Clinical Exam Head And Neck Chapter

Front 1

Number of bones in the skull

Back 1

7

Front 2

Forms the posterior triangle; what is contained within?

Back 2

Trapezius, scm, and clavicle; posterior cervical lymph nodes

Front 3

Review the location of the facial nodes

Back 3

**

Front 4

Forms the anterior triangle; what is contained within?

Back 4

Scm, mandible; inside: hyoid bone, cricoids cartilage, trachea, thyroid, and ant cervical lymph nodes

Front 5

Vein that runs diagonal across the scm

Back 5

External jugular vein

Front 6

The uppermost ring of the tracheal cartilage

Back 6

Cricoids cartilage

Front 7

Joins the 2 lateral lobes of the thyroid

Back 7

Isthmus

Front 8

Complete brain growth in children is at what age

Back 8

6 yrs

Front 9

When do anterior fontanels close

Back 9

24 mo

Front 10

When do posterior fontanels close

Back 10

2 mo

Front 11

During pregnancy, hCG can cause an increase in

Back 11

Free T4 and T3 levels

Front 12

The thyroid __ during pregnancy

Back 12

Enlarges (due to ↑ in renal clearance of iodine, thyroid compensates by enlarging to produce enough hormones)

Front 13

Horizontal jerking or bobbing is asstd w/

Back 13

Tremor

Front 14

Nodding movement can be asstd w/

Back 14

Aortic insufficiency (especially if synchronized with the pulse)

Front 15

Shortening of the scm

Back 15

Torticollis

Front 16

If entire side of face is paralyzed suspect

Back 16

Facial n paralysis

Front 17

If lower face is affected

Back 17

Facial n weakness

Front 18

If only mouth is paralyzed suspect

Back 18

Peripheral trigeminal n

Front 19

Coarse, dry brittle har is assctd w/

Back 19

Hypothyroidism

Front 20

Fine, silky hair is assctd w/

Back 20

Hyperthyroidism

Front 21

Thickening, hardening or tenderness over temporal arteries my indicate

Back 21

Temporal arteritis

Front 22

Joint palpated just anterior to the tragus

Back 22

Temperomandibular joint

Front 23

Percussion of the skull that results in pitch much lower than high-pitched skull

Back 23

Hyperparathyroidism

Front 24

Percussion of sinuses elicits tenderness

Back 24

Sinusitis

Front 25

Condition where a bruit or blowing sound may be heard over the orbit (rare) and suggests and expanding aneurysm

Back 25

Diplopia

Front 26

Place the bell of the stethoscope over the temporal region, eyes or below the occiput

Back 26

To determine vascular anomaly of the brain

Front 27

Webbing, excessive posterior cervical skin or a short neck can be asstd with

Back 27

Congenital anomalies

Front 28

A mass filling the base of the neck or tissue that glides upward when the pt swallows may indicate:

Back 28

Enlarged thyroid gland

Front 29

Unequal space between the trachea and scm indicates

Back 29

Displacement of trachea from midline; can be assctd w/a mass or pathologic condition in the chest

Front 30

Dr has finger and thumb on each side of trachea below isthmus, tugging sensation synchronous with the pulse is evidence of:

Back 30

Tracheal tugging → aortic aneurysm

Front 31

Parts of thyroid to palpate

Back 31

Isthmus, main body, and lateral lobes

Front 32

The __ lobe of the thyroid is usually larger

Back 32

Right

Front 33

Broades dimension of thyroid

Back 33

4 cm

Front 34

Vascular bruit with a soft rushing sound heard over thyroid

Back 34

Hypermetabolic state (blood dramatically increased)

Front 35

Subcutaneous edema over the presenting part of the head at delivery of baby; most common birth trauma

Back 35

Caput succedaneum (over occiput and CROSSES suture lines)

Front 36

Subperiosteal collection of blood in an infant most commonly found in the parietal region; may not be obvious at birth

Back 36

Cephalhematoma (DOES NOT CROSS suture lines)

Front 37

Bossing/bulging of FRONTAL area the infant skull can indicate

Back 37

Prematurity and rickets

Front 38

Bulging of areas other than frontal indicates

Back 38

Cranial defects or intracranial masses

Front 39

A cystic mass high in the neck may be (2 things)

Back 39

Thyroglossal duct cysts or banchial cleft cyst

Front 40

Mass over the clavicle that changes in size w/crying or respiration is asstd w:

Back 40

Cystic hygroma

Front 41

Nuchal rigidity, resistance to flexion of the neck is asstd w:

Back 41

Meningeal irritation

Front 42

Age when suture ridgelines should no longer be palpable

Back 42

6 mo

Front 43

3rd fontanel between the ant and post fontanels can be expected or common in infants w/:

Back 43

Downs Syndrome

Front 44

Palpable ridges in addition to expected suture lines can indicate

Back 44

Fractures

Front 45

The ant fontanel should no exceed __ in an infant younger than 6 mo

Back 45

4-5 cm

Front 46

Increased intracranial pressure or infx in an infant will cause:

Back 46

Bulging of the fontanel

Front 47

Snapping sensation of the outer table of the skull in an infant indicates

Back 47

Rickets or hydrocephalus

Front 48

Mass in the lower 1/3 of an infant scm

Back 48

Hematoma

Front 49

Presence of goiter in an infant suggest

Back 49

Intrauterine deprivation of thyroid hormone

Front 50

Illumination of the infants skull in a dark room indicates

Back 50

Intracranial lesion/rapidly increasing head circumference and should be less than 2 cm beyond rim; occiput less than 1 cm beyond rim

Front 51

Direct percussion of the skull in children with a cracked-pot sound; indicates ↑ intracranial pressure

Back 51

Macewen sign

Front 52

After 5 yrs, bruits in children suggest

Back 52

Anemia, vascular anomalies or ↑ intracranial pressure

Front 53

Blotchy brown pigmentation over malar prominences and forehead of pregnant women; may worsen w/sun exposure but fades after delivery

Back 53

Chloasma or “mask of pregnancy”

Front 54

Is the presence of a goiter in pregnant women expected

Back 54

No

Front 55

In pregnancy, the __ can enlarge and become palpable due to ↑ vascularity and hyperplasia

Back 55

Thyroid gland

Front 56

The thyroid feels more __ w/the aging

Back 56

Fibrotic, nodular and irregular

Front 57

A hx of insistent, severe or recurrent headache should be

Back 57

Given attention

Front 58

Expression/appearance of face and head features when considered together are characteristic of a clinical condition

Back 58

Facies

Front 59

A __ migraine is unilateral while a __ migraine is generalized

Back 59

Classic; common

Front 60

Migraines that begin in childhood vs migraines that begin in adulthood

Back 60

Childhood- classic and common; Adulthood- cluster, hypertensive, muscular tension, temporal arteritis (older adults)

Front 61

Migraines that have prodromal events

Back 61

Classic, common and cluster

Front 62

6 types of migraines

Back 62

Classic, common, cluster, HT, muscular tension, temporal arteritis

Front 63

Gender predominance in diff migraines

Back 63

Females- classic and common; Males- cluster; Equal- HT, muscular tension and temporal arteritis

Front 64

Migraine that includes symptoms of ↑ lacrimation and nasal discharge

Back 64

Cluster

Front 65

Migraine that is precipitated by alcohol consumption

Back 65

Cluster

Front 66

Migraine w/most onset occurring at night

Back 66

Cluster

Front 67

Facies w/a moonshpaed face, thin erythematous skin, and possible hirsutism (especially if due to adrenal cancer)

Back 67

Cushing syndrome

Front 68

Facies w/sunken appearance of eyes, cheeks, temporal areas, sharp nose, dry rough skin; seen in terminal stages of illness

Back 68

Hippocratic facies

Front 69

Facies are dull, puffy, yellow w/coarse sparse hair and temporal loss of eyebrows; periorbital edema and prominent tongue

Back 69

Myxedema facies

Front 70

Facies w/fine moist skin, fine hair, prominent eyes and lid retraction; staring or startled expression

Back 70

Hyperthyroid

Front 71

Facies w/butterfly-shaped rash over malar surfaces and bridge of nose; can be blush w/swelling or w/scaly maculopapular lesions

Back 71

Systemic lupus erythematosus

Front 72

Facies w/asymmetry of one side of face, eyelid not closing completely, dropping lower eyelid/corner of mouth, loss of nasolabial fold

Back 72

Left facial palsy

Front 73

Facies w/coarsening of features w/broadening of nasal alae and zygomatic arches

Back 73

Acromegaly

Front 74

Facies w/depressed nasal ridge, epicanthal folds, mongoloid slant of eyes, low set ears and large tongue

Back 74

Down syndrome

Front 75

Facies w/characterstic mandibular prognathism, drooping lower lip, short upper lip, parrot beach nose and proptotic eyes

Back 75

Craniofacial dysostosis

Front 76

Facies w/enlarged skull, low forehead, corneal clouding and short neck

Back 76

Hurler Syndrome

Front 77

Facies w/enlarged head, bulging fontanel, dilated scalp veins, bossing of skull, and sclera visible above iris

Back 77

Hydrocephalus

Front 78

Facies w/poorly formed philtrum (groove in midline of upper lip), widespread eyes, inner epicanthal folds, mild ptosis, hirsute forehead, short nose, relatively thin upper lip

Back 78

Fetal alcohol syndrome

Front 79

Most common cause of acquired mental retardation

Back 79

Fetal alcohol syndrome

Front 80

Facies w/maxillary hypoplasia, micrognathia (small jaw/mandible), auricular deformity

Back 80

Treacher-Collins syndrome

Front 81

Facies w/severe maxillary and midfacial hypoplasia

Back 81

Apert syndrome

Front 82

Facies w/severe maxillary and midfacial hypoplasia with low-set ears; shown with frontal hup above forehead

Back 82

Crouzon syndrome

Front 83

Freely moveable cystic mass high in neck at midline w/duct at the base of the tongue; embryonic remnant

Back 83

Thyroglossal duct cyst

Front 84

Oval, moderately moveable mass in upper 1/3 of SCM; may be asstd w/a fistula and is an embryonic remnant

Back 84

Branchial cleft cyst

Front 85

Usually result of injury during delivery; head tilted and twisted toward SCM, w/a hematoma palpable shortly after birth; can also occur in children/adults fr/trauma, viral or drugs

Back 85

Torticollis aka wryneck

Front 86

Most common salivary gland tumor

Back 86

Parotid

Front 87

Characterized by preference for cool climate, weight loss, nervous, easily irritated, fine hair w/loss, thin fingernails, bilateral/unilater proptosis of eyes, lid retraction, goiter, tachycardia, amenorrhea, weakness of proximal muscles

Back 87

Hyperthyroidism

Front 88

Characterized by preference for warm climate, weight gain, lethargy, coarse hair, thick fingernails, puffiness in periorbital region, no goiter, menorrhagia, good muscle strength

Back 88

Hypothyroidism

Front 89

Adult onset hypothyroidism w/a ↓ metabolic rate leads to

Back 89

Myxedema w/edema of facial features

Front 90

Autoimminue disorder more common in 3rd or 4th decade in women; thyroid enlargement, hyperthyroidism, several changes; can be dx w/measuring of T4 and T3

Back 90

Graves disease

Front 91

Chronic autoimmune disorder w/symptoms of hypo or hyperthyroidism; common in children and women 30-50

Back 91

Hashimoto disease

Front 92

Protrusion of nervous tissue through a defect in the skull; can occur an place on scalp

Back 92

Encephalocele

Front 93

Congenitally small skull caused by cerebral dysgenesis or craniostenosis; usually asstd w/mental retardation or failure of brain to develop normally

Back 93

Microcephaly (or primary familial microcephaly)

Front 94

Premature union of cranial sutures that leads to misshapen skull, not involved w/mental retardation; sutures involved determine shape

Back 94

Craniosynostosis