Primary Care of the Family I

Telehealth Physical Exam: ENT Video Transcript

Carolyn Rutledge: Good morning, Grace. I'm Carolyn Rutledge. I am the nurse practitioner, and I will be managing your case. I hear that you haven't been feeling well lately.

Grace: Yeah.

Carolyn Rutledge: Tell me a little bit about what's going on.

Grace: I've been having a sore throat for about three days, and I'm super congested.

Carolyn Rutledge: So a sore throat for three days and congested. Tell me a little bit about the sore throat. Does it hurt all the time, or...

Grace: It hurts mainly when I swallow.

Carolyn Rutledge: Okay. Mainly when you swallow, and have you had a fever?

Grace: No, I haven't had a fever. I've been taking my temperature.

Carolyn Rutledge: When was the last time you took your temperature?

Grace: Last night.

Carolyn Rutledge: So no temperature. Do you have any allergies? I know it's allergy season right now.

Grace: No, I don't have any allergies.

Carolyn Rutledge: No allergies. Okay, good. What about a headache?

Grace: It's mainly in my forehead right here. Right here.

Carolyn Rutledge: How long have you been having the headache?

Grace: For three days. That's pretty much how I've been having it.

Carolyn Rutledge: Okay. You said a little bit of a cough?

Grace: Yeah, I'm coughing every once in a while. Clearing my throat.

Carolyn Rutledge: Is it worse in the evenings when it's a little bit cooler?

Grace: It's worse at night.

Carolyn Rutledge: Okay. What about any earache? Do your ears hurt?

Grace: Yeah, it almost feels like I'm hearing through a tunnel. It doesn't hurt. It just feels like I'm hearing everything through a tunnel.

Carolyn Rutledge: What about tonsils? Do you still have your tonsils?

Grace: I got my tonsils removed when I was 12.

Carolyn Rutledge: Okay. Have you taken any medications for this yet?

Grace: I took some Halls lozenges and Tylenol last night. I took it last night, not this morning.

Carolyn Rutledge: Okay. Have you been using the lozenges a fair amount?

Grace: Quite a bit, yes. To help with my sore throat.

Carolyn Rutledge: Okay. What about any nasal drainage?

Grace: Yes, I've been having some nasal drainage.

Carolyn Rutledge: Have you had to blow your nose a lot?

Grace: Yes.

Carolyn Rutledge: Okay. So sort of congested feeling?

Grace: Mm-hmm (affirmative).

Carolyn Rutledge: I also want to know about your eyes, because with the type symptoms you have, sometimes you have matted eyes in the morning, or conjunctivitis. Have you noticed your eyes matted in the morning or anything?

Grace: No, I don't think so.

Carolyn Rutledge: What about smell or taste? Have you lost a sense of smell or taste?

Grace: No, I have not.

Carolyn Rutledge: Okay. Well, good. Are you allergic to any medications?

Grace: No, I don't have any medication allergies.

Carolyn Rutledge: Good. I've got a pretty decent history, and I'm not going to be able to put my hands on you to examine you, so I'm going to have you do a few things to help me do the physical exam. One of the first things I want you to do is bite down like you're grinding your teeth, and tell me if anything hurts.

Grace: That does hurt quite a bit.

Carolyn Rutledge: So you're feeling some sort of pressure, sensitivity there?

Grace: Yeah.

Carolyn Rutledge: Okay. Can you tilt your nose back, and get the camera, and show up into it? Okay, come a little bit closer. Slide the camera up. Okay. Good. Very good. Okay, great. Thank you. That's really good. Your nose, I don't notice a lot of irritation.

Grace: Okay.

Carolyn Rutledge: It doesn't seem to be really boggy. One of the other things that I would like to do is I'd like to look at your throat.

Grace: Okay.

Carolyn Rutledge: So I want you to do something similar to what you just did, and I might need a light, but let's see how good it is without using a flashlight.

Grace: Okay.

Carolyn Rutledge: Okay. Open your mouth real wide. It's pretty dark back there. Do you have an iPhone?

Grace: Yeah.

Carolyn Rutledge: Could you get the light from the iPhone, and shine it back there?

Grace: Is this better?

Carolyn Rutledge: Okay. You need to tilt your head back a little. Oh, that's so much better, and go, "Ah." Okay, that's great. Good job. I don't see any exudate back there, but it does look like might be having a little bit of drainage in the back. The next thing I want you to do is take your hands and feel along your neck. What you're going to be feeling for is any kind of knots, or lumps, or any area that's sort of tender. We're feeling to see if you're... Just slide it gently down your neck. Okay. Are you feeling anything?

Grace: No, I don't have any tenderness.

Carolyn Rutledge: Okay, and no real lumps that you notice?

Grace: No.

Carolyn Rutledge: You might feel a little bit of your lymph nodes, but we don't want them to be very big. The next thing I want to do, I want to look at your eyes. Can you take off your glasses?

Grace: Yeah.

Carolyn Rutledge: Move a little bit closer to the camera and just sort of… okay, that's good. Yeah. Hold. Okay. Very good. That's good. That's good enough. Gotcha. One of the things I want you to do now is lean over and touch your toes like you would if you were tying your shoes.

Grace: Okay.

Carolyn Rutledge: So just lean forward. Okay. Do you experience anything there?

Grace: That hurts. That hurts a lot.

Carolyn Rutledge: Where does it hurt?

Grace: Hurts in my head. It's a lot of pressure.

Carolyn Rutledge: Okay. Tap your forehead and tell me if that hurts.

Grace: Yeah, that hurts a lot.

Carolyn Rutledge: What about down here?

Grace: Yes, that hurts.

Carolyn Rutledge: Go on and swallow for me, and tell me what happens.

Grace: It hurts a lot in my throat.

Carolyn Rutledge: What about your ears? Do you feel a popping or anything?

Grace: Yeah, my ears are popping when I do that, when I swallow.

Carolyn Rutledge: We might be getting a good handle on what's going on. One last thing, take a couple deep breaths. Are you having any trouble with your breathing?

Grace: No, my breathing's okay.

Carolyn Rutledge: Okay. Good. Grace, from the symptoms that you've given me and from the physical exam, it looks like you probably have a sinusitis.

Grace: Okay.

Carolyn Rutledge: Some of the things that really indicate that was like when you leaned forward, and you felt all that pressure in your face, and the popping in your ears, probably some fluid behind your ear drums. What I would like to do is go on and put you on an antibiotic, and I have your electronic health records here. So, I can go on and send that in to the pharmacy. Since I can't actually look in your ears, I can't tell whether you have an ear infection, but if there's an ear infection going on, the medication for your sinusitis will take care of that.

Grace: Okay.

Carolyn Rutledge: I'm also going to put you on a decongestant, and I want you to drink lots and lots of fluids, and the fluids, the way they work, they help with the drainage, they help thin some of the thick secretions there. Take some Tylenol, that will help with some of the discomfort. I want you to stop using the Halls lozenges, because if you use those too often, they can actually start irritating your throat. Maybe use salt water gargles, warm salt water to help with that. Just so that we have the right plan for you, and you understand what to do, I'm going to send you a secure email with these instructions in it as well. You should start feeling better pretty quickly.

Grace: Okay.

Carolyn Rutledge: Well, if you don't have any questions, we will just go on and send this in.

Grace: All right. Thank you so much.

Carolyn Rutledge: Enjoyed meeting with you today. Thanks Grace, and hope you feel better.

Grace: All right. Thank you.

Carolyn Rutledge: All right, bye.