Head, Face, Neck, & Lymphatics Flashcards
Vertex
Top of the head
Scalp
Calvarium
Parotid duct AKA…
Stenson’s duct, drains saliva into the mouth just behind 2nd molar
Worton’s duct
Submandibular duct
TMJ
Tempormandibular joint
Common or concerning symptoms of the head include…
Headache, history of head injury
Common or concerning symptoms of the eyes include…
Visual disturbances, spots (scotomas), flashing lights, use of corrective lenses, pain, redness, excessive tearing, double vision (diplopia)
Common or concerning symptoms of the ears include…
Hearing loss, ringing (tinnitus), vertigo, pain, discharge
Common or concerning symptoms of the nose include…
Drainage (rhinorrhea), congestion, sneezing, nose bleeds (epistaxis)
Common or concerning symptoms of the oropharynx include…
Sore throat, gum bleeding, hoarseness
Common or concerning symptoms of the neck include…
Swollen glands, goiter
What are the structures of the face
Maxilla Mandible Zygomatic Arch Nasal bones TMJ
What is the TMJ
Joint where the mandible interacts with the temporal bone
What is unique about the zygomatic bone (think trauma)
It is often fractured when Pt is punched in the face (AKA orbital floor fracture)
What are the palpebral fissues
The space between the eye lids
What do the palpebral fissures look like in a downs pt? What about FAS pt?
They are upslanted in downs syndrome. They are shorter horizontally in fetal alcohol syndrome
What are the epicampful folds
Where the eyelids meet laterally (think palperbral commisure)
What are the nasolabial folds
The line from nares to the corner of the mouth
What do the nasolabial folds look like in Pts who have had a stroke
The pt will have facial droop due to damage to facial nerve so you won’t see the fold on the side effected by the stroke
What are the sinuses of the face
Frontal
Sphenoid
Ethmoid
Maxillary
What is the NLS?
The nasolacrimal sinus
Where does the NLS drain
Duct/sinus drains into the inferior meatus of the nose
Where are the frontal and maxillary sinuses
Frontal = superior to eyebrows Maxillary = inferior to orbits
What is the Down’s syndrome facies? What are other signs of Down’s?
Slanted palpebral fissues, flatened nasal bridge, prominent epicanthal folds, low set ears, large tongue, & brushfield spots on the iris
What is the Cushing’s Syndrome facies (i.e. Cushoid Facies)
Round face, double chin, increased cheek fat deposits, and facial flushing
What are the signs of FAS
Low nasal folds, flat face, Shorter nose, Underdeveloped jaw, & thin upper lip with smooth filtrum (most characteristic)
What is the most common cause of acromegaly?
pituitary adenoma secreting GH
What are the signs of acromegaly
Enlargement of hands, feet, and head Frontal bossing Palmar thickening Coarse features Prognathism (large, protruding jaw)
What is a pituitary issue called when it occurs before puberty? What about after puberty?
Pituitary issue before puberty = giantism
Pittuitary issue after puberty = acromegaly
What are possible causes of parotid enlargement
Sjogren’s Syndrome
Mumps
Chronic disease (DM, obesity, liver cirrhosis, etc)
Neoplasm
What is Sjogren’s?
It is an autoimmune disorder that attacks saliva secreting glands/cells in the body
What are some signs Sjogren’s is associated with
Associated with dry eyes, dry mouth, and arthritis leading to 40% increased chance of lymphoma
How is Sjogren’s diagnosed? How is it treated?
Dx with +SSA/SSB antibodies
Rx of cyclophosphamide and/or corticosteroids
If the parotid enlargement is unilateral it is most likely due to…
A neoplasm
What would a parotid enlargement due to neoplasm feel like
It would be hard and nontneder
If the parotid enlargement is bilateral it is most likely due to…
An infection
What is an infection in the parotid gland called
Parotitis
What is the most common cause of parotitis
Infection by Staph aureus
What would you notice upon palpation with parotitis
Pus from stenson’s duct, warm, & tender
What is enlargement of the thyroid called
Thyromegaly
What is the most common cause of thyromegaly world wide
Iodine deficiency
Multinodular goiter characteristics are…
Rough, uneven, large
In Hashimoto’s the thyroid enlargement is due to…
Hypothyroidism
In Grave’s thyromegaly is due to…
Hyperthyroidism
Some signs/symptoms of thyromegaly include…
Horseness, SOB, stridor, and dysphagia (from compression on trachea)
Besides thyromegaly, the main characteristic of Grave’s disease is…
Exopthalmous (bulging eyes due to autoimmune response to the soft tissue around the eyes)
Solitary nodule upon palpation should raise the flags for…
A malignancy
A malignant nodule is… (characteristics)
Fixed, hard, non-tender, solitary
The chance of malignancy is much more common in what type of patient (age)
Chance in a pediatric Pt is much more common than in an adult
What structures make up the anterior triangle of the neck? What about the posterior triangle?
Posterior – trapezius, SCM, and clavicle
Anterior – SCM, mandible, neck midline
What is lymphadenopathy (LAD)
Swollen, palpable, irregular lymph nodes
LNs that are solitary, hard, fixed, non-tender, and growing are characteristic of…
A malignancy
LNs that are solitary, erythematous, tender, fluctuant, and growing are characteristic of…
An infection (local)
LNs that are diffuse, symmetric, nodular, and static are characteristic of…
A systemic disease
LNs that are solitary or grouped, tender, and mobile are characteristic of…
A regional infection (such as sarcoid or lymphoma)
What are shotty nodes? What are their characteristics?
They are hard LNs due to hyperplastic lymph from previous inflammatory process. They should be static and mobile
Enlargement of supraclavicular nodes, especially on L, suggests…
mets from thoracic or lung malignancy
Supraclavicular adenopathy is…
swelling of the supraclavicular nodes; should NEVER be present; may be indicitative of thoracic, lung, or gastric cancer
Tinia capitus is…
Dermatafite infection of the scalp, can cause allopicia, often see exclamation point hairs; if untreated may turn into full blown kerion which is a full blown fungal infection; treat with systemic drugs
Excessive scaling on scalp may be…
Cellulitis or may be subarachnic dermatitis;Tx is with selenium sulfide
With polysistic ovarian syndrome a patient may have…
Excess facial hair due to excess testosterone
Roasia in elderly exhibits as…
Redness in face
What are the headache warning signs?
More frequent/severe over 3 months
“Thunderclap” “Worst of my life”
New onset after 50
Associated constitutional (fever, sweats, wt loss)
Known Ca, HIV, or pregnancy
Recent head trauma
Focal deficits, vision change, neck stiffness (meningitis, neuro deficits, etc)
What is the main reason we palpate the retinal arteries?
To make sure there is adequate blood flow to the retinas
What is a condition that may cause irregular temporal pulses?
Giant cell arteritis
If the pt has more pain in their sinuses when bending forward what condition may they have?
Sinusitis
Pt has unilateral facial pain that is tender to palpation, dull toothache, purulent nasal drainage (symptoms greater then 7 days). What might they have?
Bacterial sinusitis
Tracheal deviation may be a sign of…
Pneumothorax, mediastinal mass, or atelectasis
What type of curvature should the C-spine have
Lordotic
What are the origins and insertions of the trapezius
Origin – nuchal line of occipital bone; sp of C7-T12
Insertion – lateral clavicle, acromion process, and scapular spine
How many different directions can the neck move
6 directions
