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Physical Diagnosis > PD Head and Neck > Flashcards

PD Head and Neck Flashcards

1
Q

Common head and neck complaints

A 
Trauma
Headache
Vision changes
diplopia
Otalgia
Hearing loss
Tinnitus
Vertigo, dizziness, lightheaded
Syncope
Epistaxis
Sore throat
Changes in smell and taste
Swollen glands
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2
Q

Name some vision changes

A

Hyperopia
Presbyopia
Myopia
Scotomas

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3
Q

What are the bones of the face?

A 
Frontal
Nasal
Zygomatic
Ehtmoid
Lacrimal
Sphenoid
Maxillary
Mandible
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4
Q

Innervation of facial muscles

A

CN V Trigeminal

CN VII Facial

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5
Q

Blood supply to face

A

Temporal artery

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6
Q

Salivary glands

A

Parotid
Submandibular
Sublingual

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7
Q

Head position for inspection

A

Upright and still

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8
Q

Bobbing or jerking during inspection

A

Tremor

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9
Q

Nodding movement during inspection

A

Aortic insufficiency

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10
Q

Head tilt during inspection

A

Favor unilateral hearing or vision loss

Toticolis

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11
Q

Inspection of facial features

A 
Symmetry
Shape
Tics
Characteristic facies
Unusual features
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12
Q

Symmetry of facial features

A

Symmetry of eyelids, eyebrows, palpebral fissures, nasolabial folds, mouth

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13
Q

Shape of face

A 
Edema
Puffiness
Coarse features
Prominent eyes
Hirsuitism
Lack of expression
Muscle wasting
Diaphoresis
Pallor 
Pigmentation
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14
Q

Tics

A

Spasmodic muscle contractions of head, neck, or face

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15
Q

Inspection of skull

A 
Size
Symmetry
Scales
Hair pattern
Trauma
Nits, parasites
Shape
Lesions
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16
Q

Cushing syndrome

Causes

A

Effects of hypercortisolism (increased adrenal hormone production)

Adenoma or adenocarcinoma
Stimulation by excess ACTH from pituitary tumor
Corticosteroid therapy

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17
Q

Features of Cushing’s syndrome

A 
Moon facies
Hirsuitism
Thick neck, central obesity with thin extremities
Purple striae
Pink cheeks
Buffalo hump
Peripheral edema
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18
Q

Cause of myxedema

A

Severe hypothyroidism

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19
Q

Features of myxedema

A 
Round, puffy face
Dry, coarse, sparse hair
Periorbital edema
Slow speech
Hoarseness
Cold, dry, thick, scaling skin
Weight gain
Cold intolerance
Bradycardia
Hypotension
Hypothermia
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20
Q

Features of nephrotic syndrome

A

Face edematous and pale
Swelling begins around eyes
Eyes may become slit like with severe edema

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21
Q

Nephrotic syndrome is classified as proteinuria…

A

Proteinuria over 3 gm/dl

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22
Q

Causes of nephrotic syndrome

A

Renal disease
DM
Idiopathic
Preeclampsia

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23
Q

S&S with nephrotic syndrome

A

Anorexia
Vomiting
Diarrhea
Lassitude

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24
Q

Parkinson’s features

A 
Mask like facies
Decreased facial mobility - blunted expression
Decreased blinking
Characteristic stare
Upper neck and trunk flexed forward
Patient seem to peer upward towards you
Facial skin is oily
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25
Q

Bell’s palsy features

A 
Facial nerve palsy
Asymmetry of one side of face
Drooping of lower eyelid and corner of mouth
Loss of nasolabial fold
Inability to completely close eye
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26
Q

Causes of bell’s palsy

A

Idiopathic
Viral infections
Most common over 70

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27
Q

What percentage of patients recover from bell’s palsy?

A

85%

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28
Q

Causes of parotid gland enlargement

A

Bacterial infection
Mumps
Neoplasm
Cirrhosis

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29
Q

Hurler syndrome features

A 
Mucopolysaccharidoses
Enlarged skull
Low forehead
Corneal clouding
Short neck
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30
Q

Craniosynostosis

A

Premature fusion of cranial sutures
Sutures involved determine the shape of the head
Not associated with mental retardation

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31
Q

Microcephaly

A

Congenitally small skull

Associated with mental retardation and failure of brain to develop normally

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32
Q

Down syndrome features

A 
Trisomy 21 (extra chromosome)
Depressed nasal bridge
Monogoloid slant of eyes
Low set ears
Large tongue
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33
Q

Fetal alcohol syndrome features

A 
Small eye openings
Hypoplastic philtrum
Thin upper lip
Flat mid face
low nasal bridge
Microceophaly
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34
Q

Hyperthyroidism features

A 
Prominent eyes
Exopthalamos
Lid lag
Startled expression
Thin, fine hair
Moist, smooth skin
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35
Q

Hippocartic facies features

A 
Marked cachexia
Sunken eyes, cheeks
Temporal muscle wasting
Sharp nose
Dry, rough skin
Seen in end stages of terminal illness or malnutrition
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36
Q

Palpation of head and scalp

A 
Symmetry
Smoothness
Hair texture
Scalp movement
Areas of tenderness, swelling, masses
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37
Q

Scalp in hyper hypothyroidism

A

Hyper - fine and silky

Hypo - dry and coarse

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38
Q

Which arteries do we palpate and where?

A

Temporal arteries - continuation of external carotid arteries anterior to the ear

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39
Q

Palpation of temporal arteries

A

Thickening
Decreased pulsations
Tenderness

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40
Q

Temporal arteritis features

A 
Necrotizing vasculitits
Persistent, severe, throbbing headache
Hard and nodular
Red and edematous
Vision impaired, may cause blindness
MS changes common

Idiopathic

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41
Q

Palpation of TMJ

A

Open and close mouth
Laterally back and forth
Protrude and retract

Note tenderness, popping, locking, crepitus

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42
Q

What is a normal gap between upper and lower teeth for an open jaw?

A

3-6 cm

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43
Q

How many cm is a normal lateral movement?

A

1-2 cm

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44
Q

Palpation of salivary glands

A

Asymmetry
Masses
Tenderness
Discharge through duct into mouth

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45
Q

Other name for parotid duct

A

Stenson’s duct

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46
Q

Other name for submandibular duct

A

Wharton’s duct

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47
Q

Where does the parotid duct open in the mouth?

A

Opens in buccal mucosa adjacent to maxillary second molar

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48
Q

Where does the submandibular duct open in the mouth?

A

Opens adjacent to the lingual frenulum

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49
Q

Sialadentitis

Features

A 
Bacterial infection of the gland
Swelling
Tenderness
Pain with eating
Fever
Can milk pus through the affected duct
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50
Q

Which ducts are the most common to get sialadentitis?

A

Parotid, then submandibular

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51
Q

What bacteria is the most common cause of sialadentitis?

A

Staph aureus

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52
Q

What are the risk factors for sialadentitis?

A

Dehydration
Dry oral mucosa
Sjogren’s syndrome

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53
Q

Sialolithiasis features

A

Postprandial pain and swelling

Sucurrent sialodentitis

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54
Q

wharton’s stones

A

Larger

Radiopaque

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55
Q

Stenson’s stones

A

Smaller

Radiolucent

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56
Q

Repeated episodes of stone formation may necessitate…

A

Sialadenectomy

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57
Q

Where is the most common salivary gland tumor? Are they malignant or benign?

A

80% in the parotid gland, and 80% are benign

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58
Q

Presentation of salivary gland tumors

A

Asymptomatic mass

Facial nerve involvement strongly correlates with malignancy

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59
Q

What is the choice imaging modality for salivary gland tumors?

A

MRI and CT

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60
Q

Anterior triangle of the neck

A

SCM
Midline
Mandible

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61
Q

Structures within anterior triangle

A 
Hyoid bone
Cricoid cartilage
Trachea
Thyroid
Anterior cervical LN
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62
Q

… artery and vein lie deep in the anterior triangle and run parallel to SCM

A

Internal jugular and carotid

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63
Q

… crosses the surface of the SCM diagnoally

A

External jugular

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64
Q

Posterior triangle of the neck

A

SCM
Trapezius
Clavicle

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65
Q

Contents of posterior triangle

A

Cervical chains LN

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66
Q

LN of head and neck

A 
Preauricular
Post auricular
Occipital
Tonsillar
Submandibular
Submental
Superficial cervical
Deep cervical
Posterior cervical
Supraclavicular
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67
Q

History complaints with neck

A 
Pain
Stiffness
Decreased ROM
Dysphagia
Masses, lumps, swelling
Dyspnea
Radiculopathies
Thyroid over/under activity
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68
Q

Inspection of neck

A 
Symmetry of structures
Deviation of trachea
Masses
Lesions
Scars
Jugular venous distension
ROM
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69
Q

Examples of masses in the neck

A

Carcionoma
Branchial and thyroglossal duct cysts
Lymph nodes

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70
Q

Palpation of the neck

A

Trachea midline
Hyoid bone
Cartilage - thyroid, cricoid, tracheal rings
Thyroid gland

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71
Q

How do we palpate for a midline trachea?

A

Place finger along one side of trachea and note distance between it and SCM - should be equal

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72
Q

Cause of trachea deviation

A 
Pneumothorax
Masses
Unilateral thyroid enlargement (goiter)
Aortic aneurysm
Atelectasis
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73
Q

Palpation of thyroid

A

Should be smooth and contender
Should move under finger when pt swallows

Size
Shape
Consistency
Configuration
Tenderness
Nodules
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74
Q

What position do we inspect the thyroid?

A

Could be either facing patient or from behind

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75
Q

When palpating the thyroid, fingers should be just below…

A

Cricoid cartilage

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76
Q

When is the thyroid auscultated?

A

If enlarged

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77
Q

Auscultation of thyroid - diaphragm or bell?

A

Bell

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78
Q

Auscultation of thyroid

A

Hypermetabolic state has increased blood supply - bruit is heard

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79
Q

Features of hyperthryoidism

A 
Heat intolerance
Weight loss
Fine hair, hair loss
Thinning hair
Exopthalmos
Lid retraction
Goiter
Tachycardia, palpitations
Diarrhea, Increased B
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80
Q

Features of hypothyroidism

A 
Cold intolerance
Weight gain
Coarse hair, brittle hair
Dry, flaky skin
Periorbital puffiness
No goiter
Constipation
Menorrhagia or amenorrhea
Lethargic, but muscle strength usually intact
81
Q

Palpation of LN

A 
Site
Size
Shape
Warmth
Tenderness
Consistency - hard, soft, rubbery
Mobility
Discrete or matted
Fluctuance, suppuration
82
Q

Features of infected LN

A 
Soft
Mobile
Discrete
Tender 
Warm
83
Q

Features of malignant LN

A

Hard
Fixed
Matted
Non tender

84
Q

Thyroglossal duct cyst

Features

A 
Remnant of embryologic development
Common before 20
Midline neck mass
Painless, could have discomfort with swallowing
Fluctuant, soft, mobile mass
85
Q

Thyroglossal duct cyst cause and presentation with…

A

Noted during or after URI

May present with sinus or fistulous tract

86
Q

Tx thyroglossal duct cyst

A

Surgical excision

87
Q

Branchial cleft cysts

A

Congenital epithelial cysts

Common in early adulthood 20-30

88
Q

Features of branchial cleft cysts

A 
Smooth
Non tender
Fluctuant
Mass along anterior SCM
May become tender and firm if secondarily infected
Sinus tract may develop
Odynophagia
89
Q

Tx of branchial cleft cysts

A

Surgical excision of non infected cyst and duct

90
Q

Torticollis aka…

A

Wryneck

91
Q

Congenital torticollis cause

A

Hematoma or partial rupture of SCM at birth results in unilateral muscle shortening

92
Q

Adult torticollis cause

A 
Trauma to SCM
Chronic spasm
Infection
Neoplasm
psychiatric
93
Q

Ocular torticollis

A

Head position assumed to compensate for vertical squint or an ocular muscle palsy/imbalance

94
Q

History complaints of eyes

A 
Red eyes
Painful
Change in visual acuity
Pruritic
Eye discharge
Increased or decreased tearing
Trauma
Foreign body
Diplopia
Flashing lights, floaters
95
Q

Causes of red eyes

A 
Conjunctivitis
Allergies
Glaucoma
Iritis
Trauma
Foreign body
Corneal abrasion/ulcer
Environmental irritants
96
Q

Causes of painful eyes

A 
Glaucoma
Iritis
Conjunctivitis
Trauma
Headaches
Foreign body
Corneal abrasion/ulcer
Sinusitis
Trachoma
Entropion
Hordeolum
Chalazion
Tumor
Eye muscle strain
Dry eyes
97
Q

Causes of pruritic eyes

A 
Conjunctivitis
Allergies
Noxious stimuli
Dry eyes
Eye fatigue
98
Q

Causes of eye discharge

A 
Conjunctivitis
Trachoma
Allergies
Infection
Foreign body
99
Q

Causes of increased tearing

A 
Foreign body
Trauma
Allergies
Infection
Noxious stimuli
Emotions
100
Q

Causes of decreased tearing

A

Fatigue
Sjogren’s syndrome
Obstruction of tear ducts
Trauma to CN VII

101
Q

Causes of loss of vision

A 
Optic neuritis
Detached retina
Retinal hemorrhage
Cataracts
Macular degeneration
Central retinal vascular occlusion
Glaucoma
Infection
CVA
Trauma
Tumor 
Retinopathy
102
Q

Causes of diplopia

A 
Head trauma
Cranial nerve palsy
Poor ocular muscle coordination
Opthalmoplegia
Tumor
Cataracts
Retinal detachment
Central retinal venous occlusion
Migraine
MS
103
Q

External eye inspection

A

Symmetry
Eyebrows
Eyelids

104
Q

PERRLA

A

Pupils equal, round and reactive to light and accommodation

105
Q

Palpation of eye

A

Nodules

Tenderness

106
Q

Ptosis

A

Dropping of upper eyelid

107
Q

Causes of ptosis

A

Muscular weakness (myasthenia gravis)
Damage to CN III
Interference with sympathetic nerves (Horner’s syndrome)

108
Q

Exopthalmus

Causes

A

Widened palpebral fissures
Bulging of the eyes

Hyperthyroid, Grave’s disease

109
Q

Ectropion

A

Excessive laxity or sagging of lower eyelid

110
Q

Cause of ectropion

A

Common in elderly

Trauma to nerve

111
Q

What happens when the punctum is turned outward in ectropion?

A

Tearing may be present due to abnormal drainage

112
Q

Entropion

Complications

A

Lower eyelid and lashes roll inwards
Common in elderly
Can cause inflammation and trauma to cornea

113
Q

Periorbital edema causes

A 
Infection (cellulitis)
Crying
Allergies
Myxedema
Nephrotic syndrome
CHF
Trauma
114
Q

Herniated fat pad

A

Swelling under eye due to fat accumulation

Common in elderly, may result from trauma

115
Q

Dacrocystitis

A

Pain, swelling of the lacrimal sac due to infection or trauma
Pressure on sac may produce purulent drainage

116
Q

Xanthelasma

Associated with…

A

Raised yellow plaques found on the nasal aspect of upper and lower eyelids
Hyperlipidemia

117
Q

Hordeolum

A

Sty
Pustule on the lid margin, forms when sebaceous gland near the hair follicle is inflamed
Hyperemia and swelling
Rupture and heal on its own

118
Q

Chalazion

A

Acute inflammation of Meibomian gland

Deeper, more chronic than hordeolum

119
Q

When do we inspect the upper conjunctivae?

A

If a foreign body is suspected

120
Q

Method of inspecting conjunctivae

A

Cotton swab, gently press onto surface of upper eyelid
Patient looks down
Gently grab rim of eyelid
Break suction and pull lid up over cotton swab

121
Q

Conjunctivitis Causes

A

Pink eye

Allergies
Bacterial
Viral
Foreign body

122
Q

Features of conjunctivitis

A

Red eyes from hyperemia of conjunctival vessels
Crusting of eyes
Exudate
Burning

123
Q

Conjunctival petechiae causes

A

Finding in endocarditis from emboli

Seen with bleeding disorders or sudden change in venous pressure

124
Q

Causes of subconjunctival hemorrhage

A

Trauma
Bleeding DO
Sudden increase in venous pressure
Sponatneous

125
Q

Pinguecula

A

Normal, slightly raised fatty structure under conjunctiva between the canthus and limbus, usually nasal side

126
Q

Pterygium

A

Chronic inflammation extends a vascular membrane over the limbus towards the center of the cornea
Benign, but vision may be obstructed

127
Q

Where is pterygium more common?

Causes

A

Southwest, patients older than 35
Nasal side

Wind and dust irritation

128
Q

Arcus senilis

A

Gray band of opacity in the cornea is separated from the limbus by a narrow clear zone
Bilateral
Due to deposits of lipids
No effect on vision

129
Q

Causes of corneal abrasion or ulcer

A

Infection - bacterial, viral, or fungal

Abrasion/injury

130
Q

S&S of corneal abrasion/ulcer

A 
Pain - superficial
Circumcorneal injection
Vision usually decreased
Photophobia
Watery or purulent drainage
131
Q

Hyphema

A

Blood in anterior chamber

132
Q

Hyphema causes

A

Trauma
Bleeding DO
Increase in venous pressure

133
Q

Hypopyon

A

Pus in anterior chamber

134
Q

Lens

A

Made of water and protein
Posterior to iris and pupil
Transparent

135
Q

Cataract

A

Protein clumps together and clouds the lens

136
Q

Causes of cataracts

A 
Congenital from rubella or CMV
DM
Steroids
Trauma
Advancing age
137
Q

S&S of cataracts

A

Slow blurring of vision over months to years
One or both eyes
No pain, redness, or discharge

138
Q

Pupil inspection

A

Size
Symmetry
Roundness
Reactivity to light and accommodation

139
Q

Miosis

A

2 mm or less

140
Q

Mydriasis

A

6 mm or greater

141
Q

Iritis

Causes

A 
Inflammation of iris due to infection
Surgery
Injury
Systemic conditions:
IBD
Sarcoidosis
RA
Reiter's syndrome
Lupus
142
Q

S&S of iritis

A 
Pain
No discharge
Ciliary infection
Decreased vision
Pupil irregular, sluggish
Photophobia
143
Q

Anisocoria

When is it benign

A

Difference in pupil size
Normal variant in about 20% of population
If pupillary reactions are normal, considered benign

144
Q

When is anisocoria serious?

A

Horner’s syndrome
Oculomotor nerve palsy
Glaucoma

145
Q

Pupillary reactions

A

Should dilate with light on same side and consensually

146
Q

When do we test accommodation?

A

If abnormal pupil response to light

147
Q

What do pupils do during accommodation tests?

A

Should constrict when looking at close object and dilate when looking far away

148
Q

What conditions may cause an abnormal pupillary reaction but normal accommodation?

A

DM

Syphilis

149
Q

Where is corneal reflection seen?

A

Slightly nasal to the center of pupils

150
Q

Why do we pause at extreme upward and lateral gazes during the H pattern?

A

To detect nystagmus

151
Q

Blink reflex (4)

A

Closing the eye is accomplished by muscles innervated by CN VII
Light touch to cornea will cause blink mediated by CN V
Loud noise will cause blinking by CN VIII
Bright light will cause blinking by CN III

152
Q

Which axons remain ipsilateral a and which cross?

A

Temporal remain ipsilateral

Nasal axons cross at optic chiasm

153
Q

What does the image appear as on the retina?

A

Reversed and inverted

154
Q

Where does the temporal retina see? Nasal retina?

A

Temporal retina sees over the nose

Nasal retina sees out to the sides

155
Q

Which occipital cortex sees the right world?

A

Left cortex

156
Q

Confrontation Test

A

Gross defects in visual fileds

Cover eye and slowly bring fingers from hand from periphery towards the center until the patient can see

157
Q

How many directions do we do the confrontation test from?

A

4 directions

158
Q

Homonymous

A

Loss of same visual field in both eyes

159
Q

Heteronymous

A

Different visual field loss in each eye

160
Q

Hemianopsia

A

Half of visual field is lost in both eyes

161
Q

Quadrantanopsia

A

1/4 of visual field is lost

162
Q

What two charts do we use to screen visual acuity?

A

Snellen

Rosenbaum pocket chart

163
Q

What do the first and second numbers mean in 20/40?

A

Patient is 20 feet from the chart

A normal person can read the line from 40 feet away

164
Q

Myopia

A

Nearsightedness

Eyeball and or cornea is elongated, focusing light rays before the retina

165
Q

Myopia - red or green diopters

A

Red

166
Q

Hyperopia

A

Eyeball and or cornea is shallower, focusing lights rays behind the retina

167
Q

Hyperopnia - red or green diopters

A

Green diopters

168
Q

Astigmatism

A

Cornea is irregularly shaped
Light rays can focus anywhere
Difficulty seeing near and far

169
Q

Astigmatism - red or green diopters?

A

Diopter setting varies

170
Q

Retinal detachment features

A

Blurring of vision unilaterally
“Curtain covering eye”
No pain, swelling, redness, or discharge
Seen with fundoscopy

171
Q

Where is the most common site for retinal detachment?

Who commonly suffers?

A

Superior temporal area

Older than 50

172
Q

Central vision remains intact with retinal detachment until…

A

Macula detaches

173
Q

Central and branch retinal artery occlusion features

A

Sudden profound vision loss

Retinal swelling

174
Q

Amaurosis fugax

A

Fleeting blindness - seconds to minutes
Curtain coming over eye vertically
No major fundoscopic findings

175
Q

Causes of amaurosis fugax

A

70% have ipsilateral carotid stenosis

Think cardiac dz, a fib

176
Q

Optic neuritis

Features

A

Blurring of vision unilaterally
Develops rapidly
Pain in region of eye with eye movement
Optic disc appears swollen

177
Q

Causes of optic neuritis

A

MS
Viral infection
Autoimmune disorder

178
Q

Tx for optic neuritis

A

Steroids - IV then PO

179
Q

Fundoscopic exam allows for the visualization of…

A

Retinal background
Macula
Optic disc/cup
Vessels

180
Q

What is the first thing to visualize on fundoscopy?

A

Red reflex

181
Q

What do opacities in the path of the light on red reflex appear as?

A

Black densities

182
Q

Causes of lack of red reflex

A

Ill positioned scope
Large cataracts
Hemorrhage into vitreous humor

183
Q

Color of fundus

A

Pink or yellow background

184
Q

Which settings do you use if patient is myopic? Hyperopic?

A

Myopic - Red, minus lens

Hyperopic - Green, plus lens

185
Q

Vessels branch to or away from the optic disc?

A

Vessels branch away from optic disc

186
Q

Difference between arteries and veins

A

Arteries are smaller and brighter red

187
Q

Disc margin

A

Sharp and well defined

188
Q

Macula features

A

Darker in color that surrounding retinal background
Usually about 1 disc diameter in size
2 DD temporal to the disc

189
Q

Fovea centralis

A

Centermost point of macula, does not contain rods

190
Q

Optic disc/cup

A

Most prominent landmark
Round or oval
Nasal side
Vessels from all 4 quadrants emerge

191
Q

How large is the cup in comparison to the disc?

A

Cup should not be more than 1/2 disc diameter in size

192
Q

What does the disc look like in papilledema?

A

Loss of disc margins

193
Q

Causes of papilledema

A 
Increase IC pressure
Head trauma
Tumor
Increased intraocular pressure
Glaucoma 
Bleeds
194
Q

Hypertensive retinopathy features

A

Exudates
Flame hemorrhages
Increased arterial reflex

195
Q

Cotton wool spots

Causes

A

Irregular white/gray lesions with irregular borders

Infarcted nerve fibers
Seen in HTN

196
Q

Hard exudates

Causes

A

Creamy, yellow lesions with well defined borders, small and round
Clusters

DM or HTN

197
Q

Drusen bodies

Cause

A

Yellowish round spots
Tiny in size

Due to lipid deposits
Appear with normal aging

198
Q

Proliferative Diabetic retinopathy

A

New vessels on disc
Multiple hemorrhages
Dilation of retinal veins

199
Q

Retinoblastoma

A

Malignant retinal tumor that develops in children

Physical Diagnosis (10 decks)

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