WEEK 33 OSPAP Programme MPHM 13 ENT examination

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WEEK 33 OSPAP Programme MPHM 13 ENT examination Slide 1 of 53 MPHM 14

WEEK 33 OSPAP Programme MPHM 13 ENT examination Slide 1 of 53 MPHM 14 OSPAP ENT examination

WEEK General inspection 33 • • • General health of the patient Obvious pain

WEEK General inspection 33 • • • General health of the patient Obvious pain Colour- cyanosis/pallor Signs of temp/infection/signs of ENT disease Nutritional status Observes for swelling Slide 2 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 3 of 53 Temporomandibular joint MPHM 14 OSPAP ENT examination

WEEK 33 Slide 3 of 53 Temporomandibular joint MPHM 14 OSPAP ENT examination

WEEK 33 The Neck Slide 4 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 The Neck Slide 4 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 5 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 5 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Neck examination • Inspection • Look for symmetry, masses or scars •

WEEK 33 Neck examination • Inspection • Look for symmetry, masses or scars • Observe any visible enlargement of the parotid or submandibular glands or lymph nodes Slide 6 of 53 MPHM 14 OSPAP ENT examination

WEEK The neck - lymphatic drainage 33 • If a malignant or inflammatory lesion

WEEK The neck - lymphatic drainage 33 • If a malignant or inflammatory lesion is observed look for involvement of the regional lymph nodes which drain the area • If a lymph node is tender or enlarged look for the possible source of infection in the region that it drains Slide 7 of 53 MPHM 14 OSPAP ENT examination

WEEK Examination of Nodes 33 • • • Palpate Ensure the neck is fully

WEEK Examination of Nodes 33 • • • Palpate Ensure the neck is fully exposed Flex neck slightly forward Use the pads of the index and middle fingers Examine both sides at once using a mini rotatory movement across the skin of the neck Slide 8 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 9 of 53 Lymph nodes MPHM 14 OSPAP ENT examination

WEEK 33 Slide 9 of 53 Lymph nodes MPHM 14 OSPAP ENT examination

WEEK 33 The Mouth & Throat Slide 10 of 53 MPHM 14 OSPAP ENT

WEEK 33 The Mouth & Throat Slide 10 of 53 MPHM 14 OSPAP ENT examination 10

WEEK 33 Slide 11 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 11 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 12 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 12 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 13 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 13 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 14 of 53 See SIGN guidelines MPHM 14 OSPAP ENT examination

WEEK 33 Slide 14 of 53 See SIGN guidelines MPHM 14 OSPAP ENT examination

WEEK 33 Slide 15 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 15 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 16 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 16 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 17 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 17 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Nose & Sinuses Slide 18 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Nose & Sinuses Slide 18 of 53 MPHM 14 OSPAP ENT examination 18

WEEK Sinuses 33 Slide 19 of 53 MPHM 14 OSPAP ENT examination

WEEK Sinuses 33 Slide 19 of 53 MPHM 14 OSPAP ENT examination

Nasal cavity anatomy WEEK 33 • Septum • Membrane • Turbinates Slide 20 of

Nasal cavity anatomy WEEK 33 • Septum • Membrane • Turbinates Slide 20 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 21 of 53 Turbinates MPHM 14 OSPAP ENT examination

WEEK 33 Slide 21 of 53 Turbinates MPHM 14 OSPAP ENT examination

WEEK Turbinates 33 • The turbinates are small bones lined by mucosa inside the

WEEK Turbinates 33 • The turbinates are small bones lined by mucosa inside the nose • Their purpose is to moisten the air the pt breathes • Excessive swelling of these tissues can contribute to nasal obstruction. • Can also be damaged eg. With cocaine, steroids polyps, growths Slide 22 of 53 MPHM 14 OSPAP ENT examination

WEEK Turbinates 33 rhinitis Slide 23 of 53 MPHM 14 OSPAP ENT examination

WEEK Turbinates 33 rhinitis Slide 23 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 24 of 53 Allergic Rhinitis MPHM 14 OSPAP ENT examination

WEEK 33 Slide 24 of 53 Allergic Rhinitis MPHM 14 OSPAP ENT examination

WEEK 33 Watch video Slide 25 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Watch video Slide 25 of 53 MPHM 14 OSPAP ENT examination

WEEK The Septum 33 Slide 26 of 53 MPHM 14 OSPAP ENT examination

WEEK The Septum 33 Slide 26 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 27 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 27 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 28 of 53 Saddle nose deformity MPHM 14 OSPAP ENT examination

WEEK 33 Slide 28 of 53 Saddle nose deformity MPHM 14 OSPAP ENT examination

WEEK 33 Slide 29 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 29 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 30 of 53 Foreign bodies MPHM 14 OSPAP ENT examination

WEEK 33 Slide 30 of 53 Foreign bodies MPHM 14 OSPAP ENT examination

WEEK 33 Slide 31 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 31 of 53 MPHM 14 OSPAP ENT examination

WEEK Nasal polyps 33 Slide 32 of 53 MPHM 14 OSPAP ENT examination

WEEK Nasal polyps 33 Slide 32 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 33 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 33 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 The Ear Slide 34 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 The Ear Slide 34 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 35 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 35 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 36 of 53 Ear examination MPHM 14 OSPAP ENT examination

WEEK 33 Slide 36 of 53 Ear examination MPHM 14 OSPAP ENT examination

WEEK External auditory canal 33 • Permits transmission of sound to the tympanic membrane

WEEK External auditory canal 33 • Permits transmission of sound to the tympanic membrane from the enviroment • Protects the middle and inner ear from trauma, infection and environmental extremes Slide 37 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Ear Canal • Discharge: if present, note colour and odour • If

WEEK 33 Ear Canal • Discharge: if present, note colour and odour • If frank blood or clear watery drainage following trauma: immediate referral • CSF feels oily and tests positive for glucose • Foreign bodies • Redness or swelling • Cerumen: grey, dry and flaky, wet and colour honey to dark brown Slide 38 of 53 MPHM 14 OSPAP ENT examination

WEEK Tympanic membrane 33 • Consists of the pars tensa and the pars flaccida

WEEK Tympanic membrane 33 • Consists of the pars tensa and the pars flaccida • Flaccida- small segment, lies superiorly, fibrous layer missing, so is thinner than rest of drum • Pars tensa is larger, taut portion of drum • A normal tympanic membrane should be pearly grey and slightly translucent in appearance Slide 39 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 40 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 40 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 5. 2. 4. 3. 1. 6. Slide 41 of 53 MPHM 14

WEEK 33 5. 2. 4. 3. 1. 6. Slide 41 of 53 MPHM 14 OSPAP ENT examination

WEEK The Middle Ear 33 • An air filled cavity situated within the petrous

WEEK The Middle Ear 33 • An air filled cavity situated within the petrous temporal bone • The eustacian tube opens into the anterior part of the middle ear • Transmits sound in the form of air pressure waves from the tympanic membrane via a chain of three bones to the fluid in the inner ear where a liquid wave is set up Slide 42 of 53 MPHM 14 OSPAP ENT examination

WEEK The Inner Ear 33 • Responsible for hearing and balance • Comprises membranous

WEEK The Inner Ear 33 • Responsible for hearing and balance • Comprises membranous and bony labyrinth • Cochlea (membranous labyrinth) – a complex system of channels surrounded by the hard bony labyrinth • Cochlea filled with fluid - endolymph Slide 43 of 53 MPHM 14 OSPAP ENT examination

WEEK Earache – Common Causes 33 Infective otitis media Infective otitis externa Boils and

WEEK Earache – Common Causes 33 Infective otitis media Infective otitis externa Boils and furuncles of the canal and pinna Trauma (especially cotton buds) and foreign bodies (including wax) • Throat problems: tonsillitis/pharyngitis/quinsy • • Slide 44 of 53 MPHM 14 OSPAP ENT examination

WEEK Earache - Occasional 33 • • • TMJ dysfunction Dental abscess Impacted molar

WEEK Earache - Occasional 33 • • • TMJ dysfunction Dental abscess Impacted molar Trigeminal neuralgia Ear canal eczema/seborrhoeic dermatitis Chondrodermatitis nodularis helicis externa outer aspect of the ear middle age men Slide 45 of 53 MPHM 14 OSPAP ENT examination

WEEK Earache - Rare 33 • • • Mastoiditis Cervical spondylosis Cholesteotoma- see notes

WEEK Earache - Rare 33 • • • Mastoiditis Cervical spondylosis Cholesteotoma- see notes Malignant disease Barotrauma Slide 46 of 53 MPHM 14 OSPAP ENT examination

WEEK Red Flags 33 • Consider mastoiditis if foul smelling discharge present for more

WEEK Red Flags 33 • Consider mastoiditis if foul smelling discharge present for more than 10 days. Check for swelling behind the ear and downward displacement of the pinna • Don’t be too ready to diagnose Otitis Media in children – URTI’s and crying lead to some redness of the drum. Indiscriminate prescribing may lead to iatrogenic problems and masking the true diagnosis Slide 47 of 53 MPHM 14 OSPAP ENT examination

WEEK Ready Reckoner 33 OM OE Boils Tauma Throat Problems Discharge Possible Yes Possible

WEEK Ready Reckoner 33 OM OE Boils Tauma Throat Problems Discharge Possible Yes Possible No Pain on pulling pinna and pressing tragus No Yes Possible No Red bulging ear drum Yes No No Deafness Yes Possible No Pain on swallowing No No Yes Slide 48 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 49 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 49 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 50 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 50 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Acute otitis media symptoms • Pain • Fever • Tugging at ears

WEEK 33 Acute otitis media symptoms • Pain • Fever • Tugging at ears • Hearing loss • Documented fever when patient examined • Bulging, usually erythematous tympanic membrane which does not move on pneumatic otoscopy • Erythema (or redness) of tympanic membrane (ear drum) • Bulging of tympanic membrane • Pus in middle ear (bacteria in the middle ear effusion) Slide 51 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 52 of 53 MPHM 14 OSPAP ENT examination

WEEK 33 Slide 52 of 53 MPHM 14 OSPAP ENT examination