Transcript Eye and ENT Exam

Eye and ENT Examination
Ear, Nose, and Throat
Anatomy
Oral Cavity
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Pharynx
Uvula
Tonsils
Lymph Nodes
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1 - Anterior
cervical
2 - Posterior
cervical
3 - Preauricular
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2
Ears
Pinna
Ear Examination
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3 steps
• Outer ear
• Canal
• Inner ear
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General inspection and palpation (outer
ear)
Otoscopic examination (canal and inner
ear)
Outer Ear Exam
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Look for deformities, lumps, skin lesions
(eg. Herpes lesions, hematomas)
Associated structures
• Lymph nodes
• Pharynx
• Eustachian tube
Ear Canal and Inner Ear Exam
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Use proper sized otoscope tip
Turn on otoscope and check that
light works
Pull ear up, back, and toward you
Use pinky finger for support and to
prevent injury
Place otoscope tip in ear canal, then
lean forward and start looking into
the otoscope
Ear Canal Exam
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Look for redness, swelling,
discharge, foreign bodies, wax
Pain with tragus and pinna
manipulation can indicate problem
with canal, as opposed to inner ear
Examination of TM
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The TM is clear (transparent)
when light passes through the
membrane
The TM is dull (opaque) when
light does not pass through
the membrane so that the
bony landmarks can not be
clearly seen
Bulging TM
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The bulging often
impairs the visibility
of the landmarks
Lymph Nodes
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1 - Anterior
cervical (pharyngitis)
2 - Posterior
cervical (mono)
3 – Preauricular
(conjunctivitis)
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Lymph Nodes
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Roll the lymph node area under the
pads of your fingers, compressing it
against the underlying structures
Feel for size and tenderness
Check for symmetry
• Is there an enlarged gland that just happens to
be on the side of the earache or sinus pressure?
Sinuses
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Grasp head fairly
firmly, and push with
thumbs on the
frontal and maxillary
areas
For ethmoid sinuses,
squeeze firmly
between eyes with
thumb and index
finger
Evaluate for
tenderness
Fairly nonspecific
Eye Examination
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4
components
- Visual acuity (Snellen eye chart)
- Visual fields (by confrontation)
- Extra ocular movements (“H”)
- Ophthalmoscopic examination
1- Visual Acuity Exam
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Use a Snellen eye chart
• 20 feet from chart
• Read at least half of each line
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Read posters, magazines, newspaper
if nothing else is available
2 - Visual Fields Exam
(by Confrontation)
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Have patient cover one eye lightly and
look at your nose
Stand facing patient (confronting them)
holding hands out to sides
Check upper fields by wiggling fingers of
one or both hands
Repeat for lower fields
Repeat for other eye
3 - Eye Movements Exam
(Extra ocular movements)
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Ask patient to look at your fingers
Keep head still. Stabilize chin if needed
Make large “H”
Convergence test (bring finger to their nose)
• Cross eyed
4 - Ophthalmoscopic Exam
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Adjust proper settings on scope (light
intensity, light shape, light color, focus)
Position patient and adjust ambient
lighting
Start laterally from a distance and obtain
red reflex, then approach steadily as if
peering through a keyhole
If lots of glare, use a smaller diameter
light setting
Find optic disc directly or by following a
blood vessel from narrower aspect to
wider aspect, which will lead you to the
optic disc
Quiz Time
Generally speaking, you don’t have to
worry about rupturing a patient’s
tympanic membrane with a typically
placed otoscope tip because,
a. The tympanic membrane is tough like
shoe leather
b. They still have another good ear
anyway!
c. The canal is about 1 inch deep
c
Match the Swollen Lymph Nodes!
Anterior cervical nodes only
Anterior and posterior
cervical nodes
Preauricular nodes
Tonsillitis
Mono
Herpes
Possible Diagnoses – Herpes infection on temple, mono, tonsillitis
If you were to tug on someone’s
pinna or poke someone’s tragus you
would expect,
a. A slap
b. Pain which could indicate an
acute otitis media
c. Pain which could indicate
otitis externa
c
To look in a person's ear, you would
move the pinna in the following
direction.
a. Down and out
b. Up, back, and toward you
c. Straight up
d. Consult your GPS, then proceed as
directed
b
If you were looking in a healthy right
ear, you would expect to see which of
the following?
a. The cone of light to the left
b. Our new kitty from last year
c. Same cat this year
d. A shiny, somewhat
transparent-appearing
tympanic membrane
d
Matching Game?
If you wanted to evaluate someone’s visual acuity, you
would (choose either best, pretty good, bad, or stupid!),
Bad
Ignore their complaint of decreased vision
altogether
Best
Use a Snellen eye chart
Stupid
Pretty good
Poke them in the eye with your
ophthalmoscope
Have them read from a magazine
Which of the following is the single
greatest scientific achievement of all
time?
Einstein’s theory of relativity.
The concept of the number “0”.
Darwin’s discovery of Evolution.
Vaccination.
None of the above.
It’s the Mr. Clean
Magic Eraser.