otoscope, you can get a partial view of each nasal vestibule. Note unusual skin markings,
obvious deviation of the septum (asymmetry), discharge, or flaring of the nares. If the
patient has a history of trauma to the nose, ask if there has been a change in his ability to
smell. The nose, in conjunction with the paranasal sinuses, filters, warms, and moistens
the air. The paranasal sinuses are air-filled cavities with ciliated mucous membrane
linings. Only the frontal and maxillary sinuses are accessible to physical examination.
(5) Examine the throat. Include the lips, teeth, gums, tongue, buccal mucosa,
uvula, and tonsils (figure 6-6). Observe the color and moisture of the lips. Note any
cracking, lumps, or ulcers. Look into the patient's open mouth. Use a tongue blade and
light to inspect the buccal mucosa for color, pigmentation, ulcers, white patches, and
nodules. Patchy brown pigmentation is normal in black people. If the patient wears
dentures, offer a container or paper towel and ask the patient to remove them so that you
can look at the mucosa underneath. Look for swelling, bleeding, retraction, discoloration,
and inflammation of the gums. Look for loose, missing, or carious teeth. Note
abnormalities in the position or shape of the teeth. Inspect the back, sides, and
undersurface of the tongue. Explain what you plan to do and put on gloves. Ask the
patient to stick out his tongue. With one hand, grasp the tip of the tongue with a square of
gauze and gently pull it to the side. Inspect the side of the tongue, and then palpate it with
your other gloved hand, feeling for any hardening of tissue. Reverse the procedure for the
other side of the tongue. With the patient's mouth still open, press the tongue blade down
upon the midpoint of the arched tongue and inspect the uvula and tonsils. Note any
evidence of pus, swelling, ulceration, or tonsillar enlargement. Whitish spots of normal
tissue may sometimes be seen on the tonsils. White patches with redness and swelling,
however, suggest pharyngitis. Break and discard the tongue blade after use. Inspect the
neck, noting its symmetry and any masses or scars. Look for enlargement of the parotid
or submaxillary glands, and note any visible lymph nodes.
NOTE: Determine the last medical check-up in each of these areas and the patient's need
for corrective devices such as glasses, hearing aid, or braces.
Figure 6-6. Oral cavity.