What should you observe in the present health status of HEENT?<ul><li>Changes in overall health or HEENT</li><li>Chronic conditions</li><li>Medications</li><li>Corrective diseases</li></ul>
What past medical and surgical history should you consider in a HEENT?<ul><li>Surgeries&nbsp;</li><li>Injuries in the face, sensory structures, and neck</li></ul>
What family history should you be concerned about with HEENT?<ul><li>HEENT cancers</li><li>Hearing, vision, thyroid problems</li></ul>
What personal/psychosocial history would be be concerned about with a HEENT?<ul><li>Last dental, vision, hearing exam</li><li>Daily practices of brushing teeth, flossing, contact lens care, and sun glasses</li><li>Occupational risks</li><li>Smoking and or alcohol use</li></ul>
What history of present illness should you be concerned with in a HEENT?<ul><li>Headache</li><li>Dizziness&nbsp;</li><li>Hearing loss</li><li>Vision changes</li><li>Earache</li><li>Sore throat</li><li>Toothache</li><li>Neck pain&nbsp;</li><li>Swelling in the HEENT</li></ul>
Describe a tension headache<ul><li>Most common headache</li><li>Often front or back of head</li><li>Feels tight or viselike&nbsp;</li></ul>
Describe a sinus headache<ul><li>May have frontal or maxillary sinus pain</li><li>Could be sign of upper respiratory infection</li></ul>
Describe a pathologic headache<ul><li>A disease that is causing a headache</li><li>Could be from hypertension, hypothyroidism, or tumors</li></ul>
Describe a post traumatic headache<ul><li>After an injury/concussion</li><li>Lack of ability to concentrate, dizziness, giddiness</li></ul>
Describe a cluster headache<ul><li>Unilateral, excruciating pain (eye, temple, forehead, or cheek)</li><li>Happens suddenly for about 30 minutes to 2 hours</li><li>May have nasal stuffiness or discharge, red eye, drooping eye on associated side</li><li>Occurs in clusters (1 or more a day for 6-12 weeks) and then remission period&nbsp;</li></ul>
Describe migrane headaches<ul><li>Periodic intervals for a few hours to 1-3 days</li><li>Often unilateral, throbbing pain</li><li>Aura, Nasea, vomiting, light sensitivity</li></ul>
What is a red flag for headaches?"Patient says, ""Worst headache of my life"""
"What do you do when a patient says, ""I'm having the worst headache of my life""""<ul><li>Notify provider immediately and send to ER</li><li>Don't let patient drive&nbsp;</li></ul>"
What is presyncope?Near faint, usually cardiovascular in nature
What is disequilibrium?Feeling of falling, inner ear/vestibular function disorder
What is vertigo?Sensation of movement, usually spinning
What is a cardinal sympton of vestibular dysfunction?Vertigo
What is lightheadedness?"Vague description of dizziness that doesn't fit the other classifications"
What are some HEENT concerns?<ul><li>Vision or hearing loss</li><li>Sore throat</li><li>Nasal discharge</li><li>Nosebleed</li><li>Mouth sores</li><li>Tooth pain</li><li>Neck pain</li></ul>
What is a sign of meningeal inflammation?Acute neck stiffness
Name the cranial nervesOh Oh Oh To Touch And To Feel Very Green Vegetables AH<br><br>I - Olfactory (1)<br>II - Optic (2)<br>III - Oculomotor (3)<br>IV - Trochlear (4)<br>V - Trigeminal (5)<br>VI - Abducen (6)<br>VII - Facial (7)<br>VIII - Vestibulococchlear (8)<br>IX - Glossopharyengeal (9)<br>X - Vagus (10)<br>XI - Spinal Accessory (11)<br>XII - Hypoglossal (12)
What is the description for a normal sized head?Normocephalic
What is the term for an abnormally small head?Microcephaly
What is the term for an abnormally large head?Macrocephaly
What should you inspect the face for in a HEENT?<ul><li>Symmetry</li><li>Movement</li><li>Skin characteristics</li><li>Facial expressions</li><li>Facial hair</li></ul>
When you palpate the skull for a HEENT what are you looking for?<ul><li>Symmetry</li><li>Tenderness</li><li>Intactness</li></ul>
If someone feels pain when you palpate the temporal artery what is that a sign of?Temporal arteritis
What are you looking for when you palpate the TMJ?<ul><li>Clicking</li><li>Pain&nbsp;</li><li>Shifting&nbsp;</li><li>Limited range of motion</li></ul>
What is the motor function of CN V, the trigeminal, in a HEENT?Palpate clenched teeth, bite on tongue depressor and attempt to remove
What is the sensory function of CN V, trigeminal, in a HEENT?Light touch with closed eyes, on forehead, cheeks, chin
What is the motor function of CN VII, facial, in a HEENT?<ul><li>Smile</li><li>Frown</li><li>Close eyes tightly</li><li>Open eyes wide</li><li>Raise eyebrows&nbsp;</li><li>Show teeth</li><li>Puff cheek</li></ul><div>SHOW SYMMETRY IN ALL</div>
What is the sensory function of CN VII, facial?Assess taste
"What is the cause of Bell's Palsy?&nbsp;"Inflammation of CN VII, facial&nbsp;
"When is the recovery time of Bell's Palsy?"2 weeks - 6 months
"What is Bell's Palsy?"Half paralysis of the face
What is the focused history of a HEENT?<ul><li>Vision difficulties or changes</li><li>Glasses or contancts</li><li>Floaters, halos, or blind spots?</li><li>Night blindness</li><li>Light sensitivity</li><li>Redness or swelling</li><li>Dry eyes</li><li>Past eye pressure readings</li><li>Consider social effects&nbsp;</li></ul>
What is diplopia?Double vision
What is photophobia?Light sensitivity
What nerve checks vision acuity?Optic nerve CN II
What is the distance eye chart?Snellen
What is the near eye chart?Rosenbaum
What does the numerater and denominator of the snellen chart mean?Numerator is the distance from the chart<br>Denominator is the distance from which a patient can read the line
What is myopia?Nearsightedness, can see close but not far
What is hyperopia?Farsightedness, can see far but blurry up close
What population is hyperopia common in?Elderly
What is presbyopia?Farsightedness caused by age and loss of elasticity of the lens
What is hemianopia?Vision loss in half of visual field&nbsp;
What is macular degeneration?Loss of central vision
What is the confrontation test?"Comparing the client's peripheral vision with your own<br><ul><li>Cover one eye and with opposite hand use finger to assess for peripheral vision</li></ul><div><img alt=""anatomy of the patient exam Flashcards | Quizlet"" src=""X-BW-LZkrd6ke-jl9oLxpA.png""><br></div>"
What nerve is the confrontation test assessing?CN II Optic
When you assess eye structures, what should you be noting?<ul><li>Symmetry</li><li>Skin characteristics</li><li>Discharge</li></ul>
What is Ptosis?Drooping eyelid
What is ectropion?"Eyelid turns out<br><br><img alt=""Ectropion - EyeWiki"" src=""paste-c396c06c5573a47f453e39fd7b7836b776e0f758.jpg"">"
What is entropion?"Eyelid turns in&nbsp;<br><br><img alt=""Entropion"" src=""paste-c935cc2377c05b7e2312c9de7df42fc3729bd4c6.jpg"">"
What should the conjuctiva look like?<ul><li>Pink&nbsp;</li><li>Clear</li><li>Without drainage</li></ul>
What should the sclera look like?<ul><li>White&nbsp;</li><li>Clear</li><li>Slight yellow with darker skin tones</li></ul>
If there is redness in the sclera, what should you assume?Inflammation or hemorrhage
What should the cornea look like?Clear and shiny
How should the iris look like?<ul><li>Round and consistent coloration</li></ul>
When you palpate closed eyelids what should you feel?<ul><li>Slightly indent with gentle pressure</li><li>No pain or nodules</li></ul>
How should you palpate the lacrimal puncta?Press against the lacrimal sac, just outside the lower orbital ring
When you palpate the lacrimal puncta, what should you note?No mucoid discharge or tenderness
What is the hirschberg test?The corneal light reflex
What is the corneal light reflex text (hirschberg test) for?Assessng symmetry within the corneas
Describe the hirschberg test<ul><li>Have patient look at still object in distance</li><li>Shine penlight towards bridge of nose&nbsp;</li><li>Ensure light reflection is symmetrical in both corneas&nbsp;</li></ul>
What is strabismus?Crossed eyes
When should you do the cover test?"If the patient's corneal light reflex test is abnormal"
Describe the cover test"<ul><li>Cover right eye and observe the left eye for movement</li><li>Remove the cover and observe the right eye for movement&nbsp;</li><li>Repeat on opposite side</li></ul><div>Patient should not show deviations or movements from fixed gaze</div><div><br></div><div><img alt=""PPT - Assessment: Eyes and Ears PowerPoint Presentation, free download - ID:3642525"" src=""images-9a3143b44c9194cbd5b408077df5fc7a8efede08.jpg""><br></div>"
What test do you use to assess eye movements?Six cardinal fields of gaze aka diagnostic positions test
What nerves are used in the six cardinal fields of gaze?CN III Occularmotor<br>CN IV Trochlear<br>CN VI Abducens<br><br>3, 4 , 6
What is the six cardinal fields of gaze testing for?Extraocular muscle strength and movements
What is nystagmus?"Involuntary, jerking eye movement ""shaking"""
What can cause abnormal results with the six cardinal fields of gaze test due to weakness of extraocular muscles?Strabismus (Lazy eye)
What should be expected with the six cardinal fields of gaze test?<ul><li>Smooth movements</li><li>Able to follow finger/object without issues</li><li>EOM intact</li></ul>
When you expect the pupils what should you pay attention to?<ul><li>Size&nbsp;</li><li>Shape</li><li>Reaction to light</li><li>Consenual reaction&nbsp;</li><li>Accomadation</li></ul>
What is normal when you assess pupils?<ul><li>&nbsp;2- 6 mm in size</li><li>Dialate with distant objects</li><li>Constrict with close objects</li></ul>
What nerve is in the pupillary light response?CN III Occulomotor
What is a direct response in the pupillary light response?Pupil constricts when exposed to light&nbsp;
What is a consensual response in the pupillary light response?Pupil constricts at the same time the other pupil is exposed to light
What is PERRLA?Pupils are equal, round, reactive to light, accommodation
What is anisocoria?Unequal size of pupils&nbsp;
What is corneal arcus?"White ring around the cornea, usually from high cholesterol&nbsp;<br><br><img alt=""Corneal Arcus or hypercholesterolaemia"" src=""Corneal_Arcus.jpg""><br>"
What is subconjuctival hemorrhage?"Bright red blood that gets absorbed in the conjunctivis<br><br><img alt=""Subconjunctival Hemorrhage - Optometrists.org"" src=""subc.png"">"
What is bacterial conjuctivitis?"Bacterial infection on the conjuctivis of eye, eye is usually shut closed<br><br><img alt=""Acute Conjunctivitis - Ophthalmology - Medbullets Step 2/3"" src=""paste-7efdc8924722754fca70d6e3c66c52d414f11453.jpg"">"
What is blepharitis?Inflammation of eyelid, oil gland is inflamed
What is hordeolum?"A stye, an infection of the sebacceous or hair gland. Usually needs heat and drains very easily<br><br><img alt=""Chalazion and Hordeolum (Stye) - Eye Disorders - Merck Manuals Professional Edition"" src=""paste-16f3af8024b31b7154fbc1e4240c5e7573f3b741.jpg"">"
What is a corneal abrasion?An abrasion on the cornea caused by a foreign body, improper contact fit or prolonged wear, virus, bacteria, or fungus
What is an ophthalmoscope exam?Assessing the intraocular eye structures and checking for the red reflex of the retina
What should you see on the red reflex of an opthalmoscope exam?Red glow&nbsp;
What nerve is the ophthalmoscope exam testing for?CN II Optic
What tests are CN II Optic nerve involved in?<ul><li>Confrontation test</li><li>Vissual acuity (Schnellen, Rosenbaum)</li><li>Fundoscopic (Ophtalmoscope exam)</li></ul>
What tests are the occulomotor, trochlear, and abducens nerves involved in?Six cardinal fields of gaze?
What nerve is used for PEERLA?CN III Oculomotor
What is otalgia?&nbsp;Ear pain
What is otorrhea?Drainage from the ear
What is Presbycusis?The gradual onset of hearing loss over time due to aging
What is tinnitus?Ringing in the ear
What should be in the focused history of an ear exam?<ul><li>Ear pain</li><li>Drainage from the ear</li><li>Hearing loss</li><li>Ringing in the ear</li><li>Vertigo&nbsp;</li><li>History of ear infections&nbsp;</li><li>Social effects</li></ul>
What nerve is used in a hearing exam?CN VIII Vestibulococchlear
When do you assess hearing?During yearly physicals or with hearing concerns and complaints
What is the whisper test?Have a patient cover one ear and stand behind them whispering three or more simple 1-2 syllable words, repeat on other side<br><br>Should be able to hear at least 50% of words for each ear
What is the weber test?"Placing a tuning fork on the midline of the skull for hearing assessment. Ask, ""In which ear is the sound heard louder?""<br><br>N:&nbsp; Patient hears tone eaqually in both ears"
What is the rinne test?Placing a tuning fork directly on the mastoid process. Time the seconds that the patient no longer hears the tone and move the tuning fork towards the front of the ear and time once more.<br><br>N: Air conduction should be 2:1 to bone conduction, placing fork at the opening of the ear should be twice as long
What is conductive hearing loss?Hearing loss caused by obstruction/trauma
What are examples of conductive hearing loss?<ul><li>Cerumen impaction</li><li>Otittus media with effusion</li><li>Perforated tympanic membrane</li></ul>
What should you note when inspecting and palpating the external ear?<ul><li>Size</li><li>Shape&nbsp;</li><li>Alignment</li><li>Skin condition</li><li>Tenderness</li></ul>
"What is Darwin's tubercle?"Painless nodule on helix with normal variation
What are low set ears a sign of?"Congenital disease such as down's syndrome"
What is microtia?Ear is less than 4 cm in length
What is macrotia?Ear is bigger than 10 cm in length
What are tophi?"Small, white nodules on the helix of the ear. Common with gout<br><br><img alt=""Crystal arthropathies"" src=""image4.jpeg.jpg"">"
What is cauliflower ear?Result of frequent blunt trauma to cartilage, very common in wrestlers<br>
Who can use otoscopes?Specialty or advanced practice
How do you use otoscopes on patients three or older?Pull pinna up and back&nbsp;
How do you use the otoscope on patients less than three years old?Pull the earlobe down and back
What should you note when expect the ear canal?<ul><li>Discharge</li><li>Erythema</li><li>Edema&nbsp;</li><li>Odor</li><li>Excessive cerumen&nbsp;</li><li>Foreign bodies&nbsp;</li></ul>
What should the tympanic membrane look like?<ul><li>Intact&nbsp;</li><li>Pearly gray</li><li>Cone of light is present</li></ul>
What is otitis externa?Ear canal infection<br><ul><li>Edema&nbsp;</li><li>Erythema&nbsp;</li><li>Drainage</li></ul>
If you notice yellow or amber and bubbles in the tympanic membrane, what should you assume?"Otitis media with effusion<br><ul><li>Serious fluid in the middle ear</li></ul><div><img alt=""Otitis media"" src=""paste-7cd26fee027e93fcf0ff34607d52d13b0fef1945.jpg""><br></div>"
What should you assume if you see red or chalky white with some bone retraction in the tympanic membrane?"Acute otitis media (ear infection)<br><br><img alt=""Acute Otitis Media: Practice Essentials, Background, Anatomy"" src=""images-9f2486dbf28331e9db80e50008fb382668674321.jpg"">"
What sense can tympanostomy tubes affect?Speech&nbsp;
What is a bulging tympanic membrane a sign of?Acute otitis media
Can perforated tympanic membranes heal on their own?"Yes<br><br><img alt=""Tympanic Membrane Perforation (Hole in the Ear Drum) - Sydney ENT Clinic"" src=""paste-c4ba980544cc8e41544e76d99c6fe8fc8f960844.jpg"">"
What can you do to help with impacted cerumen on the tympanic membrane?Irrigate or flush with water
What should be in the focused history of a nose assessment?<ul><li>History of nosebleeds</li><li>Sinus pain&nbsp;</li><li>Nasal discharge</li><li>Loss of smell</li><li>History of allergies</li></ul>
What is another word for nosebleed?Epistaxis
What is another word for loss of smell?Anosmia
When you inspect and palpate the external nose, what should you note?<ul><li>Appearance</li><li>Symmetry</li><li>Discharge</li><li>Tenderness</li><li>Lesions</li></ul>
What is a sign of respiratory distress with noses?Nasal flaring in kids
How can you test the patency of nostils?Have patient close one nostril and breathe, repeat on other side
What should you use to inspect nasal mucosa and assess for septal deviation?Otoscope or penlight
What should the inner nose look like?<ul><li>Pink&nbsp;</li><li>Intact</li><li>Midline nasal septum</li></ul>
What is a symptom of a deviated septum?Chronically stuffy or nasal congestion
Should the nasal septum be perforated?No
What sinuses should you palpate?Frontal and maxillary
How do you palpate the frontal sinus?Raise patients eyebrows and feel forehead
How do you palpate the maxillary sinus?Press on patients cheeks by the nose
What should be in the focused history of a mouth and throat assessment?<ul><li>Loss of taste</li><li>Mouth sores or lesions</li><li>Mouth pain</li><li>Gingivitis</li><li>Tooth pain or concerns</li><li>Tobacco and or alcohol use&nbsp;</li><li>Self care behaviors&nbsp;</li><li>Dysphagia&nbsp;</li><li>Hoarseness</li></ul>
What are additional questions you should ask the elderly in a mouth and throat exam?<ul><li>Care of teeth or dentures?</li><li>Dry mouth</li></ul>
What is xerostomia?Dry mouth
What are additional questions you should ask children in a mouth and throat exam?<ul><li>Frequent sore throats</li><li>Tooth eruption</li><li>Bottle use</li></ul>
When you assess the lips what should you note?<ul><li>Color</li><li>Moisture</li><li>Edema&nbsp;</li><li>Lesions</li></ul>
What is circumoral cyanosis?Blueness around the mouth due to hypothermia or hypoxia
What are dry cracked lips a sign of?Dehydration or a vitamin B deficiency
What is herpes simplex?Very contagious coldsore of HSV-1<br><br>Vesicle -&gt; Pustule -&gt; Crust
What is hyperplasia?"Gums are overgrown, can be due to reaction to medication<br><br><img alt=""Treating a Pregnant Patient – Teeth &amp; Chiefs"" src=""image-21.png"" width=""413"">"
What is gingivitis?"Sore or bleeding gums, usually due to lack of flossing<br><br><img alt=""Язвенно-некротический гингивит - причины, симптомы, диагностика и лечение"" src=""paste-f993e9d492694ba357cb52ce1c06494fe8665bce.jpg"">"
What is baby bottle rot?Errosion of teeth of infants, due to leaving baby with bottle in mouth and sugars decay teeth
What nerve is used to stick out the tongue?CN XII Hypoglossal&nbsp;
What should the toungue look like?Pink, moist, and symmetric
What is geographic tongue?White maps that come and go on the tongue
What is black, hairy tongue?Overgrowth of papilla caused by&nbsp;<br><ul><li>Antibiotics</li><li>Not cleaning well</li><li>Smoking</li></ul>
What is thrush?"A fungal infection on the tongue due to antiobiotics or shows immunocompromised<br><br><img alt=""Oral candidiasis: causes, types and treatment"" src=""Oral-candidiasis-causes-types-and-treatment-SS20-927x617.jpg"">"
What should you use to assess the mouth?Penlight and tongue blade
When you inspect the buccal mucosa what should you notice?<ul><li>Color</li><li>Lesions&nbsp;</li><li>Moisture</li><li>Odor</li></ul>
When you ask the patient to say ah, what nerve is being used?CN IX Glossopharyngeal
What cranial nerve is noted when the patient has a hoarse voice when saying ah?CN X Vagus
What nerve is used to check gag reflex?CN IX Glossopharyngeal&nbsp;
What nerve is used to check for swallowing?CN X Vagus&nbsp;
What nerve is used for taste?CN VII Facial&nbsp;
What nerve is innervated when the uvula rises and is midline?CN IX Glossopharyngeal&nbsp;
What should the pharynx (throat) look like?Pink, without exudate, and no tonsillar enlargement
What is an aphthous ulcer (canker sore) caused from?"Patient did something to irritate mouth<br><br><img src=""paste-97f32b17b3a8009251c330665ac26829d37f1393.jpg"" width=""261"">"
What is a sign of oral cancer?"A tear under the tongue or in mouth that doesn't cause pain or heal"
What do you do when you see a white tongue?Further evaluate
What is leukoplakia?"White painless patches that are precursor to oral cancer<br><br><img alt=""Leukoplakia: Causes, Symptoms, and Diagnosis"" src=""paste-c97ed2bffd6a7d4348f15cea284d1e5cfc96161b.jpg"">"
What is a +1 in tonsillar grading?Visible tonsils
What is a +2 in tonsillar grading?Halfway between tonsillar pillars and uvula&nbsp;
What is a +3 in tonsillar grading?Tonsils are nealy touching uvula
What is a +4 in tonsillar grading?"Tonsils are nearly touching or touching one another, ""kissing tonsils"""
What are concerns with +4 tonsils?Respiratory issue and swallowing
What is tonsillar exudate a sign of?"Strep throat or tonsilitis<br><br><img alt=""DR.VIJAYNIVAS (Closed Down) Photos, Palayamkottai, tirunelveli - "" src=""ent-clinic-nellai-town-tirunelveli-paediatricians-nst4fg8obu-250.jpg"">"
Should larger tonsils be a concern in adolescents or kids?"No, they're usually bigger and shrink, biggest at 5 years old"
What should the focused history by in a neck assessment?<ul><li>Lumps or swelling in neck</li><li>Trouble swallowing or breathing</li><li>Tobacco or alcohol use</li><li>History of thyroid use</li><li>Change in ROM</li></ul>
When you inspect the neck, what should be considered normal?<ul><li>Midline&nbsp;</li><li>Neck muscles are symmetrical</li><li>No masses or lesions</li><li>Skin color consistent with body</li><li>Midline trachea</li></ul>
When you assess neck ROM, what is normal?<ul><li>Symmetrical&nbsp;</li><li>Controlled&nbsp;</li><li>Smooth&nbsp;</li><li>Painless</li></ul>
What muscles are involved in assessing the strength of the neck?Sternocleidomastoid and trapezius
What nerve is innervated in assessing the strength of the neck?CN XI Spinal Accessory
What is normal in a neck strength test?Equal strength bilaterally
When you palpate the trachea, what is normal?Trachea is midline
What should be normal when you palpate lymph nodes?<ul><li>Nonpalpable</li><li>Less than 1/2 in (pea-sized)</li><li>Soft</li><li>Nontender</li><li>Mobile&nbsp;</li><li>Equal bilaterally</li></ul>
What is lymphadenopathy?Enlargement of the lymph nodes
What do the lymph nodes feel like during acute infection?<ul><li>Enlarged</li><li>Tender</li><li>Firm&nbsp;<br></li><li>Moveable&nbsp;</li></ul>
What do the lymph nodes feel like when malignant?<ul><li>Enlarged</li><li>Hard&nbsp;<br></li><li>Asymmetric</li><li>Fixed</li><li>Nontender</li></ul>
"What is virchow's node?""A single enlarged nontender LEFT supraclavicular node often indicative of cancer<br><br><img alt=""Virchow's Node | NEJM"" src=""paste-d7e67a84adafd96659041f5343fe65f7f54025f2.jpg"">"
What do you do in a thyroid gland assessment?Assess for enlargement or nodules in the neck and thyroid
Who can do a thyroid gland assessment?Advanced practice
What is a goiter?"Overgrowth of thyroid tissue, indicative of thyroid condition<br><br><img alt=""Goiter: Causes, Types, and Treatment"" src=""paste-0af366dd1f9854989882f207d50d0c5d09635bbf.jpg"">"
What are tension headaches usually caused from?Stress or lack of sleep
"You assess your&nbsp;<span style=""color: rgb(3, 1, 2); background-color: rgb(255, 255, 255);"">patient’s pupils and they are round, equal, and reactive to light and <br>accommodation. How should you document this in the patient’s chart?</span>"PEERLA
"<span style=""color: rgb(3, 1, 2); background-color: rgb(255, 255, 255);"">You are assessing a 13-year-old with complaints of a sore throat. On exam, you notice that his <br>throat is erythematous and his tonsils are almost touching each other. You grade these as:</span>"+3