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H&P #1 > H&P #2 - Neck & Thyroid > Flashcards

H&P #2 - Neck & Thyroid Flashcards

1
Q

Identify the (7) anatomical landmarks of the neck:

A

a. Sternal notch
b. Sternocleidomastoid muscle (SCM)
c. Trapezius muscle
d. Anterior and Posterior triangles
e. Trachea
f. Thyroid gland (bilateral lobes and isthmus)
g. Cricoid cartilage

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2
Q

Identify the (3) muscles of the anterior triangle of the neck:

A
  1. Superior: inferior border of mandible
  2. Medial: midline of neck
  3. Lateral: anterior border of sternocleidomastoid muscle
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3
Q

Identify the (3) muscles of the posterior triangle of the neck:

*What muscle sits in the posterior triangle”?

A
  1. Sternocleidomastoid muscle
  2. Trapezius muscle
  3. Clavicle

The Omohyoid muscle

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4
Q

Identify the (4) vascular supply of the neck:

A
  1. Internal jugular vein
  2. External jugular vein
  3. Carotid artery
  4. Carotid sinus
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5
Q

What artery crosses the thyroid gland?

A

Superior thyroid artery

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6
Q

Anatomically identify and locate the (9) regional cervical lymph node groups.

A
  1. Pre-auricular (close to tragus)
  2. Post-auricular (behind the ear)
  3. Occipital
  4. Tonsillar (upper portion of the jaw)
  5. Submandibular (mid to the jaw line)
  6. Submental (under chin)
  7. Anterior cervical chain (on the SCM)
  8. Posterior cervical chain (posterior to SCM)
  9. Supraclavicular (patient have to shrug to palpate)
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7
Q

List five (6) characteristics to describe lymph nodes found on physical
examination:

A
  1. Size (pea, golf-ball)
  2. Shape (cluster or misshaped)
  3. Delimitation (boundaries)
  4. Mobility (easily movable or abnormally fixed)
  5. Consistency
  6. Tenderness
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8
Q

List the ROS for the neck and lymph nodes:

A
  1. Pain
  2. Swelling
  3. Stiffness
  4. Enlarged lymph nodes
  5. Masses (thyroid)
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9
Q

List the ASSOCIATED ROS for the neck and lymph nodes:

A
  • Fever/Chills
  • Weight loss/gain
  • Fatigue
  • Sweats/night sweats
  • Heat/cold intolerance
  • Cough
  • Sore throat
  • Dysphagia
  • Hoarseness
  • Sinus congestion
  • Ear pain
  • Constipation/diarrhea
  • Heart palpitations
  • Dry skin/brittle nails
  • Hair loss
  • Nervousness
  • Depression
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10
Q

Describe the significance of finding enlarged or tender lymph nodes on physical exam.

A

Tender nodes are typically suggestive of an INFLAMMATION; HOWEVER, hard or fixed nodes suggest MALIGNANCY

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11
Q

Describe the significance of finding enlarged supraclavicular node on physical exam.

A

Enlargement of a supraclavicular node, especially on the left, suggests possible metastasis from a thoracic or abdominal malignancy

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12
Q

Describe the significance of finding palpitations of the supraclavicular node on physical exam.

A

Possible malignancy; NEED WORK UP

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13
Q

What does a pulsating “tonsillar node” mean?

A

It is not the tonsillar node, but the CAROTID ARTERY

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14
Q

What does a “tonsillar node” that is high and deep between the mandible and the SCM mean?

A

Styloid process

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15
Q

Describe the significance of finding an enlarged thyroid gland or thyroid nodules.

A

May indicate a GOITER

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16
Q

Describe a Retrosternal Goiter and its associated symptoms:

“What problem can occur with a Retrosternal Goiter”?

A

Refers to a thyroid gland that is abnormally below the suprasternal notch and may not be palpable.

Symptoms:
1. Hoarseness
2. SOB
3. Stridor
4. Dysphagia

Problem:
It can constrict or compress the windpipe (trachea) and the large arteries/veins in the neck and axilla.

17
Q

How do you evaluate a patient with a problematic goiter?

A

PEMBERTON SIGN:
used to evaluate venous obstruction in patients with goiters. The sign is positive when bilateral arm elevation causes facial flushing; attributed to a “cork effect” resulting from the thyroid obstructing the thoracic inlet, thereby increasing pressure on the venous system.

18
Q

What does an enlarged posterior cervical chain mean?

A

Infectious mononucleosis

19
Q

What does an enlarged cervical anterior cervical chain mean?

A

Strep throat

20
Q

What are (4) abnormal findings on a lymph node physical examination?

A
  1. Enlargement
  2. Non-mobile, fixed
  3. Hard
  4. TTP/non-TTP
21
Q

What are (3) abnormal findings on a thyroid gland physical examination?

A
  1. Masses/nodules
  2. Gross enlargement
  3. TTP
22
Q

What is an abnormal finding on a trachea physical examination?

A

Tracheal deviation

23
Q

Locate the anatomical region drained by the tonsillar lymph nodes.

A

Jugulodigastric

24
Q

Locate the anatomical regions drained by the submandibular lymph nodes.

A

Cheek, side of nose, lower lip, gums, anterior tongue

25
Q

Locate the anatomical regions drained by the submental lymph nodes.

A

Lower lip, floor of mouth, apex of tongue

26
Q

Locate the anatomical regions drained by the anterior cervical chain lymph nodes.

A

Superficial cervical: lower ear and parotid

Deep cervical: other nodes of the head and neck, occipital scalp, ear, back of neck, tongue, trachea, nasopharynx, nasal cavities, palate, esophagus

27
Q

Locate the anatomical regions drained by the supraclavicular lymph nodes.

A

Thorax and abdomen

28
Q

List (9) physical signs of hyperactive thyroid disease:

A
  1. Goiter
  2. Bulging eyes
  3. Palpitations/rapid pulse
  4. Sweating and heat intolerance
  5. Warm, moist hands, hand tremor
  6. Nervousness, irritability, shakiness
  7. Tiredness and weak muscles
  8. Mood swings or aggressive behavior
  9. Looseness of the bowels
29
Q

List (10) physical signs of hypoactive thyroid disease:

A
  1. Fatigue, Weakness, Tiredness
  2. Weight gain or difficulty losing weight
  3. Cold intolerance
  4. Dry, rough pale skin
  5. Thinning hair/eyebrows, Hair loss
  6. Slow pulse
  7. Poor appetite, Constipation
  8. Muscle cramps, muscle aches, Carpal tunnel syndrome
  9. Depression, Irritability, Memory loss
  10. Abnormal menstrual cycles, Decreased libido
30
Q

How does Tracheal Deviation occur?

A

Happens when your trachea is pushed to one side of your neck by abnormal pressure in your chest cavity or neck

31
Q

What are (6) conditions associated with Tracheal Deviation:

A
  1. Spontaneous & Tensions pneumothorax
  2. Pneumonectomy
  3. Atelectasis (collapsed lung)
  4. Pleural effusion
  5. Enlarged lymph nodes
  6. Cancer (tumor within bronchi/lung/pleural cavity; lymphomas associated with mediastinal lymph nodes)
32
Q

Describe the significance of finding GENERALIZED lymphadenopathy on physical exam.

A

infection, inflammation, malignant conditions (HIV/AIDS, infectious mononucleosis, lymphoma, leukemia, sarcoidosis)

33
Q

Soft and possible nodularity of thyroid suggests:

A

Graves Disease

34
Q

Firmness of thyroid may suggest:

A

Hashimotos thyroiditis & malignancy

H&P #1 (8 decks)

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