Head and Neck Examination

Question 1

Order of areas

Answer 1

Hair/Scalp -> Face -> Ears -> Eyes -> Nose -> Throat -> Neck (Lymph nodes/Thyroid)

Question 2

What to look for: Hair

Answer 2

Hair Quality:
Fine Hair – Hyperthyroidism
Course Hair – Hypothyroidism
Tiny white Ovoid granules – nits (lice eggs)
Dandruff (Seb dem, Ezxema, Psoriasis)

Question 3

What to look for: Scalp

Answer 3

Redness – Seborrheic dermatitis / Eczema
Redness with plaques – Psoriasis
Soft lumps - pilar cysts
Brown moles - May raise concern for melanoma

Question 4

What to look for: Skull

Answer 4

observe general size, inspect any depressions

Question 5

What to look for: Face

Answer 5

Facial Expression
Asymmetry
Pigmentation – port wine stain
Acne
Bells palsy

Question 6

What to look for: Face - Cushing syndrome

Answer 6

moon face, red cheeks, excessive hair growth

Question 7

What to look for: Face - Nephrotic syndrome

Answer 7

swelling around the exes, pale looking, puffy face

Question 8

What to look for: Face - Parkinsons

Answer 8

Hypomania (decreased face mobility, stare)

Question 9

What to too look for: Forehead

Answer 9

Temporal arteritis
SInusitis at Frontal Sinus

Question 10

What to look for: Ears

Answer 10

Inspect the auricle and surrounding tissue
Observing for Deformities, Lumps, Bumps, Skin lesions, Cauliflower ears, Tophi or Discharge

Question 11

Ear Tug test: Gently pull down on the ear lobe, or press
the tragus to see if it causes pain

Answer 11

Pain – Otitis Externa
No Pain – Otitis Media

Question 12

What to look for: Eyes

Answer 12

Eyebrows, Eyes, Eyelids, Iris of Eyes

Question 13

Eyebrows

Answer 13

Hair loss - SLE
Lateral Thinning - HYpothyroidism

Question 14

Eyes/Eyelids

Answer 14

Ptosis - Horners syndrome, Myasthenia gravis
Xanthelsma -
Exopthalmos & Lid retraction - Hypothyroidism; Graves Disease

Question 15

Eyes/Eyelids

Answer 15

Red and Painful eye - Conjunctivitis
Epiphora - Watering eyes
Absence of tearing - Dry eyes (drug side effect, environmental)
Yellow eyes - Sign of jaundice

Question 16

Iris of eyes

Answer 16

Wilson’s Disease
* Kayser- Fleisher Ring
* Brown Ring around the eye - Copper Deposits

Arcus Senilis
* Grey / White ring, common in elder

Question 17

Eye Examination

Answer 17

Gentle pressure, be aware this is a close up examination!
* Use of the fingers
* Examine the palpebral conjunctiva and sclera
* Ask patient to look up/down to see the sclera

Question 18

Lips

Answer 18

Blue lips – cyanosis
Cheilitis – Inflammation of lips
Herpes Simplex
Angioedema
Mouth ulcers
Carcinoma of lips

Question 19

What to look for: Nose

Answer 19

Palpate sinuses
Record any difference in pressure from left to right
Look for deviation of nose laterally or superiorly/inferiorly
Septum deviation/damage due to drug use
Nasal drip (allergies, cold, flu,)
Epistaxis (nose bleeds)
Broken nose

Question 20

Gums

Answer 20

Gums (gingiva) - Should be a healthy pink/red colour
Gengivitis - Red swollen bleeding gums

Question 21

What to look for: Mouth

Answer 21

Lips, Gums, Teeth, Tongue
Examine the external lips first, Use two fingers from each hand to gently look at the internal lips, gingiva and teeth

Question 22

Tongue

Answer 22

Ask patient to protrude tongue
Normal colour (Pink)
Red (B 12 deffiiency)
Tonsilitis
Enlarged Tonsils

Question 23

Teeth

Answer 23

Yellow Staining (smoking)
Brown staining (Coffee)

Question 24

Neck

Answer 24

Inspection: Symmetry, Torticollis, Tracheal deviation
Checking thyroid - Goitre (swelling of thyroid)
Palpation - Stand behind patient, Ask them to swalow (Observe any deviations)
Trachea - Locate below the cricoid cartilage, Look for any obvious deviation,
Palpate either side and note the distance to the SCM (Distance should be the same)

Question 25

Tracheal deviation

Answer 25

Deviates away from affected side:
-Tension Pneumothorax
-Pleural Effusion
-Large Mass
Towards affected side:
-Atelectasis (collapsed lung)
-Pleural fibrosis

Question 26

Lymph nodes

Answer 26

Inspect and palpate to see if they are Tender/Enlarged
- Usually related to Infection e.g.URTI, Mononucleosis (EBV),Tonsillitis
- Occasionally related to tumour e.g.metastases or Leukaemia or Lymphoma

Lymph nodes 15
1= Submental
2= Submandibular
3= Preaurical
4= Posterior articular
5= Tonsillar
6= Occipital
7= Anterior superficial cervical
8= Posterior cervical
9= Deep cervical chain
10=Supraclavicular