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UC Adv. Health Assessment HEENT Part 3 (KMH) Solved 2024
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UC Adv. Health Assessment HEENT Part 3 (KMH) Solved 2024
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UC Adv. Health Assessment HEENT Part3 (KMH) Solved 2024
A 22 yr old nursing assistant presents to you clinic b/c of a painful bump on the edge of
her eyelid that appeared this morning. On exam, there is a red bump that is tender to
palpation on the lower lid margin, located around a hair follicle. What is your most likely
Dx? - ANSWER-Sty (Hordeolum)
A 3 yr old boy is brought to the office b/c he has had a fever and has been tugging on
his right ear since yesterday. He has had clear drainage from nose. On exam of the ear,
the right TM is red and bulging with loss of landmarks. No purulent drainage. What is
most likely Dx? - ANSWER-Otitis Media
Abnormal Otoscopic findings for Bulging Drum: - ANSWER-increased pressure
Abnormal Otoscopic findings for other problems: - ANSWER-Blue/Dark red color is
blood/trauma, decreased or absent landmarks is chronic OM, Black/white dots in canal
or drum is fungal infection
Abnormal Otoscopic findings for Otitis Media: - ANSWER-Otitis Media: Yellow-amber
color of drum, red color, absent or distorted landmarks, air/fluid bubbles behind drum
Acoustic blink reflex - ANSWER-blinking of the infants eyes in response to a sharp
sound. Many children are not dx with a hearing disorder until there are 2 clues: Parental
concern and delayed speech
Bones of the middle ear: - ANSWER-malleus, incus, stapes
Children's Noses - ANSWER-Maxillary sinuses at age 4, Sphenoid in place by age 6,
Fontal by age 6-7, Transillumination of paranasal sinuses of younger kids has poor
sensitivity and specificity for Dx sinusitis
Common findings on nose transillumination (abnormal): - ANSWER-Allergic rhinitis: red
mucosa, Chronic allergic rhinitis-boggy and pale, perforated septum: cocaine abuser,
possible nasal polyps, Epistaxis-nasal bleed
Conductive hearing loss - ANSWER-dysfunction of external or middle ear, > cerumen,
FB, perf TM, ososclerosis
Cotton Wool Patches in eye - ANSWER-"white fluffy spots" s/o HTN and DM
Drusen bodies - ANSWER-random white bodies normally seen increase with age
earliest feature of age related macular degeneration
, During the eye exam the NP should attempt to visualize the physiologic cup. What is
true about the physiologic cup? - ANSWER-Blurring of the nasal outline is normal
Ear Exam, Otoscope use: - ANSWER-Adult pull pinna up only, Child pull pinna up AND
back
Ear, Hearing Loss - ANSWER-2 types: Sensorineural and Conductive
Ear, Hearing Mechanism: - ANSWER-Ear transmits sound, converts to vibration,
analyzed by brain, binaural arrangement, pathways, Normal is AC air conduction,
Alternate is BC bone conduction vibrations transmitted directly to CN 8
External anatomy of nose: - ANSWER-Nares open at base, Vestibule widening of
nares, Collumella divides the 2 nares, Ala is outside wing
External ear inspection and palpation, if tender when push tragus: - ANSWER-Otitis
Externa, swimmers ear
Eye Emergencies - ANSWER-FB: use fluorescein stan & slit lamp: rust ring--get to
opthamology ASAP, Red eye- hyperemic & congested may be vision-threatening,
always evaluate thoroughly, Pain, Blurred Vision, Red eye= send to Opthalmology
Eye Emergency: Acute Angle closure Glaucoma: - ANSWER-build up of pressure=pain,
nausea, change in visual acuity, red teary eye, cloudy cornea, forward bowing iris, mid-
dilation of the pupil, high intraocular pressure (as high as 4x normal pressure)
Function of middle ear: - ANSWER-conducts sound vibration from outer to internal,
protects inner ear by reducing amplitude, allows equalization of pressures
Function of the nose - ANSWER-moistens, filters, and warms air. Is the resonating
chamber for speech with olfactory receptors for smell
Hairy Leukoplakia - ANSWER-a white rough patch that arises on the LATERAL tongue.
Usually seen in immunocompromised such as HIV, multiple white, warty , painless
plagues on lateral aspect of tongue, cannot be scraped off
Hard Exudates in eye - ANSWER-"hard white spots" s/o HTN and DM
Hearing tests: - ANSWER-Weber (place vibrating tuning fork midline of skull) Normal is
heard equally in both ears, louder in ear with cerumen b/c solid conducts sound better
than air, Louder in good ear with sensory loss and Rinne (compares air to bone
conduction) Normal is air conduction is 2x as long as bone conduction,
How would you grade tonsils that touch the uvula? - ANSWER-Grade 3+, Grade 4+ is
when tonsils touch tonsil to tonsil
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