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Bates Reading: Eye Examination (pages 205-222,244,254-267)
- Pathway for pupillary light reactions and near reactions
- Pupillary Light Rxn = Occulomotor.
- Autonomic nerve supply to the eye
- Occulomotor parasympathetic
- Nerves and muscles involved in the six cardinal directions of gaze
- Lateral, medial, superior, inferior rectus. Inferior and superior oblique.
- The meaning of the two numbers expressing visual acuity
- 20/30 means at 20 feet you can read something that normally is read at 30 feet.
- Miosis vs. mydriasis vs. anisocoria
- Miosis = constriction of pupils
- Mydriasis = dilation of pipls
- Anisocoria = papillary inequality of more than 0.5mm
- Nystagmus and What is normal vs. abnormal:
- Nystagmus normal = rhythmic oscillation of eye. A few is normal, but sustained is abnormal.
- Lid lag and its significance:
- The lid “lags” (almost closes) when you look downwards. If you have hyperthyroidism, the rim of sclera is visible above iris with downward gaze.
- How to use an ophthalmoscope:
- Hold with right hand to examine right eye.
- Hold 15 degrees lateral to patient’s line of vision.
- Examining the optic disc and retina including differentiating veins and arteries
- Locate optic disc
- Look at the angle the arteries branch to know where to trace optic disc
- If patient nearsighted, adjust more negative.
- Significance of an absent red reflex
- Cataract, retinoblastoma, detached retina
- Changes seen on retinal exam with chronic open angle glaucoma
- Enlarged cup
- Significance of loss of venous pulsations
- Elevated intracranial pressure.
- Abnormalities of the eyelid
- Ptosis – myasthenia gravis, damage to oculomotor nerve, horner’s syndrome
- Entropion – inward turning of lid margin
- Ectropion – outward turning of lid margin – eye can’t drain well.
- Causes of red eyes
- Subconjunctival Hemorrhage
- Corneal injury or infection
- Acute iritis
- Pupillary abnormalities
- Anisocoria – unequal pupils – impaired parasympathetic (occulomotor), Horner’s Syndrome
- Small, irregular pupils – can be caused by syphilis.
- Swelling of optic disc, bulging of physiologic cup, due to increased intracranial pressure transmitted to optic nerve. Caused by meningitis, subarachnoid hemorrhage, trauma, etc.
- Hypertensive changes of the retina
- Arteriolar-venous crossing changes
- Copper wiring of arterioles
- Cotton-wool spot
- Diabetic changes of the retina
- Red dots – microaneurysm, hemorrhage
- Neovasularization (if proliferative)
Bates Reading: ENT Examination ( pages 222-236,268-280)
- External Anatomy of the ear
- Landmarks of the tympanic membrane
- Cone of light, malleus, incus
- Signs of external otitis and otitis media
- Otitis Externa – canal is swollen, moist, pale, tender
- Otitis Media – red bulging ear drum
- Weber and Rinne tests (conductive vs. sensorineural hearing loss)
- Weber – put tuning fork on head – test for lateralization. If you close one ear, is it louder?
- Rinne – Air vs. Bone conductance.
- Inspecting the inside of the nose
- Septum, Nasal Passage, Middle turbinate, inferior turbinate
- Abnormal inside of the nose: viral rhinitis vs. allergic rhinitis vs. polyps
- Viral rhinitis – red and swollen
- Allergic rhinitis – pale, blue, or red.
- Polyps, from middle meatus, semitranslucent, pale.
- Causes of nasal septal perforation
- Cocaine use
- Signs and symptoms of sinusitis
- Pain when you press on sinus
- Recognize the location of the opening of the parotid ducts
- On side of cheek (on buccal mucosa) above second molar
- Recognize and describe abnormalities of the ear drum
- Effusion – fluid accumulates – otitis media, bacterial infection
- Bullous Myringitis—viral infection. Hemorrhagic vesicles on tympanic membrane.