Examination of the Head and the Neck Andrea Křivanová M.D., Ph.D. IHOK FN Brno Bohunice Physical examination •inspection •palpation •percussion •auscultation •smelling and tasting Examination of the Skull-inspection •Microcephaly,macrocephaly, turricephaly.. •Facies •febrilis, •pallida (pale face), • myxedematosa, •mitralis, •abdominalis (Hippocratica), Cushingoid face (moon face), •nephritica, •acromegalica • pic00026 Facies mitralis • PIC00001 Facies pletorica (Polycytemia vera) Cushingoid face • pic00065 –Facies myxoedematosa - hypothyreosis image4 scan20 Thyreotoxicosis – G-B disease • •Exopthalmus Exophthalmos (Eye Protrusion) Exophthalmos associated with Grave's disease Facies Hippocratica, abdominalis, peritonealis • C:\Documents and Settings\Klárka\Plocha\facies Hipocratica.bmp Facies nefritica (eye lids oedema) • pic00011 Facies alcoholica -rhinophima Facies acromegalica • 4810395f3 acromegaly_face_ap pic00017 •251cm •74 cm Facies leontina (Lepra) • pic00079 Neurofibromatosis C:\Documents and Settings\Klárka\Plocha\Neurofibromatosa.bmp Facies sclerodermica – scls02 scls04 ALOPECIA »difuse (chemotherapy, tyreotoxicosis) »areata alopecia 2 chemopic5 alopecia3 Hypertrichosis-werewolf syndrom C:\Documents and Settings\User ONE\Plocha\hypertrichoza.jpg C:\Documents and Settings\User ONE\Plocha\hypertrichoza2.jpg C:\Users\75267\Desktop\syndrom vlkodlaka 3 sestry.jpg Skin lessions • herpes_zoster SHC_Acne Herpes simplex SLE – butterfly exantema – sle_butterfly SLE_02_17077 Local oedema –Dental –Sinusitis maxilaris –Parotitis 62juvenilparotis 20050706_1143_0000 Cornu cutaneum - precancerosis Cranial nerves C:\Documents and Settings\User ONE\Plocha\hlavové nervy.jpg Paresis/plegia N.VII. •Upper motor neuron - central – brane disturbance –e.g. stroke •Lower motor neuron - peripheral –e.g.Bell‘s palsy – lagophtalmos (rabbit‘s eye) • lagophtalmus%20Kopie lym_abb4a Stroke with tongue deviation pic00012 Percussion and palpation of the Skull •Injury, sinusitis •Sensory innervation of the face – N.V. • 3 branches •Temporal arteriitis • Horton C:\Documents and Settings\Klárka\Plocha\arteritis_cel_gigantes_2.jpg Arteriitis temporalis Horton • C:\Documents and Settings\Klárka\Plocha\F3_small.gif C:\Documents and Settings\Klárka\Plocha\no_arttempo_kopf.jpg C:\Documents and Settings\Klárka\Plocha\RM793.jpg Examination of the eyes •Supraorbital ridges (acromegalia) •Eyebrows (myxoedema) •Eyelids –swelling, pigmentation, xanthelasma •Eyeballs - exophtalmos –uni or bilateral • - enophtalmos –Horner‘s trias • •Movement of the eyeballs –Ny, N.III, IV, VI Xantelasma palpebrarum pic00008 xantelasmata “glasses haematoma“ – pic00010 Eye lids oedema • pic00011 C:\Users\75267\Desktop\eye lids oedema.jpg •Conjunctiva – pale, purple, hematomas, xerophtalmia •Sclera – icterus (jaundice), bleeding, blue •Cornea –arcus senilis cornea, Wilson´s disease (Cu) – Kayser-Fleischer ring •Iris and pupils – mydriasis, miosis, reaction to light Conjuctiva -chemosis – conjunctivitis image Click on the image to close this window -bleeding Sclera – -icteric - hyperbilirubinaemia • – – • •-blue - Osteogenesis imperfecta Icterus blue-sclera-1 Cornea –Arcus senilis cornae GERONTOXON •hyperlipidemia, elderly patients • – • pic01-35 Arcus Lipoides Senilis (Gerontoxon) 177wilsons Kayser-Fleisher%20ring –Kayeser-Fleischer ring •green ring •in Wilson disease (Coper) • – • Asymetric eyes •peripheral paresis of facial nerv VII. •CLAUDE-BERNARD-HORNER trias miosis, ptosis, enophtalmus - cervical sympaticus (lung cancer) – • f034 cbh Exophtalmus •bilateral – thyreotoxicosis •unilateral – orbital tumors exoph_endokrin Cavernous Hemangioma Bilateral exophtalmus – G-B disease •GRAEFE´s sign •Moebiś sign – bulb divergention in looking to short distance •Stellwagś sign – seldom blinking • Exophthalmos associated with Grave's disease Pupils -anisocoria •cerebral bleeding, brain tumors •Claude-Bernard-Horner syndrome horner3 ps_13 MYDRIASIS •coma •atropin •Glaucoma •St.p.op.cataractae • • Eye_bzp pic00005 MIOSIS •morphin •iridocyclitis • • Fig. 2: Miosis colinergicomimética. Examination of the Nose and Ears •Nose – size, form and secretion (epistaxis –bleeding, mucous, mucopurulent or purulent) •Ears – size, secretion,goat • gout 1_82_L Examination of the Lips and Mouth •Lips - cyanosis, pale, angular stomatitis, herpes • simplex labialis •Oral cavity - tongue - size, colour, surface (coating), protrudes in the midline (N.XII), bites, xerostomia • - oral mucosa - thrush, graphite spots • - teeth • - tonsils and oropharynx •Foetor ex Ore (bad breath) - caries, gingivitis, • f. hepaticus, uremicus, ketoacidoticus, putrid Lips 13_1 24840077 • Central cyanosis pic00011 pic00018 Dry tongue pic01-36 –Tongue surface –brown – malnutrition, liver disease –white – THRUSH – candidosis –Lingua villosa nigra (bad hygiene) • –bites - epilepsy • • • – – – 14621_1462OPH0682-03 200305nm10b –Tongue surface •dry – dehydratation •smooth – iron or vitamin B 12 deficiency • • • • – – – glositis_a i~000022 This smooth tongue would tell a doctor that the patient was suffering from pernicious anaemia, a complication of Addison's and other auto-immune diseases Mucosis •pale – anemia •inflamation - stomatitis - imunodeficiency • – – – stomatitis AIDS, HIV, Oral, Canker Sores Aphthous Stomatitis on Lip Mucosis •petechiae, sufusis – bleeding disorders •ulcerations – neutropenia, st.p. CHT •thrush – candidosis - -,,- • • • • – – – petechia mucositis candida thrush in mouth Mucosis •graphite spots – Adisson disease • • – – – AddisonDisease1 Gingivas •gingivitis •bleeding – paradentosis, bleeding diseases •hypertrophy – drugs (CSA, hydantoin), AML • – – – fig 1 Gi_Hyp_kli Tonsilas •Tonsilitis acuta – Streptococcus •Lymfoma, cancer • • • • • • – – – 302px-Tonsilitis tonsillitis tonsillitis Examination of the Neck •Carotic arteries –palpation, auscultation •Jugular veins – not exceed 2 cm above a horizontal plane drawn at the sternoclavicular junction •Cervical lymph nodes •Thyroid gland –goiter (struma) •Mobility of the neck Palpation and auscultation aa.carotides Vv.Jugulares in the heart failure C:\Documents and Settings\User ONE\Plocha\zvýšená náplň krčních žil.jpg Goiter (struma) • struma 2 Post strumectomy pic00007 Neck lymphonodes Thank you for your attention!