EENT EXAM Flashcards
Visual acuity
- Ask if pt wears corrective lenses
- Near vision with Rosenbaum chart @ 14 inches
- Can do far vision & color with Snellen @ 20 ft
Visual fields by confrontation
- assess peripheral vision
Confrontation: 1 foot in front of eye, shoulder length apart, centered around
each eye
Position & alignment of eyes:
- Hirschberg corneal reflex: ambient light reflected off of same spot in each eye. o Non-alignment = strabismus
- Note exophthalmus or enopthpalmus
eye inspection
- Pull eyelid down and ask pt to look left, right, up, down
* Note redness (injection), jaundice, nodularity
inspection of cornea and lens
Look for opacities with oblique light
Anterior chamber
• Examine with the penlight or slit aperture
• Look for hyphema (blood in ant chamber), hypopyon (pus) or inflammatory
cells floating in aqueous humor (flare of iritis)
Iris:
Use tangential light to assess iris crescent shadow (shine light lateral to medial).
o Sign of increased IOP and acute glaucoma
• Note any irregularity of iris
Pupils: PERRLA
• Have pt look off into distance.
• Are Pupils Equal?
o Aniscoria <0.4mm is normal
o Large = >5mm, Small = <3mm
• Are pupils Round?
• Reactive to Light? Shine light obliquely for all o Direct: pupil constricts with direct light
o Consensual: pupil constricts with light into opposite eye
• Accomodation?
o Constriction: pupils constrict when they look at something close to them (ask them to look at your pen, then look in distance to see change)
o Convergence: eyes move inward following object in towards nose
Extraocular movements:
• HandXinspace
• Note conjugate movements in all directions, nystagmus (horizontal, or vertical/rotational), lid lag, or subjective diplopia
o Problem with lateral movements = CN6 (Abducens)
o Problem with inferior/medial movement = CN4 (Trochlear) o Any other movement issues = CN3 (Oculomotor)
Ophthalmoscopic exam: Adjust diopters to account for refractive error.
- Look at object 20 feet away and get it into focus with diopter to set diopter for your eyes.
- Ask pt if they wear glasses/contacts. Is this for reading(hyperopic/farsighted/green/+) or distance(myopic/nearsighted/red/=)? In a real exam pt should take out contacts.
Ophthalmoscopic exam: observe red reflex
do it :)
Ophthalmoscopic exam: Locate the optic disc
• Estimate cup-to-disc ratio, note disc outline.
o Cup/disc ratio is normally 0.2-0.5 (cup diameter takes up 20-50% of
disc diameter).
Glaucoma:cup enlarged to 0.8
Papilledema: swelling of disc and bulging ofcup(meningitis,
subarachnoid hemorrhage, etc)
• Normal color: yellowish orange or creamy pink. Cup (inside disc) is usually yellowish white.
Ophthalmoscopic exam: Inspect retina, including arteries and veins and crossings
• Follow the vessels peripherally in each of the 4 directions- Superior-Medial,
Inferior-Medial, Inferior-Lateral, Superior-Lateral (go back to center/disc between each direction)
o Note any loss of spontaneous venous pulsations, which may indicate papilledema.
• Examine 4 arterioles and crossings
o Size: Arteries are 2/3 to 3/5 size of veins, bright red, with light reflex o A-V nicking = gaps at crossing indicate thickened wall of artery dt
atherosclerosis.
Copper wire arteries
yellow color = hyperlipidemia
Silver wire arteries
no light reflex = HTN/arteriosclerosis
Mini hemorrhages
green filter makes them look black = indicate
microvascularization all over body
Neovascularization
tortuous, proliferative vasculature seen in DM
Drusen/Drusen bodies
deposits around macula, cellular debris
Opthalmoscopic exam: visualize fovea
Look laterally for fovea and surrounding macula. Do this at end of exam dt light sensitivity.
opthalmoscopic exam: anterior chamber
Examine anterior chamber using slit aperture and positive diopters for magnification.
• Note any hypopyon (pus) or hyphema (blood)
Ear exam: inspect auricle
Inspect and palpate the auricle and mastoid for tenderness.
2. Apply traction to auricle and examine ear canal with otoscope.
o Noted any swelling, redness, foreign bodies, impacted cerumen or discharge
Ear exam: inspect TM
Color: pearly grey (normal), dull or cloudy, amber, red, hemorrhage, blue discoloration, bullae
o Position: bulging, neutral, retracted
o Cone of light:
o Body landmarks: manubrium of malleus should be present o Perforations: marginal or central, location and size
o Mobility using insufflation (not on these GPA instructions)
Whispered Voice test
For auditory acuity
Abnormal test is 4/6 incorrect words
Weber
512 Hz tuning fork
- Differentiate conductive and sensorineural hearing loss
- Compares bone conduction in both ears
Hittuning fork on shoe, place fork on top of head.
Ask pt if there is a difference in sensation or hearing in one ear. Normal:Hearing/feeling vibration in middle of head.
Conductive loss: lateralizes to bad ear
Sensory loss: lateralizes to good ear
Rhinne
Compares air conduction to bone conduction.
Pinchtuningfork,placeendonmastoid.Askpttotellyouwhentheyno
longer hear it.
Thenmovetuningforktorightnexttoear.Askptiftheycanhearit.
Normal:Ptcanstillhearitbcairconductionisgreaterthanbone
conduction.
Conductiveloss:Ptcannotstillhearitbcboneconductionisgreaterthanair conduction.
Sensorineuralloss:Bothairconductionandboneconductionarediminished.
Nose and Sinus Exam
- Inspect anterior nares and vestibule
- Inspect septum for deviation, perforation or inflammation 3. Inspect the nose with an otoscope
o Observe nasal mucosa, septum, unusual discharge, bleeding, redness, polyps or swelling of turbinates - Palpate the frontal and maxillary sinuses for tenderness
Inspect lips:
o Retract lips and cheeks with moistened tongue blade to inspect. o Note color, moisture, lumps, cracking, ulcers or other lesions
Inspect oral mucosa:
o Note parotid salivary ducts (inside upper cheeks)
o Note color, pigmentation, ulcers, nodules, leukoplakia, candidiasis.
Inspect the gums and teeth:
o Note any dental caries or retraction of the gums, inflammation, bleeding, retraction, missing teeth, fillings, abnormal shape or position.
Roof of the mouth:
o Visualize and palpate the hard and soft palate. o Inspect the color and architecture
o Note if torus is present.
Tongue and the floor of the mouth:
o Have pt stick tongue out and move side to side. Note
symmetry (CN12- Hypoglossal).
o Inspect the sides and undersurface of the tongue for
lesions or ulcerations (MC locations for cancer).
o Can retract tongue laterally with gloved hand (esp in smokers and drinkers over 50yo).
o Have the patient lift the tongue to inspect the floor of the mouth and the submandibular salivary ducts.
Pharynx:
o Inspect the pillars, tonsils and posterior pharynx for
redness, exudates and symmetry
o Place tongue blade on middle third of tongue and
traction forward and down. Pt says “Ahhh” at
different pitches. o Grade tonsils 1-4
Palpate lymph nodes of the head and neck:
o Preauricular, posterior auricular, occipital, tonsillar, submandibular, submental,
superficial cervical, posterior cervical, deep cervical and supraclavicular o Note size, shape, mobility, consistency, and any tenderness/inflammation
Trachea:
o Inspect for deviation
Thyroid gland:
o Look first, then have pt swallow water. Then have pt swallow w your finger in place to
feel isthmus. Then palpate isthmus and lobes.
o Lateral flexion to palpated side can help with palpation of lobes (spongy). o Use tangential light.
o Note size, symmetry, consistency, nodules.
Size:Normal=5-20g;1.5-2timesnormal=20-40g;>2timesnormal=>40g
Ifenlarged,listenforbruits
Carotid artery and jugular veins:
Note any JVD or unusually prominent arterial pulsations
