eye and ent examination
DESCRIPTION
Eye and ENT Examination. Ear, Nose, and Throat Anatomy. Oral Cavity. Pharynx Uvula Tonsils. Lymph Nodes. 1 - Anterior cervical 2 - Posterior cervical 3 - Preauricular. 3. 1. 2. Ears. Pinna. Ear Examination. 3 steps Outer ear Canal Inner ear - PowerPoint PPT PresentationTRANSCRIPT
Eye and ENT Examination
Ear, Nose, and Throat Anatomy
Oral Cavity
Pharynx Uvula Tonsils
Lymph Nodes
1 - Anterior cervical
2 - Posterior cervical
3 - Preauricular1
3
2
Ears
Pinna
Ear Examination
3 steps• Outer ear• Canal• Inner ear
General inspection and palpation (outer ear)
Otoscopic examination (canal and inner ear)
Outer Ear Exam Look for deformities, lumps, skin lesions
(eg. Herpes lesions, hematomas) Associated structures
• Lymph nodes• Pharynx• Eustachian tube
Ear Canal and Inner Ear Exam
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
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
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 The bulging often
impairs the visibility of the landmarks
Lymph Nodes
1 - Anterior cervical (pharyngitis)
2 - Posterior cervical (mono)
3 – Preauricular (conjunctivitis)
1
3
2
Lymph Nodes
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 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
4 components 1 - Visual acuity (Snellen eye chart) 2 - Visual fields (by confrontation) 3 - Extra ocular movements (“H”) 4 - Ophthalmoscopic examination
1- Visual Acuity Exam Use a Snellen eye chart
• 20 feet from chart• Read at least half of each line
Read posters, magazines, newspaper if nothing else is available
2 - Visual Fields Exam(by Confrontation)
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)
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 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 deepc
Anterior cervical nodes only
Anterior and posterior cervical nodes
Preauricular nodes
Possible Diagnoses – Herpes infection on temple, mono, tonsillitis
Tonsillitis
Mono
Herpes
Match the Swollen Lymph Nodes!
If you were to tug on someone’s pinna or poke someone’s tragus you
would expect,
a. A slapb. Pain which could indicate an
acute otitis mediac. 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 outb. Up, back, and toward youc. Straight upd. 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 leftb. Our new kitty from last yearc. Same cat this yeard. 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!),
Ignore their complaint of decreased vision altogether
Use a Snellen eye chart
Poke them in the eye with your ophthalmoscope
Have them read from a magazine
Stupid
Pretty good
Bad
Best
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.