ENT Examination Flashcards
Outline the relevant parts of a ENT examination. (7)
General inspection
Set of basic observations
Lymph nodes/throat/TMJ/Nose/Ear examination
Perform a general inspection as part of the ENT examination. (7)
General health
Obvious pain
Colour - cyanosis/pallor
Signs of temp/infections/signs of ENT disease
Nutritional status
Observes for swelling
Perform a TMJ examination as part of the ENT examination. (6)
Palpate both sides/around for tenderness
Px to open and close mouth feel for: Clicking/Popping/Grinding/Discomfort
Perform a lymph node examination as part of the ENT examination. (13)
Neck: Symmetry, masses, scars. Observe for visible enlargement of the parotid/submandibular glands/lymph nodes. Goitre = swollen thyroid.
Lymph Exam: Lymphadenopathy (swollen lymph nodes) causes: Common cause of cervical lymphadenopathy is infection/inflammation. Usually acute onset. Other causes can be malignancy, sarcoidosis, lymphoma.
Technique: Expose neck, flex neck slightly upwards, use pads of the index and middle fingers, examine both sides at once using a mini rotatory movement across the skin of the neck.
Feel and look for: Size (< 0.5cm), Location (drains into that area, is this the source of infection?), Fixation (lymph nodes = deeper structure indicate malignancy), Consistency (normal nodes = soft, hard = malignancy), Infection (tenderness/node enlargement.)
If lymphadenopathy hasn’t resolved after 2-4 weeks = urgent referral.
Perform a mouth + throat inspection as part of the ENT examination. (5)
Inspect: around the mouth, lips, inside the mouth (gums, teeth, tongue, uvula and tonsils)
Perform a nose inspection as part of the ENT examination. (3)
Inspect inside/around the nose
Palpate around the nose.
Perform an ear examination as part of the ENT examination. (15)
Outer ear: Discharge (if present, note colour and odour) If blood/clear watery drainage following trauma; immediately referral. Wounds and bruising. Dry skin - eczema. Tenderness (Tragus, lobule, helix, mastoid bone)
Tympanic membrane: Pars Tensa (larger, taut portion of drum) Pars Flaccida (small segment, lies superiority fibrous layer missing so is thinner than rest of drum.) Normal (pearly grey and slightly translucent appearance).
Ear canal: Foreign bodies, redness/swelling (infection), ear wax (cerumen): grey,dry/flaky, wet and colour honey to dark brown. Wounds (use of sharp objects), dry skin (eczema). Pars tensa, Head of malleus, cone of line, handle of malleus, pars flaccida, ear canal.
Red Flags: Mastoiditis (foul smelling discharge), check for swelling behind the ear and downward displacement of the pinna.
What are the common presenting symptoms for nose + sinuses? (7)
Nasal obstruction
Nasal discharge
Epistaxis
Sneezing
Nasal and facial pain
Trauma - deviation and haematoma
Sinusitis
What are the common causes for earache? (5)
Infective otitis media/externa
Boils and furuncles of canal and pinna
Trauma (especially cotton buds) and foreign bodies (including wax)
Throat problems (tonsillitis, pharyngitis, quinsy)
What are the rare causes for earache? (5)
Mastoiditis
Cervical spondylosis
Cholesteatoma
Malignant disease
Barotrauma
What are the occassional causes for earache? (5)
TMJ Dysfunction
Dental Abscess
Impacted Molar
Trigeminal Neuralgia
Ear Canal Eczema
State the main differences between OM, OE, Boils, Trauma and throat problems regarding presentation. (5)
OM:
- Discharge: Possible
- Pain on pulling pinna and pressing tragus: No
- Red bulging ear drum: Yes
- Deafness: Yes
- Pain on Swallowing: No
OE:
- Discharge: Yes
- Pain on pulling pinna and pressing tragus:Yes
- Red bulging ear drum: No
- Deafness: possible
- Pain on Swallowing: No
Boils:
- Discharge: Possible
- Pain on pulling pinna and pressing tragus: Yes
- Red bulging ear drum: No
- Deafness: No
- Pain on Swallowing: No
Trauma:
- Discharge: Possible
- Pain on pulling pinna and pressing tragus: Possible
- Red bulging ear drum: No
- Deafness: Possible
- Pain on Swallowing: No
Throat Problems:
- Discharge: No
- Pain on pulling pinna and pressing tragus: No
- Red bulging ear drum: No
- Deafness: No
- Pain on Swallowing: Yes
What are the main presentations of Otitis externa? (5)
Itching
Watery discharge
Appears to be in pain
Pain to pinna/tragus
Erythema to the canal.
What are the main presentations of Otitis media? (6)
Earache
Bulging tympanic membrane
Appears to be in pain
Hot to touch
Purulent discharge
Perforated membrane
What are the main presentations of Pharyngitis?
Earache
Appears to be in pain
Hot to touch
Pain on swallowing
Swollen lymph nodes in neck
Red/swollen throat
Change in voice
What are the main presentations of Tonsilitis? (9)
Earache
Appears to be in pain
Hot to touch
Pain on swallowing
Swollen lymph nodes in neck.
Halitosis
Red/swollen throat
Swelling both sides of throat
White patches on both sides of throat.
What are the main presentations of Quinsy? (7)
Earache
Appears to be in pain
Hot to touch
Swelling on one side of throat
Red/swollen throat
Change in voice
Trismus
What are the main presentations of Sinusitis? (7)
Earache
Appears to be in pain
Hot to touch
Halitosis
Postnatal drip
Thick nasal discharge
Change in voice
