3. SESSION 3.4: Nose, Mouth & Throat

Question 1

Six landmarks of the external nose

Answer 1

• Bridge
• Free corner or tip
• Nares
• Kiesselbach region
• Columelia
• Ala nasi

Question 2

What is the kiesselbach region?

Answer 2

Anteroinferior part of the nasal septum, where four arteries anatomose. Most nosebleeds happen here.

Question 3

What is the columelia

Answer 3

“Little column” between nares

Question 4

Ala nasi

Answer 4

Expanded outer wall of cartilage on each side of nose.

Question 5

Anterior edge of nasal cavity is lined with (1) for (2). Remainder of cavity is lined with (3) to (4)

Answer 5

1) Coarse nasal hairs
2) Filtering air
3) Ciliated mucous membranes
4) Filter dust and bacteria.

Question 6

Why is the nasal mucosa redder than oral mucosa?

Answer 6

Larger blood supply in the nasal mucosa.

Question 7

Name the three lateral wall turbinates of the nasal cavity and what they connect to.

Answer 7

• Superior meatus - ethmoid cells.
• Middle meatus - sinuses
• Inferior meatus - tears.

Question 8

• Define sinuses

- Name the four sinuses

Answer 8

• Air-filled pockets within the cranium to lighten the weight of the skull
• Frontal R&L, maxillary R&L

Question 9

7 Health History Questions - NOSE

Answer 9

1) Discharge
2) Frequent colds
3) Sinus pain
4) Trauma, Deviated septum?
5) Epistaxis
6) Allergies
7) Altered smell

Question 10

Five components of physical exam: Nose & Sinus.

Answer 10

• Inspect and palpate external nose
• Inspect and palpate nasal septum
• Inspect and palpate turbinates
• Test patency of nostrils
• Palpate or percuss the sinus areas (frontal, maxillary)

Question 11

How do you evaluate airway patency?

Answer 11

Pt covers one nostril at a time and sniffs.

Question 12

What should you try to view while inspecting the nasal cavity? (3)
What should you note? (3)

Answer 12

• Inferior turbinate
• Middle turbinate
• Septum
  (Note ulcers, perforation, deviation)

Question 13

What is the difference between allergic rhinitis and actue rhinitis?

Answer 13

Allergic rhinitis is a pinkish color, while acute rhinitis is bright red (viral)

Question 14

Nasal polyps can sometimes block the __________.

Answer 14

Turbinates

Question 15

Name the three salivary glands.

Answer 15

1) Lingual
2) Submandibular
3) Sublingual

Question 16

PAROTID GLAND

• Location
• Where does it open?
• Name of ducts

Answer 16

• In cheek
• Opens into cheek at second molar
• STENSOID ducts.

Question 17

Where/what are the stenson ducts?

Answer 17

• Near the second molar (small dimple)

- opening of the parotid gland.

Question 18

SUBMANDIBULAR GLAND

• Location
• Where does it open?
• Name of ducts
• How many openings

Answer 18

• Right and left lower jaw
• Opens into mouth under tongue
• WHARTON ducts.
• Many openings

Question 19

Where/what are the Wharton ducts?

Answer 19

• Under the tongue

- Opening for the submandibular gland

Question 20

SUBLINGUAL GLANDS

• Location
• Number of ducts

Answer 20

• Under the tongue

- Have MANY openings.

Question 21

Health history - Mouth and throat (9)

Answer 21

1) Sores or leisons
2) Sore throat
3) Bleeding gums
4) Toothache
5) Hoarseness
6) Dysphagia (difficulty swallowing)
7) Altered taste
8) Smoking, alcohol consumption
9) Self-care behaviors

Question 22

What is dysphagia?

Answer 22

Difficulty swallowing

Question 23

What are two oral self-care behaviors you should ask about?

Answer 23

• Dental hygiene

- Visits to dentist

Question 24

7 components of oral physical exam

Answer 24

• Inspect lips
• Inspect gums and teeth
• Inspect buccal mucosa
• Inspect tongue
• CN XII (stick out tongue, side to side)
  CN IX and X (uvula and soft palate)
• Inspect posterior pharynx and grade tonsils.

Question 25

What is the little divider on lower jaw under tongue?

- Normal variation

Answer 25

• Torus Palatinus

- Normal variation = overgrowth

Question 26

Dots on cheek = normal finding

These are called ________

Answer 26

Fordyce spots

Question 27

How do you inspect the tongue? What are you looking for?

Answer 27

• Have pt stick out tongue, move it side to side

- Looking for nodules on sides or under tongue = cause for concern

Question 28

Name the three types of tongue papillae

Answer 28

• Vallate (back tastebuds)
• Fungiform (tastebuds)
• Filiform

Question 29

Two normal findings in tongue

Answer 29

• Scrotal tongue

- Geographic tongue

Question 30

CN XII

• Name
• What to check for (2)

Answer 30

HYPOGLOSSAL NERVE

• Should protrude midline (deviates toward paralyzed side if applicable)
• Note any tumors or deviation

Question 31

CN X

• Name
• How to check it
• 3 things you’re looking for

Answer 31

• Vagus nerve
• Have patient “open up and say Ahhh”
• Soft palate should rise, uvula should rise, should be midline.

Question 32

How to grade tonsils

Answer 32

1+ = visible
2+ = Halfway between pillars and uvula
3+ = Touching uvula
4+ = touching each other

Question 33

Are large cryptic tonsils a problem?

Answer 33

No, except that food can get stuck.

Question 34

Describe viral pharyngitis (4)

Answer 34

• Red throat
• Cobblestone activity on posterior pharynx
• Pt is complaining of sore / scratchy throat.
• No visible tonsils.

Question 35

Describe bacterial pharyngitis (4).

What 2 infections might be responsible?

Answer 35

• Red throat
• Exudate on tonsil
• Fever
• Enlarged cervical nodes
• Strep or mono

Question 36

What gland is responsible for the facial swelling in mumps?

Answer 36

PAROTID gland.