Examination of head and neck Flashcards
1
Q
What are the 4 systematic steps in principal examination
A
- Inspection = visual examination of the area
- Palpation = feeling the area of examination
- Percussion = tapping around the area
- Auscultation = listening to area with stethoscope
2
Q
How does Cushing’s syndrome present on the face
A
- Moon face
- Plethora = redness
- Hirsutism = excessive facial hair
- Acne
3
Q
How does Cushing’s syndrome present else where on the body
A
- Red striae on abdomen
- Weight gain; buffalo hump
- Ammenorhoea
- Personality change
- Hypertention
- Osteoperosis
- Diabetes due to increased gluconeogenesis
4
Q
What are the causes of Cushing’s syndrome
A
- Cushing’s disease
- Ectopic ACTH secreting tumours (small cell lung cancer and bronchus carcinoma)
- Adrenal tumour causing cortisol production
- Excess cortisol exposure e.g. prednisolone
5
Q
What is the dental relevance of Cushing’s syndrome
A
- Candidiasis (if DM)
- If on bisphosphonates risk of osteonecrosis of the jaw
- Need steroid cover for dental surgeries
6
Q
What is the difference between Cushing’s disease and Cushing’s syndrome
A
Disease = due to pituitary tumour causing XS ACTH
Syndrome = due to exogenous steroids, small cell lung cancer, adrenal tumours
7
Q
How does hypothyroidism present on the face
A
- Coarse mottled skin
- Peaches and cream complexion
- Peri-orbital oedema
- Loss of eyebrows
- Dull, listless appearance
8
Q
How does hypothyroidism present elsewhere on the body
A
- Tiredness
- Poor appetite, weight gain and constipation
- Cold intolerance
- Hairloss
- Infertility
- Heavy irregular periods
- Depression
- Bradycardia
- Myxoedema facies
9
Q
What causes hypothyroidism
A
- Dietary iodine deficiency (needed for thyroxine production)
- Thyroidectomy
- Pituitary gland disorder thus no TSH production
- Hashimoto’s thyroiditis = autoimmune
- Drugs e.g. amiodarone, lithium
10
Q
What is the dental relevance of hypothyroidism
A
- Delayed dental eruption
- Glossitis
- Dysgeusia
- Delayed wound healing
- Compromised periodontal health due to delayed bone formation
11
Q
What is myxoedema coma
A
Lethal deterioration of the patients mental status when the body’s compensatory responses to hypothyroidism are overwhelmed by a precipitating factor such as drug or infection (this means they cannot be put under GA)
12
Q
How does acromegaly present on the face
A
- Frontal bossing
- Prominent supraorbital ridge
- Brow furrow
- Enlarged nose
- Prognathism (bulging of lower jaw)
13
Q
How does acromegaly present else where on the body
A
- XS hair growth (hirsutism) and sweating
- Spade-like hands and feet
- Carpel tunnel (where medial nerve is trapped)
- Loss of temporal vision (bitemporal heminopea)
14
Q
What causes acromegaly
A
Fast growth causing gigantism as a result of an anterior pituitary tumour
15
Q
What is the dental relevance of acromegaly
A
- Macroglossia
- Spacing of teeth
- Malocclusion
- Anterior open bite
- Hypercementosis of root
- Enlarged prognatic mandible
16
Q
What can acromegaly cause
A
CVS - hypertension, cardiomyopathy, coronary artery disease
Metabolic - DM type II, impotence, amenorrhea
Osteoarthritis
17
Q
Why do patients with acromegaly have bitemporal hemianopia
A
Because the anterior pituitary tumour can enlarge to compress the optic chiasm meaning the nasal half of fibres are disrupted causing loss of vision in temporal region (decussation)
18
Q
How does downs syndrome present on the face
A
- Dysmorphic round face
- Eyes that slant upwards
- Epicanthic folds (upper eyelid skin fold covering inner eye)
- Brushfield spots (white spots in iris arranged circularly)
- Small nose with a flattened bridge
- Protruding tongue
- Small low set ears
- Flat occiput (back of head)
19
Q
How does downs syndrome present else where on the body
A
- Small head and short neck
- Broad and short hands with single palmar crease
- Hyperflexible joints
20
Q
What is the cause of downs syndrome
A
Trisomy of chromosome 21
- there is a random error is cell division causing an extra chromosome
21
Q
What is the dental relevance of downs syndrome
A
- Delayed eruption
- Small teeth causing spacing or
- Crowding due to small upper jaw
- Unstable neck due to atlantoaxial subluxation which can compress spinal chord (take care extending neck)
- Increased periodontal disease risk
- Macroglossia
- Anterior open bite
22
Q
What complications can downs syndrome cause
A
- Congenital heart disease; predisposed to IE
- Learning difficulty and developmental delay
- Increased risk of leukaemia and infections
- Intestinal problems
- Hyperthyroidism
- Hearing and visual problems
- Risk of Alzheimer’s
23
Q
How does Bell’s palsy present on the face
A
- Unilateral facial weakness
- Inability to furrow brow
- Droopy eyelid (ptosis) cannot close eye
- Loss of nasolabial fold
- Drooping corner of the mouth; cannot smile or pucker
- Abnormal contraction of the platysma muscle
- Facial numbness
- Changes in salivation
- Alterations of taste sensation (afferent fibres of taste receptors)
24
Q
How does Bell’s palsy present else where on the body
A
Patients are sensitive to sound and light
Hyperacusis or ear pain due to involvement of somatic afferent fibres of the external auditory canal and pinna
25
What causes Bell's palsy
It is caused by lower motor neurone lesion of the facial nerve which can occur due to; herpes, EBV/CBV or be autoimmune
There is inflammation and swelling of the facial nerve near the stylomastoid canal which can cause compression and ischaemia or demyelination of the nerve
26
What is the dental relevance of Bell's palsy
1. Hard to clean teeth on affected side
2. Food accumulation so risk of tooth decay and gum disease
3. Xerostomia so increased caries risk
4. Dentures don't fit well due to poor cheek tone
27
What is the difference between the symptoms experienced from upper and lower motor neurone lesions
UMN lesions spare the upper face so unilaterally affects lower half of face
LMN lesion (Bell's palsy) affects the face unilaterally
28
What are the causes of bilateral parotid gland swellings
1. Diabetes
2. Alcoholic liver disease
3. Sjogren's syndrome
4. Infections like mumps
29
What are the causes of unilateral parotid gland swellings
1. Parotitis = painful bacterial infection
2. Salivary calculus
3. Parotid tumour
30
What is peri-orbital erythema
Redness and swelling around the eye; this could be due to an adverse drug reaction, local infection (periorbital cellulitis) or an allergy
31
What can peri-orbital bruising indicate
If it is not a result of trauma/soft tissue injury it can indicate life threatening conditions such as cancer
32
What is a meibomian cyst
Lump or swelling on the eyelid due to blockage of a tarsal gland
33
What is a stye
A staph infection of the hair follicle affecting the eyelid; this is self healing but can be aided with hot water compresses and antibiotics if infected
34
What is xanthalessma
Yellow fatty deposits commonly on the medial aspect of eyelids due to hyperlipidaemia, diabetes and hyperthyroidism
35
What is eyelid retraction characteristic of
Graves disease; autoimmune attack on thyroid causing hyperthyroidism
36
What is exopthalmos
Bulging out of the eye
37
What does a red sclera indicate
conjunctivitis
38
What does a yellow sclera indicate
jaundice
39
What does a blue sclera indicate
osteogenesis imperfects where there is thinning of the sclera which means the veins show through causing a blue appearance
40
What can changes in the conjunctiva indivate
Pale/pink is characteristic of anaemia and dryness could indicate Sjogren's
41
How does basal cell carcinoma present on the face
Pink localised skin cancer with raised and rolled edges and telangactasia, and this can crust and bleed - this is slow growing but if left untreated it can form a rodent ulcer which will require skin grafting
42
What are the causes of jaundice
1. Pre-hepatic = haemolytic anaemia
2. Hepatic = dysfunction causing hepatitis, drugs, alcohol, tumours in the liver
3. Post-hepatic = bile duct issue e.g. gallstones so bile cannot drain, or a pancreatic tumour obstructing the biliary tree
43
What are the common causes of bilateral exopthalmous
1. Grave's disease
2. Metastatic neuroblastoma
3. Lymphoma/leukemia
4. Cavernous sinus thrombosis
44
What are the common causes of unilateral exophthalmos
1. Eye trauma/infection (bleeding behind eye or orbital cellulitis)
2. Optic nerve tumour
3. Meningioma
4. Haemangioma
45
What is stomatitis caused by
Infection, iron deficiency, chemotherapy, contact dermatitis
46
What GIT disease could be the cause of ulcers in the mouth
Crohn's disease (not ulcerative colitis) because Crohn's affects from the mouth to anus
47
What can gingival hypertrophy be caused by
- Ca2+ channel blockers
- Phenytoin (anti-epileptic)
- Cyclosphorin (immunosuppressive)
48
What is lichen planus on the tongue a result of
Chronic inflammatory condition which is premalignant for squamous cell carcinoma and appears as white lacy patters on the tongue or oral mucosa
49
What is geographic tongue
When there is inflammation on the top and sides of the tongue
50
What is angular chelitis
Inflammatory condition affecting corners of the mouth
51
What can abnormal pigmentation on the lips and around oral cavity be caused by
1. Addison's disease; not enough cortisol
2. Peutz-Jeghers syndrome; genetic condition where there is benign colonic polyps (hamartomas) which can bleed and cause GI blood loss
52
What is oral candidiases
Fungal infection by Candida albicans which is related to diabetes, HIV and patients that are immunosuppressed
53
What can cause atrophic glossitis
- B12 deficiency
- Iron deficiency anaemia
- Folate deficiency
54
What can cause macroglossia
- Acromegaly
- Amyloidosis
- Hyperthyroidism
55
Describe the anatomical locations of the two triangles of the neck
```
Anterior = below digastric, infant of sternomastoid
Posterior = behind sternomastoid, infront of trapezius, above clavicle
```
56
Describe how a neck lump should be assessed
Site, size, shape, surface (smooth or nodular)
Texture, consistency, temperature, tenderness
Motility and surrounding tissues and fluctuance
Overlying skin changes, pulsatilitu, lymph drainage
57
What are fluctuant neck lumps
These are fluid filled and can be assessed by
- holding the lump by its sides and applying pressure to the centre of the mass
- if it is fluid filled then it will budge outwards
58
What does transillumination of neck lumps indicate
That it is fluid filled e.g. cystic hygroma
59
What is a vascular bruit
This is an audible vascular sound associated with turbulent blood flow and can indicate goitre or carotid body tumour when found in neck lumps and is heard in Grave's disease
60
How does goitre present
It is an enlargement of the thyroid gland and appears as a diffuse central neck swelling which will move up on swallowing and not move upon tongue protrusion
61
What type of neck swelling will move up on tongue protrusion
Thyroglossal cycst
62
Outline how the thyroid gland is palpated
1. Move behind the patient and identify cricoid cartilage with fingers of both hands
2. Move downwards 2/3 tracheal rings while palpating for the isthmus
3. Move laterally away from the midline while palpating for the lobes of the thyroid
63
What does retrosternal dullness upon percussion below neck indicate
Large goitre extending inferiorly
64
What is the only neck swelling that is pulsatile
Carotid body tumours
65
What is a laryngocoele
Congenital anomalous air sac communicating with the cavity of the larynx showing as an anterior neck swelling
66
List anterior triangle neck swellings
1. Lymphadenopathy
2. Thyroid swelling
3. Parotid tumour
4. Branchial cyst
5. Dermoid cyst
Rare; carotid body tumour, laryngocoele
67
List midline neck swellings
1. Lymphadenopathy
2. Thyroid swelling
3. Thyroglossal cyst
68
List posterior triangle neck swellings
1. Lymphadenopathy
2. Cystic hygroma
3. Cervical rib
