PA week 1 and week 2

Preaucilar lymph node location

before the ear

Posterior auricular location

Behind the ear

Occiptial lymph node

Behind head

Tonsilsar lymph node

end of jawline behind it

Submental lymph node

Underneath the chin

Submandibular lymph node location

Underneath the jaw

PMH of head

Headaches, head injury, surgery on head

PMH of neck

Neck injury, neck cancer, thyroid issues, thyroid nodules

FMH for head AND neck

Family history of head and neck cancers

Physical exam for head includes

Inspect and palpate skull, scalp, hair

Physical exam for face includes (nerves)

Cranial nerve 7 and 5, temporal arteries, and temporomandibular joint.

When inspecting head, note the..

Size and shape

Normocephalic

Normal head size and shape

Macroceophalic/macrocephaly

Big head size and shape, abnormal

Microcephalic/microcephaly

Head is small in size and shape

Use fingertips to palpate the skull for..

Lumps

Inspect the scalp for any…

Lesions, redness, scaling

Inspect the face for..

Facial expressions, symmetry, involuntary movements, abnormal facial structures

Acromegaly (head abnormalities)

Body makes too much growth hormone and causes body parts to get bigger over time

Fetal alcohol spectrum disorders (head abnormalities)

Microcephaly, thin upper lip,

Exophthalmos(head abnormalities)

Eyeballs stick out more than usual, common sign of hyperthyroidism

Cushing sydrome (head abnormalities)

Body has too much cortisol and causes face swelling

Testing cranial nerve 7 includes these actions

Raise eyebrows, close eyes tightly, smile, frown, puff out cheeks

When testing cranial nerve 7, all expressions should be

Symmetrical

Bells palsy is when…

cranial nerve 7 is affected and entire side of face does not move

Cranial nerve 5 controls

Sensory and motor

Cranial nerve 7 controls

Facial movement

How to test cranial nerve 5 for sensory

putting cotton wisp to each of the 3 divisions of the nerve and ask pt to say now when touch is felt

Be sure to test both sides of cranial nerve 5 for

Symmetry

Three divisions of the trigeminal nerve, nerve 5

Opthamalic, maxillary, mandibular

How to assess motor in cranial nerve 5

Palpate temporal and masseter muscles bilaterally as pt opens their mouth and clenches their teeth

for cranial nerve 5, muscles should feel..

Equally strong on both sides

Temporal arteritis

Tenderness and hard band with palpation, abnormal

Pulstations for temporal artery

Pulsations should be +2 bilaterally

TMJ normal findings

Movements should be smooth, no pain/tenderness

Physical assessment components for neck include

Palpate and ausculate carotids, lymph nodes and trachea, test cranial nerve XI, palpate thyroid gland

Inspect neck for…

Lumps, measels, pulsations, symmetry, JVD

JVD is

vein in neck is big and sticks out

Palpate trachea during…

Neck assessment

Tracheal deviation (abnormality)

Unequal deviation results from unequal intrathoracic pressure and is most often clinical emergency

Test cranival nerve 11 by..

Assessing trapezii and sternocleiodmastoid

Test trapezii by…

Placing one hand on each shoulder and ask pt to shrug upwards against pressure

Normal findings of trapezii include…

Strentgh and contractions are equal

How to test sternocleioidmastoid

Pt turn their head against your hand on each side

Nirmal findings of sternocleoidmastoid includes..

Strength and contractions should be equal bilaterally

Palpating thyroid steps include

pt bend head slightly forward to the right, push trachea to the right, use fingers to feel trachea and muscle, ask pt to swallow, thyroid should move up under your finger with trachea and larynx

if thyroid is enlarged…

Use the bell of stethoscope to listen for bruits

Goiter (neck abnormality)

Enlarged neck

TMJ should be without…

Pain and crepitus

Documentation of cranial nerve assessment will..

Go under neuro

Documentation of JVD will go under…

Cardiovascular

PMH of hair includes

Hair disorders

PMH of nails includes..

Nail diseases or abnormalities

Equipment needed to examine skin

Good lighting, pen light, gloves, cm ruler

Pallor

Paleness of the skin

Pallor in melanated skin shows…

Yellow/brown to ashen color

Pallor can be observed in..

Lips, nail beds, mucus membranes

Erythema

Intense redness of skin due to excess bloood in dilated superficial capillaries

Hypoxia

low oxygen in tissues and organs

Hypoxemia

Low oxyen in blood

Cyanosis

Bluish color of skin that signifies hypoxemia

cyanosis occurs when..

Shock, heart failure, cardiac arrest, chronic bronchitis

Central cyanosis

Associated with arterial desaturation and involves the lips, tongue, mouth

Peripheral cyanosis

Affects fingers/toes due to poor circulation

Jaundice

Yellowing of skin due to high levels of bilirubin

Vitilgo

Decreased pigmentation

Acanthosis nigricans

Increased pigmentation

what developmental condition is this?

Congenital dermal melanocytosis. Blueish spot on butt

what is this?

Cafe au lait spot. Large round patch of pigment

Numerous Cafe au lait spot means….

Nerocutaneous disease

What condition?

Acrocyanosis. Benign condition of bluish hands and feet in infants

what condition is this?

Cutis marmorata. Marbeled pattern on skin, normal

Seborrheic keratosis. Non cancerous skin growth, raised, thickened pigmentation

Senile lentigines. Common, non cancerous skin spot, clusters of melanocytes after skin exposure

Perspiration appears normally in response to activity, warm environment, or anxiety, on the…

Face, hands, axillae, skin folds

Dehydration may be apparent by

Dry lips, dry or cracked mucous membranes

Xerosis

Dry skin

Developmental considerations for older adults for moisture…

Sebeacous glands decrease causing dry skin

Diaphoresis

Excessive sweating

Hyperthermia

Increased temperature

Hypothermia

Low temperature

Atrophic skin

Thin and shiny, occurs with arterial insufficiency

Edema

Fluid accumulating in the interstitial spaces

Rebounds immediately

Grade 1 edema

<15 sec rebound

Grade 2 edema

60 second rebound

Grade. 3 edema

2-3 min rebound

Grade 4 edema

Anasarca

Generalized edema, usually bc of kidney failure

Turgor

Ability for skin to to return back to place

Normal turgor

Skin goes back to place quickly

Tenting

Abnormal finding when testing skin turgor

Tenting may be normal in older adults because..

As they age their skin loses elasticity

Mobility

Skins ease of rising

Normal mobility

Skin rises easily

Abnormal mobility

Unable to lift

Primary skin lesions include..

Macule, patch, plaque, pustule, nodule, vesicle, bullae, wheals, urticaria

Macule, primary lesion. freckles, flat, moles, what type of lesion is this and class

Identify class and type

Patch, primary lesion. Flat, vitiligo, cafe au lait, irregular borders

Identify class and type and features

Plaque, primary lesion. Palpable, psoriasis.

Identify class and type

Papule, primary lesion. Raised, insect bites, common wart.