Head

Diseases Description Examples of abnomalities

Headache One of the most common
symptoms in clinical practice, with
a lifetime prevalence of 30% in the
general population
Three most important attributes of
headache
> severity
> chronologic pattern >associated
symptoms
overuse of analgesics,
ergotamines, or triptans mya
cause headache
Types:
*Tension headache-often arise in the temporal areas, predominant,
episodic and tend to peak over several hours.
*Thunderclap headaches reaching maximal intensity over several
minutes occur in 70% of patients with subarachnoid hemorrhage
*Unilateral headache- occurs in migraine and cluster headaches,
cluster headaches may be retro-orbital.
Classified as:
-primary-without an identified underlying disease
e.g. migraine, tension, cluster, and chronic daily headaches
-secondary-with an identified underlying disease
e.g. meningitis, subarachnoid hemorrhage (severe and of sudden
onset) mass lesion, tumor, or abscess.

Note: Nausea and vomiting are common with migraine, but also
occur with brain tumors and subarachnoid hemorrhage.

Valsava maneuvers
>leaning forward-sinusitis
>lying down-mass lesion

Women aging 35yrs+ avoid use of estrogen–progestin contracepives

Migraine -unilateral
-primary
-nausea & vomiting
-60%-70% have a symptom
prodome prior to onset
-experience visual aura:
>spark photopsis (flashes of light)
>fortifications (zig-zag arcs of light)
 > scotomas (areas of visual loss
with surrounding normal vision).
-Genetic inheritance is present in
30% to 50% of patients with
migraine.
Eyes
Hyperopia -Difficulty with close work,
farsightedness
presbyopia (aging vision)
myopia with distances, nearsightedness
vitreous hemorrhage sudden visual loss is unilateral If PAINLESS
-diabetes/ trauma
-macular degeneration
-retinal detachment
-retinal occlusion
-central retinal artery occlusion

If PAINFUL:
-affects cornea, anterior chamber
-corneal ulcer, uveitis, traumatic hyphema, and acute angle closure
glaucoma

If bilateral If PAINLESS
-consider vascular etiologies such as giant-cell arteritis or
nonphysiologic causes.

If PAINFUL
-consider chemical or radiation exposures.

Optic neuritis from multiple sclerosis

cataracts or macular degeneration -Gradual vision loss
-Slow central loss
advanced open-angle glaucoma -peripheral loss
hemianopsia and quadrantic -one-sided loss
defects
fixed defects, or scotomas -suggest lesions in the retina or Note: Moving specks are vitrous floaters
visual pathways.

detachment of the vitreous body - Flashing lights with new vitreous -Prompt consultation is indicated
from the retina floaters

subconjunctival hemorrhage -red painless eye

viral conjunctivitis - red eye with a gritty sensation
hyphema, episcleritis, acute angle - red painful eye
closure glaucoma, herpes keratitis,
foreign body, fungal keratitis, and
sarcoid uveitis.
Diplopia lesions in the brainstem or -horizontal diplopia: palsy of CN III or VI
cerebellum -vertical diplopia: palsy of CN III or IV
-weakness or paralysis of one or
more extraocular muscles. Note: Diplopia in one eye, with the other closed, suggests a problem
in the cornea or lens.
Ears
sensorineural loss -have trouble understanding Medications that affect hearing:
speech -aminoglycosides, aspirin, NSAIDs, quinine, and furosemide.
-often complaining that others
mumble
conductive loss -noisy envi- ronments may help
otitis externa -Pain occurs in the external canal Note: Acute otitis externa and acute or chronic otitis media with
-inflammation of the external ear perforation usually present with yellow-green discharge.
cana
otitis media infection of the middle ear
Tinnitus - is a perceived sound that has no -When associated with hearing loss and vertigo, suspect Ménière
external stimulus disease
 -is a common symptom, increasing - popping sounds originate in the temporomandibular joint
in frequency with age.

Vertigo -is the sensation of true rotational benign positional vertigo, labyrinthitis, vestibular neuri- tis, and
movement of the patient or the Ménière disease.
surroundings.
-room is spinning and tilting
-represents vestibular disease,
usually from peripheral causes in
the inner ear
Presyncope -Feel as if falling or pass out Symptoms similar to:
-Feeling light- headed, weak in the arrhythmia, orthostatic hypotension, or vasovagal stimulation.
legs, or about to faint points t
Disequilibrium -unsteady or losing balance
Ataxia, diplopia, and dysarthria -signal central neurologic causes in
the cerebellum or brainstem such
as cerebral vascular disease or
posterior fossa tumor
presbycusis -Aging is the most important risk risk factors
factor -congenital or familial hearing loss, syphilis, rubella, meningitis,
- degenerating hair cells in the ear diabetes, recurring inner ear infections, exposure to ototoxic agents,
lead to gradually progressive frequent use of headphones, and exposure to hazardous noise levels
hearing loss, particularly for high- at work, leisure, or on the battlefield.
frequency sounds.
Nose and Sinuses
Rhinorrhea -drainage from the nose
-nasal congestion, a sense of
stuffiness or obstruction.
-Causes include viral infections,
allergic rhinitis (“hay fever”), and
vasomotor rhinitis. Itching favors
an allergic cause.
allergic rhinitis. -Seasonal onset or environmental Noe: Drug-induced rhinitis occurs in excessive use of topical
triggers decongestants, or use of cocaine.
Acute bacterial
sinusitis/rhinosinusitis
deviated nasal septum, nasal
polyp, foreign body, Wegener
granuloma, or carcinoma.
Epistaxis
Mouth, Throat, and Neck
- Tobacco and alcohol account for about 75% of oral cavity cancers
Sore throat or pharyngitis
sore tongue
gingivitis
Hoarseness
is unlikely until viral URI symptoms
persist more than 7 days; both
purulent drainage and facial pain
should be present for diagnosis
(sensitivity and specificity are
above 50%)
nasal congestion only on one side
is bleeding from the nasal
passages. Bleeding can also
originate in the paranasal sinuses
or nasopharynx.
is a frequent complaint, usually
associated with an acute URI.
However, sometimes a sore throat
is the only symptom.
may result from local lesions as
well as from systemic illness
bleeding gums
-change in voice quality, rough,
harsh, or lower pitched than usual.
Local causes of epistaxis include trauma (especially nose-picking),
inflammation, drying and crusting of the nasal mucosa, tumors, and
foreign bodies.
Types:
Hemoptysi-coughing blood
Hematemesi-vomited blood
Anticoagulants, NSAIDs, vascular malformations, and coagulopathies
can contribute to epistaxis.
Diagnosis for streptococcal and Fusobacterium necrophorum
pharyngitis:
fever history, tonsillar exudates, swollen tender anterior cervical
adenopathy, and absence of cough
aphthous ulcers and sore smooth tongue of nutritional deficiency
Acute:
-consider voice overuse
-acute viral laryngitis
-neck trauma.
 If hoarseness lasts over 2 weeks, refer for laryngoscopy and consider
causes such:
-hypothyroidism
-reflux, vocal cord nodules

head and neck cancers:

-thyroid masses
-neurologic disorders
-Parkinson disease
-amyotrophic lateral sclerosis
-myasthenia gravis.
periodontal disease bleeding, pus, recession of the Risk factors:
gums, and bad breath. low income, male gender, smoking, diabetes, and poor oral hygiene

note: Inspect the mucous membranes, the palate, the oral floor, and
the surfaces of the tongue for ulcers and leukoplakia, warning signs
for oral cancer and HIV disease
pharyngitis Accompaied by Enlarged tender
lymph nodes
goiter thyroid function may be increased,
decreased, or normal
hypothyroidism Intolerance to cold, weight gain,
dry skin, and slowed heart rate
point
hyperthyroidism intolerance to heat, weight loss,
moist velvety skin, and palpitations
point
Eyes
cataracts clouding of the lens
macular degeneration mottling of the macula, variations
in retinal pigmentation, subretinal
hemorrhage or exudates
glaucoma change in color and size of the
optic disc
Primary open-angle glaucoma -gradual loss of vision in the
(POAG) peripheral visual fields, resulting
from loss of retinal ganglion cell
axons

- pal- lor and increasing size of the

optic cup
Head
hyperthyroidism Fine hair
hypothyroidism coarse hair
seborrheic dermatitis or psoriasis Presence of redness and scaling
pilar cysts Soft lumps
melanoma Pigmented melanoma
hydrocephalus or Paget disease of Enlarged skull
bone.
Hirsutism (excessive facial hair) polycystic ovary syndrome
Eyes
Anatomy and Physiology
palpebral fissure The opening between the eyelids
conjunctiva clear mucous membrane with two
easily visible components
bulbar conjunctiva covers most of the anterior The two parts of the conjunctiva merge in a folded recess that
eyeball, adhering loosely to the permits movement of the eyeball.
underlying tissue.
palpebral conjunctiva lines the eyelids
levator palpebrae the muscle that raises the upper
eyelid, is innervated by the
oculomotor nerve, CN III
tarsal plates firm strips of connective tissue
meibomian glands tear fluid protects the conjunctiva parallel row
Conjuctival glands and cornea from drying, inhibits
Lacrimal glands microbial growth, and gives a lies mostly within the bony orbit, superior and lateral to the eyeball
smooth optical surface to the cor-
nea.
levator palpebrae the muscle that raises the upper
eyelid, is innervated by the
oculomotor nerve, CN II.I
lacrimal puncta two tiny holes where tear fluid The tears then pass into the lacrimal sac and on into the nose through
spreads across the eye and drains the nasolacrimal duct.
medially
aqueous humor -A clear liquid that fills the
anterior and posterior chambers of
the eye
-produced by the ciliary body
-drains out through the canal of
Schlemm.
optic fundus The posterior portion of the eye Structures here include: retina, choroid, fovea, macula, optic disc,
that is seen through the and retinal vessels.
ophthalmoscope
fovea darkened circular area
macula surrounds the fovea, but has no
discernible margins
vitreous body transparent mass of gelatinous
material that fills the eyeball
behind the lens and helps to
maintain the shape of the eye
visual field is the entire area seen by an eye
when it looks at a central point
Nerve impulses stimulated by light, are conducted
through the retina, optic nerve (CN
II)
optic radiation curving tract
Pupillary Reactions size changes in response to light
and to the effort of focusing on a
near object
Light Reaction
near reaction
Autonomic Stimulation
six cardinal directions
CN IV (trochlear nerve) damage
Direct reaction: light beam shining retina, optic nerve (CN II), and optic tract, which diverges in the
onto one retina causes pupillary midbrain. Impulses back to the constrictor mus cles of the iris of each
constriction in both that eye eye are transmit- ted through the oculomotor nerve, CNIII
Consensual reaction to light:
contralateral eye
-mediated by the oculomotor
nerve (CN III)
when a person shifts gaze from a convergence of the eyes- medial rectus movement
far object to a near object, the
pupils constrict accommodation- increased convexity of the lenses caused by
contraction of the ciliary muscles.
-mediated by the oculomotor
nerve (CN III)
Parasympathetics: Pupillary
constriction
Sympathetics: Pupillary dilation
and raising of upper eyelid
(superior tarsal muscle)
(CN III)- right inferior rectus, down
and right, prinicipally responsible
for moving the right eye
(CN IV)- superior oblique,
prinicipally respo for movig the left
eye
due to:
head trauma
congenital causes
central lesions

Presbyopia
glaucoma, optic neuropathy, optic
neuritis, and glioma
stroke and chiasmal tumors
left homonymous hemianopsia
glaucoma, optic neuritis, and
papilledema
esotropia
exotropia
Graves disease or ocular tumors
seborrheic dermatitis
hypothyroidism
Down syndrome
blepharitis
conjunctival inflammation or
corneal irritation, or impaired
drainage, caused by ectropion, and
nasolacrimal duct obstruction
Sjögren syndrome
Jaundice
causes dysfunction of the superior
oblique muscle
leads to:
diplopia (double vision)
causes focusing problems for near legally blind when vision in the better eye, corrected by glasses, is
vision, found in middle-aged and 20/200 or less.
older adults. A presbyopic person
often sees better when the card is Legal blindness also results from a constricted field of vision: 20° or
farther away. less in the better eye.
Causes of anterior pathway
defects
Posterior pathway defects
when the patient’s left eye
repeatedly does not see your fin-
gers until they have crossed the
line of gaze
An enlarged blind spot occurs in
con- ditions affecting the optic
nerve
inward deviation
outward deviation
abnormal protrusion
Scaliness
lateral sparseness
Upslanting palpebral fissures
Red inflamed lid margins
Excessive tearing may be from
increased production
Dryness from impaired secretion
A yellow sclera
nodular episcleritis Local redness
acute narrow-angle glaucoma -crescentic shadow present increases the risk for acute narrow-angle glaucoma a sudden increase
-very narrow angle with the in IOP when drainage of the aqueous humor is blocked
cornea