Nose, Mouth & Throat Flashcards
the superior part (nasal bone)
Bridge
the anterior part of nose (cartilage)
Tip
filter coarse matter from entering nasal cavity
Hair
filters dust and bacteria. The rich blood supply warms and humidifies the air
Ciliated mucous membrane
increase the surface are of the nasal cavity so that more air is filtered, warmed, and humidified
Turbinates (conchae)
Present at birth
Ethmoid and maxillary sinuses
develop
between 7 and 8 years
Frontal
develop after puberty
Sphenoid
nose is symmetric, midline, proportional
Normal external nose
nasal mucosa pink, smooth, and moist
Normal findings nasal cavity
Abnormal findings of nasal cavity
note any bleeding, swelling, redness, discharge, foreign body
Rhinitis – mucosa swollen, red, and often includes discharge (watery,
thick, purulent, green) in upper resp infection
(benign growths) – smooth, gray, avascular, mobile, nontender
Polyps
Midline placement. Shape symmetrical and consistent with age, gender, and
race/ethnic group.
No nasal flaring.
No drainage.
Normal findings
Misalignment of nose or shape inconsistent with patient’s biographical information
Nasal flaring
Clear, bilateral drainage
Clear, unilateral drainage
Clear, mucoid drainage
Yellow or green drainage
Bloody drainage
Abnormal findings of external nose
Trauma, hypertension, or bleeding disorders.
Bloody drainage
Upper respiratory infection.
Yellow or green drainage
Viral rhinitis
Clear, mucoid drainage
May be spinal fluid as a result of head trauma or fracture
Clear, unilateral drainage
Allergic rhinitis
Clear, bilateral drainage
Suggests respiratory distress, especially in infants, who are obligatory nose breathers
Nasal flaring
Previous trauma, congenital deformity, surgical alteration, or mass. Abnormal shape also associated with typical facies, including acromegaly or Down syndrome.
Misalignment of nose or shape inconsistent with patient’s biographical information
• Have the patient occlude one nostril with a finger.
• Ask the patient to breath in and out through the nose as you observe and listen for air
movement in and out of the nostril.
• Repeat on the other side.
Procedure (PATENCY)
Internal Inspection
a. Position the patient with the head in an extended position
b. Place the non dominant hand firmly on the top of the patient’s head
c. Using the thumb of the same hand, lift the tip of the patient’s nose.
d. Gently insert the nasal speculum.
e. Assess each nostril separately
f. Observe for: COLOR, DISCHARGE, SWELLING, DRAINAGE, LESIONS, POLYPS
Normal findings of internal nose
■ Pink, variations consistent with ethnic group/race and with oral mucosa.
■ Moist, with only clear, scant mucus present.
■ Intact, with no lesions or perforations.
■ No crusting or polyps.
■ Septum located midline.
Abnormal findings in internal nose
Bright red mucosa
Pale or gray mucosa
Copious or colored discharge
Clustered vesicles
Ulcers or perforations
Dried crusted blood
Polyps
Deviated septum
Inflammation from rhinitis or sinusitis; also suggests cocaine abuse.
Bright red mucosa
Allergic rhinitis
Pale or gray mucosa
Allergic or infectious disorder, epistaxis, head or nose trauma.
Copious or colored discharge
Herpes infection
Clustered vesicles
Chronic infection, trauma, or cocaine use
Ulcers or perforations
Previous epistaxis
Dried crusted blood
Allergies, irritation or chronic infections
Polyps (elongated, rounded projections)
Normal variant or following trauma.
Deviated septum
Observe the patient’s face for any swelling around the nose and eyes.
Inspection of the sinuses
There is no evidence of swelling around the nose and eyes
Normal findings of sinuses
SINUSITIS
Abnormal findings of sinuses
Palpation and Percussion of sinuses
Stand in front of the patient.
Gently press the thumb under the bony ridge of the upper orbits (for the frontal sinus).
Under the infraorbital ridge using the thumb or middle finger (for maxillary sinus).
Observe for the presence of pain.
Percuss the areas using the mid or index finger of the dominant hand (immediate percussion)
Note the sound.
No discomfort during palpation and percussion. Air-filled – resonant.
Normal findings of sinuses(palpation & percussion)
If palpation and percussion of the sinuses suggests sinusitis,
TRANSILLUMINATION OF THE SINUSES should be performed
TO EVALUATE THE FRONTAL SINUSES
• Patient should be in a sitting position in the dark room.
• Place the penlight under the bony ridge of the upper orbit.
• Observe the red glow over the sinuses and compare the symmetry of the two sides.
TO EVALUATE THE MAXILLARY SINUSES
• Place the patient in a sitting position facing you.
• Place the light source firmly under each eye and just above the infraorbital ridge.
• Ask the patient to open the mouth; observe the red glow on the hard palate. Compare the
two sides.
Head and Neck Nodes
◼ Preauricular
◼ Posterior auricular
◼ Occipital
◼ Tonsillar
◼ Submandibular
◼ Submental
◼ Superficial cervical
◼ Posterior cervical
◼ Deep cervical
◼ Supraclavicular
Inspect Lips
COLOR, MOISTURE, SWELLING, LESIONS, INFLAMMATION
Palpation of lips
LESIONS
Abnormal findings of lips
PALLOR
CRACKED LIPS
SWELLING OF THE LIPS
CHEILOSIS
SQUAMOUS CELL CARCINOMA
HERPES SIMPLEX
CHANCRE
LEUKOPLAKIA
Palpation procedure for lips
a. Don gloves
b. Gently pull down the patient’s lower lip with the thumb and index finger of one hand and
pull up the patient’s upper lip with the thumb and index finger of the other hand.
c. Note the tone of the lips as they are manipulated.
d. If lesions are present, palpate them for consistency and tenderness.
Normal findings of palpation of lips
Lips should not be flaccid and lesions should not be present.
Abnormal findings of palpation of lips
Asymmetry of placement
Pallor
Cyanosis
Redness
Cheilitis (inflammation of lips), drying, and cracking
Cheilosis (fissures at corners of lips)
Chancre
Angioedema
Herpes simplex (clustered area of fullness/nodularity that forms vesicles, then ulceration)
Congenital deformity, trauma, paralysis, or surgical alteration
Asymmetry of placement
Anemia
Pallor
Inflammatory or infectious disorder
Redness
Vasoconstriction or hypoxia
Cyanosis
Infectious or inflammatory disorder
Lesions
Cheilitis
Dehydration, allergy, lip licking.
(inflammation of lips), drying, and cracking
Cheilitis
Deficiency of B vitamins or maceration related to overclosure
Cheilosis
Single, painless ulcer of primary syphilis
Chancre
Allergic response
Angioedema
Herpes simplex
Herpes viral infection
Herpes simplex
(clustered area of fullness/nodularity that forms vesicles, then ulceration)
Assessment of the tongue
a. Ask the patient to stick out the tongue (CN XII)
DORSAL & VENTRAL SURFACE:
COLOR
HYDRATION
TEXTURE
SYMMETRY
FASCICULATIONS
ATROPHY
POSITION IN THE MOUTH
LESIONS
b. Ask the patient to move the tongue from side to side, up and down.
c. With the tongue back in the mouth , ask the patient to press it against the cheek. Provide
resistance with your tongue depressor. Note the strength of the tongue and compare it bilaterally.
c. Ask the patient to touch the tip of the tongue to the roof of the mouth or grasp the tip of the
tongue with a gauze, inspect and palpate.
Normal findings of tongue
Tongue is in the midline of the mouth.
Dorsum of the tongue should be pink, moist, rough (from the taste buds), and without lesions.
Coloring may vary consistent with ethnic group/race.
Mucosa intact with no lesions or discolorations.
Papillae intact. Tongue is freely and symmetrically mobile (CN XII intact).
The strength of the tongue is symmetrical and strong.
The ventral surface of the tongue has prominent blood vessels and should be moist without
lesions.
Wharton’s ducts are patent and without inflammation or lesions.
Lateral aspect of the tongue should be pink, smooth and lesion free
Abnormal findings of tongue
Absence of papillae, reddened mucosa, ulcerations
Color changes
Black, hairy tongue
Hypertrophy and discoloration of papillae
Reddened, smooth, painful tongue, with or without ulcerations (glossitis)
Cancers may form on the tongue and on other oral mucosa.
PROTRUSION OF THE TONGUE
ENLARGED TONGUE
LEUKOPLAKIA
THRUSH
DEVIATION OF THE TONGUE
GEOGRAPHIC TONGUE
HEMANGIOMA
SCROTAL TONGUE
FISSURED TONGUE
SQUAMOUS CELL CARCINOMA OF THE TONGUE
Allergic, inflammatory, or infectious cause
Absence of papillae, reddened mucosa, ulcerations
Color changes
May indicate underlying problems; for example, red “beefy” tongue is seen with pernicious anemia.
Black, hairy tongue
Fungal infections
Hypertrophy and discoloration of papillae
Antibiotic use
Reddened, smooth, painful tongue, with or without ulcerations (glossitis)
Anemia, chemical irritants, medications