3. TEETH INSPECT C.

Inspect for color, number, missing teeth, loose teeth, extraction, caries and filling N- adults have 28 or 32 teeth -smooth, white, with shiny tooth enamel A- chalky white discoloration of an enamel -caries -plaque (caused by debris & saliva) -discolored teeth ( -yellowish teeth 4. Roof of Mouth (hard and soft palate) Inspection C. Inspect for color, architecture and deformities N- hard palate is whitish and dome-shape -soft palate is light, pink and smooth 5. Tongue -Inspect the dorsum for color, texture, moisture, papilea and position Inspect for hypoglassal nerve function -Inspect the size and symmetry -Inspect the base of the tongue, floor of the mouth and the frenulum N- the dorsum should be medium, moist, slightly rough on the top surface and smooth along the lateral margins. Centrally located Raised papilea (taste buds) Move freely Deviation and tremors not noted Hypoglassal nerve intact Symmetrical and regular size

Ventral surface of tongue should be pink and smooth with prominent veins between the frenulum folds A- Macroglosia - Leukoplakia - Ankyloglossia- short tongue, cant stick out - Tongue splitting 6. OROPHARYNX Inspection C. inspect fo color, symmetry, discharge, ulcerations and enlargement of tonsils, alignment and characteristics of uvula N- Pharyngeall tissues are normally pink and smooth ASymmetrical No discharges and ulcerations noted Tonsils are pink and smooth, reqular in size and no discharges Uvula raises centrally Edema and ulceration Clear exudates Yellow and green exudates Typical sore throat

Tonsilitis: Grade 1 (normal) Grade 2 Grade 3 Grade 4 Deviated uvula Bifurcated uvula Inflamed uvula Uvula without tonsils P.A. of NECK 1. Thyroid cartilage & cricoid cartilage 2. Thyroid gland

3. Trachea Muscles of the Neck: -sternocleidomastoid & trapezius Inspection of Neck: C--Inspect of symmetry of neck muscles, scars growth and enlargement of the parotid gland N--neck must spear symmetrical, without scars, growth and enlargement of the parotid glands Aparotitis -torticollis (sternocleidomastoid muscle always contracting) PALPATION OF THE LYMPH NODES C. palpate for lymph nodes Nlymph nodes are not easily palpable Aenlarged and fixed, inflamed - non-tender, hard, discrete nodes - presence of node (use 3 middle fingers) SEQUENCE OF PALPATION -OCCIPITAL -POST AURICULAR -PRE-AURICULAR -TONSILLAR -SUBMAXILLARY -SUBMENTAL -ANTERIOR CERVICAL CHAIN -POSTERIOR CERVICAL CHAIN -DEEP CERVICAL CHAIN

-SUPRACLAVICULAR -INFRACLAVICULAR INSPECTION AND PALPATION CInspect and palpate the trachea --inspect and palpate the thyroid gland Nthis is located at the midline of the neck, above the suprasternal notch --Thyroid gland is not visible on inspection --Thyroid is small, smooth and free of nodules. It ascends during swallowing but is not visible Alater displacement --Enlargement --masses P. A. OF THE CHEST Anterior Thoracic Landmarks 1. 2. 3. 4. Suprasternal notch Sternum Angle of Louis ICS (inter costal angle; usually less than 90*)

Posterior Thoracic Landmarks 1. C7 2. Spinous process 3. Scapula