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2010-03-14 18:50:58

heent 500
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  1. migraine HA sx description
    • usually unilateral
    • throbbing/aching
    • variable severity
    • onset: fairly rapid, peak 1-2 h
    • associated factors: N/V, photophobia, aura..
  2. tension HA
    • usually bilateral
    • often frontotemporal
    • pressing or tightening pain
    • mild to moderate intensity
    • gradual onset
    • often recurrent with persistence over long periods
    • NO n/v
  3. Cluster HA
    • Location: unilateral, periorbital
    • Quality/severity: deep, continuous, severe
    • Onset: abrupt, peaks within minutes
    • Duration: up to 3h
    • Course: episodic. several each day for period of time, then relief
    • Associated
  4. Primary HA
    Migraines, tension or cluster HA
  5. Secondary HA
    HA having underlying medical cause.
  6. Subarachnoid Hemorrhage
    • Location: generalized
    • Quality/Severity: very severe, "worst HA of my life"
    • Associated: N/V, possible decrease LOC, neck pain
    • Process: bleeding, most often s/p ruptured intracranial aneurysm
  7. HA from sinusitis
    • Location: Frontal or maxillary sinuses
    • Process: mucosal inflammation of paranasal sinuses
    • Quality: aching, throbbing. Variable in severity.
    • variable onset
    • associated: local tenderness, nasal congestion, discharge, fever
    • +/- aggravated by coughing, sneezing, jarring head, bending down (anything that increases pressure)
  8. Meningitis
    Secondary HA

    • Quality: steady or throbbing, very severe
    • Fairly rapid onset
    • Persistent HA in an acute illness
    • associate: fever, stiff neck

    Pain location: generalized
  9. vertigo
    spinning sensation accompanied by nystagmus and ataxia

    usually from peripheral vestibular dysfunction.
  10. ptosis
    drooping of upper lid.

    causes: congenital, myasthenia gravis, oculomotor nerve damage, weakened muscle, relaxed tissue, weight of herniated fat
  11. entropion
    inward turning of lid margin.

  12. ectropion
    margin of lower lid is turned outward, exposing palpebral conjunctiva

    • eye no longer properly drains b/c punctum of lower lid turns outward. See increased tearing.
    • more common in elderly
  13. Exophthalmos
    eyeball protrudes forward.

    Consider: Graves' hyperthyroidism as cause
  14. Papilledema
    • Appearance: Optic disc swollen with blurred margins
    • enlarged blind spot
    • pink, hyperemic
    • often loss of venous pulsations
    • Disc vessels more visible, more numerous
    • physiologic cup not visible

    venous stasis leads to engorgement and swelling of optic disc
  15. Normal optic disc
    • Appearance:
    • Margins sharp.
    • yellowish orange to creamy pink
    • tiny vessels
    • physiologic cup central to temporal. 2:1
  16. A-V nicking
    vein appears to stop abruptly on either side of artery
  17. torus palatinus
    midline bony growth on hard palate. benign.
  18. gingivitis
    • reddened and swollen gingival margins. Interdental papillae are blunted, swollen and red.
    • Bleeding during teeth brushing
  19. leukoplakia
    • thickened, white patch anywhere in oral mucosa
    • usually secondary to local irritant such as chewing tobacco.
    • May lead to oral cancer
  20. chalazion
    • subacute nontender and usually painless nodule involving meibomian gland.
    • usually points inside lid (rather than lid margin like a sty)
  21. Light reaction
    • pupillary rxn to light bean in one retina
    • causes pupillary constriction in eye receiving light and other eye
    • Optic nerve (sensory) and oculomotor nerve (constrictor of iris muscles)
  22. Near reaction
    pupillary rxn to shifting gaze from far object to near one.

  23. Convergence
    • extraocular movement
    • pupillary constriction occurs, but due to change in shape of lenses to focus. not visible to observer
  24. accommodation
    increased convexity of lenses d/t contraction of ciliary muscles
  25. Extraocular movements
    coordinated action of six eye muscles innervated by CNs III, IV, VI

    • nl= conjugate/parallel gaze.
    • paralyzed muscle-> deviated eye from nl position.
    • LR 6, SR 4, the rest are three, there are no more

    (Lateral rectus, medial rectus, superior rectus, inferior rectus, superior oblique, inferior oblique)
  26. blepharitis
    red inflamed lid margin often with crusting
  27. anisocoria
    pupillary inequality

    mild deviation nl in about 20%. If PERRL WNL, then benign.
  28. nystagmus
    fine rhythmic oscillation of eyes.

    assess during EOM at extreme lateral gaze.
  29. absence of red reflex suggestive of...
    • ...lens opacity (cataract) or vitreous
    • detached retina
    • retinoblastoma
  30. weber test
    test for sound lateralization

    nl: heard midline or equally on both ears
  31. conductive hearing loss
    external or middle ear issue
  32. Rinne test
    • compares air conduction and bone conduction
    • nl: AC>BC
  33. strabismus
    dysconjugate gaze d/t imbalance in ocular muscle tone

    • Esotropia. inward
    • exotropia: outward
  34. cover-uncover test
    to confirm strabismus when corneal reflections are asymmetric

    • ??Cover LEFT eye. R eye moves outward to fix on light.
    • uncover: