Chapter 7 The Head and Neck Flashcards
Hyperthyroidism
Fine hair
Hypothyroidism
Course hair
Lice
Tiny white granules may be eggs of lice
Seborraheic dermatitis (psoriasis)
redness and scaling; most common form in adults dandruff; in infants cradle crap
Pilar cysts (wens)
soft lumps
hydrocephalus
Enlarged skull may signify this; also called Paget’s disease of bone
Trauma
tenderness or stepoffs are common after trauma (i.e. Gaby Lee Giffords)
Acne
Common in adolescents
Hirutism
excessive amounts of hair in women where men typically grow hair (face, chest, back)
Alopecia Areata
Clearly demarcated round or oval pathes of hair loss, usually affecting young adults and children. There is no visible scaling or inflammation.
Tinea capitis
Ringworm of scalp usually caused by fungal infection; round scaling pathes of alopecia (can mimic seborrheic dermatitis); hairs broken off close to surface of scalp
Trichotillomania
Hair loss from pulling, plucking, or twisting hair.
Cushings
Increased adrenal cortisol produces a round or “moon” face with red cheeks. Excessive hair growth may be present in the mustache and sideburn areas on the chin
Nephrotic syndrome
Face is edematous and often pale. Swelling usually appears around the eyes and in the morning
Parkinson’s
Mask like face with characteristic stare (decreased facial mobility blunts expressions)
Tarditive dyskinesia
Involuntary movement and ticks; sometimes permanent
Psoriasis
silvery, scaly lesions, mainly on extensor surface
Vitiligo
depigmented macultes appear on face, hands, feet, and extensor surfaces
Cushing’s sydrome
Increased cortisol production of produces a round or “moon” face with red cheeks
Nephrotic syndrome
Face is edematous and often pale
Myxedema
Pt with severe hypothyroidism has a dull puffy face
Parotid gland enlargement
Chronic bilateral asymptomatic parotid gland enlargement may be associated with obesity, diabetes, cirrhosis
Acromegaly
Increased growth hormone produces enlargment of both bone and soft tissues
Rhinorrhea
is drainage from the nose often associated with nasal congestion.
rhinitis medicamentosa
Excessive use of decongestants can worsen symptoms
Acute bacterial sinusitis
Sx: pain bending forward, maxillary toothache, fever or local headache, (~80-90% of cases) appear after URI
Nasal congestion limited to one side
Consider a deviated nasal septum, foreign body, or tumor
Epitaxis
Bleeding from nose; Local causes include trauma (especially nose picking), in?ammation, drying and crusting of the nasal mucosa, tumors, and foreign bodies. Bleeding disorders may contribute to epistaxis (bleeding from the nose)
Farsightedness
Difficulty with close work suggests hyperopia
Presbyopia
aging vision
Myopia
nearsightedness
Unilateral visual loss is painless
consider vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion.
Unilateral visual loss is painful
causes are usually in cornea and anterior chamber as in corneal ulcer, uveitis, traumatic hyphema, and acute glaucoma. Optic neuritis from multiple sclerosis may be painful.
If bilateral AND painless
could be due to meds that change refraction (cholinergic, anticholinergics, and steroids)
If bilateral AND painful
consider chemical/radiation exposures
If bilateral visual loss is gradual
Usually arises from cataracts or macular degeneration
Central visual loss
nuclear cataract, macular degeneration
Peripheral loss
adv open-angle glaucoma
One sided loss
hemianopsia and quadrantic defects
Specks in vision
Moving specks suggests vitreous floaters, FIXED defects (scotomas) suggest lesions in the retina or visual pathways
Flashing lights (new vitreous floaters)
suggest detachment of vitreous from retina
Diploia (double vision)
may arise from a lesion in the brain stem or cerebellum, or from weakness or paralysis of one or more extra ocular muscles, as in horizontal diplopia from palsy of CN III or VI, or vertical diplopia of CN III or IV.
Diplopia in one eye
with the other closed, suggests a problem in the cornea or lens
Strep throat
Fever, pharyngeal exudates, and anterior lymphadenopathy, especially in absence of cough, suggest streptococcal pharyngitis
Sore tongue
Aphthous ulcers is a sore smooth tongue of nutritional deficiency; Sore tongue may result from local lesions as well as systemic illness
gingivitis
Bleeding from gums is a common symptom, esp. during teeth brushing
Hoarseness
Overuse of voice and acute infections are the most likely causes. Chronic causes includes smoking, allergy, voice abuse, hypothyroidism, and chronic infections such as TB
Pharyngitis
Accompaning sx: Enlarged tender lymph nodes
Goiter
Thyroid function may be increased, decreased, or normal
Thyroid function evaluation
Ask about temperature intolerace and sweating.
Hypothyroidism
Intolerance to cole, preference for warm clothing and many blankets and decreased sweating
Hyperthyroidism
The opposite sx: palpitations and involuntary weight loss
Assymetric protrusion
suggests a lesions of CNXII
Cancer of the tongue
second most common cancer of the mousth, second only to the lip. Any persistent nodule or ulcer, red or white, must be suspect Often occurs on side of tongue
CN X paralysis
the soft palte fails to rise and the ulvula deviates to the opposite side
Lymph nodes
tender nodes suggest inflammation; hard or fixed nodes suggest malignancy
Diffuse lymphadeopathy
raises suspicision of HIV or AIDS
Tracheal deviation
masses in neck may push trachea to one side; may signifiy important problems in thorax, such as mediastinal mass, atelectasis or a large pneumothroax
Thyroid gland
soft in graves’ disease; firm in Hasmitoto’s thyroiditis, malignancy. Benign and malignant nodules tenderness in thyroiditis
Exudative Tonsillitis
A characteristic red throat that has a white exudate on the tonsils. This togehr with fever and enlarge cervical nodes, increases the probability of group A streptococcal infection or infectious mononucleosis. Anterior cervical lymph nodes are usually enlarged in the formers, and posterior nodes in the latter.
Hutchinson’s Teeth
Smaller and more widely spaced than normal and are notched on their biting surfaces. The sides of teeth taper toward the biting edges. The upper central incisors of the permanent (not the deciduous) teeth are most often affected. These teeth are a sign of congenital syphillis.
Thrush on palate
A yeast infection due to Candida. Thick, white plaque are somewhat adherent to underlying mucosa
Tracheal deviation
Masses in the neck may push the trachea to one side. May also signify problem in the thorax, such as a medastinal mass, atelectasis, or a large pneumothorax.
