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Clinical Assessment > Head, Face, and Neck > Flashcards

Head, Face, and Neck Flashcards

1
Q

What are the things you ask about when a patient has a headache?

A
  • recurrent, new, or uncharacteristic?
  • Location and severity
  • associated nausea or vomiting, vision changes, neurologic changes
  • chronology of symptoms
  • Aggravation/Alleviation
  • Triggers
  • Family Hx
  • Past treatments or outcomes, Meds used
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2
Q

Scotomas

A

specks in the vision or areas where patient cannot see

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3
Q

PE of Head

A
  • Skin and hair –> scalp and face

- Bony structures –> skull and face

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4
Q

What are you looking for in the hair?

A

quantity, distribution, texture, and any pattern of loss

-loose flakes of dandruff

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5
Q

What are you looking for on the scalp?

A

-Scaliness, lumps, nevi, or other lesions
-redness/scaling = seborrheic dermatitis or psoriasis
soft lumps= pilar cysts

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6
Q

What are you looking for on the skull?

A

deformities, depressions, lumps or tenderness
enlarged skull= hydrocephalus or Paget’s disease
-Palpable tenderness of step-offs may be present after trauma

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7
Q

Battle’s sign

A

Brain injury presented as bruising behind the ears

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8
Q

Raccoon Eyes

A

Bruising around the eyes associated with Basilar skull fracture

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9
Q

Symptoms of Bell’s Palsy

A

Affected sign:

  • inability to wrinkle brow
  • drooping eyelid or inability to close eye
  • inability to puff cheeks; no muscle tone
  • drooping mouth; inability to pucker/smile
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10
Q

Symptoms of Nephrotic Syndrome

A
  • swollen pale face
  • swelling seen first around eyes and in the morning
  • eyes may become slitlike if swelling is severe
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11
Q

Symptoms of Hypothyroidism

A
  • swelling of face (doughy)
  • Fatigue
  • lethargy
  • weight gain with anorexia
  • cold intolerance
  • constipation
  • cramps
  • irregular menses
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12
Q

Symptoms of Cushing’s Syndrome

A
  • increased adrenal cortisol production
  • produces round (“moon”) face with red cheeks
  • excessive hair growth may be present in mustache and sideburn areas
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13
Q

Symptoms of Parkinson’s

A
  • decreased facial mobility blunts expression
  • masklike face may result, with decreased blinking and a stare
  • skin may become oily
  • drooling may occur
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14
Q

Symptoms of Acromegaly

A
  • increased growth hormone produces enlargement of bone and soft tissues
  • head is elongated, with bony prominence of the forehead, nose, and lower jaw
  • Nose, lips, and ears enlarge
  • facial features appear coarsened
  • most likely due to tumor on pituitary
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15
Q

Three Diseases associated with Facial Swelling

A

Cushing’s Syndrome, Nephrotic Syndrome, Myxedema

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16
Q

ROS of Neck and Endocrine

A
  • swollen glands or lumps in neck
  • heat/cold intolerance; sweating, history of thyroid enlargement or problems
  • Neck surgery, trauma, recent viral infection
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17
Q

PE of Neck

A
  • overlying skin and neck muscle
  • Contour/symmetry (tracheal deviation, lymphadenopathy, goiter, H & N alignment)
  • Scars
  • lesions, tenderness, erythema
  • Trachea
  • Lymph Nodes
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18
Q

What to look for in the lymph nodes?

A
  • Size, shape, consistency, mobility, tenderness
  • Use a circular motion w/pads of index & middle fingers
  • Examine both sides simultaneously
  • Shotty= lymph node that worked hard and became fibrous
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19
Q

Sequence of the Cervical Lymph Nodes

A
  1. Preauricular
  2. Posterior auricular
  3. Occipital
  4. Tonsillar
  5. Submandibular
  6. Submental
  7. Superficial
  8. Posterior Cervical
  9. Deep Cervical Chain
  10. Supraclavicular
20
Q

Preauricular Nodes

A

in front of the ear

21
Q

Posterior auricular Nodes

A

Superficial to the mastoid process

22
Q

Occipital Nodes

A

at the base of the skull posteriorly

23
Q

Tonsillar Nodes

A

at the angle of the mandible

24
Q

Submandibular Nodes

A

midway between the angle and the tip of the mandible

25
Q

Submental Nodes

A

midline a few centimeters behind the tip of the mandible

26
Q

Superficial Cervical Nodes

A

superficial to the sternomastoid

27
Q

Posterior Cervical Nodes

A

Along the anterior edge of the trapezius

28
Q

Deep cervical chain Nodes

A

deep to the sternomastoid

-need to hook thumb and fingers around either side of sternomastoid to find them

29
Q

Supraclavicular Nodes

A

deep in the angle formed by the clavicle and the sternomastoid

30
Q

Cervical nodes & GABHS

A
  • Sore throat

- Enlarged & tender: tonsillar, submental & submandibular nodes

31
Q

Cervical nodes & mononucleosis

A
  • Enlarged & tender: posterior
  • Fever, fatigue, sore throat, rash
  • Epstein-Barr virus
32
Q

Cervical nodes & malignancy

A
  • Stony hard, fixed, enlarged
  • Non-tender
  • Discrete
  • B/L or U/l
33
Q

Signs of Hypothyroidism

A
  • Bradycardia
  • dry, coarse, cool skin, sometimes yellowish
  • somnolent (drowsy)
  • periorbital puffiness
  • delayed deep tendon reflex
  • no lateral eyebrows
  • decreased systolic and increased diastolic
34
Q

Symptoms of Hyperthyroidism

A
  • Nervous
  • Good appetite with weight loss
  • sweating and heat intolerance
  • palpitations
  • amenorrhea (absence of menstruation)
  • frequent BMs
  • tremors
35
Q

Signs of Hyperthyroidism

A
  • Exophthalmos (with Grave’s disease)
  • tachycardia
  • warm, smooth, moist skin
  • palmar erythema
  • proptosis/lid lag stare
  • hyper-reflexia
  • tremors
  • Increased systolic and decreased diastolic
36
Q

Exopthalmos

A

bug-eyed appearance because fat and tissue deposits behind eye push eye forward

37
Q

Proptosis

A

lid takes longer to close

38
Q

Warning Signs (“red flags”) of Headaches

A
  • Progressively severe or progressive over 3 months
  • Sudden onset
  • New onset 50+ y/o
  • Affected by change in position
  • Triggered by Valsalva maneuver
  • Associated: F/C, night sweats, wt loss, papilledema, neck stiffness, focal neurologic deficits
  • Confirmed CA, IUP, HIV
  • Recent head trauma
39
Q

Attributes of Migraines

A
  • U/L - throbbing, aching, variable pain scale
  • Timing: rapid onset, peak 1-2 hrs, duration 4-72 hrs, recurrent (weekly to monthly)
  • Associated: N/V, photophobia, phonophobia, aura: visual or motor
  • Triggers: EtOH, food, stress, menses, barometric pressure/altitude, noise, light
  • Relief: quiet & dark, sleep, lying still
40
Q

Attributes of Tension Headaches

A
  • B/L – generalized/localized back of head & upper neck or frontotemporal
  • Steady pressing or tightening, non-throbbing, low to medium pain scale
  • Timing: gradual onset, duration 30 min–7 days, episodic to chronic
  • Triggers: sustained muscle tension
  • Relief: massage, relaxation, ergonomics
41
Q

Attributes of Cluster Headaches

A
  • U/L – behind/around eye or temple
  • Deep, continuous & severe pain
  • Timing: abrupt, peaks in minutes, duration – 3 hrs, episodic, clustered (several/day x 1-2 mos) w/relief 6-12 mos
  • Associated: lacrimation, rhinorrhea, miosis, ptosis, eyelid edema, conjunctival infection
  • Triggers: EtOH
42
Q

Dizziness

A

-nonspecific term used by patients that encompasses several problems including vertigo, presyncope, disequilibrium, psychiatric, multifactorial/unknown

43
Q

Vertigo

A

spinning sensation accompanied by nystagmus and ataxia

44
Q

Ataxia

A

lack of coordinated voluntary muscle movements

45
Q

Nystagmus

A

fine rhythmic oscillation of the eyes; normal in extreme lateral gaze

46
Q

Presyncope

A

a near faint from “feeling faint or lightheaded”

47
Q

Disequilibrium

A

unsteadiness or imbalance when walking

Clinical Assessment (11 decks)

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