NSG 6020 midterm exam |44 questions and answers.

The Head Skull is a rigid bony box which house & protects the brain & special sense organs 14 facial bones Cranium is supported by cervical vertebrae C1 is the atlas C2 is the axis C7 vertebra: vertebre prominents Human face appearances & expressions ("the mood tellers") are formed by facial muscles which are mediated by CN VII (facial nerve) Facial sensations of pain or touch are mediated by the 3 sensory branches of CN V (trigeminal nerve) Cranial bones walls of the skull): frontal, parietal, occipital, & temporal Adjacent cranial bones unite at meshed immovable joints named "sutures" Coronal suture crown" from ear to ear at the union of frontal & parietal bones Sagittal suture separates the head lengthwise between the 2 parietal bones Lambdoid suture separates parietal bones crosswise from the occipital bone confluence points of the cranial sutures form the anterior, posterior, anterolateral (sphenoid), and posterolateral (mastoid) fontanelles The fontanelles close sequentially and the sutures function as growth centers. metopic suture fuses by 8 months of age in nearly all children. The remaining sutures fuse late in life. Virchow's law states that premature suture fusion results in compensatory skull growth parallel to the fused suture and a decreased growth perpendicular to the suture. Headaches(Primary) Migraine Tension Cluster Headache(secondary) Analgesic rebound From eye disorders From sinusitis Meningitis Intracranial process: increased ICP, tumor, GCA, subarachnoid hemorrhage Post concussion Cranial neuralgias Headache warning signs Progressively frequent or severe over a 3-month period Sudden onset like a "thunderclap" or "the worst headache of my life" New onset after age 50 y/o Aggravated or relieved by change in position Precipitated by Valsalva maneuver Associated symptoms of fever, night sweats, or weight loss Presence of cancer, HIV infection, or pregnancy Recent head trauma Associated papilledema, neck stiffness, or focal neurologic deficits Head complaints Headache, change in vision (hyperopia, presbyopia, myopia, scotomas), diplopia, hearing loss, earache, tinnitus, vertigo, epistaxis, hoarseness, sore throat, swollen lymph nodes 7 glands, and goiter Head inspection Skull: Size, contour Scalp: Scaling, nevi Hair: Distribution, quantity Face: Expression, contours Skin: color, pigmentation, hair distribution, lesions Head palpation Skull: Lumps Scalp: Pest inhabitants Hair: Texture Face: Sinuses Skin: Texture, temperature INFANTS: Fontanels - anterior closes ~7-19 months; posterior closes ~8 weeks PHACE syndrome association between infantile hemangioma and malformation of eyes, heart, major arteries, and brain. PHACE 1st defined by Dr. Freidan in 1996. The acronym PHACE stands for: Posterior fossa brain malformations Hemangiomas, particularly large, segmental facial lesions Arterial anomalies Cardiac (heart) anomalies and coarctation of the aorta Eye abnormalities and Endocrine abnormalities Abnormal head shape causes Causes of abnormal head shape in infants results from pressure on the malleable bones in the newborn skull; or persistent gravitational forces on the occiput when an infant is kept in supine position for prolonged periods (AKA positional deformational plagiocephaly); or premature fusing of one or more of the cranial sutures (craniosynostosis). Craniosynostosis is by far the rarest of these 3 etiologies. Head shape abnormalities caused by molding usually disappear within the first few weeks of life. Those that persist beyond this time or become apparent later require a thorough workup that includes a medical and family history, various skull measurements, checking for torticollis, and careful palpation of the head and neck. Skull radiographs can rule out craniosynostosis in infants with pronounced shape abnormalities. Deformational plagiocephaly is usually treated with repositioning therapy or, in more severe or persistent cases, helmet therapy. To prevent this disorder, advise parents to provide their child with at least 5 minutes of "tummy time" daily. Severe cases of craniosynostosis accompanied by associated deformities requires surgical correction. Eye inspection Position & alignment Eyebrows: quantity, distribution Lacrimal apparatus Lacrimal gland & sac for swelling Increased lacrimation Excessive tearing may be from increased tear production or impaired drainage Lids & conjunctiva Eyelids Width palpebral fissures Edema Color: erythema Lesions Condition & direction of eyelashes Adequacy of closed eyelids Ability of lid to move Ectropion Eyelid droops away from the eye disrupting draining process which may trigger: erythema, irritation, watering of the eye, grit feeling in the eye, c/o mucous D/C & crusting of eyelids Ectropion lower eyelid turns/droops outwards Entropion Eyelid folds inward Usually congenital Rarely causes problems in infants (lashes are very soft and do not damage eye) May be seen in older adults -usually caused by spasm or weakening of muscles surrounding lower part of eye Eye conditions in older adults Eyeballs recede into orbit Corneas lose luster Pupils become smaller Dry eyes are a common complaint Presbyopia occurs to nearly everyone -starting at 40 y/o Ectropion or entropion may occur Blepharodermatochalasis -eyelid falls over eye levator palpebrae superioris muscle in the orbit that elevates the superior tarsal muscle (smooth muscle attached to the levator palpebrae superioris), and inserts on the superior tarsal plate as well Uveitis inflammation of the uvea causing swelling and irritation 3rd leading cause of preventable blindness in the developed world Also known as iritis Often seen in autoimmune inflammatory diseases- RA, reactive arthritis, ankylosing spondylitis; and AIDS Cataract an opacity of the eye lens Onset is gradual Ranges from cloudy, hazy to vision loss Portion of vision affected: unilateral or bilateral Causes: congenital and aging (not clear why) On inspection you see clouding & loss of red reflex Is an avoidable cause of blindness Chronic Open Angle Glaucoma Most common type of glaucoma, affecting ~ four million Americans Onset is gradual Vision change: from gradual darkening to complete vision loss Portion of eye affected: unilateral or bilateral; peripheral vision lost first Acute Closed Angle Glaucoma Sudden onset Presents with head/eye pain, nausea, eye redness Severity of vision change: blurring, halos; can range to total vision loss Portion of vision affected: unilateral On exam: red eye, ciliary flush, fixed pupil, corneal edema A ciliary flush is a ring of red or violet spreading out from around the cornea of the eye