Head&Neck examination

1) Signs and symptoms with aponyms

Argyll Robertson pupils ( colloquially as"Prostitute's Pupil") are bilateral small pupils that reduce in size when the patient focuses on a near object (they “accommodate”), but do not constrict when exposed to bright light (they do not “react” to light). They are a highly specific sign of neurosyphilis. In general, pupils that “accommodate but do not react” are said to show light-near dissociation.

Kocher's sign is a medical sign that denotes an eyelid phenomenon in hyperthyroidism and Basedow’s disease. In fixation on a fast upwards or downwards movement there occurs a convulsive retraction of the eyelid ( place finger in the distance ca.30 cm from the patients eye, then quickly elevate it: small part of cornea will be visible between iris and upper eyelid-> its because eyelid moves upward faster than the eyeball). Associated with Graefe's sign.

Von Graefe's sign (lid lag sign) is the immobility or lagging of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter (Graves' Disease). Results from disturbance in cooperation between upper eyelid and eyeball when patient is follwoing object mowing downward-> eyeball moves faster, eyelid movement is delayed ( thats why part of cornea can be then visible)

Moebius sign: innability of the the ecternal recti ocular muscles to perform convergence; when moving the object toward a patients eyes ( from the distnace ca.30 cm) suddenly on eye jumps aside ( positive test result) due to the weakness of external recti muscles.

Stellwag's sign: rarely blinking of the eyelids seen in hyperthyroidism and Parkinson's disease.

Dalrymple's sign is a widened palpebral opening, or eyelid spasm, seen in thyrotoxicosis (as seen in Graves' disease, exophthalmic Goitre and other hyperthyroid conditions), causing abnormal wideness of the palpebral fissure. As a result of the retraction of the upper eyelid, the white of the sclera is visible at the upper margin of the cornea in direct outward stare.

Graves' ophthalmopathy (also known as thyroid eye disease, dysthyroid/thyroid-associated orbitopathy , Graves' orbitopathy) is an autoimmune inflammatory disorder affecting the orbit around the eye, characterized by upper eyelid retraction, swelling (edema), redness (erythema), conjunctivitis, and bulging eyes (proptosis)

Popowa sign: associated with Greafe's sign; contracture of upper eyelid. The sign is possitive when eyball is moving downward ( focused on an object) and eyelid movement is delayed with visible jumping pattern. Seen in hyperthyroidism disorders.

Jellinka's sign: abnormal pigemntation of upper eyelid seen in hyperthyroidism disorder.

Hurler syndrome: mucopolysaccharidosis ( facial swelling)

Horner's syndrome: ptosis, miosis, anhydrosis, endophthalmos

Apert syndrome: malformations of the skull, face, hands and feet; 1st branchial arch affected ( mandible and maxilla hypoplasia)

Treacher-Collin's syndrome: craniofacial deformities ( absent zygomatic bones), auricular deformity, micrognathia ( small mandible), droping eyelids.

Crouzon syndrome: 1st branchial arch affected-> severe maxillary and midfacial hypoplasia with low-set ears.

2) Facies:

Cushing syndrome: facies include a rounded or moon-shaped face with thin, erythematous skin. Hirsutism may also be presnt

Hyperthyroid face: moist skin, prominent eyes, exopthalmos, eyelid retraction

Hippocratic facies: associated with cachexia ( wasting sydrome), sunken appearance of the eyes, cheeks and temporal areas, sharp nose, dry, rough skin ( seen in terminal stages of ilness)

Myxedema facies: associated with severe hypothyroidims; dull, puffy, yellowed skin, temporal lose of eyebrows, periorbital edema, prominent tongue; mucopolysaccharides deposition in dermis ( swelling of affected area)

Systemic lupus erythematosus facies: due to autoimmune disease; buuterlfy-shaped rash over malar surface and bridge of nose

Craniofacial dystosis: mandibular prognatism, dropping lower lip, short upper lip, proptopic eyes; due to inborn fisrt branchial arch syndrome ( Ist arch- precursor of mandible and maxilla)