Head and neck Flashcards
(157 cards)
1
Q
Which test involved a 512 Hz tuning fork to be placed on the apex of the patient’s head?
A
Weber test
2
Q
What finding is needed to diagnose conductive hearing loss in a Weber test?
A
Hearing preferentially in the bad ear
3
Q
What finding is needed to diagnose a neurosensory hearing loss in a Weber test?
A
Hearing preferentially in the good ear
4
Q
Which test is more accurate for conductive hearing loss, weber or rinne?
A
Rinne
5
Q
What is angular cheilosis?
A
Erythematous inflammation of lips to extends beyond the mouth
6
Q
What is Brachial cleft cyst?
A
A congenital lesion due to the incomplete involution of the brachial left
7
Q
What is a bulging fontanel indicate?
A
rise in intracranial pressure
8
Q
What is cheilits?
A
cracked lips
9
Q
What is cholesteatoma?
A
mass of keratinizing squamous epithelim and cholesterol in the middle ear, usually caused by chronic otitis media
10
Q
What is crainiosynostosis?
A
premature closure of an infant’s skull
11
Q
What is choasma?
A
common facial discoloration seen in pregnancy
12
Q
What is Encephalocele?
A
Neural tube defect with protrusions of brain and membranes that cover the skull (bifida of the cranial part of the spinal cord)
13
Q
What are epstein pearls?
A
small, multiple white, epithelial inclusion cysys found in the midline of the palate in newborn infants
14
Q
What are fordyce spots?
A
Ectopic sebaceous glands of the buccal mucosa appearing as small yellow-white raised lesions found on the inner surface and vermilion border of the lips
15
Q
What are Koplik’s spots?
A
Small red spots with bluish-white centers on the buccal mucosa opposite the molar teeth, appearing in the prodromal stages of measals
16
Q
What is leukoplakia?
A
circumscribed, firmly attached, thick white patches on the tongue. Often precancerous.
17
Q
What is molding when referring to newborn children?
A
Shape of the head
18
Q
What is otosclerosis?
A
deposits of bone resulting in immobilization of the stapes
19
Q
What is presbycusis?
A
impairment of heading due to aging
20
Q
What is a thyroglossal duct cyst?
A
A palpable cyst in the neck due to an incomplete closure of the thyroglossal duct
21
Q
What is tophi?
A
small, whitish uric acid crystals along the peripheral margins of the auricles in persons who may have gout
22
Q
What is torus mandibularis?
A
a bony protuberance on the linguinal aspect of the lower jaw in the canine-premolar region
23
Q
What is torus palatinus?
A
a bony protuberance in the midline of the hard palate
24
Q
What is tympanosclerosis?
A
The formation of dense connective tissue in the middle ear, often resulting in hearing loss
25
What is Xerostomia?
Dry mouth
26
What is webbing?
Excessive posterior cervical skin the is often associated with chromosomal abnormalities
27
What is the findings necessary for a Rinne test to indicate conductive hearing loss?
Bone conduction heard as long, or longer than air conduction
28
What would be a normal finding in a Rinne test?
If the patient can hear the sound through the air for twice as long or more
29
What would indicate a neurosensory loss in a Rinne test?
Air conduction will be heard longer than the bone (but obviously be diminished from normal)
30
What would indicate an abnormal Romberg test?
The inability to stand for 60 seconds with feet together and eyes closed.
31
True or false: If the Romberg test is abnormal, you should continue to testing to further evaluate the extent of the cerebellar dysfunction.
False
32
Which side do patients with vestibular lesions fall toward: toward or away from the lesion?
Toward the side with the lesion
33
Which side does numbering the teeth begin on?
Top right
| to top left, then from bottom left, to bottom right
34
Which side will the trachea deviate in lung volume loss?
Toward the lung with volume loss (like a vacuum)
35
Which side will the trachea deviate in thyroid enlargement--toward or away from the affected side?
Away from the affected side
36
Which side will the trachea deviate in tension pneumothorax--toward or away from the affected side?
Away from the affected side
37
Which side will the trachea deviate in pleural effusion--toward or away from the affected side?
Away from the affected side
38
Which side will the trachea deviate in a collapsed lung--toward or away from the affected side?
Toward the affect side
39
What is a "tug" in reference to the trachea?
It is a palpable pull out of midline with inspiration
40
Which way is the ear pulled in an adult?
Up and back
41
Which way is the ear pulled in a child?
Down and back
42
What is the typical location of a migraine headache?
Unilateral (70%) or bifrontal/global
43
What is the typical location of a tension headache?
Bilateral/generalized to back of head
44
What is the typical location of a cluster headache?
Unilateral, usually behind/around the eye
45
What is the quality and severity of a migraine headache?
Throbbing/aching
| variable severity
46
What is the quality and severity of a tension headache?
pressing/tightening.
| Mild to moderate severity
47
What is the quality and severity of a cluster headache?
Deep, continuous, severe
48
What is the process involved in migraine headaches?
neuronal dysfunction
49
What is the process involved in tension headaches?
Unclear--possibly heightened CNS
50
What is the process involved in a cluster headache?
Unclear--possibly hypothalmic then trigemino-autonomic activation
51
What is the timing involved in a migraine headache (onset, duration, course)?
```
Onset = Rapid (peak = 1.5 hours)
Duration = 4-72 hours
Course = recurrent
```
52
What is the timing involved in a cluster headaches (onset, duration, course)?
```
Onset = abrupt
Duration = 3 hours
Course = episodic, (in clusters)
```
53
What is the timing involved in a tension headaches (onset, duration, course)?
```
Onset = gradual
Duration = 30 minutes to 7 days
Course = episodic (non-cluster)
```
54
What are the associated factors with migraine headaches?
n/v photophobia, phonophobia, AURA.
55
What are the associated factors with tension headaches?
NO nausea.
| Sometimes photophobia/phonophobia
56
What are the associated factors with cluster headaches?
Autonomic symptoms (rhinorrhea, lacrimation)
57
What are provoking factors for migraine headaches?
EtOH/foods
stress
noise/bright lights
58
What are provoking factors for tension headaches?
Sustained muscle tension
59
What are provoking factors for cluster headaches?
EtOH? (unclear)
60
Nervousness is symptomatic of what (hypo or hyper-thyroidism)?
Hyperthyroidism
61
Fatigue/lethargy is symptomatic of what (hypo or hyper-thyroidism)?
Hypothyroidism
62
Weight loss with increased appetite is symptomatic of what (hypo or hyper-thyroidism)?
Hyperthyroidism
63
Palpitation are symptomatic of what (hypo or hyper-thyroidism)?
Hyperthyroidism
64
Modest weight gain with anorexia is symptomatic of what (hypo or hyper-thyroidism)?
Hypothyroidism
65
Dry, coarse sking is symptomatic of what (hypo or hyper-thyroidism)?
Hypothyroidism
66
Frequent BMs are symptomatic of what (hypo or hyper-thyroidism)?
Hyperthyroidism
67
Constipation is symptomatic of what (hypo or hyper-thyroidism)?
Hypothyroidism
68
Tremor/proximal muscle weakness is symptomatic of what (hypo or hyper-thyroidism)?
Hyperthyroidism
69
Cold intolerance is symptomatic of what (hypo or hyper-thyroidism)?
Hypothyroidism
70
Weakness, arthralgias is symptomatic of what (hypo or hyper-thyroidism)?
Hypothyroidism
71
Swelling of the hands/face/legs is symptomatic of what (hypo or hyper-thyroidism)?
Hypothyroidism
72
Loss of hair is a sign of what (hypo or hyper-thyroidism)?
Hypothyroidism
73
Increased BP is a sign of what (hypo or hyper-thyroidism)?
Hyperthyroidism
74
Tachycardia/A-fib is a sign of what (hypo or hyper-thyroidism)?
Hyperthyroidism
75
Hyperdynamic cardiac pulsations/accentuated S1 is a sign of what (hypo or hyper-thyroidism)?
Hyperthyroidism
76
Periorbital puffiness is a sign of what (hypo or hyper-thyroidism)?
Hypothyroidism
77
Decreased BP is a sign of what (hypo or hyper-thyroidism)?
Hypothyroidism
78
Bradycardia is a sign of what (hypo or hyper-thyroidism)?
Hypothyroidism
79
Dry, coarse, cool skin is a sign of what (hypo or hyper-thyroidism)?
Hypothyroidism
80
Warm, moist skin is a sign of what (hypo or hyper-thyroidism)?
Hyperthyroidism
81
Impaired memory is a sign of what (hypo or hyper-thyroidism)?
Hypothyroidism
82
Mixed hearing loss is a sign of what (hypo or hyper-thyroidism)?
Hypothyroidism
83
Somnolence is a sign of what (hypo or hyper-thyroidism)?
Hypothyroidism
84
Peripheral neuropathy is a sign of what (hypo or hyper-thyroidism)?
Hypothyroidism
85
Carpal tunnel syndrome is a sign of what (hypo or hyper-thyroidism)?
Hypothyroidism
86
What are the questions that should be asked in head trauma (9 on handout)?
```
A&O?
MOI
Time of injury
LOC?
Subsequent level of alertness
Amenesia
HA
Vision changes
Bleeding from nose/ear/eyes
```
87
True or false: LOC is the best way to tell if a patient has had a concussion.
False - can occur without LOC
88
What are signs of a concussion?
Unsteadiness
Abnormal behavior
Impaired brain function
89
When does the anterior fontanel usually close?
18 months
90
When does the posterior fontanelle close?
2 months
91
What is a common cause of a sunken fontanelle?
Dehydration
92
What are common causes of a bulging fontanelle?
Vomiting, coughing, crying
93
What is the normal fontanelle size at birth?
4-6 cm
94
What is caput succedaneum?
Subcutaneous edema over the presenting part of he head at delivery (scalp edema)
95
How can you differentiate caput succedaneum from other etiologies?
Edema of the head usually crosses over suture lines
Transluminates
96
What is cephalhematoma?
Subperiosteal collection of blood
97
How can you differentiate cephalhematoma from other etiologies?
DOES NOT cross suture line
| DOES NOT transluminate
98
What is plagiocephaly? How is it usually caused?
Asymmetry of the head
| Baby laying in the same way for long periods
99
External/middle ear disorders are what type of hearing loss (conductive or sensorineural)?
Conductive
100
inner ear disorders are what type of hearing loss (conductive or sensorineural)?
Sensorineural (involve cochlear nerve)
101
How do you determine if the ears are low in a child?
Draw a line from the side of the eye to the ear
102
What is the accumulation in the ear of newborns that prevent their TMs from being seen?
Vernix caseosa
103
Why is pneumatic otoscopy used?
To determine if a child has otitis media, as their crying/coughing/vomiting may cause their TMs to become erythematous and inflamed.
It checks for fluid.
104
How do infants breathe? (out of nose, mouth, with ribcage, abdomen etc)?
Obligate nasal breathers
105
A nasal crease is the result of what activity?
Rubbing nose due to drainage
106
Allergic shiners are what?
Pooling of blood (seen as a dark spot) beneath the eyes due to congestion.
107
When do the maxillary sinuses develop?
About 1 year old
108
When do the ethmoid sinuses develop?
About 6 years of age
109
When do the sphenoid sinuses develop?
About 6 years of age.
110
When does the frontal sinus develop?
About 10 years of age
111
When are the sinuses fully developed?
About 21 years of age.
112
Are antenatal teeth removed?
Yes
113
How long to epstein pearls last?
2-3 months after birth
114
Kissing tonsils are what grade?
4+
115
When does the peak size of tonsils occur?
Between 2-6 years of age
116
True or false: 2+ tonsils are always a worrisome sign.
False--common size for young age. Worrisome if erythematous or exudate
117
When do teeth begin to erupt?
6-7 months
118
How many teeth are added every month after the first teeth erupt?
about 4 teeth every 4 months
119
Which, generally, are the first teeth to erupt?
The upper and lower incisors
120
When is the full complement of teeth erupted?
2-3 years
121
When does shedding of teeth generally occur?
5 years old
122
When do second teeth begin to erupt?
6-7 years
123
Where are stentson's ducts found?
Near the 2nd upper molar
124
Where are Wharton's ducts found?
Below the tongue
125
A deviation of the tongue to one side may be indicative of a lesion of what nerve?
CN XII
126
If the uvula does not rise with phonoation, this may be an issues in what nerve?
CN X
127
What opthalmic emergency is indicated with flashing lights in an eye?
Retinal detachment
128
Transient loss of vision may be a medical emergency if this is the cause (among others).
Emoboli occluding the opthalmic artery.
129
Exophtalmos is most commonly caused by what?
Thyroid disease
130
What is the numerator in the Snellen eye chart?
Distance from the chart
131
What is the denominator in the Snellen eye chart?
Distance the average eye can read the chart.
132
When is a swinging light test indicated?
When you suspect Marcus Gunn Pupil
133
What does the lateral penlight test look for? Why is it important?
Estimates the depth of the anterior chamber of the eye. NEED to do this before instilling mydriatic drops to the eye.
134
A bulging TM is indicative of what?
otitis media
135
A retracted/neutral TM with other signs of infection is indicative of what?
Otitis media with effusion
136
What are the indications of an otoscopic exam for children?
1. URI
2. Tugging of ears
3. Irritability
4. Difficulty sleeping
5. Fever
6. Otalgia
7. Otorrhea
8. Hearing loss
137
what position should uncooperative children be placed in when performing an otoscopic exam?
Supine or prone, held down by parents
138
What are the signs on the eyebrows of a patient with hypothyroidism?
Short and do not extend beyond temporal canthus
139
What are xanthalasma?
Fatty deposits around the eyes that may indicate hypercholestremia
140
Fasciculations/tremors of the eyelids can be seen in what disease?
Hyper thyroidism
141
What are epicanthal folds?
The vertical fold of skin nasally that covers the lacrimal caruncle
142
What is leukocoria?
A white reflex in the eye that may be caused by a congenital cataract or retinoblastoma
143
When is visual fixation present?
Birth
144
When is visual fixation well developed?
6-9 weeks
145
When is visual following developed?
3 months
146
When is visual accommodation developed?
4 months
147
When is steropsis developed?
4 months
148
True or false: poor visual fixation after 6 months of age is ALWAYS worrisome.
True
149
What should eye screening at 6-12 months include?
Red reflex, inspection, fix and follow
150
What should eye screening at 3-5 years consist of?
Red reflex
Inspection
Visual acuity
Cover-uncover test
151
What is the normal visual acuity for children 3+?
20/40 or better
152
What is strabismus?
Misalignment of the eyes
153
What is esotropia?
Inward misalignment of the eye
154
What causes psueudostrabismus?
An apparent misalignment of the eyes that is actually caused by epicanthal folds, and is not an actual misalignment
155
How can you differentiate between pseudostrabismus and true strabismus?
Look for the light reflection--should be in the pupils for both eyes.
156
What is amblyopia?
Loss of visual acuity due to active cortical suppression of vision of the eye
157
What is the cause of amblyopia?
Untreated strabismus (among others)
