Head and Neck

Question 1

Skull is composed of 7 bones

Answer 1

2 frontal, 2 parietal, 2 temporal and 1 occipital

Question 2

The major facial landmarks are…

Answer 2

Palpebral fissures (opening between eyelids) and nasolabial folds

Question 3

Facial muscles are innervated by which cranial nerves?

Answer 3

V Trigeminal

VII Facial

Question 4

Salivary glands

Answer 4

Parotid-located anterior to the ear and above the mandible
Submandibular- medial to the mandible at the angle of the jaw
Sublingual- anterior in the floor of the mouth

Question 5

The neck is formed by…

Answer 5

cervical vertebrae, ligaments, sternocleiomastoid muscle, trapezius muscle

Question 6

Anterior triangle

Answer 6

Medial border of the SCM, the mandible and the midline

Question 7

Posterior triangle

Answer 7

trapezius, SCM and clavicle

Question 8

Thyroid

Answer 8

produces t3 and t4

two lateral lobes, butterfly shaped and joined by isthmus at the lower aspect

Question 9

Infant Skull anatomy

Answer 9

Cranial bones separated by sutures, ossification of sutures begins about age 6 and is finished by adulthood
Posterior fontanel closes by 2 months
Anterior fontanel closes by 24 months

Question 10

Pregnancy and thyroid

Answer 10

Increased renal clearance of iodine causes compensatory enlargement of thyroid gland

Question 11

Older adult thyroid

Answer 11

Rate of t4 production decreases, becomes more fibrotic

Question 12

Facies

Answer 12

an expression or appearance of the face and features of the head and neck that when considered together are characteristic of a clinical condition or syndrome

• develop slowly and are not a subtle diagnostic tool
• if suspected ask the patient to provide an old picture of themselves

Question 13

Facial paralysis and associated nerves

Answer 13

Facial nerve paralysis when entire side of face is affected

Facial nerve weakness when lower face is affected

Peripheral trigeminal nerve if only the mouth is involved

Question 14

Tic

Answer 14

spasmodic muscular contraction of face, head or neck

could be pressure or degeneration of facial nerve!

Question 15

Tinea capitis

Answer 15

common cause of hairloss in children, fungal infection of scalp

Question 16

Assessment of temporal arteritis

Answer 16

Palpate temporal arteries and note thickening, hardening or tenderness.
Auscultate for bruit

Question 17

Cardarellis sign

Answer 17

Can be felt by pressing on the thyroid cartilage and displacing it to the patients left. Allows systolic pulsations from the aorta to be felt at the surface if an aneurysm is present

Question 18

Olivers sign

Answer 18

Gently grasping the cricoid cartilage and applying upward pressure while patient stands with chin extended upward. A downward tug of the trachea may be felt if an aneurysm is present.

Question 19

Assessment of thyroid

Answer 19

Have patient sip water while palpating

Question 20

Caput Succedaneum

Answer 20

most common form of birth trauma

Scalp edema usually over occiput, crosses suture lines, margins poorly defined

Question 21

Cephalhematoma

Answer 21

subperiostial collection of blood, common in parietal region

Firm, edges are well defined, does not cross suture lines

Question 22

Brachiocephaly

Answer 22

long narrow heads common with preterm infants

Question 23

Plagiocephaly

Answer 23

skull asymmetry or flattened spot on the back or one side of the head

Question 24

Craniosynostosis

Answer 24

Premature fusion of one of the sutures

Question 25

Positional plagiocephaly

Answer 25

caused by external deformation, common in infants with torticollis

Question 26

Bossing

Answer 26

Bulging of the skull

if noted in frontal areas assc with prematurity, thalassemia and rickets

Question 27

Mastoid fontanel

Answer 27

third fontanel located between anterior and posterior fontanel
may be an expected variant but also common with downs

Question 28

Bulging fontanel

Answer 28

With marked pulsations may indicate increased ICP or meningitis

Question 29

Craniotabes

Answer 29

softening of the outer table of the skull

a snapping sensation similar to a ping pong ball= prematurity, rickets, hydrocephalus, marasmus, syphillis or thallesmia

Question 30

Transillumination

Answer 30

Ring should be 2cm or less. Beyond that suggests excess fluid or decreased brain tissue in the skull

Question 31

Macewen Sign

Answer 31

Percussion of skull, strong resonant sound indicates increased ICP, hydrocephalus or brain abcess

Question 32

Cholasma

Answer 32

“mask of pregnancy”

Blotchy, brownish hyperpigmentation of the face

Question 33

Salivary gland tumor

Answer 33

Most common in parotid
benign usually smooth, malignant usually irregular
Slow growing painless lump

Question 34

Thyroglossal duct cyst

Answer 34

Palpable cystic mass in neck
remnant of fetal development
Freely movable cyst in the MIDLINE

Question 35

Branchial cleft cyst

Answer 35

Congenital lesion formed by incomplete involution of branchial cleft

Anteromedial border of SCM

Question 36

Torticollis

Answer 36

Wry neck

head tilted and twisted towards the SCM with chin elevated

Question 37

Hypothyroid vs hyperthyroid s/s

Answer 37

you should know this….

Question 38

Myxedema

Answer 38

Severe prolonged hypothyroid

typical hypothyroid s/s

Question 39

Graves disease

Answer 39

Autoimmune, antibodies to thyroid-stimulating hormone receptor leading to overactive thyroid

(typical hyperthyroid s/s + pretibial myxedema)

Question 40

Hashimoto

Answer 40

Autoimmune antibodies against thyroid gland

often causes hypothyroid

Question 41

Encephalocele

Answer 41

Neural tube defect with protrusion of brain and membranes that cover it through openings in the skull

Question 42

Microcephaly

Answer 42

Circumference of the head is smaller than normal because the brain has not developed properly or has stopped growing

Question 43

Craniosynostosis

Answer 43

Premature closure of one or more cranial sutures before brain growth is complete

Leads to misshapen skull, can increase ICP