Nose, Mouth & Throat Flashcards
1
Q
the superior part (nasal bone)
A
Bridge
2
Q
the anterior part of nose (cartilage)
A
Tip
3
Q
filter coarse matter from entering nasal cavity
A
Hair
4
Q
filters dust and bacteria. The rich blood supply warms and humidifies the air
A
Ciliated mucous membrane
5
Q
increase the surface are of the nasal cavity so that more air is filtered, warmed, and humidified
A
Turbinates (conchae)
6
Q
Present at birth
A
Ethmoid and maxillary sinuses
7
Q
develop
between 7 and 8 years
A
Frontal
8
Q
develop after puberty
A
Sphenoid
9
Q
nose is symmetric, midline, proportional
A
Normal external nose
10
Q
nasal mucosa pink, smooth, and moist
A
Normal findings nasal cavity
11
Q
Abnormal findings of nasal cavity
A
note any bleeding, swelling, redness, discharge, foreign body
Rhinitis – mucosa swollen, red, and often includes discharge (watery,
thick, purulent, green) in upper resp infection
12
Q
(benign growths) – smooth, gray, avascular, mobile, nontender
A
Polyps
13
Q
Midline placement. Shape symmetrical and consistent with age, gender, and
race/ethnic group.
No nasal flaring.
No drainage.
A
Normal findings
14
Q
Misalignment of nose or shape inconsistent with patient’s biographical information
Nasal flaring
Clear, bilateral drainage
Clear, unilateral drainage
Clear, mucoid drainage
Yellow or green drainage
Bloody drainage
A
Abnormal findings of external nose
15
Q
Trauma, hypertension, or bleeding disorders.
A
Bloody drainage
16
Q
Upper respiratory infection.
A
Yellow or green drainage
17
Q
Viral rhinitis
A
Clear, mucoid drainage
18
Q
May be spinal fluid as a result of head trauma or fracture
A
Clear, unilateral drainage
19
Q
Allergic rhinitis
A
Clear, bilateral drainage
20
Q
Suggests respiratory distress, especially in infants, who are obligatory nose breathers
A
Nasal flaring
21
Q
Previous trauma, congenital deformity, surgical alteration, or mass. Abnormal shape also associated with typical facies, including acromegaly or Down syndrome.
A
Misalignment of nose or shape inconsistent with patient’s biographical information
22
Q
• Have the patient occlude one nostril with a finger.
• Ask the patient to breath in and out through the nose as you observe and listen for air
movement in and out of the nostril.
• Repeat on the other side.
A
Procedure (PATENCY)
23
Q
Internal Inspection
A
a. Position the patient with the head in an extended position
b. Place the non dominant hand firmly on the top of the patient’s head
c. Using the thumb of the same hand, lift the tip of the patient’s nose.
d. Gently insert the nasal speculum.
e. Assess each nostril separately
f. Observe for: COLOR, DISCHARGE, SWELLING, DRAINAGE, LESIONS, POLYPS
24
Q
Normal findings of internal nose
A
■ Pink, variations consistent with ethnic group/race and with oral mucosa.
■ Moist, with only clear, scant mucus present.
■ Intact, with no lesions or perforations.
■ No crusting or polyps.
■ Septum located midline.
25
Abnormal findings in internal nose
Bright red mucosa
Pale or gray mucosa
Copious or colored discharge
Clustered vesicles
Ulcers or perforations
Dried crusted blood
Polyps
Deviated septum
26
Inflammation from rhinitis or sinusitis; also suggests cocaine abuse.
Bright red mucosa
27
Allergic rhinitis
Pale or gray mucosa
28
Allergic or infectious disorder, epistaxis, head or nose trauma.
Copious or colored discharge
29
Herpes infection
Clustered vesicles
30
Chronic infection, trauma, or cocaine use
Ulcers or perforations
31
Previous epistaxis
Dried crusted blood
32
Allergies, irritation or chronic infections
Polyps (elongated, rounded projections)
33
Normal variant or following trauma.
Deviated septum
34
Observe the patient’s face for any swelling around the nose and eyes.
Inspection of the sinuses
35
There is no evidence of swelling around the nose and eyes
Normal findings of sinuses
36
SINUSITIS
Abnormal findings of sinuses
37
Palpation and Percussion of sinuses
Stand in front of the patient.
Gently press the thumb under the bony ridge of the upper orbits (for the frontal sinus).
Under the infraorbital ridge using the thumb or middle finger (for maxillary sinus).
Observe for the presence of pain.
Percuss the areas using the mid or index finger of the dominant hand (immediate percussion)
Note the sound.
38
No discomfort during palpation and percussion. Air-filled – resonant.
Normal findings of sinuses(palpation & percussion)
39
If palpation and percussion of the sinuses suggests sinusitis,
TRANSILLUMINATION OF THE SINUSES should be performed
40
TO EVALUATE THE FRONTAL SINUSES
• Patient should be in a sitting position in the dark room.
• Place the penlight under the bony ridge of the upper orbit.
• Observe the red glow over the sinuses and compare the symmetry of the two sides.
41
TO EVALUATE THE MAXILLARY SINUSES
• Place the patient in a sitting position facing you.
• Place the light source firmly under each eye and just above the infraorbital ridge.
• Ask the patient to open the mouth; observe the red glow on the hard palate. Compare the
two sides.
42
Head and Neck Nodes
◼ Preauricular
◼ Posterior auricular
◼ Occipital
◼ Tonsillar
◼ Submandibular
◼ Submental
◼ Superficial cervical
◼ Posterior cervical
◼ Deep cervical
◼ Supraclavicular
43
Inspect Lips
COLOR, MOISTURE, SWELLING, LESIONS, INFLAMMATION
44
Palpation of lips
LESIONS
45
Abnormal findings of lips
PALLOR
CRACKED LIPS
SWELLING OF THE LIPS
CHEILOSIS
SQUAMOUS CELL CARCINOMA
HERPES SIMPLEX
CHANCRE
LEUKOPLAKIA
46
Palpation procedure for lips
a. Don gloves
b. Gently pull down the patient’s lower lip with the thumb and index finger of one hand and
pull up the patient’s upper lip with the thumb and index finger of the other hand.
c. Note the tone of the lips as they are manipulated.
d. If lesions are present, palpate them for consistency and tenderness.
47
Normal findings of palpation of lips
Lips should not be flaccid and lesions should not be present.
48
Abnormal findings of palpation of lips
Asymmetry of placement
Pallor
Cyanosis
Redness
Cheilitis (inflammation of lips), drying, and cracking
Cheilosis (fissures at corners of lips)
Chancre
Angioedema
Herpes simplex (clustered area of fullness/nodularity that forms vesicles, then ulceration)
49
Congenital deformity, trauma, paralysis, or surgical alteration
Asymmetry of placement
50
Anemia
Pallor
51
Inflammatory or infectious disorder
Redness
52
Vasoconstriction or hypoxia
Cyanosis
53
Infectious or inflammatory disorder
Lesions
54
Cheilitis
Dehydration, allergy, lip licking.
55
(inflammation of lips), drying, and cracking
Cheilitis
56
Deficiency of B vitamins or maceration related to overclosure
Cheilosis
57
Single, painless ulcer of primary syphilis
Chancre
58
Allergic response
Angioedema
59
Herpes simplex
Herpes viral infection
60
Herpes simplex
(clustered area of fullness/nodularity that forms vesicles, then ulceration)
61
Assessment of the tongue
a. Ask the patient to stick out the tongue (CN XII)
DORSAL & VENTRAL SURFACE:
COLOR
HYDRATION
TEXTURE
SYMMETRY
FASCICULATIONS
ATROPHY
POSITION IN THE MOUTH
LESIONS
b. Ask the patient to move the tongue from side to side, up and down.
c. With the tongue back in the mouth , ask the patient to press it against the cheek. Provide
resistance with your tongue depressor. Note the strength of the tongue and compare it bilaterally.
c. Ask the patient to touch the tip of the tongue to the roof of the mouth or grasp the tip of the
tongue with a gauze, inspect and palpate.
62
Normal findings of tongue
Tongue is in the midline of the mouth.
Dorsum of the tongue should be pink, moist, rough (from the taste buds), and without lesions.
Coloring may vary consistent with ethnic group/race.
Mucosa intact with no lesions or discolorations.
Papillae intact. Tongue is freely and symmetrically mobile (CN XII intact).
The strength of the tongue is symmetrical and strong.
The ventral surface of the tongue has prominent blood vessels and should be moist without
lesions.
Wharton’s ducts are patent and without inflammation or lesions.
Lateral aspect of the tongue should be pink, smooth and lesion free
63
Abnormal findings of tongue
Absence of papillae, reddened mucosa, ulcerations
Color changes
Black, hairy tongue
Hypertrophy and discoloration of papillae
Reddened, smooth, painful tongue, with or without ulcerations (glossitis)
Cancers may form on the tongue and on other oral mucosa.
PROTRUSION OF THE TONGUE
ENLARGED TONGUE
LEUKOPLAKIA
THRUSH
DEVIATION OF THE TONGUE
GEOGRAPHIC TONGUE
HEMANGIOMA
SCROTAL TONGUE
FISSURED TONGUE
SQUAMOUS CELL CARCINOMA OF THE TONGUE
64
Allergic, inflammatory, or infectious cause
Absence of papillae, reddened mucosa, ulcerations
65
Color changes
May indicate underlying problems; for example, red “beefy” tongue is seen with pernicious anemia.
66
Black, hairy tongue
Fungal infections
67
Hypertrophy and discoloration of papillae
Antibiotic use
68
Reddened, smooth, painful tongue, with or without ulcerations (glossitis)
Anemia, chemical irritants, medications
69
Assessment of the teeth
◼ Instruct the patient to open the mouth
◼ Observe dentures or orthodontics fit
◼ Remove any dentures
◼ Shine the penlight in the mouth
◼ Use the tongue depressor to move the tongue to visualize the gums
◼ Inspect color, condition, lesions of mucosa
◼ Observe for redness, swelling, bleeding, retraction from the teeth or discoloration
◼ Note condition of gingiva, bleeding, retraction, or hypertrophy
70
Normal findings of teeth
◼ Gum margins are well-defined
◼ Gums consistent in color with other mucosa and intact
◼ No pockets are found in between the gums and teeth
◼ No swelling, No bleeding
◼ Color variants acceptable if consistent with patient’s ethnic group/race
◼ Color is pale red in light-skinned individuals
◼ Patchy brown pigmentation in dark-skinned individuals.
71
Abnormal findings of teeth
Painful, reddened mucosa, often with mildly adherent white patches
Reddened, inflamed oral mucosa, sometimes accompanied by ulcerations
Small, painful vesicles that often have a reddened periphery and a white or pale yellowish base
Nodular, macular, or papular lesions widely involving the integument and often evident on the oral mucosa
Inflammatory changes of the integument, often found on oral mucosa as chronic gray, lacy
patches with or without ulceration
Reddened mucosal change that may progress to form cancer
Gingivitis
Recession of gums
Gum hyperplasia
Leukemia
Early HIV periodontitis and Advanced HIV periodontitis
Leukoplakia
Cancer on the oral mucosa
Fordyce granules
72
Candida albicans
Painful, reddened mucosa, often with mildly adherent white patches
73
Reddened, inflamed oral mucosa, sometimes accompanied by ulcerations
Allergic stomatitis
74
Small, painful vesicles that often have a reddened periphery and a white or pale yellowish base
Kaposi’s sarcoma. Incidence has increased with the development of acquired immunodeficiency syndrome (AIDS)
75
Inflammatory changes of the integument, often found on oral mucosa as chronic gray, lacy
patches with or without ulceration
Lichen planus. May progress to neoplasm
76
Reddened mucosal change that may progress to form cancer
Erythroplakia
77
Gingivitis
Pale or gray gingivae: Chronic gingivitis
78
Recession of gums
Gum recession or inflammatory gum changes (gingivitis/periodontal
disease)
79
Cause of recession of gums
Poor dental hygiene or vitamin deficiency
80
Gum hyperplasia
Side effect of medications, such as dilantin or calcium channel blockers
81
Leukemia
Inflamed, bleeding gingivae may also be seen with leukemia
82
Early HIV periodontitis and Advanced HIV periodontitis
Inflamed, bleeding gingivae may
also be seen with human immunodeficiency virus (HIV)
83
Leukoplakia
White, adherent mucosal thickening: May progress to cancer
84
Cancer on the oral mucosa
Cancer on lip or oral mucosa:Cancers can be found on the
lips, gums, oral mucosa or other areas of the mouth and are associated with tobacco use and
alcohol abuse
85
Fordyce granules
Enlarged sebaceous glands on buccal mucosa, white/yellow raised lesions
86
ASSESSING the TEETH and JAW ALIGNMENT
a. Have patient open and close mouth. Note occlusion and number, color, condition of teeth.
b. Count the upper and lower teeth.
c. Observe teeth for discoloration, loose or missing teeth, caries, malocclusion and malformation.
87
Normal findings of hard and soft palate
Color - pink and concave
- no lesions, no malformation
■ Palate intact, smooth, pink.
■ Bony, mucosa-covered projection on the hard palate (torus palatinus) or on floor of mouth
(torus mandible) are normal variations.
88
Abnormal findings of hard and soft palate
Torus palatinus
Torus mandible
Perforation: Congenital or from trauma or drug use
Cocaine use
HIV palatal candidiasis
89
Assessing the throat
◼ Ask the patient to tilt the head back and to open the mouth widely.
◼ With the right hand, place the tongue blade on the middle third of the tongue.
◼ With the left hand, shine a light at the back of the patient’s throat.
◼ Ask the patient to say AHHH.
◼ Observe the position, size, color and general appearance of the tonsils and uvula.
90
Assessing the oropharynx
Inspect oropharynx for color, lesions, and drainage.
91
Normal findings of oropharynx
■ Mucosa is pink, moist, intact. The lymphoid-rich posterior wall may have a slightly irregular
surface.
■ No lesions, erythema, swellings, exudate, or discharge.
92
Abnormal findings of oropharynx
Yellowish or green streaks of drainage on the posterior wall
Gray membrane/adherent material
White or pale patches of exudates with erythemic mucosa
Erythema
Scattered vesicles/ulcerations
93
Yellowish or green streaks of drainage on the posterior wall
Postnasal drainage
94
Gray membrane/adherent material
Diphtheria
95
White or pale patches of exudates with erythemic mucosa
Infection, including streptococcal
bacterial infection or mononucleosis viral infection. Gonorrhea and chlamydia are also associated with exudative pharyngitis
96
Erythema
Inflammatory response, typically associated with infectious pharyngitis; also common in smokers
97
Scattered vesicles/ulcerations
Herpangioma
98
Normal findings of tonsils
■ Locate tonsils posterior to arches on sides of throat.
■ Note color, size, and exudate.
■ Symmetrical, pink, clean crypts. Crypts may have normal variation of small food particles
(tonsilar pearls) or scant amounts of white cellular debris.
99
Abnormal findings of tonsils
■ Bulges adjacent to the tonsilar pillars: Potential peritonsillar abscess.
■ Reddened, hypertrophic tonsil, with or without exudates: Acute infection or tonsillitis.
■ Lymphoid cobblestoning.
■ Enlarged tonsils with exudates.
100
ASSESSING the SALIVARY GLANDS
◼ Stensen’s duct: Inspect inner aspect of cheek (buccal mucosa) opposite the second upper
molar.
◼ Wharton’s duct: Have patient lift tongue and inspect the floor of mouth
101
Normal findings of salivary glands
■ Stensen’s duct intact at buccal mucosa at level of second molars.
■ Wharton’s duct intact at either side of frenulum.
■ Both ducts with moist and pink mucosa; no lesions, swelling, or nodules.
102
Abnormal findings of salivary glands
Parotitis
103
Parotitis
Fullness or inflammatory changes of glands: Blockage of duct by calculi, infection, malignancy. Parotitis is inflammation of parotid glands.
104
Normal findings in assessing the uvula
◼ When the patient says AHH, the soft palate and the uvula should rise symmetrically (CN
IX, glossopharyngeal & CN X, vagus ,intact).
◼ Uvula is in the midline, pink, moist, without lesions.
◼ Gag reflex should be present but congenitally absent in some (CN IX & X).
105
Abnormal findings of uvula
■ Erythema, exudate, lesions: Infectious process.
■ Asymmetrical rise of the uvula: Problem with CN IX and CN X.
Cleft palate – Bifid Uvula
106
ASSESSING the BUCCAL MUCOSA
a. Ask the patient to open the mouth as wide as possible.
b. Use a tongue depressor and the penlight to assess the inner cheeks and the opening of the
Stensen’s ducts.
c. Observe for color, inflammation, hydration and lesions.
107
Normal findings of the buccal mucosa
Color - vary with race
Moist, smooth and free of lesions
108
Abnormal findings of buccal mucosa
Stomatitis
Oral melanoma
109
Common yeast infection that affects men& women. Not classified as STI
Thrush
110
Benign vascular tumor derived from blood vessel cell types
Hemangioma
111
Normal findings of teeth and jaw alignment
Most adults have 28 teeth, or 32 if the four third molars, or wisdom teeth, are erupted, which
should be white, not loose, with good occlusion and in good repair. With smooth edges, in proper
alignment and without caries.
112
Abnormal findings of teeth and jaw alignment
Overbite
Underbite
Malocclusion
Dental caries
Tetracycline staining
Fluorosis
113
Fluorosis
Mottled enamel: (excessive fluoride)
113
Discoloration of teeth: tetracycline may discolor teeth gray if
administered before puberty
Tetracycline staining
114
Stomatitis
Inflammation & redness of the oral mucosa that can lead to pain& difficulty
115
Very rare malignancy thag progresses rapidly & proves to be particularly aggressive
Oral melanoma
116
made out of bone (whitish color)
Hard palate
117
made out of muscle (more pink in color)
Soft palate
118
hangs from middle of soft palate
Uvula
119
striated muscle assist with mastication and swallowing. Papillae on dorsal surface of tongue hold neurons responsible for taste
Tongue
120
Salivary glands
Parotid gland
Submandibular gland
Sublingual gland
121
Parotid gland
Located superior of mandibular angle
122
Submandibular gland
Lies beneath the mandible
123
Sublingual gland
Lies posterior to the tongue at the floor of the mouth
124
Nasopharynx
◼ Located behind the nose, above the soft palate
◼ Contains adenoids (pharyngeal tonsils)
◼ Eustachian tube opens during swallowing to equalize pressure within the middle
125
Oropharynx
◼ Located behind the mouth, below the nasopharynx
◼ Shared passageway for breathing and swallowing
◼ Contains palatine tonsils, which guard the body against microorganisms
126
Laryngopharynx
◼ Extends from base of tongue to the esophagus
◼ Critical dividing point where solids are separated from air
◼ Divides larynx from esophagus
127
Throat(Pharynx)
NASOPHARYNX —OROPHARYNX—LARYNGOPHARYNX
128
◼ Children have 20 deciduous (temporary) teeth (compared to the adults’ 32).
◼ Deciduous teeth are lost beginning at 6 years until about 12
Developmental Considerations – Infants and Children
129
◼ Nasal hair grow coarser and stiffer and may not filter air as well. Decreased sensation of
smell.
◼ Loss of taste due to soft tissue atrophy
◼ Decrease in salivary secretion
◼ Tooth surface is abraded. Gums begin to recede and erode.
◼ Poor oral hygiene may cause tooth loss, which increase the difficulty of mastication
◼ Use of medications may have anticholinergic effects, which further decrease salivation
Developmental Considerations – Aging
130
Nasal discharge? (rhinorrhea)
Cold, allergies, sinus infection, trauma
131
Frequent colds?
immunosuppression
132
Epistaxis (nosebleeds)?
may occur with trauma, irritants
133
Sores or lesions in mouth or oral cavity?
may be malignant
134
Sore throat?
Determine if bacterial or viral cause. Strep throat may lead to rheumatic
fever. Are tonsils still in place?
135
may indicate poor oral hygiene
Bleeding gums or toothache
136
may be caused by GERD, pharyngitis, neurologic diseases, cancer
Dysphagia (difficulty swallowing)?
137
Black people normally have
Bluish lips
138
What do bluish lips signify in light skinned people?
Hypoxemia or hypothermia
139
Pallor on lips?
Anemia,shock
140
Cherry red lips?
CO poisoning, acidosis
141
Angular cheilitis (inflammation of lips)
Painful fissures at corners of mouth caused by Candida infection
142
Herpes simplex virus
◼ Mostly HSV-1 virus, possibly HSV-2
◼ Vesicles or pustules, highly contagious
143
Mostly crusted or ulcerated
Carcinoma
144
Teeth normally look white, straight, and free of decay. In the back, the upper molars should directly rest on the lower molars. In the front, upper incisors should overlap lower
incisors
Assessing the teeth
145
Yellowing of teeth is a result of
Tobacco use
146
misalignment of upper and lower teeth
Malocclusion
147
tooth decay as result of acids produced by bacteria “eating”
carbohydrates and sugars, destroying enamel
Dental carries
148
Normally the gums look pink, with well defined margins between teeth and gums
Assessing the gums
149
enlargement of gums. Possible SA of Dilantin
Gingival hyperplasia
150
redness, swelling, or bleeding of gum margins caused by anaerobic
bacteria as a result of poor dental hygiene or vitamin C deficiency . If disease is untreated and spreads to bone, the result is periodontitis
Gingivitis
151
Absorption of bones
Periodontitis
152
◼ Normally the tongue is pink with a roughened dorsal surface and moist underneath
◼ Inspect tongue by holding it with cotton gauze pad and moving to each side
Assessing the tongue
153
Tongue abnormalities
Enlarged tongue (macroglossia)
Fissured tongue
Candidiasis
Atrophic Glossitis(glossy tongue)
Black hairy tongue
Carcinoma
154
Enlarged tongue
Macroglossia
155
occurs in Down syndrome, acromegaly, cretinism, myxedema
Enlarged tongue (macroglossia)
156
congenital, benign. Mild form may be caused by dehydration
Fissured tongue
157
◼ White, cheesy, patch on buccal mucosa or tongue
◼ Occurs after use of antibiotics, steroids, and immunosuppression (AIDS)
Candidiasis
158
surface of tongue is smooth and shiny, burning. Occurs with pernicious anemia (vit B 12 deficiency), folic acid deficiency, and iron deficiency anemia
Atrophic Glossitis (glossy tongue)
159
fungal infection usually due to prolonged antibiotic use
Black hairy tongue
160
common underneath the tongue
Carcinoma
161
◼ Normal mucosa looks pink, smooth, and moist
◼ Inspect by using light and a tongue blade
◼ Note presence of Stensen’s ducts (openings of parotid gland) which are inflamed and red
with mumps
◼ Also notice breath. Fruity odor might indicate ketoacidosis.
Assessing the buccal mucosa
162
Normal mucosa looks
pink, smooth, and moist
163
prodromal sign of measles
Koplik's spots
164
◼ The anterior hard palate is normally filled with irregular transverse rugae
◼ Might appear yellow with jaundice in whites and yellow-brown in blacks
◼ The posterior soft palate is pinker, smooth, and upward movable. Contains the uvula
◼ To check for CN X (vagus nerve) reflex, ask person to open mouth and say
“ahhhh.” Uvula should move up.
Assessing the palate
165
Palate abnormalities
Cleft palate
166
a congenital defect where the maxillary process fails to fuse. This causes a gap in the hard palate and possibly the upper lip. Surgery required.
Cleft palate
167
◼ Normal are pink at the sides of mouth, barely visible
◼ Inspect by depressing the tongue blade on the tongue
◼ During an upper respiratory infection, the tonsils become bright red, swollen, and might
contain exudate and/or white spots
Assessing the tonsils
168
Tonsils visible
1+
169
Tonsils inflamed
2+
170
Tonsils touching uvula
3+
171
Tonsils touching each other
4+
