Head and Neck Exam Flashcards
General observation
Symmetry, size, contour issues Eye position Nose Ears - high, low, rotated Hair issues
Neck general observation
Trachea position Mm definition Jugular vein Carotid artery Thyroid cartilage
Pigmentation/Discoloration
Asymmetry of pigmented area Border is irregular Color variation in area Diameter greater than 6mm Elevation and elargement
Movement
General ROM
Abnormal movement patterns
Eye motion
Mouth opening and closing
Mouth inspection
Use pen light
May need tongue depressor and gloves
Can check CN IX, X, and XII at this time
CN testing that can be done now - simple commands
CN VIII - motor function
CN V - clench your teeth
CN VII - frown or wrinkle your forehead, close eyes tightly smile and show your teeth, puff your cheeks and hold
Palpation
Facial mm and lymph nodes
Lymph nodes size, shape, description, mobility consistency
less than 1 cm Oval Discrete Freely mobile Soft No pain or tenderness
Abnormal findings for lymph nodes
Enlarged or tender - acute inflmmation
Enlarged and nontender - chronic condition or serious pathology
Firm, rubbery, hard - RED flag
Matted - might be chronic infection or metastasis
Fisxed and hard - metastasis
Specific node - red flags
Supraclavicular and axillary and auricular
What else to palpate
Parotid gland Submandibular gland Sublingual gland Temporal artery Carotid artery
Sinus palpation
Frontal
Ethmoid
Maxillary
Transillumination
Skull palpation
Shape Tenderness Consistency (edema, lumps) Skin condition Hair texture
Skull infants
suture line palpation (6 months) soft spots (2 yrs)
Trachea and thyroid
Identify position
Indentify thyroid cartilage
Identify insertion of SCM
Post approach easier
Percussion
not useful in head and neck exam
Auscultation
Carotid arteries
Thyroid
Should not hear anything! Have patient hold breath
CN 1
Olfactory
Use pleasant, familiar smells
CN II
Optic
Visual acuity and visual fields
Acuity with Snellen eye chart
Fields with confrontation test for peripheral vision
CN III, IV, VI
Oculomotor, Trochlear, Abducens
Pupillary light reflex - direct and consenual light refelxes
Accomodation - eyes ability to focus from a far object to a closer object
Medial rectus
CN III
nasal
Lateral rectus
CN VI
Temporal
Superior rectus
CN III
Up an temporal
Inferior rectus
CN III
Down and temporal
Inferior oblique
CN III
Up and nasal
Superior oblique
CN IV
Down and nasal
CN V
Ophthalmic Maxillary Mandibular (includes taste) Motor function - Mass, temp, ptery Corneal reflex
CN VII
Facial
Sensory - taste
Motor - Moore pg 848
CN VIII
Vestibulocochlear
Hearing - whisper and rub hair together
Tuning fork tests - WEber and RInne
CN IX and X
Glossopharyngela and Vagus
Sensory - no ttypically done
Motor - gag reflex, ahhh for pharyngeal movement, voice quality
CN IX
Accessory
SCM and trap
CN XII
Tongue condiiton and strength
