ENT, Ophthalmic exam Flashcards
superficial temporal artery
passes right above ear where it is readily palpable
parotid gland
superficial and lies behind of the mandible becoming visible and mandible when enlarged
submandibular glands
deep to mandible below tongue w/ duct visible w/in oral cavity
common or concerning symptoms of HEENT
headache change in vision resulting in hyperopia, presbyopia, myopia, or scotomatas double vision (diplopia) hearing loss, earache, or tinnitus vertigo
Upper eyelid
covers portion of iris but does not cover pupil. opening between eyelids is palpebral fissure
sclera
white buff colored at periphery
conjuctiva
clear mucous membrane w/ two easily visible components
bulbar conjunctiva- covers most of anterior eyeball adheres loosely to underlying tissue and meets cornea at limbus
palpebral conjunctiva- lines upper and lower eyelids two parts merge in folded recess that permits movement of eyeball
Conjunctival injection: diffuse dilatation of conjunctival vessels with redness that tends to be maximal peripherally Mild discomfort rather than pain Vision is not affected except for temporary mild blurring due to discharge Watery, mucoid, or mucopurulent. Due to varied causes
Bacterial- crusted nasty stuff
Viral-
Allergic- bilateral in both eyes can see changes in conjunctiva cobblestone look
tarsal plates
w/in eye lid lie firm strips of connective tissue each plate contains parallel row of meibomian glands which open on lid margin.
levator palpebrae
muscle of upper eyelid
tear fluid
protects conjunctiva and cornea from drying and infection comes from lacrimal gland, conjunctiva glands, and meibomian glands
lacrimal gland
above eye drains medially through lacrimal punta and passes into lacrimal sac and onto nose through nasolacrimal duct atop small elevatoion of lower lid medially. sac rests inside bony orbit. and is not visible
Dacryocystitis swollen infected lacrimal sac.
Unlike in dry eye do not push on canthus to try and express fluids leading you to think of blocked lacrimal apparatus.
If blocked duct swollen not red and may be painful can push
cornea
transparent anterior portion of outer covering of eye
iris
: ciliary bodies control thickness of lens and allow for focusing, muscles of iris control size of pupil
ciliary body
muscles of this control thickness of lens allowing eye to focus on near or distant objects
produces clear liquid aqueous humor which helps control pressure inside eye and drains out through canal of schlem
fundus
posterior part of eye seen through otoscope.
optic nerve
enters eye posteriorly find it w/ opthalmoscope of optic disc where retinal arteries and veins converge. follow retinal vessels ventrally
fovea
lateral and slightly inferior to disc is darkened circular area surrounds small depression in retinal surface that marks point of central vsion
macula
surrounds fovea w/ no discernible margins no retinal vessels
retina
light sensitive membrane that covers fungus,
vitreous body
transparent mass of gelatinous material fills eyeball not usually visible through ophthalmoscope helps maintain shape of eye
seeing an image
light reflected from image must pass through pupil and be focused on sensor neurons in retina. image projected on retina upside down and reverse left to right. nerve impulses stimulated by light conducted through retina, optic nerve, and optic tract into brain.
snellen eye chart
have patient stand 20 ft. don’t wear reading but other contact or glasses. hold card over left eye and read smallest line possible on both eyes
first number equals distance of patient from chart second number distance at which normal eye can read line of letters
deter lesions in anterior and posterior pathway
static finger wiggle test
place hands 2 feet apart lateral to patients ears slowly move your wiggling finger of both hands along the imaginary surface of bowl toward central vision line have patient tell you when they see it. map out maximum extent of left and right monocular vision fields. if defect do boundaries to one eye at time look at opposite eye from defective toward center
kinetic red target test
move 5mm red topped pin along the boundary of each quadrant along a line bisecting the horizontal and vertical meridians have patient tell you when the pin first appears to be red. insect patients eye for position and alignment, width of palpebral fissures, edema and color, lesions, and condition and direction of eyelashes, adequacy of eyelid closure (when prominent, facial paralysis or when patient unconscious