[#10]

OBSERVED HEENT

[#10]

Eye Exam - Preparation Notes:

CORNEAL LIGHT REFLEX

1. Have the child look straight ahead
2. Project a penlight into cornea of both eyes simultaneously
3. The normal exam will show symmetrically centered reflections
4. An abnormal exam will show a corneal light reflex that is not centered over
the pupil - this is indicative of muscle deviation or misalignment
RED REFLEX
1. Set ophthalmoscope at "0" diopters

2 Hold the ophthalmoscope 10-12 inches in front of the eye

3. Aim the light at the pupil

4. A normal exam will produce a red/orange hue from the pupil; it simply means
that there are no major obstructions between the cornea and retina
COVER-UNCOVER
1. Have the patient fixate on a distant object
2. While the patient is fixating, cover one eye - watch the uncovered eye
3. A normal test will be indicated by steady staring of the uncovered i.e. no
sudden jump
4. Next move the occluder to the previously uncovered eye - watch the newly
uncovered eye - a normal test would be indicated by no sudden correction
jump of the newly uncovered eye
HEENT Exam Tips and Images:
At the SOM Blackboard Site go to Pediatric Clerkship

.. Click on left-sided menu click Study Guides

.. Select Study Guide #10

.. Review powerpoint presentation images

Otitis Media
Pathogens
S pneumoniae

- H influenza nontypeable

- Moraxella catarrhalis

Acute onset
Pain

Decreased hearing

Inflammation

Bulging or obscured landmarks

Evidence of effusion : : .:

~ TM mobility by bulb insufflation or tympanogram

Treatment - Initial
Amoxicillin 80-90 mg/kg/day div Q12
1M 50mg/kg/day x one dose

(or q 8 hr)

Treatment After 3
of clinical failure
Amoxicillin-clavulanate (Augmentin) 90 mg/kg/day of amoxicillin x 10
OR
Ceftriaxone - 1M 50mg/kg/day for 1-3

session to
rn Bulb Insufflation::::.: Pneumatic Otoscopy
Technique
-Insert speculum into the ear
to form a tight seal
- Slowly and Gently
and
bUlb.
1"""\>:).;:)<;:;;:,>:) mobility of the ear drum as pressure is applied and
on the bulb applies positive pressure
Letting up applies negative
-With normal mobility
ear drum moves inward and then back.
-In cases of acute otitis
middle ear is filled with purulent material.
The drum bulges toward
examiner and moves minimally.
\I)

Causes of minimal mobility or no mobility

-Acute Otitis Media
.Occluded EAC (cerumen, foreign object)

otitis/effusion
Perforated ear drum
Tympanogram see below

11/28/2016

Tympanometry
Measures the compliance of the tympanic

membrane

Normal and Flat Tympanogram

Gp.

=Dq D

d".P,

~Jr~ 0I.l
...
"

.0...'

-200

*.

F'R ES ':- I) ~'E - de.

L;

1 :::'~~

200

'"

Norm al Tympanogram
I dic ares nc'mally iunc Honing middle

ear system

EAC Obstruction
Perforated TM
Otitis Media
Effusion

CHECKLIST

o Introduced

Outlined agenda

Washed hands
Obtained name and age of patient

nail bed to occlude blood

blow

Skin - discoloration, allergic salute,

edema, lesions
dysmorphism, symmetry
- ptosis, discharge, discoloration
Auricle and Pinna - position, shape,
pits/dimples
Nose - flaring, discharge, discoloration,
swelling, swelling

"Color should return to

nail
in less than 3 secnds
Skin Turgor
.. Pinch the skin between the
thumb and finger
"
skin
"Skin fold should return to
original position within one
second (Persistence of
pinched fold =
of turgor)

shape
scalp
hair distribution

pain on palpation of face

circumference (cm)
graphing_ _ __

anterior landmark (supraorbital ridge)

posterior landmark occipital ridge

D conjunctiva/sclera - discharge, color (erythema, pallor)

EOM
D PERRL - direct, consensual
corneal light reflex
red reflex
cover-uncover
external ear - pain, swelling, discharge, lesions, discoloration (erythema, bruising)
- pain, cerumen, foreign body, color, discharge
Tympanic Membrane - color, translucency, landmarks, bulging, mobility
septum - midline, intacUperforation

mucosa/ turbinates - color, swelling, discharge

move anterior to posterior; do not put your hands in the mouth or gauze on the tongue
anterior - lips, buccal mucosa (moisture, exudates, inflammation)
D middle tongue (color,
hydration, lesions): check for frenulum attachment
o middle - dentition (discoloration, caries, fillings), gums (inflammation, pain, bleeding)
D posterior - palate integrity, midline uvula
posterior tonsils (grading, exudates, inflammation)
Palpation - masses, swelling, tenderness

Lymph nodes auricular (pre, post), cervical

post), mandibular, submaxillary,

submental. occipital
Range of motion - supple/rigid (flexion, extension, lateral)
Clavicle palpation crepitus,
masses