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Head, Ears, Eyes, Nose and Throat Assessment
122 Plays11 months ago
In this episode we cover the assessment of HEENT systems, as well as abnormal findings, common disease processes, and an example of normal documentation. To get involved you can email me at jaxon.jorgensen@gmail.com or follow the Facebook group at https://www.facebook.com/groups/1415202242471170/
Sources:
Dains, J., Baumann, L., & Scheibel, P. (2024). Advanced health assessment and clinical diagnosis in primary care (7th ed.). Elsevier.
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2024). Bates’ Guide to Physical Examination and history taking. Wolters Kluwer.
Medscape.com sources:
- Infectious Mononucleosis-Kartika Shetty MD, 2021
- Peritonsillar Abscess-Benoit Gosselin MD, 2022
- Streptococcal Pharyngitis-Zartash Zafar Khan, MD, 2021
- Epiglottitis-Sandra Grompf MD, 2024
- Thrush-Mudra Kumar MD, 2023
Recommended
Transcript
Introduction to the Podcast
00:00:00
shermanappel
Hello and welcome value listeners to episode three of the advanced practice nursing mastery podcast. My name is Jackson Jorgensen. I am a nationally certified critical care registered nurse. I'm currently working in the ICU. I am also a student at Baylor university pursuing my DNP and FMP. I'm hoping to become a primary care provider. The goal of this podcast is to assist myself and other graduate level nursing students in mastering these skills of assessment and helping to kind of parse out how to document those assessment findings a little bit better. I'm hoping that this podcast is useful for as a review content to those graduate level nursing students. And it's also just to help myself study the material and be more familiar with it.
Assessment Techniques Overview
00:00:47
shermanappel
So today we're going to be doing the assessment of the head, ears, eyes, nose, and throat. We'll begin with talking about how we assess the head and neck. We'll move on to how we assess the eyes, then the ears, and then of course the nose, mouth, and throat. um We'll be following up each of those systems assessments with a brief review of abnormal findings or terminology related to abnormal or normal findings and either in any of those systems. And then we'll cap off the podcast with an example of normal documentation for the head, ears, eyes, nose, and throat. So I hope you guys enjoy the podcast. And if you have any questions,
00:01:26
shermanappel
or feedback for me as I am new to podcasting, feel free to either look it up on Facebook or send to my email at Jackson dot.Jorgensen at gmail dot.com. That's J-A-X-O-N period. J-O-R-G-E-N-S-E-N at gmail dot.com. I am more than open to ah criticism to to help me improve.
Head and Neck Assessment Techniques
00:01:51
shermanappel
So beginning with our head and neck assessment, Um, the assessment of the head and neck as all these assessments are, well, not all of them, but many of them are going to be inspection and palpation. So it's recommended that you inspect before you palpate. Um, and you can use the clues from your inspection to inform where you're palpating or any other assessments you might want to use to follow up. So you're going to assess the patient you're inspecting for symmetry of the face and head and shape. You're going to be assessing the hair and the scalp. So you'll be running your fingers through their hair.
00:02:26
shermanappel
Inspecting and filling as you go ah for any deformities or anomalies. um You'll note the condition of the skin on these areas, whether it's consistent with the rest of the body's normal tone, or whether it is a you know different in color, different in temperature, different in moisture, um as well as just whether or not it's intact. While you're palpating, you're going to be palpating specific areas, so you want to be ah Sorry, I just bumped my microphone. ah You're going to be palpating the skull and face. So, for the face, you'll be paying attention to the maxillary area, feeling the maxillary just above those, what what you would call the cheekbones, feeling that area, making sure that there's no deformities or breakages. You're going to be palpating the jaw as well. ah And then an important area to also palpate is the temporal artery. that you Make sure that you have perfusion there.
00:03:19
shermanappel
and then the temporal mandibular joint um the or the TMJ as it's often abbreviated. For that one, you're going to palpate both while the patient is at rest as well as while they're actively moving their jaw up and down and you're going to be feeling for clicking or any sort of abnormal movement in their jaw there. um You also ask the patient whether or not they've been experiencing any pain related to any of this. um Moving on to our assessment of the neck, you're going to be looking for swelling and masses here. ah You want to look for any any weird bumps or lumps you want to pay attention to. You're going to be looking for symmetry of the neck. You want to make sure that the trachea is midline. ah You'll also assess range of motion. So help the patient look up, down, side, side, move their head in all of the directions the head's supposed to be able to move.
00:04:10
shermanappel
um You also have the patient swallow and be making sure to look for a mass that's midline ah behind the sternocleidomastoid muscles there. um You'll inspect and palpate the thyroid area. So the thyroid, for palpating that, a lot of people are not familiar with ah with how to do that. So you're going to use the posterior approach. um You're just going to you know be behind the patient while they're seated. Make sure that they understand that you're going to be touching their neck and that it may feel a little bit uncomfortable or like they're being choked. And you're just going to use ah your index fingers, at well two fingers, your index and middle fingers just below the cricoid cartilage to feel their thyroid there. um And what you're looking for is any soft nodular feeling or if it's very firm or if it's enlarged, those would all be abnormal findings with the thyroid.
00:05:03
shermanappel
um
00:05:06
shermanappel
After palpating the thyroid, you can also palpate all of the lymph nodes. ah So there's a, the way that I like to do this is to work back to front. So I'll start up actually on the back of their head, filling downward for the posterior cervical lymphoid lymph nodes, nodes, sorry, lymph nodes. And then I'll go for the anterior cervical lymph nodes. And then I'll also pill underneath the jaw for their sublingual and submental lymph nodes, noting any enlargement as you go um or extreme firmness or hardness, you know, anything that wouldn't be typical to fill. After doing the anterior cervical, you can move down and fill the supraclavicular and subclavicular lymph nodes and be paying attention to that.
Understanding Headache Types
00:05:55
shermanappel
um And that is pretty much sufficient for your lymph node assessment on the head and neck.
00:06:02
shermanappel
A note on palpation for the thyroid, ah soft and nodular would be common in Graves' disease, whereas very, very firm or enlarged may be in Hashimoto's disease. So yeah the thyroid is either under-reactive or over-reactive, under-reactive being a hypothyroid ah related disorder and over-reactive being hyper. So um'm speaking of which, be a conscious of related diseases to ah hyper or hypothyroidism. For example, with hyperthyroidism, it's common to see AFib. And so you may be wanting to screen for any sort of cardiac arrhythmias in your hyper and hypothyroid patients just to so that you can be cognizant of other risk factors.
00:06:51
shermanappel
um For Abnorm Maldives in the head and neck. It's important that we speak about headaches. So headaches are a very common symptom that people report having will be a common reason to come into the clinic. There's a few different red flags for headaches. If if it's extremely sudden onset, um if it gets progressively worse over time, a new onset of headaches and a patient over age 50 that hasn't had them previously. um If it's aggravated or relieved by positioning, if it's caused by exertion or bearing down, if it's accompanied by fever, night sweats, weight loss ah in the presence of cancer or HIV or other serious infection, if it is very, very, you know, difficult for a person experiencing pregnancy at the time, if it's a, you know, a consistent problem for them. um Recent head trauma.
00:07:47
shermanappel
change in pattern from previous headaches. So if they've had headaches before, but this is a new brand, so to speak. And then if there's any associated papillodema, neck stiffness, or focal neurological deficits. I know that's a lot, but those are all red flags, things that you want to be paying attention to that says this headache is and this isn't just a headache. You say, oh, we'll go home and take some Tylenol or ibuprofen. You'll be fine.
00:08:11
shermanappel
um So I wanted to cover the three different main types of headaches that you'll probably be tested on. We have tension headaches, migraine headaches, and cluster headaches. So tension headache is mild to moderate in pain with a gradual onset. You'll notice that the patient's reporting tightness or pressure in their head. They may have visual disturbances with a tension headache. There will not be any nausea or vomiting. So on your test questions, if they're saying like the patient comes in reporting a headache and has nausea and vomiting, you can automatically rule out tension headaches.
00:08:44
shermanappel
um It's not usually aggravated by movement. The neck muscles might feel tight as well, so that tightness might extend down into their neck. um Causes for tension headaches include stress, sleep deprivation, anxiety, and caffeine or tobacco use. For migraine headaches, you're going to have throbbing, aching feelings. It's moderate to severe. It can be generalized, but generally it it will be unilateral, meaning just on one side of the head. It can last four to 72 hours. So I mean, this is pretty significant for patients. That's three days potentially that they're having these headaches and it could be extremely severe pain. So really making sure we address this problem is important as they may be missing work or ah other important events because of this.
00:09:31
shermanappel
um Migraine headaches may be accompanied by nausea or vomiting, can be accompanied with photophobia or phonophobia, meaning that they're extremely sensitive to noises and light. ah It may have an aura that precedes it, which means the patient's like, you know, they kind of sense something's coming on, they might see some ah strangeness in the light, and then, boom, headache. miggrarantine caffeine or my Migraine headaches can be related to stress, caffeine, sleep alterations, ah specific foods might trigger it for patients, missed meals, ah the menstrual cycle can cause migraine headaches, alcohol use, and hormone supplements. Lastly, we have cluster headaches. Cluster headache is sharp, penetrating, burning, unrelenting pain. It is quick onset, which is going to be your
00:10:23
shermanappel
ah um differentiation between a migraine and a cluster headache. Also, it'll only last 15 to 3 hours generally for the cluster headaches. It can be ah accompanied by lacrimation, so tearing, congestion. ah It'll generally be cyclical in pattern, so you know they'll they'll have these recurring headaches that happen in a similar way. ah and that pattern just kind of cycles itself over and over again. Very common in men compared to women. ah Smoking and alcohol are related risk factors as are vasodilator use and seasonal or altitude changes. um This is just my conjecture here with vasodilator use. i my My thought there with why it would be more common in men is Viagra is a vasodilator. So um just thinking there possibly could be skewing the data there.
00:11:17
shermanappel
All right, so I think that pretty much wraps up our assessment of the head and neck.
Syndrome Findings in Head and Neck
00:11:21
shermanappel
ah Make sure to ask your patient about those red flags. It may indicate that they need to have a CT scan done to rule out stroke. Let's see. Oh, the only other thing I wanted to review was um related to Cushing's disease, nephrotic syndrome, and myxodema. So give me one second to pull up that information. might time So Cushing's disease, nephrotic syndrome, and myxedema can all produce findings that you'll notice on your head, ears, eyes, nose, and throat exam, especially while you're assessing the head and the neck. um So Cushing's syndrome, that is where you have abundant cortisol due to renal disease, or possibly they're on cortisol supplements. So the way that you're going to see this present will be with a moon face, red cheeks. You know, their face is very swollen and rounded. ah Their cheeks will be red.
00:12:13
shermanappel
They could have excessive hair growth, ah either in the mustache or sideburn areas and chin. um You'll especially notice that in women, as with men, it's a you know normal finding to have hair in those places abundantly. For nephrotic syndrome, you're dealing with a kidney disease that causes too much albumin to be excreted, and that increases the osmotic pressure, and it can induce hypovolemia or dehydration. um as well as sodium and water retention. So it's kind of a um not typical of what you would think would go on in dehydration. The face will become edematous and it is often pale. um You will will notice a swelling first around the eyes in the morning. And ah if it's really severe, it'll actually make it so their eyes almost close up. So especially here, you're going to be noticing swelling around the eyes, but the pi the face will be generally puffy and pale.
00:13:09
shermanappel
And then for myxodema, which is a finding in severe hypothyroidism, um and it could actually protest it to coma if you've heard of a myxodemic coma. But the you will have a edema in the face here pronounced especially around the eyes. It will not pit with pressure. um The hair and eyebrows will be dry and coarse, which is a common finding with hypothyroidism. um And it will also be thin.
00:13:37
shermanappel
Uh, the skin in this disease will be dry. Let's see. I think those were the only abnormalities for the head and neck I wanted to cover. So we covered Cushing's nephrotic syndrome and mixodema. We also talked about the different types of headaches that might be ah experienced by your patients and how to reassess those moving on now to our assessment of the eyes.
Eye Assessment Procedures
00:13:59
shermanappel
ah You want to ask the patient if they have a history of blurry vision, eye pain, red eyes, or any vision loss. You can also assess for family history of those issues, if they had family members that experienced blindness later than life, and whether it was ah ah macular degeneration or other eye disease. you know Just get an idea of what their eye history looks like.
00:14:24
shermanappel
You'll inspect the eyebrows, eyelashes, eyelids, ah assess the position of the eyes relative to the rest of the face, whether in they're in the correct spot. ah You'll be assessing the cornea, the iris, and the pupils. um For the pupils, it's pretty adequate to assess whether they are equal, round, and reactive to light. You'll also be assessing the extraocular muscles and making sure that they're able to move their eyes in the six cardinal directions. So that is up, down, side, side, and then diagonally to each side. And then you'll also note the corneal right light reflex if present. So you're going to need a light to perform this um as well as an ophthalmoscope. For an ophthalmoscopic exam, I don't feel like a podcast is a great way to cover that.
00:15:14
shermanappel
um I may include a link in the podcast notes to an ophthalmoscopic exam, ah but there's just a lot of techniques that goes into that and describing it isn't going to be as useful as having you guys just see somebody do it. um But during that ophthalmoscopic exam, you'll be noting whether there's red reflex present in the eyes while you're doing it. ah You'll also assess the optic disc, blood vessels, and fovea, and the surrounding macula. During that exam, when you're looking at the blood vessels, that's a really important clue and indicator for a couple of different disease processes that we'll discuss later. um You're going to be looking for the following abnormal findings. Arcus sinulus is a great opacity in the cornea, common in people over the age of 60. It would be a you know not super abnormal finding for them.
00:16:03
shermanappel
But if it's seen before age 40, then you should suspect hyperlipidemia for your patient. It would be worth getting their blood drawn and tested for hyperlipidemia. A corneal ulcer is a corneal abrasion that has become affected. So they've had some sort of damage to their cornea. It's become infected. And now they're experiencing discharge and photophobia related to that. Vision loss may occur depending on the location of that. If it's right over where the pupil is, It can impact their vision. For entropion, entropion is a word where the lower eyelid is turning in. That would be an abnormal finding. Ectropion is where the eyelid is turning out. Both are common in the elderly. Cholazion is a clogged mamobian gland. Poor. It'll become inflamed. It won't be tender. um a gla Glaucoma
00:16:57
shermanappel
This is an increase in intraocular pressure and it can damage the nerve fibers at the optic disc. So basically the pressure is is compressing that nerve, ah your optic nerve, and that impacts the vision. Open-angle glaucoma is one of the more common versions and it impacts the vision by causing halos of light around ah the patient's eyes. And it can progress to blindness. a hordiolum or stye is a painful tender inflammation to the gland and to glands in the margin of the eyelid. I've had several of these as I work night shift, you know, having your eyes dry out can be a risk factor for that staying up all night. So for us night nurses, it's just something that you might have to live with sometimes. ah Very, very painful, though, not fun to deal with.
00:17:46
shermanappel
um Diabetic retinopathy, um this is caused from damage to the macular region and you'll be able to see this during your ophthalmoscomic exam because it'll be micro aneurysms and blot hemorrhages with that. So while you're assessing the blood vessels in that ophthalmoscomic exam, if you're seeing a lot of damage to their blood vessels or aneurysms, that would be indications for a possibility of diabetic retinopathy in your diabetic patient. Last one I wanted to mention was something people probably don't think about, but you can get malignant melanoma in your eyes. So if you go back to the episode on skin assessment and talking about ah investigating melanomas, you'll be able to see this on the ophthalmoscopic exam as well, and it is something that you should screen for as it is potentially life-threatening. Eyes can get sunburned too, folks. All right, moving on to our assessment of the
Ear Inspection and Palpation
00:18:41
shermanappel
ears. You're going to work from the outside of the ear in. So you're going to inspect and then you'll palpate the oracle and the surrounding tissues, the tragus. ah You may at this time, if you wanted to ah defer your TMJ assessment, you could assess it now. um You're going to be looking for the mastoid bone um assessing for pain. So you want to make sure that, you know, as you're palpating, what's tender, what's not, this will give you clues to what's going on with this patient.
00:19:14
shermanappel
Is there any inflammation or drainage obvious on the ear? Sometimes just from the outside of the ear, you can look at it and say, oh yeah, your ear is red and irritated. um Is there scratching on it? Especially in kids, if you notice scratching around the ear, this can be an important finding that might indicate they have an ear infection of some sort. um It may also be appropriate to do a gross hearing test. So the most common one for this is the whisper whisper test where you'll whisper a series of words while the patient covers one ear. and see if they're able to repeat the words or letters or numbers, whatever it is that you whisper ah correctly. And then you'll do that for the other side and having them plug one ear while doing that. ah The other two tests for hearing are the Weber and Rhine test. If you haven't heard of those, it'd be good to go and look at a video of how they're done. ah It involves using a tuning fork um and you'll assess on the top of the head, middle of the head with the tuning fork.
00:20:10
shermanappel
ah making sure that it sounds even on both sides. And then for the rhyme test, it is making sure that you take the tuning fork, you'll put it on the mastoid bone just behind their ear um and see when they stop hearing the vibration. Once they've stopped hearing the vibration while it's actually touching their ear, the base of the tuning fork, you'll take that tuning fork and put it next to their ear so that they can hear through air conduction. So you're testing bone conduction versus air conduction hearing. And the normal finding for that is that they should be able to hear the air-conducted sound for longer than the bone-conducted sound. If that's not the case, then they may have an obstruction in their ear canal that's ah causing decreased air conduction.
00:20:58
shermanappel
For your autoscopic exam, you're going to be assessing the inside of the ear, the ear canal, and the tympanic membrane, as well as ah if you're able to see behind the tympanic membrane and assess the the bones pertinent to hearing there. So you should be able to see the malleolus, or the what do we call it? The malleolus. There we go. And what's called the malleolus, which is a different part of the bone in our body. so You'll be looking at those. You want to note any drainage that they have. You'll note cerumen. You'll note the color and position of the tympanic membrane, um as well as if there's any swelling or bulging on the other side of the tympanic membrane. The tympanic membrane should be pearly gray and intact. If it's not pearly gray and intact, like if it's yellow or red um or if it's ruptured, those are all abnormal findings that need to be investigated. It is important to note that
00:21:49
shermanappel
ah ruptured tympanic membrane can have a number of causes. They may have had a foreign body inserted into the ear. It may have been ah exceptionally loud noise, or it could be from ear infection. If they get enough of an ear infection behind that tympanic membrane, it could actually cause enough pressure on the membrane to rupture it, which is quite painful for the patient. Okay, so there's a couple of different abnormalities I want to talk about here. There's otitis media, which is your inner ear infection. There is otitis externa, which is your outer ear or ear canal infection. And then I wanted to talk about ah necrotizing malignant external otitis because it is a nasty disease process. It needs to be ah nipped in the bud. So for otitis media, you're looking for a bulging tympanic membrane that's off color. So it'll either be yellow or red, may even be white.
00:22:41
shermanappel
It's not that nice pearly gray that it's supposed to be. um The bones of the the here will not be visible, um and there may be drainage. For otitis externa, you're looking Common risk factor for this, by the way, is swimming. A common word for it is swimmer's ear. um Also use of foreign bodies in the ear. So if they use Q-tips or earplugs frequently, they may be at risk for otitis externa. And pain for this increases with movement of the pinna as ah as opposed to otitis media. So if while you're palpating their ears when you're moving the pinna, if that causes pain, this is this is more likely to be otitis externa than it is to be otitis media.
00:23:24
shermanappel
But there's obviously other risk factors and other ah findings that you can look at for differentiating. um that The tragus will be tender to palpation. um The ear canal itself will be very sensitive. And you'll notice swelling and redness in the ear canal. So then necrotizing malignant oxtrinolotitis, that is a basically otitis externa that embeds itself into the ear and it can burrow down. um and and you know spread infection to the skull. So you want to make sure that if you see that, that you start some pretty serious antibiotic therapy probably for your patient.
Nasal and Oral Assessment
00:24:04
shermanappel
Moving on from the assessment of the ears, we're going to do our nose, mouth, and throat. ah Once again, inspect, palpate. So you're going to be looking for, while you're assessing the nose, you're going to use your otoscope to assess for any drainage in the nose, look for any obstructions,
00:24:21
shermanappel
While you're palpating the nose, note any pain for the patient um or any structural deformities. ah With your otoscope, you should be able to see if there's any nasal polyps, which would be a benign sign of chronic inflammation. So once again, it's benign. The nasal polyp is benign as opposed to, you may have heard of polyps in the digestive tract being potentially malignant, but in this case, it is a benign sign. just that it's been chronically inflamed. So that's common finding in, you know, patients that have had allergies long-term and frequently have allergic rhinitis.
00:24:53
shermanappel
um For, let's see, the mouth, you're going to be noting the condition of the lips, tongue, and mucosa. So you want to know at color and moisture of those items. You'll also be noting and any deformities that you observe. um You'll ask the patient to smile and to stick out their tongue. This allows you to assess cranial nerves 7 and 12. And then you'll observe the condition of the teeth overall. Do they have obvious cavities or poor dentition? Does their hygiene seem to be good? Does it look like they've been flossing or do they have a lot of gum breakdown? You'll have them open their mouths and you'll assess the uvula that it rises when they say ah. You look at the back of the throat.
00:25:37
shermanappel
You'll note and estimate the size of the tonsils. If they have them, it'll be graded one through four, by the way, four being you know pretty much closing off their throat and one being hardly any and ah impact at all. ah You'll note any swelling, drainage, or exudate, or any lesions on those things, including the back of the throat. you know So if there's cobbling on the back of their throat, if there's obvious drainage coming down, this would all be important findings to note on your mouth exam.
ENT Diseases Discussion
00:26:05
shermanappel
There are a lot of diseases related to the head, ears, eyes, nose, and throat. ah I just wanted to cover infectious mononucleosis, paratonsular abscesses, streptococcal pharyngitis, epiglottitis, and thrush during this podcast. There's certainly more that you can look for, but I just wanted to go through each of these. So infectious mononucleosis, common findings with that. The patient will present with fatigue.
00:26:31
shermanappel
ah general malaise and their throat will be swo sore and it may be swollen and they'll have a cough generally and you may also notice photophobia on your exam for people with infectious mononucleosis. For paratonsular abscess, a history of acute pharyngitis and tonsillitis is a significant risk factor. um They'll also report general ma's malaise and fatigue with a headache. ah They may have severe pain um You'll notice physical asymmetry of the neck, so one side will be swollen bigger than the other. um We actually had a couple of patients recently in our ICU with paratonsular abscesses that got super infected, and yeah that was a mess. It became septic in the whole the whole critical care shebang. With paratonsal abscesses, you'll also notice a tonsular exudate. So some drainage coming from the tonsils and a contralateral displacement of the uvula. So the uvula will be pushed towards the other side. um For streptococcal pharyngitis, also known as strep throat, ah you'll notice swollen lymph nodes while you're palpating the neck. ah There may be tonsular exudate. They won't generally have a cough. And in fact, the ah note that I have from pediatrics is that if they have
00:27:50
shermanappel
rhinorrhea, viral upper respiratory infection, or a ah cough, then it can generally be, ah you know, you can generally rule out streptococcal pharyngitis in the pediatric population, according to Dr. Zartash Safar Khan, MD on Medscape, and that was as of 2021. So I'll include links, by the way, to my ah sources for each of these diseases in there. i rundowns so that you guys can see what I'm looking at where I'm getting my information. For epiglottitis, you may notice the patient in tripod position ah because it may be difficult for them to breathe. They may be drooling and they won't be able to click clear their own secretions very well.
00:28:35
shermanappel
especially in children. ah You may hear strider. ah So strider is a respiratory noise. It almost sounds like a whistling and that indicates that they basically almost don't have an airway. And it's very concerning finding you will you will want to ah be prepared to secure an airway for them. Their voice may be muffled. ah due to the to the swelling around their vocal cords and they will have dysphagia. So beyond not being able to clear their own secretions, they certainly will have a difficult time eating and swallowing. um Just a note, epiglottitis is life-threatening for children. um So this is something that you want to refer to the emergency room immediately.
00:29:20
shermanappel
For thrush, thrush is a ah Canada infection usually of the mouth. um Common risk factors being recent antibiotic or steroid use. You'll notice focal areas of white plaques on the oral mucosa. If you were to scrape them off, it would reveal a super duper angry red tissue underneath it, and they may even bleed. ah So that is causative for thrush. Let's see. All right, that pretty much covers what I wanted to talk about with with our assessment of the head, ears, eyes, nose, and throat.
Example of Assessment Documentation
00:29:53
shermanappel
ah For normal documentation, by the way, ChatGPT is a great tool if you're looking for ah examples of documentation on any of these systems. um I actually had it generate this one for us just to use an example. So it says, for the head, the head appears normal, cephalic, and atramatic. Hair distribution is even with no evidence of lesions, nodules, or scars.
00:30:15
shermanappel
Scalp is intact and without tenderness or mass is on palpation. Eyes, pupils are equal, round, and reactive to light and accommodate appropriately. Extraocular movements are intact without nystagmus or strabismus. Conjunctiva are pink and moist and sclera are anic-terric. Fundascopic exam reveals sharp discs with distinct margins, no hemorrhages, exudates, or papillodema. Ears, external ears are symmetrical without lesions, nodules, or discharge. Autoscopic examination of those bilateral tympanic membranes are pearly gray, intact, and mobile on insufflation. No signs of inflammation, effusion, or cerumen obstruction noted. Nose, nasal mucosa is pink and and moist without erythema, swelling, or discharge. but Septum is midline, no sinus tenderness to palpation, no polyps or masses noted on inspection.
00:31:11
shermanappel
Oropharynx is pink and moist without exudates, ulcers, or lesions. Tonsils are non-enlarged, grade one. No erythema or exudate. Uvula is midline. No masses or lymphadenopathy appreciated in the neck. Voice is normal in quality. So I think that was a pretty succinct, yet thorough note. And I appreciate that we have tools such as chat b t two chat GPT and other language learning AIs that are able to do such. amazing work. I appreciate your guys' time. I hope you enjoyed the podcast and found it interesting. If you have any feedback for me, feel please please feel free to email me or ah put a post on the Facebook page for the podcast. um I would be more than happy to receive and respond to your input and feedback. Until next time, this is Jackson Jorgensen.