ICM 2 Quiz 3

Bates Reading: Eye Examination (pages 205-222,244,254-267)

1. Pathway for pupillary light reactions and near reactions
   1. Pupillary Light Rxn = Occulomotor.
2. Autonomic nerve supply to the eye
   1. Occulomotor parasympathetic
3. Nerves and muscles involved in the six cardinal directions of gaze
   1. Lateral, medial, superior, inferior rectus. Inferior and superior oblique.
4. The meaning of the two numbers expressing visual acuity
   1. 20/30 means at 20 feet you can read something that normally is read at 30 feet.
5. Miosis vs. mydriasis vs. anisocoria
   1. Miosis = constriction of pupils
   2. Mydriasis = dilation of pipls
   3. Anisocoria = papillary inequality of more than 0.5mm
6. Nystagmus and What is normal vs. abnormal:
   1. Nystagmus normal = rhythmic oscillation of eye. A few is normal, but sustained is abnormal.
7. Lid lag and its significance:
   1. The lid “lags” (almost closes) when you look downwards. If you have hyperthyroidism, the rim of sclera is visible above iris with downward gaze.
8. How to use an ophthalmoscope:
   1. Hold with right hand to examine right eye.
   2. Hold 15 degrees lateral to patient’s line of vision.
9. Examining the optic disc and retina including differentiating veins and arteries
   1. Locate optic disc
   2. Look at the angle the arteries branch to know where to trace optic disc
   3. If patient nearsighted, adjust more negative.
10. Significance of an absent red reflex
    1. Cataract, retinoblastoma, detached retina
11. Changes seen on retinal exam with chronic open angle glaucoma
    1. Enlarged cup
12. Significance of loss of venous pulsations
    1. Elevated intracranial pressure.
13. Abnormalities of the eyelid
    1. Ptosis – myasthenia gravis, damage to oculomotor nerve, horner’s syndrome
    2. Entropion – inward turning of lid margin
    3. Ectropion – outward turning of lid margin – eye can’t drain well.
14. Causes of red eyes
    1. Conjunctivitis
    2. Subconjunctival Hemorrhage
    3. Corneal injury or infection
    4. Acute iritis
15. Pupillary abnormalities
    1. Anisocoria – unequal pupils – impaired parasympathetic (occulomotor), Horner’s Syndrome
    2. Small, irregular pupils – can be caused by syphilis.
16. Papilledema
    1. Swelling of optic disc, bulging of physiologic cup, due to increased intracranial pressure transmitted to optic nerve. Caused by meningitis, subarachnoid hemorrhage, trauma, etc.
17. Hypertensive changes of the retina
    1. Arteriolar-venous crossing changes
    2. Copper wiring of arterioles
    3. Cotton-wool spot
18. Diabetic changes of the retina
    1. Red dots – microaneurysm, hemorrhage
    2. Neovasularization (if proliferative)

Bates Reading: ENT Examination ( pages 222-236,268-280)

1. External Anatomy of the ear
   1. Helix
   2. Antihelix
   3. Tragus
2. Landmarks of the tympanic membrane
   1. Cone of light, malleus, incus
3. Signs of external otitis and otitis media
   1. Otitis Externa – canal is swollen, moist, pale, tender
   2. Otitis Media – red bulging ear drum
4. Weber and Rinne tests (conductive vs. sensorineural hearing loss)
   1. Weber – put tuning fork on head – test for lateralization. If you close one ear, is it louder?
   2. Rinne – Air vs. Bone conductance.
5. Inspecting the inside of the nose
   1. Septum, Nasal Passage, Middle turbinate, inferior turbinate
6. Abnormal inside of the nose: viral rhinitis vs. allergic rhinitis vs. polyps
   1. Viral rhinitis – red and swollen
   2. Allergic rhinitis – pale, blue, or red.
   3. Polyps, from middle meatus, semitranslucent, pale.
7. Causes of nasal septal perforation
   1. Cocaine use
8. Signs and symptoms of sinusitis
   1. Pain when you press on sinus
   2. Tenderness
   3. fever
9. Recognize the location of the opening of the parotid ducts
   1. On side of cheek (on buccal mucosa) above second molar
10. Recognize and describe abnormalities of the ear drum
    1. Effusion – fluid accumulates – otitis media, bacterial infection
    2. Perforation
    3. Bullous Myringitis—viral infection. Hemorrhagic vesicles on tympanic membrane.