Examination Flashcards
-overall order (7)
- examine external ear
- otoscopy
- hearing - rinne and weber
- nose
- oral cavity and oropharynx
- glands
- neck
-ENT examinations general
>ALWAYS consent explain and check PAIN.
>pts shouild remove aids eg glasses, hearing aids, detures for inspection
>ensure good lighting
>during maccs give examiner commentrary of insepction and palpation
>when combined entire ent examination will need personal order
examining external ear pinna/auricle.
-inspect pinna. comment on (2) identify (7). may need remove aid
-inspect both lateral and medial pinna
-signs to look for (8)
-palpate (2)
-inspect pinna
>comment on size and shape. identify helical fold, antihelical fold, tragus, antitragus, concha, lobule, triangular fossa
-signs to look for - cartilage tags, perauricular sinus, trauma, scars, skin lesions, general skin condition, otorrhea .
- palpate for pain by gentle tugging pinna, palpate pre and post auricular lymph nodes
- -scars*
- >hair line incision - occasionally used to harvest temporalis fascia*
- -post auricular approach*
- -end aural approach*
- -lobule incision - used to harvest fat in spedectomy*
otoscopy
- check (1)
- select (1)
- what should you do to pinna and why(1)
- how to hold otoscope(2)
- inspect (1) …
- inspect (1)…
- check light
- select correct size speculum (big as poss). new one for each pt.
- hold pinna up and back to straighten external auditory meatus.
- hold in hand same side as pts ear. eg left hand for patients left ear. stabilize with litte finger. insert otoscope gentle along the line of the ear canal.
- inspect skin of external aud meatus > hairy and deep parts comment on normal/pathology.
-inspect typmanic membrance
>pars tensa(inc handle and lateral process of malleus), cone oflight,pars flaccida important to look here as this iS where cholestaetomas are first seen. comment on normal/pathology
-nb look straight on at a tympanic membrane : the lateral process of the malleus and cone of light should be more toward the right side of the pts right ear drum and vica verca
in examination of hearing macc do both weber and rinnes and relay results
- -nb audiogram is gold standard test for hearing*
- webers test
>for distinguishing whether a unilateral hearing loss is conductive or sensorineural
>tuning fork stuck where (1) patient asked (1)
>result. negative weber lateralisation is normal. if there is weber lateralisation what does this mean.
-webers test
>tuning fork places pts forehead. patient asked which ear sound heard best.
> if there is weber lateralisation - in pts with unilateral hearing loss - - conductive type localises to worse ear (because the obestruction conceals background noise from outside). sensorineural loss localised to better ear (1)
in examination of hearing macc do both weber and rinnes and relay results
-rinnes test
>determines is sound is best heard through air (AC) or bone (BC). tests for conductive or sensorineural loss in each ear
>steps to test (3)
> rinne positive(1). meaning (1)
>rinne negative (1) meaning (1)
>tuning fork placed alignenment to pinna for few seconds nb with forks in line with opening. then moved to the mastoid process. asked which heard best out of these turns
>rinne positive is AC>BC. occurs in pts with normal ears and or sensorineural loss in test ear
>rinne negative AC<bc>
</bc>
examination of nose
-inspect external nose. inspect (2)
>look for signs (6)
- inspection of internal nose without device.hold tip of nose upwards. inspect nasal vestibule. inspect (2)
- inspection of internal nose with device. hold tip of nose upwards. inspect nasal vestibule. inspect (5)
- can use light of pen torch. or of otoscope. or an otoscope with a large ear speculum and place only the tip in nose. or Thudicum’s speculum with a light source*
- palpate bony and cartilginous skeletons
- -*testing airway patency (2)
-inspect nose from infront sides above. inspect skin and external anatomical features - bony and cartilaginous skeleton. from front, above, sides
>look for bend, deformity, swelling, skin creases, lesions, scars, any skin conditions, rhinorrhea
- without device inspect shape of anterior nares and position of columella
- -*with device nasal cavity mucosa, vestibular region, inf (and middle) turbinates, nasal septum, lesions, Littles area
-use misting device eg metal tongue depressor and look at pattern. also test by occluding each nares in turn and asking pt to sniff in an listening for inspiration.
exmaination of oral cavity and oropharynx
- can use a light source
- inspect in turn (11)
-test movement (2)
-what pathology may be found (3)
- may need to ask pt to remove dentures
- examine in turn lips, tongue (upper, sides, lower surfaces), floor mouth, submandibular gland opening (at base of tongue), lower teeth, lower gums (inner and outer surface) parotid duct opening (use a tongue depressor to lift cheek away, opening found opposite upper solond molar), upper teeth, upper gums, hard and soft pallates, pres or abs of tonsillar tissue
- test movement of tongue stick out and of soft pallate say ahh
- -*lesions in oral cavity - patches of leukoplakia, erythroplakia, ulcers
examination of parotid gland and salivary glands
examination of submandibular, sublingual salivary glands
-inspect and compare (1). inspecting for (3)
-inspect (1)
-palpate submandibular and salivary glands
examination of parotid glands
-inspect parotid regions
-inspect (1)
-palpate parotid gland and regional lymph nodes - lymph nodes can be done as part of neck examination.
submandibular, sublingual salivary glands
-inspect submandibular triangles for mass, swelling, skin
-inspect submandibular duct orifaces landmark covered in mouth
-palpate submandibular and salivary glands
>using gloved hands. bimanual technqiue. right finger first inside mouth. discard one glove then do the other side.
>palpate from posterior to anterior. submandibular then along submandibular duct. sublingual lies along duct
parotids
-inspect parotid region externally for swelling, mass, skin
-inspect parotid duct opening. landmark covered in mouth
-palpate parotid externally i think
examination of neck
- expose neck inc clavicles and tips of shoulders
- inspect neck for (4) demonstrate (2)
- palpate neck - ant (7) and post trianges(4)
- massage not play the piano*
-inspect neck for lump, swelling, scars, skin changes. can swallowing and tongue protrustion can demonstrate movement of structures found if relevent
-anterior triangle
>start at mastoid process
>palpate pre and node auricular nodes
>palpate parotid already done in gland examination
>palpate along mandible - submandibular and sublingual regions
>palpate down midline - palpate larynx, trachea, thyroid gland palpate each lobe of thyroid gland stablizing the other one
>palpate ant border of scm - jugular chain(?)
>palpate inside triange if not covered
-posterior triangle
>palpate down post border scm . inc muscle itself . to sternum
>palpate above and along clavicle - supraclavicular fossa so from medial to lateral
>palpate up anterior border of trapizius and occipital region
>palpate inside triange if not covered
- examination of neck part 2
- image attached showed mms*
- identify surface anatomy of
>digastric mm
>submandibular glands
>parotid gland region
>carotid bifurcation (1)
>hyoid bone
>thyroid cartilage
>cricoid cartilage
>cricothyroid membrance
>trachea
>thyroid gland
>scm
>trapezius
>mastoid process
>carotid bifurcation - splits into the external and internal carotid at around the level of the fourth cervical vertebra
image attached shows carotid
image showing laryngeal carilages
image showing thyroid and cricoid cartilages (laryngeal cartilages)
