Question

25-year-old patient c/o left sided earache for 1 week. Explain how you would complete a focused assessment and what questions you would ask based on their complaints. ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

65-year-old patient c/o swelling to the right side of his face; Face appears to be swollen, red, and warm to touch (swollen parotid gland). Explain how you would complete a focused assessment and what questions you would ask based on their complaints.

Answer 1

25-year-old patient c/o left sided earache for 1 week. Explain how you would complete a focused assessment and what questions you would ask based on their complaints

-history taking:-

How did the pain start? Was it sudden or gradual in onset?

Did you insert ear buds in to the ear?

Is there any radiation of pain?

Any history of trauma to ear? Or impacted wax?

Is there any dental caries?

Associated with fever? Sore throat or rhinitis? Headache

Is there any sound heard in your ear? (Tinnitus)

Any relieving or aggravating factors?

Is this your first episode? Or where any history in the past?

Examination:

Check the temperature?

Vitals

Systemic examination:

HEENT:

Head: check for sinus tenderness,

Neck rigidity

Nose: septal deviation?

Any polyp

Ear : check for tragal tenderness

Local swelling

Mastoid tenderness

Examine the ear with otoscope to find any foreign body,

Tympanic membrane: torn or intact or tensed, pus pointing?

It's hazy or translucent?

Oral: mucosa for any erosion or ulcer

Dental caries( it can also lead to ear pain)

Throat: position of uvula

Tonsil: normal or inflammed

Abscess present or absent

Posterior pharyngeal wall to be examined for any membrane or collection of pus.

Tunning fork test : to check for any hearing loss

Respiratory system:

Respiratory rate

Accessory muscle of respiration used?

Chest movement

Auscultate for wheeze and air Entry

Cardiovascular system: any murmur?

CNS : for any neurological defeceit

2.unilateral parotid swelling in 65 year old man

History: how did it start? What is the duration of swelling

Any associated symptoms?

Pain while chewing present or not?

Is there any swelling in neck? ( lymphadenopathy)

Is there any history of diabetes or hypertension?

Similar history of parotid disease in the family?

Habit of alcoholic intake?

History of liver disease in the past?

Examination:

Vitals : temperature: fever +/-

Cyanosis

Pedal edema +/-

Systemic examination:

HEENT:

Head: unilateral or bilateral swelling

Redness+/-

Swollen+/-

Swelling: fluctuating or not

: indentation to deeper plane +/-

Swelling moving with opening and closing of mouth

Ear : for swelling

Trsnsluency of tympanic membrane

Oral:mucosa for dryness

Palpate for duct of parotid gland

Examine the floor of mouth for other salivary glands.

Throat :

For uvula position

Tonsil

Post pharyngeal wall:

Neck : palpate for lymphadenopathy

Extension of swelling

Systemic examination:

GIT: lnspect for distended abdomen

Dilated veins

Palpate for liver enlargement

Percuss for ascites

Auscultate for bowel sounds

Respiratory system;

Inspect for gynaecomastia

Auscultate for added sounds

Diagnosis

parotitis

Endocrine disease like hypothyridism or it s medication side effects

Sialadenitis

Auto immune disease

Infection like ( cat scratch disease,