Chapter 13: Skin, Neck and Face (including regional lymphatics) Flashcards
Cranial Bones
Frontal, Parietal, Occipital, Temporal
2 pairs of salivary glands are accessible to examination on the face
Parotid glands are in cheeks over mandible, anterior to and below ear; the largest of salivary glands, they are not normally palpable
Submandibular glands beneath mandible at angle of jaw
Structures of the head
Cranial bones Sutures Facial bones Facial muscles Salivary glands
Internal carotid branches off wearing and supplies what?
Branches off common carotid and runs inward and upward to supply the brain
External carotid supplies what?
face, salivary glands, and superficial temporal area
Cranial Nerve XI
Innervates major neck muscles sternomastoid and trapezius
Sternomastoid
enables head rotation and flexion and divides each side of neck into two triangles: anterior and posterior triangles
Thyroid gland
Synthesizes and secretes thyroxine (T4) and triiodothyronine (T3), which are hormones that stimulate rate of cellular metabolism
Thyroid gland location
an important endocrine gland straddles trachea in middle of the neck
The gland has two lobes, connected in middle by a thin isthmus and above that by the cricoid cartilage or upper tracheal ring
What are you looking for when you are looking at the thyroid, trachea, carotid arteries and lymph nodes
Thyroid gland: looking for right size, no tenderness
Trachea: central
Carotid arteries: palpable, even pulse, strength of pulse
Lymph nodes: no swollen, not palpable (sometimes there is one in children)
Lymphatic system function
extensive vessel system, is major part of immune system, which detects and eliminates foreign substances from body
Where is the greatest supply of the lymph nodes?
Head and Neck and Breasts
Nodes are small, oval clusters of lymphatic tissue that filter lymph and engulf pathogens, preventing potentially harmful substances from entering the circulation
Locations and names of lymph nodes
- Preauricular, in front of ear
- Posterior auricular (mastoid), superficial to mastoid process
- Occipital, at base of skull
- Submental, midline, behind tip of mandible
- Submandibular, halfway between angle and tip of mandible
- Jugulodigastric, under angle of mandible
- Superficial cervical, overlying sternomastoid muscle
- Deep cervical, deep under sternomastoid muscle
- Posterior cervical, in posterior triangle along edge of trapezius muscle
- Supraclavicular, just above and behind clavicle, at sternomastoid muscle
Where do lymph nodes drain to?
Cervical chain
Cephalohematoma
is when there’s bleeding in the brain on one side (it doesn’t pass the suture lines) that leads to a collection of blood shaping the head, but the breakdown of blood vessels can lead to jaundice.
Caput Succadaneum
general fluid buildup, usually more dispersed
When do babies have control of their head?
at 3 - 4 months
Is head or chest larger for newborn at birth
Head is bigger
Pregnant woman consideration with thyroid
Thyroid gland is slightly enlarged during pregnancy as a result of hyperplasia of the tissue
Aging adult consideration with skin and face
Facial bones and orbits appear more prominent
Facial skin sags as a result of decreased elasticity, decreased subcutaneous fat and decreased moisture in the skin
Palpebral Fissures
opening between top and bottom eyelids
Nasolabial folds
Smile lines
How to palpate temporomandibular joint
As the person opens the mouth, and note normally smooth movement with no limitation or tenderness
Cranial nerve XI
spinal accessory
How to test muscle strength in the neck
Push on shoulders and they push against resustance
Have them turn their head towards you to press against your hand and do to the other side
What to notice in jugular veins?
Distension because distension can mean heart failure
Way to inspect and palpate the Thyroid gland
Posterior approach
Anterior approach
Auscultate (with bell of stethoscope) thyroid for bruit (Abnormal blood flow to the area usually caused by a an obstruction), if enlarged
How to examine Lymph Nodes
Using a gentle circular motion of finger pads, palpate lymph nodes
Beginning with preauricular lymph nodes in front of ear, palpate the 10 groups of lymph nodes in routine order
Are lymph nodes normally palpable in children
Yes they are, usually do to ear infections
During what semester does chloasma usually show in a pregnant mom
Second semester
Thyroid gland during pregnancy
May be palpable which is normal
Senile tremors
Various shaking
Temporal arteries in Aging Adult
May look twister and prominent
Purpose of cranial nerve VII when looking at the head, face and neck
Symmetry of movements
Microcephaly vs Macrocephaly
Micro: small head
Macro: big head
Hydrocephalus
fluid buildup and pressure, notice increase head circumference and mental delays, bulging eyes, bulging fontanelles
Positional Plagiocephaly
babies that don’t have tummy time and are constantly on their back and head flattens
Pediatric Facial Abnormalities
Fetal Alcohol syndrome and Down Syndrome
Acromegaly
enlarges bones caused by too much growth hormone
Parkinsons syndrome
no changes in facial expressions, mask like face
Cushings syndrome main sign
Moon shape face
Bell’s palsy
sudden weakness to one side of the face, features asymmetric, problem
with cranial nerve 7
Stroke
asymmetric facial
features that is hard to move, deficit to entire side of body usually not just face
Facial movements asymmetric
abnormal because it can be due to bell’s palsy or stroke
Nasolabial folds equal, normal or not?
Normal finding
TJM Crepitation
abnormal because bones are rubbing together, clicking can be normal but crepitation means synovial joint loss
Tenderness to temporal artery abnormal or normal?
abnormal, shouldn’t be pain
JVD
Abnormal because it can be due to fluid overload or heart failure
Scaly scalp
abnormal because can be due to psoriasis, in an infant may be due to cradle cap
Unilateral facial paralysis
abnormal because it can be due to facial nerve VII
Slight lip tremor
abnormal can be due to parkinson’s
Scalp tenderness
abnormal can be due to swelling
Thyroid bruit
abnormal because you shouldn’t have blood build up
Nuchal Rigidity
Abnormal because stiffness in the neck that can be a sign of meningitis
