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Clinical Methods in ENT
PT Wakode
PART I: BASICS OF HISTORY TAKING
1:
Introduction
Bull's Eye Lamp (Figure 1-1)
Head Mirror (Figure 1-2)
Aural Speculum (Figure 1-3)
Nasal Speculum (Figure 1-4)
Laryngeal Mirrors (Figure 1-5)
Post-nasal Mirrors (Figure 1-6)
Siegle's Pneumatic Speculum (Figure 1-7)
USES
Tuning Forks (Figure 1-8)
Wire Vectis with Cerumen Spud (Figure 1-9)
Tongue Depressor (Figure 1-10)
Cotton Wool Carrier (Figure 1-11)
Nasal Packing Forceps (Figure 1-12)
Suction Cannula
Spirit Lamp
Sitting Arrangement (Figure 1-13)
Otoscope (Figure 1-14)
2:
History Taking
Name
Age
Sex
Occupation
Residence
Complaints
History of Present Illness
Past History
Personal History
Family History
Physical Examination
3:
Examination of Swelling, Ulcer and Fistula
History
DURATION
MODE OF ONSET
ASSOCIATED SYMPTOMS
EXACT SITE
OTHER SWELLINGS OVER BODY
General examination
Local Examination
Inspection
SITE
SIZE
SHAPE
SURFACE
MARGINS
SKIN OVER SWELLING
PULSATIONS
COLOUR
CHANGE IN SIZE OF SWELLING ON COUGHING/STRAINING OR VALSALVA
Palpation
FIXITY TO SKIN
MOBILITY OF SWELLING
Fluctuation (Figures 3-1A and B)
Transillumination Test (Figure 3-2)
Reducibility
Compressibility (Figures 3-3A and B)
Pulsatile Swelling
Percussion
Auscultation
REGIONAL LYMPH NODES
EXAMINATION OF SINUS OR FISTULA
Sinus
Fistula (Figure 3-4)
EXAMINATION OF ULCER (FIGURE 3-5)
History
Examination of Ulcer
PART II: OTOLOGY
4:
Examination of Ear
Otorrhoea
DURATION
SEVERITY
LATERALITY
PERIODICITY
CHARACTER OF THE DISCHARGE
Hearing Loss
DURATION
SEVERITY
LATERALITY
PERIODICITY
NATURE OF DEAFNESS
Tinnitus
Otalgia
DURATION
CHARACTER
SEVERITY
LATERALITY
PERIODICITY
Giddiness
Itching in the Ear
Blocking/wooly or FB Sensation in Ear
Autophony and Hyperacusis
Swelling in pre- and post-auricular Area
Bleeding from Ear
Past History (History of Major Illnesses)
Family History
Personal History
General Examination
Local Examination
EXAMINATION OF EAR
Examination of Pinna, Pre- and Post-aural Area (Figures 4-2 to 4-5)
EXAMINATION OF EXTERNAL AUDITORY CANAL
Examination of Ear with Aural Speculum (Figure 4-6)
EXAMINATION OF TYMPANIC MEMBRANE
Mobility of TM (Figures 4-7 and 4-8)
Abnormalities of Tympanic Membrane
FISTULA TEST
Fallacy
Tips
TUNING FORK TESTS
Rinnie's Test (Figure 4-14 and Table 4-1)
Weber Test (Figure 4-15)
Absolute Bone Conduction (ABC) Test (Figure 4-16 and Table 4-3)
Systemic Examination
Radiological Examination of the Ear
Audiometry
PURE TONE AUDIOMETRY (PTA)
Few Ear Conditions
CONGENITAL
Anotia
Microtia
Meatal Atresia (Figure 4-26)
Treacher Collin's Syndrome (mandibulo-facial dysostosis) (Figure 4-28)
Pre-auricular Sinus (Figure 4-29)
Dermoid Cyst (Figure 4-30)
TRAUMATIC
INFECTIVE
Diffuse Otitis Externa (Figure 4-31)
Post-aural Intertrigo (Figure 4-32)
Otomycosis
Malignant Otitis Externa
Common Conditions of Middle Ear
SUPPURATIVE OTITIS MEDIA
Acute
Chronic Suppurative Otitis Media
NON-SUPPURATIVE OTITIS MEDIA
OTOSCLEROSIS (TABLE 4-5)
Common Conditions of Inner Ear
Few Common Procedures
SYRINGING (FIGURES 4-37A AND B)
PART III: RHINOLOGY
5:
Examination of Nose and Paranasal Sinuses
Nasal Obstruction
DURATION
LATERALITY
LATENCY
SEVERITY
CHARACTER
Nasal Discharge (Rhinorrhoea)
DURATION
LATERALITY
SEVERITY
LATENCY
CHARACTER
Watery
Mucoid
Mucopurulent
Purulent
Blood Stained Discharge
Bleeding Per Nose (Epistaxis) (FIGURE 5-1)
Sneezing
Nasal Mass
Crusting
Disturbances of Smell
Itching in Nose
Nasal Regurgitation
Foreign Body in Nose
Swelling over Nose and Face
Pain in and Around Nose
HEADACHE
EPIPHORA (WATERING FROM EYES)
ALTERATION IN VOICE
Snoring
Clinical Examination of Nose and PNS
INSTRUMENTS
Examination of External Nose and Face
INSPECTION
PALPATION
Anterior Rhinoscopy
STRUCTURES TO BE SEEN IN ANTERIOR/RHINOSEOPY
Posterior Rhinoscopy (Figure 5-5)
PROCEDURE
Sinus Tenderness (Figures 5-6A to C)
Cold Spatula Test (Figure 5-7)
Transillumination Test
Nasal Endoscopy
INDICATIONS
INSTRUMENTS REQUIRED (FIGURES 5-8 AND 5-9)
PROCEDURE
Advantages of Diagnostic Nasal Endoscopy
RADIOLOGICAL EXAMINATION OF NOSE AND PARANASAL SINUSES
Occipito-mental View (Water's View) (Figures 5-15 and 5-16)
Occipito-frontal View (Caldwell View) (Figures 5-17 and 5-18)
X-ray Base Skull (Submento-vertical View) (Figures 5-19A and B)
FEW CONDITIONS OF NOSE AND PARANASAL SINUSES
Atrophic Rhinitis (Figure 5-21)
Rhinolith
Adenoiditis (Figure 5-23)
Sinusitis
Deviated Nasal Septum (Figures 5-25A and B)
Nasal Polyps
ANTROCHOANAL POLYP
ETHMOIDAL POLYPOSIS
RHINOSPORIDIOSIS
RHINOSCLEROMA (FIGURE 5-29)
Stages
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA (FIGURE 5-30)
Some Tumours Seen in Nose and PNS
CARCINOMA OF MAXILLARY ANTRUM (FIGURES 5-38 AND 5-39)
SOME COMMON PROCEDURES IN NASAL DISEASES
Local Anaesthesia for Nasal Procedures
Infiltration Anaesthesia
ANTRAL PUNCTURE (ANTRAL LAVAGE) (FIGURE 5-41)
ANTERIOR NASAL PACKING (FIGURE 5-43)
POST-NASAL PACKING (FIGURE 5-44)
FB REMOVAL (FIGURE 5-45)
PART IV: HEAD AND NECK
6:
SECTION A: Oral Cavity and Oropharynx
Examination of Oral Cavity and Oropharynx
INSPECTION
Tongue
Teeth and Gums
Cheeks and Gingivo-labial Gutters
Hard Palate, Soft Palate, Uvula (Figure 6-1D)
Anterior Pillars, Tonsils and Posterior Pillars
PALPATION
Tongue
Floor of Mouth (Figure 6-3)
Tonsils and its Bed
Base of Tongue
Swelling in Oral Cavity
PERCUSSION AND AUSCULTATION
Pharyngitis
Tonsillitis
Quinsy (Synonyms: paratonsillar abscess, peritonsillar abscess) (Figure 6-5)
Retropharyngeal Abscess (Figure 6-6)
Parapharyngeal Abscess
Ludwig's Angina
Aphthous Stomatitis
Leucoplakia (Figure 6-8)
Cleft Palate
Malignancy (Figure 6-9)
Submandibular Sialoadenitis (Figure 6-10)
7:
Examination of Larynx and Laryngopharynx
Change in Voice
Difficulty in Breathing
Stridor
Difficulty in Swallowing
CAUSES
Pain in Throat
CAUSES
Foreign Body (FB)
FB INHALATION
FB INGESTION
Causes
Cough
Neck Swelling
Indirect Laryngoscopy
Common Conditions Involving Larynx and Laryngopharynx
LARYNGOTRACHEOBRONCHITIS
FB IN LARYNX AND LARYNGOPHARYNX (FIGURES 7-2A TO 7-3D)
JUVENILE LARYNGEAL PAPILLOMATOSIS (FIGURE 7-4)
LARYNGOMALACIA
VOCAL NODULE (FIGURE 7-5)
VOCAL CORD PALSY
MALIGNANCY OF LARYNX
8:
Thyroid Gland
Introduction
History Taking
General Examination
PULSE RATE
BLOOD PRESSURE
Swelling in Thyroid Region
Examination of Thyroid Gland
INSPECTION
PALPATION
PERCUSSION
AUSCULTATION
Eye Signs
Systemic Examination
Types of Goitre (Figures 8-1 and 8-2)
GRAVE'S DISEASE
HASHIMOTO'S DISEASE
BENIGN NEOPLASMS
MALIGNANT THYROID TUMOURS
9:
SECTION B: Examination of Neck
Palpation
ECTOPIC THYROID (FIGURE 9-7)
THYROGLOSSAL DUCT CYST (FIGURE 9-8)
DERMOID CYST
Clinical Features
THYROID SWELLING (FIGURE 9-9)
LUDWIG'S ANGINA
Symptoms
Treatment
SEBACEOUS CYST
Clinical Features
BRANCHIAL CYST (FIGURES 9-10A TO C)
LIPOMA (FIGURE 9-11)
CYSTIC HYGROMA (LYMPHANGIOMA) (FIGURE 9-12)
CAROTID BODY TUMOUR (CHEMODECTOMA) (FIGURE 9-13)
LYMPHOMAS
SECONDARY DEPOSITS IN NECK (FIGURE 9-14)
LARYNGOCOELE (FIGURES 9-15 TO 9-17)
10:
Examination of Salivary Glands
Parotid Gland
11:
SECTION C: Diseases of Oesophagus
Dysphagia
Regurgitation
Bleeding
Respiratory Symptoms
FB in Oesophagus
CLINICAL EXAMINATION
INVESTIGATIONS
Radiography
Oesophagoscopy
Diseases of Oesophagus
12:
Tracheo-bronchial Tree
Examination of Trachea and Bronchi
PALPATION OF TRACHEA IN NECK (FIGURE 12-2)
Diseases of Trachea and Bronchi
FOREIGN BODIES IN TRACHEA AND BRONCHI
FACTORS FOR FB LODGEMENT IN RESPIRATORY TRACT
PATHOPHYSIOLOGY
Investigations (Figures 12-4 to 12-8)
Complications
BRONCHIECTASIS
CARCINOMA BRONCHUS
PART V:
13:
Examination of Cranial Nerves
Olfactory Nerve
CLINICAL EXAMINATION (FIGURES 13-1A TO C)
Optic Nerve
Oculomotor Nerve
PUPILLARY LIGHT REFLEX
Clinical Examination (Figure 13-4)
Trochlear Nerve
Trigeminal Nerve (Figure 13-5)
INTRODUCTION
APPLIED ANATOMY
CLINICAL EXAMINATION
Sensory Functions
Corneal Reflex
Motor Function
TRIGEMINAL NEURALGIA (TIC DOLOUREUX)
Abducent Nerve
Facial Nerve
MOTOR FUNCTIONS
CLINICAL EXAMINATION
SENSORY FUNCTION TESTING
SECRETO-MOTOR FUNCTION
Vestibulo-cochlear Nerve
COCHLEAR NERVE
Glossopharyngeal Nerve
CLINICAL EXAMINATION
Vagus Nerve
CLINICAL EXAMINATION
RESULTS
Spinal Accessory Nerve
ANATOMY
CLINICAL EXAMINATION
Causes for Lesion
Hypoglossal nerve
INDEX
TOC
Index
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