Physical Examination of the Head and Neck.ppt
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1、Physical Exam of the Head&NeckA Lect.of Clin Skills for Med Students(Nepalese Class),Part I PE of the Head,All through the approach of PE in general involves 4Steps Sequentially:Inspection Palpation Percussion Auscultation,the 1st one(inspection)is esp,important and useful for PE of headThis is beca
2、use many traits or findings from the head,esp,the face,is so attractively draw our attention when we firstly look at the ptFor Ex,the emotional reactions:,expressive/unexpressive,keen/dull;nutritional status palor,puffiness of the faces,Plethora,Xanthoma,over growth of facial hair of a woman,and fac
3、ial asymmetries,all highly pathogenomonic for a peculiar illness,A certain feature of observation or the integration of a set findings will lead to an“armchair diagnosis”of a disease for an experienced physician,General appearance(faces),Thyrotoxic faces The pt is often thin and wasting,accompanied
4、by an alert,startled,flushed and anxious appearance.,Eye signs of Graves disease,This 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
5、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
6、.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 face,Paralysis of facial nAsymmetry of the f.esp.the
7、 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.,Paralysis of facial n.,The ability to wrinkle pts forchead onthe affected side helps to identify thetype of the lesion.A:How to distinguish?
8、,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 lesio
9、n 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 c
10、arotenemia,resulting from excessive ingestion of carrots or be secondary to increased serum levels of carotene in the setting of hypothyroidism and nephrosis.,Sudden obstruction of the airwayCOPDPneumonia(critical SARS)HF(esp CHF)Congenital heart disease(with the shunt of RL)Note cyanosis may not oc
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