1. Physical DiagnosisScalp, Ears, Nose and Sinuses

2. Describe the patient’s scalp. Diagnosis?

3. Psoriasis

4. Describe findings.

5. Normal TM • Malleus(short process & handle) • Cone of light • Incus • Pars tensa • The unbelievable UMBO

6. Describe findings.

7. Otitis Media • Red and bulging • Hyperemia • Dullness of light reflex • Opaque

8. Describe findings.

9. Serous OM • Bulging, amber drum • Decreased mobility

10. Describe findings.

11. Cerumen in Canal • Parents may be advised to soften first • May remove yourself in physician’s office • VA patients: May remove a lot of ear wax in the ER

12. Describe findings.

13. Bullous Myringitis • Large vesicles/bullae visible on the drum • Landmarks obscured • Drum is reddened • Viral infection characterized by painful hemorrhage

14. Traumatic Perforation • Usually result from purulent infection of the middle ear • Central perforation or marginal

15. Tympanostomy Tube • May be placed in children with a series of ear infections • The major goal is to prevent conductive hearing loss to prevent delayed language development • “Mom, the TV is so loud!”

17. Nose and Sinuses

18. Sinus Anatomy: Front View • Frontal sinus = black check • Maxillary sinus=red • Anterior ethmoid sinuses = green • Posterior ethmoid sinuses = purple • Sphenoid sinus = yellow

19. Sinus Anatomy: Side View • Frontal sinus = black check • Maxillary sinus = red • Anterior ethmoid sinuses = green • Posterior ethmoid sinuses = purple • Sphenoid sinus = yellow

20. Observe the turbinates.Diagnosis?

21. Nasal Polyp