Exam #2: Head & Neck Examination Flashcards
What are the seven attributes of a symptom?
1) Location
2) Quality
3) Quantity
4) Timing
5) Setting (in which it occurs)
6) Mitigating & Exacerbating Factors
7) Associated Symptoms
What is a primary headache?
A headache that is idiopathic — occurring for no obvious reason, and not the result of any underlying disease or process
What is a secondary headache?
A headache that arises from an underlying structural, systemic, or infectious cause
What are the different types of primary headaches?
1) Migraine
2) Tension
3) Cluster
4) Medication Rebound
5) Chronic Daily Headache
What are three potential causes of a secondary headache?
1) Meningitis
2) Subarachnoid Hemorrhage
3) Mass Lesion
Characteristics of a Migraine
- Unilateral
- Throbbing or aching
- Peaks within 1-2 hours but can last 4-72 hours
- More common in women
- Associated Symptoms include nausea & vomiting
- Prodrome
- Triggered by missing meals, menses, birth control, stress, food
Characteristics of a Tension Headache
- Adulthood
- Bilateral or Unilateral
- Band-like, constricting & non-throbbing
- Gradual onset & lasts hours to days
- Photophobia & Phonophobia maybe, but NO nausea
- NO prodrome
- Triggered by stress, anger, and teeth grinding
Characteristics of a Cluster Headache
- Unilateral & retro-orbital
- Intense burning, searing, knife-like
- Abrupt onset that peaks in minutes
- Lasts several nights for several days and then gone
- More common in men
- Associated symptoms: increased tearing & nasal discharge
Characteristics of a Medication Rebound Headache
- Diffuse
- Dull or Throbbing
- Onset hours or days after last dose & lasts hours
- Seen in patients taking daily analgesics w/ abrupt cessation
Red Flag Symptoms with Headaches
- Progressively frequent or severe
- Sudden onset- “Thunderclap”
- “Worst headache of my life”
- New onset after 50 years old
- Aggravated or relieved by a change in position
- Precipitated by the Valsalva maneuver
- Associated with fever, night sweats, or weight loss
- Hx of cancer, HIV infection, or pregnancy
- Recent trauma
- Associated papilledema, neck stiffness, or focal deficit
What should you consider if headache is severe and of sudden onset?
SAH or Meningitis
What is concerning of a headache that is new, persisting, & progressively severe?
Raises concern for tumor, abscess, or mass lesion
What types of headaches are unilateral?
Migraine & Cluster
What type of headache often arises in the temporal area?
Tension
What type of headache is often retro-orbital?
Cluster
What type of headache has a prodrome?
Migraine
Why is exacerbation of a headache with the Valsalva maneuver concerning?
May increase pain from acute sinusitis or mass lesion & ICP
What are important considerations in head trauma?
- LOC
- Mechanism of Injury
- Level of Consciousness
- Time of Injury
- Amnesia
- Headache
- Vision changes
- Bleeding from ears, nose, mouth, eyes
Concussion
Disturbance in brain function caused by a direct or indirect force to the head, resulting in a constellation of symptoms that does not necessitate LOC
Symptoms suspicious for concussion
- Headache
- Unsteadiness
- Impaired brain function or confusion
- Abnormal behavior
What is the Sport Concussion Assessment Tool (SCAT2)?
Pre-season cognitive screening to be compared to post-injury; if athlete is not back to baseline, no participation
Symptoms of Hyperthyroid
- Nervousness
- Weight Loss
- Excessive sweating/ heat intolerance
- Warm, smooth, moist skin
- Grave’s Disease
- Tachycardia
Symptoms of Hypothyroid
- Fatigue, Lethargy
- Modest weight gain
- Dry coarse skin
- Cold intolerance
- Swelling of face, hands, and legs
- Bradycardia
- Impaired memory
Conductive Hearing Loss
Problems with the external or middle ear
Sensorineural Hearing Loss
Problems with the inner ear, cochlear nerve, or its connections to the brain
Difficulty understanding speech & worse hearing in noisy enviornment
Sensorineural
Noisy environment improves hearing
Conductive
Medications that affect hearing
- aminoglycosides
- aspirin
- NSAIDs
- quinine
- furosemide
Vertigo
Perception of spinning caused by problems in the labyrinths of the inner ear, peripheral lesion of CN VIII, or central lesions of CN VIII
Sutures
Membranous tissue spaces that separate the bones of the skull
Fontanelles
Areas that sutures intersect
When do you need to measure head circumference in a child?
Birth to 24 months
When does the anterior fontanelle close?
18 months
When does the posterior fontanelle close?
2 months
What is a bulging fontanelle an indication of?
- Increased ICP
- As well as coughing, vomiting, cyring
What is a sunken fontanelle an indication of?
Dehydration
Microcephaly
Small head i.e. less than the 3rd percentile
Hydrocephalus
Deficient CSF circulation causes an increase in ICP & enlargement of the calavarium
What are normal variants seen on physical examination of the infant?
- Overlapping sutures
- Molding
- Caput Succedaneum
- Cephalohematoma
Caput Succedaneum
- Subcutaneous edema over the presenting part of the head during delivery
- CROSSES the SUTURE line
- TRANSLUMINATES
- typically occopitalparietal
Molding
Repositioning of the cranial bones to allow passage through the birth canal
Cephalohematoma
- Subperiosteal collection of blood
- DOES NOT CROSS SUTURE
- DOES NOT TRANSLUMINATE
- Commonly in parietal region
- Typically resolves within 10-14 days
Crainosynostosis
Premature closure of the sutures
Brachycephaly
Premature closure of the coronal suture
Plagiocephaly
- Asymmetry of the skull & face due to lying on one side
- Treated most often with parental education
- Typically self-resolves with age
Microencephaly
small brain
Signs & symptoms of increased ICP
Headache, vomiting, & papilledema
How do you palpate the infants neck?
While the infant is supine and with one or two fingers
Shotty
Term referring to lymph nodes in toddler & young children
What are the five elements of hair inspection?
1) Color
2) Quantity
3) Distribution
4) Texture
5) Condition (nits, parasites, dandruff…etc.)
What are the eight elements of a head exam?
1) Symmetry, shape, & size of head
2) Scalp symmetry & movement
3) Inspect scalp for: lesions, scaliness, lumps, infestation
4) Presence of involuntary head movement
5) Facial symmetry, shape & size
6) Movement of eyebrows, eyes, mouth
7) TMJ: alignment and presence of crepitus
8) Temporal arteries: Palpate & Auscultate
