Unit 3 Head And Neck Flashcards
What is a tracheal tug
Downward displacement of the cricoid cartilage with each ventricular contraction
What happens when a downward tug of the trachea is synchronized with systole
Reveals the presence of an aortic arch aneurysm
What is campbell’s sign
The downward displacement of the thyroid cartilage during inspiration due to COPD
What does campbell’s sign displacement correlate with
The severity of compromise of the FEV
What causes campbells sign
Due to strong diaphragmatic contractions of COP patients
What is craniotabes of infants
Softening of the outer table of the skull
What is transillumination used for
You transilluminate the skull of infants who have suspected intracranial lesions or a rapidly increasing head circumference
Why is transillumination performed less often today
Because the availability of computed tomograpy (CT) scan
What is macewen sign
Use percussion of the skull that results in stronger resonant sound when either hydrocephalus or a brain abcess is present
Children up to 5 years with anemia have what commonly
Bruits
When auscultating a patient with a goiter or findings of hyperthyroidism what can be present
A bruit can be heard indicating increased vascularity
Bruit found in someone exibiting hyperthyroidism is a strong. Indicator of what?
Grave thyrotoxemia
What is the upper limit of the thyroid gland
15-25 gm
Where are most people iodine deficient
Mountainous regions/away from the sea
What is a thyroid gland that has posterior extracapsular tissue extending superiorly from the posterior aspect of the tongue
Lingual thyroid and can extend into the mediastinum
Who exhibits false positives
Thin patients, long necklines (psuedogoiters), fat pad,
What causes false negatives
Inadequate exam, short/thick neck, atypical/ectopic placement of thyroid
What is a chronic enlargement of the thyroid
A goiter
What causes a goiter
Non neoplastic nor inflammatory process, it is result of hypertrophy or degeneration of the gland
When do fetal thyroid glands become functional
In the second trimester
What is a skin and tissue disorder usually due to severe/prolonged hypothyroidism
Myxedema
What is it called when autoimmune antibodies are sent to thyroid-stimulating hormone receptor, leading to overactive thyroid
Graves disease
What is an autoimmune antibodies against the thyroid gland causing hypothyroidism
Hashimoto disease
What happens to the rate of T4 production and degradation with aging
It gradually decreases because the thyroid gland becomes more fibrotic
What does unilateral salivary gland swelling mean
Ductal calculus due to infx or rarely a tumor
What is a congenital lesion formed by incomplete involution of branchial cleft
Branchial cleft cyst
What is a neural tube defect with protrusions of brain and membranes that cover it through openings in the skull
Encephalocele
What is a problem in the formation, flow, absorption, of CSF that leads to an increase in volume of the CSF
Hydrocephalus
What is a circumference of head that is smaller than normal because the brain has not developed properly or has stopped growing
Microcephaly
What is a premature closure of one or more cranial sutures before brain growth is complete and leads to a misshapen skull
Craniosynostosis
What abnormality is characterized by inflammation of one or more lymphatic vessels
Acute lymphangitis
What abnormality is characterized by infx and inflamm of a lymph node and may affect a single or localized group of nodes
Acute suppurative lymphadenitis
What abnormality is edematous swelling due to excess accumulation of lymph fluid in tissue caused by inadequate lymph drainage
Lymphedema
What abnormality is a malignant neoplasm of the lymphatic system and the reticuloendothelial tissues
Non-hodgkin lymphoma
What abnormality is a malignant lymphoma
Hodgkin lymphoma
What causes infectious mononucleosis
Epstein barr virus mononucleosis
What is a congenital malformation of dilated lymphatics
Lymphangioma/cystic hygroma
What is a massive accumulation of lymphedema throughout the body and the most common cause of secondary lymphedema worldwide
Lymphatic filariasis (elephantiasis)
What is among the most common causes of subacute or chronic lymphadenitis in children
Cat scratch disease
What is a dysfunx of cell mediated immunity
Acquired immune deficiency syndrome
What type of hypersensitivity is serum sickness
Type 3 hypersensitivity reaction
What is an allergic contact dermatitis that involves the immunne system and is caused by chemicals in latex products
Immune complex disease latex allergy
What type of hypersensitivity is immune complex disease latex allergy
Type 4 (delayed hypersensitivity)
What type of reaction is a true allergic reaction caused by protein antibodies of latex
Latex allergy type 1 reaction
When the immunce system fails the individual may experience a variety of illnesses like
Allergic reaction or immunodeficiency (congenital or acquired)
The lymphatic system supports a network of defenses against what
Microorganisms
Except for what 2 structures, every tissue supplied by blood vessels has lymphatic vessels
Placenta and brain
Without lymphatic drainage where would lymph build up
Interstitial spaces due to more fluid leaving capillaries than absorbed
The lymph nodes recieve lymph from collecting ducts and pass them through what vessels
Efferent
Ultimately the large ducts of the lymph system merge into what and where
The venous system at the subclavian veins
What is the drainage point for the right upper body
Lymphatic trunk that empties into the right subclavian vein
What is the major vessel of the lymphatic system
The thoracic duct
What drains lymph from the rest of the body into the left subclavian vein
The thoracic duct.
Where does the lymph fluid return fluids/proteins to in order to form a closed but porous circle
The cardiovascular system
What does the lymphatic system rely on for movement
The cardiovascular system, it is more sluggish
As lymph fluid volume increases what happens
It flows faster in response to mounting capillary pressure, increased metobolic activity, mechanical compression
What is central to the body’s response to antigenic substances
Lymphocytes
Where are lymphocytes primarily produced
In the bone marrow
Where do marrow derived lymphocyte cells first flow
To the thymus where it can be differentiated as a T lymphocyte
What type of immunity involves the anitbodies produced by B cells
Humoral
What type of immunit involves attacks on invaders by the cells themselves
Cellular
Which has a longer life span b or t cells
T cells
What does an increased number of lymphocytes in the blood represent
Systemic response to most viral infections and to some bacterial infection
In early life what is the thymus’ role
Development of protective immune function
What is the white pulp of the spleen
Made up of lymphatic nodules and diffuse lymphatic tissue
What is the red pulp of the spleen
Made up of venous sinusoids
What are spleens functions
Destroy and store RBC’s, produce antibodies, filter microorganisms from the blood
Defensive responses to inhaled and intranasal antigens are activated in what tissues
Tonsils/adenoids
When enlarged what is the problem with adenoids and tonsils
They can obstruct the nasopharyngeal passageway
When does the immune and lymphoid system begin developing
20 weeks of gestation
When does the mass of lymphoid tissue increase
Between ages 6-9 years and regress by puberty
When does the umbilical cord drop off
By 1-2 weeks after birth, delayed is associated with leukocyte adhesion defect
When is the thymus largest relative to rest of body
Shortly after birth, reaches greatest absolute weight at puberty
What type of nodes are more common in older children compared to first year
Cervical and submandibular
What type of node when present in children associates with high incidence of malignancy and is always cause for concern
Supraclavicular nodes
What happens to lymph nodes as we age
They may diminsh in number and size more likely to become fibrotic and fatty
Disorders of the lymph system can present with what three physical signs
Enlarged nodes, red streaks on overlying skin, and lymphedema
What is a node that feels like it contains fluid
Fluctuant node
What does a fluctuant node suggest
Suppuration from infection
What characteristic is most common from fixation of a node to underlying tissue
Metastatic cancer, but also can occur with chronic inflamm
What is found that is widespread and involves several lymph node regions indicating systemic disease/disorder
Lymphadenopathy
What is the six step sequence of nodes on the head
Occipital, postauricular, preauricular, partoid/retropharyngeal, submandibular, submental
What is the 4 step sequence palpating nodes down the neck
Superficial cervical nodes, posterior cervical nodes, cervical nodes deep to SCM, supraclavicular areas (virchow nodes)
Where is the lymphatic drainage of the testes
Into the abdomen
Nodes in the inguinal area enlarge if there are lesions of what
The penile and scrotal surfaces
It is not unusual to find enlarged postauricular and occipital nodes in children younger than what age
2 yr old
Past the age of 2 an enlarge postauricular and occipital node may be siginificant for what
Mumps/immune deficiency
Cervical and submandibular nodal enlargement is less common in children younger than what
1 year of age
Nodes smaller than ___ are not concerning and nodes with diameter of ____ or less in the cervical do not always indicate a problem
0.5 cm; 1 cm
Excessive enlargement of the palatine tonsils if too enlarged can do what
Obstruct the nasopharynx, increase risk of sleep apnea, and rare but pulmonary HTN
What is the largest endocrine gland in the body
The thyroid
What hormones does the thyroid produce
Thyroxine (T4) and triiodothyronine (T3)
When does ossification of infantile sutures begin
After completion of brain growth around age 6
What happens to T4 as we age
T4 production and degradation gradually decreases with aging and the thyroid gland becomes more fibrotic
Holding the head tilted to one side to favor something is usually what
Favor a good eye/ear
Holding the head tilted to favor eye or ear can also be asymptom of what
Torticollis
What is defined as an expression or appearance of the face and features of the head and neck that when considered together is a characteristic of a clinical condition or syndrome
Facies
Percussion on the masseter muscle may produce what
Hyperactive masseteric reflex (the chvostek sign)
What type of bruit is considered common in children
Intracranial bruits
Individuals with ____ that hav a bruit over the orbit suggests an expanding cerebral aneurysm
Diplopia
Nuchal ridigity, resistance to flexion of the neck may be associated with what
Meningeal irritation
In an infant dilated scalp veins and a head circumference increasing faster than expected may indicate what
Increased intracranial pressure
What is a subcutaneous edema over the presenting part of the head at delivery
Caput succedaneum
What is the most common form of birth traua of the scalp and usually occurs over the occiput and crosses suture lines
Caput succedaneum
What is a subperiosteal collection of blood and is therefore bound by suture lines
Cephalhematoma
What can result from premature fusion of one of the sutures
Plagiocephaly
Positional plagiocephaly is common among infants with what
Toriticollis
A bulging fontanel with marked pulsations may indicate what
Increased intracranial pressure from space occupying mass or meningitis
What indicates craniotabes and what is it associated with
Snapping sound; premature, rickets, hydrocephalus, syphilis, thalassemia
What is indicative of fracture in a clavicle of newborns
A fracture during birth
What do you do if you suspect intracranial lesions or rapidly increasing head circumference
Transilluminate
Cranial bruits are common in children up to how old
5 years of age or in children with anemia, past that may present vascular anomalies
What is a congenital lesion formed by incomplete involution of branchial cleft
Branchial cleft cyst
What is a skin and tissue disorder due to severely prolonnged hypothyroidism
Myxedema
What condition is an autoimmune antibodies against the thyroid gland
Hashimoto disease
