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When inspecting the head, what are you looking for?
- Hair (distribution, quantity)
- Scalp (scaling, nevi)
- Skull (size, contour)
- Face (expression, contours)
- Skin (color, pigmentation, hair distribution, lesions)
What are you palpating for during the head exam?
- Hair texture
- Skull (lumps)
- Face (sinuses)
- Skin (texture, temperature)
During inspection of the eyes, what are you looking for?
- Position and alignment of eyes
- - quantity, distribution
- -Width of palpebral fissures (distance between eyebrow)
- - Edema, color, lesions
- - Condition and direction of eyelashes
- - Adequacy of closed eyelids
- Conjunctiva and sclera
- - Color, vascular pattern
- Cornea and lens
- - opacities
- Lacrimal apparatus
- - Lacrimal gland and sac for swelling
- – markings clearly defined
- – size, shape, symmetry, reaction to light (direct and consensual)
How do you test for visual acuity of the eye?
- Central vision:
- -Snellen eye chart; position patient 20 feet from the chart
- -Patients should wear glasses if needed
- -Test one eye at a time
- Near vision:
- -hand-held card (can use news paper or magazine)
- -hold 14 inches from patient’s eyes
When you test extraocularmovements/six cardinal directions of gaze, what are you looking for?
- Normal conjugate movements
- Lid lag
What are the parts of the outer, medial, and inner ear?
Name the parts of the outer ear? (basic anatomy we need to know)
When you inspect the ear, what are you looking for?
Auricle for redness, lesions, note piercings
- o Discharge,foreign bodies, redness, swelling
- Tympanic membrane
- o Color, contour
When you palpate the ear, what are you assessing?
Auricle for lumps, tenderness
What is the conductive phase pathway for hearing?
sound from the external ear through the middle ear. Disorders in these areas cause conductive hearing loss.
What is the sensorineural phase pathway for hearing?
sound involving the cochlea and cochlear nerve. Disorders in these areas cause sensorineural hearing loss.
How do you test for auditory acuity?
Test one ear at a time
Whisper test, standing 1-2 feet beside patient, softly say “nine-four,” “baseball” or “1, 2, 3 “
If hearing is diminished try to distinguish conductive from sensorineural loss. You will need a tuning fork between 512 or 1024 Hz
What is the weber test for hearing?
- Lateralization of sound. Should be heard on both ears so no lateralization
- -Place the base of the lightly vibrating tuning fork on top of the patient’s head or on the mid-forehead.
- -Ask where the patient hears it- on one or both sides. Normally the sound is heard equally in both ears*
- *Because people with normal hearing can lateralize, this test should be restricted to
- those with hearing loss
Describe the Rinne test for hearing
- Compare time of air vs. bone conduction. Normally the sound is heard longer through air than through bone. AC>BC
- -Place base of vibrating tuning fork on the mastoid bone, when the patient can no longer hear the sound, quickly place the fork close to the ear and assess if the sound can be heard. Normally the sound is heard longer through air than bone (AC>BC)
________ have horizontal Eustachian tubes and ____ have sloped Eustachian tubes
Infants and Adults
To examine the ear:
For an ______ examination of internal ear pull
pinna up and back.
For ________pull pinna straight down
adults, young children
When you inspect the nose and sinuses, what are you looking for?
- Anterior and inferior surface – asymmetry or deformity
- Inside of nose
- o Mucosa – color, swelling, bleeding, exudate, ulcers, or polyps
- o Septum – deviation, inflammation, or perforation
- o Turbinates – use otoscope to view middle and inferior turbinates
Where do you palpate for sinuses?
When you examine the mouth and pharynx, what are you looking for?
- Lips (Note color, moisture, lumps, ulcers, cracking, or scaliness)
- Oral mucosa (Note color, ulcers, and nodules)
- Gums and teeth (Note color, presence, and position of teeth)
- Roof of mouth (Note color)
- Tongue and floor of mouth (Note color and texture, ulcers, nodules)
- Pharynx: soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx (Note color, symmetry, presence of exudate, swelling, ulceration, or tonsillar enlargement)
How do you grade tonsils?
When you assess the neck, what are you looking for?
- Range of Motion
- Neck muscles
- Lymph Nodes
- Thyroid Gland
When you palpate the neck, what are you looking for?
- Lymph nodes (size, shape, delimitation, mobility, consistency, tenderness)
- o Preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical chain, supraclavicular
Where are your lymph nodes? Name them!
How do you examine the thyroid gland?
- Flex neck slightly forward
- Place fingers of both hands with index fingers just below the cricoid cartilage
- Ask patient to swallow; feel for the thyroid isthmus rising up under your finger pads (not always palpable)
- Displace trachea to the right and palpate laterally for the right lobe of the thyroid;
- repeat on the left side
- Note the size, shape, and consistency
- Identify any nodules or tenderness
- If enlarged, listen over lateral lobes to detect a bruit
What is Serous Otitis:
eustachian tube cannot equalize the air pressure in middle ear with that of outside air. Occurs w/URI, flying, diving. Amber fluid behind eardrum.
What is Acute Otitis Media?
purulent effusion caused by bacterial infection. Sx include fever, ear pain, hearing loss. TM is red, loses landmarks and bulges
Why are Tympanostomy Tubes placed?
inserted to relieve middle ear pressure and prevent recurrent middle ear infections in children
What is Ptosis?
drooping of upper lid
What is ectropian?
Lower lid is loose and rolls outward
What is entropian?
Lower lid is loose and rolls inward
Pterygium: scar tissue from cornea
Chalazion – usually points inside the lid
Pinguecula – harmless yellow triangular nodule on either side of the iris
What is Subconjunctival Hemorrhage?
leakage of blood outside of the vessels, generally not painful and does not affect vision, may result from trauma or a sudden increase in venous pressure such as heavy coughing
Central gray opacity =
AV Nicking is a disorder of the retina. What is this?
- the vein appears to stop abruptly on either side of the artery.
- Associated with hypertension
TRUE or FALSE. Hypertension can cause damage to the retina of the eye.
What are some funcoscopic changes associated with diabetes
What are cotton-wool patches?
White or grayish ovoid lesions with irregular “soft” borders. Seen in hypertension and many other conditions.
Describe moderate and severe papilledema
associated with increase intracranial pressure
- Moderate- disc is swollen with margins blurred
- Severe – physiologic cup and disc are not visualized
What are some considerations/problems you may see when assessing the head of a neonate? (think shape)
- Molding resolves by 2 days
- caput succedaneum (across suture): days
- to resolve
- Cephalehomatoma: (not across suture line) wks/months to resolve *wear a hat :)
When you should neonates fontanelles close? What do you assess if they are open?
- Posterior Fontanel: birth-2nd month of life
- Anterior Fontanel: 12 -19 months
- Persistent overriding suture lines
Palpate for size, level of tenseness and pulsations
What is Craniosynostosis? (newborn)
small HC or abnormal shaped head -development of the brain and sensory organs is hindered