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Ashley's - Paramedicine III > Week 7 - HEENT (Head, Ears, Eyes, Nose, and Teeth) > Flashcards

Week 7 - HEENT (Head, Ears, Eyes, Nose, and Teeth) Flashcards

1
Q

Show me the eyeball

A
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2
Q

Show me retenal detachment

A
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3
Q

Show me a corneal Ulcer

A
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4
Q

Show me the types of glacoma

A
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5
Q

Show me the structures involved with glacoma

A
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6
Q

Show me the Nose and the possible fracture sites

A
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7
Q

Show my what peritonsillar abscess looks like

Puss filled tissue

A
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8
Q

Show me the Ear

A
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9
Q

Show me the Inner Ear

A
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10
Q

Dizziness Differentials

Peripheral?

Central?

A

Meniere’s Disease

Acute Otitis Media

Perilymphatic Fistular CNS Trauma

Cholesteatoma

Viral Labyrinthitis

Bacterial Labyrinthitis

Vestibular Neuronitis Motion sickness

Ototoxicity

Otologic Surgery

Otologic Injury/Trauma

Otosyphilis

Benign ParoxysPPV

Acoustic Neuroma

Brainstem CVA

Carotid Stenosis

CNS Neoplams

Multiple Sclerosis

Vertebrobasilar Insufficiency

Medication Overdose

Presbystasis

Psychogenic Disorder

Arnold-Chiari Malformation

CNS Infection

Seizure Disorder

Migraine

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11
Q

Dizziness Differentials

Systemic?

A

Cardiac Arrhythmia

Cardiac Valvular Disease

Orthostatic Hypertension

Alcohol Intoxication

Sleep Deprivation

Toxin Exposure

Hypoglycemia

Autonomic Dysfunction

Hyperventilation

Pain/Anxiety

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12
Q

What is Vertigo?

What is Vestibular Neuritis?

A

an abnormal sensation that is described by a person as a feeling that they are spinning, or that the world is spinning around them, and may be accompanies by intense nausea and vomiting. This feeling may be associated with loss of balance to the point that the person walks unsteadily of falls. Vertigo itself is a symptom or indicator of an underlying balance problem, either involving the labyrinth of the inner ear, or the cerebellum of the brain

thought to be the result of inflammation of the vestibular portion of the eighth cranial nerve and classically presents with vertigo, nausea, and gait imbalance

The seventh cranial nerve sends information between the brain and the muscles used in facial expression (such as smiling and frowning), some muscles in the jaw and the muscles of a small bone in the middle ear

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13
Q

What is Bell’s Palsy?

What is BPPV? (Benign Paroxysmal Positional Vertigo)

A

the most common cause of facial weakness, whereas vestibular neuritis ranks second or third as the most frequent cause of sudden onset of dizziness and vertigo. The two conditions can occur either singly or in combination to cause facial weakness and debilitating dizziness

a brief, intense episode of vertigo that occurs because of a specific change in the position of the head. A person also may experience BPPV when he or she rolls over in bed. BPPV sometimes may result from a head injury or aging

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14
Q

What are the top 9 differentials for HEENT?

What are ototoxic agents?

A

Tinnitus

Ototoxic Agents

Mastitis

Tonsilitis

Otitis Media

Auricular Hematomas/Cauliflower (rugby, MMA, Soccer)

Perichondritis – Trauma/Piercings

Otic Barotrauma – TM Preformation (many tubes)

Ear drainage tubes – Tympanostomy tubes

more than 600 prescriptions and over the counter drugs that can trigger tinnitus, make existing tinnitus worse, or cause a new tinnitus-causing drugs sprinkled throughout.

For example, antibiotics, painkillers, anti-anxiety, and anti-depression drugs, antimalarial medications, anti-cancer drugs, and blood pressure controlling medications – to name a few – can trigger tinnitus

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15
Q

Special Considerations

Eye Trauma?

A

Suspect head injury

Loss og vision is traumatic

Great Anxiety

Contact Lenses

Transient S+S

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16
Q

What are the Priority diagnosis for eyes?

A

Sudden vision loss

chemical injury

vision - threatening trauma

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17
Q

What will you do for a focused assessment for the eye?

A

Visual acuity

External inspection: lids, lashes, conjunctiva, and cornea, symmetry of eyes, eye movement

Paplate orbital rim

pupils

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18
Q

What’s the eyes external examination?

What’s the physical exam?

A

Penlight examination

Eyelids

Conjunctiva

Corneal Clarity

Pupil Size (oculomotor)

Pupil Symmetry

Pupillary light reactions (consensual)

Accommodation

Visual Acuity

Cranial Nerve II – Optic Nerve

Palpate the orbital rim

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19
Q

What are the extraocular movements?

What’s the eye assessment?

A

Cranial Nerve III – Oculomotor

Cranial Nerve IV – Trochlear

Cranial Nerve VI – Abducens

Current History – Mechanism of Injury, New/Recurrent problem, Loss/Change of
vision

How does the eye feel?

How does the eye look?

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20
Q

What’s the differentials for red painful eye(s)?

Eyes - traumatic emergencies?

A

Glaucoma

Corneal Abrasion

Foreign body

Corneal ulcer

Conjunctivitis

Iritis

Scleritis

Episcleritis

Eyes: Traumatic Emergencies

Corneal Abrasions and lacerations

Corneal foreign bodies

Penetrating eye injuries

Retinal detachment (traumatic)

Burns

Acute vitreous hemorrhage & hyphema

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21
Q

Tell me about corneal abrasions and lacerations?

A

Common

Causes partial or complete removal of corneal epithelium

Prognosis – Depends on depth or injury

C/O severe pain, tearing and blepharospasm (lid spasm)

Management: Irrigate with normal saline, dry light pressure dressing over both
eyes with eyelids closed (do not tape eyelids closed)

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22
Q

Corneal Foreign Bodies

What are the clinical features?

What’s the physical exam?

A

Something in my eye

History of object being propelled into the eye

Tearing, conjunctival reddening blepharospasm

Dull non-localizing ocular ache and decreased vision

Complete Inspection of the eye

Note presence of absence of material

Note presence of rust ring

Visual Acuity

Multiple foreign bodies

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23
Q

Corneal Foreign Bodies

What’s the management?

What do you need to do for penetrating eye injuries?

A

ABCs

Avoid external pressure on the globe

Superficial conjunctival or corneal foreign bodies may be irrigated

Cover both eyes if injury/ pain is severe

Be prepared for emesis

Massive trauma only a brief look should be attempted

May have penetrated the globe

Control bleeding using minimal pressure

Do NOT manipulate, palpate, irrigate or apply cold packs

24
Q

Acute Iritis/ Anterior Uveitis

Tell me about it

A

Anterior Uveitis – Inflammation of the anterior segment of the eye

Acute iritis – Mild inflammatory reaction of the iris – seen after blunt trauma

Clinical Features: Pain (Deep ache), Headache above eyebrow, photophobia,
excessive tearing

25
Q

Retinal Detachment (traumatic)

Tell me about it

What’s the physical exam?

A

Blunt trauma may caused violent shifting of the vitreous body – causing renal
tears

Tears may ‘dissect’ the retina for the choroid (vascular layer) as blood enters
this space and hematoma develops

In acute injury, if patient reports seeing a flash of light, consider detachment

May be a latent period between injury and detachment (up to months)

Not painful – only symptom is VISUAL

Perceived as a curtain descending over the visual field (progressive loss of vision)

Loss of vision may also be sudden

Reports of light flashes and cloudy vision

Nothing visible (blood) on inspection

26
Q

Retinal Detachment (non-traumatic)

Tell me about it

A

Spontaneous retinal detachment occurs most frequently in the elderly

Results from fluid or blood leakage from vessels within the retina

Causes: Hypertension, toxemia of pregnancy, papilledema (optic disc swelling)

Retinal damage can progress slowly or enlarge quickly resulting in complete
detachment

27
Q

Burns to the Eyes

Tell me about akali burns

Tell me about acid burns

A

True ocular emergency

Alkaline exposure dissolves tissues until it is removed

Immediate Irrigation – minimum 20 minutes

Remove any particles

Severity can be judged by corneal cloudiness and scleral whitening

Tend to be less devastating

The body is better able to deal with acids

Treatment is same as for alkali exposure

28
Q

Burns to the Eyes

Tell me about thermal burns

Tell me about radiation/ultraviolet burns

A

Affect the eye lids more than the globe

Determine if vision is decreased/blurred

Limit assessment to inspection

Cover affected eyes with moist dressing

Hot liquid splashes and cigarette ashes to the cornea usually results in a
superficial corneal epithealial injury – treat as corneal abrasion

Results in direct corneal epithelial damage

Latent period of 6-10 hours

Patient develops foreign body sensation, intense pain, tearing, photophobia and
blepharospasms

Cover the affected eyes for p

29
Q

Hyphema and Acute Vitreous Hemorrhage

What is that?

What are the clinical features and physical exam?

A

Hyphema is blood in the anterior chamber resulting from rupture of one or more
iris vessels

Extent varies from microscopic to ‘8 ball’ hyphemas in which the entire anterior
chamber fills with blood

Clinical Features
Principle cause is traumatic, retinopathies in diabetic patients may also be
causative

Physical Exam

C/O pain and cloudy vision (floaters/spots)

Visible reddish tint in anterior chamber

30
Q

What’s Enucleation?

A

Surgical management of malignancy

Severe Infection

Trauma

A ball implant is then inserted

31
Q

What is the physical exam for enucleation?

A

Orbital edema and ecchymosis

Localized facial swelling

Pain

Tingling/Loss of sensation

Diplopia

Inability to elevate eye/restricted extraocular movements

Subconjunctival hemorrhage

Enophthalmos or exophthalmos

Subcutaneous emphysema

32
Q

Eyes - what are the medical emergencies?

A

Central retinal artery occlusion

keratitis

Corneal ulcers

Acute glaucoma

Acute iritis

Conjunctivitis (bacterial/viral)

33
Q

Tell me about central retinal artery occlusion?

What are the causes?

A

Blood supply to the retina is obstructed producing a painless, total or near total
black out of vision

Re-establishment of retinal circulation MUST be accomplished within 90 minutes to regain vision

Predisposing factors

Atherosclerosis of carotid artery (clot formation)

Atrial Fibrillation

Prolonged pressure on eye with swelling/tight dressing

34
Q

Central Retinal Artery Occlusion

What’s the physical exams?

What’s the management?

What’s the clinical progression?

A

Patient presents without pain

Sudden loss of unilateral vision

No history of trauma

Associated with history of hypertension or hypercoagulable states

Emotional Support

Transport

Immediate recognition

In 90-120 minutes, retina becomes necrotic and edematous – irreversible
blindness

35
Q

What is Keratitis/what does it look like?

What are corneal ulcers?

A

Inflammation of the cornea

Caused by infections, hypersensitivity reactions, ischemia, defects in tears,
trauma

Presents as moderate to severe pain depending on the amount of epithelial
disruption present

Scar tissue formation is the leading cause of blindness

Divided into non-ulcerative and ulcerative

Integrity of the corneal epithelium is disrupted

Symptoms include pain, increased tearing, photophobia, ocular irritation

36
Q

What is glaucoma?

What are cataracts?

A

Defined as a group of conditions characterized by increased intraocular
pressure

Caused by alterations in the circulation and resorption of aqueous humor

Classified as open angle or closed angle

Opacity of the lens of the eye or the capsule or both leading to a painless loss of vision

Due to aging process, but can be caused by infection, injury, exposure to radiation or chemicals, UV radiation or metabolic disorders

Presents with a distortion of the visual image especially at night or in bright light

Management is surgical

The iris may appear distorted in post-op surgery patients

37
Q

What is Conjunctivitis (Viral)?

What is Conjunctivitis (Bacterial)?

A

Infections and accounts for the majority of “pink eye”

Frequently occurs in conjunction with an URI

Redness & tearing are common

Treatment is symptomatic

Presents with a mucopurulent discharge of varying colors (gray, yellow, green).

Typically there is matting of the lashes in the morning, but minimal, if any pain.

Treatment consists of topical antibiotic drops for one week

Warm soaks should be used to keep the lids/lashes free

38
Q

What is Macular Degeneration?

A

Degeneration of the macular area of the retina in the eye (the macula is in the
center of the retina)

Causes: Age related unknown, injury, inflammation, nutritional and hereditary factors implicated

S/S: loss of central vision, visual distortion

39
Q

Orbital Cellulitis

Periorbital?

The S+S

Orbital?

A

Fever

Periorbital edema

Eye tenderness

No proptosis (bulging eye)

Visual Changes

Pain with EOM

Decreased visual acuity

Ophthalmoplegias

Spreads from adjacent infections

Can extend into dural sinuses and meninges

40
Q

What are the top 3 emergencies for traumatic ear injuries?

What are potential ear trauma injuries?

A

Ear trauma

Foreign body in ear

Ruptured tympanic membrane

Lacerations & contusions

Thermal Injuries

Chemical Injuries

Traumatic perforations

Barotitis (ears ‘pop’ from flying at high altitudes, scuba)

41
Q

Foreign Body in Ear clinical features?

A

Patient usually state something is in ear

Quite often an insect (adult), bead (peds)

Patient may present with pain and purulent drainage and not be aware of foreign body

Important: Is there a history of tympanic membrane rupture

42
Q

What is a ruptered typmpanic membrane?

What are more Ear medical emergencies?

A

Perforations of TM result from: acute changes in air or water pressure (blast injury), direct trauma (foreign body, Q-tips), caustics, lightning strike, otitis media, or associated temporal bone fractures.

The patient may complain of slight hearing loss or pain

The presence of concurrent vertigo or acute deafness suggests associated injuries to the semicircular canals

Otitis media & otitis externa

Meniere’s disease

Tinnitus

Labyrinthitis

Vertigo

43
Q

What is Otitis Externa?

What is the etiology?

A

Defined as an inflammation of the outer ear

The limited form of otitis externa is common to swimmers

Physical findings may be limited to erythema

Water-facilitates infection

Bacteria – usually pseudomonas

Fungal – aspergillosis and candida (immuno-compromised, chronic users of steroid drops)

Malignant otitis externa: Osteomyelitis of the skull, begins as typical OE, nonresolving, OE defaults to this for diabetic, HIV, Ca pts

44
Q

What is Otitis Media?

What is Menere’s disease?

A

Otitis media includes the initial acute infection, otitis media with effusion, and
chronic otitis media

Acute Otitis Media (AOM) presents with the rapid onset of ear discomfort

Typically follows URI

Pain associated is not aggravated by movement

Defined as a chronic disorder of the inner ear. Triad of symptoms: vertigo,
tinnitus and sensorineural hearing loss

Overaccumulation of fluid in the membranous labyrinth of the inner ear

Onset of symptoms may be gradual or sudden

45
Q

What are the S+S of Meniere’s disease?

What is tinitus?

A

Severe rotary vertigo (may be associated with N/V)

Tinnitus

Nystagmus during acute attacks

Most common complaint with otologic conditions

Ranges from mild ringing to a loud roaring in the ear

Causes include: presbycusis, otosclerosis, Meniere’s, loud noise, certain drugs and a wide variety of pathological disorders

Treatment is resolving underlying disorder

45
Q

What is Labyrinthitis?

What is vertigo and dizziness?

A

Infection of the labyrinth

Clinical Manifestations: hearing loss, tinnitus and spontaneous nystagmus to the
affected side

Causes include: nearby infections of ear, nose or throat. Otitis media or
meningitis; toxic effect of certain drugs

Common clinical manifestation of many ear disorders

Dizziness is described as a disturbed sense of the proper relationship to space

Three systems combine to give input regarding balance: visual, vestibular and the proprioceptive system

Associated symptoms of vertigo: Nausea/Vomiting, falling, nystagmus, hearing loss and tinnitus

46
Q

What are the nose traumatic emergencies?

What is Epistaxis?

A

Epistaxis

Fractured nose

Foreign Body in nose

Highly vascular

Bleeding may originate in the anterior or posterior nose

Causes include medications, particularly antiplatelets or anticoagulants and:
* Anterior: drying, infection, blunt, trauma, manipulation, cocaine use and local infection
* Posterior: Blood dyscrasias, hypertension, diabetes and trauma

47
Q

Fractured Nose

What are the mechanisms?

What’s the physical exam?

A

Trauma that produces a fracture of the nasal bones may come from frontal,
superior to inferior or lateral direction

Of these – laterally directed trauma most likely to fracture since no cartilage to
absorb or dissipate the force

Suspected in all patients with significant facial trauma

Swelling

Tenderness/Pain

Crepitus

Ecchymosis (bruising)

Deformity

Epistaxis

48
Q

Tell me about foreign body in the nose?

What are the clinical features?

A

Most common for insertion of foreign bodies by children

Patient was seen inserting the object

Or presents with a purulent unilateral malodourous nasal discharge

Body Odor

49
Q

What is sinusitis?

What are the acute symptoms?

A

Inflammation with resulting infection of the mucous membranes of one of more
paranasal sinuses

Commonly follows URTI or viral rhinitis

Causes include URI, nasal polyps, deviated septum, tooth abscess, abuse of nasal decongestants, swimming and diving, frequent changes in barometric pressure

Constant, often severe pain and tenderness

Maxillary sinus involvement may lead to teeth pain

Headache

Fever

Purulent nasal discharge

Sore Inflamed throat

50
Q

Sinusitis 

What are the subacute OR chronic symptoms?

A

Dull, intermittent or constant pain 

Purulent nasal discharge  

Chronic cough  

Recurrent episodes  

Loss of sense of smell

51
Q

Throat

Traumatic Fractured Larynx - tell me about it

What’s the physical exam?

A

Blunt or penetrating trauma to the anterior neck can cause fracture or dislocation of laryngeal or tracheal cartilages 

Need a high degree of suspicion for associated vascular injury  

Injuries associated include fractures of hyoid bone, fractures of thyroid cartilage, fracture/dislocation of cricothyroid and fractures of trachea  

History/Mechanism  

Hoarseness or aphonia  

Edema and bleeding (hemoptysis)

52
Q

Throat

Medical Peritonsillar Abscess  - tell me about it

What are the potential complicaitons?

What’s the physical exam?

A

Bacterial – streptococcus/staphylococcus  

Infection spreads into tissue between the tonsils and underlying muscle and creates an abscess  

Untreated – infection can spread deep into neck with the potential for eroding a large vessel or aspiration of purulent drainage if abscess ruptures when patient is asleep  

Edema may threaten patency of the airway
Erosion into the carotid artery

Physical Exam/History  

Sore throat x days with clinical progression to malaise and fever  

Unilateral pain and difficulty swallowing  

Patient may drool 

Red edematous area above the tonsil between the soft palate and the tonsil often displacing the uvular  

53
Q

Throat

Medical Retropharyngeal Abscess  - tell me about it

A

Retropharyngeal space extends from base of skull to tracheal bifurcation  

Fever, dysphagia, neck pain, sore throat, muffled voice, respiratory distress, stridor in kids  

Immediate ENT consult is required  

Fatal complication: airway compromised

54
Q

Dental trauma - tell me about it

How do you care for an avulsed tooth?

A

Normal adult mouth has 32 teeth 

3 Sections – crown, neck, root  

Can involve fractures alone or fractures in combination of jaw (mandibular #) or facial bones  

With fractured teeth, oral cavity should be examined for tooth fragments 

Cold, fresh milk or saline for tooth transport  

Do not rinse tooth  

Take care NOT to handle by the root

Ashley's - Paramedicine III (16 decks)

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