Week 9: HEENT Flashcards
General HEENT diagnostic tools and what they do (2)
- CT scan: noninvasive test that hows a more detailed picture of the head
- MRI: noninvasive test that shows VERY detailed pictures of virtually all internal body structures
Sinus specific diagnostic tool
CT scan
Throat-specific diagnostic tools and what they do (4)
- Swallowing evaluation: observe the muscles of the face and throat to assess for dysphagia
- Modified barium swallow study: barium sulfate is given to highlight the upper GI tract + see abnormalities
- Fiberoptic endoscopic evaluation of swallowing: endoscope passed through the nose into the pharynx
- Throat culture: swab of the back of the throat is analyzed for infectious organisms
Neck-specific diagnostic tools and what they do (5)
TSH test: evaluates thyroid gland functioning
T3 test: blood test used to diagnose an overactive thyroid gland
Free T4: blood test used to differentiate different causes of thyroid dysfunction
Thyroid ultrasound: Noninvasive test that gets an image of the thyroid gland via sound waves
Thyroid scan: Nuclear medicine test to assess functioning, masses, and/or inflammation of the thyroid gland
Rhinorrhea
Thin, watery discharge from the nose
Postnasal drip
Mucus drips from the back of the nose into the upper pharynx
Epistaxis
Nosebleeds
Xerostomia
Dry mouth
Drug classes that cause xerostomia (7)
- Anticholinergics
- Anticonvulsants
- Antidepressants
- Antihistamines
- Antihypertensives
- Antineoplastics
- GI smooth muscle relaxants + antipasmodics
Implications of jaw pain (3)
- Grinding teeth
- TMJ disorder
- Cardiac conditions
Characteristics to observe when inspecting the head (4)
- Size
- Shape
- Configuration
- Movement
Macrocephaly
Abnormally large head size
Acromegaly
Enlargement of the bones of the face, hands, and feet
Medical conditions with facial identifiers: Bell’s palsy
Facial paralysis on one side of the face
Medical conditions with facial identifiers: Cushing’s syndrome
Excessive accumulation of fat in the face (“moon face”), facial redness due to increased blood volume
Medical conditions with facial identifiers: Graves’ disease
Bulging eyes, Lid lag and edema, corneal ulceration
Medical conditions with facial identifiers: Hirsutism
Woman have terminal hair growth on face
Medical conditions with facial identifiers: Menopause
Peach fuzz, dry skin with increased facial wrinkles
Medical conditions with facial identifiers: Myxedema
Dull expression, periorbital puffiness, hypothermia, yellow skin, facial pallor/swelling
Medical conditions with facial identifiers: Parkinson’s disease
Mask-like facial appearance, soft speech, slurred speech
Medical conditions with facial identifiers: Rosacea
“Flush/blush” area, “sunburned” appearance, visible small blood vessels
Medical conditions with facial identifiers: Sideroblastic anemia
Facial mask of fatigue, sallow-colored skin, pale mucous membranes
Angular cheilitis
Inflammation at the corners of the mouth
Angioedema
Edema of the lips
Herpes simplex virus
Cold sores or blisters on lips
Aphthous stomatitis
Canker sore manifested by one or more painful erosions or ulcers on the oral mucosa
Gingivitis
Red, swollen, bleeding gums
Gingival hyperplasia
Enlargement or overgrowth of the gum tissue
Periodontal disease
Chronic infection of the gums, gums pull away from teeth and allow bacteria to accumulate
Thrush
Thick, white to yellow patches on the tongue or buccal mucosa (fungal infection)
Torus palatinus
Abnormal growth that develops midline in the hard palate
Atrophic glossitis
Smooth red or pink tongue
Hairy tongue
White to dark overgrowth
Leukoplakia
White spots or patches on the mucous membrane of the tongue
Squamous cell carcinoma
Thickened white or red patches or plaques
Tonsillitis: Definition and grading
- Viral or bacterial infection of the tonsils where they become large and have drainage
- 1-4 scale based on swelling:
+1 tonsils are visible and slightly protruding
+2 tonsils are halfway between the tonsillar pillars and uvula
+3 tonsils are almost touching uvula
+4 tonsils are touching each other
Pharyngitis
Diffuse pharyngeal erythema at the back of throat
Torticollis
Contraction or contracture of the muscles of the neck, causing head to tilt to one side
Reasons for tracheal shift: Trachea deviates to affected side (3)
- Pulmonary fibrosis
- Pleural adhesions
- Large pulmonary atelectasis
Reasons for tracheal shift: Trachea deviates to unaffected side (3)
- Tumor or aneurysm
- Thyroid lobe enlargement
- Pneumothorax
Characteristics assessed when auscultating the thyroid
Appearance and movement, palpability
Ear-specific diagnostic tests and what they do (2)
- Audiometric testing: Hearing evaluation to assess hearing loss at different high and low frequencies
- Tympanometry: Assesses the movement of the tympanic membrane and disorders of the middle ear
Presbycusis
Age-related hearing loss
Tinnitus
The perception of sound when no actual external noise is present
Darwin’s tubercle
A congenital deviation; a small cartilaginous protuberance on the helix of the ear
Cauliflower ear
Occurs from repeated trauma or hitting the ear; a blood clot forms under the skin or there is damage to the cartilage causing a change in shape and structure of the ear; commonly seen in wrestlers or individuals who play contact sports
Microtia
A congenital deformity of abnormally small ears; the pinna is underdeveloped or incompletely formed; may involve one or both ears; less than 4 cm (approximately 1.5 inches) in vertical height in adults.
Macrotia
Abnormally large ears; greater than 10 cm (approximately 4 inches) vertical height in adults.
Tophi
Hard, whitish, or cream-colored, nontender deposits of uric acid crystals indicative of gout.
Types of hearing loss: Conductive
When sound is not conducted through the outer ear canal to the eardrum and bones of the middle ear.
Potential causes:
- Ear canal: Physical blockage
- Middle ear: Fluid, infection, bone abnormality
- Eardrum injury
Types of hearing loss: Sensorineural
Inner ear hearing loss due to damage to inner ear/cochlea or nerve pathways
Speech sounds muffles, most common type of permanent hearing loss
Types of hearing loss: Mixed
Includes both conductive and sensorineural hearing loss
Weber test vs Rinne test
BOTH SHOULD ALWAYS BE DONE TOGETHER
Weber: Tuning fork placed on the top of the head
- Ask if the sound is heard equally loud in both ears
Rinne: Tuning fork placed on mastoid bone (behind ear)
- Record how long pt can hear the fork when its on their mastoid bone (bone conduction - BC). Then record how long pt can hear the fork when its next to their ear but not touching (air conduction - AC)
Rinne test: Grading
Positive Rinne (normal): AC is heard twice as long as BC
Negative Rinne (abnormal): BC is heard longer than AC, indicative of conductive hearing loss
Cranial nerves that control motor activity of the eye (3)
CN III - Oculomotor
CN IV - Trochlear
CN VI - Abducens
Extraocular structures (4)
- Eyebrows and eyelashes
- Eyelids
- Conjunctiva (water line)
- Lacrimal glands
Intraocular structures (12)
- Sclera: Whites of eyes
- Extraocular rotator muscles
- Aqueous humor: Fluid that helps maintain eyeball shape and supplies nutrition to the eye
- Choroid: Supplies blood to the retina
- Iris: Colored part of eyes
- Lens
- Pupil: Hole in the iris
- Posterior chamber: Space between iris and lens
- Fundus: Back of the eye
10: Macula: Most sensitive area of the retina - Optic disk: Where optic nerves leave the eye
- Retina: Where all the photoreceptors are
Eye-specific diagnostic tools and what they do (2)
- Comprehensive dilated eye examination: Eye is completely dilated to observe inner structures
- Tonometry: A device to measure intraocular pressure
Cataracts
Clouding of the lens that causes blurry, decreased, or lost vision.
Glaucoma
A buildup of intraocular pressure that damages the eye’s optic nerve causing loss of peripheral vision.
Macular degeneration
A deterioration of the central part of the retina causing loss of central vision.
Describe how vision is graded
Using Snellen Chart. The top number is your distance in feet from the chart. The bottom number is the distance at which a person with normal eyesight can read the same line
Normal vision is 20/20. ‘Legally blind’ is 20/200 or worse
Loss of visual acuity vs visual field
Loss of visual acuity: The inability to see objects clearly
Loss of visual field: The inability to see from side to side or up and down without moving the eyes or turning the head
Hyperopia vs myopia
Hyperopia: Farsightedness, difficulty seeing near objects
Myopia: Nearsightedness, difficulty seeing far objects
Diplopia
Double vision
Sequence of eye assessment (9)
- Inspection
- Assess visual acuity
- Assess for color blindness
- Assess central vision
- Assess peripheral vision
6.Assess ocular motility
7.Assess for accommodation
8.Assess pupil size and consensual response
9.Assess internal structures using ophthalmoscope
Nyctalopia
Night blindness
Characteristics to assess during inspection of the eye: Eyelids, eyelashes, eyebrows, cornea, lens, sclera, conjunctiva, lacrimal duct, palpebral fissures
- Eyelids
- Open and close completely
- Drainage - Eyelashes
- Distribution
- Drainage
- Crusting - Eyebrows
- Symmetry
- Distribution of hair and any scaly, flaky skin - Cornea
- Smoothness and clarity - Lens
- Clarity
- Color and round shape - Sclera
- Color and smooth surface area. - Conjunctiva
- Color of the mucosa - Lacrimal duct
- Swelling or excessive tearing - Palpebral fissures
- Symmetry
Exopthalamos
A protrusion of the anterior portion of the eyeball; common in hyperthyroidism; may cause patient to have dry eyes and difficulty closing the lids.
Periorbital edema
Swelling in the tissues around the eye.
Ectropion
An everted eyelid (turns outward); lower eyelid is most commonly affected.
Entropion
An inverted eyelid (turns inward); lower eyelid is most commonly affected.
Hordeolum
A stye, is an infection of a follicle of an eyelash that causes redness, inflammation, and a lump at the site.
Corneal abrasion
A painful scratch to the clear surface of the eye, usually related to trauma to the eye.
Scleral jaundice
A sign of elevated bilirubin in the blood; occurs with patients who have a liver disease.
Conjunctivitis
A bacterial or viral infection causing erythema of the sclera and yellow-green drainage of the conjunctiva.
Subconjunctival hemorrhage
Bleeding from broken blood vessels under the clear surface of the eye; may be related to coughing, sneezing, clotting disorders, or be spontaneous.
Pterygium
A gelatinous, abnormal growth of the conjunctiva; occurs more commonly on the nasal side of the eye.
Presbyopia
The progressive loss of the ability to focus clearly on near objects related to aging; the patient holds the print farther away to focus; magnifying glasses are used to read.
Macular degeneration
A breakdown of cells in the macula of the retina, causes loss of central vision.
Scotoma
An area of reduced or absent vision surrounded by an area of normal vision.
Hemianopia
When half of the visual field is lost.
Diplopia
A visual impairment in which a single object becomes doubled that may be related to a muscular dysfunction of the eye or neurological problem.
Nystagmus
An involuntary, cyclical movement of the eyes; occurs when the patient gazes or follows an object; may also occur if the patient has a fixed gaze in the peripheral field; may indicate a neurological disorder.
Anisocoria
Unequal size of the pupils; may be harmless or a medical emergency; causes may be related to genetics, medications, or a neurological disorder or injury
Mydiasis
Bilateral dilated and fixed pupils; may be caused by eye drops, stimulation of sympathetic nerves, anesthesia, or central nervous system injury.
Miosis
An abnormal constriction of the pupils; may be caused by a stroke, medications, or brain damage.
Horner syndrome
A sign of a medical condition that affects one side of the face; drooping eyelid, constricted pupil (miosis).
