head, neck, and neuro

Question 1

what to do when inspecting

Answer 1

inspect first
then palpate

Question 2

skull

Answer 2

• a rigid box that protects the brain
  
  • includes the bones of the cranium and face
  • supported by the cervical vertebra

Question 3

cranial bones and sutures

Answer 3

bones - frontal, parietal, occipital, temporal
sutures - coronal, sagittal, lambdoid

Question 4

structure and function of the head

Answer 4

 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

Question 5

structure and function of the neck

Answer 5

Neck delimited by
 Base of skull and inferior border of
mandible above, and by manubrium
sterni, clavicle, first rib, and first
thoracic vertebra below

Question 6

the neck is conduit to?

Answer 6

 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

Question 7

major neck muscles

Answer 7

sternocleidomastoid, trapezius, both innervated by cranial nerve XI

Question 8

sternocleidomastoid enables? (Exam)

Answer 8

Head rotation and flexion and divides each side of the neck into two triangles: anterior and posterior triangles

Question 9

what moves the shoulders to extend and turn the head

Answer 9

two trapezius muscles

Question 10

structure and function of the thyroid

Answer 10

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

Question 11

developmental competence of pregnant female and aging adult

Answer 11

 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

Question 12

genetics and the environment in headaches

Answer 12

 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

Question 13

subjective data in health history

Answer 13

headache
head injury
dizziness
neck pain, limitation of motion
lumps or swelling
history of head or neck injury

Question 14

questions to ask about headaches

Answer 14

 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

Question 15

questions to ask about head injury

Answer 15

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

Question 16

inspecting and palpating the skull

Answer 16

 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

Question 17

inspecting the face

Answer 17

 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

Question 18

inspecting and palpating the neck

Answer 18

 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

Question 19

inspecting and palpating the trachea and thyroid

Answer 19

 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

Question 20

physical examination on aging adults

Answer 20

 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

Question 21

abnormal findings of primary headaches

Answer 21

 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

Question 22

congenital torticollis

Answer 22

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

Question 23

simple diffuse goiter (SDG)

Answer 23

Endemic goiter due to iodine deficiency that results in chronic enlargement of the thyroid gland

Question 24

thyroid-multinodular goiter

Answer 24

Multiple nodules usually indicate inflammation or multinodular goiter rather than a neoplasm; however, suspect any rapidly enlarging or
firm nodule

Question 25

pilar cyst

Answer 25

Benign growth that presents as smooth, fluctuant swelling on the scalp
- typically here on the scalp

Question 26

parotid gland enlargement

Answer 26

Rapid painful enlargement seen in response to mumps, blockage of duct,
abscess, or tumor

Question 27

graves disease presentation

Answer 27

 Physical presentation of neck and face
 Goiter
 Eyelid retraction
 Exophthalmos

Question 28

thyroid disorder: hypothyroidism

Answer 28

 Physical presentation of neck and face
 Puffy edematous face
 Periorbital edema
 Coarse facial features
 Coarse hair and eyebrows

Question 29

acromegaly

Answer 29

Elongated head, massive face, overgrowth of nose, lower jaw, heavy eyebrow ridge, and coarse facial features

Question 30

Cushing syndrome

Answer 30

Classic “moonlike” face, red cheeks, and hirsutism

Question 31

bell palsy

Answer 31

paralysis on one side of the face as a result of the LMN lesion
- generally resolves on its own

Question 32

stroke or brain attack

Answer 32

UMN lesion leading to paralysis of lower facial muscles

Question 33

parkinson’s

Answer 33

Classic “maskline” appearance, elevated eyebrows, staring gaze, oily
skin, and drooling due to dopamine deficiency

Question 34

cachectic appearance

Answer 34

Sunken eyes, hollow cheeks, and defeated expression that accompanies chronic wasting diseases

Question 35

when inspecting the TMJ what do you feel for (Exam)

Answer 35

popping or crepitus

Question 36

healthy lymph nodes are?

Answer 36

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

Question 37

how to identify a lymph node that is indicating an issue with the body

Answer 37

swollen, painful and/or tender to the touch, like they are hard or stuck in place,

Question 38

what to check with cranial nerves (Exam)

Answer 38

check for sharp or dull feelings

Question 39

trigeminal (Exam)

Answer 39

sensory and motor functions
- sensory -> sensation (touch, pain, temp, proprioception)
- motor -> mastication (enables chewing, biting, and clenching the teeth)

Question 40

steps for examination (Exam)

Answer 40

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