2.1 Head, Face, Neck Assessment

Question 1

Structure/Function of Head/Face/Neck

Answer 1

- Structures assessed include
(Skull, Face, Glands, Temporal Artery)
Skull Assessment
- Cranial and facial bones that protect the brain
Neck Assessment
- Assessing Muscles and Thyroid Gland

Question 2

Neck

Answer 2

• Passageway for vessels, nerves and lymphatics
• Drainage pattern for lymph nodes are assessed in the neck. When nodes are enlarged, check drainage path for source of problem.

Question 3

Review of systems (Migraine)

Answer 3

Headaches/Migraines
- Causes, what helps, what makes them worse
(Assessment for Pain)
O - Onset 
L - Location
D - Duration
C - Characteristics 
A - Aggravating Factors
R - Relieving Factors
T - Treatment

Question 4

Review of Systems (Head Injury)

Answer 4

• Was there a loss of consciousness (before or after)

- Loss of consciousness before a head injury can indicate a cardiac problem (syncopal episode)

Question 5

Review of Systems (Dizziness/Vertigo)

Answer 5

- Is there a history of Vertigo
Objective Vertigo
- Room spinning around them (neurological problem)
Subjective Vertigo
- Person feels like they are spinning

Question 6

Review of Systems (Neck Pain)

Answer 6

• Limitations to range of motion

- Severe neck stiffness can be meningeal inflammation

Question 7

Review of Systems (Other Issues)

Answer 7

• History of lumps/swelling (location of lymph nodes)
• Dysphagia (difficult to swallow)
• Head or Neck Surgeries

Question 8

Physical Assessment (Objective)

Answer 8

• Head and Face Palpated first then check Neck

Question 9

Assessing the Head

Answer 9

1st - Check Size
Normocephalic - Normal Size
Microcephaly - Small Head
Macrocephaly - Big Head
2nd - Palpate Temporal Artery
Palpated above cheek bone between eye and top of ear
Abnormal - Temporal Arteritis vessel appears tortuous and hardened. Tender to touch.

Question 10

Assessing Face

Answer 10

• Appropriate expression for mood
• Symmetrical Facial Features
• No Swelling/Involuntary Movements.
• Face/Head should feel round with normal protrusions and no tenderness to palpate.
• Palpate Temporomandibular Joint (Jaw/Temporal Joint)
  TMJ Disorder is common, and include crepitus (crackling over joint), tenderness and limited ROM.

Question 11

Assessing Face

Answer 11

Abnormal
Pilar Cyst - Swelling on top of scalp that contains keratin and sebum. Benign growth.
Hydrocephalus - Obstruction of drainage of cerebral spinal fluid. Downcast/sunsetting eyes, dilated scalp veins, enlarged cranium.
Acromegaly - Excessive secretion of growth hormone from pituitary gland. Elongated Head, Massive Face, Coarse Facial Features.

Question 12

Assessing Neck Symmetry

Answer 12

• Is neck aligned with head
• Is there unnatural tilting
• Is the trachea midline

Question 13

Assessing Lymph Nodes

Answer 13

• Lymph Nodes should feel movable and soft.
• Lymph Nodes should be separate and distinct
• Use gentle circular motion with finger pad to palpate
• Begin with preauricular lymph than go in a routine order.
• Nodes are closely packed so you must be systemic
• Lymphadenopathy - Enlarged lymph nodes found with infection, cancer, HIV and lymphomas

Question 14

Assessing Thyroid Gland

Answer 14

• Palpate for enlargement
• Should feel spongy and no tenderness when palpated
• If unilateral (like donut across neck) could indicate cancer or hormone disease.
• Enlarged thyroid may cause bruit (whooshing sound heard over vessels under high pressure)
• Auscultate over gland

Question 15

Abnormal Neck Findings

Answer 15

Thyroid - Hard and fixed. Bruit. Enlarged thyroid in pregnant women.
Lymph Nodes - Feel fixed, tender, matted, enlarged, rubbery.
Torticollis - Caused by hematoma. Head tilt to one side with limited neck ROM. (Twisting of Neck)
Parotoid Gland Enlargement - Rapid painful inflammation of parotoid gland (saliva creating gland). Common in AIDS. Swelling occurs with duct blockage, abscess, or tumor.

Question 16

Developmental Considerations (Infants, Children)

Answer 16

• Measurement of head should be done each visit up to 2 years old and every year up to 7 years.
• Infants can turn head side to side at 2 weeks.

Question 17

Assessing Infants Head

Answer 17

Triangle shaped posterior fontanel should develop in 1-2 months.
Diamond shaped anterior fontanel between 9 months and 2 years.
Hydrocephalus, down syndrome, hypothyroidism, rickets - delayed closure or abnormally large fontanels.
Depressed fontanels indicate malnutrition and dehydration. Bulging indicates increased intracranial pressure.

Question 18

Special Assessments for Infants/Children

Answer 18

Percussion and Auscultation of Skull.
Infants you can percuss with plexor finger against head surface.
Bruits are common in children under 4-5 years of age with anemia.
After age 5 it can indicate increased intracranial pressure, aneurysm, or arteriovenous shunt.

Question 19

Abnormal Skull Findings in Infants/Children

Answer 19

Caput Succedaneum - (Cone Head) Swelling of head caused by birth trauma. Resolves in a few days.

Cephalhematoma - Hemorrhage as result of birth trauma. Appears several hours after birth and increases in size. Reabsorbed in the first few weeks of life but may cause jaundice in baby.