Eyes and Ears

Question 1

Presence of excessive tearing may indicate what?

Swelling of the lacrimal gland may show as what?

Answer 1

Blockage of the nasolacrimal duct. Regurgitation of fluid out of the puncta confirms blockage.

A visible bulge in the outer part of the upper lid.

Question 2

What is the resting size of the pupil in the adult?

Answer 2

3-5 mm

Question 3

A small number of people (5%) have pupils of two different sizes, termed?

Answer 3

Anisocoria

Question 4

How do you test the pupillary light reflex?

Answer 4

Darken room and ask person to gaze into the distance to dilate the pupils. Advance a light from the size and notice response.
Should see construction of the same-sided pupil (a direct light reflex) and simultaneous constriction of the other pupil (a consensual light reflex)

Question 5

How do you text for accommodation of the pupils?

Answer 5

Person focuses on distant object. Person shifts gaze to near object such as examiners finger held about 7-8 cm/3 in from persons nose.
Normal includes pupillary restriction and convergence of the axes of the eyes.

Question 6

What does PERRLA stand for?

Answer 6

Pupils equal, round, react to light and accommodation

Question 7

What is the unit of strength on each lens in an ophthalmoscope?
Black and red numbers?

Answer 7

Diopter
The black numbers indicate a positive diopter, they focus on objects near in space to the scope.
The red numbers show a negative diopter and are for focusing on objects farther away.

Question 8

How do you inspect the media?

Answer 8

Select large aperture with white light. They stare at distant object. Begin about 25cm/15in away at an angle 15 degrees lateral to person’s vision. Note red reflex, keeping sight and moving closer to the eye. Adjust lens to +6 and note any opacities in the media. These appear as dark shadows or black dots interrupting the red reflex.

Question 9

How do you inspect the ocular funds?

Answer 9

After inspecting media, adjust diopter setting to bring fundus into focus. If everyone has normal vision this should be at zero. (Use red for nearsighted and black for farsighted). Inspect structures: optic disc, retinal vessels, general background, and macula.

Question 10

When inspecting optical disc what should be found?

Answer 10

Color: creamy yellow-orange to pink
Shape: round or oval
Margins: distinct and sharply demarcated, nasal edge may be slightly fuzzy
Cup-disc ratio: Distinctness varies. Physiologic cup is brighter yellow-white than rest of the disc. Width is not more than one-half the disc diameter.

Question 11

Normal variation. Gray-white new moon shape hat occurs when pigment is absent in the choroid layer and you are looking directly at the sclera.

Answer 11

Scleral crescent

Question 12

Normal variation, black, caused by an accumulation of pigment in the choroid.

Answer 12

Pigment crescent

Question 13

The globe of the eye is longer than normal and light rays focus in front of the retina

Answer 13

Myopia, nearsighted.

Compensate by using a negative diopter (red or concave lens)

Question 14

The globe of the eye is shorter than normal. Light rays would focus behind the retina if they could pass through.

Answer 14

Hyperopia, farsighted.

Compensate by using a positive diopter (black or convex lens)

Question 15

Hearing loss involving a mechanical dysfunction of the external or middle ear. A partial loss because the person is able to hear if the sound amplitude is increased enough to reach normal nerve elements in the inner ear.

Answer 15

Conductive hearing loss.
May be caused by impacted cerumen, foreign bodies, perforated tympanic membrane, pus or serum in the middle ear, and otosclerosis

Question 16

Hearing loss that signifies pathology of the inner ear, cranial nerve VIII, or auditory areas of the cerebral cortex. Increase in amplitude may not help hearing.

Answer 16

Sensorineural/perceptive
May be caused by presbycusis, a gradual nerve degeneration that occurs with aging. Or ototoxic drugs, which affect hair cells in the cochlea.

Question 17

A combination of conductive and sensorineural hearing loss in the same ear.

Answer 17

Mixed loss

Question 18

A common cause of conductive hearing loss in young adults between the ages of 20 and 40 years.

Answer 18

Otosclerosis. A gradual bone formation that causes the footplate of the stapes to become fixed in the oval window, impeding the transmission of sound and causing progressive deafness.

Question 19

Assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance

Answer 19

Romberg test

Question 20

When examining a child, where should the ears be positioned?

Answer 20

The top of the pins should match an imaginary line extending from the corner of the eye to the occiput. The ear should also be positioned within ten degrees of vertical