If a patient sees flashing lights, what is it a sign of?
detached retina
What is the vertex of the head?
the top of the head
What is wharton’s duct?
secretes saliva from submandibular gland
What does the parotid gland secrete saliva via?
Stensen’s duct located behind molars
What is the most commonly fractured bone in orbital floor fracture?
Zygomatic arch
Where is ear pain often referred to?
TMJ
Mental protuberance
chin
Frontal eminence
forehead
laryngeal prominence
Adam’s apple
Palpebral fissures
the slit between your eyelids
Describe the palpebral fissures of a person with Trisomy 13, 18 or 21
up-slanted
Describe the palpebral fissures of a person with FAS
horizontal
Epicanthal folds
skin folds near the nasolacrimal gland - thicker in people with down’s syndrome
Nasolabial folds
lines made from the nares to the lateral aspect of the mouth when smiling
When will nasolabial folds not occur?
in a person who suffered a CVA - due to damage to CN VII on the contralateral side of the affected area
What sinuses are associated with the face
frontal, sphenoid, ethmoid (bubbles), maxillary
What does the NLS drain into?
inferior meatus
What are facies
Characteristic of a certain syndrome or disorder with distinct facial features
What are characteristics of people with down’s syndrome?
Prominent epicanthal folds, low-set ears, macroglossia, flat nasal bridge, brush-field spots on iris
What are characteristics of people with Cushing’s syndrome?
Moon facies: fat cheeks, brittle bones, cataracts, plethoric face, double chin, thin skin, allopecia
What are characteristics of people with FAS?
low nasal bridge, short nose, diminished epicanthal folds, small head, flat face, thin upper lip and smooth philtrum, underdeveloped jaw
When does FAS generally occur?
first trimester (12 wks)
What causes acromegaly?
excess GH from a pituitary adenoma after fusion of the epiphyseal growth plates
What causes gigantism?
excess GH from a pituitary adenoma before fusion of the epiphyseal growth plates
What are characteristics of people with acromegaly?
large hands, feet, head, frontal bossing, palmar thickening, coarse features, prognathism
What can cause parotid enlargement?
Sjogren’s syndrome, Mumps, Neoplasm (if unilateral), chronic disease (DM, obesity, liver cirrhosis)
What should be considered with any unilateral mass?
neoplasm
Describe Sjogren’s syndrome
Occurs in pts with HLA phenotype, autoimmune disease that attacks mucus producing cells, associated with dry eyes and mouth, arthritis. Dx with SSA and SSB antibodies with a negative rheumatoid factor, Tx with steroids, higher probability of getting lymphoma
What can cause parotitis? S/S?
S. aureus, tender, warm, red parotid glands - palpate with mouth open and if pus comes out of Stensen’s gland then it indicates a suppuratous infection
How can you treat parotitis?
Sialogogues (increase saliva), heat, massage from posterior to anterior, hydration
What is the hyoid bone important for? Why is it unique?
Swallowing, tongue movements, not articulated
If a patient cannot have oropharyngeal intubation what is an option?
Make an opening in the cricoid cartilage
What is the middle of the thyroid gland called? Where is it located?
isthmus - lacated between the SCM
What happens to the thyroid when you swallow?
it moves superiorly and loos asymmetric
What is the most common cause of thyromegaly?
Iodine deficiency - hypo/hyperthyroidism and increased TSH (Hashimoto’s and Grave’s diseases)
True or false: diffuse thyromegaly is benign.
TRUE
What normally causes diffuse thyromegaly?
autoimmune disease
What are characteristics of Grave’s disease?
exopthalmus - autoimmune response that causes hyperthyroidism also attacks the tissue around the eyes
What disease other than grave’s disease shows exopthalmos?
orbital tumor - unilateral exopthalmos
True or false: multinodular goiters are benign.
TRUE
What can cause thyroiditis?
viral/autoimmune
What type of thyroid abnormality is indicative of malignancy?
solitary nodule that is firm, not tender, fixed
What age group has a higher likelihood of thyroid malignancy?
children
How can you diagnose thyroid malignancy?
Radial iodine scintography will tell you if it is hot or cold (cold = malignant and not active) plus FNA for histology
What characteristics are important to describe for thyroid nodules?
location, consistency, size, pain, erythema, symmetry
What are the borders of the anterior neck triangle?
SCM, midline of neck, jaw
What are the borders of the posterior neck triangle?
SCM, clavicle, trapezius
What does the jugular vein traverse?
SCM
Where is bone marrow made?
flat bones: sternum, pelvis
Where can lymph tissue be found?
liver, spleen, gut (Peyer’s patches)
Where does the right lymphatic duct drain into?
SVC
Where does the left lymphatic duct drain into?
subclavian vein via thoracic duct
LAD that is solitary, fixed, non-tender, growing
malignant
LAD that is solitary, erythematous, tender, fluctuant, growing
infection (suppurative)
LAD that is diffuse, symmetric, nodular, static
systemic disease - HIV or malignancy
LAD that is solitary or grouped, tender and mobile
regional (local) infection/inflammation (sarcoidosis) or lymphoma
Sarcoidosis
inflammation occurs in the lymph nodes, lungs, liver, skin, eyes, or other tissue
What are shotty lymph nodes?
hyperplastic lymph from previous inflammatory process - should be mobile and non-tender
What is the difference in age groups of effected patients with hodgkin’s vs. non-hodgkin’s lymphoma?
Hodgkin’s: bimodal, Non-hodgkin’s: older and immunocompromised
Where should LAN absolutely NOT be?
Supraclavicular lymph nodes - indicates mediastinal malignancy and lung or gastric CA
What node can be palpated with metastatic gastric CA?
Irish’s node - left anterior axillary lymph node, virchow’s node, trosier’s node
What axillary lymph nodes can be palpated?
lateral axillary, central axillary, subscapular, pectoral
What lymph nodes might be inflammed with Rheumatoid arthritis?
Epitrochlear
What is the function of the epitrochlear lymph nodes?
drain ulnar aspect of the hand
How should the epitrochlear lymph nodes be palpated?
arm at 90*, superior to medial epicondyle of humerus
What can cause inguinal LAN?
HSV, LGV (lymphogranuloma venereum)
What is the function of the popliteal lymph nodes?
drain lower 1/2 of the leg
What do bruits in thyroid gland indicate?
hypermetabolic activity or infection
What does scaling of the scalp indicate?
seborrheic dermatitis, tx with selenium sulfate (H&S)
Why is it impportant to check the scalp of children?
They easily get tinea capitis: allopecia with excalamtion point hairs over lesion
What can tinea capitis turn into if it is not treated?
Kereon: fungal mass - treat with systemic drugs
What are warning signs of a headache?
more frequent/severe over 3 months, new onset after 50, fever, sweats, weight loss, HIV, known CA, pregnancy, neck stiffness (others are obvious)
Why is HA bad in pregnancy?
indicates preeclampsia
What could cause edema of the face?
diabetes, HTN, allergic reaction, cellulitis
Why is palpation of the temporal artery so important?
it branches to the opthalmic artery and could cause blindness if occluded
How is the TMJ palpated and how do you treat TMJ syndrome?
palpate with the ulnar aspect of the hands, treat with NSAIDs
What is giant cell arteritis?
temporal arteritis: occurs in people over 50 with TMJ pain, bounding, tender temporal artery, autoimmune disease, increased ESR, untreated can lead to blindness, tx with corticosteroids
How would a pt with PCOS present onf PE?
hirsutism due to increased T
Where is the most common place to find basal cell carcinoma?
on the nose/face
What type of facies do people with Parkinson’s have?
flat facies
How is bacterial sinusitis diagnosed?
sxs > 7 days, purulent nasal drainage, facial pain/toothache, fever, tenderness to palpation
What could cause tracheal deviation?
pneumothorax
What is the curve of the C-spine?
lordosed
What portion of the SCM are the superficial cervical lymph nodes and the posterior clavicular lymph nodes located?
superficial: sternal portion of SCM, posterior: clavicular portion of SCM
If the thyroid is enlarged on PE what hsould you do?
listen for bruits
T10 dermatome
umbilicus
What nerves are responsible for the patellar reflex?
L4, L5
What nerve is responsible for the achilles reflex?
S1
S1 dermatome
lateral foot
L4 dermatome
big toe
S5 dermatome
anus
S2, S3 dermatomes
genitals
C6 dermatome
thumb
C7 dermatome
index/middle finger
C8 dermatome
ring/little fingers