Extraoral Exam Flashcards
What is gait?
The way someone walks
Hemiphelgia is
paralysis on one side, usually from a stroke
Paraplegia is
paralysis on both sides
Hemiparesis is
weakness on one side
Paraparesis is
weakness on both sides
Ataxic is
w/o order least common form of cerbalplasia.
Gross incoordination of muscle movements
Parkinsonian is
tremor (clasps hands or hides it), rigidity, postural instability, hypokinesia
Parkinson’s gait
taking small, shuffling steps, jerky steps. moving more slowly than expected for you age.
Freezing gait
loose the ability to pick up their feet, which makes them “stuck” in place
Ataxia gait is
abnormal, uncoordinated movements. unsteady, staggering gait. Walking is uncoordinated and not ordered.
Causes of ataxia gait are
stroke, alcohol abuse, MS, Alzheimer’s
Proper way to interact with pt in wheelchairs
Avoid presumptions about a persons physical abilities, greet them the same as you would anyone else, speak directly to them, learn the locations of accessible ramps, doors, and parking, offer to help when appropriate.
Wheelchair transfer?
Yes, if possible. There may be a good head rest and a back recline which should take advantage of
If you must transfer a pt in a wheelchair, then
Position as close as possible, lock all wheels in place, fold footrests out of the way, ask pt. what works best (lifting under armpits, a belt?), and use ur legs
What is the pt stature and habits?
Statue: short to tall
Habitus: thin or obese
Marfan’s syndrome description
Genetic disorder - affects the body’s connective tissue
Marfans signs
Tall, thin, arachnodactily, wingspan>height, chest concavity, heart murmur? Possibly precuts excavated
Abnormalities of the spin
Scoliosis: side curvature
Kyphosis: round back
Head lice
The hair should be discreetly observed for nits (white eggs - not dandruff), new strain is resistant to most meds, dismiss pt and vacuum chair, fresh headrest cover for every pt
Facial landmarks /Users/ivysparlin/Desktop/IMG_9B4FF3C84C5A-1.jpeg
out canthus inner canthus ala philtrum tragus nasion
Head and neck exam
Head, eyes, ears, nose, throat.
Look for lumps in neck, hoarseness, scratchy throat that doesn’t get better. Pain in neck, jaw, or ears.
Head and facial form
is there symmetry?
Prognathic profile?
Retrognathic profile?
What are some questions to ask during a Head and neck exam?
Nosebleeds?
Congestion?
Trouble swallowing?
Look for skin lesions where and looks?
Hands, arms, neck, face, ears.
Rash, mole, patch
Are the skin lesions….
chronic, non-healing lesions?
Change in pre-existing lesions?
Sun exposure?
Basal Cell
Most common.
Middle 2/3 of face
Wont heal, bleeds easily, maybe heals then returns, blood vessels around them.
usually benign
More than 3 million cases/yr
Most this its from pad of glasses but it grows wide and deep
Squamous cell carcinoma
Irregular borders or crusty surface
Melanoma
Multiple colors and irregular borders
Eyes
Pupil - black? React equally to light?
Sclera: white?
Iris: colored?
Ptosis is
lid of eyes lag - sometimes a sign or a stroke
Ocular hypertelorism
excess spacing btw eyes - caused by formation of the sphenoid bone
Expothalmos
Bulging eyes, sign of hyperthyroidism, megligancy, graves disease
Yellow sclera of the eye
hepatotoxicity -> hepatitis or jaundice
Lymph nodes are
part of the lymphatic system (thymus, spleen, and bone marrow) and filters
Lymph node groups
Cervical (head/neck)
Axillary (underarm)
Inguinal (groin)
Internal (pelvic, abdominal, thoracic): cannot palpate
Cervical lymph nodes
300 in the head/neck area/800 in body.
Submental, submandibular, parotid/jugulodigastric, preauricular, postauricular, occipital, anterior cervical chain, supraclavicular, posterior cervical chain
Healthy lymph nodes
Soft like a grape vs firm like a ball
Moveable vs. fixed (attached)
Lymphadenopathy
any abnormality in size, consistency, and number.
Describe any abnormality fully: location, size, tenderness, consistency, mobility
Lymph nodes abnormalities
enlargement/tenderness (usually cold/local infection)
Change in firmness (rubbery - possible cancer)
Fixed - attached to underlying tissue (possible cancer)
Cervical lymph node enlargement - what do you do?
Rule out infection - teeth, tonsils, respiratory.
Search for cancer
Watch for 2 weeks, if still present: refer to ENT
Clues to routine swelling from recent infection
tender, mobile, current or recent viral infection, bilateral, predictable locations, long duration without change
Mumps
infection of the parotid gland: swelling in the cheek + sore lymph nodes
Thyroid
Larynx and trachea (windpipe)
“Adam’s apple”
Thyroid exam
gently place fingers on either side of Adam's apple then slide to just below it ask pt to swallow fell gland rise up, then drop back feel for any asymmetry or lumps
Lip landmarks
philtrum, vermillion border, commissures (angles or corners)
Angular chelitis where and why?
corners of mouth (saliva builds up), usually candida. Caused by drooling or dry mouth, elderly, immunosuppressed, anemic, kids with binkys
TMD
Collection of symptoms. 20% of US. 85.4% women. Primarily ages 20-40
TMD symptoms
joint pain (76%) headaches (82%) ringing ears = tinnitus insomnia neck ache dizziness teeth sens to H and C
TMD diagnostic classes
Muscle, soft tissue of the joint, or hard tissue of the joint
Causes of TMD
Bruxism, clenching, stress, malocclusion, arthritis, trauma, ergonomics
TMJ screening questions
- Do you have difficulty, pain or both when opening you mouth wide?
- Does your jaw get “stuck” or “locked or “go out”
- Do you have difficulty, pain or both when chewing, talking or using your jaw?
- Are you aware or noises in the jaw joints?
- Do you have pain in or around the ears, temples, or cheeks?
- Does your bite feel uncomfy or unusual?
- do you have frequent headaches?
- have you had a recent injury to your head, neck or jaw?
- When did this pain start? Emotional trigger? Trauma trigger?
- Have you previously been treated for a jaw joint prob? if so, when?
TMJ palpation
palpate bony prominence - just anterior to ear, start off light, then add to moderate pressure, “any discomfort?”
then have pt open and close, “any discomfort?”
then palpate all around joint
TMJ diagnostic exam
measure range of motion (opening and right and left lateral)
palate for crepitus (grinding and clicking while opening and closing
palpate for tenderness in the master and temporals muscles
Muscles of mastication
masseter, temporalis, 4-6 lbs pressure, tenderness scale (0 = no discomfort and 3= extreme sensitivity)
TMD exam
excessive tooth mobility, migration in the absence of perio ds, buccal mucosal ridging, lateral tongue scalloping, inspect symmetry and alignment of - face, jaws, and dental arches
Treatment of TMD
Stabilization appliance therapy - repositioning splint, night guards, and localized interference guards.
Meds: anti-inflammatory, antianxiety
TENS: transcutaneous electrical nerve stimulation
Surgery: very rare
Sources of TMD
Occlusion, trauma, emotional stress, referred pain form CV disease?
TMJ and occlusion
pure canine guidance only 20% of US, greater the slide = greater the instability, can have stable malocclusions
= adaptation
Referred pain
Temporalis = generally ant teeth Masseter = generally post teeth
