NRSE2231- Ch. 17 Mouth, Nose, Throat Abnormalities

Retention cyst (Mucocele)

-a round, well-defined, translucent nodule that may be very small or up to 1 to 2 cm. -a pocket of mucous that forms when a duct of a minor salivary gland ruptures

Carcinoma on tongue presents as:

-an ulcer with rolled edges; Indurated -loc: sides, base and under the tongue -may go unnoticed for months -rich lymphatic draining increases risk for metastasis

Acute rhinitis (non allergic)

-clear, watery discharge, rhinnorhea, which later becomes purulent -sneezing, nasal itching -stimulation of cough reflex and inflamed mucosa -Turbinates are dark red and swollen

Meth mouth r/t

-crystal meth abuse -we see extensive dental cavities

Dry mouth (Xerostomia) is common in:

-older adults due to side effects of many drugs: Antidepressants, antichoallergenics, antispasmodics, antihypertensives, antipsychotics, bronchodilators

Four features that indicate Streptcoccal Pharyngitis

1) absence of cough 2) swollen and tender cervical lymph nodes 3) fever above 100.4 4) tonsillar exudates

Tonsil grading

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

How long should you wait to investigate a lesion?

2 weeks

Epulis

A benign, nontender fibrous nodule of the gum emerging between the teeth; An overgrowth of vascular granulation tissue

Tooth avulsion is caused by:

A traumatic injury may dislodge a primary or permanent tooth from its socket

oral Kaposi sarcoma is the most common early lesion in people with ______.

AIDS

Seasonal allergies rhinitis (AR or hay fever)

AR is an abnormal immune response from repeated exposure to antigens. Turbinates are usually pale and their surface looks smooth and glistening

Dappled brown patches are present with...

Addison's disease

When is saliva present in children?

After 3 months

A bifid uvula is most likely to be seen in which patients?

American Indian

In light skin people, acidosis is r/t?

Asprin poisoning or ketoacidosis

Leukoedema presentation:

Benign, milky, bluish-white opaque appearance of the buccal mucosa that occurs commonly in African Americans and east indians

African American lips are usually:

Bluish and have a dark line on the gingival margin

Acute Tonsillitis and Pharyngitis present as:

Bright red throat, swollen tonsils, white or yellow exudate on tonsils and pharynx, swollen uvula, and enlarged, tender anterior cervical and tonsillar nodes. Sore throat, painful swallowing, fever.

Nursing bottle caries presentation:

Brown discolorations on upper front teeth

Oral Kaposi Sarcoma presents as:

Bruise-like, dark red or violet, confluent macule, usually on the hard palate, may be on soft palate or gingival margin

When should a child have all 20 teeth?

By 2 and a half

In light skinned people, cherry red lips occur with what?

Carbon monoxide poisoning

Dental cavities

Cavities, progressive destruction of tooth, later turns brown or black

Who has a higher incidence of GAS (Group A Strep.)?

Children 5-15 years old

Inability to cross catheter through nasal cavity indicates...

Choanal atresia

Transverse bridge in children occurs with:

Chronic allergies from wiping nose

Gingivits presents as:

Crevices between teeth and gums, pockets of debris; Bleeding with slight pressure is indicative of this

Fissured or Scrotal Tongue presents as:

Deep furrows divide the papillae into small irregular rows

Dry mouth occurs with..

Dehydration, fever; tongue has deep vertical fissures

Baby bottle tooth decay

Destruction of numerous deciduous teeth may occur in infants and toddlers who take a bottle of milk, juice, or sweetened drink to bed and prolong bottle-feeding past the age of 1 year. Liquid pools around the upper front teeth. Mouth bacteria act on carbohydrates in the liquid, especially sucrose, forming metabolic acids. Acids break down tooth enamel and destroy its protein.

Fissured or Scrotal Tongue is seen with:

Down Syndrome and people with a hx of chronic smoking/alcohol use

Tooth eruption can be delayed due to...

Down Syndrome, rickets, cretinism. Bottle feeding, thumb sucking

An enlarged tongue (macroglossia) may accompany:

Down syndrome; it also occurs with cretinism, myxedema, and acromegaly

Koplik spots are a diagnostic indicator of:

Early prodromal (early warning) sign of measles

Angular Cheilitis (Stomatitis, Perleche)

Erythema, scaling, and shallow and painful fissures at the corners of the mouth occur with excess salivation and Candida infection.

Group A Strep presents with:

Fever over 100.4, absence of cough, tonsillar exudates and cervical adenopathy -Confirm with rapid antigen test and throat culture

A patient undergoing diabetic ketoacidosis has what type of breath odor?

Fruity odor

Excess saliva and drooling occur with?

Gingivostomatitis and parkinson disease

Pregnant women gums may present with:

Gum hypertrophy (pregnancy gingivitis)

Enlarged tongue occurs with...

Hypothyroidism, acromegaly

In light skinned people, cyanosis can be r/t:

Hypoxemia and chilling

Gingivitis

Inflammation of the gums

Sinusitis

Inflammation of the sinuses

A dark line on gingival margins occurs with what?

Lead poisoning and bismuth poisoning

Thrombophlebitis

Lemierre syndrome, rare but life threatening condition caused by gram negative F nephorom leading to sepsis

Small tongue occurs with...

Malnutrition

Enlarged tongue

May protrude from mouth. Not painful but may slur speech

When might a white membrane be covering the tonsils?

Mono, leukemia and diphtheria

Rhinitis presents as:

Nasal mucosa is swollen and bright red with URI, discharge is common, varying from watery and copious to thick, purulent and green yellow

Are tonsils visible in the newborn?

No

Torus palatinus is defined as:

Nodular bony ridge down the middle of the hard palate

Gingival hyperplasia

Painless enlargement of the gums, sometimes overreaching the teeth; Occurs with puberty, pregnancy, and leukemia

Bifid uvulua

Partly severed and may indicate sub mucous cleft palate which feels like a notch at the junction of the hard and soft pallets

Untreated Group A strep can lead to what?

Peritonsillar abscess, rheumatic fever, glomerulonephritis

What occurs with dysphagia?

Pharyngitis, gastroesophageal reflux disease, stroke and other neurological diseases, esophageal cancer

In light skinned people, pallor can be r/t:

Shock and anemia

Suckering tubercle presents as:

Small pad in the middle of the upper lip from friction of breastfeeding or bottle feeding

Fordyce granules

Small, isolated, white or yellow papules on oral mucosa -painless and not significant

Epstein pearls (presentation)

Small, white, round epithelial cysts on the hard palate and along the gum margins

Nasal polyps

Smooth, pale gray nodules (overgrowth of mucosa) from chronic allergic rhinitis. Middle meatus

Polyps Presentation:

Smooth, pale gray, avascular, mobile, nontender

How does mucosa look with chronic allergies?

Swollen, boggy, pale, and gray

Cleft palate

The failure of the palate to close during the early development of the fetus

Carcinoma

The initial lesion is round and indurated, it becomes crusted and ulcerated with an elevated border. -most occur between the outer and middle thirds of the lip -any lesion that is unhealed after 2 weeks should be referred

Where are high risk sites for oral squamous cell cancer?

The lateral and ventral tongue, the floor

Stenson duct is the:

The opening of the parotid gland that runs forward to open at the buccal mucosa opposite the upper second molar

What should you do when a pt has a nosebleed?

Tilt head forward, pinch soft part of nose above nostrils for 10-15 minutes

When does epistaxis (Nosebleedes) occur?

Trauma, vigorous nose blowing, foreign body

Bednar apthae are what?

Traumatic areas or ulcers on the posterior hard palate on either side of the midline. They result from abrasions while sucking.

Peritonsillar Abscesses are r/t:

Untreated acute step -suppurative complications, pentitonsillar complications, abscess or thrombophlebitis

How should you palpate the sinuses?

Using your thumbs, press up and under the eyebrows and over the maxillary sinuses below the cheekbones -Person should feel firm pressure but no pain

Bifid uvula

Uvula split in two, common in American indians

When does Rhinorrhea occur?

With colds, allergies, sinus infection and trauma

When does the hard palate appear yellow?

With jaundice

In blacks with jaundice, how does the hard palate appear?

Yellow, muddy yellow, or green brown

Chonal Atresia is:

a congenital bone septum between the nasal cavity and the pharynx is not common in the newborn

Deviated septum presents as:

a hump or shelf in the nasal cavity; Not significant unless airway is obstructed

Which medication will decrease saliva production?

anticholinergic medications

Furuncle presentation

appears red and swollen and is quite painful

A perforated nasal septum presents as:

as a spot of light from a penlight -occurs with cocaine use

Viral Pharyngitis presents as:

erythematous tonsils with no hypertrophy or exudate

Streptococcal Pharyngitis would present as:

erythematous, enlarged tonsils with exudates

Nasal bridge in black and asian children is usually:

flat

Retention cyst (Mucocele) may occur where?

on the buccal mucosa, on the floor of the mouth, or under the tip of the tongue.

Nasal flaring in the infant r/t:

respiratory distress

Perforated septum is usually caused by:

snorting cocaine, chronic infection, trauma of picking crusts or nasal surgery

A tooth from a tooth avulsion must be:

stored in milk because dry storage runs risk of necrosis

Epitaxis (nosebleed) most common site:

the Kiesselbach plexus in the anterior septum

Meth results in:

vasoconstriction and decreased saliva, increases the urge to consume sugars

Herpes simplex

"Cold sores"; clear vesicles with red base that evolve into pustules, usually at lip-skin junction

Aphthous Ulcers presents as:

"canker sore" -a vesicle at first, then small round punched out ulcer -painful

Furuncle

- a small boil located in the skin or mucous membrane -avoid any manipulation or trauma that may spread the infection.