Head, Face and Neck including Regional Lymphatic System

Question 1

What are 2 questions to ask about someones headache?

Answer 1

• Unusually frequent or severe

- Onset: gradual or suddenly

Question 2

When asking for location of headache, what can we determine from that? (which headaches occur where)

Answer 2

• Tension headaches: occipital or frontal, or bandlike tension
• Migraines: supraorbital, retro-orbital or frontotemporal
• Cluster Headaches: pain around eye, temple, forehead and cheek

Question 3

When asking patient if pain is localized on one side or all over, what does this tell us?

Answer 3

Unilateral or bilateral pain is a clue to the type of headache (ex. cluster headaches, always all over pain)

Question 4

What does it mean when we ask about character of headache?

Answer 4

Whether the pain is throbbing or aching

Question 5

What is the difference between throbbing and aching headache, and what type of headache does it usually mean

Answer 5

Throbbing: Pounding and shooting, migraine/temporal arteritis
Aching: vicelike, constant pressure and dull, tension headache

Question 6

What type of headaches would you experience ‘excruciating’ pain

Answer 6

Migraine and cluster headaches

Question 7

How often on average do migraines occur and how long do they last

Answer 7

2 per month, lasting 1-3 days

Question 8

How often on average do cluster headaches occur and how long do they last

Answer 8

1-2 headaches/day, lasting .5- 2 hours for 1-2 months, but then complete remission for months/years

Question 9

What can bring on cluster headaches?

Answer 9

Alcohol ingestion and daytime napping

Question 10

What can bring on migraines?

Answer 10

Alcohol, letdown after stress, menstruation and eating chocolate/cheese

Question 11

What would be associated factors to headaches?

Answer 11

• Nausea or vomiting, stomach problems
• Vision changes, bright lights
• Neck pain or stiffness
• Fever, weakness, moodiness

Question 12

What symptoms are associated with migraines?

Answer 12

Nausea, vomiting and visual disturbances

Question 13

What symptoms are associated with cluster headaches?

Answer 13

Eye reddening, tearing, eyelid drooping, rhinorrhea and nasal congestion

Question 14

What symptoms are associated with tension headaches?

Answer 14

Stress and anxiety

Question 15

What symptoms are associated with meningitis or encephalitis?

Answer 15

Nuchal Rigidity (neck resistance to flexion) and fever

Question 16

Why do we ask about other illnesses patient may have? Give examples

Answer 16

Other illnesses such as hypertension, fever, hypothyroidism and vasculitis can produce headaches

Question 17

What type of medications can produce headaches?

Answer 17

Oral contraceptives, bronchodilators, alcohol, nitrates and carbon monoxide inhalation

Question 18

Why do we ask if there is any family history of headaches?

Answer 18

Migraines are associated with family history of migraines

Question 19

What do people do in effort to treat migraines? Cluster headaches?

Answer 19

Migraines: people lie down to feel better

Cluster Headaches: need to move, even just pacing

Question 20

What could it mean if someone loses consciousness before they fall?

Answer 20

The head injury may not be caused by the fall, instead they could have a cardiovascular problem

Question 21

When someone has a head injury, why do we ask if they have had a change in consciousness since the injury

Answer 21

Change in consciousness is important in evaluating for neurological deficit

Question 22

What is our definition of dizziness?

Answer 22

Lightheaded, swimming sensation or falling feeling

Question 23

What is vertigo

Answer 23

True spinning feeling caused by neurological disease

Question 24

What in the brain causes vertigo?

Answer 24

Labyrinthine-vestibular apparatus and vestibular nuclei in brain stem

Question 25

When vertigo is objective, the patients perception is _______, when it is objective the patients perceptive is _______

Answer 25

the room spins, he or she is spinning

Question 26

When we ask patient about what caused the onset, what can neck stiffness, headache and fever be symptoms of?

Answer 26

Meningeal inflammation

Question 27

What is the vicious circle of pain?

Answer 27

Tension increases pain and disability, which produces more tension

Question 28

When asked if patient has lumps or swelling in neck, what are we looking for?

Answer 28

Tenderness: acute infection | Persistant lump: causes suspicion of malignancy (40+ suspect unless proven otherwise)

Question 29

History of irradiation (enlargement?) of neck can increase risk of what?

Answer 29

Risk of salivary or thyroid tumours

Question 30

Dysphagia is______

Answer 30

Difficulty swallowing

Question 31

Smoking and large alcohol consumption increases____

Answer 31

risk of cancer

Question 32

What are the 4 questions we ask about head/neck surgery

Answer 32

- Ever had surgery in head or neck - For what condition - When did the surgery occur - How do you feel about the results

Question 33

What are the two questions we make sure to ask older adults?

Answer 33

- Dizziness and how it affects daily activities | - Pain and how it affects ADL