ENT - Skull, face, Nose, Ears Flashcards
How do we introduce an examination?
Your ID Patients ID Explanation Consent Pain
What is done directly after the introduction?
General inspection of patient and environment
What is looked for in the focused inspection of the face?
Symmetry
Swellings
Scars
Skin - rashes, acne or vitiligo
What is inspected for in the eyes?
Lig lad
Ptosis
Bulging eyes - thyroid eye disease
Pull down eyelids looking for jaundice of sclera or pale conjunctiva
What is looked for in the nose?
Look from front, sides and from above - assessing shape of nasal pyramid
Look for discharge
Ask patient to block one nostril and assess air flow in other nostril
Elevate tip of nose and inspect inside using a pen torch
What are the ears inspected for?
Pinna - nodules and lesions, is pinna pushed forward
External auditory meatus - discharge
Behind pinna - scarring
Mastoids process - bruising or battle’s sign
What is battle’s sign?
Bruising over the mastoid indicating middle cranial fossa fracture
What is done after inspection of the ear?
Auriscope examination
How do we perform an auriscope examination?
Screen for pain
Hold auriscope like a pen
Inspect outer ear, pinna etc
Go in slowly and inspect ear canal for tympanic membrane
Repeat on both ears
What are you inspecting the tympanic membrane for?
Posterior and anterior folds
Handle of malleus
Light reflex
What is done after inspection?
Palpation of:
- skull and face: mastopid process, orbital margin, temporal artery tenderness, maxilla and mandible, TMJ joint (ask patient to open and close mouth and move jaw side to side)
- ears: stretch pinna and ask if it hurts (infection)
- nose: feel the nasal cartilage, bones and sinuses (maxillary ethmoidal and frontal)
What is done after palpation?
Hearing tests
- whisper test
- rinnes
- webers
If the whisper test fails what would you do?
Repeat it at a distance of 15cm
