CASE REPORT 48-Year-Old Man
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HEENT EXAMINIATION ______HEENT Exam Exam Overview
HEENT EXAMINIATION ____________________________________________________________ HEENT Exam Exam Overview I. Head A. Visual inspection B. Palpation of scalp II. Eyes A. Visual Acuity B. Visual Fields C. Extraocular Movements/Near Response D. Inspection of sclera & conjunctiva E. Pupils F. Ophthalmoscopy III. Ears A. External Inspection B. Otoscopy C. Hearing Acuity D. Weber/Rinne IV. Nose A. External Inspection B. Speculum/otoscope C. Sinus areas V. Throat/Mouth A. Mouth Examination B. Pharynx Examination C. Bimanual Palpation VI. Neck A. Lymph nodes B. Thyroid gland 29 HEENT EXAMINIATION ____________________________________________________________ HEENT Terms Acuity – (ehk-yu-eh-tee) sharpness, clearness, and distinctness of perception or vision. Accommodation - adjustment, especially of the eye for seeing objects at various distances. Miosis – (mi-o-siss) constriction of the pupil of the eye, resulting from a normal response to an increase in light or caused by certain drugs or pathological conditions. Conjunctiva – (kon-junk-ti-veh) the mucous membrane lining the inner surfaces of the eyelids and anterior part of the sclera. Sclera – (sklehr-eh) the tough fibrous tunic forming the outer envelope of the eye and covering all of the eyeball except the cornea. Cornea – (kor-nee-eh) clear, bowl-shaped structure at the front of the eye. It is located in front of the colored part of the eye (iris). The cornea lets light into the eye and partially focuses it. Glaucoma – (glaw-ko-ma) any of a group of eye diseases characterized by abnormally high intraocular fluid pressure, damaged optic disk, hardening of the eyeball, and partial to complete loss of vision. Conductive hearing loss - a hearing impairment of the outer or middle ear, which is due to abnormalities or damage within the conductive pathways leading to the inner ear. -
PDF in English
Case Report Article Labyrinthitis Ossificans. Report of One Case and Literature Review Leandro Ricardo Mattiola*, Mark Makowiecky**, Carlos Eduardo Guimarães de Salles**, Marcela Pozzi Cardoso***, Samir Cahali****. * ENT doctor. Post-graduation student in Head and Neck Surgery at HSPE-SP. ** 2nd yr. Resident Doctor in ENT and Head and Neck Surgery at HSPE-SP. *** ENT Doctor. Assistant doctor in the Otology Department at HSPE-SP. **** PhD in Otorhinolaryngology by UNIFESP. Head of ENT and Head and Neck Surgery Department at HSPE-SP. Institution: Hospital do Servidor Público Estadual de São Paulo - FMO. Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço. São Paulo / SP – Brazil. Address for correspondence: Leandro Ricardo Mattiola – Rua José de Magalhães 600 - Vila Clementino – São Paulo / SP – Brazil - Zip code: 04026-090 – Telephone/ Fax: (+55 11) 5088-8406 - E-mail: [email protected] Article received on May 31st, 2007. Article approved on November 8th, 2007. SUMMARY Introduction: Labyrinthitis ossificans is a pathology characterized by sensorioneural hearing loss; secondary to infectious process, which produces irreversible injury to inner ear. Objective: To report a labyrinthitis ossificans case and review the literature. Case Report: A seven-year-old male patient, with profound hearing loss in tonal audiometry; no response from brainstem audiometry and compatible CT findings. Conclusion: Labyrinthitis ossificans results ossification on the inner ear structures. Pacient presents profound irreversible hearing loss, followed or not by disequilibrium, that can have important implication on educational socio-development. Diagnosis is important for cochlear implantation cases of the selected cases. Key words: labirinthitis, cochlea, hearing loss, osteogenesis 300 Intl. Arch. Otorhinolaryngol., São Paulo, v.12, n.2, p. -
Correlations Between Audiogram and Objective Hearing Tests in Sensorineural Hearing Loss
International Tinnitus Journal, Vol. 5, No.2, 107-112 (1999) Correlations Between Audiogram and Objective Hearing Tests in Sensorineural Hearing Loss L. Bishara,1 J. Ben-David,l L. Podoshin,1 M. Fradis,l C.B. Teszler,l H. Pratt,2 T. Shpack,3 H. Feiglin,3 H. Hafner,3 and N. Herlinger2 I Department of Otolaryngology, Head and Neck Surgery, and 3Institute of Audiology, Bnai-Zion Medical Center, and 2Evoked Potentials Laboratory, Technion, Haifa, Israel Abstract: Owing to its subjective nature, behavioral pure-tone audiometry often is an unre liable testing method in uncooperative subjects, and assessing the true hearing threshold be comes difficult. In such cases, objective tests are used for hearing-threshold determination (i.e., auditory brainstem evoked potentials [ABEP] and frequency-specific auditory evoked potentials: slow negative response at 10 msec [SN-1O]). The purpose of this study was to evaluate the correlation between pure-tone audiogram shape and the predictive accuracy of SN-IO and ABEP in normal controls and in patients suf fering from sensorineural hearing loss (SNHL). One-hundred-and-fifty subjects aged 15 to 70, some with normal hearing and the remainder with SNHL, were tested prospectively in a double-blind design. The battery of tests included pure-tone audiometry (air and bone conduction), speech reception threshold, ABEP, and SN- 10. Patients with SNHL were divided into four categories according to audiogram shape (i.e., flat, ascending, descending, and all other shapes). The results showed that ABEP predicts behavioral thresholds at 3 kHz and 4 kHz in cases of high-frequency hearing loss. -
Bates' Pocket Guide to Physical Examination and History Taking
Lynn S. Bickley, MD, FACP Clinical Professor of Internal Medicine School of Medicine University of New Mexico Albuquerque, New Mexico Peter G. Szilagyi, MD, MPH Professor of Pediatrics Chief, Division of General Pediatrics University of Rochester School of Medicine and Dentistry Rochester, New York Acquisitions Editor: Elizabeth Nieginski/Susan Rhyner Product Manager: Annette Ferran Editorial Assistant: Ashley Fischer Design Coordinator: Joan Wendt Art Director, Illustration: Brett MacNaughton Manufacturing Coordinator: Karin Duffield Indexer: Angie Allen Prepress Vendor: Aptara, Inc. 7th Edition Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2009 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2004, 2000 by Lippincott Williams & Wilkins. Copyright © 1995, 1991 by J. B. Lippincott Company. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appear- ing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia PA 19103, via email at [email protected] or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Bickley, Lynn S. Bates’ pocket guide to physical examination and history taking / Lynn S. -
Hearing Screening Training Manual REVISED 12/2018
Hearing Screening Training Manual REVISED 12/2018 Minnesota Department of Health (MDH) Community and Family Health Division Maternal and Child Health Section 1 2 For more information, contact Minnesota Department of Health Maternal Child Health Section 85 E 7th Place St. Paul, MN 55164-0882 651-201-3760 [email protected] www.health.state.mn.us Upon request, this material will be made available in an alternative format such as large print, Braille or audio recording. 3 Revisions made to this manual are based on: Guidelines for Hearing Screening After the Newborn Period to Kindergarten Age http://www.improveehdi.org/mn/library/files/afternewbornperiodguidelines.pdf American Academy of Audiology, Childhood Screening Guidelines http://www.cdc.gov/ncbddd/hearingloss/documents/AAA_Childhood%20Hearing%2 0Guidelines_2011.pdf American Academy of Pediatrics (AAP), Hearing Assessment in Children: Recommendations Beyond Neonatal Screening http://pediatrics.aappublications.org/content/124/4/1252 4 Contents Introduction .................................................................................................................... 7 Audience ..................................................................................................................... 7 Purpose ....................................................................................................................... 7 Overview of hearing and hearing loss ............................................................................ 9 Sound, hearing, and hearing -
Current Audiometric Tests for the Detection of Functional Hearing Loss
CURRENT AUDIOMETRIC TESTS FOR THE DETECTION OF FUNCTIONAL HEARING LOSS by JOAN PHYLLIS COOPER X^^ Be A., Union College, 1965 A MASTER'S REPORT submitted in partial fulfillment of the J requirements for the degree MASTER OF ARTS Department of Speech KANSAS STATE UNIVERSITY Manhattan, Kansas 1963 Approved by: Ma j or ? ro re s s or . bo 11 C6£ TABLE OF CONTENTS Chapter Page I , Introduction .••••••••••••••••••«••• • • • 1 Definitions ....?................«« •••••••• 2 II. Tests for Functional Hearing Loss 4 General Behavior in the Clinical Evaluation 4 The Ear, Nose, and Throat Examination 9 Pure-tone Audiometry 12 Saucer-shaped Audiograms 14 False-alarm Responses During Pure-tone Audiometry ...................... c 17 Inappropriate Lateralization ,« 17 Bone Conduction Audiometry 20 Speech Audiometry ••••••••••••••••• • 22 Speech Discrimination ••••••••••• 22 Speech Reception Threshold ........ ............... 23 Errors During Measurement of Spondee Threshold ... 2 3 Inappropriate Lateralization 26 Pure-tone Stenger Test 26 Modified (Speech) Stenger Test 29 Doerf ler-Stewart Test 30 Lombard Test ............ o 36 De layed Auditory Feedback ., 39 Psychogalvanic Skin Resistance Test 45 Modification of EDR Test , . .. 50 Bekesy Type V Tracing ......... o ..... ....... ... s ...... 51 c ^ . iii Chapter Page ( II. Rainville Test 5S Sensorineural Acuity Level Test ..... 59 Lipreading Test .....«•..•.<.«•......,....•............ 61 The Variable Intensity Pulse Count Method 62 Rapid Random Loudness Judgments ..................... c 63 Middle Ear -
Copyrighted Material
Index Page numbers in italics denote fi gures, anion gap 263 Baker’s cyst 100, 104 those in bold denote tables. ankle swelling 195–8 bamboo spine 189 ankle-brachial pressure index 70–1 basal cell carcinoma 77 abdominal aortic aneurysm 145 ankylosing spondylitis 179, 189 basic life support 282–5 abdominal distension 143–7, 145 antalgic gait 25, 42, 94 Behçet’s disease 181 abdominal examination 10–19 anti-tuberculosis drugs 223 benign paroxysmal positional vertigo abdominal masses 17–18, 17 antiepileptics 223 173 abdominal pain 137–42 antihypertensives 223 benign prostatic hypertrophy 57 acute 138 anxiety berry aneurysm 33 chronic 139 faintness 175 biceps tendonitis 81 investigations 139–40 palpitations 120 bleeding diathesis 149 origin of 140–1, 141 tremor 169 blood gas analysis see arterial blood gas abducens nerve 34 aortic dissection 116 analysis abscess 193 aortic regurgitation 3 Boerhaave’s syndrome 149 breast 54 aortic stenosis 3 Bouchard’s nodes 90 perianal 57 aorto-enteric fi stula 149 bowel cancer see colorectal cancer acidosis apex beat 4 bowel obstruction 144, 146 metabolic 263, 265 Apley’s test 102 brachial plexus 85 respiratory 264 apologising 237 brain natriuretic peptide 6 acoustic neuroma 34, 175 appendicectomy 218 breaking bad news 208–10 acquired immunodefi ciency syndrome apraxic gait 25 SPIKES framework 209 see HIV/AIDS arterial blood gas analysis 262–6, 264–5 breast abscess 54 acromioclavicular joint arterial examination 68–72 breast examination 53–5 arthritis 81 arterial ulcer 70 description of lumps 55, 55 Scarf test -
Primary Care Assessment of Suspected Stroke-TIA Pathway
Primary Care Assessment of Rapid onset of new neurological deficit or symptom Suspected Stroke/TIA Rapid means over seconds or minutes, or rarely, hours Exclude/ treat Click for hypoglycaemia more info Perform face, arm, speech test (FAST) • Has the person’s face fallen on one side? Can they smile? • Can they raise both arms and keep them there? • Is their speech slurred? FAST positive FAST negative See pathway Negative, but history Primary Care Risk of FAST positive now Stratification of Suspected resolved TIA Upper or Lower Motor Neurone Sparing of the forehead, and possibly maintenance of spontaneous smiling = UMN Quick assessment Facial nerve weakness lesion. Lower Motor Neurone Leg weakness YES for other neurological only? Whole of one side affected, including the facial weakness forehead = LMN lesion. This could be caused by a deficit brainstem stroke in which case it would be Diplopia squint 3rd, 4th, accompanied by other signs such as tremor, 6th ataxia, vertigo and horizontal gaze palsy Weakness 11th of Rapid onset of other shoulder elevation, NO Upper Motor Neurone motor symptoms or Other cranial nerves ninging of scapula, (sparing of forehead) signs weakness of head turning See pathway Deviation of tongue or Management of uvula 12th nerve Suspected Stroke Numbness or altered Exclude peripheral nerve sensation or dermatomal pattern Rapid onset sensory Click for more symptoms or signs info Sensory inattention Comprehension difficulties may be for the spoken or written word or for both or for one language only Speech difficulties -
Examples of Questions for the Exam
MedIS exam 2013 Course title: Nervesystemet og bevægeapparatet II - MedIS Programme: Bachelor in education Semester: 5. semester Exam date: 21-1-12 Time: 9:00 - 12:00 Evaluation form 7-point scale – External censur Important information: Remember to bring your student identification card Remember to put your student number – not your name and cpr no – on all sheets that you hand in for evaluation Remember to hand in the assignment if you leave the exam before it has ended No written aid is allowed Quicktionary pen is allowed Your paper must be handed in on paper in hand written form The study board/the university cannot be held liable if any problems should occur regarding the electronic aid during the examination It will be considered cheating or attempting to cheat if the technical equipment of the student is communicating or trying to communicate with other equipment not relevant to the exam, without an explicit permission. Before the beginning of the exam, the student should make sure that all communication devices in the equipment at the exam are turned off. Communication is not allowed The exam consists of a mixture of multiple choice questions and essay questions. The total amount of questions is 36. The total amount of points is 60. This lists the grades corresponding to the points: 12 (passed): 56-60 points 10 (passed): 51-55.5 points 07 (passed): 46-50.5 points 04 (passed): 41-45.5 points 02 (passed): 36-40.5 points 00 (failed): 18-35.5 points -2 (failed): 0-17.5 points 1 1. -
Vestibular Neuritis, Labyrinthitis, and a Few Comments Regarding Sudden Sensorineural Hearing Loss Marcello Cherchi
Vestibular neuritis, labyrinthitis, and a few comments regarding sudden sensorineural hearing loss Marcello Cherchi §1: What are these diseases, how are they related, and what is their cause? §1.1: What is vestibular neuritis? Vestibular neuritis, also called vestibular neuronitis, was originally described by Margaret Ruth Dix and Charles Skinner Hallpike in 1952 (Dix and Hallpike 1952). It is currently suspected to be an inflammatory-mediated insult (damage) to the balance-related nerve (vestibular nerve) between the ear and the brain that manifests with abrupt-onset, severe dizziness that lasts days to weeks, and occasionally recurs. Although vestibular neuritis is usually regarded as a process affecting the vestibular nerve itself, damage restricted to the vestibule (balance components of the inner ear) would manifest clinically in a similar way, and might be termed “vestibulitis,” although that term is seldom applied (Izraeli, Rachmel et al. 1989). Thus, distinguishing between “vestibular neuritis” (inflammation of the vestibular nerve) and “vestibulitis” (inflammation of the balance-related components of the inner ear) would be difficult. §1.2: What is labyrinthitis? Labyrinthitis is currently suspected to be due to an inflammatory-mediated insult (damage) to both the “hearing component” (the cochlea) and the “balance component” (the semicircular canals and otolith organs) of the inner ear (labyrinth) itself. Labyrinthitis is sometimes also termed “vertigo with sudden hearing loss” (Pogson, Taylor et al. 2016, Kim, Choi et al. 2018) – and we will discuss sudden hearing loss further in a moment. Labyrinthitis usually manifests with severe dizziness (similar to vestibular neuritis) accompanied by ear symptoms on one side (typically hearing loss and tinnitus). -
Sudden Sensoryneural Hearing Loss As a Rare Attack Type in Multiple Sclerosis
380 Arch Neuropsychiatry 2018;55:380−382 LETTER TO EDITOR https://doi.org/10.5152/npa.2017.19270 Sudden Sensoryneural Hearing Loss As a Rare Attack Type in Multiple Sclerosis Amber EKER1 , Bahar KAYMAKAMZADE1 , Aslı TUNCER KURNE2 , Çağrı Mesut TEMUÇİN2 , Rana KARABUDAK2 1Department of Neurology, Near East University Faculty of Medicine, Nicasia, Cyprus 2Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey ultiple sclerosis (MS) is a chronic, multifocal, inflammatory, A 35-year-old male patient who had been following with MS was Mdemyelinating disorder of the central nervous system. In addition admitted to hospital with the complaint of acute hearing loss. He had to common symptoms like optic neuritis (ON), sensorial, pyramidal, diagnosed with definite MS two years ago. The presenting symptom was and cerebellar dysfunction, a wide range of rare symptoms could be a left sided weakness, and hypoesthesia on the left upper extremity. At feature of MS. Rare symptoms could be the presenting symptom of MS. that time, the magnetic resonance imaging (MRI) of the brain revealed Herein, we report a case with MS with a very rare symptom; unilateral demyelinating lesions in periventricular white matter, corpus callosum vestibulocochlear nerve involvement and aimed to emphasize the and left capsula interna. Cervical MRI showed C3-C4 intramedullary importance of electrophysiological studies in the diagnosis. demyelinating plaque. None of the lesions had contrast enhancement. (a) Figure 1. a, b. T2 (a) and contrast enhanced T1 (b) sequences of the brain MRI does not (b) reveal any new lesion. Cite this article as: Eker A, Kaymakamzade B, Tuncer Kurne A, Temuçin ÇM, Karabudak R. -
MEDICINE TODAY Audiometry -~60
9 November 196S Schizophrenia-Freeman MEDIALSHRNAL 373 In the Salford comprehensive community mental health ser- FURTHER READING vice vulnerable cases of schizophrenia have been treated with Bennett, D. H., New Aspects of the Mental Health Services, ed. H. L. Frceman and J. Farndale, 1967. Oxford. this preparation for nearly two years and experience has been Brown, G. W., Bone, M., Dalison, B., and Wing, J. K., Schizophrenia gained in over 100 cases. This confirms results from elsewhere and Social Care, 1966. London. Br Med J: first published as 10.1136/bmj.4.5627.373 on 9 November 1968. Downloaded from Kinross-Wright, J., and Charalampous, K. D., Int. 7. Neuropsychiat., that it represents an important step forward in the community 1965, 1, 66. management of schizophrenia. The injections may be given in Psychiatric Hospital Care, ed. H. L. Freeman, 1965. London. Treatment of Mental Disorders in the Community, ed. G. R. Daniel and hospital clinics, at general practitioners' surgeries, or by nurses 1968. London. at the patients' homes. An interested family doctor can H. L. Freeman, certainly make a big contribution to the community care of his schizophrenic patients by undertaking these injections, since it is possible to do a rapid check on the mental state B.M.J. Publications at the same time, or perhaps receive a report from an The following are available from the Publishing Manager, B.M.A. accompanying relative. It may also be necessary to issue House, Tavistock Square, London W.C.1. The prices include regular prescriptions for antiparkinsonian drugs, since side- postage. effects are fairly common, at least in the early stages of the The New Gcneral Practice ..