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Function of skull is to protect what?.: cerebrum, cerebellum, brain stem, spinal cord, vision, smell, taste and hearing
Which glands are protected by and directly affected by abnormalities of skull and neck?: Pituitary gland, thyroid/parathyroid glands
Trauma to temporal skull can result in what?: tear of middle meningeal artery and EPIDURAL hemorrhage
Basilar skull fracture can reuslt in?: tear of meninges and leakage of spinal fluid. Meningitis and hemorrhage are risks also
Trauma to sphenoid, fronta, facial bones, nasal structures and orbital structures affect what?: Ability to move eyes and see, smell and taste, affect speech and swallowing
Frontal Trauma associated with: memory loss and confusion
occipital trauma associated with: visual changes and alterations in balance
temporal trauma associated mostly with: motor function deficits
structural abnormalities of mandible, orbits and zygomatic nones will affect: chewing and speech, eye movement and balance. cephalgia, otodyna, torticollis and neck deformities
Damage or structural changes to neck and hyoid bone affect: speech and swallowing, and respiration
Thyroid cartilage and cricoid cartilage are protective of the vessel and glands ofthe neck and with what help to define the respiratory structures of the mid upper airway: trachea
trauma to which part of the skull is a medical emergency: temporal
The bodies of which sensory functions are in the skull: vision - CN II
smell - CN I
hearing - CN VIII
taste - V, IX
when does the skull become smooth and symmetrical: after 2 years of age
name two clinically important markers in multiple congenital abnormalities: angle of the eyes, setting of the ears
What are the vascular structures of the head and neck that are subject to examination: temporal arteries
carotid sinus
int/ext carotid arteries
vertebral basilar arteries
optic arteries
ext/int jugular veins
subclavian arteries and veins
brachiocephalic artery/veins
what are the salivatory glands of the head and neck: parotid
sublingual
submandibular
what are the 8 palpable lymphatic nodes/chains: occipital
tonsillar
ant/post auricular
ant/post cervical
submandibular
submental
jugular
supraclavicular
what are the boundaries of the anterior triangle of the neck: trachea, anterior margin of SCM, clavicles and mandible
what does the anterior triangle contain: lymphatic glands
salivary glands
carotid and jugular vessels
thyroid
hoid bone
cricoid and thyroid cartilage
where is the bifurcation of the carotid artery generally located: upper margin of thyroid cartilage
which gland may have a pyramidal lobe near the midline: thyroid
what is an accessory lobe: defect in embyrological development and migration of the gland generally found in sublingual area - thyroglossal duct/cyst
what is a brachial cyst: remnant of embryonic develoment
related to thymus development and generally lateral and superior to thyroid when found in anterior triangle
what are the boundaries of the posterior triangle of the neck: posterior margin of SCM, clavicle, anterior edge of trapezius
what does posterior triangle contain: posterior lymph nodes
what is horizontal jerking: associated with tremor or tic such as familial tremor, parkinsons.
nodding of head can be associated with what: aortic insufficiency if timed with heart beat or can be intentional in anxiety states
tilting of head can be: compensatory to defects in hearing or vision.
secondary to torticollis
secondary to shortening of muscles from trauma or congenital defect
what is torticollis: abnormailty of scm muscle secondary to spasm, trauma, hematoma
if mouth is involved in defect of face what does that indicate: defect in CN V - trigeminal instead of CN VII
what will you see in palsy of CN VII: lower face deformity
what will you see in paralysis of CN VII: paralysis of CN VII
what are most common scalp abnormalities that are associated with trauma: lacerations and hematomas
what can cause bossing or thinning of outer plates of skull, this is also seen with congenital defects such as downs syndrome: persistant intracranial pressure
name a few clinical states that produce changes in appearance of skull: microencephaly, craniosynostosis, hydrocephalous, persistent torticollis, rickets, bossing
what are webbing of the neck and short neck often related to: chromosomal abnormalities and developmental defects
normal ranges of motion for: flexion extension side bending rotation: flexion - 45
extension - 55
side bending - 40
rotation - 70
what is fine hair associated with? Course thick hair?: fine hair - hyperthyroidism
course and thick hair - hypothyroidism
what are hard, prominent, pustule temporal arteries associated with: temporal arteritis and vasculities especially in ELDERLY patients
Temporal arteritis and vasculitis produce what and what are they risk factors for: persistent cephalgia and visual changes. risk factor for blindness and stroke
defects of TMJ are associated with: headaches, ear pain, painful phonation or chewing
hyper or hypo thyroidism: preference for cold and weight loss with good appetite: hyper
hyper or hypo thyroidism: prominence of eyeballs puffiness of eyelids: hyper
hyper or hypo thyroidism: double vision decreased motility: hyper
hyper or hypo thyroidism: goiter: hyper
hyper or hypo thyroidism: palpations peripheral edema increased bowel movements: hyper
hyper or hypo thyroidism: polyuria decreased fertility muscular fatigue weakness tremulousness: hyper
hyper or hypo thyroidism: nervousness irritability hair thinning increased perspiration change in skin texture and pigmentation: hyper
hyper or hypo thyroidism: heavier menses decreased fertility: hypo
hyper or hypo thyroidism: lethargy thickened, dry skin hair loss brittle nails leg cramps puffy eyelids and puffy cheeks: hypo
hyper or hypo thyroidism speech disorders short attention span tremor: hypo
hyper or hypo thyroidism weight gain with regular diet chilly while others are warm obesisty: hypo
hyper or hypo thyroidism constipation fatigue enlarged tongue hypotension bradycardia: hypo
2 most common symptoms related to neck: neck mass and stiffness
capit capitate: pertaining to head

head-shaped
cepahl(o) cephalometry: head

measurement of head
cleido cleidomastoid: clavicle

pertaining to clavicle and mastoid process
cranio craniomalacia: skull

abnormal softening of skull
occipito occipitoparietal: back portion of skull

pertaining to occipital and parietal bones
odont(o) odontorrhagia: tooth, teeth

hemorrhage following tooth extraction
thyro thyromegaly: thyroid gland

thyromegaly
dysphagia: difficulty swallowing
dysphonia: change in voice, customary with laryngeal disease
ptyalism: excessive production of saliva
deglutition: act of swallowing particularly food
where do 85% of lingual cancers occur: lateral aspect of tongue
what drains in whartons ducts: submandibular salivary gland
how do you assess CN IX and X: observe uvula when patient says "ah"
how do you assess XII: stick out the tongue
**What happens with right hypoglossal nerve CNXII palsy: when patient sticks out tongue it goes to right side of mouth
** what happens with left hypoglossal nerve CN XII palsy: when patient sticks out tongue it goes to left side of mouth
** what happens with right glossopharyngeal nerve CN IX palsy: when patient says ah uvula goes left
**if the uvula deviates right when the patient says ah what does that indicate: left glossopharyngeal nerve palsy CN IX
trachea deviation to one side may indicate what: intrathoracic or mediastinal defect such as pneumothorax, effusion, lymphoma
isolated nodes in neck may initially be the only signs of what: hodgkins lymphomas , actinomycosis, metastatic lesions from lung or liver, tb
enlargement with pain of the thyroid gland is associated with what: hashimotos thyroiditis or graves disease
t/f the loudness of a bruit corresponds to the degree of occlusion of the vessel: false
how long is anterior fontanel open: 18-24 months
when does the posterior fontanel close: 2-6 months
what do dilated scalp veins, bulging fontanels, increased head circumference in infants indicate: increased intracranial pressure from mass effect, or increased fluid such as hydrocephalus, hemorrhage or infection
describe craniotabes when is it generally seen: snapping sensation associated with softening of outer table of skull

seen with rickets or hydrocephalus
what is caput succedaneum describe it: common birth injury associated with edema of scalp

swelling crosses suture lines since it involves soft tissues of skull and not deeper structures
what is cephalic hematoma describe it: indicates sub periosteal collection of blood, does not cross suture lines

more common in parietal area, can harden and become calcified
what is size of light halo in normal translumination: <2 cm and <1 cm over occipital
**what are 4 critical components in determining degree of intracranial injury (relating to history): loss of consciousness, duration of loss, associated injuries, mechanism of injury
when do skull injuries gap: when there is damage to underlying bone and periostium
**what kind of bleed is associated with tearing of middle meningeal artery, common with trauma to temporal bone: epidural - rapid deterioration
**what kind of bleed is associated with tearing of bridgine veins found in subdural area that results in slow accumulation of blood, gradual deterioration of mentation, slow development of lateralizing signs: subdural bleed
**what kind of cranial bleed can cause death: epidural
**what is stiff neck or neck pain most commonly associated with: trauma or muscle fatigue
**what can siff neck or neck pain be indicative of: inflammatory diseases, meningitis, myositis, thyroiditis, collagen vascular diseases
**changes in face, eyes, hair, nails, skin, emotions and mentation, reflexes, weight, bowel habits, blood pressure and heart rate can all be associated with what: thyroid abnormalities
**lips of this color are associated with what?

pallor: anemia
**lips of this color are associated with what?
blueness: cyanosis
**lips of this color are associated with what?
cherry redness: acidosis or CO2 exposure
**lips of this color are associated with what?
circumoral pallor: scarlet fever
**lips of this color are associated with what?
telangiectasias: osler rendu-weber and peutz jeghers
**what kind of lip lesions are secondary to HSV 1 and II and occasionally to HSV or HIV: herpetic lesions
**what kind of lesions are seen in 60% of the population. they begin as maculopapular lesions that ulcerate then become white and painful, no healing and are not pre-malignant: aphthous ulcers or chancre sores
**describe herpetic lesions: begin as vesicles then ulcerate and heal with crusting
**what are the five common associations with squamous cell carcinoma of mouth: smoking, spirits, syphilis, spikes
**sudden onset of multiple painful ulcers on lips and in mouth is: erythema multiforma, hsv, drug reactions, malignancies, endocrine changes
**what is a mucocel and where is it common. what does it look like: cystic, movile, painless lesion covered by skin. common in oral cavity. bluish in color with clear fluid
**where do most squamous cell CA occur: on lateral edges of tongue (85%)
*what is wharton duct the opening to and where is it located: opening of saliary glands, portion of sublingual glands and submandibular glands. located on floor of mouht under tongue
what is dysphagia: abnormal swallowing
what is dysphonia: hoarseness or alteration of vocal quality not loss
leuko leukoplakia: white

white patch on mucous membrane
plakia erthroplakia: patch

red patch of mucous membrane often premalignant
**What is dubowitz clinical assessment scale: standardized system for assessing gestational age

based on 1- neurological signs and 11 external signs
**what is duboqitz score associated with gestational age of 37-41 weeks: 46-60
**what is gestational age of term infant: 37-41 weeks
**What are the important tests utilized by duboqitz assesment scale: square window
arm recoil
leg recoil
heel to ear
scarf sign
head lag
**what is square window test: hand flexed on forearm between thumb and index finger
angle between hypothenar eminence and ventral aspect of forearm is measured
**what is arm recoil: flex forearms for 5 seconds then fully extend them by pulling on hands and then release
fully positive if arms return briskly to full flexion(2)
**what is leg recoil: hips and knees fully flexed for 5 seconds and then exteneded and releasedd
maximal response is full flexion (2)
**what is heel to ear test: put baby's foot as near to head as will go without forcing it
observe distance between foot and head and degree of extension of knee
**What is scarf sign: try to put baby hand around neck and as far posteriorly as possible around opposite shoulder
**head lag: pull baby into sitting position
**What is Appropriate for gestational age: birth weight from 10-90th percentile
**What can small for gestational age be caused by: gongenital anomalies, hypogluycemia, congenital infections
**what are all preterm infants at risk for: hyaline membrane disease, hypoglycemia, hypocalemia
**what are large for gestational age babies at risk for: hypoglycemia and polycythemia
*What are the normal ranges for vital signs of newborn: respiratory rate temp pulse: rr - 30-50 breaths per minute, periods of apnea and periodic breathing are common. check for 1-2 minutes

pulse: 120-140 or 90-140 or > 100
What are two categories used for maturity rating of new born: dubowitz and weight
Is red reflex good or bad: red reflex is good
What does absence of red reflex indicate: view is obstructed by cataract or intraocular tumor - most commonly malignant tumor
what is most common abdominal mass in infant: hydronephrosis - obstructed urinary tract of kidneys
**What is ortolani's test and how is it performed: ortolani's test - examines each hip for joint stability

flex newborn legs at hips, hold legs, then abduct hips to almost 90 degrees.
presence of palpable or audible click - dislocated hip
**what are the normal neurological reflexes of newborn (infantile automatisms): rooting response
plantar grasp
palmar grasp
moro's reflex
perez's reflex
galant's reflex
placing response and stepping response
describe rooting response: infant lie with hands against cheeck. touch corner of infants mouth or cheek
normal response is turning head to same side and opening of mouth to grasp finger
describe plantar grasp: flex leg at hip and knee. dorsiflex infants foot with hand - normal is plantar felxion of toes over hand
describe moro's reflex: hold baby supine, let head drop a little bit, baby should splay upper extremities and then bring them back
one of MOST IMPORTANT motor automatisms
normal - intact CNS
describe galant's reflex: stroke one side of back along paravertebral line from shoulder to buttocks, normal response is lateral curvature of trunk toward stimulated side
describe perez's reflex: rub thumb firmly along spine toward infants head. normal response is extension of head and spine with flexion of knees
frequently infant will urinate
absence - severe neurologic disease of cerebrem or cervical spinal cord
what is the purpose for routine use of growth charts to record height and weight: used to determine if child is growing and developing according to groups of standards
descrepancy between length and wight by more than two percentage lines requires deviation
**what is languo hair: fine, soft, immature hair
covers scalp and brow in premature infants but usually absent in term infants
if tuft of hair on lumbosacral area - spina bifida
**what is telangtasias: stork bites or angel kisses - frequently disappear during first few years - eyelids, nape of neck
**what is nevus flammeus: port wine stain - pink to purple macular lesion of variable size - present at birth and remains - comonly on face
**What is mongolian spot: large, slate blue, well demarcated areas of pigmentation near buttocks
little meaning
usually fade
present more in african americans adn asian americans
**what is erthema toxicum: common rash among newborns
self limited bengin eruption of unkown cause
erythematous macules, papules and pustules
**where is anterior fontanelle and when does it close: junction of sagittal and coronal sutures.
closes at 18-24 months
**where is posterior fontanelle and when does it close: junction of sagittal and lambdoid sutures, closes between 2-6 months
**describe caput succedaneum: edema of soft tissues over vertex of skull, related to birth process
CROSSES SUTURES and disappears after a few days
**describe cepahlohematoma: subperiosteal hemorrhage limited to one cranial bone, usually parietal
SWELLING DOES NOT cross suture lines
**name routine tests used to assess visual acuity in newborn: response to bright light - optical blink relex - newborn blinks and dorsiflexes head in response to bright light
what is normal visual acuity in infant: 20/200
**what are the developmental milestones utilized for determining normal patterns in infants: gross motor, fine motor, language, personall development
**what is the denver developmental screening test: used to detect developmental delays in first 6 years of childs life
**when is special emphasis placed upon in denver developmental screening test: first 2 years
** what are for main areas measured by denver developmental: gross motor
fine motor
language
personal development
**what is the apgar score used to measure: cardiopulmonary system integrity
** what are the five signs evaluated by apgar: color
heart rate
reflex irritability
muscle tone
respiratory effort
**what does the following apgar score relate to
3-4

5-6

>8: 3-4 severe cardiopulmonary depression, infant requires immediate resuscitative measures

5-6 mild cns depression

>8 grossly normal
**when is apgar performed: immediately and again at 5 minutes
** what would apgar score be
pale, blue baby
hr >100
grimace
flaccid muscle tone
good crying: 0
2
1
0
2
total 5
**What is tanner scale used for and what is range: used to record sexual maturity
scale I-V
**What do each of the Tanner stages for males indicate: I - infant genitals
II - enlargement of testes
III - enlargement of testes and lengthening of penis
IV - enlargment of testes and widening of penis
V - mature
**What do each of the Tanner stages for females indicate: I - no breast
II - breast buds
III - widening and raising of areola
IV - widening of base, areola projects above base, secondary mound
V - mature breast
What are the components of a mental status exam: level of consiousness
speech
orientation
knowledge of current events
judgments
abstraction
vocabulary
emotional responses
recent memory
remote memory
calculation ability
object reconigtion
praxis
what is the usefulness of and how do you assess the following level of consiousness: is pat awake, alert, oriented to person place and time,
what is the usefulness of and how do you assess the following speech: have pt recite short phrases such as no ifs, ands, or buts
evaluate language articulation, rate of speech, loud or soft voice, fluency, quantity of talking
what is the usefulness of and how do you assess the following organization: is patient oriented to person, place and time. where are you today, what is todays date
what is the usefulness of and how do you assess the following knowledge of current events: presidents of us
what is the usefulness of and how do you assess the following judgments: checks higher cerebral function - what would you do if you found a wallet
what is the usefulness of and how do you assess the following abstraction: intact higher cerebral function - what do apples and oranges have in common
what is the usefulness of and how do you assess the following vocabulary: many different factors. ask in order of increasing difficulty
what is the usefulness of and how do you assess the following emotional response: mood changes, spirits, patient affect
what is the usefulness of and how do you assess the following recent memory: repeat three words after me, then recall them
what is the usefulness of and how do you assess the following remote memory: inquire about important past life events for patient

potential abnormality in temporal lobe
what is the usefulness of and how do you assess the following calculation ability: serial sevens test

tests dominant cerebral hemisphere and intelligence and attention span
what is the usefulness of and how do you assess the following object recognition - visual agnosia: show patient objects have name them

tests for lesion in nondominant parietal lobe
what is the usefulness of and how do you assess the following praxis - integration of motor activity: have patient do sequence of functions

CNS lesion usually in frontal lobe
What is dysarthria What is generally responsible for dysarthria: difficulty in articulation
lesions of tongue and palate are responsible
What is a motor aphasia? What are the other names for aphasias: present when patients known what they want to say but hae motor impairment and cannot articulate properly. Understand written commands but cannot repeat them.
Also called Expressive, nonfluent
What is often the cause of motor aphasia: frontal lobe lesion
What is sensory aphasia What are the other names aphasias: patient articulates spontaneously but uses words inapproprately. difficulty understanding written and verbal commands and cannot repeat them

also called receptive, fluent ephasia
What is often the cause of sensory aphasia: temporoparietal lesion
What is dysphasia: difficulty comprehending or speaking as result of cerebral dysfunction
What are symptoms that relate to neurological disease: headache
loss of consiousness
dizziness
ataxia
changes in consiousness
visual disturbances
dysphagia
brain failure
cerebrovascular accident
gait disturbance
tremor
numbness
weakness
pain
what is amaurosis fugax: transient visual loss lasting up to 3 minutes
feature of internal carotid artery disease
what is acute painless visual loss: caused by vascular accident or retinal detachment
what is acute narrow angle glaucoma: transient loss of vision with intense ocular pain
what is painless loss of vision: compression of optic nerve or tract or radiation
what is glaucoma: often cause of chronic insidious, painless loss of vision
What is diplopia caused by: caused by ocular motor palsies, thyroid abnormalities, myastenia gravis and brain stem lesions
what happens with brain failure: progressive impairment of orientation, memory judgement and cause, increasing inability to comprehend written material
What is tactile agnosia: inability to recognize object by palpation in absence of sensory deficit
What leads to tactile agnosia: lesion in nondominant parietal lobe
What is a visual agnosia: normal vision but fails to recognize object
What is autopagnosia: inability to recognize own body part
What is apraxia: inability to perform voluntary movement in absence of deficits in motor strength, sensation or coordination
What is dyspraxia: decreased ability to perform activity. understand comand but cannot integrate motor activities
What is function of CN I What is name of nerve How do you test: olfactory - smell
have patient smell something
What is name of CN II What is function How do you test: Optic nerve
vision
test with confrontation testing and do visual acuity testing
What is name of CN III What is function How do you test: occulomotor
eye movements, papillary constriction, accomodation
test with pupillary response to light and accomodation
What does PERRLA mean: pupils of equal size and reat act to light and accomodation by restricting
What do the six cardinal eyemovements test: CN III, IV, VI
What is name of CN IV What is function How do you test: trochlear
eye movements
have pt gaze up, down, sideways. perform extraocular eye movements to check for superior oblique eye muscle movement
What is name of CN V What is function: trigeminal
general sensation of face, scalp, teeth, chewing
What is corneal reflex Which nerve (s) tested: patient looks up and away, bring hand in with wisp of cotton and touch cornea. normal response is closure of both lids when one eye is touch. tests V and VII
How do you test CN V: touch sensation, distinguish between 2 point discrimination, temperature, clench teeth
What is name of CN VI What is function How do you test: abducens
eye movements
test by testing extraocular eye muscles - if lateral rectus muscle is intact
What is kussmaul's breathing: fast and deepassociated with metabolic acidosis
What is biot's breathing: irregular periods with long periods of apnea

increased intracranial pressure, drug induced respiratory, brain damage
What is Cheyne-Stokes breathing: Irregular breathing with increased or decreased rates and depths of breaths and alternating periods of apnea
What is Cheyne-stokes associated with: drug induced resp dep, congenital heart failure, brain damage
- death rattle
What are the 5 fxns of the nose: humidify
filter
warm
olfaction
airway
what drains into inferior meatus: nasal lacrimal duct
what drains into middle meatus: frontal
maxillary
anterior ethmoid
drains into superior meatus: posterior ethmoid
conduction of sound into inner ear thru external auditory canal and middle ear: air conduction
sound conduction thru inner ear and bones of skull: bone conduction
2 parts of tympanic membrane: pars flaccida - on top, smaller

pars tensa - on bottom, bigger
pars tensa divided by malleus into...: anterior and posterior folds
external ear composed of: external auditory canal

pinna
pinna made of: cartilage and skin
external auditory canal is made of: outer 1/3 - cartilage - hair and ceruminous glands

inner 2/3 - bone
biggest turbinate and composition: inferior turbinate

semierectile tissue
major area bleeding in nose: little's area
largest sinus, bounded by eye, cheek, nasal cavity and hard palate: maxillary sinus
multiple, present in ethmoid bone...medial to orbit: ethmoid sinuses
above ethmoid sinus, bounded by forehead, orbit, ant cranial fossa: frontal sinus
behind ethmoid: sphenoid
fxn of paranasal sinuses: nothing, lighten head
major symptoms of ear: hearing loss
vertigo
tinnitus
otorrhea
otalgia
itching
specific symptoms related to nose: obstruction
discharge
bleeding
normal hearing test: AC>BC
anything that blocks the transmission of sound waves ext --> int: conductive hearing loss BC>AC

can be cerumen, foreign bodies, infection, congenital abnormalities
sensoneural heariong loss caused by: disease process in inner ear structures or auditory nerve VIII

i.e. congenital deafness - 50% deafness in kids

rubella, systemic disease, noise, tumors, viral infections
ansomia: loss of smell
otalgia: ear pain

may be inflammation conditions/referred from anatomic structures
d/c from ear: otorrhea
Symptoms of sinus infection: fever
malaise
cough
nasal congestion
max toothache
purulent nasal d/c
headache
season of otitis externa vs otitis media: ext - summer
media - winter
fluid behind ear drum in otitis media? ext?: yes
not in ext
pain on tragus indxicates which - ot med or ot ext: externa
otitis externa commonly seen as: swimmers ear via p. aeruginosa
external ear canal in ot ext vs. media: ext - edematous

media - normal
fever in otitis ext? media?: yes to both
hearing loss in ext or media: ext - slight or none

media - yes
enlarged lymph nodes in otitis media?: yes
auditory acuity testing which nerve?: VIII
rinne test: use 256, 512 HZ tuning fork

AC>BC = normal
weber test normal? abnormal?: determines if unilateral loss is conductive or sensorinueural
normal - sound is midline
abnormal - sound laterizes to one ear
sensoneural hearing loss: AC>BC
weber lat to GOOD side
rinne hear better in good ear
conducting hearing loss: BC>AC
weber - lat to bad ear
rinne - BC>AC in bad ear
Rt ear: AC>BC Lt ear: BC>AC weber left: bone conduction loss in left ear
Rt: AC>BC Lt AC>BC weber: lat right: sensoneural loss left ear

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Deck Info

Number of cards 250