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61 Cards in this Set

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What is the Kiesselbach region of the nose?
The anteroinferior part of the nasal septum, where 4 arteries anastomose

*most frequent place for a nose bleed
What is a columella?
means "little column"
What are the ala nasi?
expanded outer wall of cartilage on each side of the nose
What nerve innervates the nose?
CN I
What is the function of the external nose?
-warm, moisten, filter inhaled air

-a sensory organ for smell
Which structures line the anterior edge of the nasal cavity and what is their purpose?
Course nasal hairs

filtering air
What is the remainder of the nasal cavity lined with and what is its purpose?
Ciliated mucous membranes

filter dust and bacteria
Why is the nasal mucosa redder than the oral mucosa?
larger blood supply
What are 3 components of the lateral wall turbinates and what are their functions?
1. superior meatus (ethmoid cells)
2. middle meatus (where frontal sinuses drain)
3. inferior meatus (where tears drain)
Which two components of the lateral wall turbinates can you see with the otoscope?
middle & inferior meatus
Describe the turbinates.
very rich in blood supply

they are layers with more surface area to warm air
What are sinuses?
Air-filled pockets within the cranium to lighten the weight of the skull
What are the 4 pairs of sinuses known as?
1. Frontal
2. Maxillary
3. Ethmoid
4. Sphenoid
Which are the only 2 pairs of sinuses that can be examined during a physical?
1. frontal
2. maxillary
What is epistaxis?
nosebleeds
What objective data should you acquire during the physical exam of the nose and sinus?
INSPECT & PALPATE
1. External nose
2. Nasal cavity
(nasal septum, trubinates)

TEST PATENCY OF NOSTRILS

PALPATE OR PERCUSS THE SINUS AREAS
-frontal and maxillary sinuses
-transillumination
What is a normal finding in the inspection of the external nose?
-symmetric
-midline
-proportional to other facial features
How do you evaluate airway patency?
As the patient to breath IN while holding either side
When would you test CN I? How?
If you are concerned with CN I

Use common smells (ie coffee)

Don't use ammonia because it affects CN V
How do you inspect the nasal cavity?
Gently press the tip of the nose upward

Insert speculum gently into vestibule, avoiding contact with the sensitive nasal septum
What should you try to visualize during the inspection of the nasal cavity?
-inferior and middle turbinates
-septum

*note ulcers, perforation, deviation

*point the otoscope away from the septum
What are 4 abnormalities of the nose to watch out for?
1. Acute rhinitis
2. Allergic rhinitis
3. Perforated septum
4. Polyps

*nose usually appears red & moist
What are some features of acute rhinitis?
swollen, bright red mucosa

watery, clear discharge
What are some features of allergic rhinitis?
watery, itchy nose and eyes

sneezing

swollen turbinates
What are some causes of a perforated septum?
-snorting cocaine
-overuse of nasal sprays
-both
-injury
What do polyps in the nose look like?
smooth, grayish overgrowth of mucosa
What are the causes of polyps?
1. chronic allergies (usually)
2. neoplasms (must biopsy!)
3. snoring
4. choking
What can you suspect if palpation (or percussion) of sinuses reveals pain?
sinusitis or an infection
What is transillumination?
A red glow that shines through the mouth if the sinus is air-filled
Why is the mouth important?
It is the first segment of the digestive system and airway for the respiratory system

In addition, the mouth contains taste buds and aids in speech production
How many teeth are in adults?
32
How many teeth are in kids?
20 temporary (deciduous) teeth by 2 years old
What parts on the tongue are prominent on some people and should be there?
Vallate papilla on base of tongue
What are 3 possible causes of parotid swelling?
1. mumps
2. stone in duct
3. cancer
What is the name of the duct of the parotid gland?
Stenson's duct
What is the duct that opens from the submandibular gland?
Wharton duct
Can you check the ducts for the salivary glands?
Not really, there are too many openings
What should you inspect when looking at ducts?
check openings

push duct to see if saliva comes out (may need to suck on a lemon to assist this)
What is the number one sign for coagulation problems?
bleeding gums
What is dysphagia?
difficulty swallowing

*ask, is it with solids, liquids, or both
What parts of the body can you inspect through a physical exam of the mouth?
1. lips
2. teeth/gums
3. buccal mucosa
4. tongue
5. CN XII
6. CN IX and X
7. posterior pharyns and grade tonsils
What do healthy gums look like?
pink/coral with dotted surface
What is Stensen's duct?
opening of the parotid salivary gland

small dimple opposite the upper second molar
What is Wharton's duct?
opening of submandibular salivary glands

sublingual gland with many openings
What are fordyce spots?
normal

due to the entrapment of normally functioning sebaceous glands during development of the embryo. These spots are generally seen in the buccal mucosa in the retromolar area. There is no abnormality of the thin epithelial covering. No inflammation is present. The granules are observed as small, rounded elevations (maculopapules) of a yellowish-white color
What is torus platinus?
normal

a bony protrusion on the hard palate
How should a normal dorsal and ventral surface of the tongue appear?
dorsal: rough, some people have a thin white color

ventral: smooth
What grade of tonsils do children usually have? Why?
3+

because they're exposed to a lot of new agents

*abnormal in adults
What is the problem with large cryptic tonsils?
though a normal finding, food might get caught in the crypts

*best to advise to gargle
What is viral pharyngitis?
redness and vascularity of the pillars and uvula

may diffuse and be intense

patient complains of a sore throat (or at least a scratchy one)

*the back of the pharynx looks very red and cobblestone-like
Describe bacterial pharyngitis.
-red throat with exudate on tonsil
-tonsils appear nearly 4+
-fever and enlarged cervical nodes
What does the fever and enlarged cervical nodes of bacterial pharyngitis place a patient at risk for?
increased causal probability of group A streptococcal infection or infectious mono
What is a scrotal tongue?
Normal

tongue with fissures (caution: food might get caught)
What is a geographic tongue?
benign

no papilla on the tip of the tongue
How do you check CN XII (hypoglossal)?
Ask the patient to stick out the tongue and move it side to side

-should protrude midline
-note any tremors/deviations
**deviation occurs toward paralyzed side
How do you check CN X?
Ask patient to say "ah"

look for raise of UVULA and SOFT PALATE
Tonsil grade 1+?
visible
Tonsil grade 2+?
halfway between pillars and uvula
Tonsil grade 3+?
tonsils touching/almost touching uvula
Tonsil grade 4+?
tonsils touching each other

*may be a medical emergency
(ie mono is characterized by huge tonsils)
Tonsil grade 0?
tonsils absent