Chapter 7 The Head and Neck

Question 1

Hyperthyroidism

Answer 1

Fine hair

Question 2

Hypothyroidism

Answer 2

Course hair

Question 3

Lice

Answer 3

Tiny white granules may be eggs of lice

Question 4

Seborraheic dermatitis (psoriasis)

Answer 4

redness and scaling; most common form in adults dandruff; in infants cradle crap

Question 5

Pilar cysts (wens)

Answer 5

soft lumps

Question 6

hydrocephalus

Answer 6

Enlarged skull may signify this; also called Paget’s disease of bone

Question 7

Trauma

Answer 7

tenderness or stepoffs are common after trauma (i.e. Gaby Lee Giffords)

Question 8

Acne

Answer 8

Common in adolescents

Question 9

Hirutism

Answer 9

excessive amounts of hair in women where men typically grow hair (face, chest, back)

Question 10

Alopecia Areata

Answer 10

Clearly demarcated round or oval pathes of hair loss, usually affecting young adults and children. There is no visible scaling or inflammation.

Question 11

Tinea capitis

Answer 11

Ringworm of scalp usually caused by fungal infection; round scaling pathes of alopecia (can mimic seborrheic dermatitis); hairs broken off close to surface of scalp

Question 12

Trichotillomania

Answer 12

Hair loss from pulling, plucking, or twisting hair.

Question 13

Cushings

Answer 13

Increased adrenal cortisol produces a round or “moon” face with red cheeks. Excessive hair growth may be present in the mustache and sideburn areas on the chin

Question 14

Nephrotic syndrome

Answer 14

Face is edematous and often pale. Swelling usually appears around the eyes and in the morning

Question 15

Parkinson’s

Answer 15

Mask like face with characteristic stare (decreased facial mobility blunts expressions)

Question 16

Tarditive dyskinesia

Answer 16

Involuntary movement and ticks; sometimes permanent

Question 17

Psoriasis

Answer 17

silvery, scaly lesions, mainly on extensor surface

Question 18

Vitiligo

Answer 18

depigmented macultes appear on face, hands, feet, and extensor surfaces

Question 19

Cushing’s sydrome

Answer 19

Increased cortisol production of produces a round or “moon” face with red cheeks

Question 20

Nephrotic syndrome

Answer 20

Face is edematous and often pale

Question 21

Myxedema

Answer 21

Pt with severe hypothyroidism has a dull puffy face

Question 22

Parotid gland enlargement

Answer 22

Chronic bilateral asymptomatic parotid gland enlargement may be associated with obesity, diabetes, cirrhosis

Question 23

Acromegaly

Answer 23

Increased growth hormone produces enlargment of both bone and soft tissues

Question 24

Rhinorrhea

Answer 24

is drainage from the nose often associated with nasal congestion.

Question 26

rhinitis medicamentosa

Answer 26

Excessive use of decongestants can worsen symptoms

Question 27

Acute bacterial sinusitis

Answer 27

Sx: pain bending forward, maxillary toothache, fever or local headache, (~80-90% of cases) appear after URI

Question 28

Nasal congestion limited to one side

Answer 28

Consider a deviated nasal septum, foreign body, or tumor

Question 29

Epitaxis

Answer 29

Bleeding from nose; Local causes include trauma (especially nose picking), in?ammation, drying and crusting of the nasal mucosa, tumors, and foreign bodies. Bleeding disorders may contribute to epistaxis (bleeding from the nose)

Question 30

Farsightedness

Answer 30

Difficulty with close work suggests hyperopia

Question 31

Presbyopia

Answer 31

aging vision

Question 32

Myopia

Answer 32

nearsightedness

Question 33

Unilateral visual loss is painless

Answer 33

consider vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion.

Question 34

Unilateral visual loss is painful

Answer 34

causes are usually in cornea and anterior chamber as in corneal ulcer, uveitis, traumatic hyphema, and acute glaucoma. Optic neuritis from multiple sclerosis may be painful.

Question 35

If bilateral AND painless

Answer 35

could be due to meds that change refraction (cholinergic, anticholinergics, and steroids)

Question 36

If bilateral AND painful

Answer 36

consider chemical/radiation exposures

Question 37

If bilateral visual loss is gradual

Answer 37

Usually arises from cataracts or macular degeneration

Question 38

Central visual loss

Answer 38

nuclear cataract, macular degeneration

Question 39

Peripheral loss

Answer 39

adv open-angle glaucoma

Question 40

One sided loss

Answer 40

hemianopsia and quadrantic defects

Question 41

Specks in vision

Answer 41

Moving specks suggests vitreous floaters, FIXED defects (scotomas) suggest lesions in the retina or visual pathways

Question 42

Flashing lights (new vitreous floaters)

Answer 42

suggest detachment of vitreous from retina

Question 43

Diploia (double vision)

Answer 43

may arise from a lesion in the brain stem or cerebellum, or from weakness or paralysis of one or more extra ocular muscles, as in horizontal diplopia from palsy of CN III or VI, or vertical diplopia of CN III or IV.

Question 44

Diplopia in one eye

Answer 44

with the other closed, suggests a problem in the cornea or lens

Question 45

Strep throat

Answer 45

Fever, pharyngeal exudates, and anterior lymphadenopathy, especially in absence of cough, suggest streptococcal pharyngitis

Question 46

Sore tongue

Answer 46

Aphthous ulcers is a sore smooth tongue of nutritional deficiency; Sore tongue may result from local lesions as well as systemic illness

Question 47

gingivitis

Answer 47

Bleeding from gums is a common symptom, esp. during teeth brushing

Question 48

Hoarseness

Answer 48

Overuse of voice and acute infections are the most likely causes. Chronic causes includes smoking, allergy, voice abuse, hypothyroidism, and chronic infections such as TB

Question 49

Pharyngitis

Answer 49

Accompaning sx: Enlarged tender lymph nodes

Question 50

Goiter

Answer 50

Thyroid function may be increased, decreased, or normal

Question 51

Thyroid function evaluation

Answer 51

Ask about temperature intolerace and sweating.

Question 52

Hypothyroidism

Answer 52

Intolerance to cole, preference for warm clothing and many blankets and decreased sweating

Question 53

Hyperthyroidism

Answer 53

The opposite sx: palpitations and involuntary weight loss

Question 54

Assymetric protrusion

Answer 54

suggests a lesions of CNXII

Question 55

Cancer of the tongue

Answer 55

second most common cancer of the mousth, second only to the lip. Any persistent nodule or ulcer, red or white, must be suspect Often occurs on side of tongue

Question 56

CN X paralysis

Answer 56

the soft palte fails to rise and the ulvula deviates to the opposite side

Question 57

Lymph nodes

Answer 57

tender nodes suggest inflammation; hard or fixed nodes suggest malignancy

Question 58

Diffuse lymphadeopathy

Answer 58

raises suspicision of HIV or AIDS

Question 59

Tracheal deviation

Answer 59

masses in neck may push trachea to one side; may signifiy important problems in thorax, such as mediastinal mass, atelectasis or a large pneumothroax

Question 60

Thyroid gland

Answer 60

soft in graves' disease; firm in Hasmitoto's thyroiditis, malignancy. Benign and malignant nodules tenderness in thyroiditis

Question 61

Exudative Tonsillitis

Answer 61

A characteristic red throat that has a white exudate on the tonsils. This togehr with fever and enlarge cervical nodes, increases the probability of group A streptococcal infection or infectious mononucleosis. Anterior cervical lymph nodes are usually enlarged in the formers, and posterior nodes in the latter.

Question 62

Hutchinson's Teeth

Answer 62

Smaller and more widely spaced than normal and are notched on their biting surfaces. The sides of teeth taper toward the biting edges. The upper central incisors of the permanent (not the deciduous) teeth are most often affected. These teeth are a sign of congenital syphillis.

Question 63

Thrush on palate

Answer 63

A yeast infection due to Candida. Thick, white plaque are somewhat adherent to underlying mucosa

Question 64

Tracheal deviation

Answer 64

Masses in the neck may push the trachea to one side. May also signify problem in the thorax, such as a medastinal mass, atelectasis, or a large pneumothorax.