head, neck, and neuro Flashcards
what to do when inspecting
inspect first
then palpate
skull
- a rigid box that protects the brain
- includes the bones of the cranium and face
- supported by the cervical vertebra
cranial bones and sutures
bones - frontal, parietal, occipital, temporal
sutures - coronal, sagittal, lambdoid
structure and function of the head
14 facial bones also articulate at sutures
Facial expressions formed by facial muscles, which are mediated by cranial nerve VII, the facial nerve
Two pairs of salivary glands accessible to examination on the face:
Parotid glands are in cheeks over mandible, anterior to and below ear; the largest of salivary glands, they are not normally palpable
Submandibular glands beneath mandible at angle of jaw
Third pair, sublingual glands, lies in floor of mouth
Temporal artery lies superior to temporalis muscle, and
pulsation is palpable anterior to ear
structure and function of the neck
Neck delimited by
Base of skull and inferior border of
mandible above, and by manubrium
sterni, clavicle, first rib, and first
thoracic vertebra below
the neck is conduit to?
Vessels, muscles, nerves, lymphatics, and
viscera of respiratory and digestive
systems
Internal carotid branches off common
carotid and runs inward and upward to
supply brain
External carotid supplies face, salivary
glands, and superficial temporal area
major neck muscles
sternocleidomastoid, trapezius, both innervated by cranial nerve XI
sternocleidomastoid enables? (Exam)
Head rotation and flexion and divides each side of the neck into two triangles: anterior and posterior triangles
what moves the shoulders to extend and turn the head
two trapezius muscles
structure and function of the thyroid
Endocrine gland
Straddles trachea in middle of the neck
Synthesizes and secretes
Thyroxine (T4) and triiodothyronine (T3), which are hormones
that stimulate rate of cellular metabolism
The gland has two lobes
Connected in middle by a thin isthmus and above that by the
cricoid cartilage or upper tracheal ring
Thyroid cartilage
Small palpable notch in upper edge (“Adam’s apple” in males)
Cricoid cartilage or upper tracheal ring
Isthmus of the thyroid gland
developmental competence of pregnant female and aging adult
Pregnant female
Thyroid gland enlarges slightly during
pregnancy as a result of hyperplasia of
tissue and increased vascularity
Aging adult
Facial bones and orbits appear more
prominent
Facial skin sags resulting from
decreased elasticity, decreased
subcutaneous fat, and decreased
moisture in skin
Lower face may look smaller if teeth
have been lost
genetics and the environment in headaches
Headache
Leading cause of acute pain and lost productivity
Classified by etiology and often misdiagnosed
Types
Tension-type headaches (TTH) most common
Migraine – 2nd most common
Episodic and Chronic
Identify triggers
Environment, foods, and/or stress
Loss of productivity & impact on ADLs
subjective data in health history
headache
head injury
dizziness
neck pain, limitation of motion
lumps or swelling
history of head or neck injury
questions to ask about headaches
onset pattern characteristics
location pattern
pain characteristics
course and duration
precipitating factors
associated factors
alleviating factors
what makes it worse
presence of comorbidities
medication history
patient-centered care
questions to ask about head injury
Ask about
onset, setting, and description of injury
changes in levels of consciousness
loss of consciousness and/or fall
history of comorbidity
location of injury
duration/pattern of symptoms
presence of associated symptoms
treatment plan
emergency, hospitalization, and/or medication
inspecting and palpating the skull
Size and shape
Normocephalic: round and symmetric
Assess shape: place fingers in person’s hair and palpate scalp
Cranial bones that have normal protrusions:
Forehead, lateral edge of parietal bones, occipital bone, and mastoid process behind each ear
Temporal area
Palpate temporal artery above zygomatic (cheek) bone between eye and top of ear
inspecting the face
Facial structures
Always should be symmetric
Note facial expression and appropriateness to behavior or reported mood
Note any abnormal facial structures
Coarse facial features, exophthalmos, changes in skin color or pigmentation, or abnormal swellings
Note any involuntary movements (tics) in facial muscles; commonly, none occur
inspecting and palpating the neck
Head and neck symmetry
Head position is centered in the midline, and accessory neck muscles should be symmetric
Head should be held erect and still
Range of motion
Note any limitations
Test muscle strength
Observe for enlargement of glands and/or pulsations
Lymph nodes
Palpate nodes noting location, size, shape, delimitation, mobility, consistency, and tenderness
inspecting and palpating the trachea and thyroid
Trachea
Should be midline
Palpate for any tracheal shift
Note any deviation from midline
Thyroid gland
Difficult to palpate; check for enlargement, consistency,
symmetry, and presence of nodules
Position the patient for the best approach
Posterior approach
Anterior approach (alternate method)
Auscultate thyroid for bruit, if enlarged
physical examination on aging adults
Temporal arteries
may look twisted and prominent
In some aging adults, a mild rhythmic tremor of the head may be normal
Isolated head tremors are benign and include head nodding and tongue protrusion
If some teeth have been lost
lower face looks unusually small, with mouth sunken in
Neck may show an increased concave curve
to compensate for kyphosis
Maintain patient safety by indicating that the patient
performs ROM and position changes slowly
Minimize the potential for dizziness
abnormal findings of primary headaches
Diagnosed by patient history with no
abnormal findings on exam or laboratory
results
Types of headaches:
Tension, migraine, and cluster
Factors to review:
Definition, location, character, duration, quantity and severity, and timing
Aggravating symptoms or triggers, associated symptoms, and relieving factors, an effort to treat
congenital torticollis
Hematoma in one sternomastoid muscle, probably injured by intrauterine malposition, results in head tilt to one side and limited
neck ROM to the opposite side
generally born with it
simple diffuse goiter (SDG)
Endemic goiter due to iodine deficiency that results in chronic enlargement of the thyroid gland
thyroid-multinodular goiter
Multiple nodules usually indicate inflammation or multinodular goiter rather than a neoplasm; however, suspect any rapidly enlarging or
firm nodule
pilar cyst
Benign growth that presents as smooth, fluctuant swelling on the scalp
- typically here on the scalp
parotid gland enlargement
Rapid painful enlargement seen in response to mumps, blockage of duct,
abscess, or tumor
graves disease presentation
Physical presentation of neck and face
Goiter
Eyelid retraction
Exophthalmos
thyroid disorder: hypothyroidism
Physical presentation of neck and face
Puffy edematous face
Periorbital edema
Coarse facial features
Coarse hair and eyebrows
acromegaly
Elongated head, massive face, overgrowth of nose, lower jaw, heavy eyebrow ridge, and coarse facial features
Cushing syndrome
Classic “moonlike” face, red cheeks, and hirsutism
bell palsy
paralysis on one side of the face as a result of the LMN lesion
- generally resolves on its own
stroke or brain attack
UMN lesion leading to paralysis of lower facial muscles
parkinson’s
Classic “maskline” appearance, elevated eyebrows, staring gaze, oily
skin, and drooling due to dopamine deficiency
cachectic appearance
Sunken eyes, hollow cheeks, and defeated expression that accompanies chronic wasting diseases
when inspecting the TMJ what do you feel for (Exam)
popping or crepitus
healthy lymph nodes are?
Healthy lymph nodes are usually too small to feel, but if you can feel them, they should feel like small, smooth, pea-sized lumps that are movable under the skin and not tender
how to identify a lymph node that is indicating an issue with the body
swollen, painful and/or tender to the touch, like they are hard or stuck in place,
what to check with cranial nerves (Exam)
check for sharp or dull feelings
trigeminal (Exam)
sensory and motor functions
- sensory -> sensation (touch, pain, temp, proprioception)
- motor -> mastication (enables chewing, biting, and clenching the teeth)
steps for examination (Exam)
1) inspect and palpate the skin
2) inspect and palpate the face
3) inspect and palpate the neck
4) auscultate the thyroid (if enlarged) for bruit
