9 Ear Canal and Inner Ear Exam Use proper sized otoscope tipTurn on otoscope and check that light worksPull ear up, back, and toward youUse pinky finger for support and to prevent injuryPlace otoscope tip in ear canal, then lean forward and start looking into the otoscope
10 Ear Canal ExamLook for redness, swelling, discharge, foreign bodies, waxPain with tragus and pinna manipulation can indicate problem with canal, as opposed to inner ear
11 Examination of TMThe TM is clear (transparent) when light passes through the membraneThe TM is dull (opaque) when light does not pass through the membrane so that the bony landmarks can not be clearly seen
12 Bulging TMThe bulging often impairs the visibility of the landmarks
14 Lymph NodesRoll the lymph node area under the pads of your fingers, compressing it against the underlying structuresFeel for size and tendernessCheck for symmetryIs there an enlarged gland that just happens to be on the side of the earache or sinus pressure?
15 SinusesGrasp head fairly firmly, and push with thumbs on the frontal and maxillary areasFor ethmoid sinuses, squeeze firmly between eyes with thumb and index fingerEvaluate for tendernessFairly nonspecific
17 1- Visual Acuity Exam Use a Snellen eye chart 20 feet from chartRead at least half of each lineRead 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 noseStand facing patient (confronting them) holding hands out to sidesCheck upper fields by wiggling fingers of one or both handsRepeat for lower fieldsRepeat for other eye
19 3 - Eye Movements Exam (Extra ocular movements) Ask patient to look at your fingersKeep head still. Stabilize chin if neededMake large “H”Convergence test (bring finger to their nose)Cross eyed
20 4 - Ophthalmoscopic Exam Adjust proper settings on scope (light intensity, light shape, light color, focus)Position patient and adjust ambient lightingStart laterally from a distance and obtain red reflex, then approach steadily as if peering through a keyholeIf lots of glare, use a smaller diameter light settingFind optic disc directly or by following a blood vessel from narrower aspect to wider aspect, which will lead you to the optic disc
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 leatherb. They still have another good ear anyway!c. The canal is about 1 inch deepc
24 Match the Swollen Lymph Nodes! Anterior cervical nodes only Anterior and posterior cervical nodes Preauricular nodesTonsillitisMonoHerpesPossible Diagnoses – Herpes infection on temple, mono, tonsillitis
25 If you were to tug on someone’s pinna or poke someone’s tragus you would expect, a. A slapb. Pain which could indicate an acute otitis mediac. Pain which could indicate otitis externac
26 To look in a person's ear, you would move the pinna in the following direction. a. Down and outb. Up, back, and toward youc. Straight upd. Consult your GPS, then proceed as directedb
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 leftb. Our new kitty from last yearc. Same cat this yeard. A shiny, somewhat transparent-appearing tympanic membraned
28 Matching Game? If you wanted to evaluate someone’s visual acuity, you would (choose either best, pretty good, bad, or stupid!),BadIgnore their complaint of decreased vision altogetherUse a Snellen eye chartPoke them in the eye with your ophthalmoscopeHave them read from a magazineBestStupidPretty good
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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