Occur more than once a day & last for less than 1 hour to about 2 hours; most painful

Unilateral with burning or stabbing pain over the eye, temple, forehead, & cheek; may occur w/ nasal stuffiness or discharge, red teary eyes, or drooping eyelids

Relieved with movement

Occur at periodic intervals, may last from a few hours to 1-3 days; occurs with menstrual periods

Unilateral with throbbing pain; may be accompanied by visual disturbances, nausea, & vomiting

Relieved with rest

Most common type

Gradual onset; front or back of the head; viselike (described as a tight band around head)

Secondary to a head injury or concussion

Dull, generalized head pain; lack of ability to concentrate, giddiness, or dizziness

Feeling of faintness experienced within the client

Have client define what he or she means by "dizziness" - what is the perception of movement?

Sensation of movement, usually rotational motion such as whirling or spinning

Cardinal symptom of vestibular dysfunction

Subjective - sensation that one's body is spinning

Objective - sensation that objects are spinning around the body

Bacterial infection - thick or purulent green-yellow, malodorous

Foreign body or chronic sinusitis - unilateral, foul-smelling

Allergies - watery

Neoplasm, trauma, or opportunistic infection (fungal disease) - bloody

Nose bleed (epistaxis) - secondary to trauma, chronic sinusitis, malignancy, or a bleeding disorder; cocaine abuse

Light reflections should appear symmetrically in both corneas

Asymmetrical reflections - may indicate weak extraocular muscles

Pupils are

Equal

Round and

React to

Light and

Accomodation

Accomodation - remember C's and D's

- Pupils constrict when focusing on a close object

- Pupils dilate when focusing on a distant object

Eyeball that is very firm and resists palpation; increase in intraocular pressure

Open-angle - no specific symptoms; gradual loss of vision

Closed-angle - complain of sharp eye pain & seeing a halo around lights

Thickened, disfigured auricle; from repeated episodes of trauma

Children - suspect abuse

Caused by a direct trauma from a contact sport or a blow to the side of the head

Children - suspect abuse

Small, hard, whitish yellow, nontender nodules on helix; contain uric acid crystals

Sign of gout

Bloody or clear - suspicion of possible skull fracture

Purulent or crusty - infection or presence of foreign body

Cracks & erythema in corners of mouth

Smooth or beefy-red colored, edematous tongue with slick appearance

Protrusion of upper or lower incisors or upper incisors that do not overlap the lower ones

Underbite

Hairy tongue with yellow-brown to black elongated papillae - occurs secondary to antibiotic therapy, superinfection, or pipe smoking

Enlarged tongue - mental retardation or hypothyroidism

White, round, or oval ulcerative lesions with a red halo

Canker Sore

With or without exudates - indicates infection

Grades:

1+ visible

2+ halfway between tonsilar pillars & uvula

3+ nearly touching the uvula

4+ touching each other

Enlarged thyroid; may be seen as fullness in the neck; seen in hypothyroidism

Hear a bruit (abnormally large volume of blood flow)

Abnormal ocular alignment in which the visual axes do not meet at the desired point

Nonparalytic (muscle weakness) or Paralytic (motor imbalance)

Opacity of the crystalline lens

Clients report cloudy or blurred vision, glare from lights, double vision, poor night vision; Red reflex is absent

Changes in retinal capillaries

Described as a curtain coming down over eye; Blindness

Most common type of endocrine malignancy

Usually no symptoms; as tumor grows - changes in voice & problems w/ swallowing or breathing

Infection of middle ear

Early stages - TM inflamed, red, bulging, immobile

Late stages - TM has discoloration (white & yellow drainage) & opacification

Purulent drainage w/ sudden relief of pain - suggests perforation

Inflammation of the middle ear space resulting in accumulation of serous fluid

Clogged sensation, problems w/ hearing & balance; some report clicking or popping sound

TM is retracted & is yellow or gray w/ limited mobility

Caused by interference of air conduction to the middle ear

Decreased ability to hear & reports muffled tones

Caused by structural changes, disorders of inner ear, or problems w/ auditory nerve

Gradual & progressive bilateral deafness w/ a loss of high-pitched tones; have difficulty filtering background noise

Hypertrophy of the nose caused by rosacea

Papules, pustules, telangiectasia, & tissue hypertrophy of the nose

Opportunistic oral infection

Soft white plaques on the tongue, buccal mucosa, or posterior pharynx

may or may not be palpable; should be soft, mobile, nontender, & bilaterally equal

enlarged, tender, & firm but freely moveable - infection of head or throat

unilateral, hard, asymmetric, fixed, & nontender - suspect malignancy

Occipital nodes - base of skull

Preauricular - front of ear

Postauricular - behind ear

Anterior & posterior cervical chain - w/in the neck

Parotid - along the angle of the jaw

Submental & submandibular - under the mandible

Supraclavicular - under the clavicle

Pupils constrict

Looking up, looking down & away

Ophthalmic branch

Corneal reflex (blink)

Motor branch

Corneal reflex (blink)

Place tuning fork on the midline of client's skull; should hear tone equally in both ears

- Lateralization to affected ear suggests conductive hearing loss

- Lateralization to unaffected ear suggests sensorineural hearing loss

Compares air conduction of sound to bone conduction; should be AC>BC by 2:1

If BC>AC - conductive hearing loss

If AC>BC but less than 2:1 ration - sensorineural hearing loss

Often not detected - considered normal

If felt: should feel small, smooth, soft, & should move freely during swallowing, should be nontender