ENDOCRINE & ENT

Question 1

ENT - GENERAL INSPECTION

Answer 1

1. Check mouth
2. Tap on sinuses
3. Check thyroid gland
4. Check lymphatic

Question 2

ENT - CHECKING THE MOUTH

Answer 2

• Looking for swollen uvula
• White spots on tonsils/swollen
• Throat redness
• Grey furry tongue

Question 3

ENT - TAP ON SINUSES

Answer 3

• Tap on paranasal sinuses – maxillary, frontal, sphenoid and ethmoid.
• Looking for pain swelling or tenderness.
• Frontal – above both central eyebrows
• Maxillary - largest ones located under the eyes in the maxillary bones
• Ethmoid - Either side of nose between eyes
• Sphenoid - Cant feel the sphenoid but side of face just bellow top of ear.

Question 4

ENT - THYROID EXAM

Answer 4

• Palpate cricoid cartilage, come down and out slightly
• Should feel like a butterfly
• Shouldn’t be inflamed
• Do one side at a time
• Turn head slightly to feel properly (relaxes SCM)

Question 5

ENT - WHAT DOES IT MEAN IF THE THYROID IS INFLAMED?

Answer 5

• Hard feel – could be an indication of cancer Uncontrolled weight loss, fever, night sweats?
  Hyperthyroid
• Anxious, nervous, irritable, heat intolerance?
• Angina, palpitations, breathlessness?
• Weight loss, diarrhoea?
• Menstrual cycle- scanty (oligomenorrhoea) or absent (amenorrhoea)
• Hypothyroid
  
  • Fatigue, cold intolerance?
  • Angina, palpitations, breathlessness?
  • Weight gain, constipation?
  • Menstrual cycle- heavy (menorrhagia)

Question 6

ENT - WHAT SHOULD YOU BE LOOKING AT WITH LYMPH NODES?

Answer 6

• Size- should be no bigger than a pea
• Consistency- soft, characteristically rubbero
  
  • TB- matted
  • Metastatic cancer- hard (not painful)
• Tenderness- bacterial/viral infection cause tender, variably enlarged nodes
• Fixation- if fixed to deep structures or skin suggest malignancy

Question 7

ENT - LYMPH NODE EXAM SEQUENCE

Answer 7

• Inspect for visible lymphadenopathy (enlarged nodes)
• Palpate one side at a time using flat fingers
• Compare to contralateral side
• Site, size, consistency, tenderness

Question 8

ENT - CHECKING CERVICAL LYMPH NODES

Answer 8

E1. Start at submental
2. Along chin to masseter area for parotid and slightly up maxillary
3. Move towards front of inner ear and then behind ear
4. Follow round to occiput and down neck (around lateral masses) for posterior cervical chain
5. Back up to mastoid process, palpate down SCM for superficial and deep ant chain
6. Palpate supra/infraclavicular areas

Question 9

ENT - CHECKING AXILLARY AND EPITROCHLEAR LYMPH NODES

Answer 9

• 1st sing of malignancy in breasts
• Ant + central- flat hand
• Lats/teres- grip underneath and push
• Hands on hips, push elbows slightly forward
• Epitrochlear-o Look for signs of skin cancer on forearmo Slightly up from normal PROM
• Always assess axillary, epitrochlear and cervical if you suspect anything

Question 10

ENT - CHECKING INGUINAL LYMPH NODES

Answer 10

• ASIS- follow inguinal ligament
  
  • femoral pulse, bring contact down slightly
• Follow horizontal group then vertical group