Head, Face, Nose, Sinus and Neck Examination Flashcards
Torticollis
Rotation w/out lateral flexion
Ocular causes of abnormal head position
Strabismus and diplopia
Non-ocular causes of an abnormal head position
Cerebral palsy, bony abnormalities, occipital cervical synostosis, Parkinsonism syndromes & unilateral hearing loss
Hydrocephalus
shape irregular due to birth trauma or congenital disorders
Padget’s disease
Enlarged skull
Down syndrome
One biological marker is abnormal or accelerated rate of head circumference
Acromegaly
Elongated head and prominent brow and jaw
Edamatous face: Causes
causes include nephrotic syndrome, hypothyroidism (myxedema) or pre-eclampsia
Cushings Syndrome
Round or “moon” face with red cheeks
Parotid gland enlargement
Swelling anterior to the ear lobes & above angles of jaw; causes include mumps, etc.
Parkinson’s Disease: Symptom
Mask-like expression
What CN causes facial paralysis
CNVII
Hypothyroidism: Symptom
Thinning of outer 1/3 of eyebrow
Enophthalamos
Eyes placed back; related to hypothyroidism
Ptosis (symptoms/associations)
-Eyelid drooped
-Associated with Horner’s syndrome, myasthenia gravis or oculomotor nerve lesion
Entropion (symptoms/association)
-Turning inward of lid margin
-Elderly
Ectropion
-Turning outward of the lid margin
-Associated with elderly
Anisocoria
-Pupils asymmetrical
-Causes include: benign, trauma, medication etc.
Strabismus
-Pupils do not align
-CN III, IV, VI
Amblyopia
-Type of strabismus with one eye turning inward
-Cranial nerve III, IV, VI
Nasal flaring
-Respiratory distress
Pursed lips
-COPD
Cradle-cap
-White, yeasty looking
-Seen in children
Seborrhetic dermatitis
Redness and Scaling
Nits
Tiny tan, yellow or brown oval dots close to the scalp or after hatching, shell looks white or clear & continues to be firmly attached to the hair shaft
Hypertrichosis
Excessive male hair growth
Hirsutism
Excessive male-pattern hair growth in women due to androgen dominance
Alopecia
-Hair loss, including balding
-May suggest hormonal imbalances, aging or hypothyroidism
What condition is associated with coarse hair?
Hypothyroidism
What condition is associated with fine hair?
Hyperthyroidism
Pilonidal Cysts
Palpate the mass: Soft lumps or cyst (sac) of hair and debris
Pigmented nevi
Palpate for mass
Parotid gland enlargement
Swelling anterior to the ear lobs & above the angles of the jaw
-Causes include mumps
Giant Cell Artertis
Listen for bruits (temporal artery)
Unilateral bruit
-May be seen with seizures, headaches, stroke syndromes, intracranial mass lesions or carotid bruits
-Associated with orbital artery assessment
Bilateral bruits
-May suggest hyperthyroidism
-Associated with orbital artery assessment
CN V Trigeminal nerve assessment interpretations
-Cranial never lesion (is suggested)
-Sensory is decreased
-Patient does not blink
-Patient cannot maintain hold on tongue depressor
CN VII Facial Nerve assessment interpretation
-Cranial nerve lesion: Suggested if patient is unable to do
External nose interpretations
Broken nose or furuncle
A history or obvious broken nose may predispose a patient to
sinusitis
Furuncle
Tenderness of the nasal tip or alae may suggest local infection
Acute Coryza (common cold)
Fiery red mucosa, clearly watery discharge
Viral rhinitis
Mucosa is reddened & swollen
Allergic rhinitis
Mucosa is pale blue gray or pale pink & swollen/boggy
Epistaxis
May result from nose-blowing, picking, direct trauma, dry air, septum issues, drug abuse etc
Polyps
Pale, semi translucent masses
Septal perforations
Include trauma, surgery & drug use
Septal deviation
Due to trauma, congenital
Obstruction during the nasal patency
Causes including sinusitis, allergies, polyps
Sinusitis
May be painful to touch and percussion
Pale colouration
May indicate poor circulation, cold temperature
Nevi (Lips)
Moles: congenital or acquired from sun exposure
Blotchy hyperpigmentation (Lips)
Dark or black looking pigmentation due to Addison’s disease, trauma or smoking
Angioedema
-Swelling of the lips
-Allergic reaction
Carcinoma of the lip
-May present as a scaly plaque, ulcer w/ or w/o a crust as a modular lesion
-May also appear on tongue/gums
Chellitis
-Inflammation of the lip
-May suggest B12 or iron deficiency, allergy or precursor to skin CA
Angular chellitis
Inflammatory lesion at the labial commissure or corner of the mouth & is often BL
Labial HSV1 (aka cold sore or fever blisters)
-Small, sometimes painful fluid-filled reddish or purple blisters around the lips or corners of the mouth
-Over several days, the blisters tend to merge and then collapse
-A yellowish crust often forms over the sores
Cracks or tissues (lips)
May be due to hydration status, poor fitting dentures, braces
Aphthous stomatitis
-Aka: Canker sore or apithous ulcer
-White or oval lesion with an inflamed, red border (sometimes white circle or halo around the lesion)
Mucocele
Benign cycles that forms between the gums and buccal walls (not common)
Petechiae
May be present in individuals who bite their cheeks and in those with platelet disorders
Bruxism
Bite marks
Koplik spots of measles
Gray white spots near parotid duct opening
Fordyce spots
Yellowish granulations
Normal gums
-Pink
-Patchy brownness may be present, especially but not exclusively in those with dark-skin
Gingivitis
Inflammation and infection of gums
Gingival hyperplasia
May be caused by Dilantin (seizure) therapy, puberty, pregnancy and leukaemia
Alveolar pyorrhea
-Severe infection of the teeth with recession of gums
-May see tooth loss
Hyperpigmentation (gums)
Several causes including Addison’s disease, medication, smoking or benign
Blue or black line along gum
May be caused by heavy metal toxicity
Discoloration of teeth
-Several causes: smoking, coffee, wine, cola, antibiotics
Bruxism
Surface of teeth may be affected
Malocclusion
Teeth do not meet correctly
Leukoplakia
Adherent white patches on the mucous membranes of the mouth and tongue
Candiasis
Yeast-like fungus overgrowth on tongue or throat
Atrophic glossitis
Beefy, red tongue associated with pernicious anemia, iron deficiency etc
Geographic tongue
Map-like appearance of tongue due to irregular patches on its surface
Cancer of the tongue
-Suspect any persistent red or white nodule or ulcer
-Induration increased the possibility
-M/C side of tongue at it’s base
-2nd M/C CA of the mouth
Ankloglossia
-AKA tongue tie
-A congenital anomaly characterized by an abnormally short lingual frenulum
-Often found in infants that have difficult breast feeding
Stensen’s Ducts
(Parotid) open on the buccal mucosa opposite the 2nd molar on each side of the upper jaw
Wharton ducts
(Submandibular gland ducts) under the tongue on each side of the frenulum
Siaorrhea
-May be caused by medications, Parkinson’s or GERD
Xerostomia
-May be caused by medications, nutrition, or Sjogrens
Torus Palatinus
Midline growth in the hard palate that is fairly common in adults, size & lobulation vary
-May be insignificant, contributory to migraines or a characteristic of acromegaly
Pharyngitis
-Inflammation of the throat
-Most common in viral & bacterial infections
Tonsillitis
Red throat
Strep throat
Red throat with white exudate on the tonsils (due to strep or mono)
Cord nodules or polyps
May see with hoarseness
Absence of gag reflex
Alone it does not support neurogenic dysphagia
Abnormal gag reflex
-Soft palate fails to rise & uvula deviates away
-May be caused by movement disorders, myasthenia gravis, stroke, dementia & cervical spine surgery
A lower motor lesion (hypoglossal)
-Will cause Deviation to the IL side
-Corresponding fasciulcations & atrophy
Upper motor neuron lesion (hypoglossal)
Will cause the tongue to deviate away from the side of the cortical lesion
-Fasciulations and atrophy seen in the LMN are not always present
Halitosis
-Causes may include poor hygiene, infection, GERD etc.
Conditions of Head and Face
-High intercranial pressure headache
-Syncope, presyncope, dizziness
-Transient Ischemic Attact (TIA)
-CN VII hemiparesis (Bells Palsy & Stroke)
Conditions of Nose
Anosmia, Rhinorrhea & acute coryza, Rhinitis (viral and allergic), acute sinusitis, hypertrophied turbinate, polyps, malignant cancer, snoring
Conditions of Neck
Hypothyroidism, Hashimoto’s thyroiditis, hyperthyroidism, thyroid cancer
