Clinical examination in ENT

from Dr. T. Balasubramanian‘s website: clinical examination of ear, nose, throat.

Pediatrics vedios

BALLARD SCORE: newborn assessment -neuromuscular  done immediately after birth & physical  done within 24hrs of birth. [download pdf]

1. Methods of determine gestational age, Discussion of active and passive muscle tone]
   
2. Assessing Flexor tone, Appropriate for 20-44 weeks gestation, Neuromuscular Assessment, Posture, Square Window, Arm Recoil
3. Neuromuscular Assessment (continued) [Popliteal Angle, Scarf Sign, Heel to Ear]
   Physical Assessment [Skin, Lanugo]
4. Physical Assessment (continued) [Lanugo (continued), Plantar Surface, Breast, Eye/Ear]
5. Physical Assessment (continued)[Male,Female], Summary of Gestational Assessment and the New Ballard Score

INFANT REFLEXES:

1. Galant’s reflex [Hold the baby horizontally and prone in one of your hands. Stimulate one side of the baby’s back approximately 1 cm from the midline along a paravertebral line extending from shoulder to the buttocks. This produces a curving of the trunk toward the stimulated side, with shoulders and pelvis moving in that direction. Pelvic response to stimulation of the back and flanks should be symmetrical. This reflex is absent in transverse spinal cord lesions or injuries]
2. Grasp reflex [Stimulate the palm of the baby's hands and observe the reflex grasping of your finger. Stroke the sole of the foot, and the toes will flex and curl around your examining finger. Make sure that the response is not inhibited by unintended stimulation of the dorsal aspect of feet and hands.
   Persistence of the palmar grasp reflex beyond 6 months suggests cerebral dysfunction. It should be noted that babies normally hold their hands clenched during the first month of life. Persistence of the fisted hand beyond 2 months also suggests central nervous system damage]
3. Pull to sit [Starting in the supine position, the baby is pulled by the arms to the sitting position. The head and the arms are observed during the maneuver. The arms should remain partially flexed at the elbow and the head may lag behind the trunk. When the baby is in the sitting position, the head should be able to come to the upright position for at least a few seconds before dropping forward or backward.Watch the sternocleidomastoid muscles which should bilaterally anticipate the pull to sit; the head flexes for a moment before head lag occurs]
4. Moro reflex/Startle response [In response to loss of balance (the infant's head suddenly shifts position), the baby arches his back, flings his arms outwards, extends his legs, and opens his hands, after which he slowly returns to a flexed position, often resembling an embrace. The infant cries loudly (0-3 months)]
5. Magnet reflex [If light pressure with e.g. the thumb is applied to the sole of the foot of a newborn lying in a supine position, the baby pushes back against the pressure. And when the parent withdraws his thumb, he has the sensation that his thumb is drawing the limb out as by a magnet]
6. Crawling reflex [it can be stimulated by placing the neonate prone on a flat surface. The neonate will attempt to crawl forward when the sole of his feet are touched. Voluntary crawling begins around 7 months]
7. Rooting reflex [With the baby’s head positioned in the midline and hands held against the anterior chest, stroke with your finger the perioral skin at the corners of the baby’s mouth and the midline of the upper and lower lip. In response, the mouth will open and turn to the stimulated side. This response will also occur with stimulation of the infant’s cheek at some distance from the corners of the mouth. Absence of this reflex indicates severe generalized or central nervous system disease]
8. Sucking reflex [The sucking reflex is common to all mammals and is linked with the rooting reflex and breastfeeding. It causes the child to instinctively suck at anything that touches the roof of their mouth. You can test this reflex with a pacifier, baby's finger or your finger]
9. Stepping/Walking reflex [Keep the baby upright and allow the soles of the feet to touch the surface of the table. Move the baby forward to accompany any stepping. Alternating stepping movements with both legs will occur. This response depends on arousal of the baby but it’s continuous absence can indicate paresis or be present in babies born by breech delivery]
10. Tonic neck reflex [With the baby in the supine position, turn the head to one side, holding the jaw over the shoulder. The arm and leg on the side to which the head is turned extend, while the opposite arm and leg flex. This response does not normally occur each time this maneuver is performed, and when it is elicted each time it is evoked it should be considered abnormal, at any age. It will persist beyond the time of expected disappearance in major cerebral damage]
11. Glabellar tap [when the glabella is tapped, the eyelids of neonate blink]
    
12. Head lifting reflex [lifts his head when placed on his stomach. Five days after birth 50 % of the neonates can lift their head by bending their back for at least 2 sec. Absence of this reaction might reveal brain damage]
13. Reverberatory reflex [In supine position the arms of healthy babys are partly or totally flexed. When both forearms are extended and then suddenly released, they reverberate (spring) immediately to their original, flexed position]
14. Babinski’s reflex [When a newborn's foot is stroked on the outside of the sole, the baby will flex the big toe upward while the other toes fan out.The reflex is caused by a lack of myelination in the corticospinal tract in young children]
15. Landau’s reflex [With the examiner's hand supporting the trunk - face down, the baby raises his head, arch his back and extends his arms and legs and thus showing muscle tone. When the head is gently pushed into flexion, the legs drop into flexion like a clasp-nife. The reaction is elicitable from the 3rd to 9th month]
16. Diving reflex
    

PHYSICAL EXAMINATION VEDIOS OF THORAX, ABDOMEN, LOWER LIMBS

• Medical Video lecture series- FREE at Learnerstv.com thorax surface anatomy- trachea,intercoastal,spinous processes, lung lobes. [later part has brief resp lung exp,tactile fremitus- refer resp vedio.]

• Medical Video lecture series- FREE at Learnerstv.com breath sounds consolidation- bronchial sound- bronchophony, prectiloq, egophony crackles,wheeze,rhonchi end part has review of key points.

• Medical Video lecture series- FREE at Learnerstv.com lung expansion tactile fremitus percussion

• Medical Video lecture series- FREE at Learnerstv.com

  percussion analogy procedure [later part has heart- surface anatomy- refer cardio vedio]

• Medical Video lecture series- FREE at Learnerstv.com heart- surface anatomy, inspection, palpate [great] , perc, ausc. [good - compensate with virginia's cvs heart sounds description]
• Medical Video lecture series- FREE at Learnerstv.com initial part has BP later part of the vedio has JVP

• Physical Examination-Abdomen-Part1 clear surface anatomy

• Physical Examination-Abdomen-Part2 surface anatomy

• Medical Video lecture series- FREE at Learnerstv.com clear & regular than virginia, though less details for lower limb examination.
• Physical examination of knee
• Upper extremities examination-1
  
• 2-Upper limb & Spine examination
  

Physical Examination -Neurological examination

Complete examination module -quick with great details: from Uni of Toronto

Some other souces: [given in reverse order]

• Physical Examination-Detailed Neurological examination-Part7

  weber & rhinne test for hearing reinforcing reflexes- jadr manuever/ clench+fist pronator drift discrimination spinal cord lesion- blunt/pin touch – over severeal dermatomes

• Physical Examination-Detailed Neurological examination-Part6

  clear procedure- smell, taste, visual acuity, visual fields, corneal reflex, mastication ms

• Physical Examination-Detailed Neurological examination-Part5

  prone elicitation of reflexes [initial part in previous part with supine elicitation] grading of reflexes good proprioception procedure tips vibration ex procedure

• Physical Examination-Detailed Neurological examination-Part4

  femoral & peroneal nerve ex, muscle strength grading details reflexes

• Physical Examination-Detailed Neurological examination-Part3

  good tips- cranial nerves except optic , passive range of movts of limbs.

• Physical Examination-Detailed Neurological examination-Part2

  optic nerve ex – good tips & pt advice on procedures & ophthalmoscope use tips.

• The Neurologic Examination

  check out the sections: testing cranial nerves, reflexes, gaits, coordination