Question

Brad presents with report of foreign object in right eye.Brad Pittman is a 35 year old welder.While at work welding , a metal splinter lodged in his eye.

Scenario:.The patient is afebrile and appears in moderate distress,clutching his face.Respirations increased .Heart rate elevated.Patient is slightly diaphoretic.No obvious debris lodged in the face,neck or hands.Nares clear.Ipsilateral lids normal.Sclera grossly inflamed .Upon examinatiuon with slit lamp,the metal splinter is embedded in the cornea but does not enter the anterior chamber.Splinter removed without complications .Contralateral eye is unaffected.Identify the Examinatio elements in this note by organ system,

A. Eye, Ears, Nose

B. Mouth, Throat

C. Skin

D. Cardiovascular and Respiratory

E. all of the above

Answer 1

Option E all of the above because each and every examination confirms the final diagnosis

1)Ocular Examination

.Testing of visual acuity :a)Distant visual acuity (snellens fest) b)visual acuity for near(jaegers chart)

.External ocular examination :Examination for head posture ,of forehead and facial symmetry  ,eyebrows ,eyelids,lacrimal apparatus,eyeball as a whole,conjunctiva,of Sclera,Cornea ,anterior chamber ,of iris ,pupil,lens,intraocular pressure

.Fundus examination (media,disc,blood vessels,macular area,general background)

.Visual field examination

Ears

The facial nerve function test (The examiner should ask the patient to lift their eyebrows, squeeze their eyes shut and to resist forceful eye-opening, puff out their cheeks, and show their teeth. Any weakness should be graded using the House-Brackmann grading system.)

Nose

.The examination of the nose includes inspection of external and internal structures. Inspection of the nasal passage through an otoscope allows only for examination of the vestibule, anterior portion of the septum, and the inferior and middle turbinates.

B]Mouth and throat

Lips, oral mucosa and gums:
Evaluate the lips, noting color and moisture level. Scaliness or cracking may be indicative of pathology. With a good light source, ask the patient to open his or her mouth. Evaluate the oral mucosa for ulcers, color changes or nodules. Note the color of the normally pink gums, recognizing that in people of color, brown patches may be normal. Evaluate the dentition and note the presence of gum erythema or edema suggestive of gingivitis

Pharynx:
With the patient's mouth open, ask the patient to say, "ahh." In a patient with an intact 10th cranial nerve, this action should raise the soft palate enabling full visualization of the pharynx. If this does not allow visualization, use a tongue blade to depress the tongue. Inspect the tonsilar pillars, tonsils if present, uvula and pharynx. Evaluate for color, symmetry, exudate and enlargement.
CVS and Rs (inspection,palpation,percussion,auscultation )