NOSE, REGURGITATION OF FOOD THROUGH

Ask the Following Questions:

1. Are there structural abnormalities on examination of the nasopharynx? Structural abnormalities of the palate indicate cleft palate, congenital short soft palate, trauma, tuberculosis, syphilis, carcinoma, leprosy, and post-tonsillectomy scarring.
2. Are the abnormalities congenital or acquired? Congenital abnormalities of the palate include cleft palate and congenital short soft palate. Acquired abnormalities of the palate include trauma, syphilis, tuberculosis, carcinoma, leprosy, and post-tonsillectomy scarring.
3. Is there paralysis of the soft palate? The finding of paralysis of the soft palate may suggest myasthenia gravis, poliomyelitis, Guillain-Barré syndrome, pseudobulbar palsy, brain tumor, basilar artery insufficiency, and syphilitic meningitis.
4. Is the paralysis of the soft palate intermittent or constant? Intermittent paralysis of the soft palate should suggest myasthenia gravis.
5. Are there associated hypoactive or hyperactive reflexes? The presence of hypoactive reflexes would suggest poliomyelitis or Guillain-Barré syndrome. The presence of hyperactive reflexes or sensory findings would suggest pseudobulbar palsy, a brain tumor, basilar artery insufficiency, and syphilitic meningitis, among other conditions.

DIAGNOSTIC WORKUP

Routine laboratory tests include a CBC, sedimentation rate, urinalysis, chemistry panel, VDRL test, smear and culture from the lesions in the nasopharynx, and a tuberculin test. A chest x-ray also should be done if tuberculosis is suspected. A neurologic workup consists of MRI of the brain, EMG and nerve conduction velocity studies, spinal fluid analysis, acetylcholine receptor antibody titers, and Tensilon tests. It is best to consult an ear, nose, and throat specialist or a neurologic specialist before ordering expensive diagnostic tests.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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