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Acute otitis media
Exams - Ear Sinus Nose Mouth Lymph Romberg if dizzy
Treatment: “Your symptoms are consistent with an infection in your ear behind the eardrum. I’m going to refer you to your primary care physician who will also take a look, and if he or she agrees, will probably prescribe some oral antibiotics.”
Acute otitis externa
Exams -
Ear (positive tug test)
Romberg if dizzy
Vertigo
Romberg (usually a symptom of something else. May prescribe ondansetron, or an OTC meclizine until doctor can be seen).
Meniere disease
Ear
Romberg
Gait
Sinusitis
Sinus
Mouth/Pharynx
Nose
Lymph
Strep
Mouth/Pharynx
Lymph
Sinus
Nose
Stroke details:
Eye exam
Make an H (tests acuity and lid lag)
Bring pen close and far away (convergence)
HEENT details: Ear
Tug auricle in 3 spots
Palpate tragus
Palpate mastoid process
Use otoscope to examine external ear canal and tympanic membrane
Whisper test
Weber and Rinne test (only if whisper is abnormal)
Romberg (only if dizziness if present)
HEENT details: Sinus
Palpate and percuss frontal and maxillary sinuses
HEENT details: nose
Externally examine for symmetry, obstruction
Use otoscope with speculum
Examine vestibules, mucosal color, septum
HEENT details: throat
Remove appliances External exam of symmetry, sores, color Oral mucosa: ulcers, candida, color Teeth, hard palate, soft palate Check for tonsils Tongue
HEENT details: Lymph
Visual inspection of neck, lymph nodes, thyroid (no swelling of the neck, symmetry)
Palpate 10 lymph nodes (and thyroid)
Diabetes neuropathy
Foot exam:
Inspection (skin color, MK calluses, chart foot, vascular abnormalities)
Temperature of foot
Palpation of dorsals pedis and posterior tibial
Capillary Refill
10-g monofilament
Vibration
How do you perform the diabetic foot exam using a monofilament and tuning fork?
Monofilament: “This tool does not hurt, hold out your hand. Close your eyes, and say ‘yes’ each time you feel the touch.” Touch 10 places, including one on the top of foot.
Tuning fork: “Again, I am going to have you close your eyes. Tell me when you can feel the vibration, and tell me again when it stops.” Move from big toe bone to ankle to shin if they cannot feel. (Loss of protective sensation.
What are the lung etiologies?
Bronchitis CAP TB Influenza Asthma COPD PE Medication-induced cough
What are the heart etiologies?
Arrythmia: A-fib, A-flutter, V-tach Murmurs and gallops Endocarditis Angina (stable and unstable) MI (STEMI and non-STEMI) Heart Failure
What are the abdominal etiologies?
Appendicitis Gastoenteritis GERD Peptic ulcer disease Irritable bowel syndrome Inflammatory bowel disease (UC and Crohn's) Diverticulitis Bowel Obstruction Hepatitis UTI and pyelonephritis Nephrolithiasis Medication-induced SE's of N/V, diarrhea and constipation Pancreatitis Gallbladder disease
What are the peripheral vascular and skin etiologies?
Peripheral artery disease (intermittent claudication and ulcerations)
Raynaud’s
Arterial embolic disease
Venous insufficiency (edema, ulcerations, varicose veins)
Stroke/Cerebral vascular accident
Eye: Follow my finger (H and close/far away) check PERRLA
Facial muscles: bmwp, frown, puff out cheeks, stick tongue out, push tongue against cheeks, raise eyebrows, say dnlt.
Push against hands on shoulders, on face
Squeeze fingers, resist pushing on arms.
Balance: Romberg
Parkinson’s
- Flip hands front to back quickly
- Move heel up and down shin
- Romberg
- Heel-to-toe
Meningitis
- Kernigs (lay down, knees to 90 degree angle, straighten)
- Brudzinski’s (lay flat, raise neck which might or might not bring knees up)
- Neck range of motion
