Flashcards in Head and neck Deck (157):
Which test involved a 512 Hz tuning fork to be placed on the apex of the patient's head?
What finding is needed to diagnose conductive hearing loss in a Weber test?
Hearing preferentially in the bad ear
What finding is needed to diagnose a neurosensory hearing loss in a Weber test?
Hearing preferentially in the good ear
Which test is more accurate for conductive hearing loss, weber or rinne?
What is angular cheilosis?
Erythematous inflammation of lips to extends beyond the mouth
What is Brachial cleft cyst?
A congenital lesion due to the incomplete involution of the brachial left
What is a bulging fontanel indicate?
rise in intracranial pressure
What is cheilits?
What is cholesteatoma?
mass of keratinizing squamous epithelim and cholesterol in the middle ear, usually caused by chronic otitis media
What is crainiosynostosis?
premature closure of an infant's skull
What is choasma?
common facial discoloration seen in pregnancy
What is Encephalocele?
Neural tube defect with protrusions of brain and membranes that cover the skull (bifida of the cranial part of the spinal cord)
What are epstein pearls?
small, multiple white, epithelial inclusion cysys found in the midline of the palate in newborn infants
What are fordyce spots?
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
What are Koplik's spots?
Small red spots with bluish-white centers on the buccal mucosa opposite the molar teeth, appearing in the prodromal stages of measals
What is leukoplakia?
circumscribed, firmly attached, thick white patches on the tongue. Often precancerous.
What is molding when referring to newborn children?
Shape of the head
What is otosclerosis?
deposits of bone resulting in immobilization of the stapes
What is presbycusis?
impairment of heading due to aging
What is a thyroglossal duct cyst?
A palpable cyst in the neck due to an incomplete closure of the thyroglossal duct
What is tophi?
small, whitish uric acid crystals along the peripheral margins of the auricles in persons who may have gout
What is torus mandibularis?
a bony protuberance on the linguinal aspect of the lower jaw in the canine-premolar region
What is torus palatinus?
a bony protuberance in the midline of the hard palate
What is tympanosclerosis?
The formation of dense connective tissue in the middle ear, often resulting in hearing loss
What is Xerostomia?
What is webbing?
Excessive posterior cervical skin the is often associated with chromosomal abnormalities
What is the findings necessary for a Rinne test to indicate conductive hearing loss?
Bone conduction heard as long, or longer than air conduction
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
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)
What would indicate an abnormal Romberg test?
The inability to stand for 60 seconds with feet together and eyes closed.
True or false: If the Romberg test is abnormal, you should continue to testing to further evaluate the extent of the cerebellar dysfunction.
Which side do patients with vestibular lesions fall toward: toward or away from the lesion?
Toward the side with the lesion
Which side does numbering the teeth begin on?
(to top left, then from bottom left, to bottom right)
Which side will the trachea deviate in lung volume loss?
Toward the lung with volume loss (like a vacuum)
Which side will the trachea deviate in thyroid enlargement--toward or away from the affected side?
Away from the affected side
Which side will the trachea deviate in tension pneumothorax--toward or away from the affected side?
Away from the affected side
Which side will the trachea deviate in pleural effusion--toward or away from the affected side?
Away from the affected side
Which side will the trachea deviate in a collapsed lung--toward or away from the affected side?
Toward the affect side
What is a "tug" in reference to the trachea?
It is a palpable pull out of midline with inspiration
Which way is the ear pulled in an adult?
Up and back
Which way is the ear pulled in a child?
Down and back
What is the typical location of a migraine headache?
Unilateral (70%) or bifrontal/global
What is the typical location of a tension headache?
Bilateral/generalized to back of head
What is the typical location of a cluster headache?
Unilateral, usually behind/around the eye
What is the quality and severity of a migraine headache?
What is the quality and severity of a tension headache?
Mild to moderate severity
What is the quality and severity of a cluster headache?
Deep, continuous, severe
What is the process involved in migraine headaches?
What is the process involved in tension headaches?
Unclear--possibly heightened CNS
What is the process involved in a cluster headache?
Unclear--possibly hypothalmic then trigemino-autonomic activation
What is the timing involved in a migraine headache (onset, duration, course)?
Onset = Rapid (peak = 1.5 hours)
Duration = 4-72 hours
Course = recurrent
What is the timing involved in a cluster headaches (onset, duration, course)?
Onset = abrupt
Duration = 3 hours
Course = episodic, (in clusters)
What is the timing involved in a tension headaches (onset, duration, course)?
Onset = gradual
Duration = 30 minutes to 7 days
Course = episodic (non-cluster)
What are the associated factors with migraine headaches?
n/v photophobia, phonophobia, AURA.
What are the associated factors with tension headaches?
What are the associated factors with cluster headaches?
Autonomic symptoms (rhinorrhea, lacrimation)
What are provoking factors for migraine headaches?
What are provoking factors for tension headaches?
Sustained muscle tension
What are provoking factors for cluster headaches?
Nervousness is symptomatic of what (hypo or hyper-thyroidism)?
Fatigue/lethargy is symptomatic of what (hypo or hyper-thyroidism)?
Weight loss with increased appetite is symptomatic of what (hypo or hyper-thyroidism)?
Palpitation are symptomatic of what (hypo or hyper-thyroidism)?
Modest weight gain with anorexia is symptomatic of what (hypo or hyper-thyroidism)?
Dry, coarse sking is symptomatic of what (hypo or hyper-thyroidism)?
Frequent BMs are symptomatic of what (hypo or hyper-thyroidism)?
Constipation is symptomatic of what (hypo or hyper-thyroidism)?
Tremor/proximal muscle weakness is symptomatic of what (hypo or hyper-thyroidism)?
Cold intolerance is symptomatic of what (hypo or hyper-thyroidism)?
Weakness, arthralgias is symptomatic of what (hypo or hyper-thyroidism)?
Swelling of the hands/face/legs is symptomatic of what (hypo or hyper-thyroidism)?
Loss of hair is a sign of what (hypo or hyper-thyroidism)?
Increased BP is a sign of what (hypo or hyper-thyroidism)?
Tachycardia/A-fib is a sign of what (hypo or hyper-thyroidism)?
Hyperdynamic cardiac pulsations/accentuated S1 is a sign of what (hypo or hyper-thyroidism)?
Periorbital puffiness is a sign of what (hypo or hyper-thyroidism)?
Decreased BP is a sign of what (hypo or hyper-thyroidism)?
Bradycardia is a sign of what (hypo or hyper-thyroidism)?
Dry, coarse, cool skin is a sign of what (hypo or hyper-thyroidism)?
Warm, moist skin is a sign of what (hypo or hyper-thyroidism)?
Impaired memory is a sign of what (hypo or hyper-thyroidism)?
Mixed hearing loss is a sign of what (hypo or hyper-thyroidism)?
Somnolence is a sign of what (hypo or hyper-thyroidism)?
Peripheral neuropathy is a sign of what (hypo or hyper-thyroidism)?
Carpal tunnel syndrome is a sign of what (hypo or hyper-thyroidism)?
What are the questions that should be asked in head trauma (9 on handout)?
Time of injury
Subsequent level of alertness
Bleeding from nose/ear/eyes
True or false: LOC is the best way to tell if a patient has had a concussion.
False - can occur without LOC
What are signs of a concussion?
Impaired brain function
When does the anterior fontanel usually close?
When does the posterior fontanelle close?
What is a common cause of a sunken fontanelle?
What are common causes of a bulging fontanelle?
Vomiting, coughing, crying
What is the normal fontanelle size at birth?
What is caput succedaneum?
Subcutaneous edema over the presenting part of he head at delivery (scalp edema)
How can you differentiate caput succedaneum from other etiologies?
Edema of the head usually crosses over suture lines
What is cephalhematoma?
Subperiosteal collection of blood
How can you differentiate cephalhematoma from other etiologies?
DOES NOT cross suture line
DOES NOT transluminate
What is plagiocephaly? How is it usually caused?
Asymmetry of the head
Baby laying in the same way for long periods
External/middle ear disorders are what type of hearing loss (conductive or sensorineural)?
inner ear disorders are what type of hearing loss (conductive or sensorineural)?
Sensorineural (involve cochlear nerve)
How do you determine if the ears are low in a child?
Draw a line from the side of the eye to the ear
What is the accumulation in the ear of newborns that prevent their TMs from being seen?
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.
How do infants breathe? (out of nose, mouth, with ribcage, abdomen etc)?
Obligate nasal breathers
A nasal crease is the result of what activity?
Rubbing nose due to drainage
Allergic shiners are what?
Pooling of blood (seen as a dark spot) beneath the eyes due to congestion.
When do the maxillary sinuses develop?
About 1 year old
When do the ethmoid sinuses develop?
About 6 years of age
When do the sphenoid sinuses develop?
About 6 years of age.
When does the frontal sinus develop?
About 10 years of age
When are the sinuses fully developed?
About 21 years of age.
Are antenatal teeth removed?
How long to epstein pearls last?
2-3 months after birth
Kissing tonsils are what grade?
When does the peak size of tonsils occur?
Between 2-6 years of age
True or false: 2+ tonsils are always a worrisome sign.
False--common size for young age. Worrisome if erythematous or exudate
When do teeth begin to erupt?
How many teeth are added every month after the first teeth erupt?
about 4 teeth every 4 months
Which, generally, are the first teeth to erupt?
The upper and lower incisors
When is the full complement of teeth erupted?
When does shedding of teeth generally occur?
5 years old
When do second teeth begin to erupt?
Where are stentson's ducts found?
Near the 2nd upper molar
Where are Wharton's ducts found?
Below the tongue
A deviation of the tongue to one side may be indicative of a lesion of what nerve?
If the uvula does not rise with phonoation, this may be an issues in what nerve?
What opthalmic emergency is indicated with flashing lights in an eye?
Transient loss of vision may be a medical emergency if this is the cause (among others).
Emoboli occluding the opthalmic artery.
Exophtalmos is most commonly caused by what?
What is the numerator in the Snellen eye chart?
Distance from the chart
What is the denominator in the Snellen eye chart?
Distance the average eye can read the chart.
When is a swinging light test indicated?
When you suspect Marcus Gunn Pupil
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.
A bulging TM is indicative of what?
A retracted/neutral TM with other signs of infection is indicative of what?
Otitis media with effusion
What are the indications of an otoscopic exam for children?
2. Tugging of ears
4. Difficulty sleeping
8. Hearing loss
what position should uncooperative children be placed in when performing an otoscopic exam?
Supine or prone, held down by parents
What are the signs on the eyebrows of a patient with hypothyroidism?
Short and do not extend beyond temporal canthus
What are xanthalasma?
Fatty deposits around the eyes that may indicate hypercholestremia
Fasciculations/tremors of the eyelids can be seen in what disease?
What are epicanthal folds?
The vertical fold of skin nasally that covers the lacrimal caruncle
What is leukocoria?
A white reflex in the eye that may be caused by a congenital cataract or retinoblastoma
When is visual fixation present?
When is visual fixation well developed?
When is visual following developed?
When is visual accommodation developed?
When is steropsis developed?
True or false: poor visual fixation after 6 months of age is ALWAYS worrisome.
What should eye screening at 6-12 months include?
Red reflex, inspection, fix and follow
What should eye screening at 3-5 years consist of?
What is the normal visual acuity for children 3+?
20/40 or better
What is strabismus?
Misalignment of the eyes
What is esotropia?
Inward misalignment of the eye
What causes psueudostrabismus?
An apparent misalignment of the eyes that is actually caused by epicanthal folds, and is not an actual misalignment
How can you differentiate between pseudostrabismus and true strabismus?
Look for the light reflection--should be in the pupils for both eyes.
What is amblyopia?
Loss of visual acuity due to active cortical suppression of vision of the eye