Head and Neck Flashcards
Inspect head and scalp for
tilt, tremor
size, shape (molding), symmetry, lesions, trauma
Inspect facial features for
symmetry shape unusual features tics characteristic faceis pallor/pigmentation
Palpate head and scalp for
symmetry, tenderness (sinuses)
scalp movement
sutures, fontanels
hair texture, color distribution
Auscultate the temporal arteries for
thickening, hardness and tenderness
Inspect and palpate the…
salivary glands
and check for infant head cricumference
Inspect neck for the following
tracheal position
tracheal tug
movement of hyoid bone and cartilage
lymph nodes
Palpate thyroid gland for
consistency size shape configuration tenderness nodules auscultate for bruits if gland is enlarged ROM of neck
Skulls is composed of seven fused bones
Frontal: 2 bones
Parietal: 2 bones
Temporal: 2 bones
Occipital: 1 bone
What are the three facial cavities
eyes, nose and mouth
Face bones
frontal nasal zygomatic ethmoid lacrimal sphenoid maxillary madible (movable)
What cranial nerves innervate the muscles of the fave
CN V and VII
Salivary Glands
Produce saliva - moisten, prevent caries and intiate digestion of carbs
Three paired glands
Parotid
Submandibular
Sublingual
Structure of the neck formed by
cervical vertebrae
ligaments
SCM muscles
trapezium muscle
Posterior triangle consists of
trapezius
SCM
clavice
Anterior triangle consists of
medial border of SCM
madible
Neck contains
trachea esophagus internal and external jugular veins common carotid internal and external carotid arteries thyroid
Thyroid
largest endocrine gland
T3 - thyroxine
T4 - triiodothyronine
Infants
Bones are soft and separated by sutures
sutures ossify (6-18 years)
Fontanels close (2 months - 2 years)
Skull is molded when infant is exiting the birth canal
resumes normal shape and size within first few days
Ossification of sutures begins after brain growth at about 6y/o
Male Adolescent Changes during Childhood
Nose and thyroid cartilage enlarge
Facial hair appears on upper lip
Pregnant women
Euthyroid state
Increase in renal clearance of iodine
thyroid enlarges to produce sufficient hormones
Adequate iodine intake (200mcg/day) will not cause thyroid to change in size
Older Adults
T4 production and degradation decreases
Thyroid gland becomes fibrotic
HPI: Head injury
independent observer description
state of conciousness after injury - immediately, 5 minutes after, combative, alert or dazed
predisposing factors-epilepsy, hypoglycemia, syncope
associated symptoms - head or neck pain, laceration, local tenderness, change in breathing pattern, diplopia, discharge, n/v, incontinence, ability to move extremeties
medications
HPI: Headache
onset - time of day?
duration - relieved by medication or sleep, clusters
location - entire head, neck, sinus, behind eyes,
character
severity
visual prodone - scotoma, hemianopia, decreased vision or blindess
pattern - awakens patient, worse in evenings?
change in LOC
associated symptoms
precipitating factors - alcohol, fever, fatigue, food, stress, allergies, menstrual cycle, sexual, oral contraceptives, caffeine
treatment efforts medications
HPI: Stiff neck
neck injury or stain, head injury, swelling
fever, bacterial or viral
character - limited ROM, pain with movement, pain relieved by movement, radiating
predisposing factors - unilateral vision, hearing loss, work position
efforts to treat - heat or PT
HPI: thyroid problems
Change in temperature preference
swelling of neck - dysphagia, redness, pain with touch,
change in texture of hair, skin and nails
change in emotional stability - mood or energy
increased prominence of eyes (exopthalmus)
tachycardia, palpitations
change in menstrual flow
change in bowel habits
medications: thyroid preparations
PMHx
head trauma, subdural hematoma, recent lumbar puncture
radiation treatment around head and neck
Headaches: migraines, vascular
surgery for tumor, goiter
seizure disorder
thyroid dysfunction
FH
headaches: type, character
thyroid dysfunction
Personal and Social
Employment risks
stress
injury risks
nutrition - intolerances, skipping meakls
use of alcohol, street, recreational drugs
sports played, weight training, new activities, use of productive padding and helmet if necessary
Hx for infants
prenatal hx - maternal use of drugs, uterine abnormalities, treatment of hyperthyroidism
birth hx - firstborn usually torticollis, c-section, difficult delivery,
unsual head shape - bulging or flattening
head control
acute illness - diarrhea, vom, fever, limited head movement, irritability (meningitis)
congenital abnormalities - craniofacial, microcephaly
neonatal screening for hypothyroidism -
Hx for pregnant women
Gestation or postpartum duration
presence of preexisting conditions
hx of pregnancy -induced HTN
use of alcohol or recreational drugs
Hx for older adults
Dizziness with head or neck movement
weakness or impaired balance
Inspection of head and face
facial features facial asymmetry tics spasms, tremor? - horizontal jerking or bobbing head position and shape - upright and still skull size and shape scalp hair pattern
Palpation of head and face
skull symmetric and smooth scalp movement hair texture temporal arteries temporomandibular (TMJ) joint salivary glands
Percussion and Auscultation
Percussion is not routinely performed
Auscultation is only used for bruits in cerebral aneurysm or temporal arteritis
Neck
muscle symmetry alignment of trachea landmarks of triangles fullness at base of neck masses webbing unusual shortness asymmetry carotid artery prominence JVD ROM
Palpation of Neck
tracheal alignment
smoothness and tenderness of hyoid bone, thyroid cartilage, cricoid cartilage
tracheal tugging (possible aortic aneurysm) Cardarelli sign
Lymph nodes
Inspection of thyroid gland
symmetry and swallowing symmetry
palpation of thyroid gland
size and shape
configuration and consistency
tenderness
nodules
Auscultation of thyroid gland
If enlarged, auscultate for vascular sounds
A hypermetabolic state increases blood supply and soft rushing sound (vascular bruit) may be heard
Examination in infants
head circumference head symmetry and shape fontanels scalp scaling or crusting, dilated scalp veins hair and hairline cephalhematoma head control, position and movement
Inspection of infants
facial features, symmetry
neck symmetry, size and shape
Palpation of infants
suture lines and fontanels - sites of fusion should not be palpable after 6 months, sagittal suture may be felt
craniotabes: softening of the outer table of the skull
neck muscle tone and masses
trachea
thyroid goiter
Scalp should move freely over skull c no tender, swelling or depression
Transillumination
Inspect skull of infants for possible lesions or rapidly increasing head circumference
A ring of 2cm or less (or 1cm at occiput)
Any larger will indicate excess fluid or decreased brain tissue in the skull
Palpation in children
Can be performed with one finger
Bruits common up to age 5
Thyroid may or may not be palpable
Examination of pregnant women
inspect for chloasma - dark brown “confetti” blotches on face
Palpate for hypertrophy of thyroid
Auscultate for thyroid bruit
Examination in older adults
facies - facial distortions
sunken eyelids, loose and wrinkled
evaluate ROM for pain or crepitus or jerkiness
Palpate thyroid for nodules or abnormalities
Thyroid will be more fibrotic
Feels nodular an irreguar
Abnormalities of the head
Classic migraine Common migraine cluster hypertensive muscular tension temporal arteritis
Abnormalities of thyroid
Hypo-, hyperthyroidism
Myxedema - skin disorder
Graves disease
Autoimmune, antibodies go to TSH, leading to overactive thyroid
Hashimoto disease
Autoimmune antibodies AGAINST thyroid causing hypothyroidism
Thyroid isthmus
lies across the trachea below the cricoid cartilage
A pyramidal lobe extends upward from isthmus and slightly to the left of midline
present in about 1/3 of population
Head bobbing may indicate?
aortic insufficiency if nodding is synchronized c a pulse
Unilateral hearing loss indicator
holding the head tilted to one side to favor good eye or ear or torticollis (excessive contraction of SCM)
Facies
edema, bruising, coarsened features, exophthalmos (eye-bulging), hirsutism, lack of expression, excessive perspiration, pallor or pigmentation
When facial asymmetry is present….
Note whether features on one side of the face are affected or one portion such as forehead, lower face or mouth.
Facial nerve paralysis when entire side of the face is affected and suspect facial nerve weakness when lower face is affected
Mouth problem? peripheral trigeminal nerve
Tics
spasmodic muscular contractions of the face, head or neck
Possibly psychogenic or Tourette’s
Alopecia
hair loss
Bitemporal recession of hair or balding at the crown is common in men
Hair loss in younger girls may be d/t tight braiding
Fungal infection of scalp may be tinea capitis
Palpation of salivary glands
check for asymmetry or enlargement
fixed, movable, soft, hard, tender or nontender
Have pt open mouth to express material through ducts
Stenson duct
is the parotid duct that opens into the mouth next to the maxillary second molar tooth
Submandibular duct (Wharton duct)
opens in a small papilla at the sides of the frenulum
Enlarged, tender gland may indicate either viral or bacterial infection, or a ductal stone preventing saliva from exiting gland.
Discrete nodule may be cyst or tumor (benign or malignant)
Chvostek sign
Percussion of masseter muscle may produce a hyperactive masseteric reflex in those c hypocalcemia
Webbing, excessive cervical skin or an unusually short neck may be…
Chromosomal abnormality
Turner syndrome
Cervical lymphadenitis
Edema of the neck may be a local infection
Mass filling the base of the neck or visible thyroid tissue that glides upward when the patient swallows may be enlarged thyroid
ROM of neck
flex, extend, rotate, and laterally turn head and neck
Movement should be smooth and painless and not cause dizziness
Nuchal ridgidity, resistance to flexion, may be meningeal irritation (CN XI)
Compare space between the trachea and SCM on each side
Unequal space may indicate displacement of the trachea from midline and may be associated with a mass or pathologic condition in chest
Thyroid cartilage
Hyoid, thyroid and cricoid should be smooth and nontender and should move under finger when patient swallows
Thyroid Gland - Swallowing
Inspect for size, symmetry and contour
Inspect lateral side for enlargement
Inspection for goiter
no visible thyroid on lateral inspection
Cardarelli sign
pressing and displacing thyroid to pt’s left
increase contact between left bronchus and aorta
Systolic pulsations form aorta can be felt at the surface is aneurysm is present
Oliver sign
grasp cricoid cartilage and applying upward pressure whle the patient stands with his or her chin extended up
Downward tug may be felt if aneurysm is present
Abnormalities in thyroid during swallow eval
Right lobe 25% larger then left
consistency should be firm yet pliable
coarse tissue or gritty sensation may be inflammation
enlarged, tender thyroid is thyroidits
