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79 Cards in this Set
- Front
- Back
External ear
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Auricle or pinna, collects sound and transmits to middle ear
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Tympanic membrane
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Separates external and middle ear
Three layers- skin, fibrous tissue and mucous membrane |
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Pars flaccida, pars tensa, umbo
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Pars flaccida - upper portion, little support
Pars tensa - lower portion, taut Umbo - center, attached to tip of malleus |
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Middle ear
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Transmits sound vibrations across bony ossicle chain to inner ear
Protects auditory apparatus from intense vibrations Equalizes air pressure on both sides of TM to prevent rupture |
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Auditory ossicles
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Malleus (hammer), incus (anvil), stapes (stirrup)
Linked in a chain and vibrate in place |
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Eustachian tube
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links middle ear with nasopharynx to equalize air pressure
Normal function keeps nasopharynx contaminants from middle ear Opens during yawning/swallowing URI/allergies can obstruct middle ear drainage -> otitis media, effusion |
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Inner ear
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closed fluid filled space within temporal bone
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Bony labyrinth
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Vestibule and Semicircular canal maintain equilibrium
Semicircular canals contain cristae- respond to body movement, control balance Cochlea- the organ of hearing |
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External exam - auricle
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Inspect for position and symmetry of auricle, tip of ear should line up with the corner of eye. Check skin color, for lesions/nodules. Palpate auricle and pre and post auricular lymph nodes, pull helix back check for tenderness, palpate and percuss mastoiditis.
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External exam - external auditory canal (EAC)
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Inspect opening for;
Discharge- color, consistency Redness Odor Nodules, masses, cysts, pimples Foreign bodies |
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Otoscope exam
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Note cerumen, hair, scaling, redness in EAC, TM should be pearly gray, transparent, light reflex tells you if TM is bulging, inflamed or retracted. Note placement of malleus and umbo. Insufflate and note mobility of TM.
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Normal placement of light reflex
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Use different “times” to note displacement of TM
4-6:00 in R ear normal 6-8:00 in L ear normal |
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Decreased/increased mobility of TM
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Decreased motion can represent increased pressure in the inner ear (as with otitis media, serous otitis, eustachian tube dysfunction)
Increased mobility can represent perforation |
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Cerumen
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Aids in sound conduction, protect from infection, moisten EAC, typically gray to brown color.
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Impaction of cerumen
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Blockage of EAC by cerumen – decreases hearing, causes discomfort, can affect equilibrium
Treat by flushing |
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Otitis externa
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"Swimmer's ear"
Inflammation of EAC due to bacteria, fungus, trauma, irritation. Typically resulting in secondary infection Ear pain (especially with auricle tug), redness of EAC, inflammation of EAC, flaking or maceration of tissue, discharge from EAC |
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Acute otitis media (AOM)
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Infection of the middle ear
Results from inflammation of tissues in the nasopharynx that lead to Eustachian tube dysfunction Ear pain (not affected by auricle tug), sensation of fullness in the ear, decreased hearing, URI symptoms, irritability in infants, fever |
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Types of acute otitis media (AOM)
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OM
Serous OM Bullous Myringitis |
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Perforations
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Hole in the tympanic membrane – due to procedure, trauma, infection, or other
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Cholesteotoma
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A skin cyst of the middle ear that grows destructively and affects hearing, REFERRAL
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Whisper test
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Stand 2 ft behind the patient, have pt cover tragus of one ear with his finger
Whisper a number with 2-3 syllables (68, 100, 99 etc) Repeat with other ear |
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Weber test
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Determines conductive vs sensorineural hearing loss
512 cycles per second tuning fork Strike against your hand and place on top of patients head Normal weber’s is equal hearing in both ears Tone better in one ear = R or L lateralization If lateralizes to impaired ear = conductive hearing loss If lateralized to good ear = sensorineural hearing loss |
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Rinne test
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Compares air conduction to bone conduction
Strike tuning fork with hand and place on mastoid process When patient tells you tone stops, move to front of ear Note each segments time in seconds Normal: Air conduction = 2 times bone conduction If in hearing loss ear bone > air = conductive hearing loss If in hearing loss ear air > bone = sensorineural hearing loss |
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External nose
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Inspect bridge, nares, vestibule, nasolabial fold for color, symmetry, masses, obstructions, changes. Palpate tip of nose, bridge, ala and paranasal bones.
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Internal nose
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Inspect nasal muscosa, turbinates, look for masses, septum.
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Unilateral rhinorrhea
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Typically an obstruction (paper, toy, bead, candy, etc.)
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Epistaxis
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Most common area is anterior and inferior septum in Kiesselbach's plexus = Anterior Bleed
Posterior bleeds are less common but more problematic |
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Sinusitis
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Inflammation of the sinus mucosa due to infection, irritation, trauma, or other
Headache, sinus pressure, congestion, rhinorrhea, fever Inspection: of turbinate show edema and rhinorrhea Palpation: tenderness Percussion: tenderness, dullness Transillumination: absence of glow suggests opacification of sinuses. Reddish glow is normal |
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Mouth and throat - external
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Inspect lips, nasolabial folds, skin, palpate for masses
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Angioedema
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Rapidly developing, tense swelling of the lips, tongue and oral mucosa, usually allergic in origin
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Herpes labialis
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Cluster of vesicles due to herpes simplex 1, healing in 10-14days (cold sore, fever blister)
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Angular chelitis
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Fissures at the corners of the mouth.
Causese: nutritional deficiency, over closure of mouth, infection |
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Squamous cell carcinoma of the lip
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cancer of the lip, usually lower lip. Firm, scaly plaque, ulcer (with or without crust), or nodular mass of the lip
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Hereditary hemorrhagic telangiectasia
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petechial red spots on the lips and oral mucosa. Areas may bleed with trauma/irritation. Friable=bleeds easily, occurs in the entire GI tract.
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Cyanosis
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Bluish coloring of the lips d/t lack of systemic oxygenation
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Mouth and throat - internal
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Inspect teeth, gums, oral mucosa, tongue, floor of mouth, soft and hard palate, pharynx. Palpate gums, teeth, salivary ducts, floor of mouth, tongue.
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Checking CN XII
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Ask pt to protrude tongue, asymmetric protrusions suggest CN XII lesion, tongue will point toward muscular deficit.
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Torus palatinus
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Midline bony growth on hard palate
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Leukoplakia
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“white patch” thickened white patch on the oral mucosa or tongue, results from local irritant. Common in chewing tobacco can lead to cancer
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Aphthous ulcer
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(canker sore) a painful, round, ulcer White ulcer on a red base. Can occur on gums, tongue, and oral mucosa
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Petechiae
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small red spots resulting from blood escaping capillaries into tissue. Cause: infectious, trauma, thrombocytopenia
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Koplick spots
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small white specks against a red backround. “grains of salt”. An early sign of measles
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Mucocele
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mucous cyst. Bluish, translucent.
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Inspect and palpate gums
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Inspect the color of the gums (normally pink), patchy brownness may be present, especially but not exclusively in black individuals
Redness of gingivitis Black line of lead poisoning Inspect and Palpate the gum margins and the interdental papillae for swelling or ulceration |
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Inspect and palpate teeth
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Missing, discolored, misshapen, or abnormally positioned, caries (normal 32 teeth)
Palpate teeth gloved with index finger or tongue blade for tenderness and loose teeth |
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Erosion of teeth
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chemical erosion of teeth enamel by toxic acids. Common in bulimia with gastric contents and ingested acids.
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Dental caries
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Cavities of the teeth. Causes are poor dental hygiene, methamphetamine use, and others
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Gingivitis
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Inflammation of the gums. The most common periodontal disease. Redness, swelling, and sometimes bleeding of the gums. Causes: bacteria
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Geographic tongue
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benign, smooth red areas denude of papillae. Map-like pattern that changes with time
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Hairy tongue
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yellow, brown, or black elongated papillae on the tongue. Benign. Causes: antibiotics, pepto bismol, tobacco, other
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Fissured tongue
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Fissuring increases with age. Benign.
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Atrophic glossitis
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smooth and sore tongue, lacks papillae. Causes: ribofalvin, niacin, folic acid, B12, pyridoxine, or iron deficiency, or recent chemotherapy.
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Cancer of the tongue
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irregular, nodular, red or white, sometimes ulcerated areas of abnormal tissue. Second most common cancer of the the mouth secondary only to the lip.
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Checking the pharynx
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Say "ah" with tongue depressor. Note the rise of the soft palate—a test of cranial nerve X. Inspect soft palate, anterior and posterior pillars, uvula, tonsils and pharynx. Note edema, exudates, ulcerations, crypts, masses, discolorations.
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CN X Paralysis
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Soft palate fails to rise and the uvula deviates toward the opposite side of muscular defect
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Tonsillar crypts
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tonsils have crypts, or deep in-foldings of squamous epithelium, whitish spots of normal exfoliating epithelium or food particles may sometimes be seen in these crypts
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Pharyngitis
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Inflammation of the pharynx commonly due to infection (bacterial or viral), irritant, trauma, allergies. Redness, edema, increased vascularity, sore throat, possible fever and cervical adenopathy.
Viral makes up 90% of all pharyngitis. Of the 10% of bacterial pharyngitis Strep causes 90% Allergic – may see cobble stoning |
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Oral candidiasis
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yeast infection due to Candida.
White plaques that are adherent, but removable to underlying tissue. Causes: immune suppression, recent antibiotics |
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Peritonsillar abscess
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A complication of tonsillitis which results in collection of pus near the tonsil (abscess). Red, edematous tonsils and pharynx, exudates, mass like uvula deviation.
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Inspecting the neck
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Note symmetry and masses or scarring, look for enlarged parotid or submandibular glands, visible lymph nodes. Identify midline structures.
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Identify the following midline structures...
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(1) the mobile hyoid bone just below the mandible
(2) the thyroid cartilage, readily identified by the notch on its superior edge (3) the cricoid cartilage (4) the tracheal rings (5) the thyroid gland |
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Lymph nodes in neck
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10 sets:
Preauricular, postauricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical chain, and supraclavicular. |
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Palpating lymph nodes
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Use the pads of your fingers to palpate the 10 sets of lymph nodes. Rubbing your fingers over the node and checking it’s mobility. You should usually examine both sides at once.
Supraclavicalar enlargement suggests metastasis Hard fixed notes suggest malignancy |
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Diffuse lymphadenopathy
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Suspicion for HIV/AIDs or lymphoma
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Parotitis
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Inflammation of the parotid gland due to infection, obstruction, or autoimmune disease
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Anterior cervical adenopathy
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Seen in URI and strep throat
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Posterior cervical and occipital adenopathy
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Seen in mononucleosis
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Inspecting the trachea
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For deviation and masses. Place finger between trachea and sternomastoid muscle, note symmetry. Tracheal deviation may signify important problems in the thorax, such as a mediastinal mass, atelectasis, or a large pneumothorax (away from pneumothorax).
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Inspecting the thyroid
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enlargements (Goiter), symmetry, masses, movement with swallowing. Ask pt to flex neck slightly forward, place fingers of both hands on pts neck so that index fingers are below the cricoid cartilage. Ask pt to swallow, feel thyroid isthmus. Below, feel lobes of thyroid. Note size, shape, consistency and identify nodules or tenderness.
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Enlarged thyroid
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Listen over the lateral lobes with a stethoscope to detect a bruit, a sound similar to a cardiac murmur but of noncardiac origin.
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Goiter
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Soft enlargement, non-tender
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Thyroiditis
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Tender enlargement of gland
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Hashimoto's thyroiditis
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Firm enlargement
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Thyroid masses
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Nodules/cyst – firm, clear margins, non-tender
Malignant – firm, asymmetry of mass, and ill defined margins, non-tender |
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Hyperthyroidism
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Nervousness, weight loss despite increased appetite, excessive sweating and heat intolerance, palpitations, frequent bowel movements, muscular weakness. Warm, smooth, moist skin, with Grave's disease, eye signs such as stare, lid lag, and exophthalmos. Increased systolic and decreased diastolic BP. Tachycardia and atrial fibrillation. Hyperdynamic cardiac pulsations with an accentuated S1.
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Hypothyroidism
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Fatigue, lethargy, modest weight gain with anorexia, dry coarse skin and cold intolerance. Swelling of face, hands and legs. Constipation. Weakness, muscle cramps, arthralgias, paresthesias, impaired memory and hearing. Skin sometimes yellowish from carotene, with nonpitting edema and loss of hair. Periorbital puffiness. Decreased systolic and increased diastolic BP. Bradycardia and hypothermia. Intensity of heart sounds sometimes decreased.
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Jugular venous distention (JVD)
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May be visible in sitting position. Caused by venous engorgement.
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Thyroglossal duct cyst
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fibrous cyst that are due to persistent thyroglossal duct formed during embryonic development of the thyroid gland. Midline mass, non-tender
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Branchial cleft cyst
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an epithelial cyst usually on the lateral side of the neck that is caused by failure of obliteration of the second branchial during embryonic development
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