Professional Documents
Culture Documents
Sensor y System
Eyes, Ear s,
Nose, Mouth and
T hroat
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-1
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 14
Eyes
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-2
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Structure and Function, cont.
Internal Anatomy
Inner layer- sclera
A rough protective white covering
Continuous anteriorly with the smooth transparent cornea,
covers the iris and pupil
Sensitive to touch- corneal reflex
CNV and CN VII
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-3
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Structure and Function, cont.
Internal Anatomy
Inner layer—retina
– Optic disc
– Retinal vessels
– Macula
• Fovea centralis
• Area of sharpest and keenest vision
• Receives and transforms the light stimulus into nerve
impulses through the optic nerve and the optic tract to
the visual cortex of the occipital lobe
Visual reflexes
– Pupillary light reflex
• Direct light reflex
• Consensual light reflex
– Fixation
– Accommodation
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-4
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
3
1
Aging adult
– Presbyopia
• Lens loses elasticity
– Cataract
– Glaucoma
Subjective Data—
Health History Questions
Vision difficulty (decreased acuity, blurring, blind spots,
halo around the light)
Pain, photophobia
Strabismus (will cause amblyopia exanopsia), diplopia
Redness, swelling
Watering, discharge
Past history of ocular problems
Glaucoma
Use of glasses or contact lenses
Self-care behaviors
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-5
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Chapter 14
Eyes
Objective Data—
The Physical Exam
Preparation
– Position
Equipment needed
– Snellen eye chart
• 20/20- you can read 20 feet what the normal eye could have
read at 20 feet
• numerator: distance
• denominator: the distance the normal eye could have read
– Handheld visual screener
– Opaque card or occluder
– Penlight
– Applicator stick
– Ophthalmoscope
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-6
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 14
Eyes
Objective Data—
The Physical Exam, cont.
Test central visual acuity
– Snellen eye chart
– Near vision
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-7
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Chapter 14
Eyes
Objective Data—
The Physical Exam, cont.
Inspect external ocular structures
– General
– Eyebrows
– Eyelids and lashes
– Eyeballs
– Conjunctiva and sclera
• Pinguecula -thickening of bulbar conjunctiva
• Arcus senilis- cloudy cornea as lipid deposition
• Xanthelasma- raised yellow plaques on the lids
– Eversion of the upper lid
– Lacrimal apparatus
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-8
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Pinguecula -thickening of bulbar conjunctiva
Pinguecula
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Arcus senilis
Objective Data—
The Physical Exam, cont.
Inspect anterior eyeball structures
– Cornea and lens
– Iris and pupil
• Size and shape
• Pupillary light reflex
• Accommodation
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-9
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Far vision- pupil dilate Near vision- pupil
constrict
Objective Data—
The Physical Exam, cont.
Inspect the ocular fundus
– Use of the ophthalmoscope
– Red reflex
– Optic disc
• Color
• Shape
– Retinal vessels
• Number
• Color
• A:V ratio
• Caliber
– General background of the fundus
– Macula
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-10
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 14
Eyes
Abnormal Findings
Abnormalities in the Eyelids
Periorbital edema
Exophthalmos (protruding eyes)
Enophthalmos (sunken eyes)
Ptosis (drooping upper lid)
Upward palpebral slant
Ectropion (lower lid is loose)
Entropion (the lower lid roll in)
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-11
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Ptosis (drooping upper lid)
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Pseudostrabimus
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Ectropion (lower lid is loose)
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Chapter 14
Eyes
Abnormal Findings
Lesions on the Eyelids
Abnormal Findings
Vascular disorders of the Abnormalities of the
external eye cornea and iris
– Conjunctivitis – Pterygium
– Subconjunctival • Chronic exposure to
hemorrhage hot, dry, sandy
– Iritis (circumcorneal • pinguecula
redness) – Corneal abrasion
– Acute glaucoma – Hyphema (blood in
• Circumcorneal redness anterior chamber)
around the iris – Hypopyon (purulent
• Dilated pupil matter in anterior
• Halo around light chamber)
• Sudden eye pain
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-13
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Pterygium
Chronic exposure to hot, dry, sandy
from pinguecula
Abnormal Findings
Abnormalities in the Pupil
Abnormal Findings
Opacities in the Lens
Senile cataracts
– Central gray opacity—nuclear cataract
– Star-shaped opacity—cortical cataract
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-15
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Chapter 14
Eyes
Abnormal Findings
Abnormalities in the Abnormalities in the
optic disc retinal vessels
– Optic atrophy (disc – Arteriovenous crossing
pallor) – Narrowed arteries
– Papilledema (choked – Vessel nicking
disc) – Silver wire arteries
– Excessive cup:disc – Copper wire arteries
ratio
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-16
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Chapter 14
Eyes
Abnormal Findings
Abnormalities in the
General Background
Diabetic retinopathy
Microaneurysms
Dot-shaped hemorrhages
Flame-shaped hemorrhages
Soft exudates
Hard exudates
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 14-17
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Chapter 15
Ear s
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-1
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Chapter 15
Ears
Middle ear
– Malleus, incus, and stapes
– Eustachian tube- equalization of pressure
– Functions
Inner ear
– Vestibule and semicircular canals
– Cochlea
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-2
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 15
Ears
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-3
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Chapter 15
Ears
Subjective Data—
Health History Questions
Earaches
Infections
Discharge
Hearing loss
Environmental noise
Tinnitus
Vertigo
Self-care behaviors
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-4
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Note to examiner
Person lip reading
Frowning
Posturing of head
Misunderstands your questions
Act irritable
Person’s speech sound garbled
Inappropriately loud voice
Flat ,monotonus tone of voice
Objective Data—
The Physical Exam
Preparation
– Position
– Cleaning the ear canal
Equipment needed
– Otoscope with bright light
– Pneumatic bulb attachment (sometimes needed with
infants or young children)
– Tuning forks in 512 and 1024 Hz
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-5
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 15
Ears
Objective Data—
The Physical Exam, cont.
External Ear – Inspect and Palpate
Size and shape
Skin condition
Tenderness
External auditory meatus
Otoscopic Examination
Position the head and ear
Method of holding and inserting otoscope
External canal
– Color
– Swelling – Lesions
– Discharge
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-6
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Chapter 15
Ears
Objective Data—
The Physical Exam, cont.
Otoscopic Examination, cont.
Tympanic membrane
– Color and characteristics
– Position
– Integrity of membrane
Test hearing acuity
– Conversational speech
– Voice test
– Tuning fork tests
• Weber test
• Rinne test
Vestibular apparatus
– Romberg test
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-7
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Chapter 15
Ears
Abnormal Findings
Abnormalities of the External Ear
Frostbite
Otitis externa (“swimmer’s ear”)
Brachial remnant and ear deformity
Cerebrospinal fluid otorrhea
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-8
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Chapter 15
Ears
Abnormal Findings
Lumps and Lesions on
the External Ear
Darwin’s tubercle
Sebaceous cyst
Tophi
Chondrodermatitis nodularis helicis
Keloid
Carcinoma
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-9
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Darwin’s tubercle
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Chapter 15
Ears
Abnormal Findings
Abnormalities in the Ear Canal
Excessive cerumen
Otitis externa
Osteoma- nodule obscures the drum, benign
Foreign body
Exostosis- small, bony hard ,round nodules
Furuncle- painful, redened, infected hair follicle
Polyp
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-10
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Chapter 15
Ears
Abnormal Findings
Abnormalities of
the Tympanic Membrane
Retracted drum
Serous otitis media
Acute purulent otitis media
Perforation
Insertion of tympanostomy tubes
Cholesteatoma
Scarred drum
Blue drum (hemotympanum)
Bullous myringitis
Fungal infection (otomycosis)
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-11
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Chapter 15
Ears
Abnormal Findings
Tuning Fork Tests
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 15-12
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Chapter 16
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-1
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Chapter 16
Nose, Mouth, and Throat
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-2
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 16
Nose, Mouth, and Throat
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-3
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 16
Nose, Mouth, and Throat
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-3a
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Chapter 16
Nose, Mouth, and Throat
Subjective Data—
Health History Questions
Nose
– Discharge
– Frequent colds (upper respiratory infections)
– Sinus pain
– Trauma
– Epistaxis (nosebleeds)
– Allergies
– Altered smell
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-4
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Chapter 16
Nose, Mouth, and Throat
Subjective Data—
Health History Questions, cont.
Mouth and throat
– Sores or lesions
– Sore throat
– Bleeding gums
– Toothache
– Hoarseness
– Dysphagia
– Altered taste
– Smoking and/or alcohol consumption
– Self-care behaviors
• Dental care pattern
• Dentures or appliances
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-5
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Chapter 16
Nose, Mouth, and Throat
Objective Data—
The Physical Exam
Preparation
– Positioning
Equipment needed
– Otoscope with short, wide-tipped nasal speculum attachment
– Pen light
– Two tongue blades
– Cotton gauze pad (4 x 4 inches)
– Gloves
– Long-stem light attachment for otoscope (occasionally)
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-6
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Chapter 16
Nose, Mouth, and Throat
Objective Data—
The Physical Exam, cont.
Mouth—Inspect Throat—Inspect
Lips Tonsils grading
Teeth and gums Use of tongue blade
Tongue Posterior pharyngeal wall
U-shaped area under the
tongue
Buccal mucosa
Palate
– Hard and soft palate
– Torus palatinus
– Uvula
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-8
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Chapter 16
Nose, Mouth, and Throat
Objective Data—
The Physical Exam, cont.
Nose—Inspect and Palpate
External nose
Test patency of nostrils
Nasal cavity
– Holding the otoscope
– Nasal septum
– Turbinates
Sinus Areas—Palpate
Frontal and maxillary sinuses
Transillumination
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-7
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Chapter 16
Nose, Mouth, and Throat
Abnormal Findings
Abnormalities of the Nose
Epistaxis Polyps
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-9
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Chapter 16
Nose, Mouth, and Throat
Abnormal Findings
Abnormalities of the Lips
Cleft lip
Herpes simplex I
Angular cheilitis (stomatitis, perleche)
Carcinoma
Retention “cyst” (mucocele)
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-10
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 16
Nose, Mouth, and Throat
Abnormal Findings
Abnormalities of the Abnormalities of the
teeth and gums buccal mucosa
– Baby bottle tooth – Aphthous ulcers
decay – Koplik’s spots
– Malocclusion – Leukoplakia
– Dental caries – Candidiasis or
– Epulis monilial infection
– Gingival hyperplasia
– Gingivitis
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-11
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright © 2003, Elsevier Science (USA). All rights reserved.
malocclusion
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Aphthous ulcers
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Chapter 16
Nose, Mouth, and Throat
Abnormal Findings
Abnormalities of the Abnormalities of the
tongue oropharynx
– Geographic tongue – Cleft palate
(migratory glossitis) – Bifid uvula
– Smooth, glossy – Oral Kaposi’s
tongue sarcoma
(atrophic glossitis) – Acute tonsillitis and
– Black hairy tongue pharyngitis
– Enlarged tongue
(macroglossia)
– Carcinoma
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 16-12
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Black hairy tongue
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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