BASIC ENT EXAMINATION (AB)

Question 1

Why is a general history and physical examination important in a basic ENT exam?

Answer 1

Systemic diseases often demonstrate signs and symptoms in the head and neck.

Question 2

What is the prerequisite for a basic ENT examination?

Answer 2

A thorough physical examination and history taking.

Question 3

What is the proper position for the examiner during an ENT exam?

Answer 3

The examiner may stand or sit but must not stoop down and should be comfortable for proper ergonomics.

Question 4

What is the ideal position for a patient during an ENT exam?

Answer 4

Seated with head slightly higher than the examiner’s, slightly leaning forward, back straight, and legs uncrossed and flat.

Question 5

What type of light source is recommended for an ENT exam?

Answer 5

A 100-watt or stronger unfrosted light bulb mounted on a gooseneck stand without a reflector.

Question 6

Where should the light source be positioned in an ENT exam?

Answer 6

Slightly to the right or left of the patient’s head, on the same side as the head mirror.

Question 7

Why is a strong light source important in an ENT exam?

Answer 7

ENT examination includes areas where natural sunlight does not reach.

Question 8

What is the size of a standard head mirror used in ENT exams?

Answer 8

3 ½ inches in diameter with a ½ inch central hole.

Question 9

What is the focal length of a standard ENT head mirror?

Answer 9

14 inches.

Question 10

Why should the head mirror be placed as close as possible to the face?

Answer 10

To provide a wider angle of view and allow binocular vision for depth perception.

Question 11

What is the main challenge of using a head mirror?

Answer 11

Maintaining the correct angle and focal length, requiring patient head movement instead of examiner repositioning.

Question 12

What is an alternative to the head mirror in ENT exams?

Answer 12

A focusable light mounted on a headband.

Question 13

What are the four basic maneuvers of physical examination?

Answer 13

Inspection, Palpation, Percussion, and Auscultation.

Question 14

What is the order of examination in an ear exam?

Answer 14

Start from least invasive to most invasive.

Question 15

Why is percussion used in an ear exam?

Answer 15

To check for dullness and tenderness in the sinuses.

Question 16

What does the presence of bruits in the neck indicate?

Answer 16

Possible inferior vena cava thrombosis or arteriovenous malformations.

Question 17

Why should hemangiomas not be punctured or aspirated?

Answer 17

Hemangiomas do not clot and may cause significant bleeding.

Question 18

What is the first step in examining the ear?

Answer 18

Inspect and palpate the pinna and surrounding areas.

Question 19

Why should the external auditory canal be examined without a speculum first?

Answer 19

To inspect the concha and estimate the size of the external auditory meatus for proper speculum selection.

Question 20

What is the advantage of using the largest comfortable speculum?

Answer 20

It maximizes the angle of view while avoiding pain.

Question 21

What is the disadvantage of using a small speculum?

Answer 21

A small speculum provides a narrow angle of view and limits examination.

Question 22

What is the anatomical significance of the mastoid process?

Answer 22

It contains air cells connected to the middle ear, making it a site for potential mastoiditis.

Question 23

What structures are closely related to the external auditory canal?

Answer 23

Temporomandibular joint, greater temporal arteries, nerves, veins, and parotid gland.

Question 24

Why should ear pulling techniques be adjusted for different age groups?

Answer 24

Adults: Pull ear backward and upward to straighten the S-shaped canal; Infants: Pull ear backward and downward due to C-shaped canal.

Question 25

What is the purpose of a hand-held speculum in ear exams?

Answer 25

To better visualize the tympanic membrane.

Question 26

What is the advantage of a hand-held speculum?

Answer 26

Easy to use.

Question 27

What is the disadvantage of a hand-held speculum?

Answer 27

No magnification.

Question 28

What is the most commonly used instrument for ear examination?

Answer 28

Battery-powered otoscope.

Question 29

What is the function of a pneumatic otoscope?

Answer 29

To assess tympanic membrane mobility and detect perforations or middle ear effusion.

Question 30

What indicates a perforated tympanic membrane on pneumatic otoscopy?

Answer 30

No movement of the tympanic membrane.

Question 31

What does shifting of the meniscus on pneumatic otoscopy indicate?

Answer 31

Presence of fluid in the middle ear.

Question 32

What is the color of a serous effusion in the middle ear?

Answer 32

Amber, sometimes with air-fluid levels or bubbles.

Question 33

What is the appearance of a mucoid effusion in the middle ear?

Answer 33

Dull gray to white with loss of middle ear landmarks.

Question 34

What are the three parts of a pneumatic otoscope?

Answer 34

Handle (battery pack), Head (houses bulb), and Speculum.

Question 35

Why is the largest possible speculum preferred in otoscopy?

Answer 35

A larger speculum provides a better angle of view without causing discomfort.

Question 36

What is the function of tympanoscopy (pneumatic otoscopy)?

Answer 36

To change the pressure in the external auditory canal and assess tympanic membrane compliance.

Question 37

What is an operating head otoscope used for?

Answer 37

Removing foreign bodies, impacted cerumen, and performing tympanostomy.

Question 38

What should be inspected in the external examination of the nose?

Answer 38

Deformities, asymmetry, skin quality, lesions, or discoloration.

Question 39

What is the proper technique for anterior rhinoscopy?

Answer 39

Hold the nasal speculum with the right hand for the left nostril and vice versa.

Question 40

Why should the nasal speculum be inserted closed?

Answer 40

To avoid injuring the patient and ensure gentle opening of the nasal cavity.

Question 41

Why should the nasal speculum not be completely closed when removing it?

Answer 41

To prevent pulling out nasal hairs, which may cause discomfort.

Question 42

What does anterior rhinoscopy assess?

Answer 42

Nasal septum, inferior turbinates, and internal nasal valve.

Question 43

What is the narrowest part of the nasal airway?

Answer 43

Internal nasal valve.

Question 44

What should be examined in the oral cavity?

Answer 44

Lips, buccal mucosa, teeth, gingiva, tongue, and floor of the mouth.

Question 45

What tool is used to inspect the oral cavity?

Answer 45

Wooden or metal tongue depressor with a headlamp.

Question 46

What conditions may be suspected if white plaques are present in the oral cavity?

Answer 46

Oral thrush (scrapable) or leukoplakia (non-scrapable).

Question 47

What are Fordyce spots?

Answer 47

Normal sebaceous glands appearing as small yellow spots in the buccal mucosa.

Question 48

What is the best technique for examining the tongue?

Answer 48

Gently grasp the tongue with gauze and inspect all surfaces.

Question 49

How should the patient be instructed when examining the tongue?

Answer 49

Ask the patient to lift the tongue toward the hard palate instead of sticking it out.

Question 50

What is the purpose of including a general history and physical examination in every head and neck evaluation?

Answer 50

"Many systemic diseases manifest in the head and neck

Question 51

What is the recommended position for an examiner during a basic ENT examination?

Answer 51

"The examiner may stand or sit but must be comfortable and avoid stooping down for work ergonomics."

Question 52

How should a patient be positioned during an ENT examination?

Answer 52

"The patient should be seated with their head slightly higher than the examiner's

Question 53

What is the recommended light source for an ENT examination?

Answer 53

"A 100-watt or stronger unfrosted light bulb mounted on a gooseneck stand without a reflector."

Question 54

Why is the light source positioned slightly to the right or left of the patient's head?

Answer 54

"To align with the side where the head mirror is placed and provide proper illumination for the examination."

Question 55

What is the purpose of using a head mirror in an ENT examination?

Answer 55

"To reflect light from the lamp into the area being examined

Question 56

What is the focal length of a standard head mirror?

Answer 56

"14 inches."

Question 57

What is the main challenge in using a head mirror?

Answer 57

"Maintaining the angle and focal length

Question 58

What is an alternative to using a head mirror?

Answer 58

"A focusable light mounted on a headband."

Question 59

What are the four basic maneuvers in the physical examination of the ear?

Answer 59

"Inspection

Question 60

Why is percussion performed on the sinuses during an ear examination?

Answer 60

"To check for dullness and tenderness."

Question 61

What does the presence of bruits in the neck indicate?

Answer 61

"Possible inferior vena cava thrombosis or arteriovenous malformations."

Question 62

Why should hemangiomas not be punctured or aspirated?

Answer 62

"They do not clot and could lead to significant bleeding."

Question 63

What is the first step in an ear examination?

Answer 63

"Inspection and palpation of the pinna and surrounding areas."

Question 64

Why is the external auditory canal initially examined without a speculum?

Answer 64

"To inspect the concha and estimate the size of the external auditory meatus before inserting an otoscope."

Question 65

Why should the largest speculum that fits comfortably be chosen for otoscopy?

Answer 65

"To maximize the angle of view while avoiding patient discomfort."

Question 66

How should the ear be straightened in adults for otoscopy?

Answer 66

"By pulling the auricle backward and upward."

Question 67

How should the ear be straightened in infants for otoscopy?

Answer 67

"By pulling the auricle backward and downward."

Question 68

What is the advantage of a hand-held speculum?

Answer 68

"It is easy to use."

Question 69

What is the disadvantage of a hand-held speculum?

Answer 69

"It does not provide magnification."

Question 70

What is the most commonly used instrument for ear examination?

Answer 70

"A battery-powered otoscope."

Question 71

What is the purpose of pneumatic otoscopy?

Answer 71

"To detect tympanic membrane perforation or middle ear effusion by altering external auditory canal pressure and observing membrane movement."

Question 72

What does no movement of the tympanic membrane indicate during pneumatic otoscopy?

Answer 72

"A perforation of the tympanic membrane."

Question 73

What does a shifting meniscus in pneumatic otoscopy indicate?

Answer 73

"Partial fluid accumulation in the middle ear."

Question 74

What color does serous effusion appear as in pneumatic otoscopy?

Answer 74

"Amber

Question 75

What color does mucoid effusion appear as in pneumatic otoscopy?

Answer 75

"Dull gray to white

Question 76

What are the three main parts of a pneumatic otoscope?

Answer 76

"Handle (battery pack)

Question 77

What is the purpose of a tympanoscopy?

Answer 77

"To assess tympanic membrane mobility by changing pressure in the external auditory canal."

Question 78

Where does nasopharyngeal carcinoma most commonly present?

Answer 78

"In the fossa of Rosenmüller."

Question 79

What instrument is used to visualize the nasopharynx?

Answer 79

"A nasopharyngeal mirror (size 0) warmed with a humidifier

Question 80

What should the patient do to relax the soft palate during nasopharynx examination?

Answer 80

"Breathe through the nose."

Question 81

How is the laryngeal mirror used during hypopharynx and larynx examination?

Answer 81

"It is warmed

Question 82

What should be done if a patient gags during a laryngeal examination?

Answer 82

"Ask the patient to pant or apply a topical anesthesia spray."

Question 83

Why should patients avoid eating or drinking after topical anesthesia in the throat?

Answer 83

"To prevent aspiration pneumonia

Question 84

What structures should be examined in the hypopharynx?

Answer 84

"Vallecula

Question 85

What is the function of the true vocal cords?

Answer 85

"They open during inhalation and close during vocalization."

Question 86

What are the arytenoids, and what is their function?

Answer 86

"Cartilages that pivot on the cricoid cartilage to open and close the vocal cords."

Question 87

What is the significance of the pyriform sinus?

Answer 87

"It is the opening of the esophagus

Question 88

What is the common term for the upper esophageal sphincter?

Answer 88

"‘Bab el-Mandeb