PDF CONTENTS

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Mind Maps in ENT-Neck Examination

Introduction

Tools / Mind Map / Clinical Tips Basic steps in ENT

Examination This Course

Created by Acknowledgment

References

Tools / Mind Map / Clinical Tips

Mind Map / Clinical Tips

Tools / Mind Map / Clinical Tips

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Created By…

▪ Maher Sefein, MBBCh, D. ORL, D. Medical Education (Dundee.UK). Associate Professor Faculty of Medicine and health sciences, UMS.

▪ Ng Giap Weng, PhD Computer Science (Salford, UK). Associate Professor Faculty of Computing and Informatics, UMS.

▪ Angeline Lee Ling Sing, PhD Computer Science Student, Faculty of Computing and Informatics, UMS.

▪ Carlson Lazorus, MSc Computer Science Student, Faculty of Computing and Informatics, UMS.

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^st

edition-December2020

Maher Sefein Ng Giap Weng Angeline Lee Carlson Lazorus

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• The e-book concerns with the main steps and clinical examination techniques in visual way rather than the classic wordy methods.

Design:

practical session as it provides an instant guide during

performing.

When to use it? During

• This e-book easily downloaded in any portable mobile gadgets .

Download:

• It is used in conjugation with text books, and not replacing any of it. Details should be read

about techniques of exam.

How to use it?

the clinical sessions to revise the key tips before the exam.

When to use it? After When to use it? Before

the clinical session to prepare your mind to receive the instructor’s explanation.

• The learners will be able to revise the concept of Ear-Nose-Throat-Larynx-Neck examination at a glance.^.

Objective:

• E-book applies Mind Maps to show the contents, so both sides of brain works together to consolidate the learned facts.

INTRODUCTION

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THIS COURSE

The course is composed of FIVE modules:

1. Ear Examination

2. Nose and Nasopharynx Examination

3. Oral Cavity and Oropharynx Examination 4. Larynx and Hypopharynx Examination 5. Neck Examination

This e-book enables the learner to revise the examination techniques of ENT, in various ways, using:

Tools’ Gallery

Mind Map: Steps of Clinical Examinations Mnemonic lists

Clinical Tips

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BASIC STEPS in ENT-Neck EXAMINATION

ENT Examination is usually performed in 4 main steps. The sequence of steps may be changed as in nose when the examiner performs function test (patency) before local inspection.

Regional inspection

Regional palpation

Local inspectio n

Function tests

This

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i - Tools for Ear Examination.

Ii - Mind map of Ear Examination iii - Mnemonic List of Otoscopy

1. EAR EXAMINATION

Revise

• Anatomy of The Ear

• Tympanic

membrane is the window of middle ear.

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TOOLS FOR EAR EXAMINATION

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Pneumatic Otoscope

Attached to The Pump Tuning Fork 512 Hz Ear Suction Jobson Horne’s

Probe and Ring Curette

Normal Pinna Normal Pinna Normal

Tympanic Membrane

Normal

Tympanic Membrane

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➢ External meatus,

2. Regional Palpation

➢ Pre –auricular area

➢ Auricle

➢ Post auricular area

➢ external canal

Tympanic membrane:

Mnemonic List : COLUMPIA

3. Local Inspection (Otoscopy)

➢ Fork/Tuning test

➢ Facial Nerve Examination 4. Function

Tests

➢ Fistula test

➢ Field Test

MIND MAP OF EAR EXAMINATION

1. Regional

Inspection

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MNEMONIC LIST IN OTOSCOPY: COLUMPIA

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Color? Pale/Pearl grey

Light reflex (Cone of light) at Antero-Inferior corner Opacity: SemiTransparent

Ultra-findings (as tympanosclerosis, Grommet tubes)

Mobility: Mobile, not restricted or hypermobile

Intact: Not perforated

(Perforation described in 7S)

Position: Normal position,

not retracted nor bulging

Access: The external auditory meatus

and canal, first to comment, wax r polyp

may block TM view

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2. NOSE & NASOPHARYNX EXAMINATION

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i - Tools for Nose Examination..

ii - Mind map of Nose, Sinuses &

Nasopharynx Examination

iii - Clinical features of allergic Rhinitis

Revise

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Thudicum’s Nasal Speculum

Vienna’s Nasal Speculum Clair Thomson’s Posterior Rhinoscopic Mirror

Post Nasal Space Mirror (Mobile Mirror)

Rigid Nasal Hopkin’s Endoscope

Flexible Naso-pharyngo- laryngoscope

Surface Anatomy of Nose and Sinuses

Surface Anatomy of Nose And Sinuses

1. Nasion

2. Nasal tip

3. Nasal bridge

( crooked in this case )

4. Philtrum

5. Nasal alae

6. Supraorbital margin 7. Infraorbital margin 8. Maxillary eminence

TOOLS FOR NOSE EXAMINATION

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➢ Facial skeleton, nasal framework and sinuses.

➢ A. Anterior Rhinoscopy

➢ B. Posterior Rhinoscopy

1. Regional Inspection

➢ The nasal framework and the middle third of face.

2. Palpation

3. Local Inspection

➢ A. Patency test: (Cold Spatula Test)

4. Function Examination

➢ B. Smell test

^1. Nasal cavity

2. Inferior turbinate 3. Eustachian cushion 4. Fossa of Rosenmuller 5. Adenoids

6. Uvula

MIND MAP OF NOSE, NASAL SINUSES & NASOPHARYNX EXAMINATION

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CLINICAL FEATURES OF ALLERGIC RHINITIS

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Ask About Cardinal Symptoms Then Examine Nose and

Related Structures for Signs of Allergy

Cardinal Symptoms

Signs of Allergy

Loss sense of smell

Signs of Complications:

Sinusitis, Granular pharyngitis, Serous

otitis Media, Oedema of vocal

folds

Ocular Signs

Oedema of lids, dark circles around eyes ,

congestion of conjunctiva.

Allergic nasal Polyposis Salute Sign

Transverse nasal crease

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3. ORAL CAVITY & OROPHARYNX EXAMINATION

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i - Tools for Throat Examination Ii - Mind map of Oral Cavity

& Oropharynx Examination iii - Clinical Tips in Oral Cavity &

Oropharynx Examination

Revise Anatomy of Oral

Cavity & Ororpharynx

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Local Anesthesia Lignocaine 4 % Tongue Depressors

Post-nasal Space mirror Flexible Naso-pharyngol-aryngoscope

TOOLS FOR THROAT EXAMINATION

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Regional Inspection :

lower third of face and mouth symmetry.

Local inspection:

oral cavity and oropharynx.

Palpation:

Submandibular salivary glands, draining lymph nodes in neck and any associated masses.

Special (Functional examination):

To test taste sensation.

MIND MAP OF ORAL CAVITY & OROPHARYNX EXAMINATION

Tonsil

•Look for Size of tonsils

•Signs of inflammation

•Unilateral swelling is red flag sign

Tongue •Tongue mobility and deviation on the protrusion.

•Lateral side and posterior third for hidden lesions

•Any congestion, postnasal drip mucus or blood, lymphoid hyperplasia

Oro- Pharynx

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Common Infections in Oral Cavity:

A. Acute Pharyngitis, B. Acute follicular tonsilitis,

C. Quinsy

C .Quinsy case look for:

1. Congested soft palate 2. Deviated uvula

3. Site of incision for quinsy drainage

4. Anterior pillar 5. Posterior pillar 6. Left tonsil

During Inspection of Oral cavity

(AS a HALL), Identify the landmarks in sequence:

1. Soft Palate ( ROOF) 2. Uvula (ROOF) 3. Palatoglossal arch

(WALL)

4. Palatopharyngeal arch & Vestibule

(WALL)

5. Palatine tonsil &

Tongue (CONTENTS) 6. Crypta Magna

7. Oropharynx (POSTERIOR DOOR)

• LIPS: ANTERIOR DOOR)

• FLOOR is formed by Myelohypid muscle

CLINICAL TIPS IN ORAL CAVITY & OROPHARYNX EXAMINATION

A

B

A

B

C

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4. LARYNX & HYPOPHARYNX EXAMINATION

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i - Tools for Laryngeal Examination.

ii - Mind map of Larynx and Hypopharynx Examination iii - Mnemonic List to Describe

Laryngeal Inlet

Revise

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Local Xylocaine spray 4%

Indirect

Laryngeal Mirror Indirect laryngoscopy Flexible Naso-pharyngol- aryngoscope

70 Degree Rigid Endoscope

Rigid Endoscopy for Examining Larynx and

Hypopharynx

The Inlet of The Larynx

As Viewed Through The Laryngeal Examination

The Inlet of The Larynx

As Viewed Through The Laryngeal Examination

TOOLS FOR LARYNX EXAMINATION

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➢ Indirect Laryngoscopy ( in center )

➢ Fibre-optic Laryngoscopy (Rigid 70 degree)

➢ Flexible Naso-pharyngo Laryngosopy

➢ Mnemonic List: COMPASS

➢ Palpate Laryngeal framework

➢ Elicit Laryngeal Crepitus

➢ Any tenderness?

1. Regional Inspection :

➢ Inspect the external framework of larynx

➢ Notice the movement of thyroid gland on deglutition

2. Palpation

➢ Mobility of vocal folds

➢ Patient says EEE

4. Function tests

3. Local Inspection:

1. 4.

2. 3.

MIND MAP OF LARYNX AND HYPOPHARYNX EXAMINATION

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Mnemonic List to Describe Laryngeal Inlet ^”COMPASS

^”

Key Words and Normal Findings are Mentioned Inside The Circles.

Abnormal Lesions Shown Outside The Circles, They areRED FLAG SIGNS of Serious Cases!

O C

S

S A

P M

Retention cysts in Valleculae?

Turban epiglottis (Pseudoedema)?

Ant. Commissure can not seen?

V.F. mobility Restricted?

Paralyzed VF?

V.F. in Paramedian

Position?

Cadaveric Position?

Any discoloration?

Hyperaemia?

Asymmetry?

of VF

Nodes?

Polyps?

Cysts?

Ulceration?

Whitish Patches?

Pooling of saliva in Pyrifom fossae?

Mass in Postcricoid region?

Granulation tissue?

Ulceration?

Base of Tongue, Epiglottis Aryepilottis folds

,

Ant. cOmissure ABNORMAL

Red Flag FINDINGS

C: Colour of Vocal folds (VF), O: Anterior cOmissure, M: Mobility of VF, P: Position of VF, A: Aretynoids , S: Surface of VF, S:Something else?

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5. NECK EXAMINATION

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i - Mind map of NECK Examination ii - Mnemonic List to Describe

Neck Mass

Revise

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1. Identify neck triangles first.

2. Flex the neck to ease palpation.

4. Percussion over sternum for

retrosternal goitre, if you cannot get under lower border of the thyroid gland. Auscultate over the thyroid swelling for a systolic bruit.

5. Examine the thyroid status

& perform ENT Examination

1. Regional Inspection

2. Regional Palpation:

Anterior & Posterior palpation

of Neck

3. Local Examination

of Lesion

(lump, ulcer, …)

4. Percussion

&

Auscultation 5.

Complementary

Exam.

MIND MAP OF NECK EXAMINATION

3. Local Exam: Follow the mnemonic list STEP.CoM

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MNEMONIC LIST TO DESCRIBE NECK MASS : STEP.CoM

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Co ³ M

Local

Examination of

Neck Mass

S ⁵

T ⁴

E P.

• Texture

• Temperature

• Tenderness

• Transillumination

▪ Edge: : distinct or indistinct

▪ Pulsatility & Bruit

• Consistence: (Hard Soft, Firm, rubbery )

• Cystic : Fluctuation

• Compressibility

Site (Position): relation to the neck triangles Size in centimeters

Shape in three dimensions: spherical, ovoid, Skin Colour, and texture

Surface (smooth or irregular), and edge

• Mobility & attachment to deeper structures

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REFERENCES

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•

Browse, N.L., Black, J., et al., (2005). Browse’s Introduction to The Symptoms and Signs of Surgical Diseases.

Chapter11, The Neck. Publishers Hodder Headline Group, London., 270-311.

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Dhingra, P.L., Dhingra, S., (2014).Diseases of Ear, Nose and Throat, &Head and Neck Surgery.6thedition .Elsevier, India.

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Donoguhue MG, NarulaAA, Bates J.G.(2010) Clinical ENT : an illustrated text book. 3rd edition. Singular Publishing group.

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Hazaika P, Nayak RD. (2005). Clinical and operative

methods in ENT and Head and Neck surgery: A systematic approach. CBS Publisher India..

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Kullar P, Manjaly J, Yates P. (2013). ENT OSCEs: Passing DO- HNS and MRCS ENT OSCE. Master pass. UK

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Omar R., Narayanan.P.,Rajagopalan ( 2007 ). Ear, Nose Throat Colour Atlas and Synopsis. University Malaya press.

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Oxford medical education (OME). accessed 2020.

http://www.oxfordmedicaleducation.com/ clinical- examinations/neck-examination

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Thanks for photos from Common Creative.