Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Health Assessment > Week 8 HEENT > Flashcards

Week 8 HEENT Flashcards

1
Q

What subjective data do we want to know about when assessing the head and face

A
  • headaches (new or intense)
  • head injury
  • head or neck surgery
  • traumatic brain injury
  • dizziness (syncope v. near syncope v. vertigo)
  • lumps or masses
  • surgery (trauma to head or face)
  • scalp/hair issues
  • new or old issues with face (lumps, skin, etc)
  • allergies
  • meds and or treatments used
  • immunizations
  • family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between primary and secondary headaches? What other conditions should you rule out first

A 
Primary = no organic reason for having a headache
Secondary = arises from other conditions

Rule out life-threatening causes such as:

  • aneurysm
  • CVA
  • meningitis (stiff neck, nuchal rigidity, light sensitivity, fever, rash)
  • subdural or intracranial hemorrhage
  • tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the headache red flags

A
  • recent onset
  • > 50 years age (increased risk of stroke)
  • acute onset like thunderclap
  • markedly elevated blood pressure
  • presence of rash or signs of infection (meningitis)
  • presence of cancer, HIV, or pregnancy
  • vomiting, especially projectile (seen with intracranial pressure)
  • recent head trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are we looking for when inspecting the head and scalp?

A
  • hair: quality, quantity, distribution, texture
  • scalp: lumps, nevi (moles), scaling, dandruff, nits
  • skull: size (normocephalic, microcephalic, macrocephalic) and contour (deformities, lumps, depressions, suture lines, tenderness, protrusions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are we looking at when inspecting, palpating the face

A
  • facial structures (eyebrows, palpebral fissures, nasolabial folds, symmetry)
  • facial expression (formed by facial muscles and facial nerve VII, looking for symmetry) (smile, frown, puff out cheeks)
  • TMJ: clench teeth and palpate muscles above and below joint; palpate joint anterior to tragus during opening and closing of mouth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What assessments should you perform facial expression (cranial nerve 7)

A
  • smile
  • puff cheeks
  • show teeth
  • wrinkle brow
  • squeeze eyes shut against resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What subjective data do we want to know about when gathering a history of the neck

A
  • stiffness, pain
  • injury
  • meds
  • neck masses
  • swollen glands (fixed, immobile, larger than 1.5cm, widespread)
  • swollen thyroid (goiter)
  • surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What objective information are you assessing for with palpation and inspection of the neck

A
  • symmetry: palpate trachea and assess deviation which could be pneumothorax and obvious masses
  • musculature (MSK): palpate shoulders, turn head against resistance, bend neck forward and back, side to side, rotation (ROM)
  • blood supply (CV/PV system): carotid pulses, and jugular distention (R sided heart failure)
  • glands: salivary and thyroid (lower 1/3 of neck)
  • lymph nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What subjective data do we want to know about related to the ears

A
  • pain
  • hearing loss (use of assistive devices)
  • discharge (otorrhea)
  • tinnitus (ringing in ears)
  • vertigo (intense spinning)
  • trauma, noise overexposure
  • medications (ototoxic meds such as vancomycin or aspirin)
  • URI/allergy symptoms (nasal congestion, fever, sore throat, jaw/tooth pain, referred ear pain due to increased pressure)
  • history of infections (OM, OE), surgery (tubes)
  • family history (presbycusis = loss of hearing with age, especially high pitched)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What objective data are we looking for when inspecting and palpating the ears

A
  • external ear: collects sound and supports inner structures, inspect pinna, palpate pinna (move/pull and assess for canal tenderness), external auditory canal (S shaped, 2.5 cm long in adults)
  • palpate mastoid process and tragus
  • inspect tympanic membrane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you inspect the ears using the otoscope

A

Exam:

  • pull ear up and back in adults to straighten canal
  • pull ear down and back in children

Auditory canal:
- color, edema, discharge, cerumen (wax)

Tympanic membrane:
- color, +/- perforation, bulge (otitis media)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the outer ear structure and function

A
  • gather sounds and funnels to middle ear

- skin glands produce protective ear wax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the structure and function of the middle ear

A
  • conducts sound, equalizes air pressure and reduces loudness
  • auditory ossicles (malleus, incus, stapes) which transmits vibration from TM to inner ear
  • eustachian tube which equalizes air pressure from middle ear to nasopharynx; more horizontal in child; more angled in adult
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the structure and function of the inner ear

A
  • labyrinth: semicircular canals, vestibule, and cochlea responsible for balance and transmission of sound
  • cochlea converts vibrations and sends through cochlear nerve to brain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name and explain the different types of hearing loss and what causes them

A

Conductive loss:

  • mechanical dysfunction in external or middle ear
  • foreign object in canal, perforated TM, otosclerosis (bones get hardened due to repeat infection)
  • always outer ear

Sensorineural loss;

  • cochlear, auditory nerve damage or auditory area of cerebral cortex damage
  • presbycusis = loss of high frequency sound due to aging
  • inner ear disease, ototoxic drugs
  • always inner ear

Mixed loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can cause conductive hearing loss

A
  • impacted cerumen
  • foreign bodies
  • external otitis
17
Q

What can cause sensorineural hearing loss

A
  • Meniere’s disease
  • noise exposure
  • presbycusis
  • ototoxicity
18
Q

What is the gold standard for testing for hearing

A

audiometry

19
Q

What is the subjective data that we want to know about for the eyes

A
  • history: cataracts, glaucoma, family history
  • surgery: acuity correction, glaucoma, cataract repair
  • trauma
  • environmental irritants, occupational hazards (do they wear safety goggles)
  • any vision screening: last exam date and results, glasses or contacts?
  • visual changes: blurring, dark spots, diplopia, photophobia
  • pain, redness, discharge
  • excessive tearing
20
Q

What structures are we inspecting with the eyes

A
  • eyelids, eyebrows, eyelashes (symmetry)
  • conjunctiva
  • sclera
  • cornea (should be clear)
  • lens
  • iris and pupil: pupillary light reflex, direct and consensual; accommodation, pupillary constriction when focusing on a near object after looking far away and convergence, eyes inward
  • lacrimal apparatus (tear ducts)
21
Q

What is accommodation and how do you assess

A
  • far vision, pupils dilate

- near object, pupils constrict

22
Q

Explain myopia, hyperopia, and presbyopia

A

Myopia: nearsighted; can’t see things far away

Hyperopia: farsighted; can’t see things that are close

Presbyopia: decreased accommodation with aging (needs to move object farther away to see it)

23
Q

What does the cover/uncover test assess for

A

strabismus; weaker eye will deviate

24
Q

What are the steps to assessing visual fields by confrontation

A
  • position yourself with 12 inches between you and patient, face to face
  • instruct patient to look at your eyes; do not move eyes
  • wiggle two fingers in each outer quadrant at edge of visual field
  • begin outside the range of vision behind patient then
  • bring two finger into the range of vision
  • test all 6 fields
25
Q

What are the subjective things we need to know about when assessing the nose

A
  • sinus pain, facial pain, teeth pain
  • hx sinusitis, sinus surgeries
  • hx COVID 19
  • nasal stiffness, discharge, bleeding (postnasal drip)
  • history of previous nose issues/surgery/injuries
  • seasonal allergies
  • snoring (excessive)
  • changes in ability to smell (Alzheimer’s linked to ability to smell)
  • lifestyle habits: air quality, pets, alcohol, tobacco, and recreational drugs
26
Q

What are the assessments performed when inspecting and palpating the nose and sinuses

A
  • inspection of nose (internal and external): use the otoscope with largest speculum piece appropriate for the patient but only use light source)
  • palpation of sinuses (frontal and maxillary)
  • nasal patency (sniff): cover each nostril and ask to breathe
  • sense of smell: ask about allergies, use odiferous scent like spices, if combining patency with sense of smell: pt closes eyes, covers one nare then test one side; repeat for other side with different smell (CN 1)
27
Q

What subjective data do you want to know about when assessing mouth and throat

A
  • condition of gums and teeth: dentist?
  • painful teeth or gums
  • bleeding, bad breath
  • sore tongue, lip, mouth
  • hoarseness, drooling, difficulty swallowing
  • sore throat
  • difficulty speaking or swallowing
  • lifestyle: use of tobacco or vaping
  • PMHx: infections, chronic issues
28
Q

What are we inspecting and palpating in the mouth and throat

A
  • note any slurred speech
  • lips, buccal mucosa, gums, teeth, palate, salivary ducts
  • stick tongue out, grab with gauze, move side to side, test strength
  • dorsum, sides and ventral surface of tongue
29
Q

What are the signs of oral cancer

A
  • sores, bumps, lumps, unusual spots
  • red or white sores/lesions on gums of inside cheek
  • pain/numbness (cheeks, tongues, gums, throat)
  • difficulty talking, chewing, drinking, breathing
  • chronic sore throat/knots in neck or cheeks
  • feeling like something is stuck in mouth/throat
  • severe bleeding/sudden loss of teeth
  • obvious signs of infection that persist
30
Q

How do you document tonsillar swelling

A 
0 = no tonsils 
1 = extend to posterior arch 
2 = in between posterior arch and uvula 
3 = up to uvula 
4 = crosses midline of uvula (pushes uvula)
31
Q

What is the HEENT assessment that we will do on the hospitalized patient

A
  • PERRL (always direct and consensual, sometimes accommodation)
  • evaluate facial movement and external eyes
  • assess airway (mouth, nose, throat, trach)
  • assess speech (clear, drooling)
  • inspect oral cavity (hydration status, lips, dentures, oral care, gums/buccal membranes for color)
  • ability to swallow
  • assess O2 delivery system and tubing (nasal membrane, behind ears, facemask pressure points)
  • assess hearing/hearing aids if used
  • assess vision: glasses at bedside, squinting, tracking while moving
32
Q

Know headaches (table 10-1 and 10-2)

migraines
tension
from sinusitis
meningitis

Faces (10-3)
only the ones discussed in lecture/questions

A
33
Q

Studying tips for abnormal ears, eyes, and mouth

  • ptosis (11.3)
  • exophthalmos (11.3)
  • conjunctivitis (11.1)
  • table 12-1: dizziness, vertigo, pre syncope, will not need to know peripheral vs central vertigo
  • conductive and sensorineural loss (table 12-4)
  • angioedema (12-5)
  • table 12-6 page 317 and thrush on 318
  • table 12-8 pg 322 only
A

Health Assessment (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions