Eye, Ear, Nose And Throat Flashcards
Keratitis
Inflammation of cornea
Conjunctivitis
Inflammation of the conjunctiva
Scotoma
Areas or specks where a patient is unable to see
Scintillation
Flashing or sparkling light, abnormal vision finding
Eye structures before the lateral geniculate nucleus
Retina, optic nerve, optic chiasm, optic tract
Eye structures after the lateral geniculate nucleus
Optic radiation, visual cortex
What is eyeritis?
Erythema haloed or circumferential around the iris of the eye. Usually indicative of a serious complication needing optho consult ASAP
Which cranial nerves are you testing if someone can see?
Cranial nerves 3, 4 & 6
Testing extraocular movement
Make a wide H in the air, asking the patient to follow you as you move through the six cardinal directions of gaze. Check for smooth, symmetric, nystagmus, lid lag
How to test for convergence or accommodation upon completing the test for extraocular movements
Your patient should be able to follow an object within 5 to 8 cm of their eyes. You look for pupillary construction as the eyes converge, making sure they are symmetric and not deviating. Ensure that the patient’s head does not move with your hand moving
Esotropia
Obvious misalignment of eyes as eye is uncovered. Nasal medial deviation
Exotropia
Obvious misalignment of eyes as eye is uncovered. Temporal lateral deviation
Exophoria
Latent misalignment of eyes after eye is covered and then is uncovered. Temporal lateral deviation
Esophoria
Latent misalignment of eyes after eye is covered and then is uncovered. Nasal medial deviation
AV nicking
And observation through ophthalmic exam which shows an artery in front of the vein looking like it’s cutting the vein in half. Some space may be shown on either side of the artery where the vein should be
Documentation of ophthalmoscopic exam
Disc margins are sharp, vessels appear normal without evidence of arteriolar narrowing or AV nicking, No retinal hemorrhages or exudates are seen
Eye Exam documentation
Visual acuity 2020 bilaterally, visual fields are intact to confrontation. Gaze is conjugate, EOMs full. Lids and eyelashes appear normal, Perry orbital areas are normal in appearance and nontender to palpation. Sclera or white, palpebral conjunctiva are pink without exudate. Gross examination of the cornea and lens reveal no evidence of lesions. Pupils are 4 mm, round, and symmetric with risk direct or consensual response to light and accommodation (PERRLA).
Normal ear canal otoscope finding
Smooth pale flesh toned color of canal
Otitis externa otoscope finding
Bacterial infection involving the canal which is quite swollen and erythematous. There may be purulent clear drainage. It’s super painful
Seborhheic dermatitis
Note skills without significant signs or symptoms of infection. Often associated with itching. The eardrum is obscured because of edema
Cerum impaction
Almost all of the Tim panic membrane is totally obscured
Anatomical areas of the eardrum
Pars flaccida, incus, pars tensa
Short process of malleus, handle of malleus, umbo, cone of light
perforated eardrum
White arrow seen in otoscopic exam; can see middle of the ear
Tympanosclerosis findings
Calcium phosphate & hyaline deposit scar seen on tympanic membrane. Yellow arrow
Serous effusion findings on otoscope
amber fluid noted behind eardrum and air / fluid levels; decreased hearing may be found, especially with chronic allergies / asthma
acute otitis media otocscope finding
bulging eardrum; most landmarks are obscured. Red tympanic membrane and poor cone of light
auditory acuity-whispered voice test
90 - 100% sensitive but not super specific (70 - 87%)
Will not detect mild hearing loss- will only detect > 30 db
Stand 2 feet behind seated patient and occlude non-test ear w/ finger and gently rub tragus in a circular motion; exhale and then whisper a combo of 3 numbers and letters and repeat with other ear using a different combo. If 4 of 6 numbers and letters are incorrect, test for conductive v. sensorineural hearing loss with 256 or 512 Hz tuning fork
Weber test looks for what?
Lateralization of hearing. In unilateral sensorineural hearing loss, sound is heard only in good ear
Rinne test looks for what?
Compare air conduction v. bone conduction hearing.
If conductive hearing loss BC = AC or BC > AC.
If sensorineural hearing loss, AC > BC, which is also a normal finding
Ear exam documentation
External ear: Non-tender w/o evidence of lesions, swelling or drainage.
Otoscopic: External auditory canal is clear, w/o lesions or drainage. The TMs ar translucent w/ normal landmarks and cone of light.
Hearing: Acuity to whispered voice is normal bilaterally. Weber-midline; Rinne AC > BC.
What to note regarding color and character of nasal mucosa
Inflammation, pallor, bogginess, swelling, bleeding, exudate, lesions / polyps
Septum - deviation, inflammation, perforation, lesions present?
Nose documentation
Nose: No external lesions / abnormalities noted. Septum midline, no lesions noted. Nasal mucosa pink.
Sinuses: Frontal and maxillary sinuses non-tender to palpation
xanthelasma
soft, yellow spot / plaque in groups around eyelid
arcus senilis
dull grey / white ring surrounding edges of the cornea; r/t fat deposits / tissue breakdown in cornea
Diabetic retinopathy
Disorder of the blood vessels n the retina of the eye; you may see bleeding
Papilledema opthalmoscopic exam finding
swelling of optic disk, irregular or non-distinct margins of optic disc
