Nose Examination Flashcards
Introduction
Hello, I’m An Nakamura, a 3rd year medical student.
I’ve been asked to examine your nose
This will involve me gently looking into and feeling your nose
Is this ok?
Do you have any pain?
External nose inspection
Skin changes
- BCC - pearly rolled lesions, telangiectasia
- SCC - scaly lesions, ulceration, hyperpigmentation
- keratoacanthoma - raised lesions with keratin core
Deformity
Deviation in nasal bones, cartilage - fracture?
Nose bleed
Gross nasal cavity inspection
- method
- what are you looking for
Carefully elevate tip of nose with thumb => nasal cavity more visible
Illuminate with pen torch
Inspect nasal mucosa, septum
Compare nasal cavity alignment
Nasal vestibule - inflammation, ulceration, edema?
Nasal septum - polyps, deviation, perforation, hematoma
Inferior turbinates - asymmetry, inflammation, polyps
Nasal cavity inspection with speculum
-how to use
Insert index finger into bend of speculum
Support it above with thumb
Middle and ring finger manipulates prongs
Press prongs together to allow them to be placed within the nostril => reduce grip to widen prongs and view
Nasal bone and cartilage palpation
Warn patient that you are going to be applying some pressure onto their nose
Ask them to let you know if they’re in pain
Palpate nasal bones
- alignment
- tenderness
- irregularity - fracture?
Palpate nasal cartilage
- alignment
- tenderness
Palpate infraorbital ridges and assess eye movement if there is a history of trauma - orbital blowout fracture?
Nasal airflow
- assessment
- interpretation
Place a cold shiny surface under the nose
Observe for misting of the metal surface as the patient breathes and compares the misting pattern of the 2 nostrils
Disparity in the amount of misting - unequal/absent airflow through a particular nostril
Outro and further assessments
Inspection of ext nose
Inspection of nasal cavity
Nasal airflow
Cranial nerve with the olfactory assessment
Oral cavity
Ear assessment
