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Pharynx
Uvula
Tonsils

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1 - Anterior cervical
2 - Posterior cervical
3 - Preauricular
2
1
3

Pinna

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3 steps
• Outer ear
• Canal
• Inner ear
General inspection and palpation (outer ear)
Otoscopic examination (canal and inner ear)

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Look for deformities, lumps, skin lesions
(eg. Herpes lesions, hematomas)
Associated structures
• Lymph nodes
• Pharynx
• Eustachian tube

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Use proper sized otoscope tip
Turn on otoscope and check that light works
Pull ear up, back, and toward you
Use pinky finger for support and to prevent injury
Place otoscope tip in ear canal, then lean forward and start looking into the otoscope

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Look for redness, swelling, discharge, foreign bodies, wax
Pain with tragus and pinna manipulation can indicate problem with canal, as opposed to inner ear

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The TM is clear (transparent) when light passes through the membrane
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The TM is dull (opaque) when light does not pass through the membrane so that the bony landmarks can not be clearly seen

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The bulging often impairs the visibility of the landmarks

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1 - Anterior cervical
(pharyngitis)
2 - Posterior cervical
(mono)
3 – Preauricular
(conjunctivitis) 2
1
3

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Roll the lymph node area under the pads of your fingers, compressing it against the underlying structures
Feel for size and tenderness
Check for symmetry
• Is there an enlarged gland that just happens to be on the side of the earache or sinus pressure?

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Grasp head fairly firmly, and push with thumbs on the frontal and maxillary areas
For ethmoid sinuses, squeeze firmly between eyes with thumb and index finger
Evaluate for tenderness
Fairly nonspecific

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4 components
1 - Visual acuity (Snellen eye chart)
2 - Visual fields (by confrontation)
3 - Extra ocular movements (“H”)
4 - Ophthalmoscopic examination

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Use a Snellen eye chart
• 20 feet from chart
• Read at least half of each line
Read posters, magazines, newspaper if nothing else is available

(by Confrontation)
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Have patient cover one eye lightly and look at your nose
Stand facing patient (confronting them) holding hands out to sides
Check upper fields by wiggling fingers of one or both hands
Repeat for lower fields
Repeat for other eye

(Extra ocular movements)
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Ask patient to look at your fingers
Keep head still. Stabilize chin if needed
Make large “H”
Convergence test (bring finger to their nose)
• Cross eyed

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Adjust proper settings on scope (light intensity, light shape, light color, focus)
Position patient and adjust ambient lighting
Start laterally from a distance and obtain red reflex, then approach steadily as if peering through a keyhole
If lots of glare, use a smaller diameter light setting
Find optic disc directly or by following a blood vessel from narrower aspect to wider aspect, which will lead you to the optic disc

Generally speaking, you don’t have to worry about rupturing a patient’s tympanic membrane with a typically placed otoscope tip because, a. The tympanic membrane is tough like shoe leather b. They still have another good ear anyway!
c. The canal is about 1 inch deep c

Match the Swollen Lymph Nodes!
Anterior cervical nodes only
Anterior and posterior cervical nodes
Preauricular nodes
Tonsillitis
Mono
Herpes
Possible Diagnoses – Herpes infection on temple, mono, tonsillitis

If you were to tug on someone’s pinna or poke someone’s tragus you would expect, a. A slap b. Pain which could indicate an acute otitis media c. Pain which could indicate otitis externa c

To look in a person's ear, you would move the pinna in the following direction.
a. Down and out b. Up, back, and toward you c. Straight up d. Consult your GPS, then proceed as directed b

If you were looking in a healthy right ear, you would expect to see which of the following?
a. The cone of light to the left b. Our new kitty from last year c. Same cat this year d. A shiny, somewhat transparent-appearing tympanic membrane d

If you wanted to evaluate someone’s visual acuity, you would (choose either best, pretty good, bad, or stupid!),
Bad
Best
Stupid
Pretty good
Ignore their complaint of decreased vision altogether
Use a Snellen eye chart
Poke them in the eye with your ophthalmoscope
Have them read from a magazine

Which of the following is the single greatest scientific achievement of all time?
Einstein’s theory of relativity.
The concept of the number “0”.
Darwin’s discovery of Evolution.
Vaccination.
None of the above.
It’s the Mr. Clean
Magic Eraser.