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CE Head and Neck
Mosby's chapter 10: Head and Neck
101
Medical
Graduate
03/06/2012

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Term
The major accessible artery of the face
Definition
temporal artery
passes just anterior to the ear, over the temporal muscle and onto the forehead
Term
horizontal mobility is greatest between which cervical vertebrae?
Definition
4 and 5
or
5 and 6
Term
name the borders of the anterior triangle of the neck
Definition
SCM muscle, mandible and midline
Term
name the borders of the posterior triangle of the neck
Definition
trapezius, SCM, and the clavicle
Term
which two vessels run along the medial margin of the SCM?
Definition
common carotid artery and the internal jugular vein
Term
what is the largest endocrine gland in the body?
Definition
the thyroid
Term
where is the pyramidal lobe located and what percentage of the population has it?
Definition
extends upward from the isthmus of the thyroid gland and is found in 1/3 of the population (33.3%)
Term
when does ossification of the sutures begin and end?
Definition
begins after completion of brain growth, at age 6 and finishes in adulthood (usually around 30 y)
Term
When do the fontanels of the head ossify? distinguish posterior and anterior fontanels.
Definition
posterior = 2 months
anterior = 24 months
Term
A horizontal jerking or bobbing motion of the head may be associated with what disorder?
Definition
tremor
Term
A nodding movement of the head my be associated with what disease?
Definition
aortic insufficiency (especially if nodding is synchronized with pulse).
Term
facies (definition)
Definition
an expression or appearance of the face and features of the head and neck that when considered together are characteristic of a clinical condition or syndrome
Term
Cushing syndrome facies
Definition
rounded or "moon-shaped" face with thin, erythematous skin and buffalo hump
Term
Hippocratic facies
Definition
sunken appearance to the eyes, cheeks and temporal areas
sharp nose, dry rough skin
seen in pts who are terminally ill
Term
Butterfly rash
Definition
seen in systemic lupus erythematosis
butterfly-shaped rash over malar surfaces and bridge of nose; blush with swelling or scaly, red, maculopapular lesions may be present
Term
Myxedema facies
Definition
dull, puffy, yellowed skin; coarse, sparse hair and temporal loss of eyebrows, periorbital edema and prominent tongue
Term
hyperthyroid facies
Definition
fine, moist skin with fine hair, prominent eyes and lid retraction, and starting or startled expression
Term
Bell's palsy facies
Definition
left facial palsy of CN VII
asymmetry of one side of the face, eyelid not closing completely, drooping lower eyelid and corner of mouth
Term
Acromegaly facies
Definition
coarsening of features with broadening of the nasal alae and prominence of the zygomatic arches
Term
Down syndrome facies
Definition
depressed nasal bridge, epicanthal folds, mongoloid slang of eyes, low-set ears, and large tongue
Term
Pierre-Robin sequence facies
Definition
micrognathia (undersized jaw), glossoptosis (downward or backward placement of the jaw), and palatal clefting, and small retruded mandible
Term
Hurler syndrome facies
Definition
enlarged skull with low forehead, corneal clouding, and short neck
Term
Hydrocephelus facies
Definition
enlarged head, thinning of the scalp with dilated scalp veins, and bossing of the skull; "sun-setting sign" (sclera visible above the iris)
Term
Fetal Alcohol Syndrome facies
Definition
poorly formed philtrum, widespread eye with inner epicanthal folds and mild ptosis, short nose and relatively thin upper lip
Term
Apert syndrome facies
Definition
severe maxillary and midfacial hypoplasia
Term
Treacher-Collins syndrome facies
Definition
maxillary hypoplasia, micrognathia and auricular deformity
Term
Crouzon syndrome facies
Definition
severe maxillary and midfacial hypoplasia with low set eyes
Term
Tics
Definition
spasmodic muscular contractions of the face, head or neck
a feature of Tourette syndrome or possible psychogenic origin
Term
tinea capitis
Definition
fungal infection of the scalp
common cause of hair loos in children
Term
coarse, dry, and brittle hair may be associated with _____________.
Definition
hypothyroidism
Term
fine, silky hair is associated with _________.
Definition
hyperthyroidism
Term
Temporal arteritis is seen most commonly in which age group
Definition
older adults
Term
Chvostek sign
Definition
hyperactive masseteric reflex when percussion of the masseter muscle is performed
seen in hypercalcemia
Term
What does a rare bruit or blowing sound over the orbit suggest?
Definition
expanding cerebral aneurysm
Term
A bruit on the head is highly suggestive of what anomaly?
Definition
vascular anomaly
can be associated with temporal arteritis
Term
Cardarelli's sign
Definition
abnormal pulsation of the trachea when palpating the thyroid cartilage
sign of dilation or aneurysm of the aortic arch
Term
Oliver's sign
Definition
elicited by gently grasping the cricoid cartilage and apply upward pressure while the pt stands with his or her chin extended upward. A downward tug may be felt if an aneurysm is present.
Term
Turner's syndrome facies/features
Definition
webbing, excessive posterior cervical skin, or unusually short neck
**may also be associated with other chromosomal abnormalities
Term
features associated with meningeal irritation
Definition
nuchal rigidity and resistance to flexion of the neck
Term
how should a normal thyroid gland feel on palpation?
Definition
small, smooth and free of nodules, firm but pliable
should rise freely with swallowing
broadest dimension is approx 4 cm
right lobe is often 25% larger than the left
Term
A coarse or gritty sensation when palpating the thyroid is characteristic of what?
Definition
inflammatory process
Term
an enlarged, tender thyroid may indicate what?
Definition
thyroiditis
Term
When will a vascular bruit be heard over the thyroid and why?
Definition
in hypermetabolic states because vascular supply to the thyroid is increased
Term
Caput succedaneum
Definition
subcutaneous edema over the presenting part of the head at delivery (caused by birth trauma)
usually occurs over the occiput and crosses suture lines
Term
cephalhematoma
Definition
subperiosteal collection of blood that is bound by the suture lines
commonly found in the parietal region and may not be immediately obvious at birth (unlike caput succedaneum)
Term
brachiocephaly
Definition
long, narrow heads
seen in preterm infants because their soft cranial bones become flattened with positioning and the weight of the head
Term
plagiocephaly
Definition
flattened spot on the back or side of the head
can result from premature fusion of one of the sutures or from external deformation (positional plagiocephaly)
Term
craniosynostosis
Definition
premature fusion of one of the sutures
Term
bossing
Definition
bulging of the skull
of the frontal areas = associated with prematurity, thalassemia and rickets
of other areas = may indicated cranial defects or intracranial masses
Term
A cystic mass high in the neck in infants may be ________ or a ____________
Definition
thyroglossal duct cyst or a branchial cleft cyst
Term
A mass over the clavicle, changing in size with crying or respiration suggests ________________
Definition
a cystic hygroma
Term
mastoid fontanel
Definition
between the anterior and posterior fontanels
may be an expected finding but is also common in infants with Down's syndrome
Term
in infants younger than 6 months, the anterior fontanel diameter should not exceed ______
Definition
4-5 cm
and should get progressively smaller beyond
Term
bulging fontanels with marked pulsations may indicate _________
Definition
increased intracranial pressure OR meningitis
Term
craniotabes
Definition
"skull wasting"; a softening of the outer table of hte skull
detected with a snapping sensation
may be associated with prematurity, rickets, hydrocephalus, marasmus (protein-energy malnutrition), syphilis or thalassemia
Term
A mass in the lower 1/3 of the SCM may indicated what in infancts?
Definition
a hematoma
Term
When tranilluminating an infant's head, a ring of _______ beyond the rim of the light is expected, except in the ________ when it should be _____
Definition
2 cm or less
occiput = 1 cm or less
**illumination beyond these parameters suggests excess fluid or decreased brain tissue
Term
Macewen sign
Definition
percussion of the skull with one finger to detect hydrocephalus or brain abscesses
Term
cranial bruits are common in __________
Definition
children up to 5 years of age or in children with anemia
Term
chloasma
Definition
"mask of pregnancy"
hyperpigmentation of the face, particularly over the malar prominences and the forehead (fades after delivery)
Term
Which type of headache has an age of onset in childhood?
Definition
classic migraines
Term
Which type of headache has an age of onset during older adulthood?
Definition
Temporal arteritis
Term
Which type of headache is holocranial or diffuse in location?
Definition
medication rebound headache
Term
Which type of headache is bilateral or occipital?
Definition
hypertensive headache
Term
Which type of headache has rapidly increased frequency that awakens the pt from sleep?
Definition
space-occupying lesion
Term
Which type of headache has a typical time of onset at night?
Definition
cluster headache
Term
Which type of headache can occur at anytime (no particular time of onset)?
Definition
temporal arteritis
OR muscular tension (but commonly in afternoon or evening)
Term
Which type of headache has a pulsating or throbbing pain?
Definition
classic migraine
Term
Which type of headache has a dull or throbbing pain?
Definition
medication rebound headache
Term
Which type of headache has an intense burning, boring, searing, knife-like pain?
Definition
cluster headaches
Term
Which type of headache has just a typical throbbing pain?
Definition
hypertensive headache and temporal arteritis
Term
Which type of headache has a bandlike, constricting pain?
Definition
muscular tension headache
Term
Which type of headache has predromal aura?
Definition
classic migraine
Term
Which type of headache has a predromal personality change or sleep disturbances?
Definition
cluster headache
Term
Which type of headache is aggravated by coughing or bending forward?
Definition
space-occupying lesion
Term
Which type of headache is precipitated by menstrual period, missing meals, birth control pills or letdown after stress?
Definition
classic migraine
Term
Which type of headache is precipitated by alcohol consumption?
Definition
cluster headaches
Term
Which type of headache by stress, anger or bruxism?
Definition
muscular tension headaches
Term
Which type of headache develops in temporal relation to the neoplasm?
Definition
space-occupying lesion
Term
Which type of headache usually lasts twice a week?
Definition
classic migraine
Term
Which type of headache gradually increases in headache frequency daily?
Definition
medication rebound headache
Term
Which type of headache occurs several times nightly for several nights and then none for awhile?
Definition
cluster headaches
Term
Which types of headache occur daily?
Definition
temporal arteritis, hypertensive, and muscular tension headaches
Term
Which type of headache are progressive in frequency?
Definition
space-occupying lesions
Term
Which type of headache have a predilection for females?
Definition
classic migraines and medication rebound headaches
Term
Which type of headache have a predilection for males?
Definition
cluster headaches
Term
Which type of headache also has nausea and vomiting?
Definition
classic migraines
and space-occupying lesions
Term
Which type of headache is not controlled by alternate or preventive medications?
Definition
medication rebound headaches
Term
Which type of headache is associated with increased lacrimation and nasal discharge?
Definition
cluster headaches
Term
thyroglossal duct cyst
Definition
palpable cystic mass in the neck
remnant of fetal development, rises from the foramen cecum at the junction of the anterior 2/3 and posterior 1/3 of the tongue
Term
Branchial cleft cyst
Definition
congenital lesion formed by incomplete involution of branchial cleft
epithelium-lined cyst, solitary, painless, located in lateral neck, may have intermittent swelling and tenderness (seen when infected)
Term
Torticollis (wry neck)
Definition
often associated with birth trauma or intrauterine malposition
acquired torticollis is result of tumors, trauma, CN IV palsy, muscle spasms, infection or drug ingestion
head tilted and twisted toward AFFECTED SCM with chin elevated and turned toward OPPOSITE SIDE
Term
hypothyroidism
Definition
under active thyroid
can cause weight gain, constipation, fatigue and cold intolerance, thick fingernails, puffiness in periorbital area, constipation, menarrhagia, and coarse, scaling, and dry skin
Term
hyperthyroidism
Definition
overactive thyroid
can cause weight loss, tachycardia, heat sensitivity, nervousness, easily irritable, goiter, b/l or u/l proptosis (exophthalmos), increased frequency of bowel movements, and amenorrhea, increased weakness in proximal muscles
Term
myxedema
Definition
skin and tissue disorder usually due to severe prolonged hypothyroidism
decrease in metabolic rate, deposition of glycosaminoglycan in all organ systems = mucinous edema of facial features
cognitive impairment, slowed mentation, depressed mood, constipation, muscle pains, hearing problems, deafness, coarse thick skin, thickened nose, slow speech, weight gain, thin brittle hair with hair loss
Term
Grave's disease
Definition
autoimmune, antibodies to thyroid-stimulating hormone receptor leading to overactive thryoid
more common in women
symptoms of hyperthyroidism
Term
Hashimoto disease
Definition
autoimmune antibodies against thyroid gland
often causes hypothyroidism
more common in children and and women between 30 and 50 y
Term
Encephalocele
Definition
neural tube defect with protrusions of brain and membranes that cover it through openings in the skull
cause = failure of neural tube to close completely during fetal development
genetic component (family hx of spina bifida)
Term
Microcephaly
Definition
circumference of head is smaller than normal because the brain has not developed properly or has stopped growing
causes = congenital infections, neuroanatomic abnormalities
associated with mental retardation
head circumference is 2-3 cm below mean for age
Term
Craniosynostosis
Definition
premature closure of one or more cranial sutures before brain growth is complete
leads to misshapen head
usually NOT accompanied by mental retardation
can cause intracranial pressure to increase
Term
What is the difference between a classic and non-classic migraine?
Definition
non-classic migraines do not have a prodromal aura
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