Heent

• usually unilateral
• throbbing/aching
• variable severity
• onset: fairly rapid, peak 1-2 h
• associated factors: N/V, photophobia, aura..

• usually bilateral
• often frontotemporal
• pressing or tightening pain
• mild to moderate intensity
• gradual onset
• often recurrent with persistence over long periods
• NO n/v

• 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

Migraines, tension or cluster HA

HA having underlying medical cause.

• 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

• 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)

Secondary HA

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

Pain location: generalized

spinning sensation accompanied by nystagmus and ataxia


usually from peripheral vestibular dysfunction.

drooping of upper lid.

causes: congenital, myasthenia gravis, oculomotor nerve damage, weakened muscle, relaxed tissue, weight of herniated fat

inward turning of lid margin.

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

eyeball protrudes forward.

Consider: Graves' hyperthyroidism as cause

• 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

• Appearance:
• Margins sharp.
• yellowish orange to creamy pink
• tiny vessels
• physiologic cup central to temporal. 2:1

vein appears to stop abruptly on either side of artery

midline bony growth on hard palate. benign.

• reddened and swollen gingival margins. Interdental papillae are blunted, swollen and red.
• Bleeding during teeth brushing

• thickened, white patch anywhere in oral mucosa
• usually secondary to local irritant such as chewing tobacco.
• May lead to oral cancer

• subacute nontender and usually painless nodule involving meibomian gland.
• usually points inside lid (rather than lid margin like a sty)

• 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)

pupillary rxn to shifting gaze from far object to near one.

oculomotor

• extraocular movement
• pupillary constriction occurs, but due to change in shape of lenses to focus. not visible to observer

increased convexity of lenses d/t contraction of ciliary muscles

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)

red inflamed lid margin often with crusting

pupillary inequality

mild deviation nl in about 20%. If PERRL WNL, then benign.

fine rhythmic oscillation of eyes.

assess during EOM at extreme lateral gaze.

• ...lens opacity (cataract) or vitreous
• detached retina
• retinoblastoma

test for sound lateralization

nl: heard midline or equally on both ears

external or middle ear issue

• compares air conduction and bone conduction
• nl: AC>BC

dysconjugate gaze d/t imbalance in ocular muscle tone

• Esotropia. inward
• exotropia: outward

to confirm strabismus when corneal reflections are asymmetric

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