Eyes and Ears Flashcards
Distance between upper and lower eyelid
Palpebral fissure
Hyperthyroidism, upper eyelid doesn’t cover any of the iris
Bulging
Very sick; end stage cancer
Sunken
Droopy, but symmetrical eyelids
Pseudoptosis 
Expected color of the sclera is ___
White
Eyelids and lashes expected finding is that they have an
Even palpebral fissure
A brown spot in the sclera of the eye, could be an expected finding in patients with dark skin
Melanosis
Yellowing of the sclera
Jaundice
A patient with jaundice may indicate
Liver disease
Eyeballs may protrude if patient has ? (3)
Thyroid problems, eye injury, or eye tumor
Lower eyelid sags when patient’s eyes are closed, still revealing an area of the eyeball that is open and at risk for dust and dirt
Ectropian 
Lower lid turns inward and lashes are constantly brushing up against the eyeball
Entropion, opposite of ectropian
Asymmetrical droopy eyelid
Ptosis
Ptosis is a deficit in cranial nerve ___
3
What does PERRLA stand for
Pupils, equal, round, react to light, accommodation
How big (in mm) should pupils be?
3-5 mm
Three expected findings for pupils
A size of 3 to 5 mm, briskly react to light, and are equal and round
In a dimly lit room, swipe a penlight twice over each eye. Patient should NOT have on glasses
The pupillary light reflex test
What is the expected finding for the pupillary light reflex test?
Pupils constrict bilaterally and briskly
After performing the pupillary light reflex test, if the pupils were sluggish or didn’t constrict this indicates ? (4)
A neurological problem, brain injury, medication, or street drugs
Ask patient to focus on a distant object. This dilates the pupils. After a few seconds, have patient look at your finger and bring it a few inches from patient’s nose. 
Accommodation test
Expected finding for accommodation test
Three D’s and three C’s
Three D’s and three C’s
Distance - Dilate and diverge
Close - Constrict and converge
The pupil the light is shining on during pupillary light reflex test
Direct
Pupil the light is not shining on during pupillary light reflex test
Consensual
Three unexpected findings of the pupils
Inequal, oval shaped, or laceration
Seeing two of everything
Diplopia
At a distance of 12 to 18 inches, direct a beam of light that just covers both the eyes of the patient
Corneal light reflex/Hirschberg test
The expected finding for the Hirschberg test is
A symmetrical light reflects centered on both of the pupils
What does the corneal light reflex test tell us about our patient?
That the muscles in both eyes are able to keep the patient’s eyes looking straight
Four types of strabismus
Esotropia, hypertropia, exotropia, hypotropia
Eye turns towards nose
Esotropia
Eye turns up
Hypertropia
Eye turns towards ear
Exotropia
Eye turns downward
Hypotropia
At 12 inches away and a steady head, have patient follow nurses finger with their eyes only in 6 directions. Nurse’s finger creates a cat whiskers pattern
Cardinal Fields of Gaze test/Diagnostic Positions test
Expected finding for the diagnostic positions test
Smooth, coordinated movements and parallel tracking of the eyes
What does the Cardinal fields of Gaze test tell us about our patient if their eye muscles are not working correctly?
We know it’s because cranial nerve three, four, or six are not working correctly, and it could be due to a stroke/brain trauma/brain injury 
A fine, oscillating movement best seeing around the iris
Nystagmus
Nystagmus is ___, but constant nystagmus is ___
Expected; unexpected
Constant nystagmus could be due to ? (3)
Meds, drugs, vertigo
Standing 2 feet from patient, have patient cover one eye and nurse covers her same eye across from the patient. Nurse brings hand in front from other side and wiggles fingers from the sides, below, and above
Confrontation test
Expected findings for confrontation test
50° superior, 70° inferior, 90° temporal, and 60° nasal
What does the confrontation test tell us about our patient?
If our patient has good peripheral vision
The buildup of pressure in the eye. Begins as peripheral loss but can progress to blindness
Glaucoma
Where the nerves cross in the brain
Optic chiasma
If a patient had damage or injury to the LEFT side of their brain past the ___ ___, it might be the RIGHT side of the brain that is impacted
Optic chiasma
Testing one eye at a time, hold a pocket card 14 inches away
Rosenbaum near vision test
Stand 20 feet from patient and have patient cover one eye at a time. Start at the lowest line and allow for one mistake or less. 
Far Snellen test
Expected finding for visual acuity of a 3 y/o
4 y/o?
7 y/o?
20/50
20/40
20/20
 A lighter color appearance at the Olympus 
Arcus senillis
Outer circle of colored iris
Olympus
Progressive loss of vision
Cataracts
Central vision loss
Macular degeneration
General poor vision due to high blood sugar affecting blood vessels in the eye
Diabetic retinopathy
At 65 years old at least __% of people have some type of vision loss, especially cataracts
30
Have patient close one nostril and present a familiar smell like vanilla, orange, or coffee.
What nerve does this test?
Sensory or motor?
Expected finding?
Tests CN 1, olfactory
Sensory
Pt should have symmetrical recognition of smells
Have patient close their eyes and do a light touch on their face with a cotton wisp on both sides of forehead, cheeks, and chin.
What nerve does this test?
Sensory or motor?
Expected finding?
Tests CN 5, trigeminal
Sensory
Pt should recognize where they are touched
Ask a patient to clench their teeth and palpate the muscles for equal strength
What cranial nerve does this test?
Sensory or motor?
Expected finding?
Cranial nerve 5, trigeminal
Motor
Face muscles and strength should be symmetrical
Ask patient to smile, frown, close eyes tightly, lift brows, show teeth, and puff cheeks
What nerve?
Sensory, motor, or parasympathetic?
Expected finding?
Cranial nerve 7, facial
Motor, sensory, and parasympathetic
Expected finding is symmetry
Tests hearing by the ability to hear a normal conversation and by the whispered voice test.
What nerve?
Sensory or motor? 
Expected finding?
CN 8, acoustic
Sensory
Patient should be able to repeat back 3/3 or 4/6 words whispered to them
Press tongue with tongue blade and have patient say “aah”
What cranial nerve?
Expected finding?
Cranial nerve 9, glossopharyngeal
Uvula should hang midline and rise when patient says “aah”
Larynx = ?
Talking
Pharynx = ?
Swallowing and gag reflex
Assessing voice tests what cranial nerve?
Expected finding?
CN 10, vagus
Voice should be smooth and not strained
Have patient rotate their head and shrug shoulders against our resistance
Which nerve?
Sensory or motor?
Expected finding?
CN 11, spinal accessory
Motor
Patient should be able and have symmetrical muscle strength
Ask patient to stick out tongue and move in all different directions
Which nerve?
Sensory or motor?
Pt should be able to say what 3 words clearly?
CN 12, hypoglossal
Motor
Light, tight, dynamite
Absent or diminished smell
Anosmia
Outer ear hearing loss
Conductive hearing loss
Inner ear hearing loss
Sensorineural hearing loss
Foreign body, impacted cerumen, ear infection
Examples of conductive hearing loss
Trauma, bone fracture, noise
Examples of sensorineural hearing loss
Sensorineural hearing loss may affect CN
8
Stand behind patient, have patient listen to a series of numbers and letters, repeat on both sides
Whispered voice test
If patient can’t hear whispers this indicates a ____ loss
High-tone
Strike tuning fork and place it on patient’s forehead or scalp. Ask patient if they can hear the vibration sound in both ears
Weber test
2 expected findings of the weber test?
Patient should be able to hear vibration in both ears. Air conduction = bone conduction
Strike tuning fork and place behind ear on mastoid bone. Time the stimulus. When patient says they can’t hear vibration anymore, move tuning fork to the external portion of the patient’s ear. Time this as well.
Rinne test
Expected finding of Rinne test?
After moving fork to external ear, patient should be able to hear vibration twice as long.
Air conduction > bone conduction.
- Cilia becomes coarse and stiff, drier cerumen
- gradual sensorineural loss
- narrow range of tolerable sounds (can’t stand yelling)
- Has trouble localizing sounds
Developmental changes in the ears the elderly
All newborns are screened for hearing loss before they leave the hospital
1 in the 1-3-6 program
All infants who do not pass the hearing test at birth must have a follow up by three months of age
3 in the 1-3-6 program
If follow up confirms infant has hearing loss, baby must get hearing aids by 6 months
6 in the 1-3-6 program
A soft probe is placed in infant’s ear canal to measure response (echo) when clicks are played in infants ear
Otoacoustic emissions test (OAE)
Clicks are played through soft ear phones placed over babies ears while electrodes on the head measure how the auditory nerve and brainstem carries sound from the ear to the brain
Auditory brainstem response test (ABR)
