Head and Neck (chapters 10 and 11)

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Terms in this set (142)
salivary glandsthe _____ _____ *produce saliva* -moistens mouth -prevents caries -initiates digestion of carbohydratesamylasethe enzyme _____ initiates digestion of carbohydratesparotid gland submandibular gland sublingual glandthere are *3 paired salivary glands*, name themparotid glandthe _____ _____ is *anterior* to the *ear*, above mandiblesubmandibular glandthe _____ _____ is *medial to mandible* at angle of *jaw*sublingual glandthe _____ _____ is *anterior* in the *floor of the mouth*parotid glandwhat is the *purple* dot pointing tosubmandibular glandwhat is the *blue* dot pointing tosublingual glandwhat is the *green* dot pointing toneckthe _____ provides support and movement structures include: -7 cervical vertebra -ligaments -sternocleidmastoid muscles -trapezius musclesposterior triangle*trapezius, SCM, and clavicle* -contents: posterior cervical lymph nodesanterior triangle*medial border of SCM and mandible* -contents: hyoid bone, thyroid and cricoid cartilage, trachea, thyroid, and anterior cervical lymph nodescarotid internal jugulardeep, parallel to sternocleidomastoidexternal jugularcrosses sternocleidomastoid diagonallyhyoidbelow mandiblethyroid cartilage"shield"cricoid cartilageupper ring of *tracheal cartilage*thyroidthe _____ is *located on each side of the trachea* and joined by the *isthmus* below the cricoid cartilageT3 triiodothyronine T4 thyroxinethe *thyroid* produced *2 hormones* called _____ and _____pyramidal lobethe _____ _____ *extends form the isthmus* to the *LEFT* in 1/3 of populationlymphaticscomponents: -lymph fluids, nodes, collecting ducts -spleen, thymus, tonsils, adenoids, Peyer's patchesimmunityfunctions of the lymphatic system: _____: *antibodies* and *lymphocytes* phagocytosis absorption (fats and fat soluble vitamins) manufactures blood (if 1 sources compromised)immunocompetent_____ means the body is very healthy and easily fights off infections; the only down side would be *tissue rejection*a healthy immunocompetent pt has antibodies that will see a tissue/organ replacement and attack it because it is foreign; immunosupressvrs for the rest of their lifewhy would an immunocompetent person have issues with *tissue rejection*?immunoincompetent_____ means the pt has many allergic rxn, immunodeficiency, autoimmune diseasebrain and placenta (during pregnancy)where are the only 2 places without lymphatics?vascularthe _____ and the *lymphatic* systems are very *interactive* with one anotherlymphatic vessels_____ _____ are *present in all body tissue* except for the placenta and brain -helps maintain CV fluid balance as fluid is exchanged form the CV to the lymphatic systeminterstitial spacesfluid moves from bloodstream to _____ _____ -clear fluid, WBCs, occasional RBClymph vesselsonce in *interstitial spaces* lymph gets collected by _____ _____ and carried to lymph nodes where it is filtered and returned to the venous system at the subclavian veinslymph nodeswhere is *lymph filtered*?to the venous system at the subclavian veinswhere does lymph go after its been filtered?right (subclavian vein)receives lymph drainage from the *right upper body*left (subclavian vein)receives lymph from the *rest of the body* via the *thoracic duct*CV systemlymphatic system has NO pumping mechanism of its own: uses _____ _____ -obstruction results in lymphedemalymphedemaobstruction of the lymphatic system leads to _____lymph nodes_____ _____ occur in groups superficially and deep throughout the bodypalpable*superficial nodes* easily _____diseaselymph nodes are a significant indicator of _____filter= microorganisms produce= lymphocyteslymph node functions: filter _____ produce _____antigenslymphocytes *respond* to _____bone marrow*lymphocytes* are primarily *produced* in _____ _____ (nodes secondary)B lymphocytesproduce antibodiesT lymphocytescontrol response triggered by B lymphocytesmarrowB and T lymphocytes are both mainly *produced* in _____thymusT lymphocytes mature in _____marrowB lymphocytes mature in _____10%the *thymus* is only _____% functional in adultsthymusthe _____ is the site of *T lymphocyte maturity* in *adults*, most mature in the nodes --produced in bone marrowthymus_____ is the *site of T lymphocyte production* and *maturity* in infants and young *children*infancy / childhoodwhen does one develop immunity?LUQ (left upper quadrant)spleen location?what pulp (lymph) red pulp (vascular)what does the spleen contain?spleenfunction of _____ -destroys old RBCs (macrophages) -filters microorganisms from blood -produces antibodies (response to antigens) -stores RBCsimmature*antibody production* is _____ in *neonates*larger*tonsils* are _____ in infants/childrenactivethymus is _____ in production of T lymphocytes in infants / childrenmatureszaympathic system _____ by age *9-12*decreasein the elderly: _____ in number and size of nodesfibrous fattyin the elderly: nodes may be more _____ and or _____ on palpationhead injury-independent observer's description of event is important! -state of consciousness after injury -predisposing factors -associated symptoms -medicationsheadache and stiff neck/neck pain:-detailed history important -determine the severity -associated symptomsenlarged lymph nodes-character: sift, har, painful -associated symptoms -predisposing factors: infections, chronic conditions, traumathyroid problems-changed temperature preference -swelling of neck -trouble swallowing -redness -pain / discomfort -changes in hair, skin, nails -changes in emotions -changes in eyes/vision -tachycardia -menstrual flow change -change in bowel habits -medicationscotton tipped applicators cotton balls tongue depressors waterhead and neck exam equipment?head and face inspection-head position -skull size/shape -scalp: lesions, infestations, scabs, scales -hair pattern -palor, pigmentation -salivary glands -lymph nodes -facial features -hirsutism -tics -spasms -prominent eyesmicrocephaly macrocephaly2 types of *skull SHAPE/SIZE abnormalities*?microcephalyface is normal size but the cranial vault is very smallmacrocephalycranial vault is larger than normal; most commonly due to hydrocephalycraniectomy_____ is a surgical procedure when a point of skull bone is removed; could be due to relive brain pressure after injurynits/eggs (lice) eczema / dandruffcommon *scalp abnormality?head and neck inspection-facial asymmetry at rest, with movement, and expression -CN V, VII innervate face -what part of face affected? entire side of face: CN VII paralysis; no movement portion of face: CN VII paresisCN VII *paralysis**entire side of face*; no movementCN VII *paresis**portion of face*; weakness; limited movementfeatures vary with *nutritional status* eyes may be *sunken * with *soft bulges* underneath lids *wrinkled* and hang loose -can also have coarse eyebrow hairfacial features in the *elderly*?front to backhead and face palpation: *facial bones and skull*: palpate _____ to _____ -not tenderness, swelling, depressions, exostoses -scalp should freely movehead / hair palpationhead and face: -hair texture, color, distribution -note if coarse/brittle or fine/silk -not if firmly attached to scalptemporal arteriesin the _____ _____ note tenderness, *thickening*; auscultate for bruits w/ bell if arteries abnormallymph nodes for palpationoccipital post and pre auricular parotid tonsillar submandibular submentaluse *pads* of 2nd, 3rd, and 4th fingerstechnique for palpation?location size shape mobility tenderness erythema warmth consistencywhat are important characteristics to note about the lymph nodespressuregradually increase _____ as your palpate the lymph nodesparotid submandibular sublingual3 salivary glands for palpation?place fingers anterior to tragus slips into joint space as pt opens mouth note: pain, locking, crepitus, poppingtechnique for palpating the *temporomandibular joint*?percussions and auscultation not routine sinuses can be percussed can listen for bruits over skill (temporal arteries) and eyesnot routine examinations for head and face?ophthalmic maxillary mandibular*3 parts of the TRIGEMINAL* nerve? (CN 5)observe face for muscle atrophy, jaw deviation as *pt clenches teeth*, palpate muscles over jaw test strength by attempting to open jaw as pt *resists* or close the *open jaw*testing CN 5 (trigeminal)? *MOTOR*3 divisions (scalp, cheek, and chin); evaluate for *light touch localization* and *sharp and dull distinction* *corneal sensitivity*testing CN 5 (trigeminal) *SENSORY*corneal sensitivity for CN 5 (trigeminal) sensoryask pt if they have contacts in; have pt look forded, and with the fluff of the cotton swap lightly tough their corneaCN 7 (facial) motor-observe facial expressions -wrinkle forehead, raise eyebrows, squeeze eyes shut, smile, frown, show teeth, puff cheeks -blink reflex on corneal sensitivity testingCN 7 (facial) sensory-taste buds on anterior 2/3 of tongue, salty, and sweethyperextended and swallowingneck inspection: observe in anatomical position, _____ and _____lateral (from the side)make sure to do a _____ inspection of lymph nodesneck inspection-muscle symmetry -triangle landmarks -alignment of trachea and midline structures -fullness at base of neck -masses/nodes -edema/erythema -excessive skin folds -unusual shortness -webbing -carotid artery prominence -jugular vein distension (JVD)flexion 45 degrees extension 55 degrees rotation 70 degrees lateral flexion 40 degreesneck inspection ROM?slowlyROM in the *elderly* should be done _____ isolate each movement note: pain, crepitus, dizziness, decreased ROMSCM evaluation of CN 11 (accessory) motorask pt to *turn head as your apply resistance at jaw/face* (bilateral)trapezius evaluation of CN 11 (accessory) motorask pt to *shrug*. shoulders against downward *resistance*midlinetracheal alignment: should be _____hyoid bone thyroid cartilage cricoid cartilage3 things to palpate in the trachea and midline structures?tuggingpalpate for tracheal _____: sign of *aortic aneurysm*superficial and deepneck sequence: note _____ and _____ *anterior cervical and posterior cervical* -also palpate the supraclavicular nodes technique: pads of 2nd, 3rd, and 4th fingers note: location, size, shape, mobility, tenderness, erythema, warmth, consistencysupraclavicularhow to check for _____ lymph nodes? -ask pt to *raise shoulders top but look down*thyroid gland-observe for symmetry at *rest and with swallowing* -pt positioned seated, neck *slightly flexed* forward and lateral *to the side* being examined -palpate for size, shape, consistency, tenderness, nodules -palpae via *anterior or posterior approach*anterior approach-use finger pads of left hand to palpate right lobe and opposite for left lobe -ask pt to swallow and palpate isthmus -thyroid should move with swallowing -after locating the isthmus, displace trachea to the right and palpate the right lobe with your left finger pads -reverse for other sideposterior approach-palpate using 2 fingers of each hand placed on each side of the trachea, below cricoid -to palpate the right lobe, displace the trachea to the right -reverse for the leftnormal thyroid-smooth, small, not nodular -firm, pliable -moves freely with swallowing -*right lobe often larger* -4cm at largest diameterright thyroid lobe is largerwhich thyroid lobe is *larger*?abnormal thyroid-coarse/gritty: inflammation -nodules: note number, location, size, etc -enlarged: auscultate for vascular sounds associated with hyperthyroidism--> bruitfibroticthey thyroid in the *elderly*: becomes _____ due to *decreased production and degradation of T4*; normally feels more nodular and irregularmigraine cluster muscular tension3 types of headaches?migraine-seen more often in *women* -begins *early in age* -can be on halls of the head -*pulsing or throbbing* headache -duration can be a *couple hours to severe days* -*aura* occurs -*prodrome* occurs -certain things can trigger this reaction or *oral contraceptives, wine, anxiety, certain cheeses* -common *associated symptoms: nausea vomiting, photophobia, photophobia*cluster-more often seen in *men* -specific age group= *middle aged men* -feels like an "ice pick to the face" and is very painful -*short lived typically 30 minutes* -usually *unilateral and on the upper side of the face* -the headache comes in waves -*prodrome: sleep disturbances, slight changes in irritability and mood* -*precipitating factor: alcohol* -*associated symptoms: tearing on the same side as the headache as well as clear rhinorrhea*muscular tension headache-*most common type of headache* -can be brought on by *emotions* -lasts for various amounts of time -NO aura -NO prodrome -NO associated symptoms -*precipitating factors: stress, anxiety*facies_____ are expression for appliance of the face and features of the head and neck that are characteristics of a *particular condition or syndrome*; can help make a diagnosis even before examining a ptslowlyfacies *develop* (slowly/quickly)?Cushing syndrome*moon face*, thin *reddened* skin, possible *hirsutism*hippocratic facies-seen in *terminally ill pts* -*sunken features*, shape nose, rough skindown syndrome*depressed nasal bridge*, *low set ears*, slanted eyesfetal alcohol syndrome*wide set eyes*, short nose, mild ptosis, *poorly formed philtrum*, hirsute foreheadthyroglossal duct cyst brachial cleft cyst goiter3 common *neck abnormalities*?goiteran *enlargement of the thyroid gland*; not necessarily due to hyper or hypothyroglossal duct cyst-lies in the *midline* -duct cyst -soft and boggy to the touch -*easily moves* -*non-tender* -usually pts are *asymptomatic*brachial cleft cyst-*lies laterally* of the midline structures -lies along the *SCM* -can form an opening of *tract with the skin and can start draining through the skin* -lots of possible *bacterial invasion* -usually gets *surgically removed*hyperthyroidism*hot* *weight loss* nervous / irritable fine hair / hair loss warm skin thin nails *proptosis* *tachycardia* diarrhea scant menses proximal muscle weaknesshypothyroidism*cold* *weight gain* complacent / disinterested coarse / breakable hair *scaly dry skin* *thick nails* puffy eyes no tachy / bradycardua *constipation* menorrhagia *good muscle strength*myxedema*adult* onset *HYPOthyroidism*Graves diseaseautoimmune *HYPERthyroid*Hashimoto diseaseautoimmune *HYPOthyroid*acute lymphangitis-*inflammatory process* -characteristic: *red streak* -pain, malaise, fever -look *distally**diphenylhydantion*; used as seizure medication*drugs* and *node enlargement* most common?ASA (asprin), barbiturates, PCN, TCN, Iodide, cephalosporins, sulfonamides -sufla drugsother drugs that result in *node enlargement*?