🩺 Gizmo-Style Study Guide

Slides 1–2: Structure and Function – Head

The skull is a rigid box that protects the brain and contains the bones of the cranium and face. It is supported by the cervical vertebrae.

Cranial Bones:

• Frontal
• Parietal
• Occipital
• Temporal

These bones are joined by sutures, where adjacent cranial bones interlock:

• Coronal suture → separates frontal from parietal bones.
• Sagittal suture → separates the two parietal bones.
• Lambdoid suture → separates parietal bones from occipital bone.

The face has 14 bones that articulate at sutures. Facial expressions are controlled by muscles innervated by cranial nerve VII (facial nerve).

Salivary glands accessible for exam:

• Parotid glands → located in cheeks, over the mandible, anterior and below ear; largest salivary gland; normally not palpable.
• Submandibular glands → beneath the mandible at the angle of the jaw.
• Sublingual glands → in the floor of the mouth.

Temporal artery: Located superior to the temporalis muscle; pulsation palpable anterior to the ear.

👉 Key Points

• Skull: cranial + facial bones, supported by cervical vertebrae.
• Cranial sutures: coronal, sagittal, lambdoid.
• 14 facial bones articulate at sutures.
• CN VII controls facial muscles for expression.
• 3 pairs of salivary glands; parotid is largest.
• Temporal artery pulsation palpable anterior to ear.

📝 Detail Information

• Infant skulls: Sutures and fontanels remain open to allow brain growth; closure occurs gradually.
• Salivary glands: Parotid enlargement may indicate mumps, obstruction, or neoplasm. Submandibular swelling may suggest infection or salivary duct stones.
• Temporal artery: Palpation is key in diagnosing temporal arteritis (giant cell arteritis), which can cause irreversible vision loss if untreated.
• Nursing exam relevance: Always compare both sides of the face for symmetry, palpate salivary glands for tenderness or enlargement, and check cranial nerve VII by asking patient to smile, frown, or puff cheeks.

Slides 3–4: Structure and Function – Neck

The neck functions as a conduit for structures that connect the head to the rest of the body. It contains blood vessels, muscles, nerves, lymphatics, and part of the respiratory and digestive systems.

Landmarks and Boundaries

• Extends from the base of the skull and mandible down to the manubrium of the sternum.
• Major vessels and structures pass through here, making it a critical site in physical assessment.

Carotid Arteries

• Internal carotid artery: supplies blood to the brain.
• External carotid artery: supplies blood to the face, salivary glands, and superficial tissues.

Muscles of the Neck (innervated by Cranial Nerve XI – Spinal Accessory Nerve):

• Sternomastoid → rotates and flexes the head; divides each side of the neck into two regions:
• Anterior triangle (in front).
• Posterior triangle (behind).
• Trapezius → moves the shoulders and extends/turns the head.

👉 Key Points

• Neck = vital passage for vessels, lymphatics, and airway.
• Landmarks: base of skull → sternum.
• Internal carotid → brain; external carotid → face/glands.
• Sternomastoid divides neck into anterior and posterior triangles.
• CN XI innervates sternomastoid and trapezius.

📝 Detail Information

• Anterior triangle: Contains the carotid artery, internal jugular vein, thyroid gland, larynx, and trachea → essential landmarks for assessment and clinical procedures.
• Posterior triangle: Contains the external jugular vein, part of the subclavian artery, and lymph nodes. Also, the spinal accessory nerve crosses here and is vulnerable during lymph node biopsies.
• Nursing note: Assessment of the carotid pulse is performed one side at a time to avoid stimulating the carotid sinus, which can cause bradycardia.

Slide 5: Thyroid Gland

The thyroid gland is an endocrine gland that straddles the trachea in the middle of the neck.

• Composed of two lobes connected by a thin isthmus.
• Produces T3 (triiodothyronine) and T4 (thyroxine), which regulate cellular metabolism.
• Landmarks: cricoid cartilage (upper), thyroid cartilage (Adam’s apple), and tracheal rings.

👉 Key Points

• Thyroid gland = endocrine organ regulating metabolism.
• Two lobes + isthmus, located in midline of neck.
• Hormones: T3 and T4.
• Landmarks: thyroid cartilage, cricoid cartilage, trachea.

📝 Detail Information

• The thyroid is highly vascular and receives blood supply from the superior and inferior thyroid arteries.
• Enlargement (goiter) may indicate iodine deficiency, hyperthyroidism (Graves’ disease), or hypothyroidism (Hashimoto’s).
• Nodules are clinically significant: solitary nodules may suggest malignancy, while multiple nodules are usually benign.
• Nursing exam: Palpate thyroid during swallowing; auscultate if enlarged for bruit (indicates hyperthyroidism).

Slide 6: Lymphatic System – Function and Distribution

The lymphatic system is a major part of the immune system, helping to detect and eliminate foreign substances.

• Lymph nodes filter lymph fluid before it returns to the bloodstream.
• The head and neck have the greatest supply of lymph nodes in the body.

Key Head and Neck Lymph Node Groups:

Node Group	Location
Preauricular	In front of the ear
Posterior auricular	Superficial to the mastoid process
Occipital	At the base of the skull
Submental	Midline, behind the tip of the mandible
Submandibular	Halfway between the angle and the tip of the mandible
Jugulodigastric	Under the angle of the mandible
Superficial cervical	Overlying the sternomastoid muscle
Deep cervical	Deep under the sternomastoid muscle
Posterior cervical	Along the edge of the trapezius muscle
Supraclavicular	Above and behind the clavicle, at the sternomastoid muscle

👉 Key Points

• Lymphatic system = defense + drainage.
• Head and neck → densest node supply.
• 10 major groups of nodes; systematic palpation required.
• Supraclavicular nodes are especially significant.

📝 Detail Information

• Normal lymph nodes: small (<1 cm), mobile, soft, and non-tender.
• Abnormal findings: hard, fixed, or enlarged nodes suggest malignancy; tender nodes usually indicate infection.
• Virchow’s node (left supraclavicular): sentinel node for thoracic/abdominal malignancy.
• Nursing exam: Palpate nodes in a systematic order to avoid missing small or deep ones.

Slides 7–8: Developmental Considerations

Infants and Children

• At birth, the head is larger than the chest circumference.
• Cranial bones are soft and separated by sutures and fontanels:
• Posterior fontanel closes at 1–2 months.
• Anterior fontanel closes between 9 months and 2 years.
• Head growth is rapid in infancy; reaches 90% of final size by age 6.
• Lymphoid tissue grows rapidly; reaches adult size by age 6 and continues to grow until puberty, when it begins to shrink.

Adolescents

• Facial hair develops in boys (first on upper lip, then cheeks/chin).
• Enlarged thyroid cartilage appears in males (Adam’s apple).
• Deepening of the voice occurs with laryngeal growth.

Pregnant Female

• The thyroid gland enlarges slightly due to hyperplasia of tissue and increased vascularity.

Aging Adult

• Facial bones and orbits appear more prominent as subcutaneous fat decreases.
• Skin sags due to decreased elasticity and reduced moisture.
• If teeth are lost, the lower face may appear smaller.

👉 Key Points

• Posterior fontanel closes at 1–2 months; anterior at 9–24 months.
• Head 90% adult size by age 6.
• Lymph tissue: adult size by 6, peaks before puberty.
• Adolescence: facial hair, thyroid cartilage, deeper voice.
• Pregnancy: thyroid enlarges.
• Aging: prominent bones, sagging skin, possible lower face shrinkage.

📝 Detail Information

• Infant assessment: Palpate fontanels; sunken indicates dehydration, bulging suggests increased intracranial pressure.
• Children: Persistent enlarged lymph nodes may indicate chronic infection.
• Adolescents: Rapid endocrine changes can cause temporary asymmetry in facial growth.
• Pregnancy: Goiter can become more evident due to increased demand on thyroid.
• Older adults: Loss of fat pads and elasticity contribute to “sunken eyes” and wrinkling, important for assessing malnutrition or cachexia.

Slides 11–12: Headache – Epidemiology and Classification

Headaches are the leading cause of acute pain and lost productivity worldwide. They are frequently misdiagnosed because they have multiple possible causes.

Classification

• Headaches are classified by etiology (origin/cause).
• Various theories exist regarding their development, including vascular, muscular, neurological, and biochemical mechanisms.

Chronic Migraine

• Defined as headache occurring on more than 15 days per month.
• Often associated with impaired quality of life and high healthcare use.

Gender Differences

• Headaches, especially migraines, are more common in females than in males.
• Peak prevalence occurs in midlife, where rates become more equal between sexes.

Ethnic Differences

• Headaches, particularly migraines, are more prevalent among Caucasian and Hispanic populations compared to other groups.

Culture and Genetics

• Cultural perceptions affect headache reporting and management.
• Genetic predispositions also influence headache frequency and severity.

👉 Key Points

• Headaches = leading cause of acute pain and lost productivity.
• Classified by etiology; often misdiagnosed.
• Chronic migraine = >15 days/month.
• More common in women; equalizes at midlife.
• Higher prevalence in Caucasian and Hispanic groups.

📝 Detail Information

• Types of headaches:
• Tension: band-like pressure, often from stress/muscle tension.
• Migraine: unilateral, throbbing, with photophobia, nausea/vomiting.
• Cluster: severe, unilateral, orbital pain, more common in men.
• Red flag symptoms: sudden onset, “worst headache of my life,” neurological deficits, fever, or onset after age 50 → require urgent evaluation.
• Nursing considerations: Assess triggers (food, stress, hormones, sleep changes), use pain scales, and evaluate impact on daily life.
• Genetics: Migraine shows strong familial trends, often autosomal dominant inheritance.
• Culture: In some populations, headaches are underreported due to stigma, while in others they are more openly discussed, affecting prevalence data.

Slides 9–10: Health History Questions

When assessing the head, face, neck, and lymphatics, the nurse should ask targeted questions to gather relevant history.

For aging adults—patient-centered care- Ask about Dizziness and/or neck pain and How does it affect your daily activities?

Head or Neck Surgery

• Ever had surgery on head, face, neck, or thyroid?

👉 Key Points

• Key questions: headache, head injury, dizziness, neck pain, lumps/swelling, surgeries.
• Differentiate dizziness (lightheadedness) vs vertigo (room spinning).
• Always ask about thyroid history and symptoms.

📝 Detail Information

• Headache assessment: Distinguish types (tension, migraine, cluster). Red flags include sudden severe headache (“worst headache of my life”) → possible subarachnoid hemorrhage.
• Head injury: Loss of consciousness requires evaluation for concussion or intracranial bleeding.
• Neck pain: Stiff neck with fever may indicate meningitis.
• Lumps: Painful, tender lumps suggest infection; hard, immobile lumps suggest malignancy.
• Thyroid: Symptoms of hypo/hyperthyroidism should be screened (fatigue, weight change, heat/cold intolerance).

Physical Examination

Slide 13: Physical Examination – Head

During the physical exam, the nurse inspects and palpates the head to assess for normal size, shape, and condition.

Inspection: Size and Shape

• The head should be normocephalic, meaning round, symmetric, and appropriately related to body size.
• Assess for abnormal head sizes:
• Microcephaly → abnormally small head.
• Macrocephaly → abnormally large head, may indicate hydrocephalus or other pathology.

Palpation: Skull

• Palpate the skull to ensure it is smooth, symmetric, and free of tenderness.
• There should be no depressions, lumps, or abnormal protrusions.
• Normal protrusions: frontal, parietal, occipital, and mastoid bones.

Palpation: Temporal Area

• Palpate the temporal artery above the zygomatic bone between the eye and the top of the ear.
• Palpate the temporomandibular joint (TMJ) as the person opens and closes the mouth.
• The joint should move smoothly without limitation or tenderness.

👉 Key Points

• Head exam = inspect & palpate.
• Normal = normocephalic, symmetric, smooth skull.
• Abnormal: microcephaly (small), macrocephaly (large).
• Palpate temporal artery and TMJ for smooth movement.

📝 Detail Information

• Clinical red flags: Macrocephaly may indicate hydrocephalus, intracranial bleeding, or genetic disorders (e.g., acromegaly). Microcephaly can be congenital or caused by infections (e.g., Zika virus).
• Temporal artery: Should feel elastic and non-tender. A hard or tortuous artery suggests temporal arteritis, which can cause blindness if untreated.
• TMJ disorders: Clicking, limited movement, or tenderness may indicate TMJ syndrome, often associated with teeth grinding, arthritis, or dislocation.
• Nursing note: Always inspect for symmetry and alignment. Palpation should be gentle to avoid discomfort, especially in patients with trauma history.

Slide 14: Physical Examination – Face

The nurse inspects the face for symmetry, expression, and involuntary movements.

Inspection: Facial Expression

• The patient’s facial expression should be appropriate to the situation.
• Expressions should match mood and reported feelings.
• Abnormalities may indicate neurologic or psychiatric disorders.

Inspection: Symmetry

• Both sides of the face should look symmetric.
• Check for symmetry of eyebrows, palpebral fissures, nasolabial folds, and sides of the mouth.
• Asymmetry may suggest stroke, Bell’s palsy, or other nerve involvement.

Inspection: Involuntary Movements

• Observe for tics, fasciculations, or excessive blinking.
• Note any abnormal, involuntary facial movements.

Inspection: Skin

• Inspect for edema (periorbital or facial).
• Look for abnormal color changes, lesions, or masses.

👉 Key Points

• Normal: facial symmetry, appropriate expression, no involuntary movements.
• Abnormal: asymmetry (stroke, Bell’s palsy), tics, edema, skin lesions.
• Observe symmetry of eyebrows, eyes, folds, and mouth.

📝 Detail Information

• Facial nerve (CN VII) controls most expressions. Stroke typically produces lower facial asymmetry (drooping of mouth, but upper face may still move). Bell’s palsy causes complete unilateral facial paralysis (upper and lower face).
• Tics and tremors may be seen in Parkinson’s disease or Tourette syndrome.
• Edema can be nephrotic syndrome, myxedema (hypothyroidism), or allergic reaction.
• Nursing note: Ask the patient to smile, frown, close eyes tightly, raise eyebrows, and puff cheeks to test CN VII function.

Slide 15: Physical Examination – Neck

The neck exam involves inspection and palpation to assess symmetry, range of motion, and the presence of lymph nodes or thyroid abnormalities.

Inspection: Symmetry

• The head should be held midline and erect.
• Both sides of the neck should appear symmetrical.

Inspection: Range of Motion (ROM)

• Ask the patient to move the head:
• Side to side (rotation).
• Up and down (flexion/extension).
• Tilt to each shoulder (lateral flexion).
• Movement should be smooth and controlled.
• Note any limitation of motion, pain, or involuntary movements.

Inspection: Pulsations

• Observe for abnormal pulsations, particularly in the carotid arteries or jugular veins.

Palpation: Lymph Nodes

• Palpate systematically using a gentle circular motion with fingertips.
• Examine all 10 groups of lymph nodes in order (preauricular → supraclavicular).
• Normal nodes are non-palpable or feel small, soft, mobile, and non-tender.
• Document size, shape, mobility, and tenderness if abnormal.

Palpation: Trachea

• Inspect and palpate tracheal position.
• It should be midline.
• Deviation may signal mass, atelectasis, or pneumothorax.

Palpation: Thyroid Gland

• Inspect neck while patient swallows; thyroid moves with swallowing.
• Palpate thyroid from behind or in front.
• Normally not enlarged; if enlarged, auscultate for bruits.

👉 Key Points

• Neck should be symmetric, head midline.
• ROM: rotation, flexion/extension, lateral flexion; smooth movement.
• Palpate lymph nodes systematically; normal = small, soft, mobile, non-tender.
• Trachea midline; deviation is abnormal.
• Thyroid moves with swallowing, normally not enlarged.

📝 Detail Information

• Neck stiffness with fever may suggest meningitis.
• Enlarged, fixed, hard lymph nodes suggest malignancy; tender, mobile nodes suggest infection.
• Thyroid:
• Diffuse enlargement = goiter.
• Nodular enlargement may indicate tumor, multinodular goiter, or cyst.
• Hyperthyroidism may cause bruit (increased vascularity).
• Nursing note: Always assess for carotid bruits in older adults; never palpate both carotids simultaneously to avoid compromised cerebral blood flow.

Slides 16–18: Physical Examination – Lymph Nodes

The lymph nodes of the head and neck should be assessed carefully because they provide early clues to infection or malignancy.

Palpation Technique

• Use the pads of your fingertips in a gentle, circular motion.
• Palpate systematically, covering all 10 groups of lymph nodes in sequence:
1. Preauricular – in front of the ear.
2. Posterior auricular – behind the ear, over mastoid.
3. Occipital – base of the skull.
4. Submental – midline, behind the tip of the mandible.
5. Submandibular – halfway between angle and tip of mandible.
6. Jugulodigastric – under angle of mandible.
7. Superficial cervical – over sternomastoid.
8. Deep cervical – deep under sternomastoid (tip patient’s head slightly toward side being examined).
9. Posterior cervical – along trapezius edge.
10. Supraclavicular – above and behind clavicle.

Normal Findings

• Nodes may not be palpable.
• If palpable, they should feel small (<1 cm), soft, mobile, and non-tender.

Abnormal Findings

• Enlarged, tender nodes → acute infection.
• Firm, rubbery nodes → lymphoma.
• Hard, fixed nodes → malignancy.
• Enlarged supraclavicular node (Virchow’s node) → may indicate thoracic or abdominal cancer.

👉 Key Points

• Palpate lymph nodes systematically, using circular motion.
• Normal = non-palpable or small, soft, mobile, non-tender.
• Infection = tender, enlarged.
• Malignancy = hard, fixed, irregular.
• Virchow’s node (left supraclavicular) = possible abdominal malignancy.

📝 Detail Information

• Nursing exam tip: Always compare nodes bilaterally for size and consistency. Document exact location, size, mobility, tenderness, and whether unilateral or bilateral.
• Generalized lymphadenopathy (enlargement of multiple node groups) may indicate systemic infection (HIV, mononucleosis, leukemia).
• Localized lymphadenopathy usually reflects drainage from a specific site of infection or tumor.
• Supraclavicular nodes are the most significant “sentinel” nodes and should never be ignored if enlarged.

Pregnant Female Examination – Thyroid and Neck Changes

During pregnancy, several physiological changes occur in the head, neck, and thyroid region due to hormonal influence.

Chloasma may show on face. → A blotchy, hyperpigmented area over cheeks and forehead that fades after delivery

Thyroid Changes

• The thyroid gland enlarges slightly during pregnancy.
• This change is usually symmetric and not associated with nodules.
• The thyroid gland may become more prominent on inspection and easier to palpate.
• Bruits are not normally heard in pregnancy; their presence may suggest thyroid disease (e.g., hyperthyroidism).

Clinical Relevance

• Most thyroid changes in pregnancy are benign and physiological.
• Uncontrolled thyroid disease in pregnancy can affect both mother and fetus (e.g., increased risk of miscarriage, preeclampsia, low birth weight, developmental issues).

👉 Key Points

• Pregnancy → mild thyroid enlargement from hyperplasia + vascularity.
• Normal: symmetric, smooth, no nodules.
• Assess carefully for thyroid disease; abnormal findings may complicate pregnancy.

📝 Detail Information

• Nursing considerations: During prenatal visits, palpate the thyroid gently. If abnormal enlargement or nodules are found, follow-up testing (TSH, free T4) may be indicated.
• Goiter in pregnancy is rare in areas with sufficient iodine intake but still occurs in regions with iodine deficiency.
• Hyperthyroidism in pregnancy can lead to maternal complications (thyroid storm, heart failure) and fetal risks (prematurity, growth restriction).
• Hypothyroidism can cause infertility, miscarriage, or impaired fetal brain development if untreated.
• Nurses should also note that pregnant women may experience physiologic vascular engorgement in the neck region, making vessels more prominent on exam.

Physical Examination – Aging Adult

Temporal Arteries

• The temporal arteries may appear twisted and prominent in older adults.
• This can be a benign age-related change but should be differentiated from temporal arteritis, which presents with tenderness, hardness, or decreased pulsation.

Head Tremor

• A mild rhythmic head tremor may be normal in aging adults.
• This is often associated with senile tremor and does not necessarily indicate neurological disease.

Neck Examination

• The neck may show an increased concave curve (cervical lordosis) as part of normal aging.
• Range of motion (ROM) may be limited by arthritis, degenerative cervical spine changes, or muscle stiffness.

Patient Safety Consideration

• During examination, patients should be instructed to perform ROM and positional changes slowly.
• This minimizes the risk of dizziness, imbalance, or falls, which older adults are more prone to.

👉 Key Points

• Temporal arteries: may look twisted/prominent; assess for tenderness.
• Mild rhythmic head tremor may be a normal finding.
• Neck: increased concave cervical curve, limited ROM common.
• Patient safety: instruct to perform movements slowly to prevent dizziness.

📝 Detail Information

• Safety in older adults: Dizziness can be caused by postural hypotension, inner ear changes, or decreased proprioception. Nurses should anticipate these risks during exam.
• Cervical spine: Osteoarthritis may reduce ROM and cause pain with movement. Document any limitations and encourage safe techniques for daily activities.
• Clinical red flags: If tremors are asymmetric, progressive, or associated with rigidity, further neurological evaluation is warranted.
• Nursing note: Always support patient safety during exam by being ready to assist with balance, especially in frail or dizzy patients.

Abnormal Findings – Primary Headaches

Primary headaches are those that occur independently and not due to another medical disorder. The three main types are tension, migraine, and cluster headaches.

Tension Headaches

• Most common type.
• Band-like, tight pain; usually bilateral.
• Gradual onset; lasts 30 min–days.

Migraines

• Unilateral, throbbing pain; may have aura.
• Associated with nausea, vomiting, photophobia, phonophobia.
• Lasts 4–72 hours; more common in women.

Cluster Headaches

• Severe, stabbing pain around eye or temple.
• Associated with tearing, nasal congestion, ptosis.
• Occur in clusters over weeks; more common in men.

👉 Key Points

• Primary headaches: tension, migraine, cluster.
• Tension → bilateral, band-like.
• Migraine → unilateral, throbbing, ± aura.
• Cluster → unilateral, severe, orbital/temporal, autonomic signs.

📝 Detail Information

• Red flags: sudden severe onset, new after age 50, with fever or neuro changes → urgent evaluation.
• Tension: stress-related; responds to NSAIDs, rest, relaxation.
• Migraine: strong genetic link; triggers = hormones, certain foods, sleep changes, stress. Managed with triptans or preventive therapy.
• Cluster: excruciating but rare; treated with high-flow oxygen or triptans.
• Nursing focus: take a detailed headache history, encourage headache diary, identify triggers, and educate on lifestyle modifications.

Abnormal Findings: Thyroid Disorders & Facial Abnormalities

Graves’ Disease (Hyperthyroidism)

• Autoimmune condition leading to increased thyroid hormone production.
• Physical presentation: goiter, eyelid retraction, and exophthalmos (bulging eyes).
• Systemic features include weight loss, tachycardia, heat intolerance, and nervousness.

Hypothyroidism (Myxedema)

• Caused by decreased thyroid hormone production.
• Physical appearance: puffy, edematous face, periorbital swelling, coarse facial features, coarse hair, and thickened eyebrows.
• Systemic symptoms: fatigue, cold intolerance, bradycardia, weight gain.

Acromegaly

• Results from excessive growth hormone (usually pituitary adenoma).
• Facial features: elongated head, massive face, overgrowth of nose and jaw, heavy brow ridge, coarse features.

Cushing’s Syndrome

• Caused by prolonged exposure to corticosteroids or adrenal hypersecretion.
• Facial features: “moon face” with red cheeks, hirsutism, and sometimes acne.

Bell’s Palsy (Peripheral Facial Paralysis)

• Lower motor neuron lesion of cranial nerve VII (facial nerve).
• Causes unilateral paralysis of facial muscles.
• On affected side: flattened nasolabial fold, inability to close eye, drooping mouth.
• Often temporary, but may require corticosteroid treatment.

Stroke (Cerebrovascular Accident, CVA)

• Upper motor neuron lesion leading to paralysis of lower facial muscles on the contralateral side.
• Unlike Bell’s palsy, the upper face is usually spared (patient can still wrinkle forehead and close eyes).
• Often accompanied by other neurological deficits.

Parkinson’s Syndrome

• Caused by deficiency of dopamine in the basal ganglia.
• Characterized by a “masklike” face: decreased facial mobility, elevated eyebrows, staring gaze, oily skin, and drooling.

Cachectic Appearance

• Seen in chronic wasting illnesses such as cancer, dehydration, or starvation.
• Facial features: sunken eyes, hollow cheeks, exhausted or defeated expression.

👉 Key Points

• Graves’ disease: goiter + exophthalmos.
• Hypothyroidism: puffy face, periorbital edema, coarse hair/skin.
• Acromegaly: enlarged jaw, brow, coarse features.
• Cushing’s: “moon face,” red cheeks, hirsutism.
• Bell’s palsy: unilateral paralysis of upper & lower face.
• Stroke: paralysis of lower face only; forehead movement intact.
• Parkinson’s: masklike face, drooling, staring.
• Cachexia: sunken eyes, hollow cheeks.

📝 Detail Information

• Thyroid disease: Graves’ disease also presents with pretibial myxedema; untreated hypothyroidism can progress to myxedema coma (life-threatening emergency).
• Acromegaly: Along with facial changes, patients often have enlarged hands, feet, and organomegaly; untreated cases can cause heart failure.
• Cushing’s: Look for truncal obesity, purple striae, and easy bruising. Nursing assessments must monitor for infection risk and glucose intolerance.
• Facial nerve lesions:
• Bell’s palsy is peripheral → affects whole face.
• Stroke is central → forehead spared due to bilateral cortical innervation.
• Parkinson’s: Rigidity and bradykinesia contribute to reduced facial expression (hypomimia).
• Cachexia: Red flag for underlying chronic disease; careful nutrition and hydration assessment are critical in nursing care.

⚡ That covers all abnormal findings from Swellings of Head and Neck → Facial Abnormalities associated with systemic disease.

👉 Do you want me to now finish the set with the Summary Checklist slide that comes at the very end of this block in your deck?