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197 Cards in this Set
- Front
- Back
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What seven bones comprise the skull?
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2 fontal, 2 parietal, 2 temporal, 1 occipital
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Which cranial nerves innervate facial muscles?
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CN 5 and 7
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What is the major accessible artery of the face?
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Temporal Artery
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What forms the anterior triangle?
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medial border of SCM, mandible and midline
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What forms the posterior triangle?
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trapezius, SCM and clavicle
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What cartilage is the uppermost ring of tracheal cartilage?
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Cricoid Cartilage
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What is the significance of the Thyroid notch?
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Marks the levels of bifurcation of common carotid artery
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what is the largest endocrine gland in the body?
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thyroid gland
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what are the two hormones produced by the thyroid?
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thyroxine (T4) and Triiodothyronine (T3)
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When does ossification of the skull begin and end?
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Begins around 6 years old and ends by adulthood
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When does the posterior fontanel close?
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by 2 months of age
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When does the anterior fontanel close?
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by 24 months of age
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Does the thyroid enlarge during pregnancy?
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Yes, but cannot be detected by PE but can by ultrasound
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What happens to the thyroid with age?
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rate of T4 production decreases and thyroid become more fibrotic
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What may a horizontal jerking or bobbing of the head be associated with?
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a tremor
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what may a nodding movement of the head be associated with?
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aortic insufficiency especially is nodding is synchronized with pulse
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what may holding of head tilted to one side indicate?
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unilateral hearing or vision loss or torticollis
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What are facies?
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expression of appearance of the face and features of the head and neck that are characteristic of a clinical condition
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What should you see when there is facial nerve paralysis?
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the entire side of the face is affected
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What should you see when there is facial nerve weakness?
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the lower face is affected
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What should you see with a problem of the peripheral trigeminal nerve?
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when only the mouth is involved
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What are characteristic facies of cushing syndrome?
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moon shaped face with thin erythematous skin and buffalo hump
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What are characteristic facies of hippocratic facies?
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sunken appearance of eyes, cheeks and temporal areas, sharp nose, and dry rough skin
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What are characteristic facies of myxedema?
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dull puffy , yellowed skin; coarse, sparse hair; temporal loss of eyebrows; periorbital edema and prominent tongue
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What are characteristic facies of hyperthyroid?
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fine, moist skin with fine har, prominent eyes and lid retraction and staring or startled expression
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What are characteristic facies of systemic lupus?
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butterfly-shaped rash over malar surfaces and bridge of nose
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What are characteristic facies of Bell's Palsy
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assymetry of one side of the face, eyelid not closing completely, drooping lower eyelid and corner of mouth, and loss of nasolabial fold
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What are characteristic facies of early acromegaly?
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coarsening of features with broadening of the nasal alae and prominence of zygomatic arches
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What are characteristic facies of Pierre-Robin sequence?
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a triad of micrognathia, glossoptosis, and palatal clefting
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What are characteristic facies of down syndrome?
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depressed nasal bridge, epicanthal folds, mongoloid slant of eyes, low-set ears and large tongue
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What are characteristic facies of hurler syndrome?
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enlarged skull with low forehead, corneal clouding, and short neck
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What are characteristic facies of hydrocephalus?
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dilated scalp veins and sclera visible above iris (paresis of upward gaze termed "sun-setting sign"
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What are characteristic facies of fetal alcohol syndrome?
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one of most common causes of mental retardation, poorly formed philtrum, widespread eyes, inner epicanthal folds and mild ptosis; hirsute forehead; short nose; and relatively thin upper lip
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What are characteristic facies of Treacher-Collins syndrome?
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maxillary hypoplasia, micrognathia and auricular deformity
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What are characteristic facies of apert syndrome?
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severe maxillary and midfacial hypoplasia
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What are characteristic facies of Crouzon syndrome?
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severe maxillary and midfacial hypoplasia with low-set ears
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What are tics?
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spasmodic muscular contractions of the face, head or neck; may be associated with pressure on or degenerative changes of the facial nerves
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What features may be associated with hypothyroidism?
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coarse, dry, and brittle hair
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what features may be associated with hyperthyroidism?
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fine, silky hair
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what features may be associated temporal arteritis?
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thickening, hardness or tenderness
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what is the hyperactive masseteric reflex associated with hypercalcemia?
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Chvostek sign
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Which side of the stethoscope shoudld you use if you suspect a vascular anomaly?
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bell and listen over temporal region, over eyes, and below occiput
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what may webbing, excessive posterior cervical skin or an unusually short neck be associated with?
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chromosomal abnormalities
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what may nuchal rigidity and resistance to neck flexion be associated with?
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meningeal irritation
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what is a tugging sensation, synchronous with the pulse evidence of?
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tracheal tug sign (Cardarelli's or Oliver's sign)
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What does a tracheal tug suggest?
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aortic aneurysm
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what is the most sensitive test for determining the presence of a goiter?
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estimation of thyroid size by lateral inspection
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does the thyroid gland move with swallowing?
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yes
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does subcutaneous fat mimicking a goiter move with swallowing?
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no
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which lobe of thyroid is larger?
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right by 25%
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what does coarse tissue or a gritty sensation of the thyroid suggest?
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inflammation
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if a thyroid is enlarged why should you auscultate for vascular sounds with a bell?
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in a hypermetabolic state the blood supply increases dramatically and a vascular bruit may be heard
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what is caput succedaneum?
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subcutanous edema over the presenting part of the head at delivery; most common form of birth trauma and goes away in a few days
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what is a cephalhematoma?
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subperiosteal collection of blood; may not be obvious atbirth
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what is brachiocephaly
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long, narrow heads; feature of preterm infants
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what is plagiocephaly?
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flattened spot on the back or one side of the head of baby
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what is craniosynostosis?
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premature fusion of one of the sutures
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what is bossing?
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bulging of the skull
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what is bulging of the frontal areas of the skulls associated with?
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prematurity, thalassemia and rickets
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What may bulging of other areas of the skull indicate
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cranial defects or intracranial masses
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what does a mass over the clavicle, changing size with crying or respiration suggest?
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cystic hygroma
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within what population is a mastoid fontanel common?
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infants with down syndrome
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what does a snapping sensation indicate?
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craniotabes (skull wasting) that may be associated with rickets hydrocephalus, marasmus, syphilis, or thalassemia
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what is a crunch indicative of when palpating clavicles?
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fracture that occurred at the time of birth
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what is a mass in the lower third of the SCM indicate?
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hematoma
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a tranillumination beyond 2cm in all regions of the head and beyond 1 cm in the occiput suggests?
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excess fluid or decreased brain tissue in the skull
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a strong resonant sound when percussing the junction of the frontal, temporal and parietal bones suggest
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hydrocephalus or a brain abcess is present; sound is physiologic when fontanels are open
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within what population are cranial bruits common?
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children up to 5 years old and children with anemia; after 5 years may suggest vascular anomalies or increased intracranial pressure
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what is chloasma?
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mask of pregnancy
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is the presence of goiter an expected finding during pregnancy?
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no
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what is the age of onset for a classic migraine?
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childhood
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what is the age of onset for cluster headache?
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adulthood
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what is the age of onset of hypertensive headache?
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adulthood
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what is the age of onset for a muscular tension headache?
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adulthood
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what is the age of onset for a temporal arteritis headache?
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older adulthood
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where is a classic migraine located?
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unilateral or generalized
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where is a medication rebound headache located?
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holocranial or diffuse
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where is a cluster headache located?
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unilateral
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where is a hypertensive headache located?
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bilateral or occipital
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where is a muscular tension headache located?
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unilateral or bilateral
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where is a temporal arteritis headache located?
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unilateral or bilateral
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where is a space-occupying lesion located?
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localized
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what is the duration of a classic migraine?
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hours to days
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what is the duration of a medication rebound headache?
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hours
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what is the duration of a cluster headache?
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1/2 to 2 hours
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what is the duration of a hypertensive headache?
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hours
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what is the duration of a muscular tension headache?
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hours to days
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what is the duration of a temporal arteritis headache?
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hours to days
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what is the duration of a space-occupying lesion?
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rapidly increasing frequency
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when is the time of onset of a classic migraine?
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morning or night
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when is the time of onset of a medication rebound headache?
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predictably begins within hours to days of the last dose of medication
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when is the time of onset of a cluster headache?
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night
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when is the time of onset of a hypertensive headache?
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morning
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when is the onset of a muscular tension headache?
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anytime, commonly in afternoon or evening
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when is the onset of a temporal arteritis headache?
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anytime
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when is the onset of a space-occupying lesion?
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awakening from sleep
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what is the QOP of classic migraine?
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pulsating or throbbing
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What is the QOP (quality of pain) of a med rebound ha?
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dull or throbbing
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what is the qop of a cluster ha
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intense burning, boring, searing, knifelike
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what is the qop of a hypertensive ha
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throbbing
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what is the qop of a musc tension ha
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bandlike, constricting
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what is the qop of a TA ha
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throbbing
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what is the frequency of migraine headaches
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2/week
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what is the freq of med rebound ha
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gradual increase to daily
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what is the freq of cluster ha
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several times nightly for several nights, then none
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what is the freq of hypertensive ha
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daily
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what is the freq of musc tension ha
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daily
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what is the freq of TA ha
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daily
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what is the freq of space-occupying lesion
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progressive
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which gender more commonly gets classic migraines?
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females
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which gender more commonly gets med rebound ha
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female
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which gender more commonly gets cluster ha
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male
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which gender more commonly gets hypertensive ha
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equal
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which gender more commonly gets musc tension ha
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equal
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which gender more commonly gets TA ha
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equal
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which gender more commonly gets space-occupying lesion
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equal
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what are the prodromal event (early symptoms) associated with a classic migraine?
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vague neurologic changes, personality change, fluid retention, appetite loss to well-defined neurologic event, scotoma, aphasia, hemianopsia, aura
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what is the prodromal event associated with med rebound ha?
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daily analgesics use
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what are the prodromal events for cluster ha
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personality changes, sleep disturbances
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are there prodromal events for hypertensive, musc ten, or TA ha?
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no
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what is the prodromal event of a space occupying lesion
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aggravated by coughing or bending forward
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what is a precipitating event of a classic migraine
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menstrual period, missing meals, birth control pills, letdown after stress
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what is a a precipitaing event of med rebound ha
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abrupt discontinuation of analgesics
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what is a precipitating event of cluster ha
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alcohol consumption
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is there a precipitating event for hypertensive or TA ha?
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no
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what is a precipitating event of a musc tension ha
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stress, anger, bruxism (clenching or grinding teeth)
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what is a precipitating event of a space-occupying lesion
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develops in temporal relation to the neoplasm
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what are other symptoms of CM
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nausea and vomiting
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what are other symptoms of med rebound ha
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alternative or preventive medications fail to control the headache
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what are other symptoms of cluster ha
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increased lacrimation and nasal discharge
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what are other symptoms of hypertensive ha?
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generally remits as day progresses
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are there other symptoms of musc tension or TA headaches?
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no
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what are other symptoms of a space-occupying lesion
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vomiting, confusion, abnormal neurologic findings, gait abnormality, apilledem, nystagmus
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what is one of the most self-medicated abnormalities?
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headaches
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when should a complete neuro evaluation be done
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with patient complaining of headache
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where is a salivary gland most commonly found?
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parotid gland
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what is a slow-growing painless lump, either in front of ear or under jaw indicate
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salivary gland tumor
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what are some symptoms associated with a salivary gland tumor
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facial weakness, fixation of the lump, sensory loss, ulceration, difficulty opening mouth and tongue weakness or numbness
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what is a thyroglossal duct cyst
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palpable cystic mass in the neck
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what is a remnant of fetal development and rises from the foramen cecum at junction of anterior 2/3 and posterior 1/3 of tongue
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thyroglossal duct cyst
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what are some symptoms of a thyroglossal cystic duct
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tenderness, redness, swelling in midline of neck and difficulty breathing or swallowing
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what is a freely movable cystic mass in neck midline that moves upward with tongue protrusion and swallowing
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thyroglossal duct cyst
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what is a branchial cleft cyst
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congenital lesion formed by incomplete involution of branchial cleft
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what is an epithelium-lined cyst with or without a sinus tract to overlying skin
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branchial cleft cyst
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what are the symptoms of branchial cleft cysts
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solitary mass, painless in lateral neck, may have intermittent swelling and discharge if associated with a sinus tract
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what is an oval, moderately movable, smooth nontender, fluctuant mass along the anteromedial border of SCM
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branchial cleft cyst
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what is another name for torticollis
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wry neck
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how does torticollis develop
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often result of birth trauma or intrauterine malposition
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why does acquired torticollis develop
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result of tumors, trauma, CN 4 palsy, muscle spasms, infection or drug ingestion
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what are symptoms of torticollis
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stiff neck
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what is the appearance of torticollis
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head tilted and twisted toward the affected SCM with chin elevated and turned toward opposite side, hematoma may be palpated shortly after birth, firm fibrous mass may be felt in muscle
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what is hypothyroid
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under active thyroid
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what can cause weight gain, constipation, fatigue and cold intolerance
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hypothyroid
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what is hyperthyroid
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over active thyroid
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what can cause weight loss, tachycardia, and heat sensitivity
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hyperthyroid
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what is the temperature preference in hyperthyroid
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cool climate
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what is the temperature preference in hypothyroid
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warm climate
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what type of emotional state is associated with hyperthyroid
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nervous, easily irritated, highly energetic
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what type of emotional state in associated with hypothyroid
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lethargic, complacent, disinterested
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what type of hair is associated with hyperthyroid
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fine with hair loss
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what type of hair is associated with hypothyroid
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coarse with tendency to break
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what skin changes are seen with hyperthyroid
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warm, fine, hyperpigementation at pressure points
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what skin changes are seen with hypothyroid
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coarse, scaling, dry
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what fingernail changes are seen with hyperthyroid
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thin with tendency to break; may how onycholysis
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what fingernail changes are seen with hypothyroid
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thick
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what changes to the eyes are seen with hyperthyroid
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bilateral or unilateral proptosis (bulging), lid retraction, double vision
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what changes to the eyes are seen with hypothyroid
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puffiness in periorbital region
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is goiter associated with hyperthyroid
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yes
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is goiter associated with hypothyroid
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no
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what GI changes are associated with hyperthyroid
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increased frequency of bowel movements; diarrhea rare
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what GI changes are associated with hypothyroid
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constipation
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what menstrual changes are seen with hyperthyroid
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scant flow, amenorrhea
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what menstrual changes are seen with hypothyroid
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menorrhagia
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is there muscle weakness with hyperthyroid
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yes
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is there muscle weakness with hypothyroid
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no but lethargy present
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what skin and tissue disorder is a result of severe prolonged hypothyroidism
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myxedema
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what is the pathophysiology of myxedema
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decreased metabolic rate, accumulation of hyaluronic acid and chondroitin sulfate in the dermis; deposition of glycosaminoglycan in all organ systems leading to mucinous edema of facial features
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what are some subjective symptoms of myxedema
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cognitive impairment, poor concentration, decreased short-term memory, depressed mood, constipation, muscle pains, hearing problems
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what are some objective symptoms of myxedema
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coarse thick skin, swollen lips and puffy eyes, slow speech, mental problems, weight gain, thin brittle hair with bald patches
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what is grave's disease
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autoimmune disease where antibodies to thyroid stimulating hormone recptors lead to overactive thyroid
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in what population is grave's disease more common
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women during their third and fourth decades
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what symptoms are associated with grave's disease
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same at hyperthyroid
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what characteristics are seen on physical exam of someone with grave's disease
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diffuse thyroid enlargement; prominent eyes (exophthalmos); dermatologic, constitutional, menstrual, and musculoskeletal abnormalities and nonpittng edema
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what is hashimoto disease
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autoimmune antibodies against thyroid gland
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what does hashimoto dissease often cause
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hypothyroid, most common in children and women between 30 and 50 years old
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what is seen on the physical exam of a person with hashimoto disease
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enlarged nontender smooth thyroid
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what is an encephalocele
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neural tube defect with protrusions of brain and membranes that cover it through openings in the skull
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why does an encephalocele occur
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neural tube failed to completely close during fetal development
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what abnormalities are seen in an infant with an encephalocele
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craniofacial abnormalities or other brain malformations, hydrocephalus
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what is microcephaly
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when the circumference of the head is smaller than normal because the brain has not developed properly or has stopped growing
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when can microcephaly be detected
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it is present at birth or may develop in the first few years of life
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what causes microcephaly
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congenital infections and neuroanatomic abnormalities
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what features are associated with microcephaly
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mental retardation and failure of brain to develop normally
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what physical features are seen during an examination of someone with microcephaly
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head circumference is 2 to 3 standard deviations below mean for age
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what is craniosynostosis?
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premature closure of one or more cranial sutures before brain growth is complete; leads to misshapen skull
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Does mental retardation usually accompany craniosynostosis?
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no
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What can premature fusion of sutures lead to?
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increased intracranial pressure
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