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Eye and ENT Examination. Ear, Nose, and Throat Anatomy.

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Presentation on theme: "Eye and ENT Examination. Ear, Nose, and Throat Anatomy."— Presentation transcript:

1 Eye and ENT Examination

2 Ear, Nose, and Throat Anatomy

3 Oral Cavity Pharynx Pharynx Uvula Uvula Tonsils Tonsils

4 Lymph Nodes 1 - Anterior cervical 1 - Anterior cervical 2 - Posterior cervical 2 - Posterior cervical 3 - Preauricular 3 - Preauricular 1 3 2

5 Ears Pinna

6

7 Ear Examination 3 steps 3 steps Outer earOuter ear CanalCanal Inner earInner ear General inspection and palpation (outer ear) General inspection and palpation (outer ear) Otoscopic examination (canal and inner ear) Otoscopic examination (canal and inner ear)

8 Outer Ear Exam Look for deformities, lumps, skin lesions (eg. Herpes lesions, hematomas) Look for deformities, lumps, skin lesions (eg. Herpes lesions, hematomas) Associated structures Associated structures Lymph nodesLymph nodes PharynxPharynx Eustachian tubeEustachian tube

9 Ear Canal and Inner Ear Exam Use proper sized otoscope tip Use proper sized otoscope tip Turn on otoscope and check that light works Turn on otoscope and check that light works Pull ear up, back, and toward you Pull ear up, back, and toward you Use pinky finger for support and to prevent injury Use pinky finger for support and to prevent injury Place otoscope tip in ear canal, then lean forward and start looking into the otoscope Place otoscope tip in ear canal, then lean forward and start looking into the otoscope

10 Ear Canal Exam Look for redness, swelling, discharge, foreign bodies, wax Look for redness, swelling, discharge, foreign bodies, wax Pain with tragus and pinna manipulation can indicate problem with canal, as opposed to inner ear Pain with tragus and pinna manipulation can indicate problem with canal, as opposed to inner ear

11 Examination of TM The TM is clear (transparent) when light passes through the membrane The TM is clear (transparent) when light passes through the membrane The TM is dull (opaque) when light does not pass through the membrane so that the bony landmarks can not be clearly seen The TM is dull (opaque) when light does not pass through the membrane so that the bony landmarks can not be clearly seen

12 Bulging TM The bulging often impairs the visibility of the landmarks The bulging often impairs the visibility of the landmarks

13 Lymph Nodes 1 - Anterior cervical (pharyngitis) 1 - Anterior cervical (pharyngitis) 2 - Posterior cervical (mono) 2 - Posterior cervical (mono) 3 – Preauricular (conjunctivitis) 3 – Preauricular (conjunctivitis) 1 3 2

14 Lymph Nodes Roll the lymph node area under the pads of your fingers, compressing it against the underlying structures Roll the lymph node area under the pads of your fingers, compressing it against the underlying structures Feel for size and tenderness Feel for size and tenderness Check for symmetry Check for symmetry Is there an enlarged gland that just happens to be on the side of the earache or sinus pressure?Is there an enlarged gland that just happens to be on the side of the earache or sinus pressure?

15 Sinuses Grasp head fairly firmly, and push with thumbs on the frontal and maxillary areas Grasp head fairly firmly, and push with thumbs on the frontal and maxillary areas For ethmoid sinuses, squeeze firmly between eyes with thumb and index finger For ethmoid sinuses, squeeze firmly between eyes with thumb and index finger Evaluate for tenderness Evaluate for tenderness Fairly nonspecific Fairly nonspecific

16 Eye Examination 4 components 4 components 1 - Visual acuity (Snellen eye chart) 1 - Visual acuity (Snellen eye chart) 2 - Visual fields (by confrontation) 2 - Visual fields (by confrontation) 3 - Extra ocular movements (“H”) 3 - Extra ocular movements (“H”) 4 - Ophthalmoscopic examination 4 - Ophthalmoscopic examination

17 1- Visual Acuity Exam Use a Snellen eye chart Use a Snellen eye chart 20 feet from chart20 feet from chart Read at least half of each lineRead at least half of each line Read posters, magazines, newspaper if nothing else is available Read posters, magazines, newspaper if nothing else is available

18 2 - Visual Fields Exam (by Confrontation) Have patient cover one eye lightly and look at your nose Have patient cover one eye lightly and look at your nose Stand facing patient (confronting them) holding hands out to sides Stand facing patient (confronting them) holding hands out to sides Check upper fields by wiggling fingers of one or both hands Check upper fields by wiggling fingers of one or both hands Repeat for lower fields Repeat for lower fields Repeat for other eye Repeat for other eye

19 3 - Eye Movements Exam (Extra ocular movements) Ask patient to look at your fingers Ask patient to look at your fingers Keep head still. Stabilize chin if needed Keep head still. Stabilize chin if needed Make large “H” Make large “H” Convergence test (bring finger to their nose) Convergence test (bring finger to their nose) Cross eyedCross eyed

20 4 - Ophthalmoscopic Exam Adjust proper settings on scope (light intensity, light shape, light color, focus) Adjust proper settings on scope (light intensity, light shape, light color, focus) Position patient and adjust ambient lighting Position patient and adjust ambient lighting Start laterally from a distance and obtain red reflex, then approach steadily as if peering through a keyhole Start laterally from a distance and obtain red reflex, then approach steadily as if peering through a keyhole If lots of glare, use a smaller diameter light setting If lots of glare, use a smaller diameter light setting Find optic disc directly or by following a blood vessel from narrower aspect to wider aspect, which will lead you to the optic disc Find optic disc directly or by following a blood vessel from narrower aspect to wider aspect, which will lead you to the optic disc

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22 Quiz Time

23 Generally speaking, you don’t have to worry about rupturing a patient’s tympanic membrane with a typically placed otoscope tip because, a. The tympanic membrane is tough like shoe leather b. They still have another good ear anyway! c. The canal is about 1 inch deep c

24 Anterior cervical nodes only Anterior and posterior cervical nodes Preauricular nodes Possible Diagnoses – Herpes infection on temple, mono, tonsillitis Tonsillitis Mono Herpes Match the Swollen Lymph Nodes!

25 If you were to tug on someone’s pinna or poke someone’s tragus you would expect, a. A slap b. Pain which could indicate an acute otitis media c. Pain which could indicate otitis externa c

26 To look in a person's ear, you would move the pinna in the following direction. a. Down and out b. Up, back, and toward you c. Straight up d. Consult your GPS, then proceed as directed b

27 If you were looking in a healthy right ear, you would expect to see which of the following? a. The cone of light to the left b. Our new kitty from last year c. Same cat this year d. A shiny, somewhat transparent-appearing tympanic membrane d

28 Matching Game? If you wanted to evaluate someone’s visual acuity, you would (choose either best, pretty good, bad, or stupid!), Ignore their complaint of decreased vision altogether Use a Snellen eye chart Poke them in the eye with your ophthalmoscope Have them read from a magazine Stupid Pretty good Bad Best

29 Which of the following is the single greatest scientific achievement of all time? Einstein’s theory of relativity. The concept of the number “0”. Darwin’s discovery of Evolution. Vaccination. None of the above. It’s the Mr. Clean Magic Eraser.


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