Warning Signs of Stroke

Warning Signs of Facial Abnormalities

• Frontal, parietal, and occipital prominences indicate normal facial features
• Face drooping, arm weakness, and speech difficulty are signs of emergencies
• Deviations from normal include disproportionate or asymmetric parietal and temporal prominences, increased head circumference, square or bulging bones, and hydrocephalus
• Bell palsy is characterized by drooping, weakness, or paralysis on one side of the face
• Parkinson's disease is marked by a "mask-like" face
• Cachexia is characterized by a "sunken" face with depressed eyes and hollow cheeks
• Acromegaly is marked by an inconsistently large head size in adolescents or adults
• Myxedema is characterized by a dull, puffy face with edema around the eyes

Inspection of Facial Features

• Normal facial features include symmetric features, evenly distributed eyebrow hair, and equal palpebral fissures
• Deviations from normal include asymmetric features, increased facial hair, thinning of eyebrows, and exophthalmos (bulging or protruding eyeballs)

Symmetry of Facial Movements

• Normal facial movements include symmetric raising and lowering of eyebrows, blinking, and closing eyes tightly
• Deviations from normal include asymmetric facial movements

Inspection of Eyes

• Normal eyes have no edema and are not sunken
• Deviations from normal include periorbital edema (swelling around the eyes) and sunken eyes, cheeks, and temples

Palpation of the Head

• Normal head consistency is smooth and uniform, with no nodules or masses
• Deviations from normal include sebaceous cysts, local deformities from trauma, and masses or nodules

Inspection of Neck Movements

• Normal neck movements include smooth, controlled movements
• Deviations from normal include torticollis (twisting of the neck), asymmetric cartilage movement, and goiter or malignant masses

Anatomy of Thyroid and Parathyroid Glands

• Normal anatomy includes a non-visible thyroid gland with no masses, swelling, or hypertrophy in the mid to lower half of the anterior neck
• Deviations from normal include enlargements, lymphadenopathy, and lymphoma

Inspection of Neck

• Normal neck anatomy includes a midline neck with no lumps, bulges, or masses
• Deviations from normal include lymphadenopathy, lymphoma, and goiter or malignant masses

Palpation of the Neck

• Normal palpation reveals a supple, moving, and non-tender neck with no masses
• Deviations from normal include masses, tenderness, and lymphadenopathy

Inspection of the Ears

• Normal ear anatomy includes a helix of ear level with the imaginary line drawn through the inner and outer canthus to the occiput
• Deviations from normal include microtia (small ears), macrotia (large ears), and missing or malformed landmarks
• Ear pits or sinuses are usually located anterior to the tragus and are associated with internal ear anomalies

Hearing Process

• Air conduction is the primary mechanism of hearing
• Sound waves reach the tympanic membrane (eardrum), causing vibrations that move the malleus, incus, and stapes bones
• Vibrations are transmitted to inner ear structures, leading to hearing

Otoscopic Examination

• A flashlight-type viewer is used to visualize the eardrum and external ear canal
• Normal otoscopic examination reveals a normal eardrum and external ear canal
• Deviations from normal include lesions, skin cancer, and impacted cerumen

Palpation of the Ears

• Normal palpation reveals soft and palpable, non-tender ears with no nodules or swelling
• Deviations from normal include tenderness of the mastoid, helix, tragus, or pinna, indicating ear infections

Hearing Tests

• Whisper test is used to assess low-pitch deficits
• Watch tick test is used to assess high-pitch deficits
• Weber test is used to evaluate conduction of sound waves through bone to help distinguish between conductive and sensorineural hearing loss### Maceration and Related Concepts
• Maceration relates to the soft palate and its structures
• UVula is a fleshy cone-like structure in the center of the soft palate
• Overclosure of the soft palate can lead to halitosis and other issues
• Salivary glands secrete saliva containing amylase to convert starch to maltose
• There are three major salivary glands: parotid, submandibular, and sublingual glands
• Herpes simplex is a viral infection that can affect the oral cavity

Dental Anatomy and Inspection

• Normal adult dental anatomy consists of 28 teeth, or 32 if including wisdom teeth
• Deviations from normal can include loose, poorly anchored, or malaligned teeth
• Dental caries are caused by acid on enamel surfaces
• Discoloration of teeth can be a sign of deviation from normal
• Mottled enamel is a normal variation

Oral Mucosa and Gums

• Normal oral mucosa is pink, moist, and intact
• Gums should be consistent in color with other mucosa and be intact
• Deviations from normal can include gum hyperplasia, recession, or bleeding
• Allergic stomatitis can cause reddened, inflamed oral mucosa
• Aphthous ulcers are acute, painful ulcers in the oral cavity

Pharynx and Oropharynx

• Normal pharyngeal examination reveals a pink, moist, intact mucosa
• Deviations from normal can include postnasal drainage, erythema, swelling, or exudate
• Pharyngeal diphtheria is an exudative pharyngitis caused by bacterial infection
• Herpangina is a viral infection causing scattered vesicles and ulcerations in the pharynx

Tongue Inspection and Palpation

• Normal tongue examination reveals a pink, moist, and freely mobile tongue
• Deviations from normal can include loss of papillae, discolorations, or lesions
• Geographic tongue is a normal variation with a map-like appearance
• Hypertrophy and discoloration of papillae can be a deviation from normal

Tonsils and Glands

• Normal tonsillar examination reveals symmetrical, pink, clean crypts
• Deviations from normal can include peritonsillar abscess, reddened or hypertrophic tonsils
• Parotid glands should be non-palpable and non-tender
• Submandibular and sublingual glands may be palpable but should be non-tender and soft