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Physical Diagnosis > PD Head and Neck > Flashcards

Flashcards in PD Head and Neck Deck (199):
1

Common head and neck complaints

Trauma
Headache
Vision changes
diplopia
Otalgia
Hearing loss
Tinnitus
Vertigo, dizziness, lightheaded
Syncope
Epistaxis
Sore throat
Changes in smell and taste
Swollen glands

2

Name some vision changes

Hyperopia
Presbyopia
Myopia
Scotomas

3

What are the bones of the face?

Frontal
Nasal
Zygomatic
Ehtmoid
Lacrimal
Sphenoid
Maxillary
Mandible

4

Innervation of facial muscles

CN V Trigeminal
CN VII Facial

5

Blood supply to face

Temporal artery

6

Salivary glands

Parotid
Submandibular
Sublingual

7

Head position for inspection

Upright and still

8

Bobbing or jerking during inspection

Tremor

9

Nodding movement during inspection

Aortic insufficiency

10

Head tilt during inspection

Favor unilateral hearing or vision loss
Toticolis

11

Inspection of facial features

Symmetry
Shape
Tics
Characteristic facies
Unusual features

12

Symmetry of facial features

Symmetry of eyelids, eyebrows, palpebral fissures, nasolabial folds, mouth

13

Shape of face

Edema
Puffiness
Coarse features
Prominent eyes
Hirsuitism
Lack of expression
Muscle wasting
Diaphoresis
Pallor
Pigmentation

14

Tics

Spasmodic muscle contractions of head, neck, or face

15

Inspection of skull

Size
Symmetry
Scales
Hair pattern
Trauma
Nits, parasites
Shape
Lesions

16

Cushing syndrome
Causes

Effects of hypercortisolism (increased adrenal hormone production)

Adenoma or adenocarcinoma
Stimulation by excess ACTH from pituitary tumor
Corticosteroid therapy

17

Features of Cushing's syndrome

Moon facies
Hirsuitism
Thick neck, central obesity with thin extremities
Purple striae
Pink cheeks
Buffalo hump
Peripheral edema

18

Cause of myxedema

Severe hypothyroidism

19

Features of myxedema

Round, puffy face
Dry, coarse, sparse hair
Periorbital edema
Slow speech
Hoarseness
Cold, dry, thick, scaling skin
Weight gain
Cold intolerance
Bradycardia
Hypotension
Hypothermia

20

Features of nephrotic syndrome

Face edematous and pale
Swelling begins around eyes
Eyes may become slit like with severe edema

21

Nephrotic syndrome is classified as proteinuria...

Proteinuria over 3 gm/dl

22

Causes of nephrotic syndrome

Renal disease
DM
Idiopathic
Preeclampsia

23

S&S with nephrotic syndrome

Anorexia
Vomiting
Diarrhea
Lassitude

24

Parkinson's features

Mask like facies
Decreased facial mobility - blunted expression
Decreased blinking
Characteristic stare
Upper neck and trunk flexed forward
Patient seem to peer upward towards you
Facial skin is oily

25

Bell's palsy features

Facial nerve palsy
Asymmetry of one side of face
Drooping of lower eyelid and corner of mouth
Loss of nasolabial fold
Inability to completely close eye

26

Causes of bell's palsy

Idiopathic
Viral infections
Most common over 70

27

What percentage of patients recover from bell's palsy?

85%

28

Causes of parotid gland enlargement

Bacterial infection
Mumps
Neoplasm
Cirrhosis

29

Hurler syndrome features

Mucopolysaccharidoses
Enlarged skull
Low forehead
Corneal clouding
Short neck

30

Craniosynostosis

Premature fusion of cranial sutures
Sutures involved determine the shape of the head
Not associated with mental retardation

31

Microcephaly

Congenitally small skull
Associated with mental retardation and failure of brain to develop normally

32

Down syndrome features

Trisomy 21 (extra chromosome)
Depressed nasal bridge
Monogoloid slant of eyes
Low set ears
Large tongue

33

Fetal alcohol syndrome features

Small eye openings
Hypoplastic philtrum
Thin upper lip
Flat mid face
low nasal bridge
Microceophaly

34

Hyperthyroidism features

Prominent eyes
Exopthalamos
Lid lag
Startled expression
Thin, fine hair
Moist, smooth skin

35

Hippocartic facies features

Marked cachexia
Sunken eyes, cheeks
Temporal muscle wasting
Sharp nose
Dry, rough skin
Seen in end stages of terminal illness or malnutrition

36

Palpation of head and scalp

Symmetry
Smoothness
Hair texture
Scalp movement
Areas of tenderness, swelling, masses

37

Scalp in hyper hypothyroidism

Hyper - fine and silky
Hypo - dry and coarse

38

Which arteries do we palpate and where?

Temporal arteries - continuation of external carotid arteries anterior to the ear

39

Palpation of temporal arteries

Thickening
Decreased pulsations
Tenderness

40

Temporal arteritis features

Necrotizing vasculitits
Persistent, severe, throbbing headache
Hard and nodular
Red and edematous
Vision impaired, may cause blindness
MS changes common

Idiopathic

41

Palpation of TMJ

Open and close mouth
Laterally back and forth
Protrude and retract

Note tenderness, popping, locking, crepitus

42

What is a normal gap between upper and lower teeth for an open jaw?

3-6 cm

43

How many cm is a normal lateral movement?

1-2 cm

44

Palpation of salivary glands

Asymmetry
Masses
Tenderness
Discharge through duct into mouth

45

Other name for parotid duct

Stenson's duct

46

Other name for submandibular duct

Wharton's duct

47

Where does the parotid duct open in the mouth?

Opens in buccal mucosa adjacent to maxillary second molar

48

Where does the submandibular duct open in the mouth?

Opens adjacent to the lingual frenulum

49

Sialadentitis
Features

Bacterial infection of the gland
Swelling
Tenderness
Pain with eating
Fever
Can milk pus through the affected duct

50

Which ducts are the most common to get sialadentitis?

Parotid, then submandibular

51

What bacteria is the most common cause of sialadentitis?

Staph aureus

52

What are the risk factors for sialadentitis?

Dehydration
Dry oral mucosa
Sjogren's syndrome

53

Sialolithiasis features

Postprandial pain and swelling
Sucurrent sialodentitis

54

wharton's stones

Larger
Radiopaque

55

Stenson's stones

Smaller
Radiolucent

56

Repeated episodes of stone formation may necessitate...

Sialadenectomy

57

Where is the most common salivary gland tumor? Are they malignant or benign?

80% in the parotid gland, and 80% are benign

58

Presentation of salivary gland tumors

Asymptomatic mass
Facial nerve involvement strongly correlates with malignancy

59

What is the choice imaging modality for salivary gland tumors?

MRI and CT

60

Anterior triangle of the neck

SCM
Midline
Mandible

61

Structures within anterior triangle

Hyoid bone
Cricoid cartilage
Trachea
Thyroid
Anterior cervical LN

62

... artery and vein lie deep in the anterior triangle and run parallel to SCM

Internal jugular and carotid

63

... crosses the surface of the SCM diagnoally

External jugular

64

Posterior triangle of the neck

SCM
Trapezius
Clavicle

65

Contents of posterior triangle

Cervical chains LN

66

LN of head and neck

Preauricular
Post auricular
Occipital
Tonsillar
Submandibular
Submental
Superficial cervical
Deep cervical
Posterior cervical
Supraclavicular

67

History complaints with neck

Pain
Stiffness
Decreased ROM
Dysphagia
Masses, lumps, swelling
Dyspnea
Radiculopathies
Thyroid over/under activity

68

Inspection of neck

Symmetry of structures
Deviation of trachea
Masses
Lesions
Scars
Jugular venous distension
ROM

69

Examples of masses in the neck

Carcionoma
Branchial and thyroglossal duct cysts
Lymph nodes

70

Palpation of the neck

Trachea midline
Hyoid bone
Cartilage - thyroid, cricoid, tracheal rings
Thyroid gland

71

How do we palpate for a midline trachea?

Place finger along one side of trachea and note distance between it and SCM - should be equal

72

Cause of trachea deviation

Pneumothorax
Masses
Unilateral thyroid enlargement (goiter)
Aortic aneurysm
Atelectasis

73

Palpation of thyroid

Should be smooth and contender
Should move under finger when pt swallows

Size
Shape
Consistency
Configuration
Tenderness
Nodules

74

What position do we inspect the thyroid?

Could be either facing patient or from behind

75

When palpating the thyroid, fingers should be just below...

Cricoid cartilage

76

When is the thyroid auscultated?

If enlarged

77

Auscultation of thyroid - diaphragm or bell?

Bell

78

Auscultation of thyroid

Hypermetabolic state has increased blood supply - bruit is heard

79

Features of hyperthryoidism

Heat intolerance
Weight loss
Fine hair, hair loss
Thinning hair
Exopthalmos
Lid retraction
Goiter
Tachycardia, palpitations
Diarrhea, Increased B

80

Features of hypothyroidism

Cold intolerance
Weight gain
Coarse hair, brittle hair
Dry, flaky skin
Periorbital puffiness
No goiter
Constipation
Menorrhagia or amenorrhea
Lethargic, but muscle strength usually intact

81

Palpation of LN

Site
Size
Shape
Warmth
Tenderness
Consistency - hard, soft, rubbery
Mobility
Discrete or matted
Fluctuance, suppuration

82

Features of infected LN

Soft
Mobile
Discrete
Tender
Warm

83

Features of malignant LN

Hard
Fixed
Matted
Non tender

84

Thyroglossal duct cyst
Features

Remnant of embryologic development
Common before 20
Midline neck mass
Painless, could have discomfort with swallowing
Fluctuant, soft, mobile mass

85

Thyroglossal duct cyst cause and presentation with...

Noted during or after URI
May present with sinus or fistulous tract

86

Tx thyroglossal duct cyst

Surgical excision

87

Branchial cleft cysts

Congenital epithelial cysts
Common in early adulthood 20-30

88

Features of branchial cleft cysts

Smooth
Non tender
Fluctuant
Mass along anterior SCM
May become tender and firm if secondarily infected
Sinus tract may develop
Odynophagia

89

Tx of branchial cleft cysts

Surgical excision of non infected cyst and duct

90

Torticollis aka...

Wryneck

91

Congenital torticollis cause

Hematoma or partial rupture of SCM at birth results in unilateral muscle shortening

92

Adult torticollis cause

Trauma to SCM
Chronic spasm
Infection
Neoplasm
psychiatric

93

Ocular torticollis

Head position assumed to compensate for vertical squint or an ocular muscle palsy/imbalance

94

History complaints of eyes

Red eyes
Painful
Change in visual acuity
Pruritic
Eye discharge
Increased or decreased tearing
Trauma
Foreign body
Diplopia
Flashing lights, floaters

95

Causes of red eyes

Conjunctivitis
Allergies
Glaucoma
Iritis
Trauma
Foreign body
Corneal abrasion/ulcer
Environmental irritants

96

Causes of painful eyes

Glaucoma
Iritis
Conjunctivitis
Trauma
Headaches
Foreign body
Corneal abrasion/ulcer
Sinusitis
Trachoma
Entropion
Hordeolum
Chalazion
Tumor
Eye muscle strain
Dry eyes

97

Causes of pruritic eyes

Conjunctivitis
Allergies
Noxious stimuli
Dry eyes
Eye fatigue

98

Causes of eye discharge

Conjunctivitis
Trachoma
Allergies
Infection
Foreign body

99

Causes of increased tearing

Foreign body
Trauma
Allergies
Infection
Noxious stimuli
Emotions

100

Causes of decreased tearing

Fatigue
Sjogren's syndrome
Obstruction of tear ducts
Trauma to CN VII

101

Causes of loss of vision

Optic neuritis
Detached retina
Retinal hemorrhage
Cataracts
Macular degeneration
Central retinal vascular occlusion
Glaucoma
Infection
CVA
Trauma
Tumor
Retinopathy

102

Causes of diplopia

Head trauma
Cranial nerve palsy
Poor ocular muscle coordination
Opthalmoplegia
Tumor
Cataracts
Retinal detachment
Central retinal venous occlusion
Migraine
MS

103

External eye inspection

Symmetry
Eyebrows
Eyelids

104

PERRLA

Pupils equal, round and reactive to light and accommodation

105

Palpation of eye

Nodules
Tenderness

106

Ptosis

Dropping of upper eyelid

107

Causes of ptosis

Muscular weakness (myasthenia gravis)
Damage to CN III
Interference with sympathetic nerves (Horner's syndrome)

108

Exopthalmus
Causes

Widened palpebral fissures
Bulging of the eyes

Hyperthyroid, Grave's disease

109

Ectropion

Excessive laxity or sagging of lower eyelid

110

Cause of ectropion

Common in elderly
Trauma to nerve

111

What happens when the punctum is turned outward in ectropion?

Tearing may be present due to abnormal drainage

112

Entropion
Complications

Lower eyelid and lashes roll inwards
Common in elderly
Can cause inflammation and trauma to cornea

113

Periorbital edema causes

Infection (cellulitis)
Crying
Allergies
Myxedema
Nephrotic syndrome
CHF
Trauma

114

Herniated fat pad

Swelling under eye due to fat accumulation
Common in elderly, may result from trauma

115

Dacrocystitis

Pain, swelling of the lacrimal sac due to infection or trauma
Pressure on sac may produce purulent drainage

116

Xanthelasma
Associated with...

Raised yellow plaques found on the nasal aspect of upper and lower eyelids
Hyperlipidemia

117

Hordeolum

Sty
Pustule on the lid margin, forms when sebaceous gland near the hair follicle is inflamed
Hyperemia and swelling
Rupture and heal on its own

118

Chalazion

Acute inflammation of Meibomian gland
Deeper, more chronic than hordeolum

119

When do we inspect the upper conjunctivae?

If a foreign body is suspected

120

Method of inspecting conjunctivae

Cotton swab, gently press onto surface of upper eyelid
Patient looks down
Gently grab rim of eyelid
Break suction and pull lid up over cotton swab

121

Conjunctivitis Causes

Pink eye

Allergies
Bacterial
Viral
Foreign body

122

Features of conjunctivitis

Red eyes from hyperemia of conjunctival vessels
Crusting of eyes
Exudate
Burning

123

Conjunctival petechiae causes

Finding in endocarditis from emboli
Seen with bleeding disorders or sudden change in venous pressure

124

Causes of subconjunctival hemorrhage

Trauma
Bleeding DO
Sudden increase in venous pressure
Sponatneous

125

Pinguecula

Normal, slightly raised fatty structure under conjunctiva between the canthus and limbus, usually nasal side

126

Pterygium

Chronic inflammation extends a vascular membrane over the limbus towards the center of the cornea
Benign, but vision may be obstructed

127

Where is pterygium more common?
Causes

Southwest, patients older than 35
Nasal side

Wind and dust irritation

128

Arcus senilis

Gray band of opacity in the cornea is separated from the limbus by a narrow clear zone
Bilateral
Due to deposits of lipids
No effect on vision

129

Causes of corneal abrasion or ulcer

Infection - bacterial, viral, or fungal
Abrasion/injury

130

S&S of corneal abrasion/ulcer

Pain - superficial
Circumcorneal injection
Vision usually decreased
Photophobia
Watery or purulent drainage

131

Hyphema

Blood in anterior chamber

132

Hyphema causes

Trauma
Bleeding DO
Increase in venous pressure

133

Hypopyon

Pus in anterior chamber

134

Lens

Made of water and protein
Posterior to iris and pupil
Transparent

135

Cataract

Protein clumps together and clouds the lens

136

Causes of cataracts

Congenital from rubella or CMV
DM
Steroids
Trauma
Advancing age

137

S&S of cataracts

Slow blurring of vision over months to years
One or both eyes
No pain, redness, or discharge

138

Pupil inspection

Size
Symmetry
Roundness
Reactivity to light and accommodation

139

Miosis

2 mm or less

140

Mydriasis

6 mm or greater

141

Iritis
Causes

Inflammation of iris due to infection
Surgery
Injury
Systemic conditions:
IBD
Sarcoidosis
RA
Reiter's syndrome
Lupus

142

S&S of iritis

Pain
No discharge
Ciliary infection
Decreased vision
Pupil irregular, sluggish
Photophobia

143

Anisocoria
When is it benign

Difference in pupil size
Normal variant in about 20% of population
If pupillary reactions are normal, considered benign

144

When is anisocoria serious?

Horner's syndrome
Oculomotor nerve palsy
Glaucoma

145

Pupillary reactions

Should dilate with light on same side and consensually

146

When do we test accommodation?

If abnormal pupil response to light

147

What do pupils do during accommodation tests?

Should constrict when looking at close object and dilate when looking far away

148

What conditions may cause an abnormal pupillary reaction but normal accommodation?

DM
Syphilis

149

Where is corneal reflection seen?

Slightly nasal to the center of pupils

150

Why do we pause at extreme upward and lateral gazes during the H pattern?

To detect nystagmus

151

Blink reflex (4)

Closing the eye is accomplished by muscles innervated by CN VII
Light touch to cornea will cause blink mediated by CN V
Loud noise will cause blinking by CN VIII
Bright light will cause blinking by CN III

152

Which axons remain ipsilateral a and which cross?

Temporal remain ipsilateral
Nasal axons cross at optic chiasm

153

What does the image appear as on the retina?

Reversed and inverted

154

Where does the temporal retina see? Nasal retina?

Temporal retina sees over the nose
Nasal retina sees out to the sides

155

Which occipital cortex sees the right world?

Left cortex

156

Confrontation Test

Gross defects in visual fileds
Cover eye and slowly bring fingers from hand from periphery towards the center until the patient can see

157

How many directions do we do the confrontation test from?

4 directions

158

Homonymous

Loss of same visual field in both eyes

159

Heteronymous

Different visual field loss in each eye

160

Hemianopsia

Half of visual field is lost in both eyes

161

Quadrantanopsia

1/4 of visual field is lost

162

What two charts do we use to screen visual acuity?

Snellen
Rosenbaum pocket chart

163

What do the first and second numbers mean in 20/40?

Patient is 20 feet from the chart
A normal person can read the line from 40 feet away

164

Myopia

Nearsightedness
Eyeball and or cornea is elongated, focusing light rays before the retina

165

Myopia - red or green diopters

Red

166

Hyperopia

Eyeball and or cornea is shallower, focusing lights rays behind the retina

167

Hyperopnia - red or green diopters

Green diopters

168

Astigmatism

Cornea is irregularly shaped
Light rays can focus anywhere
Difficulty seeing near and far

169

Astigmatism - red or green diopters?

Diopter setting varies

170

Retinal detachment features

Blurring of vision unilaterally
"Curtain covering eye"
No pain, swelling, redness, or discharge
Seen with fundoscopy

171

Where is the most common site for retinal detachment?
Who commonly suffers?

Superior temporal area
Older than 50

172

Central vision remains intact with retinal detachment until...

Macula detaches

173

Central and branch retinal artery occlusion features

Sudden profound vision loss
Retinal swelling

174

Amaurosis fugax

Fleeting blindness - seconds to minutes
Curtain coming over eye vertically
No major fundoscopic findings

175

Causes of amaurosis fugax

70% have ipsilateral carotid stenosis
Think cardiac dz, a fib

176

Optic neuritis
Features

Blurring of vision unilaterally
Develops rapidly
Pain in region of eye with eye movement
Optic disc appears swollen

177

Causes of optic neuritis

MS
Viral infection
Autoimmune disorder

178

Tx for optic neuritis

Steroids - IV then PO

179

Fundoscopic exam allows for the visualization of...

Retinal background
Macula
Optic disc/cup
Vessels

180

What is the first thing to visualize on fundoscopy?

Red reflex

181

What do opacities in the path of the light on red reflex appear as?

Black densities

182

Causes of lack of red reflex

Ill positioned scope
Large cataracts
Hemorrhage into vitreous humor

183

Color of fundus

Pink or yellow background

184

Which settings do you use if patient is myopic? Hyperopic?

Myopic - Red, minus lens
Hyperopic - Green, plus lens

185

Vessels branch to or away from the optic disc?

Vessels branch away from optic disc

186

Difference between arteries and veins

Arteries are smaller and brighter red

187

Disc margin

Sharp and well defined

188

Macula features

Darker in color that surrounding retinal background
Usually about 1 disc diameter in size
2 DD temporal to the disc

189

Fovea centralis

Centermost point of macula, does not contain rods

190

Optic disc/cup

Most prominent landmark
Round or oval
Nasal side
Vessels from all 4 quadrants emerge

191

How large is the cup in comparison to the disc?

Cup should not be more than 1/2 disc diameter in size

192

What does the disc look like in papilledema?

Loss of disc margins

193

Causes of papilledema

Increase IC pressure
Head trauma
Tumor
Increased intraocular pressure
Glaucoma
Bleeds

194

Hypertensive retinopathy features

Exudates
Flame hemorrhages
Increased arterial reflex

195

Cotton wool spots
Causes

Irregular white/gray lesions with irregular borders

Infarcted nerve fibers
Seen in HTN

196

Hard exudates
Causes

Creamy, yellow lesions with well defined borders, small and round
Clusters

DM or HTN

197

Drusen bodies
Cause

Yellowish round spots
Tiny in size

Due to lipid deposits
Appear with normal aging

198

Proliferative Diabetic retinopathy

New vessels on disc
Multiple hemorrhages
Dilation of retinal veins

199

Retinoblastoma

Malignant retinal tumor that develops in children