Head & Neck

Question 1

Hairy tongue

Answer 1

• Brown and black elongated hairy papillae appear on the dorsum of the tongue.
• This benign condition is associated with antibiotic therapy.

Question 2

Hairy leukoplakia of tongue

Answer 2

• often affect the sides of the tongue
• Appear as whitish raised areas with a corrugated pattern.
• Unlike candidiasis these areas cannot be readily scraped off.
• Mostly associated with HIV and AIDS infection.

Question 3

Hyperthyroidism

Answer 3

• Ex. Grave’s disease
• Symptoms: Nervousness, weight loss despite increased appetite, excessive sweating, palpitations, diarrhea, fine tremors and proximal muscle weakness.
• Signs: warm, smooth, moist skin. With Grave’s one can see eye signs like lid lag and exopthalmos. Increase systolic and decreased diastolic pressures. Tachycardia and atrial fibrillation. Hyperdynamic cardiac pulsations with accentuated S1. Fine tremors.

Question 4

Hypothyroidism

Answer 4

• Ex. Hashimoto’s thyroiditis
• Symptoms: Fatigue, weight gain, loss of appetite, dry coarse skin and cold intolerance, swelling of the face, hands and legs, constipation, weakness, muscle cramps arthralgia.
• Signs: Dry, coarse, cool skin, with non pitting edema and loss of hair more so in the lateral eye brows, periorbital puffiness. Decrease systolic blood pressure, bradycardia, muffled heart sounds, somnolence, peripheral neuropathy and carpal tunnel syndrome.

Question 5

Migraines

Answer 5

• Unilateral 70% of the times
• Bilateral or global 30%
• Throbbing or aching
• Fairly rapid in onset 1-2 hours • Total duration 4-72 hours
• Peak incidence- Adolescence
• Prevalence: 15% in women and 6% in men.
• Usually monthly recurrence.
• Associated mostly with nausea, vomiting, photophobia or phonophobia.
• Aura could be visual.
• Aggravated by alcohol, certain foods, or stress.
• Relieved by quiet dark room, sleep.

Question 6

Tension headaches

Answer 6

• Etiology is unclear, tenderness over the peri- cranial muscles may be present.
• Usually bilateral, may be generalized or localized to the back of the head.
• Pain steady, non-throbbing, mild to moderate in intensity
• Gradual in onset.
• Lasts from 30 minutes to 7 days
• Usually episodic, may be chronic.
• There may be associated photophobia.
• Driving or typing may aggravate it because of muscle tension.
• Massaging or relaxation may relieve the pain.

Question 7

Cluster headaches

Answer 7

• more common in men
• Unilateral, usually behind or around the eye or temple
• Deepcontinuousseverepain
• Duration is up to 3 hours.
• Episodic and clustered in time with several attacks every day for 4-8 weeks
• Autonomic symptoms could be associated with it, like lacrimation, rhinorrhea, miosis, ptosis, edema of the eye lid etc
• During the attack sensitivity to alcohol may increase.

Question 8

Temporal arteritis (ex of 2o headache)

Answer 8

• Temporal arteritis, is a form of vasculitis
• The pain is severe and localized near the artery involved.
• Could be rapid or gradual in onset.
• Recurrent and persistent for weeks.
• Associated symptoms-scalp pain, fever, fatigue, weight loss and vision changes including blindness.
• Movement of the shoulders may aggravate the pain.

Question 9

Head examination (selected)

Answer 9

• On examination of skull inspection & palpation can be done simultaneously
• Sunken fontanelles: dehydration in infants
• Frenulum lingulae: Tears may indicate abuse

Salivary glands:

i) Parotid gland: Stenson’s duct opens opposite upper 2 molar [a tongue blade should be used to retract the buccal mucosa]
ii) Submandibular gland: Wharton’s duct opens as a single large caruncle near the base of the frenulum linguae

Question 10

Trachea

Answer 10

• Oliver’ s sign: Downward displacement of the cricoid cartilage with ventricular contraction – observed in patients with an aortic arch aneurysm
• Campbell’ s sign: Downward displacement of the thyroid cartilage during inspiration – seen in patients with COPD

Question 11

Meniere’s disease or syndrome

Answer 11

• build-up of fluid pressure inside inner of 2 fluid-filled compartments in iner ear, endolymphatic system.
• Syndrome: when identifiable cause of increased pressure is present.
• Disease: no identifiable cause

Question 12

Myringitis

Answer 12

Inflammation of ear drum