Head And Neck Examination

Question 1

What steps need to be taken on inspection in a head and neck examination?

Answer 1

Look around the face, head and neck for expression, symmetry, swellings, hair distribution/loss, shape of face and skull, scars, skin and movements
Check eyes for- lid lag, ptosis, eye movements, check sclera for jaundice or anaemia and features of thyroid eye disease
Skull and face- facial symmetry and features of cushings, acromegaly and changes suggestive of underlying disease
Nose- look from in front, the side and from above the patient to observe the nasal pyramid. Ask patient to block one nostril and assess air flow through the other. Elevate the tip of the nose to inspect the nasal vestibule using a light
Ears- note any lesions on pinna, note if pinna is pushed forward, check external auditory meatus for any discharge, behind pinna for scars and mastoid process for any swelling

Question 2

What steps need to be taken on auriscope examination in a head and neck examination?

Answer 2

Screen for any pain
Inspect the outer ear and meatus, then gently pull pinna upwards and backwards
Rest little finger on patients cheek
Inspect the auditory canal and visualise the tympanic membrane looking for surface landmarks
Remove auriscope gently and repeat on other ear, changing the speculum if any discharge was present

Question 3

What steps need to be taken on palpation in a head and neck examination?

Answer 3

Skull and face:
-palpate each mastoid process
-run fingers around each orbital margin
-check for tenderness along temporal arteries on both sides
-feel the maxilla and mandible
-place index fingers over TM joint, ask patient to open mouth and move jaw sideways
Nose:
-palpate the nasal cartilage and bones
-feel for tenderness over paranasal sinuses
Ears:
-press in front of meatus or pull gently on the pinna
-palpate gently over each mastoid process

Question 4

What steps need to be taken doing hearing tests in a head and neck examination?

Answer 4

Whispered voice test: 
-stand behind patient and start with conversational voice while masking the other ear and say a series of sounds for the patient to repeat. If heard, repeat with whispered voice 
Tuning fork tests: 
-use a 512Hz tuning fork 
- Rinne's air vs bone 
-Weber's midline

Question 5

What steps need to be taken on inspection in a mouth, throat and neck examination?

Answer 5

Expose neck down to clavicles and ask patient to remove any jewellery
Mouth:
-lips (cyanosis, angular stomatitis etc)
-open mouth- inspect inside, dentition, floor of mouth, hard and soft palate, inside of cheeks, parotid duct opening. Ask patient to Say ah
-oropharynx, uvula, tonsillar folds and tonsils
-tongue- dorsal surfaces and both lateral borders
-ask patient to touch roof of mouth with tongue to inspect underside of tongue and floor of mouth, frenulum, submandibular duct and opening
Bite- ask patient to gently bite teeth together
Neck:
-scars, swelling
-lumps, observe site, size and skin changes
-movement with tongue protrusion and swallowing (take sip of water, hold in mouth then swallow)

Question 6

What steps need to be taken on palpation in a mouth, throat and neck examination?

Answer 6

Neck:
-check position of trachea
-move behind patient to examine neck (make sure patient knows you’ll do this)
-palpate the lateral aspects and whole front of neck following a Z
-determine if any swelling is mobile, cystic, vascular or hard, and note if position is midline or lateral
Bimanual palpation of mouth:
-palpate along floor of mouth, inside of cheeks, salivary glands and substance of tongue to feel for any cystic swellings, irregular roughened areas or stones in the parotid duct

Question 7

What steps need to be taken on percussion in a mouth, throat and neck examination?

Answer 7

If there is a palpable thyroid swelling consider percussion for retrosternal thyroid

Question 8

What steps need to be taken on auscultation in a mouth, throat and neck examination?

Answer 8

Listen over the carotid artery for bruits
Listen over an enlarged thyroid- use diaphragm of stethoscope and ask patient to hold their breath and listen over both thyroid lobes