Nose, Mouth And Throat Flashcards
How to inspect the nasal cavity?
Use otoscope and insert into nasal vestibule (avoid pressure on nasal septum); inspect nasal mucosa for colour (normal is red and moist surface); note swelling, discharge, bleeding, foreign bodies; inspect septum for deviation, perforation, bleeding; inspect middle and inferior tubinates (superior is not visible) for colour, swelling, exudate, polyps
How to inspect and palpate the external nose?
Inspect for symmetry, in midline, in proportion to other facial features; deformity, asymmetry, inflammation, skin lesions; test patency of each nostril (by pressing nostril closed and asking patient to inhale)
Sense of smell = cranial nerve 1
How to palpate the sinus area?
Use thumbs to press over frontal sinuses below eyebrows and over maxillary sinuses below cheekbone (only maxillary and frontal are palpable - cannot palpate ethmoid and sphenoid sinuses) - looking for swelling, tenderness
How to inspect the mouth?
use a penlight and tongue blade (depressor) to retract structures
How to inspect lips?
inspect for colour, moisture, cracking, and lesions; retract lips and note inner surface
How to inspect teeth and gums?
This is an index of patient’s general health
Note diseased, absent or loose teeth; normal teeth look white, evenly spaced, straight, and clean and free of debris; compare number of teeth (adults have 32); have patient bite together and note alignment of upper and lower jaw; upper teeth rest directly on lower teeth in the back, and front upper teeth (incisors) slightly override bottom incisors; normal gums look pink/coral with stippled surface; gum margins are tight and well defined; check for retraction of gingival margins, spongy, bleeding and discoloured gums
How to inspect tongue?
Check colour, surface characteristics, moisture; normal colour is even and pink; dorsal surface is normally roughened from papillae; ventral surface looks smooth, glistening and shows veins; saliva is present; pull tongue out to each side and inspect for white patches (normally there would be none present); inspect U-shaped area under the tongue, behind the teeth
how to inspect buccal mucosa?
use wooden tongue blade to hold cheek open; inspect for colour, nodules and lesions; normally pink, smooth and moist (patchy hyperpigmentation is normal in dark skinned people); inspect Stenson’s duct (opening of parotid salivary gland), looks like a small dimple opposite 2nd year molar; may see raised occlusion line when teeth close and rub on cheek; Fordyce’s granules are small white or yellow papules on mucosa of cheeks, tongue and lips and are sebaceous cysts that are painless and non-significant
how to inspect palate?
inspect roof of mouth with penlight; the more anterior hard palate is white with irregular transverse ruage; posterior soft palate is smooth, pinker and upwardly moveable; note torus palatinus, which is a normal body ridge down the centre of the hard palate
how to inspect the uvula?
observe uvula; normally looks like a fleshy pendant hanging midline; ask patient to say “ahh” and note the soft palate and uvula rise in midline; this is a function of cranial nerve x (10), the vagus nerve; also note any breath odour during examination - halitosis
how to inspect throat?
use penlight to observe the oval, rough-surfaced tonsils behind the anterior tonsillar pillar; colour is the same as oral mucosa; surface have indentations/crypts; may have whitish debris collected by crypts - does not indicate infection; should be no exudate; tonsils are graded in size
how to grade tonsils?
1+ = visible
2+ = halfway between tonsillar pillars and uvula
3+ = touching the uvula
4+ = touching each other
note - tonsils may be absent due to tonsillectomy
