EENT EXAM

Question 1

Visual acuity

Answer 1

• Ask if pt wears corrective lenses
• Near vision with Rosenbaum chart @ 14 inches
• Can do far vision & color with Snellen @ 20 ft

Question 2

Visual fields by confrontation

Answer 2

• assess peripheral vision

Confrontation: 1 foot in front of eye, shoulder length apart, centered around
each eye

Question 3

Position & alignment of eyes:

Answer 3

• Hirschberg corneal reflex: ambient light reflected off of same spot in each eye. o Non-alignment = strabismus
• Note exophthalmus or enopthpalmus

Question 4

eye inspection

Answer 4

• Pull eyelid down and ask pt to look left, right, up, down

* Note redness (injection), jaundice, nodularity

Question 5

inspection of cornea and lens

Answer 5

Look for opacities with oblique light

Question 6

Anterior chamber

Answer 6

• Examine with the penlight or slit aperture
• Look for hyphema (blood in ant chamber), hypopyon (pus) or inflammatory
cells floating in aqueous humor (flare of iritis)

Question 7

Iris:

Answer 7

Use tangential light to assess iris crescent shadow (shine light lateral to medial).
o Sign of increased IOP and acute glaucoma
• Note any irregularity of iris

Question 8

Pupils: PERRLA

Answer 8

• Have pt look off into distance.
• Are Pupils Equal?
o Aniscoria <0.4mm is normal
o Large = >5mm, Small = <3mm
• Are pupils Round?
• Reactive to Light? Shine light obliquely for all o Direct: pupil constricts with direct light
o Consensual: pupil constricts with light into opposite eye
• Accomodation?
o Constriction: pupils constrict when they look at something close to them (ask them to look at your pen, then look in distance to see change)
o Convergence: eyes move inward following object in towards nose

Question 9

Extraocular movements:

Answer 9

• HandXinspace
• Note conjugate movements in all directions, nystagmus (horizontal, or vertical/rotational), lid lag, or subjective diplopia
o Problem with lateral movements = CN6 (Abducens)
o Problem with inferior/medial movement = CN4 (Trochlear) o Any other movement issues = CN3 (Oculomotor)

Question 10

Ophthalmoscopic exam: Adjust diopters to account for refractive error.

Answer 10

• Look at object 20 feet away and get it into focus with diopter to set diopter for your eyes.
• Ask pt if they wear glasses/contacts. Is this for reading(hyperopic/farsighted/green/+) or distance(myopic/nearsighted/red/=)? In a real exam pt should take out contacts.

Question 11

Ophthalmoscopic exam: observe red reflex

Answer 11

do it :)

Question 12

Ophthalmoscopic exam: Locate the optic disc

Answer 12

• Estimate cup-to-disc ratio, note disc outline.
o Cup/disc ratio is normally 0.2-0.5 (cup diameter takes up 20-50% of
disc diameter).
Glaucoma:cup enlarged to 0.8
Papilledema: swelling of disc and bulging ofcup(meningitis,
subarachnoid hemorrhage, etc)
• Normal color: yellowish orange or creamy pink. Cup (inside disc) is usually yellowish white.

Question 13

Ophthalmoscopic exam: Inspect retina, including arteries and veins and crossings

Answer 13

• Follow the vessels peripherally in each of the 4 directions- Superior-Medial,
Inferior-Medial, Inferior-Lateral, Superior-Lateral (go back to center/disc between each direction)
o Note any loss of spontaneous venous pulsations, which may indicate papilledema.
• Examine 4 arterioles and crossings
o Size: Arteries are 2/3 to 3/5 size of veins, bright red, with light reflex o A-V nicking = gaps at crossing indicate thickened wall of artery dt
atherosclerosis.

Question 14

Copper wire arteries

Answer 14

yellow color = hyperlipidemia

Question 15

Silver wire arteries

Answer 15

no light reflex = HTN/arteriosclerosis

Question 16

Mini hemorrhages

Answer 16

green filter makes them look black = indicate

microvascularization all over body

Question 17

Neovascularization

Answer 17

tortuous, proliferative vasculature seen in DM

Question 18

Drusen/Drusen bodies

Answer 18

deposits around macula, cellular debris

Question 19

Opthalmoscopic exam: visualize fovea

Answer 19

Look laterally for fovea and surrounding macula. Do this at end of exam dt light sensitivity.

Question 20

opthalmoscopic exam: anterior chamber

Answer 20

Examine anterior chamber using slit aperture and positive diopters for magnification.
• Note any hypopyon (pus) or hyphema (blood)

Question 21

Ear exam: inspect auricle

Answer 21

Inspect and palpate the auricle and mastoid for tenderness.
2. Apply traction to auricle and examine ear canal with otoscope.
o Noted any swelling, redness, foreign bodies, impacted cerumen or discharge

Question 22

Ear exam: inspect TM

Answer 22

Color: pearly grey (normal), dull or cloudy, amber, red, hemorrhage, blue discoloration, bullae
o Position: bulging, neutral, retracted
o Cone of light:
o Body landmarks: manubrium of malleus should be present o Perforations: marginal or central, location and size
o Mobility using insufflation (not on these GPA instructions)

Question 23

Whispered Voice test

Answer 23

For auditory acuity

Abnormal test is 4/6 incorrect words

Question 24

Weber

Answer 24

512 Hz tuning fork
- Differentiate conductive and sensorineural hearing loss
- Compares bone conduction in both ears
Hittuning fork on shoe, place fork on top of head.
Ask pt if there is a difference in sensation or hearing in one ear. Normal:Hearing/feeling vibration in middle of head.
Conductive loss: lateralizes to bad ear
Sensory loss: lateralizes to good ear

Question 25

Rhinne

Answer 25

Compares air conduction to bone conduction. Pinchtuningfork,placeendonmastoid.Askpttotellyouwhentheyno longer hear it. Thenmovetuningforktorightnexttoear.Askptiftheycanhearit. Normal:Ptcanstillhearitbcairconductionisgreaterthanbone conduction. Conductiveloss:Ptcannotstillhearitbcboneconductionisgreaterthanair conduction. Sensorineuralloss:Bothairconductionandboneconductionarediminished.

Question 26

Nose and Sinus Exam

Answer 26

1. Inspect anterior nares and vestibule 2. Inspect septum for deviation, perforation or inflammation 3. Inspect the nose with an otoscope o Observe nasal mucosa, septum, unusual discharge, bleeding, redness, polyps or swelling of turbinates 4. Palpate the frontal and maxillary sinuses for tenderness

Question 27

Inspect lips:

Answer 27

o Retract lips and cheeks with moistened tongue blade to inspect. o Note color, moisture, lumps, cracking, ulcers or other lesions

Question 28

Inspect oral mucosa:

Answer 28

o Note parotid salivary ducts (inside upper cheeks) | o Note color, pigmentation, ulcers, nodules, leukoplakia, candidiasis.

Question 29

Inspect the gums and teeth:

Answer 29

o Note any dental caries or retraction of the gums, inflammation, bleeding, retraction, missing teeth, fillings, abnormal shape or position.

Question 30

Roof of the mouth:

Answer 30

o Visualize and palpate the hard and soft palate. o Inspect the color and architecture o Note if torus is present.

Question 31

Tongue and the floor of the mouth:

Answer 31

o Have pt stick tongue out and move side to side. Note symmetry (CN12- Hypoglossal). o Inspect the sides and undersurface of the tongue for lesions or ulcerations (MC locations for cancer). o Can retract tongue laterally with gloved hand (esp in smokers and drinkers over 50yo). o Have the patient lift the tongue to inspect the floor of the mouth and the submandibular salivary ducts.

Question 32

Pharynx:

Answer 32

o Inspect the pillars, tonsils and posterior pharynx for redness, exudates and symmetry o Place tongue blade on middle third of tongue and traction forward and down. Pt says "Ahhh" at different pitches. o Grade tonsils 1-4

Question 33

Palpate lymph nodes of the head and neck:

Answer 33

o Preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical and supraclavicular o Note size, shape, mobility, consistency, and any tenderness/inflammation

Question 34

Trachea:

Answer 34

o Inspect for deviation

Question 35

Thyroid gland:

Answer 35

o Look first, then have pt swallow water. Then have pt swallow w your finger in place to feel isthmus. Then palpate isthmus and lobes. o Lateral flexion to palpated side can help with palpation of lobes (spongy). o Use tangential light. o Note size, symmetry, consistency, nodules. Size:Normal=5-20g;1.5-2timesnormal=20-40g;>2timesnormal=>40g Ifenlarged,listenforbruits

Question 36

Carotid artery and jugular veins:

Answer 36

Note any JVD or unusually prominent arterial pulsations