Head, Face, and Neck Flashcards
What are the things you ask about when a patient has a headache?
- recurrent, new, or uncharacteristic?
- Location and severity
- associated nausea or vomiting, vision changes, neurologic changes
- chronology of symptoms
- Aggravation/Alleviation
- Triggers
- Family Hx
- Past treatments or outcomes, Meds used
Scotomas
specks in the vision or areas where patient cannot see
PE of Head
- Skin and hair –> scalp and face
- Bony structures –> skull and face
What are you looking for in the hair?
quantity, distribution, texture, and any pattern of loss
-loose flakes of dandruff
What are you looking for on the scalp?
-Scaliness, lumps, nevi, or other lesions
-redness/scaling = seborrheic dermatitis or psoriasis
soft lumps= pilar cysts
What are you looking for on the skull?
deformities, depressions, lumps or tenderness
enlarged skull= hydrocephalus or Paget’s disease
-Palpable tenderness of step-offs may be present after trauma
Battle’s sign
Brain injury presented as bruising behind the ears
Raccoon Eyes
Bruising around the eyes associated with Basilar skull fracture
Symptoms of Bell’s Palsy
Affected sign:
- inability to wrinkle brow
- drooping eyelid or inability to close eye
- inability to puff cheeks; no muscle tone
- drooping mouth; inability to pucker/smile
Symptoms of Nephrotic Syndrome
- swollen pale face
- swelling seen first around eyes and in the morning
- eyes may become slitlike if swelling is severe
Symptoms of Hypothyroidism
- swelling of face (doughy)
- Fatigue
- lethargy
- weight gain with anorexia
- cold intolerance
- constipation
- cramps
- irregular menses
Symptoms of Cushing’s Syndrome
- increased adrenal cortisol production
- produces round (“moon”) face with red cheeks
- excessive hair growth may be present in mustache and sideburn areas
Symptoms of Parkinson’s
- decreased facial mobility blunts expression
- masklike face may result, with decreased blinking and a stare
- skin may become oily
- drooling may occur
Symptoms of Acromegaly
- increased growth hormone produces enlargement of bone and soft tissues
- head is elongated, with bony prominence of the forehead, nose, and lower jaw
- Nose, lips, and ears enlarge
- facial features appear coarsened
- most likely due to tumor on pituitary
Three Diseases associated with Facial Swelling
Cushing’s Syndrome, Nephrotic Syndrome, Myxedema
ROS of Neck and Endocrine
- swollen glands or lumps in neck
- heat/cold intolerance; sweating, history of thyroid enlargement or problems
- Neck surgery, trauma, recent viral infection
PE of Neck
- overlying skin and neck muscle
- Contour/symmetry (tracheal deviation, lymphadenopathy, goiter, H & N alignment)
- Scars
- lesions, tenderness, erythema
- Trachea
- Lymph Nodes
What to look for in the lymph nodes?
- Size, shape, consistency, mobility, tenderness
- Use a circular motion w/pads of index & middle fingers
- Examine both sides simultaneously
- Shotty= lymph node that worked hard and became fibrous
Sequence of the Cervical Lymph Nodes
- Preauricular
- Posterior auricular
- Occipital
- Tonsillar
- Submandibular
- Submental
- Superficial
- Posterior Cervical
- Deep Cervical Chain
- Supraclavicular
Preauricular Nodes
in front of the ear
Posterior auricular Nodes
Superficial to the mastoid process
Occipital Nodes
at the base of the skull posteriorly
Tonsillar Nodes
at the angle of the mandible
Submandibular Nodes
midway between the angle and the tip of the mandible
Submental Nodes
midline a few centimeters behind the tip of the mandible
Superficial Cervical Nodes
superficial to the sternomastoid
Posterior Cervical Nodes
Along the anterior edge of the trapezius
Deep cervical chain Nodes
deep to the sternomastoid
-need to hook thumb and fingers around either side of sternomastoid to find them
Supraclavicular Nodes
deep in the angle formed by the clavicle and the sternomastoid
Cervical nodes & GABHS
- Sore throat
- Enlarged & tender: tonsillar, submental & submandibular nodes
Cervical nodes & mononucleosis
- Enlarged & tender: posterior
- Fever, fatigue, sore throat, rash
- Epstein-Barr virus
Cervical nodes & malignancy
- Stony hard, fixed, enlarged
- Non-tender
- Discrete
- B/L or U/l
Signs of Hypothyroidism
- Bradycardia
- dry, coarse, cool skin, sometimes yellowish
- somnolent (drowsy)
- periorbital puffiness
- delayed deep tendon reflex
- no lateral eyebrows
- decreased systolic and increased diastolic
Symptoms of Hyperthyroidism
- Nervous
- Good appetite with weight loss
- sweating and heat intolerance
- palpitations
- amenorrhea (absence of menstruation)
- frequent BMs
- tremors
Signs of Hyperthyroidism
- Exophthalmos (with Grave’s disease)
- tachycardia
- warm, smooth, moist skin
- palmar erythema
- proptosis/lid lag stare
- hyper-reflexia
- tremors
- Increased systolic and decreased diastolic
Exopthalmos
bug-eyed appearance because fat and tissue deposits behind eye push eye forward
Proptosis
lid takes longer to close
Warning Signs (“red flags”) of Headaches
- Progressively severe or progressive over 3 months
- Sudden onset
- New onset 50+ y/o
- Affected by change in position
- Triggered by Valsalva maneuver
- Associated: F/C, night sweats, wt loss, papilledema, neck stiffness, focal neurologic deficits
- Confirmed CA, IUP, HIV
- Recent head trauma
Attributes of Migraines
- U/L - throbbing, aching, variable pain scale
- Timing: rapid onset, peak 1-2 hrs, duration 4-72 hrs, recurrent (weekly to monthly)
- Associated: N/V, photophobia, phonophobia, aura: visual or motor
- Triggers: EtOH, food, stress, menses, barometric pressure/altitude, noise, light
- Relief: quiet & dark, sleep, lying still
Attributes of Tension Headaches
- B/L – generalized/localized back of head & upper neck or frontotemporal
- Steady pressing or tightening, non-throbbing, low to medium pain scale
- Timing: gradual onset, duration 30 min–7 days, episodic to chronic
- Triggers: sustained muscle tension
- Relief: massage, relaxation, ergonomics
Attributes of Cluster Headaches
- U/L – behind/around eye or temple
- Deep, continuous & severe pain
- Timing: abrupt, peaks in minutes, duration – 3 hrs, episodic, clustered (several/day x 1-2 mos) w/relief 6-12 mos
- Associated: lacrimation, rhinorrhea, miosis, ptosis, eyelid edema, conjunctival infection
- Triggers: EtOH
Dizziness
-nonspecific term used by patients that encompasses several problems including vertigo, presyncope, disequilibrium, psychiatric, multifactorial/unknown
Vertigo
spinning sensation accompanied by nystagmus and ataxia
Ataxia
lack of coordinated voluntary muscle movements
Nystagmus
fine rhythmic oscillation of the eyes; normal in extreme lateral gaze
Presyncope
a near faint from “feeling faint or lightheaded”
Disequilibrium
unsteadiness or imbalance when walking
