Nose and Throat Exam Flashcards
What should you note about nasal discharge?
color consistency odor amount timing bilateral/unilateral? CABCOT
Normal nasal discharge is
clear/colorless
thin (not viscous)
no odor
some discharge (none is not normal)
Bacterial infection may have what type of discharge?
green/yellow
classic presentation of a nasal foreign body is
unilateral, malodorous, nasal discharge
patency
how well you breathe through your nose
congestion, timing, uni/bilateral
associated symptoms that are typical with nasal complaints
dental pain
burning
headache
fever
things to observe when beginning nasal exam
swelling
deformity (bony abnormality)
erythema
things to palpate during nasal exam
tenderness (at joint of nasal bone and cartilage)
crepitus (cracking sound or sensation-two bones rubbing together)
warmth
any skin lesions?
things to observe when looking into the nasal canal
discharge septum (midline? deviated? blood vessels visible?) inferior turbinate (blob of pink tissue)
viscous discharge is called
crusting
kesovexplexus
most common spot of nose bleeds (area in the anterior nasal canal that is highly vasculated)
turbinate
filtering units in the bone
covered with rich vasculated mucosa
what does the maxillary sinusitis make the inferior turbinate look like?
coated in purulous fluid
what are you noting when palpating the maxillary and frontal sinuses?
tenderness
bony abnormalities
hard when touched (could indicated cancer)
transillumination can be used to diagnosis
fluid in the sinuses (should be able to see light on hard palate if sinuses are free of fluid-place the light on the cheek)
nasal polyps
translucent, pearly mass in the nose
sign of chronic irritation (drugs, smoking, allergies)
may originate in the nose or in the sinuses
pt presents with persistent nasal congestion
deviated septum
can be caused by trauma
>70% occlusion would indicate surgery
may cause hypertrophy of the turbinate on the “free” side
CC may be sleep apnea/snoring
nasal vestibulitis
usually bacterial staph (MRSA) infection
red bulbous tip of their nose
red just inside the nose (vestibule)
nasal foreign bodies may be combined with
impetigo (from scratching and breaking the skin)
-strep and staph infection
best way to deal with nasal foreign bodies
try to blow it out
new links are being made between oral health and
CV disease
what to note w/lip inspection
color and moisture lumps ulcers cracking scaliness
leukoplakia
precursor to cancer from ill-fitting dentures
what to note w/oral mucosa inspection
color
ulcers
white patches/red patches
nodules
what to note w/ gum inspection
color
caries
ulcers
when patient phonates, the uvula should
elevate
what does having the pt swallow test for?
nerve test
floor of mouth holds
wartons duct
mandibular salivary gland
asymmetry of tongue indicates
cranial nerve problem
steps of the mouth exam
- evert the lip (you can or have pt do it)
- using pen light to visualize
- use two tongue blades
- palpate (careful with old people-dementia and little people)
areas to palpate of the tongue
- tongue
- floor of mouth
- buccal mucosa
- roof of mouth
(use two fingers)
acute exudative tonsillitis
cryptic tonsils (surface has divites)
infection of the tonsils
erythema
common in mononucleosis
apthous stomatitis
cold sore on the inside of the mouth
organism is herpes virus
dental abscess
infection of the teeth (cavities gone wild)
herpes labialis
cold sores on the outside of mouth (around lips)
painful, pt may become dehydrated (painful to drink)
peritonsillar abscess
tonsil itself is not abscessed, it is the peritonsillar space behind the tonsil that pushes the tonsil toward the midline
CC: severe aphagia, dysphagia, look sick, high fever
Rendu-Osler-Weber
familial telangectasias
present all over lips, tongue, nose
-most common on oral mucosa but can present anywhere on the body
preauricular lymph node palpation
in front of the ear, usually reacts to infections of eye and scalp
posterior auricular lymph node palpation
superficial to the mastoid process, usually reacts to infections of scalp and ear
parotid nodes
palpable could indicate mumps, reacts to abnormality in parotid glands
pharyngeal nodes
responds to whats going on in the throat (tonsillitis, pharyngitis)
submandibular nodes and submental
along angle of the jaw/ at point of chin
respond to whats going in lower teeth of lower jaw
occipital nodes
reacts to what goes on in the scalp
anterior cervical node
in a smoking person is cancer until you prove that it’s not
reacts to things in the neck or throat
posterior cervical nodes
react to things in neck and throat
classic finding in mononucleosis
supraclavicular node
classic presentation of lymphoma (one node) and also may be present in breast cancer
goiter
enlarged thyroid gland
what to include when describing masses
size shape consistency mobility position
the throat is separated into
anterior and posterior triangle (separated by the sternoclaudomastoid muscle
thyroglossal duct cyst
congenital cyst (usually asymptomatic) may get infected
branchail cleft cyst
on left side of neck
usually on division line of anterior and posterior triangle
