ENT

Question 1

ENT general check

Answer 1

EARS
Nose
Throat

4 checks:
Check mouth
Tap on sinuses
Check thyroid gland
Check lymphatic

Question 2

Checking the mouth

Answer 2

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

Question 3

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

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

If Thyroid is inflamed/neck p

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

Examination of lymph nodes

Answer 6

• Size- should be no bigger than a pea
• Consistency- soft, characteristically rubber
  o TB- matted
  o 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

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

Cervical nodes

Answer 8

1. 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

Axillary + epitrochlear

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 forearm
  o Slightly up from normal PROM
• Always assess axillary, epitrochlear and cervical if you suspect anything

Question 10

Inguinal

Answer 10

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