ENT/endocrine examination

Question 1

Checking the ENT

Answer 1

Check mouth (uvula, tongue etc)

Tap on sinuses

Check thyroid gland

Check lymph

Question 2

Checking mouth

Answer 2

Look at the uvula, tonsils and the tongue within the mouth, ensure they look normal

• diabetes
• infective endocarditis (poor dental hygeine)
• stomatosis and halitosis are big indicators of GI problems

Question 3

Tap on sinuses

Answer 3

Sinuses- air-filled cells and extensions of the nasal cavities, that serve a similar function to that of the nose

Maxillary (next to nose each side)

Frontal (above eyes and eyebrows)

Ethmoid (directly above eye like on the eyebrow)

Question 4

Checking thyroid gland

Answer 4

– inspect the neck from the front, looking for a goitre

– ask the pt to speak, as in severe hyperthyroidism, the voice can be slow

– hold out hands and look for tremor and sweating- both can occur in hyperthyroidism

• feel pulse, tachycardia and atrial fibrillation (hyperthyroidism)

– look for proptosis above

– provide water to sip to watch the pt swallow

– feel the thyroid gland

Normal:
– not palpable
– if you can find it- it should be soft and firm to be classed as normal

Hard thyroid gland:
– possible cancer

Enlarged lobe:
– goitre?
—- hyperthyroidism? Hypothyroidism?

Question 5

Examination of the lymph nodes

Answer 5

Size- normal nodes are rarely >0.5cm in diameter

Consistency- normal nodes feel soft
—- in Hodgkins disease (uncommon cancerous disease) they feel rubbery
—- Tuberculosis- they feel hard centrally as they necrotize centrally. They feel ‘matted’
—- metastatic cancer- they feel hard

Tenderness- acute viral or bacterial infection

Fixation- lymph nodes fixed to deep structures or skin suggest malignancy

Abnormal nodes:
– discrete or matter together
– mobile or fixed
– soft hard and firm consistency
– tenderness

Malignancy:
– slowly progressive
– firm
– multiple nodes involved
– stuck together and to underlying structures
– not tender

Question 6

Sequence of lymph node examination

Answer 6

look for visible lymphadenopathy

Palpate one side at a time using the flat of your fingers of each hand in turn

Compare the nodes on each side to each other

Cervical nodes:
– move round the jaw from the chin (submandibular nodes), up to the mastoid process up past the ear on the inside, round the ear and down the neck posterior to the SCM
– clavicle above and below

Under jaw- submandibular nodes

Inside of ear- pre auricular nodes

Inside of SCM (closer to Adams apple)- anterior cervical nodes

Posterior to SCM- posterior cervical nodes

Above clavicle- supraclavicular nodes

Below clavicle- infraclavicular nodes

Question 7

Analysing axillary lymph nodes

Answer 7

Axillary lymph nodes- there are anterior middle and posterior
—- can the 1st sign of malignancy in women so need to be able to feel the axillary lymph nodes

Epitrochlear- looks for signs of skin cancer

Question 8

Femoral nodes

Answer 8

Find the ASIS, move down the inguinal ligament until the femoral artery is felt.

There is a vertical and a horizontal group