ENT - Mouth, Throat, Neck

Question 1

How do we introduce this exam?

Answer 1

Your ID
Patient ID
Explanation and Consent
Pain
Positioning 
General inspection

Question 2

How would the patient be positioned?

Answer 2

Sitting in chair
Neck exposed to clavicles - remove jewelry
Glass of water nearby

Question 3

What parts would you inspect?

Answer 3

Mouth

Neck

Question 4

What is looked for in the mouth?

Answer 4

Lips - cyanosis, angular stomatitis, lesions

Open mouth - dentition, hard and soft palate, uvula, tonsil, inside of cheeks and parotid duct openings

Tongue - dorsal surface, lateral borders, fasciculations, dryness, wasting

Underside of tongue - frenulum, submandibular ducts

Question 5

What is done after inspection of mouth?

Answer 5

Ask patient to gently bite teeth together while using 2 tongue depressors to separate cheeks

Question 6

What would you inspect on the neck?

Answer 6

Scars and swellings
Lumps - site, size and skin changes

Movement:

• Tongue protrusion “please stick your tongue out”
• Swallowing “please take a sip of water, holt it in your mouth, then swallow”

Question 7

What would you palpate on the neck?

Answer 7

Lymph nodes

Question 8

What pattern/order would you palpate in?

Answer 8

"Z" shape
Level 1 - submental, submandibular
Level 2 - anterior chain upper 1/3rd
level 3 - anterior chain middle 1/3rd
Level 4 - anterior chain lower 1/3rd
Level 5 - posterior triangle

Then finish with occipital, pre and post auriculal

Level 6 is the pre-tracheal lymph nodes

Question 9

If swelling is present in neck - what must you determine about the swelling?

Answer 9

Is it:

• mobile
• cystic (compressible)
• nodular (hard)
• vascular (pulsatile)

Question 10

What should be done if a thyroid swelling?

Answer 10

Palpate the thyroid (fingers just above the sternal notch on trachea)
Ask patient to swallow water
Thyroid should move up

Question 11

What is palpated in the mouth?

Answer 11

Bimanual palpitation of the mouth:

• means use one finger on inside of mouth and one on outside
• Submandibular and parotid gland (feel on outside 1st)
• Floor of mouth under tongue
• tongue substance (may trigger a gag)

Question 12

What is auscultated?

Answer 12

Carotid artery stenosis - bruits, use diaphragm and ask patient to hold breath

If thyroid is enlarged - listen over both lobes, in graves a bruit may be heard