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90 Cards in this Set
- Front
- Back
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Nose |
-First part of respiratory system. Warms, moistens, and filters inhaled air and is the sensory organ for smell.
-Made up of bridge, tip, nares, vestibule, columella and ala -Upper third of external is bone; the rest is cartilage |
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nasal cavity
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- lined with a blanket of ciliated mucous membrane; course nasal hairs line ant. cavity
-Divided by septum into two slit like air passages |
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Kesselbach’s plexus
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- the anterior part of the septum holds a rich vascular network
-The most common site of nosebleeds |
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turbinates
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- the bony ridges curving down from the lateral walls
- they line the lateral walls of each nasal cavity containing three parallel bony projections - Increase the surface area so that more blood vessels and mucous membranes are available to warm, humidify, and filter the inhaled air. - the superior turbinate cannot be viewed but the middle and inferior turbinates appear the same light red colour as the nasal mucosa |
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Meatus
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- a cleft underlying each turbinate
-Named for the turbinate above -Sinuses drain into the middle meatus -Tears from nasolacrimal duct drain into inferior meatus |
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Olfactory receptors
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- hair cells
-Lie at roof of the nasal cavity in the upper one third of the septum -Receptors merge into the olfactory nerve, CNI |
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Paranasal sinus
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- air filed pockets w/in the cranium
They communicate with the nasal cavity - Lighten the weight of the skull bones, act as resonators for sound production, provide mucus which drains into the nasal cavity - the sinus openings are narrow and easily occluded, which causes sinusitis - the frontal sinuses and maxillary sinuses are the only ones examinable; in addition there are the ethmoid and sphenoid sinuses - only maxillary and ethmoid sinuses are present at birth; frontal reaches full size by puberty; sphenoid sinuses develop after puberty |
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Mouth
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-First segment of the digestive system and an airway for the resp system
-Oral cavity is short passage bordered by lips, palate, cheeks, and tongue; contains the teeth, gums, tongue, and salivary glands |
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Palate
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- the arching roof of the mouth
-Anterior hard palate – made of bone and is whitish in colour -Posterior soft palate – arch of muscle that is pinker colour and mobile |
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Uvula
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Free projection hanging down from the middle of the soft palate
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Tongue
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-Is a mass of striated muscle arranged in a crosswise pattern so that it can change shape and position
-Papillae are rough, bumphy elevations on dorsal surface -Vallate papillae in an inverted V are enlarged -frenulum is the midline fold of tissues that connects the tongue to the floor of the mouth -function is in mastication, swallowing, and clensing the teethand formation of speech -taste sensation – taste buds are on the sides of the tongue and on the soft palate |
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parotid gland
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-largest salivary gland
-lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw -Stensen’s duct opens on the buccal mucosa opposite the second molar |
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Submandibular gland
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-The size of a walnut
-Lies beneath the mandible at the angle of the jaw -Wharton’s duct opens at either side of the frenulum |
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Sublingual gland
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-Smallest salivary gland, almond shaped
-Lies within the floor of the mouth under the tongue -Many small openings along the sublingual fold under the tongue |
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Throat (pharynx)
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- Oropharynx is separated from the mouth by a fold of tissue on each side, the ant tonsillar pillar
Behind the folds are the tonsils (mass of lymphoid tissue) - nasopharynx continuous with oropharynx; pharyngeal tonsils (adenoids) are located here |
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Infants and Children
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-Salivation starts at 3 months and baby drools for a few months before learning to swallow saliva
-Teeth begin development in utero -Children have 20 deciduous teeth that erupt for 6 months to 24 months of age and all 20 teeth should erupt by 2 ½ years -Deciduous teeth are lost from ages 6-12 |
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Pregnant female
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-Nasal stuffiness and epistaxis may occur during pregnancy due to increased vascularity in the upper respiratory tract
-Gums may be hyperaemic and softened and may bleed easily |
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Aging adult
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-Nasal hairs grow coarser and stiffer and may not filter as well; clipping of hairs can cause infection
-Sense of smell may diminish b/c of less olfactory nerve fibers; begins after age 60 -Soft tissues in oral cavity atrophy causing loss of taste buds with ~80% decrease in function -Decreased salivary secretions -Atrophic tissue ulcers easily - Tooth loss and teethe drift causing malocclusion. The stress of chewing with maloccluding teeth can cause further problems - tend to eat soft foods high in carbohydrates and therefore are at risk for malnutrition |
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Subjective Data
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Ask questions to elaborate on the following conditions
Nose: Discharge, frequenct colds, sinus pain, trauma, epistaxis(nose bleeds), allergies, altered smell Mouth and Throat: Sores or lesions, sore throat, bleeding gums, toothache, hoarseness, dysphagia, altered taste, smoking & alcohol consumption, self-care behaviours, dental care pattern, dentures or appliances |
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Inspection and Palpation of the external nose
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- midline, in proportion to other facial features
-Inspect for deformity, asymmetry, inflammation, or skin lesions -Palpate for pain or break in contour if injury is reported -Test patency of each nostril |
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Inspection and palpation of nasal cavity
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-Gently lift tip of nose before inserting otoscope
-Head tilted back -Inspect nasal mucosa, noting its normal red color and smooth moist surface -Note any swelling, discharge, bleeding or foreign body -With chronic allergy the mucosa looks swollen, boggy, pale, and gray - Rhinitis – nasal mucosa is swollen and bright red with an upper respiratory infection -Discharge is common varying from watery and copious to thick, purulent, and green-yellow - Deviated Septum - Looks like a hump or self in one nasal cavity - Perforation – seen as a spot of light from penlight shining in other naris occurs with cocaine use -Inspect turbinates noting any polyps, benign growths that accompany chronic allergyk, and distinguish them from the normal turbinates |
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Palpate sinus areas
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-Thumbs press over frontal sinus below the eyebrows and over maxillary sinuses below the cheekbones
-Normally pt will feel firm pressure but no pain -Pain is felt in those with acute infection and chronic allergies |
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Transillumination
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- use if you suspect sinus inflammation – an inflamed sinus filled with fluid does not transilluminate
- darken the room; hold light deep under the superior orbital ridge against the location of the frontal sinus. Cover with your hand. A diffuse red glow is a normal response - same technique with the maxillary sinus. Ask them to tilt head back and open mouth -Light on each cheek just under inner corner of the eye. Dull glow should be noted inside the mouth - a significant finding is one sinus illuminated and the other clouded. If one has fluid, it looks darker than the healthy one |
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Inspect the lips
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- for colour, moisture, cracking, or lesions
-Retract lips and note their inner surface as well -Light skinned people circumoral pallor occurs with shock and anemia; cyanosis with hypoxemia and chilling; cherry red lips with CO poisoning, acidosis from aspirin poisoning , or ketoacidosis |
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Cheilitis
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Cracking at the corners
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Inspect the Teeth and gums
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Condition of teeth is an index of the person’s general health
Normally teeth look white, straight, evenly spaced, clean and free of debris and decay - brown with excessive fluoride use; yellow with tobacco use - compare the number of teeth with the number expected for the age - ask the pt to bite and not alignment of upper and lower jaw; normal occlusion in the back is the upper teeth resting directly on the lowers; in the front, the upper incisors slightly over the lower - normal gums look pink with stippled (dotted) surface -Gum margins at the teeth are tight and well defined -Check for swelling; retraction of gingival margins and spongy bleeding or discoloured gums - gums bleeding with slight pressure indicates gingivitis; |
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Inspect the tongue
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- colour (pink and eve), surface characteristics (dorsal surface roughened from papillae), and moisture ventral surface should look smooth, glistening and shows veins, saliva present
- with glow hold tongue with cotton gauze and swing the tongue out to each side - any white patches or lesions are abnormal - inspect Ushaped area under the tongue behind the teeth is a common area for oral malignancies; note any white patches or , nodules, or ulcerations - palpate lesions if there is a Hx of smoking or alcohol use and stabilize jaw with hand underneath Any lesions lasting for more than 2 weeks must be investigated |
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Inspect the Buccal Mucosa
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- cheek open with wooden tongue blade
Check for colour, nodules, or lesions - should look pink, smooth, and moist - orifice of Stenson’s duct is red with mumps - Fordyce’s granules are small isolated white or yellow papules on the mucosa of cheek, tongue, and lips Inspect the palate - shine light on roof of the mouth - ant hard palate is white with irregular transverse rugae; posterior soft palate is pinker, smoother, and movable -torus palatines is normal variation – nodular bony ridge down the middle of hard palate - observe uvula 0 normal is like a fleshy pendant hanging in the midline |
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Inspect the throat
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-with light observe the oval, rough-surfaced tonsils behind the ant. tonsillar pillar; colour is same pink as oral mucosa and surface is peppered with indentations, or crypts
- should be no exudates - assess CN XII – hypoglossal nerve –stick tongue out |
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Haliotosis
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-Breath odour
-Important to note this -Usually due to a local cause but can sometimes indicate a systemic disease |
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Infants and children Oral exam
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- if any crying episodes occur use the opportunity to examine the open mouth and oropharynx
Otherwise leave until the end - infant supine on examining table with arms restrained, or may be held in parents lap - try to make it a game for children where they examine a puppet - tongue blade can elicit a strong gag reflex in infants - transverse ridge in children with chronic allergies from nose wiping - patency of the nares is very important in newborns - avoid using nasal speculum when examining an infant - toddler might have foreign body lodged in nose - sinuses can only be palpated in children 8 and up - make sure number of teeth is appropriate for age – under 2 take age in months and minus 6 should equal the number of teeth - tonsils are not visible in newborn – gradually enlarge during childhood, |
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Tonsil grading
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1+ visible
2+ halfway between tonsillar pillars and uvula 3+ touching the uvula 4+ touching each other Normal is 1+ or 2+ |
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Tongue size
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-Occurs with mental retardation, hypothyroidism, acromegaly
-Small tongue accompanies malnutrition |
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Choanal atresia
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A bony or membranous septum b/w the nasal cavity and pharynx of the newborn. When bilateral it requires immediate insertion of an oral airway; when unilateral it is asymptomatic until first respiratory infection
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Epistaxis
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-Most common site of nosebleed is Kiesselbach’s plexus in ant septum
-May be spontatneous from local cause or sign of underlying illness\causes include nose picking, forceful coughing or sneezing, fracture, foreign body, rhinitis, heavy exertion, or a coagulation disorder -Posterior hemorrhage is less common but more profuse, harder to mange and more serious |
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Foreign Body
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Especially in children
Unilateral mucopurulent drainage and foul odor |
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Furuncle
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-A small boil located in skin or mucous membrane
-Appears red and swollen, and is quite painful -Avoid manipulation or trauma that may spread infection |
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Perforated Septum
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-A hole in septum, usually in cartilaginous part
-Causes: snorting cocaine, chronic infection, trauma from continual picking of crusts, or nasal surgery -Seen directly, or as a spot of light when the penlight is directed into the other naris |
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Acute Rhinitis
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-First sign is clear, watery discharge, rhinorrhea which later becomes purulent
-Accompanied by sneezing and swollen mucosa, turbinates are dark red and swollen |
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Allergic rhinitis
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-Rhinorrhea, itching of nose and eyes, lacrimation, nasal congestion, and sneezing
-Note serous edema and swelling of turbinates to fill the air space |
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Sinusitis
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-Facial pain, after URTI
-Signs: red swollen nasal mucosa, swollen turbinates and purulent discharge, fever chills, malaise -Dull throbbing pain |
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Nasal Polyps
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-Smooth, pale gray nodules, which are overgrowth of mucosa
-Usual cause is chronic allergic rhinitis -Symptoms include the absence of the sense of smell |
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Carcinoma (nose)
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-Appears gray white and nontender
-May produce slow bloody unilateral discharge |
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Cleft lip
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-Maxillafacial clefts are the most common congenital deformities of the head and neck
-Early treatment preserves the functions of speech and language formation and deglutition |
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Sinusitis
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-Facial pain, after URTI
-Signs: red swollen nasal mucosa, swollen turbinates and purulent discharge, fever chills, malaise -Dull throbbing pain |
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Herpes Simplex 1
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-The cold sores are groups of clear vesicles with a surrounding indurated erythematous base. These evolve into pustules, which rupture, weep and crust
-Caused by HSV-1 -Lesion is highly contagious and spread by direct contact |
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Nasal Polyps
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-Smooth, pale gray nodules, which are overgrowth of mucosa
-Usual cause is chronic allergic rhinitis -Symptoms include the absence of the sense of smell |
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Angular Cheilities (stomatitis, Perleche)
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Erythema, scaling, shallow and painful fissures at the corners of the mouth occur with excessive salivation and Candida infection
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Carcinoma (lip)
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-Initial lesion is round and indurated, and then it becomes crusted and ulcerated with an elevated border
-Majority occur b/w the outer and middle thirds of lip -Any lesion that is still unhealed after 2 weeks should be referred |
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Carcinoma (nose)
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-Appears gray white and nontender
-May produce slow bloody unilateral discharge |
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Retention “Cyst”
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A round, well defined translucent nodule that may be very small or up to 1 or 2 cm. It is a pocket of mucus that forms when a duct of a minor salivary gland ruptures.
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Cleft lip
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-Maxillafacial clefts are the most common congenital deformities of the head and neck
-Early treatment preserves the functions of speech and language formation and deglutition |
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Baby Bottle Tooth Decay
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Destruction of numerous deciduous teeth may occur in older infants and toddlers who take a bottle of milk or sweetened drink to bed and prolong bottle feeding past the age of 1 yr. Liquid pools in front of mouth and teeth break down
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Herpes Simplex 1
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-The cold sores are groups of clear vesicles with a surrounding indurated erythematous base. These evolve into pustules, which rupture, weep and crust
-Caused by HSV-1 -Lesion is highly contagious and spread by direct contact |
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Malocclusion
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-Upper or lower dental arches are not in alignment and incisors protrude from developmental problem of mandible or maxilla, or incompatibility b/w jaw size and tooth size
-May cause speech problems, chewing difficulties, or negative body image |
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Angular Cheilities (stomatitis, Perleche)
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Erythema, scaling, shallow and painful fissures at the corners of the mouth occur with excessive salivation and Candida infection
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Carcinoma (lip)
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-Initial lesion is round and indurated, and then it becomes crusted and ulcerated with an elevated border
-Majority occur b/w the outer and middle thirds of lip -Any lesion that is still unhealed after 2 weeks should be referred |
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Sinusitis
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-Facial pain, after URTI
-Signs: red swollen nasal mucosa, swollen turbinates and purulent discharge, fever chills, malaise -Dull throbbing pain |
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Retention “Cyst”
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A round, well defined translucent nodule that may be very small or up to 1 or 2 cm. It is a pocket of mucus that forms when a duct of a minor salivary gland ruptures.
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Nasal Polyps
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-Smooth, pale gray nodules, which are overgrowth of mucosa
-Usual cause is chronic allergic rhinitis -Symptoms include the absence of the sense of smell |
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Baby Bottle Tooth Decay
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Destruction of numerous deciduous teeth may occur in older infants and toddlers who take a bottle of milk or sweetened drink to bed and prolong bottle feeding past the age of 1 yr. Liquid pools in front of mouth and teeth break down
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Carcinoma (nose)
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-Appears gray white and nontender
-May produce slow bloody unilateral discharge |
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Malocclusion
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-Upper or lower dental arches are not in alignment and incisors protrude from developmental problem of mandible or maxilla, or incompatibility b/w jaw size and tooth size
-May cause speech problems, chewing difficulties, or negative body image |
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Cleft lip
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-Maxillafacial clefts are the most common congenital deformities of the head and neck
-Early treatment preserves the functions of speech and language formation and deglutition |
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Herpes Simplex 1
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-The cold sores are groups of clear vesicles with a surrounding indurated erythematous base. These evolve into pustules, which rupture, weep and crust
-Caused by HSV-1 -Lesion is highly contagious and spread by direct contact |
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Angular Cheilities (stomatitis, Perleche)
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Erythema, scaling, shallow and painful fissures at the corners of the mouth occur with excessive salivation and Candida infection
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Carcinoma (lip)
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-Initial lesion is round and indurated, and then it becomes crusted and ulcerated with an elevated border
-Majority occur b/w the outer and middle thirds of lip -Any lesion that is still unhealed after 2 weeks should be referred |
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Retention “Cyst”
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A round, well defined translucent nodule that may be very small or up to 1 or 2 cm. It is a pocket of mucus that forms when a duct of a minor salivary gland ruptures.
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Baby Bottle Tooth Decay
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Destruction of numerous deciduous teeth may occur in older infants and toddlers who take a bottle of milk or sweetened drink to bed and prolong bottle feeding past the age of 1 yr. Liquid pools in front of mouth and teeth break down
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Malocclusion
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-Upper or lower dental arches are not in alignment and incisors protrude from developmental problem of mandible or maxilla, or incompatibility b/w jaw size and tooth size
-May cause speech problems, chewing difficulties, or negative body image |
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Dental Caries
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-Progressive destruction of tooth
-Decay initially looks chalky white and later turns black or brown and forms a cavity. Early decay only apparent on x-ray. |
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Epulis
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Nontender, fibrous nodule of the gum, seen emerging b/w the teeth; an inflammatory response to injury or hemorrhage
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Gingival Hyperplasia
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Painless enlargement of the gums, sometimes overreaching the teeth. This occurs with puberty, pregnancy, leukemia, and with long therapeutic use of phenytoin (Dilantin)
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Gingivitis
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Gum margins are red, swollen, and bleed easily. This case is severe; gingival tissue has desquamated, exposing roots or teeth. Inflammation is usually due to poor dental hygiene or vit C deficiency.
May occur during pregnancy or puberty due to hormonal changes |
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Meth Mouth
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-Illicit meth abuse leads to extensive dental caries, gingivitis, tooth cracking, and edentulism.
-Meth causes vasoconstriction and decreased saliva while increasing the urge to consume sugar and to give up oral hygiene |
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Aphthous ulcers
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-A ‘canker sore’ is a vescilce at first, then a small, round, “punched-out” ulcer with white base surrounded by a red halo
-Quite painful and lasts for 1 to 2 weeks. Cause unknown all through associated with stress, fatigue, and food allergy |
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Koplik’s Spots
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Small blue-white spots with irregular red halo scattered over mucosa opposite the molars. Early sign, and pathognomonic, of measles
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Leukoplakia
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-Chalky white, thick, raised pathc with well0defined borders.
-The lesion is firmly attached and does not scrape off -May occur on the lateral edges of tongue -Lesions are precancerous, and the person should be referred |
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Candidiasis or Monilial Infection
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-A white, cheesy, curdlike patch on the buccal mucosa and tongue
-It scrapes off, leaving a raw , red surface that bleeds easily. Termed “thrush” in the newborn -It is an opportunistic infection that occurs after the use of antibiotics, corticosteroids, and in immunosuppressed persons |
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Ankyloglossia
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(Tongue-tie) a short lingual frenulum, here fixing the tongue tip to the floor of the mouth and gums.
This limits mobility and will affect speech (pronunciation of a, d, n) if the tongue tip cannot be elevated to the alveolar ridge. A congenital defect |
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Fissuered or Scrotal tongue
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-Deep furrows divide the papillae into small irregular rows.
-The condition occurs in 5% of the general pop’n and in Down Syndrome -The incidence increases with age |
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Geographic Tongue (Migratory Glossitis)
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Pattern of normal coating interspersed with bright red, shiny, circular bald areas with raise pearly borders.
Pattern resembles a map, and changes in a few days. Not significant and its cause is not known |
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Smooth, Glossy tongue (Atrophic Glossitis)
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The surface is slick and shiny; the mucosa thins and looks red from decreased papillae. Accompanied by dryness of tongue and burning. Occurs with vit B12 deficiency (pernicious aneama), folic acid deficiency, and iron deficiency anemia.
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Black Hairy Tongue
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-Not real hair but elongation of filiform papillae and painless overgrowth of mycelia threads of fungus infection on the tongue
-Colour varies from black-brown to yellow. It occurs after use of anti biotics, which inhibit normal bacteria and allow proliferation of fungus |
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Enlarged tongue (macroglossia)
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The tongue is enlarged and may protrude from mouth
Not painful but may impair speech development |
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Carcinoma of the tongue
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-An ulcer with rolled edges; indurated. Occurs particularly at sides, base, and under the tongue
-When it is in the floor of mouth, it may cause painful movement or limited movement of tongue -Risk of early metastasis is present b/c of rich lymphatic drainage -Heavy smoking and alcohol use place persons at greater risk |
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Cleft Palate
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A congenital defect, the failure of fusion of the maxillary process
Upper lip only, palate only, uvula only, cleft of the nostril and hard and soft palates |
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Bifid Uvula
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-Uvula looks partially severed
-May indicate a submucous cleft palate , which feels like a notch at the junction of the hard and soft palates -May affect speech development b/c it prevents necessary air trappings |
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Oral Kaposi’s Sarcoma
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-Bruiselike, dark red or violet, confluent macule, usually on the hard palate, may be on the soft palate or gingival margin
-Oral lesions may be among the earliest lesions to develop with AIDS |
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Acute Tonsillitis and Pharyngitis
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-Bright red throat; swollen tonsils; white or yellow exudates on tonsils and pharynx; swollen uvula; and enlarged, tender anterior cervical and tonsillar nodes
-Severe sore throat, painful swallowing, fever of sudden onset -Cannot discriminate bacterial from viral infection on clinical data alone; all sore throats need a throat culture |
