The exam should be performed in an orderly fashion as follows: 1. Have the patient stick out their tongue so that you can examine the posterior pharynx (i.e. the back of the throat). Ask the patient to say "Ah", which elevates the soft palate, giving you a better view. If you are still unable to see, place the tongue blade � way back on the tongue and press down while the patient again says "Ah," hopefully improving your view. This causes some people to gag, particularly when the blade is pushed onto the more proximal aspects of the tongue. It may occasionally be important to determine whether the gag reflex is functional (e.g. after a stroke that impairs CNs 9 or 10; or to determine if a patient with depressed level of consciousness is able to protect their airway from aspiration). This is done by touching a q-tip against the posterior pharynx, uvula or tongue. It is not necessary to do this during your routine exam as it can be quite noxious!
2. Note that the uvula hangs down from the roof of the mouth, directly in the mid-line. With an "Ah," the uvula rises up. Deviation to one side may be caused by CN 9 palsy (the uvula deviates away from the affected side), a tumor or an infection. CN9 Pasly Cranial Nerve 9 Dysfunction: Patient has suffered stroke, causing loss of function of left CN 9. As a result, uvula is pulled towards the normally functioning (ie right) side. 3. The normal pharynx has a dull red color. In the setting of infection, it can become quite red, frequently covered with a yellow or white exudate (e.g. with Strep. Throat or other types of pharyngitis).
4. The tonsils lie in an alcove created by arches on either side of the mouth. The apex of these arches are located lateral to and on a line with the uvula. Normal tonsils range from barely apparent to quite prominent. When infected, they become red, are frequently covered by whitish/yellow discharge. In the setting of a peritonsilar abscess, the tonsils appear asymmetric and the uvula may be pushed away from the affected side. When this occurs, the tonsil may actually compromise the size of the oral cavity, making breathing quite difficult.
5. Look carefully along the upper and lower gum lines and at the mucosa in general, which can appear quite dry if the patient is dehydrated.
6. Examine the teeth to get a sense of general dentition, particularly if the patient has a dental complaint. Pain produced by tapping on a tooth is commonly caused by a root abscess. Tooth Abscess: Tooth abscess involving left molar region. Associated inflammation of left face can clearly be seen. 7. Have the patient stick their tongue outside their mouth, which allows evaluation of CN 12. If there is nerve impairment, the tongue will deviate towards the affected side. Any obvious growths or abnormalities? Ask them to flip their tongue up so that you can look at the underside. If you see something abnormal, grasp the tongue with gauze so that you can get a better look. Left CN 12 Dysfunction: Stroke has resulted in L CN 12 Palsy. Tongue therefore deviates to the left.
8. Make note of any growths along the cheeks, hard palate (the roof of the mouth between the teeth), soft palate, or anywhere else. In particular, patients who smoke or chew tobacco are at risk for oral squamous cell cancer. Any areas which are painful or appear abnormal should also be palpated. Put on a pair of gloves to better explore these regions. What do they feel like? Are they hard? To what extent does a growth involve deeper structures? If the patient feels something that you cannot see, try to get someone else to hold the light source, freeing both your hands to explore the oral cavity with two tongue depressors.

A video showing impaled objects

A technique for reducing an inferior shoulder dislocation. watch to learn more

it's a 8 years old boy with previous medical history of Sickle cell disease presented with gall stone and repeat abdominal pain. A laparoscopic cholecystectomy is performed. The cystic duct is controlled with 2 stiches of absorbable suture. The cystic artery is simply cauterized with the hook cauter...y. the specimen is removed through the umbilical port using an 10mm endobag.

Experience with endoscopic retrograde cholangiopancreatography (ERCP) in children has been limited due to multiple factors, including the relatively low incidence of diseases requiring ERCP in this age group, the impression that the procedure is technically difficult in children, and because the indications and safety of ERCP in children have not been well defined. As a result, patients are generally referred to a tertiary care facility or to adult endoscopists who perform a high volume of procedures.

COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. This is usually cigarette smoke. Air pollution, chemical fumes, or dust can also cause it. At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. They include A cough that produces a lot of mucus Shortness of breath, especially with physical activity Wheezing Chest tightness Doctors use lung function tests, imaging tests, and blood tests to diagnose COPD. There is no cure. Treatments may relieve symptoms. They include medicines, oxygen therapy, surgery, or a lung transplant. Quitting smoking is the most important step you can take to treat COPD.

You may have recently found out that you are deficient or know someone who is. It's shocking for most people when they have never had a problem before and believe nothing has changed to make it a problem now. The truth is that a lot has changed, and vitamin D deficiency and insufficiency is now a global public-health problem affecting an estimated 1 billion people worldwide. The most well-known consequences to not having enough vitamin D are rickets in children and osteomalacia in adults. These are far from the only problems associated with a vitamin D deficiency.

This 25 year young female wanted her split earlobe hole to be repaired.Ear lobe ring hole usually elongated due to continuous use of fancy heavy ear rings.most young ladies suffer from this problem, subsequently this get converted to complete split ear lobe.This needs surgical repair only.This is a cosmetic repair .watch the video , how this repair is done.Usually the split is completely closed with suture.After healing new hole to be done little distance from the repair site.

Watch that video to know How To Remove Teeth Plaque Without Going To The Dentist

DMC Pediatric Plastic and Reconstructive Surgeon Dr Arlene Rozzelle and her team of specialists repair a newborn’s cleft lip.

The condition is caused by a blockage in the lymphatic system, part of the immune and circulatory systems. Lymphedema is most commonly caused by lymph node removal or damage due to cancer treatment. The main symptom is swelling in an arm or leg that may be accompanied by pain or discomfort. Exercise, wrapping, massage, and compression can help.

ADH's job is to act on the kidneys to promote water reabsorption. In this lesson, we'll compare and contrast diabetes insipidus, or DI, in which there is too little ADH, and syndrome of inappropriate antidiuretic hormone secretion , or SIADH, in which there is too much ADH.

Graphic content of Mohs surgical removal of a large Squamous Cell Carcinoma on scalp followed by reconstruction with 10 week follow up. Visit us @ skincancercentre.com.

Watch that video to know the Erectile Dysfunction - Cause and Treatment

Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. You can do Kegel exercises, also known as pelvic floor muscle training, just about anytime. Start by understanding what Kegel exercises can do for you — then follow step-by-step instructions for contracting and relaxing your pelvic floor muscles.

Medical students at Johns Hopkins University are getting a real-life birthing experience when a robot goes into labor. Kasey-Dee Gardner reports.

STDs are infections that are transmitted during vaginal, anal, and oral sex. They are very common and many people who have them don't show any symptoms.

Watch that video of a Very Large Mole Removal Surgery

Open Inguinal Hernia Repair Surgery - German Narration

Learn the SIRS Criteria and how to calculate it. Greater than or equal to 2 or more of the following: Temperature Fever of greater than 38°C (100.4°F) or Less than 36°C (96.8°F) Heart Rate Greater than 90 beats per minute Respiratory Rate Greater than 20 breaths per minute or PaCO2 of less than 32mm Hg White Blood Cell Count Greater than 12,000cells/mm³ or Less than 4,000cells/mm³ or Greater than 10% Bands