Head and Neck Exams

Question 1

What should you generally observe when you walk a patient to an exam room regarding head and neck?

Answer 1

Size and Shape
Surgery or trauma
Cyanosis or jaundice
Pallor or pigment

Question 2

Which tissues do not have lymphatics?

Answer 2

Brain, inner ear, bones, cartilage

Question 3

Lymph system is an accessory route for interstitial fluid to go back into the blood

Answer 3

Free card

Question 4

What’s the purpose of the lymph system?

Answer 4

Drainage of interstitial fluid to the blood
Drains plasma proteins and cellular garbage
Absorbs and transports fats from the GI system
Protects from infection
Defense mechanism!

Question 5

Where does the lymph system drain into?

Answer 5

Lymph > veins > kidneys > out

Question 6

What are lymph nodes made out of?

Answer 6

T and B cells

Question 7

What is the purpose of B and T cells? Where are they most often found?

Answer 7

Phagocytize foreign proteins and prevent spread of infection to rest of body

Question 8

What’s the most common reason for lymph adenopathy?

Answer 8

Viral infection

Question 9

What can cause lymph adenopathy?

Answer 9

Hyper-/neo-plasm
Autoimmune
Cancer
Inflammation
Leukocytic infiltrates

Question 10

What does tender lymph nodes indicate?

Answer 10

Acute inflammation

Question 11

How many lymph nodes are in the head?

Answer 11

300

Question 12

Which lymph chains of the head drain more specific areas? Small or large? What can you learn about an infection?

Answer 12

Small areas drain more specifically. Will tell you where an infection may be

Question 13

What are the smaller chains of the head?

Answer 13

Occipital
Pre auricular
Post auricular
Submandibular
Submental

Question 14

What does occipital drain? Where is it?

Answer 14

Under little occipital bump
Small chain lymph
Drains posterior scalp

Question 15

What does posterior auricular lymph drain? Where is it?

Answer 15

Small chain lymph behind ear

Drains scalp, pinna and meatus

Question 16

What does the submandibular lymph drain? Where is it?

Answer 16

Small chain under jawline
Upper lip, cheek, 1/3 lower lid
Anterior nasal cavity and sinuses
Tongue, soft palate, floor of mouth

Question 17

What does the submental drain? Where is it?

Answer 17

Small chain cold sore bump
Lower lip, chin skin
Tip of tongue, floor of mouth

Question 18

What does the preauricular (AKA anterior auricular) drain? Where is it?

Answer 18

Upper and medial 2/3 lids

Pinna and auditory meatus

Question 19

Which nodes drain from around the eyes?

Answer 19

Submandibular and preauricular

Question 20

What are the larger chains of the head?

Answer 20

Posterior cervical, superficial cervical, deep cervical, supraclavicular

Question 21

What does the posterior cervical lymph drain? Where is it?

Answer 21

Large chain. Posterior to sternocleidomastoid. Scalp, neck, occipital and postauricular

Question 22

What does the superficial cervical lymph drain? Where is it?

Answer 22

Large chain. On top of sternocleidomastoid. Cheek, neck

Question 23

What does the deep cervical lymph drain? Where is it?

Answer 23

Large chain. Underneath/behind sternocleidomastoid. Most of head and neck

Question 24

What do tonsillar nodes drain?

Answer 24

Tonsils and tongue

Question 25

Where are the supraclavicular lymph nodes

Answer 25

Right above clavicles

Question 26

In what order should you evaluate the nodes?

Answer 26

Occipital, Posterior auriculuar, Posterior cervical, Superficial cervical, Deep Cervical, Anterior auricular, Tonsillar, Submandibular, Submental

Question 27

How should you approach palpating the lymph nodes?

Answer 27

Walk four fingers along lymph nodes using pads of fingers. | Do both sides at same time

Question 28

How would you evaluate the lymph nodes

Answer 28

``` Difficult to feel = normal Tender = acute Soft = inflamed Hard and rubbery = metastatic/cancer (lymphoma) Fixed and matted = Malignant ```

Question 29

How big would a lymph node be to be considered abnormal?

Answer 29

>1cm (unless fought off prolonged infection)

Question 30

What is the largest endocrine gland in the body?

Answer 30

Thyroid

Question 31

Where is the thyroid gland ?

Answer 31

At base of neck where bowtie would go | Medial to sternocleidomastoid

Question 32

What does the thyroid gland do?

Answer 32

Produce hormones that affect Growth/maturation Heart rate and output Thermoregulation and carb metabolism

Question 33

What would an anterior approach to palpating the thyroid be? How would you make sure the thyroid was free moving?

Answer 33

Have pt turn head to side you're palpating to relax sternocleidomastoid Push larynx over with thumb and palpate with other hand Have patient swallow to ensure it's free moving Repeat on other side

Question 34

How would you do the posterior approach to palpating the thyroid? What's the disadvantage?

Answer 34

From back, palpate both sides of thyroid using pads of fingers

Question 35

How would you interpret your findings with palpating the thyroid

Answer 35

Hard to feel = normal Soft = goiter/inflam Hard and rubbery = cancer Tender = hemhorrage/infection

Question 36

When would you do a nose or throat exam on a patient?

Answer 36

Epiphora/dryness, proptosis, conjunctivitis, double vision Headache, eye ache, bitemporal and occipital pain Autoimmune or infective conditions

Question 37

What's the purpose of the turbinates?

Answer 37

Warm, clean, moisten air Lower = nasolacrimal drainage Middle = most sinus drainage

Question 38

What do you want to examine when looking at the nose?

Answer 38

Shape (congenital anomalies) Trauma Inflammation

Question 39

How would you look into a patient's nose? How far back do you need to go?

Answer 39

Have pt tilt head back, pignose them with thumb, brace hand and insert otoscope Need to shine light past hairs

Question 40

What are you looking at when evaluating the nose?

Answer 40

Straightness of septum State of the mucosa (inflam? discharge?) Patency of nostrils, symmetry

Question 41

What is the light line on the nose of little kids called? What does it indicate?

Answer 41

Transverse lateral crease Sign of allergies Kids push their little noses up to wipe them

Question 42

What are you looking for when examining the mouth?

Answer 42

Color, symmetry, growths

Question 43

How do you look at the pharynx and tonsils

Answer 43

Place depressor in middle third of tongue, press down and have them say "ah"

Question 44

What are you keeping a careful lookout for when looking for lesions in the mouth?

Answer 44

Kaposi's sarcoma