头部和颈部检查.pptVIP

Physical Exam of the Head NeckA Lect. of Clin Skills for Med Students(Nepalese Class) Part I All through the approach of PE in general involves 4 Steps Sequentially: Inspection Palpation Percussion Auscultation the 1st one (inspection) is esp, important and useful for PE of head This is because many traits or findings from the head, esp, the face, is so attractively draw our attention when we firstly look at the pt For Ex, the emotional reactions: General appearance (faces) Eye signs of Graves’ disease Paralysis of facial n. 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) Hyperpigmentation appearing as a diffuse brown, tan, and darkening of the facial skin, and esp, the unexposed parts, such as the gum, or buccal mucosa or other areas, as the nipples, creases of the hand, etc. added weakness, fatigability, loss of appetide, nausea / vomiting, and hypotension strongly points to adrenocortical insufficiency (hypocortisolism or Addison’s disease). ? 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. ? Cyanosis A bluish cast to the skin, that is easily seen in the tip of the nose, lips, cheeks, oral nucosa, conjunctivae, tongue, and the nail beds. usu. caused by↑amount of unoxygenated Hb in the circulation fr a nunmber of