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
- 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?
-Snellen eye chart; position patient 20 feet from the chart
-Patients should wear glasses if needed
-Test one eye at a time
-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
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
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
When you palpate the neck, what are you looking for?