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HEENT Nose, Mouth
HEENT Examination
| Question | Answer |
|---|---|
| First segment of the respiratory system | Nose |
| Warms, moistens and filters inhaled air | Nose |
| Sensory organ for smell | nose |
| Resonance of laryngeal sound | nose |
| Divides nasal cavity in two | Nasal Septum |
| a vascular network located superficially on the anterior superior portion of the septum | Kiesselbach plexus |
| site of most anterior nosebleeds | Kiesselbach plexus |
| air-filled paired extensions of the nasal cavities within the bones of the skull | Paranasal sinuses |
| lined with mucous membranes and cilia that move secretions along excretory pathways | Paranasal Sinuses |
| drained into the medial meatus | paranasal sinus |
| Serve as resonators for sound Provide mucous for the nasal cavity | paranasal sinuses |
| Only sinuses available to examination | Frontal and maxillary |
| nasal breathing should be noiseless and easy thru the open nares | True |
| Nasal Mucosa | should appear deep pink ( pinker than the buccal mucosa) & glistening |
| In normal adult, the nasal septum is seldom precisely a midline structure | True |
| a film of clear discharge is often apparent on the nasal septum | Nasal Septum |
| only the inferior and middle turbinates will be visible | True |
| lesion of CN 1 or nasal obstruction - commonly due to closed head trauma - invariably accompanied by a perceived change in taste of food ( bland & unpalatable | Loss of smell ( anosmia |
| this is a common complaint in patients who have loss of smell | Abnormal smell/ taste ( dysgeusia |
| if it is paroxysmal and associated with behavioral symptoms, it suggests complex partial seizures | Abnormal smell/ taste ( dysgeusia |
| Describe as to its character ( watery, mucoid, purulent , bloody | Nasal Discharge |
| Unilateral nasal discharge indicative of this | Choanal atresia Head injury or surgery |
| Bilateral nasal discharge indicative of this | Allergies Infection |
| most common site posteriorly | Back 3rd of the Inferior Meatus |
| most common site of bleeding anteriorly | Kiesselbach plexus |
| Causes of generalized epistaxis | Congenital :hereditary telangiectasia Inflammatory/immune : Wegener granulomatosis Infectious : typhoid fever, dengue, diphtheria Metabolic/toxic :aspirin, scurvy |
| Causes of generalized Epistaxis | Mechanical : change in atmospheric pressure ( mountain climbing, flying), exertion Neoplastic : nasopharyngeal Ca, leukemia Vascular: hemophilia, thrombocytopenia |
| Causes of generalized Epistaxis | Trauma: nasal and maxillary fracture Elevated venous pressure: Cor pulmonale Congestive Heart failure Elevated arterial pressure : HPN,coarctation of aorta |
| causes of a hole in the nasal septum | chronic infection, nasal surgery, repeated trauma in picking off crusts ,cocaine abuse Sy, TB |
| Acute Rhinitis | Rhinoviruses infect the mucous membranes of the nose & sinuses causing inflammation and inc. nasal secretions |
| Vasomotor Rhinitis | nonallergic mucosal edema and rhinorrhea ass. with vasodilatation of the nasal vessels, mucosal edema & inc. mucous production |
| Suppurative Paranasal Sinusitis | due to Strep. pneumonia, H. influenza severe pain in the face occuring 7-14 days after signs & symptoms of an acute URTI pain & pressure without fever suggest sinus obstruction requiring decongestants |
| Cavernous Sinus Thrombosis | This is the most feared complication of nasal infections. It can cause blindness or death Infection spreads from the nose>angular veins> cavernous sinus> septic thrombosis |
| Symptoms of Cavernous Sinus Thrombosis | patient complains of pain deep in the eyes - Both eyes are involved, immobilization of the globes, periorbital edema, chemosis May involve CN 3,4, &6 Sudden chills, high fever, prostated, comatose, death within 2-3 days |
| First segment of the digestive system | Mouth |
| Airway for the respiratory system | Nose, Mouth |
| largest of the glands, located in the cheeks, front of the ear. Stenson’s duct opens in buccal mucosa | Parotid Gland |
| walnut size, beneath the mandible at the angle of the jaw. Wharton’s duct either side of the frenulum | Submandibular Gland |
| smallest, almond shape, under tongue | Sublingual gland |
| continues from the oropharynx but it is above it and behind the nasal cavity | Nasopharynx |
| Examination of the mouth | Hold the tongue blade in the left hand and penlight in the right hand |
| Lip examination | should be pink , smooth surface, free of lesions. - distinct border between the lips and facial skin should not be interrupted by lesions - Vertical and horizontal symmetry both at rest and with movements |
| Teeth examination | ask patient to clench his/her teeth , smile and observe the occlusion of the teeth. - facial nerve is also tested Make sure teeth are firmly anchored, probing each with a tongue blade Generally ivory white in color with 32 permanent teeth in adults |
| Examining the buccal mucosa | with mouth open, using a tongue blade,inspect for color, pigmentation, nodules,white patches- normally pinkish red, smooth, moist- orifice of the stensen duct should appear as a whitish yellow or whitish pink |
| in normal adult, tonsils seldom protrude beyond the faucial pillars | true |
| surface of the tonsils have crypts where cellular debris and food collect | true |
| examining the pharynx | It should be smooth and glistening pink mucosa with some irregular spots of lymphatic tissue and small blood vessels Test CN 9 and 10 touch the posterior wall of the pharynx on each side (+) gag reflex |
| dry cracked lips due to dehydration from wind chapping, dentures , braces, or excessive lip licking | chelitis |
| cause of angular cheilitis | due to candidiasis |
| Cheilosis ( angular stomatitis | ulcerations of skin at the corners of the mouth due to crusting 2ndary to riboflavin deficiency or ill fitting dentures |
| due to incomplete fusion of the frontonasal process with the 2 maxillary processes | cleft lip |
| congenital failure of the fusion of the maxillary process | cleft palate |
| Grade size 1+ visible …………….2+ ½ way b/t tonsillar pillars and uvula …………….3+ touching the uvula …………….4+ touching each other | tonsil grading |
| Acute viral pharyngitis | mucosa of oropharynx shows lymphoid tissue are elevated but noo edema - sore throat, rhinorrhea, malaise, myalgia |
| Streptococal or staphylococcal pharyngitis | Pharyngeal mucosa is bright red, swollen, edematous studded with white or yellow follicles Tonsils maybe enlarged |
| Pharyngeal diptheria | patch of white membrane in the tonsils. - pharyngeal mucosa bleeds on surface, reddened , reddened, swollen ,edematous |
| Candidiasis | shining raised white patches on posterior pharynx, buccal mucosa and tongue |
| causes of bleeding gums | traumatic – toothbrush, laceration, dental caries, tartar on the teeth infection – pyorrhea alveolaris, stomatitis neoplasm – epulis, papilloma of gums Scurvy, syphilis Metal poisoning :phosporous, lead, mercury |
| scurvy effect on gums | tender , swollen, spongy and easily bleeds - due to scurvy ( ascorbic acid deficiency) |
| Periodontitis ( Pyorrhea Alveolaris) | lower teeth are involved - with purulent and retracted gums |
| Epulis | fibrous tumor arising from periosteum and emerges from between the teeth |
| most common cause of hoarseness | acute laryngitis |
| laryngeal edema | signs of obstruction – hoarseness, dyspnea and stridor |
| Laryngeal spasm | acute obstruction of the upper airways accompanied by hoarse brassy cough, dyspnea in children - due to allergy, infection, FB, neoplasm |
Created by:
betahelix
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