Physical Examination of the Head and Neck.ppt

Physical Exam of the Head NeckA Lect. of Clin Skills for Med Students(Nepalese Class) 成都医学院 临床技能中心 赖雁 Color and pigmentation Vitiligo—Absence of pigm of the f. skin. occurring in patches. Mask of pregnancy—yellowish 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. Sudden obstruction of the airway COPD Pneumonia (critical SARS) HF (esp CHF) Congenital heart disease (with the shunt of R→L） Note cyanosis may not occur in case that Hb is less than 5g/dl even through all Hb became HHb Facial hair Excessive 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. AQ 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 virchow’s 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. ? Xan