코, 부비동, 구강 및 인두 검사
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Q1: What are the main functions of the nose?
The nose performs four critical functions: detecting smell, warming inspired air, moistening it, and filtering particles. The upper third of the nose is bony, while the bottom two-thirds is cartilaginous. Air passes through the nasal vestibules into a narrow passageway between the nasal septum and bony turbinates before reaching the lungs.
Q2: How do you inspect the nasal cavity during a physical exam?
Use an otoscope with the largest available ear speculum. Tilt the patient's head back slightly and gently place the speculum in the nasal vestibule, holding the handle perpendicular and away from the chin. Gradually move posteriorly and angle upward to visualize the inferior and middle turbinates, nasal septum, and intervening passage. Note mucosal color, which is normally pinkish.
Q3: What do different nasal mucosa colors indicate during examination?
Mucosal color reveals underlying pathology. Normal mucosa appears pinkish due to abundant vascular supply. Viral infections produce a deep red mucosa, while allergies produce a pale bluish appearance. These color changes help differentiate the cause of nasal symptoms and guide clinical decision-making.
Q4: How do you palpate the frontal and maxillary sinuses?
Position your first and second fingers on top of the patient's forehead while firmly pressing your thumbs upward under the bony brows, avoiding eye pressure. Move your thumbs down and press firmly on the cheeks just medial and inferior to the zygomatic bone. Tenderness suggests acute sinusitis, especially if accompanied by facial pain, fever, and purulent nasal discharge.
Q5: What structures should you inspect when examining the oral cavity?
Inspect the lips for color, moisture, ulcers, or cracking. Examine the gingiva for bleeding, ulcers, or swelling, and check for missing, discolored, misshapen, or loose teeth. Inspect the tongue for ulcerations, plaques, masses, or discoloration, particularly on the sides and base where oral cancers commonly develop.
Q6: What is the lingual frenulum and where is it located?
The lingual frenulum is a midline fold of tissue connecting the undersurface of the tongue to the floor of the mouth. Located near this structure are the Wharton ducts, which drain the submandibular glands into papillae on either side. Examining this area helps identify swelling, ulcerations, or other abnormalities affecting the floor of the mouth.
Q7: How do you properly examine the pharynx and what should you look for?
Request the patient to open their mouth wide and say 'ah' while watching the soft palate rise. Inspect the uvula, anterior and posterior pillars, tonsils, and pharynx for symmetry, discoloration, ulcerations, swelling, masses, or tonsillar exudate. If visualization is unclear, have the patient repeat while firmly pressing down on the tongue with a depressor, taking care not to gag the patient.