Head and neck Exam Flashcards
Hair and scalp
Quantity
Distribution
Texture
Hair loss - Telogen effluvium, drug SE, Sx of medical illness, tinea capitis, alopecia areata, trichotillomania
Trauma
Dz such as Paget’s of the skull or Hydrocephalus, fetal alcohol syndrome, acromegaly
Psoriasis
Battle sign - Sign of a basilar skull Fx, 1-3 days s/p injury; retro-auricular or mastoid ecchymosis
Palpations
Any area that you can depress an artery against the bone, such as the temporal artery, which might reveal s/s of giant cell arteritis;
General palpation for erythemia, warmth, bumps bruises, depressions
Auscultations
Can listen for bruits over the superficial temporal artery
Visualize the Major Landmarks of the Face
Face Exam
Inspect - pt expression and facial contours, look for any asymmetry, check for involuntary movements
Can reveal D/o such as hyperthyroidism, hypothyroidism, cushings, bell’s palsy, parotitis
Palpate - TMJ, Sinuses, Deformities/Injuries, salivary glands
Percuss - the sinuses
TMJ Exam
Inspection for Facial Asymmetry, swelling, redness
Palpate for ROM, Swelling, Clicking, Tenderness
Neck Exam
Symmetry, masses, scars, deformities, swelling, enlarged glands/nodes, trauma
Trachea - check position and alignment
Thyroid gland - symmetry, Enlargement and masses
Lymph nodes - may be hard or large with pathology
Check for bruising or trauma,
Check the cervical spine
Seat belt sign of the neck can indicate injury to the great vessels
Thyroid Exam
Two approaches;
Ask Pt to swallow
Palpate for enlargement, tenderness, mass/nodule
Thyroid enlargement
Diffuse Enlargement: isthmus and lateral lobes, no nodules.
Grave’s disease, Hashimoto’s thyroiditis, endemic goiter
Single node: Cyst, benign tumor, false positive (only one nodule of multinodular goiter detected).
Elevates index of suspicion for malignancy.
Assess for risk factors: radiation exposure, hardness, rapid growth, fixation to surrounding tissue, cervical LAD, male, others.
Multinodular Goiter- iodine deficiency
Softin Grave’s Disease, may have bruit.
Firmin Hashimoto’s thyroiditis, malignancy, & benign and malignant nodules.
Tenderin thyroiditis.
Systolic or continuous bruitmay be heard over lateral lobes in hyperthyroidism.
Lymph nodes
Normal -
Small
Spongey or soft
Mobile
+/- tender
Oval or flat
Concerning for Malignancy -
Larger than 2-3 cm
Hard
Fixed, adherent
Non-tender
Spherical
Lymph Node Nodes
Suboccipital- scalp/head
Preauricular or post auricular – otitis externa
Submandibular- dental abscess
Posterior cervical- strep, mono
R SCN - mediastinum lungs esophagus
L SCN - thoracic duct drainage (thorax, abd)
Axillary – breast ca, infections, lymphoma
Inguinal- STIs
Virchow’s notch
the supraclavicular notch
Cervical Spine
Inspect
Check for curvature
Look for obvious deformities
Palpate
midline bony tenderness
paraspinous muscle tenderness or spasm
