Nose, Mouth, Throat, Neck

Question 1

What are the causes of rhinorrhea and nasal congestion? What is rhinitis medicamentosa?

Answer 1

Rhinorrhea and nasal congestion may be caused by viral infections, allergic rhinitis, and vasomotor
rhinitis.
Rhinitis medicamentosa is rhinitis due to excessive use of decongestants worsening symptoms.

Question 2

Define epistaxis. What are its local and systemic causes?

Answer 2

Epistaxis means nosebleed. Local causes include trauma, inflammation, drying and crusting of nasal
mucosa, tumors, and foreign bodies. Systemic causes include bleeding disorders.

Question 3

What are the symptoms of Strep Pharyngitis?

Answer 3

Fever, pharyngeal exudate, and anterior lymphadenopathy, especially in the absence of cough.

Question 4

What are the causes of acute and chronic hoarseness of voice?

Answer 4

Acute causes of hoarseness include overuse of the voice and acute infections.

Chronic causes of hoarseness include smoking, allergy, voice abuse, hypothyroidism, chronic infections,
and tumor.

Question 5

How does nasal mucosa look in viral rhinitis and allergic rhinitis?

Answer 5

viral rhinitis - red, swollen mucosa

allergic rhinitis - pale, bluish or red mucosa

Question 6

What are the possible causes of nasal septum perforation?

Answer 6

trauma, surgery, intranasal use of cocaine or amphetamine

Question 7

What are the characteristics of nasal polyps?

Answer 7

pale, saclike growths of inflamed tissue that can obstruct air passage or sinuses

Question 8

What are the signs and symptoms of acute sinusitis?

Answer 8

local tenderness, pain, fever, discharge

Question 9

What are two infections causing exudative tonsillitis? What are the signs and symptoms?

Answer 9

group A streptoccal infection
infectious mononucleosis

red throat, white exudate, fever, enlarged cervical nodes

Question 10

What are the characteristics, causes, and associated conditions (if any) of angular cheilitis, actinic cheilitis, angioedema, hereditary hemorrhagic telangiectasia, Peutz Jeghers syndrome?

Answer 10

angular cheilitis - softening and cracking of angles of the mouth due to nutritional deficiency or, more commonly, to overclosure of the mouth

actinic cheilitis - loses its normal redness and may become scaly, somewhat thickened, and slightly everted due to excess sun exposure

angioedema - diffuse, tense, subcutaneous swelling, usually allergic

hereditary hemorrhagic telangiectasia - red spots, associated bleeding from nose and GI

Peutz Jeghers syndrome - brown spots of lips and buccal mucosa, intestinal polyps

Question 11

What are the physical exam findings in oral cavity and throat in diphtheria, thrush, Kaposi’s sarcoma, measles?

Answer 11

diphtheria - dull red throat, gray exudate (pseudomembrane)

thrush - thick, white plaques adherent to mucosa

Kaposi’s sarcoma - deep purple lesions

measles - Koplik’s spots - small white specks resembling grains of salt on red background

Question 12

What is the gum finding in lead poisoning?

Answer 12

black line

Question 13

What are the causes of marginal gingivitis and gingival hyperplasia?

Answer 13

marginal gingivitis - poor oral hygiene

gingival hyperplasia - phenytoin therapy, pregnancy, puberty, leukemia

Question 14

Describe Hutchison’s teeth. In which condition is it present?

Answer 14

smaller, spaced out, notched

congenital syphillis

Question 15

Paralysis of which nerve causes asymmetric tongue protrusion?

Answer 15

CN XII

Question 16

What are the first and seconds most common sites of cancer in the mouth? What types of lesions are suspicious of cancer?

Answer 16

lip, tongue

red or white nodules especially indurated

Question 17

What are the causes and characteristics of smooth tongue and hairy leukoplakia?

Answer 17

smooth tongue - loss of papillae, caused by vitamin B deficiency, iron deficiency or chemotherapy

hairy leukoplakia - white, raised hairy areas, usually on side. Seen in AIDS, HIV

Question 18

What are the exam findings in soft palate and uvula in CN X paralysis?

Answer 18

the soft palate fails to rise and the uvula deviates to the opposite side

Question 19

Name the lymph nodes of head and neck in sequence of examination. Mention the location of each. What aspects of node should you note?

Answer 19

Pre auricular group
post auricular group
occipital group
tonsils group
submandibular group
submental group
superficial cervical group
posterior cervical group
deep cervical group
supraclavicular group

note for size, shape, delimitation, consistency, tenderness

Question 20

What are the significance of enlarged supraclavicular node, tender nodes, hard or fixed nodes, generalized lymphadenopathy?

Answer 20

supraclavicular node - possible metastasis from a thoracic or an abdominal malignancy
tender node - inflammation
hard or fixed node - cancer
generalized lymphadenopathy - HIV/AIDS

Question 21

What are the thoracic causes that can cause deviation of trachea from its usual midline position?

Answer 21

mediastinal mass, atelectasis,

or a large pneumothorax

Question 22

What are the tips for palpating thyroid gland from posterior approach?

Answer 22

Ask patient to flex neck slightly
Place finger of both hands w/ index finger just below cricoid cartilage
Ask patient to sip and swallow water. Feel for thyroid isthmus rising up under your finger pads.

Question 23

What are the causes of enlarged soft thyroid gland and enlarged firm thyroid gland?

Answer 23

soft - Graves’ disease

hard - Hashimoto’s thyroiditis, malignancy

Question 24

What are the three important causes of facial swelling? What are the characteristic features of each?

Answer 24

Cushing’s syndrome - moon face, red cheeks

Nephrotic syndrome - Periorbital edema, Puffy pale face, swollen lips

Myxedema - dull, puffy, dry face, periorbital edema w/ no pitting

Question 25

What are the causes of chronic bilateral asymptomatic enlargement, gradual unilateral enlargement and acute enlargement of parotid glands?

Answer 25

chronic bilateral asymptomatic enlargement -obesity, diabetes, cirrhosis

gradual unilateral enlargement - neoplasm

acute enlargement - mumps

Question 26

What are the facial features in Parkinson’s disease?

Answer 26

masklike face with decreased blinking and a characteristic stare