ENT Flashcards
What are the main features of the tympanic membrane?
posterior and anterior malleolar folds, pars flaccida, umbo, lateral process of the malleus, handle of the malleus
Where does the chorda tympani run into the tympanic membrane?
in the upper 1/3 (incisions are always below it in the posteroinferior aspect of the membrane)
What equipment should you bring an ear exam?
otoscope, speculum of otoscope tip, and 512 Hz tuning fork
What are the standard otoscope tip sizes?
4mm in adults and 2.5 in children
Should you use the largest or smallest speculum tip that a patient can handle?
largest
Should you start the exam with the health or affected ear? Why?
the healthy to get a better understanding of what is normal to the patient
How should the otoscope be held during a hearing exam?
in the hand of the ear being examined and held in a “pen” grip
What things should you look for when examining the tympanic cavity?
Is the tympanic membrane smooth or sucked in (retracted)?
Are there any holes?
Are there any deep pockets in the membrane?
What is tympanosclerosis?
calcification of the tympanic membrane that causes conductive hearing loss in the ear
Where is ear wax created?
ceruminous glands in the outer ear (is aka cerumen).
NOTE: using Q-tips is not recommended and may lead to compaction of the ear wax in the canal
How should an otoscope enter the nose?
enter horizontally and then change the angle of the otoscope once inside the nasal cavity
T or F. You can assess a patients nasal potency by placing a wooden tongue depressor under their nose
F. you should place a metal tongue depressor under the nose and look for signs of condensation
T or F. A pen light is the best source available for a nasal exam
F. A head scope is much better
T or F. It is a good idea to give the patient local anaesthetic intranasally before place a nasoendoscope
T
T or F. When looking through the nasal cavity while using an otoscope, you can see the inferior turbinate
T
The parotid duct is aka?
Stensen’s duct (the submandibular duct is aka the Wharton’s duct)
T or F. The most common place for mouth cancer is the hard palate
F. the common sites for mouth cancer are the retromolar fossa and the floor of the mouth
What is a quincy?
A quincy is a collection of pus that develops between the tonsils and the wall of the back of the throat (aka a peritonsillar abscess)
What are some risk factors for mouth cancer?
smoking, alcohol, and recreational drugs.
NOT HIV, HOV, lack of fruits and veggies, and betel nut chewing
Why do doctors ask patients to say “Ahh’?
elevates the soft palate and allows visualization of the base of the tongue, uvula, tonsillar pillars, and even the hypo pharynx (and to some extent CN IX and X)
Cervical lymph nodes are insignificant if what size?
less than 2 cm
In the axilla and inguinal regions, what is the max size of a lymph node that will not cause concern?
3cm
In the supraclavicular region, what is the max size of a lymph node that ill not cause concern?
1cm
What would a lymph node with a soft consistency indicate?
insignficant
What would a lymph node with a rubbery consistency indicate?
classically lymphoma
What would a lymph node with a hard consistency indicate?
classically malignancy and granulomatous infection
Are enlarged inguinal lymph nodes common?
Yes, very are very common. Usually, they are shotty lymph nodes which are small, often hard, lymph nodes that are usually of no clinical concern. The term “shotty” comes from the fact that they have a similar feel to buckshot
Why should you test for symmetry in a lymph node exam?
clinically significant nodes are classically asymmetric
Are the salivary glands considered lymph nodes?
No
How can you distinguish the carotid artery/bulb from lymph nodes?
pulsation
What is the most significant area for nodes?
the supraclavicular fossa
An enlarged left supraclavicular node (virchow’s node) is an indication of what?
abdominal process
An enlarged right supraclavicular node is an indication of what?
an intrathoracic process
Infraclavicular nodes are an indication of what?
classically breast cancer or malignant lymphoma
How are epithrochlear lymph nodes best felt?
by moving fingers up and down. Arm should be relaxed, found right above the olecranon.
What do lymph nodes arise from?
some early infection in life
A tender lymph nodes would indicate?
classically an infection
Classically, a non-tender lymph node would indicate?
malignancy
Do patients 2-12 yo commonly present with insignificant lymph nodes in the necks secondary to frequent viral infection?
Yes, it is a normal part of maturation
Performing the Exam
Patient should be seated for waste-up lymph nodes. Abnormal lymph nodes are usually not symmetrical so palpate using both hands at the same time. Test post auricular, pre auricular, submandibular, cervical, and supraclavicular nodes.
Are posterior auricular nodes typically abnormal?
Yes, you will not typically find any here (same for pre-auricular nodes)
Abnormal lymph nodes are usually what shaped?
spherical, normal is flat and oval shaped
Are supraclavicular nodes normal?
No, not usually found here. Same with infraclavicular space (breast cancer or lymphoma)
Should you be concerned about nodes in the lateral part of the axilla?
No
Are there typically inguinal lymph nodes?
Yes, because there are typically infection in that region and they can be palpated
Are femoral lymph nodes common?
sometimes, can be felt by rolling the artery
Are iliac nodes common?
go over the inguinal ligament into the iliac fossa. They can be
Lymph nodes in the abdomen have to be what side before they can be palpated?
5-7cm
The first hard structure when palpating down from the chin is what?
top of the thyroid cartilage (will not feel the hyoid bone). Will hit the cricoid cartilage next and then the first two rings of the thyroid
The isthmus of the thyroid runs over which two tracheal rings?
2-3
Thyroid exam
Get behind the patient. Place the first two digits of both hands just below the cricoid cartilage so that left and right fingers meet on the patient’s midline at the 2-3 tracheal rings. Place thumbs posterior to patient’s neck and flatten all fingers against the neck. use finger pads, no tips, to palpate. gently draw fingers laterally 1-2 cm and palpate the latter lobes. Ask the patient to swallow
What would diffuse enlargement of the isthmus and lateral lobes of the thyroid without nodules indicate?
Grave’s disease, hashimoto’s thyroid’s, endemic goiter
What would a single thyroid node indicate?
Cyst, beging tumor, elevates index of suspicion for malignancy.
Assess for rick factors: radiation exposer, hardness, rapid growth, fixation to surrounding tissue, cervical ALD, male, etc.
A soft thyroid could indicate?
Graves disease and may have a bruit
A firm thyroid could indicate?
Hashimotos, malignancy, and being and malignant nodules
A tender thyroid could indicate?
thyroiditis
A systolic or continuous bruit may be heard where in relation to the thyroid?
over lateral lobes in hyperthyroidism
