Head and neck

1. mass in neck, neck pain, bleeding from mouth, bad greath, sinus congestion, sore tong, sores in mouth that don't heal, white/red/dark patches in mouth that will not go away, earache, unusual bleeding or numbness in mouth, lump in lip/mouth/gums, enlarged lymph glands in neck, slurring of speech, hoarse voice 6+w, sore throat 6+w, difficulty swallowing food, change in diet or weight loss
2. enlarged LN, sore throat, hoarse voice, lump or sore in throat/neck that doesn't go away, dysphagia, dysarthria, peristent earache, numb/paral of facial muscs

1. alcohol + tobacco, diet (processed + red meat), betel nut
2. infection: HPV, EBV
3. GORD
4. Hematoopoietic stem cell transplantation

1. needle biopsy -> histopathology

1. surgery
2. radiation therapy

1. exam
   1. red reflex- if immature, still occurs, if dense cataract, no red reflex
2. presentation
   1. blurred vision
      1. if unilateral, often unnoticed (but loss of steropsis affects distance judgement)
      2. bilateral cuase gradual loss of vision (freq glasses changes) +/- dazzle, +/- monocular diplopia
3. treatment
   1. surgery: if troubling, lifestyle restricted, or unable to read while driving

      Nota:

      • complics: capsule thickening i%, easily treated by capsulotomy   astigmatism, eye irritiaon, anterior uveitis
      1. ideally day case, local anesthetic, small incision surg + phacoemulision + intraocular lens implant

1. dull, constant, aching pain over frontal or maxillary sinus, with tender overlying skin +/- postnasal drip. pain worse on bending over.
2. ethmoid or sphenoid sinus pain: deep in midline at root of nose. common w/coryza.
3. pain lasts 1-2w

1. CT can confirm diagnosis but is rarely needed
2. investig not recommend unless complications or chronic 12+ w

1. viral or bact infect, or allergy or autoimmune
   1. upper rest tract infect, usually virus, is most common cause of acute (incl rhinoviruses, coronaviruses, influenzaviruises)
   2. <10 days usually viral; >10 days oft bacterial
2. inflamm of lining of sinuses

1. abxcesses, meningitis, preseptal or orbital cellulitis -> abscess

1. gernally conservative: warm moist cloth, sufficient fluids, inhaling steam
2. if bacterial- antibiotics (amoxicillin) if don't resolve w/in 10 days. if don't resolve after 1 seven day course- co amoxiclav
3. surgery: if chronic or recurrening

Nota:

• is a symptom complex rather than a single condit.  is multifactorial

1. symps/signs
   1. dull/ache, poorly localised, usually intermitent pain on palp of musc or joint, restricted mandib move, noises from TMJ during jaw movement
      1. usually aggravated by manip or funct eg chewing, yawning. often worse on waking
      2. more oft unilat than bilat
   2. often benign and self limiting
2. treat
   1. splint, Cog behave therapy, analgesia
3. perhaps due to anterior disc displacement of articular disc
4. precipating factors

   Nota:

   • trauma, occlusal changes, parafunction, stress, (genetic hormonal and anatomical factors also predispose) psychosocial disorders big risk factors
5. exam: palpate of joint and musc of mastic, auscult over j?
6. epidemiology
   1. very common. more F than M. 20-30% of adult pop?. Btw 20-40y
   2. 2nd most common cause orofacial pain (behind toothache)

1. complications: may cause difficulty breathing, sepsis
2. causes
   1. Infection
      1. strep throat, measles, ear infections, dental abscess, mono/glandular fever EBV, cellulitis or other skin/wound infects, HIV
   2. Autoimmune
      1. lupus
      2. RA
   3. Malignancies
      1. lymphoma
      2. leukemia
      3. 2ndry mets
   4. drugs
      1. phenytoin (anti-seizure med), malaria prophylaxis
3. symps: depend on cause
4. signs
   1. size
      1. insignif if <2cm (in axilla and inguinal <3cm, in supraclavic fossa >1cm is signif)
   2. consistency
      1. soft
         1. insignif
      2. rubbery
         1. classically lymphoma
      3. hard
         1. classically malignancy + granulomatous infection
   3. tender
      1. classically infection
      2. non-tender: classically malignancy

1. see endocrine

Nota:

• parotid, submandibular, sublingual

1. causes
   1. acute lymphoblastic leukemia
   2. mumps
   3. HIV
   4. myxoedema
   5. bulimia
2. hx: lumps; swelling related to food; pain; taste; dry eyes
3. exam: note sexternal swelling; look for secretions; bimanual palp for stones. examine CN VII and regional lyph nodes
4. test
   1. cytology
      1. Fine needle aspiration
5. symps/signs
   1. acute swelling
      1. mumps
      2. HIV
   2. recurrent unilat pain and swelling (partic on eating)
      1. stone
         1. 80% submandibular
         2. +see red, tender, swollen, but uninfected gland
         3. investig: plain xray or sialography
         4. can remove by mouth or excision of gland
   3. chronic bilat symps
      1. + dry eyes and mouth and autoimmune disase
         1. (eg hypothyroidism, mikulicz's or sjogren's, also bulimia)
   4. fixed swelling
      1. tumor, acute lymphoblastic leukemia, sarcoid, amyloid, wegener's syndrome, idopathic
         1. 80% are parotid tumors
            1. deflection of ear outwards is classic sign
            2. remove any salivary gland swelling for assess if present for >1mo
            3. VII nerve palsy means malignancy