Head and Neck Assessment

Question 1

Sections of the cranium

Answer 1

neurocranium and viscerocranium

Question 2

How many bones comprise the skull?

Answer 2

21

Question 3

What is the only movable bone on the skull?

Answer 3

mandible

Question 4

Function of the foramina on the skull

Answer 4

openings through which cranial nerves, arteries, veins, and other structures pass

Question 5

How many bones establish the frontal region of the skull?

Answer 5

One

Question 6

What does the frontal bone form?

Answer 6

The forehead, anterior cranial floor, and part of the eye orbit

Question 7

How many bones form the parietal region of the skull?

Answer 7

Two

Question 8

How many bones form the temporal region of the skull?

Answer 8

Two

Question 9

Where is the sphenoid bone and what does it form?

Answer 9

Anterior base of the skull and forms the walls of the orbit.

Question 10

What are the main sutures of the skull?

Answer 10

Coronal, sagittal, and lambdoid

Question 11

What do the skull sutures fuse together?

Answer 11

Coronal: frontal to parietal bones
Sagittal: parietal bones
Lambdoid: occipital to parietal

Question 12

How many facial bones are there?

Answer 12

14

Question 13

Which facial bones are paired?

Answer 13

Zygomatic, lacrimal, nasal, inferior nasal conchae, palatine, maxilla

Question 14

What are the unpaired facial bones?

Answer 14

vomer (nasal septum), mandible

Question 15

What is assessed when observing facial landmarks?

Answer 15

Size
Shape
Position
Prominence

Question 16

Function of neck muscles

Answer 16

Speech
Swallowing
Stabilization

Question 17

Purpose of anatomic “triangles” of the neck

Answer 17

Useful in assessing superficial structures

Question 18

Components of the anterior triangle

Answer 18

bifurcation of common carotid artery, anterior cervical lymph nodes, facial, glossopharyngeal, vagus, accessory, and hypoglossal cranial nerves.

Question 19

Size of the thyroid with age

Answer 19

Increases in volume with age and body weight

Question 20

Most common presenting symptom of the head and neck

Answer 20

Headache, neck pain

Question 21

Red flags indicating secondary headache disorder

Answer 21

Systemic symptoms: unexplained fever, weight loss, myalgia
Neurologic symptoms: ALOC, sensory loss, weakness
Onset: sudden
Older age: new onset in those >50yrs
Pattern change: 4 Ps of pattern change

Question 22

What are the 4 Ps of pattern change?

Answer 22

Progressing to daily
Precipitated by valsalva
Postural aggravation
Papilledema

Question 23

How do you begin a head and neck exam?

Answer 23

observation

Question 24

What are you OBSERVING for in a head and neck exam?

Answer 24

symmetry
quality/condition of skin and hair
alignment
pain/ROM

Question 25

What are you PALPATING for in a head and neck exam?

Answer 25

``` edema tenderness clicking nodules sensation ```

Question 26

Is percussion necessary in a head and neck exam?

Answer 26

No, unless there are specific concerns or symptoms

Question 27

What are some major laboratory considerations for the head and neck?

Answer 27

``` Thyroid function (TSH, T3, T4, free T4) Parathyroid function (PTH, vitamin D, Calcium) ```

Question 28

What are some imaging considerations for the head and neck?

Answer 28

imaging is not necessary for uncomplicated headaches and as long as there are no red flags for structural disorders

Question 29

What is a CT scan of the head most indicated for?

Answer 29

Skull fracture, intracranial bleed

Question 30

What is an MRI of the head most indicated for?

Answer 30

Prolonged symptoms, worsening symptoms, or suspected structural pathology

Question 31

How should evaluation of a thyroid nodule begin?

Answer 31

TSH level

Question 32

What diagnostic test should be done if the TSH is high or low?

Answer 32

thyroid ultrasound

Question 33

What is the next step if a thyroid ultrasound has abnormal results?

Answer 33

fine-needle aspiration

Question 34

What are the symptoms of an epidermal hematoma?

Answer 34

The pt will have a brief loss of consciousness, regaining of consciousness, followed by progressively worsening headache, then they become obtunded

Question 35

What is an epidermal hematoma?

Answer 35

A neurosurgical emergency in which the meningeal artery becomes severed from either blunt trauma or other traumatic injuries

Question 36

What are two major signs of a skull fracture?

Answer 36

Raccoon eyes=more serious basal skull fracture | Battle's sign (mastoid ecchymosis)= basal skull fracture

Question 37

What is the most common type of skull fracture?

Answer 37

Linear fracture that traverses the full thickness of the bone

Question 38

Signs and Symptoms of a mild TBI

Answer 38

``` Incoordination Inability to focus/blank stare/stunned appearance Disorientation, slurred speech Headache, dizziness Emotional deficits/memory deficits ```

Question 39

Key assessment of a TBI

Answer 39

History of the incident Current symptoms/mental status Neurologic exam

Question 40

Key signs and symptoms of hypoparathyroidism

Answer 40

paresthesia of the fingertips, toes, and lips, myalgia, muscle spasms, fatigue, and dry skin.

Question 41

Key signs and symptoms of hyperparathyroidism

Answer 41

``` Kidney stones Abdominal pain Joint/bone pain osteoporosis fatigue depression *more likely in older adults ```

Question 42

Causes of hypothyroidism

Answer 42

``` iodine deficiency Hashimoto's thyroiditis (autoimmune thyroiditis) medications (lithium, immunotherapies) radioactive iodine therapy thyroidectomy pospartum thyroiditis ```

Question 43

Key assessment findings for hypothyroidism

Answer 43

``` fatigue, weakness, sob on exertion cold intolerance weight gain constipation cognitive slowing bradycardia, diastolic hypertension delayed relaxation of DTRs periorbital edema, tongue enlargement dry skin, hair loss myalgia, arthralgia heavy menstrual bleeding ```

Question 44

Causes of hyperthyroidism

Answer 44

Grave's disease (autoimmune) Goiter toxic adenoma Iodine-induced (too much contrast)

Question 45

Common signs of hyperthyroidism in older adults

Answer 45

unexplained weight loss decreased appetite new onset a-fib

Question 46

Key assessment findings for hyperthyroidism

Answer 46

``` diaphoresis heat intolerance hyperpigmentation, thinning of hair stare, impaired eye movement exophthalmos tachycardia, systolic hypertension, palpitaitons weight loss anxiety tremor ```

Question 47

Signs of neoplasm in a head and neck exam

Answer 47

``` fixed hard mass dysphagia hoarseness cervical lymphadenopathy vocal cord paralysis tracheal deviation ```

Question 48

Individuals at risk for thyroid cancer

Answer 48

History of childhood head or neck irradiation <30 years of age family history of thyroid cancer

Question 49

Facial characteristics of those with fetal alcohol syndrome

Answer 49

``` microcephaly epicanthal folds smooth philtrum flat nasal bridge upturned nose thin upper lip ```

Question 50

Characteristics of Turner syndrome

Answer 50

low hairline thickened neck prominent ear lobes