What are the three types of headaches?
Migraine, Cluster and Tension
What is the most prevalent type of headache?
Tension
Are neurological symptoms, like photo and phono-phobia common wit htension ehadaches?
No
What are the symptoms of Tension headaches?
Bandlike, Bilateral, constant pain, tightness and pressure
What is the estimated 1 year prevalence of Tension headaches in mena and women?
Men 63%, women 86%
How many headaches constitutes chronic?
15 days/month or >180 days/year
Are chronic tension headaches often related to episodes of stress?
No
What type of headache is common with TMJ?
Tension
How are chronic tension headaches often managed?
Rx's and botulism toxin
How are most Tension headaches managed?
OTCs
What problem can OTC treatment of tension headaches result in?
Rebound
Are women or men more affected by tension headaches?
Women
What are the features of a tension headache?
Pulsating, unilateral, often around temple
What percent of patients experience prodrome of migraines?
50%
What percent of patients experience aura of migraines?
10%
What is the estimated 1 year prevalence of Migraine headaches in men and women?
Men 6.5%, women 18.2%
What is the age of onset for Migraines?
15-35 years
When are migraines most prevalent?
35-40 years of age
What type of migraine pain is common in children?
Bifrontal
How long do migraine headaches last?
4 hours to 3 days
In what type of headache does pain often worsen with physical activity?
Migraine
What general types of symptoms are associated with migraine headaches?
Physiologic, neurologic, constitutional and autonomic
What type of headache is Nausea and Vomiting common with?
Migraines, Cluster Headaches
When does Prodrome of migraines occur?
Prior to headache, up to one day before
How does Migraine Aura manifest?
Usually as sensory changes, including smells and lights that are not really there and tingling in the extremities
What is parasthesias?
Tingling in the extremities
What are the common treatments for Migraines?
OTC analgesics, ergotamine derivatives and serotonin receptor agonist
What is the most severe of the primary headache disorders?
Cluster Headaches
Describe a cluster headaches:
A series of severe constant unilateral headaches attacks, lasting weeks or months often centered around the eye, each last 15 minutes to 3 hours
What population is most likely to have cluster headaches?
Men in their 30s
Do cluster headaches throb?
No, usually constant
What are the Concomitant symptoms of Cluster headaches?
Drooping of the eye, nasal stiffness, tearing, phono-photo-phobia, nausea, vomiting
Are Cluster headaches episodic or chronic?
Can be both
How long do individual cluster headaches last?
15 minutes to 3 hours
How long are patients in remission between episodes?
2 years
What relieves pain of cluster headaches in 70% of patients?
Oxygen therapy
Hypoxemia is likely an issue with what type of headaches?
Cluster
What medications are associated with Migraine's?
Vasodilators and Hormone therapies
What type of headache is often associated with emotional stress?
Tension
What areas need to be considered when making a headache diagnosis?
Location and concentration, duration and frequency, triggers, concomitant symptoms, medications, sensation
What are the signs that a patient need emergent care when complaining of a headache?
Very severe with sudden onset, stiff neck, papilledema, systemic signs (weight loss, fever), seizures
What is papilledema?
Optic disc swelling
What is sinusitis?
Acute swelling, inflammation or infection of the paranasal mucosa
How many adults in the US get sinusitis in a year?
30 million
How long does acute sinusitis last?
7-10 days
What defines chronic sinusitis?
>10 days on > 4 occasions per year, disease present 8 weeks or repeated medical treatment failure
What are the signs of Sinusitis?
Mucopurulent discharge, abnormal transillumination, poor response to decongestants, headaches refractory to analgesics
What are the symptoms of Sinusitis?
Purulent nasal discharge, cough, fever, maxillary toothache, nasal congestion, facial pain
The majority of sinusitis cases are caused by viruses or bacteria?
Viruses
What are the major viruses implicated in sinusitis?
Rhinovirus, Influenza, ParaInfluenza, Adenovirus
What are the major bacterial pathogens implicated in sinusitis?
Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis
Persistence of sinusitis symptoms beyond 7-10 days indicates what type of pathogen?
Bacterial
Is bacterial sinusitis under diagnosed by family practice physicians?
No, over diagnosed
What defines chronic bacterial sinusitis?
Inflammation that lasts over 3 months with the persistence of respiratory symptoms
What defines acute sinusitis?
Resolves in 30 days
What are the areas that should be inspected for a differential diagnosis of sinusitis?
Time of day, Concomitant symptoms, location and duration
Where will pain be located when sinusitis is located in the Frontal sinus?
Forehead
Where will pain be located when sinusitis is located in the Maxillary sinus?
Upper jaw, teeth or cheek
What will pain be like when sinusitis is located in the Ethmoid sinus?
Pain between the eyes, swelling of the eyelid
Where will pain be located when sinusitis is located in the Sphenoid sinus?
Deep achig of the top of the head, neck ache, earache,
A headache at what time of day may indicate a sinus headache?
Waking in the AM
Why is an AM headache indicative of a sinus problem?
Sinus issues are senstivie to position of the head, usually worse when lying down
What can drainage of mucus from paranasal sinus infection cause?
Pharyngitis and worsening cough
An infection of the teeth can cause what problems?
Facial pain and halitosis
Infection of the teeth may result in what symptoms?
facial pain or halitosis
What is halitosis?
Bad breath
What is rhinitis?
Inflammation of the nasal mucous membranes due to inhalation of allergenic materials
What are the two type of Non-infectious rhinitis?
Allergic and Non-allergic
What are the two type of infectious rhinitis?
Bacterial and viral
What are the two types of Allergic Rhinitis?
Perennial and Seasonal
What is an allergic shiner?
Dark circles under the eye due to allergies
What are the signs of allergic rhinitis?
Transverse nasal crease, allergic shiners, Adenoidal breathing, periorbital swelling, conjunctival redness and swelling, pale blueish edematous nasal turbinates
What is adenoidal breathing?
Difficulty breathing through the nose
What are the symptoms of Allergic Rhinitis?
Post nasal drip, sneezing, itching eyes, ears, nose and palate, Clear rhinorrhea, wheezing
Rhinitis medicamentosa is caused by what?
Rebounding nasal congestion due to tachyphylaxis to topical decongestants
What needs to be considered in a diagnosis of Rhinitis?
Location, Duration, Concomitant symptoms, Time of day, Medications
What is Rhinorrhea?
Recurrent water chronic nasal discharge
What type of rhinitis may cause purulent nasal discharge?
bacterial
What type of rhinitis can happen any time with no pattern?
Viral
A patient with viral rhinitis would generally have what concomitant symptoms?
Fever, fatigue, malaise, sore throat
What is the most common etiology of rhinitis?
Allergies
What are the risk factors for allergic rhinitis?
Concurrent atopic disease or Family history
What are common symptoms that are commonly seen with patient who have rhinorrhea?
Purulent sinusitis, nasal polyps, otitis media, loss of hearing, mouth breathing and chronic conjunctivitis
What is the most moderate form of periodontal disease?
Gingivitis
What are the signs of Gingivitis?
Swollen puffy ginga, bleeding upon probing, sucular depth measured at > 4 mm, erythema of the gums, blueish hue to gums
What are the symptoms of Gingivitis?
Bleeding upon brushing, Tender gums, red gums
What areas should you consider when making a differential diagnosis of gingivitis?
Location, duration and frequency, medications, dental hygiene, causes
The severity of gingivitis depends on what?
The number of areas
What group is acute necrotizing ulcerative gingivitis most common in?
adolescents and young adults
What is the onset for necrotizing ulcerative gingivitis like?
Sudden
What are the concomitant symptoms for necrotizing ulcerative gingivitis?
Fever, malaise, lymphadenopathy and halitosis
What can Carcinomas of the mouth result in?
Lymphadenopathy, Halitosis, and bleeding of the mouth
What is the cause of Gingivitis?
Inadequate dental hygiene
What can un-remediated Gingivitis result in?
Accumulation of plaque and tooth loss
What is a common cause of gum inflammation in geriatrics?
Loose or malfitted dentures
What is Hyperemia?
Excess blood in the vessels
What are the signs of Pharyngitis?
Hyperemia of the pharynx, tonsilar exudate, hypertrophied tonsils, swollen, tender anterior cervical lymph nodes
What are the symptoms of Pharyngitis?
Sore throat, Dysphagia, Fever
What is Pharyngitis?
Inflammation of the pharynx and surrounding lymphoid tissue
What are most cases of pharyngitis caused by?
Viruses
What are most cases of bacterial pharyngitis caused by?
Group A streptococcus
What are the major bacteria implicated in pharyngitis?
Group A Strep, C. diphtheriae, N. gonorrhoeae, Mycoplasma pneumonia, Chlamydia pneumonia
What are the major viruses implicated in pharyngitis?
Coronavirus, Adenovirus, Herpes simplex, Influenza, Parainfluenza and Epstein-Barr virus
In a child less than 4 years, what would suspect the cause of pharyngitis would be?
Viral
What percent of symptomatic pharyngitis in children and adults is from Group A Strep?
10% in adults, 30% in children
Can Group A strep caused pharyngitis go untreated?
No, can be serious and life threatening
What life threatening complications can come from an untreated case of Group A strep pharyngitis?
Reactive arthritis, glomerulonephritis, abscess formation, rheumatic fever
What are the considerations for a differential diagnosis of sore thorat?
Concomitant symptoms, duration and environmental causes
In children, parainfluenza is accompanied with what symptom 80% of the time?
Fever
A pain felt in the ears with a sore throat indicates what?
Tonsillary involvement
How long do Environmental contaminants cause sore throat?
Only as long as hazard is around
What is another term for Oral pharyngeal candidiasis?
Thrush
What is Oral pharyngeal Candidiasis caused by?
Candida albicans (fungus)
What are the two kinds of Thrush?
Mucocutaneous and Atrophic
What type of Thrush is common with Older individuals/those with dentures?
Atrophic
What are the common risk factors for thrush?
Infancy, Denture, inhaled corticosteroids, chemotherapy, radiation, immunosuppression, Broad spectrum antibiotics
What are the signs of Thrush?
White plaques on the buccal mucosa, palate or oropharynx
What are the symptoms of Thrush?
Often asymptomatic, angular chelitis and painful when wearing dentures
What is angular chelitis?
Inflammation of the corner of the mouth
What are the areas of consideration for differential diagnosis of Lymphadenopathy?
Onset of formation, duration, concomitant symptoms, moveable, pain
Acute enlargement of a lymph node is a sign of what type of lymphadenopathy?
Viral or bacterial
Persistent enlargement of a lymph node is a sign of what type of lymphadenopathy?
Malignancy
What will infected lymph nodes feel like?
soft, moveable and tender
What are malignant lymph nodes often like?
Hard and fixed
Can chicken pox cause lymphadenopathy?
Yes
A patient with large painful lymph nodes, sore throat, fever and fatigue, likely has what?
Mononucleosis
What medications can cause lymphadenopathy?
Phenytoin, hydralazine and allopurinol
What behaviors increase the risk of head and neck cancer?
Smoking and chewing
What is Microencephalopathy?
Decreased skull size
What is Macroencephalopathy?
Enlarged skull size
What is Hydrocephalus?
Excessive fluid in the skull with head enlargement that does not include the skull
What is Acromegaly?
Abnormal enlargement of facial and skull bones
What can acromegaly be resultant of?
Overactive pituitary
What disease results in an abnormal roundness of the face, red skin and excessive upper lip hair?
Cushing's
Protruding and bulging eyes along with face thinning is indicative of what disease?
Grave's disease
What is Grave's Disease caused by?
Excessive thyroid hormone production
What should normal Nasal mucosa look like?
Deep pink
What should abnormal nasal mucosa look like?
Red colored
What tools are used to view Nasal mucosa?
Otoscope and nasal speculum
What techniques are used for physical exam of the Sinuses?
Palpitation and Transillumination
What will transillumination of a normal patient look like?
Red glow
What will transillumination of an infected sinus look like?
No illumination
What response to palpitation is not normal for the sinuses?
Pain
What response to palpitation is normal for the sinuses?
No response to firm pressure
Depression of the nasal bridge indicates what?
Fracture to the nose
What indicates a foreign body in the nose?
Maloderant purulent nasal discharge, unilateral
What can pale blue colored lips in light skinned people indicate?
Shock, anemia, cyanosis
White spots on the sides of the mouth, soft palate, or hard palate may indicate what?
candidiasis (oral thrush) or leukoplakia
What is leukoplakia?
whitish lesions often caused by irritation
Swelling and redness of the interdental papillae may be caused by what disease discussed in class?
Gingivitis
Dark-skinned patients routinely present with a dark line along the gum margin, is this normal?
Yes
Gingival hyperplasia presents as what?
swollen gingival masses that may be severe enough to cover the teeth
A persistent red or white nodule or ulcer on the tongue should be suspected as what until proven otherwise?
Cancer
Cancer of the tongue occurs primarily on what areas?
Side
Most cases of ulcers or nodules that are non-cancerous appear on what part of the tongue?
Base
A white exudate on the posterior pharynx or tonsils may indicate infection of what?
strep throat or mono
Deviation of the uvula to the side or absence of movement may indicate what?
nerve damage
Sweet, fruity breath is seen in what diseases?
Diabetic ketoacidosis or malnourishment
Patients with end-stage renal failure may have breath that smells like what?
Ammonia
A musty odor to the breath may indicate what?
Liver disease
A foul odor to the breath may indicate what?
dental or respiratory infections
What should you note about the neck in a physical examination?
Pain, stiffness, limited motion or rigidity
How should you perform a Physical exam of the neck?
Have the patient move their head in these ways: Chin to chest, side to side, ear to shoulder, head backward (the later indicates a need for exorcism)
How should you perform a lymph node exam?
Both sides at once to get a comparison
What do normal lymph nodes feel like?
Soft, nontender, moveable and discrete
Acute infection of the lymph nodes has what qualities?
Bilaterally enlarged, warm, tender, firm but moveable
Cancer of the lymph nodes has what qualities?
unilaterally hard, nontender and fixed
HI has what qualities in the lymph nodes?
bilaterally enlarged, nontender and moveable
Infectious mononucleosis may cause enlargement or tenderness of what lymph nodes?
the cervical, inguinal, and axillary lymph nodes
What is the gold standard for diagnosis of bacterial pharyngitis?
Throat culture
A rapid streptococcus test that is negative indicates no further testing needed?
No, often titers are too low, infection may be present still
What are the three types of headaches?
Migraine, Cluster and Tension
What is the most prevalent type of headache?
Tension
Are neurological symptoms, like photo and phono-phobia common wit htension ehadaches?
No
What are the symptoms of Tension headaches?
Bandlike, Bilateral, constant pain, tightness and pressure
What is the estimated 1 year prevalence of Tension headaches in mena and women?
Men 63%, women 86%
How many headaches constitutes chronic?
15 days/month or >180 days/year
Are chronic tension headaches often related to episodes of stress?
No
What type of headache is common with TMJ?
Tension
How are chronic tension headaches often managed?
Rx's and botulism toxin
How are most Tension headaches managed?
OTCs
What problem can OTC treatment of tension headaches result in?
Rebound
Are women or men more affected by tension headaches?
Women
What are the features of a tension headache?
Pulsating, unilateral, often around temple
What percent of patients experience prodrome of migraines?
50%
What percent of patients experience aura of migraines?
10%
What is the estimated 1 year prevalence of Migraine headaches in men and women?
Men 6.5%, women 18.2%
What is the age of onset for Migraines?
15-35 years
When are migraines most prevalent?
35-40 years of age
What type of migraine pain is common in children?
Bifrontal
How long do migraine headaches last?
4 hours to 3 days
In what type of headache does pain often worsen with physical activity?
Migraine
What general types of symptoms are associated with migraine headaches?
Physiologic, neurologic, constitutional and autonomic
What type of headache is Nausea and Vomiting common with?
Migraines, Cluster Headaches
When does Prodrome of migraines occur?
Prior to headache, up to one day before
How does Migraine Aura manifest?
Usually as sensory changes, including smells and lights that are not really there and tingling in the extremities
What is parasthesias?
Tingling in the extremities
What are the common treatments for Migraines?
OTC analgesics, ergotamine derivatives and serotonin receptor agonist
What is the most severe of the primary headache disorders?
Cluster Headaches
Describe a cluster headaches:
A series of severe constant unilateral headaches attacks, lasting weeks or months often centered around the eye, each last 15 minutes to 3 hours
What population is most likely to have cluster headaches?
Men in their 30s
Do cluster headaches throb?
No, usually constant
What are the Concomitant symptoms of Cluster headaches?
Drooping of the eye, nasal stiffness, tearing, phono-photo-phobia, nausea, vomiting
Are Cluster headaches episodic or chronic?
Can be both
How long do individual cluster headaches last?
15 minutes to 3 hours
How long are patients in remission between episodes?
2 years
What relieves pain of cluster headaches in 70% of patients?
Oxygen therapy
Hypoxemia is likely an issue with what type of headaches?
Cluster
What medications are associated with Migraine's?
Vasodilators and Hormone therapies
What type of headache is often associated with emotional stress?
Tension
What areas need to be considered when making a headache diagnosis?
Location and concentration, duration and frequency, triggers, concomitant symptoms, medications, sensation
What are the signs that a patient need emergent care when complaining of a headache?
Very severe with sudden onset, stiff neck, papilledema, systemic signs (weight loss, fever), seizures
What is papilledema?
Optic disc swelling
What is sinusitis?
Acute swelling, inflammation or infection of the paranasal mucosa
How many adults in the US get sinusitis in a year?
30 million
How long does acute sinusitis last?
7-10 days
What defines chronic sinusitis?
>10 days on > 4 occasions per year, disease present 8 weeks or repeated medical treatment failure
What are the signs of Sinusitis?
Mucopurulent discharge, abnormal transillumination, poor response to decongestants, headaches refractory to analgesics
What are the symptoms of Sinusitis?
Purulent nasal discharge, cough, fever, maxillary toothache, nasal congestion, facial pain
The majority of sinusitis cases are caused by viruses or bacteria?
Viruses
What are the major viruses implicated in sinusitis?
Rhinovirus, Influenza, ParaInfluenza, Adenovirus
What are the major bacterial pathogens implicated in sinusitis?
Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis
Persistence of sinusitis symptoms beyond 7-10 days indicates what type of pathogen?
Bacterial
Is bacterial sinusitis under diagnosed by family practice physicians?
No, over diagnosed
What defines chronic bacterial sinusitis?
Inflammation that lasts over 3 months with the persistence of respiratory symptoms
What defines acute sinusitis?
Resolves in 30 days
What are the areas that should be inspected for a differential diagnosis of sinusitis?
Time of day, Concomitant symptoms, location and duration
Where will pain be located when sinusitis is located in the Frontal sinus?
Forehead
Where will pain be located when sinusitis is located in the Maxillary sinus?
Upper jaw, teeth or cheek
What will pain be like when sinusitis is located in the Ethmoid sinus?
Pain between the eyes, swelling of the eyelid
Where will pain be located when sinusitis is located in the Sphenoid sinus?
Deep achig of the top of the head, neck ache, earache,
A headache at what time of day may indicate a sinus headache?
Waking in the AM
Why is an AM headache indicative of a sinus problem?
Sinus issues are senstivie to position of the head, usually worse when lying down
What can drainage of mucus from paranasal sinus infection cause?
Pharyngitis and worsening cough
An infection of the teeth can cause what problems?
Facial pain and halitosis
Infection of the teeth may result in what symptoms?
facial pain or halitosis
What is halitosis?
Bad breath
What is rhinitis?
Inflammation of the nasal mucous membranes due to inhalation of allergenic materials
What are the two type of Non-infectious rhinitis?
Allergic and Non-allergic
What are the two type of infectious rhinitis?
Bacterial and viral
What are the two types of Allergic Rhinitis?
Perennial and Seasonal
What is an allergic shiner?
Dark circles under the eye due to allergies
What are the signs of allergic rhinitis?
Transverse nasal crease, allergic shiners, Adenoidal breathing, periorbital swelling, conjunctival redness and swelling, pale blueish edematous nasal turbinates
What is adenoidal breathing?
Difficulty breathing through the nose
What are the symptoms of Allergic Rhinitis?
Post nasal drip, sneezing, itching eyes, ears, nose and palate, Clear rhinorrhea, wheezing
Rhinitis medicamentosa is caused by what?
Rebounding nasal congestion due to tachyphylaxis to topical decongestants
What needs to be considered in a diagnosis of Rhinitis?
Location, Duration, Concomitant symptoms, Time of day, Medications
What is Rhinorrhea?
Recurrent water chronic nasal discharge
What type of rhinitis may cause purulent nasal discharge?
bacterial
What type of rhinitis can happen any time with no pattern?
Viral
A patient with viral rhinitis would generally have what concomitant symptoms?
Fever, fatigue, malaise, sore throat
What is the most common etiology of rhinitis?
Allergies
What are the risk factors for allergic rhinitis?
Concurrent atopic disease or Family history
What are common symptoms that are commonly seen with patient who have rhinorrhea?
Purulent sinusitis, nasal polyps, otitis media, loss of hearing, mouth breathing and chronic conjunctivitis
What is the most moderate form of periodontal disease?
Gingivitis
What are the signs of Gingivitis?
Swollen puffy ginga, bleeding upon probing, sucular depth measured at > 4 mm, erythema of the gums, blueish hue to gums
What are the symptoms of Gingivitis?
Bleeding upon brushing, Tender gums, red gums
What areas should you consider when making a differential diagnosis of gingivitis?
Location, duration and frequency, medications, dental hygiene, causes
The severity of gingivitis depends on what?
The number of areas
What group is acute necrotizing ulcerative gingivitis most common in?
adolescents and young adults
What is the onset for necrotizing ulcerative gingivitis like?
Sudden
What are the concomitant symptoms for necrotizing ulcerative gingivitis?
Fever, malaise, lymphadenopathy and halitosis
What can Carcinomas of the mouth result in?
Lymphadenopathy, Halitosis, and bleeding of the mouth
What is the cause of Gingivitis?
Inadequate dental hygiene
What can un-remediated Gingivitis result in?
Accumulation of plaque and tooth loss
What is a common cause of gum inflammation in geriatrics?
Loose or malfitted dentures
What is Hyperemia?
Excess blood in the vessels
What are the signs of Pharyngitis?
Hyperemia of the pharynx, tonsilar exudate, hypertrophied tonsils, swollen, tender anterior cervical lymph nodes
What are the symptoms of Pharyngitis?
Sore throat, Dysphagia, Fever
What is Pharyngitis?
Inflammation of the pharynx and surrounding lymphoid tissue
What are most cases of pharyngitis caused by?
Viruses
What are most cases of bacterial pharyngitis caused by?
Group A streptococcus
What are the major bacteria implicated in pharyngitis?
Group A Strep, C. diphtheriae, N. gonorrhoeae, Mycoplasma pneumonia, Chlamydia pneumonia
What are the major viruses implicated in pharyngitis?
Coronavirus, Adenovirus, Herpes simplex, Influenza, Parainfluenza and Epstein-Barr virus
In a child less than 4 years, what would suspect the cause of pharyngitis would be?
Viral
What percent of symptomatic pharyngitis in children and adults is from Group A Strep?
10% in adults, 30% in children
Can Group A strep caused pharyngitis go untreated?
No, can be serious and life threatening
What life threatening complications can come from an untreated case of Group A strep pharyngitis?
Reactive arthritis, glomerulonephritis, abscess formation, rheumatic fever
What are the considerations for a differential diagnosis of sore thorat?
Concomitant symptoms, duration and environmental causes
In children, parainfluenza is accompanied with what symptom 80% of the time?
Fever
A pain felt in the ears with a sore throat indicates what?
Tonsillary involvement
How long do Environmental contaminants cause sore throat?
Only as long as hazard is around
What is another term for Oral pharyngeal candidiasis?
Thrush
What is Oral pharyngeal Candidiasis caused by?
Candida albicans (fungus)
What are the two kinds of Thrush?
Mucocutaneous and Atrophic
What type of Thrush is common with Older individuals/those with dentures?
Atrophic
What are the common risk factors for thrush?
Infancy, Denture, inhaled corticosteroids, chemotherapy, radiation, immunosuppression, Broad spectrum antibiotics
What are the signs of Thrush?
White plaques on the buccal mucosa, palate or oropharynx
What are the symptoms of Thrush?
Often asymptomatic, angular chelitis and painful when wearing dentures
What is angular chelitis?
Inflammation of the corner of the mouth
What are the areas of consideration for differential diagnosis of Lymphadenopathy?
Onset of formation, duration, concomitant symptoms, moveable, pain
Acute enlargement of a lymph node is a sign of what type of lymphadenopathy?
Viral or bacterial
Persistent enlargement of a lymph node is a sign of what type of lymphadenopathy?
Malignancy
What will infected lymph nodes feel like?
soft, moveable and tender
What are malignant lymph nodes often like?
Hard and fixed
Can chicken pox cause lymphadenopathy?
Yes
A patient with large painful lymph nodes, sore throat, fever and fatigue, likely has what?
Mononucleosis
What medications can cause lymphadenopathy?
Phenytoin, hydralazine and allopurinol
What behaviors increase the risk of head and neck cancer?
Smoking and chewing
What is Microencephalopathy?
Decreased skull size
What is Macroencephalopathy?
Enlarged skull size
What is Hydrocephalus?
Excessive fluid in the skull with head enlargement that does not include the skull
What is Acromegaly?
Abnormal enlargement of facial and skull bones
What can acromegaly be resultant of?
Overactive pituitary
What disease results in an abnormal roundness of the face, red skin and excessive upper lip hair?
Cushing's
Protruding and bulging eyes along with face thinning is indicative of what disease?
Grave's disease
What is Grave's Disease caused by?
Excessive thyroid hormone production
What should normal Nasal mucosa look like?
Deep pink
What should abnormal nasal mucosa look like?
Red colored
What tools are used to view Nasal mucosa?
Otoscope and nasal speculum
What techniques are used for physical exam of the Sinuses?
Palpitation and Transillumination
What will transillumination of a normal patient look like?
Red glow
What will transillumination of an infected sinus look like?
No illumination
What response to palpitation is not normal for the sinuses?
Pain
What response to palpitation is normal for the sinuses?
No response to firm pressure
Depression of the nasal bridge indicates what?
Fracture to the nose
What indicates a foreign body in the nose?
Maloderant purulent nasal discharge, unilateral
What can pale blue colored lips in light skinned people indicate?
Shock, anemia, cyanosis
White spots on the sides of the mouth, soft palate, or hard palate may indicate what?
candidiasis (oral thrush) or leukoplakia
What is leukoplakia?
whitish lesions often caused by irritation
Swelling and redness of the interdental papillae may be caused by what disease discussed in class?
Gingivitis
Dark-skinned patients routinely present with a dark line along the gum margin, is this normal?
Yes
Gingival hyperplasia presents as what?
swollen gingival masses that may be severe enough to cover the teeth
A persistent red or white nodule or ulcer on the tongue should be suspected as what until proven otherwise?
Cancer
Cancer of the tongue occurs primarily on what areas?
Side
Most cases of ulcers or nodules that are non-cancerous appear on what part of the tongue?
Base
A white exudate on the posterior pharynx or tonsils may indicate infection of what?
strep throat or mono
Deviation of the uvula to the side or absence of movement may indicate what?
nerve damage
Sweet, fruity breath is seen in what diseases?
Diabetic ketoacidosis or malnourishment
Patients with end-stage renal failure may have breath that smells like what?
Ammonia
A musty odor to the breath may indicate what?
Liver disease
A foul odor to the breath may indicate what?
dental or respiratory infections
What should you note about the neck in a physical examination?
Pain, stiffness, limited motion or rigidity
How should you perform a Physical exam of the neck?
Have the patient move their head in these ways: Chin to chest, side to side, ear to shoulder, head backward (the later indicates a need for exorcism)
How should you perform a lymph node exam?
Both sides at once to get a comparison
What do normal lymph nodes feel like?
Soft, nontender, moveable and discrete
Acute infection of the lymph nodes has what qualities?
Bilaterally enlarged, warm, tender, firm but moveable
Cancer of the lymph nodes has what qualities?
unilaterally hard, nontender and fixed
HI has what qualities in the lymph nodes?
bilaterally enlarged, nontender and moveable
Infectious mononucleosis may cause enlargement or tenderness of what lymph nodes?
the cervical, inguinal, and axillary lymph nodes
What is the gold standard for diagnosis of bacterial pharyngitis?
Throat culture
A rapid streptococcus test that is negative indicates no further testing needed?
No, often titers are too low, infection may be present still