19. History of the patient in particular reference to pain
درد ﺑﻪ ارﺗﺒﺎط در ﻣﺮﯾﺾ ﺗﺎرﯾﺨﭽﻪ
yawning,
chewing,
drinking hot and
cold liquids
mild and
severe pain
burning, throbbing, , shooting, , vague , splitting, dull, aching,
lacinating, cutting, boring, constricting, gripping, , pounding,
heavy,
pressing, sharp, bright, , cramping, squeezing, or searing
localized or diffused,
radiating
or spreading and
enlarging or migrating
s
p
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a
f
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t
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v
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o
n
,
h
e
a
r
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n
g
,
s
m
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l
l
talking, brushing
of teeth, shaving,
washing the
face, turning the
head, lying down
i
n
t
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m
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By: Dr Mohammad Nasir (Sharify )
42. Bilateral palpation: This
is done to differentiate
between
symmetrical structures
on both side of face
Bidigital palpation: In this, two
fingers are used to manipulate the
tissue. It is used for thinner
structure
By: Dr Mohammad Nasir (Sharify )
43. Bimanual palpation: It is done by palms of both hands.
In this, one hand is used to support the structure hand
and another is used to manipulate the structure. This
type of palpation is used in floor of mouth
By: Dr Mohammad Nasir (Sharify )
45. radial pulse (located on
ventral
aspect of wrist)
branchial pulse (located
medial to biceps
tendon in the antecubital
fossa)
carotid pulse (medial
to sternocleidomastoid
muscle, inferior and medial to the
angle of mandible)
By: Dr Mohammad Nasir (Sharify )
47. : ﻧﺒﺾ ارزﯾﺎﺑﯽ در اﻫﻤﯿﺖ ﺑﺎ ﻧﮑﺎت
1. Rate : Fast or Slow (normal: 60_ 100 beat /min)
2. Rhythem : Regular or Irregular (Ventricular ectopic --
Arterial fibrillation).
3. Volume (Pulse Pressure Normal 40 -60 mmHg :
High or Low
(wide pulse pressure: Aorteic and Mitral Regurgitation ,High
outpute state: Pregnancy , Anemia Left ventricular Failure,
obstraction of Left ventricleMitral Stenosis , aortic stenosis)
: ﻧﺒﺾ ﻫﺎی وﯾﮋﮔﯽ
Water hammer pulse : Aortic regurgitation.
Paradoxus pulse : Pericardial effusion.
ﻣﻮج در آﻫﺴﺘﻪ ﺑﯿﺖ دو ﺷﮑﻞ ﺑﻪ ﮐﺮوﺗﯿﺪ ﺷﺮﯾﺎن ﻧﺒﺾ،ﺣﺎﻻت اﯾﻦ در
.ﻣﯿﺸﻮد اﺣﺴﺎس ﺳﯿﺴﺘﻮﻟﯿﮏ
Pulsusbisfringus : in Aortic Stenosis .
ﻣﻮج در ﺳﺮﯾﻊ ﺑﯿﺖ دو ﺷﮑﻞ ﺑﻪ ﮐﺮوﺗﯿﺪ ﺷﺮﯾﺎن ﻧﺒﺾ،ﺣﺎﻻت اﯾﻦ در
.ﻣﯿﺸﻮد اﺣﺴﺎس ﺳﯿﺴﺘﻮﻟﯿﮏ
By: Dr Mohammad Nasir (Sharify )
48. Delay of the left temporal pulse compared with right
pulse is found in coarctation of aorta.
در راﺳﺖ ﻧﺒﺾ ﺑﺎ ﻣﻘﺎﯾﺴﻪ در ﭼﭗ ﻧﺒﺾ ﺗﺎﺧﯿﺮ
Coarectation Aorta
.ﺷﻮد ﻣﯽ ﯾﺎﻓﺖ
By: Dr Mohammad Nasir (Sharify )
52. By: Dr Mohammad Nasir (Sharify )
Conversion Of Fahrenheit To Celsius
ﺳﺎﻧﺘﯿﮕﺮاد ﺑﻪ ﻓﺮاﻧﻬﺎﯾﺖ ﺗﺒﺪﯾﻞ
Fahrenheit into Celsius
subtract 32 and multiply by 5/9
97.9°F (36.6°C) to
99°F (37.2 °C).
54. Bacteremia is the simple presence of
bacteria in the blood while Septicemia is
the presence and multiplication of
bacteria in the blood. Septicemia is also
known as blood poisoning.
56. Harmful effects:
hypercatabolism—N2 nitrogen( increased circulating catabolic hormones (eg, cortisol,
catecholamines) and inflammatory cytokines (eg, tumor necrosis factors, interleukin-1beta)
wastage and weight loss, fluid and electrolyte imbalance due to
sweating, convulsions, brain damage, circulatory overload
and arrhythmias, Seizure, Coma, death
: ﺗﺐ ﻣﻔﯿﺪ ﺗﺎﺛﯿﺮات
ﻧﺘﯿﺠﻪ در ﮐﻪ ﻣﯿﺸﻮد داﺧﻠﯽ ﻫﺎی ﭘﺎﯾﺮوﺟﯿﻦ ﺳﺎزی ازاد ﺑﺎﻋﺚ اﻣﺮاض از ﺑﻌﻀﯽ در
ﺣﺠﺮات ﺷﺪن ﻓﻌﺎل ﺳﺒﺐ
T cell
.ﻣﯿﺪﻫﺪ اﻓﺰاﯾﺶ را ﻣﯿﺰﺑﺎن دﻓﺎﻋﯽ ﻣﯿﮑﺎﻧﯿﺰم و ﺷﺪه
57. Hypothermia:
Hypothermia may be caused by endocrine
disorders like :
hypothyroidism
Hypopituitarism hypoglycemia( Insufficient ACTH hormone secretion
results in cortisol deficiency; therefore, hypopituitarism may cause hypoglycemic events in diabetic
patients on medical treatment including insulin therapy.
Toxicity (Alcohol intoxication)
Barbiturate poisoning
Ketoacidosis
Exposure to cold
Autonomic dysfunction.
58. Respiration
Anesthesia and in early postoperative days
One complete cycle of inspiration and expiration is
counted as one. Normal rate—14–18 cycles/minute
Tachypnea (fast breathing): It occurs in fever, shock,
hypoxia, cerebral disturbances, metabolic acidosis,
tetany, and hysteria
Bradypnea: Slow and deep respiration is seen in cerebral
compression
Snoring noise: Paralysis of the soft
palate causes an inspiratory.
Central cyanosis seen in
tongue showing bluish
59. Icterus
• Definition: In jaundice, there is icteric tint of the skin, due to
presence of bilirubin, which varies from faint yellow of viral
hepatitis to dark olive greenish yellow color of obstructive
jaundice
• Site where you should look of icterus:The places where one
should look for icterus are sclera of the eyeball
nailbed, lobule of ear, tip of the nose and under surface of
tongue
• Hypercarotenemia: Jaundice may be confused with
hypercarotenemia in which yellow pigment of carotene is
unequally distributed and is particularly seen in the face, palm
and soles but not in the sclera. It occurs mostly in vegetarians
61. Skin
Appearance ( Rashes, sores, lumps or itching ,history of
sun exposursure
Color : Anemia and jaundice.
Texture : Dehydration (skin is dryed),Atropheid skin ( age
and in Glucocorticoods treatments).
Signs: Petechial hemorrhage indicating blood
dyscrasias.
Edema: Acute nephritis marked with swollen face at
raising in morning.
62. Head
Headache : Persistent , intermittent ,localized ,
generalized. Unilateral , bilateral or frontal.
Site:
Radiation:
Severity oTiing and duration:
Character: Shooting or pricking
Occurrence or aggravation: What brings it on, and what
makes it worse.
Relief:
63. Jaws
Normal landmark: Normal anatomic landmarks to be
identified include mandibular border, angle of mandible,
condyle and coronoid process, maxillary bone, lingual
notch and maxillary sinus.
Tenderness over the jaws: Note any tenderness over
the joint or masticatory muscles
Trauma:
64. TMJ
History: Rheumatoid arthritis, degenerative joint disease, osteoarthritis
trigeminal neuralgia, multiple sclerosis, glossopharyngeal neuralgia,
temporal arteritis, migraine headache, angina pectoris,
pulpoperiodontal disease, salivary gland inflammation, duct blockage,
otitis, sinusitis and psychogenic pain.
symmetry of face :
Interincisal opening : Normal(35-50mm), degree of opening pain begin.
Mandibular movement: Normal lateral ( 8-10mm).
– Does the TMJ click or pop on opening or closing?
– Has there been limitation in the movement or deviation
of the lower jaw on opening?
– Has the jaw ever locked or dislocated on opening?
– Has the patient experienced pain and dysfunction in
other joints of the body?
Pretragus palpation method
Intra-articular palpation method
65. Palpation of joint :listen for
clicking and crepitus during the opening and closing of the jaw.
Use stethoscope to characterize and locate this sound accurately.
Explore the anterior wall of external auditory
meatus for tenderness and pain that are usually
associated with arthritic changes
66. Methods of palpation
ﻓﮑﯽ ﺻﺪﻏﯽ ﻣﻔﺼﻞ ﺗﻔﺘﯿﺶ ﻣﯿﺘﺪ
1. Pretragus palpation: patient should be requested to slowly open
and close the mouth while the doctor bilaterally palpates the
pretragus depression with his/ her index fingers.
67. 2. Intra-auricular palpation: It is also performed by
inserting the small finger into the ear canal and pressing
anteriorly.
Methods of palpation
ﻓﮑﯽ ﺻﺪﻏﯽ ﻣﻔﺼﻞ ﺗﻔﺘﯿﺶ ﻣﯿﺘﺪ