head face neck hape Flashcards
common or concerning symptoms of the head
Neck mass or lump
Thyroid mass, nodule, or goiter
Neck pain
Headache
what are lymphatic drainage patterns helpful for?
helpful when assessing possible malignancy or infection. For suspected malignant or inflammatory lesions, look for enlargement of the neighboring regional lymph nodes; when a node is enlarged or tender, look for a source in its nearby drainage area.
when should a persisent neck mass raise concern for malignancy?
in an adult older than 40
what do enlarged tender lymph nodes normally accompany?
pharyngitis
thyroid function and goiter
thyroid function may be increased, decreased, or normal
what do intolerance to cold, weight gain, dry skin, and slowed heart rate point to
hypothyroidism
what might intolerance to heat, weight loss, moist velvety skin, and palpitations point to
hyperthyroidism
key components of head and neck examination
-Examine the hair (quantity, distribution, texture, any pattern of loss).
-Examine the scalp (scaliness, lumps, nevi, lesions). -Examine the skull (size, contour, deformities, depressions, lumps, tenderness).
-Inspect the skin in the head and face (expression, contours, asymmetry, involuntary movements, edema, masses).
-Palpate the cervical lymph nodes (size, shape, delimitation, mobility, consistency, tenderness). -Examine the trachea (deviation, breath sounds over it).
-Examine thyroid gland (size, shape, and consistency).
what might an enlarged skull signify?
hydrocephalus or Paget disease of bone
hirsutism
(excessive facial hair) may appear in some women with polycystic ovary syndrome.
what does an enlargement of a supraclavicular node, especially on the left (Virchow’s node) suggest?
possible metasasis from a thoracic or an abdominal malignancy
what do hard or fixed lymph nodes suggest?
malignancy
what do enlarged or tender lymphnodes call for ? (if unexplained)
(1) re-examination of the regions they drain and (2) careful assessment of lymph nodes in other regions to identify regional from generalized lymphadenopathy.
what is generalized lymphadenopathy seen in?
multiple infectious, inflammatory, or malignant conditions such as HIV or AIDS, infectious mononucleosis, lymphoma, leukemia, and sarcoidosis.
what does tracheal deviation caused by masses in the neck raise suspicion of?
conditions in the thorax such as a mediastinal mass, atelectasis, or a large pneumothorax
stridor
is an ominous, high-pitched musical sound from severe subglottic or tracheal obstruction that signals a respiratory emergency.
Causes include epiglottitis,2 foreign body, goiter, and stenosis from placement of an
artificial airway
pemberton sign
used to evaluate venous obstruction in patients with goiters. The sign is positive when bilateral arm elevation causes facial plethora
what disease is the thyroid soft and what disease is it hard?
soft in graves and hard in hashimotos
what is Jugular venous distention a hallmark of?
heart failure
thyroid health promotion and counseling
Screening for thyroid dysfunction
Thyroid cancer screening
cushing syndrome
The increased adrenal cortisol production of Cushing syndrome produces a round or “moon” face with red cheeks. Excessive hair growth may be present in the mustache, sideburn areas, and chin (as well as the chest, abdomen, and thighs).
nephrotic syndrome
Glomerular disease causes excess albumin excretion, which reduces intravascular colloid osmotic pressure, causing hypovolemia, then sodium and water retention. The face becomes edematous and often pale. Swelling usually appears first around the eyes and in the morning. When severe, the eyes appear slit like.
myxedema
In severe hypothyroidism (myxedema) mucopolysaccharide deposition in the dermis leads to a dull, puffy facies. The edema, often pronounced around the eyes, does not pit with pressure. The hair and eyebrows are dry, coarse, and thinned, classically with loss of the lateral third of the eyebrows. The skin is dry.
acromegaly
The increased growth hormone of acromegaly produces enlargement of both bone and soft tissues
when do the conjunctivae become “bloodshot”
during times of infection, inflammation, or injury.
what can lead to diplopia?
Nerve damage or injury to the muscle, due to head trauma, congenital causes, or central lesions, can cause aberrations in this yoked system
common or concerning symptoms with the eye exam
Change in vision: blurred vision, loss of vision, floaters, flashing lights
Eye pain, redness, or tearing
Double vision (diplopia)
difficulty with close work suggests
hyperopia (farsightedness) or presbyopia (aging vision)
difficulty with distant vision suggests
myopia (nearsightedness).
what should you consider if sudden vision loss is unilateral and painless?
consider vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion.
if vision loss is sudden, unilateral, and painful what should you consider?
causes are usually in the cornea and anterior chamber such as corneal ulcer, uveitis, traumatic hyphema, and acute angle closure glaucoma
if sudden vision loss bilateral and painless
consider vascular etiologies, stroke, or non-physiologic causes
if sudden vision loss bilateral and painful
consider intoxication, trauma, chemical or radiation exposures.
what does gradual vision loss arise from?
cataracts, glaucoma, or macular degeneration.
scotomas
fixed defects that suggest lesions in the retina, visual pathway, or brain.
red and painless eye is seen in…
subconjunctival hemorrhage and episcleritis
a red eye with a gritty sensation is seen in
viral conjunctivitis and dry eye
a red painful eye is seen in
corneal abrasions, foreign bodies, corneal ulcers, acute angle closure glaucoma, herpes keratitis, fungal keratitis, hyphema, and uveitis
diplopia
seen in lesions in the brainstem or cerebellum and with weakness or paralysis of one or more extraocular muscles, as in horizontal diplopia from palsy of CN III or VI or vertical diplopia from palsy of CN III or IV.
key components of the eye exam
Test visual acuity using a Snellen eye chart.
Test visual fields by confrontation.
Test color vision and contrast sensitivity.
Assess position and alignment of the eyes (protrusion, deviation).
Inspect eyebrows (fullness, distribution, scaliness). Inspect eyelids and eyelashes (width, edema, color, lesions, eyelid closure).
Assess the lacrimal apparatus (lumps, swelling, tearing, dryness).
Inspect the conjunctivae and sclerae (vascular pattern, color, nodules, swelling).
Inspect the cornea, iris, and lens (opacity, anterior chamber depth).
Inspect the pupils (size, shape, symmetry).
Test for pupillary reaction to light (direct and consensual light reactions).
Inspect the light reflection in the corneas.
Test the extraocular muscle movements.
Perform ophthalmoscopic (funduscopic) examination including optic disc and cup, retina, and retinal vessels.
how is visual acuity expressed?
two numbers (e.g., 20/30): the first indicates the distance of the patient from the chart, and the second, the distance at which a normal eye can read the line of letters
myopia (near sightedness)
causes focusing problems for distance vision
hyperopia (farsightedness)
describes eyesight that is blurry on objects nearby.
what is astigmatism
an imperfection of the cornea or lens causing distortion while looking at near and far objects
what does presbyopia do?
causes focusing problems for near vision, found in middle-aged and older adults. A person with presbyopia often sees better when the card is farther away.
when is left homonymous hemianopsia is present?
when the patient’s left eye repeatedly does not see your fingers until they have crossed the line of gaze
what are the most commonly recognized color vision abnormalities?
sex-linked congenital red-green
deficiencies
Upslanting palpebral fissures are noted in…
down syndrome
Lagophthalmos
failure of the eyelids to close
what is helpful in diagnosing Argyll Robertson, tonic (Adie) pupils, and other neurologic syndromes
testing the near reaction
proptosis
an abnormal protrusion of the eyeballs in hyperthyroidism, leading to a characteristic “stare” on frontal gaze
what should you consider if there is a unilateral lid lag?
consider an orbital tumor or retrobulbar hemorrhage from trauma
what does an absence of red reflex suggest?
an opacity of the lens (cataract) or, possibly, the vitreous (or even an artificial eye). Less commonly, a detached retina; mass; or; in children, a retinoblastoma may obscure this reflex.
refractive error
light rays from a distance do not focus on the retina
macular degeneration
an important cause of poor central vision in older adults
vitreous floaters
are dark specks or strands seen between the fundus and the lens
cataracts
are densities in the lens
afferent pupillary defect, sometimes termed a Marcus Gunn pupil.
an abnormal pupil showing aberrant pupillary response in certain ocular disorders
health promotion and counseling for the eyes
Visual impairment
Screening for glaucoma
UV-related eye injuries
