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_Patient Care II > 1/4 Extraoral Exam > Flashcards

1/4 Extraoral Exam Flashcards

1
Q

How must an exam be performed to ensure that no parts are missed?

A

Thoroughly & systematically

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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

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3
Q

What is important to know regarding an exam?

A

What normal is so that you can identify if there is an abnormality

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4
Q

What is a ‘normal’ exam classified as?

A

Found in most individuals

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5
Q

What is an ‘atypical’ exam classified as?

A

Not present in all individuals but still within normal limits (a variation of normal)

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6
Q

What is a ‘pathologic’ exam classified as?

A

Associated with infection, trauma, neoplastic growth, errors in development

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7
Q

What are the four types of gait?

A

Hemiplegia
Paraplegia
Hemiparesis
Paraparesis

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8
Q

What is hemiplegia?

A

Paralysis one side, usually from stroke

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9
Q

What is paraplegia?

A

Paralysis both sides

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10
Q

What is hemiparesis?

A

Weakness one side

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11
Q

What is paraparesis?

A

Weakness on both sides

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12
Q

What does it mean if a patient is ataxic?

A

Presence of abnormal, uncoordinated movements

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13
Q

What does ataxic gait describe?

A

Signs and symptoms without reference to specific diseases

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14
Q

What is parkinsonian gait?

A

Taking small, shuffling steps

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15
Q

What are signs of parkinsonian gait?

A

Tremor
Rigidity
Postural instability
Hypokinesia

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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
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17
Q

What are the 5 ways to interact with wheelchair riders?

A

Avoid
Greet
Speak
Learn
Offer

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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
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19
Q

What are the types of stature and habitus?

A

Stature - short, tall
Habitus - thin, obese

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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

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21
Q

What are signs of Marfan’s syndrome?

A

Tall
Thin
Arachnodactily
Wingspan > height
Chest concavity
Heart murmur

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22
Q

What is scoliosis?

A

Side curvature

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23
Q

What is kyphosis?

A

Roundback

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24
Q

What are signs of head lice?

A

Nits
- white egg cases
- not dandruff!

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25
Q

What should you do with a patient who has head lice?

A
  • new strain is resistant to most meds
  • dismiss pt and vacuum chair
  • fresh headrest cover for every patient
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26
Q

Name the 6 facial landmarks and where they’re located

A
  1. Outer
    canthus
  2. Inner canthus
  3. Ala
  4. Philtrum
  5. Tragus
  6. Nasion
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27
Q

What are aspects of a head and neck exam?

A

Head
Eyes
Ears
Nose
Throat

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28
Q

What are the three types of head and facial forms?

A

Normal profile
Prognathic profile
Retrognathic - mandible sits backwards

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29
Q

What should you look for in a head and neck exam?

A

Lumps in neck, hoarseness, scratchy throat that doesn’t get better!!, pain in neck, jaw or ears, nosebleeds, congestion

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30
Q

What are complications of cancer?

A

Adverse bleeding
Side effects of drugs
Infection
Immunocompromised

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31
Q

What are types of cancer precautions?

A

Chemotherapy, immunocompromised
Head and neck radiation therapy
Med consult

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32
Q

What are side effects of head and neck radiation therapy?

A

Xerostomia
Mucosal irritation
Cervical caries

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33
Q

What kind of skin lesions should we pay attention to?

A

Chronic, nonhealing lesion
Change in pre-existing lesion
Sun exposure
Rash, mole, patch

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34
Q

What is the most common extraoral skin cancer?

A

Basal cell cancer

35
Q

What are characteristics of basal cell cancer?

A

Middle 2/3 of face
Won’t heal
Usually, benign (not harmful)
More than 3 million cases in the US per year

36
Q

What are characteristics of squamous cell carcinoma?

A

Irregular borders
“Crusty” surface
Persistant thick roughly scaly patches that may bleed
Comprises 90% of all oral cancers

37
Q

What are characteristics of melanoma?

A

Multiple colors
Irregular borders
Flat or slightly raised borders and somewhat asymmetrical in form

38
Q

What are nodular melanomas?

A

Aggressive lesions that have only a vertical growth
- highly infiltrative

39
Q

What are the parts of an eye?

A

Pupil: black
Sclera: white
Iris: colored

40
Q

What is ptosis?

A

Lid lag
- sometimes sign of past stroke

41
Q

What is ocular hypertelorism?

A

Excess spacing between the eyes

42
Q

Should pupils react equally to light?

A

Yes

43
Q

What is exophthalmos?

A

Abnormal protrusion of the eye
- sign of hyperthyroidism

44
Q

What is a sign of hepatotoxicity?

A

Yellow sclera

45
Q

What are lymph nodes?

A

Filters
Part of lymphatic system
- thymus
- spleen
- bone marrow

46
Q

Where are lymph nodes grouped?

A

Cervical (head/neck)
Axilalry (underarm)
Inguinal (groin)
Internal (pelvic, abdominal, thoracic): Can’t palpatate

47
Q

Where are the 9 locations of lymph nodes?

A

1 = submental
2 = submandibular
3 = tonsillar/
jugulodigastric
4 = preauricular
5 = postauricular
6 = occipital
7 = ant. cervical
chain
8 = supraclavicular
9 = post. cervical chain

48
Q

What are submental lymph nodes?

A

Just below the chin

49
Q

What are submandibular lymph nodes?

A

3-6 nodes, beneath the body of the mandible

50
Q

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.

A

tonsillar/jugulodigastric lymph nodes

51
Q

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?

A

Anterior cervical chain lymph nodes

52
Q

What are lymph nodes in the hollow above the clavicle,
just lateral to where it joins the sternum?

A

Supraclavicular

53
Q

What are lymph nodes that extends in a line posterior
to the SCM but in front of the trapezius?

A

Posterior cervical chain

54
Q

Infected lymph nodes tend to be…

A

Firm, tender, enlarged, warm
Inflammation can spread to the overlying skin, causing it to appear reddened

55
Q

Dedscribe malignancies in lymph nodes

A

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
Q

What is the lymph node palpatation sequence?

A
  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
Q

What should healthy lymph nodes look like?

A

Soft like a grape
Movable

58
Q

What is lymphadenopathy?

A

Any abnormality in lymph:
Size
Consistency
Number

59
Q

Describe a lymphadenopathy abnormality?

A

Location
Size (<1cm>)
Tenderness
Consistency
Mobility

60
Q

Where is lymphadenopathy most common?

A

Cervical (head nad neck)

61
Q

What are clues to routine swelling from recent infection?

A

Tender
Mobile
Current or recent viral infection
Bilateral (but not always)
Predictable locations
Long duration without change

62
Q

What are mumps?

A

Infection of the parotid gland: swelling in the cheek and sore lymph nodes

63
Q

Where is the thyroid located?

A

Inferior to the larynx and just superior to the clavicles

64
Q

Is the thyroid palpable?

A

Most often not

65
Q

Describe the steps of the thyroid exam?

A
  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
Q

What are the landmarks of the lip?

A

Philtrum
Vermillion border
Commisures
- “angles”
- “corners”

67
Q

What is angular cheilitis?

A

Corners of mouth
Usually candida

68
Q

Who do temporomandibular disorders effect?

A

20% of U.S.
85.4% of women
Common condition in adults but becoming more pervalend in adolescents and children

69
Q

What are TMD symptoms?

A

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
Q

What are causes of TMD?

A

Bruxism
Clenching
Stress
Malocclusion
Arthritis
Trauma
Stimulants

71
Q

What are 3 broad diagnositc classes of temporomandibular disorders?

A

Muscles
Soft tissues of the joint
Hard tissues of the joint

72
Q

What are types of referred pain?

A

Tempralis = generally ant teeth
Masseter = generally post teeth

73
Q

What are TMJ screening questions?

A

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
Q

What are the steps of palpate for TMJ?

A
  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
Q

What are the steps of a TMJ diagnostic exam?

A
  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
Q

What should you pay attention to in a TMD exam?

A

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
Q

What are night guards/bruxism splints-used to?

A
  1. Redistribute
    occlusal forces
  2. Relax the
    masticatory muscles
    and stabilize the
    joint
  3. Protect dentition
    and dental work
78
Q

What are meds for TMD?

A

Anti-inflammatory (NSAIDs)
Anti-anxiety
Muscle relaxers

79
Q

What do anti-inflammatory ot NSAIDs do for TMD?

A

used for joint pain, inflammation, and
stiffness
Tend to be inexpensive,
easily accessible and well
tolerated

80
Q

What do anti-anxiety meds do for TMD?

A

Help relieve the stress that may aggravate RMD

81
Q

What do muscle relaxers do for TMD?

A

Relax muscles and decrease spasms
- botox lasts 3-4 months not FDA approved for TMD

82
Q

How does physical therapy help for treatment of TMD?

A

Helps ease pain and increase movement and normal jaw function
Surgery: very rare

83
Q

What is treatment of TMD?

A

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
Q
A

_Patient Care II (10 decks)

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