Examination of the Nose and Mouth

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.