Lecture 5: Head and Neck, Including Regional Lymphatic System Flashcards
Head - Structure and Function
- Cranial bones
- Sutures
- Facial bones
- Facial muscles
- Salivary glands
Neck - Structure and Function
- Neck muscles
- Anterior and posterior triangles
- Thyroid glands
Lymphatics - Structure and Function
- Preauricular
- Posterior auricular (mastoid)
- Occipital
- Submental
- Submandibular
- Tonsillar
- Superficial cervical
- Deep cervical
- Posterior cervical
- Supraclavicular
Developmental Considerations: Infants and children
- Fontanelles
- Head growth
- Lymphatic system
Skull: head circumference, caput succedaneum, cephalhematoma
Face: symm, appearance, swelling
Neck: muscle development and head control - Special considerations
Developmental Considerations: Pregnant women
- Slight enlargement of thyroid gland
Developmental Considerations: Older adults
- Sagging facial skin
- Presence of senile tremors, concave cervical curve, dizziness on range of motion
Subjective Data: Health History
- Headache
- Head injury
- Dizziness
- Neck pain or limitation of motion
- Lumps or swelling
- History of head or neck surgery
- Thyroid problems
Additional Health History Q’s: Infants and children
- Prenatal drug exposure
- Type of delivery
- Growth pattern
Additional Health History Q’s: Older adults
- Dizziness
- Neck pain
Objective Data: Physical exam
Head - Inspect and palpate the skull
Size and shape (normocephalic)
- Macrocephalic, microcephalic
- Fontanelles in infants
Temporal area
- Temporal artery
- Temporomandibular joint
Head - Inspect the face
Facial structures
Sinuses
Physical Exam Neck: Inspect and Palpate
- Symm
- ROM
- Lymph nodes
- Trachea
- Thyroid gland (posterior approach, anterior approach, auscultate for bruit)
Pediatric Facial Differences
- Fetal alcohol syndrome
- Down’s syndrome
- Atopic (allergic) facies)
- Allergic salute and crease
Eye External Anatomy (Eye)
- Eyelids
- Palpebral fissure
- Limbus
- Canthus
- Caruncle
(Look @ directions of movement slide)
Visual Pathways and Visual Fields (Eye)
- Refraction of light rays
- Crossing of fibres at optic nerve
Visual Reflexes (Eye)
- Pupillary light reflexes
- Fixation
- Accommodation
Developmental Considerations: Older Adults (Eye)
- Presbyopia
- Macular degeneration
- Cataracts
- Glaucoma
- Diabetic retinopathy
- Decreased tear production
- Decreased adaptation to darkness
Developmental Considerations: Infants/children (Eye)
- Limited eye function at birth
- Farsighted until age 7-8
Subjective Data: Health History (Eye)
- Vision difficulty
- Pain
- Strabismus, diplopia
- Redness, swelling
- Watering, discharge
- History of ocular problems
- Glaucoma
- Glasses or contact lenses
- Self-care behaviours - eye protection, last eye exam
- Meds
- Vision loss
Additional Health History Q’s: Infants and children (Eye)
- Mother’s vaginal infection during delivery
- Developmental milestones
- Routine vision testing
- Safety measures
Additional Health History Q’s: Older Adults (Eye)
- Movement and visual difficulty
- Glaucoma testing
- Cataracts
- Dryness of eyes
- Decreased activities
Physical Exam (Eye)
Preparation: Position
Equipment: Snellen eye chart, handheld visual screener, opaque card or occluder, penlight, applicator stick, ophthalmoscope
Central visual acuity: Snellen eye chart, near vision
Visual fields: Confrontation test
External Inspection (Eye)
General: Periorbital edema
Eyebrows
Eyelids and lashes: Ptosis, xanthelasma
Eyes: Exophthalmos
How to inspect cornea (Eye)
Shine light from side
How to inspect conjunctiva and sclera (Eye)
Have patient look up; pull down lower lids gently
Extraocular Muscle Function: Inspect (Eye)
- Diagnostic positions test
- Patient follows the movement of an object 12 inches away
- Normal: tracking with both eyes
- Nystagmus only normal at extreme lateral gaze
Accomodation (Eye)
- Have patient focus on examiners finger or pen
- Move object toward patients nose
- Observe for convergence and pupillary constriction
Pupillary Light Reflex (Eye)
- Part of neuro (cranial nerve) exam
- Dark room, shine light from side
- Measure pupils in mm, before and after light: resting should be 3-5mm, brisk response vs sluggish response or fixed
- Consensual response - opposite pupil also constricts
PERRLA (Eye)
Pupils
Equal
Round
Reactive to
Light and
Accommodation
Assess Visual Acuity (Eye)
Snellen Eye Chart:
- 20ft away
- Top # is distance from chart
- Bottom # is distance at which someone at which someone with normal vision could read the line
20/20 is normal vision
20/30 is nearsighted
- The higher the bottom number, the worse the nearsightedness is
Developmental (Eye)
- Children 2 and a half to 3 yrs - test by showing cards with familiar objects
- Children 3-8 yrs - tumbling E chart
Use of Ophthalmoscope (Eye)
- Functions as appendage of examiner’s eye
- Shine light to patient’s eye, find red reflex, then follow in to view ocular fundus
Diseases to the eye
- Cataract
- Arcus Senilis
Ear Structure/function
External ear: External auditory canal, tympanic membrane
Middle ear: malleus, incus, and staples, eustachian tube
Inner ear: Vestibule and semicircular canals (bony labyrinth), cochlea
How does the ear work and what is it used for?
- Used for hearing and balance
- Sound waves through external auditory canal to tympanic membrane: Translucent pearly grey, separate external and middle ear
- Auditory canal lined with glands that secrete cerumen
Middle and inner ear
Middle: Contains malleus, incus, stapes - conduct sound vibrations, reduce amplitude of loud noises, equalizes air pressure via Eustachian tube to prevent tympanic membrane rupture
Inner: Vestibule and semicircular canals (balance), cochlea (hearing)
- Information travels to brain via cranial nerve V11
Developmental: Infants/children
Shorter, horizontal Eustachian tube: Pathogens move from nasopharynx to middle ear, increased incidence Otitis Media if bottle fed lying down
Developmental: Older adults
- Cilia course and stiff, impacted cerumen
- Presbycusis - gradual hearing loss
Cultural and Social Considerations
- Increased incidence of otitis media in: Aboriginal children, premature infants, infants with down syndrome, infants bottle fed in supine position
- Cerumen: genetically determined; dry and wet cerumen
- Hearing loss third most common chronic condition in older adults: audism; discrimination based on hearing ability
Promoting Health (Ears)
- Earbuds placed directly in the ear canal
- No distortion in sound (digital)
- Listeners tend to listen for hours
- 60-60 rule recommended
- Use larger headphones/noise cancelling headphones
Health History (Ears)
- Earaches (otalgia)
- Infections
- Discharge (otorrhea)
- Hearing loss
- Environmental noise
- Tinnitus
- Vertigo
- Self-care behaviours
For infants: - Ear infections
- Hearing loss
- Injury
Physical Exam (Ears)
Preparation: Position, cleaning the ear canal
Equipment: Otoscope with bright light, pneumatic bulb attachment
External ear - Inspect and palpate: Size, shape, condition, tenderness, external auditory meatus
Otoscopic Exam
Otoscopic Examination:
- Position of head and ear
- Method of holding and inserting otoscope
External canal:
- Colour
- Swelling
- Lesions/foreign bodies
- Discharge (colour, odour)
Tympanic Membrane
- Colour and characteristics
- Position
- Integrity of membrane
Testing Hearing
- Test hearing acuity
- Vestibular apparatus
Development: Infant and young children
- Ear position
- Timing of otoscopic exam
- Positioning of children
- Testing hearing acuity and developmental milestones
- Behavioural manifestations
Development: Older Adult
- Loss of elasticity if pinna
- Eardrum whiter, more opaque, duller
- Loss of hearing of high-tone frequencies and consonants in whispered voice test
- Isolation in groups
Function/Structure: Nose, Mouth, Throat
Nose
- 1st segment of resp sys; warms, moistens, and filter air
- Shaped as a triangle; 2 oval openings at the base of the triangle (nares); divided in 1/2 by the septum
Mouth
- 1st segment of digestive system and an airway for resp
- Bordered by the lips, palate (soft and hard), cheeks and tongue
- Contains the teeth, gums, tongue and salivary glands
Throat (pharynx)
- Area behind the mouth and nose
- Separated from the mouth by the tonsils
Structure and Function - Nose
- External nose
- Nasal cavity: septum, turbinates, meatus
Structure/Function - Paranasal Sinuses
- Frontal
- Maxillary
- Ethmoid
- Sphenoid
Structure/Function - Mouth
- Oral Cavity
- Hard and soft palates
- Uvula
- Tongue
Structure/Function - Salivary Glands
- Parotid
- Submandibular
- Sublingual
- Teeth and gums
Structure/Function - Throat
- Throat (pharynx)
- Oropharynx
- Tonsils
- Nasopharynx
Developmental Considerations: Infants and children
- Salivation
- Deciduous teeth
- Nose: obligate nose breathers
- Positioning
- Tonsils
Developmental Considerations: Pregnant Women
- Nasal stuffiness
- Epistaxis
- Hyperemic gums
- Pregnancy-related gingivitis
Developmental Considerations: Older adults
- Diminished smell and taste
- Atrophic tissue
- Dental changes (malnutrition)
- Malnutrition
- “Purse string” appearance of mouth
- Yellow teeth
Cultural Social Considerations (Nose, mouth, throat)
- Increased incidence of dental disease in indigenous peoples
- Correlation between socioeconomic variables and dental disease
Health History - Nose
- Discharge (rhinorrhea)
- Frequent colds (upper resp infections)
- Sinus pain
- Trauma
- Epistaxis (nosebleeds)
- Allergies
- Altered sense of smell
Health History - Mouth and Throat
- Sores or lesions
- Sore throat
- Bleeding gums
- Toothache
- Hoarseness/Dysphagia/Altered tate
- Smoking, alcohol consumption
- Self-care behaviours: Dental care pattern, Dentures or appliances
Additional Health History Q’s: Infants and children
- Mouth disease
- Throat disease
- Tooth disease
- Self-care behaviours
Additional Health History Q’s: Older adult
- Mouth dryness (xerostomia)
- Teeth/dentures
- Mouth care
- Taste and smell
- Effect on nutrition
Promoting Health: Smokeless Tobacco (SLT) and Cancer Risk
Chewing tobacco and snuff (dry or moist) used in Canada
- Looking out for oral cancer
- Using SLT can lead to oral, esophageal, or pancreatic cancer
Physical Exam: Nose
Inspect and palpate
- External nose
- Nasal cavity: holding the otoscope, nasal septum, turbinates
- Have patient block one nostril and snif
Physical Exam: Sinus Areas
Palpate
- Frontal and maxillary sinuses
Physical Exam: Mouth
Inspect
- Lips
- Teeth and gums
- Tongue (test cranial nerve X11)
- Buccal mucosa
- Palate and uvula
