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HEENT
Head, Eyes, Ears, Nose, Throat
HEENT common/concerning symptoms
  • headache
  • change in vision (hyperopia, presbyopia, myopia, scotomas)
  • double vision / diplopia
  • hearing loss, earache, tinnitus
  • vertigo
  • nosebleed / epistaxis
  • sore throat
  • swollen glands
  • goiter
most frequent cause of headache
migraines (up to 80% of cases)
life threatening diagnosis which can come from headache complaint
  • meningitis
  • subdural/intracranial hemorrhage
  • mass lesion
primary headache
no identifiable underlying cause
secondary headaches
arise from other conditions (some may be life-threatening)
"red flags" of headaches
  • recents onset (<6 months)
  • onset after 50 years
  • acute onset like a "thunderclap"
  • "worst headache of life"
  • really high BP
  • presence of rash/signs of infection
  • presence of cancer, HIV or pregnancy
  • vomiting
  • recent head trauma
  • persisting neuro deficits
severe headache w/ sudden onset
consider subarachnoid hemorrhage or meningitis
new and persisting, progressively severe headaches
raise concern of tumor, abscess or mass lesion
nausea/vomiting w/ headache
common w/ migraine but also w/ brain tumor, subarachnoid hemorrhage
prodromes to oncoming migraine
60-70% have prodrome;

20% experience an aura (photphobia, scintillating scotomata, or visual/sensory symptoms)
visual difficulty w/ close work
hyperopia (farsightedness) or presbyopia (aging vision)
visual difficulty w/ distances
myopia (nearsightedness)
sudden uni-lateral, painless vision loss
consider:
  • vitreous hemorrhage (from diabetes/trauma),
  • macular degeneration,
  • retinal detachment,
  • retinal vein occlusion
  • central retinal artery occlusion
sudden unilateral painful vision loss
causes:
  • corneal ulcer,
  • uveitis
  • traumatic hyphema
  • acute glaucoma
  • optic neuritis (from MS)
bilateral, painless vision loss
causes:
  • medications that change refraction (cholinergics, anticholinergics, steroids)
bilateral, painful vision loss
causes:
  • chemical/radiation exposures
gradual bilateral vision loss
causes:
  • cataracts
  • macular degen.
slow central vision loss in nuclear cataract
cause:
  • macular degen.
slow peripheral vision loss
cause:
  • open-angle glaucoma
slow one-sided vision loss
causes:
  • heianopsia
  • quadrantic defects
moving specks/strands in vision
causes:
  • vitreous floaters
fixed defects in vision (scotomas)
causes:
  • lesions in retina/visual pathways
flashing lights in vision
causes:
  • detachment of vitreous from retina
diplopia
double-vision;

causes:
  • lesion in brainstem/cerebellum
  • weakness/paralysis of 1+ extraoccular muscles
horizontal diplopia
causes:
  • palsy of CN III or VI
vertical diplopia
causes:
  • palsy of CN III or IV
diplopia in one eyes (w/other closed)
suggest problem in cornea or lens
conductive hearing loss
results from problems in external or middle ear;

noisy environments may help
sensorineural hearing loss
results from problems in inner ear, cochlear nerve or its central connections to brain;

often have trouble understanding speech (complain others mumble);

noisy environments make it worse
medications that affect hearing
  • aminoglycosides
  • asprin
  • NSAIDs
  • quinine
  • furosemide
ear pain
suggests:
  • problem w/ external ear (ex. otitis externa)
  • problem in inner ear (if associated w/ respiratory infection - otitis media)
  • refered pain from mouth, throat, neck
abnormalities in discharge from ear
unually soft ear wax, debris from inflammation, or rash in ear canal; may be secondary to otitis media
tinnitus
percieved sound that has no external stimuli (ringing/rushing/roaring);

may accompany hearing loss;

common w/ inc. age;
tinnitus accompanied w/ hearing loss, vertigo
suggest Meniere's disease
vertigo
perception of rotating/spinning;

suggest:
  • inner ear problems
  • peripheral lesions of CN VIII (or its central pathways)
rhinorrhea
drainage from nose;

often associated w/ nasal congestion;

causes:
  • viral infections
  • allergic rhinitis (hay fever)
  • vasomotor rhinitis
rhinitis medicamentosa
rhinorrhea caused by overuse of decongestants
rhinorrhea after URI w/ fever, local headachepain bending forward, or toothache
suggest acute bacterial sinusitis
drugs that cause stuffiness
oral contraceptives, reserpine, guanethidine, alcohol
congestion limited to one side
causes:
  • deviated septum
  • foreign body
  • tumor
epistaxis
bleeding from the nose;

usually from nose itself but may originate from paranasal sinus/nasopharynx

causes:
  • trauma
  • inflammation
  • drying/crusting or nasal mucosa
  • tumors
  • foreign bodies
  • bleeding disorders
fever, pharyngeal exudates & anterior lymphadenopathy (usually in absence of cough)
suggest strep. paryngitis (strep throat)
sore tongue
result from local lesions or systemic illness
bleeding gums
causes:
  • gingivitis
hoarseness
causes:
  • hypothyroidism
  • chronic infections (ex. TB)
  • disease of larynx
  • extralaryngeal lesions
  • overuse of voice
  • allergy
  • smoking
  • inhaled irritants
  • acute infections
enlarged, tender lymph nodes
commonly accompany pharyngitis
goiter
thyroid fxn may be incr., decr. or normal
hypothyroidism symptoms
  • intolerance to cold
  • preference to warm clothing
  • decreased sweating
hyperthyroidisms ymptoms
  • palpitations
  • involuntary weight loss
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