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👃 Finals: Nose Examination

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Introduction

The examination of the nose is a crucial component of an ENT exam. Final year medical students should be prepared to perform this skill with precision and fluency. Practicing on both normal and pathological nose will help in identifying abnormalities with greater ease. During exams, actors may simulate nasal symptoms and nasal deformity may displayed using prompts.

Preparation and Introduction

  • Infection control: Clean your hands using alcohol gel, and mention the importance of infection control.
  • Introduce yourself to the patient: "Hello, I am [Your Name] a final year medical student. I understand you’ve had some trouble with your nose."
  • Confirm the name and DOB of the patient
  • Consent and Explanation: "May I examine your nose and sinuses - this will involve me having a look on the outside and inside of your nose, and performing some breathing tests. Is that okay?"
    • Inform the patient you’ll explain each step of the process and encourage them to ask any questions.
  • Exposure: expose the nose and neck - to expose any scars.

Inspection of the External Nose

  1. Positioning: Sit facing the patient, knees together and to one side.
  2. Inspection: Look at the nose from the front, sides, and behind to check for:
    • Skin lesions (e.g., basal cell carcinoma, squamous cell carcinoma)
    • Scars (e.g. lateral rhinotomy scar, excision scars, columellar scar)
    • Deformities (e.g., nasal fractures, deviations in the nasal bones or cartilage)

Palpation of the External Nose

  1. Warn the patient: Inform the patient before applying pressure to their nose.
  2. Palpation:
    • Nasal bones: Assess alignment, tenderness, or irregularity.
    • Nasal cartilage: Check for alignment and tenderness.
    • Infraorbital ridges: If trauma is suspected, assess for tenderness and eye movement to rule out orbital blowout fractures.