HENT Flashcards
Visual Acuity
CN11
Hearing
CNVIII
EOMs
CN III, IV, VI
Facial expression
CN VII
Mastication
CN V
Soft touch face
CN V
Soft plate
CN IX, X
Movement of tongue
CN XII
Head and movement
CN XI
Alopecia Areata
autoimmune, hair loss
Androgenic alopecia
Receding, thinning hair
Inspect hair for
Lice, nits, hair loss, seborrheic dermatitis
Face inspection
Asymmetry, lesions, rashes, swelling
Facies
Cushings syndrome
Acromegaly
large bones, elongated, prominant, growth hormone
Myedema
periorbital edema, hair is thin,severe hypothyroidism
Nephrotic syndrome
edematous, slitlike eyes, swelling around eyes
Cushing
moon facies, red cheeks
Parotid gland
swelling around parotid gland, anterior lobes, above angles of jaw,
Parkinsons
decreased facial movement, drooling, masklike,
Palpation of Face
tenderness, palpate sinuses
TMJ palpation
listen for clicks and check ROM, open close, side to side, chench teeth CNV
CV V sensory test
touch 3 areas (opthalmic, maxillary, mandibular), touch all 3 areas using cotton tip
Facial CN VII
Raise eyebrows
Squint, smile, frown, puff out cheek
Bells Palsy
7th nerve, droop, flattened nasolabial fold,
-tape eye shut while sleeping to prevent corneal abrasion
idiopathic
-dx between stroke, ask if forehead wrinkle remains
Assessing Temporal Artery
palpate
assess bruis
Giant cell arteritis
PMR, elevated ESR
Jaw claudication, HA
adults >50
-increase risk of stroke and blindness with increase of PMR
Eye anatomy
Pupil, medial canthus, limbus, lateral canthus
Lacrimal apparatus: sac, gland, puncta, nasolacrimal duct
Eyelid anatomy
Tarsal plates, Meibomian glands (sebaceous)
Bulbar conjunctiva: covers anterior eyeball
Palpebral conjunctiva: covers inner eyelides
Snellen Chart
test central vision at 20 feet
myopia
Rosembaum
14 inches
presbyopia (impaired near vision)
Lacrimal apparatus
look for excess tearing/dryness
Bulbar conjunctiva
injection, icterus
Palpebral conjunctiva
pallor
Pupils
look for equality and pupillary reaction
near far accomodation
-convergence: both eyes moving at same time
Pupils PERRL
Equal round reactive to light
Miosis
excessive constriction
Mydriasis
excessive dilation
Anisocoria
pupils unequal size
Direct pupillary reflex
pupil constricts on same side as light
Consensual pupillary light reflex
constriction in opposite eye
Near-far accommodation
Patient focuses on object 10 cm away then focus on object 6 feet away
watch for pupilary constriction with near effort, dilation with distance
Narrows with near
Dilates with distance
Extraocular Muscles (EOMI) H pattern
Draw H pattern,
just move eyes
watch for nystagmus» seen in neuro conditions
-convergence with near vision after H pattern
Extraocular Movements
Lateral Rectus: CNVI
Superior Oblique CNIV
Others CNIII
Corneal Light Reflex
Shine light into patients eyes, tests for conjugate gage
Eyelid examination
edema, lesions, width of palpebral fissures
- Ptosis seen with CNIII (drooping eyelid)
- Incomplete closure with CNVII
Chalazion
Nontender blocked gland points inside eyelid
Hordeolum (Stye)
Tender, red infection, margin of eyelid
Staph aureus
Inner eyelid:Obstructed Meibomian gland
Outer lid: obstructed eyelash follicle or tear gland
Dacryocystitis (Lacrimal Sac Inflammation)
Nasolacrimal sac, secondary block of nasolacrimal duct
swelling between base of nose and eye
Causes of periorbital edema
Contact dermatitis
Allergic reaction
Cellulitis
Trauma
Entropion
Inward lid
irritation of conjunctiva, cornea
elderly
Ectropion
outward turning
elderly
tearing excess
Pingueculum
Yellow triangular growth, harmless, vision WNL
Pterygium
Interfere with vision
pterygium wing across eye
slowly across cornea
Scleral Icterus
Yellow discoloration of sclera, elevated bilirubin
Jaundiced skin
Xanthelasma
raised, yellow, well-circumscribed cholesterol filled plaques around eyelids
HLD
Conjuctivitis
Viral vs bacterial
Allergic vs irritant
Exopthalmos
abnormal protrusion of eyeball, lid retraction,
Graves disease (thyroid)
Thyroid dysfunction (hypothyroidism) is 1/3 lateral third of eyebrow
Episcleritis
Self limiting
benign
localized ocular inflammation of episceleral
vessels
autoimmune
Subconjuctival Hemorrhage
hx of cough, sneeze
self limiting,
asymptomatic
goes away
Hyphema
secondary trauma
vision threatening
alot more blood
anterior chamber blood
Corneal Abrasion
foreign body, photophobia, increase lacrimation, contacts
scratch on eye
Corneal Chemical Burn
hx of liquid of gas
immediate prolonged irrigation
Eye puncture
puncture wound with hemorrhage and asymmetric, non reactive dilated pupil
Cataract
older age
RF: corticosteroid use, ETOH, smoking, DM
clouding of lens
causes painless progressive of vision loss
Cobalt filter
fluorescein staining to visualize lesions
Tips for opthalmic exam
Darken room
use small or large round beam of light on scope
Disc to 0 diopters, ask patient to look over shoulder at fixed point
Follow blood, vessels centrally to find optic disc, adjust diopter dial to adjust focus
Cup to disc ratio 1:2
Veins are larger and darker than arteries
Hand positioning
R hand, R eye Pt R eye
