Head, Face, and Neck

Question 1

What are the things you ask about when a patient has a headache?

Answer 1

• recurrent, new, or uncharacteristic?
• Location and severity
• associated nausea or vomiting, vision changes, neurologic changes
• chronology of symptoms
• Aggravation/Alleviation
• Triggers
• Family Hx
• Past treatments or outcomes, Meds used

Question 2

Scotomas

Answer 2

specks in the vision or areas where patient cannot see

Question 3

PE of Head

Answer 3

• Skin and hair –> scalp and face

- Bony structures –> skull and face

Question 4

What are you looking for in the hair?

Answer 4

quantity, distribution, texture, and any pattern of loss

-loose flakes of dandruff

Question 5

What are you looking for on the scalp?

Answer 5

-Scaliness, lumps, nevi, or other lesions
-redness/scaling = seborrheic dermatitis or psoriasis
soft lumps= pilar cysts

Question 6

What are you looking for on the skull?

Answer 6

deformities, depressions, lumps or tenderness
enlarged skull= hydrocephalus or Paget’s disease
-Palpable tenderness of step-offs may be present after trauma

Question 7

Battle’s sign

Answer 7

Brain injury presented as bruising behind the ears

Question 8

Raccoon Eyes

Answer 8

Bruising around the eyes associated with Basilar skull fracture

Question 9

Symptoms of Bell’s Palsy

Answer 9

Affected sign:

• inability to wrinkle brow
• drooping eyelid or inability to close eye
• inability to puff cheeks; no muscle tone
• drooping mouth; inability to pucker/smile

Question 10

Symptoms of Nephrotic Syndrome

Answer 10

• swollen pale face
• swelling seen first around eyes and in the morning
• eyes may become slitlike if swelling is severe

Question 11

Symptoms of Hypothyroidism

Answer 11

• swelling of face (doughy)
• Fatigue
• lethargy
• weight gain with anorexia
• cold intolerance
• constipation
• cramps
• irregular menses

Question 12

Symptoms of Cushing’s Syndrome

Answer 12

• increased adrenal cortisol production
• produces round (“moon”) face with red cheeks
• excessive hair growth may be present in mustache and sideburn areas

Question 13

Symptoms of Parkinson’s

Answer 13

• decreased facial mobility blunts expression
• masklike face may result, with decreased blinking and a stare
• skin may become oily
• drooling may occur

Question 14

Symptoms of Acromegaly

Answer 14

• increased growth hormone produces enlargement of bone and soft tissues
• head is elongated, with bony prominence of the forehead, nose, and lower jaw
• Nose, lips, and ears enlarge
• facial features appear coarsened
• most likely due to tumor on pituitary

Question 15

Three Diseases associated with Facial Swelling

Answer 15

Cushing’s Syndrome, Nephrotic Syndrome, Myxedema

Question 16

ROS of Neck and Endocrine

Answer 16

• swollen glands or lumps in neck
• heat/cold intolerance; sweating, history of thyroid enlargement or problems
• Neck surgery, trauma, recent viral infection

Question 17

PE of Neck

Answer 17

• overlying skin and neck muscle
• Contour/symmetry (tracheal deviation, lymphadenopathy, goiter, H & N alignment)
• Scars
• lesions, tenderness, erythema
• Trachea
• Lymph Nodes

Question 18

What to look for in the lymph nodes?

Answer 18

• Size, shape, consistency, mobility, tenderness
• Use a circular motion w/pads of index & middle fingers
• Examine both sides simultaneously
• Shotty= lymph node that worked hard and became fibrous

Question 19

Sequence of the Cervical Lymph Nodes

Answer 19

1. Preauricular
2. Posterior auricular
3. Occipital
4. Tonsillar
5. Submandibular
6. Submental
7. Superficial
8. Posterior Cervical
9. Deep Cervical Chain
10. Supraclavicular

Question 20

Preauricular Nodes

Answer 20

in front of the ear

Question 21

Posterior auricular Nodes

Answer 21

Superficial to the mastoid process

Question 22

Occipital Nodes

Answer 22

at the base of the skull posteriorly

Question 23

Tonsillar Nodes

Answer 23

at the angle of the mandible

Question 24

Submandibular Nodes

Answer 24

midway between the angle and the tip of the mandible

Question 25

Submental Nodes

Answer 25

midline a few centimeters behind the tip of the mandible

Question 26

Superficial Cervical Nodes

Answer 26

superficial to the sternomastoid

Question 27

Posterior Cervical Nodes

Answer 27

Along the anterior edge of the trapezius

Question 28

Deep cervical chain Nodes

Answer 28

deep to the sternomastoid | -need to hook thumb and fingers around either side of sternomastoid to find them

Question 29

Supraclavicular Nodes

Answer 29

deep in the angle formed by the clavicle and the sternomastoid

Question 30

Cervical nodes & GABHS

Answer 30

- Sore throat | - Enlarged & tender: tonsillar, submental & submandibular nodes

Question 31

Cervical nodes & mononucleosis

Answer 31

- Enlarged & tender: posterior - Fever, fatigue, sore throat, rash - Epstein-Barr virus

Question 32

Cervical nodes & malignancy

Answer 32

- Stony hard, fixed, enlarged - Non-tender - Discrete - B/L or U/l

Question 33

Signs of Hypothyroidism

Answer 33

- Bradycardia - dry, coarse, cool skin, sometimes yellowish - somnolent (drowsy) - periorbital puffiness - delayed deep tendon reflex - no lateral eyebrows - decreased systolic and increased diastolic

Question 34

Symptoms of Hyperthyroidism

Answer 34

- Nervous - Good appetite with weight loss - sweating and heat intolerance - palpitations - amenorrhea (absence of menstruation) - frequent BMs - tremors

Question 35

Signs of Hyperthyroidism

Answer 35

- Exophthalmos (with Grave's disease) - tachycardia - warm, smooth, moist skin - palmar erythema - proptosis/lid lag stare - hyper-reflexia - tremors - Increased systolic and decreased diastolic

Question 36

Exopthalmos

Answer 36

bug-eyed appearance because fat and tissue deposits behind eye push eye forward

Question 37

Proptosis

Answer 37

lid takes longer to close

Question 38

Warning Signs ("red flags") of Headaches

Answer 38

- Progressively severe or progressive over 3 months - Sudden onset - New onset 50+ y/o - Affected by change in position - Triggered by Valsalva maneuver - Associated: F/C, night sweats, wt loss, papilledema, neck stiffness, focal neurologic deficits - Confirmed CA, IUP, HIV - Recent head trauma

Question 39

Attributes of Migraines

Answer 39

- U/L - throbbing, aching, variable pain scale - Timing: rapid onset, peak 1-2 hrs, duration 4-72 hrs, recurrent (weekly to monthly) - Associated: N/V, photophobia, phonophobia, aura: visual or motor - Triggers: EtOH, food, stress, menses, barometric pressure/altitude, noise, light - Relief: quiet & dark, sleep, lying still

Question 40

Attributes of Tension Headaches

Answer 40

- B/L – generalized/localized back of head & upper neck or frontotemporal - Steady pressing or tightening, non-throbbing, low to medium pain scale - Timing: gradual onset, duration 30 min–7 days, episodic to chronic - Triggers: sustained muscle tension - Relief: massage, relaxation, ergonomics

Question 41

Attributes of Cluster Headaches

Answer 41

- U/L – behind/around eye or temple - Deep, continuous & severe pain - Timing: abrupt, peaks in minutes, duration – 3 hrs, episodic, clustered (several/day x 1-2 mos) w/relief 6-12 mos - Associated: lacrimation, rhinorrhea, miosis, ptosis, eyelid edema, conjunctival infection - Triggers: EtOH

Question 42

Dizziness

Answer 42

-nonspecific term used by patients that encompasses several problems including vertigo, presyncope, disequilibrium, psychiatric, multifactorial/unknown

Question 43

Vertigo

Answer 43

spinning sensation accompanied by nystagmus and ataxia

Question 44

Ataxia

Answer 44

lack of coordinated voluntary muscle movements

Question 45

Nystagmus

Answer 45

fine rhythmic oscillation of the eyes; normal in extreme lateral gaze

Question 46

Presyncope

Answer 46

a near faint from "feeling faint or lightheaded"

Question 47

Disequilibrium

Answer 47

unsteadiness or imbalance when walking