Chapt 14: Head, Face, Neck, and Regional Lymphatics

Question 1

What is the thyroid gland? What does it do?

Answer 1

Endocrine gland that secretes thyroxine (T4) and triiodothyronine (T3), hormones that stimulate the rate of cellular metabolism.

Question 2

How many lymph nodes are in the head and neck?

Answer 2

60-70

Question 3

What lymph nodes are in the head and neck?

Answer 3

• Preauricular, in front of the ear
• Posterior auricular (mastoid), 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 (tonsillar), under the angle of the mandible
• Superficial cervical, overlying the sternomastoid muscle
• Deep cervical, deep under the sternomastoid muscle
• Posterior cervical, in the posterior triangle along the edge of the trapezius muscle
• Supraclavicular, just above and behind the clavicle, at the sternomastoid muscle

Question 4

Describe what is the lymphatic system?

Answer 4

separate vessel system from the cardiovascular system and a major part of the immune system, whose job it is to detect and eliminate foreign substances from the body.

Question 5

Nodes are located throughout the body but are accessible to examination in what four locations?

Answer 5

head and neck, arms, axillae, and inguinal region.

Question 6

What are fontanels? What is their purpose?

Answer 6

bones of the neonatal skull are separated by sutures with membrane-covered “soft spots” allow for growth of the brain during the 1st year and compression during vaginal birth.

Question 7

Where are tension headaches usually located?

Answer 7

occipital, frontal, or with bandlike tightness.

Question 8

Where are migraines located?

Answer 8

supraorbital, retro-orbital, or frontotemporal

Question 9

Where are sinus headaches located?

Answer 9

around the eye or cheek.

Question 10

What characterizes chronic vs episodic migranes?

Answer 10

• each episode lasting 1 to 3 days.
• chronic occur ≥15 days/month or <15 days/month if episodic

Question 11

What is a concussion?

Answer 11

results after a direct blow to the skull causes the brain to shift rapidly back and forth inside.

Question 12

What is presyncope?

Answer 12

light-headed, swimming sensation or feeling of fainting or falling caused by decreased blood flow to brain or heart irregularity causing decreased cardiac output.

Question 13

What is vertigo? What is objective vs subjective vertigo?

Answer 13

true rotational spinning often from labyrinthine-vestibular disorder in inner ear. With
- objective vertigo the person feels like the room is spinning;
- subjective vertigo the person feels like he or she is spinning.

Question 14

What is disequilibrium?

Answer 14

shakiness or instability when walking related to musculoskeletal disorder or multi-sensory deficits

Question 15

What is Dysphagia?

Answer 15

difficulty swallowing.

Question 16

How do you describe a round symmetric skull that is appropriately related to body size?

Answer 16

Normocephalic

Question 17

What is the characteristic description and location of tension headaches?

Answer 17

• Bandlike tightness, viselike non-throbbing, nonpulsatile.
• Usually both sides, across frontal, temporal, and/or occipital region of head: forehead, sides, and back of head

Question 18

What is the duration of a tension headache?

Answer 18

Gradual onset, lasts 30 minutes to days

Question 19

What is the characteristics and locations of a migraine?

Answer 19

• Throbbing, pulsating
• Commonly one-sided but may occur on both sides
• Pain is often behind the eyes, the temples, or forehead

Question 20

What is the duration of a migraine?

Answer 20

Rapid onset, peaks 1-2 hr, lasts 4-72 hr, sometimes longer

Question 21

What is the characteristics and locations of a cluster headache?

Answer 21

• Continuous, burning, piercing, excruciating
• Always one-sided
• Often behind or around the eye, temple, forehead, cheek
• Can occur multiple times a day, in “clusters,” lasting weeks
• Severe, stabbing pain

Question 22

What is the duration of a cluster headache?

Answer 22

Abrupt onset, peaks in minutes, lasts 45 - 90 min

Question 23

What is Hydrocephalus?

Answer 23

Obstruction of drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure, and enlargement of the head.

Question 24

What is Down’s Syndrome?

Answer 24

This is the most common chromosomal aberration
(trisomy 21). Head and face characteristics may include
upslanting eyes with inner epicanthal folds; flat nasal
bridge; small, broad, flat nose; protruding, thick
tongue; ear dysplasia; short, broad neck with webbing;
and small hands with single palmar crease.

Question 25

What is Plagiocephaly?

Answer 25

asymmetry of the cranium when seen from the top caused by a positional preference. It is not associated with premature closing of cranial sutures, and growth of the brain proceeds normally. This can be mitigated by “tummy time,” when the parent places the infant prone for awake playing.

Question 26

What is Acromegaly?

Answer 26

Excessive secretion of growth hormone from the pituitary gland after puberty creates an enlarged skull and thickened cranial bones. Note the elongated head, massive face, overgrowth of nose and lower jaw, heavy eyebrow ridge, and coarse facial features.

Question 27

What is Cushing Syndrome?

Answer 27

With excessive secretion of adrenocorticotropic hormone (ACTH) and chronic steroid use, the person develops a rounded, “moonlike” face; prominent jowls; red cheeks; hirsutism on the upper lip, lower cheeks, and chin; and acneiform rash on the chest.

Question 28

What is Bell's Palsy?

Answer 28

lower motor neuron lesion (peripheral), producing rapid onset of cranial nerve VII paralysis of facial muscles; almost always unilateral. This may be a reactivation of herpes simplex virus (HSV-1) latent since childhood. Note complete paralysis of one-half of the face; person cannot wrinkle forehead, raise eyebrow, close eyelid, whistle, or show teeth on the left side. Usually presents with smooth forehead, wide palpebral fissure, flat nasolabial fold, drooling, and pain behind the ear. This is greatly improved if corticosteroids and antivirals are given within 72 hours of onset.

Question 29

What is a stroke?

Answer 29

upper motor neuron lesion (central). A stroke is an acute neurologic deficit caused by blood clot of a cerebral vessel, as in atherosclerosis (ischemic stroke), or a rupture in a cerebral vessel (hemorrhagic stroke). If you suspect a stroke, ask if the person can smile. Note paralysis of the lower facial muscles but also note that the upper half of face is not affected because of the intact nerve from the unaffected hemisphere. The person is still able to wrinkle the forehead and close the eyes. (Compare this with Bell palsy.) However, stroke requires emergency 9-1-1 treatment.

Question 30

How do you differentiate between Bell's Palsy and a stroke?

Answer 30

Bell's Palsy: person cannot wrinkle forehead or close eyes Stroke: still able to wrinkle the forehead and close the eyes

Question 31

What is Parkinson Syndrome?

Answer 31

deficiency of the neurotransmitter dopamine and degeneration of the substantia nigra of the basal ganglia in the brain. The immobility of features produces a face that is flat and expressionless, “masklike,” with elevated eyebrows, staring gaze, oily skin, and drooling.

Question 32

What is Cachectic Appearance?

Answer 32

Accompanies chronic wasting diseases such as cancer, dehydration, and starvation. Features include sunken eyes; hollow cheeks; and exhausted, defeated expression.