Neck Flashcards
What does JVD stand for?
Jugular Venous Distention
JVD is an indirect measure of what?
CVP (Central Venous Pressure)
Pressure in the right atrium of the heart
What happens to the jugular vein in JVD?
Jugular vein distends/bulges
For a normal pt, if they turn their head to the right should you be able to see their jugular vein bulging?
no
What does it mean if CVP is elevated?
jugular vein is bulging, CVP is elevated, right atrium pressure is elevated
JVD may indicate…
heart disease or vascular disease
Where is the external/internal jugular vein emptying into?
jugular vein is emptying into the superior vena cava of the heart
Where does the superior vena cava empty into?
superior vena cava empties into the right atrium of the heart
What is hypervolemia?
increased blood volume
What does it mean if a pt has hypervolemia?
pt suffering with hypervolemia means that there is an increase of CVP, which indicates JVD
If the tricuspid valve is stenosed, what does this mean?
blood is having hard time to flow from right atrium to the right ventricle of the heart causing regurgitation into superior vena cava
What does it mean if the blood can not flow properly into the right atrium?
if blood cannot flow properly, blood will accumulate in the right atrium and will regurgitate back into the superior vena cava (JVD)
Can you see JVD in a pt if they’re laying down?
Rarely, if you’re doing something with the heart, the bed should always be at a 30-45 degree angle
What is the spurling test designed for?
designed to reproduce symptoms by compression of affected nerve root
How do you perform a spurling test?
press axially with both hands on the patient’s head (their head should be slightly tilted/rotated)
radiating neck pain is consistent with nerve root compression
What general assessments should you use on a carotid artery?
palpate and auscultate
What should you hear through a stethoscope for a normal carotid artery?
normal heart thumping sounds “lub dup”
What is an abnormal auscultation sound heard through stethoscope when examining the carotid artery or thyroid gland?
bruit
What does a bruit sound indicate?
a vascular problem
What is a bruit sound?
an abnormal sound through blood vessels that is indicating turbulent blood flow from plaque (atherosclerosis)
Bruit sound is more common in _______
Bruit sound is more common in elderly
T/F
If you’re examining left carotid artery, have pt turn head to right and vice versa
true
What imagining test should you refer a pt to if they have a bruit?
ultrasound, this may prevent a stroke
What does a bruit sound like?
blowing or swooshing noise
What is a thyroid bruit?
increased blood flow to thyroid gland
Which disease do you commonly see enlarged thyroid glands?
Grave’s disease
Define nuchal rigidity
neck is rigid, cannot flex neck
What does nuchal rigidity indicate?
meningitis
What is another name for the larynx?
voice box
What is another name for thyroid cartilage?
“adam’s apple”
If a pt experiences pain while you’re palpating their thyroid gland, it may indicate….
infection or a hemorrhage
What can make it easier for you while examining/palpating the thyroid gland?
Hint: there are 2 things
have pt sit up and extend their head
have pt swallow water/saliva and it’ll allow the thyroid gland to elevate
Where should you start when you examine a patient’s thyroid gland?
start right under the chin
Can you see the thyroid gland for all patients?
no, it is most commonly seen in patients who have a goiter
The thyroid gland is made up of how many lobes? What is the structure called that joins the lobes?
2 lobes, isthmus joins them together
inferior or superior?
Isthmus is _____ to the cricoid cartilage
Isthmus is inferior to the cricoid cartilage
What should you first feel for when palpating the thyroid gland and surrounding structures?
you should first feel the thyroid cartilage (it’s the largest, and has a little notch at the top)
What should you feel next if you move down from the thyroid cartilage?
cricoid cartilage
What structure is below the cricoid cartilage?
the first tracheal ring
After palpating the tracheal rings, which direction should you move your fingers? What are you palpating once you get there?
move fingers laterally from the tracheal rings, this is your thyroid gland
What were the 2 types of goiters we learned in class?
1) goiter of graves disease (usually hyperthyroidism)
2) multinodular goiter (usually seen in thyroid cancers)
What is lymphadenopathy?
abnormality of size or inconsistency on the lymph nodes that you can palpate for
Name the triangles of the neck
anterior and posterior triangles
What is the anterior triangle bounded by?
mandible, midline of neck, and sternocleidomastoid muscle (SCM)
What does SCM stand for?
sternocleidomastoid muscle
What is the posterior triangle bounded by?
sternocleidomastoid muscle (SCM), trapezius muscle, and the clavicle
In simplest terms, what do lymph nodes do?
exchange fluid through vessels
drain lymphatic capillaries
How much fluid remains in blood capillaries?
15%
What happens to the “leftover” fluid in the blood capillaries?
that 15% will be exchanged through lymphatic capillaries
Describe lymphatic capillaries permeability
EXTREMELY permeable, everything is allowed in/out
Can easily result in cancer
What percent of blood is returned to a normal heart through blood vessels?
85%
What does it mean if lymph nodes are swollen/inflamed?
there is an infectious process present = infection
What does it mean if lymph nodes feel hard when you palpate?
often indicates malignancy
Where are lymph nodes typically?
everywhere, all over the body
When examining the head/neck should you assess one side at a time or both simultaneously?
both sides simultaneously so you can compare symmetry, size, misalignment, etc.
What does URT stand for?
upper respiratory tract
What does mental mean in a medical setting?
chin
List the 9 lymph node locations for the neck
1) anterior auricular
2) posterior auricular
3) occipital
4) tonsillar
5) submandibular
6) submental
7) superficial and deep cervical
8) posterior cervical
9) supraclavicular
Which lymph node location should you start with when inspecting/palpating the neck/head
anterior auricular
Where is anterior auricular lymph node? How many fingers should you use to palpate here?
in front of the ear, use 2 fingers in a circular motion
An enlarged/inflamed anterior auricular lymph node indicates….
external ear infection
Where is the posterior auricular lymph node? How many fingers should you use to palpate here?
at the mastoid process, use 2 fingers
Where is the tonsillar lymph node? What does it drain?
beneath the mandible
drains tonsils and posterior pharynx
Where is the submandibular lymph node? What does it drain?
under mandible
drains the floor of the mouth and the salivary glands
Where is the submental lymph node? What does it drain?
under chin
drains the entire oral cavity
Where is the superficial and deep cervical lymph nodes? What does it drain?
superficial and deep to the sternocleidomastoid muscle (SCM)
they drain the thyroid gland, tonsils, and the pharynx
Where is the posterior cervical lymph node? How many fingers should you use here? What does it drain?
posterior to the sternocleidomastoid muscle (SCM)
anterior to the trapezius muscle
use 4 fingers here
drains the skin on the back of the head and neck
What does an enlarged posterior cervical lymph node mean?
Upper Respiratory Infection (URI)
What is the last lymph node you should look at on the neck?
supraclavicular, it is the deepest lymph node on the neck/head
Where is the supraclavicular lymph node? How hard should you push here? What does it drain?
the deepest lymph node on the neck/head
really push down here, it is on the anterior triangle of the neck
drains part of the thoracic cavity and abdomen
What are 2 tests you can do in office if a pt have nuchal rigidity and you suspect they have meningitis?
1) brudzinski test
2) kernig test
What is meningitis?
inflammation of meninges
If either/both brudzinski and kernig test give a negative test result should you still write it in the SOAP note?
no, only record in SOAP if brudzinski and/or kernig test is positive test result
If pt has nuchal rigidity and you suspect they have meningitis what should you do besides the brudzinski and kernig tests?
refer them out for lab work
Describe brudzinski test
have pt lay flat and flex their neck/head
as the pt does this, you will stretch their meninges
if they feel pain, then that is a positive test result
if they put their legs up/bend them it will help alleviate some of that pain
Describe kernig test
pt is supine
flex the patient’s knees to 90 degrees and try to extend the legs
this stretches the meninges, if it causes pain then its a positive test result
pt can sit up to help alleviate pain
When palpating the patient’s cervical spinous processes, what should you pay attention to?
pt facial expression –> they may not tell you if its slightly painful, stiff, or tender
Where should the trachea be?
midline
