Head and Neck Assessment Flashcards
Sections of the cranium
neurocranium and viscerocranium
How many bones comprise the skull?
21
What is the only movable bone on the skull?
mandible
Function of the foramina on the skull
openings through which cranial nerves, arteries, veins, and other structures pass
How many bones establish the frontal region of the skull?
One
What does the frontal bone form?
The forehead, anterior cranial floor, and part of the eye orbit
How many bones form the parietal region of the skull?
Two
How many bones form the temporal region of the skull?
Two
Where is the sphenoid bone and what does it form?
Anterior base of the skull and forms the walls of the orbit.
What are the main sutures of the skull?
Coronal, sagittal, and lambdoid
What do the skull sutures fuse together?
Coronal: frontal to parietal bones
Sagittal: parietal bones
Lambdoid: occipital to parietal
How many facial bones are there?
14
Which facial bones are paired?
Zygomatic, lacrimal, nasal, inferior nasal conchae, palatine, maxilla
What are the unpaired facial bones?
vomer (nasal septum), mandible
What is assessed when observing facial landmarks?
Size
Shape
Position
Prominence
Function of neck muscles
Speech
Swallowing
Stabilization
Purpose of anatomic “triangles” of the neck
Useful in assessing superficial structures
Components of the anterior triangle
bifurcation of common carotid artery, anterior cervical lymph nodes, facial, glossopharyngeal, vagus, accessory, and hypoglossal cranial nerves.
Size of the thyroid with age
Increases in volume with age and body weight
Most common presenting symptom of the head and neck
Headache, neck pain
Red flags indicating secondary headache disorder
Systemic symptoms: unexplained fever, weight loss, myalgia
Neurologic symptoms: ALOC, sensory loss, weakness
Onset: sudden
Older age: new onset in those >50yrs
Pattern change: 4 Ps of pattern change
What are the 4 Ps of pattern change?
Progressing to daily
Precipitated by valsalva
Postural aggravation
Papilledema
How do you begin a head and neck exam?
observation
What are you OBSERVING for in a head and neck exam?
symmetry
quality/condition of skin and hair
alignment
pain/ROM
What are you PALPATING for in a head and neck exam?
edema tenderness clicking nodules sensation
Is percussion necessary in a head and neck exam?
No, unless there are specific concerns or symptoms
What are some major laboratory considerations for the head and neck?
Thyroid function (TSH, T3, T4, free T4) Parathyroid function (PTH, vitamin D, Calcium)
What are some imaging considerations for the head and neck?
imaging is not necessary for uncomplicated headaches and as long as there are no red flags for structural disorders
What is a CT scan of the head most indicated for?
Skull fracture, intracranial bleed
What is an MRI of the head most indicated for?
Prolonged symptoms, worsening symptoms, or suspected structural pathology
How should evaluation of a thyroid nodule begin?
TSH level
What diagnostic test should be done if the TSH is high or low?
thyroid ultrasound
What is the next step if a thyroid ultrasound has abnormal results?
fine-needle aspiration
What are the symptoms of an epidermal hematoma?
The pt will have a brief loss of consciousness, regaining of consciousness, followed by progressively worsening headache, then they become obtunded
What is an epidermal hematoma?
A neurosurgical emergency in which the meningeal artery becomes severed from either blunt trauma or other traumatic injuries
What are two major signs of a skull fracture?
Raccoon eyes=more serious basal skull fracture
Battle’s sign (mastoid ecchymosis)= basal skull fracture
What is the most common type of skull fracture?
Linear fracture that traverses the full thickness of the bone
Signs and Symptoms of a mild TBI
Incoordination Inability to focus/blank stare/stunned appearance Disorientation, slurred speech Headache, dizziness Emotional deficits/memory deficits
Key assessment of a TBI
History of the incident
Current symptoms/mental status
Neurologic exam
Key signs and symptoms of hypoparathyroidism
paresthesia of the fingertips, toes, and lips, myalgia, muscle spasms, fatigue, and dry skin.
Key signs and symptoms of hyperparathyroidism
Kidney stones Abdominal pain Joint/bone pain osteoporosis fatigue depression *more likely in older adults
Causes of hypothyroidism
iodine deficiency Hashimoto's thyroiditis (autoimmune thyroiditis) medications (lithium, immunotherapies) radioactive iodine therapy thyroidectomy pospartum thyroiditis
Key assessment findings for hypothyroidism
fatigue, weakness, sob on exertion cold intolerance weight gain constipation cognitive slowing bradycardia, diastolic hypertension delayed relaxation of DTRs periorbital edema, tongue enlargement dry skin, hair loss myalgia, arthralgia heavy menstrual bleeding
Causes of hyperthyroidism
Grave’s disease (autoimmune)
Goiter
toxic adenoma
Iodine-induced (too much contrast)
Common signs of hyperthyroidism in older adults
unexplained weight loss
decreased appetite
new onset a-fib
Key assessment findings for hyperthyroidism
diaphoresis heat intolerance hyperpigmentation, thinning of hair stare, impaired eye movement exophthalmos tachycardia, systolic hypertension, palpitaitons weight loss anxiety tremor
Signs of neoplasm in a head and neck exam
fixed hard mass dysphagia hoarseness cervical lymphadenopathy vocal cord paralysis tracheal deviation
Individuals at risk for thyroid cancer
History of childhood head or neck irradiation
<30 years of age
family history of thyroid cancer
Facial characteristics of those with fetal alcohol syndrome
microcephaly epicanthal folds smooth philtrum flat nasal bridge upturned nose thin upper lip
Characteristics of Turner syndrome
low hairline
thickened neck
prominent ear lobes
