PE Head & Neck Flashcards
How many bones are in the head?
7
What are the bones in the head?
two frontal,
two parietal,
two temporal,
one occipital.
The facial bones include?
frontal,
nasal,
zygomatic,
ethmoid,
lacrimal,
sphenoid,
maxillary bones
mandible
Major facial landmarks are the ______ and the _______.
palpebral fissures and the nasolabial folds
Facial muscles are innervated by what cranial nerves?
V and VII
What is the major artery that feeds the face?
The temporal artery
What are the salivary glands? Where are they?
1) Parotid glands – located anterior to the ear and above the mandible.
2) Submandibular glands – located medial to the mandible at the angle of the jaw.
3) Sublingual glands – located anteriorly in the floor of the mouth.
The neck is formed by what?
cervical vertebrae,
ligaments
sternocleidomastoid
trapezius muscles
What are the lymph nodes for the exam?
occipital
posterior auricular (mastoid),
preauricular,
parotid,
retropharyngeal (tonsillar),
submental.
Anterior cervical chain,
two posterior cervical chains
supraclavicular chain.
Which gland has two lateral lobes are butterfly shaped and are joined by an isthmus at their lower aspect.
Thyroid
When gathering HPI for a TBI what is asked?
1) State of consciousness after injury
(duration of unconsciousness, combative, confused, alert, or dazed).
2) Predisposing factors
(seizure disorder, hypoglycemia, poor vision, lightheadedness, syncope, sports participation).
3) Associated symptoms
(head or neck pain, laceration, local tenderness, change in breathing pattern, blurred or double vision, discharge from nose or ears, nausea or vomiting, urinary or fecal incontinence, ability to move all extremities.
When gathering HPI for a Headache what is asked?
(a) Patients with headaches should describe the Onset (acute versus chronic), Duration (minutes, hours, days), Location (entire head, unilateral, sinus region, behind eyes, hatband distribution), Character (throbbing, pounding, dull, constant pressure), Severity, and Pattern of Pain.
(b) Associated symptoms (visual, sinus, nausea, vomiting).
(c) Efforts to treat
(sleep, pain medication, caffeine not consumed, antiarrhythmics, oral contraceptives, antidepressants, NSAIDS, narcotics)
When gathering HPI for a Stiff Neck what is asked?
Pertinent data include signs of swelling, fever, characteristics of discomfort, causes, and treatment attempts.
When gathering HPI for a Thyroid problem what is asked?
Temperature preference, neck swelling, skin and hair texture, emotional status, eye prominence, and menstrual and bowel patterns.
When gathering HPI for a Thyroid problem what is asked?
Temperature preference, neck swelling, skin and hair texture, emotional status, eye prominence, and menstrual and bowel patterns.
When gathering HPI for a Thyroid problem what is asked?
Temperature preference, neck swelling, skin and hair texture, emotional status, eye prominence, and menstrual and bowel patterns.
Past Medical History questions for Head/neck
Previous TBI, subdural hematoma, lumbar puncture, radiation treatment, headaches, surgeries, seizures, thyroid dysfunction.
Family hx for head/neck questions to ask
Family members with headaches or thyroid conditions.
Personal and Social History questions to ask?
(1) Employment: Type of work, risk of TBI, use of protective head gear, exposure to toxins
or chemicals.
(2) Stress; tension; demands at home, work, or school.
(3) Potential risk of injury: Use of seat belts, car seats/booster seats; unsafe environment
(4) Nutrition: Recent weight gain or loss, food intolerances, eating habits.
(5) Use of recreational drugs and/or alcohol.
(6) Sports participation, weight training, use of protective padding and helmet.
Head upon inspection
Normal is:
What are you going to note?
- Should be upright and still
Note any jerking or bobbing motion (tremor),
nodding synchronized with pulse (aortic insufficiency),
head tilted or favoring one side (unilateral hearing/vision loss or torticollis)
Defined as an expression or appearance of the face and features of the head and neck that, when considered together, is characteristic of a clinical condition or syndrome
(Cushing syndrome, Lupus Erythematosus, Acromegaly, Bell Palsy, Down syndrome).
Facies
When and where would you auscultate on the head
- Bruits over the eye and occiput (with associated diplopia) may suggest cerebral aneurysm.
- Bruits over the temporal artery are associated with temporal arteritis.
Bruits over the temporal artery are associated with
temporal arteritis
During a neck inspection jugular vein and carotid artery distribution may indicate what?
Nuchal rigidity (resistance to flexion) may be associated with
meningeal irritation.
how do you check for tracheal tugging
With neck slightly extended position index finger and thumb on each side of the trachea below the thyroid isthmus.
Checking the trachea
What is Cardarelli sign or Oliver sign?
tugging sensation, synchronous with the pulse
This suggests presence of an aortic aneurysm
The thyroid is approximately how long and what side is longer?
4 cm, and the right lobe is often 25% larger
than the left
Bruits over the thyroid may indicate what?
hypermetabolic state (hyperthyroidism),
Disorder association
Tracheal deviation
Displacement by mass in the chest
Disorder association
Tracheal deviation
Displacement by mass in the chest
Disorder association
Bruits over the eye and occiput
Cerebral aneurysm
Disorder association
Bruits over the temporal artery
Temporal arteritis
Disorder association
Tracheal tug
Aortic aneurysm.
Disorder association
Nuchal rigidity
Meningeal irritation
Disorder association
Grittiness of thyroid on palpation
Thyroiditis
Disorder association
Fine or coarse hair
Related to thyroid disease.
Disorder association
Skull depression or ridges
Fracture.
Disorder association
Persistent, recurrent, and severe headaches
Brain tumor or migraines.
Disorder association
Webbing or short neck
Chromosomal anomalies
Disorder association
Enlarged mass at base of neck
Thyroid problem
Disorder association
Unusual hair patterns
Genetic disorder
What type of facies?
(a) Rounded, “moon-shaped” face
(b) Thin erythematous skin
(c) +/- Hirsutism
Cushing syndrome:
What type of facies?
(a) Rounded, “moon-shaped” face
(b) Thin erythematous skin
(c) +/- Hirsutism
Cushing syndrome:
What type of facies?
(a) Puffy, dulled yellowed skin.
(b) Coarse, sparse hair.
(c) Temporal loss of eyebrows.
(d) Periorbital edema.
(e) Prominent tongue.
Myxedema
What type of facies?
(a) Fine, moist skin.
(b) Fine hair.
(c) Prominent eyes.
(d) Lid retraction.
(e) Staring/startled expression.
Hyperthyroidism
What type of facies?
(a) Coarsened features.
(b) Broadened nasal alae.
(c) Prominence of zygomatic arches.
Acromegaly
What type of facies?
(a) Coarsened features.
(b) Broadened nasal alae.
(c) Prominence of zygomatic arches.
Acromegaly
What type of facies?
(a) Sunken eyes, cheeks, temporal areas
(b) Sharp nose
(c) Dry, rough skin
(d) Terminal stages of illness
Hippocratic Facies
What type of facies?
(a) Asymmetry of 1 side of face
(b) Eyelid not closing completely
(c) Drooping lower lid
(d) Drooping corner of mouth
(e) Loss of nasolabial fold
Facial Palsy
What type of facies?
(a) Enlarged head
(b) Bulging fontanel
(c) Dilated scalp veins
(d) Bossing of skull
Hydrocephalus
What type of facies?
(a) Depressed nasal bridge
(b) Epicanthal folds
(c) Mongoloid slant of eyes
(d) Low-set ears
(e) Large tongue
Down Syndrome
What type of facies?
a) Butterfly rash
(b) Malar surfaces and bridge of nose
(c) Blush with swelling
(d) Scaly, red maculopapular lesions
Lupus (SLE)
What type of facies?
(a) Freely movable cystic mass
(b) High in neck
(c) Midline
(d) Duct at base of tongue
(e) Remnant of fetal development
Thyroglossal duct cyst
Skin and tissue disorder usually due to severe prolonged hypothyroidism
Myxedema
Pt has these issue
(a) Autoimmune, antibodies to thyroid stimulating hormone receptor, leading to
overactive thyroid
(b) Characterized by diffuse thyroid enlargement (goiter)
Graves’ disease
Autoimmune antibodies against thyroid gland, often causing hypothyroidism
Hashimoto disease
