1/4 Extraoral Exam Flashcards
1
Q
How must an exam be performed to ensure that no parts are missed?
A
Thoroughly & systematically
2
Q
What happens to an exam with experience?
A
examination will become
second nature and can be done quickly, but at
first, it must be broken down into steps
3
Q
What is important to know regarding an exam?
A
What normal is so that you can identify if there is an abnormality
4
Q
What is a ‘normal’ exam classified as?
A
Found in most individuals
5
Q
What is an ‘atypical’ exam classified as?
A
Not present in all individuals but still within normal limits (a variation of normal)
6
Q
What is a ‘pathologic’ exam classified as?
A
Associated with infection, trauma, neoplastic growth, errors in development
7
Q
What are the four types of gait?
A
Hemiplegia
Paraplegia
Hemiparesis
Paraparesis
8
Q
What is hemiplegia?
A
Paralysis one side, usually from stroke
9
Q
What is paraplegia?
A
Paralysis both sides
10
Q
What is hemiparesis?
A
Weakness one side
11
Q
What is paraparesis?
A
Weakness on both sides
12
Q
What does it mean if a patient is ataxic?
A
Presence of abnormal, uncoordinated movements
13
Q
What does ataxic gait describe?
A
Signs and symptoms without reference to specific diseases
14
Q
What is parkinsonian gait?
A
Taking small, shuffling steps
15
Q
What are signs of parkinsonian gait?
A
Tremor
Rigidity
Postural instability
Hypokinesia
16
Q
What does parkinson’s gait look like?
A
- moving more slowly than expected for your age
- taking jerky steps
- freezing of gait: losing the ability to pick up their feet, which makes them “stuck” in place
17
Q
What are the 5 ways to interact with wheelchair riders?
A
Avoid
Greet
Speak
Learn
Offer
18
Q
If you must transfer a wheelchair patient, what should you do?
A
- position wheelchair as close as possible
- lock all wheels in place
- fold footrests out of way
- ask pt. what works best
- use your legs
19
Q
What are the types of stature and habitus?
A
Stature - short, tall
Habitus - thin, obese
20
Q
What type of disorder is Marfan’s syndrome?
A
Genetic disorder - affects the body’s connective tissue
- rectus excavatum
- arachnodactyly
- dilation of the aorta
21
Q
What are signs of Marfan’s syndrome?
A
Tall
Thin
Arachnodactily
Wingspan > height
Chest concavity
Heart murmur
22
Q
What is scoliosis?
A
Side curvature
23
Q
What is kyphosis?
A
Roundback
24
Q
What are signs of head lice?
A
Nits
- white egg cases
- not dandruff!
25
What should you do with a patient who has head lice?
- new strain is resistant to most meds
- dismiss pt and vacuum chair
- fresh headrest cover for every patient
26
Name the 6 facial landmarks and where they're located
1. Outer
canthus
2. Inner canthus
3. Ala
4. Philtrum
5. Tragus
6. Nasion
27
What are aspects of a head and neck exam?
Head
Eyes
Ears
Nose
Throat
28
What are the three types of head and facial forms?
Normal profile
Prognathic profile
Retrognathic - mandible sits backwards
29
What should you look for in a head and neck exam?
Lumps in neck, hoarseness, scratchy throat that doesn't get better!!, pain in neck, jaw or ears, nosebleeds, congestion
30
What are complications of cancer?
Adverse bleeding
Side effects of drugs
Infection
Immunocompromised
31
What are types of cancer precautions?
Chemotherapy, immunocompromised
Head and neck radiation therapy
Med consult
32
What are side effects of head and neck radiation therapy?
Xerostomia
Mucosal irritation
Cervical caries
33
What kind of skin lesions should we pay attention to?
Chronic, nonhealing lesion
Change in pre-existing lesion
Sun exposure
Rash, mole, patch
34
What is the most common extraoral skin cancer?
Basal cell cancer
35
What are characteristics of basal cell cancer?
Middle 2/3 of face
Won't heal
Usually, benign (not harmful)
More than 3 million cases in the US per year
36
What are characteristics of squamous cell carcinoma?
Irregular borders
"Crusty" surface
Persistant thick roughly scaly patches that may bleed
Comprises 90% of all oral cancers
37
What are characteristics of melanoma?
Multiple colors
Irregular borders
Flat or slightly raised borders and somewhat asymmetrical in form
38
What are nodular melanomas?
Aggressive lesions that have only a vertical growth
- highly infiltrative
39
What are the parts of an eye?
Pupil: black
Sclera: white
Iris: colored
40
What is ptosis?
Lid lag
- sometimes sign of past stroke
41
What is ocular hypertelorism?
Excess spacing between the eyes
42
Should pupils react equally to light?
Yes
43
What is exophthalmos?
Abnormal protrusion of the eye
- sign of hyperthyroidism
44
What is a sign of hepatotoxicity?
Yellow sclera
45
What are lymph nodes?
Filters
Part of lymphatic system
- thymus
- spleen
- bone marrow
46
Where are lymph nodes grouped?
Cervical (head/neck)
Axilalry (underarm)
Inguinal (groin)
Internal (pelvic, abdominal, thoracic): Can't palpatate
47
Where are the 9 locations of lymph nodes?
1 = submental
2 = submandibular
3 = tonsillar/
jugulodigastric
4 = preauricular
5 = postauricular
6 = occipital
7 = ant. cervical
chain
8 = supraclavicular
9 = post. cervical chain
48
What are submental lymph nodes?
Just below the chin
49
What are submandibular lymph nodes?
3-6 nodes, beneath the body of the mandible
50
Tends to be some of the largest lymph nodes in the cervical chain due to
their significant lymphatic drainage
It does
decrease in size with age in a cancer free patient.
tonsillar/jugulodigastric lymph nodes
51
What are nodes that lie both on top and beneath the sternocleidomastoid muscles (SCM) on either side of the neck, from the angle of the mandible to the top of the clavicle?
Anterior cervical chain lymph nodes
52
What are lymph nodes in the hollow above the clavicle,
just lateral to where it joins the sternum?
Supraclavicular
53
What are lymph nodes that extends in a line posterior
to the SCM but in front of the trapezius?
Posterior cervical chain
54
Infected lymph nodes tend to be...
Firm, tender, enlarged, warm
Inflammation can spread to the overlying skin, causing it to appear reddened
55
Dedscribe malignancies in lymph nodes
These nodes tend to be-firm, non-tender, matted (stuck to each other), fixed ( not freely mobile but attached to underlying tissue) and increase in size
over time
56
What is the lymph node palpatation sequence?
1. Ahead and behind ear
2. Slide down to under angle of mandible
3. Slide down to SCM
- turn head opposite way
- anterior and posterior borders
4. Slide down to above collarbone
57
What should healthy lymph nodes look like?
Soft like a grape
Movable
58
What is lymphadenopathy?
Any abnormality in lymph:
Size
Consistency
Number
59
Describe a lymphadenopathy abnormality?
Location
Size (<1cm>)
Tenderness
Consistency
Mobility
60
Where is lymphadenopathy most common?
Cervical (head nad neck)
61
What are clues to routine swelling from recent infection?
Tender
Mobile
Current or recent viral infection
Bilateral (but not always)
Predictable locations
Long duration without change
62
What are mumps?
Infection of the parotid gland: swelling in the cheek and sore lymph nodes
63
Where is the thyroid located?
Inferior to the larynx and just superior to the clavicles
64
Is the thyroid palpable?
Most often not
65
Describe the steps of the thyroid exam?
1. Gently place fingers on
either side of Adam’s Apple
2. Then slide to just below it
3. Ask patient to swallow
4. Feel gland rise up, then
drop back
5. Feel for any asymmetry or
lumps
66
What are the landmarks of the lip?
Philtrum
Vermillion border
Commisures
- "angles"
- "corners"
67
What is angular cheilitis?
Corners of mouth
Usually candida
68
Who do temporomandibular disorders effect?
20% of U.S.
85.4% of women
Common condition in adults but becoming more pervalend in adolescents and children
69
What are TMD symptoms?
Joint pain
Headaches
Tinnitus–ringing in the ears
Insomnia
Neck ache
Teeth become sensitive to hot, and
cold-
This is one of the 1st signs of bruxism
70
What are causes of TMD?
Bruxism
Clenching
Stress
Malocclusion
Arthritis
Trauma
Stimulants
71
What are 3 broad diagnositc classes of temporomandibular disorders?
Muscles
Soft tissues of the joint
Hard tissues of the joint
72
What are types of referred pain?
Tempralis = generally ant teeth
Masseter = generally post teeth
73
What are TMJ screening questions?
Do you have difficulty, pain or both when opening your mouth wide (yawning, etc)?Does your jaw get “stuck,” “locked,” or “go out”?
Do you have difficulty, pain or both when chewing, talking or using your
jaws?
Are you aware of noises in the jaw joints?
Are you aware of noises in the jaw joints?
Do you have pain in or around the ears, temples, or cheeks?
Does your bite feel
uncomfortable or unusual?Do you have frequent
headaches?
Have you had a recent injury to your head, neck, or jaw?Have you previously been
treated for a jaw joint problem? If so, when?
74
What are the steps of palpate for TMJ?
1. Bony prominence anterior to ear
2. have pt open and close
3. "any discomfort?"
4. look for altered opening and closing pathways, abnormal sounds, tenderness, and limitations in opening
75
What are the steps of a TMJ diagnostic exam?
1. Measure range of motion
- opening
- right and left lateral
2. Palpate for crepitus
(grinding) & clicking
while opening and
closing.
3. Palpate for tenderness in
the masseter and
temporalis muscles
76
What should you pay attention to in a TMD exam?
Excessive tooth mobility
Widened PDL seen
radiographically
Migration in the absence of
perio ds
Buccal mucosal ridging
Lateral tongue scalloping
Inspect symmetry and
alignment of Inspect symmetry and alignment of face, jaws, dental arches
77
What are night guards/bruxism splints-used to?
1. Redistribute
occlusal forces
2. Relax the
masticatory muscles
and stabilize the
joint
3. Protect dentition
and dental work
78
What are meds for TMD?
Anti-inflammatory (NSAIDs)
Anti-anxiety
Muscle relaxers
79
What do anti-inflammatory ot NSAIDs do for TMD?
used for joint pain, inflammation, and
stiffness
Tend to be inexpensive,
easily accessible and well
tolerated
80
What do anti-anxiety meds do for TMD?
Help relieve the stress that may aggravate RMD
81
What do muscle relaxers do for TMD?
Relax muscles and decrease spasms
- botox lasts 3-4 months not FDA approved for TMD
82
How does physical therapy help for treatment of TMD?
Helps ease pain and increase movement and normal jaw function
Surgery: very rare
83
What is treatment of TMD?
Joint rest and reducing jaw movement. Keeping teeth slightly ajar
Soft-food diet
Medications to relieve pain and/or relax muscles
Hot or cold compresses
TMJ physical therapy
Wearing of a night guard/splint
84
