ENT & Endocrine Flashcards
(20 cards)
the neck
Neck specific symptoms= horseness, stridor (noisy breathing due to an obstructed airflow through a narrowed airway), dysphagia (swallowing difficulties) and neck pain
Stridor–> can be sudden (due to an inhaled foreign body or anaphylaxis) or gradual (due to tumour in the pharynx or larynx, compression of trachea lymph nodes or gioter (swollen thyroid))
the eustachian tube
=originates in the rear of the nose adjacent to the soft palate and ends in the middle ear space–> connects the middle ear space to the rear nose
Supporting structure= cartilage in the first two thirds of the tube. Last third is supported by bone
Lining tissue= similar to the tissues of the nasal cavity and may swell and produce mucus in reaction to similar stimuli
The tube is usually closed but can become partially/ completely blocked due to common colds or allergies–> can cause sensations of popping, clicking and ear fullness
ear, nose & throat
The nose= an organ of respiration and olfaction’s–> filters, humidifies and regulates the temp of inspired air
Superior, middle and inferior turbinates= elevations on the lateral nasal walls–> they are well insulated with blood vessels and they help control the temperature of inspired air
The nasal septums and the turbinates create an air flow pattern in the nose that maximises air conditioning function of nose and paranasal sinuses
Paranasal sinuses= maxillary, frontal, sphenoid and ethmoid bones–> similar functions to nose
Tap each sinus- possibly not ethmoid as too deep- should feel hollow
Assess the throat with a torch
Viral infection= red swollen tonsils and throat redness
Bacterial infection= swollen uvula, whitis spots, red swollen tonsils, throat redness, grey furry tongue
neck pain in front/ side
-Uncontrolled weight loss?
-Fever?
-Night sweats?
hyperthyoid q’s–> - Anxious, nervous, irritable, heat intolerance?, Angina, palpitations, breathlessness?, Weight loss, diarrhoa?, Menstrual cycle- scanty or abscent?
hypothyroid q’s–> - Fatigue, cold intolerance?, Angina, palpitations, breathlessness?, Weight gain, constipation?, Menstrual cycle- heavy?
night sweat causes
-Menopause
-Idiopathic hyperhidrosis
-Infection
-Cancers
-Medications
-Hypoglycemia
Hormone disorders
-Neurologic conditions
thyroid examination
Palpate the isthmus and then move laterally and assess each thyroid lobe unilaterally
2 hormones excreted from the thyroid–> T4 thyroxine and T3 tri-iodothyronine
Parathyroid gland- rare to be inflamed
If the thyroid is hard then it may be cancerous. If its enlarged, then its swollen
waldeyer ring
=ring of lymphoid tissue around the pharynx
pharyngeal tonsils (or nasopharyngeal tonsils, due to the location; also known as ‘adenoid(s)’ when inflamed/swollen) They are located on the roof of the nasopharynx, under the sphenoid bone.
tubal tonsil (bilaterally, where each Eustachian tube opens into the nasopharynx)
palatine tonsils (commonly called “the tonsils” in the vernacular, less commonly termed “faucial tonsils”; located in the oropharynx
Lingual tonsils (on the posterior tongue)
lymph node examination of cervical
Should be the size of a pea and consistency is –>if it’s a cancerous lump it should feel like a marble
If a lymph node is swollen or a lump is found: assess for size, consistency, tenderness and fixation
-Under jaw (submandibular nodes)
-By cheeks (facial)
-Up to TMJ (preauricular nodes)
-Around ear (retroauricular)
-Back of occiput (suboccipital)
-Down back of neck (posterior cervical nodes)
-Posterior SCM (anterior cervical nodes)
-Supra/ infra clavicular (supreclavicular nodes)- indicates breast or stomach cancer
axillary nodes
-Patient is sat with their hands on their hips
-Put hand into armpit and push into pec to see it move (anterior), then push up (central) and then push even more up into shoulder (posterior)
epitrochlear nodes
-Around the epicondyles of the forearm
-Look or skin cancer
inguinal nodes
-Find ASIS and push into inguinal ligament and palpate inguinal pulse
-There’s a horizontal and vertical group
-Palpate for changes
lymphatic system contraindications
-Fracture/ acute injuries
-Malignant diseases
-Spleen/ liver trauma
-Acute hepatitis
-Infections
-Acute asthma attack
-Odema with pathology/ heart/ lungs
-Untreated malignant tumour
-Thrombosis
-Cardiac insufficiency
-Aneurysms
-Acute stroke
opening impediments for lymph
in order to move lymph around, practitioners have to remove barriers to impediments
-Have to release central first before peripheral
-Then move lymph to the heart
To open the impediments–> reduce hyper sympathetic activity
Diagnose and treat diaphragmatic dysfunctions
Cervical- open ears. Also flexion and extension of csp
1.Rib raising–> patient seated, pull at the angle of the ribs. Rhythmic technique from T1-T12
2.Rib head pushing–> patient supine. Find rib angles and lift/ paddle up. Go down ribcage.
3.Thoracic inlet–> works on patients first rib and its attachments. Patient supine. Compress first rib. Sidebend into my contact and repeat until a release. Can do with rotation but rotate away from contact
4.Thoracic inlet via clavicle–> fix off on ribs 2/3 with an opposite contact. Pull arm out and push into ribs. Can also do the phone hold and pull wrist and arm up (cross contact)
diaphragm
Assess abdominal diaphragm–> see how the diaphragm moved, push into either side. Observe from both sides.
Find diaphragm process with thumbs as patient breathes in, lean into it and keep leaning (patient can bend knees to relax rectus abdominals). When done, gently spring out.
Pelvic diaphragm:
-Patient supine, practitioner sat on plinth.
-Prop their leg up and rest weight on my shoulder.
-contact on sitting bone (ischial tuberosity)
-Push into diaphragm with other hand- should feel movement in both.
pec traction
-Patient supine. Sit at top end of plinth.
-Hook under pec tendons ad lean back.
thoracic pump
-Patient supine
-Cross hands over their chest and pump down
abdominal pump
-Push up into rib cage.
liver pump
-Patient sidelying
-Arm holding shoulder
-Push into sides
Lymphatic technique
Pectoral traction
Abdominal pump
explanation
thyroid exam= helps in diagnosing thyroid diseases such as Grave’s disease, hypo/ hyperthyroid
lymph nodes= provides information about the possible presence of a malignant or inflammatory process and the localization or generalization of that process
diaphragm= observe elasticity of inspiration and expiration, muscle weakness, diseases
