Eye History
THICC VOV
- Vision changes: Change of visual acuity? Tunnel vision (missing objects/people to the side)? Seeing Floaters? Fogginess? Black spots? Other?
- Ocular signs/symptoms: Pain? Redness ? puss? Itchiness? Feeling of foreign body? Bleeding?
- Vascular Risk factors: Any Hx of DM, Hyperlipidaemia, Hypertension
- Current systemic illnesses
- Trauma/Injury: to eye or head?
- History of cancer or metastasis?
- CNS symptoms: 5D’s and 3 N’s: dizziness, dysphagia, diplopia, drop attacks, dysarthria, ataxia, numbness, nausea, nystagmus
- Infection/ RF signs: atypical headaches, neck rigidity, fever, vomiting
Eye Examination
Inspection: Redness, trauma, puss, pupil shape
Pupillary reflexes: Pupil constriction, Consensual constriction, Swinging flashlight (efferent problem eye with light and afferent on eye with no light)
Eye movements: H test
Visual fields: Close one eye pt and practitoner. Bring eye into visula field above, below, left, right
Opthalmoscopy
- Explanation of procedure and consent obtained
- Instrument Checked
- Patient position: allows proper access
- Room Set up: dimming of lights
- Ask patient to look ahead focusing on one point.
- Place hand on patient shoulder or head
- Check red eye reflex.
- Starts at 30-45 deg lateral, adjust focus; scans eye lateral to medial
- Use L eye to scope L eye of patient and visa versa (for patient comfort).
Red light reflex
Fundus
Optic disc (cup to dis ratio, shape)
Blood vessels
Macula
Retina
Nose and Throat History
TON
Throat: Pain? Difficulty/pain with swallowing? Voice changes? Feeling of lump
Nose: Rhinorrhea ? Mucus? Blood? blockage
Other symptoms of illness: cough (phlegm?), sneezing, fever, headaches
Examination of Nose and Throat
- Inspection external/ internal (oral cavity/throat) with light and tongue depressor
- If there are signs of Resp system changes, mention need for respiratory exam
- Listen for voice changes: ask patient to repeat a sentence
- Check nasal passage turbulence
- Sinuses: Palpation or percussion (lean forward, tap sinuses with finger tip)
- Tracheal deviation
- Palpation of cervical lymph nodes and anterior neck
Ear History
SHARV M
- Signs of infection: Any ear pain? discharge? Feeling of blocked ear?
- Hearing: hearing loss or tinnitus?
- Vestibular: Any dizziness, vertigo, loss of balance?
- Any history of trauma or suspicion of presence of foreign body?
- Recent or chronic systemic illness?
- Medications
Examination of the Ear
- Inspection: inspects outer ear for redness, exudate, bleeding, foreign body
- Hearing tests: renee’s and webber’s
- If dizziness present: to perform dix- hallpike, limb co-ordination tests, Rhombergs.
Otoscopy
- Explanation of procedure and obtains consent
- Patient position: allows safe access
- Check instrument.
- Use a clean speculum
- Pulls pinna gently upwards and backwards
- Place tip of speculum at EAM, places finger on face to guide motion, scopes and safely advances speculum
Vitals
BP, Resp, Pulse, Temp
