ch 17 nose, mouth, throat Flashcards
1
Q
anterior part of the septum holds a rich vascular network
-most common site of nosebleeds
A
Kiesselbach plexus
2
Q
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.
A
lateral walls of each nasal cavity contain three parallel bony projections
3
Q
Underlying each turbinate is a cleft, the
A
meatus
4
Q
lie at the roof of the nasal cavity and in the upper one-third of the septum.
A
olfactory receptors (hair cells)
5
Q
each naris widens into the ?
A
vestibule
6
Q
divides the two nares and is continuous inside with the nasal septum
A
columella
7
Q
is the lateral outside wing of the nose on either side
A
ala
8
Q
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
9
Q
openings are narrow and easily occluded, which may cause inflammation or sinusitis.
A
sinus
10
Q
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.
A
frontal sinuses (can be examined)
11
Q
in the maxilla (cheekbone) along the side walls of the nasal cavity.
- reach full size after all permanent teeth have erupted
A
maxillary sinuses(can be examined)
12
Q
between the orbits
-grow rapidly between 6 and 8 years of age and after puberty.
A
ethmoid sinuses(can’t be examined)
13
Q
deep within the skull in the sphenoid bone.
- minute at birth and develop after puberty.
A
sphenoid sinuses(can’t be examined)
14
Q
Only the ?and ? sinuses are present at birth
A
maxillary and ethmoid
15
Q
arching roof of the mouth is the;
it is divided into two parts.
A
palate
16
Q
is made up of bone and is a whitish color.
A
anterior hard palate
17
Q
Posterior to this is the? , an arch of muscle that is pinker in color and mobile
A
Posterior soft palate
18
Q
is the free projection hanging down from the middle of the soft palate
A
uvula
19
Q
is a mass of striated muscle arranged in a crosswise pattern so it can change shape and position
A
tongue
20
Q
are the rough, bumpy elevations on its dorsal surface.
A
papillae
21
Q
is a midline fold of tissue that connects the tongue to the floor of the mouth
A
frenulum
22
Q
mouth contains three pairs of salivary glands
A
parotid
submandibular
sublingual
23
Q
clear fluid that moistens and lubricates the food ?, starts digestion, and cleans and protects the mucosa.
A
bolus
24
Q
32 permanent teeth—16 in each arch. Each tooth has three parts: the
A
crown, the neck, and the root
25
infant salivation starts at
3 months.
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
deciduous, or temporary, teeth
27
Nasal stuffiness and epistaxis may occur during pregnancy as a result of
increased vascularity in the upper respiratory tract
28
tooth loss occurs, the remaining teeth drift, causing
malocclusion
29
The stress of chewing with maloccluding teeth causes: .
(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
30
shows the uvula split either completely or partially
Bifid uvula
31
is a benign bony ridge running in the middle of the hard palate
Torus palatinus
32
is a benign, milky, bluish-white opaque appearance of the buccal mucosa that occurs commonly in African Americans
Leukoedema
33
is an infectious process that occurs when bacteria (Streptococcus mutans) interact with carbohydrates in juice, sweet drinks
Dental caries (tooth decay)
34
affects the structures surrounding the tooth, including the gingiva and alveolar bone
-linking type 2 diabetes and periodontitis.
Periodontal disease
35
occurs with colds, allergies, sinus infection, trauma.
Rhinorrhea (nose discharge)
36
occurs with trauma, vigorous nose blowing, foreign body.
Epistaxis (nosebleed)
37
“Seasonal” rhinitis if caused by pollen;
perennial
38
Sense of smell diminishes with
cigarette smoking, chronic allergies, aging
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
group A streptococcal (GAS) pharyngitis
40
has many causes: overuse of the voice, URI(cause sinsinitis), chronic inflammation, lesions, or a neoplasm.
Hoarseness of the larynx
41
occurs with pharyngitis, gastroesophageal reflux disease, stroke and other neurologic diseases, esophageal cancer.
Dysphagia
42
is delayed with Down syndrome, cretinism, rickets.
teeth Eruption
43
increases risk for tooth decay and middle ear infections.
Prolonged bottle use
44
usually occurs in sleep or from dental problems or nervous tension.
-grinding teeth
Bruxism
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
Pertussis (whooping cough)
| -vaccine (tetanus-diphtheria-pertussis)
46
(dry mouth) is a side effect of many drugs: antidepressants, anticholinergics, antispasmodics, antihypertensives, antipsychotics, bronchodilators
Xerostomia (aging adult)
47
Absence of sniff indicates
obstruction (e.g., common cold, nasal polyps, rhinitis).
48
Nasal mucosa is swollen and bright red with URI
Rhinitis
49
mucosa looks swollen, boggy, pale, and gray.
chronic allergy
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
deviated septum
51
(benign growths that accompany chronic allergy), and distinguish them from the normal turbinates.
-smooth, pale gray, avascular, mobile, nontender
polyps
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
Sinus
53
from aspirin poisoning, or ketoacidosis.
acidosis
54
with carbon monoxide poisoning,
cherry red lips
55
occurs with shock and anemia
circumoral pallor
56
—Cracking at the corners.
Cheilitis (perlèche)
57
brown teeth with excessive
fluoride use
58
yellow teeth with
tobacco use.
59
; plaque—soft debris; caries—decay.
Grinding down of tooth surface
60
(poor biting relationship), protrusion of upper or lower incisors.
Malocclusion
61
Dark line on gingival margins occurs with lead and
bismuth poisoning.
62
crevices between teeth and gums, pockets of debris
Gingival hyperplasia
63
occurs with hypothyroidism, acromegaly; a small tongue accompanies malnutrition.
Enlarged tongue
64
occurs with dehydration, fever; tongue has deep vertical fissures.
Dry mouth
65
Saliva is decreased when taking
anticholinergic
66
occur with gingivostomatitis and Parkinson disease.
Excess saliva and drooling
67
may be a mass or lymphadenopathy(swollen lymph node)
indurated area
68
is common and normal in dark-skinned people.
patchy hyperpigmentation (Buccal Mucosa)
69
are present with Addison disease (chronic adrenal insufficiency).
Dappled brown patches(Buccal Mucosa)
70
the opening of the parotid salivary gland. It looks like a small dimple opposite the upper second molar.
- red with mumps.
Stensen duct,
71
—Early prodromal (early warning) sign of measles.
Koplik spots
72
Nasal flaring in the infant indicates
respiratory distress.
73
, a small pad in the middle of the upper lip from friction of breastfeeding or bottle-feeding.
sucking tubercle (normal finding) infants
74
, a short lingual frenulum, can limit protrusion and impair speech development
Ankyloglossia
75
are traumatic areas or ulcers on the posterior hard palate on either side of the midline. They result from abrasions while sucking.
Bednar aphthae
76
by skin patch and gum,
nicotine-replacement therapy (smoking)
77
Measuring expired carbon monoxide (CO) via a
CO monitor
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
```
Choanal Atresia (
Nose Abnormalities)
```
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
Epistaxis(
| Nose Abnormalities)
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.
Sinusitis (
| Nose Abnormalities)
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.
Seasonal Allergic Rhinitis (AR or Hay Fever)// (
| Nose Abnormalities)
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.
Foreign Body// (
| Nose Abnormalities)
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.
```
Acute Rhinitis (Nonallergic)// (
Nose Abnormalities)
```
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.
Perforated Septum// (
| Nose Abnormalities)
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.
Nasal Polyps // (
| Nose Abnormalities)
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.
Furuncle// (
| Nose Abnormalities)
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).
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Cleft Lip (
Lip Abnormalities)
```
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.
Herpes Simplex 1 (HSV-1)// (
| Lip Abnormalities)
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.
```
Angular Cheilitis (Stomatitis, Perlèche)// (
Lip Abnormalities)
```
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.
Carcinoma// (
| Lip Abnormalities)
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.
Retention “Cyst” (Mucocele)// (
| Lip Abnormalities)
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.
Baby Bottle Tooth Decay//
| Teeth and Gum Abnormalities
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.
Dental Caries//
| Teeth and Gum Abnormalities
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
Tooth Avulsion/
| Teeth and Gum Abnormalities
95
benign nontender, fibrous nodule of the gum seen emerging between the teeth; an overgrowth of vascular granulation tissue.
Epulis/
| Teeth and Gum Abnormalities
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).
Gingival Hyperplasia/
| Teeth and Gum Abnormalities
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.
Gingivitis/
| Teeth and Gum Abnormalities
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.
Meth Mouth/
| Teeth and Gum Abnormalities
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.
Aphthous Ulcers //(
| Buccal Mucosa Abnormalities)
100
Small blue-white spots with irregular red halo scattered over mucosa opposite the molars. An early sign, and pathognomonic, of measles.
Koplik Spots in Measles/(
| Buccal Mucosa Abnormalities)
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.
Leukoplakia/(
| Buccal Mucosa Abnormalities)
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.
Candidiasis or Monilial Infection/(
| Buccal Mucosa Abnormalities)
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.
Candidiasis in Adul/(
| Buccal Mucosa Abnormalities)
104
HSV-1 infection on the hard palate
Herpes Simplex 1/(Buccal Mucosa Abnormalities)
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.
Ankyloglossia/(Buccal Mucosa Abnormalities)
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.
Geographic Tongue (Migratory Glossitis)/(Buccal Mucosa Abnormalities)
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.
Smooth, Glossy Tongue (Atrophic Glossitis)/(Buccal Mucosa Abnormalities)
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.
Black Hairy Tongue/(Buccal Mucosa Abnormalities)
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
Carcinoma/(Buccal Mucosa Abnormalities)
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.)
Fissured or Scrotal Tongue/(Buccal Mucosa Abnormalities)
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.
Enlarged Tongue (Macroglossia)//(Buccal Mucosa Abnormalities)
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
Bifid Uvula (Oropharynx Abnormalities)
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.
Oral Kaposi Sarcoma(Oropharynx Abnormalities)
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
Peritonsillar Abscess(Oropharynx Abnormalities)
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.
Acute Tonsillitis and Pharyngitis(Oropharynx Abnormalities)
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.
Cleft Palate(Oropharynx Abnormalities)
