HEAD AND NECK ASSESSMENT

Question 1

GENERAL APPROACH:

Answer 1

1. PATIENT POSITION: Patient seated on exam table

2. EXAMINER POSITION: Stand to patient’s right side

Question 2

HEAD EXAMINATION: **Ask patient for permission to touch head
HEAD/SKULL INSPECTION

Answer 2

A. Head Position: Tilted, tremors

B. Skull/Scalp: Size, shape, symmetry, lesions, trauma, hair pattern

Question 3

FACE INSPECTION:

Answer 3

A.  Symmetry
B.  Shape
C.  Unusual Features
D.  Tics
E.  Characteristic Facies-Expression or appearance of face & features of head/neck suggesting a clinical condition/syndrome
F.  Pallor/Pigmentation Variations

Question 4

HEAD/SCALP PALPATION:

Answer 4

A.   Symmetry
B.    Tenderness:  Scalp, mastoid, frontal/maxillary sinuses
C.    Scalp Movement
D.   Sutures/Fontanels (infants)
E.    Hair Texture/Color/Distribution

Question 5

TEMPORAL ARTERY EXAMINATION:

Answer 5

A. Inspection: Asymmetry, edema, bruising
B. Palpation: Thickening, hardness, tenderness
C. Auscultation: Bruits (use BELL)-Suggestive of vascular anomaly of brain or temporal arteritis

Question 6

TEMPOROMANDIBULAR JOINT (TMJ) EXAMINATION:

Answer 6

A. Palpation: Crepitus, clicking, popping, pain when opening/closing mouth

Question 7

SALIVARY GLAND EXAMINATION:

Answer 7

A. Inspection: Asymmetry/enlargement of salivary glands

B. Palpation: Masses (fixed or movable, soft or hard, tender or non-tender)

Question 8

NECK EXAMINATION:

NECK INSPECTION:

Answer 8

A.   Symmetry
B.    Alignment of Trachea
C.    Fullness
D.   Masses/Webbing/Skinfolds
E.    Range of Motion

Question 9

NECK PALPATION:

Answer 9

A. Tracheal Position
B. Tracheal Tug: Cardarelli sign/Oliver sign suggests aortic aneurysm
C. Movement of Hyoid Bone & Cartilages with Swallowing
D. Lymph Nodes: OCCIPITAL, POSTAURICULAR, PREAURICULAR, PAROTID & RETROPHARYNGEAL (TONSILLAR), SUBMANDIBULAR, SUBMENTAL, SUPERFICIAL ANTERIOR CERVICAL, SUPERFICIAL POSTERIOR CERVICAL, SUPRACLAVICULAR
E. Tenderness: Paravertebral muscles & posterior spinous processes

Question 10

THYROID EXAMINATION: **Perform 3 times (trachea midline & trachea displaced to right then left)-Stand behind patient

Answer 10

A. Inspection: Swallowing
B. Palpation: Size, shape, configuration, consistency, tenderness, nodules
C. Auscultation: If thyroid enlarged, auscultate for bruits (use BELL)