Head and Face

Question 1

What are you looking for when you inspect facial features?

Answer 1

Symmetry, any abnormalities

Question 2

How can you test CN VII (facial nerve)

Answer 2

facial symmetry

wrinkle forehead, raise eyebrows, squeeze eyes shut

Smile and puff out cheeks

Question 3

How can you test CN V (trigeminal) sensory

Answer 3

check for light touch to ophthalmic , maxillary and mandibular (forehead, cheeks, chin)

Question 4

How can you test for motor function of masseter (CN V)

Answer 4

ask pt to close mouth and “bite down”

Question 5

Temporal arthritis (aka giant cell arthritis) what is it? What symptoms do these patients present with?

Answer 5

Inflammation of arteries around the scalp

Headache. “It hurts when I comb my hair”

Can lead to blindness.

Question 6

If you have a concern for temporal arteritis what should you do in your PE?

Answer 6

palpate the temporal arteries for tenderness

Question 7

Define facies

Answer 7

expression or appearance of the face, head or neck that is characteristic of a clinical condition ex. acromegaly, down syndrome, myxedema

Question 8

What is Acromegaly? facies for these patients?

Answer 8

Results for excessive growth hormone. Usually due to benign tumor or pituitary gland.

Generalized expansion of the skull. Pronounced brow protrusion, often with ocular distention. Pronounced lower jaw protrusion. Macroglossia (teeth gapping)

Question 9

What is cushing’s Syndrome?

facies?

Answer 9

Hypercortisolism

“moon face” facial swelling, red cheeks, hirsutism

Question 10

What is Myxedema? facies?

Answer 10

Severe hypothyroidism

Dry, coarse, and sparse hair. Thin lateral eyebrows. Puffy face. Puffy eyes.

Question 11

Parkinson’s Disease? facies?

Answer 11

Decreased facial ability.

Stare, blunted expression, mask-like face.

Question 12

What can cause parotid gland enlargement

Answer 12

major salivary gland

Enlargement can be caused by Parotitis (infectious/blockage), measles, chronic bilateral enlargement can be seen with obesity, DM and cirrhosis

Question 13

Bell’s Palsy

Answer 13

Idiopathic paralysis of the facial nerve

Unable to perform functions involving facial nerve i.e wrinkle forehead, squeeze eyes shut.

Question 14

What is generally included in a head/face exam?

Answer 14

• inspect facial features
• test muscle/CN function
• palpate facial features and sinuses
• test muscle/ CN
• inspect & palpate the hair, scalp and skull

Question 15

What should you look for when inspecting hair, scalp and skull?

Answer 15

Hair: quantity, distribution and texture

Scalp: redness? scaling? Lesions? wildlife?

Skull: size, shape, symmetry, deformities or tenderness

Question 16

Male pattern baldness

Answer 16

begins above both temples., hair also thins at the crown of the head

Question 17

Alopecia areata

Answer 17

clearly demarcated round or oval patches of hair loss. Usually affects young adults and kids. Can be caused by lots of stress

Question 18

Seborrheic dermatitis

Answer 18

results from overproduction of sebum. Flaky white to yellowish scales on oily skin.

Question 19

Hirsutism

Answer 19

Male pattern hair growth on a women. Due to excess androgen

symptom of disease, including Polycystic Ovarian Syndrome

Question 20

Paronychia? Cause?

Answer 20

Acute or chronic inflammation of the nail folds. Nail folds are swollen, red and tender.

Caused by local trauma (nail bitting) or frequent hand immersion in water

Question 21

Leukonychia

Answer 21

nonuniform white spots that grow slowly out with the nail.

Caused by trauma

Question 22

Koilonychia

Answer 22

spoon nails.

Abnormally thin nails, may become concave.

Associated with iron deficiency anemia and Plummer-Vinson syndrome

Question 23

Onycholysis

Answer 23

painless separation of the whitened opaque nail plate from the pinker translucent nail ben

Caused by trauma and by some systemic diseased (DM, anemia, hyperthyroidism)

Question 24

Onychocryptosis

Answer 24

ingrown toenail, nail grows into dermis.

Cause: improperly cutting toenails. Tight shoes

Question 25

Oncyomycosis

Answer 25

fungal infection of the nail bed, plate or matrix

Cause: occlusive footwear ,, looker room exposure

Question 26

Terry’s nails

Answer 26

nail plate turn white with distal band of reddish brown

Cause: aging, some chronic disease ( liver disease, cirrhosis, DM)

Question 27

Beau’s lines

Answer 27

transverse linear depressions of nail plate, usually bilateral

Cause: temporary disruption of proximal nail growth from systemic illness

Question 28

nail pitting

Answer 28

punctate depressions of the nail plate

Cause: defecting layering of the superficial nail plate

Question 29

Nail clubbing

Answer 29

bullous swelling of the soft tissue at the nail base with loss of normal angle

Nail bed feels spongy or floating

Cause: conditions associated with hypoxia (congenital heart disease, lung diseases)