Physical Assessment Lynch

Tardive Dyskinesia

  • Most commonly from older antipsychotics (esp. Haldol)
  • Repetitive, purposeless movements
  • Tongue smacking

Presentation of Cluster Headache

  • Watery eye
  • Drooping eyelid
  • Runny nose

PERRLA
Pupils Equally Round and Reactive to Light and Accommodation
Accommodation
The act of physiologically adjusting crystalline lens elements to alter the refractive power and bring objects that are closer to the eye into sharp focus
Nystagmus

  • Horizontal/rebound nystagmus most associated with drug-induced causes
  • Barbituates, phenytoin, sedatives, EtOH, street drugs (hallucinogens)
  • Other types of nystagmus mainly associated with brain/nerve lesions, congenital malformations, cancers

Constricted Pupils

  • Natural in high-light environments
  • Can be drug-induced
  • Narcotic analgesics, clonidine overdose, sedative overdose, insecticide overdose, MAO-I overdose
  • May result from brain-stem lesions or injury

Risk Factors for Developing Cataracts

  • UV light
  • Smoking
  • Diabetes
  • Family History
  • Prolonged corticosteroid use
  • Previous eye surgery or trauma

Xerostomia

 

  • Dry mouth resulting from absent or decreased salivary flow
  • Can be drug-induced (affects Muscarinic-3 receptors)
  • Other causes:

Uncontrolled diabetes (dehydration)

Sjogren’s Syndrome (autoimmune destruction of salivary glands)

Lambert-Eaton Myasthenic Syndrome (impaired release of ACh)

Crystal Meth

  • Leading cause of drug-induced oral pathologies in certain populations
  • Leads to severe xerostomia — vasoconstriction, cutting off blood supply to the mouth
  • Has anticholinergic properties

Erythema Multiforme

  • Mucocutaneous lesions
  • Typicaly symmetrical

Lichenoid Lesions

  • White striations or plaques
  • Typically on lateral aspect of tongue or on buccal mucosa
  • Unilateral lesions much more common in drug reactions than in idiopathic lichen planus
  • Presence of eosinophils histologicaly is suggestive of drug reaction
  • Should diminish over 5-7 days after discontinuing offending drug therapy

Gingival Hyperplasia

  • Co-exists with gingivitis (leading to drug accumulation)
  • Chemically-induced overgrowth of epithelial fibroblasts and collagen
  • Dose-related incidence
  • Phenytoin, cyclosporine, nifedipine

Allergic Shiners

  • AKA blood pooling
  • Associated with ongoing allergic symptoms

 

Slug-Tracks
AKA post-nasal drip
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