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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.
Hypoglycemia is a common and serious medical emergency which may occur in both daibetic and non-diabetic patients. The signs and symptoms of hypoglycaemia may be present in many individuals, but may also be masked in several individuals due to a condition called hypoglycaemia induced autonomic failure. This presentation aims to deal with the causes, clinical features, diagnosis and management of various causes of hypoglycaemia. The causes of hypoglycaemia may be divided into hypoglycaemia in ill or medicated individuals and hypoglycaemia in previously asymptomatic individuals. A variety of causes are discussed under both headings. Management of hypoglycaemia is also discussed in detail. There is also a brief discussion about management of insulinoma.
Osteoporosis is a disease that weakens bones over time. Because of this, it puts you at risk for breaking a bone. Postmenopausal osteoporosis is the most common form of osteoporosis. It affects many women after menopause, leaving some women at high risk for fracture. - See more at: https://www.prolia.com/postmenopausal-osteoporosis/deeper-look/?WT.z_co=A&WT.z_in=PMO&WT.z_ch=PDS&WT.z_st=Site1&WT.z_mt=Broad&WT.z_pdskw=www%20osteoporosis&WT.z_ag=Osteoporosis%20Information%20-%20Broad&WT.z_se=G&WT.srch=1&WT.z_prm=DSE__&WT.mc_id=A_PMO_PDS_G_DSE___Broad_www%20osteoporosis_Osteoporosis%20Information%20-%20Broad#sthash.x5Ys3Now.dpuf
Homocystinuria is an inherited disorder that affects the metabolism of the amino acid methionine. Amino acids are the building blocks of life. Causes Homocystinuria is inherited in families as an autosomal recessive trait. This means that the child must inherit a non-working copy of the gene from each parent to be seriously affected. Homocystinuria has several features in common with Marfan syndrome, including joint and eye changes. Symptoms Newborn infants appear healthy. Early symptoms, if present, are not obvious. Symptoms may occur as mildly delayed development or failure to thrive. Increasing visual problems may lead to diagnosis of this condition. Other symptoms include: Chest deformities (pectus carinatum, pectus excavatum) Flush across the cheeks High arches of the feet Intellectual disability Knock knees Long limbs Mental disorders Nearsightedness Spidery fingers (arachnodactyly) Tall, thin build
Bacterial abscess of the liver is relatively rare; however, it has been described since the time of Hippocrates (400 BCE), with the first published review by Bright appearing in 1936. In 1938, Ochsner's classic review heralded surgical drainage as the definitive therapy; however, despite the more aggressive approach to treatment, the mortality remained at 60-80%.[1] The development of new radiologic techniques, the improvement in microbiologic identification, and the advancement of drainage techniques, as well as improved supportive care, have reduced mortality to 5-30%; yet, the prevalence of liver abscess has remained relatively unchanged. Untreated, this infection remains uniformly fatal. The three major forms of liver abscess, classified by etiology, are as follows: Pyogenic abscess, which is most often polymicrobial, accounts for 80% of hepatic abscess cases in the United States Amebic abscess due to Entamoeba histolytica accounts for 10% of cases [2] Fungal abscess, most often due to Candida species, accounts for fewer than 10% of cases
The gastrointestinal tract (GIT) arises initially during the process of gastrulation from the endoderm of the trilaminar embryo (week 3) and extends from the buccopharyngeal membrane to the cloacal membrane. The tract and associated organs later have contributions from all the germ cell layers. During the 4th week three distinct regions (fore-, mid- and hind-gut) extend the length of the embryo and will contribute different components of the GIT. The large mid-gut is generated by lateral embryonic folding which "pinches off" a pocket of the yolk sac, the 2 compartments continue to communicate through the vitelline duct. The oral cavity (mouth) is formed following breakdown of the buccopharyngeal membrane (oropharyngeal or oral membrane) and contributed to mainly by the pharynx lying within the pharyngeal arches (More? Head Development). Loss of buccopharyngeal membrane opens the tract to amniotic fluid through the remainder of development, and during the fetal period is actively swallowed.
Dr. Erica Hodgman discusses pediatric surgery at the Johns Hopkins Children's Center Pediatric General Surgery program, what common surgeries the program specializes in, what makes the program unique and her work as a pediatric surgeon. #PediatricSurgery #JohnsHopkinsChildrenCenter
Questions Answered:
0:03 Describe the pediatric general surgery division at Johns Hopkins Children's Center.
1:00 What makes this program unique?
1:31 What are some common pediatric surgery cases?
2:23 Explain your work as a pediatric general surgeon?
Atherosclerosis is a narrowing of the arteries caused by a buildup of plaque. It’s also called arteriosclerosis or hardening of the arteries. Arteries are the blood vessels that carry oxygen and nutrients from your heart to the rest of your body. As you get older, fat and cholesterol can collect in your arteries and form plaque. The buildup of plaque makes it difficult for blood to flow through your arteries. This buildup may occur in any artery in your body and can result in a shortage of blood and oxygen in various tissues of your body. Pieces of plaque can also break off, causing a blood clot. Atherosclerosis can lead to heart attack, stroke, or heart failure if left untreated.
New Minimally Invasive Procedure with No Pain or Downtime… From Dr. Michael Goodman, Caring For Women Wellness Center Laser Vaginal Tightening for Improved Sexual Pleasure and Relief from Minimal Urinary Incontinence Laser Vaginal Therapy for reversing Vaginal Atrophy (Good also for Breast Cancer Survivors with Vaginal Atrophy)
Johns Hopkins Children’s Center Surgeon-in-Chief David Hackam provides information about general pediatric surgery and when it is time to see a general pediatric surgeon. #PediatricSurgery #JohnsHopkins
For more information on general pediatric surgery at Johns Hopkins Children's Center, visit https://www.hopkinsmedicine.or....g/johns-hopkins-chil
FAQ's
0:02 What is a general pediatric surgeon?
0:31 When is it time to see a pediatric surgeon?
1:02 What are some of the most common surgical problems seen by general pediatric surgeons?
1:43 Describe research being done in the field.
2:15 Why choose Johns Hopkins Children's Center for general pediatric surgery?
Dr. Celia Divino, Chief, Division of General Surgery at The Mount Sinai Hospital, performs a laparoscopic appendectomy. Visit the Division of General Surgery at http://bit.ly/18z944M. Click here to learn more about Dr. Celia Divino http://bit.ly/12RF0ee
Craniectomy is neurosurgical procedure that involves removing a portion of the skull in order to relieve pressure on the underlying brain. This procedure is typically done in cases where a patient has experienced a very severe brain injury that involves significant amounts of bleeding around the brain or excessive swelling of the brain.
A modified radical mastectomy is a procedure in which the entire breast is removed, including the skin, areola, nipple, and most axillary lymph nodes; the pectoralis major muscle is spared. Historically, a modified radical mastectomy was the primary method of treatment of breast cancer. [1, 2] As the treatment of breast cancer evolved, breast conservation has become more widely used. [3, 4] However, mastectomy still remains a viable option for women with breast cancer. [5, 6]