Week 3: Head And Neck Flashcards
Examination of the head
Examination of the Head (overall observation)
What does this tell us??
- Hair
- Quality
- Quantity
- Distribution
Scalp
• Lumps, bumps, rash, itchiness, flaking
Skull
• Deformity • Size
Face
• Expression • Contours
Skin • Colour • Pigment • Lesions • Thickness • Hair distribution
Relevant case history What would you ask the patient about there Head Ears Eyes Neck Throat?
- Head: Headache, head injury, dizziness, light- headedness.
- Eyes: Vision difficulty, glasses or contact lenses, pain, redness, excessive lacrimation (tearing), double vision (diplopia), blurred vision, any other visual disturbances or conditions.
- Ears: Hearing difficulty, tinnitus, vertigo, ache, infection, discharge (otorrhea)
- Nose and sinuses: Frequent colds, nasal congestion, discharge (rhinorrhea), hay fever, nosebleeds, or sinus trouble.
- Throat (mouth and pharynx): any ongoing or recent dental problems, dry mouth, frequent sore throats, hoarseness.
Common Disorders of the Head • Hair changes: • Fine hair > endocrine > • Course hair/ hirsutism > hormones imbalance • Dandruff • Scalp: • Erythema >
- Skull
- Enlarged>
- Enlarged >
Common Disorders of the Head
• Hair changes:
• Fine hair > endocrine > hyperthyroidism
• Course hair/ hirsutism > endocrine > hypothyroidism or sex hormones imbalance
• Dandruff
• Scalp:
• Erythema > eczema/dermatitis, psoriasis • Skull:
• Enlarged > endocrine > excessive growth hormone (GH) > “acromegaly”
• Enlarged > Paget’s disease of the bone, hydrocephalus in infants
- Face/ Skin:
- Asymmetry
- Oedema > Nephrotic syndrome, Cushing’s syndrome
- lumps > Parotid gland enlargement;
- Sinusitis > Pain while pressing
- Acne
- Hirsutism
- skin lesions/neoplasia > BCC, SCC, Melanoma remember the skin cancers and where they are most likely to occur as well as their appearance
Label the facial landmark on slide 13
H
What are the common disordered seen in the eye?
How do you test the eye?
- Ptosis:
- Due to muscle weakness of Lev Palpebrae Sup
- Causes:
- Myasthenia gravis, damaged oculomotor nerve (CN III), Interference with sympathetic nerves to eye
• Cataract:
-clouding of lens inside eye which leads to decrease in vision
-opacification of the lens obstructs light from passing and being focuses on to retina at back of eye
-treated with surgery
Caused by- ageing, radiation, genetics, skin disorders (eczema)
• Conjunctivitis
• Horner’s syndrome > ptosis (drooping eyelid)+ miosis(constriction of pupil) + anhydrosis (decreased sweating)
Causes: trauma, inner ear infection, tumour, migraine
• Exophthalmos > Grave’s disease > hyperthyroid
-autoimmune disease affected the thyroid causing it to become enlarged
-causes increased HR, muscle weakness, irritability, budging of the eyes
Refer to Maddys notes
- Proptosis
- Pituitary adenoma > visual disturbance > anopia (visual defect)
Special Tests: • Reaction to light (direct and consensual) If the above is abnormal: test near respons
- Visual fields:
- Testing is called visual fields by confrontation
- Tests for peripheral vision
- Common problems: CN II Optic > pituitary tumour
Ears
Name some disorders and what they are
External lesions and lumps
Mastoiditis: bacteria spreads from the middle ear info the mastoid air cells, where inflammation causes damage to the bony structure.
Otis externa, media and interna - inflammation of the out ear.- Upper respiratory tract infection with bloackage of the eustachian tube and effusion of the middle ear, so then it gets infected. Signs and symptoms are pain, ear discharge and itchiness
Perforation of the eardrum- rupture of the tympanic membrane as a result of Otis media, trauma, explosion. Can lead to conductive hearing loss. -ear ache, mucus discharge
Labyrinthitis-
How do you test for conductive/ neurosensory loss
Tuning fork 256 hz Webber test (on top of head) Normal- vibration heard in both ears One ear- sensorineural loss Neither-conductive hearing loss
Rhine test: mastoid then next to ear
Normally sound is heard longer through air than bone
If sound is heard longer through bone its conductive hearing loss
If sound is heard longer through air- sensorineural hearing loss
Research
Jaundice:
Yellowish pigmentation of the skin and sclera and other mucosal membranes -increased levels of bilirubin in blood Causes: -hepatitis -liver cancer -biliary block
Anaemia:
Deficiency of number/ quality of RBC or haemoglobin Causes: Lack of Fe, B12 or folic acid -malabsorption -hypothyroidism -rhematoid arthritis
Treatment:
- antibiotics
- transfusion
- supplements
Claucoma
Group of diseases that slowly destroy the optic nerve
-build up of pressure through a blockage of aqueous circulation or drainage, poor blood supply- fibres, weakness in structure of health of fibres
no symptoms untill loss of eyesight
-eye examination easiest way to detect
-no cure
Temporal arteritis
-inflammation and damage to blood vessels supplying the head area (particularly neck and temporal)
-unknown cause but may be inflammatory response ➡ associated with sever infection or high doses to antibiotics
-excessive sweating, fever , muscle ache, vision
-head examination and blood tests
Treatment: oral dose of corticosteroids
Retinopathy Form of non-inflammatory damage to retina Hypertensive Diabetic Describe changes in both
Hypertension
- induces changes in blood vessels in the eye
- cholesterol forms in blood vessels causing bleeding in retina
- no change in vision
- found through eye examination
Diabetic: -change in blood vessels in retina -swell or fluid leak or growth of new abnormal blood vessels -overtime leads to visual loss 4 stages 1. Mild non-proliferative 2. Moderate Meg
Hyperthyroidism hypothyroidism
Hyper
Over production of thyroid hormone graves disease
Causes: nodular goitre, inflammation, infection
Treatment: medication and surgery
-fast/ irregular pulse, warm skin, thin hair, diarrhoea, decreased weight, increased appetite, sweats, heat intolerance
Hypothyroidism:
Under active thyroid
-increases with ages
-tired, sleepy, lethargic, increased weight, hoarse voice, dry thin hair
-thyroid hormone supplement
Myasthenia gravis
Immune system attacks healthy tissue- body then produces antibodies that block muscle cells from receiving neurotransmission
- associated with tumours of the thrymus
- difficulty chewing, talking p, facial paralysis, double vision, eyelid drooping
- no cure- medication
Mastoiditis
Infection of the mastoid
Caused by: acute Otis media as infection spreads from ear to mastoid
-ear pain, fever, headache, hearing loss
-repeated treatment or long term required as medication can’t reach deep enough ➡ antibiotics injected then oral dose
