125 eyes ears mouth tongue cranial nerves

disease of eyes

screen time, sun/UV rays and wildfire smoke and pollution -71% of canadians have had eye symptoms in past two years

common problems w/ eyes

vision changes, itchy eyes, dry eyes, infection, glaucoma, cataracts

eyes general survey

overall impression: eyebrow placement, lashes, eye color -skin: colour, rashes, skin around eye, oozing -anatomy: as expected, symmetry, movement symmetrical -movement symmetrical, behaviour expected

eyes symptom history

ask about concern -LATERSNAPS - know whats normal vs not normal

eye health history

visual difficulty (acuity, blurring, blind spots) -acute or slow progressive problem? -refraction errors -pain -photophobia (light sensitivity) -strabismus -diplopia -redness, discharge -meds -chronic illness -surgical history -allergies -glasses/contacts -self care -eye protection -resources

refraction errors

myopia (near sightedness), hyperopia, presbyopia, astigmatism

physical assessment eyes

inspection and palpation -need to know and recognize anatomy -brows and lashes

conjunctiva

clear, some small blood vessels -tissues should be pink and well vascularized

sclera

white, small minor vessels

anisocoria

unequal pupil size, harmless if genetic, bad if after trauma

miosis

small or ocnstricted pupil, eyelids asymmetrical, indicates trauma

mydriasis

dilated pupils, can happen after eyedrops, but can indicate brain injury

arcu senalis

older adults more common, discoloration around cornea, cholesterol deposits, concerning in younger patients

pupillary light response

respond symmetrically and as expected, direct and consenual response, can indicate normal anatomy and neurological response -also done on newborns

visual acuity

eyes ability to accommodate to see far and near

test of macular fx

macula fives ride to majority of optic nerve fibers

snellens test

distance visual acuity -distance from chart 20 ft away / distance that someone with expected vision would stand from the chart to read that line -20/20 is normal -legal blindness 20/200

jaegar test

near vision -14 inches from eye -read to smallest letter

extraocular muscles and movements

see eys respond to symmetric manner -cardinal directions -corneal reflection -cover test

cover test

examiner covers eye and looks for movement and then uncovers eye and looks for movement

strabismus

altered extra ocular movement -generally same eye will cause problem -unilateral changes -hypotropia, hypertropia, exotropia (eye turns out), esotropia (eye turns in)

lesions and visual field deficits

whats/where causing change? -lesions, alterations, cut, tear, tumor, interruption in neural path

right vision loss

1 -after cross over

bitemporal hemianopia

loss on outer sides of vision -2 at crossover

left nasal hemianopia

loss of right side of vision of left eye -3

right homonymous hemianopia

loss of vision of right side of both eyes -4

left homonymous hemianopia with macular sparing

vision loss in left half of both eyes but central part still has vision left homonymous hemianopia with macular sparing -5 -caused by lesion in right occipital lobe of brain

static confrontation

test for visual fields -close one eye, test each quadrant

kinetic confrontation

test visual fields -slowly bring fingers in to compare visual fields

internal ocular structures

use opthalmascope -vasculature, fovea, optic nerve, smooth vessels (if has thicker portion its a blockage) -compare left to right to see issue

fundoscopy

to see macula, vein width > artery 2:3 or 4:5, see optic disc -arterial or venous changes can mean elevated bp, cholesterol or trauma

cataracts

in older popn -healthy lens, clear and responsive, fills up with fluid and plaques, gets opaque and effects vision, can go blind

red reflux

important screening tool for kids to check for retinablastoma (eye cancer) -light should be symmetrical

why test pupils when have brain injury

way of testing neural anatomy and neural pathway -brain and eyes intricately involved -can indicate subderal hemotoma or lesion can effect path which effects eyes -pressure from blood on brain can put pressure on nerves and tumours, blood clots etc can do same

disease/disorders of ears

between 40-79, 63% of men and 46% of women had measurable hearing loss -much more common

hypertension

this and meds used to tx have been linked to hearing loss and tinnitus

ears general survey

skin colour, rashes, fluid, anatomy as expected, symmetry,

ears symptom history

lots of otitis media in kids -tell me about concern -LATERSNAPS

ears health history

earaches, infections/discharge, hearing loss, environmental noise, tinnitus, meds, vertigo (can be related to inner or middle, self care behaviours (ear protection, cleaning)

otalgia

earaches

otorrhea

infections/discharge

one of biggest risks to hearing

environmental noise

physical inspection ears

inspection, palpation/techniques -know anatomy, notice abnormal things -palpate for lesions, cysts, proper cartilage

middle ear

use otoscope, manubrium and light reflex (right has right side light reflex) -put in safely and brace -pull pinna up and back as adult -pull pinna straight down for kids

tympanic membrane

should be vascular colour, almost clear, light grey, umbo is yellowish, manubrium more vascular -no light reflex in otitis media

abnormal tympanic membrane

full, very vascular membrane -infected ear pushes membrane out -can put tube in ear to release chronic fluid build up

whisper test

from 60 cm away, one ear covered, should be able to hear whisper -if cant move onto rinne and weber test

rinne test

should have better air conduction than bone conduction -conductive hearing loss if bone is longer than air

weber test

when fork applied should hear equally on both sides

mouth and tongue disorders

gum disease, gingivitis, cavities, oral cancer, thrush, sore throats, lesions

gum disease

one of the most common dental problems adults face, but can begin at just about any age. 

gingivitis

inflammation of the gums. 

cavities

small hole that forms on surface of a tooth

oral cancer

disease resulting from abnormal cell growth in the mouth, lips, tongue, or throat

mouth general survey

overall impresion, skin, colour, anatomy as expected, movement symmetrical especially of tongue and while talking

mouth health history

pain, movement concerns, sores/lesions, sore throat, burning, coughing, reflux -prevention:last dental appointment? -self care routine: toothpaste, flossing, bad breath causes

mouth physical exam

know anatomy, teeth amount, colour, texture, lips, mouth, tongue movement, upper and lower palate, uvula, look at vascularization

adult teeth amount

32

kids teeth amount

20

red flags

trauma to eyes or ears -sudden changes in vision or hearing -raccoon eye -fluid leaking

raccoon eyes

take time to develop -need to protect brain

cn 1

olfactory, smell, sensory

cn 2

optic, vision, sensory

cn 3,4,6

oculomotor, trochlear, abducens -move eyes -cn 3 constricts pupil and accomodates, also mixed-others are motor

cn 5

trigeminal -chews, feels the face, front of head -mixed

cn 7

facial -moves the face, tastes, salivates, cries, feels some ear parts -mixed

cn 8

vestibulocochlear -hears, regulates balance -sensory

cn 9

glossopharyngeal -taste, salivate, swallows, monitors carotid body and sinus -mixed

cn 10

vagus -tastes, swallows, lifts palates, talks, communication to and from thoraco-abdominal viscera -mixed

cn 11

accessory -turns head, lifts shoulders -motor

cn 12

hypoglossal -moves tongue -motor

cn 1 test

smell test -head traumas, pressure or changes that puts pressure on nerve can change response

cn 2 test

visual acuity -field of vision -visualization of fundus -pupillary light response

cn 2 and 3 test

PERRLA -symmetry to pupils and cornea

PERRLA

pupils, equal, round, reactive to light, and accommodation

cn 3, 4, 6 test

follow and track hand, convergence test

cn 3 and 7 test

position of eyelid -opening, closing and positioning, symmetry

cn 5 test motor

-for mouth jaw, temporal masseters -ask to open mouth and observe for jaw deviation -palpate masseter and temporalis muscles and ask client to clench -move jaw side to side and examiner try to push midline

cn 5 test sensory

compare sides, pain and temperature -light touch -eyes, tongue, taste

jaw jerk reflex

dont do normally, patient mouth is slightly open with jaw relaxed -examine tap front of patients chin w/ reflex hammer -expected response is masseter and temporalis muscles contract, which causes mouth to close suddenly -indicates normal trigeminal nerve

cn 7 test motor

observe facial movements -symmetrical -facial expression test

cn 7 test sensory and autonomic

taste anterior of tongue -external ear sensation rarely detected -function of stapedius muscles (should contract at loud noise) -lacrimal glands: ask about dry eye -salivary glands: ask abt dry mouth

hyperacusis

over sensitive to sound -possible disfunction of stapedius muscle -cn 7 damage proximal to stapedius muscle

cn 5 and 7 test

corneal reflex: automatic blinking touch cotton ball to eye -conjunctival reflex

cn 8 test

vestibular nerve -observe eyes for nystagmus -romberg test

nystagmus

eyes make rapid, repetitive, uncontrolled movements -romberg test: stand with eyes open then eyes closed and see how balance is (some times not effective) -requires proprioception, vision, and vestibular fx

cn 7 and 8 test

acoustic reflex -respond to sound and vocalization -stapedius with loud noise (7) or own voice (8) -ipsilateral stimulus (on one side) causes bilateral response -tympanometry test -sensorineural hearing loss = diminished reflex

tympanometry

a test that measures how well your eardrum moves in response to air pressure and sound -probe changes air pressure and produces a tone

cn 9 and 10 test

tested together -oropharyngeal muscles kkkk? -mmmm also 7 -lalala also 12 -swallowing -gag reflex -x alone: palatal arches: damaged side can’t work, look for lowered and flattened palatal arch -palates should rise equally and symmetrically

cn 11 test

push head against hand and shoulder up against hands -larger muscles -shoulder should be equal at rest

cn 12 test

cheek and jaw movements

rinne test positive

AC>BC