

Hordeolum vs Chalazion

A

Hordeolum & Chalazion
Hordeolum: stye; pustular infection of the eyelid margin (external); usually infected hair follicle

Chalazion: internal hordeolum/stye- inside the eyelid; usually infected oil gland

warm compresses no antibiotics

46
Q

What is Blepharitis

A

Blepharitis

Inflammation of the eyelids near lashline- causes scaling/sloughing of skin- they can become irritated, red, itchy and may cause crusting/flaking

occurs when the tiny oil glands of the inner eyelid become inflamed. It
often occurs along with other skin conditions or allergies.

47
Q

Bacterial vs Viral conjunctivitis

A 
Bacterial
Bilateral involvement 50%
Discharge- mucopurulent
Thick, pus like, yellow or green tint
Conjunctival Erythema
No pruritus
Viral
Bilateral involvement- 25%
Discharge- watery
Maybe yellow tint but mostly watery
Conjunctival Erythema
No pruritus
48
Q

Orbital vs Periorbital Cellulitis

A

Orbital vs Periorbital Cellulitis
The difference is serious- one can threaten vision & lead to sepsis if untreated

Periorbital cellulitis is an infection of the eyelid and area around the eye; orbital cellulitis is an infection of the eyeball and tissues around it.

49
Q

Considerations for Older Adults for hearing and ear

A

Presbycusis: normal hearing loss that occurs with age. Unable to hear distinct words, may sound muffled
Hearing aids? (do they have one and dont wear them? Run out of battery)
Cerumen impaction: common, how do we remove it?
Ear lavage
Hair: excessive, course, may contribute to cerumen
Vertigo: what causes this?
Tinnitus?

50
Q

Presbycusis

A

normal hearing loss that occurs with age. Unable to hear distinct words, may sound muffled
Hearing aids? (do they have one and dont wear them? Run out of battery)

51
Q

Geographic Tongue: Benign Migratory Glossitis

What is it?

A 
Geographic Tongue: Benign Migratory Glossitis
A “map like” appearance on tongue
Benign condition
May have some slight burning or stinging
Red patches w/out papillae
Approx 3% of people have it
52
Q

Consideration for older adults for throat and mouth

A 
Considerations for Older Adults
Sense of taste: may decline>>affects appetite (taste sweets the best)
Oral health is important!
Dentures:   How do they fit? 
Gum disease: Bleeding? 
Dehydration: Dry mucous membranes
Angular Chelitis: skin breakdown at corners of the mouth
Coughing w/drinking or eating?
53
Q

Considerations for Infants & Children

A 
Tonsils are not visible in newborns
Use gloved finger to check for tooth eruption and suck reflex
Open your mouth “as big as a lion”
Stick out your whole tongue, “pant like a doggie”
Toddlers: in parents lap
Play a game?  Make noises? 
Always stabilize the head while inspecting nose, mouth, throat, ears
Do they visit dentist regularly? 
Recurrent strep throat?
Cleft Lip and/or Palate or other congenital malformations
Feeding difficulties?
Formula type?
Thrush?
Food allergies? 
Exposures? Daycare? 
To bed with a bottle? 
Smoke/tobacco exposure?
Lead exposure?
54
Q

Cobblestone appearance: indicates?

A

think Allergies

55
Q

Indicator for strep throat?

A

fever, anterior cervial lymphadenopathy, tonsilar exudate, absence of cough

3 or greater points complete a rapid strep, score less than 3 do not require strep test

56
Q

What is a control wool spot

A

Feature of both mild and severe diabetic retinopathy

Health Assessment (9 decks)

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