Head and Neck

Question 1

Where can one place a finger to palpate the temporomandibular joint?

Answer 1

In front of triages or in the external auditory meatus

Question 2

A patient should be able to open their jaw wide enough to insert how many fingers vertically into the mouth?

Answer 2

3

Question 3

What is the primary source of TMJ disorder?

Answer 3

Malocclusions (bite problems)

Question 4

The TMJ is a favorite site for what kind of joint disease?

Answer 4

Rheumatoid arthritis

Question 5

What condition produces crepitus in the TMJ with movement?

Answer 5

Osteoarthritis

Question 6

What condition is to be expected with tenderness of the TMJ?

Answer 6

Rheumatoid arthritis

Question 7

What is a sign of a displaced TMJ cartilage?

Answer 7

Clicking when opening the mouth

Question 8

What are usually the causes of unilateral swollen salivary glands?

Answer 8

Bacterial infection (like Parotitis)
Ductal calculus in Stenson’s or Wharton’s duct
Cyst or tumor

Question 9

Which salivary duct opens by the second upper molar? By either side of the frenulum of the tongue?

Answer 9

Second upper molar - Stenson’s

Frenulum - Wharton’s

Question 10

What are usually the causes of bilateral swollen salivary glands?

Answer 10

Viral infection (like mumps)
Drug reactions
Lymphomas

Question 11

Every tissue in the body with blood vessels has lymphatic vessels except what two areas?

Answer 11

Placenta and brain

Question 12

Fluid collected in the lymphatic system from the right and left sides of the head and neck eventually empty into what vessels?

Answer 12

Right and left subclavian veins

Question 13

Both legs, abdomen, and left chest lymphatics all drain into which vein?

Answer 13

Left subclavian vein

Question 14

Right chest lymphatics drain into which vein?

Answer 14

Right subclavian vein

Question 15

What are the superficial lymph node sites?

Answer 15

Head and neck
Axillary
Inguinal

Question 16

Superficial lymph nodes of the head and neck can be palpated anterior and posterior to which major muscle?

Answer 16

SCM

Question 17

Where are the superficial lymph nodes of the head and neck palpated?

Answer 17

Under occiput and jaw
Anterior and posterior to ear and SCM
Supraclavicular
Pretrapezial

Question 18

Where are the superficial lymph nodes of the axillary region palpated?

Answer 18

Pectoral
Subscapular
Humeral
Dome of armpit

Question 19

Where are the superficial lymph nodes of the inguinal region palpated?

Answer 19

Above and below inguinal ligament

Question 20

What kind of infection produces small, mobile, and tender lymph nodes?

Answer 20

Acute

Question 21

What kind of infection produces multiple and less tender lymph nodes?

Answer 21

Chronic

Question 22

Describe the lymph nodes seen with Hodgkin’s disease.

Answer 22

Large rubbery nodes

Question 23

Describe the lymph nodes seen with metastatic cancer.

Answer 23

Stony hard, non-tender nodes

Question 24

What is a likely suspicion if a patient presents with large lymph nodes but no signs nor symptoms of infection?

Answer 24

Cancer

Question 25

If a large lymph node but no signs nor symptoms of infection are seen in a patient, what other signs and symptoms may be present that are indicative of cancer?

Answer 25

Cachexia, skin changes, unhealed sores, digestion issues, nagging cough, unusual bleeding, etc.

Question 26

What is the name of the swollen lymph node that can be found in the left supraclavicular group that lacks a typical explanation?

Answer 26

Virchow's node (signal node)

Question 27

A Virchow's node is indicative of what condition?

Answer 27

Thoracic or abdominal cancer

Question 28

Why is a Virchow's node indicative of thoracic or abdominal cancer?

Answer 28

Last and only location lymphadenopathy originating in majority of trunk can be detectable

Question 29

True or false: lymphadenopathy in a primary care setting is most commonly due to serious illness.

Answer 29

FALSE

Question 30

What things can cause tracheal deviation?

Answer 30

``` Head tilt/cervical rotation Unilateral goiter Extremely large lymph node Unilateral pneumothorax or pleural effusion Unilateral atelectasis Pulmonary fibrosis ```

Question 31

What is tracheal deviation usually a sign of?

Answer 31

Significant lung pathology

Question 32

What muscle runs obliquely across the lobes of the thyroid gland?

Answer 32

SCM

Question 33

What is the major function of the thyroid gland (in general)?

Answer 33

Establish metabolic rate

Question 34

What structure in the neck rises and falls upon swallowing?

Answer 34

Thyroid gland

Question 35

Which would be immobile during swallowing: lymph node or goiter? Which would be mobile?

Answer 35

Immobile - lymph node | Mobile - goiter

Question 36

What condition is congenital hypothyroidism?

Answer 36

Cretinism

Question 37

What is the cause of cretinism?

Answer 37

Iodine deficiency

Question 38

Why is cretinism rare in the United States?

Answer 38

Iodized salt

Question 39

What are the physical signs of cretinism?

Answer 39

Dwarfism, mental deficiency, puffy face, dry skin, LARGE TONGUE, muscular incoordination

Question 40

What is the number one cause of hypothyroidism in the United States?

Answer 40

Hashimoto's Disease

Question 41

What is the number one cause of hypothyroidism worldwide?

Answer 41

Cretinism

Question 42

What condition is a severe, advanced form of adult-onset hypothyroidism?

Answer 42

Myxedema

Question 43

What are the physical signs and symptoms of Hashimoto's Disease?

Answer 43

Goiter, weight gain, mental and physical lethargy, cold intolerance, dry skin, constipation, arthritis

Question 44

How and why can a woman's voice change with Hashimoto's Disease?

Answer 44

Become huskier due to edema

Question 45

What are the physical signs and symptoms of hyperthyroidism?

Answer 45

Goiter, weight loss, nervousness, tremors, fatigue, heat intolerance, diarrhea, palpitations

Question 46

What is the most common form of hyperthyroidism?

Answer 46

Grave's disease

Question 47

What extra sign is exhibited in Grave's disease?

Answer 47

Exopthlamos

Question 48

What is the motor test for the trigeminal nerve?

Answer 48

Feel muscles of mastication when patient clenches teeth

Question 49

What is the sensory test for the trigeminal nerve?

Answer 49

Ask the patient to respond when they feel a light touch not the brow, cheek, and chin with their eyes closed

Question 50

If a sensory defect of cranial nerve 5 is detected, what test should be done?

Answer 50

Temperature check using tuning fork: fork will feel warmer on impaired side

Question 51

The corneal reflex tests which cranial nerve?

Answer 51

5 (trigeminal) and 7 (facial)

Question 52

What is the motor test for cranial nerve 7, the facial nerve?

Answer 52

Analyze bilateral symmetry when a patient raises eyebrows and shows teeth

Question 53

What is the sensory test for cranial nerve 7, the facial nerve?

Answer 53

Have patient identify salty and sugary tastes on anterior tongue

Question 54

What cranial nerve is responsible for identification of sour and bitter tastes on the posterior tongue?

Answer 54

9 (glossopharyngeal)

Question 55

Taste bud information on the epiglottis are transmitted by which cranial nerve?

Answer 55

10 (vagus)

Question 56

What is the motor test for cranial nerve 11, the spinal accessory nerve?

Answer 56

Patient rotates head against resistance (SCM) then shrugs shoulders against resistance (trapezius)

Question 57

Is trapezius weakness most often due to neck/shoulder pain or cranial nerve 11 lesions?

Answer 57

Neck/shoulder pain

Question 58

What injury precedes a whiplash headache?

Answer 58

Flexion-extension injury

Question 59

What are the first two symptoms of a whiplash injury?

Answer 59

1 stiff neck | 2 new, atypical headache

Question 60

What movement makes a whiplash headache feel worse?

Answer 60

Flexion

Question 61

What are the diagnostic studies involved with a whiplash injury/headache?

Answer 61

Flexion-extension X-rays can show soft tissue damage | MR = definitive

Question 62

What type of headache may be the most common in a chiropractic office?

Answer 62

Whiplash

Question 63

What are symptoms of a concussion headache?

Answer 63

Amnesia, confusion

Question 64

What diagnostic study is used for a concussion headache?

Answer 64

Head CT

Question 65

What are risk factors for a dissecting vertebral artery headache?

Answer 65

Smoking, high BP, atherosclerosis

Question 66

What type of headache is expected when a patient describes it as the "worst headache ever"?

Answer 66

Dissecting vertebral artery

Question 67

What are the symptoms of a dissecting vertebral artery headache?

Answer 67

5 D's and 3 N's: Dizziness, double vision, dysarthria, difficulty walking, dysphagia Nausea, numbness, nystagmus

Question 68

What are the diagnostic studies involved with a dissecting vertebral artery headache?

Answer 68

Doppler ultrasound, MRA of head

Question 69

What is the location of pain for a dissecting vertebral artery headache?

Answer 69

Unilateral behind one ear and occipital area

Question 70

What gender is more likely to experience migraine headaches?

Answer 70

Females

Question 71

What kind of headache has a familial history rate of about 90%?

Answer 71

Migraine headaches

Question 72

What are triggers for migraine headaches?

Answer 72

Hormonal shifts, stress, lack of sleep, certain foods

Question 73

For what kind of headaches are neurologic and vascular exams essentially negative?

Answer 73

Migraine headaches

Question 74

When does a patient with migraine headaches typically experience their first episode?

Answer 74

Childhood or young adulthood

Question 75

What kind of headache is seen in adolescents or adults experiencing emotional or physical stress?

Answer 75

Tension

Question 76

What kind of headaches exhibit pressure and pain in the "hatband" area of the head and why?

Answer 76

Tension; due to contraction of neck, scalp, face, and jaw muscles

Question 77

What is the timeline for chronic tension headaches?

Answer 77

More than 15 days a month for at least three consecutive months

Question 78

What moment can aggravate sinusitis?

Answer 78

Bending over (increases pressure)

Question 79

What are risk factors for sinusitis?

Answer 79

Cigarette smoke, allergies, polyps, recurrent and chronic respiratory conditions

Question 80

What kind of discharge can be seen in sinusitis?

Answer 80

Blood stained, mucopurulent

Question 81

What are the salivary glands?

Answer 81

Parotid, submandibular, and sublingual glands