Physical Assessment: Head, Face And Neck

Front 1

Name the major skull bones

Back 1

Front 2

Where are the two pairs of salivary glands that are accessible on examination of the face? (3rd is sublingual)

Back 2

1. The parotic gland: in the cheeks over the mandible anteriro to and below the ear...normally not palpable
2. Submandibular glands: beneatht eh mandible at teh angle of the jaw.

Front 3

Name the major neck vessels

Back 3

Front 4

Name the major neck muscles

Back 4

Front 5

Which cranial nerve innervates the neck muscles?

Back 5

Cranial nerve XI

Front 6

describe the boundaries of the anterior triangle of the neck (helpful in describing findings in neck)

Back 6

lies in front between the sternomastoid and the midline of the body with its base up along the lower border of the mandible and apex at the suprasternal notch

Front 7

describe the boundaries of the posterior triangle of the neck (helpful in describing findings in neck)

Back 7

behind the sternomastoid muscle, with the trapezius muscle on the other side and with its base along the clavicle below

Front 8

where is the thyroid gland/

Back 8

straddles trachea in middle of neck

Front 9

What is the thyroid gland?

Back 9

an endocrine gland that secretes hormones (T3 and T4) that control rates of metabolism.

Front 10

Where is the "Adam's Apple" exactly?

Back 10

It is the palpable notch on the upper edge of the thyroid cartilage

Front 11

Name and locate structures/cartilage landmarks of the larynx

Back 11

cricoid cartilage, adams apple (top of thyroid cartilage), hyoid bone, trachea, thyroid gland, sternomastoid muscle, manubrium, clavicle

Front 12

Which direction do the head/neck lymph nodes drain

Back 12

mostly in a generally inferior direction

Front 13

If a lymph node is swollen what area should you explore?

Back 13

area proximal (upstream) to that lymph node(s)

Front 14

purpose of the lymph nodes

Back 14

filter lymph and engulf pathogens, preventing harmful substances from entering circulation

Front 15

Nodes are located throughout the body but only accessible for examination in what four areas?

Back 15

head and neck
arms
axillae
groin

Front 16

where is the greatest supply of lymph nodes?

Back 16

head and neck

Front 17

Describe location of majority of the head/neck lymph nodes

Back 17

(see picture)

Front 18

when vertigo is objective the person feels like _____ and when vertigo is subjective the person feels like _______

Back 18

the room spins,
they themselves spin

Front 19

major symptoms of meningeal inflammation

Back 19

acute onset of neck stiffness with headache and fever

Front 20

normocephalic

Back 20

denotes a round symmetric skull that is appropriately r/t body size

Front 21

microcephaly

Back 21

abnormally small head

Front 22

macrocephaly

Back 22

abnormally large head

Front 23

edema in the face occurs where first?

Back 23

around the eyes and cheeks where subq tissue is relatively loose

Front 24

mumps swells which gland?

Back 24

the parotid gland (salivary gland in front of ear)

Front 25

edema in the face occurs where first?

Back 25

around the eyes and cheeks where subq tissue is relatively loose

Front 26

mumps swells which gland?

Back 26

the parotid gland (salivary gland in front of ear)

Front 27

fontanels

Back 27

the spaces where sutures have not fully intersected in neonatal skull.

Front 28

Purpose of fontanels?

Back 28

Allow for growth of the brain during the first year of life.

Front 29

When do fontanels close?

Back 29

triangle shaped posterior fontanel closes by 1 to 2 months and the diamondshape anterior fontanel closes between 9 months to 2 years

Front 30

lymphadenopathy

Back 30

enlargement of the lymph nodes (>1cm) d/t infection, allergy or neoplasm

Front 31

signs that a lymph node is cancerous

Back 31

unilateral, hard, , >3cm, nontender, matted and fixed

Front 32

in chronic inflammation, lymph nodes are usually _______

Back 32

clumped

Front 33

Which lymph nodes are commonly enlarged in HIV?

Back 33

occipital

Front 34

Is the normal thyroid gland usually palpable?

Back 34

no

Front 35

The trachea is pulled towards the unaffected side in what conditions?

Back 35

aortic aneurysm
a tumor
unilateral thyroid lobe enlargement
pneumothorax

Front 36

The trachea is pulled towards the affected side in what conditions?

Back 36

large atelectasis
pleural adhesions
fibrosis

Front 37

What is "tracheal tug"?

Back 37

A rhythmic synchronous downward pull that occurs with systole often in presence of an aortic arch aneurysm

Front 38

Auscultating a bruit in thyroid means.....

Back 38

A bruit occurs with accelerated/turbulent blood flow, so it indicates hyperplasia (proliferation of cells) of the thyroid
e.g. hyperthyroidism

Front 39

caput succedaneum
(kay-put sux sidane ium)

Back 39

edamatous swelling ad ecchymosis of the presenting part of teh head caused by birth trauma

Front 40

cephalhematoma

Back 40

subperiosteal hemorrhage, result of birth trauma (head cones back towards back-top of scalp) No treatment. Is reabsorbed during first few weeks of life.

Front 41

periosteum

Back 41

mebrane that lines the outer surface of all bones

Front 42

skull sutures are palpable in infants until they reach ______ of age

Back 42

6 months

Front 43

tonic neck reflex

Back 43

lay an infant supine, turn head to side, same side arm extends and leg flexes

Front 44

when should the tonic neck reflex disappear

Back 44

by 5 months (if not, may indicate brain damage)

Front 45

Nuchal Rigidity

Back 45

inability to flex head forward d/t stiff neck. Sign of meningitis.

Front 46

3 major types of headaches

Back 46

tension
migraine
cluster

Front 47

tension headache

Back 47

usually both sides
tight non throbbing
mild-moderate pain
gradual onset lasts 30" to days
associated with stress
occurs situationally (stress)

Front 48

migraine headache

Back 48

commonly one sided,sometimes both
throbbing/pulsating
rapid onset, lasts 4 hours
mod to severe pain
about 2x a month
often preceded by aura (tingling, visual changes, vertigo abd pain)

Front 49

cluster headache

Back 49

always one sided
continuous burning piercing pain
abrupt onset lasts 45-90 minutes
can occur multiple x in day (clusters)
exacerbated by ETOH, stress, wind or heat exposure
relieved by moving/pacing

Front 50

hydrocephalus

Back 50

obstruction of drainage of CSF results in excessive accumulation, increasing ICP and enlargement of head

Front 51

Macewen's sign

Back 51

"crack pot" sound on percussing head, common in hydrocephalus, normal in infants pre fontanel closure

Front 52

hydrocephalus

Back 52

obstruction of drainage of CSF results in excessive accumulation, increasing ICP and enlargement of head

Front 53

Macewen's sign

Back 53

"crack pot" sound on percussing head, common in hydrocephalus, normal in infants pre fontanel closure

Front 54

Paget's disease ("padge-it")

Back 54

skeletal disease of increased bone resorption and formation which softens, thickens and deforms bone. Affects 10% of those older than 80, more in males.
Characterisitcs: bowed legs, fractures, enlarged skull presses on cranial nerves-headaches, deafness etc.

Front 55

Acromegaly

Back 55

excessive sxrn of growth hormone from pituitary gland after puberty creates enlarged skull and thickened cranial bones (often pituitary tumor)

Front 56

Torticollis (Wryneck)

Back 56

hematoma in one sternomastoid muscle (often d/t intrauterine malposition) results in head tilt. Permanent ROM problems if not treated

Front 57

goiter

Back 57

chronic enlargement of the thyroid gland that occurs in some regions of the world where the soil is low in iodine. NOT d/t neoplasm

Front 58

Pilar Cyst (Wen)

Back 58

smooth firm swelling on scalp that contains sebum and keratin. Benign growth.

Front 59

Parotid gland enlargement

Back 59

rapid painful enlargement of the parotid, occurs with mumps or blockage of duct, abscess or tumor. Can occur with dehydration.

Front 60

Fetal alcohol syndrome

Back 60

growth and developmental abnormalities from drinking during pregnancy.
Characteristic facies: mid facial hypoplasia, short pallpebral fissures (eyes), thin upper lip

Front 61

Down syndrome

Back 61

chromosomal aberration (trisomy 21).

Front 62

Cushing syndrome

Back 62

excessive sxrn of corticotropin hormone (ACTH) and chronic steroid use, person develops "moon face", prominent jowls, red cheeks, hirsuitism upper lip

Front 63

myxedema

Back 63

deficiency of thyroid hormone, when severe, causes a non pitting edema or myxedema

Front 64

Bell's palsy

Back 64

lower motor neuron lesion (peripheral) producing cranial nerve VII paralysis which is almost always unilateral. rapid onset.
Cant' whistle, raise eyebrows etc.

Front 65

scleroderma

Back 65

literally "hard skin", rare connective tissue disease characterized by chronic hardening and shrinking, degenerative changes in skin, vessels, skeletal muscles, synovium.
Characteristic facies: hard shiny skin, thin pursed lips

Front 66

atopid (allergic) facies

Back 66

children with chronic allergies have these facial characteristics: exhausted face, blue shadows below eyes d/t sluggish venous return, open mouth breathing, central facial pallor

Front 67

Parkinson syndrome

Back 67

deficiency of neurotransmitter dopamine and degeneration fo basal ganglia in the brain. Immobility of features produces flat expression.

Front 68

most common cause of hyperthyroidism

Back 68

Grave's disease (goiter, bulging eyes)

Front 69

cachetic appearance

Back 69

accompanies chronic wasting disease such as cancer, dehydration, starvation. sunken eyes, hollow cheeks, exhausted, defeated expression

Front 70

stroke facies

Back 70

an upper motor neuron (central ) lesion. Upper half of face not affected because of the intact nerve from the unaffected hemisphere. can still close eyes/wrinkle forehead.