Nose, Mouth, Throat Flashcards by B -

Nose, Mouth, and Throat

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STRUCTURE AND FUNCTION

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NOSE

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The ________ is the first segment of the respiratory system. It warms, moistens, and filters the inhaled air, and it is the sensory organ for smell.
A)nose
B)throat
C)both a and b

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The _________ is shaped like a triangle with one side attached to the face.On its leading edge, the superior part is the bridge and the free corner is the tip. The oval openings at the base of the triangle are the nares; just inside, each naris widens into the vestibule.
A)external nose
B)internal nose

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The _____________ divides the two nares and is continuous inside with the nasal septum.
A)columella
B)ala

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The________ is the lateral outside wing of the nose on either side.
A)ala
B)nose

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The upper third of the external nose is made up of bone; the rest is cartilage.
A)true
B)false

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the nasal cavity is much larger than the external nose would indicate.
A)true
B)false

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It extends back over the roof of the mouth. The anterior edge of the cavity is lined with numerous coarse nasal hairs, or vibrissae. The rest of the cavity is lined with a blanket of ciliated mucous membrane.
A)nasal cavity
B)oral cavity

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The _________ filter the coarsest matter from inhaled air.
A)nasal hairs
B)mucous blanket

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the ____________ filters out dust and bacteria.
A)nasal hairs
B)mucous blanket

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Nasal mucosa appears redder than oral mucosa because of the rich blood supply present to warm the inhaled air.
A)true
B)false

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The nasal cavity is divided medially by the septum into two slitlike air passages.
A)true
B)fase

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The ____________ of the septum holds a rich vascular network, Kiesselbach plexus, the most common site of nosebleeds.
A)anterior part
B)posterior part

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ln many people, the nasal septum is not absolutely straight and may deviate toward one passage.
A)true
B)false

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The lateral walls of each nasal cavity contain three parallel bony projections-the superior, middle, and inferior turbinates. They increase the surface area so that more blood vessels and mucous membranes are available to warm, humidify, and filter the inhaled air.
A)true
B)false

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The lateral walls of each nasal cavity contain three parallel bony projections-the superior, middle, and inferior turbinates. They ?
A)increase the surface area so that more blood vessels and mucous membranes are available to warm, humidify, and filter the inhaled air.
B)decrease the surface area so that less blood vessels and mucous membranes are available to warm, humidify, and filter the inhaled air.

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Underlying each turbinate is a ______, the meatus, which is named for the turbinate above.
A)cleft
B)mucus

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The sinuses drain into the
A)middle meatus,
B)inferior meatus.

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tears from the nasolacrimal duct drain into the
A)middle meatus
B)inferior meatus

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The ________________ lie at the roof of the nasal cavity and in the upper one third of the septum. These receptors for smell merge into the olfactory nerve, cranial nerve 1, which transmits to the temporal lobe of the brain.
A)olfactory receptors (hair cells)
B)facial receptors

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Although it is not necessary for human survival, the sense of smell adds to nutrition by enhancing the pleasure and taste of food.
A)olfactory receptors
B)sinus receptors

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The ___________ are air-filled pockets within the cranium. They communicate with the nasal cavity and are lined with the same type of ciliated mucous membrane. They lighten the weight of the skull bones, serve as resonators for sound production, and provide mucus, which drains into the nasal cavity.
A)paranasal sinuses
B)olfactory sinuses

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The ________openings are narrow and easily occluded, which may cause inflammation or sinusitis. A)sinus B)olfactory sinuses

Two pairs of sinuses are accessible to examination: A)the frontal sinuses in the frontal bone above and medial to the orbits; B)the maxillary sinuses in the maxilla (cheekbone) along the side walls of the nasal cavity. C)both a and b

``` : the ______ sinuses in the frontal bone above and medial to the orbits; A) frontal B)maxillary C)ethmoid D)sphenoid ```

``` the _________ sinuses in the maxilla (cheekbone) along the side walls of the nasal cavity. A) frontal B)maxillary C)ethmoid D)sphenoid ```

The other two sets are smaller and deeper: the ethmoid sinuses between the orbits; and the sphenoid sinuses deep within the skull in the sphenoid bone A)true B)false

True

``` The other two sets are smaller and deeper: the _________ sinuses between the orbits; A) frontal B)maxillary C)ethmoid D)sphenoid ```

``` The other two sets are smaller and deeper: the ________ sinuses deep within the skull in the sphenoid bone A) frontal B)maxillary C)ethmoid D)sphenoid ```

Only the maxillary and ethmoid sinuses are present at birth. A)true B)false

What sinuses are present at birth A)maxillary B)ethmoid C)both a and b

The maxillary sinuses reach full size after all permanent teeth have erupted. A)true B)false

The ethmoid sinuses grow rapidly between 6 and 8 years of age and after puberty. A) true B) false

Ethomoid sinuses grow rapidly between the ages of A)11,15 B)6,8 C)2,5

The frontal sinuses are absent at birth, A)true B)false

are fairly well developed between 7 and 8 years of age, and reach full size after puberty. A)frontal sinuses B)ethmoid

Frontal sinuses are developed between what ages A)7,8 B)9,13 C)4,6

The sphenoid sinuses are minute at birth and develop after puberty. A)true B)false

MOUTH

The ________ is the first segment of the digestive system and an airway for the respiratory system. A)mouth B)nose

The _______ is a short passage bordered by the lips, palate, cheeks, and tongue. It contains the teeth and gums, tongue, and salivary glands. A)oral cavity B)nasal cavity

The_______ are the anterior border of the oral cavity- the transition zone from the outer skin to the inner mucous membrane lining the oral cavity. A)lips B) tongue C)both a and b

The arching roof of the mouth is the palate; it is divided into two parts. A)anterior (hard plate) posterior (hard plate) B)anterior (hard plate) posterior (soft plate) C)anterior (soft plate) posterior (hard plate) D)anterior (soft plate) posterior (soft plate)

hard palate is made up of bone and is a whitish color. A)anterior B)posterior

is the soft palate, an arch of muscle that is pinker in color and mobile. A)anterior B)posterior

The ________ is the free projection hanging down from the middle of the soft palate. A)uvula B)lips

The cheeks are the side walls of the oral cavity. A)true B)false

The floor of the mouth consists of the horseshoe-shaped mandible bone, the tongue, and underlying muscles. A)true B)false

The________ is a mass of striated muscle arranged in a crosswise pattern so that it can change shape and position. A) tongue B) lips

The_______ are the rough, bumpy elevations on its dorsal surface. A) papillae B)lips

Note the larger ________ in an inverted V shape across the posterior base of the tongue, and do not confuse them with abnormal growths. A)vallate papillae B)paplliae

Underneath, the ventral surface of the tongue is smooth and shiny and has prominent veins. A)true B)false

The_______ is a midline fold of tissue that connects the tongue to the floor of the mouth. A)frenulum B)papallie

The________ ability to change shape and position enhances its functions in mastication, swallowing, cleansing the teeth, and the formation of speech. A)lips B)tongue's C)teeth

The______ also functions in taste sensation. A)tongue B)cheeks

Microscopic taste buds are in the papillae at the back and along the sides of the tongue and on the soft palate A)true B)false

The largest, the_______ gland, lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. Its duct, Stensen's duct, runs forward to open on the buccal mucosa opposite the second molar. A)parotid B)submandibular

The largest, the parotid gland, lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. Its duct, __________,runs forward to open on the buccal mucosa opposite the second molar. A)parotid B)submandibular C)stensens's duct

The________ gland is the size of a walnut. It lies beneath the mandible at the angle of the jaw. Wharton's duct runs up and forward to the floor of the mouth and opens at either side of the frenulum A)parotid B)submandibular

The submandibular gland is the size of a walnut. It lies beneath the mandible at the angle of the jaw. ___________,runs up and forward to the floor of the mouth and opens at either side of the frenulum A)parotid B)submandibular C)Wharton's duct

The smallest, the almond-shaped _______ gland, lies within the floor of the mouth under the tongue. It has many small openings along the sublingual fold under the tongue. A)sublingual B)submandibular

The glands secrete saliva, the clear fluid that moistens and lubricates the food bolus, starts digestion, and cleans and protects the mucosa. A)true B)false

Adults have 32 permanent teeth-16 in each arch. A)true B)false

Each tooth has three parts: the crown, the neck, and the root. A)true B)false

The _________ collar the teeth. They are thick, fibrous tissues covered with mucous membrane. The ________ are different from the rest of the oral mucosa because of their pale pink color and stippled surface. A)teeth B)gums (gingivae) C)glands

THROAT

The throat, or pharynx, is the area behind the mouth and nose. A)true B)false

The throat, is also called________, is the area behind the mouth and nose. A)larynx B)pharynx C)both a and b

The__________ is separated from the mouth by a fold of tissue on each side, the anterior tonsillar pillar. Behind the folds are the tonsils, each a mass of lymphoid tissue. A)oropharynx B)nasophaynx

The tonsils are the same color as the surrounding mucous membrane, although they look more granular and their surface shows deep crypts. A)true B)false

_________tissue enlarges during childhood until puberty and then involutes. A)Tonsillar B)gums

The posterior pharyngeal wall is seen behind these structures. Some small blood vessels may show on it. A)true,oropharynx B)false

The________ is continuous with the oropharynx, although it is above the oropharynx and behind the nasal cavity. The pharyngeal tonsils (adenoids) and the eustachian tube openings are located here. A)nasopharynx B)oropharynx

The pharyngeal tonsils (adenoids) and the eustachian tube openings are located here. A)nasopharynx B)oropharynx

DEVELOPMENTAL COMPETENCE | Infants and Children

In the infant, salivation starts at 3 months. A)true B)false

The baby will drool for a few months before learning to swallow the saliva. This drooling does not herald the eruption of the first tooth, although many parents think it does. A)true B)false

The teeth, both sets, begin development in utero. A)true B)false

Children have 20 deciduous, or temporary, teeth. These erupt between 6 months and 24 months of age. All 20 teeth should appear by 2 1/2 years of age. A) true B)false

``` Deciduous teeth erupts at what age A)6-24months B)18-24months C)11-24months D)2-14months ```

All 20 teeth should appear by 2 1/2 years of age. A)true B)false

The deciduous teeth are lost beginning at age 6 years through age 12 years. They are replaced by the permanent teeth, starting with the central incisors. The permanent teeth appear earlier in girls than in boys, and they erupt earlier in Black children than in white children. A)true B)false

The permanent teeth appear earlier in girls than in boys, and they erupt earlier in Black children than in white children. A)true B)false

The nose develops during adolescence, along with other secondary sex characteristics. This growth starts at age 12 or 13 years, reaching full growth at age 16 years in females and age 18 years in males. A)true B)false

DEVELOPMENTAL COMPETENCE | The Pregnant Woman

Nasal stuffiness and epistaxis may occur during pregnancy as a result of increased vascularity in the upper respiratory tract. A)true B)false

Also, the gums may be hyperemic and softened and may bleed with normal toothbrushing. Contrary to superstitious folklore, pregnancy does not cause tooth decay or loss. A)pregnant woman B)aging adut

DEVELOPMENTAL COMPETENCE | The Aging Adult

A gradual loss of subcutaneous fat starts during later adult years, making the nose appear more prominent in some people. A)aging adult B)child

The nasal hairs grow coarser and stiffer and may not filter the air as well. The hairs protrude and may cause itching and sneezing. A)aging adulth B)young adult

Many older people clip these hairs, thinking them unsightly, but this practice can cause infection. A)true B)false

The sense of smell may diminish because of a decrease in the number of olfactory nerve fibers. A)aging adult B)infant C)pregnant

The decrease in the sensation of smell begins after age 60 years and continues progressively with age A)pregnant B)aging adut

In the oral cavity, the soft tissues atrophy and the epithelium thins, especially in the cheeks and tongue. This results in loss of taste buds, with about an 80o/o reduction in taste functioning. A)aging adult B)infant

Further impairments to taste include a decrease in salivary secretion that is needed to dissolve flavoring agents and the presence of upper dentures that cover secondary taste sites A)infant B)adult C)aging adult

Atrophic tissues ulcerate easily, which increases risk for infections such as oral moniliasis. The risk for malignant oral lesions also increases. A)aging adult B)pregnant women

Many dental changes occur with aging. The tooth surface is abraded. The gums begin to recede, and the teeth begin to erode at the gum line. A)young adult B)aging adult

A smooth V-shaped cavity forms around the neck of the tooth, exposing the nerve and making the tooth hypersensitive. Some tooth loss may occur from bone resorption (osteoporosis), which decreases the inner tooth structure and its outer support. A)aging adult B)younger adult

Natural tooth loss is exacerbated by years of inadequate dental care, decay, poor oral hygiene, and tobacco use. A)true B)false

If tooth loss occurs, the remaining teeth drift, causing malocclusion. A)true B)false

If tooth loss occurs, the remaining teeth drift, causing A)malocclusion B)deviation

The stress of chewing with maloccluding teeth causes further problems: ( l) further tooth loss; (2) muscle imbalance from a mandible and maxilla now out of alignment, which produces muscle spasms, tenderness of muscles of mastication, and chronic headaches; and (3) stress on the temporomandibular joint, leading to osteoarthritis, pain, and inability to fully open the mouth. A)true B)flase

Read again true

A diminished sense of taste and smell decreases the aging person's interest in food and may contribute to malnutrition. A)true B)false

Saliva production decreases; saliva acts as a solvent for food flavors and helps move food around the mouth. Decreased saliva also reduces the mouth's self-cleaning property. A)infant B)aging adult C)both a and b

The major cause of decreased saliva flow is not the aging process itself but, rather, the use of medications that have anticholinergic effects. More than 250 medications have a side effect of dry mouth. A)true B)false

The major cause of reduce salvia production in aging adults is A)degeneration B)medication C)foods

More than 250 medications have a side effect of dry mouth A)true B)false

The absence of some teeth and trouble with mastication encourage the older person to eat soft foods (usually high in carbohydrates) and to decrease meat and fresh vegetable intake. This produces a risk for nutritional deficit for protein, vitamins, and minerals. A)true B)false

This produces a risk for nutritional deficit for protein, vitamins, and minerals. A)The absence of some teeth and trouble with mastication encourage the older person to eat soft foods (usually high in carbohydrates) and to decrease meat and fresh vegetable intake. B)false

CULTURE AND GENETICS

______, a condition in which the uvula is split either completely or partially, occurs in 18% of some American Indian groups and in 10% of Asians. The occurrence in whites and Blacks is rare. A)Bifid uvula B)cleft

The occurrence in whites and Blacks is rare. A)Bifid uvula B)cleft

_______________ are most common in Asian-American newborns ( 1/800) and American Indians, less common in Caucasians (1/1000), and least 28 common among African Americans ( 1/ 1200) A)Cleft lip and cleft palate B)bidifa

Both genetic and environmental factors contribute to the emergence of ________, a benign bony ridge running in the middle of the hard palate. The prevalence of torus palatinus and torus mandibularis is higher in Asians than in Caucasians and is higher in women than in men. A)torus palatinus B)cleft lip

The prevalence of torus palatinus and torus mandibularis is higher in Asians than in Caucasians and is higher in women than in men. A)true B)false

The prevalence of torus palatinus and torus mandibularis is higher in A) Asians than in Caucasians B)higher in women than in men C)both a and b

_________is a milky, bluish-white, opaque appearance of the buccal mucosa. It occurs more often in darkly pigmented persons and is seen most often in African Americans. A)Leukoedema B)bifidav

The incidence of natal teeth (baby born with teeth) is rare, about 1:2000 to I :3500 live births, but is more common among American Indian infants. A)true B)false

whites have more tooth decay than Blacks. A)true B)false

True

The differences in tooth decay between Blacks and whites occur because Blacks have harder and denser tooth enamel, which makes their teeth less susceptible to the organisms that cause caries. A)true B)false

A true

Blacks, Hispanics, American Indians, and Alaska Natives have the poorest oral health of all racial and ethnic groups in the United States. A)true B)false

The incidence rate was 20% higher for African-American men than for white men, while the difference between women was small. A)pharyngeal cancer B)cancer

SUBJECTIVE DATA

``` Nose 1 . Discharge 2. Frequent colds (upper respiratory infections) 3. Sinus pain 4. Trauma 5. Epistaxis (nosebleeds) 6. Allergies 7. Altered smell Mouth and Throat 1. Sores or lesions 2. Sore throat 3. Bleeding gums 4. Toothache 5. Hoarseness 6. Dysphagia 7. Altered taste 8. Smoking, alcohol consumption 9. Self-care behaviors Dental care pattern Dentures or appliances A)subjective data B)objective data ```

Nose

Discharge. Any nasal discharge or runny nose? Continuous? • Is the discharge watery, purulent, mucoid, bloody? A)Rhinorrhea occurs with colds, allergies, sinus infection, trauma. B)Most people have occasional colds; thus asking this more precise question yields more meaningful data.

Frequent colds. Any unusually frequent or severe colds (upper respiratory infections)? How often do these occur? A)Most people have occasional colds; thus asking this more precise question yields more meaningful data. B)Any sinus pain or sinusitis?

Any sinus pain or sinusitis? A)inflammation of sinuses B)none

Trauma. Ever had any trauma or a blow to the nose? • Can you breathe through your nose? Are both sides obstructed or one? A)Trauma may cause deviated septum, which may cause nares to be obstructed. B)Epistaxis (nosebleeds). Any nosebleeds? How often?

Epistaxis (nosebleeds). Any nosebleeds? How often? A)Epistaxis occurs with trauma, vigorous nose blowing, foreign body. B)Person should sit up with head tilted forward, pinch nose between thumb and forefinger for 5 to 15 minutes C)both a and b

Any allergies or hay fever? To what are you allergic (e.g., pollen, dust, pets)? A)Seasonal" rhinitis if due to pollen; "perennial" if allergen is dust. B)Misuse of over-the-counter nasal medications irritates the mucosa, causing rebound swelling, a common problem. C)both a and b

Altered smell. Experienced any change in sense of smell? A)Sense of smell diminishes with cigarette smoking, chronic allergies, aging. B)none

Mouth and Throat

Sores or lesions. Noticed any sores or lesions in the mouth, tongue, or gums? A)History helps determine whether oral lesions have infectious, traumatic, immunologic, or malignant etiology. B)none

Sore throat. How about sore throats? How frequently do you get them? Have a sore throat now? When did it start? A)Untreated strep throat may lead to the complication of rheumatic fever. B)false

Any toothache? Do your teeth seem sensitive to hot, cold? Have you lost any teeth? A)true B)false

Any hoarseness, voice change? For how long? A)Hoarseness of the larynx has many causes: overuse of the voice, upper respiratory infection (URI), chronic inflammation, lesions, or a neoplasm. B)false

Larynx means A)throat B)voice box

Dysphagia. Any difficulty swaJlowing? How long have you had it? A)Dysphagia occurs with pharyngitis, gastroesophageal reflux disease, stroke and other neurologic diseases, esophageal cancer. B)false

Smoking, alcohol consumption. Do you smoke? Pipe or cigarettes? Smokeless tobacco? How many packs per day? For how many years? A)Chronic tobacco use leads to tootl1 loss, coronal and root caries, and periodontal disease in older adults B)false

When was your last alcohol drink? How much alcohol did you drink that time? How much alcohol do you usually drink? A)Chronic tobacco use and heavy alcohol consumption highly increase risk for oral and pharyngeal cancers. B)false

Tell me about your daily dental care. How often do you use a toothbrush and floss? A)Assess self-care behaviors for oral hygiene. B)Periodic dental screening is necessary to note caries. C)both a and b

Any problems with talking-do the dentures whistle or drop? Can you chew all foods with them? How do you clean them? A)Lesions may arise from ill-fitting dentures, or the presence of dentures may mask the eruption of new lesions. B)false

Additional History for Infants and Children

Did the child's teeth erupt about on time? A)Eruption is delayed with Down syndrome, cretinism, rickets B)false

Do the teeth seem straight to you? A)checking for Malocclusion. B)false

Is the child using a bottle? How often during the day? Does the child go to sleep with a bottle at night? A)Prolonged bottle use increases risk for tooth decay and middle ear infections B)false

Have you noticed any thumb sucking after the child's secondary teeth came in? A)Prolonged thumb sucking (after age 6 to 7 years) may affect occlusion. B)false

Have you noticed the child grinding his or her teeth? Does this happen at night? A)Bruxism usually occurs in sleep, from dental problems, nervous tension. B)false

Evaluate child's self-care. Early self-care has best compliance. A)true B)false

Additional History for the Aging Adult

Any dryness in the mouth? Are you taking any medications? (Note prescribed and over-the-counter medications. A)Xerostomia (dry mouth) is a side effect of many drugs: antidepressants, anticholinergics, antispasmodics, antihypertensives, antipsychotics, bronchodilators. B)false

Have you lost any teeth? Can you chew all types of food? A)Note a decrease in eating meat, fresh vegetables, and cleansing foods such as apples. B)false

Are you able to care for your own teeth or dentures? A)Self-care may be decreased by physical disability (arthritis), vision Joss, confusion, or depression B)false

Noticed a change in your sense of taste or smell? A)Some people add extra salt and sugar to enhance food when taste begins to wane. B)Also, diminished smell may decrease the person's ability to detect food spoilage, natural gas leaks, or smoke from a fire. C)both a and b

OBJECTIVE DATA

Position the person sitting up straight with his or her head at your eye level. If the person wears dentures, offer a paper towel and ask the person to remove them. A)true B)false

INSPECT AND PALPATE THE NOSE

External Nose

Test the patency of the nostrils A)by pushing each nasal wing shut with your finger while asking the person to sniff inward through the other nares. B)false

Test the patency of the nostrils by pushing each nasal wing shut with your finger while asking the person to sniff inward through the other naris. This reveals any obstruction, which later is explored using the nasal speculum. A)true B)false

The sense of smell, mediated by cranial nerve I, is not tested in a routine examination. A)true B)false

The procedure for assessing smell is presented with cranial nerve testing A)true B)false

``` Absence of sniff indicates obstruction A)common cold B)nasal polyps C)rhinitis D)all the above ```

Nasal Cavity

Attach the short wide-tipped speculum to the otoscope head and insert this combined apparatus into the nasal vestibule, avoiding pressure on the nasal septum. Gently lift up the tip of the nose with your finger before inserting. A)true B)false

View each nasal cavity with the person's head erect and then with the head tilted back. Inspect the nasal mucosa, noting its normal red color and smooth, moist surface. Note any swelling, discharge, bleeding, or foreign body. A)true B)false

Rhinitis- nasal mucosa is swollen and bright red with URI. A)true B)false

________- nasal mucosa is swollen and bright red with URI. A) Rhinitis B)herpes

Discharge is common with rhinitis and sinusitis, varying from A)watery and copious to thick, purulent, and green-yellow. B)false

With chronic allergy, mucosa looks swollen, boggy, pale, and gray A)true B)false

Observe the nasal septum for deviation. A)true B)false

A deviated septum is common and is not significant unless air flow is obstructed. (If present in a hospitalized patient, document the deviated septum in the event that the person needs nasal suctioning or a nasogastric tube.) A)true B)false

Also note any perforation or bleeding in the septum. A)true B)false

A deviated septum looks like a hump or shelf in one nasal cavity. A)abnormal finding B)normal finding

_______is seen as a spot of light from a penlight shining in the other naris and occurs with cocaine use. A)Perforation B) Epistaxis

_______commonly comes from anterior septum A)Epistaxis B)false

Inspect the turbinates (the bony ridges curving down from the lateral walls). A)true B)false

The superior turbinate will not be in your view, but the middle and inferior turbinates appear the same light red color as the nasal mucosa. Note any swelling but do not try to push the speculum past it. Turbinates are quite vascular and tender if touched. A)true B)false

The_______ turbinate will not be in your view, but the middle and inferior turbinates appear the same light red color as the nasal mucosa. A) superior B) inferior

Note any swelling but do not try to push the speculum past it. Turbinates are quite vascular and tender if touched. A)true B)false

Note any polyps (benign growths that accompany chronic allergy), and distinguish them from the normal turbinates. A)inspecting nasal cavity B)false

_______are smooth, pale gray, avascular, mobile, nontender. A)Polyps B)false

PALPATE THE SINUS AREAS

Using your thumbs, press the frontal sinuses by pressing up and under the eyebrows and over the maxillary sinuses below the cheekbones. Take care not to press directly on the eyeballs. The person should feel firm pressure but no pain. A)inspecting and palpating the sinuses B)Sinus areas are tender to palpation in persons with chronic allergies and acute infection (sinusitis).

Sinus areas are tender to palpation in persons with chronic allergies and acute infection (sinusitis). A)abnormal finding of sinuses B)normal finding of sinuses

Transillumination

There is no evidence to support the practice of transillumination of the frontal or maxillary sinuses when you suspect sinus inflammation. 10 The diagnosis requires distinct differences in the illumination of one of the sinus pair. Thus the technique would not help in chronic sinusitis that has diffuse swelling of all sinus mucosa. Although there is more fluid collection with acute sinusitis, the asymmetry of light illumination still is not valid because many healthy sinuses normally will not transilluminate. A)Transillumination B)false

INSPECT THE MOUTH

Begin with anterior structures and move posteriorly. Use a tongue blade to retract structures and a bright light for optimal visualization. A)true inspecting the mouth B)false

Inspect the lips for color, moisture, cracking, or lesions. Retract the lips and note their inner surface as well. All racial groups have lips that are deeper or pinker than facial skin. However, some African Americans normally may have bluish lips and a dark line on the gingival margin. A)true B)false

some African Americans normally may have bluish lips and a dark line on the gingival margin. A)true B)false

In light-skinned people: circumoral pallor occurs with shock and anemia; A)true B)false

In light-skinned people: cyanosis with hypoxemia and chilling; A)true B)false

In light-skinned people: ; cherry red lips with carbon monoxide poisoning, acidosis from aspirin poisoning, or ketoacidosis A)true B)false

In light-skinned people: circumoral pallor occurs with shock and anemia; cyanosis with hypoxemia and chilling; cherry red lips with carbon monoxide poisoning, acidosis from aspirin poisoning, or ketoacidosis A)true B)false

________cracking at the comers. A)Cheilitis (perleche) B)herpes zoster

The condition of the teeth is an index of the person's general health. Your examination should not replace the regular dental examination, but you should note any diseased, absent, loose, or abnormally positioned teeth. The teeth normally look white, straight, evenly spaced, and clean and free of debris or decay. A)true B)false

. The teeth normally look white, straight, evenly spaced, and clean and free of debris or decay. A)true B)false

Discolored teeth appear A)brown with excessive fluoride use, B)yellow with tobacco use C)both a and b

Compare the number of teeth with the number expected for the person's age. Ask the person to bite as if chewing something and note alignment of upper and lower jaw. Normal occlusion in the back is the upper teeth resting directly on the lowers; in the front, the upper incisors slightly override the lower incisors. A)true B)false

Ask the person to bite as if chewing something and note alignment of upper and lower jaw. Normal occlusion in the back is the upper teeth resting directly on the lowers; in the front, the upper incisors slightly override the lower incisors. A)true B)false

Grinding down of tooth surface; plaque-soft debris; A)abnormal finding of teeth B)normal finding of teeth

Malocclusion (poor biting relationship), protrusion of upper or lower incisors A)abnormal findings of the teeth B)normal finding of the teeth

Normally, the gums look pink or coral with a stippled (dotted) surface. The gum margins at the teeth are tight and well defined. Check for swelling; retraction of gingival margins; and spongy, bleeding, or discolored gums. Some African Americans normally may have a dark melanotic line along the gingival margin. A)true B)false

. Some African Americans normally may have a dark melanotic line along the gingival margin. A)true B)false

Gingival hyperplasia , crevices between teeth and gums, pockets of debris. A)abnormal finding of the gums B)normal finding of the gum

Gums bleed with slight pressure, indicating A)gingivitis | B)inflammation

Dark line on gingival margins occurs with A)lead poisoning B)bismuth poisoning C)both a and b

Check the tongue for color, surface characteristics, and moisture. The color is pink and even. The dorsal surface is normally roughened from the papillae. A thin white coating may be present. Ask the person to touch the tongue to the roof of the mouth. Its ventral surface looks smooth and glistening and shows veins. Saliva is present. A)normal finding of the tongue B)abnormal finding of the tongue

Beefy red, swollen tongue. Smooth glossy areas. A)abnormal finding of the tongue B)normal finding of the tongue

``` Enlarged tongue occurs with A)mental retardation B) hypothyroidism C)acromegaly D)all the above ```

a small tongue accompanies A)hypothyroidism B)malnutrition

With a glove,* hold the tongue with a cotton gauze pad for traction and swing the tongue out and to each side. Inspect for any white patches or lesions-normally none are present. If any occur, palpate these lesions for induration. A)true B)false

Inspect carefully the entire U-shaped area under the tongue behind the teeth. Oral malignancies are most likely to develop here. A)true B)false

Oral cancer is to develop where on the tongue A)U shape part B)false

Note any white patches, nodules, or ulcerations. If lesions are present or with any person older than 5O years or with a positive history of smoking or alcohol use, use your gloved hand to palpate the area. Place your other hand under the jaw to stabilize the tissue and to "capture" any abnormality. Note any induration. A)true B)false

Any lesion or ulcer persisting for more than 2 weeks must be investigated. A)true B)false

An indurated area may be a mass or lymphadenopathy, and it must be investigated. A)true B)false

Always wear gloves to examine mucous membranes. This follows Standard Precautions to prevent the spread of possible communicable disease. A)true B)false

Buccal Mucosa

Hold the cheek open with a wooden tongue blade, and check the buccal mucosa for color, nodules, or lesions. It looks pink, smooth, and moist, although patchy hyperpigmentation is common and normal in dark-skinned people. A)true B)false

. It looks pink, smooth, and moist, although patchy hyperpigmentation is common and normal in dark-skinned people. A)inspecting the cheek B)false

Dappled brown patches are present with A)Addison's disease (chronic adrenal insufficiency) B)herpes

Dappled brown patches are present with Addison's disease (chronic adrenal insufficiency) A)abnormal finding of the cheek B)normal finding of the cheek

An expected finding is Stensen's duct, the opening of the parotid salivary gland. It looks like a small dimple opposite the upper second molar. You also may see a raised occlusion line on the buccal mucosa parallel with the level the teeth meet. This is caused by the teeth closing against the cheek. A)true B)false

An expected finding is ________, the opening of the parotid salivary gland. It looks like a small dimple opposite the upper second molar. A) Stensen's duct B) pink moist cheek

You also may see a raised occlusion line on the buccal mucosa parallel with the level the teeth meet. This is caused by the teeth closing against the cheek. A)true B)false

Orifice of Stensen's duct looks red with mumps. A)abnormal finding of the cheek B)normal finding of the cheek

Koplik spots-early prodromal (early warning) sign of measles A)abnormal finding of the cheek B)normal finding of the cheek

A larger patch also may be present along the buccal mucosa. This is leukoedema, a benign, milky, bluish white, opaque area, more common in Blacks and East Indians. When it is mild, the patch disappears as you stretch the cheeks. It is always bilateral. With age, it looks grayish white and thickened. The cause is unknown. A)true B)false

Do not mistake leukoedema for oral infections such as candidiasis (thrush). A)true B)false

A larger patch also may be present along the buccal mucosa. This is leukoedema, a benign, milky, bluish white, opaque area, more common in __________ and ___________. When it is mild, the patch disappears as you stretch the cheeks. It is always bilateral. With age, it looks grayish white and thickened. A)blacks B)east Indians C)both a and b

Candida infection will usually rub off, leaving a clear or raw denuded surface A)abnormal finding B)normal finding

__________ are small, isolated white or yellow papules on the mucosa of cheek, tongue, and lips. These little sebaceous cysts are painless and not significant. A)Fordyce granules B)false, cancerous

The chalky white raised patch of leukoplakia is abnormal A)true B)false

Palate

The more anterior hard palate is white with irregular transverse rugae. The posterior soft palate is pinker, smooth, and upwardly movable. A normal variation is a nodular bony ridge down the middle of the hard palate, a torus palatinus. This benign growth arises after puberty and is a more common finding in American Indians, Inuits, and Asians. A)true B)false

The more anterior hard palate is white with irregular transverse rugae. The posterior soft palate is pinker, smooth, and upwardly movable. A normal variation is a nodular bony ridge down the middle of the hard palate, a ____________. This benign growth arises after puberty and is a more common finding in American Indians, Inuits, and Asians. A)leukoplakia B)torus palatinus

This benign growth arises after puberty and is a more common finding in American Indians, Inuits, and Asians. A)leukoplakia B)torus palatinus

torus palatinus,This benign growth arises after puberty and is a more common finding in A)American Indians B) Inuits C)Asians D)all the above

The hard palate appears yellow with jaundice. In Blacks with jaundice, it may look yellow, muddy yellow, or green-brown A)true B)false

The hard palate appears yellow with jaundice. A)true B)false

The plate of Blacks with jaundice, it may look A)yellow, muddy yellow, or green-brown B)red

Oral Kaposi sarcoma is the most common early lesion in people with A)AIDS B)cold sores

Observe the uvula; it normally looks like a fleshy pendant hanging in the midline. Ask the person to say "ahhh" and note the soft palate and uvula rise in the midline. This tests one function of cranial nerve X, the vagus nerve. A)true B)false

A _____ looks like it is split in two; more common in American Indian. A)leukoplakia B)bifid uvula

Any deviation to the side or absent movement indicates nerve damage, which also occurs with poliomyelitis and diphtheria A)abnormal finding of the uuluva B)normal finding

INSPECT THE THROAT

With your light, observe the oval, rough-surfaced tonsils behind the anterior tonsillar pillar. Their color is the same pink as the oral mucosa, and their surface is peppered with indentations, or crypts. In some people, the crypts collect small plugs of whitish cellular debris. This does not indicate infection. A)true B)false

With an acute infection, tonsils are A)bright red and swollen B)may have exudate or large white spots. C)both a and b

``` A white membrane covering the tonsils may accompany infectious A)mononucleosis B)leukemia C)diphtheria D)all the above ```

Tonsils are graded in size as follows: 1+ Visible 2+ Halfway between tonsillar pillars and uvula 3+ Touching the uvula 4+ Touching each other

True

Tonsils are graded in size as follows: 1+ A)Visible B) Halfway between tonsillar pillars and uvula

Tonsils are graded in size as follows: 2+ A)Halfway between tonsillar pillars and uvula B)Touching the uvula

Tonsils are graded in size as follows: 3+ A) touching each other B)Touching the uvula

Tonsils are graded in size as follows: +4 A)Touching each other B) Halfway between tonsillar pillars and uvula

You may normally see l+ or 2+ tonsils in healthy people, especially in children, because lymphoid tissue is proportionately enlarged until puberty. A)true B)false

Tonsils are enlarged to 2+, 3+, or 4+ with an acute infection A)abnormal finding B)normal finding

Enlarge your view of the posterior pharyngeal wall by depressing the tongue with a tongue blade.Push down halfway back on the tongue; if you push on its tip, the tongue will hump up in back. Press slightly off center to avoid eliciting the gag reflex. You can help the person whose gag reflex is easily triggered by offering a tongue blade to depress his or her own tongue. (Some people can lower their own tongue so the tongue blade is not needed.) Scan the posterior wall for color, exudate, and lesions. When finished, discard the tongue blade. A)true B)false

You can help the person whose gag reflex is easily triggered by offering a tongue blade to depress his or her own tongue. (Some people can lower their own tongue so the tongue blade is not needed.) Scan the posterior wall for color, exudate, and lesions. When finished, discard the tongue blade. A)true B)false

Although usually it is not done in the screening examination, touching the posterior wall with the tongue blade elicits the gag reflex. This tests cranial nerves A)IX and X, the glossopharyngeal and vagus. B)false

Although usually it is not done in the screening examination, touching the posterior wall with the tongue blade elicits the gag reflex. This tests cranial nerves IX and X, the glossopharyngeal and vagus A)true B)false

Test cranial nerve XII, the hypoglossal nerve, by asking the person to stick out the tongue. It should protrude in the midline. Children enjoy this request! Note any tremor, loss of movement, or deviation to the side A)true B)false

Test cranial nerve _____, the hypoglossal nerve, by asking the person to stick out the tongue. It should protrude in the midline. Children enjoy this request! Note any tremor, loss of movement, or deviation to the side A)6 B)7 C)8

With cranial nerve XII damage, the tongue deviates toward the paralyzed side A)true B)false

With cranial nerve XII damage, the tongue A)deviates toward the paralyzed side B)remains the same

A fine tremor of the tongue occurs with hyperthyroidism; a coarse tremor occurs with cerebral palsy and alcoholism. A)true B)false

A fine tremor of the tongue occurs with A)hyperthyroidism; | B)cerebral palsy and alcoholism.

; a coarse tremor occurs with A)cerebral palsy and alcoholism. B)hyperthyroidison

A _________ of the tongue occurs with hyperthyroidism; A)fine tremor. B)coarse tremor

a _______ occurs with cerebral palsy and alcoholism. A)coarse tremor B)false

During the examination, notice any breath odor, halitosis. This is common and usually has a local cause, such as poor oral hygiene, consumption of odoriferous foods, alcohol consumption, heavy smoking, or dental infection. Occasionally it may indicate a systemic disease. A)true B)false

During the examination, notice any breath odor,_______. This is common and usually has a local cause, such as poor oral hygiene, consumption of odoriferous foods, alcohol consumption, heavy smoking, or dental infection. Occasionally it may indicate a systemic disease. A)odor B)halitosis

Diabetic ketoacidosis has a sweet, fruity breath odor; this acetone smell also occurs in children with malnutrition or dehydration. Others are an ammonia breath odor with uremia; a musty odor with liver disease; a foul, fetid odor with dental or respiratory infections; an alcohol odor with alcohol ingestion or chemicals; a mouselike smell of the breath with diphtheria. A)true B)false

______________ has a sweet, fruity breath odor; this acetone smell also occurs in children with malnutrition or dehydration. A)diabetic ketoacidosis B)ammonia

Others are an ________ breath odor with uremia; A)ammonia B)musty

a ________ odor with liver disease; A)ammonia B)musty

a foul, fetid odor with dental or respiratory infections; A)true B)false

an alcohol odor with alcohol ingestion or chemicals; A)true B)false

a mouselike smell of the breath with diphtheria. A)true B)false

DEVELOPMENTAL COMPETENCE | Infants and Children

timing is best toward the end of the complete examination, along with the ear examination. But if any crying episodes occur earlier, seize the opportunity to examine the open mouth and oropharynx. A)true B)false

As with the ear examination, let the parent help position the child. Place the infant supine on the examining table, with the arms restrained. The older infant and toddler may be held on the parent's lap with one of the parent's hands holding the arms down and the other hand securing the child's head against the parent's chest. A)true B)flase

Use a game to help prepare the young child. Encourage the preschool child to use a tongue blade to look into a puppet's mouth. Or place a mirror so that the child can look into the mouth while you do. The school-age child is usually cooperative and loves to show off missing or new teeth. A)true B)false

The school-age child is usually cooperative and loves to show off missing or new teeth A)true B)false

The _________ child is usually cooperative and loves to show off missing or new teeth A)infant B)school-age

You may avoid the tongue blade completely with a cooperative preschooler and school-age child. Try asking the young child to "Open your mouth as big as a lion," "Can you stick out your WHOLE TONGUE?" and to move the tongue in different directions. To enlarge your view of the oropharynx, ask the child to stick out the tongue and "pant Like a dog." A)TURE B)false

At some point, you will encounter an uncooperative young child who clenches the teeth and refuses to open the mouth. If all your other efforts have failed, slide the tongue blade along the buccal mucosa and turn it between the back teeth. Push down to depress the tongue. This stimulates the gag reflex, and the child opens the mouth wide for a few seconds. You will have a brief look at the throat. Make the most of it. A)true B)false

Nose. The newborn may have milia across the nose. The nasal bridge may be flat in Black and Asian children. There should be no nasal flaring or narrowing with breathing. A)true B)false

Nose. The newborn may have milia across the nose.The nasal bridge may be flat in A)Black B) Asian children. C)both a and b

Nasal flaring in the infant indicates respiratory distress. A)abnormal finding B)normal finding

A transverse ridge across the nose occurs in a child with chronic allergy from wiping the nose upward with the palm. A)abnormal finding B)normal findings

Nasal narrowing on inhalation is seen with chronic nasal obstruction and mouth breathing A)abnormal finding B)normal findings

It is essential to determine the patency of the nares in the immediate newborn period because most newborns are obligate nose breathers. Nares blocked with amniotic fluid are suctioned gently with a bulb syringe. If obstruction is suspected, a small-lumen (5 to 10 Fr) catheter is passed down each naris to confirm patency. A)true B)false

. Nares blocked with amniotic fluid are suctioned gently with A)a bulb syringe. B)If obstruction is suspected, a small-lumen (5 to 10 Fr) catheter is passed down each naris to confirm patency.

. If obstruction is suspected, the nurse will use A)a small-lumen (5 to 10 Fr) catheter is passed down each naris to confirm patency. B)false

Inability to pass catheter through nasal cavity indicates choanal atresia, which needs immediate intervention. A)true B)false

Inability to pass catheter through nasal cavity indicates ________, which needs immediate intervention. A)choanal atresia B)false

Avoid the nasal speculum when examining the infant and young child. Instead, gently push up the tip of the nose with your thumb while using your other hand to shine the light into the naris. With a toddler, be alert for the possible foreign body lodged in the nasal cavity A)true B)false

Only in children older than 8 years do you need to palpate the sinus areas. ln younger children, sinus areas are too small for palpation. A)true B)false

``` Only in children older than ____ years do you need to palpate the sinus areas. ln younger children, sinus areas are too small for palpation. A)5 B)6 C)7 D)8 ```

A normal finding in infants is the sucking tubercle, a small pad in the middle of the upper lip from friction of breastfeeding or bottlefeeding. A)true B)false

Note the number of teeth and whether it is appropriate for the child's age. A)true B)false

Also note pattern of eruption, position, condition, and hygiene. A)true B)false

A normal finding in infants is the __________, a small pad in the middle of the upper lip from friction of breastfeeding or bottlefeeding. A) sucking tubercle B)bottle feeding

No teeth by age 1 year. A)abnormal finding B) normal finding

Discolored teeth appear yellow or yellow-brown with infants taking tetracycline or whose mothers took the drug during the last trimester; appear green or black with excessive iron ingestion, although this reverses when the iron is stopped. A)abnormal finding B)normal finding

Use this guide for children younger than 2 years: the child's age in months minus the number 6 should equal the expected number of deciduous teeth. Normally, all 20 deciduous teeth are in by 2 1/2 years. Saliva is present after 3 months of age and shows in excess with teething children. A)true B)false

Malocclusion: upper or lower dental arches are out of alignment. A)abnormal finding B)normal finding

Mobility should allow the tongue to extend at least as far as the alveolar ridge. A)true B)false

Ankyloglossia, a short lingual frenulum, can limit protrusion and impair speech development A)abnormal finding B) normal finding

______, a short lingual frenulum, can limit protrusion and impair speech development A)leukoplakia B)Ankyloglossia

Note any bruising or laceration on the buccal mucosa or gums of the infant or young child. A)true B)false

Trauma may indicate child abuse from forced feeding of bottle or spoon. A)abnormal finding B)normal finding

On the palate, Epstein pearls are a normal finding in newborns and infants. They are small, whitish, glistening, pearly papules along the median raphe of the hard palate and on the gums, where they look like teeth. They are small retention cysts and disappear in the first few weeks. A)abnormal finding B)normal finding

On the palate, ________ are a normal finding in newborns and infants. They are small, whitish, glistening, pearly papules along the median raphe of the hard palate and on the gums, where they look like teeth. They are small retention cysts and disappear in the first few weeks. A)keloid B)Epstein pearls

A high-arched palate is usually normal in the newborn A)abnormal finding B)normal finding

Abnormal finding of a very narrow or high arch plate also occurs with A)Turner's syndrome, Ehlers-Danlos syndrome, B)Marfan's syndrome C)Treacher Collins syndrome or develops in the mouth-breather in chronic allergies D)all the above

Bednar aphthae are traumatic areas or ulcers on the posterior hard palate on either side of the midline. They result from abrasions while sucking. A)true B)false

________ are traumatic areas or ulcers on the posterior hard palate on either side of the midline. They result from abrasions while sucking. A)Bednar aphthae B)leukoplakia

The tonsils are not visible in the newborn. They gradually enlarge during childhood, remaining proportionately larger until puberty. Tonsils appear still larger if the infant is crying or gagging. Normally the newborn can produce a strong, lusty cry. A)true B)false

Insert your gloved finger into the baby's mouth and palpate the hard and soft palate as the baby sucks. The sucking reflex can be elicited in infants up to 12 months old. A)true B)false

As teeth begin to erupt in the older infant and child, check age at eruption, sequence, and condition. Teeth should emerge straight up or down from the gums, and enamel could be clear white and smooth. Lift the upper lip to check for dental caries (tooth decay); normally there are none A)true B)false

Nursing bottle caries are brown discolorations on upper front teeth. A)abnormal finding B)normal findings

DEVELOPMENTAL COMPETENCE | The Pregnant Woman

``` Gum hypertrophy (surface looks smooth and stippling disappears) may occur normally at puberty or during pregnancy (pregnancy gingivitis) A)true B)false ```

Gum hypertrophy (surface looks smooth and stippling disappears) may occur normally at A)puberty B)during pregnancy (pregnancy gingivitis) C)both a and b

DEVELOPMENTAL COMPETENCE | The Aging Adult

The nose may appear more prominent on the face from a loss of subcutaneous fat. A)aging adult B)infant

In the edentulous person, the mouth and lips fold in, giving a "purse-string" appearance. The teeth may look slightly yellowed, although the color is uniform. Yellowing results from the dentin visible through worn enamel. A)aging adult B)infant

The surface of the incisors may show vertical cracks from a lifetime of exposure to extreme temperatures. The teeth may look longer as the gum margins recede. A)aging adult B)infant

The surfaces look worn down or abraded. Old dental work deteriorates, especially at the gum margins. The teeth loosen with bone resorption and may move with palpation. A)true B)false

The tongue looks smoother as a result of papillary atrophy. The aging adult's buccal mucosa is thinned and may look shinier, as though it were "varnished." A)true B)false

PROMOTING A HEAL THY LIFESTYLE: SMOKELESS TOBACCO AND CANCER RISK Smokeless Does Not Mean Harmless!

``` Smokeless tobacco (SL-1) carries significant health risks, including cancers, fatal myocardial infarcts and stroke, dental decay, hypertension, and decreased sperm counts and sterility A)true B)false ```

SL-T use is higher in young white and American-Indian/ Alaskan-Native males A)true B)false

Pain is rarely an early symptom of oral cancer, which is why a thorough examination of the mouth is important. Early signs of oral cancer to look for include:

• A sore that does not seem to heal • A smooth or leathery white patch or lump • A prolonged sore throat or feeling that something is in the throat • Difficulty chewing • Restricted movement of the tongue or jaw A)Pain is rarely an early symptom of oral cancer, which is why a thorough examination of the mouth is important. Early signs of oral cancer to look for. B)false

ABNORMAL FINDINGS

Abnormalities of the Nose

A bony or membranous septum between the nasal cavity and the pharynx of the newborn. When the condition is bilateral, it requires the immediate insertion of an oral airway to prevent asphyxia because most newborns are obligate nose breathers. 'When the condition is unilateral, the infant may be asymptomatic until the onset of the first respiratory infection. A)Choanal Atresia B)Epistaxis

The most common site of a nosebleed is Kiesselbach plexus in the anterior septum. It may be spontaneous from a local cause or a sign of underlying illness. Causes include nose picking, forceful coughing or sneezing, fracture, foreign body, rhinitis, heavy exertion, or a coagulation disorder. Bleeding from the anterior septum is easily controlled and rarely severe. A posterior hemorrhage is less common (

Children particularly are apt to put an object up the nose (here, yellow plastic foam), producing unilateral mucopurulent drainage and foul odor. Because some risk for aspiration exists, removal should be prompt. A further problem comes from impaction from a small button battery from an electronic device (watch, video game). Once occluding the nostril, the battery can release voltage or chemicals that cause burns, necrosis, or perforation. A)Foreign Body B)Perforated Septum

A hole in the septum, usually in the cartilaginous part, may be caused by snorting cocaine, chronic infection, trauma from continual picking of crusts, or nasal surgery. It is seen directly or as a spot of light when the penlight is directed into the other naris. A)Perforated Septum B)Furuncle

A small boil located in the skin or mucous membrane; appears red and swollen and is quite painful. Avoid any manipulation or trauma that may spread the infection. A)Acute Rhinitis B)Furuncle

The first sign is a clear, watery discharge, rhinorrhea, which later becomes purulent. This is accompanied by sneezing and swollen mucosa, which causes nasal obstruction. Turbinates are dark red and swollen A)Allergic Rhinitis B)Acute Rhinitis

Rhinorrhea, itching of nose and eyes, lacrimation, nasal congestion, and sneezing are present. Note serous edema and swelling of turbinates to fill the air space. Turbinates are usually pale (although may appear violet), and their surface looks smooth and glistening. May be seasonal or perennial, depending on allergen. Individual has a strong family history of seasonal allergies A)Allergic Rhinitis B)Sinusitis

Facial pain, after upper respiratory infection. Signs include red, swollen nasal mucosa; swollen turbinates; and purulent discharge. Person also has fever, chills, malaise. With maxillary sinusitis, dull, throbbing pain occurs in cheeks and teeth on the same side, and pain with palpation is present. With frontal sinusitis, pain is above the supraorbital ridge. A)Sinusitis B)keloid

With_______ sinusitis, dull, throbbing pain occurs in cheeks and teeth on the same side, and pain with palpation is present. A).maxillary B)frontal

With_______ sinusitis, pain is above the supraorbital ridge. A)maxillary B)frontal

Smooth, pale gray nodules, which are overgrowths of mucosa, most commonly caused by chronic allergic rhinitis. May be stalked. A common site is protrusion from the middle meatus. Often multiple, they are mobile and nontender in contrast to turbinates. They may obstruct air passageways as they get larger. Symptoms include the absence of a sense of smell and a "valve that moves" in the nose as the person breathes. A)Nasal Polyps B)Cleft Lip

Abnormalities of the Lips

Maxillofacial clefts are the most common congenital deformities of the head and neck. The incidence varies among racial groups, being highest in American Indians and in Asians and lowest in Blacks. Early treatment preserves the functions of speech and language formation and deglutition (swallowing). A)Cleft Lip B)Carcinoma

The initial lesion is round and indurated, and then it becomes crusted and ulcerated with an elevated border. The majority occur between the outer and middle thirds of lip. Any lesion that is still unhealed after 2 weeks should be referred. A)Herpes Simplex 1 . B)Carcinoma

The cold sores are groups of clear vesicles with a surrounding indurated erythematous base. These evolve into pustules, which rupture, weep, and crust and heal in 4 to I 0 days. The most likely site is the lip-skin junction; infection often recurs in same site. Caused by the herpes simplex virus (HSV-1), the lesion is highly contagious and is spread by direct contact. Recurrent herpes infections may be precipitated by sunlight, fever, colds, and allergy. It is a very common lesion, affecting 50% of adults. A)Herpes Simplex 1 B)Angular Cheilitis (Stomatitis, Perleche)

Erythema, scaling, shallow and painful fissures at the corners of the mouth occur with excess salivation and Candida infection. It is often seen in edentulous persons and in those with poorly fitting dentures causing folding in of corners of mouth, creating a warm, moist environment favoring growth of yeast A)Retention "Cyst" (Mucocele) B)Angular Cheilitis (Stomatitis, Perleche)

A round, well-defined, translucent nodule that may be very small or up to I to 2 cm. It is a pocket of mucus that forms when a duct of a minor salivary gland ruptures. The benign lesion also may occur on the buccal mucosa, on the floor of the mouth, or under the tip of the tongue. A)Retention "Cyst" (Mucocele) B)cancer

ABNORMAL FINDINGS FOR ADVANCED PRACTICE

Abnormalities of the Teeth and Gums

Destruction of numerous deciduous teeth may occur in older infants and toddlers who take a bottle of milk, juice, or sweetened drink to bed and prolong bottle-feeding past the age of 1 year. Liquid pools around the upper front teeth. Mouth bacteria act on carbohydrates in the liquid, especially sucrose, forming metabolic acids. Acids break down tooth enamel and destroy its protein A)Baby Bottle Tooth Decay B)Malocclusion

Upper or lower dental arches are not in alignment and incisors protrude from developmental problem of mandible or maxilla or incompatibility between jaw size and tooth size. The condition increases risk for facial deformity, negative body image, chewing problems, or speech dysfluency. A)Malocclusion B)Dental Caries

Progressive destruction of tooth. Decay initially looks chalky white. Later, it turns brown or black and forms a cavity. Early decay is apparent only on x-ray study. Susceptible sites arc tooth surfaces where food debris, bacterial plaque, and saliva collect. A)Epulis B)Dental Caries

A nontender, fibrous nodule of the gum, seen emerging between the teeth; an inflammatory response to injury or hemorrhage. A)Epulis B)Gingival Hyperplasia

Painless enlargement of the gums, sometimes overreaching the teeth. This occurs with puberty, pregnancy, and leukemia and with long therapeutic use of phenytoin (Dilantin). A)Gingival Hyperplasia B)Gingivitis

Gum margins are red and swollen and bleed easily. This case is severe; gingival tissue has desquamated, exposing roots of teeth. Inflammation is usually due to poor dental hygiene or vitamin C deficiency. The condition may occur in pregnancy and puberty because of changing hormonal balance. A)Meth Mouth B)Gingivitis

Illicitbmethamphetamine abuse (crystal meth, meth ice) leads to extensive dental caries, gingivitis, tooth cracking, and edentulism. Methamphetamine causes vasoconstriction and decreased saliva, and its use increases the urge to consume sugars and starches and to give up oral hygiene. Absence of the buffering saHva leads to increased acidity in the mouth, and the increased plaque encourages bacterial growth. These conditions and the presence of carbohydrates set up an oral environment prone to caries, cracking of enamel, and the damage seen here A) Meth Mouth B)Aphthous Ulcers

Abnormalities of the Buccal Mucosa

A "canker sore" is a vesicle at first and then a small, round, "punched-out" ulcer with a white base surrounded by a red halo. It is quite painful and lasts for 1 to 2 weeks. The cause is unknown, although it is associated with stress, fatigue, and food allergy. It is common, affecting 20o/o to 60o/o of the population. A) Aphthous Ulcers B)Koplik Spots

Small blue-white spots with irregular red halo scattered over mucosa opposite the molars. An early sign, and pathognomonic, of measles A)Leukoplakia B)Koplik Spots

Chalky white, thick, raised patch with well-defined borders. The lesion is firmly attached and does not scrape off. It may occur on the lateral edges of tongue. It is due to chronic irritation and occurs more frequently with heavy smoking and heavy alcohol use. Lesions are precancerous, and the person should be referred. (Here, the lesion is associated with squamous carcinoma.) A)Candidiasis or Monilial B)Leukoplakia

A white, cheesy, curdlike patch on the buccal mucosa and tongue. It scrapes off, leaving a raw, red surface that bleeds easily. Termed "thrush" in the newborn. It is an opportunistic infection that occurs after the use of antibiotics and corticosteroids and in immunosuppressed persons. A)Candidiasis or Monilial Infection B)Ankyloglossia

Abnormalities of the Tongue

A short lingual frenulum, here fixing the tongue tip to the floor of the mouth and gums. This limits mobility and will affect speech (pronunciation of a, d, n) if the tongue tip cannot be elevated to the alveolar ridge. A congenital defect. A)Ankyloglossia (Tongue-tie) B)Geographic Tongue (Migratory Glossitis)

Pattern of normal coating interspersed with bright red, shiny, circular bald areas with raised pearly borders. Pattern resembles a map and changes in a few days. Not significant, and its cause is not known. A)Geographic Tongue (Migratory Glossitis) B)Smooth, Glossy Tongue (Atrophic Glossitis)

The surface is slick and shiny; the mucosa thins and looks red from decreased papillae. Accompanied by dryness of tongue and burning. Occurs with vitamin B12 deficiency (pernicious anemia), folic acid deficiency, and iron deficiency anemia. Here, also note angular cheilitis A)Black Hairy Tongue B)Smooth, Glossy Tongue (Atrophic Glossitis)

This is not really hair but, rather, the elongation of filiform papillae and painless overgrowth of mycelial threads of fungus infection on the tongue. Color varies from blackbrown to yellow. It occurs after use of antibiotics, which inhibit normal bacteria and allow proliferation of fungus. A)Fissured or Scrotal Tongue B)Black Hairy Tongue

Deep furrows divide the papillae into small irregular rows. The condition occurs in 5% of the general population and in Down syndrome. The incidence increases with age. (Vertical, or longitudinal, fissures also occur with dehydration because of reduced volume of the tongue.) A)Fissured or Scrotal Tongue B)Carcinoma .

An ulcer with rolled edges; indurated. Occurs particularly at sides, base, and under the tongue. When it is in the floor of mouth, it may cause painful movement or limited movement of tongue. Risk for early metastasis is present because of rich lymphatic drainage. Heavy smoking and heavy alcohol use place persons at greater risk. A)Carcinoma B)Enlarged Tongue (Macroglossia)

The tongue is enlarged and may protrude from mouth. The condition is not painful but may impair speech development. Here, it occurs with Down syndrome; it also occurs with cretinism, myxedema, acromegaly. Also, a transient swelling occurs with local infections. A)Enlarged Tongue (Macroglossia) B)Cleft Palate

Abnormalities of the Oropharynx

A congenital defect, the failure of fusion of the maxillary processes. Wide variation occurs in the extent of cleft formation, from upper lip only, palate only, uvula only, to cleft of the nostril and the hard and soft palates. A)Cleft Palate B)Bifid Uvula

The uvula looks partly severed. May indicate a submucous cleft palate, which feels like a notch at the junction of the hard and soft palates. The submucous cleft palate may affect speech development because it prevents necessary air trapping. The incidence of bifid uvula varies among racial groups: it is common in American Indians, uncommon in whites, and rare in Blacks A)Bifid Uvula B)Oral Kaposi Sarcoma

Bruiselike, dark red or violet, confluent macule, usually on the hard palate, may be on soft palate or gingival margin. Oral lesions may be among the earliest lesions to develop with AIDS A)keloid B)Oral Kaposi Sarcoma

Bright red throat; swollen tonsils; white or yellow exudate on tonsils and pharynx; swollen uvula; and enlarged, tender anterior cervical and tonsillar nodes. Accompanied by severe sore throat, painful swallowing, fever >I 0 I o F of sudden onset. A)Acute Tonsillitis and Pharyngitis B)cleft lip

Evidence-based practice recommends using the criteria listed above to determine when to seek further testing.A rapid antigen test or standard throat culture will then diagnose streptococcal pharyngitis and limit antibiotic therapy to those who test positive. If untreated, group A beta-hemolytic streptococcal pharyngitis may lead to glomerulonephritis and rheumatic fever. This is a serious complex illness characterized by fever, malaise, swollen joints, rash, and scarring on the heart valves. A)Acute Tonsillitis and Pharyngitis B)cleft lip

Summary Checklist: Nose, Mouth, and Throat Examination

NOSE 1. Inspect external nose for symmetry, any deformity, or lesions 2. Palpation-test patency of each nostril 3. Inspect with nasal speculm: - Color and integrity of nasal mucosa - Septum-note any deviation, perforation, or bleeding - Turbinates-note color, any exudate, swelling, or polyps 4. Palpate the sinus areas-note any tenderness

Read again TURE

Mouth and Throat 1. Inspect with penlight: - Lips, teeth and gums, tongue, buccal -mucosa-note color; whether structures are intact; any lesions - Palate and uvula- note integrity and mobility as person phonates - Grade tonsils - Pharyngeal wall-note color, any exudate, or lesions 2. Palpation: - When indicated in adults, bimanual palpation of mouth - With the neonate, palpate for integrity of palate and to assess sucking reflex

Read again true

EXTRA INFORMATION

If untreated, group A beta-hemolytic streptococcal pharyngitis may lead to glomerulonephritis and rheumatic fever. This is a serious complex illness characterized by fever, malaise, swollen joints, rash, and scarring on the heart valves. A)Acute Tonsillitis and Pharyngitis B)cleft lip

``` A 37-year-old Asian American primipara asks to speak with the nurse about a concern she has over potential genetic defects in her fetus. What congenital problem would the nurse expect questions about based on the patient's ethnicity? Choose one of the following A)Transposition of the great vessels B)Spina bifida C)Cleft lip and palate D)Down syndrome ```

``` An emergency department nurse is caring for a 4-year-old with intractable nose bleeds. What is the most common site of epistaxis? Choose one of the following A)Rosenmuller fossa B)Columella C)Ala D)Kiesselbach plexus ```

``` The nurse is assessing an 11-year-old boy for allergies. What might the nurse expect to find as an indication of allergies in this patient? Choose one of the following A)traverse ridge B)Crusting C)Bluish turbinates D)A reddened septum ```

When assessing the nose, sinuses, mouth, and throat, it is common for nurses to perform focused examinations rather than general assessments. Choose one of the following A)True B)False

``` When assessing a patient's lips, which of the following is an indication of a viral infection? Choose one of the following A)Edema B)Cracking C)Aphthous ulcer D)Swelling ```

Dryness or cracking of the lips may indicate A)inadequate hydration B) viral infection. C) suggests allergy.

Lesions or aphthous ulcers may represent a A)viral infection. B) suggests allergy.

Swelling or edema of lips suggests A)allergy. B) infection

Dryness or cracking of the lips may indicate __________. A)dehydration B)swelling

``` An APRN is assessing a patient in the ED following a motor vehicle accident. The patient experienced head trauma in the accident. What laboratory studies might the APRN order for this patient? Select all that apply. Select all that apply: A)Basic blood panel B)Beta-2-transferrin C)Throat culture D)Biopsy ```

A B

Inspection of the mouth is especially important in patients taking antibiotics who are at risk for oral candidiasis. A)true B)false

The nurse is inspecting the mouth of a patient who takes Macrobid for a urinary tract infection. This examination is especially important because this patient is at risk for __________. A)infection B)oral candidiasis

The anatomy and physiology instructor is discussing the normal functioning of the nose and sinuses with the prenursing class. What would be the best description of the major factors related to the normal functioning of these structures? Select all that apply. Select all that apply: A)Normal cilia function B)Deep cervical and retropharyngeal nodes C)Normal quality and quantity of the mucus D)Patency of the sinus ostia E)An abundant lymph supply

A C D

``` The three salivary glands also contain drainage ducts. Which drainage ducts are associated with the submandibular gland? Choose one of the following A)Sublingual ducts B)Stensen ducts C)Wharton ducts D)Parotid ducts ```

``` The nurse is caring for a 77-year-old Caucasian female admitted to the unit 10 days ago with pneumonia. When making shift assessment, the nurse notes white patchy lesions in the patient's mouth. The nurse suspects candidiasis and updates the care plan to include the findings. One outcome written for this patient is "Oral mucous membranes pink, moist, and without coating, lesions, or masses." What interventions might the nurse use to achieve this outcome? Select all that apply. Select all that apply: A)Restrict intake of sweets B)Encourage fluids C)Provide oral care every shift D)Consult with a speech therapist E)Culture mouth lesions ```

B C

The lining of the nose is known as the vestibule. Choose one of the following A)True B)False

True

When writing a care plan for a patient with mouth and nose problems, what outcomes might the nurse identify? Select all that apply. Select all that apply: A)Teeth are intact with no evidence of caries visible B)The patient states that breathing is more comfortable and less congested C)The patient's oral mucous membranes are pink and intact D)Nasal septum shows no evidence of deviation E)The patient swallows with evidence of aspiration

B C E

``` An advanced practice nurse in the urgent care center is assessing a 12-year-old who was involved in a skateboarding accident. Which of the following findings is indicative of nasal fracture? Choose one of the following A)Epistaxis B)Bruising C)Crepitus D)Clear discharge ```

Tenderness on palpation and crepitus suggest fracture. A)true B)false

Bruising and epistaxis do not indicate a nasal fracture. A)true B)false

Clear discharge would indicate a possible basilar skull fracture. A)true B)false

________rhinitis may occur in older adults with increased clear rhinorrhea at meal time A)sines B)Gustatory

African American patients are at increased risk for nasopharyngeal cancer. Choose one of the following A)True B)False

Increased risk of nasopharyngeal cancer is noted with A)Chinese B)Asian ancestry C)both a and b

``` Many older adults are edentulous, which can cause overclosure of the mouth. What can this lead to? Choose one of the following A)Traverse ridge B)Koplik's spots C)Crusting D)Angular cheilitis ```

``` A nursing student in the otolaryngology clinic is asked by her instructor about what findings during a sinus examination suggesting infection. Which of the following findings would the student include in her response? Select all that apply. Select all that apply: A)Bright red septum B)Bluish turbinates C)Tenderness D)Fullness E)Absence of mucous ```

C D

The nurse is assessing a new patient in the obstetric clinic. What is the most likely question that the nurse would ask this patient when assessing the upper respiratory tract? Choose one of the following A)Do you have any lesions anywhere? B)Are you taking medication for nasal congestion? C)Are you a smoker? D)Are you having nosebleeds?

"canker sores"-small, painful, round ulcers in the oral mucosa of unknown cause A)Aphthous ulcers B)candidiasis

(moniliasis) white, cheesy, curdlike patch on buccal mucosa due to superficial fungal infection A)Candidiasis B)crypt us

_________closure of nasal cavity due to congenital septum between nasal cavity and pharynx. A)Choanal atresia B)crypt us

_________ indentations on surface of tonsils. A)Crypts B)epulis

________nontender, fibrous nodule of the gum. A)Epulis B)fordyce granules

_____________ small, isolated, white or yellow papules on oral mucosa A)Fordyce granules B)Koplik spots

_________small, blue-white spots with red halo over oral mucosa; early sign of measles. A)Koplik spots B)thrush

_________oral candidiasis in the newborn. A) thrush B)none

___________ a normal variation, a nodular bony ridge down the middle of the hard palate. It is a benign growth that occurs after puberty and is a more common finding in Native Americans, Inuits, and Asians A)Torus palatinus B)Leukoedema

____________: a large patch, grayish opaque that may be present along the buccal mucosa. It is more common in blacks and East Indians. When it is mild, the patch disappears as you stretch the cheeks. The severity increases with age, and it looks grayish white and thickened. The cause is unknown. A)Leukoedema B)Candidiasis

____________: monilial infection, a white cheesy, curdlike patch on the buccal mucosa and tongue. It scrapes off, leaving a raw, red surface that bleeds easily A)Candidiasis B)Leukoplakia

_____________: chalky, white, thick, raised patch with well-defined borders. The lesion is firm and does not scrape off, and is due to chronic irritation. These lesions are precancerous. A)Leukoplakia B)Fordyce’s granules

__________: small, isolated white or yellow papules on the mucosa of the cheek, tongue, and lips. They are painless sebaceous cysts and not significant A)Fordyce’s granules B) Sucking tubercls

_________: a normal finding in infants, a small pad in the middle of the upper lip from friction of breastfeeding or bottle-feeding A)Sucking tubercle B)Epstein’s pearls

__________: a normal finding in newborns and infants, small, white, glistening, pearly papules on the hard palate, and on the gums, where they look like teeth. They are small retention cysts and disappear in the first few weeks A)Epstein’s pearls B)Bednar aphthae

____________: traumatic areas or ulcers on the posterior hard palate on either side of the midline that result from abrasions while sucking. A)Bednar aphthae B)none

The inferior nasal turbinates should appear the same light red color as the nasal mucosa. A)true B)false

Nasal polyps are smooth, pale gray, avascular, mobile, and nontender A)true B)false

the nasal mucosa of an individual with rhinitis would be A)bright red and swollen B)pale with bright red bleeding

the examiner notices a fine tremor when the patient sticks out his or herr tongue. what disorder is consistent witth this finnding A)hyperthyroidism B)halitois

a term used to described any breath odor A)halitosis B)alcholism

a coarse tremor occurs with A)alcoholism B)hyperthyroidism

an enlarged tongue may accompany A)down syndrome B)hairy tongue

in addition to initiating digestion of food,saliva also A)cleans and protects the mucosa B)augments taste sensation

one of the purpose of the paranasal sinuses is to A)lighten the weight of the skull bones B)warm and moisten the inspired air

nasal mucosa and turbinates A)warm,humidify, and filter the inhaled air B)false

the parotid glands duct opens into the mouth opposite the second molar is A)stensen duct B)wharton duct

which of the following pair of sinuses is absent at birth, is fairly well developed between 7 and 8 years of age, and is fully developed after puberty? A)frontal B)maxillaary

what is the major cause of decreased saliva production in the older adult A)use of anticholinergic medications B)normal aging pocess

patient sticks out tongue is assessing cranial nerve A)11 B)12 C)9

asseesss gag reflex by testing cranial nerve A)9,10 B)3 C)5

The habitual, involuntary grinding or clenching of the teeth, usually during sleep, as from anger, tension, fear, or frustration. A)bruxism B)halitois

a congenital anomaly in which the mucous membrane under the tongue is too short limiting the mobility of the tongue A)ankyloglossia B)asphyxia

Nose, Mouth, Throat Flashcards

(454 cards)