Health- Head Face Neck

headaches

beginning of a stroke

pre clampshia

concussion

direct blow to the head causes the brain to shift rapidly back and forth inside

people lie down to feel better

With migraines

they need to move—even to pace the floor—to feel better.

whereas with cluster headaches

Tension headaches

occipital, frontal, or with bandlike tightness

migraines are

supraorbital, retro-orbital, or frontotemporal

sinus headaches

produce pain around the eye or cheek

with cluster headaches, pain is always

unilateral and always on the same side of the head

Pain is often

severe with migraine

Pain is excruciating

with cluster headache.

Alcohol, stress, menstruation, and eating chocolate or cheese

may trigger migraines.

Nausea, vomiting, and visual disturbances are associated with migraines;

anxiety and stress are associated with tension headaches;

nuchal rigidity and fever are associated with meningitis or encephalitis

Hypertension, fever, hypothyroidism, and vasculitis

produce headaches.

Oral contraceptives, bronchodilators, alcohol, nitrates,

and carbon monoxide inhalation produce headaches.

Loss of consciousness before a fall

may have a cardiac cause (e.g., heart block)

Presyncope,

(before falling) a light-headed, swimming sensation or feeling of fainting or falling

caused by decreased blood flow to brain or heart irregularity causing decreased cardiac output.

Vertigo is true rotational spinning often

from labyrinthine-vestibular disorder in inner ear.

With objective vertigo

the person feels like the room is spinning

with subjective vertigo

the person feels like he or she is spinning.

Disequilibrium

a shakiness or instability when walking related to musculoskeletal disorder or multisensory deficits. (elderly)

Vertigo together with unilateral hearing loss

suggests Meniere disease.

A persistent lump may be malignant.

For people older than 40 years,

suspect malignancy until proven otherwise.

Surgery for head/neck cancer often is disfiguring

and increases risk for body image disturbance.

Normocephalic is the term that denotes

a round symmetric skull that is appropriately related to body size.

Microcephaly, abnormally small head;

macrocephaly, abnormally large head (hydrocephaly, acromegaly).

Palpate the temporal artery

above the zygomatic (cheek) bone between the eye and top of the ear.

The temporomandibular joint is just below the temporal artery and anterior to the tragus.

Palpate the joint as the person opens the mouth

and note normally smooth movement with no limitation or tenderness.

Inspect the face, noting the facial expression

and its appropriateness to behavior or reported mood.

Tense, rigid muscles may indicate anxiety or pain;

a flat affect

suggests depression.

Marked asymmetry with central brain lesion

(e.g., stroke) or peripheral cranial nerve VII damage (Bell palsy)

Nystagmis accompanies

a presenting concern of vertigo.

Head position is centered in the midline, and the accessory neck muscles should be symmetric.

The head should be held erect and still.

Head tilt

occurs with muscle spasm.

Rigid head and neck as a unit

occur with arthritis.

The parotid is swollen

with mumps or AIDS

parotid

infront of ear but on cheek, bigger gland

submandibular

beneath jaw/ chin area

under parotid

sublingual

under the tongue

Graves Disease (Hyperthyroidism)

An autoimmune disease with increased production of thyroid hormones causes an increased metabolic rate, just like ramping up the furnace.

goiter, eyelid retraction, and exophthalmos (bulging eyeballs).

hyperthroidsim

hyperthyroidism symptoms

nervousness, fatigue, weight loss, muscle cramps, heat intolerance, poor sleep, irritability, anxiety or depression, oligomenorrhea, amenorrhea, diarrhea.

tachycardia; shortness of breath; excessive sweating; fine muscle tremor; thin silky hair; warm, moist skin; infrequent blinking; a staring appearance; and hyperreflexia.

The carotid artery runs medial to the sternomastoid muscle,

it creates a brisk localized pulsation just below the angle of the jaw.

Lymphadenopathy caused by infection, allergy, or neoplasm

enlargement of the lymph nodes (>1 cm)

look at the lymph nodes ABOVE an enlargement

check the area they drain for the source of the problem

mono

a cause of lymphaneopathy (enlarged nodes)

mobile movible soft less than 1 cm

normal lymph nodes characteristics

Place your index finger on the trachea in the sternal notch and slip it off to each side

the space should be symmetric on both sides. Note any deviation from the midline.

The trachea is pushed to the unaffected (or healthy) side with

an aortic aneurysm, a tumor, unilateral thyroid lobe enlargement, and pneumothorax (collapsed lung)

The trachea is pulled toward the affected (diseased) side with

large atelectasis, pleural adhesions, or fibrosis.

The thyroid gland is difficult to palpate;

shine light tangentially across the neck to highlight any possible swelling.

Tilt the head back to stretch the skin against the thyroid. Inspect the neck as the person swallows. Thyroid tissue moves up with a swallow and then falls into its resting position.

Posterior approach

palpate, move behind the person (Fig. 14.14A).

Ask the person to sit up very straight and then to bend the head slightly forward and to the right.

Use the fingers of your left hand to push the trachea slightly to the right.

Curve your right fingers between the trachea and the sternomastoid muscle, retracting it slightly, and ask the person to swallow.

Often you cannot palpate the normal adult thyroid.

Anterior Approach.

Try to identify the isthmus by placing your thumb 3 cm below the thyroid cartilage prominence as the person swallows.

Then, ask the person to tip the head forward and to the right.

Use your right thumb to displace the trachea slightly to the person’s right.

Hook your left thumb and fingers around the sternomastoid muscle.

Feel for lobe enlargement as the person swallows

enlarged lobes that are easily palpated before swallowing

or are tender to palpation (see large goiter in Fig. 14.14B) or the presence of nodules or lumps- CANCER

If the thyroid gland is enlarged

auscultate it for the presence of a bruit.

This is a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope. The bruit is not present normally.v

A bruit occurs with accelerated or turbulent blood flow,

indicating hyperplasia of the thyroid (e.g., hyperthyroidism).

aging

The temporal arteries may look twisted and prominent.

In some aging adults a mild rhythmic tremor of the head may be normal.

Isolated head tremors are benign and include head nodding (as if saying yes or no)

AND tongue protrusion.

If some teeth have been lost, the lower face looks unusually small, with the mouth sunken in.

NORMAL in aging adult

aging

The neck may show an increased anterior cervical (concave or inward) curve

when the head and jaw are extended forward to compensate for kyphosis of the spine

An older adult may have prolapse of the submandibular glands,

which could be mistaken for a tumor. But drooping submandibular glands feel soft and are present bilaterally.

Many older adults have low-lying thyroid glands that are impossible to palpate.

The gland lies behind the sternomastoid muscles and clavicles.