Uppers Face and Eyes

Question 1

nasal fracture

Answer 1

fracture to nasal bones
most common fracture of the face and skull
S/S
-bleeding
-deformity
-ecchymosis
-tenderness to palpation
check for
-deviated septum
-septal hematoma

Question 2

nose inspection

Answer 2

nose
-alignment - have athlete view in mirror if unsure
-epistaxis
-septum and mucosa
–otoscope or penlight - asymmetry or angulation
eyes and face
-raccoon eyes - periorbital ecchymosis

Question 3

auricular hematoma

• what
• S/S
• Tx
• RTP
• cauliflower ear

Answer 3

buildup of fluid between the skin and cartilage
-commonly seen in wrestling
S/S
-observable and palpable collected fluid between the pinnae
Tx
-refer for draining
RTP
-wear headgear
cauliflower ear
-scarring that results from repetitive hematomas

Question 4

ruptured tympanic membrane

• causes
• S/S
• Tx
• RTP

Answer 4

causes
-direct trauma
-direct puncture
-changes in pressure - URI
S/S
-pain
-hearing loss
-tinnitus
-hear the ocean (echoey)
Tx
-refer for drops
RTP
-ear protection if ear comes into contact with another surface (swimming, wrestling)

Question 5

inner ear exam

Answer 5

pars tensa

-inferior half - transparent/translucent

Question 6

mandibular fracture

• MOI
• most commonly effects
• S/S
• Tx

Answer 6

MOI
-direct blow
most commonly effects the ramus or mental protuberance (chin)
S/S
-swelling or deformity
-malocclusion of the teeth
-intraoral or extraoral ecchymosis
-pain with movement
- + tongue blade test
Tx
-refer

Question 7

zygoma fracture

Answer 7

Russell Westbrook

Question 8

maxillary fracture

Answer 8

can occur with a tooth fracture

Question 9

LeFort fractures

Answer 9

midface fractures
uncommon in athletics
type 1: maxillary bone
type 2: maxillary + nasal bones
type 3: orbit and zygomatic bones
common with airbags/punch

Question 10

temporomandibular joint dysfunction (TMJD)

-MOI

Answer 10

MOI
-lateral blow
teeth malaligned
decreased jaw ROM

Question 11

tooth fractures

Answer 11

class 1
-chip
-lack of pain
class 2
-when dentin is exposed
class 3
-dentin and pulp are exposed
class 4
-dentin and pulp are exposed
-full separation of top and bottom of tooth

Question 12

tooth luxations

Answer 12

partial displacement
-rotational force
intrusion
-tooth compressed into alveolar process
extrusion
-tooth is partially withdrawn
total avulsion
-whole tooth comes out of place
-save the tooth
--Save-a-tooth
-milk
-in something wet (damp gauze)

Question 13

oral cavity

Answer 13

lips

• vermilion border (between lips and skin) laceration
• -referral
• teeth
• -obvious or subtle fractures
• tongue
• lingual frenulum (membrane below tongue)
• gums
• -gingivitis - inflammation of the gums

Question 14

throat injury

Answer 14

respiratory distress
inability to speak/change in voice
loss of consciousness (trauma to carotid sinus)
bruising around the larynx
examine inside of mouth
-bloody sputum
don’t correct deviations - refer immediately

Question 15

eye history

Answer 15

prior visual assessment

general health

Question 16

prior visual assessment

Answer 16

prior visual acuity
corrective lenses
nystagmus
previous injuries
preexisting conditions

Question 17

general health

Answer 17

chronic illness
-ex: diabetes - retinopathy
location and description of Sx
-photophobia
-"something in my eye"
--foreign body
--displaced lens
--corneal abrasion
-"itchy"
--conjunctivitis
injury mechanism

Question 18

eye inspection

Answer 18

trauma to external structures may mask underlying pathology
a normal external eye may still have internal damage
periorbital area
general appearance
eyelids
cornea
globe

Question 19

periorbital area

Answer 19

discoloration
-hematoma
gross deformity
-gross bony deformity
-skin surrounding eye swells easily
-lacerations

Question 20

general appearance

Answer 20

enophthalmos
-eye is sunken back
exophthalmos
-eye protruding out - displacement of globe

Question 21

eyelids

Answer 21

swelling
ecchymosis
lacerations
stye
-inflammation of tear duct

Question 22

cornea

Answer 22

normally clear
-cloudiness –> intraocular pressure
hyphema

Question 23

globe

Answer 23

conjunctiva
-foreign body
-subconjunctival hematoma
sclera
iris
pupil shape and size
-anisocoria
-"teardrop" pupil
--corneal laceration
--ruptured globe

Question 24

eye functional assessment

Answer 24

visual acuity
pupillary reaction to light
eye motility

Question 25

visual acuity

Answer 25

devices
-Snellen eye chart
-near-vision card
-newspaper
-game program
-fingers
monocularly (one eye)
binocularly (both eyes)
wear corrective lenses at the time of assessment

Question 26

pupillary reaction to light

Answer 26

dysfunction

• includes
• -dilation
• -diminished PEARL
• indicates
• -head trauma

Question 27

eye motility

Answer 27

smooth, symmetrical ROM

Question 28

referral of eye injuries from history

Answer 28

loss of all or part of the visual field
persistent blurred vision
diplopia
photophobia
throbbing or penetrating pain around or within the eye
pain when blowing nose
-pain with orbit fracture

Question 29

referral eye injuries from inspection

Answer 29

foreign body protruding into the eye
laceration of the eyelid margin
deep laceration of the lid
inability to open the eyelid because of swelling
protrusion of the globe
loss of corneal clarity
hyphema
pupillary distortion
unilateral pupillary dilation or constriction

Question 30

referral from palpation and function

Answer 30

crepitus or deformity of the orbital rim
restricted eye movement
diplopia occurring with eye movement

Question 31

neurological tests

Answer 31

numbness or paresthesia over the lateral nose and cheek

abnormal pupillary reaction

Question 32

“I feel I have something in my eye”

Answer 32

don't rub the eye
locate the object
-pull the upper eyelid out and ask the patient to look up, down, left, and right
-use a pen light
-evert the eyelid
flush the object
-flush away from the uninvolved eye

Question 33

orbital fracture

• blowout
• S/S
• Tx
• RTP

Answer 33

blowout
-direct blow to the eye
S/S
-may appear sunken back
-bruising
-can't look up
--fractured floor
-diplopia
-pain with blowing nose
Tx
-refer
-some will resolve on own
-may need surgery
RTP
-as soon as 2-4 weeks
-wear protective eyewear for up to 6 months

Question 34

corneal abrasions

• MOI
• S/S
• Tx

Answer 34

MOI
-scrape across the eye
--rock/sand flies into eye and you move the eye around
S/S
-feels like something is in eye
-photophobia
-teary
Tx
-refer
--will prescribe antibacterial and/or numbing drops
-will self-resolve
--minor: 1-2 days
--more major: around a week

Question 35

corneal lacerations

Answer 35

direct trauma to the globe
-usually from sharp object
S/S
-irregularly shaped pupil
--tear-drop
--elliptical
-decreased vision
-potential blood in tears
Tx
-surgically repair
-antibiotics

Question 36

subconjunctival hemorrhage

• MOI
• S/S
• Tx

Answer 36

MOI
-allergies
-straining (lifting)
-trauma
S/S
-redness
Tx
-no trauma - self-resolve
-trauma/other Sx - refer

Question 37

hyphema

• what
• MOI
• S/S
• Tx
• RTP

Answer 37

blood in anterior chamber of eye
MOI
-blunt trauma directly to the eye
S/S
-pain
--from initial blow and intraocular pressure
-blurred vision
Tx
-refer
--upright or semi-reclined
-eyepatch
RTP
-protective eyewear
-high risk for re-bleed

Question 38

detached retina

• problem
• MOI
• S/S
• Tx

Answer 38

disrupts nerve pulses going to eye (optic nerve)
MOI
-jarring force to head
-sneeze
S/S
-visual disturbances
--halos
--flashes of light
--curtain over field of vision
Tx
-refer
-surgical repair

Question 39

traumatic iritis

• secondary to
• S/S
• DDx
• Tx

Answer 39

secondary to blunt trauma
S/S
-photophobia
-red ring around cornea
DDx
-corneal abrasion
-hyphema
-retinal detachment
Tx
-anti-inflammatories
-refer

Question 40

ruptured globe

• MOI
• what happens
• S/S
• Tx

Answer 40

worst possible
MOI
-severe blunt trauma directly to eye
rupture of cornea or sclera
-internal contents come out
S/S
-vision loss
-globe displaced
-swelling
-hyphema
Tx
-shield the eye
-refer