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head & neck cond
med sci exam 1 material
| Question | Answer |
|---|---|
| 3 categories of headaches according to HIS | primary HA disorders, secondary HA disorders, painful cranial neuropathic & other facial pains |
| most acute headaches are diagnosed based entirely on | the patient interview |
| types of primary headaches | tension type, migraine, cluster, other |
| causes of secondary headaches | cranial/cervical vascular disorders, disorders of homeostasis, HEENT disorders, infection, psychiatric disorders, head injuries |
| what to ask patient for acute HA | pattern and rate of onset, pain location, quality of pain, duration of episodes, medication used, associated mechanism, coping mechanism |
| pain is behind brow bone or cheeckbones | sinus HA |
| pain is in and around one eye | cluster HA |
| pain is like a band squeezing the head | tension HA |
| pain, nausea, and visual changes are typical of classic form | migraine |
| pathophysiology of tension type | increased resting muscle tension |
| epidemiology of tension HA | any age, males = females |
| patients describe tension HA as | dull pain or tightness from forehead to occiput (head being squeezed with a vice/clamp) |
| diagnosis of tension HA | specific clinical criteria which puts HA into 3 categories: infrequent, frequent, or chronic |
| treatment of tension HA | lifestyle and pharmacologic , non -opioid analgesics combined with caffeine |
| tension HA is usually (bilateral/unilateral) | bilateral |
| most common type of HA | tension |
| pathophysiology of migraine | primary neuronal dysfunction leading to sensitization, serotonin also plays a role |
| epidemiology of migraine | genetic predisposition, women > men, often begin in adolescence |
| different subtypes of migraine | classic (with aura), common (without aura), others |
| migraine triggers | emotional stress, hormones, not eating enough, weather, alcohol |
| aura | pulsating / throbbing unilateral pain lasting hours to days |
| diagnosis of migraine | criteria: unilateral, pulsating HA aggravated by PA. nausea, photophobia |
| treatment of acute migraines | non-opioid analgesics with caffeine, migraine specific meds |
| migraine specific meds | triptans, ergots (can't use these together!) |
| migraine is(unilateral/bilateral) | unilateral |
| migraine can last | 4 to 72 hours |
| pathophysiology cluster HA | unknown |
| cluster HA epidemiology | males > females, 20-40 yo |
| cluster HA description | unilateral, severe orbital, supraorbital, or temporal pain lasting 150-180 minutes |
| to be a cluster HA, must meet | timeline criteria- HA occurs in clusters over several days or weeks and then go away until the next cluster begins |
| _____ is a significant trigger for cluster HA | alcohol |
| symptoms of cluster HA | ipsilateral, lacrimation, nasal congestion, miosis, ptosis |
| treatment of acute cluster HA | triptans and supplemental oxygen |
| cluster is (unilateral/bilateral) | unilateral |
| other causes of primary HA | cough, exercise, associated with sexual activity, cold-stimulus, external pressure |
| serious / life-threatening HA | head trauma, cerebral aneurysm, CVA, tumor, cerebral infection, CSF leak |
| frequent HA: symptoms present at least _____ | 15 days per month |
| frequent HA is most commonly due to ___ or ___ | tension or migraine HA |
| craniosynostosis | birth defect in which the bones in an infant's skull fuse together too early, causing abnormal head shape |
| flexible "joint" between cranial bones which normally close between ages 2 months - 5 years | sutures |
| "soft spots", normal anatomy in infant | fontanelles |
| multiple subtypes of craniosynostosis, based on ___ | which suture prematurely closes |
| if 1 involved suture, | isolated defect (most common) |
| if 2+ involved sutures, | likely a genetic syndrome |
| possible complications of craniosynostosis | increased intracranial pressure, abnormal neurological development |
| sagittal craniosynostosis | scaphocephaly |
| metopic craniosynostosis | trigonocephaly |
| unicoronal craniosynostosis | plagiocephaly |
| bicoronal craniosynostosis | brachycephaly |
| treatment of craniosynostosis | referral to craniofacial specialist (neurosurgeon is 2nd choice), helmet therapy, surgical correction |
| neck masses: top priority is | determining if mass is benign or malignant |
| 3 types of neck masses | acute, subacute, chronic |
| acute neck masses | most common cause is lymphadenopathy of infectious / inflammatory origin |
| subacute neck masses | concerning for malignancy |
| chronic neck masses | most commonly caused by congenital masses/cysts and thyroid pathology |
| lymphadenopathy | enlarged lymph nodes |
| causes of lymphadenopathy | inflammation, infection, autoimmune, cancer |
| the harder the node.... | the more likely it is a malignancy |
| the more tender the node, | the more likely it is enlarged due to inflammation |
| most common cause of lymphadenopathy | infection |
| acute lymphangitis | inflammation of 1+ lymphatic vessels caused by distal infection site |
| acute lymphangitis typical presentation | pain, fever, malaise, erythematous streaking with possible induration |
| acute lymphangitis treatment | treat underlying infection |
| acute suppurative lymphadenitis | firm, tender, erythematous node |
| acute suppurative lymphadenitis common causes | group A beta-hemolytic strep, staph |
| acute suppurative lymphadenitis management | antibiotics |
| lymphangioma | congenital malformations of the lymphatic systems that involve the skin and subcutaneous tissues |
| macro cystic lymphatic malformation, most common location | neck |
| macro cystic lymphatic malformation, possible complications | compression symptoms, compromised airway, secondary infection |
| lymphangioma - cystic hygroma presentation | bacterial infection, compression symptoms |
| lymphangioma - cystic hygroma diagnosis | prenatal ultrasound, postnatal CT/MRI |
| lymphangioma - cystic hygroma treatment | surgery, sclerotherapy or ablation to close defect |
| lymphedema | excessive accumulation of lymph fluid caused by decreased lymphatic transport |
| 2 types of lymphedema | primary or secondary |
| most common type of lymphedema | secondary |
| primary lymphedema | genetic / congenital |
| secondary lymphedema | caused by disruption or obstruction of lymph pathways due to disease or post-surgical radiotherapy |
| causes of secondary lymphedema | surgery, lymph node dissection, trauma, radiation, tumors, filariasis |
| filariasis | infectious tropical disease caused by any one of several thread-like parasitic round worms (transmits from mosquitos) |
| most common cause of secondary lymphedema in the USA | lymph node dissection |
| early presentation of lymphedema | skin appears doughy |
| late presentation of lymphedema | skin is fibrotic, thickened, verrucous |
| lymphedema diagnosis | clinical, or severity scales |
| lymphedema treatment | compression, PT can do manual drainage, complete decongestive therapy |
| severity scale for lymphedema | cheng lymphedema grading scale |
| lymphomas | heterogeneous group of malignant neoplasms of lymphocytes, which can involve lymphatic tissue, bone marrow, or extra nodal sites |
| lymphomas risk factors | genetic, infections (HIV, EBV), inflammatory (RA, lupus, celiac disease) |
| lymphomas A symptoms | lymphadenopathy |
| lymphomas B symptoms | constitutional symptoms including fever, night sweats and weight loss |
| compression (local) symptoms lymphomas | depends on site of involvement |
| hodgkin lymphoma | primary cancer of lymph tissues resulting in lymphadenopathy |
| hodgkin lymphoma most commonly arises in | supra diaphragmatic lymph nodes |
| hodgkin lymphoma has a ____ presentation | bimodal |
| hodgkin lymphoma diagnosis | PET, CT, biopsy (reed-stern berg cells) |
| stage 1 hodgkin lymphoma | single nodal group or single extralymphatic lesion |
| stage 2 hodgkin lymphoma | multiple nodal groups on same side of diaphragm, or limited contiguous extra lymphatic involvement |
| stage 3 hodgkin lymphoma | multiple nodal groups on both sides of the diaphragm, may involve spleen |
| stage 4 hodgkin lymphoma | noncontiguous extralymphatic involvement |
| hodgkin lymphoma treatment | refer to heme/onc. localized - treat with radiation. advanced - treat with radiation and chemotherapy |
| hodgkin lymphoma post-treatment complications | secondary malignancies, infertility, thyroid dysfunction |
| secondary malignancies of hodgkin lymphoma | AML, non-hodgkin lymphoma, carcinoma of breast, thyroid, lung |
| the ____ typically has a bilobed nucleus that gives an "owl's eyes" appearance | malignant reed-stern berg cell |
| non-hodgkin lymphoma | malignant neoplasms of B, T, NK cells that infiltrate both lymphoid and hematopoietic tissues, can also extend to other organs |
| congenital neck masses | branchial cleft cysts & thyroglossal duct cysts-remnants of fetal development. present at birth but may not be noticed until later, depending on size and development of inflammation |
Created by:
thomask9
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