EENT

Question 1

Eye History

Answer 1

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

Question 2

Eye Examination

Answer 2

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

Question 3

Opthalmoscopy

Answer 3

• 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

Question 4

Nose and Throat History

Answer 4

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

Question 5

Examination of Nose and Throat

Answer 5

• 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

Question 6

Ear History

Answer 6

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

Question 7

Examination of the Ear

Answer 7

• 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.

Question 8

Otoscopy

Answer 8

• 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

Question 9

Vitals

Answer 9

BP, Resp, Pulse, Temp