Eye, Ear, Nose And Throat

Question 1

Keratitis

Answer 1

Inflammation of cornea

Question 2

Conjunctivitis

Answer 2

Inflammation of the conjunctiva

Question 3

Scotoma

Answer 3

Areas or specks where a patient is unable to see

Question 4

Scintillation

Answer 4

Flashing or sparkling light, abnormal vision finding

Question 5

Eye structures before the lateral geniculate nucleus

Answer 5

Retina, optic nerve, optic chiasm, optic tract

Question 6

Eye structures after the lateral geniculate nucleus

Answer 6

Optic radiation, visual cortex

Question 7

What is eyeritis?

Answer 7

Erythema haloed or circumferential around the iris of the eye. Usually indicative of a serious complication needing optho consult ASAP

Question 8

Which cranial nerves are you testing if someone can see?

Answer 8

Cranial nerves 3, 4 & 6

Question 9

Testing extraocular movement

Answer 9

Make a wide H in the air, asking the patient to follow you as you move through the six cardinal directions of gaze. Check for smooth, symmetric, nystagmus, lid lag

Question 10

How to test for convergence or accommodation upon completing the test for extraocular movements

Answer 10

Your patient should be able to follow an object within 5 to 8 cm of their eyes. You look for pupillary construction as the eyes converge, making sure they are symmetric and not deviating. Ensure that the patient’s head does not move with your hand moving

Question 11

Esotropia

Answer 11

Obvious misalignment of eyes as eye is uncovered. Nasal medial deviation

Question 12

Exotropia

Answer 12

Obvious misalignment of eyes as eye is uncovered. Temporal lateral deviation

Question 13

Exophoria

Answer 13

Latent misalignment of eyes after eye is covered and then is uncovered. Temporal lateral deviation

Question 14

Esophoria

Answer 14

Latent misalignment of eyes after eye is covered and then is uncovered. Nasal medial deviation

Question 15

AV nicking

Answer 15

And observation through ophthalmic exam which shows an artery in front of the vein looking like it’s cutting the vein in half. Some space may be shown on either side of the artery where the vein should be

Question 16

Documentation of ophthalmoscopic exam

Answer 16

Disc margins are sharp, vessels appear normal without evidence of arteriolar narrowing or AV nicking, No retinal hemorrhages or exudates are seen

Question 17

Eye Exam documentation

Answer 17

Visual acuity 2020 bilaterally, visual fields are intact to confrontation. Gaze is conjugate, EOMs full. Lids and eyelashes appear normal, Perry orbital areas are normal in appearance and nontender to palpation. Sclera or white, palpebral conjunctiva are pink without exudate. Gross examination of the cornea and lens reveal no evidence of lesions. Pupils are 4 mm, round, and symmetric with risk direct or consensual response to light and accommodation (PERRLA).

Question 18

Normal ear canal otoscope finding

Answer 18

Smooth pale flesh toned color of canal

Question 19

Otitis externa otoscope finding

Answer 19

Bacterial infection involving the canal which is quite swollen and erythematous. There may be purulent clear drainage. It’s super painful

Question 20

Seborhheic dermatitis

Answer 20

Note skills without significant signs or symptoms of infection. Often associated with itching. The eardrum is obscured because of edema

Question 21

Cerum impaction

Answer 21

Almost all of the Tim panic membrane is totally obscured

Question 22

Anatomical areas of the eardrum

Answer 22

Pars flaccida, incus, pars tensa

Short process of malleus, handle of malleus, umbo, cone of light

Question 23

perforated eardrum

Answer 23

White arrow seen in otoscopic exam; can see middle of the ear

Question 24

Tympanosclerosis findings

Answer 24

Calcium phosphate & hyaline deposit scar seen on tympanic membrane. Yellow arrow

Question 25

Serous effusion findings on otoscope

Answer 25

amber fluid noted behind eardrum and air / fluid levels; decreased hearing may be found, especially with chronic allergies / asthma

Question 26

acute otitis media otocscope finding

Answer 26

bulging eardrum; most landmarks are obscured. Red tympanic membrane and poor cone of light

Question 27

auditory acuity-whispered voice test

Answer 27

90 - 100% sensitive but not super specific (70 - 87%) Will not detect mild hearing loss- will only detect > 30 db Stand 2 feet behind seated patient and occlude non-test ear w/ finger and gently rub tragus in a circular motion; exhale and then whisper a combo of 3 numbers and letters and repeat with other ear using a different combo. If 4 of 6 numbers and letters are incorrect, test for conductive v. sensorineural hearing loss with 256 or 512 Hz tuning fork

Question 28

Weber test looks for what?

Answer 28

Lateralization of hearing. In unilateral sensorineural hearing loss, sound is heard only in good ear

Question 29

Rinne test looks for what?

Answer 29

Compare air conduction v. bone conduction hearing. If conductive hearing loss BC = AC or BC > AC. If sensorineural hearing loss, AC > BC, which is also a normal finding

Question 30

Ear exam documentation

Answer 30

External ear: Non-tender w/o evidence of lesions, swelling or drainage. Otoscopic: External auditory canal is clear, w/o lesions or drainage. The TMs ar translucent w/ normal landmarks and cone of light. Hearing: Acuity to whispered voice is normal bilaterally. Weber-midline; Rinne AC > BC.

Question 31

What to note regarding color and character of nasal mucosa

Answer 31

Inflammation, pallor, bogginess, swelling, bleeding, exudate, lesions / polyps Septum - deviation, inflammation, perforation, lesions present?

Question 32

Nose documentation

Answer 32

Nose: No external lesions / abnormalities noted. Septum midline, no lesions noted. Nasal mucosa pink. Sinuses: Frontal and maxillary sinuses non-tender to palpation

Question 33

xanthelasma

Answer 33

soft, yellow spot / plaque in groups around eyelid

Question 34

arcus senilis

Answer 34

dull grey / white ring surrounding edges of the cornea; r/t fat deposits / tissue breakdown in cornea

Question 35

Diabetic retinopathy

Answer 35

Disorder of the blood vessels n the retina of the eye; you may see bleeding

Question 36

Papilledema opthalmoscopic exam finding

Answer 36

swelling of optic disk, irregular or non-distinct margins of optic disc