Phys Di

Question 1

Nose ROS

Answer 1

rhinorrhea
congestion
sneezing
itching
obstruction
nosebleed
change in smell

Question 2

nose anatomy

Answer 2

• glabella
• root (right between eyes)
• nasal sidewall (side of nose)
• ala (lateral nare)
• nasolabial fold (between nose and mouth)
• dorsum (bridge of nose)
• columella - between nares

Question 3

where is the opening to the eustachian tube

Answer 3

nasopharynx

Question 4

two palpable sinuses

Answer 4

• frontal with thumb (under bony brow)

- maxillary with thumb or index & middle (under zygomatic process)

Question 5

what size speculum to use in nose exam

Answer 5

largest avail ear speculum

Question 6

what to avoid touching during inside of nare inspection

Answer 6

nasal septum

Question 7

When perform transillumination of frontal and max sinus

Answer 7

palpation was tender or infection present

Question 8

where place light source during frontal sinus transillumination

Answer 8

medial aspect of supraorbital rim

Question 9

where place light source during max sinus transillumination

Answer 9

lateral to the nose, just beneath medial aspect of eye

Question 10

Mouth/oropharynx ROS

Answer 10

• sore throat
• hoarseness
• bleeding gum
• lesions
• change in taste
• change in breath
• recurrent infections
• last dental exam
• dentures

Question 11

Philtrum

Answer 11

two lines between nose and upper lip

Question 12

name of edge of lips

Answer 12

vermillion border

Question 13

name for lateral edge of lips

Answer 13

lateral commisure

Question 14

name for dry lips

Answer 14

Cheilitis

Question 15

name for fissures at corner of mouth

Answer 15

angular cheilosis

Question 16

where is Stenson’s duct

Answer 16

aligned with second upper molar - white/yellow or white/pink protrusion
- parotid gland

Question 17

CN tested when stick tongue out

Answer 17

CN XII

Question 18

What ducts are found below the tongue

Answer 18

Warton ducts - submandibular duct

Question 19

colors/shape of hard and soft palate

Answer 19

Hard: pinkish-white, dome shape
Soft: more pink

Question 20

“Ahhh” and gag reflex test what CN

Answer 20

CN IX (sensation)
CN X (motor)

Question 21

tonsil measurement system

Answer 21

1+ visible
2+ halfway between pillars and uvula
3+ nearly touching uvula
4+ touching each other

Question 22

Fordyce spots

Answer 22

• expected variation
• enlarge sebaceous glands appear on buccal mucosa and lips
• numerous small, yellow-white raised lesions
• asymptomatic

Question 23

Torus palatinus

Answer 23

bony protuberance at midline of hard palate

- expected variation

Question 24

normal lymph node characteristics

Answer 24

• ovoid

- less than 1 cm short axis

Question 25

Affected areas of submental/submandibular nodes

Answer 25

- oral cavity - face - salivary glands - thyroid - larynx

Question 26

reactive lymphadenopathy - characteristics

Answer 26

- enlarged lymph nodes - tender - typically related to URI

Question 27

Deep neck abscess - def - from what usually

Answer 27

- lymphatic infection with transition to abscess | - oral cavity and pharyngeal infections

Question 28

Deep neck abscess sx

Answer 28

- pain - fever - toxic appearance - torticollis - hoarseness - odynophagia (painful swallowing)

Question 29

When to surgically incise and drain deep neck abscess

Answer 29

airway management

Question 30

lymphadenitis

Answer 30

inflamed lymph node

Question 31

when suspect lymph node malignancy

Answer 31

persistent adenopathy without any infectious cause

Question 32

Find a cancerous lymph node in neck - what else is happening

Answer 32

lymph is secondary malignancy, must find first, send to specialist

Question 33

How treat reactive lymphadenopathy?

Answer 33

don't | - usually resolves on own

Question 34

Imaging methods to workup neoplastic neck mass

Answer 34

- US: est. size and characteristics, no radiation, good to monitor growth - CT w/contrast: characterize extent and character, most common - MRI: alt to CT but less common, more time and money

Question 35

Ways to biopsy neck mass

Answer 35

fine needle aspiration - w/ or w/o US guidance - easily palpable masses Open surgical - avoided if possible - use in lymphoma to best characterize tumor

Question 36

PET-CT imaging

Answer 36

tracks uptake of fluorodeoxyglucose (FDG) - radioactive isotope of fluorine attached to glucose - increased uptake in infected tissue, malignant neoplasms

Question 37

When is PET-CT imaging used

Answer 37

- staging | - post-treatment f/u

Question 38

Squamous cell carcinoma

Answer 38

- aways metastatic - most common ca head and neck - must determine source for adequate therapy

Question 39

Unknown primary squamous cell carcinoma

Answer 39

- prim. source is unable to be determined | - entire pharynx from naso- to hypo- is treated with chemo/radiation

Question 40

Salivary malignancy

Answer 40

- drain to level 1-3 - surgical excision - radiation

Question 41

Lymphoma

Answer 41

- present in any lymph group - FNA biopsy to determine malignant process - excisions biopsy usually needed for further classification

Question 42

Supraclavicular adenopathy

Answer 42

- LEFT nodes should raise concern for visceral mal | - Thoracic duct