Head, Neck, Face Flashcards by B -

STRUCTURE AND FUNCTION

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THE HEAD

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The______- is a rigid bony box that protects the brain and special sense organs, and it includes the bones of the cranium and the face .
A)skull
B)cervical
C)both a and b

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cranial bones:are
A) frontal, parietal, occipital, and temporal.
B) frontal, parietal, occipital, and zygomatic.

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The adjacent cranial bones unite at meshed immovable joints called the
A)sutures
B)phontenels

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At birth the sutures are soft and messy when they ossify?
A) The sutures gradually ossify during early childhood
B)The sutures gradually ossify during early adult hood

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The_______ suture crowns the head from ear to ear at the union of the frontal and parietal bones
A)coronal
B)parietal

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The_______ suture separates the head lengthwise between the two parietal bones
A)sagittal
B)cornal

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The_________ suture separates the parietal bones crosswise from the occipital bone.
A)lambdoid
B)cornal

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The 14 facial bones also articulate at sutures (note the nasal bone, zygomatic bone, and maxilla), except for
A)the mandible (the lower jaw). It moves up, down, and sideways from the temporomandibular joint, which is anterior to each ear.
B)false 22 facial bones

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The cranium is supported by the cervical vertebra: C1, the “atlas”; C2, the “axis”; and down to C7.
A)True
B)false

True

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The cranium is supported by the cervical vertebra: C1, the
A)”atlas”;
B)”axis”;

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The cranium is supported by the cervical vertebra: C2
A) “atlas”
B)”axis”

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The expressions are formed by the facial muscle, which are mediated by cranial nerve
A)VII, the facial nerve.
B)IV, the facial nerve

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Facial muscle function is symmetric bilaterally, except for an occasional quirk or wry expression.
A)true
B)false

True

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The palpebral fissures-the openings between the eyelid are equal bilaterally
A)true
B)false

True

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Facial sensations of pain or touch are mediated by the three sensory branches of cranial nerve
A)V, the trigeminal nerve.
B)VI, the trigeminal nerve

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Two pairs of salivary glands are accessible to examination on the face.select all that apply
A) The parotid glands 
B)The submandibular glands . , 
C)the sublingual glands
D)temporal gland

A B

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The _____________ are in the cheeks over the mandible, anterior to and below the ear. They are the largest of the salivary glands but are not normally palpable.
A)The submandibular glands
B)parotid glands

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. The _________________ are beneath the mandible at the angle of the jaw. A third pair, the sublingual glands, lie in the floor of the mouth.
A)parotid glands
B)submandibular glands

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) The temporal artery lies superior to the temporalis muscle; its pulsation is palpable anterior to the ear.
A)true
B)false

True

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THE NECK

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The______ is delimited by the base of the skull and inferior border of the mandible above, and by the manubrium sterni, the clavicle, the first rib, and the first thoracic vertebra below.
A)neck
B)cranial

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Think of the neck as a conduit for the passage of many structures, which are lying in close proximity: blood vessels, muscles, nerves, lymphatics, and viscera of the respiratory and digestive systems. Blood vessels include the common and internal carotid arteries and their associated veins.
A)true
B)false

True

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The internal carotid branches off the common carotid and runs inward and upward to supply the brain; the external carotid supplies the face, salivary glands, and superficial temporal area. A)true B)falsse

True

The ___________ carotid branches off the common carotid and runs inward and upward to supply the brain; A)internal B)external

the________ carotid supplies the face, salivary glands, and superficial temporal area. A)internal B)external

The carotid artery and internal jugular vein lie beneath the A)sternomastoid muscle. B)trapezes muscle

The external jugular vein runs diagonally across the sternomastoid muscle. A)true B)false

The major neck muscles are the sternomastoid and the trapezius; they are innervated by cranial nerve XI, the spinal accessory. A)true B)false

What are the two major neck muscles? A)sternomastoid and trapezes B)trapezes and biceps

The major neck muscles are the sternomastoid and the trapezius; they are innervated by cranial nerve A)XI, the spinal accessory. B)XII the spinal nerve

The sternomastoid muscle arises from the sternum and the clavicle and extends diagonally across the neck to the mastoid process behind the ear. It accomplishes head rotation and head flexion. A)true B)false

The two trapezius muscles on the upper back arise from the occipital bone and the vertebrae and extend fanning out to the scapula and clavicle. The trapezius muscles move the shoulders and extend and turn the head. A)true B)false

The sternomastoid muscle divides each side of the neck into two triangles. The anterior triangle lies in front, between the sternomastoid and the midline of the body, with its base up along the lower border of the mandible and its apex down at the suprasternal notch. The posterior triangle is behind the sternomastoid muscle, with the trapezius muscle on the A)true B)false

The anterior triangle lies in front, A) between the sternomastoid and the midline of the body, with its base up along the lower border of the mandible and its apex down at the suprasternal notch. B)is behind the sternomastoid muscle, with the trapezius muscle on the

. The posterior triangle is behind the sternomastoid muscle? A)with the trapezius muscle on the other side and with its base along the clavicle below. It contains the posterior belly of the omohyoid muscle. B)false, their are no triangles

The ________ gland is an important endocrine gland with a rich blood supply. It straddles the trachea in the middle of the neck. This highly vascular endocrine gland synthesizes and secretes thyroxine (T4) and triiodothyronine (T3), hormones that stimulate the rate of cellular metabolism. A)thyroid B)parotid C) sublingual

The gland has two lobes, both conical in shape, each curving posteriorly between the trachea and the sternomastoid muscle. The lobes are connected in the middle by a thin isthmus lying over the second and third tracheal rings. A)thyroid B)sublingual C)parotid

Just above the thyroid isthmus, within about 1 cm, is the ________ cartilage or upper tracheal ring. A)cricoid B)cartilage C)hyoid

Just above the thyroid isthmus, within about 1 cm, is the cricoid cartilage or upper tracheal ring. The _______ cartilage is above that, with a small, palpable notch in its upper edge. A)hyoid B)thyroid C)both a and b

Just above the thyroid isthmus, within about 1 cm, is the cricoid cartilage or upper tracheal ring. The thyroid cartilage is above that, with a small, palpable notch in its upper edge. This is the prominent "Adam's apple" in males. A)true B)false

The highest is the hyoid bone, palpated high in the neck at the level of the floor of the mouth. A)true B)false

LYMPHATICS

the head and neck have a rich supply of A)lymph nodes B)lymph sections C)both a and b

• Preauricular, in front of the ear -Posterior auriwlar (mastoid), superficial to the mastoid process • Occipital, at the base of the skull Submental, midline, behind the tip of the mandible • Submandibular, halfway between the angle and the tip of the mandible -Jugulodigastric, under the angle of the mandible -Superficial cervical, overlying the sternomastoid muscle -Deep cervical, deep under the sternomastoid muscle • Posterior cervical, in the posterior triangle along the edge of the trapezius muscle -Supraclavicular, just above and behind the clavicle, at the sternomastoid muscle A)Note that their labels correspond to adjacent structures. B)false

When nodes are abnormal, check the area they drain for the source of the problem. Explore the area proximal (upstream) to the location of the abnormal node A)true B)false

The lymphatic system is an extensive vessel system, which is separate from the cardiovascular system and is phylogenetically older. A)true B)false

The lymphatics are a major part of the immune system, whose job it is to detect and eliminate foreign substances from the body. A)true B)false

The vessels allow the flow of clear, watery fluid (lymph) from the tissue spaces into the circulation. A)true B)false

___________ are small, oval clusters of lymphatic tissue that are set at intervals along the lymph vessels tissue that are set at intervals along the lymph vessels like beads on a string. A)phagocytes B)Lymph nodes C)both a and b

The nodes filter the lymph and engulf pathogens, preventing potentially harmful substances from entering the circulation. A)true B)false.

Nodes are located throughout the body but are accessible to examination only in four areas: head and neck, arms, axillae, and inguinal region. The greatest supply is in the head and neck. A)true B)false

Nodes are located throughout the body but are accessible to examination only in four areas: A)head and neck, arms, axillae, and inguinal region. B)head and neck,chest, arms, and legs

The greatest supply is in the head and neck A)lymph nodes B)fugal

DEVELOPMENTAL COMPETENCE | Infants and Children

The bones of the neonatal skull are separated by sutures and by fontanels, the spaces where the sutures intersect. These membrane-covered "soft spots" allow for growth of the brain during the 1st year. A)true B)false

__________They gradually ossify; the triangle-shaped posterior fontanel is closed by l to 2 months, and the diamond-shaped anterior fontanel closes between 9 months and 2 years. A)fontanels B)sutures

the triangle-shaped posterior fontanel is closed by A)l to 2 months, B) 9 months and 2 years

the diamond-shaped anterior fontanel closes A) closed by l to 2 months, B)between 9 months and 2 years

Head size is greater than chest circumference at birth. A)true B)false

The head size grows during childhood, reaching 90o/o of its final size when the child is 6 years old. But during infancy, trunk growth predominates so that head size changes in proportion to body height. A)true B)false

. Facial bones grow at varying rates, especially nasal and jaw bones. A)true B)false

True

In the toddler, the mandible and maxilla are small and the nasal bridge is low, so that the whole face seems small compared with the skull. A)true B)false

Lymphoid tissue is well developed at birth and grows to adult size when the child is A)2 years old. B)6 years old. C)both a and b

The child's lymphatic tissue continues to grow rapidly until age 10 or 11 years, actually exceeding its adult size before puberty. Then the lymphatic tissue slowly atrophies. A)true B)false

In adolescence, facial hair appears on boys, first above the lip, then on cheeks and below the lip, and last on the chin. A)true B)false

A noticeable enlargement of the thyroid cartilage occurs, and with it, the voice deepens. A)adolescents B)school age C)young adult

DEVELOPMENT COMPETENCE | The Pregnant Woman

The thyroid gland enlarges slightly during pregnancy as a result of hyperplasia of the tissue and increased vascularity. A)true B)false

The ________ gland enlarges slightly during pregnancy as a result of hyperplasia of the tissue and increased vascularity. A)submandibular B)thyroid C)patroid

DEVELOPMENT COMPETENCE | The Aging Adult

The facial bones and orbits appear more prominent, and the facial skin sags as a result of decreased elasticity, decreased subcutaneous fat, and decreased moisture in the skin. The lower face may look smaller if teeth have been lost. A)the pregnant women B)aging adult

SUBJECTIVE DATA

1. Headache 2. Head injury 3. Dizziness 4. Neck pain, limitation of motion 5. Lumps or swelling 6. History of head or neck surgery A)objective data B)subjective data

HEADACHE

Any unusually frequent or unusually severe headaches? A)This is a more meaningful question than "Do you ever have headaches?" because most people have had at least one headache. Because many conditions have a headache as a symptom, a detailed history is important. B)false, do not answer

Ever had this kind of headache before? A)A red flag is a severe headache in an adult or child who has never had it before. B)Unilateral or bilateral (e.g., with cluster headaches, pain is always unilateral and always on the same side of the head).

Where do you feel it: frontal, temporal, behind your eyes, like a band around the head, in the sinus area, or in the occipital area? A)Tension headaches tend to be occipital, frontal, or with bandlike tightness; migraines (vascular) tend to be supraorbital, retro-orbital, or frontotemporaL; cluster headaches (vascular) produce pain around the eye, temple, forehead, cheek. B)false

Is pain localized on one side, or all over? A)Unilateral or bilateral (e.g., with cluster headaches, pain is always unilateral and always on the same side of the head). B)Character is typicaUy viselike with tension headache, throbbing with migraine or temporaJ arteritis.

Character. Throbbing (pounding, shooting) or aching (viselike, constant pressure, dull)? A)Character is typically viselike with tension headache, throbbing with migraine or temporal arteritis. B)false

Is it mild, moderate, or severe? A)Pain is often severe with migraine, or excruciating with cluster headache. B)false

Course and duration. What time of day do the headaches occur: morning, evening, awaken you from sleep? A)Migraines occur about twice per month, each lasting 1 to 3 days; cluster headaches occur once or twice per day, each to 2 hours for 1 to 2 months, and remission may last for months or years. B)false

Migraines occur about twice per month, each lasting 1 to 3 days; A)true B)false

cluster headaches occur once or twice per day, each to 2 hours for 1 to 2 months, and remission may last for months or years. A)true B)false

Precipitating factors. What brings it on: activity or exercise, work environment, emotional upset, anxiety, alcohol? (Also note signs of depression.) A)Alcohol ingestion and daytime napping typically precipitate cluster headaches, whereas alcohol, letdown after stress, menstruation, and eating chocolate or cheese precipitate migraines. B)false

Associated factors. Any relation to other symptoms: any nausea and vomiting? (Note which came first, headache or nausea.) Any vision changes, pain with bright lights, neck pain or stiffness, fever, weakness, moodiness, stomach problems? A)Nausea, vomiting, and visual disturbances are associated with migraines; eye reddening and tearing, eyelid drooping, rhinorrhea, and nasal congestion are associated with cluster headaches; anxiety and stress are associated with tension headaches; nuchal rigidity and fever are associated with meningitis or encephalitis. B)false,patient is okay

Do you have any other illness? A)Hypertension, fever, hypothyroidism, and vasculitis produce headaches. B)hypotension

Do you take any medications? A)Oral contraceptives, bronchodilators, alcohol, nitrates, carbon monoxide inhalation produce headaches B)weed smoking

What is the frequency of your headaches: once a week? Are your headaches occurring closer together? A)Migraines are associated with family history of migraine B)none

Effort to treat. What seems to help: going to sleep, medications, positions, rubbing the area? A)With migraines, people lie down to feel better, whereas with cluster headaches they need to move-even to pace the floor-to feel better. B)head injury

HEAD INJURY

Lose consciousness and then fall? A)Loss of consciousness before a fall may have a cardiac cause (e.g., heart block) B)no change

Duration. How long were you unconscious? Any symptoms afterward-headache, vomiting, projectile vomiting? Any change in level of consciousness nfter injury: dazed or sleepy? A)a change in level of consciousness is most important in evaluating a neurologic deficit. B)no change noted

Associated symptoms. Any pain in the head or the neck, vision change, discharge from ear or nose-is it bloody or watery? Are you able to move all extremities? Any tremors, staggered walk, numbness and tingling A)true B)fase

DIZZINESS

Experienced any dizziness? (Determine exactly what the person means by dizziness.) Was it a feeling of light-headedness or of falling? Or was it a spinning sensation? A)Dizziness is a light-headed, swimming sensation, feeling of falling. True vertigo is true rotational spinning from neurologic disease (labyrinthine-vestibular apparatus, vestibular nuclei in brainstem). When vertigo is objective, the person feels like the room spins. When vertigo is subjective, the perception is that the person spins. B)person affect is cooperative

Dizziness is a light-headed, swimming sensation, feeling of falling. True vertigo is true rotational spinning from neurologic disease (labyrinthine-vestibular apparatus, vestibular nuclei in brainstem). A)true B)false

When vertigo is__________, the person feels like the room spins. . A)subjective B)objective

When vertigo is_______, the perception is that the person spins. A)subjective B)objective

Onset. Abrupt or gradual? After a change in position, such as sudden standing? A)dizziness B)headache

Associated factors. Any nausea and vomiting, pallor, immobility, decreased hearing acuity, or tinnitus along with the dizziness? A) true B) false

NECK PAIN

Any neck pain? A)Acute onset of neck stiffness with headache and fever occurs with meningeal inflammation B)false,

Associated symptoms. Any limitations to range of motion (ROM), numbness or tingling in shoulders, arms, or hands? A)true B)false

Pain creates a VICIOUS circle. Tension increases pain and disability, which produces more anxiety. A)true B)false

True

LUMPS OR SWELLING

? Any recent infection? Any tenderness? A)Tenderness suggests acute infection B)check hands

For a lump that persists, how long have you had it? Has it changed in size? A)A persistent lump arouses suspicion of malignancy. For people older than 40 years, suspect malignancy until proven otherwise. B)Any history of prior irradiation of head, neck, upper chest?

Any history of prior irradiation of head, neck, upper chest? A)Increased risk for salivary and thyroid tumors. B)decrease risk of salivary tumors

Any difficulty swallowing? A)Dysphagia. B)mouthphagis

Do you smoke? For how long? How many packs a day? Do you chew tobacco? A)Smoking and chewing tobacco increase risk for oral and respiratory cancer. B)false

When was your last alcohol drink? How much alcohol do you drink a day? A)Smoking and large alcohol consumption together increase the risk for cancer. B)Smoking and large alcohol consumption together increase of no cancer.

HISTORY OF HEAD OR NECK SURGERY

had surgery of the head or neck? For what condition? When did the surgery occur? How do you feel about results? A)Surgery for head and neck cancer often is disfiguring and increases risk for body image disturbance. B)no, fase question

Additional History for Infants and Children

Did the mother use alcohol or street drugs during pregnancy? How often? How much was used per episode? A)Alcohol increases the risk for fetal alcohol syndrome, with distinctive facial features (see Table 13-4, Pediatric Facial Abnormalities, p. 274). Cocaine use causes neurologic, developmental, and emotional problems B)none

Was delivery vaginal or by cesarean section? Any difficulty? Use of forceps? A)Forceps may increase the risk for caput succedaneum, cephalhematoma, and Bell's palsy. B)Additional History for the Aging Adult

Additional History for the Aging Adult

If dizziness is a problem, how does this affect your daily activities? Are you able to drive safely, maneuver about the house safely? A)Assess self-care. Assess potential for injury B)false

OBJECTIVE DATA

Inspect and Palpate the Skull

Normocephalic is the term that denotes a round symmetric skull that is appropriately related to body size. Be aware that "normal" includes a wide range of sizes. A)true B)false

Deformities: microcephaly, abnormally small head; macrocephaly, abnormally large head (hydrocephaly, acromegaly, Paget's disease) A)TURE for skull B)false for skull

microcephaly, A)abnormally small head B)abnormally large head

macrocephaly, A)abnormally small head; B)abnormally large head

``` macrocephaly, abnormally large head are associated with which of the following diseases A)hydrocephaly B) acromegaly C)Paget's disease D)all the above ```

The skull normally feels symmetric and smooth. Cranial bones that have normal protrusions are the forehead, the side of each parietal bone, the occipital bone, and the mastoid process behind each ear. There is no tenderness to palpation A)true B)false

True

Note lumps, depressions, or abnormal protrusions A)abnormal finding of the skull B)abnormal finding of the hand

Palpate the temporal artery above the zygomatic (cheek) bone between the eye and top of the ear. A)true B)false

The artery looks tortuous, feels hardened and tender with temporal arteritis. A)abnormal finding of temporal artery B)normal finding

The temporomandibular joint is just below the temporal artery and anterior to the tragus. Palpate the joint as the person opens the mouth, and note normally smooth movement with no limitation or tenderness A)true B)false

Crepitation, limited ROM, or tenderness. A)normal finding B)abnormal finding of the TMJ

Inspect the Face

Anxiety is common in the hospitalized or ill person. A)true B)fase

Hostility or aggression. Tense, rigid muscles may indicate anxiety or pain; a flat affect may indicate depression. A)abnormal finding in the face B)normal finding

Note symmetry of eyebrows, palpebral fissures, nasolabial folds, and sides of the mouth. A)true B)false

Marked asymmetry with central brain lesion (e.g., stroke) or with peripheral cranial nerve Vll damage (Bell's palsy). A)abnormal vision the face B)normal vision

Note any abnormal facial structures (coarse facial features, exophthalmos, changes in skin color or pigmentation) or any abnormal swelling. Also note any involuntary movements (tics) in the facial muscles. Normally none occur. A)true,normal for face B)false

Edema in the face occurs first around the eyes (periorbital) and the cheeks where the subcutaneous tissue is relatively loose. Note grinding of jaws, tics, fasciculations, or excessive blinking. A)abnormal finding of the face B)normal finding

A habitual spasmodic contraction of the muscles in the face A)tics B)nicks

Inspect and Palpate the Neck

The head should be held erect and still. A)normal finding B)abnormal finding

Head tilt occurs with muscle spasm. Rigid head and neck occur with arthritis. A)abnormal finding of the neck B)normal finding of the neck

Note any limitation of movement during active motion. Ask the person to touch the chin to the chest, to turn the head to the right and left, to try to touch each ear to the shoulder (without elevating shoulders), and to extend the head backward. When the neck is supple, motion is smooth and controlled A)normal finding B)abnormal finding

Note pain at any particular movement. Note ratchety or limited movement from cervical arthritis or inflammation of neck muscles. The arthritic neck is rigid; the person turns at the shoulders rather than at the neck. A)normal findings in ROM in the neck B)abnormal findings in ROM in the neck

Test muscle strength and the status of cranial nerve Xl by trying to resist the person's movements with your hands as the person shrugs the shoulders and turns the head to each side A)true, neck strength B) false.shoulder workout

As the person moves the head, note enlargement of the salivary glands and lymph glands. Normally no enlargement is present. Note a swollen parotid gland when the head is extended; look for swelling below the angle of the jaw. Also, note thyroid gland enlargement. Normally none is present A)true, normal finding B)false, abnormal finding

Thyroid enlargement may be a unilateral lump, or it may be diffuse and look like a doughnut lying across the lower neck A)abnormal finding of the eek B) normal finding of the ECM

Also note any obvious pulsations. The carotid artery runs medial to the sternomastoid muscle, and it creates a brisk localized pulsation just below the angle of the jaw. Normally, there are no other pulsations while the person is in the sitting position A)true, normal finding of the neck B)false abnormal finding of the neck

INSPECT and PALPATE THE NECK | Lymph Nodes

Using a gentle circular motion of your fingerpads, palpate the lymph nodes A)true B)false

(Normally the salivary glands are not palpable. When symptoms warrant, check for parotid tenderness by palpating in a line from the outer corner of the eye to the lobule of the ear.) A)true B)false

check for parotid tenderness by palpating in a line from the outer corner of the eye to the lobule of the ear. A)true B)false

Beginning with the preauricular lymph nodes in front of the ear, palpate the 10 groups of lymph nodes in a routine order. Many nodes are closely packed, so you must be systematic and thorough in your examination. Once you establish your sequence, do not vary or you may miss some small nodes A)true B)false

The parotid is swollen with A)mumps B)herpes

Parotid enlargement has been found with what disease A)herpes B) AIDS

-Use gentle pressure because strong pressure could push the nodes into the neck muscles. -It is usually most efficient to palpate with both hands, comparing the two sides symmetrically. However, the submental gland under the tip of the chin is easier to explore with one hand. -When you palpate with one hand, use your other hand to position the person's head. -For the deep cervical chain, tip the person's head toward the side being examined to relax the ipsilateral muscle (Fig. 13-10). Then you can press your fingers under the muscle. -Search for the supraclavicular node by having the person hunch the shoulders and elbows forward (Fig. 13-ll ); this relaxes the skin. -The inferior belly of the omohyoid muscle crosses the posterior triangle here; do not mistake it for a lymph node. A)true B)false

Use gentle pressure because strong pressure could push the nodes into the neck muscles. It is usually most efficient to palpate with both hands, comparing the two sides symmetrically. A)true B)fase

the submental gland under the tip of the chin is easier to explore with one hand. When you palpate with one hand, use your other hand to position the person's head. A)true B)false

For the deep cervical chain, tip the person's head toward the side being examined to relax the ipsilateral muscle. Then you can press your fingers under the muscle. A)true B)false

Search for the supraclavicular node by having the person hunch the shoulders and elbows forward; this relaxes the skin. The inferior belly of the omohyoid muscle crosses the posterior triangle here; do not mistake it for a lymph node. A)true B) fase

True

If any nodes are palpable, note their location, size, shape, delimitation (discrete or matted together), mobility, consistency, and tenderness. Cervical nodes often are palpable in healthy persons, although this palpability decreases with age (Fig. 13-12). Normal nodes feel movable, discrete, soft, and nontender. A)true B)false

. Cervical nodes often are palpable in healthy persons, although this palpability decreases with age (Fig. 13-12). A)true B)false

True

Normal nodes feel movable, discrete, soft, and nontender. A)true B)false

_________is enlargement of the lymph nodes (> 1 em) from infection, allergy, or neoplasm. A)Lymphadenopathy B)edema

If nodes are enlarged or tender, check the area they drain for the source of the problem. For example, those in the upper cervical or submandibular area often relate to inflammation or a neoplasm in the head and neck. Follow up on or refer your findings. A)true B)false

An enlarged lymph node, particularly when you cannot find the source of the problem, deserves prompt attention. A)true B)false

Acute infection-acute onset, s lymphoma A)true B)false

True

____________-acute onset, duration, nodes are bilateral, enlarged, warm, tender, and firm but freely movable. A)acute infection lymph nodes B) chronic infection lymph nodes

______________ (e.g., in tuberculosis the nodes are clumped). A)chronic inflammation B)cancerous

_________nodes are hard, >3 em, unilateral, nontender, matted, and fixed. A)Cancerous B)noncancerous

• Nodes with HIV infection are enlarged, firm, nontender, and mobile. Occipital node enlargement is common with HIV infection. A)true B)false

Occipital node enlargement is common with A)HIV B)herpes

• A single enlarged, nontender, hard, left supraclavicular node (Virchow's node) may indicate A)neoplasm in thorax or abdomen. B) Hodgkin's lymphoma

• Painless, rubbery, discrete nodes that gradually appear occur with A)Hodgkin's lymphoma B)herpes

INSPECT AND PALPATE THE NECK | TRACHEA

Normally, the trachea is midline; palpate for any tracheal shift. Place your index finger on the trachea in the sternal notch, and slip it off to each side (Fig. 13-13). The space should be symmetric on both sides. Note any deviation from the midline. A)true B)false

Conditions of tracheal shift:

• The trachea is pushed to the unaffected (or healthy) side with an aortic aneurysm, a tumor, unilateral thyroid lobe enlargement, and pneumothorax. • The trachea is pulled toward the affected (diseased) side with large atelectasis, pleural adhesions, or fibrosis. • Tracheal tug is a rhythmic downward pull that is synchronous with systole and that occurs with aortic arch aneurysm A)true B)false

• The trachea is pushed to the unaffected (or healthy) side with an aortic aneurysm, a tumor, unilateral thyroid lobe enlargement, and pneumothorax. A)abnormal finding of the trachea B)normal finding of the trachea

• The trachea is pulled toward the affected (diseased) side with large atelectasis, pleural adhesions, or fibrosis. A)normal finding of the trachea B)abnormal finding of the trachea

• Tracheal tug is a rhythmic downward pull that is synchronous with systole and that occurs with aortic arch aneurysm A)abnormal finding of the trachea B)normal finding of the trachea

INSPECT AND PALPATE THE NECK | Thyroid Gland

The thyroid gland is difficult to palpate; arrange your setting to maximize your likelihood of success. Position a standing lamp to shine tangentially across the neck to highlight any possible swelling. Supply the person with a glass of water, and first inspect the neck as the person takes a sip and swallows. Thyroid tissue moves up with a swallow A)true B)false

Look for diffuse enlargement or a nodular Jump A)abnormal finding of the thyroid gland B) normal finding of the thyroid gland

Posterior Approach. To thyroid is? - To palpate, move behind the person. Ask the person to sit up very straight and then to bend the head slightly forward and to the right. This will relax the neck muscles on the right side. Use the fingers of your left hand to push the trachea slightly to the right. - Then curve your right fingers between the trachea and the sternomastoid muscle, retracting it slightly, and ask the person to take a sip of water. The thyroid moves up under your fingers with the trachea and larynx as the person swallows. Reverse the procedure for the left side. - Usually you cannot palpate the normal adult thyroid. If the person has a long, thin neck, you sometimes will feel the isthmus over the tracheal rings. The lateral lobes usually are not palpable; check them for enlargement, consistency, symmetry, and the presence of nodules.

Read again true

Abnormalities: enlarged Lobes that are easily palpated before swallowing or are tender to palpation (see large goiter ) found in A)thyroid B)submandibular

Anterior Approach. To the thyroid is? -This is an alternate method of palpating the thyroid, but it is more awkward to perform, especially for a beginning examiner. Stand facing the person. Ask him or her to tip the head forward and to the right. Use your right thumb to displace the trachea slightly to the person's right. Hook your left thumb and fingers around the sternomastoid muscle. Feel for lobe enlargement as the person swallows

Read again true

Auscultate the Thyroid

If the thyroid gland is enlarged, auscultate it for the presence of a bruit. This is a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope. The bruit is not present normally. A)true B)fase

A_______ occurs with accelerated or turbulent blood flow, indicating hyperplasia of the thyroid (e.g., hyperthyroidism). A)bruit B)crack

. This is a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope. A)bruit B)crack

DEVELOPMENTAL COMPETENCE | Infants and Children

Measure an infant's head size with measuring tape at each visit up to age 2 years, then yearly up to age 6 years. A)true B)false

Note an abnormal increase in head size or failure to grow. A)true B)false

The newborn's head measures about 32 to 38 em (average around 34 cm) and is 2 cm larger than chest circumference. At age 2 years, both measurements are the same. A)true B)false

During childhood, the chest circumference grows to exceed head circumference by 5 to 7 cm A)true B)flase

True

Microcephalic- A)head size below norms for age B)head size above norms for age

Macrocephalic- A)an enlarged head or rapidly increasing in size (e.g., hydrocephalus [increase cerebrospinal fluid]) B)big legs

Frontal bulges, or "bossing," occur with A)prematurity B)rickets C)both a and b

Nordic children tend to have A)long heads B)have broad heads

Asian children have A)broad heads B) have long heads

A __________ is edematous swelling and ecchymosis of the presenting part of the head caused by birth trauma. It feels soft, and it may extend across suture lines. It gradually resolves during the first few days of life and needs no treatment. A)caput succedanewn B)cephalhematoma

A_____________ is a subperiosteal hemorrhage, which is also a result of birth trauma. It is soft, fluctuant, and well defined over one cranial bone because the periosteum (i.e., the covering over each bone) holds the bleeding in place. It appears several hours after birth and gradually increases in size. No discoloration is present, but it looks bizarre, so parents need reassurance that it will be reabsorbed during the first few weeks of life without treatment. Rarely, a large hematoma may persist to 3 months. A)cephalhematoma B)macromicro

An infant with cephalhematoma is at greater risk for A)jaundice as the red blood cells within the hematoma are broken down and reabsorbed B)no greater risk.

As you palpate the newborn's head, the suture lines feel like ridges. By 5 to 6 months, they are smooth and not palpable. A)true B)false

As you palpate the newborn's head, the suture lines feel like ridges. By ____ to ____ months, they are smooth and not palpable. A)2,4 B)5,6 C)7,9

Sutures palpable when the child is older than 6 months. A)normal finding B)abnormal finding

A newborn's head may feel asymmetric and the involved ridges more prominent due to molding of the cranial bones during engagement and passage through the birth canal. A)true B)false

Marked asymmetry, as in__________, a severe deformity caused by premature closure of the sutures. Premature closing of the suture results in a long, narrow head. A)craniosynostosis B)closetosis

Marked asymmetry, as in craniosynostosis, a severe deformity caused by premature closure of the sutures. Premature closing of the suture results A)in a long, narrow head. B)board flat head

________is overriding of the cranial bones; usually, the parietal bone overrides the frontal or occipital bone. Reassure parents that this lasts only a few days or a week. A)Molding B)jaundice

Babies delivered by ___________ are noted for their evenly round heads. A)cesarean section B)flat section

Also, some asymmetry may occur if an infant continually sleeps in one position; which the nurse knows that A)this is a flattening of the dependent cranial bone, usually the occiput B)false, stronger suture building

Flattening of the skull also occurs with A)rickets B)mental retardation. C)both a and b

Gently palpate the skull and fontanels while the infant is calm and somewhat in a sitting position (crying, lying down, or vomiting may cause the anterior fontanel to look full and bulging). The skull should feel smooth and fused except at the fontanels. A)true B)false

The fontanels feel firm, slightly concave, and well defined against the edges of the cranial bones. You may see slight arterial pulsations in the anterior fontanels. A)true B)false

A true tense or bulging fontanel occurs with A)acute increased intracranial pressure. B)dehydration or malnutrition.

Depressed and sunken fontanels occur with A)dehydration or malnutrition. B)Marked pulsations occur with increased intracranial pressure.

. Marked pulsations occur with increased intracranial pressure. A)true B)fase

The posterior fontanel may not be palpable at birth. If it is, it measures 1 cm and closes by I to 2 months. The anterior fontanel may be small at birth and enlarge to 2.5 cm x 2.5 cm. A large diameter of 4 to 5 cm occasionally may be normal under 6 months. A small fontanel usually is normal. The anterior fontanel closes between 9 months and 2 years. Early closure may be insignificant if head growth proceeds normally. A)true B)fase

The______ fontanel may not be palpable at birth. If it is, it measures 1 cm and closes by I to 2 months. A)posterior B)anterior

The _________ fontanel may be small at birth and enlarge to 2.5 cm x 2.5 cm. A large diameter of 4 to 5 cm occasionally may be normal under 6 months. A)posterior B)anterior

A small fontanel usually is normal. The _______ fontanel closes between 9 months and 2 years. Early closure may be insignificant if head growth proceeds normally. A)anterior B)posterior

Posterior fontanels close first A)true B)false

``` Delayed closure or larger-than-normal fontanel size occurs with?select all that apply A)hydrocephalus B)Down syndrome C)hypothyroidism D)rickets. ```

A B C D

A small fontanel is a sign of microcephaly, as is early closure. A)true B)false

A small fontanel is a sign of________, as is early closure. A)microcephaly B)macrocephaly

The infant can turn the head side to side by 2 weeks and shows the tonic neck reflex when supine and the head is turned to one side (extension of same arm and leg, flexion of opposite arm and leg). A)true B)flase

The tonic neck reflex disappears between 3 and 4 months, and then the head is maintained in the midline. A)true B)false

Head control is achieved by 4 months, when the baby can hold the head erect and steady when pulled to a vertical position. A)true B)false

Head control is achieved by____ months, when the baby can hold the head erect and steady when pulled to a vertical position. A)4 B)7

The tonic neck reflex disappears between ___ and ___ months, and then the head is maintained in the midline. A)2,7 B)3,4 C)3,9

Tonic neck reflex beyond 5 months may indicate brain damage. In children, head tilt occurs with habit spasm, poor vision, and brain tumor. Head lag after 4 months may indicate mental or motor retardation. A)true B) fase

Tonic neck reflex beyond____ months may indicate brain damage. A)5 B)2 C)3

``` In children, head tilt occurs with A)habit spasm B)poor vision C)brain tumor D)all the above ```

Head lag after 4 months may indicate A)mental B)motor retardation C)both a and b

Check facial features for symmetry, appearance, and presence of swelling. Note symmetry of wrinkling when the infant cries or smiles (e.g., both sides of the lips rise and both sides of forehead wrinkle). Children love to comply when you ask them to "make a face." Normally, no swelling is evident. Parotid gland enlargement is seen best when the child sits and looks up at the ceiling; the swelling appears below the angle of the jaw. A)true B)false

Children love to comply when you ask them to "make a face." Normally, no swelling is evident. A)true B)false

Parotid gland enlargement is seen best when the child A)sits and looks up at the ceiling; the swelling appears below the angle of the jaw. B)is prone with chin up ad straight

Unilateral immobility indicates nerve damage (central or peripheral) (e.g., note angle of mouth droop on paralyzed side). Some facies are characteristic of congenital abnormalities or chronic allergy. A)abnormal finding of the face B)normal finding of the face

An infant's neck looks short; it lengthens during the first 3 to 4 years. You can see the neck better by supporting the infant's shoulders and tilting the head back a little. This positioning also enhances palpation of the trachea, which is buried deep in the neck. Feel for the row of cartilaginous rings in the midline or just slightly to the right of midline. A)true B)false

An infant's neck looks short; it lengthens during the first ___ to ___ years. A)3,4 B)6,7

You can see the neck better by A)supporting the infant's shoulders and tilting the head back a little. This positioning also enhances palpation of the trachea, which is buried deep in the neck. Feel for the row of cartilaginous rings in the midline or just slightly to the right of midline. B)false put infant in prone

A short neck or webbing (loose fanlike folds) may indicate A)congenital abnormality (e.g., Down or Turner syndrome) B)it may occur alone C) both a and b

Assess muscle development with gentle passive ROM. The nurse thens A)Cradle the infant's head with your hands and turn it side to side and test forward flexion, extension, and rotation. B)Note any resistance to movement, especially flexion. C)Ask a child to actively move through the ROM, as you would an adult. D)all the above

Head tilt and limited ROM occur with which of the following? A)torticollis (wryneck) B)sternomastoid muscle injury during birth or a congenital defect. C)both a and b

Resistance to flexion (nuchal rigidity) and pain on flexion indicate A)meningeal irritation B)meningitis C)both a and b

During infancy, cervical lymph nodes are not palpable normally. A)true B)false

a child's lymph nodes are-they feel more prominent than an adult's until after puberty, when lymphoid tissue begins to atrophy. A)true B)false

At what age do lymph nodes begin to atrophy. A)puberty B)young adult C)older adult

Palpable nodes less than 3 mm are normal. They may be up to 1 cm in size in the cervical and inguinal areas but are discrete, move easily, and are nontender. A)true B)false

Children have a higher incidence of infection, so you will expect a greater incidence of inflammatory adenopathy. No other mass should occur in the neck. A)true B)false

Cervical nodes > 1 cm are considered enlarged. A)true B) false

Thyroglossal duct cyst-cystic lump high up in midline, freely movable, and rises up when swallowing. A)abnormal finding in the infant B)normal finding

``` Supraclavicular nodes enlarge with A)Hodgkin's disease B)HIV C) AIDS D)both b and c ```

The thyroid gland is difficult to palpate in an infant because of the short, thick neck. A)true B)false

The child's thyroid may be palpable normally. A)true B)false

``` The nurse would have a hard time palpating which of the following lymph nodes on a patient. A)adult B)infant C)child D)aging adult ```

Special Procedures | INFANTS AND CHILDREN

_________. With an infant, you may directly percuss with your plexor finger against the head surface. This yields a resonant or "cracked pot" sound, which is normal before closure of the fontanels? A)percussion B)auscultation

The sound occurs with hydrocephalus from separation of cranial sutures (Macewen's sign) A)abnormal finding in percussion B)abnormal finding in auscultation

The sound occurs with hydrocephalus from separation of cranial sutures, and when the nurse checks the percussion it is called what sign A) (Macewen's sign) B) fontanels sign

__________. Bruits are common in the skull in children younger than 4 or 5 years or in children with anemia. They are systolic or continuous and are heard over the temporal area A)percussion B)auscultation

``` After 5 years of age, bruits indicate A)increased intracranial pressure B)aneurysm C)arteriovenous shunt D)all the above ```

DEVELOPMENTAL COMPETENCE | THE PREGNANT WOMAN

During the second trimester, chloasma may show on the face. This is a blotchy, hyperpigmented area over the cheeks and forehead that fades after delivery. The thyroid gland may be palpable normally during pregnancy. A)true B)false

During the second trimester,________ may show on the face. This is a blotchy, hyperpigmented area over the cheeks and forehead that fades after delivery. The thyroid gland may be palpable normally during pregnancy. A)chloasma B)hyperpigmental

DEVELOPMENTAL COMPETENCE | The Aging Adult

The temporal arteries may look twisted and prominent. In some aging adults, a mild rhythmic tremor of the head may be normal. A)aging adult B)young adult

_________ are benign and include head nodding (as if saying yes or no) and tongue protrusion. A)Senile tremors B)chloasma

If some teeth have been lost, the lower face looks unusually small, with the mouth sunken in. A)aging adult B)younger adult

The neck may show an increased anterior cervical (concave or inward) curve when the head and jaw are extended forward to compensate for kyphosis of the spine. A)aging adult B)infant

During the examination, direct the __________ to perform ROM slowly; he or she may experience dizziness with side movements. A)aging adult B)infant

An ______ may have prolapse of the submandibular glands, which could be mistaken for a tumor. But drooping submandibular glands will feel soft and be present bilaterally. A)aging adult B)younger adult

PROMOTING A HEAL THY LIFESTYLE: BRAIN INJURY PREVENTION Use Your Head. Wear a Helmet.

Helmets are designed to protect the brain from injury and trauma by absorbing the impact energy in a collision or fall. A)true B)false

``` Children and adults should wear a sport- or activity-specific helmet when participating in the following sports or recreational activities: • Alpine sports, including skiing, snowboarding, and snowmobiling • ATV riding and Go-karting • Baseball and softball • Bicycling • Football • Horseback riding • Ice hockey • Lacrosse • Roller and in-line skating • Rock climbing • Scooter riding and segways • Skateboarding ```

True

ABNORMAL FINDINGS

Primary Headaches-Compare and Contrast

Tension headaches

-Usually both sides, across the frontal, temporal, and/or occipital region of head: forehead, sides and back of head -Bandlike tightness, viselike Non-throbbing -Gradual onset, lasts 30 minutes to days -Diffuse, dull, aching pain Mild to moderate pain -Situational, in response to overwork, posture -Stress, anxiety, depression, poor posture -Fatigue, anxiety, stress ,Sensation of a band tightening around head, of being gripped like a VICe -Sometimes photophobia or phonophobia -Rest, massaging muscles in area, NSAlD A)tension headaches B)migraine headaches

Migraine headaches

-Commonly one-sided but may occur on both sides -Pain is often behind the eyes, the temples, or forehead -Throbbing, pulsating -Rapid onset, peaks 1-2 hr, lasts 4 hr to 72 hr, sometimes longer -Moderate to severe pain -About 2/month, lasts 1-3 days -Hormonal fluctuations (premenstrual) -Foods (e.g., alcohol, caffeine, MSG, nitrates, chocolate, cheese) -Letdown after stress Changes in sleep pattern -Sensory stimuli (e.g., flashing lights or perfumes) -Changes in weather -Physical activity -Often preceded by an aura (visual changes such as blind spots or flashes of light, tingling in an arm or leg, vertigo) -Nausea, vomiting, photophobia, abdominal pain -Family history of migraine -Lie down, darken room, use eyeshade, sleep, take NSAID or narcotic when severe A)migraines headaches B)cluster headaches

Cluster headaches

-Always one-sided -Often behind or around the eye, temple forehead, cheek -Continuous, burning,piercing, excruciating -Abrupt onset, peaks in minutes, lasts 45-90 min -Can occur multiple times a day, in "clusters" -Severe stabbing pain -1-2/day, each lasting to 2 hr, for 1 to 2 months; then remission for months or years -Exacerbated by alcohol, stress, wind or heat exposure -Nasal congestion or runny nose, watery or reddened eye, eyelid drooping, miosis, feelings of agitation -Need to move, pace the floor A)cluster headaches B) tension headaches

Abnormalities in Head Size and Contour

Obstruction of drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure, and enlargement of the head. The face looks small compared with the enlarged cranium. The increasing pressure also produces dilated scalp veins, frontal bossing, and downcast or "setting sun" eyes (sclera visible above iris). The cranial bones thin, sutures separate, and percussion yields a "cracked pot" sound (Macewen's sign). A)Hydrocephalus B)Paget's Disease of Bone (Osteitis Deformans)

A skeletal disease of increased bone resorption and formation, which softens, thickens, and deforms bone. It affects 1Oo/o of those older than 80 years and occurs more often in males. The disease is characterized by bowed long bones, sudden fractures, frontal bossing, and enlarging skull bones that form an acorn-shaped cranium. Enlarging skull bones press on cranial nerves, causing symptoms of headache, vertigo, tinnitus, progressive deafness, and optic atrophy and compression of the spinal cord. A)Acromegaly B)Paget's Disease of Bone (Osteitis Deformans)

Excessive secretion of growth hormone from the pituitary gland after puberty creates an enlarged skull and thickened cranial bones. Note the elongated head, massive face, prominent nose and lower jaw, heavy eyebrow ridge, and coarse facial features, especially when compared with the same woman's face on the left pictured several years before she had a pituitary tumor. A)Acromegaly B)wry neck

Swellings on the Head or Neck

A 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. You will feel a firm, cliscrete, nontender mass in mid-muscle on the involved side. This requires treatment, or the muscle becomes fibrotic and permanently shortened with permanent limitation of ROM, asymmetry of head and face, and visual problems from a non-horizontal position of the eyes. A)goiter B)Torticollis (Wryneck)

A chronic enlargement of the thyroid gland that occurs in some regions of the world where the soil is low in iodine. Not due to a neoplasm. A)Goiter B)thyroidpathogy

Multiple nodules usually indicate inflammation or a multinodular goiter rather than a neoplasm. However, suspect any rapidly enlarging or firm nodule. A)Thyroid-Multiple Nodules B)single nodules

Most solitary nodules are benign, although a solitary nodule poses a greater risk for malignancy than do multiple nodules and poses a greater risk in a young person. Suspect any painless, rapidly growing nodule, especially the appearance of a single nodule in a young person. Cancerous nodules tend to be hard and are fixed to surrounding structures. A)Single Nodule B)multiple nodule

Smooth, firm, fluctuant swelling on the scalp that contains sebum and keratin. Tense pressure of the contents causes overlying skin to be shiny and taut. It is a benign growth A)Pilar Cyst (Wen) B). Parotid Gland Enlargement .

Rapid painful inflammation of the parotid occurs with mumps. Parotid swelling also occurs with blockage of a duct, abscess, or tumor. Note swelling anterior to lower ear lobe. Stensen duct obstruction can occur in aging adults dehydrated from diuretics or anticholinergics. A)Parotid Gland Enlargement B)fetal alcohol syndrome

Pediatric Facial Abnormalities

A pregnant woman who abuses alcohol is at great risk for producing a baby with a wide range of growth and developmental abnormalities. Facial malformations may be recognizable at birth. Characteristic facies include narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia A)Fetal Alcohol Syndrome B)Congenital Hypothyroidism

Thyroid deficiency at an early age produces impaired growth and neurologic deficit. Without neonatal screening, characteristic facies develop by 3 to 6 months of age: low hairline, hirsute forehead, swollen eyelids, narrow palpebral fissures, widely spaced eyes, depressed nasal bridge, puffy face, thick tongue protruding through an open mouth, and a dull expression. Head size is normal, but the anterior and posterior fontanels are wide open. A)fetal alcohol syndrome B)Congenital Hypothyroidism

Chromosomal aberration (trisomy 21). Head and face characteristics may include upslanting eyes with inner epicanthal folds; flat nasal bridge; small, broad, flat nose; protruding, thick tongue; ear dysplasia; short, broad neck with webbing; and small hands with single palmar crease A)Down Syndrome B)Atopic (Allergic) Facies

Children with chronic allergies such as atopic dermatitis often develop characteristic facial features. These include exhausted face, blue shadows below the eyes ("allergic shiners") from sluggish venous return, a double or single crease on the lower eyelids (Morgan's lines), central facial pallor, and open-mouth breathing (allergic gaping). The open-mouth breathing can lead to malocclusion of the teeth and malformed jaw because the child's bones are still forming A)Atopic (Allergic) Facies B)Allergic Salute and Crease

The transverse line on the nose is also a feature of chronic allergies. It is formed when the child chronically uses the hand to push the nose up and back (the "allergic salute") to relieve itching and to free swollen turbinates, which allows air passage. A)down syndrome B)Allergic Salute and Crease

Abnormal Facies with Chronic Illnesses

A deficiency of the neurotransmitter dopamine and degeneration of the basal gan glia in the brain. The immobility of features produces a face that is flat and expressionless, "masklike," with elevated eyebrows, staring gaze, oily skin, and drooling. A)Parkinson Syndrome B)Cushing Syndrome p

With excessive secretion of corticotropin hormone (ACTH) and chronic steroid use, the person develops a plethoric, rounded, "moonlike" face; prominent jowls; red cheeks; hirsutism on the upper lip, lower cheeks, and chin; and acneiform rash on the chest. A)down syndrome B)fetal alcohol syndrome C)Cushing Syndrome

Goiter is an increase in the size of the thyroid gland and occurs with hyperthyroidism, Hashimoto's thyroiditis, and hypothyroidism. Graves' disease (shown here) is the most common cause of hyperthyroidism, manifested by goiter and exophthalmos (bulging eyeballs). Symptoms include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance; signs include tachycardia, shortness of breath, excessive sweating, fine muscle tremor, thin silky hair and skin, infrequent blinking, and a staring appearance. A)Hyperthyroidism B)Myxedema (Hypothyroidism) .

A deficiency of thyroid hormone, when severe, causes a nonpitting edema or myxedema. Note puffy, edematous face, especially around eyes (periorbital edema), coarse facial features, dry skin, and dry, coarse hair and eyebrows. A)Myxedema (Hypothyroidism) B)Bell's Palsy (Right Side)

A lower motor neuron lesion (peripheral), producing cranial nerve VII paralysis, which is almost always unilateral. It has a rapid onset, and its cause is currently thought to be herpes simplex virus (HSV). Note complete paralysis of one half of the face; the person cannot wrinkle forehead, raise eyebrow, close eye, whistle, or show teeth on the right side. Usually presents with smooth forehead, wide palpebral fissure, flat nasolabial fold, drooling, and pain behind the ear. A)Stroke or Cerebrovascular Accident B)Bell's Palsy (Right Side)

An upper motor neuron lesion (central). A stroke (or brain attack) is an acute neurologic deficit caused by an obstruction of a cerebral vessel, as in atherosclerosis, or a rupture in a cerebral vessel. If you suspect a stroke, ask if the person can smile. Note paralysis of the lower facial muscles, but also note that the upper half of face is not affected because of the intact nerve from the unaffected hemisphere. The person is still able to wrinkle the forehead and close the eyes. A)Stroke or Cerebrovascular Accident B)Cachectic Appearance

Accompanies chronic wasting diseases such as cancer, dehydration, and starvation. Features include sunken eyes; hollow cheeks; and exhausted, defeated expression. A)Cachectic Appearance B)Scleroderma

Literally, "hard skin," this rare connective tissue disease is characterized by chronic hardening and shrinking degenerative changes in the skin, blood vessels, synovium, and skeletal muscles. Changes can occur in the skin, heart, esophagus, kidney, lung. Characteristic facies: hard, shiny skin on forehead and cheeks; thin, pursed lips with radial furrowing; absent skinfolds; muscle atrophy on face and neck; absence of expression. A)Scleroderma B)fetal alcohol syndrome

Summary Checklist: Head, Face, and Neck, Including Regional Lymphatics Examination

1. Inspect and palpate the skull General size and contour Note any deformities, lumps, tenderness Palpate temporal artery, TMJ 2. Inspect the face Facial expression Symmetry of movement (cranial nerve VII) Any involuntary movements, edema, lesions 3. Inspect and palpate the neck Active ROM Enlargement of salivary glands, lymph nodes, thyroid gland Position of the trachea 4. Auscultate the thyroid (if enlarged) for bruit

True

EXTRA INFORMATION

Nausea, vomiting, and visual disturbances are associated with A)migraines; B)tension headaches

eye reddening and tearing, eyelid drooping, rhinorrhea, and nasal congestion are associated with A)cluster headaches; B)migraines

anxiety and stress are associated with A)tension headaches; B)cluster headaches

nuchal rigidity and fever are associated with A)meningitis B)encephalitis C)both a and b

________— a complete or partial collapse of a lung or lobe of a lung — develops when the tiny air sacs (alveoli) within the lung become deflated. A)lungsio B)Atelectasis

_________: A sign to detect hydrocephalus and brain abscess. Percussion (tapping) on the skull at a particular spot (near the junction of the frontal, temporal and parietal bones) yields an unusually resonant sound in the presence of hydrocephalus or a brain abscess. A)Macewen sign B)hydropervuse sign

``` A patient comes to the trauma unit in respiratory distress following a motor vehicle accident. On examination, the nurse notices that his trachea is deviated from the midline. What does this finding indicate? Choose one of the following A)Flail chest B)Tension pneumothorax C)Severe neck fracture D)Cardiac tamponade ```

``` A patient is being assessed for a headache. Symptoms include throbbing and severe pain lasting for the last 8 hours and vomiting. What type of headache could these findings indicate? Choose one of the following A)Benign B)Tension C)Migraine D)Cluster ```

``` Risk factors for cancers of the neck include which of the following? Select all that apply. Select all that apply: A)Alcohol consumption B)Tobacco use C)Age older than 35 years D)Improper diet E)Male gender ```

A B E

Risk factors for cancers of the neck include male gender, age older than 50 years, tobacco use, and alcohol consumption. Risk factors do not include age older than 35 years or an improper diet. A)true B) false

``` A woman brings her 1-month-old infant to the ED. The mother states the baby's head bulges when he cries. The nurse assesses the baby and notices both fontanels appear normal and the baby seems perfectly healthy. What should the nurse do next? Choose one of the following A)Assess for dehydration B)Document a normal finding C)Call the physician D)Get the baby to cry ```

A bulging fontanel may be normal when an infant cries but otherwise needs further evaluation as a sign of possible increased intracranial pressure. Documenting normal findings would be the nurse's next action. It would be inappropriate to call the physician, assess for dehydration, or make the baby cry. A)true B)false

Where is the temporal artery palpated? Choose one of the following A)Between the mandibular joint and the base of the ear B)Just left or right of the spine at the base of the skull C)Above the cheek bone near the scalp line D)Just left of midline at the base of the neck

If the patient is wearing a wig or hairpiece, the nurse asks him or her to remove it. The nurse then washes the hands. The patient is usually seated, facing the examiner. The nurse can instruct the patient to report any discomfort as he or she performs the different parts of the head and neck examination. The nurse would don gloves if the patient has an open lesion or wound. A)true B)false

A nurse is going to inspect and palpate a patient's head and neck. After asking the patient to remove the wig, what should the nurse do next? Choose one of the following A)Wash hands B)Put on examination gloves C)Instruct the patient to lie flat with feet together D)Instruct the patient to report any discomfort

``` A nurse is caring for a 56-year-old woman who has just undergone surgery to remove a thyroid tumor. The nurse is assessing for symptoms of hyperthyroidism. What are some of the symptoms of hypermetabolism? Select all that apply. Select all that apply: A)Bradycardia B)Headache C)Anxiety D)Tachycardia E)Diarrhea ```

C D E

Hyperthyroidism may present as an emergency, with symptoms of hypermetabolism in all systems. The most common sign is tachycardia, but other possibilities include diarrhea, anxiety, fever, weakness, and even psychosis, coma, or death. Nurses should recognize patients at greatest risk for this emergency state. Such patients include those with thyroid tumors and those who have undergone thyroid surgery. A)true B)false

Signs of hypermetabolism do not include bradycardia or headache. A)true B)false

For patients with chronic back problems, what can the nurse teach? Choose one of the following A)Ways to reduce the risk of falling B)Which medications to take and when C)To sleep in the semi-Fowler's position D)Proper posture, bending, and lifting techniques

A useful neck landmark is the vertebral prominence, which is the spinous process of C7, the longest cervical vertebrae. Of the vertebrae of the neck, C7 and T1 are usually the most easily palpable, and the one that protrudes the furthest is C7. Locating C7 during assessment of the head, neck, and posterior thorax facilitates more accurate description of findings. A)true B)false

A useful neck landmark is the __________, which is the spinous process of C7, the longest cervical vertebrae. A)cervical B)prominence

``` A 63-year-old man comes to the ED with a new onset of pain in his neck and jaw. What system requires emergency assessment? Choose one of the following A)Integumentary B)Nervous C)Respiratory D)Cardiovascular ```

Acute situations that need emergency assessment and intervention include head or neck injuries, neck pain (may be cardiac), A)true B)false

In infants, the posterior fontanel closes by 2 months and the anterior fontanel closes by 12 to 18 months. Choose one of the following A)True B)False

True

``` Which type of vessels filter pathogens from the body and drain the fluid that has moved outside of the circulation back into the vessels? Choose one of the following A)Aortic B)Lymphatic C)Veins D)Arteries ```

Hypothyroidism in the older adult can be difficult to diagnose. Why? Select all that apply. Select all that apply: A)Symptoms attributed to the aging process B)Denial of problems C)Communication deficits D)Subtle onset E)Chronic diseases

A D E

``` What is the most common type of hyperthyroidism? Choose one of the following A)Moon face B)Thyroid cancer C)Graves' disease D)Cushing's syndrome ```

The nurse is discharging a 26-year-old man who received 18 staples for a head laceration he got while mountain biking. What can the nurse focus on while doing discharge teaching? Choose one of the following A)Encourage the patient to take a safety course B)Teach proper posture, bending, and lifting C)Encourage the use of safety equipment D)Encourage proper nutrition to promote healing

The nurse is assessing a patient complaining of swelling in his neck. While palpating his neck, the nurse finds a 2-cm lump that is fixed and hard. Why does this finding require emergency investigation? Choose one of the following A)This could be a sign of pneumothorax B)This could be a sign of a parotid stone C)This could be a sign of cancer D)This could be a sign of an embolus

A 25-year-old man has just had X-rays and computed tomography scanning of the head and neck following a mountain bicycling accident. All results are negative. What should the nurse assess for next? Choose one of the following A)Headache B)Shortness of breath C)Range of motion of the neck D)Range of motion of the arms and shoulders

The nurse is assessing an elderly woman who reports lethargy and weakness. During the examination, the nurse notices that the patient's face is drooping slightly on the right side. Why does this finding require emergency intervention? Choose one of the following A)This is a sign of hypothyroidism B)This is a sign of hyperthyroidism C)The patient could be experiencing a stroke D)The patient could be suffering from dehydration

The thyroid gland is usually palpable in healthy people. Choose one of the following A)True B)False

A woman brings her 1-month-old infant to the ER. She says the baby is not eating or drinking well. The nurse finds the fontanels are depressed slightly. Why does this require further assessment? Choose one of the following A)This could be a sign of increased intracranial pressure B)This could be a sign of physical abuse C)This could be a sign of dehydration D)This is a normal finding and needs no further assessment

• In acute infection: nodes are bilateral, enlarged, warm, tender, and firm but not freely movable. A)true B)false

• In chronic inflammation: nodes are clumped. A)true B)false

• In cancer: nodes are hard, unilateral, nontender, and fixed. A)true B)false

• ____________ is an edematous swelling and ecchymosis of the presenting part of the head due to birth trauma (see Fig. 13-16, p. 265). It feels soft and may extend across suture lines, but requires no treatment and gradually resolves in a few days. A) Caput succedaneum B)herpes

• _________ is a subperiosteal hemorrhage that is soft, fluctuant, and well defined over one cranial bone because the periosteum holds the bleeding in place. It is also due to birth trauma, and is reabsorbed gradually, over time, without treatment. See Fig. 13-17, p. 265. A)Cephalhematoma B)fundus

Facial characteristics of_________: puffy edematous face, especially around the eyes (periorbital edema), coarse facial features, dry skin, and dry coarse hair and eyebrows. A)hyperthyroidism B)hypothyroidism

The tonic neck reflex in an infant occurs when supine; the head is turned to one side (extension of same arm and leg, flexion of opposite arm and leg). After ages 3 to 4 months, the head is maintained in the midline. A)true B)false

blowing, swooshing sound heard through the stethoscope over an area of abnormal blood flow A)bruit B)goiter

``` Bleeding into the periosteum during birth is known as: A)caput succedaneum. B)Craniosynostosis C)Molding D)cephalhematoma. ```

A __________ is edematous swelling and ecchymosis of the presenting part of the head caused by birth trauma. A)caput succedaneum B)craniosynostosis.

bleeding into the periosteum during birth is known as A)cephalhematoma B)molding

craniosynotosis is a serve deformity caused by A)premature closure of the sutures B)hydrocephalus

increased intracranial pressure, obstruction of drainage of the CSF results in excessive accumulation of CSF,increasing pressure, and enlarging the head. A)hydrocephalus B)paget diseaase

(Ostetitis deformans) is a localized bone disease of unknown etiology that softens,thickens and deforms the bone A)paget disease B)acromegaly

narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia are characteristic of A)down syndrome B)fetal alcohol syndrome

upslanting eyes with inner epicanthal fold, flat nasal bridge, small broad flat nose,protruding thick tongue and ear dysplasia A)down syndromme B)fetal alcohol snydrome

kyphosis of the spine is common with aging. to compensate, older adults will A)extend their heads and jaws forward B)shuffle

a statement is accurate related to aggravating symptoms or triggers of headaches A)alcohol consumption may precipitate the on set of cluster or migraine headaches B)poor posture

Most facial bones articulate at a suture. which facial bone articulates at a joint A)Mandible B)zygomattic

a server deficiency of the thyroid hormone leading to nonpittinng edema, coarse facial features,, dry skin, and dry coarse hair is known as A)Myxedema(hypothyoridism) B)scleroderma

which of the following statements describing a headache would warrant an immediate referral A)i have never had a headache like this before, it is so bad i cant function B)this is the worst headache i had since puberty

what diseaseis characterized by a flat,expressionless, or mask like face a starring gaze, oily skin and elevated eyebrows. A)parkinson disease B)cushing syndrome

a patient is admitted to the ER after a MVA. the trachea is deviated to the left side. this finding is characteristic of; A)right pneumothorax B)aortic anerysum

in infant the nurse will measure the head size and palpate the fontanels A)true B)false

in a pregnant woman the nurse, assess for chloasma and thyroid gland enlargement A)true B)false

in ann aging adult, observe for prominent temporal arteries and senile tremors. A)true B)false

Tension headaches tend to be A)occipital, frontal, or with bandlike tightness B) (vascular) tend to be supraorbital, retro-orbital, or frontotemporaJ;

migraines (vascular) tend to be A)supraorbital, retro-orbital, or frontotemporal; B) produce pain around the eye, temple, forehead, cheek

cluster headaches (vascuJar) produce pain around the A)eye, temple, forehead, cheek B)everywhere

With migraines, people lie down to feel better A)true B)false

With cluster headaches they need to move-even to pace the floor-to feel better. To feel better A)true B)false

a primitive reflex in which forcibly turning the head of a normal newborn elicits extension of the limbs on the side to which the head is turned and flexion of the contralateral limbs. A)tonic neck reflex B)false

Head, Face, and Neck, Including Regional Lymphatics