O6U Faculty of medicine

Skill Lab Block 6 contents

Ear examinations

Tuning fork tests

a) Rinne’s test: compares hearing by air conduction (AC) with hearing by bone conduction (BC)
in the same ear. The fork is first applied to the external canal and when the patient can no
longer hear its vibration, the fork is applied to the mastoid bone.
- Normally: AC is better than BC ( Rinne’s +ve).
- In conductive deafness: BC is better than AC ( Rinne’s –ve).
- In perceptive deafness: AC is better than BC but both are reduced than normal (reduced +ve
Rinne’s).
b) Weber’s test: compares bone conduction in both ears. The fork is applied to the forehead. It is useful
when there is marked difference in hearing between the two ears.
- Normally: the sound is heard in the midline or in both ears equally.
- In conductive deafness: the sound is heard better in the diseased ear (the outside noise masks
hearing of the normal ear).
- In perceptive deafness: the sound is heard better in the normal or better hearing ear.
Pure Tone Audiometry (PTA) The audiogram is interpreted as conductive, sensorineural or
mixed deafness.
 O6U Faculty of medicine
Skill Lab Block 6 contents
Tympanometry:

Normal ear: Symmetrical graph (Type A).

Eustachian tube obstruction: -ve peak tympanogram curve (Type C).

Secretory otitis media: Flat tympanogram curve (Type B).

Ossicular disconnection: Hypermobile tympanogram curve (Type Ad).

Otosclerosis: Restricted tympanogram curve (Type As).

 O6U Faculty of medicine
Skill Lab Block 6 contents

Taking swabs for different purposes

 1/Use universal precautions for collecting and handling all specimens.

2/Whenever possible, collect all culture specimens prior to administration of any

antimicrobial agents.
 3/Avoid contamination with indigenous flora
 4/All specimens must be appropriately labeled with two patient identifiers
 5/Deliver all specimens to the laboratory as soon as possible after collection
 6/Specimens for bacterial culture should be transported at room temperature. If
transport is delayed the following specimens should be refrigerated
 7/Specimens should be in tightly sealed, leak proof containers and transported in
sealable, leak-proof plastic bags.
 8/If anaerobic culture is requested, make certain to use proper anaerobic collection
containers
Lump examination

NECK SWELLINGS
A) Midline swellings:
Neck swellings derived from unpaired midline structures. These swellings tend to lie in the
midline.

1. Thyroglossal cyst:
Most common midline neck swelling and usually presents as a painless, rounded cystic lump
which moves on swallowing or protruding the tongue.
2 .Dermoid cyst:
These usually present as painless solid or cystic masses anywhere between the suprasternal
notch and the submental region.
3. Nodule of thyroid isthmus; which may be due to goiter or malignancy.
4. Perichondritis of thyroid cartilage: due to infection or malignant infiltration.
5. Thymus gland which may appear above the sternum.
6. Lymph nodes:
 Submental: which drain tip of tongue, lower lip, and chin.
 Prelaryngeal and pretracheal: which drain cancer larynx.
 O6U Faculty of medicine
Skill Lab Block 6 contents

B). Lateral swellings:

Neck swellings derived from paired lateral structures. These swelling tend to lie laterally in the
neck.

1. Thyroid swelling:
 Physiological: in pregnancy and puberty.
 Nodular goiter.
 Thyroid cancer.
 Toxic: graves disease.
2. Cervical lymphadenopathy:
 Inflammatory: Acute (mobile and tender).
Chronic: e.g. T.B (painless or cold abscess).
 Metastatic: Hard, fixed with apparent or occult primary.
 Infectious mononucleosis (Glandular fever).
 Lymphamas.
3. Branchial cyst:
-Usually present in young adult more on the left side.
- Along the anterior border of the sternomastoid muscle
4. Carotid body tumour:

-Tumor of the chemoreceptor apparatus at the carotid bifurcation.

-They tend to be oval and non tender, move laterally but not up and down.
-Pressure on it causes fainting (carotid sinus syndrome).
5. Cystic hygroma:

- Cavernous lymphangioma in infants.

- Soft painless diffuse swelling in the posterior triangle.
- They the only one that transilluminate (diagnostic).
6. Submandibular region swellings: e.g, sialoadenitis, Ludwing’s angina, LNs.
 O6U Faculty of medicine
Skill Lab Block 6 contents

Blood Transfusion

Indications

Complications