Phys Di Flashcards
Nose ROS
rhinorrhea congestion sneezing itching obstruction nosebleed change in smell
nose anatomy
- 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
where is the opening to the eustachian tube
nasopharynx
two palpable sinuses
- frontal with thumb (under bony brow)
- maxillary with thumb or index & middle (under zygomatic process)
what size speculum to use in nose exam
largest avail ear speculum
what to avoid touching during inside of nare inspection
nasal septum
When perform transillumination of frontal and max sinus
palpation was tender or infection present
where place light source during frontal sinus transillumination
medial aspect of supraorbital rim
where place light source during max sinus transillumination
lateral to the nose, just beneath medial aspect of eye
Mouth/oropharynx ROS
- sore throat
- hoarseness
- bleeding gum
- lesions
- change in taste
- change in breath
- recurrent infections
- last dental exam
- dentures
Philtrum
two lines between nose and upper lip
name of edge of lips
vermillion border
name for lateral edge of lips
lateral commisure
name for dry lips
Cheilitis
name for fissures at corner of mouth
angular cheilosis
where is Stenson’s duct
aligned with second upper molar - white/yellow or white/pink protrusion
- parotid gland
CN tested when stick tongue out
CN XII
What ducts are found below the tongue
Warton ducts - submandibular duct
colors/shape of hard and soft palate
Hard: pinkish-white, dome shape
Soft: more pink
“Ahhh” and gag reflex test what CN
CN IX (sensation) CN X (motor)
tonsil measurement system
1+ visible
2+ halfway between pillars and uvula
3+ nearly touching uvula
4+ touching each other
Fordyce spots
- expected variation
- enlarge sebaceous glands appear on buccal mucosa and lips
- numerous small, yellow-white raised lesions
- asymptomatic
Torus palatinus
bony protuberance at midline of hard palate
- expected variation
normal lymph node characteristics
- ovoid
- less than 1 cm short axis
Affected areas of submental/submandibular nodes
- oral cavity
- face
- salivary glands
- thyroid
- larynx
reactive lymphadenopathy - characteristics
- enlarged lymph nodes
- tender
- typically related to URI
Deep neck abscess
- def
- from what usually
- lymphatic infection with transition to abscess
- oral cavity and pharyngeal infections
Deep neck abscess sx
- pain
- fever
- toxic appearance
- torticollis
- hoarseness
- odynophagia (painful swallowing)
When to surgically incise and drain deep neck abscess
airway management
lymphadenitis
inflamed lymph node
when suspect lymph node malignancy
persistent adenopathy without any infectious cause
Find a cancerous lymph node in neck - what else is happening
lymph is secondary malignancy, must find first, send to specialist
How treat reactive lymphadenopathy?
don’t
- usually resolves on own
Imaging methods to workup neoplastic neck mass
- 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
Ways to biopsy neck mass
fine needle aspiration
- w/ or w/o US guidance
- easily palpable masses
Open surgical
- avoided if possible
- use in lymphoma to best characterize tumor
PET-CT imaging
tracks uptake of fluorodeoxyglucose (FDG)
- radioactive isotope of fluorine attached to glucose
- increased uptake in infected tissue, malignant neoplasms
When is PET-CT imaging used
- staging
- post-treatment f/u
Squamous cell carcinoma
- aways metastatic
- most common ca head and neck
- must determine source for adequate therapy
Unknown primary squamous cell carcinoma
- prim. source is unable to be determined
- entire pharynx from naso- to hypo- is treated with chemo/radiation
Salivary malignancy
- drain to level 1-3
- surgical excision
- radiation
Lymphoma
- present in any lymph group
- FNA biopsy to determine malignant process
- excisions biopsy usually needed for further classification
Supraclavicular adenopathy
- LEFT nodes should raise concern for visceral mal
- Thoracic duct
