Head and Neck

Question 1

Inspection

Head and Face

Answer 1

• Expression
• Facial Symmetry
• Hair
  Shape of face and skull
• Scars
• Skin (e.g. rashes, acne, blisters)
• Features of Cushing’s, acromegaly, bony changes
• Swellings
• Movements

Question 2

Inspection

Eyes

Answer 2

• Lid lag, proptosis, eye movements
• Check the sclera for jaundice or anaemia
• Features of thyroid eye disease

Question 3

Inspection

Nose

Answer 3

• Look at the nose from in front, the side and from above the patient, observe the nasal pyramid, notice any discharge
• Ask the patient to block one nostril and assess the air flow in the other nostril (reverse the nostril tested). Preferred method for checking the air flow is to ask the patient to block the end of the nostril with their thumb.
• Elevate the tip of the nose to inspect the nasal vestibule – use a light source eg otoscope/pen torch or head light

Question 4

Inspection

Mouth

Answer 4

• Lips (cyanosis, angular stomatitis, other lesions)
• Open mouth: inspect inside, dentition, floor of mouth, hard and soft palate, inside of cheeks, parotid duct opening (2nd upper molar)
• Oropharynx, uvula, tonsillar folds and tonsils (ask patient to stick tongue out and move side to side)
• Tongue - dorsal surface, both lateral borders (dryness/fasiculation/wasting)
• Ask the patient to touch roof of mouth with the tongue to inspect underside of the tongue and floor of the mouth, frenulum, submandibular duct and opening

Question 5

Inspection

Dentition

Answer 5

• Assess oral hygiene, being aware of halitosis (can be due to poor tooth brushing, post nasal drip or acid reflux)
• Note any loose teeth, broken teeth or worn down teeth (due to recent trauma, neoplastic causes such as maxillary sinus tumours, acid erosion from vomiting/diet/reflux, tooth grinding(bruxism)
• Presence of dentures and recent changes to fit (due to rubbing, breakage, bony changes eg Paget’s or soft tissue lesions/ulcers)
• Assess occlusion (or bite) and ask if it feels normal to the patient when they bite together
• Assess gums for inflammation or pallor (anaemia) hyperplasia (drug reactions)
• Assess gums for pigmentation (normal in Black and Ethnic minority groups. Can be an indication of metabolic disorders such as Addison’s disease, amalgam tattoos from fillings, heavy metal poisoning, heavy smoking, malignancy

Question 6

Inspection

Ears

Answer 6

• The pinna (outer ear): note any nodules or other lesions
• Note if the pinna is pushed forward
• External auditory meatus (note any discharges)
• Behind the pinna (for scars)
• Mastoid process (bruising or Battle’s sign)

Question 7

Inspection

Neck

Answer 7

• Scars, swelling
• Lump - observe site, size, skin changes
• Movement with tongue protrusion and swallowing