ch 17 nose, mouth, throat

Question 1

anterior part of the septum holds a rich vascular network

-most common site of nosebleeds

Answer 1

Kiesselbach plexus

Question 2

the superior, middle, and inferior turbinates
-increase the surface area so more blood vessels and mucous membranes are available to warm, humidify, and filter the inhaled air.

Answer 2

lateral walls of each nasal cavity contain three parallel bony projections

Question 3

Underlying each turbinate is a cleft, the

Answer 3

meatus

Question 4

lie at the roof of the nasal cavity and in the upper one-third of the septum.

Answer 4

olfactory receptors (hair cells)

Question 5

each naris widens into the ?

Answer 5

vestibule

Question 6

divides the two nares and is continuous inside with the nasal septum

Answer 6

columella

Question 7

is the lateral outside wing of the nose on either side

Answer 7

ala

Question 8

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.

Answer 8

paranasal sinuses

Question 9

openings are narrow and easily occluded, which may cause inflammation or sinusitis.

Answer 9

sinus

Question 10

in the frontal bone above and medial to the orbit

-absent at birth, are fairly well developed between 7 and 8 years of age, and reach full size after puberty.

Answer 10

frontal sinuses (can be examined)

Question 11

in the maxilla (cheekbone) along the side walls of the nasal cavity.
- reach full size after all permanent teeth have erupted

Answer 11

maxillary sinuses(can be examined)

Question 12

between the orbits

-grow rapidly between 6 and 8 years of age and after puberty.

Answer 12

ethmoid sinuses(can’t be examined)

Question 13

deep within the skull in the sphenoid bone.

- minute at birth and develop after puberty.

Answer 13

sphenoid sinuses(can’t be examined)

Question 14

Only the ?and ? sinuses are present at birth

Answer 14

maxillary and ethmoid

Question 15

arching roof of the mouth is the;

it is divided into two parts.

Answer 15

palate

Question 16

is made up of bone and is a whitish color.

Answer 16

anterior hard palate

Question 17

Posterior to this is the? , an arch of muscle that is pinker in color and mobile

Answer 17

Posterior soft palate

Question 18

is the free projection hanging down from the middle of the soft palate

Answer 18

uvula

Question 19

is a mass of striated muscle arranged in a crosswise pattern so it can change shape and position

Answer 19

tongue

Question 20

are the rough, bumpy elevations on its dorsal surface.

Answer 20

papillae

Question 21

is a midline fold of tissue that connects the tongue to the floor of the mouth

Answer 21

frenulum

Question 22

mouth contains three pairs of salivary glands

Answer 22

parotid
submandibular
sublingual

Question 23

clear fluid that moistens and lubricates the food ?, starts digestion, and cleans and protects the mucosa.

Answer 23

bolus

Question 24

32 permanent teeth—16 in each arch. Each tooth has three parts: the

Answer 24

crown, the neck, and the root

Question 25

infant salivation starts at

Answer 25

3 months.

Question 26

Children have 20 deciduous, or temporary, teeth. These erupt between 6 and 24 months of age. All 20 teeth should appear by 2½ years of age.
-deciduous teeth are lost beginning at 6 years through 12 years of age

Answer 26

deciduous, or temporary, teeth

Question 27

Nasal stuffiness and epistaxis may occur during pregnancy as a result of

Answer 27

increased vascularity in the upper respiratory tract

Question 28

tooth loss occurs, the remaining teeth drift, causing

Answer 28

malocclusion

Question 29

The stress of chewing with maloccluding teeth causes: .

Answer 29

(1) further tooth loss;
(2) muscle imbalance from a mandible and maxilla now out of alignment, which produces muscle spasms, tenderness, and chronic headaches;
(3) stress on the temporomandibular joint, leading to osteoarthritis, pain, and inability to fully open the mouth

Question 30

shows the uvula split either completely or partially

Answer 30

Bifid uvula

Question 31

is a benign bony ridge running in the middle of the hard palate

Answer 31

Torus palatinus

Question 32

is a benign, milky, bluish-white opaque appearance of the buccal mucosa that occurs commonly in African Americans

Answer 32

Leukoedema

Question 33

is an infectious process that occurs when bacteria (Streptococcus mutans) interact with carbohydrates in juice, sweet drinks

Answer 33

Dental caries (tooth decay)

Question 34

affects the structures surrounding the tooth, including the gingiva and alveolar bone
-linking type 2 diabetes and periodontitis.

Answer 34

Periodontal disease

Question 35

occurs with colds, allergies, sinus infection, trauma.

Answer 35

Rhinorrhea (nose discharge)

Question 36

occurs with trauma, vigorous nose blowing, foreign body.

Answer 36

Epistaxis (nosebleed)

Question 37

“Seasonal” rhinitis if caused by pollen;

Answer 37

perennial

Question 38

Sense of smell diminishes with

Answer 38

cigarette smoking, chronic allergies, aging

Question 39

is more likely with fever over 100.4° F, absence of cough, tonsillar exudates, and cervical adenopathy. Untreated GAS can cause peritonsillar abscess, rheumatic fever, and glomerulonephritis

Answer 39

group A streptococcal (GAS) pharyngitis

Question 40

has many causes: overuse of the voice, URI(cause sinsinitis), chronic inflammation, lesions, or a neoplasm.

Answer 40

Hoarseness of the larynx

Question 41

occurs with pharyngitis, gastroesophageal reflux disease, stroke and other neurologic diseases, esophageal cancer.

Answer 41

Dysphagia

Question 42

is delayed with Down syndrome, cretinism, rickets.

Answer 42

teeth Eruption

Question 43

increases risk for tooth decay and middle ear infections.

Answer 43

Prolonged bottle use

Question 44

usually occurs in sleep or from dental problems or nervous tension.
-grinding teeth

Answer 44

Bruxism

Question 45

is on the rise because of lack of adherence to recommended vaccination schedule and waning immunity in adolescents and adults, who become carriers to unvaccinated infants (tdap)vaccine

Answer 45

Pertussis (whooping cough)

-vaccine (tetanus-diphtheria-pertussis)

Question 46

(dry mouth) is a side effect of many drugs: antidepressants, anticholinergics, antispasmodics, antihypertensives, antipsychotics, bronchodilators

Answer 46

Xerostomia (aging adult)

Question 47

Absence of sniff indicates

Answer 47

obstruction (e.g., common cold, nasal polyps, rhinitis).

Question 48

Nasal mucosa is swollen and bright red with URI

Answer 48

Rhinitis

Question 49

mucosa looks swollen, boggy, pale, and gray.

Answer 49

chronic allergy

Question 50

Perforation is seen as a spot of light from a penlight shining in the other naris and occurs with cocaine use
-looks like a hump or shelf in one nasal cavity

Answer 50

deviated septum

Question 51

(benign growths that accompany chronic allergy), and distinguish them from the normal turbinates.
-smooth, pale gray, avascular, mobile, nontender

Answer 51

polyps

Question 52

areas are tender to palpation in people with chronic allergies and acute infection (sinusitis)
-Another sign of sinusitis is to check for focal pain when the person bends over

Answer 52

Sinus

Question 53

from aspirin poisoning, or ketoacidosis.

Answer 53

acidosis

Question 54

with carbon monoxide poisoning,

Answer 54

cherry red lips

Question 55

occurs with shock and anemia

Answer 55

circumoral pallor

Question 56

—Cracking at the corners.

Answer 56

Cheilitis (perlèche)

Question 57

brown teeth with excessive

Answer 57

fluoride use

Question 58

yellow teeth with

Answer 58

tobacco use.

Question 59

; plaque—soft debris; caries—decay.

Answer 59

Grinding down of tooth surface

Question 60

(poor biting relationship), protrusion of upper or lower incisors.

Answer 60

Malocclusion

Question 61

Dark line on gingival margins occurs with lead and

Answer 61

bismuth poisoning.

Question 62

crevices between teeth and gums, pockets of debris

Answer 62

Gingival hyperplasia

Question 63

occurs with hypothyroidism, acromegaly; a small tongue accompanies malnutrition.

Answer 63

Enlarged tongue

Question 64

occurs with dehydration, fever; tongue has deep vertical fissures.

Answer 64

Dry mouth

Question 65

Saliva is decreased when taking

Answer 65

anti­cholinergic

Question 66

occur with gingivostomatitis and Parkinson disease.

Answer 66

Excess saliva and drooling

Question 67

may be a mass or lymphadenopathy(swollen lymph node)

Answer 67

indurated area

Question 68

is common and normal in dark-skinned people.

Answer 68

patchy hyperpigmentation (Buccal Mucosa)

Question 69

are present with Addison disease (chronic adrenal insufficiency).

Answer 69

Dappled brown patches(Buccal Mucosa)

Question 70

the opening of the parotid salivary gland. It looks like a small dimple opposite the upper second molar.
- red with mumps.

Answer 70

Stensen duct,

Question 71

—Early prodromal (early warning) sign of measles.

Answer 71

Koplik spots

Question 72

Nasal flaring in the infant indicates

Answer 72

respiratory distress.

Question 73

, a small pad in the middle of the upper lip from friction of breastfeeding or bottle-feeding.

Answer 73

sucking tubercle (normal finding) infants

Question 74

, a short lingual frenulum, can limit protrusion and impair speech development

Answer 74

Ankyloglossia

Question 75

are traumatic areas or ulcers on the posterior hard palate on either side of the midline. They result from abrasions while sucking.

Answer 75

Bednar aphthae

Question 76

by skin patch and gum,

Answer 76

nicotine-replacement therapy (smoking)

Question 77

Measuring expired carbon monoxide (CO) via a

Answer 77

CO monitor

Question 78

Congenital bony septum between the nasal cavity and the pharynx is not common in the newborn; but when bilateral, it is an airway emergency because newborns are obligate nose breathers. Note airway obstruction, stridor, and cyclical cyanosis that improves with crying because baby then breathes through the mouth. When unilateral, the infant may be asymptomatic until the first respiratory infection

Answer 78

Choanal Atresia (
Nose Abnormalities)

Question 79

most common site of a nosebleed is Kiesselbach plexus in the anterior septum
-Causes include nose picking, forceful coughing or sneezing, fracture, foreign body, illicit drug use (cocaine), topical nasal drugs, warfarin (Coumadin), aspirin, or a coagulation disorder

Answer 79

Epistaxis(

Nose Abnormalities)

Question 80

Acute inflamed infected sinus areas following URI n do not need antibiotics
- Consider bacterial infection when signs last over 10 days without improvement
Major signs are mucopurulent drainage, nasal obstruction, facial pain or pressure. May also have fever, chills, malaise. Maxillary sinusitis has dull, throbbing pain in cheek and teeth and pain with palpation and when bending over. Frontal sinusitis has pain above supraorbital ridge.

Answer 80

Sinusitis (

Nose Abnormalities)

Question 81

abnormal immune response from repeated exposure to antigens, with rhinorrhea, itching of nose and eyes, lacrimation, nasal congestion, and sneezing. Note serous edema and swelling of turbinates to fill the air space. Turbinates are usually pale (although they may appear violet), and their surface looks smooth and glistening. Common allergens are dust mite, animal dander, mold, pollen. AR produces disordered sleep, obstructive sleep apnea, sinusitis, avoidance of outdoor activities, and poor work performance.

Answer 81

Seasonal Allergic Rhinitis (AR or Hay Fever)// (

Nose Abnormalities)

Question 82

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.

Answer 82

Foreign Body// (

Nose Abnormalities)

Question 83

first sign is a clear, watery discharge, rhinorrhea, which later becomes purulent, with sneezing, nasal itching, stimulation of cough reflex, and inflamed mucosa, which causes nasal obstruction. Turbinates are dark red and swollen.

Answer 83

Acute Rhinitis (Nonallergic)// (
Nose Abnormalities)

Question 84

hole in the septum, usually in the cartilaginous part, caused by snorting cocaine or methamphetamine, 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.

Answer 84

Perforated Septum// (

Nose Abnormalities)

Question 85

Smooth, pale gray nodules, which are overgrowths of mucosa, are 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 are absence of sense of smell and a “valve that moves” in the nose as the person breathes.

Answer 85

Nasal Polyps // (

Nose Abnormalities)

Question 86

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.

Answer 86

Furuncle// (

Nose Abnormalities)

Question 87

Maxillofacial clefts are common congenital deformities and occur with strong family history; maternal use of phenytoin (Dilantin), alcohol, and certain drugs; and maternal diabetes. Early treatment preserves the functions of speech and language formation and deglutition (swallowing).

Answer 87

Cleft Lip (
Lip Abnormalities)

Question 88

common 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 10 day
-highly contagious and spread by direct contact. Recurrent infections may be precipitated by sunlight, fever, colds, and allergy.

Answer 88

Herpes Simplex 1 (HSV-1)// (

Lip Abnormalities)

Question 89

Erythema, scaling, and 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 those with poorly fitting dentures, causing folding in of corners of mouth, which creates a warm, moist environment favoring growth of yeast.

Answer 89

Angular Cheilitis (Stomatitis, Perlèche)// (
Lip Abnormalities)

Question 90

initial lesion is round and indurated; it becomes crusted and ulcerated with an elevated border. Most occur between the outer and middle thirds of the lip. Any lesion that is still unhealed after 2 weeks should be referred.

Answer 90

Carcinoma// (

Lip Abnormalities)

Question 91

round, well-defined, translucent nodule that may be very small or up to 1 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.

Answer 91

Retention “Cyst” (Mucocele)// (

Lip Abnormalities)

Question 92

Destruction of numerous deciduous teeth may occur in 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.

Answer 92

Baby Bottle Tooth Decay//

Teeth and Gum Abnormalities

Question 93

Progressive destruction of tooth. Decay initially looks chalky white. Later it turns brown or black and forms a cavity. Early decay shows only on x-ray image. Susceptible sites are tooth surfaces where food debris, bacterial plaque, and saliva collect.

Answer 93

Dental Caries//

Teeth and Gum Abnormalities

Question 94

traumatic injury may dislodge a primary (deciduous) or a permanent tooth from its alveolar socket. Trauma is often the result of falls or sports collision. T

Answer 94

Tooth Avulsion/

Teeth and Gum Abnormalities

Question 95

benign nontender, fibrous nodule of the gum seen emerging between the teeth; an overgrowth of vascular granulation tissue.

Answer 95

Epulis/

Teeth and Gum Abnormalities

Question 96

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

Answer 96

Gingival Hyperplasia/

Teeth and Gum Abnormalities

Question 97

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

Answer 97

Gingivitis/

Teeth and Gum Abnormalities

Question 98

Illicit methamphetamine 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 give up oral hygiene. Absence of the buffering saliva leads to increased acidity, and the increased plaque encourages bacterial growth. These conditions and carbohydrate presence produce caries, cracking of enamel, and the damage seen here.

Answer 98

Meth Mouth/

Teeth and Gum Abnormalities

Question 99

common “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.

Answer 99

Aphthous Ulcers //(

Buccal Mucosa Abnormalities)

Question 100

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

Answer 100

Koplik Spots in Measles/(

Buccal Mucosa Abnormalities)

Question 101

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 caused by chronic irritation of smoking and alcohol use. Lesions are precancerous; must refer to specialist.

Answer 101

Leukoplakia/(

Buccal Mucosa Abnormalities)

Question 102

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 people.

Answer 102

Candidiasis or Monilial Infection/(

Buccal Mucosa Abnormalities)

Question 103

Candida species as normal oral flora is present in 60% of healthy adults. Overgrowth of Candida occurs with steroid inhaler use, HIV infection, use of broad-spectrum antibiotics or corticosteroids, leukemia, malnutrition, or reduced immunity.

Answer 103

Candidiasis in Adul/(

Buccal Mucosa Abnormalities)

Question 104

HSV-1 infection on the hard palate

Answer 104

Herpes Simplex 1/(Buccal Mucosa Abnormalities)

Question 105

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

Answer 105

Ankyloglossia/(Buccal Mucosa Abnormalities)

Question 106

Pattern of normal coating interspersed with bright red, shiny, circular bald areas caused by atrophy of the filiform papillae, with raised pearly borders. Pattern resembles a map and changes with time. Not significant, and its cause is not known.

Answer 106

Geographic Tongue (Migratory Glossitis)/(Buccal Mucosa Abnormalities)

Question 107

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.

Answer 107

Smooth, Glossy Tongue (Atrophic Glossitis)/(Buccal Mucosa Abnormalities)

Question 108

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 black-brown to yellow. It occurs after use of antibiotics, which inhibit normal bacteria and allow proliferation of fungus, and with heavy smoking.

Answer 108

Black Hairy Tongue/(Buccal Mucosa Abnormalities)

Question 109

ulcer with rolled edges; indurated. Occurs particularly at sides, base, and under the tongue. It grows insidiously and may go unnoticed for months. It may have associated leukoplakia. Rich lymphatic drainage increases risk for early metastasis. Smoking and alcohol use account for most cases of oral cancer. HPV-related oral pharyngeal cancers also are increased.9

Answer 109

Carcinoma/(Buccal Mucosa Abnormalities)

Question 110

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 tongue volume.)

Answer 110

Fissured or Scrotal Tongue/(Buccal Mucosa Abnormalities)

Question 111

ongue is enlarged and may protrude from the mouth. The condition is not painful but may impair speech development. Here it occurs with Down syndrome; it also occurs with cretinism, myxedema, and acromegaly. A transient swelling also occurs with local infections.

Answer 111

Enlarged Tongue (Macroglossia)//(Buccal Mucosa Abnormalities)

Question 112

uvula looks partly severed and may indicate a submucous cleft palate, which feels like a notch at the junction of the hard and soft palates. This may affect speech development because it prevents necessary air trapping. The incidence is more common in American Indians

Answer 112

Bifid Uvula (Oropharynx Abnormalities)

Question 113

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.

Answer 113

Oral Kaposi Sarcoma(Oropharynx Abnormalities)

Question 114

Untreated acute streptococcal pharyngitis may cause suppurative complications, peritonsillar abscess, or suppurative thrombophlebitis. Thrombophlebitis is Lemierre syndrome, a rare but life-threatening condition caused by the gram-negative F. necrophorum, leading to sepsis. The two major red flags are worsening symptoms or neck swelling, along with fever and decreased range of motion

Answer 114

Peritonsillar Abscess(Oropharynx Abnormalities)

Question 115

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 >101° F of sudden onset. Bacterial infections may have absence of cough.

With severe symptoms (listed above) or sore throat lasting >3-5 days, consider streptococcal infection and confirm with rapid antigen testing or throat culture. Treat positive tests with antibiotics.

Answer 115

Acute Tonsillitis and Pharyngitis(Oropharynx Abnormalities)

Question 116

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.

Answer 116

Cleft Palate(Oropharynx Abnormalities)