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CP Final


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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
trauma to which part of the skull is a medical emergency
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
what are the 8 palpable lymphatic nodes/chains
ant/post auricular
ant/post cervical
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
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
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:
side bending
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 or hypo thyroidism:
prominence of eyeballs
puffiness of eyelids
hyper or hypo thyroidism:
double vision
decreased motility
hyper or hypo thyroidism:
hyper or hypo thyroidism:
peripheral edema
increased bowel movements
hyper or hypo thyroidism:
decreased fertility
muscular fatigue
hyper or hypo thyroidism:
hair thinning
increased perspiration
change in skin texture and pigmentation
hyper or hypo thyroidism:
heavier menses
decreased fertility
hyper or hypo thyroidism:
thickened, dry skin
hair loss
brittle nails
leg cramps
puffy eyelids and puffy cheeks
hyper or hypo thyroidism
speech disorders
short attention span
hyper or hypo thyroidism
weight gain with regular diet
chilly while others are warm
hyper or hypo thyroidism
enlarged tongue
2 most common symptoms related to neck
neck mass and stiffness

pertaining to head



measurement of head


pertaining to clavicle and mastoid process


abnormal softening of skull

back portion of skull

pertaining to occipital and parietal bones

tooth, teeth

hemorrhage following tooth extraction

thyroid gland

difficulty swallowing
change in voice, customary with laryngeal disease
excessive production of saliva
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
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
**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?

**lips of this color are associated with what?
**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?
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


white patch on mucous membrane


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
**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
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
**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
personal development
**what is the apgar score used to measure
cardiopulmonary system integrity
** what are the five signs evaluated by apgar
heart rate
reflex irritability
muscle tone
respiratory effort
**what does the following apgar score relate to


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
flaccid muscle tone
good crying
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
knowledge of current events
emotional responses
recent memory
remote memory
calculation ability
object reconigtion
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
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
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
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
intact higher cerebral function - what do apples and oranges have in common
what is the usefulness of and how do you assess the following
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
loss of consiousness
changes in consiousness
visual disturbances
brain failure
cerebrovascular accident
gait disturbance
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
test with confrontation testing and do visual acuity testing
What is name of CN III
What is function
How do you test
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
What is name of CN IV
What is function
How do you test
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
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
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
what drains into inferior meatus
nasal lacrimal duct
what drains into middle meatus
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 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
fxn of paranasal sinuses
nothing, lighten head
major symptoms of ear
hearing loss
specific symptoms related to nose
normal hearing test
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
loss of smell
ear pain

may be inflammation conditions/referred from anatomic structures
d/c from ear
Symptoms of sinus infection
nasal congestion
max toothache
purulent nasal d/c
season of otitis externa vs otitis media
ext - summer
media - winter
fluid behind ear drum in otitis media? ext?
not in ext
pain on tragus indxicates which - ot med or ot ext
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?
auditory acuity testing which nerve?
rinne test
use 256, 512 HZ tuning fork

AC>BC = normal
weber test


determines if unilateral loss is conductive or sensorinueural
normal - sound is midline
abnormal - sound laterizes to one ear
sensoneural hearing loss
weber lat to GOOD side
rinne hear better in good ear
conducting hearing loss
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
weber: lat right
sensoneural loss left ear

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