tailieunhanh - Ebook Hamilton bailey's physical signs (19th edition): Part 2

(BQ) Part 2 book "Hamilton bailey's physical signs" presentation of content: The face and jaws, the head, nose and throat, salivary glands, the thyroid and parathyroids, breast and axilla, evaluation of the cardiac surgical patient, abdominal hernias, non acute abdominal conditions, the acute abdomen,.and other contents. | PART 4 Head and neck 19 The head 20 The face and jaws 21 The ear 22 The orbit 23 The mouth 24 Nose and throat 25 Salivary glands 26 The neck 317 21/11/15 12:28 am This page intentionally left blank CHAPTER 19 The Head Murad Lala and Basant K. Misra LEARNING OBJECTIVES THE SCALP Lesions of the scalp are often not apparent due to the presence of hair, so parting the hair will enable a closer inspection. Look for any congenital malformations, characteristic facies, prominences, lumps, nodules, scars, rashes, areas of seborrhoeic dermatitis, naevi, hair loss or other lesions. Look for facial asymmetry, involuntary movements and the presence, absence and symmetry of oedema and wrinkling. Palpate the scalp to identify any tenderness or deformity. Scalp lesions superficial to the galea aponeurotica can be moved, and move with the skin when the patient voluntarily contracts the frontalis or occipitalis muscle. Any lesion deep to the galea aponeurotica or invading it and the adjacent pericranium will remain fixed with no movement. Capillary malformations appear as a red-purple skin discoloration. Venous malformations appear as swellings that can be emptied, as can other fluid-containing communicating swellings such as meningoceles. A sinus pericranii (a haemorrhagic cyst of the intracranial dural venous sinus) also shows this sign. It appears as a soft swelling in the midline, usually on the occiput, contains blood instead of cerebrospinal fluid (CSF) and communicates with a venous sinus through a defect in the skull. A sebaceous cyst (Figure ) is the most common swelling of the scalp. It is a retention cyst of a hair follicle, is often multiple (Figure ), is round and is attached to the overlying skin. The contents are cheesy in nature, non-fluctuant and firm on palpation. A punctum is usually visible in the centre of the cyst. 319 • To elucidate and understand the pathophysiology of the lesion involved • To construct