Extraoral Exams Flashcards
What are some examples of atypical structures in the mouth?
tori
3rd molar prevelance
What term is associated with
infection, trauma, neoplastic
growth, errors in development?
pathologic
What term is not present in all
individuals but still within normal
limits ( a variation of normal)?
Atypical
What is hemiplegia?
paralysis one side (usually from stroke)
What is paraplegia?
paralysis both sides
What is hemiparesis?
weakness one side
What is paraparesis?
weakness on both sides
What type of gait is ataxic?
presence of abnormal,
uncoordinated movements
What type of gait is parkinsonian?
motor disturbances-resting tremors
- Tremor
- Rigidity
- Postural instability
- Hypokinesia
What type of gait is known from small, shuffling steps?
parkinson’s gait
What should you do when interacting with wheelchair riders?
- avoid presumptions about a person’s physical ability
- greet them the same as anyone else
- speak directly to the person using the wheelchair
- learn the locations of accessible areas
- offer to help when appropriate
How should you perform a wheelchair transfer?
- Position wheelchair as close as possible
- Lock all wheels in place
- Fold footrests out of way
- Ask pt. what works best (Lift under armpits? Hold onto belt in back?)
- Use your legs!
What are the two different statures and habitus?
stature - short, tall
habitus - thin, obese
What genetic disorder affects the body’s connective tissue?
marfan’s syndrome
How many people does marfan’s syndrome affect?
1 - 5,000
What are the symptoms of marfan’s syndrome?
tall
thin
arachnodactily
wingspan > height
chest concavity
heart murmur
What is an abnormal side curvature of the spine called?
scoliosis (can happen in marfan’s syndrome)
What is an abnormal curvature of the spine leading to a rounded back?
kyphosis (can happen in marfan’s syndrome)
How should you deal with a patient with head lice?
- dismiss patient
- vacuum chair
- fresh headrest cover for every patient
What are the six important facial landmarks?
- Outer canthus
- Inner canthus
- Ala
- Philtrum
- Tragus
- Nasion
What are 1-6 called?
- Outer canthus
- Inner canthus
- Ala
- Philtrum
- Tragus
- Nasion
What does HEENT stand for in a head and neck exam?
Head
Eyes
Ears
Nose
Throat
What is important for head and facial form symmetry?
HEENT (head, eyes, ears, nose, throat)
What is a prognathic profile?
mandible jets outward (underbite)
- often has a pointy chin
What is a retrognathic profile?
mandible is shorter/pulled in more (overbite)
- “no chin”
What are three things you should ask about during a head and neck exam?
nosebleeds
congestion
trouble swallowing
During a head and neck exam you should look for (very generally)?
LOOK FOR LUMPS IN NECK, HOARSENESS, SCRATCHY THROAT THAT DOESEN’T GET BETTER. PAIN IN NECK, JAW OR EARS
What are some complications with oral cancer?
adverse bleeding
side effects of drugs
infection
What are some cancer precautions?
- chemotherapy (immunocompromised)
- head and neck radiation therapy (xerostomi, mucosal irritation, cervical caries)
- med consult
What are the locations of skin lesions to watch for?
hands, arms, neck, face, ears
What are things to watch out for when considering skin lesions?
- chronic, non healing lesions
- change in pre-existing lesion
- sun exposure
What is the most common type of skin cancer?
basal cell carcinoma
What are the characteristics of basal call carcinoma?
- middle 2/3 of face
- won’t heal
- usually, benign
How many people have basal cell carcinoma every year in the US?
more than 3 million cases
What are the characteristics of squamous cell carcinoma?
- irregular borders
- “crusty”surface
- persistent thick rough scaly patches
What percent of oral cancers are squamous cell carcinomas?
90%
What are the characteristics of melanoma?
- multiple colors
- irregular borders
- flat or slightly raised borders
- somewhat asymmetrical
- highly infiltrative
What are the issues with nodular melanomas?
aggressive lesions that have vertical growth
What are the parts of the eye?
pupil (black)
sclera (white)
iris (colored)
What is ptosis?
lid lag (can be a sign of past stroke)
What is ocular hypertelorism?
excess spacing between eyes
What is exophthalmos?
abnormal protrusion of the eye (could be a sign of hyperthyroidism)
What can yellow sclera of the eye be a sign of?
hepatotoxicity
What are the groups of lymph nodes?
cervical
axillary
inguinal
internal (can’t palpate)
What are the nine cervical lymph nodes that should be palpated?
1 = submental
2 = submandibular
3 = tonsillar/
jugulodigastric
4 = preauricular
5 = postauricular
6 = occipital
7 = ant. cervical chain
8 = supraclavicular
9 = post. cervical chain
1
submental
2
submandibular
3
tonsillar/jugulodigastric
4
preauricular
5
postauricular
6
occipital
7
anterior cervical chain
8
supraclavicular
9
posterior cervical chain
What are the characteristics of an infected lymph node?
firm, tender, enlarged, and warm (can appear reddened)
What are the characteristics of a lymph node with maligancies?
firm, non-tender, matted, fixed, and increases in size over time
What is the sequence of palpation of the lymph nodes?
- ahead and behind ear
- slide down under the mandible
- slide down to SCM (turn head opposite way)
- slide down to above collarbone
What is a more thorough sequence of palpatating lymph nodes?
- ahead of the ear
- behind ear
- anterior border of SCM
- posterior border of SCM
- anterior and posterior SCM simultaneously
- floor of mouth
What do healthy lymph nodes feel like
soft like a grape
moveable
You should describe any lymphadenopathy (abnormal lymph node) by…
location
size
tenderness
consistency
mobility
Where is the most common lymphadenopathy?
cervical (head and neck)
What are clues that suggest routine swelling from a recent infection?
tender
mobile
current or recent viral infection
bilateral (sometimes)
predictable locations
long duration without change
What are mumps?
infection of the parotid gland (swelling in the cheek and sore lymph nodes)
Where is the thyroid located?
inferior to the larynx and just superior to the clavicles
Can you palpate the thyroid?
usually no
How should you do a thyroid exam?
- place fingers on either side of Adam’s apple
- slide down to just below it
- ask patient to swallow
- feel gland rise up and then drop back
- feel for any asymmetry or lumps
What are the three lip landmarks?
- philtrum
- vermillion border
- commisures (angles/corners)
What is angular cheilitis?
- corners of the mouth crack and irritate
- usually caused by candida
What percent of people in the US are affected by TMD?
20%
What percent of those with TMD are women?
85.4%
What are the symptoms of TMD?
joint pain
headaches
tinnitus
insomnia
neck ache
teeth become sensitive to temp (bruxism)
What are the causes of TMD?
bruxism
clenching
stress
malocclusion
arthritis
trauma
stimulants
What are the three broad diagnostic classes of TMD?
- muscles
- soft tissue of the joint
- hard tissues of the joint
Where is the referred pain of TMD?
temporalis - anterior teeth
masseter - posterior teeth
What are the pterygoid muscles?
lateral pterygoid
medial pterygoid
What are some screening TMJ questions to ask?
- 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?
- 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?
How to palpate TMJ?
- palpate the bony prominence just anterior to the ear
- have patient open and close
- look for altered opening/closing paths, abnormal sounds, tenderness, and limitations in opening
What to look for when doing an exam on TMJ?
- measure range of motion
- palpate for crepitus (grinding) and clicking while open/close
- palpate for tenderness in the masseter and temporalis muscles
What are signs during 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 face, jaws, and dental arches
What is the main treatment of TMD?
- night guards/ bruxism splits
… used to redistribute occlusal forces, relax the masticatory muscles, protect dentition and dental work
What are some medication treatments for TMD?
anti-inflammatory
anti-anxiety
msucle relaxers
botox
What is the more “rare” treatments for TMD?
surgery
What are some regular everyday treatments for 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
What things are important during an extraoral exam?
gait
accessibility
stature/habitus
headlice
head/facial form (jaw)
cancer
skin lesions
eyes
lymph nodes
thyroid
lips
TMJ
