Physical Examination of the Head and Neck.ppt

Thyrotoxic faces The pt is often thin and wasting,accompanied by an alert,startled,flushed and anxious appearance.Eye signs of Graves diseaseThis is characterized by protrusion of one or both eyes(exophthalmos)associated with retraction of the upper eyelids,(“lid lag”)which results in exposure of the white conjunctiva above the cornea(Von-Gravefs Sign)Other eye signs including Cushingoid f.Features moon f.plethora,acne,hirsutism(over-growth of body hair,esp.mustache of a woman)The appearance of the f.of some pts with mitral stenosis of long duration,marked by rosy,flushed cheeks and dilated capillaries.Mitral f./mitrotricuspid f.Other facesCretins f.dull,yellow appearance with thick lips,enlarged tongue,puffy eyelids,wrinkled forehead.Nephritic f.Edematous eyelid and pale appearance.Acromegalic face A typical appearance characterized by a prominent forehead and large nose,Other signs of the faceParalysis of facial nAsymmetry of the f.esp.the loss of the normalnasolabial fold,indicating the paralysis of facialn.This changes become most obvious if you letthe pt try to smile or show his/or her teeth.The ability to wrinkle pts forchead onthe affected side helps to identify thetype of the lesion.A:How to distinguish?Color and pigmentationVitiligoAbsence of pigm of the f.skin.occurring in patches.Mask of pregnancyyellowish brown pigm symmetrically on the forehead,cheeks,and neck of some woman during pregnancy.or taking contraceptive pills.(due to hormonal changes)Systemic lupus erythematosis(SLE)the skin lesion with pigm(facial rash)is distributed in a butterfly shape over the cheeks and the surfaces and bridge of the nose)Jaundice yellowish pigm mild degree of jaundice can be found by carefully check the sclerae in daynight.(may not be visible in artificial light).Jaundice should not be confused with carotenemia,resulting from excessive ingestion of carrots or be secondary to increased serum levels of carotene in the setting of hypothyroidism and nephrosis.nSudden obstruction of the airwaynCOPDnPneumonia(critical SARS)nHF(esp CHF)nCongenital heart disease(with the shunt of RL）Note cyanosis may not occur in case that Hb is less than 5g/dl even through all Hb became HHb Xanthoma This is circumscribed collections of lipid material in the eyelids,a flat/elevated yellowish patch vary in size from 1mm to 2cm.(associated with TC and DM)Facial hairExcessive growth of hormone-dependent hair(hair on cheeks or upper lip,chin)in women,suggesting hirsutism,and verified by associated androgenism,such as the levels of male hormones,muscularity,and an enlarging clitoris.This is seeing in androgen-secreting tumors,such as Polycystic ovaries Adenoma/carcinoma of adrenal glands Drugs(androgen,contraceptive pills)A&Q Questions What are the facial feature of esetinism?How to distinguish central Vs peripheral paralysis of the facial nerve?What are the common causes of cyanosis?What is the cliniacal implication of virchows lymph node?Briefly depict the skill for the palpation of thyroid gland.References History and Examination.Edited by James Marsh Pages 77,97-98,112,137 and 158-160.Mosby,2002 Physical Diagnosis.Edited by prior JA and Silberstein J.S.5th ed.Ch7,8,9,10 C.v.Mosby,1977.Swarz M H:Textbook of Physical Diagnosis 4th de,Ch8,P179-193,2002,W.B.Saunder W.