Student Handout

Name: Team #: PHM 6165: Health Assessment, Session 10

Session 1: Eyes, Ears, and Head

Watch this video: https://www.youtube.com/watch?v=b80LyZRZOFY
Ear:

Activity Patient Results Notes or Abnormal Findings

Inspect the ear
 Examine external ear and check for
appropriate color, scarring, or anything
abnormal
Otoscopic Examination Identify the handle of malleus,
 Refer to the laminated images pars flaccida, pars tensa, and
 Choose the largest speculum that will fit cone of light (light reflex)
comfortably in the patient’s ear canal
 Tilt the patient’s head slightly away from
you toward the opposite shoulder.
 Inspect the auditory canal with the
otoscope penlight. Note any redness,
swelling, lesions, foreign bodies, or
discharge.
 Pull the auricle (up and back on an adult
or older child. Pull the auricle down on
an infant or child younger than 3 years of
age.)
 Hold the auricle gently but firmly
throughout the examination.
 Hold the otoscope by the handle and rest
the back of your hand along the person’s
cheek to stabilize the instrument.
 Insert the speculum slowly and carefully
along the axis of the canal. Watch the
insertion, then put your eye up to the
otoscope. Avoid touching the canal wall.
 Rotate the otoscope to visualize all the
tympanic membrane. Note the
membrane’s color, position, and integrity.
The normal eardrum is a shiny and
translucent pearly-gray color, flat, and
intact. Visualize the cone of light and the
bony landmarks.
 Practice using the Rubric for the OSCE.

1. What would you expect to find in a patient with otitis externa?

2. What would you expect to find in a patient with otitis media?

Eyes: Examination of the pupil
Activity Patient Results Notes or Abnormal Findings
 Inspect the size, shape, and symmetry of
both pupils
 Measure the pupils using the diagram on
the penlight.
 Note if the pupils are large (>5 mm), small
(<3 mm) or unequal.
 Test the pupillary light reflex.
o Darken the room, stand to one side,
and ask the patient to gaze into the
distance.
o Advance a light in from the side and
note the response of the pupil in the
eye on the same side. Constriction
of the pupil on the same side is a
normal direct light reflex.
o Advance the light in from the side
again, and note the response of the
pupil in the eye of the opposite side.
Constriction of the pupil on the
opposite side is a normal consensual
light reflex.
o Repeat for the other side.
 Test for accommodation
o Hold your finger approximately 3 in
from the patient’s nose. Ask the
patient to focus on a distant object.
Have the patient shift his/her gaze
to your finger. A normal response
includes constriction of the pupils
and convergence of the eyes.
3. What does PERRLA stand for?

4. What medications cause dilated pupils?

5. What medications can cause pin point pupils?

Testing Visual Acuity
Activity Patient Results Notes or Abnormal Findings
 Use the Snellen vision chart
o Have the patient stand 20 ft away
from a Snellen eye chart (marked
on the floor). Conduct the test with
glasses or contacts on.
o Have the patient cover one eye.
o Ask the patient to read the smallest
line of print possible. Encourage
the patient to try the next smallest
line as well.
o Note the line on the chart at which
the patient can identify more than
half the letters.
o Record the numerical fraction that
is to the left of that line, along with
the use of glasses.
o Repeat with the opposite eye.
6. Explain in patient friendly language the finding that a patient’s vision is 20/40?

Sinuses:

Activity Patient Results Notes or Abnormal Findings

 Inspection and Palpation of the Sinuses
o Palpate the frontal and maxillary
sinuses for tenderness and injury.
o Place your thumb on the upper
inner aspect of the orbit of the eye
and press gently but firmly upward.
Note any increase in pain or
tenderness as well as any swelling.
o For the maxillary sinus, place your
thumb under the zygomatic bone
(cheek bone) and gently press
upward. Note any pain or
tenderness.
Differentiating ear conditions
Patient comes to your consultation window asking for a recommendation ear pain. What are some questions that you
would ask?
Question(s) Possible answers for acute otitis Possible answers for otitis externa
media
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Differentiating eye conditions
Patient comes to your consultation window asking for a recommendation for their red eyes. What are some questions
that you would ask?
Question Possible Answers for Possible answers for Possible answers for
allergic conjunctivitis viral conjunctivitis bacterial conjunctivitis
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Section 2: Lymph Node Exam, Dermatology, SCHOLAR MAC practice
https://www.youtube.com/watch?v=SZkIq6P-0UQ

Neck and Lymph Nodes:

Activity Patient Results Notes or Abnormal Findings

 Refer to laminated diagram
 Ask the patient to relax the muscles of
his/her neck and to bend slightly forward
toward the side you are palpating.
 Use the pads of your index and middle
fingers to gently move the skin over the
tissue where the nodes are located. Feel
the following nodes: preauricular,
postauricular, submandibular,
submental, posterior cervical, anterior
cervical and occipital.
 If you palpate an enlarged node, note its
size, consistency, mobility, tenderness,
temperature, and location.
 To distinguish a lymph node from a
muscle or artery, try to roll the node in
two directions: Up and down and side to
side. This cannot be done with a muscle
or artery.
 Ask the patient if the node is tender.
Part 2: Dermatology

Match the following skin conditions to their pictures and provide a brief justification for your choice:

 Atopic dermatitis ____

 Cellulitis ____

 Herpes Zoster ____

 Impetigo ____

 Pediculosis Capitis ____

 Psoriasis ____

 Rosacea ____

 Scabies ____

 Seborrheic dermatitis ____

 Tinea Capitis ____

 Tinea Corpus ____

Patient Interview Practice

Use the provided cases to interview each other using SCHOLAR-MAC.

1. What is the most likely diagnosis for J. Dutton? What subjective information led you to this diagnosis?

2. What is the most likely R. Wheeler? What subjective led you to this diagnosis?
Differentiating Headaches
Patient comes to your consultation window asking for a recommendation for their headache. What are some questions
that you would ask?
Question Possible Answers for Possible answers for Possible answers for
migraine tension headache cluster headache
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OSCE: Lymph node and Ear Exam Checklist PHM 6165

Student Name:___________________________ Evaluator:_______________________________

Completed
Demonstration
Student washes hands prior to examination of patient
Student introduces self to patient
Lymph node exam
Uses pads of index and second fingers (three fingers okay)
Student palpates the Preauricular and Postauricular nodes in appropriate area
Verbalizes palpating Preauricular and Postauricular nodes
Student palpates tonsillar, submandibular and submental lymph nodes in appropriate area
Verbalizes palpating the tonsillar, submandibular and submental lymph nodes
Student palpates the anterior cervical, posterior cervical, and occipital lymph nodes in appropriate area
Verbalizes palpating the anterior cervical, posterior cervical, and occipital lymph nodes
Ear Exam – Student to demonstrate on one side only
Verbalizes need to examine external ear and check for appropriate color, scarring, or abnormalities
If examining right ear, hold otoscope right hand (left ear, left hand)
Holds otoscope in appropriate hand like a pen between thumb and index finger horizontal to head with
hand on patient face to stabilize
Pulls pinna upwards and backwards in adults
Verbalizes would pull pinna downwards and back in child
Student appropriately demonstrated insertion of otoscope
Verbalizes inspecting canal for wax, discharge, inflammation and abnormalities
Verbalizes continue looking down canal until see tympanic membrane and inspect for normal landmarks
Verbalizes landmarks □light reflex □handle of malleus □pars tensa □pars flaccida
States would repeat other ear (does not repeat on other ear)
Patient Education
Verbalized result to patient (normal or abnormal)
Student verbalizes whether patient needs follow-up with primary care
Other
Completes exams within 5 minutes
Completed in logical order
Score: ________/23_
Role Play Case #1
Patient Name: J. Dutton
DOB: 12/25/1947
Chief Complaint
What brings you in today? My head hurts
History of Present Illness
Symptoms I guess it’s a headache, I just have this pain in my head
Characteristics Pain is constant (5/10 if asked), it’s like I have a band squeezing on my head
History I’ve had them before and used BC powder which works sometimes, I haven’t tried
anything this time
Onset It started this morning after I had an argument with my son
Location Both sides
Aggravating Nothing I’ve noticed
Remitting Nothing so far
Medical history
Medications Amlodipine, Atorvastatin, Tylenol as needed for pain
Allergies NKDA
Medical conditions Hypertension, Dyslipidemia, TMJ
Hospitalizations 2 years ago for GSW
Immunizations Up to date on all my immunizations
Family history Both parents deceased, father lived until 90s and died of old age, mother cause of death
is unkown
Social history Retired law enforcement officer, Widowed, 4 children (one decreased, one adopted),
drinks 1-2 bourbons 4-5 days per week, red wine with dinner, no tobacco, no illicit drugs;
Eats “heart healthy” diet, only exercise is physical work to maintain land
Role Play Case #2
Patient Name: R. Wheeler
DOB: 11/3/1971
Chief Complaint
What brings you in today? My throat hurts
History of Present Illness
Symptoms Sore throat, a runny nose that started 2 days ago
Characteristics It’s painful and red back there. (4/10 if asked)
History I haven’t had a sore throat since I was a kid, tried gargling warm salt water and that
worked a little bit Tested for COVID it was negative
Onset I woke up this morning with it, but I guess it was a little sore yesterday
Location Just all over the back of my throat
Aggravating It hurts when I swallow
Remitting Warm salt water rinse, hard candies
Medical history
Medications None
Allergies None
Medical conditions None
Hospitalizations None
Immunizations COVID-19 (Pfizer) x 3, influenza this year
Family history Adopted with no children
Social history Married, no children, chews tobacco x 30 years, drinks 2-4 whiskeys or beers every night,
works on a ranch, no specific diet, exercise