00:01
Now we'll move on with
examination of the nasal passages
focusing on the
nasal turbinates.
00:06
Folks, of course who have an
upper respiratory infection,
you may see evidence of
erythematous, boggy nasal turbinates
with a lot of nasal discharge.
00:14
Alternatively, you can see
signs of some chronic issues.
00:16
For example, folks who have nasal
polyps may have aspirin allergy,
and there's a variety of other
manifestations that you may see with that.
00:24
So let's go ahead
and take a look.
00:25
I'm going to have you tilt your
head back a little bit, Shayla.
00:28
Great, and I usually just use my thumb
to lift up the bridge of the nose
so we can get a good look.
00:34
Nasal passages are
nice and clear.
00:37
There's no evidence of
any boggy turbinates.
00:39
Let's switch over
to the other side.
00:45
Great.
00:50
So now we can move on to
gross inspection of the mouth.
00:52
And I'll have you just open your
mouth up now please, Shayla.
00:56
Great.
00:57
So sticking her tongue out just
very quickly looking at her tongue,
we can see that she has no evidence
of any fissures in her tongue.
01:04
You can close your
mouth now for a moment.
01:06
So when you see a furrowed tongue
that actually has a significant
likelihood ratio in
support of hypovolemia,
that's one sort of
thing you may look for,
it's just something as
simple as a fissured,
dry fissured looking tongue.
01:19
She also has moist
mucous membranes.
01:21
These are things that help to support
the idea of her not being hypovolemic,
which is just quick, useful,
physical exam findings
at the bedside that you can use to
detect whether somebody is hypovolemic.
01:33
In addition,
looking at the tongue,
she has a nice healthy tongue with the
normal papillae on the surface there.
01:38
There's no evidence of her being
a person who smokes cigarettes,
those folks tend to have somewhat of a
yellowish discoloration to the tongue
and oftentimes something
called a hairy tongue
with increased
hyperkeratinization of the
papillae on the
top of the tongue.
01:54
Looking at the
back of the tongue,
I can see her uvula is
hanging nice immediately.
01:58
I also see the plated
arches are symmetric
and even or soft palate is even which
tells me that her glossopharyngeal nerve
and vagus nerves are
operating correctly.
02:07
On the surface of
her soft palate,
there's no evidence
of petechiae there.
02:11
Sometimes folks who have for example,
measles will have Palatal petechiae
on the upper palate.
02:20
Next up looking at the
sides of the mouth,
looking at her buccal mucosa.
02:24
On either side, sometimes you can
see aphthous ulcers in that location,
so called canker sores.
02:30
So there's nothing there either.
02:32
And now let's just take
a look at our teeth.
02:37
Lift up your tongue for
me, please.
02:39
Folks who have icterus or
jaundice, I should say,
you may see some yellowish
discoloration at the base of the tongue.
02:44
So we don't see
any of that either.
02:46
And at this point, it's time to go
in with a manual exam of the mouth.
02:52
Having done gross inspection
of the mouth and oral cavity,
we're now going to move on to
palpation of the oral cavity.
02:58
This will be particularly
important in patients for whom
you're concerned about a
cellulitis in the mouth.
03:03
Patients who have cellulitis
in the deep layers of the mouth
will not only have lymphadenopathy
here in the submandibular area,
but may have exquisite
tenderness underneath the tongue.
03:13
And people who have pain in that
area, it's called Ludwig's angina.
03:16
If you wouldn't mind opening
your mouth again, Shayla.
03:18
Lift up your tongue for a bit.
03:20
I'm just going to palpate
right underneath your tongue,
looking for any
bugginess in that area
or again any swelling
or lymphadenopathy.
03:27
Next up, patients of course
often report tooth pain.
03:30
Now while I am not a dentist,
there are some very quick limited
parts of the exam that we can do
to look for a tooth abscess and any
evidence of gingival irritation.
03:40
I'm just going to
basically look along
gingiva here, I'm just palpating
you're at the base
of each tooth.
03:48
And I can do the same
thing on the top.
03:51
Also looking at the
health of the gingiva
and you're looking for
canker sores on the lips,
the upper lip and the
lower lip as well.
03:59
And that largely
concludes our oral exam.