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Physical Exam Techniques > Face, Neck, & Lymphatics > Flashcards

Face, Neck, & Lymphatics Flashcards

1
Q

common or concerning symptoms of the head

A

headache, history of head injury

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2
Q

common or concerning symptoms of the eyes

A 
visual disturbances
spots (scotomas)
flashing lights
use of corrective lenses
pain
redness
excessive tearing
double vision (diplopia)
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3
Q

common or concerning symptoms of the ears

A 
hearing loss
ringing (tinnitus)
vertigo
pain
discharge
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4
Q

common or concerning symptoms of the nose

A

drainage (rhinorrhea)

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5
Q

vertex

A

top of the head

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6
Q

calvarium

A

whole head

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7
Q

common or concerning symptoms of the oropharynx

A

sore throat
gum bleeding
hoarsness

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8
Q

Stenson’s duct

A

secrete’s salivary fluid from parotid glands

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9
Q

common or concerning symptoms of the oropharynx

A

swollen glands

goiter

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10
Q

Warton’s duct

A

secrete’s salivary fluid from submandibular glands

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11
Q

palpebral fissures

A

the elliptic space between the medial and lateral canthi of the two open lids

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12
Q

nasolabial folds

A

fold from nares to the mouth- seen when one smiles.

Created by cranial nerve VII

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13
Q

sinuses of the face

A

frontal
sphenoid
ethmoid
maxillary

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14
Q

The ethmoid sinuses are filled with

A

air.

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15
Q

Nasal Conchae

A

turbinates

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16
Q

The nasolacrimal duct drains into…

A

the inferior meatus.

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17
Q

facies

A

describes a characteristic feature of a syndrome that you can see in someone’s face.

Clinical syndromes or disorders with distinctive facial features have a specific “facies.”

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18
Q

characteristic facies of Down’s Syndrome

A 
Upslanting palpebral fissures
Epicanthic folds
Flat facial profile/flat nasal bridge
Folded or dysplastic ears
Low-set small ears
Brachycephalic
Brushfield spots
Open mouth
Protruding tongue 
Furrowed tongue
Short neck
Excessive skin at nape of the neck
Narrow palate
Abnormal teeth
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19
Q

epicanthic fold

A

a skin fold of the upper eyelid, covering the inner corner (medial canthus) of the eye

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20
Q

facies of Cushing’s Syndrome

A 
"moon facies"
round face
facial flushing - plethoric facies
increased fat deposits around the cheeks
double chin
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21
Q

prolonged corticosteroids can cause…

A

Cushing’s Syndrome

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22
Q

facies of Fetal Alcohol Syndrome

A 
small head
low nasal bridge
epicanthal folds
small eye openings
flat midface
short nose
smooth phithrum
underdeveloped jaw
thin upper lip and smooth philtrum
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23
Q

signs and symptom’s of acromegaly

A 
enlargement of hands, feet, and head
frontal bossing
palmar thickening
coarse features
Prognathism
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24
Q

most common cause of acromegaly

A

pituitary adenoma

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25
Q

most common cause of gigantism

A

excess growth hormone before bone growth has stopped.

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26
Q

common causes of Parotid Enlargement

A 
Sjogren's Syndrome
Mumps
Chronic disease - DM, obesity, liver cirrhosis
Neoplasm - Unilateral
Parotitis
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27
Q

How do you diagnose Sjogren’s Syndrome?

A

look up.

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28
Q

What do Sjogren’s Syndrome have a higher risk form?

A

Lymphoma

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29
Q

anatomy of the neck

A 
hyoid bone
thyroid cartilage
cricoid cartilage
thyroid gland
larynx
trachea
clavicle
sternocleidomastoid muscle
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30
Q

portions of thyroid gland

A

thyroid lateral lobes

isthmus

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31
Q

when one swallow’s what does the thyroid do-

A

move’s superiorly - looks assymetrical

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32
Q

thyromegaly

A

thyroid enlargement

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33
Q

most common cause of goiters in the world

A

iodine deficiency

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34
Q

common causes of goiters

A

Grave’s Disease - hyperthyroidism

Hoshimoto’s Syndrome - hypothyroidism

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35
Q

diffuse thyromegaly

A

no bumpy lesions.

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36
Q

what is pathopneumonic for Grave’s disease

A

exophthalmos

goiter

37
Q

multinodular thyroid

A

thyroiditis (viral or autoimmune)

38
Q

what to look for in a goiter

A

look up

39
Q

solitary nodule on thyroid - fixed, hard, non-tender

A

think malignancy

40
Q

what if you find a solitary nodule in a child

A

immediate invasive biopsy

41
Q

what if you find a solitary nodule in an adult

A

find out if it is hot or cold using radioactive iodine synctiography
If cold - do biopsy to determine histology

42
Q

hot nodule of thyroid

A

actively produces thyroxine

43
Q

cold nodule thyroid

A

does not produce thyroxine - more likely to be cancerous

44
Q

Where is bone marrow produced?

A

flat bones

45
Q

lymphadenopathy

A

swollen, palpable, irregular nodes

46
Q

LAD; LAN

A

lymphadenopathy

47
Q

LAD - solitary, hard, fixed, non-tender, growing

A

malignancy

48
Q

LAD- solitary, erythematous, tender, fluctuant, growing

A

infection

49
Q

LAD- diffuse, symmetric, nodular, static

A

systemic disease - HIV, malignancy

50
Q

LAD -solitary, grouped, tender, moblie

A

regional or localized infection (sarcoid) or lymphoma

51
Q

shotty lymph node

A

benign

characteristic of hyperplastic lymph from previous inflammatory process

52
Q

the thoracic duct drains into

A

left subclavian

53
Q

What organs contain lymphoid tissue?

A

Appendix

Large intestine

54
Q

lymph nodes of the face

A 
anterior auricular
posterior auricular
occipital
posterior cervical
supraclavicular
deep cervical
submental
submaxillary
tonsillar
55
Q

enlargement of the supraclavicular node - especially on the left suggests…

A

mets from thoracic or lung malignancy

56
Q

epitrochlear nodes drain

A

the ulnar aspect of the hand

57
Q

everything except the ulnar aspect of the arm and hand drain into

A

infraclavicular nodes

58
Q

When are epitrochlear nodes best noted?

A

when arm is flexed at 90 degrees and palpated between the biceps and triceps

59
Q

What does inflammation of the epitrochlear nodes indicate?

A

Sever Infection

Rheumatoid Arthritis

60
Q

inguinal adenopathy is seen with

A

STD
lymphogranuloma vinarium (LGV)
genital infections

61
Q

NAVL of the femoral region

A

nerve
artery
vein
empty space (or lymph node if inflammed)

62
Q

the popliteal nodes drain

A

the lower extremity below the knee

63
Q

bruit

A

the term for the unusual sound that blood makes when it rushes past an obstruction (called turbulent flow) in an artery when the sound is auscultated with the bell portion of a stethoscope.

64
Q

equipment for the head and neck exam

A

stethoscope
cup of water
transilluminator

65
Q

inspection of the head includes:

A 
hair distribution (quantity)
scalp - scaling, nevi
skull - size, contour
face - expression, contours
skin- color, pigmentation, hair distribution, lesions
66
Q

palpation of the head includes:

A

hair texture
skull- lumps
face- sinuses
skin- texture, temperature

67
Q

tinea capitis

A

also known as “Herpes tonsurans”,”Ringworm of the hair,” “Ringworm of the scalp,” “Scalp ringworm”, and “Tinea tonsurans”) is a superficial fungal infection (dermatophytosis) of the scalp. The disease is primarily caused by dermatophytes in the Trichophyton and Microsporum genera that invade the hair shaft. The clinical presentation is typically single or multiple patches of hair loss, sometimes with a ‘black dot’ pattern (often with broken-off hairs), that may be accompanied by inflammation, scaling, pustules, and itching. Uncommon in adults, tinea capitis is predominantly seen in pre-pubertal children, more often boys than girls.

68
Q

warning signs for headache

A 
more frequent/severe over 3 months
"thunderclap", "worst of my life"
new onset after 50
fever, sweats, wt loss
known Ca, HIV, or pregnancy
recent head trauma
focal deficits, vision changes, neck stiffness
69
Q

What should be examined in the face?

A 
symmetry
skin lesions
edema
color
expression
70
Q

palpate in the face

A

temporal arteries
TMJ
parotid glands

71
Q

palpate and percuss - face

A

frontal sinuses

maxillary sinuses

72
Q

temporal arteritis

A 
giant cell arteritis
frequently occurs >50 yo
inflammatory condition of the arteries
autoimmune
bounding or tender temporal artery
TMJ pain
if untreated - leads to blindness
73
Q

if there is increased pain in the sinuses when the bends forward it indicates

A

sinusitis

74
Q

bacterial sinusitis

A 
pain greater than 7 days
purulent nasal drainage
distinct facial pain (toothache) 
tenderness to palpation
fever
75
Q

transillumination of the sinuses

A

frontal sinus
maxillary sinus
bacterial sinusitis

76
Q

anterior triangle margins of neck

A

sternocleidomastod
mandible
neck midline

77
Q

posterior triangle margins of neck

A

trapezius
sternocleidomastoid
clavicle

78
Q

main causes trachea displacement

A

pneumothorax
mediastinal mass
atelectasis

79
Q

inspect the neck for

A

symmetry, masses, scars, enlargement of glands or lymph nodes

80
Q

inspect the trachea for

A

position

alignment

81
Q

inspect the thyroid gland for

A

symmetry

82
Q

palpate the neck

A

lymph nodes (size, shape, delimination - ex 1 cm x 2 cm, mobility, consistency tenderness)

83
Q

lymph nodes of neck

A 
preauricular
posterior auricular
occipital
tonsillar
submandibular
submental
superficial cervical
posterior cervical
deep cervical chain
supraclavicular
84
Q

exam of range of motion of the neck (6)

A

flexion
extension
rotation (both sides)
bending (lateral flexion)

each passively and actively (against resistance)

85
Q

Inspect the neck

A

use direct light and tangential light
look for tracheal deviation
look for masses
look for skin lesions

86
Q

lymph nodes to remember

A 
preauricular
posterior auricular
occipital
tonsillar
submandibular
submental
anterior cervical (superficial and deep)
posterior cervical
supraclavicular
87
Q

palpation of the neck includes

A

C-Spine at rest and during ROM
Trachea
Muscles- paravertebral, trapezius, SCM
Palpation of the thyroid

88
Q

palpation of the thyroid includes

A

flex neck slightly forward
place fingers of both hands with index fingers just below the cricoid cartilage
ask patient to swallow; feel for the thyroid isthmus rising up under your finger pads (not always palpable)
displace trachea to the right and palpate laterally for teh right lobe of the thyroid; repeat on left side
note the size, shape, and consistency
Identify any nodules or tenderness
If enlarged, listed over lateral lobes to detect a bruit

Physical Exam Techniques (1 decks)

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