ENT (B) Flashcards
1
Q
Main physiological functions of nose?
A
- Humidify and warm air
- Special sense smell
- Hairs trap foreign material
- Speech - resonating chamber
2
Q
Main functions of throat and mouth?
A
- Nutrition - saliva lubricates, amylase production starts digestion, muscles mastication
- Airway - entry into lungs, epiglottis closes airway off when swallowing
- Immune - mucosal membranes are barriers, saliva contains immunoglobulins
- Special sense taste
- Speech articulation
3
Q
Symptoms you’d get from disease of the nose
A
- Visible deformity - eg saddle, deviated septum or swelling
- Epistaxis - unilateral is red flag
- Facial pressure/pain - sinusitis
- Anosmia
- CSF leak
- Rhinorrhoea
- Blocked nose
- Snoring
- Post nasal drip
4
Q
Symptoms you’d get from disease of throat and neck
A
- Hoarse voice/change in voice
- Odonophagia
- Dysphagia
- Halitosis
- Sore throat
- Bad taste in mouth
- Cough
- Palpable mass/swelling
- Enlarged lymph nodes
- Weight loss
- Referred pain to ear/jaw
- Fever
- SOB
5
Q
How to examine the nose
A
- Inspect - from front, side and below. Split nose into 1/3rds when describing Shape, deviation, symmetry, scars, skin changes, sunken
- Palpate - assess tip recoil and thickness of nasal skin
- Anterior rhinoscopy - Thudichum’s speculum and
headlight - look for septal deviation, inflammation, swelling, polyps, prominent blood vessels - Can do nasal misting to assess humidifcation of each nostil on Lacks cold metal depressor
- Examine oropharynx
- Can then do special tests eg flexible nasal endoscopy
6
Q
Examination of throat and neck
A
- Inspect - masses, scars
- Palpate - thyroid from behind, use fingertips, get patient to swallow water and stick out tongue. Assess if tender, temp difference, any nodules/masses
- Examine LN - anterior and posterior triangle, then begin with submental and work backwards. Don’t forget supraclavicular
- Auscultate for bruit for hyperthyroidism
- Percuss superior sternum - stoney dullness associated with retrosternal enlarge goitre
7
Q
Thyroid status exam
A
- General - appropriate dress, sweaty?
- Hands - nails for thyroid acropachy, tremor, palmar erythema, feel temp
- Radial pulse
- Face - peaches and cream for hypothyroidism, loss outer 1/3rd eyebrow?,
- Examine eye movements and check for lid lag
- Legs - pretibial myxoedema? ankle reflexes
- Pembertons test - raise arms above head, check for head and neck venous congestion and hoarse voice - shows retrosternal goitre
8
Q
Three sensory inputs of the balance system
A
- Vestibular
- Visual
- Somatosensory
9
Q
What happens once these inputs are processesd by the brain?
A
- They are processed - involves brainstem, cerebellum and cerebrum
- Efferent pathways then act on extraocular muscles to adjust eye position
- Also act on limb and trunk muscles to maintain body position
10
Q
Define vertigo
A
- A sensation that you or the environment around you is moving or spinning
- It is often described as dizziness
11
Q
How does vertigo differ from other dizziness?
A
- Vertigo is a rotational sensation
- Feels like the room is spinning
- Other dizziness descriptions may be from lightheadedness, instability, presyncope
12
Q
How to ask a patient if they have vertigo?
A
- Do you ever have the sensation that the room is spinning around you?
13
Q
Define syncope and presyncope
A
- Syncope - temporary loss of consciousness and posture usually due to decreased blood flow to the brain
- Presyncope - the feeling that one is about to faint or lose consciousness. May feel lightheaded, dizzy or nauseaous and can get tunnel vision
- Usually associated with decreased blood flow to the brain but not enough to cause syncope
14
Q
Define nystagmus
A
- Rhythmic, involuntary oscillation or movement of the eyes
- May involve horizontal, vertical or rotational movements
15
Q
What is the slow and fast phase of jerk nystagmus?
A
- Slow phase - slow and smooth movement/ drift of the eyes away from their primary position (straight ahead gaze). Considered normal/phsyiological and usually tries to reset the eyes back to primary position
- Fast phase - quick fast movement of eyes in the opposite direction. Abnormal and pathological component
- These two together create a back and forwards jerking motions
