診斷學(xué)-Physical-Examination-of-the-Head-and-Neck(頭頸部檢查)課件

1、Head Wang xinjun王新軍PE of the Head is by inspection and palpationThe inspection is esp, important and useful for PE of headThis is because many traits or findings from the head, esp, the face, is so attractively draw our attention when we firstly look at the patient.For Ex, the emotional reactions:Th

2、yrotoxic faces The patient is often thin and wasting, accompanied by an alert, startled, flushed and anxious appearance. Cushingoid face Features: moon face, plethora, acne, hirsutism (over-growth of body hair, esp. mustache of a woman)Paralysis of facialHead examinationIn the general head examinati

3、on, the examiner should:Identify signs of generalized diseaseRecognize local lessions within the purview of the generalistRecognize local lesions requiring specialist care changes in the hairAlopecia 脫發(fā) Clinical occurrence: hypothyroidism et alHirsutism and hypertrichosis多毛癥和毛發(fā)過(guò)多 polycystic ovary, g

4、lucocorticoid excess多囊卵巢、糖皮質(zhì)激素過(guò)多SKULL MALFORMATION 頭顱畸形Craniosynostosis顱縫早閉: premature union of special sutures leads to skull malformations.Hydrocephalus腦積水Meningocele腦脊膜膨出EyesEyelids 眼瞼Conjunctiva 結(jié)膜Eye ball 眼球Cornea 角膜Sclera 鞏膜Iris and lens and pupils 虹膜、晶狀體、瞳孔Failure of lid closureThe facial ner

5、ve(CN VII) supplies the orbicularis oculi muscle眼輪匝肌.Disorder of this nerve, as in Bell palsy（貝爾麻痹，面神經(jīng)麻痹）, causes partial or complete paralysis of the orbicularis.Failure of lid openingThe congenital form is usually bilateral from paralysis or failure to develop the levator palpebrae superioris提上瞼肌.

6、Clinical occurrence: encephalitis, Horner syndrome, paralysis of the levator muscle.Lid swellingLocal infection cause inflammatory edema of the eyelids.nephritis.It occurs early in the course of both myxedema and the exophthalmos of Graves disease.Eye ballLid lag(Von Graefe Sign)(hyperthyroidism)A l

7、ag is indicated by white sclera appearing between lid and limbus.Sclera鞏膜In obstructive jaundice（黃疸）, conjugated bilirubin膽紅素 infiltrates all body tissues and fluids, it colors the sclera evenly.Iris and lens and pupils虹膜、晶狀體和瞳孔Note the size, shape, and equality of the pupils.pupillary reaction to l

8、ightTest pupillary reaction to light by having the patient fix on a distant object so that the patient does not fixate on the light and use accommodation.pupillary reaction to lightShine a penlight into the pupil from the side while obseving the direct pupillary reaction直接對(duì)光反射.earsPinna耳廓External ac

9、oustic meatus外耳道Rough quantitative test for hearing lossnoseExternal nasal deformitiesEpistaxis(nosebleed)鼻出血Suppurative paranasal sinusitis化膿性鼻竇炎Mouse and parotid gland腮腺Examination is by inspection and palpation.Facing the patient, hold a tongue blade壓舌板 in the left hand and a penlight in the righ

10、t.If a head lamp or mirror is used, your right hand is free to hold a nasal or laryngeal mirror喉鏡.Mouse and parotid glandLips口唇Buccal mucosa口腔黏膜Teeth牙齒Gums牙齦Tongue舌Oropharynx口咽Tonsils扁桃體Larynx喉Parotid gland腮腺lipsHave the patient attempt to whistle, to reveal paralysis from facial nerve(CN VII) lesio

11、ns.Labial enlargementThe lips may appear large in cretinism克汀病/呆小病, myxedema粘液性水腫, acromegaly肢端肥大癥.Buccal pigmentation(Addison disease)Dappled brown pigment in the lining of the cheek strongly suggests Addison disease.Oral white patches(口腔白斑，鵝口瘡)Infection of the oral mucosa with Candida spp.白色念珠菌 oc

12、curs in patients who are immunosuppressed or have received broad spectrum antibiotics.teethPigmented teeth(fluoride氟 pits)Opaque chalkwhite spots, 12 mm in diameter, are seen scattered on the surface of multiple teeth.This is a harmless condition found in persons who have ingested large amounts of f

13、luoride in the water during childhood.Tongue舌Have the patient protrude his tongue.Assess its size; look for deviation from the midline.Lingual enlargement舌體增大The tongue is enlarged in Down syndrome, cretinism, and adult myxedema.It increases in size during the development of acromegaly.Lingual tremo

14、rIncreased sympathetic activity is associated with fine tremor.A fine tremor of the tongue is often present in hyperthyroidism.Lingual deviation(paralysis of the hypoglossal nerve(CN XII)The tongue protrudes by tensing the two lateral muscle bundles, paralysis of one bundle causes the tongue to devi

15、ate to the paralyzed side. tonsilsThe normal adult tonsils seldom protrude beyond the faucial pillars咽腭弓.Hyperplasia is usually attributed to chronic infection, but it may be associated with obesity, hyperthyroidism, or lymphoma.Larynx喉laryngeal paralysis喉麻痹The vocal cords聲帶 are innervated by the re

16、current laryngeal nerves喉返神經(jīng), which are susceptible to injury in the neck and chest inferior to the larynx.Following thyroidectomy(either or both sides), aneurysm of the aortic arch主動(dòng)脈弓(left side), and mediastinal tumor縱膈腫瘤neckIf cervical fracture is suspected, and in trauma cases, immobilize the pa

17、tient and obtain X-rays before trying to elicit physical signs.Inspection視診The neck is inspected for Asymmetry Limitation of motion Abnormal pulsations Goiter Masses Neck scar (thyroidectomy,tracheotomy)NeckAnatomyFollowed by checking of the front cervical triangle searching for enlarged lymph nodes

18、 and tumors, then the parotid, salivary glands, and the pre-auricular lymph nodes.Then, the tracheal position is determined for deviation. Elevated central venous pressureOverfilling of the vascular space kidney failure, rapid infusion of fluids and bood products, chronic congestive heart failure wi

19、th edema.Thyroid gland and tracheaThe normal adult thyroid is often not palpable.A goiter is any enlarged thyroid gland.inspectionHave the patient seated in a good cross-light.Inspect the lower half of the neck in the anterior triangles.Have the patient swallow to note any ascending mass in the midl

20、ine.Palpation from behindHave the patient seated in a chair and stand behind her.Instruct the patient to lower her chin and relax her neck muscles.Place your thumbs in back of the patients neck, curling your fingers anteriorly so their tips just touch while resting over the upper tracheal rings.Palp

21、ation from behindRun the fingers up and down the tracheal rings, feeling for any tissue on their anterior surface.If found, it is likely to be a hyperplastic thyroid isthmus.During the examination, shift the inclination of the patients head to relax the neck muscles, and have the patient swallow to

22、test the adherence of palpated masses to the trachea.Should be done with the pt seated in a chair while the physician examines the neck for both behind and in frontof the pt Palpation of the thyroidFrontal palpationFace your patient placing the fingers of one hand at the back of the neck with your extended thumb forward at the base of the thyroid cartilage.With the pulp of this thumb, push the trachea gently away from the midline while the fingers of the other hand