what type of a face does cushings syndrome produce

 a round or moon face with red cheeks

excessive hair in the mustache and sideburn areas

what type of face does nephrotic syndrome produce

edematous and often pale

swelling usually appears first around the eyes and in the morning

eyes may be slitlike with severe edema

what type of a face is produced from myxedema (hypothyroidism)

dull puffy face

edema around the eyes does not pit

hair and eyebrows are dry coarse and thinned

the skin is dry

what diseases are associated with chronic bilateral enlargement of the parotid gland

obesity, diabettes, cirrhosis, and others

what are the common facial features associated with parotid gland enlargement

swellings anterior to the ear lobes and above the angles of the jaw

what does gradual unilateral enlargement of the parotid gland suggest

neoplasm

where is acute partoid gland enlargement seen

mumps

what are the facial features produced from acromegaly

head is elongates

bony promience of the forehead, nose, and lower jaw

soft tissue of nose lips and ears enlarged

features are generally coarsened

what facial features are produced from parkinsons disease

 decreased mobility blunts expression

a masklike face with decreased blinking and characteristic stare

patient seems to peer upwards

skin is oily and drooling may occur

what produces a horizontal visual defect

occlusion of a branch of the central retinal artery

 what produces unilateral blindness

a lesion of the optic nerve and the eye itself

what would produce visual loss in the temporal half of each eye

lesion at the optic chiasm

what would produce a left or right hemianopsia

a lesion at the left or right optic tract the loss would be on the same side of both eyes

 what would produce a homonymous left or right superior quadrantic defect

a partial lesion of the optic radiation in the temporal lobe

what would produce a left homonymous hemianopsia

a complete interruption of fibers in the optic radiation (similar to lesion in optic tract)

 what is ptosis

drooping of the upper lid

what are some of the causes of ptosis

 myasthenia gravis

damage to occulomotor nerve

damage to sympathetic nerve supply (horners syndrome)

congenital

what does a wide eye stare suggest

retracted eyelids

what is a common cause of retracted eyelids

hyperthyroidism

what happens to the eyeball in exophthalmos

it protrudes forward

what does bilateral exophthalmos suggest

infiltrative ophthalmopathy of Graves' hyperthryroidism

what is pinguecula

harmless yellowish triangular nodule in the bulbar conjunctiva on either side of the iris

what is episcleritis

localized ocular redness from inflammation of the episcleral vessels

what are the characteristics of episcleritis vessels

vessels appear salmon ink and are movable over the scleral surface

what is a sty

a painful tender red infection in a gland at the margin of the eyelid

what is a chalazion

subacute nontender and usually painless nodule involving a meibomian gland

usually points inside the gland rather than on lid margins

what is xanthelasma

 slightly raised yellowis well circumscribed plaques that appear along the nasal portions of one or both eyelids

this usually accompanies lipid disorders

xanthelasma

 what is inflammation of the lacrimal sac

 swelling between the lower eyelid and the nose

what is the difference between acute and chronic inflammation of the lacrimal sac

acute = painful red and tender

chronic = associated with obstruction of the nasolacrimal duct

what happens when pressure is applied to the lacrimal sac that is inflammed

regurgitation of material through the puncta of the eyelids

what is the pattern of redness, pain, vision, ocular discharge, pupil, cornea, and significance associated with conjunctivitis

 pattern of redness: diffuse dialation of the cujunctival vessels with redness maximal peripherally

 Pain: mild discomfort rather than pain

Vision: No effect other than temporay blurring due to discharge

Ocular Discharge: Watery, mucoid, or mucopurulent

Pupil: not affected

Cornea: clear

Significance: Bacterial, viral, other infections, allergy, irritation

 what is the pattern of redness, pain, vision, ocular discharge, pupil, cornea, significance associated with subconjuctival hemorrhage

pattern of redness: leakage outside of vessels producing a sharply demarcated red area that fades to yellow and disappers

pain: absent

Vision: not affected

Ocular discharge: absent

Pupil: not affected

Cornea: clear

significance: often none. trauma, bleeding disorder, increase in venous pressure as from cough

what is ciliary injection an important sign of

one of three conditions

corneal injury or infection

acute iritis

glaucoma

what is the pattern of redness associated with ciliary injection

dilation of deeper vessels that are visible as radiating vessels or a reddish violet flush around the limbus.

 what is the pain, vision, ocular discharge, pupil, cornea, and significance associated with corneal injury or infection

pain: moderate to severe, superficial

vision: usually decreased

ocular discharge: watery or purulent

pupil: not affected unless iritis develops

cornea: changes depending on cause

significance: abrasions, other injections, viral and bacterial infections

what are the pain, vision, ocular discharge, pupil, cornea, and significance associated with acute iritis

pain: moderate aching pain

vision: decreased

ocular discharge: absent

pupil: may be small and with time irregular

cornea: clear or slightly clouded

significance: associated with mamy ocular and systemic disorders

what are the pain, vision, ocular discharge, pupil, cornea, and significance associated with glaucoma

pain: severe, aching, deep

vision: decreased

ocular discharge: absent

pupil: dilated, fixed

cornea: steamy cloudy

significance: acute increase in intraocular pressure an emergency

what is corneal arcus

a thin grayish white arc or circle not quite at the edge of the cornea

where do we see corneal arcus

 normal with aging

seen in younger patients especially african americans

may suggest hyperlipoproteinemia in younger people

what is a corneal scar

superficial grayis wite opacity in the cornea, secondary to an old injury or to inflammation

what is a pterygium

a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea

what are cataracts

opacities of the lenses visible through the pupil most common in old age

what are the two types of cataracts

nuclear cataract

peripheral cataract

what is a nuclear cataract

 looks gray when seen by a flashlight, if pupil is widely dialated the gray opacity is surrounded by a black rim, through an opthalmascope the cataract looks black agains the red reflex

what is a peripheral cataract

produces a spoke like shadows that point inward gray against black as seen with a flashlight or black against red with an opthalmoscope

what is anisocoria

unequal pupils

what does it mean when anisocoria is greater in bright light

larger pupil cannot constrict properly

what does it mean when anisocoria is greater in dim light

smaller pupil cannot dilate properly

what is tonic pupil

pupil is large regular and usually unilateral

deep tendon reflexes are often decreased

what happens with oculomotor nerve paralysis

dilated pupil is fixed to light and near effort

even more dilated and fixed pupil may result form atropine like eyedrops

what is horners syndrome

the small pupil reacts briskly to light and near effort. ptosis of the eyelid is present perhaps with loss of sweating of the forehead

 what happens in congenital horners syndrome

the involved iris is lighter in clor than its fellow

what do small irregular pupils indicate

argyll robertson pupils seen in central nervous system syphilis

they accomodate but do not react to  light

what happens to the pupils with one blind eye

 pupils are same size as long as parasympathetic and sympathetic innervation is good to both irises however if light goes in good eye we see the consensual reaction in the blind eye but if light enters the blind eye we do not see the consensual reaction in the good eye

 what is a keloid

a firm nodular hypertrophic mass of scar tissue extending beyond the area of injury

Often on pierced ear  lobe

what is a tophi

 a deposit of uric acid crystals characteristic of chronic tophaceous gout. It appears as hard nodules in the helix or antihelix and may discharge chalky white crystals through the skin

what is a cutaneous cyst

a dome shaped lump in the dermis forms a benign closed firm sac attached to the epidermis a dark dot may be visible on surface

 what is a basal cell carcinoma

raised nodule shows the lustrous surface and telangiectatic vessels of basal cell carcinoma a common slow growing malignancy that rarely metastasizes

 what is a perforation of the drum

a hole in the drum may be central or marginal

what causes perforations of the drum

infections of the middle ear

what is tympanosclerosis

deposition of hyaline material within the layers of the tympanic membrane

what is serous effusion

 usually caused by viral upper respiratory infections or by sudden chages in atmospheric pressure as from flying or diving the eustachian tube cannot equalize the pressure air is absorbed by blood stream and serous fluid collects there.

common symptoms: popping of ears and mild pain

what is acute otitis media with purulent effusion

caused by bacterial infection symptoms include earache, fevere, and hearing loss. the eardrum reddens loses its landmarks and bulges laterally toward the examiners eye

what is bullous myringitis

 viral infection characterized by painful hemorrhagic vesicles that appear on the tympanic membrance

symptoms: earache bloodtinged discharge from the ear and hearing loss of conductive type

what are the causes of conductive hearing loss

foreign body, otitis media, perforated eardrum, otosclerosis of ossicles

what are the causes of sensorineural loss

loud noise exposure, inner ear infections, trauma, tremors, congenital and family disorders, aging

what happens with webers test with conductive loss

 tuning fork at vertex

sound lateralizes to impaired ear

room noise not well heard so detection of vibrations improves

what happens with webers test with sensorineural hearing loss

sound lateralizes to good ear inner ear or cochlear nerve damage impairs transmission of affected ear

what happens during rinne test with conductive loss

BC>AC

vibrations bypass the problem to reach the chochlea

what happens during the rinne test with sensorineural loss

AC>BC

the inner ear or cochlear nerve is less able to transmit impulses regardless of how the vibrations reach the chochlea

what is angular cheilitis

starts with the softening of skin at the angles of the mouth followed by fissuring

can lead to secondary infection

what are the causes of angular cheilitis

nutritional deficiency, overclosure of mouth as with people with no teeth or ill fitting dentures

what is actinic cheilitis

 lips loses redness and may become scaly somewhat thickened and slightly everted results from excessive exposure to sunlight and effects primarily the lower lip

 what is herpes simplex

cold sores

small cluster of vesicles first develops as these break yellow brown crusts form and healing ensues

what is angionedema

diffuse nonpitting tense swelling of the dermis and subcutaneous tissue

may be associated with hives but does not itch

what is hereditary hemorrhagic telangiectasia

small red spots on the lips

spots are dilated capillaries and may bleed with trauma

what is peutz-jeghers syndrom

pigmented spots on the lips are more prominent than freckling of the surrounding area

multiple intestinal polyps are often associated

chancre of syphilis

 a firm buttonlike lesion that ulcerates and may become crusted

lesion of primary syphilis may appear on the lip rather than the genitalia

what is carcinoma of the lip

may appear as scaly plaque as an ulcer with or without a crust or as a nodular lesion

what are exudative tonsils

what is diphtheria

throat is dull red and a gray exudaate is present on the uvula pharynx and tongue

the airway may become obstructed

what is thrush  on the palate

yeast infection due to candida

thick white plaques are somewhat adherent to the underlying mucosa

what are the predisposing factors to thrush on the palate

prolonged treatment with antibiotics or corticosteroids

AIDS

what is kaposis sarcoma

deep purple color of lesions which may be raised or flat common on the palate

among people with AIDS

what is torus palatinus

 a midline bony growth in the hard palate that is fairly common in adults

it is harmless

what is fordyce spots

 sebaceous glands that appear as small yellowish spots in the buccal mucosa or on the lips

what is petechiae

small red spots that result when blood excapes from capillaries into the tissues

 what is leukoplakia

 a thickened white patch may occur anywhere in the oral mucosa

may lead to cancer

what is marginal gingivitis

 gingival margins are reddened and swollen and interdental papillae are blunted, swollen and red

brushing teeth  makes them bleed

common in teenagers and young adults

what is acute necrotizing ulcerative gingivitis

 occurs suddenly in adolescents and young adults ulcers develop in the interdental papillae the destructive process spreads along the gum margins wher pseudomembrane develops

what is gingival hyperplasia

gums are enlarged by hyperplasia are swollen into heaped up masses that may even cover teeth

causes: dilantin therapy, puberty, pregnancy, leukemia

what is pregnancy tumor

gingival enlargement forming a tumorlike mass that usually originates in the interdental papilla

what is attrition of teeth and

recession of gums

attrition of teeth: teeth are worn down from use until yellow brown dentin is exposed

recession of gums: gums receed exposing the root giving a long tooth apperance

what are hutchinsons teeth

teeth are smaller and more widely spaced and notched on the their biting surface

what are hutchinsons teeth a sign of

congenital syphillis

what is a hairy tongue

yellowish brown or black elongated papillae on the tongues dorsum

what is a fissured tongue

benign fissure in tongue occur with age

may be called scrotal tongue

what is a smooth tongue

 smooth and often sore and has lost its papillae

suggests deficiency: ribflavin, niacin, folic acid, B12, pyridoxine, iron

Or treatment with chemotherapy

what is candidiasis

thick white coat on tongue due to candida infection

seen in immunosuppressed conditions

what is hairy leukoplakia

whitish raised areas with a feathery or corrugated pattern most often affect sides of tongue

cannot be scraped off

seen in HIV and AIDS

varicose veins

small purplish or blue black round swellings appear under the tongue with age

 Aphthous Ulcer (canker sore)

painful, round or oval ulcer that is white or  yellowish gray and surrounded by a halo of reddened mucosa

mucous patch of syphilis

painless lesion highly infectious

slightly raised, oval, and covered by gray membrane

what are tori mandibulares

rounded bony growths on the inner surfaces of the mandible

 carcinoma in floor of the mouth

ulcers on floor of mouth with reddened area medially called erythroplakia suggesting malignancy

what types of enlargements are there with the thyroid gland

diffuse enlargement

single nodule

multinodular goiter

what is diffuse enlargement of the thyroid

includes the isthmus and lateral lobes

what are the symptoms of hyperthyroidism

  nervousness

weight loss despite increased appetite

excessive sweating and heat intolerance

palpitations

frequent bowl movements

muscular weakness

what are the symptoms of hypthyroidism

 fatigue, lethargy

modest weight gain with anorexia

dry coarse skin with cold intolerance

swelling of face hands and legs

constipation

weakness muscle cramps arthralgias

impaired memory or hearing

what are the signs of hyperthyroidism

warm smooth moist skin

with graves disease eye signs such as stare, lid lag, and exophthalmos

increased systolic and decreased diastolic

tachycardia or atrial fibrillation

hyperdynamic cardiaac pulsations with an accentuated S1

tremor and proximal muscle weakness

what are the signs of hypothyroidism

dry coarse cool skin sometimes yellowish from carotene with nonpitting edema and loss of hair periorbital puffiness

decreased systolic and increased diastolic

bradycardia and in late stages hypothermia

intensity of heart sounds decreased

impaired memory mixed hearing loss somnolence peripheral neuropathy carpal tunnel syndrome

smell is associated with which cranial nerve

1

visual acuity, visual fields and ocular fundi are associated with which cranial nerve

2 optic

pupillary reactions are associated with which cranial nerve

2 optic and 3 occulomotor

extraocular movements are associated with which cranial nerves

3 occulomotor, 4 trochlear, 6 abducens

coroneal reflexes, facial sensation, and jaw movements are associated with which cranial nerve

5 trigeminal

facial movements are associated with which cranial nerves

7 facial

hearing is associated with which crainal nerve

8 vestibularcochlear

swallowing and rise of palate and gag reflex are associated with which cranial nerve

9 glossopharyngeal 10 vagus

voice and speech are associated with which cranial nerves

5 trigeminal, 7 facial, 10 vagus, 12 hypoglossal

shoulder and neck movements are associated with which cranial nerve

11 accessory

tongue symmetry and position are associated with which cranial nerve

12 hypoglossal

what can cause face weakness of paralysis

lesion anywhere on 7

a central lesion involving the upper motor neuron system between the cortex and the pons

what happens with peripheral lesion on 7

paralyzes that entire side of the face

what happens with an upper motor system lesion

the bottom opposite side of face will experience paralysis because top half is controlled from both sides