3. SESSION 3.4: Nose, Mouth & Throat Flashcards
Six landmarks of the external nose
- Bridge
- Free corner or tip
- Nares
- Kiesselbach region
- Columelia
- Ala nasi
What is the kiesselbach region?
Anteroinferior part of the nasal septum, where four arteries anatomose. Most nosebleeds happen here.
What is the columelia
“Little column” between nares
Ala nasi
Expanded outer wall of cartilage on each side of nose.
Anterior edge of nasal cavity is lined with (1) for (2). Remainder of cavity is lined with (3) to (4)
1) Coarse nasal hairs
2) Filtering air
3) Ciliated mucous membranes
4) Filter dust and bacteria.
Why is the nasal mucosa redder than oral mucosa?
Larger blood supply in the nasal mucosa.
Name the three lateral wall turbinates of the nasal cavity and what they connect to.
- Superior meatus - ethmoid cells.
- Middle meatus - sinuses
- Inferior meatus - tears.
- Define sinuses
- Name the four sinuses
- Air-filled pockets within the cranium to lighten the weight of the skull
- Frontal R&L, maxillary R&L
7 Health History Questions - NOSE
1) Discharge
2) Frequent colds
3) Sinus pain
4) Trauma, Deviated septum?
5) Epistaxis
6) Allergies
7) Altered smell
Five components of physical exam: Nose & Sinus.
- 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)
How do you evaluate airway patency?
Pt covers one nostril at a time and sniffs.
What should you try to view while inspecting the nasal cavity? (3)
What should you note? (3)
- Inferior turbinate
- Middle turbinate
- Septum
(Note ulcers, perforation, deviation)
What is the difference between allergic rhinitis and actue rhinitis?
Allergic rhinitis is a pinkish color, while acute rhinitis is bright red (viral)
Nasal polyps can sometimes block the __________.
Turbinates
Name the three salivary glands.
1) Lingual
2) Submandibular
3) Sublingual
PAROTID GLAND
- Location
- Where does it open?
- Name of ducts
- In cheek
- Opens into cheek at second molar
- STENSOID ducts.
Where/what are the stenson ducts?
- Near the second molar (small dimple)
- opening of the parotid gland.
SUBMANDIBULAR GLAND
- Location
- Where does it open?
- Name of ducts
- How many openings
- Right and left lower jaw
- Opens into mouth under tongue
- WHARTON ducts.
- Many openings
Where/what are the Wharton ducts?
- Under the tongue
- Opening for the submandibular gland
SUBLINGUAL GLANDS
- Location
- Number of ducts
- Under the tongue
- Have MANY openings.
Health history - Mouth and throat (9)
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
What is dysphagia?
Difficulty swallowing
What are two oral self-care behaviors you should ask about?
- Dental hygiene
- Visits to dentist
7 components of oral physical exam
- 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.
What is the little divider on lower jaw under tongue?
- Normal variation
- Torus Palatinus
- Normal variation = overgrowth
Dots on cheek = normal finding
These are called ________
Fordyce spots
How do you inspect the tongue? What are you looking for?
- Have pt stick out tongue, move it side to side
- Looking for nodules on sides or under tongue = cause for concern
Name the three types of tongue papillae
- Vallate (back tastebuds)
- Fungiform (tastebuds)
- Filiform
Two normal findings in tongue
- Scrotal tongue
- Geographic tongue
CN XII
- Name
- What to check for (2)
HYPOGLOSSAL NERVE
- Should protrude midline (deviates toward paralyzed side if applicable)
- Note any tumors or deviation
CN X
- Name
- How to check it
- 3 things you’re looking for
- Vagus nerve
- Have patient “open up and say Ahhh”
- Soft palate should rise, uvula should rise, should be midline.
How to grade tonsils
1+ = visible 2+ = Halfway between pillars and uvula 3+ = Touching uvula 4+ = touching each other
Are large cryptic tonsils a problem?
No, except that food can get stuck.
Describe viral pharyngitis (4)
- Red throat
- Cobblestone activity on posterior pharynx
- Pt is complaining of sore / scratchy throat.
- No visible tonsils.
Describe bacterial pharyngitis (4).
What 2 infections might be responsible?
- Red throat
- Exudate on tonsil
- Fever
- Enlarged cervical nodes
- Strep or mono
What gland is responsible for the facial swelling in mumps?
PAROTID gland.
