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Clinical Medicine > Head and Neck Exam > Flashcards

Head and Neck Exam Flashcards

1
Q

Common Head Sxs

A
  1. HA
  2. Change in vision
  3. Double vision
  4. Hearing loss, earache, tinnitus
  5. Vertigo
  6. Nosebleed or epistaxis
  7. ST, hoarseness
  8. Swollen glands
  9. Trauma
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2
Q

Common concussion Sxs

A
  1. Sxs such as HA
  2. Physical signs such as unsteadiness
  3. Impaired brain function or confusion
  4. Abnormal behavior
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3
Q

Sports Concussion Assessment in Iowa

A
  1. No student should return to play/practice/ competition on the same day as concussion
  2. Needs medical clearance to RTP
  3. Medical team must follow a stepwise protocol for RTP
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4
Q

Classic Migraine

A
  1. Unilateral
  2. Pulsating or throbbing
  3. Hours to days
  4. Female
  5. Nausea/ vomiting
  6. Missing meals, menses, BCP, stress, certain food
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5
Q

Cluster Headache

A
  1. Adulthood
  2. Unilateral
  3. 0.5 to 2 hours
  4. Intense burning, searing, knife like
  5. Several nights for several days then gone
  6. Males
  7. Increased tearing/ nasal discharge
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6
Q

Tension Headache

A
  1. Adulthood
  2. Unilateral or bilateral
  3. Hours to days
  4. Anytime
  5. Bandlike, constricting
  6. No prodrome
  7. Stress, anger, teeth grinding
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7
Q

Medication Rebound Headache

A
  1. Diffuse
  2. Hours
  3. Hours or days of last dose
  4. Dull or throbbing
  5. Daily analgesics- abrupt stop
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8
Q

Hyperthyroidism

A
  1. Nervousness
  2. Weight loss
  3. Excessive sweating and heat intolerance
  4. Warm, smooth, moist skin
  5. Graves Disease
  6. Tachycardia
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9
Q

Hypothyroidism

A
  1. Fatigue, lethargy
  2. Modest weight gain
  3. Dry, coarse skin- cold intolerance
  4. Swelling of face, hands, legs
  5. Bradycardia
  6. Impaired memory
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10
Q

Additional Pediatric Head Examinations

A
  1. Head Circumference- 0-24 months
  2. Transillumination of the skull for excess fluid accumulation
  3. Palpation
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11
Q

Head length at Birth

A

1/4 the body length

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12
Q

Head Weight at Birth

A

1/3 the body weight

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13
Q

Head Sutures

A

Membranous tissues separating skull bones

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14
Q

Fontanelles

A

Area where the sutures intersect

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15
Q

Anterior Fontanelle

A
  1. 4-6 cm at birth

2. Closes around 18 months

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16
Q

Posterior Fontanelle

A

Closes around 2 months

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17
Q

Microcephaly

A

Smaller sized head

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18
Q

Hydrocephalus

A

Increase ICP from deficient spinal fluid circulation causes enlargement of the calvarium before the sutures are closed

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19
Q

Normal Variants of the Pediatric Head

A
  1. Overlapping sutures: cause ridge and may decrease size of anterior fontanelle
  2. Molding
  3. Caput Succedaneum
  4. Cephalohematoma
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20
Q

Molding

A

Repositioning of the cranial bones to allow passage of the baby through the birth canal

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21
Q

Caput Succedaneum

A
  1. Subcutaneous edema over the presenting part of the head at delivery
  2. Usually occurs over the occitoparietal area and crosses suture lines
  3. Transilluminates
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22
Q

Cephalohematoma

A
  1. Subperiosteael collection of blood
  2. Does not cross over suture lines
  3. Commonly found in the parietal region
  4. Does not transilluminate
  5. May not be obvious at birth
  6. May take 10-14 days to resolve
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23
Q

Plagiocephaly

A
  1. Occurs when infant lies on one side constantly
  2. May cause facial asymmetry
  3. Treatment: parental education, different holding patterns, placing objects of interest opposite normal head rotation
  4. Self resolves with age and more upright, active babies
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24
Q

Craniosynostosis

A
  1. Premature closure of sutures, can cause asymmetry
  2. Early closure of fontanelles
  3. Bracycephaly: premature closure of coronal suture
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25
Q

Congenital Muscular Torticolis

A
  1. Injury and possible bleed into sternocleidomastoid muscle at birth
  2. Treatment with stretching exercises
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26
Q

Whisper Test

A
  1. Stand behind and to side 1-2 ft away
  2. Pt places finger in the non tested ear and moves it around
  3. Exhale fully and then whisper 3 numbers or letters
  4. Ask the patient to repeat what they heard
  5. Repeat for the other ear
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27
Q

Weber Test

A
  1. Assesses hearing: helps to differentiate between neurosensory and conductive hearing loss
  2. Need 512 Hz vibrating fork
  3. Place in the middle of the pt’s vertex
  4. Ask “where do you hear sound?”
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28
Q

Rinne Test

A
  1. Helps to determine whether each ear detects sound better through air or bone
  2. A vibrating fork (512 Hz) is placed on pt’s mastoid process then ask the pt to tell you when they no longer hear the sound, note the time in seconds
  3. Immediately move the fork so the vibrating tines are about 2.5 cm from the pt’s auditory canal
  4. Ask the pt to tell you when they can’t hear the sound, note the time in seconds
  5. Normal test hears sound through air longer than bone
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29
Q

Conductive Hearing Loss

A
  1. External or middle ear disorder
  2. Causes: foreign body, otitis media, perforated eardrum, otosclerosis
  3. Sound lateralizes to impaired ear
  4. Bone conduction longer then or equal to air conduction
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30
Q

Sensorineural Hearing Loss

A
  1. Inner ear disorder involving the cochlear nerve
  2. Causes: loud noise exposure, inner ear infections, trauma, acoustic neuroma, familial disorders
  3. Sounds lateralizes to the good ear
  4. Air conduction longer than bone conduction
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31
Q

Pediatric External Ear Exam

A

Note position in relation to the eyes: upper portion of auricle joins the scalp at or above the level of a line drawn from the inner and outer canthus of the eye

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32
Q

Pediatric Otoscopic Exam

A
  1. Difficult to see the TM in the first few days of life secondary to the vernix caseosa accumulation
  2. Ear canal goes directly down from the outside
  3. Pull the ear gently downward to see the TM
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33
Q

Pneumatic Otoscopy

A
  1. Should be a part of every exam of the ear

2. Diminished movement is found in ear effusions and acute otitis media

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34
Q

Pediatric Nose Exam

A
  1. Newborns are “obligate” nose breathers
  2. Test patency by occluding one nare and observe breathing pattern
  3. Catheter placement if concerned
  4. Assess for a crease
  5. Asses for allergic shiners
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35
Q

Sinus Development

A

Maxillary: 1 year
Sphenoid/ Ethmoid: 6 years
Frontal: 10 years

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36
Q

Pediatric Mouth Exam

A
  1. Inspect the lips for any cleft
  2. Inspect the palate for any cleft
  3. Inspect the mouth for antenatal teeth
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37
Q

Epstein’s Pearls

A

Pin head sized white or yellow, rounded elevations that are located along the midline of the hard palate near its posterior border or gums- causes by retained secretions and disappear within a few weeks to months

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38
Q

Pediatric Tonsils

A
  1. Relatively larger in middle childhood than in infancy or adolescence
  2. Peak size of tonsils occurs between 2-6 years of age
  3. Look for other signs of infection- erythema, cobblestoning, exudate, asymmetry
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39
Q

Teeth Eruption

A
  1. Teeth begin to erupt by 6-7 months with upper and lower central incisors
  2. Four teeth are added every 4 months after that
  3. Full complement of teeth by 2-3 years
  4. Shedding of primary teeth usually occurs at 5 years
  5. Secondary teeth usually begin in the 6th or 7th year
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40
Q

Pediatric Nasal Foreign Body

A
  1. Common in children from 9 months to 5 years
  2. Chronic unilateral rhinitis or congestion
  3. Foul smell or bad breath
  4. Treatment: removal
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41
Q

Alopecia

A

Hair loss

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42
Q

Angular cheilosis

A

Reddish inflammation of the lip or lips and production of fissures that radiate from the angles of the mouth

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43
Q

Anosmia

A

Absence of the sense of smell. It may be due to lesion of the olfactory nerve, obstruction of the nasal fossae, or functional, without any apparent causative lesion

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44
Q

Branchial cleft cyst

A

a congenital lesion due to the incomplete involution of the branchial cleft which is usually located in the lateral neck

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45
Q

Bulging fontanel

A

A condition of the fontanel that may indicate increased ICP

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46
Q

Caries

A

Microbial destruction or necrosis of teeth

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47
Q

Cerumen

A

Ear wax

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48
Q

Chelitis

A

Inflammation and cracking of the lips

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49
Q

Cholesteatoma

A

a mass of keratinizing squamous epithelium and cholesterol in the middle ear, usually caused by chornic otitis media, with squamous metaplasia or extension of squamous epithelium inward to line an expanding cystic cavity that may involve the mastoid and erode surrounding bone

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50
Q

Craniosynostosis

A

premature closure of sutures of the skull

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51
Q

Chloasma (mask of pregnancy)

A

common facial discoloration seen in pregnancy

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52
Q

Encephalocele

A

A neural tube defect with protrusions of brain and membranes that cover the openings in the skull

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53
Q

Epistaxis

A

Bleeding from the nose

54
Q

Epstein Pearls

A

Multiple, small, white epithelial inclusion cysts found in the midline of the palate in newborn infants

55
Q

Fordyce spots

A

Ectopic sebaceous glands of the buccal muscosa appearing as small yellow- white raised lesions found on the inner surface and vermilion border of the lips

56
Q

Frenulum

A

Small fold of tissue that attaches the tongue to the floor of the mouth

57
Q

Gingivitis

A

Inflammation of the gingiva

58
Q

Hyperthyroidism

A

Overactivity of the thyroid gland

59
Q

Hypothyroidism

A

Underactivity of the thyroid gland

60
Q

Koplik’s Spots

A

Small red spots with bluish- white centers on the buccal mucosa opposite the molar teeth, appearing in the prodromal stage of measles

61
Q

Leukoplakia

A

Circumscribed, firmly attached, thick white patches on the tongue and other mucous membranes, often occurring as a precancerous growth.

62
Q

Microcephaly

A

Abnormal smallness of the head

63
Q

Molding

A

The size and shaping of the head of a newborn in accommodation to the birth canal

64
Q

Oropharynx

A

Area of the throat that is located between the mouth and nasopharynx

65
Q

Ossification

A

Formation of bone tissue

66
Q

Otitis Externa

A

Inflammation of the external auditory canal, usually due to bacterial or fungal infection; swimming, cerumen accumulation, foreign body, and trauma

67
Q

Otitis Media

A

Inflammation/ infection of the middle ear or tympanum

68
Q

Otosclerosis

A

Deposits of bone resulting in the immobilization of the stapes

69
Q

Peritonsillar abcess

A

Deep infection in the space between the soft palate and the tonsil

70
Q

Pharyngitis

A

Inflammation/ infection of the mucous membrane and underlying parts of the pharynx

71
Q

Pinna

A

Projecting shell- like structure on the side of the head, auricle

72
Q

Presbycusis

A

The impairment of hearing due to aging

73
Q

Rhinitis

A

Inflammation of the nasal mucosa

74
Q

Rhinorrhea

A

A thin watery discharge from the nose

75
Q

Thyroglossal duct cyst

A

A palpable cystic mass in the neck due to incomplete closure of the thyroglossal duct

76
Q

Tinnitus

A

An auditory sensation in the absence of sound heard in one or both ears, such as ringing, hissing or clicking

77
Q

Tophi

A

Small, whitish uric acid crystals along the peripheral margins of the auricles in persons who may have gout

78
Q

Torticollis

A

Abnormal contraction of the neck muscles resulting in an unatrual positioning of the head

79
Q

Torus mandibularis

A

A bony protuberance on the lingual aspect of the lower jaw in the in canine- premolar region

80
Q

Torus palatinus

A

A bony protuberance in the midline of the hard palate

81
Q

Tympanosclerosis

A

The formation of dense connective tissue in the middle ear, often resulting in hearing loss when the ossicles are involved

82
Q

Uvula

A

Conical projection of the posterior margin of the soft palate

83
Q

Vertigo

A

Illusion of rotational movement in a patient that is often associated with an inner ear disorder

84
Q

Webbing

A

Excessive posterior cervical skin that is often associated with chromosomal anomalies

85
Q

Xerostomia

A

Dry mouth

86
Q

Focusing Problems

A

Do we need glasses?

87
Q

Cataracts

A

Leading cause of blindness if not corrected

88
Q

Diabetes- Eye Exam

A

Leading cause of blindness <65 in the US. Cause cranial nerve paralysis of III, IV, and VI, and retinopathy

89
Q

Macular Degeneration

A

Central vision loss

90
Q

Glaucoma

A

Elevated pressure- peripheral vision lost first

91
Q

Transient loss of vision

A

Young pt may be due to migraine and in an older adult may be an emobli problem

92
Q

Flashes of light

A

Retinal detachment

93
Q

Diplopia

A

Double vision, 2 eyes alignment problem or one eye optical problem

94
Q

Snellen Eye Chart

A
  1. Position pt 20 ft from chart
  2. If they use glasses other than reading use them
  3. Cover one eye- read the smallest line
  4. Usually start left to right in one eye and then switch eyes and go right to left for the second eye
  5. Record as fraction
95
Q

Rosenbaum Chart

A
  1. Testing near vision with hand held card
  2. Helps identify the need for reading glasses or bifocals
  3. Held 14 inches from pt’s face
96
Q

Visual Fields by Confrontation

A
  1. Testing for defect in any quadrant of the field of vision
  2. Stand 3 ft from pt at eye level
  3. Pt needs to focus on your eye- use glasses or contacts
  4. Cover one eye, slowly bring your finger into the visual field halfway between you and the pt- 45 degree angle in each quadrant (4 per eye)
  5. Request they report how many fingers they see
97
Q

Assess Extra-ocular Muscles

A
  1. Eye movement is controlled by 3 cranial nerves, III, IV, and VI, and 6 extra-ocular muscles
  2. Stand 3 ft from pt and have pt follow your fingers without moving head
  3. Draw large “X” and then a “+” with index finger
98
Q

Nystagmus

A

A jerking or drifting of the eyes

99
Q

Accommodation Testing or Near Reaction Testing

A

Checking to see if the eyes will converge and the pupils will constrict
*older patients lose this ability

100
Q

Pupillary Responses

A
  1. Measure each pupil size- under normal light with a light shining in the eye
101
Q

Direct Pupil Reaction to Light

A

Look at pt’s right eye and shine a light into it, the constriction is the direct response

102
Q

Consensual Reaction to Light

A

Shine a light into the left eye and watch for constriction of the right eye

103
Q

Swinging Light Test

A
  1. Clinical test for functional impairment in the optic nerves
  2. Shine a light in one eye then rapidly swing over to the other eye
  3. Should have a slight dilation in the second eye while light is crossing the bridge of the nose, but it should still constrict equally to the first eye as the light enters the pupil
  4. If it continues to dilate rather than constrict an afferent defect is present (Marcus Gunn Pupil)
104
Q

Lateral Penlight Test

A
  1. Helps to estimate the depth of the anterior chamber of the eye
  2. Should be done before instilling mydriatic drops in the eye
  3. Shine light from the temporal side of the head across the front of the eye parallel to the plane of the iris
  4. Note the illumination of the iris nasally, if not lighted pt has a shallow anterior chamber indicating a risk of acute- angle glaucoma
105
Q

Corneal Light Reflex

A
  1. Testing for ocular alignment by reflecting light off the pt’s pupils
  2. Stand in front of the pt about 2-3 ft away and shine light towards pt and observe where light reflects
106
Q

Esotropia

A

Eye turned in, light reflected lateral to pupil

107
Q

Exotropia

A

Eye turned out, light reflected medial to the pupil

108
Q

Cover Test

A
  1. Test used to detect tropia
  2. Cover one of the pt’s eyes when they are focused on a specific point
  3. Observe movements in the uncovered eye
109
Q

Exotropic

A

Eye shifts outward

110
Q

Esotropic

A

Eye shifts inward

111
Q

Cover- Uncover Testing

A
  1. Used to detect presence of a phoria
  2. Cover and uncover an eye and observe whether the covered eye moves
  3. Results in esophoria or exophoria
112
Q

Corneal Sensitivity

A
  1. Testing cranial nerve V
  2. Out of line of vision, touch the cornea with a wisp of cotton
  3. If intact CN V senses the touch as a FB in the eye
  4. Sensory is CN V and motor response is CN VII
113
Q

Percentage of vision problems in preschoolers

A

5-10%

114
Q

Percentage of refractive errors in preschoolers

A

5-7%

115
Q

Percentage of strabismus present in preschoolers

A

4%

116
Q

Percentage amblyopia affects those with strabismus

A

40%

117
Q

Epicanthal Folds

A

Vertical fold of skin nasally that covers the lacrimal caruncle

118
Q

Red Reflex

A
  1. Orange to red light reflex from the fundus. This should be equal in both eyes and fill the pupil completely
  2. Absent or abnormal reflex is reason for referral
119
Q

Leukocoria

A

A white reflex and could be caused by a congenital cataract or retinoblastoma

120
Q

Age of visual fixation present

A

Birth

121
Q

Age fixation well developed

A

6-9 weeks

122
Q

Age visual following develops

A

3 months

123
Q

Age accommodation develops

A

4 months

124
Q

Age stereopsis develops

A

4 months

125
Q

Visual Screening at 6-12 months

A
  1. Red reflex and corneal light reflex
  2. Inspection
  3. Fix and Follow
126
Q

Visual Screening at 3-5 years

A
  1. Red reflex
  2. Inspection
  3. Visual Acuity
  4. Cover-uncover test
127
Q

Visual Acuity of newborn

A

20/400- 20/800

128
Q

Visual Acuity of 3 years and up

A

20/40 or better

129
Q

Strabismus

A

Misalignment of the eyes

130
Q

Pseudostrabimus

A
  1. An appearance of misalignment of the eyes without actual strabismus present
  2. Occurs most commonly when there is a broad nasal bridge
  3. Light reflection is in the same place in both eyes
131
Q

Amblyopia

A
  1. Loss of visual acuity due to active cortical suppression of the vision of the eye
  2. Strabismus is one of the main causes
  3. Single most effective screening test is the determination of visual acuity in noninvasive screening

Clinical Medicine (2 decks)

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