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Clinical Assessment
HEENT
37
Medical
Graduate
10/03/2009

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Cards

Term
Types of Headaches
Definition
Migraines, tension, cluster
Term
Migraines
Definition
Process: neuronal dysfunction; Character: throbbing or aching; Location: unilateral ~70%, bifrontal or global ~30%; Onset: rapid, reaching a peak in 1-2 hours; Duration: 4-72 hrs; Exacerbation: alcohol, certain foods, tension, premenstration, noise, bright light; Palliative: quiet, dark room, sleep; Associative: nausea, vomiting, photophobia, phonophobia, visual, sensory or motor auras
Term
Tension headache
Definition
Process: unclear; Character: pressing or tightening pain; Location: usually bilateral, back of head and upper neck; Onset: gradual; Radiation: none; Intensity: mild to moderate; Duration: minutes to days; Exacerbation: sustained muscle tension; Palliative: massage, relaxation; Associated: photophobia, phonophobia, no nausea
Term
Cluster headache
Definition
Process: unclear, possibly extracranial vasodilation; character: deep, continuous; location: unilateral, usually behind eye; onset: abrupt, within minutes; radiation: none; intensity: severe; Duration: up to 3 hours; Exacerbation: sensitivity to alcohol; Palliative: none; Associated: lacrimation, rhinorrhea, mioisis, ptosis, eye lid edema, conjunctival infection
Term
analgesic rebound
Definition
process: withdrawal of meds; character: variable; location: previous headache pattern; onset: variable; intensity: variable; duration: variable; Exacerbation: fever, carbon dioxide, hypoxia, withdrawal, hypoxia, withdrawal of caffiene; palliative: depends
Term
Errors of refraction
Definition
Process: strain of EOM; character: steady, aching, dull; location: around and over the eyes; onset: gradual; radiation: to occipital region; Exacerbating: prolonged use of eyes, particularly for close work; Palliative: rest of eyes; Associated: eye fatigue, redness of the conjunctiva
Term
Acute glaucoma
Definition
Process: increased intraocular pressure; character: steady, aching, often severe; location: in and around one eye; onset: often rapid; intensity: variable; Duration: variable; Exacerbation: drops that dilate pupils; Associated: diminished vision, nausea, vomiting
Term
Headache from Sinusitis
Definition
Process: mucosal inflammation or paranasal sinuses; character: aching or throbbing; location: frontal or maxillary sinuses; onset: variable; intensity: variable, consider migraine; Duration: several hours, recurring; Exacerbation: coughing, sneezing, jarring of the head; Palliative: nasal decongestants, antibiotics; Associated: local tenderness, nasal congestion, discharge, fever
Term
meningitis headache
Definition
Process: infx or meninges; character: steady or throbbing, very severe; location: generalized; onset: fairly rapidly; duration: variable, usually days; associated: fever, stiff neck
Term
subarachnoid hemorrhage
Definition
process: bleeding, intracranial aneurysm; character: "worst of my life"; location: generalized; onset: usually abrupt, severe; duration: variable, usually days; associated: nausea, vomiting, possibly loss of consciousness, neck pain;
Term
Brain tumor headache
Definition
Process: pressure on vessels or nerves; character: aching, steady; location: variable; onset: variable; intensity: variable; duration: often brief; exacerbating: coughing, sneezing, sudden movements of head
Term
Giant Cell (Temporal) Arteritis
Definition
Process: vasculitis from cell-mediated immune response; character: throbbing, generalized, persistent; location: localized near involved artery, temporal or occipital; onset: gradual or rapid; intensity: often severe; duration: variable; exacerbation: movement of neck or shoulders; associated: tenderness of adjacent scalp, fever, fatigue, wt. loss, new headache, jaw claudication, visual loss or blindness, polymyalgia rheumatica
Term
posttraumatic headache
Definition
process: unclear; character: generalized, dull, aching, constant; location: localized to injury area, variable; onset: hours to 1-2 days after injury; duration: weeks, months, years; exacerbation: mental and physical exertion, straining, stooping, emotional excitement, alcohol; palliative: rest; associated: poor concentration, problems with memory, vertigo, irritability, restlessness, fatigue
Term
trigeminal neuralgia headache
Definition
Process: compression of CNV; character: shocklike, stabbing, burning; location: cheek, jaws, lips, or gums, division 2 and 3> 1; onset: abrupt, paroxysmal; intensity: severe; duration: may last for months, disappear, then recur, each jab lasts for seconds but recurs; exacerbation: touching certain areas of lower face or mouth, chewing, brushing teeth; associated: exhaustion form recurrent pain
Term
Peripheral vertigo
Definition
benign positional, vestibular neuronitis, Meniere's dx, drug toxicity, acoustic neuroma (CN V, VII and VIII compression)
Term
Red Eyes
Definition
conjunctivitis, subconjuntival hemorrhage, corneal injury or infection, acute iritis, glaucoma
Term
corneal arcus
Definition
usually benign; a thin grayish white arc or circle no quite at edge of the cornea
Term
corneal scar
Definition
superficial grayish white opacity in the cornea, secondary to an old injury/inflammation; do not confuse with cataract
Term
pterygium
Definition
triangular thickening of bulbar conjunctiva that grows across the outer surface of the cornea, usually from the nasal side
Term
tonic pupil (Adie's pupil)
Definition
pupil is large (midriasis), regular & usually unilateral (anisocoria: un= unilaterally)
• Rxn to light reduced, near retraction slowed, accommodation → blurry vision
Term
oculomotor nerve (CNIII) paralysis
Definition
dilated pupil is fixed to light and near effort, ptosis of eyelid, and lateral deviation of the eye
Term
horner's syndrome
Definition
damage to superior sympathetic trunk one side → ptosis, constricted pupil (miosis) & no sweat
• Neurosyphilis
Term
Argyll Robertson pupil
Definition
pupils small & irregular- react to accommodation, but not light
• Localization is to midbrain – caused by neurosyphilis
Term
Benign positional vertigo
Definition
onset: sudden; duration: brief, few weeks recurs; Associated: nauses, vomiting, nystagmus
Term
Labrynthitis (vestibular neuritis)
Definition
onset: sudden; duration: hr, days, weeks, recurs; associated: nausea, vomiting, nystagmus
Term
Meneniere's
Definition
onset: sudden; onset: hr to day, recurs; associated: hearing impaired, tinnitus, nausea, vomiting, pressure in ear
Term
Drug toxicity
Definition
onset: acute, linked to meds; duration: may be reversible; Associated: +- hearing, +- tinnitus, nausea, vomiting
Term
acoustic neuroma
Definition
onset: CN VIII compression; duration: duration: variable; Associated: hearing one side, tinnitus, may involve V and VII
Term
Central vertigo
Definition
onset: often sudden; duration: variable but rarely continuous; Associated: brain stem deficits (dysarthria, ataxia, crossed motor and sensory deficits)
Term
entropion
Definition
inward turning of lid margin, lashes may irritate conjuctiva & lower cornea (common in elderly)
Term
ectropion
Definition
margin of lower lid turned out exposing palpebral conjunctiva (common in elderly)
• If punctum turns out, eye may not drain properly
Term
pinguecula
Definition
harmless yellow triangle in bulbar conjunctiva on either side of iris – frx with aging
Term
episcleritis
Definition
ocular redness from inflammation of the episcleral vessels; pink and movable over the scleral surface
Term
Sty (hordeolum)
Definition
painful, tender red infection in a gland at the margin of the eyelid
Term
chalzion
Definition
subacute, non-tender & usually painless nodule involving a meiboman gland
• Unlike sty, usually point inside the lid rather than on lid margin
Term
xanthelasma
Definition
yellowish, well-circumscribed plaques that appear along the nasal portions of one or both eyelids
Term
dacrocystitis
Definition
inflammation of lacrimal sac
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