A perceived sound that has no external stimulus
The perception that the patient or environment is rotating or spinning
refers to drainage from the nose and is often associated with nasal congestion, a sense of stuffiness or obstruction
Bleeding from the nose
enlarged thyroid gland
inequality in the diameter of the pupils
constriction of the pupils
dilation of the pupils
fine rhythmic oscillation of the eyes
swelling of the optic disc and anterior bulging of physiological cup
inflammation of the ear canal
Most common symptom in clinical practice?
Difficulty with close work suggests?
Hyperopia (Farsightedness), or presbyopia (aging vision)
If sudden unilateral visual loss is painless consider?
Vitreous hemorrhage, macular degenartion, retinal detachment, retinal artery occlusion.
If sudden unilateral visual loss is painfull consider?
Causes are usually in the cornea and anterior chamber such as a coneal ulcer, uveiteis, traumatic hyphema, acute glaucoma, and optic neuritis.
Bilateral visual loss?
Painless= medications that change refraction such as cholinergics, anticholinergics, and steroids. Painful= chemical or radiation.
Specs in the vision, or areas where a patient cannot see. Suggest lesions
Moving specks or strands in the vision.
Conductive hearing loss
Results from problems in the external or middle ear. Ask pt "do you have trouble understanding people speak?"
Results from problems in the inner ear, the cochlear nerve, or it's central connections in the brain. Ask pt "What diff. does a noisy environment make?"
Causes of epistaxis
Trauma, inflammatory disorders, structure abnormalities, or bleeding disorders
How do you easily evaluate thyroid gland?
Ask patient about temperature intolerance and sweating. "Do you prefer hot or cold weather?" "Any new palpitations or changes in weight?"
What effect do medications have of salivary flow?
They commonly decrease salivary flow.
Important areas to examine on the head?
Hair, scalp, skull, face, and skin.
2 components of conjuctiva
Bulbar conjuctiva (covers the anterior eyeball) Palpebral conjuctiva (lines the eyelids)
Increased convexity of lenses. Brings near objects into focus.
Autonomic nerve that produces dialation?
Autonomic nerve that produces constriction?
Muscle most responsible for right eye movement?
Right inferior rectus (CN III)
Muscle most responsible for left eye movement?
Left Superior oblique (CN IV)
Important areas to examine in the eyes?
Visual acuity, visual field, conjunctiva and sclera, cornea, lens, pupils, extraocular movements, fundi (opitic disc & cup, retina, retina vessels)
Should a pt. with reading glasses use them during snellen eye chart exam?
No, only regular glasses permitted
20/30, what does this mean?
First number indicates the distance of the patient from the chart. The second indicates the distance at which a normal eye can read the line of letters. So 20/30 means the pt can read at 20 ft. what a normal eye can read at 30 ft.
Scalliness around eye. Example of why it's imp. to inspect eyelids/eyebrows
What do you inspect on the pupils?
Size, shape, & symmetry. 1mm of size diff. considered normal.
Fine oscillations in the eye. Pay att. to which way the nystagmus occurs and record this.
Left cranial nerve disorders of eye movement.
Paralysis of CN VI, IV, III
Abnormal protrusion of the eyeball in hyperthyroidism, leading to a characteristic "stare"
What do you inspect on the optic disc?
Sharpness, color, size, symmetry.
How do you descibe lesions position in the eye?
Give clock directions from optic disc & relative distances. EG: 3 O'clock from optic disc, at a distance of 12 optic discs.
Bypasses external & middle ear and directly stimulates cochlea.
When inspecting ear drum you should note?
Handle of the malleus along with it's position, and the short process of the malleus.
Placing the tuning fork on top of the pt. head to test for lateralization.
Compares Air conduction (AC) with bone conduction (BC). Place fork on mastoid process, then quickly place next to ear canal comparing how long pt could hear the tuning fork in each location.
conductive hearing loss
sound is heard as long or longer through bone than air.
Sensorineural hearing loss
Sound is heard longer through air.
What to observe in the nose/paranasal sinus
Nasal mucosa (color, edema, bleeding, or exudate), nasal septum (deviation, edema, perforation), abnormalities (ulcers or polyps)
What do you inspect on the oral mucosa?
Color, ulcers, white patches, nodules.
Mandible, sternomastoid laterally, and midline of the neck.
Sternomastoid, trapezius, and clavicle.
Tender lymph node suggests?
Hard or fixed lymph nodes suggest?
How do you correctly ID a lymph node?
You should be able to roll a node in 2 directions: up and down, & side to side. Neither a muscle or an artery will pass this test.
Enlarged thyroid gland.
Objective measuring tool to measure protruding eyes. Upper limits of normal are 20 mm in whites and 22 mm in blacks.
Swinging flashlight test
Functional test for impairment within the optic nerves. As you swing the light onto one eye the other should dilate as well.